Covid-19 Diary : Thursday 31 December, 2020

 

Happy New Year’s Eve!

A bit of exciting (at least, for me) news to start with.  As a lovely way to end 2020, I received a copy of my book “The Covid Survival Guide” in the mail today.  Sure, I’d of course ordered a Kindle version when that came out on Tuesday last week, but the book feels so much massively more “real” now that I’ve a print copy in my hands.

With the virus clearly still going to be with us for some time to come, and with cases and deaths at historic high levels, you really can benefit from the resources concentrated into this book’s four parts, 17 chapters, 69 figures and charts, 470 pages, 650 links, and 780 footnotes.  The book has made #1 best seller in various Amazon categories on several days.  The Kindle version remains at $4.95 for a few more days, and the print version is $19.95.  The Kindle version will soon be adjusted to be in line with other similar eBooks (ie $8.95), the print version price will stay stable until the end of March, at which point, there’ll be a small increase due to increased printing prices coming out then.

I’ve another book coming out some time in January too (just as soon as I complete the cover design, a dismayingly extended process).  But it is nothing to do with the virus at all.  It is a fiction work, a lengthy “techno-thriller”, a genre made popular by Tom Clancy.  It is now available for pre-order, at a lovely low price of $2.99.  The print edition (not available for pre-order) will probably be $16.95 on Amazon, and $19.95 elsewhere.  They say you should write about what you know, so this story is set variously on a submarine, in Seattle, and in St Petersburg (I am more familiar with two of these locations than I am the third!).

For people like me, almost obsessively focused on tracking the spread of the virus and understanding trends, it has been a very frustrating week.  Much of the data during the Christmas period, and extending on through early next week, is unreliable.  Has there really been a significant drop in new cases and deaths in the US (and other countries too) or is this due to lack of efficient reporting during this time?  At other times, are sudden surges real, or are they the result of several days reporting all being grouped together?

Not to sound like an eager ambulance chaser, but we’re now at the point where any Christmas “bump” in new cases should start appearing and it would be helpful to know what the outcome is proving to be.  The Christmas bump clearly hasn’t appeared at all, but is that due to effective control measures, or lack of reporting?  This article suggests it can take up to two weeks for new Covid cases to be officially entered into the system.  That is unacceptable.  Why is it possible to buy anything on Amazon in less than two minutes, and often have it delivered within 24 hours, but it can take two weeks for a piece of computer data to travel from a doctor’s office or laboratory to the people and places who count cases?

Our colossal failure to manage the virus is made up not only of people refusing to wear masks, and defiantly eating/drinking in crowded bars and restaurants, but also by colossal incompetence across every facet of our public health system.  We can sort of understand the idiots who ignore the safety guidelines, but what excuses can we make for people earning generous six figure salaries, but who can’t figure out how to get data from a doctor’s office to a central server in under two weeks, or who are taking similar periods of time to urgently air-courier vaccines from central depositories to dispensaries?

More incompetence can be found wherever we choose to look.  For example, the eagerly awaited vaccines.  While some people are desperate to be vaccinated, we have been struggling with the twin problems of central repositories of vaccines being slow to distribute them to the states, and when eventual dispensing locations receive the vaccines, they too are slow to actually then vaccinate the people who sometimes are literally camped outside their front door.

Here’s an article that tries to explain the inexplicable, under the headline “Here’s Why the ‘Last Mile’ of Vaccine Distribution Is Going So Slowly“.  Unfortunately, excuses, although available in rich abundance, are useless against the virus.

It gets worse.  In West Virginia, health officials accidentally gave 42 people an experimental monoclonal antibody treatment instead of a vaccine shot.  The monoclonal antibody treatment is intended to be given via a drip, not via an injection, and while authorities say there shouldn’t be any harm to the 42 people given the wrong drug, we wonder if there’ll be an interaction now between the antibodies and the vaccine.

It gets still worse.  In Wisconsin, a hospital employee deliberately destroyed 570 doses of the vaccine.  We’re not told why.

But all of this pales into insignificance compared to the latest nonsense from public health authorities, first in Britain, and now being eagerly copied in the US, too.

Someone in Britain decided “We’re so short of vaccine that instead of giving as many people as we can the proper double shot of vaccine, let’s give twice as many people a single shot of vaccine.”

This created an initial stunned shock, before Pfizer responded (as quoted in a Guardian article that has subsequently been rewritten to remove this quote) :

Data from the phase 3 study demonstrated that, although partial protection from the vaccine appears to begin as early as 12 days after the first dose, two doses of the vaccine are required to provide the maximum protection against the disease, a vaccine efficacy of 95%.  There are no data to demonstrate that protection after the first dose is sustained after 21 days.

Government officials then seemed to conjure out of thin air some “proof” that a single shot might be 50% or more effective.  But they did not directly respond to Pfizer’s point that there is no evidence that the first weak level of created immunity, whatever it might be, lasts beyond 21 days.

This change in dosing is not a result of field trials and rigorous double blind testing.  It is some administrator who came up with the idea, and clearly is most influenced by the concept of giving something, anything, to twice as many people.

The government then said “Well, never mind Pfizer, we know with “our own” Oxford vaccine (aka the AstraZeneca vaccine), there is plenty of evidence of long-lasting benefits, because to start with, for a while, AstraZeneca was testing a single dose rather than moving to a double dose subsequently.  The response to that claim is to note the single dose data applies only to people under 55, and has so few data points as to again be only weakly persuasive, and to further note that the reason AstraZeneca switched from a single dose to a double dose is because the single-dose effectiveness was considered unacceptably low.

The government then put out an official statement trying to justify this astonishing move that flies in the face of all the vaccine manufacturers’ approved vaccination plans.  It reads well on the surface, but statisticians will see enormous confidence intervals associated with the claims, showing how weak and statistically insignificant the claims are.  The methodology to re-sort the data by these new parameters to try and generate a perception of extended benefit from a single dose is also very weak and full of assumptions and hopes.

The funniest line of all though is where the document says

Protective immunity from the first dose likely lasts for a duration of 12 weeks (unpublished data).

So, we have “likely lasts for” – hardly a positive guarantee, and then we’re told the data on which this already weak statement is being made is unpublished and unable to be shared.  And let’s not drill down into what the opening pair of words “Protective immunity” actually is promising, because that’s a very unclear and unsupported number too.

Would you bet your life on that type of weak promise?  That’s like being told “perhaps three times out of four, this rope is probably strong enough to hold you for a while before it breaks, but we can’t tell you how we tested it to determine its strength”, and then being asked to dangle at the end of the rope, 100 ft above a hard concrete surface, for an extended time.

Here’s a rather complicated commentary and explanation about what the UK government is doing and why, although the commentator repeatedly has to say “I’m unable to evaluate this statement because there isn’t enough data”.  The thing that most clearly sticks out, to me, is how shambolic the entire AstraZeneca trial was, with changes from one to two doses, an accidental group getting a half dose then a full dose, and as a result of these different “sub-trials” an insufficiency of supporting data for any of the different variations, but rather an awkward amalgamation of data from very different sub-trials.

The US then said “Gosh, we’d love to be able to ‘vaccinate’ twice as many people too”, but as you can see from the earlier discussions, above, the problem in the US isn’t a shortage of vaccine, it is an inability to get the vaccine from the bulk storage and into people’s arms.  Surely that would be a better problem to address and solve.

A NY Times article several weeks ago was headlined “Pfizer’s Vaccine Offers Strong Protection After First Dose”.  That sounds wonderful, but when you read the article, you discover that the “strong protection” is actually 52% – and that is not something that should be described as “strong” by any reasonable measure.

People saying “Due to the accidental mistakes in the AstraZeneca testing, we know their vaccine works for months after a single shot, so therefore, obviously the Pfizer and Moderna vaccines do the same, even though they’ve not been tested that way” are totally wrong.  The thing is, the AstraZeneca vaccine is totally different to the Pfizer and Moderna vaccines.  It “teaches” immunity in a different manner, and there is no reasonable basis for saying “If the AstraZeneca vaccine has these characteristics, then of course, the different type of vaccines will have the same characteristics too”.

We also don’t know how effective a delayed second dose will be, either.  It is intended to “refresh” the body’s memory and knowledge of how to respond to Covid, but if the body has largely forgotten, over an extended time, will a refresher dose be enough, or will some other dosing regimen be needed?  No testing has been done about that, but it appears we’re now going to abandon the testing structure that was required to get a vaccine approved, on a specific basis and dosage, and now change it any way people wish, without any validation whatsoever.

I remain cautious about taking any vaccine.  But when I do come around, after watching real world outcomes and hopefully validations for a few more months, and hold my arm out, I definitely want the double dose, properly spaced apart, not a single dose.

Lastly, in this unhappy rant to end 2021, while I’ve been very critical of our officials in the preceding comments, let’s not spare ourselves.  I can understand how some people have different opinions about things like social distancing, mask wearing, and where to balance the conflicting interests of protecting people and protecting businesses (although in truth, and in the mid rather than very short term, protecting one protects the other, too).  But what is distinctive, particularly in the US, is the aggressive and even violent expression of these different opinions, and sadly it seems the less mainstream and less supported-by-evidence the views, the more aggressive people become.  We (collectively – of course, you and I are not like that!) are as much a problem as are our public health officials.

Current Numbers

As I started off saying above, the current data is probably not as reliable as normal due to holiday schedules and backlogs.  But here it is, anyway.

I have to feel a frisson of pride to see my home state of Washington now in fifth best position – no small accomplishment when you remember back to the early days when Washington was the very first “epicenter” of the virus in the US.

In the small country case list, Gibraltar has suddenly appeared, going straight to fifth place.  In the large country case list, the Czech Republic extends its lead over the US, while third place Belgium falls further behind, and the UK appears again, going straight to ninth place.  In the death list, the US drops from its briefly held sixth place, and is now back at seventh place.

US Best and Worst States

Rank Cases/Million Deaths/Million
A week ago Now A week ago Now
1 Best VT (10,867) VT (11,878) VT (192) HI (203)
2 HI HI HI VT (218)
3 ME ME ME ME
4 OR OR AK AK
5 NH (28,610) WA (32,329) OR (335) OR (350)
47 UT (81,283) TN (85,926) CT (1,624) SD (1,682)
48 NE UT (86,281) ND ND
49 IA IA MA MA
50 SD SD NY NY
51 Worst ND (119,345) ND (121,375) NJ (2,103) NJ (2,161)

 

Top Case Rates Minor Countries (cases per million)

Rank One Week Ago Today
1 Andorra (99,567) Andorra (104,090)
2 Montenegro Montenegro
3 Luxembourg Luxembourg
4 San Marino San Marino
5 French Polynesia Gibraltar
6 Georgia French Polynesia
7 Slovenia (53,880) Slovenia
8 Bahrain Georgia
9 Armenia Liechtenstein
10 Panama (51,451) Panama (55,824)

 

Top Case Rates Major Countries (cases per million)

Rank One Week Ago Today
1 Czech Republic (61,618) Czech Republic (67,046)
2 USA (57,575) USA (61,501)
3 Belgium (54,445) Belgium (55,467)
4 Netherlands Netherlands
5 Spain Sweden
6 Sweden Spain
7 France Portugal
8 Portugal France
9 Brazil UK (36,565)
10 Argentina Brazil
11 Italy Argentina
12 Poland (32,781) Italy (34,877)

 

Top Death Rate Major Countries (deaths per million)

Rank One Week Ago Today
1 Belgium (1,649) Belgium (1,674)
2 Italy Italy
3 Peru Peru
4 Spain Spain
5 UK (1,023) Czech Rep (1,080)
6 USA (1,015) UK (1,080)
7 Czech Republic (1,005) USA (1,065)
8 Argentina France (989)
9 France Mexico (964)
10 Mexico (928) Argentina (951)

I Am Not a Doctor, But….

While some countries continue to treat the UK as a pariah for being the first to discover a new more infectious strain of the virus, the reality, as I’ve previously shown, is the new strain is already well distributed around the world, but undetected, because other countries are being slower to discover it, due to not sequencing so many cases.

This week saw the first known US infection, in Colorado, followed by a case in California, and mere minutes later, a second case in California.  With all these cases occurring “in the community” (ie with no clear understanding of where the infection was picked up from and no links to Britain) it is clear the new strain is already well established in the US.

One of the unfortunate virus outcomes is that some people don’t fully recover, and instead, suffer many months with various ongoing virus symptoms.  The latest strange extended case symptom is a word I had to look up – parosmia.  People are experiencing imaginary disgusting smells of fish, burning, and sulphur.  A bit like a vision of Hell, isn’t it!

Apparently free speech isn’t quite as unconstrained as we thought.  There have been active moves to prevent reporters from taking distressing photos of overloaded hospitals.

You know things are getting really serious if alcohol sales are being banned, as they currently are in South Africa, albeit for the weakest of virus-related reasons.  South African President Cyril Ramaphosa explained :

Reckless behavior due to alcohol intoxication has contributed to increased transmission. Alcohol-related accidents and violence are putting pressure on our hospital emergency units.

The spirit of prohibition is never far in the background, is it.  This is a bit like gun-control – “some people are irresponsible, therefore everyone has to be penalized”.

Meanwhile in the UK, the virus is being used to tighten up further on restrictions to do with selling what the UK government deems to be “junk food”.  The justification is the government “knows” people want to be offered healthy choices.  If people really wanted healthy choices, they’d of course be offered by retailers, rather than forced on the public by government edict.  The truth, as we all know, is that we actually like junk food and want to be able to treat ourselves not just to the fresh fruit and vegetables that we know are good for us, but for some of the fun stuff, too.

What has this to do with Covid?  The government says “The COVID-19 pandemic has brought to the fore the impact that obesity can have on people’s health and health outcomes.”

Here’s a dismayingly lightweight article, reporting on how some hotels are offering to arrange/coordinate for guests to get Covid tests during their stay.  There’s one omission in particular that I’d love to understand – how much will the tests cost?

Vaccine News

It is plainly apparent that while the vaccine may not be made mandatory, life for the unvaccinated will be increasingly restricted.  In Spain, they will create a register of people who refuse to be vaccinated, and will share that list with the rest of the EU.  The implications of being on the list aren’t yet being fully divulged, but travel restrictions are already being hinted at.

Even worse, this article reports on companies eager to profit from developing “vaccine passports” – and not just a “yes, they have been vaccinated” type certificate, but with details of the type of vaccine used, with the anticipated reason being it will then allow countries and private entities to decide which vaccines will be deemed to be acceptable and which ones won’t (that’s a scary complication, isn’t it).  The article goes on to anticipate electronic vaccine passports won’t just be needed for international travel, but will be needed to get access to a shopping mall or movie theater or probably just about anywhere/everywhere else, as well.

Just think of all the lovely demographic data the shopping malls and other venue owners will now be getting.  But, of course, that’s not the reason they’ll want to require these electronic passports, is it……  And there’ll be plenty of “privacy protection”…..

I’d mentioned above the slowness to distribute the vaccine in the US.  But we’re a veritable model of efficiency compared to France, which managed to vaccinate a mere 100 people in its first three days of vaccinating.  In the same three days, approximately 6,200 babies were born in France, so 100 vaccinations in three days is 62 times less than the natural rate of population growth.  They’ll never vaccinate any measure of the population at that rate, although, as the article goes on to point out, less than half the people in France want to be vaccinated, anyway.

I was surprised to see China has now officially approved one of its several different vaccines.  The surprise element was due to assuming it had been approved some time prior, but apparently not.

This page has an interesting list of the various vaccines that have either been recently approved, or soon will be.

 Timings And Numbers

We’d earlier reported 28 states with dropping rates of new cases on Sunday.  There was no report issued by rt.live on Monday, then 28 states with dropping new case rates again on Tuesday.  This reduced to only 19 on both Wednesday and again today – we wonder if the brief rise to 28 “good” states may have been a result of under-reporting over the Christmas period.  Maine has been consistently the worst performing state in terms of strongly growing rates of new cases.

Russia semi-surprised the world by admitting, earlier this week, that it had been under-counting its Covid death numbers.  The revised number is more than three times higher than the earlier official count.  Not stated, but we can’t help thinking they need to revise their case numbers too – if they leave their case numbers the same, their death rate as a percentage of cases is astonishingly high.

It has long been thought that Russia was undercounting its numbers of cases and deaths, but few people thought they needed to triple the numbers.

Closings and Openings

Movie theaters have been dramatically affected by the virus.  That is unsurprising.  But we were surprised to see in this article the CEO of a small chain of movie theaters is predicting that when life returns back to normal, there will still be a permanent 25% decline in attendance at theaters.  He didn’t explain why he feels that way.  If I were a shareholder of that company, I’d be gently suggesting a new more optimistic CEO might be called for.

Not so much troubled by declines in numbers is the Disney Empire.  Indeed, this article reports they might be being slightly naughty, and in some cases have quietly been filling up their rides back to normal levels again.

That is nuts.  If it was dangerous to have full rides several months back, with lower virus rates, how on earth can it be safe to fill up the rides now that virus infection rates are higher and a new more infectious strain is emerging?  What would Walt think of their desire to put profitability ahead of guest safety?

In Washington state, it seems Costco was exempted from the state’s requirement for retail stores to limit the number of people in their store to 25% of normal capacity.  The last couple of times I’ve been, the car park has been close to full rather than only 25% full, and the checkout lines have been stretching all the way back into the product aisles.  Perhaps they should have been included in the provision, because now one of their stores is reporting 145 employees have been infected in a very few days.  In total, the store employs 383 people, so that’s a 38% detected infection rate, so far.

Who Should Pay

Do you remember back to the panicked days in March when hand-sanitizer couldn’t be found anywhere.  More than 800 micro-distilleries converted from making alcohol to drink, and started making alcohol for hand sanitizer instead.  For many people, that was a god-send and the only way they could get hand sanitizer.  Some distilleries were even giving it away for free as a public relations exercise.

Now, many months later, the FDA is telling them they’ll have to pay a $14,060 registration fee for the privilege of selling simple hand sanitizer – something so easily made that there are hundreds of recipes on the internet about how to make it at home.  Shame on the FDA.

In what alternate universe does it make sense to charge any company $14,060 to mix up some alcohol with some water, perhaps some glycerin, perhaps some coloring and some oils and perfume essences, and call it hand sanitizer?

Shortages

Are you conscientious?  Organized?  Diligent?  Perhaps a bit of a perfectionist?  Are you prudent?  I’ll happily admit to most of those characteristics, to a greater or lesser extent.  This study says if you have those characteristics, you are more likely to have stocked up on toilet paper earlier this year.  And, yes, I definitely did.  Guilty as charged (and not the least bit remorseful!).

Logic?  What Logic?

Have you ever been locked in a terrible scenario where you are so swamped with essential work, you can’t take the time off from “fighting fires” to hire and train more people to help you with your crippling workload?

Maybe that explains – but doesn’t excuse – the latest set of institutional hate for a drug that promises to help people avoid coming down with a serious Covid infection.  First the “medical establishment” hated on HCQ with the most specious of reasons (there are now 219 studies, 156 peer-reviewed, that overwhelmingly prove the benefits of HCQ).  Then, second, they ignored ivermectin entirely, and pretended it didn’t exist.  The evidence in support of ivermectin is even stronger than that for HCQ.

Now, with new and approved monoclonal antibody treatments, and many hundreds of thousands of doses just waiting to be dispensed, the usual suspects are again refusing to consider giving these treatments to anyone.  In addition to the usual offensive nonsense about “unproven”, they say they’re too busy dealing with seriously ill patients to prevent other people, in the early stages of the virus, from in turn becoming serious patients, too.

The time it takes to give a patient the monoclonal antibody treatment?  Minutes, in an outpatient department.  The time it takes to treat a seriously-ill patient?  Days, probably weeks, including possibly ICU time, even ventilators, requiring huge amounts of resource and staffing.

The monoclonal antibody drugs have been approved by the FDA, on exactly the same basis as the two approved vaccines, but still these idiots won’t dispense them.  How many people have to die before we all demand and take back from doctors the right to determine and demand our own treatments?

Medical

Maybe this guy should try a course of monoclonal antibodies – assuming he can find any doctor to give it to him.  So far, in a multi-month Covid illness, he has been hospitalized seven times.

Here’s an issue we doubt will see wide-spread adoption – telling people that after they have been vaccinated, they still have to keep wearing a mask for some vague number of months.  The weakest part of that mandate is that the mask wearing isn’t to protect themselves, but to protect other people.  Good luck with that….

Please stay happy and healthy; all going well, I’ll be back again on Sunday.

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