Covid-19 Diary : Thursday 21 January, 2021

 

Happy “first birthday” – to the coronavirus.  It is one year since the first coronavirus case in the US, in Washington State – a man rumored to be a Boeing employee and recently returned from China.  A year later, and we are counting 25.2 million cases in the US with 420,028 deaths.  The last week or so has seen a slight drop in new cases and in deaths, but with today’s death count being 4,363, the third worst day ever, we’re still a long way from seeing any lights at the end of the tunnel that aren’t oncoming express trains.

On the other hand, a lot of people feel that a new President and administration will bring a welcome change in how the virus has been handled from a public health point of view.  I do not intend to defend anything done by the past administration, but my impression is the bulk of the mismanagement over the last year has been not just by political appointees but by career employees at the CDC and FDA and all the other agencies at federal, state, county and city level, and by political appointees at state/county/city levels.  The career appointees remain, and there has only been little turnover of political appointees at state and lower levels.

However, the “new broom” is already rushing to “sweep clean” and, as is always the case no matter which party succeeds the other, rushing even more to blame everything on the recently departed.  For example, and in particular, the claims of the vaccine distribution planning by the Trump administration to be “so much worse than we could have imagined“.

Although I’ve not hesitated to criticize our vaccine distribution, that’s a statement that demands some response, starting with dismay that the new coronavirus response coordinator is so apparently unaware of what had been done prior to taking over.  None of it was secret.  And much of the problem is at the state and county level – many states and counties are awash with vaccine, with less than 35% of their stocks dispensed.  Nationally, as of today, only 39% of our stocks have been dispensed.

But most of all, the interesting thing is that, while our response has been very much less than perfect in every imaginable way, astonishingly it has still been one of the very best responses in the entire world.  Only China and Russia started vaccinating prior to us, with unproven untested vaccines, and then Israel was next, starting one day before us.  In total, we have vaccinated more people than any other country in the world (we’ve dispensed 16.5 million doses, followed by China with 15 million then the UK with 5.4 million).

Expressed as a “per hundred people” rather than as an absolute number, the outstanding vaccination winner is Israel (35 doses per hundred people) followed by the UAE (21.9), then Bahrain (8.5) and the UK (8.0).  Those are all physically small countries with fewer logistic challenges, and coordinated healthcare systems, rather than the semi-anarchy that rules here.  The next nation is the US, with 5.0 doses per hundred people.  That is outstanding for the US with its much greater challenges in coordination and distribution.

Note – you should halve the number of doses to approximate the number of people with the two-dose complete vaccination.

That’s not a record to be embarrassed about at all.  Both Canada and Europe have achieved a much lower count of 1.8, barely one third our rate.

Meantime, actions such as this one “out of an extreme abundance of caution” and throwing away 330,000 vaccine shots as a result of the approach, are not anything that can be blamed on anyone other than the front-line people who decided to ditch the doses.

As you may know, I consider the statement “out of an abundance of caution” to always indicate that what follows will be indefensibly stupid.  Out of an extreme abundance of caution probably means “what we did is extremely indefensibly stupid”!

Talking about indefensibly stupid, the Brits are starting to have second thoughts about their plan to give more people one vaccine dose but no-one the two doses that are required for full vaccine effectiveness.  This was justified on the spurious grounds that one dose gives people appreciably more than 50% protection, so it is better to have twice as many people with “more than 50% protection” than it is to have a lower number with 95% protection.

That was always an incredibly weak claim, because it was never something that was tested for during the vaccine trials, merely something empirically guessed at from insufficient statistical data.  However, with the Israelis administering and monitoring a large number of doses, they are starting to build up a real-world understanding of how well protected people become after their first vaccine shot, and their analysis suggests the level of protection after one shot is insubstantial rather than substantial and less than earlier claimed.

British “experts” say they’ll look very carefully at the Israeli data.  That is good, but – wouldn’t you love to be living in a world where experts “looked carefully” at the data before making decisions, especially when the data to date and vaccine manufacturers recommended against their first decision….

This article seeks to explain why you still need to wear a mask and avoid crowds after being vaccinated.  The main reason, to paraphrase, is because we really don’t know very much at all about what the vaccines may or may not do, because we didn’t take the time to trial and test for all these considerations.  One wonders what else was missed in the rush to get vaccines approved, and one also wonders just exactly how rigorous the approval process was.

On the positive side, we were delighted to see Joe Biden adding a federal mandate to wearing a mask when on public transport.  It was also good seeing him setting a goal – 100 million doses within 100 days.  It is great to have a number to be measured alongside.

On the other hand, if we do 100 million doses in 100 days, has anyone wondered how long it would take to get the entire country vaccinated?  Sure, it is very unlikely that everyone would want to be vaccinated, but at a rate of a million doses a day, and factoring in the 16.5 million doses dispensed already, that will see us triumphantly concluding the program in mid October.  Next year.  2022.

This is an inexplicably slow rate and a massively underachieving goal.  We’re pushing vaccinations into people’s arms at that rate already.  All Biden is striving for is to stay at our present rate.

We manage normal ‘flu vaccinations at a two-three times greater rate.  Why can’t we aim to at least vaccinate for Covid at the same speed as we do for annual influenza outbreaks?

The sainted Dr Fauci said that to achieve herd immunity, we’ll need as many as 280 million people vaccinated, which he might have predicted will happen by this fall.  The first day of fall is around 21 September.  At the target rate of 1 million doses a day, we’ll have vaccinated less than half the 280 million people needed for herd immunity by then.

Lastly in the introductory comments, it is amazing to see what a difference having a massive PR budget and lobbying group can do for a drug and drug maker.  This article touts a new expensive drug developed by Eli Lilly that can only be taken by IV as reducing a person’s risk of getting Covid.

Why the snark?  What’s not to like about that?  Nothing at all, but a quiet voice at the back says “isn’t that the same thing that ivermectin does, but by simply taking two tablets, for a dollar or less?”.  And whereas the Eli Lilly claim is backed by nothing more than biased research by Eli Lilly itself, the ivermectin benefits are supported by 53 different studies, 19 of which has been peer reviewed.

Sadly, our approach to treating Covid seems to be driven by PR and big budgets, not by common sense and medical science.  We eagerly await President Biden’s actions on ivermectin (and hydroxychloroquine).

Current Numbers

In the US, Rhode Island showed a massive growth in new cases, while worst state ND is easing in new cases and might in time be overtaken by SD and possibly other states.  In the death rates, Mississippi displaced Connecticut.

In the minor country list, French Polynesia dropped off the list, as did Georgia, being replaced by Israel and Lithuania.  In the major country list, the UK eased back a place.

Very little obvious change in the death list, but the UK has caught up to both the second and third countries and if its very high casualty rate continues much longer, may overtake them both and move into second place.  The encouraging news for the UK is their new case rate is sharply falling, but it may take a few more days before the lagging death rate starts to fall as well.

US Best and Worst States

Rank Cases/Million Deaths/Million
A week ago Now A week ago Now
1 Best VT (15,342) VT (16,955) HI (225) HI (232)
2 HI HI (17,473) VT (260) VT (269)
3 ME ME AK AK
4 OR OR ME ME
5 WA (37,662) WA (39,338) OR (412) OR (437)
47 RI (95,289) TN (102,177) CT (1,838) MS (1,904)
48 TN (98,179) RI (102,690) RI (1,884) RI (1,960)
49 UT (99,053) UT (103,080) MA MA (2,018)
50 SD (118,138) SD (120,262) NY (2,079) NY (2,151)
51 Worst ND (125,158) ND (126,460) NJ (2,280) NJ (2,338)

 

Top Case Rates Minor Countries (cases per million)

Rank One Week Ago Today
1 Andorra (114,674) Andorra (121,279)
2 Gibraltar (104,168) Gibraltar (115,214)
3 Montenegro Montenegro
4 San Marino San Marino
5 Luxembourg Luxembourg
6 Slovenia Slovenia
7 Panama Panama
8 French Polynesia Lithuania
9 Liechtenstein (62,063) Israel (63,372)
10 Georgia (61,383) Lichtenstein (63,238)

 

Top Case Rates Major Countries (cases per million)

Rank One Week Ago Today
1 Czech Republic (80,834) Czech Republic (85,574)
2 USA (71,786) USA (75,872)
3 Belgium (57,696) Belgium (58,897)
4 Netherlands Portugal (58,463)
5 Sweden Spain (54,754
6 Portugal (50,862) Netherlands
7 UK (47,890) Sweden (53,575)
8 Spain (47,300) UK (52,047)
9 France France
10 Brazil Brazil
11 Argentina Argentina
12 Italy (38,671) Italy (40,194)

 

Top Death Rate Major Countries (deaths per million)

Rank One Week Ago Today
1 Belgium (1,743) Belgium (1,771)
2 Italy (1,338) Czech Rep (1,397)
3 Czech Rep (1,293) Italy (1,394)
4 UK (1,263) UK (1,389)
5 USA (1,198) USA (1,266)
6 Peru (1,161) Peru (1,182)
7 Spain (1,135) Spain (1,177)
8 France (1,061) Mexico (1,113)
9 Mexico (1,056) France (1,102)
10 Sweden (1,005) Sweden (1,078)

 

I Am Not a Doctor, But….

We understand the desire to solve as many problems as possible with technology, but sometimes old fashioned approaches can work better.

In this case, there has been an interesting smart-watch app developed at Stanford that appears to sense when a person is fighting off an infection, primarily by detecting elevated heart rates.  The only problem is the app can’t readily distinguish between the symptoms of, eg, a common cold, and those of the Covid virus, so it is not yet quite ready for prime time, even though its developers are eager to push the app out to 10 million Fitbit wearers.

With alarm growing about the spread of new virus strains that are more infectious, people are wondering if it might be better to wear two masks rather than one, indeed, some people are already doing so.  A smaller group of people wonder if three masks might be better still.

We’ve had over 25 million people come down with the virus in the US in the last year, and 420,000 of those have died.  Don’t you think someone, somewhere, would have researched the subject of masks and published standards for which are the best and worst masks, and whether 2, 3 or 4 masks are better than 1?  Aren’t masks one of the most important front-line defenses against becoming infected?

Sadly, no-one has studied this to the point of generating any scientific data or conclusions, even though it is relatively simple and straightforward to do so.  Instead, we have articles such as this asking the question but being unable to answer it.

All we can do is guess.  My guess is that the more layers of mask, and the harder it is for air to flow through a mask, the more air will want to sneak in and out around the sides of the mask, bypassing the mask filtering entirely.  At what point does the negative impact of this air leakage exceed the positive benefits of doubling (or more) the mask layers?

No-one can answer that question, even though it is, today, literally a life and death issue.  We know it will be many more months before the vaccine starts to really stop the virus scourge, and we continue to inexplicably spend tens of billions of dollars on vaccines ($13 billion spent so far, another $20 billion just approved by Biden) while not spending a penny on cures such as ivermectin, or preventatives such as masks.

Why is that?  Meantime, today, we had another 4,363 people die.  Tomorrow, probably a similar number.  One every 20 seconds, all day and all night.

How many of those people could have been saved by ivermectin or optimized mask wearing?

To make it even clearer, less than a million dollars, on a study that could take less than a week, might enable us to make major shifts in our mask wearing practices that might start saving, oh, perhaps 1,000 lives every day.  Why isn’t this the highest priority?

Talking about avoiding inhaling virus particles, masks are not so helpful when you’re eating or drinking.  It is true the risk of inhaling virus particles is much greater indoors than outdoors.  So this suggestion – allowing restaurants to be open just so long as there is a natural air flow, in from one side of a restaurant and out the other side, seems, on the face of it, sensible.

Unfortunately, it may create more harm than good.  There is a famous early study of diners in a Hong Kong restaurant, where an a/c unit blew air from one side of the restaurant to the other.  As the diagram in the study shows and narrative discusses, it seems the air flow picked up virus particles from the infected person at one table and blew them to two other tables of diners.

Air flow such as in a plane is great.  In a plane, the air goes straight down, from ceiling to floor.  But a lateral flow of air, whether it be from inside or outside, risks picking up virus particles and then spreading them.

If only “experts” could agree, on air flow strategies, and many other things.  A couple of weeks ago, “experts” were all nodding sagely and saying that companies could lawfully mandate their employees be vaccinated, and fire any people who refused.

Now, a second group of “experts” are saying that maybe employers can’t mandate vaccinations, at least, not if the employees are covered by a union/collective bargaining agreement.

So, who to believe?  I guess we’ll need to get more “experts” involved and hope for the best of three.  Or, more likely, abandon the experts entirely and turn to lawyers and judges.

I’d mentioned before President Biden’s intention to toss another $20 billion generically at the topic of vaccines.  Why?  What for?  The first $13 billion was way beyond the amount needed to fund the research, most of which was done a year ago, and only then needed to be validated.  Indeed much of it has been spent buying doses of the vaccines being developed.

You might say “the $20 billion is to buy the doses needed so everyone can be vaccinated for free”.  Well, not really.  Pfizer is charging $20/dose for its vaccine, and some other vaccines are even less expensive.  So, even if everyone in the country were to be dosed, that would cost $13.2 billion.

And, one more thing.  We’ve already paid for 700 million doses with the money spent already.  That is more than we need to dose everyone in the country.  We don’t need to spend another penny on vaccines.

What is the extra $20 billion for?  Why couldn’t we spend the tiniest percent of that on validating ivermectin and determining how best to wear a mask?

Vaccine News

Sadly, vaccines have become a political tool.  On the international stage, national pride has encouraged the development and distribution of vaccines that haven’t yet been fully tested, or which, when tested, reveal massively disappointing results compared to other vaccines from other countries.  At a country level, vaccine availability is a measure by which politicians and their popularity can rise or fall (possibly even here in the US).

So in Brazil, with President Bolsonaro’s popularity dropping, his opponents have used vaccine availability as a tool against him, and as a possible result, the country is rushing into placing one of the Chinese vaccines into mass production and distribution.

Never mind how effective the vaccine is.  Which brings up an important point.  There are many different vaccines out there at present, with widely different approaches to how they help a person avoid a Covid infection, and greatly different effectiveness levels.

My sense is that currently the Pfizer vaccine might be the very best, closely followed by the Moderna vaccine.  There is also the AstraZeneca vaccine, thankfully not yet approved in the US, and with such a hodge-podge of testing and results as to make it very difficult to understand exactly how well it works, for which age groups, and with what dosing regimens.

Mainly for the benefit of readers outside the US, I recommend you make sure you know which vaccine you’re getting, and if possible, insist on the Pfizer or Moderna vaccines.  Is the AstraZeneca vaccine better than nothing?  Yes, but make sure that if you get that vaccine, you’ll still be able to get a better vaccine in the future, too.

Does one vaccine create side-effects that prevents other vaccines from also being taken?  Ummm, that’s not yet been studied, but some “experts” (ugh) have wondered and worried if these new types of vaccines might create antibodies that attack rather than learn from future vaccine antibodies.

We expect to see a lot more of the AstraZeneca vaccine, particularly because, as shown in this article, India is starting to gear up to make and export it in large quantities.  What a shame they’re making the vaccine with currently the least persuasive of the three claims about effectiveness.

Timings And Numbers

Things are looking more positive than they have for many months.  After reporting 30 states (more than half – yay!) with declining rates of new cases on Sunday, that number grew to 36 on Monday, 38 on Tuesday, and then steadied at 40 for Wednesday and Thursday.  As a resident of Washington state, I was pleased to see, after way too long leading the “bad states”, on Thursday WA finally moved down from being the state with the worst new case growth rate and now is fourth worst with an almost stable new case rate.

The above chart is a fascinating chart, because it shows the current level not the historic total levels of new cases occurring.  This shows how first Belgium spiked so spectacularly, and then the Czech Republic, and Spain is now shooting upwards at an extraordinary rate.

This too is a great chart, showing the cumulative rates of vaccines dispensed per hundred citizens.  Remember that the maximum total is 200 doses – enough for two for each person.

Both charts, and many more, can be seen here.

Closings and Openings

One of the problems with “experts” is often that the more a person learns about a specific subject, the less they unavoidably know about other subjects and so it is difficult for them to put their knowledge in a broader context.  Additionally, as the saying goes, “when the only tool you have is a hammer, every problem looks like a nail”.

So you get siloed experts advocating solutions narrowly within their own small sector of expertize, but with no comprehension of the broader world in which such a solution would be placed.  Is it any surprise that many times, the solutions advocated by experts have ended up doing spectacularly more harm than good – for example, the policy to discharge elderly sick people out of hospitals to make room for the anticipated rush of critical “normal people” Covid cases (which never eventuated).  Instead, these elderly people were sent back to their regular care homes, where they proceeded to then infect many more elderly people, with very high mortality rates, while the hospitals remained more empty than full.

The latest example of how experts can kill us with the best of scientific reasons was a policy to shut down outdoor dining in California.  This article wonders if rather than helping reduce the rate of Covid infection in California, it might have accelerated it, by requiring people who wanted to dine with friends to resort to more risky “at home” type experiences.

But the real shocker of the article, and please be outraged by this, is the admission that some experts realized it would do no good at all to ban outdoor dining, but it was still worthwhile because it would “send a message” to the public.

Exactly what the message that was sent is unclear, but the outcome is clear.  A raging rate of new cases, and an acceleration of restaurant bankruptcies.

Seriously, folks, we’re the US.  We’re supposed to be better than this.

Logic?  What Logic?

If I had to shelter somewhere for three months to avoid any risk of catching the virus, I can think of several places I might want to go, and also several places I’d definitely avoid.  High on the list of places I’d try to steer well clear of would be airports.

But this gentleman apparently disagreed, and was discovered after having been living at O’Hare for three months, to avoid the virus.

One final item today.  Reader Linda advises of a new major side effect being experienced by many people when they finally get their second dose, particularly if they’ve been worrying for the three weeks prior to then if they’ll get it or not.

The side effect?  Relief.

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

Scroll to Top