Coronavirus - worldwide spread and control

The USA has now gone through a very sad threshold.

 

Article courtesy of the Daily Mail on how Covid can be spread on long-distance flights:

http://www.msn.com/en-gb/travel/new...-15-others/ar-BB19eCBP?li=BBoPWjQ&ocid=ASUDHP

 

I'm decided to stop most posts about COVID-19 cases and deaths in Florida. The major variation in reports has to do with weekends and news cycles, not any underlying medical problems. I've been trying to make estimates based on excess deaths, but these numbers are now themselves political footballs. Medical examiners make their own determinations of causes, but the state has stopped them from releasing data independently. My best guess right now is that there has been a new increase in cases in Florida following the Labor Day holiday and the opening of schools. Meanwhile, we are still accounting for those who died due to earlier surges.

This interview with Justin Lessler at Johns Hopkins University explains problems and misunderstandings of excess deaths. I've written journalists who covered this angle early in the pandemic, and concluded the undercount in Florida was likely hundreds, not thousands, at that time. I've suggested the data since then points to a need to revisit the analysis, but have not heard back. (It is really hard for journalists to cope with tricky analyses when they are facing a deadline. Officials who want to spin data are well aware of the problem.)

At a national level it is possible an excess death analysis would add up to 50% more than officially admitted. We might already have 300,000 deaths.

At a personal level, a friend with relatives in Italy just told me one relative infected six months ago has died. This could have been recorded as due to respiratory failure, pneumonia, heart failure or COVID-19. Some rules for counting causes of death would prevent this from being considered a COVID-19 death because of the delay. All those other causes could be downstream effects of the initial infection.

 

Today the CDC pulled guidelines which said the virus can spread through air, something we now know the President was told months ago when he told a journalist in a recorded interview.

The CDC is no longer the center controlling release of data on the pandemic, that has been moved to HHS, where political appointees have more control. The result is that I can't easily cross check what my state government is telling me by using national statistics. The state government has also stopped local medical examiners from determining COVID-19 deaths, or at least releasing their own determinations. I've been through another frustrating exercise with county or school district health advisers. When we had a dispute about reopening schools with face-to-face classes, those advisers were forbidden to offer any advice which indicated this was a bad idea. We have strong indications the state government is trying to control the data to support political decisions already made.

For anyone who thinks my suspicions are overblown, I offer this screenshot from The Covid Monitor on what data Florida's state government is providing on cases in schools. The site is running a volunteer operation to fill the gap.

 

At least the French government is telling you about classes that have been closed. Here in Florida I don't find out until an entire school is shut down. I doubt there is any deliberate decision about "herd immunity", what has happened is that officials have become tired of dealing with complaints. They then think, "it won't make too much difference if we only isolate children for a few days", or whatever relaxation of rules is suggested. The result is a bureaucratic experiment.

One of our county health advisers, a political appointee I will not name, just made a statement about Orange County having reached a "good plateau" in cases. This is not a term I'm familiar with from any literature on epidemiology. Epidemics either grow or decline, unless the infectious agent has become endemic. In other countries, I take stability in figures as evidence the statistics are being manipulated by bureaucrats who don't have a clue about the dynamics of real epidemics.

One of his points for bragging was that reduced testing now meant that their existing team of contact tracers could quickly trace all case contacts. The implicit reasoning here was that reduced testing => reduced cases. If he had any idea about finding an estimate of the cases they missed, he didn't say so. The political advantage, besides "avoiding panic" is that tracing can now be accomplished without any new funding. Various pieces of paperwork are also filled out.

This kind of response always gives me a sinking feeling about what will happen when we find out what has been going on. Withholding data on schools does nothing to reassure me.

The current legal reason for withholding data seems to be student privacy. State officials have previously argued that privacy rules prevented them from discussing cases in long-term care facilities, jails or prisons. These resulted in 5,061 LTCF deaths and 123 deaths in prisons. For the rest of us, there were many thousands of cases among those who worked in these places, but also lived out in the community. This did a great deal to spread the pandemic.

 

https://www.technologyreview.com/20...aus-covid-coronavirus-herd-immunity-pandemic/

 

https://twitter.com/user/status/1309148871730368518

 

I was so glad when I saw that the CDC was finally acknowledging airborne transmission and was shocked when they quickly retracted the report. I've been reading about airborne transmission of the virus for months, and it's so important. As troubling as this type of transmission is, we can do something about it. From what I've read, the best thing businesses and clinics can do is open windows to dilute any virus inside. If that's not possible, they could increase the amount of outside air circulated through HVAC. Installing UV lights in HVAC systems or installing portable HEPA air purifiers could help.

I'm trying to figure out why the CDC pulled its report about airborne transmission. As is sickeningly clear, the CDC and FDA have sometimes bowed to pressure and meddling from this administration. I'm speculating, but I think the resistance to letting the public know about airborne transmission is fear that businesses, schools, and healthcare facilities would have to change some of their practices and incur costs from improving ventilation. Also, knowing that virus particles can travel over 6 ft. would require allowing fewer people into a building. In the U.S., there's a real resistance to any kind of regulations for businesses.

Lately, there are days I envy the dinosaurs dying quickly from the asteroid. At least they didn't die from their own stupidity.

 

I was reading an interview earlier today, a doctor was commenting on the reasons for numbers currently increasing in several parts of Sweden.

He mentioned parties, travel, and people not staying home despite having symptoms. He also said that some people don't even bother isolating themselves when getting symptoms a few days after having spent time together with someone with confirmed covid-19

I was wondering what it's like in other countries, so I found this tweet very interesting. Thank you!

 

A comment on Florida's strange statistics. After a weekend when matters looked better, and some officials claimed success, we had a day yesterday when 202 deaths were reported. Today we reported 177 deaths. I think it is safe to say we are still talking about thousands of cases and hundreds of deaths per day. This is not control of a pandemic, nor is it grounds for reopening more activities that can spread virus.

I am not able to estimate the number of deaths blamed on comorbities rather than COVID-19 because official statistics tell me nothing about this. Nor am I able to estimate the number of infections missed because of reduced testing. Anyone who has access to better data should feel free to correct me.

 

But. I was told by very serious people that people are panicking to the point of madness and this surely must be the cause of long Covid.

This can't be. That would mean they are making this all up. No, that's impossible.

 

Really? I'd been about to post this one which I found in an old newspaper from a week or so ago, asking whether we'd all got it wrong about Sweden:

https://www.standard.co.uk/news/world/sweden-coronavirus-covid19-lockdown-a4546976.html

Is that no longer the case?

 

Just to compare our local situation with others around the world I checked on a few other countries. Spain is clearly in a second wave, even without flu. France is still in an epidemic, and I'm not sure the first wave ever ended. Deutsche Welle reports that both France and the U.K. are experiencing new surges. What I can tell from the last U.K. Prime Minister's Questions is that there are now serious questions in Parliament about losing control of the virus.

(Is anyone in the U.K. claiming the pandemic is under control?)

What I've seen repeatedly is that politicians are approaching a medical crisis the way they approach any political problem. I don't even know the affiliations of many leaders, so I'll offer this generic template for how a politician approaches a crisis. First, you promise great things if you are given additional power. On gaining power, you go to great lengths to tell people you are doing great things, while often doing something else. Finally, when things go wrong politically, you blame this on the fact that some people were so benighted as to oppose your absolute dominance. At each step this strategy is all about convincing people of matters which may or may not be true.

The idea of actions achieving any purpose other than convincing people is alien. The idea of critical measurements to see if your actions are having the desired effects, beyond convincing some people, is positively antagonistic to spin control. Multiple countries, with a range of political systems, ran variations on test and trace, with different kinds of isolation or quarantine. They bragged about their testing, or about the numbers testing revealed, without connecting this with tracing and isolation. They generally avoided questions about how many cases their testing missed. (Note: by some standards, an infection is not a case unless it is detected. This is particularly valuable to politicians who don't want to know.) They tried everything they could to spin numbers to make their handling of the crisis look better. They spread confusion when things looked bad. They could say, "We tried A. We tried B. We tried C." Since none of these alone were magic, the crisis continued. They weren't making sure the pieces fit together. When hospitals dumped infected patients who did not need acute care on long-term care facilities which had lower priorities for medical personnel and supplies of PPE there were examples of such actions spreading the infection in vulnerable populations.

The result was that the only action which nearly halted the spread was a full lock-down. This was not tenable for long, and leaders backed off without eliminating the virus anywhere. Now the pandemic has resumed, and there is no obvious place where an infected population might be isolated. Community spread is everywhere.

What about countries where things went better? Well, just as an example, the vice president in Taiwan was trained as an epidemiologist.

Taiwan had 509 cases and 7 deaths.

 

No, that is not the case. The numbers have been relatively low for a few weeks, but I see no reason to celebrate. The now rising numbers were expected, with people starting to travel more again, using public transport more frequently when returning to school and work, spending more time indoors etc.

At the moment the infection seems to be spreading the quickest among younger people (sports, house parties, schools/"gymnasiet" etc), which might explain why the number of deaths isn't very high (yet), although it is rising. 6 deaths reported yesterday, 5 the day before that. However, reports are delayed, so these are most likely not true numbers.

Tegnell said the other day that "the risk is pretty high that we will be seeing a higher number of deaths" (as you know, he is known for having overly optimistic opinions/speculations...)

Some random examples of recent Swedish headlines:

The increase in numbers of infected is at record levels in Västerbotten - "A worrying development"
SVT: Rekordökning av coronasmittade i länet – ”En oroande utveckling”

The head of healthcare Region Stockholm says "if it continues to increase lke this, we could soon be in a very serious situation again"
Omni: Ökad smitta i Stockholm – varnar för ”allvarligt läge”

Covid-19 is back in several care homes in Stockholm
Sveriges Radio: 20-tal smittade på äldreboenden

Tegnell says "we are slowly but surely moving in the wrong direction"
Omni: Tegnell om utvecklingen i Sverige: ”Går sakta men säkert åt fel håll”

The number of infected in Stockholm has doubled over the last two weeks, an epidemiologist is suggesting that some experts might have had an overly optimistic view on immunity
Omni: Expert: Överdriven syn på immunitet i Stockholm

The number of infected in Norrbotten is rising: "At risk of uncontrolled spread"
SVT: Ökad smittspridning i Norrbotten: ”Riskerar okontrollerad spridning”

The number of infected in Dalarna is rising; ice hockey players are infecting their parents, and it is spreading to work places
DT: Risk för ökat tryck på vården – barn smittar föräldrar: ”Sprider sig till arbetsplatser”

Finland tightens their restrictions again after loosening them less than a week ago (people who live in Sweden but work in Finland will be allowed to cross the border, others won't)
SVT: Finland inför nya restriktioner

FHM's statistics of infected, deaths, and intensive care. Updated Tuesday-Friday at 2pm:
https://experience.arcgis.com/experience/09f821667ce64bf7be6f9f87457ed9aa

 

Previously, I have argued that I could no longer say what Florida's official COVID-19 statistics meant. I had also noted that officials were using weekly variations, and variations caused by reduced testing, to claim victory over the pandemic. I should have drawn the obvious conclusion: they were about to remove all restrictions on businesses. Any reported consequences are likely to become apparent after the election. I've also commented on the state's ability to delay reports by weeks to months.

Today alone the state reported another 120 deaths due to COVID-19. (The 7-day average remains above 100 per day.) If you count those non-residents who had the misfortune to die here, the death toll is already over 14,000. The state admitted we had a crisis on March 1, over 6 months ago. The positivity rate I'm watching is just under 17%, not the state's claimed 5%. All that is missing for a real disaster in an outbreak of influenza.

 

I keep wondering if we got it wrong about Sweden but then:

The other three Scandinavian countries have death rates per million of 50, 62, 112
Sweden is 581, up with the worst cases like UK, USA and Latin America where at least there is the excuse of population density.

 

Sweden introduced far less stringent policies than the UK though, and deaths there didn't continue to increase in the way I expected. It is complicated by other differences, and Sweden has much a much higher proportion of single occupancy properties, but I'd still expected things to go more badly there. I think my prediction was wrong (so far). Maybe the summer weather is particularly valuable for helping people effectively socially distance in a relatively relaxed manner?

 

If you look at the cases per million on https://www.iancampbell.co.uk/covid-19.php and compare Sweden with similar countries (Norway, Finland) it is pretty bad and has the same uptick coming, despite there being no lockdown to be lifted. Most of the deaths in Europe have been due to infection of vulnerable people in hospital settings or care homes. The hospital problem became a chain reaction wherever resources were overloaded.Sweden probably had a good enough system to avoid that. They also have much fewer BAME health workers.

What has struck me recently is how important heterogeneity within cultural groups is likely to be. The curves are not simple exponentials driven by R numbers. Within each country there are multiple local and culture and age specific flares. The Norfolk chicken factory flare showed that it is actually quite easy to stop a flare once you have data. What now appears to be a juggernaut of a second wave is in fact a whole lot of parallel flares all driven by the relaxations in July-August in different ways. It is still perfectly possible to get numbers down to near zero in three weeks but you need the political atmosphere in Australia where the health minister has just resigned for not ensuring the tight quarantine was truly tight.