Post #720: Some followups on coronavirus


Source:  Japanese Ministry of Health, Labor, and Welfare.

Yesterday’s count of just 13 cases in Fairfax appears to have been real.  A few times in the past, we’ve seen glitches in Virginia’s data systems result in a very low count one day, followed by a catch-up high count the next.  But that’s not the explanation of yesterday’s low count.  Today’s count of new cases in Fairfax is 50, which is still far below recent trend.  Here’s how the last 28 days of new case counts looks, as of today:

Hydroxychloroquine appears to be dead, for now, pending any controlled trial of the zinc combination that is rumored to be effective.  A few days aga, it was announced that a large-scale controlled trial of that drug (not in combination with zinc) showed no material benefit among gravely ill COVID-19 patients.  Unsurprisingly, the FDA recently rescinded its emergency approval for use of the drug in treating COVID-19.  Presumably, any ongoing clinical trials can still continue.  And I’m not sure that affects continuing use of the drug for COVID-19 patients.  It just means that such use is clearly “off-label” now.

Separately, yesterday’s news about dexamethasone helping to prevent COVID-19 deaths wasn’t really news, as such.  Physicians have been routinely providing steroids to the most severely ill COVID-19 patients, trying to prevent their immune systems from destroying their lungs.  This was by analogy to other situations where patients appear to suffer damage from an out-of-control immune system.  The findings reported yesterday were not really the discovery of some new drug.  They were simply the reported results of a controlled clinical trial of this already-in-use steroid therapy.  And, yes, it is helpful.  And so physicians will continue to use it when it appears to be indicated.

Church services are beginning to appear as centers of COVID-19 spread in the US.  This is not really a surprise:  One of the original US outbreaks was due to a large funeral service.  Put a crowd of people in a room and have them all speak aloud, maybe thrown in some singing, and that’s pretty much a recipe for aerosol-based spread of disease.  Both speaking and singing generate large quantities of aerosol (under-five-micron-sized) drops that can remain suspended in the air for quite some time.  Such aerosol spread can result in a single infected individual infecting many others, especially if that individual is part of the few percent of the population that is a “super-emitter” of aerosols (that is, generates far more aerosols than the average person.) And while this does not seem to matter much outdoors (as the aerosols are soon rapidly diluted below the level that can cause infection), large gatherings indoors remain hazardous due to aerosol spread.

Recall that we now know that COVID-19 is fairly hard to spread in most cases.  It doesn’t really spread well in a one-on-one situation.  If someone in your home is infected, or if you spend 10 minutes in face-to-face conversation with an infected individual, you have just a 15% chance of becoming infected yourself.  Further, 70% of those infected will never go on to infect anyone else.  So, most infected people, and most interactions with infected people, do not spread infection.

Instead, the virus remains active in the community largely because a small fraction of infected individuals go on to infect many people, and super-spreader events (where one individual infects many others in a single event) are one of the mainstays for keeping the virus in circulation.  Such super-spreader events can only occur in crowds, and so far, appear vastly more likely when that crowd is indoors, as opposed to outdoors.

And so, in addition to numerous church-based events already documented here, new church events appear to be reported daily.  So, here’s the biggest outbreak so far in Oregon, with hundreds of cases traced back to a single church service with “hundreds of worshipers singing, dancing, and jumping around …”. Here’s five churches in West VirginiaCaliforniaHouston.

Some of those might properly be classified as “workplace” incidents, no different from (say) meat packing plants.  That is, in some cases, it was merely the clergy that were affected.  But the largest of them are true church-based within-congregation spread.  And you should expect to see more of that in the coming weeks.

Everybody can take a tip from Japan:  Steer clear of the three Cs.  That’s the graphic at the top of the page.  Note that they specifically say that when you have all three, that generates high risk:  An enclosed space, with a crowd of people, all talking.  But that’s pretty much the definition of a church service.

A lot of pro-church people don’t quite seem to understand this.  They use (e.g.) Home Depot as an analogy.  If you can go to Home Depot, then what’s the problem with going to church.  And it’s the three C’s.  Home Depot is indoors, mostly.  But it’s not crowded, and you don’t have a bunch of people talking or singing in close proximity.  People who think that attending a church service is the equivalent of picking up an item at the Home Depot are simply misinformed.

As a final note, as of yesterday, the Merrifield Home Depot was strictly enforcing the Governor’s mandatory mask policy.   A lot of businesses now have a sign at the door saying that masks are required.  But they aren’t turning down business from people show up without a mask.  Not so at our local Home Depot.  Yesterday, there was a security guard at the front of the store, and I saw her politely turn away a couple of folks who weren’t wearing masks.

I think that’s the way forward.  Like Japan.  Instead of a lockdown, we have a lifestyle change.  You need to shop for hardware?  Wear a mask.  It’s not some huge hardship.  It’s not virtue signalling.  It’s just the way things need to be, for now.

Avoid the three Cs.  That’s not really rocket science, now is it?