Post #818: Well, turns out, this *is* as good as it gets.

Three days ago, the head of the US CDC said, more-or-less, that you’re going to get more protection from wearing a mask than you are from the forthcoming US vaccine.  He’s had to recant, publicly, since then.  But my guess is the he got it right the first time.

I summarized that in Post #815, What if this is as good as it gets?  With the title being my take on that testimony.  We’ve been expecting a vaccine to make a radical change in the situation.  But, taken at face value, the US CDC director basically just told us, that’s not going to happen.  Presumably, the implication of what he said is that it’ll do no more than mask wearing and social distancing have done.

Today I stumbled across a recent interview with Dr. Fauci where he said that if we adhere to all the current public health measures, and we get a “good” vaccine, we might be able to return to normalcy as early as the end of 2021.  Apparently, he’s been saying 2021 for some time.  This is the first time I’d seen it stated as the end of 2021.  And seen that conditional on having a “good” vaccine.

So, twice in the last couple of days, responsible public health leaders have told us that this is about as good as it gets, for the time being.  Vaccines really won’t alter the situation in any material way, for quite some time.  Even with a “good” vaccine, the situation we are in right now — with the shutdowns and social distancing and all of that — that’s as good as it gets, until at least the end of 2021.  And that’s only projected to end if we have a “good” vaccine, and everybody adheres to the other public health measures like social distancing and mask use.

At this point, I feel like I’ve been sleepwalking through this.  I need slap myself across the face, wake up, and start listening to the people who know what they’re talking about, and plan accordingly. 

The smartest people in the room are trying to tell us that we’re going to be in this semi-lockdown, socially-distanced, mask-wearing limbo for … a year or years to come.  Vaccine or no vaccine.

And now that I’m waking up, I realize just how many things I’d let slide because I unconsciously assumed that there was a chance that we could return to normalcy soon.  Particularly with numerous vaccines on the way.  No sense in doing things that incur a risk of COVID-19 infection if US society is likely to be COVID-free in the near future.

Should I list a few?  I’ve been slacking off on exercise, thinking, well, I’ll be able to get back to the gym soon enough.  Nope.  No I won’t.  So I’ve been putting on weight accordingly, but you know, that’ll come off when I can get back to the gym three days a week.  Nope, that’s not going happen any time soon.  I’ve put off seeing the doctor, figuring, it can wait until things are back to normal.  No sense being around a lot of sick people during a pandemic.  I’ve put off a major home repair because I don’t want workmen in the house, figuring things won’t have rotted out completely by the time we’re over this COVID thing.  Again, wrong, wrong, wrong.  And so on.

So I think I finally am getting my mind around this.  This really is as good as it gets.  For quite some time, anyway.  That’s what the smartest people in the business are telling us.  If you try to live your life in a reality-based fashion, plan accordingly.

 

Post #817: Vaccine and sins of omission.

I’ve had a series of posts arguing that Russia (and now the China) are doing the right thing by deploying their vaccines before they know their effectiveness.  That was stated most recently in Post #814.  Both countries are already providing those vaccines to high-risk populations such as health care workers, before they know how effective the vaccines are (or aren’t) in preventing (or lessening severity of) COVID-19 infection.

Today’s twist is that they are also winning allies and gaining international influence by supplying vaccines, now, to other countries that need them.  That’s written up in this Washington Post article.  So not only are they ahead in their own country, but they are gaining influence around the world by being first-to-market in a number of countries that need help right now.  (And, in an odd twist, they’ve decided to pool some efforts on their vaccines. )

In this post, I’m going to review the logic behind this one last time, and then do the grade-school arithmetic that validates that logic.  Something that, apparently, neither our elected officials nor our public health bureaucracy seems willing or able to do.  Or at least, to admit to doing, in public.

My best guess, using some quite conservative estimates, is that providing 10 million doses of vaccine now, instead of six months from now, would save just under 10,000 hospitalizations (worth about a quarter-billion dollars), and about 2800 lives.  This doesn’t even count other costs saved, such costs saved by avoidance permanent organ damage from COVID-19, or economic losses from work or school time not missed due to COVID-19 illness and quarantine.    Not only would the avoided hospital costs more than pay for the vaccine itself, these numbers are vastly higher than any plausible health or economic damage from any as-yet-undiscovered rare side effects of the vaccines.

Details follow.
Continue reading Post #817: Vaccine and sins of omission.

Post #816: We actually did have a rational, national plan for mask use?

Source:  The Daily Beast, from an article on the demonization of masks in Trump world.

Yep, we did.  We had a national mask initiative in the works.  It’s just that the President killed it.  As you can read in this famously not-liberal publication, Business Insider.  You can also see the same information buried inside this Washington Post article.  You can also see that the bare bones of this story were reported back in April, when the mask initiative was killed.

I just wanted to document this here, as it really didn’t get much play on its own and it’s already slipping out of the news. Continue reading Post #816: We actually did have a rational, national plan for mask use?

Post #815: What if this is as good as it gets?

Source:  Immunogenicity and protective efficacy of influenza vaccination
Claude Hannouna, Francoise Megas,  James Piercy,  Virus Research 103 (2004) 133–138.

The importance of this graph will be clear about five paragraphs down.

At this point, with the Phase III trials of coronavirus vaccines well underway, even if they don’t have enough “statistical power” to do the formal statistical test, our public health bureaucracy ought to have a fairly good indication of how things are shaping up.

I’ve been waiting for any US public health leader to start leaking information on the likely effectiveness of the coronavirus vaccines.   Informally tossing some numbers out there, to get us prepped for the eventual formal announcement.

We just got our first indication today.  And, although the CDC Director broke the news gently, and indirectly, and with spin, if you paid attention, the news was clearly not good. Continue reading Post #815: What if this is as good as it gets?

Post #814: COVID-19 vaccines. The Chinese get it, the Russians get it. We don’t get it.

In Post #777 (and earlier), I talked about why the Russian strategy of early use of their vaccine made good sense.  And now, it turns out that the Chinese are doing the same thing as the Russians.  They just didn’t brag about it, the way the Russians did.  I guess I am unsurprised that the Chinese are doing the rational thing here.

In both cases, they are taking vaccines that have passed safety trials, but have not yet completed trials showing whether or not they work, and they are using them right now, for high-risk populations such as health care workers.

This is so rational, and so logical.  And yet, apparently so beyond the grasp of our government.  Either our elected leaders or our professional bureaucracy. Continue reading Post #814: COVID-19 vaccines. The Chinese get it, the Russians get it. We don’t get it.

Post #813: Radford University, how not to report COVID-19 data

Source:  Radford University COVID-19 dashboard.

Edit:  And, when they finally published the data, there were just 40 new COVID-19 positive cases on campus, down from 64 the prior “week” (6-day period).

I’ve been a health care data analyst for more-or-less all of my professional life.  And one thing I have noticed is that when an organization is obliged to report information, but has some discretion as to timing, the better the news, the quicker it gets published.

And, vice-versa.

So when I see a university pledge to update their COVID-19 case counts weekly, what I want to see is that they update their COVID-19 case counts weekly.  Not, sometimes weekly.  Not, weekly if they can get around to it.  But, weekly, on the dot.  The way the Commonwealth reports the daily counts by 10 AM, full stop.

I say this because I’ve been tracking the situation at Radford University.  Not because of any personal connection.  But because they were the first Virginia University to report a serious COVID-19 outbreak, and because it looked like they were going to be able to pull through, despite a surge of cases traced to three large student parties.

(I’m also tracking William and Mary, where I do have a personal interest.  Thankfully, their COVID-19 dashboard remains roughly as exciting as watching paint dry.  This week, they are 99.86 percent uninfected.)

Last week’s update from Radford was good news.  It showed cases reported through 9/6/2020, posted to their website on 9/7/2020.  Which means that should have been updated yesterday.  But it wasn’t.  And hasn’t been updated yet today.

Looking at the Commonwealth of Virginia data for Radford City, unless something truly odd has happened, Radford University should once again report about 60 new cases in the past week.  But I also note that, based on the Commonwealth’s data, two people in Radford City were hospitalized for COVID-19 in the past few days.

And then there’s this.  Which, at first, I thought had to be a hoax.  And that’s not a commentary on the subject of the rally.  It’s a commentary on urging your student body to attend a mass public rally, of any sort, in the middle of an on-campus outbreak of COVID-19.

Am I really that more serious about this than most people?  So that this strikes me as a ludicrously unnecessary additional risk?  I mean, I was floored when I read that.  Perhaps I am far, far out of the mainstream with regard to taking unnecessary risks.  And in particular, on asking others to take risks.

So, Radford can’t seem to report their own infection data in a timely fashion.  But they did ban student gatherings of more than ten persons.  Before they urged their students to attend a mass rally this weekend.

That’s a set of some seriously mixed messages there.

Post #812: Vaccine distribution: The National Academy of Medicine plan

 

Source: Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine, Committee on Equitable Allocation of Vaccine for the Novel Coronavirus, National Academies of Sciences, Engineering, and Medicine (September 1, 2020).

I almost missed this one, and thought I might bring it to your attention. Continue reading Post #812: Vaccine distribution: The National Academy of Medicine plan

Post #811: Qualitative rankings of activities by risk of COVID-19 infection

Source:  Clipart-library.com

One remarkable aspect of this epidemic is that you can’t get any good information on what actions are risky, or not, for catching COVID-19.  How much does, say, going to the gym regularly raise your risk of COVID-19 infection, if at all? In other words, what are the odds that a trip to the gym will get you infected?

That question — what are the odds — turns out to be remarkably difficult to answer.  I laid that out fairly well in Post #716.  In a nutshell, even if they could accurately identify the  activity that got an individual infected, typically, nobody has the data on how many individuals engage in that activity.  You might know that (e.g.) 20 people in Virginia were infected in the course of routine dental care, but you don’t know if that’s 20 times in 20,000 visits, or 20 times in 2,000,000 visits.

For now, the bottom line takeaway from Post #716 is that you aren’t going to see any good, systematic information on your odds of being infected by doing X.  All you are going to see is more-or-less what anybody can cobble together.  Targets of opportunity.  And whatever has been analyzed in the scholarly literature.

Keep that in mind when you see studies that seem to be talking about the risk of catching COVID-19, from various activities.  What you are going to see published is probably better than nothing. And probably, no matter how it gets written up, almost none of it is actually going to tell you the odds of infection associated with any particular activity.

With that as background, yesterday the US CDC announced the results of one small-scale, sample-of-convenience study of individuals who had COVID-19 symptoms About half actually had COVID-19, the other half did not.  They contrasted those two halves in terms of what activities they had done in the prior two weeks.  Click here to see the study.  Or read a plain-language writeup of the results in the Miami Herald.

The CDC’s bottom line is that restaurant dining of any sort — indoor or outdoor — was about twice as common among those who had COVID-19, compared to those who didn’t.  And they found a weaker result for going to bars/coffee shops does as well.

The implication is that restaurant dining (and bar/coffee shop use) raises your risk of infection.  And that seems plausible enough.  But you still have no clue what the odds are.  Does it raise your risk from infinitesimally small to merely incredibly small?  Or is restaurant dining in the COVID-19 era the equivalent of drunk driving?

So I decided to compile what I could find, about who says what is risky, and why.  It ain’t much, but it’s all we’ve got.  This is the first of two postings, comparing various lists of what’s risky and not.  Detail follows. Continue reading Post #811: Qualitative rankings of activities by risk of COVID-19 infection

Post #810: An air-curtain approach to indoor restaurant safety in the coronavirus pandemic

The CDC has finally started doing some epidemiology that will help ordinary citizens to judge the risks of certain activities.  And the very first thing their research highlighted was the risk from dining in restaurants.  In their small-scale study of a sample of individuals with COVID-like symptoms,  persons who tested positive for COVID-19 were twice as likely to have gone to restaurants in the past two weeks, compared to those who tested negative.

I started to write up my own analysis of this issue of risk.  But I got sidetracked by an email discussion about the coming crisis that restaurants in the Town of Vienna are likely to face, if COVID-19 gets any worse, or if the economy gets any worse.  We don’t need any more analysis.  We need a solution that would plausibly increase the safety of indoor dining.

So, instead of just analyzing the situation, I’m going to offer you my cheap solution for safer indoor dining.  In a nutshell, use ceiling-mounted box fans, with high-end air filters, to bathe each table in its own individual stream or “curtain” of clean air.  And to sweep any virus-laden air down to floor level, for further filtering and recirculation.

Detail follows.

Continue reading Post #810: An air-curtain approach to indoor restaurant safety in the coronavirus pandemic

Post #809: Missing the big story on Trump and airborne coronavirus

If you’ve been reading this website, you know that I have harped on the issue of airborne (aerosol) spread of coronavirus.  In particular, I’ve pointed out how strong the evidence of it is, how important it is for determining how best to protect yourself.

 

And I have pointed out how ridiculously inconsistent the CDC’s guidance and analysis of events is, because they apparently cannot say the words “airborne” or “aerosol” in communications to the public.  I went so far as to speculate on why the CDC’s position is so jumbled (Post #771), and to point out how the CDC has to tie itself in knots to avoid referencing airborne transmission (Post #768).

Now it turns out that top US officials, starting with the President, have known that the coronavirus was airborne all along.

Reporting right now is focused on the President.  But I think that mainstream news is missing the big story here.  I mean, Trump lied, and people think that’s news?

What about the CDC?

We now know that top US officials were completely aware of aerosol (airborne) transmission of COVID-19 from the beginning.  And yet, the CDC guidance to citizens completely ignored aerosol spread. And continues to ignore it. 

The big stories are a) how did that happen, and b) why is that still happening right now.

Recall that the initial CDC guidance said that nobody needed to wear a mask, as long as we were all “social distancing”. That’s because they assured us that droplet transmission” was how COVID-19 was being spread. (Droplets differ from aerosols in that they fall quickly to the ground, and so do not float on air currents.)

The CDC still says that COVID-19 is spread by droplet transmission, and nowhere in their guidance to citizens do they mention aerosol (airborne) transmission.

If that is the result of political pressure, then that is the big story here.

Trump lied to the American public. Dog bites man. But if Trump’s minions forced the CDC to lie to the American public, and we had people die based on that purposefully incomplete advice? That’s the real story that we need to see some reporting on.