Category: COVID through 2022

The new normal in Virginia seems to be 1000 cases per day, and stable low case counts in the “late-reopening” areas (NoVA+Richmond City+Accomack).

There was an apparent spike in cases yesterday, but this was a result of a backlog in reporting, not an actual one-day spike.

Below, blue = Virginia, orange = Fairfax County, updated to 7/26/2020.

Below, blue = late-reopening areas, orange = rest of state.  Apparent jump in new cases yesterday is an artifact of data reporting issues.

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Hydroxychloroquine doesn’t work on lung cells

And the (almost) final piece of the puzzle/nail in the coffin of hydroxychloroquine was published earlier this week.  It doesn’t protect human lung cells from COVID-19.  It protects other tissues, but not the lungs, as this detailed news article explains.

For those who were keeping score, randomized controlled controlled trials of this tended to show very close to no impact.  And “observational data” studies (just comparing people who were and were not given the drug by their physicians) gave hugely contradictory results.

In rare instances there’s still some effect worth nothing, but usually, when you see that combination, it means there’s no there, there.   And that’s the case for hydroxychloroquine.  The politicization of it didn’t help matters.  But the results are the same regardless if whether or not it was some sort of token of political faithfulness.

As I have emphasized here before, there were many good reasons for looking at this drug as a possible COVID-19 treatment.  (Long before the President mentioned it.)  The foremost of which is that it demonstrated strong anti-viral activity against COVID-19 “in vitro”, that is, in cultures of cells.  The last piece of the puzzle was explaining why this drug appeared to be so effective at suppressing COVID-19 infections “in vitro” but not in humans.    And the answer, per the study referenced above, is that it is effective in suppressing infection in kidney cells.  But not lung cells.

The only wild card remaining is whether hydroxychloroquine’s role as one of very few known zinc ionophores means that this drug, in combination with zinc supplements, might still be helpful.  This was explained back in Post #607.  The spectacular case reports at that time involved use of zinc supplements with hydroxychloroquine.

Source:  Wikipedia

If that’s true, then the role of the drug is not in suppressing COVID-19 directly, but in allowing zinc to pass into cells (“zinc ionophore”), where high zinc levels may suppress some aspect of COVID-19 reproduction.  But if that’s the case, then the key ingredient is the zinc, and any substance that acts to transport zinc through cells walls (e.g., quercetin) would service along with zinc supplements.

Guess the new norm is about 1000/day for the Commonwealth, maybe 60/day for Fairfax County.  Anyway, the good news is that it doesn’t look like we’re headed down the AZ/FL/TX path.  My three standard graphs follow, updated to today (7/23/2020).

Last 28 days of new cases, Virginia = Blue, Fairfax County = orange.

Last 28 days, late-reopening areas (NoVA, Richmond City, Accomack) = Blue, early-reopening areas = orange.

And the ZIPs of Vienna:

 

My three main graphs, updated to today (7/20/2020) where possible.  The only material change is that the recent uptick in cases in Virginia, in the early-reopening areas, appears to be leveling off.  In short, although the rate of new cases is high in some (mainly) Hampton Roads area cities and counties (Post #758), it doesn’t look like we’re getting ready to join Florida and Arizona any time soon.

Virginia (Blue) and Fairfax County, updated to 2/20/2020:

Virginia, NoVA+Richmond+Accomack (late-reopening areas, blue) versus rest of state (orange).  This is only updated to 7/19/2020 due to a glitch on the Virginia Department of Health website today.

Town of Vienna, counts given for ZIP code 22180 today, and one week ago.

Notice, I’m not saying “intelligent leadership”.  I’m not even saying “effective leadership”.  Just “leadership”.

This brings together all my “school of hard knocks” posts.  And related.  And boils down to dinosaurs.  We, in the US, have become dinosaurs.  Ponderous, slow, fundamentally stupid — dinosaurs.

Recall that, three months+ ago, I, a no-credentials blogger (eh, well, Ph.D. economist), talked about the German use of pooled testing for COVID-19, in a math-oriented post (Post #605).

That’s German, as in Germany, the country.  The country that is succeeding in dealing with COVID-19.

Three.  @#$(ing.  Months.

And today, we find out that the US FDA has issued an “emergency” authorization to allow some (not all, but some) US labs to do something like what the Germans were doing three months ago.

You do have to wonder what their definition of “emergency” is.

Not stupid enough for you yet?  Let’s look at some direct quotes:

FDA Commissioner Dr. Stephen Hahn said in the statement. “Sample pooling becomes especially important as infection rates decline and we begin testing larger portions of the population.”

Yeah, that’s really what’s key right now.  We really have to be looking forward to the point where infection rates decline.

Ah, let’s just finish this with one final quote:

“Quest said in a statement it expects to deploy the testing technique at two of its laboratories by the end of next week, and additional laboratories will follow.”

Two laboratories.  End of next week.

For those of you who have no professional interest in health care, Quest is, (I think) the largest laboratory services provider in the USA. If they aren’t #1, then they are #2.

And, maybe, two of their labs, next week, might be set up for this.

Better watch out.   I hear there’s an ice age coming.

See, the thing is, bureaucracies, in and of themselves, may eventually get to the right answers.  But bureaucracies are, by their nature, ponderously slow.

That’s why you need leadership.  Something that countries outside the US have had, to varying degrees.

But absent that, the you get what we’re getting.  Eventually, we’ll probably get something close to the right answers to whatever questions actually got asked.

And that’s our COVID-19 response, in a leadership vacuum.

Have we stopped being stupid yet?  In the US, regarding COVID-19?

Oh, heck no. 

The only school that’s still fully in session is the school of hard knocks.   And that one’s doing a bang-up business.

Source:  zippythepinhead.com  This image is copyright Bill Griffith, and is used without permission.  But with the notation that “Are we having fun yet??” in fact originates with Bill Griffith/Zippy the Pinhead, but has been so frequently copied that many people incorrectly believe the source is apocryphal. Continue reading Post #760: Have we stopped being stupid yet?

My standard graphs, updated to today (7/17/2020), are below.

At this point, it does not look like they are going to get exponential case growth in the Hampton Roads area.  But it may be too soon to tell.  As of today, it just looks like they went from a steady 300 new cases a day in the early-reopening portions of Virginia, to 800 new cases a day.

Otherwise, the story remains unchanged.  The late-reopening areas are doing OK.  Most of the state outside of the Hampton Roads area, mostly ditto.  Hampton Roads are, not so much.

Oddly, Vienna (22180) picked up 11 new cases last week, which is quite a bit higher than rate observed for the past few weeks.

Virginia (blue) versus Fairfax County (orange)

Late-reopening areas (blue, NoV+Richmond+Accomack) versus rest-of-state (orange)

Vienna, VA area ZIP codes.  Figures are today, and one week ago.

Here are my standard charts, updated to 7/13/2020.

In Virginia (blue, below), the seven-day moving average of new cases reached 800.  In Fairfax (orange), the seven-day moving average was steady at about 50 cases per day.  Both of those would be expected to rise a bit in the coming days as some low-count days pass out of the seven-day window, replaced by the most recent high-count days.

The problem continues to be outside of the late-reopening areas (Blue below, consisting of NoVA, Richmond City ,Accomack County).  Presumably, the problem continues to be in the Hampton Roads area, but I did not explicitly check that.

 

Source:  New York Times 7/13/2020  Red and green markings were added for purposes of illustration.

1:  Young people.  The cases that are showing up, in these outbreaks, are far younger, on average, than COVID-19 cases to date.

2:  Explosive growth.  A second outstanding factor in those states was the extremely rapid ramp-up in the case load.  On the graphic above, the green line shows the worst rate of case growth experienced in Virginia.  If you look carefully, you can see that in the three key states, they went from well under that level well over that level in a single week.  And from there, to crisis levels of daily new cases in another week or two.  From “everything is fine” to “public health emergency” in the span of a few weeks.

3:  Relatively few deaths, as shown below.  In part, that’s because deaths lag infections by a couple of weeks, on average.  But these upticks have gone on long enough now that we can also say this is partly “real”, in the sense that the mortality rates do not (now) appear to be climbing as steeply as the new case counts did.

Source:  New York Times 7/13/2020  Red markings were added for purposes of illustration.

The fact that 1) and 3) are related is obvious:  The mortality rate ramps up steeply with age, and COVID-19 mortality case rate among young people is quite low.  I discussed this in Post #730, where I estimated the impact the shift in age mix on average mortality using data from the Virginia.

But I bet that 1) and 2) are also related.  Not due to “bad behavior” by young adults, per se.  (Though that certainly may contribute).  I think low age and explosive growth may go hand-in-hand merely as a matter of arithmetic.

This conclusion is an expansion of the addendum portion of Post #723.  The cases that get counted are just the tip of the iceberg of all infections.  Lately, FWIW, CDC estimated that there are, on average about 10 infections for every reported (diagnosed, tested) case.  (I saw FWIW, because that’s based on a sample of convenience in a handful of sites.)  But I’ll bet that with young adults, the size of the iceberg (all infections) is vastly larger than the tip of the iceberg (cases testing positive for COVID-19). 

And in that situation, you would, as a matter of arithmetic, expect the counted cases to grow much more rapidly.  In other words, for a given uptick in counted (diagnosed) cases, your actual underlying epidemic is much worse if those cases are all young people.  By interpreting the early upticks in these states using  historical norms for a much older COVID-19 population, the states missed out on just how widespread these outbreaks were.

If true, this matters to us here in Virginia, because the recent uptick in cases (see next post) in the Hampton Roads area has been reported to be due to cases concentrated among young adults.  If the theory above is right, then the current case counts underestimate total new infections by a much larger margin than has been historically true.  And so we risk seeing the type of unexpected explosion of case counts as has been noted elsewhere when this has morphed into a young person’s epidemic.

Details follow.

Continue reading Post #755: COVID-19, younger people, and explosive growth. A theory, but no data.