Category: COVID through 2022

This post updates some key graphs to 6/11/2020.  At the last update (6/6/2020), it looked like we were finally seeing a slowdown in new case growth in Fairfax and in Virginia (Post #704).  That has panned out.  For Fairfax County, the seven-day moving average of daily new cases is down to about 150 new cases per day.  For Virginia, it’s down to 750 new cases per day.  For Vienna (ZIP 22180), it’s down to maybe one new case per day.

Whatever we’re doing under Phase I of re-opening, it’s not creating a spike in new cases.  If there are new cases attributable to this modest relaxation of restrictions, they are being swamped by ongoing trends that have nothing to do with re-opening.  Near as I can tell, the trends in case counts have nothing to do with re-opening or not, in Virginia.

This matches my earlier analysis of US national data, and appears to match the European re-opening experience, as reported here.  I need to revisit the national data in light of recent events (e.g., in Arizona).

Continue reading Post #712: Key graphs updated to 6/11/2020.

If you read this blog, you realize I’ve been tracking the pandemic pretty closely.  So when the WHO was quoted today as saying that “asymptomatic cases don’t routinely spread COVID-19”, I said, why is that news?  They’ve been saying that for months.

 Then I read the coverage, and I realize that it’s news only because people don’t know what “asymptomatic cases” means.  And can’t be bothered to stop for ten minutes and figure it out.

Thus confirming the #1 problem in America today.  Everybody feels entitled to a firmly held and vehemently expressed opinion.  Nobody feels compelled to do even the tiniest bit of homework first.

So, let me fill in the homework.  As briefly as possible, “asymptomatic cases” means individuals who never, ever show any symptoms.  That does NOT mean “pre-symptomatic” cases, that is, individuals who are in the period between infection and onset of symptoms.  Guaranteed, 99% of what you read in the popular press will have confused the two. Continue reading Post #711: “Asymptomatic cases” and the spread of COVID-19

Source:  US CDC, The ten essentials of public health.

It’s epidemiology week here at savemaple.org.  I hope you’re as excited about that as I am.

Let’s kick it off with a practical piece outlining the goal of this.  So, what’s the point of reviewing what is known about the epidemiology of COVID-19?  It’s to help you decide which precautions make sense for you, if you are determined to return to something approaching your pre-COVID-19 lifestyle. Continue reading Post #710: Kicking off epidemiology week at savemaple.org

Source: Wikipedia.

Little or nothing about the continued spread of COVID-19 in the US makes sense to me.  I can’t quite imagine why or how Virginia manages to have 1000 new cases a day, week in and week out.  Ditto for 300-a-day in Fairfax County, or 4 to 5 a day in Vienna (ZIP 22180).

For viral epidemics, I understand explosive “exponential” case growth.  I understand the disease fading away.  But this is one where it’s just kind of hanging out.  Where, aside from mask use and literal isolation from the rest of the world, there seems to be little to explain which countries are hard-hit and which have fully recovered.

Take the chaotic re-opening of retail establishments in Wisconsin.  That’s sort of an “acid test” for what we think we know.  There, the Supreme Court struck down all restrictions, all at once.  The Governor of that state described the result as a “wild west” situation.  There was a lot of press coverage of the resulting “party down” atmosphere showing crowded bars and restaurants full of non-masked younger patrons.

Clearly, this was nobody’s idea of a safe way to re-open businesses.  And there were widespread predictions that this would lead to a spike in cases.

Because?  Because, logically, if social distancing is necessary to prevent the spread of disease, then breaking all those social distancing rules, in a big way, ought to lead to an uptick in infections.

As a matter of logic, you can’t believe in one and not the other.  Unless you belive in luck, magic, divine intervention, or maybe that other factors are driving the actual transmission of disease.

Four weeks after than 5/13/2020 Wisconsin Supreme Court decision, here’s what you don’t see reported.  Because, by conventional wisdom, there’s no story here.  No uptick, no vast surge in new cases, hospitalizations deaths.  Nothing.  Bupkis.   Zip. 

Source:  New York Times accessed 6/7/2020.

Just … business as usual.  At least, that’s what I get from that graph, by eye.  A mild upward trend in new cases continued, after the wild west scenes.  Until it didn’t.  And daily new cases began to fall, some time prior to June 1.

I think this is a huge story.  The headline should read “massive violation of social distancing guidelines has no impact in Wisconsin”.  To me, with my generally scientific bent, that’s big news.  But not to the average person, I guess.

It’s tough to say just how massive a violation of social distancing actually occurred.  But if you’re going to wag your collective fingers at the Cheeseheads over it, I think that, by rights, you have to admit that you were wrong.  Not that this was a smart thing to do, or a good gamble on their part.  But the fact is, wrong is wrong.  And the idea of massive negative fallout from the chaotic and all-at-once removal of restrictions — that was wrong.

Just for a contrast, ask what they did wrong in Utah?  And the answer is, nobody knows.  For the first month of  their slow, measured, planned re-opening, nothing happened.  That’s from May 1 to June 1.  Now, new cases are spiking upwards.  And, these are dispersed state-wide — this isn’t the result of a few events (e.g., a meatpacking plant or similar).

Source: New York Times.

Meanwhile, in Virginia, as I continue to report, a similarly measured re-opening strategy has had no discernible impact.

The bottom line is that for a person with some scientific training, looking for cause and effect, this is an unsolvable puzzle.  The awful part being, of course, that if you can’t tell what you’re doing wrong, then you can’t fix it.  You take whatever precautions seem reasonable to you.  With no firm evidence basis for doing that.  And, otherwise, you just live with this seemingly random disease, until such time as a vaccine is produced and distributed.

 

 

 

 

 

This post updates some key graphs to 6/6/2020.  New cases appear to be slowing.  For Fairfax County, the seven-day moving average of daily new cases finally broke below 200 cases this week.

There’s no noticeable increase in new COVID-19 cases from Phase I re-opening in Virginia.  This matches my earlier analysis of US national data, and appears to match the European re-opening experience, as reported here.

Impact of re-opening, Phase I, in Virginia, update to 6/6/2020

Source:  Analysis of county-level data as reported by the Virginia Department of Health.  NoVA plus is Northern Virginia, Richmond City, and Accomack County.  The latter is in the late-reopening group because because they had 500+ cases of COVID-19 in two poultry processing plants.

The red line is the areas that entered Phase I re-opening on 6/15/2020.  Any resulting uptick in cases should have appeared by now.  Those areas are now entering Phase II of re-opening.

Continue reading Post #704 updated: Key graphs updated to 6/6/2020

Even within the astonishing incompetence of the Trump administration’s response to COVID-19, I find this one hard to fathom.

Mainstream denominations, and even whole countries, have figured out that singing at church creates a significant, avoidable risk of spreading COVID-19.  The reason is that singing generates large amounts of aerosol (under 5 micron) particles.  And all it takes is one infected individual, who is also a high-volume emitter of aerosols, to infect a large number of individuals.

See Post #682 and earlier posts for background, and a little simple math.

If you work through the list of religions in the DC area with significant top-down control, you’ll find that the leadership has figured out this issue.

For example, in the Catholic Archdiocese of Washington DC, re-opening of churches included this piece of guidance:  “5. The use of choirs should be omitted. The preferred musical accompaniment at Mass consists of one cantor and one organist or pianist. … ”

How about the Episcopal Church in DC.?  “No live singing with exception of vocalist with mask and microphone.”

The Presbyterians?  “Since congregational singing and choral music are particularly risky activities when it comes to the spread of Covid-19, these elements of worship should be omitted when churches first return to public worship, until such a time as it is deemed safe.”

That’s enough to get the drift.

And, in the past, the US government got that.  On 5/22/2020, my wife sent me the text of the newly-published CDC re-opening guidance to churches.  It said:

Consider suspending or at least decreasing use of a choir/musical ensembles and congregant singing, chanting, or reciting during services or other programming, if appropriate within the faith tradition. The act of singing may contribute to transmission of COVID-19, possibly through emission of aerosols.

Good advice.  And pretty mild stuff, really, when Germany has simply banned church singing outright, for the duration of the pandemic.  And when church-based superspreader events have been identified in many countries, starting with the Mount Vernon, Washington choral event.

To be clear, as with meat packing plants, church-based superspreader events are a universal phenomenon.  They aren’t some one-off, unique, random event.  They occur repeatedly, suggesting some underlying fundamental risk.  For example, it’s not that US meat packing plants have an issue.  It’s that meat packing plants around the world have been subject to outbreaks.  And it’s not that a US church choir or two has had a problem.  It’s that churches around the world have been the sites of superspreader events.   See Post #679 for a brief list of some such events.

Today I got a note from a colleague pointing to this NPR article.  Apparently, somebody at the White House objected to that language, so it’s gone. The CDC now no longer even mentions singing in its advice to churches.

You truly have to wonder what they were thinking.  Of all the material in that “interim guidance”, that one passage, referencing singing, had to go.   The one thing for which we have spectacular evidence of the risks involved, documented in detail by the US CDC.  NPR says that change to the guidance happened a few days ago, I think it happened just after 5/22/2020, when the CDC removed the word “aerosol” from that passage.

God save the Republic.  The people in charge certainly aren’t going to.

Source:  Clipart-library.com

I used to like McDonald’s french fries.  My opinion was that they tasted great.  And that was an opinion that I thought many people shared.

But then I found out that President Trump likes them.  Now I hate those fries.  I think they taste terrible.  And I take delight in every article showing that they’re bad for your health.

If that strikes you as perfectly reasonable, just stop here.  We’re not on the same page, and never will be.

By contrast, if that strikes you as irrational, read on.

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Source:  Wikipedia.

In Post #701 (and earlier posts), I put down all the reasons why hydroxychloroquine was (and still is) a plausible candidate for treating COVID-19.  Up to and including why the combination of that drug, with zinc supplements, was already in an NIH-registered clinical trial as a prophylactic (preventative) for at-risk health care workers.

A recent study of observational (i.e., non-experimental) data seemed to show that giving hydroxychloroquine to COVID-19 patients was hugely detrimental.  Seemed to cause an enormous increase in deaths.  And so on.

In that post, I explained what I saw as the main problem with that study.  Having done dozens of “observational” studies like that, for various health care manufacturers, my observation is that they always show that the people who got the drug (or device, or treatment) were worse off.  For the simple reason that you give drugs to sick people, and that direction of causation (sicker people get treatment) swamps any positive effect the treatment may have (treatment makes people somewhat better).  The net result of those two factors is a negative correlation between receiving a drug (device, treatment) and health status.

(This is why you have to test drugs using randomized clinical trials.  Those trials tend to be hugely expensive.  If you could reliably test the effectiveness of drugs from simple observational data, nobody would bother with randomized trials.  But you can’t .  Because, believe it not, if you leave it up to physicians, they’ll treat the sick people, not the healthy ones.)

And that “observational data” study had all the earmarks of that, including an apparently huge impact of the drug.  That is, not only did it appear detrimental, it appeared to kill people in very large numbers.  And yet, physicians continued to administer it.

As it turns out, a lot of knowledgeable people are now questioning that study.  Not just from my perspective.  But it appears that a lot of the medical detail, including dosages and prevalence of side effects, also appear anomalous.  You can see a good writeup in Science magazine, a publication of the American Association for the Advancement of Science.

But that’s not really my point.  My point is that, based on comments to various news articles, a lot of Americans celebrated the fact that hydroxycholorquine appeared to be deadly mistake, rather than a plausible treatment, for COVID-19.

And they did so purely because President Trump liked it.

If you understood the straw man at the top of this post, then you understand how completely irrational that is.  I think it’s hugely unfortunate that Mr. Trump is our President.  Ditto, the fact that he touted hydroxychloroquine.

None of that changes my opinion about the potential benefits of the hydroxychloroquine/zinc combination therapy.  I sure hope it’s effective.  You should hope so, too.  Keep an open mind until we see some actual clinical trial data on the effectiveness of that combination.

Addendum:  A large-scale randomized trial  shows no impact of hydroxychloroquine.

This was reported by CBS on 6/4/2020, and the actual research is written up in the New England Journal of Medicine.  It’s a double-blind randomized trial of a large sample of individuals who were exposed to COVID-19. There was no significant difference in the eventual rate of COVID-19 infection between the group given hydroxychloroquine and the group given a placebo.

Despite a few modest limitations, I’d say that pretty effectively rules out hydroxychloroquine, by itself, as an effective prophylactic.

I still have not seen the results of any trial of the hydroxychloroquine and zinc combination that has been rumored to be effective.

That study incidentally provides some interesting information.  First, the incidence of “secondary infection” is about 15 percent.  That is, if someone in your household has COVID-19, you have about a 15 percent chance of being infected.  Second, within this heavilyi-exposed cohort of younger individuals, only about 13 percent got infected, despite spending at least 10 minutes face-to-face with a COVID-19 infected individual, at a distance of less than six feet, without protective equipment.  Third, in this large cohort of mostly younger people, there were about 800 heavy exposures to COVID-19, about 110 infections, and just two hospitalizations.

The one-on-one infectiousness of this does not seem all that high, based on that.  And that jibes with something else I recently read, in that most of the reported cases come from superspreader-type events.  That is, depending on the country, 80% of cases come from just 10% to 20% percent of infected individuals.

A good detailed discussion of that is in Science magazine.  To me, this fairly strongly suggests that your main risks are not really in occasional one-on-one interactions (e.g., at the checkout counter at the grocery store).  Your main risks are in large groups, where, if the timing is just exactly right, a single aerosol superspreader can infect many individuals simultaneously.  This is particularly true if the environment is noise (so people must talk loudly), or if it’s a place where people sing.

 

Source:  Analysis of county-level data as reported by the Virginia Department of Health.  NoVA plus is Northern Virginia, Richmond City, and Accomack County.  The latter is in the late-reopening group because because they had 500+ cases of COVID-19 in two poultry processing plants. Continue reading Post #704 amended: Quick update to 5/29/2020, NoVA opening day

Source:  Analysis of data from the Virginia Department of Health.  Areas of Virginia that entered Phase I of re-opening are in red.  Areas that did not — but will start tomorrow — are in Blue (NoVA, Richmond City, and Accomack County).

Aside:  I finally found out why rural Accomack County is in the late-reopening group.  They had more than 500 workers test positive in chicken processing plans owned by Perdue and Tysons, per this news story.  So they are the Virginia chapter of the national story on meat-processing facilities, and contributed to the recent small uptick in cases in Virginia. Continue reading Post #703: Virginia, please publish redacted case reports and crowd-source a key analysis.

The Governor will require use of masks by individuals over the age of 10, in indoor spaces, starting on 5/29/2020.  There are a handful health-related exceptions, and masks are not required during exercise.

Enforcement will be by the Virginia Department of Health, and will be targeted at establishments that flout this requirement.

The notice does not specifically mention churches, but they seem to be included by reference (“Any indoor space shared by groups of people who may congregate within 6 feet of one another or who are in close proximity to each other for more than 10 minutes“).

Beyond a doubt, the usual right-wing suspects will be complaining bitterly about this.  But from a public health standpoint, in a pandemic, it’s clearly the right thing to do.  Not only does the CDC recommend it (and has since 4/3/2020), but the head of the Chinese CDC called failing to require masks “The big mistake” that the US and Europe made during this pandemic.

If you read this blog, you know that I’ve advocated for mandatory use of masks in enclosed public spaces for a while now.   On 3/26/2020, I shaved my beard so I could wear a tight-fitting mask in public (Post #573).  That was based on the emerging evince of aerosol transmission of COVID-19.   I changed where I shop for groceries, because two stores (Giant and Safeway) couldn’t be bothered to require masks for the employees (let alone their customers).  I now shop at Fresh Market, which has had a mandatory mask policy in place for some time now.

Northern Virginia doesn’t meet anybody’s standards for being “ready to re-open”.  We still routinely see hundreds of new COVID-19 cases per day.  And yet, on Friday, we move on to Phase I of the re-opening some businesses and other institutions.  I would say that, given the circumstances, a mandatory mask order is minimum due diligence.  Should have happened a long time ago.

Given that most people don’t own (and now can’t buy) a high-quality mask, this is going to be no magic bullet.  And given that many already wear masks, and many establishments already require them (e.g., my dentist does), the net impact of a mandatory policy should be small.  That said, this should reduce transmission of disease by forcing the ignorant to get with the program, and wear a mask.

Everything else in the CDC guidance still stands.  So this doesn’t excuse being lax about (e.g.) maintaining distance and hand washing.  This is layered on top of those ongoing precautions.

Finally, my reading of this is that the Governor mostly wants to avoid having one of those “depiction of public stupidity” scenes occur here in Virginia.  You know the ones — big crowds of people, with no masks, and no social distancing.  Party scenes that are just begging to become COVID-19 superspreader events.

We’re always going to have the random willfully butt-headed person who refuses to wear a mask.  Usually they seem to think this has something to do about their person freedom.  It doesn’t, no more than (say) outlawing reckless driving is about restriction of personal freedom.  Or banning outhouses in urban areas.  This is a public health measure.  You can say that all you want, and some people still don’t quite understand what “public” means.

This edict is clearly not aimed at those stray morons among us.  It’s there to prevent those morons from clustering together.   And that is, by itself, sound public health policy.  One non-masked person in a crowd of 100 is an annoyance, but not particularly a threat.  By contrast, a hundred such people gathered together is a situation in which rapid and broad spread of infection may occur.  And so, consistent with generally good government here in the Commonwealth, the Governor’s policy seems more intent on suppressing willfully ignorant institutions, not individuals.  And for all of our sakes, let’s hope it succeeds in doing that.