14 March 2021 – Sunday – #138

This post marks the anniversary of Covid Diary BCN. I first posted on 16 March 2020, at the beginning of my self-isolation. I wrote for my sanity and to create a record of living during the Covid-19 pandemic—last March, it was still so early in the Covid-19 story that there were debates about whether Covid-19 even met the criteria to be designated as a “pandemic.”

I wanted to create a record of the Covid-19 pandemic because when I was researching my novel Dear Mustafa, I found nuggets of historical information about the AIDS crisis scattered around the Internet, but no contemporaneous diary that chronicled day-to-day revelations. It was hard for me to remember the order of events and how they connected to each other.

For the first 100 days during the lockdown, I posted to Covid Diary BCN every day. After the first lockdown, as Covid-19 surprises slowed, I switched to posting once weekly, on Sundays. The resulting 138 posts contain a total of about 200,000 words, the equivalent of a 600 page book.

Spring 2020 I was locked down. This year I’ll have my first outdoor Barcelona Spring. Catalonia and the EU have vaccinated less than 10% of the population, so I’ll be playing it safe for a month or two longer than my US friends. But safe this year already looks much better than safe last year. Here’s safe kids’ entertainment outside in Gracia last week.

Children watching a puppet show, Plaça de la Vila de Gràcia.

There’s a modicum of night life as well. Before the 10p curfew, people congregate in places like Carrer de Verdi. It’s quieter than pre-pandemic times. Hardly any tourists and still a chill in the air during the ten remaining days of Winter. Nonetheless, signs of Barcelona night life re-emerging outside.

Carrer de Verdi last Friday evening.

Last week I posted about an adventure to the top of Parc Güell. This week instead of turning right at the top of old Gracia, I turned left so I could hike through Parc del Turó del Putxet (the big Parc Turó up the hill, not the tony one near Avinguda Diagonal). As I walked through Gracia, I checked mask compliance. Over 90% of people on the street were wearing masks correctly. Masks haven’t been politicized in Barcelona the way they have been in the US.

The history of Parc del Turó isn’t as colorful as Parc Güell. Maybe that’s why it’s not much of a tourist trap. As I walked up Parc del Turó—and I mean up—it reminded me of a couple city parks from my past. The size and slope of the park are similar to Buena Vista Park in San Francisco. The views from the top are more like Runyon Canyon in Hollywood.

View of Barcelona from Parc del Turó del Putxet at sunset.

Today the Covid-19 pandemic feels to me like the AIDS crisis felt around 1995, when antiretrovirals measurably slowed down the US AIDS death rate. Between the first known AIDS cases in the US in 1981 and the slowdown in 1995, I knew about 90 men who died of AIDS. Between 1995 and now, about five friends have died of AIDS. These days my gay friends are dying of more mundane things like cancer and heart attacks. Sometimes being heteronormative feels okay.

While the death rate for Covid-19 is still high right now, places that are getting vaccines are seeing Covid-19 cases slow down the same way antiretrovirals slowed down AIDS in the US around 1995. As of this writing, about 1% of the world population has been vaccinated, so there’s a ways to go.

Cumulative Covid-19 vaccine doses administered by country as of 14 January 2021. Source: Our World in Data.

The big question now is whether vaccines will eradicate Covid-19 or whether we’ll live with Covid-19 for the long haul because anti-vaxxers or new mutations keep the virus in play.

There are many other differences between Covid-19 and AIDS. One is that that Covid-19 is much more contagious and much less deadly than AIDS.

WorldwideCovid-19HIV / AIDS
Approx Total Infections (millions)12070
Approx Infections per Year (millions)1201.8
Approx Deaths (millions)2.633
Implied deaths per Infection2.1%47.1%
Covid-19 infections and deaths worldwide compared to HIV / AIDS.

Another difference is that AIDS went much longer without an effective drug than Covid-19. While it took less than a year to develop and approve effective Covid-19 vaccines (astonishing!), it took about three years just to figure out what caused AIDS (namely, HIV) and then it took another dozen years for an effective AIDS treatment (namely, antiretrovirals). There still is neither a cure nor a vaccine for HIV.

About 33 million people died of AIDS worldwide by the end of 2019. As bad as Covid-19 infections have been the past year, fewer than three million people have died of Covid-19 worldwide. On the other hand, there have been about 120 million Covid-19 infections in just over a year compared to about 70 million HIV infections over 40 years.

That makes Covid-19 roughly 69 times more contagious than AIDS. Net of the antiretrovirals used since 1995, that makes AIDS about 18 times more deadly than Covid-19. If antiretrovirals were available and used everywhere, AIDS would be much less than 18 times more deadly than Covid-19. Without antiretrovirals, AIDS would be something like 40 times more deadly than Covid-19.

I don’t have time in this post to dredge through all 138 Covid Diary BCN posts, but I remember distinctly the 29 March 2020 entry because I first wrote about the likely magnitude of the Covid-19 death toll in the US. Based on Spanish and Italian Covid-19 statistics at the time, I estimated at least 100,000 Covid-19 deaths in the US if the US followed the lockdown models of Spain and Italy.

In other words, the US is already looking at over 100,000 Covid-19 deaths if it locked down today the same way Italy and Spain have. But the president is talking about loosening the already rather loose lockdown. If he does that, I expect these numbers to grow significantly. Covid-19 is an exponential math problem.

Covid Diary BCN, 29 March 2020 – Sunday – #14.

The confirmed US Covid-19 deaths today are 534,000. The IMHE predicts 630,000 US Covid-19 deaths by 1 June 2021 based on excess US deaths. Last week, for the first time in 3-1/2 months, the US recorded fewer than 1,000 Covid-19 deaths per day.

US Population as % of World Population4.2%
US Covid-19 Deaths as % of World Deaths20.2%
US Covid-19 Vaccination Doses as % of World Vaccination Doses29.0%
US versus the World, Covid-19 statistics.

One similarity between Covid-19 and AIDS in the US is the lack of federal government leadership. Reagan made jokes about AIDS and Bush’s wife pushed Republican party limits when she cradled an HIV-positive baby. There was no significant US support to fight AIDS until the 1990 Ryan White Act. Even that was named after a hemophiliac rather than a gay man so Republicans wouldn’t have to acknowledge they passed a law to help homosexuals. Nothing against Ryan White, of course, who fought hard for the legislation and died of AIDS.

Forty years after the first US AIDS cases, at least Trump was able to acknowledge the existence of Covid-19 rather than joke about it. I wonder what his response would have been if Covid-19 also was sexually transmitted. Other than giving pharmaceuticals money to develop vaccines and promoting off-label use of hydroxychloroquine, Trump barely lifted a finger to stop Covid-19.

Former US president hopes everyone remembers him.

While the former US president craves credit for Covid-19 vaccines, if he’d followed San Francisco public health guidelines, 364,000 more people would have been alive to get vaccinated. If he’d followed South Korean public health guidelines, over a half million more would have been alive for a vaccination.

Instead Trump conned Americans. He knew otherwise when he said Covid-19 would just go away.

The impact of Trump’s Covid-19 neglectful leadership goes beyond unnecessary deaths. From polls of his base, it’s clear his Covid-19 con will cripple the US response long after his departure. While most Americans acknowledge the devastation of Covid-19, Trump’s Republicans do not. A year ago, 58% of Republicans said the danger of Covid-19 was exaggerated. 530,000 confirmed Covid-19 deaths later, 57% of Republicans still say the danger of Covid-19 is exaggerated.

The same way Republicans thirty years ago were able to turn their backs on a hundred thousand dead gay men, a vast majority of the party remains indifferent to the deaths of over a half million of their fellow countrymen. By contrast, 3,000 Americans died during 9/11 and the US started wars in Afghanistan and Iraq that cost trillions of dollars. Republicans seem obsessed with property damage.

Parenthetically, Brazilian President Bolsonaro is following a natural immunity strategy more aggressively than Trump (what else does Trump’s “it will just go away some day” mean other than natural immunity?). A natural immunity strategy prioritizes economic activity over public health. In the isolated Amazon city of Manaus, nearly everyone was infected with Covid-19 last year. So of course it was a surprise when Manaus’ healthcare system was swamped again with Covid-19 cases. The virus had done what viruses do—it mutated. Its P1 mutation is not only more contagious, but it has reinfected people in Manaus who already had had Covid-19. Besides unnecessary death and disease, reinfection is a critical shortcoming of Bolsonaro’s and Trump’s natural immunity strategy.

When it comes to pandemics, the US is not a beacon of hope. Unfortunately, as most Republican leaders fail to role model healthy Covid-19 behavior, vaccination behavior of Trump supporters may well determine whether the world eradicates Covid-19.

Democrats are now 27 percentage points more likely than Republicans to say they plan to get, or have already received, a coronavirus vaccine (83% to 56%). This gap is wider than those seen at multiple points in 2020.

Pew Research Center, “Growing Share of Americans Say They Plan To Get a COVID-19 Vaccine – or Already Have,” 5 March 2021

There were silver linings to both the AIDS crisis and Covid-19. The AIDS crisis pushed gay men out of the closet whether or not they wanted to come out. It forced the gay movement to organize and use unconventional ACT-UP tactics to get action on yet another (mostly) gay problem the US government failed to address. HIV also accelerated scientific understanding of the human immune system, without which we still would be waiting for a Covid-19 vaccine.

In the same way that the AIDS crises accelerated immunology, the Covid-19 pandemic has accelerated test and vaccine development. Scientist applied CRISPR gene editing technology—a technology that got its start down the coast in Alicante and was only 8 years old at the start of the Covid-19 pandemic—to develop the first Covid-19 tests as well as to aid in almost every other aspect of understanding the virus.

On the vaccine front, researchers are hot on the trail of a one-size-fits-all Coronavirus vaccine. The mRNA vaccine platform that BioNTech and Moderna used to bring their Covid-19 vaccines to market ahead of other vaccine platforms provides hope for other diseases like malaria. The viral vector and protein based vaccine platforms also have benefited from Covid-19 efforts, offering more vaccine platform options in the future.

In addition to tests and vaccines, Covid-19 has accelerated progress in everything from video medicine to supply chain management. There’s even a robotics company startup that automates PCR sample prep and other laborious lab processes.

As the world gets vaccinated, everyone wants the pandemic to be in the rear view mirror. US air travel provides a preview of the problems the world will face as vaccinations increase.

Driving towards normal as Covid-19 vaccines rollout. Source: John Darkow, Cagle.

US air travel correlates well with Covid-19 infections. More passengers, more infections. So, CDC guidance to avoid air travel makes sense until the US reaches herd immunity.

As might be expected, the airlines are pushing back, saying that air travel is safe. Passengers are siding with airlines. Airports are recording the highest passenger levels during this spring break since last year’s lockdowns.

The problem is that, even with vaccinations so close, people are still getting Covid-19 infections in the US at high rates.

“It’s kind of like running the race and getting to the last 15 yards and tripping and falling,” said Bill Moore, 68, a guitarist and government contractor who tested positive for the virus in early March.

Washington Post, “‘I almost made it’: Close to a vaccine, these Americans got covid-19 instead,” 14 March 2021.

Covid-19 bits.

  • An unintended consequence of Covid-19? 1,200 new German words to describe everything from watching a game with an empty stadium (Geisterveranstaltung) to restrictions on going out (Ausgehbeschränkung).
  • The oral antiviral molnupiravir eliminated Covid-19 in patients’ nasopharynx in five days. Very good news. More studies needed.
  • Scientists used CRISPR screening to identify host factors required for Covid-19 infection. The factors include phosphoinositide 3-kinase (PI3K) type 3 and lysosomal protein TMEM106B. Small molecules targeting these might be the basis for a drug that inhibits Covid-19 infection and possibly other Coronavirus infections.
  • A mobile app uses AI to interpret rapid Covid-19 serological test results. Variations in factors like test model, test manufacturer, and patient can make some test result lines difficult to read.
  • Nine months after the first Covid-19 lockdown, Spain measured a 23% decline in live births. France and other countries have reported similar declines.
  • Novavax announced it’s Covid-19 vaccine is 96% effective and will apply for regulatory approval.
  • Several countries stopped administration of the AstraZeneca Covid-19 vaccine after concerns about blood clots. The company says its vaccine is safe and effective. The EMA says the vaccine benefits outweigh any risks.
  • BioNTech is forming a consortium of pharmaceutical companies to manufacture its Covid-19 vaccine. This is an echo of last week’s announcement that Merck would manufacture Johnson & Johnson’s Covid-19 vaccine.
  • On Monday, the CDC offered new post-vaccination guidance. In small gatherings, those vaccinated for Covid-19 don’t have to wear masks or distance, even when the group includes people who haven’t been vaccinated. Also, after exposure to Covid-19 cases, those vaccinated for Covid-19 don’t have to quarantine. Otherwise, guidance remains the same until more vaccinations.
  • On Thursday, the EMA, Europe’s version of the FDA, approved the Johnson & Johnson Covid-19 vaccine. The EU has ordered 200 million doses of the one-dose vaccine.
  • Also on Thursday, President Biden announced that all adults would be eligible for Covid-19 vaccinations by the First of May and asked all Americans to get vaccinated when it’s their turn so the US can celebrate Independence Day without fear of Covid-19.

There are rarely right answers in a pandemic. There are always hard trade-offs. That doesn’t keep us from believing we know things.

Covid-19 reveals who we are.

Covid-19 reveals who we are.

Covid-19 reveals who we are.

I write Covid Diary BCN for my sanity and to make a record of life during the Covid-19 pandemic. Please feel free to share its contents (with credit, please).

Most of the blog entries serve to chronicle Covid-19 from my point of view. As a gay man living in Barcelona, I’m seeing the US and the world through a different lens. It’s nice to live in a place that’s not just gay accepting or gay friendly, but gay supportive.

Gay rights public service announcement on Barcelona bus stop.

At the end of January—as Covid-19 vaccines rolled out, as an experienced US administration took over, and as the end of the Covid-19 story started coming into view—I decided to change up things and write informal essays on a number of Covid-19 topics.

Here’s an index of sorts to help if you’re interested in a particular topic.

  • 31 January 2021
    • Covid-19 vaccines and mutations
  • 7 February 2021
    • Covid-19 testing
    • Trading off Covid-19 public health with the economy
  • 14 February 2021
    • Covid-19 and romance
    • Covid-19 vaccine rollout
  • 21 February 2021
    • Covid-19 politics and inequality
  • 28 February 2021
    • Covid-19 transmission
    • Covid-19 misinformation
  • 7 March 2021
    • Long-haul Covid-19
    • Mask politicization
    • School reopening
    • Covid-19 vaccine passports
  • 14 March 2021 (this post)
    • Spring in Barcelona
    • Comparing the Covid-19 pandemic with the HIV / AIDS crisis.

I also want to note that the bullet-point “Covid-bits” section I started adding to the end of each blog post makes a good summary of significant Covid-19 developments. When viewed one after the other, they give a sense of how the Covid-19 story unfolded week by week.

Last tip. I don’t get paid to write this and I’ve been too cheap to pay for the WordPress super duper search service. If you want to search Covid Diary BCN, do what I do. Enter site:coviddiarybcn.com search-term into Google (try replacing search-term with, say, Wu Lien, the guy who discovered that masks stop airborne infections).

After a year of posting, I’ll be taking a break from this blog to sell my novel Dear Mustafa, to write a couple of other novels—Trans Librarian Saves Planet and Confidence Man—and to complete some short stories. I’ll post here from time to time. Thanks for following along!

7 March 2021 – Sunday – #137

Last week Brad had a “zero” birthday. We hosted a Covid-19 compliant birthday BBQ at Casa Solar. In my quest to learn how to cook Catalan cuisine, Joanmi helped me improvise a grill to roast calçots.

Calçots on the grill.

Calçots are a cross between leeks and green onions. You roast them directly on the flames for about five minutes, then let them cool for about five more minutes. When they’re cool enough to touch, you pull off the outer skin, dip the remaining meat of the calçot in Romesco sauce, and then try to get the dripping mess into your mouth without ruining your shirt.

There are calçots restaurants in Barcelona that open just for the winter calçot season. Last year, right before the first lockdown, Ana took Brad and me to one such restaurant called Balmes Rosselló.

Scene from Vicki Cristina Barcelona at Restaurante Balmes Rosselló Brasería.

You might remember Restaurante Balmes Rosselló from an opening scene of Vicki Cristina Barcelona (2008, Woody Allen). It’s a bit of a tourist affair with lots of room for buses in the parking lot, but the food isn’t touristy. If you visit Barcelona during the winter, take your empty stomach on a Metro trip or taxi ride up the hill for calçots.

Brad’s birthday party was good fun, but I’m going a bit stir crazy. I’ve been cooped up in Barcelona for nearly two months with the current Covid-19 restrictions. It doesn’t look like Spanish inter-regional travel restrictions will change much until after Easter. I had the urge to see something new last week, so I took a long walk through neighborhoods of Barcelona I had never visited above old Gracia.

Instead of scrambling over Parc del Turó del Putxet and walking back down Carrer de Balmes, I wandered around the back side of Carmel Hill and ended up atop Parc Güell. Through a light fog, the view of Sagrada Familia was indistinct, but a crane indicated that the church still is not finished.

Foggy Barcelona view from Park Güell. Sagrada Familia with cranes on left side, W Hotel in the distance on the right.

Sagrada Familia is a Barcelona touchstone. Antoni Gaudi, the architect of both Parc Güell and Sagrada Familia, was a proponent of Catalan independence. That couldn’t be more clear from the independent thinking in his work. Guadi abhorred right angles and integrated natural curves into his design.

After recovering from a bullet wound to the neck during the Spanish Civil War, the British writer George Orwell viewed Sagrada Familia in 1937. “For the first time since I had been in Barcelona I went to have a look at the cathedral — a modern cathedral, and one of the most hideous buildings in the world. It had four crenellated spires exactly the shape of hock bottles. Unlike most of the churches in Barcelona it was not damaged during the revolution — it was spared because of its ‘artistic value’, people said. I think the Anarchists showed bad taste in not blowing it up when they had the chance, though they did hang a red and black banner between its spires.” (Homage to Catalonia, p.188).

There’s no accounting for taste, as they say. What Orwell didn’t know was that revolutionaries had attacked the crypt of Sagrada Familia in 1936, delaying construction for 16 years until Gaudi’s models and plans were resurrected. But, hey, what’s the hurry. The construction started 139 years ago and there are perpetually five more years left to finish it.

Gaudi’s free flowing style is a precursor to Frank Gehry’s design. Sagrada Familia has been as transformational for Barcelona as Gehry’s Guggenheim Museum has been for Bilbao. Both monuments have played a significant role in revitalizing their respective cities.

Construction on Sagrada Familia commenced at a time when cities built identities around new churches, an era culminating with Le Corbusier’s Ronchamp chapel built in the mid-1950s. The Guggenheim Museum in Bilbao, on the other hand, is squarely in the current era of expressing civic identity through skyscrapers and art museums. The Guggenheim was completed in less than five years and opened in 1997.

Going on a quick tangent, New York City may have started a new era of civic identity with its Little Island. My friend James took a drone flight over the man made island next to the island of Manhattan. I thought Little Island was a par course for Chelsea Piers. Instead it looks like Barry Diller’s cruising area to replace the gay cruising areas of yore. Perhaps during the era of global warming, man made islands are the new form of civic identity.

I write that Sagrada Familia is a touchstone because, like Barcelona, it’s fun, it always will be completed sometime in the near future, and it never will conform. Sagrada Familia was the last place I walked to before last year’s Covid-19 lockdown and the first place I walked to afterwards. On last week’s hike, it was nice to see an old friend, even from a hilltop through a light fog. The light fog seemed appropriate, waiting for my vaccination as I am. The fog of the Covid-19 pandemic is like the fog of war.

For some Covid-19 long-haulers, Covid-19 fog is an actual physical manifestation of the virus. As in, Covid-19 scrambles their brains. Scientists are zeroing in on megakaryocytes as the culprit in so-called Covid-19 brain fog. The abnormal brain cells have been found during autopsies of Covid-19 victims and may cause a mental fog by displacing blood flow to healthy brain cells.

Covid-19 long-haulers can have a myriad of other symptoms. For instance, post-Covid-19 autoimmune diseases. In about 10%-15% of severe Covid-19 cases, killer T-cells stay on the job long after the patient has cleared the virus. This part of the immune system normally kills infected cells, but in these patients the T-cells damage normal cells, leaving long-term organ damage.

Covid-19 also confuses some patients’ immune systems, causing them to create autoantibodies that attack their own immune system. One study found autoantibodies attacking patients’ interferon, weakening their ability to fight any infection.

People who’ve had asymptomatic cases of Covid-19 also can be long-haulers without knowing it. For instance, up to half of asymptomatic Covid-19 cases may have significant lung damage or heart damage. Scientists still don’t know how severe and how long-term this damage will be.

“There may be a fair amount of damage going on that [asymptomatic patients are] completely unaware of. But they can go from asymptomatic to a ‘long hauler’ with long-term outcomes.”

Daniel Jacobson, lead researcher for computational systems biology at Oak Ridge National Laboratory in Tennessee

Given the Covid-19 death toll and the horrendous health consequences for many who survive Covid-19 infections, it seems as though wearing a mask would be a no-brainer, at least until Covid-19 vaccinations provide herd immunity. In the US, that’s not the case.

Masks have become part of the US culture war and Republicans are antsy to remove them. Maybe it’s the puritanical streak in US culture that lures Americans into nonsensical purity tests. Maybe it’s the adversarial two-party political system that encourages Americans to take sides even when they share so many values. Maybe Americans think they’re so close to herd immunity, a few months without masks doesn’t matter.

The problem? New Covid-19 mutations are much more contagious. That is what viruses do, after all, learn to infect as many hosts as possible. The more contagious Covid-19 variants are coming to the US with the same virulence as Covid “classic.” Just when Americans let down their masks, the drop in Covid-19 cases is plateauing as the new mutation drive another wave of infections.

Nevertheless, many states are rescinding masks laws. Utah legislature, for instance, passed a law to ban masks mandates by the beginning of April. Yesterday Idaho had mask burning protests, as though masks have some moral equivalence to witches.

After a winter storm which knocked out power and water in Texas, Gov. Abbot rescinded mask and most other Covid-19 restrictions. Abbot made his order without consulting with public health experts, apparently as a blessing to voters for the sins of the power and water debacle. Abbot failed to give Texas schools a heads up on his decision, leaving them to figure out whether he’d just ordered students back to school

Mask policy is a mess in the US for partisan reasons, but schools everywhere have been perhaps the most intractable of Covid-19 policy problems. I’ve assiduously avoided the topic of school reopening because it’s so heated and so complex.

Covid-19 pits parents against teachers. Parents want their kids in school both to give their kids an education and to give themselves more time to work. The health risks seem small to kids who rarely get sick. Teachers, on the other hand, are concerned about the health of students, the students’ families, and of themselves.

School closures exacerbate class differences. Wealthy parents have more education options (they can afford private schools with in-person classes) and their kids have better technology workarounds (Internet access and new computers). Poorer families often have older relatives living at home, relatives more likely to die if a child carries Covid-19 home from school.

As a rule, it seems that school reopening is safe when community Covid-19 positivity is low. Some studies say that children are not significant Covid-19 vectors. Others studies, not so much. Here’s one Spanish study on Covid-19 transmission by age.

Spanish Covid-19 study shows school age children are drivers of Covi-19 infections.

In case there’s any question, however, the new variants appear to take advantage of school age children as Covid-19 vectors, maybe better vectors than adults.

Recent UK Covid-19 test results by age.

France is reporting a similar age distribution for Covid-19 infections with the B117 variant.

None of this is to say that schools can’t reopen safely with adequate social distancing, masking, and ventilation. But policy makers haven’t had good data to make these decision until last fall, so the debate has created lots of political friction without clear data.

With Covid-19 vaccines on the scene, the latest workaround is to prioritize teachers for vaccinations so that at least they will remain healthy. California Governor Newsom made just such an order. While he wants to allocate 10% of its Covid-19 vaccine to teachers, California’s private healthcare system has proven too unwieldy to deliver 10% of the state’s vaccine to teachers so far. That’s a problem because California students are supposed to go back to class in about a month and the vaccine takes about that long to become effective.

Which brings up the US healthcare system versus most of the rest of the world. One advantage of single payer healthcare systems is ease of complex policy implementation. In Catalonia, for instance, CatSalut prioritizes Covid-19 vaccine and then measures delivery by group. Try getting a chart like this in any US state.

Covid-19 vaccination progress by priority class. Source: Catalan News.

One final topic this week: vaccine passports.

Israel plans to require Covid-19 vaccine passports. For me, the vaccine passport is Dead on Arrival. In theory, vaccine passports allow governments to screen visitors and protect against Covid-19 outbreaks. Vaccine passports might be a good idea if herd immunity were more than a year away. Then it might be worth figuring out pesky details like how to confirm someone who claims to be vaccinated actually is.

The reality is that vaccinations are going so fast that by the time a vaccine passport program is working worldwide, most of the world should have been vaccinated anyway. In places like Israel, where herd immunity is expected this month, there won’t be a Covid-19 outbreak if a sick passenger arrives. Travel related revenue losses from a vaccine passport program will probably outweigh the medical costs of a few visitors with cases of Covid-19.

Covid-19 bits.

  • Hugo López-Gatell, the controversial Undersecretary of Health leading Mexico’s Covid-19 effort, was hospitalized for a moderate case of Covid-19. López-Gatell has downplayed the need for masks or testing in Mexico.
  • Texas, Mississippi, Michigan, and Louisiana lifted their mask mandates on Monday. As US cases plateau at the same level as last summer’s peak case rate, the CDC has ask states to maintain mask mandates, anticipating another wave of Covid-19 due to new mutations. The states could wait 2-3 months, by which time the US will have provided vaccinations to all Americans. At least Texas Gov. Abbot is keeping his mansion closed in compliance with CDC guidelines.
  • The Pope has called on Catholics to take any Covid-19 vaccine, even if its development or manufacturing involves the use of stem cells from an aborted fetus. The Archdiocese of New Orleans, however, has called the Johnson & Johnson vaccine immoral while Bishop Joseph E. Strickland of Tyler, Texas says Catholics should avoid any of the three vaccines approved in the US.
  • Spain, a largely Catholic country, still expects to vaccinate 70% of its population even though supply problems have throttled early efforts. In Catalonia, the regional public health system will deliver vaccinations at the famed Sagrada Familia, giving new meaning to mass vaccinations.
  • A clinical study showed an insignificant difference in outcomes for Covid-19 patients taking the anti-parasitic drug ivermectin.
  • Singapore now has a Covid-19 “bubble” hotel. Guests can interact safely for in-person business meetings during their 14-day quarantine. They cannot leave the hotel, though, unless they return to the airport or complete their quarantine.
  • Barcelona will hold a pilot outdoor concert with 5,000 attendees on 27 March. Attendees must pass an antigen test before entering. While there will be no social distancing, attendees will be segregated in large groups of about a thousand. The concert features the local band Love of Lesbian.
  • Merck will help Johnson & Johnson manufacture Covid-19 vaccine.
  • The US administered 2.9 million doses of Covid-19 yesterday.

From a year ago:

Elon Musk tweet about Covid-19 a year and a day ago.

Society is the accumulation of our decisions. Our decisions leave behind beautiful monuments like Sagrada Familia. They also leave behind garbage cans full of mask ashes. During a pandemic, we need humility and decency more than ever. Please wear a mask, keep your distance, wash your hands, and get vaccinated as soon as you can.

I write this for my sanity and to make a record of living during the Covid-19 pandemic. Please pass on to family and friends. For more frequent Covid-19 updates, follow me on Twitter.

28 February 2021 – Sunday – #136

I had a dream this week that I wasn’t wearing a mask. Does that mean I can stop wearing a mask?

Let’s review the current Covid-19 situation. A good source of current information is Dr. Tom Frieden. He’s posted Twitter threads through most of the pandemic as a way of compensating for the muzzled CDC. Even after President Biden unleashed the CDC, Frieden’s threads are still a useful public health summary of the past week.

The winter wave is over, but looks like another wave might be on the way. So, until we understand Covid-19 transmission in a post-vaccine world, yes, I need to wear a mask. For what it’s worth, it seems like we still don’t completely understand Covid-19 transmission in a pre-vaccine world, either.

One reason it seems like we don’t understand Covid-19 transmission is that our understanding of Covid-19 transmission keeps changing. I remember last March watching Youtube videos demonstrating meticulously how to decontaminate groceries. I myself never went full grocery decontamination. I got as far as leaving the groceries outside on the rear porch to air for a day or two, assuming any Covid-19 virus on packages or produce would be inactive by then. I washed my hands more frequently then, and still do, but now I don’t worry about touching my face before I wash my hands.

What we do know now that we didn’t know last March is that most Covid-19 transmission is airborne and that superspreader events are the main source of infections. 80% of infections come from 20% of cases. Stop the superspreader events and new cases would drop 80%.

We also understand where superspreader events are likely to occur, namely inside when people don’t wear masks. This chart shows where they are more likely.

Odds Ratios compare for a given type of location the frequency of someone who tests positive for Covid-19 having visited such a location to the frequency of someone who doesn’t test positive. The higher the Odds Ratio, the great chance Covid-19 infections take place in that type of location.

Even though we know all this, we still can’t predict superspreader events. Predicting a Covid-19 superspreader event is as hard as predicting when a Boeing 777 will lose an engine. We know a lot of things that might cause an engine to fall off, but that doesn’t mean we can predict when it will happen. In that sense, masks are to Covid-19 what second engines are to a 777. You probably don’t need a mask 99.99% of the time, but it’s sure great to have one on when you need it.

Another important thing we know now about Covid-19 is that outbreak severity is different from region to region. In a long and ultimately satisfying New Yorker article, Siddhartha Mukherjee explores how much we know and how little we understand about difference in Covid-19 outbreaks. As Mukherjee explains, scientists try to model Covid-19 cases and deaths based on a myriad of factors like demographics, population density, public health systems, and climate. None of the models predicts India and Pakistan accurately. None of them get Nigeria right. So, what is it that makes Covid-19 super deadly around Milan and London while it’s more like a mild flu in Lagos or New Dehli?

It could be environment (e.g., warmer places have more ventilation). Perhaps public health systems and overall fitness of a population explain the differences. Many places misreport Covid-19 by as much as 20% – 30%, so maybe reporting skews differences. Is it age demographics? India has a much lower mean age than Italy. Scientists have started considering whether Covid-19 shares traits with earlier viruses that produce a cross-reactive immune response. Many of these factors have at least some correlation to Covid-19 infections and deaths, but none is the silver bullet the explains the range of viral responses in different places.

The fact is that Covid-19 is a vastly different disease in different communities. That makes it hard to compare, say, the effect of different Covid-19 policies on different local economies because different regions have such different Covid-19 outcomes even when they have similar policies.

As researchers improve their models, parsing all these factors in India, Pakistan, Nigeria, and elsewhere, we will learn things about transmission that contradict public health advice during the pandemic. Already, one study already says that businesses didn’t need to close if they’d followed masking, distancing, and ventilation guidelines. In India, even those restrictions don’t appear to be necessary. Businesses there haven’t closed and, practically speaking, there are no Covid-19 restrictions, yet India’s Covid-19 mortality is low.

I suspect there will be many I-told-you-so’s as transmission is better understood. After all, when all is said and done, California and Florida have arrived at about the same place in terms of Covid-19 cases and deaths even though they adopted significantly different restrictions. It’s too early to say that policy didn’t matter and it’s important to remember the lives lost from throwing public health guidelines out the window for the sake of the economy. The meat packing industry is a good example of an industry that flaunted guidelines, lost many of its employees to Covid-19, and spawned outbreaks in communities around its meatpacking plants.

All this brings me to my main point: Covid-19 misinformation. I’m going to start the Covid-19 misinformation portion of today’s post with a quick story about a diversity training seminar I attended. In one of the exercises, the instructor wrote a sentence on the whiteboard and asked each of us to write down on a piece of paper how many times the letter “e” occurred in the sentence. That seemed stupid, but everyone wrote down the number of times “e” occurred in this sentence.

Then the instructor asked how many participants wrote down “1.” No hands. She asked who wrote down “2.” No hands. Then “3.” A few hands went up. The “4.” Some other hands went up. And so on.

The point was that participants looking at the same sentence saw it in different ways. The subjective experience of the sentence was different from the objective sentence. That’s important in understanding diversity, of course, but also for understanding a key aspect of misinformation. If we were to get invested in our first perception, which we are likely to do, we may end up with a cognitive bias. Even when provided evidence that an initial perception is incorrect, people may continue to advocate it if only to save face.

Social media compounds our initial (mis)perception by reinforcing it with messages we want to hear. Once you have taken a stance and are saving face, sharing stories that support your stance lend credence to your cause. In this way, the propagation of misinformation on social media may be a larger long-term public health problem than Covid-19.

Short-term, it’s likely that social media is keeping some people locked into their Covid-19 vaccine misperceptions. As our understanding of Covid-19 transmission has evolved and as public health policies have changed, it’s easy to assert that no one really knows anything. But public health is changing in response to more and better Covid-19 information (e.g., airborne transmission and superspreader events).

It’s more significant when the people thriving on misinformation are healthcare providers who influence medical decisions. Mother Jones investigated nurses’ social media groups and found rampant sharing of vaccination misinformation.

It’s not hard to find vaccination misinformation online. Even when Youtube and other platforms remove misinformation videos, misinformation purveyors make their videos available on their own websites and leverage social media to drive traffic to those sites. The sales pitch during these videos is akin to an MLM get-rich-quick scheme.

Anti-vaxx is big business. The Centre for Countering Digital Hate estimates that social media companies rake in about US$1 billion in ad revenue for anti-vaxx ads. Two groups fund over half the anti-vaxxer ads on Facebook, the World Mercury Project, chaired by Robert F Kennedy Jr., and Stop Mandatory Vaccinations, owned by Larry Cook.

Who is Larry Cook? He’s a former sound technician and was Executive Director of the California Naturopathic Doctors Association from 2012 to 2016. He is now what I would call a social media influencer, someone who makes his money promoting healthy lifestyles on social media platforms.

Having worked in the social media influencer business, my guess is that Cook raises money for anti-vaxx ads, takes a cut of the donations, and drives traffic to places where he not only provides anti-vaxx misinformation, but also sells merchandise. What separates Cook from someone like Steve Bannon, who misappropriated donations for building a border wall, is that Cook doesn’t promise to deliver anything. Cook’s business model probably looks like the NRA, whose executive staff waves the American flag while it lines its pockets with donations derived from fear mongering gun rights misinformation.

The business model problem is that social media companies don’t want to lose US$1 billion in revenue. I am one of the people who don’t see anti-vaxx ads because they’re targeted for anti-vaxxers, but Cook and others create a self-reinforcing echo chamber of anti-vaxx information. Social media algorithms thrive on targeting anti-vaxx content. The communities they create online have real world consequences.

Anti-vaxxers protest in Melbourne as Australia rolls out Covid-19 vaccination program.

While social media platforms earn US$ billions and a few influencers make bank on Covid-19 misinformation, the social costs are devastating. The Director of the NIH, for instance, says he can make a case the tens of thousands of lives were lost to Covid-19 because of the politicization of masks.

One last word about Covid-19 misinformation: privilege. Last week I wrote about how Covid-19 reveals who we are. Those who advocate against Covid-19 vaccines in the face of overwhelming evidence how much disease and suffering they prevent are usually in a position of privilege. Not privilege in the sense of having money, but privilege in the sense of not wearing a motorcycle helmet or seat belt. It’s the privilege of saying, in effect, if my misinformed decision fails me, I expect those who listened to and followed expert advice to take responsibility for my decision.

Covid-19 bits.

I write Covid Diary BCN for my own sanity. If it helps you, please forward a link to friends and family. For more frequent Covid-19 updates, follow me on Twitter.