24 January 2021 – Sunday – #131

Most of the Covid-19 news is in the US this week, but Covid-19 also has its share of news in Spain, Catalonia, and Barcelona. The door on the corner Catalan restaurant Can Saia has been closed all week with a handwritten sign that reads “Closed until further notice, sorry for the inconvenience.”

Can Saia closed until further notice.

I’m hopeful, of course, that Can Saia’s closure is temporary. Eduard, the chef there, likes to serve fresh food and I assume it’s just not worth his time to shop and cook until he can open for a full lunch and full dinner. Plus he drives an hour each way to and from his restaurant. Under current restrictions, he’d be spending more time in his car than serving food.

In other Barcelona news, my friend M. came in contact with someone who tested positive for Covid-19, so M. is in isolation for ten days. Our chats about Covid-19 testing protocol reminded me that if you’re exposed to Covid-19, wait 5-7 days to get a test. The El País article from last month on Covid-19 transmission offers good graphics on why it’s best to wait a few days for a test and why a cheaper and faster antigen test is more useful than a more accurate and expensive PCR test.

Duration of positive Covid-19 tests for PCR, antigen, and antibody tests. Source: Nature.

I think M. will be okay. He’s young, healthy, and the rest of his immediate family has cleared Covid-19 unscathed. Still, there’s a bit of HIV / AIDS PTSD for me, remembering young, healthy friends who vanished so quickly during the 1980s and 1990s.

The good news in Catalonia is that the Christmas and New Year’s wave of Covid-19 seems to have peaked about 10 days after Three Kings Day. Catalan public health imposed more Covid-19 restrictions the day after, on 7 January 2021. The latest restrictions look like they are paying off, although hospitalization and infection rates are dangerously high at the moment.

Covid-19 Outbreak Risk (blue) and Reproduction rate R (yellow) through 22 January 2021. Source: Catalan News.

The race in Catalonia and Spain is between the spread of the new, more virulent strains of Covid-19 and the ramp up of vaccinations. Three Spanish regions, Madrid, Basque Country, and Valencia, have imposed additional Covid-19 restrictions as their infection rates skyrocket. Seems likely that the skyrocketing rates are due, in part, to the new B.1.1.7 variant from the UK which is 30% more deadly and 70% more transmissible than previous Covid-19 strains.

The new strain wouldn’t be so scary if Catalonia were vaccinating people faster. Last week the region vaccinated fewer people than the week before. It’s hard to know whether that’s because of supply issues (Pfizer says it temporarily reduced supply to supplement long-term production capacity) or local administration issues. At a great almuerzo yesterday, my friend Joanmi said the former was to blame. It makes more sense that something happened to reduce the supply than to reduce administration capacity.

The big, big, big news last week was in the US. After the failure of Trump’s insurrection at Congress that left five dead (coincidentally on Three Kings Day), he left the White House of his own volition, allowing President-elect Biden to become President Biden without further incident last Wednesday.

This chart sets the stage for President Biden’s Covid-19 challenge. It should be no surprise that Trump’s promise that there would be plenty of Covid-19 vaccine by the end of February was another of his false promises.

US Covid-19 case timeline leading up to Biden inauguration. Source: Financial Times.

Hours after his inauguration, Biden signed several executive orders that reversed Trump policies. With respect to Covid-19, Biden mandated masks in all federal buildings and created the position of Covid-19 response coordinator, a position that will report directly to the president. The administration is sending Dr. Fauci to attend WHO meetings next week and proposing economic measures to protect people from evictions, place a moratorium on student loans, and provide US$1.2T in stimulus funds. That was day one.

On the day after the inauguration, Biden signed even more Covid-19 executive orders. These orders establish Covid-19 related transportation rules, provide FEMA support to states, and start a process of building vaccination centers around the US. As I read details about Biden’s executive orders, I wondered why Trump hadn’t signed similar orders. After all, if there’s one thing everyone knows about Trump, it’s that he loved signing executive orders in front of an audience.

Well, turns out that Biden administration officials have found that Trump didn’t seem to think much about Covid-19. He left behind very few Covid-19 plans and a vaccine distribution system that’s “worse than we imagined.” The Tiberius vaccine tracking system operated from the Pentagon lacks the information to manage supply and demand. As a result, the Trump’s HHS recommended broadening vaccine eligibility to increase demand in January. States followed the recommendation, but now there’s not enough vaccine to meet demand in many locations.

“There is nothing for us to rework. We are going to have to build everything from scratch.”

Biden administration source on Trump’s Covid-19 vaccine distribution plan. Source: CNN.

The reason the Trump administration wasn’t willing to share Covid-19 information with the incoming Biden administration has become clear: there was nothing to share.

Dr. Fauci’s interview with Rachel Maddow last week covers a lot of important Covid-19 topics. It’s like the White House Covid-19 information dam broke. Here Fauci describes to Maddow how different the Trump administration was from the other five he’d worked for previously.

Dr. Fauci describes to Rachel Maddow how Trump distorted and discounted science.

I commend the entire interview, especially the segments on additional Covid-19 vaccines in the pipeline and therapeutics in development to treat the disease.

I don’t want to imply that scientists got everything right. Recent reporting on the CDC finds plenty of problems in its Covid-19 response, especially with respect to testing. Unfortunately, because of Trump’s political interference, which started well before the pandemic, it will be difficult to parse what parts of the US Covid-19 failures were due to institutional issues at CDC, FDA, and HHS, and what parts due to Trump’s interference.

Trump has left states with no good way to plan for vaccinations because the Federal government can’t predict supply and track demand. California public health officials, for instance, say it will take until June to vaccinate Californians over 65. The state can only count on receiving 400,000 to 500,000 doses per week because that’s what it’s been receiving, but even that’s not certain.

Trump’s Covid-19 legacy also includes dissuading people from taking Covid-19 vaccines or, if not dissuading, than at best not promoting vaccines as an important way to contain the Covid-19 in the US.

Likelihood to take Covid-19 vaccination by US county. Source: MIT Technology Review.

Eyeballing the distribution of people in the US who say they’ll get a Covid-19 vaccine, it looks like a pretty good overlap with people who voted for Biden rather than Trump.

Compared to the rest of the world, Spain and the US are doing better than most countries in Covid-19 vaccinations, as this Bloomberg world vaccination map shows.

Covid-19 vaccinations to date by country. Source: Bloomberg.

The problem is that doing better than most countries right now translates into somewhere between two or four more years of vaccinations to achieve herd immunity.

As of last night, 63 million people have been vaccinated worldwide. Very roughly, the world is about 1% of the way to herd immunity after a month. At the current rate, it will take eight years for herd immunity. In other words, the world needs to deliver Covid-19 vaccines about 10x faster for herd immunity next year.

While I’m on the world stage, a couple of shining stars in Covid-19 management have slipped up lately. Japan’s Prime Minister Yoshihide Suga decided to promote domestic tourism last fall. Travel related Covid-19 cases appear to have jumped three times, so the travel discounts were discontinued last month.

China is having its worst Covid-19 outbreak since March. New cases are running in the low hundreds per day. By comparison, the new US cases of Covid-19 are running about 2,000 times higher even though the US has about 1/4 the population of China. In front of New Year celebrations, China is stepping up Covid-19 testing in an attempt to bring new cases back down to zero.

Still, since May, the worst days for Covid-19 in Japan and China are better than the best days in Spain and the US. Leadership and government have made a difference in Covid-19 responses.

Covid bits.

Now that Biden has reintroduced expertise to the White House, it’s worth noting one of the many moving performances during his inauguration. Here’s a great musicological examination of Lady Gaga’s performance of The Star Spangled Banner.

The metaphor is clear. Expertise matters for great performance, even in a piece of music as mundane as a national anthem, and Biden wants the White House to deliver the way Lady Gaga delivered.

Here’s another expert performance that’s gone into distribution from the White House website.

The White House Twitter account has useful information again.

Thanks for reading. I write this to create a record of living during the Covid-19 pandemic. If you like it, please pass it on to family and friends. For more frequent Covid-19 updates, check my Twitter feed.

17 January 2021 – Sunday – #130

Mom got her first Covid-19 vaccination. She reports no side effects. That makes me happy.

I’m starting to notice other signs that Covid-19 vaccinations are happening in the wild. For instance, details are emerging on how each of the counties in the San Franscisco bay area will administer Covid-19 vaccinations. I also got a notice from my previous healthcare provider in New York City that it is giving Covid-19 vaccinations to people over 75 and certain essential workers. Friends are even posting in my social media streams about getting vaccinated.

While these reports are heartening, after a month of vaccinations, the US vaccination rate is still about 3x – 5x slower than it needs to be for herd immunity this year. 25 million doses have been distributed, yet only about 8 million have been administered. The ramp up problems seem to be primarily in Washington, DC. Here are two examples, one about distribution partner problems, the other about vaccine supply problems.

West Virginia has outperformed other states in Covid-19 vaccinations, delivering 90% of the doses it received. It’s also the only state that didn’t follow a federal recommendation to coordinate vaccine distribution and administration for long-term care and assisted living facilities with CVS and Walgreens. Why? Because neither CVS nor Walgreens have a significant footprint in West Virginia.

Instead West Virginia built its Covid-19 vaccine distribution and administration network with small local providers that had existing relationships with these facilities. Because its providers are small, they are more flexible and responsive.

“When [the Covid-19 vaccine] got here, we already had pharmacies matched with long-term care facilities, so we were already ready to have vaccinators and pharmacists ready to go into those facilities and start providing first doses.”

Krista Capehart, Director of Regulation, West Virginia Board of Pharmacy

Other states following the federal recommendation have been slowed down as they negotiate with large corporations to adapt to local needs. The federal recommendation was appropriate for scale and simplicity of state-level contracts, but required many new local business relationships and failed to anticipate idiosyncratic “last mile” issues.

On the supply front, Operation Warp Speed said it was holding doses of Covid-19 vaccine in reserve to make sure there were enough for second doses. The reserve was a prudent way to make sure there would be enough for second doses in case of vaccine manufacturing hiccups.

After the second week of US vaccinations, there had been no vaccine manufacturing hiccups. With manufacturing scaling up, President-elect Biden’s Covid-19 team requested that the Trump administration release its Covid-19 vaccine, allowing states to widen vaccine eligibility and increase vaccine demand. Two weeks ago, the Trump administration balked at Biden’s request and said Biden’s team didn’t know what it was doing.

Then last week the Trump administration reversed itself and said it would release its Covid-19 vaccine reserve. The only problem? Turns out there was no reserve. As the Washington Post was reporting that the Trump administration didn’t realize it already had shipped its Covid-19 vaccine reserve, Pfizer released a statement that it was ready to ship second doses.

If you’re confused about Covid-19 vaccine supplies, imagine public health administrators trying to determine vaccine allocations in their state.

In a nutshell, these examples show how poorly Covid-19 supply chains are being managed. Not that I would expect supply chains to scale to millions of daily doses without a hiccup, but everything in the US seems to be broken from manufacturing predictions to distribution systems to local administration plans. The amount of finger pointing is inversely proportional to the quality of federal coordination.

After his inauguration next week, President-elect Biden will refresh the US Covid-19 vaccine program. He announced the US will set up 100 vaccination centers, deploy FEMA resources, and reimburse states 100% for any National Guard expenses to operate state vaccination programs. In addition, he will invoke the Defense Production Act to ramp up production of not only vaccines, but also vials, needles, and other vaccination items.

I’m optimistic about Biden’s chances for success. Unlike Trump, who promised 100 million doses by the end of 2020, and then promised 20 million doses, and then delivered about 3 million doses, Biden is holding his team accountable for 100 million doses in his first 100 days in office. Biden also got a gift when Twitter closed Trump’s account. Misinformation has dropped by 73% in the week since the closure and that will take friction out of Covid-19 public discourse.

The US isn’t alone in its vaccine woes. Spain’s Covid-19 vaccinations started three weeks ago and most Spanish regions are having trouble administering anywhere close to 100% of the Covid-19 vaccine doses they received. Only five regions have injected more than 80% of doses received.

To its credit, though, the region of Melilla delivered 102% of Covid-19 vaccine doses it received. Before you jump to the conclusion that there is an accounting error, Melilla has found it can get six or seven doses from a vial, one more than the five doses a vial is supposed to contain. These “bonus” doses have been observed elsewhere and are a good sign that, when vaccinations do ramp up, there will be more doses available than predicted.

Unfortunately for me, Catalonia is administering only 66% of the doses it has received. At least that’s better than Madrid at 51%. I have to wonder if the Spanish capital used its political clout to receive proportionately more doses only to find it couldn’t administer them. Color me skeptical.

With Spain and other European countries failing to administer all the doses they receive, it’s probably the right time for Pfizer to reduce its projected European shipments while it adjusts manufacturing processes to boost output.

Parenthetically, it looks like my advice last week to help Madrid reduce Covid-19 worked. I suggested that if Madrid’s conservative government re-branded Covid-19 restrictions as “snow days,” it might get better compliance and drive down its Covid-19 reproduction rate R. Conservatives seem to stomach restrictions due to weather better than restrictions due to a virus. The weather cooperated and Madrid closed schools until tomorrow for “snow.” Time will tell if R drops as a result of “snow days.”

Covid-19 vaccinations are not the end of the pandemic. At a financial conference last Wednesday, Moderna CEO Stephane Bancel noted that Covid-19 will become endemic, saying “SARS-CoV-2 is not going away.” Science Magazine suggests Covid-19 will follow the course of other coronaviruses.

Science Magazine says Covid-19 won’t go away after vaccinations.

Living with Covid-19 requires science and medicine to manage the virus. I’ve noted previously that the current high levels of infection enable significant Covid-19 mutations. By March, experts expect new highly contagious strains of Covid-19 to dominate US cases, driving up total expected deaths in the US to a million. New strains may require adjustments to existing vaccines and may reinfect people previously infected by a different strain.

Even after herd immunity is established worldwide, there will continue to be cases of Covid-19. It is heartening to know that the Biden administration will fund development of Covid-19 treatments.

Dr. David Kessler explains plans for a US antiviral program.

In the years before the entire world achieves herd immunity, air travel continues to provide a good vector for outbreaks in regions that haven’t been vaccinated and for individual cases in regions that have. My friend Nicole returned to Spain from the US recently and said that, while negative Covid-19 tests were required for flights, no one actually checked her paperwork. High tech companies are working on a Vaccination Credential Initiative (VCI) to protect travelers, but it’s anyone’s guess whether the travel industry will adopt the technology.

My friend Shane works in the travel industry. He noted that even if air travel is safe again, business has learned to operate successfully without it. Since business travel subsidizes personal travel, if businesses decide not to resume travel to pre-Covid-19 levels, consumers should expect higher travel prices to compensate. Higher prices, in turn, mean that not only will business travel contract, but personal travel as well.

My friend Deborah works in commercial real estate. As with travel, Deborah noted that even if offices are safe again, many businesses have learned to operate successfully without them. She expects it will take years and a lot of creative deal making to redeploy existing inventory.

Then there’s the issue of what the Covid-19 pandemic has done to women. In the latest US labor report, 140,000 people lost jobs. Well, actually, 156,000 women lost jobs and 16,000 men gained jobs. The Covid-19 pandemic has reversed gains women have made in the labor force. Whether women can regain jobs lost during the pandemic probably depends on how day care and schools evolve as herd immunity is reached.

I have to comment on political developments in the US. Trump has become the first US president to be impeached twice. In my opinion, he should be impeached for allowing 400,000 Americans die from Covid-19, but insurrection at the Capitol is a clearer case for the Senate to adjudicate on a constitutional basis.

One of the political features of the insurrection at the US Capitol was the sequestration of members of congress.

Republican House members refused to wear masks. Many members in the room tested positive for Covid-19 afterwards. Democrats were furious. Here is Representative Marjorie Taylor Greene’s (R-Georgia) response.

I hope Biden finds a way to push Covid-19 past partisanship. Trump made Covid-19 a political issue and it cost 400,000 lives.

Things with Covid-19 are still bad.

Covid-19 is so bad in Los Angeles, it’s taking on toll of reporters.

Sara Sidner reports on Covid-19 parking lot funerals in Los Angeles.

Covid-19 bits.

Here’s some fun advice on stopping the spread of Covid-19 while making speech less dangerous.

I write this for my sanity and to make a record of living in the time of Covid-19. If you find it useful, please pass it on to friends and family. For more frequent Covid-19 updates, follow me on Twitter.

10 January 2021 – Sunday – #129

Mom says she’s getting her Covid-19 vaccination next week. She lives in Oakland, so maybe California is getting its vaccine act together. I told Mom I’ll believe it after she gets the shot. Not that I don’t trust my mother, but the US Covid-19 vaccine rollout has been flawed and now it’s the last thing on anyone’s mind.

How could Covid-19 vaccine be the last thing on anyone’s mind? In case you missed it, after Spain celebrated Dia de los Reyes on Wednesday, Trump led an insurrection at the US Capitol. To judge from US headlines I see, I’d have thought the Covid-19 pandemic was pretty much over.

Yahoo! News headlines, 10 January 2021.

On the sixth of January, Trump’s “Stop the Steal” insurgents swarmed the Capitol to interrupt the certification of President-elect Biden’s election. Certification is the final formality before Biden is inaugurated in ten days. By late Wednesday, the Capitol was cleared of insurgents and, by early Thursday morning, congress completed its certification. By Thursday, House Speaker Pelosi was calling for Trump’s removal from office.

The world gasped at the breach in democracy. Everyone was watching. Even our local storekeepers, who were kind enough to ask Brad and me what in the actual fuck was going on. It sounds nicer when they ask that in Spanish.

Here in Barcelona, news of Trump’s insurrection brought back fond memories of the long ago Catalan independence movement.

As the world gasped, Spain was battening down the hatches for Tormenta Filomena. To judge from Spanish headlines, I also might have concluded the Covid-19 pandemic was over.

El País headlines, 10 January 2021.

Spain’s weather has been unseasonably cold. I can make that claim with some authority since I spent winter in Spain last year. Filomena blanketed Madrid with snow, which is unusual but not unheard of. The capital had about 20 cm of snow, shutting down its airport and halting train service.

The bad news is that even though it’s snowing throughout Spain, Covid-19 restrictions prohibit travel to ski slopes. The good news is that the Madrid government’s snow restrictions should bring down its Covid-19 reproduction rate R.

If Filomena dumped snow for another week, the conservative Madrid government could continue its snow restrictions and R would drop below one just as Covid-19 vaccinations ramp up.

I’m jesting, of course. A little. It turns out that public health officials are getting better at imposing Covid-19 restrictions that work because they have more data.

Closing schools and universities, which is what Madrid has ordered because of snow, correlates well with lower Covid-19 R. If Madrid’s R does drop next week, it may be that what its conservative government needed to do all along to improve Madrileños’ compliance with Covid-19 restrictions was to re-brand the restrictions as “snow days” or “enjoy your family week.”

Here in Barcelona, the independence movement complained that Madrid got all the snow while Barcelona was left with none. The snow protests turned violent.

Okay, now I am jesting. But it’s nice to know people have a little sense of humor left, even if it’s at the expense of Trump’s inexcusable insurrection.

Here in Catalonia it actually has been very quiet after Three Kings Day. This was the scene last night in Gracia.

Gracia street, 9 January 2021.

That’s a Saturday night. Woo-hoo!

Like the US, the Covid-19 vaccine rollout here is slow.

Catalonia Covid-19 vaccine administrations as of Friday, 8 January 2021. Source: Catalan News.

Please welcome the latest member of the Covid-19 family of charts, the vaccination rollout chart. Averaging the first 13 days of Catalonia’s vaccine administration, the region will achieve herd immunity in about four years. At least the curve is going in the right direction. I’m debating how soon to call my healthcare provider about availability.

In the first 3 weeks of US Covid-19 vaccine administration, about 2% of the US population has been vaccinated. At that rate, it will take about 2-1/2 years to reach herd immunity. Too bad Trump isn’t paying attention. Vaccinations need to go 5x – 10x faster. In ten more days, Biden’s team will take over the US vaccination charge.

Sorry to harp on this, but the “let the virus burn” argument to achieve herd immunity has many flaws. Besides assuming an unacceptable number of fatalities is a price that must be paid to save the economy, proponents discount the danger of mutations. Last week I blogged about the rising reproduction rate R of emerging Covid-19 strains.

This week, with confirmed worldwide cases approaching 90 million, new Covid-19 mutations now appear to be a source of Covid-19 reinfection.

The good news on the new UK and South African strains of Covid-19 is that lab tests indicate vaccines will continue to be effective against emerging strains. As I also noted last week, Dr. Bell from Oxford expressed concern about about how much the Spike protein changed in one of the recent South African mutations. Pfizer said this week that it doesn’t think that will be a problem for its vaccine.

Covid-19 bits.

My news feeds were swamped with news of Trump’s insurrection this week. I think that’s the right way to end this week’s post.

Chris Hayes reports on the insurrection at the US Capitol on 6 January 2021.

I write this for sanity, not for money. And to create a record of living through a pandemic. If you like it, please pass it on to friends and family. For more frequent Covid-19 updates, follow me on Twitter. It’s a million times nicer there now that they shut down Trump’s account.