22 November 2020 – Sunday – #122

The strangest thing happened this week. Something clicked in my brain and de repente I could habla the español. My anxiety of never learning to speak Spanish transformed overnight into my anxiety that I will forget how. If my language seems a bit confused today, es porque tengo huevos revueltos entre mis orejas ahora.

I’m starting this 122nd diary entry with some pretty photos of what’s going on around Barcleona. First, if you’ve wondered how movers haul someone’s worldly possessions in and out of a fifth story walk up on a narrow Gracia street, here’s the exterior elevator platform they use.

Moving into a Gracia apartment.

The second photo is an update on the remodeling of the L’Abaceria Mercat in Gracia. Each district in Barcelona has its own mercat, a sheltered farmers market. As I’ve mentioned, it’s one of the highlights of Barcelona for me.

The L’Abaceria Mercat has operated from a temporary location on Passeig de Sant Joan since I arrived. The demolition of the original structure has been hidden but, as its façade disappeared last week, it became clear the remodel is extensive—all the way down to the bones.

L’Abaceria Mercat demolition.

Today’s third and final photo is a restaurant on Passeig de Sant Joan called Kook. I discovered it on my scouting trip here last year, so I have a sentimental warm spot for the food. With Catalonia’s restaurants closed due to Covid-19 restrictions, Kook’s doors have been sealed for weeks. It was a pleasant surprise when I walked by on Friday to see someone wheeling in crates of produce in advance of next week’s re-re-opening.

Kook restaurant preparing to re-open.

The photos are a way of saying day-to-day life goes on, with or without Covid-19 restrictions, with or without live performance and other cultural accoutrements of city life. Some days it seems like it’s hardly worth living in a city until humanity figures out how to dance with this virus. No concerts, no theater, no clubs, no large gatherings. Might as well wake early and fish on a river.

Yesterday was a pleasant break from the day-to-day. U.b., Will, and their daughter hosted a delicious pre-Thanksgiving Thanksgiving at their place in Gothic. After the meal, Vicki recited a Mary Oliver poem and Claudia sang an Italian love song from an opera I couldn’t place. Live performances! Later, over evening margaritas, we discussed Barcelona’s cultural history. It was a multicultural oasis in the Covid-19 cultural desert.

Back to my mundane day-to-day life. After all, diaries can’t be all highlights. Last week, I wrote that I’d have have a progress update on my flu vaccination. The update is that Spanish bureaucracy was designed by Franz Kafka.

The saga continues. To get vaccinated, I need to provide CatSalut, the public health system where one gets vaccinations, a document called an Acreditativo del Derecho a Asistencia Sanitaria. It identifies me as a corner case, someone who doesn’t qualify for public assistance, but who should be allowed vaccinations anyway because I happen to reside here. Needless to say, no one seems to know how to obtain this form because there are so few people in Spain who don’t qualify for some form of public assistance.

I’m supposed to obtain the document from INSS, the Spanish Social Security administration. INSS office visits, already space constrained by Covid-19 restrictions, are also date constrained because demand for unemployment is up. So I’m navigating the INSS website in Spanish, filling out online forms (is my sex “M” for masculino or “H” for hombre?), and hoping for the best. Stay tuned for exciting developments. I may end up getting a sex change along with my flu shot.

The flu shot is practice, of course, for the Covid-19 shot. News on that front was very good last week with Pfizer applying for FDA approval of its Covid-19 vaccine and Moderna announcing its Covid-19 vaccine is 94.5% effective.

While this Covid-19 vaccine news from Pfizer and Moderna is great, there are many hurdles to distribution and administration.

Here are a few Covid-19 vaccine distribution issues in the US:

  • No agreement how cash-strapped state public health systems will pay for vaccines.
  • Runaway Covid-19 infections already stretching healthcare systems to limit.
  • No state has a system to track low-temperature distribution logistics at scale.
  • Many rural areas lack low-temperature distribution infrastructure.
  • No state has a system to track that adults get the second booster shot.
  • One in three Americans say they will not get a Covid-19 vaccination.
  • CDC should coordinate the vaccine program nationally, but very low morale.
  • Trump refuses to coordinate a public health transition with President-elect Biden.

Due to its regional public health system, Spain’s vaccine logistics problems are similar to the US. That makes Phase-3 trials of the Johnson & Johnson Covid-19 vaccine welcome here (and the UK). The J&J vaccine has less stringent cold storage requirements than the Pfizer and Moderna vaccines, simplifying vaccine logistics. For example, the J&J vaccine can be stored a refrigerator temperatures for three months before inoculation.

Spain has two advantages over the US in deploying a vaccination program. One is that it doesn’t have a lame-duck president stiff-arming an incoming administration. The other is that, in stark contrast to the US, 71% of Spaniards say public health restrictions are more important than the economy. That means the restrictions imposed after the second wave of Covid-19 here are, for the most part, taking hold and Covid-19 infections are dropping.

Still, it will be a month or more for Spain’s Covid-19 numbers to come back to tierra.

Covid-19 news in Catalonia continues to be good. A month after initial restrictions, numbers are turning the right way. New cases load was about 1,000 per day during the summer. It was running about double that last week, but it’s dropped to a third of the peak reached about three weeks ago.

Covid-19 confirmed cases in Catalonia, 20 November 2020. Source: Catalan News.

Hospitalizations here are dropping and ICU beds are opening up which allows the Catalonian government to relax restrictions over the next two months. With an election coming up in three months, public health decisions are becoming more political, but nothing like the US.

Restaurants will re-re-open tomorrow. First reports were that they could serve lunch, but had to close seating areas by 5:30p. New reports say indoor dining has to close at 9:30p.

Catalonian businesses that had been closed will re-re-open with capacity limits. Travel restrictions between municipalities will be eased over the coming month. Social gatherings will continue to be limited to six and the 10p curfew will stay in effect for at least a month.

Day-to-day drama here isn’t Covid-19. It’s the unending US presidential election, a huge distraction even from across the Atlantic. Trump’s theatrical coup hit its high note during last week’s “big dripper” press conference. Here’s how Australian news summarized Giuliani’s drip and other US election events last week.

Trump’s strategy is to keep states from certifying elections and to encourage Republican state legislatures to send alternative slates of electors in order to break the Electoral College. That would send the final election decision to the US House of Representatives, the only place now where Trump can win.

Trump is spewing conspiracy theories to make his case and amplifying them on social media. One conspiracy theory says that votes from districts that happen to be largely black are chock full of fraudulent ballots. What Trump supporter won’t eat up that claim?

Trump’s wilder conspiracy theory is that Clinton and Soros have teamed up with Antifa and Black Lives Matter to change votes on a server in Germany owned by Dominion, a company started by Hugo Chavez in Venezuela to control elections there. I’m not kidding.

Trump has given so much credence to conspiracy theories that they’re popping up everywhere. It seems like a day doesn’t go by when conspiracy theories move Americans to violence.

Covid-19 is the icing on Trump’s social media-fueled conspiracy theory disinformation festival. Having lived through the AIDS crisis of the 1980s and 1990s, I’m not surprised to see Covid-19 denialism the same way I saw HIV denialism.

Here’s one example of how Covid-19 news is misinterpreted to fit a point of view and then amplified on social media. A Danish study of face masks published last week has anti-maskers in a tizzy. Data for the study were collected last spring as Covid-19 was breaking out in Europe. The study is well designed, but unfortunately its results are being misinterpreted as saying that masks don’t work.

I spent the better part of a day last week pointing out to a group of anti-maskers / anti-vaxxers that, in spite of what headlines say, the Danish mask study did not say that masks were ineffective against Covid-19 transmission. The study says masks are ineffective in a very strict set of circumstances and, in these specific set of circumstance, masks failed to protect the wearer against infection. What the study explicitly did not say is 1) that masks fail to protect the wearer from infections in different circumstances, 2) that masks fail to protect others from an infectious wearer, and 3) that masks don’t reduce the severity of infections by reducing the amount of virus transmitted.

Even though all three of those things are probably true (that masks protect the wearer in many circumstances, that masks protect others around the wearer in many circumstances, and that masks reduce viral load of an infection, so, the severity of the resulting infection), the anti-maskers say they need proof. Of course. Even after I pointed out that US states have seen Covid-19 infections drop after mask requirements, the anti-maskers wanted proof. Even after I pointed out the study’s author advocates for wearing masks, the anti-maskers wanted proof.

There is more and more data that Covid-19 restrictions, including masking, do work.

The case of the Danish mask study shows that one poorly written headline gives believers permission to misinterpret important public health information in a way that fits their preconceived notions, and then to amplify their misinterpretations through social media.

Covid-19 bits.

Let’s end today’s entry with Quarantined with You, a song from Catalan musician G’beats (h/t Brad!).

I write this for my own sanity. If you like it, please mention it to friends and family. Follow me on Twitter for more frequent updates. Thanks!

15 November 2020 – Sunday – #121

It’s just really weird right now. I don’t know how else to say it. The convergence of good and terrible Covid-19 news, the winter holidays around the corner, and Trump’s faux-coup have given the world a dystopian glaze.

Catalonia has shown its colors. First off, the Covid-19 restrictions imposed a month ago continue to drive down new cases and hospitalizations. Deaths should peak and decline soon, too.

As the Covid-19 numbers improve here, the restrictions are coming off. Restaurants will re-open in a week. In the meantime, yesterday’s montanya i mar almuerzo (surf ‘n’ turf lunch) at Simon’s place was a nice way to cope with the closures. Francesc scored muscles and shrimp, Joanmi dived for clams, Brad brought Txogitxu steaks, and I cooked up samfaina. Everyone brought wine.

The fishmonger is happy to deliver while his restaurant business is off. Here’s the aftermath of the surf segment of lunch.

Montanya i Mar aftermath on Simon’s terrace. Tellarinas del mar (aka coquinas), berberechos, y gambas.

I blame my poor food porn skills on the wine. We drank wines from Priorat including a Carignan-Grenache blend (the French usually splash in those two varietals with Syrah) and a blend of four varietals, which was delish, but lost the character of any particular grape.

The nearly four hour feast almost made up for last week’s frustration with Catalonia’s bureaucracy. I have two healthcare issues that seem impossible here. I’ve written about obtaining PrEP before. I finally solved that problem.

If you live in Catalonia on a no lucrativa visa and want PrEP for free from Checkpoint BCN, you have to obtain a Tarjeta sanitaria individual (TSI). Residents who don’t work can obtain a TSI by paying into the Catsalut public health program through the Convenio Especial program established by Royal Decree 576/2013. If you’re under 65 years old, that costs 60 euros a month, which is about 5-10 euros more that buying PrEP online. It’s like paying for PrEP and getting the entire Catsalut system for a few euros more. If you’re 65 years old or over and pay for private insurance, economics favor buying PrEP online.

Before you obtain a TSI, be warned that Checkpoint BCN currently has a PrEP waiting list of over a thousand people. If you make it through the bureaucratic hoops of buying into Catsalut, you still may be buying PrEP online for months. However, if you buy PrEP online, Checkpoint BCN will test your blood quarterly for free to make sure the generic Truvada isn’t damaging your liver. Also Checkpoint BCN provided me a list of online vendors whose products it has quality tested.

My other healthcare issue is flu vaccination (vacunación contra la gripe). I promised my mother I would get one and, considering the effort Catalonia is making to inoculate its population during the winter of Covid-19, I thought that would be an easy promise to keep. I also figured that breaking the code on flu vaccination would be good practice for a Covid-19 vaccination sometime next year.

Much like PrEP, the problem is that vaccinations are public health and Catsalut controls public health in Catalonia. Catsalut has not provided vaccines to private healthcare systems. Last week I visited Catsalut and found out that, while I don’t need to pay for a TSI, I do need to register. Catsalut registration requires an empadronamiento (check), a Tarjeta de identidad de extrajeño (TIE) (check), and a form from the Instituto Nacional de la Seguridad Social (INSS) (uh oh). Of course, right now it’s hard to get information in person from INSS because Covid-19 has restricted its office capacity. My plan is to figure out online how to obtain the correct INSS form next week, then register with Catsalut, and finally get vaccinated. Stay tuned.

Speaking of Covid-19 vaccines, last week had great news. Pfizer said the preliminary reading on the effectiveness of its Covid-19 vaccine is 90%. According to Trump, 20 million Americans will get Covid-19 vaccinations this year. My tweet thread explains why Americans might want to take this claim the same way they take all his claims, with a large grain of salt.

Of course, Trump has beat Covid-19 (if you don’t count the dead people) the same way he won the election (if you don’t count mail in votes). I lost a lot of sleep two weeks ago waiting for election results. I lost more sleep this week waiting for Trump’s coup. Besides denying he lost the election, Trump installed loyalists at the DoD and DoE that portended a coup. Or might portend a coup. Or might just be an angry old man acting out with support from his grifter family. There’s no question Trump is waging his legal battle in order to milk money from his assets supporters.

Last week’s problems with Trump are twofold. First, Republicans are letting him explore all the ways he might retain the presidency. As New Republic points out, that is practically the same as letting Trump explore a self-coup. In other words, Republicans are allowing Trump to damage democracy in order to, who knows, assuage his delicate ego? Make more money? Divide the country on his way out the door?

Second is that Trump is withholding transition support to President-elect Biden. This not only increases national security risks during the interregnum, but slows Biden’s efforts to contain Covid-19 as the US is about to surpass 2,000 Covid-19 deaths per day. Even the stubborn Republican governor of North Dakota has buckled under pressure from healthcare providers and imposed Covid-19 restrictions.

The Covid-19 curves in Europe are improving after countries imposed Covid-19 restrictions.

Covid-19 cases crest in European countries after restrictions imposed. Source: BBC.

Trump and Republican governors are sweeping aside Covid-19 restrictions at the peril of Americans. US Covid-19 numbers are crazy with the Dakotas beating every country in per capita new cases.

Covid-19 cases dropping in most of Europe while skyrocketing in the Dakotas. Source ABC.

Covid-19 is killing people. Wear a mask!

Covid-19 bits.

I provided above a short list of politicians who have Covid-19. Here’s a long thread of many more from @Cleavon_MD. I wish those who haven’t died a speedy recovery.

I write this for my sanity. If it helps you, please pass it on to friends and family. You can follow me on Twitter, too, for more frequent updates.

8 November 2020 – Sunday – #120

All eyes were on the US election last week. People here are well informed and attentive. Local friends checked in, sent political cartoons, shared updates, and made prognostications. My friend Simon even stayed up all night after Tuesday’s election watching returns come in. He outlasted me. The alcohol I’d consumed overpowered my election nerves insomnia. I drifted off around 1am.

On Wednesday, I woke up at 5am to check online for a result. I’d have been better off sleeping in. Amy, Nicole, and Nicole’s daughter came over that afternoon to celebrate, although by 3pm the outcome still wasn’t entirely clear. It was nice to process the continuing election anxiety with compatriots. The vermut didn’t hurt.

Covid-19 added to my election anxiety. Wednesday night Nicole messaged that a teacher and a student at her daughter’s school tested positive. That left Brad and me in a bit of social limbo until Nicole’s daughter got her negative test result late Friday.

All last week, store proprietors who knew I was American (not hard to discern from my accent) asked polite non-partisan questions until I allowed as how I voted for Biden. Then we commiserated—as much as I can commiserate in Spanish—about the last four years of US political disaster. My commiserations boiled down to “Trump es loco.” Their commiserations felt like a blend of making sure I was okay and venting to an American. I wasn’t diplomatic in my responses. After all, the possibility of ongoing Trumpism, with or without Trump, is a big reason I’m residing in Barcelona.

Last night, after five tedious days of unending election website refreshes, eons after the winner was clear, the news services finally called the election for Biden. I found out from the zillion messages my local friends sent.

Overnight, my US friends sent messages of relief after four years of Trump’s race baiting and homophobia. Celebrations in the US spilled into the street.

The open questions today are who will deliver the bad news to Trump and whether Secret Service will have to escort him from the White House in January. As the Twittershpere notes, Trump is now like millions of Americans who got Covid-19, lost their jobs, and face eviction.

Before it was clear Biden would win, many friends in the US mentioned how smart my decision to move to Spain looked. Even my mother said that, which is a pretty big concession since she’d preferred I stay closer to home when I left. After Biden’s win, I’m content to watch the reconstruction from afar. It will take years to de-program Trump’s cult.

There is, of course, always foreign interest in US elections. This year interest is higher than normal, especially in Europe. Trump damaged US alliances bigly in four years. His nonsensical demands that NATO allies pay their fair share (they already were) and that Russia re-join the G7 (after multiple heinous international transgressions) are a couple of well-known examples of the way he upset world order in favor of authoritarianism. There are plenty more.

Covid-19 added to international anxiety about Trump. His Covid-19 response was another manifestation of his America First authoritarian streak. He alone decided on the US response, not public health experts, not scientists. He had no interest in cooperating with the rest of the world. He prioritized the US economy over its public health, then discounted the mounting death toll (“it is what it is”).

The result of prioritizing the economy while allowing Covid-19 to run its course has been predictably disastrous. By election day, the US surpassed 100,000 new Covid-19 per day. 27 US states set new records for Covid-19 cases. ICUs in Minneapolis-Saint Paul and Iowa are now over capacity. Today there are nearly 240,000 confirmed dead from Covid-19 in the US and another 100,000-200,000 projected to die by the time Biden is sworn in. In nearly every Covid-19 statistical category, the US is at or near the bottom compared to the rest of the world.

Not that Europe’s Covid-19 response has been perfect. After a summer with little Covid-19 in the air, it’s back with a vengeance. Spain set a seven day record for new cases led by Murcia, which has an as yet uncontrolled outbreak. Paris hospitals are at capacity. The UK is a week into a four week lockdown. Italy, which led the first wave of Covid-19 in Europe, has another bad case of Covid-19.

Here’s a good Twitter thread on the situation in Europe.

Unlike Trump, European authorities pay attention to experts as they shape Covid-19 policy and they prioritize health over economy. Where European leaders have failed is in building the testing and tracing capacity required to contain Covid-19 and in responding quickly enough to new outbreaks. Unlike Trump, who is doing nothing while Covid-19 burns through the US population, every European country has imposed restrictions during Europe’s second wave. European restrictions may be late, but they’re working (again).

I’m going to toot Catalonia’s horn here. While Murcia and Madrid dillydallied as Covid-19 infections soared this summer, Catalonia imposed restrictions quickly as infections took off at the beginning of October. Three weekends ago, health authorities here closed down bars and restaurants and limited social gathering to six. Two weekends ago, they imposed a 10pm – 5am curfew. One weekend ago they limited transit between municipalities during weekends. Here’s what happened.

Catalonia Covid-19 reproduction rate R and outbreak risk. Source: Catalan News.

Catalonia’s Covid-19 statistics are moving the right direction. The reproduction rate R is below 1.0 again and the highly sensitive outbreak risk is dropping. Hospitalizations have peaked.

Trump’s inaction on Covid-19 is a drag on Europe and most of the rest of the world. Brazil’s President Bolsonaro is perhaps the best example of Trump’s deadly influence. But Trump’s influence is pervasive. He implicitly has empowered conservative politicians like Isabel Díaz Ayuso, the president of the Madrid Region, to ignore public health officials and tout freedom from government at the expense of high Covid-19 infection rates. Trump implicitly empowers protests against masks and other forms of government “intrusion.”

Covid-19 is an important reason the world watched last week’s election. Foreign leaders did not wait for Trump to concede before congratulating President-elect Biden and Vice President-elect Harris.

Two stories from last week highlight the difference between the way Trump and Biden approach Covid-19.

Trump sees Covid-19 as a hindrance to his aspirations, as something best swept under the rug. When White House Chief of Staff Mark Meadows tested positive last week, Trump ordered the result kept secret. A positive test didn’t fit Trump’s campaign narrative that he’d controlled the virus and the economy was coming back.

Meadows attended several election day events without a mask, probably super-spreading the virus to White House staff and Trump supporters at the Trump election night party at the White House.

Parenthetically, it’s not clear whether Florida Representative Matt Gaetz, who also tested positive, was in contact with Meadows. Gaetz is the fourth member of Florida’s Republican delegation to get Covid-019.

Contrast Trump’s management of Meadow’s test result with President-elect Biden’s first official action on Covid-19. Tomorrow Biden is scheduled to announce a twelve member Covid-19 task force. He’s announcing his Covid-19 task force before he nominates any cabinet members. We already know the task force will be lead by “former Surgeon General Vivek Murthy, former Food and Drug Administration Commissioner David Kessler and Dr. Marcella Nunez-Smith from Yale University.”

The world will see a very different US attitude about Covid-19 emerge in the next 2-1/2 months.

There are a couple of other Covid-19 stories from this election that I don’t understand yet. One is that the economy rated higher as a factor in voters’ decision making than Covid-19. The other is that 93% of US counties with the most new Covid-19 cases per capita voted for Trump. I’m waiting for the avalanche of election analysis coming in the following weeks to understand how either of these is possible.

The big surprise to me is that Trump didn’t call out this election result. North Dakota voters elected a Republican who died of Covid-19 to the state legislature. This fits Trump’s narrative perfectly that if we simply disregard Covid-19, everything will be normal.

Covid-19 bits.

I’m ending this election edition of Covid Diary BCN with a heartfelt reaction to the election of Joe Biden and Kamala Harris.

I write Covid Diary BCN for my own sanity. If you like it, please pass it along to friends and family. Follow me on Twitter for more frequent updates.