29 March 2020 – Sunday – #14

Good news from Spain’s lockdown. Here is a chart of Covid-19 deaths by day over the past ten days. The rate of increase is flattening, a good sign that the lockdown is working and mortality is peaking this weekend.

Spanish Covid-19 mortality by day, 20 March 2020 to 29 March 2020

Here is a more comprehensive chart of Spanish Covid-19 statistics for March through today.

Spain Covid-19 statistics March 2020 through the 29th including cured, dead, active ICU cases, active non-ICU cases.

Believe me, in my 19th day of self-imposed isolation and 14th day of government-imposed isolation, these charts are very heartening.

So far, the Spanish Covid-19 ICU rate is 8.5% and its mortality rate is 8.3%. These numbers may be a little high, but Spain has reasonably good testing so they’re not far off. Countries that perform a lot of Covid-19 tests like South Korea and China are able to manage down mortality rates for a number of reasons. One is statistical: more tests makes a higher denominator in the rate and, so, a lower rate. But my hypothesis is that retrospective studies will show this statistical problem is small and that higher testing frequency enabled more effective quarantine measures and less stress to the healthcare system.

A lot of Covid-19 tests, by the way, means on the order of 5 tests per 1,000 people per day.

The news from Italy also looks good. It’s a little early to call it for sure, but the general lockdowns in Spain and Italy appear to be working. The next phase will be watching infections continue to decline and deciding the best way to let up the lockdown without risking another large Covid-19 outbreak.

General lockdown, by the way, means you get a 600 Euro fine for going outside unless you’re seeing your doctor, buying food or pharmaceuticals, or have to go to work.

The US should follow suit, but its response is crippled by Trump’s disastrous policies. In case you’re wondering why Gov. Cuomo is anticipating the need for tens of thousands of ventilators that Trump says New York doesn’t need, here’s one big clue: New York City Covid-19 infections rates are sky high.

New York City Covid-19 infection rates by neighborhood as of 26 March 2020

It doesn’t help New York City that it’s first responders and healthcare system are already stressed. So far, 500 New York City police have tested positive for Covid-19.

The US response appears in disarray as a patchwork of contradictory policies emerge:

So far it’s state governors who are providing useful policy. My friends in New York and California are generally pleased with the actions of Governors Cuomo and Newsom, respectively, to impose lockdowns and manage healthcare. On a personal note, it was great to see my college roommate and now Governor Carney on MSNBC discussing the Covid-19 issues facing his state of Delaware. John’s interview provides insights into how US governors are dealing with the Covid-19 epidemic.

In the absence of a coordinated US federal response, all is not lost. In addition to states taking action, researchers and enterprise are working on solutions to pressing problems. Duke University researchers have found that vaporized hydrogen peroxide can decontaminate an N95 mask for reuse, stretching the value a scarce resource. Also, Dyson says it has invented a simpler ventilator and will donate the first 5,000 units. However production won’t ramp up for at least another few weeks and initial units probably will go to the UK.

In testing news, Abbot Labs will provide 50,000 tests per day starting 1 April 2020. The test detects Covid-19 RNA with a swab that is analyzed by the company’s ID Now system. Henry Schein is producing an antibody pin-prick blood test. It expects to have 100,000 tests by the end of March and ramp up testing volume in April. Both systems provide results in about 15 minutes. Testing is a game-changer for all countries, but especially for the US at this point. Even with this good news, there’s a ways to go. The US needs something on the order of one to two million tests per day. The last US number I saw was 200,000 tests per day.

I had a discussion yesterday with my American friend Shane about the use of test results. Shane and his family live in Germany and, if you’ve been following along in the Covid Diary, you may remember that Germany has a robust Covid-19 testing program (and 0.5% mortality). Shane brought up the idea of somehow marking people who have a positive Covid-19 antibody test with, say, a bracelet. That way everyone would know who had immunity and could work safely.

That reminded me of the AIDS crisis. After HIV antibody tests were available, conservative writer William F. Buckley suggested gay men who tested positive for HIV be required to get an identifying tattoo. Buckley must have known his suggestion was reminiscent of the pink triangles the Nazis tattooed on gays headed to concentration camps. Shane didn’t know about Buckley’s suggestion, but it illustrates how we can learn from the not so distant past how to develop effective policies for issues like virus testing.

Speaking of learning from the past. countries that are starting to deal with Covid-19 like the US, Brazil, Mexico, India, and Russia, have plenty to learn from the past couple months. The Chinese are sharing their knowledge of Covid-19. Then there’s Vietnam. No one mentions Vietnam’s response to Covid-19, but everyone should pay attention to how good it was. How good was it? Vietnam infection rate was so low that it doesn’t even show up on any of the charts that show curves of Covid-19 infection by country. Here’s the Vietnamese response to Covid-19 in a nutshell:

  • Fast, efficient, affordable test kits
  • 14 day mandatory travel quarantine
  • Transparency via technology and social media

I’ve seen assertions on social media that the US economy is more important to the country’s overall health than a Covid-19 lockdown. This assertion is often justified by saying that Covid-19 data aren’t good enough to make a lockdown decision. Here’s the thing. Lockdowns work and they take 5-7 weeks. Need data? Take a lesson from any of the following countries: South Korea, Taiwan, Vietnam, China, Germany, Italy, or Spain. Their data might not be exact, but they all are coming to the same result.

Why should the US lockdown everywhere today? The University of Washington Institute for Health Metrics and Evaluation (IHME) predicts 81,114 Covid-19 deaths by August in the United States. The model breaks down deaths by state (use the pulldown at the top) and takes into account ICU shortages.

I think that number is low because the US response is already behind Italy’s and Spain’s. I’m going to assume that Italy and Spain have peaked and are between 1/3 and 1/2 of the way through their mortality curve. On a per capita basis, this is what I get.

Estimated Total
Deaths per
Implied US
Covid-19 Deaths
Spain13,000 – 19,0000.3 – 0.4 per 1k96,000 – 128,000
Italy20,000 – 30,0000.3 – 0.5 per 1k96,000 – 160,000
US Covid-19 deaths based on Spain and Italy estimated Covid-19 deaths

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.

I’m hopeful the states will do the right thing, but I’m not optimistic the federal government will get this right. For one thing, it keeps making mistakes. The Trump administration knew from January Intelligence reports that Covid-19 was a big problem and chose to ignore it. It turned down emergency Covid-19 funding in early February, saying that it could manage the country’s response with existing funding. For over a month, the president insisted there wasn’t a problem and his administration couldn’t convince him otherwise.

But it’s been clear since before Covid-19 that there is a problem in the White House. It was clear from the impeachment inquiry that the president is more interested in how he benefits than in what is good for the country. It’s okay if you don’t agree with me, but here’s a reminder from the impeachment hearings I keep thinking about: Why would the US ever stand for a sitting president who withholds federal aid from states that don’t please him?

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