2 April 2020 – Thursday – #18

Public transit is free in Barcelona! Now, if I could just use it.

The transit system is free until 9 April and, to avoid a fine, riders need proof that they are on their way to an essential job or a doctor.

Yesterday I mentioned that Spanish gasoline consumption is down 83%, which is easy to believe looking at how little traffic passes by the apartment. In the US, the drop in traffic is reflected in traffic accident statistics. For instance, after San Francisco’s lockdown order, weekly traffic accident reports dropped from an average of 260 to 110.

Given the fall off in automobile and truck traffic here, it’s no surprise that, in the second day of the new quarter, economic reports reflect the enormous impact of Covid-19 on Spain’s economy: 850,000 jobs lost and 300,000 new claims for unemployment. It’s easy to see on this chart the Covid-19 disruption.

Like the rest of the world, Spain’s economy was performing progressively better the past few years. In early March, the Spanish government anticipate Covid-19 with a €200 billion Covid-19 relief package including moratoriums on mortgage and utility payments, easier access to unemployment, and tax deferments. Still, today’s unemployment numbers are eye popping.

On 31 March, I mentioned a report that the official Italian Covid-19 death toll is low because it didn’t count people who died at home and weren’t tested. In Spain news is emerging that a quarter of the people who died of Covid-19 lived in retirement or nursing homes. Earlier reports suggest the facilities often were deserted by staff because of untenable conditions.

Some useful Covid-19 news. The anesthesia department at the University of Florida has invented a clever N95 mask substitute from materials many hospitals have in stock. Follow the link for instructions on constructing a substitute N95 mask.

The makeshift masks use Halyard H600 two-ply spun polypropylene that cannot be penetrated by water, bacteria, or particles. It blocks 99.9% of particulates, making the masks about 4% more effective at blocking particulate material than the N95 masks ….

Bruce Spiess, M.D., Professor of Anesthesiology, UF College of Medicine

I want to focus today on Covid-19 testing. Everyone needs to focus on testing as the next step. After lockdown, hand washing, N95 masks, and ventilators, nothing else matters in the next 90 days. Treatments and cures won’t arrive in time as most countries move through peak Covid-19 infection.

Until a Covid-19 treatment or vaccine gets to market in scale, testing is the only way to know at the end of the first wave of infection whether people need to quarantine or are safe to return to work.

Luckily , lots of test kits on the way, like this 2 minute antibody test just approved by the FDA. Alas, this test only works if you’ve been infected for a few days. This is similar to the days of AIDS when most widely available tests detected HIV only days or weeks after the initial infection.

Different Covid-19 tests will work differently from each other. Some will test for presence of the virus by using PCR to amplify any virus in the body. Others will detect antibodies, which show that the body has had an immune response to Covid-19. Other test attributes include sample acquisition type (swab, pin prick, blood draw), time for results (minutes to days), accuracy (% false positives and false negatives), and timeliness (how long a person needs to be infected to obtain a valid test result).

How much testing is enough? According to WHO, if 80% – 90% of tests come back positive, not nearly enough. 10% positive response indicates testing has reached enough of the population to manage most, if not all the Covid-19 infections. My guess based on the amount of testing South Korea needed to manage infections is that adequate Covid-19 testing requires on the order of 5 tests per thousand people per day. In the US, that works out to 1-1/2 million tests per day in round numbers. In Spain, about 1/4 million tests per day.

Countries need to have that kind of Covid-19 capacity in place in 1-3 months from now. That’s when they will be traversing the backside of the Covid-19 infection curve.

One issue with current Covid-19 testing is false-negatives. China believes its RNA tests may have up to 30% false negatives. US officials worry the US false-negative number are be worse. That means if you test negative, there’s still about a one in three chance you are actually Covid-19 positive. When calculating how many Covid-19 tests are necessary, the calculation has to assume that one person probably needs more than one test.

Okay, enough on testing. Everyone please build testing capacity asap.

We had two days of intense rain on Tuesday and Wednesday, but the sun is starting to come out today. The weather has a stronger influence on my mood during isolation. There was enough of a break in the rain yesterday to allow the neighborhood to cheer the healthcare workers at 8p local time. You can’t see many of my neighbors clapping, but you can hear them.

Many people I know in Barcelona are originally from Latin America. I’m starting to hear news about Covid-19 through them. Ecuador seems to be a disasters right now. My friend said, “In my city there has been a lot of unofficial deaths and they can’t even do anything with the bodies. People are forced to stay with their loved ones dead at home.”

One Mexican friend was able to keep her apartment here so she could delay a months-long visit to Mexico. Another Mexican friend who’s having trouble working out immigration to be with his boyfriend was asking on Facebook two days ago if there were any flights from Europe to Mexico.

A friend in Buenos Aires reports that the lockdown started there more than a week ago when there fewer than 50 Covid-19 casualties. Friends in Brazil are anxiously watching rise in Covid-19 cases. Some countries are responding, many don’t have adequate resources even if they do. Death and dislocation in Latin America is following the US and Canada.

I don’t have a happy ending today. The US just flew past the 5,000 death mark. The number of Covid-19 cases reported in the world will fly by one million today.

There’s hope. Many Asian countries have Covid-19 under control. Children in South Korea are going back to school. Also, in Europe all the slopes are turning the right direction after a month of lockdown. Countries that are about to experience a Covid-19 epidemic need to lockdown right now.

The US is going to be terrible for the next two months. The White House estimate is 100,000 – 240,000 casualties. When I look at this chart, I think my estimate of 350,000 – 500,000 US casualties may be optimistic. It makes me profoundly sad that, in spite of the resources America has, its people will suffer because poor leadership discounted Covid-19 for months. Under different leadership, America would be helping the rest of the world, not begging it for N95 masks and ventilators.

This chart doesn’t even register the rest of the world.

I know it’s selfish, but I’m glad I stayed in Barcelona. Now, if I could just get on one of those free buses and go somewhere.