7 April 2020 – Tuesday – #23

Let’s start with data. Spain’s overall mortality report is useful for seeing Covid-19 deaths in relation to all deaths.

Overall mortality in Spain during Covid-19 outbreak (note drop at end due to regions not reporting)

Deaths have been far above normal for about a three week period starting just before the 15 March shutdown. The steep drop off at the end of this chart is due to regions that haven’t reported, not the eradication of the virus. The shape indicates that a lockdown takes a little longer than the Covid-19 two week incubation period to achieve a drop in Covid-19 mortality.

It would be informative to see this chart for other countries to compare the duration and characteristics of various countries’ Covid-19 outbreaks with respect to their lockdown dates. When countries reporting out Covid-19 data have shortages of test kits, which is likely to be true for less developed countries now facing the pandemic, their Covid-19 mortality data often reflect a significant under count. With a chart of all deaths, the full Covid-19 mortality curve is apparent even if it’s not differentiated from overall deaths.

In addition to overall mortality curves, Google searches are another tool to determine the prevalence of Covid-19 in different areas. Not only that, but Google searches also are helping understand unrecognized symptoms and social distancing.

What Google and researchers have learned in tracking disease searches is that as news of a disease spreads, so do searches about that disease. What appears to indicate the actual prevalence of a disease in a particular location is searches for symptoms of that disease, which people enter as they suffer the symptom, rather than searches for general disease information or news.

About 30% of Covid-19 victims suffer anosmia, or loss of smell, so it’s no surprise that searches for “I can’t smell” are a good proxy for outbreaks.

Search frequency by day for “Non Sento Odori” (“I can’t smell”) in Italy during Covid-19 outbreak.

The search frequency of “No puedo olor” in Equador is high even though the officially reported cases of Covid-19 are low, which indicates that Equador hasn’t been able to track Covid-19 during the outbreak. In fact, in spite of the low official case numbers, Covid-19 has been catastrophic in Ecuador, especially the city of Guayaquil.

Parenthetically, if you’re hoping for a seasonal attenuation of Covid-19 cases in North America and Europe over the summer, don’t get your hopes up. Ecuador is, as its name suggests, on the warm equator.

Google searches also illuminate symptoms not commonly recognized with Covid-19. In China and Italy, searches for burning or scratchy eyes increased slightly. While researchers haven’t confirmed that Covid-19 causes eye problems, they now have a candidate symptom they previously have not associated with the disease.

Google mobile data shows how much each state has reduced its mobile phone movement and how much US states are social distancing versus Canadian provinces up north.

Social distancing as measured by reduction in movement, by state (including Canada), based on Google mobile data.

Future studies may use this type of mobility data to understand the relationship between social distancing and Covid-19 mortality. I wouldn’t want to be in Mississippi or Arkansas right now.

The last thing on the data front is an evolving story of Covid-19 antibody tests in Lombardia. According to La Stampa, 40 of 60 people who were Covid-19 asymptomatic in a town called Castiglione D’Adda tested positive for Covid-19. The data are from blood donations given in Castiglione D’Adda, which suffered a significant Covid-19 outbreak. If these data are valid, the test results would indicate the town has achieved herd immunity, a condition where enough of the population is exposed and immune that the rest don’t have to worry about a second major outbreak.

It is certain that some of Castiglione D’Adda’s population had asymptomatic cases of Covid-19 and is now immune. The question is whether the city achieved herd immunity. One problem with the blood collection data is that it’s possible residents who felt sick realized they could get a Covid-19 test they might not otherwise get by claiming they were asymptomatic and donating blood. That would skew the blood donation data set towards herd immunity. What this evolving story tells us is that it’s hard to know what data sets really mean. Good testing protocols will be imperative as countries lift their Covid-19 lockdowns in order to identify who can work without risk and whether any regions have achieved herd immunity.

I want to switch to my other topic today, leadership. Sorry in advance if I get a little political here. I am, in fact, interested in leadership that results in effective Covid-19 mitigation.

The Covid-19 pandemic is offering a rich study of comparative leadership as leaders with different styles representing countries with diverse cultures and heritage face the same Covid-19 problem. In the 28 March 2020 entry, I wrote about how the response of various US oligarchs depends on their vested financial interests. Today, I want to look at leaders in England and the US.

The English response has been mixed. Sadly, Prime Minister Boris Johnson was moved to the ICU yesterday. I wish him a speedy recovery. His absence comes at a particularly bad time in England’s Covid-19 response, when days matter and decisions need to be made expeditiously. Also sadly, Johnson’s first response to Covid-19 was to promote herd immunity, something usually achieved with a vaccine and never recommended by spreading a deadly virus. After criticism, his government changed its confused messaging, saying that what it really meant is it would take gradual steps to lock down England to avoid lockdown fatigue. Johnson’s government lost precious time getting to full lockdown as it vacillated in its goals and messaging.

Johnson was not alone. Governments in Italy and Spain also were slow to lockdown in the face of Covid-19 outbreaks. Johnson, however, had the benefit of comparing how Covid-19 responses throughout Asia and Western Europe worked. By the time he faced Covid-19 in England, Italy was a clear example that quick lockdowns were imperative, especially if testing wasn’t available.

Queen Elizabeth, on the other hand, has provided a kind of leadership missing in most of the world. She seems to understand the world stage in a way that other leaders do not. In my mind, her 4-1/2 minute address is one of the highlights of the entire Covid-19 pandemic, a contrast to Johnson’s confused messaging and a model of economical language during turbulent times.

Queen Elizabeth’s address on 5 April 2020

In her address, the Queen says the simple things people need to hear from their leaders. She praises those on the front lines for their efforts, thanks the English for doing their part staying inside, acknowledges the suffering, and provides a vision of a better future. Nothing daring, but words people need to hear, words that get everyone on the same page.

The Queen has guided her country through most of the global disasters to which the Covid-19 pandemic has been compared. In contrast, Trump’s career consists of creating one disaster after the next. His Atlantic City casinos top a list of disasters that includes Trump University, Trump Shuttle, Trump Steaks, Trump Vodka, and the New Jersey Generals.

Now that he’s in the White House, the disasters seem to follow. Trump has been unable to hire the right people to guide the US through its Covid-19 response. Also, for some unknown reason, he’s the pitch man for hydroxycholorquine. Compare Trump’s confidence man performance below with Queen Elizabeth’s eloquent address above.

Trump promotes hydroxychloroquine as a Covid-19 cure.

There are reasons for Trump to promote hydroxychloroquine the way he is, none of which have to do with public health. The drug is potentially dangerous and probably not a cure.

A recent animal study found that hydroxychloroquine may have a fatal toxicity with a common diabetes drug. Researchers on this study were so alarmed by Trump’s promotion, they issued an advisory before publishing their results. Hydroxychloroquine’s primary application is treating malaria, so it is used in populations that don’t include many diabetics. The use of hydroxychloroquine’s in the US, where diabetes is prevalent, poses substantial risk.

A recent French study indicates hydroxychloroquine is ineffective against Covid-19. The study is too small to be conclusive, but it was carried out better in terms of patient tracking and followup than the other “studies” from Paris and from rural New York. Of eleven patients tracked, one died, eight tested positive for Covid-19 after six days, and two cleared the virus. Again, not a large enough study to be conclusive, but it makes me wonder why Trump is promoting a drug that in this case might have cured 18% of Covid-19 patients. Hydroxychloroquine is nowhere near a sure fire treatment. In the researchers’ own words, “No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine & azithromycin in patients with severe COVID-19 infection.”

Trump isn’t promoting hydroxychloroquine because it’s a cure. I speculate that he’s promoting it either to distract from his disastrous Covid-19 response or to make money. As a leadership example, his hydroxychloroquine promotion couldn’t be worse. In the best case, it is distracting healthcare workers and the public from simple things known to work like social distancing, hand washing, testing, and quarantine.

In the worst case, Trump is directly benefiting from hydroxychloroquine sales. It’s unfortunate that there is even speculation about the president making money by promoting hydroxychloroquine in the midst of a pandemic killing millions of people, but Novartis, a company that will benefit financially from hydroxychloroquine sales, paid Michael Cohen US$1.2 million for access to Trump. It appears that major Trump donors may be benefiting from hydroxychloroquine sales as well. [Update – Trump has a direct stake.]

But, dear reader, watch again Queen Elizabeth and Trump. Is Trump a conman? Draw your own conclusion. Of the three world leaders I looked at today, he clearly has the worst organization and the least focus in his messaging.

Before I wrap up, I want to acknowledge one death that seems poignant given that I’m sequestered in Barcelona and people keep comparing Covid-19 to World War II. Rafael Gómez Nieto died this week from Covid-19 at the age of 99. Nieto was the last survivor of a company of Spanish soldiers called La Nueve. After losing the Spanish Civil War, La Nueve soldiers enlisted with allied forces to free Europe from fascism and fought to free Paris.

On the way out the door, here’s an update on everyone’s favorite comedian (if you’ve ever heard of him in the first place), Leslie Jordan. And, you know, while I’m not writing Covid Diary BCN every day to draw a million followers like Leslie, I will put on a suit to write Covid Diary BCN when it gets a million followers. If you’d like to show your appreciation, please share Covid Diary BCN on your social media and email a link to friends and family.

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