18 April 2020 – Saturday – #34

I’m half way through proof reading what I think is the final draft of Dear Mustafa, a novel set in the times of AIDS, of Loma Prieta, and of 9/11, three other disasters I’ve lived through. Dear Mustafa is clocking in at a little over hundred thousand words. What seems weird to me is how my brain keeps track of so many details as I’m proof reading. For instance, I noticed that I used both “meagre” and “meager.” I revised the book to have “meagre” four times. That’s the American spelling.

The reason I bring this up is that yesterday, while I was doing my hamster laps on the terrace (8,000+ steps, btw, thank you!), I had a lengthy discussion with Cristián about how we got where we are now with Covid-19. I would refer to some or another fact to bolster an argument and, quite sensibly, Cristián would challenge how I knew that fact to be true. I was sure, for example, that Germany ramped up its Covid-19 testing program very early, no later than February, but I couldn’t remember exactly how I knew that off the top of my head.

As our discussion weaved its way through disinformation and confirmation bias, I realized my head is spinning these days with Covid-19 characters and events. It’s harder to keep track of these because they’re not the characters and events I invented for a book, they’re the characters and events I’m reporting or recording or whatever it is I’m doing writing Covid Diary BCN. Characters like Avi Schiffmann, the 17-yo Seattle high school student who launched a Covid-19 tracking site in late December. Events like Begoña Alberdi’s opera recital from her Barcelona balcony and the nightly neighborhood eight o’clock applause for the healthcare workers.

Even if most people aren’t scratching out a few pages a day about Covid-19, they are creating in their head some narrative of characters and events about Covid-19.

Which brings me to this friendly reminder from Brad.

How humans learn from watching rats learn

People are great at seeing what they want to see, telling the story they want to hear. Jim reminded me the other day of the AIDS deniers of yore. More recently we have the vaccine deniers, or anti-vax contingent (will they also advocate against a Coivd-19 vaccine?). There are plenty of other Covid-19 relevant examples of people making up shit to fit what they want to see. That’s what rat researchers did, too, thinking that rats could see color before realizing rats “saw color” through smell.

Right now, lots of people (including Trump unfortunately) are creating Covid-19 narratives that we need to save the economy, or that we need to get back to normal. No one likes the movie we’re watching. If the Covid-19 is good for anything, it’s good for blowing our narratives to smithereens. Covid-19 is our Debbie Downer, our uninvited nanoparticle truth teller.

Okay, so there’s a very funny Debbie Downer Covid-19 episode with Daniel Craig from last month that I can’t share from Spain, so you’ll have to find that one on your own. But this is good, too.

We need a good story to move forward. What we really need is a blockbuster, but a good story will do for now. Effective leaders use stories to instruct us what to do next. Useful followers undertand how they fit into the story, what role they play. Not surprisingly, planners are creating Covid-19 narratives based on the data and models we have so far.

Nearly two weeks ago, I wrote about prognostications from the Financial Times and McKinsey. This week, Ezra Klein and Matthew Yglesias discuss Covid-19 scenarios in the first half of this The Weeds podcast (tl;dl) (the second half is a Bernie Sanders campaign post-mortem that I think nails the candidate’s weaknesses). The podcast is a in-depth discussion based on Klein’s Vox piece about Covid-19 plans.

According to Klein, the current narratives planners have for moving forward are not very heartening, especially for those among us who want to get back to “normal.” Klein points out that while a vaccine or treatment may come along in the next year, it’s more likely we’re looking at two or three years before we can touch our faces and breath without fear. The two dominant planning narratives that get us back towards something that resembles normal require either massive surveillance that enables instanteous contact tracing (a la the location tracking app announced by Apple and Google) or high frequency Covid-19 testing. Both the basic narratives require huge behavior modification, incredible technology development, and skilled leadership. Neither enables a nice V-shaped economic recovery.

Bottom line is we don’t have a good recovery story yet. Planners are still planning. Data is still coming in. A miracle is possible. Today the most important things continue to be maintaining distance, washing hands, and testing. We know these work.

Still, governments need to move forward, even in the absence of strong narratives. Spain is pushing to relax its lockdown in the next 2-4 weeks, but hasn’t announced clear plans for the next next stage. The US announced a plan that delegates lockdown decisions to state governors and provides guidelines for relaxing lockdowns.

Unfortunately, Trump can’t stick to a story for more than a day. He’s already advocating for states to relax their lockdowns even though they haven’t met the announced US guidelines.

Whatever narratives evolve going forward, all narratives benefit from more testing and better data.

While Spain says it expects to relax the lockdown on a sector-by-sector basis in the next few weeks, Covid-19 cases are still rising. At least the government admits now that its Covid-19 data have been inaccurate. Bad data makes it hard to interpret the trend lines. The good news is that testing is up to 40,000 per day, or 0.9 tests per 1,000 people. Last month testing was about 0.2 tests per 1,000.

Unfortunately, US testing has plateaued and there is little consistency in testing between states. Experts say US testing needs to be 2x – 3x higher. If you advocate for the high frequency testing narrative Ezra Klein described (see above), testing needs to be 125x – 150x higher than today.

US Covid-19 per capita testing by state

Some of the US testing problem is due to financial incentives. The US is doubling reimbursement for RNA tests to increase testing activity. Some of the problem is with the tests themselves.

“[The Abbot ID test] performed equivalent to the other platforms with patients that had high and moderate loads of virus. However, with lower loads of virus, a large fraction of these patients were not detected as positive.”

Alan Wells, Director of clinical laboratories, University of Pittsburgh Medical Center

In related testing news, Stanford researchers have released preliminary (NOTE: not peer-reviewed) testing of Covid-19 in Santa Clara County. The report indicates much higher prevelance of Covid-19 than previously thought, illustrating why much better testing is so important. Unfortunately, the report also indicates infection rates in Santa Clara are far below the 60%+ needed to achieve herd immunity. Take the report with a grain of salt for now, though.

Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases.

COVID-19 Antibody Seroprevalence in Santa Clara County, California, Eran Bendavid et al.

If you want all the deets on FDA activity related to Covid-19 testing, this is a comprehensive article. I won’t hate you if you don’t read it.

I’m going back to proof reading Dear Mustafa. I’m not counting on a good Covid-19 narrative before tomorrow, so I’ll keep my distance and wash my hands. At least with my characters in my book, I have some notion how things will end.

I’m ending today’s entry with a shout out to Tanya Tomkins, Eric Zivian and their Valley of the Moon Music Festival. While the festival hits the pause button on performances, Tanya is hosting a weekly Fermata Fridays online interview with festival musicians. This week is pianist Christian De Luca from the heart of Italy. I don’t need to tell you how clever the name is because, besides giving us a couple of wonderful performances, Christian tells us in the video all about the Italian word fermata.

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