14 May 2020 – Thursday – #60

Coronavirus has taken the life of Spain’s oldest person. María Branyas died at the age of 113. Among her accomplishments, Branyas was a survivor of the Spanish flu epidemic.

Lots of other Spanish news today. Barcelona will not advance to Phase 1 next week as I’d hoped. That means we still can go out for our communal exercise periods in the morning and evening, but businesses will not open on Monday. I’m a little confused because a few gelaterias and hair salons are operating already. I’m confused, but not complaining. I also was confused because some of my friends in remote parts of Catalonia have entered Phase 1 already.

Thankfully, Joan Miguel has instructed me in the nuances of Covid-19 territorial appellation. I thought that Spain was divided into “regions” and that Catalonia was a “region” and that Catalonia would move en masse into Phase 1, as a “region.” I was wrong.

First, Catalonia is an “autonomous community,” not a “region.” Second, for Covid-19 decisions, Catalonia delegates authority to medical regions that correspond to a hospital (or hospitals in the case of, say Barcelona).

To measure the chance of a new coronavirus outbreak, the regional government has combined indicators such as the number of cases in the last 14 days, the effective reproductive rate (how many people are infected by a positive case), and also the so-called EPG index, which comes from multiplying the accumulated cases in the last 14 days with the reproductive rate in the last seven days.

El Pais, “Barcelona and its metropolitan area will see further delay to coronavirus deescalation,” 14 May 2020

I’d assumed decisions to advance to Phase 1 were based on the current Covid-19 reproduction rate, R. According to El Pais, though, a local authority also uses something called the EPG index as part of its decision making. EPG, or Effective Potential Growth, is a new term to me. Here’s link to an April report that describes EPG in more detail. I can’t figure out the unit analysis for this measure, so I don’t understand exactly what EPG measures, but it seems like it’s trying to provide a notion of epidemiological acceleration or somehow account for the exponential growth characteristic of Covid-19 infections.

Perhaps the highlight of Covid-19 news from Spain today is antibody test results for the entire country.

Spanish Covid-19 antibody test results, 13 May 2020.

If you want more details, Matthew Bennett’s Twitter feed is packed with regional charts and his usual smart observations about data accuracy.

As of today, about 27,000 people have died in Spain from Covid-19. Doing some back-of-the-envelope calculations, if Spain allowed Covid-19 to run its course, the current 5%-11% infection rate implies about 250k – 600k people would die. The US has about seven times Spain’s population, so that implies if the US allowed Covid-19 to run its course, about 1.5M – 3.5M Americans would die. Please take those numbers with a large grain of salt, but it seems that Covid-19 kills about 1% of a population. I don’t have any estimate of how many additional people suffer chronic internal organ damage as a result of Covid-19.

One last tidbit of Spanish news. The government is debating mandatory use of masks. So am I.

Watching the US Covid-19 response, or lack thereof, from afar, I have to wonder whether the US is trying to get to several million Covid-19 deaths. As frustrated as I am that we’re staying inside another week in Barcelona, at least the Spanish government is communicating what we need to do next. Things aren’t so clear in the US.

Stanford Professor Keith Humphreys on the US political challenges of Covid-19.

Professor Humphreys asks the unfortunately necessary question: Is the US Covid-19 response scientific or political? The right answer seems obvious. Good politicians should guide citizens to implement the best public health policies scientists can come up with, right?

Unfortunately, that is not the case. The US response is guided by politics rather than science. For instance, in Texas, it seems that Dr. Fauci’s recommendations are heavily discounted. Texas Gov Abbot cherry picked state Covid-19 test results to say that Texas was following federal guidelines.

Texas weekly Covid-19 positive tests by day of the week.

By looking at positive test results only on Mondays and conveniently ignoring the most recent Monday test result, Gov. Abbot argued that Texas had met federal guidelines to relax Covid-19 restrictions. When you’re governor, you get to choose the data you like to tell your Covid-19 compliance story, even if it has nothing to do with good public health science.

Wisconsin has a different version of the same story. Wisconsin Republican senators sued Governor Tony Ever’s administration, claiming Wisconsin’s Covid-19 stay-at-home order over-stepped executive power. The Wisconsin Supreme Court agreed with Republican senators. Since the Republicans are unwilling to pass stay-at-home legislation, that leaves Wisconsin without adequate testing to implement a test, track, and quarantine program and with no way to enforce federal Covid-19 guidelines. Wisconsin is operating in a public health science vacuum.

It’s too bad Republicans aren’t paying attention to the science, because science keeps moving forward. Republicans seem to be betting that voters won’t remember in November how irrational Republican Covid-19 policies are in May.

One way science is getting better is modeling Covid-19 mortality. University of Massachusetts Amherst researchers are modeling the Covid-19 mortality models.

University of Massachusetts Amherst model of Covid-19 mortality models.

The US Covid-19 mortality models are converging to 110k deaths by the first week of June. Each of the underlying models in the “ensemble” of models is adjusted as newer and better data appear. Researchers retrain machine learning models and make other adjustments. With so much still unknown about Covid-19 and the swings in each model’s prediction, the UMass ensemble model “averages” the models’ underlying assumptions to yield a better prediction.

The sad part of America’s political response to Covid-19 is that Republicans seem to want more deaths than necessary because they haven’t been shown an alternative. On September 12, 2001, three thousand deaths was enough to enrage the country and start a war. Now the US has about 3,000 Covid-19 deaths a day and Republicans are ignoring public health officials because their leaders tell them the economy is more important.

Some of my smartest friends say that everyone needs to go back to work because it’s impossible to implement something as complex as test, track, and quarantine in the US. I hope my friends read the story of KK Shailaja, the health minister of the Indian state of Kerala.

The state has a population of about 35 million and a GDP per capita of only £2,200. By contrast, the UK (double the population, GDP per capita of £40,400) has reported more than 40,000 deaths, while the US (10 times the population, GDP per capita of £51,000) has reported more than 82,000 deaths; both countries have rampant community transmission.

The Guardian, “The coronavirus slayer! How Kerala’s rock star health minister helped save it from Covid-19,” 14 May 2020

It is sad to see US leadership has lost its way while governments with far fewer resources can organize and effectively manage Covid-19. It is a good lesson about American power. If Americans still think there is nothing they can do except go back to work and suffer the consequences, Vox has published a quick guide to how to fix the US Covid-19 response. It’s possible for the US to manage Covid-19. It’s not even particularly hard. But it requires Americans to prioritize science over politics.

Today’s last item is a followup to my food industry discussion yesterday. The Inn at Little Washington, a Michelin 3-star restaurant in Washington, Virginia, will seat mannequins at half its tables in order to create social distancing.

Mannequins seated at the Inn at Little Washington to create social distancing.

Chef Patrick O’Connell hopes the ploy will attract its Washington, DC customers to the country. I hope customers from the country’s capitol will appreciate that there ways to deal with Covid-19 that don’t kill everyone.

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