18 May 2020 – Monday – #64

We’re wearing masks in Spain! Actually, we’re waiting for the rules, but it’s inevitable.

I wrote a lot about masks nearly two weeks ago. Since then, Austria has noted a 90% drop in Covid-19 after instituting a mandatory mask program (standard correlation-is-not-causation disclaimer applies) and UC Berkeley research Dekai Wu has released a model showing that if 80% of a population wears masks, Covid-19 infections decline (standard models-are-not-reality disclaimer applies).

Dekai Wu explains how his mask model works.

You can play with the Covid-19 mask simulator here. As with most models, it’s a little more complicated when you make adjustments for transmission rates, mask performance, and other model parameters.

Wearing masks doesn’t matter if you don’t wear them correctly. The CDC provides a useful guide to making and wearing masks.

In the US, people are spreading this misinformation to avoid wearing masks.

HIPPA and ADA protect against wearing mask?

It is not true that HIPAA or the ADA allow people to avoid wearing masks.

Speaking of misinformation, Brad found this Twitter thread on the politicization of masks and how that’s affected public health policy and social media practices. It’s useful to think about because, as you may have noticed, we keep learning new things about Covid-19.

To me, the more interesting story from Spain is still last week’s test results that show only five percent of its population has Covid-19 exposure. Vox has a good write up on the implications of Spain’s Covid-19 test results.

The Spanish data suggests about 1.15 percent of those who got infected in Spain ended up dying. Spain has a significantly older age profile than the US, so Americans might be better off. But the fact remains that if the virus fully blows through our population, the US could end up with millions of deaths — there’s no secret pool of hidden infections to indicate the virus is much less deadly than assumed.

Vox, “The results of a Spanish study on Covid-19 immunity have a scary takeaway,” 16 May 2020

With an IFR of 1.15% and an estimated 60% exposure needed to achieve herd immunity, a country that wants to achieve Covid-19 herd immunity should expect about 0.7% of its population to die along the way, more if Covid-19 infections swamp healthcare systems, less if demographics skew younger than Spain.

In the US, for instance, that implies 2.3 million deaths to achieve herd immunity. If you are one of the Wall Street investors advocating that the US lifts its lockdowns to save the economy, maybe a better idea than lifting lockdowns to save the economy is figuring out how to change the US economy to save 2.3 million lives.

Everyone is looking at Sweden as a model for avoiding lockdowns. I still haven’t found economic statistics one way or the other on the Swedish experiment, but it doesn’t look like a great plan to me.

Swedish per-capita Covid-19 mortality versus its Scandinavian neighbors, 17 May 2020.

Swedish mortality is reaching 10x its neighbors Denmark, Finland, and Norway. Some people claim Sweden is still better than Italy and Spain, but that ignores Swedish demographics and geography. In Stockholm, Covid-19 has devastated nursing homes and immigrant neighborhoods.

Parenthetically, using Spain’s 1.15% IFR and 60% exposure for herd immunity, the number on the vertical axis of the chart above that indicates successful herd immunity is 7,000. In other words, Sweden, which is at about 350 deaths per million, should expect that about 20x more people have to die from Covid-19 to achieve herd immunity. I realize that is different from what Swedish officials are saying and the discrepancy implies that Sweden, for some reason, has a significantly lower IFR than Spain.

I don’t want to minimize the importance of the economy. Spain’s disadvantaged are queuing for supplies and services with just 5% of the population exposed to Covid-19. But I don’t think anyone is signing up to let another 250,000 Spaniards die because it might help the economy. I write might because people afraid of a virus don’t always go back to the way things were.

In the US, JBS, Tyson, and other operators kept processing livestock at their meatpacking plants. Those had to close down after turning into Covid-19 incubators that infected workers and their communities. Now Covid-19 is rearing its ugly head in other manufacturing facilities. This part of the get-back-to-work story might not get as much attention because these plants aren’t part of the food supply chain. Also, these stories are inconvenient to Trump’s reelection.

In fact, as mostly red states rush to end lockdowns, it’s clear that the Trump machine doesn’t want Americans to consider Covid-19 a public health problem. Covid-19 isn’t something to be afraid of.

It’s something the Chinese invented.

Or it’s a Democratic Party Hoax that will go away the day after the election.

Or it’s something that only African Americans get. Wait, what?

This interview with Secretary of Health and Human Services Alex Azar made my head spin. When Azar says, for instance, that things could have been much worse, he avoids the obvious comparison that things could have been much better. Sure the US mortality rate isn’t as bad as Panama or Brazil, but it’s a whole lot worse than Germany, South Korea, and Vietnam.

But the worst thing Azar says starts at about 6:30 into the interview.

Jake Tapper interviews HHS Secretary Alex Azar, 17 May 2020.

Azar blames America’s diverse population for its high mortality. If you need help with Azar’s code language, he’s saying that the US Covid-19 mortality rate is high because black people aren’t healthy.

As states open up, Azar wants everyone to believe they’re safe and the economy is on the way to recovery. Just don’t look behind the curtain. Please don’t notice that Texas saw its largest one day Covid-19 death toll. Please don’t care that Georgia’s Covid-19 reporting is a mess. And that hotspot in Palm Beach, Florida? Probably too much sun.

So now, let’s take a trip through the Department of New Things We’re Learning.

5% of Covid-19 patients get weird symptoms for a long time.

There is growing evidence that the virus causes a far greater array of symptoms than was previously understood. And that its effects can be agonisingly prolonged: in Garner’s case for more than seven weeks. The professor at the Liverpool School of Tropical Medicine says his experience of Covid-19 featured a new and disturbing symptom every day, akin to an “advent calendar”.

The Guardian, “‘Weird as hell’: the Covid-19 patients who have symptoms for months,” 15 May 2020

Hundreds of children have come down a strange auto-immune response to Covid-19.

Finally, in our tour of the Department of New Things We’re Learning, we all know that someone who’s asymptomatic with Covid-19 can transmit the disease, right?

Well, not so fast. Researchers who wrote the study used to prove there is asymptomatic Covid-19 transmission did not follow up with the person they assumed was asymptomatic. It turns out she had symptoms. That doesn’t mean that there isn’t asymptomatic transmission. It means we don’t know for sure one way or the other.

I don’t report Covid-19 deaths very often, but this death is notable because, well, when people argue that we should let old people die to save the economy, some of the old people they are talking about helped save the world. Ann Mitchell died at the age of 97 from Covid-19. During WWII, Mitchell worked at Bletchley Park where, “for nine hours a day, six days a week, from September 1943 until the final exultant hours of VE Day, the young Oxford graduate would create complex diagrams used to break strings of incomprehensible Enigma code used by the Nazis.” R.I.P. Ann Mitchell, and sorry we didn’t do enough to save you.

I’m signing off today with “How to medical” by Sarah Cooper. Dana turned me on to Sarah and her great interpretations. Enjoy!

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