19 June 2020 – Friday – #96

I have questions.

Seven months into the Covid-19 pandemic and there are still so many questions.

Three things seem unequivocal: social distancing is the best way to stop the spread of the virus; masks contain the virus reasonably well at the source; and, hand washing is an effective way to protect against contact with surface contamination. I write seem because current evidence is good for these, but experts could decide differently as they learn more. A recent meta-study in the Lancet confirms social distancing greater than a meter and mask usage reduce the spread of Covid-19.

There are attributes of the virus that have better measurements now than at the beginning of 2020. Covid-19 is significantly more deadly than the seasonal flu. The SARS-Cov-2 virus appears to have an initial R of 2 – 3 and an IFR on the order of 1%, although this seems to vary by region based on virulence of the strain, demographics, healthcare system, etc. Covid-19 mortality correlates to varying degrees with old age, blood type, baldness, comorbidity factors, and lower socioeconomic status. As with IFR, many of these correlations vary by region. Finally, the SARS-Cov-2 virus does not appear to mutate rapidly enough to thwart vaccine efforts.

From a public health perspective, it is clear that an effective Covid-19 response is not correlated with a country’s wealth. The most effective responses implemented testing and contact tracing to contain infections and avoid an outbreak. The next best responses used lockdowns and social distancing after an outbreak, presumably to be followed by test and contact tracing once infection levels drop. The worst responses have been in countries that have allowed Covid-19 to overwhelm their healthcare systems and shut down their economies.

Here are some unanswered questions about Covid-19.

• Where and when was the first human case of Covid-19?
• How is Covid-19 spread?
• Can masks alone reduce R to less than one?
• How much do children spread Covid-19?
• Is there a common set of characteristics to superspreader cases?
• Is a quick screen possible for Covid-19?
• What is the complete pathogenesis of Covid-19?
• What causes 5% – 10% of cases to develop severe or chronic Covid-19 symptoms?
• Is Covid-19 a respiratory disease, a vascular disease, or both?
• How strong is immunity after a case of Covid-19?
• How long until there is a Covid-19 treatment or vaccine?

Many of these questions have partial answers, but are missing significant or useful details. Most of these questions become academic after a treatment or vaccine enable society to return to “normal.”

There are other questions that may help in the future.

• What are the common attributes of countries with the best and the worst Covid-19 responses?
• Why do countries with female leaders manage Covid-19 outbreaks better?
• How did manufacturers and supply chains adjust during Covid-19 responses?
• Are there economic institutions that would help navigate future viral outbreaks?
• What international, national, and local public health institutions will help in a world of increasing viral outbreaks?
• How did science change to respond to Covid-19 and how can it improve next time?
• What government regulations will help manage the next outbreak?
• Did reductions in carbon-based energy consumption during the Covid-19 lockdowns provide data that helps model climate change?

Those are my questions after three months of writing about Covid-19.

I want to cover two topics quickly. One is the role of children in spreading Covid-19. This is a constant conundrum for a few friends who have four and five year olds—Nicole in Barcelona, and Shane and his husband John in Berlin. They have lots of good questions. Should the kid go to school or childcare? Should the kid play with other kids? Is the kid a strong vector for Covid-19 into the home?

When I talk about this with my friends, I always say I don’t think there are any good answers for these questions. That doesn’t help my friends but, in fact, a recent article confirms that there aren’t good answers for how raise kids during the Covid-19 pandemic.

Covid-19 doesn’t cause many deaths or even symptomatic cases in children and that’s a double-edged sword. The good news is that it’s highly unlikely your kid is going to get sick, let alone die. The bad news is that, since it’s highly unlikely, no one is studying it. Well, there are a few studies, but not enough to provide good guidance to parents.

What’s worse is that the real world results are all over the map, as it were.

Denmark reopened schools in mid-April, without serious disruptions. But when classes resumed in Israel in May, infections among children and teachers flared. In China, where a cluster of cases in Beijing has everyone on edge, authorities moved quickly this week to preemptively close schools.

Stat, “How likely are kids to get Covid-19? Scientists see a ‘huge puzzle’ without easy answers,” 18 June 2020.

I wish my friends and all other parents the best of luck! Right now, there are no right answers.

The other topic I want to cover quickly is masks. I am a convert on this topic because the information changed and because the expert recommendations changed. Not everyone is a convert, however. In the US, masks unfortunately have become yet another partisan symbol.

American and United both started requiring masks on their flights this week. A conservative pundit delayed the departure of a flight yesterday, claiming he couldn’t be forced to wear a mask. He was removed from the flight, put on a later flight on which he did not wear a mask, and now he is banned from the airline.

In California, Governor Newsom ordered mandatory masks throughout the state. The Orange County sheriff, who refused to enforce the county’s mandatory mask order, also refuses to enforce Newsom’s order.

But masks seem to be working. Public health officials were concerned that the large BLM protests over George Floyd’s murder would create a spike in Covid-19 infections. Those spikes should have shown up by now.

The absence of surges in the cities with massive demonstrations but few other large gatherings has taken many officials and health analysts by surprise. However, as they’ve examined the data and the video footage, one thing has clarified matters, to an extent: A large percentage of the protesters wore masks.

Slate, “It Doesn’t Look Like the Protests Are Causing a COVID-19 Spike,” 17 June 2020.

So the question for Trump’s Tulsa rally tomorrow is: will Trump supporters wear masks? I hope they do, but if they make it a partisan issue, it also becomes a kind of Darwinian issue, too.