19 July 2020 – Sunday – #104

I was planning to travel to Sitges this weekend. Ana recommended a paella place. I’m dying to try the different kinds of Spanish paella. A friend was all set to join me. On Friday, at the very last second, just as I picked up the phone to test my Spanish skills making a reservation at the paella place, Covid-19 laughed.

As expected, Covid-19 cases are up in Spain after the lockdown. Unfortunately, they’re up a lot in Catalonia. So, Barcelona is reverting to Phase 2 of Covid-19 restrictions. No one’s exactly sure what that means. For instance, is the beach off-limits now? But the signal is clear that we need to change our behavior. So much for my summer travel plans. I’m dying for paella, but not enough to actually die.

The first large Covid-19 outbreak here started among seasonal agricultural workers in Lleida. It’s clear that there were not enough contract tracers to follow up on all the cases.

“Germany has calculated its contact-tracing staff needs very well. It has figured out that it needs around 25 tracers for every 100,000 inhabitants. Catalonia would need between 1,500 and 2,000.”

Magda Campins, epidemiologist and chief of Barcelona’s Vall d’Hebron Hospital, El País, “Barcelona hospital chief: ‘The situation in Lleida has clearly gotten out of hand,” 14 July 2020.

At the rate Germany recommends, Catalonia should have sent over 100 contact tracers to the Lleida region. It sent nine.

Now infections in L’Hospitalet, on the west side of Barcelona, are on the rise as well. Michael Bennett graphs the Catalonia cases before and after the New Abnormal started (green vertical line).

Covid-19 cases in Catalonia ending 16 July 2020.

Catalonia’s failure to provide Covid-19 contact tracers is especially problematic because of asymptomatic cases. Researchers recently have found that a large proportion of Covid-19 cases are asymptomatic.

Asymptomatic Covid-19 cases increase likelihood of spread.

The blue area above shows the presymptomatic cases, red area the confirmed Covid-19 cases. In between blue and red, the yellow area shows cases that are hard to determine. It’s clear that most people don’t know they have (or they are about to have) Covid-19. That, by the way, is why it’s important to wear a mask even when you feel okay.

Young people are more likely to have asymptomatic cases. This heat map of the progression of Covid-19 cases in Florida shows how young people help spread the virus.

Spread of Covid-19 in Florida by age.

The horizontal axis is time and the vertical axis is age. Each square represents Covid-19 infections during a four day period for an age group of five years. The brighter the square, the higher the infection rate. The chart shows how Florida’s current Covid-19 outbreak started with young adults in their twenties who probably had asymptomatic Covid-19 cases. That hot mess then spread Covid-19 to older Floridians. There is no reason not to think the same kind of spread is taking place in Catalonia.

How bad can the asymptomatic spread of Covic-19 get? In Australia, contact tracing is working and it’s uncovering just how bad a superspreader case can be. An asymptomatic Australian woman with Covid-19 did everything right after travel, but one elevator ride apparently infected 71 people.

One asymptomatic carrier rode an elevator alone, then 71 people got COVID-19. She did everything right. She had no symptoms, but she self-quarantined anyway after travel. She stayed in her apartment. She ordered-in food. But she became patient zero in a 71-case cluster.

News.Com.AU, “Coronavirus contract tracing: Woman infects 71 people in 60 seconds,” 13 July 2020.

With high asymptomatic spread, it’s clear why masks are so important: to stop aerosol spray from asymptomatic cases.

For any skeptical readers, here is a story from The Department of Masks Really Work Department. Montgomery, Alabama is a poster child for cutting the spread of Covid-19 with masks.

Montgomery Mayor Steven Reed explains drop off in Covid-19 infections due to mandatory masks.

Really, the Montgomery story should be enough. But here’s an encore mask story for anyone who gets a hair cut.

CDC reports effectiveness in masks preventing Covid-19 spread at hair salon.

Good news on vaccines. First, the Covid-19 vaccine candidates furthest along in testing are eliciting the immune system responses needed to make a vaccine work.

“The results from Oxford yesterday add some detail to this discussion, with the good news that the two most obviously key parts of immune protection are effectively induced: antibodies that can neutralise virus entry, and T cells that can recognise and attack infected cells.”

Danny Altmann, Professor of Immunology, Imperial College London, The Guardian, “Covid-19 vaccine: what have we learned from Oxford phase one trial?,” 16 July 2020.

The questions for each of the 20+ vaccine candidates in human trials are whether they are safe and whether the particular immune system response they elicit will stop Covid-19.

Second, a Singapore study measures CD4 and CD8 response to the NP (nucleocapsid protein) fragment of the SARS-Cov-2 virus, which demonstrates immune system response and confirms SARS-Cov-2 vaccines should work. The study also found memory T-cells from the 2003 SARS-NP virus, which indicates that the immune system has created memory T-cells for other SARS viruses.

Eric Topol explains how this study helps, but doesn’t quite fill in all the gaps in our knowledge of Covid-19 and vaccines.

A look at what we know about Covid-19 and the human immune system response.

Big Pharma is gearing up to deliver vaccines even before they complete trials. Pfizer expects to deliver 100 million doses this year and a billion in 2021. It looks like we’ll be injecting something in the next year or two, but no one is quite sure what.

Whether vaccines will work against Covid-19, however, is not settled science. One doctor documents a recovered Covid-19 patient who had two negative PCR tests and then developed a second case of Covid-19. Because this is a well documented case, it shows that Covid-19 re-infection has happened. The open question is how often does re-infection occur. Is everyone susceptible to Covid-19 re-infection after a time? Or is it a one-in-a-million occurrence?

Many studies are showing Covid-19 antibodies disappearing altogether a few months after infection. Memory T cells may form for Covid-19, but that isn’t known, and, if they do, it also isn’t known if they will be effective against future infection.

All this may mean we will need booster shots for a vaccine. It certainly shows the need to continue investigating other therapeutics like monoclonal antibodies in case vaccines don’t provide the immunity needed.

It’s also important to note that New Zealand eradicated Covid-19 last week. Our kiwi friends have shown it’s possible to beat Covid-19 without treatments or vaccines if public health can do its job and people cooperate.

There are many signs that the US push to reopen is a disaster. The clearest is rising Covid-19 deaths. To paraphrase Paul Krugman, Americans needed a drink and now they’re paying the tab.

There are also many signs that the US push to reopen isn’t benefiting the economy as much as if the country had waited until Covid-19 was under control to reopen. One such sign is 5.4 million Americans losing healthcare insurance in the middle of a pandemic. That could lead to a collapse of the US healthcare system.

Another sign is the potential collapse of the housing market.

US Mortgage delinquency chart.

Even CEOs of major companies are telling government to stop the spread of Covid-19.

Perhaps the most difficult debate to watch from Spain is Trump’s push to re-open schools. Here is Sec’t of Education Betsy DeVos making the case to reopen schools no matter what.

Secretary of Education Betsy DeVos argues for schools to reopen.

It is a topic for which there are few data and fewer studies, so the debates are largely emotional because the trade-offs are unclear. The stakes couldn’t be higher with children’s well-being at risk whether they go to school or not.

Proponents of opening may want to take a look, however, at the second wave of Covid-19 infections in Israel.

On Tuesday, in testimony to the Israeli parliament, Udi Kliner, [Israeli public health chief Siegal] Sadetzki’s deputy, reported that schools—not restaurants or gyms—turned out to be the country’s worst mega-infectors.

The Daily Beast, “‘The Second Wave’ of COVID Hits Israel Like a Tsunami,” 10 July 2020.

You’ll be happy to know that Ana told me about a paella restaurant in Barcelona, near the Arc de Trionf. My friend and I didn’t have to travel to Sitges. Last night, we shared a traditional paella valenciana al fresco right in town. Covid-19 may have derailed my travel plans, but it opened my eyes to all the possibilities, culinary and otherwise, within walking distance of home.

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