16 August 2020 – Sunday – #108

I’m starting today’s entry with an awkward disclosure. August is a strange month in Spain with everyone off to the beaches or mountains, so maybe it’s appropriate just because August.

During the Covid-19 lockdown, when I completed a diary entry every day and then had to find other things to amuse myself, I searched for “how to use a bidet” videos on Youtube. I mean, yeah, I had the general concept, but I’ve never lived in a place with a bidet. It’s a search I commend to you, my dear readers. Youtubers have discovered many creative ways to explain this magic plumbing device without, well, giving it all away.

The reason I mention this is that I learned from my Youtube searches that a few people use bidets to clean a very dirty part of the body. Yesterday, that part of my body was filthy, indeed. Brad wanted to push off to see this year’s Festa Major de Grácia and I didn’t have time for a full on shower.

Remembering my lockdown videos, I grabbed a towel and closed the door. The bidet did its magic. In a matter of seconds, my feet were clean and dry. Off Brad and I went to check out the Festa.

In the spirit of Covid-19 and social distancing, this year’s Festa is virtual. Still, there were a few decorations here and there.

Festa Major de Grácia, 2020

Not too many festival attendees, though. Social distancing was in full force. I didn’t have to wait for the throngs to clear out to get this shot.

A handful of Gracia shops were open and about half the restaurants. It seems everyone has taken their Covid-19 to left town for the beaches this month. As Brad and I enjoyed lunch in a nearly deserted Plaça del Sol, an occasional fire cracker or M-80 exploded, perhaps reminders that revolutions and wars are not as distant as everyone thinks.

Speaking of which, the big news the past couple of weeks has been that Spain’s King Emeritus Juan Carlos Alfonso Víctor María de Borbón y Borbón split town for the UAE. He seemed to have financial troubles, but not so bad that he couldn’t afford a €10k per night hotel suite in Abu Dhabi. It also seems Juan Carlos I may have some of the same financial friendships in UAE and Saudi Arabia as that other royal family everyone is talking about, the Trumps.

Anyway, the point of this diary is Covid-19. The Covid-19 outbreaks have leveled off in Catalonia, but not in Spain.

Matthew Bennett compares Covid-19 post-lockdown statistics from the Spanish government and the Carlos III public health institute.

That’s clearly not helping Spanish tourism, although, along with agricultural work and family gatherings, tourism may be one of the drivers of Spain’s increase in Covid-19 cases.

“The numbers are saying that where we had good local epidemiological tracking, like [in the rural northwest], things have gone well. But in other parts of the country where obviously we did not have the sufficient local capacity to deal with outbreaks, we have community transmission again, and once you community transmission, things get out of hand.”

Rafael Bengoa, consultant and former health chief of Spain’s Basque Country region

Last week, Spain’s health ministry announced measures to reduce Covid-19 outbreaks including limiting group meetings to ten and closing bars and restaurants by 1am. How much difference these regulations will make in the middle of beach vacation season is anyone’s guess. August, as I mentioned above, is a strange month.

What I haven’t seen that I’d like to see is news that public health departments are hiring the volume of contact tracers needed to limit outbreaks. If you want to know more about the value of contact tracing, here’s a good summary of what 14 US states are learning from contact tracing.

From the US, Spain is commonly viewed as a monolithic entity. It isn’t, especially with respect to Covid-19. It’s as accurate to say Spain is having a problem with Covid-19 as saying the US is having a problem with Covid-19. The real Covid-19 story, however, is what’s happening in each Spanish region or US state.

I note this because the drivers of US Covid-19 outbreaks are similar to Spain’s.

The difference is that Spain started the summer with baseline of no Covid-19 community transmission, whereas the US has unhealthy levels of community transmission in most states. Heading into fall, the flu will join with Covid-19 to overwhelm health systems, advances in vaccines and treatments notwithstanding.

In Catalonia, I feel particularly safe because, for whatever reason, the regional public health authority has managed to keep Covid-19 cases level. At this point, unfortunately it matters which Spanish region or US state you live in. Better, for instance, to be in Catalonia than in Murcia. Better to be in New York than in Florida or Texas. Covid-19 is a dance. Choose your dance club wisely.

I want to spend a lot of time on the US, but it’s a waste of time. Trump clearly does not want to stop Covid-19. If he wanted to stop Covid-19, he would do it before the election and look like a hero. He’s missed the window of opportunity for that

My hunch is that Trump is either using Covid-19 to win the election or figuring out how to make money from it. Or both.

The USPS debacle is a clear sign that Trump thinks he can win if he confuses voters. He knows Covid-19 will scare voters from going to the polls in person. Dismantling the USPS will deter them from voting by mail. A lower vote count tends to favor Trump and Republicans.

As an example of how Trump makes money from Covid-19, he awarded a contract to a business associate to take over processing of hospital data from CDC. Now the company, TeleTracking, is refusing to answer questions about that same hospital data. The contract appears to have no value except to line the business associate’s pockets.

The US government is also letting huge contracts for Covid-19 treatments and vaccines. Not that this is necessarily bad, but in the Trump world, these are opportunities for favors or skimming. More generally, US healthcare companies are making a bundle in the middle of a pandemic. Trump likely is appeasing many US oligarchs.

At least Senator Romney is calling out Trump for letting Covid-19 deaths spiral out of control in the US. Meanwhile, the rest of conservative America is busy rationalizing the reasons the US can’t follow the EU’s example. On the school opening front, for instance, the New York Times corrected its reporting on a South Korean study of how youngsters transmit Covid-19.

What’s more important to me than the correction itself is how, in the comments section, people immediately pounce on this new information to reinforce their stand on school openings. I could say a lot more about this, but I think it boils down to the harmful effects of media, social and otherwise. This obsessive rationalization in the US is literally killing people.

What I do want to spend some time on today is science and technology (Yea!). Here’s another long and informative edition of Ground Rounds from UCSF.

UCSF Grand Rounds on Covid-19 Testing, Treatments, and Vaccines.

After watching this, I’m coming to the view that testing and behavior change are the ways the world gets back to something like normal. I’m also coming to the view that it will take another year of Covid-19 before something like normal returns. The impact of treatments and vaccines probably are 2-3 years off. You can skip to the final 10-15 minutes of the video to understand why I write this.

One cheap Covid-19 test approved this week uses saliva (spit instead of swab) and costs about $10 at retail. The virus is stable in saliva at room temperature for days and maybe weeks. The test is at least 94% as accurate as the gold standard PCR test. Here’s why it’s a game changer.

The concern about cheap tests is their accuracy, especially false negatives. If they’re not accurate, can you trust a negative result enough to socialize at home or work when you actually might be positive? It turns out that Covid-19 viral load peaks a day or two before any symptoms appear and it dissipates after about five or six days (watch Chaz’ section on testing in the video). That, in turn, means that false negatives are unlikely when someone is infectious because their viral load is so high. Testing frequently and testing those with whom you socialize also reduces the impact of a false negative.

So, a key behavior change is switching from infrequent, expensive, highly accurate PCR tests that, in a perfect world, take 1-2 days for results to frequent, cheap, less accurate spit tests that take 15 minutes to an hour for results. Lots more to come on this. It will take months to scale production and work out distribution, but it’s something that can be implemented with little risk in a year.

On the vaccine front, Russia approved the first Covid-19 vaccine. Anyone who takes it is a fool in my book. A member of the Russia Ministry of Health’s ethics committee resigned over the approval. Following Putin’s lead, Trump will announce a US Covid-19 vaccine before the election. The problem these politically motivated vaccine approvals create is distrust in vaccines, which already is a huge problem in the US.

As excited as everyone seems to be about a Covid-19 vaccine this year, the simple fact is that it takes a year to understand safety. Given reluctance to use vaccines in the US (another topic for another day), there’s no reason to think a vaccine will change Covid-19 in the US until full safety tests are completed. In addition to the UCSF video above, Vox has a good write-up on the current status of Covid-19 vaccines here.

Then there are treatments. Mortality rates are already better for Covid-19 patients because clinical practices have improved (doctors and nurses know a lot more) and because of corticosteroids. That will continue to improve incrementally as new treatments come along.

Even if a blockbuster shows up tomorrow, though, it’s a year to get through studies, manufacturing, and distribution. Speaking of blockbuster, here’s something cool from USCF (coincidentally). It’s a nasal spray called AeroNabs and here’s how it works.

AeroNabs Covid-19 treatment.

Derek Lowe provides a good third-party assessment of the AeroNabs technology here.

A related topic is Covid-19 decoys.

In a new study, published Aug. 4 in the journal Science, researchers engineered such a decoy and found that the coronavirus bound tightly to the imposter receptor, and once attached, the virus couldn’t infect primate cells in a lab dish. The decoy binds to the virus as tightly as a neutralizing antibody, a Y-shaped molecule generated by the immune system to grab the virus and prevent it from infecting cells. 

LiveScience, Decoys could trick COVID-19, keep humans safe from infection,” 10 August 2020

A developing topic of discussion with a connection to Barcelona is the study of cross-reactive T-cells. It’s much too early to know the impact of T-cells that were trained on other Coronaviruses, but there is speculation that we might be safer (as a herd) than we thought, and closer to herd immunity. That’s good news, but wait for the studies!

Okay, that’s it for this week. Except, OMG, firenados. As if the screenplay writers hadn’t thought up enough for the 2020 movie. Fires in California are turning into what are known as “firenados.”

The weather service issued its first ever firenado warning for Northern California. If you think Covid-19 is a pain in the ass, wait until the full impact of climate change.

Last, here’s why misinformation is so devastating to the eradication of Covid-19.

Covid-19 misinformation.

I write this for my sanity. If you like it, please forward to your friends. You can follow my daily Covid-19 posts on Twitter. Thanks for following along!

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