6 September 2020 – Sunday – #111

You don’t really understand Barcelona until you know instinctively what news story will trump any other news story. Headlines around the world yell out that Spain is the EU’s Covid-19 cautionary tale. The reports criticize Spain, the country that beat back the worst Covid-19 outbreak on the continent, because it has become the poster child of the civilized world for how not to behave after a lockdown. Too many discos, too many salutational kisses, too many family gatherings. Who has time for Covid-19 prevention?

All of this talk of Spain starting a second wave of Covid-19 might lead the casual tourist (there are a few tourists around Barcelona) to believe that Covid-19 would be the only thing in the news, or at least the main thing. But, no. If you really understand Barcelona, you know that not even the Second Coming could beat this news story: on Friday, Lionel Messi announced he will play at least one more year with FC Barcelona.

I could pretty much stop right there, but I didn’t get the Messi news until yesterday, so I have a few other things to write about. Brad and I missed the Messi benediction because yesterday we took the Alta Velocidad Española to Girona for the afternoon. At 200-KPH, we barely sat down before the train pulled into the Girona station. I made a little slideshow of our Girona trip to prove it.

Girona Cathedral.

Girona is the first interior city I’ve visited since I arrived in Spain on New Year’s Day. It was fun to be a tourist in a pretty river town with restaurants, shops, museums, and a spectacular cathedral. Nicole said the best part of her recent Girona trip was walking along the wall behind the Cathedral. Ironically, in the few weeks since her Girona trip, the wall has been cordoned off due to concerns about Covid-19. So much for my Covid-19 escape day-cation. While the Spaniards are busy disco dancing, kissing, and visiting their families, the only dangerous Covid-19 activity I’m interested in, seeing the views from the wall in Girona, is the only one Spain seems to be prohibiting.

I jest, of course. If you’ve read any of my posts, you know I’m scouring Covid-19 statistics to make sure it’s safe before I travel. While things in Spain overall aren’t great, things in Catalonia aren’t nearly as bad as the world thinks.

Covid-19 transmission rate and outbreak risk in Catalonia. Source: Catalan News.

As the graph shows, the Covid-19 transmission rate R is hovering between 1.5 and 2.0, which is high, but not nearly as high as the 4.5 registered during the initial outbreak. The good news is that both R and new cases have leveled off in the region for about a month. I believe this steady R is the reason public health officials aren’t applying measures more drastic than cordoning off the wall in Girona.

I jest, of course. There are other Covid-19 restrictions. For instance, inside Girona’s cathedral, seats have indications where to sit in order to maintain two meters separation.

Seats in Girona cathedral with dots indicating proper Covid-19 separation.

My non-scientific measurements of mask compliance walking on Barcelona streets is over 80%. What matters more is inside mask compliance. I haven’t counted that, but it seems high in the stores I enter and on public transit.

I don’t mean to imply there aren’t Covid-19 problems in Spain.

Most of the Covid-19 cases continue to be in Madrid, Murcia, and the Basque Country. It seems as though schools should not reopen in regions like these with high Covid-19 positivity rates. While I expect that parts of Spain will have to lockdown soon, Covid-19 doesn’t seem that bad in most of Spain.

What’s bugged me this week about the news stories labeling Spain a Covid-19 cautionary tale is how much worse Covid-19 is in my native country. If anyone wants to use “Covid-19” and “cautionary tale” in the same headline, it should be above a report about the US.

What’s also bugged me is how many unqualified people are advising the White House from Stanford’s Hoover Institute. It’s as if the Hoover Institute wants to make sure Trump is a much worse president than the eponymous President Hoover. I grew up near Hoover’s Last Erection, so this is a hometown pride thing for me.

In March, as you may remember, Trump made terrible public health decisions based on a Covid-19 paper from Richard Epstein, a legal scholar at the conservative Hoover Institute. Against all the evidence from Asia and Europe at the time, Epstein argued Covid-19 was just like the flu. In my mind, asking a legal scholar for Covid-19 policy is like asking a epidemiologist to write a nuclear treaty.

Now Trump has added Dr. Scott Atlas, a radiologist and the Robert Wesson Senior Fellow in Scientific Philosophy and Public Policy at the Hoover Institute, to the White House Coronavirus Task Force. Atlas is a Fox News contributor who advocates for Swedish-style Covid-19 policies with the aim of herd immunity. In my mind, putting a radiologist at the head of Covid-19 public health is like asking a proctologist to perform a heart valve replacement (no offense to proctologists).

Trump’s reliance on Epstein and Atlas is yet another example of Trump listening to what he wants to hear. And what Trump wants to hear is projected to lead to over 400,000 US Covid-19 deaths by the end of 2020. Atlas is giving Trump the wrong public advice just as the US heads into a new wave of Covid-19 forecasted to start in October and peak after the election. If Trump would listen instead to public health experts, Covid-19 deaths could be kept under 250,000.

I’ve written before about why herd immunity is such a bad approach, so I give you Dr. Ashish Jha from Brown University School of Public Health to explain it again.

Dr. Ashish Jha explains why herd immunity is a poor public health response to Covid-19.

In case you have trouble visualizing how immense the US Covid-19 carnage is, this chart provides some comparisons.

US Covid-19 deaths surpass casualties from WWI, Korea, Vietnam, Iraq, and Afghanistan combined.

Trump is putting most of his Covid-19 eggs in the vaccine basket. The CDC is asking states to prepare to deliver a vaccine by the first of November, just in front of the election. By prioritizing his reelection over public health, Trump is creating a perception problem.

The problem is most people don’t want a vaccine until they know it’s safe. There’s too much history of rushed vaccines that caused health problems to trust another vaccine that’s been rushed to market. Big Pharma knows this is a problem and is trying to get ahead of Trump by promising transparency. Trump’s First of November gambit buys him votes in the short term at the expense of long term vaccine uptake.

Trump’s political monkeying is too bad because Covid-19 vaccine advances are mind bogglingly fast and the science looks good. If you’re worried about the scientific integrity of the development in the US, I commend this interview with Moncef Slaoui, who leads the US Warped Speed effort.

Derek Lowe has another great rundown on the state of Covid-19 vaccine development. I summarize his rundown here:

Approach – StatusDescriptionIssues
Viral Vector – Phase 3Use adenoviruses (mostly) modified to make Covid-19 antigen proteins – used to make one vaccine (Ebola)Can build immunity to the virus used to deliver payload
RNA / DNA – Phase 3Inject RNA/DNA that makes Covid-19 antigen proteins – never used to make vaccine beforeCan build immunity; need super cold (sub-zero) distribution
Recombinant Protein – Phase 2Inject Covid-19 antigen proteins directly – used in vaccines beforeMay need adjuvants to improve response; cold distribution
Attenuated Virus – Phase NAWeakened Covid-19 that stimulates response, but not disease – used beforeRight amount of weakening
Inactivated Virus – Phase 3Heated or chemically treated Covid-19 stimulates response – used beforeBoosters may be needed
VLP – Phase 1Covid-19 surface proteins without Covid-19 RNA – used beforeDerived from modified tobacco & other plants
Summary of Covid-19 vaccine candidates.

Some other Covid-19 developments before I sign off.

While all this is going on, the Covid-19 virus continues to evolve.

Thread on evolution of Covid-19 virus.

It’s better to slow down Covid-19 now than let it spread and evolve into something that’s harder to control.

Last of all, wear a mask, keep your distance, wash your hands, and please remember to get your Covid-19 advice from the people who know.

Don’t use a radiologist for public health problems.

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