13 December 2020 – Sunday – #125

It’s looking a lot like Christmas in Barcelona.

Christmas lights in Gracia

The benefits of Catalonia’s November lockdown are accruing to a nearly normal Christmas, except almost no tourists and, please, no extended family gatherings. Overall, Spain is looking pretty good, too.

After allowing restaurants and bars to reopen and reducing retail restrictions, the Catalan government has postponed further relaxation of Covid-19 restrictions. Here’s what restaurants in the Born district looked like yesterday on my bike ride. Note: many diners, few tourists.

Restaurants operating in Barcelona’s Born District, 12 December 2020.

While the number of new Covid-19 cases has dropped since Catalonia put in place its most recent restrictions, the reproduction rate R increased to just below 1.0 in the past week as it relaxed those restrictions. Some complain that the restrictions are arbitrary here and in the US, but the data indicate that the Catalan public health authority has landed on an effective set of restrictions to contain the virus two times in a row.

Catalan Covid-19 reproduction rate R (yellow) and Outbreak Risk (blue) as of 11 December 2020. (Source: Catalan News).

How bad is Covid-19 in the US? It’s experiencing a Thanksgiving surge in new cases on top of its fall surge. On Friday, the number of new US cases surpassed 280,000. Without any public health policy adjustments, the Covid-19 death toll likely will surpass 500,000 by President-elect Biden’s inauguration.

Good leadership communicates current conditions during a crisis. In the case of Covid-19, good leadership would communicate the risks of holiday gatherings. As the numbers above show, it’s too late for Thanksgiving holiday advisories in the US, but Hanukkah has started, Christmas is around the corner, and New Year’s is less than three weeks.

I want to note a couple things about comparative leadership, specifically US versus Germany.

First, let’s look at current Covid-19 public health messaging in the US. The CDC has communicated some holiday travel guidance, but President-elect Biden’s transition team has said more. What the US should expect as deaths surpass 3,000 per day is clear guidance from the top.

Trump, however, has been largely AWOL on Covid-19 and pretty much everything else since the November election, except except except, of course, rallying his supporters in Georgia. He wants to raise as much money as he can before he leaves the White House. Trump has raised over US$200 million since the election, some of which pays for his legal efforts to overturn the election results, most of which effectively goes into his pockets.

In other words, instead of helping the US at the very worst point in its Covid-19 crisis, Trump is focused instead on what is essentially a coup to steal the presidency. His supporters are rewarding him handsomely to keep trying. After losing his Supreme Court case Friday, Trump skipped a maskless White House Christmas party, presumably to figure out other ways to win the election he lost by one of the largest margins in modern times.

As a contrast to Trump’s inaction on Covid-19, here is a great example of leadership during the Covid-19 pandemic. Regardless of whether you agree with German Chancellor Angela Merkel’s policies, her plea to Germans to avoid family gatherings at Christmas is pitch perfect.

Angela Merkel asks Germans to stay home for Christmas to contain Covid-19. (English subtitles).

Merkel acknowledges the sacrifice she’s requesting is difficult, paints a clear picture of how bad the Covid-19 situation is in Germany, advises Germans what they need to do, and sells them on the benefits. This is the kind of fleisch und kartoffeln leadership that saves lives.

Another aspect of leadership is anticipating what’s next. The Covid-19 vaccines have arrived. Now what?

US leadership seems to be MIA on the vaccine roll out. Maybe there are plans, but I haven’t read any. In fact, last week I got this message from my former healthcare provider in New York.

Covid-19 message from New York healthcare provider.

The subtext of this text is that this healthcare provider, the provider that would have administered the Covid-19 vaccine to me if I’d stayed in New York, doesn’t have enough information about the vaccine to communicate its vaccination plan. I don’t think it’s the provider’s incompetence. Have you read anywhere how the US is going to inoculate 330,000,000 people in 2021?

Let’s do some math for US vaccinations. I’m using round numbers to make it easy.

People to vaccinate targeting about 90% of population300,000,000
Doses needed600,000,000
Minutes per vaccination10
Full Time Equivalent Staff Required (at 2,000 hours per year)50,000
Labor cost (assume average $100,000 loaded per FTE)$5 billion
Labor and cost estimates for delivering Covid-19 vaccine to 300 million Americans.

The US healthcare system delivers roughly 160 million doses of flu vaccine annually, so the Covid-19 vaccine effort is about four times its current capacity. That’s a little tricky because flu shot capacity is seasonal. However, unlike the first mRNA vaccines coming to market that require super cold distribution, flu vaccine distribution is simple to manage and flu vaccine requires only one shot.

There are roughly 200,000 practicing family doctors and pediatricians and another 125,000 physicians assistants in the US. If they provide the vaccinations, about 15% of US primary healthcare would be consumed in 2021 by Covid-19 vaccinations to the detriment of other maladies. Maybe nurses and pharmacists give vaccinations, too, but the impact of this many injections is significant.

If someone has a plan, they should say so. Where do Americans go for a vaccination and who tracks that they get a second shot in a month? Are local public health systems funded to vaccinate the uninsured? Are the millions of undocumented immigrants included in the plan?

By comparison, while the US may not have and certainly hasn’t communicated a Covid-19 rollout strategy, Germany is a week or so away from setting up vaccination centers.

Berlin’s six vaccination centers are designed to inoculate 20,000 people a day. At that capacity, all of Berlin will be vaccinated by July 2021.

End of leadership discussion. Assuming you want to eradicate Covid-19 in your community, ask you leaders to be more like Germany and less like the US.

Parenthetically, if you’ve been following along, you read last week about my flu vaccine trials and tribulations. I was happy to report to Mom this week that I got my flu shot. As I was writing this entry, I realized that CatSalut probably controlled flu vaccine administration this year to streamline vaccinations in the same way Berlin is streamlining Covid-19 shots. Given the stress Covid-19 is putting on healthcare systems, CatSalut needed to streamline vaccinations.

Vaccines will play a particularly vital role in countries like the US that can’t get their Covid-19 acts together. In case you’re wondering how well the new Covid-19 vaccines work, here are data from the BioNTech / Pfizer trials.

In a perfect world, US and EU herd immunity is six months away. Here in the real world, that means something like 9-12 months for developed countries to achieve herd immunity.

However, no one is really safe until the entire planet is inoculated. Here’s where things stand with worldwide Covid-19 vaccine development and distribution plans.

Eric Feigl-Ding thread on Covid-19 vaccines, 8 December 2020.

A reminder. Countries don’t need the vaccine to stop Covid-19. In about a month, they can do what Australia did. Here’s an Australian explaining how Covid-19 eradication worked.

Australian describes how Covid-19 lockdown worked.

The other topic I want to cover today is the trade-off between the economy and Covid-19 restrictions. There is a lot of good evidence coming out that the best way to prioritize the economy is to contain Covid-19 first.

When people argue that it’s more important to keep the economy open than to prevent Covid-19, the go-to example is Sweden. However, even Sweden doesn’t want to be Sweden any more.

Another piece of evidence comes from the Anderson Business School. It predicts the US economy will pick up after the Covid-19 vaccines provide herd immunity. In other words, if the US could lockdown for a month now to contain Covid-19, it probably would see its economy come back in 1Q2021 rather than 4Q2021 (or 3Q2021, depending on when you think herd immunity occurs). A month of lock down now would buy six to nine months of economic growth.

The most interesting evidence to me comes from CO2 emissions. While CO2 emissions have dropped in the US and EU by 10% – 15% this year, China’s CO2 emissions have increased so much that the global decrease in CO2 emissions will come out at about 7%. This map may help explain. It shows Covid-19 cases by country.

Covid-19 cases by country, 13 December 2020. (Source: nCov2019.live)

Because China has contained Covid-19 (86,725 confirmed cases versus 16,549,366 in the US), its economy is operating full steam ahead. Because its economy is operating, China is emitting lots of CO2.

I’m not sure anyone wants to tell its leaders to be more like China, but please stop arguing that the economy is more important than containing Covid-19. Evidence is piling up that containing Covid-19 is the quickest path to economic well being.

Instead of Covid-19 misinformation stories this week, I want to mention two cases of Covid-19 information suppression. One comes from Florida where state police raided Rebekah Jones house, confiscating computers and phones. Jones, a data scientist, was fired by the state last summer after she claimed Governor DeSantis was suppressing unflattering Covid-19 reports. The state says Jones broke into state computers last month, but the confiscation of her equipment is widely viewed as a retaliatory effort to stop other whistle blowers.

The other case involves an Arizona ER doctor who was terminated because of his tweets about hospital conditions. Dr. Cleavon Gilman received a supportive call from President-elect Biden during all this:

The message? Many in the US are more concerned with controlling Covid-19 messaging than with controlling the virus itself. History will judge reputations.

Covid-19 bits.

Last week I noted that erectile dysfunction may be a Covid-19 symptom since the virus affects the testes, vascular system, and other parts of the male anatomy associated with fertility.

This week’s Covid-19 malady is tooth loss. Reports are anecdotal so far, but unexpected tooth loss seems to be occurring frequently in people who have had Covid-19. Covid-19 appears to impair oral vasculature in some patients, especially if they have preexisting gum problems.

Congressman Louie Gohmert’s tooth fell out spontaneously during a press conference. If you watch carefully when he says the word “2001” at about the 8:16 mark, you’ll notice the tooth fall out. He rolls the detached tooth around his mouth before he completes the word.

US Representative Louie Gohmert’s tooth falls out as he says “2001” at about 8:16.

Gohmert had Covid-19 earlier in the year. His sudden and bloodless tooth loss is exactly how Covid-19 tooth loss has been described.

Last week I suggested scented candles as a Covid-19 pandemic holiday gift that doubles as a Covid-19 test. My friend Adam suggested another appropriate pandemic gift, toilet paper. Due to shortages, toilet paper has become the unofficial pandemic currency. In fact, Adam coined a name for the new Covid-19 currency and it’s perfect for everything that’s gone wrong in 2020. The new toilet paper currency is called Shitcoin.

I don’t write this for money, I write it for my sanity. If you like it, please mention it to friends and family. For more frequent Covid-19 updates, follow me on Twitter.

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