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 1.0 and 2.0, which is high, but not nearly as high as the 5.0 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.

30 August 2020 – Sunday – #110

When Alexa came over Thursday to share Indian food on the terrace, I felt a hint of fall in the evening air. By yesterday, I was wearing long pants again. According to the forecast, the scorching summer is over in Barcelona.

By contrast, weather reports from friends and family in California are hideous. Ricardo sent a photo of the wildfire smoke that’s blown into San Francisco. He said he’d take Covid-19 over the wildfires because both require masks, but at least with Covid-19 it’s possible to breathe outside. Unfortunately, San Francisco gets both Covid-19 and masks. It’s 2020, so expect an earthquake soon, too.

Smog from wildfires in San Francisco, 28 August 2020.

Spain’s Covid-19 situation is similar to last week. In Barcelona, small Covid-19 accommodations keep appearing. Here’s a parking area that’s been converted into outside dining for the pizza and ice cream restaurants on the corner. I know what you’re thinking. Brad and I chose Casa Solar because there’s both pizza and ice cream places on the corner. I won’t deny it.

Parking area on corner converted into outside dining in Barcelona.

With the August surge in infections, Spain surpassed 100,000 Covid-19 cases last week. I was considering a day trip to Girona until I saw a report about the bar scene in nearby Queixans. Actually, even though Queixans is in the Girona region, it’s nearly three hours by car from Girona proper. Stay tuned on the Girona trip.

Madrid and Murcia continue to be the Covid-19 hotspots that make Spain’s post-lockdown recovery look bad compared to the rest of the EU.

EU post-lockdown Covid-19 infections.

Looking at this map, maybe instead of Girona, I should travel to other EU countries. I might be safer outside Spain if I’m willing to try my luck with planes and trains. Unfortunately for Spain’s travel industry, many Europeans probably are thinking the same thing.

Speaking of travel, Nicole asked this week if I knew when Spain would accept travelers from the US. The answer is that every month the EU evaluates the Covid-19 situation in countries outside the EU against a set of criteria. Based on this evaluation, it allows non-essential travel from countries that meet the criteria.

I told Nicole I don’t expect non-essential travel from the US until mid-2021 at the earliest. A resumption in 2021 requires changes in behavior and increases in Covid-19 testing Trump has not been able to achieve.

The Sturgis event in South Dakota earlier this month illustrates how much the US needs to change its behavior to stop Covid-19 from spreading. This video shows where people traveled from to reach Sturgis and then potentially how they spread Covid-19 afterwards.

The good news is that initial testing after the event indicates the town’s Covid-19 mitigation efforts may have helped keep the infection rate low. But the question remains: why do Americans prioritize non-essential travel over reducing Covid-19 infections?

If Trump wins the election, then non-essential travel from the US to the EU probably resumes 2022 or 2023. Why so long? The White House Covid-19 policy (to the extent that it has any policies) now seems to be prioritizing the economy and letting the virus run its course.

White House Covid-19 policy appears to be to let the virus run its course.

The good news is that we appear to be developing immunity to Covid-19. The bad news is that without any vaccine, the US needs about a million more people to die before the virus runs its course to the point that the country reaches herd immunity. At the current Covid-19 death rate, that will take about two years.

A Covid-19 vaccine may accelerate this “run its course” timeline, but a highly effective vaccine isn’t likely until mid-2021 at the earliest. Even then it wouldn’t reach the scale needed for herd immunity until 2022. The timeline may be shorter, too, if scientists determine that exposure to previous Coronaviruses counts towards herd immunity. That is an open question for now.

In other news, Spain has published guidelines for schools to re-open. These include “bubbles” of students that a Maine summer camp studied found to be effective at limiting Covid-19 spread. The Spanish guidelines also include good ventilation, hand washing and, for children over six, masks. It would be great to see more testing, but at least testing is recommended when symptoms are detected. My biggest questions are whether Spanish schools can implement these guidelines in time and whether local infection rates should factor in the decision to return to class.

Opening schools is treacherous. Even South Korea, which has one of the best Covid-19 track records in the world, has had to revert to online classes. School re-openings in the US are, as the world is coming to expect, a disaster. College re-openings this month prove the point.

The big US news last week was the Republican National Convention. I watched the time-shifted speeches online here in Barcelona. I had to check several times to make sure I hadn’t time-shifted to 2019. No platform, let alone a Covid-19 plan, and lots of praise for Trump’s Covid-19 response without mentioning the death toll. It seemed like either Covid-19 didn’t happen or it was over already.

The differentiation between the two US political parties with respect to Covid-19 couldn’t be more clear. At the earlier Democratic National Convention, Biden spoke directly about following the scientists’ advice to stop Covid-19. At last week’s RNC, Trump pitched an imaginary post-Covid-19 V-shaped economic recovery.

The RNC cognitive dissonance followed a rich Republicans tradition of cognitive dissonance, especially on issues like climate change. Wait! Did I mention that the RNC stuck with its V-shaped recovery narrative even as Tropical Storm Marco and Hurricane Laura slammed into Louisiana? Was anyone at the White House allowed to know there was bad weather anywhere?

Here’s one of my favorite examples of Republican climate change cognitive dissonance.

Senator Inhofe (R-OK) throws a snowball in 2014.

This is, of course, like eating a McDonald’s Happy Meal, burping, and then wondering out loud how anyone can imagine there’s hunger in the world.

In fact, the US Republican Party has distinguished itself as the only major conservative party in the world that denies climate change. At last week’s RNC, the party again distinguished itself as the only major conservative party to talk about Covid-19 in the past tense.

Rachel Maddow summarizes RNC Covid-19 statements.

Trump is a great con man selling a bright future. If the Sturgis event teaches anything, it’s that Republicans aren’t going to let Covid-19 stand in the way of even their motorcycle rallies. Maybe they believe that 182,000 countrymen gave their lives so that they could ride a chopper. Trump certainly isn’t going to tell them to stay home and save 182,000 more countrymen. That might ruin their day.

Republicans have set a very low bar for Trump and Trump is delivering them the Happy Meal of cons: you don’t need to worry about Covid-19 as long as I’m in the White House.

I’m glad I moved to Barcelona.

23 August 2020 – Sunday – #109

Brad and I traveled up to El Masnou Wednesday afternoon for a BBQ at Ruben’s place. Large portions of steak and Spanish were served. This was the first week I felt almost comfortable conversing in Spanish. Ruben is kind enough to speak a simple Spanish that I can understand. I’ve reached that awkward phase, though, where I can ask a clerk questions well enough that I get answers in full-speed-ahead Spanish. My first impulse still is to revert to English.

Anyway, Brad, Ruben, and I walked from El Masnou down the coast towards Barcelona to Montgat Nord. The coast is so beautiful, even a photo from the train station is spectacular.

Montgat Nord train station.

I remain hesitant to travel much. Looking at how things are going in the EU, though, maybe it would be better to travel outside Spain. As a rule of thumb, 100 cases per 100,000 residents per week is about the limit before lockdowns become necessary to contain community transmission.

EU Covid-19 cases after lockdowns.

In Spain, new cases in most regions have leveled off. Here in Catalonia, cases have leveled off for now at about 1,000 new Covid-19 cases per day.

Catalonia new Covid-19 per day as of 26 August 2020.

The increase in Spanish Covid-19 case growth is concentrated in a few regions. The Madrid region, for example, accounts for a third of new Covid-19 cases in Spain. Its government has recommended residents stay home until Covid-19 infection levels drop. Madrid is the one place I know of in Spain that’s protesting masks.

Protests against Covid-19 masks in Madrid.

In anticipation of a Madrid lockdown, Apple already has closed its retail store there. Parenthetically, Brad tried to visit the Apple store in Barcelona when we were at Plaça de Catalunya. Unlike Madrid, the Apple store here is open, but requires an appointment.

Unfortunately, bad behavior in a few Spanish regions is stifling tourist traffic in all regions. Tourists are headed to Italy, Croatia, and other destinations with lower Covid-19 positivity rates.

It’s always good to compare your performance to other to understand how you might improve.

Italy vs. France vs. US Covid-19 responses via TikTok.

The US passed 175,000 Covid-19 deaths last week. At the current rate of 1,200 Covid-19 deaths per day, it should reach 250,000 deaths by the election. Assuming, of course, there is an election. That will place the US first in the world not only for total Covid-19 deaths, but also for Covid-19 deaths per capita.

Trump continues his disastrous Covid-19 response with reductions in FDA oversight of Covid-19 testing and complaints that deep state actors at the FDA are slowing Covid-19 vaccine testing. He looks ready to promote oleandrin, another quack Covid-19 cure promoted by a major Trump donor.

The Trump administration presses for primary schools and universities to open, even as Covid-19 outbreaks at these schools increase cases. Here’s a good example of how things are going.

UNC student newspaper Covid-19 headline.

Places with low Covid-19 positivity like Denmark and Rhode Island have opened schools safely after putting in place Covid-19 protocols. Most of the US needs to reduce positivity before opening schools. Instead, Trump’s push to open schools is exacerbating existing Covid-19 hot spots as young asymptomatic students transmit the virus throughout their communities.

Derek Lowe’s write up of the Pfizer Phase 1 Covid-19 vaccine trial frames the state of the vaccine pipeline. It looks like vaccine candidates are doing the right kinds of things and they appear to be safe, but we won’t know any of that for sure until at least a few months into Phase 3 trials and maybe not for another year.

Several new vaccination questions are emerging. For instance, if a Covid-19 vaccine is 50% effective (the low bar set by the FDA for approval), will asymptomatic cases increase transmission as half the vaccinated population who believes they can carry on normally finds out their injections didn’t work. Also, should we prioritize vaccination of younger populations more prone to asymptomatic transmission because it’s easy to detect cases in older populations? It still seems to me like cheap and frequent Covid-19 testing will be part of life long after Covid-19 vaccines come to market.

Even with all the vaccines coming to market in the coming 3-9 months, WHO warns that life will not go back to normal anytime soon. Dr. Fa.uci discusses life after a vaccine at the 8:30 mark in this video.

Anthony Fauci discusses life after Covid-19 vaccine (starts at 8:30).

There is still plenty we don’t know about Covid-19, like why some people are asymptomatic. Here’s an excellent thread on that topic.

Another emerging concern is so-called Covid-19 long-haulers. Covid-19 long-haulers are organizing online the way people with other chronic diseases like Chronic Fatigue Syndrome and FSH have. This is the first step in publicizing the condition and developing treatments.

A few Covid-19 tidbits from last week.

Last, but not least, if your friends are having trouble with the concept of wearing masks, send them links to some of the great Covid-19 mask PSAs from Australia.

Australian Covid-19 mask public service announcement.

Why do the Aussie always make these things so fun? Masks, I mean.