16 June 2020 – Tuesday – #93

Spanish tourists, no matter where you’re from, please take note. Benidorm beaches are now by reservation.

From Monday, when the beaches reopen under the government’s coronavirus deescalation plan, people will have to log on to a webpage for a chance to occupy one of the 5,122 four-by-four-meter spaces on the Valencian shoreline, which are meant for a maximum of four people.

El País, “Benidorm’s world-famous beaches reopen by appointment only,” 14 June 2020.

Benidorm is down the Mediterranean coast from Valencia, almost to Alicante. Don’t worry if you lose your mobile device on the way. There are offices set up to take reservations, too. In the Kafka-esque world of Spanish bureaucracy, it should be a snap to reserve your little paradiso en la playa compared to renting an apartment and obtaining an empadroniamento.

I’m not sure where the tourists are coming from to fill Benidorm’s 5,122 sunbathing plots, but IATA provides help navigating Covid-19 travel restrictions to get here.

IATA Covid-19 travel restrictions by country.

Click on any country on the IATA interactive world map to find travel restrictions for your desired destination. That will tell you what restrictions apply at the time you click, although not in a week or two when you might want to travel.

Some of Spain’s tourists will come from Germany, no doubt. In fact, 189 Germans flew to Mallorca yesterday in a pilot of Spain’s Covid-19 screening program.

The UK is another typical source of tourists. The situation for English tourists is a bit fluid. At first the UK was included in the EU countries that could begin traveling to Spain on 21 June without quarantine. Then the UK said, wait a minute, anyone coming to the UK still must self-isolate for fourteen days. Okay, hold the phone. “Spain’s foreign affairs minister then said the country may impose a two-week quarantine on Britons, if the UK maintains its current travel rules.” I’ll have to get back to you on this one.

Should Spain worry with all the tourists who will theoretically show up next week? Well, yes.

Margarita del Val, a Spanish virologist and immunologist, says that Covid-19 is circulating at a higher level now than before Spain’s State of Alarm. She says that a second wave is possible, but we know more now about how to live with Covid-19. What should people do to stop a second wave?

“[Wear] a face mask. At first they were being recommended in Asia, but we didn’t believe it because they didn’t back it up with data. We have had a somewhat cavalier attitude towards anything coming out of Asia, and I think this has been a lesson in humility. As a hyper-skeptical scientist myself, I had my own doubts due to the lack of data. Stopping a wave requires several measures: closing schools, confinement, masks, limited access to parks. Just one doesn’t work. We still don’t know which one is the most important. We know the problem is the accumulated air, it’s not enough for an infected person to simply walk by you.”

Margarita del Val, virologist and immunologist, El País, “Spanish Covid-19 expert: ‘There is more virus circulating now than before the state of alarm’,” 16 June 2020.

Parenthetically, like the Spanish government, the US CDC also didn’t recommend masks until recently. Different from del Val, Dr. Fauci said the CDC didn’t recommend masks because it knew there weren’t enough masks to meet even the needs of healthcare workers.

Airlines need tourists to stay in business and know the future of tourism depends on safety. How bad is airline business? It’s bad enough that Docusign is replacing United in the NASDAQ 100 index.

On the travel safety front, United is upgrading is mask policy from coach to first class. United passengers who fail to wear a mask will be banned from future flights. I like this idea.

Also on the travel safety front, Spain is screening tourists by checking for temperatures. There’s more evidence from California testing that many Covid-19 cases don’t present with a fever. Only 12% of those who tested positive reported having a fever over 100F. Loss of smell has a much better correlation with a positive Covid-19 test than fever.

Last note on Covid-19 and travel. There are still 40,000 stranded cruise ship workers.

A few science tidbits.

In a very small, non-reviewed study, low dose radiation therapy resolved several severe Covid-19 cases in elderly patients.

The first Covid-19 vaccines may not prevent you from getting Covid-19. They may be rushed to market because they’re better than nothing and, more likely, so that Trump can claim there is a Covid-19 vaccine before the November election.

The FDA formally withdrew its Emergency Use Authorization for hydroxychloroquine. This creates a credibility problem for the US government as it issues EUAs for Covid-19 vaccinations.

In Chicago, a female Covid-19 patient in her twenties underwent a double lung transplant after the virus damaged her lungs.

I’m ending today with a bubble concert from The Flaming Lips. This may be the future of safe concerts until there is a Covid-19 vaccine.

The band performed their song for a crowd of people watching from their own individual bubbles, and frontman Wayne Coyne and his bandmates each had their own bubbles on stage — with the exception of two drummers, who shared one giant dome and wore face masks during the performance.

Decider, “The Flaming Lips Use Giant Bubbles to Keep Crowd Safe During ‘The Late Show’ Concert‘,” 11 June 2020.

I’ll let you decide whether bubble concerts are our future.

Bubble concerts to reduce Covid-19 transmission.

15 June 2020 – Monday – #92

I’m pretty sure the United States added a new state since I left in January. No, not Washington, D.C. That would be a sensible state to add. I’d like to be the first to congratulate the US on its new State of Denial.

In March, Yale professor Nicholas Chirstakis published a Twitter thread comparing Covid-19 to the 1957 H2N2 pandemic. He updated the thread yesterday. It’s not good news.

Yale professor Nicholas Christakis updates his US Covid-19 mortality prediction to 300k – 500k deaths.

Christakis now predicts 300k – 500k Covid-19 deaths in the US. That means he expects 3x – 4x more people to die from Covid-19 in the US than have died already.

Let me write that again.

After today, 3x – 4x more people are going to die in the US from Covid-19 than have died already.

No one is talking about this. The CDC seems worthless. Its new estimate for the Covid-19 death rate is 0.26%, much less than that 1.15% measured in Spain. The entire US may not be in denial, but Washington, D.C. and certainly the White House are in a state of denial.

At the end of March, I made a back-of-the-envelope prediction of US Covid-19 mortality. My estimate, based on Spain’s and Italy’s Covid-19 mortality rates at the time, was 96k – 160k US Covid-19 deaths. As the Covid-19 counting got better in Spain and Italy and as their mortality curves flattened, both countries ended up with a mortality rate just shy of 600 deaths per million. That still may be an under-count, but it’s not off wildly.

Covid-19 per capita mortality rates by country, 14 June 2020

The latest US mortality figures (above) show the US more than half way to Spain’s and Italy’s 600 Covid-19 deaths per million. In other words, the US today is in the range of mortality rates I used to make my prediction in March. The current 117k US Covid-19 death count is in the middle of my predicted range.

Parenthetically, it appears that the strain of the Covid-19 virus in Europe and New York is much more virulent than the strain of the Covid-19 virus that struck Asia and the western US. Along with all the other factors like demographics, per capita GDP, healthcare systems, etc., this is another factor that makes it difficult to determine a single Covid-19 IFR and to compare international Covid-19 mortality rates. Take my predictions with a grain of salt.

What I failed to predict in March was that the US curve would continue rising after it reached Spain’s and Italy’s end-of-March mortality rates. Given the extra weeks the US had to prepare its Covid-19 response and the CDC’s pandemic expertise, my assumption was that the US Covid-19 mortality curve would flatten sooner than Spain’s and Italy’s morality curves flattened, that the US curve would flatten at about the same per capita mortality Spain and Italy reached a month into their Covid-19 outbreaks.

Can the US get to 3x – 4x more Covid-19 deaths the way Chirstakis predicts? It’s easy to see at least 2x more Covid-19 deaths in the US the way its mortality curve is trending and easy to get another doubling with second and third waves of Covid-19.

What I failed to predict is how poorly the White House would respond. Or, perhaps more accurately, how much the White House would prioritize Trump’s re-election over public health.

As Trump pressed to get the economy going again, some US states relaxed their Covid-19 lockdowns too soon. They either didn’t meet the CDC’s guideline for 14 days of declining Covid-19 cases, or they didn’t have adequate Covid-19 testing and tracing in place.

Andy Slavitt explains the result of this early reopening by grouping states based on when they re-opened: the Rabbits, the Cheetahs, the Rhinos, and the Tortoises.

As Slavitt notes, the Rabbits are seeing Covid-19 cases increase while the Tortoises are doing just fine. In June, this is the measured change in Covid-19 cases for each group.

  • Rabbits: up 26%
  • Cheetahs: up 7%
  • Rhinos: down 31%
  • Tortoises: down 9%

Not every Rabbit and Cheetah is increasing and not every Rhino and Tortoise is decreasing, but the group averages indicate that the early-to-reopen states tended to open too soon.

Trump didn’t understand how to manage Covid-19 and he needed the economy working again to get re-elected. Now, as the states that opened too early are experiencing increasing Covid-19 cases, the US, and especially the White House, seems to be in a state of denial.

The lack of presidential leadership enables misinformation and poor policy choices at the state and local level. Some specific examples from Florida, California, and Louisiana.

Florida. Florida fired data scientist Rebekah Jones because she wouldn’t post bad data on Florida’s Covid-19 statistics site. Now Jones has launched her own Covid-19 site for Florida “showing far more COVID-19 information than she said the state allowed her to report as an employee, including statistics contradicting Florida’s official coronavirus numbers and the push to reopen the state.”

California. Orange County residences made violent threats against former Orange County Health Director Nichole Quick after her mandatory mask order. “The county sheriff said his department would not enforce the mask rule.” Quick resigned and the county rescinded her order. Masks are now encouraged, but not mandatory.

Lousiana. More New Orleans residence have died of Covid-19 than died during Hurricane Katrina. The federal response to Covid-19 in New Orleans is worse than its botched response after Hurricane Katrina, bringing up the question whether Washington, D.C., and this White House in particular, cares to help minority communities. “About a third of Louisianans are Black, but in the early going, Blacks were doing 70% of the dying, a figure that has fallen as the virus spreads among people who probably never thought their own health was tied so directly to the less fortunate, the unemployed, the uninsured.”

I could expand this list, but you get the point. Trump is only concerned about fixing the economy, or making it appear that the economy is back on track, so he can get re-elected. It’s unlikely, however, that anyone can fix the economy until public health is fixed. And it’s not that hard to change a few behaviors that likely would fix public health.

If only the president were a woman.

Female leaders managed their countries’ Covid-19 responses better than their male counterparts.

The US could have had a female president. Too bad. It’s stuck with Trump, at least through January, and the Democratic alternative is a man.

My big fear? It’s not how soon a Covid-19 treatment comes. It’s not how soon a Covid-19 vaccine comes.

My big fear is that Trump normalizes 1,000 US Covid-19 deaths every day by drawing the country’s attention to less important issues. Like his re-election.

If you need help visualizing how bad Covid-19 is, I tweeted this great visualization of Global Cause of Death.

2020 Global Cause of Death.

Trump may be in a state of denial, but the world is not. The Covid-19 numbers are too bad to deny the human toll. The only question is how soon does the US acknowledge Covid-19 is a problem that won’t be denied. How long is its state of denial?

14 June 2020 – Sunday – #91

Once I boarded the correct train, the ride up the coast to El Masnou was beautiful yesterday. Turns out it’s better to wait to make sure it’s the right train than to make a dash for a departing train headed the right direction.

Renfe R1 train near Badalona, 13 June 2020.

The passengers on the ride to El Masnou were comfortably spread out and everyone wore masks. The ride back was standing room only, though, filled with sunbathers returning before sunset. Everyone wore masks except a couple with an infant.

It was my first trip outside Barcelona since I arrived on the first of January. I didn’t get too far outside city limits. Still, after nearly six months, it was nice to have the perspective of looking at Barcelona from a distance rather than being in Barcelona.

Barcelona from El Masnou, 13 June 2020.

The New Abnormal is good so far in Spain. Spain had the worst per-capita Covid-19 mortality of any country, but also had the best turnaround, down now to an average of four Covid-19 deaths per day. There was a Covid-19 breakout in a Bilbao hospital, but authorities seem to be on the case. The central government announced Spain will open its borders on 21 June, a compromise between Spain’s desire to open its borders 1 July and the EU’s desire for Spain to open 15 June.

The New Abnormal isn’t normal. There’s the fear of another outbreak. After all, China appears to have a new Covid-19 outbreak after two months of smooth sailing. It is closing down the south part of Beijing after 57 new cases were reported in a day.

Mask compliance is good in Barcelona. Depending on the study, compliance needs to be above something like 80% to stave off Covid-19. This Covid-19 mask graph is flying through my social feeds right now.

Comparison of Covid-19 confirmed cases with and without mask rules.

The mask study of Wuhan, Italy, and New York is the first empirical study I’ve seen. Previous mask studies are in the lab or on a computer. Clearly, it would help to have more data from more locations, but so far this study by researchers from Texas A&M University, the University of Texas at Austin, California Institute of Technology, and the University of California San Diego backs up the theoretical claim that masks attenuate Covid-19 transmission with real life data.

It looks like all we might need to do until a vaccine comes along is wear masks.

Speaking of a vaccine coming along, Europe is securing Covid-19 vaccine delivery from AstraZeneca.

The deal is the latest by AstraZeneca to promise to supply its vaccine to governments who have scrambled to agree advance purchases of promising coronavirus immunisation treatments.

Reuters, “AstraZeneca agrees to supply Europe with 400 million doses of COVID-19 vaccine,” 13 June 2020.

Right now, AstraZeneca plans to provide the Oxford vaccine, assuming it passes all the trials. It seems a little early to me to place bets on a particular vaccine, but probably good news that governments are negotiating terms sooner than later regardless of what vaccine comes to market. Giving pharmaceuticals a guaranteed purchase de-risks their development, not only for financing, but also for testing, manufacturing, and distribution.

The only thing that really matters in Spain until a Covid-19 vaccine shows up is soccer, of course. Turns out technology from game maker EA is helping ease the pain.

In the US, soccer isn’t important, but politics sure is.

Republicans are hell-bent on keeping the economy open. They should take a cue from Europe. With Covid-19 in the rear view mirror, the Spanish economy seems to be recovering quickly. Instead, Republicans are arguing against all the evidence that people will act normally during a Covid-19 outbreak.

Trump, in his delusional post-Coronavirus bubble, has sidelined the CDC. Luckily, Dr. Frieden has been kind enough to provide weekly updates on behalf of the CDC.

Dr. Frieden provides the CDC weekly update since the CDC can’t.

To my American friends who insist on staying in the US, I’ll just point out that the cost of Covid-19 is high not only in terms of US economy, but also your pocketbook. Take the case of Michael Flor.

The total tab for his bout with the coronavirus: $1.1 million. $1,122,501.04, to be exact. All in one bill that’s more like a book because it runs to 181 pages.

The Seattle Times, “Coronavirus survival comes with a $1.1 million, 181-page price tag,” 12 June 2020.

Net of government Covid-19 programs, Flor probably wont have to pay more than US$6,000, but that’s still more than double my annual health insurance premium in Spain.

If you want to leave the US, if you’re willing to wear a mask until there’s a Covid-19 vaccine, and if you want to fly to Barcelona, you’ll want to think through the odds of dying on the way. Brad is thinking about this right now and he found this handy Twitter thread to help him.

Here’s a back-of-the-envelope estimate of dying from Covid-19 on a long flight from San Francisco.

Estimated odds of dying from Covid-19 on a long flight departing from San Francisco.

It looks like it’s still safer to fly than to drive a car. If your fellow travelers are willing to wear a mask, then it’s almost as safe as my train ride to El Masnou. Hope to see you in Barcelona soon!