4 October 2020 – Sunday – #115

Last weekend two things Covid happened. One is that a friend in Barcelona, whom I’ll refer to as C., got sick with Covid-19. The other is that the White House hosted a Covid-19 superspreader event to honor the nomination of Amy Coney Barrett to the Supreme Court.

When C. told me last weekend he didn’t want to meet up because he thought he was coming down with a flu, there was something in his voice that made me ask if he’d lost his sense of smell, a sure sign of Covid-19. He said no, so I relaxed and told myself not to be paranoid. Memories of the AIDS crisis, when every sniffle seemed like a premonition of infection and death. Covid-19 is rare in Barcelona and Catalonia these days. Hospitalizations have leveled off for a month and new cases look like they’re dropping. The transmission rate R stayed below 1.0 all September except for mid-month when it bubbled up just over 1.0 for a week.

In the middle of last week, though, C. did lose his sense of smell, confirming what I thought I heard in his voice. C. is younger than forty, so he’s not high risk. I check in with him every day or two. He’s feeling under the weather and he’s concerned about infecting others, but he’s okay for now. There’s not much for him to do but wait it out. I worry because just when Covid-19 looks like it’s clearing up, it can take a turn for the worse. But that’s my paranoia. Things go south far more frequently for people my age than C.’s.

While things Covid are okay here in Catalonia for now, they are bad elsewhere in Spain, especially Madrid. Currently Madrid has over one third of the Spain’s new Covid-19 cases. Under protest, the regional government will implement the central government’s Covid-19 restrictions this weekend, putting Madrid back into a lockdown. The politics of this are still a little complex for me.

Like conservatives in the US, conservatives in Madrid don’t want the state telling them how to lead their lives. While the conservative attitude towards Covid-19 is often expressed as a desire to control one’s own health decisions, this expression seems more like a rationalization of a different attitude, that my money is more important than whether I’m a viral vector for your infection.

Speaking of Madrid and conservatives, I want to divert for a moment to an observation that female leaders outperform male leaders in managing Covid-19. Early data through mid-May suggest that observation holds, at least at a national level.

F-led and M-led countries matched using GDP/pc, Pop, Pop Density and Pop over 65.

However, the observation is not holding true at the regional level. Clearly Madrid is flunking Covid-19 containment. The president of the Madrid region is Isabel Díaz Ayuso, a member of the conservative PP who’s been leading the region for about a year.

In the US, South Dakota Governor Kristi Noem, a Republican, is another counterexample to females leading successful Covid-19 responses. Noem is guiding her state through one of the worst state Covid-19 responses. South Dakota hosted, for instance, the Sturgis Motorcycle Rally which was a Covid-19 superspreader event.

It’s clear that leadership is an important—perhaps the most important—factor in the success of a Covid-19 response, both in terms of health and economy. Based on data so far, it appears males are less likely to lead an effective national response than females, and conservatives are less likely than liberals. That doesn’t mean, though, that any particular woman or liberal will succeed. I can’t wait for the PhD theses on this topic.

Madrid doesn’t have a monopoly on Covid-19 resurgence. Things Covid also are bad in Paris. Nicole planned a trip there for a “zero” birthday. In these days of Covid-19 travel, it’s hard to know what to do as conditions change on the ground. Last I heard, the plan is to take the trip and avoid public spaces. With masks and ventilation, that seems reasonable. Travel trade-offs are impossible right now.

Back to last weekend’s events. Besides C.’s Covid-19 infection, the other thing that happened last weekend was a White House superspreader event that appears to have resulted in Trump’s Covid-19 infection. The White House response to Trump’s infection gives me an opportunity to talk about Covid-19 misinformation.

In the past 72 hours, 27 people who were at the White House event last Saturday or who subsequently had contact with people at the event have tested positive, mostly Republicans and including POTUS, FLOTUS, three Republican US senators, and former Republican governor.

As this number increases, Covid-19 is throwing the Republican party further and further into disarray with an election 29 days away. I’ve read the word “schadenfreude” more in the last 24 hours than in the past 24 years. Republican party Covid-19 misinformation came back to haunt its lovely Supreme Court nomination party.

It’s an old story.

Parenthetically, check out this great story in The Atlantic about Covid-19 reproduction rates (R) and dispersion rates (k). You’ll understand how Covid-19 thrives at events like the White House superspreader.

The problem for Trump is that his infection throws his entire campaign on its head. Not wearing a mask, it turns out, has consequences. Trump’s infection runs counter to the campaign narrative that Covid-19 is over and the US is back on track. It forces the message back to today, not what the US might look like in a year or two. Trump’s Covid-19 misinformation campaign blew apart in his unmasked face. His challenge now is to become the hero of this catastrophe at the same time he’s ill in the hospital.

One might hope that the White House would worry about the presenting the facts and advising anyone who’s been in contact with Trump to test and quarantine. Nope. Studies came out in the last week showing Trump is the source of over one-third of all articles with Covid-19 misinformation (as well as lots of voter fraud misinformation), so it’s no surprise that in the aftermath of the superspreader party, the White House misinformation machine spews misinformation as Trump recuperates.

One of the new stars in this misinformation campaign is telegenic White House physician Sean Conley who insists Trump is fine while misspelling the names of the experimental treatment Trump had and correcting his timeline of events. The fact that Trump was receiving an experimental treatment is a sign that either he’s much sicker than Conley stated or he’s been watching Fox News suggest he take the treatment. Or both.

With performances by Conley and others, it’s hard to know what’s true in Trump’s Covid-19 saga. The worst reports, though, line up best with the action of moving Trump from the White House to Walter Reed Hospital. It seems Trump was contemplating death on Friday.

On Friday, Trump grew visibly anxious as his fever spiked to 103 fahrenheit and he was administered oxygen at the White House, according to three Republicans close to the White House. Two sources told me Trump experienced heart palpitations on Friday night—possible side effects of the experimental antibody treatment he received. Trump has wondered aloud if he could defeat the disease. “Am I going out like Stan Chera?” Trump has asked aides, referring to his friend, New York real-estate developer Stan Chera, who died of COVID in April.

Vanity Fair, “‘This is Spiraling out of Control:’ Allies Panic About Trump’s Hospital Stay as White House Deflects,” 3 October 2020.

After Trump moved to Walter Reed, the White House spin machine started. Even when the White House does its best to make Trump look good in videos and stills, though, he doesn’t.

Saturday’s photo shoot at Walter Reed is full of reality TV props to make everything look normal.

But it’s obvious that much has been edited (in this case with an Adobe video editing product), that we’re watching the reality TV version of Trump’s recovery.

This Twitter thread illustrates more of the problems with the underlying message in Saturday’s photo shoot, the misinformation that all is well and Trump is ready for his heroic comeback.

Trump has relied on misinformation during the entire Covid-19 pandemic. He’s not stopping now. The net result is no one knows what’s going on.

I’ll go back to my friend C. for a minute before I wrap up because C. is a real person in my life, not a reality TV star.

C. got his Covid-19 infection about the same time as Trump. The difference is that C. is young and in good shape. Not that any two case are the same, but Trump’s probably is worse than what his physician claims. Trump probably felt bad enough Friday to think he was going to die. C., on the other hand, never felt like he was going to die.

I worry about C., but his chances are good. His voice sounds healthier now. His mood is better. In real life Covid-19 sucks. C. doesn’t need to mislead me.

Trump? He’s a con man. I’ve never believed his spin. I look at the misinformation and wonder why he insists on it right now. The subtext of his entire recovery misinformation campaign is that he does need to mislead me. I don’t wish him ill, but I think his misinformation suggests he has a very rough week coming up.

Covid-19 bits.

Stay safe in all your travels. Keep your distance, wash your hands, and wear a mask.

I write this for my sanity. Daily updates on my Twitter feed. Pass on to friends and family.

27 September 2020 – Sunday – #114

I waited in line to vote Friday. It was the line at the Correo, of course, because I have to vote by absentee ballot. “Estoy votando,” I proudly told the clerk once I made it inside the post office. “No más Trump.”

The clerk smiled and said something in Spanish I didn’t understand.

The line at the Correo when I went to mail my ballot.

Friday was a watershed day, many projects coming to fruition. I mailed my absentee ballot, paid a franchise tax on a corporation, received an insurance reimbursement, and bought Rabih’s book An Unnecessary Woman, a book I’d ordered for a necessary friend at one of the English bookstores in town. None of these projects seems earth shattering. In the U.S., each would have taken ten or fifteen minutes. Here, though, each of them took me about a month. It’s part of adjusting to a new country.

I won’t bore you with all the details, but there are always surprises during the most mundane tasks. For instance, when I started the absentee voting process, I needed to print application forms. I’ve given up on owning a printer. For the number of times I print in a year, the cartridge is invariably dry when I want to print. Instead of going to a printing shop to buy a fresh cartridge, I go to a printing shop and print.

I expected to print my absentee voting application at the shop around the corner, the shop with the handsome clerk I chat up those handful of times I print documents every year. Except, of course, this happened last month, and last month was August, and in August, I learned, shops are open at random times if they’re open at all. I’m sure my handsome clerk must have been sunning on a Sitges beach when I dropped by to print my absentee ballot application.

After walking past four other printing shops Google Maps offered me, all of which were closed for August, I found the one printing shop that’s open all year in Barcelona. If you should ever need it, you’ll find it along Av. Diagonal near the furniture stores. The task of printing applications that should have taken ten minutes took half an afternoon.

I don’t know why I didn’t anticipate another surprise at the end of my voting project. That surprise was the line at the Correo when I went to vote (image above). Instead of spending five minutes to get a tracking number for my ballot, which by now was invaluable with all the time it took to complete, I spent nearly a half hour in line first. At least it was pleasant weather outside. From the first step to the last, absentee voting took longer than expected.

I’m sure in a year or two I’ll have all these details of living in Barcelona worked out. I’ll know to look for the handsome clerk in Sitges in August instead of visiting his store. I’ll know the magic hour when there’s never a line at the post office. For now, though, I feel like a child learning new language and customs. In other words, I’m scratching the surface.

Also on Friday, I talked to Henrique about traveling next month. Henrique has expiring AirBNB vouchers and I said I’d go along for the ride. The prime candidates were the Canary Islands, Valencia, Sevilla, Girona, Llançà, and pretty much any other Catalan location since Covid-19 levels are good here.

Checking Covid-19 infection levels is now part of travel planning. Here’s a list of Spanish regions and their Covid-19 infection rates.

Covid-19 cases per 100k inhabitants by region.

I’ll tell you where we’re going when we get there, but here are a couple places we’re not going due to Covid-19. No problems with Covid-19 levels in the Canary Islands and it’s warmer there this time of year, but it’s a 3-1/2 hour flight from BCN. I wasn’t too excited about that. Andulusia would be a little warmer, too, but there aren’t any recent Covid-19 statistics. That left Valencia and Catalonia.

Madrid was out of the travel picture without even mentioning it. At 750 cases per 100k inhabitants, it is dangerous to be there. The Madrid region is tightening its Covid-19 restrictions. Simultaneously the central government said Madrid had to do more and offered 7,500 troops to help with testing and tracing.

The New York Times deigned to opine on Spain’s Covid-19 problems. I have a limited understanding of Spanish politics, but that doesn’t keep me from disagreeing with many of the points in the opinion piece. However, I completely agree with this point.

One of the keys to slowing the spread of the virus is to perform polymerase chain reaction testing on as many people as possible who have been in contact with infected people. But the average number of potential cases that Spain manages to trace is lower than Zambia (9.7 for every confirmed Covid-19 case), one-fourth that of Italy (37.5) and one-twentieth of Finland (185).

The New York Times, “There’s a Simple Reason Spain Has Been Hit Hard by Coronavirus,” 24 September 2020.

The countries that beat Covid-19 have several attributes in common including strong leadership and good testing and tracing. National wealth and system of government do not correlate with outcomes. More and more, evidence points to controlling Covid-19 outbreaks as the most effective step in economic recovery from the pandemic.

Public Health Professor Devi Sridhar describes correlation between Covid-19 control and economic recovery.

Sweden continues to be used as an example of prioritizing the economy successfully, but the arguments don’t hold up. Here’s a thread comparing and contrasting Covid-19 responses of Sweden and New Zealand.

Devi Sridhar compares Covid-19 responses of Sweden and New Zealand.

Trump is candidate number one for consistently poor Covid-19 decision making and leadership. He prioritizes the US economy over its public health. A former member of the White House Coronavirus Task Force describes how Trump distracts policymakers at meetings and overrules scientific determinations.

Oliva Troye describes breakdowns in Trump’s Covid-19 decision making.

Unfortunately, Trump supporters don’t connect his poor Covid-19 leadership with the prolonged outbreaks that are shutting down more businesses than necessary. One restaurant owner forced to close a family restaurant in Maryland recycles Trump’s rationalization that the cure is worse than the disease rather than pointing out the obvious: stronger testing and tracing would have got businesses open earlier and safer.

It’s like Trump said: The cure has been worse than the disease. People spent too much time at home watching the news all day, drinking in this hysteria until they were spraying down their groceries and afraid to leave home. It became another anti-Trump thing in the press. The impeachment didn’t work, the killer bees didn’t work, so let’s blow covid out of proportion and see if it hurts him. But it’s the rest of us that got hurt. It was day after day of failure. It was a slow and painful death.

Sunset Restaurant manager Mike Fratantuono

No matter where you are in the world, if you can vote in the U.S., please join me in voting. For all the hassles of voting overseas, it was worth it to post my ballot.

Some other Covid-19 tidbits from last week.

Please wash your hands, keep your distance, and wear a mask.

Here’s Dr. Fauci putting Senator Rand Paul in his place.

Later, one of Senator Paul’s patients explained his new community immunity!

Blaire Erskine on Community Immunity.

20 September 2020 – Sunday – #113

It was fish on the menu last week. Brad had a mid-week hankering for sushi, so we walked a few blocks down Carrer del Bruc to Sun Taka for my first sushi meal in Barcelona. Didn’t have room for the sea urchin–I didn’t even realize it was the season already–but did try raw scallops the first time. I’ll be back for both.

Then yesterday I found myself in Girona. With fresh memories of Girona after our trip a couple weeks ago, Brad and I played tour guide for our Catalan friends Joanmi and Francesc. This trip was by car instead of train and took about the same time door-to-door. We viewed the Barceloninan landscape artist Modest Urgell and other Catalan artists at the Museu d’Art de Girona, and then descended to L’Estrella del Mar where Joanmi and Francesc selected almuerzo from the fresh catch.

Fresh catch at L’Estrella del Mar in Girona.

Joanmi told me he considered the restaurant typical for a good fish restaurant. That convinced me never to be a food critic because the place seemed like a great catch to me. I must be adjusting after five years dining in New York where this large a meal with this quality food prepared this well would cost 2x – 3x more, and still wouldn’t be nearly as fresh.

All this is by way of saying that, notwithstanding my mother’s reports about Spain from the US press she reads, dining and travel in Catalonia feel safe. In fact, here’s a picture of how the Covid-19 situation in all of Spain has improved in the past week.

Number of new Covid-19 cases and Re in Spain (source COVID-19 Re)

Spain’s post-lockdown Covid-19 cases increased more than anywhere else in Europe. I’m repeating myself when I write that this has been due primarily to bad Covid-19 outbreaks in three regions, Madrid, Murcia, and The Basque Country. The graphs above looked bad for Spain until the last week when trends started going the right way.

The Murcia government still doesn’t seem to have a handle on the health situation, but at least Madrid finally ordered, or might have ordered, new Covid-19 restrictions on Friday. I write might have ordered because the conservative government in Madrid gave the health director’s new restrictions a less than resounding endorsement.

Before I dive into Spanish politics, though, I note that Catalonia’s Covid-19 cases also went up after the lockdown, but leveled off quickly when public health authorities here put a few restrictions in place. Here’s a graph showing how Catalonia is managing Covid-19.

Outbreak risk and Re for Catalonia (source: Catalan News).

The Covid-19 effective reproduction rate Re (yellow bars above) went up the last two weeks of June, leveled off for a couple weeks, has been declining since mid-July, and has been less that 1.0 since the beginning of this month.

In some ways, Spain looks like the US. I can say Covid-19 is bad in both countries, but I also have to qualify where it’s bad for both countries. For Spain, I have to say it’s not bad in most places, but it’s really bad in Madrid and Murcia. For the US, I have to say it’s not bad in most places, but it’s really bad in North and South Dakota, Arkansas, Wisconsin, and Utah.

On the drive back from Girona, I quizzed Joanmi about the Spanish government and its Covid-19 response. Why is Madrid so different from Catalonia? Have Spain and the US had poor Covid-19 responses (Spain’s response relative to the EU, the US response relative to the world) because they share similar public health organizational structure? This turned out to be a good way to fill up an hour long road trip and I’m not going to bore you with the details.

The long and short of our conversation is that, yes, both Spain and the US have decentralized public health. In Spain, public health is managed at the regional level (there are 17 regions with, as far as I know, 17 different public health authorities). In the US, public health is managed at the state and territorial level. Both Spain and the US have central government public health authorities whose role is to coordinate the local authorities. That’s where public health similarities end.

The big difference is that, while Spain has a central public health authority, the authority has no resources. As Joanmi put it, Spain’s central public health organization consists of a minister and the receptionist who answers the phone. The US, on the other hand, had a world-class public health organization in the CDC, an organization that Trump has downsized and stripped of authority as he and his son-in-law dictated a free market response rather than a public health response to the pandemic.

Kushner, seated at the head of the conference table, in a chair taller than all the others, was quick to strike a confrontational tone. “The federal government is not going to lead this response,” he announced. “It’s up to the states to figure out what they want to do.”

Vanity Fair, “‘That’s Their Problem’: How Jared Kushner Let the Markets Decide America’s COVID-19 Fate,” 17 September 2020.

Joanmi also noted that the German government, which has a similar public health structure to Spain, had an effective Covid-19 response because Germany’s federal public health authority has the resources and credibility to coordinate German regions. Completely centralizing public health doesn’t seem to work. France and its centralized government structure performed about as poorly as Spain

But there’s something else interesting going on that Joanmi and I didn’t talk about, something that’s transcending comparative public health.

Covid-19 cases are becoming less deadly. Below is a graph of Case Fatality Rates (CFRs) for Spain and the US. The same thing is happening almost everywhere. Fewer people who get Covid-19 are dying. That’s a great thing, but why is it happening?

Case Fatality Rate (CFR) for Spain and US (source: Our World in Data)

Dr. Monica Gandhi from UCSF gives the long answer.

Dr. Monica Gandhi from UCSF on declining Covid-19 death rates (starts around 32:30).

If you don’t have 15-20 minutes for Dr. Gandhi’s excellent presentation, I’ve summarized it on my Twitter feed.

Summary of Dr. Ganhi’s presentation on declining Covid-19 deaths.

If you don’t have time for that, here’s the spoiler: masks. But it’s important to understand why, so watch the video or read through the summary to understand why Dr. Redfield at the CDC was correct when he said that masks may be more effective than vaccines at stopping Covid-19, and why Trump is killing people when he contradicts Redfield.

I’m going to sign off this week with a reminder of what competent Covid-19 advice looks like.

Christian Drosten discusses Covid-19 outbreaks likely this fall and winter.

It’s going to be long year before we get vaccines, so wear a mask, keep your distance, wash your hands, and enjoy fresh fish!