13 September 2020 – Sunday – #112

Every month there seems to be at least one day of celebration in Barcelona. Friday was Catalonia Day, another annual holiday that most of Barcelona celebrates by closing down.

On the eve of Catalonia Day, Brad and I hosted four Catalan friends for a BBQ at Casa Solar. They are part of a group of Catalan men who call themselves “The Carnivores.” The Carnivores is an informal group that meets about once a month at a restaurant in Barcelona serving high quality meat.

Here’s what we grilled for The Carnivores.

Manel butchering a Txogittxu steak.

Since there was a lawyer and a cop at dinner, I was able to ascertain that local customs allow the growth of one or two of what might be called strong herbal plants on the terrace. No one will call the cops and I won’t need a lawyer.

After hanging with the Catalan, I feel like I’m scratching the surface of their culture. My Brazilian friend Henrique said that he feels like he never has any time since he moved to Barcelona a year ago. I told Henrique that I feel like a child learning Spanish and Catalan languages, food, history, and customs. It’s a 24/7 job.

Learning about food didn’t stop at dinner with The Carnivores this week. Last night I had a another more vegetarian Catalan food adventure cooking Cigrons amb Espinacs (Garbanzos with Spinach).

Cigrons amb Espinacs

If you buy me a vermut, I’ll cook it for you or give yuou the name of the Catalan cookbook, whichever you prefer.

It’s feeling safe to make food porn in Catalan, where new cases of Covid-19 remain level, and especially at home right now because Spain is lagging the rest of the EU in managing Covid-19 post-lockdown. Spanish officials are quick to point out that September isn’t like March, that even though Covid-19 cases are on the rise, they are asymptomatic with fewer deaths. That’s a nice rationalization of not doing a good job.

Besides Madrid, most of the new Covid-19 cases are in Murcia. Murcia is fighting Covid-19 restrictions.

Murcia protests over bar closings after Covid-19 cases spike.

Seeing Murcia protest over what are now common sense measures to prevent transmission makes me worry that Covid-19 misinformation is floating from the US across the Atlantic.

I write often about how misinformation from Trump, social media, Fox News, and OAN keeps the US from reducing its Covid-19 transmission. In a bombshell report last week from Bob Woodward’s book Rage last week, Trump acknowledges that he’s been hiding bad news about Covid-19 from the public.

MS-NBC and Washington Post report on Woodward’s book Rage.

After Woodward released his telephone calls with Trump, Trump claimed that his intent was to keep America calm. In this Twitter thread, David Frum examines how Woodward’s report and Trump’s response to Woodward’s report reveal Trump’s incompetence.

David Frum thread on how Woodward’s report shows Trump’s incompetence.

I boil down Frum’s arguments like this: Trump is incapable of articulating anything as sophisticated as the Covid-19 response that all European leaders were able to articulate successfully. It may be that Trump isn’t smart enough. It may be that his malignant narcissism traps him. It may be that the only way he knows to survive is to create chaos. It may be that he views all problems through the lens of money. It may be that he’s listening to Putin. It doesn’t really matter. Chose your reason, but Trump cannot figure out how to articulate a Covid-19 response that will stop or slow transmission in spite of having many examples of how to do just that.

Trump’s misinformation campaign continues today. His appointees at the CDC, including Michael Caputo and Paul Alexander, are doctoring standard CDC reporting on Covid-19 to advance Trump’s ineffable agenda. Alexander complained that the CDC’s Morbity and Mortality Weekly Report (MMWR) contradicts messaging from the White House.

“The reports must be read by someone outside of CDC like myself, and we cannot allow the reporting to go on as it has been, for it is outrageous. Its [sic] lunacy. Nothing to go out unless I read and agree with the findings how they [sic] CDC, wrote it and I tweak it to ensure it is fair and balanced and ‘complete.'”

Trump appointee Paul Alexander to CDC Director Dr. Robert Redfield. (Souce: POLITICO)

The Covid-19 stakes couldn’t be higher for the US with weeks left until the election. Fauci and several Covid-19 models expect another Covid-19 wave this fall, with one model predicting over 400,000 Covid-19 deaths in the US by the end of 2020.

One upshot of Trump’s Covid-19 misinformation campaign is that it gives people permission to ignore Covid-19 models predicting 400,000 deaths this year, or to discredit them when they don’t predict accurately. But epidemiologists use different models for different applications, statistical models to forecast, for instance, deaths under current conditions and mechanistic models to test what-if scenarios. Results from Covid-19 deaths forecasts are generally accurate for 2-3 weeks but, because conditions are changing rapidly, become less reliable further out.

Another upshot is bad data for the modeling. When Trump appointees edit scientific reports from the CDC and other sources, they can skew model results. The resulting chaos may play into Trump’s message that science doesn’t have the answers, but it also exacerbates the poor government response to Covid-19.

When Trump leverages CDC, social media, Fox, and OAN to con Americans with Covid-19 misinformation, it erodes trust in public health. This short video from a Trump campaign event last week shows the results.

Trump followers rationalize why they don’t need to wear masks.

The video shows three (white) men rationalizing why they don’t wear a mask, each in their own way. One says he can’t hear others speak when people wear masks (which shouldn’t keep him from wearing a mask), a second says that most people are dying of underlying conditions rather than Covid-19 (like saying Titanic passengers died because they couldn’t swim in freezing water rather than because the ship hit an iceberg), and the third says it’s God’s plan whether he survives Covid-19 (except that he might infect his friends and family which, from their point of view, would be his plan rather than His plan). When Trump allows people to crowd into his rallies without masks, he implicitly endorses these rationalizations. In effect: Hey, if POTUS says it’s okay, how can I be wrong? Social media, Fox, and OAN reinforce Trump’s con.

Unfortunately, there are real costs to Trump’s con. One, of course, is health. The other is money. A by-product of the Sturgis Motorcycle rally is the data on Covid-19 transmission that researchers need to characterize both costs. Here’s a screen grab from a UCSF Grand Rounds video that characterizes these costs.

Screen grab from UCSF Grand Rounds video showing costs of Sturigs Motorcycle Rally in South Dakota.

Because Sturgis attendees don’t bear most of these costs, they have no strong incentives to stay home. Because Trump implicitly endorses their behavior, attendees believe their own rationalizations that they should feel free to congregate without appropriate social distancing or masks. However, as the UCSF video points out, it would have been cheaper overall to pay each of the Sturgis participants $26,000 to stay home. This is an economic cost Trump and his followers don’t want to hear.

It’s an expensive con, to tell people things are going back to normal. Social media, Fox, and OAN make lots of money promoting Trump’s con. The Americans who believe the con and feel empowered to spread Covid-19 pay little of the costs of keeping Trump in power.

This gives me the sense that Trump’s supporters will continue to drink his KoolAid.

Trump followers without masks or social distancing at campaign rally.

For those who don’t know the beverage reference, the con man Jim Jones convinced his followers to drink cyanide-laced KoolAid in 1978 as US officials were unmasking him. Trump’s cult is behaving no differently from Jones’ cult.

Falling for Trump’s con, drinking his KoolAid is expensive. Trump’s campaign stops are about 5,000 people, about one hundredth of the size of the Sturgis event. After ten campaign stops, the US can expect another 25k Covid-19 cases and another $1.2B in healthcare costs. Trump will pay none of those.

I hope transmission of Covid-19 misinformation doesn’t reach Spain, especially at Trump’s scale.

Other notable Covid-19 tidbits from last week.

Last thing. Last week I made an attempt at a table summarizing Covid-19 vaccine development. The Internet saw how bad it was and came up with a much better graphic.

Chart of Covdi-19 vaccine testing status.

[Updated 18.40 CET to correct math error.]

I write this for my sanity. If you like it, pass it along to friends. For daily updates, follow me on Twitter.

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.