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.

6 December 2020 – Sunday – #124

I know you’ve been worried about me getting a flu shot. Well, maybe not, but my mother has been and that’s worse. If you haven’t been following along, my private healthcare system said last month that I only could get the flu vaccine from CatSalut, Catalonia’s public health system. But CatSalut wouldn’t let me access public health without paying into its system. Without access, no flu shot. I could have forgone the shot. Since getting a flu shot may be a preview of getting a Covid-19 vaccine, though, it seemed important to figure out how.

I know what you’re thinking. Just pay CatSalut and get the flu shot. I tried. It’s treacherous, practically Kafkaesque. To join CatSalut, I needed dispensation from the INSS, the Spanish Social Security system. Even though I haven’t contributed to Spanish Social Security, Royal Decree 576/2013 allows me to join CatSalut with a Convenio Especial for 60 euros a month. I won’t go in the details, but I’d almost given up finding the right form when Brad and I broke the code.

After a Spanish lawyer couldn’t figure out the right INSS form, I called another medical private practice I use. Maybe they had the flu vaccine. But no, the receptionist said, they also couldn’t get vaccine from CatSalut. Then she suggested buying the vaccine at a pharmacy. A pharmacy? That was news. Brad went online and saw that recently the flu vaccine indeed became available in Catalonia through pharmacies. Magically, the broken vaccine system fixed itself.

I found a flu vaccine. Not right away. The improved system isn’t flawless. The third pharmacy I asked had it. Brad got his flu shot Friday. I’ll get mine next week.

I tell my flu shot story because it’s an example of allocation problems during a pandemic. ICYMI, Covid-19 has created some difficult one-time allocation problems. That is this week’s Covid Diary BCN theme.

Before I get to allocation and scarcity, though, I want to mention (again) that Covid-19 restrictions work. As Covid-19 numbers improve, Catalonia is relaxing more Covid-19 restrictions in front of the holidays. While I’m reading the horrendous Covid-19 news from the US, I’m shopping, exercising, planning a Covid-19 restriction compliant Christmas eve dinner, and traveling up the coast. All without enormous concerns about either getting Covid-19 or accessing good medical care if I do.

The US healthcare system is collapsing in states where (mostly Republican) governors fail to implement Covid-19 restrictions. Hospital and ICU beds are so short that families are appealing for help on social media.

When people resort to social media for hospital beds, it’s a sign free market allocation isn’t working.

The irony, of course–and there seems to be an epidemic of Covid-19 irony–is that leaders advocating against Covid-19 restrictions they claim keep their economies from opening up have created scarcity that keeps many parts of the free markets from functioning. There is scarcity throughout US healthcare, from staff to physical plant to medical supplies, scarcity that can resolve itself in 3-4 weeks with Covid-19 restrictions but can’t be fixed for months without them. Needless to say, healthcare scarcity hurts people who need healthcare for maladies other than Covid-19. Like, say, a heart attack.

Vaccines are creating an entirely different set of allocation issues. It seems like having the first two Covid-19 vaccines coming through the gates at 90% – 95% effective would be great news. It would excellent news if the two companies making them could produce in 2021 the roughly 15 billion doses needed for humankind to achieve herd immunity (both vaccines require two doses).

However, because the first two vaccines are so highly effective, it increases exorbitantly the trial costs of other vaccine candidates which now need to demonstrate similar or better effectiveness. There may be ways to reduce the cost of vaccine trials with new methods, but it looks like most of the 50+ vaccine candidates in human trials won’t be able to afford to move forward even though a few of them may be cheaper, easier to distribute, or provide longer-term protection. A portfolio of Covid-19 vaccines also reduces risk of one-off problems like supply chain anomalies for a specific vaccine.

Allocation of scarce vaccine trial resources is one vaccine problem. Another vaccine problem is ramp up. With two Covid-19 vaccines completing Phase 3 trials and entering various approval cycles, vaccine talk is turning to who gets vaccine first, another scarce resource allocation problem. In the US, if everything goes right, UCSF’s Dr. Bob Wachter expects herd immunity around September 2021.

That’s if everything goes right. This month, every country, state, and region is determining who will get the first Covid-19 vaccine shots. Will the first shots go to healthcare workers and nursing homes, or to essential workers in places like grocery stores where spread risk is high, or to bankers? Wait, bankers? Well, yeah, if you advocate that the economy is more important than people’s lives, if you advocate for opening the economy over Covid-19 restrictions, then wouldn’t you want to protect your banker first? More irony.

I’m waiting for Sarah Palin to trot out her “death panel” resource allocation scare tactics. Regardless of how fair you think socialized medicine is, your public health system is prioritizing life and death this month. The more people wear masks and keep their distance, the less life-and-death these scarce vaccine allocation decisions become. That seems like a pretty easy trade-off to me.

In every country, vaccination is a complex problem. Spain has decided the first 2.5 million people to receive Covid-19 vaccines will either be in nursing homes or be at-risk healthcare workers. After that, it’s essential workers or people with health risks. The devil will be in the detail.

My flu shot story at the top of this post gives me hope that CatSalut eventually will get to me, but I’m not expecting one-time allocation to work well. No matter where you are, you shouldn’t either. I hope the pattern of one-time allocation of scarce resources is becoming clear by now. One-time scarce resource allocation is hard and free markets rarely help. The best outcome for everyone is to avoid getting Covid-19 for the next 6-9 months.

To the best of my knowledge, the Trump administration has no nationwide plan in place to distribute and administer a vaccine in the US. It’s worse than that. In order to make Covid-19 numbers look good, Trump has mismanaged or broken reporting systems. For instance, Covid-19 hospital reports don’t reflect conditions on the ground. The evidence suggests that the only allocation problem Trump knows how to solve is how to allocate other people’s money to his pocket.

President-elect Biden will take over about a month after vaccines become available. His choice of Ron Klain as chief of staff will help, as will the task force he assembled in his first announcement as President-elect. A lot of his success will depend on Covid-19 vaccine messaging. Biden already has set the tone by asking Americans to wear masks for the hundred days after his inauguration. But getting them to take Covid-19 vaccines is a whole different ballgame.

If you’re in the US and want to see how many doses of Covid-19 vaccines your state will receive, check the Covid-19 Vaccine Allocation Dashboard. I’ve put it on the Resources page. It’s still amazing to me how much Covid-19 information comes from private efforts rather than government portals.

Another aspect of resource allocation during the pandemic is Covid-19 stimulus packages. As Covid-19 distorts markets and capitalist economies fail to provide food and resources to people, governments have to step in. After passing a stimulus package at the beginning of the pandemic, the US has been unable to agree on a new stimulus package. Among other problems, that will leave 2% of US households (representing about 10% of the population) homeless on New Year’s day.

Stimulus packages have highlighted the biases and structural problems in the US. When the current negotiations started before the November election, Republicans demanded a $500 billion package and Democrats demanded a $2 trillion package. Republicans wanted a smaller package because most of the aid would have gone to blue states. But as Covid-19 spreads to more red states and those states run into economic problems, Republicans now are coming around to a $1 trillion bipartisan proposal. Covid-19 is straining the US political system, highlighting the way the structure of the Senate and electoral college work against the financial interest of a majority of Americans during a crisis.

In the new Covid-19 stimulus package, the US congress probably won’t address structural inequality highlighted by its first package. For instance, a study of PPP payments to restaurants shows a payment bias towards restaurants in wealthier communities. The payment bias probably resulted from the way the program was administered by banks through the SBA. Restaurants in places with healthy banking infrastructure had easier access to cash. In this case, Covid-19 has shown that bias in the US system favors those who already have resources during a crisis. It also highlights that “free markets” probably aren’t providing equal access to resources when there isn’t a pandemic. Poor people have to try harder.

Misinformation compounds problems of allocating scarce resources. Regardless of what continent you are on, this is a great Twitter thread on beating the misinformation about Covid-19 vaccines.

Today’s example of Covid-19 misinformation comes from Covid-19 where Dr. Steven LaTulippe spoke at a Republican “Stop the Steal” protest.

It’s pretty easy to pick out the misinformation if you’re paying attention, and even easier to believe what LaTulippe says if you want to rationalize not using a mask. When he says Covid-19 is just like the flu, he’s wrong. When he says that N95 masks don’t filter Covid-19, he’s wrong. Oregon suspended LaTulippe medical license after this talk.

There was also a kind of misinformation about the origins of Covid-19 floating around my social media bubbles last week. Here’s a good Twitter thread challenging the CDC study.

Also, I wrote a Twitter thread addressing why understanding Covid-19 origins is important.

Covid-19 bits.

My favorite Covid-19 related story last week comes from Belgium. József Szájer, a Hungarian MEP who helped author Hungary’s 2011 constitution that forbids same sex marriage, was caught escaping a men’s sex party. The party ran past the Covid-19 curfew. After police caught Szájer, he issued a statement: “I apologise to my family, to my colleagues, to my voters. I ask them to evaluate my misstep against a background of 30 years of devoted and hard work.” I understand Szájer. Those gay parties are hard work.

No matter where you are, the best thing is to cancel any holiday travel. If you decide to risk a family gathering, everyone should get a Covid-19 test and quarantine for 10 days before gathering. That’s especially true in the US where hospital and ICU beds are in short supply.

Please wear a mask, keep your distance, and wash your hands this holiday season. I don’t do these things for me, I do them for us.

I write this for my own sanity. If you like it, please pass along to friends and family. For more frequent Covid-19 updates, follow me on Twitter.

29 November 2020 – Sunday – #123

Happy Thanksgiving! I made my first annual Paella Pavo-rita and my first Spanish language pun at the same time. It’s a Paella Valenciana, with turkey substituting for chicken.

Paella Pavo-rita.

Brad found a cranberry adjacent accompaniment and Amy lived up to her commitment to bring pumpkin ice cream with the tasty improvisation she brought. That was the guest list for this year’s small Covid-19 restriction compliant gathering.

In Spain, Thanksgiving is known as El jueves, or just another Thursday. However there are signs of American influence on this particular Thursday. For instance, Amy mentioned that the butcher at Mercat de l’Abaceria had turkey, whole and in pieces. He showed her a list of all his American customers who’d ordered a bird. Other traditional ingredients like allspice and raw cranberries are more problematic.

On the day after Thanksgiving, there also is an American-influenced Black Friday (in English). As the next photo shows, however, it’s a bit more understated here than in the states.

Black Friday sign at Carmina shoe store on Avinguda Diagonal.

The joke is that the only reason Spanish retailers have adopted Black Friday is so they can jack up their prices most of November in advance of a big one-day sale.

Barcelona is all decked out for Christmas. Here, in fact, are tastefully decked out decks above the tasteful Chanel store on Passeig de Gracia.

Christmas decorations above the Chanel store on Passeig de Gracia.

Why is it that I want to see the rent agreement that makes this perfect display possible?

A few steps down Passeig de Gracia, the Philipp Plein store has adopted a holiday skull theme, a theme which I take as an homage to Covid-19. After all, with November’s vaccine news, this may be our last chance to celebrate the holidays and look fashionable with a mask.

Skulls abound at Philipp Plein on Passeig de Gracia.

In a similar vein, the Centre d’Optometria on Carrer del Rosselló turned a motorcycle helmet into a cross between a Philipp Plein inspired skull and Damien Hirst’s For the Love of God.

Motorcycle helmet at Centre d’Optometria.

I’m not sure what the metaphor is here. Glasses protect you from Covid-19? The end is near / so buy them here?

There were two significant differences I noticed this year between Black Friday here and Black Friday in the states. The first is crazy lines. There were lines outside the stores here, mostly on the order of 5 to 10 people and mostly so shops stayed in compliance with Covid-19 occupancy restrictions.

In Los Angeles, on the other hand, helicopter views of shoppers reminded me of what life was like before Covid-19.

The other difference? Covid-19 numbers in Barcelona are under control again while most of the US needs a lockdown stat. Here’s what things look like as Catalonia starts relaxing the latest round of Covid-19 restrictions.

Covid-19 reproduction rate R (yellow) and Outbreak Risk (blue) in Catalonia as of 27 November 2020. Source: Catalan News.

The reproduction rate R has been well below 1.0 for weeks. As expected, hospitalizations are falling off. We still have a 10p curfew and a limit of six for social gatherings, but the holidays will be relatively safe in Barcelona.

On the other hand, here’s how the US is doing versus other countries in distress.

Covid-19 cases in 10 most affected countries as of 27 November 2020. Source Johns Hopkins

Like Spain, the European countries in the chart above—UK, Germany, and Italy—saw Covid-19 numbers increase in October and imposed Covid-19 restrictions around the beginning of November. The chart shows how Covid-19 infections in all three of those European countries peaked and now are dropping. While Trump has been in the White House or on the golf course sulking about his loss, the US has applied few new restrictions and Covid-19 cases are climbing inexorably (the recent bump down probably is a holiday reporting anomaly).

It is frightful to watch America’s healthcare systems collapse. Twitter is full of threads from healthcare workers documenting the collapse in most states. Typical story lines are either no ICU beds or no hospital beds left to admit ICU patients. One example:

The price of Americans insisting that they know what’s best for their health care? The advent of Governor Palin’s dreaded “death panels.” Healthcare workers now make the decisions about who lives and who dies from Covid-19. Forget about routine medical procedures.

Three things kept Americans’s minds off Covid-19 last week, Thanksgiving, Black Friday, and the news that enough states certified election results for President-elect Biden that he will win the Electoral College next month. The slow motion transfer of power has started officially, but it will take months before Biden can implement new Covid-19 policies. Trump and his legal strike force made election fraud noise all week in court and with Republican legislators. His fruitless protests primarily appear to provide fodder for fundraising because they aren’t changing the outcome of the election.

Parenthetically, last week’s assassination of Mohsen Fakhrizadeh looks like a hit job by Israel to draw the US into a conflict with Iran before Trump leaves office. Trump needs to line up US$1 billion to refinance his debt in the next four years. My little conspiracy theory is that Netanyahoo’s meeting with Saudi Arabia two weeks ago was, in part, to get Saudi buy in on the assassination and to agree on what to pay Trump if he starts an Iranian war. Trump’s strange DoD personnel changes after the election appear to insert loyalists in the chain of command who would follow Trump’s order to start such a war. Obviously war with Iran would be yet another huge distraction from Trump’s disastrous Covid-19 response.

Two small election footnotes. One is the letter of ascertainment Emily Murphy of the GSA sent to the President-elect. In the letter, Ms. Murphy informs Biden that the GSA will provide resources for a presidential transition. It’s a small thing, but her salutation is “Dear Mr. Biden” rather than “Dear President-elect Biden.” While Ms. Murphy asserted at length in her letter that the delay in her ascertainment had nothing to do with White House political pressure, her salutation has the White House’s fingerprints all over it. It is not Ms. Murphy who is refusing to address Biden as President-elect.

The other is how this election affected my writing. My mind keeps working on my writing long after I step away from the keyboard. How do I know? Most mornings when I’m working on a piece, I wake up with a few ideas. It’s a little freaky. For instance, I’ve woken up and thought of a specific word change in the middle of a hundred thousand word novel. Lately, though, I’ve had a mental block. My strange mind games stopped for the past few anxious months. The block stopped Monday night, the night it was clear Biden had the electors needed to win, the night it was clear Ms. Murphy would have to ascertain the election. After months of waking up without new ideas, Tuesday morning, I woke up with two ideas for my novel.

I will credit Trump with keeping Covid-19 off many people’s minds. About 30% of American’s minds, to be more precise.

How worried Americans have been about Covid-19. Source: fivethirtyeight.com

Americans are more worried about the economy than about Covid-19. Unlike Europe where governments are prioritizing Covid-19 containment, Trump has prioritized the economy over Covid-19 containment. The results speak for themselves.

Food lines in the US. Source: USA Today.

Food banks are broken and about two percent of US households (roughly 10% of the population) face homelessness in a month if the eviction moratorium isn’t extended.

A big problem is that Trump continues to foster a culture of social media misinformation. Yesterday, a right wing pundit I follow posted on Facebook this NPR story:

Covid-19 social media post for NPR story:”Government Model Suggests U.S. COVID-19 Cases Could Be Approaching 100 Million.”

There are a few of problems with the poster’s comment, “If so, the fatality/hospitalization rate is much lower than we thought.” One is that IFR is more useful than CFR. I calculated IFR using the CDC’s assumption that there are eight Covid-19 cases for every one case confirmed. Using the excess deaths for the US rather than the confirmed Covid-19 deaths, I came up with an IFR just shy of 0.4%. That compares with an IFR of 0.1% for flu. In other words, Covid-19 is four times more deadly than the flu and much more contagious.

Another problem with the post is the implication that, with this new CDC model, the US must be doing great managing Covid-19. As the Johns Hopkins chart above shows, the US is among the worst in the world at containing Covid-19. It would be nice to think that the US has much better outcomes caring for Covid-19 patients than the rest of the world. Even if that were true, it’s hard to believe it would continue to be true as Covid-19 cases swamp US healthcare systems.

Yet another problem is that this post focuses on one data point that, in the scheme of things, isn’t that important. What’s important? Hospitals and ICUs are out of beds and low on healthcare workers. At this point, IFRs and CFRs are a distraction. You can rationalize as much as you want about how well the US is managing Covid-19, but scarcity of healthcare resources is the high order bit, as they say, for US healthcare right now.

In my mind, the biggest problem with the post is cherry-picking a data point and sharing a conclusion as though it’s a fact. As you can see from the post, it got a lot of engagement in a day. Trump has encouraged social media behavior that challenges experts. This post is an example of how smart people post with bad consequences.

Why do I care? There are vaccines on the way!

First, I think the vaccines are likely to get Covid-19 under control in the developed world by the end of next year. But there are a lot of caveats.

While we have lots of evidence that vaccines are safe, we don’t really know short- or long-term effects of newer techniques used for mRNA and viral vectors vaccines. For example, an HIV vaccine candidate that used an adenovirus as a vector ended up making people more susceptible to HIV for reasons that aren’t understood, but probably have to do with the vector rather than the payload.

There’s also a problem with viral vectors that the immune system probably will raise immunity to the vector. That may explain why different dosing of the Oxford/AstraZeneca vaccine had such different effectiveness outcomes (a smaller initial dose may have raised less adenovirus immunity allowing the second dose to work better).

The mRNA vaccines have known cold storage issues that make distribution to most of the world’s population problematic or impossible. If most of the world’s population can’t get vaccinated, Covid-19 becomes an ongoing health problem.

Unrelated to vaccines, it’s not clear yet that everyone is clearing Covid-19. Here’s a good thread on that topic.

Like many viruses, it appears that covid-19 is hanging out in some people resulting in long-term infections. There also are plenty of documented cases of reinfection. As the pandemic spins out of control in the US, giving the virus plenty of opportunities to mutate, viral persistence and reinfection are growing wild cards for Covid-19 vaccine performance.

Covid-19 bits.

After my Black Friday exploration in Barcelona, I have a shopping tip for my readers. If you’re having trouble finding just the right gift, scented candles always make a nice holiday present. This year, they double as a Covid-19 detector. In fact, scented candle reviews on Amazon have turned out to be a good proxy for the general state of Covid-19.

I’ll leave you today with this sentimental German Covid-19 PSA.

I write this for my sanity. If you like it, please pass on to friends and family. For more frequent updates, follow me on Twitter. Stay safe!