23 June 2020 – Tuesday – #100

Welcome to the 100th entry of Covid Diary BCN! For 100 days I’ve spent my morning writing about Covid-19 from my new home in Barcelona. All in all, it adds up to about 130,000 words. If it were a book, it would be about 500 pages without illustrations. I should have a parade, a flashy dance review, a drag show, fireworks—something to celebrate the 100th entry and the end of Spain’s lockdown.

Hold the phone! Barcelona residents celebrate tomorrow’s Revetlla de Sant Joan holiday by shooting off fireworks tonight, starting around 9pm and ending around midnight, or whenever they run out of things to ignite. Most of my friends tell me it’s a great night to get out of Barcelona. Tonight’s Festival of Fire sounds more like the thunderous days I remember the Blue Angels flying over San Francisco than a bucolic Midsummer Night’s Dream. Who cares? I get my fireworks.

After 100 days, more and more19 Covid- projects are coming to fruition. Here’s one example.

Nextstrain Genomic epidemiology of novel coronavirus – Europe-focused subsampling, 22 June 2020.

The Nextstrain open-source project collects pathogen genome data and provides real time visualizations of pathogen evolution such as the tracking map above. If you play the visualization of data from December 2019 to now, you can watch as Covid-19 infections spreads across Europe, and then as airlines stop flying, lockdowns start, and infections attenuate.

Another example of projects coming to fruition is this Dexamethasone study.

Dexamethasone reduces mortality for Covid-19 patients on ventilators.

We’ve already seen results of the other drug studies. Hydroxychloroquine doesn’t help Covid-19 patients, Remdesivir shortens their hospital stays. We will see more and more studies that started 100 days ago bearing fruit. If clinicians end up with a handful of drugs like Dexamethasone that benefit very specific Covid-19 conditions, we may see the kind of decline in mortality that makes Covid-19 look more like seasonal flu. That would make Covid-19 manageable until there is a vaccine.

In the bad news department, after 100 days we also are learning that some Covid-19 survivors have dreadful outcomes.

ICU nurse Cherie Antoinette on Covid-19 complications.

In the past 100 days, we’ve learned that lockdowns lower Covid-19 infections. Lockdowns worked throughout Europe.

Lockdowns almost worked in the US, but it now looks as though poor federal leadership allowed some states to jump the gun on reopening.

Increases in Covid-19 cases in Arizona, Texas, and Florida are driving up overall US case numbers.

That same poor federal leadership is holding a campaign rally tonight at the Dream City Church in Phoenix, the new epicenter of Covid-19 in the US. But don’t fret.

Dream City Church, Phoenix Arizona describes its ventilation system.

Dream City Church installed a ventilation filter that removes 99.9% of Covid-19. It’s as safe as flying in a plane. What could go wrong?

In the past 100 days we’ve learned that Trump cares more about his re-election than about the health of Americans. I’ll take the fireworks in Barcelona tonight over the contagion in Phoenix. Every day I watch the US response to Covid-19 is another day I’m grateful to be in Barcelona.

After today, I will turn my attention to other writing projects. I want to complete another draft of Dear Mustafa this summer. I have a short Covid-19 love story I want to polish. I may write some essays based on material in Covid Diary BCN.

One of my goals writing Covid Diary BCN was to create a record of life during the pandemic. When I was researching the AIDS pandemic for Dear Mustafa, I found lots of news articles, some useful timelines and histories, as well as good literature and drama. What was missing was a record of what it was like in the moment, how new information about AIDS changed the way gay men in San Francisco lived with the disease. Of course, I remember a lot of that, but I don’t remember all of it.

Another one of my goals was to keep my sanity during the lockdown. Thankfully, that is intact.

I don’t see the Covid-19 story evolving as quickly now. A daily blog entry isn’t as necessary as it was 100 days ago. We’re far enough into the Covid-19 pandemic that we can see how the story is likely to unfold. Deeper and less frequent analysis is possible because it’s clearer what the main decisions and objectives will be. It’s time to consider bigger questions than how we decontaminate our grocery bags. Like, should we fix the economy or change it? As I write this, I plan to update the blog about once a week. Let’s see how that goes.

I have dozens of constant Covid Diary BCN readers who’ve sent notes and tips, and more readers I don’t know. Thanks to each of you for following along!

I’ll sign off for now with this performance at Barcelona’s El Liceu opera house last night.

El Liceu opera house, 22 June 2020.

A string quartet performed for an audience of nearly 3,000 plants. The plants will be donated to healthcare workers. Welcome to the New Abnormal.

22 June 2020 – Monday – #99

The first day after Spain’s Covid-19 State of Alarm went fine. And then.

Four Spanish regions recorded Covid-19 outbreaks.

In terms of the number of cases per 100,000 inhabitants over the last seven days, Madrid tops the list, with 7.91, up from 7.04 the day before. Aragón is second, with 6.9, and Catalonia third with 6.57. This parameter has risen in 12 of Spain’s 17 regions, as has the average across the country, going from 3.08 in Saturday’s ministry report to 3.53 on Sunday.

El País, “Coronavirus infection rates rise in Spain due to outbreaks in Aragón, Madrid, Canaries and Catalonia,” 21 June 2020.

Should I be concerned?

Spain is not alone in seeing Covid-19 cases increase after a Covid-19 lockdown. On Friday, Germany reported its Covid-19 R spiked from 1.06 to 1.79. The increase in the German Covid-19 reproduction rate was due to infections at a (surprise, surprise) meatpacking plant in North Rhine-Westphalia.

The German government explains why the spike in its R is not a big concern for the country.

“Since case numbers in Germany are generally low, these outbreaks have a relatively strong influence on the value of the reproduction number. A nationwide increase in case numbers is not anticipated.”

Robert Koch Institute statement, Reuters, “Germany’s coronavirus reproduction rate jumps to 1.79: RKI,” 20 June 2020.

So, I’m concerned, but not really concerned, about the increase in Spanish Covid-19 infections because Spain’s total case numbers are still relatively low. I admit I’m in less of a hurry to visit Madrid after I read it had the highest per capita case count. If Spain’s increase in cases had occurred when hundreds of people were dying daily, I would be very concerned. As long as public health officials detect and contain these new Covid–19 outbreaks, I should be okay.

Everyone is learning that the value of R has different connotations at different points in the epidemic. Welcome to the New Abnormal.

Spain’s borders opened when the State of Alarm ended. Except that, for instance, I can travel to Sweden, but not next door to Portugal.

From July 1, the Spanish government is planning to open the country’s borders to states where the coronavirus pandemic is under control, but for now there is no list of candidates. The administration is intending to accept a European pact on this list, but other EU states are already saying that they will take unilateral decisions on the matter.

El País, “European borders are reopening, but there is a lot of small print to digest,” 21 June 2020.

I’m sure all the details will be worked out in the next week. It’s only 27 countries at different points in their Covid-19 epidemics that have to agree on safety protocols. Europe’s advantage is that Trump isn’t involved.

The risks for getting travel policy right are significant. Yesterday I wrote that sick passengers are like Covid-19 embers. Many of the infections they carry will die out without significant consequences, but a few may ignite new Covid-19 outbreaks.

When Brad and I were discussing his flight to Barcelona in August, I realized that travel safety has two components. One is passenger safety, the other is the spread of Covid-19 to new locations. For obvious reasons, Brad is concerned about passenger safety. If passengers don’t feel safe, they don’t buy tickets.

On the other hand, if air travel starts a second wave of Covid-19 infections, air travel will close down again regardless of whether passengers feel safe enough to buy tickets. So, solving the passenger safety problem with, say, masks, may not keep the airlines afloat if sick passengers ignite new Covid-19 outbreaks. A low-cost screening method would keep sick passengers off planes in the first place. As with so many things Covid-19, though, no one knows for sure how to screen for Covid-19 short of a PCR test. A smell test would reduce screen about 1/3 or the cases.

Which brings me to the bigger topic of Covid-19 and capitalism. In theory, free market capitalism allocates resources optimally, but Covid-19 provides cases studies of how profit motive doesn’t seem to line up with economic problems created by the virus.

Low cost screening would have a huge payoff for industries like travel and entertainment, but the only development efforts I know about for Covid-19 screening (besides PCR testing, which is costly and slow) are big data efforts, mostly with data from wearables. Perhaps the lack of development is because the travel and entertainment industries are not in a financial position to make Covid-19 screening investments. If the free markets aren’t creating low-cost Covid-19 screening, maybe governments should initiate a Manhattan Project for Covid-19 screening.

As I noted before, there is unprecedented investment in Covid-19 vaccines and treatments, but more in low-risk re-purposing than in high-risk novel approaches. With luck, the sheer number of development and re-purposing efforts will yield a quick Covid-19 knockout punch. The calculus of profit being what it is, a knockout punch will take longer if it depends on a high-risk solution because economic resources are concentrated on solutions deemed to be low-risk.

Covid-19 also is reorganizing the way we work. Why did it take a virus to show us that many information technology employees can work remotely at lower cost? Why didn’t the free markets shows us that same thing? Covid-19 is reallocating real estate in unimaginable ways, sometimes for better (telecommuting), sometimes for worse (theater, restaurants, churches).

In particular, Covid-19 has reorganized the science community. I noted how UCSF organized a worldwide Covid-19 drug re–purposing team in days. In Wired, Maimuna S. Majumder describes the work of scientists she recruited with Twitter to work on Covid-19 problems.

Since our first hackathon, the volunteer network has grown to nearly 100 people, with 23 active research projects. One team is analyzing text extracted from hundreds of thousands of news articles to better characterize the quality of the US media’s pandemic coverage. Another is sifting through millions of tweets to understand how public sentiment toward face masks has shifted since early April, when the CDC recommended that everyone wear them. Without question, the diversity of the network, across disciplines and institutions but demographically too, has been a tremendous boon to the formulation and investigation of problems that really matter.

Wired, “Coronavirus Researchers Are Dismantling Science’s Ivory Tower—One Study at a Time,” 18 June 2020.

Of course, free market capitalism depends on the quality of the information used for pricing a transaction. We know more know now about Covid-19 than when I started Covid Diary BCN 99 entries ago. We still have more to learn.

21 June 2020 – Sunday – #98

Spain’s State of Alarm ended last night while I was sleeping. I woke up refreshed.

This doesn’t mean Spain is Covid-19-free, like New Zealand. The current Spanish infection rate is about 3 per 100,000 per day and there are about six Covid-19 deaths per day in the entire country. Covid-19 seems more like a very weak case of the flu right now.

Actually, New Zealand reported two new Covid-19 cases yesterday. Even when it appears Covid-19 has been eradicated, it’s lurking somewhere.

Actually, Covid-19 was lurking earlier than everyone thought. Sewage samples from Milano and Torino indicate the virus was first present around mid-December 2019.

The findings echo similar discoveries elsewhere in Europe suggesting the coronavirus was circulating globally well before Chinese authorities flagged the new infection on December 31. For example, a French doctor said samples from patients treated in December for pneumonia tested positive for the virus.

Politico, “Coronavirus found in Italian wastewater in December,” 19 June 2020.

The finding that Covid-19 was in Europe in December 2019 may indicate that the virus can lurk for months before starting a high-mortality outbreak. It also may indicate that, like embers drifting from a distant fire, it took several introductions of the virus to kindle the first blaze.

The questions Spain faces today are how long can it keep Covid-19 in lurking mode and how does it keep embers from drifting in. Now that everyone is on the alert for Covid-19 and understands the consequences of an outbreak, another outbreak seems less much less likely. Or so I hope.

Allow me to switch my narrative to another thing happened while I was sleeping last night. Trump had a campaign rally in Tulsa. Bringing supporters to Tulsa seemed like a recipe for disaster because Tulsa has become a Covid-19 hot spot. So many supporters were expected that Trump’s campaign built an overflow space outside. Supporters who couldn’t squeeze inside the 19,000 seat Covid-19 hot box could watch Trump on jumbotrons. As an incentive to participate from outside, Trump said he would address the remote throngs in person after the main event.

Trump says a million people want to attend his Tulsa rally.

Everyone fretted that pushing tens of thousands of people into close quarters in a city with a rapidly growing Covid-19 case count would add to the ongoing Covid-19 outbreak. No one lining up for days in advance to get a seat inside the convention center wore masks. Hours before the event, the campaign confirmed that six of its event staff had Covid-19 infections. Just as the horror film was about to start, I went to bed.

This morning I woke up expecting to see the post-rally carnage. Here’s the first view I got of the Tulsa convention center during the rally.

Small crowd at Trump’s Tulsa campaign rally, 21 June 2020.

The crowd of about six thousand wasn’t wearing masks and didn’t socially distance, but at least it was only six thousand. Those Trump’s supporters will spread Covid-19 around Oklahoma, but not as much as if the expected crowd showed up. Only about a tenth as many supporters as Trump anticipated showed up. As with Trump’s entire presidency, we got lucky. It could have been ten times worse.

My point in bringing up Trump’s rally is that there is some hope that either the polls showing Trump is losing support are correct or that even Trump’s supporters don’t buy into his Covid-19 suicide pact. In either case, that gives me hope about Covid-19.

I’m leaning towards the case that even Trump supporters aren’t buying into his suicide pact, that Covid-19 is breaking through the Trump distortion field. Trump is saying things about Covid-19 that make no sense on their face. Here’s one from his rally.

At Tulsa rally event, Trump says he asked for reduced Covid-19 testing.

While Trump doubles down on his “post-Coronavirus” narrative that increased testing is creating more cases of Covid-19, Republican governors are facing the Covid-19 realities of record cases and overwhelmed healthcare systems.

Even staunch Trump ally Florida Governor DeSantis is changing his tune. Last week DeSantis blamed the increase in Florida’s Covid-19 cases to increased testing of farm workers. Yesterday, he admitted that the rise in cases couldn’t be explained by testing.

“Even with the testing increasing or being flat, the number of people testing positive is accelerating faster than that. You know that’s evidence that there’s transmission within those communities.”

Florida Governor Ron DeSantis on Covid-19 testing, 20 June 2020.

Which brings me back to Spain. If it’s true that Trump supporters can see Covid-19 as a threat in spite of what Trump tells them, then I have hope that Spain can keep Covid-19 in lurking mode until a treatment or vaccine comes along.