20 April 2020 – Monday – #36

What does the planet look like in a year? I wrote this note to myself last Friday. The NY Times beat me to an answer. The Times gives both sides of the story, on the one hand that science and technology are making enormous strides, on the other that everyone still could be cooped up at home in twelve months. The best answer continues to be: no one knows. If you lived through the AIDS crisis, this phase of the pandemic is familiar and frustrating.

I could tell the Covid-19 story in Tweets. That’s for another day.

This tweet looks so odd from Barcelona. It’s a face off between Denver area residents protesting the Covid-19 lockdown and two healthcare workers blocking the protesters. It’s the people worried about their money and the people worried about patients with Covid-19 having a difficult time understanding each other. It’s an accurate reflection of my social feeds right now.

To me, this tweet is a clear manifestation of divisive US leadership in a time of crisis. For all of Spain’s difficulties, people are staying at home and there aren’t mass protests like in Denver and elsewhere in the US to end the lockdown.

We’re not all in this together, especially in the US. Minorities, low wage workers, and the poor and taking the brunt of the pandemic. Blacks are dying disproportionately. Inmates face higher Covid-19 mortality due to jail conditions. A couple days ago, I brought up deaths in meat processing plants where management has failed to provide low wage workers a safe working environment. In cities like New York and Las Vegas, large numbers of low wage jobs require close proxmity to the public, while in cities like San Jose, tech employees work remotely from the safety of their homes. In parts of the US (and Europe), Covid-19 deaths in nursing homes account for more than 1/2 of overall mortality. And, of course, healthcare workers are front and center for Covid-19 infections.

I’m not saying Europe doesn’t have its fair share of equality problems. I’m saying protests like the lockdown protests taking place in the US reflect a gaping failure of its leadership and a huge distraction from the Covid-19 problem at hand. All the socio-economic problems I listed above can be addressed and largely resolved. The US president doesn’t build his political capital that way. I put blame for these divisive protests, protests that pit privileged against those in harms way, squarely on the White House.

Why is Trump distracting from the core issues of Covid-19 right now? Because states are relaxing their lockdowns over the coming weeks and no one knows what’s going to happen. The problem from where I sit is that most places (Spain included) don’t have enough testing. At least Spain’s testing program is moving in the right direction (see 18 April). The so-called “opening up the economy” in most US states consists of taking small steps to enable business to function, not going back to normal. It’s good that governors are taking incremental steps. It’s bad they don’t have a way to measure what works and what doesn’t.

Trump’s failure to address and resolve Covid-19 problems doesn’t mean he won’t win re-election this year. His political strategy to push decision making to US governors is brilliant. If the governors succeed, he’ll take the credit. If they fail, he will claim that he alone can fix it. After all, he used that claim successfully in 2016 and none of his base is holding him to acount for his Covid-19 response.

I want to switch gears and look at a few specific stories that interest me.

One story is Boris Johnson. Up front, I wish the PM a full and healthy recovery. It’s been a week since he left hospital, though, and we haven’t seen him publicly yet. It’s a reminder that Covid-19 can wreak havoc on the human body beyond damage to the lungs.

Half of Covid-19 patients develop gastrointestinal symptoms including diarrhea and vomiting. A few also develop acute viral hepatis. In Wuhan and New York City, 15%-30% of Covid-19 ICU patients are reported to develop kidney damage, often requiring dialysis. A term you will hear more and more is “cytokine storm.” A cytokine storm occurs when the body’s immune system goes into overdrive and releases an excess of cytokines, a protein that tells the the immune system where to attack. Cytokine storms during a Covid-19 infection cause hyperinflammation and in inflammation throughout the body. They seem to be related to heart muscle damage and to central nervous system conditions.

Prime Minister Johnson initially advocated herd immunity for UK’s Covid-19 response. As other European countries were locking down, England lost critical days until Johnson changed his mind and ordered a lockdown. Now that he’s been through the Covid-19 wringer, I’m interested in whether he’ll present with long-term health problems and how his healthcare journey will affect his Covid-19 policy formulation. The PM has an extraordinarily personal opportunity to help everyone understand Covid-19 and provide leadership that is sadly lacking in the US.

Next up: the weird business segment.

Students at two universities are suing for tuition refunds or reduction because they are not receiving classroom instruction. I expect many small educational organizaitons will go bust during the Covid-19 depression. Larger educational institutions that survive will have to articulate to future students why classroom instruction is worth more.

Obviously, the casino business is in the tank because almost 2 billion people are social distancing. Business at online gambling sites is expected improve as people stuck at home look for things to do. If you’ve already blown through your government stimulus check, online sites are offering free versions of their games to attract new users with nothing to do at home. Bookmakers are the one online segment suffering during the pandemic because of the dearth of sporting events. Not to worry! Wagers are now available for everyone’s favorite, the Belarussian Football League.

If you’re stuck at home doing drugs, you’ve probably noticed already that prices are up. You can learn some manufacturing and supply chain tricks from the cartels while you’re waiting for your dealer to evade the lockdown police.

Cartels are increasingly shifting away from drugs that require planting and growing seasons, like heroin and marijuana, in favor of synthetic opioids such as fentanyl, which can be cooked 24/7 throughout the year, are up to 50 times more powerful than heroin and produce a greater profit margin.

Associate Press report on drug trafficking

I’m sure you’ll be proud that I learned some Spanish this morning. It’s el covid, not la covid.

I’ll end with this tweet. There’s something about music that resonates with unspoke feelings. This touched something primal inside me this morning.

19 April 2020 – Sunday – #35

The US has boarded Covid Air flight 19 with Captain Trump in command. The only gauge in the cockpit is the only one he needs to get us where we’re all going. The Dow Jones Industrial Average. No need for fancy altimeters or air speed indicators. These babies practically fly themselves.

The regulators say we need altimeters and air speed indicators for safety. What do they know? Look out the window! Do you see anything wrong? No, of course not. Captain Trump is in charge. Sit back and relax while we prepare the cabin. Captain Trump has never made a mistake in his life and he’s not about to start now that he has your life in his hands.

Seating on this Covid Air flight is by class. If you’re a paid member of Captain Trump’s mile high club or a Republican senator, we’ve reserved the first 50 rows for you. The rest of our valued customers will find comfortable seating in the rear 50 rows. Except Senator Romney. Yes, you, Senator Romney. Senator Romney, you’ll have to move to the rear section. I think I see an empty seat next to the toilet in the back there.

Please remember to use the water fountains and bathrooms assigned to your class. For your safety and the safety of those around you, passengers in the front of the cabin can do pretty much as they please. For the safety of the crew, please try to create as much social distance as possible in the rear. Rear cabin passengers in middle rows should assist in distancing by lying down in the overhead compartments or squeezing under the seats in front of them. If someone expires in your row, please press the flight attendant call button and a crew member will be happy to assist you with a choice of complimentary body bags.

In order to run Covid Air as profitably as possible, there are no seat belts, oxygen masks, or ventilators. In case of turbulence, we suggest you take a short position until things smooth out. Should you experience a sudden loss of pressure, just do what Captain Trump does. Breathe a little faster, take a Viagra, and then assist other passengers by fondling their breasts.

Oh, well, it looks like we might have a small problem with one of the engines. Don’t worry about those flames. They’re probably fake, but that never bothers Captain Trump one bit. He takes these kinds of fake news things in stride. We’ll be in the air in no time. Just as soon as Captain Trump files our flight plan and ATC gives us the go ahead. Never seen things like this ever bother him. Never, really. After all, he alone can fix it. That’s why they made him captain. That, and he’s one of the smartest people. You wouldn’t believe how smart. Wait until we get off the ground. Then you’ll understand just how smart he is. Smart as a Fox.

On Flight 19, Captain Trump will take you wherever you want to go. Promises made, promises kept! Well, not the swamp. We don’t land at the swamp because it hasn’t been drained yet. And not China. We don’t trust China. When we arrive, everything will be great again. You’ll find things just the way they were when you left 40 years ago, maybe even better. Cars are huge and safe again. There are no Mexicans. Everyone is making money like never before. No one has even heard of a pre-existing condition. The only thing is CO2. There’s hardly any CO2. You’ll get over it.

It’s a little early to talk about arriving at our destination since we haven’t even got off the ground yet, but that’s how we like to roll here at Covid Air. I’m sure Captain Trump will have that flight plan filled out shortly.

As you exit the aircraft, Captain Trump will personally sign a check for you. Whatever your destination, he wants to make sure you have enough money to enjoy yourself for a few minutes. We know your journey is all about money, so everyone gets a check. Even the people in the front of the cabin, the ones who never pay for their flights, they get a check, too.

When you’re safely inside the terminal, please check the monitors to see where it’s safe. MAGA masks will be available at the gate. If we’ve arrived at your destination, we encourage you to join the second amendment protests in front of the arrivals area. If you’re off to liberate another destination, make yourself at home in one of our cozy family restaurants and ignore CNN reports of people dying on the TV monitors. Ignore them. Fake news.

I forgot to mention, I’m Kellyanne Conway, your purser on today’s flight. I’m glad to see so many returning customers today. I recognize some of you from Covid Air flight 18. And, hey, weren’t you on Covid Air flight 1? Anyway, please sit back and relax. I’ll say anything you want to hear to make your flight more comfortable.

18 April 2020 – Saturday – #34

I’m half way through proof reading what I think is the final draft of Dear Mustafa, a novel set in the times of AIDS, of Loma Prieta, and of 9/11, three other disasters I’ve lived through. Dear Mustafa is clocking in at a little over hundred thousand words. What seems weird to me is how my brain keeps track of so many details as I’m proof reading. For instance, I noticed that I used both “meagre” and “meager.” I revised the book to have “meagre” four times. That’s the American spelling.

The reason I bring this up is that yesterday, while I was doing my hamster laps on the terrace (8,000+ steps, btw, thank you!), I had a lengthy discussion with Cristián about how we got where we are now with Covid-19. I would refer to some or another fact to bolster an argument and, quite sensibly, Cristián would challenge how I knew that fact to be true. I was sure, for example, that Germany ramped up its Covid-19 testing program very early, no later than February, but I couldn’t remember exactly how I knew that off the top of my head.

As our discussion weaved its way through disinformation and confirmation bias, I realized my head is spinning these days with Covid-19 characters and events. It’s harder to keep track of these because they’re not the characters and events I invented for a book, they’re the characters and events I’m reporting or recording or whatever it is I’m doing writing Covid Diary BCN. Characters like Avi Schiffmann, the 17-yo Seattle high school student who launched a Covid-19 tracking site in late December. Events like Begoña Alberdi’s opera recital from her Barcelona balcony and the nightly neighborhood eight o’clock applause for the healthcare workers.

Even if most people aren’t scratching out a few pages a day about Covid-19, they are creating in their head some narrative of characters and events about Covid-19.

Which brings me to this friendly reminder from Brad.

How humans learn from watching rats learn

People are great at seeing what they want to see, telling the story they want to hear. Jim reminded me the other day of the AIDS deniers of yore. More recently we have the vaccine deniers, or anti-vax contingent (will they also advocate against a Coivd-19 vaccine?). There are plenty of other Covid-19 relevant examples of people making up shit to fit what they want to see. That’s what rat researchers did, too, thinking that rats could see color before realizing rats “saw color” through smell.

Right now, lots of people (including Trump unfortunately) are creating Covid-19 narratives that we need to save the economy, or that we need to get back to normal. No one likes the movie we’re watching. If the Covid-19 is good for anything, it’s good for blowing our narratives to smithereens. Covid-19 is our Debbie Downer, our uninvited nanoparticle truth teller.

Okay, so there’s a very funny Debbie Downer Covid-19 episode with Daniel Craig from last month that I can’t share from Spain, so you’ll have to find that one on your own. But this is good, too.

We need a good story to move forward. What we really need is a blockbuster, but a good story will do for now. Effective leaders use stories to instruct us what to do next. Useful followers undertand how they fit into the story, what role they play. Not surprisingly, planners are creating Covid-19 narratives based on the data and models we have so far.

Nearly two weeks ago, I wrote about prognostications from the Financial Times and McKinsey. This week, Ezra Klein and Matthew Yglesias discuss Covid-19 scenarios in the first half of this The Weeds podcast (tl;dl) (the second half is a Bernie Sanders campaign post-mortem that I think nails the candidate’s weaknesses). The podcast is a in-depth discussion based on Klein’s Vox piece about Covid-19 plans.

According to Klein, the current narratives planners have for moving forward are not very heartening, especially for those among us who want to get back to “normal.” Klein points out that while a vaccine or treatment may come along in the next year, it’s more likely we’re looking at two or three years before we can touch our faces and breath without fear. The two dominant planning narratives that get us back towards something that resembles normal require either massive surveillance that enables instanteous contact tracing (a la the location tracking app announced by Apple and Google) or high frequency Covid-19 testing. Both the basic narratives require huge behavior modification, incredible technology development, and skilled leadership. Neither enables a nice V-shaped economic recovery.

Bottom line is we don’t have a good recovery story yet. Planners are still planning. Data is still coming in. A miracle is possible. Today the most important things continue to be maintaining distance, washing hands, and testing. We know these work.

Still, governments need to move forward, even in the absence of strong narratives. Spain is pushing to relax its lockdown in the next 2-4 weeks, but hasn’t announced clear plans for the next next stage. The US announced a plan that delegates lockdown decisions to state governors and provides guidelines for relaxing lockdowns.

Unfortunately, Trump can’t stick to a story for more than a day. He’s already advocating for states to relax their lockdowns even though they haven’t met the announced US guidelines.

Whatever narratives evolve going forward, all narratives benefit from more testing and better data.

While Spain says it expects to relax the lockdown on a sector-by-sector basis in the next few weeks, Covid-19 cases are still rising. At least the government admits now that its Covid-19 data have been inaccurate. Bad data makes it hard to interpret the trend lines. The good news is that testing is up to 40,000 per day, or 0.9 tests per 1,000 people. Last month testing was about 0.2 tests per 1,000.

Unfortunately, US testing has plateaued and there is little consistency in testing between states. Experts say US testing needs to be 2x – 3x higher. If you advocate for the high frequency testing narrative Ezra Klein described (see above), testing needs to be 125x – 150x higher than today.

US Covid-19 per capita testing by state

Some of the US testing problem is due to financial incentives. The US is doubling reimbursement for RNA tests to increase testing activity. Some of the problem is with the tests themselves.

“[The Abbot ID test] performed equivalent to the other platforms with patients that had high and moderate loads of virus. However, with lower loads of virus, a large fraction of these patients were not detected as positive.”

Alan Wells, Director of clinical laboratories, University of Pittsburgh Medical Center

In related testing news, Stanford researchers have released preliminary (NOTE: not peer-reviewed) testing of Covid-19 in Santa Clara County. The report indicates much higher prevelance of Covid-19 than previously thought, illustrating why much better testing is so important. Unfortunately, the report also indicates infection rates in Santa Clara are far below the 60%+ needed to achieve herd immunity. Take the report with a grain of salt for now, though.

Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases.

COVID-19 Antibody Seroprevalence in Santa Clara County, California, Eran Bendavid et al.

If you want all the deets on FDA activity related to Covid-19 testing, this is a comprehensive article. I won’t hate you if you don’t read it.

I’m going back to proof reading Dear Mustafa. I’m not counting on a good Covid-19 narrative before tomorrow, so I’ll keep my distance and wash my hands. At least with my characters in my book, I have some notion how things will end.

I’m ending today’s entry with a shout out to Tanya Tomkins, Eric Zivian and their Valley of the Moon Music Festival. While the festival hits the pause button on performances, Tanya is hosting a weekly Fermata Fridays online interview with festival musicians. This week is pianist Christian De Luca from the heart of Italy. I don’t need to tell you how clever the name is because, besides giving us a couple of wonderful performances, Christian tells us in the video all about the Italian word fermata.