19 March 2020 – Thursday – #4

While Nate Silver and Elon Musk tweet about who needs ventilators, the Italians are printing them. Until there are treatments or a vaccine, the difference between life and death for anyone seriously ill from Covid-19 is a ventilator and there aren’t enough. The manufacturer of said US$11,000 ventilator is suing for patent infringement (see bottom of article). “But despite hospitals asking for the 3D plans, [3D inventor] Fracassi is wary about providing them because the manufacturer has threatened to sue. And has refused to share the blueprints too.” Perhaps Elon Musk can buy the ventilator manufacturer and put the 3D model in the public domain.

In treatment news, the Chinese claim the Japanese flu drug Avigan is effective in treating Covid-19.

Patients who were given the medicine in Shenzhen turned negative for the virus after a median of four days after becoming positive, compared with a median of 11 days for those who were not treated with the drug, public broadcaster NHK said.

However, tempering that news, the Japanese were more guarded.

But a Japanese health ministry source suggested the drug was not as effective in people with more severe symptoms. “We’ve given Avigan to 70 to 80 people, but it doesn’t seem to work that well when the virus has already multiplied,” the source told the Mainichi Shimbun.

In other words, as with most other treatments under consideration, severe cases aren’t responding well to therapy and still need ventilators.

In any case, Avigan needs to go through standard testing processes. There are two million doses available. If used prophylactically the manufacturer would have to produce orders of magnitude more doses, but two million is a good start for treatment of less severe cases. Like all the other treatment candidates, it’s unlikely there will be anything at scale as Europe and the US head toward peak infection in the next month or two.

If you want to get into the nitty-gritty of all the treatments under consideration, this report from last week gives a thorough run down on candidate treatments.

I’m trying to vet these reports and find second sources because not only does the president create confusion with his changing opinions about Covid-19, but the Russians are helping him. Adding to the problem of Russian disinformation campaigns, yesterday Facebook algorithms were mislabeling articles from trusted sources as spam, as well. Think about what you’re posting! Do a little research on what Facebook might not have shown you.

I’m sure you’ll be excited to know that I went outside yesterday. I was even more excited! I had a doctor’s appointment that required me to be in the office, so no choice but to walk thirty minutes there and thirty minutes back.While I was out, I went to the grocery store, too. I’m figuring out what makes me comfortable and seems feasible for now. Here are some things I did:

  • Washed my hands before I left and put a clean paper towel in my pocket.
  • Opened doors and pushed elevator buttons with my coat (could have used the paper towel!).
  • Kept a fair distance from other pedestrians (that wasn’t hard).
  • Kept my hands in my coat pocket so I wouldn’t touch my face.
  • No one else was inelse in the waiting room, so didn’t have to worry about distance.
  • Cleaned hands with sanitizer after doctor’s visit.
  • Stopped at grocery store downstairs while I was out. In Barcelona, only groceries and pharmacies are open. These are limiting the number of customers inside at the same time. The stores are reasonably well stocked, but no eggs again. I’m beginning to think that anyone who doesn’t know how to cook buys eggs to learn. Again, it wasn’t hard to keep distance.
  • Paid attention to not touching my face once I started touching the cart and items on the shelves.
  • Noticed that I touched my mobile when I paid, so I considered it contaminated.
  • When I got home, I took off my shoes and coat, dropped the groceries on the back porch except perishables that went into the “dirty” refrigerator, and washed my hands and my mobile. I’ll let the groceries stay outside for a day or two. I kept the mobile out of my pocket for a few hours.

Nested inside my Covid-19-free zone, I felt like I’d maintained a barrier from any Covid-19. This study about virus longevity indicates 1) that closed environments with other people are unsafe for hours as any virus present dissipates in the air (measured half-life of 66 minutes in air), and 2) that exposed surfaces are contaminated from hours to days depending on surface type. I also opened my windows, although I don’t think there’s any virus hanging out inside to air out. There is a lot of variation in Covid-19 viability on different surfaces and even on the same kind of surface, so I’m trying to err on the side of safety by leaving anything new to the apartment in the foyer or back porch. I’m assuming my clothes are not contaminated. I’m still thinking about that.

On side note. I’ve stopped applying deodorant because why. I’m alone here. Then I arrived at the doctor’s office yesterday.

Some quick Barcelona updates. On the medical front, I chatted with a lab technician at one of the nearby hospitals. He says everything quiet right at Barcelona hospitals. It sounds like they’re waiting for a tsunami to hit. Routine procedures are being postponed. This was confirmed by the technician at my doctor’s office today. Also, after debates in Spain about how to allocate medical supplies, there are reports this morning that medical supplies are being held up at customs.

The other Barcelona update is that, in addition to our 8p local applause ritual, a 9p local pot banging ritual was added last night. The main difference seems to be in decibels and pitch. I don’t know how people find out about these rituals, nor do I know if last night’s ritual was a one-off or if we’re going to be doing community sound-offs every hour on the hour soon. [Update 21 March 2020: the pot banging was an anti-government protest.]

As in the beginning of the AIDS epidemic, there are debates about what behavior is safe. There are always trade-offs. My San Francisco friends report very different circumstances from Barcelona and its community sound-offs. Most bay area stores are still open and most don’t limit the number of customers. I heard that Whole Foods has set aside special shopping hours for elders and others at risk. There seem to be a lot more people outside in San Francisco than in Barcelona. The Mayor of San Francisco is having a spat with Jake Tapper from CNN about what is safe. I personally feel people in Barcelona would benefit physically and mentally from being outside a bit more. On the other hand, keeping people inside communicates the severity of the problem.

The Chinese imposed much more severe constraints during its Covid-19 battle and today was the first day with no new infections in China. So, at one extreme, lockdowns with frequent fever and Covid-19 testing appear to work. The Italians, on the other hand, have a robust lockdown and still haven’t seen country-wide payback from their effort. Italy suffered its worst one day Covid-19 death toll yesterday.

Anecdotally, my niece in New York City starts working at home today. Her insurance brokerage closed its office yesterday. She said most New York City companies are working remotely now and the city expects a shelter-in-place order any time.

All this is tough on the economy. I chatted yesterday with a musician who plays Broadway shows. No work for the foreseeable future. I was supposed to host a guitar player and his wife this weekend, but all concerts cancelled in Barcelona. My friend Leslie played her last scheduled gig last weekend. It’s not just the performing arts. I noticed that Delfina, one of my favorite San Francisco restaurants, closed. Every day I read that many more small businesses are closing.

I also chatted yesterday with a friend who runs P.R. for a large retailer about how much cash to keep on hand. He didn’t sound optimistic about job prospects and his apartment lease runs out at the end of April. Impossible choices. Another friend who manages accounting for a small technical writing consultancy is worried about cash flow. Brad didn’t get an offer on his house in San Francisco, indicating housing market illiquidity in one of the country’s hottest markets. I haven’t got any encouraging reports from friends.

The problem when an economy gets gummed up is getting it back on its feet.

In response to Covid-19, even conservative politicians have become Keynesian converts, with Europe and the US pumping trillions of dollars into the economy. This seems correct in form to me, but I’m not sure about substance. In the US, with elections around the corner, the Republicans probably don’t have any other hope to retain power, even though the spending goes against decades of Repubican party wisdom. With the Trump administration, though, it’s hard to know whether the amount or the placement or the timing will help anyone but the wealthy. Already pundits are worried that an inevitable airline bailout will go into the pockets of owners and management after the airlines spent their free cash flow repurchasing shares rather than investing in people or assets.

Random musing: what happens to all those airline miles I’ve accumulated?

Last, but not least, the Covid-19 virus has infected two members of the US Congress. I wish them a speedy recovery.

18 March 2020 – Wednesday – #3

Yesterday I became a hamster, walking 5,000 steps on the terrace. It was boring, but I have to admit it felt great. During my walk, I waved to my neighbor who was also becoming a hamster on her terrace across the street. She said something encouraging in Spanish that I didn’t understand. I yelled back in my best Spanish, “Sí, sí, sí.”  Brad says if I take a video every day of my exercise routine, my video collection will be in MoMA by the end of the year. I’m not so sure. Frederick suggested climbing the eight floors of stairs for exercise. It violates the physical seal of the apartment against Covid-19, but I might do it anyway, if only for a change of venue.

There are a few cars, buses, and pedestrians on the streets. Nothing close to normal. Here’s a video of the neighbors applauding at 8p local last night, the daily ritual. It usually lasts about five minutes. Except for my quick conversation with the neighbor, that was my main live interaction yesterday. The building super accidently pushed the entry buzzer and showed up on the video monitor. I’m not sure that counts.

Others in Barcelona are more lucky. If you live in Begoña Alberdi’s neighborhood, you get free opera recitals. If you’re looking for ways to entertain yourself at home, the Italians are providing  plenty of ideas online. I even found a fantasy about going out of the apartment for the first time. There are also vast treasures of art online to view. My friend Jamie turned me on to the Covid-19 of the Spanish art world, José Manuel Ballester. Ballester photoshops all the people out of iconic artwork, like this:

If you feel like you haven’t been productive while in confinement, take a cue from Avi Schiffmann, a 17-yo from the Seattle area. In December, Avi noticed something going on in China (too bad the president didn’t!) and started a website with the catchy name ncov2019. The site scrapes Covid-19 reporting sites from around the world and updates worldwide stats every second or so. The accuracy depends, of course, on the local reporting accuracy. 35 million people are following the site now.

As I write this:

CountryConfirmedDeceasedRecoveredSerious
Italy31,5062,5032,9412,060
Spain11,8265331,028563
USA6,203107860

That puts mortality at 7.9%, 4.5%, and 1.7% respectively. I don’t believe the US statistics because testing is so poor. I’m guessing the difference between Italian and Spanish mortality is largely a function of Italy’s healthcare system being inundated.

The site also provides a map of locations with Covid-19 infections. Here’s this morning’s snapshot of the map:

This would seem to indicate that the virus doesn’t do as well in warmer climes (note fewer infections south of the equator where it’s the end of summer). I wouldn’t get hopes up too high. Australia probably has the best reporting, and there are infections in all its major cities. Anecdotally, I understand that Brazil isn’t testing yet and I know of two cases in Sao Paulo (not shown on this map!). I’ll go out on a limb and guess that most of South America and Africa are more infected than the data here suggest. So, as much as I want to believe Covid-19 will attenuate during the summer, I can’t draw that conclusion from this information.

A tiny bit of good news from Italy in this useful Twitter thread on demographics of Covid-19 mortality. Jenn Dowd says, “We find some real-world evidence of ‘flattening the curve’ in the province of Lodi where harsh movement restrictions were enacted quickly (Feb 23rd) vs later in Bergamo (March 8th)”

In other words, even though Italy’s overall numbers are still bad, the parts of Italy that acted early are doing better than the parts that acted late. In other words, absent high volume testing, the sooner people lockdown, the better.

Two other Covid tidbits. One is that travel is unpredictable right now. My friend Frederick told me last night that his Polish friend got one of the last possible flights to the US for foreign nationals. Then Frederick told me about the nightmare after his flight from Germany to the US on Sunday. Customs took everyone’s passports and herded them into a room where hundreds were packed together. And then the officer, apparently realizing that the passengers were so tightly packed that he might get infected, ordered everyone to stand away from him. Frederick is now in 14-day quarantine at his remote place in Connecticut. As far as I can tell, there’s no enforcement of his quarantine.

Speaking of Connecticut, the other tidbit is that lack of Covid testing has sidelined 200 nurses at a Danbury, CT hospital. It is the first US hospital I’ve heard of that is operating at capacity and a sign of healthcare capacity constraints coming to other parts of the US in the next few days.

I’m not qualified after 2-½ months living in Spain to say much about Spanish or European politics. The Brexit Prime Minister pivoted on his Covid-19 plan two days ago after he discovered it would sow seeds of destruction in the UK. Now the UK is following much the same lockdown strategy as its European neighbors. Perhaps Johnson will pivot on Brexit, too, as he discovers the seeds of destruction from that debacle.

The political divisiveness that the US president has exacerbated to his political advantage may come back to bite the country’s Covid ass. Having divided the country, the president is not trying very hard to reunite it. Fox News, which coordinates closely with the White House, has changed its tune on the virus. This week Fox viewers have watched the virus mutate from hoax to something terrible. According to the president, who always finds someone to blame for his failures, not just from hoax to something terrible, but something terrible from China:

Cuomo wants “all states to be treated the same.” But all states aren’t the same. Some are being hit hard by the Chinese Virus, some are being hit practically not at all. New York is a very big “hotspot”, West Virginia has, thus far, zero cases. Andrew, keep politics out of it….

Do I need to point out that viruses don’t carry passports?

The real enemy the president has created is the militant right wing that, in the name of gun rights, is interfering with government officials protecting residents from the virus. There are reports of lines around the block for gun stores, suggesting that in America guns are even more necessary than toilet paper during a pandemic. The president has stoked a paranoia in the right that anyone who claims authority (other than the president himself, of course) is there to steal constitutional rights. Stealing constitutional rights is code for taking away guns. In his tweets he discounts the authority of not only Governor Cuomo, but also of other governors who, in trying to help their states, ignore or contradict the president.

I’m sure my friends on the right see this differently. I was heartened to read Newt Gingrich’s plea from the Vatican to take Covid-19 seriously. Covid-19 is non-partisan and it will take a non-partisan response to minimize mortality. It didn’t take long, though, after he penned his Op-ed for Gingrich to step back into the right wing echo chamber:

A reporter asked me today why conservatives were initially so skeptical of the threat of the coronavirus. I tried to explain that one of the dangerous consequences of having a totally dishonest left wing news media was that most Americans discounted their hysteria as phony.

Newt Gingrich

I try hard to look at Covid-19 objectively, but it’s hard to square the Fox News clip above with this statement from Gingrich. It’s too easy to tear apart Gingrich’s assertion. Republicans don’t seem to be able to cope with facts. I hate writing that. Democrats have been giving Republicans all the help they can with facts. The Obama administration briefed the incoming Trump administration on the dangers of a pandemic. Due to the absurdly high turnover in the Trump administration, only 1/3rd of the briefing attendees still work for the Trump administration and none of them seem to influence the president.

Trump himself claims he was unaware that the NSC pandemic response team was shuttered in 2018, but video shows him explaining that he didn’t want to retain these experts on staff because, like any good businessman, he could hire them as needed. He implies scientists and public health experts can be hired for pandemics like cleaners and caterers for a party at one of his resorts. For his part, Trump appears to have resigned himself to MCing press conferences where he parades the experts and then provides Reality TV answers to reporters’ questions. He looks like a country club manager stuck at a banquet who can’t wait to play a few holes.

While Mitch McConnell hurriedly continues to pack the courts in the midst of a pandemic (this speaks louder than anything about McConnell’s prioritization of pure power over everything else), Speaker Pelosi and Treasury Secretary Mnuchin are the actual power brokers in Washington right now. Unfortunately, the $850B bailout package probably won’t keep the world from a deep recession, if not depression.

One bad economic signal: Brad has received no offers to buy his house in San Francisco. The good news is that his place is staged like a movie set, so he’ll have a glamorous lockdown. The bad news is, well, who knows when he’ll return to Spain. Brad and I have a spare bedroom for a while if anyone in Barcelona is looking. Several spare bedrooms, actually. An abundance.

My personal loss of power yesterday was my computer monitor. I don’t think the monitor itself failed. It’s more likely the graphics driver in my 3 year old Chromebook that’s on the fritz. I haven’t found any good tools to diagnose, let alone repair the problem. I’m not sure I can get a new monitor shipped. I have other orders in transit that haven’t arrived yet. It’s a reminder of the fragility of lockdown life. There’s not a good backup if my entire Chromebook crashes. There’s not a good backup for most things in the apartment, myself included.

17 March 2020 – Tuesday – #2

The Spanish government reports 11,178 cases of Coronavirus, and 491 dead.

I spent a lot of time yesterday thinking about how to go outside. This isn’t the way I expected to spend my time when I moved to Barcelona.  I read two pieces on Covid-19 prophylaxis, one is extremely thorough with instructions including the use of UV to kill the virus. This seems like a little bit of overkill to me, but it has lots of details I hadn’t considered and good reasoning. The other is a post on a Facebook Barcelona Expat page from a woman who was in Wuhan. This seems a bit more practical. There is always a debate about facemasks when someone recommends them, whether using them works and whether it takes away from the supply for medical workers. I don’t have a strong opinion, but I won’t use them unless I’m sick. More important for healthcare workers to have them right now.

I think my prophylaxis strategy will be to bring things to the apartment and leave them in the foyer for a few days, except the produce, of course. Not sure what to do with produce yet. There are two refrigerators here, so there may be a dirty and a clean refrigerator. Next step is probably to strip and take a shower, leaving the clothes in the foyer for a few days or until I can wash them. After a week here without anyone else entering, I feel like the chance that there are active Covid-19 viruses here is nil. So it’s a matter of keeping out new active virus. I have plenty of food, so there’s no hurry to go out right now. I’m short on toothpaste and suntan lotion, though. There is a stronger anxiety about forgetting to buy something than before. More lists!

Haven’t figured out an exercise regimen, but that’s on the list to research. My fantasy was to ride a Bicing bike around town with no traffic. Bicing (which is like Citibike and all the other bike rental services now run by Lyft in the US) crushed that fantasy yesterday with a notice that Barcelona closed down the service (see below, translated from Catalan by Google). Getting a Bicing card was one of the best things about moving here and you can only get a card if you’re resident, so it felt like a significant milestone to take my first bike ride. So now what? I have a 20 meter terrace. 50 laps back and forth is a little over a mile. I will feel like a hamster.

Health concern: does Covid-19 transmit on produce? I ate a raw tomato last night and a raw pear yesterday afternoon. I bought them Saturday, but still. I woke up with a throat that felt sore until I swallowed. Now it’s fine. No fever. Anxiety.

There’s news about Covid-19 vaccines and treatments. First human tests of a candidate vaccine start in Seattle. Some anecdotal reports of cures were posted in the past week. A Twitter thread says “chloroquine (a cheap malarial drug), Gilliad’s remdesivir with interferon-beta (in clinical trials from COV-19), plasma from recovered patients, and a steroid (methylprednisilone)” have been used successfully in China. The thread is useful for insights in the way Covid-19 interferes with blood chemistry by kicking out iron from red blood cells (hemes). Another anecdotal report from Australia says Lopinavir/Ritonavir, another HIV ARV, seems to be curing Covid-19 patients. Neither of these HIV ARVs are used in Truvada or Discovey, the common medicine used for PrEP.

As an AIDS survivor, I’m happy there’s research and positive treatment reports, but skeptical that anything will move the treatment needle in the next six months. A human vaccine trial takes months and then pharmaceuticals have to scale production. If any non-vaccine treatments using existing drugs work, the advantage is they’ve gone through trials and are already in manufacturing. Most countries will reach peak infection before any of this could be available at scale. It may help significantly in managing Covid-19 after peak infection so people can get back outside and the economy can recover.

Good news from the US: testing is over 10k per day for the first time. The US has been testing at about 0.02 per 1,000. South Korea, which has turned the corner in large part due to 10k tests per day, has been testing 4 per 1,000. In the absence of any treatments, before peak infection, testing is an important way to manage down the peak. After peak infection, testing is the only way to manage people moving around without initiating a second peak.

I spent time yesterday on money, moving things around, paying off credit card bills and doctor’s bills. Why yesterday? Well, I use a mail service that scans and shreds my mail in the US. I had a problem because the original 1538 USPS form I had notarized in the US, the form that confirms I’m who I am and not, I suppose, a terrorist, was for the wrong mailbox (I changed my mailbox number to one that’s easier to remember). I didn’t find out that I needed a new 1538 until mid-February when the vendor wouldn’t scan my mail because the vendor didn’t have a proper 1538 for me. Overseas, the cost effective way to get something notarized is to visit the local US consulate. It costs US$50 and you need an appointment.

The consulate was a little more of an adventure than I anticipated. I had to turn off and surrender my mobile devices. Then I sat in a small stuffy waiting room with other people who needed new passports or visas. I sat for a long time because the notary staff was 45 minutes late for my appointment. No mobile, nothing to keep my hands busy. I sat thinking about Covid-19. There wasn’t much I could do but wait while the man behind me coughed. Finally I got the notarization, scanned it at my neighborhood copy shop, and sent it along to my mail service vendor. That’s why I didn’t get my bills until yesterday.

P.s. The Barcelona consulate is basically closed now because one of its staff tested positive for Covid-19 and everyone is in self-quarantine.

In other government news, Spain closed its land borders yesterday. Citizens and residents can enter. There are a few other exceptions. Also, I figured out that the police are issuing fines for people out for a walk. I saw a report about that on the Expat Facebook page referenced above. Also, one of my Catalan friends reported the same and told me the authorities closed 200 bars in Catalunya on Saturday, the first night of the shutdown. The Covid-19 numbers continue to go the wrong way here. Looking at Italian numbers, it will take a while to peak. Lots of anecdotal information. Brad said that in areas of Italy that shutdown early, the infection has peaked. I haven’t corroborated that, but it indicates that until there is a general shutdown, infections increase.

Speaking of Brad, he had an open Zoom video call yesterday. Everyone else on the video were Brad’s nephews and nieces. News from Washington, DC is that the bars are still open, but clients have to sit at tables spaced six feet apart. News from Guatemala is that the US is recalling all its aid workers world wide. Brad’s niece in Guatemala is serving in the Peace Corp.

I also did a family video using Marco Polo, a service one of my nieces works for (remotely). I heard from my sister and the niece who works at Marco Polo. My sister and her husband are effectively self-isolated in Berkeley where the governor has ordered people to self-isolate.

I’m getting the sense the US is starting to take Covid-19 seriously. The president had a disorganized news conference that took far too long yesterday. It seemed like a metaphor for the administration’s response, disorganized and taking too long. The president praised reporters for maintaining six feet separation while his administrators stood behind him shoulder to shoulder on stage. It’s the first time he admitted there could be a recession and he said he thought peak infection could be in July. Those are important concessions that indicate he might be taking Covid-19 seriously. Might. It looked to me like he was ready for a different job. He’s only comfortable as a cheerleader and it’s hard to cheerlead a pandemic, especially when you can’t hold rallies.

A friend from Las Vegas told me he was laid off from his hotel job Sunday. He’s in isolation with his family having trouble sleeping.

A friend in Paris heard about the shutdown there returning on the train from London. He cried on the ride.

A friend in New York City is concerned her employees, who work in her home, are not taking adequate Covid-19 precautions. This friend is in a high risk category for Covid-19. We talked about strategies for communicating with younger employees the responsibility of following Covid-19 protocols.

A friend in Sao Paulo is convinced he has Covid-19 and is freaked out by a cough that keeps him up at night. He’s worried about Covid-19 transmission from Starbucks cups. He also went out clubbing last weekend. He agreed to see a doctor.

A local friend who works at a remodeling company says he’s still going to work. He needs the money.  I asked him to guard his health.