24 March 2020 – Tuesday – #9

Let’s start with fake news that seems more salacious than nefarious.

First off, these photos are of the Spanish Legion, which currently serves mostly in overseas deployments including NATO peacekeeping missions. Second, photos used in this and similar posts were first available online between 2013 and 2018, long before Covid-19 hit the scene last year. What is true about these photos, however, is that Spanish men are hot. Also, like me, they’re mostly in isolation right now. Not in the same place as I am, though. Que lastima.

The Army is reportedly in Barcelona, although I haven’t seen any of them yet on my street. According to the local press, they are involved in cleaning operations and setting up more hospital beds.

Speaking of enforcement, one of my friends reported this morning that a couple she knew was given a fine for shopping together. Apparently these fines are significant, like hundreds of Euros. The policy is one person at a time right now, probably to keep friends from congregating. My friend is a single mother and her concern is whether she’ll be fined if she takes her young daughter along. There isn’t really an alternative.

The unfortunate update to yesterdayś entry is that cases in Catalunya shot through the roof yesterday, with 1,939 new infections reported in a day. According to the chart I posted yesterday, this is roughly double the worst day so far. The total cases in the region is now 7,864. It looks like the lockdown will last a while longer.

The other unfortunate update is the movement in the US to curtail social distancing. After I wrote about it in yesterday’s entry, it came up again during a video chat with my friend Joel who lives in LA. He’s from Texas and much of his family lives there. Joel tipped me off that Texas wants to end social distancing and return to work, echoing the president’s call to get the economy going again. This morning I found reports of a Fox interview with 69-year-old Republican Lt. Governor Dan Patrick of Texas yesterday. Patrick advocates getting back to work as the best thing to do for the future of the country. That sounds pretty good, doesn’t it?

Florida’s Governor makes it sound good, too! Floridians will be testing the jobs-before-health plan for the rest of the country.

If I may say one thing sitting in my perch in Barcelona where we’re in the middle of a lockdown, it is this: don’t fucking stop social distancing!

If you don’t believe me, for the love of Goddess, check out what Director of Johns Hopkins Center for Health Security Tom Inglesby has to say about social distancing.

If you don’t believe me, for the love of everything precious, check out this thorough piece on Covid-19 response options available to governments, Coronavirus: The Hammer and the Dance. [Tl;dr: the most cost-effective response is to lockdown for about five weeks.] In a chart, here’s how a lockdown response (the “hammer”) compares to alternatives.

If you don’t like the “Hammer,” feel free to find a better response with this cool epidemic calculator on Github. Social distancing reduces R, the measure of how many other people an infected person infects. When R < 1, then an epidemic will attenuate on its own. You can bet your bottom dollar that public health officials know exactly how these equations work and that’s why they’re recommending social distancing and hand washing.

I think in about a week the US will feel this viscerally as we do in Barcelona today. Humans aren’t good at sensing exponential change. As nightmare reports emerge from hospitals and people start dropping like flies, social distancing seems like a really good idea.

So, why would Trump want to curtail social distancing, the main method experts advocate for reducing R? Why would he want to get people back to work? Why would he choose a strategy no other country is following? Is it really for the economy?

It could be for the economy. One obvious reason is that he’s watching the US economy tank and that hurts his chance for reelection. But the US economy isn’t going to significantly outperform the world economy, which, let me tell you from here in Spain, is also tanking.

It also could be for himself. Another reason he could be advocating more work and less distance is that his personal business is hemorrhaging worse than a Covid-19 patient. Six of his seven biggest revenue producing properties have been shut down. With Mar-a-lago closed, he’s also lost his closest social circle and favorite golf course. He claims not to know how a bailout would help his businesses, but that seems the first question he would have asked Mitch McConnell.

Another important question is why does anyone believe any public health claims by Trump at this point? I don’t ask that lightly. For instance, his assertion, based on an incomplete trial on 20-some people in France, that hydroxychloroquine is the silver bullet against Covid-19 has resulted not only in unnecessary deaths of people who believe him in the US and overseas, but in shortages of the drug for people who legitimately need it.

Please don’t stop social distancing. It will make me happy if you don’t.

Also, please don’t leave the Covid-19 outbreak in your city for what seems like a safer place in the country. A New York City friend posed that question yesterday on Facebook, considering driving with his roommates to the countryside.

Nantucket is one place people go to escape the city. A pretty fancy place. It has seen an increase in population during the Covid-19 outbreak on the east coast, presumably form summer residents seeking shelter from the virus. I’ve read, but not confirmed, that Nantucket has three ventilators. Summer residents who go to Nantucket for their own safety are potentially spreading Covid-19 to permanent residence. I have news for my city friends. The swamped healthcare infrastructure that’s going to get the most help is not in small towns like Nantucket, it’s in the big city where the cases are. Stick with your city.

A couple of pieces of useful news. This is the best article I’ve seen so far on food safety. It confirms what I’ve written before about decontamination. It also says that food and food packaging are probably not significant Covid-19 vectors. One point I hadn’t thought of is that Covid-19 transmission is through the human respiratory system, not the digestive system.

This 2018 overview of both experimental and observational study of respiratory viruses from the scientific journal Current [Opinion] in Virology (COVIRO) explains that respiratory viruses reproduce along the respiratory tract—a different pathway than the digestive tract food follows when you swallow it. And while you might say that you just inhaled that salad, more likely you ate it with a fork and swallowed it.

This is reminiscent of HIV, which is spread by blood-to-blood or semen-to-blood contact. You don’t get HIV from touching it or swallowing it. Same with Covid-19.

Another piece of news is that wearable experiments are starting. Here, for instance, is an article about using wearable rings to detect Covid-19 in healthcare workers. A smart thermometer maker aggregates thermometer data to make disease outbreak maps. The next phase of the pandemic, the phase that starts as soon as possible and that lasts until there is a vaccine, cure, or treatment, is the widespread testing phase. Lots of antibody tests are coming to market worldwide, which is good news. Those need to scale and reporting of testing results needs to be integrated into public health processes before this next phase helps the economy. Coupling Machine Learning with wearables to detect Covid-19 would add an important screening tool to this coming phase.

Is anyone at Apple, Google, or Fitbit using ML to detect Covid-19 on wearables?

Last, but not not least, my friend Rigel did research on the word quarantine and posted this from Wikipedia:

The word quarantine comes from quarantena, meaning “forty days”, used in 14th-15th-century Venetian language and designating the period that all ships were required to be isolated before passengers and crew could go ashore during the Black Death plague epidemic; it followed the trentino, or thirty-day isolation period, first imposed in 1377 in Venetian-dominated Ragusa.

One of Rigel’s friend commented about the Spanish association with the word:

It’s also tradition in Spanish speaking countries to have your first quarentena after you give birth. (Which in Spanish is Dar a Luz: to give light) which I always thought was really beautiful way of looking at birth and death

So, I’ve learned a little Spanish already today. We’re all learning a lot about birth and death.

23 March 2020 – Monday – #8

Remember last month when reclining seats was the hot airline topic? It’s no longer a question of how comfortable I’ll be flying back to the US, but whether I can fly to the US at all. According to yesterday’s email from the US State Dept (or “Deep State Dept” as Dear Leader now calls it):

U.S. citizens who wish to depart Spain should do so now. Options to return to the United States from Spain using commercial carriers, via direct flights or flights with layovers in third countries, are extremely limited. We expect commercial flights to end this week. We expect all hotels, hostels, and other accommodation to close this week.

The State Dept probably is sending this because it’s not clear it will be able to maintain consular functions in Spain in the wake of the Covid-19 outbreak here. Also because it’s probably accurate.

It feels weird knowing I can’t go home for weeks, probably months. There’s no going back for now. I’m entrusting myself to Spain.

On the other had, what the fuck is going on in New York City.

One reason I decided not to return to New York (or California) is that it seems like Spain, in spite of the horrific increase in Covid-19 cases here, is responding better than the US. President Sanchez announced yesterday that the country would add fifteen more days to the general lockdown, bringing the total lockdown days to 30. My understanding is that the President could order the first 15 days on his own, but needs congressional approval for additional days. My local friends say the lockdown is bound to last longer, but telling the Spanish they have to stay inside until May would be political suicide.

According to yesterday’s official numbers, there are four regions in Spain that are bearing the brunt of the infection, La Rioja, Madrid, Navarra, and País Vasco. Charts for each of these four regions show the increases in Covid-19 notifications (I believe, but haven’t confirmed, that a “notficación” means a report to the government of a case) (note different vertical axis scales).

Things in Catalunya, by comparison, don’t look so bad.

The largest per-capita Covid-19 outbreak in Catalunya so far has been in Igualada, not the capital, Barcelona. If the trend continues for a few days, it’s safe to say the region in general, and Barcelona in particular, has escaped the worst of the Covid-19 pandemic for now. This looks a lot safer to me than New York or California.

Parenthetically, following up on yesterday’s Catalonian government form mystery, my friend Ruben found an explanation for its use. The form itself (Certificat autoresponsable de desplaçament en el marc de l’estat d’alarma per la crisi sanitària per la COVID-19) shows the reasons you may leave your residence.

As Covid-19 cases multiply exponentially in the US, hospitals there are facing dire shortages of beds, supplies, and staff. Absent a federal government response (ah, memories of AIDS), state and local governments are stepping in. Even hospitals are putting out calls for help. In Boston, Massachusetts General Hospital asked people with 3D printers to produce masks. In New York City, teaching doctors like Craig Spencer are helping out in Emergency Rooms.

Meantime, the Trump administration is bickering. After Dr. Fauci’s comments about working with the president, we’ll see if the president invites Fauci to join him at the podium ever again. Perhaps this is Fauci’s way of calling the president’s bluff, essentially putting the president on notice that if he (Fauci) can’t call the public health shots, the president should find someone else.

Meantime, the House and Senate are bicking over a US$2 trillion stimulus package, McConnell breaking off negotiations to push a corporate bailout while Pelosi and Schumer fight for more aid to low income people. A vote is set for noon ET today. I’m not sure why Congress cares how the money is allocated. Trump, who just survived an impeachment for misspending taxpayer dollars in Ukraine and who has invoked his emergency powers to hijack DoD budget for his Mexican wall, should have a field day spending US$2 trillion to buy his 2020 re-election. Don’t believe me? Trump wants US$500 billion to spend as he sees fit! You can’t make this stuff up.

Ironically, the first US senator to test positive for Covid-19, Rand Paul, is a doctor. Like most politicians, he is a social creature. He used the Senate gym yesterday before the test result. He left the Senate immediately after receiving his positive result. Now at least one other senator is asking why Paul didn’t isolate himself sooner, like, you know, instead of going to the gym. Did I mention Rand Paul is a doctor? You can’t make this stuff up.

And look who else is infected with Covid-19: celebrity inmate Harvey Weinstein! Which, if there were any justice, should alert officials that populations of prisoners, immigrant detainees, and refugees are at enormous risk of Covid-19 infection. Keeping large populations clustered together with minimal or non-existent medical services is a public health recipe for disaster. State and local prisons are cutting off access to oversight committees that monitor public health at prisons and that might order the release of low-risk convicts and low-income inmates who can’t make bail. Instead of releasing immigrant detainees to reduce public health risks, the Trump administration is ordering immigration court workers to continue proceedings, increasing the health risks not only to immigrants, but also to employees of the immigration justice system. Around the world, migrants and refugees everywhere are at the mercy of local authorities and, like these Tajik refugees stuck at airports with nowhere to go, have no defense against Covid-19. You can’t make this stuff up.

It’s not that bad, is it? Covid-19? Not that many people who get it die, right? If you still think that, then read this Michael-Crichton-like tale about what happens when you get infected with Covid-19.

And last, but not least, for today. If you lose your sense of smell, isolate yourself immediately. About 30% of Covid-19 cases present with loss of smell, or anosmia. I’m still checking out why anosmia would be related to Covid-19 infection. It may be nothing more than Covid-19 causes sinusitis and sinusitis is a cause of anosmia. Correlation is not causation. But it’s better to be safe than sorry. [UPDATE: In the US, it looks like anosmia is common in older adults with a higher prevalence in Blacks. So, anosmia seems like a valid indicator for Covid-19 infection unless you’re over 80.]

22 March 2020 – Sunday – #7

It may be a little early to call the Italian Covid-19 lockdown a success, but there is a glimmer of hope that the increases in cases and in deaths are decelerating (with Google Translate).

In #Lombardia, new ICU admissions are slowly falling (today +43, last Saturday they were +85 in one day).

The peak of hospitalizations on Monday 16 March (+1273 in one day) has not been repeated so far (today +523).

We must hold on. You will win.

If that continues for a few more days, the world will have evidence that another country’s style of lockdown is effective. As the US is about to learn, it takes 2-4 weeks from the beginning of a serious lockdown to see the infection rate decelerate.

Here in Catalunya, I’ve had some confusion over a new government form. I’m not alone. The confusion started on one of the Facebook Expat pages where someone posted that we now have to present a new form to police when we go out. Lots of questions on the Facebook page about things like whether this was fake news and how we print it without a printer–my situation since, along with pretty much everything else, the neighborhood copy store where I print and scan is closed. The original poster provided links to Telegram pages alleged to be official regional government communications about said form. Besides the fact that it didn’t make sense to distribute official pronouncements by Telegram, I couldn’t access the link anyway.

To be safe, I checked with a local who said, to my relief, that he hadn’t heard of this form. An hour later he messaged me that such a form, in fact, does exist, but said, again to my relief, not to worry about it. In Spain, it’s important to know which forms are essential and which aren’t because there are many forms. It saves a lot of time to know which ones are compulsory and which can be skipped. If I’m challenged by law enforcement, my friend said, I need to present evidence that I’m grocery shopping, buying pharmaceuticals, or visiting my doctor. Something like a receipt would do. Otherwise I get a fine.

More importantly, my local friend also messaged me a photo of a perfect Spanish tortilla he cooked and he promised he’d teach me how to cook this Spanish egg-potato-onion slice of heaven. I’ve tried and can’t get it right. Well, I got it right the first time a couple years ago, but never since. So we’re having a video catch-up and cooking lesson today.

In the midst of all this, I developed a strategy to go on a long walk outside if I go completely stir crazy in isolation. If challenged by law enforcement, my strategy is to explain that I require a particular fuet from a particular food vendor in Ramblas for a recipe a lovely Spanish grandmother taught me, so I have to walk half way across Barcelona for this particular fuet. I even might invite the law officer challenging me to taste my recipe, knowing the invitation must be declined because of the quarantine. It’s a stupid strategy, but I’m hoping my charm coupled with an appreciation of the intricacies of a local delicacy like fuet will impress the Catalonyan police enough to avoid a fine.

This Catalonian form business seems like child’s play compared to the US Department of Justice filing to end habeas corpus during the Covid-19 outbreak. Even conservative Republicans were caught off guard by the president’s request to extend his power to abuse the courts.

Anyway, while I obsess about food and bureaucratic forms from the safety of my apartment, the world burns.

My mother complained that newspaper delivery to her retirement home seemed to stop last week. I emailed back that healthcare systems around the world were collapsing, healthcare workers were dying, US unemployment claims will probably go up by two million in one week, and the US economy is probably contracting 15% this quarter, so it might be a few months until she receives newspapers again. That framing seems to have got me out of calling Financial Times to track down my mother’s missing newspapers. [UPDATE 23 March: the newspapers were delivered!]

The US and Europe are working on financial stimulus packages to respond to the worldwide economic contraction. The US Senate version under consideration yesterday provides little help for families making less than US$40,000 a year, presumably because those making less already know how to live without money. Republicans, who harped on and on about how President Obama’s 2008 bailout package would ruin free markets, have seen the stimulus light in front of the 2020 elections. In fact, they’ve seen about 1.7 trillion rays of light.

The world is experiencing in real time how different governments deal with the Covid-19 crisis. It’s a class in comparative crisis leadership. I don’t understand Spanish well enough yet to understand President Sanchez’ speeches, but the drift I pick up from commentators is that he’s drifting more during his speeches. Sanchez is balancing the demands of each region against the needs of the government seat of Madrid, which has over ½ the Covid-19 cases in Spain. Some regions want a stronger lockdown, others a weaker lockdown. Meantime, Sanchez dances because Spain has not reached, and probably won’t reach for another week or two, the deceleration of cases and deaths that Italy appears to have achieved with a similar style lockdown.

From Spain, the US looks like a case study in how not to respond to Covid-19. New York City hospitals are expected to reach capacity in the next day or two. Healthcare workers are out of protective gear. There aren’t enough tests for healthcare workers, let alone the general population. It’s clear from trade data that the federal government has done little if anything to maintain or compensate for medical supply supply chain issues.

There are now calls to Certain press outlets will stop broadcasting or reporting on the president’s remarks and press conferences because he often cites unsubstantiated claims and promulgates misinformation. For instance, the president made claims about millions of Covid-19 test kits coming to the US and tests for anyone who wants one, and then used his campaign to amplify that falsehood as an argument for his reelection. Weeks later there are about 200,000 tests completed in the US.

The latest problem is the president’s impromptu advocacy of hydroxychloroquine as a Covid-19 cure (see my notes on this claim in yesterday’s entry). Fox news is amplifying the president’s claim and praising the president for his gut instinct on complicated issues. The president’s claim already has led to deaths in Lagos due to misuse of the drug. It’s possible the president, like a broken clock that’s right twice a day, will turn out to be right on any of his claims, but his record is poor (again, see yesterday’s entry). The US (and world) can no longer rely on his claims as the body count increases in the US.
US governors are coming to the country’s rescue. Governors Inslee (WA), Newsom (CA), and Cuomo (NY) have the most Covid-19 cases to manage. I was heartened by Governor Cuomo’s press conference yesterday. At the state level, the country still has leadership that responds truthfully and thoughtfully to crisis. Listen to the praise New York’s governor gives, the factual updates he provides, and the specific plans he details to deal with Covid-19. Stopping the Covid-19 virus is a matter of taking action based on data. It boils down to a math problem: what actions reduce infections and death most cost-effectively. Like his west coast counterparts, the New York Governor doesn’t rely on his gut. He cites experts and facts.