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!

22 November 2020 – Sunday – #122

The strangest thing happened this week. Something clicked in my brain and de repente I could habla the español. My anxiety of never learning to speak Spanish transformed overnight into my anxiety that I will forget how. If my language seems a bit confused today, es porque tengo huevos revueltos entre mis orejas ahora.

I’m starting this 122nd diary entry with some pretty photos of what’s going on around Barcleona. First, if you’ve wondered how movers haul someone’s worldly possessions in and out of a fifth story walk up on a narrow Gracia street, here’s the exterior elevator platform they use.

Moving into a Gracia apartment.

The second photo is an update on the remodeling of the L’Abaceria Mercat in Gracia. Each district in Barcelona has its own mercat, a sheltered farmers market. As I’ve mentioned, it’s one of the highlights of Barcelona for me.

The L’Abaceria Mercat has operated from a temporary location on Passeig de Sant Joan since I arrived. The demolition of the original structure has been hidden but, as its façade disappeared last week, it became clear the remodel is extensive—all the way down to the bones.

L’Abaceria Mercat demolition.

Today’s third and final photo is a restaurant on Passeig de Sant Joan called Kook. I discovered it on my scouting trip here last year, so I have a sentimental warm spot for the food. With Catalonia’s restaurants closed due to Covid-19 restrictions, Kook’s doors have been sealed for weeks. It was a pleasant surprise when I walked by on Friday to see someone wheeling in crates of produce in advance of next week’s re-re-opening.

Kook restaurant preparing to re-open.

The photos are a way of saying day-to-day life goes on, with or without Covid-19 restrictions, with or without live performance and other cultural accoutrements of city life. Some days it seems like it’s hardly worth living in a city until humanity figures out how to dance with this virus. No concerts, no theater, no clubs, no large gatherings. Might as well wake early and fish on a river.

Yesterday was a pleasant break from the day-to-day. U.b., Will, and their daughter hosted a delicious pre-Thanksgiving Thanksgiving at their place in Gothic. After the meal, Vicki recited a Mary Oliver poem and Claudia sang an Italian love song from an opera I couldn’t place. Live performances! Later, over evening margaritas, we discussed Barcelona’s cultural history. It was a multicultural oasis in the Covid-19 cultural desert.

Back to my mundane day-to-day life. After all, diaries can’t be all highlights. Last week, I wrote that I’d have have a progress update on my flu vaccination. The update is that Spanish bureaucracy was designed by Franz Kafka.

The saga continues. To get vaccinated, I need to provide CatSalut, the public health system where one gets vaccinations, a document called an Acreditativo del Derecho a Asistencia Sanitaria. It identifies me as a corner case, someone who doesn’t qualify for public assistance, but who should be allowed vaccinations anyway because I happen to reside here. Needless to say, no one seems to know how to obtain this form because there are so few people in Spain who don’t qualify for some form of public assistance.

I’m supposed to obtain the document from INSS, the Spanish Social Security administration. INSS office visits, already space constrained by Covid-19 restrictions, are also date constrained because demand for unemployment is up. So I’m navigating the INSS website in Spanish, filling out online forms (is my sex “M” for masculino or “H” for hombre?), and hoping for the best. Stay tuned for exciting developments. I may end up getting a sex change along with my flu shot.

The flu shot is practice, of course, for the Covid-19 shot. News on that front was very good last week with Pfizer applying for FDA approval of its Covid-19 vaccine and Moderna announcing its Covid-19 vaccine is 94.5% effective.

While this Covid-19 vaccine news from Pfizer and Moderna is great, there are many hurdles to distribution and administration.

Here are a few Covid-19 vaccine distribution issues in the US:

  • No agreement how cash-strapped state public health systems will pay for vaccines.
  • Runaway Covid-19 infections already stretching healthcare systems to limit.
  • No state has a system to track low-temperature distribution logistics at scale.
  • Many rural areas lack low-temperature distribution infrastructure.
  • No state has a system to track that adults get the second booster shot.
  • One in three Americans say they will not get a Covid-19 vaccination.
  • CDC should coordinate the vaccine program nationally, but very low morale.
  • Trump refuses to coordinate a public health transition with President-elect Biden.

Due to its regional public health system, Spain’s vaccine logistics problems are similar to the US. That makes Phase-3 trials of the Johnson & Johnson Covid-19 vaccine welcome here (and the UK). The J&J vaccine has less stringent cold storage requirements than the Pfizer and Moderna vaccines, simplifying vaccine logistics. For example, the J&J vaccine can be stored a refrigerator temperatures for three months before inoculation.

Spain has two advantages over the US in deploying a vaccination program. One is that it doesn’t have a lame-duck president stiff-arming an incoming administration. The other is that, in stark contrast to the US, 71% of Spaniards say public health restrictions are more important than the economy. That means the restrictions imposed after the second wave of Covid-19 here are, for the most part, taking hold and Covid-19 infections are dropping.

Still, it will be a month or more for Spain’s Covid-19 numbers to come back to tierra.

Covid-19 news in Catalonia continues to be good. A month after initial restrictions, numbers are turning the right way. New cases load was about 1,000 per day during the summer. It was running about double that last week, but it’s dropped to a third of the peak reached about three weeks ago.

Covid-19 confirmed cases in Catalonia, 20 November 2020. Source: Catalan News.

Hospitalizations here are dropping and ICU beds are opening up which allows the Catalonian government to relax restrictions over the next two months. With an election coming up in three months, public health decisions are becoming more political, but nothing like the US.

Restaurants will re-re-open tomorrow. First reports were that they could serve lunch, but had to close seating areas by 5:30p. New reports say indoor dining has to close at 9:30p.

Catalonian businesses that had been closed will re-re-open with capacity limits. Travel restrictions between municipalities will be eased over the coming month. Social gatherings will continue to be limited to six and the 10p curfew will stay in effect for at least a month.

Day-to-day drama here isn’t Covid-19. It’s the unending US presidential election, a huge distraction even from across the Atlantic. Trump’s theatrical coup hit its high note during last week’s “big dripper” press conference. Here’s how Australian news summarized Giuliani’s drip and other US election events last week.

Trump’s strategy is to keep states from certifying elections and to encourage Republican state legislatures to send alternative slates of electors in order to break the Electoral College. That would send the final election decision to the US House of Representatives, the only place now where Trump can win.

Trump is spewing conspiracy theories to make his case and amplifying them on social media. One conspiracy theory says that votes from districts that happen to be largely black are chock full of fraudulent ballots. What Trump supporter won’t eat up that claim?

Trump’s wilder conspiracy theory is that Clinton and Soros have teamed up with Antifa and Black Lives Matter to change votes on a server in Germany owned by Dominion, a company started by Hugo Chavez in Venezuela to control elections there. I’m not kidding.

Trump has given so much credence to conspiracy theories that they’re popping up everywhere. It seems like a day doesn’t go by when conspiracy theories move Americans to violence.

Covid-19 is the icing on Trump’s social media-fueled conspiracy theory disinformation festival. Having lived through the AIDS crisis of the 1980s and 1990s, I’m not surprised to see Covid-19 denialism the same way I saw HIV denialism.

Here’s one example of how Covid-19 news is misinterpreted to fit a point of view and then amplified on social media. A Danish study of face masks published last week has anti-maskers in a tizzy. Data for the study were collected last spring as Covid-19 was breaking out in Europe. The study is well designed, but unfortunately its results are being misinterpreted as saying that masks don’t work.

I spent the better part of a day last week pointing out to a group of anti-maskers / anti-vaxxers that, in spite of what headlines say, the Danish mask study did not say that masks were ineffective against Covid-19 transmission. The study says masks are ineffective in a very strict set of circumstances and, in these specific set of circumstance, masks failed to protect the wearer against infection. What the study explicitly did not say is 1) that masks fail to protect the wearer from infections in different circumstances, 2) that masks fail to protect others from an infectious wearer, and 3) that masks don’t reduce the severity of infections by reducing the amount of virus transmitted.

Even though all three of those things are probably true (that masks protect the wearer in many circumstances, that masks protect others around the wearer in many circumstances, and that masks reduce viral load of an infection, so, the severity of the resulting infection), the anti-maskers say they need proof. Of course. Even after I pointed out that US states have seen Covid-19 infections drop after mask requirements, the anti-maskers wanted proof. Even after I pointed out the study’s author advocates for wearing masks, the anti-maskers wanted proof.

There is more and more data that Covid-19 restrictions, including masking, do work.

The case of the Danish mask study shows that one poorly written headline gives believers permission to misinterpret important public health information in a way that fits their preconceived notions, and then to amplify their misinterpretations through social media.

Covid-19 bits.

Let’s end today’s entry with Quarantined with You, a song from Catalan musician G’beats (h/t Brad!).

I write this for my own sanity. If you like it, please mention it to friends and family. Follow me on Twitter for more frequent updates. Thanks!

15 November 2020 – Sunday – #121

It’s just really weird right now. I don’t know how else to say it. The convergence of good and terrible Covid-19 news, the winter holidays around the corner, and Trump’s faux-coup have given the world a dystopian glaze.

Catalonia has shown its colors. First off, the Covid-19 restrictions imposed a month ago continue to drive down new cases and hospitalizations. Deaths should peak and decline soon, too.

As the Covid-19 numbers improve here, the restrictions are coming off. Restaurants will re-open in a week. In the meantime, yesterday’s montanya i mar almuerzo (surf ‘n’ turf lunch) at Simon’s place was a nice way to cope with the closures. Francesc scored muscles and shrimp, Joanmi dived for clams, Brad brought Txogitxu steaks, and I cooked up samfaina. Everyone brought wine.

The fishmonger is happy to deliver while his restaurant business is off. Here’s the aftermath of the surf segment of lunch.

Montanya i Mar aftermath on Simon’s terrace. Tellarinas del mar (aka coquinas), berberechos, y gambas.

I blame my poor food porn skills on the wine. We drank wines from Priorat including a Carignan-Grenache blend (the French usually splash in those two varietals with Syrah) and a blend of four varietals, which was delish, but lost the character of any particular grape.

The nearly four hour feast almost made up for last week’s frustration with Catalonia’s bureaucracy. I have two healthcare issues that seem impossible here. I’ve written about obtaining PrEP before. I finally solved that problem.

If you live in Catalonia on a no lucrativa visa and want PrEP for free from Checkpoint BCN, you have to obtain a Tarjeta sanitaria individual (TSI). Residents who don’t work can obtain a TSI by paying into the Catsalut public health program through the Convenio Especial program established by Royal Decree 576/2013. If you’re under 65 years old, that costs 60 euros a month, which is about 5-10 euros more that buying PrEP online. It’s like paying for PrEP and getting the entire Catsalut system for a few euros more. If you’re 65 years old or over and pay for private insurance, economics favor buying PrEP online.

Before you obtain a TSI, be warned that Checkpoint BCN currently has a PrEP waiting list of over a thousand people. If you make it through the bureaucratic hoops of buying into Catsalut, you still may be buying PrEP online for months. However, if you buy PrEP online, Checkpoint BCN will test your blood quarterly for free to make sure the generic Truvada isn’t damaging your liver. Also Checkpoint BCN provided me a list of online vendors whose products it has quality tested.

My other healthcare issue is flu vaccination (vacunación contra la gripe). I promised my mother I would get one and, considering the effort Catalonia is making to inoculate its population during the winter of Covid-19, I thought that would be an easy promise to keep. I also figured that breaking the code on flu vaccination would be good practice for a Covid-19 vaccination sometime next year.

Much like PrEP, the problem is that vaccinations are public health and Catsalut controls public health in Catalonia. Catsalut has not provided vaccines to private healthcare systems. Last week I visited Catsalut and found out that, while I don’t need to pay for a TSI, I do need to register. Catsalut registration requires an empadronamiento (check), a Tarjeta de identidad de extrajeño (TIE) (check), and a form from the Instituto Nacional de la Seguridad Social (INSS) (uh oh). Of course, right now it’s hard to get information in person from INSS because Covid-19 has restricted its office capacity. My plan is to figure out online how to obtain the correct INSS form next week, then register with Catsalut, and finally get vaccinated. Stay tuned.

Speaking of Covid-19 vaccines, last week had great news. Pfizer said the preliminary reading on the effectiveness of its Covid-19 vaccine is 90%. According to Trump, 20 million Americans will get Covid-19 vaccinations this year. My tweet thread explains why Americans might want to take this claim the same way they take all his claims, with a large grain of salt.

Of course, Trump has beat Covid-19 (if you don’t count the dead people) the same way he won the election (if you don’t count mail in votes). I lost a lot of sleep two weeks ago waiting for election results. I lost more sleep this week waiting for Trump’s coup. Besides denying he lost the election, Trump installed loyalists at the DoD and DoE that portended a coup. Or might portend a coup. Or might just be an angry old man acting out with support from his grifter family. There’s no question Trump is waging his legal battle in order to milk money from his assets supporters.

Last week’s problems with Trump are twofold. First, Republicans are letting him explore all the ways he might retain the presidency. As New Republic points out, that is practically the same as letting Trump explore a self-coup. In other words, Republicans are allowing Trump to damage democracy in order to, who knows, assuage his delicate ego? Make more money? Divide the country on his way out the door?

Second is that Trump is withholding transition support to President-elect Biden. This not only increases national security risks during the interregnum, but slows Biden’s efforts to contain Covid-19 as the US is about to surpass 2,000 Covid-19 deaths per day. Even the stubborn Republican governor of North Dakota has buckled under pressure from healthcare providers and imposed Covid-19 restrictions.

The Covid-19 curves in Europe are improving after countries imposed Covid-19 restrictions.

Covid-19 cases crest in European countries after restrictions imposed. Source: BBC.

Trump and Republican governors are sweeping aside Covid-19 restrictions at the peril of Americans. US Covid-19 numbers are crazy with the Dakotas beating every country in per capita new cases.

Covid-19 cases dropping in most of Europe while skyrocketing in the Dakotas. Source ABC.

Covid-19 is killing people. Wear a mask!

Covid-19 bits.

I provided above a short list of politicians who have Covid-19. Here’s a long thread of many more from @Cleavon_MD. I wish those who haven’t died a speedy recovery.

I write this for my sanity. If it helps you, please pass it on to friends and family. You can follow me on Twitter, too, for more frequent updates.