Archive for category COVID19

Do COVID Precautions Work?

Do COVID precautions work? Yes, but they haven’t made a big difference.

I guess it depends on the meaning of “work”

Behind a NYT paywall, so I only read the headline, which gives new meaning to adventures in cognitive dissonance – of course they are hugely important even if they don’t actually do anything! How dare you!

Says the guy who still hasn’t caught it despite my ignoring precautions to the best of my abilities. I credit the bag of oyster crackers I had to buy with my wine in New York for warding it off for the last 25 months and 25 states. I chose to focus on improving my overall health instead of an obsession with a single risk. Still do.

I know, I know, now when I catch it, I’ll die – just like when the tree fell on our house when I mocked the over the top reaction to a typical spring thunderstorm.

UPDATE: I caught COVID at Thanksgiving 2022 and thankfully survived. It felt just like the ordinary flu, which I haven’t had in a very long time, no doubt due to my totally deserved moral superiority.

Uncontrolled Spread

I finished “Uncontrolled Spread”, Dr. Scott Gottlieb’s book on why COVID crushed us and how to defeat the next pandemic. It’s not a perfect book – the narrative part ends with the vaccines are here and how great the mRNA vaccines are now and they’ll be even more wonderful in the future but it does get us through the pandemic phase so I suppose if we adopt his proposals the next pathogen won’t become endemic. The focus is on the institutions, mainly governmental, so Dr. Fauci and Dr. Birx get like 3 mentions each, and Trump comes up in a single chapter mainly about messaging. And you have to remember that Gottlieb is a former FDA commissioner and on the board of Pfizer so those institutions mainly (only?) get praise.

Before COVID I thought the CDC was pretty good for a government agency, after COVID crushed us but before I read the book I thought the CDC is just another lousy government agency, and after reading the book hoo boy they come off as one of the crappiest government agencies ever, on a par with the Austrian army of WWI. Everyone looked to them as the field general who was going to lead the public health team to victory; they saw themselves as an historian who years later would write the definitive account of the war. They screwed up testing, both by botching the initial test and then delaying all other entrants by every means at their disposal like insisting on IP protection and not providing samples of the virus. And it was all downhill from there.

The basic science was also lousy. Everybody wanted to get in on a study of some sort and most were basically worthless. For instance, 90 percent of the COVID trials run were designed in a way that would never yield actionable results that could change medical practice. That means all those participants time were wasted and it was hard to get people to enroll in the trials that could make a difference. The NIH set up the ACTIV clinical trial database and refused to participate in the British RECOVERY trials because they viewed it as insufficiently rigorous i.e. too simple. Not a single therapeutic would be authorized by the FDA based on ACTIV, the use of dexamethasone in severely ill COVID patients came from RECOVERY.

Ultimately, our failures on COVID were the failures of our public health institutions. For instance, the reason politicians up until mid march were assuring us there was nothing to worry about is that that was the message from CDC, NIH, etc. They kept saying it wasn’t here based on our data and that if it does show up we will be ready. Ha. The fact that we couldn’t test for it? We have our flu like illness system and it doesn’t show an uptick in cases. They didn’t realize the lag involved in much of the data from that system, set up by “historians”, or that the signal from COVID would be swamped by the decline in numbers at the end of a flu season. Their overconfidence was only overshadowed by their incompetence.

I could go on and on but then few have read even this far, so you get the idea. And if you want to read more, go read the book.

Lots of good recommendations in the book, but since they involve spending money in a way that doesn’t buy votes and/or a change in the way government agencies operate, I have little hope that any will be adopted.

COVID in Missouri

I plotted COVID cases and deaths here in Missouri with year on top of year which I think is important with a seasonal virus. While there were divergences between cases and deaths in 2020, 2021 they look pretty lock step taking into account the slight delay from cases to deaths.

My biggest takeaway looking at the death chart is that while happy days may not be here again, happier days are – as long as the drop isn’t due to delays in death reporting. The fact that cases and deaths have been dropping essentially for the month of August while last year they kept rising is a good sign, a sign that between vaccinations and infections the virus is running out of susceptible people to infect. I would be concerned that if the cases chart is a more accurate indication of seasonality, we might still have a fourth wave coming in November (again).

Another take away is since we’ve been through three waves in Missouri, we have achieved “herd immunity” three times already, IOW R (reproduction number) has been above 1 three times and below 1 three times (don’t even get me started on R naught for a seasonal virus). I think we are headed to COVID becoming an endemic minor childhood disease but we still have some rough times ahead to get there in the year to come. If you have not gotten infected or vaccinated yet, your choice is either to go through an infection vaccinated or unvaccinated, and I’m going to suggest vaccinated is the better way to go. COVID zero is a pipe dream, COVID as just another viral infection amongst others is the reality.

Clearly Delta is more infectious since the late summer surge was greater in 2021 than 2020 despite the fewer susceptible people more people were infected and died. The media keep saying the hospitals and ICUs are as full right now as during the peak last Nov and Dec last year, yet the death rate of the most recent peak is roughly a third what is was then so I have to wonder what is really going on. Are we hospitalizing more for treatment, or are we doing that much better keeping hospitalizations advancing to deaths? Or is the media just being negative and sensationalist? The answer is left as an excercise for the reader.

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Youth COVID Death Statistics

More stats, namely deaths of 5-17 year olds per year, data from a couple of days ago:

The good news is that car accident deaths have been declining for years. The bad news is that schools are still mostly closed for in school learning, and yet we don’t give a second thought to our children dying in car accidents (or drowning in buckets).

FYI deaths from poisoning (AKA drug overdose) doesn’t pass car accidents until age 23.

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Missouri COVID Death Statistics

While My Better Half was barreling across multiple states on her epic road trip, I put together a spreadsheet of Missouri COVID death statistics from the state of Missouri’s COVID dashboard which provided the number of cases and deaths by age group which allowed me to calculate the case fatality rate; the ratio of age related to average CFR column (not a percentage!) which is the age related CFR divided by the average CFR in the Total row – so the value of 9.91 for 80+ indicates that people in that age category have 9.91 times the risk of dying on a case basis than the average while at 55-59 you have basically half the risk; and the percentage of deaths by age group plus the cumulative percentage. I have to believe Missouri is representative of the country as a whole since we are kind of in the middle both in location and rural/urban split. Sometimes we just don’t appreciate how age drives outcome for COVID – not shown but based on other data I’ve seen the rate at which people are admitted to the ICU is driven by age, but not as strongly as deaths, and admitted to the hospital is driven by age, but even less strongly than ICU admission.

This is why I keep saying the vaccinations should only focus on older people and those with comorbidities, and any focus on an essential job will wind up killing people and keeping hospitals overburdened. More than 85 percent of deaths occur in people past the age of retirement, so the data and experience make it crystal clear our essential societal functions can thrive in the face of COVID, unlike for example extreme cold or heat or wildfires which have brought the regions of the country that have experienced them recently to their knees. It’s as deadly as putting COVID positive people back in nursing homes to vaccinate anyone younger with no comorbidity before anyone older.

Also, there have only been 3 deaths of people under the age of 18, which is less than flu kills year in and year out of this age group. People in their 20s run a tiny risk, so schools really should be open in person full time with an option for those few that do have comorbidities.

We have to abandon our preconceived notions about disease and just follow the data for the one we are actually confronted with – and COVID is not an equal opportunity killer. When the data tells us the median age of death is 79, we need to listen.

Values for Case and Death from Missouri COVID dashboard early February 2021

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You Call That a Rollout?

First, let me say get the COVID vaccine.  The only way to get past this virus is either most people catch it or get vaccinated, and vaccination is preferable.  So again, get vaccinated.

None of the testing and analysis has been short cut for the vaccines – the decision making and bureaucracy has instead.  Gone is the the general foot dragging by the manufacturer while it tries to decide if they can make money after the cost of the testing (clinical trials aren’t cheap) and manufacturing versus what the market will turn out to be plus trying to factor the risk involved.  So they tend to go slow while looking at small sets of data trying to decide if the cost of gathering larger sets of data will be worth it.  And then the FDA (the government agency that has killed more Americans, even more than the VA) has it’s own ways of slowing everything down – requesting more data, making decisions at a snails pace – because they don’t care about the human toll of delay and disapproval, just the risk they approve something and somehow they get blamed for any problems with it.  And even with all that depends on these vaccines they took weeks to schedule meetings or look at data that should have taken days at most.

Nothing really says failure of the government public health apparatus at all levels than these vaccines.  The CDC issued guidelines for a crazy multi phased, multi tiered roll out that looks like they started with something put together over a few beers after watching “Contagion”.  The plan worries about preserving societal functioning so what job you do moves you up or down in the priority list – Missouri very helpfully assigns morticians and embalmers in the same very high priority group with public health administrators and law enforcement.  And then of course equity is a big thing so being homeless or in prison or a member of disproportionately affected populations puts you in phase 2.  And then because we love our children Young Adults and Children are in Phase 3 along with another set of important workers.  And then it must have dawned on them that COVID is nothing like the fictional virus of Contagion, so they tack on to that unappetizing hodgepodge Long Term Care Facility residents, people over 65, and people with the COVID comorbidities we’ve all come to know and hate. And then they don’t even specify a Phase 4, just leave it implied that someday they’ll get around to the rest of us.

But the fact that COVID was here for like nine months before they issued these guidelines and society is no closer to collapse due to COVID (our politics maybe) didn’t seem to dawn on them, or that our hospitals, not society at large, is what is under pressure from COVID.  So despite all these wonderful charts about how COVID deaths and hospitalizations are hugely driven by age and comorbidity (basically people under 50 show very low hospitalization rates with little seasonal variation unlike all the age groups over 50, and the line for 17 and under basically hugs zero), they left in all the pointless generic virus protecting society complexity and young people.  It would have been childsplay to use the data we already have to a few levels of who is at most risk of dying/hospitalization based on age and comorbidity.  Number one would be LTCF residents, then something like people over 75 and people over 55 with comorbidities, then people over 65 and anyone with comorbidities, then everyone over 50,  and then everyone else.  That approach would both lower the death toll and relieve the strain on hospitals the quickest, and be easy to understand.  It’s crazy, people under 17 should be the last people to get the vaccine, and yet they get a bump in priority.  

The actual vaccination program has not gone well (at least it seems now to be better than our contact tracing efforts).  First the states seemed totally unprepared for a vaccination program.  Some governors would rather waste vaccine than have their priority schemes not followed.  And there seems to be 20 million dose disconnect between what the federal government thinks they’ve delivered vs what the states think they’ve received.  The target audience is old people, and so of course we use complex websites hastily thrown together to sign up to get vaccinated.  And despite the deaths and ravaged economy, can you detect a sense of urgency in the vaccination efforts?   I sure can’t.  It was like the Warp Speed team had urgency and figured out how to dramatically shorten the time from development to shipment with approval and then turned it over to normal government where it has been business as usual. 

Let me say one last time, unlike facial cover wearing, social distancing, lockdowns, and hand washing,  these vaccines have actual clinical trials to back them up, both on safety and efficacy – so quit placing your trust in the unproven and get vaccinated.  

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Leadership

I don’t know about you, but I’ve gotten pretty tired of this rule by decree we’ve fallen into at every level of government and party now. I’d love to blame our terrible political class, but we are the ones who vote them into power – we’ve fallen prey to a miserable tribalism in America and elect politicians purely on cultural grounds instead of their ability to lead.

But we need these decrees you say, why if everyone wore a mask we’d have this infection licked. Maybe, but even so I see plenty of people walking around with masks below their noses or even their mouths or wearing bandanas or balaclavas so they are technically in compliance but not really helping. And there are enough nut jobs on both sides of the mask divide or people who can’t stand even a whiff of perceived criticism I just roll my eyes. And my eyes are getting worn out over way more than just masks.

Leaders educate and motivate so that when crunch time comes we all work together to get the job done. We are stuck with politicians and a media that do their darnedest to make us dumber, divided, and sullen by hectoring and lying.

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Masks Gone Wild

How to correctly wear a mask – it’s left as an exercise for the viewer to determine which of the three ways presented are correct.

I demonstrated a fourth way yesterday as I put mine on my wrist as we walked from the library to the grocery store as a way to keep it handy but not worry about losing it. You should have seen the looks I exchanged with drivers wearing theirs.

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The Epidemic So Far

I’m no expert on the COVID epidemic, but I did excel in high school science which apparently means I’m OK to opine on Facebook about it if I can believe what so many of my friends post. Actually, I don’t think anyone has achieved expert status on the overall epidemic, even though I think there are MDs who’ve gotten pretty expert at treating it.

Anyway let’s go back to the beginning per Vizzini and take a look at the chart that at least in March explained it all, said chart which I have included a copy of for your viewing pleasure. Take a look at it.

Anything strike you about it?

If you replaced Phily with New York and St. Louis with the rest of the country and adjusted the dates by over a hundred (!) years, it sure looks to this simple mind a lot, I mean a lot, like what we are going through. Basically the virus ran rampant in Philly then and NYC now, while St. Louis then and the rest of the country now managed to keep it under much better control.

Masquerade

There is a chart that’s been floating around the inter webs for a while now that purports to show the effect of masks on coronavirus spread.  Let’s just say it’s more full of shaving cream than a 10 pound can of Barbasol.  Rather than delve into the chart, let me provide my thinking (right, wrong, or indifferent) about maskology.  

Let’s start with how you get infected.  You have an infected person who is emitting viruses.  You have an uninfected person who is taking the viruses in.  If you don’t interact with an infected person, you can’t get infected (I include encountering their viruses later on a surface and then taking that in somehow as part of interacting, but since this is about masks and CDC says (and let’s hope their right about something for a change!) surface contact is an unlikely infection route we will ignore it). 

So rule number one is limit your interactions with other people, and one A is don’t touch your face until after you wash or otherwise disinfect your hands.

But let’s say you do interact with an infected person.  You have to take in a certain threshold of viruses before you are likely to become infected, so you can think of it as ignorable risk until you hit a certain number, then your risk rapidly climbs as you take in more, and then it reaches you’re pretty much going to get infected after this number  – a big S curve of risk versus viral load (number of viruses you take in).  And you know what – the value where the risk starts to climb, where it hits 50%, and then becomes virtually certain is going to vary somewhat by person.  But for the sake of this thought process we’re just going to say when you hit a certain viral load you’re infected.

How much virus that person emits depends on what they are doing – just breathing, talking, sneezing, coughing, singing, talking loudly and excitedly, etc.  And again, it’s going to vary from person to person based on how infected they are, what stage of their illness they are in, and probably another half dozen things that we are, you guessed, going to ignore other than people emit the virus at different rates.

So you have an infected person, not wearing a mask, they emit virus at a rate such that at the geometry (i.e. distance, relative positions, direction of emitting and taking in) the uninfected person will receive an infectious viral load in 10 minutes.  So if you interact with that infected person for 10 minutes you become infected.  For you advanced thinkers out there, we’ll pick the leading edge of the rise in probability so we can say you can stand there for 10 minutes before you start up the rise in infection so you’re safe as houses until that 10 minute mark.

Now let’s add a mask.  The infected person puts on a typical cotton mask.  This reduces the number of viruses that reach the uninfected person – but by how much?  And that’s where the evidence get’s thin.  So I’m going to pick a reasonably conservative number that also happens to make the math work out easier, and say that the mask decreases the viral load per minute by 30% – so 70% makes it through.  I know, I know, if you blow particles through the material you may well come up with a higher value, but given fit, variation etc. etc. I’m picking a value that is for illustration purposes only since we don’t know the real value and it probably will vary with how well it fits, the actual material, if you wear it below you nose like some people do, etc. etc.  So that means that means you need 1/0.7 longer to reach the infectious threshold so I’ll do the math for you that means 1.4286 times longer or about 14 minutes, 17 seconds instead of 10 minutes. 

Now let’s add another mask.  The uninfected person puts on a typical cotton mask.  I’m one of those weirdo’s who thinks that to a first order if a mask  stops virus from leaving at a certain rate it stops it entering at the same rate, so we will pick the same 30% reduction.  That means that 49% of the virus gets through (70% times 70%) which I’m going to round to 50% to make the math easier.  Which means you have twice as long, 20 minutes instead of 10, before the viral load reaches the infection point.  So I think that instead of saying a mask cuts your risk by x% it’s better to think it takes longer, probably significantly longer to reach the same risk level as without a mask.

That’s how I see masks working.  They allow you to interact longer with infected people before becoming infected yourself.

What does that mean in practice?  Here’s an example.  Let’s say you go to get your hair cut.  Amy and Betty are both infected (so, yeah, a true story except for the names), and both take 10 minutes of close interaction to complete a haircut.  And the rules are both you and the stylist are masked.  When I get my haircut, the stylist is above and right behind breathing over the top of me, so the geometry is not good.  Let’s say Amy, for whatever reason, emits enough virus that without masks you are infected in 6 minutes.  So with masks, it will take 12 minutes.  You only interact for 10, so you and everyone else whose hair she cuts are not infected.  Man, masks are wonderful!  

Betty, for the sake of comparison, emits emits 50 percent more virus – maybe she’s a non-stop talker, maybe she’s a loud talker, maybe she’s in poor shape and breathes heavily, maybe all three, who knows – enough virus that without masks she infects others in 4 minutes.  So with masks, it will take 8 minutes.  You interact for 10, so she infects everybody whose hair she cut that day.  Man, masks are worthless!

So tell me, what is the effectiveness of masks if someone did a study?  If Amy and Betty work at the same salon and were infected the same day, you would be tempted to say 50% since half of the people who got their haircut that day were infected and everybody wore masks.  If Amy and Betty worked at different salons and were sick at different times, you would likely see one study that said masks are 100% effective and another that said they had no effect – and all of us would go see, I’ll keep right on believing what I want to believe because SCIENCE!

I will mention that there is some evidence and a lot of feeling that viral load affects how sick you do get with COVID, which is a very variable disease in its severity, so even Betty’s clients may see benefit from wearing a mask because even though they still were infected, they might not get as sick as they would have if they didn’t wear a mask.  

Masks are one more layer of protection that ultimately can be overcome, so wear them but don’t rely on them.  

And if you see a graphic that says if both people wear a mask you only have a 1.5% chance of infection, remember it’s full of shaving cream.  You stay close enough to an infected person long enough, you’ll get infected too even if you both wear masks (unless you’re both wearing N95s in which case it would take literally days).

For really super advanced people, let’s talk N95 masks which in theory are guaranteed to only let in 5% of tiny particles, so you would have 20 times longer – so if it takes 10 minutes without masks, just you wearing an N95 would give you 200 minutes before starting to run the risk of infection.  And I’ve read that they let in more like 3%, so you have 33 times longer.  And N99 masks – well, you get 100 times longer.  That’s right, an N99 is not 4% better than an N95, it’s 5 times better.  When you compare masks, you need to compare what they let thru, not what they stop.

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