. . . on Covid
1. The worst current covid outbreaks are in East Asia and, of these, the worst is Hong Kong, which had previously managed quite well, relying up strict immigration requirements and quarantine measures. To my surprise, however, the elderly vaccination rate was quite low so when Omicron hit it took quite a toll. Currently, Hong Kong is having the US per capita equivalent of over a million cases a day and 11,000 deaths daily.
2. It is reported that the Hong Kong outbreak has spread to China, and major cities are closing schools and imposing quarantine measures. This inevitably means further supply chain disruptions between China and the rest of the world. Adding this to the existing covid induced supply chain disruption along with the more recent Russia-Ukraine war disruption, means we are all in for even rougher times.
3. Official reported global death toll from covid is a little over 6 million, but it may actually be as high as 18 million. It is very difficult to make cross country comparisons because of this. I can tell you there are now 45 countries or jurisdictions reporting death counts in excess of 2,000 per million population, and the U.S. is #18, but I cannot with confidence tell you whether that ranking is correct, or whether other countries reporting less than 2,000, actually exceed this threshold.
4. Example 1 of the difficulty even in the U.S of making comparisons. It turns out that states are using different definitions of covid deaths. Massachusetts has just announced it is revising its definition. The state had defined as a covid death, any death where covid was listed as one of the causes on the death certificate, or where the deceased had been diagnosed with covid at any point within 60 days of their death. Massachusetts revised the latter criteria to only include deaths where covid was diagnosed with 30 days of date of death. The state is imposing this retroactively, which will reduce its previously reported death toll by 15%.
5. Example 2 of
the difficulty in making state comparisons. Comparisons of raw,
unadjusted data can be misleading, particularly if average age is not
accounted for because of the relative severity of the disease on the
elderly. If you look at Arizona and its neighbor state, New Mexico,
Arizona's death rate is 15% higher, but if adjusted for age the
difference is 2%. Unadjusted v adjusted data is even more dramatic in
other instances. Florida's death rate is 50% higher than California's,
but Florida has the second oldest population in the country (Maine is
the oldest), while California has a much younger population profile.
Adjusted for age, Florida still has a higher rate, but it is 4% instead
of 50% (as of mid-February).
6. There are also many other population and geographical characteristics that may play a role in the results. It would be good to explore these in a data drive analysis. For instance, I mentioned that Maine has the oldest population in the U.S., yet its unadjusted death rate is one of the lowest. For that matter, the three northern tier New England states all had relatively low death rates.
7. It would be useful to get more detailed analysis on international comparisons to see if we can find anything useful for us in America. For instance, the Netherlands death rate/official case is only 0.3% and its per capita rate less than half the U.S., even though its per capita case rate is higher. Why? Are they counting differently? Are their demographic differences? Are they treating the infected differently? I wish there were more reporting.
8. Why did public health officials fail to place a big emphasis on actions people could take to protect themselves in addition to masking (let's put the debate over effectiveness to the side for now), distancing, and vaccines? It was obvious early on that emphasizing losing weight, exercise, getting outdoors, working to keep medical conditions such as diabetes and high blood pressure under control, Vitamin D levels, were all important to reducing the risk of serious outcomes, yet these were mostly ignored. Why?
9. The vaccines were oversold as preventing
covid infection and that damaged the credibility of vaccination
efforts. However, they were, and remain, effective in reducing the risk
of serious consequences if you get covid. If you are old folks like us, or a younger person with underlying conditions like diabetes, immune system dysfunction, untreated high blood pressure, or seriously overweight, getting vaccinated and boosted is the most effective strategy you can have.
10. Further to #9, I am tired of reading attacks on vaccines by those who deliberately focus on cases and ignore adverse outcomes. We can directly see the difference in the Omicron surge in East Asia and Oceania. Hong Kong, Singapore and New Zealand have all seen huge surges in cases but, of the three, only Hong Kong has seen a surge in fatalities because of its low vaccination rate among the elderly.
11. I'm also tired of arguments by advocates who focus on U.S. data and ignore the rest of the world when it suits their needs, and then turn around and use international data when it does suit their needs. Or, for that matter, those who selectively use international data, ignoring any that contradicts their argument.
12. Closing many schools in 2020-21 was a disaster. Polling indicates most Americans significant overestimate covid risk for children. It is thankfully very, very small. We should not repeat this when we have the inevitable covid waves in the future.
13. Europe took a very different approach to both keeping schools open and masking for children under 12. Studies found no adverse impacts from the European approach.
14. Fitted N95 masks can be effective in preventing infection. Non-fitted, non-certified N95s can be sometimes effective. Cloth and surgical masks have very little utility. In the latter case, if those who wear cloth and surgical masks tend to keep more distance from others and to isolate themselves more frequently that may have benefits in reducing infection.
15. Even before Covid it was apparent the CDC was a troubled organization. Its mission had expanded and focus drifted from its original task regarding infectious diseases, in part because of Congressional mandates, in part because of the increasing ideological preoccupations of the public health field. But its incompetence during Covid has been staggering. I thought Trump's CDC Director, Dr Redfield, was bad, but Dr Walensky, Biden's appointee, has been even worse, sounding panicked, sending conflicting messages, and promoting unsound studies. Under this administration, the teacher's union president, Randi Weingarten, actually runs Covid policy so perhaps it would have been better to just appoint her. Congress needs to reform the CDC and return it to its original sole mission regarding infectious diseases. Of course, it won't.
16. We still don't know how Covid-19 originated. I think it was an accidental lab leak in Wuhan but both the lab leak and natural origins need to be properly investigated which has not been done. China will never cooperate, but there is a lot of additional information available in the United States which is obtainable if Congress took action. Both the NIH and NIAID (Dr Fauci's agency) have obstructed efforts to FOIA information and the EcoHealth Alliance (funded, in part, by NIH and DoD, has refused to make public documents which could clarify its role with the Wuhan lab.
17. Will anyone have the courage to force Dr Fauci out of government? During the early phase of the pandemic the doctor had the advantage of contrasting himself with the random musings of Donald Trump. Of course, even Andrew Cuomo looked good compared to Trump because, unlike Trump, he could fake empathy even as he massacred nursing home patients. Fauci's deliberate obstruction of the origins investigation, along with his role in labeling it a racist conspiracy theory, was prompted by his fear that his funding of projects to bring bat viruses to Wuhan may have been linked to the start of the pandemic. His actions are a disgrace and deserve condemnation.
18. Once Fauci is gone, I am convinced, if anyone investigates, we will find many scandals at NIAID, just as we did at the FBI after Hoover's death. Dr Fauci's reign is a prime example of letting an executive run a government agency for decades while escaping accountability. The doctor last treated patients 51 years ago; has been a senior executive at NIAID for 48 years; and run the agency for the past 38 years. Every manager in that organization owes their job and their future to Dr Fauci. Nothing is done without his direct approval or approval by his devotees. NIAID has a $6 billion budget, a large portion of which goes to funding virology research. Fauci is the largest funder of such research in the U.S. and possibly the world. Research careers are dependent upon the doctor's favor. When Josh Rogin wrote Chaos Under Heaven, his book on the Trump's administration's China policy, he reported that he was unable to get virologists to speak on the record about Fauci and the origins of Covid because of his control of their funding. Reportedly, over the course of his career, Fauci several times turned down potential nominations to head NIH. That's because he is a very astute bureaucrat. He already controlled a large budget and bureaucracy at NIAID, an organization embedded within NIH. Why heighten his profile, increase his risk of accountability and have to learn and control an even larger bureaucracy when his current position insulated him from all of that?
8. Why did public health officials fail to place a big emphasis on actions people could take to protect themselves in addition to masking (let's put the debate over effectiveness to the side for now), distancing, and vaccines? It was obvious early on that emphasizing losing weight, exercise, getting outdoors, working to keep medical conditions such as diabetes and high blood pressure under control, Vitamin D levels, were all important to reducing the risk of serious outcomes, yet these were mostly ignored. Why?
ReplyDeleteWhile I agree with much of what you wrote, and disagree with some of it, I'm not sure why this point is hard to understand. Losing weight reduces pain, blood pressure, heart attack risk, and many other conditions. If people aren't going to lose weight already from this list, will covid19 really push them over the line? It was pretty widely distributed what the comorbidities are, but solving these conditions in a healthy fashion is a years-long project for an individual, so it doesn't make much difference during a pandemic of two years even if you start.