Four months

It has been four months since Wuhan started its lockdown on Jan 23, 2020, THE singular event in modern medical history.  But it now seems like an eternity, as perhaps few people outside China even remember it. 

My first blog on COVID-19 on Jan 26 mentioned “the biggest news in the young 2020”.  Even that is a vast understatement: it is THE news in 2020.  With new developments coming in fast and furious, perceptions and predictions are being challenged, changed, and refined.  My 3/15/20 and 4/3/20 blogs reflected on some predictions on 1/26/20, 2/23, and 3/5/20 blogs.   A wrong prediction on 1/26 was the death toll would be lower than SARS, which was soon pointed out on 2/9/20.  Another wrong prediction, or rather wishful thinking, was more developed countries, aided by sparser population and warmer weather, would contain COVID-19 better and quickly (2/23 and 3/5/20).  This prediction is arguably even more wrong or worse than the first one, with the US being the prime example, as I on 4/5/2020 still didn’t think the US death toll would reach 100k.  Warm weather can help, just far from enough.

More predictions and analyses, however, have turned out right and farsighted.  One is that the fatality rate of COVID-19 will be 1% or lower (1/26/20).  Even though most countries have official death rates well over 1%, since the actual infections are much more easily undercounted than deaths, the scientific consensus now accepts the 1% magic number, under “normal” conditions.  Its most solid support, by actual data, comes from China outside Hubei: the total 13K or higher confirmed cases is large enough to eliminate any statistical chance (4/23/20).

A second prediction on Jan 26, 2020 was that COVID-19 will stay with humans for a while, which nobody will contest right now.  Another prediction is that Trump’s policies have poisoned and will continue to poison global affairs including the COVID-19 response (3/5 and 3/15/2020 blogs).  This is the biggest threat to the world, even bigger than the pandemic.  Things like WCEV (5/1/2020 blog).  It is why we are facing 1929.  COVID-19 alone can’t do the job.

Four exact months after 1/23/20, China reported for the first time zero total new confirmed case (https://news.sina.com.cn/c/2020-05-23/doc-iirczymk3092155.shtml).  This is symbolic of course, as China has had low single digit new cases daily for weeks, and nobody can guarantee or should expect all 0 from now on.  On this day China reported 2 suspected and 28 asymptomatic cases, some imported.  Suspected means having symptoms without a positive RNA test, and asymptomatic means no symptoms but RNA positive.  All are being monitored for any changes in RNA results and symptoms. 

Almost all of the asymptomatic are from Wuhan, which is conducting a city-wide RNA test of dubious importance (5/12/20).  As they approach testing 1 million per day, they are bound to find such cases.  So far the positive rates are below 1 in 10k (https://news.sina.com.cn/c/2020-05-23/doc-iircuyvi4674655.shtml).  WHO recommends counting asymptomatic as confirmed, although WHO is only advisory (so it is ludicrous to blame WHO for one’s own ill).  A separate category for the asymptomatic is not without merit: many known viral infections don’t cause diseases or symptoms for years or the whole life time.  If one keeps track of China’s asymptomatic cases, a few thousand total cases, one can easily update the official, confirmed figures.  These few thousand cases are likely only a small snapshot, but they also don’t mean active infections.  As we learn more about COVID-19, we now consider that most of these asymptomatic people have already overcome the disease, and their RNA reflects residual, dead viruses taking a long time to clear.

China’s multiple COVID-19 categories, like confirmed, suspected/probable, asymptomatic, medically monitored, etc, overlap only partially with those publicly announced in other countries’.  They make no real difference in combating the disease.  There are, of course, more substantial differences in how each country is dealing with COVID-19.  Clearly every country is unique, and local measures must fit situations on the ground. 

A big difference is how the asymptomatic or some mild cases are treated.  In China these people were sent to field hospitals (the early days when regular hospitals were crowded) or regular hospitals now.   This has the advantage of preventing familiar transmission but is costly.   In many countries these people are instructed to recover at home.  It is a policy adopted for a number of reasons, for one, the American houses are much bigger.

Then, when patients recover after hospitalization, they go home (sometimes to a central location like hotel) but quarantine for another 14 days in China.  This seems an overkill but has indeed identified some who relapsed.  A major difference here, because few countries have this 14-more-day requirement.   News reports abound that people recovered from symptoms at home, not even sure RNA negative, rested for a couple of days, and then go back out or to work.  Even worse, recovered seniors going back to nursing homes without proper quarantine (https://www.huffpost.com/entry/over-4300-coronavirus-patients-sent-to-new-york-nursing-homes-ap_n_5ec7c03ec5b6b9438505aa8e). 

The third is probably whether to wear face masks.  While this issue has been settled in the West by mid-late April 2020, face masks were explicitly and stubbornly discouraged before then such that any person wearing a mask in public was viewed with great suspicion.  Some of those objections by the scientific community in the West are reasonable, yet situations don’t always stay the same, and certainly COVID-19 is an entirely new beast.  The utmost urgency arises from the fact that infection rate in the population has risen to a non-trivial level, with many asymptomatic cases walking around.  The objections have mostly centered upon the assumption that the public don’t know how to wear masks, and that wearing a mask gives one a false sense of security.  But under the well publicized COVID-19 threat and education, the public are no idiots.   Even 50% good mask wearing is useful.  And while previous studies appeared to show viruses sticking to the outside of a mask and that people touching the mask might then get the viruses, there was little evidence how much people could get the viruses this way or even how infectious such viruses were.  Lastly, a mask will filter out viruses.  Even if it is not 100%, a person getting a smaller load of viruses will likely survive or may not get COVID-19 at all.  When dealing with a pandemic, any measure that helps counts.  Coupled with other preventive actions, wearing a mask in public might reduce R0 from 1.05 to 0.95, effectively shutting down transmission.          

There are trade-offs in various measures, and one can always find faults in any actions.  People will debate whether Wuhan lockdown was necessary or whether it could have been be handled better (5/2/2020 blog).  But the worst is perhaps seeing ideology in every move.  Going back to when Wuhan had the lockdown on 1/23/20, its meaning was impossible to miss to anyone on Earth.  If one took it on face value, he knew instantly what COVID-19 and China meant.   Unless, of course, he dismissed it by thinking China always and now only finds a new way to violate human rights.  And then when outbreaks occurred in March, he said he didn’t act because China was hiding something, although he can never offer any objective evidence, while conveniently ignoring the elephant in the room: Wuhan lockdown on 1/23/20.  In fact, the stock market began crashing only on Feb 20 (https://www.marketwatch.com/story/no-americas-billionaires-didnt-get-434-billion-richer-during-the-pandemic-quite-the-opposite-in-fact-2020-05-22?siteid=yhoof2&yptr=yahoo), when South Korea, Italy, etc, reported COVID-19 outbreaks.  The US didn’t have a concerted response until mid March, a full 3-4 weeks later.  The stock market stopped the plunge one week later.  What was China hiding on Jan 23?  Even if the US had acted on Feb 20, it would have had been much better.  Then what were South Korea and Italy hiding on Feb 20?