COVID-19 zigzag

Ever since Jan 2020 I seem to have consistently downplayed the severity of COVID-19 (5/23/2020 blog) and preferred faster reopening (6/6/2020 blog).  In truth, views on the disease itself have been on target, while it is human reactions in certain places that I have underestimated.  Now at the end of June the US is seeing record 40K new cases per day.   There is really no excuse.  If anyone was uncertain in March, it must be crystal clear now: it is not the virus, it is the domestic system.

COVID-19 cases will still increase even in places that have successfully tamed it.  This happens in China, South Korea, Japan, Germany, Serbia, etc.  The scales and locations are essentially of bad lucks and will follow a random pattern, but existing healthcare apparatus can handle small transmissions.  Three months after their first COVID-19 outbreaks, countless countries have successfully reduced new cases to <100 or even 0.  Most exceptions are now in the Americas and India.  India has a hardware problem and undercounted its cases.  Brazil and the US are examples of poor managements.

The US, in particular, has no excuse, at least in terms of its hardware.  It has the best hospitals, doctors, scientists, and companies.  In theory it shouldn’t do worse than western Europe, or EU.  Yet while most European countries have reopened for a month now without large flareups, daily confirmed cases in the US rarely dropped below 20K during May/June before racing back up to 40K.  The main culprit is the pervasive anti-science mentality, before COVID-19 and after, from the very top to the bottom.  A lot of lies against China, WHO, and others are wildly disseminated by the very top officials and the media and readily consumed by the mass, exemplified in https://www.nzherald.co.nz/world/news/article.cfm?c_id=2&objectid=12343425.  No wonder the US is in this situation right now.  The only silver lining is most new infections are the young people, and as long as nursing homes are secure, daily deaths will be lower than in March/April.  But it raises a serious question about whether COVID-19 can be contained in the US by August before cold weather returns in Oct. 

    

Recently CDC suggested that 20 million American may have been infected with COVID-19, much higher than the official, 2.5 million confirmed (https://news.yahoo.com/cdc-reports-20-million-covid-205553787.html).  The data were based on sample Ab tests, so there are a lot of caveats and need follow-ups.  But the conclusion is within the range of studies in other countries (6/6/2020 blog).  In contrast, a published paper suggesting 8.7 million Americans were infected by March (https://stm.sciencemag.org/content/early/2020/06/22/scitranslmed.abc1126) is much less believable.  This is another modelling paper, and the authors acknowledged so many limitations in the paper that they seem longer than their results and discussions!  A common problem (but not the only one) with these modeling papers is that they often ignore or run counter to existing knowledge.  For the US to going from 1 case in Jan to 8.7 million by the end of March, the authors had to assume superfast and completely free transmissions, thus playing loose with facts in the process.  For example, they suggested the first transmission started on Jan 15 in Seattle.  Indeed, the first case returned from Wuhan on Jan 15 and was diagnosed on Jan 19.  But all his close contacts were isolated, and none was positive.  Same is true for the ~ 10 similar cases by early Feb.  Other importations might have been missed around this time, and some contacts might be false negative, but it is hard to imagine COVID-19 was spreading widely as early as mid Jan, considering the attention then.  And without this assumption, the whole 8.7 million thesis falls apart quickly.  Moreover, by sequencing the viruses, the first Seattle virus might not even be the one leading to subsequent outbreaks in WA in late Feb, and certainly not the one causing outbreaks in many states, e.g., NY, which were mostly of European origin.  Lastly, if the US had 8.7 million by March but only 20 million in June, according to the CDC, COVID-19 multiplies <3 folds in months, this is a hell of a containment job: only countries that have shut down COVID-19 can claim this.  No one in his/her right mind says US is one of them.

A few reports from Europe yielded more COVID-19 surprises.  Italy identified viral RNA in its waste water samples in two cities from Dec 18, 2019 (https://www.reuters.com/article/us-health-coronavirus-italy-sewage-idUSKBN23Q1J9).  The implication is that we need to rethink the origin of COVID-19.  While late 2019 cases have been indicated in Europe, having RNA in the waste water suggests COVID-19 infections were much more than sporadic already.  It begs the question: is this transmission true, and if so, why wasn’t it detected then?  Another one from Spain pushed the timeline much earlier to Mar 2019 (https://news.yahoo.com/coronavirus-news-lockdown-social-distancing-192728167.html).  The same critique applies.  Could be false positive, or COVID-19 transmission is not a sure thing.   It is possible that most infections don’t transmit far.  To fuel a transmission, an infected must be in the right place at the right time among the right people.  The so-called superspreading event.  Thus, the initial Wuhan market is one, actually helping COVID-19 identification.  The recent Beijing wholesale market is another (https://news.sina.com.cn/c/2020-06-26/doc-iirczymk9080051.shtml).  And most of South Korea cases are traced to one at a religious gathering.   Hence, avoiding crowds is the best safeguard against COVID-19. 

PS: When outbreaks occurred in the US in March, politicians and media were all claiming China was hiding something so that the US was unprepared.  Three months later cases in TX, FL, etc are shooting up, so these states should blame NY for hiding something (https://www.yahoo.com/lifestyle/what-hotspot-coronavirus-states-can-learn-from-former-epicenter-new-york-203621365.html).                

In defense of WHO

During COVID-19 China and WHO have been the most vilified, even by people critical of their own governments’ responses.  There are many accusations and anger against China, most if not all nonsensical and unjustified (6/3/2020 blog).  But being a human is being emotional, so some of it is understandable.  Just hope emotion doesn’t turn humans into rabid animals.  Yet WHO becoming a target is simply out of the blue.  Even reasonable people express doubt about WHO: Dr Fauci said WHO is not perfect.  Sure, but is there an example of any organization is perfect?

What is WHO?  It is part of the UN and the premier health organization in the world.  It gathers disease information from member states and then gives advice and recommendations. All the information WHO has on diseases is open for the whole world to see, but WHO can’t dictate any government to act in any certain way.  Every country has its own CDC, Health Ministry, healthcare system, and government, which ultimately decide its own polices. 

For analogy, say the public is a patient.  He has an illness and goes to see a doctor, in this case the combination of the healthcare system and government.  At most WHO is a medical textbook, albeit one capable of updating.  If the patient is not satisfied with the treatment outcome, by common sense he is angry with the doctor and will sue the doctor, but has it been reported that a patient sues a medical textbook?  Here one can see the pure absurdity of attacking WHO.

Abstraction aside, below are a few things WHO is being demonized by some politicians and media.

The first is WHO is too good to China, even praising China’s effort to contain COVID-19 after a mid Feb inspection by WHO of multiple cities including Wuhan.  Or too late to declare COVID-19 whatever.  But compared to previous outbreaks like 2009 swine flu, WHO took the same steps, and timeline even shorter in 2020.  In terms of praising China, let’s see what could have gone wrong.  An obvious one is that COVID-19 in China was not really going well at all, and WHO painted a false picture.  Much of China reopened a few weeks later, and Wuhan on April 8; new confirmed cases nationwide dropped to essentially 0 since mid March.  Almost four months later, does anybody still think WHO was fooled by China?  

Another hit on the praise is, OK, maybe WHO should praise another country?  Here lies the gist: there was no another country at the time.  China was the only one fighting an endemic up until Feb 20.  Wuhan lockdown was unprecedented, even WHO was shocked.  If another country does any better later, maybe WHO could reserve the praise, but this is where the praise 4 months ago looks so farsighted and even poetic: should WHO praise the UK or US instead?  All the more surprising since China was flying blind for 2/3 of Jan and trying everything anew during much of Feb.  Humans know peculiarly little more about COVID-19 now than on Feb 20, when other countries experienced their first outbreaks.  There are a few countries in Europe and other continents handling COVID-19 well, yet the best success stories are in East and SE Asia.  Warmer weather may help (6/6/2020 blog), but even these countries aren’t standing out compared to individual Chinese provinces outside Hubei. 

So the WHO-China guilty association is anything but.  Next, move on to another specific charge: WHO gave conflicting messages: saying no mask all along then mask in May/June.  The Chinese wore masks in Jan, but WHO never recommended it for months, so maybe China and WHO aren’t the same thing after all?  But importantly, WHO doesn’t tell governments what to do.  WHO has no teeth.  Every government is completely free to decide wearing masks or not.  Is there any country that wanted to wear mask but didn’t because WHO said no?  Most criticisms, however, come from the West, which is utterly disingenuous.  WHO produced the COVID-19 testing instructions in mid Jan, but the American CDC decided to do it alone, with well-known consequences.  Furthermore and critically, it was the Western medical community’s consensus that wearing masks by the public was not only unnecessary but even counterproductive.  The West changed its tune only in April.  How could anybody in the West blame WHO, dominated by experts from the West, no less?  Does anybody have a memory any more?  Could it be that WHO wanted to see if mask wearing in the West helped, and after a few weeks decided it did, then WHO changed its advice?  In any case, plenty of countries wear masks earlier.

Last comes this WHO statement about asymptomatic transmission (6/9/2020 blog), used as a new charge against an incompetent WHO, even though it was technically feasible and might guide a new thinking of COVID-19.  

Much of the confusion was caused by the media not reporting the correct context.  The percentage of asymptomatic in COVID-19 patients is all over the map, from <10% to 40, 80%, but 40% asymptomatic doesn’t mean 40% transmission was due to the asymptomatic.  The key is the definition of “asymptomatic”, and for WHO it means the Class 2 people (my 6/9/2020 blog), not the pre-symptomatic (Class 1).  In reality every COVID-19 patient must have been pre-symptomatic, because nobody gets the virus at 11:01 am and develop symptoms at 11:05 am.  Thus, based on public data, a country’s confirmed cases are the upper limit of the pre-symptomatic.  WHO classifies all RNA+ as confirmed.  China has a separate category of the asymptomatic, so once again, WHO and China are not the same thing.  No one needs to follow each other exactly.  

All these were good and well, until new Ab testing reveals many more potential prior infections than the previously confirmed cases, leading to new Class 4: people who were never tested before, but now RNA-, Ab+, and of course no symptoms and not contagious (6/9/2020 blog).  This is likely what WHO wants to understand.  One can assume that most Class 4 were asymptomatic or very mildly symptomatic, but the question is: how much did they transmit the virus?  The short answer is we don’t know.  One way to find out is to do a better tracing of close contacts of confirmed COVID-19 patients.  For example, a confirmed case infected 5 people (Ab+ later), and all 5 are asymptomatic.  But of the 5, only one leads to subsequent infections, while all contacts of the other 4 are Ab-.  Then asymptomatic transmission is 20%, if calculated this way. 

The best guess right now is that Class 4 is more a COVID-19 stopper than enhancer.  But even if Class 4 is as infectious as Class 1, it is still novel and important information obtained only through better examining the newly realized Class 4.  WHO’s position is defensible and ahead of time, and it shows that WHO is doing its job by wanting to understand new aspects of COVID-19. 

WHO being smeared in some countries reflects the anti-science tendency of the politicians.  The worse a country does, the more politicians want to skirt responsibility, so China and WHO become the scapegoats, and the media are ever faithfully the servile mouthpiece (May 1, 2012 blog).  With a new disease and an urgency all living souls on Earth have never seen before, can anyone promise he/she can do better?  Still, China and WHO get the blame not because they do something, but because they will get the blame regardless. WHO’s information and advice are all in the open and the same to everybody and every country.  Beyond this, WHO can’t force any country to do anything.  If what WHO says is decisive, every country should perform equally good or bad.  Then if certain countries do worse than other countries, what is the logic that WHO is to blame?  Defending WHO, therefore, is defending science, defending reason, and defending human decency. 

The WHO statement about asymptomatic transmission is been perceived eerily similarly to the statement on human-to-human-transmission by Chinese doctors on Jan 14, 2020: criticizing without considering the proper context or even the right words (my 6/9/2020 blog).  In retrospect, the Chinese said a lot of other things around the time that later turned out to be quite right but never brought up since.  One of them was that risk to children was low.  An explanation then was children usually don’t go to meat markets, but now the market in question is probably merely a place where a clustered transmission occurred.  Just like Wuhan hospitals are where many people first got infected, yet nobody says the hospitals were the origin of COVID-19.  At the time, from early to mid Jan, close contacts including family members of the patients were being monitored, and few exhibited symptoms yet.  This observation, the lag in RNA testing, and not knowing the importance of the pre- and asymptomatic, all led to misdiagnosis by the doctors.  But that children are less susceptible is a remarkably early and correct conclusion.  It is common knowledge now that young kids don’t get COVID-19 easily.  When they do, their symptoms are usually mild.  This view was not a given: kids get flu easily.  Looking back, a simple sentence on human-to-human-transmission was twisted beyond recognition, while everything else was ignored.  This is the same for China or WHO.  It is easy to remember the negative, especially when the well is poisoned, so even a few good people feel obligatory to bash WHO once in a while. 

Note on 7/8/2020: Media widely reported 239 scientists in an open letter urged WHO to stress the role of aerosol transmission (https://www.nature.com/articles/d41586-020-02058-1).  This is a reasonable debate.  The Chinese actually had a vivid discussion of aerosol in Feb 2020, with the earliest example(s) reported in China.  WHO never followed up, although it has never discounted aerosol completely either.  The current evidence indicates it would happen, but only very rarely.  The open letter calls for actions to combat airborne transmission, such as renovating buildings, which is frankly not possible at a large scale or in a timely manner.  In any case, nobody is perfect.  Being wrong doesn't equate being malicious.      

A Harvard study or a Huh study?

A Harvard study (actually more Boston Univ authors than Harvard) preprint is receiving a lot of attention in the media, widely reported in the news, even though it has not been peer reviewed (https://dash.harvard.edu/bitstream/handle/1/42669767/Satellite_Images_Baidu_COVID19_manuscript_DASH.pdf?sequence=3&isAllowed=y).  In fact, it even formed the basis of a question posed to the Chinese Foreign Minister spokeswoman on Jun 9, 2020.  Government Q&A around the world is rarely of scientific nature or value, although what the spokeswoman replied was quite prescient: I don’t know what this kind of parking lot data can tell you anything definite.  

To be clear: while the undertone of the Western media is that Wuhan had an early outbreak but, again, China hid it from the world, the Harvard study said nothing of this sort.  The authors explained a lot of shortcomings with their data and analyses and pointed out it was only a correlation without controls.  Still, just on the scientific merit alone, it has a lot of problems.  It follows a long list and trend of questionable studies, preprints, and papers on the subject of COVID-19 that normally would not even have preformed or published.  Examples: a Jan 2020 Chinese paper saying snakes might be a host of COVID-19, a withdrawn Indian preprint suggesting COVID-19 was man-made, and a German paper about asymptomatic transmission (https://www.nejm.org/doi/full/10.1056/NEJMc2001468).  The German paper came on the heels of Chinese news reports of asymptomatic transmission and might be the first scientific publication, although it contained an embarrassing error.  It reported an asymptomatic Chinese traveler infected her German coworker(s).  It turned out she had already had flu-like symptom in her German hotel, so she was not asymptomatic.  She didn’t know she had COVID-19 though and only self-reported a few days later.  Regardless, these early German cases were well contained and didn’t lead to outbreaks in late Feb. 

But what exactly is the Harvard study?  Well, they basically looked at satellite data of the traffic and parking lots around several Wuhan hospitals and Baidu search phrases and suggested there was an increased activity as early as August 2019.  Linking that to COVID-19 is truly a huge leap that the authors didn’t even say it with any confidence.  But besides the hole in logic, there are myriad other problems.  The foremost is controls: how about other cities around the world, and in 2018 or early?  How often do these things happen?  This is so lacking that how can anyone draw any conclusion?  Just because Wuhan identified COVID-19 first?  If other places had the same pattern, does it mean they had COVID-19 but failed to identify it?  The Baidu search for the word “diarrhea” is likewise highly questionable: how do you know only Wuhan searched it but not other places?  That the search of “diarrhea” increased in August, hence the implication that COVID-19 started in August 2019, was eagerly devoured by the Western media but simply way over-interpreted and likely meaningless.   Wuhan is among the hottest cities in China in the summer, and poisoning due to spoiled food and fruit consumption is common, even in the days of frigs.  There could be a lag between hot weather and the search for “diarrhea”, perfectly explaining why the latter increased in August and later.

The most fatal problem with the Harvard study, however, as if it needs more, is that their data are so obtuse.  If there are 200 more cars in the parking lot, does it mean 200 COVID-19 cases?  Or 1, 10?  If it is 1, how are you sure it is not 0?  If it is 10 or 200, knowing what we know about COVID-19 now, why wasn’t the whole Wuhan infected by Dec 2019?  

To sum, from their data, they can’t conclude COVID-19 started in August, which they did not explicitly anyway.  But if anyone conclude COVID-19 started in August, he can’t explain what happened 4-5 months later.   

Of course all this is not say that there wasn’t a COVID-19 patient lurking somewhere, maybe in August or even earlier.  But there are just too many possibilities.  A close version of the virus might have circulated silently somewhere, Wuhan or not, China or not, for years.  Then it just mutated to cause COVID-19 in one person recently, and this person transmitted to others, eventually leading to the outbreak in Wuhan.  Or, the virus jumped from an animal to humans months or years ago, but those people are in the mountains or countryside and only recently coming out and leading to Wuhan outbreak.   Or the “first” human carriers were immune and asymptomatic (Class 4 in the 6/9/2020 blog) and their community lived with COVID-19 for months or years, then a susceptible outsider made a contact with them and got infected, which then through who-know-how-long-the-chain-of-transmission, caused the Wuhan outbreak.   No actual data for these scenarios yet, but they are consistent with the origins or theories about other infectious diseases.   

          

The Harvard study is another example of the COVID-19 bandwagon research with low quality and weak or unsupported conclusions.  Worthy of scientific critique but nothing more.    

Note: Wow, the beating is coming fast and furious before one can say the words.  While my critique is about the general problems with the Harvard study, this one strikes directly at its data (https://news.sina.com.cn/w/2020-06-10/doc-iircuyvi7796205.shtml).  In essence, none of their data mean anything any more.  First, the increase in parked cars can be explained by when during the day the pictures were taken.  Second, there were constructions at the hospital(s) resulting in changed parking space.  Third, COVID-19 patients are unlikely going to some of the hospitals.  Fourth, if one checks baidu.com search in 2017 and 2018, he will find the same pattern/increase in those years.  By the logic of the Harvard study, COVID-19 started in 2017 or 2018?  If so, the whole Earth is infected already!  

There is nothing special about this study.  Similar work about other diseases has been done.  The only reason it gets any media attention is because it fits the smear China mentality.  It didn't pass the smell test at first sight.  Now it won't pass any test.  This is what you get when you have dubious logic, shady data (pun intended), and no controls.  At this point, there is only one way this Harvard study can go, i.e., the way of the above Indian preprint: retraction.  But don't worry, WCEV will find another Harvard study later.