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).