COVID-19 politicization, asymptomatic transmission, death counting, testing, and SARS

The consensus explanation for why the US has the worst COVID-19 is politicization.  While this is true, the assertion is still too broad.  One should ask: what is politicized, why is it politicized, and who is politicizing?   In short answers, almost all the people in power are guilty of politicizing it.  From the beginning is the nonstop China bashing by every government official and the media.  Later on it is blame the scientists, usually by the Right.  The reason obviously is to skirt responsibility and hide incompetence.  Then ideology sets in, endless debating everything from masks to lockdowns.

A NYT report detailed the policy deliberation in the WH in April, which allowed many states to reopen from late April to early May (https://www.nytimes.com/2020/07/18/us/politics/trump-coronavirus-response-failure-leadership.html).  There were debates, completely expected and normal.  But it ended up similarly like Bush and the Iraq WMD: Trump wanted reopening, so his underlings provided the ppt to support his desire.  Dr Fauci was the nay-sayer, no wonder he was gradually pushed out.  In contrast, Dr Birx was the good soldier who played a key role in letting Trump get his wish.  It is iconic that NYT wrote: “Dr. Fauci, a friend of Dr. Birx’s for 30 years, would describe her as more political than him”.  Exactly what my April 2, 2020 blog opined!  This is the same Dr Birx that didn’t believe the Chinese figures (4/2/2020 blog).  Now she came up with her own data to convince Trump that the US curve would be like Italy’s.  Well, three months later, how wrong was she, and what an irony!  I don’t even see why anybody in his/her right mind would think the US would be like Italy if most states didn’t lockdown as long and hard as Italy (7/13/2020 blog).  Italy lockdown lasted for ~ 3 months and was even harsher than NYC, while most US states locked down loosely for 1 or 1.5 months.  NY and neighboring states would eventually turn out like Italy, precisely because they locked down similarly.  Yet for the other states, what a big difference.  And entirely predictable.  Granted, in April Italy wasn’t done yet, even though the worst had passed.  Brix could have looked at China, but the Chinese can’t be trusted, right?  Other East and SE Asian countries weren’t comparable because they never had large-scale spread like Italy, the US, and alike.  But if you don’t do the hard work, why expect the same good result?  Because, again, all lockdowns are not the same (7/13/2020 blog).  Still, this NYT story explains just one episode.  

A paper came out in Science (DOI: 10.1126/science.abc1917) showing that early viral samples in NYC revealed European origins (and from other US locations), with none directly linked to Wuhan, China.  This is no longer news: NY Governor Cuomo has been saying it for over 3 months, based on this and other data.  All evidence and notion now point to sustained outbreaks starting in the US only since mid Feb or later (7/13/2020 blog).  Thus, perhaps the US should blame Europe instead of China?  If so, the rest of the Western Hemisphere, like Canada and Brazil, even Australia, can blame the US, because cases in these countries are tied mostly to the US?

To evade this logic, the US must now say: OK, we got the virus from Europe, and we passed it to Brazil, but since Europe got it from China, everyone should blame China. 

Assuming Europe got it from China, not a given (7/7/2020 blog), then one still asks: where did China get it from?  Because the virus couldn’t have just appeared out of thin air.  How can anybody be certain it didn’t exist somewhere else earlier, and only a superspreading event in the Wuhan market led to its detection?  If the virus is guilty, its ancestral versions are guilty as well, and who knows how long and where the ancestral versions have existed?   Latest sequence analyses suggest that the COVID-19 virus might have been the product of recombination of several viruses from bats and potentially other mammals.  Who knows where these animals and the human hosts had been?  Finding the true origin of any infectious disease is a practical impossibility (3/38/2020 blog), so blaming anybody for a disease start is fundamentally invalid.  It is also akin to blaming a meteorite striking a place on that place.  It is nonsense, and has no precedent or basis.

   

With this blaming logic smashed by science and morality, there is only one straw left: we fault China not for the disease origin, but for the screwup that allowed it to become a pandemic.  

Of course what exactly China screwed up must be looked at, as a vague statement won’t do.  Yet whenever a specific was raised, every single one had been debunked (6/3/2020 blog).  Comical that the US media would charge China for “delaying” 6 days to declare human-to-human transmission (4/15/2020 blog), when US officials minimized pre- or a-symptomatic carriers until April, after China reported it in Jan (7/13/2020 blog).  In other words, this last trick doesn’t have legs, either.  It is actually amazing that since the summary of misinformation in my 6/3/2020 blog, no new accusations have surfaced.  Only the question of how WHO learned of COVID-19 on Dec 31, 2019 was raised.  Even in its worst light, however, the Chinese media already reported a novel disease on Dec 30 or 31, 2019.  Is this how you do a coverup?  

At this point, any attack on Chinese dealing with COVID-19 is hinged on the notion that China must be perfect.  Any misstep, seen only through 20/20 hindsight, is an indication of Chinese hiding sth.  By this criterion, of course, China was guilty, but is anybody else not?  The way the US has handled COVID-19, does anyone have any confidence it would have had done better had the outbreak had started in the US?  With China facing COVID-19 for the first time in Jan, while the US knowing almost everything needed to know about the disease when outbreaks started in March?  The Chinese must be perfect even when they had no idea what was going on, but we can mess up all we want, and the worse consequence is losing an election?

Much is clear.  From Jan to Feb the US officials and media politicized COVID-19 by looking gleefully at China struggling with a completely new disease.  There was no shortage of joyful commentaries and articles published in the media then.  From March to April they politicized COVID-19 by blaming China for almost everything (6/3/2020 blog).  Since May the attacks on the pandemic front have largely subsided, because nothing has stuck, but attacks on Xinjiang, HK, etc, intensified.  From the verifiable COVID-19 experience, one must ask: how credible are these other accusations? 

By politicizing COVID-19 from the start, the US failed to accept what China showed the world what the disease is.  And by continuously politicizing COVID-19, the US fails to adopt proven, effective measures to contain the pandemic.  A case in point: masks.  The Chinese (and East Asians) wear masks right away.  The American CDC recommended it in April.  Much of the US didn’t do it until late June.  Even now the issue is still hotly debated in many places.   

Another case in point and consequence of politicization: By being happy to see and even attack China struggling with COVID-19, the West was confident that it would never happen “here”.  So after banning Chinese entry in late Jan to early Feb, little was done in much of Europe and the US, because, you know it, it would never happen here.  Citizens were still allowed to return home from China, otherwise it would be indefensible.  But when the expats got home, much less attention was paid to them, compared to the Chinese travelers in Jan.  To be clear, the vast majority of Chinese tourists and expats had no virus, and according to media reports and simple calculations, many if not most infected Chinese travelers were identified and sequestered, due to heightened alerts (6/3/2020 blog).  Thus, one never knows whether Chinese or expats caused the major outbreaks in Europe, assuming Europe didn’t have its own virus source (7/7/2020 blog).  The virus then shuttled from one country to another in Europe, and eventually to the US.  Most Europe started COVID-19 outbreaks in late Feb, and the US and NY slightly later.  The Chinese ban was already in place for 3 weeks or longer, and during that time no apparent clusters were identified, indicating that even if a local transmission due to Chinese tourists can’t be excluded, it was at a very low level at best.  The fact that Europe and later NY had a COVID-19 explosion doesn’t mean an infection due to Chinese importation had been simmering for a long time.  Clearly not true in NY (DOI: 10.1126/science.abc1917), and Europe likely the same.  Germany had its first cases in mid Jan due to a Chinese traveler, quickly contained it (https://www.nejm.org/doi/full/10.1056/NEJMc2001468), but got the eventual outbreak at the same time as its neighbors.  

A scientific consensus is emerging that don’t assume any identified case will seed later events, because a transmission can stop naturally or by artificial means, and superspreading produces faster and bigger outbreaks.  Like NY: it got most of the virus from Europe, in mid Feb at the earliest, and in 2-3 weeks’ time it became unstoppable.  How does one get superspreading?  When one is not paying attention, not preparing, and, more, politicizing.

Further evidence can be gleaned from South Korea and Japan.  South Korea never bans Chinese except Wuhan/Hubei connection.  It had a few dozen cases by Feb 19.  A religious gathering soon led to a balloon of ~ 10K cases.  A prime example of superspreading; at the time there were already few Chinese tourists, who unlikely joined local religious activities and directly contributed to the superspreading.  In a sense, South Korea was both unlucky and lucky: unlucky because without the super-superspreading event South Korea would have ended up with only a few thousand total cases, but lucky because it was only one such big event, which was easy to trace and contain.  Japan had a couple hundreds of cases (not counting Diamond Princess), and then banned Chinese and others in mid March.  Now Japan has 24K, most traceable to cases in the US.  

In essence, the Chinese ban is neither necessary nor sufficient to stem COVID-19.  What is needed is nation-blind preparedness.  There is no evidence that Chinese nationals seeded any long-lasting outbreaks in Europe or the US.  Yet the blame game is never based on reality anyway.  The US government does this simply because it wants to.  Not facts, logic, or anybody can help it.  But a sad consequence is the COVID-19 situation now in the US.  Another is the repeat of 1929.

4 more science related issues.  The first is that how the asymptomatic contribute to transmission.  My 6/9/2020 and 6/12/2020 blogs posit that the true asymptomatic, not the pre-symptomatic (Class 1), don’t transmit much.  There has been discussion in the literature, one proposing close to half transmissions could be due to the asymptomatic (https://www.acpjournals.org/doi/10.7326/M20-3012), and others refuting the conclusion (https://www.acpjournals.org/doi/10.7326/M20-3012 and https://www.yahoo.com/news/asymptomatic-spread-become-bizarrely-controversial-133011551.html).  Evidence doesn’t support the “half” conclusion.  Common sense also dictates it improbable.  For one, symptom description is often subjective, so true asymptomatic are likely rarer than many people think or the media portrays.  Importantly, symptom-free means the virus is not reproducing at a high level in the body. If the body doesn’t produce much virus, then naturally the person is not very infectious.  Of course, asymptomatic and pre-symptomatic are hard to tell in real time, so protection is still key.

The second is how COVID-19 deaths are counted, as concerns of overcounting emerged (https://www.yahoo.com/news/coronavirus-phe-accused-exaggerating-deaths-093838013.html).  Usually it is the undercounting, like the allegation against China (4/1/2020, 4/17/2020, and 6/3/2020 blogs).  How to ascribe the cause of death is not simple: died from COVID-19 or died with COVID-19?  Proposals now are don’t count the death of patients who have recovered from COVID-19.  A policy China has reportedly adopted since April-May.  For >100 days mainland China has ~ 5000 cases, half confirmed and half asymptomatic, and ~80% confirmed cases are imported, and no death since April.  No death is curious but not super surprising, considering most confirmed infections are young people, and the healthcare system is better prepared.  There is, however, a media reporting that a Wuhan doctor died after a long struggle.  He underwent a lot of procedures for COVID-19, apparently recovered well enough to appear on TV, and was declared RNA negative.  Then he had a bleeding in the brain, and died one month later.  It was not added to the death tally, perhaps based on the RNA result, although his case was well publicized.  The bottomline is not to take any numbers too seriously.  They provide a big picture, but the error bars are usually so high that nick picking is meaningless.  Of the Chinese death figure, it doesn’t include ~ 30 medical staff and others who died due to heart attacks or traffic accidents while on the endemic duties, or the 29 quarantined people who died when a building collapsed.  No doctors will include them, either, but they are nevertheless part of the overall COVID-19 toll, much larger than any official tallies around the world.  Focusing on such narrow statistics is barking on the wrong tree.  

The third is about testing.  By July 18, 2020 the US has likely performed 50-60 million total tests.  Since April Trump constantly boasts the US does the most tests in the world, and no one calls him out, despite that plenty of people know China reported over 90 million tests weeks ago.  China is toxic.  Defending China requires courage, so it is better to ignore the subject when you don’t have a bad thing to say about China.  On the other hand, it is not whoever tests the most that wins, a misconception.  More testing means using more materials, resources, and money.  Testing follows purposes.  In China one person can get tested many times, for monitoring or treatment.  Conversely, when Wuhan and Beijing recently screened and tested over 20 million people, one PCR test often examined a pooled sample from 5 people, because the positive rates were known to be very low.  Out of the 20 million, <700 positive.  So the Chinese number reveals all the tests as well as all the persons being tested.  Still, doing more tests confers no badge of honor.  If a country controls COVID-19 so well it has few or no cases, of course having a low test count is perfectly fine, even preferable than a country doing tons of tests because it has so many infections.  Right now, Americans complain about testing shortage, and people often wait 5-14 days to get the results.  True, yet miss the forest.  The US is testing ~ 500K per day, already a huge number.  The real and root problem, though, is, by not able to control the pandemic, having too many positive.  If you have 100 cases, 500K is a vast overkill.  When you have 100K, of course 500K is too little.  In short, it is the infection overflow; if it continues, no amount of testing is enough.  Trump is finally right: fewer tests, fewer cases, just not how he can understand it.    

Lastly, what is the difference between SARS and COVID-19?  Both are CoVs, Ro of 2-3, by most estimates.  Viruses are 80% identical and produce largely the same symptoms.  Superspreading was also key to how SARS transmitted.  SARS has a fatality rate of 10%, COVID-19 likely <1%.  The first SARS case happened in Guangdong, China in Nov 2002.  Transmitted to HK, then overseas.  Later to Beijing in early 2003, where it died down by June 2003.  The Chinese response to SARS was much slower than COVID-19.  Then why was SARS a much smaller outbreak, with 8000 infections and 800 deaths globally?  The most apparent distinction is that SARS patients developed symptoms faster, and hence could be easily identified and quarantined.  COVID-19 patients get less sick or get sick later, while being infectious before symptoms appear, so are harder to single out quickly.  But is this enough to explain the day-and-night differences between SARS and COVID-19 outcomes?  Why didn’t SARS infect more people when nobody paid attention for months?  Is there some bad luck/good luck involved?  How has the SARS experience shaped the global response and expectation in 2020?  Important questions that haven’t been asked elsewhere.