Life in a time of COVID-19

Note: I wrote most of this post on or around March 20th, but I’ve since updated much of the information in it several times, including updated charts and graphs with links to sources, as well as updates in bold throughout the text: Last updated May 10

The title of this post is a reference to the famous Gabriel García Márquez book “Love in a Time of Cholera.” I thought it was fitting was because it feels as though COVID-19 is our version of the cholera epidemic of the 1800s, or the Spanish flu of 1918 (which wasn’t Spanish at all, but probably originated in Kansas and was a form of H1N1) or the Black Death of the 1300’s. Those changed the way we lived forever, in thousands of small ways (as this piece argues that COVID-19 will), and I find myself wondering what it would have felt like if Twitter and Facebook and the Internet had been around during the Plague years. Would they have made fun of people wearing “plague masks” that made them look like giant birds? (Side note: Here’s the story of an Italian town that beat the plague, and how they did it).

I know for sure that if social media existed during the Middle Ages, they would have been full of posts that said things like “my sister is a doctor, and she says gargling with vinegar can cure the plague!” (one popular hoax is to promote the drinking of bleach, which as I like to point out will successfully kill the virus, but unfortunately at the cost of killing the patient as well). This past week — April 24 or so — Donald Trump mused aloud at a press conference that maybe injecting disinfectants might work. In the days that followed, hundreds of people called 911 after swallowing cleaning fluid of various kinds, but Trump said he wasn’t to blame.

I went back and looked at some email newsletters I subscribe to that I hadn’t gotten around to reading from the end of February, and none of them even mentioned the coronavirus (which was still concentrated in China, and seen as not a big threat elsewhere). It was refreshing to read them, since everything is pretty much all COVID-19 all the time now, but it also felt surreal. Those newsletters were from less than a month ago, but it felt like they were from 10 or even a hundred years ago. When I started writing this post around March 19 or so, Italy (which only had 200 cases and no deaths at the end of February) had more than 20,000 cases. As of March 27, it had more than 86,000 cases and more than 900 deaths in a single day. Bodies were piling up in churches.

(Update March 29: Italy now has more than 97,600 cases and over 10,700 people have died, with more than 800 on March 28th alone. Update April 2: Italy now has 115,000 cases and almost 14,000 deaths but the curve appears to be flattening. Update April 9: 139,000 cases and 17,669 deaths — including almost 100 doctors and about 25 nurses. Update April 29: 200,000 cases and 27,000 dead, but only 200 or so died on April 24, the lowest death rate since March 14. Update May 9: total cases at 219,070 and deaths at 30,560 but rate of new cases and deaths are both falling).

When we left for our vacation in Florida on March 7, we were aware that something bad was floating around, and made sure to wash our hands etc., but thought nothing of going to the beach or the pool and going out to restaurants. About 10 days later, we were anxious to get home because the rate of infection and death was climbing in the US — in part because of a lack of testing, caused by delays and screwups by the CDC and the Trump administration — and businesses (including airlines) were shutting down. The day after we got back, on March 19th, Canada and the US announced they would be closing the border to everything except goods, and the US closed its airports to traffic from Europe.

Update April 9: So far Canada doesn’t have a huge number of cases — 19,277 and 435 deaths — but there are hotspots such as a senior’s home in Bobcaygeon where 28 people have died). On March 24th, the Italian government put the entire country on lockdown, with fines for those who leave their homes without permission. As of March 26, the country’s police forces had charged more than 100,000 people with breaching the quarantine rules, which carries a fine of up to 3,000 Euros. Update April 9: In the UK, phone and email tip lines were swamped with reports of people breaching the rules and police were handing out fines.

Chart from this Thomas Pueyo post, updated April 1

In the US, state responses are still all over the map. As of March 25th, some states including Florida were still refusing to impose a state-wide lockdown (Update: Florida finally started shutting down parks and beaches at the end of March and then started reopening them April 18). As of March 27 Florida, Texas, and Rhode Island were all stopping people with New York and in some cases Louisiana plates and adding them to a state registry, and warning them to isolate themselves for at least 14 days or face civil penalties (Trump said March 28th that he was considering a quarantine for New York, New Jersey, and parts of Connecticut, but later said it was not necessary). A colleague of our next-door neighbour’s, who crossed the border from the US into Canada around March 25th or so, says he was told by the Canadian border guards that his license plate would go into a database, and if his car was seen anywhere other than in his driveway he could be fined up to $1 million and jailed for three years under the Quarantine Act.

Over the past couple of weeks (this was written May 8), there has been increasing pressure in a number of states from those who want restrictions on businesses and social activity loosened. There have been dozens of demonstrations in different states, many of them apparently organized by right-wing groups, including some that would only happen in the US: groups of men in camouflage with assault weapons in the gallery in the state capitol in Michigan, men with rocket launchers and anti-aircraft weapons in a Subway, and so on. A security guard was shot, apparently for refusing someone entry to a Family Dollar store because their child didn’t have a mask, and two employees at a McDonald’s were shot after telling someone that the fast-food restaurant was closed due to the coronavirus.

Since I started writing this post, the US has gone from less than 20,000 cases to more than 100,000 (making it the country with the largest number of infections, and that number continues to double roughly every 3-4 days (Update March 29: 133,000 cases and 2,300 dead Update April 2: 245,000 cases and 5,800 dead Update April 6: 360,000 cases and 10,700 dead Update April 9: 437,000 cases and 15,000 dead. Update April 28: Over 1 million cases and 59,000 dead — more than the Vietnam War. Update May 9: the US now has 1.3 million cases and 75,000 deaths, which means with just five percent of the world’s population, the US has nearly 33 percent of the infected and close to the highest number of deaths as well). New York became the newest global hotspot at the end of March, with infections doubling roughly every two days. Hospitals there were quickly overloaded — New York state ordered 85 freezer trucks on March 26th to use emergency storage for bodies until they could be buried or burned, and bodies started piling up in morgues. Some models say even if self-isolation rules are maintained, the US could be looking at more than 120,000 dead before the current phase of the virus runs its course in August.

Some nurses and doctors in New York were wearing garbage bags because they ran out of protective clothing. Fashion manufacturers started making masks and hockey equipment companies began turning out face shields. On March 24, New York emergency services got more medical 911 calls than they got on September 11, 2001. (Update April 6: The chair of New York city council’s health committee said that all the 80+ freezer trucks are full of bodies — each truck holds 100 bodies — and so they might have to start burying people in parks or on Hart Island, where more than a million people whose bodies weren’t claimed are buried in a “potter’s field.” Trench graves are dug by prisoners from Riker’s Island). New York started burying on Hart Island in early April.

this chart is from this Financial Times coronavirus tracker, updated March 28th

After returning to our home near Peterborough, just north of Toronto, on March 17 we tried to remain isolated for the 14-day quarantine, even from our neighbors (our houses are separate, but joined by a common atrium area). We used gloves to open doors in the common area, and stayed at least six feet from them even when we were outside. The only real issue was whether we needed to be careful about petting their dogs, which move back and forth between our houses. From what I could tell, pet fur isn’t a particularly hospitable place for viruses to live, and some epidemiologists say not to worry about petting your dog or cat, but it is impossible to know for sure (Update April 9: There are reports that cats can contract COVID-19, and a tiger at the Bronx Zoo reportedly tested positive).

The virus lives for quite a long time in the air after someone sneezes or coughs, and can live for hours or even days on surfaces like cardboard and stainless steel (however, this critical-care doctor at Cornell Medical Center in New York says in this video posted March 27 it appears that the vast majority of cases come from sustained physical contact with an infected person, and the CDC says infection from surfaces is possible, but not the primary way the virus is transmitted). A number of studies of hotspots in China and elsewhere showed that even within an enclosed space like a restaurant, the main risk was to people who were downwind of the infected person or within the radius of air blown from the indoor air-conditioning unit.

I am almost 60 and have asthma, but we feel as though our risk is fairly small (despite having flown through two airports to get back to Canada). As I write this on March 27 we are on day 10 of our quarantine (Update April 9: We came out of quarantine on April 1 but are still isolating — only one of us goes out for groceries every few days. We did have two friends come to stay in the old farmhouse nearby, which we thought would be okay because we stayed away from them for the most part. But we did eat together (on opposite sides of a ten-foot-wide table) which made our daughter and son-in-law — both nurses — quite upset. In our defense, we were trying to help our friends stop going stir crazy and thought we took enough precautions, but we may have been wrong about that. Let’s hope we don’t wind up paying for it. Update April 28: We now have a friend staying in the old farmhouse who came back to Canada from Spain, but we only see her when she comes outside for walks.

A woman I work with said in March that she and her husband and 11-year-old daughter — who has severe asthma — all had what appears to be COVID-19, but they couldn’t get tested because they don’t meet the criteria. As of March 27 they were on day 21 of their self-quarantine and still had a fever and shortness of breath (Update April 9: They seem to be improving, but are still not at 100-percent health). Her doctor wanted her to start using an anti-malaria drug that has shown promise in some tests (hydroxychloroquine) but she can’t get approval unless she is confirmed to have the virus — and a number of doctors are warning against use of a drug that hasn’t been properly tested. The French doctor whose study showed it might have promise is known for publishing manipulated data, and his study was not scientifically approved or controlled. Hydroxychloroquine can also have some fairly severe side effects involving the eyes and other parts of the body. (Update April 9: Some hospitals have stopped their tests of the drug because of side effects, in some cases death, but there are still many promoting it as the closest thing to a cure. Some doctors who have tried it say it doesn’t really help).

Even after the virus started killing large numbers of people, some people — including the president of the United States — argued that it wasn’t that different from the seasonal flu, which kills about 400,000 people every year, mostly those who have underlying conditions or compromised immune systems. Some said it was a lot of noise over nothing, like the H1N1 was (a line of argument that shows up in the movie Contagion). But experts quickly countered this with facts. Yes, we lived through SARS in the early 2000s (which was also a form of coronavirus) and then H1N1 in 2009, but while they seemed pretty bad, they weren’t even close to what we are up against with COVID-19. Both SARS and the most recent version of H1N1 (also called “swine flu”) were significantly less dangerous than the current virus is, in part because they were so lethal.

This table comes from this regularly updated page of data

In other words, they killed people really quickly, which means from a viral point of view they weren’t very successful, because they didn’t spread as quickly or as widely as they might have. The fatality rate for SARS was in the 10 percent range, while COVID-19 appears to only kill about 2-4 percent of those infected (of course, if billions are infected, that’s still a large number). Experts say that mortality rate may come down to 1 percent or lower as there is more testing — but also point out that death rates are also likely being under-counted by a significant amount. According to recent research, a significant number of people who get COVID-19 are infectious even when they don’t have symptoms, so it’s impossible to know whether they have the virus or not, because most don’t get tested (except in countries where they are doing random testing, like South Korea — which seems to have been the most effective at halting the spread). And so they go about their lives normally, contacting other people and infecting them without realizing it. Also, according to this epidemiologist, there are signs that people can remain infectious for up to three weeks even after they recover and show no symptoms. There are also troubling signs that some people who recover and test negative later appear to become reinfected.

The the so-called “R nought” for COVID-19 — the number of people who are infected by anyone carrying the virus — is estimated to be much higher than other similar viruses. For swine flu it was about 1.5, and for COVID-19 it is estimated to be as high as 2.5 (although that changes based on the number of people tested, and could wind up being lower). So by the time a country or region figures out that people are dying from COVID-19, there are likely thousands of un-diagnosed cases wandering around or thinking they only have the regular flu. According to figures compiled by Thomas Pueyo — in a persuasive Medium piece about why countries needed to shut down completely and quarantine as many people as possible — at this point in the region of China where COVID-19 started, for every death that was recorded, approximately 800 people were already infected. The US has about 75,000 deaths as I write this (updated May 9), which suggests it may have more than 60 million infected people — a study in Iceland showed that as many as 50 percent of people don’t show any symptoms.

Unfortunately, Pueyo points out that while China and South Korea both shut things down relatively quickly and were able to escape the worst of the exponential increase in infections, the US delayed and delayed before shutting down incoming flights, large gatherings, etc. And that could mean by the time the US figures out how many cases it has, it could be too late to stop the health-care system from becoming overloaded, leading to even more deaths. Pueyo’s model projects a worst-case scenario of deaths rising to 10 million — a number that is much higher than an Imperial College study, mostly because he is including collateral effects: in other words, hospitals won’t have enough beds, respirators and doctors to treat all the people who need it — not just coronavirus patients, but anyone with a serious illness — and so large numbers of those people will die who otherwise wouldn’t have. In Italy, hospitals are turning away people who are over 70 because there is no point in treating them, and the resources are needed for others.

This graph comes from this Medium piece, updated March 19th

There have been a number of other articles (although notably, none by epidemiologists or even doctors) arguing that the US has gone overboard in shutting down businesses, closing schools, etc. because this is going to wreck the economy. According to this argument, since the coronavirus mostly attacks old people and those with underlying health problems, we should spend most of our time isolating those people, but allow others to go to school and work normally (there’s a thread from a biologist debunking much of the Medium piece linked above, which Medium took down, at which point it was republished at Zerohedge, a site known for its right-wing conspiracy theories). Experts at the CDC and elsewhere, however, say this approach — which the British government considered implementing, in the hope that “herd immunity” would develop — would result in an unacceptable number of acute cases, which would cripple the medical system. This report from the Imperial College of London helped change the mind of British legislators (on March 27th, UK prime minister Boris Johnson said that he had tested positive for the virusUpdate: on April 5th he was admitted to hospital and on April 6th he was moved to intensive care, but he responded to treatment and was later released). During the week of May 9, it was reported that multiple people have tested positive for the virus in the White House, including one of the personal valets to Donald Trump, as well as another senior aide.

As this thread from a scientist on Twitter points out, the numbers we are seeing right now are the result of decisions that were made as long as three weeks ago. Interestingly enough, Sweden appears to be taking the same approach that Britain did initially — it is the only country in Europe that hasn’t implemented some kind of restriction on the movement of citizens. The country has asked people not to gather in groups of more than 50, but compliance is voluntary — one article about the Swedish decision pointed out that it relies on the trusting nature of its citizens, but another noted that as of April 28, the country’s death rate was 22 per 100,000 or about three times as high as its neighbour Denmark. Which raises the question: Is that an acceptable level of deaths? Only Sweden can really answer that question.

Since China was the first place COVID-19 was spotted, everyone is watching what is happening there, especially since the country appears to have been successful in clamping down on the populace in the Hubei region to the point where it hasn’t had a domestically produced case of the virus for three days. The big question is what happens when China eases the restrictions that got it there — will new cases start to appear, as they already have? If those who have the virus are still infectious for three weeks after they have recovered, what does that mean for the numbers of new infected patients in China? Pueyo argues that authorities will have to ease restrictions and then watch the R nought value, and then reimpose restrictions when it rises too far, and keep doing that potentially for months or even a year, until a reliable vaccine is developed. Meanwhile, there is a lot of emphasis on “contact tracing,” to track who has been exposed. Experts say the US would need as many as 300,000 people working as contact tracers, but there were only 8,000 as of May 9. Google and Apple are said to be collaborating on an update to their operating systems that would allow people to be notified if they were in contact with someone who later tested positive, but some say there are flaws with that system. “To me, it’s just techies doing techie things because they don’t know what else to do,” said security expert Bruce Schneier.

(Update March 27: There have also been questions raised about the true level of deaths in Wuhan, as cremation urns turn up by the thousands in front of funeral homes in that region. Update April 1: A US intelligence report suggests they are almost certainly fudging the numbers for both infected and deaths, and sources agree many people dying of COVID-19 in the US aren’t being counted either). Also, there are questions being raised about whether the presence of antibodies after fighting off the disease means that someone is immune — and the WHO is saying there is not enough evidence to make that case. On an unrelated note, some doctors say they are seeing a lot of COVID-19 patients, including those in their 20s and 30s, die of sudden strokes or aneurysms, because the virus appears to cause a strange form of clotting problem. And even after this many deaths, doctors say they aren’t even sure exactly how it kills people exactly — it seems to have effects on almost every organ. It also appears to have lasting effects on the body even after people recover.

This is all pretty anxiety-inducing, the reality of what this virus means, especially for friends who are immune-compromised because of cancer, or have lung issues, or those in the health-care field (like our eldest daughter and her husband, who work in intensive care and emergency medicine). But it’s important to remember that there are still plenty of bright spots, as I remind myself every time I go for a walk in the woods with the dogs and see the birds and the new lambs in the field near our house (here’s a recent photo). There are also groups of people banding together to help the less fortunate, to go shopping for the elderly or quarantined, and engineers using 3D printers to make medical equipment. Museums are streaming their collections for free, orchestras are putting on concerts online, etc. And then there’s rugby commentator Nick Heath, who has no sports to cover any more, so he has taken to doing color commentary on everyday life. Stay safe, everyone! Somehow we will get through this together.

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