Weekend Update: The Good, The Bad and the Big Big Mystery

In terms of sheer numbers, especially of coronavirus deaths, this past week was the worst so far.  But there was also good news: the rate of new transmissions decreased in many areas of the US, and though the number of deaths remain horrendous especially in New York and other hotspots, the predicted number of deaths in the next weeks was downgraded sharply.

The slowing rate of transmissions has already translated into slowing in the rate of hospitalizations and deaths in those areas.  According to Governor Newsom, California is now confident that it has the resources to prevent the medical system from being overwhelmed.  Others are making that conclusion as well.

This is all attributed to the success of widespread isolation and physical distancing.  It is worth quoting again the words of Dr. Emily Landon, a Chicago epidemiologist when Illinois announced its stay-at-home order the third week of March: "It’s really hard to feel like you’re saving the world when you’re watching Netfliks from your couch. But if we do this right, nothing happens. A successful shelter in place means you’re going to feel like it was all for nothing, and you’d be right: because nothing means that nothing happened to your family. And that’s what we’re going for here."

In a recent New York Magazine post, David Wallace-Wells observed:"It can be easy to forget, a few weeks into something like a hemisphere-wide lockdown, just how absolutely unprecedented this public-health mobilization truly is: nearly every American in every state embracing punishing, restrictive quarantine-like isolation for the sake of the country as a whole. We are doing so willingly, with hardly any meaningful resistance to shelter-in-place guidance....This is solidarity I simply didn’t believe was possible in this country anymore and under any circumstances, and it has arrived in the space of just weeks, in the midst of national political chaos with tribal partisanship still boiling at a feverish peak. It is breathtaking."

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Meanwhile there are efforts around the world to develop and test vaccines, antibody tests and treatment protocols.  The resources of the Internet and other computer capabilities are joining a fast, free-flow of information among medical researchers and front-line practitioners.

For example the University of Pittsburgh Medical Center is experimenting with a variety of drug treatments on volunteer patients internationally, and analyzing results via artificial intelligence, in a flexible program which will identify what seems to be working best and use that more often, while adding into the mix any new drug protocols as they are developed.

As more medical professionals have experience with treating the virus, there is also the possibility of modifying existing treatments to make them more effective.  For example, there's a lively discussion about how and whether ventilators should be used.  (Josh Marshall has also been writing about this issue.)

The bad news is the continuing dysfunction of the federal government, while the Trump administration employs their version of Shock Doctrine USA to take total political control and make it permanent.  The Republican party now doesn't even bother to deny that it will manipulate the voting system in ways that benefit it, including sending people of Wisconsin out to risk death in order to vote.  More on this at another time.

That bad news also means that there is as yet no federal plan to manage a Phase Two of the crisis, after this total lockdown but before universal vaccination. “A national plan to fight the coronavirus pandemic in the United States and return Americans to jobs and classrooms is emerging — but not from the White House,” according to the top story in Friday's Washington Post.

“Instead, a collection of governors, former government officials, disease specialists and nonprofits are pursuing a strategy that relies on the three pillars of disease control: ramp up testing to identify people who are infected. Find everyone they interact with by deploying contact tracing on a scale America has never attempted before. And focus restrictions more narrowly on the infected and their contacts so the rest of society doesn’t have to stay in permanent lockdown....But there is no evidence yet the White House will pursue such a strategy.” 

Instead the administration is again considering lifting stay at home guidelines prematurely, without widespread testing or a national consensus.

 According to Ezra Klein and others, none of the public plans for Phase Two even make complete sense yet. Josh Marshall explains the crucial role that widespread testing would necessarily play. But that also depends on what may turn out to be the key Big Big Mystery.

There is a Big Mystery as well, among all the things not yet known about this virus.  The Big Mystery, as outlined by Wallace-Wells, is how infectious the virus really is, and how much it has really spread.  If it is both more infectious and more widespread among people without significant symptoms--as some studies now suggest-- it could be less lethal than believed in terms of numbers, though of course just as lethal to some of its victims.  But the potentially best news if this were true (according to Wallace-Wells): "It would also suggest that we are much further along the timeline of the pandemic and much closer to its conclusion."

But this kind of testing is probably months away, and because of differences in the tests out there (some of them of dubious reliability), without a national standard there will be no actionable information.  As Josh Marshall writes: "With those concepts and definitions in hand, let’s say it simply: You can’t go back to even a semblance of normal economic and social life until you have an integrated, national system of surveillance testing in place that will give us a good shot at avoiding a rolling series of outbreaks and lockdowns for another year. A great system in one state and a crappy one next door won’t cut it."

According to the aforementioned Washington Post story, there are a lot of good ideas on how to ramp up contact tracing (such as assigning these tasks to returned Peace Corps volunteers), but difficulties increase without a federal umbrella and federal money.  Still, if this is a people-driven part of the process, it can be done.  And if California and a few other big states agree on a standard testing system (which may have to be developed not only outside the federal government, but outside Big Pharma), others would likely follow.  It wouldn't be complete but it would be something.

Yet even with more testing, there is the Big Big Mystery, which is: does having the disease once confer immunity? All plans depend on this, yet there are troubling studies that show some patients who tested positive, then tested negative, a short time later tested positive again.  There are studies among patients who had the virus and recovered, showing that up to a third had few antibodies in their systems against the virus, and some had none at all.

It would be astonishing if the virus did not ultimately confer immunity.  But if it doesn't, the basis for all current ideas for modifying or ending lockdown is shattered.  This is a mystery that must be solved.

Locally here in Humboldt County, we ended the week on a surprising but highly welcome note: Friday was the third straight day without a new positive covid 19 case, and the day before that string began there was only one case. Saturday update: no new cases for fourth day in a row.  Our cases are still small enough in number for contact tracing, so it is known that out of 49 active cases, seven are the result of community spread.  We remain at three hospitalizations and no deaths.  Still, California officials are not expecting cases to peak until mid-May. "Let’s continue to hold the line and do this together,” Governor Newsom said. “Give us a few more weeks to see where these trend lines go.”