The Road goes ever on and on ... Day 291 (791)

As the US covid death toll exceeds one million, the Johns Hopkins University Coronavirus Resource Center reports the US death rate at 291 per 100,000. Only two countries--Brazil and Poland--have higher mortality rates. Already thinking about how the US can say it's so good yet look so bad, I came across an article comparing the US and Australia in covid terms. Australia's death rate is about one-tenth of ours. Both countries are English-speaking democracies and have similar demographics. The median age in both countries is 38. The 83 percent of Americans living in urban areas compares well to Australia's 86 percent urban. So why the big difference? Dozens of interviews, surveys, and scientific studies point to one thing: trust. That would be trust in science and institutions but most importantly, trust in one another. 

The first positive covid case was found in Australia on January 25, 2020. The first in the US was January 31, 2020. On that very day, the now-ex POTUS noted, "We think it's going to have a very good ending for us." The same day, Australia's health minister reported, "Border isolation, surveillance, and case tracing mechanisms are already in place in Australia." Australia closed its border with China on February 1 despite its being their largest trading partner. Two days later, they brought Australians in China back to Australia where they spent 14 days in quarantine. There were other factors besides Australia's taking action faster, including differences in the health care system, obtaining and used personal protective equipment, and a smaller gap between the rich and the poor. A final factor and, to me, perhaps the most important was that following rules was the social norm in Australia. We in the US are much more every-person-for-themselves. Currently, 95 percent of Australian adults are fully vaccinated and 85 percent of the total population has gotten two doses. The US is holding steady at 66 percent being fully vaccinated. 

I noted a day or two ago that deaths from guns and drug overdoses hit new highs during the pandemic. It seems that deaths from sexually-transmitted diseases also peaked. The only remotely causal factors I can think of are reluctance to see a doctor to be tested and a reluctance to go to a pharmacy for medicine. 

Covid. The disease that keeps on giving even more than we thought already? A new article in the Lancet with the title " Severe acute hepatitis in children: Investigate SARS-CoV-2 superantigens" posits a relationship between covid and the cases of severe hepatitis in children that have are cropping up. The suggestion compares to covid's loading a gun, the trigger of which is then pulled by an adenovirus. As you might expect, this is somewhat controversial. It's been pointed out that not all children with the new hepatitis have tested positive for adenovirus. At the same time, 76 percent of children with hepatitis have covid antibodies. I hope to see more on this in the near future.

Both WHO and China have offered help to North Korea. China, especially, has a priority of keeping its neighbor stable. At the same time, though, it is not at all clear that North Korea wants aid agencies in the country. Some sources suggest there may be another nuclear test as a distraction. Should North Korea decide to lock down as tightly as Shanghai, starvation is a real concern. Eleven million of the total population of 25 million are already undernourished. A US vaccine expert offers, "They really have only one option. They've got to find a way to bring in vaccines and to rapidly vaccinate the population. The world is ready to help North Korea, but they have to be willing to invite that help." And not wait until the last minute to invite it, I might add.

The Road goes ever on and on ... Day 163 (663)

We knew this already, but it's now being hyped a bit since some studies have been published. The covid death toll in the US may well be more under-counted than we thought. Deaths among people ages 18 to 64 are up 40 percent over the same time period pre-pandemic. Looking at excess deaths as an estimate of covid-related deaths show an excess of 942,431 deaths since February 2020. A representative of the insurance field notes that a 10 percent increase over the pre-pandemic period would be a one-in-200 catastrophe while a 40 percent increase is unheard of. 

Long covid is a complicating factor in the assessment of a death toll. Many deaths happen months after infection, because covid may have weakened organs or created fatal new ailments. A study from the UK suggests that covid may amplify pre-existing risks leading to the most vulnerable people to having the highest death risk. After reading about these studies, I had to stop and wonder whether it might be possible (I don't think it would) to count the deaths that occurred because people had surgery or other treatment postponed or canceled because of the number of covid patients in a facility. While they did not die of covid, they died because of covid.

A separate study coming out of the UK found that countries with high levels of trust generally did a better job of bringing covid cases and deaths down from peak levels. One of the authors, the director of the global systems institute at the University of Exeter notes, "Success with this awful pandemic appears to be more hinging on trust in each other than trust in government, which is probably a damn good thing given where we're at with trust in government." That may explain a lot about how the coronavirus has gone to town here in the US. A good many (half?) of the people don't trust the government nor do they trust people who do. A sense of community identity is a key determinant of adherence to social mitigation measures such as mask wearing, testing, and social distancing. Do we even have a sense of community identity any longer?

The US saw 662,000 new cases Thursday, the fourth highest daily total ever. The seven-day average of 597,000 set a record for the tenth day in a row. Hospitalizations are approaching 123,000, getting close to the record of 132,000 set last year. Deaths are holding steady at about 1,400 daily. That said, the CDC has predicted that over 84,000 people in the US could die of covid over the next month. 

Other items of interest: Norwegian military conscripts can no longer keep their military underwear; they must leave it for new recruits. Supply chain problems with materials mean not enough new underwear is being made. Recruits leaving the service must now return underwear including socks and bras. Says a military spokesperson, "The textiles are washed, cleaned and checked. What we distribute is in good condition."  Thinking about this, various second-hand stores do sell bras, but I'm not sure I've seen one selling underpants. North Korea has announced that it will skip the upcoming Winter Olympics because of covid. Japan has asked the US to impose lockdowns on military bases there as covid spreads to areas around the bases. Finally, French President Macron said he stood by his earlier comments about wanting to "piss off" the unvaccinated. A man of his word. Bravo!

I am starting my own informal quarantine or isolation having spent several hours last evening in the emergency room of our local non-university hospital. Without all the details, I managed to face and body plant on the wooden stairs up to our front porch. Trust me. You do not want to do this. I do not know how busy the ER usually is on a Thursday evening, but I spent a good bit of my waiting time in a hallway across from the men's room. There were multiple homeless people there, possibly getting warm before the snow forecast for overnight. When I finally spent some time in one of the waiting rooms, I sat directly across (maybe 10 to 12 feet) from a woman who insisted on relating stories about her three dogs, removing her mask each time to make sure I could hear her. I had a KN-95 mask over my mouth and was keeping a towel over my nose that would not stop bleeding, thanks to cuts at the top of my nose beside each eye. While I hope towel and mask offered enough protection from aerosol particles, I'm not going to take any chances about exposing my 89-year-old mother or any of her fellow residents in assisted living. The number of people in the ER was the highest I've been with since mid-March 2020, and I could go another two years before I'm with that many people again.

The View from the Hermitage, Day 436

Half of US adults are now fully vaccinated against the coronavirus. Including people under the age of 18 drops the percent to 39. People under 24 are especially lagging in vaccinations. They may be at lower risk of dying from covid but could still face long-term effects. At least 10,000 vaccinated people were infected with covid through the end of April, but the CDC no longer investigates mild cases. They only look into cases that result in hospitalization or death. 

How much do you trust people to be honest about their vaccination status? As expected, that varies. Eighty-eight percent of people surveyed would trust the responses of family or friends, while 71 percent would trust the responses of coworkers. For people one meets but who are outside the immediate social circle, the trust percentage drops to 38. Thirty-one percent of people surveyed would trust the vaccine-resistant. (I have to interject here that I would not at all trust someone I knew to be vaccine-resistant but who said they had been vaccinated. I'd need to see their CDC vaccination card.) People dining indoors or at a bar or nightclub and people attending outdoor sporting events of concerts would be trusted by 25 percent of people surveyed, virtually identical to the 24 percent  who would trust people at an airport. To be a good data scientist, I should report that there was a 3.2 percent margin of error.

In something of a call center reversal, desperate patients in India are turning to doctors in the US. Many of the connections are made through the American Association of Physicians of Indian Origin. The US doctors cannot write prescriptions but can offer guidance on how to use steroids or other medications Indian patients can get on their own in India. They can also offer guidance on how to interpret symptoms and lab results. Nineteen countries including Nepal, Iran, and South Africa are most at risk of running out of oxygen. Nepal, for example, now needs more than 100 times as much oxygen as it did in March. The US State Department's Level 4 travel warning for Japan--"Do not travel to Japan due to covid-19"--is somewhat moot. Right now, Japan has closed its borders to all but citizens and residents. The unknown "they" say that this warning will not complicate preparation for the Olympics that most of Japan wants nothing to do with. 

Finally, today is the first anniversary of the death of George Floyd. Has there been much change, real or imagined? How many officer-involved shootings have happened in the 12 months since Mr. Floyd died? Do Black lives matter more now than they did a year ago? I don't think such questions can easily be answered, especially out of context. I'm not sure what would have to happen to convince me.

Not a long post, but life is getting in the way. The new prescriptions glasses I got last week have never felt right, beyond the normal period of time getting used to new lenses. I'll see another optometrist on Friday to see whether their take on the prescription agrees with the first optometrist. There were no surprises at today's physical. I shall be looking into the shingles vaccine and have appointments in July for a bone density scan and a pneumonia vaccination. Growing older can be so inconvenient.