We could be Bolivia:

With no end in sight to the coronavirus pandemic, school districts from Europe to New Jersey have been teaching virtually, the idea being that educating children must not stop, no matter how imperfect the instruction.

Then there is remote and largely rural Bolivia.

I honestly just don’t get the attitude (prevalent in Seattle) that if you can’t teach everyone, you teach no one.  Wouldn’t the best choice for Bolivia be to teach children in cities?  Furthermore, the median age in Bolivia is only 25, and I bet it’s lower in rural areas.   (Our median age is 38.)  I bet the death rate in Bolivia would be quite low from Coronavirus even if medical care there is inferior to what it is in wealthier countries.

(In case you’re wondering why, for example, there hasn’t been an explosion of cases in places like India, I’m guessing asymptomatic and mild cases in an overwhelmingly young population is a huge driver.)

From the article:

Ms. Áñez, also a presidential candidate, acknowledged the problems the decision creates for parents. “It is very difficult, but we’re doing this to ensure the health of Bolivians, especially our children,” she said in a video posted on her Twitter account.

Sound familiar?  I find it very difficult to believe that Covid poses and greater threat to the children of Bolivia than it does the children of America, who are having virtual instruction to preserve their health.  How heartwarming that everyone is so concerned about the children.

Why oh why isn’t the US manufacturing its own N95s?  Obviously that wasn’t possible from Day 1, but it’s been five months, and I’ve heard nothing about this.   The US needs enough manufacturing capability for every man, woman and child to have a several month stockpile of N95s.  Covid is bad, but there is a hell of a lot worse out there.  It’s a national security issue, and going forward, N95s are as important as F22s.  Why isn’t the federal government stepping up on this?  And given that they’re not, why haven’t any of the state governments stepped up?  I can’t think of anything more worthwhile to spend money on.

Covid is a minor illness.  That’s not to say that we shouldn’t be worried about it, or that a lot of people haven’t died.  It’s just that there is much worse out there.  Even compared to the Spanish flu this is minor.  675,000 Americans died of the Spanish flu, with a population of 100 million.  That’s like 2.1 million people dying of Covid.  We’re at 160,000 deaths from Covid, or less than 10% of the equivalent per capita toll of the Spanish flu.  Furthermore, Spanish flu cut down children and people in their prime.  In a July CDC report, the median age of death for Covid was 78 in the US.  By contrast, mortality for the Spanish flu peaked at age 28.  That means the not only was mortality ten times higher for the Spanish flu, but years of life lost per death was probably five times higher per death, meaning 50 times more years of life lost.

My point here is not to minimize Covid but to point out that it could be worse.  Like A LOT worse.  And in my opinion, it will be worse.  Covid is basically a dry run.  There are a number of factors that make it likely that in our lifetimes, or, best case, in our children’s lifetimes, a more severe epidemic will sweep through.  Here are a few factors that make this likely:

1.) Global population increase, projected to continue until 2100, stopping at around 11 billion.

2.) Globalism and travel – HIV likely appeared in humans around 1908 but didn’t hit the US until around 1976.  Today, that leap would happen much more quickly thanks to increased travel to all corners of the globe and among all nations.

3.) Ongoing consumption of wild and exotic animals in Asia

4.) Climate change

5.) Industrial agriculture practices in the US and abroad, including close quarters that facilitate disease transmission, use of antibiotics on healthy animals, and others

6.) Urbanization – more people living densely in cities.

(I highly recommend Spillover by David Quammen for lots on the risk specifically of illnesses that move from animals to humans.  Covid-19 is an example of such an illness.)

When it comes, everyone who might need to leave their house ever needs access to masks.  We need domestically produced hand sanitizer and cleaning products.  We also need testing supplies.  Initially, testing was delayed by lack of tests.  Now, it’s being delayed in part by lack of test supplies, like swabs.  These things should be manufactured and stockpiled (after Covid) domestically.

One of the things that I think has actually gone really well from Covid is having people work from home.  However, the only group of essential workers I’ve seen get sufficient attention are teachers.  We need adequate protections for all essential workers, especially medical workers who are not doctors and nurses and agricultural workers.  Both groups are critical and don’t get much attention.  Washington’s biggest hot spot right now is Yakima, our main agricultural area.

Elected officials can make a difference in their communities by creating local stockpiles of essential supplies.  The rest of us can prepare enough for our families and others as well.  If one in ten people prepared for their own families and ten other families, then we’d be in OK shape.  If one in a hundred did that, we’d still be a lot better off than we are now.  If one in a hundred prepares just for themselves, that’s probably not very useful.  (I’m not suggesting we all start hoarding medical supplies now but after Covid – yes.)

It’s odd to me how conservatives are lining up behind a no-mask position.  I certainly appreciate why some people would find it troubling for the government to mandate covering one’s face.  For me, it’s uncomfortably close to the sexist policies in Saudi Arabia and other Muslim theocracies.  However, all indications point to masks being very effective, and it seems like a small imposition.  I feel like some states have gone too far – Pennsylvania mandates that 2-year-olds wear masks, indoors and out.  In my opinion, that’s over-the-top.  Others I think have not gone far enough – Texas only requires masks indoors if you’ll be within 6 feet of others.  I actually think Washington has found the Goldilocks policy for masks.  They’re required in all indoor public spaces but outdoors only if you’ll be within six feet of others.  They’re required for ages six and up and recommended for ages four and up.  My own impression is that many, but not all, four and five year olds can wear masks.  I have seen younger children wearing masks, and the vast majority seem to be chewing on them or have them around their chins, and it’s just silly.  For me, the biggest issue is school closures by far.

(I found the tale of the hair stylists with hundreds of clients who didn’t transmit Covid encouraging.  However, it’s such a small sample size (two stylists) that it’s a data point, not  a trend.  I would really like to get my hair done, but it seems like such a needless risk that I’ve been holding off.)

H just got back from NYC.  While there, he interacted with hoards of people, including lots in the hospital.  He was on two crowded flights and took multiple taxi rides.  He stayed in an apartment with his sister recently arrived from Houston, which is obviously a hot spot.  While I think it’s unlikely his sister had Covid before leaving Houston (though she does have an 18 year old son who probably doesn’t follow the rules), I’m guessing there was at least one Covid positive on her flight.  So, he decided to get tested upon his return.  To get an *evaluation* of whether a test would make sense would cost $100.  He decided not to get a test after all.  (If he shows symptoms, he’ll get a test, but by then, he’ll have spread it to all of us, not to mention anyone else he interacts with.)  Positive tests are around 4% here in King County.  Target is 2% and 1% would be better.  Why is it still so hard to get a test?

Don’t get me started on the ridiculousness of all the teachers’ unions refusing to go back to work and claiming they’re worried about the health of the children.  The data strongly suggest children between 5 and 14 are at no greater risk from Covid than from the flu, and probably significantly less.  The risk to teachers and effect on community spread of opening schools are very legitimate concerns, but it’s such BS for teachers to claim they’re concerned about the health of the children.  Please.  There have been in the US so far 14 deaths from Covid for 5 to 14 year olds, as compared to 211 deaths from the flu last year and 528 deaths from the flu the year before.  Of course the exposure level is not the same, but still.  Link to CDC.

Also, people are saying that children won’t go back to school because bars and gyms opened in places like Texas and Georgia. Um, no.  Seattle public schools are currently planning on kids being back in school one or maybe two days per week.  The teachers’ union is refusing to even support this extremely cautious and conservative plan, so it’s extremely in doubt whether kids will get to go to school at all.  And yet, bars are closed.  Gyms are closed.  Restaurants are at extremely limited capacity.  Non-essential travel (ie vacations) is banned.  Daycares are closed to non-essential workers.  Nannies and babysitters are not allowed to non-essential workers.  Playgrounds are closed.  Pools are closed.  Essential workers are required to work from home if possible.  We are having one to two deaths a day from Covid – about the same as a mild flu year.  And yet – still public schools will be open to most kids one day a week.

This is not college, or even high school.  Elementary school and middle school kids need to be in school.  Disadvantaged kids and parents will pay for this for a generation.

(For what it’s worth, I think bars and nightclubs should be closed.  But in places that have been quite conservative with reopening, it doesn’t seem to have made any difference.  Schools are closed anyway.  Teachers are apparently trending the hashtag #nocases14days or some such nonsense.  Heck, who wouldn’t want an indefinite paid vacation? )

A really interesting article on what Amazon is doing to contain Covid.  Some of it is really impressive.  The bottom line for Amazon is that they will lose money if illness spreads through their facilities – they MUST keep people healthy.  Capitalism has dictated that they implement effective means to do that, and it sounds like it’s working.  Automated temperature checks, employees encouraged to get a Covid test free at work every two weeks, cameras monitoring people to make sure they’re six feet apart – that’s the kind of thing that should happen at schools.  But probably won’t.

Meanwhile, a second person has been murdered in CHOP, the “autonomous zone” with no police in Seattle.  One Two teenagers have been murdered and a third is in critical condition (age 14).  You don’t need to be a math whiz to be able to figure out that the death toll here is going to dwarf anything the police would have done pretty quick.   Ultimately, the city of Seattle is responsible for these deaths.   The demands – 50% defunding of police among others – are not only unrealistic but also likely would not lead to a decrease in police violence.  (Justice department-mandated police reforms in Seattle, which seem to be working, have led to a considerable *increase* in budget.)  Reform needs to happen, but defunding is not the answer, at least not in Seattle, and at least not beyond what’s going to have to happen due to the impending economic downturn.

To put the above in perspective, the city of Seattle had only 19 gunshot murders in 2019 and 13 gunshot murders in 2018.  This is not Chicago.  Two teenagers shot dead in three weeks in a 5-block area or so is extremely disproportionate and a big deal.

Other coronavirus thoughts:

1.) The King County DOH just cannot seem to report accurate numbers on number of tests, number of positives, number of deaths, etc.  For example, last week before I went on vacation, I was very alarmed to see (a) a jump in the percentage of positives and (b) a jump in the number of deaths.  For the first, the website reported a few days later that they hadn’t been reporting all negatives the last few days, and the percent positive subsequently fell from 6% back to 2%.  Then, after seeing a large number of deaths, I stopped checking the site for a few days, and during my absence there were -1 deaths.  Really?  I can only assume no one came back to life and they’d flubbed the deaths numbers as well.

2.) The local papers are reporting that “less than 1%” of participants in protests locally tested positive for Covid.  This was meant to be reassuring.  However, on the order of 100,000 people participated in protests.  1% of 100,000 is . . . 1,000.  1,000 positives easily explains the surge we’ve seen in the last few weeks and then some.  Furthermore, recent positives have apparently been focused among young, urban residents.  While I doubt the youthful protesters are particularly susceptible to Covid, I worry about the next generation infections, the people they spread it to.

3.) I read that 20% of Americans have apparently been infected with Covid.  I find this very encouraging.  I can only hope that immunity hangs around for a while, or that at least people are less vulnerable the second time around.

I enjoyed my Covid news holiday, but here we go again.  My current thoughts:

1.) When all this started, the WHO was saying COVID had a 3.7% death rate.  That is scary.  Very scary.  Given that number and all the uncertainty, I think it was appropriate for the country to shut down.  We could have been facing millions of deaths.

2.) The CDC’s “best estimate” of the fatality rate of Covid for the US is 0.4% for symptomatic cases. (I will have to do some research to figure out what percent of cases they think are symptomatic.) Source.  In my opinion, it is not appropriate to shut down the country for a disease with a 0.4% fatality rate.  The CDC’s estimate of the flu fatality rate is 0.1%.  So, current best estimate is 4x worse than the flu.  Note that the uncertainty is 0.2% to 1.0%.  For the best estimate, fatality rates by age are:

• 0-49: 0.05%
• 50-64: 0.2%
• 65+: 1.3%

3.) Let’s assume 30% of the country contracts Covid with a 0.4% fatality rate.  This is pessimistic since the fatality rate applies only to symptomatic cases, and some unknown percent are asymptomatic.  We would be looking at 360,000 deaths.  That’s obviously a lot.  But consider deaths from various sources in 2017 (last year I found data):

• Heart disease: 647,000
• Cancer: 600,000
• Other diseases in the top 10: 615,000
• Accidents and suicide: 217,000
• Total deaths: 2.8 million

I guess I think a 10% bump in deaths in a year is a terrible tragedy but again, not an acceptable reason to shut down the country.

4.) Smoking causes 480,000 deaths annually in the US, including 41,000 deaths caused by secondhand smoke.  16 MILLION americans live with disease caused by smoking.  Yet, we don’t ban smoking.  But we’re willing to ban people leaving their houses and working and going to school, which will save fewer lives (given current data)?

Again, I think shutting down was appropriate for a disease with a 3 or 4% death rate.  I also support an emphasis on PPE (masks) and unemployment protections for the vulnerable.  But its time for the shutdown to end.

Finally, I continue to think that if things go well, we’ll have a widely available vaccine in a year.  Not sooner.  Furthermore, I think the likelihood of that happening is only about 50%.  It’s quite likely there will be a vaccine which is ineffective for the elderly or just ineffective in general.  Or not safe.  When the polio vaccine was initially tested on 10,000 children, it provided no protection against the disease and nine children died.  Many more were paralyzed.  Why?  Because there was a huge rush to try and prevent this horrible disease (polio).  There is obviously huge risk that excessive rushing could result in similar tragedy with Covid.  So I think we need to be very careful about assuming this is all “temporary” and we can just stay home for six more months and then be rewarded for our patience.

Can I spend a few more days not checking Covid news?  Maybe.