18 July coronavirus report #34

18 July Pandemicia coronavirus report #34

Epidemic

Globally, new cases are rising at a little more than 1% per day - and at 2.5% per day in the USA, where  a new record of 80,000 cases in a day has been reached. India has passed a million cases and Brazil 2 million. South Africa has passed Chile and Mexico, and soon Peru, to go into 5th place. Egypt and Iraq have passed China in cases, but not in deaths. Brazil looks like it has reached inflection and plateaued at just under 50,000 cases per day. 

In the USA, Florida, Texas and California between them are now accounting for a fifth of the world's coronavirus cases. Counties in Texas and Arizona have ordered refrigerated trucks to deal with the anticipated overload on morgues. California is still pretty much locked down but infected people are coming in from other states. In southern California, hospitals are full and some patients are being shipped nine hours north.  

Gov Kevin Stitt of Oklahoma is the first state governor to become infected. He has been one of the most cavalier state leaders, encouraging people to dine out and supporting large rallies.

'Patient Zero' in Sydney has been identified not as a hotel employee, but a transport company worker from Victoria who visited his Sydney office on June 30 and then went out for dinner at the hotel on July 3 with about ten of them. It shows perhaps better than any other case how easily a superspreader customer that doesn't feel particularly ill can infect large numbers of others in an open venue. Less than two weeks later, eight venues have shown infections in Sydney's south west and in small nearby towns Picton and Bowral. Sydney has begun a major test-trace-isolate blitz and half a million masks have been procured for aged care homes.

In Victoria, 100 patients are in hospital and 27 in intensive care. Hospitals have been put on notice to prepare for an avalanche of patients. A specialist ward has been set up at Royal Melbourne Hospital for elderly patients from age care homes. Five healthcare workers at the Royal Children's Hospital have tested positive, plus one back-office worker at a shop there. All hospitals are tightening restrictions - only remote consultations are happening at the Alfred. More than 100 staff  of 32 nursing homes have contracted COVID-19,  and eight have residents with infections. The reason why infections proceed so rapidly into these homes seriously needs to be established - whether it is staff or well-meaning family visitors.

In Queensland, jail terms of up to six months will be introduced for those breaking restrictions, as fines have not been sufficient to ensure compliance. The Northern Territory has banned visitors from all of Victoria and Greater Sydney.

Red extrusions are the filopodia

Researchers have discovered more about how COVID infects cells. The original picture was that the virus used its spikes to seize onto the ACE2 receptor, common throughout the body, and inject itself into the cell. Now they have discovered that infected cells extrude long filaments called filopodia that poke their way into other cells and deposit viral proteins.

For some reason, whether coronavirus travels suspended in small aerosols remains an issue.  It is already obvious from the MERS cases in hospitals we discussed. The real problem is that no-one has ever seen anyone get infected so they don't know what happens. 

Some foolish Dutch researchers posted a piece proposing that bicyclists could be spreading it around - showing their simulation of air going past a bicycle. Which frankly has nothing much to do with the problem. They managed to get it into a newspaper and then onto Twitter, where it went viral. The truth is that no-one yet has proved you can catch the virus outside! 

Response

A few other cities to go into a second-round lockdown, apart from Melbourne, have included:

• Leicester in England accounted for 10% of all British hospitalisations when it announced a second lockdown at the end of June - but cases keep increasing 
• The Segria region in Spain, which went into an indefinite lockdown on July 4 in the face of rising cases and hospitalisations.
• Beijing's hard lockdown on a few neighbourhoods on June 15 following an outbreak linked to the meat section of Xinfandi Food Market, surrounding these with zones of decreasing restriction. Neighbouring Hebei province also quarantined a half-million people. By July 7 the city reported zero new cases.
• Hong Kong had no new local cases for three weeks but now has had 180. A new set of restrictions call for gatherings to be capped at four people, restaurants to limit their dine-in hours, gyms to shut down, and masks to be worn on public transportation.

Although repeated lockdowns were part of the original Oxford modelling plan, the strategy showed poor appreciation of human endurance. "Lockdown fatigue" soon becomes and issue, violent protests can ensue, and the cost of lockdowns is around 3% of GDP per month. 

The Director of the CDC has announced the disease could be brought under control in one or two months if everyone was facemasks. Immediately, governors in Alabama, Arkansas, Colorado and Montana announced masks would be mandatory in public. On the other hand, the governor of Georgia has issued a legal challenge trying to prevent retailers from insisting on masks. Only a handful of national retailers in the USA - including Costco, Apple and now Walmart - require masks.  

Israel

Victory

Prime Minister Netanyahu of Israel was one of the first leaders to recognise the dangers of COVID-19 and impose immigration restrictions. While Israel blocked passengers incoming from Europe and China, it did not do so for the very many Israelites returning from the USA and an epidemic resulted. However, Israel brought it rapidly under control and achieved suppression. 

By 4 May, when new cases were less than 50 a day and the death toll only 235, Netanyahu announced that Israel had beaten the virus and that quarantine would be fully removed by mid-June. This enhanced his personal standing in the middle of corruption allegations. From 9-25 May Israel had less than 20 cases per day, and Israel could claim its performance on every front had been near the top of the developed world. It touted to be in Australia's 'safe travel bubble'.

But by 5 July, thousands were clamouring for Netanyahu's resignation over corruption, his economic policies and underlying it all, the failure of the COVID strategy, with daily cases about double what they had been at the first maximum. What went wrong?

From the beginning, the majority of Israeli cases have been in haredi ultra-orthodox households and neighbourhoods. Women in haredi communities have an average of seven children. Many large families live together in very cramped apartments, making it impossible to isolate, and some 72% of cases caught the virus within their homes. In the first blister ('wave'), many  infected were evacuated to 20 hotels, enabling the uninfected to return to work. Many of these households do not own TVs or internet, so the government rolled out a special information campaign explaining what was necessary. This has not been done in the second blister.

The government's regulations have also succumbed to populism and it broke out of lockdown too early. Israelis were told to 'have fun' as lockdown was removed, rather than warning for extended caution and social distancing.  The government has known that cases were largely due to superspreading, with 1% to 10% of patients infecting 80% of patients. However it has allowed up to 50 people to meet in synagogues, and cultural events and theatre audiences of 250 are permitted. Large weddings have been held, now linked to outbreaks. Mask wearing on enclosed public transport has not been enforced. 

Some 'experts' have blamed the reopening of schools - because as elsewhere this outbreak has had a younger average age and has occurred simultaneously all over the country. 

On 2 June 'black lives matter' protesters - Ethiopian Jews and black Americans - staged protests. By 6 July a mixed crowd protested plans to annex parts of the occupied West Bank, and excessive police violence against Palestinians. Thousands of Israelis are protesting the lack of state assistance within new lockdowns. A survey on 4 July showed haredi were less upset about the epidemic than other Israelis; nevertheless Protests in haredi areas have turned violent.

On the West Bank, the Palestinian Authority initially contained the virus with tough restrictions on movement. But workers returning from Israel have spread the virus throughout major Palestinian cities, which have now gone back into lockdown. 

The epidemiologist in charge of public health, Siegal Sadetzki, ended up quitting, saying the Government was not listening to her. "The achievements in dealing with the first wave were cancelled out by the broad and swift opening of the economy," she said. 

Netanyahu has been accused of getting a tax refund of hundreds of thousands of dollars through parliament to renovate his private dwelling, just at the time Israelis became aware their first round sacrifices were for nothing.

There is grave concern Israel will not be able to control this second outbreak, as the government has lost the support of the people.  

Israel has been placed on a list of excluded 'red' countries by the EU, along with the USA

Economy

Three big banks in the USA have posted large profit falls and are expecting the economic recession to last well beyond the end of the year. Banks have already allowed millions of customers to skip mortgage and credit card payments during the pandemic - but defaults will rise much more quickly once Federal income support programs stop. 

A rush of first home buyers has taken place in Australia, buoyed by government assistance and the hope of a good deal. Around a third of all dwelling finance commitments were from first home buyers (42% in Victoria). Investor purchases have fallen to a very low level.  The focus over the year has been on the purchase of new dwellings, whee values traded have risen by a massive 30% over 12 months, whereas purchase of existing dwellings has risen only 3%. In terms of numbers of dwellings there has been a 17% increase in new home buyers over 12 months, though there was a fall of 10% from April to May. This is a welcome development for those seeking relief from high house prices and improved access to housing.

Multimillionaire Ivanka Trump has told 18 million unemployed workers to "find something else" in an ad campaign criticised as "tone deaf", insensitive and "clueless". It has mentioned as growth industries things like wind turbines that President Trump has railed against.

Political and Social

Birthrates should continue to drop in many higher-income countries and climb in many poor and middle-income nations, where the U.N. Population Fund (UNFPA) projects that pandemic-driven disruptions in access to contraception could lead to millions of unplanned pregnancies. In other words - the virus will exacerbate existing trends where populations are falling in developed countries and rising in developing.

Canada

While Canada has suffered a substantial outbreak with 111,000 cases and nearly 8800 deaths, it has however performed much better than its huge neighbour the USA.

Essentially the same mis-steps were observed in Canada as anywhere else. The response was late. The government announced the virus was not really a problem. The outbreaks were so bad in some provinces the military had to be sent in. There was a critical shortage of PPE and ventilators. More than 80% of deaths were in aged care homes, where "soldiers documented abuses including cockroach infestations, force feeding and significant gross faecal contamination” in patients’ rooms. There were major outbreaks in meatworks, exacerbated by flooding. 

After a significant SARS outbreak in 2003, a commission reviewed the Ontario’s response to the outbreak said the public health-care system was “broken, neglected, inadequate and dysfunctional.” Little was subsequently done to improve the situation, or prepare for a future pandemic - unlike East Asian countries who also came in contact with the SARS coronavirus. 

The main reasons for a more orderly recovery are not therefore in medical or planning preparedness, but essentially sociopolitical. Provinces and the national government, as in Australia,  pulled together for a "Team Canada" effort in a 'rare moment of cross-partisan consensus'. A consistent message was delivered to the public by all levels of government, and a consistent response was the reward.   Canadian people have been less divided and more disciplined. Once measures were announced, they were strict, broadly uniform and widely followed. People have also been able to seek treatment without cost.

This is not to say that Canada's performance has been particularly good or that the disease is anywhere near suppressed - with over 500 cases per day still occurring and numbers apparently rising. It is just that its neighbour's performance has been so irredeemably awful. 

Odd spot

A woman from Wuhan got coronavirus after travelling to Florida.

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