1) Election Results: For Washington election results there is a neat little smartphone app that shows them with a daily update as counting proceeds. On an iPhone its icon is black. The upper half says “Election Results” in white letters and the lower half shows a bust of George Washington and the letter SOS, for “Secretary of State.” I expect there is a similar app for Android based phones. I recommend it.

I note the Republicans have chosen to challenge Governor Inslee with an extremist, rural, anti-mask sheriff, Loren Culp. In Legislative District 4 (Spokane Valley north to Mt. Spokane) it looks like, Rob Chase, resoundingly endorsed by Matt Shea, will run against Lance Gurel, a reputable and reasonable accountant, for the State Representative seat Mr. Shea left to tend to his extremist flock at Covenant Church. As pastor he can keep organizing for armed rebellion and wield influence over his old district. It will be an interesting couple of months. 

2) Comment on Covid-19 Death Risk: Several readers were startled by the 1 in 20 risk of death for those over age 65 infected with the Covid-19 virus. A study in Geneva, Switzerland, used antibodies as a marker for having been infected and showed a death rate of 5.6% for those over 65. . (https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(20)30584-3.pdf). (1 in 20 is simply a rough restatement of 5.6%) Data like this is constantly being refined, i.e. it is subject to change as more studies are published. Nonetheless, 1 in 20 is probably not wildly inaccurate. 

Frankly, I thought the U.S. whole population IFR (infection fatality ratio) published on the CDC website of 0.0065 (or 1 in 150) was scary enough, but the number from Geneva (the only source I had that broke the IFR down by age group) was quite sobering. 

I think we find it hard to comprehend numbers like 0.0065 or 5.6% until we re-interpret them as a risk of 1 in X number. It is easier to visualizer nineteen people standing and one in a casket than to make sense of “5.6%,” no matter your math skills. 

We strive to distance ourselves from others misfortune. It’s a natural defense mechanism. How often have I heard that “John died of a heart attack” and leapt immediately to thinking, “Oh well, John was a diabetic and drank too much—he wasn’t like me.”?

People did the same thing with the 1 in 20. They want to break it down, make it not apply: “How many of those folks were over 90, over 85, over 80, that is, any number older than my age?” I don’t have a finer breakdown by age. There isn’t enough published data from antibody prevalence studies to know. 

I was a little surprised to find that only 13% of the U.S. population is over 65. Being part of the group and knowing a lot of other people similarly getting on in years distorted my perception.

3) Trump and Testing: It is just like Mr. Trump and Betsy DeVos to exhort teachers, students, and students extended families to risk their lives by re-opening schools in a country where many cannot get the result of a Covid-19 test in less than a week, while for months Mr. Trump and his people have screened contacts with a test that delivers results in fifteen minutes. Meanwhile, he and his administration have accomplished almost nothing in making the rapid tests more available to those understandably reluctant to dive back into the virus cauldron.

Stay safe and

Keep to the high ground,

Here is last Wednesday’s (August 5) email, Covid-19 Refined, appended for easy reference:

Early in the pandemic our understanding of Covid-19 was necessarily based on analogies to similar diseases. Influenza was the commonest comparison. For months that comparison encouraged us to believe (or at least hope) that people with Covid-19, like flu, didn’t transmit virus until they had at least some early symptoms. Folks like the Rush Limbaugh and Mr. Trump declared, based on wishful thinking, that Covid-19 was no worse than the flu and, like the flu, would just go away with warmer weather. 

Understanding of Covid-19 is gradually building as our experience broadens and information is shared. As is the way with science, no single study is gospel, but many studies, each carefully scrutinized and all considered together, are sharpening our understanding of what we face with this disease. 

Even the sober wing of the Republican Party understands Covid-19 is not the flu. The Wall Street Journal on July 21 published an article (hidden behind a paywall), “How Deadly Is Covid-19? Researchers Are Getting Closer to an Answer.” The authors assembled the results of a number of large studies and came up with some numbers to which we should all pay attention. Much of their information came from the CDC’s Pandemic Planning Scenarios webpage (which is not hidden and was updated July 10)

The current best estimates based on multiple, worldwide studies is that Covid-19 kills one person for every 150 it infects (Infection Fatality Rate [IFR] of 0.0065). The denominator of this IFR is inflated by the estimated 40% of people who are infected (judged by antibody evidence) but never are symptomatic, even though they can transmit the virus. Best estimates of seasonal flu mortality are 1 in 900, one sixth of Covid’s IFR (and would be even smaller if the flu mortality estimate included entirely asymptomatic cases–which it does not). Rush Limbaugh, Sean Hannity, Laura Ingraham, and Donald Trump were and are ignorant, opinionated fools to declare Covid-19 to be no more worrisome than the flu.

Of course, the risk of death from Covid-19 varies with age, medical condition, available medical care, and other factors. For those of us over the age of 65, the risk of death, once infected, is about one in twenty (5.6%) Is there any activity in which you would willingly take part in which the advertised risk of being killed is one in twenty? [See P.S. below] I’ve taken part in quite a number of physically risky ventures in the course of my life, but none of them carries a one in twenty risk of death,

These Infection Fatality Ratios consider mortality, not morbidity: respiratory compromise, chronic fatigue,  and multiple other long term sequelae of infection, sequelae that weaken but don’t kill. Republicans, even Trump supporters and their families, are not immune to the reality of Covid-19 infection. Herman Cain, age 74, former presidential candidate and recent mask-dissing attendee of Trump’s Tulsa rally has been hospitalized and on oxygen for nearly four weeks with Covid-19.  (The day after I composed this email Herman Cain died.)

Other truths about this virus are also coming into focus. A Spokane teenager of my acquaintance and her friend recently lost their sense of taste and smell on the same day, one week after their only plausible exposure to Covid-19. They and two others had spent time (some of it indoors) in the company of a third friend whose brother came down with symptoms and tested positive after their time together. The friend, the only link and the only plausible carrier with whom they’d had contact, never personally manifested symptoms andtested negative for the virus twice following their contact. Fortunately, my teenage acquaintance suffered only a mild case, regained her sense of taste and smell in about a week and, with careful quarantining, did not infect her family. The other young woman had a rougher course, but recovered without experiencing pneumonia. Both young women tested positive for the virus.

The take-home from this anecdote and published data is that Covid-19 can be caught from symptomatic, pre-symptomatic, and asymptomatic people infected with the disease. One best assume that everyone with whom one comes in contact may be shedding virus. Influenza is far less contagious. Viral shedding with influenza virus mostly does not occur in the absence of early symptoms of the disease. In the current world population Covid-19 is not the flu. Covid-19 is more transmissible, more deadly, and productive of greater morbidity than influenza.

Keep to the high ground,

P.S. Unless an effective vaccine becomes widely available, the death toll from Covid-19 is probably just getting started. The following is mathematical conjecture, but, if you take the death rate of 5.6% (1 in 20) in the over age 65 cohort in the U.S. population (these over age 65 are 13% of the whole U.S. population of 330M), an IFR of 0.0065 (1 in 150) in the whole population, and assume herd immunity when 60% of the population has been infected and made antibodies, then in the U.S. alone we would see 1.44M dead overall, nearly ten times what we’ve seen so far. 1.29M of the dead would be from the over 65 yo cohort, but 212,000 of the dead  would be among working age and younger U.S. residents.

Since the greatest viral transmission occurs indoors, I predict the coming winter will be long, dark, cold, and isolated, especially for those over 65. We had better hope for a safe and effective vaccine. The earliest that could happen now appears to be early in 2021. Cross your fingers.