The state of Alaska’s COVID-19 tracker

When, oh, when are political leaders going to accept that the latest pandemic is over, and what we are all dealing with today is a new and sometimes deadly endemic disease different only by degrees from the flu or pneumonia or, for that matter, cardiovascular disease and cancer – two of the Western world’s biggest killers.

Remember how when this crisis started, the response was all about “flattening the curve?”

Well, we flattened the curve. Here in Alaska, we really, really flattened the curve. Then we relaxed the curve flattening measures, because it is impossible to live forever locked down in our homes, and SARS-CoV-2 – the virus that makes some people very sick with COVID-19 – came roaring back.

Look at the graph above. That little hump on the far left is when the curve was flattened in March. Then some tourists arrived in June and the infection rate started climbing to a peak in July before settling in August with most folks outside enjoying the great, Alaska outdoors.

Then what happened?

We started moving back indoors because of the changing weather. We masked in the belief this would protect us. And the infection rate started soaring.

The state response to this has been what? A bunch of TV ads that continue to stress that people wear their masks?

Researchers from the United Kingdom, Australia and the U.S. who examined “chronological data on NPIs (nonpharmaceutical interventions) in 41 countries between January and the end of May 2020” a week ago reported you can count on masking to do just about zilch.

As they noted, and as all scientists agree, controlling any infectious disease is about getting the R₀ or “R naught” or simply R under one, and for that masks just don’t cut it. R represents the rate of reproduction for an infectious pathogen spreading through a population.

At R-2, for example, every person with the disease infects two other people who each infect two more people, and the six now infected each infect two more, bringing the number of infected to 12 as the disease explodes logarithmically and continues to grow.

This creates that much-discussed bell curve that sees the number of infections steadily increasing until they top out, and they always top out or at least they always have.

The reason why diseases don’t kill everyone is explained by the large and invisible genetic differences within all known species of life. This has ensured, at least until now, that some members of every species are genetically equipped to survive a new infectious disease.

At the beginning of the new millennium, fisheries biologists feared a new parasite that caused so-called “whirling disease” was destined to wipe out rainbow trout in the American West because the fish had no resistance to the pathogen. 

Five years later, with some trout still alive, a study in Evolutionary Applications reported new data suggesting “natural selection has rapidly reduced whirling disease susceptibility within the population over time. The rapid observed …change in resistance patterns argues that the standing genetic variation for parasite resistance facilitated this process.”

Big brains

Humans, obviously, are smarter than fish. They are even smarter than whales, the mammals of the sea that live among the fish. Humans have figured out a lot of ways to combat new diseases instead of just letting them take their natural course

In the case of infectious respiratory pathogens like SARS-CoV-2, the trick is to reduce the aforementioned R and in this way radically slow the spread of the disease.

Alaska witnessed this when Gov. Mike Dunleavy ordered the state shutdown. The result was predictable. Infections fell to almost nothing in May.

And then the state reopened.

What happened after that was also predictable. Infection rates started climbing and climbing and climbing.

The same thing is at this moment happening in New York, a state previously devastated by COVID-19. On a per-capita basis, the disease has already killed New Yorkers at a rate of 173 per 100,000. That is a death rate almost three times that of the 59 per 100,000 in Sweden, which has been much in the news for failing to impose a severe lockdown of its citizens. 

New York did. The lockdown worked to slow the spread. Then New York started to open up again. Today’s headline at Bloomberg was this: “N.Y.’s New Virus Cases Exceed 2,000 for First Time Since May.”

How could this happen? Pretty simple really. What went down – that R – went back up. And what causes the R to go down?

Let the scientists from the universities of Oxford, Harvard, Cambridge, Manchester, Tufts, Bristol and Australian National, along with a colleague from London’s Imperial College, explain.

After taking a look at the effectiveness of disease-limiting, nonpharmaceutical interventions (NPIs) in those 41 countries and crunching the numbers this is what they reported:

“The mean percentage reduction in R associated with each NPI is as follows:

• Mandating mask-wearing in (some) public spaces: minus 1 percent.  (-13 percent to 8 percent range).
• Limiting gatherings to 1000 people or less: 13 percent (-3 percent to 31 percent range).
• Limiting gatherings to 100 people or less: 28 percent (9 percent to 44 percent range.
• Limiting gatherings to 10 people or less: 36 percent (17 percent to 53 percent range.
• Closing some high-risk businesses: 20 percent (0 to 40 percent range).
• Closing most nonessential businesses: 29 percent (8 percent to 47 percent range).
• Closing schools and universities: 41 percent (23 percent to 56 percent range).
• And issuing stay-at-home orders (with exemptions): 10 percent (-2 percent to 22 percent range).

Their study, which is published at MedRxiv and has yet to be peer-reviewed, goes on to outline ways to get that troublesome “R” down under one.

What would appear to be the economically least onerous calls for closing some businesses, shutting down schools and universities and limiting gatherings to under 10 people when the spread of the disease is accelerating and rolling back such restrictions when the disease is decelerating.

Anchorage has done this to some degree. The state has not. Some other states have. Arizona closed bars, gyms, movie theaters and more on June 29 and promptly turned the curve in that state.

Some have cited Arizona, which mandated masks in public on June 17, as an example of how stopping the spread of SARS-CoV-2 is as easy as masking up, having apparently missed the fact Arizona rates of infection continued to explode until more aggressive actions were taken. 

The team of scientists studying NPIs, led by Dr. Jan M. Brauner at Oxford, did not find the problem to be as simple as masking, although they stressed they are not anti-mask.

“While our results cast doubt on reports that mask wearing is the main determinant shaping a country’s epidemic,” they write, “the policy still seems promising given all available evidence due to its comparatively low economic and social costs. Its effectiveness may have increased as other NPIs have been lifted and public interactions have recommenced.”

The data from Alaska, where infections started climbing in June and haven’t stopped, would seem to indicate mask effectiveness has not increased from the January to May period when the study indicated masks might make things worse rather than better and were rated “low” in terms of effectiveness.

If large results – more than 35 percent – are desired, the scientists concluded, “six of the NPIs fall into a single category in a large fraction of experimental conditions: school and university closures are associated with a large effect in 99 percent of experimental conditions, limiting gatherings to 10 people or less in 94 percent. Closing most nonessential businesses has a moderate effect in 96 percent of conditions, limiting gatherings to 100 people or less in 97 percent. Making mask-wearing mandatory in (some) public spaces falls into the ‘small effect’ category in 100 percent of experimental conditions, issuing stay-at-home orders (with exemptions) in 99 percent.”

The researchers provided a link to an “epidemic forecasting” model where anyone “can interactively explore the effects of sets of NPIs: http://epidemicforecasting.org/calc. 

Their study does suggest there might be some data to back up outlaw Swedish epidemiologist Anders Tegnell’s claim masks could be “dangerous.”

Flashpoint

Sweden is in the schizophrenic news regularly these days because of its moderate approach to COVID-19.

Two days ago, Newsweek headlined “Sweden’s COVID Strategist Wants to Ease Restrictions for Elderly, Who Make Up Nearly 90 Percent of Death Toll. This came a day after a story headlined “Sweden, Which Refused Lockdown During COVID First Wave, Imposes Restrictions as Cases Soar.”

What Sweden actually appears to be doing is trying to target SARS-CoV-2 hotspots to reduce the R there and slow the spread of the disease while allowing greater social interaction in areas where the disease is waning. Humans are social animals and can live in isolation only so long.

Despite the beating Sweden has taken in much of the mainstream media for its approach to COVID-19, the data from the country would indicate it has been surviving the disease pretty well for months. A lot of Swedes – largely old people – died in late March and April, but after that the death rate in the country began falling even as the infection rate was increasing.

COVID-19 in Sweden

The averaged, daily infection rate peaked at 1,246 cases on June 26, according to a Swedish COVID-19 tracker. Three weeks later (three weeks being the average time between infection and death for those who die from COVID-19), the death rate was down to 14.4 deaths per day from an April 24 peak of 102 deaths per day when the earlier infection rate was but 437 cases per day.

The infection rate in Sweden did drop briefly below 100 at the start of September, a change that attracted headlines because it was the then lowest rate in Europe. But Sweden’s rate has gone up since then as rates have across Europe.

In fact, the Swedish infection rate has generally stayed between 200 to 500 cases per day from mid-July to mid-October, and in that time, the death rate has never topped five people per day. The average is about three and a half deaths per day. At that level, as an endemic disease, COVID-19 would kill about 1,300 Swedes per year.

This would rank COVID-19 as Sweden’s 12th leading causes of death, slotting in between diseases of the genitourinary tract, and poisoning with medicine and narcotics, according to the Statista website for data.

It is tragic that anyone – old or young – dies from the latest disease to threaten humankind, but life itself is a death sentence. We are all destined for the grave. Cancers – some of which are now known to be linked to viruses and others which might someday be linked to pathogens – kill more than 23,000 people per year in Sweden.

And Sweden’s COVID-19 death rate could again start accelerating along with the increase in infections, or not.

Tegnell has suggested that Sweden’s early and large number of deaths from COVID-19 might have been linked in part to lower than normal deaths from flu in Sweden during the 2019-2020 flu season, though he has presented no data to support that.

The Centre for Evidence-Based Medicine at Oxford, which has been carefully tracking deaths in the United Kingdom, shows that country had a huge spike in deaths in March and April, too, despite little sign of any big change in the death rates in the previous flu season.

The center uses a revealing Florence Nightengale diagram in the form of a radial plot to illustrate those deaths. It has a visibly huge spike in March and April (at the right in the illustration below), but since then monthly deaths (plotted in a clockwise direction) have been at or near historic norms even though infection rates in England and Wales remain fairly high.

CEBM graphic

In the UK as in Sweden, there are indications that the infection fatality rate (IFR) has fallen, although the true IFR for COVID-19 remains hard to pin down because so many people are asymptomatic – meaning they are infected by SARS-CoV-2 but fail to suffer the disease consequences of COVID-19 – and thus cannot be identified as infected unless tested.

It is also now well documented that the vulnerability to COVID-19 varies greatly from individual to individual and that people already suffering from chronic diseases, obesity or age are at more risk.

One explanation that might explain the data showing lower death rates in Sweden and the UK is that COVID-19 killed off so many of the most vulnerable people in the spring that there are now fewer people who will die while battling the disease.

Or it could be that many of the more vulnerable have wised up and now understand that the way to avoid contracting an infectious disease like COVID, the flu, or any other is to stay away from other people, any of whom might be carriers.

Unfortunately, it is hard for most people to live in total isolation, so it is nice to know studies are indicating there are other things humans can do to help protect themselves.

Geneticist Dr. Shuai Li from the Centre for Epidemiology and Biostatistics at The University of Melbourne in Australia today reported evidence that “genetically predicted body mass index,” a measure of obesity, is “associated with about twofold increased risks of severe respiratory COVID-19 and COVID-19 hospitalization. Genetically predicted physical activity was associated with about fivefold decreased risk of severe respiratory COVID-19, but not with COVID-19 hospitalization, though the majority of the (people) did not include one.

“This study highlights the importance of maintaining a healthy lifestyle in protecting from COVID-19 severe illness and its public health value in fighting against COVID-19 pandemic.”

Li tagged obesity and fitness as “modifiable lifestyle factors” despite genetic predispositions to being fat or thin and physiologically strong or weak. These are conditions you can still improve if you try.

Li’s work is in line with most of the other research on COVID-19, and as with thinness and fatness, there are growing indications of genetic predispositions to susceptibility to COVID-19.

Professional cyclist Fernando Gavia caught it in Abu Dhabi in March and was in the hospital for weeks. He was eventually judged free of disease and returned to racing in the summer. At the end of July, he demonstrated the health of his cardiopulmonary system by topping some of the best sprinters in the world in a race in Spain.

Two days ago, he tested positive for the second time. The doctors for his cycling team are confident he has suffered two, separate infections given that he repeatedly tested free of SARS-CoV-2 after being allowed to leave Abu Dhabi.

He illustrates many of the unknowns about dealing with COVID-19 which complicates the world living with the disease as the world is now being forced to do.

Huge debate

In an effort to break free of the fear of COVID – Covidphobia some have called it – a trio of health professionals from Harvard, Oxford and Stanford University on Oct. 4 authored what they called “The Great Barrington Declaration,” arguing that the best way forward is to “allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”

Their “Focused Protection” quickly became the focus of charges they were trying to kill people. The face of the U.S. response to COVID-19,  Dr. Anthony Fauci, told ABC News that the Declaration was “ridiculous,” “total nonsense,” and “will lead to hospitalizations and deaths.”

He was not alone.

As one group of epidemiologists and health professionals flocked to sign onto the Declaration, another group lined up to sign onto an anti-Declaration declaration.

A trio of European scientists writing in the Guardian attacked the Declaration as an attempt to “legitimise a libertarian agenda” and complained its presentation was  “carefully orchestrated for media attention, with a slick website and video produced to accompany the event, and an ostentatious champagne toast to follow.”

Their argument against it quickly deteriorated into politics as almost everything does these days. The authors – including Oxford’s Trish Greenhalgh, the world’s leading advocate for masks – blasted the plan as something supported by President Donald Trump and took off from there.

“As we approach one of the most important elections in the history of western democracy (itself described as a referendum on lockdown), we should be asking who funded this piece of political theatre, and for what purpose,” they wrote. “The American Institute for Economic Research (AIER), where the declaration was signed, is a libertarian thinktank that is, in its own words, committed to ‘pure freedom’ and wishes to see the ‘role of government … sharply confined’.

“The institute has a history of funding controversial research – such as a study extolling the benefits of sweatshops supplying multinationals for those employed in them – while its statements on climate change largely downplay the threats of the environmental crisis. It is a partner in the Atlas network of thinktanks, which acts as an umbrella for free-market and libertarian institutions, whose funders have included tobacco firms, ExxonMobil and the Koch brothers. Our questions to the AIER about its relationship to the three signatories went unanswered, but it has posted a number of articles about the declaration and herd immunity on its website.”

None of that had anything to do with the science, and the authors offered no alternative ideas on how to put the world back to work and ease the political conflicts SARS-CoV-2 has acerbated.

Instead they attacked the two epidemiologists and the biostatistician who authored the Declaration as frontmen for radical organizations and wrote that while their views were “no doubt sincerely held (though, notably, not published in any peer-reviewed scientific articles)…they are falling into a trap set by the right.”

As if COVID-19 cared about anyone’s politics.

The reality is the world has a new disease. It is not going away. A vaccine might or might not be developed.

If it is, it might reduce the risk of COVID-19 by 40 to 60 percent, as the U.S. Centers for Disease Control report the flu vaccine reduces the risk for that disease, or more or less.

There is no reason to believe it will make COVID-19 disappear. Smallpox is the only disease ever to have been eliminated by a vaccine. Efforts to find vaccines for HIV/AIDS and malaria have failed.

What the world really appears to be dealing with today is the Spanish flu, take two. The Spanish flu lasted for two years and might have killed up to 100 million people around the globe, in part because general medicine then was far less capable than now.

“By the summer of 1919, the flu pandemic came to an end, as those that were infected either died or developed immunity,” History.com records.

“Almost 90 years later, in 2008, researchers announced they’d discovered what made the 1918 flu so deadly: A group of three genes enabled the virus to weaken a victim’s bronchial tubes and lungs and clear the way for bacterial pneumonia.”

A large number of COVID-19 deaths have also been linked to associated bacterial pneumonias. Heathline reports as many as 50 percent of the people with COVID-19 also come down with bacterial pneumonia or fungal infection.

A vaccine has been developed for pneumonia. It’s efficacy is unclear. One study showed it cut mortality by 44 percent, according to John Hopkins Medicine. Others provided uncertain results. 

The pneumonia vaccine is not a magic bullet. Neither so the flu vaccine. And yet humans have learned to live with these diseases.

“Since 1918, there have been several other influenza pandemics, although none as deadly,” History notes. “A flu pandemic from 1957 to 1958 killed around 2 million people worldwide, including some 70,000 people in the United States, and a pandemic from 1968 to 1969 killed approximately 1 million people, including some 34,000 Americans.”

But life went on, and now there is a new disease people are going to have to live with because there is no alternative. Societies cannot survive long without functioning economic systems be they righty capitalist, lefty socialist, full-on communist, subsistence or some other.

Economic systems are as vital to life in the long term as biological systems are to life in the short term, and COVID-19 is strangling the life out of global economic systems.

It time to accept that, come up with a plan to deal with this new disease and get back to work. That sounds easy but it’s clearly not. The first step, however, might be simple:

Accept the pandemic is over, and recognize the need to find some way to live with a new endemic disease – a cancer upon the body politic so to speak be the righty or lefty, Republican or Democrat, U.S. or foreign-born, white or black or any color in-between, female or male, short or tall and etc.