Seven Months Later, What We Know About Covid-19 (and Don’t)

Our president announced that New Zealand suffered a major surge of Covid-19 on Monday (“big surge in New Zealand, you know it’s terrible, we don’t want that”). They had nine new cases. The U.S. had 42,000. 

For somewhat more reliable information, see this informative summary from StatNews (the article has more about each item):

. . . In the time since Chinese scientists confirmed the rapidly spreading disease in Wuhan . . . an extraordinary amount has been learned about the virus, SARS-CoV-2, the disease it causes, Covid-19, and how they affect us.

Here are some of the things we have learned, and some of the pressing questions we still need answered.

What we know

Covid and kids: It’s complicated 

. . . Everything Covid is complex, and kids are no exception. While deaths among children and teens remain low, they are not invulnerable. And they probably contribute to transmission of SARS-CoV-2, though how much remains unclear. . . 

There are safer settings, and more dangerous settings

Research has coalesced on a few key points about what types of setting increase the risk that an infectious person will pass the virus to others. . . . 

People can test positive for a long time after they recover. It doesn’t matter 

There was a lot of angst a few months ago about some people who had seemingly recovered from Covid-19 infections continuing to test positive for the virus for weeks. Were they infectious? Should recommendations be changed for how long infected people should be isolated? It turns out it is an issue of testing. . . .

After the storm, there are often lingering effects 

Name a body part or system and Covid-19 has left its fingerprints there. . . . There are growing worries that these and other health effects will be long-lasting. . . .

‘Long-haulers’ don’t feel like they’ve recovered

We know they’re out there, but we don’t know how many, why their symptoms persist, and what happens next. . . . 

Vaccine development can be accelerated. A lot

An extraordinary amount of progress toward Covid-19 vaccines has been made, in record time. . . . 

People without symptoms can spread the virus

Whatever group you’re talking about, there are some key implications for the pandemic, and trying to rein it in. . . .

Mutations to the virus haven’t been consequential 

Coronaviruses in general do not mutate very quickly compared to other viral families. This is a good thing . . .  .

Viruses on surfaces probably aren’t the major transmission route

The general consensus now is that “fomites” — germs on surfaces — aren’t the major transmission route for Covid-19. . . .But it’s clear from lots of studies that surfaces around infected people can be contaminated with viruses and the viruses can linger. . . . 

What we don’t know

People seem to be protected from reinfection, but for how long? 

The thinking is that a case of Covid-19, like other infections, will confer some immunity against reinfection for some amount of time. But researchers won’t know exactly how long that protection lasts until people start getting Covid-19 again. So far, despite some anecdotal reports, scientists have not confirmed any repeat Covid-19 cases. . . .

What happens if or when people start having subsequent infections? 

Given that most respiratory viruses are not “one-and-done” infections — they don’t induce life-long immunity in the way a virus like measles does — there is a reasonable chance that people could have more than one infection with Covid-19. . . .

How much virus does it take to get infected? 

Whether you become infected or not when you encounter a pathogen isn’t just a question of whether you’re susceptible or immune. It depends on how much of the virus (or bacterium) you encounter. . . .

How many people have been infected?

There have been 21 million confirmed cases of Covid-19 around the world, and 5.3 million in the United States. Far more people than that have actually had the virus. . . .

It’s not clear why some people get really sick, and some don’t 

The sheer range of outcomes for people who get Covid-19 — from a truly asymptomatic case, to mild symptoms, to moderate disease leading to months-long complications, to death — has befuddled infectious disease researchers. . . .

One Way To Return To Work and School

Three professors think there is a good way for people to start going back to work and school. Their suggestion is partly based on how long people who get the virus usually become contagious, which is three days on average.

First, the population would be divided into two groups — like our cars were divided into two groups by odd and even license plates when OPEC made trouble in the 1970s and it was very hard to buy gas.

Grouping could be done using the first letter of everyone’s last name, such as A to L and M to Z. Doing the groups that way would give the members of a family the same schedule (of course, there would have to be flexibility to handle special cases).

Each group would then go to work or school on a schedule of four days on, ten days off. Group A to L would start work on a Monday, work four days, then take off ten days. Group M to Z would go to work or school the following Monday, work four days and then take off.

The result would be that people would be at work or school 40% of the time: four days instead of the usual ten every two-weeks (of course, there would have to be flexibility again, one reason being that somebody has to mind the store or the police station on Fridays and weekends).

Working or being educated would still be possible during our ten days “off” at home. The totally unemployed would be working part-time. The point is that we’d be taking a step toward a more normal existence for most people.

When I read the professors’ article, I wondered why they chose a four-day schedule if people are usually contagious after three days. Aside from how four days fits nicely into the fourteen days of two weeks, they believe that getting sick would be unlikely even if people were in close contact and someone became contagious at the beginning of the four days. They did some math:

Models we created at the Weizmann Institute in Israel predict that this two-week cycle can reduce the virus’s reproduction number — the average number of people infected by each infected person — below one. So a 10-4 cycle could suppress the epidemic while allowing sustainable economic activity.

More from the article:

Even if someone is infected, and without symptoms, he or she would be in contact with people outside their household for only four days every two weeks, not 10 days, as with a normal schedule. This strategy packs another punch: It reduces the density of people at work and school, thus curtailing the transmission of the virus.

The cyclic strategy is easy to explain and to enforce. It is equitable in terms of who gets to go back to work. It applies at any scale: a school, a firm, a town, a state. A region that uses the cyclic strategy is protected: Infections coming from the outside cannot spread widely if the reproduction number is less than one. It is also compatible with all other countermeasures being developed.

Workers can, and should still, use masks and distancing while at work. This proposal is not predicated, however, on large-scale testing, which is not yet available everywhere in the United States and may never be available in large parts of the world. It can be started as soon as a steady decline of cases indicates that lockdown has been effective.

The cyclic strategy should be part of a comprehensive exit strategy, including self-quarantine by those with symptoms, contact tracing and isolation, and protection of risk groups. The cyclic strategy can be tested in limited regions for specific trial periods, even a month. If infections rates grow, it can be adjusted to fewer work days. Conversely, if things are going well, additional work days can be added. In certain scenarios, only four or five lockdown days in each two-week cycle could still prevent resurgence.

The coronavirus epidemic is a formidable foe, but it is not unbeatable. By scheduling our activities intelligently, in a way that accounts for the virus’s intrinsic dynamics, we can defeat it more rapidly, and accelerate a full return to work, school and other activities.

The Plan Is To Have No Plan

From Jay Rosen, a journalism professor at New York University:

This is my read on what the government’s guidance and actions amount to…. My purpose in posting it is to challenge the American press to be a lot clearer in its descriptions.

The plan is to have no plan, to let daily deaths between one and three thousand become a normal thing, and then to create massive confusion about who is responsible— by telling the governors they’re in charge without doing what only the federal government can do, by fighting with the press when it shows up to be briefed, by fixing blame for the virus on China or some other foreign element, and by “flooding the zone with shit,” Steve Bannon’s phrase for overwhelming the system with disinformation, distraction, and denial, which boosts what economists call “search costs” for reliable intelligence.

Stated another way, the plan is to default on public problem solving, and then prevent the public from understanding the consequences of that default. To succeed this will require one of the biggest propaganda and freedom of information fights in U.S. history, the execution of which will, I think, consume the president’s re-election campaign. So much has already been made public that the standard script for a White House cover up (worse than the crime…) won’t apply. Instead, everything will ride on the manufacture of confusion. The press won’t be able to “expose” the plot because it will all happen in stark daylight. The facts will be known, and simultaneously they will be inconceivable.

“The plan is to have no plan” is not a strategy, really. Nor would I call it a policy. It has a kind of logic to it, but this is different from saying it has a design— or a designer. Meaning: I do not want to be too conspiratorial about this. To wing it without a plan is merely the best this government can do, given who heads the table. The manufacture of confusion is just the ruins of Trump’s personality meeting the powers of the presidency. There is no genius there, only a damaged human being playing havoc with our lives. 

A Terrible List of “Hot Spots”

The New York Times has a long list of the worst virus outbreaks in the U.S. The list includes facilities with 50 or more cases.

Among facilities with more than 150 cases, jails and meatpacking plants predominate (presumably, the virus can survive longer where there’s meat). The U.S.S. Theodore Roosevelt and a few long-term care facilities, such as psychiatric hospitals, also have large numbers of cases.

Most long-term care facilities are relatively small and appear further down on the Times list. However:

Across the country, a pattern has played out with tragic consistency: Someone gets sick in a nursing home. Soon, several residents and employees have the coronavirus. The New York Times has identified more than 6,400 nursing homes and other long-term care facilities across the United States with coronavirus cases. More than 100,000 residents and staff members at those facilities have contracted the virus, and more than 17,000 have died. That means more than a quarter of the deaths in the pandemic have been linked to long-term care facilities.

It’s hard to imagine the suffering that’s going on behind closed doors (including the doors of houses and apartments).

Marion Correctional Institution — Marion, Ohio 2268
Pickaway Correctional Institution — Scioto Township, Ohio 1655
Smithfield Foods pork processing facility — Sioux Falls, S.D. 1095
Trousdale Turner Correctional Center — Hartsville, Tenn. 1037
U.S.S. Theodore Roosevelt — Guam 969
Cook County jail — Chicago, Ill. 940
Cummins Unit prison — Grady, Ark. 911
Lakeland Correctional Facility — Coldwater, Mich. 821
Bledsoe County Correctional Complex — Pikeville, Tenn. 585
Harris County jail — Houston, Texas 488
Neuse Correctional Institution — Goldsboro, N.C. 480
JBS USA meatpacking plant — Green Bay, Wis. 348
G. Robert Cotton Correctional Facility — Jackson, Mich. 347
Lansing Correctional Facility — Lansing, Kan. 336
Triumph Foods meat processing facility — St. Joseph, Mo. 295
Butner Prison Complex — Butner, N.C. 266
Sterling Correctional Facility — Sterling, Colo. 260
Paramus Veterans Memorial Home — Paramus, N.J. 256
Trenton Psychiatric Hospital — Trenton, N.J. 247
JBS USA meatpacking plant — Greeley, Colo. 245
Parnall Correctional Facility — Jackson, Mich. 243
American Foods Group meat processing facility — Green Bay, Wis. 241
JBS USA meatpacking plant — Grand Island, Neb. 230
Louisiana Correctional Institute for Women — St. Gabriel, La. 216
Shelby County jail — Memphis, Tenn. 205
Westville Correctional Facility — Westville, Ind. 200
Stateville Correctional Center — Crest Hill, Ill. 196
Hackensack Meridian Health Nursing and Rehab Care Center — Hackensack, N.J. 190
Franklin Medical Center prison hospital — Columbus, Ohio 185
Christian Health Care Center — Wyckoff, N.J. 183
The Harborage nursing home — North Bergen, N.J. 181
Tyson Foods meatpacking plant — Waterloo, Iowa 180
Andover Subacute and Rehabilitation Center II — Andover, N.J. 176
Redwood Springs nursing home — Visalia, Calif. 174
Central Detention Facility — Washington, D.C. 172
Lincoln Park Care Center — Lincoln Park, N.J. 168
PruittHealth Palmyra nursing home — Albany, Ga. 167
Tyson Foods meatpacking plant — Columbus Junction, Iowa 166
Soldiers’ Home — Holyoke, Mass. 163
Gallatin Center for Rehabilitation and Healing — Gallatin, Tenn. 162
JBS Beef Plant — Cactus, Texas 159
Dillwyn Correctional Center — Dillwyn, Va. 158
Northern State Prison — Newark, N.J. 158
California Institution for Men — Chino, Calif. 154
Perdue Farms meat processing facility — Cromwell, Ky. 154
Brookdale Paramus assisted living facility — Paramus, N.J. 153
George Beto Unit prison — Tennessee Colony, Texas 153
JBS USA pork production facility — Worthington, Minn. 151

A president who was reluctant to force the production of protective gear was willing to force meatpacking plants to stay open. Why? On one side are giant corporations who want to continue business as usual and millions of voters who would be affected by a shortage. On the other is a low-paid workforce mostly made up of people — immigrants, Latinos and African Americans — who don’t matter to the president at all. Q.E.D.