RAMBLINGS FROM WHAT I READ ABOUT CORONAVIRUS – 12th April 2020
by Dr Mario Saliba, Consultant Baromedicine Physician
- Nobel Prize winner (for chemistry) Michael Levitt1 predictive model is a good tool to see what lies ahead with Coronavirus. In it you look at the percentage increase (from day to day) in new Coronavirus cases. Once this percentage starts getting smaller, the disease is decelerating even if the total number of Corona cases is still jumping up. In other words, as he puts it, it’s like jumping into the car and accelerating its speed. Acceleration is a bad omen for Coronavirus problems. However, once the car goes on cruise control on the highway, its acceleration has stopped. If it starts slowing down, it’s in the deceleration phase; it’s coming to an end even though it is still adding miles to its meter. I searched for the data for the US and the best source is this Wikipedia page2 which is updated daily. Scroll down 2/3rds of the page and you will see a huge table on the right hand side by the title “COVID-19 Cases in the United States.” The middle column is entitled “# of cases”. This shows not just the number of new cases daily but, most important, the percentage increase from day-to-day within brackets. This bracketed number is the best predictor of what is going to happen next. Very interesting is what happened over the last fifteen days where the percentage increase from 14% + went down to 4.4%+ acceleration. As the acceleration decreases, the country (in this case USA) is on the way to recovery unless, of course, it picks up steam again. This decrease in acceleration has been persistently declining and this is a very good sign.
- In the States and a lot of other countries, only sick people are being tested and a significant number of them die as we see in Italy and Spain. However what if we test everyone, sick or not, through a random sample? This is what they did in Iceland and they found that 1% of the population has Coronavirus even if half of them were asymptomatic. Official statistics, on the other hand, show that as of today, Iceland has had 1,711 cases of Coronavirus, 8 of whom died. Now, forget the aforementioned number of official cases and take the sample statistic, 1%, and extrapolate it to the entire population of Iceland which is 364,260 people. The sample, when extrapolated, would suggest that 3,643 have Coronavirus and not just 1,170. That is, the number of Coronavirus infected people in the country is about 2.3 times what the official statistics show. Eight of them have died. Eight out of 3,643 is not as alarming, so far. In Malta, officially we have had 378 cases so far, of whom 3 died. Multiply the official number by 2.3, in the spirit of the Iceland sample, and we get 869 cases of Coronavirus of whom 3 have died. That is 0.35%.
- The best simulation of what happens in a country without social distancing is what transpired on the Princess Cruise ship where 712 of 3,711 people on board were infected. Ten of them died. Given that cruise ships are full of “newly weds and nearly deads,” ten is a pretty low number. It gives us hope that things may not be as bad. Incidentally, I count myself with the “nearly deads”; age did me in.
- The age distribution of those who die from Coronavirus follows the same age distribution of those who die and have not contracted Coronavirus. This was not the case with the Spanish flu where a lot of young people died just as a lot of old ones did.3 What Coronavirus is doing is that it is a compressing a normal death calendar over one year into a mere 3 or 4 months. In other words, roughly about 2/3rds of those who die from Coronavirus would have died anyhow within about one year from other health issues.
- According to one statistician, the probability of dying from Coronavirus is best computed through this formula: “Chances of dying (if there was no Coronavirus) within the next 2 months” multiplied by 2. If you’re very young, your chances would have been practically 0% which if multiplied by 2 would remain just as low. Statistics show that if you are below 50 the chance of dying from Covid-19 is 1 in 500. 96% of those who die from Coronavirus are 60 years or older. In Italy, as far as I am aware, nobody has died under age 30, and only 0.9% were under age 50.4
- Predictions? Ha! Three weeks ago I was thinking that in Malta we’ll be dancing in the streets in five weeks. The problem with Maltese statistics is that the Maltese sample is so small that a difference between a daily reading of 1 new case and 8 new cases shows a huge difference in the acceleration table. However, it’s a fact, for any country, that daily numbers by themselves contain a lot of noise. It’s the trend which matters. Numbers are going to increase as expected. The problem is not the numbers as such but in what state of health the people affected are going to be. Many will be affected but most of them will get over it with patience and courage. Hope that those needing critical care will get it, not as in other countries where the hospitals were overwhelmed and things went out of control.
We are heading for a peak as all other countries across the globe are. The way we reach this “peak” and the time-frame which really matters. The contingency plan and strategy adopted so far and rightly so has been and I assume will continue to be is to arrive at this peak as slowly as possible. The natural progression of the disease can only be controlled but not stopped.
- What about the “peak”? When they talk about “peak,” they are taking into account that increasingly more and more people will recover from Coronavirus and less and less people will contract it. Thus “total recovered” will increasingly exceed “total deaths”. As for “total cases,” this will keep increasing, day after day, until a cure or vaccine is found. So there will never be a peak in total cases. It’s the acceleration to the top that can slow down but it will continue to go up and up until a magic bullet (vaccine?) is found.
Secondly the “peak” is directly dependent on social isolation. The lower the incidence of new cases, the more societies will start to relax social isolation. But the moment they do so, the higher the incidence of new cases. With no vaccine or cure, there is no way out of this. They seem to have given up on the warm summer weather offering a great relief on the spread of the virus.
Certain international studies5are predicting the “peak” for different countries and if we look at what they are saying about Malta is that we will reach it by 22nd April and according to this study will have between 19 and 120 deaths. So, these two weeks are going to be crucial. I have my doubts about this prediction. First of all, with such a range (19 to 120) that’s not just a normal margin of error… but an ocean of error. Secondly I ask, after this “peak” what is going to happen? Are we going back to normal in another 3 or 4 weeks? Are we doing to have a second wave? We don’t have a vaccine yet.
We don’t want a peak. It’s the acceleration to the assumed “peak” that we need to slow down as new cases will continue to appear until a vaccine is made. So, this will take longer than they are predicting not just a few more weeks. What happens after? A second wave is always a possibility. I wholeheartedly support the strategy of our health authorities who are trying to control the spread and make it happen slowly. This is because with only one hospital on each island this is the only way we can cope. Remember people are still getting sick with other illnesses. These illnesses will not simply disappear because of Covid-19. These patients need to be looked after as well.
8. Molecular roulettes.
I am not impressed by pharmacology companies saying that they think they have the perfect vaccine in the works. It’s mostly bluff to lure big investors. Research and development in the pharmaceutical industry is frighteningly expensive, requiring mega-millions of dollars. Forty years ago, the Financial Times had described it as playing the molecular roulette since the chances of hitting the winning number (or cure) is very slim. Needless to say, if the inventors hit the winning number they’ll become billionaires overnight.
Fighting against staggering odds, the pharma companies have to hype what they are working on to procure further funding from the big investors but many times the research fizzles out, the investors end up empty handed, and the disease goes on unabated. Last week a head of research at Oxford University6 told the mass media that her team is working seven days a week and that she is 80% sure that by September the team will have the winning vaccine. For me this is just a promotion exercise to acquire more funds from investors.
There are about 120 companies worldwide currently working for a cure or vaccine. The news from Hong Kong is that the Chinese government is rethinking its strategy and is now cutting down its funding for a cure. The odds are stacked mightily against anyone chasing a cure right now. First, it’s not called molecular roulette for nothing. Second, imagine you own an R&D company; would you be willing to invest precious millions when you know that you’re racing against 119 other competitors on the track field? If yes, where will you get the millions and the additional millions during the ongoing process? So you go out touting your research as promising a major breakthrough to make potential investors salivate.
If I may generalize, the Chinese never invent anything. They just buy corporations in the West – German corporations make a lovely example – that have access to patents, take the patents to China and addio the manufacturing staff at the corporation in Germany. Or else they steal trade secrets which is why artificial intelligence is a worthwhile investment for them since it’s a conduit of all the world’s secrets.