Europe isn’t out of the woods yet

The Washington Post published this morning an opinion piece by Dr. Devi Sridahr, a professor and chair of global public health at the University of Edinburgh, entitled “We Will Pay for Our Summer Vacations With Winter Lockdowns”. The teaser line is “This was Europe’s chance to beat back coronavirus before winter comes. We’re wasting it.” The article begins:

This spring, when Western Europe became an epicenter of the coronavirus pandemic, countries imposed strict lockdowns: In France, a person needed a permit to go shopping; Spain required children to stay indoors the entire day; in Scotland and Wales, people could go outside for a walk only once a day and had to stay within a five-mile radius. Thanks to this, European countries were able to not only flatten the Covid-19 curve but to also keep levels of infection very low.

But as the weeks went by, the pressure to reopen society grew. People wanted their prepandemic lives back. They wanted dynamic economies to protect their jobs; they wanted their children educated in schools; they wanted nights out at the pub and visits to their friends. And they really wanted summer vacations.

Most European countries reopened when the virus had reached a level they considered acceptable (in the UK, that was 1,000 new symptomatic cases per day). However, that reopening coincided with the tradition of the summer holiday, which – especially since the advent of low-cost air travel – usually means going to a country with beaches, like Spain or Greece. And of course, the destination countries were all too happy to accommodate the tourists.

But now new cases are starting to rise again, although they’re still at fairly low levels compared to…say…us (where Florida alone has lately often had more daily new cases than all of Europe). Besides the huge amount of tourist travel, a lot of the increases are due to “barhopping, clubbing and partying among younger people”, as has been the case in the US recently. Dr. Sridahr points out that new cases could easily jump up again, especially as fall and winter come on – when people stay indoors and kids go back to school (yes, in most of these countries, virus levels are low enough that schools can be reopened safely).

The article continues:

The only way to stop constant increases in the coronavirus is to eliminate community transmission and to use robust test, trace and isolate policies to continue catching imported cases and clusters as they emerge. New Zealand, Taiwan, Cuba and Rwanda have each pursued this kind of maximum suppression through strict border measures and have largely returned to normal public life.

Stopping community transmission requires mandatory, enforced quarantine for incoming travelers and testing before release. Europe could do the same and cooperate across countries toward this goal so that intra-European travel and tourism can continue when a safe bubble can be built.

…..

European countries need to introduce serious limitations on nonessential travel until safe travel bubbles can be built among countries where the virus is low. The virus moves when people move. This does not mean borders need to be closed. But people need to be tested on arrival in a new country and then again five days later. There has to be enforced isolation until two negative tests at least five days apart.

Dr. Sridahr concludes:

Working to stop community transmission might seem like a dream, but after having bent the curve so significantly — and taken the hardest step of lockdown measures — why not crunch the curve fully? Stopping community transmission is the only path to stop the constant resurgence of the coronavirus, to reopen schools fully and safely and to avoid repeated national lockdown-and-release cycles over the next 18 months. That should be a lot more important than this summer’s vacation.

Of course, Dr. Sridahr points out the need for “robust test, trace and isolate policies” as well as travel restrictions. It seems that in Europe only Germany is doing a really good job of that now. Of course, the US is way behind on those, but the big takeaway from this article is that there have to be severe travel restrictions within the US (since the individual US states are as diverse as the countries of Europe) – much more severe than the lightly (if that) enforced quarantining rules that some states have imposed on travelers from some other states.

If we’re going to avoid widespread lockdowns this fall, we need not only to invest huge amounts in testing, tracing and isolation, but we also need to invest just as much in restricting interstate travel, including by land and air. And if we can’t do both of these things, it’s likely we’ll get a big fall wave, and we’ll have no choice but to go into something approaching a nationwide lockdown – which will of course has to include a lockdown on non-essential travel.

But this can’t be done on a state level – it has to be led nationally. Since the administration has declared victory over the coronavirus and gone on to more important things like making sure the November election doesn’t work, it follows that Congress needs to step up and take the lead on this – starting off with money. Of course, there was a lot of money for fighting the virus in the Democratic relief package, so at least that will be a good start when the bill’s passed…What, you say Congress has gone home for the rest of the summer without any bill at all? This isn’t good news…

The numbers

These numbers are updated every day, based on reported US Covid-19 deaths the day before (taken from the Worldometers.info site, where I’ve been getting my numbers all along). No other variables go into the projected numbers – they are all projections based on yesterday’s 7-day rate of increase in total Covid-19 deaths, which was 5%.

Note that the “accuracy” of the projected numbers diminishes greatly after 3-4 weeks. This is because, up until 3-4 weeks, deaths could in theory be predicted very accurately, if one knew the real number of cases. In other words, the people who are going to die in the next 3-4 weeks of Covid-19 are already sick with the disease, even though they may not know it yet. But this means that the trend in deaths should be some indicator of the level of infection 3-4 weeks previous.

However, once we get beyond 3-4 weeks, deaths become more and more dependent on policies and practices that are put in place – or removed, as is more the case nowadays - after today (as well as other factors like the widespread availability of an effective treatment, if not a real “cure”). Yet I still think there’s value in just trending out the current rate of increase in deaths, since it gives some indication of what will happen in the near term if there are no significant intervening changes.

Week ending	Deaths reported during week/month	Avg. deaths per day during week/month	Deaths as percentage of previous month’s
March 7	18	3
March 14	38	5
March 21	244	35
March 28	1,928	275
Month of March	4,058	131
April 4	6,225	889
April 11	12,126	1,732
April 18	18,434	2,633
April 25	15,251	2,179
Month of April	59,812	1,994	1,474%
May 2	13,183	1,883
May 9	12,592	1,799
May 16	10,073	1,439
May 23	8,570	1,224
May 30	6,874	982
Month of May	42,327	1,365	71%
June 6	6,544	935
June 13	5,427	775
June 20	4,457	637
June 27	6,167	881
Month of June	23,925	798	57%
July 4	4,166	595
July 11	5,087	727
July 18	5,476	782
July 25	6,971	996
Month of July	26,649	860	111%
August 1	8,069	1,153
August 8	7,153	1,022
August 15	7,690	1,099
August 22	8,049	1,150
August 29	8,423	1,203
Month of August	33,756	1,089	127%
Total March – August	190,527

Red = projected numbers

I. Total deaths

Total US deaths as of yesterday: 170,422

Deaths reported yesterday: 1,287

Yesterday’s 7-day rate of increase in total deaths: 5% (This number is used to project deaths in the table above; it was 5% two days ago. There is a 7-day cycle in the reported deaths numbers, caused by lack of reporting over the weekends from closed state offices. So this is the only reliable indicator of a trend in deaths, not the three-day percent increase I used to focus on, and certainly not the one-day percent increase, which mainly reflects where we are in the 7-day cycle).

II. Total reported cases

Total US reported cases: 5,416,014

Increase in reported cases since previous day: 55,526

Percent increase in reported cases since 7 days previous: 8%  

III. Deaths as a percentage of closed cases so far in the US:

Total Recoveries in US as of yesterday: 2,843,642

Total Deaths as of yesterday: 170,422

Deaths so far as percentage of closed cases (=deaths + recoveries): 6%

For a discussion of what this number means – and why it’s so important – see this post. Short answer: If this percentage declines, that’s good. It’s been steadily declining since a high of 41% at the end of March. But a good number would be 2%, like South Korea’s. An OK number would be 4%, like China’s.

I would love to hear any comments or questions you have on this post. Drop me an email at tom@tomalrich.com