Covid 10/22: Europe in Crisis

by ZviDon't Worry About the Vase15 min read22nd Oct 202013 comments

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CoronavirusWorld Modeling
Personal Blog

America’s Covid-19 situation has clearly entered a third wave. Cases and positive test percentages across the country are rising steadily, and deaths are finally starting to follow suit over the last few days. The scaremongers greatly oversold things, but that doesn’t mean there isn’t a problem, especially in the Midwest. My biggest worry at this point is that this wave could lead to ineffectual but damaging attempts at additional lockdowns. My biggest hope is that this will let us rush the vaccines out there faster and the control systems will kick in within a few weeks, same as they did last time. 

Europe’s Covid-19 situation is much, much worse. They controlled things without going for eradication and without establishing proper long term containment strategies. Then they tried to reopen exactly the maximum while keeping containment, which failed. Now they’re paying the price. European case counts are skyrocketing and have passed 100,000 per day. Within a few days they will almost certainly pass America in deaths per day as well. Hopefully my readers over there can provide more insight and good sources to follow, and we can see if this can expand to cover Europe more over the next few weeks and months.

I’m further improving the order in which I post the numbers, and finally starting with the positive test percentages, so we start with the most meaningful non-lagging indicators.

Let’s run the numbers.

Positive Test Percentages

PercentagesNortheastMidwestSouthWest
8/20 to 8/261.86%5.78%9.93%5.88%
8/27 to 9/21.87%6.37%9.38%4.78%
9/3 to 9/91.97%6.02%8.48%4.13%
9/10 to 9/162.41%5.99%11.35%4.49%
9/17 to 9/232.20%5.96%7.13%4.11%
9/24 to 9/302.60%6.17%6.18%4.27%
10/1 to 10/72.61%6.05%6.74%4.23%
10/8 to 10/142.57%8.14%7.09%4.75%
10/15 to 10/222.95%8.70%7.85%5.36%

Test Counts

DateUSA testsPositive %NY testsPositive %Cumulative Positives
Aug 13-Aug 195,293,5366.2%548,4210.8%1.68%
Aug 20-Aug 264,785,0566.0%553,3690.7%1.77%
Aug 27-Sep 25,042,1135.5%611,7210.8%1.85%
Sep 3-Sep 94,850,2535.3%552,6240.9%1.93%
Sep 10-Sep 164,632,0055.8%559,4630.9%2.01%
Sep 17-Sep 235,719,3275.2%610,8020.9%2.10%
Sep 24-Sep 305,857,0975.1%618,3781.1%2.19%
Oct 1-Oct 76,025,6335.2%763,9351.3%2.29%
Oct 8-Oct 146,324,8335.8%850,2231.1%2.40%
Oct 15-Oct 216,434,9726.4%865,8901.2%2.53%

For the second straight week the positive rate grows by 10%, or about 0.6% in absolute terms, while the test count shows a small increase. This week, that increase was evenly distributed across all four regions.

Positive Test Counts

DateWESTMIDWESTSOUTHNORTHEAST
Aug 20-Aug 26675456654013232218707
Aug 7-Sep 2550007540112741421056
Sep 3-Sep 9472737243910640821926
Sep 10-Sep 16450507526411581223755
Sep 17-Sep 23540258538112773223342
Sep 24-Sep 30554969293210630027214
Oct 1-Oct 7567429724311017034042
Oct 8-Oct 146828412574411799538918
Oct 15-Oct 227557114985113323843325

Regionally this is a steady increase across the board with all four increasing by roughly 10%. If we break it down by state, we see bigger contrasts. 

In the West region, the coastal states seem to be doing all right, with California, Washington and Oregon all holding steady, and Hawaii still actively improving. Everyone else’s counts are up 50% or more over three weeks, many of them 100% or more. Other than Arizona, all those other states are setting all-time high case counts.

In the Midwest region, Iowa, Oklahoma and Kansas, and to some extent Missouri have this contained for now to only small increases. I’m not sure why Wikipedia puts Oklahoma in the midwest either. We see 90% or bigger three-week jumps in Ohio, Michigan, Indiana and Illinois. Others are somewhere in between.

In the South the scariest numbers are from Kentucky and Tennessee, with the deep south headed in the wrong direction but slower. Florida is up 30% over the three weeks, Texas only 14%.

In the Northeast, Vermont, Connecticut, Rhode Island and New Hampshire are up over 100%. New York, New Jersey and Pennsylvania are up over 50%. 

Things are not contained across the board, with only California and Hawaii not seeing increases. The question is where these increases lead, and what they cash out into.

Deaths

DateWESTMIDWESTSOUTHNORTHEAST
Aug 20-Aug 2615037453876375
Aug 27-Sep 212457593631334
Sep 3-Sep 911417712717329
Sep 10-Sep 1611599543199373
Sep 17-Sep 2310168932695399
Sep 24-Sep 309349902619360
Oct 1-Oct 779711032308400
Oct 8-Oct 1478212172366436
Oct 15-Oct 2180415912370523

When infections increase, deaths start going up about three weeks later. There was already clearly trouble in the Midwest, but it has accelerated quite a bit, to the extent that it seems plausible that we are starting to see the beginnings of hospital overload – there is a field hospital open, I believe in Wisconsin, already. The overall death counts did not start rising again until Monday the 19th, but since then the trend seems clear. 

We are finally starting to see increased deaths. It is late October with 10 weeks to go in the year, so getting to 400,000 deaths by year’s end still seems all but impossible, but that was always an arbitrary scare tactic number rather than an attempt to model anything real. 

Overall, it seems likely that we will continue to see roughly 10% week over week increases in case counts, which will result in similar rises in deaths, until something changes. The Midwest has it worse, and there is some risk of overwhelmed hospitals there, which would make things worse still, although it’s hard to get a good read on how much worse. 

Covid Tracking Project’s Visualization

I prefer my own graphs, but the project’s graphs certainly help tell the story. Here’s what they had through yesterday:

Tests mostly look like a linear increase over time. Daily cases have two peaks and a new third peak starting, with the second peak double the first. Hospitalizations in the first and second waves are roughly equal, partly because in the first wave they were turning people away, with the third wave starting to show. Then deaths peak in the second wave at half of the first wave, and are just slightly starting to show.

That progression tells the story of a disease becoming steadily less scary, only partly offset by improved testing and hospital capacity. Cases double, hospitalizations stable, deaths down by half. Things are definitely headed in the direction of more infections, but it’s not clear that will increase deaths by that much. 

Why a Third Wave?

What’s causing this wave? What changed? I’ve written in recent weeks about various possible factors, which I am guessing are having a combined effect. In order of my guess of their importance, the issues are: People adjusting their risk tolerance as they notice Covid-19 has become less deadly, general fatigue with social distancing and other prevention efforts, colleges and related activities (much more about colleges here than primary or secondary schools but some effect across the board), rhetoric from leadership to ignore the virus, colder weather (minimal impact from this so far in many places, but the Midwest might be different). Testing has gone up, but we’ve adjusted for that and it isn’t going up that fast. 

I see people as mostly making the reasonable and rational decision that the cost of marginal prevention is rising, while the costs of catching Covid-19 are falling, with some unreasonable signaling and tribal loyalty thrown in. It makes sense, when the disease gets less deadly, for the effective equilibrium of the control system to increase the number of cases to compensate, and it also makes sense that such adjustments are slow to course correct and therefore would overshoot. 

Combine that with small structural additional changes, and the control system keeping case counts steady has broken down, at least for now. It will probably reassert itself on its own given time, as people make individual decisions to limit their risk.

Will there be another set of lockdowns if the corrections don’t come quickly? That is the big question now. 

Why So Few Deaths?

Once again, a question that comes up every week. Now a story about how there’s even two official studies, so it’s real. Studies show! They find that 7.6% of patients hospitalized for Covid-19 die, versus 25.6% at the start of the pandemic.

A quote from the story, talking about an early Covid-19 case: “It’s not that we didn’t know what we were doing. We absolutely knew what we were doing. It was just there were unknowns there.” So we absolutely knew what we were doing, except that we didn’t know what we were doing. Which is fine! There was no way to know. Alas, our blame and credit assignment mechanisms don’t work that way, so we get quotes like the above.

Story notes that treatments have been systematized and improved, but is actually quite good pointing out that it isn’t clear this is what caused the change. The people who are infected tend to be younger and healthier. So, the story asks, which of these caused the improvement? Because that’s how the media has to frame a story, to see who deserves the credit and blame. The studies see death rates going down even when correcting for patient types, so they conclude that credit is indeed due.

There’s also this potential cause of a drop in death rates per hospitalization:

 And Mateen says that his data strongly suggest that keeping hospitals below their maximum capacity also helps to increase survival rates. When cases surge and hospitals fill up, “staff are stretched, mistakes are made, it’s no one’s fault — it’s that the system isn’t built to operate near 100%,” he says.

Or one could point out that when you don’t have room for healthier people, your death rate will be higher. At one point in the story, a doctor says that ‘many things’ caused the improvement, but he’s talking only about many improvements in what doctors do, because all credit must go to doctors.

No mention of mask wearing or other precautions decreasing viral loads, or even people coming in earlier because testing is easier and they know what to suspect and don’t think the testing site is a death trap. Or possible selection for people more susceptible to getting infected by the virus for unmeasured reasons also being more likely to die from it. Certainly no mention of possible virus mutation. 

And of course, standard warnings about long Covid and hospitals filling up and how it’s still important to do ‘everything possible’ to prevent infection. 

On the plus side, warning about 400k deaths by end of year here has become 300k deaths by February, which is a warning that could plausibly actually happen. Credit where credit is due.

My best guess order of importance on less deaths per real (not detected) infection is: Younger pool of infected, healthier pool of infected, available hospital capacity, lower viral loads, better treatments, not doing existing harmful treatments, better detection, more susceptible people getting infected first. The wild card is virus mutation, which might be no effect or might be number two or three on the list. 

What Is Happening In Europe?

Oh no.

That is a far scarier set of graphs than anything we see in America. In America, we’ve had multiple waves, but from the low point of cases in June we only peaked about 350% of that, deaths only a little more than doubled. The graph never went full hockey stick. 

Europe seems to have gone full hockey stick. Infections were contained for two months under 5,000 a day, and have quickly shot past us to over 100,000 a day. Deaths were stable under 100, and already crossed 600 despite several weeks of lag and that graph being several days older than the first one – at least one doubling from here is already baked in. These graphs are really scary. If left unchecked this would presumably collapse the European hospital systems in many countries within a few weeks.

I have not been tracking things in Europe enough to understand why this is happening there, but understanding it seems important to the puzzle. Something must have happened. I do wish I’d been watching Europe more from the beginning, but what’s done is done. 

My best theory (and please keep in mind I’m speculating here) is that the Europeans didn’t have a strong enough control system of individual action any longer, due to their trust in authority and technocracy and the message that they had ‘won’, so there were no checks once the balance tipped too far and the dam broke.

When things were improving or stable, things slowly returned closer to normal. Rather than finish the job, the Europeans declared victory and left home. Things steadily started getting better slower, then got stable, then started getting worse faster and faster, they opened their universities without proper precautions, and they thought they’d won and were in good hands so no one did anything about it that wasn’t several steps behind. Just like in March. They assumed the responsible people in charge were taking care of it, except that there aren’t responsible people in charge except by comparison to America. Just like in March. Alas, reality does not grade on such curves. 

What is very clear is that we are not “two weeks behind Europe.” Europe is likely headed into uncharted territory and moving much faster than we are. It’s going to get worse before it gets better, probably quickly. 

Of course, no one on any side in America is pointing out this is happening. One side doesn’t want to admit that Covid-19 is getting worse and is a problem. The other side doesn’t want to admit that the people they admire as the responsible adults are somehow handling things worse than we are, or that by controlling things better earlier they may have set themselves up for a disaster now.

In all seriousness, check your country and region carefully, but if you are in Europe, you need to prepare for a new lockdown. One may well be imposed upon you soon, and you may want to go into one on your own even if it isn’t imposed upon you. Stock up on essentials, take care of any business you need to before things get even worse, and mentally prepare to hunker down.

My readers in Europe, can you shed more light on things? I don’t have good sources in my regular feeds, so insight and links are appreciated, especially good Twitter sources to follow and good websites to get statistics and other information. What’s the best European site that’s similar to the Covid Tracking Project?

Remdesivir

Does remdesivir help save lives, or does it only shorten recovery periods?

Science magazine reports that remdesivir and interferon fall flat in WHO’s megastudy of COVID-19 treatments, the preprint is here. As Tyler Cowen notes, the timing of the drugs is crucial to ensuring their effectiveness, and it seems like these studies are likely administering the drugs relatively late. Gilead’s response letter throws a general ‘you can’t mix all this random stuff together’ objection based on variation in what the hospitals did to get the WHO’s study done, and links to the good-looking one in the New England Journal of Medicine, which shows big mortality improvement. 

The WHO’s study is bigger than Gilead’s, but both are plenty big enough, so there’s probably different things going on in the different studies. Those who know more about the science here that I’ve talked to mostly think that remdesivir early is a good drug but later on is not good, so my default hypothesis is that the WHO study was a mix of early and late administration. Note that that could still effectively make it a bad drug on a population level, if we’re not smart enough to use it when it is good and not when it is bad.

It seems clear that treatment of Covid-19 in general has greatly improved. This is an example of how it’s hard to know how much of that is due to any particular change. 

What we do know about Remdesivir is it seems to be better administered early, and it shortens recovery time, and it won’t make you more likely to die. Even if it doesn’t make you less likely to die, that’s still enough to use it, unless it is crowding out other things, but there likely comes some point where it’s too late, and it’s not clear where that point would be.

F.D.A, Let Astrazeneca Resume Their Vaccine Trial

We’d like to resume it, and we’ve resumed the trials in England and Brazil. With those resumptions, thousands have been immunized without adverse effects, leaving only the initial issue that seems to have been in two patients, only one with clinical relevance. Which means even if it’s much much more common than it has been in the trial, it should in no way slow down anything. 

Yet thanks to our F.D.A. (delenda est!) our trial remains halted. With America’s distrust of foreign data, who knows how long this might delay things. Those dastardly Europeans even use different file formats! Which it seems may have led to a month of delay before the data could be properly converted. Presumably because there are various regulations, so one does not simply convert such sensitive data.

A year ago, I’d have had a hard time imagining that America would cripple its entire economy rather than accept an alternative file format to explain away one or two adverse events in a several-thousand person clinical trial. Now it doesn’t even surprise me that much. I guess it does still surprise me a little.

Then, yesterday, a patient in their trial died. 

Shares of Atrazeneca were down 1%.

Did I mention that the patient was In the control group? No? Whoops. Also, whew random chance.

One easy way to know is that the study wasn’t halted. If the death had been in the treatment group, the study would have been halted. So we knew the death was in the control group from the above picture alone, without having to wait for the confirmation.

Because the only way to test thousands of people for months is if none of them have any serious health problems whatsoever, despite the obvious high improbability of none of them having serious problems of one sort or another. And certainly none of them can die, despite there being thousands of people in the study with a life expectancy less than one hundred, and well, you do the math.

Meanwhile, the Chinese continue doing widespread vaccination, and their test results reportedly look good as far as they go, but doesn’t seem like much information, and also I said we should trust England’s data but this is China so let’s not go nuts.

Also meanwhile in completely insane “medical ethics,” Pfizer says if it wins emergency use authorization for its vaccine, it will immediately vaccinate the placebo group in its trials. We wouldn’t want to risk gathering additional information, so we should prioritize those placebo patients with our limited supply of the new vaccine, it seems. 

Close Contact

CDC has finally updated its guidance on the definition of a close contact. Now 15 cumulative minutes within 24 hours counts, rather than only 15 minutes in a row. This seems like an utterly obviously correct adjustment, so it’s certainly welcome. 

Alas, this is presumably the end of The Covid Shuffle, where kids got up every 14 minutes and changed seats so they would not technically become ‘close contacts’ with each other. Which did almost nothing to prevent the virus, of course, but did give the kids some well needed breaks and maybe even a little physical exercise. It’s also such a good Bavarian Fire Drill. It’s important to take victories where one finds them.

In case it needs saying here, there is no sharp distinction between close contact and non-close contact, and there is no minimum amount of time exposure to a person to catch the virus. 

And no, Washington Post, this does not ‘make mask-wearing even more important for preventing disease.’ Our major newspapers can’t figure out the distinction between what prevents the virus and what is in written guidelines, or realize that the written guidelines don’t determine how the virus spreads. Wet ground continues to cause rain, film at 11.

In Other News

Good news, everyone! The San Francisco playgrounds are opening with only 1 adult per kid, 30–minute limit, crying kids need to be removed. After only seven months. What a glorious day.

NPR attempts to actually model parts of the physical world regarding infection. Nothing terribly useful, but still warms my heart. 

If you wanted a Breathable Bacon Mask then good news, there is one available. Seems like a poor flavor choice to lead with, as a little bacon goes a long way. Still happy to see someone trying as there has been a decided lack of mask innovation. This is something the market should be there for, as we don’t need the masks to meet any standards so I don’t think there’s an important regulatory barrier? And everyone wants to look cool and feel more comfortable, so there’s gotta be a huge market.

It turns out that when you spend a lot of time and money, both fixed costs and marginal costs, to develop lifesaving monoclonal antibody treatments, the next thing corporations typically do is charge a lot of money for them. Seems legit.

Metastudy concludes that if you have ‘mild-to-moderate’ Covid-19 (an adjective that my brain still thinks only applies to people in American ads for brand name prescription drugs telling you to talk to your doctor about them) are highly unlikely to be infectious after 10 days, which we knew already. But if you have ‘severe-to-critical’ illness, which I didn’t think existed by that name even in ads for drugs, virus may be shed for longer. Which makes sense as far as it goes, so if it’s bad then presumably you should isolate until you test negative.

We expect Tier 2 British couples not in a bubble to refrain from sex. This is totally a reasonable thing to expect, will absolutely make a real difference as long as everyone keeps calm and carries on, and we’re definitely not in a young adult dystopian novel. 

When school experiences get both unsafe and otherwise radically worse, in ways that destroy much of what is valuable about them, and still charge the same tuition, we are shocked to report that enrollment is down! 16% nationwide, and 22% in community colleges. And that’s terrible.

New York advises against non-essential travel to anywhere outside New York, including New Jersey, Connecticut and Pennsylvania. That means New Yorkers will only have to quarantine after visiting the other 40 states on their travel advisory list. Congratulations for now to California, New Hampshire, Vermont, Massachusetts, Maine and Hawaii. In a few weeks that will probably be only California and Hawaii. I wonder if they’ll change the quarantine criteria when New York itself starts meeting them about two weeks from now?

In June, Trump put two political appointees into the CDC with no officially assigned roles, it seems with the express goal of preventing the flow information out of the agency. Which isn’t really news at this point, but figured I’d include it anyway.

Trump repeatedly says that 85% of people who wear masks catch Covid-19. How many people does he think wear masks? 

Trump was not tested on debate day. 

Who Deserves the Credit, And Who Deserves the Blame? 

(Nikolai Ivanovich Lobachevsky is his name.)

We Canadians did everything right. Our spin studio followed all the rules! We masked before and after spin class. Everyone knows you can’t catch Covid-19 during a class where we’re all engaged in hard physical exertion. What you can do is catch Covid-19 during the next class from surfaces infected in the previous class, so we make sure to clean all those surfaces within 30 minutes. If we take longer than that, the pizza is free. 

We Australians did everything right. Need to maintain the travel restrictions. If we make an exception to get newborns life saving surgery, where does it stop?

Spain was not doing everything right. Their expensive living conditions and small living spaces are to blame for their pandemic! America, with much bigger living spaces than any place in Europe, strangely never gets credit for that, nor does it seem to make much difference. Nor does cost of living seem to correlate with infection severity by city, although population and density do seem to matter where policy decisions mostly didn’t. And the wave hitting Europe now isn’t even concentrated in Spain.

We Americans are not doing everything right. Our schools in New York City began doing mandatory random testing. And that’s terrible, so the CDC decried it as ‘unethical and illegal.’ They also issued additional guidance:

Classrooms and schools “may” temporarily close if there is a coronavirus outbreak, and local health officials “may” test students, teachers and staff, the CDC said, stopping short of urging those actions.

We wouldn’t want to urge such actions, that would be going too far, but I guess we won’t actively stop you from stopping gatherings and doing tests when and where there is a Covid-19 outbreak. Thanks, CDC!

Flight Mask

Looks like it is safe to fly if masks are worn by all, based on this study out of Hong Kong. The numbers involved seem rather definitive. The method seems like a great natural experiment. Everyone is tested on arrival, then quarantined and tested again, so most infections should be caught, and the odds of that seems like they have a very small upper bound. 

That is great news for obvious direct reasons. If one needs to fly, it seems reasonable to get on a plane if the rules are enforced. 

But the really valuable thing is to take this information and see what other lessons we can draw from it. Masks being sufficient to drive the risk on an airplane down to very low levels seems like a key puzzle piece. 

The obvious key question is how airflow works on a commercial flight. Whatever they are doing, it seems to be working. Then we can ask the classic question of flight safety, and see about the pandemic equivalent of making the whole plane out of the same material they put into the black box.

Boeing provides this guide, Airbus is similar:

Cabin air filtration

If the airflow is coming from the ceiling, where it’s gone through heavy filtration, then flows under you and back to the filters, then it makes sense that the risks would be much lower than you would naively expect. You’re effectively outdoors or kind of a super-outdoors. Combine that with silence and mask wearing, and you’ve got a place that’s potentially mostly safe even for several hours. 

All Boeing airplanes have systems already in place to help maintain a healthy cabin environment. These systems filter the air you breathe and minimize the spread of airborne contaminants.

The volume of cabin air is exchanged every two to three minutes
HEPA filters similar to those used in hospitals capture more than 99.9% of viruses and bacteria
Cabin air flows primarily from ceiling to floor in a circular pattern and leaves through the floor grilles near the same seat row where it enters

It also makes sense that planes would be much safer than they look, because they are! Everyone’s instinct is that flying in the air in a metal box is one of the crazier, scarier and riskier things one can do, whereas (in terms of accidents) actually you’re in far more total danger driving to the airport than you are on the flight, even on an absolute basis rather than per mile. Everything about planes is safer than it has any right to be, because we demand that planes be our safe place and are willing to pay insane amounts to make that happen and also actually make sure we get what we paid for. 

There is always the risk of security theater (see the TSA) rather than actual security, but that’s because actually being safe in that case wasn’t enough, we needed to both actually be safe and then Sacrifice to the Gods on top of that to make people willing to fly. 

So on reflection, if you told me that the time in the airport was ten times riskier than the flight itself in terms of infection, because they don’t have as good a handle on air flow, I’d pretty much believe you. 

This is yet another path to victory. If we were to actually seriously model air flow, we could allow for people to be indoors together in relative safety, which would end this. 

As far as I know, air flow in buildings isn’t regulated, so it’s something one could do research and innovation to improve without worrying about it being illegal. Time to get to work, everyone.

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https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&country=ROU~AUT~BEL~HRV~CYP~CZE~DNK~EST~FIN~FRA~DEU~GRC~HUN~IRL~ITA~LVA~LTU~MKD~MDA~NLD~NOR~POL~PRT~RUS~SRB~SVK~SVN~ESP~SWE~CHE~GBR~MCO~TUR®ion=World&casesMetric=true&interval=smoothed&perCapita=true&smoothing=7&pickerMetric=location&pickerSort=asc is the best site for COVID European COVID graphs as far as I know. The UK has excellent breakdowns(including by age group): https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19roundup/2020-03-26

What really matters is people's actual behaviour, as you pointed out. In the US people are cautious because they don't trust their government to have it under control. In the Nordic countries and Germany people are cautious because they treat government advice more seriously than us Eastern Europeans treat actual legislation. The lack of a federal fiscal response also hurt. The poor states in the East can't afford generous furlough schemes(not that the furlough scheme seems to have helped the UK, France and Spain that much); France, Spain and Italy are dealing with significant debt burdens. Various pushes were made to get people back out and working and off furglough during late summer early autumn. It worked(another finger curls on the monkeys paw)!

The European story is complicated and regional, similar to the US. You got Germany, the Nordics and the Baltics doing very well in terms of case counts and (as far as I know) without insane restrictions. Then you have Eastern bloc places doing increasingly poorly, but still ok for now. Then you have the Czechs(positive rate >25%!, adding the same number of cases per day as Italy(10 million Czechs vs 60 million Italians)) in 2-weeks-til-zombie-apocalypse mode. Then you have whatever is happening in France and Spain.

Czech Republic issues, at least, seem to come from the governing party downplaying the virus a lot before their October elections. They promised they wouldn't reinstate a lockdown no matter what. 2 weeks later they're in lockdown. They're numbers went nuts right around when the campaign was picking up too. People maybe actually believed their politicians' promises that things would be OK if they relaxed. Rookie mistake, czechs, rookie mistake.

Belgium has been in political anarchy for years, the government has very little authority over the population and is indecisive and weak to boot(for an overview https://www.politico.eu/article/how-belgium-failed-its-second-corona-test/). They flip flopped on restrictions, people weren't given clear instructions from government or non-governmental experts. Netherlands aren't as governmentally incompetent but their country literally overlaps Belgium and their government wasn't super restrictive either. In fairness to both countries, they are the political(Brussels) and trade(Rotterdam and Antwerp) centers of Europe. They had travel bans in place, but there still would have been a huge amount of commercial traffic that was exempt.

Also on September 23rd Belgium eased Coronavirus restrictions(https://www.garda.com/crisis24/news-alerts/382596/belgium-authorities-ease-covid-19-restrictions-september-23-update-23), literally the next day their exponential spike begins(https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&country=~BEL®ion=World&casesMetric=true&interval=smoothed&smoothing=7&pickerMetric=location&pickerSort=asc). The easing seems to have had a gigantic impact on people's behaviour: https://ourworldindata.org/grapher/changes-visitors-covid?tab=chart&stackMode=absolute&time=earliest..latest&country=~BEL®ion=World Before the easing park and outdoors visits were 70% over baseline. 1(!) week later they were 10% over baseline. To be fair I'm not 100% sure that I understand the mobility numbers, so maybe it's just a weird data quirk, tho the drop in park time and the jump in cases overlap almost perfectly.

Greece is doing great but Cyprus is doing bad. A bit of a mystery as to why. Cyprus was maybe more aggressive in courting tourists? They famously had a COVID insurance scheme. Looking at mobility data, the Greeks just seem to have gone outside and never gone back inside :D probably a good idea, maybe hard to replicate for those of us not living in Elysium, sadly https://ourworldindata.org/grapher/changes-visitors-covid?tab=chart&stackMode=absolute&time=earliest..latest&country=~GRC®ion=World

Other places in Eastern Europe are still quite poor and can't cushion shutdowns with generous leave, so the population kinda had to be let back to work, bars and restaurants and tourism had to be opened up. I'm not sure how big the conspiracy aspect is. In Romania(where I'm from) my parents' group of friends(all in their late 50s early 60s) are averagely open to conspiratorial stuff(I think almost all adults that grew up under communism are like that) and they take the virus very seriously. But again, they're all still working, not really doing WFH, but they are masking, isolating from vulnerable relatives and each other. 

Once again, thank you for these incredibly informative posts.

"My readers in Europe, can you shed more light on things?"

  1. The sentiment of the population changed drastically in the last months. While initially there was a lot of fear, concern, seriousness, and responsibility, it got replaced by fatigue, sloppyness, conspiracy theories, and hopeful thinking. Put simply, the "Covid isn't that bad, just a little worse than the flu maybe. Also masks don't really work! Muh freedom!"-faction increased in numbers.
  2. The strategic management and policy response from governments changed drastically: While initially it was "better safe than sorry" it became "doing the absolute minimum that is required, and keep the measures as soft as somehow possible". The numbers in summer sank to an all time low, and policy makers where resting on them, while not taking precaution and prevention measures for autumn. Schools opened (almost) normally in many countries, work continued normally, people started to gather more and the regulation on events and gatherings got loosened up a lot too. There have been no regional quarantines, making covid spread across borders easily too. Even as cases jumped rapidly, measure adjustements were very mild. If you want to check one of these "curious examples" check out Czechia or Austria in particular. In Austria work and school still operates at full level, no teleworking regulation.

    As an Austrian citizen, I'm absolutely not surprised at current developments and am deeply dissapointed on the horrible progression for both citizens, as well as policy makers.

 

Also, the graph you posted from twitter is to be taken with a lot of caution:

  1. No relative numbers (cases per X citizens)
  2. No adjustment for amount of tests. To account for that, one could work with "% of tests positive", but even that metric is tainted as it doesn't adjust for different "testing strategies". For example, one country might not even test close-contacts of a positive case, and just put them in quarantine, and the other does. It will result in different "% of test positive" numbers.

Yep, I agree with all of this.

The start of coronavirus caught the conspiracy theorists unprepared. "We are not doomed!" is not a good viral message. But they had enough time to design better messages meanwhile.

(Ironically, handling coronavirus in spring too well backfired. I read on Facebook regularly: "so the goverment is trying to convince us that we are in the middle of a pandemic and millions of people have died, but I personally do not know anyone who died or even got seriously sick, and I bet neither do you; how statistically likely is that?")

People are tired. For example, in spring, I used to disinfect everything I brought home from the shop. In summer I stopped doing that. Then in autumn I noticed that I am still not doing that, despite the danger being 10× greater than in spring. (After reflection, I renewed the habit. But it took me some time to notice.) Similarly, having kids stay at home seemed like a simple and reasonable thing in spring. But now it is half year without having a quiet morning at home. For people who have kids in elementary-school age it must be even worse -- you have to babysit them, and technically handle their online lessons, all while working full-time from home -- so I understand the pressure on government to keep the schools open. Essentially, in spring people wanted the government to protect their lives, but in autumn people want a break. It is insane, but it makes sense psychologically.

During summer it seems like things were okay for a while, so people took vacations abroad like crazy. That probably contributed a lot to making things worse.

In Slovakia, in spring there was a popular demand for wearing face masks and lockdowns. People had face masks before it was mandatory, and cities were closing schools before the government required it. Which is how we got the fewest deaths per capita in the entire EU. Now we get each day as many new cases as during the entire April; and more people died in last 7 days than between the start of pandemic and mid-September. Despite knowing more, the current measures simply don't make sense -- it is mandatory to wear face masks outside, but the schools remain open! [EDIT: Most schools will close the next week.] The government latest idea is to provide free testing for the entire population... using some cheap tests that only have a 30% chance of detecting a coronavirus infection. (So the predictable result, if they really manage to deliver the tests to everyone, is to have 10000 sick people stay home in quarantine, and 20000 sick people being certified by government that they are healthy... I wonder how their behavior will change in the following days.)

Using the economist language of "revealed preferences", people are simply so tired of the coronavirus measures that they choose to die (with certain low probability). Too bad for those who disagree!

EDIT: Ok, we will have a lockdown, starting this weekend. This escalated quickly! First 4 grades of elementary schools still remain open (and the school attendance mandatory), though. Probably this makes sense to someone; definitely not me.

Out of curiosity I had to look at the FT chart with relative numbers (= seven-day rolling average of new cases (per million), by number of days since 0.1 average daily cases (per million) first recorded):

Linear scale:

https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areas=eur&areas=deu&areas=ita&areas=esp&areasRegional=usny&areasRegional=usca&areasRegional=usfl&areasRegional=ustx&byDate=0&cumulative=0&logScale=0&perMillion=1&values=cases 

Log scale:

https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areas=eur&areas=deu&areas=ita&areas=esp&areasRegional=usny&areasRegional=usca&areasRegional=usfl&areasRegional=ustx&byDate=0&cumulative=0&logScale=1&perMillion=1&values=cases 

It looks like the next weeks will show where the situation will go. The curve for some countries looks quite bumpy on the log scale. 

More than the psychological factors which you talked about (i.e. that people are weary or governments have declared triumph over the virus - which is false concerning France for instance), I think that the main reason is the seasonality of the disease (which is a well-known phenomenon observed for other diseases, as far as I know). 

 

I think one can see it observing Sweden's case: the number of infections (and deaths) had slowly diminished starting from may (not as fast as in other European countries after the lockdown) and the deaths have been rare (1 or 2 per day) until now. But now as everywhere else infections are increasing.

 

Furthermore, it is not really credible that most European nations have had coincidentally a resurgence in cases at the same time. As far as I know, it is often quite complicated right now to move from a country to another at least in my case (France), so I don't think this can be explained by spreaders from a country to another (and there were still clusters at that time (early September), so why would transnational spreaders be necessary to sparks infection anew ?).

We got a couple of air filters for the smoke from the fires in California, but even with the window and screen door open, a box fan, the oven hood fan, and a ceiling fan all running on high and the air filter on, our smoke alarm has still been going off while cooking dinner. That makes me pessimistic about making residential airflow good enough without an amount of effort that would be disruptive to actually doing things indoors, because of physical space taken up and noise generated by fans.

Also most indoor activities are going to be much less appealing if you don't talk during them, and talking over fans through masks is potentially going to raise risk. Hard to tell what the optimal tradeoff here will be.

For European covid data aggregation/visualization I don't know of anything better than Our World In Data's interactive graphs.  For Germany specifically Robert Koch Institute publishes quite a detailed report every day (with an English translation, even).

It's hard to talk about Europe generally because the tactics and outcomes are so different among the member states.  For example Germany committed to mandatory mask use indoors pretty early (IIRC in April), whereas in August the Netherlands still had no mask mandate, but each store did have an employee approach you at the entrance, unmasked, to remind you to disinfect your hands.  There's also a lot of variation in test volume/strategy.

As a follow up to my previous comment, here's a really amazing Twitter thread breaking down the situation in France: https://twitter.com/jeuasommenulle/status/1320682084973858816 (threadreader version: https://threadreaderapp.com/thread/1320682084973858816.html)

The poster also tries to estimate R0 using hospital data(which should be more reliable than case data, since the Spring wave was so undertested). He finds a R0 of 1.2, which means a doubling every 20 days. 

He estimates ICU usage levels will be as high as the spring peak in France within 25 days, if the trends stay correlated with the spring outbreak.

Lots more nice graphs in the thread too.

I saw that earlier. What I didn't understand was how we could predict when the peak would be, unless he's assuming France has now taken countermeasures and things will turn around.

I think he just meant the curves would match, ie. referring to the peak from the previous wave: https://twitter.com/jeuasommenulle/status/1320682552257089538 

Oh actually, I think he just means they'd get back to that peak level in 25 days, not that it would get better after that. I misunderstood what he was saying. I'll correct my post above.

Btw, those cream-colored charts are from https://ig.ft.com/coronavirus-chart/ . It's a very good tool.

My personal recommendation for any Europeans that can travel to Spain is Gran Canaria (there are safe coridors to head to it, including the somewhat safe option via Valenica if you don't want to bother with 2x border corssings).

The case count is extremely low (as % of population), laws regrading masks are strongly enforced (as far as I hear) and, best of all, the sunny summer~ish wheather is potentially helpful. Not necessarily in lowering infection rates (extremely debtable) but in not sucmbing to a repsiraotry infection so easily (and the first and most critical phase of covid-19, as far as I know, can still be modeled like a serious respiratory infection with a few *s).

Obviously there's the cost benefit analysis of whehter or not a flight is actually worth the risk, I think for many people here it might not be. I.e. if you can stand a few more months of heavy quarantine then it's probably safer to just get evertyhing delivered and stay put. But in order to continue "life back to normal" mode with minimal risks of infection and serious side effects it seems like the best option.