COVID19, Lag Ba-Omer edition: active cases graphs around (mostly) Europe; more sophisticated model predicts much smaller herd immunity thresholds; Swedish healthcare problems; N-acetylcysteine

Today is the minor Jewish holiday of Lag ba-Omer (33rd day of the omer count), which marks the end of a plague raging in the Holy Land (in the 2nd Century CE) that swept away the disciples of Rabbi Akiva.

(1) Speaking of modern plagues ending, where do we stand in various countries vis-a-vis active cases? Let me show you some graphs (screenshotted from worldometers) below. (Definition, for the avoidance of doubt: active cases = total – cured – deceased.)

below half of peak

one-quarter of peak

1/8 of peak

also about 1/8 of peak

Italy seems to be getting out of the woods now

with fits and starts, but overall trending down

Turning to Scandinavia: Denmark at about half of peak

Recoveries/cured data lack for Norway, but new cases are guttering out. In good shape.

Finland seems to report recoveries on certain days of the week, hence a sawtooth pattern

Sweden is quite another matter (see below)

France has had near-constant active cases for almost a month

Belgium seems to have reached a plateau

Down Under, Australia is doing great, as is New Zealand. But will be watching their numbers as the weather turns cooler there, for evidence of seasonality

The UK is not out of the woods yet. The US is just too big to look upon as a single country — and I cannot easily find recovery data at the individual states’ level. Suffice to say NYC and suburban counties in NJ and CT are skewing the results to such an extent that they mask recoveries in other states.

One remark about the European and Israel graphs with lots of recoveries, however. While these countries all went on lockdown, essentially all of them have “opened up” to greater (Austria) or lesser (Germany) extent — and the “second wave” that people kept talking about has yet to materialize.

(2) Today an interesting preprint crossed my virtual desk.
http://arxiv.org/abs/2005.04704 The authors, from Brown U, Georgia Tech, and the Technical U. of Denmark, look (mostly with paper and pencil math) at models for the spread of an epidemic absent any social distancing, and why these models almost invariably highball estimates of final spread.
TL;DR: they show that if the remaining population’s susceptibility to an infection is not assumed to be “all or nothing” but to span a range, then the first-order behavior of the simple model changes to second-order, and you end up with way lower final states. As a sanity test, they ran the 2009 H1N1 flu (where no social distancing measures were taken) and with their 2nd order model got final numbers of infected way closer to actual serological data than the traditional 1st order model (see figure below).

Related (h/t: masgramondou): https://judithcurry.com/2020/05/10/why-herd-immunity-to-covid-19-is-reached-much-earlier-than-thought/ which points to https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v1

Both papers indicate, among other things, that the infection rate required to reach herd immunity is much lower than the simple first-order model indicates — and the figures would be lower still with some limited social distancing in effect. (Even Sweden imposed some.)

(3) Concerning Sweden, Die Welt (in German) looks at what it calls the Swedish Sonderweg (“special road [taken or followed]”). Notably, it does not attribute the much higher mortality (compared to fellow Scandinavian countries) just to its not entering a lockdown (some voluntary social distancing measures are in place) — but to the “limping” Swedish healthcare system (marodes Gesundheitssystem).
They are at pains to point out that this is not a matter of money — Sweden has the 2nd highest pro capita spending in the EU, after Germany — but of inefficiency, administrative bloat, and wastage. Once upon a time, Sweden had 49.5 ICU beds per 100,000 inhabitants, which today would be the highest in the world, above even the USA. Today? Just 5.8.
Even before the COVID19 crisis, 12% of elective surgery patients has to wait 4 months or more, compared to 2% in France and none at all in Germany. One-fifth of Swedes have to wait more than 2 months for a specialist appointment, compared to only 3% in Germany.
Much like Israel’s public system, rapid access for life-threatening emergencies in Sweden is maintained at the expense of ever greater delays for everything else. [But much unlike Israel, Sweden entered the present crisis without the benefit of a young population and a warm, sunny winter and spring climate…] Doctors in the public system are salaried employees of the state, with all that entails in terms of (lack of) incentives…

(4) Finally, as a “lagniappe” 🙂 a video by Roger Seheult MD about the over-the-counter mucolytic N-acetylcysteine, and how it could be surprisingly useful for COVID19 patients as an antioxidant and even anticoagulant. I will comment on this more tomorrow — gotta run now! Let me add, however, that this one is definitely in the “even if it doesn’t help, it won’t harm” category, as N-acetylcysteine has no meaningful toxicity.

A couple of papers cited by Dr. Seheult:

https://erj.ersjournals.com/content/10/7/1535.short

Attenuation of influenza-like symptomatology and improvement of cell-mediated immunity with long-term N-acetylcysteine treatment; S De Flora, C Grassi, L Carati; European Respiratory Journal 1997 10: 1535-1541; DOI:

https://doi.org/10.1016/j.bcp.2009.08.025

N-acetyl-l-cysteine (NAC) inhibits virus replication and expression of pro-inflammatory molecules in A549 cells infected with highly pathogenic H5N1 influenza A virus

https://www.ahajournals.org/doi/abs/10.1161/circulationaha.117.027290

Potent Thrombolytic Effect of N-Acetylcysteine on Arterial Thrombi

See also https://en.wikipedia.org/wiki/Von_Willebrand_factor