COVID19 update, July 8, 2020: by CDC criteria about to fall below “epidemic” threshold in the USA?; Israel public health chief resigns, citing “frivolous” decision making process; Dr. Campbell on knowns and “known unknowns” of COVID19

(1) Instapundit reports that the death rate from COVID19 has fallen far enough that by CDC criteria it’s about to fall below the “epidemic” threshold. He comments:

WE CAN HOPE: Is The Pandemic Coming To An End At Last? “Well, firstly, it’s not actually us saying this. It’s the Centers for Disease Control, which reported that the death rate has fallen so far it’s now roughly equal to the threshold for even qualifying as an epidemic, which isn’t as severe as a pandemic.”

Death rates aren’t following case numbers up, at least not yet. In my area we had our first Covid deaths in two months last week, as case numbers climb — but we’ve had a total of 9 deaths in a county of over 400,000 people since the beginning of the pandemic. We’ve almost certainly lost more people to flu in the same period.

But case numbers are climbing, and death is a lagging indicator. Even so, though, if the disease is as fatal as it was in, say, March, deaths should be climbing much faster than they are. Some of that is no doubt because we don’t have the nursing home outbreaks we had back when Grandma-Killer Cuomo and other governors were sending infected patients into nursing homes, and some of it may be because Vitamin D levels are higher this time of year, and coronavirus fatalities seem closely tied to very low Vitamin D levels. Also, thanks to the marches and the general laxity that followed them, more of the infected are younger people, who typically don’t get as sick. That’s good, because it’s moving us toward herd immunity with as few fatalities as possible. But stay tuned; it’s still too early to know what’s really going on.

(2) Despite that, Israel is seeing a second wave of the same magnitude as the first, but again (tellingly) with much lower mortality than the first. Still, our country’s head of public health, Prof. Siegal Sadetski (on leave from Tel-Aviv U.’s medical school) suddenly resigned, and left a blistering public resignation letter.

In the letter sent to Health Ministry director-general Chezy Levy, she accused the government of “making frivolous and unsubstantiated decisions, without considering their widespread and long-term public health implications.” 

“Infinite time” is spent “calming the spirits” and “managing partnerships,” while the work that needs to be done in the field is relegated, Sadetsky said.

“Too much time is invested in debates, discussions, consultations and forums… while the operations and details required for the success of the various operations do not receive the proper attention,” she said, stressing that the work environment at the Health Ministry has become wrought with personal interests. 
“The [coronavirus] is a deadly, cunning and agile epidemic,” she added. “I feel with a high-level of certainty… that the coming months will be difficult and even tragic.”

[…] “Opening the education system first in a limited way and two weeks later in a sweeping way… led to widespread reinfection in Israel,” Sadetsky said. “Maintaining educational frameworks plays a major role in the ability to safeguard the economy and their importance to our children. However, in the absence of conformity to corona regulations, schools and kindergartens become fertile grounds for infection. 
“Israel opened the education system too quickly compared with most countries in the world. Without compatible conditions, education systems cannot be opened.”

“In the first phase, Israel’s achievements were reflected in the flattening of the morbidity curve, and the measures taken were inspirational and praised by other countries dealing with the plague. In contrast, the second phase was characterized by a vital but rapid and sweeping opening of the economy […] The atmosphere of illness treatment and decision-making has changed fundamentally, and the results are evident in the morbidity curve,” Sadetsky said. 
The government broke its promise of opening progressively and reviewing the impact of its decisions, continually moving forward even though the morbidity graph indicated the situation was getting worse, she said.

“The global experience in dealing with epidemics shows that actions and moves that are avoided due to the fear of difficult and painful decisions subsequently cost twice as much as making those difficult decisions,” Sadetsky wrote. “It was only last weekend that [the government] decided it was ready to return to preventative measures, which in my estimation is too little and too late.”

Another article in the Jerusalem Post (which sadly has gone downhill under its new editor) uses the term “ship without a rudder” and contrasts the clear voice with which authorities spoke during the first wave with the chaotic mess currently pertaining. 

The decision-making process is actually more complicated than the public is aware: Some decisions fall into the hands of the Health Ministry, some are the government’s and still others the Knesset’s, which means that even though the new directives were announced together, only some of them went into effect. 
“Sometimes, the directives are in the news, but they are not yet enforceable,” clarified Prof. Hagai Levine, a Hebrew University epidemiologist and chairman of the Israeli Association of Public Health Physicians.

But whether the directives are enforceable or not should not be a question for the public, he said, adding: “If the risk of attending a mass wedding is high, then regardless of the law, you should not organize such a wedding.” 
Nonetheless, Levine admitted that when it is unclear to the public that the decisions made by the government are based on science, rather than pressure by the loudest interest groups, it harms public trust and makes it harder for the people to follow them.

The current national unity government with its proliferation of redundant ministerial portfolios created explicitly for coalition reasons, led to the quip “we have more ministers than patients on respirators”.

In other Israel-related COVID news, El Al, Israel’s national airline which was privatized 15 years ago, is being renationalized. The company was struggling to begin with, but now was brought to its knees like many national airlines.

(3) I’ve been wanting to do a “Known knowns, known unknowns, and unknown unknowns about COVID-19” post for a while. This just-released video by Dr. John Campbell is a good starting point though.

For the impatient, there are some keyword-style talking points in the description of the video, which also links to two articles:

https://www.nature.com/articles/d41586-020-01315-7

https://www.nature.com/articles/d41586-020-01989-z

Watch the whole video (on high-speed if need be — I often run such videos at 1.25 or 1.50 speed) but I just want to highlight one aspect I haven’t ever discussed here. 

(a) viral load (around 11 minutes into the video). Paraphrasing: Ten viral particles or so might be enough to get to the throat, but are likely to be cleared by the mucociliary system. By the time viruses from the throat infection can make it down to the lungs, the innate immune system, the rapid-response part of the body’s immune system, has mobilized. For such people, it would end with a mild case.

In contrast, you get a hundred viral particles or so, and some may make it past the mucociliary system down to the lungs before immunity has had a chance to mobilize — setting you up for pneumonia and a severe case. 

(b) genetics (about 21 minutes into the video): 4,000 people in Northern Italy who got particularly bad seem to belong to two particular gene variants. There are precedents for this in, e.g., the bacterial disease tuberculosis and the viral disease Epstein-Barr. 

BEFORE I FORGET: This other video by Dr. Campbell, which is mainly about face coverings, also has a cute memory trick for the different kinds of immunoglobulins:

IgM for iMMediate action

IgG for aGGlutinating

IgA for sAlivA, sweAt, and teArs (or mucous membrAnes)

IgE in type 1 hypersEnsitivity