COVID19 update, July 17, 2020: second waves in Japan and Israel with lower mortality

“Masgramondou” drew my attention to the Japan COVID19 tracker site: https://covid19japan.com

There is apparently a second wave going on there. Reportedly, it is driven mostly by super-spreader events at theaters. Unlike in the 1st wave, it seems an active track-and-trace effort on the South Korean and Taiwanese model is being implemented.

Now from where do we start counting the 2nd wave? A somewhat arbitrary method is to look for the minimum in the active cases on worldometers (around June 24), and count from there.
In the time frame June 24–July 16, total confirmed cases went from 18,024 to 22,890, an increase of 4,866. In the same interval, cumulative deaths went from 963 to… 985, an increase of just 22. That implies an apparent case fatality rate (CFR) ≥0.49%. (Equal or greater, since deaths typically lag infections by up to 3 weeks.) Still, that figure is nothing like what was seen in the first wave: 963 dead in 18024 works out to 5.3%.

Reasons? DId the virus get weaker? Did the weakest already either die off or survive the infection? Is testing and tracking so much better this time around, so many more asymptomatic and mild cases enter the denominator and drag down the CFR? Or do doctors have more successful strategies to treat the disease? My money is on “all of the above”.

Now to Israel, where I live. Here the minimum in active cases, according to worldometers, falls around May 28, when we had 284 dead and a total of 16,872 confirmed infections. Our total confirmed infections have meanwhile risen by nearly twice that number — 29,187. Yet our total dead over the same period have gone up by “just” 100. Still 100 too many, to be sure, and caveat about deaths lagging cases, but… at ≥0.34%, that’s about one-fifth the apparent CFR of 1.68% in the first wave!!

Israel has a very detailed data dashboard (Hebrew only) that even displays occupancy rates of COVID wards in hospitals, as well as a breakdown by light, moderate, and severe case counts, or even the number of patients on respirators. At present, we have 120 moderate and 213 severe cases: note that these figures are just 0.41% and 0.73%, respectively, of all confirmed diagnoses!
Aside from the possible causes pointed out above for Japan, Israel has a “young” population (median age 31 according to the CIA World Factbook, compared to 48 for Japan). But even so, the age distribution of patients according to the dashboard shows an overrepresentation in the age groups 10-19 and especially 20-29.

There were no mass demonstrations here, but the economy opened pretty rapidly as soon as the first wave seemed behind us, and young people were clearly just tired of being cooped up. So they went out and partied: the trouble here isn’t so much hanging out together on the beach (open-air activities are probably fairly safe) but going to crowded clubs and bars, and especially the lack of prudent physical distance.

Our authorities look upon masks as the be-all and end-all — but methinks refraining from hugging, kissing, etc. between casual friends would be a good deal more effective. (That aside, the concept of personal space is almost foreign to Israelis. This surely does not help in such a crowded country.) As a colleague put it: “would be good if Israelis would become a bit more English for the duration”.

Our news media cry out every day about “new records” in new cases (1,871 yesterday, or more than twice the peak of the first wave), while everybody overlooks that daily recoveries are likewise increasing (reaching 381 yesterday and on an upward trajectory).

The health authorities, however, anxiously see occupancy of COVID19 wards climb (at least the seasonal flu and pneumonia waves are not taking up beds right now) and reach full capacity at Tel HaShomer (“Sheiba”), Shaaei Tzedek, and Assaf HaRofeh (“Shamir”) hospitals, and indeed exceed rated capacity at Hadassah Ein Kerem. For this reason, there is a push for a a brief but hard second lockdown on their part; pretty much nobody else is keen on one, as our economy was so hard-hit by the first lockdown. Netanyahu’s coalition partners, particularly Alternate Prime Minister Benny Gantz, are particularly adamant aboyt this

So the government came up with a “Belgian compromise” (i.e., one that makes everybody unhappy) where restaurants have to switch to delivery and takeaway, gatherings of more than 10 people indoors or 20 people outdoors are banned, and restaurants and malls are closed over the “long Sabbath” (Friday 5pm until Sunday 5am), but the weekday economy continues to operate. Also, the mask mandate is now being enforced, unlike (generally) in the past.
Various accusations fly each and every way, connected to political infighting and turf wars. Also, I suspect that a number of decision makers have reached the conclusion the first lockdowns around the world were an overreaction, and may now be (consciously or unconsciously) leaning toward a laissez-faire approach. The end result is, however, that the coherence of our coronafighting effort in the first wave seems to be lacking this time around. We may end up with a form of “unintentional herd immunity strategy” on the Swedish model, with efforts focused mostly on protecting the most vulnerable and improving treatment of severe cases. With luck, we might enter the winter with much of the population either immune from past infection, or having pre-existing partial or complete immunity.

One of the more creative ideas I heard bandied around was to try and mitigate until before the High Holidays, and then carry out a full lockdown over Rosh HaShanah and Yom Kippur, during a period when our economy basically shuts down anyway.

Gloomy compared to the euphoria of mid-May, when other countries looked to Israel’s first-wave success? Not all gloom: the sharp reduction in mortality (which echoes other countries, like the UK and Italy) is definitely the silver lining.

Meanwhile, Mrs. Arbel sent me this (isolated, to be sure) report of a medical professional being reinfected after getting ill and apparently recovery.

Have a great and healthy weekend, and shabbat shalom

UPDATE: University of Akron cutting 20% of faculty, including tenured faculty, citing COVID-19. Interestingly, Inside Higher Ed reports:

Regarding COVID-19 in particular, many institutions are considering faculty cuts. But Akron is a particular flash point because it is cutting so deep, and because of intense and very public faculty opposition to its plan. That opposition includes the faculty union’s contention that the administration is privileging athletics over academics, to the detriment of students.

“For years, the university has disinvested in academics while simultaneously losing millions on its athletics programs,” Akron’s chapter of the American Association of University Professors wrote in a position paper about proposed cuts earlier this month. “In the spirit of shared sacrifice, we believe that it’s time to move to a responsible and sustainable model of funding for athletics.”

While the vast majority of university revenue comes from academics in the form of student tuition and fees, the union wrote, its athletic programs are another story. According to the AAUP chapter’s accounting, Akron has been losing an average of $21.5 million per year on athletic programs for the last 10 years, topping $215 million in lost revenue during that time. Among other options, the AAUP advocates leaving Division I of the National Collegiate Athletic Association.

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