COVID19 update, US Memorial Day edition: meat-packing plants as hotspots around the world; Japan lifts state of emergency; Philippines in longest lockdown anywhere; Robert A. Heinlein for Memorial Day

(1) A reader drew my attention to a COVID19 outbreak in Nobles County, Minnesota — again linked to a meatpacking plant (JBS, in this case). According to a May 12 report from MPR (Minnesota Public Radio), https://www.mprnews.org/story/2020/05/12/latest-on-covid19-in-mn

In southwestern Minnesota’s Nobles County, where an outbreak hit Worthington’s massive JBS pork plant, about 1 in 17 people have tested positive for COVID-19. In mid-April, there were just a handful of cases. On Tuesday, there were 1,291 confirmed cases. The numbers were still increasing, although at a slower rate than in previous weeks. [Ed.: My source adds: now 1,414 positive cases out of a county population of 21,378, about 6.6% or one in fifteen. So far, there have only been 2 deaths.]

The JBS plant shut on April 20 but has partially reopened with expanded hygiene and health monitoring measures.

Similar problems have been reported in Stearns County, where COVID-19 cases tied to two packing plants — Pilgrim’s Pride poultry plant in Cold Spring and Jennie-O Turkey in Melrose — have skyrocketed. An undisclosed number of workers at both plants have tested positive for the virus.

There were about 55 confirmed cases in Stearns County two weeks ago. By Tuesday, confirmed cases had jumped to 1,512.

The Grauniad has more on US meat-packing plants. 

But this is not just a US thing. We noted several outbreaks at meat packing plants in Germany — earlier we offered a translation of an interview with an anonymous Polish worker in one such plant. In brief: work in very close quarters (2ft/60 cm. between stations) in enclosed, air-conditioned spaces; the line laborers are mostly guest workers (there from Poland, Romania,…) who sleep two to a room or even four to a room in “accommodation” arranged via the subcontractor; … 

And Australia had an outbreak near Melbourne (hat tip: Wannita F.)

 

(2) Japan is apparently lifting its state of emergency even in Tokyo, 

In contrast, the Philippines has been under possibly the longest lockdown anywhere, longer even than Wuhan reports DIE WELT. which also quotes President/strongman Duterte as saying quarantine violators should be shot.Here is a drier report in English in US News and World Report has some detail in English. : it is clear that, in a country where many people already eke out a precarious existence at the best of times, their loss of their meager income quickly brings on actual hunger. 

(3) I thought of a suitable quote for US Memorial Day. Then I figured I could add nothing to the words of Robert A. Heinlein in The Pragmatics Of Patriotism — his 1973 Forrestal Lecture at the US Naval Academy, Annapolis (of which he himself was an alumnus — he started writing after being invalided out of the US Navy). The full text is available online here. I cannot help being moved everytime I read it, especially the peroration:

The time has come for me to stop. I said that ‘Patriotism’ is a way of saying ‘Women and children first.’ And that no one can force a man to feel this way. Instead he must embrace it freely. I want to tell about one such man. He wore no uniform and no one knows his name, or where he came from; all we know is what he did.

In my home town sixty years ago when I was a child, my mother and father used to take me and my brothers and sisters out to Swope Park on Sunday afternoons. It was a wonderful place for kids, with picnic grounds and lakes and a zoo. But a railroad line cut straight through it.

One Sunday afternoon a young married couple were crossing these tracks. She apparently did not watch her step, for she managed to catch her foot in the frog of a switch to a siding and could not pull it free. Her husband stopped to help her. But try as they might they could not get her foot loose. While they were working at it, a tramp showed up, walking the ties. He joined the husband in trying to pull the young woman’s foot loose. No luck.

Out of sight around the curve a train whistled. Perhaps there would have been time to run and flag it down, perhaps not. In any case both men went right ahead trying to pull her free… and the train hit them. The wife was killed, the husband was mortally injured and died later, the tramp was killed – and testimony showed that neither man made the slightest effort to save himself. The husband’s behavior was heroic… but what we expect of a husband toward his wife: his right, and his proud privilege, to die for his woman. But what of this nameless stranger? Up to the very last second he could have jumped clear. He did not. He was still trying to save this woman he had never seen before in his life, right up to the very instant the train killed him. And that’s all we’ll ever know about him.

THIS is how a man dies. This is how a man lives!

‘They shall not grow old as we that are left grow old;
age shall not wither them nor the years condemn;
At the going down of the sun and in the morning, we shall remember them”

– Tomb of the Scottish Unknown Soldier, Edinburgh

COVID19 update, May 10, 2020: more on COVID19 outbreaks at German meat processing plants; BND drops bombshell about China and WHO; miscellaneous updates

(1) COVID19 outbreaks at meat processing plants are not just a US phenomenon anymore. Apropos the report yesterday of large outbreaks at two such plants at opposite ends of Germany (here and here, both articles in German): it was pointed out that many at these plants are foreign workers living in very tight quarters. But in addition, a friend who is a Ph.D. biologist as well as a volunteer EMT responded: “Meat packing is one of those physical jobs (so high respiration rate) which happens in close quarters, in a cool and air[-conditioned] environment. Most other airconditioned environments are probably not so close together and/or do not involve the level of physical labor. The other possible idea is that meat surfaces and the aerosols generated cutting with band-saws might be a good place for the virus to survive and thrive.”

(2) RedState, quoting German weekly Der Spiegel, has a bombshell: The BND (Bundesnachrichtendienst or Federal Intelligence Serivce, Germany’s equivalent of the CIA — in a report that is otherwise critical of Trump— says the following (my translation from the original German):

“Nevertheless, to the BND’s knowledge, China urged the World Health Organization (WHO) at the highest level to delay a global warning after the outbreak of the virus. On 21st January China’s Head of State Xi Jinping, during a telephone conversation with WHO leader Tedros Adhanom Ghebreyesus, asked the WHO to withhold information on human-to-human transmission and to delay a pandemic warning. According to the BND, China’s information policy has resulted in the loss of four to six weeks worldwide to fight the virus.” [*]

Confirmation of what was obvious to many of us.

(3) Miscellaneous updates:

{*] original wording: “Nach Erkenntnissen des BND drängte China die Weltgesundheitsorganisation WHO allerdings nach dem Ausbruch des Virus auf höchster Ebene dazu, eine weltweite Warnung zu verzögern. Am 21. Januar habe Chinas Staatschef Xi Jinping bei einem Telefonat mit WHO-Chef Tedros Adhanom Ghebreyesus gebeten, Informationen über eine Mensch-zu-Mensch-Übertragung zurückzuhalten und eine Pandemiewarnung zu verschleppen. [new paragraph] Nach Einschätzung des BND sind durch die Informationspolitik Chinas weltweit vier bis sechs Wochen für die Bekämpfung des Virus verloren gegangen.”

UPDATE: via masgramondou, a second analysis of Neil Ferguson’s COVID19 model code that is even “better” (ahem) than the first. I’ve encountered enough modeler hubris in my day job that I believe I recognize it when I see it.

COVID19 update, May 7, 2020: risk of severe case presentation increases with age too; meat processing plants; fraying lockdowns; Georgia (the country)

Busy day at work, so just some quick updates:

(1) There is a commonly quoted rule of thumb that 80-85% of COVID19 cases are mild, and the rest severe and life-threatening. But how constant is that ratio really?

I was emailed a copy of a report (in Hebrew) by a group that was consulted for our national COVID19 planning. In the section on expected hospital load was a table with a breakdown of hospital and ICU admissions by age bracket, apparently taken from a CDC Morbidity and Mortality Weekly Report, http://dx.doi.org/10.15585/mmwr.mm6912e2. Screenshotting the table here:

* Lower bound of range = number of persons hospitalized, admitted to ICU, or who died among total in age group; upper bound of range = number of persons hospitalized, admitted to ICU, or who died among total in age group with known hospitalization status, ICU admission status, or death.

Needless to say, these are data early in the epidemic (when the group had to make its recommendations). But if we use ICU admissions as a proxy for the number of severe cases, then we see a clear increase with age, the way it is seen for mortality.

(2) Elsewhere on the CDC site, one finds a report about the conditions and challenges at meat processing plants https://dx.doi.org/10.15585/mmwr.mm6918e3
Some quotes:

During April 9–27, aggregate data on COVID-19 cases among 115 meat or poultry processing facilities in 19 states were reported to CDC. Among these facilities, COVID-19 was diagnosed in 4,913 (approximately 3%) workers, and 20 COVID-19–related deaths were reported. Facility barriers to effective prevention and control of COVID-19 included difficulty distancing workers at least 6 feet (2 meters) from one another (2) and in implementing COVID-19-specific disinfection guidelines.* Among workers, socioeconomic challenges might contribute to working while feeling ill, particularly if there are management practices such as bonuses that incentivize attendance. 

 Facility challenges included structural and operational practices that made it difficult to maintain a 6-foot (2-meter) distance while working, especially on production lines, and in nonproduction settings during breaks and while entering and exiting facilities. The pace and physical demands of processing work made adherence to face covering recommendations difficult, with some workers observed covering only their mouths and frequently readjusting their face coverings while working. Some sites were also observed to have difficulty adhering to the heightened cleaning and disinfection guidance recommended for all worksites to reduce SARS-CoV-2 transmission.

Solutions to structural and operational challenges that some facilities adopted included adjusting start and stop times of shifts and breaks to increase physical distance between workers. Outdoor break areas were added at some facilities to decrease contact between workers. Some facilities installed physical (e.g., plexiglass) barriers between workers; however, this was not practical for all worker functions. Symptom and temperature screening of workers was newly instituted in some facilities and improved in others.

Sociocultural and economic challenges to COVID-19 prevention in meat and poultry processing facilities (Table 2) include accommodating the needs of workers from diverse backgrounds who speak different primary languages; one facility reported a workforce with 40 primary languages. This necessitates innovative approaches to educating and training employees and supervisors on safety and health information. In addition, some employees were incentivized to work while ill as a result of medical leave and disability policies and attendance bonuses that could encourage working while experiencing symptoms. Finally, many workers live in crowded, multigenerational settings and sometimes share transportation to and from work, contributing to increased risk for transmission of COVID-19 outside the facility itself. Changing transportation to and from the facilities to increase the number of vehicles and reduce the number of passengers per vehicle helped maintain physical distancing in some facilities.

(3) Lockdowns — useful as they undeniably are in densely populated urban regions — are not something that can be maintained forever. In the “hammer and dance” strategy of Tomas Pueyo, the “hammer” — the lockdown to break the epidemic’s back — is supposed to be hard and short, followed by a maintenance phase — the “dance” — that favors such social distance measures as yield the maximum reduction for minimal economic cost. (Face masks are one example.)
There are increasing signs that lockdowns in the US are fraying. Bethany Mandel, who lives in New York, speaks for many who express a sense that politicians of a certain stripe now keep “moving the goalposts” way beyond the original justification for lockdowns, and that they are completely oblivious to the staggering and still mounting economic costs for those who do not have guaranteed government paychecks. “We are tired of being treated like children,” one reads numerous times in the comments.[*]

Days ago, a hairdresser in Texas who had reopened her business made a tearful plea that she not be punished for wanting to feed her children. She was convicted to seven days in prison and a $7K fine. Now in a dramatic turn of events, not only have both the state Attorney-General and the Governor criticized the “excessive” punishment (the lockdown over hardressing salons ends Friday anyhow), but the state’s Lt.-Gov. donated the money from his own pocket and offered to serve the 7-day sentence himself as a proxy for the woman.

(4) DIE WELT looks at what it calls the “Coronavirus Model Pupil,” Georgia (the country, not the US state). The country, knowing it could ill afford such a calamity, locked down proactively rather than reactively, and is now exiting. (Possibly the most prescient thing it did was cut air links to China before they even saw their first case.) Now, despite a social culture much like Italy, it got a sum total of 610 cases, with just 9 (nine) dead.

(5) Finally, hard-hit Belgium is reopening after a few false starts. Summarizing the report from De Standaard (in Dutch):

  • starting May 10, every household can receive and host four designated people (a fixed list of four). Recommended to sit outdoors. No travel distance limitation
  • May 11, shops will open. One customer per 10m^2 (110 sq.ft.) floor area. Wearing a mask is recommended but not mandatory; generally recommended in situations where 1.5m (5ft) distance cannot be maintained (e.g. on public transit). If lines develop, elderly, handicapped, and care workers get priority
  • public transit in principle reserved for people who have no private means of transportation (cars, motorcycles). In practice, this will not be enforced
  • restaurants, cafés, cultural centers remain closed for now
  • public sports events are put off until July 31

[*] Without engaging in partisan political rhetoric: one reason the lockdown in Israel was largely successful, and saw a compliance well above what one might expect of our garrulous nation, was that we were treated like adults. Economic trade-offs were honestly discussed, including the limits to how long we could lock down before irreparable damage to our economy would ensue — and we were given a realistic time horizon from the start. At no point was there a sense of “bait and switch”.

UPDATE: via the Jerusalem Post, this interesting paper in the Journal of Medical Virology has an interesting theory about why the SARS-nCoV-2 coronavirus may elicit potentially fatal “cytokine storm” so much more often than seasonal influenzaviruses: https://doi.org/10.1002/jmv.25866

We have applied mathematical modeling to investigate the infections of the ongoing COVID‐19 pandemic caused by SARS‐CoV‐2 virus. We first validated our model using the well‐studied influenza viruses and then compared the pathogenesis processes between the two viruses. The interaction between host innate and adaptive immune responses was found to be a potential cause for the higher severity and mortality in COVID‐19 patients. Specifically the timing mismatch between the two immune responses has a major impact on the disease progression. The adaptive immune response of the COVID‐19 patients are more likely to come before the peak of viral load, while the opposite is true for influenza patients. This difference in timing causes delayed depletion of vulnerable epithelial cells in the lungs in COVID‐19 patients while enhancing the viral clearance in influenza patients. Stronger adaptive immunity in COVID‐19 patients can potentially lead to longer recovery time and more severe secondary complications. Based on our analysis, delaying the onset of adaptive immune responses during early phase of infections may be a potential treatment option for high risk COVID‐19 patients. Suppressing the adaptive immune response temporarily and avoiding its interference with the innate immune response may allow the innate immunity to more efficiently clear the virus.