Corona Daily 161: A Bright Orange Label 139

Christians, Muslims and Jews generally bury their dead, Hindus and Buddhists cremate them. A rumour says the resurrection of Jesus Christ provoked burials, with every Christian hoping to emulate the feat of Jesus. A more likely explanation is a practical one. When space for the living is limited, they can’t keep sharing it with coffins and tombstones. In China, since 2016, “vertical” burials are encouraged to save space. No Resting In Peace, I don’t think. Indian churches usually shift the bones to a pit after 2-3 years to make space. An Indian court has recommended building multi-story graveyards. In the pandemic, since March 2020, Sri Lanka forced Muslims and Christians to cremate. WHO has clarified burials of virus positive bodies don’t really pose a risk. After domestic outrage and international criticism, Sri Lanka amended the law last week to allow burials.

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In the USA, many families are dispersed. Some have attended funerals on zoom, memorial services have been delayed or cancelled. In 2020, more than 3.2 million Americans died, an all-time record. Unusually, more than half were cremated. (In 1960, only 4% were cremated).  

USPS, the official federal service is the only post allowed to send the “cremated remains”. The box carries a bright orange sticker, with Label 139 printed on it. Label 139 increases visibility during processing and transportation. A sealable plastic bag, bubble wrap and cardboard box is the special kit for human ashes. Sent by priority express mail, it requires a signature before the box is handed over. It would be too cruel to come back home, and find cremated remains in the post-box.

Though it is ‘priority express’ mail, Americans are facing inordinate delays. The USPS website warns about delays because of the sheer volume. One Charlotte man lost his mother in September. This was followed by lockdowns and winter storms. Then he lost his mother again, when the post misplaced the box. He finally received it a week ago. In some cases, people have received wrong boxes. Apparently, after cremation due to its high temperature burning, DNA testing can’t tell whose ashes are in the box. At an additional cost, one can ask for a witness cremation, where the tag and the loved one are identified before going to the cremation chamber.

Stan Reese, 56, has started a new business called “Eternal Alaska”. He personally collects ashes, and hand carries them to scenic places. On a video call, he scatters them for the relatives to see.

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Finances play a role. Casket and a cemetery plot are prohibitively expensive for many. Cost of dying keeps going up as well. An average funeral in the USA costs $9000. After housing and car, death care services are said to be the third costliest expense in life (or afterlife). Funeral poverty is a term increasingly used in pandemic times. The US government has set aside $2 billion to help with funeral costs. It promises to reimburse up to $7000.

Cremation, on the other hand, is simple and inexpensive. Unlike a buried body, ashes are portable (can be sent by post), divisible, and easily scattered.

American people who were married a few times, often request to divide their ashes and give equal share to each spouse. (When the spouses die, in ash form, they can be united with each of them). Parents’ ashes are usually divided when given to children.

Many cities have created scattering gardens. In particular, ashes are scattered in the garden which was the favorite of the departed soul. Boat owners ferry families three miles off shore (requirement of the environment protection agency) in case they wish to immerse ashes in a river or sea. In view of the shift to cremations, cemeteries are now planning to build more columbarium, structures with individual niches for a person’s ashes. Designers are developing new urns made of classic Carrara marble boxes or other custom-made designs.

With the post office delivering cremated remains (called cremains), the cremation stigma doesn’t exist any more. The shape of the post-pandemic world for the living is hard to predict. For the dead, though, it looks like cremation would become the first choice.

Ravi 

Corona Daily 162: Your Car is not Safe

Last month, Michael Kevane, an economics professor living in San Jose, California, parked his 2005 Prius out on the driveway. Next morning, when his son went to start it up, it sounded like a drilling machine. All the neighbours in the block could hear it. Two days later, the professor’s sister Jean, who lives in Los Angeles, had an identical experience with her 2003 Honda Accord LX. This can’t be a coincidence, thought Michael Kevane.

In another American state, Minneapolis, Andrew Reichenbach’s repair shop has had three Mitsubishis come in with their exhaust pipes sawed off. In recent months, dozens of cars were landing at the repair shop with the same limb missing. Mitsubishis seem to be the new target, said Reichenbach. He called it a pandemic within a pandemic.

This international crime wave is reported in the USA, Europe, UK, India and other places. The cars’ catalytic converters are being stolen.

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Catalytic converter is the exhaust emission control device.  It reduces toxic gasses and pollutants. America, Europe, Asia and China keep on raising emission standards.

This device is located under your car. A professional thief can unscrew the device in minutes, and take it away. But most thieves in pandemic times are not professionals. They come with a pipe-cutter or a saw and while cutting the converter also cause much damage to other car components, such as the alternator, wiring or fuel lines.

What is so attractive about Catalytic converters right now?

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They have a mix of precious metals such as platinum, palladium and rhodium. Except those with PhDs in chemistry, few would have heard of Rhodium (Rh).

Rhodium (meaning rose in Greek) is a silvery-white material, mainly used in the automobile industry. It is the best-known metal to remove the most toxic pollutants from the vehicle exhaust. As regulations on emissions become stricter, the demand for rhodium grows.

Rhodium’s price in August 2016 was $625 an ounce. Today, it has skyrocketed to $29,000 per ounce. (Making it 17 times more expensive than Gold, which is $1700 an ounce). Since the start of the pandemic, it is steadily climbing, making our cars (or rather one of their components) more expensive. And accordingly, prone to be stolen.

Why is the Rhodium price rising, and will it come down?

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South Africa is the key producer of Rhodium. If their mines were to produce more Rhodium, the prices can come down. But they won’t. Because Rhodium is not produced by itself, it is a byproduct. Each unit of ore mined typically contains 60% platinum, 30% palladium and 8% rhodium. Unless platinum is mined, rhodium can’t be produced. And currently platinum and palladium suffer from excessive supply. Rhodium shortages are estimated to be over 150,000 ounces, and expected to grow until a substitute is found or vehicles switch over to electric. The price is expected to keep rising till 2025. The risk to our cars as well.

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Since 2020, many thieves have become unemployed, and some unemployed have become thieves. Pockets are more difficult to pick in lockdown times. Cars are stationary, and some thefts are not noticed for weeks. Law enforcement is slack. A few minutes’ work under the car can fetch you over $500. The thief sells the anonymous converter in the black market, the scrapyard sells it to recyclers who extract the metals. Older cars tend to contain more of the precious metals than newer ones. Hybrid cars (using a combination of petrol/diesel and electric) contain more precious metals. Honda Jazz, Toyota Prius, Toyota Auris, Lexus RX and Mitsubishi are some of the reported popular models.

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Because no other party is involved, like in an accident, insurance generally doesn’t cover this theft. The car owner loses about $2000. It is important to park your car in secured places, and get effective alarms. If you see someone suspiciously under any vehicle, call the police.

Though they are not PhDs in chemistry or MBAs in finance, thieves worldwide have learnt to keep an eye on the price of Rhodium.

Ravi 

Corona Daily 163: The Pope in Iraq

Pope Francis arrived in Iraq today for a three-day visit.

The coronavirus cases in Iraq have surged from eight hundred a day in January to five thousand a day now. Vatican’s ambassador in Iraq, Mitja Leskovar, has tested positive, and won’t be allowed to see the Pope. On Wednesday, there were rocket attacks, including one near Erbil airport, where the Pope will arrive on Sunday. The US embassy in Iraq issued a warning today to American citizens: “Attacks may occur with little or no warning, impacting airports, tourist locations, transportation hubs, markets/shopping malls, and local government facilities.” Not known whether the warning had anything to do with the papal visit.

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In July 2019, Iraq’s president Barham Salih had invited Pope Francis. Then the pandemic happened, and the Pope went into a year-long isolation. The invitation must have been open-ended.

In 2000, Pope John Paul II sought to make a pilgrimage to Iraq. But negotiations with Saddam Hussein’s government failed. John Paul wept, according to Pope Francis. Benedict XVI was invited in 2008, but having no suicidal tendencies, he didn’t visit in the middle of a war.

Pope Francis said he didn’t want to disappoint the Iraqi people. He was perhaps emboldened by the two Pfizer shots he received. His entourage is vaccinated as well. Iraq hasn’t yet got any vaccines.

Today, he became the first Pope to visit Iraq. More than 1000 Christians and 2000 Muslims received him at the airport. Baghdad roads were cleaned and full of roses. Curfew was in place anyway for coronavirus. Large posters of the slain commander Qassim Soleimani and Iraqi militia leader Abu Mahdi al-Muhandid have been temporarily replaced by the smiling photos of Pope Francis. Pope Francis left the airport in a bullet-proof black BMW. During his trip, he will tour Iraq in cars, helicopters and flights.

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Christianity’s roots in Iraq date back to the first decades of the faith. The tombs of biblical figures such as Jonah and Joshua are believed to be here. On Saturday, the Pope will attend an inter-religious meeting at the Plain or Ur, the home of Abraham, the patriarch of Judaism, Christianity and Islam. (My short story Baqri-Id was based on the Abraham story told in Bible as well as Koran).

Until 2003, Iraq had nearly 1.2 million Christians. Saddam Hussein offered them protection; he even had a Christian deputy PM.  Between 2014 and 2017, the Islamic State tried to eliminate Christianity from Iraq. The Jihadists gave the Christians three options. Leave, convert to Islam or get killed. So many fled that the latest estimate is around 250,000 Christians.

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Earlier on Saturday, Pope Francis will fly to Najaf, the holiest city, for a meeting with Grand Ayatollah Ali al-Sistani. Pope Francis is 84, whereas the Grand Ayatollah is 90. This is a mild Ayatollah, proposed for a Nobel peace prize a few times, without getting it. In Iraq, they don’t have the celibacy nonsense. Ayatollah is married and has two sons. He and the Pope will meet by themselves (one assumes with interpreters) for peace talks.

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In June 1999, I stood for a few hours on the central street of Warsaw to see John Paul II. I was only a few feet away from him when his bullet-proof glass chariot rode past. What astounded me that day was the level of security. Snipers were placed on rooftops. The Pope is one of the highest security risks in the world.

Though Vatican has said social distancing, masks and curfew will be observed, it is unlikely to happen. Today, more than 10,000 security forces are deployed on the streets. Biden, only the second Catholic president after John Kennedy, will need to be careful not to drop any retaliatory bombs on Iraq until Monday. On Sunday, when Pope Francis performs at a soccer stadium, the roads and stadium will be full. Christians out of devotion, and Muslims out of curiosity will crowd the streets.       

Iraq is controlled by six different militia groups. Talking to the 90-year-old Ayatollah is unlikely to solve any problems. The intent of Pope Francis's visit may be good, but its timing is bizarre and irresponsible. 

Ravi                                                                                                                            

Corona Daily 164: Bee Dot One Dot Three Five One

Scientists and the World Health Organisation are genuinely worried. About the complete chaos in naming the different coronavirus variants. I wrote earlier about the 2015 WHO guidelines that prohibit places or animals when naming viruses. Nobody had imagined then that not only a virus, but its variants may have to be named.

Names should be simple, easy to pronounce, type and memorise. This is how we name our children (Elon Musk the only exception). Look at SARS-CoV-2. It looks more like a strong password. People prefer to use the imprecise Covid instead.

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It would have been all right if only the public and media were confused. But the scientists too are confused about naming the variants. One scientist said: You can’t track something you can’t name.

The dangerous variant colloquially called “the UK variant” is named VOC 202012/01 by Public Health England. VOC is Variant of Concern. A group of scientists call it B.1.1.7. Some English tabloids call it the “Kent variant”.

“20H/501Y.V2”, “VOC202012/02” and “B.1.351” (pronounced bee dot one dot three five one) are three names for the same variant popularly known as the “South African variant”. Like with a password, if you miss a single digit or dot, it may become another variant.

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It is dangerous to name the variants after nations, as is done currently. These nations have identified these variants, they didn’t necessarily start there. UK and South Africa have more advanced genome surveillance. But fearing the transmissibility of the “UK variant” some countries may be tempted to ban travel from the UK. Worse, stigmatizing places would mean their scientists would be reluctant in future to declare new variants. Expressions such as “the South African variant of the Wuhan virus” may also encourage xenophobia and racist attacks.

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When WHO didn’t exist, the world managed to come up with simple names. ‘Cancer’ is Greek for crab, because Greek physicians found some tumours similar to crabs. Asthma was the Greek word for panting. Plague was the translation of stroke or wound. Diabetes meant “to pass through”, to describe excessive discharge of urine. Influenza, an Italian word, referred to an outbreak. Its short form “flu” is a wonderful example of how easy a name can be.

Scientists the world over are trying to grapple with the naming crisis. One proposal suggests naming the variants in chronological order, V1, V2, V3 and so on. This unimaginative solution may find a few supporters. Hurricanes, Greek letters, birds, animals (though banned by WHO), local monsters are some others. Colours is another option.

One group of scientists tried to convert the scientific names into mnemonics: D614G became “Doug”, N501Y “Nelly” and E484K “Eeek”. (Eeek makes the virus less susceptible to vaccines). The last one was supposed to be called Eric, but that was the name of one scientist in the group, so they settled for Eeek.

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GSAID (Global initiative on sharing all influenza data) is a database for naming. It would have been wonderful if it was the only one. But there are two more: Pango and Nextstrain. All three competing systems follow their own methods. A mutant is a virus that has in its genetic code mutations, different from the wild genotype acquired via errors. A variant is a mutant, and a strain is a variant with a markedly different manifestation (transmissibility, lethality, effect on immunity or vaccines). Apparently, even scientists are not precise about using those terms.

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Sickened by the whole mess, on 14 January WHO held a meeting to discuss a new standardized naming system for variants. It is hoped the system will be generated before the pandemic is over.

Ravi 

Corona Daily 165: The Foetal Issue

Yesterday, the US conference of Catholic Bishops asked Catholics to avoid the newly approved Johnson & Johnson vaccine. The vaccine was termed morally corrupt, because it uses cells derived decades ago from an abortion.

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The Vatican and Pope Francis have been more practical. Considering the severity of the pandemic, and the remote connection with abortion, Vatican declared it was morally acceptable to take vaccines for the greater good. This didn’t make abortion any less evil, it added. Pope Francis took two Pfizer shots. All five thousand Vatican employees are asked to be vaccinated. Those who don’t are threatened with the loss of their jobs.

When Vatican issued the statement, the Johnson & Johnson vaccine was not yet in the picture. Pfizer and Moderna use different technologies.

What exactly is the issue with foetal tissue?

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Way back in the 1960s Dr Leonard Hayflick, an American scientist, first used cells derived from foetal tissues in clinical research. The cells were created from an aborted four-month gestation foetus. That cell line was successfully used to create a plethora of vaccines against rubella, rabies, polio, measles, chickenpox. Human foetal tissue has also been used to study HIV/AIDS, birth defects, Parkinson’s, Alzheimer’s and many other diseases.

Most of the Covid-19 vaccines use only two foetal tissues, both created in the labs of the Netherlands. One (HEK-293) is a kidney cell line derived from a foetus aborted in 1972. The other (PER.C6) is the one used in the J&J vaccine. That was created from the eye cells of an 18-week foetus aborted in 1985. Just two foetuses, one from 1972 and another from 1985. Both abortions were voluntary, requested by the parents.

It is important to note those foetal tissues are not used in the vaccines, but foetal cell lines. Foetal cell lines are grown in a laboratory. They descend from the 1972 and 1985 cells. But over the last forty or fifty years, the current foetal cell lines are thousands of generations removed from the original tissues. They hardly contain any tissue from a foetus. This is what Vatican probably meant when it talked of the vaccines’ ‘remoteness’ from aborted foetuses.

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Vaccines such as the J&J vaccine use altered adenovirus, which cannot replicate by itself. The foetal-derived cell line provides the replication machinery that allows generating vast amounts of the virus. Animal cells are not as effective in generating a robust and specific immune response as human cells.  Pfizer and Moderna did perform confirmation tests using foetal cell lines. The J&J vaccine used the foetal cell lines in production as well. That makes it morally corrupt.

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In 2019, the Trump administration banned use of foetal tissue from abortions in research. But the policy allowed use of decades old foetal cell lines. That is why we have covid vaccines today. Trump himself was treated with a cocktail of monoclonal antibodies that he described as “cure”. That and Remdesivir, the drug given to him, were both developed using cells from aborted foetuses. Republicans talk of the sanctity of human life and promoting guns in the same breath. Trump, in his last days as a president, obsessively carried out three executions, despite knowing his successor planned to abolish the federal death sentence.

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The case of Savita Halappanavar, a 31-year-old dentist in Ireland, is well known. She died unnecessarily, begging for an abortion. Catholic Irish laws didn’t allow abortions. She and the unborn baby both died.

The catholic priest sex abuse report mentions several instances of the priests asking the nuns they have impregnated to go for quick abortions.

The final decision to abort must belong to the pregnant woman, not to an organization that allows only men in their hierarchy.

Ravi 

Corona Daily 166: The Ship Slaughterhouse

Alang.

Have you heard of this place? No? But for my pandemic research, I wouldn’t have either, though it is less than 500 km from Mumbai. It is a stretch of muddy beach in North-west India. The biggest passenger and cargo ships are dismantled and demolished in Alang, the world’s largest graveyard for ships. On the Alang beach, once-glimmering royal vessels lie crumbling, their bowels exposed, their glory days over. Like slaughtering a beautiful cow, then dismembering her for human consumption.

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In the pandemic, cruise liner companies are going bankrupt. Countries like Canada have banned cruises this year. Normally, ships live longer than thirty years. Now even younger ships are sent for scrapping. Carnival corporation, world’s largest cruise operator, recently retired 17 ships, including two Fantasy Class liners. Most of these ships are demolished at Aliaga in Turkey.

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In January 2021, two UK ships, the Marco Polo and Megellan, landed at Alang. UK laws prohibit sending ships to developing countries for taking apart. The bankrupt owners auctioned the ships. One was supposed to become a floating hotel in Dubai, another in Liverpool. Instead, they were both beached in Alang for breaking. I suppose all parties knew this was a modus operandi to bypass the UK laws. Marco Polo was sold for £2 million at the auction, but later fetched £4 million as scrap.

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Alang (India), Chattogram (Bangladesh) and Gadani (Pakistan) together scrap more than half of the world’s ships. But the EU and America ban sending ships there for demolition.

The ships are valued in the Indian continent because they contain large amounts of steel. But they also contain hazardous materials, like asbestos (banned in developed countries). Workers, often exploited migrants, including children, are exposed to huge risks. Injuries or deaths can happen by fire, gas explosions and falling steel plates. Labourers and local communities become sick by the exposure to toxic fumes and substances, and air pollution. Since 2009, more than 400 workers have died. Like nuclear rubbish, ships are dumped on developing countries.

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Instead of listening to the world’s top economists, it is enough to visit the Alang Shipbreaking Yard to understand the state of the world economy. When the economy is healthy, cruises and cargo ships do well, and Alang sees a slump in its business.

In the last two months, there is a queue of luxury liners waiting to be broken. In 2010-11, the global freight market was in crisis. A record 415 ships came to Alang to be dismantled. When imports and exports decline, container ships are idle. In 2018, during a slump in the global oil market, every third vessel reaching Alang for scrapping was either an oil rig or an oil tanker.

It takes fifty labourers about three months to break down a normal-sized cargo vessel of 40,000 tonnes.

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Steel is the backbone of the shipbreaking business. Cruise liners have less steel than oil tankers, bulk carriers or container ships. The salvaged steel is sent to re-rolling mills in different states.  

In the second quarter of 2020, Alang came to a standstill because of India’s strict lockdown. Workers were not available, and ships were not allowed to land. The steel prices collapsed and still remain low. But from July onwards, the business picked up, and now it is booming.  

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Just before the pandemic, India passed an act to join the Hong Kong convention. This convention offers certificates for compliance with green recycling standards for the safe and environmentally sound recycling (euphemism for breaking) of ships. Reportedly, 90 out of 120 working plots at Alang are now certified for such compliance. Bangladesh has only one green facility and Pakistan none. Following the certification, America and Europe will be able to send ships to India for breaking. India’s market share in the global shipbreaking industry is expected to go from the current 30% to 60%.

One hopes that the green certificates will also bring in better working conditions and safety standards for the workers and community at Alang.

Ravi 

Corona Daily 167: The Sixth Continent Slumps

Yesterday, Lotte duty-free and Shilla duty-free shut their stores in Seoul’s terminal one. Seoul’s Incheon airport is known as the biggest airport shop in the world. DF2, an ever busy section before the pandemic, stopped selling perfumes and cosmetics. In 2020, the renowned Seoul airport held three auctions to sell empty store space. Not a single buyer came forward. With an 83% fall in passengers, the airport incurred a net loss of $384 million.  

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Duty-free, also known as the sixth continent, was an $86 billion industry in 2019. Even before the pandemic, certain trends were noticeable. It was moving away from cigarettes and booze. Perfumes and cosmetics accounted for two thirds of the sales. Duty-free sales were rapidly moving in the direction of China and its wealthy customers.

Worldwide duty-free sales collapsed by 70% in 2020.

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In the old days, passengers travelled by international ships for weeks, sometimes months. “Duty-free” was an allowance for whatever they “consumed” on the ship. Because during the international voyage they were not taxable in any land. During the journey, they actually could smoke 200 cigarettes and drink two liters of whiskey. As a matter of historical inertia, the same quotas continued even after people began flying.

Modern airport duty-free began in 1950. International travel had just started after WWII. Shannon airport in Ireland was one of the hubs. Brendon O’Regan, a catering accountant, noticed people liked to shop at the airport. Why not incentivize them by making the shopping tax-free, he thought. The Irish government found a way to do it by declaring Shannon airport to be not part of Ireland. That was the beginning of airport duty-free.

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In 2020, China did something similar by declaring Hainan, an island, as a duty-free port. Hainan is called China’s Hawaii, and is looked at as a potential substitute for Hong Kong. Hainan has beaches for swimming and surfing, but its bigger attraction is shopping. Chinese shoppers are now allowed to buy up to $15,500 worth of tax-free goods. This is three times the allowance pre-pandemic. China is wooing its rich citizens, who unfortunately can’t travel abroad, to visit Hainan and experience international travel. The initiative was vastly successful. Visitor numbers were down 22% due to the pandemic, but the duty-free sales went up by 127% year-on-year.

Last year, China managed to overtake Dufry (Switzerland) as the largest seller of tax-free luxury goods. Dufry sold a stake to Alibaba to acknowledge this.

China Duty Free is focusing on merging online and offline duty free. The idea is that the passenger “window-shops” online (before), off-line (at the airport), online (after reaching home). Fancy videos and livestreaming programmes have been a great success.

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“Flights to nowhere” are a pandemic special. Last October, a seven-hour flight took off from Sydney, and after flying all over Australia, reached… Sydney. Day before yesterday, Korea started a two-hour flight that enters Japanese airspace, but returns to Korea. Japan, Singapore, India and Ukraine are selling tickets for flights to nowhere. The scenic flights fly low, at 3000 feet or whatever is the legal minimum, allowing passengers to watch the scenery (new term flightseeing). Dining is an attraction on some flights. Ukraine has the cheapest flights at $95, probably because the route shows Chernobyl.

One key purpose of these flights is to promote duty-free sales. Different governments have prescribed tax-free allowances as part of the flying experience.    

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Duty-free has been criticized as immoral. It promotes consumption of high excise items like cigarettes and booze. It is a tax-avoidance scheme for the rich. When you look at the original concept of consumption on the ship, duty-free on arrival, and duty-free online are nonsensical.

With international travel reeling from pandemic shock, it is likely the duty-free concept will be re-defined in the future.

Ravi 

Corona Daily 168: Epidemiological Whodunnit: Part Final

The third suspected reason for the low cases and deaths in Asia and Africa is underreporting. Are poor countries hiding the deaths? They are known to report only about 5% of Malaria deaths. Indian villages may be cremating people without reporting them. In Lusaka, Zambia; in an interesting experiment, postmortem was conducted on 364 people. Only five of them were tested for coronavirus when alive. The postmortem found 70 people had coronavirus.

Like in a murder investigation, one needs to look for a motive. Ghana and Nigeria received billions of dollars to fight the virus. Politically, they should be interested in over-reporting.

There are at least two ways to probe this issue. One is the all-cause mortality or excess mortality statistics. It is very difficult to hide bodies, even murderers can rarely do it successfully. Most civilized countries keep reliable death records. Natural deaths have a smooth, predictable graph. They don’t jump suddenly.

If you look at the excess deaths table by The Economist (till 18 Feb), other than South Africa, all countries are from Europe and America. Between 1 April- 31 Dec 2020, Russia reported 56,250 deaths. But excess deaths were 367,880 during the same period. Russia defines a covid death only if covid-19 is written as the cause on the death certificate. In the first ten months, USA reported 360,370 covid deaths, and 448,550 excess deaths. If there is under-reporting, it is universal, not just in poor countries.

The other way to judge if official trends are right is the empirical evidence. My doctor friends tell me the situation in Bombay hospitals is fine now. Last August, some hospitals were exclusively set aside for covid patients. This year, I have heard of new cases in my neighbourhood, but no deaths.

*****  

The fourth factor is the government action and its willingness to enforce it. USA was an excellent example of what not to do. I believe at least half of the American deaths can be attributed to Trump’s recklessness and denial. In the best prepared nation, those deaths were avoidable. In rich nations, freedom of mind and expression, the ultimate test of democracy, was confused with liberty to ignore a health emergency.

Countries like Rwanda, on the other hand, were very clear with decisive control measures, strict curfew. And the Rwandan population listened. Now restrictions are lifted, and applied strictly only at a local level to suppress an outbreak.

Bombay’s Dharavi was another good example. Perseverant contact tracing, quarantine and disinfection measures managed to contain the virus in this supremely crowded giant slum.

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The fifth factor is the acquired differences in human immunity. The citizens of the poor countries believe their immunity is stronger.

B-cells and T-cells are part of acquired immunity. B cells make antibodies against viruses, T cells hunt for cells infected by a virus. Mukherjee compares B cells to a sharpshooter, and T cells to a detective. Some studies found that the novel coronavirus was triggering a T-cell response, based on a different infection earlier. The T-cell memory recognized this new foe, without meeting it earlier. In that sense, the novel coronavirus was not novel for everybody.

This cross-reactivity, the ability of immune system to protect against one pathogen based on another, appears to be stronger in Africa and Asia. A Mumbai doctor says in India people had really high levels of antibodies, the levels don’t decay even among old people, and the antibodies stay for a long time.

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Finally, the sixth hypothesis talks about the viral load. Indian cases have unusually low virus levels. Warm weather and open ventilation may be resulting in low-dose exposure. This hypothesis could also explain the large number of asymptomatic cases in India. Many serosurveys in Indian cities found more than half the population carrying antibodies.

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Mukherjee says it would be ideal to find a single cause, a single murderer for the murder. However, with so many hypotheses, he equates the case to Agatha Christie’s Murder on the Orient Express. Poirot realizes the murder to be a pre-planned collective act.

The strange matter of the coronavirus crippling rich nations may similarly be due to a combination of causes.

Ravi 

Corona Daily 169: Epidemiological Whodunnit

SARS-CoV-2 presents several mysteries. A disease of such scale and severity is expected to affect the poorest countries most. They have the worst doctor-patient ratios, poor public health infrastructure, high pollution levels. What has happened during the pandemic has baffled even the experts.

North America with 7% of the global population accounts for 30% of the cases and deaths. Same with Europe. Asia with 60% of the world population suffered only 15% deaths, and the African continent less than 4%. Dharavi, Asia’s largest slum, experienced only one tenth of the expected deaths. It hasn’t had any since December. On the other hand, Los Angeles has no spare ICU bed.

Malaria, Typhoid, Diphtheria and AIDS, as a rule, hit the poorest countries. Deaths per million is possibly the best measure for comparison. The top countries include Belgium, UK, Italy, Portugal and USA, each of them having lost more than 1500 people per million. India’s death rate is ten times lower. Nigeria’s is one hundredth that of the USA.

Some diseases are called rich man’s diseases. Covid is not that, because lots of poor people in rich countries have died. But I won’t hesitate to call it a ‘rich nation’s disease’.

What is the cause of this mystery? This week Siddhartha Mukherjee, in an excellent article in the New Yorker discusses this. Mukherjee is the Pulitzer winner for his book “The emperor of all maladies: a biography of cancer.” I will cover the key points from his article over today and tomorrow.

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First factor is the median age. Please note all the factors are hypotheses at this stage. They suggest rather than prove anything.

In India, the median age is 28, in USA 38, UK 40. Italy at 47, Germany 48, and Japan 48 are some of the oldest countries. Nigeria’s median age is 18. Most African countries are very young.

Virologists and number crunchers have stated a rule of thumb: After thirty, the chance of dying with covid-19 doubles every eight years. (No need to apply the rule to yourself, can be depressing). If true, it is only logical that countries with a high number of elderly residents will suffer the most covid casualties. Good so far. However, questions remain. For example, Mexico’s median age is like India’s. But it has lost ten times more people to covid.

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The second possible factor is the family composition. Who lives with whom and the human interaction. Usually, the richer the country, smaller is the size of the household. In UK, the average household size is 2.3, in Africa’s Benin 5.2. However, in the context of the pandemic, this statistic can be deceptive. In the UK and USA, a large number of elderly people live in long-term nursing homes. In fact, around one third of the covid deaths in the USA happened in care homes. The question then is whether an Indian or African living in a three-generation household is more at risk than the 80+ Americans or British living together in a nursing home?

Covid vulnerabilities are of two types: intrinsic (age, obesity), or extrinsic (household size, medical professional). In the morbid trade-off question, one wonders if it is better to be young in a crowded house, or old in a large house?

The statistical models base their forecasts by answering such questions. Epidemiologists were brilliant in forecasting deaths in the rich world. In the USA, the actuals almost match the projections. But the models went abysmally wrong in the poor world. As per the model, Pakistan was expected to have 650,000 deaths so far, they have had 12,000. Cote d’Ivoire lost fewer than 200, instead of the projected 52,000. Epidemiologists, last March, were certain Nigeria would suffer 418,000 deaths in a year’s time. Nigeria lost 1300, and most cases are mild.

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(Continued tomorrow)

Ravi

  

Corona Daily 170: Tokyo 2020: Here We Go

Japan last year reluctantly postponed the Tokyo Olympics by a year. It will still be called “Tokyo 2020”. Euro 2020 will also happen this year, Dubai Expo 2020 will happen from October 21 to March 22. Rebranding expense is one consideration. If we can accept Covid-19, why not Tokyo 2020?

If the Olympic happens, the first medals will be given on 24 July. The medals this time are made from recycled cell phones. After two dazzling weeks, the event will conclude with the men’s marathon on 8 August.

Before that, the Olympic torch relay will start on 25 March. The flame will travel through 47 prefectures before reaching Tokyo for the 23 July opening ceremony. The organisers may modify routes to avoid crowds. Usually being a torchbearer is an honour, this time it’s a punishment. Torchbearers are asked to take utmost care for two weeks before, no eating out, no mixing with people, minimum exposure. Celebrities are asked not to reveal their route. Comedian Atsushi Tamura withdrew because he and other celebrities were asked to carry the torch through rice paddies to avoid spectators.

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If the Olympic happens, 11,000 athletes from 200 countries, their coaches, officials, and 25,000 journalists are expected to arrive. The number of foreign tourists will depend on the virus performance in the coming weeks.

A 32-page playbook has been issued for athletes as well as fans. Spectators can clap, but not shout or sing. Vaccines are not necessary, because fit young sportsmen shouldn’t take them at the expense of the vulnerable population. But masks, covid tests, temperature checks will be a norm. Special fever clinics and reserved hospital space will be available. Everyone should stay at least one meter away from visitors, and two meters away from an athlete.

The Olympic village, normally a great joy for the Olympians, will be different. Sportsmen and their entourage are encouraged to come to Japan not earlier than five days before their event. And leave soon after their event is over, please.

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Laws prevent the Japanese government from announcing lockdowns. The Japanese can only “encourage” people to do things. For visitors, no quarantine is required. But for 14 days from arrival, they will be encouraged not to use public transport, not visit any bar or restaurant, not go to any health club, nor visit any tourist destination. Thank you.

To reduce exposure, athletes the world over were allowed to reduce or cancel doping tests, a pre-requirement for all Olympians. For organized doping, Russia is banned for four years, and will not take part. There will be no Russian flag, no Russian anthem. However, Russian athletes who are clean will participate under the banner of ROC (Russian Olympic committee).

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In case an athlete tests positive, everyone he/she came in contact with will have to withdraw. This is a risk for team sports like water polo, field hockey, basketball and soccer. This adds a new exciting dimension, in case the Olympic happens. This month, 65 Sumo wrestlers and 51 table tennis players had to withdraw from Japan’s national championships.

The cost of delaying the Olympic was $6 billion. Cancelling would cost $42 billion and Japan’s reputation. Though 80% of the Japanese population is in favour of cancellation. Coca-Cola and Toyota, the sponsors, and Lloyd’s, Munich Re, Swiss Re, the insurers are all praying the games happen as scheduled.

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As if this was not enough, Yoshiro Mori, former president of Japan, who headed the Olympic committee, had to resign this month. He said he felt annoyed because “women talk too much”. He has been replaced by a woman.

The weather in July-August promises to be awful. It is predicted this will be the hottest and most humid Olympic on record. As luck would have it, 2020 summer was cooler because of lockdowns, but this year promises to be very hot. Outdoor athletes, where they can, have included heat training. Heat stress and heat strokes are a real risk. Organisers have rescheduled the start times for certain events and enhanced medical support.  

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Japanese government confidently says Tokyo 2020 is definitely going ahead; unless cancelled.

Ravi