Ebola

No reports of new cases of Ebola Sudan in Uganda, and we are getting to be well out of the incubation period. There is not much media coverage overall, but at least one Africa centered publication has called it and quotes a number of Ugandan government officials starting to take victory laps. While there remains a small chance of a flare up from a lost contact or two, that really -should- have happened and been detected by now, so odds of that are dropping. We’ll consider this one contained as well, barring any further developments. 142 confirmed cases with 55 deaths total over the outbreak.

I don’t think they got vaccines in country and out quickly enough for the study they would need to get the Sudan versions fully approved.

Coronavirus

Couple points here, and again, we’ll try to be quick.

The big news, of course, is the rumblings from China. As we mentioned before, they are getting the omicron wave we had last year now as all COVID Zero restrictions are lifted. This is accompanied by stories of overwhelmed hospitals throughout China, with WHO estimating millions of new cases per day. There have been announcements of the deaths of major health officials who were quoted during the pandemic (and thus tough for even the CCP to hide), with official reports that they died of “undisclosed illness” being attributed to COVID.

So the reader question we got as news is trickling in through Western media, with the US looking to reimpose COVID negative testing requirements for flights from China and Italy reporting 50% of plane passengers from China testing positive, is why does China appear to have such a severe disease problem if this is just the omicron variant?

The underlying question being “has this mutated to something worse?”

You can go back a few weeks when this breakout was just beginning in China, and we mentioned that there is a non-zero chance, given the rapid spread through a LARGE and largely susceptible population, that SARS-CoV-2 could make another jump to something both contagious AND more likely to be severe. China has been too overwhelmed to be doing much sequencing to know for sure about variant evolution, and the best chance of detecting if something wicked this way comes will actually be sequencing on travellers from China who pop positive. Not ideal, as they are a small subset of what is spreading in China and self-selected for those with the means to travel, but it will be a sense of what the virus is doing there.

While the chance is non-zero, it is still far, FAR, FAR, less likely than not. The evolutionary pressure will remain to be more contagious, less severe, and you are starting from the omicron variants, which are already “tilted” in that direction.

“So then why are hospitals getting overwhelmed in China from the reports I’m reading? Isn’t this more severe disease than we saw with omicron?” I hear you say, Oh God Not Again Thinking Hypothetical Reader.

You have a confluence of factors going on here. Outside of the major cities, China really doesn’t have great healthcare infrastructure. They do not have the ICU beds per capita of some other nations. A lot of severe COVID cases, all at once, will quickly push local hospitals to a “bed’s taken” situation. On top of that, China has a relatively high per capita rate of diabetes, underlying lung disease from the severe pollution problems in many major cities, and is older, on average (and getting older faster) than many other nations. All of this means they have a comparatively high proportion of their population with risk factors for severe disease. While omicron variants are not as bad as previous variants, that’s not to say they cannot knock you on your ass (as MANY of you can attest to) and for those with risk factors, they still can, and still do, put people in the hospital. Not as many as alpha, let alone delta, on an infection by infection basis–but omicron can still put a hurt down. Like the old man in the bar fight, he may not be as good as he once was, but he can be as good once as he ever was.

Now add that the vaccination rate among those 70+ in China is 70% or less, and that’s with the empirically less effective Chinese vaccines. Oh, and JUST that 70+ cohort in China? That’s just this side of 100 million people. If this wave puts even 1% of just that group into the ICU, that’s 1 million ICU beds needed.

China, per the latest reports this week, has 138,000 ICU beds. For the entire country.

See the “severe disease” and “overwhelmed hospitals in China” quandary now?

And again, there has been like zero mention of available acute therapies in China, which makes me think they don’t have enough of them, if they have them at all.

So China has really chosen the WORST of all pandemic worlds here. You had brutally repressive lockdowns for years, with significant cost to physical and mental well being of their people, to the point that it threatened to topple the government.

While you can argue that the rampant of omicron right now in China suggests those measures worked (more than I would have expected, based on the REST of the world’s experience, in fact), since there is apparently VERY little natural immunity in China to stem this wave, this also goes to show what we said waaaaaaaaaay back in the beginning.

The lesson of history, the Black Death “Choose Your Own Adventure.”

Once a pandemic agent has gone pandemic, and shows up in your town, everyone is going to get exposed to it. Eventually. Your choice really doesn’t matter.

All you can do, I would argue, is buy what time you can for a treatment or prevention of the main pandemic threat (be it bed’s taken contagiousness for overall mortality or direct mortality, like an Ebola or bubonic plague).

But everyone is going to get exposed eventually. England got the Black Death. England was ALWAYS going to get the Black Death.

So China made their choice in that Choose Your Own Adventure. And the pandemic has come for them, full force, with its full pandemic threat of “bed’s taken” again.

Ben Hunt had a good note this past weekend describing this as China’s Vietnam. The analogy is that the Tet Offensive, while militarily a defeat for the Viet Cong, was an overwhelming Common Knowledge victory for Vietnam in the US, and ultimately won the war. The media coverage in the US had made it sound like victory was near, but there had been pressure from the frontlines all the way to the top of the government to create and pay attention to only the statistics they -wanted- to hear, and not the real strategic problems. Hackworth’s “About Face” is a great book on this. When the Tet Offensive happened, it became clear to the average US citizen that the imminent defeat of the Viet Cong was nowhere near, and the story they had been getting told was different from the reality on the ground. Not only did they know, but they now knew that everyone -else- knew that the US government was incompetent and lying in its conduct over the war.

Yes, Ben does end pointing out that not much has changed in the US in that regard with COVID across the administrations. He gilds the lily with his ICU stats in the US–the US has the lowest amount of ICU beds currently open since COVID started because expanded ICUs have been dismantled; the percentage occupancy of those ICUs has been the same for months at about 77% and the share of COVID for those is at its lowest. Shortages of over the counter cold/flu drugs for kids are supply chain issues. But frankly, if they are NOT having to card you when you buy one, it’s debatable as to how effective it is versus placebo–these aren’t “keep junior out of the hospital, WHO List of Essential Medicines” stuff. The stuff that actually works for congestion and cough is an ingredient that can become crystal meth (hence they track it with your driver’s license to make sure you are not buying in “Breaking Bad” quantities). They took the other ingredient that works well out of OTC preparations years ago because it’s a cousin of morphine and heroin. But Ben’s broader point is that when governments are NOT being effective, because perception of effectiveness is just as good for them, there is an incentive to try to manage perception. Especially if the best and brightest can convince themselves that managing perception is easier, or better yet, necessary to get through this temporary setback (this phrase should be the alarm bell for “sunk cost fallacy about to happen”).

This ended badly for trust in the US government and the Vietnam war. We will watch, but it does seem likely to be a serious erosion of trust in the CCP as well, because everyone in China now knows that everyone else in China now knows their government is incompetent and lying, and botching COVID as badly as they possibly could.

Speaking of questionable effectiveness, a large real world study of Merck’s anti-COVID pill (this is the one that seemed best, mechanism of action-wise, restricted to an older population) found no statistical difference in prevention of hospitalization or death from COVID versus no treatment with the pill. While it did appear to shorten symptoms and recovery time, and drop viral load quicker, there was no difference in the hospitalization metric. That said, my anecdotal impression is that Pfizer’s pill is the most popular acute treatment for COVID in patients with underlying risk factors for severe disease.

The FDA has also granted full approval (not merely the EUA) for a monoclonal antibody for treatment of acute COVID as well (Roche’s tocilizumab). This is a newer antibody, and aimed at the variants currently circulating widely around the globe.

Other than China, COVID activity is not that much changed from our section last week…

Socioeconomic

We’ll bullet point this.

–Recent article in the Washington Post surveying a large number of intelligence and government officials reveals that the Nordstream sabotage (yes, remember that?) may have been in the works for months, and evidence does not currently point to Russia as being responsible. Still no statement on who. Presumably 007 is working on this?

–Since gas storage levels peaked in mid November, Europe has drawn off a little more than 12% of those reserves. This is a faster decline than the average of the last 5 years. If the weather that hit most of the US last week hits Europe, either multiple times or in a sustained way, hard questions requiring difficult decisions may be asked of European power grids.

–Speaking of, the US energy grid was memorably under stress last week. Several readers were in regions with rolling blackouts of about 10 minutes every hour, and/or got notices from the power company to please reduce electricity usage, or blackouts would become necessary. The grid with the biggest challenge was New England’s, which has had to turn to burning oil to meet its marginal need, as wind, solar and other renewables were not able to supply enough continuous load and political choices had stressed a larger percentage of those sources comprising New England’s grid. Oil is more expensive and dirtier than the marginal energy sources much of the rest of the country is using. New England also suffers from Old England (and the rest of Europe’s) storage challenge, in that there is not enough oil storage available to meet the entire energy need over the season, and will require continuous supply of expensive oil all winter long. Fortunately, much milder weather over the coming weeks.

Regardless, New England’s quandary is a perfect demonstration of the incoherent US energy policy, which will need course correction. There is insufficient ability to get renewable energy sources, championed for so long, in enough quantity, to meet political commitments for energy sources. They also struggle in ways that more energy dense sources, like fossil fuels, do not in times of excess demand stress. Meanwhile, Chicago and its four nuclear power plants had no issues, and no blackouts, despite the same intensity and duration of cold last week.

When policy conflicts with physics, physics is gonna’ win. I realize again that I am “talking my book” here, but the only way to meet the energy demand requirements implied by EV mandates is with the cleanest, highest energy density source we have now. Just think of the electric demand draw if the number of EVs on the road were suddenly merely doubled, to say nothing of the actual complete replacement targets coming up. (and yes, I know–the viral Joe Rogan podcast highlighting the humanitarian disaster that is JUST cobalt mining, and the inability to scale JUST cobalt, to say nothing of other needed rare earths, suggest those targets are utterly at odds with physical and ethical reality anyways). The only way there right now is nuclear. While fusion breakthroughs recently announced were an important step, scale and commercialization of fusion is still a long way off. New generation, and smaller, fission plants need to be considered. Along with realization that fossil fuel supplementation will be necessary for longer to meet the gap until truly sustainable, replacement grade sources of energy are available.

The global system does not work, and will fail, or at least FEEL like failure, without predictable volumes of energy, at predictable cost…

–Hope the holidays went well for you and yours, and we finally get the New Year we all deserve after the slog of the most recent ones…

–Your chances of catching coronavirus are equivalent to the chances that somewhere, a conversation like this is taking place:

Life Insurance Sales Rep: “Yes, Mr. Yuri Russianoligarchovich, I got your application and paperwork for a life insurance policy. Your age, health, and hobbies all look in order. However, the underwriter has asked us to follow up with juuuuuust a few quick, easy questions. You ready?

Great.

First, how often would you say you visit hospitals?

No, no. We did indeed get your health records. I see that you haven’t been hospitalized for any health condition in quite some time. No, the underwriter is asking, based on your occupation of course, how often you actually visit hospitals. Hospitals with multiple floors, in particular. A few times a year? Once a month? Never go around hospitals if you can at all avoid it?

Uh huh. I see. Great. Marking that down. And how about windows? Are there windows in your house, your office? Windows anywhere you go to often?

Uh huh. I see. Do you spend a lot of time around those windows?

Yep.

How close to those windows do you typically get? Right up to them? Safe distance of 20 feet or more away from them?

Yes, I know these are unusual questions. It’s just something the underwriters have begun asking about those in your particular income bracket, nationality, and occupation. You know, they find these crazy actuarial risks sometimes and we wind up asking just some really off the wall stuff. But I really -do– need your answers to these before they will consider issuing any policy or quote… yeah…”

<Paladin>