Analysis – 14 July 2020

Mixed bag

Brazil: Daily positives have fallen five days in a row, now at 9.7 per 100K and daily deaths have slightly risen to 0.35 but trending more downward than the day before. Daily cases are trending down for the first time ever. But: this is still the same pattern as seen in the weeks before and I expect tomorrow's numbers to be up again (their weekend only ends now).
Outlook: Very Bad With Hope

US minus CA,NY,WA: Daily positives fell a little to 18.1 per 100K, but is still trending up. This number is almost double the one of Brazil. The upward trend might become less steep in the coming days. Daily deaths have fallen slightly to 0.11, trending down, which is what I predicted earlier. The daily positive rate remains at 9.6%.
Outlook: Very Bad

California: Daily positives remain almost the same at 21.2 per 100K but the trendline has been becoming less steep for four days in a row. Daily deaths fell to 0.06 and the trendline came down a lot. The daily positive rate fell from 8.3% to 7.7%. I am not sure if this is still the weekend drop but if it were real, it would constitute a turning point.
Outlook: Very Bad With Hope

Washington: Daily positives rose to 9.4 per 100K and the trendline is going up more steeply. Daily deaths fell to 0.1 and are still trending up. The daily positive rate remains at 6.5%. Washington's daily positives are now almost as high as Brazil's and its daily deaths are 10x higher than France's.
Outlook: Bad

New York: Daily positives rose fell from 3.8 to 2.9 per 100K and the trend is flat. Daily death numbers remain at a low 0.05 (slightly up though) and the daily positive rate remains at 1.0%. I am not sure if these positives include many asymptomatic people, which is possible, given the extremely high testing rate (24%), which by far outperforms all other regions.
Outlook: Satisfactory

France: After the weekend hiatus and a little data massaging to bridge the two-day gap, the new case numbers look almost like the ones from before the weekend. The trendline is still pointing up at the same angle But I expect it to consolidate at around 1 per 100K. Daily cases fell to 0.8 per 100K. Daily deaths remain very low, at 0.012, and the daily positive rate fell from 1.1% to 0.9%. Of concern: the R value is way above 1. This is a mixed bag but does not look too good.
Outlook: Satisfactory

Germany: Daily cases fell from 0.3 to 0.2 per 100K and the trendline is almost unchanged. Daily deaths are far below <0.01. The daily positive rate was 0.5% three days ago (waiting for the weekly update) and the R value is below one. Everybody seems to expect the numbers to rise again but so far, they have held up.
Outlook: Good

Tunisia: With 39 new cases, there is apparently a dangerous trend developing. The daily case number rose to 0.33 per 100K, which is the highest value in 87 days. Accordingly, the daily positive rate has risen from 1.3% to 1.8%. There still have been no new deaths in 27 days but I expect this trend to end in a few days, when some of the new cases have succumbed to the disease.
Outlook: Excellent With Deep Concern

Remarks – On Antibodies to the Virus

The recent publication of yet another paper (a pre-paper though) put yet another nail in the coffin of the hope for a speedy recovery. The research comes out of King College in London and reports the results from an observational study of 65 individuals who had their antibody titre (the amount of antibody to the virus found in the blood) measured at the time of disease symptoms and up to 94 days afterwards. The found that some patients with a high titre at the start of the disease had a titre that was 10 times lower at the time of the second testing, which was weeks after disease symptoms have eased. Those with lower titres at disease onset had almost no titre in the follow-up test. 

While this may look bleak, one should not forget that this was done on a very small sample with, I assume, very low statistical power. The authors themselves close with a sentence of hope: "Taken together, despite the waning (neutralising) nAb titres in individuals, it is possible that nAb titres will still be sufficient to provide protection from COVID-19 disease for a period of time."

A vaccine will, at best, trigger a neutralising antibody response that will last for up to a year. At worst, no response will be triggered at all and somewhere in the middle would be a weak response that lasts for a few months only.

There is still hope, though. This and other papers investigated the B-cell response to a viral infection. There is still the T-cell response and, in particular, the formation of memory T-cells that could fire up a rapid response upon a second infection. Very little research, if at all, has been published for SARS-CoV-2.

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