Analysis – 21 July 2020

Weekend's over but some countries need one more day to get their numbers back

Brazil: Daily case numbers shrunk again, now at 9.6 per 100K but this is a pattern similar to the two prior weeks and I assume that numbers will go up tomorrow. Likewise, daily deaths went down to 0.3, which is still far to high of a number.
Outlook: Very Bad With Lots Of Hope

US minus CA,NY,WA: Daily infection numbers have decreased for the third day in a row. This could still be the weekend effect since there are similar patterns in prior weeks. Daily infections dropped to 18.4 per 100K, but they continue their upward trend. Daily deaths came down to 0.13 but this is clearly a pattern seen before and therefore owed to the weekend. The daily positive rate gave a little to 9.6% but I expect it and all other numbers to go up again because even if there were increased mask wearing and social distancing, these measures will take three weeks or more before they are visible in the graph. This is owed to three kinds of delays: 1) Time from infection to symptoms, 2) the wait time for test results, which can be over a week and 3), delays in getting the number reported, with a mix of political and infrastructural reasons.
Outlook: Very Bad

California: Daily infection numbers are the lowest in 12 days, and while there is still the weekend effect, this drop is steeper than in the weeks before and I therefore predict that daily numbers will increase less in the weeks to come and a peak could be not too far ahead. Daily infection numbers dropped to 17.8 per 100K, but they are still trending up for over a month now. Daily deaths showed a huge drop to 0.02, which, although still trending upward, could be a turnaround akin to the daily infections. Accordingly, the daily positive rate gave a little to 7.2%. The heat map shows risk levels going for the better in more counties than the opposite, which is a good sign.
Outlook: Very Bad With Faint Hope

Washington: Daily infections fell from 12.6 to 12.1 per 100K, but the trendline is not changing its upward angle. Daily deaths fell sharply to 0.04, pushing the trendline down, which is a good sign, and would be even better if the next days would confirm this trend. The daily positive rate rose from 5.0% to 5.1% though. The heat map shows two counties having their risk going worse.
Outlook: Bad

New York: Daily infections remained almost the same, rising from 2.6 to 2.67 per 100K, but now trending flat instead of up. Daily death numbers dropped from 0.07 to 0.04, trending down. The daily positive rate remained at a good 1.2%. The heat map is encouraging but what I want to see is the counties comprising New York City, the biggest driver of the state numbers, to turn green. The governor is not too happy though, otherwise he would not be threatening to close bars if they were not following the rules.
Outlook: Satisfactory With Concern

France: After the weekend slumber and me smoothing over the two-day gap, daily case numbers went from 0.8 to 1.25 before the weekend and now to 1.03 per 100K, with no sign of coming down for good. Daily deaths though are on a clear 5-day down spree, at a low 0.012, and the trendline is finally pointing down as well. The daily positive rate remained at the pre-weekend 1.2% and the R value is a too-high 1.2.
Outlook: Satisfactory With A Lot Of Concern

Germany: The weekend is apparently over here because daily case numbers rose again from 0.3 to 0.63 per 100K but keeping the downward trendline from before the weekend and keeping stubbornly away from a real downward trend. The good side: Daily deaths remained far below 0.01 (at 0.0048), the daily positive rate was 0.6% three days prior, and the R value is below 1. There is a local increase in my district, the first in many weeks. A lot of people may look at Germany as an example of good disease management, but there are too many indicators that make Germans suspicious of this calm before the storm.
Merkel and Macron should be commended for their success in saving the EU, once more. 
Outlook: Good With Concern

Tunisia: Daily case numbers are down to 0.06 per 100K with 0 deaths reported in 33 days and the daily positive rate sinking to 1.5%. All of the 7 new cases were external and the rules for people travelling into the country are a little complicated: European hotel tourists can come without having a test done, neither at their country nor at the border. Tourists from Gulf countries, of which there are quite a few, must have a test done at the border (and some of these have tested positive in the last days since opening the country for tourism). Returning Tunisian citizens must have a test done in their country of origin and if positive, they are still allowed to return but have to go into voluntary quarantine, which, given yesterday's remarks, will be checked by the authorities. These, too, contributed to the daily new case load. So, Europeans, once again, are given carte blanche, but only if they stay at their hotel. The hotels must thus be regarded as potential hot spots for infections. 
Outlook: Excellent With Less Concern

Remarks – On False Hope

We have been hearing good news about vaccinations, which will give us all hope. Hope is what we live on but hope is a bad adviser. Only facts give good advice.

Such good news are coming out of Oxford (and there have been others), but a good immune response in 1000 test persons does not always translate to a good response in the general population. This must be tested in a Phase 3 study. While phases 1 and 2 (which are often combined) test for toxicity and efficacy of the vaccine (does it kill or have adverse effects?, does it trigger an immune response at all?) in a very small number of individuals, phase 3 goes into a much larger and more general population, because one would need to demonstrate not only that a lot more individuals of all ages and social standings have an immune response but that it protects them from infection. Proving the lack of something (no infection) is not an easy task. And it takes time.

What will be done is to test the vaccine on a population where the virus is rampant, such as in Brazil, and see if, statistically, there will be fewer new infections than in a control population, which will be administered a placebo vaccine. The longer one waits, the better the statistical power of the data (meaning: the data are believable). What is also of importance for statistical power is that the control population, the one with the placebo, be at least 3x greater than the case population with the real vaccine and that both populations be similar in composition, e.g. composed of individuals of the same age, the same income, the same health status, the same genders, etc.

And why a control population? Why not simply administering the vaccine and see if the infections go down?

A general population is not the same as a group of carefully selected individuals in a much more controlled environment. In a general population, the infection rate could go down even without the vaccine. Maybe because more people decide to wear a mask. Or because the infections spread to younger ones that are not getting sick and hence not getting tested and make the infection rate look good although it is not. 

These and yet unknown factors must be accounted for. Because otherwise one could not know for sure if the vaccine really brought down the infection. And one would start the very expensive process of vaccine production, followed by the very expensive process of vaccine administration and in the end, millions if not billions of Euros would have been wasted. 

On top of that, vaccination might instil a false sense of protection and a person might use less protection, which, combined with an ineffective vaccine, could have the opposite effect.

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