What Have Government Restrictions Accomplished with COVID-19?

Cumulative COVID-19 cases (left) and deaths (right) per million in Sweden and Denmark
(click for a larger view)

In a previous post, I compared COVID-19 cases and deaths in Sweden and Denmark. As I said then, it’s because they are very similar countries in the same basic region of the world, but they have remarkably different responses to the disease. Sweden has avoided lockdowns and tried to target their social restrictions, while Denmark has followed the practices of most other countries, strongly limiting what their citizens can do during the pandemic. While no comparison of two different countries is conclusive, I think the results are very interesting. The data come from the European Centre for Disease Prevention and Control, and while it may very well be a biased source of data, at least it is equally biased for both countries.

The graph on the left shows the cumulative COVID-19 cases per million. That means each day on the graph shows the total cases that were reported by that date, divided by the population in millions. Initially, Denmark had more cases (probably because initially they were testing more), but as you can see, Sweden quickly surpassed Denmark in cases per million, and the difference between the two countries has continued to grow. Since the death rate of COVID-19 is low (but higher than most infectious respiratory diseases), many people (including myself) think that death rate is a better indicator of the severity of the pandemic. Thus, the graph on the right shows the cumulative deaths per million. Notice that Sweden has more than 5 times the deaths per million as Denmark.

If the comparison between these two countries is legitimate, then, government restrictions did reduce the number of COVID-19 deaths per million in Denmark. However, there are those who suggest that this might be okay, since Sweden will reach herd immunity faster than Denmark. In the long term, then, Sweden will have fewer COVID-19 deaths because the spread of the disease will stop sooner.

Based on my evaluation of the data, I don’t think Sweden is significantly closer to herd immunity than Denmark. Take a look at the graph below, which records cases per day per million. Rather than adding all the cases reported by a given date (as is done in the graph on the left above), this shows the daily reports of COVID-19 cases per million.

If Sweden were closer to herd immunity than Denmark, the recent cases per million per day in Sweden should be lower than the cases per million per day in Denmark. However, they are not. For most of August, Sweden and Denmark have roughly equivalent cases per million per day. That tells me the disease is spreading roughly the same in the two countries right now, but Sweden has lost five times the people (per capita) as Denmark. As a result, my analysis indicates that Denmark’s restrictions kept a lot of people from dying of COVID-19, and that will continue to be the case in the long run.

Now please understand that this analysis considers only deaths from COVID-19. We know that government restrictions have also caused deaths. There are those who say that the government restrictions will cause more deaths than the ones that were saved from COVID-19. Others say that overall, the restrictions have saved lives. I think the data are insufficient to make that determination, but I do agree that most countries are ignoring the devastating death toll caused by the restrictions themselves. Nevertheless, I think the data are now clear that Sweden’s strategy has not accomplished what the country had hoped it would.

Another Possible COVID-19 Treatment

The three components of blood (click for credit)
So far, there are no widely-accepted treatments for COVID-19. Hydroxychloroquine, often mixed with other things like azithromycin, was initially thought to be promising, but the data so far are inconclusive. While there are some indications that it is effective (and some physicians are convinced it works very well), the controlled studies that have been done so far see no significant benefit to its use. The antiviral drug remdesivir shows some promise, as does the corticosteroid drug dexamethasone. However, there are not enough data yet to make a firm decision on either of them.

Yesterday, President Trump held a press conference to announce a new possible treatment: convalescent plasma. Based on an analysis of several different studies, it seems to be the best candidate yet (in my non-medical-doctor opinion). I say this because of the kinds of studies that have been done. First, there have been three randomized clinical trials. This means patients were assigned to either get the treatment or not get the treatment based on random chance. The group that got the treatment was compared to the group that didn’t (called the control group). In the three studies, the death rate in the treatment group was half that of the control group. There were also five matched-control studies, where the treated patients were compared to a control group specifically selected to closely match them. The results of those studies were similar to those of the randomized clinical trials. There were also four case-series studies, where patients were given the treatment and their progress was tracked. While that kind of study has practical uses for physicians, its ability to determine the effectiveness of a treatment is extremely limited. However, the case-series studies seem to support the other two kinds of studies. All of the studies were done on patients with severe or life-threatening cases of COVID-19.

Taken all together, then, the treatment looks very promising. However, I do have to say that each study was very small, so even when all the patients were analyzed, the total number was only 804. Phase three clinical trials that determine whether or not a drug should be widely used typically involve a few thousand patients. Thus, this is still a limited data set. Also, many of the studies (as well as the analysis linked above) are not peer-reviewed. As a result, there could be major flaws that have not been noticed. A recent analysis (once again not peer reviewed) of more than 35,000 patients seems to support the small studies, but since it has no control group, it cannot be used to draw any real conclusions. Nevertheless, the FDA has approved emergency use of the treatment, and it is asking those who have recovered from the disease to help in determining whether or not it is truly effective.

How can someone who has recovered from COVID-19 help determine the effectiveness of the treatment? To understand that, you need to learn a bit about the wonderful mixture that is running through your circulatory system.

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Forbes Tells You Not To Think For Yourself

I have written about a couple of instances where Forbes has censored articles because they disagree with the “scientific consensus” (see here and here). As a result, it didn’t surprise me to find that they are now actively trying to discourage people from thinking for themselves. This discouragement comes in the form of a blog article written by Dr. Ethan Siegel, who holds an earned Ph.D. in astrophysics. It is entitled, “You Must Not ‘Do Your Own Research’ When It Comes To Science”.

Dr. Siegel believes that in order to assess any scientific statement, a person must have some expertise in the relevant field. Otherwise, the person’s “research” will only end up confirming what he or she already wants to believe. He writes:

It’s absolutely foolish to think that you, a non-expert who lacks the very scientific expertise necessary to evaluate the claims of experts, are going to do a better job than the actual, bona fide experts of separating truth from fiction or fraud. When we “do the research for ourselves,” we almost always wind up digging in deeper to our own knee-jerk positions, rather than deferring to the professional opinions of the consensus of experts.

He backs up this anti-science view by giving examples of how people deny the scientific consensus on issues like fluoridated drinking water, vaccination, and global warming (aka climate change). He then relates it all to the current pandemic. He says that rather than listening to the experts and obediently following whatever they tell you to do, some people are actually looking into the matter for themselves, and the results are devastating.

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Another Exciting Development in COVID-19 Prevention

AeroNabs could be delivered as a nasal spray. (click for credit)
Scientists are pursuing several different strategies to protect people from the virus that causes COVID-19, and a recent paper that hasn’t been peer reviewed reports on a strategy I haven’t seen before. It makes use of the fact that the virus starts the infection process by employing specific chemicals called spike proteins to bind to an enzyme (ACE2) in human cells. The idea is simple: Block the virus’s ability to bind to that enzyme, and it will be unable to start the infection process. But how can that be accomplished? In the paper, the researchers report on making a small molecule, called a nanobody, that binds to the spike proteins on the virus. Once the nanobody binds to them, the spike proteins can no longer bind to the ACE2 enzyme.

First found in alpacas, nanobodies are like antibodies, but they are smaller, simpler molecules. Because of that, they are easy to make and manipulate. Essentially, scientists can build a small gene that produces the nanobody, insert it into certain microorganisms, and let the microorganisms churn out the nanobodies. As a result, there have been many, many different kinds of nanobodies produced over the years. The researchers searched a database that contained more than two billion nanobody genes, and they found 21 that should be able to bind to the virus’s spike proteins in some way. They put those genes into yeast, extracted the nanobodies that were produced, and studied them.

Based on their analysis, they found the three most promising candidates and tested them against the virus itself. One of the nanobodies was particularly effective, so they focused on it. They mutated the gene multiple times to make slight changes to the nanobody and tested the result against the virus. They then produced a gene that could take the three most effective nanobodies and chain them together. The result was a chemical that basically shut down the virus’s ability to infect human cells.

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Why Are Children Less Susceptible to COVID-19?

Children make up less than 2% of all identified COVID-19 cases. This is unusual, since they make up 20-30% of influenza cases. Why is COVID-19 so much rarer in children? A study from the Icahn School of Medicine at Mount Sinai Hospital in New York might have found the answer. Cells found in the nose, lungs, veins, and other parts of the body sometimes have an enzyme called ACE2 in their membranes. The enzyme is important, because it can participate in a process that lowers blood pressure when necessary. Studies show that the virus which causes COVID-19 (SARS-CoV-2) attacks cells by attaching to that enzyme.

The researchers examined nasal tissue from people between the ages of 4 and 60. The tissue collection had already been done between 2015 and 2018 for a research study on asthma. The researchers specifically looked at how much the gene that makes ACE2 was expressed. The more the gene is expressed, the more ACE2 is made. They found that the youngest children expressed the gene the least, older children expressed it more, young adults even more, and older adults even more. Thus, the younger you are, the fewer ACE2 proteins in the cells that line your nasal cavity, so the fewer places the virus has from which to attack. As a result, the less likely you are to be infected.

Because of the nature of the original study for which the tissue was collected, nearly half of the people from whom the tissue came had asthma. Also, they didn’t have tissue from anyone over 60 years of age. Thus, the sample is not truly representative of the nation as a whole. Nevertheless, the results are very intriguing, and they seem to explain why this respiratory virus affects children differently from most common respiratory viruses.

Please DO NOT Get Your COVID-19 Information from Social Media!

So far, I have written three articles about how horrible social media is as a source of scientific information (see here, here, and here). Facebook might be a great way to find out what your friends are eating, but it is one of the worst places you can go to learn about science, especially the COVID-19 pandemic. That’s because lots of people (left, right, and center) have decided to politicize the pandemic, and the unscrupulous among them have transformed science from its true nature (a very imperfect mode of inquiry) into a weapon. Unfortunately, many people don’t recognize weaponized science, and as a result, they tend to share things that fit their political views, regardless of whether or not they are accurate.

Consider, for example, the statement shown above. I have seen it on my Facebook feed at least a dozen times. While the statement is factually accurate, it supports a false narrative. Yes, there have been roughly 4 million cases of COVID-19 in the U.S. so far, and there were estimated to be 60 million cases of H1N1 during the 2009 pandemic. So the H1N1 pandemic of 2009 was “worse” than the COVID-19 pandemic today. Therefore, all the precautions we are taking against COVID-19 (shutting down schools, wearing masks, etc.) are just a result of politicians trying to use the current pandemic to their advantage. Of course, that’s simply not true. The reason we are taking precautions against COVID-19 is that it is significantly more deadly than H1N1. Out of the estimated 60 million cases of H1N1 in 2009, there were only about 12,500 deaths. Out of the roughly 4 million cases of COVID-19, there have been almost 150,000 deaths. Since 15 times fewer cases have produced more than 10 times as many deaths, it is easy to understand why we are taking more precautions against this virus!

Just to give you one more example, yesterday I saw this statement on my Facebook feed:

The COVID-19 death rate without a vaccine is lower than the flu death rate with a vaccine.

As far as I can tell, there is no way you can massage the data to make that statement even factually correct. For the 2018-2019 flu season, there were estimated to be more than 35.5 million cases and 34,200 deaths. Once again, for the current COVID-19 pandemic, there have been roughly 9 times fewer cases, but about 5 times as many deaths.

Now please understand that I am certain the number of COVID-19 deaths are being overreported. But they aren’t being overreported to the point where you can conceivably compare this current pandemic with the H1N1 pandemic of 2009 or the seasonal flu. In the same way, I know that politicians are using this pandemic to their advantage, but that doesn’t mean it isn’t real and isn’t serious.

So when it comes to getting information about the pandemic, choose your sources wisely, and do not include social media on the list!

A Very Promising Possibility for COVID-19 Treatment

A person using an inhaler, which is the way the drug in the study is delivered (click for credit)

There are several drug treatments that are currently being investigated for COVID-19. However, of all the studies I have seen so far, this one looks the most promising. In the study, UK-based Synairgen chose 101 hospital patients and randomly assigned them to get a placebo or a chemical called “interferon beta,” a protein that has antiviral properties and is naturally produced by the human body. Both the placebo and the protein were administered through inhalers so that they ended up in the lungs. Over the roughly two-month study, patients getting the protein were 79% less likely to develop severe symptoms that required a ventilator. Also, while three of the patients who received the placebo died, none of those who received the protein died.

The study seems well designed. For example, patient ages were very similar. The placebo group’s average age was 56.5 years, while the protein group’s average age was 57.8 years. The difference is very small, but note that it favors the placebo group. In other words, since the patients getting the placebo were younger, they were automatically a bit less at risk than the protein group. In addition, the average amount of time the patients exhibited COVID-19 symptoms before getting the treatment was very similar, 9.8 days for the placebo group and 9.6 days for the protein group.

I do, however, see two potential problems. First, the number of patients in the study is small. As a result, they made a lot of other interesting observations, but they couldn’t determine whether those observations were the result of the protein or random chance. For example, the patients who received the protein were roughly twice as likely to recover within the two-month period than the ones who did not receive the protein. However, because the number of patients is so small, mathematics tells us it is possible that this result is caused by chance and not by a difference between the placebo and the protein.

The other problem, of course, is that this study was performed and reported by the pharmaceutical company that wants to produce and sell the drug. Initially, of course, this makes sense. Studies cost money, so the company that wants to make and sell the drug should spend the money to do the studies. However, before the drug can be approved for general use, there will need to be a larger study with independent analysis. I eagerly await that kind of study.

Science in the Atomic Age is Now Available!

The pandemic delayed it, but Science in the Atomic Age has finally been finished and is available for purchase! The course is targeted at 7th/8th grade, depending on the student’s math level and experience with science. In general, students who are two years from starting algebra and have covered at least a couple of years’ worth of elementary science should take this course. Most publicly-schooled students would take a course like this in 8th grade, but homeschooled students at this age are generally a grade level ahead of their publicly-schooled counterparts. While it can be viewed as a continuation of my Science Through History series, students who have covered elementary science in some other way can use it as well.

The course is arranged so that students get a general introduction to science. It does this by exploring science through the levels of organization found in creation. First, it covers the atom. Students learn not only how scientists currently view the atom, but also how scientists arrived at that view. Throughout the discussion, I emphasize the way scientists dealt with the unknown. When Bohr proposed his model, which was based on quantum theory, he freely admitted that it was crazy, but he thought it had some merit because it could explain experimental results that no other model could explain. I share one of his iconic quotes with the students:1

Anyone who is not shocked by quantum theory has not understood it.

I try to emphasize that Bohr couldn’t explain how his model was consistent with the science that was known at the time. However, he was forced to think it had merit because it was so successful at explaining and predicting the results of experiments.

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Can a COVID-19 Virus Communicate with Other COVID-19 Viruses?

I am writing this post because a reader asked me a question that I thought was very interesting and relates to a broader concept in biology. Before I answer her question, however, I want to make an important point about the virus that causes COVID-19 and how we should react to it. A few weeks ago, I gave the commencement address to a group of homeschoolers. Before I started my official remarks, I said this:

I am not going to say much about this virus, but I will say this: As a scientist, let me assure you that no one really knows what we should be doing. There are a lot of experts saying a lot of different things, and you should listen to all of them. Then, you should decide what works best for you and your family, and you should start doing it. But once you decide what you and your family should be doing, please please please show grace to those who choose to do something different. Since the experts can’t agree on a proper course of action, there is no reason to expect your neighbor to agree with your course of action.

I think that is the best way to approach this pandemic. The experts still can’t agree on exactly what to do because we just don’t know enough about this virus to make definitive choices. As a result of this ignorance, we must all muddle through this as best we can and realize that none of us has all the correct answers.

Now let me share my reader’s question:

Recently I came across a discussion online about quorum sensing in viruses. The initial topic had been the difference between groups meeting indoors verses outdoors, as many churches are now doing. I had never heard of quorum sensing before, so I did a little research, but I wondered if you would consider addressing this sometime. It sounds pretty fascinating to think viruses and such can actually monitor their environment.

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C.S. Lewis Never Said That

Perhaps it’s the academic in me, but I am always bothered when I see a quote attributed to someone who never said or wrote it. The situation becomes even more frustrating when it is someone whose work I know well. I was scrolling through my Facebook feed this morning and saw the following:

You do not have a soul.
You are a soul.
You have a body.
-C.S. Lewis

While I appreciate the thought, it was not something C.S. Lewis ever wrote, and I can’t find any record of anyone saying that he heard Lewis say that. In fact, the phrase was written several years before Lewis was born.

It can be found in a magazine called The British Friend, which was an important publication among Quakers in the United Kingdom. The author is discussing the way a Quaker should mourn the death of a loved one. To emphasize that the body is a temporary vessel but the soul is eternal, he states:1

“Never tell a child,” said George Macdonald, “you have a soul. Teach him, you are a soul; you have a body.” As we learn to think of things always in this order, that the body is but the temporary clothing of the soul, our views of death and the unbefittingness of customary mourning will approximate to those of Friends of earlier generations.

Since the author attributes this quote to George Macdonald, a minister Lewis respected and admired, you might say that perhaps C.S. Lewis said this in a lecture, quoting George Macdonald. That could be true, but I seriously doubt the Oxford Don would do that without giving proper attribution!

REFERENCE

1. W. H. F. A., “Be Not Entangled Again in a Yoke of Bondage,” The British Friend July 5, 1892, p. 157.
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