Where are the deaths? Ten reasons the first and second Covid waves look so different

In Europe the second wave is setting new records for daily cases but not for deaths so far (thankfully). So the big question is whether this will stay the same or follow the case tally up.

It’s probably not an accident that infections are spreading fast in mid October. Not only was it late summer in Europe, but the virus has been spreading mostly through 15 to 24 year old healthy young people and when Vitamin D levels were high. But as the Northern Hemisphere tracks away from the Sun, vitamin D levels are falling, temperatures are dropping, and the sterilizing rays of ultra violet grow weak. And, as the days grow colder people gather indoors too. Viral doses are rising.

The enduring scandal of the epidemic is that there are so many ways to treat this virus but they’re not expensive enough for the TGA to recommend them. ;- )

Lots more cases but not many deaths

Exhibit One: The United Kingdom

Some people have used this graph to claim the virus poses no threat. But it isn’t that simple.

Ten reasons death rates were lower in Europe’s second wave:

So much has changed. It will take whole PhDs to unpack the factors.

1. Demographics: In the second wave young people are the most likely to be infected, not high risk older folk (so far).
2. Vitamin D : reaches a peak each year in August and Sept.
3. Masks: Many people were wearing masks — meaning a lower viral dose and they are more likely to get an asymptomatic infection.
4. Doctors have better treatment plans.
5. Hospitals are not overrun (yet).
6. Temperatures were warmer: Viruses are unstable chemical codes.  As a rule, higher doses of virus will almost always survive longer in cooler air and on cooler surfaces.  As temperatures cool, we’d expect higher doses to be transmitted which means a more severe illness.
7. Social distancing: Bigger distances and outdoor events mean lower viral doses. But as the seasons cool, we spend more time indoors, which means higher doses as they get closer together.
8. UV light was stronger — A great outdoor sterilizer. UV also helps create Vitamin D. Obviously, it’s a summer time thing.
9. More testing in the second wave. Germany is doing 3 times as many tests; France, seven times, and the UK is doing 15 times as many tests now as it was in early April. A lot of the first wave caseload was simply missed. There is roughly a three week lag from tests until mortality (and it can be up to 8 weeks). This wasn’t apparent in many countries in the first wave because they didn’t do enough testing to show the true extent of infections — they missed the entire first peak, only starting to record new daily cases numbers properly as the deaths also peaked.
10. Mutations? Perhaps the virus has changed to be less deadly. This — our favourite option — the one we all want, may be true, but there is no genetic analysis that supports it yet so who knows?. If it is the case, we ought find a reliable genetic shift that correlates with lower viral loads and healthier patients. But natural selection favours a higher viral load and a more easily spread virus, and that’s what the few mutation studies seem to suggest.

There are new papers suggesting that the virus is mutating — and the most successful variants cause higher virals loads (as we’d expect, since they can outcompete the lower dose strains). Meanwhile many other analyses from Doctors in hospitals point in the opposite direction — suggesting that patients have lower viral loads as the pandemic progresses. Most likely masks and social distancing are reducing the viral load, even though mutations appear to increase it.

 A US study from the city of Detroit, presented at this week’s ESCMID Conference on Coronavirus Disease (ECCMID, online 23-25 September) shows that the initial SARS-CoV-2 viral load in nasopharyngeal samples has been decreasing as the pandemic progressed. The authors also observed that the decline in viral load was associated with a decrease in death rate.

The authors conclude: : “During the April-June 2020 period of the COVID-19 pandemic, the initial SARS-CoV-2 load steadily declined among hospitalised patients with a corresponding decrease in the percent of deaths over time.

Also from that paper:

As patient viral loads declined over the course of the pandemic, the percentage of patients admitted to the ICU declined substantially from March (6.7%) to April (1.1%), and May (0.0%).

“As the epidemiological context changed from high to low transmission setting, people were presumably exposed to a lower viral load, which has been previously associated to less severe clinical manifestations,” the authors wrote.

Look closely at  the last two months

The surge in cases in the northern hemisphere is growing. As are the deaths.

These graphs are just from August 2 – October 19.

 The three week lag

There is loosely a three week delay between diagnosing new cases and deaths. Deaths are clearly starting to rise.

In the UK, there were around 6,000 new cases a day from Sept 27th. Last week there were about 140 deaths a day. Assuming the three week lag is accurate, that’s a rough fatality rate among the known cases of 2%. The real fatality rate is significantly lower than that, though how much? The UK is testing 50 people to find each new case.

 

 

Vitamin D levels are falling as winter approaches.

Vitamin D reduced the rate of ICU admission in one study from 50% to 2%.

It doesnt have to be this way.

Vitamin D engages with some 200 genes. It’s so important, it’s probably the reason Europeans have white skin (to make D in the higher latitudes while eating a grain diet low in vitamin D). Its levels also correlate with lower rates of cancer, diabetes, high blood pressure, asthma, heart disease, dental caries, preeclampsia, autoimmune disease, depression, anxiety, and sleep disorders. One recent long German study showed half the people who died of respiratory illnesses might not have died if they had enough Vitamin D. Not surprisingly, given all these benefits, it’s even associated with “all cause mortality” which almost no other supplement or vitamin definitively is.

It’s cheap, safe, natural, and virtually no government on Earth has a program to test and restore healthy levels in its own populace. Read about D3..

 

 

Pandemics often come in waves. Because of the nasty surprise in the first wave, many people change their behaviour, especially the most vulnerable. This is what happens in all pandemics. They wear masks and wash hands but lose enthusiasm after a while. They  self isolate, then eventually they return, and then the next wave returns too.

Check out these graphs of the UK:

Most of the first wave was hidden by inadequate testing. The initial test positivity was 40% but is now around 2% and rising. So the current wave of testing is catching many infections that were missed in the first wave.

The second graph below shows the age groups which test positive. In many countries in Europe the first wave was predominantly in older people who had more serious cases and get tested. The second wave surge started with the 15 – 29 age group and is gradually spreading to older age groups.

 

Wave 1 had an invisible three week lag

In the first wave a lag between peak cases and peak deaths in some nations was sometimes as long as 3 weeks. But in nations without enough testing there was no apparent lag. This is probably because the peak new cases rose and fell before the testing stations got up to speed. For example: In the first wave in the UK the daily cases peaked on about April 10th which was also around the same time the deaths peaked. But in South Korea the daily cases peaked on March 2nd or so, but the daily deaths didn’t peak til March 24th or so. South Korea had an organised track trace and testing policy ready to go.

The good news

It’s not all bad that the first wave was earlier and higher that the tests showed. It effectively means more survivors in the first wave and thus a lower mortality rate. The not so good news is that if someone was to test positive — the crude morality rate is still 2% and that’s at a time when most of the people who are infected are quite young. So with uncounted asymptomatic cases that 2% might be more like half a percent. Though there might be another few percent over and above that, who didn’t die, but haven’t got well yet either — the long haulers.

The test rate per capita is now very high in the UK, though the positivity rate is around 2% and rising.  For comparison, Current test positivity in Australia is about 0.2% and during its darkest hours Victoria Australia was about 3% positivity.

Spread the word about Vitamin D, and Zinc. Write to politicians to why they will spend billions, lock people indoors, but not bother fixing known deficiencies with five cent vitamins?

The bad news

High risk people can be isolated from young party-goers for a while. It takes longer in the second or third waves for dumb viruses to catch up with older folks, but it does catch up. Sadly, and that’s probably what’s coming in Europe now, unless people get very serious about Vitamin D deficiency, and the other cheap treatments like Ivermectin, Bromhexine, HCQ and melatonin, and all the other antivirals….

We’re a lot better off than in Wave One. But things could still get pretty ugly especially in Winter.

When looking at cases versus deaths graphs. Don’t forget the lag.

REFERENCE

See posts on Lockdowns, Vitamin D, HCQ, Masks, Ivermectin, Bromhexine

EU CDC: https://covid19-country-overviews.ecdc.europa.eu/

Guesseous et al (2012) Vitamin D levels and associated factors: a population-based study in Switzerland, DOI: https://doi.org/10.4414/smw.2012.13719

Mask Use, compliance and rules: https://en.wikipedia.org/wiki/Face_masks_during_the_COVID-19_pandemic

Scott Wesley Long et al (2020) Molecular Architecture of Early Dissemination and Massive Second Wave of the SARS-CoV-2 Virus in a Major Metropolitan Area https://t.co/w6fzDDijPg read/write/request review https://t.co/RnurTL3DyM #COVID19