Coronavirus in Tbilisi – May 9th, 2021

Summary

Good news: WHO approved Sinopharm, Georgians (and expats) are signing up for it, the government is planning to expand the vaccination program, and more doses are coming in.

Bad news: Testing is down slightly; despite this, numbers are still up, and they’ll probably go up again next week.

Other: I rant about shortsightedness and extended restrictions; I talk about my vaccine experience; I discuss Sinopharm in terms of health and politics.

Numbers

5567 cases reported in Tbilisi this week, up from 5195 last week.  My model projected 5453 (4253 – 6653).

Nationwide we had 9474, up from 8964.  My model projected 9006 (7025 – 10,987).

Nationwide testing declined again from 158886 to 144641 and the positive test rate is up to 6.55%.

Just a reminder that because testing is low, the reported case numbers are also low compared to the actual cases.

Projections and Risk Assessment

My model projects 6591 cases reported next week in Tbilisi (5141 – 8041).  The reported numbers at this point depend heavily on testing – right now they’re testing about 20,000 people per day; if they go back to 25,000 or even 30,000 the numbers will jump up by a lot just from that.  In fact if we had tested this week at the rate we were testing three weeks ago, we would be looking at something like 7500 case reports in Tbilisi this week rather than 5500.  I expect testing numbers to rebound at least a little bit this week given that there isn’t a major religious and public holiday, but who knows what effect the enforced extended not-lockdown “holiday” will have?  We’re also going to start seeing the impact of the Easter celebrations and the impact of the “holiday” on actual cases and I don’t know which effect will dominate.  I consider next week to be quite uncertain.

Nationwide my model projects 10,324 cases (8,053 – 12,595) reported next week.

Based on the projected worst case, I’d assess risk at 1 in 100 again – as a rule of thumb, you can expect about one person out of one hundred in Tbilisi to be carrying an active infection that they don’t know about.  At a gathering of ten people, there’s about a one in ten chance someone is infected.  Remember to avoid closed/poorly ventilated spaces, and wear a mask if you’re going to be in any kind of indoor public space.

Aside: A Polemic About Public Health Interventions

Gamkrelidze seems to be saying that the “holiday” isn’t having much of an impact, and the rate of mask wearing is down ever-so-slightly, which are bad signs.  If we have a small Easter bump and minimal help from the “holiday” we’re in for a rough time, with restrictions being tightened and/or extended.

Believe me, while I very strongly believe the government needs to coordinate, lead, and enforce public health measures to protect the vulnerable, I am not pro-restriction or pro-lockdown for their own sake or out of some authoritarian impulse.  I want my kids to be in school and I want to be able to go out and see my friends.  I just wish the government had timed restrictions so that the most severe restrictions came in winter when we would mostly have been stuck inside anyway, so that we could go into the warmer weather period with low infection rates and feeling secure about doing outdoor recreational activities with minimal risk.

Instead, Gamkrelidze is now warning us (same link as above) about the possibility of extending restrictions.  Pardon my French, but this half-assed approach isn’t solving anything.  We should have ripped off the band-aid already and gotten the painful parts over with so we could all get back to our lives.  Instead we’ve been stuck in this limbo of half-restrictions and Orwellian lockdowns disguised as “holidays” and curfews and steadily increasing infection rates for the last three months, and there’s absolutely no prospect for any of it to get better in the next month.  This makes me furious because I could see it coming in February when they started lifting restrictions early.  There’s no reason for this short-sightedness.

Yes, I know that businesses said they couldn’t survive another month of lockdown.  I know that certain individuals seemed to believe the pandemic would magically disappear with no public health interventions at all due to a mysterious force that scientists were incapable of understanding.  I know that people thought vaccines would arrive in the country and the pandemic would instantly be over on that very day.  But here we are, the pandemic hasn’t disappeared, and we’re heading into tourist season with Tbilisi racking up the highest numbers of 2021 and no end in sight.  Did it occur to anyone that this scenario might be worse for business than if we had stayed locked down throughout February?

Not to mention the human cost of allowing a totally avoidable third wave to manifest.

But instead, certain members of the “business community” threw a tantrum and demanded the government give them priority – priority over our children’s education and social well-being; priority over the medium-term health of the tourist sector and by extension the entire economy; priority over people’s lives – and the government lost its spine and collapsed like a flan in a cupboard.

This is a good illustration of why public health interventions should be based on objective benchmarks which are clearly communicated in advance – so they’re less susceptible to pressure from the loudest or most economically-powerful special interest groups.  It’s not so much that the benchmarks represent the Infallible Word of Science which must be followed – it’s rather that having a reasonable benchmark is better than letting your public health policy be blown around by the shifting political winds.

Getting Vaccinated in Tbilisi

I was vaccinated with my first dose of Sinopharm on Wednesday.  My appointment was at the National Training Center for Family Medicine, which is around the block from Fabrika, near Marjanishvili metro.  There was a sign on the door with “COVID-19” in English and “vaccination” in Georgian, which is an interesting linguistic artifact.  My wife came with me for moral support as well as help with any translation, which turned out to be necessary because there was a screening questionnaire in Georgian.

When we went in someone greeted us immediately. They asked for my surname, took my temperature with a laser thermometer, and checked me off a printed list. I arrived early and they were able to get me in about six minutes early. The 10-minute spacing for appointments meant there weren’t many people, and the clinic didn’t seem to have much else going on. I was also able to wait outside on the front steps and get some fresh air.

The appointment itself was quite routine.  The questionnaire took some extra time due to the translation back-and-forth and the evaluation of my history of allergies. The shot itself was quick and painless.

They had a fairly comfortable waiting area for the observation period. Because I have a history of allergies (but not serious ones) they kept me for 45 minutes. This area also wasn’t very crowded – everyone was able to remain spaced 2 meters apart, and chairs were placed to facilitate/encourage distancing.

I would rate this as one of my more positive experiences with medical care in Georgia – everything was organized, simple, well-designed in terms of safety and hygiene, and user-friendly.  And of course the price was right (totally free).  I’ve heard from friends that some of the other sites weren’t necessarily as user-friendly as the Chugureti site, so if you don’t speak Georgian it might be helpful to enlist the help of a translator.

In terms of side effects, I had some very mild soreness at the injection site, and some very minor itchiness the next day, both of which are normal and harmless vaccine reactions.  I also admit that I suffered anxiety about the chance of anaphylaxis which was wildly out of proportion with my actual chances of getting anaphylaxis, but fortunately I have fairly good coping mechanisms for anxiety, such as distracting myself with video games or taking four-hour-long afternoon naps, so that wasn’t much of an issue.

This gets into the reasons why I chose Sinopharm over my other options (i.e. waiting, or traveling to the US for a Western-approved vaccine), which deserve their own section.

Sinopharm: Science and Geopolitics

First of all I just want to preface this by saying that for most people the risk:reward calculation of any vaccine probably favors getting the vaccine.  Just in Georgia, there have been 4281 confirmed covid deaths and one confirmed vaccine death, and medical mismanagement was a confirmed factor in that one death.

Still, it might be worth thinking about how to minimize risk if you have, for example, a choice between several vaccine options, and/or specific risk factors for any of the rare side effects of any of the vaccines.

This paper outlines anaphylaxis risk factors in the various available vaccines, although it seems to be missing Johnson & Johnson.  Based on the ingredients, Pfizer and Moderna represent the highest risk, followed by Sputnik and AZ, followed by all the rest.  This seems to be borne out by other evidence – in the US, Pfizer’s vaccine produced anaphylaxis in about 11.1 cases per million, although later numbers show Pfizer at a lower rate, of 5 per million, with Moderna at 2.5 per million.  In comparison, so far, from what I can find, there have been zero anaphylaxis reactions to Sinopharm, out of at least 65 million doses administered.

Now, this is where the geopolitics comes in.  I keep seeing Western news sources express skepticism about China’s data – and it’s true that China is not known for transparency, and the full results of China’s internal Sinopharm studies do not seem to have been released.  So let’s crunch some numbers.  Suppose Sinopharm has anaphylaxis numbers comparable to Moderna’s (I think they’re much lower, but suppose).  At 2.5 per million, with 65 million doses administered, that’s 162.5 cases of anaphylaxis expected.  These cases would be distributed across 45 countries.  So what are the chances that this actually happened, but not a single one of these cases made news, despite the media looking for them and jumping on every chance they get to sensationalize safety concerns about vaccines, and specifically Chinese vaccines?  What are the chances that the WHO spent months studying the evidence for Sinopharm, eventually listing it for emergency use, without noticing a single one of these cases, according to their assessment of evidence for Sinopharm?

I’m not naive.  I don’t trust the Chinese Communist Party to have my best interests at heart.  But the Chinese vaccination drive is part of a larger soft power strategy.  It’s intertwined with their Belt & Road initiative.  China wants to reach out to less-developed countries and present itself as a reliable and valuable partner, and a viable alternative for those countries to relying on the Imperialist West for things like lifesaving medicines and development aid.  This extends the market for Chinese products and reduces the likelihood that partner countries will take China to task for its human rights violations.  They’re trying to build up something like social capital, but on a global scale.

And I have to be honest: it’s working – at least, for me.  I feel deeply grateful for China’s vaccine diplomacy, especially at a time when the US is sitting on 10 million AZ doses which it has neither approved nor shipped to countries that need it.  The Western narrative about Chinese products is that they’re cheap knockoffs, or unreliable, or somehow of inherently lower quality than Western products.  I suspect that rolling out a vaccine that’s safer, cheaper, and easier to distribute than Western competitors, and getting it to markets like Georgia faster, is going to shape the way people view Chinese products in general for a long time.

Knowingly selling a dangerous or defective vaccine to 45 countries and counting would completely destroy those positive perceptions.  It would be very much out of line with China’s big-picture approach to geopolitics and its perceived self-interest.  With the WHO watching, and the health departments of countries around the world watching, there’s as much scrutiny on this vaccine as there ever is on anything.  China couldn’t get away with passing off bad product any more than AstraZeneca could get away with releasing fishy data.  And so it is in China’s political and economic interests to get this vaccine rollout right.  I trust those incentives about as much as I trust anything.

Back to the science: Sinopharm is made using a “classic” vaccine technology, which for me means there’s no particular reason to think it wouldn’t work or would have unpredictable side effects or was rushed in any way.  And nothing against newer vaccines, but there’s something comforting in taking a vaccine which was manufactured in exactly the same way as most of the previous vaccines I’ve taken, like my annual flu shots.

In conclusion: It’s hard for me to say how much I’m biased by motivated reasoning because Sinopharm was the only vaccine available to me at this point (I could have waited, or traveled to the US, but I couldn’t have accessed another vaccine by now).  On the other hand I think I probably have to fight some internalized bias against Chinese products because, as I said, there are stereotypes about Chinese products in the West, and I grew up with them.  But all things considered, I was glad to be able to get Sinopharm.  Based on the information we have it seems to be the safest coronavirus vaccine available, and in terms of efficacy it’s second-tier after the mRNA vaccines but comparable to AZ and better than J&J.  It’s incredibly difficult to untangle science from politics but to the extent that I can do this I believe I am justified in saying that Sinopharm was a good choice, and I would recommend it to others.

But let me reiterate that my belief is that almost everyone should get vaccinated as soon as they can with the first vaccine available unless they have specific risk factors for that specific vaccine, because the risks from covid far outweigh the risks from any of the vaccines.

Georgia is looking to open more vaccine centers and appointments next week, according to Gamkrelidze.  When slots are available, they show up on this booking portal.

Numbers courtesy of 1tv.ge, stopcov.ge, and ncdc.ge.  Stay healthy!

 

 

 

 

Posted in Health and Sickness in Georgia, Politics | Leave a comment

Coronavirus in Tbilisi – May 2nd, 2021

Numbers

5195 cases reported in Tbilisi this week. My model projected 4742 – 7416, so we’re within the margin of error this week. We’re a bit on the low end and that’s partially due to the predictable Easter testing slowdown.

Nationwide we had 8964 cases, up from 8393 cases last week. My model projected 7892 – 12344, so again, within the margin of error, but on the low end due to reduced testing.

Nationwide testing declined again from 183523 to 158886 and the positive test rate is up to 5.47%. Remember that 5% is commonly used as a benchmark to divide adequate testing from inadequate testing, and while it’s not a magic number, an increasing positive test rate suggests more missed cases, meaning that test-and-trace and isolation measures will be less effective.

Projections and risk assessment

My model predicts 5453 cases reported next week in Tbilisi (with a 22% margin of error, that’s 4253 – 6653 cases). I don’t know how testing will look given the holidays so it won’t surprise me if we get numbers on the low end.

My nationwide model predicts 9006 (7025 – 10,987) cases reported next week.

Because it’s clear to me that this week’s numbers are based on less testing – and therefore are underreporting actual infections more than usual – I want to set my risk assessment a bit higher than the projection would suggest. Last week it was 1 in 111, so this week I’ll set it to 1 in 100. Remember, this is just a guideline to help you think about how much risk you might be taking on if you go about your usual business in Tbilisi – if you interact with 100 people you’d expect about one of them to have a transmissible infection.

Another way to think about risk is to just consider the baseline infection risk for an average person in Tbilisi. Suppose testing picks up 1000 cases per day in Tbilisi. Based on random sampling of antibodies it seems that testing is picking up about one third of actual cases. This means that about 3000 people per day in Tbilisi are actually getting infected – this is about one person in 400. So if you take an exactly average amount of risk, your daily chance of getting coronavirus in Tbilisi is 1 in 400. This is not necessarily the best way to think about risk since it isn’t clear what an “average” amount of risk is, plus the average amount of risk changes as people in general adjust their risk levels. Still, finding ways to quantify risk – even if they’re sort of vague and unhelpful – can at least put risk levels in perspective so that we can reason about them with some sort of empirical grounding, rather than just pure intuitive guesswork.

Analysis: Holiday Bump?

Last year there was a small Easter bump – small enough that I wasn’t certain it would have been noticeable if we hadn’t been looking for it. I’ve seen mixed evidence on whether holidays in general cause spikes in cases. In any case, we probably won’t know in the next week – if there is an Easter bump it will start manifesting in higher numbers after 5-10 days.

Gamkrelidze says the rate of mask wearing is up to 80%.  I don’t know where or how he gets these numbers but if they’re accurate that means mask compliance has almost doubled since the last time I happened to notice an article about it.  A month ago it was at 51%.  More masking means lower transmission rates.  I don’t know the effect size but if you’ve been following my posts you’ll know that things are not nearly as bad right now as I thought they might be based on transmission rates in early April.  The only changing circumstances I’m aware of over the last month that could explain the decline in transmission rates are warmer weather and higher masking rates.  I think that gives us some small reason to hope that the third wave is near its peak already.

In November when we started getting reports about hospitals hitting capacity, there were 18552 known cases in the country.  Right now there are 15216.  That seems perilously close.  However, officials seem to have reacted by scaling up hospital capacity.  That gives us some more reason to hope things won’t get as bleak as they did in November – December.

The post-Easter non-lockdown extended public holiday extravaganza should be helpful as well.  Anecdotally, people in my extended Georgian family seem to be doing much less gathering than they would otherwise do on Easter.  My wife also tells me that banning cemetery visits was a good idea because people tend to crowd cemeteries around Easter.  My intuition was that it wasn’t a good idea because it would divert people away from an outdoor activity and towards indoor activities like large family gatherings, but she seems to think that people will just stay home instead.  I don’t know.

But look: we’re in a holiday with unpredictable effects on behavior, in circumstances that have never happened before (even last year).  We’re following it up with a pseudo-lockdown, again, with unpredictable effects on behavior since it’s never really been done.  Cases have been rising while tests have been falling which means we’re going into this unpredictable period with lower-quality data than we usually have.  At this point we’re at the limit of making good predictions – I just have no solid prediction about how this will all turn out or how it will look afterwards.

My best guess is that actual infections will rise next week and maybe stabilize the week after, and maybe drop a bit in the third week of May.  And then, absent any public policy changes, I think we’ll end up on a high plateau in June.  But again, we’re really entering uncharted waters here.

Vaccines

I’ve booked my appointment for Sinopharm on May 5th.  Appointments are no longer available in Tbilisi at this time, but there are probably still slots in the regions, and the government is looking at adding more vaccination options in Tbilisi.  They had over a year to plan for the logistics of the vaccination process and the Sinopharm vaccines will have been sitting on shelves in Tbilisi for a month by the time the first shots get into arms, so I’m still characterizing the vaccine rollout as a miserable failure, but better late than never.

I’m pretty thrilled to be getting a vaccine, and to be able to do things like go to friends’ houses again once the vaccine kicks in.  I’ll have a peace of mind that I haven’t had in over a year.  I’m looking forward to that.

Now that vaccines are open to the general public, the moral calculation of public policy becomes somewhat different.  Once a reasonable amount of time has passed, unvaccinated people are mostly going to be people who have chosen to assume risk.  The exception is children – who, while less vulnerable, are definitely not 100% safe.  The existence of a large pool of unvaccinated people will mean that the virus and its mutations will continue spreading, and there will continue to be small outbreaks in schools, which means that either a) we’ll all decide that the death rate for children is so low that it doesn’t matter, if five or ten kids die, that’s just bad luck or b) we’ll have continued disruption to the learning process throughout the next school year.  I have two school-aged children, so of course this concerns me very greatly – and I assume that the government will choose “continued disruption” over “let kids die”, so I’m expecting my kids to have a disrupted learning experience next year – but on balance I still feel positive about the prospect of loosening restrictions in general and getting life back to some semblance of pre-pandemic normality, at least in the social sphere.  My son in particular is looking forward to in-person school again, even if it does involve occasional disruption.

Tsertsvadze says they’ll start looking at lifting restrictions when 30% of the population has been vaccinated, which, at current vaccination rates, will be in four years or so (like I said, the vaccine rollout has been a miserable failure so far), but hopefully they’ll start speeding up the vaccination process soon.

Happy Easter!

Keeping this post short and optimistic today.  Seems appropriate.  Stay safe!

Numbers courtesy of ncdc.ge, stopcov.ge, and 1tv.ge.

Posted in Health and Sickness in Georgia | Leave a comment

Coronavirus in Tbilisi – April 25th, 2021

Numbers

4998 cases reported in Tbilisi this week – higher than last week, but also lower than my projection.  My projection last week was for 6629 cases, and 4998 is 24.6% less than that – a bit outside my stated 22% margin of error (which produced a range of 5171 – 8088).  I’ll talk about the reasons for this error in my analysis section, but for now, just keep in mind that the numbers are still growing, just maybe not as quickly as they did last week.

Nationwide we saw 8393 cases reported this week (up from 6962 last week), with a positive test rate of 4.57% (up from 3.41% last week)

Testing saw a decline from 204386 tests last week to 183523 tests this week, a difference of 20,863.

Projections and Risk Assessment

Last week I adjusted my model to account for increased transmission due to the prevalence of the UK strain.  That may have been a mistake, which I’ll discuss below, so this week I’m going back to the prior, unadjusted model.  This model predicts 6079 cases reported in Tbilisi next week (with a 22% margin of error, that’s 4742 – 7416 cases).  However, due to holidays, I expect actual case reports to be on the low end again.

Nationwide, using an exponential growth model based on 7-day growth rate of 7-day total cases, I’m predicting 10,118 cases (with margin of error: 7,892 – 12,344).  Same caveat applies as above.

Worst case, about one in 111 people you encounter in Tbilisi will have coronavirus.  In a gathering of 12 people, there’s about a one in ten chance that one or more people will be infected.

This week we have a slew of holidays – including Palm Sunday, today – and in particular I don’t expect much testing, if any, to occur on Good Friday or the whole four-day Easter weekend.  So don’t be surprised if the numbers are low again next week.  Holidays play complete havoc with my margins of error.

Anaylsis

These predictions seem much more optimistic than last week’s predictions – they suggest a much lower peak than I’d feared based on the prior infection rates.  I want to be completely transparent but I also don’t want to give out the impression that people can now let their guard down, because on the off chance that anyone actually acts on what I say here, I don’t want to be responsible for someone taking risks that they otherwise wouldn’t have taken and getting sick as a result.

So just to be totally clear: we are definitely still heading towards a peak.  It may or may not be worse than the second peak – I happen to think it will, but Gamkrelidze this week said he thinks it might not be – but I think there’s broad general consensus that we’re looking at a large wave of sickness, which is why officials have gone from denying that we’re in a wave to reassuring the public that there will be enough hospital beds and enough diagnostic tests to get us through it.

That said, why are the numbers so much better this week than I thought they’d be last week?  It’s a mix of factors, some of which are favorable, and some of which are less favorable.

One: reduced testing.  Testing declined by about 10% – in fact, if it had remained steady, we’d be looking at another 400 – 600 cases in Tbilisi alone, which would have placed this week’s case report within the margin of error for last week’s prediction.  However, my prediction was about 6600 cases, and adjusting for the testing deficit only gets us to 5600, at most – explaining about a third of the error.

Two, prevalence of the UK strain.  Two weeks ago, Georgian health officials were telling us that the UK strain was 20-30% prevalent.  Then they revised upwards to 50-70%.  As of this week they’re saying 70-90%.  But the prevalence of the UK strain didn’t go from 20% to 90% in two weeks.  The UK strain spreads quickly, but not that quickly – it needs time to propagate through the population and become the dominant strain.  Even given the highest estimates of its contagiousness, for the UK strain to go from 20% to 90% should take about seven weeks, given the infection rates in Georgia right now.

So I never really had good information about the prevalence of the UK strain, and it was a mistake to trust Gamkrelidze’s number – “the best available” doesn’t always translate to “good enough”.  At 50% prevalence I would need to adjust the weekly R upwards by a factor of 1.07.  At 90% prevalence I’d only adjust the weekly R upwards by a factor of 1.035.  In the latter case we get a prediction range (6255; 4879 – 7630) which places this week’s numbers within the margin of error.

Another issue with the UK strain adjustment I made is that I applied the weekly adjustment rate to the 4-day ratio, which I think was a mistake – applying it to the (derived) 7-day ratio gets us down to 6301 (4915 – 7688), again placing this week’s numbers within the margin of error.  This is a very small difference in cases, but in exponential functions these very small differences add up.  I probably should have tested my adjusted model on historical data before using it for a prediction.  Combined, if I’d applied the 90% prevalence adjustment to the derived 7-day ratio, the projection would have been 6095 (4754, 7436).

Still, ignoring the UK strain entirely gets me a better prediction than making any adjustments at all based on it, which seems strange.  Probably adjusting a little bit for the UK strain would have been correct, and other factors were just so strong that the additional contagiousness didn’t matter.  My takeaway is that the UK strain has probably reached such a high level of prevalence that whatever effects it was going to have on the infection rates have already happened, or else are so small that they won’t factor in to future projections.  This is good news in the sense that we aren’t looking at an upcoming surge in infection rates, but bad news in that the UK strain may have worse health outcomes.  I’ll say the adjustment for the UK strain accounts for about another third of the error.

Three, weather.  Weather appeared to be a minor factor during the first two waves of the pandemic – not at all enough to prevent these waves absent good public policy.  However, when the weather is warm enough for people to gather outdoors, but cool enough that they aren’t going back indoors to get air conditioning, people might have the tendency to gather in lower-risk settings.  People might also ventilate indoor spaces more by opening doors and windows.  I don’t want to quantify this effect because it’s speculative, but I also don’t want to ignore it.

Four, the “control system” – this is when people see rising indicators in the news and adjust their behavior accordingly.  Last week I theorized that high death rates and news about hospitals filling up might contribute to people adjusting their behavior to avoid risk.  While there is talk about hospitals filling up, it hasn’t happened yet.  Death rates have been pretty stable, increasing this week but too recently to have impacted the numbers.  Maybe seeing over 1000 cases, on April 13th, was a factor – moving from three figures to four figures is a psychological focal point.

Five, random statistical noise.  It could just be a totally weird coincidence that fewer people got infected, or went in for tests.  And also, last week could have been an outlier in terms of how many cases there were, making this week a correction, or return to the previous trend.

Six, perhaps public policy pushed in the right direction.  For example, the country started cracking down on large gatherings around April 10th.  These gatherings are known to play a large role in transmission.

Finally, I want to note – while this last factor wouldn’t produce a sudden decrease in infection rates, it will push rates downward, slowly at first, and more later – we may be approaching a point where enough people have been infected/vaccinated to start slowing the infection rates.  Gamkrelidze says the country has had 600,000 to 650,000 cases so far, but the serological survey in Tbilisi found that 35.5% of adults sampled had antibodies an estimated 35.5% of the adult population of Tbilisi has either been diagnosed with covid or has covid antibodies.

Aside: Tbilisi Antibody Survey

Okay, so an aside: it turns out the way this is being reported is a bit deceptive.  According to Tsertsvadze, they sampled 903 adults who said they hadn’t been diagnosed with covid, and 215 of them had covid antibodies.  That suggests that 23.8% of adults without confirmed covid have had covid.  They then added that to the estimated 11.7% of Tbilisi’s adult population with an official covid diagnosis to get 35.5%.  35.5% isn’t the actual result of random sampling, though.

Putting that aside, I notice a discrepancy.  Gamkrelidze is saying for every diagnosed case of covid there’s another one undiagnosed.  According to Tsertsvadze’s antibody study, for every diagnosed case of covid there are another two undiagnosed.  If Tsertsvadze’s results generalize that means that anywhere from 920,000 people (triple the current official case count) to 1,320,000 people (35.5% of Georgia’s population) have had covid in Georgia.

Again, as with the UK strain numbers, I just don’t really know how to interpret this discrepancy.  Even though the methodology behind the 35.5% number – relying on a combination of random sampling plus known past test results – is a bit sus, at least it is based on empirical, mostly-current information.  But on the other hand, the results of screening tests (at least for teachers) seem to back up the 1:1 ratio rather than the 2:1 ratio.  Perhaps some of the people with antibodies had enough exposure to the coronavirus to develop antibodies but not enough to have a detectible viral load on a PCR test or detectible antigens on an antigen test?

In any case, even the highest possible estimate of coronavirus antibody prevalence – that 35.5% of Georgians have antibodies – is nowhere near the 60-70% estimates of where you’d get “herd immunity”, or even near the 50% spot where you get a point of inflection in a logistic growth curve.  At this pace of infections + vaccines we’re still months away from where we should expect to see significant effects from herd immunity.   But maybe, in combination with a population of people self-isolating (like myself) and others taking reasonable precautions, it could be pushing the infection rate down a tiny bit.

Analysis, Continued: The Third Wave

Gamkrelidze says the peak will arrive in the first two weeks of May.  As I said, he says it won’t be quite as dramatic as what we had in November and December.  I hope that means he intends for the government to take mitigation measures sooner rather than later.  Even with my revised, more modest projections, we’re heading into Easter with 10,000 cases a week nationwide and we know that Easter week means lots of travel, plus large family gatherings, plus crowds at churches.

I’m not even going to try to predict what this will do to actual case counts, or whether there will be a pause in testing that will obscure the issue.  Things are going to get weird after Easter.  I’m also not clear on exactly what the government is planning to do to ensure that the peak is in the beginning of May – in other words, that cases start going down at the end of May.  There is still a lot of pressure on the government to relax restrictions.  There is no obvious force that will stop cases from going up throughout May and even Gamkrelidze still seems to want to pretend the government can just do nothing and have the pandemic remain manageable.  As I linked above, Tikaradze is saying the government is adding hospital beds already to prepare for the influx of new patients, and in addition to that, Gabunia says they are adding hotels and working with clinics to monitor patients at home.  I appreciate the solution-oriented mindset – believe me, I do – but what’s unsaid here is that “we’re adding hospital beds, hotel rooms, and home-care options” sounds a like like the answer to the question “what are we going to do when hospitals start overflowing?” and not at all like the answer to the question “what should we do now that we’ve successfully managed the third wave?”

Tsertsvadze also says that delayed hospitalization is the most common cause of death for covid patients.  I’m not sure if this is technically correct but it seems important that covid patients receive timely care and appropriate monitoring, and being forced to use hotel and home care because there isn’t room in hospitals would seem like an impediment to that.

Director Ivane Chkhaidze of the Iashvili Children’s Clinic (a very prestigious clinic where my own kids have been treated) says there have been 30,000 pediatric infections in the country and they’ve put together a team to treat kids with long covid and multisystem inflammatory syndrome.  The issue of covid in children is bound to get worse since the UK strain apparently infects more children and since there are currently no vaccines approved for children.  I bring this up because people seem to think that since the risk to young people is relatively low, it can be ignored or rounded off in some way.  Stopping the virus with public policy until vaccines can get us to herd immunity will save lives, and not just the lives of overweight diabetic alcoholic cancer patients over the age of 70.  Letting the virus run rampant through the population for an extra month or two will kill people, including some children, and will make others sick, in some cases for months or longer.  All this stuff has consequences.

How Not To Vaccinate

Given the urgency I described above, one might think that the Georgian authorities would be doing everything they can to vaccinate the population.  One would be mistaken. Warning: the following section employs heavy sarcasm.

I read an article saying that teachers would be involved in the vaccination process.  The thing is, unless you get your news from facebook, you’re really missing out on what’s actually going on.  So when the government says “teachers are involved in the vaccination process”, if you think that means that all teachers are now eligible to receive the vaccines, you are as hopelessly naive as I am.  Because what it actually means is that the government has changed nothing, the vaccine is still available only to people over the age of 55, and teachers are involved in the sense that by coincidence there happen to be some teachers who are over the age of 55 and they will be allowed to access the vaccines just like everyone else over the age of 55.  How generous!

In completely unrelated personal news, my son’s school has moved to online-only for a week because a teacher tested positive for covid last week.  This is perfectly normal and not at all disruptive to kids’ educational experience and emotional health.  Don’t worry about vaccinating teachers, it’s not important.

In fact, don’t worry about vaccinating anyone at all!

I took a look at the vaccine booking portal this week.  Empty appointments, all week.  If I were over 55 I could have booked an appointment and had my shot an hour later.

As of April 24th, only 36,056 people have been vaccinated.  That’s less than 1000 per day, meaning there are currently more people acquiring immunity from recovering from covid than there are from getting vaccinated.  That means they haven’t even used up the initial shipments of 43,000 AZ doses and 29,000 Pfizer doses.  They haven’t even started vaccinations with the 100,000 Sinopharm doses.  But like, even if they had – people aren’t booking appointments.  There are full vials of vaccines sitting in empty offices all over Tbilisi.  I thought it would be a while before demand outstripped supply but apparently I was mistaken.

They’re also going to be pausing vaccines for four days for Easter.  Because that’s what Jesus would have wanted.  Christ is risen!  The rest of us are screwed.  Not that I can even fault the government for pausing vaccinations – I mean, if people aren’t booking appointments on a random Tuesday in April, they’re definitely not going to book them on Easter weekend.

Obviously, they should open appointments to everyone who wants them, and then vaccinate people 24/7 until they run out of doses.  They should also do first doses first.  This would save lives, prevent suffering, and allow people to get back to some semblance of a normal life much more quickly.

Or, you know, they could continue vaccinating 6000 people per week.  At that rate we’ll start approaching herd immunity – with 60% vaccinated – by sometime in the middle of 2028.  Or who knows – maybe their goal is to reach herd immunity sooner by encouraging people to emigrate.

Living with Corona

Sarcasm aside, there’s good news and bad news this week.  The good news is the infection rate dropped and the increase in new cases was lower than I expected.  The third wave’s peak will probably be lower than the worst-case scenario I outlined last week.  May will be bad but maybe not horrible – maybe more comparable to January than to November.  At least there’s some reason to hope.

The bad news is, they’re still making plans for hospitals to overflow capacity, and the vaccination program is going nowhere fast.  There’s more pandemic fatigue than ever, and people want to open everything up for summer, even as cases (and deaths) are rising.  We’re about to experience a holiday bump of unknown severity.

Based on what I’ve learned this week, I’m less pessimistic about the medium-term, and more pessimistic about the long term.  I’m pessimistic that vaccination will succeed at all in Georgia.  It’s looking like covid will end up like the flu – a seasonal problem that conscientious people will get vaccinated against and everyone else will ignore.  It’s looking like we’ll just get used to the added death toll, the added suffering, the added long-covid.  We might even get used to wearing masks in many indoor settings, especially during covid and flu season.

And maybe that’s fine.  Life is always full of risks and we can only focus so much on them before they start impacting our quality of life.  I try to limit myself to one day out of seven obsessing about covid, and I spend the other six working, hanging out with my kids, playing games, reading about non-covid stuff, etc.  Maybe by the summer it will be one day every two weeks.  Maybe we’re all just getting used to life with coronavirus, and some of us are faster to adapt than others.  I just can’t get over the feeling that we’re throwing in the towel when we’re on the cusp of victory – or that humanity as a whole could have beaten covid if we were just, like, 10% more conscientious.

On the other hand, supposedly viruses in general are supposed to evolve to become less deadly over time.  Maybe someday corona will just be another cold.  Maybe we’ll even cure it.  Maybe the takeaway is that medical science gave us options in this pandemic that we didn’t have in the Spanish Flu of 1918 – that we should be grateful the death rate is so low and the vaccines were so quick to arrive.  Sure, it could have been better – but it could have been a lot worse.

Conclusion: Confidence Levels

I’m always a bit self-conscious about making predictions about covid given how many experts have made predictions that have turned out to be total nonsense.  This is especially so in a week where my prediction was off by 24.6%.

However, if I get one prediction in 20 wrong, that’s an accuracy rate of 95%.  I should feel pretty good about that, except I’m a pessimist so my natural tendency is to focus on the one miss, rather than the nineteen hits.  Of course, focusing on the one miss does help me stay sharp, and identify mistakes and biases in my thinking, so I can improve my prediction models and train my intuition over time.  If you only focus on what you get right, it’s hard to improve.

I just want to make it clear again that when I report official numbers or official statements, I’m highly confident that they are in fact the official numbers and statements.  If I have any particular reason to doubt them (e.g. “I think the official case count is low because the positive test rate is high”) I will state that.  Usually I will link to sources.

I’m also highly confident in my week to week forecasts – generally, 90-95% confident, meaning I expect to miss about one in ten or one in twenty.

Medium-term forecasts – for instance, numbers after a week, or when the next wave will hit, or when the country will hit 60% vaccination – I’m less certain about.  Generally, you can regard them as “informed speculation” unless I put a specific confidence number on them (e.g. I might say “I’m 75% confident we won’t hit 20% vaccination in Georgia in 2021” or “I’m 60% confident there will be a fourth wave starting between September and December”).  What “60% confident” means is that if I make 10 predictions at 60% confidence, I expect 6 of them to come true and 4 to be incorrect.

Long-term forecasts – anything a year or more out – are informed speculation.  Except the upcoming robot apocalypse – that I’m certain about.

As usual, numbers from 1tv.ge and stopcov.ge unless stated otherwise.

Posted in Health and Sickness in Georgia | 1 Comment

Coronavirus in Tbilisi – April 18th, 2021

Numbers

3942 cases reported in Tbilisi this week.  My projection was between 2586 and 4045.

Nationwide there were 6962 cases reported this week, with a positivity rate of 3.41%.

There are 10478 active cases, and testing in schools confirms about .3% of adults are infected, meaning we’d expect another ~11150 active cases nationwide, which is in line with estimates that testing is picking up about half of cases.

Projection and Risk Assessment

This week I’m adjusting my model to account for growth due to the prevalence of the UK strain.  That’s a figure that I can quantify using a mathematical model, and it’s reliable in the sense that it’s based on Gamkrelidze’s statement last week that UK cases were 50-70% of new cases, and that the growth in cases this week provides some evidence that we were indeed somewhere within that range.

Pre-adjustment my model predicted 5889 cases reported in Tbilisi in the next week.  With adjustment I’m predicting 6629 (with margin of error: 5171 – 8088) cases reported in Tbilisi in the next seven days.

This gives me a risk assessment of 1 in 100 for Tbilisi in the worst case – meaning that in a gathering of 10 people, there’s about a 1 in 10 chance that one or more people have covid.  Yes, this is much riskier than last week.  This is also a very bad time to get covid, because as I will discuss, I expect hospitals to fill up soon.  There is evidence that the UK strain is more deadly than the base variant and media reports to the contrary are lying; there is also evidence that it isn’t more deadly.  I’ll leave it for experts to debate the strength of the evidence and the merits and limitations of the various studies, but please don’t fall victim to the media’s amnesia here and assume that the most recent study is necessarily the definitive one.  One point of agreement is that the UK strain is more contagious – so each interaction is more likely to spread covid now than it was during the second wave.  This would be a good time to isolate yourself if you have any risk factors, or live with people who do.

To predict nationwide cases for the next few weeks, I built a simple model based on this week’s growth rate, the UK adjustment (assuming the UK strain is 1.7 times as infectious as the base strain), and current case numbers.   The model projects 11,366 cases reported nationwide in the next week (with a 25% margin of error: 8524 – 14207).  Then 19,808 cases reported in the week ending on Easter Sunday, May 2nd.  Then 36,417 in the week ending on Sunday, May 9th.  36,000 cases in a week would represent the worst week of the pandemic – the most we’ve ever had before was 31,317, on December 4th-10th.  Two things are notable about this projection: one, it means that if the second wave is any indication, hospitals will hit capacity at some point in the week after Easter; two, it means these numbers are baked in already by Easter, and cannot be affected at all by the post-Easter “holiday” non-lockdown, or in fact by any post-Easter interventions.  In other words, my model predicts that at this rate, without a lockdown in the next two weeks, hospitals will be overflowing in three weeks.  (This model could be wrong, and predicting two-three weeks out is obviously much more error-prone than simply projecting next week because the error compounds over time, but I don’t have any specific reason to think it won’t be relatively accurate in this case.)

It’s actually a little bit worse than that, though.  During the second wave, cases were distributed around the country so that Tbilisi was getting about 40% of new cases.  This time around, we’ve been getting 50 – 60% of new cases.  If, in fact, new cases are more concentrated in Tbilisi right now (and this isn’t some kind of testing fluke) then there’s a chance that Tbilisi hospitals will hit capacity earlier.  My Tbilisi model projects that before Easter Sunday, the number of weekly new cases in Tbilisi will exceed the number of weekly new cases as of November 24th, which is when my records state hospitals in Tbilisi started overflowing.  Barring something like Tbilisi increasing its hospital capacity, it’s therefore quite possible that hospitals here will be overwhelmed at some point in the next two weeks.

I know – that sounds really extreme compared to where we are right now in terms of case numbers and how seriously everyone seems to be taking this wave.  But this is exactly what I’ve previously said is so dangerous about the UK strain – the likelihood that it will sneak up on us so that by the time anyone realizes the magnitude of the problem it will be too late to do anything about it.  It seems weird to say we could go from “everything seems fine” to “wow this is worse than the second wave” in two or three weeks.  We can, and we will, unless someone in power does something to prevent it.  Like, right now.

It’s actually even a little bit worse than that, though.  My model takes into account the current growth rate and the UK strain, but does not take into account human behavior or public policy.  That’s a problem because right now those two factors are making things worse.  If they continue to do so, my projections above will underestimate the severity of the situation by 10-15% per week (so it could easily be, like 50% worse, or more, within three weeks – we could be looking at 50,000 – 60,000 cases in the week after Easter).  I’ll just note here that my third wave predictions have been growing every week as the infection rates have continued rising and it’s looking like we’re going to be much closer to my worst case estimates than my average case estimates.

Analysis: Why is this happening?

Honestly for much of the week it was looking like the case count might be so high that it could exceed my error margin, and I spent a lot of time thinking about why.  After running the numbers, it looks like the UK strain is responsible for at most half of the increase in infection rates, and the rest therefore is down to environmental factors, testing patterns, public policy, and individual behavior.  Environmental factors have a minimal effect on coronavirus and at this point that effect would be working against an increase in infection rates anyway.  Testing had a slight drop on April 9th because of the holiday, which would have the effect of making last week’s numbers seem lower, which would have produced a low projection; testing is back on track this week so we’re getting higher numbers.  But I think probably half of the increase is down to public policy.

Not to beat this drum overly hard, but it very much looks like the government doing things like opening cinemas is causing a very noticeable increase in infection rates.  This occurs both as a first-order, direct effect – people go to cinemas, etc., and get infected – and as a second-order, indirect effect – people hear that cinemas are open and draw the conclusion that if the government says it’s safe to go to the movies, then it therefore must be safe to have a meal in a restaurant, or go to a friend’s birthday party, or something else which carries an increased transmission risk.

All of these increased transmission risks are small – going to a party with 30 people might only give you like a 1% chance of getting covid – but at the population level, when you have thousands of people increasing their daily covid risks by 1%, you’re going to get rising case numbers even though most of those people don’t end up getting infected.  And then people say “ah, I went to X event last week and I didn’t get covid” and so they go to more events, and there’s a bit of a feedback loop that only gets interrupted when something really scary happens – when someone you know dies, or when hospitals start overflowing, or something else.  So the only thing pushing back against this trend of individuals taking more risks will be when the death rate gets high enough that a lot of people know someone who has recently died, or when the hospitalization numbers get high enough that the medical system hits capacity (which is what happened in November).  I’ve come to regard this as a more or less immutable law of human nature – no amount of cajoling people about gatherings and safety can outweigh the lived experience of seeing everyone around you going to the movies or a restaurant or a birthday party and come back without covid.  We (the cajolers) just become part of the background noise that people tune out.  Empirically, only government intervention can interrupt this cycle – as we saw in Georgia during the first wave of the pandemic.

I don’t want to sound preachy.  Different people have different values, and I guess it’s to be expected that some people looked at the pandemic management in Georgians first wave and second wave and thought “yes, the government definitely handled the second wave better, let’s do that again.”  I disagree with those people, but it’s because of my values, and not because of “math” or “science”.  I just think it’s better to expend collective resources to save lives and prevent suffering.  But to circle back around to the numbers this week: in my opinion, the reason they’re high is that the government is letting them grow, which is their natural state absent intervention.  I don’t think it’s true or useful to blame individual behavior when we’ve already observed that government intervention is the only force capable of suppressing a wave.

Public Health Communication aka The Next Lockdown

Today Gamkrelidze said the virus is expected to peak in the next two to three weeks.  In some sense that sounds a lot like what I’ve just said in my projection, but there’s a difference.  I said that three weeks from now we’ll probably have had the worst week of the pandemic, so far.  Gamkrelidze is saying it will probably be the worst week, period.  In other words, Gamkrelidze seems oddly confident that things will not continue to get even worse after May 9th, whereas my projection is agnostic; we could well hit 50,000 to 60,000 cases per week in mid-May.

So where does Gamkrelidze’s confidence come from?  I hate to play the game of second-guessing these public health officials and trying to read into their statements like tea leaves.  However, it seems to me that the most likely interpretation of this statement is that Gamkrelidze knows that the government is planning a hard lockdown after Easter – or possibly before Easter – so he has good reason to believe we’ll have a peak in early May rather than mid-May or late May.  The other alternatives are that he could have a much better model than I do – for example, he could be using a logistic growth model (which takes herd immunity into account) with decent statistics about how many people in the country have acquired antibodies (statistics which I don’t have) – or he could have a much worse model than I do – for example, he might not be adjusting for the change in infectiousness due to the UK strain; or he could mean something different by “peak” than I mean by “peak”, or he could just be lying.  Normally I wouldn’t accuse someone of possibly lying, but he’s been lying about the third wave for like a month now, so I no longer trust his general statements describing the various parts of the waves of the pandemic.

The whole thing where they’re framing the next lockdown as an extended Easter holiday doesn’t seem to be fooling anyone.  I have no training or experience in PR and no evidence whatsoever about the impact that various communication strategies have on public behavior, but this just seems silly to me.  Maybe what I regard as Orwellian nonsense is actually an effective way of breaking bad news to the public?

Certainly it’s caused some confusion at schools since schools have off during a holiday but go online during a lockdown – so are schools supposed to close entirely, or go online?  It makes more sense to  me to go online so students aren’t missing yet more instruction – not that I’d mind a holiday, but if it means making up those days in June, then no thank you.

Personally, it just makes me think that they still aren’t taking this seriously.  How much time must they have wasted coming up with this ridiculous “holiday” framing and negotiating a communication strategy and then making endless clarifications because no one knows what the heck they’re talking about, just to be able to avoid admitting that we are in a deadly third wave which will be worse than the second unless the government steps in to avert the catastrophe?  I wish they’d spare us all the mental gymnastics and just do what needs to be done.

Prevention

This may be obvious, but may be worth saying anyway.  Avoid indoor gatherings of any size.  Avoid crowds outdoors.  Wear a mask, of the highest quality you can find; or wear cloth over surgical.  Vitamin D might help with covid and anyway certainly doesn’t hurt, so go outside and get some sun – at least 15 minutes a day.  A healthy diet and lifestyle in general will help – not just as an immune booster, but as a stress reducer.  Walk, exercise, breathe fresh air.  “Locked down” doesn’t mean “locked in”.

Well that’s it for this week.  Everyone stay safe and healthy!

Covid numbers via stopcov.ge, ncdc.ge, and 1tv.ge.

Posted in Health and Sickness in Georgia | Leave a comment

Coronavirus in Tbilisi – April 11th, 2021

Numbers

2437 cases reported in Tbilisi this week.  My projection was 2379 (with margin of error: 1856-2903).  The positive test rate for the week went up from 2.01 to 2.5.

The weekly infection rate (the growth from one week to the next) averaged 1.22 last week and 1.27 this week.  We can expect it to continue increasing as the UK strain becomes more prevalent and the impact of relaxed restrictions continues to set in.

Due to the holiday this week (April 9th) the reported case numbers may be slightly lower than normal, meaning we might be slightly worse off than we seem.

Projection and Risk Assessment

My exponential growth model predicts 3315 cases reported in Tbilisi next week (with margin of error: 2586 – 4045).  Including the increase in infection rate from UK cases, I’m thinking we’ll see at least 3500.  Depending on how much impact other news events (like opening movie theatres) have, we might see even more.  Also there are no holidays coming up, that I know of.  So my guess is the numbers next week will be on the high end of the prediction range.

Risk assessment based on worst case scenario is about 1 in 250 people in Tbilisi will be infected and transmitting.

At current infection rates, we’ll see roughly 5900 cases in Tbilisi the week ending on Easter (Sunday, May 2nd).  That’s the equivalent of around November 6th – 7th in the second wave.  Hospitals filled up when we got to around 10,000 cases per week in Tbilisi, which, at current rates, we’ll hit by the second week of May.  Hopefully cases won’t go much higher than that, but it means we’re probably looking at a very hard lockdown by the end of May and continuing through June, or else some kind of unprecedented collapse of the medical system.  This might happen a bit earlier depending on the state of the UK strain.  Speaking of which:

News

Gamkrelidze says the UK strain makes up 20-30% of new cases. Unfortunately there doesn’t seem to be any context for this number – is it an educated guess? Is it based on random sampling of all new tests? I have no idea how much to rely on it. If it’s correct, however, then the UK strain should overtake the original strain by around Easter (that is, more than 50% of cases will be UK), and that process would cause about a 10% rise in the overall infection rate.  That sounds small, but in practice what it looks like is an additional 900 cases that week in Tbilisi.  It also gets us to 10,000 cases per week in the first week of May rather than the second.  This might mean we get into – and out of – lockdown more quickly.  Before you celebrate, note that an earlier peak means that people who otherwise would have lived to get vaccinated won’t.  The goal of public policy should have been to delay the third wave as much as possible to get as many people vaccinated as possible.  Instead, the timing couldn’t be worse – we’re heading into a peak at the exact same time as the year’s biggest holiday and we’ll be forced into lockdown at exactly the time when we should have been opening up for tourism and mass vaccination is scheduled to start as soon as the third wave has passed.

Again, I have no idea how accurate Gamkrelidze’s number is, but it’s definitely plausible given the progression of the UK strain elsewhere.  Note that based on the last numbers released before this statement (about 72 confirmed UK cases) I had projected that the UK strain wouldn’t be dominant yet by Easter, so my overall prognosis is now a little bit worse than before in terms of how quickly the numbers will rise.

And look – as I wrote this, apparently Gamkrelidze has increased his estimate to 50-70%!  It’s breaking news, people!  At this rate, by the time I finish this post it will be 80 – 110%!  (That was a joke, obviously – it can’t be 110%).  This is just unbelievably sloppy, and Gamkrelidze needs to be more transparent as to where he’s getting this information from.  To give estimates ranging from 20% – 70% in a period of four days with no explanation is just absolutely maddening.  Where’s the data?  Where’s the transparency?  Apparently not even Gamkrelidze has any idea how accurate Gamkrelidze’s number is.  The UK strain didn’t jump from 20% to 70% in four days; this is clearly a case of Gamkrelidze not owning up to his mistakes.  If any of my students are reading this: this is why you need to cite your sources.

Speaking of a maddening lack of transparency, the Georgian government has decided to embiggen Easter this year in order to fight the pandemic.  Apparently May 3rd and 12th were already public holidays, so now they’ve added the 4th through 11th, meaning the entire Easter holiday will last from Friday, April 30th (Good Friday) to Wednesday, May 12th (St. Andrew’s Day).  Things will then go back to normal on Thursday, May 13th – unless, for some reason, you need to access emergency medical care, in which case you will probably be SOL.

What to make of this extended “holiday”?  Is this an Orwellian spin on the lockdown I’ve claimed we’ll need by the end of May?  Is this a cockamamie scheme that’s just crazy enough to work?  Is this a morale booster for beleaguered workers desperate for some more time off?  Or a poke in the eye to restauranteurs who have demanded early openings?  The fact that this announcement has apparently been met with such universal confusion that a government spokesman had to clarify what they meant by “holiday” tells me that nobody really knows.  What will be open?  What will be closed?  It’s anybody’s guess.  Again: no data, no transparency, no real clarity on what any of this means.  The government’s communication here is just egregiously bad and getting worse.

A Slight Doubling

The Ministry of Education and Science (MES) reports that there has been a slight increase in the number of coronavirus cases in schools.  The number of cases among teachers and administrators has increased from 0.1% to 0.2%.  “Twice as many cases” seems like a bit more than a “slight” increase, but who knows – maybe it went from 0.14% to 0.16% and they’re just rounding the numbers to 0.1% and 0.2%.  Apparently the MES is releasing these numbers via facebook post anyway.

That facebook post initially reported that 0.4% of students had tested positive.  This would be an astronomical increase (it was 0.02% two weeks ago, and 0.03% last week, so we could expect something like o.04% this week) and when I saw it reported on 1tv.ge I assumed it was a transcription error.  Then I checked and found the same number elsewhere (on.ge, newsreport.ge, imedinews.ge) and assumed maybe the MES had made a mistake.  I looked at their contact page and noticed that they had a facebook page, and so I went there and left a comment asking if the number was correct.  Their social media person responded quickly – within about 30 minutes – confirming that it was a typo, and the real number was 0.04%.  Note that most of these sources have now corrected the error, without printing an acknowledgement of it.

What’s the takeaway?  It’s nice having a public agency be responsive and quickly correct small mistakes.  I’m tempted to be critical of a Ministry using facebook as its primary PR tool but on the other hand it does allow for this kind of quick back-and-forth.  A hypothetical journalist who covers coronavirus in Georgia would have been able to do what I did – notice the number didn’t comport with previous weeks’ statistics, asked what was up, and received a response before publication time – rather than reprint the mistake.

On the other hand, that didn’t happen, so…

This story also shows us that it’s important to follow news critically and conscientiously.  I usually prefer analysis to raw news because the analysts are going to double-check the press releases for typos and other types of mistakes.  The analysts are going to know enough about a topic to notice when a number just sounds wrong.  However, in Georgia all I can get is the raw news, so I have to do the analysis myself.  On the other hand, reading analysis means you get the news filtered through more than just fact-checking.  Every analyst, myself included, has biases and blind spots.  The same factors that cause me to pay extra attention to numbers in schools (the fact that I’m both a teacher, and a parent of a child who is learning remotely) might cause me to pay less attention to other things.

That’s why I try to present my reasoning in addition to my conclusions – and why it’s frustrating when an actual expert like Gamkrelidze presents his conclusions (like the “20-30% of cases are UK cases”) without his reasoning or evidence or data.  If I don’t know how Gamkrelidze got that number, it’s impossible for me to independently evaluate his analysis in light of his biases and blind spots – or to predict that he’ll change his mind four days later.  If I don’t know why Gamkrelidze keeps refusing to say that we’re in the third wave, then I don’t know if I’m mistaken about something, or if he is, or if he has access to more/different information, or if he’s working on a different definition of “wave”, or if his statements are motivated by a communication strategy to manipulate the public rather than to tell the truth, or something else entirely.  Maybe I should just try writing to Gamkrelidze on facebook too.

If I were doing this full time (and spoke better Georgian) I’d be calling the Ministry of Health and the NCDC and various other agencies daily and following up with all the open questions I’m writing about here.  I don’t know why there apparently isn’t a journalist in the whole country who gets paid to cover covid.

Anyway, let’s run the same analysis on the MES numbers as I did two weeks ago.  If 0.2% of adults in schools had undiagnosed covid cases (which were caught by screening tests) then about 0.2% of the population at large will have undiagnosed covid cases.  0.2% of about 4 million is about 8000.  That suggests there are probably about 8000 active cases of covid nationwide that have not been diagnosed.  The number of known active cases is 7190.  So, the MES numbers suggest, again, that we’re missing about half of cases.  I know it looks like we’re missing slightly more than half, but honestly 0.2% isn’t enough precision to make this calculation at that level of significance.  If they’re rounding up from 0.18% then that suggests 7200, and I don’t have any evidence that they aren’t rounding up from 0.18%.  They could also be rounding down from 0.24%.  Also, teachers aren’t a random sample of the population so despite studies that teachers are generally infected at about the same rate as non-teachers there might be some confounding factor in Georgia in particular.  The MES number should give us a small amount of additional confidence that our other estimates – based on national reported testing and confirmed cases – are approximately in the right ballpark; it shouldn’t be used independently as a precise estimate of incidence in the general population.

Vaccines

There has been an increase in evidence that the AstraZeneca vaccines may cause blood clots.  Earlier I had said this was almost certainly not true, so obviously I’m really glad I put that “almost” in there.  Still, I think I’ll take the hit on this one and say I may have been too quick to dismiss the early evidence as a statistical artifact.  I don’t pretend to have any special knowledge about vaccines and my position on any vaccine is “the experts are probably right about whatever they say about it”, and so when the relevant experts were saying the number of clotting cases didn’t reach statistical significance I basically adopted that position, and now that they’re saying there might be a link after all I’m adopting this position.  Should I be less certain about the claims of vaccine experts in the future?  Probably not.  I think this type of mistake is probably rare enough that I’ll still be right more often if I believe whatever vaccine experts say about vaccines than if I believe what strangers are telling me on facebook, even if in this one particular crazy case the strangers on facebook turn out to have been right.

Georgia is still working on getting a bunch of vaccines.  I’m not going to go into specifics about most of them because, again, it’s not going to matter much for the third wave, which will peak by late May, how many vaccines we end up with in July.  The exception here is the 100,000 Sinopharm vaccines which the country has now and plans to start giving by April 20th.  That’s obviously good news for the 50,000 people who will get vaccinated, but it’s not going to move the needle much in terms of overall infection rate or the course of the third wave.

Well, I’m going to end on that.  It’s been a hectic news day, especially for a Sunday, and this post has run very long.  Good luck, everyone!

Daily numbers from stopcov.ge and 1tv.ge.

 

Posted in Health and Sickness in Georgia | Leave a comment

Lord of the Flies

I read Lord of the Flies about fifteen years ago.  Having grown up with asthma, the part that stuck with me was obviously the part where the asthmatic kid gets bullied and eventually murdered.

Yes, this is a pandemic post.

The first time I had pneumonia, I was in seventh grade.  I was in school, and I had some trouble breathing.  I took my inhaler, but it didn’t work.  That had never happened before.  I went to the main office and the school called my parents.  I had a pain in my shoulder every time I breathed in.  Turns out that was referred pain – the infection was in my lung.

When you’re twelve you don’t really have a sense of your own mortality.  I don’t think the thought “this could kill me” ever crossed my mind.  Even though kids do die from asthma, and pneumonia.  Less so now, with modern medical treatment, but even so it still happens.  I certainly had no concept that twenty-seven years later, I’d be thinking back upon that moment as the first of many damaging lung infections.

Two years ago I went to Dubai and got a sudden and severe case of pneumonia.  In retrospect I assume it was Legionnaire’s disease – severe pneumonia which spreads through ventilation systems at hotels and other large institutions.  I remember lying in bed, short of breath, and thinking – “this is how I’m going to die”.  I didn’t mean right then – I assumed I’d get over that bout – but pneumonia is getting worse, with new antibiotic-resistant strains developing, and I was worried that at some point (hopefully far in the future) I’d catch one.

Pneumonia seems like a horrible way to die.  I’d rather be mauled to death by a tiger.

After the Legionnaire’s, I had persistent chest pain and shortness of breath.  Eventually I would get a diagnosis of COPD, which is just another way of saying that all of the various things which have damaged my lungs – from bronchitis to pneumonia to air pollution – have added up to the point where they are just not functioning at 100%.

In one sense, COPD is my pre-existing condition – the thing that objectively increases my risk of leaving my children fatherless, and therefore fuels my obsession with the pandemic.  But in another sense, the psychological damage is worse.  My pre-existing condition is the trauma of decades of suffering from lung disease.  The decades of being Piggy from Lord of the Flies, always having to rely on others’ good nature to please not smoke around me, please not wear strong perfume, please slow down a bit so the asthmatic kid can keep up, etc. etc. etc.   And people are usually nice about it – the world is usually not Lord of the Flies.

But sometimes it is.

Lord of the Flies is the failure mode of civilization.  It’s not just what happens when a bunch of preadolescent boys are stranded on an island.  It’s like – and forgive me for straying into literary analysis 101 – an allegory.  In this pandemic, we’re allegorically all preadolescent boys stranded on an island.  The “preadolescence” is our inexperience with this particular pandemic.  The island is the world under covid.  The conch – a talisman that gives the holder the right to address the community – is “expertise” or scientific credentials or credibility.

It just takes one sadistic kid to kill the asthmatic kid and smash the conch to pieces.  I don’t want to sound apocalyptic, but that’s what it feels like to be vulnerable to covid and then see people ignoring experts, ignoring science, and demanding that they be allowed to just do whatever they want.  To pretend the pandemic is over when it’s not.  To pretend it never really existed in the first place.

I don’t spend my days in constant anxiety.  That would be exhausting.  At the beginning of the pandemic, when it was all still new, I would take stress naps – it would all be too much and I’d just sleep for four hours.  After about two weeks they became much less frequent.  As of now, I haven’t had a stress nap in months.

But I also can’t pretend things are totally normal.  Every time I have chest pain I go through the mantra of “this is just COPD, not covid” and I do my breathing exercises which ease COPD symptoms and also seem to reduce anxiety.  In Tbilisi the air quality seems to be pretty bad, and I get chest pains about once a week, even with my COPD meds.  In Bakuriani I went about ten days without even needing the medications.  The air quality is better up there.  Also, I was more relaxed.  It’s very hard to tease apart the physical symptoms of COPD from the physical symptoms of stress.

And that’s why when I see a news article about Georgian movie theaters opening on the same day I see an article about the UK strain now being 20-30% of new cases, I have to do some breathing exercises.  I can physically feel the anxiety building.

As a person in a “risk group” I take it personally when people advocate for things that are going to make the pandemic worse.  When restaurant owners go out on the street and demand an end to curfew, I see Roger pushing the boulder that’s going to roll down the mountain and crush me.  Oh, they can tell themselves that curfew doesn’t work, but who are they kidding?  If the curfew didn’t reduce their business they wouldn’t be out protesting, would they?  And aren’t these the same people who were out in February demanding to be allowed to operate indoor dining?  Everyone knows that running bars and restaurants and movie theaters is going to increase infection rates, and the longer they run for, the higher the increase will be.  They know, but they don’t care.  They know, but this is Lord of the Flies.

I guess I resent it, but also, this is just what my life is like.  I’m always going to be the asthmatic kid who needs to just hope that others don’t decide to randomly kill him because it seemed like a good idea at the time.  I’m always going to be the kid who asks, begs, cajoles, and demands that other people be civilized, because I know that when civilization fails I’m going to be the first victim of the “every man for himself” mentality that will ensue.

The pandemic thrust us all into an unfamiliar situation.  A demanding situation.  Everyone is being asked to make sacrifices.  It’s hard.  The government, as an instrument of a healthy and functioning civilization, needs to arrange things so that no one is starving due to these sacrifices.  I know some will say “I don’t want a handout – I just want to be allowed to work for a living.”  Well, I’m sorry, but if your job is in a high-risk sector, your pride is getting people killed.  Take the handout until the pandemic is over.  Some will say the government’s supports are not enough.  Go out and demand more, then, if you’re going to demand something.  “We need help!” is better than “Let us kill people!”

But that’s just my judgment.  This post is not about judging people.  It’s about why I feel the way I do.

My son hasn’t been in school since mid-October.  He’s been doing online lessons.  I’m not worried about his academic achievement as much as I’m worried about him missing out on a normal school experience.  Obviously “going to school but everyone is constantly on alert about spreading contagions” isn’t exactly normal, so it’s kind of a wash, but I still worry that he’s not getting the same level of socialization and classroom skills as his classmates.  It’s not just for my benefit – his grandmother lives with us too and has many more risk factors than I do, and I think keeping him home is the right choice.

But when I see someone propose something like “young, healthy people should be free to do whatever, and the vulnerable people will just have to isolate themselves” – this is what that means.  It means the children and grandchildren of vulnerable people are denied a normal school experience so that people who think they’re immortal can go watch Kong vs. Godzilla in IMAX.

I know I’m lucky in a lot of ways.  My kids have access to the best education in the country.  Millions of children around the world barely have enough to eat.  Why do I feel like I can demand that a whole society close down just to let my kid have a few months of normal schooling?

But that’s not the point.  It’s not either-or.  It’s not a zero-sum competition between starving children and pandemic-isolated children.  Both of those problems are symptoms of the same underlying failure by human civilization to tend to the needs of the most vulnerable.   If we learned how to do that, we’d all be a lot better off.

So that’s why I do what I do.  I might still be sickly and bespectacled, but I’m not a kid anymore.  I can see the boulder coming and I can try to dodge it.  I can let my decisions be guided by a detailed perusal of the latest findings by experts, rather than paranoia, fear, and panic about a mysterious beast haunting the island.  I can encourage others to make the right choice, informed by real data and real concern for the well-being of our fellow humans.

We can all do that.  We don’t *have to* live in Lord of the Flies.  We all have the capacity to live in civilization and cooperation.  We just have to choose to use it.

Posted in Health and Sickness in Georgia | 1 Comment

Coronavirus in Tbilisi – April 4th, 2021

Numbers

1852 cases this week in Tbilisi. That’s a bit on the high end of my projection from last week. Nationwide, the positive test rate is up from 1.69% to 2.01%, which suggests that new infections are rising faster than tests (although tests are rising too – from a daily average of 23836 last week to 25105 this week).

Last report has 72 cases of the UK strain detected. Again, I don’t know if this is the total UK strain cases, or new UK strain cases in some time period, or what. I don’t know what percentage of new infections are being checked for UK strain. Given current infection rates it doesn’t look like UK strain is dominant yet. I can’t say more than that at this point, but I might try to figure out a better way to investigate this issue in the next few weeks.

Projection and Risk Assessment

I project 1856 – 2903 cases reported in Tbilisi next week (average case 2379).

In my worst case scenario there will be about 2900 people diagnosed in Tbilisi in the next week, and about another 2900 with undiagnosed infections. That’s about 830 people per day getting infected. Assume these people are transmitting the infection for about four days on average and that gets you about 3300 people transmitting at any given time. That’s about 1 in 330 people in Tbilisi. This is not terribly risky, especially if you’re taking precautions. It’s not time to panic yet.

However, keep in mind that some unknown number of these people will be carrying the more contagious and more deadly UK strain. You should be somewhat more cautious this week than you would have been the last time Tbilisi was experiencing about 2400 cases per week (around January 24th) – although, since we’re on the upswing again, perhaps the more apt comparison would be the week ending in October 18th.

Things won’t be quite as bad as October, though, because we are still under curfew, which is holding the infection rate down. No, really.

Curfews Work

Lorenz Hilfiker used to have a blog about covid in Georgia. I found it to be of high quality, and his analysis solid. I’m sad that he’s dropped off the map. However, in his last post, Hilfiker pointed out that the curfew imposed on November 9th seemed to have been effective. OC Media ran an article based on this post as well. It has this to say: “Evidently, the average R dropped considerably in all regions following the night-time curfews introduced on 9 November. This is true even for regions to which the curfew did not apply.”

(I don’t really know what Hilfiker’s credentials are, but I can say that I did download and run his python package on ncdc’s covid data – including data more recent than Hilfiker’s last post – and I can confirm that it produces good estimates of R. I compared his model’s R estimates to the R estimates I’ve been using to make projections, and found that they generally match up.)

Moving outside Georgia, a paper published in Nature found curfews to be one of the most effective public policy measures to fight covid, saying “The most effective NPIs include curfews, lockdowns and closing and restricting places where people gather in smaller or large numbers for an extended period of time.”  France has found that earlier curfews are better but all curfews were effective.

I know, I know – that last paper is a preprint. Experts have been wrong. Knowledge is uncertain. But please apply skepticism judiciously. I’ve read a lot of people making very pat arguments against curfew, like “covid doesn’t sleep from 9pm to 5am” or “but then all of the people will just do night things during the day” or “curfews seem silly” or “my intuition tells me that curfews won’t work” or “people will just violate curfew”.

The reason we do experiments is because experiments sometimes disprove our intuition. Countries have experimented with curfews and the results have come in and the data say that the curfews worked, and while we cannot be 100% confident that these experiments were conducted and interpreted perfectly, we do know that the experts in charge of public policy in numerous countries have reviewed the data and come to the conclusion that we can be confident enough that curfews work that the expected benefits outweigh the costs.

So we’re in a position where people are mocking Georgia’s curfew because it doesn’t seem like something that would work, while in fact the data says it does work – here, and internationally – and there is essentially a global scientific and public policy consensus that curfews reduce transmission rates. In this position, the only reasonable thing to do is apply at least as much skepticism to your own intuition as you apply to the science of curfews.

Alternatively, you could completely ignore the science, and demand that the government lift curfew at a time when cases have been rising steadily for a month.

The Third Wave

Last week, I mentioned that some of the Georgian health officials were pretending that we weren’t in the third wave yet, and wondered why they might be doing that. This week, the pretense has become indefensible. This is the fourth week in a row of growth – and the third week of really significant growth. They’re starting in again with “point restrictions” – in other words, police checkpoints and school closures, in some parts of West Georgia, and one part of central Georgia.

Gabunia blames this on the public, but of course the public is taking its cues from the government, and the government is still easing restrictions as of this week. And since the government is still pretending that we can prevent the third wave – ignoring the fact that we’ve been in it for a month now – people are understandably under the impression that things aren’t so bad, and we should gather and be relaxed and protest curfew and do all the cool stuff we couldn’t do in January. I hate to criticize, but to me it looks like Gamkrelidze is doing more harm than good right now with his communication strategy, and furthermore it looks like there is a real vacuum of leadership in Georgia’s “coordination council” that determines the country’s covid policy.

At current infection rates we’re looking at about 5000 cases in Tbilisi on the week ending on May 2nd (and about 9000 nationwide). However, I expect infection rates to increase due to the combination of public policy changes and pandemic fatigue. I’m expecting the peak in June, with overwhelmed hospitals just like in November. There’s still plenty of time for the government to stop pretending this isn’t going to happen, and thereby make it not happen… but I don’t think that’s going to happen. On the other hand, stories like this give me a glimmer of hope: MP Shalva Papuashvili says there apparently is some possibility of tightening restrictions.

Vaccines

We still don’t have enough vaccines to make a difference to the third wave. Even with the 100,000 Sinopharm doses. We might have enough to stop a fourth wave, and go back to school in September in relative safety and with relatively few restrictions. I’m not sure about this, though. Basically I’m not optimistic, and the hype about vaccines is all happening way too early. Which I’ve been saying for months. So, no news on this front.

Daily numbers from 1tv.ge and stopcov.ge. Everyone stay healthy!

Posted in Health and Sickness in Georgia | 1 Comment

Coronavirus in Tbilisi – March 28th, 2021

Numbers

We had 1459 cases reported in Tbilisi this week. Last week I projected 1033 – 1616. Again, this week, the numbers are on the high end of my projection. The average daily positive test rate went up from 1.64% to 1.85%.

It’s come to my attention that stopcov.ge is reporting positive test rates a bit differently – they’re essentially providing a weighted average, and I’d been providing an unweighted average. I think the weighted average might be better so I’ll report that as well: it went from 1.62% to 1.69%.

Projection

My model predicts 1376 – 2152 cases reported in Tbilisi next week.

If current infection rates hold (there’s no guarantee they will) we’ll have about 4600 cases reported in the week ending on Easter, of which about 800 will be UK strain cases. That would set May up to be significantly worse than November – for reference, we had 4605 cases reported in Tbilisi in the week ending on November 1st, but none of them were the more contagious and more deadly UK strain.

So the status quo outcome – if nothing changes – is that May will be the worst month of Georgia’s pandemic so far. This is a totally avoidable outcome, though! The government is totally able to reduce infection rates, if it chooses to do so. They could also decide to impose a lockdown before the hospitals overflow, rather than a week after they overflow. Will they actually do these things? I don’t think they will. I think May is going to be the worst month of the pandemic, unless it’s exceeded by June.

In maybe slightly better news – even getting one dose of a two-dose vaccine reduces hospitalization and mortality rates, and protection definitely starts to kick in on or before day 14, so vaccination in April could really make a dent in May’s mortality rates, even if it won’t be enough to significantly impact transmission rates. Gamkrelidze says we’re getting 100,000 doses of Sinopharm in April, which is great news, only somewhat undermined by Georgia’s very low vaccine acceptance rate and the apparently low vaccination delivery capacity, which seems to have maxed out at ~750 shots per day, per Gamkrelidze – but hopefully it’s more than that? Still, at this point, the problem is supply, and not demand. There are at least a million Georgians willing to get vaccinated today if a vaccine were available – 35% of Georgians, according to the latest poll – and there are not a million doses in the country now, nor are there plans to have a million doses available before summer. Anyway if May is as bad as I think it’s going to be, vaccine hesitancy won’t be an issue. Again, the issue will be that we just don’t have the doses in country.

Risk assessment

Assume about 1 person in 500 will be carrying an undiagnosed infection. In a collection of 10 people, there’s about a 2% chance that one or more people would be infected.

Hopefully you’ve taken my previous advice of taking care of necessary in-person business before now. At this point it wouldn’t be unreasonable to start prepping for another lockdown, if you’re the type of person who prefers to prep for things.

Teacher Screening and Missed Cases

It occurred to me the other day that the screening tests performed on teachers could be a valuable source of information about how coronavirus is progressing in the country. The argument goes like this: one of the factors cited in arguments to reopen schools was that the infection rate in schools was the same as the infection rate in the general population – that is, there was no added risk from opening schools. If this relation holds then it should go both ways – in other words, the infection rate in schools should be a reasonably accurate proxy for the infection rate in the general population. The infection rate among teachers should generally reflect the infection rate among the general population.

This week’s tests showed that the infection rate among adults in schools – teachers and administrators – was 0.1%.  (I would like more precision than that but I’ll take what I can get.) Teachers are tested every two weeks – a randomly selected 20% get PCR tests, and the rest get antigen tests. Of course, these tests don’t include teachers who already know they have covid – why get an extra test? Therefore, roughly, this suggests that in addition to anyone who has been diagnosed through testing for cause (symptoms or exposure), an additional 0.1% of people – or an additional one person in one thousand – have covid but don’t know it at any given time. Applied nationwide, that suggests about 4000 undiagnosed active infections.

As of March 26th, there were 4097 known active infections in the country. So what does this information from teacher testing show us? Basically, it just reinforces our prior understanding that about half of covid cases are being missed at any given time. I’ve already been operating under that assumption for about a year, and building it into my risk projections. It’s probably a good sign that this new data essentially matches up with prior expectations, because it means that in order for us to be wrong, we’d have to simultaneously be wrong about previous studies showing that teachers get infected at the same rate as the general population and also about previous estimates that about half of all cases were being missed in official numbers – and wrong in the same direction – which is fairly unlikely.

The Third Wave

Gamkrelidze and Tsertsvadze are still saying, as of yesterday, that the third wave is preventable. Tikaradze, however, preempted them and already said on Friday that we’re in the beginning of the third wave. I’m trying to game out why these officials aren’t on the same page, but maybe they actually are? I don’t want to read too much into any of these statements, but it’s possible that Gamkrelidze and Tsertsvadze think they can motivate people to act by claiming that the third wave is preventable (hope), whereas Tikaradze thinks she can motivate people by telling them that the third wave is here (fear). For the record, I agree with Tikaradze’s statement that we are in the beginning of the third wave (which I already said last week) and I agree with the pragmatics of informing people of such things rather than pretending the third wave is avoidable. Perhaps Gamkrelidze and Tsertsvadze have some more stringent definition of a “wave” or are simply more cautious about making statements that might be interpreted as predictions rather than observations?

I’m not aware of any serious argument that we aren’t in the third wave. There’s a lot of wishful thinking that maybe there’s some kind of undetected immunity that’s going to protect us – either some giant mass of people who got infected without being reported, or something something blood types, or BCG vaccines, or something else – but all that tells us is that the third wave could potentially be less severe than the second. On the other hand the UK strain means it will probably be more severe, which is what experts are warning about in countries like Germany.

Tales from Bakuriani

We’ve had snow almost every day here. My kids have built at least three snowpersons, and the weather has been ideal for snowball fights – or for skiing. However, the town seems to be mostly abandoned. I’ve heard that most of the tourists in Bakuriani from year to year are foreign, but it’s still striking how absolutely empty everything is. Every time I’ve gone to a big grocery store in town I’ve been the only customer. I imagine there are some people in the hotels closer to the skiing areas – I don’t ski so I haven’t gone up there. It’s cool having a resort town almost entirely to yourself. I’d recommend that everyone come to Bakuriani, but if you did that, it wouldn’t be empty anymore, so I’m going to cordially invite you all to stay put, at least for another week.

My life has gone so online that there is virtually no change between being here and being in Tbilisi, except that here I have better scenery and more space to walk around in. Still, it’s enough to make me think that if I’d known how this would all shake out last March, I would have tried to buy or rent a cottage somewhere in some village to just ride out the pandemic in peace and relative isolation. Heck, I might still do that.

Next Sunday I’ll probably be in transit back to Tbilisi so the weekly update might be delayed. Until then… stay frosty!

(covid stats from stopcov.ge and 1tv.ge)

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Coronavirus in Tbilisi – March 21st, 2021

Numbers:

Last week I predicted 872 – 1364 reported cases in Tbilisi this week. Exactly 1300 were reported.

That’s on the high end, and some of it seems to be related to increased testing, but some of it seems to be a genuine increase in infection rate (increased testing should only account for about 90 cases in Tbilisi, which is about half the increase since last week).

Nationwide, the positive test rate has barely moved – from 1.62% last week to 1.64% this week. An increase in cases with essentially no change in the positive test rate also suggests that the reported increase in cases represents real spread rather than just increased testing.

Last week I thought we’d actually see a big drop in testing, but that turned out to be wrong – in fact, testing increased by about 1000 tests per day.

Projection:

My best model is projecting 1033 – 1616 cases (average: 1325) for next week.

Going forward, I think we’re going to see a steadily growing increase in case counts. Last week I said we might be on the cusp of the third wave; this week I’m saying we are probably in the third wave. To be precise, I think the case counts will now continue rising, on average, until one of the following things happen: 1) we hit a “natural” peak caused by so many people getting infected that there aren’t enough hosts for cases to rise anymore; 2) we vaccinate a significant number of people; or 3) the government reintroduces a set of restrictions to mitigate spread. I would give this prediction 80% confidence.

I made the case for fearing the UK strain last week. Last news I could find said there were now 52 confirmed cases. Data on this are terrible – sparse, intermittent, and based on occasional public statements rather than some kind of official reporting platform. This makes projecting very difficult. Still, I believe we’re barrelling towards the “natural peak” outcome at a rate that far outstrips our supply of vaccines. There’s a good chance the third wave will be worse than the second. I don’t have a good probability estimate for “good chance” and I’m going to avoid putting a number on it until I see the results of the serum sampling study they’re doing to figure out how many people have really been infected so far. If that number ends up being very high, the third wave could be a bit lower. If it’s low, we’re screwed. Also: Easter, Manaus, lockdown fatigue, etc., as I’ve said in prior posts. I am not optimistic and I went so far as doing a separate risk assessment this week for flying my entire family out of Georgia and back to New York to a) access vaccines earlier and b) avoid a wave in Tbilisi with hospitals overflowing again. Unfortunately the difficulty of flying with kids is high and the risk profile is probably worse than if I just lock myself in my apartment until August. I’ll go on record and say I think the peak will be in May, but it might be June. Based on the duration of the second wave, I’d expect the third wave to die down by August or September.

Also, the WMO (that’s World Meteorological Organization) produced a report saying that summer weather will not be enough to reverse a wave in the absence of sound public policy. So while spring will be nice because we can go out, it won’t make it any safer to be inside with people who are infected – and spending time inside air-conditioned accommodations can be dangerous.

Risk Assessment:

This week, the worst case projection is that something like 1 in 680 people may be contagious. Some number of those will probably have the UK strain, so this is a bit worse than the last time I made a similar risk projection, and also a bit worse than last week’s risk projection. However, objectively, it’s still not terribly dangerous. Take reasonable precautions, but, since I’m saying cases are mostly going to be going up from here on out, this would be a great time to take care of any lingering business because every week you wait probably increases your risk.

News:

As you probably know, the AZ vaccine has been declared safe by the EU and UK regulators despite its association with a small number of severe clotting episodes, some of which have been fatal. Experts are still looking to confirm whether these clotting episodes are caused by the vaccine or whether this is just random bad luck, but stress that the overall risk of developing blood clots is not increased by the vaccine.

Also, as you probably know, a 27-year old Georgian nurse died from anaphylaxis after receiving the AZ vaccine.

I’m going to be completely honest and say I totally understand the emotional reaction here. I have food allergies, and every time I take literally any new medication I get anxious about having a severe allergic reaction. I have considered buying myself an EpiPen just in case. I can tell myself that rationally, buying a medical device to insure against a 1 in a million rare severe outcome is not a good use of my time and energy. But emotionally, I feel the anxiety anyway.

And so one might ask, isn’t it reasonable to prefer a vaccine that has not been associated with blood clots, or which might carry a lower risk of a fatal allergic reaction? And yes – that is totally reasonable. But it’s much less reasonable to wait until a vaccine with a 1 in a million risk of severe reaction becomes available because you think a 2 in a million risk is too high, at the same time as thousands of people are dying every day from covid. The best vaccine is the one we have available. If I had a choice between AZ and Moderna, I’d obviously go with Moderna. But if I had a choice between AZ and remaining unvaccinated, I’d choose AZ. And then I’d sit in the vaccine clinic for an extra hour just in case I needed to be treated for anaphylaxis.

The fact is, since vaccination started in Georgia we’ve had one vaccination death and 57 covid deaths. That one vaccination death was incredibly improbable and unlucky, but the 57 covid deaths were entirely predictable and will continue happening every week for the foreseeable future – in fact they’ll almost certainly rise again (since cases went up this week, and deaths lag cases by 3-4 weeks).

And again, I get the emotional response to the incredibly improbable and unlucky death. I get that the emotional response to the predictable deaths is dulled, after we’ve spent over a year reading about covid death tolls. But as human beings, our reason can overcome our emotion. We can understand, numerically, that it’s better to continue the vaccination campaign, and to get vaccinated ourselves when the time comes. Our lizard brains might scream that covid is an unavoidable risk, but vaccines are an avoidable risk, and so it’s better to avoid the risks we can avoid. That is flawed reasoning, and I suspect everyone who is reading this knows it.

It actually reminds me a bit of the trolley problem. Ask someone “if you could save five people by diverting an oncoming train away from them, but at the cost of diverting it into one person” most people will choose to divert the train, saving five lives at the cost of one. Ask someone “if you could divert the trolley, but you had to actually push one person in front of the train to do it” and many people who would have diverted the train won’t push the person. Even if the outcome is the same, the act of pushing someone in front of a train activates some moral center that the act of diverting a train into a person doesn’t. We just have inconsistent moral reasoning, wired into our brains.

Think about that for a while, and I think you’ll agree that vaccination is the morally correct option at the group level even if it does end up killing one person for every thousand or ten thousand people it saves. As an individual – I still think it’s a good idea, but obviously you can make the decision for yourself. I think once all of the vulnerable people have had the opportunity to be vaccinated, then if you think your vaccine risk is higher than your covid risk, you’re not obligated to get it. My concern is just that people will underestimate their covid risk and overestimate vaccine risk, or will give way to anxiety or cognitive biases to make the decision rather than making it solely based on the probabilities of the possible outcomes.

By the way, this post is late – and not as detailed as it otherwise may have been – because I’ve taken a short trip to Bakuriani, where I’ve rented a cottage with a yard where I plan to enjoy a socially-distanced holiday building snowpersons with my kids far away from any other non-snow-persons. See – I’m doing my part for tourism and the economy.

Stay safe, everyone!

Posted in Health and Sickness in Georgia | 1 Comment

Coronavirus in Tbilisi – March 14th, 2021

Numbers:

1108 cases reported in Tbilisi this week. That’s up from 1098 last week. The positive test rate, nationwide, went up from 1.52% to 1.62%. It looks like we have hit growth again.

There was a surge in screening tests again, which probably increased the case count a bit and decreased the positive test rate a bit. I expect this biweekly – I imagine without screening tests next week we might see another dip in cases, followed by a rise again for the week ending in March 28th. I’m not ready to definitively declare this as the third wave. But even if this doesn’t turn out to be the clear beginning of the third wave, we’re certainly on the cusp of it. There’s more reopening to do. There are protests against what few restrictions remain in place. People are in the mood to party. I think while we might get another dip next week, cases will clearly be up again two weeks from now.

Projection:

Last week my projection was 775-1211 but I also said my intuition was that we’d be on the higher end of that, which we are. This week my model is projecting 872-1364 cases (average: 1118) and my intuition is that we’ll have a drop in testing and so we’ll actually be slightly below that average – maybe 1050 cases. On the other hand, I think there are no holidays this week, so we might get a bit more testing instead.

Risk assessment:

Same as last week. About one in a thousand people in Tbilisi are infected. We’re in the CDC’s “orange zone”, which means take sensible precautions.

Medium-term, if cases continue rising, the obvious conclusion is that things will be getting less safe from here on out. I’d quickly wrap up any necessary business, such as doctor visits, or shopping for items that aren’t sold in grocery stores, before things start to spiral out of control. Realistically we likely have at least a month before things become scary, but if it’s something you can do now, why take unnecessary risks later? By the way I am happy to report that my trip to the dentist last Saturday does not seem to have killed me.

Analysis:

Since the second wave peaked, we’ve never dipped below 1000 cases per week in Tbilisi, which means the situation was never really safe or stable. But because every week was better than the last, the psychological effect was to cause most people to relax their precautions, slowly, week after week.

That’s a normal human reaction, I guess, but it’s not the best way to reason during a pandemic. You need to set objective benchmarks. If you’re going to make comparisons, you can’t only compare this week to last week – you have to compare this week to all the other weeks like it.

However, even if we are reasoning objectively and correctly, we have to admit that a 1 in 1000 chance per week of contracting covid isn’t that big of a concern for most people, and this is not unreasonable. The mortality rate for someone of my age, weight, and risk profile (I have one risk factor – lung damage) is about 1 in 1000 – which means if I behaved like the average resident of Tbilisi my chances of dying from covid in any given week would be less than one in a million. For context, that’s about half the chance of dying from a traffic accident in Tbilisi. In other words, the taxi ride was the most dangerous part of my trip to the dentist’s.

It’s not unreasonable for any one individual to say “with risks this low, I don’t feel compelled to take precautions”. The problem is that when one million people simultaneously make that judgment, our collective risk starts to go up. It doesn’t take very long – it took about six weeks in the second wave – for 1 in 1000 to become 1 in 100 – and once it does, you get emergent effects, like hospitals overflowing, and second-order effects, like when people start dying from treatable illnesses that they couldn’t get treatment for because all the hospitals were full.

Also, while it’s not unreasonable on a personal level for people to decide that a one in a million chance per week of dying from covid is insignificant enough to ignore, keep in mind that this does sort of imply that there is one relatively healthy adult in Tbilisi dying per week – in addition to the dozens of other people who are much older or sicker than average. And indeed, I do hear stories, on occasion, of a seemingly healthy adult (or teenager) in Georgia dying from covid. And it *is* unreasonable – on a social level – that we have collectively let this trend continue. We could have cut the death toll by at least 30% for each week we delayed reopening. If we’d delayed for two weeks, that would mean half of those who have died since reopening would still be alive. Four weeks, and three quarters would still be alive. Ask yourself if whatever you did in February that you couldn’t have done in January was worth killing 200 people for. It probably wasn’t.

All this is to say, now that cases are going up again, perhaps people will adjust their risk tolerance down again, and perhaps the government will slow its roll with opening everything completely. And that’s especially important right now, because it seems that bars and ski lifts and every other public accommodation are back to regular operation, and people are planning large, risky gatherings, and that’s a recipe for a couple of superspreader events to vault us directly into the third wave.

The UK strain:

This is slightly old news, but all 31 of the suspected UK strain cases were confirmed as UK strain. (1)

With cases on the rise, and the UK strain spreading about 50% faster than the original strain, UK strain cases will be doubling about every 10 days. That means we’re probably on track to have the UK strain take over (e.g. the majority of cases will be UK) by Easter Sunday (which is May 2nd in Georgia). That will be terrible, because Palm Sunday and Easter Sunday are major holidays where people gather in large groups and then go and meet their families.

Nationally, I’m expecting to see a jump from about 2500-3000 cases per week in April to about 5000-10000 cases per week in May. Of course, the government might see this coming and decide not to let it happen. They keep making noises like this is what they’re going to do – various officials are practically begging the public not to make them reimpose restrictions. However, the regime seems to be embroiled in an ongoing legitimacy crisis and I think they’re even less likely than they were in October to respond proactively to a threat.

Or, people in general might observe that numbers are going in the wrong direction and decide to take fewer risks. But this is unlikely. Like I said above, it doesn’t make sense at the individual level to go out of your way to avoid a threat that’s less dangerous than crossing the street in this country. And there’s just no way to convince the average person to act now in order to avoid an outcome that mathematical models say is going to arrive two months from now – especially since skeptics of various stripes have spent a year spreading doubt and misinformation and generally attacking public confidence in the ability of math and science to generate accurate predictions. So, I think we’re… what’s the scientific term? Doomed.

And this prediction isn’t even close to the worst-case scenario. I’m assuming that the government had caught almost all of the UK strain cases by Feb 28th, and that the strain is only 50% more contagious, and that we’ll keep the infection growth rate overall down to about 1.1 per week. However, the average infection growth rate in September was 2.3 per week, and it’s entirely possible that the government only caught half of the UK strain cases, or only a third of them, or even fewer. 40,000 cases a week in May would not surprise me at all. The worst-case scenario is that we hit the top of the SIR model by the end of April – meaning that so many people are infected that transmission rates naturally come down because there aren’t enough people left to infect. That scenario comes with catastrophic shortages of medical care and a corresponding increase in mortality (and note that the UK strain is already more deadly than the original). That seems like an extreme prediction – and it is; like I said, it’s probably the worst that can happen – but if you think it can’t happen here, imagine what it was like in Manaus when scientists were telling people that they had nothing to worry about, and then things got so bad that the hospitals ran out of oxygen.

Looking back, I see that I made essentially the same point two weeks ago. So the only thing that’s really changed is that the overall infection rate is higher now, which means the prognosis is a little bit worse now.

I have to say it’s also possible – not likely, but possible – that the government somehow managed to catch and isolate every case with the UK strain, or that it somehow otherwise failed to take hold despite having already infected at least 31 people. If that’s the case, and if no other variants arrive and take hold in the country in the next two months, then the third wave will probably be lower and peak later. Again, this is not at a likely scenario at all, but it would be remiss of me to mention the worst-case scenario without mentioning the best-case scenario.

Vaccines:

The first vaccines have arrived in Georgia. 43,000 doses of the Oxford/AstraZeneca vaccine. Of course, the timing is unfortunate because there’s been a scandal about the AZ vaccines causing blood clots (which they almost certainly do not) and now the more conspiracy-minded people here are thinking that Europe is foisting unwanted, low-quality vaccines on developing countries and hoarding the good stuff for itself. Still, 43,000 people vaccinated is great news.

The government expects about another 130,000 does by the end of May, which will be too late to mitigate whatever damage is done by Palm Sunday, Easter Sunday, the reopenings, and the impact of the UK variant. There are also rumors of vaccines entering the private market. I find this deeply suspicious – there is such universal opposition to pandemic profiteering (whether or not this is reasonable is another conversation) that I am skeptical that AZ would sell its vaccine to private firms when there are still unvaccinated vulnerable populations all over the world. The PR for them would be terrible. However, if this is somehow someone in government arranging or brokering a deal – not that I’m implying that there might be corruption or nepotism in the Georgian government, certainly not – then there could be an unknown number of additional doses arriving before May and going to an unknown demographic. So, I don’t have much to say about that, from the point of view of prognostication.

There has been a ton of drama about these vaccines, and usually I don’t go into petty nonsense, but I can’t pass this up. Tikaradze intimated that she was considering suing COVAX because COVAX had blamed Georgia for vaccine delays (2). I guess Tikaradze has to say that, because the government had placed so much emphasis on getting Pfizer vaccines in February, but instead got AZ vaccines in mid-March. If she doesn’t act completely outraged it will look like the government over-promised and under-delivered (which is, of course, what happened) but the government needs to look competent in order to overcome vaccine hesitancy and, when the time comes, to impose restrictions again.

Tsertsvadze, on the other hand, took the positively Trumpian step of blaming the media and the opposition parties for not having vaccines yet (3). I’m not sure what he’s trying to accomplish with this strategy, or if perhaps he was just venting. The government should have imported Sinovac, at least (I get why Sputnik is a non-starter), and started vaccinating with it, and then anyone who wanted to wait around for Pfizer could have done that, but at least we could have had a bigger head start on the coming UK wave. The health experts should have foreseen this and gotten out to convince the public to accept Sinovac, rather than letting a bunch of empty-headed sensationalists and listless agitators override doctors and dictate public health policy.

Well, since I’ve already veered off into polemics, let me just remind everyone once more: the fact that the first vaccines are here feels like a major milestone, but it is not license to throw caution to the wind, and you should be deeply suspicious of anyone who suggests otherwise. Health experts are unanimous that people still need to be taking precautions. There is a good chance that the worst is still in front of us, and that May will bring a bigger wave and more deaths than November. I’m sorry I don’t have better news.

Antibody Survey:

The Infectious Disease center is doing a study involving antibody testing to find out how many cases of covid there have been that have gone unreported. (4) Results are due by the end of the month (they’re saying March 29th but we’ll see). They also say the results are going to be used to plan a vaccination schedule, but that doesn’t make sense to me – unless there are significant differences is demographic groups (like, if they find out that 80% of bus drivers but only 30% of teachers have had it, so they prioritize teachers in the vaccine schedule) I don’t see how test results from a random sample of residents can be used to plan a vaccine schedule. Anyway their schedule should really be “get as many vaccines as possible and give them to anyone who’s willing to take them” and I don’t see how an antibody prevalence study changes that. Still, it will be good to know about how many cases have been missed.

I feel like I’m forgetting something important, but this is already a long one, so I guess if I think of it I’ll throw it in a comment.

Until next time: good luck, everyone!

Numbers via stopcov.ge and 1tv.ge.

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