Coronavirus in Tbilisi – June 13th, 2021

Numbers and Projections

2656 cases reported in Tbilisi this week, down from 2932 last week.  The model was very close this week (2595; 2024 – 3166).  Projection for next week is similar: 2571 cases (with margin of error: 2005 – 3136).

Nationwide there were 4876 cases, down from 5495.  My model projected 5007 (3105 – 6109) so again, very close.  The model is projecting 4311 cases for next week (3363 – 5259)

Testing went up from 183654 to 212796.  Positive test rate is down from 2.99% to 2.29%.

Analysis

I notice that the two models, while very close this week, were off in different directions – the Tbilisi total was higher than projected and the nationwide total was lower than projected.  Because I’m just using an exponential curve to project into next week, that means that my projections are diverging even more – the Tbilisi model is projecting basically no change and the nationwide model is projecting a large drop in cases.

I think some of this may simply be noise – specifically, random variations in the distribution of testing throughout the week.  I also happen to know this was a screening week for schools – since I’m back teaching in person I had to get a swab on Tuesday (negative, in case you were wondering) – but remember that screening large numbers of people is going to increase testing numbers a lot, decrease the positive test rate a lot, and add a small amount to the case counts.  That definitely appears to be what happened this week.  That implies that we should expect next week to return to the baseline trend, and it looks like the baseline trend is a decrease in cases of about 14% per week for the last four weeks.  Therefore, I’d expect the Tbilisi model’s projection to be high this week, and I think that next week I’ll probably report numbers on the lower end of my prediction range – I’d guess 2300 or so.

A decrease in cases in Tbilisi to 2300 next week would also be more in line with the nationwide projection.  That gives me a bit more confidence, but of course it could also be that the distribution of cases throughout the country is changing again – maybe cases really are decreasing in the regions while holding steady in Tbilisi.  The % of nationwide cases in Tbilisi has been remarkably steady for the last four weeks – hovering in the 53% – 54% range – but hopped up a bit in the last three days to 54.6%.  Again – could be noise, could be a trend.

What’s interesting is that we’ve heard that vaccination rates are supposedly higher in the capital, but this doesn’t seem to have made a difference so far in the distribution of cases.  That is just further confirmation that not enough people have been vaccinated yet to make an observable difference in case numbers.

Vaccines

Provax.ge says that 206,742 vaccines have been administered, and there are about 4500 vaccines being administered per day.  Note that at this rate, we’ll have under 2 million total vaccines administered by one year from today, meaning under 1 million people fully vaccinated.  So we’re looking at about four years to vaccinate the whole country, and that’s assuming we don’t need boosters.  But have no fear!  According to the government’s press service, PM Irakli Gharibashvili has ordered a plan to be developed next week to scale up vaccination efforts.

We’ve had coronavirus in the country for 16 months.  We’ve known vaccines were coming imminently for at least 6 of those.  We’ve had actual vaccines in country for three months.  And only now has the government decided to set a time to start planning how these vaccines will be distributed at scale?  No, no, take your time… it’s not like people are dying here.

Provax also seems to suggest that registration for various vaccines, including Sinopharm first dose, is currently open.  I’ve heard this anecdotally from Georgian friends as well.  Who knows how long that condition will persist, but if you’ve been waiting to register, go ahead and give it another shot.

The Fourth Wave

There’s talk of the fourth wave coming in August – this time from a doctor named Bidzina Kulumbegov – although I seem to recall Gamkrelidze citing the same information earlier in the week.  I agree with this assessment – it is likely we’ll have a fourth wave in August – although I want to point out that predicting this far out is hard and there’s a good chance it will start in July, and also some chance it will be delayed until September.  I also agree that it will be less dangerous than prior waves, again because we’re vaccinating the vulnerable, we’ve increased hospital capacity, and we have better treatment protocols.  On the other hand, the delta (Indian) strain is already here and is likely to spread, and whatever strain comes next (I guess it will be epsilon?) will potentially be even more contagious.  Unfortunately developing countries are still in a bit of a race to vaccinate enough people before more contagious strains arrive, and unfortunately the Georgian government does not appear overly concerned about the implications of that fact.  Well, perhaps Gharibashvili’s plan to start planning to scale up vaccinations will work out, and by this time next week we’ll have a plan to start training people to deliver vaccines, and then who knows, maybe by the time we’re talking about the fifth wave there will be a plan to implement the plan that they’re planning to make.  One can only hope.

I don’t mean to sound sour – I’m quite pleased to be fully vaccinated and to have survived my first covid test to boot.  I’m planning on celebrating by gathering with a small group of other fully-vaccinated people to play board games in person for the first time in almost a year.  Good times.  It’s deeply unfortunate, though, that such good times are distributed so inequitably, and so many Georgians are going to suffer as a result of their government’s lackadaisical approach to vaccination planning (and to nearly every aspect of pandemic management in the last year).

Everyone stay healthy!

Numbers from provax.ge, stopcov.ge, ncdc.ge, and 1tv.ge.

 

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Coronavirus in Tbilisi – June 6th, 2021

Numbers and Projections

2932 cases this week in Tbilisi – down from last week’s 3186.  Projection for next week: 2595 cases (low: 2024; high: 3166).

Nationwide we saw 5495 cases this week – down from last week’s 6030.   Projection for next week: 5007 cases (low: 3905; high: 6109).

Positive test rate is up very slightly from 2.85% to 2.99%.  The amount of testing decreased from 211616 to 183654.

Analysis

Last week’s projection was for 2023 – 3165 and this is a bit on the higher end of that range.  Cases are still going down, but at a slower rate than before, and it’s not inconceivable that they could start going up again in the next few weeks.  On that measure I’m less optimistic this week than I was last week.  Test numbers were a tad low this week and if they increase I’d also expect to see numbers on the higher end of the model’s projections.

That’s unfortunate because we’re at a much higher baseline of cases now than we were after the second wave.  Post-second wave, we bottomed out at around 1100 cases/week in Tbilisi, in mid-March, before we saw numbers start to rise again.  Now it looks like we might not even get down to 2000 cases/week before it turns around.  If that happens, I wouldn’t rule out another peak by mid to late July.  However, take this with a grain of salt – the relatively higher case counts this week could also just be random noise.

I think politically no one has an appetite for more restrictions at this point so there is probably nothing the government can do to stave off this outcome.  We kind of just have to hope we get lucky.  Also, even if we do get a peak in July-August, we can still have small gatherings outdoors, or indoor gatherings with other people who are vaccinated, and as I’ve said the government seems to have ramped up hospital/treatment capacity to the point where we don’t have to worry about medical collapse, and many of the most vulnerable people are already fully vaccinated.  So in a sense the peaks and troughs are a bit less important now than they were, say, six months ago.  In other words, we’re just going to live with coronavirus throughout the summer, but it’s not going be as nerve-wracking anymore.

What’s more important is winning the vaccination race, because just as we are ramping up vaccinations we’re already fending off more and more contagious strains.  There’s steady progress on that front, with Georgia’s vaccination campaign seemingly gaining steam, vaccine hesitancy reduced, and more access to more vaccines imminent.  Needless to say, if you’re not vaccinated, you should look into it – check out provax.ge for info on how to do that.

I’ve seen some news lately calling the efficacy of Sinopharm into question, because some countries that administered it are calling some patients back in for boosters.  A study published in the Journal of the American Medical Association found the Sinopharm vaccines 70-80% effective at preventing symptomatic covid and 100% effective at preventing serious covid.  But look – if you can find the 20-30% of people who didn’t get fully protected by the first two doses, and give them a third dose that boosts their protection, that’s good news.  That  doesn’t mean the 70-80% efficacy number is in question – it means the 70-80% number is the floor; it’s a solid foundation we can build on.  If antibodies are fading after six months and a booster is needed, do the booster.  We need flu shots every year; it’s not surprising that we might need coronavirus vaccine boosters from time to time.  And if they figure out that one vaccine doesn’t need boosters, people could decide to prefer that vaccine.  But the vaccines are all so new that we really don’t know yet what the long-term efficacy will be, so let’s solve the short-term problem now and then worry about boosters later when and if the need should arise.  I wish the media would report this context more conspicuously when they report on vaccine efficacy, rather than give us headlines about vague “questions” and “doubts” that fuel vaccine hesitancy.

Working in a Post-Pandemic World

Much has been made about the shift to remote work and how some workers don’t want to go back to face-to-face.  Turns out I’m one of them.  Work from home has been great for my health and well-being (more on that in the next section).  It’s reduced my stress.  It’s given me more quality time with my family.  I’ve decided to stick with it.  And with more companies hiring for remote work, I’ll have opportunities to work from Georgia that I wouldn’t have had after the pandemic.  I’m excited about the change and, pardon the cliche, about the fact that a whole world of opportunity is now open to me.

It’s looking like this trend might end up having a major impact on how we do business.  Georgia was already trying to become a hub for “digital nomads” pre-pandemic.  Imagine if the number of remote workers in the world suddenly increased by an order of magnitude.  People will be looking for places like Georgia – with good food, a good climate, beautiful scenery, and a low cost of living – to live while they work for international companies doing all manner of jobs that used to be done in an office.  I think this could turn into an actually viable development strategy for Georgia.  Of course, the government would have to embrace it, and from what I hear from some of my personal friends here in Georgia who are already digital nomads, at this point the government seems to be making a lot of sudden, disruptive changes to its visa/residency/entry requirements.  I don’t have any comments on the particular policies they decide to go with but I’ll just say that a predictable and consistent implementation would be better in terms of instilling remote workers with the confidence that they can come here to work and not end up having the rug pulled out from under them in some way.

Personally, I think I’ll be looking for a job doing curriculum development (that’s what my Master’s is in), but I’m keeping an open mind about my options.

On Not Having Colds

I basically haven’t been sick in over a year, which is great, because I used to get sinus infections quite frequently.  Apparently a lot of people have been noticing this, and some are commenting that they may continue wearing masks in certain contexts, and this may become socially acceptable in the West, as it has been for some time in parts of Asia.  I’m totally on board with this trend.  I don’t love masking but I do prefer it in certain contexts, and I’m excited about the prospect of never having a cold again.

Fighting covid has not just fought off weaker colds – it’s also fought off the flu.  I wonder, now that we know that masks and reasonable distancing can save lives not just from covid but from other respiratory diseases, if we can ever really go back to the pre-pandemic status quo.  I hope we’ll just see a global cultural shift in our tolerance for risk from airborne pathogens.  I hope we establish the norm that a sick person stays home from work or school (self-isolates) and wears a mask if they need to leave the house.  I hope more remote work means that even face-to-face workers shift to work from home when they aren’t feeling well.  I hope we see more and better paid sick leave regulations.  I hope we see more and better hygiene, post-pandemic.

But I don’t know.  A lot of people seem awfully keen on just putting this all behind them and acting like it never happened.  So we’ll see.

Everyone stay healthy!

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

 

 

 

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Coronavirus in Tbilisi – May 30th, 2021

Numbers and Projections

3186 cases in Tbilisi this week.  My model was very close this time (3304, error range 2577-4030).

Nationwide there were 6030 cases (again, very close to projected 6127, error range 4779 – 7475).

Nationwide, testing went up, despite the holiday, from 175581 to 211616.  Positive test rate is 2.85% for the week.

Projections: 2594 cases reported in Tbilisi next week (2023 – 3165 error range).  5052 (3940 – 6163 error range) nationwide.

Analysis

It clearly looks like we’re on the downslope of the third wave, and the infection rates aren’t trending back upwards in any notable way, so I expect we’ll continue to see decreases in cases for the foreseeable future.  If last year is anything to go by I’d say  we can expect a relatively comfortable summer, with maybe a fourth wave in fall – although the fourth wave probably won’t be very severe.

Some people have voiced concern about the Indian strain, of which there have been five confirmed infections in the country so far.  I am not concerned – it may be more transmissible than the British strain, but the population of susceptible people is decreasing steadily and many of the most vulnerable people have already been vaccinated, which will bring down rates of death and severe infection even during a large wave.  As we saw in the third wave, hospital and treatment capacity is much higher than it was in the second wave, so contrary to my fears two months ago, now I’m saying we’re unlikely to see hospitals overflow again.  As long as the government keeps a ban on large gatherings and takes measures to discourage people from gathering indoors, we should be relatively fine in terms of avoiding a large social catastrophe.  Of course, individuals will still be in danger, especially if they are unvaccinated and incautious – but at this point, this is assumed risk for those people, and is not likely to have spillover effects like crowding out medical treatment for people who are not reckless, so I do not see a big reason to be concerned about these people.

Regardless of the dominant strain and any other factors, until school-aged children can be vaccinated, I think we’ll have to live with disruptions in schools, although these may decrease if enough teachers and staff can be vaccinated.  I still expect that the next school year will not be fully back to normal.

I’m giving my long-term prospects here because I may discontinue weekly updates after this.  I may go to a mode where I write very limited posts, or no posts, or I may write posts only in response to major deviations from this long-term outlook or major news stories, as the mood strikes me.  Then again, I thought I’d skip this week’s post but instead I’m apparently doing 2000 words on lab leak and post-vaccination masking, so…

The Lab Leak Hypothesis

I have deliberately avoided talking about the lab leak hypothesis up until now for several reasons.  Mostly I just haven’t thought enough about it to imagine that my opinion would be particularly informative or enlightening for anyone else.  But at this point, since it’s in the news, failing to address it feels like an omission.

I’m not going to do the scientific question justice in the time I have, but I’ll just say for the record that I’m open to any possibility and in favor of scientists trying to figure out, scientifically, what the origins of the coronavirus are, including how it came about and how it came to enter the general human population.

However, most of the commentary around this issue seems to be about something other than the scientific investigations into these scientific questions.

There seem to be some people who cannot, or do not want to, believe that a pandemic can come about due to natural processes.  I regard this as religious thinking: in previous generations, plagues were seen as punishments from the Gods.  In modern times, they are the result of science gone out of control.  In either scenario, human agency is at the center of the problem.  People see a complex outcome, like a plague, and conclude that some conscious or deliberate force must have planned the outcome.

This kind of thinking is a mistake.  It’s a failure mode of the human mind.  I think that the further we, as a society, can get away from this thinking, the better off we are.

You can see the bias towards human agency at every level.  The pandemic couldn’t have evolved naturally – it must have been manufactured.  It couldn’t have escaped by accident – it must have been released.  It couldn’t have been an accident – it must have been a bioweapon.  Fauci couldn’t have become so prominent just because he happened to be a public official who dealt with infectious diseases – he must have been in on it the whole time.  The Chinese government couldn’t have been taken by surprise – they must have either planned it as a bioweapon, or at least known exactly what was going on the whole time but covered it up.  Western media couldn’t have been a deeply dysfunctional echo chamber that generates consensus in favor of the status quo due to the incentive structure inherent in its business model – rather, they must have known this was a genetically-engineered superbug since day one but didn’t tell the public because They decided we weren’t ready to hear it.  Etc.

At no point are we allowed to acknowledge that the world is chaotic and that outcomes often emerge from this chaos due to forces that no one designed or planned deliberately – whether these forces are natural selection or the invisible hand of the market or just the laws of probability.

So while it’s possible that any of the steps leading us to where we are today bear the imprint of human agency, it’s not particularly likely a priori that any particular one does.  We can’t just assume, in the absence of any specific information, that the virus was created deliberately and released deliberately and that these actions were covered up deliberately by the media.

That’s not even getting into the delusional paranoia that I’ve seen in this past year.  People have claimed that the virus was created, released, and covered up deliberately in order to get us all to wear masks so that Satan-worshipping pedophiles can kidnap and traffic masked children in plain sight, or so that Big Pharma can sell vaccines, or so that Bill Gates can inject us all with microchips.  And unfortunately I think that if you’re going to put forth some version of the lab leak hypothesis, the burden is on you to distance yourself from the more radical proponents of that hypothesis.

However, with all of that said – yes, of course it is possible that SARS-CoV-2 came about through experimentation on natural coronaviruses, and was introduced into the human population inadvertently due to inadequate lab safety standards.  Or that it was picked up by scientists in a bat cave who were there to collect samples for said experiments.  But it’s also possible that the wet market hypothesis is correct and the patients with no known connection to the wet market had connections that the authorities couldn’t find.  Or something else entirely.  We may never have a conclusive answer, and that’s okay, because we can still try to improve lab safety, government transparency, media efficacy, pandemic preparedness, and anything else that has gone wrong or could go wrong in future pandemics.

But, again, I suspect that’s not really anyone’s main concern.  People just want the comfort of believing that there’s some Reason or Purpose behind everything, even if it’s malevolent globalists who want us all masked and microchipped or Satan-worshipping pedophiles who want to steal your children.  I believe that mindset is an impediment to human progress, and we need to learn to see the world in terms of systems and processes rather than narratives and grand plans.  And that’s why I’m dismissive of anything that sounds like a conspiracy theory, even if there turns out to be a core of truth to it in the end.

Sinopharm II: Pharmed and Dangerous

Sorry for the egregious pun.  I’ve had my second Sinopharm shot (remember when we used to call them shots?  When did we start calling them “jabs”?  I’m not calling it a jab, damn it) and I’m feeling safe and confident.  I’m planning on returning to work in person in the next two weeks.

There’s some question as to whether vaccinated people need to continue masking, and in what circumstances.  Specifically, are vaccinated people dangerous to non-vaccinated people?  My read of the evidence is… not particularly, but it is at least theoretically possible for a vaccinated person to contract the virus and transmit it to an unvaccinated person.  Not likely, but possible.

My beliefs are that you don’t need to mask up for your personal safety, and you aren’t morally obligated to mask up for the safety of those who refuse vaccines, but you should still follow mask rules and mandates in communities and private businesses.  Those rules are in place to protect people who haven’t had a chance to get vaccinated yet – like people with medical conditions that exclude vaccines, or children under 18, or (in Georgia) non-residents.

Once a community, through its democratically-elected leaders, decides that enough people have had the opportunity to get vaccinated and the amount of danger is low enough, the mask mandates will be lifted (as they are being lifted in the US right now).  This shouldn’t need to be said, but there isn’t a conspiracy to force us to wear masks forever.  There just isn’t.

At what point should communities and businesses lift mask mandates?  Schools should probably keep them until kids can get vaccinated or the community reaches herd immunity.  Same for businesses where you might expect to encounter a lot of vulnerable people, or people who don’t have a choice about whether or not to be there (like hospitals).

On the other hand, I’d say lift outdoor mask mandates right now.  If I had to choose between hanging out with my friends outdoors with masks, or indoors with no masks, right now I’d choose indoors with no masks, because it’s more comfortable.  But that means that if we want to keep transmission down, we’re incentivizing the wrong thing.  If they lifted the outdoor mask mandate I’d be more likely to spend more time outdoors.  It also doesn’t make sense that I can sit in an outdoor cafe with my friends with no mask but if we step outside of the (crowded) cafe and onto the sidewalk we’re required to mask up.

In any case I’m confident that as more people are vaccinated, more restrictions will loosen as a result.

The only lingering concern is that once you life the mandate for vaccinated people, there’s an incentive for unvaccinated people to lie, or to break the rules assuming that no one is going to ask to see their vaccine card.  So I think the mandates, for practical reasons, will effectively be lifted for everyone at the same time.  That’s another good reason to delay lifting mandates for a bit, at least until you have a situation like in the US where at least half the population is vaccinated.

The End

Everyone stay safe!

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

 

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Coronavirus in Tbilisi – May 23rd, 2021

Numbers

There were exactly 3900 cases reported this week in Tbilisi.  That’s down from 4551 last week, and well within my forecast (2540 – 4538).  I was also right to believe that my usual  model’s projection of 3257 cases was low and that my alternate model’s projection of 3720 cases would be more accurate.  (Both models are simple exponential growth models using a ratio of 7-day case totals; the usual model extrapolates based on the ratio between numbers 4 days apart; the alternate uses 7 days.)

Nationwide we dropped from 8456 cases reported to 7198 cases reported (also well within the projected interval – 7547 cases, with margin of error, 5887 – 9207).

Nationwide there were 175581 tests, down from 216812, also as predicted.  The positive test rate is up slightly, from 3.9% to 4.1%.

Analysis

It looks like the decline in cases is real and reflects the lingering aftereffects of the post-Easter lockdown – so the decline in testing may be due to decreased demand due to decreased infection rates.

I hate to be pessimistic, but if that’s true, then we should expect the growth rate to start increasing again now that we’re approaching two weeks past lockdown.  In fact the growth rate seems to have bottomed out on May 18th (at about .73) and has rebounded a bit since (to about .86).

As I’m sure you all know, there have been some further reductions in restrictions – the curfew has been extended to 23:00, and restaurants can open on weekends for outdoor seating.  I am not opposed to either of these measures independently as I think that a 2-hour difference in curfew onset will have minimal impact on transmission and I think that opening restaurants for outdoor dining may actually lower transmission rates, on the theory that this will cause some people to gather outdoors at a restaurant rather than indoors at someone’s house.

Despite these policy changes, though, I think the situation in the country with regards to transmission is fundamentally the same as it was a month ago.  We’ll see how much difference the warm weather makes, but I would be concerned that cases may start to rise again.

Projections and Risk Assessment

My 4-day model projects 3304 cases reported in Tbilisi next week (with margin of error: 2577 to 4030).  The 7-day model is very close this time, predicting 3342.  Again, my feeling is that we are looking at something on the high end of that range, and I wouldn’t be surprised if we actually go slightly over.

Nationwide my projection is 6127 cases (4779 – 7475).

Risk assessment is about the same as last week: in the worst case, 1 in 180 people in Tbilisi infected and contagious.  In a gathering of 10 people there would be about a 1 in 20 chance of one or more people being infectious.  I recommend going outside, enjoying the weather, maybe meeting some friends at an outdoor cafe.  Indoors I’d keep masks on unless you’re fully vaxxed.

Vaccines

The government has launched a new vaccine portal at provax.ge.  It seems good.  You can go there and select the vaccine you want and your region and find out how many slots are left, and then follow the link to go and book one.

I’m getting my second shot of Sinopharm on Wednesday.  Based on trial data I am expecting that I already have some measure of protection – in phase I/II clinical trials over 75% of patients aged 18-59 showed antibodies in their blood 14 days after the first shot; I’m 18 days after the first shot.  I won’t technically be “fully vaccinated” until June 9th, but I already feel much more comfortable with simple things like getting into my lift than I have in ages.

Vaccination is proceeding and the country has apparently fully vaccinated 112,192 people (according to provax.ge).  That is very good for those people but of course we need to get to about 2 million people fully vaccinated to even get near where experts think herd immunity will start to kick in.  What will life look like this fall, when people start to head indoors again, when school starts up again, and when only 10% – maybe 15%, if we’re lucky – of the population is vaccinated?  If I had to guess I’d say I stand by my prediction from December, which is that the most likely probability is that we live with restrictions and disruptions at least through the end of 2021.

Actually, going back through that post is interesting.  At the time the Georgian authorities were telling us that we’d have vaccines for 700,000 people by May.  Here it is May, and I observe that we’re really nowhere near having 700,000 people vaccinated, and I don’t think we even have vaccines for 700,000 people in the country.  At the time I gave it a 30% chance we’d hit herd immunity through vaccination by September; now I’d downgrade that significantly – I’d say it’s almost certainly not going to happen, so <1%.  So as I said – I expect restrictions to continue in some form – perhaps being eased and then re-imposed in response to waves – through the end of the year (and probably longer).

I also have to be honest – once I’m fully vaccinated, I may start making these posts less frequently.  I can already feel the motivation to keep up my coverage of covid running dry.  Now that we’re at the point where pretty much anyone who really wanted to get vaccinated has had the opportunity (with a few exceptions, like expats who are not legal residents and couldn’t make it to their home countries) I feel like it’s less of a public service to keep people informed about exactly how dangerous everything is.

Anyway, until next week – stay healthy!

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

 

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Coronavirus in Tbilisi – May 16th, 2021

Short post today.

Numbers are down, which means the lockdown worked – pretty dramatically well, in fact.  Whatever Easter spike there may have been was totally overwhelmed by the drop in cases due to lockdown.  Testing surged from about 20000 per day to about 30000 per day, but despite this, reported cases are *still* down.  So I have to conclude that the lockdown was way, way more effective than I had predicted it would be.  Which is great news.

I think we will continue to see benefits of the lockdown into next week, so I expect numbers to be down again.  But then two weeks from now I’d expect them to stabilize or maybe rise.

Numbers and Analysis

4551 cases reported in Tbilisi this week – that’s down from 5567 last week (but remember that last week was definitely a massive undercount due to lack of testing).  My model had forecast a low of 5141, so we’re pretty well below my lower end prediction and outside the margin of error, but I did warn readers last week that I considered this week’s projection to be particularly uncertain due to multiple conflicting factors (holiday bump, lockdown, testing variability) so I don’t feel too bad about being off this week – plus it’s always nice when things work out better than expected.

Nationwide there were 8456 cases reported this week – which *is* within my margin of error (I’d predicted 8,053 – 12,595 cases nationwide).  Why is Tbilisi seeing a larger reduction in cases than Georgia on average?  I’d imagine possibly holiday travel out to the regions could account for that – maybe during the extended holiday lockdown a lot of people spent time in their villages, reducing the overall population of Tbilisi and thus the proportion of cases picked up there.  That reduction in the number of people present in – and getting tested in – Tbilisi might also be a contributing factor to why my Tbilisi projection was off, which was a totally unexpected factor but in retrospect actually makes perfect sense.

Nationwide testing surged from 144641 tests last week to 216812 tests this week.  I think I expect testing to drop again a little bit next week since 216812 is an above-average number of tests.

Nationwide positive test rate is down to 3.9% – a good sign.

Projections

My model says to expect 3257 cases in Tbilisi next week (low: 2540; high: 3973).  Honestly this seems a bit low to me, and my 7-day ratio model predicts 3720 (low: 2902, high: 4538), which honestly looks more reasonable.  I’m going to weasel out of committing to one of these and just say I’ll expect 2540 – 4538 cases based on my forecasting models.  I wouldn’t be surprised if it’s even a little bit higher than that, but maybe I’m just being a pessimist.

Nationwide the projection is for 7547 cases (5887 – 9207).  This again looks more reasonable than the Tbilisi forecast, but we’ll see.  Risk assessment in the worst case is 1 in 180 people in Tbilisi infected and contagious.  In a gathering of 10 people there would be about a 1 in 20 chance of one or more people being infectious.

News

More vaccines are incoming – see, for example, this article about Sinopharm.  I’ve seen lots of articles about lots of vaccines coming in.  I don’t think the country has to worry about supply anymore at this point – the issue seems to be in actual vaccination capacity.  As I mentioned last week they’re promising to expand capacity, and apparently we’re up to 3600 shots going out per day, but I agree with Gamkrelidze here that this is still too slow.

Gamkrelidze also says that demand is rising (same link as above), which I’ve noticed myself anecdotally – after my own first shot, several of my Georgian relatives decided they wanted to get the shots too – so maybe vaccine hesitancy won’t be so much of a problem for the next little while.  Georgians also seem oddly more comfortable with Sinopharm than the other vaccines, and I’m not sure why.  I did pitch it pretty hard last week and maybe those reasons apply – it is a more classic formulation with fewer side effects than the adenovirus or mRNA vaccines.  I’m not sure how dispassionately people are actually evaluating the science on a population-level scale, so maybe part of this is also the media/vaccine skeptics playing up the dangers of the “new” vaccines.  Standard disclaimer: the dangers of getting and spreading covid are much worse than the risk from any of the currently-approved vaccines, so don’t hesitate to get your shots.

Back to life, back to reality

Post is short this week because I’m about to run out and enjoy the weather.  It’s warm and I’m going to take a walk in the park.  I’m still only 11 days out from my first shot, so likely not immune yet, so I’ll be avoiding contact with strangers, and keeping my mask on especially indoors.  But I’m getting really close to the point when I won’t have to do that any more.  It makes spring feel all the more springy.  This might actually be a really nice summer.

Stay healthy!

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

 

Posted in Health and Sickness in Georgia | Leave a comment

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.

 

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