South Carolina and Georgia have started relaxing coronavirus restrictions despite the fact that grounds for optimism about combatting the disease spread are looking thin. For instance:

It’s not clear if getting coronavirus confers much immunity, and if so, for how long. We’ve been hammering on this concern for a while, and it is increasingly becoming official. From the Wall Street Journal:

So far, most medical researchers who have studied coronaviruses related to the pathogen that causes Covid-19—including SARS, MERS and the common cold—are confident that people who do recover gain some immunity to SARS-CoV-2, based on preliminary studies and case reports of the new virus. They don’t know yet whether that protection will last a few months, a few years or a lifetime…. SARS-CoV-2 has a mutation rate of less than 25 mutations per year, compared with influenza’s mutation rate of almost 50 mutations per year, according to an analysis by computational biologists of the Nextstrain consortium, based at the Fred Hutchinson Cancer Research Center in Seattle and the University of Basel in Switzerland. That gives researchers hope that any natural immunity or vaccine would offer more lasting protection, said Pamela Bjorkman, a virologist at the California Institute of Technology who studies viruses that cause AIDS, influenza and Zika… In fact, little is known reliably about the risk of re-infection by the coronaviruses that cause SARS, which first emerged in 2002, or MERS, which was first detected in 2012, several infectious-disease experts said.

The WHO went out of its way to warn that having coronavirus antibodies (as in having been infected) does not necessarily confer immunity. From CNBC:

The World Health Organization issued a warning Friday about coronavirus testing, saying there’s no evidence serological tests can show whether a person has immunity or is no longer at risk of becoming reinfected. “These antibody tests will be able to measure that level of serology presence, that level of antibodies, but that does not mean that somebody with antibodies” is immune, said Dr. Maria Van Kerkhove, head of WHO’s emerging diseases and zoonosis unit.

Despite that, quite a few infectious diseases specialists have been stating in the press that getting coronavirus ought to confer immunity. Nevertheless, there are still significant questions:

– Do asymptomatic/mild symptom cases generate enough of a response to confer immunity? – What about reports of people who recovered getting the disease again? The tendency among experts was to dismiss cases of second infections China as the results of bad testing. However, it’s harder to waive off South Korea finding that 2% the patients deemed to be recovered got sick again. Some believe it’s just more botched tests, while others think it must be relapses. Virologists are strongly of the view that it’s unlikely that those who got the disease and recovered then were infected afresh.

Mutation may be occurring more rapidly complicating vaccine development. If getting an infection confers only short-term immunity, say six months to three years, it’s better than nothing but not hugely so. And on top of that, despite researchers being cheered by coronavirus appearing to mutate much less rapidly that other viruses, already has enough variants to slow coming up with a vaccine. From the South China Morning Post:

A new study by one of China’s top scientists has found the ability of the new coronavirus to mutate has been vastly underestimated and different strains may account for different impacts of the disease in various parts of the world. Professor Li Lanjuan and her colleagues from Zhejiang University found within a small pool of patients many mutations not previously reported. These mutations included changes so rare that scientists had never considered they might occur. They also confirmed for the first time with laboratory evidence that certain mutations could create strains deadlier than others. “Sars-CoV-2 has acquired mutations capable of substantially changing its pathogenicity,” Li and her collaborators wrote in a non-peer reviewed paper released on preprint service medRxiv.org on Sunday… The deadliest mutations in the Zhejiang patients had also been found in most patients across Europe, while the milder strains were the predominant varieties found in parts of the United States, such as Washington state, according to their paper. A separate study had found that New York strains had been imported from Europe. The death rate in New York was similar to that in many European countries, if not worse… The most aggressive strains could generate 270 times as much viral load as the weakest type. These strains also killed the cells the fastest. It was an unexpected result from fewer than a dozen patients, “indicating that the true diversity of the viral strains is still largely underappreciated,” Li wrote in the paper.

Needless to say, this creates additional unknowns. Does contracting a milder version of coronavirus confer much immunity to the deadlier versions? And what happens when that nasty version in New York starts making its way across the US?

Even under a best case scenario, a vaccine is 12 to 18 months away. That’s how long it takes. And don’t put your hope in the BCG vaccine as a quick save. Yes, having had the BCG vaccine appears to offer some protection against coronavirus. However, for reasons over my pay grade, which I believe are among other things due to BCG being a live vaccine, getting it now would be a bad idea (as in it would increase vulnerability near term).

Some promising treatments are getting thumbs down. Doctors in Italy had reported when they threw everything against the wall in treating Covid-19 patients, hydroxychloroquine in combination with azithromycin was beneficial when not much else helped. Trump made hydroxychloroquine controversial by hyping it long before research firmed up whether it held up to scrutiny.

The NIH is now warning against the drug combination. From the Financial Times:

Experts convened by NIH said coronavirus patients should not use a combination of hydroxychloroquine and azithromycin due to possible “toxicities”, meaning the risk of serious side effects, including poisoning… The NIH report said there was “insufficient clinical data” to determine whether hydroxychloroquine or chloroquine, another version of the antimalarial medicine, were appropriate treatments for Covid-19 patients… The report was done by a panel of 50 government and outside experts, and included members of the team that reports to Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases who serves as the top scientist on the White House coronavirus task force… There are no big studies that have proven that hydroxychloroquine works against Covid-19. And a series of smaller ones have shown mixed results. Scientists have warned that it can have significant side effects including disrupting the heart’s electrical system and psychological problems…. On Tuesday, a study of patients at hospitals run by the Veterans Health Administration taking the combination of hydroxychloroquine and azithromycin showed there were more deaths among those taking the drug than those who did not. There were also more deaths in the group taking just hydroxychloroquine… The study involving 368 patients was the largest report to date. But it was not a formal trial and the paper has not been peer-reviewed, a process designed to meet scientific standards.

Disappointingly, one of the clinical trials underway is for hydroxychloroquine only, when it wasn’t used in the field that way. The VA has a negative preliminary finding on hydroxychloroquine plus azithromycin, but the drugs weren’t administered using a clinical trial protocol (such as consistency with size and timing of doses, and one suspects, being double blind, placebo controlled). Nevertheless, the higher death rate gives cause for pause.1

CDC warns that disease may be worse in the fall. We’ve also highlighted this concern, but now it’s official. From the Washington Post:

“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” CDC Director Robert Redfield said in an interview with The Washington Post. “And when I’ve said this to others, they kind of put their head back, they don’t understand what I mean.” “We’re going to have the flu epidemic and the coronavirus epidemic at the same time,” he said.

Needless to say, the CDC chief seems to be declaring victory over the current outbreak awfully early. US cases are still rising, even if they have started falling in some large cities. And that is with those cities having moderate to severe restrictions in place. We may find that this peak might look more like a plateau, particularly if some parts of the country see infections rise and have to tighten up again.

Note this scenario isn’t allowing for a Spanish Flu-like outcome, that the second wave is also more lethal in and of itself.

On top of that, more reports indicate coronavirus death counts are understated, which isn’t surprising. If someone dies at home or in a nursing home, what is the incentive to do the forensic work to ascertain whether it was coronavirus or not? Consider this update from the Financial Times:

The coronavirus pandemic has already caused as many as 41,000 deaths in the UK, according to a Financial Times analysis of the latest data from the Office for National Statistics. The estimate is more than double the official figure of 17,337 released by ministers on Tuesday, which is updated daily and only counts those who have died in hospitals after testing positive for the virus. The FT extrapolation, based on figures from the ONS that were also published on Tuesday, includes deaths that occurred outside hospitals updated to reflect recent mortality trends.

Contrast this less than cheery news on the medical front with rising agitation in the US to get back to normal to save the economy (oh, and keep parents who can work at home from going nuts minding their offspring).

This demand ignore the fact that most workplaces have employees within close proximity to each other (that is the point, after all) which promotes contagion. And it should come as no surprise that a lot of workers have figured that out and are not keen with the risks they are or soon will be expected to take.

Remember that the Smithfield factory in Sioux Falls, South Dakota that provides nearly 5% of the US pork is closed due to a coronavirus outbreak. The Intercept reported that other Smithfield operations are disease hotspots and management has resisted taking action:

Now, the Wisconsin plant, which employs more than 1,000 workers, has more than two dozen confirmed cases and closed down on Wednesday for cleaning and sanitation. Workers at the plant, who spoke to The Intercept under condition of anonymity for fear of reprisal, say much more should have been done. One plant worker with asthma said that when he asked for a mask last month, an official at the company declined his request because if he was provided one, Smithfield would “have to do it for everyone else.” He said that one of his co-workers had brought his own mask and was reprimanded to Smithfield’s human resources department, which told him that wearing his own mask would result in suspension. After days of back and forth between the plant managers and workers, the Cudahy plant allowed its workforce to bring its own masks. Some appeared at work with homemade cloth masks, but most continued to work without basic safety equipment, such as N95 masks. “Eventually they tried to do some social distancing in the cafeteria, but actually, they’re working elbow to elbow on the line, so there’s no social distancing there,” said the sister of another plant worker. There are currently no Plexiglas dividers between workers, though UFCW Local 1473, which represents workers at the plant, has called for such safeguards to be installed.

In the “not making this up” category, Smithfield is blaming the outbreaks, including a new report of infections in a North Carolina plant, on the dirty immigrants which it is generally happy to exploit. From Buzzfeed:

“Living circumstances in certain cultures are different than they are with your traditional American family,” she explained. The spokesperson and a second corporate representative pointed to an April 13 Fox News interview in which the governor of South Dakota, Kristi Noem, said that “99%” of the spread of infections “wasn’t happening inside the facility” but inside workers’ homes, “because a lot of these folks who work at this plant live in the same community, the same buildings, sometimes in the same apartments.”

Needless to say, the rest of the article provides information that undercuts this claim.

Mike Elk in his PayDay Report is keeping tabs on employee strikes; he notes that his tally in the map below is likely to be low:

In particular, some Amazon workers have had it. In France, the government has ordered Amazon to limit operations to essential items to protect warehouse staffers. The giant retailer in a show of pique, has shuttered all six warehouses until it can get before a judge.

The press reports considerable anxiety among Amazon workers and protests have started. So far, the company asserts they don’t add up to much but organizers plan more actions.

Business Insider prepared an odd list of workers most exposed to coronavirus risk. The reason it is peculiar is that it mixes types of jobs with job characteristics. Nevertheless, it’s not hard to see that a lot of positions at establishments that will presumably reopen soon due if nothing else due to political pressure will be of workers at risk:

Medical professionals… First responders… Service workers…Barbers, fast food workers, physical therapists, athletic trainers, and manicurists all work in close physical proximity to their customers and colleagues. Retail salespersons, concierges, restaurant servers, and cashiers all work directly with the public, putting them into potential exposure with those infected with the coronavirus. Jobs without a lot of flexibility…. Airline personnel… Actors, dancers, and other performers

Americans haven’t seen much in the way of shortages beyond PPE, ventilators, and hospital beds, and for consumers, toilet paper. Most consumer shortages are the result of stockpiling, but that situation may not last.

The press warned early of the risk of shortages of some critical drugs supplied from China, as well as other key items made solely or almost solely in China like ascorbic acid. I don’t recall seeing red alerts on these fronts but I would not assume that danger has passed.

The US is seeing more lasting shortfalls, which could become shortages, on the food front. From Bloomberg:

At a Publix store in St. Petersburg, Florida, handmade signs limit customers to two packages of beef, pork and Italian sausage. In Toronto, shoppers at a west end Loblaws can’t buy more than two dozen eggs and two gallons of milk. Spoiled for choice before the pandemic, North American shoppers are finding they can’t get everything they want as grocery stores ration in-demand items to safeguard supplies. While the panic that swept through supermarkets in the first weeks of the coronavirus lockdowns has eased, people are still filling fridges and pantries with stay-at-home staples from flour and yeast to pasta sauce and meat. The strong demand comes at a time of supply disruptions as food makers adapt to dramatic shifts in buying patterns and some processing plants close as workers fall ill. As a result, stores are restricting purchases to prevent items from vanishing from shelves. For shoppers, that can be unnerving.

“Unnerving” may seem overwrought, or alternatively, proof that Americans are pampered. My mother remembers real rationing from World War II.

But I recall during 9/11, when I was pretty sure I was less rattled than most Manhattanites (it was a full three days before I had to have a drink), I was conscious of the fact that going to a grocery store was comforting. Everything on the shelves, in order, the store as tidy as it ever was (good but not great) was a proof of normalcy, that despite the deaths and the acrid smoke smell from the burning site and the upset, most things were still operating as usual.

A CO2 shortage may be a more immediate risk. From the Guardian:

An emerging shortage of carbon dioxide gas (CO2) caused by the coronavirus pandemic may affect food supply chains and drinking water, a Washington state emergency planning document has revealed. The document, a Covid-19 situation report produced by the State Emergency Operations Center (SEOC), contains a warning from the state’s office of drinking water (ODW) about difficulties in obtaining CO2, which is essential for the process of water treatment. The document says that the ODW is “still responding to [that day’s] notification of a national shortage of CO2”. It continues: “Several [water plants] had received initial notification from their vendors that their supply would be restricted to 33% of normal.”… The main reason for national shortages, according to the CEO of the Compressed Gas Association (CGA), Rich Gottwald, is a ramping down of ethanol production…. This led to plant closures, including among the 50 specialized plants that collect CO2 for the food and beverage market.

If the US were rational, water treatment plants would get priority over soda plants. But rationality hs not been much on display here.

And we have yet to see the impact of businesses failing. One thing that has kept the lockdowns feeling less dislocating than they are is people are stuck at home, the most familiar setting they have. And when they go out, while the dearth of activity is odd, it’s not unheard of. You’d see streets that empty, say very early on a Sunday or a major holiday.

When restrictions are loosened and local retail areas start having empty storefronts where long-established vendors once operated, consumers will get daily reminders of the damage.

I keep thinking of the sentence from a failed first draft that many years later spurred Margarite Yourcenar to again take up what became her classic, Memoirs of Hadrian: “I begin to discern the profile of my death.” Coronavirus marks the end of an era, just as the start of World War I did. We can only hope the outcome isn’t as bloody.

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1 Could the fact that the Italian virus was more deadly account for the difference? If that version of the coronavirus is more deadly, it would be worth the risk of the side effects, while it might not with the less lethal strain.