AstraZeneca Vaccine Clots and Coin Tosses

The Oxford-AstraZeneca vaccine for Covid-19 was first approved and used in the UK at the beginning of December. Since then it has been used in many more countries. 

On February 26, 2021, Health Canada authorized the AstraZeneca COVID-19 vaccine for use in adults 18 years of age and older.

However, on March 1, 2021, the National Advisory Committee on Immunization (NACI) recommended the use of the AstraZeneca vaccine be limited to individuals between the ages of 18 and 64, based on AstraZeneca’s clinical trial data.

On March 16, NACI reviewed more recent real-world effectiveness studies and expanded its recommendation for the use of the AstraZeneca vaccine to people 65 years of age and over.

NACI makes recommendations for the use of vaccines currently or newly approved for use. It is up to each province to tailor their own vaccination rollout plans.
https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci.html

Quebec did not restrict the use of the AstraZeneca vaccine for seniors.

BC approved the use of the AstraZeneca vaccine for workers at risk. 

Ontario decided it would not administer the AstraZeneca vaccine to seniors. Instead, it opened up vaccination reservations for people 60-64 who would get the AstraZeneca vaccine. This caused a lot of confusion, resentment and went against its own policy. 

Ontario’s policy for the Phase 1 vaccine rollout includes only the following people:
– Congregate living for seniors
– Health care workers
– Adults in First Nations, Métis and Inuit populations
– Adult chronic home care recipients
– Adults over 80 years old
https://covid-19.ontario.ca/ontarios-covid-19-vaccination-plan

The AstraZeneca vaccine should have been allocated to these other groups so that the high risk seniors over 80 years were not bypassed by a younger age group. 

This is just another example of bad vaccine management by Ontario. It won’t be the last.

________________

In the meantime, on March 7, Austria reported two cases of blood clots in people who had received vaccines, one of whom died.

On March 11, Denmark suspended all use of the AstraZeneca vaccine after several cases of blood clots were reported.

By March 16 there were 18 countries in Europe who had suspended the AstraZeneca vaccine, pending an investigation. 

All adverse events for any drug, not just vaccines, are reported to a central regulatory agency for review. In the U.S. this is the FDA, in Europe it is the European Medicines Agency (EMA). The regulator then does a thorough investigation and issues an advisory.

The EMA investigated the 25 cases of blood clots that occurred in 25 million people. On March 18, 2021 it issued its report, concluding that “benefits still outweigh the risks despite a possible link to rare blood clots”. https://www.ema.europa.eu/en/news/covid-19-vaccine-astrazeneca-benefits-still-outweigh-risks-despite-possible-link-rare-blood-clots

One of the things that was investigated is the batch of the vaccine to make sure that there was not a fault in the manufacturing of the vaccine. Other factors were investigated and when no causal link was found then the conclusion is that the variation is just a random fluctuation, since people can experience blood clots for many other reasons that are not at all related to the vaccine.

To understand random fluctuation, let’s do some coin tosses. A coin that is balanced and not weighted to any side will come up H (heads) half the time and T (Tails) half the time.

Here are a few sequences.

If you saw this sequence, would you think it was likely?

H T H T H T H T H T H T H T H T H T H T ………… 10/20 Heads, 10/20 Tails

The answer is No. This is a repeating sequence of the exact probabilities, Heads followed by Tails. In a random sequence, it is very unlikely for there to be regular repeating patterns. 

There is much more likely to be random patterns, like

H T T H T T T T H H H H T H T T T T T H ………… 8/20 Heads, 12/20 Tails

So how do you determine if 25 blood clots in 25 million people is just a random sequence or if it signifies that there is something systematic, a non-random reason for the variation?

The answer is probability and statistics, a branch of mathematics that has been used for centuries to answer questions like this.

According to such mathematical analysis, 25 blood clots in 25 million people is not significant, in other words it is most likely just normal random fluctuation.

A million is a number that gets bandied around a lot but few people have an intuitive sense of how big this number is. Who has ever counted to 1,000,000 or ever even seen 1,000,000 things with their own eyes.?

Here is a visual picture. The area of the red dot compared to the whole grey area represents roughly 100 out of a million. Computer screen resolution does not allow a smaller dot to represent only 1 out of a million, you would barely be able to see it. This picture is 100 times more than the blood clots that were reported from people who took the AstraZeneca vaccine.


Should you get the AstraZeneca vaccine?

These changing conclusions have led some people to decide that they would not get this vaccine. This is really not a wise decision. All concerns about the AstraZeneca vaccine have been thoroughly investigated by scientific experts in the field. Deciding that the vaccine is not safe when the conclusion by the EMA that the vaccine is safe is an irrational response that ignores all science. 

Unless you know for sure that if you turn down an AstraZeneca vaccine you will be able to get one of the other vaccines within a week, you are putting yourself at great risk. With the variants surging, the probability that you could get Covid may be as much as 1 in 500 each week. If you get the AstraZeneca vaccine, which has an efficacy of 76% after the first dose, your risk of getting Covid is not only significantly lower, but your infection would be a lot less severe. And your risk of getting a blood clot from the vaccine is practically 0.
https://www.astrazeneca.com/media-centre/press-releases/2021/covid-19-vaccine-astrazeneca-confirms-protection-against-severe-disease-hospitalisation-and-death-in-the-primary-analysis-of-phase-iii-trials.html

Lockdown Controversies

Ever since the first lockdowns were imposed to try to slow down and control the exponential spread of Covid-19 were imposed in March 2020, there have been many counter arguments and objections. The general argument is that lockdowns are extremely expensive not only in terms of the economy but also because of other deleterious effects on health, education and general social welfare and that therefore lockdowns are an overreaction. 

Cost/Benefit analyses have claimed to show that the cost of lockdowns is far greater than the benefits. The problem in most of these comparisons is that they use numbers for Covid cases and deaths that are after lockdown, since most countries have imposed lockdowns. This comparison needs to be done against the Covid cases and deaths that would have occurred if there had not been a lockdown.

To do this comparison, here is a spreadsheet that shows the difference between lockdown and no lockdown. It is based on actual Covid case numbers (shown in blue) from the time lockdown was imposed in Canada.

The first block (in green) shows how cases would have grown with No Social Distancing measures.

R(t) is the reproduction number, the average number of people that are infected by someone who has the virus.

On Mar 22,
New Cases are 2.8 * 188 = 526
Total Cases
rise to 526 + 252 = 778
And so on for each week. That’s all there is to this spreadsheet, pretty simple math.

Under Lockdown (pink block), R(t) reduces from 2.8 to 0.9 in May.
For a simple model, this matches the Actual data (yellow block) pretty well.

The difference between Lockdown and No Social Distancing is pretty dramatic.
On May 17 there are over 3,093,570 Total Cases of Covid if nothing is done, but only 74,100 with lockdown.

Note that Lockdown is the only social distancing measure that will reduce an R(t) of 2.8 to less than 1, which is necessary to slow the exponential growth.
https://wwwnc.cdc.gov/eid/article/27/2/20-3412-f5

You can see why so many countries went into Lockdown in March 2020. If you were a leader of a country and your health experts showed you these projections, even if you didn’t understand the math and weren’t sure of the result, would you have risked 3,000,000 cases of Covid that would have completely overwhelmed the hospitals versus 74,000 cases by not calling for a Lockdown? Most responsible leaders did not take that risk, with a few exceptions like Bolsonaro in Brazil and several U.S. state governors like DeSantis in Florida.

Another argument against Lockdown uses Covid statistics and excess mortality graphs to show that Covid-19 is no worse than a bad flu season. We don’t impose lockdown for flu, why do it for Covid?

Again, these arguments use existing Covid statistics, not what would have happened if there had been no lockdown.

Let’s look at the numbers.
A bad flu like H1N1 (Swine flu 2009) had an R(t) of 1.4. Here is the spreadsheet.

So Covid is a lot worse than a bad flu. After 9 weeks there are over 3,000,000 Covid cases versus 13,000 flu cases. Again, this is simple high school math.

References

Actual weekly case data (blue)
https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&minPopulationFilter=1000000&time=2020-03-02..latest&country=~CAN&region=World&casesMetric=true&interval=weekly&smoothing=0&pickerMetric=location&pickerSort=asc

Reproduction number for Canada
https://globalnews.ca/news/6917781/coronavirus-reproduction-number-canada/

Reproduction number for H1N1 Flu
https://www.livescience.com/covid-19-pandemic-vs-swine-flu.html

Virus Variants Update

Virus variant headlines have been superseded by excitement about new vaccines being approved.

  • In Canada, AstraZenica was approved and Johnson & Johnson approval is expected within weeks.
  • In the U.S. the Johnson & Johnson vaccine was approved and started rolling out on March 1, 2021.

Will these new vaccines be enough to change the trajectory of the virus variants?

I updated the Canada model to add new vaccines not already included under the existing contracts.

  • 2 million doses of AstraZenica from March to end of May.
  • 10 million doses of Johnson & Johnson from June to end of September. 

This increase in vaccinations will not be enough to prevent a huge spike in Covid-19 cases from the virus variants, and a lockdown will need to be imposed by the end of March.

In the U.S. the situation is quite different. Not only have they vaccinated a lot more of their population but they have also had many more Covid-19 cases which impart immunity. The U.S. immunity as of March 1 is approximately 25% of the population compared to 7% in Canada. As a result, the U.S. does not face a huge spike from the virus variants.

For a complete graph of daily new Covid-19 cases in Canada and the U.S. see
https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&country=CAN~USA&region=World&casesMetric=true&interval=smoothed&smoothing=7&pickerMetric=location&pickerSort=asc

There are many variables at play here, and these scenarios are quite sensitive — a small change in one of the variables can make a big change in the result. There is no question that there is a race between the virus variants and the vaccines. The very different case predictions between Canada and the U.S. shows how critical the immunization level (total of vaccinations and prior cases) is at the time the virus variants start to increase in mid March.

Virus Variants

The news has been full with reports of the coronavirus variants. These are several new versions of Covid-19 that have developed through mutation. In fact there have been many mutations of Covid-19 since it was first discovered. Here is a report of six strains from August 2020. https://www.sciencedaily.com/releases/2020/08/200803105246.htm

But more recently several new variants have appeared with changes in the spikes on their surface which helps them attach more easily to human cells than the original virus. These are the new variants of concern that have been identified in Canada.

UK Variant B.1.1.7 first emerged in the U.K. in September 2020. This variant spreads about 50% faster than the original strain and can be transmitted in less time.

South Africa Variant B.1.351 was first discovered in South Africa in December 2020. This variant is more efficient than others in targeting and infecting healthy cells. South Africa paused the rollout of the AstraZeneca vaccine after preliminary trial data showed it offered minimal protection against mild to moderate illness from this variant. 

Brazil Variant B.1.1.28 or P.1 was first identified in December 2020 when it caused one of the deadliest outbreaks in Manaus, Brazil. This variant may reduce the ability of antibodies developed from previous infections and vaccinations from killing the virus.

https://www.scientificamerican.com/article/the-most-worrying-mutations-in-five-emerging-coronavirus-variants/

Here are reports that show the rapid spread of the UK variant, in Ireland and Denmark.

  • In Ireland less than 10% of positive tests at Christmas were caused by the UK variant, but rose to 45% by the middle of January.
  • In Denmark the UK variant climbed from 0.3% of all samples sequenced in November to 2.9% in early January. The variant’s share of total cases is growing exponentially and is expected to be the dominant variant by mid-February. Denmark has been in lockdown since Dec. 11 and case numbers are dropping. The reproduction number is now at 0.9 but that is not particularly reassuring. “We think this is like the calm before the storm. We need to have a reproduction number below 0.7 if we want to avoid exponential growth in February and March.”
    https://www.spiegel.de/international/world/can-germany-stop-the-new-supervirus-a-e9ffc207-0015-4330-8361-b306f6053e15
     (Der Spiegel is the largest weekly news magazine in Europe)

This chart shows the percentage of all cases that are the UK variant in countries where it has been detected.

https://tomaspueyo.substack.com/p/variants-v-vaccines

The UK variant is the most prominent variant in Canada, with almost 400 identified as of February 11.
https://nationalpost.com/news/canada/the-state-of-covid-19-variants-in-canada-ontario-has-more-than-half-the-cases

On January 8, a single case of Covid-19 was detected at Roberta House, a long-term care home in Barrie, Ontario. The disease ripped through the facility with such speed that by January 25 more than 200 people had contracted the virus and 44 residents and one caregiver had died. The variant was also detected at another long-term care home in the area.
https://barrie.ctvnews.ca/more-than-100-cases-believed-to-be-u-k-covid-19-variant-linked-to-barrie-ont-care-home-1.5282898

Note that the UK variant spreads more quickly, estimated at 50%, but it is not currently known to be more virulent. That is, you are not more likely to die if you get the UK variant. It may be counter-intuitive but a virus that is more contagious will cause a lot more deaths than a virus that is deadlier, as shown in this graph.

The math for this is quite simple:

Suppose 10,000 people are infected, R=1.1, infection fatality risk=.8%, generation time=6 days. 

In a month there are 5 periods of 6 days, so transmission increases by 1.15.
So 10,000 x 1.1^5 x 0.8% = 129 new fatalities after a month of spread.

If the fatality risk increases by 50%,
10,000 x 1.1^5 x (0.8% x 1.5) = 193 new fatalities.

But if transmissibility increases by 50%,
10,000 x (1.1 x 1.5)^5 x 0.8% = 978 new fatalities.

(You can verify the numeric result of a formula by copying and pasting it into a Google search bar, which can be used as a general calculator.)

So what are the implications of these new variants?

Since they are more transmissible, you should take extra precautions when you are in the vicinity of other people.

Aside from a “third wave” spike in cases in March or April, there is not a lot being said about the full impact on the pandemic in Canada. While many epidemiologists have access to models that make predictions, I have not seen any graphs of them. Health authorities are pussy-footing around this, much as they did at the beginning of the pandemic in March 2020. 

Is it because the picture looks very grim?

This graph shows the pace of the UK variant in the United Kingdom. It peaked over a period of 2 months and increased the daily cases by a factor of 4. The UK entered lockdown on January 5, 2021, after which cases have declined.

https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&minPopulationFilter=1000000&time=2020-03-02..latest&country=CAN~GBR&region=World&casesMetric=true&interval=smoothed&smoothing=7&pickerMetric=location&pickerSort=asc

To see how a similar pattern would look in Canada, I returned to the spreadsheet model I used at the beginning of the pandemic. I “restarted” the model by entering the actual case counts for February 13, 2021 and modified the spreadsheet calculations to model the following assumptions.

– Used the Reproduction number R(t) of 1.1 reducing to .9 for lockdown periods.
https://epiforecasts.io/covid/posts/global/
– In March to April gradually Increased R(t) up to 50% to account for the increase in the UK variant.
– Added actual vaccinations that have been administered.
– Added the vaccine rollout assuming Canada hits its target that “everyone who wants a vaccination will get it by September 2021”. Since not everyone will want the vaccine, 70% of the population was used.
https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/covid-19-vaccine-treatment/vaccine-rollout.html#a4a

Here is the result, using relaxed lockdowns starting in February to reflect the fact that Ontario, Quebec, Alberta and Manitoba (but not B.C.) have begun easing restrictions.

This shows a large spike over a three month period with an increase of 4 times the number of daily cases, reaching almost 30,000 cases per day at the end of May before the vaccines start to take effect. This is very similar to what happened in the U.K.

This large increase in daily cases means that there will have to be another lockdown. 

Here is the result when a lockdown is applied for 7 weeks beginning mid-April.

This shows that by the end of the lockdown in mid-May when the percent of the population that is vaccinated reaches 33%, the number of cases stops increasing. By the end of August there are less than 100 cases per day and the percentage of the population that has been immunized (through vaccination or prior infection) is 70%. This is herd immunity. 

Life could return to normal within Canada in September 2021.

Scorecard for 2020

Here’s a summary of some of the things that were predicted in blog postings this year.

Vaccine rollout

On November 15th, in a section titled Vaccine News, it was predicted that it will likely take at least 10 months to vaccinate enough of the population to reach an immunity level that will slow the spread of Covid-19, assuming that all the challenging logistics of distributing and vaccinating millions of people can be managed without major delays. Given the track record of public health with the coronavirus this does not seem likely.
https://www.nytimes.com/2020/11/14/health/covid-vaccine-distribution-plans.html

The post on December 17th provided more detail to explain why the vaccine rollout in both the U.S. and Canada was not likely to meet the announced dates. In the last few weeks this story has become headline news almost every day.
https://anydaynow.blog/vaccine-rollout-confusion/

The U.S. had announced a plan to vaccinate 20 million Americans by the end of December. Only 15% of this goal was achieved.

In Canada, despite declarations by several provincial premiers that the federal government was not delivering enough vaccines, the actual statistics show that inoculations have lagged way behind the delivery of vaccines.
https://covid19tracker.ca/vaccinegap.html

Operation Warp Speed in the U.S. declared that they would vaccinate everyone by June 2021. In Canada, Trudeau promised that all Canadians would be vaccinated by September 2021.

The December 17 post called these targets overly optimistic and repeated the prediction made on Aug 15, 2020 that enough of the population (less than 100%) will be vaccinated to achieve herd immunity by the end of October 2021.
https://anydaynow.blog/vaccines-on-the-way-in-2021/

On Dec 31, 2020 Dr. Fauci said that the U.S. could return to normal life by early fall.
https://abc17news.com/news/health-news/2020/12/31/fauci-says-us-can-return-to-normal-by-fall-if-it-puts-aside-slow-start-and-is-diligent-about-vaccinations/

Who is more believable, Warp Speed and Trudeau or Dr. Fauci and this blog?

Continue reading “Scorecard for 2020”

Software failure causes Canada’s largest bank to lose $2 million a day

I had some funds that I wanted to invest but when I went into my RBC account, I discovered that my investing account had disappeared. I had not used it for a few years but I had never received a warning or a notice or that this was to happen. This is RBC Fault #1.

It looked like I had to create a new account. There was a link in my online RBC account to do this. After going through 10 screens entering all kinds of detailed information about myself and various investment options, I got to what looked like the last screen. I clicked on the button and received the following response:


This was incredible! I was dumbfounded that there could be such a catastrophic failure in such a critical application. RBC Fault #2.

Someone analyzing this may have estimated that RBC was losing 40 applications a day with an average portfolio value of $50,000. In other words $2,000,000 a day. Now this is really not a very thorough analysis, but it would not stop someone from posting headline news saying,

“Software failure causes Canada’s largest bank to lose $2 million a day”

I called the Direct Investing customer support number and was informed that there was a wait time of 1 hour and 45 minutes. I decided not to wait. I thought of calling outside of stock trading hours when the line might not be so busy, but I found out that the support line was only open from 8 am to 5 pm, weekdays only. For people managing an investment portfolio, where time is of the essence, this level of customer support is inadequate. Fault #3.

A few days later I was able to get to my local RBC bank branch. I asked if they could set up an RBC Direct Investing account for me. They said they were not able to do this at the branch. I would have thought that an investing account was a pretty important RBC product. Why aren’t branch banks able to help customers with it? Fault #4.

After about 10 days I thought that the web site error would be fixed, since the message said that RBC had its “best teams working hard to fix this error”. However, after painstakingly going through all the setup screens, I encountered the exact same error again. Clearly RBC’s “best teams” were not very good, or else they had never been informed that there was an error that needed to be fixed. Fault #5.

I decided I had to bite the bullet and call customer support. By now it was the December holiday season and things were slowing down. I had to wait “only” 45 minutes to get through to a support person. He could not understand how I was having such a problem. He put me on hold while he went to talk to a manager. They looked into my account and discovered that my Direct Investing account had not been deleted, it had been “hidden” from my view. They could not really understand how or why this had been done, but they were able to restore the account so I could carry on with my investment plans.

I don’t know if RBC ever fixed their web site. Clearly trying to create a new investing account when one already existed is a problem, but the error message never indicated this.

Whoever coined the phrase that the big banks are “too big to fail” clearly did not have any understanding of how software works, and does not work.

Vaccine rollout confusion

There was great excitement this week as the first Covid-19 vaccines were delivered. However, along with it has been great confusion. 

Although many reports have cautioned that there is still some way to go before reaching the end of the pandemic, they are not giving a clear indication of when that will be or why. As a consequence, many people think it will be quite soon and they don’t have to be that diligent about taking precautions and following coronavirus health guidelines. This is partly due to irresponsible reporting where journalists are not asking the right questions to explain the whole picture. It is also due to the poor planning of public health who have not made it clear how and when people will be getting vaccinated. Yet another example of how they are scrambling at every step of this public health crisis.

In the U.S., Operation Warp Speed has engaged the military to deliver the vaccine. They declared that they will have enough vaccines for everyone in the US by April 2021.
https://www.reuters.com/article/health-coronavirus-usa-immunization/explainer-when-will-covid-19-vaccines-be-generally-available-in-the-united-states-idUKL1N2H713H

More recently they changed their estimate to be more in line with the CDC who estimate June 2021. Since the vaccines required two inoculations this means that 700 inoculations need to be performed. It does not seem realistic that this can be done in six months. Warp Speed has the responsibility to deliver the vaccines from a few pharmaceutical companies manufacturing locations to a limited number of depots in the US. They may be able to deliver 700 doses. However, that is not the end of the job. A much larger part of the job and a bigger challenge is to get those vaccines from the depots and deliver them and inoculate people. The Trump administration allocated billions of dollars for Warp Speed but hardly any money for local public health to do the vaccinations. According to them this is a state responsibility. But most states do not have the funds in order to be able to do this.
https://www.cbsnews.com/video/funding-shortfalls-hinder-vaccine-distribution-in-small-towns

It is likely that Congress will pass a bill to provide some vaccination funding for the states. But this late in the day means that many states have not done the necessary planning.

In Canada there are the same questions. The military has also been enlisted to organize the logistics of the vaccine rollout. But they only know the initial part of the rollout which is getting the drugs from the manufacturer and delivering them to a limited number of distribution points across the country. After that the local provincial health departments need to figure out how they are going to vaccinate millions of people. Here is an interview with the CEO of the University Health Network, one of the two vaccination centers in Ontario, which reveals that a lot of basic questions remain unanswered.

In spite of all this uncertainty, the Trudeau government has stated that all Canadians who want to be immunized will be vaccinated by September 2021.
https://www.ctvnews.ca/health/coronavirus/canada-plans-to-vaccinate-everyone-who-wants-it-by-the-end-of-2021-1.5224265

I think this target is overly opimistimc. I am sticking to the prediction made in the blog on Aug 15, 2020 that enough of the population will be vaccinated to achieve herd immunity by November 2021.

We don’t need to vaccinate everyone to halt the exponential rise of new cases. We only need about 60% immunity in the population. At that point Covid-19 will not disappear but the number of new cases will decline to a manageable level and large outbreaks will not occur. This also means that if as many as 40% of people choose not to get the vaccine, it does not prevent us from achieving herd immunity and controlling the pandemic.

There really is no excuse for this lack of planning. It has been known for at least six months that Pfizer and Moderna would be submitting their clinical trial data to the FDA at the end of December, and that with fast track FDA approval, vaccines would be ready for rollout in January. Public health had six months to prepare plans for local distribution but in both the U.S. and Canada they seem to be scrambling.

By contrast, here are some of the plans the U.K. has in place.
https://www.theguardian.com/world/2020/nov/11/thousands-of-hospital-staff-to-be-deployed-in-covid-vaccine-rollout

https://www.theguardian.com/world/2020/nov/20/nhs-prepares-dozens-of-covid-mass-vaccination-centres-around-england

Can contact tracing be fixed?

Why are Corona virus cases surging in the U.S. and Canada whereas in many other countries like South Korea, Taiwan, Japan, Australia and New Zealand the pandemic is under control?

A big part of the reason is that these countries have succeeded in testing and contact tracing to control outbreaks before they spread throughout the broader population.

Why didn’t Canada and the US exercise such policies?

It’s not as if this strategy has been a secret. In April 2020, WHO published guidelines for lifting restrictions used to limit the spread of Covid-19. Many of these guidelines were used during the Spanish Flu in 1918 and are part of standard public health principles. The ability to test and trace every infection are critical conditions.
https://nationalpost.com/news/canada/covid-19-the-who-has-issued-guidelines-for-lifting-restrictions-but-is-canada-ready

In both the U.S. and Canada, public health policy for opening the economy after the first lockdown in the spring of 2020 was to follow the WHO guidelines and have sufficient testing and contact tracing in place to contain Covid-19 outbreaks. But public health utterly failed to build the infrastructure to do this. Part of the problem may have been their failure to convince their governments and/or “cheap” governments who would not provide sufficient funding. As a result, there were not enough people in place to do contract tracing in the first coronavirus wave and not enough new people were hired in advance of the second wave. In Asia, the people who do contract tracing are experienced and have been doing this work for many years.
https://www.nytimes.com/2020/10/03/world/europe/covid-contract-tracing.html

When case counts exceed a certain level, contact tracing cannot keep up with the number of new cases and identify them early enough to contain the outbreak. This has happened in most of the U.S. and Europe and contact tracing has been largely abandoned. Canada has fared better in some regions, such B.C. and Atlantic Canada. But it was recently revealed that Toronto has suspended contact tracing.
https://globalnews.ca/news/7376562/toronto-public-health-coronavirus-contact-tracing-suspension/

How can contact tracing be fixed?

By far the best way to provide critical contact tracing is by using a smartphone app. The app runs in the background on your phone. It continually sends out Bluetooth signals to locate other users of the app within close range and stores a record of these users. When someone using the app contracts Covid-19, they enter this into the app. Then all other users of the app who were in close proximity get an alert that they may have been exposed. Users who receive such a notification are advised to self-isolate and get a Covid-19 test.

This is instant and automatic. Compare this to traditional contact tracing. First someone gets tested for Covid-19. After a delay the result is reported. If it is positive, a contact tracer will spend at least 24 hours (a target that is not always achieved) making phone calls to try and identify anyone who was in contact with the infected person. Many phone calls are not answered or the respondent will not provide full information. Manual contact tracing is slow and unreliable. A smartphone app is fast and reliable.

A study done by Oxford University estimated that if 56% of the total population used a smartphone app (alongside other interventions) it could stop the epidemic.
https://www.research.ox.ac.uk/Article/2020-04-16-digital-contact-tracing-can-slow-or-even-stop-coronavirus-transmission-and-ease-us-out-of-lockdown

In the U.S. the federal government had no plans to create a national contact tracing app. Each state needed to create its own, leading to a patchwork of apps across the country that used different technologies and couldn’t communicate with each other. State apps effectively became useless as soon as the user crossed a state line.
https://www.vox.com/recode/2020/10/2/21497729/covid-coronavirus-contact-tracing-app-apple-google-exposure-notification

Apple and Google developed the core code for a smartphone app as their contribution to the pandemic. Together they account for 99% of smartphone operating systems (iPhone and Android).

Canada developed a smartphone app, COVID Alert, using this code framework and made it available to people in Ontario on July 31, 2020.
https://en.wikipedia.org/wiki/COVID_Alert

This was late. The Google/Apple Exposure Notification code was released on May 20, 2020. Italy had an app for their citizens June 1. Twelve other countries released apps before Canada.
https://en.wikipedia.org/wiki/Exposure_Notification#Adoption

As of Nov 25, COVID Alert is available in only 8 of the 10 provinces. It has been downloaded 5.5 million times, about 15% of the population. This is yet another failing of our leaders and public health. All of the provinces should have been pressured into getting on board and preparing for a nationwide release with a program to heavily promote the app as soon as it was available.
https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/covid-alert.html

It has been reported that a lot of people do not trust the app for privacy reasons. This is not well founded. The app was developed from the ground up with security in mind by Google and Apple, who have the most skilled software developers in the world. Privacy protection is well explained for anyone who makes the effort to read it.
https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/covid-alert/privacy-policy.html

What needs to be done is to provide a real incentive for people to install COVID Alert. A rebate of $25 should be offered to anyone who installs the app. If a target 50% of Canadians followed up on this to stop the epidemic spread, the cost would be less than $500 million. Compared to other Covid-19 costs, such as the various employment subsidies which are in the billions of dollars, this is an insignificant amount, especially compared to the benefits it promises.

Cambridge Analytica revisited

When the Cambridge Analytica scandal broke in 2018, Facebook became a focal point for the failures in protecting people’s privacy. Facebook was pilloried in the press and hauled into U.S. Senate hearings. https://www.nytimes.com/2018/04/10/us/politics/zuckerberg-facebook-senate-hearing.html

I had just finished reading a book written by one of the early developers of Facebook’s advertising, “Chaos Monkeys” by Antonio Garcia Martinez. And I had experimented with Facebook advertising to promote my computer book. Much of what was being said and reported did not square with what I knew. The main culprits in the use and abuse of privacy information are a large number of companies known as data brokers. If you don’t know who they are and what they do this article describes the tip of a very large iceberg.
https://www.webfx.com/blog/internet/what-are-data-brokers-and-what-is-your-data-worth-infographic/

The first time most people ever heard of a data broker was when Equifax was hacked and personal records of 147 million people were stolen.
https://www.nytimes.com/2020/02/10/opinion/equifax-breach-china-hacking.html

As information about the Cambridge Analytica surfaced, many people pointed fingers at Facebook or the other tech platforms like Google and Twitter. However, the only clear call that would really address serious privacy concerns came from Tim Cook. In 2019 he called for comprehensive federal privacy legislation that would establish a data-broker clearinghouse, requiring all data brokers to register, and enabling consumers to track the transactions that have bundled and sold their data, and giving users the power to delete their data on demand, freely and easily.
https://time.com/collection/davos-2019/5502591/tim-cook-data-privacy/

This call did not garner much uptake. The data brokers and advertising industry have a lot more influence in Washington than the tech companies. They are really happy to have Facebook and the other tech companies take the fall for failures in privacy information protection. By contrast, Europe has had an extensive privacy law, the General Data Protection Regulation (GPDR) since 2018.
https://www.nytimes.com/2019/06/08/opinion/sunday/privacy-congress-facebook-google.html

I finally came across an article that explains the role of data brokers and how they use Facebook advertising to help them reach their target audiences. It also reveals that there is an “industry of political data brokers”. While I don’t get overly concerned about companies using people’s identity information to target advertising, when data brokers are using this information to target and try to influence voting in elections, then I think there is a lot more cause for concern.

How politicians target you: 3,000 data points on every voter, including your phone number.

Our quest to find what politicians know about voters uncovered data troves with intimate information about income, debt, family, religion, gun ownership and a whole lot more.

By Geoffrey A. Fowler
Washington Post technology columnist based in San Francisco. He joined The Post in 2017 after 16 years with the Wall Street Journal writing about consumer technology, Silicon Valley, national affairs and China.
October 27, 2020

The campaign messages are coming fast and furious now.

“Hi Geoffrey, I’m Jess w/ People’s Action,” reads one. “Voter Alert for Geoffrey Fowler!” says another.

And the weirdest: “It’s Jonathan Del Arco, Hugh the Borg on Star Trek … Join a grass roots fundraiser with 19 cast members!”

Perhaps your text messages, Facebook feed or mailbox have also exploded with eerily personal political ads. Ever wonder: How’d they find me? I, for one, didn’t pass my digits to a campaign — much less tell them (or Hugh the Borg) I’m a Trekkie.

Blame the assault on the voter data economy, in which candidates, parties and nonprofits quietly collect, buy and exploit a ton of information about you.

Their files treat your contact details like a matter of public record and can be more intimate than credit applications, including your income, debt, family, ethnicity, religion, gym habits, whether you own a gun and what kind of car you drive. In 2020, campaigns use this data to microtarget us with record numbers of online ads, mailers, knocks on the door and text messages.

I’ve been on a crusade to find out what politicians know about me. So over the past few months, I’ve used California’s new data privacy law to force companies that specialize in collecting my personal information for campaigns to show me the data.

What I learned: Privacy may be a cornerstone of American liberty, but politicians on both sides of the aisle have zero problem invading it.

In fiercely competitive races, campaigns see our data as their edge. The Republican National Committee proudly told me it now has more than 3,000 data points on every voter. The Democratic National Committee said it acquires enough to understand you as a person, including unique identifiers from your phone that can be used to target ads across different apps.

Politicians have long had special access to voter registration and participation data, which they use to plot strategy, run polls and coordinate volunteers. But in recent years, they’ve also begun tapping into commercial data brokers and murkier social media and smartphone tracking techniques. The scandal that erupted around Cambridge Analytica, which scraped data from Facebook while working for Donald Trump’s 2016 campaign, was just the tip of the iceberg.

Many Americans, like me, find targeted ads creepy when they come from businesses, especially when they use personal data we didn’t really consent to have tracked. But I found it downright unsettling to learn that my credit score — and so much else — was going to politicians who could use it to try to manipulate me. Online political ads are so potentially dangerous for democracy that Twitter banned them entirely and Google limited how campaigns can target them. (In September, Britain’s Channel 4 documented how Cambridge Analytica used voter data to specifically disenfranchise African American voters in 2016.)

I’m not saying politicians are breaking any laws; I’m saying there just aren’t many laws designed to protect our data from politicians. As an institution, Congress has shown little interest in regulating the digital tools its members use to get into office. (Even the California Consumer Privacy Act I used in my quest applies only to the for-profit part of this economy.) Citizens with a lot of free time can try to opt out of some political databases and communications, but for the most part, we have little control.

In my data crusade, I should have been an enigma for the politicians. As a journalist, I don’t donate, sign petitions or participate in surveys. I also avoid campaign communications, though I recently signed up for text messages from both the Trump and Biden campaigns as part of this reporting.

It turns out campaigns didn’t need me to volunteer information to build detailed profiles about me. I found five major sources of personal data that fuel the political machine. 

1. State voter files

Voter registration details and voting history are a matter of semipublic record in most places. I say semipublic because states generally restrict access to campaigns, parties, academics and journalists (and the companies that help them).

When I acquired my California voter data as a journalist, I discovered the state was sending campaigns my email address and phone number, along with my address and party affiliation. If I wanted to remove the email and phone number — technically voluntary information — I could re-register to vote. But, as I learned, campaigns have plenty of other sources for that data.

2. Commercial voter files

An industry of political data brokers collects the state voter files and enhances them. They sell these files to campaigns, political parties and academics. (The Washington Post also uses these kinds of files to help run its polls.)

Where do their “enhancements” come from? Largely from data brokers that also sell it to commercial marketers. Firms such as Experian and Acxiom gobble up records and buy personal data sold by banks, subscriptions, TV companies, apps, and more. Then the voter file firms use their own algorithms to make inferences about you, including how likely you are to vote and how much you’re likely to donate.

L2, one of the largest political data firms, sent me two files with more than 700 data points, including my phone number, estimated income and credit rating, and inferences about my politics and hobbies. A few categories were real head-scratchers, such as “home decor enthusiast.”

Another firm, Aristotle, had more than 150 data points on me, including the amount of my mortgage, whether I had insurance from my employer and its guess for my interest in immigration reform. A third, called Data Trust, had over 1,500 data points, including — I kid you not — scores for how much I care about privacy and how much I trust tech companies.

After the shock of finding so much personal data subsided, what struck me was how some of it was inaccurate. Several of the voter files had wrong information about my religious background, whether I’m married and whether I have children.

This isn’t the same as when companies put you in the wrong marketing segments, such as calling you a Prius driver instead of F-150 truck lover. This information is being used by politicians to judge how you might act, donate or vote — before you’ve even made up your mind.

California residents can, like me, use the CCPA law to force voter file companies and data brokers to disclose what they know and even stop selling it. But you have to make the requests one by one.

3. What we tell them (even unintentionally)

When you engage with a politician — signing up for news updates or donating — you’re adding to his or her data trove. You might not mind, if they’re a candidate you believe in.

Every move gets registered. When I signed up, as an experiment, to stream one of President Trump’s recent rallies, it kicked off a deluge of campaign text messages begging for money, with messages appearing three, four or five times per day. (At least replying “STOP” cuts off the messages. That works for Biden, too, though not for all campaigns.)

Even when you’re just poking around a campaign website for information, you’re passing along data. Campaign websites, including for both Trump and Biden, often contain hidden trackers that, for example, tell Facebook you were there and then allow campaigns to target ads to you in the future.

Smartphones also now allow campaigns to know where we go in the physical world. The Wall Street Journal reported that campaigns for both parties have used location-data brokers to target people who attend in-person rallies. It’s now even possible for campaigns to identify people who set foot in churches, and — based on the frequency of their visits — target them with specific ads.

Sometimes, your politically active friends can be a source. Campaign apps and volunteer texting campaigns often ask people to upload their contacts list.

4. Other politicians

When campaigns end, sometimes they pay the bills or help out a friendly campaign by selling their data. Contact information for donors is particularly valuable. (No wonder Congress is not eager to legislate.) The fine print in Sen. Elizabeth Warren’s privacy policy reads: “We may share information about you … with candidates, organizations, campaigns, groups or causes that we believe have similar political viewpoints.”

Political parties themselves have also become among the largest sources of data to campaigns, doling out access to campaigns they want to support — and starving the ones they don’t. (Campaign finance laws prohibit candidates and national parties from coordinating their data with outside groups that raise money from unlimited sources.)

RNC press secretary Mandi Merritt told me the committee’s data is taken from voter registration files, information collected by volunteers, and consumer data such as magazine subscriptions, what kind of car a voter drives and whether a voter has a gym subscription. (Voters who have gym memberships are more reliable voters, she said.)

“Our historic investment in building a robust data infrastructure has given us an unprecedented ability to target and engage with voters on the issues they care about,” Merritt said.

Nellwyn Thomas, the chief technology officer of the DNC, said her party acquires data from firms that use “ethical data practices,” though she declined to name them other than Experian. “There are absolutely times we have turned down data sets where we believe the collection methods do not live up to our standards,” she said.

Thomas also said combining data resources inside DNC systems, where it’s accessed by some 9,000 campaigns, helps to ensure our privacy by keeping it secure.

But once your data is in the hands of a political party or campaign, there’s little transparency about what happens to it, or what ethical rules apply to using it. For example, do campaigns need your consent to send you texts? My phone is chock-full of evidence some think they do not.

And unfortunately, California’s don’t-sell-my-data privacy law doesn’t apply to campaigns or parties. When I sent them data requests, they either ignored me or told me go stuff it. Neither the RNC or DNC would share my data with me when I asked as a journalist, either.

If you want some of the targeted ads to go away, the DNC’s Thomas suggests voting early — that will update party databases, and campaigns won’t want to waste money on you. 

5. Facebook

Even 3,000 data points on a voter pales in comparison to the gobs that Facebook collects about what its members share and do on and off the social network. Facebook is quick to say it doesn’t sell our data to anyone, but its ad-targeting abilities are extraordinarily valuable. That’s one reason the Trump and Biden campaigns have spent more than $210 million on the social network in 2020, according to OpenSecrets, far more than the $81 million Facebook says the Trump and Hillary Clinton campaigns spent in the 2016 race.

Facebook allows, for example, a campaign to upload a list of people it knows are responsive to a particular message and then use the social network’s algorithms to find a “look-alike audience” of new people to target. Facebook has acknowledged the power and peril of its microtargeting capabilities: For the week before Election Day, Facebook has paused allowing new political ads to be created (though existing ads will still be around).

In the name of transparency, Facebook now offers a button you can click labeled “Why You’re Seeing This Ad.” But I haven’t found it very useful, in part because it doesn’t explain how my experience — the ads I see — might be different from yours.

Remember my Hugh the Borg ad? Facebook’s disclosure said only the Biden campaign wanted to reach people in the United States who were 18 or older. I wasn’t convinced that was the only reason. Sure enough, digging through my Facebook advertising settings, I discovered from years of tracking my life that Facebook on its own had decided that Star Trek was one of my advertising “interests.”

The second wave

The sharp increase in Covid-19 cases in the U.S., Canada and Europe starting at the end of October make it impossible to deny that we are in the second wave. 

Many epidemiologists and infectious disease experts who are regular commentators on the CBC National News have looked shell shocked or despondent and express disappointment. Public health officials and provincial political leaders keep threatening that if people don’t work harder to reduce their social interactions, they will bring in more severe measures. In the meantime, they cycle backwards and forwards making minor changes to policies that will not flatten this steep second wave, such as decreasing the size of social gatherings and changing the times that bars and restaurants are allowed to stay open.

What is wrong with these people?

The coronavirus second wave was predicted back in March 2020 by the Imperial College of London model and has been repeated by numerous other epidemiological models. Bonnie Henry, the Provincial Health Officer of B.C. was one of the first public health officials to admit that their model did predict a second wave. So it has been known for a long time that the second wave was most likely coming in October/November.

In June, this blog stated that it was “pie in the sky” to think that any combination of social distancing measures that did not include a full lockdown would be able to keep the virus transmission rate below 1.

It’s easy to see on the following charts that the transmission rates in Canada and the U.S. declined below 1 during the lockdown period but then started to move up in August and have kept moving up ever since.

Reproduction Rate Canada

Reproduction Rate (New York)

So there has been a clear indication since August that the second wave was on its way. But health authorities have had their head in the sand.

Did they do anything to prepare for it?

It seems like they didn’t.

They don’t have a planned policy. Some jurisdictions are keeping schools open and closing bars and restaurants and while others are closing schools and keeping bars and restaurants open.

In the first wave, many provincial premiers announced, on multiple occasions, that the high death toll in long term care homes was unacceptable and would be remedied. Those conditions are already repeating.

In the U.S. the virus is probably already out of control and this is before another big spike that will likely show up soon, two weeks after the election on November 3, when millions of people spent hours standing in lines and polling stations, many of which were probably poorly ventilated school gyms.

In Canada, if lockdowns are not initiated soon, the virus could get out of control. It is hard to believe that provincial governments have not acted more quickly to try and save December Christmas shopping and family Christmas celebrations.

Why have things gotten so bad?

It’s fundamentally a battle between those who are opposed to any kind of lockdown that will lead to a loss of income through businesses closing and jobs being lost versus people who see the devastating impact of the virus on the lives of millions of people. 

This graph shows the number of Covid-19 deaths compared to all causes of death in the U.S. While some people may find that 15% of deaths from Covid-19 is alarming, many others will not.

In fact, most people have not been touched directly by Covid-19. They do not know anyone who has died from this virus and so they don’t regard it as an imminent threat. It is just another remote risk of dying such as from an illness or an automobile accident.

What is going to happen?

In Canada and Europe where governments have a commitment to the health of their citizens, as evidenced by comprehensive public health insurance, the balance will shift to protecting lives and governments will institute full lockdowns. The key question is whether they will act quickly enough.

In the U.S. public health is the domain of private enterprise and the government does not accept responsibility for the general health of its citizens, except for seniors and some low income people through Medicare/Medicaid. Many state governors will be able to continue to ignore the health guidance of scientists and refuse to implement lockdown. The number of corona virus deaths will continue to increase to unheard of levels compared to the rest of the world and this will continue until a vaccine is available to reverse that trend.

Vaccine News

The recent news has not been all bad. Pfizer released preliminary results of its coronavirus vaccine clinical trial. Earlier results had shown that the vaccine generated antibodies which are the basis for an immune response but these results were the first direct evidence that the vaccine actually protects against infection. Not only that, but it was estimated to be 90% effective. Vaccine developers were hoping for 50% to meet the FDA requirements for early approval. There are still a lot of important questions that have not been answered yet, such as how long the immunity will last, but it was extremely encouraging news.

Moderna is also scheduled to release preliminary results in November. Since its vaccine uses a similar approach as Pfizer, based on messenger RNA (mRNA), it is expected to also show some very good results.

This confirms earlier timeline estimates for when a vaccine will be distributed widely enough to slow down the spread of Covid-19. When you will get a vaccination depends on the distribution policy of the country.

In the U.S. the CDC is favoring the WHO recommendation to break transmission ahead of vaccinating the vulnerable. It is estimated that it will take three months to vaccinate front line health workers before the general population gets vaccinated.

On the other hand, Canada is planning that those over 70 will be first in line for the vaccine, followed by health care professionals and then essential workers.

In any case, it will likely take at least 10 months to vaccinate enough of the population to reach an immunity level that will slow the spread of Covid-19. This assumes that all the challenging logistics of distributing and vaccinating millions of people can be managed without major delays. Given the track record of public health with the coronavirus this does not seem likely.
https://www.nytimes.com/2020/11/14/health/covid-vaccine-distribution-plans.html

However, to be optimistic there is a best case scenario that the pandemic can be brought under control in North America and Europe by November 2021.

CDC Mask Guidelines

The U.S. Center for Disease Control and Prevention updated its guidance to say face coverings can help protect the wearer as well as those around them. This now matches the recommendations of the World Health Organization (WHO).

Huh?

If face masks block the virus from traveling out from your mouth and nose to the air around you, it is just common sense to conclude that air going in the reverse direction will also be filtered by the mask. Why it took the CDC three months to arrive at this rather simple conclusion is unfathomable.

The CDC’s changing recommendations on face masks have been a total disaster, and the damage continues. In spite of Joe Biden’s plea, made on numerous occasions, for all Americans to wear a face mask thereby saving 100,000 lives, there are many Americans who have already decided that they don’t need to wear a mask. There will not be a big increase in the use of face masks unless it is mandated by law. However the governors in most of the conservative states have stated that they will not enact such a law. If the CDC had come out from the beginning strongly recommending face masks because it would protect the wearer, this situation could have been much different.