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.

Canada’s failure to respond to the pandemic

The early response in Canada to the pandemic has recently come under scrutiny and reveals further evidence of failures of the Public Health Agency of Canada. It looks like the Canadian response was even worse than the U.S. which has come under scathing criticism for errors in judgement from Trump on down to the CDC and the FDA.
https://www.cbc.ca/news/politics/woodward-trump-canada-response-1.5721009

At the time it may have been reasonable to follow the guidelines and recommendations of WHO instead of some independent warnings. What is not reasonable is that early warnings from the Global Public Health Intelligence Network (GPHIN) were ignored by the Public Health Agency of Canada.

The GPHIN is the crowning accomplishment of Canada’s public health system. Developed in conjunction with WHO, it gathers reports of suspected outbreaks from a wide range of sources in many languages and provides alerts to countries and agencies around the world. According to WHO, “GPHIN is one of the most important sources of informal information related to outbreaks. More than 60% of the initial outbreak reports come from unofficial informal sources.” GPHIN had an established track record detecting early signs of the 2009 swine flu pandemic, H5N1, MERS and Ebola.
https://www.who.int/csr/alertresponse/epidemicintelligence/en

The Conservative government under Harper reduced and reshaped Public Health in 2014. But the Liberals did not reverse the changes they once opposed when they took power in 2015. In late 2018 the federal government scaled back GPHIN even though its budget was a paltry $2.8 million. The shortsightedness and poor judgment in hobbling GPHIN had real consequences in Canada not receiving enough early warning information to make the correct decisions when the pandemic first surfaced.

The following is a long article but worth reading to understand some of the outstanding successes of GPHIN and why it failed (register for a free account).
https://www.theglobeandmail.com/canada/article-without-early-warning-you-cant-have-early-response-how-canadas

Only now at this late date is the Canadian government calling for a review of GPHIN.
https://www.cbc.ca/news/politics/patty-hajdu-global-public-health-intelligence-network-1.5715831

This failure of the Public Health Agency of Canada is inexcusable. For these terrible lapses of judgment and subsequent cover ups heads should roll. It doesn’t seem like even a wrist has been slapped.

The whole truth about the source of virus spread

Day after day there are reports of the spread of Covid-19 and the new case counts in the news. More often than not, these reports focus on restaurants and bars as a major cause for the spread of the virus. I suggested in the blog on September 24 that a likely overlooked source of virus spread was people going back to work. I could not find statistics to back this up until I saw this chart on the CBC National News on October 18.

This chart does not include the two largest categories, long term care homes and health care. Of the remainder, it clearly shows that 45% of cases are from Industrial settings (manufacturing) and 17% are from Congregate living (group homes). Another 15% is from general community spread. Only 4% of cases are from “Food/drink/retail”. Another suspected source of infection that is often reported is schools. This accounts for only 5% of cases.

The percentage for Food is in fact a lot lower. Contact tracing fails to identify the source of infection in over 50% of cases.
https://www.cbc.ca/news/canada/toronto/covid-19-ontario-cases-data-1.5726687

Since restaurants and bars record the names of patrons, contact tracing these cases is quite good and there will not be very many in the 50% of cases that are not traced. So instead of 4%, the total infections occurring in bars and restaurants is only about 2%.

Why the news keeps focusing on bars and restaurants as the major cause of virus spread is beyond me. Journalists may be excused since this data seems to be very hard to locate, but public health should know this data and should be reporting it so that the general public understands that being out at work and out in the community in general is their biggest risk of contracting the virus. And public health should not be recommending that bars and restaurants be closed, they are not a significant source of the spread of Covid-19.

What’s wrong with public health?

Except for a few high profile people like Anthony Fauci in the U.S. and Bonnie Henry in Canada, public health is largely a faceless army of bureaucrats.


In Canada and the U.S. they have not handled the pandemic very well and have not exercised good judgment.

At the beginning of the pandemic, lots of errors were made by the CDC and the FDA in failing to provide adequate coronavirus testing.

The flip flops over the recommendation whether to wear masks or not went on for months, causing a lot of confusion and great difficulty in getting people to follow the current recommendations to wear masks.

Here is another glaring example of “public health malpractice” where the CDC failed to follow fundamental principles and did not quarantine passengers arriving on a flight from an infected cruise ship in Europe.
https://www.cbsnews.com/news/flights-cruise-ships-covid-19-60-minutes-2020-10-18

Why are public health agencies doing such a poor job?

It is well known in the medical profession that public health is one of the least desirable specialties and one of the lowest paid, along with family medicine. When medical students select their residency, public health is often a last choice. Those who select public health as a first choice often do so because they think it is not a lot of work. So a lot of public health departments are government services with a civil service mentality and a 9 to 5 work ethic. Although they supposedly train for epidemics, they don’t seem to have been very well prepared at all for the Covid-19 pandemic. They did not learn what other countries have done to handle the pandemic, especially Asian countries who have done a much better job than the US and Canada. A direct consequence of this led to a failure of contact tracing. https://www.nytimes.com/2020/10/03/world/europe/covid-contract-tracing.html

What can be done to improve public health?

In the long term, the pandemic may actually inspire some of the brighter medical students to go into the field, since it is now more exciting than its reputation has been in the past and it has a lot of opportunities to make improvements.

It’s hard to know what can be done in the short term. In Ontario, calls for the replacement of the chief medical officer started among medical professionals on Twitter and soon became a more public assault. Whether this will lead to improvements in public health in Ontario remains to be seen.
https://torontosun.com/news/local-news/braun-dr-david-williams-forgotten-but-not-gone

In the short term it is still better to follow the advice of public health than to listen to politicians, most of whom have minimal science backgrounds, are out of touch with the realities of Covid-19 and yet are deciding critical government policy at the state, provincial and national level.

Vaccine distribution

As the prospect of a coronavirus vaccine approaches there has been a lot of discussion about how it should be distributed. On the one hand you have many countries privately contracting with leading vaccine developers to buy large numbers of vaccine doses.

On the other hand, there are calls for a worldwide effort to ensure that there is a fair and equitable distribution of the vaccine so that poorer countries get a fair share. The World Health Organisation (WHO) and several other agencies have established guidelines to fairly allocate Covid-19 vaccines that many countries have agreed to. Canada and the EU have signed the agreement, the U.S. has not.
https://www.epmmagazine.com/news/landmark-deal-signed-for-fair-distribution-of-covid-19-vacci
https://www.who.int/news/item/21-09-2020-boost-for-global-response-to-covid-19-as-economies-worldwide-formally-sign-up-to-covax-facility

So Canada has agreed that fair distribution vaccine is an important goal, but let’s look at some actual facts on the ground.

I called my doctor at the beginning of October 2020 to get an appointment for the seasonal flu vaccine, something I’ve done for many years. I was informed that they did not have any flu vaccine and would not be getting any for a few weeks because all the vaccine was being delivered to pharmacies. Somebody may have thought this this was an effective way to deliver the vaccine quickly but I don’t see any reason a proportionate amount could have been delivered to doctors based on the number of their patients. This does not bode well for a future equitable distribution of a vaccine.

Because I was really not sure when or if my doctor would get the high-dose vaccine which is very beneficial for seniors, I signed up for vaccine email alerts from my pharmacy. A week later I got a notice that the vaccine was at my local drug store. I went in the next day only to discover that people had been standing in line outside for up to two hours but that all time slots for the day were filled. I asked if I could reserve a time so I could avoid this. “No we don’t do that. It’s strictly first come first served. Come back tomorrow.”

When I arrived the next day I thought I was in luck because there was no line outside the store. But there was no line because the pharmacy had run out of the vaccine.

There was another drug store in my area that was listed in the email as having the vaccine. I called them to see if they had the high-dose vaccine (since the email didn’t make that clear) but nobody answered the phone after several attempts. So I went in person and discovered “Nope we are out of all the vaccine”. I asked the manager why an email noticed was sent saying they had a vaccine when in fact they didn’t. She replied that she didn’t know anything about messages from the central office, she just knew what was going on in her store. She said they expected another shipment in a few days. I asked again about making a reservation and yes at this store I was able to do so.

The pharmacist explained that they had been running out of the vaccine quickly, and in particular the seniors vaccine, because there was a larger demand than anticipated. Now I’m not a medical or health practitioner but I had been seeing forecasts for quite some time that there would be a very high demand for flu vaccine this year because people wanted to avoid a double whammy of having both the flu and Covid-19. I don’t think it was rocket science to have been better prepared to have enough vaccine doses to meet the demand.

Our health system has been distributing the seasonal flu vaccine for many years. If it is not able to distribute this vaccine equitably and timely, how in the world is it going to be able to distribute a new vaccine for a pandemic that they have never dealt with before? This was incompetence all the way down the line, from the Canada Public Health Agency at the top grossly underestimating the number of doses that would be required, inequitable distribution policies that bypassed family doctors and at the bottom pharmacies who were incapable of providing timely information and reservations for people to receive the shot. The pharmacy in my case was not some little local store but Shoppers Drug Mart, a national chain of one of the largest pharmacies in Canada with over 1300 stores. They can’t argue that they don’t have the resources to develop a simple online reservation system so that people can easily reserve a time in advance.

In the U.S. there has not been a lot of news about how plans are progressing to distribute the vaccine. There are a lot of critical unanswered questions and public health is scrambling. Who has the responsibility to order supplies, sign up vaccine providers, train staff and run mass vaccination clinics? And there is no funding for these programs yet, estimated at $6 billion.
https://www.npr.org/sections/health-shots/2020/10/16/924247360/facing-many-unknowns-states-rush-to-plan-distribution-of-covid-19-vaccines

And there probably will be different strategies, standards and problems in each state.
https://www.wired.com/story/in-the-us-50-states-could-mean-50-vaccine-rollout-strategies/

So the next time you hear a date about the availability of the Covid-19 vaccine, first add three months for regulatory approval and then add up to a year before you may actually get your shot. Unless you are a frontline medical worker or in a retirement home. Hopefully for these critical cases, the system will not be so badly broken and these priorities will be met.

Where’s the pandemic going, the big picture

There is a lot of news about the coronavirus pandemic especially now that cases are on the rise in Canada and Europe. A lot of the news focuses on one particular aspect. It is quite difficult to get a high level overview not only about what is happening but what is the likely progression.

Here is my analysis based on reading a lot of these news items and integrating them with a little thought.

Case counts have been on a steady increase in Canada since the beginning of September.

In the U.S. case counts have declined from the peak at the end of July, but they are still very high and are starting to rise again.

In Europe, case counts started to rise in early August.

News reports, presumably based on public health information and government policies would have you believe that these increases are due primarily to group gatherings exceeding social distancing rules. Videos to prove this point show groups of young people dancing, but in most of these videos the people are outside and not in exceedingly large crowds. These are not conditions for rapid virus spread.

A big part of the problem is that contact tracing has failed, especially in the U.S.
https://www.nytimes.com/2020/07/31/health/covid-contact-tracing-tests.html?s=09#click=https://t.co/IuIOrWkNoq

In Canada with lower case counts, some contact tracing is being done successfully. But about 33% of the new cases do not get traced. This means that the sources of infection for a lot of new cases are not discovered and these cases lead to further spread of the virus.

It’s easy to trace cases in outbreaks that are all from the same place such as a bar or a public or private gathering. But most of the new cases that are not being identified are likely from the increased interactions that have been occurring as restrictions have been relaxed. A number of people have reported that their employers have requested that they return to work, at least part-time. After six months of working from home, many employers are getting nervous that their employees are not working a full week and they want to be able to monitor them more closely. Many of these people returning to work are taking public transit which can be quite crowded.

At lunch time many people probably go out to eat in restaurants and go shopping. All of these activities lead to increased contact and increased transmission. Even if they are following guidelines and wearing masks, masks are not 100% effective. They leak and are often handled improperly. When people adjust the mask or take it off they often touch the outside of the mask. If the mask is working and protecting them from virus then the mask exterior may have virus droplets. When they take the mask off they are transferring the virus to their hands which will often then be transferred to their face.

These strong trends in rising virus case counts mean we are in the second wave and will require a full lockdown scenario. Lockdown will be lifted in early December, just in time for Christmas shopping. But a third wave will start around March 2021 and require another lockdown, as explained and predicted in this blog on May 9, 2020

As far as vaccine research progress goes, there are daily reports differing on when a vaccine will be ready. None of them explain the reasons for their dates. Here is the optimistic scenario.

Several leading vaccines will complete their phase III clinical trials by the end of December 2020. The ones that are safe and effective will get fast track approval from the FDA. It is reasonable to expect that one or more vaccines will be available for use by April 2021.

Once people start getting vaccinated it will take some time before enough people are immune to decrease the spread of the virus. If 6% of the population can be vaccinated per month, the virus will continue spreading through the summer and there may be a fourth wave that requires lockdown.

It won’t be until November 2022 that there will be sufficient immunity to slow down the spread of the virus. This is when 50% of the population has immunity from either a vaccination or from having been infected and recovered from the virus. This is the “herd immunity” that will finally stop the epidemic spread of the virus.

You don’t need a complicated epidemiological model to predict this, other than to account for some of the more subtle variatons due to lockdown periods. This is just simple math — if a country can vaccinate 6% of its population per month, it can achieve 50% herd immunity in 8 months.

Canada, Europe, the U.S. and Australia can likely achieve this timeline. For the rest of the world it will likely take longer.

Where did Covid-19 come from and where is it going?

The original source of the Covid-19 virus was one of the important unanswered questions that was summarized in a Nature article summarized in an earlier blog.
https://anydaynow.blog/waiting-for-answers-to-key-questions/

The conclusion was that it had likely originated from a bat, as did SARS, and was transmitted to another animal before jumping to a human. Despite many investigations, the intermediate species has not been identified. The following article provides more details, a story of scientific detective work.
https://time.com/5870481/coronavirus-origins

There was another claim made repeatedly by Donald Trump that the virus had come from a Chinese lab and that China was responsible for leashing the pandemic on the world. Trump and Secretary of State Mike Pompeo stated on numerous occasions that they had intelligence reports to back this up. Neither of them ever gave any details of these reports and they eventually backed off from this claim.
https://www.theguardian.com/world/2020/may/03/mike-pompeo-donald-trump-coronavirus-chinese-laboratory

There is no evidence that the virus was manmade. A director at the Wuhan Institute of Virology, a highly respected virologist, checked the inventory of all virus samples in the lab and determined that none were close to Covid-19 when the virus was first discovered in Wuhan and that everyone in the lab tested negative for Covid-19.
https://www.sciencemag.org/news/2020/07/trump-owes-us-apology-chinese-scientist-center-covid-19-origin-theories-speaks-out?utm_source=Nature+Briefing&utm_campaign=42390640f2-briefing-dy-20200727&utm_medium=email&utm_term=0_c9dfd39373-42390640f2-45132230

An important question besides where has the virus has come from is where is the virus going?

The Time article has a very interesting section on how molecular biologists are able to determine the genetic sequence of viruses. There have been many mutations since the first case of Covid-19 was identified and they have been put into an international database. The particular strain of the virus has been used to identify virus outbreaks that have occurred in different countries in the world. This chart is a stunning visual and information display of this information.


There is some thought that Covid-19 mutations have become less virulent. In Europe people are less likely to die if they get Covid-19 now compared with earlier in the pandemic. There is one mutation D614G that has become more predominant than others, but there is no confirmation that this or any other variant has actually become more dangerous.

https://www.newscientist.com/article/2252699-covid-19-is-becoming-less-deadly-in-europe-but-we-dont-know-why/?utm_medium=social&utm_campaign=echobox&utm_source=Facebook#Echobox=1598284086

https://www.nytimes.com/2020/09/11/opinion/coronavirus-mutation-reinfection.html

Why are U.S. cases declining?

States with the huge surges have reversed some reopening policies and mandated the use of masks. However, many of these states continue to have more new case counts per million than many countries with the worst outbreaks.

This article shows background graphs to demonstrate several case comparisons.
https://www.nytimes.com/interactive/2020/08/24/us/coronavirus-cases-decreasing.html