Coronavirus : Update 8 from the Epicenter

Posted by in Coronavirus

Well, as I write this, the WHO official global epicenter has shifted to the US with cases exceeding China and Italy as predicted. I guess I’m going to have to change the title of these posts…

Here are the usual charts but with the world figures added for context (on the second axis, which is about 10x the first axis). As you can see, Italy is now slowing relative to the world numbers, but the US is accelerating strongly :

As we’ve discussed before, every country is different (population density, social distancing adherence, testing regime, etc) but the US looks on track to hit half a million cases, and the economic effects are already startling at this early stage. The graph below shows that 3.3 million Americans signed on for unemployment support last week as shops, bars and restaurants start to lay off workers. This is 5 times higher than the previous record in the wake of the 70’s oil and energy crises :

This is likely to make the rate of unemployment tick up a couple of percent from its 50-year low point of 3.6%. Experts are predicting that it may reach 20% or even 30% if the situation worsens.

The G20 met yesterday and agreed to inject $5 trillion into their economies – 2 trillion of which is earmarked for the US. As the economy there is fundamentally strong, the goal will be to mix metaphors and “freeze it in amber” until the epidemic is over. To achieve this they need to do two things :

  1. Ensure that workers who have lost their jobs are compensated to a level that ensures they don’t lose their houses or go bankrupt. So far a 1 time payment of $1200 to every adult and $500 to every child has been approved, along with $600 boosters to unemployment benefits. There is also talk of making it illegal to evict renters from their homes.
  2. Ensure that robust companies survive in a dormant state so that there are jobs to go back to. This is less easily achieved and will involve deferring tax payments, guaranteeing interest-free loans, and so on.

There will be many who will see this as a repeat of the bank bailout, so the administration will be walking a fine line. Most Americans (apparently even the wealthy ones…) have few savings outside of their 401k retirement funds and so if the government gets the balance wrong then it will make a quick recovery very difficult.

Meanwhile in the UK both Prince Charles and Boris Johnson have tested positive. There seems to be more concern over the fact that both were able to be tested while doctors and nurses on the front line haven’t been…

Germany’s case numbers continue to accelerate, but the death rates remain surprisingly low – especially compared to Italy who is still suffering with 700+ daily deaths. In Update 7 I talked a lot about demographics. New data published by just a few countries shows that while Italy and Germany have similar median population, the median age of those infected is radically different : 63 in Italy compared to 46 in Germany. For some reason the disease took hold in the elderly and more vulnerable age group in Italy, whereas the majority of those infected in Germany are healthier and younger. Worryingly the median age of those infected in the UK (currently 2 weeks behind Italy in the curve) is 64…

Germany also has one of the highest numbers of critical care beds in Europe. According to data from 2011, Germany had 29.2 critical care beds per 100,000 people. Italy had 12.5 while the UK had just 6.6. Germany’s figures put it way above the European average of 11.5 beds per 100,000 people. “The German health service has a lot of spare capacity – more so than the UK or Italy,” says Michael Head, senior research fellow in global health at the University of Southampton. “Their health services have not yet been overwhelmed by it.”

The graph below plots the ration of deaths to cases for each country. You can see just how different the situation in Italy and Germany is :

It’s normal for the ratio to increase as the infection rate falls and the infected succumb to the disease, which makes the US curve particularly worrying as it is indicative of the huge acceleration in the number of cases.

OK, the final note is related to the fact that infected men appear to die more readily than women. In China 2.8% of men infected subsequently died, compared to 1.7% of women. The theory at the time was that the discrepancy was smoking-related because 30% of Chinese men smoke compared to 3.4% of women. However in Italy 70% of the 8,215 people that have lost their lives were men, and here the smoking rates between the two are similar.

It’s not related to men being more exposed to the disease, as there is little difference in the rates of infection between the sexes. Men aren’t more likely to get it – just die from it. It’s a pattern common to all Coronavirus epidemics. SARS, MERS, and even the flu pandemic of 1918 saw disproportionate death rates among men

One hypothesis is that women’s stronger immune systems confer a survival advantage to their offspring, who imbibe antibodies from mothers’ breast milk that help ward off disease while the infants’ immune systems are still developing. A stew of biological factors may be responsible, including the female sex hormone estrogen, which appears to play a role in immunity, and the fact that women carry two X chromosomes, which contain immune-related genes. Men, of course, carry only one.

In a series of experiments in 2016 and 2017, a team led by Dr. Stanley Perlman infected male and female mice with the coronaviruses that caused severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). At every age, male mice were more susceptible to infection than females.

At the same time, the death rates of infected female mice shot up when their ovaries were removed, or when they got drugs that suppressed the activity of the hormone estrogen.

To Perlman, those dual findings strongly suggest that there’s something about estrogen that protects against the ravages of deadly coronaviruses — and he suspects it’s true for the new SARS-CoV-19 virus as well.

This is also evident in rates of autoimmune diseases when the immune system creates antibodies that attack the body’s own tissue. Among people with autoimmune diseases like rheumatoid arthritis, lupus, and thyroid disease, 80% are women.