Coronavirus Sars-CoV-2/Covid-19 Megathread

[crazy canuck]

New Jersey seems like an outlier, in a good way.  Not sure why it would be the second best state in the country while neighboring a bunch of pretty bad states.

There just seems to be a fair bit of randomness to Covid-19.  I mean - why is Michigan being hit as hard as it is?  Why is Alberta?

Why Alberta?  Because your government errs on the side of not putting restrictions in place in a timely way.

https://www.ctvnews.ca/health/coronavirus/we-re-in-a-lot-of-trouble-what-s-happening-in-alberta-as-it-shatters-multiple-covid-19-case-records-1.5411005

It is the reason we have had to block the border with your province, to the extent we can.

[Barrister]

One year ago Alberta had so little Covid-19 that Edmonton was selected to be one of the NHL's two "bubble" cities to hold the playoffs in.  The restrictions we have in place now aren't significantly different than those we had in place then.

[alfred russel]

The science said don't lock down borders at all - it was wrong. The argument - especially for an efficent authoritarian country like Rwanda - is you can control who's coming in more easily at one airline entry point with testing and quarantine. Also covid is still more likely to arrive from international travellers rather than local people and it is easier to control a border if there's a hard and fast rule.

The more nuanced and developed the more you need pretty decent state capacity especially around testing. A level that European states have consistently failed at. Rwanda's really impressive but I don't know if they'd be able to implement it either.

Jesus Sheilbh, Rwanda doesn't control its borders. To the extent there are travel advisories because militant groups are able to pass back and forth from the DRC.

"covid is still more likely to arrive from international travellers rather than local people"--yeah I mean the truck driver from Uganda is more likely to have covid than the random Rwandan because truck drivers are coming into contact with more people than the average Rwandan (such as a farmer). But I don't see a reason to think the average Ugandan truck driver is more likely to have covid than the average Rwandan truck driver.

Rwanda is 26k square kilometers. A bit smaller than Massachusetts.

To another point: how can you really describe the Rwandan government as efficient? It can't even provide reliable electricity or access to water.

[Sheilbh]

Jesus Sheilbh, Rwanda doesn't control its borders. To the extent there are travel advisories because militant groups are able to pass back and forth from the DRC.

It has regular border disputes with Uganda and closes those borders all the time - there are similar issues with Burundi. My understanding was while the DRC border isn't safe in part that's because Rwanda is still a pretty big player in DRC politics by turning a blind eye on the border and supporting different groups.

But I think, for example, especially if you're an outsidere there's an internal border within Rwanda to keep away from the border zone.

"covid is still more likely to arrive from international travellers rather than local people"--yeah I mean the truck driver from Uganda is more likely to have covid than the random Rwandan because truck drivers are coming into contact with more people than the average Rwandan (such as a farmer). But I don't see a reason to think the average Ugandan truck driver is more likely to have covid than the average Rwandan truck driver.

Sure on the letting people in across the land border based on citizenship (though there is another, darker, side to that equation around the risk of spending healthcare resources on non-nationals). But in terms of people travelling from covid hotspots like Europe or the Americas, or who've connected in, say, Addis or Nairobi the risk is far higher than for farmers or truck drivers.

To another point: how can you really describe the Rwandan government as efficient? It can't even provide reliable electricity or access to water.

Compare the Rwandan government's record on development to its neighbours, or for that matter Kigali with almost any other African capital city. It's a nasty authoritarian regime, but it's pretty efficient.

[alfred russel]

It has regular border disputes with Uganda and closes those borders all the time - there are similar issues with Burundi.

And I think this gets to the root of the issue. I do not think the borders completely close all the time--that would be too extreme and create a genuine crisis: the Rwandan government closes specific elements to keep up its belligerency and then there are multistate negotiations to try to work out a solution to reopen them.

Covid comes and that gives an excuse to just close everything.

A stupid authoritarian regime is doing stupid authoritarian stuff with the excuse of covid that it couldn't easily get away with in normal times, and the instinct here is to defend them.

[HVC]

My brother in law is now on a ventilator. His wife just went to the hospital today as well. Pretty grim. They have two kids, fortunately her brother is staying with them already (he had a mild case and recovered).

Sorry to hear. Best of luck to them.

[crazy canuck]

One year ago Alberta had so little Covid-19 that Edmonton was selected to be one of the NHL's two "bubble" cities to hold the playoffs in.  The restrictions we have in place now aren't significantly different than those we had in place then.

Yeah, that is sorta the point.  The variants we have now are significantly different.

[alfred russel]

"covid is still more likely to arrive from international travellers rather than local people"--yeah I mean the truck driver from Uganda is more likely to have covid than the random Rwandan because truck drivers are coming into contact with more people than the average Rwandan (such as a farmer). But I don't see a reason to think the average Ugandan truck driver is more likely to have covid than the average Rwandan truck driver.

Sure on the letting people in across the land border based on citizenship (though there is another, darker, side to that equation around the risk of spending healthcare resources on non-nationals). But in terms of people travelling from covid hotspots like Europe or the Americas, or who've connected in, say, Addis or Nairobi the risk is far higher than for farmers or truck drivers.

I'm unconvinced that the americas and europe are a covid hotspot versus Africa. You also need covid tests to show you are free of covid when landing in Uganda or Rwanda (which are probably worthless, but whatever). But european and americans are going to make up a trivial percentage of the land border crossings into Rwanda. And very few of those are going to have been in europe or the americas within an incubation period (who is going to fly to uganda to immediately drive to Rwanda?).

But to the point: if I'm standing near the Rwandan border in Uganda (which I suspect a large percentage of american/european tourists to uganda will be at some point), is the risk to Rwanda higher from me just driving across the border, or getting on a plane, flying to Entebbe, then flying to Kigali, then driving basically to where I was before but on the Rwandan side?

[Sheilbh]

I'm unconvinced that the americas and europe are a covid hotspot versus Africa.

I don't think there's any reason not to suspect that. Even if you take account of a younger African population there's been no indication of large increases in mortality (with a couple of exceptions in outbreaks) compared with what you can see in other Europe or the Americas, or parts of Asia. Even if you just look at outbreaks in other developing countries like Ecuador and Indonesia.

I've said before but in part I suspect that infectious disease control and monitoring is more of a core state and NGO proficiency in Africa than the rest of the world. But also a pandemic is going to be spread globally depending on how connected places and how woven into international travel networks they are. In general Africa is still less connected and interwoven. There are a few hub countries like Kenya, Ethiopia etc - but it makes sense to me that it would probably be the last part of the world to get really hit by covid and actually with border controls it might be possible to avoid it altogether.

You also need covid tests to show you are free of covid when landing in Uganda or Rwanda (which are probably worthless, but whatever). But european and americans are going to make up a trivial percentage of the land border crossings into Rwanda. And very few of those are going to have been in europe or the americas within an incubation period (who is going to fly to uganda to immediately drive to Rwanda?).

I mean surely you can't have it both ways - either the land border crossings are a trivial risk or because most tourists will end up on that border and it's quite easy to cross, a quite likely risk?

But to the point: if I'm standing near the Rwandan border in Uganda (which I suspect a large percentage of american/european tourists to uganda will be at some point), is the risk to Rwanda higher from me just driving across the border, or getting on a plane, flying to Entebbe, then flying to Kigali, then driving basically to where I was before but on the Rwandan side?

But again - there are two questions for governments: what's most effective against and what are we actually able to enforce/deliver. It isn't just about the risk you as an individual present, but what resource the Rwandan (or any other state) has to actually deliver. It is easier to just ban land border crossings and you can arrest and expel anyone who is found on the wrong side, while funneling all legitimate travel through one entry point.

At Kigali airport they can test you, get the details of where you're staying and (I think) quarantine you.

[alfred russel]

I'm unconvinced that the americas and europe are a covid hotspot versus Africa.

I don't think there's any reason not to suspect that. Even if you take account of a younger African population there's been no indication of large increases in mortality (with a couple of exceptions in outbreaks) compared with what you can see in other Europe or the Americas, or parts of Asia. Even if you just look at outbreaks in other developing countries like Ecuador and Indonesia.

Ecuador and Indonesia are not comparable to Rwanda (or in general subsaharan africa excluding a few places like South Africa).

From the CIA world factbook percentage of population over 65:

USA: 16.85%
Ecuador: 8.15%
Indonesia: 7.82%
Rwanda: 2.65%

Percent urban:

USA: 82.9%
Ecuador: 64.4%
Indonesia: 57.2%
Rwanda: 17.6%

Per capita covid-19 tests (from rcp):
USA: 1.37
Ecuador: 0.08
Indonesia: 0.06
Rwanda: 0.11

The points here:
for a disease that is so dramatically age dependent in relation to fatality, there just aren't old people compared to the other countries listed. In the US I think almost half the deaths are 85+: while the US may be ~7x in terms of the 65+ portion of the population, it is far higher in that range.

urbanization seems to be significantly linked to spread, and Rwanda is dramatically less urban than the other places. which means the baseline level of infection absent countermeasures is probably a lot less. It probably helps that it is an equatorial climate without diversions like TV and aircon for most of the population to keep them inside. (that is a reason to actually think that the disease may have less incidence in Rwanda, but at this point a lot of the US population has immunity, so that does complicate the equation)

The testing regimes are off the charts bad in Rwanda, Indonesia, and Ecuador countries (and you mentioned Indonesia and Ecuador as places where we really have to rely on excess deaths). While Rwanda may at a superficial level have run more tests than those countries, they are in line with countries that have been ineffective at measuring the disease.

Also, of all these countries i think Rwanda is the only one with incomplete vital statistics records.

In summary: if you ask me today whether the per capita infections in the US or Rwanda are higher at this moment, I don't think there is enough information to really conclude.

[Josephus]

One year ago Alberta had so little Covid-19 that Edmonton was selected to be one of the NHL's two "bubble" cities to hold the playoffs in.  The restrictions we have in place now aren't significantly different than those we had in place then.

Hmmm....the other city was Toronto.

[Josephus]

In other news, looks like my brother is out of ICU. Still in hospital, but breathing without a ventilator

[Josquius]

A thought - fresh air is said to be a big protector.
In many African countries people tend to live virtually outside. Very open houses, people hanging out on the streets, etc...
However... India also has this to a large extent and it doesn't seem to be helping there.

I wonder if they ever registed the earlier theories of Asians and Arabs being particularly vulnerable?

[alfred russel]

In other news, looks like my brother is out of ICU. Still in hospital, but breathing without a ventilator

[Sheilbh]

Ecuador and Indonesia are examples of outbreaks that are evident despite official statistics. Excess deaths are what we should all be looking at (and age-adjusted excess deaths ideally), but it wasn't even excess deaths that showed the outbreak in Ecuador or Indonesia, it was the sheer volume of bodies overwhelming local ability to bury/cremate the dead. I'm not saying they're a comparison for Rwanda, but rather that a big covid outbreak can be visible even in the absence of statistics.

The factors you've flagged are relevant and it may be that Rwanda and other African countries have significant amounts of covid but it doesn't really show because possibly of urbanisation, but more likely because it's got a younger population and that's definitely likely to decrease the impact of covid. Even if there was a huge covid wave in Africa it would be far less lethal than in Europe, say.

My point is in a pandemic spreading from central China to the rest of the world, I don't think the spread will be even. I think Africa is likely to get it last and is likely to still have fewer infections than Europe and the Americas. In part we can see the volume here but also they are more integrated into global travel and the global economy than many African countries and there's far more travel within (Europe is still consistently failing to do anything significant about border controls - especially internal border controls).

You don't have enough information to really conclude, but you've also not really given any information to indicate that Rwanda or Africa have outbreaks as bad as the US per capita (in any event - if that was the case wouldn't there be a similar level of immunity in Rwanda?). I think it's more likely that there are fewer cases - for those reasons - rather than it's equally bad everywhere and we just don't know because there's less collection of statistics.

There are definitely a lot of deaths in African healthcare workers from covid - so it is there. But I just don't think there's any reason to think they've had outbreaks on the scale of Europe and the Americas.