Day 221: Constitutional Issues

Sweden, a nation of ten million people, has finally surpassed China, a nation of one billion people and the source of the novel coronavirus, in case count, putting them at #38 and #39 respectively. In #3 Brazil, Senator Flávio Bolsonaro, son of the president, has recovered from coronavirus with the help of hydroxychloroquine. In #41 the Netherlands, three more mink farms have been found infected and are being culled. (PlagueBlog hopes they don't do the same with people.)

Germ Boat #34 is HMS Queen Elizabeth, a UK aircraft carrier, currently grounded in Portsmouth over "fewer than ten" cases among the crew.

Here in the US, both Joe Biden and Kamala Harris have "walked back" their promised national mask mandate over that pesky constitution thing. Also, the right to bear nerf arms is under attack in Colorado, where a 12-year-old's green nerf gun was spotted briefly during fake online school, leading to a police visit, a five-day suspension, and his eventual withdrawal from the Hitler Youth school.

Massachusetts' cases are up a seventh of a percentage point today.

Day 196: The Mask on the Soapbox

Opinions seem mixed on whether New Zealand has traced its outbreak to a new strain (to them) or has yet to do so because many of their previous samples have yet to be sequenced. It's still up in the air whether COVID came in on cold freight, on people (through the not-entirely-sealed borders or a failure of quarantine), or had been percolating undetected for their 102 case-free days.

At a presser in Wilmington, Virginia, Democrat Presidential candidate Joe Biden called for a nationwide mask mandate:

“Every single American should be wearing a mask when they’re outside for the next three months at a minimum — every governor should mandate mandatory mask wearing,” Biden declared.

PlagueBlog doubts this is going to win him many swing voters, and reminds readers that in the vast majority of situations there is no reason or evidence for wearing a mask outdoors.

Though there's no new germ boat today, the Washington Post reports that the plague ships of Italy are getting ready to sail again. (Tourism is 13% of the Italian economy.) In passing they mention the Hurtigruten cruise line apologizing for "fail[ing] to follow its own procedures" to prevent the cases aboard Germ Boat #30, the MS Roald Amundsen.

Locally, the Commonwealth's deadline for school districts to figure out what they're doing about coronavirus is today. NBC reports that 31 districts have already decided to go all-online. (There are 292 regular school districts in Massachusetts, plus some vocational and charter districts that may or may not be treated separately for this purpose.)

Aside from some strangeness involving fewer than five people in Hancock (at the far west of the state), the old case map is looking pretty plateaued as usual. The newer, two-week positivity map has some hot-looking spots, including the cities involved in the Stop the Spread testing effort. A daily rate map is in the works but not ready yet.

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P.S. Massachusetts' cases were up a quarter of a percentage point today.

Day 189: Treading Water

California seems to be lagging lately, so much so that Florida and Texas are creeping towards their top spot. It turns out, however, that this may be due to the backlog caused by an expired certificate that they managed to not notice for five days, and then spent a chaotic week trying to fix. The error seems to have been on the government's end, and not at Quest, the lab whose results disappeared into the ether.

Massachusetts' cases are up a third of a percentage point today. Even though this is fairly typical for our plateau, the governor is concerned and has put Phase 3B of our reopening (originally scheduled for Tuesday) on "indefinite" hold. He sounded annoyed that people have been having fun at large, private events, as well as snacking very lightly with their drinks in "restaurants". "Bars" are closed until Phase 4, which is scheduled for sometime after man goes back to the Moon.

On the sane side, he did have some salient criticism of school districts that are planning for remote learning this fall:

Baker said that when schools went remote in March, relationships among students and teachers were already established. But for schools considering starting fully remote in September, he said, “you’re talking about a bunch of kids and a bunch of teachers who won’t know each other at all.”

He noted that younger students, from kindergarten through third grade, are the least likely to be infected and perhaps stand to lose the most from remote schooling.

“Trying to teach those kids how to read remotely? That’s not how you teach kids how to read,” he said.

Real Clear Politics has a real clear article on the mythical thinking behind lockdowns. In passing it mentions the medical mystery of Germ Boat #33, the Etchizen Maru, which set sail on a fishing expedition after the crew tested negative and quarantined for 14 days, and then returned to port 35 days after that when some crew began showing symptoms, and were quarantined aboard. (This is far beyond the expected incubation period of the disease.)

Day 188: Hard Labor

The world jumped well past 19 million cases today, with the US hitting 5 million and #3 India reaching 2 million cases. Bolivia (now #29) has surpassed China in cases, and the Daily Mail reports that failed state Venezuela (#64) is forcing non-mask-wearers into hard labor.

In the US, Governor DeWine of Ohio has tested positive. ABC News reports that the student who took some viral video of students not wearing masks in a crowded Georgia high school hallway has been suspended. (PlagueBlog recommends saving your education budget for PPE, not blowing it on the inevitable lawsuit.)

On the high seas, a third plague ship has joined the new fleet: passengers and "most" crew of Germ Boat #32, the SeaDream I out of Bodø, Norway, have been quarantined after a passenger from their previous cruise tested positive.

Massachusetts' cases are up a fifth of a percentage point today. Yesterday was cities and towns day; the new maps are below. In addition to being late, the report from the MDPH came with no comment about the reporting issues from late last week or whether they affect these numbers at all. Caveat lector.

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Day 186: Fear Itself

The world's case count is now 18.666 million. Bolivia has surpassed Sweden on its way to the China point. In Portugal, all-cause mortality was up 26% this July over last July, hitting a 12-year high. However, only 1.5% of those deaths were due to coronavirus; the rest appear to be due to a mix of extreme heat, postponement of care (by the providers), and patients' fear of seeking care.

Massachusetts cases are up almost half a percentage point today. Despite our big leap in case count (546, with 9 deaths), Pennsylvania was even more infected today and has now taken over our #11 spot, pushing us to #12.

Germ Boat #31 is the m/s Paul Gauguin, currently docked in Tahiti with plague aboard. The flagship of a one-boat cruise line out of Tahiti, it only began taking on international passengers again on July 29th, and scurried back to port soon after when a crewmember was found to be infected.

Day 183: Return of the Germ Boats

The world is at 18 million cases. The news found it notable that #5 South Africa surpassed 500,000 cases and #6 Mexico became #3 in deaths, surpassing the UK. The Guardian reports on a large anti-mask protest in that benighted country that is alone in the world in protesting mask mandates Berlin, Germany.

In the US, Texas has surpassed New York in cases, though with less than a quarter of that state's deaths (so far). Bloomberg reports on a peculiarly American mystery in which our laundromats remain short on quarters due to the pandemic, despite no similar issues being reported in foreign coin-operated laundromats. Also, Massachusetts cases are up a third of a percentage point today, with the MDPH still noting higher numbers due to the testing delay issue.

After a long lull in coronavirus activity on the high seas, PlagueBlog brings you another plague ship: Germ Boat #30. The Telegraph reports that the MS Roald Amundsen returned from a seven-day Arctic cruise yesterday with 33 crew infected out of 160. The 177 passengers had already disembarked, but are being quarantined and tested; so far, one has tested positive. The ship's next cruise was supposed to begin yesterday but has been cancelled.

Day 117: Because It Went So Well the Last Time

On the germ boat front, PlagueBlog is expecting some new entries from American Cruise Lines and American Queen Steamboat Company soon. These rival riverboat cruise companies making plans to start cruisin' for a COVIDding on June 28th and 29th, respectively.

Charles Robertson, ACL's CEO, said the riverboat operator is able to resume operations ahead of the cruise ships as capacity on most of their fleet's vessels falls under the 250-passenger limit covered by the Centers for Disease Control and Prevention's "no sail" order, which bars the big cruise ship operators from sailing until at least the end of July.

They're planning to reduce occupancy, and are also not expecting to fill up those first cruises.

Also on the let's try that again front, on Friday the CDC attempted to clarify the recent wording change to their coronavirus fomite advice that made an unexpected media splash a week ago now. Unfortunately their clarification isn't any clearer, nor does it give any references for the "old" science that makes fomites and singing Happy Birthday less significant than they were in the public mind:

CDC actively reviews our website to make sure the content is accessible and clear for all types of audiences. As a result of one such review, edits were made to the organization of the COVID-19 transmission page, including adding a headline in an attempt to clarify other types of spread beyond person to person. This change was intended to make it easier to read, and was not a result of any new science.

It's cities and towns day today, so watch this space for the latest plateau maps...

P.S. Massachusetts cases are up half a percent again today. Unfortunately, the promised improvements to the dashboard did not materialize, and instead the care facility information was taken out of the dashboard and put into the cities and towns data, which is now a massive PDF. At least the state bothered to put together some basic maps as part of the PDF (case counts, PCR test counts, and PCR positivity), and you will have to settle for those for the time being. The Boston Globe also has a basic map of case counts, with nicer colors but poorer scaling (and that's a hard bar to miss when it comes to the state's maps).

Day 106: More Mediocre Measles Research

PlagueBlog readers may recall a paper from Day 71 about the MMR (and especially R) providing protection against coronavirus. It seemed weak at the time, but since then even weaker papers have come on the scene. The somewhat innumerate folks from Day 95 have since gotten their collection of anecdotes onto a preprint server, and another group has actually published a rather bare statement of the thesis in an open access, print-on-demand journal.

One interesting feature of the new paper is that, even more than the second one, they ignore rubella completely in favor of measles vaccination coverage. Their focus (if you can call it that) is on the structural similarities between coronaviruses and paramyxoviruses (both measles and mumps). They hit the high points: Italy has the poorest measles vaccination coverage (84%) in Europe, while China is on the ball at 97%, measles vaccination is associated with a drop in all cause mortality for the vaccinated, and cross-reactivity. But there are few hard numbers and no statistical analysis beyond these points.

The BCG school is much further along with the math, so far so that a group of epidemiology grad students have debunked one of the (many) papers making similar connections between tuberculosis vaccine and coronavirus. Sadly, the debunking is also short on math, only mentioning that perhaps new COVID-19 numbers would lead to different results, rather than actually crunching the latest batch in search of said different results. The debunkers also mistake the argument from cross-reactivity for some sort of "common sense" approach that can be dismissed with their own somehow more common common sense. Actually the protection some vaccines provide against unintended targets is a prior result, not an illicit truism.

In plague ship news, CNN reports that there have been eight relapses aboard Germ Boat #23, the USS Theodore Roosevelt. Like the later disowned South Korean relapses, all eight sailors tested negative twice before they were allowed back aboard and caught out in later testing.

In local news, Massachusetts cases are up 2% today. Although Middlesex County is up only 1% and Camberville have never been hotspots of the county despite their density, the City of Somerville has cancelled all fun through next December—most notably HONK! and the annual Fluff Festival. (Fluff is from Somerville.)

Day 92: The Germ Boats Strike Back

The Miami Herald is still on the plague ship watch, with the latest numbers and a google spreadsheet of their data. They also reported on the mysterious death Thursday of the senior doctor of the Norwegian Cruise Lines ship Norwegian Gem. Germ Boat #28 is currently off the Bahamas with only crew aboard. Dr. Alex Guevara died in his sleep of "cardio-respiratory arrest," but rumor has it that he was suffering from pneumonia at the time, and had been working with a nurse who tested positive.

The cruise line asserts without any evidence or testing that the doctor, who was treating crew with "respiratory illnesses", did not have COVID-19. They also asserted that the previous crew death aboard, of a 56-year-old Filipino man with tachycardia arrhythmia in mid-April, was not due to COVID-19 despite the lack of either testing or an autopsy. To add insult to injury, they also acted illegally in their handling of the single COVID-19 case that they have admitted among the crew of #28.

I found Germ Boat #29, the Celebrity Apex, in the Herald's data, but the Guardian has the most recent coverage of the world's newest plague ship. The ship was completed by Chantiers de l'Atlantique in Saint-Nazaire, France in early March. It appears to have been the first cruise ship ever delivered virtually (to Celebrity Cruises), due to coronavirus restrictions on travel at the time. While the planned inaugural ceremonies were soon postponed to a much later date, a crew of 1,407 was installed and a party was held in late March despite the French lockdown.

After a handful of early cases appeared, the crew was quarantined on the ship, which has apparently never left dock at Saint-Nazaire. Wikipedia has case numbers as of April 15th, at which point 224 people were positive out of 1444 tested. (The Guardian reports that two were still hospitalized and 700 trapped aboard at that time.) An infected crew member from Bulgaria who managed to escape and recover has since launched a class-action lawsuit against the cruise line in US district court.

On the drug front, a preprint from yesterday reports on the Broad-spectrum antiviral activity of naproxen: from Influenza A to SARS-CoV-2 Coronavirus, apparently by binding to the viral nucleocapsid protein. They both modeled this interaction and reproduced it in vitro, and are now working on a clinical trial. Rumors you may have heard earlier in the pandemic that NSAIDs were bad for you were baseless even at the time; the rumor-mongers seem to have backed off when the cytokine storms blew through.

Massachusetts is up 3% again today. Currently hospitalized and ICU cases have fallen. There have been no mask rebellions like the one in Stillwater, OK. PlagueBlog has already observed risk compensation (one of the many dangers of ersatz masks) among the masked masses.

Day 80: Obesity is an Underlying Condition

Today's title is a public service announcement for the BBC, which appears to believe otherwise. They reported that a 51-year-old obese male nurse from Northumberland "did not have any underlying health conditions" when he died at home of a seemingly mild case of coronavirus. His daughter described him as "slightly overweight, but otherwise fit and healthy."

PlagueBlog notes that "otherwise" fitness is not known to negate your pre-existing conditions, and obesity has been observed to be the most significant underlying factor after age in NYC hospital admissions:

"Prior to COVID-19, we already knew that obesity is a risk factor for infection in general and more severe complications, and this is particularly true for respiratory infections," Poland said.

During the 2009 H1N1 epidemic in 2009, adults with body mass indexes over 30 were 3.1 times more likely to die from the infection than people of lower weights, while adults with body mass indexes over 40 were 7.6 times more likely to die.

In other world news, Spain has exceeded 200,000 cases, and Iran has exceeded China's case count. Next up is Russia, which, while comfortably under 50,000 cases at the moment, seems to have some trouble brewing. Reuters reports they've quarantined about 15,000 troops as part of cancelling Victory Day celebrations on May 9th.

It's Patriots' Day here in Massachusetts, but it doesn't feel the same without the Boston Marathon or the annual reenactment of the Battle of Lexington. In even more depressing news, the Boston Globe published 16 pages of obituaries this Sunday (April 19th), a significant increase over last year's seven page spread. (Reports of only 15 pages are inaccurate.) The previous Sunday's count was 11 pages, and a week before that it was nine.

P.S. Reuters reports that one of two additional Ebola patients in Beni, DRC, has escaped the treatment center and has not yet been found. The current case count is six, though one patient is still only known from the WHO's case count. Besides Ebola, the Congo is also battling COVID-19, measles, and cholera outbreaks.

P.P.S. Since the Massachusetts Department of Public Health appears to be taking Patriots' Day off of coronavirus reporting, PlagueBlog instead brings you another pair of Germ Boats. Lucky #26 and #27 are the Royal Caribbean sister ships Oasis of the Seas and Symphony of the Seas, respectively. (The latter is the world's largest cruise ship.) Three weeks ago, Royal Caribbean Cruises started evacuating sick crew off both ships to hospitals on the Florida mainland, without actually admitting to the coronavirus outbreak among the crew still on board. Today, the death toll among the ships' crew reached 3 with the death of a 41-year-old Indonesian man who had been a waiter on #26. A Filipino man who had been a bartender aboard #26 died on Saturday; his age has not been reported, though apparently he died on his birthday.

Back on Easter Sunday, a 27-year-old Indonesian man from the crew of #27 apparently became the youngest person to die of coronavirus in Florida. Because all three victims were foreign nationals they have not been included in the Florida statistics, so some details of their cases remain unclear. Royal Caribbean has refused to comment on these deaths or on how many infected crew remain in Florida hospitals and offshore.

P.P.P.S. The state did eventually cough up a pretty, if inaccessible, PDF dashboard of the day's numbers: cases were up 4%, with 103 new deaths.

Day 78: No Evidence of Immunity

The world stands at 2.33 million cases with 160,000 deaths. The US has exceeded 738,000 cases and 39,000 deaths. The situation in Spain seemed to have calmed down over Easter, but is active again now and may only take another day or two to hit 200,000 cases. The UK, at 114,000 cases, remains in sixth place but is still a contender to surpass the flattening continent. Both Turkey and Iran are looking to surpass China's revised numbers soon.

In the US, the Navajo Nation has made the news with 1,042 cases (none recovered) and 41 deaths, surpassing a handful of states although their total population, about 357,000, is less than that of any state.

If you were hoping for more pretty pictures today, I can only point you toward these charts of the Massachusetts data by something innocuous, who also posts them to Reddit daily. Massachusetts is up 6% today. While we remain in third place in case count, three states behind us have more active cases than we do. Pennsylvania in particular has over 3,300 more active cases despite having 4,600 fewer cases overall, so looks like it could catch up to us soonish.

The Telegraph reports that the WHO has cautioned against relying on serology to prove immunity to COVID-19:

There is currently no evidence to support the belief that people who have recovered from coronavirus then have immunity, the World Health Organisation has said.

Senior WHO epidemiologists warned despite the hopes governments across the world have piled on antibody tests, there is no proof those who have been infected cannot be infected again.

Germ Boat #25 is the nuclear-powered aircraft carrier Charles de Gaulle, flagship of the French navy, with more that 1,000 cases, nearly half of the ship's crew. The outbreak grew "exponentially" around April 4th, and the ship has now returned to its home port of Toulon for disinfection. Attempts to trace the outbreak to prior stops in Brest and Cyprus have not yet yielded a definitive answer.

Germ Boat #23, the USS Theodore Roosevelt, continues to make the news for its 60% rate of asymptomatic cases. There is little other test data for groups of young, healthy people.

Boston's Pine Street Inn homeless shelter made the news on Wednesday when testing of the entire population revealed a 38% positive rate (146 cases), all of them asymptomatic. One person was moved to a hospital, and the rest were isolated in temporary facilities. No news of symptoms has emerged since.

The hand-wringers are wringing extra hard about whether the virus came out of a lab, perhaps because Nobel laureate Luc Montagnier, discoverer of HIV, is in the made-in-a-lab camp. The suspect Wuhan lab has now denied it came from there.

PlagueBlog should note that the current Ebola outbreak in the Democratic Republic of the Congo remains current, due to the discovery of three or four new cases (two deceased, one receiving treatment, and one known only from the WHO case count) a full forty days after the last case had been resolved and two days before the outbreak would have been declared over.

Day 74: R0 and Rt

Today's numbers are edging ever closer to 2 million cases, hovering around 1,950,000 at the moment. A few numbers have leaked out of North Korea: four doctors and 180 soldiers have died of coronavirus. (These deaths are not included in the world total.)

The UK has joined Italy and New York City in hitting the news for its statistically suspicious death rate. Just by checking death certificates for mention of COVID-19, the Office for National Statistics picked up 15% more deaths than previously counted. A redditor noted even more of a death disparity in the ONS chart summary points:

The provisional number of deaths registered in England and Wales in the week ending 3 April 2020 (Week 14) was 16,387; this represents an increase of 5,246 deaths registered compared with the previous week (Week 13) and 6,082 more than the five-year average.

Of the deaths registered in Week 14, 3,475 mentioned “novel coronavirus (COVID-19)”, which was 21.2% of all deaths; this compares with 539 (4.8% of all deaths) in Week 13.

That's a difference of 2,607 unexpected deaths still not attributed to COVID-19. Unlike Italy and NYC, the health care system in England and Wales is not overwhelmed, so there's not a lot besides coronavirus to explain the extra deaths.

Circumstances have forced PlagueBlog to add the USS Theodore Rooosevelt to the germ boat list at #23, due to a death onboard from coronavirus. The unnamed sailor was found unresponsive last Thursday, two weeks after having tested positive, and died in intensive care on Monday. The case count aboard #23 is 585 positive out of a crew of 4,800. Rumor has it that four other infected sailors are in a hospital ashore; presumably the rest remain aboard.

Likewise, the USNS Mercy hospital ship has earned the title of Germ Boat #24 with its own outbreak. In this case they are combatting the outbreak not in the Diamond Princess way of Germ Boat #23, but by removing the seven infected sailors and their contacts to isolation ashore.

R₀, the basic reproduction number, is a somewhat vaguely defined measure of the number of people one infected person will infect in a naive population taking no precautions. For example, R₀ for measles, an extremely contagious and truly airborne disease, is generally estimated at 15. The CDC has estimated R₀ for coronavirus at 5.7 (revising an initial estimate of 2.45).

R₀ is contrasted with the effective reproduction number R (or R_t, or R_e), which is the average number of people infected by one infected person in the current situation (of precautions, partial herd immunity, etc.). Gabriel Goh at OpenAI has written a fun tool for playing with these values and others to see how they affect "the curve". Kevin Systrom, cofounder of Instagram, has a writeup about R_t as a useful, local metric of how individual US states are doing. He's pretty pessimistic about Massachusetts and Rhode Island:

Which states have the epidemic least “under control?” To answer this, I plotted states where the best case (eg. low end of HDI) is above 1.0, indicating the true value of Rt is almost certainly above 1.0. Surprisingly, Rhode Island, Maryland and Massachusetts sit at the top. Part of this may be that Rhode Island is earlier in its infection curve, but seeing large states like Massachusetts and Texas above 1.0 is worrisome—especially because none of these states have hit the headlines as being trouble spots.

P.S. Massachusetts' numbers are up 5% again today. Hospitalization numbers have dropped out of the report for undocumented reasons. (Speaking of which, the Boston Globe published a hospital-by-hospital breakdown of coronavirus cases, though Steward Health Care hospitals are omitted.) Middlesex holds a commanding lead over Suffolk County, and at least one Middlesex County mayor has decided to confuse matters by issuing hiss own mask guidelines in contradiction of the CDC and state guidelines.

Day 69 Retrospective: Making the Diamond Princess Look Good

PlagueBlog apologizes for being unavailable for day 69. (We are not infected.) Massachusetts numbers were up 13%. Also, someone's been testing our sewage and thinks we have 100,000 cases, not 18,941.

The Germ Boat of the Day on Thursday, April 9th was #22, the Aurora Expeditions ship Greg Mortimer, on a 21-day Antarctic cruise out of Ushuaia since March 15th. Though its original destination was Puerto Williams, Chile, both Chile and Argentina have closed their ports, so the plague ship instead anchored in the Rio de la Plata (between Argentina and Uruguay) on March 27th, hoping to eventually dock in Uruguay. The Uruguayan government, for its part, refused docking until all passengers died tested negative. Note that 128 passengers and crew out of 217 are infected, including the ship's doctor, but Uruguay is keeping their social distance from all 217.

A week ago Saturday six especially ill passengers were evacuated in a PPE-heavy Uruguayan naval operation. Two more such passengers were evacuated on Wednesday. This Saturday the ship finally docked in Montevideo, where about 110 Australian and New Zealander passengers were escorted "along a 'sanitary corridor'" to a waiting charter plane.

The crew of 80, along with 20 European and American passengers, remain aboard the ship waiting to die test negative.

Day 64: Black Cats

Today in Massachusetts we had 1334 new cases (13% over yesterday), and 24 new deaths. The US has more that 311,000 total cases, and Spain has surpassed Italy to earn second place. (This is especially impressive because Spain has only three-quarters the population of Italy.) Worldwide the total is over 1,200,000 cases and 64,000 deaths.

PlagueBlog has been remiss in report on pet infections. A Belgian housecat was confirmed to be the first feline patient on March 27th. "A week after its owner, the animal presented symptoms such as diarrhea, vomiting, and difficulty in breathing." A second feline case was found Monday, March 30th in an asymptomatic domestic short-haired cat from Aberdeen, Hong Kong, sent to quarantine when its owner fell ill and tested there.

At first the only cat concern was for the poor animals catching the disease from overly affectionate humans, but a preprint by Hualan Chen reports that both cats and ferrets can spread the disease, and cats can do so with "respiratory droplets." In another preprint, Chinese scientists tested stray and domestic cats in Wuhan, and found antibodies to SARS-CoV-2 in 15% of the hundred or so animals tested after the outbreak.

On the plague ship front, the title of Germ Boat #21 goes to the Coral Princess, which managed to accumulate two dead passengers on its way into the Port of Miami today. Not unlike Germ Boat #18, the Coral Princess thought it could get away with a cruise to South America a month ago, but cut the junket short in mid-March and started searching for any old port in a storm. They managed to dock in Buenos Aires for a day to offload some lucky passengers, but they turned into a germ pumpkin at midnight on March 19th and had to set sail again, this time for Fort Lauderdale. They finally docked in Miami this morning and offloaded the sickest passengers. An unfortunate passenger delayed sickening until later this afternoon, at which time his family got the run-around for hours until they called 911.

P.S. PlagueBlog is saddened to report that the death toll from methanol poisoning in Iran has reached 300 (or, by some reports, 480), and the injured exceed 1,000 (or possibly 2,850), due to the false belief that alcohol is a cure for coronavirus, along with a fatal lack of education about potable vs. poisonous alcohols. Deep distrust in their government that initially downplayed the virus may also be a factor.

Day 63: A Tale of a Fateful Trip

NHK News reports the current numbers in Japan, which include three previously unaccounted-for deaths for Germ Boat #2, the Diamond Princess, for an official total of eleven. PlagueBlog is aware of one Australian (James Kwan of Perth, 78) who tested positive after returning home and died there; he has never been included in Japan's official plague ship death toll. Wikipedia, however, has sourced the other deaths: Two Japanese men in their 70's died on March 22nd, and one Hong Kong woman in her 60's died on March 28th.

PlagueBlog is long overdue for a full accounting of who's been cruising for a COVIDding. Lists of the plague ships have appeared in Business Insider, NTD and the Telegraph (unpaywalled version). Business Insider's list is the most complete, but Wikipedia's list is by far the best documented and ordered. (Note that multiple sailings of the same plague ship are listed separately, and there are also more boats at Wikipedia than in their main list.)

GB #	Ship	WI #	BI #	Confirmed
1	World Dream	2		Yes
2	Diamond Princess	1	1	Yes
3	Anthem of the Seas			No
4	MS Westerdam	3	8	No
5	AIDAvita			No
	Voyager of the Seas	5, 10	30	Yes (previous trips)
6	Grand Princess	6	2	Yes
7	Carnival Panorama			No
8	Regal Princess		3	No
9	Costa Fortuna		7	No
10	Caribbean Princess		5	No
11	MS River Anuket/A'sara	4	10	Yes
12	RV Bassac Pandaw			Yes
	Ovation of the Seas	11	28	Yes
13	Ruby Princess	13	22	Yes
14	Costa Luminosa	12	17	Yes
15	Silver Shadow	7	12	Yes
16	Silver Explorer	8	13	Yes
	MS Braemar	9	11	Yes
	Celebrity Solstice	14	27	Yes
	Costa Magica	15		Yes
	Costa Favolosa	16		No
	Costa Victoria	17		No
17	Azamara Pursuit		19	No
18	MS Zaandam	18	29	Yes
19	MS Rotterdam			No
20	MV Artania	19		Yes
(21)	Coral Princess	?		Yes
	MSC Meraviglia		4	Yes (previous trip)
	Royal Princess		6	No (never sailed)
	MSC Opera		9	Yes (previous trip)
	Golden Princess		14	No
	Norwegian Jewel		15	No
	Pacific Princess		16	No
	Celebrity Eclipse		18	No
	Carnival Fascination		20	No
	Freedom of the Seas		21	No
	Azamara Quest		23	Yes (debated)
	Majesty of the Seas		24	Possible
	Norwegian Bliss		25	Yes
	Celebrity Summit		26	No
	MS Maasdam		31	No
	Carnival Valor		32	Yes (previous trip)
(22)	Greg Mortimer			Yes
(23)	USS Theodore Roosevelt			Yes
(24)	USNS Mercy			Yes
(25)	Charles de Gaulle			Yes
(26)	Oasis of the Seas			Yes
(27)	Symphony of the Seas			Yes
(28)	Norwegian Gem			Yes (crew)
(29)	Celebrity Apex			Yes (crew)
(30)	MS Roald Amundsen			Yes
(31)	m/s Paul Gauguin			Yes (crew)
(32)	SeaDream I			Yes (previous trip)
(33)	Etchizen Maru			Yes (fishermen)
(34)	HMS Queen Elizabeth			Yes

(Germ Boat numbers in parentheses were assigned after this post went up.)

As you can see, there were a lot of promising candidates, but the title of Germ Boat #20 goes to the freshest face on Wikipedia's list, the MV Artania, flying a Bahaman flag and currently anchored off Western Australia. After offloading most passengers, all Aussies, and all known coronavirus patients in Perth last month, the remaining 16 passengers (including 12 who were too sick or frail to fly home from Perth) and the crew seem fated to sail all the way home. They have not set sail yet.

P.S. Massachusetts' numbers are in. We are up 1436 cases (16%), for a total of 10402 with 38 new deaths (192 total). Cases in long-term care facilities are up 94% over yesterday to 382, possibly due to the completion of testing at the Holyoke Soldiers' Home, for which the Governor reported 51 positives 160 negatives at his presser today. (Speaking of the presser, someone may have made Rupert the sign language interpreter a fan subreddit today.) After having lagged behind the city for several days, Middlesex County has pulled ahead of Suffolk with 2202 cases vs. 2183, and Essex has firmed up its lead over Norfolk County.

PlagueBlog cannot overlook the irony that, due to cerveza being declared a non-essential industry in Mexico, Grupo Modelo has shut down production of Corona beer.

Day 60: Even the Queen

PlagueBlog is saddened to report the death of the Spanish Royal Princess Maria Teresa de Borbón-Parma, aged 86. Having started on FaceBook, the news took some time to reach us.

USA Today reported yesterday that the Federal Reserve Bank of St. Louis is projecting an unemployment rate of 32.1% for the second quarter. Bodies are piling up at morgues in Iraq due to fears about burying them. Japan is planning to extend its entry ban to countries including China, South Korea, the US, the UK, and most of Europe.

On the mask front, CNN reports that the WHO has dug in in their recommendation against masks. People don't seem to be listening, though; more of the unqualified masses in the streets (and more specifically, the supermarkets) seem to wearing them every day.

Rhode Island was apparently not the first spicy island state to declare open season on tourists. El Pais reports that police in the Andaman and Nicobar Islands, an Indian territory, ejected at least thirty foreign tourists at gunpoint earlier this month, shipping them all to the airport on the main island where they were forced to buy plane tickets to the mainland (while being sprayed with window cleaner). The tourists now appear to be holed up in an abandoned embassy building in Chennai, because the locals there beat one of them up when he emerged.

The New York Times reports on a super-spreading event in Georgia similar to our ill-thought-out Biogen conference. Reuters reports on a super-spreading event in France that puts all of ours to shame:

The prayer meeting kicked off the biggest cluster of COVID-19 in France - one of northern Europe’s hardest-hit countries - to date, local government said. Around 2,500 confirmed cases have been linked to it. Worshippers at the church have unwittingly taken the disease caused by the virus home to the West African state of Burkina Faso, to the Mediterranean island of Corsica, to Guyana in Latin America, to Switzerland, to a French nuclear power plant, and into the workshops of one of Europe’s biggest automakers.

And last but never least, the plague ships: Tasmania's second death is directly linked to Germ Boat #13, the Ruby Princess. According to The Guardian, the ill-fated (and ill-docked) cruise ship transported 440 cases to Sydney, which represents 10% of Australia's total case count, and 5 of its 19 deaths.

In a move the NSW health minister later admitted was a mistake, 2,700 passengers were allowed to disembark without checks from NSW Health on 19 March, with many boarding flights interstate. Another boatload of passengers did the same on 8 March.

Since we're on the topic, DutchNews reports a Dutch national was the fourth to die aboard Germ Boat #18, the MS Zaandam (Holland America), which has been at sea for a two-week tour out of Buenos Aires since March 7th. Eight people have tested positive but about 200 are showing symptoms. After the Zaandam was refused docking at its original destination in Chile as well as in other South American nations, it spent some time anchored off Panama, where it transferred some healthy passengers to Germ Boat #19, the MS Rotterdam (so designated because, despite being apparently uninfected, it is as much of a pariah as #18 and is now also its travelling companion).

Panama reversed its initial decision and let both ships through the canal "for humanitarian reasons" on Sunday. The plague ships are now chugging towards Florida, though the governor has expressed his disinterest in allowing foreigners to be "dumped" in his state.

P.S. The Hill reports that the CDC may buck the WHO and encourage Americans to wear masks.

P.P.S. Today's Massachusetts numbers are up 868 (15%) to 6620. There were 33 more deaths, though, for a total of 89. Deaths are now broken out by decade (only one was under 60), county, hospitalization status, and pre-existing conditions (yes or no). Quest performed another 2,200 tests while the state did 20 (and also somehow went down one positive over yesterday). Suffolk County has pulled ahead of Middlesex again.

It's unclear how many of today's seven deaths in Hampden County are due to the "stunning breakdown of public health protocol" at the Holyoke Soldiers Home; the Boston Globe reports a death count of 13 with 17 cases among living residents and staff and more tests pending.

[Health and Human Services Secretary Mary Lou] Sudders said state officials are still trying to confirm important details, including precisely when the residents died, when they were tested for COVID-19, and who in their families were informed. She said the deaths were not reported to state officials.

Day 51: Next Stop, Italy

The US has reached 30,000 cases, putting us in a firm third place after Italy (53,000) and the source of it all, China (81,000). New York State alone has exceeded 15,000 cases (with 9,000 in New York City alone), leaving all the other states with their impaired testing capacities in the dust. PlagueBlog does not recommend closing the border with New York at this time.

On the plague ship front, The Patriot Ledger reports that hundreds of passengers aboard Germ Boat #15, the Silver Shadow, remain quarantined in the port of Recife (Brazil) after a single passenger tested positive. Despite promises of an airlift out for Americans this weekend, about a hundred remain aboard.

A sister ship, the Silver Explorer, earns Germ Boat #16 status by being in a similar situation off the port of Castro, Chile, after an 85-year old British man disembarked in the south and tested positive in Coyhaique. Silversea Cruises is a subsidiary of Royal Caribbean.

Chile has also refused docking to Germ Boat #17, the Azamara Pursuit, despite its having no verified cases aboard. Other South American ports have refused it entry, and it may need to make the entire 13-day sail back to Miami to offload its (for the moment) healthy passengers. Azamara Cruises is a wholly owned subsidiary of Royal Caribbean.

P.S. Massachusetts' numbers are out for today: 646 cases, up 121 (23%) from yesterday, with 5 deaths (+3). The commonwealth is now providing age ranges on the case numbers. The curve is fairly flat and may be an archive of the testing priorities. Two more cases have been attributed to the Biogen conference, fifteen to travel, fourteen to local transmission, and almost 400 remain unsourced at this time. Positive results are down to 11% for the state lab and up to 7% for the commercial labs.

For some reason the DPH lumped Dukes County and Nantucket County together (with 1 case total), misleading some news outlets into claiming that every county now has a case.

P.P.S. I corrected some number comparisons above.

Day 50: And the Ship Sailed On

The worldwide case count has exceeded 309,000 with over 13,000 deaths. In Massachusetts, today's number is 525 cases, up 112 (27%) from yesterday, with 4 travel-related cases and the remainder due to community spread or not yet sourced. The biggest jumps are in the Greater Boston counties, along with noticeable increases in Essex, Bristol, and Plymouth counties. In a considerable number of cases the county is unknown.

Although not included in today's numbers, Channel 25 reports the death of a Middlesex County woman in her 50's with pre-existing conditions.

Some updates from yesterday: the death in Suffolk County was of an 87-year old Winthrop man. More disturbingly, Channel 25 reported that 9 health care workers at Brigham and Womens and 10 health care worker at Tufts Medical Center tested positive, far exceeding their actual case counts (though not the number of patients pending results at both hospitals). It's not clear how many days of testing this total represents. PlagueBlog is duly alarmed.

On the plague ship front, the numbers have changed yet again for Germ Boat #2, the Diamond Princess, with an eighth death today, a Canadian man in his 70's who had been hospitalized (apparently in Japan). Also some time last week, the Japanese suddenly counted fifteen more positives among ill passengers and their contacts who disembarked before the end of quarantine, bringing the total back up over 700 to 712. The New York Post reported Friday on a study determining that foodservice workers were the nexus of this particular germ boat outbreak.

The New York Times reports on yet another ill-omened cruise aboard Germ Boat #14, the Costa Luminosa. PlagueBlog was surprised by the Princess Cruise yesterday, but always suspected that Carnival Cruise Lines would go on operating its other cruise lines after announcing the apparently quite half-hearted closure of Princess. One of those lines is, of course, Costa Cruises.

The Costa Luminosa sailed out of Fort Lauderdale on February 24th for a Caribbean cruise on which its Italian passengers experienced some issues disembarking, though one Italian passenger was allowed to be hospitalized for an apparently unrelated condition. (He later died of coronavirus.) The ship sailed on out of Fort Lauderdale again, for Europe, reportedly only "half full". A second ill Italian was removed to hospital at a stop along the way. She also eventually tested positive. A comedy of errors ensued with no precautions being taken against the spread of the virus for a week, and then the homemade napkin masks appeared on the waiters.

The US would not permit the ship to dock at its original destination in Italy, so the plan was changed to Marseilles. Several other European ports of call turned the ship away. Yesterday, 400 American and Canadian passengers were finally airlifted home from Marseilles under "harrowing" conditions. Today the plague ship docked in Savona, Italy, despite the country being closed. Italian and Swiss passengers began to disembark; more will disembark tomorrow.

There is so much more news: more plague ships, more disturbing clusters across New England, and a run on chloroquine. PlagueBlog struggles to keep up while also working on a better view of the Massachusetts data.

Day 49: A Quarter Million Strong

Today the international case count has hit 255,000, with 10,000 deaths and almost 90,000 recovered. Italy has over 41,000 cases and 3,400 deaths. Spain has exceeded Iran in cases; both are nearing 20,000. Germany has well over 17,000 cases and the US is approaching 15,000, with 160 deaths.

Today the Treasury Secretary moved Tax Day to July 15th; filing and payment can be delayed without penalty. In a sudden move, Governor Newsom locked down the entire state of California late yesterday with a "shelter in place" order, though marijuana dispensaries and other "essential" businesses will remain open. Pennsylvania is also under a similar order. Massachusetts is still looking good, having dropped to 9th in the nation in case count with no deaths (unlike 28 states and the District of Columbia).

The Internet dug up this gem of a paper from 2007 [PDF]:

[SARS'] acute and dramatic impact on health care systems, economies, and societies of affected countries within just a few months of early 2003 was unparalleled since the last plague. The small reemergence of SARS in late 2003 after the resumption of the wildlife market in southern China and the recent discovery of a very similar virus in horseshoe bats, bat SARS-CoV, suggested that SARS can return if conditions are fit for the introduction, mutation, amplification, and transmission of this dangerous virus.

And lastly, the gift that keeps on giving: plague ships! Lucky Germ Boat #13 is the Ruby Princess, a Princess Cruises ship that (despite Carnival allegedly suspending operations of Princess Cruises a week ago) was still cruising around as late as yesterday when it docked in Sydney. Although thirteen people were ill with flu-like symptoms, the 2,700 passengers were allowed to disembark. Only the ill seem to have been tested; two passengers and one crew member tested positive. Another passenger who travelled to Tasmania has been hospitalized there and is a suspected case.

PlagueBlog trusts this germ boat will continue yielding cases for some time.

P.S. Forbes has an article on the homemade mask movement.

P.P.S Governor Cuomo tweeted his intention to lock down New York State.

P.P.P.S PlagueBlog apologizes for jinxing us: the governor reported the first death in Massachusetts during a press conference this afternoon. The victim was a Suffolk County man in his 80's with pre-existing conditions who died yesterday. The remaining numbers for today are not out yet.

P.P.P.P.S Our numbers are now out. Massachusetts has 413 cases, up 85 (26%) over yesterday, with 17 new cases of local transmission, 15 more travel-related cases, and the remainder under investigation. Middlesex County has 25 new cases, Suffolk 14, Norfolk 12, and Essex 10. Fifty of the new positives were found by the commercial and mystery labs. The state lab positive rate has gone down to 11% while the commercial lab rate has gone up to 5%. (There is still no denominator on the mystery labs.)

Day 42: Fly Now or Forever Shelter in Place

Today's numbers (according to BNO) have exceeded 138,000 cases, 5,000 dead, and 70,000 recovered. Italy has exceeded 15,000 cases and 1,000 dead. Iran is over 11,000 cases and 500 dead. South Korea, the new social distancing capital of the world, has kept their numbers under 8,000 cases, with only 67 dead. Spain is over 4,200 with 120 deaths, while France and Germany are hovering around 3,000 cases.

The US is next up, with 1,832 cases and 41 deaths. (The new deaths appear to have occurred in Washington State, though the CDC hasn't recognized them yet.) No other countries have hit 1,000 yet besides China, whose new case counts have become negligible, though Switzerland and the Scandinavian countries are getting close.

Our World in Data is tracking doubling times, though they only have them listed for EOD Wednesday right now [updated since to Thursday, with cool new graphs], when the US and Spain were at 2 days and Denmark at 1 day to double the number of cases.

Portugal provides a handy map of cases, divided into the usual Norte/Centro/Lisboa/Alentejo/Algarve/Açores/Madeira divisions (except with a rather outsized notion of Lisboa compared to the usual one), along with a chart of symptom onset dates. For confirmed cases, age and sex, number hospitalized, and symptoms are summarized. The rates of symptoms (translated for your convenience) are:

Cough	Fever	Difficulty Breathing	Headache	Muscle Pain	Weakness
65%	46%	10%	37%	40%	24%

Today is your last chance to fly home to the US from the Schengen area of Europe (i.e., most continental EU countries and some non-EU states with open borders) before Trump's travel ban goes into effect. Forty-eight hours may not sound like much notice compared to the week most closing colleges and universities have given their students to bug out, but it's still generous compared to yesterday's events at CCSU. At 11:00am, in reaction to a student who was a mere contact of a mere suspected case (later proved negative), the President of Connecticut Central State University tossed everyone out immediately. A later update indicates that the residence halls aren't closing until this afternoon (though where the residents were supposed to be in the meantime remains unclear).

New York has opened a drive-through testing facility in New Rochelle which can handle up to 200 cases a day (though perhaps erev Shabbat is not the best time to do so, considering the demographics of that outbreak). The Miami Herald reports that Francis Suarez the mayor of Miami, has tested positive, "four days after the mayor attended a Miami event with a Brazilian government official who later tested positive for the virus." President Bolsonaro was allegedly exposed, and later met with President Trump.

Plague Ships: The Japanese Ministry of Health, Labour, and Welfare reports another case off of Germ Boat #2; one asymptomatic crew member of the Diamond Princess tested positive upon release from quarantine and was sent to hospital. This brings the case count up to 697.

We have a Germ Boat #12, a Viking Cruise Journey riverboat, the RV Bassac Pandaw, with a capacity of 60 passengers. VOA Cambodia reports that one out of five passengers tested positive on Tuesday after Vietnamese authorities alerted Cambodian authorities of a case on their flight from London to Hanoi. Subsequently the remaining 59 passengers [sic] were tested and two more positive cases were found, for a total of three. (The five mentioned in the headline is the total across Cambodia.)

Business Insider reports that Viking Cruises has since suspended operations, and the Washington Post reports (behind a paywall) that Disney has as well. Once again #12 may be the last germ boat, though PlagueBlog suspects otherwise.

Local cancellations: Universal Hub reports that nine local Orthodox Jewish congregations (though that's not nearly all of them) have suspended services starting immediately.

P.S. The President declared a national emergency at a White House presser this afternoon, during which far too many important American health care industry executives (including one from Quest) got far too close to the possibly-exposed President. During questioning he mentioned that Bolsonaro has tested negative (though his wife tested positive), but PlagueBlog doubts the negative result can be relied upon so early on.

P.P.S. Massachusetts' numbers for today are 123 cases (15 over yesterday), with 94 connected to Biogen and 16 not yet connected to Biogen ("under investigation"). The Berkshire cluster and travel numbers are unchanged.