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1) Do children pass it on?

First it seemed they did not, now some studies says they do. Still to be determined.

2) Does it spread outdoors?

Again first it seemed it didn’t now some superspreader outdoor events are pointing that it is possible to have significant transmission outdoors.

3) Why are some people superspreaders?

Superspreaders play a key role but we really don’t understand what makes a person a superspreader other than they are.

4) Is a mask mandate enough?

Some countries like Sweden do not have mass mask wearing and do very well in the second wave. Are masks essential? They clearly seem to help but are they enough?

5) Are people who stop showing antibodies frequently susceptible to re
infection?

Many people who had Covid test negative on IgG and IgM a few months later. Does this mean they are susceptible to get re infected? Re infection cases are known but very rare.

6) Why did Sweden do better than Spain with its mask mandates and
severe lockdowns?

Is Covid unavoidable or are there clear policies that stop it short of shutting down the economy? Why do some countries do so much better than others? Not clear.

7) Is long Covid a lifelong challenge?

We have only had Covid for 9 months so how can we know how long Covid is. Will people still have Covid symptoms in 2030 of an illness they had a decade before?

8) Anosmia, why?

Theories abound that Covid infects the nervous system, the brain, but we really don’t seem to understand why anosmia is so common among Covid patients.

9) How did Sars CoV 2 originate?

Is it bat to another animal, to humans? Is it a lab? We don’t know.

10) Why does every Asian country, even chaotic ones like the
Philippines, do better than any European country?

This one baffles me. Philippines is so chaotic, so poorly managed as a country, so poor. Why do they do so much better than Belgium or Netherlands?

11) Is there herd immunity?

Many believe there isn’t and it is clear that some places like Madrid got hit hard in the first wave and the second wave. But other places didn’t.

12) And if there isn’t, how are vaccines supposed to work?

Vaccines are there to achieve herd immunity in a less complicated, less painful, less deadly way. If we don’t have herd immunity via infection how are we supposed to get it with a vaccine?

13) Why didn’t Western countries use the attenuated virus that China
used for the vaccines since it’s proven to work in flu, mumps,
rubella?

The Chinese approach to vaccine development seems so proven, why are Western companies trying to reinvent the wheel with the vaccines? Is it because they need new IP?

14) When and how do monoclonal antibody cocktails work?

What explains the unreal recovery of Trump? Is it the Regeneron mab cocktail? And if so will these type of therapies only work very early in the illness? The Lilly cocktail was shown not to work well in more advance patients. Will mabs be like the morning after pill?

15) Why are superspreaders asymptomatic and what percentage of them
are pre symptomatic?

This has been a debate since the beginning. Are people who spread the virus the most about to get sick themselves? If so what percentage is?

16) Why does Covid spread from those without symptoms?

Is the success of Sars Cov 2 based on a virus that has figured out that humans spread it through speaking and not coughing?

17) Are rapid antigen tests good enough to stop asymptomatic contagious people?

If the key to stopping the pandemic is to detect people when they spread it but don’t know it, do we need to rapid test everyone once a week?

18) Why do so many people keep testing positive on PCR?

Many people who recovered from Covid keep testing positive for weeks or months, are they contagious? And why do they test positive while other recovered patients don’t?

19) Until when after symptoms are people contagious?

How long should quarantines be? If we make them too long people are afraid to test themselves and more likely to hide their symptoms.

20) What percentage of people are afraid to get tested because they
don’t want to be quarantined?

How successful are we at finding Covid? are positivity rates enough? Is contact tracing enough?

21) Do politicians really have the impact we believe they have on this
illness or does it have a “mind” of its own?

Covid has unfortunately become so politicized. We live in a world in which the left seems to care about Covid and the right about jobs. But does the virus listen to politics? Probably not.

22) To what extent is weather a significant factor in the spread of Covid?

Warm weather and its outdoor life seems to limit the spread of Covid but then you have situations like Manaos, in the middle of the Amazon as one of the cities with the most incidence of Covid in the world.

23) Do children give Covid to adults in a significant way or is it
mostly the other way around?

How safe is it to open schools? Are kids active contributors to the pandemic?

24) Why are obese people so common among the hospitalized, in ICU and
among the dead?

That the average BMI of Covid patients is higher than that of the population where they come from is well known. But why?

1. Did the President give Covid to Biden? Probably not because the debate was 3 days ago and he must be tested daily. But it is a possibility.

2. Will his positive diagnosis make his followers take Covid more seriously and be positive for the development of the pandemic in the USA? Probably but it depends on the severity of his symptoms, if he goes mildly asymptomatic he will double down with his Covid denial messaging and many more will die, but if he has symptoms more common of overweight men in their mid 70s, paradoxically, Trump’s Covid will save a lot of lives.

3. Will he get convalescent plasma or the Regeneron antibody cocktail treatment? Probably and it is also possible that this plasma or cocktail with anti Sars Cov 2 antibodies will slow the spread of Covid throughout his organs. Few people have been given antibodies so early on after infection. In this case he will tout that there is a cure for Covid.

4. What impact will Trump’s Covid have on the elections? One obvious consequence is that there will be no more in person debates which should help Biden as according to polls he won the only debate that took place. But also depending on the severity of his symptoms how will the election night look like? It is only 5 weeks away. What impact would we see in the voting if on November 3rd Trump is hospitalized or in ICU?

5. At Trump’s age and weight he has around 3% chance of dying, around 20% chance of being hospitalized, around 40% chance of having severe symptoms, around 40% chance of going asymptomatic or with mild symptoms. By October 10th we will know which way the illness is going for Trump. The first week tends not to be very significant in the prognosis of Covid.

6. Considering how reckless Trump has been the question now is who else in the administration will get Covid and what are the political consequences of this.

7. In terms of the effect of the diagnosis on the election the question is this. Is an ill Trump a positive or negative for his chances of winning the election? I believe that it is a positive for Trump. There will be either a pity vote factor if he does poorly or an admiration vote factor if he comes out well. Those who are hesitant, undecided are not the kind of people who will be happy that Trump is ill.

We departed Menorca crying and disturbed at having to leave our farm and an island that we love so much. We came by boat and car so the transition would not be so sudden, a week long therapy, we wanted to emulate the times when people took a long time to travel. But now that we are here the mood has gone from somber to excited.

If you live in the USA, Spain, France, UK you would not believe how non Covid Germany feels like. Being here you see the post pandemic world you pray for in other countries to arrive one day. Today, Saturday, restaurants, parks are full, everyone is socializing, and almost nobody wears masks outdoors, (only when you enter a shop or public transport do people wear one). Also nobody seems to care about surface transmission of Covid. At the park kids were lying everywhere, practically leaking the floor

What is most pleasant to us is seeing friends without worrying about coronavirus. People here see each other all the time, I already have many in person lunch appointments this week, yes in person. We had a great day with a close friend, his son and girlfriend going to restaurants and Berlin’s awesome playgrounds.

What is the secret to German Covid success? It is not that Germans keep their distance, at least that is not the case in crowded Berlin. Yes, they kiss and hug less than in Latin Europe, but to me that is not what is decisive in stopping the pandemic. What I see that stands in contrast with many other countries are two main lines of defence against Sars Cov 2. The first one is at the border: free and quick PCR for everyone who enters the country, results in 24 hours. The second one and is that when they find a positive they have an army of contact tracers ready to test everyone related and stop the spread. They don’t let the exponential growth that took place in so many other countries happen.

If Germany feels “post pandemic” is because many health care workers, ultimately led by a female scientist leader, Angela Merkel, are working hard to protect the population. But they work on the background and society seems free. This situation is the opposite of what is happening with the forced masks on the street policies of Spain, where awareness of Covid is massive, but contact tracing and testing is very poor. Plus visitors don’t get tested at the border.

I end with two pieces of information to illustrate how mild the pandemic is in Germany. one is that of all ICU beds in Germany, only 1% of the ones occupied are occupied by Covid patients, second and more illustrative of the mood, they polled Germans what they feared most, and twice as many Germans feared Trump handling of global affairs than they feared coronavirus.

Just in the last few months:

First there was end of the world as we know it, an obsession with climate change as represented by Greta Thunberg. All the conversation centered around her every move, including the crossing of the Atlantic in a catamaran to avoid air travel. Then Covid came and we forgot about her, Greta was gone into the backdrop of social media, and we were all about the world coming to an end because of Covid. For two months it was Covid, Covid, Covid, Covid. Nothing else mattered. And then BANG, Blacks Lives Matter. BLM became more important than climate change, than Covid, it monopolized the conversation and that is what we hear about today on social media. Everybody is declaring a holiday.

Now, don’t get me wrong. All three issues need action, climate change, pandemics, and racism. But why can’t we deal with more of one of them at a time and more profoundly? Why go from social media obsession to social media obsession leaving a trail of substantive change neglect behind us? Because most likely, a month from now Black Lives will not matter much anymore. Something new will be all over social media. And in the meantime we have done nothing much about climate change, the pandemic keeps killing thousands, and endemic racism won’t go away either.

Should we stop and think for a while about how to really change what is wrong with the world for more than a few months?

On transgender people:

Studies show that around 1 person in 300 are transgender. This is an extremely small group compared to the general population. I am fine with calling transgender people the sex they want to be called. But I am not fine with all of us being unable to say that a person who is XY, does not menstruate, does not have a uterus is indistinguishable from a person who is XX, who menstruates, has a uterus and can carry a baby. The main reason why I am not fine with calling both individuals the same is because I work in assisted fertility. When it gets to help people have babies a transgender person has very different needs. But in the liberal world you say this and you get attacked.

On Blacks Lives Matter:

I am a big believer that there is systemic racism in the USA and most of the world. I am also a big believer that police systematically discriminates against black people. The data is clear. US police kills around 1000 people a year of which 220 are black but blacks are only 13% of the population, so there is 110 excess black deaths to population percentage. Having said this if you want to truly save black lives here is the sad truth. There are around 16K murders in the USA and young black men commit around 8200 murders or over half of all the murders in the USA. And 92% of those murdered by blacks are other blacks. So police kills around 110 blacks a year and other blacks kill around 7800 blacks a year. You could eliminate the police and you would do away with a tiny fraction of young black men deaths. Eliminating black deaths requires changes in the police yes, but it mostly requires establishing a world of educational opportunities for young black men so they can make better choices. But if you say this in the liberal world you get attacked.

On women in tech:

I have worked in tech and I work now in biotech. Let’s call the first one silicon based tech and the second one carbon based tech. What I have seen in these two areas is that women are very differently represented. When I built Fon, we had around 20% women engineers. Achieving gender parity in finding women interested in programming WiFi routers would have been close to impossible. But now that I am running Overture, a company that is building a robot to automate the embryology lab and make human embryos we find many talented women biologists, embryologists, engineers, who want to join our ranks. And in general in the life sciences it is much easier to find women. Indeed at Prelude now we find more women who become MDs in reproductive endocrinology than men. And overall way more women graduate in the life sciences. But if you say that there are gender preferences in career choices in tech in the liberal world you get attacked.

On climate change:

I have no doubt that humans are changing climate by having an uncontrolled level of carbon emissions. What I question is the extent of the damage. It’s been two decades since Al Gore and others have been forecasting the end of the world as we know it. Greta has brought the message home every day until Covid. Having said this humans are much more able to escape catastrophic weather events than for example pandemics. And all catastrophic weather events put together, kill around 11K people a year. I did say in January in Facebook that pandemics were much more dangerous for humanity than climate change and I was ridiculed. But it turned out to be true. If you say that climate change is a threat, but there is a green revolution going on that will fix it, that solar and wind energy are reaching grid parity, that affordable storage is coming, and that we have a bright energy future ahead of us in the liberal world you get attacked. 

On how to deal with Covid

At the beginning of the pandemic I was terrified of Covid. Covid seemed to kill 10% of those infected. But after the Spanish government asked me to co lead the development of an app to diagnose Covid by digital means and we launched it I discovered that Covid was way less lethal than what I thought. At least 800K were diagnosed as positive by the app. So not only Covid turned out to be much more common and less lethal than what we thought but also we found out that when Covid action is taken early and is combined with social distancing (no gatherings of more than 50 people, etc) it kills around the number of people that is killing in Sweden or one in 2000 and of those 90% are over 65. So Sweden turned out to be a good country to study because they applied social distancing measures but not strict lockdowns (schools, restaurants, always open) and they got as many deaths per million as Belgium, Netherlands and France with strict lockdowns. Yes, they still got more than Denmark and Norway who applied strict lockdowns as well but they let people decide best policies for themselves which I find admirable. So I still believe that Sweden had and has the best balance between freedom and prevention. I believe this because I don’t think it is the role of governments to prohibit deaths, if they did they would permanently ban smoking that still kills way more people than Covid does and every year. But governments, in spite of smoking and second hand smoke killing so many, choose to tax, not eliminate tobacco sales. Still, supporting Sweden has turned me into an unwanted person among my liberal friends who all love to use New Zealand as their success case. Yes, I agree with New Zealand policies, for New Zealand! If you are a distant island in the middle of the South Pacific with one port of entry, and by nature ISOLATED, you can eliminate Covid. And so far they did. So did we in the island of Menorca where we have been since February and there is no tourism allowed yet. But if you are a freedom loving European who lives in a heavily interconnected continental country, as all EU countries, Sweden has the most balanced approach. The proof is that, in the end, all countries are going the way of Sweden and Sweden continues to not do a lockdown. Moreover, daily deaths in Sweden are coming in sync with most other countries. Among liberals, until recently, Sweden could do no wrong, but now with Covid, if you support their Covid strategy these days, in the liberal world, you get attacked.

On Nuclear Energy. 

I believe there is such thing as radiophobia and that radiophobia affects some nations, like Germany, more than others, France. And I believe radiophobia like all other phobias has some basis in reality but little compared to the actual damage of the thing feared. Under any measure nuclear energy is the safest form of energy generation. Google “death per terawatt” and you will see that burning fossil fuels kills people in the production of the fuel and then via pollution by over 1000 times the people who have ever died from radiation. Moreover I believe that unfortunately many of the countries who are energy exporters are also countries whose views are hardly democratic. So not only nuclear energy is safe, but it is also carbon neutral, no emissions, and we have found good ways of disposing of nuclear waste, among them other reactors that could use them. And I say all this as a co founder of Eolia Renovables that we sold for over a billion last year. I have been a significant developer of wind and solar energy and green energy is phenomenal, but at times the wind doesn’t blow and the sun doesn’t shine. Nuclear works 24 hours. But the liberal world if you stand for nuclear energy you get attacked.

Oh yes, and let me tell you, I hate Trump as much as most of you do, and I hope he loses against Biden who is not a great leader but became one when the alternative is four more years of lies. 

And I do believe in health care for all, progressive taxation, gay marriage, police reform, less military spending, free college tuition to all who can’t afford it, minimum income if no income can be earned, fair pensions. 

But I also believe in everything I just said. 

Everything I have in life I have because I think differently from most others. That is where the competitive advantage of the tech entrepreneur lies. So excuse me, but I will go on thinking my way and will not change my mind until data proves me wrong.

A demographic portrait of the pandemic

The chart above is an analysis of the mortality rates of COVID19 in Spain, demonstrating that mortality rates among those over 65 are much higher than for younger populations. These trends could be applied to any other country with the caveat that Spain has a high elderly population when compared to other countries (ranking third in Europe with regards to its elderly population, it is slightly below Italy and Greece) which is coupled with extensive intergeneration social contact. COVID19 fatalities are directly linked to the patient’s age and looking in detail at which age groups are most affected by the pandemic is imperative. 

The total deaths in Spain from COVID19 are 27K and can be found in the first row. Government figures quote around 21K deaths, yet I have also added excess mortalities, which account for about 6K more deaths (for excess mortalities see Informe Momo). The official death counts and the total number of deaths are probably the result of limited testing for the virus rather than intentional undercounting (see Imperial College’s report on the number of infections). My estimate is that between now and until the end of the year, the number of total fatalities will double, with a total of 54K. These projected figures are obviously questionable, yet I find value in including not only real figures, but also a projection of how the pandemic could evolve.

In the second row are the statistics regarding people under 65 with 5.4K deaths and a total of projected deaths of about 11K. This translates to 1 in 690 people who have died already from the virus or 1 in 3.4K by the end of the year. The total population for this age group is 37.64 million yet this age group represents only 8% of the total COVID19 deaths. 

In stark contrast, people over 65 years of age, make up 92% of the fatalities due to COVID19 and amount to a total of 9.4 million in Spain. This age group has disheartening rates: 1 in 435 have died by now and possibly 1 in 215 will die by the end of the year.  When you narrow it down to people over 80, it is possible to see how incredibly lethal this virus is: those over 80 represent 60.4% of the deaths. However, there are only 4.7 million people in this age category in Spain, meaning that already 1 in 271 have died from coronavirus and around 1 in 135 will probably die by the end of the year, unless of course a vaccine is developed or a treatment is found, thus herd immunity would not have to be reached.

In terms of the impact of COVID on those under 50, it is an almost non-lethal virus and the fatalities in this age group represent only 1.7% of the total deaths. To better assess this percentage and get a better idea of what this means we must take into consideration that a person who is 35 years old has a chance of dying of 1 in 500  due to any cause between the ages of 35 and 36. The likelihood of dying from coronavirus for this age group is 1 in 61K which is statistically insignificant. By the end of the year, those under 50 will have a chance of dying from coronavirus of 1 in 30.5K. Essentially, the pandemic is a non-factor for people under 50 who amount to 28 million in Spain.  

The age group comprised between the ages of 50 to 60 represent only 3.1% of the total COVID19 deaths, while for the age group between the ages of 60 to 70 the percentage of total deaths is 8.9%. The chances of dying from COVID19 for these age groups are insignificant when compared to the chances of dying from anything else. 

Assessing the likelihood of dying from coronavirus and highlighting the high lethality of COVID-19 for older people is essential in order to decide the future steps to follow with regards to the pandemic.