A few weeks ago I wrote down some thoughts about the fifth coronavirus wave here in the country of Georgia. I didn’t get around to posting them because some events overtook me - I started teaching online again, and my son started school in person - and in the mean time the wave grew much faster than expected. Now, the thing that I was trying to project has already happened, so the notes serve more as a retrospective analysis of why that happened than as a reasonable predictive model. Still, a retrospective analysis is better than nothing, and as it turns out, the same factors will probably remain relevant for subsequent waves over the rest of the winter. So the first section of this post will address why we’re in yet another catastrophic wave.
Then, I’ll talk about some of the consequences of this wave getting out of control, and of the government’s general fecklessness about coronavirus.
Finally, I’ll talk about my predictions for the future.
If you’re all covided out, the executive summary is: we’re screwed.
Why are we in another wave?
I analyzed three types of factors to help me think about how the fifth wave might go. These are political factors, other internal factors, and epidemiological factors.
Political Factors
As I demonstrated in my previous covid post, government policy seems to be the controlling factor in determining Georgia’s covid outcomes. The primary difference between Georgia and CRRC’s list of similar countries was the change in stringency index - the “control” countries increased the stringency of anti-covid measures quickly and averted large waves, whereas Georgia did neither. In both the 2nd and 4th waves, Georgia’s downturn in cases began shortly after the government implemented anti-covid measures to restrict population mobility.
Therefore, the first question I asked myself in thinking about how the fifth wave would go was, “will the government learn from its mistakes, or will they act as they have during previous waves?”
Factors favoring a larger wave are:
- the government has played chicken with covid for the last three waves
- public sentiment opposes restrictions
- economic interests oppose restrictions
- elections and runoffs deter the government from imposing restrictions
Factors favoring a smaller wave:
- the gov't might have noticed that it's lost its game of chicken two out of three times, and adjust
- ???
Unfortunately, I was at a loss to find a ray of hope in Georgia’s political situation. This hopelessness has turned out to be justified, which I will discuss in the next section.
Overall, the political situation seemed to suggest that the government wouldn’t act, which favors a larger wave.
Internal factors
I have also learned that international comparisons have limitations, and a better basis for comparison might be Georgia’s previous waves. Therefore, the second question I asked was, “will the 5th wave follow the pattern of the 3rd (low, subsides without serious intervention) or the 2nd and 4th (among the highest in the world, only subsides after intervention)?”
Why might international comparisons fail? Perhaps Georgia has internal factors that make its waves higher than most other countries' waves. If this is the case, then that would explain why the 5th wave is so high again.
Those internal factors might include:
- population structure/network structure - how many contacts people have, how close contacts are, how often contact happens
- cultural factors: speaking volume/proximity, attitudes towards ventilation, preference for indoor vs. outdoor events
- vaccination/infection-acquired immunity
- other/unknown
Based on prior experience, internal factors seem to favor larger waves.
Epidemiological factors
The last question we would want to consider is: “from an epidemiological standpoint, what causes waves?”
Factors which seem to favor a higher wave:
- Seasonal effects are somewhat unclear. Georgia had one bad wave in fall/winter and another in summer. Covid has shown limited seasonality but if seasonality is a factor at all we'd expect it to contribute to a worse wave. The only pattern is that both of the waves which occurred in March-June (1st and 3rd) were more limited. Is there something about spring that reduces severity?
- we probably don't have enough population immunity to stave off a severe wave
- in other places (I keep bringing up Manaus) where scientists have thought population level immunity would help, sometimes it didn't
- our baseline is already higher than the peak of the third wave
Factors which seem to favor a lower wave:
- If waves are mostly caused by new, more contagious strains, then absent a more contagious strain, the 5th wave will follow the 3rd. There isn't a new variant after Delta for us to worry about... yet
- The last wave was high which might predict a low wave, esp. if there is an alternating pattern (with odd waves being lower in Geo)
Overall, the epidemiological situation is mostly undetermined. If I had to guess I'd say it slightly favors a severe wave.
Other factors
It bears mentioning that the current wave is worst in Kakheti and Imereti. The NCDC thinks that Kakheti has problems because of the wine harvesting season - which I imagine may be accompanied by gatherings and parties. In Imereti, my personal observation has been that in Kutaisi, which is Georgia’s third largest city, people have not been observing basic covid safety measures. Every time I take a bus there are a few people without masks. Almost every store I go into has a few people without masks. I’ve never seen anyone masking on the elevator in our building. I have to imagine that terrible mask discipline in a large urban area would contribute to the situation - especially as weather cools down and people move inside.
I also have to consider the election on October 2nd. While the fifth wave began several days before the election, there’s no way to tell how much worse the election has made this wave. I have to note that this wave is steeper than the previous wave, and that could well be down to elections. On the other hand, voting is no more dangerous than going to a mall or a market here, and those are things that people do every day, so I remain deeply skeptical about the impact of elections. Also, this.
What does the wave mean for Georgians?
Here’s a true story that makes me feel like a terrible parent. My daughter has a cavity in one of her baby teeth. In the past, Georgian dentists have told us that they often don’t bother filling these since the teeth are going to fall out anyway. We decided to take a “watchful waiting” approach to this one. On Friday my wife suggested taking my daughter for a jaw x-ray. Although I thought this was probably unnecessary, under normal circumstances I would have gone along with it anyway, just to be safe. These aren’t normal circumstances; on Friday we had an average of ~3500 cases per day and the weekly growth rate was 1.72, which is shockingly high in comparison to Georgia’s previous waves. We also live in Imereti, which, as noted above, is one of the hardest-hit regions.
Today my daughter complained of pain in that tooth. We looked at her mouth and she has an abscess - an infection, apparently from the root of the tooth. Probably because we left the cavity untreated, which we probably wouldn’t have done if not for covid. Tomorrow she might need to have a root canal or extraction. She might need antibiotics. She’s been miserably rinsing the site with salt water off and on for the last three hours.
Deferring routine and non-emergency medical care is bad. When I have to do it - on my own behalf, or on behalf of my kids - I do it in the hope and expectation that soon a time will arrive when we can get that care safely. We never really got that safety window this time - we went from fourth wave to fifth wave in record time without ever dropping to a place where we could have felt comfortable. Every day I’m faced with choices like weighing the harm from putting off a dental checkup against the harm of going to a dentist’s office which will inevitably be poorly-ventilated and sitting one of my kids in a room where by definition they can’t wear a mask.
Meanwhile, my son had exactly one week of in-person classes before a classmate of his tested positive, forcing the whole class to go into “isolation”, which in practice just means they’re not in school. By Friday, over 100 schools had closed nationwide and nearly 700 classes had gone into isolation. Needless to say this is incredibly disruptive to the educational process and to parents’ lives. I’ve had to rearrange my apartment to accommodate my son’s online learning and my online teaching, and for the times that I have online lessons I’m not able to support my son’s online learning process, making it much less effective on those days. Third graders just don’t have the self-management and academic skills to manage their own set of daily Zoom classes and the other challenges of online learning. My daughter, who is in kindergarten, doesn’t even have that option - we’ve just had to keep her home for the last week and have her hang out around the house and paint all day while I work and my son does lessons.
This is typical family stuff in a way but also I want to note that I am incredibly lucky. My wife and I both have jobs that allow us to teach online, so we don’t have to worry about arranging outside childcare. We have stable internet, and enough computers for everyone in the house. The other day power went out in my district for about fifteen or twenty minutes during one of my son’s lessons, and I just switched his laptop over to my 4G hotspot, before his teacher even noticed that he’d dropped. Two of the other students in his class who live near us just missed half of that class.
We’re incredibly privileged compared to the average family in Georgia - and we’re still struggling. Still making difficult choices, still unable to access stable education and medical care.
Public Sentiment and Political Leadership
My wife’s cousin’s husband died from covid a few weeks ago and most of the family couldn’t make it to the funeral because of covid risk. People are traumatized by these deaths and traumatized again by having to choose between comforting loved ones and keeping them safe.
But the death rates are down right now - only about thirty per day. As a consequence, no one is advocating for government action. No one is demanding anything - they’re all out bickering over which oligarch gets to oversee Georgia’s long slow descent into corrupt authoritarianism.
Soon, hospitals will be overwhelmed for a third time. Medical professionals will make enough public noise that the government will be forced to act. But soon after that, cases will start dropping, and within a few weeks people will start complaining about the restrictions again, saying there’s no point to them or that they are unreasonable.
These complaints, by the way, were issued when the death rate was more than double what it is now. This sentiment - public dislike of covid restrictions - must have played a role in the government relaxing restrictions, and sending kids back to school before either of the previously-announced benchmarks for doing so were met. In turn, removing restrictions before the fourth wave was fully over allowed the fifth wave to start far earlier than it should have.
Needless to say, since the start of the fifth wave, the people who complained about the restrictions have been silent on covid. It’s an absolute lack of foresight - as if people don’t realize that minimal restrictions early can preempt the need for severe restrictions later. (To be clear, by “minimal restrictions” I mean things like actual enforcement of mask mandates, restrictions on gathering sizes, and perhaps vaccine passports for admission to public accommodations, such as restaurants, bars, and entertainment venues.)
In three to four weeks the rates will be back up to seventy to eighty deaths per day, and public sentiment will turn against the government. People will demand to know why the government is letting all these people die. People will attend - or miss - another round of funerals. Unfortunately, the time for the government to have done something to prevent this outcome was two weeks ago - or last week, at the latest. Now hitting or exceeding our previous height is already baked in, even if new restrictions were implemented today, which they won’t be. So in the middle of November when people want to know why the death rate is so high - this is why. Because public sentiment is consistently against government restrictions except for like a four day period when it’s too late to prevent those deaths, and because no one in government has the spine to put restrictions into place anyway.
Cases started going up on September 30th, from an already high baseline. On October 3rd I warned in my weekly covid twitter thread that cases were rising and they’d probably continue to do so, and that benchmarks for opening schools hadn’t been met. On October 10th in my thread I warned that the NCDC’s projection of a fifth wave in November was wrong, because the fifth wave was here already, and that that would have been a good time for government intervention to prevent us from hitting or exceeding the previous peak.
Now, please note that I am just some guy. Sure, I have some experience with forecasting and modeling epidemics, some experience with policy analysis and research, and some basic math and coding skills. But I don’t have a Ph.D. in anything, or an entire government agency at my disposal. I don’t have access to any kind of special or non-public information. There’s no reason, in other words, why the Ministry of Health or the NCDC couldn’t have reached the exact same conclusions that I reached. Honestly, for most of the pandemic their projections have been pretty close to mine in terms of accuracy and timeliness. To me this feels like negligence on their part.
But also, look at this statement from Amiran Gamkrelidze, the head of the NCDC:
According to Amiran Gamkrelidze, the fifth wave will be quite heavy, so vaccination is necessary.
What will be my recommendation in the light of the deterioration of the epidemic, I can not say here openly, it will be discussed by the Coordinating Council. It is noteworthy that the vaccination marathon starts and let's see what the result will be, about 160 thousand people live in these 49 villages where we will hold the marathon and see what the tolerance and activity will be, a lot depends on them.
(Translation by Google)
Now here’s my first problem: Vaccines take an average of about two weeks to even start offering protection. Even if every unvaccinated human being in Georgia were magically given their first vaccine today, by the time those vaccines even started to kick in we’d be up to over 12,000 cases per day, at the current growth rate. That’s more than double the prior peak.
Vaccines are important for the future - but the idea that they could change outcomes on a time horizon earlier than December is nuts. Plus kids still aren’t eligible.
And here’s my second problem: why can’t Gamkrelidze say openly what he thinks his recommendation will be? I’m assuming it’s because if he makes a public recommendation and the government doesn’t follow it, that would be embarrassing for both parties. From this we can deduce that Gamkrelidze thinks there’s a good chance the government will not follow his recommendations. Also, the coordinating council usually meets on Tuesday, meaning Wednesday is the earliest we could expect restrictions to be implemented. By Wednesday, at the current rate of growth, we’ll already have exceeded the peak of the fourth wave.
I can’t imagine that Gamkrelidze doesn’t know this. He’s just openly deceiving the press at the point, talking about how bad November is going to be, pushing vaccines when he knows that right now the only thing that’s going to fend off an unprecedented wave of sickness and death is to go into an immediate emergency lockdown - which he basically admitted he can’t say because he doesn’t want to embarrass the government.
While I’m on the topic of Georgian leadership on this issue, let me also highlight this statement by Tamar Gabunia, deputy Minister of Health.
We can not call it the fifth wave, because we have not yet come out of the fourth wave, and there is some fluctuation that needs to be addressed by returning to active use of face masks, social distancing, and intensifying the vaccination process.
(Translation by Google, edited by me)
What is the purpose of downplaying this as a “fluctuation”? Isn’t that likely to make people less inclined to follow the recommendations? This came the day after NCDC announced that this wave was not caused by a new coronavirus variant - something they clearly tested for because they were caught off guard by how quickly cases were rising absent any evidence of a new strain. So they’re so shocked by the fast increase they thought there was a new mutation, but their public statements are still pretending the fifth wave is due in November and we could stop it if people would get vaccinated.
It’s hard to interpret this as anything but a set of blatant lies. Which is disappointing, because up until now we’ve enjoyed relative transparency here about covid. It’s hard, in turn, not to connect this to other signs of rising authoritarian populism in the country. I hate to make everything about a Grand Narrative, but the government seems to have grown increasingly hostile to journalists, especially since and in light of the events surrounding this year’s Tbilisi Pride, and perhaps a willingness to misrepresent the epidemiological situation in the country could be tied to a more general institutional deterioration in the relationship between the regime and the press.
In sum, political leadership is not where it needs to be, the press isn’t holding the government to account for its covid policy or really applying critical fact-checking to government covid statements, opposition politicians aren’t offering anything in the way of alternative approaches to managing covid, and public sentiment is more or less consistently wrong about what the government should be doing about covid and when.
Forecast: How Bad?
Even with Gamkrelidze’s cryptic refusal to specify recommendations, it’s hard to imagine that the coordinating council meets on Tuesday and then agrees to do nothing for another week. I expect restrictions to kick in again by Wednesday or Thursday - possibly earlier curfew, maybe mobility restrictions, probably claims about redoubling mask enforcement. They might shut down intercity transport or set up checkpoints in hard-hit regions like Kakheti and Imereti. They might close public transport in those regions as well.
There’s a real chance they’ll close down schools, since schools are already in a state of universal disruption and no one seems to care much about children’s education. On the other hand they might decide the status quo is actually fine, and press on but with half of schools closed anyway because of all the covid cases they’re having.
I’m sure whatever they settle on will be enough - Gamkrelidze may have been muzzled in public but I have to assume in private he won’t settle for ineffective measures - so we’ll probably peak next weekend or so, at maybe 6000-7000 cases per day on average.
By that time, we’ll be looking at about 710,000 total confirmed cases, which suggests a maximum of 2.1 million actual cases. About 900,000 people will be fully vaccinated, but about 500,000 of them will also have already had covid. Add the remaining 400,000 to the 2.1 million, and best case is about 2.5 million Georgians will have immunity by the end of the month. Unfortunately, that still leaves 1.2 million Georgians susceptible - which is enough to sustain at least two more waves comparable to the 4th and 5th. In other words, we could be looking at peaks in December and February that could easily be as high as this one.
Note that the same analysis I performed above would still pertain. Georgia’s political and internal factors favor additional severe waves. Seasonal factors are currently against us and will probably remain so until at least March. Herd immunity basically doesn’t exist for a virus as contagious as coronavirus delta and the best case scenario, barring some unknown natural immunity in some subset of the population, is that there are over a million people in Georgia who are still susceptible. Empirically, the waves are now not following an alternating pattern or arriving with new strains. And on that note, there’s still a chance for something worse than Delta to show up. So, basically, very nearly all of the factors that I’m aware of are against us, and most are worse for the sixth wave than they were for the fifth wave, which in turn is likely to be worse than the fourth wave.
We’re in for a tough, tough winter.