Just heard that Trump has Covid. Some quick thoughts.

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.

After a one week Menorca Berlin journey that took us on our boat from Menorca to Costa Brava and by car from Palamos to Berlin stopping in beautiful places in France and Germany we made it to Berlin. We came I would say as Covid refugees, the decision was triggered by Nina, my wife who has PCD and, because she is German, she wanted our kids to have a German schooling experience. I agreed to the move mainly because Madrid has 3000 Covid cases per day and Berlin has 70 with only 226 deaths since the beginning of the pandemic. Also and very important for my work, Berlin is an awesome and inspiring place for a tech entrepreneur to be at.

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.

Is it me or lately progressives are going from one obsession to another one leaving a path of neglected issues behind?

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?

While mainly I am an entrepreneur I am also been an active angel investor over the last 15 years and have had a chance to back a few unicorns. While others just invest, I do a combination of investing and mentoring. If you are interested in having me as an investor and especially if you are a second time entrepreneur and are doing a round please write to me at martin@preludefertility.com I invest in companies whose products I use, in founders that I get along with and at valuations that I find reasonable. I also co-invest with funds. The companies I invest in are mostly in the USA and Northern Europe, a few also in Spain and Latam. But wherever the companies are, their ambition needs to be global!

All my life I have considered myself a liberal in the USA and a centrist in Spain (a country to the left of the USA). In the USA I always voted democrat. But lately I find myself drifting away from the liberal dogma. Here are some examples:

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.

https://www.youtube.com/watch?v=pyT932OLCfs

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. 

Lessons from Covid in Europe for my friends in the USA

Policy recommendation:

Lockdown only for those over age 45, then slowly lift the lockdown for those aged 45 to 65. Keep those over 65 in lockdown until treatment or vaccine is developed or most of the population is immunised.

The reasoning:

The first and most relevant data on Covid that my friends in the USA seem to be unaware of is the age group with the highest death rate:  91% of those who died in Europe from Coronavirus were over the age of 65 and 87% were over 70. People under 40, on the other hand, have a mortality rate of less than 1% and are therefore much less likely to die from Coronavirus. In fact, people under 40 have the same chance of dying from Covid than they do of dying from the regular flu.

Secondly, Covid is extremely contagious and one would need to live a life of tremendous isolation in order not to get Covid. The official European data on how many people have been diagnosed with Covid are not accurate and the reality is probably 50 times greater. This would mean that Italy and Spain do not have a combined amount of 250k people who have been been infected with the virus, they actually have millions each. Imperial College estimates that in Spain, a country with as many people as California, 7 million people are infected.

Thirdly, Covid is nowhere near as lethal as people think. When people read published figures, namely that Spain has 125K infected and 12K dead, they conclude that around 10% of those infected die and thus panic over this high mortality rate. However, if the real numbers follow Imperial College predictions, then Covid actually kills 17 people in one thousand or as many people as a bad flu would. The difference being that bad flus kill children too, whereas Covid in Spain has killed just 2 people under the age of 20 and 10 under the age of 30.

So what should the USA do to fight Covid? It should gradually lift the lockdown according to age groups. First, lift the lockdown for those under 45 years of age (without any pre-existing medical conditions). Though those under 45 do get infected, it is extremely rare that someone without pre-existing conditions die from Covid. Especially with the caveat that the very few under 45 who might develop severe cases of Covid would have access to medical care. In order for the health system to be able to provide medical care to this age group not in lockdown, a complete lockdown with food and medical deliveries to all other age groups over 45 (who represent 99% of the fatalities) must be ensured. Younger people who live with people over 45 will have to be homeschooled for another month until the lockdown for those aged 45 to 65 is lifted.

Achieving herd immunity for those under 45 makes sense because of the incredibly low death rates in that group. Next, the question would be, what to do with those aged 45 to 65? These individuals are a key engine to the economy and an age group that does die more frequently from Covid than from the regular flu. In my view, they would have to wait for those younger than them to obtain herd immunity. This 45 to 65 age group would continue lockdown for another month after those under 45 have become immunised. Once this group’s lockdown is lifted, they will find themselves among two groups of people: older ones, who are still in total lockdown, and unable to infect others, and young ones who have become immunised. This 45 to 65 age group will also find an unburdened health care system as those over 65 have not required it for Covid and those under 45 have already been through the worst.

And what should be done with people over 65? This is an unresolved issue. In Spain, the average age of mortal victims is 80. Therefore, a month after those under 65 have been exposed to coronavirus, the lockdown of those between 65 and 75 should also be lifted. Having said this, I don’t see a way for those over 65 to safely leave lockdown until we have a vaccine or effective treatment. In Europe, it is very rare for Covid to kill a healthy, young person. Even though it has happened, it is extremely rare. We don’t know why this occurs: some speculate it is because of certain genetic predispositions, or because of viral load. What we do know is that once infected with Covid, the chance of dying for this age group is the same as your chance of dying in the next 2 years. So for example, if you are 30, the chances of dying from Covid are the same in the weeks after the exposure as the probability of dying between the ages of 30 and 32 for any medical reasons. And that probability is very low. However, if you are 80, the chances of you dying between the ages of 80 and 82 are quite high, and are similar to the ones that Covid patients of that age have. Therefore, there is no safe way to recommend that a 75 year old come into contact with the rest of society openly. Though this same 75 year old could lead a life where an App based system puts her in contact with those who are already immunised. If my recommendation is followed, there will be plenty of immunised people by the time 75 year olds leave lockdown.

Given the lethality of Covid, if our objective is to save the most lives, why not just keep everyone on lockdown indefinitely? Because the economic devastation of staying indefinitely in lockdown will kill many more people than Covid. Health does not only mean not getting Covid, it is also means not dying from everything else that could occur during lockdown: cancer, heart disease, suicides, murders. The only reason to keep everyone in lockdown would be if we believe that a vaccine is around the corner. But that is not the case. We don’t have a vaccine nor do we have an effective treatment for Covid.

I would like to end with some data on the Covid mortality rate, mixing Imperial College estimates of those infected of Covid with data obtained from the Spanish national Health system, Sanidad, regarding Covid deaths by age group. Imperial College estimates that in a country like Spain for every diagnosed case, there are 50 undiagnosed cases of people who have are asymptomatic or whose symptoms were not severe  enough to get tested. This is reasonable because in Spain or Italy your symptom have to be very severe to be tested. In Germany testing is more common and that is why the mortality rate is much lower. Around 10 times more people are diagnosed in Germany than in Italy and Spain, hence the mortality rate of these Southern neighbours is 10%  that of Germany. We can therefore estimate that the mortality of Covid in Spain is insignificant for people under 45 (with a total of 47 dead of that age group which is much less mortality rate than a regular flu). It is also very low for those under 65 (a total of 800 deaths for 7 million infected). And it is quite lethal for those 65 or over (a total of 11,200 deaths out of 7 million).

I imagine that when you read that the USA should now consider a lockdown only of those over 45 and the rest should lead mostly normal lives treating Covid as a normal flu (staying home if they are sick, going to the hospital if needed but otherwise taking their children to schools and going to work) you will think that I am exposing that younger population subgroup to tremendous danger. I do hope that after you read this data, you will agree with me.

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Forecasts are a risky business but in this moment of isolation and anxiety I want to share my optimism on the pandemia for Spain. This work is inspired by frantic reading about the pandemia since I first posted about its risks on January 27th and my work for the Spanish government at Coronamadrid.com.

Covid-19 Forecast for Spain

One week from now daily deaths will be down from the around 900 of yesterday. This week we will see peak daily deaths and peak hospitalizations. We will have spare hospital capacity in two weeks and enough supplies including masks.

Two weeks from now Spain will stop some of the most unusual and restrictive isolation measures like never allowing children out and forbidding isolated walking and running. These are allowed in most of Europe now.

Three weeks from now massive testing will arrive in Spain and show that the reason we had so many deaths is that there was a high level of contagiousness before lockdown and some during lockdown. Millions will be surprised to test positive in antibody tests. We will discover that Covid is much less lethal than what we thought in terms of percentage of infected population and mostly a risk to the elderly. We will also discover that social cohesion that had given so much support and care to the elderly and made Spain a world leader in longevity, is what sadly killed so many old in this pandemia: unusual level of contact between young and old.

Four weeks from now lockdown will end for those of working age. Schools will reopen. Those over 70 will remain in isolation as they make 90% of the deaths.

Social distancing and mask wearing will continue until June. Outdoor life will help lower contagiousness.

Weekly testing and isolation of positives will be implemented and managed via a geolocalization app.

By early July Spain will be where Korea is now. Monitoring testing but low deaths and hospitalizations.

Thanks to isolation and implementation of the above mentioned strategies post isolation, total Covid deaths in Spain for 2020 will be around 15k to 25k which is the same or slightly more than total flu deaths in 2019 of 15k.

Spain will win the war against Covid but we will not return to full normal until a treatment or vaccine is developed by 2021.

Spanish 2020 GDP will be down 10%, tourism will be especially hard hit. GDP of 2022 will be equal to 2019 GDP. And in terms of government damage and poor thinking what Pedro Sánchez did to fuel the pandemia by allowing demonstrations and large gatherings he will do to fuel bankruptcies by making it illegal to fire workers. Hence disproportionate economic damage.

Yesterday there was dramatic nonsensical violence in two cities I love: Paris and Buenos Aires.

In Buenos Aires it was an attack of River Plate fans against Boca Juniors players injuring them and destroying the Libertadores final celebration for Argentines and football fans around the world. Now Boca players are rightly fearful that they may suffer further injuries or death should they play against River Plate in their home “Monumental” stadium. The Argentine government is unable to guarantee the safety of the players and frankly of anyone who attends.

In Paris it was the French against themselves, against one of the most beautiful parts of the most beautiful city in the world. Unexplainable violence in a protest that could have been peaceful against a fuel price increase. Demonstrators went wild destroying the cobble stoned streets, restaurants, and scaring tourism off which is an essential part of the livelihood of the French.

Why do the French and the Argentine turn to violence in situations in which most of people in most other countries don’t? Argentines fans are not the only ones that use violence, but they are the world’s most violent. French demonstrators are not the only ones who use violence, but they are the world’s most violent.

In France, in Argentina, why can’t the rest of society condemn these acts? Why can’t there be large demonstration against the use of violence by extremists? In Spain for example when ETA would violently attack there would be huge demonstrations by the rest of society in which people would paint their hands white and say “they are violent we are not”. ETA was defeated peacefully. Why can’t they gather enough peaceful Argentine football fans who can defeat the small minorities who are not? Why can’t there be enough peaceful French who can massively demonstrate against random useless violence? The only solution to radical violent individuals is that the rest of us show them that their violence has no place in a civilized society.