How will Covid-19/Coronavirus Affect my Alternative Investment Portfolio? Part 35: October 24

U.S. continues to stall out while fighting second wave of deaths; World round up: Europe in crisis, and the Belgian triple-shortage nightmare; State round up: third infection wave surges across uncomfortably large swaths of the U.S.; Why the third wave may be much more challenging than the second; Georgia economic update: a mixed bag of good and awful; Economy gets tiny but welcome reprieve on new unemployment; Financial cliff update: little progress made as the clock continues to tick; Previously immune apartment REITs squeezed by rising vacancies and declining rents; FDA inspectors flag Eli-Lilly plant that's producing experimental Covid-19 vaccine for "major failure of quality assurance"; AstraZeneca and Johnson & Johnson vaccine trials are back on; Update on my portfolio strategy.

(Usual disclaimer: I'm just an investor expressing my personal opinion and not a registered financial advisor, attorney or accountant. Consult your own financial professionals before making any financial decisions. Code of Ethics: I / we do not accept any money from any sponsor or platform for anything, including postings, reviews, referring investors, affiliate leads or advertising. Nor do we negotiate special terms for ourselves in the club above what we negotiate for the benefit of members.).

Quick Summary

This week, there was a lot of news on virus-related spread and economic impact, and less health-breakthrough information than usual.

This article is part of a multi-article series that's been published weekly since the pandemic began, back in March 2020. It started with three introductory articles on the virus and its effect on the economy and on alternative investment classes. Then it moved on to weekly updates on the latest and greatest developments (along with weekly updates on my evolving personal portfolio strategy). You can see the links to every article in the series here.

U.S. continues to stall out while fighting second wave of death

For the 28th week in a row, the United States battled the coronavirus called SARS-CoV-2, which causes the Covid-19 disease. And as of Saturday morning, the death toll had climbed to 229,376 (versus 223,681 last Saturday morning).

Ten weeks ago, the U.S. turned the corner on the second wave of deaths, and wrestled it down lower for six weeks. But for the last four weeks, progress has stalled out and plateaued. How did things go this week?

Once again, there was no progress reducing deaths. And at the end of the week, deaths actually moved in the wrong direction and rose slightly. It's too soon to say that this is definitively the start of a new trend. But, it is concerning and we will watch it closely.

If we're unable to make clear progress and deaths remain high, then the overwhelming consensus of economists is that this would sabotage hopes of a quick, V-shaped recovery. Instead, the recovery would assume a different shape (W-shaped, U-shaped, etc.). This would be slower, involve more long-term damage to both health and economy, and potentially cause problems for some or many consumers, businesses and investments. (See part 14 for more information on the possible "recovery shapes" and their ramifications).

Since this is potentially so important, let's take a look at one of the leading indicators of upcoming deaths: virus infections. Virus infections tend to lead deaths by anywhere from 2 to 8 weeks (depending on how long it takes someone to die and how long it takes their particular location to report the information). These case numbers are not completely reliable due to testing labs' difficulties, in many parts of the country, with getting results back on time. And some states are not reporting all of the positive tests (specifically, the antigen tests). But they can still provide a clue of what might lie ahead with deaths.

How did virus infections look, this week?

This is not a good graph. On Friday, the U.S set an unwanted record with the most coronavirus infections since the pandemic began. This was higher than the peak in the first wave (which was primarily in New York City and New Jersey) and the peak of the second wave (which was primarily across the Sun Belt). In contrast, the third wave is spreading primarily in rural areas across the country. We'll dive into this further in the state section below.

So for the fifth week in a row, infections have also moved in the wrong direction and increased. And for yet another week, the third wave has continued to strengthen.

As we discussed earlier, a third wave was expected by many. Back in May, Memorial Day weekend ended all progress against the first death wave and ultimately triggered the second wave. And many health experts warned that Labor Day (September 7th) could be a repeat if people didn't take better precautions. (See "Forgetting History and Doomed to Repeat It: Will Labor Day Launch the Third Wave, like Memorial Day Kicked Off the Second Wave?" ).

Unfortunately, so far, they've been right. Still, we don't know what size this wave will be, or how long it will last. So, we'll continue to watch.

World Round Up: Europe in Crisis and the Belgian Triple Shortage Nightmare

How did other countries do this week?

As we discussed in part six, South Korea uses an aggressive mixture of the Three T's of epidemic control (testing, tracing and treatment). And through most of the epidemic, it has been one of the world leaders in both minimizing deaths (one of the lowest per million) and also minimizing economic damage (their economy is now mostly open and growth is projected to barely shrink this year, while in comparison, the U.S. still has significant closures and is projected to take a -5.9% hit to GDP).

This week, South Korea looked like this:

This week, South Korea's deaths rose slightly but were still lower than the peak of their third wave. So they appear to be in control of it. Still, their data is noisy, so we will continue to monitor.

Either way, the biggest positive for South Korea is that even at their highest and worst peak in all of their death waves, their rates have been extraordinarily low compared to virtually every other country in the world. (See chart below for comparison to other countries.) And this has been a major factor allowing them to keep their economy open while suffering far less damage than everyone else.

And this week again, the South Korean economy continued to remain predominantly open for business.

Meanwhile, Sweden has opted for a lockdown-lite strategy (see part 8). They have enacted some lockdown measures (they've shut down grade schools, prohibited gatherings larger than 50, instructed elderly people to stay home and young people to work remotely, enacted social distancing rules at restaurants, etc.). But, they never went into the full-on lockdown seen in many other countries. And the hope has been that if this worked well, it might provide another workable model for other countries looking to deal with the virus.

Here's how they did this week:

After deaths bounced back up last week, this week they bounced back down to a low level. So this was good to see.

Some of Sweden's achievements are most likely due to unique advantages that other countries can't duplicate. That includes an extraordinarily large number of people who live alone, are young and have no children (versus countries like the U.S., which contain a lot more families). And when they're compared to other Scandinavian countries (who have similar demographics) Sweden hasn't done very well, with a death rate that is many times worse than all of their neighbors (see chart below).

And it's even been many times worse than poorer countries who have controlled the disease well and who lack all their built-in advantages (see chart below).

However, the hope for Sweden is that if the country can keep its deaths low (while others stay high), they might be able to eventually dig themselves out of this hole (and even end up ahead).

How is the country doing there? To see, we need to look at deaths per million. Unlike raw deaths, this puts countries of different sizes on an equal playing field. Here are the numbers, this week:

For the fifth week in a row, Sweden has maintained its lead ahead of both the United States and United Kingdom (see more on the U.K. below). So this was good to see.

On the other hand, those two countries are among the worst performers in the world and simply outdoing them isn't that difficult. And Sweden's numbers are still stratospherically bad at about 580 deaths per million (which is about five times worse than the average country in the world).

Compared to its next-door neighbors with similar demographic advantages, it's doing almost 6 times worse than Denmark, almost 10 times worse than Finland, and 12 times worse than Norway. Also, compared to the best-of-show countries, it's almost 100 times worse than South Korea and almost 2000 times worse than Taiwan.

Many health experts believe we will likely get an effective vaccine/treatment later this year, and perhaps a rollout to wider populations sometime in mid-2021. If so, then there may not be enough time for Sweden to ever catch up. On the other hand, the Swedish model could still prove itself on deaths, if other things happen. It's possible we may not get an effective medicine; and/or the pandemic could mutate, leading it to run wilder than expected in 2021; and/or other countries may stumble while Sweden doesn't (which is what happened with the U.S. in the graph above).

The final big issue for Sweden to overcome is that lockdown lite has thus far failed in its main goal: protecting its economy. The country is still expected to plunge into a severe recession (their GDP is projected to be -5.6% in 2020, versus -5.9% for the U.S.). This is a bit better than the average -8.1% projected for the Euro Zone, but is not the large benefit many hoped to see. But again, if they can sustain their progress against the virus, then their economic outlook could improve as well. For now, it still appears that Sweden has suffered the worst of both worlds (receiving more damage to both its economy and its public health than have others). We'll continue to watch.

Meanwhile, Europe has been hit by a second wave of deaths. Many health experts said this was the inevitable result of loosening travel restrictions, reopening schools, public weariness/resistance to following health precautions, and also likely due to colder weather. And as the death toll has skyrocketed, authorities have enforced a variety of lockdowns (which we've described in detail in previous weeks). How are things going this week?

Spain is a popular travel destination and was one of the first to get hit by the second wave. And they've been battling an increasingly bad situation for more than two months. But last week, they finally plateaued, which gave hope that they might be finally getting control of things. Looking at their chart:

Unfortunately, they broke out of that plateau in the wrong direction and deaths increased. So, they still don't appear to have their second wave under control.

How about the U.K., France and the Netherlands?

This is a worrisome chart for the U.K., France, and Netherlands. If any of them continue like this for another month, they're going to surpass their record number of deaths from the darkest days of the early pandemic.

Meanwhile, in Belgium, Foreign Minister Sophie Wilmès (who stepped down as prime minister earlier this month) was admitted into an intensive care unit for Covid-19 on Wednesday. She is only 45 and had formerly been in good health.

And Belgian officials say that so many in the country are sick or in quarantine that there aren't enough healthy police on the streets, medical staff in hospitals and teachers in classrooms.

How did things go for the country this week?

Unfortunately, the numbers did not go well for Belgium, this week. Their third wave of deaths has now eclipsed the peak of the second. And like many other European countries, they are on track to eclipse the first wave, unless they turn things around.

On the ground in Belgium, things are not looking much better:

1) Police shortage:

In the month of October, the distressing number of 2,368 police officers across Belgium have tested positive or had to quarantine. Vincent Gilles (the head of the police union) says that as a result, the province surrounding the city of hard-hit Liège is suffering: “around 50 percent of police officers are not at work."

2) Health worker staffing shortage:

Philippe Devos, an intensive care doctor at a hospital in Liège (and also president of the Belgian Association of Medical Unions), says:

"The situation is catastrophic. We have a lot of doctors and nurses affected. At some hospitals in the city, between one-fifth and one-quarter of the medical staff is sick or quarantining. We are in deep."

Belgian Health Minister, Frank Vandenbroucke, warned:

“We are the most affected region in all of Europe. We are really close to a tsunami … that we no longer control what is happening. Today, we can still control what is happening, but with enormous difficulties and stress.

If it continues to increase, the number of hospitalisations will be such that we will have to postpone more and more non-Covid care, which is also very dangerous.”

Only last month, Belgium had been cited by U.K. Health Secretary Matt Hancock as a model of how to deal with the second wave of infections. And many believed that Belgium's policy of limiting people's interactions to small social bubbles had been effective.

But, success may have been the trigger for failure. Government authorities decided to remove the mask mandate while adults went back to work and children returned to school.

Marc Noppen, chief executive of one of the biggest hospitals in the Belgian capital of Brussels, summed it up in a tweet:

"March 2020 revisited. ANGRY that we were unable to avoid this predicted scenario.

3) School staffing shortages:

Meanwhile, Isabelle Allelyn, principal of a school in a village in one of Belgium's worst hit eastern regions, said this week:

"Half of my teachers are sick or quarantining. Of 225 students, 37 are quarantining and 45 can't come in because there's no teacher for them. In one classroom, first, the teacher got sick and then, her substitute did too. We are doing our best to cope with the pandemic. But now, the situation is pretty unstable and is almost getting out of control.”

Allelyn made the quote from home, because she herself had also tested positive for the virus.

State Round Up: 3rd Infection Wave Surges Across Uncomfortably Large Swathes of the U.S.

For the last several months, we've watched individual U.S. states to get insights into what might happen next at the national level. And here's what we saw:

1) After the Memorial Day weekend (in May), we saw the second wave of infections (and eventually deaths) start in the Sunbelt and then spread to the Midwest and Northeast. In response, many states put in place virus control measures, including reinstatements of key portions of lockdowns and rules mandating the wearing of masks (in more than 50% of states). And the Sunbelt states made huge progress.

2) Then after the Labor Day weekend (in September) the U.S. reopened schools and cooler weather began in the north. Almost immediately, a third wave began. While this started in just the Midwest and Northeast, it has now spread across every major area of the country. Last week, 44 states reported higher infections than a week ago. And while earlier waves hit mostly urban areas, this new wave is being led by rural places.

What happened this week?

1. The pandemic is evolving.

As we mentioned earlier, the country registered an all-time high for new coronavirus cases this week, when it hit 80,000 in a single day for the first time.

The last daily record was back in the second wave on July 7, with cases at 76,533. And at that time, only four Sunbelt states accounted for 40,000 of those: Arizona, California, Florida and Texas. On Friday, it was 11 completely different states who were responsible for the lion's share of spread. And in the past two weeks, 24 states have broken their records for single day highs.

And as we discussed last week, the new hotspots aren't just more plentiful and widespread...but they are disproportionately located in rural areas. This is very different from the early pandemic, when urban areas were hammered the worst.

And this week, the Financial Times put out a piece which dug into this further. Not only is there a rural/urban divide, but there are even different subsections of rural and urban America that are experiencing the third wave very differently:

It all depends on how many people live nearby. So small cities are doing worse than medium ones, which are doing worse than larger ones.

2. The third wave may be much more challenging than the second

Many health experts say this third wave is shaping up to be very different from the last one. First, the third wave's infections started off at a much higher level than they did during the second wave. And the more widespread nature of this wave may prove to be much more problematic than the relatively isolated hotspots of prior waves.

Eleanor J. Murray, an epidemiologist at Boston University, said:

"One key way we got through previous waves was by moving health-care workers around. That’s just not possible when the virus is surging everywhere. [And] we are starting this wave much higher than either of the previous waves... it will simply keep going up until people and officials decide to do something about it.”

Healthcare workers aren't the only shortage that is exacerbated by this third wave. Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, says that many areas across the nation are also experiencing a critical drugs shortage.

Specifically, Osterholm found chronic shortages across the U.S. in 29 of the 40 critical drugs needed to treat Covid-19. This includes generic drugs as simple as antibiotics, to sedatives needed to calm patients during intubation (like propofol) and heart medication (like norepinephrine).

And unlike before, we can't simply pull from full stockpiles in other regions to relieve the local scarcity. Stephen Schondelmeyer, a doctor and co-author of the study, said:

"Last spring, when we had [just] a few states hitting their peak COVID-19 demand, the wholesalers and manufacturers were able to adjust by shipping supplies from the Midwest to the Northeast when New York and New Jersey needed it, or from the South to California and Washington. But when you have 30 to 35 states or more all hitting a peak at one point in time, there's a much higher peak and really no place with excess drug supply to redistribute. Complicating the situation, the United States cannot expect to draw upon drug supplies from other parts of the world, when most other countries are also facing increased need and demand due to COVID-19."

Meanwhile, some had hoped that the third wave of infections might be just a statistical aberration caused by increased testing and not a sign of increased spread. And with a much younger subset of people getting infected, along with improved techniques and treatments, they theorized that we would not see any actual increase in hospitalizations or deaths.

Unfortunately, this idea has crumbled in recent weeks, as hospitalizations have also surged across the country. And this week, that trend accelerated with 38 states seeing an increase in the average number of hospitalizations versus last week. Additionally, 14 states reported record highs: Kentucky, Nebraska, Ohio, Oklahoma, South Dakota, Tennessee, Wisconsin, Wyoming, Iowa, Utah, Montana, West Virginia, Missouri and Kansas. And the speed of this trend has been startling to some. In the last three weeks, four states have doubled their number of hospitalizations: Connecticut, Montana, New Mexico and Wyoming.

3. Low level state-by-state data

Let's dive in to the low-level state data to get a closer look at what's happening to some of these affected states. Here's how Utah did this last week:

Unfortunately, Utah's new infections went into the stratosphere, and they blew away their previous record with 2000 cases in a single day. Deaths had previously spiked to a new high two weeks ago, and have since come down slightly. But still they're staying elevated at uncomfortably high levels.

As a result, Utah authorities are now trying to open up a field hospital at an exposition center to handle the anticipated hospital overload. And at a press conference, state epidemiologist Angela Dunn pleaded for a skeptical general public to take health warnings seriously.

"The health-care system is at capacity, hospital staff are exhausted, and Utahans are getting scared.

You know, I just don’t know what to do anymore. I’m really not trying to scare anyone. I’m just trying to inform you of what’s going on.”

Meanwhile, how did Wisconsin do this week?

That's a depressing set of charts. This was a doubly awful week for Wisconsin, with the state setting records in both new infections and deaths. In fact, on multiple days, the new deaths set soaring and unwanted records.

This week, Wisconsin governor Tony Evers said that 90% of hospital ICU beds in the state are full. And he also announced that the emergency field hospital (which we discussed in previous weeks) has been opened and accepted its first patients.

How did Idaho do this week?

Sadly, Idaho also saw increases in infections and deaths. New virus cases set a record, while fatalities remained below the previous record peak, but at high levels.

On Wednesday, hospital officials in northern Idaho announced that the entire region is at 99% capacity and has no ability to take any more patients. So people who come in with Covid-19 have to be sent to the neighboring state of Washington (Portland or Seattle) for treatment. However, they warned that even that capacity was very limited.

“Because all regional hospitals are experiencing the same situation, there will be limited opportunities to transfer patients to other facilities once at capacity. If there is no room available, Kootenai Health is currently looking at hospitals in Seattle or Portland to find space to transfer patients, but it is