Tag: SARS CoV-2

Statistical Coverup

I keep encountering people who cite the fact that “only” half a percent of kids who get SARS-CoV-2 are dangerously ill. A small percentage of a very large number is still *a large number*.
 
The Department of Education estimated 50,800,000 public school students started the 2019-2020 school year. School admission rates have been trending up, but 2019 is the latest available data. Data from the CDC puts ICU admittance for children infected with SARS-CoV-2 at 0.58% (between 0.58% and 2%, but I’ll use the lower number since I haven’t encountered an ‘only two percent’ argument).
 
If only 1% of the kids who enter public school get infected, that’s over 2,500 kids in the ICU. If 5% get infected, that’s over 14,000 in the ICU. I doubt anyone would make the argument “Schools should re-open because only 14k kids are going to end up in the ICU”.

Statistics and Mortality

I question the logic behind the “the worst is past, and it wasn’t as bad as we thought” faction that’s drove the Memorial Day partying and is gearing up for the 4th of July celebrations. The decrease we see in the NYC metro is impacting nationally aggregated data. NY and NJ have significantly reduced infection rates (and have since late April/early May). MA as well. Most other states have seen increases. Since the NYC metro had an oversized representation of cases (some 6% of the national population had, in late March, some half of the national infections), the reduction in cases there has had an oversized impact on nationwide data. Break the infection rates out by state, though? There are a lot of lines heading up, and steeply.
Hospitalization rates are already heading up outside of the NE corridor. Again, the drop-off in the “New England” and “Mid-Atlantic” buckets hide increases in aggregate. Death rates don’t have such a clear upward trend. Yet. Infection is a leading indicator, followed by hospitalization rates (it’s not like you are in the hospital on day one. Most people I’ve seen interviewed say they felt sick for a week or two), *then* death rates a month or two after hospitalization. We’ve seen infection rates on the increase since June. We’re starting to see hospitalization rates increase. I don’t doubt we’ll see death rates increasing toward the end of July. I don’t know if this misrepresentation of aggregate over partitioned data is a deliberate attempt to obfuscate the current risk level or a more easily comprehended visualization (my chart with 50 lines is a lot more difficult to read that the single-line national infection count graph). But the impact on public perception and public policy is dangerous.
What bothers me, though, is that … even if someone believes the mortality rate dropping significantly as more young/healthy people get infected or we “get better at treating it” or whatever their mental excuse for partying and venturing out without any type of protection, the hospitalization numbers *are* going up. It’s certainly better to go into the hospital for a month or two and emerge alive than to die alone in the COVID ward. Personally? I want to avoid a month or two on a ventilator. It’s a rather unpleasant experience. Not to mention the personal and national economic impact from millions of people out of work – the lucky ones have insurance that covers something like 80% of their normal salary, the less ones need SSDI, and the really unlucky ones have nothing. Even if hospitalization was a fun holiday experience? At some point, health care resources are maxed out; then resource constraint impacts mortality rate.
Risk mitigation isn’t about taking extraordinary action to avoid black swan events. When I worked in Arkansas, there would be an ice storm that shut down travel for a few days. The first year I moved there, it was a serious storm that shut down most of the state for a week or two. Access to the company network was via dial-up. We had some number of PRI’s — maybe ten, which would be 230 dial-in lines. Normal operation, we had fifty or so lines free. Ice storm? They were maxed out constantly. After that first week-long ice storm, the company executives demanded IT figure something out because they were unable to get on network. The company had 20k employees, which would require 800+ PRIs (a reasonable analysis was about 10k employees who could work remotely, so ‘only’ 400 PRIs) and the dial-in gear so those lines went somewhere. For the low, low price of a few million, we could ensure everyone could dial into the company network simultaneously. Of course, no one wanted to fund that initiative. What we did implement was a dedicated executive dial-in access number. One PRI, with one small modem bank, provided access for the 20 people who were special enough to get the number (yes, there was an authorization group preventing access by the unwashed masses who had the number). And the three IT people who supported those executives. It cost more than nothing, sure. But it was a reasonable expense to address the most critical part of the issue. In the subsequent ice storms? Lower-level employees would complain about busy signals on the VPN, their complaint would work its way up the chain, and the executives would pull out my multi-million dollar proposal to fix a problem that averaged two days a year. Technology advanced, and IP-based VPN became a thing. It has functionality beyond Arkansas ice days, and the company invested in it. Now everyone can connect to the network during the ice storm. A fairly reasonable cost that has utility 24/7.
For some reason, people are treating masks like the multi-million dollar VPN project. They’re not. It’s a cheap thing that most people can don safely. No, it’s not comfortable to sit in a warm room to attend the Township meetings wearing masks. I’m happy to head back to the car and cool off. But the hard plastic chair isn’t a big cushy couch. Their building is drafty and, while I am certain the space is conditioned, the ambient temperature isn’t as comfy as my house. There are lots of ways in which the environment isn’t comfortable. Masks are generally available — back in March, I wondered why more people didn’t just wrap a scarf around their face a few times.
People argue the efficacy of masks — most of which seems to stem from early recommendations against mask wearing that was partially driven by the reality of product availability and partially driven by the unknown of aerosol v/s large particle transmission. And, for large particle transmission, just staying physically distant from others minimizes risk. But the reality is people don’t maintain an acceptable physical distance from others. Our Township meetings have board members sitting at the far side of 6′ tables … but they move their chairs around and end up four feet apart and yelling at each other. There are people walking right next to us in the grocery store, people queuing up a foot behind me at the liquor store, people standing next to us in the aisle at Home Depot.
Even if a mask only prevents 50% of exhaled viruses from escaping and and prevents 50% of virus particles from being inhaled — that’s a huge reduction in risk. Even at 5% reduction, you’re reducing virus particles by a non-trivial amount.
I’m waiting for the lawsuits to start — it would be difficult to prove causality on a micro level (i.e. no one can sue Home Depot for failing to require customers wear masks), but at a macro level? Streets and businesses don’t altruistically have wheelchair accessible entrances. They have to. There’s a long legal history behind the requirement. Why shouldn’t businesses and government offices have to ensure access for those with compromised immune systems by requiring everyone wear a mask?

School’s Out For …

I want to know what schools are going to do in September/November after what they did in August proves to be foolishly optimistic (either ‘the virus will disappear’ or ‘one person will be able to ensure twenty six-year-old kids wear masks and stay 6 feet apart, plus we can have a janitor in each restroom sanitizing after each use’) and they’ve failed to use the intervening 4-5 months to develop a decent online teaching approach.

Ohio Public Health Warning Level

Ohio now has a per-county public health alert level rating that reminds me of the terror alert color-coded system we had after 9/11.

Of course there will be people in red or purple counties heading out to neighboring counties to shop/eat/socialize/party because those neighboring counties are only in orange so they don’t need to wear a mask there. I don’t get why I’ve got to get my car e-checked because my county borders Cuyahoga but we wouldn’t have to wear a mask for the same reason … but it’s a step in the right direction deeming masks mandatory *somewhere* based on *something*.

Masking the Free Market

I’ve noticed that dedication to “free market” seems highly correlated to “you made the decision I support” … if we make an a priori assumption that requiring a mask be worn is somehow an infringement of individual liberties (not a stance I take, but accept it for the sake of argument), isn’t each individual’s ability to “vote with their dollars” a main tenant of the so-called ‘free market’?
 
I’m close to getting a Costco membership *because* they’re the only grocery joint around here that was making customers wear masks. It’s out of the way, I don’t think they’ve got the convenient order-online-drive-through-pickup thing, and I have no idea what their vegetarian selection is like. But I hate giving my money to support Giant Eagle’s lax enforcement of actual requirements (employee wearing mask does not mean around their neck) and refusal to require common-sense safety precautions like masks for customers. And that’s the free market. Enough people go one way or the other, the companies will change their stance.
 
And *forcing* a company not to require a mask violates that company-person (thanks, Citizens United) liberties too, doesn’t it?

Biosecurity and a return to normal

I’ve been hearing a lot, lately, about the “return to normal” — what do you most want to do when we return to normal, when do you think we’ll be returning to normal, what changes do you think they’ll need to make before we can return to normal. And the questions strike me as wrong-footed. Especially as Trump and Pompeo talk about SARS-CoV-2 coming from a lab. Now “came from a lab” doesn’t necessitate malicious intent. The fundamental, longstanding problem I’ve had with gain of function research (the reason I wasn’t at all upset when the Obama administration put thought into the cost and benefits of this research and subsequently dropped government funding for this research and I didn’t think it was a stellar idea to resume funding) is that biosecurity is so difficult. And the spread of this virus highlights how vulnerable we were.

Sure, nation-states have forsworn biological warfare … but that’s not everyone. This release was probably accidental. I don’t say that because of any insider knowledge, but if I wanted to release an infectious disease … I’d have done a better job of infecting people. Get some infectious people at the Super Bowl – eating and drinking downtown, riding the public transit system, walking around the stadium. Or send people to ride mass transit in a few major cities – spend a day riding trains through Waterloo station, a day milling around Grand Central. If there are suicide bombers willing to literally blow themselves up for the cause … it seems like they’d be equally willing to inject themselves with some infectious disease. And the border agents can search whatever they want — the easiest thing in the world to ‘smuggle’ into a country is your own bloodstream. No explosive or drug sniffing dog is going to notice, no aeroport scanner will see anything because there’s basically nothing to find. Unless this is malicious intent with the forethought to make it look accidental (or a different actor framing the ‘obvious’ culprit) … it’s accidental.

The fact no one has done it yet is rather amazing. We’ve demonstrated our susceptibility to biological attack. We’re in the middle of demonstrating our unwillingness to take actions to prevent the spread of a disease. I absolutely believe this is an attack vector that will be exploited in the future. So why would we want to return to the previous “normal”?!

Protesting the Protests

There are some people protesting the stay at home orders – I see videos from outside of DeWine’s daily briefings, and several other states seem to have similar problems. Apart from the question of astroturfing, problem is that there’s very little opportunity for counter-protests. When you go to DC, there are PETA people counter-protesting the people looking to fund medical research (animal testing). There are vegans counter-protesting people looking to increase subsidies in the meat industry. I’ve never seen an abortion protest that didn’t have both sides represented.

These ‘liberate us’ protests? These are people who don’t think they should have to stay at home – they should allowed to hang out at bars, eat in restaurants, shop, party, and … oh yeah … crowd together at protests. The people who think the stay-at-home and shelter-in-place orders are important to protect their health? Seems like a far smaller portion of them would be willing to hang out in Columbus in a protest. Even if they could find masks and whatnot.

Why drive somewhere nonessential? Your car breaks down, and you’re exposed to others (and exposing them to you). You get into an accident and you’re exposed to others (and exposing them to you). Get injured in the accident and you’re adding to the patient load at hospitals. We’re not just staying at home to avoid large congregations. We’re staying at home to create less load for emergency personnel.

Visualization: Percent of Population Infected with SARS-CoV-2

Updated graph for current infection numbers

And the states kinda like Ohio graph where I still think “distance from NYC” is a pretty significant factor in how many individuals are infected. Ohio, going on a month of kids out of school and entering week three of the shelter-in-place order, isn’t seeing the exponential growth some states with similar population numbers have encountered.

Trump Impeachment / SARS-CoV-2 Timeline

The timeline below was posted to a FB group today, but I wanted a more visual format to show how much nonsense  the “impeachment was a distraction from this serious pandemic business” story is. I cross-referenced dates in the timeline with the number of US SARS-CoV-2 infections using archived data from Johns Hopkins through 23 March and the dataset from COVID Tracking (which is current but doesn’t go back far enough to provide correlation with the impeachment dates). There is some overlap, but it’s not like Trump was completely focused on impeachment activity before 05 Feb. Campaign rallies and golfing were his choice distractions. Both of which continued well after the impeachment trial ended.
Timeline with a few additional impeachment-related events added and location info for rally and golf events:
Date # US Infections Detail
18-Dec-2019 0 House Impeaches Trump
18-Dec-2019 0 Trump campaign rally – Michigan
21-Dec-2019 0 Trump maybe golfs – Florida
22-Dec-2019 0 Trump maybe golfs – Florida
23-Dec-2019 0 Trump maybe golfs – Florida
24-Dec-2019 0 Trump maybe golfs – Florida
26-Dec-2019 0 Trump golfs – Florida
27-Dec-2019 0 Trump maybe golfs – Florida
28-Dec-2019 0 Trump maybe golfs – Florida
29-Dec-2019 0 Trump golfs – Florida
30-Dec-2019 0 Trump golfs – Florida
31-Dec-2019 0 Trump maybe golfs – Florida
1-Jan 0 Trump maybe golfs – Florida
2-Jan 0 Trump maybe golfs – Florida
3-Jan 0 Trump campaign rally – Florida
4-Jan 0 Trump maybe golfs – Florida
5-Jan 0 Trump maybe golfs – Florida
8-Jan 0 First CDC warning
9-Jan 0 Trump campaign rally – Ohio
14-Jan 0 Trump campaign rally – Wisconsin
16-Jan 0 House sends impeachment articles to Senate
18-Jan 0 Trump golfs – Florida
19-Jan 0 Trump maybe golfs – Florida
20-Jan 1 First case of corona virus in the US, Washington State.
22-Jan 1 “We have it totally under control. It’s one person coming in from China. It’s going to be just fine.”
22-Jan 1 Impeachment prosecution’s opening arguments and presentation of evidence
23-Jan 1 Impeachment prosecution’s opening arguments and presentation of evidence
24-Jan 2 Impeachment prosecution’s opening arguments and presentation of evidence
25-Jan 2 Impeachment defense presentation
28-Jan 5 Trump campaign rally – New Jersey
30-Jan 5 Trump campaign rally – Iowa
31-Jan 7 Impeachment Senate vote against calling witnesses & travel restriction from China
1-Feb 8 Trump golfs – Florida
2-Feb 8 Trump maybe golfs – Florida
2-Feb 8 “We pretty much shut it down coming in from China.”
5-Feb 11 Impeachment Senate votes to acquit. Then takes a five-day weekend.
10-Feb 11 Trump campaign rally – New Hampshire
12-Feb 12 Dow Jones closes at an all time high of 29,551.42
15-Feb 13 Trump golfs – Florida
19-Feb 13 Trump campaign rally – Arizona
20-Feb 13 Trump campaign rally – Colorado
21-Feb 15 Trump campaign rally – Nevada
24-Feb 51 “The Coronavirus is very much under control in the USA… Stock Market starting to look very good to me!”
25-Feb 51 “CDC and my Administration are doing a GREAT job of handling Coronavirus.”
25-Feb 51 “I think that’s a problem that’s going to go away… They have studied it. They know very much. In fact, we’re very close to a vaccine.”
26-Feb 57 “The 15 (cases in the US) within a couple of days is going to be down to close to zero.”
26-Feb 57 “We’re going very substantially down, not up.” Also “This is a flu. This is like a flu”; “Now, you treat this like a flu”; “It’s a little like the regular flu that we have flu shots for. And we’ll essentially have a flu shot for this in a fairly quick manner.”
27-Feb 58 “One day it’s like a miracle, it will disappear.”
28-Feb 60 “We’re ordering a lot of supplies. We’re ordering a lot of, uh, elements that frankly we wouldn’t be ordering unless it was something like this. But we’re ordering a lot of different elements of medical.”
28-Feb 60 Trump campaign rally – South Carolina
2-Mar 98 “You take a solid flu vaccine, you don’t think that could have an impact, or much of an impact, on corona?”
2-Mar 98 Trump campaign rally – North Carolina
2-Mar 98 “A lot of things are happening, a lot of very exciting things are happening and they’re happening very rapidly.”
4-Mar 149 “If we have thousands or hundreds of thousands of people that get better just by, you know, sitting around and even going to work — some of them go to work, but they get better.”
5-Mar 217 “I NEVER said people that are feeling sick should go to work.”
5-Mar 217 “The United States… has, as of now, only 129 cases… and 11 deaths. We are working very hard to keep these numbers as low as possible!”
6-Mar 262 “I think we’re doing a really good job in this country at keeping it down… a tremendous job at keeping it down.”
6-Mar 262 “Anybody right now, and yesterday, anybody that needs a test gets a test. They’re there. And the tests are beautiful…. the tests are all perfect like the letter was perfect. The transcription was perfect. Right? This was not as perfect as that but pretty good.”
6-Mar 262 “I like this stuff. I really get it. People are surprised that I understand it… Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for president.”
6-Mar 262 “I don’t need to have the numbers double because of one ship that wasn’t our fault.”
7-Mar 402 Trump golfs – Florida
8-Mar 518 Trump golfs – Florida
8-Mar 518 “We have a perfectly coordinated and fine tuned plan at the White House for our attack on CoronaVirus.”
9-Mar 583 “This blindsided the world.”
1-Mar 583 Travel lockdown from Europe.
13-Mar 2179 State of emergency declared
17-Mar 6421 “This is a pandemic,” Mr. Trump told reporters. “I felt it was a pandemic long before it was called a pandemic.”
18-Mar 7783 It’s not racist at all. No. Not at all. It comes from China. That’s why. It comes from China. I want to be accurate.
23-Mar 42152 Dow Jones closes at 18,591.93
25-Mar 63928 3.3 million Americans file for unemployment.
30-Mar 160530 Dow Jones closes at 21,917.16
2-Apr 239099 6.6 million Americans file for unemployment.

 

Is it helping?

Schools in Ohio have been closed since 17 March (and a lot of districts stayed home on 16 March). Restaurants have been in delivery and carry-out mode for about the same length of time. We’ve been under a stay at home order since 24 March. And the important question is … is it helping? That’s a difficult question to answer because epidemiological predictions have very broad ranges because most of their inputs are so unknown … and the limited testing makes the data being compared wildly inaccurate. But we’ve only got the data we’ve got, so I thought I’d run some comparisons to see how Ohio is faring.

I selected the four states closest to Ohio in population — PA, IL, GA, and NC. Because these states all identified their first case well before Ohio, I added CT because the first case identified there was 08-Mar and Ohio’s first cases appear on 09-Mar.

State 1st Case Population
PA 6-Mar 12,801,989
IL pre 4-Mar 12,671,821
OH 9-Mar 11,689,100
GA pre 4-Mar 10,617,423
NC pre 4-Mar 10,488,084
CT 8-Mar 3,565,287

It looks like our curve is flattened — although North Carolina, where the first infection was identified earlier than Ohio and their their stay at home order was issued on on 27 March, has identified a thousand fewer cases as of yesterday.

Is proximity to NYC a major factor? CT and PA (as well as NJ, which has a relatively high number of cases) are all right there. But Georgia and Illinois are farther away from NYC than Ohio. Is the number of tests a factor in these case numbers? I’d expected a higher correlation between the number of identified cases and the number of tests administered. GA and CT have fewer total test reports (positive + negative tests) and have more infected people. NC has more reported tests, but fewer cases than OH. PA and IL have more reported tests and more infected people.