Tag: SARS CoV-2

Understanding Exponential Growth

Using the data from https://covidtracking.com/data/national/cases: in the most recent seven day span (10-16 November), 1,056,346 people in the US have been infected with this coronavirus. The total number of cases yesterday was 11,047,064. That means 9.562% of the *total cases* in the US were new cases in the past week.

 

This is how exponential growth works — and why you heard a lot about ‘flattening the curve’ earlier in the year. If you put a penny on the first square of a chess board, double it and put two pennies on the second square, double it and put four pennies on the third square, and continue in that fashion … mathematically, you have 2^n pennies on each square, where n is the numeric sequence of the square, 0-63. On the last square in the first row, square #7, there are 2^7 pennies — 128 pennies, or a buck and twenty eight cents. Not a lot. And the end of the second row, you have 2^15 pennies — 32,768 pennies. That’s $327.68 — over three hundred bucks. A lot more than a buck, but not a huge amount of money. But you’re up to 2^23 at the end of the third row — 8,388,608 pennies or $83,886.08. Eighty three grand is a lot of money. By the time you get to the mid-point on the board, the end of the fourth row, you have 2^31 pennies on a square. 2,147,483,648 pennies for $21,474,836.48 — over twenty million dollars. A lot of money, but it’s possible. The second half of the chessboard is where exponential growth becomes unsustainable. The end of the fifth row is 2^39 — 549,755,813,888 pennies. The end of the sixth row is 2^47 — 140,737,488,355,328 pennies. The end of the seventh row is 2^55 —  On the final square, you have 2^63 … 9,223,372,036,854,775,808 pennies for $92,233,720,368,547,758.08 … 92 quadrillion dollars. If the going price of Earth is only five quadrillion dollars, you’re putting a marker for the entire solar system (and then some) on that last square.

And that ignores the accumulating total — while you have 92 quadrillion dollars on the final square, you have another 92 quadrillion dollars on the entire rest of the board. Now, obviously, we are not doubling our rate of infections every day. But we’re entering “second half of the board” territory just the same.

Large Numbers

It’s often difficult to conceptualize large numbers — something that allows statistics dealing with large numbers to convey something other than reality. I think I heard Trump say the government is ready to vaccinate 200k people a day. That sounds like a lot of people (it is a lot of people), but there are a lot of people in the US: an estimated 328.2 million according to a quick Google search.

 

That’s four and a half years to vaccinate the current population of the US at 200k a day, every day. Which doesn’t take into account new people being born (or aging into the range where a vaccine is administered). The CDC shows 3.79 million births in 2018 — of course that number changes every year, and it’s been decreasing. But at 3.5 million births per year, new people still add a few months to the vaccination timeline. About four and three quarter years to vaccinate the US population. And that assumes a one-dose vaccine. Administering two doses to everyone, at 200k people per year, would take just under ten years. Saying ‘it could take us five years to vaccinate everyone’ isn’t nearly as impressive sounding as ‘we can administer 200,000 vaccines each day’ — but it’s the same thing.

Changing Your Mind Due To New Information Is A Problem?!

Back in 2004, John Kerry was roundly derided for being a “flip flopper”. In the political context, I never thought the term meant simply someone who changed their mind but rather someone who lacked conviction and changed their mind to match the prevailing popular opinion. Now, even that meaning, I had trouble seeing as problematic in a representative democracy. If 80% of the people I represent thought X last year and now think !X … wouldn’t they want me voting a different way this year? While Kerry attempted to explain his votes — approving military action but not a funding source — nuanced discussion isn’t effective in American political discourse.

I’m reminded of this as people protest wearing masks. I questioned the advice not to wear a mask in March — it was illogical except from a scare resource allocation strategy (i.e. if you’re sheltering in place at home where drive-through grocery pickup is the totality of your exposure … save the mask for someone with more risk). There wasn’t any research to support wearing a mask because there wasn’t much research about SARS-CoV-2 at all. But, in March, there was research on the transmission of other virus. Maybe we didn’t know if aerosol transmission was possible, but it’s basic risk mitigation to take not-too-awful precautionary measures to prevent an unknown risk. Several months later, there is research. But the odd line of thinking that means a politician who changed their mind about a vote or had nuanced reasons that their vote for “the same thing” differed seems to mean that emerging scientific research does not warrant revising one’s initial opinion.

Some in the Republican party remind me of my daughter’s default defiance. I’ve heard her refuse to eat ice cream because one of her parents told her to (and her automatic response to just about any request is “No!” or “Why?!”). The Republican party is currently objecting to the NY DA preventing the NRA from continuing to misappropriate donor funds (i.e. how dare you charge the guy who robbed me!?), refusing to wear a mask that at worst does nothing and at best prevents the spread of an infectious disease because they’ve been told to do it.

Death Panels

Texas is going to start sending the least likely to survive home to free up healthcare resources. A few months back, Italy had been floating some metrics for determining who got sent home and who rcv’d treatment. Had a few friends freaked out over the inhumanity of it, but … there’s a limited resource exceeded by need (and a metric may make it easier for healthcare workers charged with delivering awful news to families). To act like the choice is between this awful scenario and something awesome — like we could have this most-apt-to-survive-gets-treatment rule or everyone would immediately be treated (successfully, of course) for whatever ailment — is living in a fantasy world.

Those aren’t the choices available. What we’ve got without “least likely to survive get no treatment” seems to be either first-come-first-serve or highest-bidder. Neither of those are great algorithms for determining who is saved. A “death panel” sounds inhumane (and it’s obviously branding from an opposition group), but some outcome prediction to determine who gets treated … well, I guess it sucks for those with unlimited cash to ensure they’re always going to be the high bidder because they’ve now in the same boat as everyone else. But it’s about as close to an equitable solution as you can get in an awful situation.

One of my biggest problems with politics is the short-attention-span theatrics of it all. Both death panels and now — yeah, someone can come up with a terrifying phrase to make a solution sound unthinkable. But talk about the options and the rational for the approach for an hour and it’s a different picture.

I wish progressives would get better at branding and marketing — yeah, we’ve got death panels. But you’ve got the medical treatment auctioneer. This vial of insulin goes to the highest bidder — and Anne Rice wins this round. Sorry, all you penniless rubes. If you’re not in a coma in two hours, we’ll have another auction.

Hopefully people will be a little more understanding of treatment allocation based on predicted outcomes next time we talk about universal healthcare.

Mid-stream

Hospitals have been instructed to provide SARS-CoV-2 data to HHS instead of CDC. CDC falls under HHS so it’s a little like having the “parent company” handle something some subsidiary used to do. Which means the move isn’t as alarming as some people are making it out to be. The ‘parent company’ will authority to more readily mobilize resources, and moving responsibility for a project to the parent company can signify the importance of the project.
Which isn’t to say I think it’s a good move … from an IT perspective, CDC has the infrastructure in place to handle the reporting & publicizing of data. About the best case would be a reorganization — same people supporting the same thing, but adding in the uncertainty of a new organizational structure (new processes, new priorities, a new person’s take on what you should be doing). If HHS is taking over that system, there’s opportunity for failure because the new people don’t know what the old people know. If HHS is bring up a new system, there’s a LOT of opportunity for failure because, well, it’s a new system. Mid-disaster isn’t when I’d want to change my reporting process. Maybe run two in parallel because the new one is going to provide some great new insights. But I would never say “hey, everyone, stop using A and move over to B on Thursday”.
Additionally, it doesn’t inspire confidence that the HHS website has been throwing a lot of connection errors since the announcement. I expect it’s a load problem as people begin to learn what HHS is … but ‘the guy who cannot keep his website online will be taking over statistics for us’ is not exactly the direction I’d move critical reporting.

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?