Archive for the ‘Coronavirus – Covid 19’ Category

How many people are walking around infected with Covid-19?

August 7, 2020

Finally, some C-19 “prevalence” estimates…
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Loyal readers know that I’ve been frustrated by the lack of practical, personally-relevant data that the public health “experts” have been gathering, analyzing and disseminating.

For example, I’d like to know how likely I am to bump into a person who is infected with C-19 if I leave my house.

Reasonable question, right?

In infectious disease speak, that number is called the “prevalence rate” … the percentage of people in an area who are infectious-likely at a specific point in time.

Current testing procedures don’t answer the question (see: Why is COVID testing still so haphazard?) … so, the “experts” fixate on metrics that are muddled and potentially misleading (see: Birx: “Key metric that I watch is the positivity rate”).

Finally, I’ve stumbled on some “machine learning” analyses that take a stab at answering my question: What’s the Covid prevalence rate?

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OK, let’s get to work…

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C-19: State-level Cases, Deaths, Rates

August 6, 2020

Today, let’s drill down for some perspective…
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First, as oft-reported, NY & NJ lead the list for total deaths … the 2 states represent about 30% of the US total.

The Top 10 states account for 2/3’s of the US total.

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Let’s dig deeper…

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Gov. Cuomo says to follow the data, so…

August 5, 2020

Let’s compare NY (and its North East neighbors) to the spiking  Sun Belt states. 
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According to Gov. Cuomo, the fawning  MSM and  Dr. Anthony “First Pitch” Fauci:

Gov. Cuomo did a stellar job managing the covid crisis … and, all of the Sun Belt governors (except CA’s Gov. Newsome) are reckless dufasses.

Really?

I hate to ruin a good narrative with data, but since Gov. Cuomo says to follow the numbers…

Below is a current Covid recap for 4 North East states (NY, NJ, MA, CT) … 4 Sun Belt states (TX, FL, AZ, GA) … and California.

click to enlarge chart
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Here are a couple of takeaways….

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Have Covid cases peaked?

August 3, 2020

Let’s drill down on some numbers today…
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For the past 2 or 3 weeks, the number of new cases reported each day seems to have peaked … maybe plateaued, maybe turned the corner and is starting to decline.

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Over the same time period, the daily death rate has trended up from its previous trough … or, as the MSM media likes to say “in recent weeks, the daily death rate has catastrophically doubled from 500 per day to over 1,000 per day”.

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Putting those numbers into context, the daily case counts have more than doubled since the prior peak in mid-April … while daily deaths have hovered around 50% of their mid-April level.

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In numbers: New cases were running at about 30,000 per day in mid-April … and there were over 2,000 new deaths each day … a ratio of deaths to cases of about 6.7%.

During the recent spike, cases have been running at about 60,000 per day … and  new deaths each day have been averaging about 1,000  … a ratio of deaths to cases of about 1.7%.

That’s a 75% drop in the deaths to cases rate.

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Keep a watchful eye on the daily death rate …

I was very disappointed with Dr. Birx’s interview answers…

July 23, 2020

Old paradigms, lack of data, inconclusive.
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Yesterday, Bret Baer in-depth interviewed Dr. Deborah Birx.

For the record, I think that Dr. Birx is a trusted source: smart, experienced, knowledgeable, “clued in”, well-intended, apolitical, honest, etc.

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click to view video

I thought that Baer’s questions cut to the chase:

  • Where do we stand right now on the virus?
  • What is the key statistic that you track?
  • What’s the purpose of testing if it takes 3 or 4 days to get results?
  • Specifically, what do we know about kids catching and transmitting the virus?
  • What is your recommendation re: re-opening schools?
  • How susceptible are people to getting re-infected?
  • How good is the data that you rely on?

Unfortunately, Dr. Birx’s answers to these pivotal questions were, in my opinion, very disappointing.

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From “flattening the curve” to “learning curves”…

July 22, 2020

A conceptual rationale for why COVID cases are surging but deaths aren’t.
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All along I’ve been arguing that the truest and most relevant measure of COVID-fighting is the death rate.

MUST READ: How will we know when we’ve turned the COVID-19 corner?

And, I’ve recently been showcasing the relationship between confirmed cases and deaths.

See: Where’s the case-related spike in deaths?

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The data says: Since mid-April, the number of daily confirmed cases has more than doubled, but the number of daily new reported deaths has apparently stabilized at about half of mid-April levels.

How can that be?

Here’s a way of thinking about the how & why…

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Let’s end the week on a C-19 high note…

July 17, 2020

Some reasons to be optimistic
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WaPo ran an op-ed by Joseph Allen — a Harvard prof specializing in “exposure assessment science”.

Prof. Allen offers up 6 “positive developments to remind us that there is hope in this crisis”.

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Here’s Prof Allen’s list:

1. Therapeutic treatments

in addition to what we already have for most sick patients, more targeted therapeutic treatments will arrive — probably before vaccines.

Scientists have now engineered synthetic clones of coronavirus antibodies —  called monoclonal antibodies — and they are showing to be effective both therapeutically and to prevent infection.

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Coronavirus deaths spiking … or, are they?

July 16, 2020

The liberal media has been downright giddy this week, trumpeting an AP headline:

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The source of the gidddyness: An uptick in the number of daily new reported deaths … the 7-day average of daily new deaths troughed at 517 on July 6 … since then,  the 7-day M.A. has increased to 757 … or, as the press likes to say: “increased a catastrophic 50%”

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Those are the numbers … and, the only conclusion that can be drawn is that the huge spike in sun belt cases is finally working it’s way through the system … catapulting the death rate upward. Right?

Well, maybe.

But let’s add some perspective to the numbers…

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Should you send your kids back to school this fall?

July 10, 2020

It’s hard to follow “the science” when it’s inconclusive.
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It appears that most school systems are on a path to open their schools either fully or partially (e.g. rotating students every other day or every other week) … and, to mitigate the risks by capacity limiting busses, socially distancing students in classrooms, wearing masks, etc.

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In a couple of weeks, many parents will be forced to make a very big decision: Do they send their K-12 children back to school or not?

Classical public health thinking would say to focus on four questions:

1. Are kids susceptible to the coronavirus?

2. If yes, will mitigation actions sufficiently reduce the risk?

3. Are infected kids vulnerable to severe outcomes?

4. Do infected kids transmit the virus to others?

Unfortunately, “the science and the data” don’t provide much guidance…

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During this week’s White House briefing on school reopening…

Sally Goza – President of the American Academy of Pediatrics said:

Children are less likely to become infected and they are less likely to spread infection.

But, White House health advisor Dr. Deborah Birx countered that there’s not enough data to arrive at that conclusion:

The U.S. data is incomplete, because the country has not been testing enough children to conclude how widespread the virus is among people younger than 18 and whether they are spreading the virus to others.

If you look across all of the tests that we’ve done, and when we have the age, the portion that has been the lowest tested portion is the under-10-year-olds.

Our data is skewed to people with symptoms, and then skewed to adults over 18.”

Bottom line: “The science” doesn’t know whether kids are susceptible to the coronavirus or not.

The mitigation actions are likely to reduce contagions risks, but it’s unrealistic to expect that they will eliminate the risks.

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Perhaps the best news so far is that there have been practically no coronavirus deaths among children.

A lot of people are hanging their hats on the apparently low fatality rate as an indicator that severe outcomes are unlikely.

But, keep in mind that kids have been sheltered-in-place since schools closed in the spring, so they have been minimally exposed to the virus.

Some health “experts” warn that’s a double-edged sword since kids haven’t had a chance to develop immunities that counter the coronavirus.

So, when schools open, the proverbial dam may break.

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That gets us back to whether or not infected kids are likely to transmit the virus to others.

This is, in my opinion, the pivotal decision factor.

Again, the evidence is, at best, equivocal.

“While some scientists fear schools could act as accelerators for the pandemic, no country where schools have reopened has so far reported a sharp increase in infections.” WSJ

That said, I side with Dr. Birx that “there’s not enough data to conclude whether kids are spreading the virus to others.”

So, I’d apply a variant of Pascal’s Wager to the transmission question.

See HITS: Pascal’s Wager … perhaps, we should be more righteous.

That is, assume that kids are susceptible to the virus, that mitigation actions will reduce but not eliminate contagion, and that infected kids do transmit the virus.

Then, the critical question is:

Are there vulnerable people potentially exposed to infected kids?

If there are vulnerable caretakers at home (e.g. are elderly or suffer co-mobidity factors) … or anyone with compromised or underdeveloped immune systems (e.g. chemo patients or newborns) … then Pascal’s Wager kicks in.

In those cases, the risks of going back to school increase substantially, maybe reversing the decision calculus.

It may be less about whether the kids will suffer bad outcomes … and more about who the kids might infect — and what the consequences will be on them.

Hmmm…

Finally, a Covid testing plan that makes sense to me…

July 8, 2020

Tip of the hat to Georgetown on this one.
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Last week, I did some reading re: the Herculean challenges facing colleges as they contemplate when and how to re-open.

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In a nutshell, residence colleges face three major challenges:

  1. Staying afloat financially
  2. Delivering a valuable education
  3. Keeping their campuses healthy

One aspect of healthy campuses is instituting a comprehensive Covid testing program.

Many schools are rationalizing  away the need for testing, arguing that tests aren’t sufficiently accurate and that they cost too much to administer. Source

That’s not the approach that Georgetown is taking…

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HCQ: The drug that won’t die…

July 7, 2020

New peer-reviewed study finds hydroxychloroquine’s life-saving benefits.
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The results of a large-scale analysis, conducted by the prestigious Henry Ford Health System, was published last week in the peer-reviewed International Journal of Infectious Diseases.

The study examined 2,541 patients who had been hospitalized in six Henry Ford hospitals between March 10 and May 2, 2020.

More than 90% of the patients receiving hydroxychloroquine were treated with the drug within 48 hours of admission to the hospital.

The study’s fundamental finding:

26.4% of patients who did not receive hydroxychloroquine died.

But among those who received hydroxychloroquine, fewer than half that number — 13% — died.

The difference in mortality is, by all measures, statistically significant.

How can that be?

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Things to worry about…

July 6, 2020

Channeled from the Visual Capitalist

Just in case your 4th of July weekend was too celebratory, welcome back to reality.

The World Economic Forum surveyed 347 risk analysts on how they rank the likelihood of major risks we face in the aftermath of the pandemic.

In the survey, a “risk” is defined as an uncertain event or condition with the potential for significant negative impacts on various countries and industries.

These were the 10 risks considered most likely to occur:

  • 7 of the 10 most likely risks are economic
  • #5 is restriction of cross-border movement of people and goods
  • #9 is the risk of cyberattacks & data fraud
  • #10 is another coronavirus or other disease outbreak

click to enlarge image
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The risk analysts were also asked which of these risks they considered to be of the greatest concern for the world.

Here’s what they said…

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Remember when Trump advised to to use scarves during mask shortage?

July 3, 2020

Of course, he was eviscerated by the med-science community and the mainstream media
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Flashback to late March when community spread of the coronavirus was ramping up.

The WHO, the CDC and US Surgeon General were advising against wearing masks … saying that they were, at best minimally protective, could exasperate the problem if worn incorrectly and would distract people from handwashing and social distancing.

The real reason: masks were in short supply and the supply chain was impaired by Chinese hoarding and off-shored manufacturing.

In a Task Force press conference, Trump cut to the chase … said the real reason was the need to supply hospital workers with masks first … and he casually opined that, in the short-run, folks could stop-gap by using scarves or other face coverings as a make-shift protective shield.

click to view video (90 sec.)
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Of course, Trump said it — and  he’s an MSM-certified idiot, so…

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Shocker: Virus spreads on crowded buses and subways…

June 30, 2020

So, how are urban workers going to get to work?
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Remember when NYC Mayor de Blasio hopped on the subway to reassure people that they need not worry about catching the coronavirus by riding the trains? Source

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Well, a couple of recently published studies debunk de Blasio’s “not to worry” … and raises some very thorny issues…

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Remember when the med-science community told young adults that the virus wouldn’t hurt them?

June 29, 2020

Apparently, that’s a bell that can’t be unrung … and young “invincibles” are driving current coronavirus case spikes
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There’s no denying that that confirmed Covid cases have bumped back up to prior peak levels … about 30.000 new cases per day.

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Digging a little deeper…

New cases have dropped from sky-high levels in the Northeast … and held relatively constant in the Midwest.

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But, cases have exploded in the West and the South

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Source: WSJ

One obvious point: hot weather doesn’t seem to kill off the virus.

And, there is some chatter that virus-spreading air conditioning systems may be spreading the virus (think: Legionnaires disease).

But, most determining,, there has been a huge shift in the demographic profile of the cases which suggests that young invincibles aren’t so invincible after all…

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Shocker: NYC contact tracing program off to a “slow start”

June 25, 2020

Infected people are hard to locate and reluctant to give up their contact info.
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According to the NY Times…

Since June 1, NY has been ramping up its Covid test & trace program.

About 50,000 people are being tested each day.

  • Note: Scant info is reported on who is being tested … People with symptoms? Curious people without symptoms? Random samples?

The goal is to contact everybody who tests positive … and then identify and contact everybody who has recently come in close contact (within 6 feet for more than 15 minutes) … and urge the contacts to get tested and self-quarantine.

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Sounds easy enough, right?

So, what’s the problem?

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Cases up, deaths down … huh?

June 24, 2020

Let’s start with the data …

The 7-day average of Covid cases is up 30% in past week

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The 7-day average of deaths is down 10% in past week.

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How can this be?

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Re-opening schools may not be as easy as it sounds.

June 22, 2020

Complying with CDC guidelines may be cost prohibitive and logistically impossible.
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One of my biggest coronavirus concerns has been the school-shut-down impact on kids … both socially and educationally.

Since children are negligibly hurt by the virus (i.e. lower infection vulnerability, minor or no symptoms when infected, low transmission-forward rate),  I’ve been a advocate for re-opening schools ASAP.

I’ve been implicitly assuming that “cleaning” the schools’ environment would be no big deal … just move the desks further apart and double down on nighttime deep-cleaning.

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I’ve been glossing over the economics and the logistics…

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WSJ: Not to worry, hospitals have capacity.

June 19, 2020

Today, the  WSJ concedes that  cases have spiked in some areas but advises us to…

Focus on the burden on hospitals, not on models’ oft-mistaken forecasts .

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Specifically, the WSJ points out that — even in currently reported hot spots — hospitals have substantial unused capacity (beds) to cope with spikes …and, medical staffs are better prepared to treat patients more efficiently and more effectively.

Here are the numbers…

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WSJ: The data are in …

June 17, 2020

Compelling for “group distancing”, not so much for shelter-in-place
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According to a WSJ op-ed…

Four new analyses of actual results show how the initial projections overestimated the value of lockdowns.

Fortunately, economists no longer have to rely on inherently flawed projections. They can use real data.

In what might turn out to be the best paper on the economics of Covid-19, a team of economists from the University of California, Berkeley carefully evaluated empirical data on social distancing, shelter-in-place orders, and lives saved.

And, here’s what the real data is saying…

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Covid death risk: Some good news.

June 15, 2020

Today, let’s put Covid death rates in perspective…
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By now it’s clear that people older than 65 are the most vulnerable to the novel coronavirus, and the age penalty is severe for the elderly nursing home patients with underlying health conditions.

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Source: WSJ, CDC

According to the WSJ:

  • About 2/3s of Covid deaths have been over 65
  • The median age of death 80.
  • About 1/4 Covid deaths have been folks over 85.
  • 95% of deaths involved at least 1 chronic condition
  • 60% of deaths had three or more comorbidity factors
  • About 1/2 of all Covid deaths have been nursing home patients

Here’s some good news that puts those numbers in perspective…

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WSJ: “NY’s Coronavirus Response Made the Pandemic Worse”

June 12, 2020

We’ve been on this case for awhile.

Today’s WSJ  laid out the case that:

New York leaders’ coronavirus response was marred by missed warning signs and policies that put residents at greater risk and led to unnecessary deaths.

The virus has hit New York harder than any other state, cutting through its densely populated urban neighborhoods and devastating the economy.

New York state’s death toll accounts for 27% of American deaths.

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Here are the WSJ’s supporting conclusions…

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More: Can following “the science” be hazardous to your health?

June 11, 2020

Now, the WHO does a u-turn on masks.
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Longstanding,  the “gold standard” WHO advised  against wearing masks, saying:

There isn’t enough medical evidence to support members of the public wearing a mask, unless they were sick or around people with the coronavirus. WebMD

Even the CDC bailed on this one earlier, so you had to see it coming…

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Here’s the skinny…

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Update: 2/3s of C-19 deaths have been 65 and over…

June 10, 2020

Not exactly new news, but for the record …

  • About 1 in 4 C-19 deaths have been folks over 85.
  • About 2 in 3 have been over 65
  • Practically no deaths for those under 35.

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Source: WSJ, CDC

Can following “the science” around in circles be hazardous to your health?

June 10, 2020

At a minimum, it can make you dizzy…
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I  sense that coronavirus interest has started to wane, so you might have missed this one.

From the get-go, we were warned of that “silent spreaders” — the 50% of people who get infected by the coronavirus but never show any of the symptoms — would, in fact, spread the virus like wildfire.  So, bunker down.

Based on  modeling studies the WHO had advised that as much as 41% of transmission may be due to asymptomatic people … spreading through loud talking, singing or shouting. Source: WaPo

But, earlier this week the WHO — the “gold standard” in worldwide medical expertise — did a u-turn:

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Specifically, Maria Van Kerkhove, a Stanford trained MD who is the WHO’s technical lead for coronavirus response said:

From the data we have, it still seems to be rare that an asymptomatic person actually transmits onward to a secondary individual.

We have a number of reports from countries who are doing very detailed contact tracing.

They’re following asymptomatic cases, they’re following contacts and they’re not finding secondary transmission onward. Source: CNN

Whew!  One less thing to fret about, right?

Not so fast, mes amies…

It took the WHO less than 24 hours to turn the u-turn into a full 360….

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Great moments in junk science…

June 5, 2020

A couple of weeks ago, The Lancet — “a prestigious U.K. medical journal” — published a bombshell study on hydroxychloroquine (HCQ).

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In a nutshell, the study claimed that Covid-19 patients given HCQ cocktails (HCQ plus an antibiotic such as azithromycin) had their risk of ventricular arrhythmias increase fivefold. Source

Based on the report, Eric Topol, director the Scripps Research Institute and a cardiologist, noted “It’s no longer that hydroxychloroquine has no sign of efficacy, it  is now associated with an increase in mortality.”

Whoa, Nellie.

“Following the science”, the WHO put the brakes on a Fauci-pleasing double blind random clinical trial of HCQ’s efficacy … citing the increased heart risks that the study found.

France banned the use of HCQ on Covid patients.

CNN did an end zone dance: proof positive that President Trump is an idiot.

But, the proverbial worm has turned.

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Does “flattening the curve” really save lives?

June 1, 2020

… or, realistically, does it just postpone the inevitable?
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How many times have we heard: “Flattening the curve will save lives… maybe millions of them”?

Let’s hit the pause button and review the theoretical basics and what we’ve learned.

This is the conceptual drawing of the “flattening curve”  we’ve had flashed at us a zillion times.

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Time is on the horizontal axis,; number of deaths(or cases) are on the vertical axis; the high humped curve is the number of deaths (or cases) each day with no mitigation; the shallow curve is is the number of deaths (or cases) each day with with mitigation; and the white dotted line is hospital capacity.

OK, let’s unpack the curve…

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What do American cheese, cereal and golf have in common?

May 30, 2020

Hint: The coronaviris is changing consumer behavior
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Let’s start with a confession…

Several years ago — Oct. 2006 to be precise –our family travelled to Hawaii for a friend’s wedding.

As luck would have it, an earthquake hit — and, the Oahu power grids was shut down. With no electricity, hotels started emptying their refrigerators, piling food in the conference rooms and inviting guests to 24-hour all-you-can-eat buffet.

I made a dash to one specific table on which was piled the biggest hill of American cheese I’d ever seen.

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I thought I had died and gone to heaven.

You see, as my family knows,  American cheese is one of my favorite foods.  Not just favorite cheese — favorite food.

I’m in what marketers call a micro-niche.

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I tested negative, so I’m not infected, right?

May 28, 2020

Yesterday, we reached into our toolkit and pulled out behavioral economics and Bayesian Inference.

Our big conclusion in that post was that if C-19 tests are 90% accurate and 5% of the people in our reference group are walking around infected, then roughly 2/3’s of all people who get positive test results are not infected … they’re so-called false positives.

Now, let’s change one of our assumptions.

In the prior post, we assumed that we were asymptomatic, have been sheltering-in-place (i.e. minimal social contacts outside of our homes) and don’t work in a COVID-prevalent environment … and we used 5% as our base rate (of virus prevalence among our reference group).

Now, let’s assume that the reference group we’re working with is elderly, has a comorbid medical history of respiratory and heart problems and is experiencing COVID-like symptoms (high fever, persistent cough), have had contact with an infected person.  That’s essentially the only group that initially qualified for coronavirus testing.  Lets, assume that 75% of the people in that reference group are, in fact, infected with the virus.

Here’s the Bayesian results chart would look like:

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The question: what is the likelihood that the people who fit this profile are correctly diagnosed as having the virus (or not)?

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If I test positive for COVID, am I infected?

May 27, 2020

The answer may surprise you, and it has big implications for test & trace.
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In a prior post, we reported that “Asymptomatics” are not rushing to get tested and provided some subjective reasons why that might be (e.g. no doctor referral, high hassle factor, privacy concerns).

OK, let’s up our game a notch or two and throw some math & economics at the problem.

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I’m a fan of “Freakonomics” … the popular call sign for a discipline called Behavioral Economics … the study of the rationality that underlies many seemingly irrational decisions that people sometimes make.

And, in my strategic business analytics course, I used to teach something called Bayesian Inference … a way to calculate probabilities by combining contextual information (called “base rates” or “priors”) with case-specific observations (think: testing or witnessing).

Today, we’ll connect Freakonomics and Bayesian Inference and apply them to the COVID testing situation…

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MUST READ: How will we know when we’ve turned the COVID-19 corner?

May 26, 2020

Stay focused on the number of Daily New Deaths!
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Cutting to the chase, I’ve concluded that the most reliable number being reported is the number of COVID-19 related “Daily New Deaths”.

According to Worldometers – the best data aggregation site that I’ve found so far – there have been almost 100,000 COVID-19  related deaths in the U.S. so far.

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Keep in mind that “COVID-related” means “COVID present”, not necessarily “COVID caused” … and that, along the way, “present” was redefined from “confirmed” to “presumed”

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From an analytical perspective, the chart of total deaths will, by definition, never crest and turn down. It’s rate of growth will eventually slow down, though, but that’s hard to read that from a chart.

So, I think it’s more useful to look at “Daily New Deaths” …. if that number keeps going up then, by definition, we haven’t turned the corner.

When Daily New Deaths start trending down then, by definition, we have turned the corner.

Here’s our charting of what Worldometers has reported since the first coronavirus cases were identified.

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The dotted line is the 7-day moving average which smooths some of the day-to-day “noise” in the data.

Based on the 7-day moving average, it appears that the rate of growth of COVID-19 deaths trended downward since about April 21.

Bottom line: If you want to know if we’re starting to turn the corner, keep your eye on the number of COVID-19 related “Daily New Deaths”.

Choose the level of aggregation based on your specific interest … world, nation or state.

Note: I’ll be focusing on the U.S. national number … and the national number less the 3 state hot spots: NY, NJ, CT

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More specifically, why “Daily New Deaths”?

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UPDATE: Here we go again … “Science” takes still another u-turn.

May 23, 2020

It’s a bigger deal than whether we need to wipe down our counters and packages.
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After months of telling us that the coronavirus lives on door knobs, countertops, packages and whatever … and that we need to disinfect all surfaces:

The CDC has issued a new directive that informs us that “The virus spreads easily between people, but not by touching surfaces, objects or animals

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On it’s own, this course reversal doesn’t trouble me.

Yeah, people have become more germophobic … and, store shelves have been emptied as consumers stocked up on disinfectants.

That’s OK. It’s good hygiene and consumers will eventually work off their overstock.

My issue: This course reversal fits a bigger, problematic pattern.

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Would I take HCQ like Trump is doing?

May 20, 2020

Yesterday, I gave readers a gut-check question:

If an elderly loved one was hospitalized with COVID, would you advise them to try the HCQ-combo, or tell them avoid it like the plague?

I got an interesting challenge question from a reader:

Prof. Homa, My gut question for you, with all the hypothesis and analysis, are you comfortable taking the combination as a preventive measure like Mr. President is doing?

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It’s a good question. One that made me think harder about the HCQ issue.

Here’s my answer…

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COVID’s Impact: Geographically concentrated in only 30 US counties…

May 18, 2020

Great analysis from the researchers at the Heritage Foundation
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The spread of COVID-19 has been extremely concentrated in a small number of states — and among a small number of counties within all states.

To date, 10 states accounted for nearly 75% of all deaths (but only 52% of the population).

Together, New York and New Jersey (9% of the U.S. population) alone account for 44% of total COVID-19 deaths.

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And, the  COVID-19 impact is even more concentrated than the state-level data indicate…

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George Carlin: How to build a strong immune system.

May 17, 2020

WARNING: Adult content – profanity-laced, politically-incorrect, totally insensitive to the current COVID situation and likely to offend practically everyone.  Do not play in earshot of children, co-workers or sensitive adults. Hit delete now if you self-classify in that latter group.

In other word, this is classic George Carlin.

His prescription for building a strong immune system to battle germ attacks is a bit contrary to current conventional wisdom and CDC guidance.

click to view (if you dare <= you’ve been warned!)
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Data: Over half of C-19 deaths in nursing homes.

May 14, 2020

It’s now crystal clear that one of the great fails of the C-19 response was not recognizing that nursing homes would be underprepared hot spots … and then taking all-out action to contain the carnage among the most vulnerable subset of the population.

How bad has the carnage been?

According to an analysis compiled by the CTUP(The Committee to Unleash Prosperity):

Over half of C-19 deaths have befallen residents of nursing homes, veterans’ homes and other long-term care facilities … resulting in the death of over 2% of of the population in those facilities.

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See the statistical  note at the end of this post.

The percentage of reported long-term care (LTC) deaths ranges from a low of 20% in Nevada to over 80% in Minnesota.

Note: For convenience, we lump nursing homes, veterans’ homes and other long-term care facilities into a single category that we refer to as “LTC”

The reported death rate (ratio of LTC deaths to the LTC population) is below 1/2% in about 1/2 of reporting states, but ranges as a high as 11.4% in New Jersey.

Here’s more state-by-state detail…

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Oh my, what a disappointing Senate hearing…

May 13, 2020

Are these scientists just making things up as they go along?
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I watched or listened to practically all of yesterday’s Senate hearing on the coronavirus.

Bottom line: My heart sank faster and deeper than the real-time stock market ticker.

On balance, I thought the  the Senators did a pretty good job.  With a couple of exceptions (think: Sanders and Warren), there was less political venom than I expected and more reasonable, relevant questions.

Unfortunately, the format worked against the hearing.

Just like it’s easier to say mean things to someone in an email than it is to mean-speak face-to-face. the virtual-remote environment minimized “constructive tension” between the participants.

And, as usual, the 5-minute time limits precluded deep-probe closure on any issue.

For example, Sen. Romney had an exchange that caught my attention:

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Time ran out before Romney could ask the logical follow-up question:

“Well, Dr. Fauci, then who is responsible?”

My bet: The answer would certainly have been revealing … one way or another.

Let me explain…

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COVID: How about squeezing the data and doing some old-fashioned profiling?

May 12, 2020

Hint: Go back and ask people who have been tested or hospitalized.

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Finally, Gov. Cuomo has directed hospitals to ask new coronavirus patients for some demographic and behavioral information such as their occupation, usual transportation mode and neighborhood.

Cuomo says the early results from this info-seeking initiative and the state’s antibody testing have provided  some confirming data and some “shocking” revelations, including:

  • 96% had an underlying health condition (a.k.a. comorbidity factors); new admissions were predominantly minority, predominantly older; 22% came from nursing homes.
  • 66% of NY’s new coronavirus hospitalizations are people who are either retired or unemployed and not commuting to work on a regular basis … only 17% were employed.
  • The majority of recently hospitalized coronavirus patients are people who say that they have followed the precaution of staying home.
  • Only 4% in New York City said they had been taking public transportation.
  • A low percentage of new hospitalizations were essential employees — nurses, doctors, transit workers, grocery store employees — who were getting sick at work.
  • Sources: WSJ   NY Daily News

Of course, these sample sizes are small and the results may or may not be projectably true.

The point is that “they” should have been recording this sort of information from the get-go.

The plan is to start asking a battery of questions when people are tested for the coronavirus (both diagnostic and antibody testing, I assume) and when they’re admitted to the hospital.

That’s fine, but I’ve got a better idea…

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Survey: Some changes will endure post-coronavirus….

May 11, 2020

USC’s Annenberg School of Communications surveyed Americans about how they are living and coping with the rapid changes wrought by the pandemic … and which changes will endure. Source

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Based on the survey’s findings, there are at least 10 areas where the outbreak is likely to have permanent effects on our personal, professional and cultural lives.

Here’s their list…

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Gottleib: “We thought we’d be in a better place by now”

May 10, 2020

More deaths than expected … new deaths on a plateau.
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Dr. Scott Gottleib is a former head of the FDA.

My view: He usually makes a lot of sense, so I listen to him.

In a WSJ columns, Gottleib observes:

Everyone thought we’d be in a better place after weeks of sheltering in place and bringing the economy to a near standstill.

Mitigation hasn’t failed; social distancing and other measures have slowed the spread.

But the halt hasn’t brought the number of new cases and deaths down as much as expected or stopped the epidemic from expanding.

And, there’s more to the story…

(more…)

Birx: “Nothing from the CDC that I can trust”

May 10, 2020

Whoa, Nellie …
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According to the Washington Post

During a task force meeting this week, a heated discussion broke out between Deborah Birx and Robert Redfield, the director of the CDC:

Birx and others were frustrated with the CDC’s antiquated system for tracking virus data.

They worried (that he CDC system) was inflating some statistics — such as mortality rate and case count — by as much as 25 percent.

There is nothing from the CDC that I can trust,” Birx said.

The flare-up came two days after it was reported that an internal government model, based on data from the CDC (via Johns Hopkins), projected the daily death count would rise to 3,000 by the end of May.

Birx said in a statement:

Mortality is slowly declining each day.

To keep with this trend, it is essential that seniors and those with comorbidities shelter in place and that .

The Post also reports:

Whereas initially the task force found itself scrambling to deploy a whack-a-mole management effort, dealing with regular crises as they emerged — from coronavirus-infected cruise ships to the urgent need for ventilators — the administration now intends to shift its focus to what is says is more strategic longer-term planning.

NYT: Travelers from New York “seeded” outbreak across the U.S.

May 8, 2020

From China to Europe to NYC to…
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Let’s start this story near the beginning…

By mid-March , it had become apparent that New York (more specifically, the NYC metroplex) was a blazing coronavirus hot spot.

It was also becoming apparent that the West Coast outbreaks had been “seeded” by travelers from China … and, that the NYC outbreak had been seeded from Europe.

At the March 24 Task Force Press conference, Dr. Birx casually mentioned that “60% of all the new coronavirus cases in the United States stem from the New York City metro area” and advised New Yorkers, wherever they were, to shelter-in-place. Source

It was commonly misconceived that Dr. Birx was saying that 60% of new cases were occurring in New York … ignoring the key words: “stem from”.

The governors of Rhode Island and Florida understood what she was clearly saying.

Rhode Island Gov. Gina Raimondo’s directed state police to stop vehicles with New York license plates at the border, encourage them to u-turn … and if they demurred, to collect ID information from drivers and passengers and advise them to self-quarantine for 14 days to “stop the spread”. She also encouraged local law enforcement to go door-to-door looking for New York license plates and advise the car owners of the need to self-quarantine.

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Following suit, Florida Gov. Ron DeSantis started jawboning New Yorkers:

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Then, fearing that New York travelers were “akin to international travelers bringing the disease from Europe and China”, DeSantis issued an executive order requiring fliers from the New York area be tested on arrival and advised to self-isolate for two weeks upon arrival in the Florida.

President Donald Trump floated a trial balloon that he might institute a ban on New Yorkers’ travel to others states amid the coronavirus.

Encouraged by the ACLU, Gov. Cuomo accused President Trump of “trying to start a civil war”, insinuated that Gov. DeSantis was a rube “playing to his rural constituency” and threatened to sue his Rhode Island neighbor.

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President Trump let the matter drop, the Florida restrictions died under the weight of the heavy stream of New Yorkers fleeing to the Miami environs and Rhode Island caved to Cuomo’s threats.

OK, now let’s fast forward to today…

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Except for timing, the new IHME forecast isn’t as shocking as it seems…

May 6, 2020

In mid-April, we pointed out the obvious: the operative projection at the time (60,000 deaths by Aug. 4)  — which was modeled by IHME, touted by Pres. Trump, and head-nodded by Drs. Fauci & Birx — was arithmetically unlikely.

Our simple logic: At the time, the US had already had about 40,000 deaths and was running at a rate of about 2,000 new deaths each day. To stay under 60,000, the average daily death rate would need to drop to 200. That didn’t seem likely.

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And, we pointed out that IHME routinely reported a wide confidence interval (aka. zone of uncertainty) that ranged up to 140,000.

The new 134.475 projection falls within that confidence level.

Add to the mix some data mumbo-jumbo: There have been some definitional and procedural changes that have boosted the reported number of deaths.

(more…)

Maybe coronavirus deaths really are being overcounted…

May 5, 2020

Changed counting rules and an unintended consequence of hospital reimbursements?

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Early on, we concluded that coronavirus statistics are generally problematic and that “cutting to the chase, the most reliable number being reported is the number of COVID-19 related “Daily New Deaths”.

For details, see: How will we know when we’ve turned the COVID-19 corner?

I argued that if anything is discrete and countable, it’s a death (versus, say, a “confirmed case”).

I acknowledged the problem posed by the difference between “dies with” and “died because of”.

But, I assumed that the counting rules would stay the same and that there wouldn’t be incentives (intentional or unintended) to either over- or under-report.

Silly, me.

A couple of weeks ago, the CDC changed a counting rule.

The original rule: If a patient tests positive for the coronavirus and dies, put COVID on the death certificate.

The change: Doctors should also record “presumed” coronavirus deaths even if they aren’t “confirmed cases”.

In NYC alone, that change boosted the death total by almost 5,000.

That might be the right way to do it, but it did screw up the data series.

So be it.

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A second counting issue has to do with economic incentives…

(more…)

Gottleib: What we need now are rapid tests like the ones for flu or strep…

May 4, 2020

Geez, haven’t we been saying that for weeks?
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Dr. Scott Gottleib is a former head of the FDA.

In a WSJ columns, Gottleib observes:

Everyone thought we’d be in a better place after weeks of sheltering in place and bringing the economy to a near standstill.

Mitigation hasn’t failed; social distancing and other measures have slowed the spread.

But the halt hasn’t brought the number of new cases and deaths down as much as expected or stopped the epidemic from expanding.

What’s the key to getting the virus under control?

(more…)

C-19 Data Reference Guide: ALL STATES

May 4, 2020

Tests, Confirmed Cases, Deaths
Cumulative Totals and Key Ratios

Data as of May 3, 2020
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Now that we seem to be heading down the backside of “the curve” and are starting to re-open the economy … I thought it would be a good time to heatmap where states stand relative to each other along the key variables: number of tests, confirmed cases and deaths … and, to “normalize” the data by adding some key ratios.

For example, here are the 10 states with the highest number of deaths per million … and the 10 with the lowest number of deaths per million:

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>>  Click for a PDF that displays all of the data <<

The reference guide includes sections sorted by:

  • State name (alphabetical)
  • Tests per million (population)
  • Confirmed cases per million (population)
  • Ratio: confirmed (positive) cases to the total number of tests
  • Total deaths to date
  • Deaths per million
  • Ratio:deaths per confirmed (positive) test

All data is sourced from Worldometer as of May 3 2020.

Senate may be starting to ask the right questions re: testing.

May 3, 2020

“Why do we have to have symptoms to get tested?”
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The Senate (but not the Congress) is scheduled to get back on the job this week.

Roughly half the senators are 65 or older … and, thus, officially in the coronavirus’ “vulnerable” group.

So, it’s understandable that they’re eager that all colleagues have a clean bill of health before returning to the Senate chambers.

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Here’s the rub…

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Help Wanted: Vice President of Contact Tracing & Testing

May 1, 2020

Warning: Read this before you apply for the job.
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Contact tracing & testing is front and center as a fundamental component of the Coronavirus Task Force’s plan to go forward.

Dr. Fauci has said (over & over again) that the process worked fine 30 years ago when he was fighting AIDs … and the media says that the test & trace model has been South Korea’s secret sauce fighting the coronavirus.

The essence of the process: Do diagnostic surveillance testing to ID people currently infected with the coronavirus, then trace back to ID the people with whom they’ve been in contact … then notify those people and test them … if they test positive, repeat the process … then again and again.

Sounds easy enough, doesn’t it?

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But, it might not be as easy as it sounds.

Let’s run some numbers…

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So, how far & fast does a virus spread?

April 30, 2020

Here’s a crash course on the subject.
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In a press conference last week, Gov. Cuomo started talking about the “virus reproduction rate” and, channeling Germany’s Chancellor Merkel, declared that NY can’t be reopened until it is under control. WSJ

Sounds reasonable, right?

Yeah, but what the heck is he talking about?

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Fasten your seat belts and let’s do some fun math today…

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Uh-oh: With C-19 bearing down on Maryland, our area hospital furloughs 1,000.

April 28, 2020

Victim of the moratorium on elective surgery.
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Talk about timing…

On Sunday, I broached a sensitive topic with my wife: Which hospital should we go to if we catch the coronavirus?

We’re heavily biased towards teaching hospitals, and the docs at Georgetown Hospital were amazing during Kathy’s grueling bout with breast cancer.

But, we concluded that Georgetown – a metroplex hospital — would probably be overrun with cases.

So, we started leaning towards our large, modern local option: Anne Arundel Medical Center

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Then, on Monday, the news hit

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According to the Annapolis Capital Gazette

“Anne Arundel Medical Center has furloughed 1,000 employees.”

Say, what?

In accordance with federal guidelines, the Annapolis hospital canceled all elective surgeries and “ambulatory service” … which are the economic backbones of the hospital.

But, up to now, the C-19 patient load has been very light.

Bottom line: the hospital has been patient and revenue light for a month … facilities are underutilized … and the hospital is bleeding red ink.

So, there was no choice but to lay-off medical staff … they became victims of the coronavirus!

Nonetheless, the hospital says not to worry:

These furloughs do not impact our commitment or ability to safely supply and equip our hospitals to combat COVID-19,

We have trained and redeployed hundreds of staff to support the expected COVID-19 surges in the state of Maryland.

Apparently, AAMC’s predicament is not unique.

The guidelines were obviously developed with the C-19 hot spots’ hospitals in mind … and, the one-size-fits-all rules made other hospitals collateral damage.

Sad, but true.