Archive for the ‘Coronavirus – Covid 19’ Category

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…

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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.

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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…

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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?

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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.

The contrarian California docs who are challenging the scientific consensus.

April 28, 2020

YouTube blocked the video, but …   we’ve got it here!
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Drs. Dan Erickson and Artin Massih are ER physicians with 40 years of hands-on experience with viruses and respiratory infections.

They’ve been digging deep into the coronavirus, stress-testing the consensus science and the public policy that’s derived from it.

Their approach:  analysis based on science, logic and “the actual facts of the case, not predictive models”.

Their general findings aren’t particularly controversial: “COVID-19 came here earlier than previously believed, is more ubiquitous and, ultimately for the general population, is less deadly than originally thought.”

So, why are they getting blocked?

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Trump to scale back press conferences … whew!

April 27, 2020

Has he been reading the HomaFiles?
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Last week, we (and a zillion other observers) advised the President to dial back on his participation in the daily Task Force press conferences … and, rather, maintain his visibility by holding his own occasional “hot topic” news conferences.

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Looks like he’s taking the advice.

A couple of things appear to be motivating the welcomed relief….

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Dr. Birx scolds the press and millennials …

April 27, 2020

“Headlines are irresponsible … and most people don’t read the full story”.
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The poor media.

For weeks, they’d been fawning over Drs. Fauci and Birx for their Trump-thumping truth-telling.

That caricature started to unravel when Birx admited that “I didn’t see this thing coming” … then Fauci laid blame for the testing “failings” on the scientists … and then, both Fauci and Birx testified that Trump listens to them and has based big decisions (e.g. the lockdown) on their data and recommendations.

That was bad, but things got even worse in weekend interviews when Tapper, et. al., tried to get Birx to throw Trump under the bus for telling American idiots to drink Clorox and Lysol.

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Birx didn’t take the bait, instead responding:

Well, I think it bothers me that this is still in the news cycle.

I think I have answered that question.

I think I made it very clear in how I interpreted that …  and so has Dr. [Anthony] Fauci and everyone associated with the task force.

I think I have made it clear that this was a musing … a “dialogue” between President Trump and scientists. 

I think the president made it clear that physicians had to study this {sunlight and disinfectants].

Sources:    Axios   RCP   Politico

And, she went in for the kill …

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More about NY’s antibody test results…

April 26, 2020

So what about the 14% who tested positive for antibodies?
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Let’s start by flashing back to what we said before the test results came in:

Estimates from other earlier-infected countries indicate that only 15% of people infected by the coronavirus experience severe symptoms.

So, given that NY has had about 250,000 confirmed cases (which required severe symptoms), we would expect that the total number of people already infected in New York is 1.67 million (250,000 confirmed cases divided by 15%) … which is 8.6% of the NY population (1.67 divided by 19.5).

OK, the first wave of testing found that 14% of sampled New Yorkers tested positive for coronavirus antibodies … indicating that they had been infected.

That projects up to about 2.7 million people (14% times 19.4 million population).

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For details, see: NY antibody test results

So, is 14% testing positive for antibodies good news or bad news?

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How many social contacts are people having during stay-at-home?

April 25, 2020

And, how risky is it to have contact with people outside of your household?
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In a previous post, we reported a Gallup survey that indicated at least.2/3s of Americans were making a reasonably serious attempt to isolate themselves during the stay-at-home.

A new Gallup survey reports that 74% are isolating themselves “completely” or “mostly”.

That’s pretty good compliance.

And, Gallup goes a step further in the current study to calibrate what “completely” or “mostly” mean by asking respondents how many people they came in contact with — not counting fellow household members — during the past 24 hours.

Note: The forecast models generally assume that social distancing practices, including stay-at-home, reduce contacts by about 40% … 25% for work contacts and 75% for general social contacts.

The conclusion: Adults practicing social distancing generate at least 90% fewer contacts per day than those who are making little effort to social distance.

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On average, survey respondents had 9.9 contacts in the past 24 hours.

Let’s dig a little deeper into the numbers…

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Flashback: “The Tipping Point” by Malcolm Gladwell.

April 24, 2020

The forces that trigger epidemics.
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Malcom Gladwell, a pop-culture observer and author, hit it big 2 decades ago with his book The Tipping Point: How Little Things Can Make a Big Difference.

Primarily aimed at marketers, this best-seller provides a construct for understanding why some products and ideas languish and never gain traction … while others take off and rise quickly to broadscale acceptance.

Much of Gladwell’s thinking is derived from his study of contagions and epidemics … which makes it relevant today as we try to understand the coronavirus pandemic.

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Gladwell suggests that there are 3 key elements that need be present for an epidemic to reach a “tipping point” and takeoff: (1) Content – the infectious agent, (2) Carriers – the individuals who transmit the infection, and (3) Context – the environment in which the infectious agent  operates.

Let’s drill down on each of those…

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Squeezing the NY antibody test results…

April 24, 2020

Estimate: 3% of the NY state population are infected asymptomatics .. in circulation and potentially infecting others.
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In my business analytics course, I used to nudge students to “squeeze the rock” .. to get as much possible information out of each test or piece of data.

OK, let’s apply that principle today …

In a prior post, I opined that NY antibody tests were missing an information opportunity.  If they also swabbed the random sample for C-19 diagnostic tests, they’d also have an estimate of the number of infected asymptomatics who are currently in circulation in NY.

OK, it was a missed opportunity.

But, let’s not fret.

We can squeeze the data to get a rough-cut estimate of  the number of infected asymptomatics who are currently in circulation in NY.

Let’s do some arithmetic …

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Sure, Theranos was a disaster…

April 23, 2020

… but it offers some ideas for today’s crisis.
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OK, Elizabeth Holmes is a likely sociopath who charismatically defrauded investors out of billions of dollars and made fools of a lot supposedly smart, highly influential people.

In a nutshell: Holmes was 20-something Steve Jobs wannabe who visioned  that blood tests could be done from a single drop of blood and built a $9 billion company around the concept,

Here’s a 5-minute clip on Holmes & Theranosimage

There was a rub, though.

Holmes (and the company) crashed & burned when it was finally discovered that Theranos was Oz – the concept didn’t work.

Holmes is currently under Federal indictment, with a trial scheduled for this October.

Putting those dirty details aside for a moment, there are some things we can learn from Holmes and the Theranos saga.

Let me explain ….

I recently re-watched the 20/20 TV version of the Theranos story (titled “The Drop Out”) … this time, I watched with an eye to “learnings” that might have relevance to the coronavirus crisis.

Here are my takeaways…

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NY antibody test results…

April 23, 2020

~14% tested positive; over 21% in NYC
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Gov. Cuomo announced the first round of results from NY state’s broadscale coronavirus antibody test.

With 3,000 of the planned 14,000 tests completed 21.2% of NYC residents tested positive for coronavirus antibodies … an indication that they have already been infected by the virus (and recovered).

Interpreting those results requires a bit more number crunching: statewise, 13.8% tested positive … that projects to roughly 2.7 million New Yorkers

As of today, there have been 269,519 confirmed cases in NY state … that means that roughly 2.4 million people have been infected but had no or mild symptoms — so they weren’t given diagnostic tests. These are the so-called “hidden carriers”.

Said differently, based on these test results,  90% of New Yorkers who have gotten infected by C-19 have had no or mild symptoms. That’s a big deal.. perhaps the key takeaway from these test results! 

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As of today, NY has reported 20,792 coronavirus-related deaths … which given the estimated 2.7 million infectees implies a virus death rate of .8%

Nursing homes need tests with instant results!

April 23, 2020

Otherwise, viral spread with a high fatality rate is a matter of “when” not “if”.
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Let’s connect a couple of dots today…

First, the obvious has suddenly become evident: nursing homes (and other long-term care facilities) are sitting ducks for the coronavirus.

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Why is that?

Nursing homes present a “perfect storm” challenge: highly vulnerable, cloistered patients in close, constant contact with non-resident shifts of care-givers.

Let’s unpack that description and its implications …

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Let’s make the Task Force press conferences watchable…

April 22, 2020

A streamlined cast of presenters and an audience filled with subject matter experts would make the updates more informative.
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I am a news and data junkie, I am immersed in the coronavirus situation, I am Trump-tolerant and I am rooting for us to get out of this health-economic crisis as soon as possible with the fewest deaths and least economic damage.

So, I watch most minutes of most of the daily Task Force press conferences.

I am a passive TV watcher, even during sports events in which I have emotional (or financial) equity. I don’t cheer wildly for TD passes or yell at the TV when there’s an interception.

That said, I am on the verge of throwing shoes at the TV during the Task Force press conferences.

Note: Don’t say “stop watching”.  That would just be conceding defeat.

What’s the rub?

They are too long with too much predictable politics and too little pertinent new coronavirus information.

From the podium, there are too many vaguely supported reassurances and too much repetitive in loco parentis. I get that I’m supposed to wash my hands and stay at home.

From the gallery of reporters, there are too many questions that are politically-skewed, gotcha-intended, off topic or just plain stupid.

Note: I know that teachers (and retired teachers) are supposed to say “there’s no such thing as a dumb question”.  People who offer that admonition obviously didn’t sit through any of my classes.

So, what to do?

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If test kits are scarce, let’s test the right people!

April 22, 2020

Test kits are scarce and we are testing the wrong people.
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First, a quick primer on testing …

A testing system has two major components: the analysis machine … and a “kit” containing all the necessary chemicals (aka. “reagents”) and supplies (e.e. nose swabs).

Simple analogy: The analysis machine is like your trusty Keurig cup-at-a-time … and the testing kits are like the coffee pods that go into the machine. You need both parts to do a test or make a cup of coffee.

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There are plenty of analysis machines around, but they are made by several different suppliers … all of whom have uniquely different test kits.

None of the suppliers routinely carry a pandemic level of kits in inventory … the economics of doing so would be burdensome and some of the reagents have shelf lives. Ramping up to pandemic levels is a challenge because many of the kits’ components come from, you guessed it, China.

So, we’ve got plenty of lab capacity (analysis machines) … but a shortage of test kits. That makes the test kits the constraint or “pacing item”.

The shortage will eventually be filled, but until then, it’s critical that the scarce kits be used to test the right people.

We’re not doing that …

(more…)

NY antibody test results will give us clues about our future health risks…

April 21, 2020

 … and may either vindicate or indict the shut-down.
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Last week, Gov. Cuomo announced that New York will begin the “most aggressive” antibody testing in the country this week.

The goal: To determine the true number of people who have been infected by the coronavirus.

Specifically, NY will administer around 14,000 tests this week to a random sample of individuals.

That’s a good thing.

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Teaching point: I always coached my students to develop hypotheses before doing analyses or launching a test.

In high uncertainty situations — like the coronavirus infection rate — I nudged them to imagine the high & low results that might be reasonably possible … and, pre-assess the implications at each extreme.

Let’s play that game for NY’s antibody testing…

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About that forecast of 60,000 coronavirus deaths…

April 20, 2020

The past couple of days’ data suggest that, nationally, we may have reached an apex for this wave of the coronavirus.

So, I thought it would be a good time to revisit the longer term projections…

I think that there’s a lot of misunderstanding about the oft referenced IHME forecast which is currently pegged at slightly more than 60,000 (down from an original projection of about 80,000).

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Two key points:

1. 60,000 is IHME’s best case …  it assumes that all states are locked down until Aug.4 (which isn’t going to happen) … even then, as presented on the above chart, the IHME confidence interval ranges from 60,000 (most likely) to 140,000 (worst case)

2. The forecast is the cumulative number of deaths until August 4 … it’s not the number of cumulative deaths over the life of the virus (or even this wave of the virus) … certainly, there will be additional deaths after August 4.

Important: Keep in mind that  “flattening the curve” doesn’t reduce the total number of projected deaths, it just spreads them over a longer time period.

Any reduction to that total will be due to the virus dying out naturally, introduction of a virus neutralizing vaccine or introduction of life-saving drugs or therapies.

For discussion purposes, let’s hang our hat on 60,000 and August 4..

Right now, we’re sitting at roughly 40,000 deaths to date (40,565 to be precise).

Pause for a moment and consider the implications of those last 2 sentences.

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WaPo: “A glaring scientific breakdown at the CDC”

April 19, 2020

“The impact was devastating to the country.”
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Today, the Washington Post published a scathing report that details how the scientists at the CDC screwed up the launch and deployment of C-19 testing … leaving the medical community and policy-makers flying blind in the early stages of of the US coronavirus spread … and, information-short as the nation tries to transition back to re-opened normalcy.

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WaPo’s general conclusion:

The CDC’s performance with the test kits marks an unparalleled low in the 74-year history of America’s heretofore premier institution for combating the spread of catastrophic disease.

More specifically, WaPo reports a disastrous mix of scientists’ hubris,  protocol violations, slow reactions, and missed commitments.

Here are some details ….

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What Drs. Fauci & Birx said about testing…

April 18, 2020

I watched, so that you wouldn’t have to…
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During the press conference yesterday, Drs. Fauci, Birx, et. al., gave a technical presentation intended to educate us on their testing plan (and fend off critics like Gov. Cuomo).

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In general, I was frustrated by the presentation which was way more “academic” and credential-building (e.g. “what we did re: HIV”) than practical (i.e. here’s what we’re going to do and how it impacts you) … and, still didn’t answer many of my questions (e.g. going forward, exactly who will be tested? how & where will they be tested? how will the test results be used? how can I get a test? what are my odds of getting infected? why does testing require a doctors Rx note? what about the false negative problem?).

As expected he dufass politico reporters asked no meaningful drill-down questions.

That said, I drew some significant takeaways from the presentation …

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Point of emphasis: There is adequate testing capacity deployed to support the phased Open America plan. But, “the full potential of testing capacity still needs to be unlocked.” Birx

But, testing  is only a supporting component of the plan and is not “the panacea”   … it’s a diagnostic tool and a source of information for policy-setting … more testing will not stop the virus … it will help for priority-setting but we’ll still dependent on social-distancing and therapeutic interventions.

More specifically…

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Your DNA may protect you from C-19’s worst symptoms…

April 17, 2020

Maybe 23and Me has a socially redeeming value, after all .
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According to Bloomberg

Some people experience Covid-19 as nothing more than a mild cold, and others exhibit no symptoms at all.

Then there are the thousands who sicken and, often, die.

No one knows why there are such huge discrepancies in symptoms and outcomes.

One theory: It is locked deep in our genetic makeup.

So, a global consortium of scientists is working to unlock the mystery of the disease’s dramatically varying symptoms.

(more…)

What’s your Body Mass Index?

April 16, 2020

It’s a predictor of severe Covid-19 symptoms!
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A couple of weeks ago, I heard a couple of frontline docs observe than many of the most severe Covid-19 patients were overweight.

body mass index for adults

Just an anecdote, but I stored it away as a clue.

Well, turns out that there’s data supporting the docs’ anecdotal evidence…

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Let’s play “Are you ready to”

April 16, 2020

OK, relatively soon, the economy will be re-opened … though, I’m not exactly sure what that means.

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Here’s the rub…

Just because some activity is allowed to open, doesn’t mean that the public will be partaking.

Based on a recent Gallup poll, the vast majority (70%) say they plan to take a “wait & see” approach to resuming activities.

That makes sense, and the poll is directionally indicative, but decisions will likely relate to specific activities.

So, let’s play “Are You Ready To”….

 

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For example, when the economy opens, will you be ready to…

  • Take a bus or subway?
  • Ride with others in an elevator?
  • Work in an open space office?
  • Meet with colleagues at work?
  • Participate in conference room meetings?
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  • Take a plane flight?
  • Take a cruise?
  • Stay in a hotel?
  • Go to a vacation resort?
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  • Go to church?
  • Dine in at a restaurant?
  • Go to the gym to workout?
  • Shop at a discount or department store?
  • Attend a class with 30 other students?
  • Go to a big crowd sporting event?
  • Go to a movie or a play?
  • Get a haircut?

You get the idea…

What other activities should be on the list?

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Thanks to MC for feeding this idea.

Did Trump pull a Br’er Rabbit on the Governors?

April 15, 2020

Let’s start with a refresher course on the story of Bre’r Rabbit:

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Br’er Rabbit was constantly being pursued by Br’er Fox, who had personal dinner plans for the rabbit.

One day, when grabbed by Br’er Fox, the helpless but cunning Br’er Rabbit pleads, “Do any thing you want to me, but please, Br’er Fox, don’t fling me into the brier-patch.”

That prompted Br’er Fox to do exactly that.

But, Br’er Rabbit was born in this brier patch, and was  at home in thickets.

So, the resourceful Br’er Rabbit used the thorns and briers as a safe haven and the threatening fox was thwarted.. Source

OK, what does the story of Br’er Rabbit have to do with the coronavirus, the governors and President Trump?

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In this Monday’s press conference, Trump went off on his “total authority” to determine the start and speed of the country’s re-opening.

I found that odd since Trump resisted calls that he order a nationwide shutdown.  Rather, he was steadfast the the Feds could provide guidelines, but that the ultimate decisions were in the hands of the governors. Why the change of heart?

Predictably, the press went wild on “King Trump – the authoritarian despot”.

Governors (think: Gov. Andrew “Not My Fault” Cuomo) started shrieking “unconstitutional” … asserted that they were in charge … and threatened to sue to maintain control over the re-opening.

Then at the Tuesday press conference, Trump did an about face, saying that governors would be in charge … that Feds would just provide support … and. most important, the governors would be held accountable.

The press reported: “Trump folds under pressure from Governors”.

BINGO! The light bulb went on.

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A friend of mine has long opined that “Trump is playing chess while everybody else is playing checkers”.

I used to think that was a long reach, but over time, I’ve started to think my friend is right.

Think about it.

For the past couple of months, Trump has been held totally accountable for the coronavirus response.

Even when unjustified, the press and governors laid every stumble at his doorstep.  Why are the test kits late and few? Why doesn’t NY have enough ventilators? Etc.

My view: Re-opening the economy is going to be long and messy. There will be stumbles, retreats and disappointments.

Why would Trump want to “own” that whole process? Why would he want to be the only person held accountable things that happen — large and small?

Answer: He wouldn’t.

But, if his opening position had been that the governors own it and they’ll be the ones held accountable, he would have been accused of shirking his buck-stops-here responsibilities. The press and governors would have rebelled.

Instead, he pulled a variation of Br’er Rabbit’s “get what you want” gambit… getting the governors to deprive him of the authority … and  demand that they get the authority (and accountability).  They united to throw Trump into the thicket patch.  So there, Mr. President!

Now, when things large or small go haywire, Trump can simply point to the accountability-demanding governors.

Check … and CHECKMATE!

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Addendum: A loyal reader alerted me to a similar analogy – Tom Sawyer tricking his buddies into painting a fence for him. See Trump Whitewashes the Fence

Bill Maher on “Virus Shaming”

April 14, 2020

Bill Maher is a darling of the left when he’s trashing Trump … but they seem to be having difficulty accepting his politically incorrect wit when it’s aimed at them.

This is Classic Maher … must watch TV.

click to watch video
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Thanks to JC for feeding the lead.