On March 26, I asked “Number of new COVID-19 cases worldwide is declining now?” (updated every few days with data and comments) Within just a couple of days, the answer seemed to be “no”.
I’m wondering if we can finally say that coronavirus has flattened its own curve when viewed from a planetary perspective. Today’s comment:
Sweden 695 new cases/81 deaths; Denmark 153/7; Massachusetts 1,963/252. With 3,405 deaths so far in Massachusetts versus 2,355 in Sweden, the Massachusetts death rate (adjusted for population size), halfway through our second month of lockdown, is 2X Sweden’s. India has experienced only 31,332 cases and 1,007 deaths, despite the vast population and impracticality of a true lockdown.
With roughly the same number of “new cases” worldwide as at the beginning of the month, despite what must be an increased testing capacity, I am prepared to guess that the number of new cases is actually declining. Deaths in today’s report were 5,376. Deaths reported on April 1 were 4,193. (If my guesses continue to prove wrong, this will qualify me for a job as an epidemiologist at the University of Washington’s Bill Gates-funded Institute for Health Metrics and Evaluation!)
Readers: What do you think? Given the almost-flat new-case count, despite radically increased testing capacity, and the almost-flat death count, despite the time interval between infection and death, is it fair to say that the human race has reached at least some sort of steady state situation with coronavirus? Or can we even say that coronavirus is declining?
Also, how do we explain India? The population did not have natural immunity. Only a small percentage of the population has the practical means to isolate themselves the way that an American suburbanite could.
Related/Unrelated… Some young folks meet in the Target parking lot in Portsmouth, New Hampshire:
They invited us to join them and it was a nice conversation until the roof of the Toyota Avalon crew car collapsed…
A separate question to which I don’t have a good answer is “Why do all of these young people comply?” In theory, they have a First Amendment right to assemble. Maybe some of them will be persuaded by the media and/or by sentiment that they have to sacrifice their social lives in order to protect hypothetical elderly Americans (82 is the average age of a Covid-19 fatality in Massachusetts, with more than 98 percent having an “underlying condition”). But why would most of them or nearly all of them do that? And unless we can keep almost all of our social young people locked down, containing coronavirus is hopeless, right? There has never been a situation in which old people have had long-term success telling young people what to do, has there?
> despite the time interval between infection and death
The time interval makes it more likely that the number of new cases is dropping, not less likely. I’d the number of deaths is flat then the number of true cases must have been flat several weeks ago.
Bradley: I guess I didn’t word it clearly. “almost-flat death count, despite the time interval between infection and death” was meant to convey that, even though the daily death count is roughly flat, due to the time lag “flat is the new declining”.
> In theory, they have a First Amendment right to assemble.
By what theory? Most courts have been ruling that an emergency (specifically this emergency) can result in many rights being curtailed. The courts have generally required that emergency orders must be reasonable. For example, stopping all large meetings including churches has been sustained. But shutting down churches held at drive-in movies was not sustained. These young people may not have a good first-amendment defense if they get cited.
Bradley: By the theory of reading the plain words in the Constitution! Of course the government will argue that whenever a governor or President declares an emergency, the Constitution doesn’t apply. The rights in the Bill of Rights are for whenever the government says “we are not having an emergency.” That’s how the U.S. was able to intern the Japanese during World War II. See https://en.wikipedia.org/wiki/Korematsu_v._United_States
(But the reason that I wrote “in theory” was that I expect the rights written down in the Constitution to be tossed out during what everyone (except some Swedish epidemiologists and American medical school professors) agrees is a justified panic.)
Old people told young people to go to war. Since forever.
Also to say, as the young Germans said, that the octogenarians will die in 6 months anyway is wrong. The life expectancy of an age 82 male is 7 years and female is 8 years.
Bradley: It doesn’t matter whether they’re right or wrong in terms of motivating them to go out and party!
Well it’s not a good look to party because you think it’s OK for old people to die.
Bradley: A lot of young people don’t care if old people think that they don’t look good. In my personal experience as an old person, it is extremely rare for a young person to ask for my opinion on any subject.
There have always been horrible people. Some of them are young. Most people aren’t horrible, and that’s why most people (including young people) are doing what they can.
You theoretical view of the construction does not seem to comport with the rulings and widespread acceptance that the rights are not absolute. For example libel and fighting words are typically limited. Such restrictions and emergency covid restrictions are likely to withstand future scrutiny.
Godwining the argument by bringing up the internments is not a sound argument. The internments were not a reasonable restriction, and their decision (like some other supreme court decisions) do not look good in retrospect.
Just because courts make errors does not make rights absolute, and does not make today’s restrictions unconstitutional.
If you want to take an absolutist position… Good luck making that make sense in the real world.
Bradley: As noted above, I recognize that the Constitution will likely prove to be as useful to young people who want to live in freedom as it was to Japanese-Americans when FDR decided to intern them in camps.
The idea that the Constitution actually SHOULD entitle healthy young people to ignore stay-at-home orders seems to be supported by a plain reading of the document, according to constitutional law professors. Here are some interviewed: https://www.npr.org/2020/03/17/817178765/self-isolation-orders-pit-civil-liberties-against-public-good-in-coronavirus-pan
Here’s a 1990 paper: “Emergency in the Constitutional Law of the United
States” https://scholarship.law.missouri.edu/cgi/viewcontent.cgi?article=1417&context=facpubs
Until courts rule on this it is tough to say what the practical value of the Constitution is. I found one lawsuit, however, challenging the Constitutionality of a stay-at-home order for healthy people: “A judge in southern Illinois ruled Monday that Gov. J.B. Pritzker’s stay-at-home order to stem the spread of the coronavirus exceeds his emergency authority and violates individual civil rights.” https://apnews.com/761aded9e0bfec12057bb22fe65ff145
Constitution does not define rights of people. It does define limits on the rights of the governments. There are no exceptions for “emergency” in the Constitution. The home arrest (er… “shelter in place”) orders are unconstitutional and thus illegal. There are no “if”s or “but”s about that.
Fortunately for society, most people and courts don’t share that absolutist view of the rights enumerated by the constitution. Most of the lockdown orders *are* constitutional, because the courts say so. The courts sometimes err, but that the nature of any justice system.
These particular scofflaws seem to be keeping a reasonable distance.
What makes your view on India so rosy? There seems to be very little curve bending there. It’s could be just getting started.
And is there any reason to think their excess death problem won’t be worse than in richer countries?
They may have something good going on, but the fact that we ask “why” means we must seriously consider the possibility that it’s not a good situation.
Bradley: India is “just getting started”? The country had its first cases two months ago (see https://www.bbc.com/news/world-asia-india-52435463 ). We are told that this supervirus grows exponentially whenever it is not contained by thoughtful government policies, implemented with precision. Have you been to India? If so, is this kind of government policy, implemented with precision for 1.35 billion people consistent with what you observed on the ground there?
(Separately, I don’t have a “rosy” view of India because I am not a prophet like the folks at University of Washington. I am looking only at today’s WHO numbers and they strike me as low for a densely packed country of 1.35 billion where coronavirus has been spreading for two months, likely mostly unconstrained.)
The first case in the US was thought to be Jan 19 (it’s now probably earlier) in WA. It’s now almost 15 weeks later. The first case might not be a good metric. The 500th case, to pick an arbitrary number that I’ve seen some studies use as a base line: Italy Feb 27, India Mar 23. So by that measure India is a month behind Italy. A month ago Italy had 100,000 cases, whereas India has 33K cases today. A factor of 3 could be explained by the fact that India’s testing rate is among the lowest in the world. A month ago Italy’s new cases had been on a downward trend for two weeks. India’s are still growing at looks like a steeper slope now than two weeks ago. As always, as we get more days worth of data, and more accurate data, we’ll understand the situation better.
People often neglect the “other side” of exponential growth: At the beginning the growth rate is slow in absolute terms..
So a simple explanation, consistent with the data we have, is: Yes India is just getting started and is still experiencing exponential growth.
It is hard to enforce your constitutional rights when the courts are closed. Toucan thinks most governors have acted illegally but there has not been any blowback because the wheels of justice turn slowly. The good news is they do turn! As Obama always says if you like your first amendment you can keep it……
It’s been almost four years and you’re still going at Obama? You had a black president. Get over it.
I guess it’s easy to sit on the roof of the car if you didn’t have to pay for the car. 🙂
I took a political science course in college as an elective. The professor once told us “You can do anything you want to do if you are willing to face the consequences.”
In the case of government overreach there are no real consequences. You get voted out of office? No big deal since you will just go to work for one of your rich supporters. There are riots in the streets? No big deal since you are not on the front line suppressing the riots, etc., etc.
Young people are highly susceptible to social-media shaming and millennials are natural followers. Though “da utes” are not so much milliennial as Gen Z now and I don’t know if they are as communitarian as their older siblings.
> Why do all these young people comply?
For this group in Portsmouth, NH though, a couple of things are safe to say:
They look happy and well-fed. (Median family income in Portsmouth from 2010-2014: $90,208. It’s probably over $100,000 a year now.) They have pretty nice cars. They are sitting in the parking lot of a big store full of stuff, in what looks like a nice town. They probably have homes to go back to full of people who have some money saved up, or are still pulling down a work-from-home job, so they’re not in a panic for their immediate sustenance, power, electricity, rent, medical needs, etc. The pain hasn’t hit them yet. It’s kind of a surreal vacation, with some socially-reinforced cognitive-behavioral boost.
According to Wikipedia: “Politically, Portsmouth is a center of liberal politics and stronghold for the Democratic Party. In 2016, Portsmouth voted 67.70% for Hillary Clinton in the presidential election.”
So it’s a relatively wealthy, liberal town. It is 91.5% White. They are into listening to the governor, flattening the curve, and talking about what an idiotic President we have.
In New Hampshire, the virus hasn’t had a tremendous impact. There are only 2,054 cases reported in the entire state, 66 deaths total, and Rockingham County, of which Portsmouth is a part, has 670 and it’s one of the more heavily-afflicted areas! https://www.nh.gov/covid19/
So there’s just not a lot of drama going on there. It’s an extended vacation for those nice, young, white, middle-to-upper middle class kids. They got this, man. It’s easy!
The WHO Situation Report 100 (latest) is listing India with 31,332 cases and 1,007 deaths. Switzerland has 29,181 cases and 1,379 deaths. So it looks like India is doing better than Switzerland! That’s some trick!
The caveat? These numbers are “reported laboratory-confirmed COVID-19 cases and deaths.”
Ahem. Testing availability and laboratory confirmation availability differs significantly between Switzerland and India. Probably next to nobody in the masses of lower-caste Indians have been tested. When they die, they die of death. The ones getting tested and “laboratory confirmed” are probably demographically similar to the people in Switzerland, hence the similar numbers. In other words, the numbers as reported by the WHO are not telling the full story. Cough.
And even if you believe the numbers from India, the situation is grim in India. India’s new cases and new deaths are still growing. Switzerland’s new cases and new deaths are way down from peak and on a downward trend.
Alex: My personal experience with India is obsolete at this point (last visit was in 2000).
India has advanced pharma manufacturing capability (a lot of generics). India has hospitals to which people from around the world travel for procedures, e.g., if not covered by insurance in their own country. The size of the Indian “middle class” seems to be a subject for debate (see https://www.hindustantimes.com/india-news/many-layers-within-india-s-middle-class/story-18h8YO4jgMpeivUgdKyAkO.html : “Depending on the measures used, the estimated size of this middle class ranges between 78 million (Economist, Jan 2018) to 604 million (Krishnan and Hatekar, EPW June 2017).”) but I think we can all agree that the Indian middle class contains more people than the population of Switzerland or Massachusetts. For middle class Indians, I don’t know that their health care and testing would be that different from what someone in Switzerland or Massachusetts might experience. So if there were a raging epidemic, I think we would (or will, if Bradley is correct in his prediction) see it in the WHO numbers. And, among the folks depicted in the train video you cite, I don’t see how an epidemic can be avoided if the virus is as contagious as we’ve been assuming!
@Philg:
I don’t know how to explain their incredible results any better than saying they seem very fishy to me. But here’s a professor of biostatistics from the University of Michigan.
https://news.umich.edu/coronavirus-modeling-impact-on-indias-pandemic-response/
They have an app:
https://umich-biostatistics.shinyapps.io/covid19/
And they have a series of Medium articles based on their work, the third from April 24th.
https://medium.com/@covind_19/unlocking-the-40-day-national-lockdown-in-india-there-is-no-magic-key-de4e43177cb4
“The rates at which the number of cases and deaths have doubled in India (Figures 1a and 1b respectively) are slower than other COVID-19 affected countries at the same stage of the epidemic. There have been several speculative hypotheses around this observation of slower spread, including genetics, immunity, temperature, humidity, BCG vaccinations, use of antimalarials, younger population and possibly their multifactorial interactions. Or, could it really be the effect of early prevention and lockdown?”
Alex: The prophets at University of Washington are unwilling to make a prophecy regarding India! It is not one of the countries on the menu at https://covid19.healthdata.org/united-states-of-america
The article you cite reflects an essentially religious perspective: “Lockdown may not be as efficiently implemented in India as some of the other Eastern countries but still will reduce the probability of an infected individual to meet a susceptible individual. If rightly done, this is a highly effective measure in arresting the spread of the virus.”
In other words, she has faith in the Church of Shutdown even after seeing the train video!
In her Medium article, she says “Epidemiologic and mathematical models and the examples of other countries provide support for the effectiveness of a lockdown.” despite the Sweden v. France or Sweden v. Belgium examples! I would be happy to bet that the Indian lockdown will not be as effective in separating people as the French or Belgian ones (which themselves have apparently not been effective).
She seems to be an Old Order member of the Church of Shutdown, hewing to the March 2020 dogma that the number of infections under a flattened curve will be the same: “The lockdown just delays the epidemic and buys us additional time so that we can prepare our army to go on this war against COVID-19”
This is funny/sad: “our message to the public is to proceed with prudence and caution, and not panic or drown in despair.”
Shut down the economy of an already poor country, thus condemning millions of people to death via starvation, previously treatable medical issues, and lack of shelter. Then say that you weren’t acting out of panic when you did that!
@Philg:
I didn’t want to prejudice your reading of the article with my thoughts, but I chose that paragraph because it seemed to be a great example of the liturgy.
And hey, she’s a professor in Michigan, a long way insulated from the effects of the shutdown on the millions of poor Indians who have to work, beg, or starve.
I have work in Sweden and was told today that things are returning to normal. The government left it to the individual people to decide how to deal with the virus. I am told that older people often chose to isolate themselves or limit their contacts while younger people were typically out and about. Businesses remained open and some employees worked from home and some came into the office. They are aware that for now some of their numbers are worse than their Scandinavian neighbors but the ones I work with think the trade off in terms of immediate health costs vs. long term health and economic costs and was worth it. Too bad we can’t all be like Sweden.