Category: Coronapanic

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?

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On April 1, I asked “What did the hand sanitizer end up being useful for?”

On March 21, I asked “Why isn’t hand sanitizer back on store shelves?”

Despite a 1-per-customer rule, shops continue to be sold out of the stuff, right? How is that possible? As noted in my March 21 post, office buildings, non-essential stores, gyms, schools, etc. that used to buy hand sanitizer are now shut down.

Health care workers? The typical doctor and nurse who used to see patients, sanitizing every 10-15 minutes, is now mostly unemployed. Do these people need to sanitize in between filling out each new unemployment or government bailout form?

Hospitals/ICU? Most are furloughing staff. If they have fewer workers, how can they be using more sanitizer? They always used some before when going in and out of patient rooms, right? With fewer workers and fewer patients, how can they be using more?

“First responders”? Police and firefighters had hand sanitizer before. Do they need 10X of what they used to order and keep in their vehicles?

The typical consumer is imprisoned at home, right? So maybe he/she/ze/they will want to stockpile 4 bottles: one for each car, one in the kitchen, one in the bathroom. Due to the miracle of leaving the house only twice per week, however, those 4 bottles should last a year or more.

If the plants are running 24/7, where is all the extra hand sanitizer going? Why aren’t Target, Walmart, and Costco bursting with the stuff?

Related:

• “The history of hand sanitizer—how the coronavirus staple went from mechanic shops to consumer shelves” (CNBC)

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An interesting work of journalism from the Washington Post: “U.S. deaths soared in early weeks of pandemic, far exceeding number attributed to covid-19”

The analysis is similar to the New York Times effort that was the basis of “Infidels in Sweden are refusing to die” (at the time, Sweden in its refusal to shut down had 1/25th the percentage of “excess deaths” compared to the shut-down-for-a-month New York City). The authors take a deeper look at the U.S. overall.

Let’s start by trying to raise everyone’s coronapanic with a chart that starts at 40,000 rather than 0. This makes the recent rise in overall deaths look a lot more scary:

Americans are dropping dead at an alarming rate, either from Covid-19 or from the shutdown of the regular health care system or maybe from eating too much while lying on the couch! (to the newspaper’s credit, a tiny zero-based chart is presented at the bottom right of the above figure)

Almost all of these excess deaths are from one place: the New York metro area. And it is difficult to know whether their Covid-19 death numbers are comparable to other parts of the U.S.:

No jurisdiction has been as aggressive as New York City, the U.S. epicenter of the epidemic, in revising its death counts from those early weeks. As of Saturday, the city had added 2,542 covid-19 deaths to those figures, driving the total from that period up to 5,085. The newly added deaths were almost equally split between cases that were confirmed through lab testing and cases that were deemed “probable” covid-19 deaths based only on symptoms and exposure.

How does it look around the bad parts of the U.S.?

(By applying the miracle of begging the question, the above charts, with their dramatic increases in deaths after the shutdown began, actually support continued faith in the Church of Shutdown. Asked how they know that shutdown works, the faithful in the Religion of Shutdown generally respond with “the high number of deaths shows that it would have been far worse if we hadn’t shut down.”)

Is the headline a good summary of the article? Are U.S. deaths soaring? We are all in this together, right?

But in dozens of states, the Yale analysis shows that the reported number of overall deaths are either unchanged or even slightly down compared with historical patterns.

Should we suspect from these data that the problems NYC has had with Covid-19 are idiosyncratic? Some other cities and regions also had exposure starting at roughly the same time (mid-January?) and those places locked down within a few days of the NYC shutdown. Yet excess deaths are fairly low (or actually negative) almost everywhere other than NYC.

Is it possible that we’re fighting a nationwide war against a virus that is attacking only a handful of cities for reasons that are peculiar to those cities? Or possibly peculiar to the strain of the virus that has been circulating in those cities? If we take out metro NYC, Detroit, New Orleans (they’re not going to have a second Mardi Gras this year, right?), and Boston, does the “U.S.” actually have excess deaths or any kind of problem with Covid-19 that couldn’t be handled with the most basic precautions?

(And how would we handle the apparently idiosyncratic problems with these cities? Tell New Orleans that Mardi Gras is henceforth restricted to the sober (90% reduction in crowding?). Reopen the United States economy and use the money to pay roughly half of NYC residents to move out to suburbs and other states. The super high density plainly has made NYC a breeding ground for any enterprising virus. Run more subway trains in Boston so that people aren’t jammed in like sardines and/or pay people to leave the city, as in New York. I’m at at loss to know what to do about Detroit, I must confess!)

In the meantime, we’ve got healthy young people in North Carolina who are under a stay-at-home order. Their personal risk from Covid-19 may be smaller than their risk of being hit by debris from the International Space Station. Have these young people lost their freedom and jobs (and their children their education for this spring) merely because of an accident of political geography, i.e., that they’re inside the same nation-state as plague-ridden New York City and Boston?

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The richest NYC-area folks whom I know have moved away to escape coronaplague and the associated lockdown. Why be in an apartment, even a $10 million one, if restaurants, museums, theaters, and offices are shut down? The refugees from Covid-19 have washed up in large oceanfront mansions, all of which are outside of NYC and most of which are outside of New York State.

If they decide to stay away for the entire summer and into the fall, coinciding with the minimum expected period of quasi-shutdown they will hit the magic 183 days for 2020. At that point, why will they pay NYC and New York State taxes on income derived from interest and dividends, for example? Haven’t they inadvertently accomplished what 183-day Florida or Puerto Rico residents have previously done intentionally?

This has happened to a lesser extent for my Massachusetts friends during coronapanic (many of whom actually turned into Florida or Texas residents starting in 2018 when the new tax law went into effect).

States can’t print money so they need to borrow, cut spending (hah!), or default (as they did in the 19th century). What happens to New York if their richest taxpayers aren’t around for enough days in 2020 to be hit?

Related:

• “One Top Taxpayer Moved, and New Jersey Shuddered” (NYT, 2016)
• “South Florida sees swell of new residents moving from high-tax states” (Sun Sentinel, January 2020): South Florida saw a more than 60 percent increase in net personal income over 2017, and Palm Beach County alone saw a 20 percent increase, according to the IRS, which tracks changes in personal income through address changes on annual tax returns.

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From a neighbor:

I reached home last night (April 23) about 12:30. Nine hours of road
transport was followed by a three hour flight to Delhi, then a fifteen hour flight to San Francisco. and finally six hour flight to Boston in two legs (Delta via Atlanta) … i reached San Francisco about 5:30 AM yesterday. They said that the Customs would not open till 6 AM and we lingered on the runway. Coming to the terminal, the luggage did not show up for
two hours. Nobody explained. Then we were led to go to other terminal for our domestic flight. No testing or health checking was done. None of the airport employees (Police, TSA and Customs) had masks and nobody was enforcing anything. It was very different from Delhi where Corona warning was everywhere.

Californians pride themselves on having a lower rate of plague than New York, Massachusetts, and other parts of the U.S. They attribute this to their superior political leadership (yet the University of Washington prophets show that they shut down schools a little later than Massachusetts and non-essential businesses a little earlier; maybe they have a different strain of the virus?). But if they don’t at least pick up some masks and forehead thermometers for people arriving from the plague lands, won’t they just catch coronavirus as soon as they emerge from their bunkers?

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As a measure of how desperate things have become, I’ve taken to reading poetry to the kids (denied their precious and wholesome screen time due to a cruel policy of the local dictatorship).

Here’s “Happy Thought” by Robert Louis Stevenson:

The world is so full of a number of things,
I’m sure we should all be as happy as kings.

Helpful adjustment for those whose lockdown is urban:

The world apartment is so full of a number of things,
I’m sure we should all be as happy as kings.

You’re welcome!

Separately, I have composed some original haiku:

Looked up from my phone
Who’re these people in the house?
Coronavirus

Students stare closely
Zoom lecture is spellbinding
Retriever in frame

You’re double-welcome!

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Here are some folks who, had they been listened to, could have saved Americans, or at least Texans, a lot of anxiety… “Stockpiling Ventilators for Influenza Pandemics” (Emerg Infect Dis. 2017 Jun; 23(6)) by Hsin-Chan Huang, Ozgur M. Araz, David P. Morton, Gregory P. Johnson, Paul Damien, Bruce Clements, and Lauren Ancel Meyers.

Some excerpts:

In preparing for influenza pandemics, public health agencies stockpile critical medical resources. [except for masks?]

When severe influenza outbreaks cause high rates of hospitalization, a surge of medical resources is required, including critical care supplies, antiviral medications, and personal protection equipment. Given uncertainty in the timing and severity of the next pandemic, as well as the time required to manufacture medical countermeasures, stockpiling is central to influenza preparedness. However, difficulty in forecasting and limited public health budgets often constrain decisions about sizes, locations, and deployment of such stockpiles.

Mechanical ventilators are essential for treating influenza patients in severe acute respiratory failure. Substantial concern exists that intensive care units (ICUs) might have insufficient resources to treat all persons requiring ventilator support. Prior studies argue that current capacities are insufficient to handle even moderately severe pandemics…

The Centers for Disease Control and Prevention (CDC) manages this Strategic National Stockpile (SNS) and has plans for rapid deployment to states during critical events … However, SNS ventilators might not suffice to meet demand during a severe public health emergency. In 2002, the SNS included ≈4,400 ventilators, and 4,500 SNS ventilators were added during 2009 and 2010. The American Association for Respiratory Care suggested the SNS inventory should increase to at least 11,000–16,000 ventilators in preparation for a severe influenza pandemic.

Our retrospective analysis of the 2009 influenza A(H1N1) pandemic in Texas suggests that hospitals had enough ventilators on hand to treat all patients requiring mechanical ventilation throughout the pandemic. Although these quantities are expected to suffice for a moderate (1957- and 1968-like) pandemic, in which hospitalization rates roughly triple, they would fall far short in a severe (1918-like) pandemic. If we optimistically assume perfect deployment, that is, 0 wastage, by assuming timely delivery, adequately trained and available staff (respiratory therapists, nurses, and physicians), sufficient space to care for a potentially large number of patients, and requisite ancillary equipment and supplies, then even a central stockpile of 8,900 ventilators in Texas—the total number of SNS ventilators in 2010—would fall short, with an expected unmet demand of 576 patients.

Who will vote with me to put these folks in charge of the next plan to fight the last war? And who will bet that if we’d ordered ventilators in 2017 for delivery in 2018-2019 it would have been a lot cheaper?

Note: I found this paper while trying to search for what it might cost to treat a COVID-19 patient in a U.S. hospital ICU with ventilator support. Of course, that was a question that was impossible to answer.

Was this knowledge new in 2017? Has anyone done a study of what it would look like to prepare on a national level, not just in Texas? The Texas paper provides references back to 2006, all coming to the same conclusion: we need to stockpile a bunch of stuff if we want to be ready for a flu or flu-like pandemic.

One of the references from 2015 is “Estimates of the Demand for Mechanical Ventilation in the United States During an Influenza Pandemic”. It is authored by five government workers, four of whom were at the CDC (during the sorely missed administration of Barack Obama!). The authors suggest that more than 60,000 additional ventilators to provide a reasonable assurance of nobody dying for want of a ventilator. What was their conclusion for the administration and Congress of 2015?

The challenge for public health authorities is to plan and prepare how to best respond to the next pandemic that will cause such a rapid and large demand for mechanical ventilation in critically ill patients. Ventilator preparedness planning has to be prioritized against competing influenza pandemic preparedness planning efforts. The time to start planning is now, and the results presented here may help guide such efforts.

What did Barack Obama do in response to the authors’, all of whom worked for him, projection that 308,000 Americans would die if a flu pandemic hit and the ventilators weren’t stockpiled? A month after the paper:

President Obama on Friday hailed a Supreme Court decision legalizing same-sex marriage nationwide, saying justice has arrived “like a thunderbolt” for gay and lesbian couples.

Obama opposed same-sex marriage when he was first elected president in 2008. He backed it before the 2012 election, saying his views had been “evolving” during his time in the White House.

“Today, we can say in no uncertain terms that we have made our union a little more perfect,” Obama said from the Rose Garden.

From July 2015:

“What I found during the course of the presidency, and I suppose this is true in life, is that investments and work that you make back here sometimes take a little longer than the 24-hour news cycle to bear fruit.”

Well, he was right about this particular investment decision! (to not purchase PPE)

He had developed clairvoyance by November 2015:

“There’s no doubt that the longer I’m in this job, the more confident I am about the decisions I’m making and more knowledgeable about the responses I can expect. And as a consequence, you end up being looser. There’s not much I have not seen at this point, and I know what to expect, and I can anticipate more than I did before.”

Was there any politician that saw this coming? George W. Bush!

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