Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Day 66: COVID-19 Numidiocy
I don’t know whether the word coinage “numidiocy” is unique to me. It is a contraction of number idiocy. That is, whenever numbers get so numerous that it ceases to convey clear and useful information. I am not autistic. I lack the focus (and likely the faculties) to scan tables and graphs and inerrantly sense the important from the irrelevant. I hear the arguments that people make for how to order the significance of this datum versus that. In the screengrabs above I have ordered them by “active cases,” for instance, believing that “total cases” do not necessarily best reflect the present challenge.
And then there is the time element. In the screen grabs above I show Yesterday versus Now. This Worldometer chart is updated continuously as and when information is available. The current counting restarts daily at 0:00 UTC, which is 8 p.m. EDT and 5 p.m. PDT. Imagine each column that includes “new” in the header being a bucket into which water is poured and measured throughout the day with the water coming from lots of vessels of varying sizes being dumped at various hours of the day. Then the bucket is kicked over and emptied and the filling begins again.
So screengrabs of tables at random times tells of a moment, but it doesn’t provide context. And that is why graphs can be useful. @snirtler focused my attention on 91-DIVOC that provides some outstanding graphical displays of information. (91-DIVOC reflecting COVID-19; clever, right?) It lets you slice and dice data, time, place, numbers, and trends both in linear and log form. It wonderfully juxtaposes information about countries and US states in a seemingly useful manner until I realized what it wasn’t showing me and the data noise that it was.
In each chart, there is a dashed line — straight in the log presentation, curved in the linear presentation. That line represents 1.35 daily growth:
In nearly every country in the world, when the virus reaches 100 people the number of cases begins to increase by 35% daily. (Dashed black line.)
With that dashed line in place, you can clearly see countries or US states progress through time at either greater or less than 1.35 growth. The implications are clear: Countries and states with sustained growths above 1.35 are moving into greater difficulty; countries and states below 1.35 are moving into lesser difficulty. The charts comparing countries and states by population start to add noise because what does it mean that Vatican City and San Marino are so far above the 1.35 line on a per capita basis? (Somebody really needs to work on the dataset for these small places.)
As I stared at these charts I began to ask myself what is the marginal utility of the data? Yes, countries and states above the dashed line are having more cases, more deaths than they would have if they were below the line. But where is the “existential threat” line for that country or state? Where is the line where the health system fails? Where is the line for a set of cascading events that condemns them to a season of desolation and of indeterminate length? And the placement of those lines varies by locality, not just country or state.
I think it was back in the ’90s when the concept of a “dashboard” for management came into vogue. Like driving a car there would be a limited number of data outputs — speed, temperature, battery, RPM– that could be quickly scanned to determine that things are running just fine. Yes, there could be warning lights lit when the system said some combination of events were not in order. (A “check engine” light begs inquiry, it doesn’t render a verdict.) And senior managers would gather periodically to review the color-coded dashboards that reflected algorithms fashioned within the bowels of the various departments and operations. This was considered state of the art management.
But we all know the “decision makers” were far away from the point where things went wrong. The line mechanic, if properly trained, could see where welds were failing, where lubricants through addition of grit and incessant thermal assault had lost their ability to do the job. But the mechanic did not control supply chain for needed maintenance, the budget for supplies, the credit line that secured funds when revenues were unsteady. Somewhere in the dashboard the data all came together as green, yellow or red. The check engine light lit, or it didn’t.
Crash scene investigators exist because either our dashboards are faulty, misunderstood, or ignored. Sometimes all three.
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
One variable in the equation is how many would be made sick if there were no temporary shutdown. If your customers die or become disabled by the disease, you will be losing money in that way too. I think it is a tough call. I support President Trump’s actions this week and his attitude to get things back to some sort of new normal by April 12. I like what he said about the pent-up demand making the post-shutdown period prosperous. In the two weeks we have, we can work on developing and implementing contagion control equipment and procedures.
Quoting my comment in the Chix PIT last night, and let me emphasize the word “billion”:
I think the lesson here is we should ignore the Vatican :-)
I wonder if we are too late to use the one tool in the box at present (“social distancing”). A theory by British scientists (which everybody acknowledges needs a data-driven antibody study to be verified) is that 50% of the citizens of the UK have already had the virus and that a “herd immunity” response is already underway. If that is true, then (a) the rate of serious infections and death is magnitudes lower that it currently appears and (b) it is too late to get much benefit from self-isolation strategies.
My daughter and son-in-law reported having a lingering intense dry cough with fever at the end of December/beginning of January. Their toddler and the new infant were unaffected. She works for a dentist and said many people cancelled appointments at that same time complaining of similar symptoms. They live in Savannah—America’s fourth largest shipping port with an enormous foreign cargo volume.
Wish somebody was doing antibody testing there and elsewhere to see if the bug has been running loose for a lot longer than we knew. Not knowing this and much else while having to hunker down under unchallenged worst-case assumptions is frustrating for us all.
THERE IS A SOLUTION!!! Buy your very own finger-prick test!!!!!
Most hospitals are “non profits” or public. Only 26% are for-profit. They are a reliable cash cow that take in $1.3T/year growing at 5.5%. Hospitals are amazing growth industry and will gladly rent you a bed for $5K/night. It is very hard to go broke with so much tax dollars being thrown around.
Yes, and all jurisdictions with small population sizes. If Worldometer would simply not generate a number for countries and territories with have less than 2 million residents (and possibly some number above that but I am not sure what that should be) then the resulting number for comparison purposes would at least be a fraction of the total cases, rather than a multiple. But other graphics that display Worldometer data will get these multiples of actual cases with the smaller the population the larger the result.
Most hospitals are poorly managed. Too much overhead. Far too reliant on Medicare and Medicaid reimbursements.
Agreed. It’s also more difficult to pull off than specialized components like ASC’s, imaging centers, etc. On the other hand they have some things going for them too: they get favorable reimbursement rates over other types of providers (even for the same services). Plus they have more political and economic clout than other healthcare providers.
I am extremely skeptical of the estimate that 50% of the entire British population have already caught the virus. Right now the official infection rate in U.K. is at 172 people per million. A rate of 50% rate is nearly three-thousand times higher than that, meaning that for every confirmed case, there are nearly 3,000 more infected people that they have not detected yet. If testing is anything remotely like it is in the U.S., then 95% of sick people thought to actually have the disease are coming up negative, as I pointed out in an earlier comment. With a 50% infection rate, virtually all people with symptoms would be coming up positive on the tests.
Not only that, but commonsense tells you that if half of the entire British population were sick, somebody would have noticed by now. Even assuming that 1/2 of people do not show symptoms, then surely a sickness affecting 1/4 of the population would not be missed.
50% infection doesn’t mean half the population is sick.
What evidence do you have for your assumption that only 1/2 of people infected do not show symptoms?
I think the article premise is that exposure (presumably enough for some antibodies to form) does not result in any symptoms in the great majority of those exposed and that the great majority of those who get sick do not get sick enough to present for treatment. The conclusion would be that the bug is more contagious but far less lethal than the government-accepted models predicted. Given that nobody was looking for the bug nor had any way to test for the first month or more it could have been present, who knows?
The British experts have come way, way down from the earlier 500,000 / 2,000,000 deaths in U.K. / USA. so there is likely some validity to the critique offered by the Oxford epidemiologist.
This, exactly, is why I contend that our national agency senior medical experts have proven themselves brilliant amateurs:
The “existential threat” lines should be something like two lines:
Get those two planning factors and you can do competent planning and logistical support, then refine the plans and logistics estimates as you get refined models of the way a disease is progressing in a given area.
Worldometer’s calculation is correct. You take # of cases, divide by population, then multiply by 1 million. Here: 4/801*1,000,000 = 4,993.76.
The 801 population is from — you guessed it — Worldometer, here (at the very, very bottom of the chart).
Yes but it complicates malpractice litigation—Army through Federal Tort Claims act but civilians under state common law. We can’t have volume treatment plans that work if it is also gonna make subsequent lawsuits harder to bring. Priorities, man.
The time to have done this was in the 17 year between the passage of the 2003 legislation and today. You needed to have teams with skills in public health, economics, logistics, and project management to think through scenarios from a process perspective.
In addition, once a pandemic hit, you would have an operational team with that expertise ready to roll regarding each part of the response. I see the public health and economics side but what about logistics and project management? If there, it lacks visibility.
On the other hand, some of this was already known and not acted upon. For instance, we depleted the N95 reserve with the response in 2009 to H1N1 and did not replenish in the intervening decade. Even then the existing stockpile was only a fraction of the 1 billion N95s we would need in the event of a major pandemic. The way you would do this from a planning perspective is to have a larger stockpile with a logistics manager liaising with the current producers and having done the homework so everyone would know how quickly they could scale up to fill the pipeline.
Many people are arguing that not all people who are infected are showing symptoms or sickness, so I took the only known sample I know of where they tested random people instead of just sick people, in Iceland. They are finding that about 1/2 of all people coming up positive for the virus are not exhibiting any symptoms. The other half are.
https://english.alarabiya.net/en/features/2020/03/25/Coronavirus-Iceland-s-mass-testing-finds-half-of-carriers-show-no-symptoms
https://www.dailysabah.com/world/europe/icelands-mass-testing-shows-half-of-covid-19-carriers-have-no-symptoms
why is there a hospital shortage if hospitals are cash cows?
hospitals are not cash cows or profit centers.
Medicaid reimbursements are low.
Medicare is getting lower every year.
Much depends on the zip code.
poor zip codes get lower reimbursements which exacerbates the financial strain.
hospitals are not a growth industry.
Good Samaritan hospital in Los Angeles still has coin operated pay phones.
The hospital is too cheap to hire someone to remove those pay phones that no one uses today unless your last name is soprano
50% infection rate is laughable.
on the diamond princess cruise which docked in Japan, the infection rate was 20%.
3711 passengers and crew.
the fatality rate was 1.1%
I didn’t say that, and I dont know that there is a shortage of hospitals. I do know that many states and localities have some kind of community need standards before they ok any medical facilities (like ASC’s).
I believe the incidence of asymptomatic infection on the Diamond Princess was also approximately 50% (51% of 619 individuals). If I read the most recent analysis of that population correctly, the likelihood of a false negative test appears to be significantly greater for asymptomatic individuals, suggesting that the asymptomatic or very mildly symptomatic population could be larger than the numbers suggest.
There are a lot of ways in which medicine is prevented from responding to market forces. Hyper-regulated industries that derive a lot of their revenue from government sources are generally poor examples of the invisible hand in action.
Or does it mean that it is not a novel virus after all? That’s what I keep wondering. It seems possible to me that that is the error the biologists may be making and that the immune system in some people is recognizing this virus.
Marci, I’ll start by saying that I know nothing about health care or biology. Then I’ll inexplicably fail to shut up, and keep on talking.
Is the mechanism that causes the virus to be harmful, that causes symptoms to become evident, an aspect of its novelty? That is, is it the unfamiliar nature of the virus to our immune system that causes the symptomatic response? Or does that lack of familiarity merely make the virus more contagious and harder for our bodies to resist, without necessarily impacting the virulence of the illness itself?
I don’t know. I can easily imagine that we could have a highly contagious virus — one that is alien to our immune system and so meets no resistance — that is entirely benign and therefore presents no symptoms. I can also imagine one that is familiar to our immune system and so hard to catch, but horrific in its impact once infection is achieved.
I’m going to guess that the novelty relates more to the contagiousness than to the seriousness of the infection, and so isn’t a factor in matter of it being asymptomatic (at least) half the time.
Having said that, the oft cited 20% infection rate — cruise ships, medical personnel — makes me wonder, given how low it seems, if even its novelty makes it all that contagious.
But, as I said, pure speculation on my part.
Thanks. I didn’t know that.
Steven, let me cautiously refer you to this piece at Watts Up With That. I say “cautiously,” because a key element the article’s argument — that the case fatality rate of the Diamond Princess passengers was lower than had previously been thought — has credibly been called into question as some passengers remain in critical condition and an additional one has died. But the doubts raised don’t impeach the data included in the article, some of which is quite interesting.
I think the only reason it might matter is that more people might have some natural resistance to it than we think. If only we could figure out how to test for that. Perhaps Google and Microsoft and IBM can figure out how to test for it. Then we could help the hospitals in staffing them with people who have this inherited resistance to it. Right now, we can test for the presence of antibodies to it. We’re still figuring out if that will help–there have been a few, just a handful, as I understand it, people who come down with the disease twice. We don’t know if those are relapses from insufficient healing or entirely new reinfections. We soon will. If we add to that number of recovered and therefore resistant to it to another group with some inherited natural immunity to it, that would liberate a lot of people from quarantine.
I remember when HIV was first identified, the general public was really afraid of it until scientists learned that stomach acid killed that particular virus. From then on, people felt a little better about it knowing that they couldn’t get it from eating food that had been handled by someone who was infected.
This may or may not mean anything; the numbers are there if you dig.
For at least two days now, the Johns Hopkins map hasn’t given the aggregate total of US COVID-19 deaths, but a long list by location. If you want the total from them you have to add it up. Is the data available elsewhere? Sure.
Also, SARS-CoV-2 virus persists in the stool of people whose respiratory tract tests clear. This raises concern about oral-fecal spread of COVID-19
From the same link as the previous item:
And: