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Day 74: COVID-19 Italy Has Turned the Corner
The data is starting to be compelling that Italy has reached its peak and the epidemic is beginning to recede:
Deaths are lagging indicators so that when you compare the slopes of the two graphs above they make out a distinct decline in COVID-19 cases in Italy. This, of course, does not mean the illness is over or that the deaths will not continue to mount. But it does mean that there will be less illness and death going forward.
The US, nationally, is about 14 days behind Italy. But our data is heavily skewed by the NYC area. Ironically, the peak for NYC is about 7-10 days away because they do not have a flat curve, while the peaks for other localities that have flattened the curve are some weeks away. Until people see that NYC is over its peak it will be difficult to have the real conversation: when do we let people go back to work?
Apropos of that, the latest scare is that the COVID-19 indeed can be aerosolized and that everyone should be wearing the best face-covering they can manage. But the reporting on this does not address the irony that this represents: If the virus is aerosolized then many more people are exposed/infected than cases confirmed. If many more are exposed/infected then the percentage of all persons suffering serious illness and death from COVID-19 is even smaller than currently envisioned. This changes the risk profile. It also means that simply having a comorbidity is not a death sentence as the numbers of persons with a comorbidity is very large.
That is not to say that the persons who are afflicted with a severe case of COVID-19 are not suffering greatly. There are also some number of persons (as yet undetermined) who will suffer from chronic pulmonary insufficiency even after recovery. There is no need to trivialize the severity of this disease. But from a public policy standpoint, the weighing of health harms between the disease and poverty becomes more skewed in favor of poverty just based on the numbers.
And that is where an excellent article by Craig Medred, an independent reporter out of Alaska comes in. I have referenced his reporting periodically. His latest piece is Fear fear. In it Craig outlines the evolving cost-benefit considerations of lockdowns versus other public health strategies:
“Lockdown is going to bankrupt all of us and our descendants and is unlikely at this point to slow or halt viral circulation as the genie is out of the bottle,” they wrote. “What the current situation boils down to is this: is economic meltdown a price worth paying to halt or delay what is already amongst us?”
The idea has gained some traction in the medical community, but not much. Political leaders, meanwhile, have largely gone in the opposite direction. The United Kingdom suggested it might let the virus spread enough to create what is known as “herd immunity,” but quickly backed away when some scientists and the public protested.
The Dutch suggested the same idea, backed away, but are now studying it. Meanwhile there is the suggestion from many scientists that herd immunity is in some way inevitable.
At that point, the disease becomes unable to easily jump from person to person and fades out. This is herd immunity. Unfortunately, some pathogens – most notably the flu – are able mutate and again return.
Katz and Heneghan have suggested that the best way to get herd immunity might be to shelter those vulnerable to fatal COVID-19 infections and let the disease run much like the flu in the rest of the population.
“The data from South Korea, where tracking the coronavirus has been by far the best to date, indicate that as much as 99 percent of active cases in the general population are ‘mild’ and do not require specific medical treatment,” Katz argued in his NYT op-ed. “The small percentage of cases that do require such services are highly concentrated among those age 60 and older, and further so the older people are.”
But responding to COVID-19 in this way at a population-level generally runs counter to the beliefs of Western societies that prize individuals. The mere possibility that a previously unknown disease could kill younger people – and it has – appears to terrify much of the Western world.
Thus Katz’s suggestion of an alternative approach aimed at protecting the elderly and those at risk because of ill health while putting everyone else back to work has to date gained no political support.
Whether it will ever gain serious consideration is an unknown, but there are more than a handful of scientists who share Katz’s concerns about long term problems inherent in the current strategy.
And so should we all. I am going to make a prediction: by Easter, New York will be past the peak. When that happens, but sadly not much before that, the President can entertain his initial instincts that opening up America for business again needs to happen sooner rather than later.
Italy has turned the corner. China (although its totals are suspect) has done so as well. Spain will turn the corner about the same time as New York. By Easter, most health officials will still be focusing on understanding the disease, but the picture will clearer that the health crisis is receding and the economic crisis has to take priority.
[Note: Links to all my CoVID-19 posts can be found here.]
Published in General
Not that I know of, at least in the literature or in any official pronouncements. I’m sure lots of doctors and researchers have pet theories, but I think it’s still far too early for reliable studies.
However, the way one frames this question makes a big difference:
Is this a deadly virus to which young people seem to be immune, or is this a relatively benign virus that can be highly pathogenic in a minority of the population?
That may sound like semantics, but there’s an important conceptual distinction: it may be that the reason young people (and even most middle aged people) have no or only mild symptoms is because the virus is inherently benign to everyone with “normal”, healthy immune systems. In contrast, the 1918 virus had specific mechanisms it used to attack healthy bodies, which is one reason why it was particularly lethal among young (often healthy) adults.
This distinction also plays a key role in how we develop drugs, vaccines, and other therapeutic and preventive responses to the virus.
As I just explained in another thread, I don’t care to get myself invested in predictions like that.
I am surprised that we still don’t know the answer to your italicized question. The virus has been around for six months now.
I’m surprised that you’re surprised, given the type of attention you pay to these things. :-) But I am not surprised. Six months isn’t much time for coming up with solid answers.
Fair enough. But decision-makers cannot avoid it. As a governor, you can pretend not to have an opinion about, say, the in-case fatality rate or the cumulative infection rate, but then you must decide whether to to extend your state’s lock-down until May. That decision implies something about your prediction.
One of your options is not “no prediction.” You can either be explicit about your prediction or you can hide it under a cloud of rhetoric. I say it’s better to be explicit though uncertain. That way as data become available, we can update our assumptions and our responses.
We really need better virus modeling super-computing programs. I can’t believe they don’t exist yet, given the precursor viral threats such as H1N7 and Zika that we have been dealing with over the last decade. And SARS and MERS fifteen years ago.
It seems as though we should have really advanced understanding of corona viruses by now.
Research seems to go very slowly.
Depends on what kind of programs you are talking about. RNA & DNA sequencing and comparison with known sequences, widely available and very fast. Translating that into amino acid sequences (proteins) and figuring out how those fold up in 3D, tougher and slower but doable these days. Then figuring out what those proteins will do when put into a human body, only feasible in limited cases and very very hard. Living organisms are not only complex but highly variable within and among.
My thoughts keep going back to the Diamond Princess. There were 3,700 passengers on this cruise ship. According to the CDC:
In other words, only roughly 20 percent of the passengers and crew have ever tested positive for this virus. It is the other 80 percent that I am most fascinated with and have been since the beginning of this pandemic.
Speaking as just a mother, that only 20 percent actually contracted the disease sufficiently to test positively for it cannot be explained by the biosafety measures implemented on the ship after the virus was discovered to be aboard. I have had three babies, and keeping newborns safe within as near-sterile an environment as I possibly could has always made me extraordinarily grateful that the Good Lord equipped babies with an active immune system from the start. It is impossible, especially if there are older children in the household, to do that. It is my opinion that most people on the Diamond Princess were exposed to this virus at some point. I don’t see how anyone could have avoided it.
That is why I will never be convinced that some people do not have an innate resistance (I used to say “immunity,” but I’ve stopped doing that so I don’t drive Mendel nuts :-) ) to this virus. That we do not yet have a way to test for that resistance given our experience with SARS, MERS, Ebola, H1N7, Zika, and so on is just bizarre to me.
If the Diamond Princess is indicative of the general public, then as much as 80 percent of the public has a built-in resistance to this virus.
Knowing who those 80 percent are would have changed the course of history.
I don’t understand why this is not yet possible. It’s very frustrating.
You might want to check out the Medcram channel on YouTube. I’m not sure, but Roger Seheult may have some possible explanations at a level of detail that you might like. I.e. much more detailed than any news article you’ll see, but not so deep in the weeds that you can’t make anything of it. Search for Medcram Coronavirus, as he has a lot of videos on non-Coronavirus topics, too.
I’ve recently watched episodes 46 and 47, which are about the period after symptoms appear but before hospitalization is required. I think some of that information may apply to the period before symptoms appear, too, but am not sure. In any case, I’m taking some of the (speculative) information to heart in keeping my own immune system going.
Episode 47 was interesting because it features Dr. John Harvey Kellogg, generally treated as a quack doctor in the movie about him. The movie (Road to Wellsville, I think, which I haven’t seen) took things to ahistorical extremes, but the guy was a publicity hound. Because I live in Battle Creek, Michigan, I can point to lots of indirect personal connections to him. On my first bicycle excursion in roadside history in 1997, I met an old man who had been treated by him. I’m sure his story has never been published. I don’t think any of the people who encountered him at first hand are still with us, so I can tell their stories however I like! And now J.H. Kellogg comes up in a discussion of COVID-19.
Oh, I have opinions, which I adjust from day to day. And I watch the numbers and cheer on those I like. Governors have to make decisions that I don’t have to make, but they should strive to maintain flexibility, too. I see no value in my settling on a number.
Oh. Okay. I thought that’s what we were talking about.