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Day 84: COVID-19 Re-Open America; Safely but Soon
Those of you who have been following this series of posts (Day X: COVID-19….) know that I have been following this story since before the virus escaped the confines of China. The “Day X” reference is back to when the first reported case occurred somewhere other than China — signaling the potential for a pandemic. In the series of posts to date, I have marked the progression of the disease and underscored the fundamental lack of information to guide policy makers even as the demands on the health care system and the sudden deaths made some action imperative. The response of politicians was understandable and predictable –indirectly controlling the disease by directly controlling people. That is an evergreen solution for government regardless of the harm they are seeking to avoid.
The US has fallen prey to this same inclination. But at least our President finds people control abhorrent and seeks solutions to problems that reside within people, not that control them. He needs to be encouraged to continue to do so even as he is getting back-pressure from progressive politicians and their allies and other politicians fearful that people-based solutions will not work.
Tomorrow the President names and officially kicks off a task force to re-open America. That group will be considering a lot of different strategies for doing so. The one I hope they will give support to is the one that Steve Hilton, host of Fox News’ The Next Revolution is promoting. His nine-minute monologue describing it can be found here. But the plan is neatly summarized in three screen grabs from the program:
In Hilton’s monologue, he contrasts this approach with other competing ideas based on more virus testing, virus surveillance and contact tracing, and controlling people with active virus. This virus centric program involves massive population control with periodic (if targeted) lockdowns to suppress contagion. It is complicated, it is expensive, and it will continue adverse economic effects. That is why it is a progressive’s dream come true.
In contrast, the plan that Hilton is promoting focuses on prevalence testing — how many people get infected — and what specific conditions lead to serious illness and deaths. I have addressed the lack of information regarding both of these in prior posts: Day 82: COVID-19 The Missing Chart and Day 68: COVID-19 Comorbidity. No appropriate public policy can be formed without this information — how bad is the disease and who suffers the most? And yet 84 days into the pandemic these are unsettled questions.
But help is on the way if we will accept it. Hilton’s program Sunday night featured the work of academics from Stanford as well as private sector entrepreneurs who have been working on antibody tests and testing to determine the prevalence of infections in the population. If, as is beginning to be suggested by the few places that have attempted antibody testing of populations without regard to them being symptomatic or not, infection is wide-spread, then the risk of serious illness is low, maybe extremely low to a given population. If true, suppression is impossible and wrong-headed. Instead, as Hilton recommends, focus needs to be placed on identifying and protecting the truly vulnerable.
Who are they? We’ve been told without precision that they are the immuno-suppressed and the old with comorbidities. But when those comorbidities are described we don’t know whether they are talking about 100,000 or 100,000,000. @theleft coast referenced in a comment the start of a more precise description:
Ontheleftcoast (View Comment):
Study of over 400o patients looking for criteria linked with bad outcomes from COVID-19:
In the decision tree for admission, the most important features were age >65 and obesity; for critical illness, the most important was SpO2<88, followed by procalcitonin >0.5, troponin <0.1 (protective), age >64 and CRP>200. Conclusions: Age and comorbidities are powerful predictors of hospitalization; however, admission oxygen impairment and markers of inflammation are most strongly associated with critical illness.
“The chronic condition with the strongest association with critical illness was obesity, with a substantially higher odds ratio than any cardiovascular or pulmonary disease,” write lead author Christopher M. Petrilli of the NYU Grossman School and colleagues in a paper, “Factors associated with hospitalization and critical illness among 4,103 patients with Covid-19 disease in New York City,” which was posted April 11th on the medRxiv pre-print server. The paper has not been peer-reviewed, which should be kept in mind in considering its conclusions.
This is a start, but much more work needs to be done. For one, the analysis reported above needs to be converted to laymen’s language. Is “obesity” simply a BMI calculation that any of us can make? Or is it some set of conditions that overweight hints at and is confirmed by other testing? After all, according to Wikipedia —
The obesity rate has steadily increased since the initial 1962 recording of 23%. By 2019, figures from the CDC found that more than one-third (36.5%) of U.S. adults[5] and 17% of children were obese.[6] A second study from the National Center for Health Statistics at the CDC showed that 39.6% of U.S. adults were obese as of 2015-2016 (37.9% for men and 41.1% for women).
The IHME model is currently predicting that with aggressive control over the population only 61,545 people will die of COVID-19. Even if you assume that without controlling the population 100x as many would die, this would be a fraction of the US population that is obese. When you factor in the probability that the IHME prediction is high, this probability disconnect between obesity in the population and COVID-19 death becomes more pronounced. We need a more precise understanding of the comorbidities that when coupled with COVID-19 result in serious illness or death.
When we know that, it will be a much smaller group in need of protection through extreme means. And that is Hilton’s point. Rather than surveil 300 million Americans (the Gottlieb-Apple-Google approach) through their smartphones, focus on what are likely to be under 3,000,000 persons truly at risk and implement voluntary controls to protect them. The nursing home population is about 1.3 million. They reside in controlled locations and protocols can be implemented to minimize the risk to this population. The remainder are persons who can be identified and counseled regarding their risk and decisions can be made with respect to how they will live their lives.
This is a sensible, and American approach. Controlling the lives of all Americans is not.
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
I read somewhere that epidemiology is widely considered one of those fields a person enters when they don’t have the test scores to get into a better field. The author, a person who did their undergraduate degree in statistics, wrote that they were shocked at the lack of quality of their classmates and professors when they entered an epidemiology grad program. The instruction was almost all politics and hypothetical scenarios, with very little study of actual outbreaks from history. The author of the article ultimately left epidemiology for a more rigorous discipline.
Apologies that I do not have a citation, nor do I remember the name of the author or where I read the article, so obviously take the claim for what it’s worth.
Well no matter how well the staged renormalization goes, get ready for the campaigning progressive view on all that has happened. Note the organizations to which every single one of the quoted people belong:
http://enews.earthlink.net/article/us?guid=20200413/53160649-1b45-4aeb-96f1-a2772b50ef10
This is why we need continued Conservative government….So the emergency doesn’t become an open-the-floodgates stampede. Let’s have people we can trust to use discernment about what can be better emergency planning without drawing “lessons” that the entire system was wrong and every hardship by everybody (note the stress on even in normal times) has to be “remedied” by a push deeper into socialism.
Hopefully the new task force will allow America to pivot away from Fauci/Birx that are horrible communicators and are over their heads in the area of public health.
the goal was to flatten the curve.
The goal was never to lockdown until we eradicate the virus.
Excellent point. It is typical that one uses Argument 1 to achieve Objective A and then use Argument 2 to continue enforcing Objective A.
Or so we were told.
Always remember the story of the March Of Dimes whose goal was to eradicate polio but for some reason still exists.
So, Motte And Bailey Argument?
Yes yes yes!
How many times do we have to say this?
It was assumed – I thought actually desired – that we would all eventually be exposed to it. 99.9% of us will survive it. Then the problem will be over, at least until the Chinese get frisky again.
All this cowering in our homes is defeating the purpose. The curve has been flattened, dammit. Let’s all get exposed and get it over with.
Hypertension is frequently cited as a comorbidity which increases the seriousness of WuFlu. Hypertension can frequently be controlled by medication. Does only uncontrolled hypertension cause the problem, or does controlled as well?
Excellent example, @alfrench. This one that Dr. Fauci highlighted in one of his (many and diverse) pronouncements. The one I heard said that controlled hypertension was not a risk factor for a poor outcome for COVID-19.
or feminism, or civil rights…
there is nothing so permanent as a temporary government program.
They start to solve a problem, they remain to justify their continued and eternal existence.
And that includes temporary stimulus bills.
We will get rational testing around the same time we get rational election ballot counting, a rational health care system, and a complete overhaul of the US educational system.
I would love to see Steve Hilton’s 9 point plan followed, but we have already lost valuable information from the first five weeks of the COVID outbreak.
The biggest problem relating to dealing with the hysteria of the COVID situation is that the media has been owned lock stock and barrel by Big Pharma for the last 15 years. I bought a local newspaper over the weekend: COVID hysteria was in every other news story. The fact we have had 4 COVID patients here in Lake County Calif was treated by local reporters as though one in every fifteen people were infected with it. (Four out of 90,000 people living here.)
The Press Democrat in Santa Rosa was even worse. One story focused on the heroic struggle of a patient who had survived COVID. It reminded me of how in the 1940’s a local guy who fought in WWII would be treated as though he single handedly fought the battle of Iwo Jima.
Meanwhile there is nary a mention that prior to the COVID attention, some 89,00 people had died in the USA from this past winter’s horrid flu and pneumonia season. And strangely, since COVID infection in the USA cropped up, there are no deaths being reported from the plain old flu and plain old pneumonia.
Is COVID the cure for the plain old flu? And plain old Pneumonia? Or is there truth in statements by nurses on social media that they’ re supposed to treat any death where the person has died as though the death has occurred from COVID?
To be fair, it’s not just “them”.
Any organization’s first priority is the continued existence of the organization, regardless of whatever the organization’s mission statement says.
(e.g. There’s an argument out there that cities could reduce their spending on fire departments substantially without increasing the incidence of house fires because construction techniques, materials, fire codes, and fire code enforcement have improved so substantially, but they don’t do that because no politician wants to be seen as “against” firefighters.)
It’s not just flu and pneumonia. Since COVID-19 became a thing the statistics claim that rates of heart attack deaths have dropped like a stone, suggesting that even heart disease is being (mis)categorized as COVID-19. If I was a betting man, I’d wager that cancer death statistics will follow a similar pattern.
I agree with your thoughts on this, yet still need to point out the following:
Mr Bill Gates has already stated that the next ten years will be known as the “Decade of the Vaccines.” He also has attempted to educate the public that there is a strong possibility that this new virus will re-occur for people who get it and survive it. (And of course, with the fact so few people have been tested means right now we don’t know who among us may have had a mild case and survived it.)
He also quite cheerfully volunteered that if that is not the case, there will be new viruses requiring vaccines.
People think that vaccines have no cost. They are, after all, offered free of charge at every pharmacy in America from August to May for protection against influenza. (Never mind that a flu strain often mutates between the time it is cultured for the vaccine and the time the vaccine is distributed. Winter of 2014 to 2015, the flu vaccine had an efficacy rating of a mere 23%, three points lower than a placebo.)
Most vaccines, if not paid by the individual’s insurer, or Medicaid or MediCare policy would cost around 400 to 500 bucks. So if Bill Gates gets a COVID vax ready and gets it mandated on the Federal level, which is the whole reason he bribed the WHO officials to state COVID is a pandemic, then Gates and the inner circle of vaccine profiteers will get 132 billions of bucks. (The math is $ 400 per jab times 330 million Americans.) Naturally he is going to work on having a pandemic descend on us every year if he can. (And apparently as it did with regards to WHO officialdom, all it takes is 100 million dollars – for which he has little problem coming up with.)
He also made a pronouncement during a TED talk about how the world population might be reduced by his promotion of “women’s reproductive health management” and vaccines.
That is a discouraging report.
I did a year in math grad school, once upon a time, but never specifically in epidemiology. I had one college classmate who was going on to study epidemiology, but I don’t know her experience. She was a darned good mathematician.
In the prepress paper it was BMI>40.
Look at the odds ratios for hospitalization:
If you’re 75 or older your OR is 66.8. So that’s the big one. 65-74, OR is 10.9. BMI >40 has OR of 6.5, which is more or less the OR for the other risk factors.
Obesity? That’s the new SJW frontier, and all COVID-19 planning must take be sure to promote fat body positivity and avoid fat shaming and fat phobia.
Knowledge is good. It would help to know physiological vulnerabilities and exactly how they complicate the virus attack.
But I’m under the impression that the vulnerabilities encompass a huge portion of the American population. Obesity? Blood pressure? How many businesses rely only on their healthiest members?
That knowledge might not help as much as you hope.
Another thing to keep in mind is that most Republican governors hopped aboard the lockdown train. So the theory that this is essentially a power grab by Democrats seems weak. It would be more accurate to say many Democrats are eagerly capitalizing on the opportunity.
If this began with partisan problems, those problems regard information and trust more than policy. Emergency powers are a bipartisan dilemma.
And perhaps a group of people who have even fewer logical faculties than epidemiologists is our current group of politicans.
Anyone who is thinking the 2.2 trillion dollar stimulus package was well done should consider what it will do to the neediest hospitals in the country vs the better off. (And in this instance, need indicates hospitals who serve more people than others do.)
To that end, I share the following;
https://www.msn.com/en-us/news/us/nebraska-getting-dollar300g-in-federal-money-for-each-coronavirus-case-while-ny-gets-dollar12g/ar-BB12sodV?ocid=sf2
Nebraska Getting $300G in Federal Money for Each Coronavirus Case While NY Gets $12G
By Jay Hancock, Phil Galewitz and Elizabeth Lucas, Kaiser Health News
Probably few hospital systems need the emergency federal grants announced this week to handle the coronavirus crisis as badly as Florida’s Jackson Health does.
Miami, its base of operations, is the worst COVID-19 hot spots in one of the most severely hit states. (Full article at link above.)
####
Of course, if these proposed monies to shore up hospitals do get pointed out to Congress as a major failure, the same folks will just sit back down and write up another 2.2 trillion dollars stimulus act. Because after all, it is only money!
Can anyone decipher this into plain English?
Don’t put too much stock in the count from Easter Sunday. My wife is doing Covid testing and yesterday the hospital referred only a single patient for testing when they normally would get dozens or hundreds. She told me “who would want to go in for testing on Easter Sunday?” Expect the number on Monday (today) to be unusually high because of people waiting out the holiday. It is still good to hear that rates are coming down in California. The same is happening in Ohio which has almost exactly the same case rate as CA.
“Recent research suggests that we are already pushing a fifth of small businesses into bankruptcy, many of which will have taken a lifetime of honest toil to build. The proportion is forecast to rise to a third after three months of lockdown.”
Jonathan Sumption, Sunday Times, April 5th 2020
Link to Sumption’s excellent article:
https://www.thetimes.co.uk/article/coronavirus-lockdown-we-are-so-afraid-of-death-no-one-even-asks-whether-this-cure-is-actually-worse-3t97k66vj
From the website: Lockdown skeptic:
One of the most persuasive arguments for ending the lockdown is that prolonging it will lead to a greater loss of life in the long run – the cure will end up being worse than the disease, to paraphrase Donald Trump. Why? Because a prolonged lockdown will lead to a massive economic contraction and that will have a negative impact on public health. Kenneth Rogoff, the Harvard economist, thinks the “economic catastrophe” caused by locking people down is “likely to rival or exceed that of any recession in the last 150 years”, potentially leading to a “global depression”.
This argument has been set out by Philip Thomas, a professor of risk management at Bristol University, who calculates that an economic contraction of more than 6.4% in GDP per head in the UK over the next two years will result in more years of life lost than abandoning the lockdown. And a contraction of at least that size seems overwhelmingly likely, with the OECD predicting the UK economy will shrink by 25% over the next two years if the lockdown is prolonged for 18 months. “I’m worried that in order to solve one problem we’d create a bigger problem,” says Professor Thomas.
Needless to say, Thomas’s analysis has been vigorously challenged, with some economists disputing that downturns cause an overall loss of life. (Curiously, the people challenging Professor Thomas’s research are often the very same people who claim that “austerity” killed 130,000 people.) While it’s true that the years 2007-09 saw a rise in suicide rates in the US and Europe, and economic slumps generally coincide with a rise in ill-health, domestic abuse and violent crime, that doesn’t necessarily translate into a rise in mortality.
https://lockdownsceptics.org/what-is-the-economic-cost-of-the-lockdown/
Quibble: Epidemiologists are eminently logical. The problem is that the axioms from which their logic flows tend to be very limited.
Rising suicide and domestic abuse are valid concerns. But no one was excitedly promoting employment for the sake of reducing suicides and domestic abuse before the lockdowns. That’s an argument of convenience.
We all understand how serious an economic depression is. If a truly deadly and widespread epidemic broke out, that would similarly wreak havoc on an economy. The presumption at the start was that COVID-19 would not focus so starkly on retirees.
they use too many variables and rely on questionable assumptions
No, they keep adding new fire stations and giving them more and more “duties”, such that every single auto accident requires multiple Fire Department emergency vehicles, blocking off entire city blocks, while 15-20 “fire” personnel stand around for an hour or two. By requiring that ever call is a “3 alarm” emergency, they justify their continued existence and ever increasing funding.
It’s sickening.