The Wuhan Coronavirus in Michigan

 

For the last few weeks, I have been—for the most part—hunkered down at home in south-central Michigan. I drive to my office on the Hillsdale College campus two or three times a week to teach my seminars (“Machiavelli, Erasmus, and More” and “The American Constitutional Convention”) via Zoom. I would like to be able to report that I have used the time I have not spent traveling to deliver talks and participate in conferences in Pittsburgh, at Arizona State, Louisiana State, Harvard, Boston College, and in Portland, ME, to write articles and book chapters and get a start on my next book. But I haven’t. Instead, I have begun reading Decameron with my wife; I have watched season three of “Babylon Berlin”; and I have read article after article on the internet.

I will have to confess that I have not learned much that I did not already know. Xi Jinping and his minions lie and are more than willing to sacrifice the lives of their fellow Chinese in a vain attempt to avoid embarrassment, and the like can be said of the Ayatollah Khamenei, of Vladimir Putin, and of their minions. The CDC is incompetent. The FDA is so wrapped up in red tape that it cannot respond to a genuine crisis. The World Health Organization is profoundly corrupt. The models that epidemiologists construct are not necessarily more reliable than those employed by climate scientists. Donald Trump tends to say the first thing that comes into his head. Michael Bloomberg is a stooge for Xi Jinping. Bernie Sanders is crazy. Joe Biden is senile. Nancy Pelosi and Charles Schumer are attempting to take advantage of a public health crisis to push a partisan agenda, and they resolutely attack the President for foolishness they are guilty of themselves. And, yes, the mainstream press is so irredeemably corrupt that their antics would be an embarrassment to the yellow journalists of yesteryear. I knew all of that before I entered my confinement.

I wish that I could say that I now know a lot more about the Wuhan coronavirus than I knew before the lockdown. But that is not true. Reading what the “experts” say about this epidemic is like reading what the “experts” say about the likely trajectory of the stock market. Those of us who are advanced in age are anxious about both, and there is no consensus about either. In the latter case, prognostication is for the most part always guesswork. In the former case, there are too many unknowns, and guesswork and anecdote are close to all that we have to go on.

Sure, the coronavirus is exceedingly contagious and we cannot rely on herd immunity. But how contagious? Here expert opinion differs, and the evidence is scanty. The same goes for the number of those infected and for the mortality rate. The statistics that we have are not reliable – even where the authorities who compile these statistics are thoroughly honest and decent. We are caught in the same sort of “fog” that we would be trapped in if we were at war, and it is virtually impossible to make intelligent public policy decisions in these circumstances. How much worse is this epidemic likely to be than the worst of the recent flu epidemics? If we only knew . . .

Still, there are a couple of things that one can discern, and here I wish to deploy the evidence from Michigan (such as it is). Take a look at this map. With your cursor, you ought to be able to touch on the various counties and learn how many Michiganders have been diagnosed with the coronavirus and how many have died with it (if not necessarily from it):

As you can see, something like 80% of those diagnosed with the disease and 80% of those who have died live in three contiguous counties – Wayne, Oakland, and Macomb – and most of the rest reside nearby or in the vicinity of Grand Rapids. What the three counties mentioned above have in common is proximity to the Detroit Airport, which is a major hub with a host of direct flights to Asia and to Europe. Southeastern Michigan would appear to be an epicenter for the disease for the same reason that New York City and the nearby counties on Long Island, in upstate New York, and in New Jersey form an epicenter. Had we cut off all international travel earlier than we did and had we shut down domestic air travel early on, this epidemic might have much more easily been contained – and we might have been spared the economic travails now underway. I do not mean to cast blame on anyone – except for Xi Jinping and his stooges at the World Health Organization who bamboozled us. I mean only to point to the conduit by which this epidemic spread.

There are two other patterns worth noticing. In Michigan, men with the disease are far more likely to die than women. The numbers change daily, of course, but the proportions – 57% men, 43% women – are stable. Moreover, senior citizens are especially vulnerable. As of 6 April, those over 60 made up 24.2% of the state’s population and 61% of the fatalities, and the median age of those who die is, as of yesterday, 75 (it has gradually crept up from 71). The fact that women over that age greatly outnumber men over that age adds to one’s impression that men are much more vulnerable. The reason is, I presume, genetic.

There is one other pattern that is evident. A disproportionate number of those who die are African-American. Blacks make up 17% of the state’s population and 40% of those who die from the disease. The local liberals in these parts trace this to racism, but that makes little sense. If anything, there is discrimination here in favor of African-Americans, not against them. The discrepancy no doubt has something to do with place of residence and a lack of social distancing. There is a large African-American population in Detroit, which is densely populated. It may also have a genetic component. The propensity to succumb to particular diseases often does have such a component. Eventually, we will know.

Nothing that I have said here should be surprising. The same patterns are evident elsewhere. Like the flu, the Wuhan coronavirus spreads through social networks, and the older and more decrepit one is, the more likely that, if infected, one will die.

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  1. Ontheleftcoast Inactive
    Ontheleftcoast
    @Ontheleftcoast

    CarolJoy, Above Top Secret (View Comment):

    For some reason, our medical experts are not demanding hydrochloroquine, an anti malarial which is being utilized in every nation from Switzerland across Europe and down to the ultra rich nation of Bahrain.

    Most people who get COVID-19 don’t get horribly ill, so presumptive treatment with an inactive drug (i.e. placebo) before people do get that ill will look great even with placebo. Sorting that kind of thing out is why double blind placebo controlled studies are done. As these studies start to produce results, the results do not look good for hydroxychloroquine as a cure. Many of the really favorable studies use crappy outcome measures and treat patients who aren’t that sick.

    Chris Masterjohn goes into detail about two new studies in prepress, and provides some information about sorting out crappy from good studies along the way.

    Two preprints* were released yesterday that add to the growing evidence that hydroxychloroquine is not useful in COVID-19, contrary to all the hype.

    Please note that I am not a medical doctor and this is not medical advice. A more detailed disclaimer can be found at the bottom of the page.

    Let’s take a look at the data.

    A Second RCT Confirms No Effect of Hydroxychloroquine

    The first randomized controlled trial (RCT) of hydroxychloroquine was published in Chinese. I used Google Translate to read it, and analyzed it here. It was a small study done in 30 patients and found no effect of 400 mg hydroxychloroquine once a day for five days on clearance of the virus after seven days or two weeks.

    Low lymphocytes is a good predictor of poor outcome in COVID-19, but:

    Unfortunately, the authors do not report the absolute concentrations of CRP or lymphocytes. They only report the change from baseline.

    Whenever I see a paper that only reports change from baseline, I assume the authors are hiding behind bad data and trying to cover up a statistical artifact like regression to the mean. Regression to the mean is the tendency for a randomly high value to come down, and a randomly low value to go up. If the baseline CRP in the hydroxychloroquine group was 50 and was 45 in the control group, then a 7-point decline in the hydroxychloroquine group and a 3-point decline in the control group would bring both groups to 43, an identical level. You would expect something like that from regression to the mean.

    I wrote a post explaining this nine years ago, How a Study Can Show Something to Be True When It’s Completely False — Regression to the Mean.

    And:


    The Second Study: No Effect in Severe Cases


    The second preprint released yesterday was appropriately titled, No evidence of clinical efficacy of hydroxychloroquine in patients hospitalized for COVID-19 infection with oxygen requirement.”
    This was not a randomized controlled trial. Instead, they collected data from routine care to “emulate” a trial.

     

     

     

    • #31
  2. Ontheleftcoast Inactive
    Ontheleftcoast
    @Ontheleftcoast

    I’ve caught flack for quoting Derek Lowe, but ad hominem arguments don’t convince me as much as someone who knows what he’s talking about, even if he works for Big Bad Pharma, (whose many sins I am well aware of.)

    There are many clinical questions for which DBPCTs are not the right (or an economically feasible) tool, but “does drug X work for acute disease Y” is one for which they are the right tool.

    Lowe discusses the same new results as Masterjohn, and goes on:

    I get plenty of email and Twitter static to the effect that I’m favoring on-patent compounds like remdesivir over cheap generics like hydroxychloroquine, so let me reiterate the point I made earlier in this post: remdesivir isn’t looking very impressive, either. There is as yet no reason to recommend its use in the Covid-19 epidemic, either, as far as I’m concerned, and its ongoing trials are going to have to really look different from what’s come before, too. Honestly, at the moment, I don’t see any small molecule antiviral therapies that have much to recommend them based on the evidence in hand. Let’s hope that changes; there are quite a few being evaluated, and we really could use some encouraging data.

    And while we’re mentioned email and Twitter static, the number of people who are telling me that I need to believe Dr. Raoult and the Marseilles group and that we need to immediately give everyone hydroxychloroquine, well. . .they’re beyond counting. But here’s how it works: if you come across an interesting, unusual, or potentially useful result, you then have to subject it to more and more stringent tests under different conditions. Something real will be able to pass some of these. You’ll get information and guidance from seeing when the signal is there and when it isn’t. But there are huge numbers of flickering, fluttering, hazy results that just seem to evaporate when you put the magnifying glass on them, though. Every time you zoom in, every time you give them the tiniest hurdle to jump over, they vanish. That is generally the sign of something that just wasn’t real to begin with, and the more different conditions that something fails to rise to, the more times it fails to show up, the greater the chances that it was a mistake or an illusion all along. This happens all the time in science, and in biomedical research in particular. You get used to it as a researcher. If you take every result at face value (particularly every startling result) and run with it before seeing how robust it is, you will spend your career chasing shadows. And boy howdy, are there ever a lot of shadows.

    The comments to Lowe’s post are worth reading as well.

    • #32
  3. aardo vozz Member
    aardo vozz
    @aardovozz

    Ralphie (View Comment):

    WillowSpring (View Comment):

    Paul A. Rahe: I will have to confess that I have not learned much that I did not already know. Xi Jinping and his minions lie and are more than willing to sacrifice the lives of their fellow Chinese in a vain attempt to avoid embarrassment, and the like can be said of the Ayatollah Khamenei, of Vladimir Putin, and of their minions. The CDC is incompetent. The FDA is so wrapped up in red tape that it cannot respond to a genuine crisis. The World Health Organization is profoundly corrupt. The models that epidemiologists construct are not necessarily more reliable than those employed by climate scientists. Donald Trump tends to say the first thing that comes into his head. Michael Bloomberg is a stooge for Xi Jinping. Bernie Sanders is crazy. Joe Biden is senile. Nancy Pelosi and Charles Shumer are attempting to take advantage of a public health crisis to push a partisan agenda, and they resolutely attack the President for foolishness they are guilty of themselves. And, yes, the mainstream press is so irredeemably corrupt that their antics would be an embarrassment to the yellow journalists of yesteryear. I knew all of that before I entered my confinement.

    This paragraph is the best summary of where we are that I have seen lately!

    It would have been easier to list the positives. That is shorter to list the positives.

    What if those ARE the positives?

    <sarcasm off >

    <cynicism always on >

    • #33
  4. CarolJoy, Above Top Secret Coolidge
    CarolJoy, Above Top Secret
    @CarolJoy

    DJ EJ (View Comment):

    The Reticulator (View Comment):

    DJ EJ (View Comment):

    Could you tell us more about the Michigan protest movement and yesterday’s Lansing protest? Today in Wisconsin, governor Evers extended his stay at home order to May 26th. The protest movement here is organizing and growing quickly.

    May 26? That’s over a month away. If there’s anything that can be predicted that far in advance, it’s that control freaks will continue to be control freaks.

    It’s ridiculous. It’s over a week longer than New York’s extension. It’s all the more ridiculous when you look at some of the COVID-19 statistics for Wisconsin:

    Total Population of Wisconsin: 5,822,000

    Total Number of COVID-19 diagnoses as of 04/16/20 according to worldometers.info: 3875

    Percentage of Wisconsin residents diagnosed with COVID-19: 0.067%

    Total COVID-19 deaths in Wisconsin as of 04/16/20 according to worldometers.info: 197

    Percentage of Wisconsin residents who have died from?/with? (distinction unknown) COVID-19: 0.0034%

    Aurora Healthcare, which operates 15 hospitals and more than 150 clinics in Wisconsin, admitted today (because the information was going to be leaked anyway) that it has 112 hospitalized COVID-19 patients total in all of its care facilities. That’s not just Milwaukee, but 112 total in the entire state! Other healthcare providers have patients as well, but it takes a whistleblower/leaker to get that information to the public. Meanwhile, people needing/wanting to see their doctors for other types of healthcare issues are having their appointments, procedures, and surgeries postponed or cancelled by the healthcare companies in Wisconsin because they’re saving all those beds for the spike in coronavirus patients that has yet to appear.

    *edited to correct the number of hospitalized COVID-19 patients in Aurora Healthcare facilities (I had it as 106, it’s 112), and I provided a link to my source on that figure (Mark Belling, host of Newstalk 1130 WISN late afternoon show).

    California is at 0.002%, or 2 deaths for every 100,000 members of our population. So our numbers of deaths are similar to those in Wisconsin.

    The reporting is of course all hype. We had one solitary case of COVID in my county 8 days ago; then 2; then 4. So the headlines are all about “The Illness Is Doubling.” And the sky will fall when we have ten cases, I guess.

    • #34
  5. CarolJoy, Above Top Secret Coolidge
    CarolJoy, Above Top Secret
    @CarolJoy

    She (View Comment):

    Percival (View Comment):

    A model is a guess plus an algorithm, and when I heard that Neil Ferguson of Imperial College didn’t want to share his code because it’s thirteen years old, my cynicism spiked.

    I’m not an epidemiologist, or even a statistician (nor do I play one on TV) but I read somewhere that Ferguson got his initial estimate of the death toll in various countries, including the United States, by looking at the death toll from the 1918 flu epidemic, and then applying the proportion of fatalities to the size of the population then, to what it would look like if the 1918 epidemic hit today. Thus, 675K fatalities, and population of about 103M in 1918, and 2.2M fatalities in a population of 330M in 2020. And somehow, that figure, which apparently factored in no differences between “then” and “now” other than population size, was cast in cement and used to scare the United States out of what remains of its wits and into total lockdown.

    And I always thought I couldn’t understand the concept of imaginary numbers. I’ve been in the wrong line of work all my life. If that’s all it takes to be an internationally respected, well-funded, and storied researcher, even I could’a been a contender.

    I did not know that was how Ferguson got his numbers. Pretty scary to realize that is how he came about his erroneous math. Additionally – his math was all about his confirmation bias!

    You’d think someone in Great Britain would have been suspicious of him to begin with. Especially given  all the panic, economic ruin, destruction of heirloom cow, sheep, and goat bloodlines after he insisted the nation of Great Britain slaughter so many animals due to mad cow disease, but in these modern times, there really are not many checks and balances on those in power in the ivory towers, are there?

     

    • #35
  6. Percival Thatcher
    Percival
    @Percival

    She (View Comment):

    Percival (View Comment):

    A model is a guess plus an algorithm, and when I heard that Neil Ferguson of Imperial College didn’t want to share his code because it’s thirteen years old, my cynicism spiked.

    I’m not an epidemiologist, or even a statistician (nor do I play one on TV) but I read somewhere that Ferguson got his initial estimate of the death toll in various countries, including the United States, by looking at the death toll from the 1918 flu epidemic, and then applying the proportion of fatalities to the size of the population then, to what it would look like if the 1918 epidemic hit today. Thus, 675K fatalities, and population of about 103M in 1918, and 2.2M fatalities in a population of 330M in 2020. And somehow, that figure, which apparently factored in no differences between “then” and “now” other than population size, was cast in cement and used to scare the United States out of what remains of its wits and into total lockdown.

    And I always thought I couldn’t understand the concept of imaginary numbers. I’ve been in the wrong line of work all my life. If that’s all it takes to be an internationally respected, well-funded, and storied researcher, even I could’a been a contender.

    If that took him more than 50 lines of code, he’s getting a “C”.

    Wherever the virus came from, the lion’s share of his data came from China, and China has data issues.

    • #36
  7. Percival Thatcher
    Percival
    @Percival

    “Data issues.” Sometimes my own diplomacy takes my breath away.

    • #37
  8. Roderic Coolidge
    Roderic
    @rhfabian

    Paul A. Rahe: disproportionate number of those who die are African-American. Blacks make up 17% of the state’s population and 40% of those who die from the disease. The local liberals in these parts trace this to racism, but that makes little sense.

    My observations in Houston indicate that blacks are not able to follow the social distancing strategy.  They are using the bus system because they have to, and they are out in the streets.  They are also disproportionately afflicted by obesity, hypertension and diabetes, often poorly controlled.  Most of them live in dense urban areas.  I suspect that accounting for those things would explain a lot of the racial difference.

    • #38
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