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.
Coronavirus Update 5-2: All Quiet on the COVID Front
I have a COVID-19 update for you, based on reported death data through yesterday (May 2, 2020). The daily rate of increase in total reported COVID-19 deaths is now under 3% for the US and all of the major nations of Western Europe, down to and including little Luxembourg. Daily reported deaths continue at a relatively low, but significant, level throughout the West, at an average of about 2,000 per day in both the US and Western Europe (the exact figures are 1,802/day in the US and 2,095 in Western Europe, for the past week).
I. Reported Death Data
As usual, my data source is Johns Hopkins (here). On to the graphs.
The first two graphs show total cumulative reported COVID-19 deaths, per 100,000 population. The first graph shows the larger countries, plus Belgium (the hardest-hit country in this sample); the second graph shows the smaller countries, with Italy for comparison.
Here, you can see that the UK has surpassed France slightly in deaths per capita. While the US has the highest total number of deaths, due to a vastly larger population, the per capita number is much lower than most other nations. Germany remains quite fortunate for reasons that are unclear.
Next, the same data in logarithmic scale. Remember that this scale displays whether growth is “exponential,” as exponential growth yields a straight line in logarithmic scale. I started this whole graphing project to rebut the claim that COVID-19 was growing exponentially, which was erroneous and hysterical nonsense even at the time.
Of course, people rarely concede that they were wrong, so I expect that the response of the catastrophizers will be that the damaging, and sometimes draconian, house arrest of much of the population is the only thing that saved us from exponential ruin. Pay no attention to the fact that the same non-exponential pattern is apparent in every country, regardless of their policy response.
My suspicion is that when the analysis is finally done, probably in a year or so, we will see that the death rate is largely dependent on two things: (1) the extent to which populations live in relatively crowded cities, especially cities with widespread use of public transportation systems, and (2) the degree of social and physical isolation of the elderly population. These are only hypotheses at present.
The next graph shows the precipitous decline in the growth rate of cumulative reported cases, using a three-day average for data smoothing purposes. Note that this graph starts later than the others — March 25 instead of March 1 — because the early data was very chaotic.
You can see that the rate of increase is now below 3% daily in all countries and regions, and generally continues to trend downward.
II. Jerry’s Commentary
I have been quite skeptical about the claim that various lockdown, house arrest, or other social distancing policies have caused the enormous reduction in the growth rate of reported deaths demonstrated above. I do not dispute, in principle, that such measures have slowed the spread of COVID-19. What we do not know is the extent to which the reduction has been caused by policy, and the extent to which the reduction would have occurred anyway.
I am actually not particularly optimistic about the future progress of this disease over the next 3-6 months. The policy response is causing almost incalculable economic damage, and enormous interference to daily life. I do not think that this disease has run its course. Not nearly. If and when we open things up, there will be an increase in the rate of transmission, and then an increase in the number of deaths. This is unavoidable. Even draconian lockdown policies only slow the spread. They don’t stop it.
The catastrophizers dismiss these concerns as heartless concern over money, or focus on trivial things — like people dying alone, cut off from their loved ones; the elderly who no longer get to see their children or grandchildren; the ruin of the financial future of tens of millions of hard-working people; all of the high school kids who won’t get a senior prom or a graduation; the churches and synagogues shut down. Even funerals are canceled.
Those things aren’t trivial. That is life.
But the catastrophizers don’t care. I am getting very frustrated and angry at them. If I’m not willing to live in some plastic-bubble pod, then I’m a murderer.
They are wrong. Some of you are in this camp. It is time to man up, and admit that you were wrong. You want to live in fear? Fine. Hide in your house. Quarantine yourself. Stop insisting that the rest of us be quarantined.
Do you know what? It’s like the darned flu. It’s several times more deadly than the flus in living memory, but probably only by a factor of between 2 and 5. It’s a relatively minor risk, and we simply need to face it and get on with life.
Many of you are frustrated at our politicians. The problem is not really the politicians. The problem is the overprotective mother attitude present in so much of the population, men and women alike. The problem is the “people will die” argument and the accusation that anyone bravely going about life as usual — and any politician willing to let them do so — is a murderer.
There is an irony about this disease because it is a respiratory disease. Quite literally, it is spread by breathing. So the coronaphobes demand that we not be allowed to breathe free.
My inclination is to respond with something that is not COC-compliant. Instead, I will say that I dissent. I will not say that I dissent respectfully.
ChiCom delenda est.
Published in Healthcare
I dispute the claim that anyone can make that assertion, that “the reopening has to be phased in.”
No one knows what portion of the reduction in R0 was achieved by the mandated closings, versus individual personal choices, versus features of the virus itself — nor how those factors varied in different areas. For all we know, individual choices may have been sufficient, without mandated shutdowns.
The justification for this extraordinary restriction of liberty was the need to “flatten the curve.” That meant, specifically, keeping ICU utilization below hospital capacity. We achieved that, and there is no reason to believe that we can not sustain that absent mandated shutdowns in only the most exceptional cases.
So the shutdowns should end.
I think we went too far to start. However, as you correctly state, we didn’t exactly know what we were fighting. Now that we have created this unfortunate situation as a result of our over-reaction, we do need to be prudent in getting out of this shutdown. But part of being prudent is applying what we have learned about mistakes of broad brushing our country so that we allow those many counties of less dense population to behave in manners that are appropriate while the same is true for densely populated urban areas. For nearly half of this country, washing hands and some social distancing is totally adequate.
Let me suggest an alternative interpretation of “prudent.” We are in an imprudent situation right now, in that literally hundreds of millions of Americans have their rights restricted without any clear idea of when or how they will be restored, nor compelling evidence that such restrictions are actually necessary to achieve the stated goal of “flattening the curve.”
So I think it would be prudent to end that situation immediately, and then to re-impose such restrictions when and where they are required.
It would be a mistake to underestimate this virus. I was talking to my daughter Saturday night about the virus. She is a veterinarian living in east Manhattan at the moment while she completes a residency at the Animal Medical Center. She has been confined with her husband, dog, and two cats in a small apartment because her clinic has been shuttered (that said, she has been working again a couple of days a week for the last two weeks), she has been reading everything she could find in the medical journals about this virus. She asked me if I noticed the stories over the last couple of weeks about the alarm being raised that covid-19 patients were losing their sense of smell. I said, sure, but that often happens with viruses. No, she said, this is different. It means that this virus is crossing the blood-brain barrier and traveling to or through the olfactory nerve. That is very serious. Also, she said, that the virus started in animals and leapt to humans and is now showing up in pets is very serious. For viruses to go that route is extremely rare.
It’s important point to remember when people criticize the medical community. Much about this virus is like other viruses and so we know how to deal with it, but much about it is not like others we’ve seen before. My daughter is truly impressed with the nation’s doctors in their response to the virus, to be able to see and handle what’s right in front of them even though they haven’t seen some of it before. She thinks they have done a really good job.
I am in favor of shutting down the lockdown because the heat combined with the increasing humidity suggests that this is a flu-like virus and is sensitive to weather conditions, which will give us a much-needed psychological break from dealing with the virus every day. However, we may be in for a very bad second wave in November when people reenter their heated homes. The indoor heat dries out the upper respiratory tract, which creates a productive environment for the virus. With so many asymptomatic carriers walking about over the preceding six months, that would make it impossible to avoid a widespread disease vector. Of course, by then, we’ll know to keep a kettle of boiling water on the stove. :-)
But if the human immune system cannot shake off this virus next fall, and I certainly hope it will, it may be devastating and reach many different age and health groups. We need to keep working on it even while people are newly freed from their confinement.
I agree.
Let me put it this way.
The burden of proof has been shifted. The burden of proof is now on the state to justify maintaining extraordinary controls. It is time to invert our thinking: we have prevented the virus from overloading our health care; now it is time to prevent the state from continuing to deprive us of our liberties.
The fact that the virus appears to have an R0 < 1 value in almost every state, and yet most of us don’t know under what conditions the current restrictions will be lifted is indefensible.
Issuing a date is completely inadequate. We need clear and debatable metrics, specific measurable justifications for continuing this shutdown. And then we have to be able to debate them. The fact that we aren’t getting that, but instead we get arbitrary “extensions” of what borders on martial law, is sufficient for me to call for ending all mandated shutdown immediately, and demanding that the government justify their reimposition.
I am constantly amazed that there is rarely any thought given to those that have been put out of work because of this. The group most at risk are those age 75 and up (most are not currently working) and those in elder care facilities. Take care of them. Why we would put over 35 million people out of work for the next 1-2 years seems a bit excessive. When are the house arrest proponents going to tell those 35 million, face to face, that they are “non-essential” and unneeded and be happy to accept government handouts (if they come) for the foreseeable future.
Good comment. Though I think that much thought is given to this. The people who have been put out of work, if they complain, are called heartless selfish monsters who don’t care about the lives of their fellow citizens.
MiMac, I disagree with much of what you say, though I think that we may have more common ground that either of us might think. I’ll try to respond point-by-point.
I think that we are going to have many more than 200,000 deaths due to this, so I do not disagree with your figure. I disagree that we have done much of anything to prevent such deaths, and it does not appear likely that we can. We can delay them, at very high cost, but not prevent them, for the most part.
We may have better treatments for the virus in the future, and perhaps a vaccine, but this is a long way off. I do not think that we can continue to do the economic damage that we are doing, until a vaccine arrives. The first 2-4 weeks of the lockdowns may have helped, with the development of better treatments, though I haven’t seen evidence of highly successful treatment regimens. I did see one recently for remdesivir, here, that showed statistically significant shortening of recovery time, and showed some decrease in the mortality rate, though the decline in mortality wasn’t statistically significant. This is a promising result, as this particular study may have been too small to reach statistical significance.
Your final statement is a strawman — “lowering the speed to a ridiculously low number isn’t good policy.” First, it’s not a ridiculously low number — it looks like a steady level of about 30,000 new cases per day, and about 2,000 deaths per day. Second, and more importantly, your formulation takes no account of the cost. Good policy has to consider both costs and benefits. As an extreme example to prove the point, we could slow the spread by killing everyone with the virus, and burning their bodies. That is obviously unacceptable.
I think that we’ve crossed an important policy line, which I think is Hank’s point. We are quarantining healthy people and preventing them from earning a living. It’s one thing to quarantine the sick, until they get better. It is quite another thing to quarantine the healthy, because they might get sick, and then they might get someone else sick.
I’ll need another comment to address some of your other points.
Can someone remind me how to quote a string of comments without using up all the characters available? I’ve tried to copy the comment number and paste it into the comment box but all I get is the link to the comments. I’ve written two insightful, erudite comments, only to find I’ve been over the character limit before I started commenting.😏
As an aside, I’m not convinced about the principal co-morbidities arguments. These are generally presented by showing that a certain percentage of COVID-19 deaths are among the obese, or have hypertension, with no comparison showing that the rate of, say, obesity among those dying of COVID-19 are higher than the rate of obesity in the general population.
I don’t think that we are blinded by ideology. I think that both you, and I, and Hank realize that we need to get this country back to work. However, I don’t see a plausible plan that you propose. I don’t find the proposals of guys like Avik Roy to be helpful, because they seem to point toward a yo-yo lockdown situation. Open up, and test, and then take action if the infection spreads again — and I think, MiMac, that you an I actually agree that it will.
You seem to think that there’s something to be done about it, that will not be more costly than the benefits. I doubt this.
I think that we are going to have a large second wave, unless we keep severe lockdowns in place for a very long time, in which case I think that we will have about the same total number of deaths — say 2,000/day for 6 months — and are also going to have unprecedented economic and social breakdown. There are no easy options here.
We can quarantine the sick, and we can advise those at risk to be more careful. Otherwise, I think we should open up.
I would volunteer for Phase 2 trials of new vaccines. I suspect hundreds of thousands of people would do so. Phase 1 trials to establish safety are relatively fast and easy to do. It is Phase 2/3 studies to establish effectiveness that take a long time. So the risk of death from the vaccines would be very low. I use the plurals here, because all promising, safe vaccine candidates for this virus should be fast tracked.
There are some people who will not take any vaccine, no matter how safe it is and how deadly the disease it protects against. Those people will get their immunity the old fashioned way, assuming they survive the disease. :)
We need to get to “herd immunity” levels as quickly as possible (while protecting the most vulnerable) and stay there. Gradual, sensible reopening starting now is part one. Widespread, effective vaccinations are part two.
BTW: I have worked on FDA approvals for new drugs, and I’d like to see new drugs in general “rushed through the process” compared to the current approval rate. The FDA process, despite the best of intentions, adds a lot of delay and cost, often for little or no benefit. Hyper caution is embedded in our systems, because victims of a bad reaction to a drug are highly visible. People who die because a lifesaving drug was delayed a year are invisible.
I know there must be a better way, but I just delete the wording, leaving the thread of comment headers in place plus maybe the words of the last comment I am directly replying to…@jeannebodine
The more we talk, the more I think we all agree.
Dan, I generally agree with the first part, but it seems a bit inconsistent with the second part. The way to get to “herd immunity” as quickly as possible is immediate and rapid re-opening. A vaccine would be good, eventually, but I don’t think that we can wait for a vaccine before re-opening.
How would you go about “protecting the most vulnerable”? This means the elderly. Do you contemplate mandatory restrictions on them, or advising them about the greater risk and allowing them to make their own decisions? Do you contemplate things like prohibiting children or grandchildren from visiting the elderly?
I said weeks ago, and I’ll say it again now (because I think it makes even more sense now): end the lockdowns, dump several hundred billion dollars into creating an emergency infrastructure to serve and protect the most vulnerable and to shore up our ICU capacity, and let the rest of us take our chances and resume working.
That’s a fair comment but that should be solvable. My son, who is an insulin dependent diabetic, is a fireman and paramedic. I prescribed a supply of hydroxychloroquine for him as a prophylactic if he is exposed. I got them enough so his entire family, with three teenagers, have enough. I have read that many front line providers (I am retired) are taking it that same way. There is a report from Europe that 60,000 patients with lupus or rheumatoid arthritis have been taking hydroxychloroquine for that diagnosis. So far 20 have been infected by the virus with none seriously ill.
So far, he has not had any exposure at work. He is more senior as an engineer so has not had an exposure yet.
Jerry, I agree waiting for a vaccine before reopening is not feasible. Getting to herd immunity in a viable time frame means reopening. The vaccines come in after that to maintain and add to it.
I favor guidelines and recommendations for protecting the most vulnerable groups, rather than mandatory rules. That may not always be possible. To take a specific counter example: My mother (95) is in a nursing home now. Since March 7, no visitors are allowed and no outings by the residents (12 people there). The isolation is hitting her very hard, but we all understand the need for it. Personally, she would prefer to go out and take her chances, but her choice to do that would put 11 others at additional risk. Given her cognition issues, one can’t say that her choice would be entirely rational, either. Similarly, allowing Mom’s children and grandchildren to visit her would risk the lives of the other 11 people as well as hers. So the mandatory isolation of facilities with groups of vulnerable populations seems necessary to protect them from risky choices of others in the group. On the other hand, my father in law (98) lives alone in his own home in a small town in France. If he wants to go out and do things, it’s not a risk to most other people. If he wants to get together with the few others remaining in his age group, again it should be up to them.
Assisted living facilities are probably mostly in the “need to keep them isolated” category, too. Prior to the nursing home, Mom lived in an assisted living facility (12 per floor, 3 floors). Such people are overall healthier, of course, and better able to make rational decisions. Still, a lot of them are high risk for serious disease and death. I’m skeptical of the idea that one resident should be free to take risks that could kill several of the other 35. Perhaps this could be managed at the facility level, though.
[word limit]
[continued]
Independent living facilities probably need flexibility in devising their own rules, which could be mandatory for the residents. The one Mom was in had three buildings of about five floors each and hundreds of residents. Each person (or couple) had his/her own room with a kitchen. There were shared dining rooms with one meal per day included and additional ones optional. So the overall effect is something like a dormitory.
These residents are, of course, younger and healthier yet. By and large they should be free to decide the appropriate level of risk for themselves. The trick will be to protect/isolate the risk averse group of residents from the YOLO group. :)
As I said about my father in law in the previous comment, people living in their own house/apartment should be able to decide for themselves. Likewise, families with a vulnerable member in the house/apartment should be able to decide for themselves what level of risk to assume.
The “lower the speed limit…is bad policy” comment was about his argument that by my reasoning we should set the speed limit at 20mph- not that we have lowered the cumulative deaths below 200K. It is likely we have a ongoing steady diet of about 1000 deaths/day even w/social distancing & other measures b/c the virus is that contagious. Remedesivir isn’t a home run but it should help-hopefully we will have better drugs in the near future (Gottleib believes there are about 5 other drugs in the pipeline w/possible efficacy in treating COVID that could be massed produced in time for the fall).
We have crossed a line- we need to reopen soon-we all agree-my point is that we can’t go back to February 2020 rules and that it will have to be phased in to protect the vulnerable & so we can monitor the results. I am pessimistic we can just test & isolate -b/c we need enormous testing capacity & we’d often have to SEPARATE those testing positive (ie not isolate at home-but in a facility) and I don’t think that would be acceptable. My major point is we need to understand the lockdown was a valid choice, this isn’t like the flu & we need to carefully move to reopen.
MiMac, thanks. We seem to be pretty close to accord about how to move forward, and that probably goes for Hank as well.
I’ve actually been an advocate of mandatory quarantine of the infected, in a facility. I agree with you that this presents some difficult issues. I think that we could make it more acceptable by doing it in decent facilities, at government expense. There have to be a lot of empty hotels at present. I’m flexible on the point, not insistent.
I doubt that you’ll convince me that the lockdowns were a wise decision, except in very limited areas like NYC and New Orleans. It’s hard to advocate re-opening without contending that the lockdown is an over-reaction. I will agree that the original 15-day lockdown period was a lot more sensible than the extensions, and that we knew less about the disease at that time.
I may write a separate post about the “it’s like the flu” issue, which seems to raise strong feelings. I think that the two sides mean different things by this phrase. I agree that COVID-19 is significantly more deadly than any flu that we’ve seen in many decades. I continue to think that it’s like the flu, in the sense that there’s little that we can do about it, it’s a relatively small risk (especially to the non-elderly), and we mostly need to go about our business with some sensible precautions.
Yes, we’re all in agreement on broad aspects of this. I am skeptical that mandatory — versus voluntary — controls are necessary, and want to see that demonstrated before I accept what appears to be an unaccountable and open-ended set of restrictions. The criteria being used to justify the destruction of our economy are entirely two vague and fluid for my tastes, and I’d rather take chances with the disease than accept what seems to be an unchecked imposition of de facto martial law.
I think we can afford that risk. If not, we’ll discover that and reimpose constraints as necessary. But we survived the first time around, and I’m sure we will survive the second.
Incidentally, the speed limit analogy was not a straw man argument. It was an attempt to illustrate that being willing to accept preventable fatalities — even many preventable fatalities — is not prima facia evidence that one is sanguine about life and death. I am willing to risk a lot of Wuhan virus deaths because I think the costs of preventing them as we are preventing them is simply too high — as would be, for example, the cost of imposing a radically safe speed limit on America. The logic in each case is the same, a balancing of costs and benefits. It isn’t obvious to me that the current shutdown is more justifiable than, say, a 25mph national speed limit.
I keep telling people that doctors learned thousands of years ago to always maximize the downside of a prognosis. Nobody likes bad surprises. If the patient dies, it was foreordained or God’s will or the will of the gods. If the patient recovered, of course it was the physician’s skill. These public doctors have no incentive to weigh economic factors. They just don’t want to be wrong, if they can help it.
The first lecture they gave to all the new economics majors was that by speeding – even choosing to drive at all – you make an implicit calculation that getting wherever you were going faster was more important than the marginally increased risk that someone could die or be seriously harmed. The point of the exercise is that we make these decisions everyday and to deny that fact is childish. As one commentator pointed out recently, this virus is like the flu at least in the sense that we could prevent both if we all just committed to staying home all winter. But we don’t. We accept that 30,000 – 80,000 or so will die so that most people can go about their day.
If you have a multigenerational family, which seems to have made things worse in Italy, have the at risk segment take Hydroxychloroquine at the lupus dose (300 mg / day) until there is a vaccine. There are virtually no side effects and lupus patients are at increased risk but had almost no infections in that European report.
I have the same question – albeit perhaps not the same insightful, erudite comments to add.😉
The logic is only faintly similar-we are talking death rates 20x higher than traffic fatalities. It is like saying you shouldn’t fear falls from 120 feet b/c a 6 foot fall is rarely fatal.