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Day 121: COVID-19 Why Are States Obscuring the Data?
The screengrab above is from the Vermont Department of Health Weekly Summary of Vermont COVID-19 Data. It makes quite clear how residents of long-term care facilities are the majority of deaths from COVID-19 in that state. Similarly, the following chart illustrates the same thing, just adding that “Health Settings” include not only hospitals and long-term care, but therapeutic centers and behavioral health institutions as well.
Contrast Vermont’s data clarity with that of Minnesota. Although it is reported that 81% of Minnesota’s deaths occurred among residents of long-term care facilities, that is not easily demonstrated by the Minnesota Department of Health’s Stay Safe MN website. First, the only data that mention long-term care facilities is “case data,” not “death data.” Second, what death data there is is only disaggregated by race and ethnicity, not any other factors:
Congregant living?
Are LTC and Residential Behavioral Health “Non-Hospitalized?”
No correlation of deaths to anything other than race and ethnicity. Why is it important to correlate death to race and ethnicity, but not to residence in long-term care?
Of course, Minnesota is not alone in obscuring the relationship between infections in long-term care facilities and death. But why? When the data suggests that just getting your long-term care facilities infection control protocols in place would have reduced your deaths from COVID-19 by 80%, why wouldn’t you focus your energy there rather than house arrest for all residents? I get it that if you have a lot of infected but asymptomatic or minimally ill people going about, there is a greater challenge in protecting the residents of the long-term care facilities. But how is it less costly to impact the livelihoods of tens of millions rather than treat long-term care facilities more like Level 4 Bio labs?
The New York and Florida situations have been contrasted with regard to, in the one case, introducing infections into long-term care facilities, and in the other, putting emphasis on protecting residents of long-term care facilities as compared to other broader societal restrictions. As Texas Governor Greg Abbott tweeted, there does seem to be some correlation between the governing philosophies and the epidemic outcomes:
The first thing is focusing your efforts on the vulnerable, not controlling the whole of your society. Maybe you are obscuring the data so that it doesn’t make clear the consequences of your governing philosophy?
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
@mendel, here is my final question since you are obviously sitting at your computer – or at least you were 10 minutes ago.
We have several past pandemics to look to. We have several examples of coronaviruses. These have ranged in their severity, but all have followed virtually the same pattern. Why are we looking at this particular pandemic and projecting onto it all of our worst fears, rather than comparing it to past pandemics and expecting roughly the same outcome… As far as I know, it was only the spanish flu that had a “more deadly second wave,” and that was a second strain. What we know about coronaviruses is that they tend to mutate in the other direction, to become less deadly… and also that this particular coronavirus shows no sign of mutating into a more virulent “second wave” sort of bug.
I fully understand the “more deadly than the flu” comparisons, but again, I want to put it in perspective. Twice as deadly, or ten times as deadly, are sort of meaningless terms out of context. If you have 10 times more money than $1, your position with respect to wealth has not really changed in any meaningful way. If you have 10 times more money than $10,000, you’re feeling pretty good. Driving a motorcycle may be 10X, or even 100X more dangerous than driving a car, but what does that really mean?
These changes to our lives are big, yet, in all of the horror-statistic justifications for us taking drastic measures, I keep seeing those little omissions of context, and I feel that there are a lot of people who are coming to the point of saying “wait, what?” Like avoiding the house w/ the “beware of dog” sign and one day seeing a little terrier in the yard. You still don’t want to get bit, but the story changes a little…
I’m not defending your state’s policies. You live in WA, so by definition they’re going to be retarded.
I’m simply saying that any serious plan to cordon off the vulnerable while letting the virus travel relatively unfettered through the rest of the population would have to completely prohibit anyone from visiting their elderly parents/grandparents as a minimum baseline. And I have serious doubts that people would be able to adhere to those rules for longer than a few months (as I have doubts about adherence to the present guidelines in many places).
That’s why I keep finding Germany’s multi-layered plan the most sensible: a near-complete opening society while taking as many light-touch interventions as possible to lower the spread among the healthy population; at the same time, keeping the vulnerable under wraps but still finding ways for people to visit their elderly parents/grandparents every now and then (like setting up special rooms in nursing homes, providing on-site rapid testing, etc.). That seems much more sustainable to me than trying to prohibit people from visiting their loved ones for four months or longer, and the trade-off in personal inconvenience has been very well accepted by nearly all of society so far.
I don’t know where you’re getting this information but it’s only partially complete, or at least the science isn’t that settled.
One problem is that we have never lived through a coronavirus pandemic, and the virus is just different enough to make us unsure about how many parallels we can draw (in my opinion too unsure). So many in the scientific field have taken a posture of assuming that the worst aspects of influenza pandemics could hold true with Covid while simultaneously being skeptical about whether some of the more “positive” features of influenza pandemics (like much lower transmission during the summer) will hold true. Call it a double standard or call it an “assume the worst” position as you please.
But a second problem is that while entering into lockdowns was justifiable in many places, too many places jumped on the bandwagon and nobody has a clear path out. In many ways this seems to be worse in the US than in many European countries, including, again, Germany. For one, the notion of a pragmatic approach that mixes planning for worse-case (but not worst-case) scenarios while being willing to take some calculated risks seems to be missing in most states in the US – both “red” states and “blue” states.
I also think locking down in states that never had a real Covid issue triggered a psychological ambivalence. There’s a natural aversion to simply opening back up without taking any precautionary measures first, but there’s also an understandable lack of motivation to build a precautionary infrastructure for a threat that never really materialized (at least not yet). Being so close to regions that genuinely got slammed probably helped focus many European countries’ collective minds into taking positive actions that gave them the confidence to actively exit the lockdowns.
Based on what we have been learning over the past weeks, the virus still seems very plausibly capable of killing a million Americans or more if left unchecked. I think that’s a benchmark that would speak for itself to most Americans with or without a flu comparison, or an age/comorbidity breakdown, or any other relativizing factors.
Where does that figure come from? In the past few weeks a number of large-scale antibody tests have come back, both from several cities/states in the US and countries in Europe, and they fairly consistently show infection fatality rates between 0.5%-1.3%. Combine that with a new virus to which most of the population presumably has no pre-existing immunity and one million deaths is at the low end of the range. And I postulate that most of the American public would be happy to engage in extended lockdowns if they were fairly certain that would be the death toll without interventions.
Please note that I’m not predicting this will or even would happen. There are still too many unknown factors, the most glaring of which (in my opinion) is what percentage of the population is actually susceptible or would need to be infected before transmission starts to self-regulate. The infection rate on the Diamond Princess was 20%, while the Marion, OH prison infection rate is 75%, so the theoretical range is huge. There are plenty of reasons to think it may be well lower than the theoretical ceiling of about 60-75%, but we really don’t know at all.
Not if you’re a Democrat trying to hurt Trump in any way possible. Bonus points if it gets you on Biden’s short list for VP.
I think you should discount the prison rates. Start releasing prisoners, and you’ll see that it tends to spread widely. In LA, I believe, infection was quite deliberate.
I read somewhere that studies showed exposure to other coronaviruses to provide some level of immunity. I’m a little miffed by your suggestion that I’ve made outlandish claims easily disproven my a 2 minute Google search… So I won’t go any further than saying “I read about that, somewhere.”
https://www.sciencemag.org/news/2020/02/paper-non-symptomatic-patient-transmitting-coronavirus-wrong
That one references the same paper that the article I read does, but the article I read was from this week. So… was that paper squashed for several months deliberately? You would think that if more people had known about it, we would all have been acting very differently since February.
Huh… I am of the opinion that no “community” gets to make that decision for me.
Doesn’t the question of asymptomatic transmission affect our response to the pandemic? It seems to me that, if it exists, contact tracing would be much more difficult, perhaps useless.
I posted this comment on the wrong thread:
Another data point that I’ve never seen discussed: how many full basketball teams were tested back in March? Pretty sure those percentages were similar to, or even less than, diamond princess. You’d think that conditions on a basketball court and in a locker room would be perfect for transmission, especially if asymptomatic spread is real. But I have not heard discussion of this.
Again, when we talk about herd immunity, it isn’t just about math… About hitting that percentage of the population. It is about hitting some unknown percentage of the susceptible population, such that the virus effectively dies out.
I think that will look a lot different than what we have been hearing.
As far as I know, two teams were tested on March 11. One player tested positive, and the NBA put the season on hold.
1) There are plenty of examples of infection rates above 50%, the prison is just the most extreme example I’m aware of to date. None of them are real-world situations, which also holds true for the counterexamples of the Diamond Princess or the NBA. However, they are still all worth noting as a lesson that the spread of the virus is complicated and nuanced, not some homogeneous math equation. But we shouldn’t hitch our wagon to any one of these data points.
2) Yes, several studies have shown indications of potential cross-immunity from seasonal coronaviruses. Because they were lab experiments it’s difficult to predict the real-world consequences. Theoretically the discovery could be a real game-changer if it means that quite a few of the people who haven’t been infected yet will never be infected (or at least not in the next few years). On the flip side, it’s also perfectly conceivable that the cross-immunity is fairly weak and is already baked into the cake, i.e. it may help explain why some people get infected but don’t get sick, but doesn’t lower the herd immunity threshold.
Bottom line: there are good reasons to think the herd immunity threshold may be considerably lower than the simple 1-1/R0 (i.e. 60-75%), but there is not enough data to predict that with confidence. The only way to find out is to actually run the experiment, but running the experiment also poses a genuine risk of a NYC-type outbreak, which most Americans would probably be willing to go into lockdown to avoid (at least at present). That’s a vicious catch-22 with no easy answer yet.
Depends how you want to frame it.
Most mask requirements (at least the non-ridiculous ones) apply primarily to indoor business establishments, not to people’s personal premises. So if you want to go into store X but a doorman is blocking entrance because your community has decided to impose a mask requirement, I’d say the community’s decision played a key role in that outcome.
I saw a study recently (like Monday… I’ll try to find a link) that sampled COVID-19 survivors that showed a correlation between mild symptoms with COVID-19 and a cold caused by a coronavirus in the past six months. Obviously, it was a small sample, but it’s something to look at. That may help explain why there do seem to be so many mild cases out there.
That paper definitely made a big blunder with fairly wide-reaching effects, since it was published at a time when little was known about coronavirus transmission.
But it’s also important to remember that an error in a single paper doesn’t disprove the entire theory, it just disproves the paper. There are dozens of other papers on this topic that use multiple lines of evidence to suggest that asymptomatic transmission might be real – even if very few of them provide a “smoking gun”. The validity of that evidence isn’t affected by the error in the German paper.
At the same time, many experts are overconfident in the existence of asymptomatic transmission (often due to precisely that paper) and don’t adequately appreciate the uncertainty that remains. So there’s plenty of legitimate criticism to be leveled.
Bottom line: nobody knows yet for sure.
Your last line is what makes me furious. An entire nation has been under house arrest for months based on that paper. There should have been a lot more study done since early February. I know everyone was panicked at that time, but let’s be real. Outside of basically New York no hospitals in the US have been overwhelmed. Why hasn’t there been more emphasis been put on understanding transmission of this disease, led by our head of infectious diseases? The hospital system hasn’t actually been that busy for the past three months. This should not still be so mysterious, with dozens of state governors panicking at worst-case scenarios that have not borne out.
I understand that there are difficulties in doing such studies, but to simply throw hands up and not even try as lives are ruined needlessly is not acceptable.
That’s why people are getting tired of this.
It would certainly change the parameters of contact tracing. There’s quite a bit of discussion among the experts right now as to how feasible human (as opposed to smartphone-based) contract tracing would be with a major asymptomatic transmission component. Some think it’s still feasible, others disagree.
I personally think it’s very feasible based on the experience here in Europe that countries/regions that aggressively pursued testing+contract tracing tended to have much better outcomes than places that didn’t.
The real issue, though, is that most US states haven’t ramped up their contact tracing capabilities enough to deal even with a symptomatic-transmission-only scenario (at least not to the metrics published by people like Scott Gottlieb), and they likely won’t get there anytime soon. But extending the lockdowns simply isn’t an option anymore in my opinion, so those states are going to have to make do with whatever capacity they have.
I also think contact tracing is going to be seriously challenged as being Unconstitutional. Not enough talk is happening around that. Just because someone is infected doesn’t give any government the right to track their movement and contacts, let alone build an identifiable database from them. That’s simply not allowed under our system of government.
Please see my comment #36 in this thread, where I addressed this in some detail.
It’s not fair to say that researchers “aren’t even trying”. Many have been working furiously at trying to uncover the details of real-life, day-to-day transmission. And they’ve been genuine making progress, albeit less than anyone would like (for reasons I detailed in the previous comment).
But I’ll repeat my main point from that comment: the public is just as much to blame as the experts here.
Actionable information about coronavirus transmission has been conveyed to the public for weeks. But the public isn’t listening. One big chunk of the country is convinced that even young, healthy people are at significant risk of dying of Covid, and are glued to images of freezer trucks outside of NYC hospitals and soundbites of Trump telling people to drink Clorox. Another big chunk of the country just wants to hear Jay Bhattacharya and two rando ER docs claim that this virus is barely worse than seasonal flu, interspersed with the occasional story about how this unprecedented killer virus was a deliberate plot by China.
Here’s a specific example: Scott Gottlieb is the epitome of a public health expert – after all, he was Trump’s first FDA chairman. He has enough conservative “street cred” not just from his good relationship with Trump but his prior history with AEI/Hoover.
Gottlieb has been doing yeoman’s work to inform the public about the latest day-to-day, relevant findings on Covid. Not models projecting millions of deaths or ICU bed shortages, but tangible, actionable information. And he’s omnipresent in the media, showing up almost daily on Meet the Press, CNBC, the WSJ, and many other places.
Over three weeks ago, Gottlieb started banging the drum about robust studies showing that well over 90% of documented Covid transmission events took place indoors, and was publicly calling for dropping restrictions on almost all activities that occur outdoors. And he was shouting this on multiple outlets with national exposure.
How come I never heard a single peep on Ricochet about this, despite hundreds of Covid-related posts at the time? Why didn’t it show up in “enlightened” left-wing venues like Vox? I think the answer is clear: people just weren’t that interested in actual useful information, since tangible information tends to be less emotionally fulfilling.
Certainly a real possibility. I don’t know enough about the legal specifics, though.
There are numerous projects underway to develop contact tracing apps that would be used on a voluntary basis, that would be open source, and that would save all information locally and anonymously (so authorities theoretically couldn’t access the data). It will be interesting to see whether some parts of the US adopt these apps, should they ever reach maturity.
Doesn’t matter. It’s a HIPAA violation. And a Constitutional one. You cannot reveal health information about someone else. Period.
Our state is hiding data because it’s panicked about HIPAA. Any app that tries to do the same will be sued into oblivion.
Fair enough that the work has been done.
But I’m in contact every day with someone who’s working with the Governor’s office on making predictions and setting policy for my state.
This information is not making its way to our Governor, and it’s pissing me off.
I will share some Gottlieb links with him tomorrow.
But it’s also not fair to blame the “public”. There is a real tension between Democrats who want to make Trump look bad and others, and Chicken Little Karens who are afraid of everything.
But anyone who’s advocating contact tracing as an answer doesn’t actually know how government in this country works. You simply cannot force someone who has not been accused of a crime to tell you who they’ve been in contact with in the US.
That sh!t may fly in South Korea. It WILL NOT fly here. That is not a solution.
Better science about how this thing actually spreads needs to be done and communicated. That last one is not a medical thing, that’s a media thing. And the media is on the Shut It Down side.
What I dislike about contact tracing is that it is very invasive and, again, there is little reason it wouldn’t go on indefinitely. Governments say “we’re doing this for your safety,” but I don’t want the government to keep me safe at any cost. It is interesting to contrast with actual war. People volunteer to fight and give up their lives to gain liberty, but then we now volunteer to give up liberty in order to not risk our lives?
Obviously, there is a balance, but the trade-off exists. Aggressive contact tracing, mask requirements… The extreme measures wrt schools… These are all things that push me to err on the side of liberty over safety.
Another thing on this, which I think is the real clincher with respect to masks/social distancing/contact tracing.
That is, I think that people would be willing to make temporary sacrifices, and even major ones (as we have already seen) in order to rid ourselves of this particular threat. But that is where the honesty is coming in. We hear “two weeks to flatten the curve” and think ok, let’s get this over with, we’ll do the 2 weeks and flatten the hell outta that curve.
But then we start to see people telling us to socially distance, to wear masks, to put this app on your phone that tracks your movement and your medical history, and those things don’t seem like temporary measures to get rid of a disease. Because that’s not what they are. They are designed to keep the disease away, but they only work as long as you are doing them. Now, suddenly, what we are hearing about is people needing to “accept the new normal.” I read an article in the WSJ just yesterday where some “scientist” was saying that we are simply going to have to socially distance forever, and that we just need to accept that large crowds are a thing of the past.
So now, what we’re being told is that this virus isn’t going away, and that we need to live the rest of our lives in fear of it, and respond accordingly. Well, that’s where my war analogy comes in. If we were told that there was an invading army about to take us over, and what they were going to do when they got here would be to basically turn us into an Asian nation – we’d all be required to wear masks, we’d have to stay 6 feet away from each other at all times, we could only gather in groups of 50 or less, we could no longer have professional sports, and our society would be divided into classes of citizens based on our assessed value to the whole, with some being deemed “essential” and others deemed expendable, that the expendable ones could be placed under house arrest at any time, and that all of us would be subject to strict government monitoring of our movement and who we’ve been in contact with… how would we react?
Surely, there would be plenty of people who would say that’s no big deal, it’s really not such an imposition, and let’s just go along with it. But there would be a lot of people who would take up arms and fight off the invading army. We would lose 150,000, 200,000, maybe 500,000 people in that kind of war, but it is a war we would fight willingly.
“Herd immunity” is kind of like that war, and I think that’s where a lot of us stand with this virus.
As for the facts of coronavirus itself – I think the absolute best case scenario is that there is actually some sort of limiting-factor that we’re simply unaware of, that mr. Ben-Israel happens to be correct, and that our lockdowns kicked in too late and accomplished nothing. My wife has been actually depressed – like physically/emotionally depressed – about those CDC recommendations with respect to schools. Those are changes that cannot be implemented without major costs, and at the risk of sounding callous, it wouldn’t be worth saving 100 or 200 thousand of our elderly to destroy entire generations of our young.
And I totally agree. I can only tell her … well … just wait and see. This thing may yet surprise us.
(I know, completely irrational optimism. oh, well.)
@mendel; this is the sort of thing that is so deeply concerning. It’s not just a matter of “community wants masks, so just wear the stupid masks until the science says otherwise.” As I said before, there is no endgame for this. People pushing masks are doing so as a permanent lifestyle change, not as a temporary measure. There is no science that will allow for it to end, there are no numbers or benchmarks that will determine when it is “safe.” Quite the opposite. Listen to the people who are advocating masks – the safer it seems, the more deathly important it is to wear that mask! The mask is keeping us safe, it is stopping the infection from reemerging. And what is all of this based on? Hamster cages? It is based on very, very, very little evidence – it is, as I said, the paper straw of coronavirus. We can all point to the “science” that shows plastic straws are worse than paper straws, and it is the same sort of science they’re using, here.
https://www.powerlineblog.com/archives/2020/05/coronavirus-in-one-state-47.php
For what its worth, I believe several players tested positive – enough that we would expect many, many more positive cases (based on those few) if the disease spreads the way people currently assume. I suspect that there is some underlying factor that increases rates of spread in nursing homes and places like meat-packing plants, and I have a very hard time believing that some people will not figure this out. I also strongly suspect that all of those people talking about “super-spreader” events like soccer games and horse races will be proven wrong, as will all of the people calling for masks in grocery stores (or anywhere else, for that matter). But that won’t come before our lawmakers have gone hog-wild with new restrictions and mandates…
You may not be able to force people to cooperate with contact tracing, but I think most people would voluntarily comply. You would never get 100% tracing for many reasons. The question is how significant the leakage would be.
@mendel, thank you for so patiently answering questions from us laymen. You and a few others with expertise have really me understand the issues.