COVID-19: models and projections

The New Neo Posted on by

As a non-scientist non-doctor non-epidemiologist blogger, my present thoughts on COVID-19 are as follows: it will most likely end up taking a worldwide toll something like the 1957 flu, adjusted for increased population of course. Perhaps even more like the 1968 flu, which was less severe but still worse than an “ordinary” flu year, which also takes quite a toll.

At this point I’m thinking that COVID-19 is very contagious but not especially lethal to the vast majority of the people who contract it. But the problem is that even if a disease has a very low case fatality rate it can kill a lot of people if a huge percentage of the population contracts it. The situation is particularly difficult if a lot of people in a certain area contract it in a short amount of time and the hospital system is overwhelmed with the task of treating them.

At the moment, that seems to be something like what epidemiologist Neil Ferguson is saying. He’s one of the people governments have been relying on in order to decide what their response to the virus will be. His initial projections were very dire, but he seems to believe (if I understand his argument correctly) that the current more optimistic projection is justified by the social distancing put in place as well as the growing evidence that the virus is more easily transmitted than previously thought – which means that its case fatality rate is lower (the newspaper reports I’ve seen don’t really make the basis of his revised predictions clear).

With new diseases that seem to have alarming possibilities, governments are in a bind. Who to trust? Scientists differ greatly. Go with the most optimistic suggestions and you can have a terrible calamity. Go with the most dire and overreact, and you can have a different but still terrible calamity. Decisions must be made in real time with extremely insufficient information. The news media brings terrifying reports and pictures of what’s happening in other countries that were first to be hit. Social media amplifies the fear. Is the fear justified or is it not? And will the cure be worse than the disease?

Some things that seem clear: we’ve previously been coasting somewhat without truly taking the threat of a possible large pandemic seriously enough (see also this as well as this) and making sure we have the tools to deal with it effectively and quickly. Speed is of the essence.

Another thing that’s clear is that social media magnifies the fear. Maybe fear isn’t the only thing we have to fear, but it’s one of the things. But even that’s a balance. Fear can motivate people to take sensible precautions. But it can also paralyze them and/or lead to overreactions.

Today’s heroes

The New Neo Posted on by

Everybody’s saying it, but I’ll add my voice.

These are some of the heroes of this coronavirus crisis (not meant to be a complete list): doctors, nurses, EMTs, grocery store workers, truckers, delivery people, mail carriers. And although we might not agree with everything every one of them says: the task force and Trump, answering questions and informing the public day after day after day, not to mention working behind the scenes for countless exhausting and stressful hours.

Also we have various companies doing their bit to take up the slack to manufacture things like ventilators, or to make certain drugs.

I have an intense hope that one of the lessons we learn from this is to never, never ever, rely on another country to be the near-sole supplier of one of our basic needs such as medicine or medical equipment. That this was ever allowed to happen regarding China is an abomination – all the more upsetting because very few of us even knew that it was happening at the time.

Let’s talk about “exponential growth” once more

The New Neo Posted on by

All you math people out there, correct me if I’m wrong – as I’m sure you will.

Arithmetic or linear growth means that a number increases by addition. Here’s an example in which the number 2 is added to a number to get the next one: 2, 4, 6, 8, 10…

Exponential growth means it increases through multiplying. For example, doubling each number to get the next one: 2, 4, 8, 16, 32…You can see that the numbers increase much faster that way, and if you continue it out, you will also see that it doesn’t take too long for the numbers to get huge: 64, 128, 256, 512, 1024, 2048, 4096, 8192, 16384, 32768, 65536, 131072, 262144, 524288, 1048576, 2097152…

But that’s the world of numbers, and COVID-19 is not a number, although we can express things about it in numbers – and it has the number “19” in it.

When we talk about the exponential growth of COVID-19, the questions are: how fast? And for how long? A disease can spread exponentially at first at a certain rate and then have the rate slow down. One reason this happens is because, unlike numbers, diseases involve people. With a disease such as COVID-19 that kills perhaps 1% (or some other relatively small percent) of its victims, the vast majority will recover and become immune. Then it becomes harder to spread the disease as more and more people become immune.

Or a vaccine is developed. Or people are given some preventive immunity with plasma from survivors. Or more and more of the population practices social distancing, or increases its handwashing behavior. Or a better test comes out and identifies more carriers and they self-isolate for a prescribed period. All of these things can slow down the rate of transmission and therefore the rate at which doubling occurs, until that curve is flattened and then even starts going down.

Pondering Pelosi while Pelosi ponders

The New Neo Posted on by

I can’t read Nancy Pelosi’s mind in the best of times, and this is not the best of times. But her actions lately have been inscrutable, in addition to the usual adjectives we could apply to them.

Why is Nancy doing this now? After all the Senate struggles, and the polls she must surely have seen – why?:

Pelosi is spinning it as “taking responsibility for workers and families.” But she must know that actual workers and their actual families who aren’t already firmly on the left are going to see this as stalling at best and extortion at worst.

So here’s what I think is going on. Pelosi is used to one approach, which is to hold out for what she wants, sanctimoniously cast the Democrats as defenders of the downtrodden, blame everything bad on the Republicans, and expect the GOP to cave and the MSM to echo her message that they’re to blame. Some of this is happening right now – witness the NY Times getting with the program after a little hitch.

But things aren’t going as well as they often do for Nancy. Not enough of the public is swallowing it so far.

And she doesn’t seem to be a very nimble player. Perhaps she used to be, but age has slowed her ability to be creative in her responses. Perhaps she never was, and the old GOP were just pushovers and they’re not at the moment. Perhaps she never faced a crisis of this magnitude and the old playbook doesn’t work. Most certainly she never faced an opponent quite like Trump – and she has a lot of company in that.

So I think she’s just buying time, regrouping, getting feedback from whoever she listens to these days, and making sure her Democratic troops in the House stay in line. And then she’ll come up with her next step. Whether it will be same-old same-old or something different I can’t say. But when even this guy has deserted her, I think she may be floundering.

This one may surprise you: Switzerland is not doing well in the COVID-19 pandemic

The New Neo Posted on by

It surprised me. But when I thought about it for a moment and read this article, it made perfect sense. After all, Switzerland borders on Italy – specifically, northern Italy, the center of the problem in that country. And tourism is big business in Switzerland:

The country is a tourism and trucking crossroads in one of the business hearts of Europe. As well as the two cantons of Svizzera Italiana, which border Lombardy, the centre of the Italian pandemic, there are 68,000 Italian citizens who until a few days ago crossed the frontier into Switzerland from Lombardy every morning to work, returning home at nightfall.

What virtually no checks were carried out previously, all Switzerland’s land borders with Italy, Germany, Austria and France have now been sealed except to Swiss citizens and 16,000 people have been turned back when trying to enter.

One Europe was a dream, but now the nations of Europe are realizing there’s a role for border control after all.

How bad is it in Switzerland? Not so bad when you first glance at the statistics. You see they have 9877 cases and have had 122 deaths for a case fatality rate of 1.24%. But what you don’t see – and what you don’t see on almost all the charts that total deaths per country – are numbers adjusted for differences in population. [UPDATE: Just a few minutes after I published this, a reader informed me that those statistics have been added to the site. I didn’t notice them when I wrote the post because I use a large font on my screen and the far right-hand column – which is where these numbers appear – was cut off from view and I wasn’t even aware of that. So I’ve used their comparative figures now on that.] Switzerland has a population of about 8.57 million people, and its death rate per million people is listed as 14. For comparison, the population of the US is about 38 times bigger, and our death total so far is 625 (case fatality rate 1.29%), but our death rate per million is 2.

All of these numbers are in constant flux, of course, so it’s hard to conclude much of anything except that the Swiss are indeed having a significant problem that isn’t immediately apparent when you look at the charts alone.

Best sites for COVID-19 statistics?

The New Neo Posted on by

I had a couple of sites bookmarked as my go-to places to find the latest US (state by state) and world (country by country) statistics. The best one seemed to be this, but in the last few days the figures don’t seem to have changed, even though the site says it’s been updated.

What gives?

Do any of you have a better site for this?

I once came upon a site that gave the number of cases that were considered serious or critical, in addition to all the regular statistics the other sites gave. But I haven’t been able to find it again. Does anyone know where to get that information?

It’s all the Republicans’ fault: the NY Times returns to what it knows best, after a very short detour

The New Neo Posted on by

First let me say that I find what’s happening in Congress right now over the stimulus bill to be profoundly depressing.

Not really surprising, though. When I was young there was a sense and a faith that in a pinch, when there was a real crisis, Congress would work on behalf of Americans in a bipartisan manner. But that was then, and that faith died some time ago. This is only the most recent and most blatant and nasty example of it, with the media playing right along.

I would imagine most Americans are disgusted. I think it’s obvious to anyone paying attention that this is the fault of the Democrats playing politics, jettisoning a bipartisan agreement they’d previously worked on and had input to, and holding out for their wishlist of unrelated items. As Professor William Jacobson at Legal Insurrection says, “The alternative bill Pelosi put forward is the extortionist’s price for the release of your loved ones.”

It’s repulsive.

Initially, the Times surprised everyone by blaming Democrats in its first headline. That little momentary truth didn’t last long, as detailed here. Their first headline read “Democrats block action on $1.8 trillion stimulus.” It was quickly changed to “Democrats block action on stimulus plan, seeking worker protections.” And then “Partisan divide threatens deal on rescue bill” (like the old Palestinian/Israeli “cycle of violence” – remember?).

And the “evolution” of the Times’ perspective continued yesterday with an editorial from the august editors, the ones who brought you that historical wonder “The 1619 Project.” The title of the editorial is: “The coronavirus bill stalled, and it’s Mitch McConnell’s fault.” This turnaround from the first headline on Sunday night to the editorial yesterday appears to have taken about a day. And looking at the comments to the editorial just now, the readers are for the most part dutifully stepping in line to condemn McConnell and the Republicans.

In related “news,” the Times is also intent on presenting a picture of Fauci and Trump divided, one that Fauci has explicitly denied – which of course couldn’t matter less to the Times editors. Fauci says he wishes this type of coverage from the Times would stop. Dream on. That is their life’s work, and no mendacity is too great in service to the cause.

How many people are fooled by the Times these days? People on the right often say that virtually no one believes the Times anymore and it’s not influential, but I heartily disagree. Fewer people trust them than used to trust them, but plenty of people still get their information – and point of view – from the Times.

[NOTE: By the way, when I Googled “debate in Senate over bailout” just now – a rather neutral search in the political sense – that Times editorial blaming McConnell was highlighted right up in the top line of the search results, with a photo.]

Sleep that knits up the raveled sleeve of care

The New Neo Posted on by

Sorry for posting a bit late today. I find that one of the many things that happens to me lately is that my sleep has been somewhat more disturbed. I either have trouble falling asleep, or I wake up in the night thinking and then start to read my phone. I figure I’m up anyway, but it’s probably a bad idea because it only sparks more thoughts. And many of the thoughts aren’t what you’d call soothing.

I wonder whether a lot of you might be feeling the same way.

So here’s some Shakespeare for all of us:

Sleep that knits up the raveled sleave of care,
The death of each day’s life, sore labor’s bath,
Balm of hurt minds, great nature’s second course,
Chief nourisher in life’s feast.

[NOTE: I first studied “Macbeth” in high school. It wasn’t my favorite Shakespearean play and still isn’t. But I love certain passages, and that’s one of them. Note that the word “raveled” is used the way we’d use “unraveled.”]

I don’t know whether this is comic relief or just another reason to weep

The New Neo Posted on by

Maybe both.

Joe Biden, addled backseat driver of the nation, and The Man Who Would Be President:

And here’s Biden’s shout-out to the governor of Massachusetts:

From the governor:

Epidemiologists as the new gurus: what about the excess death rate?

The New Neo Posted on by

Epidemiologists deal with dry facts and figures, but the subject matter of those facts and figures can be very dramatic: illness and death, and how best to go about minimizing the former and delaying the latter. Usually we don’t pay all that much attention to them unless we have a particular interest in the subject.

But now epidemiologists are constantly in the news, and anyone with an “epidemiologist” before or after his or her name is now the new authority. We hang on their every word as though our lives depended on it. Governments set policy based on their recommendations and those policies are having extreme effects on our lives.

It is definitely true that epidemiologists have expertise in this arena that most of us lack, and that we can learn things from them. But they disagree with each other in their prognostications. They are good at describing something ex post facto, often with estimates derived from statistics that are far from exact. It often takes years to understand what has happened in an epidemic or pandemic. And that’s understandable.

But their forecasts? They disagree with each other. Well, someone’s correct, but who? The worst doomsayer? The sanguine optimist? The in-betweens?

And I have a question for them all. I know we are missing some important numbers for COVID-19 that can’t be ascertained just yet. For example, to know the all-important case fatality rate of this disease, we have to know the numbers of people infected. As we test more and more of the population we learn more about that, but not even remotely as much as we need to know. And unless we test the entire population, including those with no symptoms, and do it at intervals, we can’t know in real time or perhaps ever.

But we do know another important number: how many people have died so far of COVID-19. Or do we? Is everyone who dies of any respiratory disease being tested for the presence of the virus? And if they are all being tested, do we know that those with a positive COVID-19 test actually died from the virus and not from some other condition they might have? That sort of thing has been described as taking place in Italy, for example:

…Prof Ricciardi added that Italy’s death rate may also appear high because of how doctors record fatalities.

“The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.

“On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity – many had two or three,” he says.

This does not mean that Covid-19 did not contribute to a patient’s death, rather it demonstrates that Italy’s fatality toll has surged as a large proportion of patients have underlying health conditions.

To understand the meaning of all the deaths in Italy, it would be extraordinarily helpful to know one figure that I’ve never seen discussed: the number of excess deaths; that is, the number over and above what is usual this time of year in Italy.

I have no doubt the number is higher than usual and that there are excess deaths, particularly in certain regions of the north where the virus has been concentrated. But how much higher? Italy ordinarily has a particularly high rate of death from the flu, which makes the “excess death” figure especially important to know. Are significant numbers of the deaths we’re seeing in Italy deaths that would be taking place anyway from the flu or other illnesses we’re accustomed to? And if so, how many?

One of the huge problems with COVID-19 is that so far it seems to cause localized outbreaks that burden a health system and in particular hospital ICU sections. That in turn results in some people dying who might otherwise be saved but for the sudden influx. That is particularly frightening, and many of the strategies being brought to bear in the US are a result of trying to prevent such a calamity. But in order to know how much we need to do and what we can expect in the worst-case scenario, wouldn’t figures for excess deaths in Italy be especially helpful?

When estimates are made for pandemic death rates (that is, deaths per million in the population, or deaths expressed as a percentage of the population, as opposed to case fatality rates that are deaths among those diagnosed), the “excess deaths” figures are commonly used to arrive at those figures. I would think that epidemiologists would be well aware of the importance of knowing what the excess deaths have been so far.

So why haven’t I yet found anything that discusses it? I realize that, since the disease only began a few months ago, we don’t have figures for total excess deaths. But shouldn’t we have some preliminary figures to compare to average figures per day or per week or per month during a bad flu season and during a good flu season? Aren’t epidemiologists interested in doing this? And why aren’t more people curious about it?