Covid-19 Diary : Sunday 29 March 2020

The house next to mine sold a month or two ago, and the new owners moved in last week.  I know this because I’ve seen cars in the driveway and lights on in the house.  But I don’t know who the new people are.  Neither do the two neighborhood “sources” who are always competing to be first with the news about anything in our small neighborhood.

One of the two ladies who are usually first with the news regretfully told me this morning that while she was keen to go and introduce herself to the new people, she felt that at present, it is inappropriate to get that close to another house and people.  She’s probably entirely correct as well, and so the new neighbors will remain strangers for the foreseeable future.  We all would love to at least add them to our neighborhood email list we use to share things among ourselves, but no-one wants to go knock on their door first.

Yet another minor casualty of the social-distancing we’re all doing at present.  Yes, necessary.  But the social distancing is not a painless nor costless process.

And using the concept of “not without costs” as a segue, here’s a projection of hospital needs for the duration of the pandemic.  It was published on Thursday, so is very recent.

It makes interesting reading.

The first thing you’ll notice is that is is totally opaque about how it came up with its numbers.  It says

This study used data on confirmed COVID-19 deaths by day from WHO websites and local and national governments; data on hospital capacity and utilization for US states; and observed COVID-19 utilization data from select locations to develop a statistical model forecasting deaths and hospital utilization against capacity by state for the US over the next 4 months.

That is a pompous way of telling us nothing at all.

The next thing you’ll notice are the huge swings in likely values, which we of course can’t comment on because we’ve no idea how they were generated, for example

excess demand from COVID-19 at the peak of the pandemic in the second week of April is predicted to be 64,175 (95% UI 7,977 to 251,059) total beds and 17,309 (95% UI 2,432 to 57,584) ICU beds.

Those are huge ranges within which the real value may perhaps lie.

Which brings us to the reality check.  Click through the article to find the page (sorry, it doesn’t show its own url so I can’t directly link) where this model predicts that yesterday, Saturday, in total there would be a need for 84,211 beds within the US hospital network, of which 17,298 would be in intensive care wards.

We know, not as a projection but a fact, that yesterday, in total, there were 118,126 total active cases in the US (ie total cases minus people who have died or recovered).  We don’t know how many of these cases are hospitalized, but we’ll guess less than half.  Let’s say 40,000 – 50,000 beds, about half the 84,211 projected.  That number isn’t too far out, although keep in mind this is in the early part of the projection, barely looking forward two days from when the model was published.  That close to the real numbers, surely the model should be almost exactly right.

Let’s now look at the rest of the projected data for yesterday.  We also know (factually) there were 2,666 cases classified as serious or critical on Saturday.  Let’s assume that all of these people are in ICU care (although that is unlikely).  So, 2,666 ICU beds (or fewer) are in use, rather than 17,298 predicted.  So the model has overstated this need by 6.5 times.

The model goes on to worry that yesterday, 9,339 invasive ventilators would be needed.  With only 2,666 cases as serious or critical, and of course only some share of these needing the full-on invasive ventilator treatment, would we be wrong in assessing this as a ridiculous estimate as well?  Could this even be – as it quite likely may be – a ten-fold overstatement?

People are panicking and spending millions/billions/trillions of dollars based on projections such as this.  But the people making the projections are 100% unaccountable.

My point is not that we’re ridiculously over-reacting.  My point is that really we have utterly no idea at all if we’re over-reacting, under-reacting, or doing things absolutely right, and that’s a very uncomfortable feeling.  One way leads to unnecessary deaths, the other way leads to unnecessary extreme suffering of the financial kind.

Current Numbers

No changes in ranking today.  The seven states of any size with the highest infection rates are :

• Vatican City/6 cases/7,491 cases per million (unchanged)
• San Marino/224 cases/the equivalent of 6,602 cases per million people (unchanged)
• Andorra/334/4,323
• Faero Islands/159/3,254
• Luxembourg/1,950/3,115
• Iceland/1,020/2,989
• Gibraltar/65/1,929

Here are the top six major countries, showing death rates per million of population in the country.  Belgium moved up one, with Switzerland moving down one to match :

• Italy/10,779 deaths/178 deaths per million
• Spain/6,803/148
• Netherlands/771/45
• France/2,606/40
• Belgium/431/37
• Switzerland/300/35

To put those numbers into context, the death rates per million in US/UK/Canada are 8/18/2.

For major countries and/or outbreaks, and in general :

Spain is now a tiny fraction ahead of Switzerland as being the large country with the highest number of cases per million of population.  Both Switzerland and Italy have stopped experiencing higher rates of new cases every day.  Their daily new case rates, while very large numbers, are no longer getting bigger each day, which is enormously encouraging news.

It is difficult to find much good to say about the US, but it may be possible to suggest that while new cases continue to grow in number each day, the rate of growth seems to be slowing.  An exponential increase would anticipate larger increases each day, and instead we’re seeing relatively stable growth.  We need a few more days before this is something to be certain about.

Who Should Pay?

One of the unmentionable questions isn’t just who should pay, but how much should be paid.  Sure, Gov Cuomo claims that any amount, even many billions of dollars, is justifiable if it even saves one life.  But very few others agree with him.

Here’s a fascinating article that looks at how much most people are willing to spend to save a life.

Timings And Numbers

I mentioned, yesterday, that the US currently has 150,000 ventilators.  How soon before we’re running low on them?  Well, that’s very hard to say, but not for a few weeks, it would seem.  We had a mere 2666 cases in the “serious/critical” category yesterday, and that grew to 2970 today.  We’re not sure what percent of those cases are on ventilators, but we’re guessing less than half.  So maybe 1500 ventilators in use.  1% of our total supply.

That’s a very different perspective on ventilators, isn’t it.  Sure, we acknowledge that due to peaks and troughs of need, not all 150,000 ventilators will be ideally distributed and evenly utilized.  And some significant number is already in use for other patients with other illnesses.  We also and emphatically agree that planning ahead for the likely continued exponential growth of cases is vital.  But we’re still comfortably ahead of the curve.  There’s no need to start panicking just yet.

Dr Fauci is now saying he estimates total US deaths in the range of 100,000 – 200,000, but also hastily overlays that estimate with disclaimers.  These estimates are “a moving target”, he quite rightly says, and he also says he’s never seen an actual outcome that ends up at the worst-case end of an estimate range.

That raises the terribly complicated issue.  If the target death number is currently 100,000 – 200,000, and it is more likely the actual deaths will be closer to 100k than 200k, should we really be mobilizing a healthcare response that assumes not just the worst case of 200k deaths, but a much worse than worst case scenario, assuming some unknown number much larger?  That brings us back to the twin concepts of “out of an abundance of caution” and “If all this money saves just one life, it will have been worth it”.

But now that we’re starting to understand that the cost of this is in the order of $1 trillion a month, and quite possibly more, we need to realize that “an abundance of caution” comes with a pretty heft price sticker associated.  To be brutal, the US is no longer a wealthy country, but still spends like one.  We need to realize there are limits to how much caution we can abundantly indulge in.

Depressing news from the UK.  In these transcribed statements from an interview, their Deputy Chief Medical Officer makes some puzzling statements – maybe they made more sense when spoken aloud, but we do see she mentions the concept of “up to 6 months” for the UK to be on lockdown.  A dismaying concept, and one of the longest projections we’ve seen.  That doesn’t automatically make it wrong (or right) and perhaps she is being more forthright than some of the other people and projections have chosen to be.

There’s an amusing story about how the best source of information about any person in the US is not their FBI or CIA or NSA or other three-letter-agency records, whatever such records may be.  It is, instead, an augmented commercial credit bureau report, bolstered with information from other public-record databases.

I’ve seen some stunning detailed examples of this, although whenever I look at my own, I see that somehow I’ve become inseparably linked with the former husband of a former employee – even though we have a different name, age, address (even different state for the last 20 years), and everything else.  As best I can guess, I think because I once provided a car to the employee but required her to pay for insurance, somehow links were created between insurance records (“Susie and Bill have insured this car”) and ownership records (“David owns this car”) and perhaps employment records (“David and Susie work together”) resulting in the assumption “David and Bill are therefore the same person”.  I’ve also been linked to the former employee’s current husband too.  I guess the assumption there is “Susie’s husband is Bill or Pete.  David is Bill, so therefore David is Pete, also”.

But the underlying premise of public data containing a stunningly detailed story of one’s life is true, and the inaccuracies are probably no worse than are sometimes revealed in, for example, the TSA No-Fly/Terrorist lists.  Mistaking Bill for me is a relatively trivial thing, mistaking either of us for a wanted terrorist is a much more severe error.

Coming now to the point of this, I see with amusement that the US government is now tracking the movements of people around the country to understand and model the transmission of the Covid-19 virus by using data that indicates where their cell phone is.  That information could be obtained from three obvious sources – intelligence agencies, the cellphone companies, or commercial databases.  Guess which the government decided offered the best data.  The answer is here.

Closings

Not so much closings today, but instead, maybe, an opening.  Or is it?  According to the headline, travel restrictions have now been lifted in Wuhan.  Except that, as the rest of the headline suggests, the restrictions haven’t been lifted at all.

This raises some puzzling questions.  Has the virus been cleared out of Wuhan?  If it has, why are there still restrictions on presumably virus-free people now traveling elsewhere in China?  And if it hasn’t, where is the data on the new cases?

As always, trying to deduce the reality behind the facade of China’s official numbers is close to impossible.

Shortages

Here’s an interesting article on shortages of equipment and supplies in general.

Here’s an article reprinted from the New York Times original (but without the paywall).  The lie within it is the NYT’s.  Namely :

The scarcity of ventilators has become an emergency, forcing doctors to make life-or-death decisions about who gets to breathe and who does not.

Except that, it appears this claim may be a total unsupported lie.

If you click the link for “life-or-death decisions”, you go to a NYT article about the hardest questions doctors may face, and historical information about how in 2012, a doctor in New York City, suffering from Hurricane Sandy in 2012, had to decide who would and wouldn’t get access to ventilators due to power problems.

This is the type of commentary that is driving our public perceptions and debate at present – a claim that right now doctors are short of ventilators and are, today, deciding who to turn away and let die.

As you saw above, it appears that currently about 1% of our national stock of ventilators are in use by Covid-19 victims.  There is no shortage.  No-one is being turned away.

But for reasons best known to themselves only, the NY Times apparently lies, and supports their lies not with facts, but with allusions to what happened in 2012 in response to a hurricane.  Don’t tell us about 2012 hurricane response.  Prove your claim by specifics of hospitals, doctors, and patients where, today, there are no more ventilators in the hospital, and the doctors in the hospital are turning away patients, leaving them unable to breathe and dying.

Logic?  What Logic?

Many thanks to reader Gil who sent in a brilliant article with a really clever idea.  If we are short of testing kits, why don’t we test two (or ten or even one hundred) people simultaneously with a single kit (yes, this is apparently possible).  Best case scenario, 100 people (or however many) are all cleared simultaneously.  Alternatively, if there is a positive result, you then drop the group into two groups of 50 and test them both, meaning that perhaps after three tests, you’ve now cleared 50 people.  Another two tests (five in total) means you’ve cleared 75 people.

This concept works best when there are low incidences of the virus, but that is true in most of the country.  Even the worst affected areas only have about one case per thousand people, so nine times out of ten, groups of 100 would test all negative and all 900 people would be cleared.

The topic of ventilators has been much aired at present, and it seems to have become a vivid image that can be used to scare the bravest of us (as per the item above about the claim doctors are turning patients away right now).

Here’s an interesting article about the problems with making more ventilators, and here’s an excellent article with some great ideas about how to quickly make less expensive ventilators that would be “good enough” rather than the super deluxe models that are otherwise supplied.

This is an interesting article with a misleading headline, but which details how some parts of the country are trying to restrict people from other parts of the country traveling there.  That’s a really difficult topic, and comes very close to attacking some of our most dearly-held freedoms.  But, perhaps it is also no longer even a necessary or relevant factor.

I’ll explain why, starting with another article that looks at the same topic, but from the opposite perspective.  It is a virtue-signaling article that urges us all to stay exactly where we are, because if we stray to other places, we risk destroying those other places and the people living there with the virus we might be bringing with us.

The article might have been appropriate, back in the happy days of only a few infections in a few states, although only the incurably optimistic or naive among us ever expected the virus not to spread across the nation, from largest city to smallest townships.  But now the virus is in all 50 states, is known to be in many of the counties and probably is in most of the other counties too, lurking untested and unknown for now, the article is perhaps another victim to the rapidly changing reality we are within.

But, and here’s my point.  Its now obsolete point raises an interesting issue.  Is it time to rethink some of our social-distancing and “lockdown” concepts.  While social distancing is still essential, if a person travels “safely” (ie in their car without stopping, other than for gas and takeaway food) from City “A” to Township “B”, and stays in a socially distanced/lockdown mode in the smaller town, where is the harm in that?

Some people say “small towns don’t have the healthcare facilities to cope with a rush of new infected people”.  Overlooking the assumption that people who move there are already infected, I’d like to introduce the people who worry about that to an amazing modern invention.  The automobile and related other forms of motorized transport.

If the tiny medical center in the small town is full, why not have people check in at a larger hospital in the nearest larger city?  Unlike a stroke or other types of sudden and severe time-sensitive events, most Covid-19 suffers are “walking wounded” who can transport themselves to a health services facility, and are not risking their life or health by driving a few extra hours to get there.

My point is that we’ve conflated two different things (maybe more).  The first is quarantining affected areas, to lock the virus into limited areas and keep it out of other areas.  We’re way past that point, now.  The virus is literally everywhere.  Quarantines no longer work.

The second conflated points are the concepts of social-distancing and travel.  Traveling is not incompatible with the requirement to socially-distance.  I for sure keep at least six feet away from other people in other cars when I’m traveling in my car on the highway, and the diluting effect of the speed we’re traveling at creates additional “virtual” space between us, while the confines of being inside a car means that most of any virus I’m breathing/coughing out stays within the car, anyway.

Virus?  What Virus?

I looked at the different numbers from Norway and Sweden a couple of days ago, trying to understand why Norway’s case count was higher, but Sweden’s death count was higher, and seeing if the very different approaches to social-distancing or testing had any influence on the observed data.

Here’s an article that updates Sweden’s approach to trying to control the virus within its borders.  I’m continuing to track the numbers from both countries, but the death data in particular remains too sparse to allow for meaningful analysis, even though the temptation to do so is definitely present.  For example, look at this chart

It would appear that Sweden’s death rate started to meaningfully diverge from Norway’s around about 24 March.  This is 12 days after Norway went into lock-down mode, and is about the point at which you’d start to expect to see the effects of that flow through to death counts.  But Sweden’s surge in deaths stopped again as suddenly as it started, and the last two days, when adjusted for the different population sizes, was either less than or effectively the same as Norway as you can see here.

That sudden drop in Swedish deaths is a very surprising change, and is all the more surprising because an ill-contained contagion that now has a hold on the population, but at a low level, can reasonably be expected to continue to grow substantially.  366 reported cases per million and 11 deaths per million of population is nowhere near any possible type of “end point limit”.

But we need many more than two days of data before that becomes significant.  Perhaps we’re just seeking less complete reporting over the weekend.

I continue to be astonished that the EU hasn’t mandated a consistent set of rules for social-distancing, lockdowns, and all the other things to do with responding to this crisis.  Much stricter rules in some but not all EU countries.

I’ve never known if the expression “New York’s Finest” is meant in jest, or negatively, or sincerely.  But at present, the phrase should perhaps be amended to read “New York’s sickest”.  Currently, 4342 (12%) of the uniformed police officers in the NYPD are off sick, although only 608 (1.7%) of them have tested positive for Covid-19.

And no, I’m not going to express any conclusions from that surprisingly high sick rate.  But the 1.7% who have tested positive – that is very much higher than in the city overall.  Two possibilities – this is either because of the nature of their job and the inability to have greater social contact (with each other as well as with “customers”) or perhaps because they’ve had priority access to testing, which would imply, as just about everyone believes, that there’s a massive rate of people infected but not yet tested and confirmed as having the virus.

As we’ve said before, the higher the undetected case rate, the happier we are, because it increases all our chances of becoming a not-detected case, and having an infection so mild we don’t even realize we have it.

Medical

Australia continues to tighten up on measures to prevent new carriers of the virus entering the country – an easy thing to do when you’re an island with some distance separating you from other countries.  They are now putting all arriving international passengers (the very few people the country will even allow to enter) into mandatory quaranties, taking over hotels for the purpose.

This is a great and necessary concept. But please tell me the hotel rooms don’t end up sharing each other room’s air.

This article is interesting, and looking at the map of inter-related virus strains and their travels looks very much like a world airline route map, doesn’t it.  The good news within the article is that the virus is mutating slowly, meaning that if we can develop a vaccine (something that should not be taken for granted), it is likely to give us immunity for a number of years rather than just a single season (assuming the virus does have seasonal ebbs and flows).

Money

No Wall St activity over the weekend.

Rumors

More good news on the hydroxychloroquine and Azithromycin front (and, as an outcome, the ventilator front, too).  This came in today from a guy with a huge long list of qualifications, including being a Fellow of the American Institute for Medical and Biological Engineering

Most of the Infections in US, HydroxyChloroquine and Z-pak are significantly effective causing the need for ventilators to decrease significantly.

Other

Here’s an interesting article which exposes a problem without a solution.  The problem is that social media allows essentially unfiltered sharing of anything, and by the time anything might be exposed as wrong, the underlying error has gone viral whereas, inevitably, the correction gets overlooked.

A contributing element is that social media gives prominence to items that are well-liked.  This is an easy-to-measure attribute, and also conforms to how social media makes money – by getting more participation and more page views on which to sell more advertising.  Social media doesn’t – and more vitally – never can prioritize articles based on their accuracy.

There was a time when we looked to the mainstream media as being trusted purveyors of truth.  Sadly, those days have long since been left behind by the new generation of “journalists” who view their jobs as giving them the right to shape the truth rather than the obligation to report the truth.  The stranglehold on information that the major daily newspapers and television networks used to have is no longer so severe, but the many new sources of information, while giving us much more quantity, have not increased the quality of the news being promulgated, and if anything, the “signal to noise” ratio has got worse, not better.

We can now all choose the news that “we like”, irrespective of whether that news be accurate and fair and complete or not.  I’m not sure that is progress at all, and yearn for the days of trusted anchors such as Walter Cronkite (and, more importantly, the unseen people who actually sourced and wrote the news items that he would read).

Please stay happy and healthy; all going well, I’ll be back again tomorrow.

Please click here for a listing of all our Covid-19 articles.