COVID-19 Megathread 5: The Trumps catch COVID-19

[Florida Man for Crime]

Deaths have shot way up today. Of course, that is partly due to under-reporting deaths over the 4th of July weekend. However, if some of the deaths reported today were re-allocated to the weekend, that wouldn't make a difference for the current 7-day moving average, and with the deaths reported today it seems that the 7-day moving average has probably stabilized for the time being and may be starting to go up.

As a reminder, this is exactly when we would expect deaths to bottom and start rising if we have a similar trajectory to Iran in its 2nd wave based on the length of the lag between the Iranian case increase and their death increase.

[Florida Man for Crime]

As I mentioned when cases started to surge in the South/Southwest and some people were saying "oh, but the new infections are youngs, so it doesn't matter," it was inevitable that over time the median age of new infections would rise to more closely match the general population. Even though irresponsible youngs may initially be more likely to be exposed to the virus at bars/restaurants/gatherings/etc, they inevitably will come into contact with some older co-workers, family members, and older members of the general public in various ways, and then they spread the virus to those older people.

Here is some data from Florida (presumably other states tell a similar story, but I haven't seen data from them) which shows that exactly that has been occurring. Over the past 2 weeks, the median age of new infections has steadily risen from about 33 to about 40:



This is one factor that will inevitably lead the # of deaths to go up as long as cases continue to go up, and which will exert upward pressure on the fatality rate as well.


Another important thing that we should keep in mind at this point is that even though testing is much more widely available than it was a few months ago, the # of infections has risen by enough that testing capacity is starting to once again come under strain and to be a limiting factor. Labs are having technical problems processing all the tests and in many places larger backlogs and delays in reporting are occurring due to various limitations on the ability to scale things up. This is in addition to the long lines etc that have been observed at numerous testing sites. And since the Federal Government is not really putting much effort under Trump into fixing these issues, things won't necessarily improve very quickly, if at all.

Here is a good article explaining some of these problems that have been occurring:

A Dire Warning From COVID-19 Test Providers
U.S. coronavirus testing could fail again, as surging demand creates new backlogs and delays.

The delays have already started. Yesterday, Quest Diagnostics, one of the country’s largest medical-testing companies, said that its systems were overwhelmed and that it would now be able to deliver COVID-19 test results in one day only for hospitalized patients, patients facing emergency surgery, and symptomatic health-care workers. Everyone else now must wait three to five days for a test result.

“Despite the rapid expansion of our testing capacity, demand for testing has been growing faster,” Quest said in a statement last week warning of such a possibility. The company then said that orders for COVID-19 testing had grown by 50 percent in three weeks.

“This is very bad,” Michael Mina, an epidemiology professor at Harvard, told us. Rapid test-turnaround times are the only way to control the coronavirus without forcing every potentially contagious person—everyone who’s had contact with someone diagnosed with COVID-19—into quarantine, he said: “Our modeling efforts more or less show that if you don’t get results back in a day or so, outbreaks really can’t be stopped without isolating and quarantining all contacts preemptively.”

Quest is not the only firm to report growing problems. “We hit the wall three weeks ago,” Jon Cohen, the executive chairman of BioReference Laboratories, a lab-services company that is testing patients for the virus in New York, New Jersey, and Florida, told us. “At that point, most laboratories were already running at capacity, as far as I can tell.”

The upshot of this is that due to limitations with testing capacity, at a certain point we should expect the # of confirmed cases to stop going up as quickly - even if the virus is spreading just as fast as before - simply because it will be limited by testing capacity and backlogs. This means that at a certain point we should stop paying as much attention to raw #s of confirmed cases and more attention to the positivity rate. We will only know that things are getting better if the positivity rate starts to decline, and even if positive cases reach a plateau, things will still be getting worse as long as the positivity rate continues to rise.

[Florida Man for Crime]

So if I get covfefe'd or get have any other emergency, I'm finksed?

Don't go rock climbing and don't get into a car accident etc at the moment.

[Florida Man for Crime]

https://twitter.com/realDonaldTrump/status/1280853299600789505

South Korea and Israel opened schools, and then had to re-close them after they caused outbreaks...

The reality is it is simply not going to be viable to open schools in many places (there will be variation across localities of course). Attempting to force schools to re-open regardless of conditions will simply result in a worsening of the epidemic and then the schools re-closing after a bit of time has elapsed, similarly to how many bars/restaurants/etc have started re-closing after they were re-opened under un-safe conditions.

Insofar as schools can be opened, there ought to be much more discussion of having all classes outdoors. Similarly to a far greater degree, various essential proceedings should be being held outdoors if they have to be held at all, much like in the 1918 pandemic how court hearings were held outdoors.

[Florida Man for Crime]

Unless and until the virus is actually controlled, the economy is not going to fully recover:



Things are getting worse economically again due to the renewed uncontrolled outbreak in the USA.

Re-opening without first controlling the virus is like optimistically throwing a boomerang out into the world with edges as sharp as a knife and then being surprised when the boomerang comes back and slices your head off.

[Florida Man for Crime]

Last Wednesday (July 1) there were 676 reported deaths. So far today, we are sitting at 692 deaths, with much of California, almost all of Texas, and the entirety of 8 other states still not having yet reported. This means that the 7-day moving average of deaths will be increasing again. If this up-trend in deaths holds over the coming days/weeks, then we will have started our 2nd death wave with EXACTLY the same # of days lagging behind our 2nd case wave as Iran, literally down to the day. It is remarkable that deaths appear to be up-trending with exactly the expected time lag.

We are also at 45,574 cases so far today, compared to 52,358 last Wednesday, so it is quite clear that cases will also continue to trend up. We have a shot at breaking 60k cases for the first time if California and Texas both manage to post big numbers today. If we don't quite manage it today, we probably will tomorrow.

[Florida Man for Crime]

Do you think there is any difference with how California and Texas have handled the coronavirus pandemic? Has one state been more competent than the other? Or have they both bungled their approaches? Which Governors do you think have done the best in addressing this crisis? I'm asking this because the vast majority of states (36, at last count), are experiencing a rise in cases. This includes Colorado, where coronavirus hospitalizations and cases have increased over the past two weeks.

I would say:

1) I think that in general, most people greatly underestimate the importance of sheer luck in determining which states/countries have been hit first and hardest. The reason why luck can be a much larger factor than one would intuitively suspect is because a large amount of the transmission of the virus appears to come from super-spreader events, because virus spread is path dependent, and because viruses spread exponentially. To illustrate this, suppose that you have 2 different areas which are both initially seeded with 1 case at the same time. In area A, suppose that the initial case randomly gets spread to infect 10 other people, while in area B, the initial case randomly infects only 1 other person. Then subsequently in both areas cases double in each period (we shall say that R = 2 and each case infects other cases over the course of one "period"):

Area A:
Period 1 - 1 case
Period 2 - 10 cases
Period 3 - 20 cases
Period 4 - 40 cases
Period 5 - 80 cases
Period 6 - 160 cases
Period 7 - 320 cases
Period 8 - 640 cases
Period 9 - 1280 cases
Period 10 - 2560 cases

Area B:
Period 1 - 1 case
Period 2 - 1 case
Period 3 - 2 cases
Period 4 - 4 cases
Period 5 - 8 cases
Period 6 - 16 cases
Period 7 - 32 cases
Period 8 - 64 cases
Period 9 - 128 cases
Period 10 - 256 cases

So by period 10, area A has a noticeable outbreak, whereas perhaps only a handful if any cases have even yet been detected in area B. Why? Just a matter of luck can make a huge difference. It takes another 4 periods for area B to start exceeding the level that area A already reached on period 10:

Area B continued:
Period 11 - 512 cases
Period 12 - 1024 cases
Period 13 - 2048 cases
Period 14 - 4096 cases

So clearly this sheer luck of the draw can make a huge difference, and it has nothing to do with the policies that any governor/official might adopt, or with anything else that has a logical explanation. IMO this is the major part of the explanation for why e.g. Italy got hit hard first in Europe, or why Louisiana/Michigan got hit hard early more so than e.g. Georgia/Wisconsin.



2) If you look at variation across states, there is perhaps some which may correlate in a very approximate way with politics or the policy choices made by governors, but clearly that is not the only factor, much less the most important one. States such as North Carolina, Lousiana, and California all have Democratic governors, but are being hit to roughly comparable degrees as other states in the South/Southwest. So in general I think focusing too much on governors and the politics of governors is a mistake and a distraction from the real determinants and the real issues. That said, of course it is entirely fair and deserved to criticize governors who i.e. still don't have a statewide mask order, since that is something that can potentially contribute significantly to reducing spread at a much lower cost than just about anything else.



3) Governors are also in pretty much an impossible position because it is simply not possible to control a virus on the state/local level. Epidemiological public health is simply not a state issue or a local issue. The virus doesn't care that we draw lines on a map between "states" and it doesn't care about county borders that delineate the authority of local officials. More so than the actions of any Governors/local health officials, we are having problems because there is a mismatch between the scale and nature of the problem and the limited resources of state/local government as compared to the federal government.



4) It seems clear that how many cases a state had previously is related to how many they have now (more earlier tends to mean fewer now, and this is a significant part of the reason why the northeast is doing better at least at the moment). It is a mathematical fact that if you have have more people who were previously infected and have immunity, the effective R will be lowered and this will reduce future spread. In addition, in areas where the virus has previously hit hard, people are more likely to understand the importance of changing their behaviors in a way that will keep spread lower in the future. Still, I think we should be careful not to make too much of that. Look at Louisiana, for example. It was hit hard early on, and now is being hit hard once again (this also suggests that having, say, John Bel Edwards as Governor as compared to Asa Hutchison of Arkansas next door is not necessarily the crucial factor and doesn't by itself determine the course of the epidemic in the various states).



Overall my major take regarding governors is that we shouldn't get too focused on this as being the most important issue, much less being determinative of epidemiological outcomes. The reasons for doing so are mostly partisan point scoring rather than substantive problem solving.

[Florida Man for Crime]

This is hilarious, watch if you want a quick laugh:

https://twitter.com/mattbooshell/status/1280933495674732544

[Florida Man for Crime]

https://mobile.twitter.com/bnodesk/status/1281237294851203076?s=21

8,935 new cases reported from today's report. 

Also the positivity rate went up to 18%. So while the case # is not setting new all-time highs, it appears that this is related to the testing system now running against capacity constraints. As long as the positivity rate is rising, things are not getting better even if case numbers start to level out.

https://twitter.com/DeItaOne/status/1281236300087975936

There are similar trends across other states, with positivity rates increasing even if case #s stop increasing as much due to test processing backlogs, and with more and more states reporting rising deaths, and with the median age of infections rising (showing that the idea that it doesn't matter if young people get infected is a fiction, since even if the young people survive and don't suffer permanent health effects, young people inevitably end up infecting more vulnerable people).


If we don't want the medical system to get overwhelmed, we likely need to lock down. Mask orders and changes in public behavior can hopefully reduce the rate of transmission, but even in countries like Japan and Hong Kong where masks are near universal (and with most people having higher quality surgical masks, and not just less effective cloth masks/bandannas) have seen cases steadily rising over the past week or so. This indicates that while masks and the like can help, it is unlikely that masks and the like alone can turn back an epidemic that is already as out-of-control as the American one.

We are hearing more and more about hospitals that are running low on ICU beds etc. Hospitals do have some surge capacity that can be mobilized, but this is not unlimited. Perhaps more importantly, we don't have an infinite supply of doctors and nurses to provide the same quality of care for an increased number of beds, which means the fatality rate will rise as quality of care suffers. Shortages of doctors/nurses in New York could be covered to a significant degree by doctors/nurses from other states traveling to New York and helping out. The problem now though is that we are on course for similar problems across vast swaths of the country, so we can't really just send medical personnel from other states to plug all the gaps.

To help maintain quality of care, the Federal Government should immediately start organizing a fully funded program to recruit doctors/nurses from other countries where the virus is under control (Germany, Taiwan, China, Italy, etc) to come and save us from ourselves, offering them ridiculously high temporary hazard pay to get them to come and provide humanitarian assistance. Call it the Emergency Medical Corps or something. If the virus ever gets under control in the USA, we can continue paying the Emergency Medical Corps and send them to India/Brazil or wherever else needs the help as a humanitarian gesture.

[Florida Man for Crime]

Even if COVID kills 600k, many of them would have died anyway due to their age or underlying conditions.  More than 80% of U.S. COVID deaths are in those over age 65.

Evolution of denialist rationalizations:

1) It's just the flu, bro, and it is just in China.
2) We have like 10 cases in the USA and Trump stopped travel from China. No reason to be concerned.
3) OK, so maybe we have some more cases, but it is still just the flu bro.
4) Cases have started to drop, NYC has brought the epidemic under control. We are in the clear!
5) Deaths are now also now dropping. The epidemic is over and we can now get back to normal. And even if it is not quite fully under control yet, we have to re-open anyway because we don't want to re-open later than Europe. Re-open the economy, re-open bars, re-open casinos, without serious social distancing efforts. Maybe it is possible that a few people may die along the way, but there are things that are more important than living.
6) Cases have leveled out at about 20k. The only reason they are not dropping further is that we are doing so much testing (ignores the positivity rate). We should probably stop testing so much, can we reduce the testing?
7) Cases may be rising, but deaths are falling. Surely they will keep dropping indefinitely even as cases rise.
8) Hospitalizations may also be going up, but deaths still are not going up. So everyone will just go to the hospital, but they will all be fine.
9) 600k dead, 'tis but a scratch!




I am curious what stage #10 looks like:

10) ?

[Florida Man for Crime]

If we don't want the medical system to get overwhelmed, we likely need to lock down.

I should clarify though, there is no point in just having some states lock down, but not others. To lock down, we need a national and coordinated lockdown. Lockdowns in only certain states/localities will accomplish little, because the virus will continue to spread in other states, and as soon as the locked-down states try to stop their lockdowns and re-open, the virus will simply spread from the states where the virus is running rampant to the other states.

[Florida Man for Crime]

There is some potentially quite serious news from Kazakhstan and also Kyrgyzstan.

There is apparently some sort of unidentified/unknown "pneumonia," which is allegedly NOT COVID-19, which is circulating and resulting in a large number of deaths. The patients with this "pneumonia" apparently are testing negative for COVID-19, despite both countries reporting confirmed COVID-19 cases (1,962 yesterday from Kazakhstan and 361 yesterday from Kyrgyzstan).

This pneumonia is allegedly more deadly than COVID-19 (not sure what data that is based on though, probably crude CFRs from hospitals?).

https://crofsblogs.typepad.com/h5n1/2020/07/unknown-pneumonia-deadlier-than-covid-19-sweeping-kazakhstan-chinese-embassy-warns.html

https://www.scmp.com/news/china/diplomacy/article/3092563/chinese-embassy-warns-deadly-unknown-pneumonia-kazakhstan

https://flutrackers.com/forum/forum/the-pandemic-discussion-forum/876510-community-acquired-pneumonia-kazakhstan-and-kyrgyzstan-and-environs

The Chinese embassy in Kazakhstan has warned of a deadly “unknown pneumonia” after the former Soviet republic reported a spike in pneumonia cases since June.

“The death rate of this disease is much higher than the novel coronavirus. The country’s health departments are conducting comparative research into the pneumonia virus, but have yet to identify the virus,” the embassy said in a warning to Chinese citizens in the country.

While the Chinese embassy described the illness as an “unknown pneumonia”, Kazakhstani officials and media have only said it is pneumonia. 

It was not clear why the Chinese embassy had described the illness as “unknown” or what information it had about the pneumonia.

What is going on here? I would think, or at least certainly hope, that the most likely explanation is that this is in fact COVID-19 and there is something wrong somehow with their tests. However, if so that doesn't explain how Kazakhstan and Kyrgyzstan are able to confirm other patients as being COVID-19 positive... apparently they do have some tests that work to be able to do that... So if they have tests that work, presumably they tried using those same tests on these "pneumonia" cases...

What are other possibilities? Someone on flutrackers suggested it might be some sort of bacterial co-infection (not sure what that would imply, but if that were they were co-infected, why would they test negative for COVID-19?). Or could it be some sort of alternative mutated version of COVID? Could it be a totally different virus?

This is something that clearly needs to be investigated and sorted out ASAP. For the time being I would assume it is probably normal COVID and there is just some confusion, but if that happened not to be correct then we need to catch it and figure out what is going on immediately.

[Florida Man for Crime]

Kazakhstan apparently denies (using google translate to translate the article):

https://tengrinews.kz/kazakhstan_news/minzdrav-otvetil-zayavleniya-neizvestnoy-pnevmonii-407819/

The Ministry of Health has responded to media statements about "unknown, more deadly pneumonia" in Kazakhstan, Tengrinews.kz reports. In its official statement, the Ministry of Health emphasizes that the information is not true. "Some Chinese media report that Kazakhstan reported cases of unknown pneumonia, more deadly than coronavirus. The Ministry of Health has officially stated that this information is not true. "

"It should be noted that WHO introduced codes for pneumonia into the international classification of diseases - ICD-10, when CVI is diagnosed clinically or epidemiologically, for example, there is a symptom of frosted glass in the affected lungs, but it has not been laboratory-confirmed.
In this regard, Kazakhstan, like other countries of the world, keeps records and monitoring of this type of pneumonia, which allows timely management decisions aimed at stabilizing the incidence and prevalence of coronavirus infection. At a briefing on July 9, Kazakh Minister of Health Alexei Tsoi spoke about the number of pneumonia in the country as a whole: bacterial, fungal, viral origin, including according to the ICD-10 classification of “viral pneumonia of unspecified etiology,” the agency said.
⠀
"Therefore, the Ministry of Health emphasizes that Chinese media reports are not true."

I don't understand what that explanation is supposed to mean, but they apparently deny it.

[Florida Man for Crime]

Phoenix Mayor: Abrazo nearly out of morgue space, may be requesting refrigerated trucks

PHOENIX — Phoenix Mayor Kate Gallego says one Abrazo location is nearing capacity in its morgue and may be requesting refrigerated trucks.

ABC15 spoke with Mayor Gallego Friday morning when she said the Abrazo location, which was not identified, is "near capacity" in their morgue space and they are looking at options to prevent problems.

“It’s specific just to one area…this is not a statewide problem,” Mayor Gallego said. "Maricopa County... is looking at everything they can do..."

In other news, the positivity rate in Miami is apparently 33.5% today. I think maybe they don't have enough tests being processed. Just a hunch.

I think for the bigger picture though, the most important news is:

a) The national death moving average is clearly going to continue moving up today.
b) Louisiana reporting 2,642 new cases, just shy of their all-time high of 2,726 from way back in April 2.
c) Virginia spiking up to 943 new cases, the highest since June 7.
d) Montana with 127 new cases, the first time to break 100 and with a clear exponential rise from basically 0 just 1 month ago.
e) Ohio with 1,540 new cases, and now consistently posting ~1k+ cases per day.
f) Wisconsin is reporting an all-time high of 889 new cases.
g) It is getting increasingly hard to find states that are in a down-trend. Even New York, for example, has flat-lined over the last few weeks rather than going down.

These things are all important because they are indications that as much as we may talk about select localities such as Houston/Miami/Phoenix or particular states, this is a national problem that is continuing to get worse on the national level, pretty much everywhere.

[Florida Man for Crime]

At Least 82 Coronavirus Cases Linked To Missouri Sleepaway Camp

A COVID-19 outbreak has forced a Christian sleepaway camp in Missouri to shut down after dozens of staff, campers and counselors tested positive for the coronavirus.

The Kanakuk K-2 camp in Lampe, just north of the Arkansas border, closed after 41 campers, counselors and staff became infected with the coronavirus, the Stone County Health Department announced last week.

Four days later, local health officials said the number of infections had doubled, to 82. Many of those who tested positive had already left the camp and returned home, with cases in at least 10 states and to multiple counties in Missouri.

Seems like opening schools nationwide for in-person indoor classes ASAP is a great idea under these circumstances. What could possibly go wrong? Certainly not anything that anyone could hope to foresee...

[Florida Man for Crime]

For anyone who is interested in knowing how things are really going, I recommend reading some accounts from the people who are working desperately to save lives on the "front lines" - i.e. doctors and nurses etc.

There are some informative threads on r/medicine, in particular they have a COVID megathread which can be worth reading through a bit:

https://www.reddit.com/r/medicine/comments/hm8bak/megathread_47_sarscov2covid19_week_of_july_6_2020/

It seems like things are pretty bad, and basically everyone seems to expect them to get worse at least over the near future. We all owe the medical professionals who are working through this a great deal of gratitude. But instead, what they are actually getting from us is very little help from the government and from the American people in keeping things at a manageable level.

Another example from an ER doctor in Arizona:

https://www.reddit.com/r/IAmA/comments/ho5rcr/i_am_dr_murtaza_akhter_an_er_doctor_in_arizona/

It is worth searching for some of these various accounts and at least skimming through for the general picture as well as some anecdotes.

[Florida Man for Crime]

How many cases can there be before it just runs it’s course?

Realistic estimates are about 7% of the US population has been already infected or is infected now.

Herd immunity with no behavior changes probably requires about 70% immunity, so we would be about 1/10 of the way there. However, herd immunity combined with some behavior changes might be achievable at a lower % of the population infected (40%-50% or so?), but this would not be "back to normal."

The real problem with this discussion, however, is that we still do not know how long immunity lasts (or exactly how immune people who have been previously infected are, though there does seem to be some immunity). Immunity might last for, say, 6 months. Or 9 months. Or 1 year. Or alternatively, even if immunity lasts longer, an alternative strain that bypasses the immunity may evolve, as commonly happens with the cold/flu. If so, then the virus "running its course" would simply mean that people get infected, and a certain # get infected to stop/slow down spread. And then people get infected all over again.

And it would go on like that unless/until we get a vaccine. I do think it is likely we will get a vaccine, but it is not a sure thing. Not all viruses have vaccines. As one example, early in the AIDS epidemic there was lots of optimism about a vaccine... But there is still no vaccine... This is quite a different virus from HIV, but we should remember that the assumption that there will be a vaccine, or that there will be one soon, is just that - an assumption.

[Florida Man for Crime]

Why hasn't any state at least tried a selective lockdown of just people over 60?

For one thing, because states cannot do any such thing.

People who are over 60 require food/shelter/etc to survive, and have to pay for food/mortgages/rent/etc. Some of those people get social security or are retired anyway, but not all.

Any such program to ensure that all people over age 60 (or whatever other criteria there might hypothetically be) would need to be a federal program, because only the Federal government has a money printing machine (or the ability to impose other solutions outside of the monetary system).

So besides anything else, your entire arc of questioning, "why don't states try x" or "why don't states try y" is barking totally up the wrong tree. States cannot make functional, effective, and coherent policy in response to a pandemic. Only the Federal government can. And the Federal government (at least the executive, Trump) has no interest in making any sort of pandemic policy other than "hopefully it will just go away."

As long as that remains the case, USA can and will have no policy, and no real ability to "try" any ideas that you or anyone else might think up.