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

[Fmr. Gov. NickG]

Yet another day where deaths continue to drop rapidly versus the same day last week despite a sustained uptick in cases and a slight uptick in positive test rate.

https://twitter.com/NateSilver538/status/1275179726731182082

Yikes...

https://twitter.com/natesilver538/status/1275546160204300291?s=21

I don’t understand why Nate uses the reporting window he does.  He ends up entirely failing to count certain states some days, and then double counting them other days.

Worldometers reported 849 deaths last Tuesday, not 713.
That said, Worldometers is reporting 817 deaths today with two hours left in the reporting period, there there is a good chance they end up reporting a small week-over-week increase as well.

[Fmr. Gov. NickG]

I believe for the first time, Florida may be the state reporting the most deaths today (80 in FL vs. 72 in CA, though I’m not sure Cailfornia is done reporting).

In the other hand, California has already reported more than 6,000 new cases today, a record for them, while Florida’s daily cases are down somewhat from their highs during the middle of last week.

[Fmr. Gov. NickG]

Now 6320 cases in California? Newsom really screwed up by rushing to open up too soon.

California is still well below the national average in case per capita, and has less than half the national average of deaths per capita.  Cases have been rising there consistently for two months with no growth in deaths.  They still have a significant week-over-week drop in deaths today.  

Southern Calfornia was inevitably going to see a surge in infections at some point, and it looks like they have successfully delayed this surge until improved testing and treatment allowed them to get through it with a dramatically lower death toll.

[Fmr. Gov. NickG]

Latest US vs. European case and death graphs

Today was the first day in three weeks with a week-over-week increase in US deaths, although this is apparently attributable to a dump of old data in Delaware. (Excluding the old Delaware deaths would turn a 2% increase into a 6% week-over-week decline.)
  
Today also surprising saw a surprising 20% week-over-week surge in UK deaths, although the European overall averages still fell thanks to drops in Italy and France.  Perhaps underreported is the fact that European cases have also stopped declining, with no significant change in the overall averages in the last two weeks.

[Fmr. Gov. NickG]

Overall EU vs USA. All Trumpists should be forced to look at this:

This graph is also misleading because it ignores the dramatically higher case fatality rate in Europe.

The UK yesterday reported 921 new cases and 280 new deaths. (CFR=30%)
The US yesterday reported 36,000 new case and 863 new deaths. (CFR=2%)

Today, UK reported 652 cases and 154 deaths. (CFR=24%)
So far today, the US has reported almost 17,000 cases and 365 deaths. (CFR=2%)

Across the whole pandemic, France, Italy, Spain, and the UK all have overall CFRs in the 10-15% range, while the US is right now at 5% and falling.

The UK is consistently still reporting per capita death tolls much higher than the US.
And this is all despite the UK having done more per capita testing!

Cases is the absolute wrong stat to look at.  People are going to get infected at some point regardless of what we do.  It's how we respond to infections that's going to make a difference.

[Fmr. Gov. NickG]

https://twitter.com/StevenTDennis/status/1275847562625507329

There has been a single bright spot today though, which is that Arizona "only" reported 1,795 new cases, which is quite a bit lower than the 3,593 reported yesterday.

But 1,795 by itself is still 35 times more than the 51 new cases reported by South Korea today. And South Korea has more than 7 times the population of South Korea. That comes out to 250 times more new per capita confirmed cases in Arizona today than in South Korea. And if you were to take into account the much higher positivity rate in Arizona, it is probably actually at least something like 2500 times more cases per capita in reality, just as a rough guess.

And that is a "good" day for Arizona.

Arizona reported 79 deaths today, which is by far a record for them.  That is the stat that we should focus on.  So definitely not a good day for them.

[Fmr. Gov. NickG]

This graph is also misleading because it ignores the dramatically higher case fatality rate in Europe.

The UK yesterday reported 921 new cases and 280 new deaths. (CFR=30%)
The US yesterday reported 36,000 new case and 863 new deaths. (CFR=2%)

Today, UK reported 652 cases and 154 deaths. (CFR=24%)
So far today, the US has reported almost 17,000 cases and 365 deaths. (CFR=2%)

This is yet another example of sloppy math/thinking by people who want to downplay the virus and pretend that everything is just fine.

The people who died in the UK/USA today were not newly diagnosed today, but rather were diagnosed weeks ago. To do a proper comparison, you should be comparing new cases from a few weeks ago to current deaths. Doing so would eliminate a decent amount of the discrepancy (of course, it is true that there are also other factors involved such as per capita tests, but that fact that the amount of tests is a factor does not mean that you can validly ignore other factors such as the time lag).

As another example of sloppy math/thinking, remember a few days ago when Delaware dumped some old death data? It was quickly pointed out (correctly) by virus 'skeptics' that really a proper accounting of those deaths should re-assign them, and so that inflated the day's death totals by a bit. Then the virus skeptics compared this to previous data and said, "if you throw out the Delaware deaths which were really from various earlier days, then today was not so bad." However, did they consider the fact that various states have often similarly dumped previous data from previous days in the past? And that this would likewise apply to some of the previous days a week or two ago, and thus if you apply a correction to one day, you must also consider whether the same correction must be applied to previous days. So did they bother to do that, or even acknowledge that in principle they ought to? Nope. No consistency of that sort in analysis, just trying desperately to cling to whatever makes the situation look a little bit better.

Look, I get it. The virus sucks. Lockdowns suck. And what especially sucks are half-assed lockdowns by incompetent governments and selfish and idiotic populaces that don't even successfully contain the virus, which means that the sacrifice we made of going into lockdown was to a considerable extent in vain.

OK, 3-4 weeks ago the UK was averaging 1500-2000 cases per day, and the US was averaging 20,000-25,000.

It's still a CFR of at least 10% in the UK and well below 5% in the US, despite the UK doing more per capita testing.

I don't know of any other state that reported a big death backlog since Massachusetts did this on June 1, and I did report that in my tracking graphs.  If you know of other states that did this in the past few weeks, I'd appreciate that info.

[Fmr. Gov. NickG]

which means that the sacrifice we made of going into lockdown was to a considerable extent in vain.

The lockdown absolutely was not in vain.  We successfully delayed the outbreak in many places by several months, allowing us to significantly improve testing and treatment, thus dramatically reducing the fatality rate of the virus and saving tens of thousands of lives.

[Fmr. Gov. NickG]

I totally support requiring masks were feasible.  For the most part, this should have been done a long time ago.  But how would this work in restaurants and pools?

[Fmr. Gov. NickG]

A lot of experts had been recommending a selective lockdown as a transitional solution, in which older people are still under a relatively strict lockdown, but the economy opens up for younger people.

It seems possible to me that this may be what has ended up happening just based on people understanding their own incentives, without any legally enforced age discrimination taking place.  Younger people are going out and getting infected, leading to more cases but fewer deaths, while older people remain much more cautious.   This doesn’t seem like a bad thing to me as it gets up closer to herd immunity while minimizing the cost to human life.

[Fmr. Gov. NickG]

A lot of experts had been recommending a selective lockdown as a transitional solution, in which older people are still under a relatively strict lockdown, but the economy opens up for younger people.

It seems possible to me that this may be what has ended up happening just based on people understanding their own incentives, without any legally enforced age discrimination taking place.  Younger people are going out and getting infected, leading to more cases but fewer deaths, while older people remain much more cautious.   This doesn’t seem like a bad thing to me as it gets up closer to herd immunity while minimizing the cost to human life.

This is unfortunately not at all what is happening because lots of people who would like to not get infected are being forced to go in to their offices to work (even in cases , where they are ending up getting infected. And in some cases die. Old people and other people who wish not to be infected also need to do various other things such as get food, during which time they are vulnerable to potential infection. While well off people can minimize some of this risk by ordering things, especially many poor people who are not wealthy cannot avoid things such as physically going to stores (where in many states/localities people are still not taking basic precautions such as wearing masks). In addition, there are many people (both old and young) who need non-COVID medical care for other afflictions, and if/when hospitals are overwhelmed they cannot get this medical care and are vulnerable to death and suffering other ill-health effects as a result.

So no, Candide, that is not what is happening, everything is not for the best, and we do not live in the best of all possible worlds. Or perhaps we do, this is as good as it gets.

If you think things are terrible but really think there is nothing we can do better, why do you keep posting in the thread?

This certainly isn’t the way I would have gone about mitigating the virus, but at least things are headed in a better direction than they were back in April.

[Fmr. Gov. NickG]

I'm confused as to what people think Texas should have done differently.  They still have by far the lowest covid death rate of any large state.  Their death rate is more than twenty times lower than New York.

Under the stay-at-home order Texas consistently experienced about 1,000 cases and 30 deaths per day for a month.  They lifted the stay-at-home order, and continued to experience 1,000 cases and 30 deaths per day for the next six weeks. 

Were they supposed to just continue the stay-home-order indefinitely when they never had a significant number of deaths, and there was no evidence the order was reducing cases or deaths anyway?

[Fmr. Gov. NickG]

I'm confused as to what people think Texas should have done differently.  They still have by far the lowest covid death rate of any large state.  Their death rate is more than twenty times lower than New York.

Under the stay-at-home order Texas consistently experienced about 1,000 cases and 30 deaths per day for a month.  They lifted the stay-at-home order, and continued to experience 1,000 cases and 30 deaths per day for the next six weeks. 

Were they supposed to just continue the stay-home-order indefinitely when they never had a significant number of deaths, and there was no evidence the order was reducing cases or deaths anyway?

The biggest thing would have been a mask order. Same goes for Arizona and Florida.

I agree with that.

[Fmr. Gov. NickG]

Implementing a lockdown -earlier- in Texas would have done nothing.  There wasn’t enough spread of the virus in Texas for an earlier lockdown to make any difference.  There was virtually no difference in Texas cases or deaths between when then started the lockdown, a month later when they ended the lockdown, or a month after that when they had been open for a while. 

Texas wasn’t going to completely eliminated the virus.  And they could do things to postpone the surge.  But they were never going to entirely avoid it.

How can people say that countries like Italy and Spain and Belgium did thingss right compared to Texas when these countries have ten times the death rate of Texas right now? 

It may be that the death rate in Texas climbs dramatically with the recent surge in cases.  But it may not.  There has been very little evidence for a significantly lagged surged in deaths following a surge in cases in other places.

[Fmr. Gov. NickG]

Texas wasn’t going to completely eliminated the virus.  And they could do things to postpone the surge.  But they were never going to entirely avoid it.

That is total nonsense unless and until we see Texas-sized second waves in, among others, Canada, New Zealand, Australia, Taiwan, Japan, South Korea, China, Vietnam, Thailand, Ireland, Portugal, Spain, France, Switzerland, Italy, Luxembourg, Belgium, Netherlands, Germany, Austria, Denmark, Finland, Norway, Iceland.

If that is hard to understand, I can list them again.

Canada, New Zealand, Australia, Taiwan, Japan, South Korea, China, Vietnam, Thailand, Ireland, Portugal, Spain, France, Switzerland, Italy, Luxembourg, Belgium, Netherlands, Germany, Austria, Denmark, Finland, Norway, Iceland.

And I am forgetting/leaving out various others such as Slovakia.

All of these other countries successfully controlled the virus as soon as they realized they had a problem.

Implementing a lockdown -earlier- in Texas would have done nothing.  There wasn’t enough spread of the virus in Texas for an earlier lockdown to make any difference.

You are totally a$$-backwards. A lockdown earlier when there were fewer cases would have made more of a difference, not less. It is easier to contain the virus when you have fewer cases, not more, and public health resources can be directed more effectively to plug up the holes with contact tracing, border restrictions, isolating the infected, etc.

The one thing here that is true that even if Texas (and Texas alone) had locked down properly, it would have accomplished comparatively little of all the other states in the USA had not done the same, because then even if Texas had done its part to keep the virus under control, people from other states would have simply traveled to Texas and un-done that work. That is why national leadership is required (and, also international) and you need a national coordinated policy to be effective in a pandemic, not this nonsense ineffective patchwork quilt "federalist" (I guess f stands for failed) system that America is cursed with, where even a single state/locality failing leads to national failure.

This shouldn't be surprising. Former GOP Senator Kit Bond concluded the same thing after taking part in pandmemic-response table top simulations a year or two ago.

There was virtually no difference in Texas cases or deaths between when then started the lockdown, a month later when they ended the lockdown, or a month after that when they had been open for a while.  

Indeed, because Texas never really locked down. In areas and countries where there were actual lockdowns. Heck, even in countries such as South Korea where they *never* actually locked down but where the government is competent and the population does not consist of morons, they have managed to control the virus quite well so far while keeping the economy to a large degree open.

You keep talking as though Texas had a lockdown. The reality is that it, like much of the USA, had a lockdown in name only. Which is far worse than an actual lockdown, because you suffer pretty much the same economic damage as from an actual lockdown, but at least with an actual lockdown it is evident from what happened in other countries that it is actually possible to contain the virus.

The problem with Texas, and with America, is that Texans and Americans are simply far stupider and less capable than other people such as South Koreans are.

I don’t understand why the fact that we haven’t seen a second wave in places like Italy or Spain (yet?) has anything to do with what’s going on in Texas right now.  I think it is unlikely we will see a second wave in most Western European countries just because such a high percentage of their population has already been infected and is thus now immune.    Again, these countries have ten times the death rate of Texas.  To somehow use them as models of success is absurd.  The same is true of states that have seen steep declines like New York and Massachusetts.  The only reason they’ve fought off the virus as of now is that they suffered so badly in the first place.

Obviously many countries in Asian and the Pacific have been much more successful so far.  But it is unlikely that the tactics they used initially would be successful here now.  Or even would have been successful here three months ago given how much the virus had spread before we even started responding.  And these countries are still under extreme travel restrictions even months after they seemingly eradicated the virus.  

[Fmr. Gov. NickG]

It would be a simple thing, then, for southern governors and health agencies to suggest residents turn off their A/C and open a few windows to tame the indoor spread of COVID. Oh, and wear face masks in public places where the A/C runs nonstop.

Is this a joke?  The high in Phoenix today is 111 degrees.

[Fmr. Gov. NickG]

It would be a simple thing, then, for southern governors and health agencies to suggest residents turn off their A/C and open a few windows to tame the indoor spread of COVID. Oh, and wear face masks in public places where the A/C runs nonstop.

Is this a joke?  The high in Phoenix today is 111 degrees.

I wasn't aware Arizona is a Southern state?

Well, ok, the high today is 90 in Dallas, 95 in Tampa, and 100 in El Paso.

[Fmr. Gov. NickG]

I’m still failing to see how Italy and Spain can be seen as examples of success.  They are both top 5 among countries with the highest death rates.  Thousands of people likely died in those countries just due to hospital overcrowding and lack of resources and oversight. They seem to have suffered the worst outcomes of anywhere in the world.  Just because they are now seeing fewer deaths doesn’t mean they did a good job when it would have made the most difference.

If you want to talk about a success story, maybe point to Portugal.  They had a similar number of cases to Italy and Spain, with similar testing rates.  But they had about death rate about 75% lower (only about 150 deaths per million compared to aroun 600 in Italy and Spain).  There may have been several reasons for this, but a huge amount comes down to better treatment.  In particular, Portugal caught on the the use of dexamethasone steroids very early on.  

This is the sort of simple treatment that many contries failed to recognize at first, but which is now contributing to a huge drop in deaths in the US compared to a few months ago.

[Fmr. Gov. NickG]

It is like if you find out that you have cancer. One response is to immediately seek treatment and follow the course of treatment recommended by the doctor. Another response is to maybe google a bit about the cancer, go and talk to a doctor about it, and the doctor says that you need chemotherapy, and then maybe you show up for the first chemotherapy session, but after that to decide "Hmm, isn't this fake news? Cancer is not real!" and not show up for the rest of the treatment. After all, maybe everything will get better on it's own! The human body is a wonderful thing, it can heal itself!

People who get infected now are much more likely to tested and get treatment.  We wouldn’t even hear about most of these cases if people weren’t seeking diagnosis and treatment relatively early on.

This was not true of the majority of cases in Italy and Spain (in contrast, as I mentioned above, to Portugal).  You really think a lot of people who test positive for the virus are ignoring the treatment suggestions from doctors?  I haven’t really heard much indication of that.  

We have so many more effective treatments now than we did a few months ago.  Besides all the news we’ve heard about remdesivir, plasma transfusions, and steroids, some are as simple as laying patients on their stomachs ( https://www.nytimes.com/2020/05/13/health/coronavirus-proning-lungs.html).  Whether the death rate continues to fall as it has for the past two months may depend on whether these improvements can continue to keep pace with new cases.  Maybe I’m just more optimistic about this than others, but the rapid progress we’ve seen so far is pretty miraculous.

[Fmr. Gov. NickG]

https://twitter.com/NateSilver538/status/1276240972062613505

It definitely seems like masks are quite effective at preventing the spread of the virus.  I believe this might be the single biggest contributing factor in why most Asian countries had so much more success containing the virus than most European countries.

However, I don’t understand how so many people can look at current infection rates and still believe that partial herd immunity has no effect.  Based on Nate’s very simple model, past infections have a large negative effect on current R rate, controlling for weather and mask policy (which itself is probably pretty strongly colinear with other social distancing policies).

Everyone keeps mentioning that we are nowhere close to the commonly cited herd immunity threshold of 60-70%.  And that is certainly true.  Based on CDC head Redfield’s statements today, it sounds like the best estimate of current immunity in the US is about 8%.

But when through other policies and behaviors you’ve already reduced the R of the virus to something approaching 1, a small increase in immunity levels can make a huge difference.

For example, a few days ago someone linked to https://rt.live/, estimating current R rates in every state.  You’ll see the median state is estimated to have an R of around 1.1, and this group includes such diverse states as California, Alabama, Wisconsin, and Washington, meaning the virus is gradually growing.  New York, on the other hand, has a current R of .94, meaning the virus is gradually dying off.

What might explain the difference between CA and NY?  It might be that Cuomo has just been much better at implementing policies to slow the virus than Newsome.  Or something about the weather, etc.  But it seems most likely to me that the best explanation is that about 20% of NY’s population is already immune, while only about 5% of CA’s population is immune.  Reducing the population pool eligible for infection by 15% would reduce an R of 1.1 to .94 by itself, and turn a growing virus into a dying one.

If you look at the states with negative R values now, they are almost all state that have the highest rate of past infections.  Because when almost every state has an R value residing between .75 and .25 (as shown in the rt.live graph), the past infection rate doesn’t need to be that high to flip the state from positive to negative.

[Fmr. Gov. NickG]

The updated numbers for COVID-19 in the U.S. are in for 6/25 per: https://www.worldometers.info/coronavirus/country/us/

6/24 (Yesterday):

• Cases: 2,462,554 (+38,386 | Δ Change: ↑6.18% | Σ Increase: ↑1.58%)
• Deaths: 124,281 (+808 | Δ Change: ↓6.37% | Σ Increase: ↑0.65%)

6/25 (Today):

• Cases: 2,504,588 (+42,034 | Δ Change: ↑9.50% | Σ Increase: ↑1.71%)
• Deaths: 126,780 (+2,499 | Δ Change: ↑209.28% | Σ Increase: ↑2.01%)

If you are using worldometers as a source, I’m not sure how you are getting 2,499 deaths today.  Worldometers counted 649 deaths today, and then allocated 1,849 probable earlier deaths in New Jersey onto days in the past based on proportionate past death counts.  The actual number of new deaths represents a week-over-week decrease of 14%.

[Fmr. Gov. NickG]

Texas is closing down bars again

https://twitter.com/chadhastyradio/status/1276504017951227905?s=21

This suggests that Texas may have reopened too soon. Will other states have to follow? At this point, I'm wondering if those who were advocating for longer, rigorous lockdowns were right. Hopefully Colorado does not have to go down this path.

A longer lockdown would have just delayed the surge.  The only question is how much treatment would have continued to improve in the meantime.

[Fmr. Gov. NickG]

I think we are getting to a point where some states, or at the very least some counties/regions, are going to have to go to total shutdown again.

You can't have a functioning economy with the disease running rampant.

Conservatives are to blame. If the states were properly locked down for 3 months, the economy would've - jn the end - suffered less long-term. Desperate to "save the economy", they opened too early and f___ed the economy (and got people killed). F___ing PATHETIC and disgusting.

If you locked the country down for three months, the virus would just go back to spreading three months later.  Medical experts believe that for many people, the question is not "if" they will get the virus but "when":

“This virus is not going to rest” until it infects about 60 percent to 70 percent of the population, Dr. Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota said on “Fox News Sunday.”

https://www.nytimes.com/2020/06/14/health/coronavirus-summer-spread.html

"The length of the pandemic will likely be 18 to 24 months, as herd immunity gradually develops in the human population," the report says. "Given the transmissibility of SARS-CoV-2" — the virus that causes COVID-19 — "60% to 70% of the population may need to be immune to reach a critical threshold of herd immunity to halt the pandemic."

https://www.cbsnews.com/news/coronavirus-pandemic-update-two-years-70-percent-immunity/

The purpose of the lockdowns is not to prevent infections.  It is to prevent the healthcare system from collapsing.  And despite the surge in infections in Florida, there is little evidence that hospital resources are being overwhelmed.

And I actually don't think we need a 60% infection rate to slowly kill off the virus.  As I've discussed before, places like New York and Italy have shown that it can be done with a much lower immunity threshold.  Florida and Texas clearly haven't reached that threshold yet.  But there's little reason to just delay it further.  As long as the infections are predominantly younger people who are less likely to suffer serious adverse health effects, more infections are a good thing, because they speed up the process of immunity.

[Fmr. Gov. NickG]

Cases have actually been pretty flat in California, Arizona, and Texas over the last 5 days or so.  It looks like the crazy national spike in cases today was driven almost entirely by Florida.

[Fmr. Gov. NickG]

Apparently 9k+ is the new normal for Florida now.

https://twitter.com/BNODesk/status/1276896809080836103

Worldometers is reporting 26 deaths today in FL.  But either way, it’s a 35-40% week-over-week decline in deaths.  Yesterday also saw a small week-over-week decline in deaths.

Cases have been increasing in Florida for at least 4 weeks.  The last week of May saw 700 cases per day on average, while the first week in June saw 1200 cases per day.  But average deaths have remained stable in the 30s for the entire month.  How have we not seen any increase in deaths yet?  Even if there was a 3-4 week lag, we should be seeing some evidence by now.