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

[Del Tachi]

More news from the frontlines of the lockdown:  the number of visits at primary care clinics (including telehealth) has declined more than 60% since mid-March.

Patients are deferring "non-essential" visits and letting chronic healthcare conditions (like diabetes or heart disease) go unmanaged.  Unmanaged conditions will eventually become urgent. At worst, this will contribute to increased mortality from non-COVID conditions (and will make the true scope of the pandemic's lethality difficult to calculate).  These small family practices are also not well-posited to absorb the lost revenue, and many will have to either close or be bought by larger hospital systems or health conglomerates. 

[💥💥 brandon bro (he/him/his)]

https://twitter.com/_cingraham/status/1254792999080349697

Of course, not all the excess deaths are necessarily due to COVID-19.  It's likely that there are some due to other medical conditions where people sought help too late due to fear of going to the hospital.  In the other direction, there's probably also a decline in deaths due to auto accidents.  But regardless of the exact numbers, it seems clear that "official" COVID-19 deaths are an underestimate (which is not really a surprise).

I would just like to add that this probably isn't as scary as it looks because almost all of the excess mortality from COVID-19 is occurring in older age cohorts, and a lot of these people would have probably died in the next 24 months anyway.  The pandemic has just hastened their demise.  If anything, we should expect to see reduced all cause mortality for several months after the pandemic ends (as a lot of folks who would have died in that future time period ending up dying early from COVID).   

This is, of course, entirely speculative, in addition to being a rather cruel way to minimize the impacts of the virus.

1) It's not speculative.  Almost 60% of U.S. coronavirus deaths have occurred in persons age 75 or older.  Life expectancy for a 75-year old U.S. male is only 11.8 years, and only 5.6 years for an 85-year old.  People who are dying of this disease are mostly already at end-of-life, or at least very susceptible to developing other severe conditions/complications under non-pandemic conditions.

2) This is how excess mortality works in flu pandemics (and while COVID-19 is *not the flu, pathologically and epidemiological it behaves like a flu virus - one aspect of that being mortality is mostly confined to older, more comorbid populations).  Excess mortality from the 1957-58 flu pandemic was followed by a period of reduced all-cause mortality.  That's how epidemiological theory tells us excess mortality from an unmitigated flu pandemic works - a short period of high excess mortality, followed by a longer period of less noticeable below-average mortality.

I was referring to the clearly bogus statistic that people in the US would likely be dying within 24 months. That's the bolded claim and it's contradicted by the data you provided. Nobody argued that a 75 year old has the same life expectancy as a 25 year old.

This a classic motte-and-bailey tactic.

Also, while on this topic, it's incredibly dangerous to equate dying by COVID with dying by other natural causes. The difference betwen dying of, e.g., COVID at age 80 and dying of heart failure at age 85 is that the person who contracts COVID is highly contagious. Heart disease and the other typical diseases these people suffer have R0 of zero. When people contract COVID (regardless of age) the primary effect is that they could die but the secondary effect is that they can transmit the disease to others. Given the number of health professionals who have gotten sick due to being bombarded with the virus (without proper PPE) there's no reason to equate a COVID death with most non-COVID deaths because COVID deaths are likely begetting other hospitalizations, lost productivity, and deaths.

[Del Tachi]

https://twitter.com/_cingraham/status/1254792999080349697

Of course, not all the excess deaths are necessarily due to COVID-19.  It's likely that there are some due to other medical conditions where people sought help too late due to fear of going to the hospital.  In the other direction, there's probably also a decline in deaths due to auto accidents.  But regardless of the exact numbers, it seems clear that "official" COVID-19 deaths are an underestimate (which is not really a surprise).

I would just like to add that this probably isn't as scary as it looks because almost all of the excess mortality from COVID-19 is occurring in older age cohorts, and a lot of these people would have probably died in the next 24 months anyway.  The pandemic has just hastened their demise.  If anything, we should expect to see reduced all cause mortality for several months after the pandemic ends (as a lot of folks who would have died in that future time period ending up dying early from COVID).   

This is, of course, entirely speculative, in addition to being a rather cruel way to minimize the impacts of the virus.

1) It's not speculative.  Almost 60% of U.S. coronavirus deaths have occurred in persons age 75 or older.  Life expectancy for a 75-year old U.S. male is only 11.8 years, and only 5.6 years for an 85-year old.  People who are dying of this disease are mostly already at end-of-life, or at least very susceptible to developing other severe conditions/complications under non-pandemic conditions.

2) This is how excess mortality works in flu pandemics (and while COVID-19 is *not the flu, pathologically and epidemiological it behaves like a flu virus - one aspect of that being mortality is mostly confined to older, more comorbid populations).  Excess mortality from the 1957-58 flu pandemic was followed by a period of reduced all-cause mortality.  That's how epidemiological theory tells us excess mortality from an unmitigated flu pandemic works - a short period of high excess mortality, followed by a longer period of less noticeable below-average mortality.

I was referring to the clearly bogus statistic that people in the US would likely be dying within 24 months. That's the bolded claim and it's contradicted by the data you provided. Nobody argued that a 75 year old has the same life expectancy as a 25 year old.

This a classic motte-and-bailey tactic.

Also, while on this topic, it's incredibly dangerous to equate dying by COVID with dying by other natural causes. The difference betwen dying of, e.g., COVID at age 80 and dying of heart failure at age 85 is that the person who contracts COVID is highly contagious. Heart disease and the other typical diseases these people suffer have R0 of zero. When people contract COVID (regardless of age) the primary effect is that they could die but the secondary effect is that they can transmit the disease to others. Given the number of health professionals who have gotten sick due to being bombarded with the virus (without proper PPE) there's no reason to equate a COVID death with most non-COVID deaths because COVID deaths are likely begetting other hospitalizations, lost productivity, and deaths.

Yeah people can catch COVID and spread it around to others, but the very negative outcomes (i.e., deaths) are associated with the subpopulations that already have the highest mortality.  I’m unsure what your point is here. 

[President Johnson]

https://twitter.com/axios/status/1254791955755626496

President Snowflake cancells his "briefings" because he's been laughed at for dumb ideas he tried to label as "saracasm" afterwards? So much for Mr. Tough Guy.

[GeorgiaModerate]

https://twitter.com/meslackman/status/1254838397031464960

From the article:

That has enabled them to leap ahead and schedule tests of their new coronavirus vaccine involving more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works.

The Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective.

[President Punxsutawney Phil]

More news from the frontlines of the lockdown:  the number of visits at primary care clinics (including telehealth) has declined more than 60% since mid-March.

Patients are deferring "non-essential" visits and letting chronic healthcare conditions (like diabetes or heart disease) go unmanaged.  Unmanaged conditions will eventually become urgent. At worst, this will contribute to increased mortality from non-COVID conditions (and will make the true scope of the pandemic's lethality difficult to calculate).  These small family practices are also not well-posited to absorb the lost revenue, and many will have to either close or be bought by larger hospital systems or health conglomerates.  

This is why I stopped seeing the Kemp plan as complete insanity. These small family medical practices will need either a bailout or a fighting chance at getting revenue and staying afloat.

[Fmr. Gov. NickG]

https://twitter.com/NateSilver538/status/1254825274786668546

Good news.

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

[GeorgiaModerate]

This is interesting:

https://twitter.com/NateSilver538/status/1254856060734550017

Something I've wondered: have other countries seen protests in favor of reopening such as those that have occurred in a number of U.S. cities?

[Penn_Quaker_Girl]

https://twitter.com/meslackman/status/1254838397031464960

From the article:

That has enabled them to leap ahead and schedule tests of their new coronavirus vaccine involving more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works.

The Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective.

Fun-Fact: Debates about animal testing aside (I'm not a big fan, but reluctantly understand the reasoning), Rhesus Monkeys share about ninety-five percent of genetic material with humans - hence why they're so often used in testing. 

[President Punxsutawney Phil]

https://twitter.com/NateSilver538/status/1254825274786668546
Good news.

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

[ilikeverin]

This is interesting:

https://twitter.com/NateSilver538/status/1254856060734550017

Something I've wondered: have other countries seen protests in favor of reopening such as those that have occurred in a number of U.S. cities?

It almost seems like a cynicism index.

[Bandit3 the Worker]

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

If lockdowns worked, this decline would have happened much earlier.

Pandemics die down. People build up immunity, the seasons change, and things change.

[Bandit3 the Worker]

This is interesting:

https://twitter.com/NateSilver538/status/1254856060734550017

Something I've wondered: have other countries seen protests in favor of reopening such as those that have occurred in a number of U.S. cities?

Germany has them...

https://www.aljazeera.com/news/2020/04/dozens-arrested-anti-covid-19-lockdown-protest-germany-200426083407846.html

[parochial boy]

Something I've wondered: have other countries seen protests in favor of reopening such as those that have occurred in a number of U.S. cities?

See the video in the tweet below, there have been riots in the French banlieues (and in Belgium too). But that is playing into an ages old story of simmering tensions with the police about police brutality and racism and social dislocation in those neighbourhoods.

https://twitter.com/Actu2dinguerie/status/1252373486456037380

[Hammy]

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

If lockdowns worked, this decline would have happened much earlier.

Pandemics die down. People build up immunity, the seasons change, and things change.

Do you literally not understand, or simply refuse to, that the whole point of the lockdown isn't to magically eliminate the virus but to keep the numbers steady so the healthcare system isn't overwhemed?

[Bandit3 the Worker]

Do you literally not understand, or simply refuse to, that the whole point of the lockdown isn't to magically eliminate the virus but to keep the numbers steady so the healthcare system isn't overwhemed?

It got overwhelmed anyway. They had to use mass graves in New York.

[Joe Biden is your president. Deal with it.]

You know what I noticed? It seems like there’s good news surrounding COVID-19 and mostly everyone is immune to it or they write it off.

[Tintrlvr]

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

If lockdowns worked, this decline would have happened much earlier.

Pandemics die down. People build up immunity, the seasons change, and things change.

Do you literally not understand, or simply refuse to, that the whole point of the lockdown isn't to magically eliminate the virus but to keep the numbers steady so the healthcare system isn't overwhemed?

If that were the point, we'd be doing measured reopening right now. The healthcare system isn't overwhelmed in NYC (any more), and the number of hospitalizations is dropping very rapidly. You couldn't completely go back to normal (i.e., you couldn't hold packed concerts or nightclubs, people should avoid very crowded public spaces like a rush hour subway car if possible, masks should be worn in public), but you could even have restaurants open with basic precautions if your only goal was to reduce the rate of infection to the point where the medical system wasn't overwhelmed.

It's clear that, while not overwhelming the medical system was the original stated goal for lockdowns, political forces have dictated that the point of lockdowns now is to eliminate or nearly eliminate the virus, even though that's clearly a wrongheaded and ineffective approach, because that's what the public has come to demand. You wouldn't be continuing a lockdown almost anywhere now otherwise.

As others have pointed out, the value of "not overwhelming the medical system" seems to be pretty low with this virus anyway. Ventilators have extremely low efficacy at saving lives (they may even be killing more patients than they save), and it doesn't seem like any major medical interventions are having any net effect whatsoever on overall mortality. We are starting to find certain drugs that may help (certain antivirals, some immunosuppressants, etc.), and there are basic interventions (like proning) that do seem to make a difference, but the need specifically for fancy medical equipment or highly equipped hospitals is just not there.

[Smeulders]

https://twitter.com/NateSilver538/status/1254825274786668546

Good news.

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

Let me get this straight. You are doubting that keeping people away from one another reduces the transmission of the virus? What mechanism of transmission do you think the virus has, that apparently doesn't need physical access to new hosts?

You are right that immunity does reduce transmission. But again I am curious by what mechanism 25% immune managed to reduce transmission by more than 50%.

Your herd immunity, not distancing hypothesis also fails to account completely for the mass of other countries that managed to push R below 1 without the massive rate of infected NY has.

It's clear you are refusing to understand very simple things because of your dislike of lockdowns. Be intellectually honest, argue the lockdowns should end despite their advantages.

[Fmr. Gov. NickG]

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

If lockdowns worked, this decline would have happened much earlier.

Pandemics die down. People build up immunity, the seasons change, and things change.

Do you literally not understand, or simply refuse to, that the whole point of the lockdown isn't to magically eliminate the virus but to keep the numbers steady so the healthcare system isn't overwhemed?

Keep the numbers steady until when?  You mean the initial goal of the lockdown was to keep infections and death constant until a vaccine was developed?  So everyone was always planning on enforcing lockdowns for 18 months?

The fact is that this was NOT the goal of the lockdown.  If our goal was to spread infections around more evenly so that particular local healthcare systems didn’t get overwhelmed, we would have gone about this much differently.  We would have implemented stronger restrictions where we saw empirical signs of rapid growth, and weaker restrictions where we didn’t.  And we wouldn’t have discouraged New Yorkers from leaving town when the virus exploded there.  If we just wanted to reduce the burden on an overloaded health care system, we would have encouraged New Yorkers to leave to lighten the load on NY’s system and spread the virus to places where it could be better managed.

The goal of the lockdown was to reduce total infections.  That’s what all the models told us would happen.  But the models were wrong in many ways.  The models way underestimated the contagion of the virus and overestimated its lethality.  The lockdowns have almost completely failed to turn the spread negative, and by bluntly forcing a one-size-fits-all approach, they have increased the deaths that will result from the virus by failing to better protect the most vulnerable.

[Gass3268]

https://twitter.com/JesseFFerguson/status/1254886896376872960?s=20

[President Punxsutawney Phil]

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

If lockdowns worked, this decline would have happened much earlier.

Pandemics die down. People build up immunity, the seasons change, and things change.

Do you literally not understand, or simply refuse to, that the whole point of the lockdown isn't to magically eliminate the virus but to keep the numbers steady so the healthcare system isn't overwhemed?

Keep the numbers steady until when?  You mean the initial goal of the lockdown was to keep infections and death constant until a vaccine was developed?  So everyone was always planning on enforcing lockdowns for 18 months?

The fact is that this was NOT the goal of the lockdown.  If our goal was to spread infections around more evenly so that particular local healthcare systems didn’t get overwhelmed, we would have gone about this much differently.  We would have implemented stronger restrictions where we saw empirical signs of rapid growth, and weaker restrictions where we didn’t.  And we wouldn’t have discouraged New Yorkers from leaving town when the virus exploded there.  If we just wanted to reduce the burden on an overloaded health care system, we would have encouraged New Yorkers to leave to lighten the load on NY’s system and spread the virus to places where it could be better managed.

The goal of the lockdown was to reduce total infections.  That’s what all the models told us would happen.  But the models were wrong in many ways.  The models way underestimated the contagion of the virus and overestimated its lethality.  The lockdowns have almost completely failed to turn the spread negative, and by bluntly forcing a one-size-fits-all approach, they have increased the deaths that will result from the virus by failing to better protect the most vulnerable.

The lockdowns within a certain limit were absolutely rational, but it is clear that way too many elected officials and others have come to rely on them way too much, harming the economy and the people themselves in the process.

[💥💥 brandon bro (he/him/his)]

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

If lockdowns worked, this decline would have happened much earlier.

Pandemics die down. People build up immunity, the seasons change, and things change.

Do you literally not understand, or simply refuse to, that the whole point of the lockdown isn't to magically eliminate the virus but to keep the numbers steady so the healthcare system isn't overwhemed?

Keep the numbers steady until when?  You mean the initial goal of the lockdown was to keep infections and death constant until a vaccine was developed?  So everyone was always planning on enforcing lockdowns for 18 months?

The fact is that this was NOT the goal of the lockdown.  If our goal was to spread infections around more evenly so that particular local healthcare systems didn’t get overwhelmed, we would have gone about this much differently.  We would have implemented stronger restrictions where we saw empirical signs of rapid growth, and weaker restrictions where we didn’t.  And we wouldn’t have discouraged New Yorkers from leaving town when the virus exploded there.  If we just wanted to reduce the burden on an overloaded health care system, we would have encouraged New Yorkers to leave to lighten the load on NY’s system and spread the virus to places where it could be better managed.

The goal of the lockdown was to reduce total infections.  That’s what all the models told us would happen.  But the models were wrong in many ways.  The models way underestimated the contagion of the virus and overestimated its lethality.  The lockdowns have almost completely failed to turn the spread negative, and by bluntly forcing a one-size-fits-all approach, they have increased the deaths that will result from the virus by failing to better protect the most vulnerable.

There are more options available than indefinite lockdown until there is a vaccine and no preventative measures.

We started lockdowns in March when we had a health care system that was essentially a blank slate for dealing with the virus. Hospital capacity was one of several lagging features; we also had few tests, a cruder understanding of how the virus spread, a supply chain that was woefully ill-equipped for mass-delivering PPE and testing materials, and no infrastructure for either identifying or isolating sick people or for tracking their contacts. Lockdowns were a good tool at the time for buying time until some of the above could be implemented.

It's true the hospital system in many places has not been overwhelmed yet and appears unlikely to be overwhelmed at any point in the future. This is good news! It's also true that we have a much better understanding of how the virus spread (and have taken preventative measures to reduce transmission, e.g., encouraging wearing masks) and have a supply chain which, while not perfect, is much better than it was six weeks ago. This is also good news; it's part of the reason why some states are credibly considering lifting their lockdowns.

But there's still reason to be very cautious and abide to lockdowns or less-severe restrictions. We are behind on testing capabilities. Some areas are still lacking in PPE and this will become worse as service sector work opens back up. The vast majority of states and cities are nowhere close to any sort of contact tracing or protocols for isolating sick people.

The longer an area stays under rules which demonstrably reduce transmission, the more time they are buying to put these measures in place. How much longer is it worth putting these measures off? It's not clear, and we're going to get some useful information as states reopen. But we aren't waiting solely for the vaccine; we're also waiting on some other factors which will be very helpful for treatment and harm reduction when the rest of the country is able to reopen and are conceivably attainable on a much faster timescale.

[Dr. Arch]

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

If lockdowns worked, this decline would have happened much earlier.

Pandemics die down. People build up immunity, the seasons change, and things change.

Do you literally not understand, or simply refuse to, that the whole point of the lockdown isn't to magically eliminate the virus but to keep the numbers steady so the healthcare system isn't overwhemed?

The goal of the lockdown was to reduce total infections.  That’s what all the models told us would happen. But the models were wrong in many ways.  The models way underestimated the contagion of the virus and overestimated its lethality.  The lockdowns have almost completely failed to turn the spread negative, and by bluntly forcing a one-size-fits-all approach, they have increased the deaths that will result from the virus by failing to better protect the most vulnerable.

That is the exact OPPOSITE of what the models ever told anyone. The models are a function of number of cases over time. The whole point of flattening the curve is to have the same number of cases over a longer time span so that the system is not overwhelmed (see below).



The number of cases under the peak is the same over a longer period of time. Anyone with a basic understanding of mathematical functions can understand this. Your understanding of the models is flawed, and so is your argument by derivation.

You can't misinterpret information, assign it a different end game, and then call it a failure because it doesn't fit that interpretation. Please read up more on this information.

Finally, we don't have lockdowns. We have stay at home orders, which are far less restrictive, and a good number of people aren't even following them; there are some of those people even within our own forum community.

[#TheShadowyAbyss]

So is today a legit decline or the Sunday-Monday slump?