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

[Fmr. Gov. NickG]

https://twitter.com/blakehounshell/status/1252220777115549699

I read this (quite long) article this morning and by the end of it, it was still unclear to me why Giroir was fired at his previous university.  It honestly made him sound like one of the more competent people in this administration (though that is not saying much).

[Fmr. Gov. NickG]

https://www.nytimes.com/2020/04/20/us/politics/larry-hogan-wife-yumi-korea-coronavirus-tests.html

This is what leadership looks like - Imagine if we had this man as our president. No matter how slim his chances may be, I will drop everything and campaign my heart out for him in 2024.

This is like the best thing I’ve heard a politician do all month.
500k tests would get MD close to Iceland levels of testing.

[Fmr. Gov. NickG]

Latest cumulative European new case & death graphs (5-day weighted averages):




This week was actually pretty promising in Europe overall, with substantial week-over-week declines in cases for at least the last two weeks everywhere except UK.  Deaths have also declined week-over-week in all five countries, though the pace of decline has been slower.

[Fmr. Gov. NickG]

Whatever you think of the larger-scale serological studies, they seem to line up with studies of small populations given an actual covid test.

As one example, New York city has been testing all pregnant women admitted to the hospital for delivery.  They found that 15% of patients tested positive as of April 4, and 90% of those cases were asymptomatic.

This would suggest that NYC is underestimating infections by at least a factor of 10, and possibly significantly more.  To the extent that we see cases declining there, is may simply be because we are approaching herd immunity.  

https://www.nejm.org/doi/full/10.1056/NEJMc2009316

[Fmr. Gov. NickG]

Updated data from CDC show that more Americans over the age of 85 have died of COVID-19 than those under age 65.  The risks to young people are terribly overstated by the sensationalist media.  

How does it show that 0 people under 1 year old have died?  Weren’t there two cases of newborns who died in the national news a couple weeks ago?

It’s only showing 17,000 deaths total when the US had about 40,000 covid reported covid deaths as of April 18.

[Fmr. Gov. NickG]

Updated data from CDC show that more Americans over the age of 85 have died of COVID-19 than those under age 65.  The risks to young people are terribly overstated by the sensationalist media. 

It is a shame that an 86 year olds life means less to you people than the life of a 55 year old.

It’s fairly widely accepted to consider “potential years of life lost” rather than a constant “lives lost” when making these sort of cost/benefit analyses, especially in the allocation of medical resources.  

On a global scale, if we didn’t do this, we’d likely allocate almost all medical funding to prolonging the lives of elderly people, and researching diseases that primarily affect the elderly, to the complete exclusion of trying to prevent causes of death among younger patients, because older people are overwhelmingly more likely to die of everything than younger people.

[Fmr. Gov. NickG]

It’s interesting in the CDC report posted above that although the number of deaths among 85+ year olds is higher than all other groups, the percentage of deaths attributable to covid is remarkably constant between 2.5%-3% among all age groups excluding children.  

People under 25 are almost entirely unaffected, but covid has increased the likelihood of death for all other people by about 3%.  It’s just that a 90-year old is about 100x more likely to die overall than a 40-year old in a given month.

[Fmr. Gov. NickG]

I think that the following states should begin opening up now(Phase two)
-Alaska (except for Anchorage)
-Hawaii
-Parts of East Washington
-Idaho (Except for Boise)
-Montana
-Vermont
-Maine (except for Portland)

By May 1st, many more States and the excluded cities should be able to safely begin opening up.
 That being said, some States are doing things way too prematurely. Some need a sharper decline in cases (Like Georgia) or significantly more testing (Like Colorado) before it is safe.

What's stopping someone from going from say, California/Washington/Oregon, and going to Montana and causing another outbreak though?

I mean, States should also be banning non-essential interstate travel (with a few exceptions for border communities)

This would need to be a lot more than a “few exceptions”.  There are many major cities where a significant fraction of people who work in those cities live in a different state.  I’ve had several jobs where I lived in a different state than I worked, and thus travelled interstate multiple times every day.

[Fmr. Gov. NickG]

The early estimates of years of life lost per COVID-19 death range between ten and fifteen years, which of course means that around half of those who die are losing more than that.

The 10-15 year average sounds about right to me.  

But this distribution is going to be left-skewed, so the median is likely to be higher than the mean (the majority of people will lose less than the mean because the minority who lose more than mean will lose a lot more).  

You’d have a mean of 10 years if nine 80-year olds each lose 5 years of life for every one 30-year old who loses 55 years.

[Fmr. Gov. NickG]

The US is going to set a new daily record for deaths today (at least according to the worldometers count).  The models that projected the peak to come around April 10 were clearly way off.

[Fmr. Gov. NickG]

I wish those policymakers who are advocating for “reopening the country” would clarify what they expect to happen after lifting restrictions.

Do they believe the restrictions have already worked (or that they were never needed), and thus the virus has already been effectively killed off in their jurisdiction?

Or do they believe that the restrictions are not working, and thus we might as well lift restrictions since almost everyone is going to get virus anyway, we might as well just go ahead and let people get it now (to more quickly achieve herd immunity)?

I.e. A person could hold a coherently favor lifting lockdowns because they either believe the virus is much LESS serious than most lockdown advocates believe, OR because they believe it is much MORE serious than lockdown advocates believe.

But I feel like a lot of people on this side seem to hold both positions simultaneously in a way that ends up being incoherent.

FWIW, this is also somewhat true of people favoring continuing the lockdowns (they look at any good news as evidence that the lockdowns are working, and any bad news as evidence that the lockdowns need to stay in place).

[Fmr. Gov. NickG]

FWIW, this is also somewhat true of people favoring continuing the lockdowns (they look at any good news as evidence that the lockdowns are working, and any bad news as evidence that the lockdowns need to stay in place).

I think both can be true.

In that case, what would constitute evidence for you that the lockdowns should be lifted because they aren’t working?

[Fmr. Gov. NickG]

Nate Silver has been tweeting several times a day reflecting on covid stats.  It sounds like, just as of today, he may be a convert to the “herd immunity” position.

https://twitter.com/natesilver538/status/1252736633490812931?s=21
https://twitter.com/natesilver538/status/1252689853218803714?s=21

[Fmr. Gov. NickG]

566 new deaths in Italy today.  One week ago, this number was 578.  Two weeks ago, it was 542. 
They've been in lockdown for more than 6 weeks now.  If is was truly working, shouldn't we be seeing a steady decline in this number by now?

[Fmr. Gov. NickG]

566 new deaths in Italy today.  One week ago, this number was 578.  Two weeks ago, it was 542. 
They've been in lockdown for more than 6 weeks now.  If is was truly working, shouldn't we be seeing a steady decline in this number by now?

It looks like worldometer may have been momentarily reporting an incorrect number.  It's now reporting 437 deaths in Italy today, which would represent decent progress.  I apologize for the earlier apparently erroneous post.

[Fmr. Gov. NickG]

Scientists investigate possible positive effects of nicotine. It is being assumed that nicotine somehow (clinging onto the receptors the virus needs) has a positive shielding effect against the virus.  

https://m.oe24.at/coronavirus/Coronavirus-Wissenschafter-vermuten-positive-Wirkung-von-Nikotin/427320386

Obviously testing will be done with patches, not cigarettes.

The reason for the theory is that so far smokers have 80% lower infection rates than the General population.

I was an occasional smoker for several years (cigars only, not cigarettes) but quit a little over a year ago when my wife got pregnant. 

But I’ve relapsed a few times the last few weeks out of stress and boredom.  Now I have a good excuse!

[Fmr. Gov. NickG]

Preliminary results of a serologic study suggest that about 2.7 million New Yorkers have been infected, including 21.2% of NYC, about 10 times the rate of confirmed infections.

https://www.bloomberg.com/news/articles/2020-04-23/new-york-finds-virus-marker-in-13-9-suggesting-wide-spread

If it is true that more than 20% of the city is already infected, it does seem to me that they need to open the city back up for those with the antibodies, as well as other young and healthy people for whom the virus has relatively lower risk.

At that rate of infection and contagion, the lockdown is not going to successfully eradicate the virus except through herd immunity. Given this, a general lockdown just puts vulnerable people at more risk by prolonging the process of herd immunity among the healthy, and will eventually lead to more deaths, not fewer.

[Fmr. Gov. NickG]

Biggest overreaction ever.

I can think of another.

This is actually a pretty good analogy.  When the terrorist attacks happened on 9/11, it was pretty reasonable for us to enact a lot of new strict security measures, because we had very little knowledge of how much this initial wave represented an ongoing threat to our way of life.  But as time when on and it became apparent that terrorism was not a serious or common threat, we mostly failed to adjust our policies in light of new information.  We still have to take our shoes off and can’t take liquids on the plane despite not seeing any airplane related terrorism in almost two decades.

These serologic studies have the potential to give us real and essential information about the prevalence and fatality rates of the virus.  It would be shameful if we don’t use this information to adjust our policies.

[Fmr. Gov. NickG]

Biggest overreaction ever.

I can think of another.

This is actually a pretty good analogy.  When the terrorist attacks happened on 9/11, it was pretty reasonable for us to enact a lot of new strict security measures, because we had very little knowledge of how much this initial wave represented an ongoing threat to our way of life.  But as time when on and it became apparent that terrorism was not a serious or common threat, we mostly failed to adjust our policies in light of new information.  We still have to take our shoes off and can’t take liquids on the plane despite not seeing any airplane related terrorism in almost two decades.

These serologic studies have the potential to give us real and essential information about the prevalence and fatality rates of the virus.  It would be shameful if we don’t use this information to adjust our policies.

It’s not a good analogy at all. Increased security didn’t exactly shut down the economy. Stupid analogy, actually.

Certainly the current shutdown is a much greater inconvenience than the additional security measures after 9/11.  But the virus is also a much greater threat, so in that sense a more severe reaction was warranted.

[Fmr. Gov. NickG]

Latest studies show infection rates much higher, which means a much lower death rate.

I’ve been saying this from the very beginning. Biggest overreaction ever.

It seems weird to me that almost 50 thousand deaths in US so far are being written off as an overreaction.....

Yeah, interpreting the serologic study as proof we are “overreacting” is bizarre.

These studies suggest that far more people are going to get infected than either side of this debate has been willing to consider.  They also indicate that more people are going to die than previous estimateS.  It might be a lower IFR, but it’s still going to be more total deaths.

But they also indicate that our current reaction, while not an overreaction, might not be the right reaction.  Rather than trying to minimize infection, we may have to acknowledge that this is impossible and instead focus on mitigating the consequences of near universal infection.

[Fmr. Gov. NickG]

We may very soon need to confront the reality that the restrictions we have adopted are not sufficiently reducing cases or deaths.

The virus is way more contagious and stealthy than initially assumed.   At this rate, we will continue to see a near constant rate of cases and deaths until herd immunity is achieved, even if we remain under lockdown.

[Fmr. Gov. NickG]

Why does anyone think that cases or deaths are going to start suddenly steeply declining any time some?  There’s been no evidence of this in the US, and no evidence in countries that started their lockdowns sooner like Italy.

The lockdowns have stopped the exponential growth of the virus.  But they haven’t slowed it to the point where it is moving toward eradication.  In places where we have seen slow but significant declines, like Italy and NYC, it is likely because those places have such a high proportion infected that they are headed toward herd immunity.

[Fmr. Gov. NickG]

I’ve linked below to a study by scientists at UC Berkeley using Italian death records to estimate true covid mortality rates.  I believe this is still prior to peer review, and I have only skimmed it, but here are some interesting conclusions they seem to draw from my reading:

- Overall Italian deaths were actually twice the official reported figure (total of 52,000), though all the excess deaths are among people 70 or older.

- At least one region in Northern Italy has indeed achieved herd immunity

- The overall IFR of the virus across the entire population is estimated at 0.6%

- Differences in IFR across age groups are extreme, reaching over 10% among those 90+, but only 0.02% (1 in 5,000) among those 40-49 (they don’t estimate a rate for those under 40, I assume because there are so few deaths).

- In the discussion, the extrapolate from these figures to estimate that 25% of New York City is currently infected.

https://www.medrxiv.org/content/10.1101/2020.04.15.20067074v2.full.pdf

[Fmr. Gov. NickG]

Update cumulative European case/death graphs (5-day weighted averages).  For the first time, daily US deaths are exceeding the sum of the five big Western European nations.

[Fmr. Gov. NickG]

The analysis in the Berkeley Italian death records paper suggests that the IFR of the virus roughly increases tenfold with every 20 years of age.

So a 90-year old has about a 10% chance of dying; a 70-year has a 1% chance; a 50-year old has a 0.1% chance; and a 30-year old has a 0.01% chance of dying if infected.  (Obviously this is not exact.)