Covid 6/25: The Dam Breaks

Last week: Covid-19 6/18: The Virus Goes South

Off-topic reminder that this is happening: New York Times, Please Do Not Threaten The Safety of Scott Alexander By Revealing His True Name

The United States has failed to contain Covid-19. The fight is over in large sections of the country. We have lost.

There is no state capacity left to fight this. No will. Faced with this disease, large sections of the country have chosen herd immunity.

We can only hope it kicks in at a relatively low threshold, that our treatments have improved, and that immunity is long lasting.

Hospitals are already being overwhelmed throughout the South. Things there rapidly getting worse day by day. Even here in New York, where hope for containment is strongest, there are troubling signs. My declaration of local victory might prove premature, at least when it comes to the city itself.

Let’s run the numbers. They’re pretty alarming.

Note that starting next week I plan to truncate the numbers for space reasons, unless I get feedback that I shouldn’t do that.

Positive Tests by Region

Mar 19-Mar 25 5744 6293 7933 8354 28429
Mar 26-Apr 1 15684 20337 24224 34391 52901
Apr 2-8 19455 31148 39618 56772 65604
Apr 9-15 16291 29267 35570 61921 64463
Apr 16-22 20065 34130 33932 64669 43437
Apr 23-29 20263 42343 33773 62189 42475
Apr 30-May 6 23216 49205 37880 51693 24287
May 7-May 13 22419 43256 37591 40209 16683
May 14-May 20 22725 42762 40343 39273 13709
May 21-May 27 23979 39418 42977 26434 10595
May 28-June 3 32200 31504 50039 24250 9120
June 4-June 10 35487 24674 55731 16622 6071
June 11-June 17 41976 22510 75787 12905 4986
June 18-June 24 66292 26792 107221 10922 4524

Infections by Region 6-25

Mar 19-Mar 25 138 104 144 116 278
Mar 26-Apr 1 380 615 572 606 1656
Apr 2-8 707 1454 1309 2115 4327
Apr 9-15 890 2195 1596 3577 5318
Apr 16-22 1033 2343 1727 5147 3716
Apr 23-29 1128 2588 1685 4722 2713
Apr 30-May 6 1012 2413 1747 4908 2582
May 7-May 13 1082 2288 1597 3911 1416
Apr 23-29 1090 2060 1442 3578 963
Apr 30-May 6 775 1723 1290 2341 667
May 28-June 3 875 1666 1387 2121 436
June 4-June 10 743 1297 1230 1611 325
June 11-June 17 778 1040 1207 1270 225
June 18-June 24 831 859 1204 908 153

Deaths by Region 6-25

Positive Test percentages:

Date USA tests Positive % NY tests Positive %
Mar 19-Mar 25 347577 16.2% 88,882 32.0%
Mar 26-Apr 1 728474 20.2% 117,401 45.1%
Apr 2-8 1,064,225 19.8% 144,273 45.5%
Apr 9-15 1,026,741 20.4% 160,859 40.1%
Apr 16-22 1,235,393 16.1% 143,970 30.2%
Apr 23-29 1,552,560 13.0% 202,499 21.0%
Apr 30-May 6 1,759,548 10.6% 183,446 13.2%
May 7-May 13 2,153,748 7.5% 202,980 8.2%
May 14-May 20 2,643,333 6.0% 246,929 5.6%
May 21-May 27 2,584,265 5.7% 305,708 3.5%
May 28-June 3 3,022,469 5.1% 417,929 2.2%
June 4-June 10 3,252,870 4.6% 438,695 1.4%
June 11-June 17 3,470,057 4.6% 442,951 1.1%
June 18-June 24 3,629,478 6.0% 440,833 1.0%

Things are even scarier than these numbers imply. The scariest part is that this jump is largely concentrated in the last few days.

Here’s the daily trend in positive test rates over the last two weeks, Ex-NY:

Date Ex-NY Positive %
6/11/2020 5.5%
6/12/2020 4.4%
6/13/2020 5.6%
6/14/2020 4.8%
6/15/2020 4.6%
6/16/2020 5.7%
6/17/2020 5.4%
6/18/2020 6.6%
6/19/2020 6.2%
6/20/2020 6.1%
6/21/2020 5.9%
6/22/2020 6.6%
6/23/2020 7.1%
6/24/2020 8.4%

May 16 was the last time prior to this that we had a positive rate (excluding New York) of 7.1% or higher. We have to go back to May 9 to see one above 8%.

Unless something highly unexpected has already happened to prevent it, things are about to get very bad, very quickly. 

Talk To Your Area Man About Lagged Exponential Growth

People are bad at exponential growth. We now have had the opportunity to run a natural experiment. Having been bitten not only internationally but also domestically, will people act any differently the next time around? The answer is no. They will not.

Twitter is full of people trying to help who feel the need to repeatedly and forcefully say that this result is not due solely to a rise in testing. Who feel the need to keep insisting that things are getting worse, that the epidemic is not essentially over.

It seems that only when the ICUs are full, which is happening about now throughout several southern states, do normal people take notice that something might be wrong. Only when the death rate itself rises do people think that there might be danger.

Others think that so long as the situation is getting worse sufficiently slowly, things will turn out fine. That is not how this works. That is not how any of this works. When Cuomo put up the slide that said goal of R0 less than 1.1, the mind boggled. If your R0 is 1.05, everyone gets infected. This isn’t a hard thing to reason out. And yet.

Area Man Confesses To Heinous Crime

He also held a rally in Tulsa.

At that rally, he said that more tests meant more positives, which looked bad. So I told my people, “slow the testing down.”

I will repeat that. The President of the United States ordered coronavirus testing slowed down.

The defense was that he was kidding.

He wasn’t kidding.

When asked to deny the statement, he sidestepped it. When asked about whether he had been kidding, he responded, and I quote: “I never kid.”

I do not point this out to ask why it has yet to become an article of impeachment. I point it out for its logical implications. We need to understand what is actually happening.

To what extent are our numbers manipulated or fraudulent? In predicting the path of the pandemic, to what extent will our government actively interfere with our attempts to save people’s lives and their livelihoods? We know that the federal government has at many points actively interfered with our ability to test for Covid-19, and has waged a war of banditry and piracy to seize medical supplies.

I have seen numerous reports that Florida, along with other states, is manipulating data in order to justify reopening.

This all helps us answer the next question, which is:

What Went Wrong?

There has been a dramatic worsening of the trend lines over this past week. Even here in New York, what looked like clear steady improvement now risks falling apart. What made things go so wrong so quickly?

My current model says that it is a combination of factors.

The central thing that I believe is going on is lockdown fatigue combined with a relative-to-others sense of responsibility, and no state capacity to do anything else.

It has been several months. A lockdown can be a fun change of pace for a week. It can be not so bad for a few months. But after a while it takes its toll. One goes stir crazy. You miss your friends. You lose your job and your savings start to run out. You can’t take it anymore.

Combine that with people adjusting to the behaviors and norms they notice around them. When most people judge who is being responsible, they are grading on a curve. If others are doing unsafe things, and you’re doing unsafe things but things that are less unsafe than others are, or that seem to you more justified, then that’s not being irresponsible. That’s doing what is necessary. That’s living one’s life.

The dam broke on that. The secondary effect of the protests was something between the straw that broke the camel’s back and the unleashing of a tidal wave. People saw others breaking the rules to protest. Many did so mostly to blow off steam after such a long lockdown. The rhetoric shifted to things like ‘defund the police’ and other unpopular far-left agenda items.

People noticed. Then others noticed them noticing, and adjusted expectations. Then others noticed them in turn, and so on. With the perception that a large portion of people was doing whatever it wanted, when a lot of other people ran the program ‘be about as responsible as other people’ that quickly spiraled in many places to very little in the way of precautions.

That is then combined with the problem of air conditioning, especially central air, and it being too hot to want to be outdoors throughout the South.

Mask wearing helps where it is present, but has turned into a political issue. And it turns out that in many places, most people will do an annoying thing for only a brief period before they stop doing it. What I saw in Westchester was an exception.

Then state capacity comes in.

We don’t have any ability to reimpose restrictions at least until after the death rates skyrocket. It’s unclear we’d be able to do anything even then.

We can’t contact trace, even in places like New York City where we hired the people to do it and have a manageable case load. A tracking app is dead in the water. Our blue cognoscenti has decided that anonymity for protesters overrides any motivations to trace. Our red cognoscenti was never on board with the idea.

In Texas it’s like New York in March, ICU capacity is being maxed out and we can’t even get proper PPE to the hospital workers let alone take extra measures.

The good news is we’re starting to finally see a consensus that masks are the only way forward without complete disaster. The mask message is increasing in intensity and more people are getting on board, including red voices.

The bad news is we’re starting to finally see a consensus that masks are the only way forward without complete disaster. We’ve agreed that we don’t have the ability to do much else that is useful.

My real answer to what went wrong is that our civilization is profoundly inadequate. We have lost our ability to do things. If you haven’t read the Moral Mazes sequence, it may help explain how we got to this point. So will understanding simulacra levels. That post was originally intended to be called ‘Simulacra Levels and Covid-19’ and to connect it to the claims of Covid-19: My Current Model, but that turned out to be too ambitious for one post. My work is not yet done to connect it back to our general situation, but essentially we have lost not only the ability to focus on the object level, but where decisions are made we have lost the ability to acknowledge the object level even is a thing. Our top people don’t believe in a physical world the way our grandparents did, and deny that anyone ever believed in one in that way. I’m working on explaining this further, and hope to get the next post out in a few weeks. Can’t rush this.

Baseball! Baseball! Baseball! Baseball! Baseball! Baseball! Baseball! Baseball! Baseball! (with apologies to Bill Simmons)

For many months I have yearned for the return of Major League Baseball. Nothing would be better suited to passing the summer days while maintaining social distance. The game carries minimal risk relative to many other activities. A few can entertain so many for so long. Yet things kept being postponed, as the owners and players were locked in a battle over money.

That battle seems to have ended with the players getting most of what they wanted, through a willful (in my reading) misinterpretation of an agreement the parties reached in March. The owners of course also did not cover themselves in glory on this one. But in the end, they did agree to play ball. Whether or not circumstances let it happen is unclear. I really, really hope we find a way, even if things get bad again. Baseball will be a huge help in getting us all through this.

Football will be even more important, and that much trickier. Football is dangerous under the best of circumstances. I’m not convinced introducing Covid-19 is that big an increase in danger in percentage of risk terms for the activity, but that is not how people will think about it. We can only hope the huge psychic cost of not having it is properly respected.

I know my readers don’t get this. I do. Sports are important. Sports go sports. Athletics are number one. Participants are heroes. Go team, yeah. For real. Let me put it this way, not as a demand but as a warning and declaration of fact:

No Football, No Peace.

What Happens Now? What Should We Do as Individuals?

If you are in the area seeing the explosion in cases, expect things to look like New York City looked in March and April.

We can hope that our improved knowledge will help us better protect the most vulnerable. That is good. It does not make the world around you any less dangerous when deciding what activities to do.

This actually could make things worse. It was criminal that we let our elderly down early in the pandemic, especially by letting the virus into nursing homes. But those very deaths drove home the need for measures that contained the virus. With the new lower death rates, by the time that statistic gets people’s attention, we will be much farther along in the infection rate. A younger person’s real risk will be several times higher relative to average risk, and thus they will take even less of the precautions they need to than they would have before. Then that greater rate means the elderly in turn can’t be protected.

Florida focused early on protecting nursing homes. That is the right strategy if and only if it still lets you contain infections in general. Fail, and nothing you did will save you, unless you can protect them through full herd immunity. That’s a tall order.

Herd immunity is where the South and West are headed. A few Western states might still escape, but something would have to change. Hawaii was down to one case in an entire week, but if you don’t handle things, they come back anyway, and now they’re back up to 91 and growing fast. I think New Mexico, Colorado and parts of Northern California are the only ones who might be all right. In the South, Kentucky and Virginia might muddle through, which not coincidentally are the most northern members of the region, while Florida and Texas are looking like the biggest disasters.

The Midwest is starting to trend back in the wrong direction, and several Northeastern states looks vulnerable as well. If there’s been the same level of cultural shift here as there was down South, but delayed and/or starting from a better point, we are at severe risk of tipping back above the critical R0~1 level, and having things start to get worse again. Once that happens, unless something changes, things might go slower, but it’s only a matter of time.

You can look at my spreadsheet for further numerical details under the tab Infections by State.

If you are in the Northeast, Midwest or a relatively safe local region, enjoy your relative safety responsibly while it lasts. Wear a mask. Remember to keep things outdoors. Don’t sweat the small stuff. Get yourself psychologically prepared for things to potentially get worse again, perhaps soon. Keep an eye on local numbers.

If you are in most of the West or South, this is when the real crisis likely starts for you. Due to exhaustion and adjustment, chances supply chains break down are relatively low, but not zero. Chances the medical system collapses are very high. Be prepared. If you need to see a doctor in the next three months, now is bad but next month is worse. Be ready to not go outside for several months, or to stay within your own region of space if you have one of those within your property, if it comes to that.

Resumed The Quarantine Wars Have

New York, New Jersey and Connecticut are now telling travelers who have been to any state with positive test rates above 10% that they must quarantine for fourteen days. It would not surprise me if the rest of our regional alliance followed. The rate overall of positive tests outside New York was over 8% yesterday, so it might not be long before this is the majority of the country.

Last time this was tried, we in New York were the ones being told to quarantine and stay out. It definitely feels good to turn the tables. The question of how this could be enforced remains unclear. It is also unclear whether the rest of the country will tolerate it. What will the federal government do when a blue state says red citizens aren’t welcome? So far, it seems to have been quietly accepted. These days, it’s hard to predict what will or won’t get a reaction. Perhaps the reaction will come when enforcement is attempted.

We live in interesting times.










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29 Responses to Covid 6/25: The Dam Breaks

  1. myst_05 says:

    Does Sweden provide us with a natural experiment on what happens if the government institutes a “hands off” approach? As per, they will reach a death rate of 624/million (roughly where all other Western European countries are) and the pandemic will mostly stop. We can already see a significant decline in the deaths rate from their peak, even though only 6% of Swedes wear a mask as per latest surveys and Apple Mobility shows that even public transport usage in Sweden is back to normal.

    With a total death rate of 650/million, we are looking at ~213k deaths by the end of the year, with every state reaching 10% immunity or more. ICUs might go over capacity in some places, but this will be compensated by better treatment protocols and new drugs coming on the market. After that we should get the vaccine and the pandemic will be over for good.

    • TheZvi says:

      Sweden is spaced out quite a bit, with a culture of distance, relatively high social capital on many levels, and is rather cold (so it benefits from summer). I’d hesitate to draw too close a parallel, or to assume that net mobility correlates with risk taking as well as people would like. It’s certainly an optimistic data point if accurate.

      I’d be pretty happy if we only had 213k deaths for the year, at this point. 10% immunity definitely helps a lot, but NY is not winning by much even now…

      • myst_05 says:

        I’m a little confused. You’re saying that NY is not winning, but aren’t their deaths still dropping? Or were you expecting NY to reach zero deaths by now?

      • chevron42 says:

        “and is rather cold (so it benefits from summer)”

        if this makes sense, I don’t understand how summer helps at all; why does summer help more when it takes you from “very cold” to “chilly” than taking you from “temperate” to “hot”?

    • veliger says:

      chevron: I think the idea is that “very cold” to “chilly” encourages people to hang out outside, whereas “temperate” to “hot” encourages people to hang out inside where there is air conditioning.

  2. Brett Bellmore says:

    Wait, you’ve demonstrated that positive tests have skyrocketed, but you’re also showing that *deaths* are stable or declining, and the percentage of tests that are positive is dropping in the country as a whole.

    All that’s really happening here is that we’re doing more testing!

    • TheZvi says:

      Can’t tell if joking.

      • Brett Bellmore says:

        Why would I be joking? Positive tests here in the South have gone up from about 40K a week in May to over 100K a week in June.

        In the same interval, deaths per week have gone from about 1600 to about 1200, and the rate of positive test percentages, (This for the whole US, not the South.) has remained at 6%.

        How can the number of positive tests go up dramatically, while the percentage of tests that are positive doesn’t change, and the death rate declines?

        Simple: The pandemic is declining in severity, while testing is dramatically increasing. Indeed, there’s no way for the number of positive tests to go up while the fraction of positive tests remains the same, except increased numbers of tests!

      • TheZvi says:

        I couldn’t tell because I thought I’d addressed these concerns directly and explicitly bemoaned the need to counter these talking points. The people using them most loudly are clearly disingenuous.

        The jump in the most recent week, from 4.6% to 6%, and in the last few days to higher than that – 7%+ in non-NY states 6/23-6/25 on each day – is pretty stark. The fact that things were improving before, when conditions were different, on this stat doesn’t change the trend line now. And if you look at the positive rates in Southern states now, like Arizona, Florida and Texas, the positive rates are jumping dramatically. The reason the overall numbers don’t look so bad is that the Northeast is improving, and the Midwest isn’t yet getting worse.

        On top of that, as testing counts increase you’d expect less selection for obvious cases, and for positive rates to decline. This is not an artifact of increased testing.

        As for death rates, they lag by several weeks, and the dramatic rise is only a few weeks old. I expect a rise soon (today we had 2000+ but that’s not real, NJ dumped a ton on us, so we’re still mostly waiting for it) and would be very surprised if it didn’t happen.

        CFR is clearly dropping and IFR probably is as well, which is linked to a decreased average case age. That seems to be enough to explain that change. I don’t think we have any evidence of decreased severity, although it is possible. So is better results from better treatment. Again, conditions in the medical system are currently good almost everywhere, although that should change as the worst-hit southern states run out of capacity in July.

        Anyway, it’s good to know what isn’t being made clear enough. I should have been talking about the CFR/IFR drop and the lag in deaths more. I’ll make that up next week.

      • Brett Bellmore says:

        The nice thing about this is that, in a few weeks, we’ll know.

      • TheZvi says:

        Agreed. By end of July it will be very clear, one way or the other.

      • Brett Bellmore says:

        “On top of that, as testing counts increase you’d expect less selection for obvious cases, and for positive rates to decline.”

        Thinking about this: Doesn’t this assume the background level of people who’ve had asymptomatic or mild cases, that never came to the attention of the medical profession, is low? If we’re looking at a disease where most people have no symptoms, or think they just had a brief head cold, it’s quite possible that less selection for obvious cases wouldn’t cause the positive rate to decline much.

        You’d really have to do more random testing of the population, not directed testing, to tell. Random testing in New York City: Spoiler: Almost 1 in four people randomly tested were positive. Similar random testing in Boston found 10% of the population tested positive.

        Mind, NYC was a perfect incubator for Covid-19. But it’s quite possible that you can’t drop below about 6% positive tests at this point no matter how many people you test, because 6% of the population have already had the virus, outside of relatively isolated locations.

      • TheZvi says:

        It implies merely that the positive rate among people who want to be tested more exceeds the positive rate among people who want to be tested, or are picked to be tested, less. Given that symptomatic people like getting tested more, and asymptomatic would like testing the same, that seems obviously always true.

        And as for ‘can’t fall below 6%’ that’s only true if 6%+ are infected *right now* which would be a crisis situation. And NYC’s current testing is 2% positive (1% for the state) so to say you can’t drop that low is rather silly.

        Anyway, that wraps this up I think. I’ll post again in a week.

  3. remizidae says:

    I’m not understanding why you’re framing this as failure. The plan was to “flatten the curve,” i.e. buy time to ramp up our capacity to do testing, treatment, ventilators, hospital beds. We did that. Or at least some places did.

    Even if we have another peak in case numbers in say July, we’ll have the benefit of all the ramping up we did in March-June. True, “people get sick but hospital beds are available” isn’t as good an outcome as “no one gets sick,” but “no one gets sick” was never a feasible goal.

    Do you think that the ramping up was not done well enough or do you think that any strategy that ends in “herd immunity or vaccine” is unacceptably costly?

    • TheZvi says:

      I consider this a pretty big rewrite of history. We payed a huge economic price, and we’re going to basically get the same number of people infected and do it with overwhelmed hospitals in many places anyway. While other countries contained successfully.

      If you’d told me, choose between this scenario (should it come to pass) and going with the Swedish strategy of doing nothing, I’d have definitely done nothing. Of course if given the choice I’d go with variolation, but again we have no capacity.

      • Brett Bellmore says:

        Where exactly are these overwhelmed hospitals? Last I heard, hospitals were suffering from lack of revenue because they had cleared so many beds in anticipation of a surge of cases that never materialized.

      • TheZvi says:

        They’re in Texas. For now they’re the exception but I expect that to change.

        And yes, many hospitals are going broke in waiting, because our system is terrible at paying for the right things – I could go into that at some point but I haven’t yet in these summaries.

      • remizidae says:

        Yeah, I probably would choose doing nothing if I could go back in time. Note American death rates per capita are still lower than lots of countries’.

        And BTW, the *one* Texas hospital everyone’s talking about is only running out of capacity because it’s still allowing elective procedures and projecting the same rate of elective procedures as in normal times.

    • Sebastian H says:

      The point of the stay at home period was to give government a chance to catch up. The problem is that it pretty much didn’t do anything useful with that time. South Korea set up an excellent test and trace program in one week. We don’t even have an ok program in any state, and nothing useful in most states, 14 weeks in. I’m especially mad at my state of California because we shut down early enough that a good testing program could have done a lot of good and would have allowed us to reopen much more safely. We could have had a South Korean strategy keeping the disease well under control, but instead we’ve idiotically chosen to do the slow route to maximum deaths.

      A huge part of this is because Trump was so worried about the appearance of sickness that he was unwilling to act early.

      • Brett Bellmore says:

        There’s no question our government is pretty dysfunctional at all levels, and letting the CDC and FDA run things early on really delayed testing, because they’d screwed up their own tests while not permitting alternatives. What’s worse than bureaucratic inertia? Incompetent bureaucratic inertia. And lying about the effectiveness of masks in order to reserve them for the “right” people wasn’t helpful, either.

        But Trump actually was attacked as being *too* aggressive when he shut down entry of non-citizens from China and Europe back in January. If he’d gone all out and just slammed the border shut, some judge in Hawaii would have enjoined the order in about 30 seconds.

        See what Pelosi had to say at the time?

        Now, of course, he didn’t do enough. Then? He was doing outrageously too much.

      • remizidae says:

        I’m not convinced that inadequacies in American testing and tracing are government failures. Americans don’t trust their government and value their freedom, and a lot of us simply will not report our contacts to the government.

  4. Alyssa Vance says:

    The US response now doesn’t seem that different from the government response to the 1918 epidemic? Some places then appear to have followed the Turkmenistan strategy of actively censoring bad news about the virus, using emergency powers they had previously enacted for WWI.

  5. pithom says:

    God Loves Uganda.

    “It definitely feels good to turn the tables.”

    Fun fact: NYC has more daily cases than Canada. Or, for that matter, Germany.

    “We have lost our ability to do things.”

    What do you mean “we”, non-Finn/Irish/Icelandic/Greek/Baltic/Slovak/Austrian/Swiss/Hungarian/Slovene/Georgian/Lebanese/Tunisian White Man? China, Vietnam, and Thailand are handling the epidemic just fine without your help. Trust Xi Jinping. Trust Carrie Lam. Trust Prayut. Trust Moon. But under no possible circumstance trust the imperialists.

    Western democracy has failed, as has Russian sovereign democracy, if to a lesser extent. The twenty-first century will, luckily for all of us, unquestionably be the Chinese century.

  6. Ohlmann says:

    There’s something that make the post even more hilariously dark : herd immunity is something we hope for, not something we are assured to get after a lot of deaths. The normal state for a disease is to not create herd immunity, and it happened on humans only after vaccines were a thing.

    @pitham : Xi Jinping is an imperialist, and the claim that he dealt with the epidemic well is at best speculative. The information he released point in him not dealing with the virus better than Europa.

  7. I called it in May when I saw a long row of maskless cops preparing to fight protesters in Brooklyn and realized that both state capacity and public will to fight COVID died along with George Floyd. At least the Premier League and La Liga are back, it’s nice to watch people in civilized countries play a civilized sport. Or if I want an optimistic vision of America I can always turn to The Last of Us…

  8. zdk says:

    Are you not an NBA fan? I’m hoping that will be able to proceed safely at least.

    • TheZvi says:

      I’m not really a fan. Grew up a Knicks fan, which can’t help. Basically I can’t tell what’s interesting or strategic about the game when watching it, announcers don’t help, stakes on each play always super low until very late, and seems to be all 3s now, etc etc.

      I don’t like NBA’s chances trying to play in the middle of Florida with an incomplete bubble and lots of close contact, and the sport’s history of everyone partying super hard a lot.

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