Covid 7/9: Lies, Damn Lies and Death Rates

Previously: Covid 7/2: It Could Be Worse

When I posted the link on Twitter, I joked that we already knew this week’s headline.

It turns out we didn’t. Not quite yet. I’m waiting on that one until next week.

Here’s what I said last week about death rates not picking up:

June 18 starts the surge in positive tests that represents the full second wave. June 23 represents when it accelerates. My default assumption has been one week to test positive, and about two weeks after that to see the average death.

That would mark the surge in deaths to start around July 2. In other words, today, with things picking up speed on July 7.

So no, this isn’t weird. Not yet. But if there is no spike in the next seven days, then that’s pretty weird. If that actually happened, I’d look more carefully at hospitalization data, which I usually disregard as not worth the trouble. But mostly I’d be terribly confused. The infection fatality rate seems to clearly have fallen, but why would it have fallen so much so quickly now that a surge in infections doesn’t kill more people? Quite the tall order.

Today is July 9. There was no rise in death rates starting on July 2. The holiday weekend shifted a bunch of reporting forward a few days, so tracking changes this week has been wonky. Death rate only picked up on July 7-8, and much of that was delayed reporting. Death rate this week is only slightly higher than last week’s.

It needs to be said up front. This is really weird. It’s not as weird as it looked before the last two days, but it’s still weird. I’m not going to back away and pretend it isn’t weird. Time to further investigate and break down potential causes, along with other news.

First, let’s run the numbers.

Positive Test Counts

Date WEST MIDWEST SOUTH NORTHEAST
May 7-May 13 22419 43256 37591 56892
May 14-May 20 22725 42762 40343 52982
May 21-May 27 23979 39418 42977 37029
May 28-June 3 32200 31504 50039 33370
June 4-June 10 35487 24674 55731 22693
June 11-June 17 41976 22510 75787 17891
June 18-June 24 66292 26792 107,221 15446
June 25-July 1 85761 34974 163,472 16303
July 2-July 8 103,879 40139 202,863 18226

Infections by Region 7-1

Deaths by Region

Date WEST MIDWEST SOUTH NORTHEAST
May 7-May 13 1082 2288 1597 5327
Apr 23-29 1090 2060 1442 4541
Apr 30-May 6 775 1723 1290 3008
May 28-June 3 875 1666 1387 2557
June 4-June 10 743 1297 1230 1936
June 11-June 17 778 1040 1207 1495
June 18-June 24 831 859 1204 1061
June 25-July 1 858 658 1285 818
July 2-July 8 894 559 1503 761

Deaths by Region 7-1

Positive Test Percentages

Date USA tests Positive % NY tests Positive %
May 7-May 13 2,172,015 7.5% 202,980 8.2%
May 14-May 20 2,628,492 6.1% 246,929 5.6%
May 21-May 27 2,687,257 5.5% 305,708 3.5%
May 28-June 3 3,055,035 5.0% 417,929 2.2%
June 4-June 10 3,182,937 4.4% 438,695 1.4%
June 11-June 17 3,459,903 4.6% 442,951 1.1%
June 18-June 24 3,646,283 5.9% 440,833 1.0%
June 25-July 1 4,336,532 7.0% 419,696 1.2%
July 2-July 8 4,512,567 8.1% 429,804 1.1%

Less increase in overall positive rates than feared, but no sign of things becoming stable. New York looking like it might not head right back into the fire.

Nevertheless, She Persisted Talking To Her Area Man About Exponential Growth

Death rates have not fallen as much as a naive measurement would imply, because it takes time for deaths to accumulate as infection rates have gone up. The last two days imply rates have fallen less than we thought. The numbers are likely, shall we say, not fully accurate. But death rates have fallen. That’s excellent news.

The problem is that if we can’t otherwise contain the spread of the virus, a huge share of everyone not under a hard personal lockdown is going to get infected on our way to herd immunity.

Looking at the second and third derivatives we see, it doesn’t seem like there’s much hope of halting the exponential without bold new action. Aside from new mask mandates, I see essentially no new bold action.

You can reduce the multiplier on the exponential. That buys you a little time. But the exponential is going to dominate the multiplier, unless the multiplier keeps falling rapidly. I don’t see how that happens remotely fast enough.

Covid: Beyond Death

Before we discuss death, it is also important to remember that death is not the only consequence of Covid-19. I haven’t made enough mention of this in prior posts.

I do not know of good statistics on longer-term consequences for survivors of Covid-19, or how those consequences break down by age or other risk factors.

What I do know is that there is substantial risk of permanent lung and other damage, including in the relatively young.

The two closest people to our family who have had Covid-19 are our older son’s former teacher, and a personal trainer I used to use and have known for years. The trainer’s whole life revolved around working out, eating right and getting others to do the same. It wasn’t merely a job but a passion for her.

The good news is that both survived. The bad news is, neither has fully recovered. Months later, both are still getting regular medical treatments for ongoing problems. The damage appears permanent. The trainer’s heart and lungs are both permanently damaged, and it’s unclear she’ll ever be able to do her job properly again. Life for both remains no fun.

So, seriously folks, if you’re old enough to be reading this, you do not want to get Covid-19. You really, really don’t want to get Covid-19. Death is not he only thing that can go wrong. It’s not worth it.

It’s also a pretty bad time to get infected in many places. There’s a decent chance the health care system will not be fully there to help you, and any recent gains from better treatment will get more than reversed.

Stay safe to the extent it is feasible to do so. Don’t merely follow some official guidelines or simple rules like ‘wear a mask’ or ‘keep six feet apart’ and ‘wash your hands and don’t touch your face’ although you should also totally do those three things. Think hard about what you’re physically doing. It’s not optional until you get a positive antibody test.

I’m Not Dead Yet

Last week, I offered six potential explanations for the falling death rates. We could group them into three basic categories.

Explanations 1+5: We are doing a better job treating people who get infected.

Explanations 2+3+6: Different people are getting infected who are less vulnerable.

Explanation 4: We are increasingly covering up deaths.

I put some responsibility on each of the three categories.

Protecting the Vulnerable

The first category carries some weight and is essentially neutral news. It’s good that less people are dying, but it’s bad in the sense that everyone’s personal risk if infected hasn’t changed. One must be increasingly cautious even if death rates are down.

And they can easily be down a lot from this if things adjust! Remember my best guess at death rates by age and comorbidity. Infect everyone under age 50 that doesn’t have diabetes and isn’t obese, and the expected death rate would be about 0.03%, versus a best-guess IFR of between 0.5% and 1%, and a case fatality rate for the United States that is falling steadily but still over 3.5%. Fatalities are mostly a function of how many old and vulnerable people are infected, rather than how many infections there are across age groups.

Perhaps the surge in infections is young people modifying their behaviors, while old people don’t modify their own. In that case, you’d expect the infection rate to go up while deaths didn’t go up much or even continued to slowly decline.

For a while.

After enough cycles of this, the young would infect the old more even if the old didn’t change behavior. So unless they lock down even further than before, the death rate would start rising back up. The difference is this would be a delayed reaction. We’d see it only in infections that happened after the wave was well underway. Instead of deaths starting to increase on July 2 and accelerating on July 7, as I predicted last week, we’d see a slower ramp-up effect starting in mid-to-late July. The fatality rate would fall, but the level of deaths would still increase. When we got to herd immunity, we’d have successfully kept a lot of our most vulnerable safe, but far from all of them.

Reports are that the average age of infection in Florida is down to about 37, from a previous level of 60. That’s a big change. Fauci says this is happening throughout the South.

I think we should accept this is likely a lot of the story. It’s a big gain, but it’s a one time gain and it doesn’t impact your personal risk. Thus, we shouldn’t expect much additional gain from better protecting people going forward, beyond than the ‘gains’ from opening schools. The death rate has dropped as much from this as it is going to drop.

Better Treatment

There have also been reports that our treatment techniques are improving, and claims our testing has improved. These would be the best possible news.

On testing, see the section below about testing. Testing is actively getting worse at this point, rather than better, with long wait times. Things were improving before, but now they’re worse again, so these gains should reverse.

Hospital capacity is filling up, and treatment is getting rationed out of necessity more and more. It’s March all over again in a new location, and once again we were not prepared. The only difference is that this time there is even less excuse. These gains too should largely reverse.

I don’t have a good sense of how much better our knowledge is in terms of cashing it out in earlier detection of need to test slash be concerned, or in terms of better outcomes. I doubt anyone is that confident in the magnitude here. Given the amount of newsworthiness of a genuine breakthrough, I have to assume gains have been gradual accumulation of technique, and that it has a moderate but real effect. Nothing dramatic.

Fraud

That brings us to fraud.

It is clear that there was a lot of pressure from those in power, especially in the South, to report less deaths so that they could continue to reopen. The question is how much suppression or delay actually happened.

There are levels of fraud that might be going on.

We certainly had unusually large delays in reporting of deaths this week due to the holiday weekend. People don’t hang on in “Jefferson still lives” style because it’s our nation’s birthday. Every weekend there’s reporting pushed into the future, both tests and deaths. If anything, test reporting was not delayed much this weekend, whereas death reporting was delayed a lot, unless my July 7 prediction came true far more dramatically than I would have expected.

How much pushing of deaths into the future there was, or otherwise time shifting results to make things look good, is unclear. My guess is quite a bit.

One simple option is to attribute the deaths to something else. There are plenty of reports of people who couldn’t get a test, or whose death was attributed to either an unknown cause or to something like heart disease, pneumonia or stroke, where Covid-19 may or may not have been a ‘contributing factor.’

A similar method is to have something called ‘probable’ Covid-19 deaths, and choose to ignore them. Then pile as many deaths as possible into that category. New Jersey had a huge bump in cases when it started counting such deaths. New York City did something similar that still isn’t in the state statistics as far as I can tell. I am confident that such deaths are not currently being counted. As the system gets taxed more, it is easier and easier to let such deaths not be counted.

I asked on Twitter if anyone could help me find statistics on the number of deaths from unknown causes over time – the ‘mysterious deaths’ that one report claimed were increasing quite a bit, perhaps enough to double the Covid-19 death rate. I got some likes but no one had an answer. If you do know, please help.

All of that presumes a certain amount of shame, a sort of ordinary decent fraud. It’s reporting at Simulacra Levels 2 or 3. You’re pretending that your numbers reflect reality, or at a minimum, you’re pretending to pretend. My gut says things are somewhere in between those two. Everyone who pays attention knows we miss a lot of deaths and infections, yet we keep quoting those numbers without an adjustment, but we still like to think the numbers have a link to the profound reality. In some places, things moved on to the cooking of the books, where the numbers are pretending to pretend, and the veil is just good enough that we can’t prove anything.

Then there’s outright making things up. Is this happening? I don’t know. I certainly hope not. The last two days give me hope that it isn’t happening. But if we stayed around 500 deaths per day for another week while hospitalizations keep rising, regardless of what happens to positive cases, that means they’ll have stopped pretending to pretend. The numbers will be whatever they choose to report, full simulacra level 4 material. We’ll know, with common knowledge, what kind of government we are dealing with.

There was a Bloomberg news headline that death rates were down and it was nothing to celebrate. It was rightfully widely mocked, because actual low death rates are absolutely a good thing. But if it reported this way next week, then no. It’s not a good thing. It should be presumed to be a very very bad thing. It would mean we are being lied to on a whole new level, and much if not all is lost.

We need to at least demand a plausible lie.

Mask On, Mask Off

Wear a mask. Everyone wear a forking mask. Avoid and shame anyone not wearing a mask. That is all.

It’s not all, mostly because every authority starting with the W.H.O. lied to us and said masks didn’t work outside the exact right situations. But still, that is all.

Note that the W.H.O. still had issues with whether the virus is airborne, presumably because people might have the ‘wrong’ reaction to them admitting that.

The current debacle with the C.D.C. saying testing doesn’t work outside of the exact right situations, to try and get people to react the way they want, shows we have learned nothing. It’s not working and it’s further poisoning the well.

I have an idea. Stop lying to people. Crazy, I know.

Testing Delayed is Testing Denied

My wife is a psychiatrist. Thus, she has a Quest account to allow her to order various tests when people need them. This past week, she got an email from Quest asking her not to order Covid-19 tests if she could avoid it – they are backlogged, and ordering more tests will delay getting results to everyone else who needs them.

This lines up with reports from Arizona and other Southern states of waits of over a week to get Covid-19 test results back.

A test that takes a week isn’t completely worthless. You get to look back on what you already had, after it’s done. So that’s useful. But mostly it’s a de facto antibody test. First you get the symptoms that justify getting the test. Then, after you’re symptomatic, you have to get a test, which in many of these areas is no small feat if you don’t need hospitalization. Then, about two weeks into the infection if you’re positive, you’ll learn your status.

In the meantime, you have to act like you’re infected, or act like you’re not infected, or try to make some compromise, and all your options are terrible. Everyone who has been in contact with you is in limbo. Everyone in your family is in a panic, not knowing what to do. You can’t follow proper protocols. It’s a very bad scene. It’s much worse than a mere ‘can’t contact trace.’

We are both running more tests and have an increasing backlog of test demand. That’s another way to see things are rapidly getting worse.

I hope that everyone reading this knows what must be done – we need to prioritize however many samples the system can handle and get them back quickly, and outright refuse the rest, while working to ramp up capacity for the future.

The question is how.

This is America, so allocating scarce health care resources by price is anathema.

Given we can’t do price, the obvious answer is need. Better to determine a priority queue, based on level of exposure, vulnerability and symptoms. Process the top priority tests until you run out of capacity. Repeat.

Tests becomes less valuable to get back over time, not more, so the solution of doing this in first in, first out order is almost the actual worst solution. It encourages more tests to pile up, and gradually gets worse with even a small imbalance, like a traffic jam.

We would be better off getting those in real danger tests, then doing a pure lottery for everyone not in need of hospitalization.

Of course, all of that assumes there is a finite amount of testing to distribute. That’s not true at all. There’s as much testing as we want to pay for and permit. The good news is that the answer to that is gradually going up. The better news is that it could go up a hell of a lot faster if we’d let it. It’s really, really easy to set up useful Covid-19 testing. If only it were legal.

Taking Authorities to School

Mike Pence has said “we don’t want the CDC’s guidelines to be the reason schools don’t reopen.”

Thing is, he’s one hundred percent right on this one. It has become common these days for many people to ‘say the quiet part out loud.’ This is no exception. We can now say out loud that the CDC’s guidelines have little correlation to what is actually safe.

We should reopen the schools if and only if it is safe enough to do so that it is worth the benefits. 

What we absolutely not do is open the schools if and only if and to the extent possible they can abide by tons of other crazy regulations while also satisfying a technical requirement document that mixes arbitrary dictum with lots of ‘considers’ and ‘to the extent possibles’ that comes from an agency that (if you recall from last week) thinks that doing additional testing is not known to make a school safer.

This blog’s views on school are rather skeptical. Set those views aside, and assume that sending a child to school enriches their experience and prepares them for success and is not at all a prison where they are taught to obey arbitrary authority and guess the teacher’s password so they can be drones their whole lives. For the sake of argument, school good!

That does not make current plans of many places to partially reopen schools make sense.

Partial reopening, in practice, means students are in-person some of the time, in order to reduce class size and allow ‘proper social distancing.’

Parents who are uncomfortable sending kids to school at all will keep them home, which will help further reduce class size. That’s good.

Schools can be thought of as providing a basket of potential benefits.

To the extent that the benefit is logistical, this plan is terrible. If you need to go to a job, being free to do so half the time is not that useful. You still can’t do your job. Our society is not set up to allow this kind of half-measure to reap half the benefits.

To the extent that the benefit is social, this plan is terrible. Kids won’t be able to do social activities. That’s the whole point of social distancing.

To the extent that the benefit is physical activity and such, kids again likely won’t be able to do those things in any worthwhile way. A photo from a recess of each child in their chalk circle with their own ball remains perhaps the saddest thing I’ve ever seen.

To the extent that the benefit is signaling, burn the whole thing to the ground and nothing matters anyway.

To the extent that the benefit is educational, and I’m able to say that without laughing, it’s harder to predict. This plan does manage to potentially extract half or more of the benefits. In theory, one could even claim this is more than all of the benefits. Perhaps half the time in a 10-child class and half the time on one’s own to study is actually way better for learning than all the time in a 20-child class. Seems plausible, actually, even if you think the 20-child class is net useful. So presumably this is the argument in favor of the plan, if one could intelligently take advantage of the new structure. Somehow I don’t expect that to happen.

My expectation is that the needs of masks and social distancing guidelines, and the general confusion and paranoia and need to check off boxes, will take away all the potential gains while compounding the losses.

Could you redesign a school around the idea of checkpoints with adults to review and ask questions and introduce the next section, alternating with working on one’s own, with high customization and adaptation to each child, and have it be an improvement? Yes, I think you could.

That’s not remotely what’s going to happen almost anywhere.

All of this is being directly driven by CDC guidelines. Six feet has become even more fully a magical talisman one wraps around one’s self in order to create a Circle of Protection: Covid-19, the same way masks are now being talked about as the one and only true savior, because no one in authority believes most people can handle a story more subtle than that.

What will actually happen is that kids and teachers will be in rooms for hours on end, without windows, with bad circulation, mostly not even allowed to go to the bathroom. With many kids rotating between teachers after periods exactly long enough to ensure maximum infection opportunities. Or, if the kids would otherwise have always had the same teacher, the teacher will see the two halves of the class at different times. Everyone will be frustrated and mad and confused and distracted all the time.

Kids who are infected will give it to teachers who will pass it off at other times to other kids in other sections the next day. The gains from being young, having masks and being a few feet apart will be blown up by being constantly indoors with bad circulation.

Everything that follows is coming from the twin mandates ‘six feet apart’ and ‘given six feet apart, open the school.’ And regulations that prevent any creative solutions whatsoever.

Result, total clusterfork.

Instead, we need to choose from two options.

Option one is to admit that we can’t open the schools yet, at least in many or most places, and keep them closed until conditions improve.

As a bonus, we could admit that kids don’t need babysitters all the time. Yes, they do when they’re three. But at six years old, my son could be left alone in our house or backyard or the playground for a few hours, and if everyone thought that this was fine, it would be fine. We mostly don’t do it because society would think it insane and call the cops on us. Certainly by eight most kids are totally fine on their own. Everything to the contrary is people who are very bad at statistics. We could all use a little Christopher Titus parenting. A little. A lot would be bad. A little.

We won’t do that, of course. But it’s worth noting that not only are schools primarily babysitters, they’re babysitters we mostly never needed in the first place.

Option two is to admit that we need the schools, open them to all kids who want to go while giving parents the option of remote learning if they want it, and accept that it’s not going to be all that safe.

If schools are essential, they’re essential. Kids will be all right, those who live with the vulnerable can study from home. Vulnerable teachers can teach the at-home kids, and there are plenty of people who need jobs so hire more teachers to split up classes. Rent now-empty offices and hold classes outdoors to free up space. Get creative. Hope that’s good enough.

Either choice might be correct.

My take on this choice is that we should open the schools if either we can do so while containing the virus or we cannot contain the virus no matter what we do.

If we can contain the virus and get schools back, great, let’s do that and maintain people’s jobs and civil order and so on.

If we can’t contain the virus and get schools back, but we can contain the virus by closing schools, and it looks reasonable to hold out until a vaccine or other solution will let us reopen the schools, then it’s crazy to open the schools and we should keep them closed.

If we can’t contain the virus and get schools back, but we also can’t contain the virus by closing schools, then at this point a slower burn is worth little to us and might be actively counter-productive. Might as well reopen the schools for anyone who wants them.

We’ve managed to go down the path of nuking our economy pretty bad while also not stopping the virus. This gets us an outcome worse than either full suppression or full mitigation.

Our plan for the schools is similar.

Temporary Immunity Ending Real Soon Now Watch Continues

It seems like every week we get Dire Official Warnings that immunity to Covid-19 is short-lived. Often the reasoning is ‘another person pointed out that we don’t know how long immunity lasts.’ Other times it’s ‘we looked and people’s antibody counts are declining and oh noes.’ Or it looks like one person got reinfected.

We don’t know how long immunity lasts.

What we do know is that it lasts at least as long as this pandemic has been in the West, for essentially everyone. Reinfections are something every Responsible Journalist is on the lookout for as the next big Responsible Journalist scoop. Absence of evidence, in this case, is strong evidence of absence.

Note that when a study points out that people’s antibody counts are fading, yet there are no reports of reinfection, this implies that there is a lower than expected threshold of antibodies necessary to become immune, or even that the antibodies we are measuring aren’t the primary mechanism granting immunity from meaningful reinfection.

It seems appropriate to apply a modified form of the Lindy Rule to the length of immunity. At the start, we had no idea how long it would last. Now we know it lasts at least four months before any substantial decrease takes place (we can’t assume that enough Chinese patients were re-exposed, or that China would report it if they were infected again, so to get enough bulk we have to start around March). The scary conclusion would be that immunity could be expected therefore to start to fade after about eight months. For the average person it would be expected then to last at least twice that long, so sixteen months, which is into vaccine territory. I consider that the conservative, scary estimate, that doesn’t use other priors. But my prior at the beginning, before any evidence, was already longer than that. Good news shouldn’t shorten that estimate.

In any case, yes, going for a herd immunity strategy carries some risk that immunity does not last as long as we would like. But mostly these concerns are, in practice, scaremongering, and deserve to be called out as such, so this is the periodic calling out.

Predictions for Next Week

I expect the rise in death rates from the last two days to continue, and things to get steadily worse on all fronts. Deaths are up in the South, as one would expect. This should accelerate.

I see no reason to expect us to turn the corner any time soon. As the health care system starts breaking down in the worst areas, we likely see the death rates rise faster than the case rates, rather than slower.

Eventually, of course, things left unchecked creates herd immunity and the corner does get turned.

At this pace, if we change almost nothing, how long will it take to turn that corner? Not that long. A few months. We are already at 60,000 plus reported cases per day plus exponential growth.

 

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29 Responses to Covid 7/9: Lies, Damn Lies and Death Rates

  1. remizidae says:

    “What I do know is that there is substantial risk of permanent lung and other damage, including in the relatively young.

    The two closest people to our family who have had Covid-19…

    So, seriously folks, if you’re old enough to be reading this, you do not want to get Covid-19. You really, really don’t want to get Covid-19. Death is not he only thing that can go wrong. It’s not worth it.”

    This seems pretty anecdotal. It’s plausible that the risk of long-term damage that is not death is higher than the death risk, but it also seems that, given that death risk is very very very low for non-elderly people with no relevant preexisting conditions, the risk of long-term damage for those people is probably somewhere in the very low to very very low range. But I’d like to see data if anyone has it.

    • TheZvi says:

      It’s pretty explicitly anecdotal! I’d give stats if anyone can find them. As you note, we don’t know of anyone who does.

      It’s certainly possible that this was extremely bad luck on their part and almost everyone young is fine, but until we have stats, precautionary principles apply.

      • borscht says:

        Well, there are of course the oft-cited WHO statistics from late March which claim about 80% of cases are mild/moderate, 15% are severe, and 5% are critical. I think these statistics are stronger evidence than the anecdotes you shared, but then again, late March is a long time ago, I can’t figure out where these stats originated, and the WHO has been hemorrhaging credibility for the past few months. Also, would the two people you referred to even be considered “severe” cases, i.e. did they require hospitalization? I agree that the difference between mild and moderate needs to be explored; it seems like lots of infected people get symptoms so mild they don’t even realize they have it, and there’s a pretty big gap between “business as usual” and “will die if not hospitalized”.

      • TheZvi says:

        Yeah, huge error bars, but it’s clear that one should be looking at the 15% severe as already pretty bad news in terms of life expectations (e.g. neither of the people in question ever was in real danger of dying or even hospitalization), and the 5% is likely in real trouble even if they don’t die. So the majority of the cost of infection for someone under something like 50-60 years old is likely in the non-death consequences.

      • remizidae says:

        My anecdotal experience is the opposite–none of the people I know who had COVID required any medical treatment or found it worse than flu. But I try to remember that that isn’t any more credible than the opposite anecdote!

        While there isn’t real evidence for your claim that there is “substantial risk,” we can agree that the risk is non-zero.

  2. I’d be somewhat careful with the ‘average infected age’ change. Both comparisons are to months ago when testing availability was much worse. Restricted testing back then was almost certainly going to skew case age relative to infection age much more than it’s skewed now. The effect seems likely to be somewhat real, because otherwise the data is almost inexplicable (if it’s close to reality), but the raw numbers are going to be way overstated.

    • TheZvi says:

      Yeah, there’s so much to say that when one writes quickly stuff gets forgotten. If you’re only testing the severely sick, your average age will go way up, etc, and it’s very hard to adjust for it as regimes on testing change.

  3. Doug S. says:

    I saw about a study that some people have shown a COVID-19 specific T cell response without testing positive for antibodies.

    https://www.news-medical.net/news/20200624/Exposure-to-SARS-CoV-2-can-induce-virus-specific-T-cell-responses-without-seroconversion.aspx

  4. Chris says:

    The Financial Times (link below) is reporting ‘excess mortality’ measuring total reported deaths against historical averages. Depending on your assumptions around how much the pandemic has eliminated other deaths (driving, elective surgery, etc, etc) it doesn’t look like there is a material problem with under-reporting in the US.

    https://www.ft.com/content/a26fbf7e-48f8-11ea-aeb3-955839e06441

  5. myst_05 says:

    “Everyone who has been in contact with you is in limbo. Everyone in your family is in a panic, not knowing what to do. You can’t follow proper protocols. It’s a very bad scene. It’s much worse than a mere ‘can’t contact trace.”

    Given the lack of tests, should our optimal strategy be “wear a mask or social distance at all times, even at home”? It seems strange that so much emphasis is placed on social distancing in public, but then we’re telling a grocery store employee to go ahead and remove their mask at home. Either you and your family/friends form a super tight bubble or you have to presume each other infectious at all times and act accordingly.

    Even with a perfect turnaround of a few hours, tests can have false negatives and thus cannot be absolutely reliable.

    • TheZvi says:

      At first I would have said definitely no, because in-house infection is too hard to prevent and the mask is super annoying. Now that we know secondary infection rate isn’t *that* high… maybe? But bottom line is that I don’t think this is a practical way to live, at least for most of us.

    • Eric Fletcher says:

      Does it make sense to deliberately infect each-other within your household every day (ie, keep kissing your spouse and kids), to try to get a minimal initial viral load to everyone in the event someone gets infected?

  6. TheZvi says:

    I was wondering when they’d finally admit that. Kind of insane it took this long. Might drop in a note about it next week.

    If an organization that makes lots of decisions never pleasantly surprises you, that means you had a pretty biased estimate!

  7. hnau says:

    “People don’t hang on in “Jefferson still lives” style”
    This reference made my day. Thanks for all your work!

  8. PDV says:

    > It seems appropriate to apply a modified form of the Lindsey Rule

    I can’t find a reference to this rule except as a legal doctrine originating from the Clinton impeachment, which I’m reasonably certain you don’t mean. Clarify?

  9. Ohlmann says:

    The problem with herd immunity isn’t length of immunity.

    It’s that it probably won’t happen naturally. It don’t happen naturally for a lot of diseases where immunity is permanent. It just need an animal reservoir, or simply not aggressively contaminating enough people to alway have new host. The second one might seem at the opposite of what is seen, but the threshold for any herd immunity is pretty fucking huge, and we don’t know how much of the population got infected.

    • Brett Bellmore says:

      Well, sure, if you define “herd immunity” very strictly. But the objective of herd immunity isn’t that Covid-19 go extinct. That’s something you only achieve with a very effective vaccination program against a slowly mutating virus, like Polio or Smallpox. It would be nice to achieve with Covid-19, but unlikely.

      The objective is to just get the death rate down to something society can live with, the way we live with all sorts of other diseases that continue to kill people at some non-zero frequency. Then we just wait it out while Covid-19 continues evolving towards the infectiousness/lethality sweet spot, occupied by “the” common cold, which is actually several hundred different viruses that cluster there because it’s the best evolutionary solution if you’re an infectious disease. (High lethality is actually an evolutionary drawback if you’re a virus. You “want” to spread without getting people sick enough that they isolate or die, because dead people don’t spread you.)

      Eventually our advancing medical science can have the goal of actually abolishing infectious disease, but right now the goal is just keeping it beaten down enough that we can cope, while occasionally lucking out with a disease that’s vulnerable enough to drive to extinction.

    • TheZvi says:

      I’ve talked a lot about this issue e.g. see On R0. When I talk about herd immunity, I mean enough immunity to combine with other prevention to get R0<1, not the level at which we can have free hugs parties.

      It does not seem that Covid-19 has an animal reservoir – it can infect some animals but doesn't reinfect humans, I think? If anyone knows differently please share.

  10. Jazi Zilber says:

    re effects of covid on the recovered.

    1. here is a study about post hospitalization reduced life quality.
    80+% report at least one symptom a month after being cleared.
    44% report at least 10 points worsened life quality / health. On a 100 scale.

    https://jamanetwork.com/journals/jama/fullarticle/2768351?fbclid=IwAR1_jEPchPV3KBocGsoXU0lpC5mhXChQPCDAaR0nH2h6M2EXQPABxlE1bMI

    Limitation:
    A. Those are seriously ill (I think all hospitalized? some even ventilated.
    B. one month is not “long term” by any stretch of the imagination.
    Having been hospitalized for awhile and feeling awful a month later is not unheard of.

    Thus we do not have yet serious long term studies. Especially of the mild and very mild cases.

    2. anecdotally, your two cases.
    A, How severely ill were they?
    B, how much time has passed since they recovered fully initially?

    3. I have been looking at athletes that had COVID as an interesting sample. We do have lots of clear data and will have more once they return to play.

    Take Paulo Dybala the footballer. He is playing now competitively for Juventus. And it might be indicative, if a large enough sample is analyzed.

    • TheZvi says:

      Thanks.

      On #2, they’re both a few months in. Neither was severely ill at first, neither ever went to the hospital. One caught in late March, other in April.

  11. Jazi Zilber says:

    did HUGE amount of data crunching.

    His optimal method is “excess deaths” compared to other years.

    This solves all biases. Except for the random variation between years.
    Unknown causes. Contributing factors. Straight up lying. not tested. You name it

  12. Pingback: Analysis of Mortality Data | Don't Worry About the Vase

  13. Pingback: Covid 7/16: Becoming the Mask | Don't Worry About the Vase

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