Covid 10/1: The Long Haul

If you were watching the so-called ‘presidential debate’ on Tuesday night, first off, you have my sympathies. It was the day after the Day of Atonement. If you watched, no matter what wrongs you may have committed this past year, and no matter who you intend to vote for, no one can deny that you have atoned. Your slate is clean.

Alas, the country is not so lucky. Getting away clean is not a near-term prospect on any level. 

What did we learn from the Covid-19 portion of the debate?

Very little. The focus was on Biden blaming Trump for things being terrible, and Trump saying things are great and blaming Biden claiming that with Biden in charge things would have been worse. No one said anything about any of the real issues except for masks. On masks, Trump decided to dispute that there was agreement on masks, to point out that people changed their mind about masks, and so on, in case his supporters were in danger of protecting themselves or others by wearing one. 

Biden’s criticisms of Trump left out most of the worst things Trump did regarding Covid-19. Biden’s plans, as stated, didn’t provide the help we need to solve Covid-19. Mostly, what we learned is what we already knew. Biden has little interest in talking about the ways to actually solve the problem, and mostly does correct symbolic actions like supporting PPE or small business or wearing masks while blaming Trump for not doing so. Whereas Trump actively gets in the way of solving the problem and lies about, well, basically everything. Not where one hopes the choices to be, but hopefully an easy choice nonetheless.

Biden repeated in the debate the general expectation that another wave of infections and deaths is coming Real Soon Now, and that deaths may double over the next few months, as the rate goes up by a factor of five or more. That’s the new Very Serious Person position. 

Along with the old Very Serious Person position that herd immunity is of course ending Real Soon Now, probably last week. 

Do we see any signs of any of that? Is it justified?

Let’s run the numbers.

Positive Test Counts

DateWESTMIDWESTSOUTHNORTHEAST
Aug 6-Aug 12930426193118848621569
Aug 13-Aug 19808876338415699820857
Aug 20-Aug 26675456654013232218707
Aug 7-Sep 2550007540112741421056
Sep 3-Sep 9472737243910640821926
Sep 10-Sep 16450507526411581223755
Sep 17-Sep 23540258538112773223342
Sep 24-Sep 30554969293210630027214

The Midwest and Northeast numbers are very troubling, as things are clearly headed in the wrong direction. The West is treading water, and the South looks excellent. Test counts are slightly up overall.

Deaths

DateWESTMIDWESTSOUTHNORTHEAST
July 23-July 2917077004443568
July 30-Aug 518317194379365
Aug 6-Aug 1217386634554453
Aug 13-Aug 1915768504264422
Aug 20-Aug 2615037453876375
Aug 27-Sep 212457593631334
Sep 3-Sep 911417712717329
Sep 10-Sep 1611599543199373
Sep 17-Sep 2310168932695399
Sep 24-Sep 309349902619360

More signs that things in the Midwest continue to get worse, but the West and South continue to recover. The Northeast doesn’t look bad either. In total, it’s the best combined number in a long time.

Positive Tests By Region

PercentagesNortheastMidwestSouthWest
7/30 to 8/52.58%7.26%12.35%6.68%
8/6 to 8/132.30%5.67%14.67%6.98%
8/13 to 8/202.06%5.62%9.41%6.47%
8/20 to 8/261.86%5.78%9.93%5.88%
8/27 to 9/21.87%6.37%9.38%4.78%
9/3 to 9/91.97%6.02%8.48%4.13%
9/10 to 9/162.41%5.99%11.35%4.49%
9/17 to 9/232.20%5.96%7.13%4.11%
9/24 to 9/302.60%6.17%6.18%4.27%

Trouble slowly brewing across the Northeast. The South continues to improve.

Test Counts

DateUSA testsPositive %NY testsPositive %Cumulative Positives
July 30-Aug 55,107,7397.8%484,2451.0%1.46%
Aug 6-Aug 125,121,0117.3%506,5240.9%1.58%
Aug 13-Aug 195,293,5366.2%548,4210.8%1.68%
Aug 20-Aug 264,785,0566.0%553,3690.7%1.77%
Aug 27-Sep 25,042,1135.5%611,7210.8%1.85%
Sep 3-Sep 94,850,2535.3%552,6240.9%1.93%
Sep 10-Sep 164,632,0055.8%559,4630.9%2.01%
Sep 17-Sep 235,719,3275.2%610,8020.9%2.10%
Sep 24-Sep 305,857,0975.1%618,3781.1%2.19%

New York is in (medium term, slow moving) trouble. From what I’ve seen, a lot of it is concentrated on areas of Brooklyn and Queens, especially Orthodox Jewish areas that ignored rules during the high holidays, but it’s a big enough effect and trend that the problem is clearly widespread. Things are in no way out of control, but trends continue to be negative and if anything things are opening up more, so until the control systems set in locally, things will get worse.

Nationwide, however, we have a record number of tests, with the lowest positive rate since mid-June. We have the lowest weekly death count since mid-July. 

There’s no sign things are about to clear up. But there’s also no sign of this huge impending disaster the media are once again warning us about.

Yet they continue to do this. Why? 

Some of it is that testing went down then increased again and they’re calling that ‘rising case counts’ again because yes we really are this stupid and dysfunctional. 

You can call Donald Trump and various others whatever you like for suppressing testing in order to make the numbers look better, but the only way to stop such tactics is to stop being fooled by them time after time. I am not optimistic.

The headline from CNN linked above (here it is again) tells us to be alarmed that 21 states have rising case numbers, while testing increases, and doesn’t think we can understand that 21 is less than half of 50.

The other half is that models and those what like to be Very Serious People are making two assumptions to force this pending wave to happen.

They assume that Winter Is Coming means things get worse. And they continue to warn about immunity in all ways.

We need to push back and not leave this to the White House. They’re kind of busy, and rather short of credibility. Atlas disputes Redfield coronavirus vulnerability estimate: ‘We are not all susceptible to infection’ is the White House directly calling out the CDC, and in this case being entirely correct. The idea that everyone who doesn’t test positive for antibodies is ‘susceptible to infection’ is obvious nonsense designed to twist the data into knots and scare people. Unacceptable. Yes, the source in question often lies its ass off in other ways. That only makes this all that much harder.

I Herd Some People Had Immunity and Then Lost It, Or Never Got It To Begin With After Being Infected, Except With No Actual Examples

Alas, an ongoing series. Lots of speculation this week.

Marginal Revolution links to a study pointing out what we already know, that most coronaviruses do not create lifelong immunity. 

Another data point I heard a few people point to is that a previously hard-hit NYC neighborhood is being hit again. Similar data points are cited for European cities and such. 

Thus, the Very Serious Person consensus seems to be that immunity is fading and reinfections are happening all over the place as we speak. They just… can’t find examples of actual people that got reinfected, despite such a story containing a large number of people being an obvious way to get tons of clicks and head the national news, and also scare everyone in a way that such people think is good.

What we know is, it is now October. Lots of people were infected in March, if not sooner. Almost no one is known to have been infected in March, then in September, or anything like that. Which is what you would see, if immunity was fading.

Similarly, we continue to see people equate positive antibody tests with immunity, despite it being rather clear that this is only one of several means of immunity. The immune system has a lot of tools at its disposal, and all that.

So once again, until we see lots of reinfections of particular people, all we know each day is it is another day before serious reinfection chances occur, and our expectation for immunity length goes up by just under two days because of the Lindy rule – however long it has lasted so far, it probably will continue to last on average about that long, then slowly fade, is a reasonable prior for the mean result. 

How do we explain the data we do see?

Obvious Nonsense Paper of the Week

On a related and but different note is this paper that came up this week: Evolution of COVID-19 cases in selected low- and middle-income countries: past the herd immunity peak? 

It’s a textbook example of how deeply the SEIR folly goes. The paper looks at a curve of infections, assumes that everyone is always identical in every way within the country, then uses that to figure out how many people must have been infected in order to cause the reduction in infections! That this proves most people were infected! Then based on that, they point out how low the infection fatality rate was! 

Seriously, this is what passes for serious modeling these days. This made it into the news cycle.

The estimated base reproduction numbers, the R0 are estimated as no more than 2. Based on that and the curve, they then claim that this means 50%-80% of people must have been infected. The ‘detection rate’ for infections is then surmised to go from a high of 5% in South Africa, to a low of 0.2% in Kenya. Not death rate, detection rate.

Such utterly obvious nonsense.

The numbers are so utterly crazy. 

Florida Says Yolo

Florida’s Governor has had enough. No more restrictions on businesses. No enforcement of mask mandates by cities. It’s time, he’s saying, to let private individuals make their own choices, and whatever happens happens. His ‘health experts’ agree with this, because if you want to find an expert who agrees with a given position, or at least is willing to say they agree, you can almost always find that expert.

The usual scolds and Very Serious People are out in force about how awful this is and that everyone in Florida should once again prepare to die. Things are bad after all that locking down, the Very Serious People say. Surely you can’t stop locking down now!

The Governor is closer to correct than the Very Serious People.

What is the alternative proposal? To continue to put our lives on hold and our economy into shambles until we finish the vaccinations? 

How long a lock down before it’s better to just get the damn virus already and take your chances, if your risk isn’t that high?

Lethality is down. Hospitals being overwhelmed is highly unlikely to happen, given what happened in the previous wave. We now know how to manage our risk if we want to do so, and can make informed choices. Make trade-offs. It’s time to let people decide what they want to do, and live their lives. It’s not like everyone is going to suddenly go back to normal. Some people will choose to do that. Others won’t. We’ve been over this many times.

There are two counter-arguments. 

One is that the vaccine is coming Real Soon Now, but those same Very Serious People are saying that the vaccine is at least months away plus more months for deployment. If that’s true, then that’s too long for many people, who can make a rational choice not to wait. For those who do want to wait, it’s a reasonable amount of time to deal with a higher outside risk level.

The other is the externality argument at the heart of it all. You taking on risk puts me at risk.

The basic response I have here is that no, it doesn’t, not in a meaningful way. Not anymore, beyond the specific people you choose to have close contact with. 

That’s because there’s a solid range of risk levels, where risk is too high to allow for activities that involve substantial exposure, but not so high as to make it impossible to protect yourself (e.g. it’s not so dense that you’re worried about things like the Manhattan air having persistent miasma.) 

If we had a practical path to getting below that range and sustaining that process, great, that would be worth paying a big price to do. We don’t. This virus isn’t going away short of a vaccine, period.

If we were in danger of rising above that range, or going so high we’d break the medical system, we’d have to think carefully about what we want to do to prevent that. But those days are over. We ran the experiments. The herd immunity we have plus the control systems in place won’t let it get to that point. 

That doesn’t mean this is a zero cost. It most certainly is not. But banning things doesn’t seem reasonable.

I do think that forcibly removing municipal mask bans is still doubleplus ungood, but businesses are still free to require them, and if enough people stay away from those businesses that don’t require them, that is what will mostly happen. It’s bad, but less of a big deal than it sounds like it is.

The big mistake is indoor dining. Indoor dining is a terrible cost-benefit ratio. It’s one of the most dangerous things you can do. The experience is nice, but it’s in no way vital. The reason indoor dining is happening is because without it, the bars and restaurants would die, with long term consequences.

Going forward, of course, if things get bad in Florida they’ll blame it on this, even if things are equally bad elsewhere. If things don’t get bad, they’ll still blame this anyway. Right or wrong, that’s how the Very Serious People roll.

The right answer, of course, is utterly obvious and in front of our face, and has zero chance of happening. It’s to tax. Rarely is banning things outright a good idea. If we put a large tax on indoor dining, ideally as a function of relative safety but a fixed number would do, that’s the logical approach. We could do the same with other risky activities. If people don’t want to pay, then it wasn’t worth doing. If they do pay, then it was worth it, and we can use that money to fund our other efforts.

A number of other states are also in Yolo Mode. I learned this morning that Massachusetts is continuing to loosen restrictions, based on a justification of dropping positive test percentages, despite rising hospitalizations and rising numbers of cases. All metrics matter, but it seems clear what the result will be. 

The question remains, if we’re not willing to do what it takes to stop this, why should we also ruin everything else along the way to not stopping it? 

Going Down to Denver, Going To Have Ourselves a Time

Denver is on it with two feel good stories this week.

First, they were able to detect infection using wastewater, and contain it. This needs to be standard procedure, everywhere.

Second, Denver Broncos fill stadium with South Park cardboard cutouts.

In Other News

CDC pulls coronavirus surveyors out of Minnesota after they reported harassment, racism. Our country might indeed have some problems it needs to confront. Instead, of course, we once again ran away from several of them at once, which seems fitting. We don’t care enough to work through it.

The Long Haul

The great unknown is the frequency and severity of ‘long haul’ Covid. People, including many fully young and healthy people, suffer for months after infection and potentially have permanent damage that could substantially lower their life satisfaction. This may have happened to one of my close friends (that essentially none of my readers would know) who was otherwise healthy. I’m more afraid of the long haul problem than I am of dying from Covid.

All we know so far about ‘long haul’ Covid – estimated to affect 600,000 people in the UK estimates that 12% of those infected have symptoms that last longer than 30 days. That’s a very broad definition of ‘long haul’ on duration and on severity, and I’m guessing the denominator here is based upon a large underestimate of the number of actual Covid-19 cases in the United Kingdom. Even fully buying what’s here, we don’t get much of a handle on how to assess our personal risks and decide how much to care about them.

As Their Numbers Grow, COVID-19 “Long Haulers” Stump Experts is even less helpful. I don’t feel any better informed than before from that, as to what I actually need to know.

I wish I had answers here, and encourage those who have any reasonable estimates at all to share them and explain their reasoning. We need to figure this out.

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22 Responses to Covid 10/1: The Long Haul

  1. J says:

    > This virus isn’t going away short of a vaccine, period.

    I’m actually more optimistic about cheap rapid testing than the vaccine at the moment. The vaccine may only end up being 60% effective or so, and will take many more months to get people to take it, which many will resist. Whereas Abbott and several others are already cranking out $5 15 minute tests by the millions.

    Get in your car, swab your nose, and by the time you get to school / club / dinner party / choir practice you’ve got proof you’re clean.

    The skeptics have been using the “only the vaccine matters and it’s going to take forever, so let’s just give up” line as an excuse since the start, but it’s not true.

    Social distancing, all by itself, would save us if we were dedicated enough. Ubiquitous testing, all by itself, would do it. A vaccine can do it. In the end it’ll be all of them together.

    • TheZvi says:

      My expectation is that even if somehow they let us have the rapid tests – which they won’t – control systems would step in, and people would compensate for that plus the declining numbers, and we’d never get to zero. People aren’t going to be vigilant enough in the endgame around here, that seems clear to me.

      • Liam R says:

        Also, the type of people that are likely to be early adopters of the 15-minute test are the ones who are likely taking the most precautions anyway, so I’m not hopeful for it to have much effect on overall case numbers.

        What it WILL do, though, is allow people like me, who are dying to get out and do social things with a close group of friends an easier way to test everyone to make that happen. So I’m overall still excited about the rollout of the tests.

      • jacklecter says:

        Why won’t they? I know you’re not one for *gratuitous* cynicism, and between this week’s column and last week’s, it seems like there’s something about the Very Serious People I’m not getting.

        Is it just, the tests might not work, and they’d be blamed?

      • remizidae says:

        @jacklecter Having tests available might make people think they can take more risks, therefore we can’t allow them to be available. Can’t have people making their own decisions!

  2. enolan says:

    I’ve been fantasizing about buying a nasal spray full of virus, infecting myself, locking myself in an airbnb for 2-4 weeks, and then finally being done with this bullshit. If anyone has practical advice on how to purposefully get infected I’d be interested to hear it.

    I don’t promise to actually do it, but it’s a nice thought, and if I were more confident about long term sequelae I probably would.

    • Liam R says:

      I’ve thought about this as well, but dismissed it pretty fast because it only solves half of the issue. Yes, you can now have peace of mind, but there’s no structure in society to support those who are already immune. You’re still going to get judged for “nOt DiStAnCiNg”, you’re still going to have to wear masks indoors, many of your friends still won’t trust your immunity status, etc.

  3. Austin Chen says:

    Hey Zvi — reading your Vitamin D post, I became seriously convinced that supplementing would be a good idea on the civilizational level. Beyond telling all my friends, what I’m trying to figure out now is whether to advocate this message to a broader audience, and if so: how. I look at the success of something like 1DaySooner, which is credited for pushing forward the Human Challenge Trials now underway in the UK, and wonder if we can replicate it.

    So far, I’ve thought to reach out to some of the more prominent community figures who haven’t yet spoken on the topic — Scott Alexander, Kelsey Piper, Scott Aaronson — but no response so far. (Where they might ignore me, a rando on the internet, they might listen to you, though!) Any other ideas?

    • TheZvi says:

      Kelsey seems like she’s the one who should most be on this instinctively, but yeah, people don’t listen to randoms.

      I think the best first thing you can do is come up with the technically strongest case, putting together all the good evidence, and excluding all the evidence that looks questionable – just be able to overwhelm a target with data point / study after another with none of them being easy to go after? But yeah, basically you have to convince someone with a platform to do it, and mine doesn’t count as big enough.

      Open to hearing what others have to say. I don’t see a clear path.

  4. myst_05 says:

    I’m hopeful that Florida won’t see any huge spikes within 4 weeks and everyone else start following the same policies. Lockdowns must end no matter what.

    • TheZvi says:

      My model of political economy says that Florida not seeing a spike, or not doing badly relative to other places, will not cause others to follow suit.

  5. Torao says:

    From the link to the paper you claim made it past peer review (it’s literally at the top in bold of the link):

    This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

    Awkward.

  6. qbit says:

    I just discovered your blog / this series and I’m already looking forward to next week’s update!

    One sentence that had me confused:

    > I do think that forcibly removing municipal mask bans is still doubleplus ungood

    Do you mean mask mandates?

  7. remizidae says:

    >Indoor dining is a terrible cost-benefit ratio. It’s one of the most dangerous things you can do.

    Are you really saying that indoor dining is very dangerous, or are you just saying that it’s a bad call based on the limited benefit? Because indoor dining does require interaction with a server at typically <6 feet, but why is that more dangerous than going to any indoor business? The restaurant involves repeated interaction with 1-2 servers, but the grocery store involves brief interactions with dozens of people. It's not obvious to me which is worse.

    Florida may differ, but in my area all servers wear masks, so going to a restaurant doesn't require any interaction with nonmasked people other than your dining companions, if any.

    • remizidae says:

      If restaurant owners/servers wanted to reduce risk, there are some pretty obvious changes that could be done. Instead of stopping by ten times during a meal, servers could just come by when necessary (maybe using a call button like in Korean restaurants). Servers could stand further away, or you could replace servers with online ordering. You could have servers pause before approaching a table to give diners a chance to put on a mask. But the fact is, no one IME is doing this. Either they think it would cause them to lose business or they’re just not too worried.

    • TheZvi says:

      The restaurant involves extended time spent in one place, without masks (since you can’t eat without them). Brief interactions individually have a hard time giving you enough exposure. And you have to worry about the virus coming around via airflow over time. It’s the fact that you’re in there for 30-120 minutes maskless, more than anything else.

      I then combine that with, let’s face it, this isn’t that essential. I miss restaurants greatly, sure, likely more than most people, but it can wait.

    • David Speyer says:

      This is a good example of why the “airborne” language seems important — I feel like media have not done a good job communicating that being in enclosed air which a lot of other people have breathed into is a big risk, even if you do not get close to any of them.

  8. Dan Pandori says:

    Thanks as always for these posts. It’s really great to have a sane collation of figures by someone who can do math and will actually take the time to do so.

  9. Pingback: Covid 10/8: October Surprise | Don't Worry About the Vase

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