NedNotes (not blog): 04sep20 COVID-19 supplement to monthly letter to family members

 SCHOOL is BACK: 

¿second wave or wave good-bye?

B.L.U.F. (bottom-line, up front), while cases and deaths continue to elevate in the Midwest, South, and Southwest, governors are applying lessons learned by the population centres in March through May 2020. Leading indicators, such as they exist, are pointing in the right direction. This week's presentation serves as a suppement to this month's letter to friends and loved ones living in densely populated cities.

URGENT NOTE: Baseball great, ‘Tom Terrific’ Seaver, hero of the 1969 ‘Miracle Mets’ baseball world champions has died of full-blown COVID-19 aided by dementia. Such coronavirus deaths are real; the death of a fine, fine man and epic pitcher was due to COVID-19, notwithstanding claims to minimise the U.S. epidemic. No denial here.

INTRODUCTION
The United States is winding down the first wave of the COVID-19 epidemic. While a second wave remains likely, as new waves have already started in Viêt Nam and Spain, there is a lot to be said for being on the right side of the learning curve. The bellwether states of Arizona, California, Florida, Texas, and Oklahoma turned in uneven but improving performances over the last week led by California. The smallest state, Oklahoma, represents the rural states across the region.

A flurry of confirmed cases have emerged across the Midwest. Rural states in the South and West remain late-comers to the coronavirus contagion. Please note that the bellwether states represent 55% of the population of the South / Southwest. The community spread of infections has been lower and less virulent than expected. Specifically, the five bellwether states are posting solid results this week. The second chart, further down, reviewing thirty-three states, six territories, and one Native American Tribe covers roughly 90% of the country.

PERFORMANCE REVIEW of SOUTH and SOUTHWEST
Definitions:

1. Comparative week over week numbers = NOT the increase in cumulative cases but a sequential comparison of the number of cases confirmed and the number of deaths recorded for each of two weeks.
2. Positivity rate = percentage of tests indicating an ongoing coronavirus infection.
3. Frequency = the inverse (i.e., the odds) of the conditional probability of a person dying from COVID-19 in a certain geographic area.
   For example, frequency of 100 for a certain region would mean that one out of every hundred people in the region is dying of COVID-19, or the odds of one dying are 100-to-one.

1. BELLWETHER STATES

• 16% decline to 103,591 in the number of cases confirmed week over week
• 18% decline in the number of deaths week over week to 3,144
• marginal mortality run rate for the week of 2.8% versus 2.1% for the United States
• positivity rates of 8.7% of tests (still high) versus 5.5% for the U.S.
• frequency of 2,212 versus 1,768 for the United States

2. Arizona

• slight decline in the number of cases confirmed week over week
• slight increase in the number of deaths week over week
• marginal mortality run rate for the week of 2.5% versus 2.1% for the United States
• positivity rates of 11.3% of tests (very high) versus 5.5% for the U.S.
  frequency of 1,403 versus 1,768 for the United States

3. California

• 12% decline in the number of cases confirmed week over week
• parallel decline in the number of deaths week over week
• marginal mortality run rate for the week of 2.3% versus 2.1% for the U.S.
• positivity rates 4.4% of tests versus 5.5% for the United States
• frequency of 2,807 versus 1,768 for the U.S.

4. Florida

• 6% increase in the number of cases confirmed week over week*
• 24% decrease in the number of deaths week over week
• marginal mortality run rate for the week of 2.9% versus 2.1% for the U.S.
• positivity rates 13.5% of tests versus 5.5% for the United States
• frequency of 1,806 versus 1,768 for the U.S.
  * cases previously unreported added to weekly total

5. Texas

• 35% decrease in the number of cases confirmed week over week
• 19% decrease in the number of deaths week over week
• marginal mortality run rate for the week of 3.3% versus 2.1% for the U.S.
• positivity rates 9.0% of tests versus 5.5% for the United States
• frequency of 2,125 versus 1,768 for the U.S.

6. Oklahoma

• 7% increase in the number of cases confirmed week over week
• 14% decrease in the number of deaths week over week
• marginal mortality run rate for the week of 1.0% versus 2.1% for the U.S.
• positivity rates 9.6% of tests versus 5.5% for the United States
• frequency of 4,638 versus 1,768 for the U.S.

7. UNITED STATES of AMERICA

• 8% decrease in the number of cases confirmed to 279,372 week over week*
• 18% decrease in the number of deaths week over week to 5,686*
• marginal mortality run rate for the week of 2.1% versus 1.9% for the McDonnell clusters
• positivity rates of 5.5% of tests for the United States vs 2.6-2.9% for the McDonnell clusters*
• frequency of 1,768 for the U.S. versus 810 for the McDonnell clusters
  * S.W.A.G. (scientifically wild-assed guess)

Please review these data for a detailed perspective on the coronavirus contagion sweeping across the country. Keep in mind that the growth rate of the illness is slowing.

SUPPLEMENTAL REVIEW of The UNITED STATES
In terms of cases recorded each month, the world has confirmed 12% fewer infections over the past month, while the United States actual case count has fallen by a third. Restrictions by national and local governments through testing results for positivity rates (i.e., the percentage of tests that are positive) help as total deaths recorded over time have increased more slowly by 21% globally and 15% in the U.S. Again, the numbers of incremental deaths recorded in each of the last two months have dropped by 16% and 21%, respectively.

President Trump’s insistence upon opening schools and relaxing testing requirements has been widely rejected at the state and local levels. Nevertheless, there is some plausibility to what the President is saying in view of lower fatality rates than expected. First, children rarely suffer full-blown COVID-19, though their threat may be one of passively carrying and transmitting the virus. There is some anecdotally based thinking that anti-bodies built from exposure to other coronaviruses (e.g., those inducing the common cold) may provide enough protection for people without concurrent conditions to suppress full-blown manifestation of the disease.

There is some evidence arising that the George Floyd protests for the past three months and even the much obsessed biker rally (0.1% penetration rate recorded to date) have not caused the immediate spikes people had feared. This may well imply a mitigation through outdoors settings. The problem appears to be the indoors settings that have less air-flow, lower ultra-violet light exposure, and less distancing between individuals.

Amid this uncertainty over what is safe and what is not, 41% of the K-12 schools in the United States remain closed. These closures are meeting fierce resistance from the Trump Administration, principally because children in poorer homes often do not have inter-net access for on-line learning and also depend in part on school meal programmes for food security. Additionally, the 70,000 recently infected children may be passive carriers.

The Trump Administration has likely pressured the Centres for Disease Control into preparing for mass-distribution of vaccines in November. The go-it-alone decision by President Trump of not joining a global consortium for creating a vaccine, sponsored by the World Health Organisation, has excited deep questioning of President Trump's judgement since almost all other countries have joined.

Additionally, the accelerated authorisation for the development and expedited roll-out of plasma convalescent therapy by the Food & Drug Administration has sparked more scepticism of Trump Administration aims in light of a subsequently refuted claim that the F.D.A.-approved therapy would cut the death rate by 35% of a certain class of patients. Dr Stephen Hahn, head of the F.D.A., later apologised for the claim.

Many view the C.D.C. preparation as a political ploy, since Dr Anthony Fauci, Director for thirty-six years of the National Institute of Allergy and Infectious Diseases, has repeatedly warned against wishful thinking for a 'Hail Mary' vaccine. The typical go-to-market period of ten years or, at best, four-to-five years for vaccines make an imminent cure highly unlikely. Others, however, view the step as prudent. The F.D.A. appears to be tightening requirements for the quality of blood and plasma to be used in convalescent therapy.

CONCLUSION
The results appear to be holding for now. If not for the short life of the antibodies of three-to-six months, most of the urban areas, especially those with large minority populations more susceptible to the evil synergy between the coronavirus and pre-existing maladies (e.g., diabetes or high blood pressure), would be approaching herd immunity.

Though the vaccine will take time to develop, produce, and distribute, the previous prediction of up to 700,000 fatalities appears to be high. The death-toll, G-d willing, is likely not to match the forecasted base case of 336,000 calculated five months ago, either. The upper end of the President's 200-300,000 range appears as the more likely benchmark.