NedNotes (not blog): 24oct20 COVIData sweep

 

B.L.U.F. (bottom-line, up-front): talk of herd immunity and focussing almost exclusively on a vaccine is setting the United States up to face a deadly duo: a combination of a flu season with a second coronavirus wave.

NOTE: there is a second wave in Europe, slightly ahead in time and momentum of that in the U.S. Nevertheless, relative to populations, the death toll in the United States remains substantially higher than the level endured by Europe. The overall death rates remain low for now (i.e., roughly one-eighth the level of the final U.S. rate for the 1918 Flu) at this point in the pandemic sweeping across Europe and the Americas.

Overview of the week
The U.S. recorded the highest day of confirmed coronavirus cases since the epidemic hit the country last Winter; the nation is suffering daily infections at 7-8x the level of control recommended by Dr Fauci of 10,000 cases per day. Deaths surged to 1,101 on Thursday (i.e., as an average of data reported by the New York Times, Johns Hopkins, and Worldometers). The mortality run rate remains high and is still slow to decline at 2.6%. It quickens slightly in its improvement.

While some analysts believe the U.S. is entering a third wave, I view it as the second owing to the vastness of the country with the first wave rolling over six months. More ominous are reports that, with 'excess' deaths tabulated thus far in 2020, COVID mortality could be as high as 275,000 with 30-45% being “avoidable” due to alleged policy failures (i.e., late response, forty-four states with inadequate testing and tracing capacity, as well as,  no articulated policy from D.C.). Most states have confirmed infection growth rates higher than 5% over the past week. 

Sixteen states in the Midwest and Mountain states have reported record weekly increases. Notwithstanding President Trump’s oft-repeated fantasy of “poorly run” blue states and cities leading the pack, the West Coast and Northeast are doing quite well despite the latter region's suffering last Spring. Leading indicators have been creeping up lead by rising hospitalizations during the last month. Medical facilities are strained in some places but most states have more than adequate institutional care capacity.

General Bloviation (mortality of 38 states)
Only eleven states of those studied have endured higher death tolls relative to population than the national average. Most prominent among these are the six that have suffered during the rolling first wave: Connecticut, Louisiana, Massachusetts, Mississippi, New Jersey, and New York. Some bellwether, Southern, and Midwestern states are reporting higher-than-benchmark mortality. 

More alarming than the level of deaths are the chronic problems of testing and tracing, again due to the geographic breadth of the country and poorly coordinated resources. As the coronavirus spreads into more areas – many lacking in professional, facility, and insurance support – some of the states surging will make do with the lowest capacity for testing.

1. Idaho and Pennsylvania with one of three and one of ten people tested being ‘positive’ (i.e., confirmed) for the virus, respectively, have tested roughly half the number of people as the rest of the country.

2. Iowa, Alabama, and Mississippi, each with materially lower testing, and 17-22% positivity rates range 3-4x above the two-week 5% level prescribed by the World Health Organization for cities, regions, or countries to re-open.

3. Only fifteen states, principally those that learned the hard way last Spring, meet that W.H.O. criterion while sixteen other states substantially or critically lag the national testing rate.

4. Additionally, eight other states under review -- led by Pennsylvania, Illinois, and Tennessee -- report a sustained trend of materially increasing positivity rates for at least two weeks.

5. Another emergent issue is, or will soon be, the continuing absence of tracing preparedness.

The challenge for policy-makers remains the fact that these rural states are thinly populated and stay off the national radar too much of the time since the death tolls appear to be trifling next to the larger states. The mortality nevertheless will add up soon enough.

Cluster Quickee
New restrictions are going into effect in many of the McD. family clusters as the second wave starts to haunt those cities hardest hit in the first. The good news remains that focussed, immediate responses appear to be working in New York City as Democratic Governor, Andrew Cuomo, and Democratic Mayor, Bill DeBlasio, work together quickly to circumscribe and isolate smaller clusters, release them when the mini-red-zones are contained, and then move on. Brooklyn continues to create challenges.

Pennsylvania is the problem child when it comes to new cases in the Northeast with pockets of spreading, mainly in Philadelphia and several rural counties, including Westmoreland near Pittsburgh. Chicago and Boston are returning to containment measures like virtual schooling, limited capacity in bars and restaurants, as well as personal parties limited to six people. Maryland has done a creditable job on addressing the virus, so Governor Hogan is doubling aid to Marylanders in the absence of further largesse from D.C.

More Myth / Drug Busting
The President argues that his response to the epidemic has been excellent. That assertion is open to skepticism. His claim that the 'modelled' death toll of two million is at best disingenuous for the following reasons.

That two million number is almost certainly an interpolation of the number of people killed by the 1918 Flu epidemic, relative to the U.S. population a century ago applied to the current number of Americans: 675,000 deaths divided by 103 million people in 1918 = 0.65% multiplied by 332 million people in 2020 = 2.2 million deaths. ¡Et voilà!

1. Cursed simplification: the coronavirus is eight months old and the 1918 epidemic was two-to-three years.

2. Crazily simplistic: the 1918 Flu mutated; the coronavirus has yet to mutate widely or reach a level near its 40-70% anticipated infection rate.

3. Crushing simplistification: a conservative estimate of the first wave (i.e., the first year) of the 1918 Flu would have killed 150,000 people this year. The 1918 hit hardest in the Autumn of 1918, its second wave.

Another COVID medication is under fire: tocilizumab, even as remdesevir, discredited in off-shore studies, is now approved by the F.D.A. A study by Massachusetts General Hospital of two hundred, forty three patients belies, at least for now, the effectiveness of this little known but promising drug. This anti-inflammatory medicine targets the protein most responsible for the excessive immunological response that kills patients (i.e., too much of a good thing). Sadly, the protein inhibitor does not save lives.