NedNotes (not blog): COVID data sweep 09oct20

B.L.U.F. (bottom-line, up-front): numbers continue to improve nationally, particularly in the bellwether states. These positives shroud a quickening spread through rural areas. Though the death toll is high after the first wave, states appear to be managing the emerging second wave well.

INTRODUCTION: Update on President Trump
With the attendant publicity, the illness and hospitalisation of the President give one a peek into what (s)he can expect – in treatment, if not alacrity – should that person fall prey to the disease. The President’s ordeal presents a case study. Expertise and learning curves have kicked in for segmented mitigation. Specifically, President Trump underwent the following treatments in the following order:

• pre-hospital care in being diagnosed almost immediately, followed by;
• experimental anti-body drug aimed at preventing fresh infections from progressing, currently in initial testing, but granted to President Trump, along with a very few others, for reasons of ‘compassion’, followed  by;
• remdesevir, the anti-viral drug, originaly created to treat Ebola and adapted to COVID. and available shortly, to mitigate medium-phase breathing problems, followed by;
• dexamethasone, a common steroid, to reduce later-stage inflammation; and ending with,
• after-care.

The cost of steroid and anti-viral treatments will be affordable, while the anti-body drug will likely be prohibitively expensive. Nevertheless, President Trump released a short video promising the same treatment to all elderly, vulnerable Americans. Given the impairment to breathing initially faced by President Trump before his hospitalisation and the short time of his convalescence, however, one must question his readiness to be campaigning on the road this week-end.

COVIDIOCY: Myth-busting the flu idea
Anti-Asian slurs aside, many people aligned with President Trump argue that COVID is over-blown and nothing more than a severe influenza epidemic. These people, like the President and Vice President, assert that the Obama-Biden Admin. mishandled the SARS epidemic of 2009 and that, were that group in charge today, deaths would already be exceeding two million people. These assertions are ridiculous and easily gainsaid.

The canard, unwittingly, makes one point: the level of penetration. The swine flu did infect some sixty million Americans in 2009, as repeated ad nauseam. The significance here lies less in the level of infections than the ultimate mortality rate. Currently the mortality rate for COVID is sticky at around 2.8%, or 120x above that of the SARS epidemic, which took the lives of, at most, only 14,000 Americans (i.e., 5% of global H1/N1 deaths versus 20% today; and, 25% of total U.S. influenza deaths in 2009).

More on the undemocratic demographics
As the nation confronts the Black Lives Matter and Grey Panther movements, the COVID epidemic in the United States brings out the systemic injustice of one and the expressive grievances of the other into incontestable contrast. People of colour suffer infections at 3-8x the rate of Whites of the same age, with Hispanics and people in prime working years – likely essential workers – suffering the most.

Another sobering finding emerges from the study of the most vulnerable age group, the elderly, and their care-givers. Deaths in long-term care facilities as a percent of total deaths from the coronavirus contagion remain sobering in the Northeast, with regional outliers in Colorado and Idaho. My home state of Pennsylvania provides a prime example with two-thirds of the COVID fatalities occurring in nursing homes. Western Pennsylvania hosts the Pittsburgh cluster.

The region has been mortally dominated by one or two nursing homes in Beaver and Allegheny Counties. Ironically, for the all the invective hurled at Governor Cuomo (D-NY) for referring five thousand recovering COVID patients to nursing homes, obviously a learning curve error, only one in five COVID deaths in the Empire States has taken place in elder-care facilities.

What both the systemic racism and elder care collapse have in common are settings suited to a spurt of super spreading: densely crowded and poorly ventillated facilities. Another mishap has emerged: failing to follow the Japanese and Korean examples of backward contact tracing. The forward tracing (i.e., trailing people to see whom carriers subsequently contact) practiced across the country has too much randomness built in.

The exercise becomes a scatter-plot with no line to draw through it since only 10-20% infected people actually spread the infection to one or more people. Backward tracing (i.e., finding out whom the carrier had seen before coming down with the coronavirus), however, reliably converges upon super-spreaders as common contacts of those infected.

The case in point remains that of patient #31, a passive carrier, in Korea who single-handedly infected several thousand fellow worshippers in a gigantic church. Once she was identified by fellow parishioners, authorities intervened immediately and effectively. The U.S. is learning from this experience, but not enough since testing is still slow, when easily procured rapid ten-minute tests could start to “bust” the COVID “clusters” by anticipating them. 

WEEKLY REVIEW-in-brief
Results continue to improve strongly in the bellwether states, though Tejas continues to struggle. While Arizona is making notable progress in managing her contagion, the results noted here appear to overstate that strength. The Deep South westward through Texas and due North to the Canadian border have rising risk profiles, particularly in the more rural areas. 

The second wave has been slow in coming due to Governors and state health officials. It may already be cresting in the Northeast, being confronted by swift responses to isolate and suppress the spread of the virus. New York City Democratic Mayor, William DeBlasio, however, faces strong resistance from people in religious communities, particularly among Orthodox Jews, as he seeks to close schools and non-essential businesses.

Governor Cuomo (D-NY) likewise faces push-back for curtailing availability of restaurants and bars in his “Cluster Action initiative”. The crux of the argument in New York City boils down to one of focus: the rising positivity rates (i.e., the number of tests resulting in confirmation of COVID infection) to a level of 3.25% versus the absolute level of said City’s rate being two-thirds the national average and well below the two-week testing upper threshold of 5% positivity set by the World Health Organisation.

Leading indicators for the U.S. have up-ticked. These indicators, personal to me, include:

• number of coronavirus victims in critical care relative to total active cases; and,
• the daily mortality run-rate.

The first indicator looks at the the trend of the composition of cases (i.e., ¿are more infected people getting sicker?). The second tries to capture points when death rates rise over-take the illness-to-death lag-time, thus implying more deaths imminently to come with the deaths still uncaptured due to the lag). New York deserves credit by cutting its daily infection rate by 92% since the dark days of six months ago.

Ideally, leading indicators would base themselves upon hospitalisations rather than the extreme of critical care; these data are not available, at least from what I can find. Fortunately, the Centres for Disease Control (C.D.C.) confirm the implications of these leading indicators without defining them. The more dire regional risk profile, however, lies in the upper Midwest, where Wisconsin has faced the most severe challenge during this incipient second wave. She has set records for each of the past two weeks, with infections across the rising 2-4x over the past month.

The Governor has stated, in effect, that his state is overwhelmed. Underlying risk factors for the northern Midwest are colder autumns, forcing people to remain indoors, often in poorly ventillated settings, and the virus potentially extending its life in lower seasonal temperatures. Nevertheless, Governors – with a few exceptions – are making concerted efforts to make this 2nd wave a ripple; the first year mortality, ending 28feb20, looks to be 15-20% below the level forecast six months ago.

THE PROBLEM of testing.
The United States still lacks a comprehensive testing plan. Nonetheless, State governors are rising to the occasion by riding each other’s learning curves and imposing stricter congregational guidelines and masking mandates. Social distancing norms are beginning to stick. The public now deems this U.S. epidemic as its #1 issue in deciding for whom to vote this November, not only at the top of the ticket, but down through the state and local elections as well.  

One challenge to this ad-hoc approach is that of national testing, a responsibility properly spearheaded by Washington, D.C. Though slow to move, resources now flow to the states for rapid testing. These quick swabs are more effective in detecting hot-spots quickly, which corresponds to the sporadic nature of transmission by a few super-spreaders rather than the general populace. Half or more of the states are running positivity rates above the 5% threshold, sustained for two weeks, to permit re-openings. 

Additionally, many of the states bogged down in the rural spread are lagging in testing. Thirty-nine states have posted increased infection rates over the last week. Nine states in the virus belt show warning signs of coming or realised spikes through record setting weeks (i.e., Indiana, Kansas, Kentucky, Minnesota, Montana, North Dakota, Utah, Wisconsin, and Wyoming). Rapid-testing and backward tracing will assume a paramount policy priority in the coming weeks.