NedNotes (not blog): 06nov20 COVIData Sweep

 

B.L.U.F. (bottom-line, up-front): Truly a data dump this week for the monthly letter on family clusters. Bellwether states expanded to ten with addition of Colorado, Idaho, Illinois, Missouri, and Wisconsin. Epidemic second wave accelerating to possible warp speed. 

INTRODUCTION
The Centers for Disease Control (C.D.C.) forecast up to 30,000 deaths over the next three-to-four weeks, backing the grim warning given by Dr Deborah Birx of the Coronavirus Task Force. The spread of the coronavirus contagion is accelerating in the upper Midwest, while other states are seeing their incidence and mortality rates re-accelerate after a month or two of slowing growth. Only thirteen of the fifty-five states and territories enjoy positivity rates below the 5% threshold (for two weeks) recommended by the World Health Organization for economies to re-open.

POLITICAL PRESSURES DURING ELECTION WEEK
Since late October, the Trump Administration has ceased trying to control the epidemic, but is focussed on developing vaccines and mitigating treatments as well as allowing the virus to spread among young people to hasten herd immunity. By itself, this announcement is not too surprising. What elevates that decision to a concern is the number of Republican controlled states that have pulled back on testing in the last week or two when they need it now.

Many of these states have not availed themselves of Medicaid expansion under the Affordable Care Act, thus making tests potentially unaffordable for the uninsured constituents. This ‘perfect storm’ to turn a second wave into a potential tsunami is approaching Alabama, Florida, Idaho, Iowa, Mississippi, Missouri, South Dakota, and Texas. Three of the states carried by Vice President Biden – Pennsylvania, Minnesota, and Wisconsin – are struggling; only Wisconsin’s situation is immediately pressing.

ONE MORE MYTH TO BUST
A favorite canard of President Trump is his claim that the Obama Administration left him with nothing to confront the coronavirus contagion. While the Administration's radically cutting pandemic response programs in 2018 -- most famously by disbanding the pandemic response desk at the National Security Council -- is well known, what is less evident is what President Obama left in store for the incoming Trump Administration. The seven press accounts in this section, from 2014-18 amply liquidate the President's oft-repeated assertion:

• the successful handling of four break-outs and potential pandemics (i.e., SARS, Ebola, Zika, and the Middle East Respiratory Syndrome) by President Obama, following the success of President George W. Bush;
• development of an inter-agency modelling and coordination protocol for effective pandemic response prepared by the Obama Administration's 'Pandemic Prediction and Forecasting' as well as the 'Science & Technology' Working Groups to integrate expertise from the Departments of State, Defense, and Homeland Security; the White House Science & Technology Office; the Office of Management & Budget; the Centers for Disease Control; et many al.;
• application of lessons learned, from the four outbreaks mentioned above, to make pandemic responses affordable for poorer nations by tying rapid responses to contingency funding to timely and effective remedial actions; as well as,
• the Obama Administration winning roughly 15% more funding and proposing to Congress a second $300 million tranche for pandemic preparedness and response.

ALERT FROM DR DEBORAH BIRX
Usually remaining off-camera, Dr Birx has inserted herself into the aim of the President’s wrath, joining Dr Anthony Fauci. The recent trend of well over 100,000 cases per day and more than a thousand deaths reflects the immediate consequence of the laissez faire policy outlined by the Chief of Staff, Mark Meadows. Political observers argue that the states’ recent backing off of testing amid significant rises in case-loads and death tolls aims to suppress the apparent gravity of the outbreak so the President can claim the epidemic is slowing.

The essence of the warnings by Drs Birx and Fauci boils down to four factors: colder weather forcing people indoors; the contagion spreading South from the North as people head to warmer climes; a continual refusal by many outside of urban areas to wear masks; and, the likelihood of the virus leaping two generations from young passive carriers to elderly. That is to say: to those people most prone to contracting, and vulnerable to dying from, full blown COVID-19.

SECOND WAVE or COMING TSUNAMI?
Already, the Administration’s hands-off policy – together with relaxed vigilance in Tejas and Florida – is creating an acute care situation inside hospitals. The concerns of fewer facilities, medical first responders, and Medicaid extensions in rural states with many people there heeding the President’s line of “rounding the corner” has increased hospitalizations by two-thirds in the last month. Hospitalizations are now approaching the peak levels seen in the Northeast last Spring and in the original bellwether states last Summer. Lastly, pregnancy has emerged as a ‘co-morbidity’ insofar as being pregnant and suffering from full-blown COVID can increase the mother’s risk of death by as much as 70%.

The bellwether states show the quickening penetration of the coronavirus into the rural parts of larger Midwestern states as well as rural states. Texas, Georgia, and Florida are beginning to feel the strain of the second wave. Thinly populated states like Idaho and the Dakotas are in particular danger as the Winter arrives. Thus far, of the states under review, only Wisconsin is showing the exponential growth rates of deaths and cases of which Drs Fauci and Birx have been warning. The Administration’s apparent strategy is a race-the-clock approach to develop vaccines toward expediting herd immunity. That leaves the plains and mountain states in an increasingly precarious situation. 

With the President pre-occupied in contesting Tuesday’s tentative loss to Vice President Biden – much as he was distracted by the impeachment and trial prior to the first wave – conditions do not bode well for the 'inter-regnum' between now and the day of the inauguration of President Trump’s second term or of the rising President Biden’s new term. My previous projection of 336,000 deaths in the first year, made seven months ago, is facing strain. The death toll by (28feb21) 05mar21 may exceed 500,000, especially since many states lack the resources to distribute and administer any vaccine that arrives.