NedNotes (not blog): 29jan21 COVIData Sweep

Para cinco estadounidenses muertos por el virus corona la semana pasada. Deux hommes et trois femmes; deux nègres et trois blancs; un compétiteur olympique spécial et un unitarien. Median age of sixty-three and average of sixty-nine; from West Virginia to Minnesota.

B.L.U.F. (bottom-line up-front). A collection of, and commentary on, COVID-related data during a week in which new deaths have once again exceeded twenty thousand. Review of the ‘info-demic’ and vaccine grab around the world.

INTRODUCTION
Summary. Mixed data creating a cause for pause and concern; death rates stuck at 2.2x of pre-Thanksgiving levels. 

The week's results have shown conflicting results once again with new cases up by 4% to nearly 23,000, while hospitalizations and people in critical care have declined monotonically during the week. Specifically, hospitalizations have dropped by 13% during the week to 101,003, while critical care patients have diminished in number by 9% to 24,863. 

The concern remains whether these conflicting data represent a lag-time of deaths from the holiday surge or whether the new variants contaminating the United States are increasing viral lethality. The timing is getting late for the explanatory power of a lag-time. The feature section explores some the viral theories going viral with a closing comment on vaccine inequities. 

Leading indicators weakly suggest increasing lethality; one must greet this judgement with a healthy skepticism since these up-ticks in static-pool rates (i.e., deaths as a percentage of resolved cases, or recoveries added to fatalities) are so slight that they are as likely as not reflective of rounding errors.

CLUSTER FACTS
Summary. The geographic areas under review are trying to accelerate inoculations as vaccinations trail expectations by a large margin and a half of the distributed doses languish in dis-use. 

Baltimore-Annapolis: 5.9% of population with at least one vaccine shot (MD); 24% availability in intensive care units (i.e., I.C.U.s, MD); 4.8% test positivity rate (MD); as well as, 284 new deaths during the week (MD). Maryland is lifting her 10 p.m. curfew at bars and restaurants and allowing 50% capacity. Maryland is setting up six super-vaccination sites.

Boston & the Cape: 5.9% with least one vaccine injection; 22% I.C.U. availability (MA); 4.0% positivity rate; as well as, 457 new deaths during the week. Retirees on Cape Cod frustrated with what they deem as a lagging roll-out of, and limited access to, the vaccine. 

Chicago proper: 2.2% with at least one vaccine shot; 39% I.C.U. availability (IL); 5.3% positivity rate (IL); and, 612 news fatalities in the past week (IL). Proof that Hispanics are facing higher mortality rates than whites and currently dominate 60% of hospitalizations.

Colorado state-wide: 6.8% with ≥ one shot; 39% I.C.U. availability; 5.0% positivity rate; and, 145 new deaths this week. Telluride endures a surge in cases, extending into Dolores County. Colorado seeking to inoculate teachers over the next month.

Detroit Metro: 5.4% ≥ one shot; 27% I.C.U. available (Ml); 4.7% positivity rate (Ml); 459 new deaths this week (MI).

New York METRO: 6.9% ≥ one shot; 37% I.C.U. available; 6.2% positivity; 864 new deaths this week. Death rates in elderly care facilities 50% higher than reported, thus landing Governor Cuomo is hot water.

Pittsburgh-Philadelphia: 3.7-4.7% ≥ one shot; 25% I.C.U. available (PA); 33.9% positivity (PA); 1,231 new deaths this week (PA). National Guard deployed in elderly care facilities in Western Pennsylvania. Boy blunder or simply a collegiate con-man in Philly.

OVERVIEW of COLLECTED DATA
Summary. Results remained mixed with case growth slowing in many states as recorded infections across the country dropped 15% yet deaths rose by 5.5% during the week. Death tolls over 20,000 per week may be the new normal until vaccinations reach the level needed to slow community transmission. Gaining herd immunity is proving to be more elusive a prospect than initially expected.

The bellwether states basically replicated week-over-week performances with California and Arizona running fatality rates of 2.5% for the week, or 20% higher than the national mortality run-rate for the week of 2.1%. Illinois (2.2% weekly run rate), Missouri (1.8%), and Wisconsin (2.3%) have slowed their cumulative growth rates notably by some 20-30% as they converge toward the national periodic run-rate stand at 2.1%. 

All ten bellwether states have endured the ordeal of the fatality growth rates surpassing corresponding rate for confirmed cases. Since four weeks have lapsed in 2021, a lag-time of deaths relative to cases is losing much of its explanatory power to reconcile that growth in fatalities with the various declines in the number of cases, COVID hospitalizations and critical care patients. Out of fifty-three states and territories, Arizona and California rank fortieth and thirty-ninth in the number of vaccines administered relative to population size. 

At 5.7% and 5.8%, respectively, Arizona and California trail the national average by at least 17%. Hardening this burden is the inoculation thus far of one of every two doses on hand. Only three of the bellwether states – Colorado (7.1%), Florida (7.2%), and Oklahoma (8.2%) – are vaccinating ahead of the national average principally by realizing efficiencies in delivering the medicine. The speed of distribution and injection really has to improve as the three variants, particularly the South African mutation, may undermine the vaccines already produced and others (e.g., Johnson & Johnson, Astra-Zeneca and Novavax) coming on line, each with its unique issues. 

The efficacy of North American and European vaccines ranges from 80-95%, while the Chinese vaccine only works half the time. Nevertheless, the Western vaccines lose 20-40% of their effectiveness when deployed against the South African strain, now detected in the U.S. and likely to predominate quickly as it did in South Africa last autumn. Dr Anthony Fauci, President Biden’s leading COVID expert has stated flatly that vaccines will have to adapt to these and other strains that are more contagious and, perhaps, more lethal.

On the '38+ table' below the feature section, one can see the emergence of a new steady state at twice the lethality of pre-Thanksgiving levels. Alabama and California are the only states under review to post a double-digit growth in fatalities for the week at 11.1% and 16.9%, respectively. Other states struggling with rapidly rising mortality rates during the week include Kentucky (9.5% growth in fatalities week-over-week), Oklahoma (8.9% growth in deaths), Arizona (8.6% growth), the Carolinas (8.4% each), as well as, Tennessee (7.8%). 

Positivity rates are generally receding, though Pennsylvania (33.9%) and Connecticut (4.8%) have recorded higher rates during the past week. Eighteen states and the District of Columbia cleared the W.H.O. containment threshold of at most a 5% positivity rates during the week. These leaders include states in the family clusters of Vermont (1.9%), Massachusetts (4.0%), Michigan (4.7%), Connecticut and Maryland (4.8%), as well as Colorado (5.0%). Except for Minnesota and Massachusetts at 3.8% and 3.9%, respectively, the states with the most improved positivity rates still fall into the 14-25% range. (In other words these states have improved 'radically' from  Hell's door-step to very, very bad.)

The mystery remains why some of the more prosperous states test so little:

• Washington (the tenth highest gross domestic product per capita and a 59% testing penetration rate);
• Tejas (13th most prosperous state per capita and 68% testing rate);
• Colorado (16th most prosperous and 41% penetration); 
• Virginia (ranked 18th and 75% rate); 
• Pennsylvania (20th and 71%); 
• Oregon (21st and 76%); 
• Iowa (22nd and 46%); as well as, 
• South Dakota (23rd and 45%). 

Except for the Pacific Northwest and Colorado, these states are struggling. Yet they persist, almost willfully, in under-testing.  Capacity available in Intensive Care Units (i.e., I.C.U.s) has loosened slightly during the week with most states changing by a percentage point or two. Wisconsin, a state that had a spike in the autumn but is now bringing the case-load under control, had the greatest improvement in I.C.U. availability, increasing open beds from 43% to 48%, week-over-week. Seven states have occupied more I.C.U. beds over the week. 

The only deteriorations worth noting are three facing strains already, namely Georgia (now at 10%), Massachusetts (22%), and Missouri (at 17%). The ten-state watch-list remains unchanged with Alabama, Arizona, California, the Carolinas, Georgia, Oklahoma, Pennsylvania, Tennessee, and Texas on the list due to infection rates, mortality growth, strained I.C.U. availability, and high positivity rates. Kentucky and Mississippi continue to knock of the door. 

FEATURE: VACCINE MIS-INFORMATION
Summary. In the ‘war’ against COVID-19, the most decisive battle may be one of psychology rather than physiology. Apparently, vaccine mis-information antedates the coronavirus contagion.

The accelerated development of vaccines under 'Operation Warp Speed' remains a hallmark accomplishment of the Trump presidency. Risks exist with that acceleration, of course, the most prominent of which may be dis-information deterring enough people from receiving the vaccine for the United States to fall short of herd immunity. Social media complicates the messaging, making rational decision-making more difficult, especially for younger people, often unaffected by infections.

Opposition runs at one-third of the population stating it would not take the vaccine, a level brushing down against the lower end of the 65-85% range of people taking the vaccine required to attain ‘herd immunity’. Evidently, a high rate of rejection persists also in the European Union. Another 8-10% of the population is not sure whether they will accept a vaccine, translating into three of every seven people skeptical about the benefits of the vaccine. (‘Herd Immunity’ is the threshold majority of the population, less than 100%, required to choke off a virus due to the lack of available hosts.)

While I suspect 100% of us have some skepticism due to the alacrity of Warp Speed, a dangerously high percentage are averse toward taking the vaccine. The challenge in persuading, say, half-to-two-thirds of the skeptics to bare their arms (instead of their soles) is that social media algorithms often slot people into ‘echo chambers'; in this case, reinforcing skeptics in their tentative belief or rejection. Combine this confirmation bias with a well-founded aversion to vaccines in minority communities and, Houston, we’ve got a problem. 

(The Tuskegee experiments were a study for several decades on the effects of treated and untreated syphilis among six hundred African American men. One early treatment had fatal side effects; many of the men suffering syphilis were never treated so that doctors could observe the course of the disease throughout a life-time. Condemned widely after forty years; President Clinton apologizes on behalf of the nation seventy years after start of the experiment. $60 million in 2021 dollars awarded to victims and families in 1974.)

The principal conspiracy and other ‘dark’ theories about the coronavirus and the vaccines prey on people not too terribly schooled in science (e.g., me) and with fearful dispositions. The good news is that, at least in the earlier stage of the epidemic – during the time-line of a study on the ‘info-demic’ in 2020 – the amount of deception by individual users on Twitter, Facebook et al. around COVID-19 was lower than around other controversial health-related topics.

source: Gallows Humor Beta 2.0

State-sponsored communicants (e.g., China, Russia, lran, Qatar, and Saudi Arabia) tended to focus health messaging on the coronavirus through Twitter, and less through Facebook possibly reflecting the latter’s stated policy of connecting users to accurate information. Though quite possibly on the fringe, this dis-information revolves around the American and Chinese governments or some dark side of technology developed in the last generation. These ideas, many of which are new to me, include, but are not limited to, the following ten examples (with scholarly refutations available through linked readings):

• germ warfare by the United States against China;
• the obviation of vaccines by untested remedies (e.g., hydroxychloroquine and remdesivir);
• an accident in a Wuhan virus laboratory allowing a manufactured ‘super-virus’ to escape;
• the effects of fifth-generation information technology via radio frequencies and micro-waves emitted through smart-phones (i.e., 5-G);
• the attacking by certain vaccines of the RNA of the coronavirus altering people’s DNA;
• the vaccines leading to female infertility or endangering pregnant women;
• COVID-19 being just another flu;
• a Democratic hoax to undermine Trump’s presidency*;
• the lethality of the new vaccines, particularly for the elderly (e.g., rumors that Hank Aaron died of the vaccine a week after taking it); as well as,
• the vaccines using nano-particles in development being designed to implant a micro-chip for tracking movements toward a totalitarian culture of control.
  * no available refutation; allow the quality of the thinking to refute itself, s.v.p.

The consensus opinion holds that the coronavirus originated in a mammal, perhaps a bat, and migrated to human beings through a mainland Chinese 'wet market' selling live animals. A World Health Organization delegation is preparing to investigate the origins in China. Conspiracy theories are not confined to the United States. Half the people surveyed across the continent of Africa believe that a foreign actor created and spread the virus or that electric waves produced by 5-G technology created this pandemic.  

Now before one smirks too much, can one remember that, in the late 1990s, insurance industry executives and analysts openly worried that cell phones might cause brain cancer? These are not stupid people. Not a big stretch to think that the electronic waves emitted through 5-G are so proximate and pervasive as they may weaken the human immune system. In view of the unusual manner of sickness among different population sub-groups and the mutations of the virus can make one wonder whether . . . . 

Like anything else in life, one must assess these possibilities in their likelihood. For me, the likelihood of theories involving conspiracies, biological accidents or technological fall-outs combined is well below 5%. In an effort to push back on the info-demic, groups are working together to disseminate science-based information instead of contesting every false rumor. These rumors, like the virus, mutate as quickly as Facebook and others can weed out the untruths. In short, one is playing a whackamole with dis-information and almost always fails because responses to speculative hear-say are inherently slower to articulate than the underlying rumors.

Better to establish a central, consistent pillar of verified information to superordinate whatever rumors come along so people can not graduate coincidences into conspiracies. Supplementing this effort by Facebook and other real-time news outlets, is a series of behavioral studies to see how misinformation proliferates and disseminates to create a pro-active strategy to counter propaganda. A strong start by social media involves tagging posts with fact-checks.

ALERT: ALL's FAIR IN LOVE AND WAR AND DISEASE?
Summary: As experts remind us: none will be safe until all are protected. Wealthy nations being greedy hurt themselves almost as much as they harm poorer (wo)men.

One unfortunate reality, not a rumor, is the disparity between the number of vaccine doses delivered to the wealthier, typically white, nations versus poorer or less developed nations. Disinformation is compounding the problem with lethal consequences. The World Health Organization has gone as far as to call this deadly dichotomy a moral failure attendant to ‘vaccine nationalism’. 

While the Biden Admin. is to be commended for its concerted effort to speed up a process that is too slow, particularly for vulnerable population segments, questions of racial and economic equity will persist (even within and among the wealthier countries). Also impeding the effort in the U.S. is a combination of Trump’s planning not going far enough down from the top or releasing sufficient resources to the states to roll out the vaccine from the bottom, up.

A few other countries are twice, or more, as far along as the U.S.; the U.K. comes to mind. These nations are likely driven by the second wave from the new variant. Some U.S. states over-planned, leading to brittle procedures and a break-down of distribution amid growing confusion. The United States simply have too few inoculators. This phenomenon may explain how California gradually lost control of her epidemic. Currently 6-7% of the U.S. citizenry has received at least one dose, with whites ahead of minorities, particularly Blacks and indigenous people.

Finally, the exclusive focus of time, attention, and resources on the coronavirus, together with the paucity of resources like equipment and reinforced masks, have permitted other viruses and bacteria, already known, to churn below the radar, thereby infecting more people than otherwise would be the case. This slowness of vaccine distribution and inoculation has presented a similar challenge in Europe.

While the U.K. has inoculated 12% of her people, the core four E.U. leaders (i.e., France, Germany, Italy and Spain register rates one-quarter, or less, that of the British. Only Israël, 33% of her citizens receiving at least one shot as well as tiny U.A.E. (29%) and Seychelles (26%) are significantly out-performing Britain. Most Asian countries have yet to receive vaccines with only China, Turkey, Singapore, and India reporting vaccination rates of the populations in the 0-2% range.

METHODOLOGY 
Since this data sweep serves as a information supplement without very little research, this week provides an opportunity to clean up the presentation through the following changes. For informational purposes, this text will follow the second table on thirty-eight states and five territories in subsequent weeks. For comprehensive explanations on methodology and purpose, please revert to Appendix I. 

1st, please remember that percentages for 'population tested' implicitly assumes that anyone taking a COVID test does so only one time. Many people are getting multiple tests. For example, for various reasons, I have had five tests. That would count as five people taking tests for the datum calculated for Maryland. My S.W.A.G. (scientifically wild-assed guess) is that a more accurate level of people actually tested is half, or less, of the percentage cited in the ‘38+ table’ above.

2nd, the two averages of weekly growth rates for the ten bellwether states are clarified in the Appendix. Essentially, the geometric or compound average growth rate is a smoothed average that allows for growth-on-growth increases (i.e., similar to compounding interest). The time weighted weekly averages are a trend-weighted average of each week's particular growth rates. While the compound rate is theoretically more defensible, comparing the two averages gives one a sense of more recent trends and volatilities.

3rd, in the '38+' table (of thirty-eight states and five territories), the risk classifications  -- of very low; low; moderate; high; and, very high -- remain the same. The parameters, however, are loosened to reflect nine months of experience. The new parameters center upon the first year base case fatality level of 335,301 souls that I forecast eight months ago, together with projections of November 2020 from the University of Washington of 470,974 deaths. On 04dec20, the old and new parameters are applied to facilitate  transition.

4th, changes in how positivity rates are presented in the '38+' table above now align the data with the original intention behind presenting them. The intent here is to show whether positivity is trending up or down and to what degree. The parameters are loosened to match the practical reporting constraints and data lags facing most states. 

States with changed positivity rates of less than 10% up (i.e., worsening) or down (i.e., improving) are deemed unchanged and the information unformatted (i.e., appearing in plain black font). The formatting differentiates deteriorations from improvements in the color of the font between 10-20%. Bold fonts indicate material deteriorations or improvements of more than 20%. 

Keep in mind that these percentage changes are based on percentages; percentages of percentages can attenuate the utility of data.

5th, a refresher on the assessment of a state’s testing capacity, again on the 38+ table. The data pivot off of the tests per million people expressed as a percentage. The symbology uses hand gestures to assessment the degree of testing capability and commitment relative to the national average for the week under review. Colors indicate whether testing is declining (red font) or improving (blue font) when a states results place its commitment to a new category of, specifically:

• 👎👎 meaning a state's testing level materially below the concurrent national benchmark (i.e., > 15 points below);
• 👎 meaning a state's testing is noticeably below the weekly national average (i.e., 5-15 points below);
• 👈 meaning a state's testing activity is slightly lower than average (i.e., < 5 points below);
• 👉👈 meaning a state's testing level is basically equal to that of the nation;
• 👉 meaning a state's testing level is < 5 points above the benchmark;
• 👍 meaning a state's testing activity is 10-15 points above the weekly national level; and,
• 👍👍 meaning a state's testing commitment is > 15 points above the concurrent average.