NedNotes (not blog): Final COVIData Sweep (05mar21)

In sorrowful solidarity with five fellow Americans who died this week from COVID-19. The unique aspect of this week's group is that several had triumphed over significant adversity in their lives; their stories brought veteran journalist, Ms Judy Woodruff, to tears. 
                        
B.L.U.F. (bottom-line, up-front): a turn-around month but one ending with uncertain momentum. The last COVIData Sweep.

INTRODUCTION
Summary. These supplemental data to the last letter to my extended family surveying how the 'kin-clusters' -- principally congregating in Pittsburgh, New York, Detroit, Colorado, and Maryland -- are holding up during this pandemic. 

February ended the holiday surge that had proven to be more taxing than anticipated. This week was the third week of declines of many indicators:

• average daily cases down 13% to 60,714 confirmed but still 6x the level Dr Fauci and the Centers for Disease Control consider to be containment (i.e., 10,000 new cases per day);
• hospitalizations also down by 17% to 42,541;
• the number of patients receiving critical care down by 12% to 13,618; as well as,
• new deaths for the week down to 12,466 (versus a decline of 15,548 new fatalities the previous week).

What makes this momentum uncertain is the up-tick in deaths toward the end of the week without a corresponding increase in cases. Frankly, the the data are very choppy and I am not an epidemiologist. Nevertheless, my gut says that there is a good chance that the variants detected to date -- from the U.K., L.A., New York, Brazil, South Africa, and, less likely, Tunisia -- are proliferating in the U.S. and that one or two of these are more lethal than the coronaviruses confronted to date and which the current vaccines target.

Keeping this in mind, the table below integrates the historical experience to date of each of the thirty eight states and six territories tracked each week. While these numbers appear to be high, implying an ultimate death toll of up to one million souls, please remember that the 335,301 fatalities I projected on 05apr20 for the first year of the American epidemic proved to be 37% below the final one year tally. At the time of that projection, I felt that number of deaths to be ridiculously high.

Instead, that number proved to be ridiculously low. That is important to remember; thus far, the epidemic has produced far worse outcomes than almost anyone expected. The evolution of this new coronavirus strain leverages mutations to evade or resist anti-bodies previously attained through illness or vaccination. This documented viral adaptability renders quite possible a more lethal, resistant, and contagious variant.

WHAT MAY BE AHEAD
The epidemic will taper off over the next two years, a time during which achieving 'herd immunity' will likely stay elusive. Consequently, I have run three macro-scenarios that the vaccines do the trick; that America muddles along for the next two years; or, the variants make the epidemic deadlier (i.e., a re-run of the 1918 Flu). Each of these macro-scenarios rests on five micro-scenarios, with the 'miracle case' ending before the others (i.e., the slog-in-the-bog and the ‘flunami’).

The two conclusions cited below derive from the table above. That table tests out each of the thirty-eight states and six territories reviewed in the COVIData Sweeps by using their track records to date; performance trends since the Spring and Summer of 2020 in addition to the holiday surge just ended; as well as, the possibility of a virulent concoction of mutations and variants. 

Since I have not visited any of the clusters recently, except, of course, for my home in Maryland, assessments underlying these forecasts are likely to be inaccurate. The table merely orients the reader in considering what may be in store with this novel yet rapidly evolving coronavirus and what lessons we should remember from the difficult year of 2020. These data, broken out in the information supplement, yield the following very tentative conclusions.

1. Forecasted range of total deaths for the U.S. epidemic varies from 664,120 all the way to 1,064,645 fatalities.
2. The guesstimate of the final fatality tally equals 812,980 deaths based upon a 40% weighting for each of the base and best cases, together with a 20% weighting for the worst case.

The raw data collected from the states inform the following five micro-scenarios to determine each state's prospective outcomes under the three macro-scenarios:

• a ‘miracle’ scenario with vaccines ending the epidemic quickly;
• a ‘best-case’ scenario replicating the best part of historical performances;
• a ‘base-case’ scenario based on the periodic fatality experience during the holiday season;
• a ‘worst-case’ scenario giving equal weight to the spikes of the Spring and Summer; as well as,
• a 1918 Flu horror show solely reliant on the experience of the worse of the Spring or Summer spikes.

Those micro-scenarios then integrate into three macro-scenarios presented in the table above: a best case; a base case; and, a worst case. What motivates these scenarios is the relative likelihood of a variant or strain transmitting globally that is not only more lethal, but also vaccine evasive or resistant. 

These macro-scenarios reflect assigned weightings to the micro-scenarios. These subjectively assigned weightings capture the demonstrated performance of the diverse state leadership teams to date to generate the three alternative outcomes of the macro-scenarios for the year or two years remaining in this pandemic. 

OTHER PARTING COMMENTS
Summary. In addition to discussing the implications of the many choppy data above, this section editorializes on three topics, two in-depth: one familiar (vaccine equity) and two new (the possibility of a manufactured virus and a cursory comparison with the 1918 Flu epidemic in the U.S.).

Vaccine Equity. This issue haunts the United States with respect to people of color across the country in Maryland, Los Angeles, Chicago, New York, Philadelphia, and rural areas in populated states. Part of the inequity stems from computer literacy of less advantaged people, comparative access, as well as resourcefulness used by people looking for a poke. This domestic U.S. dimension of vaccine inequity pales relative to the many countries desperately needing vaccines yet seeing little prospect of receiving needed supplies soon. 

Some nations (e.g., China, Russia, Cuba, and India) seek to mitigate this vaccine bullionism of the wealthier countries by practicing a vaccine autarky with home-developed medicines of varying levels of reliability; these home grown anti-bodies also add some heft to great power diplomacy as Chine, not the United States, rushes vaccines to new democracies rendered fragile by COVID. Currently, a few countries dominate the use of vaccines. Such vaccine bullionism raises obvious moral and ethical questions, especially since deaths in poorer regions are most likely to be understated.

For example, I am likely or soon to be eligible for a vaccine, though I have no co-morbidities and remain in decent health for a sixty-four year old. But should I get vaccinated as opposed to a medically and manifestly more suitable candidate in one-hundred-plus countries yet to receive and start administering the life-saving medicine? Beyond simple ethics, the vaccine bullionism is based on a fool’s gold rooted in nationalism. 

Viruses have been around since 339999998 B.C.; homo sapiens since 2499998 B.C.; mankind as we know it since 129,998 B.C.; and, the nation state since 1648 A.D. Basing vaccine distribution on the 375 year old concept of the nation state flies in the face of human biology firmly in place for at least 130,000 years and viral activity for several billion years.

As nations like Tunisia struggle to get any or enough vaccines, countries like the United States overlook the fact that vaccine bullionism will further attenuate global stability and render much of the world a primordial ooze for a killer variant of the coronavirus with murderous mutations. First, vaccine bullionism is likely further to impoverish less well-off nations as tourists avoid them and medical costs rise massively.

Consequently, that re-imposed poverty may well undermine newer democracies through unrest and demagogy, likely to engender cross-border resentments apt to morph into future hostilities through war or, more likely, terrorism. Indeed, what may well prove to be the most lethal of the recent variants has sprouted from a poster child of these neglected countries burdened by demagogy; that is, Brazil.

Natural or Man-made virus? The overwhelming majority of legitimate thought-leaders (i.e., experts who are not conspiracy groupies) believe and argue passionately that this novel coronavirus emanated from an animal, likely a bat. Nonetheless, I still sense that the question remains somewhat unsettled. The alternative scenario presented here is a possibility, and a weak one, based on the following questions.

1. Was the Wuhan Institute of Virology conducting research on behalf of the People's Liberation Army? No immediate indication that I can find.
2. Was the military the go-to option in dealing with the incipient coronavirus contagion within Hubei Province because it had released the virus unintentionally? Depends upon the answer to question #1, doesn't it?
3. Is the virus morphing into possibly more lethal variants more rapidly than other viruses known to originate from animals? Though not definitive, the information I have reviewed indicates that the rate of variation is not exceptional with this novel coronavirus.
4. Are these variants springing up initially in homogeneous populations (e.g., the indigenous people of the Amazon region or people in Eastern South Africa) by targeting certain genetic markers common to the homogenetic group? Tunisia is homogeneous. lf the U.K. variant originated in Kent, then, yes, Kent is homogeneous, too.
5. Building on question #4, does this novel coronavirus display a tendency to register the host's genomic make-up for the virus to adapt to it more quickly than natural evolution would anticipate? If this coronavirus does do that, such 'registering' may be part of how any virus typically works within the host organism.
6. Why are these more contagious variants arising in places isolated from each other and infecting people with distinctly different genetic profiles? No answer that I can find, but possible that such geographically segregated variants occur with other viruses as they adapt to differing bio-genetic profiles.
7. Why is there no apparent mitigation from seasonal changes and is such versatility often the case with new viruses? Above my pay-grade and I.Q. 😳
8. Is the Chinese government serious in its contention that the U.S. Army is responsible for this novel coronavirus or is it trying to distract attention away from its actions? Sorry, not going there.

Please keep in mind that these are simply questions and none represent theories or imply any likelihoods. They point only to the question of origin. The probability of human engineering remains low, at the very most 30%. Though I believe the experts and leaders, as a risk manager by temperament and training, I keep alternative scenarios in mind along with their likelihoods. 

So what, if any evidence, lends credence to this possibility of human engineering and accident? First of all, Frontline's recent investigation into China's handling of the initial out-breaks challenges the credibility of the Peking régime severely. The investigation sheds light on the Chinese government's decision to use the military rather than the epidemiological infrastructure put into place after the S.A.R.S. epidemic of eighteen years ago. 

In the S.A.R.S. break-out that killed under a thousand people, China understandably turned to the military health-care network and field expertise to aid in treating civilians in Army facilities. The United States is doing the same with the National Guard aiding in logistics and Veterans Hospitals dispensing available vaccines to all eligible comers. 

Allegations later surfaced of the military leadership covering up the S.A.R.S. epidemic in China, though this assertion overlooks the régime's decision to undertake the cover-up out of fear of economic-then-social instability.  The use of the People's Liberation Army in the case of COVID-19, however, was more intimate in suppressing information and medical personnel with it. 

The question is why. 

The Wuhan Viral Laboratory may have been conducting research for the Chinese military and may have disseminated an engineered virus accidentally. (In no way do I believe that China would release an engineered virus intentionally, at least outside of war, if indeed the virus were engineered at all. And in no way does this speculation justify a bias against Asian-Americans or Asian émigrés living in the United States.)

ADDENDUM ADDED 11mar21 on ALABAMA, MÉXICO, and la TUNISIE
Introduction. In addition to the commentary associated with the final weekly COVIData Sweep issued over the week-end (itself a supplement to my last monthly letter home to relatives in the Northeast and Midwest), I would like to add this additional information. I had previously mentioned, only from time to time, the impact of COVID in my last three places of residence, each of which remains close to my heart. 

It has been a very difficult year for the world in general as well as Alabama, México, and Tunisia in particular. One other point that I forgot to include but requires little discussion: this coronavirus may very well be as bad or worse the 1918 Flu. How? This time around the world has the benefit of the lessons-learned from a century ago. These lessons supplement additional mitigants (e.g., vaccines) in place today. 

The presentations below, arranged in alphabetical order, will finally, and formally, close out this series. Thank you for reading these essays, I hope they have assisted you. Please note that the best, base, and worst case numbers apply to the forecast number of deaths.

ALABAMA

Current status. A tough year for Alabama. As vaccinations proceed with Alabama trailing the rest of the country, the National Guard is inoculating Alabamans in rural counties. The State’s economy is recovering faster than other states, despite precarious control over the virus. The State will lift masking mandates on 09apr21 owing to improvements in February, a move disputed by health experts across Alabama.

The question of vaccine equity has become acute as local and state officials clash over the reason for neglect of large swathes of people of color. One side argues implicit bias now becoming explicit while the other side notes an aversion by Black residents toward inoculations. The more pressing challenges remain vaccinating public school personnel and tracking the disease.

First year review and outlook. Like other rural states in the South and West, the COVID epidemic was slow in coming to Alabama, but when it came, the virus arrived with a vengeance. Through the Spring so harrowing for other states, Alabama endured roughly 13% of her fatalities. The State started re-opening in May and June of 2020, and the coronavirus contagion took off. 

Cases spiked in July and were coming down when the holiday flunami overwhelmed the State. Were she an independent country, Alabama would show the fourth highest fatality rate relative to population in the world. Alabama has consistently lagged other states, except when it comes to loosening mitigants. The death toll is expected to remain high.

MÉXICO

Current Status. Deaths per million across Querétaro = 1,558 (15th in world if QRO were a separate country, still better than U.S.A. = 1,631). Deaths per million across Baja California = 2,003 (5th in the world were B.C. a separate country; less than Alabama at 2,077). Though cases have abated recently, taking immediate pressure off of the country’s health-care system, medical first responders have been burdened by increasing cases of ‘long-haul COVID’.

The coronavirus contagion in Estado de Querétaro has moderated though hospitalizations have up-ticked. Vaccine inequity, to the extent it exists, appears to be more gender-based. Almost 150,000 additional Pfizer vaccines are arriving to Querétaro. Baja California has her advocates north of the border for vaccines distribution since the entidad federale (i.e., State = Estado) has vaccinated only 1-2% of her population. 

B.C.’s manufacturing economy is managing well enough, however, despite’s Mexico’s difficult January in employment growth; the local economy has re-opened to 66-75% capacity usage. Despite brave claims of beating out the U.S. performance by the country’s leadership, México’s fatality rate is likely to be understated by as much as 15%. The good news remains that my previous concern of the virus spreading North into the United States from México has not occurred, at least recently. 

The spread is likely more reciprocal in the Tijuana-San Diego ‘mega-region’. Following deliveries of the AstraZeneca vaccine last month, México is relying on the Chinese vaccine despite limited documentation of its reliability due to the ‘estadostúpidense’ decision not to share vaccines, a questionable choice as variants proliferate.

First year review and outlook. The basic difficulty with México the last year has been the ‘slackadaisical’ attitude evinced by the República’s president, el Sr. Andrés Manuel López Obrador. The virus arrived relatively late to the country but lifted off in the Summer of 2020 and began to accelerate in October. Fatalities have yet to slow sustainably, like the death-tolls as the pace has in the United States or Chile. 

Each of the latter two American countries has proceeded rapidly with vaccinations. Instead, México is loosening shoreline restrictions to entice Spring Break vacationers; the U.S. Embassy in D.F. has publicly advised against such travel. The Mexican government is emphasizing vaccine equity domestically by focussing vaccinations on the rural population.

La TUNISIE

Current Status. Vaccine equity is an issue with Tunisia, not only due to vaccine bullionism among wealthier nations stricken by epidemics, but also due to governmental actions. Knowledge is now surfacing that a few senior government officials received vaccinations thanks to the United Arab Emirates. Vaccinations are starting with the Russian vaccine obtained through COVAX.

lronically, the authoritarian Chinese régime has pledged 200,000 doses to the Arab World’s exemplar of popular democracy while the United States does nothing. The Islamic Republic has set aside TND 280 million ($101 million) for future vaccines. She now awaits 2.5 million doses -- under its apportionment from the Organisation of African Unity -- of the Pfizer, AstraZeneca, and Johnson & Johnson vaccines, good for poking 15% of the population.

First year review and outlook. The first half of the year saw little activity; case counts and related deaths are understated though by less than five hundred deaths. In part, Tunisians practiced enough of the mitigating behaviors for the country’s youngish population to keep her epidemic at bay. When the economy re-opened in June and July, however, the number of confirmed cases did not rise right away. 

The outdoors life of the Tunisian Summer still mitigated the epidemic. Then, perhaps, complacency set in. During September, Tunisia’s fortunes changed with cases rising rapidly. Deaths also accelerated, growing 10x in the past five months. Like most other countries in the Middle East-North Africa region, Tunisia still faces a continuing and possibly accelerating rise in cases and deaths along with her neighbors. 

These trends have nearly overwhelmed her health-care system. In recent days, prospects have taken a turn for the better with positivity rates down by half to 10%, the arrival of the first 30,000 doses of the Sputnik formula, and the imminent arrival of another two hundred thousand vaccines from China.  

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.