Ten Things I Think I Think About COVID As of April 3
Centers for Disease Control and Prevention / Public domain
1. Almost every analysis of the plague progression relies on the number of positive tests and/or the number of deaths. I think these numbers are so unreliable as to be only marginally useful. Many tests give unacceptable high false-negative numbers. Many infected are not getting tested. Many deaths are not being counted. These data may be useful for telling if and when we’re bending the curve in individual countries. But be very cautious of drawing grand conclusions from them.
2. The new blood tests are being touted as a way for people to get back to work once they’ve had it. I don’t put much faith in that right now. Again, the false positive rate is too high. And blood tests are not cheap.
3. We have no idea if chloroquine works. Only three studies have been published and all three are seriously flawed. Unlike Orac, I don’t object to a kitchen sink approach in desperate times. But temper your expectations.
4. Social distancing seems to be working in that most of the curves are flattening instead of continuing on an exponential course. But that’s not 100% clear yet. The new push for wearing masks will be a force multiplier for it, though.
5. A lot of our strategy hinges on a vaccine being available in 2021. Maybe. But vaccines are tricky things. In the end, our only option may be slowing the pandemic as it kills millions worldwide.
6. The PPE crisis is far more important than the ventilator shortage. Only a small fraction of those who go on ventilators survive. Meanwhile, doctors are being exposed to massive doses of the virus, which may worsen their outcomes.
7. Supply chains are a concern, particularly on food. The problem isn’t so much a shortage of food — although that could become a problem if migrant labor is hit by this. It’s that our food supply chains are geared for us eating half of our food in restaurants. I suspect we will adapt. But that probably means buying huge shipments of ground beef instead of individual patties.
8. We haven’t even begun to feel the economic pain.
9. The headline is needlessly hysterical, but it’s hard to imagine anyone more unqualified for this crisis than Jared Kushner.
10. Despite all of this, I am trying to remain optimistic. We’re going into a very rough and dangerous time. But if we keep our heads, we can emerge from it. I won’t say we’re seeing the light at the end of the tunnel yet. But I will say we’re seeing that it is indeed a tunnel and not a bottomless pit.
(I originally stole this bit from Stephen Bainbridge but I don’t think the concept is original to him.)
10 — Randall Munroe has always been the best of us.Report
That comic was exactly what I need right now.Report
Or over-counted (the fact that a person tested positive for Covid-19 and died does not necessarily mean Covid-19 killed them). I trust the medical pro’s to get that count right, but if other parties are working up their own numbers…Report
Due to the fact that we have lots of politicians in the United States who still really want to downplay Covid-19 for ideological and venal reasons, I’d say that down-counting is much more of a factor than over counting.Report
Yeah I get ya, but I take it as a “but for” situation. But for the CV infection this patient wouldn’t be dead today. Next year, next month, even next week maybe, but not today. I’m pretty sure the same thing happens with the yearly totals of victims you see for the flu. You know, the numbers some people want to throw out there in an attempt to mock this response to CV as overblown.
A better statistic would be to measure something like Lost Life Years (I forget the actual nomenclature) where the death of a healthy 20-yr old counts more than an already sick 80-yr old.Report
I think I agree. I also think Oscar’s point is much more valid when we’re taking about number of beds, number of ICU beds, and number of ventilators taken up.Report
I’m not sure if we’re agreeing or disagreeing since I’m pushing back a bit against the notion that we’re over-counting.
The but-for alternate reality logic has to take the overwhelming of our hospitals into account. It’s not just deaths directly attributable to CV infection but also the additional deaths from other causes that occur due to strained ER capacity. It’s a really lousy time to have a stroke, heart attack, or get shot in NYC right now.Report
Yes, I think we’re agreeing. At any rate, I agree with your comment here.Report
Some of the conservative sites have been think with folks poo-pooing the Italian numbers, saying they’re counting anybody who died from something else. That stems from the Italians saying, early on that they were going back to see if some of the elderly people they initially assumed had died from flu or natural causes had in fact had Covid-19. That’s just standard practice in the first weeks of a new disease.
In any event, these people became convinced that the Italians were just making things up, counting other deaths as Covid-19 because Italians lie, or some such thing. I pointed out the year to year death rates from similar periods, which jumped by a factor of something like 13 (this was a couple weeks ago), so their claim implies that by pure coincidence Italians suddenly started having heart attacks and motorcycle wrecks. Even if true, that would imply that Covid-19 is a smart-virus that makes people drive off cliffs or swim with sharks or something.
Last night I was in a thread where they were pointing to a study that said that for every 1% increase in unemployment, the nation has 40,000 additional suicides, the point being that we’re going to lose more people to suicide due to the lock down than we will lose to the virus.
I just noted that the Great Depression, where the unemployment rate went from 8% to 25%, saw annual suicides rise from 22,500 to 27,500, which is an increase of 5,000, not 273,000 as their claims would indicate. Other research has found little to no linkage between unemployment and suicide, and some studies have even found the opposite trend. And of course temporary unemployment due to a natural disaster like a hurricane or plague has wildly different emotional implications from realizing that you’re the least employable, most disliked person within a ten mile area.
I then suggested that we go ahead and let the virus run unchecked, as they suggest, so we could see if there’s any evidence of a link between depression and having a massive amount of your friends and family die in one big avalanche of pointless death.
Q: How does someone ignore the emotional effect of losing your spouse and parents (along with tons of your friends suffering the same tragedy), while thinking that temporarily not being a cog in a wheel at Spacely Sprockets is going to make you stick your head in the oven? A: Highly emotional motivated reasoning.
The “it’s just the flu!” crowd is very emotionally invested in making this virus a nothing-burger, and will accomplish huge feats of mental gymnastics to do it. I figure they’re the ones that are actually the most frightened, such that their mind is reaching for anything other than the poo-sandwich we’re all about to eat.Report
Who is this person, and does George Turner know his account has been hacked?Report
Sorta what I was thinking. I like the new guy.Report
You guys should read his material more closely. He leaves great comments, even if they’re a bit spicy. Probably the funniest guy around here, and maybe the one most likely to make me rethink things.Report
Ehh, 70% of his comments are agglomerations of the pro-Trump propaganda embedded *in* the dishonest lying culture he’s criticizing in the above comment.
The other 30% are solid gold, though!Report
Just like the left, I assume there’s a big difference between the online and offline right as well as between the political and non-political classes. Folks in my very conservative hometown in Kansas are taking this thing very seriously.Report
These kind of contrary narratives are mostly coming from the perpetually paranoid wing of big-L libertarians who are inclined to view almost anything as evidence of a massive government power grab. I assume that they tend to be highly over-represented online because they’re highly vocal political activists.
They come in several flavors, too. I’ve argued with a few who think that not letting them come over to my house and give my hypothetical family Covid-19 is somehow infringing on their freedom. The don’t seem to fathom that one can go through life as an exemplar of individual liberty and and be a walking lethal virus factory at the same time, and that communities and people in communities have some inherent right to protect themselves from the virus carriers. There from an odd wing that thinks “people” don’t have the right to stop a libertarian from imposing on them.
Others seem to be reasoning from the pure economic wing of personal success, and are looking for any way to argue that everybody should still be at work and just suck up the deaths from the virus because it’s somehow only going to kill people they don’t know, and won’t do any harm to those who don’t die from it. They want to treat it exactly as the flu, and repeatedly emphasize the economic effects of the lock downs. In their world, the effects of having 30% of US workers simultaneously infected during the pandemic’s big spike is an implication not worthy of extra thought. Their choice is between either lock down or business operating normally because “normal” means nobody gets sick. That’s not actually one of the options we have.
Then there are some who are in deep denial and think this is all a vast government power grab and all the virus is almost a hoax, with numbers that are wildly inflated. That’s the vast conspiracy wing that’s perpetually with us, and I’ve successfully pointed out that they have to come up with a unique vast power-grab conspiracy for each individual country that has done the same thing every other country did to fight the outbreak. Republican governors did lock downs, Democratic governors did lock downs, Australian MP’s did lock downs, Italian’s did lock downs, the French did lock downs, the Israeli’s did lock downs, the South Koreans did lock downs. Are all those government leaders part of some secret reptilian alien invasion force trying to stamp out human liberty, or are they all trying to fight a freakin’ pandemic?
Adjacent to those paranoid types are others think its a vast government power grab but do believe the virus threat is real, but that the real threat is the power grab. Having a few elected and unelected leaders out there abusing the heck out of their power just reinforces their view.
For example, Orange County’s unelected health commissioner just declared that groups “of any number” are banned, and the sheriff has the power to arrest anyone congregating in such groups. I don’t know if this applies to Chip, who will be unlikely to evade the ban even if he only gathers in groups of zero, one, two, pi, and the square-root of negative one, because “any number” is a stricture only a power-mad California regulator could dream up. If he gets busted, I suggest he claim he’s in a group “D”, and explain that some groups are numbered and some groups are lettered, and lettered groups don’t fall under the ban.
And there are those who think the response is going to do more damage than the virus, and depending on what data set they emphasize, some of those will of course have valid points. But that’s expected because depending on what you focus on, you can find all sorts of good and bad things in any different course of action. Pet adoptions are up, and driving deaths are down. Movies are dead, but Netflix is thriving. Those aren’t really good arguments about whether we should let a virus run amok.Report
I’ve read post from stats/actuary types that this is a more meaningful number, because it gets at the disparity of how the virus impacts populations (it’s like pneumonia in that it’s very dangerous for folks with other chronic or life threatening conditions).
I’m also curious about the number of seriously ill/dead who do/did smoke/vape or lived/worked in a place with very poor air quality such that their lungs and heart were already operating in a significantly degraded condition. I especially wonder about this when I hear of a young person succumbing to it.
PS Like lung cancer, I don’t wonder this because I want to avoid having empathy for people who ‘did this to themselves’, such folks still deserve the best treatment, but rather to understand the actual risk to populations.Report
It’s that our food supply chains are geared for us eating half of our food in restaurants.
Re: 7: After I shopping for TP a week or so ago (unsuccessfully) I told my wife that the shortage isn’t due to hoarding, but to the fact that everyone who used to shit at work or in restaurant or at school is now shitting at home. She said so what’s happening to all those huge TP roles businesses stock in their bathrooms? Sure enough, she saw those giant rolls being sold on Amazon for bargain basement prices.Report
Erm…..someone I know (not necessarily me, but not necessarily not me) may have bought some on Amazon.
#notallhoardersReport
#releasetheTPnow!Report
There’s a shortage of flour in New Zealand supermarkets right now because we have a shortage of the 1kg bags that flour is sold in for retail – all the cafes and bakeries that normally buy all that flour buy it in 20kg bags, so some supermarkets have started selling those.Report
I’m curious to see what happens in NZ over this outbreak. You guys are like a little control experiment in early detection and mitigation. Also, my daughter told us about the quick action your PM took on direct payments to affected workers. That’s good government.Report
My inner social scientist is glad so many countries are handling this differently, it will give us a lot of information on what approaches work.
As for our response, I think we benefited from seeing what happened to Italy, plus our isolation makes controlling this easier. I’m also pleased with how our government responded constitutionally. Parliament has been suspended, replaced with a special Select Committee, but National is leading that committee and have a majority on it. Emergency powers are very dangerous for democracies, and I’m glad that solid safeguards are in place.Report
Covid-19 is the perfect storm. The big issue is that the last people we want dealing with a major pandemic in the United States and really across most of the world are the ones that are having to deal with it. Rather than having a road to Damascus moment, most of them are using the Covid-19 pandemic to crack down and increase their power. Trump is more obviously into looking like he is doing something than doing something. The Republicans across the federal and state governments were in denial for too long with the exception of DeWine, Hogan, and Baker but the last two are states that are heavily Democratic. McConnell’s Covid-19 relief bill was going to be slush fund largess for the big corporations but the Democratic Party managed to shape his hand.
Pandemics like wars are not normal rules time but too many people either want to play by normal rules or use the pandemic as reason to advance their agenda. I think Covid-19 will result in a smaller, more inward looking world rather than leading to anything good.Report
#11: Preliminary but interesting; I was just reading that it seems that good/bad outcomes to COVID-19 infection may be related to blood type. Apparently Type-O and to a lesser degree Type-B are more resistant / have better outcomes than A or AB. Something to do with the immune response to the spike protein on COVID.Report
https://www.ncbi.nlm.nih.gov/pubmed/18818423Report
Re: #9: This is really bad. Trump utilizes his SIL to head impossible missions with no hope of success like Mideast Peace, presumably just to keep him out of his combed-over hair. Our president has conceded defeat.Report
#5 [vaccines, etc.]: I agree. Many of us think (myself included) that a vaccine will just come along and things will go back to normal. Maybe there will be a vaccine (I hope), but there will be other viruses….we haven’t seen the end of this.
As for going back to normal: No, things will change. How they’ll change, I don’t know.
#2 [testing blood for antibodies]: the OP suggests that there are too many false positivies. Do you mean false negatives? In the short term, it seems like I’d prefer a false negative for antibodies a la better safe than sorry, so that the positives are much more likely to be positives (for antibodies). (Standard “I am not a doctor or scientist or statistician, etc., etc.” disclosure)Report
It’s a classic exercise in Bayesian statistics. No test is perfect and so will inevitably throw out a few false positives and false negatives. Given the selectivity and sensitivity (ability to rule out false positives and negatives respectively) of a test and crucially, the actual occurrence in the population, it’s possible to calculate the odds that any given test result is actually true. A positive test result for an individual means one thing when 10% of the population actually has the antibodies and something else entirely when 90% have it.Report
I guess my original question, though, was, was Michael really saying there are too many false positives, or did he mean there are too many false negatives.
Either way, it seems like we’d want to be really sure that the result “has antibodies” means “has antibodies” instead of “oops, doesn’t have antibodies.”Report
Well, it appears Michael was talking about the test for the virus itself in #1 (the nasal swab thing) and the antibody test in #2. Different tests for different things.
So yeah, you would want to err on the side of false negatives vs false positives if you’re relying on it to decide whether to go out in public again. FWIW, one article I saw quoted rates that were about 6% for both types of error.Report
As a follow up: I think the “once we have a vaccine” idea is one of those things won’t happen, even if it does happen. Things might not go back to whatever was normal on Dec. 1, 2019.Report
Well we still don’t have a vaccine for HIV but that’s a tricky bastard since it directly affects the immune system. There’s no reason a priori to believe a COVID vaccine will be particularly difficult, it’s just going to take time. The good news is that virologists have at least tentatively determined that the virus isn’t mutating much so hopefully not like influenza where you need a new one every year. SARS and MERS (other coronaviruses) aren’t a current issue so hopefully this will be a one and done when it’s all over.
I’m terrified of the short-term but cautiously optimistic for the long.Report
I hope you are right.
I will just say without going into detail that in these past three weeks I have been in the lowest low places I remember being in in my LIFE. I do not deal well with isolation and idleness and the realization of how utterly useless my career is in the grand scheme of things.
eighteen more months of this? Not sure I’ll still be here.Report