The course of Covid-19 in the United States

Via Amihai Glazer.  And if you wish to verify, here is another (non-smoothed) presentation of the data.

In terms of the delta this picture is not as bad as what you sometimes hear, though data on cases are far worse, with a very long and indeed continuing plateau. And since deaths lag cases by a few weeks, you still might see reason to be alarmed.  Nonetheless, the trend we can see is one of improvement, at least for a little over two months.

Do note it is better for everyone if you think the death rate is still rising!

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Call me a pessimist, but that tail is going to continue to extend, I suspect. Many states are still in the early stages of case growth, and to the extent that at least some of those states are politically opposed to measures like masks, there isn't much to keep the death rate low.

Turns out just being serious about testing and isolating in nursing homes is enough to dramatically lower the death rate, so as long as Cuomo isn't in charge nation wide, we're unlikely to see a return to high cfr. Keeping r0 >1 just means we're on track for herd immunity, and with low cfr, doing a good job of it.

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wondering if any sumbody is allowed to point out
protestors/rioters are starting to test positive without getting
moderated/canceled & arsonized

because they aren't snowflakes...

but they may be somewhat contagious firebugs

I quit working at shoprite and now I make $65-85 per/h. How? I'm working online! My work didn't exactly make me happy so I decided to take a chance on something new… after 4 years it was so hard to quit my day job but now I couldn't be happier.

Here’s what I do….................. Bizprofit9.com

sarah
we should do lunch!
do you enjoy barbecues?

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https://www.washingtonpost.com/world/2020/06/19/countries-keeping-coronavirus-bay-experts-watch-us-case-numbers-with-alarm/

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Once red states have overwhelmed hospitals and bodies stacking up in rented semis, our fellow Americans will finally be able to put their diligent skepticism to an empirical test, and confirm first hand, no, it turns out it's easier for hundreds of New Yorkers to die every day of a bat virus than it is to spoof an elaborate hoax and, yes, oops grandma is dead.

I am being snide but it's hard for me to explain the disdain for masks and social distancing in terms other than The Matrix style simulation/simulacra. Fox News is a 24/7 reality TV show about a news station pretending to be a news station in a made up country called America. I can't tell the difference either.

How does this show end? Where are we goin as a country, as a people. As a civilization?

Toward robotic automatons? We will be a heavily bio engineered species that relies on group think for our continued evolution towards..... eing better automotons.

It’s funny the Fox News was the culprit when the left wing media was explicitly recommending that people should protest in the street in gigantic crowds.

It’s funny that people are so ideological that they can’t see how both sides have been horrendously inconsistent on covid.

I’m just saying.

Good points, also that death rates is not the relevant metric but new cases is.

No, death rate and hospitalizations are the primary metrics. New cases that aren't any worse than the flu aren't a reason for a national lockdown. It's the severity level that forces a shutdown of regions and the economy.

+1

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The drumbeat on all deceptive media channels (which includes Fox Newsj cases are spiking. Fox Radio News said that Trump is still having his rally despite rising cases in OK. I checked Covid Tracking Project and the percentage of cases testing positive: 3.3%, same as the number at 5/31. All these liars ignore the fact that many more tests are being run, which gives more positives.

So you checked one data point instead of Googling? Try Googling. Positive rates are skyrocketing.

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Sorry, Terry, and others. There is no evidence of any noticeable new cases coming from the protesters. It seems most of them have been wearing masks, which it looks like work quite well, thank you, as many have argued. However, for some ridiculous reason, apparently his pathetic fear of not looking macho enough, our POTUS has demounced wearing masks and refuses to do so. As a result we have lots of new cases in places where people pay a lot of attention to him and there have been these reopenings with few wearing masks.

+1 postmodern sophistry
"There is no evidence of any noticeable new cases coming from the protesters"

https://www.denverpost.com/2020/06/17/boulder-county-colorado-spike-coronavirus-covid/

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I ain't just fox news that is a reality TV show. There was a black woman "journalist" on the PBS NewsHour saying:

"But, on the other side of the brain, I'm thinking of my 28-year-old son, who was traveling from Atlanta to Chicago driving, and praying the entire time that he arrives home safely, that he doesn't get stopped by a police officer, that something doesn't happen to him when he stops at a rest stop."

And Judy Woodruff did not push back at all. As Glenn Loury quipped, and I paraphrase, she better not let her son go outside he might get struck by lightning.
That is Government funded reality show.
We live in hilarious times. We don't even need comedians.

I worry about my hiker son falling off a cliff way back in the woods. Since that's actually quite unlikely, I guess I too might have a dose of your cavalier mockery. Do you not worry about your loved ones belng killed by the police? Probably not. Now please think about why it is that this black woman (who is a journalist) mst worry and you don't.

As a liberal I enjoy the high intellectual caliber of MR, but the comments sections on it are truly insulting to serious thinking.

So would you ever tell some, Relax it's safe, you should not be worrying about that, he's more likely to be struck by lightening. Don't worry be happy.
Do you see that as aggression rather than kindness?
My son is planing to bike from Canada to Mexico and I'm a little worried I'd love to have someone who knew tell me how small the chances of an accident are. For now I just comfort myself with telling myself it would probably be more dangerous to bike to work and back for a year.

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Maybe you should think about why people who watch Jaws are afraid to swim in the ocean afterward.

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"please think about why it is that this black woman (who is a journalist) mst worry and you don't"

That's the point. She doesn't need to worry. Blacks are no more likely than whites to be killed in a police encounter and the rates for all are very low. They could and should be improved, but they're not something to worry about in terms of your personal life. You or your children are far, far more likely to die just driving. They should be more worried about a car accident.

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I worry about my hiker son falling off a cliff way back in the woods. Since that's actually quite unlikely, I guess I too might have a dose of your cavalier mockery. Do you not worry about your loved ones belng killed by the police? Probably not. Now please think about why it is that this black woman (who is a journalist) mst worry and you don't.

As a liberal I enjoy the high intellectual caliber of MR, but the comments sections on it are true insult to serious thinking. Also, not having to worry about your son is exactly the point in white privilege.

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The nonsensical non-analogy--a Loury trademark.

We all are subject to risks just by living. Other risks by what we choose to do--cliff climbing, for instance.

But risks imposed by the decisions of others based on the color of your skin that are not imposed on others of a different skin color--that's a different risk. A risk a mother can worry about. A worry that should not be mocked. A worry that should be eliminated.

It says everything you need to know about Loury and Floccina's intelligence and character that this escapes them, or more likely, they think it is appropriate to virtue signal to their in-group this way.

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> And Judy Woodruff did not push back at all.

Ask young people how many unarmed black people are killed by the cops each year. I do it, and the highest I've heard as an answer was "millions"

When they hear "fewer than 20, and roughly half of those were beating the hell out of the cop when they were shot" you can see this look of puzzlement cross their face.

Driving and being killed by another driver presents a far higher risk to the unarmed black person than the police. There are about 200X more black people killed by drivers each year than by police shootings of unarmed black people.

We're destroying our cities, our workplaces, our stores, our police departments, our governments over statistics that nobody knows or understands.

Sounds like a fine, reasoned argument... I'll check around for some videos of Minneapolis cops kneeling on white guy's necks to support it.

No doubt those videos exist for whites and blacks. The question is whether they are common or not. And the answer is no, it's thankfully not common.

You don't burn down your neighborhood over extremely uncommon events. You put the problem into context, and work to make it better. As we've already been doing for 50+ years.

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You have a cartoonish view of what people in red states are actually doing. The media has filled your weak mind with anecdotes about covid-deniers, but they are actually pretty rare. It's very easy for the media to fill your mind with anecdotes that confirm your worst prejudices, and this is what has happened to you. So you are getting frustrated. The media has promised you piles of dead Republicans, and you're getting impatient.

And to be frank, the giant death toll in New York is not likely to occur elsewhere, as they stuffed covid victims into nursing homes, an egregiously stupid choice. Old sick people are being looked after better now.

We've seen this movie too many times:

https://www.usatoday.com/story/news/nation/2020/06/18/arizona-sheriff-who-rebuked-stay-home-order-positive-covid-19/3212415001/

https://www.fox29.com/news/leader-of-north-carolina-group-protesting-lockdowns-reportedly-tests-positive-for-covid-19.amp

https://www.rollingstone.com/politics/politics-news/matt-gaetz-coronavirus-gas-mask-quarantine-964697/

Letting healthy people get the virus is *the point*; that's what 'herd immunity' means. This is not the sick dunk you seem to think it is.

Herd immunity is only meaningful in the context of vaccination. You can debate whether vaccination is the same as Letting healthy people get the virus. Leaving aside the fact that with a half year old virus, we do not have any longer term data on which to base any claims about longer term resistance and/or immunity.

A vaccine is meant to elicit the same antibodies as would be during a live infection, except delivered via an inert/milder agent. Whatever doubts there are about long-term immunity in a SARS-CoV2 carrier, apply to vaccine-mediated immunity as well.

True - but getting vaccinated every 2 years with a safe and effective vaccine is considerably better than getting infected at irregular intervals with SARS-CoV2, especially in association with viral spread to others while contagious.

Vaccines are not just about personal immunity per se, they are also about true herd immunity - that is, occurrence is so rare that the virus has essentially no chance to spread among a tiny pool of potential hosts. If SARS-CoV2 does not create long term immunity, herd immunity is truly unachievable without a vaccine.

Just as using the term herd immunity when talking about a disease without a vaccine is misleading at best, using any comparison to influenza also has the danger of being misleading. Nonetheless, Influenzavirus B represents what happens without a vaccine - "This type of influenza mutates at a rate 2–3 times slower than type A and consequently is less genetically diverse, with only one influenza B serotype. As a result of this lack of antigenic diversity, a degree of immunity to influenza B is usually acquired at an early age. However, influenza B mutates enough that lasting immunity is not possible. This reduced rate of antigenic change, combined with its limited host range (inhibiting cross species antigenic shift), ensures that pandemics of influenza B do not occur." The proper term to describe a widely circulating infection that does not cause a pandemic is endemic.

Public health measures have a long track record in eliminating many endemic infectious diseases, though often most effectively in combination with vaccination.

A link here a couple of days ago showed 17 yr old PBMC with SARS-CoV-1 T-cells showing robust response against that virus, and cross-reactivity against CoV-2 as well as there are significant conserved structures between the two viruses. I think it is unduly pessimistic to treat CoV-2 as some sort of anomaly. Its pathology may have greater and more diverse systemic effects but in terms of natural adaptive immunity, CoV-1 seems a reasonable signpost.

Assuming you mean SARS-CoV-1, we do not have data on its effects in a human population over 1, 5, or 10 years. This would not make it seem to be a reasonable signpost, though influenza is not a reasonable signpost either.

It is not that SARS-CoV2 is an anomaly, it is simply we do not yet have even a year's worth of experience with it as a human disease.

*Assuming you mean SARS-CoV-1, we do not have data on its effects in a human population over 1, 5, or 10 years.*

Not clear what you mean. The study I referred to showed that SARS-1 recovered patients had T-cells which showed a robust response to SARS-1 virus 17 years after they had recovered from the virus. These T-cells, incidently, also showed cross-reactivity to SARS-2.

*getting vaccinated every 2 years*

If you're assuming a 2 year immunity from a vaccine, the same should be the case for a recovered carrier.

Do the math. Herd immunity would require a 70% infection. That's over 200 million cases. Assume a 0.2% death rate, which is a bit low, and you get 400,000 dead and many more with long term health problems. If immunity only lasts two years, then this has to repeat every two years. You can do the math for that.

COVID-19 is like polio. 95% have no symptoms. 4% get pretty sick, but recover fairly well. 1% die or are permanently paralyzed. When polio hit, America was still a nation willing to do things, so people put up with quarantines and closures. Now, we are a nation of whiners, so even wearing a mask is considered too much of an imposition.

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Nobody believes in herd immunity anymore. The cost is too high.

And it's pure tragedy that places like Sweden explored that possibility to no benefit.

(The most bankrupt position is to think the Sweden's course was somehow good. Like "thanks Sweden for dying, I wanted the data.")

Herd immunity, at least in the incorrect senseof applying the term to the sort of immunity humanity has built up to a number of diseases by being exposed to them, is where we are heading right now, at a very slow pace. Such as Sweden, at 7.3% percent infected according to the latest research.

The question is whether we develop a vaccine before 1/3, 1/2, or 3/4 of the population are exposed. Sweden's course was a mistake, at least in the eyes of the people in charge of it at this point in time, but like all mistakes illustrates how to do better in the future.

At a fundamental level, "success" has to be defined as the countries with the best charts. That is, who actually wrestled the virus to the ground. Currently that isn't us.

Now in terms of herd immunity broadly defined, I agree that vaccines, and medium to long-term behavior changes, do factor in.

It's possible that old people, and those with compromised health, will wear masks in public for the next 5 or 10 years.

by that measure, the countries with the most deaths did the best job

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Traveling through Virginia (face mask requirement), fast food restaurants everyone was masked. In North Carolina with "please wear a mask" signs, literally no one wearing a mask in the hotel except for me and the employees. Literally no one.

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Maybe the virus is losing virulence. Sure you still get it, but maybe it’s just not the same covid that is was back in March.

It’s not like some scientists aren’t preaching this.

I mean how else can you possibly explain the decline in deaths, which is pretty steep but cases continue to climb all over the US?

How to explain decline in deaths? Maybe they're just running out of nursing home patients in NY. 🤷‍♀️

Updated 1:35 p.m. MDT 06/18/2020

Total Cases: 15,839 | Total Hospitalizations: 1,120 | Recovered 8,786| Deaths: 152

Utah has more than 300 long-term care facilities, which include nursing homes and assisted living locations. As of June 18, 160 of them have had confirmed cases of COVID-19.

Sixty-four people living in these facilities have died and 403 residents have tested positive for the virus. In case of an outbreak at a facility, Utah’s epidemiologist said the state can use its mobile strike teams to assist. Seven locations, all along the Wasatch Front, currently have at least five active cases.

Yes, clearly Utah is doing much better than New York.

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The increase in case count but decrease in death count is extremely is easy to explain. 75% of deaths are 70 years old and above. The infection fatality rate for younger people is extremely low and half have no symptoms. The increase in testing in the general population like "pop up test" clinics is simply catching more of these cases. Most studies show we have missed 4-11x the cases that actually exist because we only tested people with symptoms or health care workers.

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explaining New York's death rate is very easy... when the virus was first spreading, NY authorities were still encouraging people to congregate

when they started crowding NY hospitals everyone else got the social distancing memo

note almost exactly the same thing happened in Wuhan, and then Daegu... the rest of the country saw nothing like the initial breakout because they panicked when the hospitals filled up

the idea it was inevitable rural Wyoming would suffer the same fate as urban NY was always particularly idiotic, but even the other deep blue districts where things got worse saw nothing like the carnage in NY

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One reason there are fewer deaths is improved medical practice. Delaying ventilation, checking blood oxygen as opposed to fever, early use of steroids, turning patients face down and a host of other changes have made a huge difference. Early in the epidemic, hospital management often banned the use of masks for fear of making management look bad. That has stopped and masks are more available, encouraged and often required.

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No serious person, including on Fox News, is saying that COVID-19 is an elaborate hoax. Reasonable people can differ on the utilitarian calculus of how many livelihoods to destroy vs. how many lives to save if in fact that is the right way to frame the tradeoff (it probably isn't).

https://www.forbes.com/sites/legalentertainment/2020/04/10/covid-19-lawsuit-against-fox-news/#4017b55a5739

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Transforming the virus into a disease of the red states has been a political goal of certain commenters from the beginning.

They would be laughing themselves to their host's deaths at the idea that a global pandemic has something to do with any color of anything at all.

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No, it has been a warning that you have to be serious about countermeasures if you don't want a surge of cases and deaths even in rural places.

People weren't serious, and now we're getting the deaths.

Are you seriously going to blame the people who tried to warn you?

Remember how Georgia was carrying out an exercise in human sacrifice? How'd that work out?

Excluding Arizona,the runaway winner, Georgia is competing with Florida, Tennessee, and South Carolina for most new cases--unsure if that leads to most hospitalizations and deaths

meanwhile

https://www.pewresearch.org/fact-tank/2020/05/26/coronavirus-death-toll-is-heavily-concentrated-in-democratic-congressional-districts/

"is" means "was" in that cite. You can't call the final score in the early innings. One absolute truth is that the virus deaths follow the infections, they do not precede it.

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This is definitely good news. Could it be that with better precautions people aren't getting the high viral load? And of course better treatments.

On the other hand, I think the data on lung damage among asymptomatics is still looking bad.

https://twitter.com/EricTopol/status/1273602756280856576?s=19

Unlikely to be irrevirsable damage. I wish covid would attack people who think Twitter is a fine substitute for a blog post, though.

What about people who cannot process it when Twitter is a pass through to a medical journal?

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Deaths decreasing, stupidity increasing.

People with sense are staying home. That is why there is a decline. Not because the virus is any less potent at this time. The bottom line is that it is still not safe to be out and about especially of you are in a high risk category. This data is not "good news." If you are looking at it as such, you are one of the stupid people who probably think you are smart because you can "interpret" a decreas8ng trend line. Meanwhile, you have no ability to c9ntextualize what you are seeing inside of the reality that exists. Many will use this as evidence that opening up is the right thing to do. Huge mistake.

I think it really is good news. It could be much worse. In a world changing (zombie apocalypse level) pandemic, the death rates per 100,000 climb in a chain reaction. This shows we might have something to work with.

What you want to do next is look at regional graphs, to make sure local policy matches local conditions.

We certainly shouldn't let hot spots off the hook because national numbers are declining.

You are deluded if you think that California having its highest total cases yesterday is really good news. And national numbers over the last several days no longer represent a declining plateau, instead they represent an increasing plateau. Between May 1 and May 13, a decline can be seen. New cases today are equal to that of May 15. The virus is riding a pogo stick, without anybody able to stop it.

That is horrible news.

California cases increase a day (Wikipedia California pandemic):

Apr 22 to Apr 28........3.8%
Apr 29 to May 5.........3.4%
May 6 to May 13........2.7%
May 14 to May 20......2.4%
May 21 to May 27......2.4%
May 28 to Jun 3..........2.4%
Jun 4 to Jun 10............2.1%
Jun 11 to Jun 17..........2.2%

Did you not notice that your numbers are currently showing an uptick?
And here are the total numbers for five days of new cases (picked before looking at totals on Tuesday at worldometers)
May 19 - 2093
May 26 - 2908
June 2 - 2843
June 9 - 3045
June 16 - 3440
The actual number of daily new cases has risen 64.36% in one month.

That is horrible news.

Sure, and entirely predicable, and actually predicted here many times. California has many high density places, and what we see there is the effect of a "successful" lock-down. As soon as we release the lock-down, the number of cases ticks up, because no herd immunity has been built, and we are at the same situation as three months before (except for wheather, the importance of which s not completely clear). In New York, or Paris we don't see the same going up of the rates of new cases after the end of the lock-down, because some non-trivial herd immunity has been built. Places like China, or California, with their strict lock-downs that can never end, will bring utter ruin on themselves if they continue their blind policies. At least France seems to be done with lock-downs.

no, slowing the curve doesn't prevent immunity from growing

does take longer but as we saw in NY if a whole lot of people get it at once the results are horrific

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Of course I saw the uptick -- that increase that many will say has been a spike.

0.1% increase = "uptick"; delta function = "spike".

The virus cares nothing about upticK vs spike - it spreads regardless of terminology.

the raw case numbers mean little in and of themselves, they're more a function of the number of tests performed than anything else

the positive *rates* are at least moderately useful information in terms of trend, but that also varies for similar reasons

remember, the *actual number of people infected* is unknown but probably around 10x the number who were tested positive according to serology

ultimately excess deaths is probably the most informative number

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While cases have been rising, California ICU admissions are stable.

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"You are deluded if you think that California having its highest total cases yesterday is really good news."

I said exactly the opposite. I said that it's good that national numbers are going down, but that we *should* look at local data and make sure policies match.

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The bottom line is that it is still not safe to be out and about

Sure it is -- if you're really out. Drive as far as you like. Go away for the weekend and stay in a vacation rental. Order takeout meals. Go for a walk, hike, bike ride , or paddle. Lay on the beach. Play golf. Go fishing. Have a picnic. Even eat a restaurant meal sitting at an outdoor table. Just avoid being in crowded places spaces with strangers -- especially indoors. Apart from that, enjoy the summer.

I'm sorry, but I just don't see how that helps Joe Biden get elected.

+1 for coffee shooting out of my nose...

Careful - yesterday somebody lit up leftist twitter with the exhortation to throw hot coffee in the face of anyone not wearing a mask, in memory of her mother.

I would tell them to go walk through Midway airport in Chicago. And they'd better bring a lot of coffee.

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How much has the Infection Fatality Rate fallen due to better medical care?

How much is this due to more vulnerable people avoiding getting infected?

It’s simply that younger people on average are getting infected. Yes, treatments are very slowly improving

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Has anybody yet calculated the Disability-Adjusted Life Years lost per death?

I had calculated 13.5 years 2 months ago, a paper Tyler posted said 14 years. I can’t find that paper now.

If I remember well, you computed the Life Years lost by death, not the Disability-Adjusted Life Years. Since the people dying of Covid are likely to have disabling comorbidity to begin with, the second can be much less than the first.

The big question will be how many total deaths we have at the end of the year compared to a normal year. Anyone here interested in making a guess at how higher or lower that may be?

Which is the only honest answer. Other countries where that also applies are the UK and Sweden. In contrast, countries like Greece or Finland will not have to worry, as of today, that answer would not apply to them.

Nor to Japan which has had 920 deaths, 50 times as few as the U.S. despite less testing and no lockdowns. Have I mentioned this before?

They are able to handle the virus effectively. In contrast to Brazil, which also seems to have even less testing than Japan and not much in the way of effective lockdowns - certainly compared to Hokkaido.

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Hoosier, less than 150,000 excess US deaths at the end of this year seems impossible. A total of 200,000 seems optimistic to me. My guess is 250,000 excess deaths based on the assumption that the United States won't have a response like Germany in time but enough states will keep restrictions in place, there will be modest improvement in drug therapies, and a reasonably high level of fear will be maintained in the population leading to people taking personal precautions.

But it's still possible for it to be worse.

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I did take that the comorbidities into account. Now it's not precise in the sense , that there are no good statistics when people have 2 or 3 of those,
For Italy which skewed older, It was about 10 years

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There are some claims that the US still has a growth trend in deaths some regions...

But even in these subregions, the trend is clearly linear and subexponential - they "flattened the curve".

Still, that those different trends show what a horrible idea massive across the board shutdowns were, for places that hadn't really got close to them being worth it. Should have saved them til later. Leaving aside whether shutdowns do much more than credible gov advice and state support anyway, which they probably don't.

The trends on deaths really are the most meaningful information, if imperfect. Cases don't mean much due to widespread variation in cases:infections.

Max Roser (of OWID fame) recently wrote one of the dumbest tweets I've seen him write, suggesting that US real infections and deaths *must* be going up, as cases and positivity of tests were going up... Which again is an absolute failure to understand just how limited identified cases really are - both identified cases, testing and positive tests can all go up, while deaths decline, *if* medical diagnostics tests to screen who gets tested are also improving.

The across the board school closures were necessary for three reasons. We didn’t have enough testing to know if your case load was Michigan or Minnesota levels. We get to learn about the virus in published studies from earlier affected regions. My state had an inadequate supply of medical and personal protective equipment. We needed two months to have enough masks and gloves. Recently we received hospital gowns. If we were better prepared we could have instituted closures later.

Keep in mind how much of the shortages was due to China buying up all the PPE that it could before it announced the disease. There never really was an opportunity to be better prepared on that front.

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Btw, on case counts, prior_approval still seems as naive about case:infection ratio as he was four months. Then he was ranting about how "Not 1% of the population is infected in Italy and their healthcare is overwhelmed" on the basis of the official case count (when actually something like 60% in Bergamo have been infected - https://mobile.twitter.com/alexeidrummond/status/1273803179415617538). Now he's ranting about case counts in the US as if they clearly indicate trends in real infection, apparently having learned nothing in the intervening period.

True that the number of diagnosed cases is a very bad indicator, but there might be some thing indicated by the fact that it is mounting in California and plateauing in the country as a whole. Any link with the curve of deaths in California, or hospitalizations?

Hospitalizations rising in CA bit ICU admissions stable overall.
https://calmatters.org/news/2020/06/california-coronavirus-hospitalizations-climbing-record-rate/amp/

Thanks a lot. Time will tell us what to make of these divergent data.

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Any evidence beyond a tweet, whose author said he made a mistake? Alexei Drummond - I need to point out that the sample was NOT RANDOM as it turns out. So extrapolation to the whole population as I did was probably not appropriate. The study also found 30% in health professional which may well be more representative of that population. So still high.

This is recent research from Switzerland, which does address Drummond's mistake - Between April 6 and May 9, 2020, we enrolled 2766 participants from 1339 households, with a demographic distribution similar to that of the canton of Geneva. In the first week, we estimated a seroprevalence of 4·8% (95% CI 2·4–8·0, n=341). The estimate increased to 8·5% (5·9–11·4, n=469) in the second week, to 10·9% (7·9–14·4, n=577) in the third week, 6·6% (4·3–9·4, n=604) in the fourth week, and 10·8% (8·2–13·9, n=775) in the fifth week. Individuals aged 5–9 years (relative risk [RR] 0·32 [95% CI 0·11–0·63]) and those older than 65 years (RR 0·50 [0·28–0·78]) had a significantly lower risk of being seropositive than those aged 20–49 years. After accounting for the time to seroconversion, we estimated that for every reported confirmed case, there were 11·6 infections in the community.

Interpretation
These results suggest that most of the population of Geneva remained uninfected during this wave of the pandemic, despite the high prevalence of COVID-19 in the region (5000 reported clinical cases over <2·5 months in the population of half a million people). Assuming that the presence of IgG antibodies is associated with immunity, these results highlight that the epidemic is far from coming to an end by means of fewer susceptible people in the population. Further, a significantly lower seroprevalence was observed for children aged 5–9 years and adults older than 65 years, compared with those aged 10–64 years. These results will inform countries considering the easing of restrictions aimed at curbing transmission.

www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31304-0/fulltext

Switzerland's not Bergamo.

I guess the sample in Bergamo is non random, but it still difficult to get to 60% without *extreme* skew in sampling very far beyond what we see elsewhere, where even most symptomatic subjects choosing to get tested did not have it.

Note that 60% is pretty close to 1% IFR given Bergamo excess deaths (though Bergamo probably pretty old). So that's a reason to think not far off...

On a slightly different point of interest related to Italy - https://medicalxpress.com/news/2020-06-virus-italy-december.html - "Virus already in Italy by December: waste water study" another data point to add to when coronavirus arrived, to Italy... But OTOH, phylogenetics suggests all early introductions like this before mid-Feb "fizzled", as a Feb introduction is ancestral to later cases...

Drummond no longer suggests 60% for Bergamo at all due to an error on his part, but finds 30% supportable -The study also found 30% in health professional which may well be more representative of that population. So still high.

Do you have any links to any research that goes beyond Drummond's belief that 30%, not 60%, is a reasonable figure for Bergamo?

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Did you just write that extreme skewing is required to get a desired result?

It is a specialty of Chez MR

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Nope, reading comprehension fail here for you.

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Prior is a troll. He changes positions as it suits him. There isn't some consistent intellectual position or moral center behind his remarks here.

That makes him suitable to run for the GOP Presidential ticket.

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+1

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Not sure an aggregate of the whole United States is very meaningful. The whole graph is swamped by the tri-state area finally getting the epidemic under control. The US is a big place!

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The lockdown was a great success. And many Americans are mad as Hell about it! I just returned from a two-day trip to the low country. No coronavirus there. Well, there's coronavirus, but Faith has proven stronger than Fear (Faith Over Fear is a common sign in yards and in businesses). These folks are planning their next cruise! What I saw in two days caused me more anxiety than seeing a loose pit bull while riding my road cycle. Folks were offended that I wore a mask, and that I wouldn't shake hands or hug. Like the virus itself, the ignorance is breathtaking. Is ignorance too strong a term? Denial might work, but so does ignorance: it's as these folks haven't read anything about the coronavirus. All they know is what they don't hear on Fox News.

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Rising cases, falling deaths. There are many explanations, but the most likely is the identity of those getting the virus. In California, for example, where cases are rising rapidly, half the new cases are folks under age 34. https://slate.com/technology/2020/06/covid-death-rate-declining-explained.html As states re-open, the most likely to resume active social lives are, that's right, young people. Most will survive, but we don't yet know what the long-term effects will be for them. An aside, on my way back to Florida yesterday I went out of my way to avoid the checkpoint on I-95 at the Georgia-Florida border, where wait times can last hours when the traffic backs up for miles. I had a nice drive on a country road through a pine grove.

There's a checkpoint for covid on I-95 going in and out of Florid?!!! Never knew this. Crazy.

Going in, not out. Cars with passengers from New York, New Jersey, etc. are inspected for covid symptoms, while others are allowed to pass. It's ludicrous. But the governor of Florida, a Trump protege, has to justify reopening the economy early, which has resulted in a spike of new cases and hospitalizations. Today, the governor's explanation for the spike is farm workers. Maybe he will impose a checkpoint at the fields. [The inspection is done at the Florida border where tractor trailers were diverted to the right of the highway for weighing and inspection. Now, the tractor trailers stay on the highway while the cars are diverted through the inspection/weigh station to inspect the occupants of the cars.]

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What is a COVID-19 death? Has any country achieved a practical, unambiguous definition that it uses consistently over time and place?

Given that most of the deaths occur to old people who are already ill, there must be a large degree of arbitrariness in the doctor's choice of cause of death to report. That must be true because it was true before COVID-19 appeared.

There's a case for using "excess deaths": at least the fact of of death tends to be indisputable. How many of the excess deaths to attribute to COVID-19 would still be a problem but at least it would be a problem that is out in the open for discussion.

I laugh at the idea that there is secret overcounting or undercounting of "true" COVID-19 deaths. The "true" total is unknowable.

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Is treatment improving?

Yes. An ER doctor friend of mine in the upstate got it in early March. 40s and in great health. They tried several treatments and he ended up on a ventilator. 3rd day on a ventilator he received a dose of remdesivir and was off it in 3 hours. But he is dealing with the consequences. I also got it, long story short, after getting laid off my neighbor hired my wife at an engineering firm doing road projects. Office open, no masks, she was mask shamed. It is 6 to 8 weeks of terrible. Nothing at all like the flu which is super intense over a few days and gone. If anyone is wondering what it is like - your entire body is inflamed. You can "feel it" in your core and your extremities bare the brunt. And you panic as you check your oximeter 20 times a day and see it dipping into the low 80s. I had flesh peal away from wrists. My right lung isn't really there anymore. The worst is the "brain fog" but that word isn't right. I imagine this is what end of life is like after a stroke and COPD. Slowly suffocating and suffering for a long period of time. What isn't in the data is what it like, on an individuals level, to "recover". This thing was optimised to hook into every cell of your body.

The big determinant is the scope of your exposure. That is why it blew up in NYC, no masks, people were getting overloaded with parts per billion. Since people are or were taking this seriously, when you go to the grocery store with a mask and avoid people you can get this now without the load that kills you.

I think maybe this is the last time I jump into the comments section. Look at all the elite white male armchair economists and absolute stupidity. Tyler reminds me of many who came before him, he had become trapped in a persona he has built and has to maintain. What a "rebel".

I recommend rereading Black Spring by Henry Miller. Everyone sick and dying and no data. Then there are the world wars bookending things. And when things open back up there is a death wheel at the Edgar Allen Poe Museum in Richmond, VA. Of course TB didn't kill him, he was drugged and forced to vote by a political gang then baseball batted to death with whatever they used before they had baseball bats.

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Do people accept that herd immunity has now been reached in places like New York, London, Spain, and northern Italy? If not, why is the number of new cases so low?

The vulnerable beasts have been culled.

Given that death rate less than 1%, the majority of the non-susceptible group will be recovered or naturally immune rather than dead.

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public health measures & the inherent randomness of infectious
diseases can result in fewer infections without a population reaching "herd immunity"
elite leftist harvard sociologists who never took a immunology course have sorta fubared the definition of herd immunity

How? Or is your answer just "randomness". In those places the health measures have reduced and the cases are reducing alongside, even faster.

this is a purty good stab at it
https://news.yahoo.com/herd-immunity-won-t-solve-083000235.html

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For people advocating continued shutdowns, I would be interested to know what you think the long term plan is?

Here is a paper that claims immunity from having coronavirus only lasts 2-3 months: https://www.nature.com/articles/s41591-020-0965-6

Lots of people think there will be a vaccine next year. I hope they're right. But what if they're not? Or if the vaccine also doesn't confer a long-lasting immunity?

It seems to me that the red-states strategy of allowing people the liberty to determine their own risk tolerance is a good sustainable long term plan. I do wish they would encourage more masks though.

"Here is a paper that claims immunity from having coronavirus only lasts 2-3 months"

They don't claim that. They say serological antibodies have begun to reduce after 2-3 months. No need to sensationalize it.

I am certainly glad to hear an optimistic take on this.

"Forty percent of asymptomatic individuals became seronegative and 12.9% of the symptomatic group became negative for IgG in the early convalescent phase. "

It had been my understanding that "seronegative" meant that antibodies were no longer detectable and not merely that they had "begun to decrease". Have I misunderstood?

Serological antibodies are only one aspect of immunity. The people whowere asymptomatic became seronegative more than the symptomatic group. One interpretation of this is that their innate immune response was stronger, so there was less of an adaptive immune response. Because covid is a new disease, we can't prove that people can't be reinfected after 12 months, and yes, the paper certainly has potential negative implications for the duration of adaptive immunity, but it doesn't claim that immunity from coronavirus lasts only 2-3 months.

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Earlier TC posted a link to a study that used Kaiser info that was reflective of the time where the lock down was most strict. He noted that the RO was somewhere around .9 and said something to the effect of if " if this is as low as we can get it, then we have a lot more justifying to do."

So my question is if .9 is full lockdown baseline, what the delta between our current RO in the terms of lives and economic impact? The current RO I'm sure is the subject of debate, but there's surely a fair number out there (maybe the method used in another study TC linked to discussing whether an efficient gov and culturally tight people had an impact...)

I'll take a crack at it, but I'm afraid I'm rather elementary when it comes to arithmetic!

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No construction projects have been postponed due to Covid-19 concerns. They are manned up as if everything was as before. Workers aren't wearing masks or rubber gloves or surgical smocks. Oddly, we have no figures on infection or deaths of construction personnel or their families. Why not?

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Obviously the good news here is being suppressed by the nogood libtard MSM, chuck. Clearly, you are just the person to expose this. Maybe they will cover it on OANN and Trump will shout about it tomorrow night at his rally in Tulsa, where cases are rapidly increasing.

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June 19th new US cases are over 33,500. Fingers crossed this big jump is just a blip.

We have another terrible figure of over 33,000 new infections in the US for the 20th. This is horrible as there is usually a clear dip after a weekly spike like on the 19th. It's pretty clear new infections are on the rise, assuming no sudden testing blitz over the past few days. Before too long this will halt and then reverse the decline in deaths until the spread of the virus is stifled again.

26,000 new cases for the 21st. New US infections may be up by about a quarter from a couple of weeks ago.

Yeah, new daily infections are up by over a quarter in the US from what they were a couple of weeks ago. That is clear now. I hope this results in increased caution. If it doesn't, death rates will go back up to what they were, particularly as the infected young spread it to the non-isolated old.

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From what I've heard from my niece in NYC, people are getting out and getting more relaxed, but things are still pretty much shut down. Only the crazy people don't wear masks on the subway, but most New Yorkers are used to keeping social distance from crazy people.

(The Cuomo / de Blasio pissing contest was quite a spectacle. The Hudson is probably still running yellow.)

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