Tag Archives: COVID19

Here are the deaths. A tale of two states

On 29 June I wrote a post asking “Where are the Deaths” because, although the number of new cases of COVID19 were increasing, deaths were not (https://luysii.wordpress.com/2020/06/29/where-are-the-deaths/).   I said I’d check back in 2 weeks.

Florida has shown a surge in new cases and a surge in deaths since then — have a look at — https://tallahasseereports.com/2020/07/08/two-charts-show-positive-trends-for-florida-in-coronavirus-battle/.  The top chart shows the 7 day average of new cases, and the one below shows the 7 day average in deaths.   Both charts show the need for averaging, as daily deaths or new cases in any 7 day period you care to study vary by a factor of at least 2.  The 7 day average of new cases appears to be about 1,000 on 1 June.  Now (13 July) its ten times that.  The 7 day average of daily deaths was about 40 on 1 June,  now it’s twice that at 80.

Georgia (which I chose to follow because it was one of the first states to loosen the lockdown) shows nothing of the kind.  Have a look at https://dph.georgia.gov/covid-19-daily-status-report.  Page down past the map to the chart with 3 tabs —  cases (which means daily newly diagnosed cases), cumulative cases, and death.  Clicking on the tabs will move you back and forth (or better is your screen is big enough open the link twice and compared cases vs. deaths.

Daily new cases on 1 June in Georgia (7 day moving average) 769, on 30 June the 7 day moving average had exploded to 3916

What happened to deaths?  They dropped ! ! !   7 day moving average of daily deaths on 1 June 22,  On the 30th of June it had dropped to 18.

Why is Florida report results for mid July while Georgia is back at the end of June?  Because Georgia is conservative (who knew?) and doesn’t regard results as solid until 14 days have passed, and all the data has had a chance to filter in.

I have no explanation for why  two adjacent Southern states should be so different.

On a far more disquieting note, young people are now having COVID parties where they actually try to get infected — https://www.independent.com/2020/07/10/isla-vistans-deny-holding-a-covid-party/, https://www.msn.com/en-us/news/us/tulane-dean-students-who-throw-large-parties-during-covid-19-pandemic-could-face-suspension-expulsion/ar-BB16s4n0.  The links show it’s nationwide.

At first glance it appears that they are trying for a Darwin award, but on second glance, based purely on a cost benefit analysis (to them only) the chances of a healthy 18 – 20 year old dying from COVID18 are maybe 1 in a thousand.  Libido is incredibly intense at that age.   I’m not sure what I would have done in their shoes.   Think of all the gay men who knew full well how AIDS was transmitted, still got it and died.  Libido is powerful.  The classic example is Randy Shilts who wrote “And the Band Played On” about the early days of the epidemic.

I’ve found it impossible to actually talk to a human being at any State Department of Health.  I’d love to know what has happened to the 425 or so people in Massachusetts who tested positive for the virus after attending the Black Lives Matter protests. Most appear to be under 30.  Were any hospitalized?   Videos show some protecting wearing masks, but many didn’t who were vocally active. Have any been hospitalized?  Have any died?

 

What is a case of COVID19?

If you tell me you’ve had a case of the flu, I know exactly what you mean; you were sick for a time and are now over it.  That is not at all what State Departments of Health or the press mean by ‘cases’ of COVID19.

They mean one of two things

l. Presence of the virus genetic material on a sample you give

2. Presence of antibodies to the virus in your blood.

Neither means that you’ve had any clinical illness whatsoever.   In the case of the Bronx where 20 – 50% of various areas had a positive antibody test, none were hospitalized — these were people walking about.

So the scare headlines about cases of COVID19 explode are just that.  Americans love sports.  Consider the players on the active rosters of the NFL, Major Leagues and NBA last year.  If any of them had died of COVID19 you would certainly have heard about it.

On June 29th I wrote a post ”Where are the Deaths?” making the point that if ‘cases’ surged, deaths should as well. Here’s a link — https://luysii.wordpress.com/2020/06/29/where-are-the-deaths/.   It hadn’t happened then, and hasn’t happened now.

Granted there should be a lag between diagnosis and death.  Amazingly, it’s hard to find figures on just what the lag is.  An early report from Italy said 8 days, but these were mostly very old people.

I’ve been focusing on Georgia for several reasons.  First, they were the first to loosen their restrictions of activity. Second they are very conservative in the way they report data, not regarding any number as solid until 14 days have passed and all the information has had a chance to flow in. Third, Georgia uses moving averages of cases and death for the past seven days.  This smooths out the spikes (which are largely due to how the data flows in).  For an example of going off the deep end about a one day spike in cases — see https://luysii.wordpress.com/2020/05/28/data-cherry-picking-101/ — a copy of which will be found below the ****

So now hie yourself to the following website — https://dph.georgia.gov/covid-19-daily-status-report

If you scroll down to COVID-19 testing, you will see that they’ve tested a 1.17 million people (nearly 10% of the populaton).  94,000 had the virus present and 9,000 had a positive antibody test (so asymptomatic people account for nearly 10% of the ‘cases’ of COVID19

Now keep scrolling down the site, past the map of Georgia and you get to COVID-19 cases over time.  There are 3 tabs you can click: Cases, Cumulative Cases and Death.

Each is plotted vs. the date.

There is a movable cursor allowing you to see the data from any given day.  On the day restrictions were loosened (25 April) the 7 day moving average of new cases was 736, and the 7 day moving average of daily deaths was 41.

Now click on cases and look at 24 June (using the cursor), and the 7 day moving average of daily new cases has exploded to 2,100

Click on deaths and the 7 day moving average of daily deaths on 24 June is 17.

When did the explosion in daily new cases begin?   To my eye, it happened around the first of June (when the daily death rate was 24).  So during the explosion of new cases death rates continued to drop.

Very similar data is available from Florida; look at the two graphs — side by side– of new cases and daily deaths on the following link — https://www.miamiherald.com/news/coronavirus/article242270081.html

For those of you old enough to remember, the number of new cases is as useful as the body count was during the Vietnam war.  It was something which could be precisely determined, but what was irrelevant for what was really needed to be known.

The two pieces of data we need to determine whether we’re winning or losing in the pandemic are (1) the daily death rate from COVID19 (2) the number of people currently hospitalized with COVID19.

If the marked increases in new cases is meaningful and scary, we had better see a rise in the death rates soon; but it’s already been 3 weeks for Georgia (solid numbers) and about 5 weeks for Florida, and we still haven’t seen a rise in death rates comparable to the rise in the number of ‘cases’ since 1 June.  In fact we’ve seen no rise at all.

Follow the links, look at the data and draw your own conclusions.

****

Here’s the old post warning you to beware of ‘daily spikes’ of anything.

 

Data Cherry Picking 101

A friend sent me the following link — https://www.voanews.com/covid-19-pandemic/wisconsin-reports-its-highest-daily-increase-covid-19-cases.

It starts off like this — dates in parentheses added by me.

“Health officials in the midwestern U.S. state of Wisconsin reported a record number of new COVID-19 cases Thursday, (28 May) two weeks after the state Supreme Court struck down a state-wide stay-at-home order issued by the governor and enacted by the state health department.

The Wisconsin Department of Health Services reported 599 new known COVID-19 cases Wednesday, (27 May) with 22 known deaths, the highest recorded daily rise since the pandemic began. The department reports the state had more than 16,460 known cases and 539 known deaths as of Wednesday.”

Well that proves it, doesn’t it?   Removing restrictions has clearly  been a disaster.

No it doesn’t.  This is data cherry picking par excellence — one day’s cases — after a long holiday (Memorial Day)  weekend means nothing.  The ‘spike’ is an artifact of how cases are reported.

Here are the daily new COVID-19 cases from Massachusetts (which has relaxed nothing so far)
24 May 382
25 May 281
26 May 197
27 May 688 
 
QED

Where are the deaths?

Our current model of the pandemic is that if the number of people testing positive for the viral genome increases, deaths will increase.   Could the model be wrong?  We’re about to find out.  The number of cases diagnosed daily has markedly increased recently in Georgia and Florida.

The number of hospitalizations for illness due to the virus (e.g. the old meaning of Covid19)  in Miami Dade county rose from 607 on 15 June to 1,062 on 28 June. https://www.miamiherald.com/news/coronavirus/article243854907.html Certainly deaths are sure to show a similar increase.  Aren’t they?

Well so far deaths are falling as diagnosed cases are rising. https://experience.arcgis.com/experience/96dd742462124fa0b38ddedb9b25e429.  has data through 28 June (a Sunday, where reporting is likely to be slow).

If anyone knows how to get these graphics into a WordPress post, please let me know (just write a comment).  Every time I try my post collapses and nothing shows up.  The WordPress Gods must be angry with me.  The links will get you there however, but even then you’ll have to root around to find what I’m talking about.  Apologies.

There is a new WordPress editor out, and I’ll try it to see if it helps.

Florida is particularly good to study because every Friday they tally the number of cases with a positive antibody test for the virus for the past week.  These are people who have recovered, and who likely have never been very sick.  There would be little reason to test someone hospitalized with COVID19 for antibodies.  Here’s a link — http://ww11.doh.state.fl.us/comm/_partners/action/report_archive/serology/serology_latest.pdf.

It boils down to the fact that about 35% of 51,982 newly diagnosed cases of infection in the two weeks ending 26 June are really positive antibody tests.

Unfortunately Florida doesn’t have available a statewide number for the total hospitalized cases of COVID19 — like Massachusetts– https://www.mass.gov/doc/covid-19-dashboard-june-29-2020/download  — but with a population more (6.9 million) than  Miami Dade metropolitan area (5.5 million), there were only 760 cases statewide.

Now on to Georgia, which I’ve been following because they were one of the first states to lift restrictions.  As of 3PM today 29 June,  the 7 day moving average of daily deaths was 15 (this number is for 16 June, because Georgia doesn’t regard its numbers as solid until two weeks have passed).  On 25 April, the day the lockdown was partially lifted, the 7 day moving average of daily deaths was 41.

The number of cases in Georgia diagnosed (using both antibodies to the virus and the genome) has risen markedly in the past 2 weeks. Unfortunately I’ve been unable to find what percentage of the positive tests in Georgia are due to antibodies to the virus.

Both Florida and Georgia are so typical for what docs face all the time.  The data you have is never quite the data you’d like to have.

Now the time from hospitalization with COVID19 to death is unknown, but it’s unlikely to be greater than a month. However, for both states, given the rise in diagnosed cases, we had better see a rise in deaths, or something is seriously wrong with our model.

Has this ever happened before?  You bet.  The nationwide rise in obesity over the past several decades was predicted to have awful effects on mortality.  Yet life expectancy continued increasing.  For details see a copy of an old post after the ****

So I’ll revisit these states in two weeks or so to see if deaths have risen.  This post is long enough, but it’s worthwhile inserting two pieces of data from family and friends.  Family spies tell me that yuppies in Brooklyn are partying in the street without any protection.  Similarly, a friend from Baltimore notes  “Not many people are wearing masks in Baltimore or Washington, particularly individuals at high risk.”

Although Trump’s medical pronouncements are rightly ridiculed, I find it improbable that the bunch described above take what he says as holy writ and that he’s responsible for their behavior.

We are currently witnessing a massive social and medical experiment which would never get past an institutional review board.

****

https://luysii.wordpress.com/2011/03/20/something-is-still-wrong-with-the-model/

Something is still wrong with the model

We’re getting fatter and fatter as a nation and with fatness comes diabetes, hypertension, elevated lipids, strokes, heart attacks and death.  That’s the model.  There’s something wrong with it however, as people in the USA are living longer and longer, and deaths are dropping. The following is one of the first posts I wrote on the blog and it got a lot of play.

https://luysii.wordpress.com/2009/08/20/something-is-wrong-with-the-model/ (I’ll reproduce it here at the end of this post)

What’s happened since?  The following year the Center for Disease Control (CDC) reported a one month dip in expectancy to 77 years and 11 months.  Last week the CDC announced that because of a computer programming error the dip didn’t happen.   They also announced new data for the most ‘recent’ year available (2009 not 2010) and life expectancy continues to increase (now 78 years and two months for a child born today).  This is probably not a statistical fluke.  The data is based on death certificates. Why in the world we don’t have data for 2010 yet and why it took 14+ months for the CDC to collate the data for 2009 I leave to your imagination.

The absolute number of deaths  dropped by 36,000.  Now docs misdiagnose a lot of things but death isn’t one of them.  So my guess is that life expectancy is even higher, because the CDC is probably using the numbers the census counts rather than the numbers of people who are actually here (e.g. undocumented immigrants etc. etc.).

As noted earlier, one self serving explanation is that medical care is just getting better and better, and certainly it is, but it is very unevenly distributed, which was one of the points in passing ObamaCare.  More likely, in my opinion, is that obesity just isn’t as bad as its cracked up to be.  This goes against years and years of experience as a practicing physician.  Next time you visit a friend in the hospital, look at what’s lying in the beds — you will find the percentage of really heavy people much higher than the people walking the streets.  How many times have I seen an obese diabetic hypertensive, hyperlipidemic patient improve all 3 (and presumably their risk of premature death) by losing weight.   Yet facts must be faced — we’re not dropping like flies even though we’re getting fatter as a nation.  Any thoughts?

 

HERE’s the old post

Back in grad school when a theory came up with a wrong prediction, we all clapped hands because it showed us exactly where a new theory was needed, and just how it failed. No casting about for something to work on. A program that crashes intermittently is very hard to fix. Once you’ve found input that consistently makes it crash the job becomes much easier.

The Center for Disease Control released new data for 2007 (based on 90% of all USA death certificiates) showing that mortality rates dropped again (by over 2%) to 760/100,000 population. It’s been dropping for the past 8 years, and viewed longer term is half of what it was 60 years ago. Interestingly death rates from heart disease dropped a staggering 5% and even cancer dropped 2%.

But the populace is fat and getting fatter. This has been going on for 30 years. You can Google NHANES for the gory details, but the following should be enough. [ Science vol. 299 pp. 853 – 855, 856 – 858 ’03 ] The data from a recent NHANES (’99 – ’00) shows that the percentage of obese (as opposed just overweight) increased from 23% in the surveys from ’88 to ’94 to 31%. This is based on the body mass index (BMI). Someone 6′ 1″ would have to weigh 225 pounds to be obese.

We are told to be prepared for an epidemic of diabetes, high blood pressure, elevated blood lipids because of this. Every doc has seen blood sugar drop, blood pressure lowered, lipids come down in people with any/all of the above when they are able to lose a significant amount of weight. These diseases are significant only if they kill people, which they certainly seem to do in my experience. The next time you’re visiting a friend in the hospital, look at what’s lying in the beds. Very likely, many more than 31% of them are obese.

So why are death rates dropping and people living longer? Something must be wrong with the model — it’s pretty hard to quarrel with the data as being inadequate. Certainly the increased incidence of obesity should have produced something by this time (it started 30 years ago).

Well, the self serving answer for the drug developers is that their drugs are better. MDs would like to think it’s due to better care. Possibly. Here’s some detail.

#1: More people are exercising than they used to. How many joggers and walkers did you see on the streets 20, 30 years ago?

#2: Fewer people are smoking. Forget lung cancer (if you can). The big risk for smokers is premature vascular disease. Normally we all have carbon monoxide in our blood (it comes from the breakdown of hemoglobin). [ Brit. Med. J. vol. 296 pp. 78 – 79 ’88 ] Natural carbon monoxide production would lead to a carboxyhemoglobin level of .4 – .7%, but normal levels in nonsmokers in urban areas are 1 – 2%. Cigarette smoke contains 4% carbon monoxide, so smokers have levels of 5 – 6%. This can’t be good for their blood vessels.

#3: Doctors know more than they did. My brother is a very competent internist. He took over the practice of a similarly competent internist after his very untimely many death years ago. Naturally he got all the medical records on the patients. He found letters (now over 25 years old) from the late MD to his patients informing them of their lab results, and assuring them that their cholesterol was just fine at 250 mg%.

#4: The drugs are better. In addition they may be working in ways that we have yet to fathom. Consider the statins — their effect on vascular disease is far greater than their effect on blood lipids (cholesterol, triglyerides) — particularly when compared to other agents that lower blood lipids to the same extent.

Any further thoughts?

Death rates from coronavirus drop in half 2 months after Georgia loosens lockdown restrictions

There were apocalyptic predictions of doom when Georgia loosened its lockdown restrictions against the pandemic coronavirus SARS-CoV-2 on 25 April.  Here they are

From The Atlantic — “Georgia’s Experiment in Human Sacrifice — The state is about to find out how many people need to lose their lives to shore up the economy.” — https://www.theatlantic.com/health/archive/2020/04/why-georgia-reopening-coronavirus-pandemic/610882/

A month later (25 May) not much had happened —

7 day moving average of new cases of COVID19 ending 25 April — 740

7 day moving average of new cases of COVID19 ending 13 May — 525 (the state allows 14 days for all the data to roll in, so the last date they regard as having secure numbers is the 7th of May and here the number is 539)

7 day moving averages of deaths from COVID19 ending 25 April — 35

7 day moving average of deaths from COVID19 ending 13 May — 24 (the state allows 14 days for all the data to roll in, so the last date they regard as having secure numbers is the 7th of May and here the number is 27).

Back on 25 May I wrote “People who assumed (on purely correlative evidence) that lockdowns prevented new cases, and that lifting them would cause a marked increase in new cases and deaths, are clearly wrong.  It’s possible that cases will spike in the future proving them right, but pretty unlikely.  It’s only fair to give the doomsayers a sporting chance and followup is planned in a month.”

So here’s the followup.   The 7 day moving average of daily deaths had dropped to 17 as of 11 June.  Remember Georgia waits 14 days as data filters in to regard the numbers as definitive.  Here’s the link — https://dph.georgia.gov/covid-19-daily-status-report

So the death rate from COVID-19 dropped in half 2 months after Georgia loosened some of the lockdown restrictions.

There are only two useful statistics in all of this.  The moving average of the daily death rate and the number of COVID19 cases in the hospital.  I no longer follow the number of new cases, because they include people with a positive antibody test (all of whom have recovered).  We know that most cases are asymptomatic.  It’s very hard to get the second number of people sick in the hospital with COVID19 (I’ve tried with no luck).  COVID19 used to mean that you were sick — no longer, it now counts positive antibody tests, rendering the number relatively useless.  By choosing who to test, numbers can be easily inflated — https://luysii.wordpress.com/2020/06/22/new-york-city-covid-19-cases-spiked-today-stock-market-futures-tank/

Daily death rates are great for cherry picking scare headlines — it’s worth looking at this article from Tampa — https://www.wtsp.com/article/news/health/coronavirus/florida-coronavirus-cases-hospitalizations-deaths/67-4bbd0c35-6742-4f51-a59a-ea1d101f54ea

It contains a great figure with the number of deaths each day from March onward on which is superimposed the moving average — the range is from 10 to 100.  Even more impressive is the fall on weekends and the rise during the week.

Fortunately, every Friday  Florida releases the weekly results for antibody testing, so we’ll be able to see how many of these new cases of COVID19 are people who have recovered from it.

Here’s another link — well worth looking at — with the number of new cases in Florida in one graph (with the marked increase in the past week) and the number of death from the disease just below.  The deaths in the past week are the lowest they’ve been in a month — https://experience.arcgis.com/experience/96dd742462124fa0b38ddedb9b25e429

A Tale of Two States (with apologies to Dickens), the denouemont

Two days I posted the following puzzle — here is the answer and a bit more

A friend in med school, a classic University of Chicago graduate, was fond of saying “that’s how it works in practice, but how does it work in theory?”

Well, this country is currently in the midst of an immense social experiment (lockdowns) essentially based on theory (models).

We’re about to find out how it worked in practice.

Here are some recent statistics from two states.

State 1

3 day moving average of new cases of COVID19 ending 25 April — 2778

3 day moving average of new cases of COVID19 ending 13 May — 901

3 day moving average of daily deaths from COVID19 ending 25 April — 177

3 day moving average of daily deaths from COVID19 ending 13 May9 — 96

 

State 2

7 day moving average of new cases of COVID19 ending 25 April — 740

7 day moving average of new cases of COVID19 ending 13 May — 525 (the state allows 14 days for all the data to roll in, so the last date they regard as having secure numbers is the 7th of May and here the number is 539)

7 day moving averages of deaths from COVID19 ending 25 April — 35

7 day moving average of deaths from COVID19 ending 13 May — 24 (the state allows 14 days for all the data to roll in, so the last date they regard as having secure numbers is the 7th of May and here the number is 27).

One state loosened its lockdown restrictions 25 April, the other had them in effect through 13 May.  Your job is to figure out which one did and which one didn’t.

The denouement — State 1 is Massachusetts (which kept the lockdown) and State 2 is Georgia which loosened them on the 25th of April.

As usual, actual data answers some questions but raises new ones.  Contrary to the disasters predicted (see later), in Georgia the new cases of symptomatic pandemic flu declined by 29% and the number of deaths declined by 22%.  The 13th of May is way past the longest possible incubation period for cases beginning prior to 1 May.  So from this, the conclusion one might draw is that the lockdown was ineffective.

But hold on. Massachusetts also showed declines in new cases and deaths, and by greater amounts 68% and 46% than Georgia (29 and 22%)  implying the lockdown was of some use (in accelerating the decline in cases and death).

Pandemics and epidemics have a natural history of peak and decline, in the USA our pandemic is on the decline.

People who assumed (on purely correlative evidence) that lockdowns prevented new cases, and that lifting them would cause a marked increase in new cases and deaths, are clearly wrong.  It’s possible that cases will spike in the future proving them right, but pretty unlikely.  It’s only fair to give the doomsayers a sporting chance and followup is planned in a month.

Here are a few predictions of doom.  Future predictions and definitive statements from these sources should be taken with a grain or more of salt.

From The Atlantic — “Georgia’s Experiment in Human Sacrifice — The state is about to find out how many people need to lose their lives to shore up the economy.” — https://www.theatlantic.com/health/archive/2020/04/why-georgia-reopening-coronavirus-pandemic/610882/

A Tale of Two States (with apologies to Dickens)

A friend in med school, a classic University of Chicago graduate, was fond of saying “that’s how it works in practice, but how does it work in theory?”

Well, this country is currently in the midst of an immense social experiment (lockdowns) essentially based on theory (models).

We’re about to find out how it worked in practice.

Here are some recent statistics from two states.

State 1

3 day moving average of new cases of COVID19 ending 25 April — 2778

3 day moving average of new cases of COVID19 ending 13 May — 901

3 day moving average of daily deaths from COVID19 ending 25 April — 177

3 day moving average of daily deaths from COVID19 ending 13 May9 — 96

 

State 2

7 day moving average of new cases of COVID19 ending 25 April — 740

7 day moving average of new cases of COVID19 ending 13 May — 525 (the state allows 14 days for all the data to roll in, so the last date they regard as having secure numbers is the 7th of May and here the number is 539)

7 day moving averages of deaths from COVID19 ending 25 April — 35

7 day moving average of deaths from COVID19 ending 13 May — 24 (the state allows 14 days for all the data to roll in, so the last date they regard as having secure numbers is the 7th of May and here the number is 27).

One state loosened its lockdown restrictions 25 April, the other had them in effect through 13 May.  Your job is to figure out which one did and which one didn’t.

Answers tomorrow, with a lot more.

 

 

Georgia is the canary in the coal mine

The decision of the Georgia governor to relax some restrictions on activity and commerce 25 April was not met with universal acclaim.  In fact here’s how an article in the usually rather stolid The Atlantic puts it

       “Georgia’s Experiment in Human Sacrifice

The state is about to find out how many people need to lose their lives to shore up the economy.”

The presidential election will be decided in the next month — revision for clarity

Apologies to all for the previous post which was far murkier than it could have been.  The problem was that a ‘case’ of the pandemic coronavirus can mean 3 very different things.  These distinctions are tedious but crucial.

Meaning #1 — COVID19 — People who are clinically ill with the virus (official name SARS-CoV-2).  These are the people that  may die of the illness, although most do not.

Meaning #2 — The viral genome has been found in your saliva.

Meaning #3 — You have antibodies to the virus in your blood.

Here is the distinction between #2 and #3 — Antibodies (proteins) and genomes (RNA) are completely different chemically. Finding the actual genome (RNA in this case) of a virus in an individual  is like seeing a real bear up close and personal.  This can do you some damage.  In contrast, antibodies to the virus are made by an individual who has been infected by the virus in the past.       Antibodies are like seeing the tracks of the bear without the bear itself. You can’t see tracks without the bear having been present at some point in the past.  Antibodies mean you were infected at some point whether you knew it or not.

OK, so here’s another shot at what was I saying in the previous post.

I find it very sad that loosening the restrictions on activity has become so political. The left says that it will be a disaster and that cases and deaths will spike (meaning #1). As far as I’ve seen, they never say they hope they’re wrong.  The right says that deaths will continue, but the rate won’t increase.  There is evidence for both sides, but in the coming months we’ll actually have data one way or the other.

One thing is certain.  The number of cases of positive viral culture (meaning #2) will increase.  It has to because more people will be tested. So far, we’ve only studied around 1/1,000 of the population.  No one has ever said the lockdown will prevent new infection.  It hasn’t, but it has slowed things down.

I’m hoping that cases of COVID19 and death will not explode.  Not because I want Trump to win, but because getting people back to work  would be good for the country.  Should that happen, the anger of those who lost their jobs or businesses during the shutdown will be formidable.  Trump will win.

Should deaths from COVID19 explode (meaning #1) as restrictions are lifted, Trump is toast.

We should also get some idea of the percentage of the population who have been infected (manifest by antibodies to the pandemic virus meaning #3).  It almost certainly will increase, unless those already showing the antibodies lose them (which is unheard of happening this fast inFor  the antibodies we’ve studied in the past).

I’m cautiously optimistic that not much will happen when restrictions are eased. Here’s why.  All the studies on antibodies (meaning #3) done so far show they are 10 – 100 times more prevalent than cases where the virus is cultured (meaning #2).  For example 20% of Manhattan sampled population have the antibodies.  This implies that most infections with the pandemic coronavirus are asymptomatic.  

Another viral disease with a high prevalence of antibodies is infectious mononucleosis.  90% of adults in the USA have antibodies to mono, but far fewer than 90% were ever sick.

So the number of cases with positive culture (meaning #2)  isn’t what’s important.  It’s how many of them get sick with COVID19 (meaning # 1).  I think we have very good past statistics on the number of deaths and cases of COVID19   It will be clear if there is a spike in COVID19.

However be careful not to read too much into the first week’s statistics after restrictions are lifted, as there is a lag period of 2 – 11 days between infection and clinical illness.  Also try to understand which of the 3 meanings of “case” the article you are reading is talking about — this won’t always be possible.

 

The presidential election will be decided in the next month

I find it very sad that loosening the restrictions on activity has become so political. The left says that it will be a disaster and that cases and deaths will spike. As far as I’ve seen, they never say they hope they’re wrong.  The right says that deaths will continue, but the rate won’t increase.  There is evidence for both sides, but in the coming months we’ll actually have data one way or the other.

One thing is certain.  The number of cases of positive viral culture will increase.  It has to.  We’ve only studied around 1/1,000 of the population.  No one has ever said the lockdown will prevent new infection.  It hasn’t, but it has slowed things down.

I’m hoping that things stay pretty much the same.  Not because I want Trump to win, but because getting people back to work  would be good for the country.  Should that happen, the anger of those losing jobs, businesses will be formidable.  Trump will win.

Should deaths from COVID19 explode, Trump is toast.

We should also get some idea of the percentage of the population who have been infected (manifest by antibodies to the pandemic virus).  It almost certainly will increase, unless those already showing the antibody lose them (something unheard of this fast given the antibodies we’ve studied in the past).

I’m cautiously optimistic that not much will happen when restrictions are eased. Here’s why.  All the studies on antibodies done so far show they are 10 – 100 times more prevalent than cases where the virus is cultured.  20% of Manhattan for example.  This implies that most infections are asymptomatic.  So the number of cases with positive culture isn’t what’s important.  It’s how many of them get sick with COVID19 (which is the clinical illness produced by the pandemic coronavirus).  I think we have very good past statistics on the number of deaths and cases of COVID19   It will be clear if there is a spike in COVID19.  Be careful not to read too much into first week’s statistics after restrictions are lifted, as there is a lag period of 2 – 11 days between infection and clinical illness.

If you are uncertain about the difference between virus culture and antibodies to the virus — have a look at this.

Finding the actual genome (RNA in this case) of a virus in an individual  is like seeing a real bear up close and personal.  This can do you some damage.  In contrast, antibodies to the virus are made by an individual who has been infected by the virus in the past.  Antibodies (proteins) and genomes (RNA) are completely different chemically.      Antibodies are like seeing the tracks of the bear without the bear itself. You can’t see tracks without the bear having been present at some point in the past.

The death of amateur chamber music playing

Compared to the death, bereavement and economic pain of the pandemic the end of music making by amateur chamber musicians is a small thing.

Why do I say this?  You can hardly do better than the following link —

https://erinbromage.wixsite.com/covid19/post/the-risks-know-them-avoid-them

Here is a quote from it — “Indoor spaces, with limited air exchange or recycled air and lots of people, are concerning from a transmission standpoint. We know that 60 people in a volleyball court-sized room (choir) results in massive infections. Same situation with the restaurant and the call center. Social distancing guidelines don’t hold in indoor spaces where you spend a lot of time, as people on the opposite side of the room were infected.

The principle is viral exposure over an extended period of time. In all these cases, people were exposed to the virus in the air for a prolonged period (hours). Even if they were 50 feet away (choir or call center), even a low dose of the virus in the air reaching them, over a sustained period, was enough to cause infection and in some cases, death.”

Does this sound like amateur chamber music to you?  Particularly at summer festivals where hordes of the most vulnerable age  groups get together, eat together, play together, socialize together.

Is there hope that this will be transient?  Yes.  Here’s why.

First some background.

I’m sorry to keep putting this in, but I don’t want to leave anyone behind. Finding the actual genome (RNA in this case) of a virus in an individual  is like seeing a real bear up close and personal.  This can do you some damage.  In contrast, antibodies to the virus are made by an individual who has been infected by the virus in the past.  Antibodies (proteins) and genomes (RNA) are completely different chemically.      Antibodies are like seeing the tracks of the bear without the bear itself. You can’t see tracks without the bear having been present at some point in the past.

Well we’re in that situation in the USA.  Based on many studies now (California, New York State, Prison systems) the number of people who’ve been exposed to the virus enough to develop their own antibodies to it, is anywhere from 10 – 100 times greater than the number of people in whom the viral genome has been found.  This means that the vast majority of infections with the new coronavirus are asymptomatic.

So that’s the good news (but only if 3 things are true)

l. The antibody tests are accurate

2. Having the antibody means you won’t get sick if exposed to the virus

3. Having the antibody means you are free of the virus and can’t possibly transmit it to other people.

As of 10 May none of these are known with any degree of certainty, but if antibodies to the pandemic flu are like all the antibodies we’ve studied in the past they very likely are true.   It will take several months before this is all sorted out.

Things to watch out for in press accounts.

The number of known infections is certain to rise.  Officially we have currently tested around 500,000 people for the virus — way less than 1% of the population.  As more people are tested more cases will be found.

The important figure to watch is how many people have been made sick by the virus, not the number of people in whom the virus has been found– the technical term for the disease (not the virus) is COVID19.

Fortunately, I’m an amateur pianist with a huge literature for solo piano to explore (48 Bach Preludes and Fugues, 32 Beethoven sonatas, 60+ Haydn sonatas, 500+ Scarlatti sonatas, 16 Mozart sonatas).  My string  and wind instrument  playing friends aren’t so lucky.  But I miss them.