Tuesday, May 12, 2020

Wave II Is Looking Like A Doozy


Late yesterday, NBC News broke an interesting story. The White House has been hiding a secret report showing coronavirus cases spiking in Trump country. With Trump Happy Talk Hour asserting that cases are falling everywhere, his own task force's report contradicts him, showing the virus is spreading far from the coasts.

Jonathan Allen reported that the data in a May 7 coronavirus task force report are at odds with Señor Trumpanzee's declaration Monday that "all throughout the country, the numbers are coming down rapidly." Tell it to the folks in Amarillo, Texas and Central City, Kentucky. Amarillo is the only city in Potter County, which voted 19,499 (68.8%) Trump and 7,620 (26.9%) Hillary. Central City is in Muhlenberg County, which is even Trumpier-- 72.0% to 25.1% in 2016. Central City just saw a 650% increase in a week. Other cities with big spikes include Nashville, Des Moines, Charlotte, Kansas City, Omaha and Lincoln in Nebraska, Phoenix, Minneapolis, Montgomery in Alabama, Columbus in Ohio and Kenosha and Racine counties in Wisconsin.
The spiking infection rates suggest that the pandemic is spreading quickly outside major coastal population centers that were early hot spots, while governors of some of the states that are home to new hot spots are following Trump's advice to relax stay-at-home restrictions.

Alabama, Kentucky, Iowa, Missouri, Nebraska and Tennessee, for example, have no stay-at-home orders, according to a task force map. In other states where restrictions are being put in place or repealed at the local level, some counties are experiencing surges. Dallas and Fort Bend counties in Texas, where decisions are made locally, are on a "locations to watch" list because they have recorded increases in numbers of cases of 116.8 percent and 64.8 percent, respectively.

Senate Majority Leader Mitch McConnell (R-KY), whose state included the nation's highest-surging geographic area, said Monday that he has "felt no urgency" for Congress to approve another coronavirus response bill.
States that are competing for the most infections in Wave II include this list, along with the Monday numbers of cases per million:
Nebraska- 4,431
South Dakota- 3,976
Iowa- 3,922
Indiana- 3,658
Colorado- 3,452
Mississippi- 3,251
Georgia- 3,202
Virginia- 2,937
Kansas- 2,422
New Mexico- 2,417
Tennessee- 2,276
Ohio- 2,121
Minnesota- 2,092
Alabama- 2,073
Nevada- 1,997
North Dakota- 1,992
Utah- 1984
Florida- 1,908
Wisconsin- 1,789
California- 1,745
Missouri- 1,654
Arizona- 1,563
South Carolina- 1,513
Kentucky- 1,495
Texas 1,409
Yesterday, NY Times reporter Donald McNeil spent some time looking at this second wave. "Millions of working people and small-business owners who cannot earn money while sheltering at home are facing economic ruin. So dozens of states, seeking to ease the pain," he wrote, "are coming out of lockdown. Most have not met even minimal criteria for doing so safely, and some are reopening even as coronavirus cases rise, inviting disaster. The much-feared 'second wave' of infection may not wait until fall, many scientists say, and instead may become a storm of wavelets breaking unpredictably across the country. The reopenings will proceed nonetheless. The question now, scientists say, is whether the nation can minimize the damage by intelligently adopting new tactics." I wouldn't bet on it. The U.S. seems determined to have the worst plague on any country in the world. After all, as he wrote, "As the weather warms, Americans are already struggling to stay at home or remain six feet apart on crowded beaches, hiking trails and park playgrounds. Every crowd may have some silent carriers of the virus."
Evidence is mounting that masks-- if worn in public places, by everyone-- are far more effective at stopping transmission than was previously realized. Across the nation, testing remains wholly inadequate, but home-use nasal swabs and saliva tests are on the way that may provide a clearer picture of where the virus is.

...Outside New York, California and a few other states, many Americans refuse to wear masks, and governors and mayors have waffled over whether to order them to. The dispute has even led to threats and a killing.

Fifty brands of antibody tests are available, but many are inaccurate. Many states are moving too quickly for employers and retailers to make environments safe. And the lockdowns have become entwined in partisan politics, with some libertarian extremists, gun-rights advocates and anti-vaccine activists painting them as an infringement of personal freedoms.

Deaths are already far higher than the 60,000 once predicted by August. Even President Trump has begun to talk of a toll that may reach 100,000, perhaps more.

Some epidemiological models predict three times that many within months — closer to the 240,000 that the White House’s coronavirus task force predicted in March before switching to a new, more optimistic model.

Dr. Anthony S. Fauci, the task force’s chief medical adviser, has said he expects cases to spike in closed environments like nursing homes, prisons and factories.

“We’re not reopening based on science,” said Dr. Thomas R. Frieden, a former director of the C.D.C. in the Obama administration. “We’re reopening based on politics, ideology and public pressure. And I think it’s going to end badly.”

The effects of the reopenings will not be immediately apparent, and in the absence of widespread testing, it will be hard to know where the country stands in the fight against the virus.

It takes two or three weeks for the newly infected who become severely ill to need hospitalization. An initial calm may encourage more Americans to drop their guard or more governors to ease restrictions.

“I do worry that people will stay home enough in the states that open earliest so that we don’t immediately see the second wave, and then other states will draw the wrong lessons,” said Dr. Leana Wen, a former health commissioner of Baltimore.

Social distancing has proved effective at interrupting viral transmission in places where it was embraced. But now even formerly terrified New Yorkers, living at the center of the nation’s outbreak, are clearly wearying of it.

Central Park, which was so quiet in late March that the birdsong was startlingly loud, is often crowded with joggers, strollers and cyclists. Avenues that were ghostly canyons now have far more cars, Mayor Bill de Blasio has complained, and steady traffic has returned to some local highways.

Viruses persist only because they can exploit human interactions: a stray cough, a plume of virions behind a jogger, a bicycle handle no one has disinfected.

...For now, the lofty goal of tracing and testing the contacts of every infected person remains unthinkable. Epidemiological models in the United States and data from China suggest that each case generates about 50 contacts, so the 25,000 new daily cases in the United States generate another 1.3 million contacts to find each day.

Even under ideal circumstances, a team of five tracers takes about three days to find 50 contacts. So, if the number of trained contact tracers were increased to 100,000-- from 3,000, the most recent tally-- the daily case count would still have to drop below 5,000 just to stay even, assuming the tracers worked five-day weeks.

But the daily load is barely dropping below 25,000.

Digitally automating the job has been proposed. But for Bluetooth and GPS apps like those used in South Korea to work in the United States and find a useful percentage of a victim’s contacts-- about 80 percent, calculated Tomas Pueyo, author of an article titled “Coronavirus: How to Do Testing and Contact Tracing”-- Apple and Google would have to update their smartphone operating systems with built-in tracking apps that all cellphone owners would by law have to use. Also, neither location data nor Bluetooth could be turned off.

Americans are unlikely to accept that, Mr. Pueyo conceded.

“We fear 1984,” he wrote. “We want to avoid an A.I.-driven world where the government knows our every movement, rates us according to our behavior, and soon tells us what to think.”

Making masks obligatory has strong potential to cut down transmission, according to new evidence not just from Asia, where masks have long been common, but also from the Czech Republic, Germany, Israel and other countries, according to Masks4All, an advocacy group.

The single biggest mistake made in the United States and some European countries that have failed to control their epidemics “is that people aren’t wearing masks,” argued Dr. George F. Gao, the Harvard- and Oxford-trained director of China’s Center for Disease Control.

Outside New York, California and a few other states, many Americans resist wearing them.

Gov. Mike DeWine of Ohio rescinded an order to wear masks after state residents “felt affronted,” he said. Officials in Stillwater, Okla., dropped a municipal order after store clerks who asked barefaced customers to stay outside were threatened.

The issue has become mired in politics: the president won’t wear one, some protesters have compared them to Muslim face veils, and a shopper at a supermarket requiring masks wore a Ku Klux Klan hood.

In the absence of detailed national reopening standards, governors are setting their own, and some allow far closer human contact than others do.

It is or will soon be possible in 19 states to get your hair cut or roots dyed, for example. Many states are letting restaurants reopen with restrictions that require six feet between diners, outdoor seating only or disposable menus.

By contrast, Gov. Andrew M. Cuomo of New York has refused to even set a date for easing restrictions everywhere in the state, although three regions will be allowed to partially reopen on May 15. Although hospitalizations and deaths are steadily declining, he said, they are still dropping too slowly.

“All of this inconvenience, all of this turmoil, for what?” he asked this month. “To keep 100,000 people out of our hospitals, that’s for what.”

When restrictions are lifted, he said, the state’s least-affected central counties will go first and each economic sector will be phased in slowly: construction and factory jobs first, and retail establishments that can deliver goods curbside. Next: banks, insurance, law firms and other professions. Then restaurants and hotels, and finally entertainment, sports and schools.

One of the most difficult decisions is when to open primary schools. Doing so is crucial to getting young parents back to work, but scientists are still unsure about how much children spread the disease to their families. France is reopening its schools this week, as are some regions of Australia and much of Europe, so there may be some data soon on the question.

Unlike New York State, Florida, Tennessee and Texas are reopening as their cases and deaths are spiking to new highs, which means, experts said, that it is impossible to know when or how high they will peak.

If that happened, a wave of unexpected deaths could deliver some sharp political shocks, researchers predicted.

“Excess fatalities may mean some serious consequences for the governors,” said Dr. Irwin Redlener, director of the disaster preparedness center at Columbia.

Frustrated Americans, eager to break out of lockdowns, often do not realize how lax this country’s strictures are compared with those imposed elsewhere.

In Chinese cities, only a tiny corps of essential workers was allowed to leave home for months. There was virtually no travel between cities.

People lucky enough to live in apartment complexes with internal gardens could walk there; others had to stay indoors, unable to shop even for food or medicine. Building committees pooled grocery orders and distributed them internally.

No city in China was allowed to reopen until it had reached 14 days of zero new cases — a standard that no American city is expected to meet.

In Italy, many residents were not allowed to go more than 200 yards from their homes without written government authorization. Police roadblocks enforcing that rule were everywhere.

If deaths in the United States surged, harsh measures like those could, in theory, be imposed.

The 1918 Spanish flu provides some lessons.

A new analysis of that epidemic from the National Bureau of Economic Research in Cambridge, Mass., concluded that various lockdown measures had “clear success” in lowering death rates. But they ultimately failed to curb overall mortality in most cities because they were lifted prematurely.

...Dr. Frieden, the former C.D.C. director, now runs Resolve to Save Lives, the public health advocacy group that has issued detailed reopening guidelines.

“Every day, I look at the two models for approaching this,” he said. “The China model, which is to use the world’s most authoritarian regime and best digital tracking system to hunt down and stop every case and then wait for a vaccine. So far, it’s working.”

By contrast, he said, Sweden is trying to achieve “herd immunity” by letting young, healthy people become infected at what they hope will be slow, steady rates. Primary schools are open, higher ones are closed, everyone is asked to be careful in public and older adults are asked to stay home.

Israel is roughly following Sweden’s model, Dr. Frieden said, just as Asian countries are roughly following China’s.

“And then,” he added, “there’s the American approach, which is: ‘What the hell — I heard something on Fox News. Let’s try it!’”

Sweden’s model does look appealing. Television news programs have shown smiling Swedes drinking in outdoor cafes, shopping for clothes, getting their hair restyled and enjoying other little pleasures that Americans have been denied for many weeks now.

But Sweden is paying a high price, and Dr. Frieden rated its success as “still to be determined.”

As of Sunday, its per capita death rate is 319 per million Swedes, which is higher than the figure in the United States, which is 242 deaths per million.

Other Scandinavian countries, with varying degrees of lockdown, have far lower death figures: 91 per million in Denmark, 40 in Norway, 48 in Finland and 29 in Iceland.

Having 50 states and more territories do competing and uncoordinated experiments in reopening is “daring Mother Nature to kill you or someone you love,” Dr. Frieden said. “Mother Nature bats last, and she bats a thousand.”

Labels: , , ,


At 2:23 PM, Anonymous Anonymous said...

otoh, it's entirely possible that the spike in CASES (defined as positive tests?) is simply because a few more tests are being done because almost zero tests WERE being done.

The numbers and trending of corpses is the only metric that will mean anything. Measuring the numbers/trends of positives out of the paucity of actual tests being done is about as meaningful as reading Goethe to your favorite potted ficus at home.

Wave II might be a lot like a continuation of wave I except less of wave I is hidden in the fog (of delusion).

At 2:34 PM, Anonymous Anonymous said...

The elites WANT us to sicken and die. The spectacle of the proles suffering is entertaining to them.


Post a Comment

<< Home