Month: July 2020

Notice, I’m not saying “intelligent leadership”.  I’m not even saying “effective leadership”.  Just “leadership”.

This brings together all my “school of hard knocks” posts.  And related.  And boils down to dinosaurs.  We, in the US, have become dinosaurs.  Ponderous, slow, fundamentally stupid — dinosaurs.

Recall that, three months+ ago, I, a no-credentials blogger (eh, well, Ph.D. economist), talked about the German use of pooled testing for COVID-19, in a math-oriented post (Post #605).

That’s German, as in Germany, the country.  The country that is succeeding in dealing with COVID-19.

Three.  @#$(ing.  Months.

And today, we find out that the US FDA has issued an “emergency” authorization to allow some (not all, but some) US labs to do something like what the Germans were doing three months ago.

You do have to wonder what their definition of “emergency” is.

Not stupid enough for you yet?  Let’s look at some direct quotes:

FDA Commissioner Dr. Stephen Hahn said in the statement. “Sample pooling becomes especially important as infection rates decline and we begin testing larger portions of the population.”

Yeah, that’s really what’s key right now.  We really have to be looking forward to the point where infection rates decline.

Ah, let’s just finish this with one final quote:

“Quest said in a statement it expects to deploy the testing technique at two of its laboratories by the end of next week, and additional laboratories will follow.”

Two laboratories.  End of next week.

For those of you who have no professional interest in health care, Quest is, (I think) the largest laboratory services provider in the USA. If they aren’t #1, then they are #2.

And, maybe, two of their labs, next week, might be set up for this.

Better watch out.   I hear there’s an ice age coming.

See, the thing is, bureaucracies, in and of themselves, may eventually get to the right answers.  But bureaucracies are, by their nature, ponderously slow.

That’s why you need leadership.  Something that countries outside the US have had, to varying degrees.

But absent that, the you get what we’re getting.  Eventually, we’ll probably get something close to the right answers to whatever questions actually got asked.

And that’s our COVID-19 response, in a leadership vacuum.

Have we stopped being stupid yet?  In the US, regarding COVID-19?

Oh, heck no. 

The only school that’s still fully in session is the school of hard knocks.   And that one’s doing a bang-up business.

Source:  zippythepinhead.com  This image is copyright Bill Griffith, and is used without permission.  But with the notation that “Are we having fun yet??” in fact originates with Bill Griffith/Zippy the Pinhead, but has been so frequently copied that many people incorrectly believe the source is apocryphal. Continue reading Post #760: Have we stopped being stupid yet?

My standard graphs, updated to today (7/17/2020), are below.

At this point, it does not look like they are going to get exponential case growth in the Hampton Roads area.  But it may be too soon to tell.  As of today, it just looks like they went from a steady 300 new cases a day in the early-reopening portions of Virginia, to 800 new cases a day.

Otherwise, the story remains unchanged.  The late-reopening areas are doing OK.  Most of the state outside of the Hampton Roads area, mostly ditto.  Hampton Roads are, not so much.

Oddly, Vienna (22180) picked up 11 new cases last week, which is quite a bit higher than rate observed for the past few weeks.

Virginia (blue) versus Fairfax County (orange)

Late-reopening areas (blue, NoV+Richmond+Accomack) versus rest-of-state (orange)

Vienna, VA area ZIP codes.  Figures are today, and one week ago.

Here are my standard charts, updated to 7/13/2020.

In Virginia (blue, below), the seven-day moving average of new cases reached 800.  In Fairfax (orange), the seven-day moving average was steady at about 50 cases per day.  Both of those would be expected to rise a bit in the coming days as some low-count days pass out of the seven-day window, replaced by the most recent high-count days.

The problem continues to be outside of the late-reopening areas (Blue below, consisting of NoVA, Richmond City ,Accomack County).  Presumably, the problem continues to be in the Hampton Roads area, but I did not explicitly check that.

 

Source:  New York Times 7/13/2020  Red and green markings were added for purposes of illustration.

1:  Young people.  The cases that are showing up, in these outbreaks, are far younger, on average, than COVID-19 cases to date.

2:  Explosive growth.  A second outstanding factor in those states was the extremely rapid ramp-up in the case load.  On the graphic above, the green line shows the worst rate of case growth experienced in Virginia.  If you look carefully, you can see that in the three key states, they went from well under that level well over that level in a single week.  And from there, to crisis levels of daily new cases in another week or two.  From “everything is fine” to “public health emergency” in the span of a few weeks.

3:  Relatively few deaths, as shown below.  In part, that’s because deaths lag infections by a couple of weeks, on average.  But these upticks have gone on long enough now that we can also say this is partly “real”, in the sense that the mortality rates do not (now) appear to be climbing as steeply as the new case counts did.

Source:  New York Times 7/13/2020  Red markings were added for purposes of illustration.

The fact that 1) and 3) are related is obvious:  The mortality rate ramps up steeply with age, and COVID-19 mortality case rate among young people is quite low.  I discussed this in Post #730, where I estimated the impact the shift in age mix on average mortality using data from the Virginia.

But I bet that 1) and 2) are also related.  Not due to “bad behavior” by young adults, per se.  (Though that certainly may contribute).  I think low age and explosive growth may go hand-in-hand merely as a matter of arithmetic.

This conclusion is an expansion of the addendum portion of Post #723.  The cases that get counted are just the tip of the iceberg of all infections.  Lately, FWIW, CDC estimated that there are, on average about 10 infections for every reported (diagnosed, tested) case.  (I saw FWIW, because that’s based on a sample of convenience in a handful of sites.)  But I’ll bet that with young adults, the size of the iceberg (all infections) is vastly larger than the tip of the iceberg (cases testing positive for COVID-19). 

And in that situation, you would, as a matter of arithmetic, expect the counted cases to grow much more rapidly.  In other words, for a given uptick in counted (diagnosed) cases, your actual underlying epidemic is much worse if those cases are all young people.  By interpreting the early upticks in these states using  historical norms for a much older COVID-19 population, the states missed out on just how widespread these outbreaks were.

If true, this matters to us here in Virginia, because the recent uptick in cases (see next post) in the Hampton Roads area has been reported to be due to cases concentrated among young adults.  If the theory above is right, then the current case counts underestimate total new infections by a much larger margin than has been historically true.  And so we risk seeing the type of unexpected explosion of case counts as has been noted elsewhere when this has morphed into a young person’s epidemic.

Details follow.

Continue reading Post #755: COVID-19, younger people, and explosive growth. A theory, but no data.

Source:  US Centers for Disease Control.

I first wrote about convalescent plasma in Post #616, 4/9/2020.  The idea being, you take people who have recovered from COVID-19, filter the antibodies to COVID-19 out of the their blood, and give those antibodies to others, where they would help the recipients to recover from a COVID-19 infection. Continue reading Post #754: Convalescent plasma, updated