No spike in cases

Source:  Analysis of data from the Virginia Department of Health.

You may have read that Virginia reported a big spike in coronavirus cases yesterday.  Reported is the operative word there.  The “spike” is an artifact of data reporting, not an actual uptick in cases.

Note that the next-to-last bar above is very short, and the last one (the “spike”) is very long.  That’s because most of the cases, for both days , were reported on 5/25/2020.

The Virginia Department of health says this:

VDH Statement on May 25th COVID-19 Data - VDH performed maintenance on its disease reporting system yesterday. COVID-19 data reported during that time were added to today's numbers.

The reality of it is far more boring:  Fairfax keeps producing 200 to 300 new cases a day, and Virginia keeps producing 800 to 1000 new cases a day.  And Vienna (ZIP 22180) keeps producing maybe 4 or 5 a day, on average.

 

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Hydroxycholorquine plus zinc cut death rate in half in one large observational study.

In all of the chaos surrounding the President, people have lost sight of the fact that hydrocychlorioquine was being studied as a COVID-19 treatment for some very good reasons.  I’m not not to do citation of sources here (because I already did an entire post on this drug), but in a nutshell:

• It was shown to be effective in vitro (in a test tube) against the first SARS outbreak (SARS 2003).
• It was then tested and shown to be very effective in vitro against the current SARS (SARS-CoV-2, or COVID-19).
• It was already in NIH-registered clinical trials as a prophylactic (preventative) against COVID-19, for health care workers, combining a low dose of hydrocychloroquine with zinc supplements.
• There were seemingly credible case reports from widely-separated US physicians, to the effect that early treatment with the combination of zinc and hydroxychloroquine seemed effective.
• The presumed mechanism of action was that hydroxychloroquine was one of just a handful of zinc “ionophores”, substances that allow zinc to cross cell membranes.  High intra-cellular zinc levels were shown to suppress replication of the virus.

You’ve all now seen the results of a large scale “observational data” study, showing that hospitalized patients who were given hydroxychloroquine did remarkably worse than those who weren’t given it.  My recollection is that those who were given hydroxychloroquine had a death rate that was almost 50% higher than those who weren’t.

In my career, I probably did 30 or 40 such observational studies — when I couldn’t talk my clients out of it.  And without notable exception, they always showed that people who were given the drug (device, treatment, etc.) did worse that those who weren’t.  For the simple reason that you only give the drug (device, treatment, etc.) to very sick people.

In these observational studies, the overwhelming direction of causation runs from severity of illness to the treatment given.  Any modest effect that the treatment may have had, on severity of illness, gets swamped by that.

In all likelihood, that observational study reflects the fact that hydroxychloroquine — an unproven drug with significant side effects — was only used as a last resort.  Doctors took a flyer on that, on average, for patients who were at considerable risk of death.  Further, the studies didn’t use the drug in combination with zinc, which, per physician case reports, is the combination that works.

And now there’s a different observational study out, this time comparing hydroxychloroquine plus zinc to hydroxychloroquine alone or in combination with other drugs.  In other words, this is a look with a population that was sick enough that the physicians decided to take a chance on hydroxychoroquine.  While the use of zinc supplements or not was not randomized, the comparison of treatment and control arms certainly makes it look as if they were pretty much chosen at random — no difference between the two.  Reading between the lines, the necessity of supplementing with zinc only became public half-way though their study, so they added it to the protocol.  So this is more-or-less a pre-post comparison of patients, in a single hospital, where zinc was added to the hydroxychloroquine protocol.

This study — not yet peer-reviewed, but available as a pre-print — concludes the following:

After adjusting for the time at which zinc sulfate was added to our protocol, an increased frequency of being discharged home (OR 1.53, 95% CI 1.12-2.09) reduction in mortality or transfer to hospice remained significant (OR 0.449, 95% CI 0.271-0.744). Conclusion: This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19.

In a nutshell, the odds ratio (OR) for dying/going to hospice (0.449) means that  those who were given the zinc were half as likely to die.  The odds ratio for being transferred to home (meaning, well enough to get by without post-acute care, and not dying in the hospital) show that those given zinc were about 50% more likely to be able to go home unaided.

I get the feeling that this study isn’t going to get much press, so I thought I would bring it forward here.

Fact is, this is an exceptionally cheap treatment.  And, from what I’ve seen, those odds ratios are better than what you can achieve with the best anti-virals.  Those anti-virals cost, oh, thousands of times more than the combination of zinc and hydroxychloroquine.

Because no drug manufacturer stands to profit from this treatment, any tests of efficacy will have to be done outside of the drug industry.  And any push to get results made public, ditto.

 

 

 

Key graphs and links for COVID-19 in Virginia and Fairfax County

Quick bottom line:  Back to the new normal.  Maybe 900 new cases a day in Virginia, maybe 250 new cases a day in Fairfax, maybe 4 new cases a day in ZIP 22810.  There was a little spike in cases over the past week, but the seven-day moving average remains more-or-less flat.

Continue reading Updated 5/27/2020, Coronavirus graphs and key links

Above:  Daily new COVID-19 cases in Montgomery County, Alabama.  Source:  Alabama Political Reporter.

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Where are we, now?

Most of you can probably recall that we were told to stay at home to “flatten the curve”, with this nice, neat picture (or something like it) as the illustration.

Source:  NPR, credits CDC, Drew Harris; Connie Hanzhang Jin, NPR.

But months ago, it became obvious that the picture above was fundamentally misleading (Post #559, March 18, 2020).

And that, in fact, absent a vaccine, or the discipline to lock down enough to remove the virus from circulation, the actual picture for the USA was going to look more like this.

And, sure enough, that’s pretty much the picture today:

Source:  New York Times.

Some other countries, many with less warning and lead time than the US had, managed to get their act together and avoid the scenario above.  They effectively removed the virus from general circulation, then re-opened with caution.  They can now focus, in effect, on putting out the occasional brush fire — the sporadic outbreaks here and there.  This includes a handful of nations in the Far East, Australia and New Zealand, and a few others.

In the USA, we lacked the leadership, discipline, and patience to do that.  We never really shut down most of the economy.  Our Federal “guidelines” for re-opening were a purely political document (Post #673, April 29, 2020).  From a scientific standpoint they were a joke.  And they were widely ignored anyway.

States are being cautious, mostly.  But the fact is, we’re in the process of removing restrictions while the virus is still widely circulating.  Really, in most cases, before there had been any noticeable downturn in new cases.

I thought their most notable feature of re-opening was the complete and total absence of any discussion of failure (Post #673).  How you would recognize a failure, how you would address a failure.  In other words, near as I can tell, no government — certainly not the Federal government, and no state government that I have seen — has any mention of what to do if the virus gets out of hand again.

Literally, there is no plan for declaring a failure, or doing anything about it.  No plan for un-doing a re-opening if (e.g.) the virus begins to spread fast enough to overwhelm the local hospital system or the local morgue/funeral parlor system.

Thus violating the primary Mythbusters rule:

 

Source:  Amazon.com.  Source of the quote: Adam Savage, Mythbusters.

Bear in mind that, objectively, until such time as an effective vaccine is distributed, this is where we are on the grand sigmoid curve of the pandemic (below).  More-or-less.  Based on antibody testing, New York City is somewhere around the 15% line by now.  Most of rural America is pretty much still at zero.   And on average, the USA as a whole is likely somewhere around 3 or 4 percent, at this point.  About what the antibody assays showed for parts of California, a few weeks ago.

So far, there has been no indication that I can see that early re-opening did much of anything on a national average basis (Post #694).  Which means either that it really didn’t have an effect, or it’s just too soon to tell.  Although I note, for what it’s worth, that the decline in daily new cases has stopped, per the NY Times graph above.  (Nor has any effect shown up in the data for Virginia, yet, though it’s clearly to early to see such an effect there (Post #699).  )

But this is a big country and the portion of the curve above the “You Are Here” arrow is large.  It’s a pretty good bet that somewhere, sooner or later, the pandemic is going to get out of hand.  And so it will be interesting to see what happens, when that happens.

A sharp-eyed colleague has spotted what appears to be the first re-opening failure:  Montgomery, Alabama.  Apparently, they are out of ICU beds, and are shipping patients requiring that level of care to hospitals an hour away.  And, locally at least (by the Mayor of that city), this is being attributed to a spike in coronavirus cases following the removal of restrictions earlier in the month.

Source:  Alabama Political Reporter.

So, rapid rise in COVID-19 patients, with just about the right timing to be a result of re-opening.  Hospitals running out of ICU beds.  Patients being shipped to hospitals 90 miles away.  The Mayor holding a press conference, at the urging of local physicians, to publicize the situation.  The city’s emergency management agency director making appeals to the public.  Oh, and Memorial Day weekend just one week away.

And so, we wait with bated breath, to see what the first response to a possible re-opening failure will be.  And its …

Don’t worry about it.  This happens all the time in Montgomery.  They routinely run out of ICU beds.  It’s not an issue.  It’s no big deal.  They can handle with it.  And it’s not related to COVID-19.  Per the state’s chief health officer.

Which may or may not be true.  But is certainly the response I would expect, given that there is no plan for recognizing or dealing with failure. What seems fairly clear, at this point, if that if restrictions are re-imposed, it’ll have to be done by the Mayor of the city.  (Which, of course, will have no impact on the portion of the hospital catchment areas that lie outside the city limits.)

So this is going to be an interesting one to watch.  It’s interesting because it’s (possibly) the first re-opening failure.  It’s interesting because the State has completely and totally said it’s a non-issue.  But mostly, its interesting because of the long lag times between infection and the point where a case shows up in the statistics.   Even if they shut the city down today, they have another couple of weeks’ worth of case growth baked into the system.  This may be our first chance to see a local government deal with the hog-slaughter-cycle problem (Post #G01).  No matter how you slice it, this will definitely be a situation worth tracking.

 

Source:  Analysis of coronavirus case counts from the Virginia Department of Health.  Northern Virginia is defined as Arlington, Alexandria, Fairfax, Loudoun, and Prince William Counties and all Independent Cities within (Fairfax, Falls Church, Manassas, Manassas Park.)

Zip, so far.  No upward kink in that red line.  The Commonwealth outside of Northern Virginia began re-opening on 5/15/2020.  No VA will start two weeks later, on 5/29/2020.  That two week difference provides a “natural experiment” for detecting any large uptick in cases resulting from re-opening.

Given all the lags (between time of infection and onset of symptoms, between onset of symptoms and report of testing), we should not see any impact yet. 

And, sure enough, we don’t see anything yet.  Which is a good thing — it’s a test of this simple method.  We don’t see results where we shouldn’t.

Given how modest the first phase of “re-opening” is, I doubt we’ll see any at all  (Post #696).  I’ll redo this a couple of times over the next two weeks to see if anything shows up.

Addendum:  It’s actually No VA, City of Richmond, and Accomack County that have not re-opened yet.  Here’s the correct set of trends, where NoVA plus is NoVA plus those two other areas.  Different graph, same story.

 

Edward Jenner.  Source:  Wikipedia.

I read some truly astounding news today:  The US chipped in $1B toward development of the Jenner Institute (Oxford University) vaccine, via AstraZeneca.  And AstraZeneca agreed to provide 400 million doses with manufacturing capability for up to 1 billion (world-wide).

This doesn’t astound me on the technical or financial aspects.  It astounds me because this is absolutely the right thing to do, and the US Federal government is actually doing it.

It’s the right thing to do because a) they are ahead of everyone else, b) their vaccine looks promising, c) they’ve already lined up the manufacturing capability, and d) AstraZeneca has agreed to provide the vaccine at cost.

For those of you not up on the minutia of the US drug industry, AstraZeneca has a major local presence in its research facility in Gaithersburg, MD.  Among several other such facilities worldwide.

You can look back to my Post #677 (4/30/2020) for references to the original news coverage of this vaccine.  That’s the date on which the Jenner Institute partnered with AstraZeneca. And less than three weeks later, the USA BARDA is partnering up as well.  May miracles never cease.

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Isolationism and Crony Capitalism

Up to now, the US vaccine effort seemed to be a toxic mixture of isolationism  and crony capitalism. 

Isolationism.  When the rest of the world got together to pledge a group effort at vaccine production, and pledged to provide vaccine to the third world — the US pointedly refused to participate.

Offhand, I can’t recall the US ever, in my adult lifetime, refusing to help provide vaccines to poor nations.  Why?  Because we’re nice guys?  No.  Because we make money doing it?  No.

We did that because it’s insane not to, given the cost/benefit ratio for the vaccines in question. E.g. polio vaccine costs about a dollar a dose.  At that price, the idea that the wealthiest country on earth wouldn’t do its bit to (e.g.) try to eradicate polio just made no sense.

Trust me, I was not the only person who was shocked and appalled by the US refusal to participate internationally.  You can read several quotes here.

Historically, our leadership in this area was one of the great, unambiguously good things that the USA did for the world.  Ranks right up there with the Marshall Plan.  Or did, back when the US actually was a great nation, like, four years ago.  For us to abandon that role, at this time, is just an amazing statement about what we’ve become.  And it doesn’t speak well of us.

But today, this contribution to the Jenner Institute effort is, in effect, a back-door way to join the international effort.  Even if we only made the contribution to obtain access to the vaccine, money is money.  This helps us, and because AstraZeneca has made a strong commitment to provide this vaccine internationally, it de facto makes the US a participant in those international efforts.

Which is why I’m waiting to see if this particular move gets countermanded from above.

Crony Capitalism:  At present, the head of the Federal effort to coordinate domestic COVID-19 vaccine production is the former head of one of the companies in the running.  And so, we’re all supposed to turn a blind eye to that, and say, oh, I’m sure he’ll make a fair and even-handed choice.  Regarding the billions of dollars the US will spend purchasing COVID-19 vaccines over the next few years.

Believe what you want.  To me,this had the stench of crony capitalism.  The decision is wired, one of the good ol’ boys gets the dough, because the head of the chosen firm gets to direct the flow of tax dollars.  You, the taxpayer, get to live with the results.

The upshot:  With that as background, I had assumed that the US would just ignore the British vaccine, resulting in months of delay in getting any vaccine unto the US market.  Astrazeneca has already committed to providing 30M doses in Great Britain in September, assuming that all the trials show that the vaccine works.  (Everything so far suggests that it does, but you never know until the final test results are in).

And so, cynic that I am, I assumed that the US public would have to wait an additional half-year or so, for vaccine, so that the chosen US company could make the required high level of profits producing it.  Then, today, the US BARDA announces this decision.

So cynic that I am, I’m waiting for somebody higher up in the administration to countermand that, to protect the monopoly position of the anointed US firm.   I would normally say, that’s too cynical, but I’m not sure that phrase applies to the US federal government any more.

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In general, the vaccine situation looks promising

You will read, and you will continue to read, negative coverage about a vaccine for COVID-19.  In my opinion, the people writing that stuff understand neither the economics nor (typically) the technology of vaccines in this case.  And, weirdest of all, they completely ignore what the absolute cream of drug manufacturers, world-wide, have already pledged to do.

For example, read Post #623.  The world’s largest (and most profitable) health care manufacturer has said, they’ll have an effective COVID-19 vaccine in production by Spring 2021.  With a billion doses soon to follow.

Do you really think that organizations of that caliber and expertise are just kind of shooting the breeze about this?  Or do you think that various pundits are in the business of producing gloom-and-doom click-bait?

Let me just list a few that I know about, that have promising vaccines in the works, and either have the capability or can partner with the capability to produce the resulting product:

• Jenner Institute/Astrazeneca
• Johnson and Johnson, partnering with Janssen Pharmaceutical and Beth Israel/Deaconess hospital.
• Moderna (that’s the one that got all the recent press).
• Sanofi/Glaxo Smith Kline.

Those are just the heavy hitters that I happened to have stumbled across.  Within that small group there is a variety of methods, a range of delivery dates, and billions of doses of manufacturing capacity already committed to production.  I just find it hard to remain pessimistic given those facts.

Economics:  People who point to typical vaccine development times totally ignore the economic factors that drove vaccine development in the recent past.  Here’s what they miss:  Historically, the development of generic vaccines for common diseases was a truly lousy business to be in.  There was just no money in it, compared to alternative drugs that companies may pursue.  You can read a good overview of this at The Atlantic.

So a lot of what you read about how long it takes to produce a vaccine comes from that era.  Nobody was particularly interested, nobody could make good money doing it, and it was not in the vital national interest to see vaccines developed.  In most cases, there was only a limited market, and much of that might be in low-paying third-world countries.

And, accordingly, yeah, in the typical case, nobody was in any particular hurry to do so.  I hope it goes without saying that none of that applies to the current situation. 

Technology:  Again, much of what you will see from the pessimists, about vaccine development times, dates to earlier epochs.

When I was a kid, they literally cultured the raw material for vaccines — including the annual flu vaccine — in chicken eggs.  (No, I am not making that up.)  They would literally inoculate the eggs, one at a time.  They’d have batches of vaccine fail because the eggs didn’t turn out right.

Back in the day, that was the only approach possible.  It was time consuming, chancy, and expensive.

Now, that’s laughably out-of-date, right?  Nope, that’s still how they do it, for most flu vaccine, even today.  But at least today, for flu vaccine, that’s only one of several methods in use.

My point being,  you don’t need to incubate millions of chicken eggs to produce a vaccine any more.  (Though, apparently, that’s still a viable way of doing it, for flu vaccine.)

And the same goes for all the techniques and methods of vaccine production.

The Jenner Institute vaccine, for example, more-or-less produces a dummy COVID-19 virus, and gets the body to react to that.  So that, if the real thing shows up, the body is already producing the relevant antibodies, and will recognize and destroy the COVID-19 virus.

In this case, they took a weakened form of a cold virus and spliced in the genetic code for a key protein of the COVID-19 virus.  The resulting Franken-virus is at least as safe as the common cold, but it shows that key COVID-19 protein on its exterior coat.  And, in theory, the presence of that foreign protein in the body stimulates the immune system.  The body produces antibodies to that latch onto that specific COVID-19 protein.

That way, when the real COVID-19 shows up, the body is ready for it.  The antibodies do their job — they latch onto a specific protein, and in so doing uncurl a flag that signals the immune system to attack whatever they are attached to.  And the body mounts an immediate defense against the virus.

And this is only one of the approaches in the modern vaccine tool kit.  It’s a long way from culturing virus in eggs, carefully heating it to kill it (but not destroy key proteins), and injecting the resulting dead virus.

All I’m trying to say is that much of the historical timelines for vaccine development really don’t apply to the modern era.  Back in the day, sure, there was a strong hit-or-miss element to it.  And even today, it may prove difficult, which is why the US is backing a portfolio of contenders, and so spreading its risks.  But it would be foolish to take historical timelines as our guide to what can be achieved today.

I now have enough ZIP-level data from the Virginia Department of Health to say that the doubling time for coronavirus cases in Vienna (ZIP 22180) is about ten days.  That’s how long it took to go from the roughly 60 cases on 5/9/2020 to the roughly 120 cases on 5/19/2020.

Coincidentally, we’re now ten days from the planned start of the re-opening of Northern Virginia businesses.  At present, that’s scheduled for May 29, and from what I hear, many local business and other organizations are counting on that.  So, like the rest of re-opening, that’s likely to happen, regardless.

But this provides a convenient marker.  Let’s see whether or not cases in this ZIP have doubled by the re-opening date.

Currently, about 0.5% of all residents of 22180 have been diagnosed with coronavirus.  Because children are rarely tested or reported with COVID-19, it might be smarter to say that about 0.65% of adults have been diagnosed with it.

This ongoing growth in cases does not appear to be an artifact of greater testing.  The Commonwealth revised its data on 5/18/2020 to remove a small number of “antibody” tests — the kind that will show, some weeks after the fact, that a person was infected and has recovered.  That said, with the revised numbers, a cumulative total of 21% of persons tested in Vienna were positive for coronavirus.  Today’s results show 13 persons tested, and 8 new infections. 

The result is that we’re almost certainly going to have a limited re-opening of businesses and other facilities while the virus is actively in circulation in the population.  In the Town of Vienna, and elsewhere in Northern Virginia.

 

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Plan accordingly

Loudoun County government put together this excellent table, above, summarizing how the first phase of re-opening (Phase 1) corresponds to the shutdown (Phase 0).  The also have links to detailed information for each type of business or entity that may re-open.

I don’t think that re-opening of Northern Virginia is going to make things materially worse, in terms of spread of the virus.  I say that for two reason.  First, on average, that has not happened elsewhere.  See Post #694 for my statistical analysis.

Second, it’s hard to over-emphasize how rational, slow, and cautious this re-opening is.  (Similar to re-openings across the state).  If you look at the table above, you find that:

• Non-essential retail can have more customers.
• Restaurants can open for sit-down dining, but only for outdoor dining.
• You can get your hair cut/styled (and similar personal services), but only by appointment.
• Churches can have larger drive-in services.
• Some campgrounds and parks will open

What got me thinking of this is a notice I got from Vienna Aquatic Club (where my family has been members for a couple of decades).  Sure, they’re going to re-open on the 29th, as an outdoor fitness facility.  They’ll be open for lap swimming only, by appointment only, in one-hour blocks, with strict rules about entering and exiting the water to avoid crossing other people’s lanes.  So while the pool will in fact be open, it’ll be nothing like a typical summer pool experience.

That’s all in addition to what’s always remained open, which, when you do the math, accounts for the vast majority of the non-automobile retail dollar in the US anyway.  (Walmart/Target, grocery stores, drug stores, hardware stores, lawn and garden stores, gas stations, and so on.)

The fact is, we didn’t shut down the way (e.g.) Wuhan, China shut down.  We kind-of, sort-of shut down.  And now we’re kind-of, sort-of slowly re-opening those facilities that were restricted.   Which is the second reason I don’t expect this to have much of an impact.  Because, at first blush, it’s not really that big of a change from what we have now.

That said, just as businesses and other organizations clearly are planning for that date, maybe we citizens ought to be as well.  For my part, I’m probably not going to change my routine much.  But I’m in a fairly high-risk group.

The fact of re-opening won’t mean that the problem has gone away.  The virus remains in circulation in our community, and in Northern Virginia more broadly.   But on the other hand, it also isn’t likely to mean that the pandemic is going to get much worse, either. 

It just means slightly more opportunities, and a continued need for caution.  Best to start thinking, now, about those opportunities.  And if you’re in an enclosed space outside the home, wear the best mask you can get your hands on.  And keep doing all the rest that the CDC recommends.

Source:  Clipart-library.com

Quick test 1:  National trends show no impact.

Let me start with the most obvious:  The US population is split almost exactly 50/50 between states that removed restrictions “early” ,and those that did not.  (Where, for the “early” states, I am using the NY Times classification as of about 10 days ago.)  Most of the initial “re-opening” steps happened in the first week of May, with some before that, and some after that.

If there had been some huge impact of that, we’d begin to see it in the national data. And that just ain’t so. If you detect any upsurge in new cases post May 1, you have a sharper eye than I do.

Source:  New York Times. Continue reading Post #694: Re-opening, as it has been done so far, has had no impact.

Source: COMMENTARY: COVID-19 transmission messages should hinge on science. March 16, 2020, Lisa Brosseau, ScD, author, on line at the University of Minnesota Center for Infectious Disease Research and Policy.  Used without permission here, under a claim of fair use.

So, today’s headlines include:

‘Speaking causes airborne virus transmission’:

Source:  Marketwatch

A minute of loud talking can generate more than 1,000 coronavirus-laden droplets that linger in the air

Source:  Businessinsider

Loud talking can leave coronavirus in air for up to 14 minutes

Source:  Yes, even Fox “news” gets it.

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Continue reading Post #693: Shut up, they finally are getting it.

Today I was simply struck by the contrast between Hong Kong, as written up in The Atlantic, and various Wisconsin cities, as written up in the Washington Post.

It’s pretty simple, really.

In Hong Kong, when the government was acting with incompetence and stupidity, the citizens organized a much smarter response.  In Wisconsin, by contrast, when the government was acting in a rational and reasonable manner, the Republicans there helped the citizens undercut that and behave in the stupidest possible fashion.

In Hong Kong, when the government failed to take appropriate protective action, the citizens forced the government’s hand.  Everybody wore masks in public, despite a literal government ban on wearing masks in public.  Even though Hong Kong is densely populated and directly linked to Wuhan, China by rail and air lines, the citizens of Hong Kong  managed to get near-complete control of their epidemic in four weeks.

They had a (one) new case today:

The really understood that beating a pandemic is a group effort.

By contrast, those pushing for blanket removal of restrictions in Wisconsin apparently do not understand that person liberty is not the sole consideration.  There’s a reason that spitting on the sidewalk is illegal in most cities (it spreads tuberculosis).  There’s a reason you can’t discharge raw sewage into streams (it spreads cholera and other fecal-borne illnesses).  And there’s a reason you can’t go drinking in a packed bar — at least not in most of America, right now.  That’s because, right now, that’s likely to spread a deadly disease.  All those are infringements on your person freedom.  All those infringements have a reason to exist.

But it’s tough to say what will happen next.  Newspapers like click-bait, so you can’t tell whether the scenes depicted in the Post are typical, or are outliers.  But, for now at least, Wisconsin has taken the lead on plan-less, clue-less, careless re-opening.  Looks like they’ll get to be the acid test for whether the current set of preventive measures was necessary or not.

In no small part, the Hong Kong response was attributed to their having been hit hard by the last SARS epidemic (SARS 2003).  So, when the current SARS came around (SARS-CoV-2), they understood what was at stake, and acted accordingly.  But in Wisconsin, they haven’t experienced that kind of hardship within living memory.   Maybe now they’ll get to do so.  Or maybe enough people will behave responsibly enough that no harm will come from the behavior of the few.  In any case, it’s too soon to tell.

 

Source:  Unusable test count data from the Commonwealth of Virginia.

Edit:  Some time after I posted this originally, Governor Northam tweeted that the antibody-based (after-the-fact) tests account for just 9 percent of testing, and that he has directed the Virginia Department of Health to break out the two types of tests (viral DNA versus blood antibodies) separately in its data reporting.  Basically, you can ignore the rest of this now.

GIGI is a computer programming initialism:  Garbage in, garbage out.  It means that even if you have a program that does exactly what it’s supposed to do, if you feed false information into it, you’ll get false information out of it.

There are two types of tests for COVID-19.  One is a viral DNA-based test to tell whether you actively have the virus on your mucous membranes, often called a PCR (polymerase chain reaction)-based test.  It’s the test of whether you are actively infected.  It’s test used to determine how the health care system will address you, whether or not you need to quarantine, and whether you could as a newly-infected cases.

Separately, there’s a test for antibodies in your blood.  That’s an after-the-fact test, and tell you whether you were, at some time in the past, infected.  Typically, those antibodies only show up weeks after infection, at which point, you typically are no longer carrying or shedding the virus.

I got an email today, from a colleague pointing me to an article in yesterday’s Atlantic.  Turns out, the reason Virginia’s testing numbers started to go way up, without a commensurate rise in count of infected persons, is that they started combining the count of antibody tests with the count of DNA tests.  At least, that’s what was reported today in The Atlantic.  Thankfully, Virginia  has the sense not to include positive antibody tests among the count of infected cases, per their May 7 posting on how they calculate testing rates.

But the upshot is that this graph, from the Commonwealth, is no longer interpret-able as showing that testing to find infected people has gone up.  Fact of the matter is, unless the Commonwealth chooses to separate out the viral DNA (polymerase-chain-reaction or PCR test), you have no idea whether testing for active coronavirus infection has gone up or now.

All the more reason to understand that the increase in new infections isn’t an artifact of increased testing, as I discussed in an earlier post.  In fact, based on what Virginia reports, we can’t even be sure that there is “increased testing”.  At least, not of the sort that is used to find infected individuals.