Letters To Friends and Family

Thursday, April 23, 2020

Letter-158B: 2020 COVID Numbers for Family Clusters

COVID CLUSTER ANALYSES FROM 2020
Reverse Chronological Order

Friday numbers as at 04dec20

B.L.U.F. (bottom-line, up-front): a weekly service of questionable emotional value for my loved ones in the Northeast, the Midwest and Colorado, at least through early December 2020. This week's essay focusses on the eight family clusters.

SUMMARY of monthly for letter for December 2020
Conditions warrant this letter due to a 46% spike during November of 2020 in cases to 1.9 million across the clusters. The death toll has risen by a less abrupt but still alarming 7% rate to 72,312 among those clusters for a 3.8% cumulative mortality run rate. The good news is that periodic fatality rate for the clusters are falling below 1% for November.

NOTE: may be the last letter unless time and conditions warrant.

DEFINITIONS

cases = incidents confirmed by illness and / or testing
deaths = people dying from COVID-19
recoveries = people who have had the illness and are now completely recovered or proved to be asymptomatic (i.e., passive carriers)
I.C.U. = intesnsive care unit
critical care = patients in I.C.U. or acute care AND on ventillators
mortality rate = the number of deaths recorded relative to a larger group
run-rate mortality = the number of deaths DIVIDED by confirmed cases
static pool mortality = deaths DIVIDED by resolved cases (i.e., deaths PLUS recoveries)
marginal mortality rate = a run rate of deaths limited to a particular period relative to the cases confirmed during that same period (i.e., a periodic rather than cumulative rate)
positivity rate = percentage of test results that detects a coronavirus infection carried by the person tested (i.e., the individual testing positive); the World Health Organization recommends a positivity rate less than 5% for fourteen consecutive days as a pre-condition for re-opening.
testing positive = people carrying the coronavirus or anti-bodies from a past, previously undetected infection
population mortality = deaths in a specific area (i.e., city, county, state, nation, world) DIVIDED by the population of that area; rarely used here

CUMULATIVE FINDINGS SINCE EARLY APRIL

Friday numbers as at 06dec20
The New York Times has developped a user-friendly tool available for non-subscribers, for which I remain thankful. As usual, this analysis relies also upon data collected by Johns Hopkins Coronavirus Resource Center; aggregated by Worldometre; and, compiled by Bing / Microsoft. Two other key support sources are The Atlantic and Covid Act Now.

Occasionally used sources include, most frequently, The World Heath Organization and National Public Radio. One can review the supplement of general U.S. data on the coronavirus contagion that covers roughly 95% of the U.S. population and deaths recorded to date. These COVIData sweeps use a private language of symbols and calculations briefly addressed in the weekly installments; this appendix explains that language in detail.

STATIC POOL RATES U.S. versus WORLD
Static pool mortality rates continued their decline during November but remain higher than one would like to see during this ninth month of the COVID-19 pandemic. Europe, particularly in the more agrarian and less developped economies, and Latin America -- its 3.5% mortality run rate (versus 1.9% for the U.S. and 2.3% for Europe) anchored by Brazil, México, Colombia, and Peru -- are suffering most in this second global wave. Despite the hardening wave, poorer countries continue to re-open for tourism, as did Europe earlier; the dilemma between money and mitigation is morbidly acute in México, Egypt, and Kenya (sporting a composite mortality run rate of 3.8% despite materially understated data for Kenya and Egypt). Finally, the W.H.O. is accelerating approval of vaccines, while China is ready to distribute its tested vaccines to assert diplomatic leverage.

Some of the nearly one percentage point decline in the U.S. static pool rate is attributable to a 47% spike in cases over the past four weeks. The increases have hit states like California harder than previous measures had anticipated, leading to the Golden State's harshest lockdown measures to date. Notwithstanding progress in the Midwest and periodic fatality rates now trending toward the expected final mortality rate, the two coasts -- essentially the Northeast, California, and the Pscific Northwest -- endure renewed up-ticks. The family clusters in Pennsylvania, Marlyand, the N.Y.C. area, Massachusetts, Colorado, Detroit and Chicago have been outperforming the rest of the country for the last two months, contributing, in November, 11% of the deaths with 16% of the U.S. population, despite similarly high growth rates in confirmed cases.

OVERVIEW OF THE FAMILY CLUSTERS
While cases grew 46% in November, in line with the increases in the United States, political leadership reined in mortality growth successfuly to realize a 0.7% periodic mortality rate. The best overall performance clearly goes to New York METRO thanks largely to the three Democratic governors: Andrew Cuomo (N.Y.), Philip Murphy (N.J.), and Ned Lamont (CT) as well as, of course Mayor William Deblasio (D-N.Y.C.). Next in line is the City of Brotherly Love with inner city measures suppressing the death tolls to a 0.5% marginal run rate. Detroit wins the bronze medal; Democratic Governor Gretchen Whitmer has braved gun-toting protestors and a kidnapping plot to hang tough with her restrictions and keep the fatality rate of the last four weeks well beow 1%.

The laggards for November -- ironically still the two safest spots for my relatives -- have been Pittsburgh Metro and Colorado with shockingly high growth rates in confirmed cases. Each cluster doubled its case loads over the past month. While marginal run-rates remain acceptable in each case (though, at 1.3%, PGH had the highest rate of any cluster), these catapulting increases, with testing lags, could portend and very difficult month or two ahead.

REVIEW OF THE SEVEN CLUSTERS
Baltimore-Annapolis (link)
Cluster Snapshot: 38% case growth; 7% growth in deaths; 0.6% periodic mortality run rate for November; and, 60-75% of Intensive Care Unit (I.C.U.) capacity used
This week made life difficult for Maryland Republican Gorvernor Larry Hogan as positivity rates climbed aggressively to break the old daily record by some 25-30%. The cluster area encloses two of every five deaths across the state. One of every two dying Marylanders is a citizen people of color, primarily African-American, and nine of every ten are sixty years old or older. Hospitalizations in Baltimore are the highest since the peak of last Spring, tripling in November alone. While Baltimore has faced a second wave for some time, the situation has become acute in Annapolis, leading to new restrictions (e.g., ten people at gatherings; entertainment venues at 25%). Positivity rates approach 6%.

BOSTON & the CAPE (link)
Cluster Snapshot: 37% case growth; 6% growth in deaths; 1.0% periodic mortality run rate for November; and, 7.3% of I.C.U. capacity used for the Commonwealth of Massachusetts
The Cluster is managing a 50% increase in the penetration of the coronavirus this month, prompting the Massachusetts to cut outdoor gatherings from fifty to twenty-five people and indoor from twenty-five to ten people. Boston is under pressure to restore in-person schooling, particularly for students with special needs. Cape Cod and the islands have endured a concerning rise in cases around Hyannis, though these infections represent 3-4% of the state’s population and less than 2% of the cases. The state remains well-resourced.

CHICAGO proper (link)
Cluster Snapshot: 55% case growth; 22% growth in deaths; 1.1% periodic mortality run rate for November; and, 43-52% of I.C.U. capacity used
Hospitalizations across Illinois have risen 73% during November. Use of ventillators has increased 2.4x; one of every ten patients is on a ventilator, close to a half of whom are using a ventillator. The coronavirus contagion has whipped the elderly and minorities of the Windy City with two thirds of the deaths involving people over sixty-five years old and three-quarters plaguing Blacks and Hispanics. (61% of Chicagoans are minorities and a mere 12% are aged over sixty-five.) Chicago has lowered its positivity rate from 16% two weeks ago to 12%, or the level for some eased restrictions. Chicago faces the dilemma that many clusters do: ineffective contact tracing.

This problem is not due only to lack of cooperation with the tracers, but also by people likely assuming that the unrecognizable telephone number of the tracer belongs to a robo-caller. The person then blows off the call. Illinois is set to administer 55,000 vaccinations later this month, sufficient to inoculate 3-4% of the elderly in Illinois and 13-18% in Chicago. The U.S. Senate is stalling over a relief package passed seven months ago by the House of Representatives. Any final package will likely cut the original Federal largesse by two-thirds. In the interim, Democratic Mayor Lori Lightfoot has unveiled a borrowing plan of $450 million to tide Chicago businesses through to relief from D.C.

COLORADO statewide (link)
Cluster Snapshot: 106% case growth; 40% growth in deaths; 0.8% periodic mortality run rate for November; and, 73-81% of I.C.U. capacity used
Colorado's coronavirus contagion has spiralled out of control for the last month in terms of cases with a 2.3% daily growth rate. Case-loads in the sparse counties have increased by roughly 25% over the past week. Fortunately, Delores County has recorded only twenty-five cases with no deaths. Denver is moving to mitigate the explosion in cases with fresh and restrictive guidance. Colorado officials expect deaths to double by Christmas; the full impact of the Thanksgiving gatherings remains unknown for the next week or so. Hospitalizations are setting new highs as 2,000 people currently stay in facilities (i.e., 15% of total in-patients to date). The working age population is driving the increase with 65% of cases to date reported by people aged between twenty and fifty (versus 42% of the population). The State expects most schools to be closed through December with enhanced back-to-school flexibility thereafter.

DETROIT metro (link)
Cluster Snapshot: 66% case growth; 10% growth in deaths; 0.8% periodic mortality run rate for November; and, 41-63% of I.C.U. capacity used
Motown and Michigan have had a challenging month, though, this time around, the coronavirus contagion is wreaking more havoc on the rural areas (i.e., the hot-beds of armed resistance and threats to Governor Gretchen Whitmer). Positivity rates around Detroit range from 10-15%. Blacks and Latinos still suffer disproportionately with people of color representing 90% of the deaths in Detroit and 40-50% across the state (versus minority population shares of 80% for Detroit and 20% for the State, respectively ). The Governor has pushed personal responsibility back onto the mal-contents. Push-back is now lead by restauranteurs ready to defy the ongoing restrictions (e.g., closure of high schools and universities to in-person learning as well as most entertainment venues). The State is responding with various business support programs.

NEW YORK METRO (two links; one for N.Y.C. one for N.J.)
Cluster Snapshot: 27% case growth; 1.7% growth in deaths; 0.3-0.5% periodic mortality run rate for November; and, 33-59% of I.C.U. capacity used
With the Governors of New York, Connecticut, and New Jersey as well as the Mayor of the City coordinating their coronavirus responses (e.g., many entertainment venues closed with gatherings restricted from ten to twenty-five people indoors and ten to one hundred, fifty outdoors), this cluster has managed the second wave as well as could be expected. Disruptions continue in the tri-state area. Some frictions have emerged as New Jersey, and her suburbs adjacent to Manhattan, have been struggling; there has been some conflicting policy aspirations between the Democratic leaders, Mayor William DeBlasio and Governor Andrew Cuomo, particularly around in-school versus remote learning.

The biggest resistance seems to be from out-of-state politicians. Governor Cuomo expects 105,000 vaccine shipments in December, enough to inoculate 4-6% of the Empire State’s or 10-15% of Gotham City’s elderly despite the surge lasting until Martin Luther King Day; New Jersey is shooting for vaccinating 11-16% of its elderly population by mid-January. (Vaccinating 70-80% of the population is required for a return to normality.) Some irrational behavior has emerged as New Yorkers are splitting for New Jersey, where the risk is higher.

PHILADELPHIA (link)
Cluster Snapshot: 54% case growth; 13% growth in deaths; 0.9% periodic mortality run rate for November; and, 59-65% of I.C.U. capacity used
Philly metro followed Pennsylvania in setting records of new confirmed cases and now exceeds 2,000 deaths from COVID (i.e., 20% of the state total); half of these fatalities come from elderly care facilities. Hospitalizations have increased by roughly 50%. In mid-November, Philadelphia had put into effect detailed and highly restrictive guidelines (e.g., no indoor parties; five people per thousand square feet in houses of worship or retail outlets) that evidently failed to stanch the growth of illness. One predicted outcome has come true: a big hit to the private sector. Like elsewhere, young people are driving the growth in cases. The New Jersey suburbs are managing the second wave quite well.

PITTSBURGH metro (link)
Cluster Snapshot: 96% case growth; 51% growth in deaths; 1.3% periodic mortality run rate for November; and, 44-63% of I.C.U. capacity used
Pittsburgh, like Pennsylvania, has struggled during November, since Steelers Country has doubled the increase in cases of Philadelphia. All four counties in the cluster set new records for case counts today. Evidently, compliance with mitigation measures is low, possibly overwhelming the burgh’s health-care people and capacity within a month. The Commonwealth continues to delegate in-school versus remote learning decisions to local school districts. The large increases in cases and deaths remains a mystery since Allegheny County’s growth approaches that of the cluster though her growth in deaths is half that of the other counties; the majority of cases are people aged twenty-five to sixty-five.

END of LETTER for 04dec20;
previous letters follow below.

Friday numbers as at 06nov20

B.L.U.F. (bottom-line, up-front): a weekly service of questionable emotional value for my loved ones in the Northeast, the Midwest and Colorado, at least through early November 2020.

SUMMARY
Current infection rates continue to accelerate, thereby creating alarm across the country. With only one of every six cases reported, one must keep in mind that this is a high-penetration virus; key focus remains mortalities and hospital space.

NOTE: probably the last letter unless time and conditions warrant.

DEFINITIONS

cases = incidents confirmed by illness and / or testing
deaths = people dying from COVID-19
recoveries = people who have had the illness and are now completely recovered or proved to be asymptomatic (i.e., passive carriers)
I.C.U. = intesnsive care unit
critical care = patients in I.C.U. or acute care AND on ventillators
mortality rate = the number of deaths recorded relative to a larger group
run-rate mortality = the number of deaths DIVIDED by confirmed cases
static pool mortality = deaths DIVIDED by resolved cases (i.e., deaths PLUS recoveries)
marginal mortality rate = a run rate of deaths limited to a particular period relative to the cases confirmed during that same period (i.e., a periodic rather than cumulative rate)
positivity rate = percentage of test results that detects a coronavirus infection carried by the person tested (i.e., the individual testing positive); the World Health Organization recommends a positivity rate less than 5% for fourteen consecutive days as a pre-condition for re-opening.
population mortality = deaths in a specific area (i.e., city, county, state, nation, world) DIVIDED by the population of that area; rarely used here

CUMULATIVE FINDINGS SINCE EARLY APRIL

Friday numbers as at 06nov20
New York Times has developped a user-friendly tool available for non-subscribers, for which I remain thankful. As usual, this analysis relies also upon data collected by Johns Hopkins Coronavirus Resource Center and aggregated by Worldometre. Other sources include Bing / Microsoft, the This month’s review draws heavily upon the data compiled by the World Heath Organization, and Covid Act Now. One can review the supplement of general U.S. data on the coronavirus contagion that covers roughly 90% of the U.S. population and deaths recorded to date.

STATIC POOL RATES U.S. versus WORLD
As indicated by the data below, the second wave has started with global cases up 44% over the last five weeks since 02oct20, or ten percentage points higher than the level of growth in the United States. Nevertheless, static pool rates are not declining as fast as one would hope. Increased testing to detect a higher percentage of asymptomatic cases, together with the wider use of mitigating medicines and treatments, do not seem to be slowing the death rates among resolved cases commensurately.

Much of this larger global growth centers in Europe. Reports have emerged that the second wave is jumping from the young and mostly asymptomatic carriers to the far more vulnerable elderly population across Europe. The mortality run rates are declining a bit faster than the static pool rates, indicating the capture of more passive carriers with increased testing. The U.S. mortality rate is now lower than that of Europe – 2.4% versus 2.5% – though the American experience tends to lag that of Europe by three to four weeks.

OVERVIEW OF THE FAMILY CLUSTERS
The cumulative numbers remain high following the nasty heritage left by last Spring in New York, Boston, and Detroit. Marginal mortality rates for the five weeks since 02oct20 have been great for the clusters at 0.8%, substantially lower than the 1.2% mortality rate for the rest of the country. The second wave has definitely hit the Northeast (i.e. Maryland, Massachusetts, New York, Pennsylvania, Chicago, and Detroit). The state and local governments, with the modest exception of Pennsylvania, are containing the spread and mortality. Colorado is struggling with new infections but appears to be managing the extra case-flow, at least for now.

Many fear that the second wave in the United States is spiralling out of control. Dr Fauci has repeatedly stated that he will be satisfied that the epidemic is under control when daily case confirmations stabilize around 10,000 people; the past week has been posting ten times that target level of daily cases. The mortality run rate has dropped to 1.2% over the past month. Nevertheless, the past week has averaged 1,000+ deaths per day, placing strain on the expected first year death toll (through 28feb21) of 336,000 projected seven months ago.

The assessment that the epidemic is out of control and that the Trump Administration has decided to let this highly transmissible coronavirus to run its course may be unforgiving. The coronavirus is easily contagious and ultimate penetration rates have been forecast to range from 40-70% of the American population. The current penetration is officially recorded as 3%, but likely lies in the 15-30% range. The mortality run rate of the U.S. is now slightly below that of Europe, though the long-term difficulties faced by Belgium and a brutal second wave for Spain may explain that difference.

The urban areas hit by the first wave are up and ready for the second. Not so for the rural states, the fertile ground for this wave; one poorer state has as few as six intensive care beds available. Among the family clusters, the outstanding performance goes to New York METRO. The metropolitan area, the City, and Manhattan have each posted marginal mortality run rates below 1%.

The frequently criticized measures vindicate the aggressive responses taken by Governor Cuomo working (sometimes at odds) with Mayor DeBlasio. City-wide positivity rates have grown though mortality remains much improved. Chicago and Detroit have continued to improve their numbers with much improved marginal mortality run rates in the 0.6-0.7% range. Only Baltimore (1.1%), Pittsburgh (1.8%), and Boston (2.1%) posted marginal death rates above 1%.

REVIEW OF THE SEVEN CLUSTERS
Baltimore-Annapolis
21% growth in confirmed cases; 7.5% growth in deaths; 1.1% monthly marginal mortality rate
The tempo of the second wave has accelerated during the past two weeks and Governor Hogan may be preparing for a second round of restricted movements. Governor Hogan cautions that the state is in “red zone” with the Baltimore-Annapolis corridor in the thick of the spreading wave. Anne Arundel and Howard Counties already have high Intensive Care use and the State reports a shortage of medical first responders.

Boston and the Cape
21% growth in cases; 6.5% growth in deaths; 2.1% monthly mortality rate
Governor Baker has been tightening restrictions in the eastern half of the state, particularly around Boston as positivity rates increase. The entertainment / social curfew of 9:30 p.m. and general lights-out of 10 p.m. face resistance. Governor Baker worries about the Intensive Care capacity of Boston area hospitals as hospitalizations state-wide have increased 71% in the last month while positivity rates (i.e., the percentage of people tested who have the coronavirus) have doubled since August.

Chicago proper
40% growth in cases; 6.3% growth in deaths; 0.6% monthly mortality rate
Mayor Lightfoot has responded to the crisis emerging in Chicago with severe grouping restrictions and entertainment curfews as Illinois now posts more daily cases than Texas, California, or Florida. Chicago handled the first peak relatively well but is bracing for higher penetration rates than six months ago in the weeks ahead. Currently, the case-load doubles every twelve days. The coronavirus contagion spreads rampantly throughout the State as well. 20% of hospitalized patients end up in Intensive Care. Though the Intensive Care availability is adequate for now, if the current momentum does not abate, the current spike will overwhelm the health-care system in Chicago and, almost certainly, Illinois.

Colorado state-wide
70% growth in cases; 15% growth in deaths; 0.6% monthly mortality rate
Colorado’s run rate looks impressive, but the concern remains the lag between such a large number of cases and ensuing fatalities. The Denver area faces mounting cases and hospitalizations with some strain to the metropolitan area’s Intensive Care facilities. The State advises people to stay at home while some areas impose curfews. Daily cases have increased three-to-eight times in the last month while hospitalizations have increased two-to-four times around Denver. Delores County remains COVID-free.

Detroit metro
39% increase in cases; 4.0% growth in deaths; 0.7% monthly mortality rate
One big challenge for the Motor City is the high percentage of elderly and people of color particularly vulnerable to full-blown COVID-19. Governor Whitmer is pushing for a bi-partisan mask-at-all-times mandate as daily infection rate looks to double over the next two months. Though Detroit confronts a material challenge, the more rural areas of Michigan, particularly to the West and North of the State, are accelerating even more quickly. The State has adequate Intensive Care availability, while Detroit has moderately better capacity.

New York METRO
13% increase in cases; 1.4% growth in deaths; 0.9% monthly mortality rate
New York CITY
10% increase in infections; 0.9% increase in fatalities; 0.9% monthly run rate
The sharp aim at potential clusters is paying off for the Big Apple, despite a high cumulative mortality run-rate in Brooklyn lingering at 10%. All three states that contribute to the New York METRO area have reported increased case-loads and are coordinating quarantine restrictions for those entering Gotham City from forty-three states and Puerto Rico. A negative test within 72 hours of arrival is being permitted in lieu of the fourteen-day self-isolation. Hospital capacity remains very strong and able to cover for its weak link in Rockland County. New Jersey’s capacity is less certain as the New York suburbs find themselves at an elevated risk level for infections.

Philadelphia metro
26% increase in cases; 3.3% increase in deaths; 0.7% monthly mortality rate
Pittsburgh metro
47% increase in infections; 27% increase in fatalities; 1.8% monthly run rate
Philly and Steelers country reflect Pennsylvania’s relatively permissive approach to managing the coronavirus contagion. ¡HAIL TO PITT! Pitt Medical School has found a rich source of anti-bodies to the coronavirus extracted from llamas – that’s right: those funny looking guys from the Andes. Hospitalization rates have climbed rapidly across Pennsylvania but tilt toward Pittsburgh; hospital occupancy is about a third of the peak of last Spring. Beaver County remains hardest hit with respect to elder care facilities average 94 cases per facility (versus 30 for the Commonwealth). Mortality rates in Beaver County's elder care facilities remain even with those of Pennsylvania at 18% and well below those of Philadelphia of 23%. Intensive Care capacity appears to be adequate to the task for now.

==========

Second Wave Comments. Following below is the final set of answers to questions determining the magnitude of the second wave in process.

1. Will there be adequate testing and tracing in place? Answer: testing is flat; the parts of the country needing it most during this second wave lag in capacity.

2. Will the states, as a group, have re-opened too soon or too laxly? Answer: Daily infection rate at 10x desired level; frequently more than a thousand dying each day. States and cities seeking to place new restrictions, or re-cycle older ones previously let go; facing resistance from their citizens.

3. How much will the current protests of George Floyd's murder re-accelerate penetration? Answer: not material due to masking and being outdoors. The biker rally and some political rallies have spiked local rates, primarily in the West and upper Midwest.

4. Will the virus have mutated and, if so, for the worse or better? Answer: a second infection contracted by a patient has been worse due to mutations and a weakened immune system. Such cases are still rare. More immediate concern over simultaneous flu and coronavirus infections.

5. How long will people prove to be immune who have survived the illness already? Answer: looks to be three to six months.

6. How quickly can a safe and effective vaccine be developped and tested? Answer: current vaccines slowed in testing. Russia and China already trying out home-made vaccines.

7. How efficiently can, and comprehensively will, the vaccine be distributed? Answer: Summer of 2021 as base case or best guess.

8. How deep will the penetration of COVID-19 be in the rural areas? Answer: slow progression continues and now accelerating in Midwest and rural areas of large states; mortality run rates remain low.

BACK-STORY

Johns Hopkins University and Worldometer provide competing digital data of the coronavirus contagion. These data are close to real-time. These sources underlay my prediction of a 3.6% mortality run-rate in the first year (i.e., the optimistic release time of a vaccine) and my mistrust of the statistics coming out of China, for example as at 22apr20:

81% of the cases and 97% of the deaths supposedly confined to Hubei Province with 4% of China's population;
Shanghai with 27 million people, 639 cases, and seven deaths (¿REALLY?); as well as,
Peking with a population of 20 million,593 cases, and eight deaths (¿Too good to be true?).
My family on both sides tend to cluster in Pittsburgh, New York, Detroit, Boston, Colorado, Chicago, Maryland, and Philadelphia.

Every Friday, I use the sources of the linked above to calculate out mortality rates and cases to see how the pandemic is progressing in my personal red-zones.

NOTES on MORTALITY RATES
The static pool looks at the death rate relative to the total number of 'resolved' cases. The unresolved cases are those people in the states of initial infection (i.e., identified at first); convalescence (i.e., on the mend); and, critical care (i.e., on ventillators and other extraordinary measures . . . in the R.C. sense). The run-rate is simply a percentage of currently identified cases resulting in death.

Depending upon one's interpretation of the arrayed data, the difference between the two rates may indicate that likelihood of increase or decrease of future case-based (i.e., run-rate) mortality rates; the length of time and percentage of mortality of critical care cases; the length of time for convalescence; and, larger recognition, response, and resolution lags vis à the unseen and unsightly monster.

Since I am not an epidemiologist and have forgotten most of my baby statistics from school, it is S.W.A.G.-time (i.e., scientifically wild-assed guess) on any conclusions I draw. You may well have your own. One thing I do know: when this virus has worked its way all they way through this year or, more likely, this year and next, the static pool and run rates will converge.

The question probably keeping epidemiologists and medical first responders up late at night is how far the static pool rates will come down and how far with run will go up (and flatten out) before that convergence occurs. In my S.W.A.G. linked above of 3.6%, I view the death rates and levels of patients in critical care to provide an instrumental if inscrutable hint.

Friday numbers as at 02oct20
Introduction; static pool review
The mortality rate of cases confirmed and closed through death or recovery, have declined more slowly than would be expected as India continues to accelerate, while regions in the British Isles, Madrid, Paris and Eastern Europe heat up in a second wave. In the U.S., the slowing decline reflects acceleration in the Midwest as well as rural regions in the South and West.

Static Pool Rates, as an indicator of the direction of final mortality run rates, remain high at 5.5% for the United States and 4.0% globally. U.S. and world-wide mortality run rates are converging at the 3.0% level. The disturbing part of these data is that the U.S. rates have levelled off at 4-7x the hoped-for long-term mortality rate of less than 1%.

New York Times has developped a user-friendly tool available for non-subscribers, for which I remain thankful. As usual, this analysis relies also upon data collected by Johns Hopkins Coronavirus Resource Centre and aggregated by Worldometre. This month’s review draws heavily upon the data compiled by the World Heath Organisation. One can review the supplement of general U.S. data on the coronavirus contagion that covers roughly 90% of the U.S. population and deaths recorded to date.

Global Review.
One general issue that is surfacing rapidly is the environmental impact of the pandemic, both ecologic and economic, particularly on poorer countries with high unemployment especially in the 'informal sector (of day-to-day living; food insecurity in Africa, South Asia, and South America; harvesting to source a secondary element of most vaccines exerting stress on shark populations; and, the decimation of animals.

On the vaccine front, distribution issues (e.g., a necessity of 8,000 jumbo jets, or at least five times the number of planes involved in the Berlin Airlift) have assumed a proper paramountcy as many less developped areas, particularly Africa, lack the infrastructure for the expected through-put of vaccine doses. Special conditions, most often freezing the vaccines at extremely low temperatures also pose a problem.

Though lagging in development, Merck is developping a shipping friendly vaccine. In the meantime, monolonal anti-bodies that imitate the coronavirus for fortiftying the immune system may bridge the gap until the dispersion of virus-extinguishing vaccines. The COVAX compact for vaccine developpment and distribution among the E.U., U.K., Norway, Iceland, and thirty-five other economies is moving ahead under the leadership of the World Health Organisation; the U.S. thus far is forging its own path in pursuing President Trump’s mercantilist bent.

COVID-19 review in the United States.

Fire-bells are going off in the Midwest as Minnesota and Iowa are entering second waves while Wisconsin languishes in its first with new daily records in cases and deaths. Specific data about the various states are available in the weekly supplement coming out tomorrow. Dr Anthony Fauci has expressed public concern, as the country enters the flu season, that new cases are four times the level they should be to avoid doubling the death toll to 200,000+ by the time a vaccine arrives. With this uncertainty, the base case projections from six months ago shall stand, whether they be accurate, way off, or whatever.

University of Washington warns that the death toll could go much higher, or four times the current level (i.e., roughly 425,000). One possible mitigant, aside from bridging drugs (e.g., remdesevir or monoclonal anti-bodies), remains the idea of cross immunisation, or, at least, slowed illness progression from so-called T-cell memory of anti-bodies stored from human exposure to other coronaviruses. Current drivers for increasing infection appear to be related to school openings settings, like Amazon, that facilitate super-spreading.

Sweep of specific family clusters.
Overall, the cluster has performed quite well, though a second wave may be developing. Cases have risen 9% (versus 19% for the U.S.) with deaths up only 3%. The mortality run rate for the clusters have declined moderately from 6.7% to 6.3%; the marginal mortality rate (i.e., the number of deaths divided by the number of cases confirmed for the past month) remains at 2.0%, in line with the national rate.

The biggest increase within the cluster occurred in Pittsburgh metro, with a 20-30% increase in cases throughout the area; Beaver country had a rash of deaths. Nonetheless, Pittsburgh remains the safest cluster with a frequency ratio almost five times higher than that for the country. Philadelphia suburbs, particularly in New Jersey, led the increases for that cluster. Metro New York reported the slowest growth in both cases and deaths, being virtually flat in the latter.

Metro New York City: 1.0% mortality run rate for September (stable) on a 4% growth in confirmed cases. Governor Cuomo (D-NY), Lamont (D-CT), and Murphy (D-NJ) remain tough in their standards, adding Nevada, Rhode Island, Minnesota, and Arizona back to the list 14-day self-quarantine list; two of these add-backs had been cleared just two weeks ago. In N.Y.C. , positivity rates are climbing, commensurate with school openings; Mayor DeBlasio is urging calm as positivity rates remain below the 5% threshold for re-opening set by the World Health Organisation. California has been taken off the list, leaving the red-list at thirty four states plus Puerto Rico and Guam.

Boston and the Cape: 3.4% mortality run rate for September (stable) on a 9% growth in confirmed infections. Numbers during September have been inflated due to several hundred false positives out of one lab. Despite a positivity rate below 5%, Nantucket is emerging as a possible hot-spot. Boston and its suburbs to the South and West remain epicentres, too. Much of the state West of Worcester appears to be virtually virus-free. On the Cape itself, one school near Osterville has reported a spate of infections.

Pittsburgh metro: 2.7% mortality run rate for September (improving) on a case growth of 22%. The Pittsburgh metro cluster has trailed the rest of Pennsylvania, peaking in cases in July and August. Most of the deaths if Western Pennsylvania have come from four nursing homes / assisted-living facilities. Nevertheless, the cluster represents only 8% of the totals COVID deaths recorded in Pennsylvania; Pittsburgh metro represents 19% of the state’s population.

Philly metro: 2.3% mortality run rate for September (deteriorating) on a 10% growth in confirmed diagnoses. Despite rising infection rates in Pennsylvania, Delaware, and New Jersey, Philadelphia is proceeding with its re-opening plans, allowing 50% occupancy versus 25% in restaurants and bars, with outdoor dining encouraged. Between a third and a half of the population, Blacks have suffered 50% higher infection rates some 25% higher hospitalisations.

Baltimore-Annapolis: 1.1% mortality run rate for September (improving) on a 14% growth rate in cases. Notwithstanding strong positivity well below W.T.O. threshold, hospitalisation rates have climbed by 10% before tapering off. Three cheers to Governor Hogan (R) and Mayor Young (D) of Baltimore for working together with Johns Hopkins to contain infection rates and deaths in that city on a level proportionate with its population relative to the state. These numbers are permitting a cautious re-opening of elder-care facilities to visits.

Detroit metro: 2.3% mortality run rate for September (deteriorating) on an increased case of 11%. One of the hard hit states last winter, Michigan has continued to contain the spread of the coronavirus as indicated by a 3% positivity rate state-wide. With an up-tick in cases, Governor Whitmer (D) has extended the state of emergency through October.

Chicago proper: 0.9% mortality run rate for September (stable) on a 15% increase in confirmed cases. The positivity rate remains on the high side in the windy city at 4.3%, but still below the 5% threshold of containment. In response to rising numbers of cases, Chicago has imposed a self-quarantine requirement for those arriving from twenty-two more rural states primarily in the deep South and the Midwest; interestingly, Louisiana and Florida are not one of the states.

Colorado state-wide: 0.8% mortality run rate for September (improving) on a 23% increase in cases. The infection has accelerated during September, prompting responses by state and local officials. Denver is clamping down on colleges in an effort to contain the spread of the coronavirus. Boulder remains the hot-spot for the past few weeks, with a 6% positivity rate – two thirds above the state average -- and leading a 16% increase in hospitalisations (to only 177). Colorado could have as many as 4,000 deaths (i.e., twice the reported number) as these additional cases are people dying “with the virus in their systems; that would make the mortality run rate 5.7%.

==========

Second Wave Anticipation. While a second wave is starting or remains imminent in many parts of the world, the concern remains one of magnitude. Answers to the following questions will go a long way in determining the magnitude of that wave.

1. Will there be adequate testing and tracing in place? Answer: still no national plan; where there is tracing, concerns over privacy and disclosures creating gaps through which mini-hot-spots emerge. 150 million instant test kits are starting to ship.

2. Will the states, as a group, have re-opened too soon or too laxly? Answer: spikes in confirmed cases in the South, Midwest and Southwest overshadow high, if frequently slowing, increases in deaths. Daily infection rate at 4x desired level.

3. How much will the current protests of George Floyd's murder re-accelerate penetration? Answer: outdoors settings may be mitigating the expected community spread of infections.

4. Will the virus have mutated and, if so, for the worse or better? Answer: controversy over mutations though none have proven to be immediately dangerous despite some making the coronavirus more transmissible.

5. How long will people prove to be immune who have survived the illness already? Answer: only time will tell; some evidence of either re-infection or protracted infection; current guesstimate of 3-6 months.

6. How quickly can a safe and effective vaccine be developped and tested? Answer: progress on mitigating drugs, anti-bodies and steroids; vaccine targeted for late 2020 or early 2021; questions emerging on ecological impact.

7. How efficiently can, and comprehensively will, the vaccine be distributed? Answer: Centre for Disease Control preparing for mass distribution by November 2020 though consensus remains next Summer as most feasible time-frame for dispersion of vaccines; distribution surfacing as key constraint.

Friday numbers as at 04sep20
Introduction. The static pool rates declined throughout August from 5.7% to 4.6% globally versus 7.6% to 6.4% across the United States. The static pool declines are welcome but remain 2-3x the 2.3% final mortality rate (or the final static pool rate) of the 1918 flu epidemic in the United States. The saving grace is the lack of evident community transmission during many outdoor large gatherings.

The slowing improvements reflect death tolls in the South and Southwest of the United States. Yet indicators now look better as morbidity and mortality growth rates slow in the largest states in that region (i.e., Florida, Texas, and California). August has become the month, it seems, when the U.S. and the most of the world have adjusted to the presence of the pandemic.

The New York Times has developped a user-friendly tool available for non-subscribers, for which I remain thankful. As usual, this analysis relies also upon data collected by Johns Hopkins Coronavirus Resource Centre and aggregated by Worldometre. This month’s review draws heavily upon the data compiled by the World Heath Organisation. One can review the supplement of general U.S. data on the coronavirus contagion that covers in excess of 80% of the U.S. population and 90% of the deaths recorded to date.

Global Review. Despite comprising one-seventh of the global population, the Americas account for roughly half of the cases and 55% of the deaths recorded. Data integrity questions arise with China, Russia, India and, perhaps, with cash strapped third world countries. This skew toward the Americas has not abated due to México’s 10.2% and Peru’s 4.3% mortality run-rates over the last month versus a 2.4% rate globally.

While more likely to be occasioned, celebrations remain premature in the United States since current U.S. static pool rates appear to be 13x the level they should be for the Trump Administration to limit martality to the anticipated death toll of 200-300,000. The family clusters have performed well in August with a marginal mortality run rate of 1.9%. The case-load is in line with larger population though the death toll has been more than twice as high.

please click here or on image to avoid blindness while reading data.

While a growing denominator in calculating growth rates always favours lower cumulative growth rates, the world, in general, and the U.S. in particular, are adapting to the pandemic. Over the last four weeks, confirmed cases have grown by 36% across the world and a more encouraging 25% in the U.S. Globally, India and Brazil lead the pack (up 90% and 39%, respectively, with both at roughly 4 million cases).

Spain provides a promising example of the value of learning; she has entered a second wave over the past month but her marginal mortality run rate is only 0.4%; one must keep in mind that there may be a lag between the onset of a second wave of confirmed cases and subsequent deaths. The surge leaders of Cataluña and Aragón are stabilising but infection rates are re-accelerating in and around Madrid.

Brazil is another example, though hers is still a first wave, with a 2.4% marginal mortality run rate. Other countries are recording moderating marginal mortality rates for August with Colombia at 3.1%, Russia at 2.1%, and India at 1.4%. (Yet India’s case-load accelerates rapidly while deaths are likely undercounted; the mortality run rate may actually be as high as 4%). The United States has recorded a 2.1% marginal run rate during August. In fairness to Dehli, the possible mitigant identified in South Africa, discussed imminently, could quite easily apply in the sub-continent as well.

South Africa presents an interesting case. She has been expecting the worst with population density and public hygiene being unsafe in poorer urban areas, but continues to tally “mysteriously low” levels of fatalities. The lead COVID-19 epidemiologist in the country can not explain why the results are so much better than expected. Yet infection rates remain low, possibly because many people have anti-bodies from the common cold. Since the sniffles derive from coronaviruses, the anti-bodies created may be adaptable enough to thwart COVID-19.

As the world acclimates, one way or another (i.e., through denial and minimisation or aggressive measures), to the coronavirus contagion, attention is turning toward the economic fall-out of the pandemic. Two thirds of people in the developped world remain pessimistic about their future financially. Outlooks have soured most in the United States as well as other anglophone countries and Germany.

Some countries (e.g., Sweden, the U.S., and India) have lunged ahead to re-open their economies lest fiscal and economic collapse ensue. Social costs may be rising due to repeat or extended infections. Finally, my sweet and tiny Tunisia rings in with an almost certainly bogus mortality run rate of 1.9%, with a 1.1% ‘heart-warming’ mark for August.

COVID-19 landscape in the United States. Due to its being a presidential election year and with President Trump struggling at the polls, the coronavirus contagion has become a political issue as much as a health crisis. Though the United States has been struggling, the death rate per million of 577 is better than other democracies including Peru (890), Belgium (853), Spain (625), the United Kingdom (611), Chile (597), Italy (587), and Brazil (586). At 3.0%, the U.S. mortality run rate has fallen below the 3.3% world average.

As results improve in the U.S., the original prediction by the Administration of 200-300,000 deaths may prove to be on target. Repeated forescasts have previously argued for 300-500,000 deaths by year’s end. The same projections raise the possibility of as many as 700,000 fatalities by the first anniversary of the epidemc.

(Such a level would exceed the number of Americans who died during the Spanish Flu epidemic a century ago.) Current mortality and morbidity trends, however, progressively reduce the likelihood of realising such a grim scenario. Unfortunately, my unfamiliarity with the data and the concepts have constricted my forecasting to rules-of-thumb.

Leading indicators should focus on testing and hospitalisations; unfortuntely, mine do not. That said, the following conclusions lead me to forecast 225-250,000 deaths by year’s end and 250-275,000 at the end of one year (i.e., 01mar20; or, the time horizon used in the projections that I put together five months ago).

Patients in critical care total 15,000 or almost 20% below the levels of a month ago.
Critical care relative to full-blown COVID-19 cases has also declined by a similar percentage, indicating fewer medical needs to attend to.
Lastly, while uneven, the snap-shot mortality rates (i.e., new deaths divided by new cases) remain quite low, in the 2-3% range, indicating that improvements may prove durable in dealing with this pandemic.

The emerging risk factor for the Northern Hemisphere is the return to schools in North America and Europe after their Summer recesses. In the United States, thus far, some twenty-two states are not hosting in-class school for the Autumn semester, including Illinois, Kentucky, Maryland, Massachusetts, Michigan, Pennsylvania, Virginia, and Vermont. Still, U.S. cases for students are up 21% already.

To aid the states’ efforts in tacking the epidemic’s impact on schools, a high school teacher has developped a data-base to track school-house outbreaks. This remarkable data-base, being constructed by Ms Alisha Morris, tracks student and faculty cases, as well as quarantining, by school or district, as reported. Check Massachusetts here; Pennsylvania here; and, Colorado here for a sense of how the semester is progressing.

please click here or on image to preserve eyesight while reading these data

Family Cluster Review. Some analysts assert that the urban areas initially hit hardest by the U.S. epidemic (i.e., New York metro, Boston, Chicago, and Detroit) are approaching herd immunity. While re-assuring, this assertion overlooks the findings of current studies. An individual's immunity attained by recovering from COVID-19 lasts half a year or less, likely making herd immunity unsustainable.

The McDonnell family clusters, in the aggregate, represent 15% of the U.S. population, as do the cases now, at 943,625 confirmed infections, owing to rapid increase in caseloads in the South and Southwest. Nevertheless, the clusters contain a disproportionately high levels of fatalities; at 63,685 deaths, they exceed a third of the current nationwide mortality of 188,079.

Thanks to climbing death rates in the South and Southwest, Baltimore-Annapolis joins Colorado state-wide and Pittsburgh metro in being safer than the national average. Specifically in Colorado, there have been no recent cases in Delores county; total cases are only two with no deaths. Western Pennsylvania is faring well with only 18,666 cases and 3.1% run rate. Baltimore-Annapolis is facing a 20% reduction in public transit due to shrinking revenues and subsidies.

Cape Cod has had few cases and rare fatalities. Hotels remain open and September reservations are adding up, despite the enjoyment of beaches being restricted to residents. People returning to the Bay State or arriving from Colorado, Pennsylvania, New York metro area, and Vermont no longer have to self-quarantine for two weeks or submit to a test within two days before arrival. Michigan is placing 30+ test sites, including three or four in Detroit metro with the guidance of Governor Whitmer’s racial disparities task force.

New York metro had one of the first and steepest learning curves; mistakes compounded the problems in March and April. Governor Cuomo’s sober-minded leadership has paid off in recent months. Nevertheless, most New Yorkers deeply fear a harder second wave; in short, a re-play of the 1918 flu epidemic. Philadelphia’s improved results reflect a doubling in mask use during August. The City of Brotherly Love, like Chicago, has been singled out as a city to be prepared for vaccine by November, likely for testing purposes through teaching hospitals.

Summary of Findings. Specifically, the marginal mortality run rates for the clusters over the past month have been:

The United States = 2.1% versus 1.7% for July
the South and Southwest = 2.8% versus 2.1% for July
Baltimore-Annapolis = 1.5% for July and August
Boston & Cape Cod = N.A. due to revised case counting (5.3% in July)
Chicago proper = 0.9% versus 1.7% in July
Colorado statewide = 1.3% versus 0.9% in July
Detroit metro = 1.4% for July and August
New York City metro = 1.0% versus 3.6% in July
New York CITY = 1.5% versus 4.0% in July
Manhattan Island = 19.7% (re-allocation of deaths among boroughs)
Manhattan Island under old counting = 1.6% versus 2.8% in July
Philadelphia Metro = 2.0% versus 2.3% in July
Pittsburgh Metro = 3.3% versus 1.1% in July

==========

1. Will there be adequate testing and tracing in place? Answer: granular data but no national plan in place; people slow to adopt tracing apps.

2. Will the states, as a group, have re-opened too soon or too laxly? Answer: spikes in confirmed cases in the South and Southwest shrouding growth in the number of deaths; cases up in upper Midwest.

3. How much will the current protests of George Floyd's murder re-accelerate penetration? Answer: outdoors settings may be mitigating the expected community spread of infections.

4. Will the virus have mutated and, if so, for the worse or better? Answer: controversy over mutations though none have proven to be immediately dangerous or undermining vaccines in development.

6. How quickly can a safe and effective vaccine be developped and tested? Answer: progress on mitigating drugs and steroids; vaccine targeted for late 2020 or early 2021; concern over wishful thinking, especially with supposed Russian vaccine meeting scepticism.

8. How deep will the penetration of COVID-19 be in the rural areas? Answer: slow progression continues and now accelerating; mortality run rates remain low.

Friday numbers as at 07aug20

Introduction. The static pool rates declined throughout July from:
8.0% to 5.7% globally, with two-thirds of the decline in the first half of the month; versus,
12.0% to 7.6% in the United States, with the decline accelerating in the first two weeks, but slowing to near flatness in the last week as deaths started rising in the South and Southwest (S/SW).
The while decline in U.S. static pool rates is welcome, as always, the current rate is still more than twice the level of the final 2.3% mortality rate (i.e., also the final static pool rate) of the 1918 flu. Please not that there were five Fridays in July, meaning five weeks compared rather than four. When necessary, I adjust the data to assure smooth comparability; this will occur in weekly growth rates.

If the infection rates reach the stress case (i.e., the 28% penetration of the 1918 flu) or worst case (i.e., 10% penetration) levels, the Trump Administration's forecast of 200-300,000 deaths (i.e., 250,000) will yield a final mortality / static pool rate in the range of 0.3-0.7%. After five months, though progress has been noticeable, the static pool rate is still 15x the level it needs to be. Obviously a vaccine, if safe and effective, will render moot this councern.

The New York Times has developped a user-friendly tool available for non-subscribers. As usual, this analysis relies also upon data collected by Johns Hopkins Coronavirus Resource Centre and aggregated by Worldometre. One can review my compilation of general U.S. data on the coronavirus contagion that covers in excess of 80% of the U.S. population and 90% of the deaths recorded to date.

Past month (five weeks) global and U.S. review. The global level of infections rose 74% and the U.S. confirmed cases grew 76% during the period under review; weekly growth rates averaged out to 11.8% and 12.0%, respectively. Part of this growth came from greater testing globally as the deaths increased by 37% and 28%, for weekly growth rates of 6.4% worldwide versus 5.1% domestically.

Nevertheless, evidence indicates high transmission rates between children and teens. Asymptomtic cases in South Korea report equally high transmissibility as do those afflicted with full-blown COVID-19. These findings question the thinking that passive carriers may be less virulent than their suffering counterparts. This argues for higher penetration rates than reported – and in the coming weeks – in the South and Southwest (S/SW) of the U.S.

To keep the U.S. data in perspective, should these growth rates persist in the United States for the rest of the one year time horizon (through 28feb21) of my forecast four months ago, America could see close to the estimated 675,000 deaths during the 1918 flu epidemic (i.e., roughly 640,000). The COVID-19 mortality rate would be lower than that of the Spanish Flu (i.e., between 0.7% and 1.9% versus 2.3%).

Outside the U.S., Spanish speaking countries are currently leading the worldwide increase in cases. Specifically, Colombia and Argentina have reported 29% and 23% spikes in infections over the past week. While Brazil has levelled off in her growth rate in infections over the last week, she joins México, Peru, Bolivia, and Central America with a 10-15% growth over the last week. Lastly, Spain, one of the hardest hit nations earlier this year, endured an up-tick of 6% in confirmed cases last week.

While global static pool rates diminished by close to a third, the decline in the mortality run rate proved to be slightly less at just over a quarter, despite significant drops in the U.S., the U.K., Italy, Sweden, and, especially, France. Mortality run rates are increasing in scattered countries across the world, often in smaller countries. Countries with noticeable increases in mortality run rates include the Philippines, Chile, Iran, and Poland; the U.K.'s run rate for the past week of 7.1%, while better than her historical run rate, remains problematic.

Though the United States is struggling for all the world to see, the death rate per million of 495 is better than other democracies including Belgium (851), the United Kingdom (685), Peru (625), Spain (610), Italy (582), Sweden (570), and Chile (520). There are a lot of suspect numbers being reported around the world – and in some U.S. states (e.g., Florida) – particularly from China, India, Russia, Turkey, and parts of Eastern Europe. Finally, my sweet and tiny Tunisia rings in with an almost certainly bogus mortality run rate of 3.1%, with a 0.8% ‘heart-warming’ mark for the past week.

Family Review. Good news for the family clusters for this week: for data of the states of residence all relatives, go to the data separate page of data that covers thirty-three states and six territories. In the Northeast, Baltimore-Annapolis and Pittsburgh metro showed the largest elevations in confirmed cases, unfortunately led by sharper increases in Anne Arundel (MD) and Allegheny (PA) counties. Colorado also reported a spike, with no cases in Delores County and Denver's rates falling over the last two weeks.

These increases likely reflected increased testing since the mortality run rates fell by 25% in Baltimore-Annapolis and Colorado as well as by half in Pittsburgh metro to the best three rates among the clusters. While mortality run rates remain high in the New York City area and Detroit metro at 8.3% and 9.0%, respectively, the marginal rates for the past month have become a good deal safer despite rising concerns in New Jersey, New York, and Massachusetts.

Specifically, the marginal mortality run rates for the clusters for the past five weeks have been:

The United States = 1.7%
the South and Southwest = 2.1%
Baltimore-Annapolis = 1.5%
Boston & Cape Cod = 5.3%
Chicago proper = 1.7%
Colorado statewide = 0.9%
Detroit metro = 1.4%
New York City metro = 3.6%
New York CITY = 4.0%
Manhattan Island = 2.8%
Philadelphia Metro = 2.3%
Pittsburgh Metro = 1.1%

==========

Second Wave Anticipation. While a second wave is starting or remains imminent in many parts of the world, the question remains its magnitude. Answers to the following questions will go a long way in determining the magnitude of that wave.

Will there be adequate testing and tracing in place? Answer: granular data but no national plan in place; people slow to adopt tracing apps and many moving parts in tracing.
Will the states, as a group, have re-opened too soon or too laxly? Answer: spikes in confirmed cases in the South and Southwest shrouding growth in the number of deaths.
How much will the current protests of George Floyd's murder re-accelerate penetration?Answer: no hard evidence that protests have catalysed a spread the coronavirus.
Will the virus have mutated and, if so, for the worse or better? Answer: controversy over mutations though none have proven to be immediately dangerous or undermining vaccines in development.
How long will people prove to be immune who have survived the illness already? Answer: only time will tell; some evidence of either re-infection or protracted infection.
How quickly can a safe and effective vaccine be developped and tested? Answer: progress on mitigating drugs and steroids; vaccine targeted for late 2020 or early 2021
How efficiently can, and comprehensively will, the vaccine be distributed? Answer: Dr Fauci moderating expectations for rapid development and roll-out; pricing concerns being addressed.
How deep will the penetration of COVID-19 be in the rural areas? Answer: slow progression continues and now accelerating; mortality rates remain low.

Friday numbers as at 03jul20

Introduction. The static pool rates are dropping steadily now, indicating the end of the first, hopefully only, wave of the coronavirus. The rates are now 12% for the U.S. and 8% globally. This week adds two topical sections: a deeper dive into the recent spikes in the South and Southwest as well as a preview the race against the clock for a coronavirus vaccine.

This article in the Wall Street Journal, free of charge, outlines what we know about the coronavirus and how it infects people and what to look out for; Johns Hopkins Medicine has issued this handy reference. The New York Times has also made a user-friendly tool available for non-subscribers. As usual, this analysis relies also upon data collected by Johns Hopkins Coronavirus Resource Centre and aggregated by Worldometre.

HAPPY INDEPENDENCE DAY

Past week global and U.S. review. The United States has re-accelerated her growth rate in confirmed cases to 13.0%, due in large part (at least for now) to the ramping up of testing. American infection rates have edged by the global growth rate of 12.7%. The hot-spots to focus on remain emerging nations in Africa, Eurasia, and Latin America. The places leading the rise in infections include Brazil, the Indian sub-continent, México, and South Africa.

Many of the poorer countries of these regions have suspect data integrity in their reporting. The global mortality run rate is now higher than that of the United States – at 4.8% to 4.6% -- due to increased testing in the U.S. as well as the American roll-out of mitigating medications, principally remdesevir and dexamethasone. The spread into the rural areas of the United States continues; these areas host fewer doctors with fewer resources.

The second wave now emerging across the world works more like a second wave among industrialised countries but a deferred first wave for developping nations plus the Southern and Southwestern U.S. states. In reviewing the eight family clusters tracked each week, the following three reasons explain the mortality run rates so far above the national average (i.e.,7.8% versus 4.6%).

Unless there is some Asiatic genome that confers a robust defence against this virus upon inhabitants of the Asian Pacific Rim, the coronavirus appears to have mutated while it migrated west through Europe into the Eastern Americas. The Western U.S. states have managed their epidemics better, perhaps with a less malignant virus. Remember the State of Washington three months ago (before the Northeast took off)? As it turns out, as rough a start as Washington faced, Governor Inslee has managed, heroically, to keep the rates to moderate intensity (as shown below).
There was a steep learning curve to overcome with this uniquely new coronavirus. What previous experience had taught us as prudent in March (sending elderly patients to nursing homes) proved counter-productive.
Most of these clusters lie in urban areas with substantial Black and Brown populations that have suffered disproportionately due to higher levels of "co-morbidities" (i.e., kidney failure, blood pressure, diabetes, and obesity). Additionally, a higher percentage of Hispanics and Blacks have had to report to work as ‘essential’ employees (e.g., bus-drivers, garbage collectors, etc.). This racially skewed hazard reflects in part the systemic racism argued by Black Lives Matter and likely explains part of the Black-led rebellion currently taking place.
More densely populated areas tend to transmit the virus more quickly.

Pittsburgh has endured a 30% growth rate in the past week, with infections largely afflicting people under forty. This demographic likely reflects increased testing. Hospitalisation rates are also increasing slowly in Steelers country. Fortunately, Pittsburgh has superb teaching and general service hospitals that should be able to absorb any new patient-load. Elsewhere, in the other seven family clusters, growth rates hover around 1-2% with a mortality up-tick in New York metro.

The tri-state triumvirs of Governors Cuomo (D-NY), Lamont (D-CT), and Murphy (D-NJ) have been quick to preserve their heard-earned momentum gained from the ordeal of the past four months. Among possible restrictions, these states are imposing quarantine requirements on people entering from states with spikes in infections including California, the Carolinas, and Idaho (sic). A special section to follow will analyse these 'spike' states.

Grading the Trump response. The Administration has had to overcome the consequences of budget-cutting into the bone; an early mis-step by trying to go it alone (i.e., turning down test kits from the W.H.O.); a two-to-three week delay imposed by the politics of a partisan impeachment; as well as, poor public relations management by the President himself (e.g., resorting to the blame-game and making ill-advised statements). Most Americans view the Trump Administration’s management of the flu as illustrated below.

Despite the loss of credibility and many self-imposed hurdles, President Trump gets a “B-“ for the following reasons.

The U.S. has caught up to its peer group in testing.
The United States Government (U.S.G.) is finally firing on all cylinders for mitigating medicines and developing a vaccine.
The Public-Private Partnership initiated in March is bringing to bear the industrial capacity still in the U.S. on the bulk production of protective and life-saving equipment.
The painful lock-down has flattened the curve, though a rash of new cases spreads throughout the South and Southwest.
Deaths per million for the U.S., 399, are well below those of many of the Western European nations, ranging from 536-843 (i.e., Belgium, France, Great Britain, Italy, Spain, and Sweden).

The Spikes: ¿new wave, used wave, loosed wave? The first wave has ended in the areas hit hardest by the onset of the coronavirus contagion. While many Southern and Southwestern states are reporting substantial spikes in confirmed cases, as addressed in last week’s letter, mortality rates apparently remain low.

Nevertheless, Europe’s concern with a second wave has led to a short-term ban on Americans travelling there. We may be seeing less of a second wave than a deferred first wave in the rural states. Updating data from states featured last week:

Arizona confirmed cases up 32% (to some 87,500 cases) with a mortality run rate of 2.2%;
California confirmed cases up 20% (to some 250,000 cases) with a mortality run rate of 2.5%, but the state is taking action this July 4th week-end;
Florida confirmed cases up 38% (to some 170,000 cases) with a mortality run rate of 2.1%;
Georgia confirmed cases up 21% (to some 85,000 cases) with a mortality run rate of 3.3%;
Oklahoma confirmed cases up 18% (to some 15,000 cases) with a mortality run rate of 2.7%; as well as,
Texas confirmed cases up 29% (to some 185,000 cases) with a mortality run rate of 1.4%.

These data look like good and bad news: bad news of rapidly increasing case-loads (i.e., up 26% for these six states) but apparently good news of declining mortality run rates. This conclusion is not really warranted. In actuality, what one reads here is bad news in the number of cases and ‘not-as-bad’ news of mortality as deaths rising 7.2% to 17,435 victims inside these six states.

Additionally, there is the effect of lag-times of infection to interment. The initial inference drawn here is that these states are betting they can distribute a vaccine before a spike of critical care cases forces as death wave across the country. The 20-25day progression from initial infection to critical care will kick in later for some states than others.

As cases eventually taper off in these and all other states, deaths will continue to rise for some period of time. The ability of the more rural states to manage increased hospitalisations and for patients to access care will be a decisive factor, good or bad. Per the article composed three months ago, the base case remains high at 335,000 while the revised best case of 175,000 hopefully will better reflect the unfolding reality. The following factors will determine the number of eventual deaths in the busted hustings:

level of transmission (i.e., ¿how many millions infected, mostly asymptomatic?);
proximity to a hospital or well-equipped clinic;
number of qualified doctors nearby and available; and
level of Medicaid expansion under Obamacare.

Analysing the rural reach. To test the urgency of the rural states and those with spikes presently in force, I have taken the number of deaths in each state and applied the percentage of those deaths to the host-state’s population. Then I apply that percentage to the U.S. population to enable comparability of data among states with populations ranging in size from under one to almost forty million. These examples of computation suffice for Colorado and Maryland.

The states featured below include those hosting whole or partial clusters studied each week; states where only one or two of my extended family live (i.e., below the line in the upper-most section); states analysed last week; other states quarantined by Connecticut, New Jersey, and New York; as well as, additional states of interest. In evaluating the urgency of the current local coronavirus contagion, I establish the following benchmarks based upon the rate of confirmed relative to populations of the United States, New York metro, and, the whole wide fuckin’ world.

VERY HIGH = at or above 250,000
HIGH = at or above 130,000
MODERATE = at or above 50,000
LOW = at or above 30,000
VERY LOW = at or below 29,999

The current death toll in the United States approaches 130,000. Without New York metro that mortality level approximates 92,500. If the American people were to suffer the same percentage of deaths as the rest of the world, that toll would 20-25,000.

The currently popular notion that upwards of 90% of the infections are undiagnosed strikes me as wishful thinking. In any case, if that assertion be true, the mortality run rate will still be 5x that of the flu in 2019; this coronavirus contagion is not simply the flu by another name. The magnitude of impact imposed by this virus, if we are lucky, may be like that of the first wave of the 1918 Flu before it mutated murderously ending with 2.3% mortality run rate.

The race of the century already, or the vaccine rush. Aside from the second wave, the question of the development of a safe, effective, and timely vaccine remains paramount. The opening remarks by Senator Blunt (R-MO) in a hearing this week to assess the progress toward a vaccine provides a concise overview of the state of development. Three looming challenges confront the companies racing to develop the vaccine for distribution in early 2021.

Most important is the ‘rush to failure’, or relaxing testing strictures to expedite development and distribution of the vaccine. A failed vaccine might not only prove ineffective, but it could exert negative unintended consequences like side effects.
Next is the scientific question of the mutation of the virus so that the vaccine becomes quickly dated. Testimony by leading U.S.G. experts reflects a collective view, if not complete consensus, that this novel coronavirus is not apt to change its RNA composition significantly enough to undermine the effectiveness of the vaccine.
Last is the concern over distribution and availability.

Those candidates being funded in part by the U.S. share a common ability to multiply production quickly to make millions or a billion doses available quickly. The question of availability translates also into pricing. The Bayh-Dole Law of 1980 provides for the commercialisation of U.S.G. funded research.

While instrumental in launching an innovation wave during the past forty years, Bayh-Dole has created two basic political problems in the case of a vaccine rushed to market. One is the pricing of the developped pharmaceutical products. The argument here is why American consumers should pay monopolistic prices for products their tax dollars helped develop.

Representative Alexandria Ocasio-Cortez argues this point with the C.E.O. of a company that has benefitted enormously from these legislated subsidies. The issue that critics raise argues that the development and marketing risk of the product has been transferred largely to universities and the U.S.G. and, therefore, companies should not gain the out-sized rewards of monopolitic pricing for risks unassumed.

The other political question remains one of licensing. If a drug is developped and the U.S.G. seeks to contain the price to increase its availability to COVID-19 sufferers as well as to recover the subsidies of the tax-payers, companies may simply refuse to produce and prevent others from levering their intellectual property. In theory such intellectual property -- the formula of the vaccine in this case -- is protected by a patent to permit exclusive used by its owner for twenty years.

To work around this scenario, many countries have compulsory licensing provisions that allow the government to intervene and oversee manufacture through the "licensing", or renting, the intellectual property out to a third party. This "licensee" (i.e., the government hired company) then prices the product at a level affordable to consumers yet sufficient for a ‘fair’ return to the third party producer. Of course, that 'fair' return is not etched in stone and varies among contentious stake-holders.

It may be, for example, set at 15%, or the typical yearly return-on-investment (R.o.I.) for U.S. equity markets. In cases where the development risk is not transferred to tax-payers through Bayh-Dole (i.e., assumed by the companies themselves), such a 'normal' return does not create the profit necessary for pharmaceutical companies to absorb costly losses endured on most new drugs that fail in testing or in the market.

Senator Chris Murphy (D-CT) implies that the language of the Bayh-Dole statute itself – that products be taken to the market “at reasonable terms” – allows for the practice of compulsory licensing. Two big issues with compulsory licensing need to be addressed.

Most overseas laws for compulsory licensing allow for several years of non-production by the drug company before the government can intervene, an unworkable provision in the face of this COVID-19 pandemic.
The real-life practice of compulsory licensing is not working too well thus far, at least in India. Competing interests and corporate cronyism appear to subvert the implementation. More likely, governments in emerging markets (e.g., India) use this ‘last-resort’ as a lever in negotiating price limits.

Beating the odds and data update. As one reviews these data, (s)he ought to keep in mind the likelihood of a death, expressed as one death for every X people (i.e., the odds). .

World: 10,997,799 cases (up 12.7%); 524,157 deaths (up 6.4%); 4.8% mortality rate; one case for every 698 people and one death for every 14,660 people
United States: 2,816,131 cases (up 13.0%); 125,980 deaths (up 3.6%); 4.6% mortality rate; one case for every 118 people and one death for every 2,540 Americans

==========

Baltimore-Annapolis: 23,790 confirmed cases; 4.7% mortality rate; one death for every 2,502 people
Boston and the Cape: 63,451 confirmed cases; 7.3% mortality; one death for 1,002 people
Chicago proper: 91,381 confirmed cases; 5.0%; one death per 858 people
Colorado statewide: 33,352 cases; 5.1%; one death per 3,394
Detroit metro: 44,298; 10.9%; 1 death per 886
New York metro: 455,813; 8.5%; 1 per 584
New York CITY: 216,362; 10.7%; 1 per 362
Manhattan Island 26,866; 9.1%; 1 per 664
Philadelphia metro: 55,498; 7.5%; 1 per 1,462
Pittsburgh metro: 5,060 cases*; 6.3%; 1 per 7,382

==========

Second Wave Anticipation. While a second wave remains likely, the question remains its magnitude. Answers to the following questions will go a long way in determining the magnitude of that wave.

Will there be adequate testing and tracing in place? Answer: approaching adequacy with granular data but people slow to adopt tracing apps.
Will the states, as a group, have re-opened too soon or too laxly? Answer: spikes in confirmed cases in the South and Southwest shrouding growth in the number of deaths.
How much will the current protests of George Floyd's murder re-accelerate penetration?Answer: of the states catalysing the Black-led rebellion, only California has seen a significant increase in confirmed cases; state taking action during July 4th week-end.
Will the virus have mutated and, if so, for the worse or better? Answer: has and continues to mutate, though not enough to undermine proposed vaccines.
How long will people prove to be immune who have survived the illness already? Answer: only time will tell; some evidence of either re-infection or protracted infection.
How quickly can a safe and effective vaccine be developped and tested? Answer: progress on mitigating drugs and steroids; vaccine targeted for late 2020 or early 2021
How efficiently can, and comprehensively will, the vaccine be distributed? Answer: distribution may begin by January 2021; pricing concerns.
How deep will the penetration of COVID-19 be in the rural areas? Answer: slow progression continues and now accelerating; mortality rates remain low.

* confirmed cases up 30% for PGH metro

BACK-STORY

81% of the cases and 97% of the deaths supposedly confined to Hubei Province with 4% of China's population;
Shanghai with 27 million people, 639 cases, and seven deaths (¿REALLY?); as well as,
Peking with a population of 20 million,593 cases, and eight deaths (¿Too good to be true?).
My family on both sides tend to cluster in Pittsburgh, New York, Detroit, Boston, Colorado, Chicago, Maryland, and Philadelphia.

Friday numbers as at 26jun20

Static pool analysis.The static pool mortality rates declined again, with the United States accelerating toward the end of the week, to the 12.8% level; global static pool rates ended the week at 8.8%. The current wave of the pandemic is ending in Europe but lingers in the U.S. Cases grew by 14% globally, 11% in America and 5% in Europe. The Americas as well as sub-Saharan Africa and the Indian sub-continent lead the current global quickening. CRITICAL NOTE: findings by the Centre for Disease Control indicate that 'co-morbidities' (i.e., diabetes, obesity, hyper-tension as well as pulmonary and kidney problems) erase the advantage of youth. That is to say, by way of example: a twenty year old diabetic is as vulnerable to dying from COVID-19 as an eighty year old without diabetes.

Review of U.S. and international trends. The challenge for the United States remains one of speed of deceleration of infection rates. Specifically, the U.S. infection and death rates are not dropping as quickly as other nations stricken hard by COVID-19, with the exceptions of Brazil, India and Sweden. The source of the slower deceleration for the U.S. remains uncertain, though the increased testing has inflated the number of cases as today's presentation by the Coronavirus task force indicates. Apparently, younger people represent most of the new infections and are largely asymptomatic.

Interestingly, Dr Birx later emphasised the importance of her working with community leaders as the tracking data are almost granular enough to infer the course of the contagion. The big story this week was the continued proliferation of confirmed cases throughout the South and Southwest. Consequently, I decided to take a look at the states most mentioned -- Arizona, California, Florida, Texas -- as well as Oklahoma back to May 23rd.

(Unfortunately, I got the two May dates off by a day, but the information is still usable.) The start-date came before Decoration Day as well the murder of George Floyd and the ensuing protests. Arguably, these two events will prove, in hind-sight, to be inflection points. The onset of the Summer travel season and the street demonstrations broke down the discipline of social distancing. In many venues, people did not wear masks. Though a smaller state, Oklahoma hosted a rally by President Trump; I included her to look for any immediate consequence. Below are the data on new cases and deaths in the six states.

As one can see, while the infection rates have increased materially, the mortality has declined and now represents a significant improvement over both the 5.1% global and national run-rates. The U.S. mortality rate has much improved over the last six weeks. These six states compare even more favourably with the composite data for the eight clusters under review, which showed only a 1.7% growth in confirmed cases this week but a 7.8% mortality rate (versus 7.6% the previous week due to an apparent spike in Northern Jersey).

Implications of new spikes. Despite the evident brain-power of the U.S. doctors, epidemiologists, and scientists finally being brought to bear on the U.S. epidemic, the results still lag much of the rest of the world. From what I can tell, there is a twenty to twenty five day interval between infection's first contact and the progression ultimately into critical care for full-blown COVID cases. So increasing mortality rates, if they are to manifest, should make themselves felt about now, or imminently at the latest. The concern remains that of a second wave, now expected to coincide with the Autumn flu season, which could prove a deadly combination.

Europe is set to limit entry by Americans, Russians, and Brasilians due to the spikes in cases across the country. Notwithstanding, the good news this week of the efficacy of certain steroids in mitigating the full blown COVID illness, the fate of Americans may well lie in a race against the clock to test out a vaccine and have it widely distributed by March 2021. This timeliness becomes important in face of some twenty million Americans apparently infected and some 85% not reporting for various reasons.

NOTE on Idaho. Please note there was a mention in Dr Birx's remarks of an inflection taking place in Idaho. After an initial spike in April, Idaho calmed down until the end of May. Of her 5,149 cases, 45-50% have been confirmed in the last month. Idahoans appear to be a hearty crew with a mortality run rate of only 1.7%. Only one of every 347 have contracted the virus and only one of 19,637 actually succumb to it; these are the best odds of any of the McDonnell clusters.

Beating the odds and data update. As one reviews these data, (s)he ought to keep in mind the likelihood of a death, expressed as one death for every X people (i.e., the odds). .

World: 9,752,937 cases (up 14%); 492,695 deaths (up 8%); 5.1% mortality rate; one case for every 787 people and one death for every 15,596 people
United States: 2,491,672 cases (up 11%); 125,980 deaths (up 5%); 5.1% mortality rate; one case for every 133 people and one death for every 2,640 Americans

==========

Baltimore-Annapolis: 22,542 confirmed cases; 4.8% mortality rate; one death for every 2,599 people
Boston and the Cape: 62,696 confirmed cases; 7.2% mortality; one death for 1,020 people
Chicago proper: 88,650 confirmed cases; 5.1%; one death per 878 people
Colorado statewide: 31,796 cases; 5.3%; one death per 3,451
Detroit metro: 43,143; 11.1%; 1 death per 896
New York metro*: 451,703; 8.4%; 1 per 597
New York CITY: 214,070; 10.5%; 1 per 374
Manhattan Island 26,533; 9.1%; 1 per 674
Philadelphia metro: 54,032; 7.5%; 1 per 1,497
Pittsburgh metro: 3,891 cases; 8.1%; 1 per 7,571

==========

Second Wave Anticipation. While a second wave remains likely, the question remains its magnitude. Answers to the following questions will go a long way in determining the magnitude of that wave.

Will there be adequate testing and tracing in place? Answer: approaching adequacy with granular data on community spread; tracing still to follow.
Will the states, as a group, have re-opened too soon or too laxly? Answer: thus far okay with high growth rates of infection with mortality rates 40-60% of national average.
How much will the current protests of George Floyd's murder re-accelerate penetration?Answer: concerns raised since fourteen members of Trump advance team infected.
Will the virus have a seasonal effect (e.g., not prolific in hot weather)? Answer: NO.
Will the virus have mutated and, if so, for the worse or better? Answer: has and continues to mutate, though recently not for the worse.
How long will people prove to be immune who have survived the illness already? Answer: only time will tell; some evidence of either re-infection or protracted infection.
How quickly can a safe and effective vaccine be developped and tested? Answer: progress on mitigating drugs and steroids; vaccine targeted for late 2020 or early 2021
How efficiently can, and comprehensively will, the vaccine be distributed? Answer: Dr Fauci says widespread distribution may be possible by March 2021; pricing concerns.
How deep will the penetration of COVID-19 be in the rural areas? Answer: slow progression continues and now not accelerating; mortality rates remain low.

Friday numbers as at 19jun20

Static pool analysis.The static pool mortality rates continued to decline, especially during mid-week for the United States, from 15% to 14% domestically and by half a percentage point (to 9.5%) globally as the coronavirus contagion matures on the back-end of what will likely be a first wave. Cases are increasing more rapidly in certain parts of the world, largely in the Middle East, Pakistan, and India. One must keep in mind two points:

sharp increases off of a small number of cases (e.g., China’s low denominator [sic]); and,
varying levels of reporting transparency.

Review of emerging U.S. and international trends. The challenge for the United States remains one of speed of the deceleration. Specifically, the U.S. infection and death rates are not dropping as quickly as other nations stricken hard by COVID-19, with the exceptions of Brazil and Russia. Unfortunately, I can not say whether the U.S.’s slower deceleration reflects the onset of a second wave as the first wave tapers off or whether the country’s testing tends to inflate the numbers (since 90%+ of the cases are mild worldwide) to create that appearance.
No photo description available.

Florida’s rates apparently defy the argument of more testing unearthing more asymptomatic cases. The politics of COVID-19 becomes more difficult to separate out of the epidemiological challenges of a possibly pending second wave. Vice President Pence argues that the elevation of the number of confirmed cases reflects the increasing thoroughness of testing throughout the United States.

Many officials and public commentators contest these claims, often accusing the Vice President of lying. Keeping in mind my limitations in assessing the trends of disease-related data and the meaning of those data themselves as well as looking at the numbers in the Johns Hopkins site, Worldometer, the New York Times, the BBC, and NPR, I believe that it is too soon to tell.

While the spread of the virus slows in much of the country, one must note some disturbing facts amid the improving news for the states that have been more disciplined in mitigating the coronavirus contagion.

¿What's up with the McDonnells and the Trump Administration?On the plus side, the areas under review witnessed slow growth rates in confirmed cases and deaths at 2% each, one-fifth and one-half the national rates, led by significantly decelerating increases of 1-2% in New York, Detroit, and Boston. Kudos to Governors Cuomo (D-NY), Whitmer (D-MI), and Baker (R-MA). The presence of inner city teaching hospitals is beginning to show as mortality run rates in Boston-proper and the city of Philadelphia are 10-15% lower than those recorded for the wider metro areas.

Claire Purnell suggested a compelling reason for Pittsburgh’s lower COVID numbers: Steeler country is neither a destination city nor an airline hub. On the challenging side, first, the Tulsa area has seen a sharp increase in cases during the past two weeks as the President prepares to speak to as many as 62,000 people in an indoor rally venue.

Second, the President and Vice President, the head of the coronavirus task force, fail to set an example for the rest of the country by dispensing with social distancing and the wearing of masks in publicly recorded events. CNN reports that the probability of transmission is about one-in-six with social distancing practiced; it falls to roughly one-in-thirty with the addition of a mask. Third, Dr Anthony Fauci states that he has not met with President Trump for at least half a month.

New and news resources. The New York Times has produced a resource for tracking the current two-week trending of the coronavirus contagion. This remarkable tool indicates a decline in the infection rate in at least 80% of the areas under review with a flat-line for most of the balance. The only up-ticks are in suburban Denver, Howard County (Maryland), and an outlying area of Pittsburgh metro. Southwestern Colorado has confirmed no new cases in the past fortnight.

So, while the overall trend in the United States shows a 9% increase in detection rates, the area under review is improving. Some good news this week as, apparently, a steroid may provide critical care relief for patients suffering severely from COVID-19. This new medicine, Dexamethasone, supplement the mitigating medication, Remdesivir, now being manufactured by Gilead Pharmaceutical.

Beating the odds and data update. As one reviews these data, (s)he ought to keep in mind the likelihood of a death, expressed as one death for every X people (i.e., the odds). .

World: 8,587,298 cases (up 13%); 456,462 deaths (up 8%); 5.3% mortality rate; one case for very 894 people and one death for every 16,834 people
United States: 2,237,031 cases (up 9%); 119,747 deaths (up 4%); 5.4% mortality rate; one case for every 148 people and one death for every 2,777 Americans

==========

Baltimore-Annapolis: 21,585 confirmed cases; 4.8% mortality rate; one death for every 2,723 people
Boston and the Cape: 61,933 confirmed cases; 7.1% mortality; one death for 1,045 people
Chicago proper: 86,179 confirmed cases; 5.0%; one death per 912 people
Colorado statewide: 29,901 cases; 5.5%; one death per 3,524
Detroit metro: 42,076; 11.3%; 1 death per 903
New York metro*: 447,478; 8.2%; 1 per 619
New York CITY: 211,260; 10.5%; 1 per 378
Manhattan Island 26,109; 9.2%; 1 per 680
Philadelphia metro: 52,304; 7.5%; 1 per 1,559
Pittsburgh metro: 3,503 cases; 8.7%; 1 per 7,745

==========

Second Wave Anticipation. While a second wave remains likely, the question remains its magnitude. Answers to the following questions will go a long way in determining the magnitude of that wave.

Will there be adequate testing and tracing in place?Answer: open question with the ‘in-a-month’ getting old after two or three months
Will the states, as a group, have re-opened too soon or too laxly?Answer: most states are thus far okay; Florida is a noticeable exception.
How much will the current protests of George Floyd's murder re-accelerate penetration?Answer: Trump rally may compound the spread in Oklahoma
Will the virus have a seasonal effect (e.g., not prolific in hot weather)? Answer: NO.
Will the virus have mutated and, if so, for the worse or better?
How long will people prove to be immune who have survived the illness already?Answer: only time will tell; some evidence of either re-infection or protracted infection.
How quickly can a safe and effective vaccine be developped and tested?Answer: progress on mitigating drugs; vaccine targeted for late 2020 or early 2021
How efficiently can, and comprehensively will, the vaccine be distributed?Answer: not promising with slowness of testing; concerns over pricing
How deep will the penetration of COVID-19 be in the rural areas?Answer: slow progression continues but apparently not accelerating.

Friday numbers as at 12jun20
NOTE: U.S. and global static pool rates declined slowly in the first half of the week before flattening out at 14.9% and 10.2%, respectively. These static pool rates carry the same differential as before and remain high above the mortality run rates of 5-6%. All this despite a finding that the spread of the COVID-19 from passive carriers may be slower than expected. Eventually, the mortality static pool and run rates from this sixth coronavirus will converge.

¿When the end? The virus will migrate through the population, possible creating a 'herd immunity', and will end with the development and dissemination of a vaccine. A review of the data presented this week indicates that, if this first wave is the extent of the COVID-19 epidemic in the United States, one can reasonably expect the convergence of static pool and mortality run rates at some point in the range of 158-192,000 deaths, roughly a quarter above the best case level of 141,994 deaths identified ten weeks ago (and about half the base case of 335,301).

WEEK-in-SUMMARY. The flattening of static pool rates at the end of the week possibly augured a second wave. Certain states started recording increases in cases while the through-put from the first wave still cycled through the system. Additionally, epidemiologists voiced concern that protestors may amplify the coming spike. To date, the data have remained inconclusive; preliminary, largely anecdotal, evidence indicated that many protestors are wearing masks, partly with the admonishment of local leaders.

Data Problems. There was a problem, again, with inconsistent data between those reported by Johns Hopkins and those from Worldometer, the two sources underlying these updates. Most of the differences appeared to be immaterial, explicable by real-time versus periodic recording. One difference remained material, however: that of the number of people deemed as recovered. The Johns Hopkins datum stayed consistently at two-thirds that of Worldometer.

A review of the respective methodologies revealed what appeared to be a more conservative counting and confirmation method employed by Johns Hopkins as opposed to Worldometer. To address these differences, I split the difference between the two measures on U.S. and global data while, for local data, I relied upon the more granular Johns Hopkins data (with one exception for statewide in Colorado). This method employed the SWAG approach (S.W.A.G. = scientifically wild-assed guess).

Review of Family Clusters. While the politics of the murder of a black man by the police overwhelmed coverage of the pandemic, the coronavirus contagion surfaced another epidemic of public violence: that suffered by medical personnel. The share of the areas under review relative to national cases and deaths declined by roughly two percentage points each -- to 35.6% of cases and 48.6% -- indicating the up-tick recorded in twelve, largely rural states. The mortality run rates in the clusters stayed well above national and global rates (i.e., 7.6% versus 5.6%).

New York metro accounted for 60% of the cases but less than a third of the deaths among the eight areas under review, attesting to Governors Cuomo's (D-NY), Lamont's (D-CT), and Murphy's (D-NJ) effective leadership during the crisis. Only Detroit metro and Maryland showed significant increases in confirmed cases, likely due to increased testing as mortality run rates fell. The growth of cases worldwide still increased by 13% (versus 8% for the U.S. and 3% for the family clusters) led again by India, Brazil, and, perhaps, Russia.

Second Wave Anticipation. The timely topic for discussion remains that of a second wave. There will be one, almost certainly, but the question remains its magnitude. No one can say what that wave will be like. Answers to the following questions will go a long way in determining the magnitude of that wave.

Will there be adequate testing and tracing in place?
Answer: perhaps in the next month for testing.
Will the states, as a group, have re-opened too soon or too laxly? Answer: indications of spikes in Florida and Arizona; but no spike yet in Georgia.
How much will the current protests of George Floyd's murder re-accelerate penetration? Answer: too soon to tell; wait a fortnight.
Will the virus have a seasonal effect (e.g., not prolific in hot weather)? Answer: unlikely to be a seasonal pattern due to heat as evidenced by current spikes in India and Brazil.
Will the virus have mutated and, if so, for the worse or better? Answer: wait and see.
How long will people prove to be immune who have survived the illness already? Answer: only time will tell; some evidence of either re-infection or protracted infection.
How quickly can a safe and effective vaccine be developped and tested? Answer: three vaccines are under phase-3 (advanced) F.D.A. testing; possible vaccine in 2020, more likely early 2021.
How efficiently can, and comprehensively will, the vaccine be distributed? Answer: undetermined, but the the dissemination of now available tests remains slow; concerns energing over the pricing of such a future vaccine.
How deep will the penetration of COVID-19 be in the rural areas? Answer: some evidence of penetration but extent and pace remain unknown.
How will rural areas manage with fewer available facilties, medical first responders, and Medicaid extensions? Answer: that is the concern; mobile hospital capacity may help.

Beating the Odds and Data Update. As one reviews these data, (s)he ought to keep in mind the likelihood of a death, expressed as one death for every X people (i.e., the odds). .

World: 7,599,437 cases; 423,748 deaths; 5.6% mortality rate (improved from 5.9%); one case for very 1,011 people and one death for every 18,134 people
United States: 2,060,221 cases; 115,011 deaths; 5.6% mortality rate (improved from 5.7%); one case for every 161 people and one death for every 2,891 Americans

==========

Baltimore-Annapolis: 20,295 confirmed cases; 4.8% mortality rate; one death for every 2,892 people
Boston and the Cape: 60,969 confirmed cases; 7.0% mortality; one death for 1,079 people
Chicago proper: 83,978 confirmed cases; 4.9%; one death per 962 people
Colorado statewide: 28,647 cases; 5.5%; one death per 3,647
Detroit metro: 41,487; 11.6%; 1 death per 912
New York metro*: 442,696; 8.2%; 1 per 626
New York CITY: 208,517; 10.6%; 1 per 381
Manhattan Island 25,725; 9.2%; 1 per 688
Philadelphia metro: 50,969; 7.4%; 1 per 1,618
Pittsburgh metro*: 3,394 cases; 8.7%; 1 per 7,981

* Pittsburgh metro numbers appear to be unrealistically optimistic

Friday numbers as at 05jun20
NOTE: U.S. static pool rates dropped sharply until a slight up-tick for today at 15.9%, reflecting a gradual trend back up since Decoration Day. Global static pool rates trended down more slowly to 11.4%, roughly 30% below the U.S. rate; slowing the decline are the current challenges facing the U.K. (14.2% mortality run rate) and Brazil.

The concern over U.S. static rates relates to an expected second wave. Compounding the risk of re-opening too soon is the effect of widespread protests across the country following the police murder of George Floyd. This new risk factor has two dimensions: the break-down of the discipline exercised for the previous two months by many Americans and the effects of tear gas.

Between Memorial Day celebrations and protests, social distancing has declined, especially in urban areas with fewer people wearing masks. Masks keep the virus in by containing droplets of spittle; it does not keep the virus out. That is to say: people who do not wear masks can still spread the virus to those who do. These hazards of the protests will not create, but aggravate, the second wave.

Global infection levels increased by 13% with increased detection in India, the Middle East and South America. Meanwhile global static pool rates declined, indicating higher testing levels as proven by mortality run rates declining modestly from 6.1% to 5.9%. U.S. confirmed cases grew 6% with a similar improvement in the mortality run rate of two-tenths of a per cent to 5.7%.

Growth rates for four of the clusters straddled the 6% national rate, with Baltimore-Annapolis (+14%) and Colorado (+9%) being the outliers. New York and Detroit recorded the slowest growth rates of 2-3%, again reflecting disciplined mitigation. Detroit's tragically high mortality run rate of 13% reflects the age and minority demographics of its metropolitan population.

Despite slightly declining shares of the confirmed cases and deaths, the areas studied still endure mortality run rates that are a third above the national rate (i.e., 7.6% versus 5.7%). A quarter of the way into the year time-horizon of this statistical (¿sadistical?) tracking, it might be helpful to see how the current numbers across the U.S. compare with those forecast two months ago.

Actual Results after three months: 1,904,678 cases and 109,403 deaths
Best Case for one year: @3,500,000 guesstimated cases (actual to scenario cases of 55% or 55% of the way there) and 141,994 deaths (actual to forecast deaths of 77% or three-quarters of the way there)
Base Case for twelve months: 9,313,895 cases (actual to projected of 21%) and 335,301 of deaths (actual to anticipated of 32%)
Worst Case through 28feb21: @33,263,911 cases (6% of the way there) and 1,197,501 (9% of the way there)
Stress case for the 1918 Flu (i.e., its three years compressed into one): 95,000,000 cases (2%) and 2,166,706 deaths (5%).

These numbers indicate that disciplinary mitigants are working thus far, before a second wave. While the number of deaths roughly tracks those of the base case, it is too soon to be confident with these data. The Spanish Flu had an ultimate mortality run rate of 2.3%, while the projections for this pandemic are higher at roughly 3.6%. In the end, the level of penetration is the key driver.

The 2.2 million death rate of the Stress Case datum is the source of President Trump's misleading statement that he has prevented "millions of deaths" from the "Wuhan Plague". While the computation is correct, the final funeral toll for the coronavirus contagion will not be known for a year and a half, likely more.

The timely topic for discussion remains that of a second wave. There will be one, almost certainly, but the question remains its magnitude. No one can say what that wave will be like. Answers to the following questions will go a long way in determining the magnitude of that wave.

Will there be adequate testing and tracing in place?
Will the states, as a group, have re-opened too soon or too laxly?
How much will the current protests of George Floyd's murder re-accelerate penetration?
Will the virus have a seasonal effect (e.g., not prolific in hot weather)?
Will the virus have mutated and, if so, for the worse or better?
How long will people prove to be immune who have survived the illness already?
How quickly can a safe and effective vaccine be developped and tested?
How efficiently can, and comprehensively will, the vaccine be distributed?
How deep will the penetration of COVID-19 be in the rural areas?
How will rural areas manage with fewer available facilties, medical first responders, and Medicaid extensions?

As one reviews these data, (s)he ought to keep in mind the likelihood of a death, expressed as one death for every X people (i.e., the odds). .

World: 6,715,334 cases; 393,342 deaths; 5.9% mortality rate (improved from 6.1%); one case for very 1,144 people and one death for every 19,535 people
United States: 1,904,678 cases; 109,403 deaths; 5.9% mortality rate (unchanged); one case for every 174 people and one death for every 3,040 Americans

==========

Baltimore-Annapolis: 18,252 confirmed cases; 4.7% mortality rate; one death for every 3,131 people
Boston and the Cape: 59,680 confirmed cases; 7.0% mortality; one death for 1,113 people
Chicago proper: 80,713 confirmed cases; 4.8%; one death per 1,028 people
Colorado statewide: 27,360 cases; 5.5%; one death per 3,818
Detroit metro: 37,165; 12.9%; 1 death per 969
New York metro*: 436,261; 8.2%; 1 per 635
New York CITY: 205,406; 10.6%; 1 per 386
Manhattan Island 25,317; 9.2%; 1 per 703
Philadelphia metro: 49,040; 7.3%; 1 per 1,710
Pittsburgh metro: 3,259 cases; 8.9%; 1 per 8,146

* New York metro mis-stated last week at 437,456 rather than 428,456

Friday numbers as at 29may20
NOTE: U.S. static pool rates trended down modestly for the first half of the week under review before leveling off and hovering at the 19% mark. While this rate remains roughly 50% above the global static pool rate. also trending down with a slack momentum, it is not necessarily bad news. Remember how U.S. health officials sought to flatten the curve?

Our favourite docs have largely succeeded, and this is what a flattened curve looks like as the U.S. infection and mortality rates mature and slowly taper off during this first and, hopefully, only wave of the pandemic. One warning from these data -- both domestic and global -- is that some places are enduring up-ticks in illness and death as others slow down.

Growth rates in confirmed cases slowed again for the eight areas under study, with the exception of Baltimore-Annapolis. The areas under review are facing steeper challenges than the rest of the Union at this point. Specifically, they comprise four every ten cases and a little over half of the deaths nationwide, but represent only 16% of the population.

Together, the 'family compounds' endure mortality run rates a third above the national rate (i.e., 7.8% versus 5.9%). There are three reasons for our 'skewed up' family.

We live primarily in urban areas where higher population density and an older demographic.
We live in areas that tend to have advanced medical facilities to enable more testing.
We tend to live East of the Mississppi, showing the less contained transmission from Europe than from Asia.

The timely topic for discussion remains that of a second wave. There will be one, almost certainly, but the question remains its magnitude. No one can say what that wave will be like. Answers to the following questions will go a long way in determining the magnitude of that wave.

Will there be adequate testing and tracing in place?
Will the states, as a group, have re-opened too soon or too laxly?
Will the virus have a seasonal effect (e.g., not prolific in hot weather)?
Will the virus have mutated and, if so, for the worse or better?
How long will people prove to be immune who have survived the illness already?
How quickly can a vaccine be developped and tested?
By truncating the usual testing guidelines, how safe and effective will that vaccine be?
How efficiently can, and comprehensively will, the vaccine be distributed?
How deep will the penetration of COVID-19 be in the rural areas?
How will rural areas manage with fewer available facilties, medical first responders, and Medicaid extensions?

The projections of the consequences of the coronavirus contagion that I put together almost two months ago still stand. That projection only covers the first year of the virus (i.e., the best case timeline of vaccine development and roll-out; through 28feb21). That timeline allows for two waves. The results correspond to potential wave magnitudes:

2nd wave as weaker than first wave (i.e., best case; ebbing tide) of 141,994 deaths;
2nd wave as larger than the first wave (i.e., base case; rising tide) of 335,301 deaths;
2nd wave as much larger than the first wave (i.e., worst case; high and stormy tide) of 1,197,501 deaths; as well as,
2nd wave as a tsunami (stress case; replication of mortality levels relative to the total U.S. population of 1918 Flu) of 2,166,706 deaths.

The final 2.2 million datum is the source or President Trump's misleading statement that he has prevented the epidemic from being 20-25x worse. While the computation is correct, the final funeral toll for the coronavirus contagion will not be known for at least two years. Globally confirmed cases and deaths rose 14% last week while the number of deaths grew at half that rate.

Improvements are likely coming from earlier testing, better equipment, and a slower pace of infection in particularly afflicted areas. The U.S. cases climbed by 10%, significantly slower than global infection rates, but parallelled the worldwide increase in deaths at 7%. These domestic data probably reflect increased testing at an earlier stage in the American pandemic curve.

As one reviews these data, (s)he ought to keep in mind the likelihood of a death, expressed as one death for every X people (i.e., the odds). Pittsburgh and Colorado are substantially more safe than the average mortality of the U.S. population. PGH numbers are suspiciously low, given the older demographic and the 2.4 million population. Colorado's numbers may be understated as the state withheld date for today (29may20). Baltimore-Annapolis remains a little safer than average.

World: 5,934,521 cases; 363,751 deaths; 6.1% mortality rate (improved from 6.9%); one case for very 1,295 people and one death for every 22,125 people
United States: 1,761,163 cases; 103,230 deaths; 5.9% mortality rate (unchanged); one case for every 188 people and one death for every 3,253 Americans

==========

Baltimore-Annapolis: 16,576 confirmed cases; 4.9% mortality rate; one death for every 3,464 people
Boston and the Cape: 55,532 confirmed cases; 7.0% mortality; one death for 1,196 people
Chicago proper: 75,306 confirmed cases; 4.8%; one death per 1099* people
Colorado statewide: 25,121 cases; 5.7%; one death per 4,063
Detroit metro: 36,239; 11.8%; 1 death per 1,005
New York metro: 428,456*; 8.3%; 1 per 641
New York CITY: 201,051; 10.7%; 1 per 391
Manhattan Island 24,619; 9.1%; 1 per 722
Philadelphia metro: 46,697; 7.2%; 1 per 1,823
Pittsburgh metro: 3,123 cases; 9.1%; 1 per 8,289

* Chicago mortality odds adjusted to reflect Cook County; previous odds recalculated** New York metro mis-stated last week at 437,456 rather than 428,456

Friday numbers as at 22may20
NOTE: U.S. static pool rates trended down at a slowing velocity to 21.8% (i.e., only two percentage points lower than 15may20) and still 50% than the global static rate of 14.5%. This continuing 50% gap primarily reflects the maturity of the U.S. epidemic (30% of the global coronavirus contagion) trailing that of the European pandemic. This assessment assumes that differences among countries like demographics and health-care quality and availability tend to cancel each other out.

This week saw a much wider re-opening of state, primarily rural, economies. The concern commanding media attention is the Depression-level unemployment of forty million jobs sliced across the United States in two months and the proposed beneficiaries of already unaffordable Federal aid. Nevertheless, the national epidemic remains uncertain as some reports indicate cases accelerating in less densely populated areas of the country. Overall U.S case confirmation and death rates grew by 10-11% during the week.

This trend of the COVID-19 away from the larger cities specifically affected case confirmation and mortality rates in northern Maryland (+20% & +18%), Eastern Pennsylvania (+10% & +12%), and Colorado (+11% & +20%). Among urban centres, only Chicago showed a high growth in case confirmation (+11%) and mortality (+16%) as the windy city appears not to have peaked. Otherwise, New York and Detroit showed much slower rates of growth (3-4% & 3-8%).

Americans are showing mixed feelings about, and trust-levels toward, a vaccine; much of this may be a consequence of the political division renting the social fabric. Gone are the days of universal welcoming of, and trust toward, the Salk vaccine. Amid this division, the up-tick in cases in the rural and 'red' states becomes important due to the lack of hospitals after many closures; fewer and fewer qualified medical first responders; as well as, the absence of Medicaid extension.

The countries that the American government should study for lessons learned in the event of a second wave of the COVID-19 pandemic or a new virus are Germany, Canada, Japan, Australia, and South Korea. South Korea (51.2 million), Japan (125.5 million) and Germany (80.2 million) for larger populations and higher population densities. Australia (25.5 million) and Canada (37.7 million) share large land masses.

Globally confirmed cases and deaths rose 16% last week, indicating more testing and a higher level of data integrity on attributing cause of death. Please be advised that the scaling factor is important here since mortality run-rates and growth rates may appear to be high but the overall penetration of a certain cluster's area remains low. The 'odds' of dying in various places calculate the number of COVID-19 deaths of a given cluster relative to its population. This calculation renders the data from the various clusters comparable in assessing their relative gravity.

World: 5,179,515 cases; 344,537 deaths*; 6.7% mortality rate (unchanged); one case for very 1,483 people and one death for every 22,303 people
United States: 1,600,048 cases; 95,557 deaths; 6.0% mortality rate (unchanged); one case for every 208 people and one death for every 3,481 people

=====

Baltimore-Annapolis: 14,555 confirmed cases; 4.9% mortality rate; one death for every 3,942 people
Boston and the Cape: 53,317 confirmed cases; 6.9% mortality; one death for 1,272 people
Chicago proper: 67,551 confirmed cases; 4.6%; one death per 1,270 people
Colorado statewide: 23,191 cases; 5.7%; one death per
Detroit metro: 35,348; 11.7%; 1 death per 1,040
New York metro: 419,439; 8.1%; 1 per 664
New York CITY**: 190,357; 10.7%; 1 per 399
Manhattan Island 23,943; 9.2%; 1 per 736
Philadelphia metro: 43,813; 7.1%; 1 per 1,986
Pittsburgh metro: 2,934 cases; 9.4%; 1 per 8,591

* Yours truly mis-calculated last week's death toll for the U.S.; that number was approximately 300,000
* New York City numbers misstated at 17,000; correct number 190,357

Friday numbers as at 15may20

NOTE: U.S. static pool rates trended down the first half of the last week, but levelled out at 23.8%, eight percentage points above the global static pool rate. Again, this steady 50% margin of the American over global rates likely reflects the trailing maturation of the U.S. epidemic vis à vis the global pandemic.

The news is positive for now as U.S. mortality run-rates fell slightly, with improvements in New York and a slower trend in Detroit; only Pennsylvania showed significantly more than a 5% growth in cases. Nationally, cases increased 15% with deaths up 14%. The slight relative improvement is due more likely to increased testing. Please note a constraint in the static pool calculations, explained in the comment section below.

The criticism of President Trump's handling of the coronavirus contagion has been intense and, at least from the view of the lateness to respond, largely justified. Nevertheless, the numbers of deaths per million in the United States compares favourably with most other developped countries. One large constraint facing the U.S. is the scale of territory and population.

The countries that the American government should study for lessons learned in the event of a second wave of the COVID-19 pandemic or a new virus are Germany, Canada, Japan, Australia, and South Korea. South Korea (51.2 million), Japan (125.5 million) and Germany (80.2 million) for larger populations and higher population densities. Australia (25.5 million) and Canada (37.7 million) share large land masses.

In fairness to the Administration, certain success stories are emerging and should be acknowledged. Among the areas studied inside the United States, Pittsburgh may merit further examination due to the low number of cases. As always, one must be sceptical with data that appear to be outliers. China provides a an excellent example of questionable data at their face.

Recording very few cases over the last two months implies a successful Chinese lock-down of the pandemic's epicentre of Wuhan and the host-province of Hubei. Nevertheless, Hubei comprises 4% of China's population but accounts for 81% of the recorded cases and 97% of the deaths. When remote places like the Faroe Islands record higher incidence rates than China, wariness is the order of the day. One should praise China's efforts but not accept her data without reservation.

The calculations for the 'odds' of dying places the number of COVID-19 deaths of a given cluster relative to its population. This calculation renders the data from the various clusters comparable in their relative gravity.

World: 4,452,425 cases; 297,595 deaths; 6.7% mortality rate; one case for very 1,725 people and one death for every 25,821 people
United States: 1,448,012 cases; 86,945 deaths; 6.0% mortality rate; one case for every 229 people and one death for every 3,825 people

=====

Baltimore-Annapolis: 12,070 confirmed cases; 5.0% mortality rate; one death for every 4,655 people
Boston and the Cape: 45,272 confirmed cases; 6.7% mortality; one death for 1,402 people
Chicago proper: 58,457 confirmed cases; 4.7%; one death per 1,439 people
Colorado statewide: 20,838 cases; 5.2%; one death per 5,278
Detroit metro: 34,185; 11.4%; 1 death per 1,104
New York metro: 405,215; 8.2%; 1 per 691
New York CITY: 190,357; 10.9%; 1 per 410
Manhattan Island 23,056; 8.9%; 1 per 795
Philadelphia metro: 39,696; 6.9%; 1 per 2,218
Pittsburgh metro: 2,723 cases; 9.6%; 1 per 9,016

NOTE: New York Metro's 'odds' were erroneously calculated at one death for every 427 the previous week; the recalculation for that week is 732.NEW York City's odds were misstated in the previous week; that number should be 427
Friday numbers as at 08may20
NOTE: Happy 75th V.E. Day. U.S. static pool rates trended down the first half of the last week, but up-ticked to 27.2% on Thursday and Friday. The slight increase does not lend itself to causation, particularly the inference that several states have re-opened pre-maturely. While that possibility remains likely, one can not yet prove it.

Eventually static pool rates will decline to a level close to the mortality run-rate. The determinants of the pandemic's severity rests on the long-term penetration rate among Americans and the long-term steady-state mortality run-rate. As a reference, the penetration rate, across the United States, of the 1918 Spanish Flu levelled out at roughly 28%, with a long-term mortality run-rate of 2.3%.

For those skeptical of the recent anti-social distancing policies, were those Spanish Flu rates repeated today with current U.S. population in excess of 3x that of a century ago, the number of confirmed cases would approach 94 million, with more than two million compatriots succumbing to the disease. People need to guard against the temptation to celebrate as final the modest improvement in recent figures for two reasons:

the highly transmissible nature of the virus itself; as well as,
static-pool mortality rates still being 6.5x the first year forecasted run-rate of 3.6% and a current global static pool rate well below that of the United States (i.e., 27% versus 16%).

Such an increase from a second wave is likely in the first year of the coronavirus contagion, especially with widespread testing turning up cases without symptoms. Nevertheless, other factors may accelerate or decelerate penetration and mortality (e.g., the benefit of allaying drugs like remdesevir, seasonality, effective anti-bodies, etc.).

This week's information adds one datum for each geographic segment: the odds of dying from the coronavirus. One calculates this ratio by dividing the area population by the number of deaths recorded in that area. This statistic will give one a sense of scale. For example, assume that one looks at Chicago and Pittsburgh mortality rates only,

That person would initially conclude that Chicago is doing a superb job as indicated by her 4.4% mortality run rate versus the far poorer 9.2% rate recorded for Pittsburgh. Except that Pittsburgh has a much lower population penetration rate. Consequently, Pittsburghers currently have a one in 10,000+ chance of dying from COVID-19.

Yet Chicagoans are eight times more likely to die with odds of one in every 1,300 people. The difference between the global mortality odds of one in 28,000+ versus one in 4,000+ in the United States may indicate the infancy of the global pandemic that has yet to diffuse itself completely around the world, while the coronavirus contagion rapidly penetrates urbanised populations of wealthier, more urbanised, countries.

Using the American odds of one death among every four thousand people as a median and benchmark, one can infer that Baltimore, Colorado, and Pittsburgh are doing well at this stage

World: 3,911,087 cases; 271,039 deaths; 6.9% mortality rate; one death for every 28,351 people
United States: 1,259,083 cases; 76,420 deaths; 6.1% mortality rate; one death for every 4,353 people

=====

Baltimore-Annapolis: 10,132 confirmed cases; 4.7% mortality rate; one death for every 5,913 people
Boston and the Cape: 45,272 confirmed cases; 6.2% mortality; one death for 1,655 people
Chicago proper: 48,341 confirmed cases; 4.4%; one death per 1,859 people
Colorado statewide: 18,371 cases; 5.1%; one death per 6,100
Detroit metro: 32,327; 11.0%; 1 death per 1,206
New York metro: 386,248; 8.0%; 1 per 732
New York CITY: 180,216; 10.9%; 1 per 427
Manhattan Island 21,662; 8.7%; 1 per 869
Philadelphia metro: 34,551; 6.4%; 1 per 2,757
Pittsburgh metro: 2,512 cases; 9.2%; 1 per 10,272

Friday numbers as at 01may20
NOTE: Happy International Labour Day. U.S. static pool rates trended down consistently during the week by one-fifth to the current level of 29% versus a slightly improved global rate of 19%. While this is good news, the U.S. static pool rates remain 50% above the global rates and 8x above the projected eventual mortality rate of 3.6%.

The measures taken across most states are slowing infection rates, perhaps suggesting a peak. Such a peak could mean that, if the curve / parabola were symmetric -- i.e., what goes up comes down in an identical manner -- the United States would be about half way through the coronavirus contagion. This conclusion, however, is tenuous for the following reasons:

possibly premature re-opening of states (e.g., Georgia and Florida);
misdiagnoses and under-reporting of cases during the early phase; and, most ominously,
virus mutation or weather conditions catalysing a second wave.

As it is, the U.S. comprises roughly a third of the confirmed cases world-wide. A lot of the current discussion in the press, the medical fraternity, and the government alike centres on a second wave. If like the Spanish Flu of a century ago, this second wave could be worse. In most cases, with other flues as a fuzzy parallel, it should not be. The hunt for a vaccine continues with a hopeful roll-out in early 2021.

Much of the related publicity has become political and economic; tensions boil over in states with stricter controls due to economic stress and a general climate of anger. Among the family clusters, New York and Chicago showed the most encouraging results while Boston, Detroit and Pittsburgh endured significantly higher death rates during the last week

World: 3,283,435 cases; 233,781 deaths; 7.1% mortality rate
United States: 1,082,665 cases; 63,445 deaths; 5.9% mortality rate

=====

Baltimore-Annapolis: 7,491 confirmed cases; 4.6% mortality rate
Boston and the Cape: 38,965 confirmed cases; 5.6% mortality
Chicago proper: 36,515 confirmed cases; 4.4%
Colorado statewide: 15,284 cases; 5.1%
Detroit metro: 30,584; 10.3%
New York metro: 358,203; 7.7%
New York CITY: 167,478; 10.8%
Manhattan Island 19,837; 8.1%
Philadelphia metro: 29,060; 5.1%
Pittsburgh metro: 2,263 cases; 8.4%

Friday numbers as at 24apr20
NOTE: U.S. static pool rates remained erratic over the past week. Though thee range was lower than last week, between 35.3% and 37.1%, the latter percentage represented the calculation of Friday 24th April as U.S. static pool rates started back up. The global static pool rate remained basically unchanged at 20.2%, still significantly below U.S. levels.

What may portend a downward change in static pool rates for the U.S. versus the rest of the world is that 1.9% of U.S. active cases are in critical care versus 3.1% of global cases; I would advise against relying too heavily on these findings since figures are distorted by incomplete or inaccurate reporting and under-testing in other parts of the world. Since U.S. cases represent close to a third of global cases, the high U.S. static pool rates may be shrouding signs of maturing infection rates elsewhere.

Though New York Metro represents more than a third of U.S. cases, its trends are slowing, not yet declining. Bloomberg Philanthropy, Johns Hopkins (Mayor Mike's alma mater) and New York State are now taking aggressive measures to help the CITY out by implementing a contact-tracing programme. The politics is getting testy and down-right strange; if interested, please consult the many rants careening across social media.

World: 2,779,078 cases; 194,333 deaths; 7.0% mortality rate
United States: 891,657 cases; 50,533 deaths; 5.7% mortality rate

=====

Baltimore-Annapolis: 5,977 confirmed cases; 3.7% mortality rate
Boston and the Cape: 29,241 confirmed cases; 4.0% mortality
Chicago proper: 25,811 confirmed cases; 4.4%
Colorado statewide: 11,262 cases; 4.9%
Detroit metro: 27,450; 9.1%
New York metro: 319,966; 7.7%
New York CITY: 150,473; 10.9%
Manhattan Island 17,803; 7.6%
Philadelphia metro*: 22,810; 4.4%
Pittsburgh metro: 1,999 cases; 7.4%

* Number of deaths incorrectly stated last week for Philadelphia as 115,924; correct datum of 15,924 deaths

Friday numbers as at 17apr20:
NOTE: U.S. static pool rates (i.e., deaths / [deaths+recoveries] are trending down slightly from 40% to 38% over the last week, implying that the U.S. may be peaking now but the data are not yet actionable as the rate is high. These arresting rates, in the face of lower global static pool rates (21%) may be attributable to people dying after ten days to weeks after extraordinary measures creating a lag-time or over-hang of mortality.

These data bear out Governor Cuomo's contention that the longer one is on a ventillator, the more certain (s)he will face the ultimately adverse outcome. Now remember: complaisance can kill, but only one out of every ten thousand Americans have died thus far. There is no reason to panic; mortality rates will also come down as the United States ramps up her testing, now at 3.4 million.

Medical student, Lucas Kogut, who is entering residency, sheds some light on how the coronavirus works and why Dr Bill Bauer's concern over complaisance applies; reading this, one can only pray for medical first responders. Perhaps the grimmest part of this experience, thus far not as lethal as expected, is the toll it is taking on the nation's Blacks and other peoples of colour.

World: 2,211,877 cases; 150,673 deaths; 6.8% mortality rate
United States: 685,003 cases; 35,062 deaths; 5.1% mortality rate

=====

Baltimore-Annapolis: 4,023 confirmed cases; 2.5% mortality rate
Boston and the Cape: 20,404 confirmed cases; 3.5% mortality
Chicago proper: 18,087 confirmed cases; 4.0%
Colorado statewide: 8,675 cases; 4.3%
Detroit metro: 23,298; 7.6%
New York metro: 258,007; 6.5%
New York CITY*: 123,146; 9.3%
Philadelphia metro: 15,924; 3.5%
Pittsburgh metro**: 1,487 cases; 5.0%

* Johns Hopkins now breaks out N.Y.C. boroughs Manhattan: 15,539 cases; 6.0% mortality rate
** Pittsburgh now includes Butler.
PGH without Butler: 1,333 cases; 4.9% mortality rate

Friday numbers as at 10apr20:
NOTE: U.S. static pool rates (i.e., deaths / [deaths+recoveries] are still rising from 37% at 41% over the last week, implying that the U.S. either is peaking now or has not peaked yet. These rates will fall as more people recover. These arresting rates may also be attributable to a lag in testing across the country.

World: 1,639,473 cases; 99,331 deaths; 6.1% mortality rate
United States: 475,601 cases; 17,878 deaths; 3.75% mortality

=====

Baltimore-Annapolis: 2,634 confirmed cases; 2.2% mortality rate
Boston and the Cape: 12,044 confirmed cases; 1.8% mortality
Chicago proper: 11,415 confirmed cases; 3.1%
Colorado statewide: 6,202 cases; 3.6%
Detroit metro: 17,760; 5.2%
New York metro: 187,033; 4.3%
New York CITY: 87,028; 6.1%
Philadelphia metro: 11,280; 2.0%
Pittsburgh metro: 1,078 cases; 2.3%

Friday numbers as at 03apr20:
One explkanatory factor here for the difference between the rates of say Philly, Boston, and Pittsburgh may be the presence of ample medical facilities and teaching hospitals.

World: 1,062,051 cases; 56,255 deaths; 5.3% mortality rate
United States: 258,762 cases; 6,596 deaths; 2.5% mortality

=====

Baltimore-Annapolis: 1,155 confirmed cases; 1.1% mortality rate
Boston and the Cape: 5,620 confirmed cases; 1.3% mortality
Chicago proper: 5,575 confirmed cases; 1.9%
Colorado statewide: 3,728 cases; 2.6%
Detroit metro: 9,022; 4.2%
New York metro: 109,447; 2.0%
New York CITY: 57,159; 2.7%
Philadelphia metro: 2,100; 0.6%
Pittsburgh metro: 558 cases; 0.7%

Friday, April 17, 2020

Letter-158A: How COVID-19 may work inside a human host

The RNA mechanics of, and response to, this coronavirus

Below is shared the deep domain expertise, Lucas Kogut, currently in his residency in the University of Lublin, Poland. Below that is a professional assessment by Dr Bill Bauer of Seattle, who specialises in internal medicine. These thoughts on how the coronavirus itself functions within infected hosts as well as the response through mid-April were shared in a separate thread on another social medium.

Both essays are well worth the thirty minutes to read through. I commend Dr Kogut for making complicated concepts accessible to lay readers uninitiated in the hard sciences (e.g., me). While I obviously lack the expertise to endorse these analyses, I nevertheless trust it and pass it along to you.

===========================
Ned McDonnell QUESTION:
"One last question: ¿how solid is the argument that this virus will not mutate into a deadlier form as did the Spanish Flu?😳"

Lucas Kogut William ANSWER:
"Thank you Dr Bauer for that humbling introduction.. 😅

"But to answer your question on mutation and the 2nd wave, Ned McDonnell, the issue with this virus is not so much its mutational rate (which recently was the theory that it possessed a very high mutation rate leading to its own demise in sequential time) but rather, it's the ability of the virus to under-go very proficient and rapid recombination of its very large genome (~32 kb).

"The frequency of which this recombination of its massive nucleotide genomic sequence occurs is determined by selective pressure once trying to adapt to survive in a new host, or recently recovered host by a cousin strain of its lineage. And interestingly (and also quite problematic in terms of duration of this viral infection), they (coronaviruses as a whole) possess a proofreading enzyme/protein known as exonuclease (ExoN), which gives the virus a high fidelity rate once its recombination sequences have "fit just right" in being able to establish disease in its present host.

"Coronaviruses establish infection through their ability to actively inhibit and keep at bay, the host immune response (particularly the innate immune arm; aka; the "first line of defense" immune cells), thus giving the virus time (~4-5 days incubation) to replicate like mad and find its "winner-winner-chicken-dinner"- if you will, type viral strain. (Best sequence to maintain on-going viral activity and progeny).

"So to summarize and conclude; the second wave has potential to be very damaging as for reasons Dr Bauer just mentioned, and is indeed a very real and present threat with this very unique and evolutionarily well-tuned virus. However, to leave things on a positive note, our human innate systems (if not inhibited by age, comorbidities, or immunosuppression) are perfectly capable of overwhelming the coronavirus in due-time.

"Especially the younger the host. Antibody intervention and vaccination (modeled after antibody activation through natural infection*) will only go so far in prevention of this virus, and again that's due more to its massive recombination ability from its massive genome and not so much its mutational rate and ability."

Covid-19-pandemi: Her er dine patientrettigheder - Dansk ...

Ned McDonnell QUESTIONs:
"Thank you, Sir, for a detailed response, accessible to a layman (i.e., me). Just three questions of differing types.

"> Can a vaccine be developped that permits anti-bodies to mirror re-combination by the virus?

"> May I post this in my Linked-In and F.B. feeds, of course with proper attribution?"

Lucas Kogut ANSWERs
"You are most welcome.

"As far as the vaccine trials currently underway; their aim is at development of a vaccine targeted against the mRNA genomic sequences made by the virus that codes for the "S-spike" protein domain. Which is its route of entry into our cells through the ACE2 receptor as I'm sure you are well aware of by now. This would be effective at preventing a large pool of the current virus from entering and establishing infection in our cells via ACE2, but as we've seen with other cousin strains, they may enter via other receptor routes (DPP4 receptor in MERS-CoV for example) and since they all share an "RNA-Quasispecies" interaction, they have capabilities to "call-up" and put in play other genomic sequences held within their 28-32 kb genome, via recombination, and hence allow for further infectivity.

"You most certainly may share and post away!

"The leading consensus is that this has not been a product of laboratory alteration and manipulation. The complexity and unique properties of this virus genus lies in its ability to affect a very wide range of hosts, from whales to bats. And bats, are the most heavily invested research target, ever since the 2002/2003 SARS outbreak, they are host to some staggering 400+ Coronavirus strains.. and have learned to live asymptomatically with the virus, almost in a symbiotic relationship. The more we can understand of that host-virion relationship, the better our understanding of what true immunity from this virus really looks like in humans. Though the cross-species adaptation models will require more intermediate host testing (ideally simian/primate hosts)

"If there are any further questions, please don't hesitate to ask, I will do my best to answer as honestly as I can. And since we still know only a handful of facts about this virus, I will do my best to answer any relevant information that I can. I have read numerous NIH/PUBmed, Lancet and JAMA articles in reference to the specific virology of these viruses and from the lump-sum of information I've gathered, there still seems to be a lot of guess-work involved thus far. But the information I've shared with you above is information that is reinforced by several relevant research articles, most notably from NIH."

==========================

Assessment of Dr Bill Bauer of Seattle from 14th April 2020

"What I am working on. If you want to inject partisan politics or conspiracy theories in this thread I will delete your comment. I do, however, want serious input into this process, with references. especially if I am missing something! I will edit this document as your comments come in, in order to improve it and my always problematic grammar and typing.

"COVID First Wave After Action Report and Summary

"Executive summary

"The COVID 19 virus started in early December of 2019 in Wuhan China. From there it spread geometrically within Wuhan and eventually spread to China and the rest of the world. The crisis that ensued included large scale deaths associated with overwhelmed health systems. The mainstay of treatment was social isolation which when finally implemented a great economic cost seemed to stem the geometric growth of the disease.

"Viral diseases often come in waves. Currently most of the world in the first wave with China and Singapore possibly being in the beginning of a second wave. Generally, second waves of viral illnesses are deadlier than the first for a variety of reasons but usually thought mainly do to increased complacency as well as a loss of resources in the first wave, making resource depletion more problematic in the 2nd wave.

"There are many political and cultural issues at play throughout this crisis. It is not the purpose of this report to address these.

"Things that worked.

"1) Social Distancing. Large scale social distancing especially when practiced early seemed to have huge beneficial effects on outcomes. Without an effective vaccine, this will again be the mainstay of any mitigation efforts.

"2) Telemedicine and other work from home strategies. These should continue to be funded, in that they both mitigate disease spread and allowed valuable and scarce healthcare personnel to still treat and take care of their patients.

"3) Closing schools and preschools. This helped but at some cost to learning and inequity in learning as roughly 1/3 of students in public schools lacked adequate computers and internet connections to meaningfully participate.

"4) Distribution systems. For the most part Grocery and pharmacies remained stocked as did liquor stores. Similarly, gas stations remained brimming with gasoline as petroleum companies pushed inventory as far forward as possible.

"5) PPP and EIDL. These programs were huge lifesavers to all small businesses and their employees. They were given out to any and all small businesses without exception. This was a huge benefit after one week of getting it started the money was dispersed by banks and paychecks started flowing. The creativity and flexibility by the SBA and Federal reserve was crucial. Not limiting this money or putting restrictions on the recipients made it crucial to keep many employed in sectors that others find objectionable from abortion providers to parochial schools and churches to marijuana shops. Basically banks were told to disperse the money (which the fed loaned them) and the SBA would make them whole. This allowed money to go out within a week of this starting.
(Notably this experience had wide variations and is still indeterminate)

"6) Increased unemployment benefits. These helped stem the effects of the tide of layoffs and the effects of everyone's increased needs in preparing for the epidemic.

"7) Critical infrastructure plants housed their critical employees early on sight so as to have a non-infected isolated group of core employees to keep electricity and other services running.

"8) Critical infrastructure like water, sewage, NG, and electricity continued unabated despite their just in time practices practices prior to the crisis. Did they become aware and store necessary chemicals or were the chemicals domestically available?

"9) Safety issues – there was not the widespread looting or civil breakdown which we have seen in other crisis. This should be studied to figure out if this signals a change in culture or other factors with a high possibility that high rates of monitoring cameras by homes and neighborhoods, gun ownership. Isolation protocols, etc all served to deter this behavior.

"10) Bureaucratic rules. Early on several bureaucratic rules were suspended in this initial and second national crisis declaration, including state by state licensing, antitrust rules for hospitals to coordinate care and others. These helped hospitals coordinate resources and care.

"11) Use of teleconferencing technology to keep people together and reality checking their ideas.

"12) Takeout food and delivered food was negatively associated with disease progression

"13) Closing international travel seemed to help stem the early spread of the disease.

"14) Closing Churches seemed to help (Catholic, mainline protestant, LDS)

"15) Suspending airline "use it or lose it" rules at airports and landing spots.

"16) A ratio of 10 tests per positive test seemed correlated with bringing COVID under control in each state. With tests of 20 to 1 the disease did not seem to gain much of a foothold. This seemed to be the case repeatedly in fairly similar states with similar starting points.

"17) On a short term basis at least, massive quantitative easing stabilized the financial and bond markets.

Areas of breakdown

"1) Nursing home care. Nursing homes and other elder care facilities were centers of thousands of outbreaks within the united states. Enhanced isolation protocols including onsight living of crucial personnel during the outbreak and telehealth will need to be instituted in further outbreaks.

"2) Prisons. Prisons were sights of huge outbreaks and deaths in MI , LA, and with the BOP. Clearing and reducing prison sizes, length of incarceration, and clearing elderly prisoners seemed to stem the tide in other systems.

"3) School distance learning for early grade school years. 1/3 of grade school children did not have internet connections or computers with active camera/video conferencing capabilities. This must be addressed.

"4) Grocery store panic buying and crowding. We saw this increase disease in many locales where this occured. This must be limited in future outbreaks using assigned shopping times and online pickup and delivery systems.

"5) Not enough available online pickup and delivery capacity of groceries by the stores themselves and it is unclear if Instacart uses food stamps. This gap must be cleared quickly in a future outbreak given seniors limited resources.

"6) Inadequate spare petroleum storage. When the strategic petroleum reserve was first started it was to store oil in case of a shortage. It turned out to be crucial in emergently storing oil so as oil pumping and extraction was not stopped too quickly as to permanently damage oil fields and downstream operations. Large spare salt caverns should be developed to handle both crude and refined products in case of future emergencies. Natural gas already has developed an underground reserve systems and can also rely on making plastic pellets and nitogen fertilizer during low cost and reserve producing times.

"7) Limited industrial base – early on in the crisis shortages of PPE, ventilator, and testing reagents along with threatened shortages of generic drugs became evident. These shortages were critical because the US industrial base did not make and did not have the supplies and expertise needed to address many of these shortages. This critical industrial deficit has strategic and practical implications. These must be addressed through tariffs and limits to imports.

"8) Limited meatpacking facilities and providers – the concentration of meat packers allowed meat packers to close plants and increase both prices for products sold while decreasing prices for products bought. They were able to squeeze both sides of the market. This concentration was too much for efficient markets to prevail

"9) Loss of Insurance. The massive layoff that accompanied the social isolation orders caused huge dislocations in health insurance and care. People were left with having to spend their unemployment checks solely to obtain COBRA coverage, or accessing the ACA healthcare websites. This was made more perilous due to indefinite Medicaid recapture laws which in some states are thought to permanently bar passing inheritance if this insurance is accessed between the ages of 55-65.

"10) Loss of first responders due to quarantine and isolation. Many responders were employment was cut short due to isolation and quarantine protocols. After shortages of first responders appeared, they were called back to work. Upon finishing their shifts though they often lacked housing to go home to so as not infect their family. This needed to be addressed.

"11) Multiple essential industry workers faced going home to elderly parents and others after working in grocery stores, hospitals, firedepartments, and elsewhere where they were at high likely hood to be exposed to COVID. They also needed separate housing during this crisis. This was troubling because it was simultaneous to hotels and motels being empty.

"12) Lack of face covering for workers in high exposure industries and others early on. Further in many grocery stores employees were specifically disallowed to wear face coverings in their work place. All high risk businesses should maintain a one month supply of face coverings for those working and N95 and other PPE is in high risk areas. Employees should be allowed to face covering to help themselves or prevent/decrease risk of transmission of disease to customers.

"13) Adherence to pre-crisis drug testing protocols. During the crisis there was a large sociopolitical debate on the efficacy of quinine based and other antimicrobial drugs. This debate was informed by limited studies. It would seem a rapid randomization protocol could have been achieved and implemented in a national emergency to address this and other agents and protocols

"14) University professional lectures (Grand Rounds) were late in addressing this problem or failed to address it at all (University of Washington). Clearly emerging threats need early professional discussion and planning.

"15) CDC lacked critical infectious disease infrastructure, personnel, and response. It continuously underestimated the problem and most notably failed to come up with adequate testing for either the virus or its antibodies despite months of lead time.

"16) Lack of CDC communication with Taiwan. Taiwan was the first to alert and understand the nature of this crisis but its warnings were ignored due to political considerations. Taiwan’s public health infrastructure must be full recognized.

"17) Naval ships are close quarters operations. When the Nimitz prepared to re-deploy they decided to house the entire crew on ship for 2 weeks prior to departing. This caused hotbox phenomena and a spread of the epidemic within the ships crew. The navy should have isolated sailors in individual tents or other forced isolation for 3 weeks prior to leaving and weeded out all those who were symptomatic or tested positive.

"18) Large parades seemed to be correlated with large scale outbreaks in NYC and NOLA.

"19) Buffets were associated with outbreaks in the US and abroad. They should be closed early in epidemics.

"20) Keeping large scale gatherings, casinos, and ski resorts open once the first community spread occurred negatively impacted outcomes.

"21) Funerals were implicated in large scale outbreaks in several parts of the country, and Spain. Notably also with the Ebola crisis. This is probably because the deceased may have had COVID unknowingly from the deceased prior to them dying, and relatives picked it up and then spread it to fellow funeral goers who themselves are often and usually elderly.

"22) Not closing churches and orthodox synagogues in NY and GA seemed to increase spread.

"23) Not closing cruise ships which became hot boxes areas of disease spread both with COVID and enteroviruses. New cruise ship designs will need to consider design changes to limit spread of diseases (more copper on contact surfaces, negative pressure on interior rooms, limiting buffets).

Things that are indefinite

"1) Best method of coming out of a crisis
"2) Best way to pay for the crisis
"3) Effect of large-scale injection of monetary liquidity into the markets on a medium and long term basis.
"4) Effects of loss of rent payments.
"5) Use of second homes by those who had them – did they negatively impact the local healthcare environment or not?
"6) Was lock down necessary or better than isolation in place allowing for people to go outside and exercise at a distance.
"7) Racial and other SDOH measures on outcomes. In many states African Americans suffered disproportionately whereas others they suffered death at one half the ration of Caucasians and Asians (WA state). What factors came into play?
"8) Climate impact on the disease and disease progression.
"9) Does releasing prisoners increase or decrease crime and deaths.
"10) does widespread testing, if it were available, decrease spread and help in control of the disease?
"11) Should people have antibody testing prior to returning to work? Should we develop a health passport?
"12) If given adequate PPE and testing, could a more surgical approach to quarantine be effective as appeared to be the case in South Korea?
"13) Would surgical isolation work in a second wave disease where community spread was already present in the first wave.?
"14) How accurate where the statistical models used? what caused the high variation.
"15) long term effect of triaging on healthcare personnel.
"16 Outcomes in high trust verus low trust communities and states."

Friday, April 3, 2020

Letter 158: thoughts -- selfish and social -- on the coronavirus contagion

«J’aime Muhamad beaucoup. »

« Moi, aussi. »

« Il est très heureux toujours. »

« Oui, ça c’est vrai. »

« C’est pourquoi je suis très heureux avec sa récupération. »

« Non, pas de tout. Il mourra demain ou le jour suivant. »

« Cela ne puisse pas être possible! Il est plein de l’énergie, de la vie. »

« Ça c’est vrai. J’estime ses qualités tellement élevées. »

« Alors vous êtes d’accord avec moi. »

« Non, Muhamad sera mort dans deux jours. »

« Shit alors! »

– a conversation between Michel, a French nurse, and me in the Calcutta Subway, 1992.

Introduction: the first two chapters are optional.

After two introductory chapters that one can easily skip, as they are neurotically confessional, this essay will explain my wholly inconsistent “sputterances” with family, friends and Facebook with this pandemic. Like me, the essay will be fragmented.

B.L.U.F. (bottom-line, up-front)
The key take-away remains that values and ideas often clash, leaving a stark choice: ¿does one follow his or her mind in consistency or my heart with integrity? The gulf between the head and heart makes the Gulf of México look like a sidewalk puddle.

CHAPTER-1: The wisdom of death.
B.L.U.F. (bottom-line, up-front): death remains an inscrutable part of life, even when many face the danger of personal extinction as we do with the coronavirus.

In 1992, my withered soul still limped after the death a woman whom I had loved a dozen years earlier. We were not meant for each other, but she was one of singularly magnificent people I have ever known in her mesmerising beauty, her creative intelligence, her machine gun giggle, and her knowledge of the world that still surpasses my own. A dozen years later, I confronted a nagging sensation that my father might not be long for the world.

Dad and I discussed it; he complimented me on my sensitivity and perception. Privately, I cried and cried, but, like it or not, his death would have to be a part of life and I was still off-balance from 1980. The hour had come to confront the shunned but overbearing dimension of the mortality of oneself and his or her loved ones. So, I ventured to a hospital for the dying in Calcutta, booking no hotel reservations, doing no research. Indians kindly helped me out.

When I first arrived at the hospital itself, people tested me out in various tasks. First, I tried my cissy-soft white hands at dish-washing. Soon, however, I had opened up small lesions in my fingers and people were concerned that I would ingest a germ and become very ill. So, the informed and informal foreman – a great guy from California and a hardened veteran of three weeks – took me off that chore.

The next day the formal foreman, a harried Calcuttan with a cool head, assigned me to help a very old, very ill man take his shower, except that he had soiled his cot in a foul-smelling manner. In the shower, I almost dropped him as I came very close to puking with the sight of the smeared excrement and its odour; dropping the poor fellow would likely of have killed him. So, I got fired from that activity as well – gee, sounding like my career-in-brief.

The informal foreman had noticed the way the problematic Yank (i.e., me) had kept patients company during idle minutes. He approached me and asked me how I kept my gaze steady to calm someone complaining in Bengali. Shrugging my shoulders, I answered, “I rub his shoulders and say, ‘l need you because I love you.’” His head knocked back with a seeming ‘aha’ moment.

Just before lunch, he came to me and again complimented me on a quality he perceived in me. “Well, Edward, you’re pretty good at just sitting there.”

Smiling, I quipped, “Been great at doing nothing my whole life.”

Still uncertain whether I had just received a compliment or not, he continued, “Here is something you can do. The man in bed number thirty-three – over there by the front doors – won’t eat and he is agitated. Can you sit with him and try and feed him?” That sounded like a purpose and, so, I went for it. The tubercular man shivered and spit out any juice or pulp I would give him, try as I might to trick him or distract his attention to sneak vital nourishment between his clenched jaws and through his puckered lips.

So, I started feeling defeated again. That self-pity ended with my 'aha' moment: this man was not rejecting me or the food – he just wanted to die; he was ready to depart.

So, ¿what should I do?

Soothe him, of course, so he could relax and leave his world of struggle in peace and a harsh life with dignity. With the patient asleep at the noon hour, I went to lunch, slipping out one of the two exits flanking either side of his bed, fully expecting to spend more time with him. When I returned an hour later, the bed was empty; the patient had died.

Next morning, the informed informal foreman approached me and dispatched me once again to cot number thirty-three, with another stubborn non-eater. Only a couple of minutes had passed for me to understand the situation was the same as the previous day: this man was ready to depart. He had fought hard for long enough. Obviously, I repeated the approach of the previous day, though it took two hours for the patient to attain the tell-tale calm of readiness.

Upon returning from lunch, I learned that this gentleman, too, had departed during the hour of absence. As I would learn later, with my father’s death, most people prefer to die alone.

The next morning, the Californian – a good, if temporary, friend – asked me how I had felt about the previous two days. Shrugging my shoulders thoughtlessly, I answered spontaneously, “All’s cool of the Western Front. But, if you want me to go back to bed number thirty-three, perhaps you ought to get the express consent of the patient, first.”

Little did I understand that my flippancy proved that I had accomplished my mission: death, finally, really became – and remains – part of life.

CHAPTER-2: The burden of integrity in character.
B.L.U.F. (bottom-line, up-front): integrity implies resolving, on a transitory basis, the constant, daily clash of preferred ideas against embedded values.

Death is a part of life. Fighting it does little. Fearing it does less. Fleeing it does nothing. The tragedy of a young woman’s death in 1980 plus the suicide of two close friends in the following two years made for a stinking, ultimately maturing, teen-age trauma. (In my mid-twenties, mine was a particularly late puberty.) At the core of the universe lurks an element of the casually chaotic, inexplicable to limited human intellection, occasionally crushing in its arbitrary timing and circumstance.

Rationally, that should make me an atheist; yet I value religion and need it to be a part of my life. Conservative by nature, I lean on tradition. The only one of the older faiths that makes sense, at least to me, is Judaism. The stories of the Hebrew Bible tell me that there is an uneasy monism – riddled with good and evil, primarily indifference – that makes one’s mission that of walking in the way of the Lord with virtue being its own reward.

The bottom-line?

Do the best I can today and only today.

Additionally, values run deeper than ideology.

When ideas and values conflict, turmoil ensues forcing an irrevocable choice between one or the other. No learning curve makes these choices easier over time. One finds no relief from the back-breaking burden of an elusive integrity on the deepest level. Repeatedly, one stumbles anew into that core void at the centre of the universe, of life, that I first perceived forty years ago. No markers. No guidance. No ideology. No road-map.

All badges and polysyllabic words are stripped away: one must use what lies at his or her innermost core. Another diversion may elucidate why this ‘G-d trap’ leads to occasionally spectacular, usually evident, inconsistency or bare-faced flip-flopping in my “sputterances” on Facebook and in life.

In 1982, I was in a career ‘feed-in’ internship in the U.S. Senate with the non-standing Republican Policy Committee. Though I had voted for President Carter twice, and would never reconsider either vote (though President Ford has emerged as the best President of my life-time), I was a middler and peddled my more conservative views to get by.

One day, I interviewed, for the third time, some ‘insider’ in the rising right-wing of the Republican Party to be his gofer, deputy, etc. (i.e., ‘general factotum’) in his super-P.A.C. fund-raising and lobbying. He and I would be calling on people like the Koch brothers, the Hunt brothers, Adolf Coors, Richard Mellon Scaife, etc.

My prospective manager, in making the job offer, made it quite clear that these men had daughters or grand-daughters and would find me an ideal addition to the family. In short, I was set. That offer came on a Friday. No wild guess that I entered the week-end elated.

(To be clear: it may all have been one big snow-job; if not, I likely would have gotten stubborn, then principled, then fired.)

Yet, something did not feel quite right. First, I recalled the widespread scorn heaped the preceding week on Senator Weicker, a Republican hero of Watergate, as he defended bussing. The élite in which I would (supposedly) enter, to be sure, would not brook such government intrusions as bussing or, perhaps, de-segregation.

Then, as the week-end wore on, I could not suppress thinking of President Johnson’s Great Society, President Kennedy’s Peace Corps, Senator Robert Kennedy’s ‘new’ America, Vice President Humphrey’s exhortation to vote for hope, not fear; and, of course, President Jimmy Carter's resolve in bringing home over fifty of his fellows alive from Teheran, despite suffering humiliation, perhaps foregoing re-election (sic).

Rationally, I should take the job. The politics involved corresponded more closely to my own than any of the Democratic titans previously mentioned. The trade-off was not so much to ask, really; we all make adjustments in life, ¿right? Even in the worst case of the ‘insider’ being a B.S.er, I would still learn and travel a lot. All good for my career ambitions. The values were important but I could make them ‘personal’ by forgetting them and getting on with life.

No brainer. Except . . . .

. . . . the values emerged triumphant and I turned down the position on the following Monday, to the shock of my proposed manager, not to mention many other of the emerging kulturkampfers around me. Thus ended my good standing and my internship. The professional field that I had figured I was born into was long gone, now.

Okay, that happens. Except . . .

. . . . almost everybody privy to the situation correctly viewed me as inconsistent. A majority reasonably dismissed me as a fool. Many validly wrote me off as a hypocrite. A few understandably disliked me as a liar.

The decision was not an act of courage, but neither was it easy. From the dollar and cents realities of a world measured by outward appearances and managed through impressions, I had earned those censures. Looking back almost four decades later, being honest with myself did not cost me all that much, but it proved to be a burden almost beyond forbearance at the time.

CHAPTER-3: this pandemic as a case study in explaining ideas, values, and flip-flops.
B.L.U.F. (bottom-line, up-front): the anxieties, existential and intellectual, surfacing these days reflect a state of “not-knowingness”; thus people cling to ideology as a life preserver in the stormy salt-waters of ambiguity. Ideas change; values endure. The latter steer one through.

The basic problem we are seeing here is that even the best-informed people really have no idea just how bad this pandemic will prove to be. As a hopeless Pisces and middler, I seek out persuasively argued theses, meticulous in their research and evidenced adduced, from both liberal and conservative thinkers alike so I can decided for myself, however tentatively, what the Hell is going on.

The rub is that, while professional experts may be better informed in their details, outcomes and consequences remain a mystery to be resolved by the grinding tyranny of time and whip-sawed by arbitrary surprises, over the next year or two. Thus, I find me at that core void of chaos at the centre of life once again. This time, however, the wisdom of the Hebrew Bible – G-d’s rod and staff – comforts me.

After all, this pandemic is not about me and no one, most especially me, ultimately knows what (s)he is talking about in well thought out assertions like 40-70% global infection rates. That does not mean that Dr Lipsitch and I are intellectual equals ¡No way! My final recourse lies less in time-conditioned knowledge; I must rely upon my deepest pre-natal values, the breath of G-d that gave me life at birth.

So, for better, worse or, most likely, presumptuous, that sixty-three-year-old breath echoes even today: the essence of inconsistency of thought and perseverance of conscience.

So, I join three hundred million of my closest friends in confronting the daily barrage of emotionally charged social media and verbal expressions, all understandable since the stakes for each of us are quickly becoming existential. For oneself, not really a big deal. For his or her loved ones, the very big deal of that core, non-negotiable, and arbitrary chaos at the centre of the universe invading the web of life. Those statements include:

President Trump’s destroying the pandemic prevention infrastructure;
President Trump’s placing medical first responders at risk;
President Trump’s deeper concern for the economy rather than people; as well as,
President Trump’s indecision costing two hundred to three hundred thousand lives.

There are, of course, countering points to each assertion as well as other, derivative talking points on both sides. Anyone following this situation more than casually stipulates to the basic veracity of most, or all, of these statements. For me, at least, these statements appear to have factual validity. Values clash with ideas, charged with the emotions of ideology, when people impugn motives to the President.

Now as I look at these sobering statements, my values are tapping me on the shoulder big-time. And what are those values, politically and otherwise? They primarily include, as far as I can identify them:

fairness in seeing both sides of an argument;
forbearance of human faults and mis-cues;
humility in judging the actions of others;
seeking to place myself in the other man’s shoes; as well as,
courage to state transparently and paying the price of criticism.

Quickly and superficially (to avoid 'tome-aine' poisoning), I will address the idea-values clash of each of the accusation levelled at President Trump.

First, the elimination of the pandemic prevention infrastructure. The evidence remains irrefutable. No one likes it, including me; now to the test of ideas against values.

Fairness: we do not know the decision-making here and President may not have known about the dissolution of one particular team in one of hundreds executive agencies.
Stoicism: one must remember that the President had to cut the budget somewhere.
Humility: admit alternative possibilities; e.g., a reduced level of remote C.D.C. stations reflecting a post-peak level of need.
Empathy: I can see myself making the same hard choice in the face of incomplete information.
Transparency: stating, inconsistently, that the fact is irrefutable but acknowledging that the President was not necessarily stupid or indifferent.

Second, I next address the assertion that the President placed medical first responders at risk heedlessly and needlessly. This statement surfaces both anxiety and recrimination for obvious reasons. Yes, our doctors and nurses are at risk. Many people have friends and family in those higher callings; one can only hope – ¡what a whimpy feeling, thoughts and prayers! – that these people survive. Many will not. Factually, I can agree easily with the ideas underlying this assertion; now to the test of ideas against values.

Fairness: any president, even President Obama, would be facing this dilemma imposed by realising efficiencies in hospital care at the expense of the redundancy usually maintained by public non-profit utilities.
Stoicism: one must accept that the nation lacks the resources to stock every national stock-pile (e.g., the strategic petroleum reserve) per a worst-case scenario.
Humility: it is impossible to know how one will decide in these situations until (s)he is there..
Empathy: yes, I would regret the lack of resources; what counts now are the decisions taken going-forward.
Transparency: stating, inconsistently, that the fact is irrefutable but praising the President for a concerted public-private response despite its tardiness.

Third, I next address the assertion that the President deems the economy more important than people; a loaded proposition from which many aspersions arise. The President downplayed the pandemic without question. He stymied the delivery of tests by the World Health Organisation. President Trump has mentioned the importance of the economy. There is increasing evidence of, at least attempted, self-dealing from this contagion, within the Admin. All of these statements are true and I share the same out-rage as many others; now to the test of ideas against values.

Fairness: any president, even President Obama, would be worrying about the economy, too, whether up for re-election or not.
Stoicism: one must realise that most people hope that unexpected things will go away.
Humility: I have no idea what I would be thinking and I am not convinced that l would necessarily be up to a decision where any choice means somebody loses.
Empathy: the same people gnashing their teeth at the President now would be doing the same if he locked down the country and cratered the economy; the argument would run that the President really sought to crush the middle class so the 1% could gobble up more assets (i.e., foreclosed homes) on the cheap by willfully shutting down the economy.
Transparency: praising, inconsistently, the rapidity (i.e., five-to-six weeks) of the President in building a sweeping private-public-N.G.O. coalition for a concerted and communal response after ‘dithering’ for at most two weeks when he faced the climax of a partisan impeachment and Senate trial.

Fourth, I wind up by addressing the final assertion of the President’s delay causing two to three hundred thousand deaths. This assertion also whips up many emotional derivative claims, mainly that the President has proven his malevolence and indifference to suffering by spinning his upcoming, almost certain, failure as an achievement to win re-election. There may be some of that, as most actions and decisions involve more than one motive, savoury and otherwise. Nevertheless, I thoroughly and heatedly disagree; now to the test of ideas against values.

Fairness: if current penetration rates prove to be correct, three hundred thousand deaths will calculate out to a mortality rate of less than 1%, and more like 0.1%; truly an accomplishment vis à vis the Spanish Flu of a century ago.
Stoicism: in looking at the totality of response, the President’s response, if delayed and imperfect, one must concede that it is comprehensive.
Humility: available resources are limited and the decision-taking here remains sobering no matter how good or bad the decision-taker.
Empathy: it is obvious to me, at least, that I would have focussed exclusively on the impeachment and Senate trial, even if it had been deserved though partisan, and would have waited to see if the suspension of air-service would be enough.
Transparency: praying, inconsistently, that the President will succeed at limiting the death toll to 300,000 of my fellow Americans.

Conclusion: detaching with compassion.
As I did in 2015, do I still believe that President Trump is dangerously authoritarian? Yes.

As I refused to do in 2016, will I vote for President Trump in 2020? No way.

As I did in 2017, do I still hate this President? No, but I will always dislike him.

As I rejoiced in 2018 with the mid-term elections for the House of Representatives, do I wish for a repeat toward a liberal ascendancy in 2020. Absolutely.

As I argued angrily in 2019, do I detest many of this Administration's policies? Without hesitation.

In 2020, can I understand the President’s hurt over his justified, if partisan, impeachment and his subsequent Senate trial? Yes.

In 2020, can I sympathise with the human pain the President faces with the dilemmas, many of his own making, imposed by this COVID-19 killing spree? Of course.

In 2021, will I believe that President Trump's response will prove to be more concerted than would that of any other President of my life-time? Probably, with the likely exceptions of Presidents Eisenhower and Johnson.

This flip-flopping maps out the course ahead, for me at least: support the President’s effort; match his perceptible mistakes with solutions; and, appreciate what he does right.

Sunday, May 12, 2019

Letter 157: Why originalism is dangerously original

"I smell a rat!" -- Patrick Henry, 1787.
“Our civil rights have no dependence on our religious opinions any more than our opinions in physics or geometry...” – Thomas Jefferson, 1786.

So what is originalism? Hard for me to say, really. It doesn’t pass the smell test, not mine at least. To those who practice it, originalism is the philosophy of jurisprudence that argues for strict adherence to the ‘original intent’ of the people who framed the law, the part of the Constitution, or the governing principle being evaluated.

To me, at least, originalism either amounts to little more than history-as-casuistry or provides an ideological cover story for policies that harm people. Natural law dictates that constitutional arrangements, made by and adhered to by us, ensure domestic tranquillity, not violent futility.

To repeat: bogus doctrines like 'originalism' are simply ideological cover stories. Arguably, originalism and biblical literalism are really cut from the same cloth: that of superstitions posing as decision-rules. The 2nd Amendment amply demonstrates this point.

One can not easily believe that Messrs Thomas Jefferson, James Madison, and George Mason ever had in mind anything like the ability to wipe out a dozen or more people in a minute with bullets designed to rip them asunder. And who is the archangel of originalism? Chief Justice Taney in Dred Scott. That worked out well, didn't it?
https://nedmcdletters.blogspot.com/2016/06/letter-120-high-tea-in-low-times.html
In fact, while I am sympathetic with sentiments against historical presentism since many tainted figures also had noble qualities I seek to emulate, originalism imposes an anti-intellectual stasis on deliberations with its implicit assumption that people like President Madison or General Lee lacked the capacity to grow with the times.

Most of us must readily acknowledge that conservative justices who attended top-ranking law schools likely understand the law, the Constitution and its history, as well as the Federalist Papers, the notes taken in the Constitutional Convention and legal precedent far better than those of lesser minds and educations (e.g., me).

Nevertheless, unless these people can prove to us, beyond a shadow of a doubt, that they can read people's minds and until séances be documented as valid and reliable through use of the scientific method, originalism does nothing more than obscure reckless speculations. This feckless guess-work often serves unsavoury notions of who is an American and what does each American deserve as a minimum (e.g., the Four Freedoms).

For, as silly as that notion of mind-reading and séances sounds, that is what originalism implicitly does: assume that one can think in exactly the same manner, thought for thought and idea for idea, as a founding father did and somehow know what he would think today. That special art would require mind-reading and communications with men dead for two hundred years.

Such super-powers then could certify our founders’ opinions about implicit rights to privacy for women; the meaning of, and limits upon, second amendment rights; the death penalty; and, the rest. That is just what Chief Justice Taney tried to do when he started or invoked most publicly this non-sense in 1857: no exceptions from the dead men for, “Well, what I really meant was…” or for, "Yes, but that was our world. Your world..."

At least the Democrats make no pretence of applying President Thomas Jefferson's basic belief that the world belongs in stewardship to the living. When I hear originalists bloviating ad nauseam with their assumptions, garbed in historical pretence and garbled by polite pedantry, I can only wonder: "Okay...¿who wins here and who loses?"

If arguments defending or promoting (my preference and instinct for) conservatism can not stand on their own without resorting to legal legerdemains -- no matter how loudly or incessantly one repeats this historical hooey -- one must remain accountable, if not quite true, to himself.

No matter how viciously a political prig attacks the personalities or views of those who dare to oppose his view (one too often stated as being from God, the Constitution, the Bible or whatever other rhetorical diversion), that conservative has to look at the man in the mirror (i.e., himself) and ask, “Am I really telling the truth as I see it or am I angling for something else?”

In the end, when ideologues publicly invoke God, as divined fourteen centuries ago, or ‘the sanctity’ of the Constitution, as written two hundred twenty-five years ago, to control others' rights, they have debased themselves; they have blasphemed their Creator; and, they have sullied the social contract by which we live.

Letters To Friends and Family

Life of an average joe

Thursday, April 23, 2020

Letter-158B: 2020 COVID Numbers for Family Clusters

COVID CLUSTER ANALYSES FROM 2020
Reverse Chronological Order

Friday numbers as at 04dec20

END of LETTER for 04dec20;
previous letters follow below.

Friday, April 17, 2020

Letter-158A: How COVID-19 may work inside a human host

The RNA mechanics of, and response to, this coronavirus

Assessment of Dr Bill Bauer of Seattle from 14th April 2020

"COVID First Wave After Action Report and Summary

"Executive summary

"Things that worked.

Areas of breakdown

Things that are indefinite

Friday, April 3, 2020

Letter 158: thoughts -- selfish and social -- on the coronavirus contagion

Sunday, May 12, 2019

Letter 157: Why originalism is dangerously original

Followers

Blog Archive

About Me

Letters To Friends and Family

Life of an average joe

Thursday, April 23, 2020

Letter-158B: 2020 COVID Numbers for Family Clusters

COVID CLUSTER ANALYSES FROM 2020Reverse Chronological Order

Friday numbers as at 04dec20

END of LETTER for 04dec20; previous letters follow below.

Friday, April 17, 2020

Letter-158A: How COVID-19 may work inside a human host

The RNA mechanics of, and response to, this coronavirus

Assessment of Dr Bill Bauer of Seattle from 14th April 2020

"COVID First Wave After Action Report and Summary

"Executive summary

"Things that worked.

Areas of breakdown

Things that are indefinite

Friday, April 3, 2020

Letter 158: thoughts -- selfish and social -- on the coronavirus contagion

Sunday, May 12, 2019

Letter 157: Why originalism is dangerously original

Followers

Blog Archive

About Me

COVID CLUSTER ANALYSES FROM 2020
Reverse Chronological Order

END of LETTER for 04dec20;
previous letters follow below.