Letter 158B: 2021 COVID Family Cluster Analyses

Family Cluster COVID-19 review
Issued the 5th of March 2021

B.L.U.F. (bottom-line, up-front): the holiday fever broke, but that may not last long as potentially more lethal variants are already making themselves felt. Last family cluster letter. Please refer to the data supplement co-issued with this dismissive missive.

INTRODUCTION
Summary. Strong results over the past four weeks, though vaccination problems have arisen from an aversion toward vaccines among inner-city Blacks in Philadelphia and elsewhere, inmates refusing vaccines in Michigan and Connecticut, as well as personnel constraints in Boston. Cross-country data show up in the supplement for this week.

The second half of February saw a break in the growth of confirmed cases putting the brakes on mortalities. There are indications that the new variants are more lethal, but the country is containing them effectively thus far. This final letter will address the following four topics:

1. the difference between a variant and a mutation;
2. a perspective of a weird COVID year;
3. ideas about the future of the U.S. epidemic; as well as,
4. a review and outlook for the various family clusters to be read selectively, if relevant.

This series of monthly letters about ‘kin clusters’ and the associated weekly COVIData Sweeps have addressed more than the collected data. These letters and supplements have addressed certain considerations irreducible to numbers. Though incorrect more often than not, even the miscues provide meaning. Side-bar elaborations on deeper ideas include, but are not limited to, the following:

• explanation, immediately below, of the differences among strains, variants, and mutations;
• discussion the four potentially problematic variants (i.e., Italian, South African, U.K., and Brazil);
• the unmentionable impact of the coronavirus upon fellow citizens of color and some history behind the skepticism;
• the COVID epidemic’s impact upon the arts;
• Los Angeles Times deep dive into the South African variant;
• review of the constraints and obstacles facing vaccines;
• refutations of vaccine myths, gossip and the ‘kung flu’ canard;
• clarifications as well as overall clean-up of parameters, output, and calculations;
• assessment of the Trump claim of an excellent record with respect to COVID; as well as,
• discussion of the Bayh-Dole Law and compulsory licensing in the context of the mad-mad-mad-vax race in the 03jul20 letter to friends and familiares on coronaviral ‘kin-clusters’ (scroll down two-thirds of the document to find referenced content).

MUTATIONs versus VARIANTs versus STRAINS
Summary.  For many years I had felt these three ‘virulent’ terms were inter-changeable. They are not. ¡Whhuuupppps! There is typology to viruses that:

• distinguish them broadly by strains;
• group those variants closely related to each other under their associated strains; and,
• allow for incidental features, or mutations, of these variants of a strain.

Think of Aristotle meeting Detroit. Typologies break out into the genus (i.e., the viral strain), a species for a variant, and a substance / an accident (i.e., an incidental feature) for a mutation. This confusing philosophy makes Motown a g-dsend. The coronavirus underlying COVID-19 is a strain similar in breadth to ‘motor vehicles’; that is, vicious virus fits into a genus – or broad category – of disease agents sharing basic characteristics (i.e., for motor vehicles: two or four wheels, an engine, etc.).

Variants emerge from that broader class as a species, say, automobiles. This species is defined by its chassis. One variant may depend upon a larger chassis for a four-door sedan, while another variant relies upon a smaller chassis for a compact. Both cars are built on similar chassis, though they differ in size. Accidents (or substances) are those differences incidental to the species (e.g., fins in the back, sun-roofs, etc.).

That is to say: individual cars differ visibly in degree of detail, but not in kind of chassis. When one gets to a tractor built to haul a trailer, however, the truck chassis is radically different from that of a car. Thus, these vehicles differ in kind: cars versus trucks. Now comes the sticky part: where does an S.U.V., used as a family car but built on a truck chassis, fit into the mix? That is a challenge of virology and I defer to those better qualified than I to figure it out. In this case, we see new variants when the basic structure self-replicates closely but not completely.

Still the same virus but different in degree. Then come mutations, which are details added to a virus (e.g., the coronavirus spike protein). Now this is subjective. How much deviation from perfect replication makes for a strain? I have no idea. Additionally, how many incidentals (i.e., mutations added on) make for a new strain? Again, I have no idea. Evidently, vaccines are doing a creditable job of accounting for the differences among variants of the same species but remain vulnerable to mutations and new strains. An add-on mutation rendered the 1918 Flu virus much deadlier than its earlier version. Vaccines can disappoint in one of two cases:

• a change in the basic underlying viral structure creating a new strain that remains unaddressed by the current serums being administered; and / or,
• a variant and mutation teaming up to foil the vaccine (i.e., the tweaked virus able to evade the anti-bodies produced by the original formula of the vaccine).

That is why the COVID vaccination has become a race against the clock, not only for the United States or Great Britain, but the world over. Additionally, this race against the clock is a global one; borders are fictions ignored by viruses. Being stingy with vaccines may benefit a nation in the short-run but leave the rest of the world prey to germinating variants and mutations – perhaps even new strains – that come back to haunt the greedy countries later on. 

The rub is that many of the wealthy countries scooping up too many doses are democracies answerable to voters. COVAX, the U.N. vaccination effort for poorer countries has administered only 2-3% of the vaccine injections across the world. The ten nations leading in vaccine distribution currently control 80% of the vaccines distributed; that share is up from 75% a week ago. 

This vaccine bullionism has prompted the World Health Organization to call for the waiver of patent protections in favor of compulsory licensing. Elected leaders face a dilemma in allowing some of their constituents to die to rescue others in countries about which none of their voters give a damn. Added to this mix, of course, is the profit-seeking of private firms that have produced these medicines. 

Pfizer, for evident example, faces an ethical quandary: distributing limited supplies justly versus making money for its investors. So, when one country pays a 50% premium for its doses, other countries see reductions. Nevertheless, one vaccine inoculation may very well suffice for people who have already recovered from COVID-19. If that assertion be true, there will be needed doses available to allocate to others more in need.

HISTORICAL REVIEW of a WEIRD COVID YEAR
What a long, strange trip it’s been. After tracking the coronavirus contagion for a month and putting together a forecast disseminated on 05apr20, this series of letters started in earnest 10½ months ago. That forecast from April 2020 offset two ‘wrong way’ assumptions – projecting twice the mortality rate (i.e., 3.6% versus 1.8%) and coincidentally expecting less than half the viral penetration rate (i.e., 10% versus 29%) – for a final projection of 335,301 fatalities at the end of the first year of the pandemic. 

At the time, however, this guess was 1.7x to 3.3x the U.S.G. guidance for the full course (i.e., more than one year) released a week prior to issuing this opening essay. This theme has been mentioned before many times before. What remains important to note is that, at the time l published this essay, I figured my estimate of 335,301 was far too high for one year, yet it ended up falling more than a third shy of the eventual results. 

Put another way: the 527,149 fatalities recorded after the first year equal 2.6-5.3x the predictions made for the whole pandemic by the Trump Administration Coronavirus Task Force a year ago. After two months of lock-downs, U.S. cumulative mortality run rates began to slow by late Spring 2020. 

Previously, U.S. fatalities had accelerated ahead of the global rates despite the scourge of the Italian mutation overwhelming one of the world’s best health-care systems in March and April. Industrial states in the Northeast (i.e., New York, Connecticut, Massachusetts, New Jersey, and Pennsylvania); the Midwest (i.e., Illinois, Ohio, and Michigan); as well as, Louisiana and Washington State all suffered their worst ordeals during the Spring of 2020.

Three factors explained this initial and deadly spike: the transmission of the virus within elder-care facilities; mistakes typically incurred while ascending a learning curve; and, the initially slow response by the Trump Administration to exercise its bully pulpit to urge the practice of behavioral mitigants. The President faced an impeachment trial that consumed almost all of the Admin.’s band-width until early to mid-February 2020. 

A secondary, temporary issue remained one of whether people should mask now or defer use to assure that medical first responders received the requisite P.P.E. (i.e., personal protective equipment) to do their heroic and life-saving work. Lost in that shuffle for many of us was the idea that a home-made cloth mask, while less than ideal, was better than nothing. Consequently, U.S. static pool rates remained 50% above those of the rest of the world into the second half June. 

As behavioral mitigants came into wider use across the United States in May and June, however, domestic cumulative mortality run rates fell below the global level in July (i.e., 4.6% for the U.S. versus 4.8% globally) notwithstanding a Summer spike in several U.S. regions. Currently, the U.S. cumulative fatality rate consistently runs 15-20% below the global (i.e., 1.8% versus 2.2%), despite a recent up-tick in domestic mortality run rates from 1.7% to 1.8%. 

Infections began to climb with the onset of Summer in the more rural states, particularly in the Deep South and the Midwestern plains. Georgia, Florida et al. re-opened their economies prematurely. In mid-year, concern emerged about a second wave potentially more lethal than first, recalling the 1918 Flu. Waves are not discrete as much as they comprise a cycle of illness; separating them is something of a fool’s errand. 

Seasonality is not the determining factor in separating statistics into waves. One may be better served by falling back on the experience of the 1918 Flu by using new variants as the threshold between one wave rolling through and a next discrete flu-story. Some assurance came out of the Trump Admin.’s coronavirus task force during the Summer by predicting the arrival of vaccines in a three-month window between November 2020 and January 2021.

Outdoor venues, in conjunction with behavioral mitigants, proved to be effective in reducing risks of transmission as attested to by the Black Lives Matter rallies following the murder of George Floyd during the Decoration Day week-end of 2020. On the other hand, the virus continued to transmit through children rapidly in August with the ultimate impact on the youngsters still an unknown. 

Happily, by October (i.e., seven months in), weekly case and fatality rates had dropped from double-digit growth to 0.6-2.1% for the family clusters. Throughout the Autumn, the United States outperformed the world with key performance measures running around two-thirds the world-wide level. In other words, case growth and fatalities, week in and week out, ran some 50% higher in the rest of the world than in the U.S.

As discussed along the way, this good news potentially shrouded some disturbing trends just beneath the surface. California, Ohio, and Pennsylvania were gradually losing control of the coronaviral contagions unfolding within their borders. Southern states continued to struggle, while Missouri, Wisconsin, and the Dakotas remained hot-spots. 

The McDonnell family clusters, except for the two in Pennsylvania, fared better as elected city and state leaders placed the learning curve errors behind them. The happy-songs ended between late November 2020 and early February 2021, as the holiday season was deadlier than imagined. During that fourteen-week period, American fatalities nearly doubled from 257,719 to 484,726 souls, for an unsustainable weekly accumulation rate of 4.5% (or doubling fatalities every four months or so). 

Vaccines started to arrive in December but choke-points hampered initial distribution and inoculation due to inadequate collaboration between the Trump Admin. and the states. The Trump Admin. was pre-occupied with contesting the November 2020 election and failed to add the muscle required to get the loaded needles out the door and into arms. While frustrating, these delays were not altogether surprising in view of the massive scale of ‘Operation Warp Speed’, the signature accomplishment of President Trump. 

Sadly, the President’s checking out of the epidemic in mid-October 2020 diminished the luster of this break-through. Other initiatives for comprehensive contact tracing, led by subject matter experts (e.g., a $250 million program by the National Institute of Health and a parallel drive by the Bloomberg philanthropies and Johns Hopkins), fell flat. 

Two problems deep-sixxed these efforts: individual reluctance to divulge private details and the tendency to conduct forward rather than backward contact tracing. Forward tracing is typically what people consider to be contact tracing; or, ¿whom did the coronavirus carrier run across AFTER (s)he was infected? 

That looking forward produced a random, scatter-plot approach. Backward tracing -- ¿whom did the infected person see just BEFORE (s)he was infected? – pin-pointed quickly exactly who the spreaders were and what activities catalyzed community transmission. What also became apparent, were strident protests in Michigan and elsewhere, reflecting cultural constraints in the U.S.

Here, individualism superseded community guide-lines seen as inconvenient. The past two weeks have shown significant declines in the number of deaths, though periodic fatality rates have hovered around 3% (but, fortunately, under 2% for the ‘kin clusters’). Forward indicators show that at least two of the known variants recently detected along with various mutations may be more lethal than the ones against which the vaccines protect. 

Such variants include ones from ltaly (March 2020), South African (August 2020), California (November 2020), Great Britain (December 2020), New York City (January 2021), and Tunisia (February 2021). The U.K. variant is expected to dominate American case counts by the end of this month, while the British and other variants presently sweep across Europe.

WHAT to CONSIDER
Summary. We are only one year – or a third to a half – of the way through the pandemic. 

While the epidemic is easing in the United States with states now on board uniformly to address the coronavirus contagions within their borders, the square-off between variants and vaccines remain paramount in charting out the fate of the United States, of the world, as well as, depending upon the latter, of the U.S. again in the longer-term.

These variants may evade anti-bodies enough to keep pharmaceutical companies and national laboratories bogged down in trying catch up in a Sisyphean game of whack-a-mole, spending one-to-four months fine-tuning vaccines only to see them undermined by new variants. Fortunately, recent monitoring of vaccine results argues for material progress in containing the COVID epidemic in the United States.

There are conflicting views – optimistic and pessimistic – on whether another surge, similar to earlier spikes, will occur or whether the vaccination drive will suffice. In confronting this uncertainty, I have run forecasts among three macro-scenarios that, first, the vaccines do the trick; alternatively, that America muddles along for the next two years; or, finally, the variants make the epidemic deadlier (i.e., a re-run of the 1918 Flu).

The conclusions listed listed in the data supplement derive from a table that tests out each of the thirty-eight states and six territories reviewed in the COVIData Sweeps by using the historical experience to date; repeating performance trends since the Spring and Summer; as well as, the possibility of a virulent conspiracy of a mutations and variants.  

Since I have not visited any of the clusters, except for my home in Maryland, these assessments may prove to be incorrect and do not represent a comprehensive conclusion on the competence or character of a particular state's government or chief executive. These data, broken out in the information supplement, yield the following very tentative conclusions.

1. The epidemic will taper off over the next two years with some micro-scenarios (the miracle case) ending before the others (i.e., the slog-in-the-bog and the ‘flunami’).
2. Forecasted range of total deaths for the U.S. epidemic varies from 664,120 to 1,064,645 fatalities.
3. The guesstimate of the final fatality tally equals 812,980 deaths.

BALTIMORE-ANNAPOLIS

Snap-shot: 15.8% ‘shot’ ≥ once; cases up 7.0%; deaths up 9.7%; cumulative mortality run rate 2.0% (1.5% for Annapolis); periodic fatality rate for February 2.8% (2.1% for Annapolis); 20% I.C.U. availability; positivity rate = 3.6%

Current dirt. Controversy over Baltimore’s ‘excess share’ of vaccines despite questions of vaccine equity in that city as well as across the rest of the cluster. Day of Remembrance hosted by Governor Hogan. Anne Arundel County maintains her financial standing.

Perspective. This cluster faced a large spike in cases during May 2020, running a mortality rate 2.5x that of the country. Nevertheless, Republican Governor, Larry Hogan, managed the coronavirus contagion well by working with health leaders in Baltimore, including the world class facilities and brain-power of Johns Hopkins. Demographics played a large part in this cluster’s story as 63% of Baltimore's population is Black with 69% people of color. 

People of color make up 34% of the cluster’s 2.8 million residents and 40% of the State of Maryland. Thus far in Maryland, the share of fatalities from COVID-19 is 45% for Blacks, well above the African-Americans’ 31% share of the population. The epicenter for the cluster last Spring was Howard County, then Baltimore; over time, Anne Arundel County has run mortality rates at three-quarters of those of the cluster.

Grade & Outlook. Governor Hogan has managed to strike and maintain the right balance between the coronavirus and the State’s economy. While Maryland has teetered a few times, Governor Hogan and the State Health Department have maintained a robust testing capacity with a moderate positivity rate. 

Despite some push-back by restauranteurs, principally against the Anne Arundel Heath Commissioner’s additional restrictions beyond those imposed by the State, Maryland remains open for business at less than full capacity.

• Grade of A-, 87% of the way through the overall three-year mortality burden.
• Expected additional deaths for the cluster for the next two years: 423 souls.

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BOSTON & the CAPE
Snap-shot: 17.8% ‘shot’ ≥ once (23.0% for Cape Cod and the islands); cases up 8.8%; deaths up 9.4%; mortality run rate 2.9% (3.4% on the Cape); periodic fatality rate 4.4% (4.9% on the Cape); 22% I.C.U. availability (58% on the Cape); positivity rate = 3.0% (3.3% for the Cape)

Current dirt. School teachers imminently to be inoculated with J.&J. on the way. Cape Cod and the islands top ten thousand cases. Controversial decision to out-source contagion / vaccination response at the expense of the Commonwealth’s previous investment in planning and distribution.

Perspective. The hub city ended up ranking as the twenty-second most lethal city in the United States due largely to a large spike last Spring attendant to the Italian variant and catalyzed by a ‘super-spreader’ event (i.e., a week-end conference hosted by Biogen in early 2020). Boston metro is not as heavily populated by African Americans, but one sees many Hispanics, elevating the population share of people of color to 43%. 

Like other Northeastern clusters, the coronavirus contagion hit the elderly very hard, especially those in long-term care facilities. In early October, six months in, close to two-thirds of the deaths endured in Massachusetts had occurred in nursing homes; even today, closing in on five months later, such deaths in elderly care facilities comprise 53% of the Commonwealth’s fatalities.

Grade & Outlook. Republican Governor Charlie Baker had found the Ariadne’s thread to guide his way through the policy labyrinth of 2020, but saw that command slip away during the strain of Boston’s ‘Christmas bombings’ that nearly collapsed a world-class health-care system. 

Slightly higher fatality rates on Cape Cod reflected the region’s hosting one of the most elderly populations in the United States. The Commonwealth currently faces a vaccine crunch, less in supplies than in a relative short-fall of professional inoculators. Governor Baker continues to pursue vaccine equity for his constituents of color.

• Grade of B, 86% of the way through the overall three-year mortality burden.
• Expected additional deaths for the cluster for the next two years: 1,367 souls.

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CHICAGO-proper
Snap-shot: 14.9% ‘shot’ ≥ once; cases up 4.1%; deaths up 5.0%; cumulative mortality run rate 2.0%; periodic fatality rate for February 2.4%; 35% I.C.U. availability; positivity rate = 3.2%

Current dirt. The N.H.L. is back and Blackhawks are on the coronavirus war-path. Mega-vaccine center built in anticipation of J.&J. doses arriving shortly. First case of more lethal Brazilian variant reported in Chicago. Cook County reaching out with economic and housing rental assistance.

Perspective. With a population of that is 55% Black and / or Hispanic, disproportionately represented in essential jobs, Chicago reeled with a two-month spike from mid-April until mid-June that strained the health-care system. Roughly 35-40% of the deaths in the Windy City for the year under review occurred during this Spring fever. Yet Chicago has a number of teaching and other hospitals and plentiful I.C.U. capacity. 

Democratic Mayor Lori Lightfoot has imposed tight restrictions to manage down the cumulative mortality run-rate by 60% since last Spring. The Mayor has faced several struggles during the past year including a long-running stand-off with the teachers’ union over when to return to the class-room; controversially allocating large amounts of Federal COVID stimulus monies to fund the police payroll; as well as, the demoralization of the community during the George Floyd / B.L.M. protests in July that helped accelerate the city’s already high homicide and growing crime rates.

Grade & Outlook. Mayor Lightfoot has had to walk on eggshells along a razor’s edge rim of an active and noisily smoldering volcano. Stake-holder differences are sharper in Chicago with the surfeit of firearms, the resentment towards police, the excessive force used by police, and a strong union presence demanding that teachers be accorded the same priority as essential workers. 

Much of this process involves negotiation; that the Windy City shows progress despite rampant dislike and distrust speaks to the Mayor’s ability to hold her coalition together. The big problem appears to be the dearth of vaccines being administered.

• Grade of B-, 79% of the way through the overall three-year mortality burden.
• Expected additional deaths for the cluster over the next two years: 2,565 souls.

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COLORADO state-wide 
Snap-shot: 19.7% ‘shot’ ≥ once; cases up 7.9%; deaths up 4.9%; mortality run rate 1.4%; periodic fatality rate 0.9%; 36% I.C.U. availability (27% in Denver); positivity rate = 3.3% (3.6% in Denver); a tribute to six Coloradans felled by the wicked virus.

Current dirt. Elderly-care facilities enjoying significantly better experience thanks to vaccines. Denver area loosens up; Governor Jared Polis sees close to a normal Summer ahead. Reports of re-infections; rare but not unheard of. In the face of rapidly easing local restrictions, Colorado Democratic Governor Polis keeps the state-wide masking mandate in place. Dolores County maintains 4.0% positivity rate.

Perspective. Colorado’s minority population is primarily Hispanic, representing a third of the Denver population and a fifth of the State’s population. Relatively unpopulated, Dolores County is 90-95% white. Racial tensions appear to be low since age trumps racial identification as the catalyst for the large spike of cases during the Summer and into the autumn. 

In actuality, people over sixty-five years old comprise less than 15% of the State’s population, while they dominate 84% of the deaths from the coronavirus contagion. Colorado almost lost control of the contagion over a Summer-time three-month period with a 9% weekly growth rate in deaths. That surge accounted for more than half of the deaths to date. Democratic Governor, Jared Polis, rallied his citizens and now Colorado has stabilized and has led almost all other states in recent weeks.

Grade & Outlook. Though struggling earlier in the year, Governor Polis has established his leadership in containing the contagion. After a hiccup in January, the State has demonstrated her efficiency in getting the vaccine from delivery into the patients’ biceps 85-95% of the time. 

Indeed, Colorado now ranks as the fourth safest state in the U.S. as her mortality rates – both periodic and cumulative – consistently declining from one period to the next, placing the State at the forefront of the eight clusters under review. One should keep in mind, however, that Colorado’s testing effort is one of the worst in the country.

• Grade of B, 81% of the way through the overall three-year mortality burden.
• Expected additional deaths for the cluster over the next two years: 1,396 souls.

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DETROIT Metro
Snap-shot: 9.8% ‘shot’ ≥ once (12.9% in Oakland County); cases up 5.6%; deaths up 4.0%; mortality run rate 3.3% (2.7% for Oakland County); periodic fatality rate 2.3% (2.4% for Oakland County); 30% I.C.U. availability; positivity rate = 3.9% (2.8% for Oakland County)

Current dirt. Michigan is opening up vaccine eligibility to fifty-year-olds on up during March; Motown extending eligibility to factory workers. Cases rising in the suburbs attendant to return to class-room schooling. Controversial decision by Detroit to stick with Moderna and Pfizer vaccines and shun the J.&J. anti-bodies.

Perspective. Like other Midwestern cities (e.g., Pittsburgh and Chicago), Michigan’s fatal surge came in the last few months of 2020. Earlier in the year, Democratic Governor Gretchen Whitmer had to fend off an angry electorate, some of whom stormed the Capitol in May, with a few later plotting to kidnap and assassinate her (and other politicians). The surprising detail in this extended grievance is that the militants attacked the Capitol during the Spring reacting to what, in retrospect, proved to be a noticeably smaller rise in cases (roughly one-third of the total) than the holiday season (nearly half). 

The racial composition concentrates Blacks in the city where Motown is 79% African-American and 8% Hispanic. Whites dominate the population living in the suburbs of Oakland County et al. to drive Black representation in the metropolitan area down to 23%. While Blacks represent a disproportionate amount of deaths relative to population that gap has narrowed substantially over the last few months.

Grade & Outlook. Governor Whitmer has earned credit for managing Michigan through a raging citizenry and coronavirus contagion during the Spring and for remaining cool despite a conspiracy to kidnap her and assassinate her. Michigan was hit hard in the Spring, but she has managed the cumulative mortality run rate down by almost three-quarters to 3.3%. 

While Detroit struggles, the cluster has occasionally posted monthly periodic fatality rates below 1%. Governor Whitmer’s measured re-opening, notwithstanding pressure from restauranteurs and retailers to throw caution to the winds, has balanced economic and health interests adroitly.

• Grade of B+, 85% of the way through the overall three-year mortality burden.
• Expected additional deaths for the cluster over the next two years: 1,434 souls.

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NEW YORK METRO
Snap-shot: 15.8% ‘shot’ ≥ once; cases up 15.2%; deaths up 6.1%; cumulative mortality run rate 3.2%; periodic fatality rate for February 1.4%; limited I.C.U. availability; positivity rate = 6.9%

Update on getting vaccines across the tri-state area.

N.Y.C.: 5.8% positivity rate; 4.0% mortality run rate; 1.2% periodic fatality rate; 14.5% ‘shot’ ≥ once;  current state
Co-op city getting vaccine site as J.&J. doses set to pour into the Empire State. Brooklyn improves cumulative mortality run rate (4.3% today vs 4.7% a month ago) but slips on periodic rate (2.1% vs 1.4%); slightly behind with a 6.1% positivity rate; lagging other boroughs with 11.8% vaccination rate with more vaccines on the way.

Westchester-Fairfield: 4.7% positivity rate; 2.2% mortality run rate; 1.4% periodic fatality rate; 19.9% ‘shot’ ≥ once; current state (two links)
New Rochelle remembers two thousand fatalities over past year. Governor Lamont (D-CT) working with stake-holders in Bridgeport to appeal to people of color for vaccination; Danbury inmates refuse vaccine. Long year in the Hudson valley.

Long Island: 5.5% positivity rate; 1.9% mortality run rate; 1.3% periodic fatality rate; 18.2% ‘shot’ ≥ once; current state
J.&J. vaccine already giving its one-shot in central L.I. High school student fund-raising for Mom-&-Pops through GoFundMe ‘adopt a business’ campaigns. Teachers start getting poked.

New Jersey: 8.6% positivity rate; 3.2% mortality run rate; 1.5% periodic fatality rate; 15.7% ‘shot’ ≥ once; current state
Merck willing to pitch in to assist J.&J. after its vaccine failed; J.&J. rolling out in home state. Teachers eligible for vaccination. New Jersey deemed one of the three deadliest  states during the past year.

Perspective. New York got hammered in the Spring by the Italian mutation or variant, which may very well have morphed again on its way from Europe to the United States as it had from Wuhan to Lombardy. Lessons-learned were bitter, but Democratic Governor Cuomo took charge effectively after the bitter experience of sending patients to nursing homes to convalesce. This infected the elderly population in New York, precipitating a large number of deaths. Another problem has emerged with evident mis-information about booking the deaths of nursing home patients as hospital fatalities when these people died in critical care.

This static interference is a shame since New York METRO has turned in superior results since the opening surge, a ghastly two months during which deaths grew weekly by 24% (i.e., doubling every three weeks). Those deaths still account for more than half (i.e., 53%) of all the fatalities incurred to date in the Empire State. For the METRO region, that opening scourge comprises two-thirds or more of the fatalities incurred to date with the grim memories of Westchester elder-care facilities being ravaged by the coronavirus.

Grade & Outlook. New York METRO and its four principal players – Governors Andrew Cuomo (D-N.Y.), Ned Lamont (D-CT), and Phil Murphy (D-N.J.) as well as Mayor Bill de Blasio (D-N.Y.C.) – deserve credit for managing through harrowing lessons-learned the hard way to cut the cumulative mortality run rate from 8%+ to to 3.2% in five months. The cluster has posted decent periodic rates during this time as well, led by Manhattan and Long Island.

Nevertheless, coordination and trust among the stake-holders may be wearing thin as Governor Cuomo’s mis-judgement is proving to be an unforced political error, spurring each of the other three leaders to start charting more of his own course. Such a break-down of collaboration may prove costly. With half of N.Y.C. and the New York METRO cluster being people of color, vaccine equity has become an important and persisting issue.

• Grade of C+, 84% of the way through the overall three-year mortality burden.
• Expected additional deaths for the cluster over the next two years: 10,151 souls.

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PHILADELPHIA Metro
Snap-shot: 10.1% ‘shot’ ≥ once (2.6% in Philly-central; 16.2% for cluster without inner city); cases up 9.0%; deaths up 4.0%; mortality run rate 2.7% (2.6% in Philly-central); periodic fatality rate 2.6% (2.1% in Philly-proper); 31% I.C.U. availability; positivity rate = 5.4% (4.5% in Philly-proper)

Current dirt. F.E.M.A. up-&-running in Philadelphia. COVID casualties way down in N.J. nursing homes thanks to vaccine. Vaccine desert in South Philly elicits efforts toward equity. Suburban anger due to vaccine shortages. Pennsylvania to vote on of the 'deadly COVID trio'.

Perspective. Like other Northeastern cities dotting the Boston-D.C. megapolitan axis, last Spring was rough for the City of Brotherly Love. Coming into May after a catastrophic April, Philly had fared well enough among the clusters performing slightly better than average. Like her sibling cities on the East Coast and in Pennsylvania, Philadelphia’s mortality run rate increased by 40% in May in her single most brutal month, staying in the middle of the pack. From there, Philly tapered off her fatalities with a flat outdoor Summer. 

Like everybody else, no one was quite prepared for the holiday surge though Philly handled it relatively well. In fact, that two month opening blast from the first week in April to the first week in June, rough as it was, represented roughly 50% of the deaths. From mid-June to October added in only about 15% of the deaths. Nevertheless, the December surge, when Pennsylvania basically lost her COVID grip (sadly, not grippe), has generated the remaining third of the deaths. Two big problems are at play here. First, Democratic Governor Wolf has tried his best to avoid cratering Pennsylvania’s tenuous economy.

The trade-off between business and quarantining is acute in Pennsylvania since she is now basically a rural Commonwealth. The trade-off by the Governor was a sensible move given the precarious finances of so many people after the Keystone State’s basic industries off-shored or just went away in the eighties. While one can understand Governor Wolf’s thinking, and believe in his goodwill, like many gambles, this one simply did not pay off. 

The other challenge remains the low vaccination rate in inner-city Philadelphia. This situation is not to be trifled with. Blacks have historical reasons to avoid medical solutions proposed or injected by Whites. Nonetheless, should minorities continue to shun the vaccine and penetration remain very low, the City of Brotherly Love may become the hot-spot of a new and deadlier variant. In short, like the many neglected people around the world, Philadelphia may end up becoming a human Petri dish for all kinds of variants and / or mutations.

Grade & Outlook. If vaccination rates remain low, one can expect many more cases, likely fatalities, in Philadelphia thanks to these transmissible coronaviral variants. Herd immunity may or may not be out of reach, but herd resistance is still very much in play. Much will depend upon the success or failure of Governor Wolf’s re-opening initiatives.

• Grade of C-, 57% of the way through the overall three-year mortality burden.
• Expected additional deaths for the cluster for two the two years: 6,395 souls.

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

PITTSBURGH Metro
Snap-shot: 15.7% ‘shot’ ≥ once; cases up 9.3%; deaths up 9.6%; cumulative mortality run rate 2.4%; periodic fatality rate for February 2.5%; 25% I.C.U. availability; positivity rate = 5.6%

Current dirt. Vaccines ramping up throughout the steel valley; some people now allowed in to watch sports events; Sidney Crosby not yet one of them. Hospitalizations down 25% in Allegheny County.

Perspective. Like her sister city to the East, Pittsburgh managed the first wave adequately, despite a flurry of nursing home deaths in the ex-urbs of Beaver and Butler Counties, similar to the ordeals of New York and Massachusetts. Like Massachusetts and some other states with ageing populations, deaths in nursing homes had accounted for two-thirds of the fatalities six months in; they still represent a slim majority in Pennsylvania. Pittsburgh, however, emerged as far and away the safest cluster of all, something like 68% safer. 

This gap widened during the early Summer, though a minor wave cut the edge in September back to a 50% lead. It was rather like the Steelers going 11-0 on a relatively easy schedule; first came the injuries and then the harder part of the season. Likewise, the the holiday surge contributed two-thirds of the deaths endured by Steelers Country. The pattern of deaths resembles other Midwestern and plains states like Minnesota, Wisconsin, Colorado, Ohio, Illinois, Missouri et al., except with a more extreme swing during the end of the year.

There are only three reasons that l can divine for this similarity in pattern with the Midwest and the extremity in amplitude. First, the Pittsburgh metropolitan area is far more de-centralized than most other cities. Farms come to the edge of civilization, much to the ordeal of hay fever sufferers. Second, as I have always believed with pride, Pittsburgh is a Midwestern city. This idea has been a constant source of debate among members of my extended family and friends in the Burgh. 

That split is about fifty-fifty and so the question lingers on despite evidence like these data. The first two elements explain the similarity. Third, Pittsburgh is very much a contingent city. To use an analogy from my R.C. up-bringing, if one is happily married with children and can live away from the coast, the Steel City is almost heaven. If one is single, the Burgh is much like Purgatory. If one is unhappily married, the place is as hellish as the blast furnaces used to be.

Dante had nothing on Pittsburgh; we are a divine dramady! What this autobiographical tripe boils down to is that Pittsburghers take family life the most seriously, perhaps, of all the ‘kin clusters’. Thanksgiving, Chanukah, Christmas and amateurs’ night out are big deals and families value intimate gatherings for affection, throwing shoes at one another, or whatever the case may be. 

That familial necessity, along with (perhaps) complacency, broke down the discipline required to flatten the second big curve as Detroit and Chicago excelled at doing. Needless to say, Pittsburgh’s ordeal in the thermo-nuclear holiday season wrecked her honored position as the safest of the clusters. She is now third, poised to ease into fourth behind Philadelphia. ¡Scheiße!

Grade & Outlook. Vaccinations are proceeding after a slow start, so, hopefully, my belovèd Midwestern home-town will once again be a blessèd venue for families rather than an accursed coronaviral cauldron. Time will tell. One problem Pittsburgh may face is that of diminishing I.C.U. availability and a supply constraint with vaccines.

• Grade of D, 54% of the way through the overall three-year mortality burden.
• Expected additional deaths for the cluster for two the two years: 2,679 souls.

END of LETTER for 05feb21 please revert to separate link for 2020 letters

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

LETTER for 05feb21

Family Cluster COVID-19 review;
Issued the 5th of February 2021

B.L.U.F. (bottom-line, up-front): The holiday months have ended and the clusters did okay; no time for complaisance as explained in the supplement.

SUMMARY of monthly for letter for January 2021 (five weeks)
Conditions warrant this letter to cover the Thanksgiving- Chanukah / Christmas - New Year's Eve stretch. One of every twelve Americans has been infected while the number of cumulative fatalities in the U.S. has increased by 32% during the five weeks under review. The clusters are doing much better, enduring only a 14% increase in deaths. Interestingly, certain communities oriented toward families had a rougher Thanksgiving than December. Pittsburgh metro is the only cluster to see her cumulative mortality run rate increase during January due to the virus re-infesting elderly care facilities. New York has faced down the greatest challenge with her population density. Baltimore and Chicago are the stars this month.

NOTE: the last family cluster review will be issued the evening of 05mar21
NOTE: this blog post compiles reports for 2021; for the 2020 posts, please click here.

STATIC POOL RATES U.S. versus WORLD
Summary. As detailed in the data supplement to this letter, the five weeks under review suffered more than twenty-two thousand deaths per week during each of the five weeks under review. Globally, mortality static pool and run rates remained stubbornly high during January attendant to the emergence of three new variants on three different continents. 

Global static pool mortality rates have reversed the up-tick suffered during December, declining slightly from 3.4% to 3.3%. The U.S. static pool rate has also dropped a tenth of a percentage point to 3.2%. Both data remain slow to decline as quickly as they should be as testing captures more passive carriers and vaccines have been available for a month in North America. Once the pandemic has run its course, the static pool rate will equal the cumulative mortality run rate. Yet, the static pool rates (i.e., deaths / closed cases) remain 54-85% above the run rates. 

Additionally, daily cases have fallen by half but are still 12-15x the level Dr Fauci believes to be the 'containment' level of of the American epidemic. Notwithstanding COVID hospitalizations declining by a third from their peak in mid-January and a 23% decrease in the number of patients requiring critical care, fatalities have remained above 22,000 for the fifth week in a row. This week ends 22,591 deaths for a lower than anticipated dip of 1.2%. These levels represent 2.2x the level of the week before Thanksgiving. 

The United States has a lower run rate, probably due to more testing and capture of asymptomatic infections. When data across countries is normalized for population sizes, however, the American position has deteriorated, with the U.S. back in the top ten nations in deaths per million, surging past México, Brazil, and Spain. Only Italy, home to the first deadly mutation of last Spring, and the U.K., host of one of the three new strains, have suffered a greater relative deterioration. Yet, ominously, the U.S. cumulative fatality rate is edging up while the static pool rate is making little progress. 

The concern with these U.S. data remains one of the as-yet unfelt presence, only now beginning to gain momentum, of two vaccines with at least two others waiting in the wings. Complicating the inevitably slower than ideal up-take in vaccines is the onset of at least three identified and more contagious mutations. As covered in this week's COVIData Sweep, at least two of these new mutations appear to be more lethal. Each mutation, especially the newest strain from Brazil, may be resistant to vaccines and 'evade' anti-bodies already in one's system. 

These factors are conspiring to augur one year mortality levels far above that projected by me ten months ago of 335,301 and well above the prediction two-to-three months ago by the University of Washington of 471,000. One should keep in mind that the first projection was 1.4-4x the levels contemporaneously predicted by experts in late March 2020 for the entirety of the epidemic. The higher, more expert forecast is recent and already revised upward to 516,000 (or 2.2-6.5x the levels predicted by epidemiologists at the beginning of the American epidemic). Part of the accelerated death-toll lies again in the virus re-infecting elderly care facilities, though that began to abate in January with targeted vaccinations.

In late January, Microsoft / Bing quit counting recoveries in the U.S. The static pool component data are sourced from Worldometer, the fatalities recorded by Johns Hopkins, and the last known datum by Bing plus marginal increases of the Worldometer recovery levels. Not a pretty calculation but the numbers yielded appear to be usable at least for the four weeks remaining in this series. As stated before, the cessation of compiling a key datum can be interpreted bad news; that is, an ill omen due to an implied loss of control. On the other hand, different agencies, states, etc. define a recovery differently and so a composite datum becomes, perhaps, too fuzzy to calculate.

REVIEW OF THE FAMILY CLUSTERS 
(note: fuzzy guesstimates for Intensive Care Availability and Vaccinations)
The Family Clusters tend to fall in densely populated areas (e.g., New York and Chicago). Contrary to expectations, periodic mortality run rates have remained essentially flat in January at 1.5%, ahead of the national baseline of 1.7%. Anchoring this better-than-average performance by the family clusters are Baltimore-Annapolis (from a 2.8% run rate in December to 0.7% in January) and Chicago (from 1.9% in December to 1.1% in January). Five of the eight clusters have endured higher mortality run rates during the last five weeks as one would expect during the holiday season.

The most noticeable up-ticks are occurring in Pittsburgh Metro (from 2.1% to 3.3%) and Motown Metro (from 2.2% to 2.9%). New York METRO recorded some deterioration but the leadership of Governors Cuomo, Lamont, and Murphy as well as Mayor de Blasio of New York City are doing a creditable job in containing the January mortality run rate to 1.3%. In fact, over the season of Thanksgiving through New Year's Day, New York METRO has posted a sterling 1.1% periodic fatality rate thanks to the suburbs, led by Northern New Jersey's improvement from 1.4% in December to 0.9% in January. 

NOTE: the trend graphs below for each cluster do not exactly correspond with the clusters; they are inserted for a visual glimpse of the history of the coronavirus contagion in each cluster.

Baltimore-Annapolis; general vaccination information here and for Anne Arundel County here; for Baltimore here:

• 26% growth in confirmed cases versus 8% growth in deaths;
• 0.7% periodic fatality rate in January 2021 versus 2.8% in December 2020;
• 8.2% estimated vaccination rate versus 7.5% vaccination rate for state;
• 3.7% positivity rate for Baltimore versus 4.4% for Maryland; as well as,
• 19% I.C.U. availability for cluster versus 24% for Maryland.

The national tension over how much economic relief makes sense has shown up in Maryland as the Democratic legislature ups the Republican Governor’s $1 billion proposal by 50%. Blacks may face vaccine inequity. They make up 31% of the State’s population but have endured 40-45% of the deaths to COVID while they have received only 15% of the vaccines administered to date. Part of this issue may reflect hesitance already seen in other minority communities and that targeted nursing home populations may be predominantly white. 

In an effort to shore up choke-points around the State to combat the emergence of the more contagious U.K. variant mid-month, together with the ominous detection of community spread of the deadlier South African variant this week, Maryland National Guardsmen trained in vaccinations are deploying to  Anne Arundel County where the worst infection rates in mid-January occurred, prompting added restrictions beyond the state-wide minimums. The difficulties of vaccine shortages may be alleviated for those already surviving the coronavirus needing only one dose to supplement anti-bodies organically developed.

Boston and Cape Cahd; vaccination centers here:

• 41.7% growth in confirmed cases versus 17.5% growth in deaths;
• 1.5% periodic mortality rate in January versus 1.0% in December;
• 8.9% estimated vaccination rate versus 7.2% for the Commonwealth; 
• 2.8% positivity rate for Boston versus 3.2% for Massachusetts; as well as,
• I.C.U. availability for Boston of 11% versus 24% for the Commonwealth.

Massachusetts is one of several states rolling a higher proportion of her vaccine orders into the more manageable Moderna vaccine that does not require super-freezing temperatures as spaces open up in the Boston area for appointments. Behind the national curve in inoculations, Massachusetts has allocated 54% of her vaccines to the Boston-Middlesex area and 3% for the Cape and the islands. The disparity principally reflects population share (i.e., the Cape counting for 3.5% of the Commonwealth’s population), though the mortality run-rate now exceeds 3.2% for the Cape versus 2.8% for Massachusetts. 

Mortality is improving in the vulnerable region and a vaccine center will arrive this month. Another competing pressure is the requirement for vaccine equity for minorities heavily impacted by the coronavirus and no more remote from vaccine outlets than their White counterparts. Governor Baker has pledged 20% of the vaccines under Phase-2 to people of color in the current roll-out (or 2-3x the percentage of the population that is Black and Brown). Like other states, Massachusetts has suffered a seasonal surge during January, evident by mid-month as people deferred testing and loosened precautions around the holidays. 

The surge has nearly overwhelmed Boston hospital capacity. Additionally, the U.K. variant is making its way into the Commonwealth, starting the third week of January. Middlesex County, specifically Cambridge, has been running positivity rates as high as 15-20% during the holidays; fortunately, across the cluster, infection and fatality rates are declining despite the seasonal spike and U.K. virus.

Chicago proper; vaccine information here:

• 16.5% growth in cases versus 8.4% growth in deaths;
• 1.1% mortality run rate for January versus 1.9% for December;
• 5.7% vaccination rate versus 6.7% for Illinois;
• 32% I.C.U. availability for the cluster versus 39% for Illinois; as well as,
• 6.2% positivity rate for the cluster versus 3.5% for Illinois.

Despite her being a star among clusters in January, Chicago’s vaccination program is having difficulty gaining traction as people flock to the city from the suburbs, even from out of state. Chicago is largely sticking to her restrictions, permitting only limited loosening of them as vaccines roll out. Continued reliance upon behavioral mitigants attend racial disparities in vaccine administration. Infections and fatalities are re-converging with pre-Thanksgiving levels. 

School re-openings remain a contested issue as the Center for Disease Control (C.D.C.) continues its guidance that teachers need not be vaccinated for schools to re-populate and Chicago is lagging in its inoculations of teachers. The Teachers' Union and the city leadership have reached a contentious impasse over whether teachers ought to return to their class-rooms. Mayor Lightfoot has demanded that teachers return on Monday, but whether or not the educators will comply remains unclear.

Colorado state-wide; vaccine information here: 

• 19.6% growth in confirmed cases versus 17.9% in fatalities;
• 1.4% monthly mortality rate for January versus 1.8% for December;
• estimated vaccine rate of 8.4% in Denver versus a state level of 8.2%; 
• 4.8% positivity rate for Denver versus 4.4% for Colorado; as well as,
• 27% I.C.U. availability for the Mile High City versus 40% for the State.

The State is facing administrative problems with the COVID vaccine, impeding her targeting vaccines properly and possibly exacerbating inequitable distribution at the expense of Hispanics. Denver is leading the way for all Coloradans aged seventy or older to receive vaccines by doing so before the end of this month. Next week, the State will start inoculating people over sixty-five once 50% of the elderly have received at least one vaccination. The Rocky Mountain State is set to loosen restrictions, which makes sense since Colorado has been rated as the fourth safest state during the epidemic by the on-line personal financial planning site, Wallethub. 

In addressing vaccination and other COVID concerns, Governor Polis has reached out directly to the larger community in a remarkable town-hall meeting. Though under-populated, Dolores County faces her own challenges. The trade-off leading to what appears to be loosening targeted groups is to build toward state-wide immunity by not losing time tracking down the last individuals in the 70+ primary cohort. Likely repeated elsewhere, a disturbingly high majority of inmates have contracted COVID across Colorado.

Detroit Metro; vaccine information here: 

• 16.3% growth in confirmed cases versus 14.2% in deaths;
• 2.9% periodic fatality rate in January versus 2.2% in December;
• 10.0% estimated vaccination rate versus 8.2% for the State; 
• 9.8% positivity rate for the cluster versus 4.6% for Michigan; 
• 25% I.C.U. availability for Detroit versus 28% for the State.

Cases and hospitalizations have tapered off across Michigan in late January to hit a three month low (i.e., pre-Thanksgiving) in positivity rates. This improvement may not last as long as one would hope as the U.K. variant has been detected in Motown. Compounding that problem is confusion over a high inoculation capacity (enough to gain herd immunity in four months) but limited supply of vaccines in addition to certain vulnerable employees being sent back to work. Possibly compounding the health challenges across urban Michigan is the epidemic’s distraction away from other non-COVID fatalities. 

This phenomenon has been observed elsewhere, as far away as Europe. A court decision is unravelling the effective measures taken by Governor Whitmer, possibly undermining the enforceability of the program. Otherwise the Detroit area appears to be returning as close to normal as is possible. Like some other metropolitan areas, Detroit is heading toward emphasizing the easier-to-use Moderna vaccine. After shortages in the first half of January, Motown appears to be enjoying higher than average inoculations.

New York METRO; vaccine information for N.Y. here as well as Northern N.J. here and Connecticut here:

• 42.6% increase in cases for the cluster versus 12.4% increase in deaths;
• 1.3% monthly fatality rate across the cluster in January versus 0.9% in December;
• 9.0% estimated vaccination rate for the North Jersey suburbs versus 7.9% for the Garden State;
• 8.0% estimated vaccination rate for New York and 10.3% for Connecticut; 
• 5.3% positivity rate for New York City and 7.8% in Brooklyn versus 4.9% in the Empire State; as well as,
• 35% I.C.U. availability for the cluster versus 31% for New York State.

The economic weight of COVID counter-measures, plus the arrival of vaccines, have persuaded Governor Cuomo to re-open parts of the economy in New York City despite discouraging numbers following the seasonal spike and the onset of the U.K. strain in N.Y.C. and Northern New Jersey. Other contentions include the State government’s manipulating the data and allegations of previous under-reporting of the dire impact of the coronavirus contagion upon the elderly. 

Since mid-month, vaccinations have nearly been depleted due to overwhelming demand from loosening eligibility requirements and receipt of fewer doses than expected. As the Empire State receives new vaccines – including, possibly, the Johnson & Johnson entrant in March – Governor Cuomo is phasing beyond hospital workers and the elderly toward people with co-morbidities. Additionally, Gotham City is lagging other parts of the state in vaccine availability. Positivity rates range from 3-7% across the cluster with Brooklyn and Westchester (great human interest story) veering toward the middle. Meanwhile Long Island continues to perform well despite recent struggles. 

A two month mortality analysis follows immediately below; please note that Rockland County (N.Y.) is included with Westchester (N.Y.) and Fairfield (CT) Counties. (Please click on the unreadable image to view a readable one.)

Philadelphia Metro; vaccine information here: 

• 27.7% growth in confirmed cases versus 21% increase in deaths;
• 2.2% monthly mortality rate for January versus 1.7% for December;
• 6.6% vaccination rate versus 7.2% for Pennsylvania; 
• 6.4% positivity rate for Philadelphia versus 10.6% for the Commonwealth; as well as,
• 16% I.C.U. availability for Philadelphia versus 28% for Pennsylvania.

Like Pittsburgh, part of Philadelphia’s vaccine lag reflects the poor management of vaccine distribution at the state level; city leaders fear that vaccinations will take a year to complete. Not helping matters for the City of Brotherly Love is a breaking scandal over a start-up that isn’t just as the U.K. variant is penetrating the cluster. Community leaders have started to appeal to people of color to enter the vaccination program. 

Philadelphia proper heavily lags the rest of Pennsylvania with vaccination rate of less than 1%. Eastern Pennsylvania’s first mass vaccination site for the elderly has opened only in the last week, two weeks behind the New Jersey suburbs. Infection and mortality rates are improving in Philadelphia’s suburbs, with Montgomery and Camden (N.J.) Counties experiencing more gradual improvements.

Pittsburgh Metro; vaccine information here (expandable); for Pittsburgh here:

• 31.0% growth in confirmed cases versus 49.3% growth in fatalities (led by Beaver and Butler Counties);
• 3.3% periodic fatality rate in January versus 2.1% in December;
• 8.1% vaccination rate versus 7.2% for Pennsylvania; 
• 5.7% positivity for Pittsburgh versus 10.6% for the Pennsylvania; as well as,
• 19% I.C.U. availability for Pittsburgh versus 28% for Pennsylvania.

Like Philadelphia, part of Pittsburgh’s vaccine lag reflects the poor management of vaccine distribution at the state level. In this context of the Commonwealth’s flagging efforts, the Pittsburgh area and Western Pennsylvania have started ahead of the keystone-curve from the get-go before running low recently on supplies. This head-start reflects Pittsburgh’s reeling from increased deaths and a re-invasion of the virus into elderly care facilities north of the Steel City. Allegheny County has suspended some vaccine guidelines to avoid wasting doses to respond to mild rise in cases. 

Assurance to accept a vaccine comes for people fighting cancer. Pittsburgh and Western Pennsylvania suffered most in December; things have improved in January and are coming under control slowly. The Pennsylvania National Guard is being dispatched to nursing homes to re-start the vaccinations at month’s end; Pittsburgh still leads Pennsylvania. Part of the problem is the thin coverage of rural Pennsylvania for vaccinations while supplies increase slowly.

END of LETTER for 05feb21 please revert to separate link for 2020 letters

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

LETTER for 01jan01

Family Cluster COVID-19 review;
Issued the 1st of January 2021

B.L.U.F. (bottom-line, up-front): December 2020 data capturing the post-Thanksgiving spike. Supported by a data supplement.

SUMMARY of monthly for letter for December 2020
Conditions warrant this letter due the sharp increase of cases across the country of 39% (versus 35% for the family clusters) and in deaths 24% (well above fatality growth of the clusters of 13%) during December of 2020. Like the rest of the country, results deteriorated among the clusters. The eight regions under review in Connecticut, Colorado, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York, and Pennsylvania had a slightly worse periodic fatality rate of 1.5% than the rest of the country at 1.2%. Baltimore, Colorado, and Pittsburgh, endured a higher growth in deaths than new cases.

NOTE: may be the last letter unless time and conditions warrant.
NOTE: this blog post compiles reports for 2021 (i.e., 01jan21, 05feb21, and 05mar21, at which point the series, if continued, shall end); for the 2020 posts, please click here.

STATIC POOL RATES U.S. versus WORLD
Global static pool mortality rates up-ticked from 3.3% to 3.4% during December despite the introduction of vaccines produced by Pfizer and, a couple of weeks later, Moderna. There are three basic reasons for this unexpected, disturbing increase. First, Belgium, Italy, México, Spain, and the United Kingdom suffered pronounced spikes that together knocked the United States out of the top-ten countries in deaths per every million people. 

Second, the pandemic started penetrating lesser developed countries with fewer resources to combat it (e.g., countries in Eastern Europe). Third, though very few in number, vaccines disproportionately flowed to the wealthiest and most powerful countries that already have mitigating place and the resources to absorb the economic consequences of those measures. 

The good news remains the accelerated distribution of many more doses in the months ahead. Static pool mortality rates appeared to fall far more rapidly in the United States than they actually did. In mid-December, Johns Hopkins ceased its publication of a national level of recoveries for the U.S.A.; the Baltimore school did not explain why it dropped this datum. To calculate the U.S. static pool mortality rate, I had to substitute data from Bing / Microsoft for those from Johns Hopkins. These substitute data resemble more those from Worldometer than from Johns Hopkins. 

Of the four primary sources used in in my calculations -- Johns Hopkins, Microsoft / Bing, The New York Times, and Worldometer -- Worldometer reports the highest values for deaths, cases and recoveries versus Johns Hopkins reporting the lowest levels. What this stacks up to is that the U.S. static pool rate, using Johns Hopkins data (if the recoveries for the nation had still existed), would more likely have portrayed a less dramatic improvement from 4.0% in November to 3.7% in December. 

Three-tenths of a percentage point is not Earth-shattering news. What is big news is decision taken by Johns Hopkins. Johns Hopkins apparently lacked the confidence in its data collection to publish total recoveries for the United States, notwithstanding its continuing to publish recoveries for other countries. This unannounced and unexplained change represents, in itself, a significant piece of information: it lends credence to the widespread fear that the U.S. epidemic is out of control.  

The other point to note is that the U.S. static pool rate remains slow in declining and remains twice the level of the mortality run rate; the two eventually converge. One had hope that convergence would be occurring now, especially with testing capturing passive carriers as recovered. Together with other leading indicators, this insight argues that the death toll will be above the 471,000 predicted by the University of Washington in November. 

As it is, the first year death toll (at 05mar21) is already above the level projected nine months ago. The significance of the second datum is not the logic behind the calculation, but my reaction to that projection of 335,301 fatalities across the United States after one year of the epidemic. At the time, this level of fatality struck me as unreasonably high; it was 1.5-4x the levels projected by others. To blow right through what I had deemed as too high a fatality level more than two months ahead of the end-date is cause for concern.

REVIEW OF THE FAMILY CLUSTERS 
(note: fuzzy guesstimates for Intensive Care Availability)
The Family Clusters tend to fall in densely populated areas (e.g., New York and Chicago). The post-Thanksgiving surge hits these areas harder than some other parts of the country. The growth of confirmed cases among the clusters, at 35%, proved to be better than the 39% growth for the country at large. Chicago, Baltimore and Detroit did the best job of containing the number of cases to moderate the overall growth rates. Nevertheless, three clusters actually recorded higher growth rates in deaths than in new infections:

• Baltimore-Annapolis with a 30% growth rate in cases versus a 38% growth rates in fatalities;
• Colorado with a 33% growth in cases versus a 45% growth in deaths; and,
• Pittsburgh Metro with a noticeable 78% increase in confirmed cases versus a disheartening 166% growth in fatalities.

These three centers pushed the periodic mortality run rate up 1.5%, or twice the level of November. The grim reality remains that periodic mortality run rates will almost certainly increase again in January. Significant choke-points have emerged in the distribution of the two vaccines already approved; most people are unlikely to be inoculated for at least six months. Unfortunately, contrary to the claims of the Trump Admin., less than 1% of American citizens have received their first dose. 

Fortunately, one elder stateman of the Republican Party is calling for expert planning to enable the states to distribute the vaccine, something he rebukes Trump for never getting around to doing. This gesture by Senator Romney (R-UT) may be a signal to President Biden that he and, hopefully, others will be able to reach across the proverbial aisle to build herd immunity sooner rather than later.

The good news hidden in these data remains the outstanding performance of New York METRO, which dominates 43% of the aggregate population of the eight regions reviewed. That cluster is sill posting a periodic mortality run rate below 1%. Outside of New York METRO, however, the rest of the clusters ran a rather high 2.4% mortality run rate for December, led by Detroit, Maryland, and Western Pennsylvania. That represents twice the level of the country at large.

Baltimore – Annapolis (two links)
Monthly snap-shot: 30% case growth; 38% growth in deaths; 2.8% periodic mortality run rate for December; and, 20-22% of Intensive Care Unit (I.C.U.) capacity available
Republican Governor Larry Hogan has been effective, at least in part, by consulting Dr Anthony Fauci, head of National Institute of Allergy and Infectious Diseases. Dr Fauci is publicly calling for Black Lives (to) Matter now by targeting vaccines toward Marylanders of color. Thus far, Maryland has vaccinated 0.9% of her residents (ahead of New York City and Florida).

Governor Hogan’s road-map to recovery, rolling down to the county level and issued mid-month, builds on the success of flattening the curve earlier, while maintaining restrictions at least through January (i.e., for the duration of the expected Christmas surge). Anne Arundel County is adding additional stringency to the gubernatorial plan; that is interesting since the periodic mortality run-rate is less than 1% for the Annapolis area, though cases have risen 41%. Volunteerism is stepping in, prepared to fill the breach of the newer highly contagious strain of virus.

Boston – Cape Cod (two links)
Monthly snap-shot: 52% case growth; 11% growth in deaths; 1.0% periodic mortality run rate; and, 24% of I.C.U. available
Massachusetts has modified its approach to risk weightings to apply knowledge gained through experience and with the goal of getting as many children back to school as soon as possible. The community spread has extended onto the Cape with only the more remote areas toward Provincetown and in western Martha’s Vineyard remaining at low risk for now; available critical care capacity is already strained. Nevertheless, the Cape and islands remain roughly 55% safer than the rest of Massachusetts. 

Almost 100,000 people (i.e., 1.6% of the population of the Commonwealth; ¡twice the level of New York City!) have received a first dose of the vaccinations from Moderna and Pfizer and Republican Governor Charlie Baker expects to meet his previously outlined schedule. With vaccines just beginning to arrive, one infectious disease M.D. in Boston believes the epidemic is out of control in the eastern half of Massachusetts. Governor Baker is also singling out for criticism those national politicians and their aids seeking vaccinations ahead of more vulnerable essential workers. 

A recently released study implies that some 40% of the cases to date in Massachusetts trace back to two ’super-spreader’ events: a bio-tech conference that released two strains of the coronavirus into the population in February and an elderly care facility in April.  The partial lock-down this winter (e.g., limits of public businesses to 25% of capacity) will impose more hardship and spread more cases in the cold if people are forced to wait in line outside to purchase necessities. Reports have emerged of side effects from the two vaccines, some being severe.

Chicago proper (one link)
Monthly snap-shot: 24% case growth; 21% growth in deaths; 1.9% periodic mortality run rate; and, 30% of I.C.U. capacity available
While Chicago weathers the winter of her discontent, the good news is that only one-in-four of the Windy City’s ventillators is being used. Skepticism remains inside the city over the vaccines, whether they will work (for the good) or whether Blacks will see any soon. The COVID-19 death-rate among young people is becoming personal to families in the Chicago area as this tragic case of a high school senior, with no co-morbidities, portrays so sadly. 

Chicago remains aggressive in trying bring down infection rates, for example by shutting down parties. The city is making some headway, as explained in its health department tweet citing that “COVID-19 case incidence has decreased across all race-ethnicity groups in Chicago. It is too early to know what the impact of the holiday season will have on case rate in Chicago.” The contagion has spread once again to the suburbs.

Colorado state-wide (two links)
Monthly snap-shot: 33% case growth; 46% growth in deaths; 1.8% periodic mortality run rate; and, 20-29% of I.C.U. capacity available
Colorado is complicated these days. She has the dubious distinction of hosting the first known COVID-19 case in the U.S. of a new, more contagious strain of the coronavirus first detected in the U.K. The mutated virus has shown up in California and, likely, other states; it has spread through Europe and into Asia. Colorado’s second case, tragically, has found its way into an elder care facility; such facilities seem to be getting infected again. 

The State faces a difficult January as insecurity descends on young and old alike.  Communications problems due to Democratic Governor Jared Polis’s possible vacillation between lives and jobs has heightened the uncertainty over what measures to enforce; the risk of indoor dining; and. the fate of Colorado housing assistance. Dolores County still records high positivity rates, if low-to-no fatality rates.

Detroit Metro (one link)
Monthly snap-shot: 25% case growth; 15% growth in deaths; 2.2% periodic mortality run rate; and, 26% of I.C.U. capacity available
Though caught in its second wave, Michigan in general, and Detroit in particular, appear to be coping with this round. The eighth most populous state with a large population of people of color, Michigan currently ranks fifteenth in number of cases, though fifth in fatalities, as well as twenty-fourth in hospitalizations, despite a relative strain on intensive care / critical care capacity. In actuality, hospitalizations are improving unlike the rest of the country. Subsequent to vetoing two-thirds the initial amount budgeted by the Republican-led legislature, Democratic Governor Gretchen Whitmer has now signed off on $106 million of economic relief.

Nevertheless, December has suffered the second highest number of COVID-related deaths since the peak week in April. The current community spread is dispersed through the rural center and west of the State as well as the upper peninsula. In the Detroit Metro region, only Wayne County is seeing a noticeable up-tick in cases right now. The University of Michigan’s stadium in Ann Arbor is a new vaccine-hub for the cluster. Prisons, with a 40% infection rate, and, once again, nursing homes have suffered the most during this second wave. Consequently, large drug-store chains – CVS and Walgreens – are rolling out the vaccines to the staff of elderly care facilities. The deaths from COVID-19 of two highly regarded Detroit-area municipal leaders has cast its pall over Motown.

New York METRO (one link)
Monthly snap-shot: 36% case growth; 6% growth in deaths; 0.9% periodic mortality run rate for December; and, 37% of Intensive Care Unit (I.C.U.) capacity available
New York City, Westchester County, New Jersey, Connecticut
New York has answered the Thanksgiving virus armed with the painful lessons learned from last Spring. Governor Cuomo has initiated a policy of nipping outbreaks in the bud before their points of origin become radial hot-spots. Though Democratic politicians – Governor Andrew Cuomo and Gotham City Mayor Bill DeBlasio – frequently clash, the response has been coordinated and effective. Notwithstanding current hiccoughs in distribution, Mayor DeBlasio is seeking to inoculate one million New York metropolitans next month.

Nevertheless, hospitalizations have risen in N.Y.C. to levels raising concern, not panic, as the more transmissible U.K. corona-strain makes its way into the U.S. likely elevating the case count. Death tolls in New York have risen to levels seen last Spring as a fall-out of the Thanksgiving surge. Governors Cuomo (D-N.Y.), Lamont (D-Connecticut), and Murphy (D-N.J.), together with various mayors, have been effective, in the context of renewed contagion, yet the metro region has paid a heavy price in her economy.. 

To combat this, the City has been testing ways to reduce community spread on rapid transit to aid the $4 billion of relief money on the way enacted under the new Federal stimulus bill. While Connecticut, as well as Westchester County and Long Island have faced surges, the suburban area of greatest challenge remains northern New Jersey. Medical first responders have started pushing back in recent weeks, lending a new urgency for their protection; tragically, the vaccination roll-out is not meeting the expectations set by the Trump Administration. Thus far, the Empire state has vaccinated only 0.7% of her people and lags Florida.

Philadelphia Metro (one link)
Monthly snap-shot: 41% case growth; 31% growth in deaths; 1.7% periodic mortality run rate; and, 21% of I.C.U. capacity available
The Philly region continues to struggle with the economic weight of the epidemic, though its COVID numbers remain commendable. Mixed signals may be confusing the residents as local officials increase their restrictions (e.g., pushing back-to-school dates by at least a week of two) since hospital space has been tightening. Meanwhile, the Democratic Governor Tom Wolf plans to relax mitigants on Monday. 

Like Pittsburgh, Philadelphia is providing a safety-net for workers while Federal unemployment benefits should flow without interruption. This week is proving to be a pause before the onslaught of the Christmas surge when the lag times from holiday togetherness run out. For some reason, vaccination rates apparently remain slower in the Philadelphia area than Pittsburgh. Additionally the virus has leached into an area veterans’ home, compounding the demographic difficulties facing the City of Brotherly Love.

Pittsburgh Metro (one link)
Monthly snap-shot: 78% case growth; 166% growth in deaths; 2.2% periodic mortality run rate; and, 8-22% of I.C.U. capacity available
The month of December has imposed a horrific COVID burden on Pennsylvania as Democratic Governor Tom Wolf has slowly lost control. Much of that adversity has fallen on Western Pennsylvania, with cumulative cases doubling and deaths up almost 3x. 

In one respect, however, a new city ordinance has brought Pittsburgh into line with best civic practices for pandemic relief, at least for workers in most entreprises. While the numbers climb, one piece of good news is the stepping up of Pittsburgh’s Jewish philanthropy – joining the Mellons, Presby et al. – in matching a rich history of aiding people in need. The big question right now in Steelers Country is whether fans can return to games after the Governor’s restrictions are (curiously) lifted on Monday.

END of LETTER for 01jan21 please revert to separate link for 2020 letters

BACK STORY
(glossary; methodology)

GLOSSARY

• cases = incidents confirmed by illness and / or testing
• critical care = patients in I.C.U. or acute care AND on ventillators 
• deaths = people dying from COVID-19
• I.C.U. = intesnsive care unit
• marginal (or periodic) 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)
• mortality rate = the number of deaths recorded relative to a larger group
• population mortality = deaths in a specific area (i.e., city, county, state, nation, world) DIVIDED by the population of that area; rarely used here
• 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
• recoveries = people who have had the illness and are now completely recovered or proved to be asymptomatic (i.e., passive carriers)
• run-rate mortality = the number of deaths DIVIDED by confirmed cases
• static pool mortality = deaths DIVIDED by resolved cases (i.e., deaths PLUS recoveries)
• testing positive = people carrying the coronavirus or anti-bodies from a past, previously undetected infection

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.

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 Worldometer; 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.

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.

Letter #168: Trump may fade but kulturkampf will not

". . . . certain socio-economic changes, notably the decline of the middle class and the rising power of monopolistic capital, had a deep psychological effect. These effects were increased or systematized by a political ideology – as by religious ideologies in the sixteenth century – and the psychic forces thus aroused became effective in a direction [for the lower middle class] that was opposite to the original economic interests of that class. Nazism resurrected the lower middle class psychologically while participating in the destruction of its old socioeconomic position." --Erich Fromm, 1941.

B.L.U.F. (bottom-line, up-front): No, Rash Boombox (d / b / a Rush Limbaugh) et al. notwithstanding, secessionism does not pose the threat of infection that the coronavirus contagion does. Yet, the country, our country, must face up to cultural divides too long exploited by demagogues. This split shall become even more apparent following the Supreme Court’s public repudiation of the premise and the argument underlying a recent law-suit from Tejas, effectively ending, at least, the bloodless phase of Trump’s attempted coup d’état.

INTRODUCTION
The COVID epidemic across the United States has not divided the United States any more than the despicably racist occupant of the 0val Office has. Both have brought divisions, dark divisions, into the public -political discourse. This meticulously documented essay by liberal historian, Dr Heather Cox Richardson, serves as a wake-up call to disentangle the two forces – the coronavirus contagion and Trump's attempted coup d'état – that bring out in bold relief the underlying cultural divisions.

One may disagree with Dr Richardson, as I frequently do, but her fine work is the source of perspective in a time of clashing and confusing cross currents. Several of the links in this essay are swiped, shamelessly I assure you, from her daily ‘sources’. Please note that, unless I stipulate that some statement is attributable to Professor Richardson, anything I say reflects solely my thinking, or lack thereof. As it is, the good political historian's influence will flow these thoughts.

THE DIVIDES
The source. Traditionally, one has seen a split in the “theories of life” among and between regions and areas across the United States (e.g., the coastal cities versus the great plains) as well as within them (Chicago versus down-state Illinois). The most consequential, of course, is the central division that led to secession one hundred sixty years ago followed by the Great Civil War. These divisions go back to the Founders when the urbane Alexander Hamilton clashed with President Jefferson and his vision of the ideal democracy with the yeoman farmer. One saw it later with President Jackson’s feud with Nicholas Biddle and the privately chartered central bank of the United States.

In the seven decades before the Civil War, slavery radicalized this cultural wedge as a Southern planter plutocracy insinuated itself into control of the Federal government and policy. Ironically, some of the greatest minds of that era, arrayed on both sides of the divide, had strikingly similar views that differed decisively in nuance. One such split was Jefferson’s idealization of the yeoman farmer versus urban political organizations along the East coast (e.g., New York and Philadelphia); later the Great Lakes; and, ultimately the West Coast).

The similarities. President Lincoln’s initial views toward slavery were those of non-extensionism so ‘free-soilers’ could make a living. Free-soilers were white farmers homesteading in the Midwest, emerging as America’s heartland. Many founding Republicans did not argue against slavery as much as having no blacks at all, save a few freedmen, tragically and often unwelcome by their white compatriots, in the terrirtories in great plains. Restricting the free-soil to free whites homesteading sounds an awful like President Jefferson’s ideas about yeoman farmers, ¿doesn’t it?

The difference, of course, is that President Jefferson was a slave-holder, eventually addicted to that systematized and degrading exploitation. President Lincoln, himself a racist by cultural bias (as many of us are today; e.g., me) became a model of citizenship by growing while he was President and maturing his vision into a conviction of universal liberty, enfranchisement, and conciliation. Such growth by a President in office – recall that other favorite son of Illinois, President Obama – is hardly the norm. 

The contemporary choice for those whites, imbued with a culture of racism, remains stark: ¿do I combat this racism within me or let it flourish? Another unsettling similarity between slavocrats and Lincolnian Republicans is a key tenet argued by Vice President John C. Calhoun and Dr Richardson’s view of President Lincoln’s view of innovation and progress. The big difference, again of course, was that Vice President Calhoun’s theories served infamously as an apology and indirect justification for his ‘peculiar institution’. Vice President Calhoun’s ‘March of Progress’ stipulated that upward social mobility among small farmers and merchants would pressure the slave-controlling élite out of any complacency and into accelerating progress as the leaders of Southern society.

Dr Richardson argues that President Lincoln introduced an alternate idea of innovation and progress: that it was a bottom-up rather than top-down process and that President Lincoln sought to empower the common man. (General discussion minutes 31-42; definition minutes 36:00-37:30.) That rings reminiscent with Calhoun’s thinking (minus the racism), ¿doesn’t it? To be clear, Rash Boombox's mind will never rise to that of Vice President Calhoun. We are a point-of-pivot between the top down individualism and bottom up communalism.

Boombox, an undeserving recipient of the President Medal of Freedom from Trump – one demagogue anointing the other – is a durable but ultimately historical ephemeron craving attention rather than wisdom. (Erich Fromm nailed it with the Rush Limbaughs and other macho mouths of the world in 1941 by writing in his great work, Escape From Freedom: “If the meaning of life has become doubtful, if one's relations to others and to oneself do not offer security, then fame is one means to silence one's doubts.”)

The rub is that Trump uses the populism, as Michael Moore foresaw in October 2016, of the urban-rural divide as a cover story for his agenda of business oligarchy and people like Rash Boombox and Congressmen Nunes, McConnell, Paul, Cruz, Cotton, and Collins actively enable it while craven quislings in the G.O.P. like Senators Ernst, Kennedy, et al. permit it. No, conspiracy here, but a coincidence of interests of ten difficult to brake then break.

Undoubtedly, Vice President Calhoun despicably defended slavery yet, paradoxically, he remains one of America’s foremost minds in political theory. Even now, some of his political thinking lives on as producing some of the freshest ideas this crazy republic has produced. His ideas on concurrent majorities remain applicable today. For example, instead of states enjoying a nullification right to protect their own sordid rights, segments of the population would benefit from such a right of concurrent majorities and ought to, in the case of women, be able to exercise it. 

Practical example. Roe versus Wade should not be overturned and abortion rendered illegal without a concurrent referendum among women in the United States eighteen years old or above of any citizenship or status. Why? Because overturning Roe versus Wade and / or passing legislation that inhibits abortions by those women choosing them abridges their natural right to privacy with respect to personal sovereignty over their own bodies. In a concurrent referendum, a super-majority of women (i.e., 60-75%, as stipulated) would have to consent to the abridgement of a natural right before the state could deprive them of it.

My knowledge of the industrial era of the United States is limited. Suffice it to say that, since 1876, Party roles have switched and today the Republican Party is the élite Party fronting for plutocrats who are not planters but profiteers. This process has accelerated demographically after 1968 and economically after 1980. These days, since the 1890s, the Democrats are the bottom up Party seeking to empower the common man with Republicans having made their ideas plain under Trump.

Summary view. So, in addition to the city-country gap, one sees a wider gap between who fuels progress: people innovating from the bottom through communal support or those at the top, the individuals charged with leading the progress. The strands are clear from the Republic’s earliest days:

• top down personified by Messrs Hamilton, Biddle, Hoover, Reagan, G.W. Bush, and Trump;
• or bottom up with Messrs Jackson, Lincoln, La Folette, F.D. Roosevelt, and L.B. Johnson as well as Ms Chisolm; or,
• surfing on two boards featuring Messrs Washington, Cleveland, T. Roosevelt, Eisenhower, Ford, G.H.W. Bush, Clinton, and Obama as well as Ms Clinton.

The struggle for the country is to straddle these two discordant themes so all can work together for the common good. President Biden thus far appears to be intent on mastering the precarious and perilous art of surfing on two boards by openly building a new and open coalition while keeping its leadership moderate.

ALONG COMES COVID
The cultural divergence polarizing since the 1980s has featured right-wing intellectuals like Patrick Buchanan calling for a kulturkampf. As a young man, I was initially sympathetic to these conservative concerns against godless secularism underlying this kulturkampf, principally with respect to being pro-life and supportive of school prayer. In the mid-1980s, Patrick Buchanan began to alienate me from this right-wing push-back with his odious comparison between gays suffering from A.I.D.S. and the punishment meted out by G-d against Sodom and Gomorrah.

This culture war has gradually crystallised into the direct attack on our participatory democracy waged and perpetrated by Trump, his ideologically irredentist allies, and too many craven quislings in the G.O.P. These demagogues, racists, élitists, and cowards are mostly white men over the age of fifty. A few lonely voices in the G.O.P. have pushed back against Trump; those in office have often paid a heavy price.

If my erstwhile Party of Lincoln is to survive, these oldsters representing a dangerously opportunistic ideology of cupidity must be cleaned away and room made for conservative intellectuals with fresh ideas without the years in power to make them crave job security over public service. In the interim, the epidemic has wrought its havoc on the world, but most particularly on the United States by laying these divisions bare with too many of our compatriots falling through the ideological cracks. The rural-city split has manifested with ‘red’ states (i.e., chronically Republican) being rurally oriented and reflecting, often crassly, the Jeffersonian yeoman farmer.

At its best, this vision represents the core American values of thrift, self-reliance, living in peace with one’s neighbor, and personal integrity. At its worst, this vision represents darker core American values of racism, neglect for individuals, and blaming the victim in the name of assuming personal responsibility. These values need to be promoted and pruned selectively; they remain anterior to the assumed utility of capitalism in allocating scarce economic resources efficiently. The urban side is more communal by virtue of population density and argues that people should have the opportunity to make money no matter who they are.

This vision reflects a different array of values. At its best, the urban vision manifests in communal economic rights through unionization of the work-force, providing universal access to education and medicine, and pursuing distributive justice to expand the middle class. At its worst, these alternate values include the excesses of wealth, the zero-sum reality of social Darwinism, and institutional corruption. The poisonous paradox here is that the rural states have rejected ‘tax-&-spend’ liberalism exemplified by Medicaid extensions under the ‘Affordable Care Act’ (a / k / a ObamaCare).

In doing so, and in supporting elected officials sympathetic to Trump’s élitist power-grab, these people are heading toward catastrophe in the shadow of an out-of-control epidemic in the remote areas as my writings on the coronavirus contagion have warned repeatedly. In her ‘Letter of an American’ for 10dec20, Dr Richardson summarizes this situation aptly, at least from my particular perspective. The evidence of this unintended self-immolation?

The seventeen state Attorneys General supporting the Texas law-suit seeking to overturn the election results in Georgia, Michigan, Pennsylvania, and Wisconsin (now joined by a majority of Republican House members and, of course, Trump).  With the possible exceptions of Florida and Tennessee, these are rural states that desperately need the largess of Medicaid assistance due to hosting fewer doctors and facilities to combat COVID; a large majority of these states has either rejected or implemented half-heartedly such health-care expansion.

Yes, this preference away from 'socialized' medicine may reflect rugged self-reliance, a core and worthy value, but it short-changes the dignity of poorer Americans. The influence of the other divide of – individually versus communally led – innovation is more subtle. One touchstone for that split may be the focus on ‘shareholder wealth’ maximization and rewarding individual achievement with enrichment starting with the arguments of Ayn Rand in the mid-twentieth century.

President Biden, in seeking to surf on two boards, is assembling an urban-based, politically progressive voting coalition while remaining moderate on any progressivity in taxation. Which of the two boards will assume paramountcy waits to be realized. The 2020 election and the necessity of overcoming Trump’s evident neglect of the pandemic should augur for a more communalist governance now that the Supreme Court has manifestly and unanimously rejected the premise and, with the two dissenters, the logic of the Texas law-suit.

Letter #167: Free will and determinism: ¿realization or resignation?

"Ned, what happens when we die?"
"Not sure. Tell you what: I'll be sure to send you a post-card."

". . . . these methods (e.g., 'customer is king') of dulling the capacity for critical thinking are more dangerous to our democracy than many of the open attacks against it, and more immoral--in terms of human integrity--than the indecent literature, publication of which we punish."    

-- Erich Fromm, Escape from Freedom, 1941.

"G-d has a plan for you, Ned."
"Well, I'd appreciate it He'd clue me in, you know?"

B.L.U.F. (bottom-line, up-front): Free will feels right, but determinism is closer than one would ever suspect, particularly with the 'theodicy' (i.e., the best of all possible worlds).

INTRODUCTION
Recently, my niece analyzed my natal chart, basically a sky-map of the exact positions of the planets in the solar system at the exact minute and particular place of my birth. Astrology excites comments from skeptics. The discussion became heated at times, which set me to thinking why since I myself am a skeptic. In reviewing these discussions, none of which were on F.B., I sensed that a larger issue was in play.

PLEASE note that the service performed by my niece in reading my natal chart was triple-A all-the-way in her professionalism, thoroughness, and her uncanny insights that taught a (sixty-three year) old dog (i.e., me) some new tricks. Thank you, Miss Elizabeth Purnell of Brooklyn, New York. If the reader trusts astrology, (s)he would trust my niece and her services. Of course I am not biassed. 😉

DETERMINISM versus FREE WILL
The common argument, if not consensus, postulates that one can not, or, at least, has not yet tested the likelihood of truth of Astrology through use of the scientific method. Frankly, I am old enough to know that many things can not be reduced to the scientific method. That "something more" basically boils down to a lack of comfort with the possibility determinism.

This essay makes a case in favor of the thinking written by Gottfried Leibniz, German philosopher, in the early eighteenth century in his great work on theodicy, or the idea that, notwithstanding the evils of suffering and wrongdoing so evident around one, this world remains the best possible under the stewardship of G-d. Leibniz's thesis basically apologizes on behalf of G-d for permitting the evil that man created as 'necessary'. 

The essay basically argues that through the telescope of modern portfolio theory, one can see that theodicy can still function in the wider context of free will in our day. No way out of the dilemma of determinism and free will likely ever emerge as, like Astrology, the scientific method really can not test out answers empirically. Humankind, therefore, will wrestle with the question. 

Any consensus will not last due to the cogent criticisms of either argument by its opponents. Any answers can not be reduced to the scientific method. Determinism sounds un-hip to the elbow-patch crowd, but minds far better than mine believe that determinism still has a role after "A Century of Self", albeit it is manufactured more by man than by G-d or by fate. Erich Fromm wrote in Escape from Freedom (1941):

"The ‘style’ of the whole period corresponds to the picture I have sketched. Vastness of cities in which the individual is lost, buildings that are as high as mountains, constant acoustic bombardment by the radio [i.e., television, audios, videos, etc.], big headlines changing three times a day and leaving one no choice to decide what is important . . . these and many other details are expressions of a constellation in which the individual is confronted by uncontrollable dimensions in comparison with which he is a small particle . . . He can act; but the sense of independence, significance, has gone."

Leibniz: catch him if you can
The whole idea of necessary (determined) and moral evil argued by Leibniz confused me because I do not have the mind of the 17th century during which G-d was quite alive with a mind "above" reason. People simply did not go there. We live in an era in which a famous atheist, and a very enlightened human being, seriously sought to devise an equation of everything. 

There is no question of free will anymore, Freud notwithstanding. We also live in an age defined by four horrific wars, making the idea of this world being the best possible world absurd. So, I could not understand Leibniz until I put my finance cap on and thought about portfolio management. You see, Leibniz views certain evil acceptable to God because it leads to an optimal, not perfect outcome. 

Gottfried goes to grad school for an M.B.A.
Then I thought through Modern Portfolio Theory. That theory reduces the aggregate behavior of a securities market (i.e., the stock market) to the classic equation of a line plotted on a Cartesian coordinate plane. 

First a refresher on, or de-coding of, what "y=mx+b" means . . . The Cartesian plane, shown by the grid-marks in the illustration, is split into four quadrants by two axes: a vertical axis (y) intersecting a horizontal axis (x). That equation plots a dependent (calculated) value based upon the influence of an independent (i.e., input) value. That equation is: 

• y = mx + b; 
• where 'y' equals the calculated or dependent value;
• where 'x' equals the independent of input value;
• where 'm' equals a pre-determined slope (i.e., the movement on the 'y' axis relative to the movement on the 'x' axis); and,
• where 'b' equals the point at which the line crosses the 'y' axis.

source: https://mathbitsnotebook.com/JuniorMath/Graphing/GRLineEquations.html  

Evil is akin to risk of loss in the old capital asset pricing model (C.A.P.M.). The y=mx+b equation uses different, including two Greek, letters. In a simplified re-telling:

• y = mx + b;
• where, in the C.A.P.M., y = R for total return of an individual security or portfolio (i.e., dependent variable or calculated value);
• m = Beta (slope) for sensitivity to market movements, or market risk;
• x = expected market return or MktRet (i.e., independent or input variable);
• b = Alpha (y-axis intercept) as return unrelated to the market movements; and, therefore,
• R = β(MktRet) + α . . . OR . . . R=α+β(MktRet).

Please note that the 'αlpha' factor has two components.

1. The risk-free rate, or the time-value of money. This rate is what one would earn if (s)he did nothing with the money. In the real world, one assumes this value to be the interest earned by investing in three-month bonds (i.e., treasury bills) issued by the U.S. Government. 
2. The company specific returns, or returns of an individual stock attributable to factors unique (i.e., idiosyncratic) to a particular company (e.g., quality of management, company pricing strategy, etc.)
3. Since the risk-free rate is the same for all, it drops out as a 'value-driver'.
4. The idiosyncratic returns of various companies tend to cancel each other out (or so the theory postulates).

Along comes Gottfreid . . . There is systematic risk which no one can avoid; it is like the systemic evil born of original sin and nature's imperfections in the world (e.g., an earthquake in Lisbon) that act as universal sources of pain and tragedy. The sensitivity of one to that evil corresponds to the 'βeta' of the C.A.P.M. 

Then there is moral evil, the action done by the free-will. That parallels idiosyncratic or unsystematic risk. (On the up-side this unsytematic risk is known as 'αlpha' and people go as mad hunting for it as did the conquistadors for the fountain of youth; on the down-side, negative αlpha often means time to dust off the résumé.😱)

In a diversified risk-managed portfolio of stocks, for example, the market risk is assumed by everyone. Unsystematic risks can be diversified away as unique weirdnesses of many different securities tend to cancel each other out. Such an absence of coincidental behavior corresponds with independent events, or acts, of free will.

Eventually, an efficient frontier of optimal (i.e., likely to be the best possible) returns emerges, based on the amount of systematic risk assumed, or the sensitivity to general evil one is willing to accept. For example, people continue to buy and build luxury homes on beaches, though the property hazards (i.e., sensitivity to the systemic risk-as-evil, in this case hurricanes and erosion) stare them in the face from day-1.

¿Theodicy or the idiocy?
So, in Leibniz's world, G-d is the portfolio manager and foresees the petty evils of people exercising free will and allows for a certain element of universal risk (i.e., evil or, nowadays, suffering). Together, these universal risks-as-evils that G-d assumes, or permits to exist, produce the highest return of happiness to the people of our fallen world, which is, ironically, managed into being the best of all possible worlds.

For the greater reward, the more risk (or suffering) that G-d assumes into our world. Put another way: for the higher eventual happiness of humankind, the larger of acceptable evil permitted by G-d. The last element of the old C.A.P.M.-as-analogy is the 'αlpha' return (specifically, the component apart from the risk free rate and independent of the risk premium expected by the investment's βeta), which is not explained by the systematic / unsystematic risk factors. 

That risk-free rate of return is positive; as such, it may serve in this analogy as G-d's unconditional love for man expressed as G-d's grace. (Or, alternately, man being created in the image of G-d.) Consequently, an evil man using free will has to burn through G-d's grace, freely conferred upon him as a birth-right, before his soul is extinguished (i.e., the αlpha turns negative). This accounts for the difference, in traditional R.C. theology, between:

• venial sins (i.e., minor infractions) absorbed by G-d's unconditional love as expressed by the given risk-free rate for a lower but still positive y-axis intercept; and,
• mortal sins (e.g., the seven deadly sins), the commission of which consign people to HELL as their gravity exceeds G-d's unconditional love, thus creating a negative αlpha or a negative y-axis intercept.

What about sincere atheists?
Atheism -- at least as I see it practiced among atheists I know -- is not about the decline of humanity, but of the expectation of humanity's cracking the code of knowledge that used to be "above reason", as Leibniz asserted three hundred ten years ago, and, therefore, reserved to G-d. G-d and religion remain important to me, but these personal preferences would be deeply heretical to a genius like Leibniz.

The history versus theodicy rift
Theodicy does seem like the idiocy in the face of four globally catastrophic wars, genocides, colonialism, slavery, climate change as well as pandemics like the 1918 flu and COVID. An apologist for Leibniz could argue that God permitted these vast evils because they modernized technology, transportation, food production, economic structures, and security as well as medicine and daily health.

These advancements, albeit commanding a high price, enhanced the optimization of this best of all possible worlds. To me, at least, such rationalizing represents a ridiculous argument. Another point worth considering is the possibility of determinism on a ‘portfolio’ level. That is to say, in parallel with modern portfolio theory, G-d determined the end state – some utopia, live or memorex – but not the actions of specific people in getting there.

Any one person would inevitably deviate from the perfect path to that end-state due to personal short-comings and elements of individual free will. Across humanity, however, these ‘unsystematic’ risks-as-transgressions (i.e., random variances) cancel each other out. Consequently, the systemic progress "pre-formed" by G-d (a term used by Leibniz) continues apace toward the divinely optimized end-state.

Thus G-d acts as a prudent expert (i.e., a portfolio manager diversifying across many investments) rather than a “prudent man” micro-managing our lives (by agonizing over each investment, one at a time). In truth, this world likely is not the best of all possible worlds, but G-d and man can try to avail themselves of the best of both worlds: divine direction and human free will. The key here is what Leibniz labelled as "equipoise": a balance between the temporal and eternal.

A new determinism to mankind's detriment?
A devout believer could argue that man has used his 'ego' (i.e., easing G-d out) by supplanting human knowledge through science for divine direction above reason, a transcendent realm no longer taken seriously. With a crushing global conformity around the scientific method as the final arbiter of knowledge, free will is no longer random but univocal. That prideful consensus creates an imbalance – reminiscent of the Tower of Babel (or the endless hours of babble) – that nullifies the optimization of human progress and this world we live in. In a sense, then determinism has a greater sway than ever due to an enforced consensus forged by minds lesser than G-d's.