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:
- the difference
between a variant and a mutation;
- a perspective
of a weird COVID year;
- ideas
about the future of the U.S. epidemic; as well as,
- 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.
- 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’).
- Forecasted
range of total deaths for the U.S. epidemic varies from 664,120 to 1,064,645
fatalities.
- The
guesstimate of the final fatality tally equals 812,980 deaths.
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.
===========================
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.
===========================
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.
===========================
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.
===========================
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.
===========================
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.
===========================
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.
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.