US COVID Update - Instilling needless panic.

I got hung up a little, so this is later than I wanted. But. . .

There are two things about the COVID panic that have really bothered me (aside from bad policies). They are:

1. Over-reliance on the number of cases (infections – is it really a 'case' if you have the virus but no symptoms?) as opposed to watching the data on hospitalizations and especially on deaths, and

2. the definition of COVID deaths. The first is just media hype, the “cases” (really just infections in a sense) are real, but the second is very important. Ordinarily we talk about deaths caused by some objective connection to a causal agent. With COVID we have been talking about death “with the presence of” an agent (the virus). Why is that? It distracts from how deadly the virus actually is. With the seasonal flu we have a definition of a death “caused by the flu” not an assumption of a death “with the flu virus present.” Why the change for COVID?

“In the past, the CDC determined the severity of a SARS virus by looking at evidence and incidence of pneumonia and acute respiratory distress syndrome. A SARS case was designated to be “severe respiratory illness” if a patient had the following:

Temperature higher than 100.4°F (38°C), AND
One or more clinical findings of lower respiratory illness (e.g., cough, shortness of breath, or difficulty breathing)

AND

Radiographic evidence of pneumonia, OR
Acute respiratory distress syndrome, OR
Autopsy findings consistent with pneumonia or acute respiratory distress syndrome without an identifiable cause”

Why don't we do that with COVID (SARS-CoV-2)?

That data can be found at: https://data.cdc.gov/NCHS/Conditions-contributing-to-deaths-involving-corona/hk9y-quqm/data

In fact, only 15,000 or so of the deaths currently listed would be counted as COVID “caused” deaths under the above definition. (And that may be the reason the earlier SARS deaths were so much lower than COVID deaths. So much depends on how you define what you're measuring and the data you then collect based on those definitions. Dr Birx says she still thinks we're over-counting deaths by by 25%. This looks like way more than that.

So it looks to me like we are over-counting both true cases and COVID-caused deaths. Maybe it's just me.

Where do we stand then. Well, for one thing, if we go by the incubation to confirmed positive to death period from March thru May, then the recent increase in cases can be tied to:

1. a lot more testing (more than triple),
2. in the Southwest US an influx of COVID+ patients from Mexico, and
3. the presence of large protests way more than any re-opening of bars, beaches, restaurants, or parties. The numbers fit for a link to the protests (and the ages of those testing positive) much more than they do from the re-opening.

Indeed, if we were truly in a Second Wave we should have seen an increase in new deaths of nearly 30% starting about 2 weeks ago. Instead the 7 day Moving Average continued a straight line decline for 10 straight weeks. This past Tuesday and Wednesday we did see a small increase, and this shows up as a small increase for the past two reporting periods (7 day MA) of about 1% each day. That is even less than I would expect since it is base on nearly 30% more new cases per MA over the past month+, and nearly double the new cases the past 2 days compared to the worst of April.

We are now up to nearly 600K new tests daily and are seeing only a doubling of “new cases” and a flat rate of hospitalization of new cases. In fact, I can't even trust new hospitalizations or “Hospitalized due to COVID” because all those people who waited for surgeries and are now being admitted are routinely tested and if they test positive they are listed as “hospitalized with COVID”. That goes even if you are in for, say, a knee joint replacement and have no symptom at all. So that data is no longer trustworthy to me.

At any rate, the Case Fatality Rate (CFR) is still declining, and the positive test results show a weird pattern. Once we began to get 100K tests per day the test positive rate dropped from over 20% (when we were testing only those with symptoms and a few others) to around 4.5 % and stayed there, then around mid-June the % positive climbed to around 9% and is now staying in that area. That seems to be the result of the CDC (and most states) lumping the virus and antibody tests together, thus counting as “new cases” the antibody teats that show the cases happened weeks in the past. That is not good data procedure. It really looks like about half the “new cases” are really cases where asymptomatic or mild case patients have recovered. If that is true, then the “new cases” news hysteria is really overblown. It would mean that:

1. we really only have about as many new cases as we were having near peak April, AND
2. the CFR of those cases is way down as well. That would make sense if most of the true “new cases” were people under the age of 50 (and that seems to be the case outside of the Mexican border counties) and the other less vulnerable.

The Infection Fatality Rate (IFR) is still hard to determine due to the data factors I've mentioned. But the CDC says it is 0.26% but the data suggests that overall it is 0.15% or less, about the same as seasonal flu. AND, it is highly concentrated among those aged 65 or more. That should have been important in devising policy to combat the epidemic. FL and TX did do that. They protected the vulnerable by not sending infected elders to care facilities and not closing down so hard. NY, NJ, CT, MI, and IL essentially did the opposite. The deaths per 1M are NJ 1736, NY 1661, CT 1218, MI 627, IL 577, and FL 181, and TX 102. Which states would you rather have been in? Watching Gov Cuomo talk trash about FL is just weird. He is, in my opinion. Pretty directly responsible for at least 6000 COVID deaths that didn't have to happen.

So. It looks to me like we are really near herd immunity and while cases will increase maybe a lot (especially if we keep adding new antibody cases) deaths will probably increase only a bit, and as a bonus there may well be no true Second Wave this flu season whether we have a useful vaccine by then or not. Some are pretty obviously trying to keep the panic going as long as possible, but I really doubt that the lockdown cat can be totally put back in the bag.

I was at the dentist this morning, and on the way back I listened to Gov Whitmer deliver the COVID update. My takeaway if “The floggings will continue until you obey me totally” and “implicit bias training will fix the COVID problem.” Odd, but there you have it.

Have a great rest of the summer.