US COVID Update - Surge in cases continued.

I'm really getting to hate writing about this, mostly because there seems to be no real discussion about what we know and should be doing.

That is especially true about the current media hysteria about “surging” new cases of the virus. Below are some things we all know that I rarely see or hear.(My local new radio station seems particularly bad about this [it's CBS News]. But at least this afternoon after hyping “surges” in “locales” in some states, and saying that MI “the most new cases since May” (not really true) then slipped in the “news that we had ONE new death yesterday.)

1. We had to reopen at some point.
2. Unless we didn't reopen until next year we would quickly (around 2-3 weeks) begin getting more new cases. That is because uninfected people would be encountering infected people and some of them would get infected.
3. As we increased tests the number of new cases would be increased since we would be finding more of the asymptomatic and mild cases we knew existed but hadn't had enough test kits to check.
4. As we began testing serologically we would find cases of people who had had asymptomatic or mild cases who had recovered without being counted.
5. #2 and #3 mean we could expect to see new cases increase in a linear fashion reflecting whatever the true transmissability is (which was unknown at the time, and we still don't have a solid number. This in turn would mean a constant linear increase in new cases. However, unless we see an exponential increase the seen increase would NOT mean that we were entering a second round.
   6.#5 and #4, when #4 then was added to the viral tests that would mean we were finding “recovered cases”, 40% of which could be at least 6 months old and counting them as new cases when they are not. In other words, we (the states and CDC) are deliberately distorting the number of new cases.
6. #5 and #6 means the linear increase would be steeper than when using only viral tested new cases, and might briefly look exponential. It still isn't.
7. Since we still don't know the true Infection Fatality Rate (IFR), any estimate based on the previously known rate will not be useful for projecting future deaths from “new cases”, especially since the “new cases” number is distorted by the above issues.

There is more, but I think those 8 give you an idea. WE KNOW THINGS. But those are rarely or never mentioned. Why?

Things I know now, and you could too by looking for the data.

1. The Case Fatality Rate (CFR – the % of those who are detected as positive who then die) is decreasing because we are finding many, many more asymptomatic and mild cases than serious cases. That means the CFR is declining and will probably decline more.
2. The actual number of new deaths is declining even despite the increase in new cases. (This may well be because so many of the most vulnerable died in Mar/Apr/May.)
3. For the first time a majority of new cases are in those <50, whose IFR to date has been similar to or lower than the IFR for that group from the flu.
4. The states with the biggest increases in new cases are still seeing declining deaths AND a decreasing CFR. And all of those states have had much lower cases/1M and deaths/1M that the hardest hit states. (Their IFR is, of course, decreasing as well.)
5. The serological tests are finding about 10 times as many recovered cases (as a %) than the viral tests are finding new cases (as a %). This strongly implies that we may have as many as 20M people who have had and have recovered from COVID, and possibly more.
6. That then implies that the true IFR rate is as low as seasonal flu, or lower. COVID-19 is not the killer it was projected to be. It is new and nasty, which is a concern but not something to panic over, even now.
7. The local increases in new cases may be related to “peaceful protests” more than to reopening based on the lag times between each and the beginning of the increases.
8. I don't really have a good 8 for this one. ;-) Well, it could be that despite the MSM failing to report it, or denying that it has happened, the “surge” came 3-4 weeks (the incubation period) of mass protests.

Another thing. I use multiple data sources for my thoughts. They rarely totally agree on the numbers, for various reasons, including when they gather the data, but they usually track each other closely. Two days ago one of them, covidtracking.com, suddenly added 2500 new deaths to their US total. I could not find a reason for that. They didn't say. None of their state level data showed any such numbers. I had hoped it was just a mistake, but it is still there today. I am now being very careful in considering how/if I use their data.

Anyway. Some further stuff. The increases in CA/AZ/TX in large part can be attributed to persons who are US citizens, visa holders, greencard holders, and/or their family members.

More interesting data: the border states to Mexico (Southern California, Arizona, New Mexico and Texas), have been responsible for 26.3% of all positive tests in the past 21 days in the U.S. Prior to May 29, they were responsible for 7.7%. Community growth or outside source?
(Above data from USAfacts.org county data.)

In FL it really looks like a combination of super-spreader protest activity (although its not obvious any of the new cases are being asked if they participated) and young people going back to bars. In both cases that helps explain the relative youth (20-40 year olds are the majority by a lot) of the new cases.

The MSM is bashing FL. Here is a small chart of a comparison of NY/TX/FL.

State	Population	Cases	Deaths
NY	19.5M	414347	31373
TX	30M	137152	2234
FL	22M	114018	3329

So, for FL to catch up to NY FL needs 300,000+ new cases and about 28,000 deaths. Seems a bit of a steep hill to climb.

The latest numbers for the US show the 7 day MA of deaths down to below 4000 for the first time since Apr 1. The drop in deaths has been linear since late April. It still has the same slope since then. We have had 600K tests the past two days. The % of positive tests is just above for the 7 day MA, but the 7 day MA of the CFR is below 5% for the last two days, from 5.7% at the peak. That is a 15% decrease, which is pretty good.

On the other hand, the 7 day MA new cases in the past week rose steeply from 180K to 240K. That's a 33% increase. it is so far negatively correlated to new deaths.

Other Notes That May Be Of Interest:

“Hundreds test positive at Tyson Foods plant in Arkansas” was the headline of an AP article on Sunday. That will naturally alarm the public. However, the real headline is that although 13% of all Tyson Foods employees in Benton and Washington counties tested positive, 95% of them had no symptoms. Twenty-six of the 481 who tested positive did present some symptoms. In the Berry Street facility, which had the largest number of cases out of the six facilities, 223 of 227 who tested positive were asymptomatic.
The percentage of asymptomatic cases supports the belief of the CDC that the number of cases in the US may be 20M or higher.

“a study from the University of California found, “Growing evidence suggests that asymptomatic and mild SARS-CoV-2 infections, together comprising >95% of all infections, may be associated with lower antibody titers than severe infections.” They estimate that only 40% of asymptomatic patients would retain antibodies for 180 days, 60% of mildly symptomatic, and 95% of severe cases.”

Last month the U.S. Centers for Disease Control and Prevention (CDC) estimated that the risk of death for people with COVID-19 symptoms is just 0.05 percent among patients younger than 50. That risk rises to 0.2 percent among 50-to-64-year-olds and 1.3 percent among people 65 or older.

That last number for June 23 on the chart shows a huge jump. Should we be worried? Is this the much-dreaded surge some have been talking up?
Apparently not. A big part of that one-time gain came from a revision by one state: Delaware. “To put the increase in deaths in context, Delaware added 69 deaths today: ‘The revision came from identifying 67 deaths dating back to April.’ So if you take out those 67 deaths, the week-over-week deaths have not changed.”

The volume of coronavirus tests has risen 23% in the past two weeks, but positive results have increased just 123 percentage points to 7.2% (including what appears to be around 25% serological tests indicating previous cases in the past). Meanwhile, deaths have fallen over the past two weeks by 14%.

A review of Minnesota deaths through late May, for instance, found that of 741 registered COVID-19 deaths, fewer than 41% listed it as a “primary cause.” By that standard, George Floyd, who died in police custody and tested positive for the Wuhan coronavirus, could have been counted as a COVID-19 fatality had his death not been so well publicized.

CDC says: “For 7% of the deaths, COVID-19 was the only cause mentioned. For deaths with conditions or causes in addition to COVID-19, on average, there were 2.5 additional conditions or causes per death.”

New IMHE forecast “The new IHME worst-case forecast - 179,106 U.S. lives lost by Oct. 1 - was revised downward from the 201,000 deaths projected on June 15.” (Reuters) (Past IHME estimates have not been particularly accurate.)

"Our best estimate right now is that for every case that's reported, there actually are 10 other infections," CDC director Dr. Robert Redfield said on a call with reporters Thursday. The estimate comes from looking at blood samples across the country for the presence of antibodies to the virus. For every confirmed case of COVID-19, 10 more people had antibodies, Redfield said.

A lot to consider. I'm still processing. Use this to inform yourselves, but it is not gospel, mostly my thoughts and the data of the states and other reporters, and some other stuff I found of interest. You should interpret it for yourselves.