Good News on COVID 19

When you write a post that goes viral in which you say things like “I crave knowing when I’m wrong” and if I’ve said something that’s false, “TELL ME” … well, people tell you. And since the majority of what I had to say that night was not hopeful, a few people gave me some hopeful news. It’s time to share! Ready? Let’s go!

First COVID 19 Death

On Wednesday we saw fresh reporting that the first deaths in the US were actually further in the past than we originally knew. It’s rarely good news when you add to the death toll on a pandemic, but this time it is. The timeline stretched from seven weeks to ten. This has implications to pandemic models… they use the first death as the starting point, so if it took 40% longer to get to where we are today, that’s changes the shape of the curve.

This news is pretty much everywhere, but here’s a link to one of them.

When I posted on this topic, the information I shared was based on what we knew at the time. And that information was wrong.

Age DOES Matter

My thinking on Sunday was age was not as important as underlying health issues. Today I think it’s more important. This thing CAN kill you at any age, but for those of you younger than 45, it looks better than we thought initially. Based on NYC data (two days old), the mortality rate curve is dramatically skewed to the elderly. I’ll repeat what I’ve been saying all along… calculating mortality rates during an outbreak is an exercise in futility… but this DOES paint a picture. In NYC, 18-44 year olds known to have contracted COVID 19 are experiencing a mortality rate of 0.8%, giving you a 1/121 chance of succumbing to the illness. Compare that to 65-74 year olds, and we get 14.3% mortality, or a 1/7 chance of succumbing.

That’s NOT what I was saying on Sunday. This is real, actionable data. When we know more about who is most at risk, it makes sense to use different precautions based on actual risk factors.

Link to NYC’s data. Similar data is available in other places, such as these data from Massachusetts.

That said… the underlying risk factor argument still holds water.I wish the CDC had an updated version of this chart, but it’s also compelling.

FluSurv-NET_MedicalConditionsImage

I made my assertion based on what I knew at the time. Thanks both data maturing over time and me being made aware of some things I could have known at the time, I can safely give myself a grade of “It’s Complicated.” I am much more hopeful on this front than I was a week ago.

NIMBY

I still think that just because COVID 19 is “not in my back yard” you can’t go party like it’s 2019. It wasn’t in my back yard, until it was. That said, I must acknowledge that the community you live in, its risk factors, and how present the disease is, must all come into play as we develop our strategies for “returning to normal.” My thinking continues to evolve here.

Prolonged Quarantine

This was never an argument I was making. Like most of you, I am very concerned about not just how the shelter in place is impacting us individually, but the economy as a whole. The US economy works, in particular, because we believe it does. Consumer confidence gets people buying things. So does having a job. We have a job loss in my house… I’m feeling it.

It’s worse for people in abusive relationships, bad living conditions, those with mental illness, etc.

We need to find a safe way out of this mess as quickly as humanly possible.

The worst statistic

People are still dying at alarming rates. If it’s true that the United States has entered a period of negative growth (I’ve seen it asserted and refuted in the last 24 hours), it hasn’t shown up in the fatality data. Yesterday there were 3,179 confirmed deaths from COVID 19 in the United States. We’re averaging nearly 2,000 dead per day in April here in the United States.

And yes, I know that many people die from other things. But that’s 1,950 people a day with the country on lock down. Say what you will about ANY of these other, more hopeful data, and it doesn’t change that we’re on pace to lose 60k Americans this month to a disease that didn’t even exist here at the beginning of the year.

Another point of view

Ok – here’s someone else’s voice. I respect and value this man’s opinion. I think you’ll see why when you continue reading. You could easily spend several hours going through all the links and source data he provided. This is my kind of response! Take a read, and see if it doesn’t influence you’re thinking.

Some things about me before starting is background is in Operations Research (not as heavy on statistics but includes modelling and simulation, gaming and game theory) and National Resourcing Strategies. In application in the military, one of my usual tasks was to present the other side of any issue to provide insights. For example, if your position was the glass is half full, I will present the position of the glass is half empty, because all too often accepting any one truth or statistic or metric as the only truth results in deception and bad decisions.

In that vein, the opening of “hard core quarantined” and also thinks this whole COVID 19 thing is being blown out of proportion. Already we have a disconnect, right?

Not necessarily a disconnect.

https://www.realclearpolitics.com/coronavirus/country/united-states/

The state by state (and DC and Puerto Rico) data table fills up a few pages if you paste it, but from the bottom of this link are the data sources: Data Sources: WHO, CDC, ECDC, NHC, DXY, JHU, RCP | Population: U.S. Census | Seasonal Flu 1: CDC 2008–2018 10-Year Avg

Agree that total deaths in the United States as a whole for COVID 19 have passed the 10 year average of total deaths in the United States for an average seasonal flu outbreak. That said, peeling the onion back one level reveals only 8 states and DC have more COVID than flu deaths as of midnight 20-21 April.

https://covid19.healthdata.org/united-states-of-america

This is the IHME model results for 17 April (the last known run I know of) that have been used to update the public. Similar to the previous data set, it can be run at the national level as well as being parsed to each individual state. Anything that changes by a factor of 10 or more catches my attention. The model has been pretty good with New York, estimating ~16,000 deaths in 1 April and up to ~22,000 deaths on the current 17 April run, as well as Michigan, estimating ~3000 deaths on 1 April and currently ~3300. But it has had some order of magnitude changes too: Tennessee ~5000 down to ~250; North Carolina ~2500 to ~250.

https://www.cdc.gov/nchs/fastats/deaths.htm

This is the latest posted data from CDC on annual deaths. Including because glass half empty is usually looking at only COVID or COVID and flu data, while the glass half full view is to look at all deaths and acknowledging COVID will be an addition to the data this year as the other deaths will not magically stop because the COVID virus is here, and in theory the “Do no harm” regarding health is still being applied equally to any and all individuals in the United States. Given current data and projections, COVID will not even make it into the top 5 causes of death based on raw numbers. It will probably surpass #7 (Diabetes at ~85K, but it will be interesting to see how CDC bins those who passed away with the preexisting condition diabetes as well as testing positive for COVID 19), but unlikely to catch #1 Heart Disease ~650K or #2 Cancer~600K, especially with the following concerning trends:

https://www.beckershospitalreview.com/finance/49-hospitals-furloughing-workers-in-response-to-covid-19.html

Many U.S. hospitals and health systems have suspended elective procedures to save capacity, supplies and staff to treat COVID-19 patients. Especially in areas that have not been hit as hard as New York, Detroit and New Orleans, hospitals outside these areas have too much excess capacity.

https://coronavirus.maryland.gov/

This is the data for my home state. I include as it shows the number of cases by county. My Congressional District stretches from Montgomery County (2768 cases) to Garrett County (4 cases).

https://www.health.pa.gov/topics/disease/coronavirus/Pages/Cases.aspx

https://coronavirus.ohio.gov/wps/portal/gov/covid-19/dashboards

I also follow PA and OH as our parents (all in there 70’s or 80’s) with preexisting conditions live, and to compare and contrast what data is, and is not, shared with the public.

So the conclusion is where you sit probably heavily influences where you stand, and in some instances it is fair to believe that it appears portions of the COVID 19 threat have been blown out of proportion.

Probably too long as most folks do not read more than a page, but including the data links tends to make the one page goal challenging. I also fully support the following from your closing: We had a good conversation about COVID 19. They didn’t convince me of anything, and I didn’t convince them… but we were respectful, and said our piece, and kept it moving. No need to be disagreeable just because we disagree about something. My addition would be even if two or more people agree, there is benefit in bursting the bubble in order to acknowledge that there is another side to every coin.

One final thought for consideration:

https://ncadv.org/statistics

I have friends who are health care providers, social workers and law enforcement professionals who work with all forms of domestic violence, and based on the data (the above is just one dataset), state wide stay at home orders are negatively impacting the health of those who do experience emotional, physical and/or sexual domestic abuse in these homes. For all those advocating for quarantines of 12-18 months, have any of those advocates attempted to address the negative health impacts on these individuals?

 

 

 

 

Some Clarifications on “stay home”

When I rattled off my Facebook post just before midnight a few nights ago, I wasn’t expecting more than a couple of thumbs up and maybe an angry emoji or two. It’s been a long time since I wrote for a larger audience, especially out of a business setting, but the thing got shared, shared again, and lit a small fire among my circle of friends.

So it’s important for me to say this: I didn’t thoroughly think through that post. It was just me ranting right before I went to bed. The things that meant the most to me from that post were that the mortality rate really is bad, saying it’s like the flu is wrong, people of all ages are dying, NIMBY is dumb, we can’t reopen schools right now, and no, 20% of the population hasn’t already had the disease. As I’ve engaged in some really amazing conversations with people who disagree with some of my points, my positions are shifting, so more on those topics in a later post. Keep challenging me, I like it. I like to admit that I was wrong.

…which is why we’re here.

When I was signing off on that post, I finished it with some things I have been saying on some of my video blogs… stay home, wash your hands, be nice.

That “stay home” thing really struck a nerve with a lot of people. If it made you angry, I apologize.

Here’s a confession… I don’t stay home all the time. I go to the grocery store. Sometimes I go to Lowe’s. I’ve gone and picked up take-out food a few times. These are all risky activities if you come in contact with someone with COVID 19. I’ve never clarified what I mean by stay home in any of my communications, and some of you are probably thinking to yourself that I’m a little bit of a hypocrite.

Oops.

Look, I don’t have all the answers. If I could write a paragraph instead of saying “stay home,” it would look like this:

Stay home if you can, especially if you live in an area with a significant outbreak of COVID 19. When you do go out, please practice social distancing. Wear a mask… not so much to keep from getting sick, but to prevent spreading it in case you are infected but don’t know. We wear masks to protect other people at this point, please participate. Don’t bother with the gloves, they tend to give a false sense of security and lead to behaviors that aren’t necessarily in your best interest. But do wash your hands after coming into contact with public items (shopping cart, for example). And for the love of humanity, don’t throw your personal protective equipment on the ground when you’re done with it.

Both my daughters are in “essential services,” and they interact with the public constantly. They’re making sure you have the things you need, so they’re at higher risk than those who are working from home, or unfortunately, laid off or otherwise out of work. Please, when you do not stay home, wear a mask. The lives of my family and yours may depend on it. Every time a transmission doesn’t occur because of a mask, it’s another victory.

It’s worth noting that crucial behavior in a hot spot is different in other locations. And yes, the measures that have been put in place are devastating. The economy has never taken a hit like this, and it’s no where near being done. We absolutely need to get “back to normal” as fast as humanly possible… I shudder to think what will happen if we end up in quarantine for six months, a year… more? We need real solutions and we need them very quickly.

I look forward to hearing what you think.

Sourcing my assertions

EDIT: I’m adding this note on June 9, 2020. I don’t believe anyone will come back to look at this page again, but it’s important to note the following:

  1. This information is what I thought was relevant back in April when I posted it.
  2. I’ve learned a lot since then, and changed my opinions on much of this.
  3. Seven (7) weeks later, it’s already completely outdated.
  4. Many of the assertions are either out-dated or wrong, and you can find my updated thinking in blue edits.
  5. I grow weary of the debate, but here we are.

If you want to read the original post I’m backing up, you can either find it on Facebook, or you can find it here. Instead of reposting it, I’m pulling out the assertions and supporting them on this page.

  1. Some people don’t believe that mortality rates are all that high. This is kind of a no brainer, this information is everywhere. People are starting to protest, and my debate partner was suggesting that it’s not as bad as the powers that be say it is. People are still making this assertion and it boggles the mind. We’re up to 110,990 dead as of this writing in the USA, over 400k globally. Just because it didn’t happen to you doesn’t mean it isn’t happening to others.
  2. The mortality rate globally is 6.2%. That’s what it was yesterday. Today we think it’s 6.6%. It will continue to change as we develop better testing, reporting, etc. There’s a really good infographic that is being updated daily by the team at Information Is Beautiful… they’re visualizing the data at Johns Hopkins… it’s both reliable and current. I review this page daily. Measuring mortality during an outbreak is challenging at best and almost never accurate. I should have said “known mortality rate” and put lots of caveats here. It’s a real shame we don’t have better testing.
  3. The mortality rate in the US is 4.9%. This is a rapidly shifting statistic, and was accurate according to the page I was looking at when I typed it. As I type this sentence, the mortality rate in the US is 5.4%. Source: Johns Hopkins Coronavirus resource center, Mortality page. Measuring mortality during an outbreak again… see above.
  4. I asserted that underlying medical conditions may be a stronger indicator for COVID 19 being lethal than age. This particular point is based on a few things I’ve read lately. The data is still developing, but here’s a good primer at the CDC on risk factors. It’s true this thing will kill anyone, but I think we can all agree that age is the most likely reason why COVID 19 will kill you.
  5. Math doesn’t care what you believe. Because if 759,086 people in the US have COVID 19, and 40,661 of them have died, that’s 5.4% mortality. Take one and divide it by the other. See? Math! I’ll refer you back to Information is Beautiful, Johns Hopkins, or the CDC sites previously linked. Side note: why don’t they all agree? Because they’re all updating their pages as frequently as possible, and it takes time. Also, measuring mortality rate during an outbreak is pretty much impossible.
  6. Comparing it to influenza as asinine. For the 2018-2019 influenza season, the CDC estimates 34,200 deaths over 35.5 million illnesses. Having established an affinity for mathematics, that’s 0.1% mortality rate. Here’s where I made a mistake in my original post: I said one person in 700 dies from the flu, but last season it was actually one person in 1,038. Compare that to 5.4%, or one person out of every 19 who get the disease. Again, measuring mortality rates during an outbreak… blah blah blah. But it’s still not influenza. We’re equipped to deal with influenza. This thing? Not so much. But we’re getting better at it.
  7. In the 51 days since the first fatality, COVID 19 is already the number one cause of death in this country. This was true a week and a half ago according to Live Science.com. Since then pretty much all reputable sources agree. What’s no longer on the top killer list? Trauma injuries. We drive less right now… Turns out it was more than 51 days since the first death, for those keeping score of me admitting things I wrote were wrong.
  8. Coronavirus isn’t a problem in my neighborhood is a dumb argument. This is an opinion, so I’m the source. I’m going to point you at every place on the planet not named Wuhan where people are dying. NONE of those places had COVID 19 six months ago. Since then, over 160,000 people not living in Wuhan have died. I am NOT asserting that what we’re doing is perfect. We’re learning on the fly. I’m looking forward to seeing the ingenuity of the human race comes up with. We need to do much better than we’re doing today. I stand by this.
  9. Dr. Oz said we can tolerate 3% fatalities in schools. To be fair, he said “the opening of schools may only cost us 2-3% in terms of total mortality” so I guess he wasn’t saying 2-3% of students would die, he was asserting that there would be an extra 2-3%. So if you believe that 100,000 would die with schools closed, he’s asserting an extra 2,500 dead is a small price to pay to get the kids back to school. I’m going to count this is as a bad quote on my part… but an even worse assertion on his part. He’s apologized, so I’ll give him credit for that. I can’t find an original video of Oz doing this, but if you want to see it yourself it’s in here. I stand by this.
  10. Dr. Oz is a hack. Personal opinion. Anyone who promotes Reiki healing and other pseudoscientific mumbo jumbo is a hack. The worst part is he really is a doctor, he’s very well educated, so people find him quite credible. And Dr. Oz is still a hack. That’s not a fact, it’s a personal opinion.
  11. I said that 20% of the country has NOT gotten COVID 19. Again, to the data. 329 million people live in the United States. A little more than 750,000 people have the disease. So that’s 0.2% of the population so far. Source: previously linked sites and the US Census. Lot of nuance here with antibody testing that I didn’t mention, but this is still true. Best estimates say we’re still not there seven weeks later.
  12. Countries that attempted to stay business as usual suffered dramatically. Back to data. Check out the global coverage on the Johns Hopkins Coronavirus resource center page to see what’s going on, or Information Is Beautiful for an easy to digest graphical representation. Update: This sucks.
  13. GE is kicking ass with our pandemic response, including partnering with Ford on building thousands of ventilators as fast as humanly possible. Check it out. Haven’t heard much about this since then.
  14. I said Gilead was developing a treatment that shows some promise. Here is some early information about the efficacy of Remdesivir published by the New England Journal of Medicine. And oh look, it really seems to help… and we’re about to run out. Argh. Who’s in charge around here?
  15. There are 70 vaccines under development (as of April 11). Three of these are actually already in human trials! Here’s the raw World Health Organization information, and a more human friendly analysis by the folks at Time magazine. Seven weeks later, there are over 100 in development, and a couple are about to go into stage three human trials. Amazing!
  16. Bill Gates’ heroic response to COVID 19. Bill has spent his retirement trying to figure out how to prevent death and improve the standard of living around the world. But on April 2 he committed to building seven (SEVEN!) vaccine factories so when we DO have viable vaccines, they can be produced in record numbers. Here’s an excellent video where he talks about it. And if you never caught his TED talk, here’s the proof that he’s been thinking about this for quite some time. All still relevant, and it’s astonishing to see the conspiracy theorists try to tear the man down.

Ok – there you have it. Keep in mind this information is outdated by the time your read it. It’s good to know, but it’s better to know it from one day to the next so you know how this is trending and can make informed decisions.

Good luck to all of us.

Some thoughts on the Coronavirus pandemic

Last night I got pretty worked up about the Coronavirus and I made a post on the subject on Facebook. It’s since been shared quite a few times, and gets a LOT of comments. I didn’t expect it to gain that kind of traction. Here’s that post:

Some things are on my mind. I had a conversation with someone who both self describes as “hard core quarantined” and also thinks this whole COVID 19 thing is being blown out of proportion. Already we have a disconnect, right? Let’s break it down.

If you bother to read this, some things to know about me. I am a certified industrial statistician by training and a process engineer by profession. I like to get into the weeds with the numbers. Data matter. I’m skeptical by nature, but actively seek ways to hone that feature of my personality. How to find truth in the age of disinformation. What makes a source trustworthy and how do you separate fact from opinions. Which also means I crave knowing when I’m wrong, so if something that follows is demonstrably false, I want to know. TELL ME. And give source material.

Ok. Buckle in because I’m worked up and I’ve been studying. Here we go.

1) Some don’t believe the mortality rate is that high.

According to reporting maintained by Johns Hopkins University, the mortality rate globally is 6.2% and in the US is 4.9%. While this includes all age groups and risk factors, that’s a 1 in 20 chance that if you get COVID 19 in the United States, you’ll die. My daughters will have better odds. Me, I’m high risk because of recurring bouts of bronchitis and pneumonia. So I give myself worse odds. Maybe 1/10? Who knows. But the real point is COVID 19 doesn’t care what you believe. It’s true that measuring mortality rates during an outbreak is an exercise in futility, because we don’t know enough and the testing efforts in this country have been completely substandard. I expect the rate to be less at the end of the day, but it’s not up for debate whether or not, of known cases in this country, 4.9% of the people who get sick die.

Math doesn’t care what you believe.

2) Comparing it to influenza and how many people die of the flu is asinine. With maximum effort to contain the virus, it’s already the number one cause of death in this country. And the first death was just a couple months ago. It went from zero to worst in 51 days. During that time, we shut damn near everything down.

And it wasn’t enough.

COVID 19 doesn’t compare to the flu in ANY meaningful way. One person in over 700 who get it die from the flu, and the majority of them are already at end of life. It’s the straw that breaks the camel’s back.

COVID 19 kills in every age group. Which brings me to my next point.

3) COVID 19 is not just here for grandma and grandpa. The data is still being crunched, but mortality trends towards having stronger correlation with other risk factors. Yes, the longer you live, the more risk factors you are likely to accumulate, but having type 1 diabetes doesn’t mean the flu will kill you. But it DOES mean COVID 19 has a much better chance of taking you out.

Or in my case, recurrent pneumonia.

4) NIMBY (not in my back yard) is a dumb argument. The profundity of short sightedness in saying your neighborhood is fine boggles the mind. Ok. You’re fine. Now. But the reason it’s ok is because we shut the country down… too late for 32,917 Americans who have already died, but we still did what we could to put a lid on it. You want that number to go through the roof? Go ahead and get “back to normal” without viable medication for the sick and vaccines for the healthy.

5) No, we can’t just open the schools back up because Dr. Oz said so. That hack even said it would cost us 3% mortality for our youth (If you follow Dr. Oz’s math, that means 1 of ever 33 kids die, less than the general population because they don’t have as many risk factors). But it doesn’t end with kids dying. Kids get sick and bring it home. Parents get sick and they’re dying at a higher rate. And there aren’t enough ventilators on the planet to support that kind of reckless behavior.

6) “If this thing is as virulent as they say then 20% of the US has already had it.”

No. Just no. Serious no. That’s wishful thinking. This was followed by some envelope math: 20% is 65 million people, and if it really is 5% mortality, then how come 3 million people aren’t dead?

Because you don’t get to make shit up and say that’s what’s happening, that’s why.

So far we know of just over 667,000 cases in the US. That’s it. And if it just happened to be a big fat nothing burger for most of us, hot spots wouldn’t be a thing. But they ARE a thing. The facts are inconvenient but consistent. WHEN a community hits critical mass, the health care system overloads and people die.

Many countries tried to stay business as usual and they’re proof that it doesn’t work (Belgium, Switzerland, France, etc). When hospitals get overwhelmed, the decisions become “let’s give the ventilator to the person most likely to survive.” That’s why in England, where up until a couple of weeks ago, the strategy was to hope enough people survived the virus that the country would obtain herd immunity, the mortality rate is currently 13.2%. If you get this thing in England, there’s a one in 8 chance you’ll die. Because they did NOT stay home. And they cannot deal with the consequences effectively.

Conclusions. This sucks. And it’s going to keep sucking for a while. But there is hope.

We’re going to rewrite history in terms of how we deal with this. I’m proud that my company is on the front lines in building ventilators… faster, better, and partnering with others so they can flex their manufacturing know how with GE’s health care technology brains and get stuff done. Also, companies like Gilead are developing medications based on the virus’s DNA. We couldn’t do that ten years ago. But today we can.

Did you know that over 70 possible vaccines are currently being developed around the world? Most won’t work. But some will. And there are leaders out there like Bill Gates who are putting their personal fortune on the line helping fund not just research but also investing in the infrastructure needed to scale vaccine production up in unprecedented ways (he’s spent his retirement preparing for this moment… Google it).

So yeah, in closing, I’m both pessimistic and hopeful. Most of us will get through this.

Stay home. Wash your hands. And be nice. We don’t know how much time we will have together, but it’s not nearly enough. Make it count.

There’s an earlier version where I wasn’t quite as articulate about the Dr. Oz one in 33 children dies comment, but I cleaned that up to make it a little more clear what I meant.

Interesting to me is the number of people who requested my source material. I’m working on a new post that will include documentation to support my assertions. Stay tuned.

Also worth noting: the person I talked to that spurred this outpouring is a family member. We had a good conversation about COVID 19. They didn’t convince me of anything, and I didn’t convince them… but we were respectful, and said our piece, and kept it moving. No need to be disagreeable just because we disagree about something.