Not enough crayons …

Between the sheer magnitude of the misreporting going on in the major news media, and the monumental incompetence and feckless positioning to take advantage or avoid blame for the COVID19 crisis among US political leaders, it’s hard to know where to start.  The second biggest thing that bugs me is the assumption that people are stupid and have to be manipulated.  The biggest thing that bugs me is that the people doing the manipulating (media, leaders) think they are knowledgeable and smart enough to know what is best and that manipulation is required.  So for today a “short” post pointing out one small element of the madness.

Imperial College, London, released a report on modeling the potential impact of the virus.  It’s an interesting study, properly interpreted it’s good, valuable work.  But that’s certainly not what is happening.  One example is the New York Times article on the study.  They plucked out a graphic showing 2.2 Million US deaths, labeling it in the fine print as showing the number of deaths “in the absence of actions.”  What they don’t say is what the report itself said: that this scenario was unlikely.  That upper bound assumes that people would do nothing even as others around them fell sick.  Worse, this scenario is now in fact impossible: actions already taken will have a profound reduction on this total, even if the assumptions in the model (which are very bad case assumptions) are correct.  There are also reasons to believe that many of the assumptions in the paper are extreme, based on data that has become available later – this is a rapidly moving situation, and it is hard for peer reviewed research to keep up.  But it is valuable document showing the potential impact of various mitigation actions.

 

As I have ranted previously, there are always a huge range and variation of scenarios for any disaster.  Which scenario you use for a given purpose varies depending on the application.  There is no “right” number.  But there are a lot of wrong numbers, especially for what is most likely to happen.  I think most people understand that you sometimes have to plan and take action based on what could happen, even if though what is likely to happen is something more benign.  The problem is, by always emphasizing what might happen (much less the most extreme version of that) just causes a lot of fear, anxiety, and panic.  I just don’t buy it you have to scare people: most people, most of the time, will do the right thing if you just take the time to explain it to them.

As I have been saying all along, your best bet as to what to do is still the CDC COVID-19 web site.  For other preparation tips, try the DHS/FEMA site.  By now you should know the drill: wash your hands, don’t touch your face, social distancing as needed, stay home if you don’t feel good.  Help those around you as needed.  And try not to stress too much over the numbers, the drama, and the politics.  Most of the numbers (and the rhetorical extremes) are bogus anyway.

The Worst Case Scenario (15 March 2020)

OK, here it is: SARS-COV2 continues to mutate and the mortality rate increases for younger demographics, with the whole population mortality exceeding 10%.  The economic spiral rapidly accelerates into a financial system collapse, and a global depression results.  As social unrest spreads, various state and non-state actors seek to exploit the situation, and a peer-on-peer nuclear exchange is ultimately triggered.  The surviving fraction of humanity is reduced to a mad-max style existence. This is not a joke or exaggeration, this is what some of the models and associated analyses are currently forecasting as our near term future.  However …

Mad Max Fury Road promo shot. Or Abercorn Street in Savannah on word that WalMart has toilet paper. Could go either way.

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You’re Doomed, Friday the 13th Special Edition

Some argue COVID19 is like the flu.  Others scream in outrage that it isn’t at the slightest implication that it is.  Both are right, yet dangerously wrong.

Those who say it’s nothing like the flu are right.  In many ways the SARS-COV-2 virus that causes COVID-19 is potentially much more dangerous, especially to certain segments of society.   It is especially devastating to the health care system for two key reasons: it spreads quickly, and while the total numbers becoming seriously sick appear smaller than influenza it has a much higher complication rate for those who do get sick with it.  If we don’t take action, the US we will run out of respiratory support equipment (and people trained to use it) quickly, and it’s going to get ugly. South Korea has four times the hospital beds per capita than Italy – 12.4/1000 vs 3.4/1000.  Most areas of the US are under 3 per 1000. South Korea is farther along the progression than Italy, yet has a hospitalized/identified mortality rate of less than 1%. Italy is currently at 6.6%.

But those who say “worse than the flu!” are also wrong in a very dangerous way.  In societal terms, the hospitalization and mortality rates are comparable to influenza.  As of yesterday evening, those numbers in the outbreak areas in China and South Korea are still converging to the same range as influenza.  In areas that are still in the “exponential” part of the curve, Italy, Iran, and now Seattle, the day to day increases are scary, but are progressing in about the same way.  (As an aside, beware mathematicians who extrapolate the exponential expansion numbers: that is only one phase of the progression and doesn’t last forever …)  This is manageable with some common sense: concern is justified, appropriate and measured action is justified, fear and over reaction is not. The societal and economic impacts of fear are significant, and our economy in particular has a number of fault lines (especially in the areas of liquidity) that this has the potential to cause a major recession or worse.

Those who say it is similar to influenza also have a point, in general terms.  As noted above, the overall number of people who are getting sick, dying, etc. are about like bad influenza year.  In total number terms, based on what we saw in China and are seeing in Italy, about 400 thousand Americans will need hospitalization, and sadly about 30,000 will die.  But, again, the H3N2 influenza out break of 2017, against which the vaccine was only partially effective (and only 37% got anyway), hospitalized 810,000 and killed 61,000.  But, saying “it’s just the flu” misses the point just as badly as saying “it’s a bazillion times worse than the flu!” for the reasons noted above: it’s moving faster, and a greater strain on the health care system that doesn’t handle the annual flu outbreaks well.

This is a fascinating exercise in how people deal with risk.  It is also yet again a depressing example of a major societal threat we knew was coming, that experts warned about for many years, and recommended plans be made to deal with it.  But the short-sighted leadership class (of all political stripes) utterly failed in their responsibilities to get ready for it, and are now failing to react appropriately.  And it’s the average person who pays the price for that failure.  Sigh.

Get Away From Me! What part of “social distance” do you not understand?

Usual reminder that the CDC web site has consolidated information and links on the current situation, and as to what actions various at-risk groups should do, as well as what the general public can do to help stop the spread to those groups.

 

Dualistic Thinking and Prophecy (COVID update, 12 March 2020)

Before the numbers, a question: Is the COVID19 pandemic a crisis, or not?  In the US how you answer that seems to break along political lines.  But the answer isn’t really a simple “yes” or “no,” and that is a source of conflict and confusion in a society that demands simple, sound bite style answers that hopefully break down along party lines.  In many instances, the question “is or is not” (“to be or not to be” as some English dude wrote) is the wrong question.  The Buddhists call this “dualistic thinking”.  In the COVID crisis, the answer to the question above is a firm “it depends.”

The short version (and you know the longer version is below!) is that this is not a crisis for the vast majority of people.  Even if you get it, it’s not as bad as many of the influenza strains going around.  HOWEVER: if you are in a vulnerable population, it is as much as 10 times deadlier than the flu.  In addition, because of the rapid progression, lack of immunity, and severe respiratory distress of patients who present for treatment, it is a potential catastrophe for our health care system, which does not have the capacity to deal with this.  Thus the contradiction and conflict: for most people it’s not a big deal, but for the health care system it risks overload, and for vulnerable populations, it’s deadly.  So how do you balance all that, prepare, but not scare people and wreck the economy?  Clearly, not how we’re doing things at the moment …

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The Decision To Cancel … (10 March 2020 Notes)

The US is now well in to the mode where state and local leaders are having to take key decisions on COVID-19 with respect  to closures.  It’s a difficult situation.  The dilemma is that the available data indicates this has no more implications for the general population than a bad influenza strain. That’s not to minimize COVID19; the problem is we don’t take influenza as seriously as we probably should. The 2017 H3N2 strain hospitalized 810,000 people and killed about 61,000.  The current modeling indicates that COVID19 will hospitalize 378 thousand, and kill about 20,000.  Big numbers, but smaller than the flu.  However …

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ZOMG! The COVID Numbers Changed! (Or did they?)

One of my major frustrations with the “news” media is how they treat numbers. In a situation like we are facing with the COVID-19 outbreak, the data is very fuzzy, and we are apparently seeing wild swings in the numbers.  Headlines like this one in the New York Times are facing folks as they wake up this morning: Cases and deaths surge in Italy as its north is locked down.  So we should panic, right?  Maybe not.  

As previously noted, I’m using data from the nCoV-2019 Data Working Group data base, Epidemiological Data from the nCoV-2019 Outbreak: Early Descriptions from Publicly Available Data as well as the current (9 March 2020) World Health Organization database. I’m also indirectly using other sources of information to cross check these data.

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The Numbers Game Continues (How bad is COVID?)

As someone who deals in data (usually sketchy, fuzzy data), I’m totally frustrated at how people are drawing conclusions and doing extrapolations on the COVID19 data.  It’s causing panic and bad decision making, and as I have been saying for a couple of weeks the panic is potentially worse than the pandemic (and make no mistake, despite the reluctance to use the word, this is a pandemic, but as has been pointed out by myself and others, pandemic does not automatically mean widespread death and the collapse of society).  When I look at the COVID19 data (just the data, not the reaction to it), I see reason for concern by the health care community and some sectors of the population, but not the population at large.  Here’s the latest on what you should do, what the numbers are, and what they mean …

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Dissecting COVID19 Statistics: what they really mean.

Everybody in the media seems to have become experts in epidemiology and statistics, talking about cases, R0, and mortality rates.  Here’s what all these numbers mean to you: Not much. Wash your hands, don’t touch your face, don’t freak out.  The best sources of practical information are at the CDC web site, and the DHS/FEMA “ready.gov” site. Essentially, these are common sense actions.  But, since a 100 word post just isn’t in my nature, here are a thousand or so more words on what we seem to know about COVID19 statistics from a public policy, economics, and emergency management perspective.

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COVID-19 Tuesday 3 March 2020 Update

I didn’t really plan to do daily updates on this (and probably won’t unless things change), but I did listen in on the CDC briefing that just wrapped up at a few minutes ago (1:30pm ET) as well as some earlier telcons.  All told, I didn’t hear anything that changed my view that:
a) Most people getting COVID19 have mild symptoms and many probably don’t even know it or confused the symptoms with a normal cold, flu, or (if you live in the south), allergies from the god-awful pollen coating everything in sight;
b) The usual vulnerable populations (over 65, anyone with health issues) need to be especially cautious and use good hygiene;  So does everyone else.
c) Panic is still a bigger threat than the virus.
d) The Medical Community needs to prepare for a spike in respiratory distress cases even if total case counts stay manageable and below normal influenza rates;
e) The economic and political impacts of COVID19 will be disproportionate to the medical impacts.

The bottom line is everyone needs to practice good “flu” season behavior, as much to protect the vulnerable since if we can limit the spread it limits the opportunity for vulnerable people to be exposed.  If you feel bad, stay home.  Don’t spread the joy.  If someone is sick, it’s safe to take care of them, just frequent hand washing, vigilant surface cleaning, etc.  There are some indications are this isn’t quite as communicable as thought, but be sensible.  You’ll hear the phrase “social distancing.”  That’s doing things like not shaking hands, touching people, etc.  Ditching Facebook might help – can’t hurt, and might make you more sane 😛 …

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CDC COVID-19 Briefing Delayed, Monday 2 March 2020

First, the CDC briefing teleconference “on hold” music is terrible.

Normally I try to post something after the CDC briefing, but it has been postponed, and I may not have time to follow up with a post this afternoon.  They are also in the process of updating their guidance, no doubt in response to new information such as the fact the virus has almost certainly been in the US, and spreading, for at least 6-8 weeks, as well as other developments such as new cases and other data.

We’re in the scary phase of this, where there are now local outbreaks, and speculation is far outrunning information. The key problem now, as throughout this event, is that the lack of accurate testing has prevented us from getting a handle on several key variables:  how many total people have been exposed, how many got sick and to what degree, and how many became seriously ill and needed hospital level medical intervention. There is some reason to be very cautiously not pessimistic (I wouldn’t say “optimistic” yet) that the first two numbers are such that the third number, those who “crash” with this, is statistically small enough to make the pandemic manageable. So while there is still no reason to panic, the truth is we just don’t know for sure yet, and the medical community is wise to continue to prepare for various scenarios even while “go about your life, being aware this may or may not require action” is still the word of the day. In economics, as usual avoiding the extremes of “irrational exuberance” or “suicidal depression” is always the challenge …

As always, if you want the latest facts and recommendations, go to the the CDC COVID-19 web site. Click “CDC Recommends” for access to specific guidance for health care providers, etc.  Most of what you need to do is just common sense (hand washing, don’t buy all the TP and beef jerky, etc.)  For general “how to prepare” guidance on both this and other potential disasters, the DHS/FEMA “Ready.Gov” site has checklists and suggestions.  Maybe pick up a couple of extra items each trip to the store until you have a small stash.  Then swap out items over time so they don’t expire.  It’s good habit to be in since … HURRICANE SEASON IS COMING!  Or earthquakes.  Or something.