The new Corona virus, should we worry?

scools12

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Here are his tweets:

He had 4 negative tests. I guess it made for good TV?

“Today host Hoda Kotb noted during the interview that Fair had received four negative tests for the virus but said, "clearly you have it." Fellow host Craig Melvin called Fair's "false negative" tests "scary," and cohost Savannah Guthrie called it a "cautionary tale."
 

USAF

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You may want to do a bit more research. We are talking about the WHO here, not some two-bit operation. Statements like "asymptomatic spreading is very rare" in the month of June from the WHO is not to be waved away. It was complete nonsense that was retracted the next day. There are more examples if those willing to look.

To suggest that opposition to WHO is only based on politics shows just how narrow your view of the World is. Open your eyes. Think for yourself. Stop making everything in life about D vs R.
Just a coincidence this is an election year? Never brought up before?
 

CutDownTheNet

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I'm always looking at the MUCH bigger picture. I'm not focused solely on the virus. we are in the midst of a political revolution, so unfortunately, my concern is much less on slightly reducing the spread.
Well, if we had a vaccine for preventing the spread (and blind adoption without even understanding what these dufuses are saying) of political ideas that are only going to head us toward a more dystopian society than we already have, then I would say that vaccine would be equally a good thing as an effective coronavirus vaccine.
 

CutDownTheNet

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MSNBC was on at the gym this morning, and every 15 minutes they were talking about how Florida is now the epicenter of COVID after yesterday's record reporting of deaths.

Not a peep about California, one of the most heavily locked down and masked states throughout the pandemic, who had more deaths than Florida yesterday, and twice as many as Florida over the last two days. I wonder why...

Here's when Florida's deaths actually occurred from yesterday's report.

Better buy those Florida folks a faster computer. Maybe they can borrow one from NASA at Cape Canaveral. What, you say they are still using an abacus?
 

howeda7

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Does the White House control production of N95 masks and other PPE? Do States sit around waiting for the White House to ship this stuff to them? Do you blame Trump for thunderstorms?
Trump claimed he was going to use the defense production act, as he has the power to do, to ensure there was adequate masks and PPE. He clearly has not done so. He has done almost nothing to deal with the crises at all, except for the January travel ban.

The Federal response has been nothing short of a train-wreck and they're official policy since at least May has been "ignore it and it'll go away." It's a large reason we are where we are. 50 individual states left to figure it out on their own.
 

Spoofin

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Just a coincidence this is an election year? Never brought up before?
Opposition to the WHO is brought up now because it is an election year? Do you even listen to yourself? Any chance it is being brought up because there is a pandemic and people are observing it’s reaction to said pandemic? Most people couldn’t have told you anything about WHO before 2020.

You really need to examine your assumption that anyone’s opposition to WHO must be because they are pro-trump. At the same time, check your assumption that anyone who opposes Walz must also be. These are very narrow minded views and demonstrate that you are told your opinions rather than you deciding them yourself. Too bad.
 

KillerGopherFan

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Trump claimed he was going to use the defense production act, as he has the power to do, to ensure there was adequate masks and PPE. He clearly has not done so. He has done almost nothing to deal with the crises at all, except for the January travel ban.

The Federal response has been nothing short of a train-wreck and they're official policy since at least May has been "ignore it and it'll go away." It's a large reason we are where we are. 50 individual states left to figure it out on their own.
Total hack!
 

Spoofin

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Trump claimed he was going to use the defense production act, as he has the power to do, to ensure there was adequate masks and PPE. He clearly has not done so. He has done almost nothing to deal with the crises at all, except for the January travel ban.

The Federal response has been nothing short of a train-wreck and they're official policy since at least May has been "ignore it and it'll go away." It's a large reason we are where we are. 50 individual states left to figure it out on their own.
The feds should have done more, no doubt - but those 50 individual States are run by elected officials and not Children. Not a one of them deserves a pass because “Trump didn’t do enough.” That sounds like a 2nd grader pointing fingers. There WAS something each one of them could have done. Many failed, miserably.
 

CutDownTheNet

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Here is a summary (plus a bit of augmentation by myself) of major points from the Atlantic article ...

COVID-19 Cases Are Rising, So Why Are Deaths Flatlining? by Derek Thompson.

Warning to right-leaning readers: the Atlantic leans so far left that it sometimes makes no sense anymore (and the subtitle gives you a clue of how hard-left the Atlantic is: "The gap between soaring cases and falling deaths is being weaponized by the right to claim a hollow victory in the face of shameless failure. What’s really going on?"), yet this article is actually quite good and has good references. So here we go, condensed (and then augmented) from the full article ...

Cases have soared to terrifying levels since June. Yesterday, the U.S. had 62,000 confirmed cases, an all-time high—and about five times more than the entire continent of Europe. Several U.S. states, including Arizona and Florida, currently have more confirmed cases per capita than any other country in the world. But average daily deaths are down 75 percent from their April peak. Despite higher death counts on Tuesday and Wednesday, the weekly average has largely plateaued in the past two weeks. (Note: This is confirmed by my own analysis, but where it heads from there is the question, and this article gives some hints about the factors in play.)

The gap between spiking cases and falling-then-flatlining deaths has become the latest partisan flashpoint (to the point of pitting Fauci against Trump). On Tuesday, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, warned Americans against “[taking] comfort in the lower rate of death” just hours before Trump tweeted triumphantly: “Death Rate from Coronavirus is down tenfold!” (Note: This was the dumb tweet by Trump in which, near as we can tell, he was talking about Case Fatality Rate (CFR, also known as Case Fatality Risk) that is virtually useless as a statistic unless you also go into a detailed explanation plus relevant data that can convert CFR into an estimate of IFR (Infection Fatality Rate).)

In the fog of pandemic https://www.theatlantic.com/ideas/archive/2020/03/fog-pandemic/608764, every statistic tells a story, but no one statistic tells the whole truth. What follows are five possible explanations for the case-death gap. Take them as complementary, rather than competing, theories.

(Note: I'll list these possible explanations here to get the big picture, then we'll return to a condensed discussion of each point, including a 6th point of my own.)

1. Deaths lag cases—and that might explain almost everything. (Note: I think this may be a lesser part of the explanation, although it certainly does explain why we need to wait a couple weeks to see what the next trend is. Also, 2(c) factors into this one.)

2. Expanded testing is finding (a) more cases, (b) milder cases, and (c) earlier cases.

3. The typical COVID-19 patient is getting younger.

4. Hospitalized patients are dying less frequently, even without a home-run treatment.

5. Summer might be helping—but probably only a little bit.

(Plus an additional point of my own that is not sufficiently emphasized in this article, and is an expansion on point 2(a) above.)

6. Total/Daily Cases (along with stats like CFR) are meaningless, and what we should really be interested in are Total/Daily Infections, and if you were to look at Daily Infections, you might see that going sideways similarly to Daily Deaths.

(Now let's discuss each point in turn.)

1. Deaths lag cases—and that might explain almost everything.

(But it doesn't explain everything.)

Even where deaths are rising, corresponding cases are rising notably faster.

There is a lag between a surge in cases and a surge in deaths. There can be a lag between the death and the date the death certificate is issued, and another lag before that death is reported to the state and the federal government (see post #17239). As this chart from the COVID Tracking Project shows, the official reporting of a COVID-19 death can lag COVID-19 exposure by up to a month. This suggests that the surge in deaths (due to the surge in cases) is (still) coming.

In Arizona, Florida, and Texas, the death surge is already happening. Since June 7, the seven-day average of deaths in those hot-spot states has increased 69 percent, according to the COVID Tracking Project.

1594418196551.png

2(a). Expanded testing is finding more cases.

The simplistic version, which we often hear from the president, is that cases are surging only because the number of tests is rising. That’s just wrong. Since the beginning of June, the share of COVID-19 tests that have come back positive has increased from 4.5 percent to 8 percent. Hospitalizations are skyrocketing across the South and West. Those are clear signs of an underlying outbreak. But the huge increase in testing might be tricking us with some confusing weeks of data.

In March and April, tests were scarce, and medical providers had to ration tests for the sickest patients. Now that testing bandwidth is markedly increased, we are testing a much broader cross-section of the population, and (as Trump has duly noted) we are finding additional infections (that are then tabulated as cases) beyond what we would have found in a more restricted testing regime, such as we had earlier in the pandemic. Testing has also expanded into smaller and more remote communities across the U.S., which earlier may have needed to ship their COVID sick to a larger city for treatment (and testing after the fact of symptomatic diagnosis).

2(b). Expanded testing is finding milder cases.

Due to wider and more frequent testing, the results might also be picking up milder, or even asymptomatic, cases of COVID-19. These would either have not been caught at all previously (e.g., asymptomatic) or else told by a doctor to self-treat and isolate at home (but not be formally tested, thus not appearing in the case count earlier in the pandemic).

The whole point of testing is to find cases, trace the patients’ close contacts, and isolate (and treat) the sick. But our superior testing capacity (now, versus our inferior testing capacity earlier in the pandemic) makes it difficult to do apples-to-apples comparisons with the initial surge. (See also point 6, below.)

2(c). Expanded testing is finding earlier cases.

The epidemiologist Ellie Murray has also cautioned
that identifying new fatal cases of COVID-19 earlier in the victims’ disease process could mean a longer lag between detection and death. This ties into point 1, impacting the length of delay between test results (e.g., establishment of a case that appears in the new-cases count) and reporting of deaths. This phenomenon, known as “lead time bias,” might be telling us that a big death surge is still coming.

But there are still reasons to think that any forthcoming death surge could be materially different from the one that brutalized the Northeast in March and April.

3. The typical COVID-19 patient is getting younger.

In Florida, the median age of new COVID-19 cases fell from 65 in March to 35
in June. In its latest daily report, the Florida Department of Health says the median age is still in the high 30s http://ww11.doh.state.fl.us/comm/_partners/covid19_report_archive/state_reports_latest.pdf. In Arizona, Texas, and California, young adults getting sick have been driving https://www.texastribune.org/2020/06/16/texas-coronavirus-spike-young-adults the surge https://www.wsj.com/articles/corona...-west-looks-different-from-norths-11593203105.

That would partly explain the declining death count, since young people are much less likely to die from this disease. International data from South Korea, Spain, China, and Italy suggest https://ourworldindata.org/mortality-risk-covid#case-fatality-rate-of-covid-19-by-age that the COVID-19 case-fatality rate for people older than 70 is more than 100 times greater than for those younger than 40.

Maybe older Americans are being more cautious about avoiding crowded indoor spaces. Maybe news reports of young people packing themselves into bars https://abc13.com/spire-night-club-...n-texas-covid-19-governor-greg-abbott/6278691 explain the youth spike, since indoor bars are exquisitely designed to spread the virus https://www.theatlantic.com/ideas/archive/2020/05/how-will-we-ever-be-safe-inside/611953. Or maybe state and local governments that rushed to reopen the economy pushed young people into work environments that got them sick. (Also, in going back to work, a rather young workforce may have had mandatory testing required by their employers, thus both finding additional new cases, but also on-average additional young cases.) Texas Governor Greg Abbott blamed reckless young people for driving the spike, but the true locus of recklessness might be the governor’s mansion.

Young people infected with COVID-19 still face extreme dangers—and present real danger to their close contacts and their community. “We see people in their 20s and 30s in our ICUs gasping for air because they have COVID-19,” James McDeavitt, the dean of clinical affairs at Baylor College of Medicine, told https://www.wsj.com/articles/corona...-west-looks-different-from-norths-11593203105 The Wall Street Journal. Young people who feel fine can still contract long-term organ damage, particularly to their lungs. They can pass the disease to more vulnerable people, who end up in the hospital; a youth surge could easily translate into a broader uptick some weeks from now.

4. Hospitalized patients are dying less frequently, even without a home-run treatment.

So far, we’ve focused on the gap between cases and deaths. But there’s another gap that deserves our attention. Hospitalizations and deaths moved up and down in tandem before June. After June, they’ve diverged. National hospitalizations are rising, but deaths aren’t. (Note also that during the mutual decline, deaths declined more steeply than hospitalizations.)

1594418345366.png

The hospitalization and death data that we have aren’t good enough or timely enough https://covidtracking.com/blog/hospitalization-data to say anything definitive. But the chart suggests some good news (finally): Patients at hospitals are dying less. Indeed, other countries have seen the same. One study from a hospital in Milan https://www.tandfonline.com/doi/full/10.1080/20477724.2020.1785782 found that from March to May, the mortality rate of its COVID-19 patients declined from 24 percent to 2 percent—"without significant changes in patients’ age.” British hospitals found that their hospital mortality rate has declined every month since April https://www.cebm.net/covid-19/declining-death-rate-from-covid-19-in-hospitals-in-england.

Also read: A Devastating New Stage of the Pandemic

So what’s going on? After millions of cases and hundreds of white papers, we now know more. For example, doctors know to prescribe the steroid dexamethasone https://www.bbc.com/news/health-53192532 to rein in out-of-control immune responses that destroy patients’ organs. (We also are now learning that HCQ is perhaps useful as an early treatment.)

5. Summer might be helping—but probably only a little bit.

The transition to summer may have stamped out other illnesses that were weakening our immune systems. People in the Northern Hemisphere may absorb more Vitamin D in the summer https://www.theatlantic.com/health/...hamblin-can-vitamin-d-stop-coronavirus/612547, which might mitigate COVID-19 mortality https://www.sciencedaily.com/releases/2020/05/200507121353.htm.

The virus might have mutated to become more contagious https://www.washingtonpost.com/science/2020/06/29/coronavirus-mutation-science/?arc404=true, but not more deadly, which might—in combination with other factors, like superior hospital treatment of the disease—exacerbate an outbreak in cases that doesn’t correspond with an increase in deaths. (From the above reference: "At least five laboratory experiments suggest that the mutation makes the virus more infectious, although only one of those studies has been peer-reviewed. That study, led by scientists at Los Alamos National Laboratory and published Thursday in the journal Cell https://www.cell.com/cell/fulltext/S0092-8674(20)30820-5, also asserts that patients with the G variant actually have more virus in their bodies, making them more likely to spread it to others.") The summer factor enters into this bullet point only in the sense that some time has gone under the bridge, and the inevitable mutations of the coronavirus (by summer) may have given us a new predominant strain that is less deadly but slightly more infectious. (Note that more infectious is an evolutionary advantage, but more deadly would be an evolutionary disadvantage since the virus ends up in dead bodies.)

Finally, as more people wear masks and move their activities outside in the summer, they might come into contact with smaller infecting doses of COVID-19. Some epidemiologists have claimed that there is a relationship https://www.cebm.net/covid-19/sars-cov-2-viral-load-and-the-severity-of-covid-19 between viral load and severity. With more masks and more outdoor interactions, it’s possible that the recent surge is partly buoyed by an increase in these low-dosage cases.

This virus is a cryptic devil. It can brutalize people’s bodies for weeks or months, even if it doesn’t kill them. It can savage the lungs of young people
, even when it doesn’t produce other symptoms. Those who are infected can transmit it to more vulnerable people.

(I'll leave the political diatribe paragraph intact, below, which is decidedly anti-Trump. I'll just caution that many governors, especially Democrat governors, have been equally deceitful and duplicitous and their bad policies had a huge role in making our US response to the coronavirus much more of a fail than it could have been with better leadership.)

When President Trump and others point exclusively to lagging death figures during a surge, they are trying to tell you that America is, secretly, winning the war on COVID-19. But we’re not. The summer surge is an exceptionally American failure, born of absent leadership and terrible public-health communication. (And I'll add, terrible failure by the CDC, especially the very-early testing fail.)

(That's the end of the article discussion, but I'll conclude by discussing my own additional point, here.)

6. Total/Daily Cases (along with stats like CFR) are meaningless, and what we should really be interested in are Total/Daily Infections, and if you were to look at Daily Infections, you might see that going sideways similarly to Daily Deaths.

This point is (in a sense) a continuation and completion of point 2(a), namely that much higher testing rates right now are having the effect of inflating the rate of discovering new cases. There is an extremely important point that the article neglects to make, and it's both a philosophical point as well as an important point for the mathematics and statistics of COVID-19. Specifically, we really don't (or at least we shouldn't (hear that, Trump?)) give a darn about numbers of Cases, but rather, we should care about numbers of Infections. An infection is person who got sick (even mildly or asymptomatically) with COVID, whereas a Case is one of those sick infectees who got counted in the total of new cases, by virtue of having taken a test, and the test came back positive. (And with regard to false positives or false negatives, yes they exist, be we won't even go there.)

Total Cases are but the tip of the iceberg of Total Infections. Perhaps more important (to see what's happening now versus back then) are the time rate of change of these statistics, such as Daily New Cases and Daily New Infections. Actually, the weekly versions are better since it provides needed smoothing. Minus the various outside effects such as those discussed in points 1-5, we could compare properly-lagged Weekly New Infections to Weekly New Deaths, and we ought to see the causal relationship there. But we're not going to see the causal relationship if we compare Weekly New Cases to Weekly New Deaths since Weekly New Cases is only the tip of the iceberg. Moreover, the portion of the (New Infections) iceberg that the (New Cases) tip represents, is continually changing over time - especially as a function of the variable amount of testing over time and the variable percent of positive tests over time. (This is the expanded version of the "can't compare apples to apples" discussion, above.)

It's as if Infections is the proper solid basis of currency for how many infections we have at any time, but Cases is the paper money that we actually use. The paper money is now (lately) devalued since it represents less (gold) Infections per Case than it used to represent when we were finding only a much smaller tip of the iceberg.

Besides the philosophical problem that we're really interested in Infections, not Cases, there are a couple more pragmatic problems. First, we don't have the right statistics we need to convert Cases (or New Cases) into Infections (or New Infections). The problem just seems too difficult at this point. But we do know that since we're finding out more Infections as formal Cases these days, that each Case represents a smaller number of (formerly) hidden Infections. So if we did try to plot Deaths versus Infections, we'd have to multiply Cases by a much larger X-factor on the left (earlier) part of the graph and a much smaller X-factor on the right side of the graph, to get Infections. This growth in recent testing would thus squash down the recent growth in Cases, perhaps almost completely. New Infections might be going more sideways than up.

The other issue is that what we really need is a multi-dimensional graph so that on the same graph we could plot all of the first 5 factors above, as well as Cases (magically converted to Infections) and Deaths. The extra dimensions would help explain why the relation between Infections and Deaths is not as trivial as one might think.
 
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BarnBurner

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How? Do you have a link to this evidence? If someone has the virus already, how does the virus clinging to the inside of their mask put them at a greater risk?

There's lots of evidence that show masks at least help decrease the chances of someone that has the virus from spreading it to others. That should be enough for people to wear them because they want to help others. It's bizarre to me.
Look up the studies. I am sure the studies won’t meet your own, very pro mask stance.
 

BarnBurner

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The feds should have done more, no doubt - but those 50 individual States are run by elected officials and not Children. Not a one of them deserves a pass because “Trump didn’t do enough.” That sounds like a 2nd grader pointing fingers. There WAS something each one of them could have done. Many failed, miserably.
Cuomo, finally, admitted it was his responsibility as governor of my to prepare for a pandemic. But first, he blamed trump over and over.
Utterly ignorant and not prepared to be a guv.
 

KillerGopherFan

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MSNBC was on at the gym this morning, and every 15 minutes they were talking about how Florida is now the epicenter of COVID after yesterday's record reporting of deaths.

Not a peep about California, one of the most heavily locked down and masked states throughout the pandemic, who had more deaths than Florida yesterday, and twice as many as Florida over the last two days. I wonder why...

Here's when Florida's deaths actually occurred from yesterday's report.

I read a story about the 120 deaths with a vague mention that some of the deaths occurred days or weeks ago. I later searched all over Google to find that comment about that high daily death number to use in response to JTF’s smarmy post cheering on the 120 dally death total. I looked at over 20 reports and couldn’t find it again. The media is totally dishonest about these facts and does everything it can to distort and instill panic. Thanks for posting the above.
 

KillerGopherFan

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Reporting is delayed. More at 11.
You said I made some “triumphant” post, when actually I was just stating a fact. Not a fact that I expected to hold true based on the trend mind you, but just a fact. You responded to the Florida 120 daily death total in what I would say was a celebratory manner b/c you thought you had something on me, even though you didn’t.

You can’t admit you were wrong, and even a little giddy, about reporting the 120 daily death total high. It was a correction and the media lied and distorted, and you fully bought into it.

When you see a one day total so dramatically different than other days, you might want to think ’data correction’, unless of course your ego prevents you from wanting to believe it.

Having said that, I don’t doubt that the trend of daily deaths will continue to increase in Florida, but I seriously doubt that they will rise at anything close to the rate of cases in Florida. And, as I said before, IF deaths don’t rise significantly after seeing cases rise so dramatically, it would suggest that new daily case totals aren’t a good measure of concern for deaths.
 

stocker08

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Man, you have a 1-track mind. I was referring to the misinformation they have sent out on multiple occasions. You do know they have had to retract multiple erroneous statements already, right?
Good thing Trump has been around to put out correct info about the coronavirus. And when he has screwed up....he has the humility to retract those statements.
 

stocker08

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Trump claimed he was going to use the defense production act, as he has the power to do, to ensure there was adequate masks and PPE. He clearly has not done so. He has done almost nothing to deal with the crises at all, except for the January travel ban.

The Federal response has been nothing short of a train-wreck and they're official policy since at least May has been "ignore it and it'll go away." It's a large reason we are where we are. 50 individual states left to figure it out on their own.
Yup. Complete and total failure by Trump and company. Add that to the lies and downplaying of the virus....which no doubt exacerbated the problem. Unfortunately the idiot has a bunch of sheep followers who can't think for themselves.
 

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On the good news front ...

Remdesivir approved as the primary treatment in Australia. In general, Remdesivir is looking good. Apparently it reduces the death rate by 60% in advanced cases.

On the vaccine front, the collaboration between Pfizer and BioEnTech is reporting some success with their Messenger RNA based approach. The drug induces (artificially) more antibodies against coronavirus than are generated in someone who actually had the disease. They expect to be able to field the vaccine by the end of the year.

There are, in total, apparently about 200 vaccine research programs underway. This incredible research effort is probably unmatched in recent times (you might have to go back to WW2's war production effort to see anything similar in scale). Now if they could only manufacture sufficient N95 masks.
 
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CutDownTheNet

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Per a segment on Tucker Carlson, a Chinese virologist named Li-Meng Yan is attempting to flee China and seek asylum in the US. She wants to spill the beans about the coronavirus and the Chinese coverup.

See Chinese virologist accuses Beijing of coronavirus cover-up, flees Hong Kong: 'I know how they treat whistleblowers' at https://www.foxnews.com/world/chinese-virologist-coronavirus-cover-up-flee-hong-kong-whistleblower.

Also, the WHO task force supposedly going to China to study the origins of coronavirus, will apparently only be allowed by China to study the zoonotic theory. They will not be investigating Wuhan Institute of Virology.
 

howeda7

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Over 71,000 cases today. The President says all is well.
 

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Here is a summary (plus a bit of augmentation by myself) of major points from the Atlantic article ...

COVID-19 Cases Are Rising, So Why Are Deaths Flatlining? by Derek Thompson.

Warning to right-leaning readers: the Atlantic leans so far left that it sometimes makes no sense anymore (and the subtitle gives you a clue of how hard-left the Atlantic is: "The gap between soaring cases and falling deaths is being weaponized by the right to claim a hollow victory in the face of shameless failure. What’s really going on?"), yet this article is actually quite good and has good references. So here we go, condensed (and then augmented) from the full article ...

Cases have soared to terrifying levels since June. Yesterday, the U.S. had 62,000 confirmed cases, an all-time high—and about five times more than the entire continent of Europe. Several U.S. states, including Arizona and Florida, currently have more confirmed cases per capita than any other country in the world. But average daily deaths are down 75 percent from their April peak. Despite higher death counts on Tuesday and Wednesday, the weekly average has largely plateaued in the past two weeks. (Note: This is confirmed by my own analysis, but where it heads from there is the question, and this article gives some hints about the factors in play.)

The gap between spiking cases and falling-then-flatlining deaths has become the latest partisan flashpoint (to the point of pitting Fauci against Trump). On Tuesday, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, warned Americans against “[taking] comfort in the lower rate of death” just hours before Trump tweeted triumphantly: “Death Rate from Coronavirus is down tenfold!” (Note: This was the dumb tweet by Trump in which, near as we can tell, he was talking about Case Fatality Rate (CFR, also known as Case Fatality Risk) that is virtually useless as a statistic unless you also go into a detailed explanation plus relevant data that can convert CFR into an estimate of IFR (Infection Fatality Rate).)

In the fog of pandemic https://www.theatlantic.com/ideas/archive/2020/03/fog-pandemic/608764, every statistic tells a story, but no one statistic tells the whole truth. What follows are five possible explanations for the case-death gap. Take them as complementary, rather than competing, theories.

(Note: I'll list these possible explanations here to get the big picture, then we'll return to a condensed discussion of each point, including a 6th point of my own.)

1. Deaths lag cases—and that might explain almost everything. (Note: I think this may be a lesser part of the explanation, although it certainly does explain why we need to wait a couple weeks to see what the next trend is. Also, 2(c) factors into this one.)

2. Expanded testing is finding (a) more cases, (b) milder cases, and (c) earlier cases.

3. The typical COVID-19 patient is getting younger.

4. Hospitalized patients are dying less frequently, even without a home-run treatment.

5. Summer might be helping—but probably only a little bit.

(Plus an additional point of my own that is not sufficiently emphasized in this article, and is an expansion on point 2(a) above.)

6. Total/Daily Cases (along with stats like CFR) are meaningless, and what we should really be interested in are Total/Daily Infections, and if you were to look at Daily Infections, you might see that going sideways similarly to Daily Deaths.

(Now let's discuss each point in turn.)

1. Deaths lag cases—and that might explain almost everything.

(But it doesn't explain everything.)

Even where deaths are rising, corresponding cases are rising notably faster.

There is a lag between a surge in cases and a surge in deaths. There can be a lag between the death and the date the death certificate is issued, and another lag before that death is reported to the state and the federal government (see post #17239). As this chart from the COVID Tracking Project shows, the official reporting of a COVID-19 death can lag COVID-19 exposure by up to a month. This suggests that the surge in deaths (due to the surge in cases) is (still) coming.

In Arizona, Florida, and Texas, the death surge is already happening. Since June 7, the seven-day average of deaths in those hot-spot states has increased 69 percent, according to the COVID Tracking Project.

View attachment 8707

2(a). Expanded testing is finding more cases.

The simplistic version, which we often hear from the president, is that cases are surging only because the number of tests is rising. That’s just wrong. Since the beginning of June, the share of COVID-19 tests that have come back positive has increased from 4.5 percent to 8 percent. Hospitalizations are skyrocketing across the South and West. Those are clear signs of an underlying outbreak. But the huge increase in testing might be tricking us with some confusing weeks of data.

In March and April, tests were scarce, and medical providers had to ration tests for the sickest patients. Now that testing bandwidth is markedly increased, we are testing a much broader cross-section of the population, and (as Trump has duly noted) we are finding additional infections (that are then tabulated as cases) beyond what we would have found in a more restricted testing regime, such as we had earlier in the pandemic. Testing has also expanded into smaller and more remote communities across the U.S., which earlier may have needed to ship their COVID sick to a larger city for treatment (and testing after the fact of symptomatic diagnosis).

2(b). Expanded testing is finding milder cases.

Due to wider and more frequent testing, the results might also be picking up milder, or even asymptomatic, cases of COVID-19. These would either have not been caught at all previously (e.g., asymptomatic) or else told by a doctor to self-treat and isolate at home (but not be formally tested, thus not appearing in the case count earlier in the pandemic).

The whole point of testing is to find cases, trace the patients’ close contacts, and isolate (and treat) the sick. But our superior testing capacity (now, versus our inferior testing capacity earlier in the pandemic) makes it difficult to do apples-to-apples comparisons with the initial surge. (See also point 6, below.)

2(c). Expanded testing is finding earlier cases.

The epidemiologist Ellie Murray has also cautioned
that identifying new fatal cases of COVID-19 earlier in the victims’ disease process could mean a longer lag between detection and death. This ties into point 1, impacting the length of delay between test results (e.g., establishment of a case that appears in the new-cases count) and reporting of deaths. This phenomenon, known as “lead time bias,” might be telling us that a big death surge is still coming.

But there are still reasons to think that any forthcoming death surge could be materially different from the one that brutalized the Northeast in March and April.

3. The typical COVID-19 patient is getting younger.

In Florida, the median age of new COVID-19 cases fell from 65 in March to 35
in June. In its latest daily report, the Florida Department of Health says the median age is still in the high 30s http://ww11.doh.state.fl.us/comm/_partners/covid19_report_archive/state_reports_latest.pdf. In Arizona, Texas, and California, young adults getting sick have been driving https://www.texastribune.org/2020/06/16/texas-coronavirus-spike-young-adults the surge https://www.wsj.com/articles/corona...-west-looks-different-from-norths-11593203105.

That would partly explain the declining death count, since young people are much less likely to die from this disease. International data from South Korea, Spain, China, and Italy suggest https://ourworldindata.org/mortality-risk-covid#case-fatality-rate-of-covid-19-by-age that the COVID-19 case-fatality rate for people older than 70 is more than 100 times greater than for those younger than 40.

Maybe older Americans are being more cautious about avoiding crowded indoor spaces. Maybe news reports of young people packing themselves into bars https://abc13.com/spire-night-club-...n-texas-covid-19-governor-greg-abbott/6278691 explain the youth spike, since indoor bars are exquisitely designed to spread the virus https://www.theatlantic.com/ideas/archive/2020/05/how-will-we-ever-be-safe-inside/611953. Or maybe state and local governments that rushed to reopen the economy pushed young people into work environments that got them sick. (Also, in going back to work, a rather young workforce may have had mandatory testing required by their employers, thus both finding additional new cases, but also on-average additional young cases.) Texas Governor Greg Abbott blamed reckless young people for driving the spike, but the true locus of recklessness might be the governor’s mansion.

Young people infected with COVID-19 still face extreme dangers—and present real danger to their close contacts and their community. “We see people in their 20s and 30s in our ICUs gasping for air because they have COVID-19,” James McDeavitt, the dean of clinical affairs at Baylor College of Medicine, told https://www.wsj.com/articles/corona...-west-looks-different-from-norths-11593203105 The Wall Street Journal. Young people who feel fine can still contract long-term organ damage, particularly to their lungs. They can pass the disease to more vulnerable people, who end up in the hospital; a youth surge could easily translate into a broader uptick some weeks from now.

4. Hospitalized patients are dying less frequently, even without a home-run treatment.

So far, we’ve focused on the gap between cases and deaths. But there’s another gap that deserves our attention. Hospitalizations and deaths moved up and down in tandem before June. After June, they’ve diverged. National hospitalizations are rising, but deaths aren’t. (Note also that during the mutual decline, deaths declined more steeply than hospitalizations.)

View attachment 8708

The hospitalization and death data that we have aren’t good enough or timely enough https://covidtracking.com/blog/hospitalization-data to say anything definitive. But the chart suggests some good news (finally): Patients at hospitals are dying less. Indeed, other countries have seen the same. One study from a hospital in Milan https://www.tandfonline.com/doi/full/10.1080/20477724.2020.1785782 found that from March to May, the mortality rate of its COVID-19 patients declined from 24 percent to 2 percent—"without significant changes in patients’ age.” British hospitals found that their hospital mortality rate has declined every month since April https://www.cebm.net/covid-19/declining-death-rate-from-covid-19-in-hospitals-in-england.

Also read: A Devastating New Stage of the Pandemic

So what’s going on? After millions of cases and hundreds of white papers, we now know more. For example, doctors know to prescribe the steroid dexamethasone https://www.bbc.com/news/health-53192532 to rein in out-of-control immune responses that destroy patients’ organs. (We also are now learning that HCQ is perhaps useful as an early treatment.)

5. Summer might be helping—but probably only a little bit.

The transition to summer may have stamped out other illnesses that were weakening our immune systems. People in the Northern Hemisphere may absorb more Vitamin D in the summer https://www.theatlantic.com/health/...hamblin-can-vitamin-d-stop-coronavirus/612547, which might mitigate COVID-19 mortality https://www.sciencedaily.com/releases/2020/05/200507121353.htm.

The virus might have mutated to become more contagious https://www.washingtonpost.com/science/2020/06/29/coronavirus-mutation-science/?arc404=true, but not more deadly, which might—in combination with other factors, like superior hospital treatment of the disease—exacerbate an outbreak in cases that doesn’t correspond with an increase in deaths. (From the above reference: "At least five laboratory experiments suggest that the mutation makes the virus more infectious, although only one of those studies has been peer-reviewed. That study, led by scientists at Los Alamos National Laboratory and published Thursday in the journal Cell https://www.cell.com/cell/fulltext/S0092-8674(20)30820-5, also asserts that patients with the G variant actually have more virus in their bodies, making them more likely to spread it to others.") The summer factor enters into this bullet point only in the sense that some time has gone under the bridge, and the inevitable mutations of the coronavirus (by summer) may have given us a new predominant strain that is less deadly but slightly more infectious. (Note that more infectious is an evolutionary advantage, but more deadly would be an evolutionary disadvantage since the virus ends up in dead bodies.)

Finally, as more people wear masks and move their activities outside in the summer, they might come into contact with smaller infecting doses of COVID-19. Some epidemiologists have claimed that there is a relationship https://www.cebm.net/covid-19/sars-cov-2-viral-load-and-the-severity-of-covid-19 between viral load and severity. With more masks and more outdoor interactions, it’s possible that the recent surge is partly buoyed by an increase in these low-dosage cases.

This virus is a cryptic devil. It can brutalize people’s bodies for weeks or months, even if it doesn’t kill them. It can savage the lungs of young people
, even when it doesn’t produce other symptoms. Those who are infected can transmit it to more vulnerable people.

(I'll leave the political diatribe paragraph intact, below, which is decidedly anti-Trump. I'll just caution that many governors, especially Democrat governors, have been equally deceitful and duplicitous and their bad policies had a huge role in making our US response to the coronavirus much more of a fail than it could have been with better leadership.)

When President Trump and others point exclusively to lagging death figures during a surge, they are trying to tell you that America is, secretly, winning the war on COVID-19. But we’re not. The summer surge is an exceptionally American failure, born of absent leadership and terrible public-health communication. (And I'll add, terrible failure by the CDC, especially the very-early testing fail.)

(That's the end of the article discussion, but I'll conclude by discussing my own additional point, here.)

6. Total/Daily Cases (along with stats like CFR) are meaningless, and what we should really be interested in are Total/Daily Infections, and if you were to look at Daily Infections, you might see that going sideways similarly to Daily Deaths.

This point is (in a sense) a continuation and completion of point 2(a), namely that much higher testing rates right now are having the effect of inflating the rate of discovering new cases. There is an extremely important point that the article neglects to make, and it's both a philosophical point as well as an important point for the mathematics and statistics of COVID-19. Specifically, we really don't (or at least we shouldn't (hear that, Trump?)) give a darn about numbers of Cases, but rather, we should care about numbers of Infections. An infection is person who got sick (even mildly or asymptomatically) with COVID, whereas a Case is one of those sick infectees who got counted in the total of new cases, by virtue of having taken a test, and the test came back positive. (And with regard to false positives or false negatives, yes they exist, be we won't even go there.)

Total Cases are but the tip of the iceberg of Total Infections. Perhaps more important (to see what's happening now versus back then) are the time rate of change of these statistics, such as Daily New Cases and Daily New Infections. Actually, the weekly versions are better since it provides needed smoothing. Minus the various outside effects such as those discussed in points 1-5, we could compare properly-lagged Weekly New Infections to Weekly New Deaths, and we ought to see the causal relationship there. But we're not going to see the causal relationship if we compare Weekly New Cases to Weekly New Deaths since Weekly New Cases is only the tip of the iceberg. Moreover, the portion of the (New Infections) iceberg that the (New Cases) tip represents, is continually changing over time - especially as a function of the variable amount of testing over time and the variable percent of positive tests over time. (This is the expanded version of the "can't compare apples to apples" discussion, above.)

It's as if Infections is the proper solid basis of currency for how many infections we have at any time, but Cases is the paper money that we actually use. The paper money is now (lately) devalued since it represents less (gold) Infections per Case than it used to represent when we were finding only a much smaller tip of the iceberg.

Besides the philosophical problem that we're really interested in Infections, not Cases, there are a couple more pragmatic problems. First, we don't have the right statistics we need to convert Cases (or New Cases) into Infections (or New Infections). The problem just seems too difficult at this point. But we do know that since we're finding out more Infections as formal Cases these days, that each Case represents a smaller number of (formerly) hidden Infections. So if we did try to plot Deaths versus Infections, we'd have to multiply Cases by a much larger X-factor on the left (earlier) part of the graph and a much smaller X-factor on the right side of the graph, to get Infections. This growth in recent testing would thus squash down the recent growth in Cases, perhaps almost completely. New Infections might be going more sideways than up.

The other issue is that what we really need is a multi-dimensional graph so that on the same graph we could plot all of the first 5 factors above, as well as Cases (magically converted to Infections) and Deaths. The extra dimensions would help explain why the relation between Infections and Deaths is not as trivial as one might think.
I really like your posts. They are long tho. I’m not complaining, just stating. For those that aren’t up for the full read, let me give my translation (NOTE: I am not speaking for CDtN, just me).

TRANSLATION: Here is a really long, convoluted, non-factual article to try and justify why the data doesn’t support the doomsday we have been preaching is coming.
 
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