Covid 10/​1: The Long Haul

Link post

If you were watch­ing the so-called ‘pres­i­den­tial de­bate’ on Tues­day night, first off, you have my sym­pa­thies. It was the day af­ter the Day of Atone­ment. If you watched, no mat­ter what wrongs you may have com­mit­ted this past year, and no mat­ter who you in­tend to vote for, no one can deny that you have atoned. Your slate is clean.

Alas, the coun­try is not so lucky. Get­ting away clean is not a near-term prospect on any level.

What did we learn from the Covid-19 por­tion of the de­bate?

Very lit­tle. The fo­cus was on Bi­den blam­ing Trump for things be­ing ter­rible, and Trump say­ing things are great and blam­ing Bi­den claiming that with Bi­den in charge things would have been worse. No one said any­thing about any of the real is­sues ex­cept for masks. On masks, Trump de­cided to dis­pute that there was agree­ment on masks, to point out that peo­ple changed their mind about masks, and so on, in case his sup­port­ers were in dan­ger of pro­tect­ing them­selves or oth­ers by wear­ing one.

Bi­den’s crit­i­cisms of Trump left out most of the worst things Trump did re­gard­ing Covid-19. Bi­den’s plans, as stated, didn’t provide the help we need to solve Covid-19. Mostly, what we learned is what we already knew. Bi­den has lit­tle in­ter­est in talk­ing about the ways to ac­tu­ally solve the prob­lem, and mostly does cor­rect sym­bolic ac­tions like sup­port­ing PPE or small busi­ness or wear­ing masks while blam­ing Trump for not do­ing so. Whereas Trump ac­tively gets in the way of solv­ing the prob­lem and lies about, well, ba­si­cally ev­ery­thing. Not where one hopes the choices to be, but hope­fully an easy choice nonethe­less.

Bi­den re­peated in the de­bate the gen­eral ex­pec­ta­tion that an­other wave of in­fec­tions and deaths is com­ing Real Soon Now, and that deaths may dou­ble over the next few months, as the rate goes up by a fac­tor of five or more. That’s the new Very Se­ri­ous Per­son po­si­tion.

Along with the old Very Se­ri­ous Per­son po­si­tion that herd im­mu­nity is of course end­ing Real Soon Now, prob­a­bly last week.

Do we see any signs of any of that? Is it jus­tified?

Let’s run the num­bers.

Pos­i­tive Test Counts

DateWESTMIDWESTSOUTHNORTHEAST
Aug 6-Aug 12930426193118848621569
Aug 13-Aug 19808876338415699820857
Aug 20-Aug 26675456654013232218707
Aug 7-Sep 2550007540112741421056
Sep 3-Sep 9472737243910640821926
Sep 10-Sep 16450507526411581223755
Sep 17-Sep 23540258538112773223342
Sep 24-Sep 30554969293210630027214

The Mid­west and North­east num­bers are very trou­bling, as things are clearly headed in the wrong di­rec­tion. The West is tread­ing wa­ter, and the South looks ex­cel­lent. Test counts are slightly up over­all.

Deaths

DateWESTMIDWESTSOUTHNORTHEAST
July 23-July 2917077004443568
July 30-Aug 518317194379365
Aug 6-Aug 1217386634554453
Aug 13-Aug 1915768504264422
Aug 20-Aug 2615037453876375
Aug 27-Sep 212457593631334
Sep 3-Sep 911417712717329
Sep 10-Sep 1611599543199373
Sep 17-Sep 2310168932695399
Sep 24-Sep 309349902619360

More signs that things in the Mid­west con­tinue to get worse, but the West and South con­tinue to re­cover. The North­east doesn’t look bad ei­ther. In to­tal, it’s the best com­bined num­ber in a long time.

Pos­i­tive Tests By Region

Per­centagesNorth­east­Mid­west­SouthWest
730 to 852.58%7.26%12.35%6.68%
86 to 8132.30%5.67%14.67%6.98%
813 to 8202.06%5.62%9.41%6.47%
820 to 8261.86%5.78%9.93%5.88%
827 to 921.87%6.37%9.38%4.78%
93 to 991.97%6.02%8.48%4.13%
910 to 9162.41%5.99%11.35%4.49%
917 to 9232.20%5.96%7.13%4.11%
924 to 9302.60%6.17%6.18%4.27%

Trou­ble slowly brew­ing across the North­east. The South con­tinues to im­prove.

Test Counts

DateUSA test­sPos­i­tive %NY test­sPos­i­tive %Cu­mu­la­tive Pos­i­tives
July 30-Aug 55,107,7397.8%484,2451.0%1.46%
Aug 6-Aug 125,121,0117.3%506,5240.9%1.58%
Aug 13-Aug 195,293,5366.2%548,4210.8%1.68%
Aug 20-Aug 264,785,0566.0%553,3690.7%1.77%
Aug 27-Sep 25,042,1135.5%611,7210.8%1.85%
Sep 3-Sep 94,850,2535.3%552,6240.9%1.93%
Sep 10-Sep 164,632,0055.8%559,4630.9%2.01%
Sep 17-Sep 235,719,3275.2%610,8020.9%2.10%
Sep 24-Sep 305,857,0975.1%618,3781.1%2.19%

New York is in (medium term, slow mov­ing) trou­ble. From what I’ve seen, a lot of it is con­cen­trated on ar­eas of Brook­lyn and Queens, es­pe­cially Ortho­dox Jewish ar­eas that ig­nored rules dur­ing the high holi­days, but it’s a big enough effect and trend that the prob­lem is clearly wide­spread. Things are in no way out of con­trol, but trends con­tinue to be nega­tive and if any­thing things are open­ing up more, so un­til the con­trol sys­tems set in lo­cally, things will get worse.

Na­tion­wide, how­ever, we have a record num­ber of tests, with the low­est pos­i­tive rate since mid-June. We have the low­est weekly death count since mid-July.

There’s no sign things are about to clear up. But there’s also no sign of this huge im­pend­ing dis­aster the me­dia are once again warn­ing us about.

Yet they con­tinue to do this. Why?

Some of it is that test­ing went down then in­creased again and they’re call­ing that ‘ris­ing case counts’ again be­cause yes we re­ally are this stupid and dys­func­tional.

You can call Don­ald Trump and var­i­ous oth­ers what­ever you like for sup­press­ing test­ing in or­der to make the num­bers look bet­ter, but the only way to stop such tac­tics is to stop be­ing fooled by them time af­ter time. I am not op­ti­mistic.

The head­line from CNN linked above (here it is again) tells us to be alarmed that 21 states have ris­ing case num­bers, while test­ing in­creases, and doesn’t think we can un­der­stand that 21 is less than half of 50.

The other half is that mod­els and those what like to be Very Se­ri­ous Peo­ple are mak­ing two as­sump­tions to force this pend­ing wave to hap­pen.

They as­sume that Win­ter Is Com­ing means things get worse. And they con­tinue to warn about im­mu­nity in all ways.

We need to push back and not leave this to the White House. They’re kind of busy, and rather short of cred­i­bil­ity. At­las dis­putes Red­field coro­n­avirus vuln­er­a­bil­ity es­ti­mate: ‘We are not all sus­cep­ti­ble to in­fec­tion’ is the White House di­rectly call­ing out the CDC, and in this case be­ing en­tirely cor­rect. The idea that ev­ery­one who doesn’t test pos­i­tive for an­ti­bod­ies is ‘sus­cep­ti­ble to in­fec­tion’ is ob­vi­ous non­sense de­signed to twist the data into knots and scare peo­ple. Unac­cept­able. Yes, the source in ques­tion of­ten lies its ass off in other ways. That only makes this all that much harder.

I Herd Some Peo­ple Had Im­mu­nity and Then Lost It, Or Never Got It To Be­gin With After Be­ing In­fected, Ex­cept With No Ac­tual Examples

Alas, an on­go­ing se­ries. Lots of spec­u­la­tion this week.

Marginal Revolu­tion links to a study point­ing out what we already know, that most coro­n­aviruses do not cre­ate lifelong im­mu­nity.

Another data point I heard a few peo­ple point to is that a pre­vi­ously hard-hit NYC neigh­bor­hood is be­ing hit again. Similar data points are cited for Euro­pean cities and such.

Thus, the Very Se­ri­ous Per­son con­sen­sus seems to be that im­mu­nity is fad­ing and re­in­fec­tions are hap­pen­ing all over the place as we speak. They just… can’t find ex­am­ples of ac­tual peo­ple that got re­in­fected, de­spite such a story con­tain­ing a large num­ber of peo­ple be­ing an ob­vi­ous way to get tons of clicks and head the na­tional news, and also scare ev­ery­one in a way that such peo­ple think is good.

What we know is, it is now Oc­to­ber. Lots of peo­ple were in­fected in March, if not sooner. Al­most no one is known to have been in­fected in March, then in Septem­ber, or any­thing like that. Which is what you would see, if im­mu­nity was fad­ing.

Similarly, we con­tinue to see peo­ple equate pos­i­tive an­ti­body tests with im­mu­nity, de­spite it be­ing rather clear that this is only one of sev­eral means of im­mu­nity. The im­mune sys­tem has a lot of tools at its dis­posal, and all that.

So once again, un­til we see lots of re­in­fec­tions of par­tic­u­lar peo­ple, all we know each day is it is an­other day be­fore se­ri­ous re­in­fec­tion chances oc­cur, and our ex­pec­ta­tion for im­mu­nity length goes up by just un­der two days be­cause of the Lindy rule – how­ever long it has lasted so far, it prob­a­bly will con­tinue to last on av­er­age about that long, then slowly fade, is a rea­son­able prior for the mean re­sult.

How do we ex­plain the data we do see?

Ob­vi­ous Non­sense Paper of the Week

On a re­lated and but differ­ent note is this pa­per that came up this week: Evolu­tion of COVID-19 cases in se­lected low- and mid­dle-in­come coun­tries: past the herd im­mu­nity peak?

It’s a text­book ex­am­ple of how deeply the SEIR folly goes. The pa­per looks at a curve of in­fec­tions, as­sumes that ev­ery­one is always iden­ti­cal in ev­ery way within the coun­try, then uses that to figure out how many peo­ple must have been in­fected in or­der to cause the re­duc­tion in in­fec­tions! That this proves most peo­ple were in­fected! Then based on that, they point out how low the in­fec­tion fatal­ity rate was!

Se­ri­ously, this is what passes for se­ri­ous mod­el­ing these days. This got into the news cy­cle.

The es­ti­mated base re­pro­duc­tion num­bers, the R0 are es­ti­mated as no more than 2. Based on that and the curve, they then claim that this means 50%-80% of peo­ple must have been in­fected. The ‘de­tec­tion rate’ for in­fec­tions is then sur­mised to go from a high of 5% in South Africa, to a low of 0.2% in Kenya. Not death rate, de­tec­tion rate.

Such ut­terly ob­vi­ous non­sense.

The num­bers are so ut­terly crazy.

Florida Says Yolo

Florida’s Gover­nor has had enough. No more re­stric­tions on busi­nesses. No en­force­ment of mask man­dates by cities. It’s time, he’s say­ing, to let pri­vate in­di­vi­d­u­als make their own choices, and what­ever hap­pens hap­pens. His ‘health ex­perts’ agree with this, be­cause if you want to find an ex­pert who agrees with a given po­si­tion, or at least is will­ing to say they agree, you can al­most always find that ex­pert.

The usual scolds and Very Se­ri­ous Peo­ple are out in force about how awful this is and that ev­ery­one in Florida should once again pre­pare to die. Things are bad af­ter all that lock­ing down, the Very Se­ri­ous Peo­ple say. Surely you can’t stop lock­ing down now!

The Gover­nor is closer to cor­rect than the Very Se­ri­ous Peo­ple.

What is the al­ter­na­tive pro­posal? To con­tinue to put our lives on hold and our econ­omy into sham­bles un­til we finish the vac­ci­na­tions?

How long a lock down be­fore it’s bet­ter to just get the damn virus already and take your chances, if your risk isn’t that high?

Lethal­ity is down. Hospi­tals be­ing over­whelmed is highly un­likely to hap­pen, given what hap­pened in the pre­vi­ous wave. We now know how to man­age our risk if we want to do so, and can make in­formed choices. Make trade-offs. It’s time to let peo­ple de­cide what they want to do, and live their lives. It’s not like ev­ery­one is go­ing to sud­denly go back to nor­mal. Some peo­ple will choose to do that. Others won’t. We’ve been over this many times.

There are two counter-ar­gu­ments.

One is that the vac­cine is com­ing Real Soon Now, but those same Very Se­ri­ous Peo­ple are say­ing that the vac­cine is at least months away plus more months for de­ploy­ment. If that’s true, then that’s too long for many peo­ple, who can make a ra­tio­nal choice not to wait. For those who do want to wait, it’s a rea­son­able amount of time to deal with a higher out­side risk level.

The other is the ex­ter­nal­ity ar­gu­ment at the heart of it all. You tak­ing on risk puts me at risk.

The ba­sic re­sponse I have here is that no, it doesn’t, not in a mean­ingful way. Not any­more, be­yond the spe­cific peo­ple you choose to have close con­tact with.

That’s be­cause there’s a solid range of risk lev­els, where risk is too high to al­low for ac­tivi­ties that in­volve sub­stan­tial ex­po­sure, but not so high as to make it im­pos­si­ble to pro­tect your­self (e.g. it’s not so dense that you’re wor­ried about things like the Man­hat­tan air hav­ing per­sis­tent mi­asma.)

If we had a prac­ti­cal path to get­ting be­low that range and sus­tain­ing that pro­cess, great, that would be worth pay­ing a big price to do. We don’t. This virus isn’t go­ing away short of a vac­cine, pe­riod.

If we were in dan­ger of ris­ing above that range, or go­ing so high we’d break the med­i­cal sys­tem, we’d have to think care­fully about what we want to do to pre­vent that. But those days are over. We ran the ex­per­i­ments. The herd im­mu­nity we have plus the con­trol sys­tems in place won’t let it get to that point.

That doesn’t mean this is a zero cost. It most cer­tainly is not. But ban­ning things doesn’t seem rea­son­able.

I do think that forcibly re­mov­ing mu­ni­ci­pal mask bans is still dou­ble­plus un­good, but busi­nesses are still free to re­quire them, and if enough peo­ple stay away from those busi­nesses that don’t re­quire them, that is what will mostly hap­pen. It’s bad, but less of a big deal than it sounds like it is.

The big mis­take is in­door din­ing. In­door din­ing is a ter­rible cost-benefit ra­tio. It’s one of the most dan­ger­ous things you can do. The ex­pe­rience is nice, but it’s in no way vi­tal. The rea­son in­door din­ing is hap­pen­ing is be­cause with­out it, the bars and restau­rants would die, with long term con­se­quences.

Go­ing for­ward, of course, if things get bad in Florida they’ll blame it on this, even if things are equally bad el­se­where. If things don’t get bad, they’ll still blame this any­way. Right or wrong, that’s how the Very Se­ri­ous Peo­ple roll.

The right an­swer, of course, is ut­terly ob­vi­ous and in front of our face, and has zero chance of hap­pen­ing. It’s to tax. Rarely is ban­ning things out­right a good idea. If we put a large tax on in­door din­ing, ideally as a func­tion of rel­a­tive safety but a fixed num­ber would do, that’s the log­i­cal ap­proach. We could do the same with other risky ac­tivi­ties. If peo­ple don’t want to pay, then it wasn’t worth do­ing. If they do pay, then it was worth it, and we can use that money to fund our other efforts.

A num­ber of other states are also in Yolo Mode. I learned this morn­ing that Mas­sachusetts is con­tin­u­ing to loosen re­stric­tions, based on a jus­tifi­ca­tion of drop­ping pos­i­tive test per­centages, de­spite ris­ing hos­pi­tal­iza­tions and ris­ing num­bers of cases. All met­rics mat­ter, but it seems clear what the re­sult will be.

The ques­tion re­mains, if we’re not will­ing to do what it takes to stop this, why should we also ruin ev­ery­thing else along the way to not stop­ping it?

Go­ing Down to Den­ver, Go­ing To Have Our­selves a Time

Den­ver is on it with two feel good sto­ries this week.

First, they were able to de­tect in­fec­tion us­ing wastew­a­ter, and con­tain it. This needs to be stan­dard pro­ce­dure, ev­ery­where.

Se­cond, Den­ver Bron­cos fill sta­dium with South Park card­board cutouts.

In Other News

CDC pulls coro­n­avirus sur­vey­ors out of Min­nesota af­ter they re­ported ha­rass­ment, racism. Our coun­try might in­deed have some prob­lems it needs to con­front. In­stead, of course, we once again ran away from sev­eral of them at once, which seems fit­ting. We don’t care enough to work through it.

The Long Haul

The great un­known is the fre­quency and sever­ity of ‘long haul’ Covid. Peo­ple, in­clud­ing many fully young and healthy peo­ple, suffer for months af­ter in­fec­tion and po­ten­tially have per­ma­nent dam­age that could sub­stan­tially lower their life satis­fac­tion. This may have hap­pened to one of my close friends (that es­sen­tially none of my read­ers would know) who was oth­er­wise healthy. I’m more afraid of the long haul prob­lem than I am of dy­ing from Covid.

All we know so far about ‘long haul’ Covid – es­ti­mated to af­fect 600,000 peo­ple in the UK es­ti­mates that 12% of those in­fected have symp­toms that last longer than 30 days. That’s a very broad defi­ni­tion of ‘long haul’ on du­ra­tion and on sever­ity, and I’m guess­ing this is a large un­der­es­ti­mate of the num­ber of ac­tual cases in the United King­dom. Even fully buy­ing what’s here, we don’t get much of a han­dle on how to as­sess our per­sonal risks and de­cide how much to care about them.

As Their Num­bers Grow, COVID-19 “Long Haulers” Stump Ex­perts is even less helpful. I don’t feel any bet­ter in­formed than be­fore from that, as to what I ac­tu­ally need to know.

I wish I had an­swers here, and en­courage those who have any rea­son­able es­ti­mates at all to share them and ex­plain their rea­son­ing. We need to figure this out.