Is it a National Crisis or a New York Crisis?

One of the big questions that I think most people have about Covid-19 is whether all of this has really been necessary?

We were told that we had to flatten the curve. If we did not do that our hospitals would be overwhelmed and hundreds of thousands might die due to lack of care.

Of course, flattening the curve does not mean any fewer people will get the virus. It just spreads out the time period over which people get infected. It also does not decrease the numbers who will naturally die from the virus. It only prevents those who would die who could have otherwise been saved with hospital intervention if those resources were not overwhelmed.

You can see this in the graph from the CovidActNow.org model for Ohio that I shared in a previous blog post in late March. The area under the green curve is the same as the pink curve. This was the model as of March 27.

These were the predicted outcomes that could be expected after 3 months according to the model at that time. Even with 3 months with a shelter in place policy it was projected there would be 7,000 to 174,000 deaths in Ohio.

Credit: CovidActNow.org, 3/27/20

As of today, Ohio has 471 deaths. 49% of deaths have been of those over age 80. 75% for those over age 70. The median age is 79.

Credit: Ohio Department of Health

Massachusetts also just released their summary data on deaths for the last two weeks by age groupings. 59% were over the age of 80. 85% over age 70.

These are actual counts rather than percentages.


Under age 40     0
40's                    1
50's                    7
60's                   17
70's                   44
80's                   56
90's                   42
100's                  1


Looking at the data, the obvious question is what is the "excess mortality" of this disease? In other words, when we put everything together how many deaths can really be said to be above and beyond what we would have expected otherwise?

The CDC has historically tracked pneumonia and flu as part of its surveillance system. In fact, this surveillance system is being used by the President's Coronavirus Task Force to monitor states and counties as they move towards opening up. They are going to rely on this surveillance system to tell them if a state or county needs to go back to stricter mitigation standards.

The surveillance system monitors visits to medical providers for flu-like symptoms as well as tracking deaths from the flu and pneumonia (P&I) as a percentage of total deaths.

This data can be very useful in answering the question of what the excess mortality is of Covid-19 when all is said and done. It is a little more difficult in getting absolute answers today because of lags in the reporting of the data.

This chart shows deaths from P&I as a percent of all deaths for the previous 5 years before the 2019/20 flu season.

Credit: CDC

You can see that 2014/15 and 2017/18 saw much higher P&I deaths than normal. However, those deaths typically spiked in weeks 1 to 10 of the year (January 1-March 15). Those spikes also usually resulted in about 11% of deaths from all causes. Deaths in a normal year usually spiked at about 7-8% of all deaths.

This is the chart of 2019/20 from the CDC. Notice that up until week 10 there was nothing out of the ordinary going on with deaths from P&I nationally. However, it exploded upwards starting about that time. That has to be the result of Covid-19. Deaths in week 14 were 12.9% of all deaths.

Credit:CDC

This would seem to suggest excess mortality is present. However, what about the fact that deaths earlier in the year were much less than other heavy flu seasons? Considering the age of most of the victims could it not be argued that had we had a tougher flu season in January-February some of those individuals might have succumbed earlier to seasonal flu?

In reviewing the CDC data I was also interested in seeing what "total deaths" have typically been over the years since these charts only compare P&I deaths as a percent of total deaths. What do we typically expect "total deaths" to be and how does that compare to what we are seeing right now?

Here is a chart that shows average "total deaths" from all causes for the last four years for weeks 9-14 according to the CDC. I have compared it to "total" deaths reported from all causes for the same period from the CDC for the current year. These are all the weeks that the CDC considers to be 100% complete for data purposes. That is data through April 3.

Total deaths from all causes is actually less this year than the average of the previous four years.

How is that possible with what we hear on the news each night?

How is that possible considering what we have done to our economy?

My guess is that some of this is due to a lag in reporting. The CDC data is incomplete even though its website claims the data is 100% complete for weeks 14 and prior as shown in this screen shot.

Credit; CDC
https://gis.cdc.gov/grasp/fluview/mortality.html

I do not believe that is true so in the chart below I have adjusted the current year deaths upwards on the assumption that we will eventually find that the CDC data is not complete right now. I adjusted deaths in week 9 upwards by 1.02x and increased the adjustment by .02x for every week until I made a 1.12x adjustment for week 14. That suggests that week 14 data is only 88% complete.

Even with this adjustment, this data does not show any excess mortality in the aggregate for this six week period in 2020 compared to the average of the previous 4 years. In total, this year is about 1,600 deaths short of the four year average.

This is not to say that this will not change. Deaths lag Covid-19 cases and we will definitely see some excess mortality in April (weeks 15-18) where we normally see lower overall death counts as the seasonal flu season has run its course. The daily death totals we have seen in April should guarantee that. In addition, total deaths usually decrease by 2,000 per week in April compared to March which should also push excess mortality totals higher.

There is also no question that we have seen excess mortality in New York City in the data already.

Here is the CDC chart for New York City. In week 14, P&I deaths made up 31.5% of all deaths according to the CDC data. Last year it was 8.6% in the same week.

Credit:CDC

For additional perspective, New York City usually averages about 1,100 deaths per week in March.

In week 13 the CDC data shows that NYC had 2,474 total deaths.

In week 14 the data shows 4,408 total deaths.

I know there are some who are questioning whether all of the Covid-19 deaths being reported are really due to the virus.

When you see total deaths running as high as four times normal in New York City there is little doubt that there is a lot of excess mortality taking place and Covid-19 is the cause.

However, the same is not evident in looking at the national numbers. That seems even more true when you consider the New York City numbers are included in the national numbers.

If the national numbers show no excess mortality over the last six weeks, even though New York City has had so much, that has to mean that deaths are actually down even more in the rest of the country compared to what we would normally expect.

I intend to closely monitor the CDC FluView surveillance website in the weeks ahead to see if it provides some further perspective on all of the questions that are out there.

We should also learn a lot from the CDC surveillance data on what occurs when some of the mitigation policies in the various states are lifted. Will we see an immediate increase in cases as the CovidActNow and other models suggest? Or will warmer weather and a lower R0 help keep the lid on the contagion?

However, looking at the data as of now I have to ask...

Is this a national crisis or is it a New York crisis?

Stay tuned.

Context Around Covid-19

Regular readers of BeeLine know I am a big believer in providing context around an issue.

As I often say, context is everything when assessing anything.

There is no subject that requires more context when assessing anything than most information you hear about Covid-19. It is almost impossible to wrap your mind around all of the numbers and economic implications.

A little context around Covid-19 that I recently have found interesting.

Over 50% of deaths in Europe are from residents of nursing homes

We often hear that Covid-19 is more deadly to those that are older. It is not just their age. It is also where they have been living. Here is a little context on that issue that shows how many deaths in major European countries have come from people living in nursing homes.

Over half of the combined deaths in these countries are from residents of nursing homes.

Credit: https://ltccovid.org/wp-content/uploads/2020/04/Mortality-associated-with-COVID-12-April-3.pdf

The two big hot spots in Europe ---57% in Spain. 53% in Italy.

Deaths in Sweden are declining even though economy was never totally shutdown

Sweden has gotten a lot of attention around the world by not closing its schools and shutting down its economy as many countries have done. Many have argued that Sweden will regret that decision. However, let's put that argument into context. 

Recent data from Sweden suggests that deaths have already peaked and are now declining in that country.

Time Series: Deaths per day
https://experience.arcgis.com/experience/09f821667ce64bf7be6f9f87457ed9aa

Sweden has about the same population as the state of Georgia in the USA. (approx. 10 million).

Here is the graph of deaths in Georgia by date. Sweden's death rate per capita is about double that of Georgia but the slopes of the graphs are remarkably similar going up, peaking and heading down on a similar timeline. 

https://dph.georgia.gov/covid-19-daily-status-report

I thought it was also interesting to see the age distribution of deaths in Sweden.

23% of all deaths in Sweden have been from people age 90 or older.

64% of deaths have been age 80 or older.

Deaths from those under age 50 almost do not show up on the graph.

Deaths per age group
https://experience.arcgis.com/experience/09f821667ce64bf7be6f9f87457ed9aa

For context, here is the most recent data from Florida. Note that the age distribution of deaths in Florida is very similar to Sweden.

Also of note is the fact that Florida's deaths per capita are 1/4 of that in Sweden. Recall that Governor DeSantis was heavily criticized for not instituting a stay-at-home order for the entire state until April 1. That was at least two weeks after most other major states took that action.

Credit: https://twitter.com/AlexBerenson/status/1250888639418163205

Unemployment claims in the last month almost equal to all job gains over the last decade

An additional 5.2 million unemployment claims were filed for last week in the United States. 22 million people have now filed for unemployment in the last four weeks.

Let's put that in context.

That is about the same number of jobs that have been created in the last 10 years in the United States.

In other words, what it took a decade to create has been demolished in one month.

Credit: ZeroHedge

 Effects of Economic Impacts of Covid-19 by Age

Everyone has been affected by the economic effects of Covid-19. However, this survey by Data for Progress shows that younger voters have been hit especially hard. 33% of all voters say they have lost their job, been placed on leave or had their work hours cut. However, 52% of those under age 45 have been affected in this way. It is only 26% for those age 45 or older.

How much time would it take to test everyone in the USA for Covid-19?

Some are saying that the United States should not open the economy until everyone can be tested for Covid-19. 

How long would that take?

Let's look at some numbers assuming one test is administered every second of the day, 24 hours a day, 7 days a week until everyone has gotten tested.

1 test per minute

60 tests in one minute

3,600 tests in one hour

86,400 tests in one day

2,592,000 tests in one month

31,536,000 tests in one year

There are an estimated 328 million people in the United States.

At one test per second it would take over 10 years to test everyone in the United States.

Can we wait 10 years to open up the country? 

Even at 10 tests per second it would take one year. That would mean conducting 864,000 tests per day. That is over 5 times that number we are doing per day right now.

These numbers also provide context on the incredible progress in testing in the United States over the last month.

Tests administered as of 4/16    3,401,064 

Tests administered as of 3/16         42,286

People are really staying at home

Why have oil prices gone into free fall? All cruise ships are sitting idle. Air travel is down 96% from last year. Miles driven by personal vehicles since February 2 looks like this.

 Things are not quite as bad as you might think if you own stocks

Most people don't even want to look at their stock values or 401(k) balances with all the bad news they hear each day about the economy.

One thing we all should be thankful for is that this Covid-19 crisis did not occur in 2008/2009. We had some margin to provide some cushion for the economic shock. That also applies to the employment numbers.

A few pieces of good news that most people are not aware of.

NASDAQ stock average is actually higher today than it was 6 months ago.

S&P 500 is higher than it was on June 3 of last year.

These factoids would normally be good cocktail conversation to share with friends this weekend.

Not this weekend.

I guess your best option is to forward this information to a friend. 

Stay safe.

Life and Death

I take a lot of what any politician says with a huge grain of salt. I know much of what they say is merely for public consumption and is generally heavily laden with political correctness.

I would like to think that much of what they say, they could not possibly believe. For that reason, I ignore most of the pablum, pontifications and platitudes that are uttered by politicians.

However, occasionally I hear something cross the lips of a politician that is just so beyond the pale that I simply can't ignore it.

Credit: Forbes.com

Such was the case with Governor Andrew Cuomo a few weeks ago when he said this about the actions that he was taking to shutdown almost all business in the state and instituting a "stay-at-home" order for all but essential reasons.

“I want to be able to say to the people of New York — I did everything we could do,” Cuomo told reporters at the state Capitol. “And if everything we do saves just one life, I’ll be happy.”

Seriously?

He is saying that all the job losses, economic misery and personal sacrifices being sustained by 19.9 million New Yorkers would be worth it even if it only saved just one life?

What do we know about that cost in New York?

In just three weeks 800,000 workers have filed for unemployment in New York. 17 million have filed for unemployment over the same period nationally.

Those numbers undoubtedly will grow much higher. New York reports that it received 1.7 million calls and had 2.3 million visits to the state's unemployment department in one week's time.

Many more unemployment claims can be expected for the simple reason that many who have lost their jobs cannot get through to even file for their benefits.

As of the end of last week, New York had seen 3,565 deaths from Covid-19 at the same point 800,000 people had lost their jobs. Deaths a week later were approaching 10,000. Unemployment claims will more assuredly go over 1,000,000 when we get the numbers for last week.

1,000,000 lost jobs to save just one life? I am sorry Governor Cuomo, that makes no sense.

1,000,000 lost jobs to save 10,000 lives? Perhaps.

Then again, perhaps not.

Life and death decisions must be balanced every day in our society.

Those decisions often have to factor in economic costs.

One example is the speed limit we establish on various roads. Permitting higher speeds on a roadway allows for more throughput on the road. It makes use of the road more cost effective in economic terms.

However, allowing higher speeds also leads to more deaths.

We could set the speed limit on interstates to 45 mph and reduce auto accidents and deaths. Setting the speed limit at 90 mph would probably result in more deaths. A decision is made to balance life and death in establishing that speed limit.

For example, here is the headline from Consumer Reports that argues that the 55 mph national speed limit should not have been abolished in 1995 because the higher speed limits have led to an additional 37,000 deaths.

Judgments are always being made between acceptable fatalities and economic costs.

Auto vehicles are much safer today than they used to be but they could be made much safer. If the only objective was to save lives you could build each car like a tank. However, it would cost much more, it would get 2 mpg and its weight would destroy our roads in the process.

Airplanes generally have redundant systems on a lot of the key components should there be a mechanical failure. However, we don't engineer three and four back-ups. That may lead to result in more deaths if there is a systems failure but it is not deemed worth the economic cost to do it.

Decisions by leaders balancing life and death are seen most visibly in times of war. These decisions go beyond mere economic trade-offs. They may involve the very future of the society at large.

Over 600,000 Americans died during the Civil War because Abraham Lincoln believed that the United States had to be preserved as a union. That was a great cost to our country that at that time had a population of 31 million---less than one-tenth of our population today. Stop and imagine 6 million deaths today to understand the true nature of that cost.

Dwight Eisenhower was told shortly before the D-Day invasion that casualties among the 18,000 paratroopers that would parachute over Normandy on June 6, 1944 would be as high as 75%. In addition, 90% of glider pilots would be lost before they ever hit the ground. Ike said that making the decision to proceed with the planned invasion after being given that casualty estimate was the most difficult he had to make during the entire war.

However, Eisenhower also knew that if the Allies were not able to successfully invade France, there was little chance that Germany could be defeated. In the end, Eisenhower had to accept the risk of death to his men balanced against the lives of so many, many more.

The projections of the experts proved wrong. Or as Eisenhower later told the story, "the airborne boys did their jobs."

Casualties only ended up being 8% for the paratroopers that day. That was still almost 1,500 men. However, in the three months it took after D-Day to get the Germans to retreat beyond the Seine River, the United States sustained 125,000 casualties with another 83,000 from British, Canadian and Polish ground forces. Total deaths numbered 37,000 Allied for ground forces and another 17,000 among Allied air forces.

President Trump has stated that the timing of the decision to reopen the United States economy will be the toughest decision of his life. That is saying something considering that he already made the decision to shut down the largest economy in the world during a time when it was performing at one of the highest levels in history.

A popular narrative is that Donald Trump became President primarily to enrich himself. The argument is that almost every decision he makes is in order to  benefit himself personally. Step back and consider that in the context of his decision to shut down the economy.

Trump's wealth is almost entirely tied to hotels, hospitality and entertainment. His decision as President probably impacted this sector of the economy more than any other. His decision was completely counter to his personal interests.

Trump also signed the CARES Act into law that provides $500 billion in federal loans and other relief for the airline, hotel, hospitality, entertainment and other industries that have been significantly impacted by the Covid-19 economic shutdown.

However, that law specifically prohibits President Trump and other federal officials from any aid money. Make no mistake, others are mentioned but that provision was specifically targeted at Donald J. Trump.

"The president, vice president, members of the Cabinet and members of Congress are barred from benefiting from the money carved out for corporations. That also extends to the "spouse, child, son-in-law or daughter-in-law."

I personally think this is unfair. Trump and the others should be treated, no better, or worse, than anyone else that is similarly situated. However, that is the reality of the politics. Trump fully understands the game.

Keep all of this in mind as you hear that Trump is in this totally for himself.

Trump is the only President in my lifetime that will undoubtedly have less wealth when he leaves office than when he entered. Contrast that with Obama, Clinton and others who enriched themselves by tens of millions of dollars when they left office. For that matter, compare Trump with Joe Biden after he left the Vice Presidency.

There is no doubt that Obama and Clinton never had to make any decisions balancing life and death anywhere close to what President Trump has been confronted with. In fact, only Lincoln, FDR (and Truman) have faced anything similar.

Is the loss of one life difficult to take?

Yes. However, it is never that simple. Invariably we have to balance life within the context of a society that needs to be preserved and sustained for today and tomorrow.

There are no easy answers involving life and death.

Lincoln understood it. Eisenhower, FDR and Truman did as well.

I hope Andrew Cuomo really doesn't believe that everything being done would be worth it even if it saved just one life. That doesn't give much consideration or respect to a whole bunch of other lives.

May God grant President Trump, our governors and our other leaders the wisdom and discernment at this time in our history to balance life and death in their decisions as well as any human being can be expected to in these trying times.

Two-Faced Fauci?

I have generally been supportive of Dr. Anthony Fauci who is considered the nation's top infectious disease expert.

He comes across as someone who doesn't mince words and is a pretty straight shooter.

However, I must also admit that I have seen some things that have troubled me when it comes to Dr. Fauci during the Covid-19 crisis.

First, Fauci has had the top job regarding infectious diseases at the National Institute of Health since 1984---36 years.

As people begin to ask whether we should have been better prepared wouldn't the first person that should be questioned regarding that lack of preparation be Dr. Fauci?

Yes, I know he is only a bureaucrat and he doesn't control funding and the like. However, politicians have one million issues (and especially Presidents) on their plates. Fauci had responsibility that included one very big issue---our response to a pandemic. Did he use his platform and his influence effectively to insure we were prepared?

Fauci also seems to have been going out of his way to defend the World Health Organization and China in their responses to the Covid-19 crisis.

Again, I understand that Fauci must have a lot of friends in the WHO and with infectious disease experts in China. However, it would seem to be better to say nothing than defend the actions of the WHO and China in all of this.

China clearly did not share the seriousness of the outbreak with the rest of the world in a timely fashion that might have allowed the virus to be contained. It did not share the RNA sequence of the virus for nearly two months after it first appeared. That information was critical in order to develop test kits. As cases around the globe increase, the cases and numbers that the Chinese have published also look more and more suspect.

The WHO seems to have been complicit in the Chinese cover-up in that as late as mid-January it was still stating that there was "no clear evidence that virus was being transmitted by human-to-human contact." Further, the WHO criticized Trump's China travel restriction claiming that it "would not help."

I also have a hard time in understanding how Dr. Fauci can stand up at those press conferences and say that his sole focus is on health recommendations to the President. He is being charged with overseeing the public health of the United States. Yes, that includes the nation's short term response to the virus. However, how do public health concerns also not extend to the longer term implications of the economic shutdown. He says he is not an economist. In my view, it is not enough for him to say that it is not his concern. There is a public health component in that as well that he should be considering and weighing in his recommendations.

I really came to question Dr. Fauci this weekend when he was interviewed by Jake Tapper on CNN's State of the Union and Fauci intimated that he and other public health officials had advised President Trump to shutdown the country in the third week of February.

Of course, this exchange led to this salacious headline. I guess we could have shutdown the country for the entire year of 2020 and the numbers would be even better.

I don't know what Fauci might have advised President Trump between February 15 and February 22.

However, I do know what Dr. Fauci was telling the rest of the country in February at the same time.

Before I get to that, let me give you some context on what the confirmed cases from Covid-19 were in the United States the third week of February when Fauci was interviewed by USA Today.

Confirmed Cases (2/21/20)  34 cases  (21 cases from abroad, 13 cases from within the U.S.)

This is what Fauci told USA Today on February 17 when asked how worried Americans should be about coronavirus.

Could Fauci be that two-faced that he told the President to shut the country down at the same time he was telling everyone else that "the risk is really relatively low'?

Q. Bottom line, how worried should people in America be?

A. The risk of coronavirus in this country is still relatively low, but, as I said about the possibility of emerging into a pandemic, this could change. As of today, on the 17th of February, the risk is really relatively low. But we, the public health officials, have to take this seriously enough to be prepared for it changing and there being a pandemic.

In the same interview Fauci spoke of China's efforts to contain the virus that included locking down 50 million people. USA Today asked the obvious question regarding the United States.

Q. That would never happen here, would it? Locking down 50 million people?

A. No, not a chance. It would never happen.

I guess you could argue he was right. We only have  250 million people under lockdown in America right now.

Again, I ask the question---if Fauci had advised the President to shutdown the country in mid-February, why would he be saying this to the public at the same time?

Fauci was either not truthful in the interview or he was not being truthful with Jake Tapper this weekend.

It does not end there.

Dr. Fauci was on the Today Show on February 29 where he was asked whether Americans needed to stop anything they were doing in their daily lives? He was specifically asked whether people should stop going to the mall, the movies or the gym? Fauci stated that there was no need for Americans to change anything in their day-to day lives at that moment. However, he also admitted that may have to change.

You can see the video here.

The reality is that it would have also been very hard for Fauci, the President, or anyone else to convince the American people to take the dramatic actions we under right now at a time with 34 confirmed cases among 330 million people.

Did Fauci really tell the President something different a week or two before?

It is hard to believe that Fauci was pounding on President Trump's desk telling him to "shut it down" when we see what he was telling everyone else.

I am not going to call Fauci two-faced because I don't think he did that in the Oval Office.

In fact, at today's press conference Fauci confirmed that he never made a recommendation to the President that was not acted on. Not once.

What this looks like to me is another life-long government bureaucrat trying to cover his rear end as the advice and the expert opinions he shared look increasingly suspect.

As this crisis passes and people look for those to cast blame, I believe that the public health bureaucrats should be first on the list. As I stated above, President Trump and the various Governors have a million issues to be concerned with. Whether we have enough test kits and ventilators in reserve to deal with a pandemic is not going to be very high on that list.

In my view, the CDC's role in all of this has been absolutely atrocious. It completely botched getting test kits out early. It also vastly slowed down the process early on by insisting that all test kits had to be processed at the CDC lab in Atlanta. This left state public health labs completely out of the loop. As a result, precious time was lost in reacting to the virus.

President Trump finally lost patience and brought in the private sector and took control of testing away from the CDC. You may have noticed that CDC experts have rarely been present at Trump press conferences.

It should not be lost in all on this what I wrote about the failures of the CDC in responding to Ebola back in 2014. As a result, I can't say any of this was a surprise to me.

One of the interesting things I found in researching that blog post was that the CDC had spent $3 billion in its Prevention and Public Health Fund over the previous five years. However,  three times as much money was spent on community transformation grants (healthy foods, inner city grocery stories, bike lanes and street lighting) as was spent on programs protecting, detecting and responding to infectious diseases and other public health threats. 

How did bike lanes and street lighting become more important to the CDC than pandemic preparation efforts?

What more do you have to know about the priorities of the Centers for Disease Control and Prevention and the bureaucrats who are in charge?


The deep state seems to be just as deep in the public health bureaucracy in our government as anything else.

What If It Has Been Here Since November?

What if the first case of Covid-19 did not appear in the United States in January?

What if it had actually first start infecting people in late November/early December of last year?

What if we are really in what might be considered a second wave of the virus?

What if there is much more herd immunity in the population than we realize?

What if, as a result, we could get back to normal much sooner than most would expect?

These are questions that an increasing number of people are asking.

Those questions are also supported by an increasing amount of data.

Researchers at Stanford have started conducting anti-body tests of 3,200 people in the San Francisco Bay Area to attempt to answer some of those questions. The results of their research will not be available for several weeks but many are interested in their findings.

Their work might shed some light on also answering the question as to why California has seen much lower confirmed cases and deaths from Covid-19 than New York despite its much larger population.

New York (as of April 11, 2020)

Population  19.5 million

Confirmed Cases  180,458  (9,254 per million)

Deaths  8,627  (442 per million)

California (as of April 11, 2020

Population  39.9 million

Confirmed Cases  20,615 (517 per million)

Deaths  609  (15 per million)

The differences in these numbers are astounding. On a per capita basis New York has 18x more cases and 29x more deaths than California.

It is even more incredible when it is considered that California sees much more travel from China (the origin of the virus) than New York.

Could President Trump's early travel ban from China, compared to the later shutdown of flights from Europe, have had that much effect? Could the fact that California started its shelter-in-place order two days before New York made that much difference?

Or is this all a result of the virus invading California much earlier? Could the virus have been slowly infecting people for several months before anyone knew it? Could this then allowed for a certain amount of herd immunity to develop in the community as a result?

We now know that the Chinese were aware of the virus as early as mid-November, 2019. However, China did not release the RNA sequence required to develop a test until January 12, 2020---nearly two months later.

It is important to remember that there was no test to specifically identify Covid-19 in the United States until mid-January, 2020. It is thought that the first case in the United States occurred on January 20 from someone who had recently travelled from Wuhan, China.

However, what if the virus had been present in the United States without anyone knowing it simply because there was no test to identify it?  The reality is that this could have been the case for up to two months before the test was developed

We do know that there were a large number of people in the United States who sought medical attention with flu-like illness beginning in early December.

This is the CDC chart on the percentage of visits made for Influenza-like illnesses for the current flu season compared to other years. Note the tremendous increase in visits in late November/early December.

Credit: https://www.cdc.gov/flu/weekly/index.htm

We also know that a large portion of these people tested negative for the flu. Could a significant number of them have had Covid-19?

The chart below shows that dramatic increase in flu-like cases nationally beginning around December 1 compared to the two previous years without a corresponding positive test for the flu. This chart subtracts positive tests for the flu from the ILI visits.

In fact, it shows that in the week of December 30 there were over twice as many such cases of flu-like illnesses (without a confirming test) as had been seen in the previous two years.

In fact, there were an additional 120,000 such cases in the month of December alone compared to the two previous years. Coincidentally, this about the same number of Covid-19 cases that were confirmed in the United States between February 28 and March 28.

It also stands to reason that a large percentage of these cases were on the West Coast because of the large amount of air traffic between China and cities like Los Angeles, San Francisco and Seattle.

A.J. Kay developed the chart above and wrote an article on this subject entitled "The Curve Is Already Flat"  and explains it this way.

The number of positive seasonal flu tests is relatively small in comparison to total ILI visits. That is, most cases of ILI visits in any given year remain unexplained by the flu. However, this year was unique in both the sheer volume of unexplained ILI visits and the early date that the surge of visits began.

Even 2017–18, the most deadly flu season in four decades, did not produce either the volume or the extended duration of ILI visits that year that we have seen over the past 6 months.

Subtracting the weekly positive seasonal flu tests from the total number of ILI visits for each year reveals that in late 2019, tens of thousands of Americans per week were complaining of a mysterious, unidentified illness that acts enough like the flu to be included in flu surveillance data.

Kay is one who believes that many more have been infected by the virus than we know and that herd immunity is a factor in California's lower infection rates and deaths.

Recent tests in Germany of people in the city at the epicenter of the epidemic in that country suggest that as many as 15 per cent may already have immunity – three times as many as previous estimates.

This was cited as a reason that the lockdown may be lifted sooner than expected in that country.

That higher infection rate also suggests that the death rate from the virus is five times lower (.37%) than previously thought.

One of the more interesting stories that I saw on this subject last week was about a study in Massachusetts that had analyzed wastewater at a treatment plant for a large metropolitan city in the state and found evidence of higher levels of the virus in the population than is being reported.

Earlier this week, researchers at the lab in Somerfield announced initial findings from an unidentified "large metropolitan area" in Massachusetts, over a week in late March, indicating the spread of COVID-19 may be exponentially higher than has been reported.

Based on wastewater data, Biobot gave an estimate of anywhere from 2,300 to over 115,000 infected persons within the area sampled, though only 446 cases in the area had been reported. While the estimate had a very wide range, it was the discovery that there were likely many more infected people than revealed by numbers based on COVID-19 clinical testing alone that set off alarms.

 Why is this important?

The more people who have been infected (and recovered or had the virus but never knew it) the less chance that the virus can be passed on to others. This is referred to as "herd immunity".

Credit: https://www.slideshare.net/singh_br1762/r0-value-herd-immunity

The R0 is what public health experts refer to as the contagiousness of the disease. The higher the R0 the more likely it is to be passed to someone. The seasonal flu has an R0 of about 1.5. It is thought that Covid-19 is in the 2.0 to 3.0 range. This is the number of other people the average infected person will transmit the disease to others.

Compare the R0 on various diseases and you will see that Covid-19, while more contagious than seasonal flu, is less infectious than a host of other diseases that have plagued mankind through the years.

These are the R0 values for diseases on a population that has not been previously exposed to the disease.

Credit: https://www.slideshare.net/singh_br1762/r0-value-herd-immunity

However, the R0 decreases as more and more people establish immunity.

If 50%-60% of people in a population have immunity to a disease with an R0 of 2-3, it will be eradicated. It will have no way to continue to duplicate.

Therefore, it also follows that if we find that more people have been exposed to the virus that also means that there is less chance it can continue to spread.

This is why if we find Covid-19 has been around since November, rather than January, it will be a significant finding.

If studies show that many more people have been exposed to Covid-19 than is now believed this could also be an important factor in deciding when to open up the economy.

I have no doubt that President Trump will be pushing his public health experts for this data as the decision on opening the economy looms in the coming days and weeks.

How Much Will The Models Cost?

I have written before that there has never been a time in the history of mankind where more has been wagered on the output of a model than we are seeing right now.

Large sums of money, and the lives of many people, have been put on the line many times throughout history. Most of those instances involved going to war with an enemy that was known and a threat that was real and very well understood.

There is no question that Covid-19 is a threat. However, there is so much we don't know and understand about the disease. Even today we still don't understand the real nature of the threat. We don't know enough about its transmission. We don't know how many people have actually been infected. As a result, we don't really know how lethal it is.

For example, research in the last few days is starting to suggest that the use of ventilators may actually be doing more harm to Covid-19 patients than good.

In the last 3–5 days, a mountain of anecdotal evidence has come out of NYC, Italy, Spain, etc. about COVID-19 and characteristics of patients who get seriously ill. It’s not only piling up but now leading to a general field-level consensus backed up by a few previously little-known studies that we’ve had it all wrong the whole time.

There is no ‘pneumonia’ nor ARDS. At least not the ARDS with established treatment protocols and procedures we’re familiar with. Ventilators are not only the wrong solution, but high pressure intubation can actually wind up causing more damage than without, not to mention complications from tracheal scarring and ulcers given the duration of intubation often required… They may still have a use in the immediate future for patients too far to bring back with this newfound knowledge, but moving forward a new treatment protocol needs to be established so we stop treating patients for the wrong disease.

The past 48 hours or so have seen a huge revelation: COVID-19 causes prolonged and progressive hypoxia (starving your body of oxygen) by binding to the heme groups in hemoglobin in your red blood cells.

People are simply desaturating (losing o2 in their blood), and that’s what eventually leads to organ failures that kill them, not any form of ARDS or pneumonia. 

If true, that is quite a revelation in that all of the models have used ventilators as one of the key resource restraints we would have to have to treat the disease.

It is also where tremendous sums of money have been spent by hospitals, state governments and the federal government to make sure we have enough ventilators that cost from $25,000-$50,000 each.

In fact, the federal government currently has contracts with various manufacturers for the production of tens of thousands of additional ventilators.

Let's look at what the models were telling us a week ago and compare it to where we are today.

The IHME model seems to have had the most influence on government policy makers.

This is what that model predicted exactly one week ago as to the hospital resources that would be required today (April 9) in New York.

76,130 hospital beds needed.

11,782 ICU beds required.

9,427 ventilators would be necessary.

Keep in mind that this was not a model from one month ago. It was a model that was projected needs one week ago on April 2.

What are the actual numbers reported today by New York State?

18,279 Hospital beds in use. (24% of what the model projected)

4,925 ICU beds in use. (42% of the model)

Ventilators being used. (No numbers released but ICU is only about half of what ventilator projection was for this date)

What about my home state of Ohio?

This is the projection of hospital resource utilization in Ohio in the IHME model for today from one week ago.

4,892 hospital beds needed.

878 ICU beds.

703 ventilators.

What are the actual numbers reported on April 9?

1,612 Hospitalizations (33% of actual)

 497 in ICU (57% of actual)

No numbers provided on ventilators being used. However, the numbers in ICU are just over 2/3 of the number of ventilators that were projected to be required.

If you want to get an idea of how faulty the models and the logic that surrounds the reaction to the virus in Ohio is, consider this slide that Governor Mike Dewine recently used to show the success of the stay at home order and other mitigation efforts. (Hat tip to @AlexBerenson for pointing this out.)

Notice how this model shows a peak of 62,000 new cases if no mitigation efforts were undertaken.

However, also notice that the model shows a peak date of March 22.

When did the stay-at-home order in Ohio become effective? March 23. That is one day after the supposed peak according to the model.

Granted, Dewine closed the schools, bars and restaurants effective March 16. However, the fact is that it generally takes 5-7 days from the time someone is infected until symptoms manifest. Most cases showing up on March 22-23 would have resulted from people picking up the virus before most mitigation efforts had been implemented.

It should be noted that Dewine also banned any mass gatherings of 100+ on March 12. That could be responsible for the drop in cases from the original model. Do these numbers also suggest that this mitigation approach might have the greatest benefit at the least cost? It is worth considering. Was it really necessary to do everything else that was done?

How many confirmed cases were there in Ohio on March 23?

2,023 TOTAL CASES. That is not a daily count as shown in the graph. Those are all the cases.

The actual daily count of new cases on that date was 146.

That is the count the Ohio Department of Health is using today (April 9, 2020).

On March 23, this is what they were reporting at the time the stay-at-home order went into effect. The numbers have been revised upwards since that time.

Credit: https://www.wyso.org/post/coronavirus-ohio-live-coverage

Let's recap.

The model that Ohio used to justify the stay-at-home order projected 62,000 new cases on March 22 the day before the stay-at-home order was implemented.

The actual number of new cases on that day were 146 and almost all of those new cases involved infections that had to be received before any mitigation efforts went into effect.

146 out of 62,000 is .24%.

That means the model was off by 99.76% compared to actual results.

Below is Governor Dewine on Twitter extolling the great success of the mitigation efforts in Ohio compared to the original model.

For additional context, it was just over 10 days ago that Ohio's model was suggesting that we would see 10,000 new cases per day at the peak of the crisis in mid-May with full mitigation efforts in place. It was at that point I lost all confidence in the models Ohio or anyone else was using. I wrote in detail about my skepticism about the models being used in Ohio and elsewhere on March 29. I predicted that they would be proven wrong.

In other words, Dewine is taking credit for mitigation efforts for reducing cases in which a model had predicted would occur before almost anything was actually done!

That is quite a feat.

Let's be clear. I am not suggesting that the mitigation efforts have not been effective. They clearly have been. As stated, the ban on mass gatherings might be proven in the end to have produced the greatest bang for the buck. There is no doubt that fewer cases and fewer deaths have resulted from all of this social distancing.

If you doubt that take a look at this chart from HealthWeather.US which tracks readings from smart thermometers around the country and allows for the surveillance of fever-based seasonal illnesses such as influenza and Covid-19 in the United States.

This chart shows these illnesses were following a typical seasonal path until the beginning of March when we began to see atypical experience. That is when Covid-19  started to take hold in the country. The variance reached a peak on March 16 with about 5.1% of the population showing signs of illness compared to an expected 4.2%. Interestingly, this is also the exact time that many states started social distancing rules.

Credit; HealthWeather.US

You can see what happened next. Fever-related illnesses went into free fall. At this point, we have succeeded in almost completely wiping out all fever-based illnesses in the country. We are currently at 0.42% compared to an expected 2.66%!

However, the question in all of this is what are we supposed to compare these models to?

You can readily see that the model Ohio was relying on was flawed.

You can see the the IHME model was flawed.

We have seen success but at what cost?

Do the benefits outweigh the costs?

We are likely to see many more politicians and public heath experts bringing out the models and showing us what a great job they did as the Covid-19 crisis winds down.

Will those results be justified by the economic costs that have been incurred?

That question is likely to be with us for a very, very long time.

It practically begs for someone to create another model to help us determine the answer. 😀

Blinded By Their Bias

One of the more interesting things that I have observed during the Covid-19 crisis is how much it has revealed the true tendencies of the liberal left and mainstream media.

A common narrative from both is that Donald J.Trump is a fascist, authoritarian, autocratic leader who does not care about individual rights or civil liberties. They say he believes he is above the law and is only interested in consolidating and extending his power over the nation.

Here is a headline from an article that follows this theme.

However, what are we seeing with our own eyes during the Covid-19 crisis?

President Trump is governing with guidelines, recommendations and working to facilitate public/private sector solutions to the crisis. He has closely followed the guidance has has received from public health experts. There have been no orders, directives or a declaration of martial law for Trump to wield authoritarian power.

Trump has deferred to the nation's Governors to fashion customized responses to individual state needs and has supported them with national resources when needed. He has been very judicious in using the Defense Production Act that would make private businesses an arm of the federal government.

Of course, the same people who have been calling Trump an authoritarian, power-hungry fascist are now questioning Trump as to why he has not ordered all Governors to shut down their states and why he is not using the Defense Production Act to force all industries to do his bidding.

The fact that Trump is following the Constitution in all that he is doing seems to be lost on these people. As President, he is being very careful to not trample on state's rights or individual liberties to the greatest extent possible in this crisis. It is the exact opposite of what a power hungry authoritarian would do.

It should also be noted that we find the most authoritarian and autocratic responses to the crisis in cities and states governed by liberal Democrats. To be fair, we have also seen this behavior by Republican governors in blue states as well.

For example, Los Angeles Mayor Eric Garcetti is encouraging people to report businesses and others who are violating his stay-at-home order. He is even offering a reward for those who do so.

“You know the old expression about snitches—well, in this cases, snitches get rewards,” he said. “we want to thank you for turning folks in and making sure we are all safe.”

Garcetti also threatened to cut off the power and water to any non-essential business that continued to operate in violation of his order.

A lone paddleboarder was arrested in California for violating Governor Gavin Newsome's statewide stay-at-home order. The man faces a jail term of six months or $1,000 fine, or both, if convicted of the charge.

In Vermont, Republican Governor Phil Scott has ordered that all big box stores like Walmart, Target and Costco must stop the sale of nonessential items in the store even if they are allowed to be open to sell "essential" items.

These stores are supposed to take nonessential items off of the shelves or block customers from the aisles that have these items even as the store is open.

One of the nonessential categories is home and garden items. Therefore, you can go into the store to buy lettuce or carrots but you would not be able to buy the seeds to plant your own garden this spring. You also would be prohibited from buying a fishing rod at Walmart if you wanted to fish for your dinner rather than make another trip to the grocery store. How much sense does this make?

Trump is a "full-on authoritarian"? Compare his actions to some of the examples above.

How often do we also hear those on the liberal left decry economic injustice and privilege?

Who is being hurt the most from what we are going through?

I can assure you it is not the political class, public sector employees or limousine liberals.

Those being hurt the most are those that liberal Democrats claim are the people they want to help the most.

The people that are most vulnerable to what is going on with Covid-19 are lower and middle class workers who don't have the luxury of being able to work from home. They are in the front lines at work or have lost their jobs. They most assuredly are not "sheltered at home" in any shape or form.

The coronavirus is spreading a dangerous strain of inequality. Better-off Americans are still getting paid and are free to work from home, while the poor are either forced to risk going out to work or lose their jobs.

This chart shows how large the impact is on those as you go down the income ladder.

Credit: https://www.axios.com/axios-ipsos-coronavirus-index-rich-sheltered-poor-shafted-9e592100-b8e6-4dcd-aee0-a6516892874b.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosam&stream=top

Who is the one who talks most about getting America back to work?

Why is President Trump castigated and ridiculed by the Left and mainstream media for wanting to get Americans back to work?

And considering the reality of the numbers in that chart, why did the Governors in Virginia and Maryland institute stay-at-home orders until June 10 hours after President Trump extended his guidelines until April 30?

This is nothing compared to what former Obama health advisor Zeke Emanuel said on MSNBC. By the way, Emanuel is also said to be Biden's top health advisor on his campaign.

12-18 months? Will there be a United States of America left by then if this was the policy put into place?

Below is another interesting chart I came across recently on Twitter. It was prepared by The New York Times and it uses cellphone data to assess which counties across the nation had the most travel last week compared to normal.

Credit: https://twitter.com/WLNSAlexSims/status/1246479343087497217

I thought it was an encouraging chart in that it showed just how effective social distancing and the stay-at-home orders have been. This is readily apparent in looking at the northeast part of the country and states like Ohio, Michigan, Illinois, Indiana and Wisconsin. It shows almost no travel is going on.

However, this was not how some of the liberals on Twitter saw it. They see everything as an  opportunity to demean and belittle anyone who doesn't breathe the rarefied air of their enclaves of privilege and pomposity.

A few examples in the responses to this chart that were on Twitter.

Do you notice a common theme? It doesn't matter the circumstances. There is a constant refrain from many liberals to denigrate and demean anyone who doesn't share their world view. Multiply it ten-fold if it has anything to do with Donald J. Trump or his supporters.

What seems to be lost on these people is that those areas in red on the map are mostly in rural areas with very low population density. They don't have a Whole Foods or Trader Joe's up the street they can walk to. They might have to drive 20 miles to get to an IGA. There is no corner drug store.

In fact, a lot of those people are still doing their jobs in growing crops and delivering essential items to the local stores of these self-righteous nincompoops in their mega metro areas.

In addition, if those people who were so quick to comment on Twitter had been willing to take the time to look a little closer at the map, they would have seen that there was no difference in the behaviors of those in the large metro areas in the red states than what is going on in the metro areas of the blue states.

I have highlighted the low travel in metro areas such as Raleigh-Durham, Charlotte, Miami, Atlanta, New Orleans, Nashville, Kansas City, St. Louis, Dallas-Ft. Worth and Houston. There is no "red" there.

The Covid-19 has been a massive wake-up call to our nation. It should cause every American to take a step back and reconsider a number of questions.

Should we rely on China and others for critical medical supplies and drugs?

Should we rely on China and others for a number of other strategic materials and goods?

How reliant should we allow ourselves to be on any other country in our supply chain of other goods?

How much can we trust Communist China to be transparent and open about issues that could have worldwide effects?

Seeing the risk of disease coming across the border so easily, should we be implementing much stronger measures at border control?

Can anyone still believe that an open border policy really serves the American people?

How much should we trust models to determine the expenditure of trillions of dollars? If the models in this case can vary 80-90% in a couple of weeks, how much trust should we put in climate models that are forecasting events a decade or more in advance?

There are many more.

One thing that has been answered unequivocally is that much of what comes out of the mouths of the mainstream media and Democrats about the fascist, authoritarian Donald Trump could not be further from reality.

It is in full view every day.

Unfortunately, too many people are blinded by their bias to see what is right in front of them.