The Indefatigable Iconoclast

One of the most popular blog posts I wrote last year was entitled "The Indefatigable Donald Trump".

Indefatigable is one of my favorite words.

If there is one word that should be used to describe Donald Trump it is indefatigable.

Trump doesn't tire. He doesn't quit. He is persistent and unrelenting in pursuing his goals.

Watching the Coronavirus Task Force press conferences it has occurred to me there is another word  that also describes Donald Trump. I like this word as well. I have written about it before. However, when I wrote about that word back in 2012 Donald Trump was far from my mind.

This is that word.

Iconoclast

Donald Trump is not afraid to challenge conventional wisdom. He is not afraid to attack and callout institutions like the WHO, NATO and the WTO when he thinks they have not served the interests of the United States of America. He is not satisfied with the status quo.

He is not even afraid to challenge scientists and doctors to ask if there may not be a better way.

Of course, this drives the media crazy and they immediately attempt to paint Trump as unbalanced, insane or ill-informed.

One example is Trump suggesting trying hydroxychoriquine as a treatment for Covid-19 given its proven history of safely treating malaria and lupus and evidence from some doctors that it shows promise in helping some patients  recover from the virus. Another is his early questioning of why a N95 mask could not be disinfected and reused. (Both are now being done)

Yesterday saw the White House press corps go further off the rails when Trump, upon seeing evidence that Covid-19 quickly dies when exposed to heat, humidity, sunlight and disinfectant, asked the question of the experts whether it was possible to use UV light or something like an injection cleaning to kill the virus internally.

This is the transcript documenting  exactly what Trump said at the press conference which I watched live.

The media jumped on this and said that Trump was telling people to inject Lysol into their bodies or that he was claiming that going out into sunlight would cure someone of Covid-19.

As shown above, he said nothing of the sort. He said these things might be worth researching with medical doctors. He said these were interesting topics for further research.. He said it would be powerful if it would work.

He was merely raising the question of whether further research could be done to see whether those things that kill the virus outside the body could somehow be modified to impede the virus inside the body.

Is that "out there"?

Yes, it is. However, that is what an iconoclast does. They challenge traditional or conventional ideas. Most progress in the world has come from someone challenging the status quo or asking whether there might be another, or better, way.

Soon after I saw Trump suggest the use of UV rays inside the body to kill the virus I came across this YouTube video.

What are doctors and researchers at Cedars Sinai Hospital in LA working on? They have developed what they call a Healight that does exactly what Trump asked about.

Is Donald Trump crazy or is he just an iconoclast that is two steps ahead of most everyone else?

I don't know about you but I want a President who is not afraid to ask these two questions with regard to almost any issue presented to them.

Why?

Why not?

Read what I wrote about iconoclasts in 2012 and my wish that one day soon we would get a few in Washington.

Eight years later, we actually may have one.

Iconoclast
(originally published January 5, 2012)

I`con`o`clast/ n / A person who does something that others say can't be done.

Iconoclast is my most favorite word for 2012.  We need more inconoclasts.  We need them in business.  We need them in education.  We need them in science. We most certainly need them in government.  We need people who will challenge the status quo and can bring fresh thinking and ideas to solve problems.  I like Albert Einstein's quote in this regard.

"We can't solve problems by using the same kind of thinking we used when we created them."

I am currently reading a book titled "Iconoclast" by Gregory Berns who is a Professor of Neuroeconomics at Emory University.  Berns delves into the reasons that iconoclasts are so creative and successful.  He also explains how we can all become more iconoclastic by learning to see things clearly for what they are and not being influenced by other people's opinions.  By not letting fear rule our decisions and by learning the necessary social networking skills so that other people will eventually come to see things the same way as the iconoclast.

Berns introduces the book with a story about Howard Armstrong.  That is a name I was not familiar with but he was quite a man, and quite an iconoclast.

More than any other person, Armstrong was responsible for the three basic technologies that make radio and television possible.  In addition to his first discovery, called regeneration, which is the technique that allows radio signals to be amplified, Armstrong invented the superhetererodyne receiver, which transforms high-frequency waves into audible sound waves.  But his crowning achievement, and his ultimate undoing, was the creation of FM radio-a technology that the entire radio industry had dismissed as inferior.

We all know now that the sound quality of FM radio is vastly superior to that of AM radio.  However, Armstrong was alone in his belief of the superiority of FM in the 1930's when he developed the first FM receiver.  He was discredited and disparaged by the AM adherents who only knew what they knew.  He ultimately took his own life in 1954 not knowing that his iconoclastic views would eventually be fully accepted after his death.

I have been thinking a lot about iconoclasts this year which led me to an interesting article in today's Wall Street Journal about 13-year old Aidan Dwyer from Northport, NY.  This young man looks to me like a budding iconoclast.

This past summer, Aidan won a national science competition with what seemed to be a bright idea: His research appeared to show that solar panels arrayed like the leaves on a tree collect sunlight more efficiently than traditional setups.

Many people on the Web called the Long Island teenager a "genius" who had achieved a true "breakthrough" in solar power. Others praised him for proving that nature's own designs are superior to man's.

But there was one little problem: To prove his hypothesis, Aidan had measured the wrong thing. 

As readers figured out the mistake, the Internet went supernova. Commenters and bloggers attacked Aidan with vitriol usually saved for political enemies and the Kardashians. Blogs decried his experiment as "bad science" and "impossible nonsense." Someone called him "an alien—a cool one, though."

Aidan and his family watched in amazement as strangers around the world debated his intelligence and abilities, as well as his opinion of subjects generally beyond the scope of a suburban boy his age: politics, evolution and the state of modern society, for example.

Does that sound somewhat similar to the experience of others like Howard Armstrong who advance a new and novel idea?  How did Aidan see something new and what got him cross-wise with so many others?

On a recent afternoon, Aidan and his parents admitted they were somewhat baffled by the attention for a project that began two years ago on a winter hiking trip through the Catskill Mountains.

Aidan, then 11, stared at the tree branches denuded of leaves and noticed they looked alike; he wondered why. Back home, his parents encouraged him to research the subject. Google searches uncovered that a mathematical concept called the Fibonacci number sequence underlies the structure of tree branches. 

His parents had been hoping to install solar panels on their Long Island house, but their yard was too small and their roof wasn't suitable. There was, however, enough room for a tree. Perhaps, Aidan postulated, trees arranged their branches to improve the collection of sunlight. If he used the Fibonacci sequence to imitate that design with solar panels replacing leaves, maybe the structure could fit his family's limited space, look pretty—and power the house.

He did chores to earn the money to buy about $75 worth of materials. With help from his father—and after many mistakes—Aidan ended up with two models: a traditional flat-panel array and a tree-shaped solar collector designed to mimic the branch sequence of an oak tree. Over the course of months he compared measurements. To his delight, the tree structure's numbers were higher. 

Exuberantly, he submitted the results to the Young Naturalist Awards, a national contest run by the American Museum of Natural History. Of 700 entries, his was picked as one of 12 winners.

"Then," Aidan said with a slight smile, "things got out of hand."

As the report went viral, attacked and championed in hundreds of comments, museum officials became worried. "We do think it's really important that information that we put forth is scientifically accurate," said Rosamond Kinzler, senior director of science education at the museum. They were also concerned for Aidan, she said.

Critics had a point: Aidan had recorded voltage, when he needed to calculate power. It is a serious flaw, explained Jan Kleissl, an assistant professor of environmental engineering at the University of California, San Diego.

Imagine a water pipe, he said. Voltage is equivalent to water pressure. Current is the size of the pipe. Power is equal to the flow of water out of the pipe, which depends on both variables.

Aidan has not been deterred.  He has listened to the constructive advice he got, ignored the critics and the vitriol, and gotten back to work.  A true iconoclast.

On a recent afternoon, Aidan showed a visitor his newest model, tweaked to respond to his critics: a towering seven-foot tree form adorned with solar panels and painted green. He is now measuring current and power. So far, he said, the tree continues to outperform the traditional panel. "I'm thinking that it could actually change the world."

Aidan may or may not be proven right in the end.  However, it is people like Aidan, Florence Nightingale, Henry Ford, Walt Disney, Jackie Robinson and Steve Jobs that move us forward as a society.  My fervent wish for 2012 is that we will send some iconoclasts to Washington.  We need them so that people like Aidan can pursue their dreams and ideas for the betterment of us all.

The Covid-19 Puzzle

I have written extensively about Covid-19 over the last two months. It is an interesting subject to write about as it involves a great deal of data and yet there is still much that is unknown about the virus and the appropriateness of our response to it.

It is like to trying to put together a 1000 piece puzzle but you have no idea what you are assembling as you pick up each piece and try to put it together. As you work, you are not sure where any piece fits and you also are not sure what you are going to have when you are done.

There is no better example of that than when I learned earlier this week that in my home state of Ohio over 4,000 cases of Covid-19 have been confirmed among prisoners and staff at Ohio's prisons.

As of Tuesday, when the latest prison numbers were released, that represented about 30% of all the Covid-19 cases in the state.

One facility, the Marion Correctional Institution had 2,011 inmates test positive. That is 80% of the prison's population. It is now the largest source of infections of any place in the United States.

That is a great example of one of those puzzle pieces.

An 80% infection rate in one facility shows how contagious this virus can be. However, if there is any place that is about as locked down as it can be it is a prison. How did the virus get into the prison? I assume the prison had stopped allowing visitors but staff still came and went. It shows the limitations of any lockdown unless it is total and complete.

Nursing homes have also been a hot spot for the virus in Ohio and elsewhere. You don't see it mentioned at Governor Cuomo's press conferences but 25% of all deaths in New York have been nursing home residents. Part of that seems to have resulted from a questionable state policy of requiring nursing homes to admit or readmit patients who had tested positive for Covid-19 thereby putting other residents at risk.

The Ohio Department of Heath reported on Monday that 1,200 confirmed cases have been reported in Ohio long-term care facilities. These are also generally locales from which residents are not circulating much in the community. These seniors mostly were stay-at-home before stay-at-home became a state order. Visitors were banned from nursing homes in Ohio in mid-March. Nevertheless, staff go in and out even though I know all Ohio nursing homes have been doing temperature checks of everyone entering their facilities since the same time in mid-March.

If you take prisons and nursing homes together, there are over 5,200 confirmed cases in Ohio out of what is reported as slightly more than 14,000 total confirmed cases.  Therefore, almost 40% of all cases are in populations that were essentially locked down before we even locked down a good part of the other 11.7 million people in Ohio.  

Compared to the dire forecasts of public health models at the outset of the virus, it can be argued that the mitigation strategy has been an enormous success. The politicians who took these actions are arguing that vociferously right now. That includes President Trump. What else can they do?

However, it has come at an enormous economic cost. Job losses in Ohio are at almost 1 million. The state is projecting at least a $5.4 billion budget shortfall for the fiscal year that ends in June. (To put that in context, the state budgeted for the collection of about $ 9 billion per year in personal income taxes before the Covid-19 hit). Ohio was expecting to end the year in surplus six weeks ago.

We still don't know what the final costs will be to local government and school budgets. It seem certain that all of us will be living with the economic consequences of the lockdown for years and years to come.

That is another piece of the puzzle. Is the economic cost and disruption to society worth it? This takes on an added dimension as it is now known that almost 40% of Ohio cases are in prisons and nursing homes. If this is the result, even after instituting a stay-at-home order for the rest of the state, it raises more questions and makes the puzzle even more puzzling.

Short of requiring the guards at state prisons and the staff of nursing homes to lock themselves in with the prisoners and patients and never go home, could any of this have been prevented anyway?

The models first estimated that almost 200,000 people could die in Ohio due to Covid-19. Based on those forecast models Governor Mike Dewine made Ohio one of the first states to ban mass gatherings, close schools, bars and restaurants and implement a stay-at-home order.

Despite those actions, on April 2, over two weeks into locking down the economy, the IMHE model was projecting that at the peak of the crisis on April 19 that Ohio would have 6,716 hospitalized of which 1,238 patients would need ICU care. 

This is a screenshot of that projection that was made on April 2. Bear in mind, these projections in the model were made with assumptions that included social distancing and stay-at-home orders in place.

These are the actual numbers for Ohio as of April 19.

Hospitalized    2,565 (38% of forecast)

ICU                    765 (62% of forecast)

It must also be considered that Ohio only reports cumulative hospitalizations and ICU admissions in its data. Therefore, the Ohio numbers above are overstated compared to the IMHE model that is focused on hospital resource availability at a point in time.

Here is another piece of the puzzle.

There were 349 Covid-19 deaths in Ohio for the two weeks ended April 18.

That is not insignificant. However, the average deaths from all causes for that two week period over the last three years in Ohio is 4,780 deaths. Those 349 deaths would represent about 7.3% of all deaths in the state for the last two weeks based on the average of all deaths over the last 3 years.

To put that in perspective, that is about the same percentage of deaths that would be expected from an average flu season as seen in this chart from the CDC that shows pneumonia and influenza deaths as a percent of all deaths in the state of Ohio since 2015.

Source: CDC FluView Mortality Data

So many puzzle pieces.

So little known on how they all fit together.

And nothing is at all known on what all of this looks like when (and if) it can be put back together.

We are about to begin looking at another piece of the puzzle when various states begin to gradually open up for business.

Some alarmists argue that this is ill-advised and will inevitably result in a substantial increase in additional cases.

Others point to the economic effects and the additional harm that is being done to the nation's physical and mental health as a result of putting so many people out of work.

26 million people have now filed for unemployment since mid-March. This suggests the unemployment rate is close to 20% nationally. It was 3.5% in early March.

Who is right? What is right?

The Covid-19 puzzle. Nothing has been more puzzling in my lifetime.

Does New York City "Work" In a Covid-19 World?

As I have studied the data from Covid-19 it is impossible to not see the enormous disparity between the cases (and deaths) in the New York City metro area compared to the rest of the United States.

For example, look at this graphic that Dr. Birx showed at the Saturday briefing that compared the New York City metro area to all other major metro areas in the United States.

The New York City metro area has over 10 times as many cases as the next highest metro area.

You can also see how New York City impacts the state of New York and New Jersey from this slide that Dr. Birx also shared at the briefing.

Why is this?

One answer is population density.

New York City has the highest population density of any major city in the United States and two other cities in the metro area (Jersey City, NJ and Newark, NJ are also in the top 10).

Credit: US Census Bureau via Cleveland.com

The large number of international travelers into the major New York City gateway hub airports (JFK and Newark) also made the area more vulnerable to other metro areas than other cities initially.

However, as I study the data it seems inescapable to me that a large reason for the spread of the virus in the New York metro area is the large use of public transit by the population.

For example, here is public transit usage in the New York City metro area compared to other major metro areas in the Unites States.

U.S. cities with the largest metro systems in 2019, by ridership (in million unlinked transit passenger trips)*
Credit: Statista.com

The New York City metro area has more than ten times as many passenger trips on public transit as the next largest city. In fact, it has more public transit trips than all of other cities combined on this chart.

The reality is that most who work in New York City get to their jobs by public transit. They take the subway or the bus in the city. It they live in New Jersey, Westchester, Long Island or Connecticut, and work in the city, they are most likely commuting into the city on a train.

For example, the New York City subway system alone had about 5 million turnstile entries on a typical weekday before the Covid-19 outbreak.

Of course, each of those trains or buses is a vector for transmission of the virus. They are crowded and people are contained in a tight, constrained space.

Why does the New York metro area have half of the cases and deaths in the United States?

Could it be because half of all the public transit trips in the country are also in the New York City metro area?

My thesis seems to also be supported by a recent paper from an MIT economist who has just published a paper entitled "The Subways Seeded the Massive Coronavirus Epidemic in New York City".

This is the abstract of that paper.

New York City’s multitentacled subway system was a major disseminator – if not the principal transmission vehicle – of coronavirus infection during the initial takeoff of the massive epidemic that became evident throughout the city during March 2020. The near shutoff of subway ridership in Manhattan – down by over 90 percent at the end of March – correlates strongly with the substantial increase in the doubling time of new cases in this borough.

           Maps of subway station turnstile entries, superimposed upon zip code-level maps             of reported coronavirus incidence, are strongly consistent with subway-facilitated             disease propagation. Local train lines appear to have a higher propensity to                     transmit infection than express lines. Reciprocal seeding of infection appears to               be the best explanation for the emergence of a single hotspot in Midtown West in               Manhattan.

 Bus hubs may have served as secondary transmission routes out to the   periphery of the city.

In that people in the New York metro area rely on public transit to get to their jobs how does New York City "work" in the Covid-19 world?

How will New York City truly get back to work if the major method they use to do that could be the major transmitter of the virus in the community?

It appears to me that New York City metro is facing an enormous challenge in getting back to anything close to normal considering the transportation model that the area relies on.

Credit: Powerline.com

The proximity that New York City has provided for business, finance, entertainment, media and other sectors of the economy has always been an asset to that metro area. However, in an era of social distancing, proximity has become a huge liability.

What good does social distancing do at work, in a restaurant or at another venue if you first need to travel there by public transportation?

How does social distancing work with public transit?

The only answer would appear to be more trains and buses, limits on passengers per train or bus, and extensive and continual disinfection procedures of subway cars, turnstiles and buses to limit the risk of virus transmission.

However, this will cost enormous sums of money. That is something that the New York MTA did not have a lot of even before Covid-19. One observer called the MTA's fiscal condition "precarious" two months ago.

Ridership is down 90% since then and the New York Times recently reported that the MTA faces revenue losses of $8.5 billion by the end of the year.

This quote in the same New York Times story really says it all.

“The MTA is the economic engine of the entire region; the economy is built around the spine of the subway, buses and commuter rails,” said Lisa Daglian, executive director of the Permanent Citizens Advisory Committee to the MTA, a watchdog group.

“You can’t reopen the economy without the transit system in New York.”

So very true.

It is very hard for me to see how New York City "works" in a Covid-19 world since the transit system is extricably tied to the economic system.

New York City has had more to deal with in responding to Covid-19 than anywhere else in the United States.

The path forward for New Yorkers in returning to work and a sense of normalcy might prove to be even more difficult due to their reliance on public transit.

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.