Wednesday, May 13, 2020

Nice Distraction

A lovely little distraction today:
First time windsurfing in almost 2 months! Flat water, averages in the low 30s, sun, and warm enough - finally, everything came together. After a couple of hesitant turns, I even remembered how to jibe again. I took the "cheater" gear (Skate 110, Idol 5.0), since I'll need a few more sessions to be fit enough for a speed session. But 29 knots on freestyle gear feels plenty fast.

Monday, May 11, 2020

When Looks Matter More Than Lives

He never understood why testing is important. However, he is very concerned that it will "make ourselves look bad". He has access to all the scientists at the CDC, NIH, FEMA, and whatever government agency he wants, but the only thing he can think of is this:
"But they think they're doing it because it'll hurt me, the longer it takes to — hurt me in the election, the longer it takes to open up"
Have a quick look at the countries that lead the "COVID-19 death chart" - the countries with the most COVID-19 death per million inhabitants:
 All the countries at the top did not understand the importance of testing until it was too late. Several of them (the UK, the Netherlands, and Sweden) tried to mostly ignore COVID-19, and only keep "old and sick" people inside. It failed miserably every single time. Most of the countries in the list had to issue "stay-at-home" orders that were much more severe than those in the US - Spain, for example, had 30,000 road blocks to keep people from driving, and kids were not allowed to leave home at all for many weeks. Here is a graph that shows how COVID-19 "surprised" Spain:
The death curve follows the cases curve with just 2 days delay. In well-managed countries, the time between first symptoms and deaths is about 19 days. Even with allowing a few days for testing, the delay should be at least 2 weeks. Spain got blindsided, and paid a very high price for it. By the time they knew that they had a problem, millions were already infected.

In countries that had testing ready, the death toll was a lot lower. Examples include Germany, Austria, Australia, New Zealand, and Taiwan. In many of these countries, the epidemic started to slow down even before the first government measures were taken: when people heard that others were dying, and saw how quickly case numbers rose, they started to be careful, going out less and keeping their distance. When someone had symptoms, they knew that they should stay home so they would not infect others.

No ramping up testing quickly enough is much worse than just covering your eyes and hoping that "it will just disappear". It has cost many lives, and continues to cost many lives. The deaths are noticed whether there are tests or not; without tests, they instill even more fear. Fear keep people at home, away from flights, restaurants, and stores; it kills the economy, even without stay-at-home orders.

The only way out for the US without many hundreds of thousands of deaths, and many months of misery, is a massive ramp up in testing. "Test and track" is important, but tracking COVID-19 infections is extremely challenging because many infections happen before symptoms, or are transmitted by people who never get symptoms. In view of the realities in the US, test and track alone will not allow a "return to normal" - not even together with "6 ft social distancing". But repeated testing on a very large scale would be one thing that might actually work in the US.

It's not about looking good. It's about containment without sacrificing hundreds of thousands of lives.

Monday, May 4, 2020

Pants on Fire

"We’re going to lose anywhere from 75-, 80- to 100,000 people," Trump said. 
A day or two later, when the New York Times presented evidence that the White house had been warned about a much higher death toll, the White House immediately rejected the report. According to an NPR article, White House spokesman Judd Deere said:
 "The president's phased guidelines to open up America again are a scientific driven approach that the top health and infectious disease experts in the federal government agreed with. The health of the American people remains President Trump's top priority"
 Let us do a quick reality check. The "top health and infectious disease experts in the federal government" are working for or with the CDC. The CDC maintains a web page that lists a number of different computer models, and explains clearly why forecasting COVID-19 deaths is critical.

The web page also includes a link to a downloadable spreadsheet file that contains the numbers for all the models listed. I looked at some of the models (which now do not include the terrible IHME model anymore), and then downloaded the data file to have a closer look. Some models only predict one week into the future, but most models predict between 4 and 7 weeks ahead. Here are the total numbers of COVID-19 deaths that the models predict:

Model
Projected COVID-19 Deaths
CU-80 contact
336,930
LANL-GrowthRate
242,352
CU-70 contact
242,043
CU-60 contact
219,258
YYG-ParamSearch
218,893
COVIDhub-ensemble
189,105
UT-Mobility
160,977
MOBS_NEU-GLEAM_COVID
143,314
UMass-MechBayes
135,688
MIT_CovidAnalytics-DELPHI
119,337

There is quite a variation in the predictions, which range from 119,337 deaths to 336,930 deaths over the next 4-7 weeks. 


Even the most optimistic model predicts close to 120,000 COVID-19 deaths. On average, the models predict about 200,000 deaths; half of the models predict more than 200,000 deaths. There is not a single model that supports the numbers Trump gave; all numbers are substantially higher. A "scientific driven approach" would list the range that the models indicate, perhaps leaving out the highest and lowest predictions: 135,000 to 242,000 deaths.

Note at all of the model predictions cover a period shorter than the next 2 months, and that all models still predict a substantial daily death rate at the end of the prediction period. In my model runs, the total deaths toll at the end of 2020 was about 50% higher than for the next 6 weeks. Clearly, the overall expected death toll in 2020 is even higher than the numbers in the table, quite possibly twice as high.

Furthermore, most of the models assume that social distancing measures remain in place. There is absolutely no doubt that COVID-19 transmissions and therefore deaths will increase when states "re-open", as many states have started to do. Nobody knows exactly by how much, but even a modest increase of transmissions by about 20% would result in more than 400,000 additional deaths.  A more dramatic increase could lead to more than a million additional deaths in 2020. The only thing that will hopefully prevent such an enormous increase in deaths will be state governors who "lock down" states again when they see case numbers increasing. But it looks like they will have to do so against the resistance of the White House.



Friday, May 1, 2020

Pictures Tell The Story

On the bright side, I have finally been back on the water. It was a short foil session where the wind dropped, and my finger tips hurt the entire time because it was a bit cold, but it was sunny, and I got flying a few times. It was pretty much exactly one year after last year's disaster session,  so we'll count it as a big success.

On the not-so-bright side, it seems the US is largely ready to give up the fight against COVID-19. The federal guidelines on social distancing, meager as they were, have expired, and 30 states have announced "re-opening" plans. The likely result is at least 700,000 deaths from COVID-19 in the US, and possibly more than a million. Time to switch to picture mode.

The model that the White House loves predicts zero daily COVID-19 death by the end of June. "It will just disappear".

Well, it did disappear in China. The curve above is for the Hubei province where Wuhan, the original epicenter of the epidemic, is in. The super-smart scientists at the IHME figures that it must just happen the same way in the US.
That's an overlay of the two graphs. Quite a clear picture, right?

Let's have a quick look at the streets in Wuhan during the lockdown:

They were completely empty. Private traffic was verboten. Nobody was allowed to leave the city.

How about the US? Here's an image from Atlanta, a city that has a lot of COVID-19 cases and death:
Not empty. On Cape Cod, the rentals for summer guests are full, and the streets are as busy as in any other year. Beaches are crowded, but not yet as crowded as in California:
Surveys show that many people in the US don't bother with masks. Pictures show the same:
About a month after "social distancing" was recommended in the US, it is ignored by many.

Most flight have been canceled, but some flights still operate, and leisure travel is allowed:

For comparison, China increased the strictness of measures against the spread of COVID-19 several times in Wuhan. About a months after the first measures, teams were going door-to-door to check Wuhan citizens for COVID-19 symptoms like fever:
Anyone with symptoms was put in quarantine camps, and released only after two successive PCR tests came back negative after at least 2 weeks.

I am not advocating the same measures in the US. But it is important to understand that they were much more drastic, and therefore much more effective. Some measures remained in effect after the eventual "re-opening":
Meanwhile, the governor of Massachusetts has deemed landscaping an "essential business" that is allowed to ignore the stay-at-home order. God beware the horror of overgrown lawns! Priorities are priorities.

The result is quite predictable:
About 6 weeks after the federal guidelines were announced, and more than a months after most states have issued "stay-at-home" guidelines, the number of cases per day is almost unchanged for the peak.  Compare this to the very rapid decay for China in the second model - there really is no comparison. The IHME model is 100% based on the assumption that the "Wuhan curve" applies to the US. That's a 100% wrong assumption. The model is braindead. Worse, it appears to be intentionally misleading by predicting a completely unrealistic low number of death.

Wuhan and New York City both have about 10 to 11 million inhabitants. New York City ended up with a much higher number of COVID-19 deaths, and a higher infection rate. China prohibited all travel out of Wuhan until the number of cases was near zero; NYC residents are, and always have been, free to travel wherever they want to. But the so-called president calls armed and masked protesters like these "good people":

He encouraged protests against his own guidelines while they were still in effect:

The US had at least one month more warning about COVID-19 than China had. Now, the US has 14 times more COVID-19 deaths than China, and is on track to have 50, 100, or even 250 times more. No attack on China will fool anyone with half a brain about who is responsible for this.