Friday, May 1, 2020

In Fragmented Response To Reopeninig - Survivng COVID -19 May Depend On Your State Getting the R-Nought Down To 1.0


Armed domestic terrorists  in Lansing, MI yesterday, antsy to rush back to croak from the SARS- Cov-2 virus.  Most are brainwashed dupes of the coronavirus truthers at FOX.


"Look, in a public swimming pool there is no separate area designated for urination. In the same sense, if you have one state opening up that hasn't controlled infections it affects all other states." - Health specialist last night on All In'

"Today, The Wall Street Journal ran an editorial about R nought - but they don't even look at their own news stories which feature the Asian successes.  I mean we're not so stupid in America that we can't learn from the others.  Right now it's like a madhouse that we don't know what to do.  Like governors and states are debating the dates to open and not the contact tracing.  Not following the confirmed cases, not preparing the quarantine.  This is the tragedy because we're wasting our time Do we have any sense of learning the most basic things, that's the real issue."-  Dr. Jeffrey Sachs, Columbia University, on 'All In' Wednesday night

" This is what I a deeply and profoundly concerned about, which is the over interpretation that some of these early antibody studies that suggest as many as 80fold more have actually seen the virus, that this is being used to suggest 'oh this is not a devastatingly deadly or virulent disease.  But anchor it on what we actually see. In the major cities that have been hit, whether in Wuhan, China, northern Italy or New York City iur intensive care units have been overwhelmed with virus. Even in the worst flu years we don't see the bodies piling up in morgues that can't handle them.  This is far worst than flu and we have to be careful as we interpret these early assessments of the percent of people in our communities that have seen the virus, We have to be careful that we don't reopen the economy too early because this will provoke a second wave of epidemic, and behind it we will see the deaths start to mount,
 -Dr. George Q. Daley, Dean of Harvard Medical School, Wednesday night on 'All In'

"You can't just leap over things and getting into a situation where you're really tempting a rebounf. That's the thing I get concerned about. I hope they don't do that."  Dr. Anthony Fauci, yesterday

"All of humanity’s problems stem from man’s inability to sit quietly in a room alone.”  -  Philosopher Blaise Pascal

In this pandemic era let us concede delusions run wild, not only amidst the ongoing culture wars where liars (coronavirus truthers)  and armed right wing terrorists run amuck. But also  in the rarefied realm of pie-eyed  than Wall Street  investors who have single-handedly  pumped the S&P 500 up by 31 percent since March 23rd.  This according to the NY Times, and despite waves of grim news: Over 1 million US. cases, 60,000 dead, 16 percent unemployment, a tanking GDP - irrational exuberance continues to hold sway.  Much of this is tuned to the belief - not really supported empirically - that the world in 10-12 months will look manifestly better than it does now. This despite states reopening their economies when they haven't even shown progress in declining infections, testing or lowering the transmission rate, otherwise known as R-nought.


As Chris Hayes so superbly explained on his 'All In' show Wednesday night: 


"There is actually a specific goal every society is trying to accomplish, and that is to keep the rate for transmission of the coronavirus down.  So that each infected person, on average, infects less than one other person.  This is the key benchmark: if the transmission rate is less than 1 the disease is declining. If the transmission rate is more than 1 the disease is spreading. That is literally the threshold to create a society and an economy that are working."


And unlike the trolls and Covid truthers on FOX News   - like Tucker Carlson and Sean Hannity - this is basic  science biology if you will.   As opposed to propaganda to feed the gullible, poorly educated, or Right wing loons toting ARs into statehouses.  The warp and woof of this virus then, is defined by two fundamental parameters: the transmission rate ("R nought")  and fatality rate.  Both of which, I might add, assorted medical quacks have tried to lowball in recent weeks, even despite overflowing ERs, even dozens of rotting bodies as discovered in a Brooklyn funeral home yesterday.  According to the NY Times (April 30, 'Bodies Pile Up As N.Y. Struggles To Bury Its Dead'):


"With more than 18,000 announced fatalities and a total death toll that is almost certainly higher, the coronavirus crisis is the worst mass casualty event to hit New York since the Spanish flu pandemic a century ago. At the height of the outbreak in April, a New Yorker was dying almost every two minutes — more than 800 per day, or four times the city’s normal death rate. And though the daily toll has recently slowed, hundreds of bodies are still emerging each day from private homes and hospitals."
 

 Would a "seasonal flu"  cause such an overflow - or 60,000 dead in 2 months? No, only a dedicated liar, imbecile or quack would say so, given a low fatality rate virus would not generate nursing homes or funeral homes full of rotting corpses, or flooded ICUs. 

Unlike our moron leader, Germany's Angela Merkel holds a doctorate in quantum chemistry. She was thereby eminently qualified to explain the basis of the reproduction rate barely two weeks ago, as Germany prepared to open up its economy. She noted, for example, at this time (when the R-nought was about 1.0):


"I can only say that for one chain of infection, if one person will infect on other person that is an average of one person infecting one other. If we get to the point each person infects 1.1. other people then by October we would reach the capacity level of our health system, and its assumed number of intensive care beds. If we get to 1.2 people infected per person - which is just 20 percent more than what we have now - then we will reach the limit of our health care system in July.  And if it is 1.3 people infected per person we will reach the limit in June.


So that is where we can see how little the margin is. The margin for error."


As Hayes said, imagine having a leader with that kind of ability, to be able to describe the core issue to citizens, with that level of nuance.  Well, as we know, we lack such a leader in this country. We are left with only a pretender and dyspeptic brat moron, part of the reason we've now racked up more deaths than in the Vietnam war.   We also understand that propping up  this phony leader is an entire propaganda establishment, determined to try to shoehorn him into office again despite revealing himself as totally unfit in this pandemic. 

 Like FOX News and its coronavirus truthers, the Trump Propaganda Axis includes Rush Limbaugh, and the Wall Street Journal Editorial staff - responsible for its op-ed pages.  Hence, Jeffrey Sachs' reference (see quote at top) to these editors not even "looking at their own news stories".  Well, they don't because those pages are under the control of Rupert Murdoch himself and will always hew to the truther line echoed by FOX.  Hence, the 4/29 editorial ('Germany's R0 Experiment', p. A18) barking bollocks like:


"The upward drift in Germany's reproduction rate (R0) now suggests that those strict lockdown measures may not have stopped the disease in its tracks so much as delayed the inevitable at enormous cost."


But as Merkel herself stated in her speech (replayed on All In) that time bought by the lockdown actually freed up one third more capacity in hospital ICUs.  While it is true that the R-value has crept back up to 1.0 from 0.8,  Lothar Weiler - head of the Robert Koch Institute (which the WSJ editors quote)  has asserted:  "the increase alone is not cause for alarm" - but "we don't want it to go back up again" i.e. to 1.1.  That Germany is considering reimposing lockdown measures, then, merely shows Ms. Merkel has her hands on the brakes and is powering up the German economy under strict controls. 

This as opposed to the reckless "race car" ambitions of states in the U.S. - all headed for a huge crack up-- and Trump's refusal to take any responsibility.  It certainly doesn't mean Germany has only "delayed the inevitable" as the WSJ paints it.   It is also instructive to read - from the WSJ's own regular news pages (e.g. 'South Korea To Open Up But Carefully', p. A9) how South Korea is gearing up with multiple conditions for reopening.  This in a nation that's already tested almost to the limit, and now "has a rule for almost everything".   I.e.  "The guidelines spell how everything from how to work to how to relax ahead of a full resumption of daily activities."


This, compared to the U.S. where Trump has now insisted his guidelines for reopening  have been aborted from today, May 1st.  And further indicating lack leadership, this in a nation that's tested barely one percent of citizens while S. Korea has tested close to 10 percent. South Korea then, like Japan, Taiwan and other nations, has a rational basis to reopen. Again using testing and contact tracing to systematically track down the disease- to thereby KNOW where it is before unleashing its masses. The U.S under Trump and the truthers is doing just the opposite. Fortunately, many in the U.S. just aren't going to bite, and will remain in lockdown whatever nutsos - like Rick Desantis in FLA- recklessly open up. 


But the key point that may be lost on too many, is how many of the states now opening up are using the science and information described by Angela Merkel.  In other words knowing what their existing real time R value is, called  t , before opening up.   It appears hardly any are, in fact 8 states (Alabama, Idaho, Texas, North Dakota, Indiana, Iowa, Utah, Wyoming) are rushing to open despite having no declines over the past 14 days - one of the Trump bunch's "Phase 1"  determinants. Hence,  without thought of the exponential rate of infection which is why the margin for error is so small.  Err too much on the side of opening things up - while ignoring the R-value in your area- and you face a calamity such as now occurring in Black Hawk County, Iowa - thanks to a moron governor mandating sick people go to work.  Or listen too much to the rubbish data and "over interpretations"  (the term of Harvard's Medical School Dean)  trotted out by the quacks  (Joseph Ladapo)  and proto-quacks  like John Ioannides and his Stanford ilk


Other nations like S. Korea (WSJ, April 29, p. A9) and Taiwan have been able to keep the virus suppressed by lots of testing and contact tracing - which latter aspect the Trumpies seem to have barely heard of.  This, even as a nitwit like Jared Kushner brags that the response has been next to sublime.  Fortunately, intelligent state governors now have a tool at hand which can forecast for them the number of cases and deaths if they relent too soon on social restrictions.   The tool is known as the  Massachusetts General Hospital simulator, and can be found at this link:

https://analytics-tools.shinyapps.io/covid19simulator06/


One need only select the state and what level of extending existing sequester conditions apply.  The simulator will then show the total cases up to some date 'x' as well as expected fatalities.

According to The Boston Globe,  Massachusetts Gov. Charlie Baker plans to announce later this week whether the coronavirus order closing nonessential businesses in Massachusetts will be extended.  But according to this Massachusetts General Hospital  (MGH) simulator, the decision ought to be a no brainer .  According to the Globe (April 29)

"As other states across the country began easing restrictions meant to curb the spread of COVID-19 over the weekend, researchers at the Boston hospital released the new interactive online tool predicting a second wave of COVID-19 infections and deaths this summer if shutdown orders are lifted this spring — both across the country and in Massachusetts. According to the MGH simulator, the state’s business closure order and stay-at-home advisory should remain in place for another 12 weeks — or until roughly July 20 — to ensure against a late-summer surge in COVID-19 hospitalizations and to keep the number of statewide deaths due the disease just under 5,000 through the end of August. As of Monday, the COVID-19 death toll in Massachusetts stood at just over 3,000.
But if the state’s current restrictions were allowed to expire in four weeks and replaced by “minimal restrictions,” on May 25, the simulator predicts catastrophe.
The outbreak would accelerate again in July, killing more than 27,000 people in Massachusetts and infecting more than 2.8 million people — or roughly 40 percent of the state’s population — by the end of August. And if restrictions were lifted in just two weeks, the model predicts 42,700 deaths — and nearly 3.4 million cumulative COVID-19 cases in Massachusetts alone. In both scenarios, the state’s health care system would be completely overwhelmed by a second surge of patients dwarfing the number available hospital beds, according to the model."
Jagpreet Chhatwal, the MGH project lead, said the simulator is intended to inform coronavirus response efforts in the midst of the quickly changing and uncertain environment. But the staggering worst-case numbers belie the fact that the somewhat rigid, if illustrative, tool doesn’t cleanly map onto the policy options before the Baker administration.

The simulator models three differing intervention levels: a complete travel lockdown, the state’s current orders, and “minimal restrictions” — the latter of which includes no state mandates and only “learned social awareness” about the disease.  Even with those efforts in mind, Chhatwal told WBUR in an interview Sunday that the model suggests the state shouldn’t lift restrictions until the end of June, when the state will have enough testing to isolate all active COVID-19 cases.  In the words of the MGH researcher and assistant professor at Harvard Medical School:

Before that, if we lift restrictions, the virus can spread in the community, which can be difficult to trace,”  
Is this simulator result a shot over the bow of other states, especially the likes of Iowa and Georgia where Governors are literally mandating workers (e.g. in meat packing plants in Iowa) go back to work? You bet it is.  Right now, from what research professional such as Prof. Ashish Jha and Harvard's Medical Dean, Dr. George Q. Daley argue, we are in deep trouble.  That's because this reopening operation is moving ahead blindly with too limited testing capacity - despite enormous capacity being unused. ('U.S. Testing Capacity Is Going Unused', WSJ, 4/ 30, p. A5)   Why is this happening? Because of a total abdication of responsibility by the Trump administration. To wit, "largely leaving the challenge up to the states" .

 So: "the result is a disorganized system that isn't matching limited supply with demand."

Without that testing, and a rigorous program of contact tracing,  we are witnessing too many states and citizens acting like lemmings in their yen to jump into an open economy- rife with the virus.  They need to settle down, put rifles away, and study the news images from a  Brooklyn neighborhood, i.e.  when the police found dozens of decomposing bodies stashed inside two trucks outside a funeral home on Utica Avenue in Brooklyn.

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