Thursday, March 12, 2020

Trump's Irrational "Travel Ban" - And Why The U.S. Is Now Unlikely To Flatten The COVID-19 Pandemic Infection Curve

COVID-19 Infection -Flattening graph - from WSJ,  March 11, p. A2)

"When all you have is a wall then everything looks like an invasion. And that's how they've approached this from the beginning. ..It is profoundly worrying that the president still talks about this in  the ways he talked about the migrant caravan. As if it's a foreign invasion that can be kept out with strong measures..  But it's in the country and transmitting now. 

We are on the epidemic curve of the country of Italy, a place where he's banning travelers from. Meanwhile the issues of mitigation and social distancing didn't make up one twentieth of his speech. "   - Chris Hayes last night, MSNBC, After Trump's 11 minute speech.

"Even with next to zero information on the size of the American epidemic, because of next to zero testing, because of the failure of the federal government on that front, the numbers we do have are bad.  They're still rapidly trending upward,and that's from just what's known  - the tiny tiny sliver of people who can manage to get tested."   Rachel Maddow last night, MSNBC

"Tom Hanks got tested because he was in Australia. If he was in New York it would have been almost impossible for him to have been tested."  Ron Klain, former Ebola czar in Obama admin., last night on MSNBC

Now that our Governor has declared Colorado to be in a state of emergency,  one senses events to do with the newly declared COVID-19 pandemic are spiraling out of control.  Certainly in this country with its pathetic, next to nil testing- coupled with Trump's happy talk.   That only saw push back from reality yesterday when the CDC's Anthony Fauci  testified before the House Oversight Committee and said we could have as many as 100 million infected, if we don't get underway with mitigation and containment.  But see, the problem is you can't know the extent of what you need to do unless you test and see how many are already infected.  From that perspective Americans - thanks to the Trump bunch - are living in a fool's paradise.

Rachel Maddow's quote above highlighted this, and then she quoted Dr. Brian Monahan (attending physician of congress) from a closed door meeting with Senate staff that he expects "75 to 150 million people in the U.S. to become infected.".  And what is our illustrious preznit Dotard doing? Yapping about a "foreign virus" and an idiotic travel ban that conflates goods and people (cargo isn't banned)  and makes absurd exceptions, like the UK.  Apart from which, are Americans really supposed to take any guidance from a certified imbecile who hobnobs with infected people, e.g.

And then tells us with a straight face "I am not really concerned.".   The markets ought to really give this orange asswit the proverbial Bronx cheer today..

Chris Hayes' graph (on 'All In', before the Trump PR speech) showed a snapshot of where we are now in Dr. Monahan's projection.  That is, 4 weeks ago there were 15 U.S. cases, and just over a week ago there were 100 cases.  Yesterday there were over 1,200 cases. An exponential increase, patterned after what Italy is seeing (Though not to the same degree, since we are still early on the infection curve and testing is almost nonexistent.)

 In the news consistently for the past few days has been the infection curve for the novel coronavirus, as shown in the graphic above, from Greg Ip's WSJ column yesterday.  There are two regions with which we need to be concerned: the red hump denoting the behavior when there is little or no intervention (say by the national gov't at risk) and the broader, flatter yellow curve with peak that does not reach the critical dotted line, e.g. for capacity of the U.S. health care system.

The "flattening the curve"  strategy aims to extend the duration of  the pandemic so it affects fewer patients simultaneously. Medical researchers and specialists would then have more time to work on treatments and vaccines, as well as prevent hospitals from being overwhelmed with a flood of patients.  (Some 15- 20% of COVID-19 patients will require hospitalization.)

Let's first deal with that last capacity issue given this post is mostly about the numbers, and then we can go to Trump's absurd speech last night, in which he accomplished nothing but distraction.   As it stands now, as CDC head Anthony Fauci and former Obama Ebola czar Ron Klain noted  last night, the U.S. has 1 million available hospital beds, of which 700,000 are occupied at any given time. This leaves 300,000 available - which is the current capacity for treating additional patients that need it - say from the COVID-19 virus.  Also, that capacity includes about 70,000 ICU beds, and 65,000 respirators.  These represent the capacity numbers which must not be surpassed, as indicated by the red hump.

But do the damned math!  If only 10 percent of Dr. Monahan's lower limit of 75 million U.S. infections are severe case, that is 7.5 MILLION patients! Where in the hell are we going to put them? And if even half - say 3.75 million - need respirators, where will we get them? Who will make them? China? Its factories are still shuttered, at least most, though a number are coming back But over three million respirators?   This is why it's so critical to get a bead on the actually infected walking among us and that means tens of millions of tests. It also means social distancing as a means to keep COVID-19 from spreading beyond the point it exceeds our medical capacity to deal with it. As Greg Ip wrote in his column yesterday ('Old Battles Impair White House Response', p. A2):

"To minimize economic disruption, the administration has been reluctant to endorse social distancing. ..Nonetheless, health experts say such measures are necessary to 'flatten the curve'"

Now, the bad news: As shown last night on 'All In', the U.S. incidence is already following the exponential growth of the Italian outbreak.  This is at least for the early stages.  The truth is we may well have surpassed the infections in Italy but we've no idea, because we don't know given we have not been testing like other major nations.   For reference, the U.S. has only managed 10,000 cases in toto thus far, while South Korea is doing 10,000- 12,000 per day.  Point being you can't know what you don't know, or don't measure. For all we know there could be a million cases afoot in this country, but we aren't registering them because we've not been testing en masse. Instead, we've privatized testing by farming them out to private labs like Quest and Labcorp.,  People who then suspect they might be infected are supposed to go to these labs and hope their insurance covers the cost of the test.  (Currently, the U.S. is at the bottom of the global league table for coronavirus testing, at a rate of just five people in every million.)

This is doing it ass -backwards, as Ron Klain pointed out to Rachel Maddow. In his words: 

"What the White House has done the past week is said we're going to privatize testing. We're going to get the big testing labs, Quest and Labcorp, to run the tests.   What we really need to be doing is testing all the people not raising their hands to be tested: every person in a nursing home, every person in a senior center, every person with one of these pre-existing health conditions. We should be conducting surveillance, going out and looking for the disease, not just waiting for people to show up in their doctor's office."

This is why Alan Blinder, former Chairman of the Federal Reserve, wrote yesterday (WSJ op ed, 'The Best Stimulus Is Coronavirus Testing Kits', p. A17) that:

"It's a shame and disgrace how slow the U.S. has been with testing.  The goal should not be the million or five million tests Mike Pence has promised,  but perhaps 100 million or more."

Going on to note COVID-19 symptoms don't show up immediately, and "may be hard to distinguish from the flu, so many may need more than one test."

What about Trump's performance last night?  After very briefly (2 mins.) giving hope he really was stable and had finally put his interests behind the nation's it all crumbled. In the course of nine minutes, Trump swiftly reverted to type. He described Covid-19 as a “foreign virus”, and took pains to point out that “a large number of new clusters in the United States were seeded by travellers from Europe”. His doctrine of “America first” – a phrase he used once again – emerged full blown.  This execrable mindrot forever pits the U.S. against the world, with its implication that America’s purity is permanently under threat of contamination by alien hordes. Trump has used that imagery in the context of immigration for more than four years.  Bottom line, Traitor Trump was basically issuing a dog whistle to his white nationalist supporters and hurled a 'bird' at the rest of the nation.   

The use of  the term "foreign virus", i.e.  from China, was especially choice.  Forgetting that in the weeks after the outbreak in Wuhan,  Dotard and his dotty crew made no fewer than 13 exceptions - for people and cargo - coming in from China, including Wuhan.  In other words, the dope "seeded" the infections himself! (In one case heeding the yelps of a Reeptard stuck on a cruise who desperately wanted to get back home, and bringing 14 Americans already infected back with non-infected passengers. No, folks, you cannot make this  shit up.)

What else did we see?  Well, total incompetence and an irrational response. How so?  Trump is banning travel from all European nations for 30 days - excepting the UK.  What's wrong with this?  First,  for the last several weeks millions - including U.S. students studying in places like Italy - have been pouring in from Europe and haven't even been checked with thermometers.  So, what Trump is doing now is pretty much like shutting the barn door after the cattle have escaped.   Second, the UK has more COVID-19 cases than 12 other European nations as pointed out last night by Ron Klain.  So all Trump has done is created a distraction.

Meanwhile millions need testing in the U.S. and few are getting it. Hell, even doctors are having to try to beg, borrow or steal test kits.   As this is happening we are poised to see an exponential increase in infections as well as fatalities, just as Italy is now - forcing its Prime Minister to quarantine the whole country.   In that country, the total number of fatalities has increased 30 percent in one day, from 631 to 827.

When Chris Hayes superimposed the U.S increases over Italy's (longer curve) one beheld an almost perfect match at the lower end of recorded cases. As Hayes put it: "It's the exact same trajectory, only a week behind."  Adding, that what we're seeing is what we also saw with Wuhan, China, the virus overwhelming health care capacity.  As already noted, at any given time there's a fixed amount of doctors, ICUs,  beds, ventilators. The systemic risk this virus poses around the world, including in the U.S., is reflected in what's happening in Italy.  Translation: Doctors are having to intubate patients in hallways, and make wartime triage decisions, i.e. whom to let die and whom they can afford to treat given limited resources.  This is what we are headed for, thanks to Dotard and his crew of buffoons.

Hayes noted that Tom Bossert - Trump's former  Homeland Security adviser- told MSNBC News yesterday that we are "ten days away from the hospitals getting creamed."   

The only thing left to do in this country, because the testing has been so dramatically screwed up by the Trumpies, is to take dramatic steps collectively to socially distance ourselves.  To try to flatten the curve and slow the transmission of this virus.  That means no more dining out in restaurants, no more movie theaters or plays, no more going to huge sports events, and certainly no more political rallies of any kind.  See e.g.

It's either that, or we are all for the high jump, to use the Bajan parlance.

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