Archived Facebook Coronavirus Posts: March 10th

[I'm transitioning a bunch of Facebook posts I made on the Coronavirus to my blog.  This was from March 10th]

Some comments on the data on this article:

https://www.bloomberg.com/…/how-bad-is-the-coronavirus-let-…

For the record:

My own prediction--based on various news items, the behavior of the virus in general, and *some* preliminary studies--is that we will ultimately find out the CFR to be on the bottom end of the range presented in this article (I think 0.5% is likely to be close and I don't even think it's the true bottom of the possible range) *but* we will ultimately see it as more easily transmissible than is currently being indicated by top health organizations like the WHO and the CDC.

The WHO has been pretty dismissive of the theories that the virus can propagate asymptomatically, whereas I have seen several case studies where asymptomatic transmission seems pretty well proven. Also, I've seen peer reviewed studies that indicate pretty strongly that the virus can spread over the air farther and more easily than the WHO has been indicating *and* linger on exposes surfaces a lot longer than they've been saying.

Oh, and one important caveat on this article: a crucial set of numbers this article does not deal with is the percentage of deaths *by age*. I know it is true of the flu as well that it kills the elderly much more commonly than anyone else . . . but I feel like this may be even more true for the coronavirus. For example, a full 99% of all deaths in Italy (at least initially) were people over 60 years old. So I think the CFR is going to vary heavily by percentage of elderly in a population.

You can see this in action by looking at what happened at the Life Care Center in Washington. This case is actually worse than most people realize, because the initial news headlines had it as "13 residents have died of COVID-19". In reality, a full 26 residents died in the span of about a week there, compared to a typical 3-6 residents a month who die normally. Only 13 of those residents tested positive for COVID-19 (2 were inconclusive)--but they *haven't done* post-mortem testing yet on 11 remaining. So it's a safe assumption that almost *all* of those 26 deaths were due to COVID-19; that's a CFR of at least 21% *so far* in that population. *And* there is another 40 or so residents still hospitalized and in serious condition; fewer than half of the original 120 residents were unaffected.

So, we can expect COVID-19 to be really bad when it hits a nursing home, and I expect the worst headlines going forward to follow the Life Care Center pattern.

Archived Facebook Coronavirus Posts: March 2nd (second post)

[I'm transitioning a bunch of Facebook posts I made on the Coronavirus to my blog.  This was from March 2nd]

(More morbid coronavirus musings)

It just occurred to me that with Buttigieg and Klobuchar out, all potential candidates for the presidential election are now in the highest risk age group for Covid-19 fatalities, the 70+ range (I'm counting four Democrats and Trump here). So what's the chances that the coronavirus claims the life of one of the candidates before November?

Earlier, I estimated that 15% of the population was a reasonable estimate for how many American's were going to become infected by the coronavirus. With all the hand-shaking and baby-kissing that politicians have to do, I feel that it is reasonable to up the probabilities for our candidates to a full 25%.

Now, Covid-19 gets far more lethal with the age of the patient, all the way up to a full 15% fatality rate for the 80+ crowd (according to my current data). Our current crop of candidates are in the 70-80 range, though, so this gives them a much better 8% fatality rate. This gives an even 2% chance for each candidate that he or she will not make it to November, and a grand total of about 10% that *one* of the five will be picked off before the end (though not necessarily before dropping out for other reasons).

Archived Facebook Coronavirus Posts: March 2nd

[I'm transitioning a bunch of Facebook posts I made on the Coronavirus to my blog.  This was from March 2nd]

(Warning: musing on fatality statistics and the coronavirus follows. Not necessarily edifying material . . . though I suppose it is true that Catholics are urged to consider the Last Things during Lent.)

I've been reading on how Case Fatality Rates (CFR) are calculated in order to try to figure out whether Covid-19 is actually going to be worse than the seasonal flu or not, and roughly how much if so. The CFR is defined as how many people who are infected will end up dying. For the seasonal flu, it's surprisingly difficult to calculate, but I see numbers *in the US* generally from 0.02% to 0.08%. I've also seen a lot of people throw a "0.1%" number around, but I think that's a *worldwide* estimate. Death rates vary substantially according to quality of medical care in these cases.

The important factor that makes this difficult to judge in the real world is the difference between what you might define a "case" to be. In the early stages of a pandemic, usually the only way to define a "case" is either "someone admitted to a hospital with the right symptoms" or "someone who tested positive for the disease". In *either* case, this will inflate the actual fatality of the disease because it will not count those people who came down with the disease in a milder form and did not seek admission to the hospital, nor ever get tested.

In studies that have calculated the CFR from hospital admitted cases, we have seen estimates ranging from just under 1% up to 5%, but most people think these numbers will get smaller after all infected and not just hospital cases are considered. Can we attempt to do that now?

One approach would be to use the Diamond Princess cruise passengers as guinea pigs. In this case, with a captured audience that was under intense scrutiny, I think we can be confident that we actually know all the people who were infected. Everyone was tested and nobody who got sick in that situation would have shrugged it off as "no big deal". So what do the numbers that we know from the Diamond Princess cases tell us?

As of today, 6 out of the 705 people who have been confirmed to have caught the disease on the ship have died. Assuming all infected people were caught, this makes for a CFR of about .8. *But* we also need to correct for another factor, which is age. Cruise ships have a higher proportion of elderly passengers compared to the general population. My methods here are not very exacting (basically I found a graph of passenger age distribution on cruise ships and a graph of the general age population and squinted at them side-by-side), but I would estimate that cruise ships have 2-3 times the number of the crucial >70 age group compared to the general population. At least 5 out of the 6 people who have died so far from the Diamond Princess were older than 70. So in estimating the CFR from the Diamond Princess, I would divide by 3, and then adjust up a little bit more to account for the fact that there are still some passengers sick who may yet die. This gives me a real-world CFR of about 0.3%.

Two big problems with this estimation strategy: First, this is a small sample size. We really shouldn't put too much weight in what we can learn from a population of under 1000 patients. Second, as mentioned there are still people in this population who have not completed the course of the illness. So it is quite conceivable that another 20 people could still die from this group, which would dramatically change the final CFR.

Supposing, though, that 0.3% is a correct CFR for Covid-19. How many people would we expect to die from this illness if it becomes epidemic in the United States? This is also very difficult to determine, because we know even less about the total number of infected the coronavirus is likely to cause than we do about its fatality rates.

The seasonal flu is estimated to infect between 3% and 11% of the United States population each year. The new coronavirus is liable to infect more people: it has been estimated to have a base infectivity rate well over double that of the seasonal flu, it spreads asymptomatically or close to it, there is no "herd" immunity to the virus in the population, and it is unlikely to be slowed by a change of seasons (this normally happening to viruses *after* they become endemic in a population and not during their first introduction to the scene). So I think a guess of 15% of the population being infected is pretty reasonable.

This works out to a total death rate in the United States of about 150,000 people this year, overwhelmingly from the >70 year old population, but hitting a fair amount of younger people as well.

One important caveat to this number: the difference between a 1% hospitalized CFR and 5% CFR in China is largely between the Hubei province and everywhere else in China. To the extent you trust these numbers, the natural corollary is that as hospital systems get overwhelmed, as happened in Hubei, the fatality of the disease increases as the ability to care for the critical cases goes down. So *if*, in the United States, we start to see hospitals overwhelmed with critical cases, we could see the death rate go up to something closer to the 500-600 thousand mark.

Archived Facebook Coronavirus Posts: Feb 24th

[I'm transitioning a bunch of Facebook posts I made on the Coronavirus to my blog.  This was from February 24th]

OK, so--realistically--the coronavirus is a pandemic now. Community spread in Asia, the Middle East, Europe and (from what I'm hearing though this is not confirmed yet) Africa is now happening.

What does that mean for us?

1. At the governmental level, I don't think it changes a lot. Any government that wasn't already preparing as hard as possible for the pandemic was foolish. Furthermore, restricting travel and trying to track down sources of infection and quarantine them off is still worth doing. I don't think it's realistic to think we can *halt* the spread of the virus, but it should still be possible to *slow* the spread of the virus.

This is very important, because however bad this virus will be, it will be much, much worse in areas where it hits *suddenly*. The worst danger is the overwhelming of medical resources, where we are unable to care for all of the seriously ill because too many are infected at once.

So I think aggressive travel restrictions are still a good idea.

2. At the personal level, again I think the most useful thing is to do things that will slow the spread of the virus. That means, cutting down on unnecessary travel, cutting down on unnecessary social mingling. Stop shaking hands; try to keep more social space between you and other people. If you can, avoid visiting hospitals.

More importantly, I think it means responsible self-isolation. Do you have one child with a fever? Keep them all home. (Note: this is good advice even in normal flu season). Do you feel just a bit sick, but still well enough to do things? Unless necessary, stay at home! This particular virus spreads as badly as it does largely because it can spread from people with little to no symptoms.

For Catholics, if you are even a little bit sick, I'd recommend not receiving Communion on the tongue. I'd recommend either receiving on the hand or just abstaining.

I'm not suggesting here that we paralyze society and freeze all social activity--for now, I think we should all just add reasonable restrictions that we can practice and still function. All of these restrictions exist in a continuum, and given that there is no evidence of community spread here in the States yet, I think we can decide to practice just the "low hanging fruit" restrictions for now. We can decide to ramp up the restrictions as circumstances dictate.

Finally, we should all take care to practice impeccable hygiene. Wash your hands frequently and for 20 full seconds (the time it takes to sing "Happy Birthday" twice). Stop touching your face with your hands. Cover your mouth with the inside of your elbow when you sneeze or cough. Etc. There's no recommendation here that's not also a good idea in regular flu season, so I think now is a good opportunity to learn how to tighten up our regular hygiene practices.

Archived Facebook Coronavirus Posts: Feb 14th

[I'm transitioning a bunch of Facebook posts I made on the Coronavirus to my blog.  This was from February 14th]

With multiple children who are at relatively high risk to a pneumonia-causing disease, I have been following news of the novel coronavirus disease (aka Covid-19 now) pretty closely. I now think it is pretty likely--maybe more likely than not--that Covid-19 will become a global pandemic that will reach to the United States.

At any rate, it is now very reasonable to start talking about common sense preparations people can do *in case* we do end up with a medical crisis on our shores.

I think the first thing to do is to understand what such a crisis would look like, *if* it did happen. So here's my attempt to pre-construct a worst-case scenario that is reasonable to consider:

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1. A certain threshold of number of infected people is crossed in your community. Most (85%) of these people are showing very mild or even no symptoms and spread the disease around before they know to contain themselves. The disease is now essentially anywhere and everywhere in your community. Let's say for the sake of argument that the disease infects 25% of the entire population within a relatively short time period.

2. In about 15% of cases, the Covid-19 causes serious problems, specifically pneumonia requiring hospital aid. This contingent consists primarily (but not entirely) of vulnerable people, specifically:
* the elderly
* immunocompromised
* diabetics
* people with Down Syndrome
* smokers or ex-smokers
* healthcare workers or anyone who has to spend a lot of time in hospitals.

Depending on the whose numbers are accurate here, maybe 1 or 2 percent of the total who fall sick will die, mostly from Acute Respiratory Distress Syndrome, or ARDS..

3. Suppose you live in a town of about 20,000 people. With the numbers above, about 5000 people will become infected and 750 will become seriously ill. Of these, about 50-100 will die even if they receive full care.

4. In a town of 20,000, the local hospital will not have anything near the resources to deal with 750 seriously ill people in a short period of time. The primary stressed resources will be personnel, hospital space, and ICU resources, particularly ventilators.

5. The likeliest consequence, I think, is that a distinction will have to be made between *seriously* ill people and *critically* ill people. People with "just" pneumonia will be told to stay at home, self-care and self-monitor, with occasional visits from over-worked health care workers for check-ups. Only the people at death's door are going to be admitted to the hospital for ICU treatment. This is what (we're pretty sure) has been happening in Wuhan.

6. There is some evidence that this state of affairs greatly increases the case fatality rate. That is, even with full hospital care the CFR might be 1%, *but* some estimates put the CFR in Wuhan at 18%. This difference *might* be because of the large number of people who are being left at home out of necessity.

7. Note that for this scenario I have chosen numbers that are very plausible and have put forward as the best guess actual proportions by people I consider pretty expert and knowledgeable. However, the numbers are not certain and it is quite possible that they could be worse in reality.

------------------

So this is the plausible scenario that we might try to plan for. What can we actually do in such a scenario? Well, first I think we can all educate ourselves on how to avoid picking up viruses of this sort as much as possible--learn all of the hygiene rules and be able to self-isolate as much as possible.

Second, I think we should learn the symptoms of ARDS, especially those of us with vulnerable family members. I have two links for this: an excellent YouTube video on ARDS (https://www.youtube.com/watch?v=okg7uq_HrhQ) which includes some information on recent research on how to improve survival rates from ARDS. And also here is a symptom run-down of ARDS from healthline: https://www.healthline.com/…/acute-respiratory-distress-syn….

Archived Facebook Coronavirus Posts: Jan 30th

[I'm transitioning a bunch of Facebook posts I made on the Coronavirus to my blog.  This was from January 30th]

Typical symptoms of the new coronavirus (2019-nCoV):

98% of the time: Fever
76% of the time: Cough
55% of the time: Shortness of Breath

*Note the absence of sneezing and runny nose.*

I've been following the news on the coronavirus pretty closely for the past few days. I believe that it's too early to say yet how severe this disease will become, worldwide. I think that those news outlets that are already saying, "hey, the flu is a bigger problem than the coronavirus" are being premature. Obviously it's not right to panic or stress out about this, but I think it's good to get some information out at this point.

Specifically, I think it's wise to be aware of the particular set of symptoms that are characteristic of this virus; if in the next few weeks you come down with specifically that combination of symptoms, then either get tested or stay home--especially if you have been travelling or have been around people who have been travelling. (I mean, "stay home if you have a fever" is good advice regardless.) And if you come down with just a normal cold or flu--with the sneezing and the runny nose--then *don't* run to the hospital panicking about the coronavirus.

Why am I concerned? There are a few things that concern me about the infection data that's been coming out on 2019-nCoV, which you can see here: https://gisanddata.maps.arcgis.com/…/opsdashboa…/index.html…

1. The graph of confirmed cases over time (the yellow line in the bottom left) has been following an exponential curve and is not leveling off.

2. The ratio of confirmed cases to confirmed fatalities is sitting at around 2.1 % for the whole dataset *but* if you look specifically at Hubei (the origin of the virus and where it has had the longest chance to play out), the ratio is actually 3.5%. I'm thinking maybe the 3.5% is the more accurate number? For reference, the ratio for the typical flu is 0.1% and the ratio for the 1918 Spanish Flu was 2.5%.

So we *may* be looking at something that spreads aggressively in a flu-like manner but kills 35 times as much.

3. This data is primarily from China, and I take it as a given that China is strongly disposed to downplay bad news as much as it can get away with.

4. There are only about 100 cases outside of China so far, and so far no deaths from these cases. *Hopefully* this means the mortality rate of the disease isn't as bad as the Chinese data makes it seem--*but* since the rest of the world is clearly multiple weeks behind China in the timeline, I don't think we can say that is the case *yet*. The non-Chinese mortality rate is something I'm going to be paying particular attention to going forward.

So, I'm currently in a cautious, "let's pay close attention in case this is a real serious problem", state right now, because I think that's what *could* happen.

Supply Chain Environmentalism and the "First 90%" Rule

The "First 90%" Rule

In 1970, Congress passed the Clean Air Act.  Without any real engineering plan behind its numbers, government decreed that in 5 years the emissions coming out of cars should be 90% cleaner than they were.  And as it turned out, this worked.  The automobile industry was able to implement improvements that drastically improved air quality across the world.  I don't think the original goal was quite reached in 5 years, but it didn't take all that much longer than that.

In the 40 years after this success, the EPA continued to make the requirements for automobile emissions stricter and stricter.  More and more engineering effort has been required to meet increasingly strict standards.  However much money was originally spent researching, designing and retooling in order to meet the original emissions standards, surely at least an order of magnitude more has been spent in meeting the further emission goals of the EPA.  And the results have been forthcoming, however whereas the original effort yielded a 90% decrease in emissions, the subsequent efforts have had a harder time eking out improvements.  In terms of total percentage of emissions reduced, all those subsequent efforts have yielded about 1/10th the reduction of the original smog reduction campaign, with an end result that cars today produce about 98% fewer emissions than did their '60s counterparts.

What I am trying to establish here is not that the EPA's increasingly strict standards were necessarily pointless--I put a very high premium on clean air myself, and I think I prefer to live in a world with 98% fewer emissions compared to the '60s as opposed to only 90% fewer.  However, it is clear that in this particular case, environmental regulations have been subject to a law of diminishing returns.  The first and easiest improvements that were made were the cheapest to do and also the most impactful.  Subsequent improvements were more costly and of less impact, though not useless.

This law of diminishing returns is not guaranteed to be the case for every type of environmental regulation, but I strongly suspect that it does hold for most types of environmental regulation.  And this has some very important implications for the manufacturing and energy production industries.  It should cause us to be circumspect about applying too-stringent environmental policies on industrial sectors that are apt to move to areas of least resistance.

Energy Production

One great example is fracking.  Energy is a fungible good, and therefore energy production is a very mobile industry.  If a country doesn't produce the energy it needs itself, it will import it from somewhere else.  The means of producing energy vary greatly in how bad they are for the environment.  Coal, for example, is much worse than oil or natural gas, all things taken into consideration.

Fracking stacks up very well against coal as a cleaner energy solution.  It's much better than coal--but it's not zero-impact.  It does have environmental costs.  From what I've read, the worst of the environmental costs can be mitigated with some fairly simple regulation, but even with this "low hanging fruit" regulation implemented, fracking is definitely going to have some environmental impact.  And so some people are against fracking entirely in the United States and want it completely banned.

But the impact of a complete ban against fracking would clearly and necessarily be an increase in the use of coal and oil fired power plants; this is inevitable.  It would also clearly increase the US total reliance on imported energy--and the places from which we import oil and gas do not give anything like the same consideration to the environment as we do.  For the sake of small improvements to the environment specifically in the States, we would be increasing the total harm to the environment world-wide.  Some people are just fine with this trade-off; I am not.  I think we should accept a lesser good in order to avoid a greater evil.

Manufacturing

Likewise, factory manufacturing has largely left the United States.  This is largely due to the average wage of Americans compared to other parts of the world, but it is also due at least in part to stricter environmental regulations.  Factory manufacturers have been acting in a very predictable way here; they compete with each other in terms of driving down cost of production.  The ones that survive, therefore, find areas with cheap labor and lax regulations on how rigorously they have to deal with the byproducts of manufacturing.  Our minimum wage laws and environmental regulations therefore do not have the effect of eliminating dirty factories staffed by impoverished workers; rather, they push that reality to other places of the world where we don't have to see it happening.

Manufacturing in China, in particular, has been a grotesque confluence of capitalism and communism.  Capitalism's blindness to consequences apart from the bottom-line and Communism's innate brutality and willingness to subject both man and nature to social engineering has produced a slow-motion humanitarian and ecological horror story.  Because China really doesn't give a c**p about the environment, as the clouds of pollution regularly infecting its skies attest.  They are not doing even the lowest cost mitigation work in order to achieve that first 90% of environmental benefit.

Solution?

What I believe we should be aiming for, then, is some way to impose minimal environmental and humanitarian standards upon our basic factory manufacturing supply chains, across the globe.  Increasing environmental standards on manufacturing in the US or in Europe is probably pointless and quite possibly even counter-productive.  We might even look to decrease our own standards slightly, if it could reduce exportation of manufacturing to third-world areas.  What is far more important for the environment as a whole is some way of getting that first 90% improvement on the bulk of manufacturing.

This is obviously very difficult to achieve.  These countries that have no regard for basic human rights or basic environmental cleanliness are also pretty much all willing to lie and cheat on everything they do, economically.  For the automobile industry, we were able to make global improvements by imposing standards on what is produced.  We can test cars that are manufactured in China and empirically determine how well they do on emissions.  We can't directly test a batch of chemicals shipped from China to see how clean was the process by which they were produced.

If we find a solution for this problem, it will probably include some requirement of openness and willingness to be inspected by impartial investigators . . . and this sort of thing has proven very difficult to make workable in the past, given unscrupulous sovereign nations who have a vested interest.  This is a strong motivation for us to favor nations as manufacturing partners who do not own their own manufacturing industries.  It will be much easier for us to demand accountability and good practices from factories, say, in Mexico where the owner of the factory is not a government with a vested interest in controlling a target percentage of world production capacity.  What this argues for is some type of tariff on goods produced from socialist states--a "freedom index" tariff of some sort.

Finally, I think it is very important for the sake of any effort to clean up the supply chain that we eschew environmental extremism.  It has been the nature of the environmentalist movement for some time that it lets the perfect be the enemy of the good; for the sake of a much cleaner manufacturing supply chain, we should very vigorously fight that tendency.  Let's work on making the supply chain "OK" rather than "pristine", because moving it to "OK" from "horrible" is going to be work enough for a lifetime.  Let's remember the importance of that first 90%.