Thursday, June 25, 2020

Cases Are Increasing and Not Because of Increased Testing

Updating a post from several days ago, about whether US COVID-19 cases are increasing because there's more testing or because there's really more cases independent of testing.

Most of what I read, other than about the Grand Epidemiologist, has the experts saying cases are increasing more so than testing is increasing.

First, here are some numbers on testing, US-wide. I'm not recording the numbers every day, so the number for a given date is the average for that date and the date with data before it. In other words, I just interpolate between the dates with data:

Here is the same interpolation for cases/test, which I think is easier to intuit than my previous tests/case:

So while cases were definitely declining relative to the number of tests administered, that decline had almost stopped, while the number of tests had been holding (about) the same.

I think this is good proof that rising cases aren't simply an artifact of increasing testing. And reading the news, it seems to coming from from Arizona, Texas, Florida and Georgia. And a few other states. All states that ignored the science a couple of months ago. Or rather, all states whose leadership ignored the science a couple of months ago. All states being let down (for example, by ending federal funds for testing, which is insanity) by federal leadership today, at the highest level.

So many have died and there are so many whose health has been permanently altered that there should be a Truth and Reconciliation process when this is all over. Or something.


David in Cal said...

CDC says COVID-19 cases in U.S. may be 10 times higher than reported
The estimate comes from a nationwide look at antibody tests.

This is a factor to be taking into account, if it's correct.

David, your comment "states that ignored the science" ignores the enormous economic and social cost of the shutdowns. If one wanted to be equally inflammatory, one could refer to the "states that ignored the economics".

As you know, keeping closed down has big costs and re-opening also has big costs. Re-opening may well be the better decision, even if it leads to more cases. Bear in mind that original goal of the shutdown was to "flatten the curve" so that there would be adequate medical care. On this basis, re-opening is justified, even if it leads to more cases.


David Appell said...

Hi David.

Yes, but....

Have a look at this graph:

The solution to the economic problem was to take the pandemic very seriously the first time, as did the EU countries, South Korea, Canada, etc. Lots of testing from the very beginning, a strict lockdown, masks strictly required (and provided by the govt), everything closed but the bare essentials...with an economic package large enough to tide people over. We have some of the best experts and scientists and health policy people and economists in the world -- we should have had several powerful task forces going starting in January.

Instead we had Trump and all his ignorance, narcissism, stupidity, insecurity, and inabilities. He royally screwed everything up. He made this into a disaster. He was helped in this by ignorant, science denying red state governors who allowed spring breakers and reopened early and now look at the mess they've caused.

In short, if we'd had one good, serious, science-based lockdown with real economic and social support we'd be like the EU and other countries weathering the pandemic well. Instead we are a pathetic mess with no national leadership -- in fact, with *negative* national leadership -- with a problem no one sees an end to.

David in Cal said...

David - the EU countries had considerably higher mortality rates than the US. Several were twice as high as the US. When you compare US to EU, we look pretty good.

Blue states in the Northeast had the highest mortality rates. The top 6 are NY, NJ, CT, MA, RI, DC. Drs. Fauci and Birx continually warned states to protect the most vulnerable. NY, among others, did the opposite. They required that old age facilities take back infected people. One reason we're not seeing higher mortality now, even though the case numbers are up, is that all states now ARE protecting seniors. (Another reason is that deaths lag cases by a couple of weeks. I expect mortality to rise in a couple of weeks.)

In retrospect the US could have done better. However, state by state, the Republican states generally had lower mortality than the Democratic states. If you want to make Covid-19 a partisan issue, the Republicans outdid the Democrats.

Layzej said...

the EU countries had considerably higher mortality rates than the US. Several were twice as high as the US. When you compare US to EU, we look pretty good.

Worldometer shows Europe 252 deaths/1M pop. EU does slightly worse with 298 deaths/1M. USA has 383 deaths/1M pop.

There are countries in Europe that do worse than the USA overall, but that is the only continent that this is true of.

The worst states in the EU are:
1) Belgium with 840 deaths/1M.
2) Spain with 606 deaths/1M.

By contrast the worst states in the USA are:
1) NJ with 1,690 deaths/1M.
2) NY with 1,613 deaths/1M.

It's not really clear that USA is doing better than the EU. The current trajectories mean that the contrast will only become starker.

David in Cal said...

Layzej - Another way to look at comparative mortality rates

Democratic states >> EU >> Republican states

Seriously, the US did some bad things and some good things

1. F*ckup by CDC and FDA on developing tests in February
2. Some states failed to protect senior living centers. (IIRC something like 30% or 40% of deaths came from senior living centers.)
3. CDC recommended AGAINST masks for several months
4. New York City failed to find a way to deal with the contagion risk in public transportation.
5. Trump's anti-mask attitude sets a bad example
6. Some states permitted huge mass demonstrations

1. China ban and Europe ban
2. Eventual development of enormous testing capability
3. Pretty much having adequate medical capability throughout the pandemic
4. Needs such as food, medicine, etc. was available throughout the pandemic.


J. D. said...

2. Yes that was a disaster but it didn't happen in a vacuum. The hospitals at that point were under great stress and the hospital managers were asking for help.
3. There was a problem getting masks for several months. By mid March the CDC was telling hospitals that if they were short of them they should reuse them or cancel procedures were they where needed. At the beginning of April they were suggesting that the public should use cloth, not proper masks as they were in short supply.
5.Agreed.Thats not the only way he set a bad example.
6. That's another way Trump set a bad example. When he decided the lockdown had lasted long enough he encouraged his supporters to protest on the streets then started planning rallies in indoor stadiums knowing very few would wear masks.

1. There wasn't a China ban. Americans were free to travel there and return. Not only that for the next few weeks Trump kept playing the threat down. He kept implying it was just like the flu that killed people every year and that the number of people dying would soon be zero anyway. This was bound to have consequences because a lot of Trump supporters believe everything he says. Loads of people online were saying nothing to worry about it's only flu.
2.Eventual being the operative word here.
3 and 4. I think most countries were the same. I did see people early on who were lupus sufferers complaing that Hydroxychloroquine was in short supply. I wonder why that was? Couldn't have been the President saying "just take it, what have you got to lose"?
That was another example of Trump supporters hanging on to his every word. I've seen people patiently trying to explain to Trump supporters that the jury was out until there were properly conducted studies showing it actually cured more people than it killed and them being accused of having Trump Derangement Syndrome. That's another consequence of having a President whos i.q. is about 50 lower than he thinks it is.

Layzej said...

2. Some states failed to protect senior living centers. (IIRC something like 30% or 40% of deaths came from senior living centers.)

Canada is the worst by far here. It had 82% of deaths from old age homes at one point.

David Appell said...

David in Cal made a couple of good points, #1 and #2 for sure. I don't know enough to judge #4. In the way of the Internet, I will ignore all these (smiley face, no harm intended DiC, props where they're due, yadda yadda) and get to MY points (smile):

>> 3. CDC recommended AGAINST masks for several months

Yes. CDC has been all kind of disappointments in this pandemic. Sad, almost tragic, reconciliation is due. But Fauci said this mask thing was because they knew there would not be enough masks for both public and health care workers, and had to prioritize PPE for health care workers, so had to lie to the public for a couple of months. Hardly ideal, but I blame Trump...(really -- fed govt failure).

>> 5. Trump's anti-mask attitude sets a bad example

The devil incarnate :-)

>> 6. Some states permitted huge mass demonstrations

From what I've read these aren't responsible for the come-back in cases. Reasons: (1) they took place outdoors, (2) a lot of protestors wore masks.

Don't forget, tear- and pepper-gas made a lot of protestors cough and spit phlegm, = dangerous. Tear gas isn't even allowed in warfare.

Trump wouldn't cancel his rallies, either.

David in Cal said...

David - I am familiar with the "not enough masks for public and health care workers" excuse. IMHO it does not make sense.

1. I believe the mask shortage that JD refers to was the fancy N95 masks. All the public needs is a simple cloth or paper mask that can capture or slow most of their outgoing saliva droplets.

2. It's easy as pie to make a cloth mask. The first one I had was cut out from an old sock. It required no sewing at all. I found instructions on the internet. Friends of mine have been sewing masks and giving them away. They've made thousands. Manufacturing a mask is trivial, requiring a piece of cloth and some elastic. It should have been obvious that when masks were recommended, the supply would appear very very rapidly.


David Appell said...
This comment has been removed by the author.
David Appell said...

"According to Anthony Fauci, the nation’s leading infectious disease expert and a key member of the White House coronavirus task force, masks weren’t advised to the public from the start because of the anticipated PPE shortages."

The Hill, 6/16/20

David Appell said...

David, back to your very first comment:

"Protecting health is not getting in the way of economic recovery, it's the route to economic recovery."
-- Andrew Revkin, ex-NYT science journalist