I briefly commented yesterday on reaching the end of May, with the ability to compare our actual epidemic impacts from those projected by version 3 of the model used by the Governor to justify his extreme actions in response to the epidemic. Other events have interfered with the normal messaging, and that is exactly what it is, around the epidemic by the Governor and his staff. Yesterday’s briefing was yet another opportunity, especially having passed the end of May, for an acknowledgement that projections used in decision-making are not even close to reality. Instead the health commissioner and her staff continue to try to spread the danger message, and referred to waves of the disease. Time to give it up.
One interesting item we finally got a little clarity on is the issue of advance directives. A question was asked about those, and the response was that yes, not only do many of the long-term care residents have advance directives forbidding intensive care or even hospitalization, but a number of the deaths occurred among people on hospice or other end-of-life care who just happened to contract coronavirus disease before they died. It would be nice to get a clear delineation of actual place of death and advance directive or end-of-live care status. My guess is that as many as half of the long-term care deaths fall into this category, especially since so many are apparently dying in the nursing home or residence, not a hospital. Should those deaths really be treated as coronavirus epidemic deaths? And if you did that analysis nationally, this wouldn’t even look a normal flu year.
Let me give you a little more information on how great the data and science the Governor has been using to guide his decision-making is. I gave you a little sense yesterday on badly the epidemic model was performing. The Governor has continued to talk about how we are “moving up the curve” and it is just getting more dangerous. Let me show you just how absurd the numbers are. Let us look at what the model, based on the current mitigation strategy and actions, says will have happened by June 15, two weeks from now.
The model which conforms to the current mitigation of spread strategy says that we will have 4338 deaths on June 15. More absurdly, you have to look at the projections for cases by age group. In the 0 to 9 age group, there are projected to have been 311,520 cases or 48.5% of the entire population in that age group. It gets better, for the 10-19 year-old cohort, there will have been 601,833 cases, or 82.5% of that entire group. You get the drift. But wait, in the 60 to 69 aged cohort, which has basically the same population as 10-19; 20-29, and 50-59 cohorts, there have been only 110,831 cases, or 15.5% of the population in that age group. And in the 80 plus group, only 20,874 cases, or 8.1%.
Aside from the wildly high numbers, what is noticeable is that the contact model, the formulas that determine how often people will have contacts with others, says that the epidemic progresses more slowly and there are fewer deaths in the oldest groups. While there is some support for the idea that proportionately there are more cases in the middle-aged cohorts, deaths are very disproportionately skewed to the older groups. The other factor which is clearly out of whack is the R or transmissibility factor starting at 3.87 and then staying relatively high. More recent evidence is that it is closer to 2.5 and now some are saying that in the general population it may actually be below 1. That high R is what is giving such large case numbers.
In any event, while May was embarrassing for the model output, June 15 is simply laughable. I am eagerly awaiting to see the press call out the Governor et al to explain this and to explain how and why reality is diverging so strongly.