Okay, I want to start with a couple of notes. First the panic purveryors (again, can’t spell pandemic without panic) are ecstatic about what they view as runaway case growth in some states. Some is clearly due to more testing, related to back to work testing or just bigger capacity and greater encouragement for everyone too get testing. Some is repeat testing of the same individual. And there are more cases, largely among younger people and almost all asymptomatic or mild cases. This is a good thing, the more people who have these kinds of infections the better for reaching population immunity at a minimal cost, which will be the surest way to protect the vulnerable. These people failed miserably in their hysterical projections the first time around; pay no attention to them this time.
And the same thing goes for hospitalizations. Here is why hospitalizations are up even though deaths are down. A lot of people get coronavirus when in the hospital for another reason and then are counted as a CV patient. Doctors may be putting people in the hospital out of an excess of caution, because they don’t want to get sued. That is not good for patients; hospitals are dangerous places to be. People are staying in the hospital longer, because they don’t want to be discharged to nursing homes for the end of their recovery. People are staying in the hospital longer because many are getting remdsivir, which has very limited benefit, but has a five day course of treatment, so once started on the drug the patient has to stay in the hospital for five days. The hospitals love this, they get to mark up an expensive drug to make money and they get paid for extra days. I have been working with hospitals for 40 years. They are masters at maximizing revenue. They get paid extra for coronavirus patients. I guarantee you they are treating as many people as possible as coronavirus patients. But in most hospitals coronavirus patients are a small percent of all patients in the hospital, so unless we want to go back to killing people by having them defer other needed care, hospitals are going to be pretty full, as they normally are.
We need much better data on hospitalizations. For every patient, in addition to basic demographics we need to know date of admission, date of discharge, major treatments, such as ventilators, ICU or remdisivir, while hospitalized, how they acquired the disease, where they acquired it (including if in the hospital), when they were diagnosed and place of discharge. Hospitals have this data readily available; we need to see it in aggregate form so that real trends and causes can be identified.
The daily Minnesota briefings are getting shorter and today Commissioner Malcolm didn’t even bother to attend. Lot of teeth gnashing about young people going out and socializing and getting infected and how dangerous that is to themselves and others. Please start telling the truth. If you are under 30 for sure you have a very low risk of serious illness. And people who have asymptomatic or even mild infections, aren’t very infectious. And my comment above about this being good for population immunity stands. We need lots of asymptomatic and mild illness among young people.
The second thing was again the dancing around a question about Wisconsin. They just can’t be honest about it and say we are worse in deaths and it is probably because we were so slow to deal with long-term care issues. They tried again to tell the lie that sometimes we look better than Wisconsin and sometimes worse. Since about the first three weeks, when there were few cases in either state, we have consistently been worse and the gap steadily widened. And that is with Wisconsin not having a statewide lockdown since May 13. I have looked at the social distancing and mobility measures and Wisconsin has consistently been more active than Minnesota since the end of the lockdown, which makes the comparison even harder for Minnesota officials to explain. At least they didn’t go with the science is different is different places explanation.
Finally, and I forgot to put this in when I wrote the post last nite, according to an article in the local paper, we are to be blessed with another version of the Minnesota epidemic model to help guide us through the months ahead. Several million dollars later, I am hoping they can be close to right this time.
This study, which I will quickly summarize, basically says that strict lockdowns in developing countries, using Brazil, Bangladesh, Pakistan, Chile and South Africa as examples, have failed to bring the epidemic under control and that the socio-economic impacts are even more devastating in these nations than in developed ones. (Medrxiv Paper) They didn’t work particularly well in the developed world either.
And this story reports on a study of schoolchildren in France. (BB Story) This is a final version of a paper I posted on some time ago, and I will just quote from the story, so everyone gets the message pretty clearly “The study confirms that children appear to show fewer telltale symptoms than adults and be less contagious, providing a justification for school reopenings in countries from Denmark to Switzerland. The researchers found that 61% of the parents of infected kids had the coronavirus, compared with about 7% of parents of healthy ones, suggesting it was the parents who had infected their offspring rather than the other way around.” Open the damn schools now!
These researchers used daily deaths to estimate the actual number of cases in Spain. (Medrxiv Paper) They used antibody survey results to estimate true incidence at a certain time and compare to death numbers to get a CFR, which could be used for other dates. Treating date of testing as the date of infection is erroneous they believe and they work backward from average lag to symptoms and death to estimate dates for undetected infections. They found that there were 30 to 40 times more infections than were reported by confirmed infection tests, which is astounding if accurate. They also believe the first infection in the country was in early January, over a month before the first confirmed case.
And here is another paper attempting to ascertain the true infection rate. (Medrxiv Paper) The authors purported to use daily tests, cases, hospitalizations and deaths to derive a formula to determine the variance of reported cases from true numbers. Leaving aside the very complicated math, the authors focus on the positive rate of tests as a key variable for the prediction of total number of cases and that rate’s relationship to hospitalizations and deaths. They did their calculations of actual cases, etc. by state, and generally find many multiples of actual cases. In Minnesota for example, on the date a couple of weeks ago when we had 3o,199 cases, their formula says we actually had 267,000. Not sure I totally buy the approach, especially because it assumes the population is equally sampled for severity of illness, which I have repeatedly said I believe is wrong–the epidemic is front-loaded with severe cases. But it is likely there are more actual cases than detected ones.