No Reason to Panic, But That Won’t Stop It From Happening

Yes, cases are rising in Minnesota and some other parts of the country, mostly the Upper Midwest and the Rocky Mountain states, and the rise isn’t all due to more testing, although it would be really nice for the state to reveal the distribution of cycle numbers and verify how many false and low positives we are seeing.  And yes, hospitalizations are rising, and that is a more significant measure to me.  But in Minnesota at least, length of stay is shorter, indicating less serious illness.   It appears that many of the hospitalizations are observational in nature, for oxygen level monitoring, and/or for remdesivir administration.  I also wonder how many hospitalizations attributed to CV-19 are actually situations where the patient acquired the infection in the hospital.  See this study from the CEBM finding that in England about 18% of all CV-19 hospitalizations are ones in which the patient got infected in the hospital after being admitted for another reason.  (CEBM Study)

And deaths also appear to have risen.  I am just over a week into doing daily pulls of the CDC updates to its weekly date of death reporting, and for some reason, deaths are not being added at a pace as quickly as Minnesota reports them, so either there is a lag in Minnesota sending stuff to the CDC or there is a processing lag at the CDC.  But the deaths that are added are almost all in the last two or three weeks.  The deaths, however, continue to be highly concentrated in the frail elderly, many in long-term care facilities.  We are not yet close to May weekly death totals, but definitely much higher than weekly totals in the summer.  These trends seem very similar in all the other Upper Midwest and Rocky Mountain states.  And it should be obvious that all the nonsense we hear about masks, social distancing, the LTC battle plan, more testing, more contact tracing, and so on, make absolutely no difference.  The curve is the curve.

The other notable feature is that unlike the earlier spike in cases in spring, which was largely in higher population areas, this one is more dispersed.  I suspect that is because the opportunities for transmission are greatly reduced in areas that were harder hit before.  Our so-called expert epidemiologists, one of the most prominent of whom is from Minnesota, have done a horrible job explaining the basic concept of population immunity.  Population immunity doesn’t imply that the virus miraculously disappears.  This virus is never going to disappear unless it mutates beyond current recognition.  It is going to be endemic, or with us at a background level with occasional outbreaks.  I bolded that because we all need to accept that, it is reality.  Politicians need to accept it, and if our public health experts aren’t giving the politicians that advice this is another glaring failure on their part.  That reality should guide our policy, with a long-term view.

Population immunity refers to a sufficient number of people in the population being resistant to becoming infected, and more importantly, infectious, so that the virus has fewer targets to hop to and continue its spread.  That resistance could be a result of pre-existing immune defenses, general or specific to coronaviruses; adaptive immune responses to a CV-19 infection; and vaccine-prompted immune defenses against CV-19.  Forget the nonsense about classical levels of infection resistance needed to really slow transmission, those are grotesquely outdated models.  Better understanding of contact patterns in particular, and variability in susceptibility to infection and infectiousness, suggest much lower levels are needed for substantial spread to be eliminated.  But the effect is really a scaling one–at every point after initiation of the epidemic, obviously the opportunities for spread are being reduced, and are being increasingly reduced.  So if even 20% of the population has resistance to being infectious, spread is going to slow dramatically.  This is partly because those with the most contacts are most likely to be infected and once infected and resistant to infectiousness, you are removing a lot of total contacts from the potential for transmission.  So in Minnesota, for example, spread in the Twin Cities metropolitan area does not appear to be occurring at the same rate as in some outstate areas, and I would attribute that to a level of population immunity that inhibits transmission.

Remember these features of this epidemic:  geographic variability; population density; age bifurcation; front-loading and death pull-forward.  Just for reference, here, from the latest Minnesota Department of Health weekly report, which I encourage you all to read, (for those from other states, I assume you can find similar data on various websites) are the stark numbers showing that ongoing age bifurcation.  There are 12,807 cases in people 70 or over.  This is 9% of all cases.  There are 1936 deaths among this group, that is 80% of all deaths.  At the other end, people under 40 are responsible for 78,063 cases or 55% of the total.  But there are only 24 deaths among this cohort, or 1% of the total.  If you looked at these numbers on a percent of population basis, the spread would be even more extreme.  Hospitalizations show a similar, but not as extreme, trend.  So why are we restricting the general population at all?  Supposedly to protect those vulnerable elderly?  Aside from the ongoing failure of the state to produce any actual evidence of transmission from the young to the old, most of the serious illness among the old is concentrated in long-term care residents, who by definition don’t live in the community and are in a more isolated, theoretically more protectable environment.  Yet 73% of all deaths are among these residents.

My biggest concern is that, as we are seeing in Europe, Coronamonomania sets in and panicked politicians, as always, aided by a hysteriaphilic media, begin implementing even stricter business and school closures and stay at home orders.  It is like we haven’t learned a thing.  These measures make no difference in the epidemic curve and only create the conditions for greater pain in the future.  I strongly suspect that several governors, like our own IB, are only waiting for the election to be over to announce measures to supposedly squelch transmission, but that won’t do a thing in that regard.  As you all know from reading the research summaries, there is study after study showing the health care harms, including deaths, caused by this obsession with preventing CV-19 infections.  And what we have done to our children is, in my judgment, literally criminal, and politicians should be held to account for that damage.