A Little Late Night Rambling

By November 5, 2020Commentary

I traveled again this week, brave soul that I am, went to a business meeting.  Given the current ventilation specs an airplane may be the safest place to be these days; they practically suck the air right out of your lungs.  In any event, gave me a chance to ruminate on the epidemic, what we might have learned, what we are seeing now in the case surges in Europe and North America (why not Asia–did they have a much bigger epidemic last spring than anyone realized?  Are they ignoring it now?  Is there something meteorologically different there?  It isn’t masks, etc., look at the pictures coming out of Chinese night clubs.)

Another big case dump today in Minnesota, but again, look at the case table by specimen date, pretty interesting pattern to follow.  And more deaths to help us climb up to Sweden’s rate.  Some European countries are already seeming to plateau or slow in their case growth rate.  Everywhere the rate of deaths is much lower than in the spring, so people wonder why.  I will go back to what I have been saying since the spring.  This epidemic is front-loaded.   Meaning that if you imagine the virus as an agent sampling the population with the purpose of killing those it samples, it wasn’t doing a random sample.  It was preferentially finding and infecting the most vulnerable and it was killing many of them.  It still is more likely to cause serious disease when it reaches the vulnerable, but frankly there are less of them.  We have killed 2% of our LTC population in Minnesota.  So while hospitalization rates are somewhat similar, death rates are lower.  Better treatment accounts for some of this as well.

You may recall that in the spring and into the summer, the CDC, and the Minnesota Department of Health, were estimating that only around 10% of infections were being detected.  This was based on antibody prevalence surveys and the knowledge that most infections were asymptomatic or mild, so most people didn’t even think they were infected with anything and most didn’t seek medical care.  At that point there was very limited testing.  The infamous Minnesota Model (still waiting for that update) made a similar assumption.  If that were true throughout the epidemic, we would have 1,650,000 Minnesotans who had been infected, or about 30%.  In anyone’s epidemic model, and especially in ones that take heterogeneity in contacts, infectiousness and susceptibility into account, that is enough to dramatically slow transmission.  If the virus walks into a bar with ten people, three aren’t targets, and more realistically, only 5 out of 10 people are actually in the bar.

I don’t believe we are detecting only 10% of cases under the current testing regime.  I have begun looking at some somewhat complicated math to equalize testing and detection rates, by assuming that as testing ramped up, detection improved.  Someone may be able to figure out some better formulas than I have, and I will show my work shortly as part of my exercise in normalizing cases to testing.  But I would guess, and it is a guess, that now we are probably catching at least 25% of infections.  That assumes that people with symptoms are getting tested for sure (not a rigorous assumption) and that contact tracing, testing before health care appointments and mandated work testing are picking up a lot of asymptomatic or presymptomatic cases.  God knows we are testing enough.   If that is true we have had about 650,000 infections in Minnesota or around 10% of the population.  Still enough to substantially slow transmission in a heterogenous population, largely because it is a very good assumption that those with the most contacts are the most likely to get infected first, so you are removing a large number of total contacts from the susceptible pool.

So again, the current features of the epidemic, with summary thoughts:

Testing–way too much, likely lots of false and low positives.  Ineffective to guide contact tracing efforts.

Cases–a clear swell in cases, driven a little by testing, but more by meteorological factors–less sunlight, lower temperature, lower humidity–which apparently are more hospitable to CV-19; by human physiology–lower vitamin D levels, perhaps other biological changes; and by human behavioral changes–we are indoors more and we are at home more, both of which are associated with more transmission.

Hospitalizations–also clearly up, length of stay appears to be down, almost certainly driven by remdesivir administration and shorter observation stays to monitor oxygen levels.  What do total hospital days look like?  Rates per cases do not appear up.

Deaths–also up, rates per cases definitely not up.  Still occurring largely among LTC residents, although a lower percent than in the Spring, partly due to so many already having been killed and partly to avoidance of being in an LTC facility.  Occurring at as high or higher rate among the elderly as in the Spring.  Community dwelling population rates of serious disease and death are low.

I will go out on the limb again today, which I really try to avoid doing, because there is so much uncertainty about this virus, and say that I believe we will see the case peak in this swell in a week or two, then with the usual pattern, cases will fall off first, followed shortly by hospitalizations, with deaths tailing off last.  I could be very wrong, perhaps we will see some astounding surge all winter long, but I don’t think so.  Look at NYC and New York as a whole.  They have much lower current cases number than we do on a much higher population base, but they also had antibody prevalence rates as high as 25% or more.  Current transmission rates appear strongly related to depth of epidemic in the Spring.

Join the discussion 9 Comments

  • Steve says:

    Your analysis is clear and logical. Unfortunately, politicians, public health officials and “experts” successfully scared people enough that they are resistant more to reason than to the virus. In my healthcare consulting career we were told to never reveal preliminary thoughts about a study because people will lock onto that first utterance and never let go. We see this wisdom play out in the China virus plague; for political purposes they conditioned people to be fearful and still, to this day, people cannot let go of that fear. My grandchildren who go to a Catholic School have been in person for 8 weeks without incident. And, this is true among other Catholic Schools in Maryland Yet, public schools either remain closed or hybrid at best.

    My daughter who is 37 years old wanted to have a social event with other kindergarten mom’s. After the event was scheduled one of the mothers said the gathering had more than 20 people and therefore would be too risky. She insisted that no one should go and concluded her remarks by indicating she is an M.D. I said to my daughter, oh, she must be a virologist- actually she is not but in this era of panic anyone who sports M.D. after there name assume they are an expert

    I asked would she attend if the gathering was 19 not 20? How did they decide 20 was safer but no more.If a restaurant server entered the room wouldn’t that make it 21. People have lost any degree of common sense

  • Chuck says:

    Thank you for the great insight Kevin! And I think Steve makes great points. I was scared by the initial phase of this pandemic. As Kevin and people like Steve shed more light, I only wish the mass of doomsdayers would gain some common sense. Follow the science!

  • SteveD says:

    What happens in the next few months will be interesting. My feeling is that we were lucky to have born the brunt of COVID19 out of season (so to speak; in the summer). This allowed us to gradually build up immunity over the summer months and hopefully mitigate the seasonal increase which is currently occurring. The seasonal peak or bump should be much reduced compared to what we might have seen if COVID19 had started to spread in September rather than February.

    According to the CoVid tracker, deaths don’t appear up; maybe slightly but we’ll see what the depths of winter bring. Deaths being front-loaded is one reason they are less, but we also have become much better at treating it.

    ‘I asked would she attend if the gathering was 19 not 20?’

    I bet if we used the base-8 system rather than base-10 (decimal) system for numbering, our limit would be 16 or 24 and our 50th birthday wouldn’t be anything special. 🙂

  • Michael Timmer says:

    Good post, Steve. The science is tough in the case of this new virus. Unfortunately science itself doesn’t supply the answers as to how to live with the virus. Trade-offs have to be made, and those decisions should be made with a large dose of humility. The politicos, almost to a man, are unfortunately acting like politicos. Science only becomes settled to the extent that it can with long re-examination, and politicians simply hate to admit that they can be misguided or wrong. The anecdotal evidence of the Catholic schools should give them pause, but, of course, hell no.

  • Ganderson says:

    Here’s where I meant to post:

    I suspect we’re headed for another full lockdown here in Massachusetts. As I posted here yesterday, we are required now to wear masks at all times in public, both indoors and outdoors, including while playing golf. Next step will be to require all schools to go remote. Charlie Baker has gone insane!

  • Lee says:

    on Asian counts – do they user lower cycle counts for PCR Testing? Frankly, I’ve always been suspicious of their death counts, but then we in the US probably count too many of them. I am SOOOO tired of this. I think every nurse acquaintance on FB is publishing things about “Wear you Mask!!!” And my hairdresser said one of her clients who is religious about her mask got thrush! Go figure. Thanks for you posts. I consider them my daily sanity dose!

  • Darin Kragenbring says:

    Excellent as usual, Mr. Roche. And wonderful reader comments as well.

    I believe the test sensitivity has to play a major role in the extreme rise in cases, along with testing every asymptotic person who saw someone who is infected. Early in the pandemic when the virus’ lethality may not have been fully known, it may have made sense to test everyone. Now, it just seems like an exercise in futility —similar to the “hygiene theater.” We know who is vulnerable—protect them as best we can.

    The comments about the psychology associated with the pandemic are insightful and woefully forgotten amid the fear. Mentally latching onto the first anything is extremely difficult for people to later let go. The reluctance or inability of leaders to admit mistakes—is there anyway to reintroduce humility into politics? And masks! The “mask up” mantra may be the most insidious thing from the pandemic. There is no way cloth masks materially reduce the spread of the virus. A cloth mask might help in a specific incident; however, there will be innumerable times when the “safety” of a mask leads people to behavior which helps the spread. What little research there was before the pandemic about cloth masks showed they were ineffective. And why wasn’t there more research….maybe because common sense would tell you cloth masks aren’t effective against a virus?!

    It’s been so refreshing to find this blog—for the connection to research and to the critical thinking which will be necessary for society to move forward. If educated people are unable to recognize the arbitrary and capricious restrictions plaguing the globe right now, this will take longer than I ever imagined or feared. Life is going on out there—go live it, as safely as you can—yet do live it!

    Cheers!

  • Dirtyjobsguy says:

    I’m trying to digest the results of the mass testing in Slovakia. Roughly two thirds of the total adult population was tested over a weekend (3.5 Million tests). Only 1% tested positive. If these were basically asymptomatic people (a reasonable assumption I think), then they have probably got a plausible upper bound for the currently infected. BUT, like all testing based regimes I think the data was pretty much useless. Yes they could isolate the 1% (and possibly do some ineffective contact tracing to isolate a few more), but the other 30% untested are enough to provide a source of infection.

    Are the epidemologists simply afraid to say they’ve reached the limit of isolation usefulness?

  • Rob says:

    Bureaucrats like Fauci certainly will never admit that they don’t really understand exactly how viruses work nor will they ever admit that mitigation techniques are limited and not even their area of study. Snake oil is illegal to sell unless government is the seller. When the bureaucrats are on the hot seat, they’ll flush scientific rigor down the crapper if it gets people off their backs while they’re happy to jump on anyone’s back who dares point out their limitations and mistakes.

    If you think it’s bad now, wait a couple years when these frauds start claiming immunity from lawsuits. Like the financial fraudsters 12 years ago, one or two will get prosecuted as examples and then nothing will happen to the rest.

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