A couple of introductory comments. One, on the vaccine news, from Pfizer, that the interim results from its large Phase trial suggest the vaccine is 90% effective, should be good news. That is an extraordinary effectiveness for a respiratory pathogen. However, I would caution you that it is unlikely to be as effective in the elderly, for whom vaccines, including the flu vaccine, often don’t provide as high a level of protection. Since the great majority of the burden of illness is in the old, I worry that given the hysterical reaction to date, even 10% to 20% of cases continuing to exist among the elderly might be enough to justify ongoing restrictions for the panic-prone.
And assuming that we actually have a President-elect, and the electoral college, not the media, will be the determiner of that, the proposed coronavirus task force is full of people who do not have a balanced perspective, including one prominent Minnesota epidemiologist, who has advocated locking us all down forever. Not a good start to ensuring that we minimize the total health and economic damage done by the epidemic and associated responses. I have some news for the experts, people die from things other than CV-19. Coronamonomania strikes again. And since I am slow completing this post, that prominent Minnesotan has indeed advocated for a complete national lockdown until we have the virus under control, or the year 2050. This guy is an embarrassment to himself, the profession and the state. He literally is clueless on important aspects of the epidemic. But the good news for all of us, every time he calls for a lockdown, it is the top in cases, so expect a rollover soon.
And here is a little data tidbit from my work on current prevalence. The rate of doubling of any event does tell you something about how fast it is occurring. The state started issuing weekly reports every Thursday (weird day to pick, use Friday or Sunday) since May 14. Based on the current number in the November 5 report, total cases doubled in about 8 weeks. Scary? Okay may not so much. Testing doubled in about 9 1/2 weeks. But testing is a huge number, almost 3 million, so not surprising it takes a long time to double. (okay, another screwed up thing about the weekly reports, they don’t use unique individuals tested, they use all tests, so you don’t actually know cases, which are a unique individual, compared to tests of unique individuals, or the true positivity rate) Hospitalizations have doubled in 12 1/2 weeks, which reflects that slowing rate of hospitalizations versus cases. And deaths doubled in a little over 20 weeks, again reflecting a even greater decline in the rate of deaths versus cases. So cases going up with some speed, hospitalizations and deaths much slower.
And one more tidbit as it is taking me forever to finish this post. In today’s daily report from Minnesota, the number of people “released” from isolation rose by 3581 people. As I suggested a week or so ago, the higher cases with about a two week lag would start to show up in higher numbers of no longer infectious or released persons. So the daily active case number will begin to show much slower growth. A little over 3900 new cases were reported today (again, these are basically all actually from test specimens collected on days in the prior week) and 23 died. So your actual active case number grew by only 300 cases. I would anticipate that in about a week, we may begin to see a decline in the active case number.
A relative paucity in the release of new papers in the last few days, so I am relatively caught up. Here is an interesting tidbit. One of the mask modeling papers which supposedly showed lower case growth in counties with mask mandates has been withdrawn. The authors note that recent case surges mean they need to update the work. You may recall I have criticized this and other similar studies for being too selective in the dates they select, for ignoring confounding factors and for using mask mandates rather than mask wearing. I am sure these authors will find some way to make it look like the mandates are still effective, but at least they recognized that the prior research was misleading at best. (Medrxiv Withdrawal)
The CDC wrote a paper on CV-19 hospital readmissions. (CDC Paper) Hospital readmissions are pretty common and the Medicare program and private payers have spent a lot of effort trying to force reductions, since they are viewed as sign of low-quality care. 9% of hospitalized CV-19 patients were readmitted within 60 days. These are really sick patients in general, with lots of comorbidities, so that number isn’t surprising at all. 8% had been admitted to the hospital for something other than CV-19 in the three months before, so these are patients who are in the hospital frequently due to their serious comorbidities. And they weren’t readmitted for CV-19, but because of the comorbidities. The media of course made it sound like this was related to CV-19. Interestingly, however, people with influenza hospitalizations have even higher readmission rates, 14% in only 30 days and 47% within a year, and for the same reason–they are people in very poor health who use a lot of hospital care.
I am going to publish this post now, although I now do have some additional research to summarize, but I also have to listen to two press conferences by the IB and give some reaction to those.