Update on the pandemic in the U.S.; Cases and deaths in Europe; Masks; Scott Atlas interview; Epidemiologists Stray From the COVID Herd; NYC schools; Debate over Trump's handling of the pandemic
I continue to closely follow the pandemic, sending lengthy e-mails to my coronavirus e-mail list every week or two (if you'd like to receive them, simply send a blank e-mail to: cv-subscribe@mailer.kasecapital.com).
Here's the e-mail I sent to my readers yesterday afternoon...
1) Part of the pandemic is playing out just the way I predicted in my last e-mail 12 days ago (posted here):
- Near-term news flow will likely be negative as the third wave burns through previously less-affected areas: based on our analysis of state hospitalization data, we expect that reported daily deaths will peak in six to 12 weeks at around 1,000 to 1,200 (less than half the peak levels reached in April), and will remain elevated for at least three weeks.
The key question is whether the other part of my prediction will prove true:
- What's happening is evidence for, not against, the herd immunity threshold/breakpoint theory because of where the surges are occurring: namely, in the parts of the country (Midwest and the Mountain West) as well as rural areas that were not hit in the first and second waves.
- We believe this wave will be: a) the least serious one... and b) the last one. We are now in the "burnout" phase of the pandemic.
- Nearly all major regions and population centers in the U.S. are at or will soon reach the herd immunity threshold (roughly 20% to 30% prevalence), so the spread of the virus should slow substantially (even without considering the potential positive impact of the many new vaccines and therapies being developed in record time).
I continue to think the odds of this are good.
Here are the latest national data:
Tests per day continue to rise, which explains roughly half of the rise in cases:
Cases per day are at or near record highs (this is what the media is going berserk over):
But far more important are hospitalizations and deaths – and here, the news is better. As you can see in this chart, the former have only ticked up a little:
Lastly, as I predicted, the number of deaths per day is beginning to rise, though nowhere near the jump in cases, for two reasons: a) deaths are a lagging measure... and b) the fatality rate is quite a bit lower than it was earlier this year, likely for a number of reasons: better drugs, docs knowing how to better treat sick patients, younger and healthier people catching COVID-19, etc. (here's an NPR story about this: Studies Point to Big Drop in COVID-19 Death Rates):
This trend is likely to continue. To repeat: "We expect that reported daily deaths will peak in six to 12 weeks at around 1,000 to 1,200 (less than half the peak levels reached in April), and will remain elevated for at least three weeks."
2) Europe is seeing an even more extreme version of what's happening in the U.S. – cases skyrocketing to far above the highs earlier this year, but deaths per day are 80% to 99% lower (so far, anyway – again, they're a lagging indicator). Here are charts for France, Spain, Italy, Germany, Sweden, and the U.K. (Belgium and the Netherlands are the same), which all show pretty much the same thing:
France
Spain
Italy
Germany
Sweden
U.K.
Here's more info about the U.K.:
A New York Times op-ed called the virus in Europe "fully out of control," but that's not clear to me based on these charts. Yes, countries should take measures to tighten things up (which they're doing), but I think they're right to resist going back to full lockdowns.
3) I find it sad (and emblematic of our polarized times) that something as simple and obvious as wearing masks has become so politicized. Here's a blurb in yesterday's NYT about recent evidence that it helps slow the spread of the virus:
The power of mask mandates
They're restrictive, tedious, and hotly contested, but since the early days of the pandemic we've known masks to be an efficient and cost-effective way to help prevent the spread of the coronavirus.
And they're even better, it turns out, when you oblige people to wear them.
Take Kansas, where a real-world experiment in face coverings emerged this summer. In early July, Gov. Laura Kelly, a Democrat, issued a statewide mask order, but was forced to let counties opt out of it under a law limiting her emergency management powers.
Only 20 of the state's 105 counties enforced the order, which required residents to wear masks in public. Those 20 counties saw half as many new coronavirus infections as the counties that did not have the mandate in place, according to a new study from the University of Kansas.
Cellphone-tracking data from the University of Maryland showed no differences in how often people left home in the counties with or without mask mandates, so it seemed likely that the masks made the difference.
Experts say it's part of a countrywide trend: Localities that impose mask mandates often see fewer cases, fewer hospitalizations, fewer deaths and lower test-positivity rates than nearby localities that do not.
Other studies have turned up similar results in Alabama, Oklahoma, South Carolina and Texas. A recently published report from the Centers for Disease Control and Prevention found a 75 percent drop in coronavirus cases in Arizona less than a month after mask-wearing became enforced and bars and gyms were shuttered.
One of my readers, epidemiologist Dr. Kevin Maki, commented:
My view on masks is that the evidence to support their effectiveness is weak, but suggestive of a modest benefit. Although the evidence is not strong, the cost and risk are low. Most of the benefit is likely secondary to reducing the quantity of viral particles that get aerosolized (i.e., protecting others from someone who is infectious), although there is a reasonable argument to be made that wearing a mask may reduce the degree of viral exposure for the mask wearer, resulting in a less severe infection if one occurs.
Even small reductions in either direction may translate into important effects because the relationship is non-linear. While I am not sure we need to be too concerned about young people infecting one another, the risk from SARS-CoV-2 is much higher for older people and those with comorbidities, so face coverings have an important potential role in protecting the vulnerable.
4) The idea of the herd immunity threshold or breakpoint is very controversial, and those who espouse it have been severely criticized, so I think it's only fair to hear what they have to say, in their own words.
Here's a 13-minute video interview (with transcript) with Scott Atlas: "I'm disgusted and dismayed." Excerpt:
Herd immunity policy?
"No. It's a repeated distortion, lie, or whatever you want to call it... What they mean by 'herd immunity strategy' is survival of the fittest, let the infection spread through the community and develop a population immunity. That's never been the policy that I have advised. It's never even been discussed inside the White House, not even for a single minute. And that's never been the policy of the President of the United States or anybody else here. I've said that many, many times... and yet it persists like so many other things, hence the term that the President is fond of using called fake news."
On herd immunity
"Population immunity is a biological phenomenon that occurs. It's sort of like if you're building something in your basement: it's down on the ground because gravity puts it there. It's not a 'strategy' to say that herd immunity exists – it is obtained when a certain percentage of the population becomes resistant or immune to an infection, whether that is by getting infected or getting a vaccine or by a combination of both. In fact, if you don't that believe herd immunity exists as a way to block the pathways to the vulnerable in an infection, then you would never advocate or believe in giving widespread vaccination – that's the whole point of it... I've explained it to people who seemingly didn't understand it; I've mentioned this radioactive word called herd immunity. But that's not a strategy that anyone is pursuing."
What is his policy?
"My advice is exactly this. It's a three-pronged strategy. Number one: aggressive protection of high risk individuals and the vulnerable (typically the elderly and those with co-morbidities). Number two: allocate resources so that we prevent hospital overcrowding, so that people can be treated for this virus and get the other serious medical care that is needed. Number three: open schools, society and businesses because keeping them closed is enormously harmful – in fact it kills people."
And here's a Wall Street Journal interview with two of the three authors of the Great Barrington Declaration: Epidemiologists Stray From the COVID Herd. Excerpt:
What unites the two men is their revulsion against the "current COVID policy." This policy "violates every single value I hold dear," Dr. Bhattacharya says. "Every single one." Elaborating, he says he accords paramount importance – "derived, in my case, from Rawlsian and Christian commitments" – to the protection of the vulnerable and the poor world-wide from "avoidable death and suffering." The lockdowns have "manifestly failed to do this by inducing economic collapse that has placed the lives of 130 million poor people world-wide at risk of starvation."
He also values "the norms of medical ethics that militate against doing harm to patients." The current lockdown policy, in his telling, asks children and young adults – "who face more medical and psychological risk from the lockdowns than they do from COVID infection"– to accept this harm "in the false hope that this sacrifice will protect the vulnerable people."
Mr. Kulldorff describes lockdowns as "the worst assault on the working class in half a century – the worst assault since segregation and the Vietnam War." Present policies are protecting "very low-risk college students and very low-risk professionals – attorneys, bankers, journalists like you, scientists like me – because basically we can work from home." (Working at home hasn't been a hardship for either man, though Dr. Bhattacharya's life became much easier after he persuaded a neighbor that it was safe for his young son to play outdoors with the Bhattacharya children. Mr. Kulldorff's biggest worry isn't COVID; it's his 18-year-old son driving the family car.)
In contrast to privileged professionals, Mr. Kulldorff says, the blue-collar class is "out there working, including high-risk people in their 60s. So the working class is building up the population immunity that will eventually protect all of us." Dr. Bhattacharya adds that one of the reasons "minority populations have had higher mortality in the U.S. from the epidemic is because they don't often have the option – even if they're older or have co-morbid conditions – to stay at home."
Lockdown policies are not only "regressive," with their disparate impact on the poor and minorities; they reflect, Dr. Bhattacharya says, a "sort of monomania." The world "panicked in March, and the focus came to just be on COVID control and nothing else." People saw pictures from Wuhan, China, and Bergamo, Italy, and concluded that they had to do "something very, very drastic in order to address this drastic thing that's happening." There was "an action bias that led to the adoption of lockdowns as a form of contagion itself." (There is an academic paper that models the lockdown-contagion idea, titled "Explaining the homogenous diffusion of Covid-19 nonpharmaceutical interventions across heterogeneous countries.")
Mr. Kulldorff says the Covid-19 restrictions violate two cardinal principles of public health. First, "you can't just look at COVID, you have to look holistically at health and consider the collateral damage." Among the damage: a worsening incidence of cardiovascular disease and cancer and an alarming decline in immunization. "People aren't going to the doctor," he says. Dr. Bhattacharya also points to the suspension of tuberculosis programs in India and of malaria-eradication programs elsewhere.
Mr. Kulldorff's second principle: "You can't just look short-term." Dr. Bhattacharya says we will "be counting the health harms from these lockdowns for a very long time." He says anti-COVID efforts are sowing the seeds of other epidemics: "Pertussis – whooping cough – will come back. Polio will come back because of the cessation of vaccination campaigns. All these diseases that we've made substantial progress in will start to come back."
5) Good news from New York City (and further evidence that we're at/near the herd immunity threshold here – see citywide data here): In NYC Schools, Only 18 Positive Coronavirus Tests Out of 10,676.
6) With the election less than a week away, I wanted to share both sides of the argument about the Trump administration's response to the virus:
- From Democrats, here is a 10-minute video
- From Republicans, here is an article from City Journal: Confronting COVID: The American response has been far better than critics acknowledge, and here is a graphic:
Best regards,
Whitney