You need to forget the idea of a “peak”

I haven't posted something like this before, but you may want to look at this video of doctors and nurses in Spain applauding a taxi driver who has been driving people with likely Covid-19 to the hospital for free. He got an order to pick someone up at the hospital, and they ambushed him with their applause and a check. Now tell me you didn't get choked up watching this - in fact, don't tell me. I won't believe you.

  

Over the weekend, I had a very good discussion with Steve Parker of EnergySec on Facebook (where I’ve been posting the link to The Pandemic Blog every day) about the course of pandemic deaths. Steve has been doing his own work to project deaths, and he sent me his spreadsheet, which I finally reviewed this morning.

He takes a very different approach to total deaths than I do. I’m just projecting them using the most recent figure for total deaths, grown by the most recent 3-day growth rate in that figure. On the other hand, he’s broken the population into specific age categories and calculated their death rate so far. To get the absolute worst case for total deaths – when literally every person in the country, of any age, is infected – he multiples each group’s death rate by their absolute numbers, and adds the results.

Doing this, he comes up with a figure of a little less than 6 million for total deaths in the worst case. I don’t think anyone will argue that six million deaths isn’t terrible, but at least it’s not like some much higher numbers that you could arrive at using other means.

More importantly, it’s highly unlikely that the entire population would get infected. A lot of epidemiologists talk about “herd immunity” as something that will kick in when between 40 and 70% of the population is infected. Using the 40% figure, Steve calculates there would be about 2.3 million deaths. Of course, this shouldn’t be a comfort to anybody.

However, there are still serious questions about the herd immunity idea. In fact, it’s not a good assumption that someone who has either had the virus or been heavily exposed to it will be immune. Sure, they’ll develop antibodies, but there are still some big uncertainties, including:

1. What level of antibodies is required to confer immunity.
2. How long that immunity will last. An article in the Wall Street Journal this morning quoted an immunologist as saying the range could be 6 months to 60 years – unfortunately, it won’t really be known until some people who have sufficient antibodies get sick again.
3. Most scary, there’s still concern whether there is any real immunity at all. The South Korean government is looking into 160 cases of people who were infected, recovered and tested negative, and then were reinfected. Another scientist said this was probably because the virus can hide deep in the lungs of a person and escape the normal tests. But either way, the fact is that just because someone was infected, has antibodies and had a negative test doesn’t mean they’re not still infected, or couldn’t get infected again. The moral of this story is that anyone who thinks that antibody testing will be the key to a “magic ticket” that will let someone safely attend ball games, work in crowded factories, etc. is over-optimistic.

In other words, we’d better hope that something will stop this epidemic in the US, long before we even have to start hoping that herd immunity will “save” us (if that’s even the right word for 2.3 million deaths!).

The scientists have been unanimous on what can stop the virus: a total lockdown of the country, combined with widespread availability of testing and contract tracing. Only by doing a total lockdown of at least a month will we have any hope at all of identifying everyone who has the virus, tracing all their contacts and quarantining them, probably shutting down all domestic and international travel (by land, air and sea), etc. That’s the only way we stop the virus dead in its tracks – not eradicate it, but have it totally under control. And by the way, if we’d done that when it was first discussed widely in early March, we would now be in a position to start safely opening up.

This was kinda sorta the idea behind the administration’s plan announced on Thursday evening, which president Trump (correctly) got compliments on. But the next day, he threw all that away by essentially calling on citizens in blue or purple states (including one state he won in the 2016 election, Michigan) to rise up against their governors and end the shutdowns that are in place in those states immediately – and, of course, to violate the law in doing son.

What about testing? Trump has declared that not to be a problem (and, disgracefully, Drs. Birx and Fauci seem to support his position, although they didn’t talk that way at all last week), although he did say yesterday he was going to order an unnamed company to produce lots of the cotton swabs whose relative unavailability (along with the other supplies needed for each test) is the main reason testing is so far behind now (i.e. there are a lot of test kits out there which can’t be used because the supplies required to do a test aren’t available).

Remember when Trump said he was a general leading the battle against the virus? Well, guess what? He’s now saying he’s won the war, even though the enemy has burst through our gates and is in the process of slaughtering our fellow citizens.

Remember, things are only going to get worse, not better – just look at the numbers below, which have actually improved since yesterday because the death rate fell vs. the previous day (although it still lacks a clear downward trend). The problem is, the only way we’ll ever beat the virus is if the infection rate goes to zero – and that’s only with a total lockdown. As it is, that doesn’t seem to be in the cards at all. Currently we’re in a loosening period, and a few weeks after that happens deaths will again start to climb at a faster rate than they are now. People will get alarmed and restrictions will be re-imposed, which will later lead to the death rate going down, and the cycle repeats.

That’s why I say you need to forget the concept of a “peak” of this pandemic. It will probably continue until a vaccine appears and is manufactured in enough quantity so that the whole world can have some (remember, every developed country is racing to develop a vaccine. It’s not at all guaranteed that the US will be the first to develop it. If we want to be able to share in somebody else’s vaccine, we need to say now that we will share ours if we happen to be first to develop one. Is that likely to happen, given today’s White House? I’ll let you answer that one).

The earliest a vaccine will be developed, adequately tested and manufactured in big quantities will probably be two years. And this would still be pretty good; the mumps vaccine took four years just to be developed. This means we have at least two years of start and stop opening up and closing down. Of course, during this time there will be no question of having rock concerts, sporting events, etc. – maybe even church services – and there will be many months over the two years when we’ll all be at home like we almost all are now. But this is the price we’re evidently willing to pay, since it seems the decision has been made that we’ll never bite the bullet and do a total lockdown.

The Numbers

We’re on the third day of decline in the three-day growth rate of total Covid-19 deaths in the US, which is the number I’m now using to project out deaths into the future. It would be nice to think this is just the beginning of a final decline in deaths to zero – which of course is the ultimate goal of fighting the pandemic. It would also be nice to think that every child in the world will find a pony waiting outside for them when they wake up tomorrow morning.

This decline came after a sharp spike last week, which was preceded by a decline that ended last Monday (at 26%, vs. 17% yesterday), and by a month long cycle that began around March 13 and peaked at 159% on March 24. I hope you get the idea: This number has been up and down, and to assert that this three-day downtrend will continue until we get close to zero (we certainly won’t reach zero for a long time – see above) is to substitute hope for reality. We already have the top people in our government who do that daily – they don’t need further assistance in that effort.

And remember: As the absolute numbers get larger and larger, the fact that the rate of increase is declining becomes more and more beside the point. For example, using the 20% 3-day growth rate I measured in yesterday’s post (and used for my projections), we would have 2.9 million deaths due to Covid-19 from March through June. With today’s rate of 17%, we’ll “only” have 1.8 million deaths in the same time period. Does that make anybody feel happy?

Week ending	Deaths reported during week/month	Avg. deaths per day during week/month	Pct. Change from previous week/month
March 7	18	3
March 14	38	5	111%
March 21	244	35	542%
March 28	1,928	275	690%
Month of March	4,058	131
April 4	6,225	889	223%
April 11	12,126	1,732	95%
April 18	18,434	2,633	52%
April 25	16,682	2,383	-10%
Month of April	69,489	2,316	1712%
May 2	26,359	3,766	58%
May 9	36,270	5,181	38%
May 16	50,595	7,228	39%
May 23	79,946	11,421	58%
May 30	110,004	15,715	38%
Month of May	299,590	9,664	431%
June 6	153,451	21,922	39%
June 13	242,468	34,638	58%
June 20	333,631	47,662	38%
June 27	465,403	66,486	39%
Month of June	1,447,563	48,252	483%
Total March - June	1,820,700

Red = projected numbers

I. Total deaths

Total US deaths as of yesterday: 40,565

Increase in deaths since previous day: 1,551

Percent increase in deaths since previous day: 4%  

Yesterday’s 3-day rate of increase in total deaths: 17% (used to project deaths in table above)

II. Total reported cases

Total US confirmed cases: 764,265

Increase in cases since previous day: 25,342

Percent increase in cases since yesterday: 5%

Percent increase in cases since 3 days previous: 13%

III. Reported case mortality rate so far in the pandemic in the US:

Total Recoveries in US as of yesterday: 71,012

Total Deaths as of yesterday: 40.565

Deaths so far as percentage of closed cases (=deaths + recoveries): 36% (vs. 36% yesterday) Let’s be clear. This means that, of all the coronavirus cases that have been closed so far in the US, 36% of them have resulted in death. Of course, this number will come down as time goes on and more cases are closed in which the victim recovered. But this number has gone down and up since Worldometers started publishing the recovery rate on March 26 (when it was 41%), and on about half the days, it’s gone up; there is still no sign of a downward trend, and other countries like Italy and France show comparable percentages.