Covid 8/13: Same As It Ever Was

Last time: Covid 8/6: The Case of the Missing Data

I got the opportunity during this past week to work with a state official to try and solve the case of the missing data. It felt great to have the help and also to potentially be reaching someone who could make a difference, even if this particular attempt didn’t amount to much.

What we found was that there were seemingly independent, plausibly innocent explanations for a substantial portion of the testing gap. Any one of them would have been easy to accept. Even any two of them. But all of them happening at once, in ways that couldn’t be attributed to the storm, was harder to accept as random chance.

We didn’t get to the bottom of it all and figure out what was going on. We didn’t have the resources to follow up on a detail level and go county by county or hospital by hospital, which would have been the way forward. If anyone knows, they aren’t talking. All I know how to do in that situation is to move forward, while keeping all eyes open for the missing pieces. As usual, each day and each week continue to tell the story. What was unclear will become clear over time.

The biggest question this week was whether the decline in testing was temporary due to the storm, an artifact of poor data collection, or something more permanent. Now that we know it wasn’t a momentary blip, the question is whether things will continue to deteriorate, stabilize at this new level, or start improving again.

And if things aren’t improving, the follow-up question is why, and whether we are being sabotaged. Sabotaged by those who think, like the President has claimed many times, that the way to avoid having Covid-19 cases is to avoid testing for Covid-19.

There is of course also the data itself. Last week wasn’t only alarming because the number of tests declined. It was also alarming because the positive rate went up. Would that continue as well?

Let’s run the numbers.

Positive Test Counts

Date	WEST	MIDWEST	SOUTH	NORTHEAST
May 21-May 27	23979	39418	42977	37029
May 28-June 3	32200	31504	50039	33370
June 4-June 10	35487	24674	55731	22693
June 11-June 17	41976	22510	75787	17891
June 18-June 24	66292	26792	107221	15446
June 25-July 1	85761	34974	163472	16303
July 2-July 8	103879	40139	202863	18226
July 9-July 15	108395	53229	250072	20276
July 16-July 22	117506	57797	265221	20917
July 23-July 29	110219	67903	240667	26008
July 30-Aug 5	91002	64462	212945	23784
Aug 6-Aug 12	93042	61931	188486	21569

Same question as last week. Is the South recovering, or is it hiding its problem by not testing?

Deaths

Date	WEST	MIDWEST	SOUTH	NORTHEAST
Apr 30-May 6	775	1723	1290	3008
May 28-June 3	875	1666	1387	2557
June 4-June 10	743	1297	1230	1936
June 11-June 17	778	1040	1207	1495
June 18-June 24	831	859	1204	1061
June 25-July 1	858	658	1285	818
July 2-July 8	894	559	1503	761
July 9-July 15	1380	539	2278	650
July 16-July 22	1469	674	3106	524
July 23-July 29	1707	700	4443	568
July 30-Aug 5	1831	719	4379	365
Aug 6-Aug 12	1738	663	4554	453

Northeast deaths number is disappointing, but not alarming, as the number last week was too big a drop to not involve reporting delays.

The West and Midwest peaking is great, but again, it’s too soon. Midwest and West situations definitely weren’t improving two weeks ago, so how are their death counts going down already? That goes double when we consider variable lags, which should push the reported deaths peak even farther past the infections peak.

I don’t buy it. And ‘delays’ doesn’t work as well as an argument this week as it did last week.

Positive Test Percentages and Test Counts

Date	USA tests	Positive %	NY tests	Positive %	Cumulative Positives
June 4-June 10	3,177,318	4.4%	438,695	1.4%	0.61%
June 11-June 17	3,446,858	4.6%	442,951	1.1%	0.66%
June 18-June 24	3,638,024	6.0%	440,833	1.0%	0.72%
June 25-July 1	4,331,352	7.1%	419,696	1.2%	0.82%
July 2-July 8	4,461,980	8.2%	429,804	1.1%	0.93%
July 9-July 15	5,196,179	8.4%	447,073	1.1%	1.06%
July 16-July 22	5,481,861	8.5%	450,115	1.1%	1.20%
July 17-July 29	5,757,290	7.8%	448,182	1.1%	1.34%
July 30-Aug 5	5,079,828	7.9%	479,613	1.0%	1.46%
Aug 6-Aug 12	5,014,573	7.5%	502,046	0.9%	1.58%

(Note that North Carolina deleted 220,000 negative tests that it now claims belonged in other states. I’ve added those back to avoid it warping the weekly total.)

Another decline in testing, although this one was small. Positive test percentages fell instead of rose, so arguably real progress was made. New York seems to have resumed making progress again, and is down to 39 deaths and a positive rate substantially under 1% in the past week.

There’s still plenty to be concerned about.

Messing With Texas

The scariest state right now by far is Texas.

That’s a running seven-day average. It peaked over 60,000 tests per day, and it’s now down under half of that and still falling fast. Positive test rates are over 20%. One of our biggest states, that is also one of the epicenters right now, has lost the majority of its testing capacity, or is hiding a huge percentage of its tests.

So, seriously. What the hell? Who is messing with Texas? Why isn’t this a headline crisis.

Current hospitalizations are down 25% in Texas over the last two weeks. I want to treat that as a good sign, but, again, what the holy hell. There’s no way real cases are down that much. Even if they were, it takes a while for previous patients to work their way out of the system, and the system should have been at or over capacity before. Deaths aren’t declining yet, so it should be really alarming that hospitalizations are way down.

Arizona also has a dramatic test decline, with its moving average down by almost half. The difference is that Arizona’s positive test percentages are coming under control, and case numbers are falling even faster. They’re down by more than two thirds in a month, and more than half over the last two weeks. Hospitalizations are down by half. It’s still not a good situation, and certainly too early to start winding down testing capacity, but one could consider that a success story.

I won’t bother making a section of it because I’ve already covered similar ground many times, but if there is an explanation for Arizona’s uniquely rapid improvement that isn’t ‘Arizona had a ton of people get infected and is now getting tons of benefit from herd immunity’ I would like to hear it in the comments.

Florida’s testing is also down by a third, and isn’t recovering now that the storm has passed.

Thus, the situation definitely is substantially worse than it looks in the overviews. The states with the highest positive test percentages are doing less tests. Other Southern states that were doing better don’t see the same testing declines.

This looks a lot like a concerted effort to make the numbers look superficially good at the cost of our ability to contain and treat the virus.

Are things generally improving in the South? I think so, but it’s not clear. Elsewhere, it’s even less clear.

And of course: Winter is coming. School is coming.

Responsible Adult Tries To Help

If you haven’t read it yet, I highly encourage you to read this Wired interview with Bill Gates.

Bill Gates is not perfect. One can certainly criticize Bill Gates for various failures to better optimize his actions. He made plenty of mistakes, especially mistakes of omission, on Covid-19. He has made many other mistakes with the Gates Foundation in other domains. Certainly those I know in the Effective Altruism movement would have plenty to say on these subjects.

What makes him unique is that Bill Gates is actually trying.

As far as I can tell, no one else with billions of dollars is actually trying to help as best they can. Those same effective altruists are full of detailed thoughts, but aside from shamefully deplatforming Robin Hanson it’s been a long time since I’ve heard about them making a serious attempt to do anything. Covid-19 was a real world test of every charitable group’s ability to actually do effective things when faced with a real crisis, and every billionaire’s ability to get out there and do something.

Almost all of them failed completely.

Bill Gates didn’t. He’s out there doing the best he knows how to do.

Thus, we should quote Theodore Roosevelt, and first and foremost applaud him and learn from him.

Also, read the whole thing. Mostly the information speaks for itself.

Here are some of the key takeaways:

C.D.C. has been sidelined and prevented from doing helpful things by the White House. The White House is not letting them engage.
The White House is not interested in improvements that would show there was some imperfection before, so they are not interested in essentially any improvement.
He estimates the impact of Covid-19 on a similar scale to the world wars.
The President is an active vaccine skeptic and forces Bill Gates to meet with Robert Kennedy and other anti-vax advocates and listen to them, and won’t let Bill challege when they say obvious nonsense.
The President has declined to meet directly with Gates.
Gates has had to struggle even to get basic funding (e.g. 4 billion) for vaccines in trillions-sized rescue bills, despite the vaccine money being by far the most important thing in those bills.
If infected, Bill would ask for Remdesivir and dexamethasone. He doesn’t want special treatment. They improved hospital outcomes by ‘a factor of two’ although it’s not clear what that means.
Other antivirals are two to three months away. Antibodies are also two to three months away. They will help more.
Direct quote: The majority of all US tests are completely garbage, wasted. If you don’t care how late the date is and you reimburse at the same level, of course they’re going to take every customer. Because they are making ridiculous money, and it’s mostly rich people that are getting access to that. You have to have the reimbursement system pay a little bit extra for 24 hours, pay the normal fee for 48 hours, and pay nothing [if it isn’t done by then]. And they will fix it overnight.
Another direct quote directly after, on why we don’t do that: Because the federal government sets that reimbursement system. When we tell them to change it they say, “As far as we can tell, we’re just doing a great job, it’s amazing!” Here we are, this is August. We are the only country in the world where we waste the most money on tests. Fix the reimbursement. Set up the CDC website. But I have been on that kick, and people are tired of listening to me.
Gates is willing to work with anyone who is willing to work with him, of either party.
He uses a normal surgical mask, so he doesn’t know of better tech on that.
For a vaccine, we need 3-4 months of Phase 3 data to know if it is safe and effective, and the FDA is doing a good job resisting pressure to move too fast.

The point about fixing reimbursement is the most important and well-taken of all. All we have to do is rule that tests get (well) paid for if and only if they get back quickly, and suddenly every test gets back quickly. It really is that simple. Anyone blaming private actors for responding to their financial incentives is not engaging in useful behavior.

I’m mostly not interested in the blame game, but it must be pointed out: If the story told here is accurate, and I have no reason to believe that it isn’t, then this is additional confirmation that the President and White House are actively sabotaging the response to Covid-19. We should treat them accordingly.

I disagree with Gates on two points.

First, Gates seems to be treating the actions of the F.D.A. as if they were reasonable and appropriate. This in terms of what tests to allow and what requirements should be before approving those tests, and also in terms of vaccine development and approval. He declines to bring up other F.D.A. actions shutting down additional helpful action in other areas, but wasn’t asked.

My assumption is that Gates is furious about all that, but has decided that it doesn’t do any good to fight on that front, and so has chosen other fronts. I can certainly understand that decision. It might even be the tactically right decision in his position. As those who read these summaries know, I have a very different position.

My other disagreement with Gates is on his not wanting special treatment. This is outrageous!

It’s not a minor disagreement. It’s an entire philosophy that thinks the solution to “You have two cows” is “kill the cows because you didn’t bring enough cows for everyone else in the class, then also don’t eat the meat because there isn’t enough of that for everyone either.” It is a death cult and a suffering cult, and it has to stop.

Rapid Rapid Testing Update

There are signs of hope. Scott Gottlieb reports here that we are close to a rapid test being approved:

This simple, accurate saliva test could soon be first test authorized for asymptomatic screening and may be lowest cost test to hit market with ability to be pooled. It’s independent of supply chains. Runs in 2 hours. Owes to work of NBA, Yale docs, others https://t.co/h2bMJjdjSJ

— Scott Gottlieb, MD (@ScottGottliebMD) August 9, 2020

If this delivers as advertised, it will be a huge step forward.

It’s not the strip. It takes two hours. It can be pooled, which means pooling it is a thing one might reasonably want to do. So it’s not everything we hoped for.

It’s still a huge step forward. Let’s hope this is for real and happens soon, and can scale quickly.

There’s even competition coming:

The University of Illinois–which created a saliva test which returns our COVID-19 results to us online within hours–is taking steps to make this technology available to others nationwide https://t.co/qNmBqa6dXk

— Julian Reif (@JulianReif) August 11, 2020

There’s also this post from Marginal Revolution explaining why rapid tests are great, which is likely the best link to give someone if they want an explanation.

Marginal Revolution also suggested a LIFO approach to testing, which they called Stack-Push-Pop, where we focus on getting as many tests back within a day or two as possible by evaluating the most recently received test we have rather than the oldest, and discarding old tests if we don’t get to them within two days.

On its face, this makes perfect sense, because it’s obviously the right thing to do and maximizes test effectiveness. Unfortunately it is a non-starter for several reasons.

First, it would lead to people getting multiple tests at once because they’re afraid of their tests being discarded. People would totally do this. This would cripple the system.

Second, it would be called ‘unfair’ and we’d hear about nothing else. These charges would be deeply stupid, as are most charges that things are ‘unfair’ and it would be better to be deeply inefficient so that everyone can be be worse off together, but one must recognize when such reactions would be too strong and find another way.

Third, there would be concern about cheating and playing favorites, which would no doubt take place. Some of that concern would no doubt prove justified.

It’s still good for someone to shout from the rooftops the obviously correct solution, even if it’s not practical. But alas, we must find a better way.

One obvious better way is the one suggested by Bill Gates, above. It seems like the best option available if we’re going to refuse to approve the rapid tests – pay for speed and only for speed, and you get speed. Period.

School Hard

School is hard. It’s thirteen to twenty-two years hard time.

It doesn’t have to be this hard.

The debacle at Paulding County High School is an encapsulation of our entire Covid-19 response.

Immediately upon school resuming, a student posted photos of the hallways between classes. They looked like this:

Ugh, what a preventable mess— The Paulding County high school that became infamous for hallways crowded with unmasked students… now reports 6 students and 3 staffers in the school now with #COVID19 after a week of classes.

WHY WHY WHY? so predictable.https://t.co/XHk7LFcv94

— Eric Feigl-Ding (@DrEricDing) August 9, 2020

Halls packed with students, all forced to hurry between classes at being punished for being late. Few if any of them wearing masks of any kind. I didn’t see any reports of how things looked inside the classrooms, but I have a feeling they didn’t magically find a way to organize them in a remotely safe manner. If they had even adhered to the illusion of security of sitting six feet apart, attendance would have to be down enough that the hallways wouldn’t be packed.

So, of course, the school suspended the student who posted the photos.

The stated justification was that the student had violated school policy, posting on social media and using the phone during school hours, and posted photos of other students online. The actual justification is so obvious it need not be said.

There was such a Twitter uproar that the school backed down, and allowed the student to return to class.

This story is more than a little backwards. The student was being forcibly imprisoned in a way that greatly endangered the health of them and their family. They were punished by being kicked out of that dangerous prison in favor of staying home. Then everyone protested and the student was told to report back to the prison cesspool. That this student brought this problem to our attention and has been taught to strongly signal every woke cause out there (citation: five seconds looking at their Twitter account), yet doesn’t realize they should want out of their hot zone of a prison rather than back into it, speaks volumes.

When asked about why masks were not required, the response was that schools could not enforce a rule requiring masks.

There have been some big lies told regarding Covid-19. This might be the new champion.

A school can’t enforce wearing masks?

Schools tell students where to stand. Where to sit. What to say with what tone of voice at what time. They don’t let you go to the bathroom without a permission slip. When they get mad at you, they imprison you for longer on a whim and you can’t do anything about it. They require slave labor on your own time in the form of “community service.” They police social media posts. They regulate the length of girl’s skirts. They require exactly defined proper attire for physical education on point of failure. Many schools outright have entire uniforms. They make many kids go through metal detectors and live shooter drills over statistically non-existent risks. They have security cameras everywhere.

And you. Are telling me. That you can’t make students. Wear. A. Forking. Mask.

That’s it. America simply ‘can’t’ do it. Just like we ‘can’t’ do lots of other things.

Which, in turn, means we have failed in our sacrifices to the Gods. We must be punished.

Thus, when the school reports an ‘outbreak’ a few days into the school year, before there is time for any kids to infect other kids at the school, of course we blame it on them not wearing masks.

It wasn’t even a surprising number of students. There’s this thing called base rates.

The school had six positive tests among students, for a 0.33% positive rate.

During that two week period, 0.43% of Georgia tested positive for Covid-19. For the one week period, that number was 0.23% of its 10.62 million people.

Thus, if the start of school coincided with an inclination to test, the number of infected was actually a pleasant surprise statistically speaking. Yes, there’s a lot of other factors, it’s not that simple and all that, but there’s nothing to be horrified about other than the general situation in the country.

The three faculty testing positive was higher than one would like, but it was the first week of class and it typically takes five days to test positive.

There is of course a valid point that the school would inevitably need to close. Which it did this week, for a completely pointless ‘deep cleaning.’ Which is basically this, at about that level of performative skill.

But so what? That had nothing to do with its terrible policies. It had everything to do with the base rates, and with our obsession with deep cleaning.

Of course, you could reasonably argue that while it makes no sense to close the school now if you were going to open it in the first place, you can’t commit to that action. Which means, given that you are definitely going to close the school in this situation, that’s a good reason not to open it in the first place. And that’s fair.

Also, what the hell are they doing putting kids into a school in early August in the first place? That has to be some sort of cruel and unusual punishment even in normal times.

What of the future? What happens when more schools are open?

As I’ve said several times, expect any schools that do open to spread the virus regardless of what nominal distancing measures are taken. Taking no measures whatsoever, as in Paulding, will do it faster and more reliably. But no given school is inevitably going to become a cluster, and no in-person school is that unlikely to become a cluster unless it is a region that keeps the virus contained. If a region allows many in-person schools, keeping the virus contained is not going to be easy.

Also expect such schools to close every time there is any tangible sign of infection or trouble, despite the base rates saying that these infections are to be expected continuously. Thus increasing the pressure to avoid, sabotage or hide testing.

There’s this article from the Washington Post about vaccinations and Covid-19. It’s got a lot of good info, but one section in particular caught my eye.

They knew that the vaccine for smallpox, for example, had been shown to protect against measles and whooping cough. Today, a number of existing vaccines are being studied to see if any might offer cross-protection against SARS-CoV-2.

The results were intriguing: Seven types of vaccines given one, two or five years in the past were associated with having a lower rate of infection with the new coronavirus. Two vaccines in particular seemed to show stronger links: People who got a pneumonia vaccine in the recent past appeared to have a 28 percent reduction in coronavirus risk. Those who got polio vaccines had a 43 percent reduction in risk.

We Want To Play

The big sports news this week was the partial cancellation of college football.

As far as we can tell, almost all the players want to play.

As far as we can tell, almost all the coaches want to play.

As far as I can tell, the players as a group will be as safe or safer with respect to Covid-19 on their football teams as they would be without them, if the teams act responsibly. We had an example last week of a team acting deeply irresponsibly, but that seems to be the exception rather than the rule, at least in the power five.

As far as I can tell, the risk of Covid-19 for a college student is trivial compared to the risks of playing football normally. The reduced number of games likely meant that the 2020 season would have been actively safer than the 2019 season. There are essentially no worlds where it is responsible to let them play in 2019 and 2022, but not in 2020.

College football provides a massive amount of revenue to schools, many of which will now face gigantic fiscal gaps that will have to be made up somehow.

College football provides great joy to at least tens of millions of Americans, and its absence will make it much harder to maintain safe procedures elsewhere.

One ESPN talking head opined that football is actually likely to be relatively safe from the virus, as everyone is wearing gloves and helmets to begin with. That seems right to me. We can put face shields into the helmets. Basketball seems like a much more dangerous sport to play during the pandemic.

Football is still riskier than baseball, but that’s an extremely low bar. As with baseball, although not to the same extent, I expect the real risk of football to be what happens on the sidelines, in the locker rooms and during practices. I expect relatively little spread between teams or during games.

Despite that, first the MAC, then the Big-10, then the PAC-12 have pushed their seasons to the spring. As of this writing, the SEC and ACC seem determined to proceed, and the Big-12 is leaning that way as well.

Same as it ever was. The red states get on with their lives. The blue states shut things down.

Once one actor shuts something down, anyone else who doesn’t shut down something similar becomes blameworthy, so they’re under tons of pressure to cave and shut down. Which creates pressure on others to shut down in turn, whether or not it makes sense. The decision to shut down is made largely on the basis of who else will then shut down because that makes you look like a responsible bold leader taking a principled stand, whereas if they didn’t follow you’re the one who screwed things up for no good reason.

It’s true when the right move is to shut down. It’s true when the right move is to get on with life.

The parallels to other forms of cancellation seem clear.

I’m torn about what I want to happen now.

The first best solution would be what I advocated weeks ago. Play a full spring season. Give us two full days per week of football from September to May, every weekend, first NFL and then college, avoiding the dead zone of sports for those of us who aren’t into basketball. The NFL can avoid the disaster that is Thursday night. We can finally watch all the good college games each week without having to guard against spoilers at the bottom of the screen. Ideally it would all be permanent.

So part of me hopes the ACC, SEC and Big-12 cave and move to the spring and everything works out.

The problem is that I have no confidence that everything would work out. Once postponed once, would things be postponed again at the slightest sign of trouble? Would we end up with a massively truncated season? Would college football’s entire structure come under attack and potentially collapse? There are some very large risks here, and I see no reason to assume a sensible response to real conditions when the time comes to make decisions.

Thus, the hope that we get the second best solution, and the remaining three conferences play now, decide the championship, and essentially force the hand of the PAC-12 and Big-10 in the spring. If they skip their entire season while other conferences play, they’ll be at a huge disadvantage the next few years in both recruitment and performance, and their players will lose out massively in the draft. It will be a huge blow, and one I will enjoy watching happen.

Even more fun would be if Nebraska and a few other teams carry through on their threat and join the southern conferences for the year. I don’t expect anything like this to happen, but I’d love to see a Big-12 supplemented with Ohio State, Michigan, Penn State and Nebraska. Chaos. Always root for chaos. Sweet, delicious chaos. Plus we still get spring football to tide us through.

I definitely know that before the cancellations, I was heavily rooting for the season to proceed as planned. And I know I am taking this opportunity to say shame to everyone who cancelled football and other athletics to avoid looking irresponsible. Also shame to everyone who didn’t investigate the physical situation, and thus assumed that playing would indeed be irresponsible.

The worst case scenario, of course, would be if shutting down college football led to pressure to shut down the NFL. We can’t shut down the NFL. No football, no peace.

The good news is that, per ESPN, the positive rate on NFL players right now is 0.58%, much lower than the population level despite much greater testing and the generally completely irresponsible default behavior of football players. That’s a great sign.

We Are Playing And It’s Great

Mets suck. Good news is, I’m used to that and I’m fine with it. Play ball!

Cause otherwise, this baseball season’s going pretty great.

The USA today page listing positive Covid-19 has been updated through August 9 as of press time. In the extra four days, there were three positive cases, all on the Cardinals. I haven’t heard about any other cases and there are no news items concerning additional cases, so it’s likely no one tested positive on August 10 or 11. That’s three cases, which presumably are related to the previous Cardinals cases. For a random set of a thousand people we would have expected one new positive test, but that’s due to our lack of sufficient testing. We would expect more than three new actual positives, probably between five and ten.

I don’t want to make that sound like some great triumph. Cases come in clusters, so it makes sense that most weeks would look good and then occasionally a week would look quite bad. Still, if we average in the additional week, and its ability to calm everyone down about the need to cancel the season, things look very good. Looks like we’re going to make it.

Covid 8/​13: Same As It Ever Was