Posts Tagged ‘pandemics’

Colorado’s Increased Deaths

Monday, October 12th, 2020

The Denver Post has a really interesting review of excess deaths this year in Colorado.

The official numbers say that Colorado currently has 2,113 “deaths among cases” of COVID-19, and 1,998 “deaths due to COVID-19.”

But deaths are actually up around 20% over normal, or “at least 3,788,” says the Post. In terms of raw numbers, “the state recorded on average” 18,935 deaths “for the same period during the three years prior,” and “an estimated 22,723 . . . between March and August.”

A caveat: “There’s a lag in death-certificate data so it’s possible the number of fatalities during the first six months of the pandemic could still rise further.”

Another key detail: “Of the excess deaths, at least 1,627 were Coloradans who died from COVID-19 complications. This number is lower than the state [official] count of such fatalities [because] unlike the death-certificate data, [the official count] includes non-residents who died from the disease while in the state.”

The upshot is that fewer than half of the excess deaths are accounted for by formal findings of COVID-19. What’s responsible for the rest of the deaths?

Uncounted COVID-19 cases are part of the mix, but “it’s unclear how many of the fatalities are from missed COVID-19 diagnoses,” the Post says.

The Post did find that deaths from “cirrhosis, heart disease, diabetes and Alzheimer’s also saw significant spikes.” The best explanation for most of these deaths is that people delayed care. What about Alzheimer’s, which saw a 26% spike? Maybe the increased deaths have to do with worse care and more social isolation. Or (I think more likely) maybe more people with Alzheimer’s were dying of COVID-19 but not diagnosed with it.

Here’s a surprising finding: “Suicides dropped 2% over previous years, to 639 deaths.”

However, “between March and August, 597 Coloradans died of overdoses, which is up 40% from the 3-year-average of 424 deaths, according to the state data.”

The Political Threat to the Supply Chain

Friday, September 11th, 2020

“The biggest risk to medical supply chains is not free markets, a global pandemic, or a natural disaster, but politicians themselves.”

Speaking of supply-chain issues, inputs for N95 masks remain scarce. The AP blames the government’s lack of contracts and “letting” people sell materials overseas; I think the real problem probably is U.S. price controls that disrupt the market.

Masks as Immunity Device

Thursday, September 10th, 2020

I’ve written a bit about variolation, a sort of poor-man’s version of a vaccine. The idea is you intentionally (or accidentally, I suppose) get a small dose of an infectious disease that hopefully won’t make you too sick but will make you sick enough to develop immunity.

Here’s an intriguing idea: Maybe wearing a mask can act as a sort of variolation device, to reduce one’s exposure to the virus and hence reduce the severity of symptoms. This could help explain declining COVID-19-related deaths. See an article by Web MD (which quotes Amesh Adalja) a study by NEJM.

COVID-19 Updates

Thursday, September 3rd, 2020

I haven’t posted updates about COVID-19 for a while. This is by no means intended as anything like a comprehensive run-down.

Apparently Colorado businesses are not required to notify customers if the business suffers a COVID-19 outbreak. Moreover, “contact tracing efforts rarely extend to customers.” What a disaster.

Tyler Cowen writes, “The FDA has been too risk-averse in the very recent past, for instance in its reluctance to approve additional Covid-19 testing. Economists have generally concluded that the FDA is too risk-averse in the long term as well, considering all relevant trade-offs.” Cowen argues that vaccine approval is inherently political and that people who want to advocate for delays in a vaccine need to offer better arguments.

Atul Gawande discusses how to ramp up testing: “To get out of this pandemic, we need fast, easy coronavirus testing that’s accessible to everyone. . . . We could have the testing capacity we need within weeks. The reason we don’t is not simply that our national leadership is unfit but also that our health-care system is dysfunctional.” He puts much of the blame on the CDC and FDA (as do others).

Steroids cut deaths.

Colorado’s COVID-19 Testing

Monday, July 27th, 2020

Ben Markus has out a report about Colorado’s lackluster testing program for COVID-19. Aside from the terrible federal response, the state had two main problems: the health department had a serious leadership meltdown leading into the pandemic, and outside help didn’t seem to accomplish much. I Tweeted a summary with some supplementary information.

In other news: “Thousands of people defy public health orders, pack into a field in Weld County for an outdoor concert.” Here’s more.

And: “Woodland Park [Colorado]-based Andrew Wommack Ministries held a multi-day conference that included over 1,000 attendees from July 30th through July 3rd. Now the Colorado Department of Public Health and Environment has traced a COVID-19 outbreak to the event, with seven staff members and fifteen attendees testing positive.”

Protest Avoidance Behavior and COVID-19

Monday, July 20th, 2020

Denver economist Andrew Friedson thinks the George Floyd protests did not on net cause an increase in COVID-19 cases because they scared other people indoors. What this doesn’t answer, of course, is whether the protests themselves led to any new cases of COVID-19, or how many.

Moderna Vaccine

Wednesday, July 15th, 2020

In a phase 1 trial with 45 people, the Moderna vaccine induced an immune response in all participants.

Watson on COVID-19

Monday, July 13th, 2020

Nell Watson has an absolutely terrifying take on COVID-19. The upshot is that many people who get it are likely to have severe long-term health problems.

The Possibility of Plasma

Saturday, July 11th, 2020

Scientists have devised a way to use the antibody-rich blood plasma of COVID-19 survivors for an upper-arm injection that they say could inoculate people against the virus for months. . . . But the idea exists only on paper. Federal officials have twice rejected requests to discuss the proposal, and pharmaceutical companies—even acknowledging the likely efficacy of the plan—have declined to design or manufacture the shots, according to a [Los Angeles] Times investigation.”

I am continually amazed by how poor the American response to COVID-19 is—and how good it could be if people got serious about it.

The U.S. Testing Fiasco

Saturday, June 27th, 2020

Paul Romer discusses “the massive damage that the FDA is doing by restricting the supply and use of tests for the SARS-CoV-2 virus.” He notes that “although the FDA promptly approved the broken test from the CDC, it took an excruciatingly long time to approve tests that actually worked.” Romer includes many details and many citations pointing to specific aspects of the problem. Maddening.

Protests and COVID-19

Saturday, June 27th, 2020

So this is an interesting finding: “Black Lives Matter protests increased net stay-at-home behavior, likely among non-protesters, and COVID-19 case growth did not increase.” Of course, we are seeing case growth around much of the U.S., so it would interesting to know how much COVID-19 did spread through the protests, even if there was a stronger offsetting effect. Based on headlines I’m seeing it seems like bars and parties are a big part of the current rise.

Liberty and Pandemics

Monday, June 22nd, 2020

Various people who work for, and who are associated with, the Ayn Rand Institute have been working up some very interesting ideas on government’s proper role in a pandemic. Here I address a new article by Onkar Ghate on the topic and a summary op-ed by Ben Bayer. The upshot: Government should play an active role in protecting people from infection by others, should have spelled-out and delimited powers in this area, and should not resort to wide-scale lockdowns.

Bayer writes, “The freedom that matters is the individual’s right to be free from the physical interference of others. This means freedom from murder, robbery, battery, and the threat of infection from another’s disease. So a government dedicated to protecting liberty rightly has the power to quarantine individuals who threaten to infect others with a dangerous disease.”

Ghate takes the now-common view that government properly tests people for infectious diseases (of sufficient severity), traces contacts, and quarantines the likely infectious.

So these Objectivists definitely do not take a libertarian anti-government stance. And they lay out an expansive concept of “interference” against which government properly acts that includes even unintentional infection.

COVID-19 Updates for June 16

Tuesday, June 16th, 2020

Eric Feigl-Ding summarizes, “Children and teenagers are only half as likely to get infected with the coronavirus as adults age 20 and older, and they usually don’t develop clinical symptoms of COVID-19. This lends support to kids returning to school in the fall.” See the related Washington Post story.

An incident in in the U.S. Army suggests that a 14-day quarantine may not be sufficient to prevent subsequent infection.

I think it’s a stretch to say Anthony Fauci “lied” about masks, but he certainly didn’t go out of his way to clarify the matter early on, either.

Dexamethasone proves first life-saving drug.” Maybe. But, even if this result holds up, it only does so much. “It cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth,” the BBC reports.

Julia Marcus recommends creating small social bubbles of a few friends or a couple of households, who limit their other social interactions.

Atul Gawande summarizes that two Missouri hair stylists saw 140 clients while infected with the coronavirus, but, likely because they wore masks, didn’t infect anyone else.

Adalja on Navigating the Pandemic

Monday, June 15th, 2020

Infectious disease expert Amesh Adalja writes, “There are some values that are worth pursuing, even in the face of risk to oneself and to others whom one may infect. Public health officials who made that case during the protests perhaps should have communicated the message earlier — and they should be more consistent in its application.” Adalja points to the double-standards of many in evaluating the anti-lockdown protests and the Black Lives Matter protests. He argues, “Physicians and policymakers must respect that different people will be willing to risk exposure for different things; such pluralism is at the heart of a liberal society.”

COVID-19 in Children

Saturday, June 13th, 2020

What what Alasdair Munro believes: “Children almost certainly DO transmit COVID-19.” How a Daily Mail headline summarizes his paper: “Experts cannot find a single child under 10 who has passed on coronavirus to an adult.” Munro does say, “So where do we stand? We don’t know for sure but growing evidence suggests children are less susceptible to infection, have milder infection, and are infrequently responsible for household transmission.” See the paper to which he contributed. Regarding the misleading media reports, Munro adds, “Looks like many of the more reputable outlets have changed their headlines following some fairly extensive efforts from myself and the excellent media team at [the Royal College of Paediatrics and Child Health] yesterday.”

Wear Masks

Saturday, June 13th, 2020

Widespread use of masks, by itself, could reduce the effective reproduction rate below 1.

Cautious Optimism about Protests and COVID-19

Saturday, June 13th, 2020

Protests in Minnesota don’t seem to have resulted in a spike in COVID-19 illnesses so far. Looking at the state’s data, cases seem to be headed down, as do hospitalizations. But the numbers remain worrisome, as hospitalizations haven’t declined by much, and daily reported deaths remain relatively high (with 25 as of the last update). I’ll be interested to see real studies that evaluate whether the protests led to any measurable uptick in cases.

Pueyo on Lockdowns

Friday, June 12th, 2020

Tomas “Hammer and Dance” Pueyo is back. He asks, “Should we aim for herd immunity like Sweden?” I’m convinced we shouldn’t. Even Sweden seems convinced now. Granted, I was more open to the idea initially, when I thought Sweden was much further along the path to herd immunity than was the case. But that doesn’t imply that Pueyo’s own lockdown-then-manage (hammer and dance) strategy is optimal either.

Pueyo points out that most countries that “crushed the virus” in fact imposed lockdowns. To his credit, he lists five that did not: Cuba, Japan, Taiwan, Iceland, and South Korea. He writes, “All [are] islands (South Korea is de facto an island since its only ground border is with North Korea and it’s sealed) and all five had advanced methods to deal with the virus. Taiwan and South Korea took all the right preventative measures, as did Cuba. Japan had massive mask wearing and a strong healthcare network with contact tracing experience. Iceland went straight into dancing, testing a massive share of the population (around 17%) and isolating all the positive cases.” He discusses Hong Kong elsewhere, which, notably, is not an island.

Here’s something odd about his Chart 7, though, which shows “countries that beat the coronavirus.” The only thing that matters to Pueyo here is whether a country’s infection line goes up quickly and then comes down quickly; he doesn’t care what the magnitude of the peak is. Hence, he includes countries with almost no COVID deaths, such as New Zealand, with countries with incredibly high COVID deaths, such as Italy, Spain, and Belgium. Indeed, Belgium has the absolutely highest rate of deaths per million. I’m pretty skeptical of any approach that treats New Zealand and Belgium equally as success stories.

This bit is interesting: “For countries that applied very heavy Hammers, their case growth stops around two weeks after the Hammer.” But not so fast. Pueyo’s Chart 8 shows that, in New York and Spain, social mobility declined steadily headed into the lockdown and and pretty much bottomed out around the time the lockdowns went into effect. So there are two ways to interpret this. 1. “The lockdowns themselves didn’t cause the reduction in cases; the lockdowns and the increased social distancing both were caused by public fear of the disease.” 2. “The lockdowns did something important on top of measured social distancing to slow the disease.” (See my May 22 updates for a discussion of some of the causal complexities involved.)

Granted, it’s easier to stop a disease on an island. Given that, the interesting question is, is it possible for other countries to stop a disease without lockdowns? Some people claim that just universal mask wearing can bring the effective reproduction rate under 1. I’m convinced that, if the U.S. had had an effective hygiene-test-trace-isolate strategy from the outset, along with moderate social distancing, lockdowns and intense social distancing could have been avoided. In Pueyo’s terms, you don’t need a hammer to dance.

Pueyo comes close to granting this. He writes, “The Hammer and the Dance was meant for countries that were overwhelmed with cases and didn’t know how to handle the situation, to limit the outbreak while figuring out what to do. But now we know what to do. We can keep the economy open and reduce the caseload, the way South Korea, Taiwan, Vietnam or Hong Kong have been able to. Many measures can be taken to stop the coronavirus, including testing, contact tracing, isolations, quarantines, universal masks, hygiene, physical distancing, public education, sewage testing, travel restrictions and crowds restrictions. All countries should apply these measures, since they’re mostly proven, much cheaper, and can dramatically reduce the epidemic. . . . Whether it’s admitting it or not, the US is pursuing a Herd Immunity strategy. At this point, it’s not realistic to apply new lockdowns everywhere. Thankfully, they’re not needed: States can apply all the measures mentioned above. They’re affordable and doable. Dozens of countries are doing it, many US states are doing it too.”

Lockdowns Coming Again?

Thursday, June 11th, 2020

Eric Feigle-Ding warns, “Cases are rising in nearly half the states. They all had lockdowns lifted. Most have rising percent positivity too. (I.e., it’s not just more testing). Unless governors are insane, lockdowns coming again—not if, but when.” He refers to an AP article. I sincerely hope he’s wrong. I hope that it’s not too late to ramp up mask wearing, testing, contact tracing, and effective isolation of the infected.

Notably, Colorado (largely) reopened and also had extensive protests, and our case, death, and hospitalization numbers look not too bad (although not awesome by Pacific Rim standards).

Eastern Equine Encephalitis

Thursday, June 11th, 2020

This mosquito-born virus is hard to contract, but those who do contract it do very badly, with 40% dying and many of the rest suffering “neurological impairment for years to come.”

The False Choice between Lockdowns and Nothing

Wednesday, June 10th, 2020

Much of the conversation in the U.S. has been about the effectiveness of lockdowns, as opposed to doing nothing, to stop COVID-19. I was pleased to see Jennifer Nuzzo remark,”Though I think Sweden’s high case fatality is worrisome, I don’t think the lesson is that total lockdowns are the way to go. Other countries successfully avoided major lockdowns through targeted public health measures—testing, tracing and isolation.”

COVID-19: Italy Versus the U.S.

Wednesday, June 10th, 2020

Max Roser of Our World in Data writes, “There was no difference in the speed of the outbreak between Italy and the U.S. The difference—which is leading to the rapidly rising death toll in the US—is that European countries achieved a much faster decline of the outbreak.” He shows a chart showing a much steeper decline in daily cases per million in Italy versus the United States.

COVID-19 Trouble in Arizona

Wednesday, June 10th, 2020

COVID-19 hospitalizations are going down in Colorado. Arizona, on the other hand, seems to be having trouble. Reported cases are up. More tellingly: “Hospitalizations have steadily risen. Statewide hospitalizations as of Sunday were at 1,266 inpatients in Arizona with suspected and confirmed COVID-19, which was the second highest number, behind Friday, since the state began reporting the data on April 9. The past eight days have seen inpatient hospitalizations statewide for suspected and confirmed COVID-19 eclipse 1,000. The percentage of positive tests per week increased from 5% a month ago to 6% three weeks ago to 9% two weeks ago, and 12% last week.” That’s really bad. By contrast, the positivity numbers in Colorado are under 3%, and new reported cases are somewhat down.

Cases in Utah also are on the rise. Texas, Florida, and California also are having trouble.

Trouble in Belgium

Wednesday, June 10th, 2020

I was looking at Our World in Data’s chart on total COVID-19 deaths per million, by nation, and at first I thought the UK was highest with 602. By contrast, the U.S. has 338, Brazil has 181, and New Zealand has 5. But then someone pointed out that Belgium, a country of 12 million people, has 830 deaths per million. So what’s going on there? A May 17 Washington Post article points out that other countries may be undercounting their deaths. Moreover: “One explanation, he [health official Steven Van Gucht] said, might be Belgium’s relative population density in comparison to its neighbors: the Brussels airport, an international transportation hub, might have helped seed the disease in the crowded capital region. And many Belgians were on skiing vacations in northern Italy during national school vacations in late February.” And: “Belgium’s nursing homes account for more than half of its deaths, partly because older Belgians are more likely than their counterparts in other European countries to live in elder-care housing.”

Masks Work

Wednesday, June 10th, 2020

Lyman Stone reviews data from the USS Theodore Roosevelt and concludes, “Masks work. What’s amazing here is that this is individual protection, not community-based protection: prior studies suggested masks were NOT very good for individual protection. . . . By the way, that serology studies turned up an 80% attack rate among non-mask-wearers suggests that herd immunity probably won’t occur . . . until 80%. . . . That masks worked as well as they did in a contained environment with tons of unavoidable close contact is pretty remarkable. I would have bet against masks doing much in this scenario.” Of course, my guess is that people in the military have good masks and good discipline in wearing them. From what I’ve seen, many people in the general public have neither.

A study (lead Timo Mitze) that looks at Germany finds that “face masks reduce the daily growth rate of reported infections by around 40%.”