COVID-19: What about Sweden?

Well, both sides of the COVID-19 debate are pointing to Sweden to make their point.  Some say, "Look at Sweden.  They didn't lock down and they aren't doing any worse than other countries."  Others, as the death toll in Sweden has climbed, are saying, "Well, Sweden is really regretting their irresponsible actions now, aren't they?"

My opinion is that what Sweden shows is that lock-down or not...it doesn't make any real difference.  COVID is acting like viruses do, spreading through a population and having the worse effect on the most vulnerable. This graph below shows Sweden's deaths per million of population (4/26/20) compared to some other countries. All the others have put lock-downs in place. Some are better, some are worse.

Remember, "Flatten the Curve" was never meant to lessen the total number of those who got the virus...or those who died from it.  I don't think a lot of people really understood this.  Flatten the Curve was simply about spreading it out so that the healthcare system was not overwhelmed. The graph below depicts how I believe people saw Flatten the Curve, as opposed what it really meant.  Everyone saw the graphics they put out, so why would I say they don't understand?  Because so many are saying that if we ease the restrictions, more people will die.  Yes, that was always understood.  Some hoped we would have a vaccine in place, but that was never realistic.  We cannot keep the economy shut down for 18 - 24 months.  

The thing that was never considered in the Flatten the Curve model was the damage to the economy, and the potential exponential nature of the collapse as more and more businesses go under as time goes on.  This was a plan put together by people who had healthcare and disease expertise, not by a broader-based group that included economists or other social science types.  

So, if the flattened curve never meant less total deaths, and the numerical models have proven to be way overblown, and lock-down means real financial damage...I say, Sweden had it right and many other countries had it all wrong.  

The real question is, how long to we continue to damage the entire economy to guard a small segment of the economy, namely healthcare...and not all of healthcare, because much of it is also shutdown.  The longer we go, the worse the damage, the longer it takes to recover.  We know what is needed now to support healthcare.  Let's do that instead of collapsing everything else.

COVID-19: The New York Problem

I'm not sure exactly what to make of the chart below, but it is very interesting.  This chart shows the total number of reported COVID-19 deaths in all fifty states plus D.C., sorted by population (as of 4/17/20).

As this shows, New York, the fourth most populous state, is an outlier in the country.  And, from what we know, it is particularly New York City where the vast majority of reported deaths have happened.  The next highest number of deaths, New Jersey, NYC's closest neighbor is only 22% of that of New York.  California, the most populous state, is at only 6% that of New York.

Yes, there are sound reasons why New York would have the highest numbers.  While the state is the fourth most populous, New York City (8.2 million) is the most populous city in the country, by far.  The next closest city, Los Angeles is only 49% the size, and not nearly as dense.  But, should New York be this far out of the average?  

Maybe, but lets examine some theoretical possibilities.  Maybe it is because there are so many flights that come to New York from China, where the virus started.  That is why there was so much worry about Washington (state) and California early on, but they are at 4% and 6% of New York deaths.  Maybe everyone else has just done a much better job in limiting the spread of the virus?  I can't believe this is true.

We know, and I covered in a previous post, that the number of deaths have been very liberally counted...I would say over reported.  Could it be that some of the difference is due to a higher level of over-reporting?  Maybe.  As was reported in The Telegraph, Italy now says that only 12% of the deaths reported as caused by COVID-19, were actually caused by the virus.  How much over-reporting in New York?  We can't be sure yet, but let's say, because of the density of  NYC, that their real numbers are up to 25% of reported.  That would be 4282 deaths, still the highest in the country, but seems much more in line.  Regardless of the percentages, I think this whole subject needs to be closely examined...starting now.  This is very important data to have correct when you are making decisions on locking down the economy.

So, what can we do with this data?  Well, if we are going to shut down any economies, maybe we should just do it to New York, and maybe, New York City in particular.   If you break down the number of deaths, you will see that:

• 20 states have under 100 deaths
• 32 states are under 200 deaths
• 43 are under 1000

But maybe this isn't the right metric, due to the relative populations.  So what if we look at Deaths/1M Population?  This is a much better way to view the effect on a given population. If we look at it this way, 43 states are under 100 deaths per million in population.  New York is at 873 per million.  So maybe we lock down the states that are over 100 deaths per million in population?

Regardless of how you look at it, New York is an extreme outlier and we should make it a priority to find out why.  We should also not make policy for the whole country based on New York.  In many types of analysis, you take outliers like this and throw them out because you don't want to make decisions based on the extremes.  If we do have an over-reporting issue in a few states, and those states are locked down when others aren't, I would imagine that they would get their numbers corrected quickly.

As I have said before, and I blame this as much on the Trump administration as on the over-hyping of the media and the Democrats, but I repeat myself (as Andrew Klavan says).  There are not only two choices...SHUT DOWN or WE ALL DIE.  We need much better leadership at all levels than we are getting.  There needs to be more subtly in our response.  This should not be viewed as one size fits all.

#CriticalThinking  #QuestionPower 

EDIT 4/27/20: A new study by MIT economist Jeffery Harris suggests that one of the big causes of such high numbers in NYC may be the subway system.  This article by Reason.com provides an overview of the findings.

US COVID-19 Deaths Surpass Influenza...Or Has It?

So, COVID-19 deaths have exceeded those of what we have been seeing for seasonal influenza...just as the "experts" told us they would.  But, have they really?

It has been admitted that, as Dr. Deborah Birx said in a recent press conference, "...in this country, we've taken a very liberal approach to mortality."  She went on to say,  "There are other countries that if you had a pre-existing condition and let's say the virus caused you to go to the ICU and then have a heart or kidney problem. Some countries are recording that as a heart issue or a kidney issue and not a COVID-19 death."  She then concludes that, "The intent is right now if someone dies with COVID-19, we're counting that as a COVID-19 death."

Notice the difference.  If you died with COVID-19, they are counting it as you died from COVID-19.  And, I will remind you, that even with the "very liberal" accounting of COVID-19 deaths, it is still far lower than pneumonia deaths (42,560 in the first 12 weeks of 2020 alone).

But there is also more to this story.  Dr. Birx talks about the virus "causing" you to go to the ICU, but there are reports coming out, like this one on Fox News from Dr. Scott Jensen, that, unlike at other times, doctors are being encouraged to count deaths of nearly any kind as a COVID-19 death if they have been confirmed to have have the virus.  Dr. Jensen said, "If I have a patient died a month ago, had fever, a cough, and died after three days and had maybe been an elderly, fragile individual, and there happened to be an influenza epidemic around our community, I wouldn't put influenza on the death certificate, and I've never been encouraged to do so.  I would put, probably, respiratory arrest would be the top line and the underlying cause disease would be pneumonia, and in the contributing factors I might well put emphysema or congestive heart failure.  But, I would never put influenza down as the underlying cause of death, and yet, that's what we're being asked to do here."

Much has also been made of the bad time that Italy has had with the virus.  In fact the US and other countries have been using numbers from Italy to model the possible spread and lethality of the epidemic.

But, is Italy the proper case to base a model on.  It has been widely discussed that Italy's demographics skew significantly toward the older population, which are the most vulnerable to COVID-19.  As reported in The Telegraph:

According to Prof Walter Ricciardi, scientific adviser to Italy’s minister of health, the country’s mortality rate is far higher due to demographics - the nation has the second oldest population worldwide - and the manner in which hospitals record deaths. 

“The age of our patients in hospitals is substantially older - the median is 67, while in China it was 46,” Prof Ricciardi says. “So essentially the age distribution of our patients is squeezed to an older age and this is substantial in increasing the lethality.” 

But, beyond the demographic issues with Italy, we now learn that Italy too used a very liberal accounting for COVID-19 deaths.  From The Telegraph again:

“The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.

“On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity - many had two or three,” he says. 

Read it again!  "only 12 per cent of death certificates have shown a direct causality from coronavirus."  12 percent...TWELVE...the number of deaths times 0.12.  Okay, that's significant!

So, what would the chart look like if the US over-reporting was in the same range as Italy?  And remember what Dr. Birx said above, "very liberal."  It would look something like this:

This is much more in-line with what some experts on epidemics were predicting.

The point I will make is that if we are to take such drastic steps...steps that are causing massive unemployment like we have never seen...we have to be more sure of the numbers.  The devastation to the economy in the long-term could likely be much worse than the short-term affects of the coronavirus pandemic.

I am not going offer conjecture on all the reasons for over-estimating the numbers so massively.  I also admit that some number of the cases where COVID-19 was not the cause of death, it may have been a contributing factor.  The point I will make is that if we are to take such drastic steps...steps that are causing massive unemployment like we have never seen...we have to be more sure of the numbers.  The devastation to the economy in the long-term could likely be much worse than the short-term affects of the coronavirus pandemic.

These are the kinds of results you get when you allow "government experts," of any kind, to make extremely consequential decisions for the whole country.  Remember that their initial models that caused the panic to begin with...the ones that launched the police-state lock-downs...were that 2 million Americans could die.  They have continued to back down those predictions, but their prescription has remained the same, and has gotten worse as more and more jurisdictions have inflicted stricter "social distancing" mandates on their citizens.

Fauci, Birix and the other CDC experts are all working from mathematical modeling that, as Fauci admits "are only as good as the assumptions you put into the model."  But, while he claims to not pay too close attention to the models, these were the numbers that have been reported that caused panic and were, at least in the early days, used to justify the lock-downs.

But these experts are only expert in one, narrow area.  They are not economists...they don't have any real concern for economic realities.  Their concern has always been expressed about "overwhelming the healthcare system."  In addition, the experts in charge...the ones who have the current levers of power...are allowed to ignore other, contradicting expert opinions, like Stanford University epidemiologist John Ioannidis and others.  Some say that "flattening the curve" only prolongs the problem, and therefore the economic affects, by delaying the acquisition of "herd immunity" in the population.  But, they only allow voices that agree with their assessments, even as they are shown to be wrong.

A sample epidemic curve, with and without social distancing. 

Image credit: Johannes Kalliauer/ CC BY-SA 4.0)

 Notice in the diagram above, "flattening the curve" may help the health care system, but it drags the over-all problem out over a much longer time horizon.  This will, therefore cause longer-term negative effects to the economy.  The longer a business is kept from pursuing revenue, the less likely it will be able to survive...the higher the number of long-term unemployed and financial damage.  But, as you can see from the diagram, the total number of deaths is likely to be nearly the same.

While we know that the defense of the "flattening the curve" approach is to guard against overwhelming the healthcare system, have we really critically questioned the assumptions.  Yes, some areas are being hit hard, New York City, in particular, but nothing like what was predicted.  Remember, Governor Anthony Cuomo's exasperated question "What am I going to do with four hundred ventilators when I need thirty thousands?"  Well, it hasn't turned out that they have needed anywhere near that number.  But even if it had been worse than it is, we have the vast majority of the rest of the country with excess healthcare sitting idle with employees being furloughed..  Surely we could have made this work in the short term to get through this faster.

When asked about when we can expect to open the country back up, Dr. Fauci said. "I think reopening it is not going to be like a light switch that you switch on or off.  Because, if you look at throughout the country, it's a large country and the outbreaks are really quite different, depending on where you are."  This seems to make some sense, but the question I have is why did we have to switch the country off all at one time?   As Fauci continued, "New York, New Jersey area is very different from now what we've seen in Washington State and in California, in which there was the threat of a real big spike, but it really didn't occur and is at that low level."

In fact, it is true that areas in the country are very different.  The following chart shows the number of deaths (reportedly) caused by COVID-19 per State as of April 10th.

 So, from this chart, we have to ask, why do we have nearly the entire country on lock-down?  The answer is simple...FEAR.  Fear started and perpetuated by the so-called experts, based on faulty mathematical modeling.  Fear of the disease...but also fear that politicians of all stripes might be held responsible for not doing enough.  Fear that was not tempered in any way by the opinion of other "experts" in the same or other areas.  I've laid out what I think some of the other causes have been in a previous post.

The arguments we keep seeing are based on a false dichotomy.  There are not only two choices: Total shut-down...OR...we're all going to die!  There are many, many choices in between.  As we get through this current scare and come out the other side, I hope, and believe that the economy will rebound.  There is no-doubt pent up demand that is being held back by the lock-down.  But, how many of your favorite businesses will survive it?  How many people will be out of jobs?  The longer this goes, the worse those effects will be.  Let's start reversing this lock-down anywhere we can...NOW.

We cannot retain our liberty if we uncritically accept anything that comes from so-called government experts.

COVID-19 Update: 4/4/20

Perspective: The Worldometer site, the one that has been publishing the COVID-19 statistics, added one yesterday - Tests/1M Population.

As of the close of the day yesterday 2,110/1M Population had been tested in the US. With a population of ~329,671,200. That means that approximately 695,606 tests have been done in the US. That is 0.21% of the population.

It also means that only 39.84% of those tested have actually shown to be positive. This number is likely skewed high, and maybe significantly so, for general population exposure since most of the testing is being done for people who have symptoms or who suspect that they have been exposed.  Many who think they may have it are being denied testing and just told to self-quarantine, because their symptoms are not serious enough.

What does this all mean? Well, all the figures being touted for mortality rate, for example, are just guesses based on extrapolations from a very small sample of the population.

It also means that the Total Number of Cases figure means almost nothing. This is just a factor of how many who have been tested. But the news media keeps hyping this number. "The US has now surpassed Italy in the number of cases!" So what? The more significant number is how many have died in proportion to the population. Italy is at about 243 total deaths/1M in population. The US is at about 22 per 1M.

Chart as of close of day 4/3/20

I believe this is why the CDC does not publish "Mortality Rate" numbers for flu and pneumonia. There's no way to know unless they actually test a much larger sample of population.

Let's also remember that only between 2.1% and 2.6% of those known Active Cases are Serious (hospitalized) or Critical (ICU)... and only a percentage of Critical (I heard one doctor say about half) are in need of ventilators at some point.

Let's just all keep perspective and look past the hype to try to understand what the true numbers are...what they really mean...and what they don't tell us.