Math and More Questions

I’ve been working out math problems all day, trying to answer some questions. I’m not satisfied with the results. I think I’m getting more questions than answers. Some of this has to do with lack of accurate data—same problem everyone else has right now.

I’ll share some of the data anyway, and then just ask the questions.

This chart compares different populations and the number of deaths attributed to Covid-19. All I’ve done is divide the actual number of deaths by population in millions to find deaths per million people. 

Place	Population in millions	Covid-19 Deaths as of April 30, 2020	Covid-19 deaths Per million
Texas	30.54 M	722	23.64
Harris County	4.6 M	109	23.69
USA	328.88 M	58,356	177.44
World	7,597.78 M	233,014	30.67
Italy	60.46 M	27,967	462.57
New York State	19.44 M	18,274	940.0
New York City	8.75 M	18,069	2,065.0
Sweden	10.1 M	2,586	256.0
Norway	5.4 M	210	38.89

There's a lot of difference between New York and pretty much everywhere else.

This is a snapshot. It doesn’t tell you the death rate of Covid-19. For that you need to know how many people were exposed to and contracted the disease. Then you divide that number by how many deaths.

So, in the absence of that data, everybody’s trying to make guesses.

I took a good look at the video getting a lot of attention this week of two ER doctors in Kern County, California. They’re making the case for opening up. And their non-numerical arguments for that are persuasive—like how we lose immunity strength when we avoid all exposure to germs. And that the costs to society at large—and to overall healthcare and people’s well-being—because we are focusing on this single health issue are something we need to be talking about.

Dr. Dan Erickson (left) and Dr. Astin Massihi
screenshot found here

Drs. Dan Erickson and Astin Massihi are doing Covid-19 testing on everyone that comes in to their five ER centers, if I’m understanding them correctly. Not just for possible Covid-19 cases, but everyone who comes in for anything, which gives them their own raw data. Their numbers show that 6.5% of those they test (several thousand) test positive. I’m unclear whether that means people actually have it, people have antibodies because they had it, or a total including both. Then they point out how many have been tested in California. Dr. Ericksen says,

We have 33,865 Covid cases, out of a total of 280,900 total tested. That’s 12% of Californians were positive for Covid.

Then they extrapolate that 12% to the population at large. But that’s not accurate for a couple of reasons. Most tests, beyond their own sample, have been done on probable cases, not a random sample. If we were randomly testing populations, that information could be extrapolated to the community the sample represents. But most of our testing has been done on people with symptoms. That leaves out all people who are asymptomatic or have such mild symptoms they don’t get a test—or don’t qualify to get tested, in many places. Also, according to some, current tests tend to have a high false positive rate. 

They use this extrapolation as “the best we have” right now with the lack of data. But, while their arguments are valid, and a conversation worth having, we really can’t deduce death rates by this extrapolation. If you assume the sample covers everyone, then it looks like more have been infected than have been, and your death rate calculations will be far lower than reality—just as death rates appear far higher than reality when you only count verified cases. Too many assumptions.

As they say, the more testing, the better. We just don’t have the right sample sets yet.

We know the death rates are much lower than what the data shows. But how much lower? Because, if it’s in the range of a typical flu year, then we can let people take precautions and then take their chances—the same way we do for the flu.

What we also don’t know is, what will the contraction and death numbers be when we get through this season? By that I mean probably the year. Flu seasons tend to go from fall through the following spring, not the whole year. By the time it comes around again, it’s a different flu, which is why there’s an annual—different from the past year—flu shot. So we can count annual flu deaths and that data is relatively solid. Not all cases get reported, but deaths caused by flu would be.

We don’t know season length of this virus. We don’t know if it will mutate enough to make herd immunity a moot point or a proper goal. Either way, we’re nowhere near the 60-80% required for herd immunity, meaning enough people have had it that the virus has a hard time finding a new host.

Anyway, we don’t have a stopping point at which we can look at the different approaches and say one worked better than another.

Among all the questions, I’d also like to know a few more things:

·         If it’s true that urban areas are more likely to be hit hard, how do you explain the discrepancy between Houston and New York City? Houston’s shutdown was mid-March, close to New York’s. New York had a few more cases by then, but not that explosive a difference.

·         Does it occur to anyone else that public transportation has a lot to do with the spread of the virus? During the NYC shutdown, they have kept their subways running. (My germ senses are making me shudder.)

·         How much lower would the death data be if we took nursing homes out of the data? Less than half? If so, why have we shut down society instead of super-protecting nursing homes?

·         Sweden did some social distancing but no shutdown. Norway, by comparison, did a full shutdown. There are differences, but are they differences in timing only? How many inevitable cases have hit Sweden already but will take longer to eventually hit Norway? Do shutdowns stop cases from happening or simply postpone them?

Mark Ramsey, my SREC Chairman, compared Sweden and the USA graphically this week on Facebook, with this explanation:

Graph of the day. USA and Sweden. As identical as possible, except for Y-axis, which is different mostly due to extreme difference in size of the population, and increased testing in the US. Based on the SHAPE of the two bar-graphs, has turning off a VAST PART of the US economy been significantly better than Sweden, who simply had recommended practices and a VERY FEW closures? Has it been "worth it"? The initial models were very very wrong, and we now have millions of tests to calibrate the risk with. The answer needs to change accordingly. (data from WorldoMeters.info at 13:00 CDT, 4-28-2020)

Comparison graphs of Sweden and USA
from Mark Ramsey on Facebook

Then there are some political questions. I hope this virus hasn’t actually become political. Maybe it’s more of an urban/suburban/rural difference—which, again, doesn’t explain Houston vs. New York. Is it the prevalence of cars instead of mass transit in Houston? By the way, California’s deaths per million is about 31. I didn’t have today’s data, so I didn’t include California on the chart, above. But I’m guessing driving instead of mass transit is a reasonable explanation there too. Also sunshine.

Facebook friend Leslie May has been looking at the politics and the data the last couple of days. She said this yesterday on Facebook:

CHANCES OF CONTRACTING OR DYING OF COVID-19.... overall, Democratic-governed states are more urban with an average population density of 123 people per square mile....

average population density of Republican-governed state: 71 people per square mile

for all Democratic-governed states, the average rate of COVID-19 cases reported per 100,000 residents is 414

for R-governed states, the average is only 180 (less than half)

the average mortality per 100,000 in D-governed states is 23

the average mortality per 100,000 in R-governed states is 7, less than 1/3

by the way, Harris County, Texas, rates are 130 reported cases per 100,000 residents, and 2 deaths per 100,000 residents, lower than the average STATE....Texas as a state is 93 reported cases per 100,000 residents with 3 deaths per 100,000 residents.

Today she adds a map and more questions and data:

Wondering why certain states have no stay home orders (labeled 1 on the map below), others just "recommendations" (2 on the map), and some STILL have them in place (3 on the map)? Here's what our country looks like as with the "order" status / party of the governor superimposed on the actual cases per 100,000 people in that state. Also looked at where cases are increasing, decreasing or about the same.

7 states, all with R governors, are under NO stay home orders: SD, ND, OK, WY, NE, IA, AR. SD, WY, OK are in the lowest category on the map for number of cases/100,000. The others are, pardon the pun, "all over the map."

4 states are under stay home recommendations, including TX. The others are KY, UT and CT (kinda another outlier in the northeast, although cases decreasing may explain it). 2 with D governors, 2 with R.

39 states are still under stay at home, 22 D governors, 17 R. Oregon, Montana, Minnesota, NC, WV and ME are low in cases/100,000. Only WV's governor is R, although if memory serves, I think that is a relatively recent development.

In terms of increasing, decreasing or about the same number of cases, I could see little rhyme or reason to how that influenced these decisions -- for those in the middle with recommendations, TX and KY about the same, UT increasing, CT decreasing.

Finally, Harris County, TX, has 6161 cases, or 134 cases /100,000 residents, with 109 deaths or 2/100,000 -- about the same size geographically as Rhode Island with 8247 cases, 778/100,000 people, 251 deaths, or 24/100,000 residents. RI has twice the death rate of Harris County per capita.

Graphic from Leslie Joan May, from Facebook

Texas starts opening up tomorrow. There’s a mixture of “hurray”s and “no no no”s. I lean toward the hurrays. But I’m not rushing to a theater any time soon. And I’m still wearing a mask at the grocery store, and carrying hand santizer, wipes, and gloves for use as needed.

If we can be sensible while getting people back to work, I think that’s a win.

I don’t think it was ever our intention to hold everyone housebound until there was no more risk. We were told 2-3 weeks, and maybe a little longer (it’s been 4 weeks tacked on to the original 3 already) to “flatten the curve.” That never meant fewer people would contract the illness; it meant fewer would get it at the same time. The number that would eventually get it was expected to remain the same. See my question about Sweden and Norway above. So my question is, what's the rationale for making it take longer but not limiting the actual number who get it? Is that goal, whatever it is, worth economic collapse, with associated famine, hunger, poverty, and hopelessness?

One advantage of time has been the possibility of finding treatments that work. The new drug remdesivir was announced this week as a successful treatment. Because it’s new, it will be more expensive than hydroxycholoquine plus zinc plus Z-pac (one meme I saw showed $1,000 instead of $20). Still, it’s great news. Enough for a stock market bump upward.

Others treatments are coming. Even a vaccine may be coming soon, which would be in record time. So this could mean that the pause was of some value beyond guaranteeing our hospitals wouldn’t be overwhelmed, which it turned out was not the case even in NYC.

This morning Ben Shapiro talked about a new data piece on his show (haven’t tracked it down elsewhere yet) that there’s not a single case in which a child has spread the illness to an adult. I don’t know how they know that, but that’s great news. If true, then schools and play dates will start looking safe again. And maybe we’re in time for summer sports leagues.

At the very least, I think we need an absolute rational explanation for every infringement on our freedom from this point forward. “For your safety” won’t do. Neither will “The public can’t be trusted.” We need something like, “Here's the data that shows this (X requirement) limits spread of the disease by (X)%, and it is imperative that you not spread this disease in (X location) before (X time).” 

Failure to provide that information might just lead us to believe that fear and control are a goal when what we really want are freedom and innovation.

Look to Literature

With a global pandemic going on, if you’re spending more time at home than usual and wondering what to do, maybe it’s time to read a book or two, or ten.

We’re in the middle of this pandemic, so maybe there’s some literature to enlighten us. I’m avoiding The Hot Zone or I Am Legend for now. I’m less interested in the fear, looking more at the strategic and moral questions and how they’ve been handled.

cover image from here

Last week, I think it was the very day we were directed to avoid gatherings of ten or more people, I was in the middle of Brandon Sanderson’s The Hero of Ages, third in the Mistborn Saga. That series is made up of two trilogies, the first three from an earlier age, and the second three of a later age—early industrial age, with trains and guns, but still the semi-magical aspects of the earlier trilogy. I’ve read them all, mostly out of order. This is the last one for me, the third in the earlier trilogy.

One of the main characters in The Hero of Ages is a leader named Elend. He’s now the emperor, after the defeat of the Lord Ruler in the previous book—which ended up setting free an evil force that is wreaking havoc in their world.

There are a couple of significant oddities in their world: mist and ash. The dark mist comes out at night. People have been superstitious about it for centuries, worried it can harm them. But the ones with the special powers know the mist is safe, just a part of nature. Until now.

Now the mists are starting to kill people. Also, the mists are coming earlier, before dusk, and staying later, after dawn, encroaching on the day and shortening the time the sun is out for crops, so the food supply is threatened. It’s further threatened because of the falling ash, possibly from some distant volcano. This ash is very black, not a normal ashy gray, and the growing ashfall has to be shoveled off paths and crops each day, also threatening the food supply.

So, in this natural disaster, Elend is trying to gather forces to fight off the evil. I don’t know how all of that is going to go yet. But he’s moving an army toward a nearby city state that has some particular resources they will need. The plan is to negotiate if possible, but fight if necessary.

Meanwhile, the mist is attacking villages, and anyone out and about. It is like a plague. It doesn’t strike anyone indoors, even inside a tent such as the soldiers are housed in during their trek. So the soldiers can safely stay inside until the mist passes. But that is getting later and later in the day.

The mist seems to arbitrarily attack some and leave others. And among those attacked, some are killed that very day, while others remain ill and then recover—leaving some of their cohorts worried that they are cursed somehow. But once the mist has passed over someone, they’re impervious to any future mist attack.

Elend realizes that they can’t get into a battle while his troops are hiding in their tents until the mist passes. They could be attacked by an army of mist survivors. What he realizes they have to do is purposely expose themselves. All of them. While they are far enough out from the city to be safe from attack.

He knows he will lose men. He is calling on them all to risk their lives: follow his order and probably survive to become inoculated soldiers, but possibly die. These are healthy men, so he hopes that will be in their favor. But he thinks long and hard before giving the order.

By the way, an exact 16% die. To the man. Of those attacked with illness, they remain ill for exactly 16 days. Something weird is going on. But now they have data to work with.

OK, so that is one approach: mass exposure, acceptable casualty rate—with the survivors becoming an immune population.

I’m looking at the ways various countries are handling this Wuhan novel coronavirus known as COVID-19.

Elend’s way looks something like Italy or Iran. His 16% is a pretty high casualty rate—ours is unknown because exposure is unknown, but will probably turn out to be more like 1-3%. But we live in an age where wiping out even one or two of every group of a hundred we participate in looks pretty ugly. Also, Italy has an older population, which seems to be more susceptible to serious illness. And serious illnesses require hospital beds, ventilators, and other resources that aren’t usually required in such high numbers. Italy’s leaders are making the tough decisions about who gets those resources. And the world looks on horrified as they decide not to treat people over age 80, but just let them die. 

Korea has been possibly the most successful. To start with, they knew not to trust the Chinese government. With their first case, they caused “social distancing,” as we’re doing here. And they tested widely. Anyone who tested positive was put in absolute quarantine. Having testing resources was a huge bonus for them, which we are just ramping up to here.

Other countries have been trying other methods. Quarantine the elderly and immune-system compromised, while others can go about their lives almost as normal. Denmark is trying this; we’ll get data from them that can be used in future decision-making. If it works, it’s less financially devastating than semi-quarantining everyone—or totally quarantining everyone, as China has had to do. Great Britain was on the Danish path but found casualties too high and moved toward more general lockdown.

We’ve had a more general lockdown in the US, getting more and more strict as the virus spreads. The plan here is to lengthen the time frame for people to get the virus, so that the supply of beds and ventilators and other resources does not get overwhelmed. To “flatten the curve,” as they say, based on this graph:

image from here

People have been spreading a meme that says, “Hey, remember when everyone rushed to the store to buy toilet paper at the same time and it ran out before the supply could be restocked and everyone freaked out? Now imagine the same thing at your local hospital. But instead of TP that’s out, it’s beds and ventilators. That’s why everything is cancelled. That’s why you should stay home.”

Another book that came to mind during this crisis is Sinclair Lewis’s Arrowsmith. It’s about a doctor/researcher. It has been too long since I last read it, but I remember a couple of things about Martin Arrowsmith, the main character. He is pretty flawed. He has some idealistic reasons for researching cures for plague outbreaks. But there is also a lot of excitement at the chance to take on a real life problem, to have personal purpose. Arrowsmith wants to find out who he is, and be more than he has been. And he needs to be better. His wife, Leora, and his mentor, Dr. Gottlieb, give him support in that quest. Gottlieb describes their world in religious terms:

To be a scientist—it is not just a different job, so that a man should choose between being a scientist and being an explorer or a bond-salesman or a physician or a king or a farmer. It is a tangle of very obscure emotions, like mysticism, or wanting to write poetry; it makes its victim all different from the good normal man. The normal man, he does not care much what he does except that he should eat and sleep and make love. But the scientist is intensely religious—he is so religious that he will not accept quarter-truths, because they are an insult to his faith (p. 267).

Often Arrowsmith is restless and dissatisfied. Then comes the excitement of a real outbreak in the West Indies. Bacillus pestis among rats, spreading to people, thought at first to be just a flu. He has the opportunity to experiment. And the ethical dilemma of experimenting on people. But he goes. And he makes what he thinks is likely to be a cure. Tragedy strikes. And guilt. And resolve. Go ahead and read it.

The book, from a century ago, is way behind the science of today. But it’s probably still worth reading, because it’s more about the life inside this man’s mind than it is about science (although a scientist did help Lewis with the writing of it).

I watched a video a couple of weeks ago, on body language, looking at a CNN interview with Dr. Robert Redfield, head of the CDC. Mandy, the bombardsbodylanguage.com commentator/instructor, points out how his face lights up, and he smiles, talking about what we would normally consider bad news. But this man is a scientist, with responsibility over outbreaks such as this. His work has suddenly gotten very exciting. He’s not thinking about the mass casualties or economic disasters about to befall us; he’s thinking about what energizes him: the opportunity for new and exciting discovery. This might not seem like a normal human response, but it is normal for a type of person who does a specific type of work—and we need people who do that work. 

CDC Director Dr. Robert Redfield
screenshot from here

There are actual people out there, doing research, working for a response to this virus as fast as they can. Just this morning Glenn Beck interviewed a man named Gregory Rigano, Stanford Advisor to SPARK, and Project Lead for Clinical Trials for COVID-19 prevention, who was reporting that two drugs—I think working together, but both are also being studied separately—anyway, these drugs have been shown to cure the disease 100% of the time in six days. He referred to an immunologist from France, so I think that’s where this combination has been tried. He’s was asking for healthcare professionals to join in the open-data clinical trial. 

He hoped that within a couple of months, the treatment could be widespread. He still calls for social distancing, so we don’t overwhelm the available resources. But these drugs may give us time for other remedies and possibly vaccines to be developed in a year or two—without the world economy having to shut down until then.

The drugs he mentioned are generics that have been around for several decades. One is hydroxychloroquine, which was developed shortly after WWII for treating malaria, and has also been used to treat rheumatoid arthritis. The other is azithromycin, the antibiotic often referred to as Zithromax, or in its package called a Z-pak. The FDA has already approved these drugs; they just have to approve them for this off-label use.

Later today President Trump held a press conference announcing the FDA’s allowing for hydroxychloroquine and a couple of other drugs (I didn’t catch all the names, but azithromycin wasn’t among them, so there are additional ones) to be used for the off-label purpose of treating COVID-19. This is a very hopeful development. 

The FDA Commissioner, speaking alongside the President, said that, when he was a cancer doctor and researcher, he knew how important it was to offer a patient hope. Not false hope, but real hope. He believes the announcement today, along with other efforts to combat this illness, offers real hope. I think he’s right. I’m much more hopeful today than I was even yesterday.

We live in interesting times. My Utah friends and family lived through an earthquake, and its aftershocks, yesterday morning. One meme started referring to all that’s been going on as “apocalypse bingo,” and the card is filling up.

Our literary friend Gandalf had this conversation with Frodo over such times:

“I wish it need not have happened in my time,” said Frodo.

“So do I,” said Gandalf, “and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.”        —J.R.R. Tolkien, The Fellowship of the Ring

image found here