Disease updates

A lot of news has been bouncing around my head. Let me start with the most recent information about Kentucky, then I'll say a few things about the US, and finally, compare America to the rest of the world.

Why Kentucky? Aside from the fact I live here, Kentucky has been held up as a bellweather state for its early, decisive, and consistent action to limit the spread of COVID-19 -- as contrasted to neighboring Tennessee, for example.

To begin, these are the latest COVID-19 figures for Kentucky, acording to Newsweek:

With the 273 additional confirmed infections, Kentucky now has 2,960 cases of the novel virus and 1,122 recoveries. [Governor] Beshear also announced four new deaths on Sunday, bringing the total number of fatalities across the state to 148.

If the disease kills 1% of those who have the virus, as has been frequently estimated, that would mean  there are about 15,000 current Kentucky infections. Likewise, if we assume that only the most serious cases are being tested, which still seems to be true, and that prior estimates are correct that about 20% of cases are very serious or critical, then there would be about 15,000 current Kentucky infections.

But 12,000 of those either had mild versions of the disease or are "silent carriers."

Some experts in the medical community estimate that the number of asymptomatic people is likely to be even higher than we think -- and that experience with prior pandemics reveals that case fatality rates (CFR) are almost always overstated in the early stages. Two different credible medical sources suggest the CFR might be closer to 0.35 or 0.37. That's good news, though still much worse than the flu or other illnesses.

If it's accurate, then the number of cases in Kentucky is closer to 50,000 and half probably don't know it at all.

Then again, there seems to be evidence that the COVID-19-related death rate is dramatically undercounted because lots of people are dying at home without ever entering the medical system. The uptick for people over age 65 is particularly dramatic compared to recent years. Some of those deaths are likely from other causes as people stay home despite evidence of heart attack or other illness that eventually proves fatal.

In any case, Kentucky has 4.468 million residents. If 15,000 people have had COVID-19, then that's 0.003% of the population. Obviously, slightly more than triple that (using a lower CFR) and the infection rate is higher -- 0.01%.

Basically, the lower estimate would mean a 15,000 person crowd at a rock concert or ballgame would likely include 45 infected people. With the higher rate, it would mean 150 infected people in that crowd. That assumes the infected are randomly distributed across the state and in attendance at this stadium.

For a 60,000 person football game, just multiple those numbers fourfold -- 180 infectious people in the crowd at the lower rate and 600 at the higher rate.

How long would it take for the virus to spread quickly to many new human hosts under those circumstances?

It's a major problem that up to 80% of those infected don't know it. Even if a substantial chunk of those individuals think they had the disease because of minor symptoms they experienced, half of the carriers are asymptomatic. Plus, some unknown percentage of people have had similar symptoms but did not actually have COVID-19 and are not immune. However, they might think they have had the sickness and erroneously believe they have developed lifesaving antibodies.

US and Comparative data.

The figures for the US as a whole are parallel. As that same Newsweek story providing Kentucky figures reported:

As of Sunday afternoon, more than 764,000 individuals had tested positive for COVID-19 in the U.S., with over 40,500 deaths caused by the new disease and 71,000 recoveries.

If 40,500 deaths reflect a 1% mortality rate, then 4.05 million Americans have been infected by the virus. If the 764K positive test results reflect primarily the worst 20% of cases, then 3.82 million people carry the virus. Both figures suggest about 4 million cases of infection across the country. In a nation of 328 million people, that's a 0.012 infection rate, nearly 4 times the Kentucky rate.

If the case mortality rate is actually at the lower ~0.35 figure mentioned above, then the US would have more like 12 million active cases, in a country of 328 million. That's a 0.037% infection rate, again more than 3 times Kentucky's rate using the same assumption about CFR.

Adjust the stadium figures accordingly. For the two different infection rates, figure 135 or 450 infected people in the smaller concert crowd, or 540 or 1800 in the larger football crowd.

What does this mean in a worldwide context?

Sadly, the US seems to be far behind the rest of the advanced industrial states based on the information available from the millions of tests that have now been conducted.

From month-to-month, March to April, the US positivity rate stayed flat. About 20% of those tested for the virus are positive -- and that many were also positive last month. That's not good compared to other countries and any nation nearing a decision to open its economy should have a much lower rate especially as the number of tests increases:

South Korea—which discovered its first coronavirus case on the same day as the U.S.—has tested more than half a million people, or about 1 percent of its population, and discovered about 10,500 cases. The U.S. has now tested 3.2 million people, which is also about 1 percent of its population, but it has found more than 630,000 cases. So while the U.S. has a 20 percent positivity rate, South Korea’s is only about 2 percent—a full order of magnitude smaller. 

South Korea is not alone in bringing its positivity rate down: America’s figure dwarfs that of almost every other developed country. Canada, Germany and Denmark have positivity rates from 6 to 8 percent. Australia and New Zealand have 2 percent positivity rates. Even Italy—which faced one of the world’s most ravaging outbreaks—has a 15 percent rate. It has found nearly 160,000 cases and conducted more than a million tests. 

I think the only conclusion from all of this is that it is premature to be talking about opening the country on May 1. That link verifies that this understanding is Dr. Fauci's assessment. After about 2 weeks, it seems likely that the infection and death rate would begin to skyrocket again.

We need millions of tests, to find out the actual infection rate and identify the individuals who need to be quarantined and perhaps monitored for the good of public health.

At the same time, we need millions of antibody tests so we can figure out potential blood donors for use to aid the newly sick -- and so we can figure out who might be able to return to more active life sooner rather than later. We simply need much more information to act.

Moreover, "opening up" in its early stages, according to the experts, won't mean the old normal. Social distancing, masks, small crowd sizes, and other limitations would very much be needed. Regular poker games are going to be out for some time:

“What’s the downside to asking people to put on masks or wrap their faces with a shawl?” he [Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University] asked. “It may make some people think they’re bulletproof. Some bozo out there will say, ‘Let’s put on our bandannas and have a poker party tonight.’ 

“That’s what we call, in my family, ‘d-u-m dumb,’” he said.

And dangerous.

In fact, any premature return to the normal of February would apparently mean millions of new cases of the disease and tens of thousands of additional deaths. Hospitals would again face scarcities of PPE and risk collapse from overburden.

The infectiousness of this disease is part of the problem, but so is the prevalance in the USA. Either because the country's leadership reacted too slowly to the outbreak or because people have not been truly careful, the US is far behind other advanced nations.

The only real solution is to continue isolating for the foreseeable future. I know that's economically quite painful, but it's also true that other nations have used superior economic and social welfare policies to ease that pain as well. The US Congress and Trump administration can move on that issue with more political cooperation and leadership.

How about a rally to urge that?



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