I started this document on May 23, 2020, to keep track of select updates about COVID-19. Items are listed in reverse order relative to when I examine them (latest updates on top). This follows my first “COVID-19 Updates” file (April 28 to May 22) and the “COVID-19 Resources” page started March 24. My last post here is June 4. For subsequent updates about this, see my Liberty ‘Gator pandemics tag.
Major data sources: Our World in Data, Johns Hopkins, Worldometer, CO Dep’t of Public Health, USA Data (which has U.S. state-level data), CDC COVID-19 data, EndCoronavirus.org (which has great country and U.S. state case comparisons), Rt.live (which has estimates of reproduction rate, the accuracy of which I know not), Gu Infections Tracker (also includes R estimates), IMF Policy Tracker (country summaries), COVID-19 Projections Colorado page, AEI U.S. state and county tracker. See also Johns Hopkins’s Research Compendium. A handy stat: The U.S. population (estimated May 7) is 330,721,000.
Colorado: “16 grocery stores across Colorado have confirmed outbreaks of COVID-19.”
CDC: The New York Times has a scathing critique of the CDC. Tom Frieden and Jeffrey Duchin in turn call the article misleading. Duchin says the paper “quotes me omitting numerous examples I shared on how CDC has supported our front line public health response on many levels.”
Japan: The country’s “cluster busting” strategy relies on the fact that most infected people don’t spread the disease, and some spread it a lot.
Vaccine: “Moderna’s Phase 3 Covid-19 Vaccine Trial Of 30,000 Individuals Will Begin In July.”
South Korea: “South Korea is testing a new quick response (QR) code system this week to log visitors at high-risk entertainment facilities, restaurants and churches in a bid to track coronavirus cases and prevent further spread of the disease” (Reuters).
Protests: NPR reports, “The risks of congregating during a global pandemic shouldn’t keep people from protesting racism, according to dozens of public health and disease experts who signed an open letter in support of the protests.” The letter does encourage the use of masks, social distancing, and other mitigating measures. I basically approve of the message. At the same time, I sympathize with Leon Wolf, who points to the double standards: “I am really [irritated] that apparently the life-and-death need to destroy this country was apparently not so life and death. The people who told us and scolded us (including public health experts), who told us there was literally no reason that would justify ignoring them or violating social distancing rules suddenly find that literally no reason means ‘unless it’s a reason that’s societally important.’ . . . So, having established that I think the fight for police reform is really important, I have to ask: was it not important to prevent tens of thousands of predicted deaths from suicide due to the psychological effects of the lockdown and ensuing depression? Is it not important that people, especially small business owners and employees, are able to feed there families? Is it not important that, you know, black people have jobs? Black employment was at historical highs in March, now less than half of black people are employed.”
Free-Rider Problem: I Tweeted, “I definitely see a ‘free rider’ problem coming up with COVID-related actions. Most of us, those who are under 60 and healthy, have much-reduced risks of suffering from the disease. And if a small fraction of that group party it up, that doesn’t much affect disease spread. But then the costs of keeping disease spread down are falling on those who maintain stricter social distancing. And those with the least risks of suffering from the disease still can serve to transmit it to more-vulnerable people.”
Fatality Rate: Adam Kucharski writes, “I’m seeing frustrating trend emerging – early on, some researchers suggested populations already had high immunity, and serology would show this. Now serology is available and doesn’t show this, these claims are apparently shifting post-hoc to justify why new data can be ignored.”
Hydroxychloroquine: David Harsanyi is right: “That hydroxychloroquine study everyone was writing hysterical columns about a few weeks ago was a fake.” Or at least it is highly problematic. Here is the Guardian‘s take. Harsanyi’s take is not an outlier. For example, Gideon Meyerowitz-Katz, an epidemiologist, has also questioned the study. Of course, that hardly means the drug is effective and safe for treating COVID-19. This is quite a line from the Guardian about the company that provided the underlying data: “A search of publicly available material suggests several of Surgisphere’s employees have little or no data or scientific background. An employee listed as a science editor appears to be a science fiction author and fantasy artist. Another employee listed as a marketing executive is an adult model and events hostess.” Another bit: “The Guardian has since contacted five hospitals in Melbourne and two in Sydney, whose cooperation would have been essential for the Australian patient numbers in the database to be reached. All denied any role in such a database, and said they had never heard of Surgisphere.” This is scandalous. Yet, as I Tweeted, “‘The experts’ and the media created this gigantic mess over hydroxychloroquine. Fair critique! And ‘the experts’ and the media also cleaned up the mess.” * Ronald Bailey also addresses the issue. * But the drug still seems not to work for COVID-19. Natalie Dean has some useful comments about this. * WHO will continue testing.
Sweden: Sweden’s chief epidemiologist Anders Tegnell said, “If we were to encounter the same disease again knowing exactly what we know about it today, I think we would settle on doing something in between what Sweden did and what the rest of the world has done.” Yet I think this particular article (by National Review) is misframed. The article presents the issue as one of severity of lockdowns. But there are many things a country can do besides lockdowns, and some of the most successful countries did not impose lockdowns. All of the successful strategies involve variants and aspects of the standard hygiene-test-trace-isolate.
Contact Tracing: There has actually been a rally to protest contact tracing.
Protests: “Glen Mays, a professor of health policy at the Colorado School of Public Health,” fears that police use of tear gas and pepper balls at protests may exacerbate dangers of COVID-19 by causing people to cough. * Denver has expanded COVID-19 testing to anyone who fears having been exposed. Previously testing had been limited to people with symptoms or exposure to a positive case. * Trevor Bedford is worried about a spike from the protests, although, as Zeynep Tufekci notes, the larger problem might be the arrests (putting people together indoors). And Bedford presents graphs showing walking and driving mobility nearly back to pre-pandemic levels.
Disease: This makes sense: “Coronavirus May Be a Blood Vessel Disease” (Dana Smith).
Treatments: Zoe Hyde reports that “anakinra,” “a cytokine-blocking drug,” has shown some early success in reducing mortality. “Randomized trials are needed.” * I like this idea by Siddhartha Mukherjee: “It is time to run a trial of EARLY rx with Remdesivir (or antibodies) in NON-hospitalized COVID patients. That would invert the paradigm: if you have a risk factor (diabetes, obesity) then test early, treat early. That would make it safe to open the economy.”
Farm Spread: This is terrifying: Seth Holmes reports very high rates of positive tests among Florida agricultural workers.
Protests: I’m not the only person very worried about the possible spread of SARS-CoV-2 at the recent protests. Amesh Adalja says, “Anytime people are socially interacting, the virus has an opportunity to transmit. There’s also a lot of yelling and shouting during these events.” I hope that being outdoors will have helped dissipate virus-laden particles, but I’m really worried about this. * Meanwhile, although Denver Mayor Michael Hancock urged protesters to get tested, the Denver web site says that only people with symptoms, and people who have been exposed to someone with a positive test, can get tested. * I Tweeted more about this here and here. * Tom Frieden, however, is not as worried about outdoor protests, and he cites studies showing much lower risk outside. But I doubt the relevant studies apply well to a protest environment. Usually people who are outdoors are not part of large, densely-packed crowds of chanting people. In a protest environment, I fear, the virus may spread relatively easily. I hope those fears are unfounded; we’ll know soon enough.
Colorado: In a media conference today, state health experts said that, under most modeling scenarios, they expect a second Summer peak greater than the April peak.
Fatality Rate: Carl Bergstrom harshly criticizes an NPR story with the headline, “Antibody Tests Point To Lower Death Rate For The Coronavirus Than First Thought.” Bergstrom replies, “What the story actually reports are recent results from and Indiana serosurvey suggesting infection fatality rates in exactly the range of what most epidemiologists have been saying for weeks to months.” The story “even acknowledge[s] . . . that the 0.5%–1% IFR has been conventional wisdom for months.” He adds, the misleading headline “matters because this pandemic is so heavily politicized. When you put out stories like this, it provides ammunition to those who are trying to spin alternative narratives.”
Media: Bergstrom also criticizes a Reuters story claiming the virus is “losing potency.” He replies, “But there’s no evidence that this was part of a formal study of any sort, and he [the doctor behind the claims] offers no figures, no data, and no writeup. It seems to be an off-hand remark and little more.”
Cost: One patient got a bill for COVID-19 treatment for $840,386.94. The person was insured. Government has badly broken the health market.
Mitigation: Eric Feigl-Ding suggests putting UV systems in public transportation to kill viruses. Sounds like a great idea to me.
South Korea: “South Korea closes schools again amid coronavirus spike, days after reopening.”
Testing: “Antibody tests were hailed as way to end lockdowns. Instead, they cause confusion.” The piece discusses efforts in Pitkin County, Colorado, Teluride, elsewhere.
Vaccines: “Challenge trials can speed development of a Covid-19 vaccine. Planning for them needs to start now” (Josh Morrison).
Economics: “The Commercial Real-Estate Market’s Impending Crash.”
Risk Factors: “People with a genetic mutation that increases the risk of dementia also have a greater chance of having severe Covid-19.”
Colorado: Chris Vanderveen reports on the positive trends in Colorado. One really interesting chart shows emergency room visits for COVID way down.
Response: Dylan Morris has a good discussion about disease dynamics and uncertainty: “John Ioannidis and Nassim Taleb . . . pointed out early in the pandemic that there was a lot we didn’t know. But Ioannidis argued that this meant taking action to slow the spread was dangerous and unsupported by the science. Taleb argued that our uncertainty was precisely why we had to act immediately. As you might guess, I agreed with Taleb. What Taleb understood, and what public health officials in places like Hong Kong, Taiwan, South Korea, and Vietnam understood, was that there was an asymmetry between overreacting and under-reacting.” Generally I agree with this. But I’d point out that the best way to “act immediately” is to squash the disease through a robust test-trace-isolate strategy, not to wait until the disease gets out of hand and then impose society-wide lockdowns.
Epidemiology: Gideon Meyerowitz-Katz warns about “arm-chair epidemiology,” “It’s easy to get these things wrong. The ideas aren’t always simple, and often they are fiendishly counter-intuitive.” He discusses the problems with test accuracy.
Collateral Damage: “Concerning drop in U.S. colorectal cancer screenings and surgeries” (there has been).
Vaccines—Markets: Tyler Cowen advocates a limited place for markets in vaccines. He concedes government needs to provide vaccines to “health-care workers and others in critical jobs.” My take: Cowen (along with almost everyone else) assumes the current context of heavily controlled markets in health care. I think that assumption should be questioned and that a genuinely free market should be on the table.
Test-Trace-Isolate: The Royal Society has out a document. However, it still assumes heavy reliance on social distancing.
Japan: “It drove down the number of daily new cases to near target levels of 0.5 per 100,000 people with voluntary and not very restrictive social distancing and without large-scale testing. Instead, the country focused on finding clusters of infections and attacking the underlying causes, which often proved to be overcrowded gathering spots such as gyms and nightclubs.” * Eric Topol thinks masks were a huge deal in Japan.
United States: Helen Branswell has a poignant way of stating U.S. deaths: “The United States, which makes up roughly 4.25% of the globe’s population, accounts for ~28% of the global COVID-19 deaths.”
Testing: Eric Feigl-Ding has a good discussion on testing accuracy. He points out that the CDC warns that a positive antibody test does not actually guarantee immunity. But so what? Those tests are useful for general disease tracking, and they are one good indicator of an individual’s likely immunity and vulnerability. As for the problem of false positives, that can easily be mostly remedied simply by giving people a second test and even a third one. The solution to problems with testing accuracy is more testing and better tests. Feigl-Ding embeds a really useful video explaining why, when a low percent of the population has been infected, the tests do a poor job in terms of returning lots of false positives. But, again, the answer is multiple rounds of testing.
Lockdowns: Tomas Philipson presents a graph showing restaurant dining dropping off well before government orders went into effect. * From May 8: “81 Percent of NYPD’s Social Distancing Summonses Were Issued to Blacks and Latinos”
New Zealand: It “has no new coronavirus cases and just discharged its last hospital patient.”
Fatality: Gideon Meyerowitz-Katz has helped publish new estimates of infection fatality rates. He writes, “For example, Spain’s very large serology study showed an IFR of 1–1.3% The Czech Republic had an impressive study that found closer to 0.6% In Wuhan, it appears to have been 0.35%. These are not contradictions.”
Regulations: Good news for the Cordair Art Gallery: “Open for business: Napa retail art galleries claim victory as county backs down in the face of a legal challenge.”
United States: “The person who ignited the first chain of sustained transmission in the United States probably returned to the country in mid-February. . . . The United States missed opportunities to stop the SARS-CoV-2 virus from taking root in this country,” writes Helen Branswell for Stat. The article cites a May 21 paper by lead Michael Worobey. From the abstract: “Our results refute prior findings erroneously linking cases in January 2020 with outbreaks that occurred weeks later. Instead, rapid interventions successfully prevented onward transmission of those early cases in Germany and Washington State. Other, later introductions of the virus from China to both Italy and Washington State founded the earliest sustained European and US transmission networks. Our analyses reveal an extended period of missed opportunity when intensive testing and contact tracing could have prevented SARS-CoV-2 from becoming established in the US and Europe.” That was an epic, catastrophic failure. * “The anti-science leadership of Trump, Bolsonaro, and Putin led to the worst coronavirus outbreaks in the world,” writes John Haltiwanger.
Risk Factors: A May 25 letter (lead Daniel Westreich) warns about the problems of sorting out “risk factors” of the disease, such as claims of a “protective effect” of smoking. The letter responds to a May 6 study (lead Elizabeth Williamson).
Shopping: In response to reports of people shopping “shoulder to shoulder” in stores where people have contracted COVID-19, I Tweeted, “I sincerely do not understand why so many people are going into stores, when delivery and curbside pickup are options most places. (Yesterday I placed orders for coffee, evap cooler parts, even grass seed.)” * Increased use of Instacart and comparable delivery services reduces disease spread in three ways. 1) Professional deliverers often shop multiple orders at once. 2) They tend to shop more efficiently, thereby minimizing their in-store time per order. 3) They can substitute for more-vulnerable shoppers. * This article confirms the points about multiple orders and efficient shopping.
Contact Tracing: As I’ve discussed, there are trade-offs between testing and tracing: If you have more of one you can get away with less of the other. I personally like Paul Romer’s plan to lean heavily on mass testing. But even with that plan we need some effective contact tracing. It would be great if had sufficient contact tracing to lean more heavily on that. * Craig Welch (National Geographic) has a lengthy review of contact tracing. * “While U.S. struggles to roll out coronavirus contact tracing, Germany has been doing it from the start.”
Testing: Paul Romer went on an extraordinary Twitter rant about testing. He summarizes, “When they [health scientists] (i) dismiss policies with benefits that exceed cost by orders of magnitude [i.e., mass-testing], and (ii) bless an endless cycle of lockdown and reopening, scientists are observationally equivalent to madmen and fools.” He adds, “Experts from epidemiology might also want to avoid policy recommendations that are devoid of any attention to the costs and benefits that people care about.” Natalie Dean responded favorably. Gideon Meyerowitz-Katz pointed out that certain tests have very high false negative rates. (The particular example was Wuhan testing.) But I think this misses Romer’s broader point: Clearly we do have tests accurate enough for effective mass-testing. * Romer, pointing to a May 28 paper, says it is “blatantly false” that “the false negative rate on PCR tests exceeds 67%.” * Amy Maxmen writes about the FDA’s stoppage of a home-testing program in the Seattle area. * Update: Adam Kucharski replied to Romer, “I don’t think anyone is saying recurrent lockdown is best option. We modeled it early on as scenario, but targeted measures/innovation obviously [are] preferable. Testing [is an] important part of this, but Paul seems to agree that’s bit harder that he first assumed.”
Lockdowns: Lyman Stone continues his critique of lockdowns. Here’s how he summarizes events: “If you limit searches in lockdown effect estimates to 2019 and early you will find a grand total of three papers, all studying the very short Ebola lockdowns. They disagree on effects and all concede that case is too muddy to reach a clear conclusion. So there’s a policy that pre-COVID research said had super ambiguous effects we couldn’t really quantify, we rolled it out on a huge scale, and we got . . . super ambiguous effects we couldn’t really quantify!” He also points out that what people look at in these studies is level of social interaction, which probably correlates poorly with interaction “by infectious people in circumstances that facilitate transmission.” He points to Peru and Brazil, which both experienced post-lockdown outbreaks. * Stone also extends his critique of the Texas paper (leads Dhaval Dave and Andrew Friedson, see May 25 entry). Stone calls the study “nonsense.” The problem, in Stone’s view, is that the study uses case growth to examine the effects of lockdown orders. But case growth seems poorly related to excess mortality and reported COVID deaths, which Stone regards as more-reliable indicators. Stone also points out that figuring out where an infection occurred is hard, as “cases are not reported by ‘county where infection occurred.” Stone concludes, “SIPs [shelter-in-place orders] maybe increase staying at home a little bit but we can’t actually say if they reduce case growth, and also case growth is a dumb metric anyways.” Yet another problem: “[T]hey find that somewhere around 30–75% of the SIP effect shows up 0–4 days after implementation. Which is weird since that’s not enough time for COVID to incubate. COVID doesn’t even necessarily show up positive on a PCR test before 1–3 days!” Stone also points out that a public “groundswell of support for distancing” can induce politicians to impose lockdowns, so sorting out causation is hard.
Colorado: Chris Vanderveen offers the latest updates from the Colorado health department. Here is one detail: “Businesses should consult CDPHE guidance and close for 48 hours after 2 cases to prevent a larger outbreak.” And mobility data indicate that people started spending more hours at home starting in early March, with hours at home peaking in late April and coming down steadily through May. The state estimates an effective reproduction rate of less than 1 as of early May, but of course what we all want to know is where it’s gone with partial reopening. Some key information: “We [the state] still ask people to stay home as much as possible and avoid social interactions.” Vanderveen writes, “Dr. Jonathan Samet’s modeling says any scenario where we go below 65% social distancing as a whole (where we are now) WILL result in overrun of ICU bed space in late summer/early fall.” The state assumes social distancing will be “maintained indefinitely.” * Jennifer Brown suggests that the 65% social distancing guidelines apply only to people “age 60 and older,” yet a slide presented by Vanderveen refers to “population-wide social distancing.” Brown also reproduces a chart showing hospitalization rates coming down pretty dramatically since early April. * The Colorado health department issued a May 26 release (with slides) and related May 23 modeling information. The release says, “Mobility, as measured by time spent away from home using anonymized and aggregated mobile device data, was lowest in early April and has been increasing steadily since mid-April.” Obviously the timing of the lockdown orders does not account for that trend. The release says, “Increases in case detection and isolation, mask-wearing, and physical distancing of approximately 65% can prevent a surge in infections in excess of hospital capacity in the coming summer months.” This is for all ages. Alternately, “If Colorado moves to lower levels of physical distancing (55%), older adults need to maintain physical distancing at the level seen during the Stay at Home in order to avoid exceeding hospital capacity.” There is no scenario the state considers, except society-wide social distancing at 65%, that doesn’t lead to a major Second Wave by this Fall, although some other scenarios keep hospitalizations within capacity. * Jared Polis also hosted a media conference about this.
Colorado—Testing: The state’s COVID testing page currently says that no “doctor’s note” (prescription) is necessary for a test at most testing locations. However, both Denver and a Jefferson County testing site say that only symptomatic people can be tested (with some exceptions).
Regulations: The FAA makes it extremely difficult for airlines to hand out hand sanitizer.
Colorado: Restaurants can reopen Wednesday with limited indoor capacity (50%) and hygiene requirements. “Bars remain closed.” * Chris Vanderveen reviews: Colorado testing positivity has been below 10% for “15 straight days,” and hospitalization numbers are the “lowest since March 30” with “daily admissions generally below 50.” But we’re still seeing hundreds of new cases per day. * “Mile High Brendan” reports that mobility is up across the state, but it’s up a lot more in lower-density, more-conservative areas.
Lockdowns: Bryan Caplan accepts that people’s behavioral changes preceded government lockdowns. But, he adds, lockdowns can prolong and amplify the behavior. He adds the point about economics: “The welfare cost of prohibition is much greater than the welfare cost of large behavioral changes.” This flows from standard marginal value analysis. To this I’d add another point: It’s also reasonable to think that the marginal benefits of lockdown-induced behavioral changes in terms of disease containment are lower. Caplan adds that subsidies for people not working increase “the sustainability of the lockdown.”
Lockdowns—Texas: Here is an interesting paper (Dhaval Dave, Andrew Friedson, et al.): “We exploit the unique laboratory of Texas, a state in which the early adoption of local SIPOs [shelter-in-place orders] by densely populated counties covered almost two-thirds of the state’s population prior to Texas’s adoption of a statewide SIPO on April 2, 2020. Using an event study framework, we document that countywide SIPO adoption is associated with a 14 percent increase in the percent of residents who remain at home full-time, a social distancing effect that is largest in urbanized and densely populated counties. Then, we find that in early adopting counties, COVID-19 case growth fell by 19 to 26 percentage points two-and-a-half weeks following adoption of a SIPO, a result robust to controls for county-level heterogeneity in outbreak timing, coronavirus testing, and border SIPO policies. This effect is driven nearly entirely by highly urbanized and densely populated counties. We find that approximately 90 percent of the curbed growth in COVID-19 cases in Texas came from the early adoption of SIPOs by urbanized counties, suggesting that the later statewide shelter-in-place mandate yielded relatively few health benefits.” Lyman Stone complains the study is “totally invalid because it uses reported cases and that’s a worthless indicator and we shouldn’t even publish it anymore.” No doubt there’s an issue here, but I doubt it “totally” invalidates the study’s results. The authors specifically address this concern, to my mind satisfactorily (see p. 16 of the full paper). Let’s look at the full pdf. It references an earlier paper, also by Dave and Friedson et al., showing “that SIPOs were much more effective at slowing the spread of COVID-19 in states that had higher average population density relative to states with lower average population density.” Let’s detour to that other paper: “We document that adoption of a SIPO was associated with a 5 to 10 percent increase in the rate at which state residents remained in their homes full-time. Then, using daily state-level coronavirus case data collected by the Centers for Disease Control and Prevention, we find that approximately three weeks following the adoption of a SIPO, cumulative COVID-19 cases fell by 44 percent.” Note the term “associated” here. My big complaint has been that underlying factors help explain both the increase in social distancing and the adoption of the orders. Going back to the Texas paper, this bit is interesting: “County SIPO policies created important variation both in the timing of local SIPOs as well as the density of the local population impacted by these local orders.” Here is a conclusion: “County-level SIPOs enacted in Texas were somewhat more effective at eliciting social distancing behavior in more densely population areas.” But my alternate thesis seems as justified: “More densely populated areas were somewhat more willing to socially distance and to embrace orders.” Here is an interesting bit: “[T]he parallel trends assumption . . . would be visibly violated if . . . SIPOs serve as an observable marker for difficult-to-measure county-specific variables that are correlated with coronavirus growth, such as local information shocks or voluntary social distancing.” I can’t comment on how well their modeling accounts for this. The authors find, “the marked increase in sheltering-at-home in the treated counties relative to the non-adopters materializes only after the implementation of the SIPO.” Timing seems to matter a lot: “We find significant reductions in the COVID-19 case growth following implementation of a local SIPO, but only for the earliest adopting counties.” And: “We continue to find no beneficial effects of the statewide-SIPO for the remaining counties that had not enacted local orders.” Here’s what seems undeniably true: Increased social distancing, early in disease spread, in high-density areas, in the absence of other robust containment measures, substantially reduces disease spread. Then the two points of contention are, 1) how much do the orders cause the distancing (rather than both orders and distancing being caused by underlying social factors), and 2) would other measures (early test-trace-isolate strategies) have been more successful and less costly? * Reason compiled some comments of Lyman Stone and Friedson on lockdowns. My summary: They agree on key details (lockdowns had some effect but don’t explain all social distancing), but disagree on magnitude of the effect. * Update: For more of Stone’s critique of the Texas paper, see the May 27 updates.
History: Walter Olsen, citing a paper by Ernest Caulfield, writes, “The Framers were exceedingly familiar with the ravages of communicable disease, which may be one reason there appears to have been so little controversy over use of the state police power to block its spread.”
Disease Dynamics: As Jacob Sullum reviews, the CDC thinks that 35% of cases are asymptomatic and that the fatality rate for symptomatic cases is around 0.4%. That implies a lower total case fatality rate. But we should bear in mind that the fatality rate in New York City seems to have been quite a lot higher.
Testing: “In Senegal, a new COVID-19 test will cost just $1 and take 10 minutes for results.” It’s an antibody test. The big question is accuracy. * People without symptoms finally can get tested in Ontario.
Lockdowns—Iowa: A study compared locked-down Illinois counties with unlocked Iowan counties and thinks the lockdown made a difference. A big problem for the study’s conclusions is a major outbreak at Iowa meat-packing plants. Aria Bendix summarizes, “The researchers concluded that a stay-at-home order might have prevented around 30% of cases in Iowa’s border counties from March 21 to April 20.” Let’s look at the May 15 study itself (Wei Lyu and George Wehby). Here’s one possible issue: “Population density was higher in the Iowa counties.” The paper states, “Trends of cumulative COVID-19 cases per 10,000 residents for the Iowa and Illinois border counties were comparable before the Illinois stay-at-home order” of March 21. “After that, cases increased more quickly in Iowa and more slowly in Illinois. Within 10, 20, and 30 days after the enactment of the stay-at-home order in Illinois, the difference in cases was −0.51 per 10,000 residents . . . −1.15 per 10,000 residents . . . and −4.71 per 10,000 residents . . . respectively” (skipping the confidence and range figures). “The estimates indicate excess cases in the border Iowa counties by as many as 217 cases after 1 month without a stay-at-home order. This estimate of excess cases represents 30.4% of the 716 total cases in those Iowa counties by that date.” This is a fairly modest effect anyway. Notably, Iowa did impose fairly rigorous restrictions: “The state has issued a series of orders, including banning large gatherings and closing bars and restaurant dining on March 17, 2020; closing some nonessential businesses (e.g., dental offices, clothing stores, barbershops, massage therapy, medical spas) on March 26, 2020; closing all primary and secondary schools (recommended on March 15, 2020) on April 2, 2020; and closing additional businesses (e.g., malls, nongrocery stores, museums, libraries, social clubs) on April 6, 2020.” There is a big potential problem for the study’s conclusions, though: “In the last 2 days of the study period (i.e., April 19-20), Iowa began announcing an increase in cases from surveillance testing following outbreaks in meat-processing facilities. . . . Meat-processing plants would not be closed during a stay-at-home order because they are considered essential businesses.” That outbreak was a very big deal, as Iowa Public Radio relates (April 15): “The new coronavirus is now spreading faster in Louisa County than anywhere else in Iowa.” On April 19, the Iowa Department of Public Health (IDPH) announced, “261 or 67% of today’s 389 additional positive cases can be attributed to surveillance testing of meat processing facilities.” On April 20, IDPH announced, “46 of today’s 257 new positive cases are part of surveillance testing for meat processing facilities.”
Colorado: “Colorado Will Test For Coronavirus At Every Nursing Home Every Week For 8 Weeks.” * “Gov. Polis, Mayor Hancock unveil massive coronavirus testing site at Pepsi Center.” But: “Testing at the Pepsi Center won’t be for people who are asymptomatic.” So a massive failure. * Last month Colorado Senator Michael Bennet proposed a “health force.” This seems like a giant make-work program to me. I think testing should be at-home via the mail and contact tact tracing should be mostly over the phone and led by state and regional agencies. * Definitely: “Keep Colorado’s to-go alcohol sales after emergency order ends.”
Protective Gear: “Employers are scrambling to get enough protective equipment to create a safe work environment.” Maybe if politicians hadn’t imposed price controls on protective gear more of it would not be available.
Today I’m going through a lot of collected links, so I’ll include some material that’s older.
Ethics: Anthony Fauci said, “Now is the time to care selflessly about one another.” I agree people should care appropriately about each other, but I wouldn’t put it the way Fauci did. Here’s how I would (and did) put it: “A person’s interests and values normally encompass the welfare of other people.”
Japan: Lisa Du and Grace Huang write, “No restrictions were placed on residents’ movements, and businesses from restaurants to hairdressers stayed open. No high-tech apps that tracked people’s movements were deployed. The country doesn’t have a center for disease control. And even as nations were exhorted to ‘test, test, test,’ Japan has tested just 0.2% of its population—one of the lowest rates among developed countries.” I note that Japan, with a population of around 127 million, has suffered a relatively-low 808 total COVID-related deaths. Japan has good contact tracing, the article notes, and the country has had a “loose lockdown.” * Hironori Funabiki attributes Japan’s success to its “Cluster Response Team.” * Lyman Stone notes, “Japan uses scans to test for symptoms instead of PCR; including scans their testing rate would be very high.”
Collider Bias: Several people I follow on Twitter have recommended Tim Morris’s take on collider bias, so I figured I should check it out. The idea: “A collider is a variable that is influenced by two other variables of interest.” From the paper (lead Gareth Griffith): “The optimal way to mitigate the problem is to use appropriate sampling strategies at the study design stage.”
Data: JP Morgan has assembled quite a lot of COVID-related data. But I haven’t found this documentation claiming to show that the disease reproduction rate has fallen in most states “after lockdown ended.” Carl Bergstrom is skeptical.
Plasma Antibody Treatment: There’s controversy regarding whether such treatments available in America work (Alexander Nazaryan). But I’m not seeing much downside. But this seems odd: “A person can donate blood for the Mayo Clinic expanded access program if he or she received a positive diagnostic test for the coronavirus, then waited 14 days after symptoms of the disease disappeared. Around this time, the body should be producing high levels of antibodies, although there has been some suggestion that two weeks is too soon to donate blood for coronavirus convalescent plasma.” Thankfully, at least some blood banks are now actually testing for antibodies before sending the blood on for treatment.
Vaccines: Scott Gottlieb says, “There’s probably not going to be enough virus here in the United States circulating to enroll clinical trials in July and August to find out whether or not these vaccines are working, so we’re really going to have to wait until the fall.” Waiting is ridiculous. Lots of people would volunteer for “human challenge trials,” and they should be allowed to do so. * Eric Topol reports early successes in vaccines and cites a May 22 Lancet paper indicating, “The Ad5 vectored COVID-19 vaccine is tolerable and immunogenic at 28 days post-vaccination.” * Pfizer is in the hunt.
Brazil: Lyman Stone is perplexed about Brazil. The country had early lockdowns and extensive social distancing yet a large recent outbreak. Looking at Our World in Data, Brazil seems to have had a pretty steady upward progression of daily deaths since early or mid-April. To date Brazil, a country with a population of around 210 million people, has suffered around 21,000 COVID-related deaths. Brazil, with 99 deaths per million, is quite a bit better off on net than the U.S., with 290. Brazil seems to be suffering a “late wave.” Why? The only theory I can think of offhand is that Brazil’s actual level of social interaction increased more than the data that Stone presents indicate. Stone’s broader point is that lockdowns and social distancing sometimes seem to have the intended effect and sometimes don’t. * Jon Lee Anderson points to Bolsonaro’s public rallies and dismissiveness of the pandemic.
Denmark: Stone continues, “Meanwhile, distancing in Denmark was actually less extensive than in most US states. Danes have distanced about as much as non-locked-down US states. A Danish lockdown is a ‘light touch’ U.S. policy. And yet Denmark has had very low deaths! Because their distancing was early.” Stone recommends, that, rather than impose harsh policies, governments implement “reasonable policies at the very earliest warning signs.” * From a Swedish site, via Google Translate: “It is thus still unclear why increased infection activity is still not recorded 4-4.5 weeks after the first reopening of Denmark. We do not know whether this is due to high compliance with physical distance and hygiene advice, or whether it is possibly due to biological conditions, such as weakening of virulence.” HT Lyman Stone and Derek Thompson.
Mutations: A May 21 (posted) paper (lead Lucy van Dorp) addresses “speculations that some lineages of SARS-CoV-2 may be evolving towards higher transmissibility.” Results: “We do not identify a single recurrent mutation convincingly associated with increased viral transmission. Instead, recurrent SARS-CoV-2 mutations currently in circulation appear to be either neutral or weakly deleterious.” Francois Balloux, one of the authors, summarizes the paper.
Testing: Today Complete Colorado published my column advocating Paul Romer’s plan for mass-testing. * Romer relates news about German schools. The New York Times reports that, when a student was tested, “It took less than three minutes. The results landed in her inbox overnight. A positive test would require staying home for two weeks. [The student in question] tested negative. She now wears a green sticker that allows her to move around the school without a mask—until the next test four days later.”
Variolation: Richard Yetter Chappell notes that variolation (which I discuss) allows for early treatment and near-complete elimination of the spread of infection from the variolated person to others. Although Chappell and others (including me) often discuss variolation in the context of reaching herd immunity, I note that it also could be quite useful even within a test-trace-isolate framework, especially for people in sensitive jobs (such as caring for the elderly). And it might provide a good source of blood antibody donations.
Colleges: Ilya Somin offers some ideas for opening in-person teaching at colleges this Fall. I’ll point out that if we had mass testing his recommendations would mostly be irrelevant.
Colorado: “Protest over public health orders sweeps through downtown Durango.” * Governor Polis spent $1.6 billion without legislative oversight. * “Colorado’s unemployment rate hit 11.3% in April.” * “The first female professor at Johns Hopkins University,” Florence Sabin, remade Colorado’s health infrastructure in 1948.
Bad Actors: Mississippi: “Church That Defied Coronavirus Restrictions Is Burned to Ground.”
Masks: “Adding A Nylon Stocking Layer Could Boost Protection From Cloth Masks.”
Continue reading at the previous “COVID-19 Resources.”