Category Archives: Coronavirus

Give Back My Stolen Face

24 Saturday Apr 2021

Posted by in Coronavirus, Grateful Dead, Social Control

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She looks good in a mask, and I grant you: masquerades often convey exciting undertones of sexual adventurism. But masquerades and masks should be novelties, not a constant way of life dictated by over-precautious public health authorities.

That brings me to the subject of an outdoor concert I’m attending with some friends on May 8th. It’s to be held at a grassy amphitheater along the Mississippi River in south St. Louis County. Unfortunately, the county health department imposes idiotic rules at this and other outdoor facilities. In the document at the link, it’s clear the rules were given some spin by the band who will perform that night, Jake’s Leg, a very good Grateful Dead cover band. And I get it: these guys just want to play music and perform for their fans, who will be happy to soak in the sounds, party, and dance the night away. Still, some of the rules are absurd and fly in the face of “the science”.

There is a certain libertarian streak among Grateful Deadheads, though in terms of realpolitik, probably the majority is of a more collectivist persuasion (not me). Some in the crowd will welcome the rules and might even go so far as to rat-out anyone whose behavior they find “unsafe”. Others will just go along with the rules as they interpret them. Some like me might push the envelope. But as the evening wears on… what a nice expression, … “as the evening wore on…”, it will be interesting to see whether forces tear loose from the prescriptive axis.

I’ve excerpted some of the rules below and added brief commentary. They appear in the order listed in the document, though it might seem a bit jumbled. I’m sorry to have left out most of the friendly color added by the band:

“Bring a cloth or paper face covering. You will not be allowed entry if you do not have one. Gaiters, bandanas and full-face shields are not acceptable as primary or only face covering. Face coverings must completely cover the nose and mouth. Children under 2 years old are not required to wear a face covering.”

The chances of contracting COVID outdoors are virtually nil, and don’t tell me we’re just learning these details … we’ve known that since almost the beginning of the pandemic. Second, in any case, cloth and paper masks are ineffective at stopping the aerosols responsible for most viral transmission. That’s been known for many years. Our public health experts are only now starting to admit these facts. Allowing toddlers to go maskless is the only concession, and it’s true that transmission by children is unlikely and COVID severity in children is very low. But that goes for older children as well, not just toddlers. Asymptomatic spread is similarly rare, so if you feel good enough to go (and they’ll check your temperature at the gate), you are unlikely to present a risk to anyone.

“Please bring small personal coolers only (no coolers w/ wheels) for your favorite beverages (cans and non- breakables please), along with snacks and food, chairs, blankets and personal use items for you and your small group.”

So, maybe not so bad… it’s about like the usual charade at restaurants: we must enter wearing masks, but then we can rip them off as soon as we find a spot to enjoy the music, our snacks, beverages and those all-important personal use items. Hmm, I guess the unsanitary passing of spleefs ist verboten. A hookah with several hoses could accommodate a small group, but that never goes over with an event staff! Edibles are fine!

“Have your ticket ready to be scanned … and always maintain at least 6 feet social distancing while you’re in line. Markers will be placed as a reminder for you.”

Even indoors, three feet of distancing has been acknowledged as adequate by the undeservedly celebrated Dr. Anthony Fauci.

“Please spread out and maintain at least six feet social distancing from other attendees outside of your small group. There is plenty of room to move and dance.”

More of the same hogwash. Note that the requirements offer no definition of “small group”. To appreciate the absurdity and unnecessary ass-covering inherent in all this, let me point out that my “small group” will consist of six or seven friends who haven’t met as a group in more than a year, We are almost sure to mix with other friends whom we’ll see at the show. So group members will migrate between groups, or small groups might merge into somewhat larger “small groups”. This will be happening all over, and it’s a pretty sure bet there will be lapses in mask compliance. If you happen to be spinning or dancing, the last thing you should do is wear a mask. You need oxygen, and you should avoid trapping hot breath and spittle right up against your face (see the latter part of this article).

“Once you’ve found a place to watch the show, please stay with your group at your area. If you must leave your space, you must wear a face covering at all times whenever you are not able to maintain at least 6 foot social distancing.”

Uh-huh… “Distancing” is not always clear-cut behavior. You pass people coming and going and dancing around. Are you “distancing” on average? Will you be ejected if you briefly come within a few feet of another concert-goer, sans mask? These are matters of uncertain degree, and it’s generally why police don’t enforce mask mandates in pedestrian areas, aside from a few draconian “mask traps” outside stores. Outdoors, it’s absurd.

“Please wash/sanitize your hands before and after using all restroom facilities. Always be kind, think of others and practice social distancing when waiting.”

Post-toilet hand washing is always a good practice, of course, but these guys are nuts! When I arrive at the restroom, I’m generally not worried about the remote chance that my hands will pass the virus to my genitals or vice-versa, and we know that the virus isn’t transmitted from surfaces. It’s also regrettable that masks and distancing will limit those sometimes entertaining conversations in bathroom lines.

“All attendees must adhere to these guidelines regardless of vaccination status.”

This also is sheer stupidity, and I’m complaining only because it reflects the “Zero COVID” mentality of the public health authorities holding us hostage. I guess I’d rather not bring my vaccination card along in any case, and at least they aren’t requiring “vaccine passports” for entry to the venue. But just in case I’m misunderstood, the chance that a fully vaccinated individual will catch or transmit the virus is very low and not even worthy of concern in any rational balancing of risk and benefit.

“Disclaimer: All venue initiatives to prevent the spread of COVID-19 are strictly followed and enforced. Those on premises are subject to compliance with all venue safety procedures and protocols. Non-compliance will result in refused entry or ejection from venue without refund. Upon purchasing tickets for the event, you acknowledge and agree to adhere to all venue policies.”

Again, as a practical matter, some of the rules listed above are virtually unenforceable, but we’ll see how the evening unfolds with a crowd of free-wheeling Deadheads. It could be all strangers stopping strangers, just to bump their elbows. Either way, if past is prelude, the amphitheater will be something of a heart-of-gold land.

Bottom-Line Booster Shots

17 Saturday Apr 2021

Posted by in Coronavirus, Public Health, Vaccinations

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The barrage of precautionary COVID missives continues, and with a familiar “follow-the-money” twist. The CEOs of both Pfizer and Moderna say that booster shots are likely to be needed a year after initial administration of their COVID vaccines, and almost certainly every year thereafter. Of course, this message is for those who felt compelled to be vaccinated in the first place, whether out of concern for their own health, high-minded community spirit, fear of social ostracism, or fear of possible vaccine passport requirements. It’s probably also intended for those who acquired immunity through infection.

There are reasons to believe, however, that such a booster is unnecessary. This case was made a few days ago in a series of tweets by Dr. Monica Ghandi, an infectious disease expert and Professor of Medicine at UCSF. Ghandi says immunity from an infection or a vaccine can be expected to last much longer than a year, despite the diminished presence of antibodies. That’s because the immune system relies on other mechanisms to signal and produce new antibodies against specific pathogens when called upon.

So-called B cells actually produce antibodies. Another cell-type known as T cells act to signal or instruct B cells to do so, but so-called “killer” T cells destroy cells in the body that have already been infected. Dr. Ghandi’s point is that both B and T cells tend to have very long memories and are capable of conferring immunity for many years.

While our experience with COVID-19 is short, long-lasting immunity has been proven against measles for up to 34 years, and for other SARS-type viruses for at least 17 years. Dr. Ghandi links to research showing that survivors of the 1918 flu pandemic were found to have active B cells against the virus 90 years later! The COVID vaccines cause the body to produce both B and T cells, and the T cells are protective against COVID variants.

A last point made by Dr. Ghandi is intended to dispel doubts some might harbor due to the relatively ineffectual nature of annual flu vaccines. The flu mutates much more aggressively than COVID, so the design of each year’s flu vaccine involves a limited and uncertain choice among recent strains. COVID mutates, but in a more stable way, so that vaccines and adaptive immunity tend to retain their effectiveness.

While I’m sure the pharmaceutical companies believe in the benefits of their vaccines, there are undoubtedly other motives behind the push for boosters. There is money to be made, and much of that money will be paid by governments eager to jump on the precautionary bandwagon, and who are likely to be very insensitive to price. In fact, the vaccine producers might well have encouraged those pushing vaccine passports to include annual booster requirements. This would be another unwelcome imposition. The very discussion of boosters gives government officials more running room for other draconian but ultimately ineffective mandates on behavior. And the booster recommendation gives additional cover to public health “experts” who refuse to acknowledge real tradeoffs between the stringency of non-pharmaceutical interventions, economic well being, and other dimensions of public health.

Blow Me Down: Obesity, Age, and Aerosol-Borne Particles

09 Friday Apr 2021

Posted by in Coronavirus, Lockdowns, Public Health

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Super-spreading events are gatherings at which one or more attendees are already harboring an infection and manage to transmit it to a number of others. These people, in turn, spread it to their close contacts, possibly at the same event. Super-spreading has dominated the transmission of COVID-19. These transmissions have almost always taken place indoors in spaces with limited ventilation, and they have usually involved close or prolonged contact. In addition, super-spreading originates with a small subset of infected individuals. That’s essentially what the chart above shows. It ranks individual subjects by their exhaled quantity of aerosolized particles per liter of air.

For more than a year, we’ve also known that obesity and age are associated with more severe COVID infections. Now, it’s startling to learn that obese and/or older, infected individuals are more prone to transmitting virus: this study found that a high body mass index (BMI) is associated with significantly greater quantities of exhaled aerosol, and that age has a similarly strong association. So called BMI-years, or age x BMI, has an extremely powerful association with the exhalation of aerosol-borne particles. The authors, David A. Edwards, et al, believe this is a consequence of the properties of mucus produced by different individuals in response to infections and how their lungs and airways handle it. The authors say:

“Our findings indicate that the capacity of airway lining mucus to resist breakup on breathing varies significantly between individuals, with a trend to increasing with the advance of COVID-19 infection and body mass index multiplied by age (i.e., BMI-years). Understanding the source and variance of respiratory droplet generation, and controlling it via the stabilization of airway lining mucus surfaces, may lead to effective approaches to reducing COVID-19 infection and transmission. … ”

“Surfactant and mucin compositional and structural changes, driven, in part, by physiological alterations of the human condition—including diet (10), aging (11), and COVID-19 infection itself (12)—may therefore be anticipated to alter droplet generation and droplet size (7) during acts of breathing.”

So there is substantial variation in the exhalation of aerosol-borne particles across individuals. In the study, less than 20% of healthy subjects produced more than 156 particles per liter of air, accounting for 80% of the exhaled particles. This defined their so-called “super-spreader” cohort. The association of BMI-years and exhaled particles was less pronounced but still positive within the “low-spreader” cohort.

Edwards, et al speculate that these fine droplets might help explain the greater severity of COVID infections among the elderly and obese. Not only does the breakup of mucus into tiny droplets cause these individuals to exhale aerosols more profusely, it probably also leads to deep penetration into their lung tissue.

This knowledge might be broadly applicable to infectious diseases, and SARS viruses in particular. The elderly know they are vulnerable. It’s not clear that the obese have viewed themselves as vulnerable, but they should, even in the age of “body positivity“. And not only are they vulnerable: they appear to pose an elevated hazard to others. I came across a couple of sardonic comments that got right to the apparent elephant in the room: “Instead of a mask mandate, how about a push-up mandate?”; and “Instead of a vaccine passport, how about a BMI passport?”

The debate about how to care for the most vulnerable is ongoing, but the mere mention of regularities like those identified by the study might lead to proposals for coercive policies. But first, a few practical points to bear in mind: 1) while the study identifies a major risk factor for transmission, it must be replicated by others, and there must be research into the underlying reasons for the phenomenon; 2) while the obese and seniors may be more likely to super-spread, not all of them are super-spreaders; and 3) as a matter of policy, how would “super-spreaders” be defined? What would be the cutoff BMIs at various ages? No matter what was decided, restrictive policies predicated on mere statistical associations would involve gross injustices to a large number of individuals.

With the degree of acquired immunity already in the population and fairly widespread voluntary vaccination (since alarmists have scared the bejeezus out of everyone), the whole issue might seem moot. It’s not, however, because COVID-19 is likely to become endemic, the immunities of some individuals might erode more quickly than expected, new and more dangerous variants might arise, and new SARS viruses are likely to emerge with time.

In a pandemic, however, and even without knowing who is infected, it is ethically barbaric to probabilistically isolate classes of individuals, whether based on age, BMI, or anything other than contagious status. The social cost is simply unacceptable. Instead, public health authorities should provide information to those at high risk, facilitate vaccination for those who desire it, and promote rapid, at-home tests. This is essentially a deregulatory agenda relative to the mindless lockdown approaches favored by so many public health experts.

Everyone must balance their own personal risks and rewards. Based on the study of exhaled particles discussed above, some might shun the obese and seniors until the threat has passed. Some of the obese and elderly might shun each other. That might be another regrettable dimension of the costs of a pandemic. On the other hand, perhaps more of us will respond to the unquestionably positive incentives for weight loss, of which we’re almost all aware.

CDC Wags Finger; Diners Should Wag One Back

09 Tuesday Mar 2021

Posted by in Coronavirus, Public Health

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The CDC’s new study on dining out and mask mandates is a sham. On its face, the effects reported are small. And while it’s true most of the reported effects are statistically significant, the CDC acknowledges a number of factors that might well have confounded the results. This study should remind us of the infinite number of spurious and “significant” correlations in the world. Here, the timing of the mandates (or their removal) relative to purported effects and seasonal waves is highly suspicious, and as always, attributing causality on the basis of correlation is problematic.

On one hand, the CDC’s results are contrary to plentiful evidence that mandates are ineffective; on the other hand, the results are contrary to earlier CDC “guidance” that masks and limits on indoor dining are “highly effective”. Nevertheless, the latest report has massive propaganda value to the CDC. The media lapped up the story and provided cover for Democrats eager to pass the COVID (C19) relief package. Likewise, the Biden Administration is apparently committed to the narrative of an ongoing crisis as cover for continued attempts to shame political opponents in states that have elected to “reopen” or remain open.

Right off the bat, the study’s authors assert that the primary mode of transmission of C19 is from respiratory droplets. This is false. We know that aerosols are the main culprit in transmission, against which cloth masks are largely ineffective.

Be that as it may, let’s first consider the findings on dining. There was no statistically significant effect on the growth rate of cases or deaths up to 40 days after restrictions were lifted, according to the report. In fact, case growth declined slightly. There was, however, a small but statistically significant increase after 40 days. The fact that deaths seemed to “respond” faster and with greater magnitude than cases makes no sense and suggests that the results might be spurious.

The CDC offers possible explanations the long delay in the purported impact, such as the time required by restaurants to resume operations and early caution on the part of diners. These are speculative, of course. More pertinent is the fact that the data did not distinguish between indoor and outdoor dining, nor did it account for other differences in regulation such as rules on physical distancing, intra-county variation in local government mandates, and compliance levels.

Finally, the measurement of effects covered 100 days after the policy change, but this window spans different stages of the pandemic. There were three waves of infections during 2020, which correspond to the classic Hope-Simpson pattern of virus seasonality. One was near year-end, but as each of the first two waves tapered (April-May, August-September), it should be no surprise that many restrictions were lifted. Within two months, however, new waves had begun. Karl Dierenbach notes that most of the reopenings occurred in May. Here’s how he explains the pattern:

“The map on the left shows counties where there was no on-premises dining (pink) in restaurants as of the beginning of May (4/30). … The map on the right shows that by the end of May, almost the entire country moved to allow some on-premises dining (green).”

“In the 100 days after May 1, cases nationwide fell slightly, then began to rise, and then plateaued.”

“And what did the CDC find happened after restaurants were allowed (changing mostly in May) to have on-premises dining? … Surprise! The CDC found that cases fell slightly, then began to rise, and then plateaued.”

The summer “mini-wave” is typical of mid- and tropical-latitude seasonality. Thus, the CDC’s findings with respect to dining restrictions are likely an artifact of the strong seasonality of the virus, rather than having anything to do with the lifting of restrictions between waves.

What about the imposition of mask mandates? The CDC’s findings show a much faster response in this case, with statistically significant changes in growth during the first 20 days. Another indicator of spurious correlation is that the growth response of deaths did not lag that of cases, but in fact deaths have reliably lagged cases by over 18 days during the pandemic. Again, the CDC’s caveats apply equally to its findings on masks. A large share of individuals adopted mask use voluntarily before mandates were imposed, so it’s not even clear that the mandates contributed much to the practice.

It’s a stretch to believe that mask mandates would have had an immediate, incremental effect on the growth of cases and deaths, given probable lags in compliance, exposure, and onset of symptoms. Moreover, a number of mask mandates in 2020 were imposed near the very peak of the seasonal waves. Little wonder that the growth rates of cases and deaths declined shortly thereafter.

We’ve known for a long time that masks do little to stop the spread of viral particles. They become airborne as aerosols which easily penetrate the kind of cloth masks worn by most members of the public, to say nothing of making contact with their eyes. The table below contains citations to research over the past 10 years uniformly rejecting the hypothesis of a significant protective effect against influenza from masks. There is no reason to believe that they would be more effective in preventing C19 infections.

The CDC’s report on dining restrictions and mask mandates is a weak analysis. They wish to emphasize their faith in non-pharmaceutical interventions (NPIs) to minimize risks. They do so at a time when the vaccinated share of the most vulnerable population, the elderly, has climbed above 50% and is increasing steadily. Thus, risks are falling dramatically, so it’s past time to weigh the costs and benefits of NPIs more realistically. The timing of the report also seemed suspicious, coming as it did in the heat of the battle over the $1.9 trillion COVID relief bill, which subsequently passed.

It’s also a good time to note that zero risk, including “Zero COVID”, is not a realistic or worthwhile goal under any reasonable comparison of costs and benefits. Furthermore, NPIs have proven weak generally (also see here); claims to the contrary should always make us wary.

CDC Flubs COVID Impact on Life Expectancy

03 Wednesday Mar 2021

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The CDC choked on a new analysis estimating COVID-19’s impact on U.S. life expectancy as of year-end 2020: they reported a decline of a full year, which is ridiculous on its face! As explained by Peter B. Bach in STAT News, the agency assumed that excess deaths attributed to COVID in 2020 would continue as a permanent addition to deaths going forward. Please forgive my skepticism, but isn’t this too basic to qualify as an analytical error by an agency that subjects its reports to thorough vetting? Or might this have been a deliberate manipulation intended to convince the public that COVID will be an ongoing public health crisis. Of course the media has picked it up; even Zero Hedge reported it uncritically!

Bach does a quick calculation based on 400,000 excess deaths attributed to COVID in 2020 and 12 life-years lost by the average victim. I believe the first assumption is on the high side, and I say “attributed to COVID” as a reminder that the CDC’s guidance for completing death certificates was altered in the spring of 2020 specifically for COVID and not other causes of death. Furthermore, if our objective is to assess the impact of the virus itself, under no circumstances should excess deaths induced by misguided lockdown policies enter the calculation (though Bach entertains the possibility). Bach arrives at a reduction in average life of 5.3 days! Of course, that’s not intended to be a projection, but it is a reasonable estimate of COVID’s impact on average lives in 2020.

The CDC’s projection essentially freezes death rates at each age at their 2020 values. We will certainly see more COVID deaths in 2021, and the virus is likely to become endemic. Even with higher levels of acquired immunity and widespread vaccinations, there will almost certainly be some ongoing deaths attributable to COVID, but they are likely to be at levels that will blend into a resumption of the long decline in mortality rates, especially if COVID continues to displace the flu in its “ecological niche”. I include the chart at the top to emphasize the long-term improvement in mortality (though the chart shows only a partial year for 2020, and there has been some flattening or slight backsliding over the past five years or so). As Bach says:

“Researchers have regularly demonstrated that life expectancy projections are overly sensitive to evanescent events like pandemics and wars, resulting in considerably overestimated declines. … And yet the CDC published a result that, if anything, would convey to the public an exaggerated toll that Covid-19 took on longevity in 2020. That’s a problem.”

There were excess deaths from other causes in 2020, which Bach acknowledges. Perhaps 100,000 or more could be attributed to lockdowns and their consequences like economically-induced stress, depression, suicide, overdoses, and medical care deferred or never sought. The Zero Hedge article mentioned above discusses findings that lockdowns and their consequences, such as unemployment spells and lost education, will have ongoing negative effects on health and mortality for many years. The net effect on life expectancy might be as large as 11 to 12 days. Again, however, I draw a distinction between deaths caused by the disease and deaths caused by policy mistakes.

The CDC’s estimate should not be taken seriously when, as Kyle Smith says, there is every indication that the battle against COVID is coming to a successful conclusion. Public health experts have not acquitted themselves well during the pandemic, and the CDC’s life expectancy number only reinforces that impression. Here is Smith:

“We have learned a lot about how the virus works, and how it doesn’t: Outdoor transmission, for the most part, hardly ever happens. Kids are at very low risk, especially younger children. Baseball games, barbecues, and summer camps should be fine. Some pre-COVID activities now carry a different risk profile — notably anything that packs crowds together indoors, so Broadway theater, rock concerts, and the like will be just about the last category of activity to return to normal.”

But return to normal we should, and yet the CDC seems determined to poop on the victory party!

Hooray For Florida!

22 Monday Feb 2021

Posted by in Coronavirus, Public Health

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It’s been said that many of the so-called “heroes” of the COVID pandemic who’ve been celebrated by the media are actually villains, and perhaps Governor Andrew Cuomo of New York should top the list. He saw to it that retirement homes were seeded with infected patients by ordering them returned their care homes rather than admitted to hospitals. Deaths in these facilities mounted, and they mounted faster than Cuomo’s administration was willing to admit. But the media and even Democrat state legislators have begun to take note, which is practically a miracle!

It seems equally true that some vilified by the media for their COVID response are actually heroes. Governor Ron DeSantis of Florida might deserve top honors here. Having spent the last month in Florida, I can attest that the business and social environment here is quite open compared to my home state (despite the presence of a few freaked out northerners who can’t quite fathom how stupid they look wearing masks on the beach). Florida’s infections, hospitalizations, and deaths have been lower than in California, New York, and many other states where lockdown measures have been stringent. (The first chart below is just a little busy…)

As I’ve written for much of the past year, COVID is far more dangerous to the elderly than anyone else, particularly those with co-morbidities. It’s also true that blacks (and some other minorities) are more vulnerable than whites, but if we want to save more black lives, we’re still better off prioritizing the elderly than racial groups. DeSantis understands this, and Florida is among the leaders in vaccinating the elderly population. (States don’t report this data on a uniform basis):

This approach to saving lives is obvious, yet critics at outlets like NBC News insist that DeSantis must be pandering to the senior population in Florida. Well, one wouldn’t want to be responsive to voters who happen to face high mortality risks, right? Others such as horror writer Stephen King have jumped onboard to offer their bumbling public health expertise as well.

There were many experts and the usual collection of numbskulls on social media who were wrong about Florida. DeSantis handled the pandemic as it should have been handled elsewhere. But the propaganda to the contrary goes unabated. For example, this article is pathetic. Can these people be serious? Or are they really that stupid? This goes for the Biden Administration as well, which had entertained the notion of imposing federal travel restrictions on Florida!

The political attacks on Florida and its governor reveal the extent to which opponents wish to ignore the evidence in plain sight. The data on COVID outcomes put the lie to the narrative of a public health emergency requiring massive restrictions on personal liberty. We know those policies are powerless to control the course of the contagion. The pandemic, however, was the key to convincing the public to accept a more authoritarian role for government. It’s a blessing that not everyone bought in, and that there are places like Florida where you can still go about your business in approximate normalcy.

COVID Cases Decline Despite New Variants

19 Friday Feb 2021

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For weeks, even months, we’ve been hearing about dangerous new mutations of the coronavirus, and they’ve been identified in cases in the U.S. There’s a UK strain, a South African strain, a Brazilian strain, and still others, which differ in seemingly minor ways. Nevertheless, these variants are said to be more infectious. It’s also been reported that the South African and Brazilian strains might resist antibodies from prior infections from earlier strains.

Kyle Lamb has provided the following charts to put things in perspective:

Just to round things out, here is the trend in cases worldwide:

There is a great deal of concern about the new variants. A search for “COVID-19 variants” turns up plenty of scary articles. However, there is some evidence that the new variants are not as dangerous as alarmists contend. The resistance to specific antibodies does not necessarily imply resistance to protection by T-cells. As Youyang Gu points out, even if a new strain becomes “dominant”, that does not imply that cases will reverse their decline. This study indicates that the Pfizer vaccine is protective against both the UK and South African strains, and there is evidence that other vaccines offer adequate protection as well (and see here).

The charts demonstrate that the new strains haven’t arrested or reversed the declines in infections witnessed worldwide since early January. That doesn’t mean the mutations haven’t made a difference: perhaps the declines would have been faster in their absence. And we don’t know what the future will hold as the virus in various forms becomes endemic. Still, it’s reassuring to see that the increased transmissibility of the new strains hasn’t overcome factors that have contributed to the recent declines, which in all likelihood are related to increasing immunity in the population with a minor assist from vaccinations (thus far). As Lamb wryly notes about the recent declines in transmission: “Just saying”.

Revisiting Excess Mortality

31 Sunday Jan 2021

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In early December I said that 2020 all-cause mortality in the U.S. would likely be comparable to figures from about 15 years ago. Now, Ben Martin confirms it with the chart below. Over time, declines in U.S. mortality have resulted from progress against disease and fewer violent deaths. COVID led to a jump in 2020, though some of last year’s deaths were attributable to policy responses, as opposed to COVID itself.

Here’s an even longer view of the trend from my post in December (for which 2020 is very incomplete):

As Martin notes sarcastically:

“Surprising, since the US is undergoing a ‘century pandemic‘ – In reality it is an event that’s unique in the last ‘15 years’”

The next chart shows 2020 mortality by month of year relative to the average of the past five years. Clearly, excess deaths have occurred compared to that baseline.

Using the range of deaths by month over the past 20 years (the blue-shaded band in the next chart), the 2020 figures don’t look quite as anomalous.

Finally, Martin shows total excess deaths in 2020 relative to several different baselines. The more recent (and shorter) the baseline time frame, the larger the excess deaths in 2020. Compared to the five-year average, 364,000 excess deaths occurred in 2020. Relative to the past 20 years, however, 150,000 excess deaths occurred last year. While those deaths are tragic, the pandemic looks more benign than when we confine our baseline to the immediate past.

Moreover, a large share of these excess deaths can be attributed to non-COVID causes of death that represent excesses relative to prior years, including drug overdoses, suicide, heart disease, dementia, and other causes. As many as 100,000 of these deaths are directly attributable lockdowns. That means true excess deaths caused by COVID infections were on the order of 50,000 relative to a 20-year baseline.

As infections subside from the fall wave, and as vaccinations continue to ramp up, some policy makers are awakening to the destructive impacts of non-pharmaceutical interventions (lockdown measures). The charts above show that this pandemic was never serious enough to justify those measures, and it’s not clear they can ever be justified in a free society. Yet some officials, including President Biden and Anthony Fauci, still labor under the misapprehension that masks mandates, stay-at-home orders, and restaurant closures can be effective or cost-efficient mitigation strategies.

COVID Now: Turning Points, Vaccines, and Mutations

20 Wednesday Jan 2021

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The pandemic outlook remains mixed, primarily due to the slow rollout of the vaccines and the appearance of new strains of the virus. Nationwide, cases and COVID deaths rose through December. Now, however, there are several good reasons for optimism.

The fall wave of the coronavirus receded in many states beginning in November, but the wave started a bit later in the eastern states, in the southern tier of states, and in California. It appears to have crested in many of those states in January, even after a post-holiday bump in new diagnoses. As of today, Johns Hopkins reports only two states with increasing trends of new cases over the past two weeks: NH and VA, while CT and WY were flat. States shaded darker green have had larger declines in new cases.

A more detailed look at WY shows something like a blip in January after the large decline that began in November. Trends in new cases have clearly improved across the nation, though somewhat later than hoped.

While the fall wave has taken many lives, we can take some solace in the continuing decline in the case fatality rate. (This is not the same as the infection mortality rate (IFR), which has also declined. The IFR is much lower, but more difficult to measure). The CFR fell by more than half from its level in the late summer. In other words, without that decline, deaths today would be running twice as high.

Some of the CFR’s decline was surely due to higher testing levels. However, better treatments are reducing the length of hospital stays for many patients, as well as ICU admittance and deaths relative to cases. Monoclonal antibodies and convalescent plasma have been effective for many patients, and now Ivermectin is showing great promise as a treatment, with a 75% reduction in mortality according to the meta-analysis at the link.

Reported or “announced” deaths remain high, but those reports are not an accurate guide to the level or trend in actual deaths as they occur. The CDC’s provisional death reports give the count of deaths by date of death (DOD), shown below. The most recent three to four weeks are very incomplete, but it appears that actual deaths by DOD may have peaked as early as mid-December, as I speculated they might last month. Another noteworthy point: by the totals we have thus far, actual deaths peaked at about 17,000 a week, or just over 2,400 a day. This is substantially less than the “announced” deaths of 4,000 or more a day we keep hearing. The key distinction is that those announced deaths were actually spread out over many prior weeks.

A useful leading indicator of actual deaths has been the percentage of ER patients presenting COVID-like illness (CLI). The purple dots in the next CDC chart show a pronounced decline in CLI over the past three weeks. This series has been subject to revisions, which makes it much less trustworthy. A less striking decline in late November subsequently disappeared. At the time, however, it seemed to foretell a decline in actual deaths by mid-December. That might actually have been the case. We shall see, but if so, it’s possible that better therapeutics are causing the apparent CLI-deaths linkage to break down.

A more recent concern is the appearance of several new virus strains around the world, particularly in the UK and South Africa. The UK strain has reached other countries and is now said to have made appearances in the U.S. The bad news is that these strains seem to be more highly transmissible. In fact, there are some predictions that they’ll account for 30% of new cases by the beginning of March. The South African strain is said to be fairly resistant to antibodies from prior infections. Thus, there is a strong possibility that these cases will be additive, and they might or might not speedily replace the established strains. The good news is that the new strains do not appear to be more lethal. The vaccines are expected to be effective against the UK strain. It’s not yet clear whether new versions of the vaccines will be required against the South African strain by next fall.

Vaccinations have been underway now for just over a month. I had hoped that by now they’d start to make a dent in the death counts, and maybe they have, but the truth is the rollout has been frustratingly slow. The first two weeks were awful, but as of today, the number of doses administered was over 14 million, or almost 46% of the doses that have been delivered. Believe it or not, that’s an huge improvement!

About 4.3% of the population had received at least one dose as of today, according to the CDC. I have no doubt that heavier reliance on the private sector will speed the “jab rate”, but rollouts in many states have been a study in ineptitude. Even worse, now a month after vaccinations began, the most vulnerable segment of the population, the elderly, has received far less than half of the doses in most states. The following table is from Phil Kerpen. Not all states are reporting vaccinations by age group, which might indicate a failure to prioritize those at the greatest risk.

It might not be fair to draw strong conclusions, but it appears WV, FL, IN, AK, and MS are performing well relative to other states in getting doses to those most at risk.

Even with the recent increase in volume, the U.S. is running far behind the usual pace of annual flu vaccinations. Each fall, those average about 50 million doses administered per month, according to Alex Tabarrok. He quotes Youyang Gu, an AI forecaster with a pretty good track record thus far, on the prospects for herd immunity and an end to the pandemic. However, he uses the term “herd immunity” as the ending share of post-infected plus vaccinated individuals in the population, which is different than the herd immunity threshold at which new cases begin to decline. Nevertheless, in Tabarrok’s words:

“… the United States will have reached herd immunity by July, with about half of the immunity coming from vaccinations and half from infections. Long before we reach herd immunity, however, the infection and death rates will fall. Gu is projecting that by March infections will be half what they are now and by May about one-tenth the current rate. The drop will catch people by surprise just like the increase. We are not good at exponentials. The economy will boom in Q2 as infections decline.”

That sounds good, but Tabarrok also quotes a CDC projection of another 100,000 deaths by February. That’s on top of the provisional death count of 340,000 thus far, which runs 3-4 weeks behind. If we have six weeks of provisionals to go before February, with actual deaths at their peak of about 17,000 per week, we’ll get to 100,000 more actual deaths by then. For what it’s worth, I think that’s pessimistic. The favorable turns already seen in cases and actual deaths, which I believe are likely to persist, should hold fatalities below that level, and the vaccinations we’ve seen thus far will help somewhat.

Long COVID: a Name For Post-Viral Syndrome

15 Friday Jan 2021

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I see references to “long COVID” or “long-haul COVID” almost every day. No, it’s not an extended COVID infection or an extra scary version of COVID. It’s about lingering or new symptoms after recovery from the infection. Reportedly, these symptoms range from fatigue or anxiety to joint pain. Sometimes they are rather unusual afflictions such as “COVID toes”, described as rashes or red spots on toes. Sebastian Rushworth notes that there is “no hard evidence that long COVID is a distinct entity”. It was essentially invented on social media by groups of individuals who connected to discuss various post-COVID symptoms. Rushworth says:

“The most common symptoms in people with long covid (defined in the study as still having symptoms after four weeks) were fatigue (98%) and intermittent headache (91%). … symptoms of long covid are extremely unspecific, so it is probable that long covid is actually a whole bunch of different things, of which I would think post-viral syndrome is likely a significant part.”

Post-viral syndrome should not be a big surprise, since COVID is, well, a virus! PVS can last for months and commonly has the following symptoms:

Those sound familiar. PVS symptoms are thought to be a consequence of the body’s effort to fight off a virus, including the lingering effects of a strong immune response and the inflammation it can induce. Such an immune response can lead to even greater problems for those with a genetic predisposition for autoimmune diseases like diabetes. It happens. But none of this is new or unique to COVID.

While PVS and autoimmune diseases are very real, the unbridled panic over COVID has led to a few false claims. “COVID toes” is one of them. Moreover, the pandemic precipitated an avalanche of poor-quality academic research, rushed in an effort to produce useful findings. Some of that research is implicated in the COVID myths we’ve heard. An example discussed at the last link is the incidence of heart inflammation or myocarditis in COVID patients. This was all over the media in the months leading up to the college football season, as young athletes were said to be vulnerable. In fact, it’s incidence among COVID patients is fairly rare, and it’s not unique to COVID.

COVID can be a nasty infection, primarily for the aged and those with pre-existing conditions, including obesity. PVS is an unfortunate reality for many patients. But “long-COViD” is merely a varied collection of post-viral symptoms. Many of them are vague and usually self-diagnosed. Long COVID is, as Rushworth says, “basically whatever the person who thinks they have it says it is.” That the media has promoted long COVID and its varied manifestations as something wholly new, including a few probable “imagifestations” (to coin a term), is one more example of the “panic porn” to which we’ve been subjected during the pandemic.