Category Archives: Pandemic

False Positives, False Cases, False Deaths

14 Monday Sep 2020

Posted by in Coronavirus, Pandemic

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The tremendous increase in testing for COVID-19 (C19) this summer was associated with an increase in cases. Most of these tests were so-called PCR tests with samples collected via deep nasal swabs. More testing did not fully explain the increased case load, but false positives (FPs) still accounted for a substantial share. That’s especially true in light of the decline in positivity rates, which reflected a decline in the actual prevalence of active infections. FPs also account for a substantial share of the deaths attributed to COVID, which are obviously cases of false attribution. If a test for C19 is positive, it will be listed on the death certificate.  

COVID Case Inflation

The exaggeration of confirmed cases due to FPs is more substantial as the prevalence of active infection declines. That’s because the share of true positives in the tested population declines, while the share of false positives must rise due to the greater share of uninfected individuals in the population.

Now, as the contagion is waning in former hot spots, there is a danger that FPs create the impression of persistence in the case counts. That’s costly not just for those incorrectly diagnosed, but also in terms of medical resources, for communities subject to excessive public intervention, such as inappropriate lockdowns, and in terms of the fear promoted by these inaccuracies.

FPs are extremely disruptive when testing is relied upon in critical situations such as health care staffing, or even among sports teams. For example, at the University of Arizona, out of 25 positive tests on September 3, only 10 were confirmed as positives in later tests. The NFL has also had its share of false positives. 

Lax Testing Standards

There is evidence that testing standards under CDC guidance are so broad that a large number of inactive, non-infectious cases are being flagged as positives (see the chart above for the intuition, as well as the graphic at the bottom of this post). The tests sometimes amount to a coin flip when it comes to evaluating positives; some of the positives might even come from non-novel coronaviruses such as the common cold! This paper by Andrew N. Cohen, Bruce Kessel, & Michael G. Milgroom – CKM) questions the guidance of public health authorities on testing more generally. From the abstract (my emphasis):

“Unlike previous epidemics, in addressing COVID-19 nearly all international health organizations and national health ministries have treated a single positive result from a PCR-based test as confirmation of infection, even in asymptomatic persons without any history of exposure. …  positive results in asymptomatic individuals that haven’t been confirmed by a second test should be considered suspect.”

False Positive Math

When I wrote about “The Scourge of False Positives” in July. I noted that a test specificity of 95% implies that 5% of uninfected individuals will falsely test positive. Unfortunately, that still produces a huge number of FPs when testing is broad. That’s NOT a good reason to avoid broad testing; it just means that positive tests should be confirmed by another test. (In this case, two tests with the same specificity reduce a 5% false positive rate to 0.25%. That’s why fast, cheap tests are necessary for confirmation.

Again, exaggerated case counts due to FP’s become more severe as a contagion wanes. That’s because FPs become an increasingly large share of positive test results and overstate the persistence of the virus. If active infections fall to 1% of 750,000 daily tests, or 7,500 true cases, the 5% specificity implies 37,125 FPs: true positives would be only 17% of positive cases. Much worse than a coin flip! And again, which cases are infectious?

How Bad Are FPs, Really?

This recent research, also authored by CKM, explains the reasons why FPs are usually an issue in the real world, despite the tests’ reportedly perfect reactivity to anything other than the virus’ genetic fragments. CKM find that the median FP rate in their sample of “tests of tests” was 2.3%. That means 23 out of every 1,000 uninfected people tested will test positive.

If that seems small to you, suppose the true prevalence of active infection in a population is 4%. If 1,000,000 people are tested and there are no false negatives (unlikely), then 40,000 infected people will be identified by the test. However, another 22,000 uninfected people will also test positive ((1,000,000 – 40,000 infected) x 0.023). That means the number of positive tests will be inflated by 55%. They’ll all receive some form of treatment or ordered into quarantine. Expanded Testing and FPs This summer, the volume of daily tests increased from about 150,000 a day in early April to more than 750,000 a day in July. That’s a 400% increase, but the true prevalence of active infection in the expanded test population during the summer was almost certainly lower than in the spring. Suppose active infections fell from 10% of the test population in the spring to 5% in the summer. That means the daily number of “true positives” would have risen from 15,000 to 35,000 in the expanded test population (and again I assume no false negatives for simplicity). The number of FPs, however, would have risen from 3,105 to 16,445. Therefore, FPs would have accounted for 40% of the increase in “confirmed” cases between spring and summer.

False COVID Deaths

FPs are also inflating COVID death counts. PCR tests are routinely given at hospital admission for any cause, and even after sudden death, especially as the availability of tests increased late in the spring. This subset of the tested population will certainly have its share of FPs. If such a patient dies, regardless of underlying cause, it might well be attributed to COVID-19 as it will still appear on the death certificate. The same has occurred in the case of traffic fatalities, suicides, and other sudden deaths.

Antibody Tests

The FP problem also plagues tests of seroprevalence, which determine whether an individual has had the virus or is cross-protected against the virus by antibodies acquired via non-novel coronavirus infections. The consequences of these antibody FPs can be serious as well, because it means a positive test might not ensure immunity. As the exposed share of the population increases, however, the FP share of antibody tests is diminished.

Conclusion

As long as testing is required, dealing with FPs (and false negatives, of course) requires repeated testing, as CKM state unequivocally. And the tests must be fast to be of any use. The current testing regime must be overhauled to prevent false positives from costly impositions on the lives of uninfected patients, consuming unnecessary medical resources, making unrealistic assessments of cases and deaths, and unnecessary suspensions of normal human social activity and liberty.

Teachers Face Low-to-Moderate COVID Risk

29 Saturday Aug 2020

Posted by in Education, Pandemic, School Choice, Uncategorized

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A quick follow-up to my recent post “COVID Hysteria and School Reform“: the graphic above is from an occupational risk study recently conducted by Swedish health authorities. The horizontal axis is obscured by the lower banner from Twitter (my fault), but the average risk of infection across all occupations was slightly less than 1%, and the highest-risk occupations were in the 4 – 5% range. Keep in mind, the data was collected while the virus was still raging in Sweden, while schools remained open. The virus hasn’t completely vanished in Sweden since then, but it has largely abated.

The study found that teachers had roughly average or below average risk, especially for pre-school and upper secondary (so-called “gymnasium”) teachers. The results demonstrate the lack of merit to claims by teachers unions that their members are somehow at greater risk of contracting coronavirus than other “essential” workers. We already know that children have extremely low susceptibility to COVID-19 and that they do not readily transmit the virus.

The health benefits of closing schools or taking them on-line do not compensate for the loss of educational effectiveness and detrimental health effects of preventing children from attending schools. The digital divide between children from disadvantaged households and their peers is likely to grow more severe if online learning is their only option. They should have choices, including functioning public schools.

To the last point, however, read this link for the sort of thing one teachers union supports. If the members are okay with that insanity then they shouldn’t be teaching your kids.

COVID Hysteria and School Reform

24 Monday Aug 2020

Posted by in Education, Pandemic, School Choice

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Many haven’t quite gathered it in, but our public education system is an ongoing disaster for many low-income and minority students and families. The pandemic, however, is creating a major upheaval in K-12 education that might well benefit those students in the end. But before I get into that, a quick word about National Public Radio (NPR): it doesn’t make its political leanings a secret, which is why it should not be supported by taxpayers. Yes, like many other mainstream media outlets, NPR serves as a political front organization for Democrats (and worse).

Last week, NPR did a segment on “learning pods”, which I’d describe as private adaptations to the failure of many public schools (and teachers’ unions) to do their job during the pandemic. Glenn Reynolds passed along an interpretation of that NPR segment from a friend on Facebook, which I quote in its entirety below (bold emphasis mine). It was either this segment or else NPR has taken it down … but that link more or less matches the description. The post is somewhat satiric, but it captures much of what was actually said:

“Hilarious NPR, last week’s edition. They had an hour-long segment on learning pods. Participants: Host (white woman), Black Woman Activist, Asian Woman Parent, School-System Man.

Slightly editorialized (but true!) recollections below.

Host: In wealthy areas, parents get together and organize learning pods. What do we make of it?

School-System Man: Inequitable! Inappropriate! Bad! We do not support it!

Asian Woman Parent: Equity requires that we form these pods to educate our own children! Otherwise, only the rich can get education! Rich bad!

Host: Rich bad.

School-System Man: Rich horrible! They withdraw kids from public schools during the pandemic, so schools have less money!

Asian Woman Parent: We have no choice. You are not teaching.

Host: But what are you doing for the equity?

Asian Woman Parent: Why are the parents supposed to be doing something for the equity? That’s why we pay taxes, so professionals do something!

School-System Man: We cannot fix equity if you are clandestinely educating your own children, but not everyone else’s children!

Asian Woman Parent: The proper solution would have been to end the pandemic. But Trump did not end the pandemic. So, we must do learning pods. As soon as the pandemic is over, we’ll get back to normal, and everyone will catch up.

Everyone [with great relief]: Trump bad. Bad.

Black Woman Activist: No, wait a minute. This sounds as though in a regular school year, black children get good education. And they are getting terrible education! Unacceptable!

Host: Bad Trump!

Black Woman Activist: Foggeraboutit! It’s not Trump! It’s always been terrible! Black children are dumped into horrible public schools, where nobody is teaching them! So, my organization is now helping organize these learning pods for minority kids everywhere.

School-System Man [cautiously]: This is only helping Trump…

Black Woman Activist: Forget Trump! Don’t tell me black kids get no education because things are not normal now. When things were normal, their education was just as bad!

School-System Man: Whut??? How dare you! Our public schools are the best thing that ever happened to black children.

Asian Woman Parent: I’ll second that. Public schools in my neighborhood are just svelte.

Black Woman Activist: That’s the point! You live in a rich suburb, and your kids get a great public school! Black kids don’t!

Asian Woman Parent: If Trump managed the pandemic properly, we would not be having this conversation.

Host: Bad Trump!

Everyone: Bad Trump!

The end.”

Ah yes, so we’re back to blaming Donald Trump for following the advice of his medical experts, most prominently Dr. Anthony Fauci. And, while we’re at it, let’s blame Mr. Trump for following federalist principles by deferring to state and local governments to deal flexibly with the varying regional conditions of the pandemic, rather than ruling by federal executive edict. Of course, some of those state and local officials botched it, such as Andrew Cuomo. That’s tragic, but had Trump followed a more prescriptive tack, the howling from the Left would have been even more deafening.

We know that children are at little risk from the coronavirus. Nor do they seem to transmit the virus like older individuals, but teachers unions are adamant that the risks their members face at school would far exceed those shouldered by other “essential” workers. And the unions, not shy about partisanship even while representing public employees, want nothing more than to see Trump lose the election. So the unions and the schools districts they seem to control hold parents hostage. They collect their tax revenue and salaries while delivering virtual service at lower standards than usual, or no service at all. (Of course, public schools in some parts of the country are in session.) 

The teachers’ unions and public schools might get their comeuppance. The situation represents a tremendous opportunity for private schools, home schooling, and innovative schooling paradigms. Many private schools are holding classes in-person, more parents are homeschooling, and alternative arrangements like learning pods have formed, many of which are quite cost-effective.

Pressure is building to allow education dollars to follow individual students, not simply to flow to specific government schools. You can buy a decent K-12 education for $12,000 a year or so, and it’s likely to be a better education than you’ll get in many public schools. (One of the panelists on the NPR segment smugly called this an “insidious temptation”). At long last, parents would be allowed real choice in educating their children, and at long last schools would be incentivized to compete for those students. That might be one of the best things to come out of the pandemic.

COVID Seasonality and Latitudes

23 Sunday Aug 2020

Posted by in Pandemic

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The coronavirus (C19), or SARS-CoV-2, has a strong seasonal component that appears to closely match that of earlier SARS viruses as well as seasonal influenza. This includes the two distinct caseloads we’ve experienced in the U.S. 1) in the late winter/early spring; and 2) the smaller bump we witnessed this summer in some southern states and tropics. 

COVID Seasonal Patterns and Latitude

The Ethical Skeptic on Twitter recently featured the chart below. It shows the new case count of C19 in the U.S. in the upper panel, and the 2003 SARS virus in the lower panel. Both viruses had an initial phase at higher latitudes and a summer rebound at lower latitudes.

 

 

 

 

 

 

 

 

 

 

I particularly like the following visualizations from Justin Hart demonstrating the pandemic’s pattern at different latitudes (shown in the leftmost column). The first table shows total cases by week of 2020. The second shows deaths per 100,000 of population by week. Again, notice that lower latitudes have had a crest in the contagion this summer, while higher latitudes suffered the worst of their contagion in the spring. Based on deaths in the second table, the infections at lower latitudes have been less severe.

Viral Patterns in the South

Many expected the pandemic to abate this summer, including me, as it is well known that viruses don’t thrive in higher temperatures and humidity levels, and in more direct sunlight. So it is a puzzle that southern latitudes experienced a surge in the virus during the warmest months of the year. True, the cases were less severe on average, and sunlight and humidity likely played a role in that, along with the marked reduction in the age distribution of cases. However, the SARS pandemic of 2003 followed the same pattern, and the summer surge of C19 at southern latitudes was quite typical of viruses historically.

A classic study of the seasonality of viruses was published in 1981 by Robert Edgar Hope-Simpson. The next chart summarized his findings on influenza, seasonality, and latitude based on four groups of latitudes. Northern and southern latitudes above 30° are shown in the top and bottom panels, respectively. Both show wintertime contagions with few infections during the summer months. Tropical regions are different, however. The second and third panels of the chart show flu infections at latitudes less than 30°. Influenza seems to lurk at relatively low levels through most of the year in the tropics, but the respective patterns above and below the equator look almost like very muted versions of activity further to the north and south. However, some researchers describe the tropical pattern as bimodal, meaning that there are two peaks over the course of a year.   

So the “puzzle” of the summer surge at low latitudes appears to be more of an empirical regularity. But what gives rise to this pattern in the tropics, given that direct sunlight, temperature, and humidity subdue viral activity?

There are several possible explanations. One is that the summer rainy season in the tropics leads to less sunlight as well as changes in behavior: more time spent indoors and even less exposure to sunlight. In fact, today, in tropical areas where air conditioning is more widespread, it doesn’t have to be rainy to bring people indoors, just hot. Unfortunately, air conditioning dries the air and creates a more hospitable environment for viruses. Moreover, low latitudes are populated by a larger share of dark-skinned peoples, who generally are more deficient in vitamin D. That might magnify the virulence associated with the flight indoors brought on by hot and or rainy weather.   

Mutations and Seasonal Patterns

What makes the seasonal patterns noted above so reliable in the face of successful immune responses by recovered individuals? And shouldn’t herd immunity end these seasonal repetitions? The problem is the flu is highly prone to viral mutation, having segments of genes that are highly interchangeable (prompting so-called “antigenic drift“). That’s why flu vaccines are usually different each year: they are customized to prompt an immune response to the latest strains of the virus. Still, the power of these new viral strains are sufficient to propagate the kinds of annual flu cycles documented by Hope-Simpson.

With C19, we know there have been up to 100 mutations, mostly quite minor. Two major strains have been dominant. The first was more common in Southeast Asia near the beginning of the pandemic. It was less virulent and deadly than the strain that hit much of Europe and the U.S. Of course, in July the media misrepresented this strain as “new”, when in fact it had become the most dominant strain back in March and April.

What Lies Ahead

By now, it’s possible that the herd immunity threshold has been surpassed in many areas, which means that a surge this coming fall or winter would be limited to a smaller subset of still-susceptible individuals. The key question is whether C19 will be prone to mutations that pose new danger. If so, it’s possible that the fall and winter will bring an upsurge in cases in northern latitudes both among those still susceptible to existing strains, and to the larger population without immune defenses against new strains.

Fortunately, less dangerous variants are more more likely to be in the interest of the virus’ survival. And thus far, despite the number of minor mutations, it appears that C19 is relatively stable as viruses go. This article quotes Dr. Heidi J. Zapata, an infectious disease specialist and immunologist at Yale, who says that C19:

“… has shown to be a bit slow when it comes to accumulating mutations … Coronaviruses are interesting in that they carry a protein that ‘proofreads’ [their] genetic code, thus making mutations less likely compared to viruses that do not carry these proofreading proteins.”

The flu, however, does not have such a proofreading enzyme, so there is little to check its prodigious tendency to mutate. Ironically, C19’s greater reliability in producing faithful copies of itself should help ensure more durable immunity among those already having acquired defenses against C19.

This means that C19 might not have a strong seasonal resurgence in the fall and winter. Exceptions could include: 1) the remaining susceptible population, should they be exposed to a sufficient viral load; 2) regions that have not yet reached the herd immunity threshold; and 3) the advent of a dangerous new mutation, though existing T-cell immunity may effectively cross-react to defend against such a mutation in many individuals.

 

The FDA Can Put Virus Behind Us, Sans Vaccine

19 Wednesday Aug 2020

Posted by in Liberty, Pandemic, Vaccinations

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Most of the news about COVID vaccine development is positive, but there are still huge doubts about 1) whether an effective vaccine(s) will ever be available; 2) when it will be available; 3) in what quantities (supply chains for vaccines present issues that most lay persons would never imagine) ; 4) the best approaches to allocation across young/healthy vs. old/vulnerable; 5) how long it will provide protection (the news is good on lasting immunity as well); and 6) whether people will actually take it. Given all these uncertainties, it’s worth considering an approach to stanching the coronavirus that won’t require a vaccine while still allowing a return to normalcy: cheap, rapid tests available to consumers on a daily basis in their homes or in businesses.

The full benefits of cheap, rapid tests can take people a while to wrap their heads around. In fact, there are skeptics who’s views on any and all testing are colored by suspicions that increased testing is some sort of conspiracy to spread fear and keep the economy hobbled. It’s true that increased testing drove much of the increase in COVID cases this summer, which caused the mainstream media to delight in spinning alarmist narratives. Fair enough, but that misses the point, which I’ll try to elucidate below. I credit a John Cochrane post for bringing this to my attention.

A successful vaccine breaks the so-called “transmission chain”, but so does frequent testing to identify infectious individuals on an ongoing basis so they can self-quarantine. As Alex Tabarrok has emphasized, we should worry about identifying infectious individuals, as opposed to infected individuals. They are not the same. Cheap, rapid, and easy-to-administer tests have already proven to be fairly accurate during the infectious stage. The idea is for individuals to self-test every day and stay home if they are positive. Or, employers can test workers every day and send them home if they are positive. Frequent testing also makes it simpler to trace the source of an infection and may reduce the importance of tracing.

To those who say this represents an affront to personal liberty, and I’m very touchy on that subject myself, recall that even now people are being screened in their workplaces using thermometers, questionnaires, or on the basis of any frogginess perceived by supervisors and co-workers. Those “tests” are far less accurate in identifying COVID-19 contagiousness than the kinds of cheap tests at issue here, and they are certainly no less intrusive. Then there are the many businesses facing restrictions on their operations: how “accurate” is it to keep everyone at home by locking down places of business? How intrusive is that? Those restrictions are indefensible, and especially with the advent and diffusion of cheap, rapid tests.

Of course, people might cheat and not report positives. Tests could be administered at workplaces to avoid that possibility, or at points of admission to businesses and facilities, but a few minutes of delay would be necessary. I would not support a centralized database of daily test results. If nothing else, relying on the good faith of individuals in reporting their results would be a giant leap forward in breaking the transmission chain now, rather than counting on the possibility of a successful virus in the indefinite future. And we might then avoid the whole pro-vax/anti-vax imbroglio that already foments, which raises major questions bearing on individual liberty.

Then there is the question of positive tests within multi-person households. Should the entire family or household self-quarantine? I say no, not if the others are negative, but then the others should test twice before going out, which dramatically reduces the probability of a false negative, and they should probably test more frequently, perhaps several times a day.

There are other important details to address: Who will pay for the tests? Will workers be paid to stay home if they test positive? How long will they be required to stay home? How will repeated tests be treated? I don’t want to get into detail on all of these points, but cheap, fast tests can help overcome many of these difficulties, and I believe many of the details can and should be worked out privately.

Unfortunately, the FDA has approved only two rapid tests, and they are not very rapid and not cheap enough. Only one had been approved up until last weekend because the FDA found the accuracy to be lacking … compared to PCR tests! But the FDA finally issued an Emergency Use Authorization for a saliva-based test (SalivaDirect) developed at Yale, partly funded by the NBA and the Players Association. The test still requires processing at a lab, so it’s really not convenient enough and not fast enough. Here is Zach Lowe on the cost:

“The cost per sample could be as low as about $4, though the cost to consumers will likely be higher than that — perhaps around $15 or $20 in some cases, according to expert sources.”

Not bad, but it’s much higher than more rapid, paper tests developed by Harvard’s Wyss Institute for Biologically Inspired Engineering and a company called E25Bio. Both of those are expected to cost about $1 per sample and can be completed anywhere. That’s a price that can work. And there are other promising candidates.

The benefits of tests that are rough, ready, and cheap will be huge. Such tests will also enable retesting, which helps to overcome the dilemmas of false positives and negatives. False negatives might be of greater concern to the FDA, but again, false negatives are less likely during the contagious stage of an infection, and the tests will be accurate enough that transmission risk will be drastically reduced.

The FDA needs to move beyond its stodgy insistence on achieving laboratory levels of accuracy. It’s unlikely that a single test source will be adequate to stanch the transmission chain, so the agency should rush to approve as many cheap, rapid tests as possible, with as many advisories and patient warnings regarding test results and follow-up instructions as it deems necessary. Remember, these tests are much better than thermometers!

Evidence of Fading COVID Summer Surge

16 Sunday Aug 2020

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Lately I’ve talked a lot about reported deaths each week versus deaths by actual date of death (DOD). Much of that information came from Kyle Lamb’s Twitter account, and he’s the source of the charts below as well. The first one provides a convenient summary of the data reported through last week. The blue bars are reported deaths each week from the COVID Tracking Project (CTP), which are an aggregation of deaths that actually occurred over previous weeks. Again, the blue bars do NOT represent deaths that occurred in the reporting week. The solid orange bars are “provisional” actual deaths by DOD. “Provisional” means that recent weeks are not complete, though most deaths by DOD are captured within three to four weeks. The CDC also produces a “forecast” of final death counts by DOD, shown by the hatched orange bars.   

Note that the recent surge in deaths has been much smaller than the one in the spring, which was driven by deaths in the northeast. The CDC “expects” actual deaths by DOD to have declined starting after the week of July 23rd. However, CTP was still reporting deaths of over 1,000 per day last week. The actual timing of those deaths in prior weeks, and the ultimate extent of the summer surge in COVID deaths, remains to be seen.

Certain leading indicators of deaths are signaling declines in actual deaths in August. Two of those indicators are 1) the positivity rate on standard PCR tests for infections; and 2) the share of emergency room visits made for symptoms of “COVID Like Illness” (CLI). The charts below show those indicators for FEMA regions that had the largest uptrends in cases in June and July. Florida is part of Region 4, shown in the next chart:

Here is the Region 6, which includes Texas:

Finally, Region 8 includes Arizona and California:

Out of personal interest, I’m also throwing in Region 7 with a few midwestern states, where cases have risen but not to the levels reached in Regions 4, 6, and 8:

With the exception of the last chart, the clear pattern is a peak or plateau in the positivity rate in late June through late July, followed by declines in subsequent weeks. The share or ER visits for CLI was not quite coincident with the positivity rate, but close. The decline in the CLI share is evident in Regions 4, 6 and 8. Again, these three regions include states that drove the nationwide increase in cases this summer (AZ, CA, FL, and TX), and the surge appears to have maxed out.     

Here is a chart showing the share of CLI visits to ERs for all ten FEMA region from mid-June through last week. Clearly, this measure is improving across the U.S.

Nationwide, the CLI percentage at ERs has decreased by about 47% over the past four weeks, and the positivity rate has decreased by about 28% in that time. In addition to these favorable trends, COVID hospitalizations have decreased by about 40% over the past three weeks. All of these trends bode well for a downturn in COVID-attributed deaths.

The summertime surge in the virus was not nearly as ravaging as in the spring, and it appears to be fading. We’ll await developments in the fall, but we’ve come a long way in terms of protecting the vulnerable, treating the infected, approaching herd immunity thresholds (which means reduced rates of transmission to susceptible individuals), and the real possibility that we can put the pandemic behind us. 

Joe’s Moronic Outdoor Mask Mandate

15 Saturday Aug 2020

Posted by in Pandemic, Public Health

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Do you wear a mask whenever you step outside? In your yard? At the beach? In the park? On an empty sidewalk? Then congratulations! You are a colossal imbecile, like all the others in the mandatory mask crowd. Now, Joe Biden, in an attempt to prove either dementia or a full-fledged alliance with irredeemably lefty Karens, is demanding a three-month nationwide mandate for masks to be worn by everyone … OUTDOORS!

Really, what kind of moron believes there is any real danger of contracting coronavirus outside short of close and prolonged exposure to an infected individual? We know outdoor transmission is extremely rare. Nearly 100% of cases are contracted indoors, almost always in tight, poorly ventilated spaces.

It’s not hard to fathom why outdoor environments are of such low risk. Outdoors, air is of such enormous volume that virus particles are quickly diluted, dramatically reducing any viral load one might encounter. Air circulation is much better outdoors as well, driven by differences in temperatures across lateral and vertical space. Any breeze effectively disperses the particles. And those small loads drifting through open air won’t survive long: the ultraviolet waves in direct sunlight tend to kill it very quickly. Humidity is also associated with more rapid deactivation of the virus. Air tends to be more humid outdoors whenever forced air heating or air conditioning are used without sufficient humidification.

Cloth masks, in any case, may be effective against transmission by droplets expelled from coughs or sneezes, but they are of questionable value against transmission by aerosols from exhaled air. Outside, if you are distanced, you really have only aerosols to worry about. Under those circumstances, cloth masks are more for show than anything else.

And on what pretext do officials, or your nitwitted neighbors, get the idea that mandatory masks OUTSIDE is in the interest of public health? I mean, besides buying-in to a ridiculous nanny-state narrative promoted by the media? Well, there is also some crap “research” to consider. Here is a good example: a study on masks from the Kansas Department of Health and Environment (KDHE). Take a look at what these guys tried to pull off…  Here’s what KDHE hoped would serve as “proof” of the dramatic efficacy of masks:

Wow! Notice two things in this chart: 1) the two lines are plotted with respect to different vertical axes; and 2) the chart begins on July 12th. Now take a look at a longer history in which the lines are plotted against the same axis.

It certainly doesn’t appear that the mandate beginning on July 3 had a favorable impact on new cases. What KDHE did here was incredibly dishonest, and I applaud the Kansas Policy Institute and it’s publication The Sentinel (linked above) for calling out KDHE for their dishonest piece of crap.

Other studies have exaggerated the general efficacy of masks as well. It’s also noteworthy that Europe’s medical establishment is unimpressed with masks. And after all, to my knowledge there have been no randomized control trials supporting the efficacy of masks — the only acceptable form of test according to Anthony Fauci! Now, none of that means masks don’t reduce COVID transmission. I happily wear a mask when I enter public buildings. What’s at issue here is whether masks should be required outdoors. Furthermore, I dispute the notion that a nationwide mask mandate is needed, because not all localities are at equal risk. I’m an advocate of the federalist principle that the best state and local solutions are crafted at the state and local levels. And at a personal level, I say ignore the intrusive bastards. Get outside in the fresh air, and forget the mask if you have some space.

Election Snafus, Fraud: Invite and They Will Come

12 Wednesday Aug 2020

Posted by in Democracy, Pandemic, Voter Fraud

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There is understandable controversy over the prospect of more mail-in voting, but it’s reasonable to believe that some additional mail-in or postal voting may be necessary in light of the pandemic. Social distancing reduces the volume of activity that polling places can handle in a single day, and administrative decisions about the voting process can’t be deferred until late October in order to observe the state of the pandemic and make last-minute changes. Most states already permit voters to request a mail-in ballot for a variety of reasons: travel, illness, or other exigencies are usually sufficient, if a reason is even required. In the context of the pandemic, such a request should certainly be granted to those most concerned about contracting the coronavirus. So the option to vote by mail seems reasonable, at least in the abstract, as long as those who prefer to cast their ballots in person can do so.

“Universal” mail-in voting is another story, but the term first requires some qualification. I construe “universal” in this case to mean voting by citizens of the United States, a right protected and reserved to citizens by the 19th Amendment to the Constitution. That also means voters must be registered and must comply with state requirements for identification, if any, before receiving a ballot. In other words, under current state laws, a voter might be required to appear before an election authority to obtain a ballot for return by mail. The proponents of universal postal mail, however, seem to think states should simply mail ballots to the addresses of all registered voters. Many proponents go further, suggesting that all individuals of voting age should be mailed ballots.

The first major problem with a large expansion of postal voting is administrative complexity. It would represent a significant challenge for many jurisdictions to arrange in short order. It’s bound to create major delays in counting and reporting results, and it is likely to create doubt as to the reliability of the official election results. Here are some administrative issues and examples worth considering:

This recent experiment by CBS revealed delays in the official receipt of mailed ballots, a problem that will be more acute given plans in some jurisdictions to send ballots to postal voters only a week prior to the November election. The study also revealed some mis-sorting and misplacement of returned ballots. It concluded that a percentage of voters is likely to be “disenfranchised” by mail-in voting.

In early August, primary balloting by mail in Atlantic County, NJ was said to be especially problematic. Signatures on ballots were difficult to match to DMV records signed on “screen”; there was an extra step in delivering ballots to a central post office location and then on to election officials, causing delays; the voter registration system was plagued by technical glitches related to heavy demand for updated records; and there was insufficient time between sending ballots to voters and the deadline.

New York City’s primary election in June was similarly afflicted with a high rate of invalid mailed ballots. “The city BOE received 403,103 mail-in ballots for the June 23 Democratic presidential primary. … But the certified results released Wednesday revealed that only 318,995 mail-in ballots were counted. … That means 84,108 ballots were not counted or invalidated — 21 percent of the total. … One out of four mail-in ballots were disqualified for arriving late, lacking a postmark or failing to include a voter’s signature, or other defects. The Post reported Tuesday that roughly 30,000 mail-in ballots were invalidated in Brooklyn alone. … The high invalidation rate provides more proof that election officials and the Postal Service were woefully underprepared to handle and process the avalanche of mail-in ballots that voters were encouraged to fill out to avoid having to go to the polls during the coronavirus pandemic, critics said.”

From the New York Times, “In the last presidential election, 35.5 million voters requested absentee ballots, but only 27.9 million absentee votes were counted, according to a study [NYT link is bad] by Charles Stewart III, a political scientist at the Massachusetts Institute of Technology. He calculated that 3.9 million ballots requested by voters never reached them; that another 2.9 million ballots received by voters did not make it back to election officials; and that election officials rejected 800,000 ballots. That suggests an overall failure rate of as much as 21 percent.”

The problem of rejected mail-in ballots is all too common throughout the country. For example, redistricting can cause mail-in voters to cast their votes in the wrong precinct at a higher rate; people move frequently, especially low-income voters, so updating voter rolls is a tremendous challenge; and voters often fail to follow instructions carefully, and there is no one at hand to offer assistance.

Again, these are just the administrative problems. The upshot is that mail-in voting is likely to introduce uncertainties and delays in determining election outcomes, and is likely to result in numerous legal challenges as well.

This piece by Eric Boehm in Reason is skeptical of our ability to vote by mail without major complications of that kind. Boehm then turns to the question of mail-in ballots and fraud, however, quoting a variety of experts who claim that election fraud is a miniscule problem and that fraud has not had a partisan bias in the past. But partisan bias is not really the critical issue… fraud is, party by party, district by district, and state by state.

Despite Boehm’s protestations and widespread denial in the news media, election fraud is a “thing”. More importantly, the risk of election fraud is a thing. It’s instructive that two U.S. Senators (Ron Wyden (OR) and Amy Klobuchar (MN)) have introduced legislation that not only would authorize more widespread voting by mail, but “ballot harvesting” as well. The latter is the practice of visiting homes and “offering” to collect residents’ postal ballots for delivery to collection points. It has been a flagrant form of vote fraud in the past.

So what is our experience with fraud? Here is a “sampling” of 1,290 cases of election fraud, many of which involved absentee ballots and ballot harvesting. Detail on most of these cases can be found here.

The following testimonial reinforces the ease with which fraud can be perpetrated via mail-in voting:”I know because I did it“:

“Last year, a political operative working for North Carolina Republican congressional candidate Mark Harris was charged with fraud for directing a group of people to fill out as many as one thousand absentee ballot requests on behalf of voters — most of whom were unaware the ballots were being requested. … These people then collected the ballots and filled them out themselves. … 

Also in 2019, a Democratic city clerk in Southfield, Michigan, was arrested and charged with six felonies for falsifying absentee ballot records to say that 193 of the ballots in one election were missing signatures or a return date, when in fact they had both. The correct records were found in the trash can in her office.

… J. Christian Adams of the Public Interest Legal Foundation (PILF) says if states aren’t careful, they’ll be issuing ‘an open invitation to fraud. … There are two big problems with vote by mail,’ Adams told InsideSources. ‘Number one … people voting the ballot for other people through undue influence. … The second one — the voter rolls are a mess.’ … Adams’ organization has sued several states and counties for refusing to maintain accurate voter rolls, allowing the names of thousands of dead voters, felons and non-citizens to remain in the system.”

Fraud risk always exists even if detected and proven levels of fraud are low, and the level of risk scales with the extent to which ballots are cast by mail. The sudden, massive expansion in mail-in voting now contemplated by some would create unprecedented opportunities for fraud.

Consider the 28 million mail-in ballots that went missing between 2012 and 2018, roughly 20% of mail-in ballots issued during those years. According to Logan Churchwell of PILF:

“So what do people that really focus on the election process do about that? They go into ballot harvesting. If there’s so many ballots out there in the wind unaccounted for by election officials, surely some manpower could be dedicated to go bring them in. And that’s another part of the system where you have weaknesses and risk.”

It takes only a small percentage of the vote to swing many elections, so ballot harvesting, enabled by more widespread voting-by-mail, is a serious threat to the integrity of the democratic process. The last link cites a few reports that should give mail voting proponents some pause:

“There’s little doubt that as the number of mail-in ballots increases, so does fraud. A 2012 report in The New York Times noted that voter fraud involving mail-in ballots ‘is vastly more prevalent than the in-person voting fraud that has attracted far more attention, election administrators say. In Florida, absentee-ballot scandals seem to arrive like clockwork around election time.’ According to a Wall Street Journal report on voter exploitation in Hispanic communities in Texas, mail-in ballots have ‘spawned a mini-industry of consultants who get out the absentee vote, sometimes using questionable techniques.’ Poor, elderly, and minority communities are most likely to be preyed upon by so-called ballot ‘brokers.’

Concerns about fraud in mail-in ballots were serious enough that a 2008 report produced by the CalTech/MIT Voting Technology Project recommended that states ‘restrict or abolish on-demand absentee voting in favor of in-person early voting.'”

It’s no coincidence that most countries in the European Union restrict mail-in voting to those who are unable to vote in-person, such as those working or studying abroad, as well as the sick and elderly. There are exceptions, of course, but many of these developed countries reject the notion that mail-in voting is worth the risks.

It’s reasonable to expect many cautious voters to request ballots for return by mail. But at a minimum, any large-scale transition to postal voting should be done with care for the security and integrity of the voting process. It is not an exercise to be done in haste, as proponents now demand. The result of such a drastic change would be significant delays, legal challenges, and reduced confidence in the outcome of elections. And there will almost certainly be fraud. As in almost all things, a voluntary option subject to jurisdictional risk controls is far preferable to either mandatory or “universal” postal voting.

COVID at Midsummer

04 Tuesday Aug 2020

Posted by in Pandemic, Public Health

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It’s been several weeks since I last posted on the state of the coronavirus pandemic (also see here). The charts below show seven-day moving averages of new confirmed cases and reported C19 deaths from the COVID Tracking Project as of August 3. Daily new cases began to flatten about three weeks ago and then turned down (it can take a few days for such changes to show up in a moving average). Daily C19-attributed deaths began climbing again in early July, lagging new cases by a few weeks, and they slowed just a bit over the past several days. Obviously, both are good news if those changes are maintained. The other thing to note is that deaths have remained far below their levels of April and early May.

The daily death count is that reported on each date, not when the deaths actually occurred. Each day’s report consists of deaths that were spread across several previous weeks or even a month or more. That makes the slight downturn in deaths more tenuous from a data perspective. There are sometimes large numbers of deaths from preceding weeks reported together on a single day, so reporting can be ragged and the final pattern of actual deaths is not known for some time. More on that below.

States

The increase in cases and deaths during late June and July was concentrated in four states: Arizona, California, Florida, and Texas. Here’s how those states look now in terms of cases and deaths, from the interactive COVID Time Series site:

 

New cases began to flatten or drop in these states two to three weeks ago, driving the change in the national data. Daily deaths have not turned convincingly, but again, these are reported deaths, which actually occurred over previous weeks. One more chart that is suggestive: current hospitalizations in these four states. The recent declines should bode well for the trend in reported deaths, but it remains to be seen. 

Meanwhile, other parts of the country have seen an uptrend in cases and deaths, such as Illinois, Missouri, South Carolina, and Tennessee. Here are new cases in those states:

It’s worth emphasizing that the elevated level of new cases this summer has not been associated with the rates of fatality experienced in the Northeast during the spring. There are many reasons: better patient care, new treatments, more direct summer sunlight, higher humidity, and tighter controls in nursing homes.

More On the Timing of Deaths

Back to the discrepancies in the timing of reported deaths and actual deaths. This is important because the reported totals each day and each week can be highly misleading, even to the point of frightening the public and policy makers, with consequent psychological and economic impacts.

The latest summary of provisional vs. reported deaths is shown below, courtesy of Kyle Lamb, who posts updates on his Twitter feed. This report ends with the last complete week ending August 1. It’s a little hard to read, but you might get a better look if you click on it or turn your phone sideways. Some of the key series are also graphed below. 

The table shows the actual timing of deaths in the fourth column, with dates alongside. The pattern differs from the statistics reported by the Covid Tracking Project (CTP) in the top row (shaded orange), and from the totals of actual deaths by reporting day in the third row (shaded gray). The reporting dates are always later than the dates of death. This can be seen in the chart below. The most obvious illustration is how many of the deaths from around the peak in mid-April were reported in May. In March and April, the daily reports were short of the ultimate actual death counts because so few deaths with associated dates were known by then.

 

The right-hand end of the red line shows that many deaths reported by CTP have not yet been placed at an actual date of death by the CDC.  At this point, the actual date of death has not been placed for over 10,000 deaths! Again, those will be spread over earlier weeks.

The blue line is dashed over the last four weeks because those counts are most “highly” provisional. Small changes in the actual counts are likely for dates even before that, but the last four weeks are subject to fairly substantial upward revisions. Eventually, the right end of the blue line will more closely approximate the totals shown in red.

To get an indication of trends in the actual timing of deaths, I plotted the weekly actual deaths reported for the last four reporting weeks going back in time. In the table, those are the four lowest, color-coded diagonals. In the graph below, which should include the qualifier “by recency of report week”, actual deaths in the most recent report week are represented by the blue line, the prior weekly report is red, followed by green (three weeks prior), and purple (four weeks prior… sorry, the colors are not consistent with those in the table). The lines extend farther to the right for more recent report weeks.

The increase in actual deaths occurring in July has declined or flattened in each of the four most recent report weeks. Only the second-to-last week increased as of the August 1st report. On the whole, those changes seem favorable, but we shall see.

Closing

It’s getting trite to say, but the next few weeks will be interesting. The increase in deaths in July was a sad development, but at least the extent of it appears to have been limited. Even with a somewhat higher death count, the fatality rate continued to decline. Let’s hope any further waves of infections are even less deadly.

COVID Politics and Collateral Damage

26 Sunday Jul 2020

Posted by in Pandemic, Public Health

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Policymakers, public health experts, and the media responded to the coronavirus in ways that have often undermined public health and magnified the deadly consequences of the pandemic. Below I offer several examples of perverse politics and policy prescriptions, and a few really bad decisions by certain elected officials. Some of the collateral damage was intentional and motivated by an intent to inflict political damage on Donald Trump, and people of good faith should find that grotesque no matter their views on Trump’s presidency.

Politicized Treatment

The smug dismissal of hydroxychloraquine as Trumpian foolishness was a crime against humanity. We now know HCQ works as an early treatment and as a prophylactic against infection. It’s has been partly credited with stanching “hot spots” in India as well as contributing strongly to control of the contagion in Switzerland and in a number of other countries. According to epidemiologist Harvey Risch of the Yale School of Public Health, HCQ could save 75,000 to 100,000 lives if the drug is widely used. This is from Dr. Risch’s OpEd in Newsweek:

“On May 27, I published an article in the American Journal of Epidemiology (AJE) entitled, ‘Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis.’ That article, published in the world’s leading epidemiology journal, analyzed five studies, demonstrating clear-cut and significant benefits to treated patients, plus other very large studies that showed the medication safety. …

Since [then], seven more studies have demonstrated similar benefit. In a lengthy follow-up letter, also published by AJE, I discuss these seven studies and renew my call for the immediate early use of hydroxychloroquine in high-risk patients.”

Risch is careful to couch his statements in forward-looking terms, but this also implies that tens of thousands of lives could have been saved, or patients might have recovered more readily and without lasting harm, had use of the drug not been restricted. The FDA revoked its Emergency Use Authorization for HCQ on June 15th, alleging that it is not safe and has little if any benefit. An important rationale cited in the FDA’s memo was an NIH study of late-stage C19 patients that found no benefit and potential risks to HCQ, but this is of questionable relevance because the benefit appears to be in early-stage treatment or prophylaxis. Poor research design also goes for this study and this study, while this study shared in some shortcomings (e.g., and no use of and/or controls for zinc) and a lack of statistical power. Left-wing outlets like Politico seemed almost gleeful, and blissfully ignorant, in calling those studies “nails in the coffin” for HCQ. Now, I ask: putting the outcomes of the research aside, was it really appropriate to root against a potential treatment for a serious disease, especially back in March and April when there were few treatment options, but even now?

Then we have the state governors who restricted the use of HCQ for treating C19, such as Gretchen Whitmer (MI) and Steve Sisolak (NV). Andrew Cuomo (NY) decided that HCQ could be dispensed only for hospital use, exactly the wrong approach for early stage treatment. And all of this resistance was a reaction to Donald Trump’s optimism about the promise of HCQ. Yes, there was alarm that lupus patients would be left without adequate supplies, but the medication is a very cheap, easy to produce drug, so that was never a real danger. Too much of the media and politicians have been complicit in denying a viable treatment to many thousands of C19 victims. If you were one of the snarky idiots putting it down on social media, you are either complicit or simply a poster child for banal evil.

Seeding the Nursing Homes

The governors of several states issued executive orders to force nursing homes to accept C19 patients, which was against CMS guidance issued in mid-March. The governors were Andrew Cuomo (NY), Gretchen Whitmer (MI), Gavin Newsom (CA), Tom Wolf (PA), and Phil Murphy (PA). This was a case of stupidity more than anything else. These institutions are home to the segment of the population most vulnerable to the virus, and they have accounted for about 40% of all C19 deaths. Nursing homes were ill-prepared to handle these patients, and the governors foolishly and callously ordered them to house patients who required a greater level of care and who represented an extreme hazard to other residents and staff.

Party & Protest On

Then of course we had the mayor of New York City, Bill De Blasio, who urged New Yorkers to get out on the town in early March. That was matched in its stupidity by the array of politicians and health experts who decided, having spent months proselytizing the need to “stay home”, that it was in their best interests to endorse participation in street protests that were often too crowded to maintain effective social distance. That’s not a condemnation of those who sought to protest peacefully against police brutality, but it was not a good or consistent recommendation in the domain of public health. Thankfully, the protests were outside!

Testing, Our Way Or the Highway

The FDA and CDC were guilty of regulatory overreach in preventing early testing for C19, and were responsible for many lives lost early in the pandemic. By the time the approved CDC tests revealed that the virus was ramping up drastically in March, the country was already behind in getting a handle on the spread of the virus, quarantining the infected, and tracing their contacts. There is no question that this cost lives.

Masks… Maybe, But Our Way Or the Highway

U.S. public health authorities were guilty of confused messaging on the efficacy of masks early in the pandemic. As Joel Zinberg notes in City Journal, Anthony Fauci admitted that his own minimization of the effectiveness of masks was motivated by a desire to prevent a shortage of PPE for health care workers:

“In discouraging mask use, Fauci—for decades, the nation’s foremost expert on viral infectious diseases—was not acting as a neutral interpreter of settled science but as a policymaker, concerned with maximizing the utility of the limited supply of a critical item. An economist could have told him that there was no need to misinform the public. Letting market mechanisms work and relaxing counterproductive regulations would ease shortages. Masks for health-care workers would be available if we were willing to pay higher prices; those higher prices, in turn, would elicit more mask production.”

Indeed, regulators made acquisition of adequate supplies of PPE more difficult than necessary via compliance requirements, “price gouging” rules, and import controls.

Bans on Elective Surgery

Another series of unnecessary deaths was caused by various bans on elective surgeries across the U.S. (also see here), and we’re now in danger of repeating that mistake. These bans were thought to be helpful in preserving hospital capacity, but hospitals were significantly underutilized for much of the pandemic. Add to that the fright inspired by official reaction to C19, which keeps emergency rooms empty, and you have a universe of diverse public health problems to grapple with. As I said on this blog a couple of months ago:

“… months of undiagnosed cardiac and stroke symptoms; no cancer screenings, putting patients months behind on the survival curve; deferred procedures of all kinds; run-of-the-mill infections gone untreated; palsy and other neurological symptoms anxiously discounted by victims at home; a hold on treatments for all sorts of other progressive diseases; and patients ordinarily requiring hospitalization sent home. And to start back up, new health problems must compete with all that deferred care. Do you dare tally the death and other worsened outcomes? Both are no doubt significant.”

Lockdowns

The lockdowns were unnecessary and ineffectual in their ability to control the spread of the virus. A study of 50 countries published by The Lancet last week found the following:

“Increasing COVID-19 caseloads were associated with countries with higher obesity … median population age … and longer time to border closures from the first reported case…. Increased mortality per million was significantly associated with higher obesity prevalence … and per capita gross domestic product (GDP) …. Reduced income dispersion reduced mortality … and the number of critical cases …. Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people.”

That should have been obvious for a virus that holds little danger for prime working-age cohorts who are most impacted by economic lockdowns.

Like the moratoria on elective surgeries, lockdowns did more harm than good. Livelihoods disappeared, business were ruined, savings were destroyed, dreams were shattered, isolation set in, and it continues today. These kinds of problems are strongly associated with health troubles, family dysfunction, drug and alcohol abuse, and even suicide. It’s ironic that those charged with advising on matters pertaining to public health should focus exclusively on a single risk, recommending solutions that carry great risk themselves without a second thought. After all, the protocol in reviewing new treatments sets the first hurdle as patient safety, but apparently that didn’t apply in the case of shutdowns.

Even as efforts were made to reopen, faulty epidemiological models were used to predict calamitous outcomes. While case counts have risen in many states in the U.S. in June and July, deaths remain far below model predictions and far below deaths recorded during the spring in the northeast.

One last note: I almost titled this post “Attack of the Killer Morons”, but as a concession to what is surely a vain hope, I decided not to alienate certain readers right from the start.