15 June 2020 – Monday – #92

I’m pretty sure the United States added a new state since I left in January. No, not Washington, D.C. That would be a sensible state to add. I’d like to be the first to congratulate the US on its new State of Denial.

In March, Yale professor Nicholas Chirstakis published a Twitter thread comparing Covid-19 to the 1957 H2N2 pandemic. He updated the thread yesterday. It’s not good news.

Yale professor Nicholas Christakis updates his US Covid-19 mortality prediction to 300k – 500k deaths.

Christakis now predicts 300k – 500k Covid-19 deaths in the US. That means he expects 3x – 4x more people to die from Covid-19 in the US than have died already.

Let me write that again.

After today, 3x – 4x more people are going to die in the US from Covid-19 than have died already.

No one is talking about this. The CDC seems worthless. Its new estimate for the Covid-19 death rate is 0.26%, much less than that 1.15% measured in Spain. The entire US may not be in denial, but Washington, D.C. and certainly the White House are in a state of denial.

At the end of March, I made a back-of-the-envelope prediction of US Covid-19 mortality. My estimate, based on Spain’s and Italy’s Covid-19 mortality rates at the time, was 96k – 160k US Covid-19 deaths. As the Covid-19 counting got better in Spain and Italy and as their mortality curves flattened, both countries ended up with a mortality rate just shy of 600 deaths per million. That still may be an under-count, but it’s not off wildly.

Covid-19 per capita mortality rates by country, 14 June 2020

The latest US mortality figures (above) show the US more than half way to Spain’s and Italy’s 600 Covid-19 deaths per million. In other words, the US today is in the range of mortality rates I used to make my prediction in March. The current 117k US Covid-19 death count is in the middle of my predicted range.

Parenthetically, it appears that the strain of the Covid-19 virus in Europe and New York is much more virulent than the strain of the Covid-19 virus that struck Asia and the western US. Along with all the other factors like demographics, per capita GDP, healthcare systems, etc., this is another factor that makes it difficult to determine a single Covid-19 IFR and to compare international Covid-19 mortality rates. Take my predictions with a grain of salt.

What I failed to predict in March was that the US curve would continue rising after it reached Spain’s and Italy’s end-of-March mortality rates. Given the extra weeks the US had to prepare its Covid-19 response and the CDC’s pandemic expertise, my assumption was that the US Covid-19 mortality curve would flatten sooner than Spain’s and Italy’s morality curves flattened, that the US curve would flatten at about the same per capita mortality Spain and Italy reached a month into their Covid-19 outbreaks.

Can the US get to 3x – 4x more Covid-19 deaths the way Chirstakis predicts? It’s easy to see at least 2x more Covid-19 deaths in the US the way its mortality curve is trending and easy to get another doubling with second and third waves of Covid-19.

What I failed to predict is how poorly the White House would respond. Or, perhaps more accurately, how much the White House would prioritize Trump’s re-election over public health.

As Trump pressed to get the economy going again, some US states relaxed their Covid-19 lockdowns too soon. They either didn’t meet the CDC’s guideline for 14 days of declining Covid-19 cases, or they didn’t have adequate Covid-19 testing and tracing in place.

Andy Slavitt explains the result of this early reopening by grouping states based on when they re-opened: the Rabbits, the Cheetahs, the Rhinos, and the Tortoises.

As Slavitt notes, the Rabbits are seeing Covid-19 cases increase while the Tortoises are doing just fine. In June, this is the measured change in Covid-19 cases for each group.

  • Rabbits: up 26%
  • Cheetahs: up 7%
  • Rhinos: down 31%
  • Tortoises: down 9%

Not every Rabbit and Cheetah is increasing and not every Rhino and Tortoise is decreasing, but the group averages indicate that the early-to-reopen states tended to open too soon.

Trump didn’t understand how to manage Covid-19 and he needed the economy working again to get re-elected. Now, as the states that opened too early are experiencing increasing Covid-19 cases, the US, and especially the White House, seems to be in a state of denial.

The lack of presidential leadership enables misinformation and poor policy choices at the state and local level. Some specific examples from Florida, California, and Louisiana.

Florida. Florida fired data scientist Rebekah Jones because she wouldn’t post bad data on Florida’s Covid-19 statistics site. Now Jones has launched her own Covid-19 site for Florida “showing far more COVID-19 information than she said the state allowed her to report as an employee, including statistics contradicting Florida’s official coronavirus numbers and the push to reopen the state.”

California. Orange County residences made violent threats against former Orange County Health Director Nichole Quick after her mandatory mask order. “The county sheriff said his department would not enforce the mask rule.” Quick resigned and the county rescinded her order. Masks are now encouraged, but not mandatory.

Lousiana. More New Orleans residence have died of Covid-19 than died during Hurricane Katrina. The federal response to Covid-19 in New Orleans is worse than its botched response after Hurricane Katrina, bringing up the question whether Washington, D.C., and this White House in particular, cares to help minority communities. “About a third of Louisianans are Black, but in the early going, Blacks were doing 70% of the dying, a figure that has fallen as the virus spreads among people who probably never thought their own health was tied so directly to the less fortunate, the unemployed, the uninsured.”

I could expand this list, but you get the point. Trump is only concerned about fixing the economy, or making it appear that the economy is back on track, so he can get re-elected. It’s unlikely, however, that anyone can fix the economy until public health is fixed. And it’s not that hard to change a few behaviors that likely would fix public health.

If only the president were a woman.

Female leaders managed their countries’ Covid-19 responses better than their male counterparts.

The US could have had a female president. Too bad. It’s stuck with Trump, at least through January, and the Democratic alternative is a man.

My big fear? It’s not how soon a Covid-19 treatment comes. It’s not how soon a Covid-19 vaccine comes.

My big fear is that Trump normalizes 1,000 US Covid-19 deaths every day by drawing the country’s attention to less important issues. Like his re-election.

If you need help visualizing how bad Covid-19 is, I tweeted this great visualization of Global Cause of Death.

2020 Global Cause of Death.

Trump may be in a state of denial, but the world is not. The Covid-19 numbers are too bad to deny the human toll. The only question is how soon does the US acknowledge Covid-19 is a problem that won’t be denied. How long is its state of denial?

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