WE JUST PASSED TWO SOBERING COVID-19 MILESTONES

Today the world rumbled past two grim markers of the progress of our current plague. There have now been more than three million confirmed COVID-19 cases worldwide, which have caused more than 210,000 deaths. And here in the US, we've just confirmed our one millionth case, with more than 56,000 deaths.

The SARS-NCoV-2 virus, the virulent, microscopic cause of the COVID-19 pandemic

Credit: US Department of State

It's tragic to realize that the US, with just 4.25 percent of the world's population, accounts for close to one-third of the world's COVID-19 cases and has suffered one-quarter of the deaths.

It's not an overstatement to rate our national response to the coronavirus pandemic as catastrophically poor.

Donald Trump, the virulent, macroscopic enabler of the COVID-19 pandemic in the United States

Credit: Olivier Douliery-Pool/Getty Images

We can and must do better, but that's not going to be possible with Donald Trump as our leader. Because of his deeply flawed  character, lack of intelligence and world-class lack of empathy and humanity, he is incapable of leading us through this dark and dangerous time. He has puffed, prattled and preened while 56,000 of us have died.

Still, as pathological and incompetent as he is, Trump has one super-power--the spell he casts over some 45 percent of Americans. Finding the antidote to that is as urgent and vital as creating a vaccine for the coronavirus.

GOOD NEW AND BAD NEWS ABOUT COVID-19

Researchers are constantly trying to refine their understanding of the coronavirus pandemic in order to make meaningful recommendations and accurate predictions. To help with this, they have a suite of mathematical models that, for example, can predict the impact that interventions like social distancing, universal mask-wearing, or stay-at-home orders will have on the trajectory of the pandemic.

What are your chances of finding yourself in a situation like this?
Credit: U.S. Air Force/Staff Sgt. Kevin Linuma

However, as anyone who has ever tried to analyze data knows, the best model in the world is useless if it's fed inaccurate data. This is captured by an acronym that dates back at least to 1963, GIGO--garbage in, garbage out.

Probably the most garbage-laden information about the COVID-19 pandemic is the actual number of people in a given region who have been infected by the SARS-CoV-2 virus. This number is necessary in order to calculate how infectious the virus really is, how quickly it can spread through a population, what proportion of the population remains vulnerable, and, crucially, how deadly it is.

Unfortunately, in the absence of widespread testing and contact tracing, typically only severe cases get confirmed and counted. The trick is to get a handle on how many uncounted cases there are for each confirmed one.

That's the key number which is now providing us both good and bad news.

The bad news is that multiple signs point to there being many more people who have been or are currently infected than the official, confirmed case counts tell us. That's bad because it means that you're much more likely to run into someone carrying and potentially shedding the virus than you and public health authorities probably thought.

The good news is that if there are in fact many more COVID-19 cases than we thought, but if the count of  deaths is reasonably accurate, then the virus may be significantly less lethal than we thought in terms of the number people who die compared to the total number who catch the virus.

Here are some relevant data points:

--Out of 3,330 people tested for antibodies to the SARS-CoV-2 virus in Santa Clara County, California, 1.5 percent tested positive. That doesn't sound like much, but it implies that the actual number of cases in that county is 50 to 85 times greater than the confirmed case count.

--A similar study in Los Angeles County found an infection rate between 2.8 and 5.6 percent among adults. Compared to the 8,000 confirmed cases at that time, it implies a true incidence of infections between 27.5 and 55 times greater than the official count.

--New York State has turned out to be the unfortunate epicenter for the virus, with more than 288,000 confirmed cases and more than 22,000 deaths to date. When 3,000 people in 19 counties were tested for antibodies, 13.9 percent tested positive (and a remarkable 21.2 percent in New York City). Those numbers indicate that there have been at least 10 undocumented cases in the state for every confirmed case.

The picture is still blurry--we need much more testing, not only to make the models and their predictions more accurate, but, along with contact tracing and effective isolation, to be able to get our lives and the economy back to normal.

Critics tell us that the above numbers must be scrutinized with care. Statisticians point out that when the incidence of a disease is low, a less-than-perfect test can produce enough false positives to significantly blur the picture.  Others point out that it is hard to match these indicators of a more widespread but milder and much less lethal illness with well-documented clusters of cases and fatalities, as we saw on several cruise ships.

Still, if we squint, it looks as though there are probably ten times or  more actual cases of COVID-19 than confirmed cases.

So again, when you go out, someone comes to your door or you find yourself among a group of people, anyone you're close to is 10 times more likely to be contagious than you might have thought.

But that also implies that the SARS-CoV-2 virus may well be ten times less lethal than we've been told so far; it may kill just two out of a thousand cases rather than the more frequently cited estimates of from 7 to 34 out of a thousand. From the point of view of the population as a whole, that's definitely good news.

However, if you, like 92 million other Americans, are over 65 or have an underlying medical condition such as hypertension, diabetes or obesity,  you remain at high risk of serious illness or a miserable death from the virus. For those at high risk, the crucial, and potentially vital take-away is the fact that there may be 10 times more potential sources of contagion outside your door than you thought.

Please take care!

WHAT DIDN'T HE KNOW AND WHEN DIDN'T HE KNOW IT?

What didn't Trump know and when didn't he know it?

Concerning Trump in general and his handling of the COVID-19 pandemic in particular, the simple answer is that he knows nothing, always. Despite being "a very stable genius," perennial ignorance is his stock in trade. It lets him avoid responsibility across the board. Unlike President Truman, the buck never stops at Trump's desk (or if it does, like Macavity, Trump wasn't there. He never got the memo.)

Harry Truman, 1959--the buck stops here

Credit: Levan Ramishvili/flickr

Unfortunately for America, sometimes ignorance, especially arrogantly willful ignorance, has costs, real-world impacts that can't be erased by shifting blame to someone else (right now WHO's on first), smearing someone with a smarmy nickname, or filing a lawsuit.

MACAVITY'S NOT THERE

Credit: Pixabay

As I write this, 565,835 Americans have been sickened by the coronovirus, and 22,850 have died. That's more cases than the next three worst-hit countries combined, and more deaths than any other country. So much for MAGA and "we're number one."

Tragically, neither those deaths nor those yet to come will make a difference to Trump's core supporters; his approval ratings have ranged from 41 to 49 percent as the pandemic has raged.  Still, for those of us who at least try to live in the real world, it might be interesting to figure out what Trump could have known, and ought to have known, and when he chose to ignore it and go with his--also brilliant--gut.

We now know that multiple agencies were trying to alert Trump to the approaching tsunami starting in January. These included the National Security Council, Health and Human Services, the CDC, Homeland Security, the VA and the Pentagon--at least 10 high-level warnings between January 18 and February 25. Clearly enough of these early warnings got through to him to stimulate him to do what comes naturally to him--closing borders. On January 31 he banned most travelers coming from China. 

Domestically, however, Trump presented a very different face to the U.S. public. From January 20th through mid-March, Trump blatantly downplayed the seriousness of the pandemic. His consistent message was "no worries," "under control," and "it will disappear." Finally, in mid-March, and some six weeks too late, he began to take the pandemic seriously in terms of what should be done within the U.S.

What he could have known if he were capable of and willing to listen to experts, was that viruses like SARS-CoV-2 have the capacity to go viral--duh--for the number of people sickened or killed to increase exponentially.  If he had digested that bit of information, his native genius could have led him to the conclusion that days count. In a country the size of the US, putting effective control measures into place a week or two sooner could mean the difference between a few thousand deaths and a few hundred thousand deaths .

We can see this clearly if we compare New York and California. New York dithered while California took quick and serious steps to slow the spread of the virus.  As of 4/13/20, New York has registered 195,031 cases and suffered 10,056 deaths. California has just one-eighth as many cases, 23,428 and one-fifteenth as many deaths, 675. The contrast becomes even starker when you consider that California has twice the population of New York. So, per population, California has just one-sixteenth the number of cases and one-thirtieth he number of deaths. If California had failed to act as quickly and decisively as it did, 20,000 more people might have died.

What the experts tried to get across to Trump starting in January is that when you're dealing with the potentially exponential explosion of a fatal disease, there isn't room for half measures nor time for delay. Trump only heard what he wanted to hear, and reality steamrolled over all his magical thinking, political positioning and base-soothing blather to remind us that ignorance can be fatal. That makes Trump even more dangerous than we thought just a few months ago.

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REA

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6/28/20:  Just to add one more data point to the ongoing drama of what Trump didn't know and when didn't he know it, we now have the scandal of Russian intelligence paying a bounty to the Taliban for the murder of US soldiers. As usual, Trump missed the briefing, and the next briefing, and the one after that . . .

ONE MILLION CASES AND GROWING FAST

The official count of coronavirus or COVID-19 cases passed one million worldwide early today (4/2/20).** But that number is already out of date, since the count is growing by at least 70,000 per day. As I write this in the late afternoon, 20,000 more people have been diagnosed, and 6,000 have died. That's just today.

Wall Street in lockdown

(along with Main Street)

Credit: Dan Nguyen/Flickr

Tragically, the US is number one among the nations on this statistic.  Despite having less than 5 percent of the world's population, we've incurred nearly 25 percent of the COVID-19 cases, and 11 percent of the deaths. (One day after this posting, the US sped past a grim milestone--1000 COVID-19 deaths in a day).

Many factors are contributing to our unfortunate leadership in this area. Our healthcare system is focused on providing top-quality care to people who are well off or well insured, but lacks a comparable commitment to public health, In response to a problem that requires a  quick, coordinated, disciplined response, and a response that requires personal sacrifice, our national love of individualism and our more recent Ayn Randian valuation of putting oneself first certainly contributed.

Still, if we're going to assign responsibility for where we are today, an awful lot needs to go to our tweeter-in-chief, Donald Trump. As anyone whose memory has not been wiped clean by the Ministry of Truth knows. Trump treated the looming pandemic as--take your choice--a hoax, a Democrat scheme to discredit him, just like impeachment; as a threat to his re-election; as something totally under control; as an ordinary, relatively trivial event, like the flu; as another reason to close borders; as something that could be cleared away by Easter, and, even if it risked thousands of deaths, should not be allowed to upset the economy. With his narcissistic, impulsive and erratic leadership, the US was ill prepared, slow to respond, and still extremely spotty in dealing with this grave crisis.

By the way, the fact that even as thousands of Americans die every day--deaths that could have been prevented by prompt and well-informed leadership, Trump's approval ratings are approaching 50 percent suggests that the Ministry of Truth* is doing a bang-up job.

The big question is how we proceed from here. The US is still at the beginning of the epidemic. Nothing that we've done so far in the US has "flattened the curve." Instead, COVID-19 cases in the US are on a steeply rising exponential trajectory.  Experts tell us that social distancing--staying at home and avoiding as many contacts with other people as possible-- is crucial. So is hand washing. If everyone, sick, possibly sick or well, wears a face mask in public, that may help.

A separate, perhaps more crucial factor is testing as many people as possible in order to isolate people who are shedding the virus, along with tracking and isolating their contacts. Where this has been done, for example in South Korea, it has controlled the spread of the virus without shutting down the country, businesses and the economy. Again, unfortunately, the US lags far, far behind on testing.

What lies ahead is in our hands. A swift, strong, coordinated, nationwide attack on the virus can still save thousands or perhaps even hundreds of thousands of live. The two key questions are:

Will enough Americans wake up and do what's needed, or will half of them remain in the dark and asleep even as the plague surges towards them?

Will government, starting with Trump, get its act together, and in time?

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* For another example of Trump's Ministry of Truth revising history as we speak, click here.

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** The number of cases worldwide passed two million on 4/15/20. In other words, the global doubling time for the virus is around 13 days. We'll see if the enormous sacrifices that nations and individuals are making are making a difference. When will we suffer 4,000,000 cases?

REA