COVID-19: The Disconnect between Cases and Deaths

As many (including me) have observed, COVID-19 case statistics don’t give a reliable picture of the spread of COVID-19 in the U.S. Just a few of the reasons are misdiagnosis; asymptomatic (and untested) cases; and wide variations in the timing, location, and completeness of testing. As a result, the once-tight correlation between reported cases and deaths has loosened to the point of meaninglessness:

Source: Derived from statistics reported here.

So when you hear about a “surge” in cases, do not assume that they are actually new cases. It’s just that new cases are being discovered because more tests are being conducted. The death toll, overstated as it is, is a better indicator of the state of affairs. And the death toll continues to drop.

Just Another Thing or Two about COVID-19

Though it’s tough to make predictions, especially about the future, and I sort of promised not to make any more predictions about the spread of COVID-19 in the United States because the data are unreliable (examples at the link and here). But I can’t resist saying a few more things about the matter.

Specifically, since my last substantive post about COVID-19 statistics, I now project 2 million cases and 135,000 deaths by mid-August, as against my earlier projections of 1.3 million and 90,000. The new estimates rely on the same database as the old ones, so they aren’t any more reliable than the old ones.

But I have revised my calculations so that they are based on 7-day average numbers of cases and deaths. This is an attempt to smooth over obvious lags in reporting (sudden drops in numbers of cases and deaths followed by sudden surges).

The equations in these two graphs …

… yield these projections:

Those are nationwide numbers. The good news (pending the results of “re-opening”) is that the daily number of new cases has declined sharply from the peaks of late March and late April. But there’s still a long way to go. The first graph in this post is worrisome because recent observations are a bit above the trend line; that is, the incidence of new cases may not be declining quite as rapidly as the equation suggests.

The number of new deaths has declined also, from the peak 7-day average of 2,041 on April 21 to 1,430 as of May 15. Overall, the rate of new deaths per new case seems to have stabilized at 5.7 percent. (The overall percentage will be somewhat higher because the deaths/case rate was higher than 5.7 for quite a while.)

Of course, the situation varies widely from State to State (and, obviously, within each State):

Regional and state variations in death rates
(I am using same assignment of States to regions as used by my data source.)

Nine of the 12 States of the Northeast (including D.C.) are among the top 12 in deaths per resident. The exceptions are the more rural Northeastern States: Main, New Hampshire, and Vermont.

In general, States with large, densely populated metropolitan areas have fared worse than less-urbanized States with smaller cities. That’s unsurprising, of course. But it also underscores the resistance of large swaths of the populace to “New York” rules.

Other related posts:

Contagion Nation?
“Give Me Liberty or Give Me Death”

Contagion Nation?

The coronavirus outbreak in the United States is of a piece with the steady rise in influenza cases over the past 13 years, which is the period for which CDC maintains tallies of flu tests and test results.

Here are some raw statistics, representing weekly results since the 40th week of 1997:

The rate of positive tests has remained steady since 1997, with a slight upward bump coincident with the swine flu epidemic of 2009-2010:

The steadiness of the positive-test percentage suggests that the presence of flu-like symptoms was just as likely to have prompted testing in 1997 as in 2020. Another way to put it is that the first graph accurately represents a steady rise in the occurrence of flu-like symptoms in the population.

This can be seen in the following graph:

Despite the fairly stable incidence of positive tests, the number of positive tests has grown far more rapidly than the population of the U.S.

The bottom line: Americans have become increasingly prone to contract flu-like illnesses. Though the increase can’t be explained by the overall rise in the country’s population, it is probably due in part to greater population density in urban areas. It is probably also due in part to the weakening of immune systems relative to the ability of viruses to mutate.

It is possible that influenza won’t be as prevalent in the future as more Americans take precautions against contagion in the wake of COVID-19. But memories are short, and precautions are easily cast aside when the world seems to have returned to normal. So I expect that in a few years the incidence of flu will resume its long-term rise.

COVID-19: Public Service Announcement

It has become obvious that COVID-19 stats are unreliable; see this, this, and this, for example. I am therefore withdrawing from the business of reporting official stats and making projections based on them. I leave that endeavor with this thought.

COVID-19 in the United States: Updated Statistics and Projections

Details here.

It is noteworthy that the 2019-2020 flu season was taking a much heavier than normal toll until COVID-19 came along. That alone should cast a lot of doubt on the COVID-19 figures being reported by the States and D.C. Then there is the problem of comorbidity, especially among older persons. In sum, there won’t be a good estimate of the actual death toll of COVID-19  until it’s possible to compute “excess” deaths — taking all other causes into account — when the final tally of deaths in 2020 becomes available a few years hence.

There is also the looming possibility that (1) the COVID-19 infection rate is vastly understated; (2) the COVID-19 fatality rate is therefore vastly overstated; and (3) millions of persons who are already immune to COVID-19 because they have already (unknowingly) recovered from it (believing that they had a cold, the flu, or allergies) and are being held hostage by lockdown orders that are killing the economy. (See this for example.)

Flattening the Curve

What does it mean to “flatten the curve”, in the context of an epidemic? Here is Willis Eschenbach’s interpretation:

What does “flattening the curve” mean? It is based on the hope that our interventions will slow the progress of the disease. By doing so, we won’t get as many deaths on any given day. And this means less strain on a city or a country’s medical system.

Be clear, however, that this is just a delaying tactic. Flattening the curve does not reduce the total number of cases or deaths. It just spreads out the same amount over a longer time period. Valuable indeed, critical at times, but keep in mind that these delaying interventions do not reduce the reach of the infection. Unless your health system is so overloaded that people are needlessly dying, the final numbers stay the same.

I beg to differ. Or, at least, to offer a different interpretation: Flattening the curve — reducing its peak — can also reduce the total number of persons who are potentially exposed to the disease, thereby reducing the total number of persons who contract it. How does that work? It requires not only reducing the peak of the curve — the maximum number of active cases — but also reducing the length of the curve — the span of time in which a population is potentially exposed to the contagion.

Consider someone who has randomly contracted a virus from a non-human source. If that person is a hermit, the virus may kill him, or he may recover from whatever illness it causes him, but he can’t infect anyone else. Low peak, short duration.

Here’s an example of a higher peak but a relatively short duration: A person who randomly contracts a virus from a non-human source then infects many other persons in quick succession by breathing near them, sneezing on them, touching them, etc., in a short span of time (e.g., meeting and greeting at a business function). But … if the originator of the contagion and those whom he initially infects are identified and quarantined quickly enough, the contagion will spread no further.

In both cases, the “curve” will peak at some number lower than the number that would have been reached without isolation or quarantine. Moreover, and more important, the curve will terminate (go to zero) more quickly than it would have without isolation or quarantine.

The real world is more complicated than either of my examples because almost all humans aren’t hermits, and infections usually aren’t detected until after an infected person has had many encounters with uninfected persons. But the principle remains the same: The total number of persons who contract a contagious disease can be reduced through isolation and quarantine — and the sooner isolation and quarantine take effect, the lower the total number of infected persons.

COVID-19 in the United States: Latest Projections

UPDATED 04/21/20

Relying on data collected through April 20, I project about 1.3 million cases and 90,000 deaths by the middle of August. Those numbers are 50,000 and 6,000 higher than the projections that I published three days ago. However, the new numbers are based on statistical relationships that, I believe, don’t fully reflect the declining numbers of new cases and deaths discussed below. If the numbers continue to decline rapidly, the estimates of total cases and death should decline, too.

Figure 1 plots total cases and deaths — actual and projected — by date.

Figure 1

Source and notes: Derived from statistics reported by States and the District of Columbia and compiled in Template:2019–20 coronavirus pandemic data/United States medical cases at Wikipedia. The statistics exclude cases and deaths occurring among repatriated persons (i.e., Americans returned from other countries or cruise ships).

But there is good news in the actual and projected numbers of new cases and new deaths (Figure 2).

Figure 2

As shown in Figure 3, the daily percentage changes in new cases and deaths have been declining generally since March 19.

Figure 3

But there is, of course, a lag between new cases and new deaths. The best fit is a 7-day lag (Figure 4).

Figure 4

Figure 5 shows the tight relationship between new cases and new deaths when Figure 3 is adjusted to introduce the 7-day lag.

Figure 5

Figure 6 shows the similarly tight relationship after removing 8 “hot spots” which have the highest incidence of cases per capita — Connecticut, District of Columbia, Louisiana, Massachusetts, Michigan, New Jersey, New York, and Rhode Island.

Figure 6

Figures 5 and 6 give me added confidence that the crisis has peaked.

The Lesson from the Diamond Princess, Underscored

What I say here, Willis Eschenbach says here (in greater detail).

Related reading:

Brian C. Joondeph, M.D., “Remember the H1N1 Pandemic? I Don’t Either“, American Thinker, March 16, 2020

J.G. Walsh, “Weighing the Future: Coronavirus and the Economy“, American Thinker, March 16, 2020

Gordon Wysong, “The Coronavirus Will Save America“, American Thinker, March 16, 2020

See also my posts, “America’s Long Vac” and “Trump, the Coronavirus Panic, and the Stock Market“.

Lesson from the Diamond Princess: Panic Is Unwarranted

As of today there have been 696 reported cases of coronavirus among the 3,711 passengers who were aboard the Diamond Princess cruise ship. The ship was quarantined on February 1; all passengers and crew had disembarked by March 1. As of March 1, there were 6 deaths among those infected, and the number hasn’t grown (as of today).

Given the ease with which the virus could be transmitted on a ship, the Diamond Princess may represent an upper limit on contagion and mortality:

  • an infection rate of 19 percent of those onboard the ship
  • a fatality rate of less than 1 percent among those known to have contracted the disease
  • a fatality rate of less than 2/10 of 1 percent of the population potentially exposed to the disease.

Conclusion: There is no question that coronavirus represents a significant threat to life, health, and economic activity. But the panic being fomented by the media and opportunistic politicians is unwarranted.

A Summing Up

This post has been updated and moved to “Favorite Posts“.

HillaryCare Returns

It’s all over the blogosphere. Glen Whitman has the best take on it because he ackn0wledges the slippery-slope, camel’s nose-in-the-tent factor.

What’s next after mandating health insurance for all? How about: the kind of health care we must have, who must deliver it, how it must be delivered, at what price, and on and on into the night. It’s a poisonous prescription for America’s still-excellent — if already somewhat socialized — health-care industry.

And there’s nowhere left to turn. Canada’s out because it already has fully socialized medicine. (Canadians in search of better medical attention are coming here, for crying out loud.) Mexico’s out because it’s a third-world country with fourth-rate health care and quacks who cater to desperate, terminally ill Americans with more money than sense. Medicine on the Moon, anyone?

P.S. A good post here.

P.P.S. More about health care in Canada here.

The Better Half or the Worse Half?

Arnold Kling, writing about a post of Robin Hanson’s, says:

My guess is that if Robin were to try to make this argument to a general audience, he would get a hostile response.

Hanson’s argument?

Cutting half of medical spending would seem to cost little in health, and yet would free up vast resources for other health and utility gains. To their shame, health experts have not said this loudly and clearly enough.

…The claim is not that there would be no harmful health effects of such a policy, but rather that harmful effects would be roughly balanced by helpful effects. And the claim is not that harmful and helpful effects would exactly balance, but rather that any net health harm will be small compared to the health gains possible by spending the savings on other health influences, and to the utility gains possible from spending the savings in other ways.

Kling continues:

However, the opposition would be almost entirely emotional, with little or no rational component….The intensity of the emotions is probably a sign that Hanson is onto something.

I don’t think it’s emotional to ask two questions:

1. Who does the cutting?

2. How does the cutter know, for each affected individual, whether the cut removes the better half or worse half of that individual’s health care?

Cato Unbound (where Hanson’s post appears) seems to be off-line. Perhaps I’ll have more to say when I’m able to read the whole post.

Okay, I’ve now read Hanson’s post. Hanson’s point about over-spending on medical care is well supported, but here’s the key passage about how to cut spending:

How should we cut medical spending? There are many possibilities, and I may prefer some possibilities to others….The obvious first place to cut would be our government and corporate subsidies for medicine, including direct payments, tax exemptions, and regulatory requirements. Socially, we should also try to give medicine far less prestige than we now do. After these one could consider taxing medicine, limiting it by law, or nationalizing the industry and using agency budgets to limit spending.

Yes, I know, these are not politically realistic proposals.

The least realistic proposals, politically, are to cut government and corporate subsidies, tax exemptions, and regulatory requirements. Such changes would be the most beneficial because they would restore income and discretion to the actual recipients and beneficiaries of medical care.

The politically realistic proposals (taxing medicine, limiting it by law, or nationalizing the industry) would be ruinous. Necessary medical care would become more expensive and harder to come by.

Does Hanson seriously endorse taxes, government-imposed rationing, and nationalization as substitutes for the the judgments of individuals who actually need medical attention? Perhaps he would prefer to live in Canada or the UK.

Socialized Medicine in the U.S.A.

Cato‘s Michael Cannon has it exactly right in “Socialized Medicine Is Already Here” (TCS Daily). Go and read it.

Insofar as medicine is concerned, we have traveled all the way down the slippery slope, following one and then another of the paths I trace in “The Slippery Slope of Constitutional Revisionism.”

Can it get worse? Yes. See:

Thomas Sowell, “No Health Care?”
These three posts at Cato-at-Liberty

Note, also, the planned presence of U.S. Senator Bernie Sanders (“Independent”-VT) at the convention of Democratic Socialists of America. Were they honest about their true political orientation, almost all Democrats in Congress and far more than a few Republicans would join Sen. Sanders at the convention.

The Case against Genetic Engineering

Slate‘s William Saletan, writing at The New York Times, reviews Michael J. Sandel’s The Case against Perfection: Ethics in the Age of Genetic Engineering. I have not read Sandel’s book, nor do I plan to read it. My case against genetic engineering, to which I will come, may bear no resemblance to Sandel’s. But there’s no way of learning what Sandel’s case is, given Saletan’s rather glib criticism of Sandel’s book.

Saletan’s glibness is evident in passages such as these:

[G]enetic engineering is too big for ethics. It changes human nature, and with it, our notions of good and bad.

When norms change, you can always find old fogeys who grouse that things aren’t the way they used to be….But eventually, the old fogeys die out, and the new norms solidify.

Once gene therapy becomes routine, the case against genetic engineering will sound as quaint as the case against running coaches [a practice apparently unknown before the 1924 Olympics].

In a world…controlled by bioengineering, we would dictate our nature as well as our practices and norms. We would gain unprecedented power to redefine the good. In so doing, we would strip perfection of its independence. Its meaning would evolve as our nature and our ideals evolved.

Saletan, in so many words, professes a tautology: The future will bring what it will bring, and whatever it brings will be the future. Saletan might as well write this: If murder is widely accepted in the future, murder will be acceptable in the future. I doubt very much that Saletan would endorse such a statement. I suspect, rather, that an effort to be clever at Sandel’s expense led Saletan down a moral blind alley of his own construction.

What is that moral blind alley? If it is not obvious to you, consider this passage from the entry for moral relativism at the Stanford Encyclopedia of Philosophy:

Metaethical Moral Relativism (MMR). The truth or falsity of moral judgments, or their justification, is not absolute or universal, but is relative to the traditions, convictions, or practices of a group of persons.

The definition of MMR* points to Saletan’s error. He treats the same (or very much the same) group of persons as being a different group because of the passage of time. In other words, the future just “happens” — as if people cannot make judgments in the present about the consequences, for them, of pending or reversible decisions.

To come at it a different way, Saletan conflates what could be with what should be. There could be a market for genetic engineering, but should there be such a market? There are, after all, markets for murder, arson, and the fruits of theft (among other such things), but I doubt that Saletan would condone such markets.

The real issue, then, is whether to allow genetic engineering, in light of its consequences. Saletan finally approaches that question when he says that “self-engineering….seizes control of humanity so radically that humanity can no longer judge it.”

But Saletan waits until the final paragraph of his review to say even that much. He then quickly closes the review with with smart-alecky observations instead of pursuing the consequences of genetic engineering. Perhaps he thinks that he has done so when, earlier in the review, he writes this:

The older half of me shares [Sandel’s] dismay that some parents feel blamed for carrying babies with Down syndrome to term. But my younger half cringes at his flight from the “burden of decision” and “explosion of responsibility” that come with our expanding genetic power. Given a choice between a world of fate and blamelessness [without genetic engineering] and a world of freedom and responsibility [with genetic engineering], I’ll take the latter. Such a world may be, as Sandel says, too daunting for the humans of today. But not for the humans of tomorrow.

There again, Saletan assumes that the future will be what it will be. More importantly, he badly mischaracterizes the world of today. Our present world, contra Saletan, is (relative to the brave new world of genetic engineering) one of freedom and responsibility. To use the example of a baby with Down syndrome (properly Down’s syndrome), parents who choose to abort such a baby (for that is what Saletan means) have every bit as much “freedom” to make that choice (under today’s abortion laws) and are just as responsible (morally) for their decision as they would be if they were to choose bioengineering instead. Genetic engineering simply introduces different “freedoms.”

Thus we come to the real issue, which is the wisdom (or not) of allowing genetic engineering in the first place. For, as we know from our experience with the regulatory-welfare state, once an undesirable practice gains the state’s approbation and encouragement it becomes the norm.

And that is the broad case against allowing genetic engineering: If it gains a government-approved foothold it will become the norm. It will result in foreseeable (and unforeseeable) changes in the human condition. It will cause most of us who are alive today to wish that it had never been allowed in the first place.

How so? Consider the specific case against genetic engineering:

  • Following upon (but not supplanting) abortion, it would enable humans to retreat further from the acceptance of responsibility for the consequences of the procreative act. The prospective acceptance of responsibility for our actions is a restraining influence upon which civil society depends. That restraining influence has been lessened enough by such elitist initiatives as the legalization of abortion, leniency in the punishment of criminals, and permissiveness in the face of disruptive speech and behavior in public schools.
  • It would reinforce the attitude — inherent in abortion — that humans are mere machines to be overhauled or junked at will. It would, in other words, take us another giant step down the slippery slope toward state-condoned (if not state-conducted) euthanasia.
  • From there it would be an easy step for the state (controlled by “liberal” elites) to dictate who may have children, how many children they may have, the gender-mix of the children, the occupations those children may pursue, etc., etc., etc.

Yes, genetic engineering could have some positive consequences (e.g., reducing the number of children born with Down’s syndrome). But the prospect of such consequences should not eclipse the broad, fundamental, negative consequences for human dignity and liberty.
* The validity of MMR is a matter for another post…sometime, perhaps.

People Are Idiots

The proof is found in the lede of an AP story:

People overwhelmingly support two of the Democrats’ top goals — increasing the minimum wage and making it easier to buy prescription drugs from other countries….

Increasing the minimum wage will hurt the class of persons it is intended to help. There will be fewer jobs (or worse working conditions) for those unskilled workers who now seek employment, and even fewer jobs for succeeding generations of unskilled workers.

Making it easier to buy prescription drugs from other countries will result in (a) fraudulent sales of inferior substitutes and (b) less R&D by American drug companies. Those results will harm the consumers of drugs.

As I say, people are idiots.

About Stem-Cell Research and Vetoes

Putting aside the pro-life and humanitarian aspects of embryonic stem-cell research, I have this to say:

The federal government has no business funding research of any kind, except that which is intended to foster the common defense.

Regardless of the reasons for President Bush’s veto of a bill to provide federal funds for embryonic stem-cell research, he was right to veto it. Now that Bush has found his veto pen, perhaps he will use it more often and on measures of greater fiscal import.

The Romney Plan: Part II

I wrote a few weeks ago about the new health-care scheme in Massachusetts. It’s worse than I thought. Arnold Kling, writing at Cato-at-liberty, quotes

Betsy McCaughey [who] digs into some of the details on the effects on business of Massachusetts’ brave, new health insurance experiment:

Say, for example, you open a restaurant and don’t provide health coverage. If the chef’s spouse or child is rushed to the hospital and can’t pay because they don’t have insurance, you — the employer — are responsible for up to 100% of the cost of that medical care. There is no cap on your obligation. Once the costs reach $50,000, the state will start billing you and fine you $5,000 a week for every week you are late in filling out the paperwork on your uncovered employees (Section 44). These provisions are onerous enough to motivate the owners of small businesses to limit their full-time workforce to 10 people, or even to lay employees off.

What else is surprising about this new law? Union shops are exempt (Section 32).

The next step should be the repeal of the Massachusetts plan because it is bad medicine for the people of Massachusetts. It will cut employment and wages, while driving up the cost of health care. Most of the intended beneficiaries of the plan will suffer as a result.

Given the perverse political climate of Massachusetts, the next step probably will be the State’s seizure of health-care services. The State will disclaim responsibility for the failure of its plan. Instead, it will pin the blame on the private sector, and the gullible public will swallow the story. The State will then declare itself the single payer of health-care costs, effectively creating a State-run health-care system. Welcome to Canada.

Related posts:
Fear of the Free Market — Part I
Fear of the Free Market — Part II
Fear of the Free Market — Part III
Free-Market Healthcare
Where’s Substantive Due Process When You Need It?
The Romney Plan