... seeking simple answers to complex problems, and in the process, disrupting the status quo in technology, art and neuroscience.

Tuesday, March 31, 2020

Covid-19 - the Zendemic Wrapped in Toilet Paper

Here's a radical idea. I want it in the public record as of March 14th, 2020.

What if Covid-19 is actually not as deadly as it seems?

What if we're undercounting the actual cases, and over attributing the deaths caused by it?

OK, let me put that a little differently. What if Covid-19 on its own only rarely causes death? I'm deadly serious. What if Covid-19 is actually a relatively mild biological challenge to a normal healthy human, similar to its cousin the common cold. OK, maybe a cold that kills some people. But would the numbers of diagnosed cases of Covid-19, and the deaths "caused" by it, look any different than they do now?

As obvious evidence, why such inconsistent numbers from country to country? The disease is the common element. The variance must reflect standards for data capture or perhaps the demographics or lifestyle of the patients. Let's address data first.

When and why does a case become a case? While we're questioning, where are the useful comparative data? Out of a thousand people without confounding issues, how many will die per age group? And why do we have no random sample control groups to track overall transmission rates and deaths instead of guessing about the denominator? This denominator problem is best understood by the difference in the death rate between China (9.9%) and Korea (0.7%). Korea did more testing and so have a more useful denominator. Another way of looking at it is that China only tested those who already had a serious case. They didn't bother to test mild cases. This lack of testing is happening in the U.S. as well. At least so far. I realize there's a priority for tests being used to track individual contact and transmission, but a baseline of periodically sampled control groups would be of great value in learning how the disease is evolving in a given population.

Now for lifestyle and demographics. What is the general health of the population? Compare Italy (7.9%) and Germany (0.3%) percent. Are Germans that much healthier than the Italians? Or is this also confounded by denominator issue in Italy? We'll know in the long term.

Also, why does China now have so few new cases and deaths? Were they THAT good at stopping transmission? It's hard to believe China effectively isolated a hundred thousand from the other 1.4 billion. And did it without exception. If this disease is so contagious, China should be keeping its early lead in both cases and death. They obviously aren't. Or else they aren't reporting it.

Which brings us to this problem with the skewing of the death demographic (65 plus years old, immuno-challenged, etc.). This demographic is extraordinary for a deadly disease. But perhaps not for an ordinary cold. It's clear that most of the deaths are those over 65 years old, but what percent of 65 and older that contract Covid-19 die? Also, there is that lack of dying children. Why?

Normally, about 150,000 people die around the world each day. That's about 20 people per day per million. The most convincing data will be when deaths exceed 20 people per day, per million. So far, Covid-19 has only added another 633 people per day. Or has it? How many of those 633 would have died from other causes within 24 hours? It seems that Covid-19 might be taking the blame for a normal death rate in a typical winter. Or at the very least, taking the blame for far more death than it deserves.

With nearly eight billion people, at any given moment there are thousands of people in the world on the edge of death. Sad but true. A simple cold or flu can push some of them over that edge. What then is the cause of that death? Their pre-existing condition? Or the most recently diagnosed cold or flu? What if this Covid-19 event is largely an attribution artifact? What if they simply die a bit earlier of additional Covid-19 biological stress. Which disease or chronic condition should get the credit?

If we didn't know that the Covid-19 virus existed, would these deaths be blamed on other causes? Would they even be seen as abnormal? Is Covid-19 simply an artifact of an improved technical ability to measure a new disease? And to publish the results in the media instantly?

Then there is the toilet paper thing. If you haven't realized it yet, there is no "real" shortage of toilet paper, just people hoarding it. It's a self-fulfilling prophecy. This happened once in the 1970s. I remember it well. The same thing happened with gasoline at about the same time. Here's why it matters. 

A run on TP is similar to a run on medical services. If you hear that there is a new disease, you might be just a bit more likely to go to the hospital and get tested. When the result is positive - boom - they isolate you and fill up a bed. Soon someone else comes in with a positive test and our hypersensitive medical system responds. Even a small shift in demand can overwhelm this medical system. Soon the hospital's full and there's an "epidemic". Hyper-analysis of this epidemic will find a correlation with whatever version of cold or flu that happens to have emerged during the season. In this case, that disease might be Covid-19. And the media runs with it. Panic ensues.

Is Covid-19 the first actual media disease not unlike this run on toilet paper?

If so, this Zendemic will resolve quickly, no more than a few weeks. Otherwise, deaths will exceed the typical 150,000 per day for months on end. So far it hasn't, but we will know soon.

Habeas corpus.

03-18-20 The picture is becoming more clear.

03-25-20 What is coronavirus – and what is the mortality rate?

The above article finally addresses some of the questions I presented above. Well, sort of. For instance, I noted and questioned, "It's clear that most of the deaths are those over 65 years old, but what percent of 65 and older that contract Covid-19 die?"

Though I didn't use 80 years old to define my question, that age nicely frames the issue and makes my point. I might have said 90 percent of those that die are over 80 years old, but what percent of 80 and older that contract Covid-19 die?

Their answer - 10%.

So if Covid-19 could be exposed to all 80-year-olds (which is impossible), how many would die? Google says three million. Normally about 300,000 will die each year (linear rate). That is a useful baseline, and also the estimate The Guardian makes for Covid-19. Which was my original point. Of course, the final count could be greater, but not by orders of magnitude, and likely well under 50 percent greater.

So the question becomes, how much do we economically impact eight billion people for any excess death over 300,000?

Actually, I think this has been a good test run for a bug ten or a thousand times worse that may occur next year. Or the year after that. But not yet. Covid-19 is not the black plague. Not even close.

03-27-20 I posted the following to a friend's Facebook feed:

Justin is correct. The numbers of deaths in America so far attributed to Covid-19 are so low they get lost in the noise of the typical death rate caused by respiratory failure which is around 500 per day in America, or 1.5 deaths per day per million. But that's just the view from the top and ignores the denominator problem - how many died per day per what size population? Even though this Covid-19 has been declared a pandemic, it remains epicentric, meaning most of the deaths occur in hot spots like Wuhan, Milan and New York. What is the size of each of those exposed populations? We don't have good numbers yet, but we can use China as an example. As shown there, the ultimate impact will be far less than the media currently suggests. So far, the sky is not actually falling, and is unlikely to do so.

03-29-20 another Facebook comment:

Bruce, over 6000 people in America die every DAY for one reason or another. That's 180,000 in the month or so that we've been keeping count of Covid-19. Now, many of those deaths are from accidents, etc. but a large number are from chronic conditions, many of which, are conflated with Corvid-19 because that is the current proximate cause of death. In only a few of your 2043 cases is Covid-19 the clear and direct cause of death. In 2009 hundreds of thousands died from swine flu. Or did they? Like Covid-19, many of those deaths had respiratory and other comorbid factors as well. Yes, it's sad, but the reality is, various diseases ripple through our population each winter bringing early death to hundreds of thousands that might have lived a few more days, weeks or months. Only a small minority would live for years longer. I'm not suggesting that Covid19 isn't deadly and we of course should try to avoid its spread, or at least slow it down. I think this exercise is good practice for when we get a really bad bug like Ebola, but let's try to keep these numbers (and causes of death) in context. So far this is no worse than a bad flu, and if China, South Korea, and Germany are useful examples, it will end about the same way within a few weeks. "If you can keep your head when all about you are losing theirs...yours is the Earth and everything that's in it..." Rudyard Kipling.

Sunday, March 29, 2020

Defy Aging - Keep Moving and Stay Hungry

First posted on my sixtieth (or is that fortieth?) birthday, 01-29-12. Updated periodically:

60 is the new 40. 50 is the new 30. I've even seen a proclamation that 80 is the new 30!

Such declarations about this new "age" can be seen everywhere. Are they simply age denial? Do baby-boomers refuse to grow old? And is this denial just a way to lie about our age? Will lying to ourselves help us live longer? Maybe.

There's been lots of interesting research about the placebo effect in all its forms. What's interesting is, placebos seem to work even when the patient KNOWS it's a placebo. And how is lying about your age different from giving yourselves a placebo?

Unfortunately, the placebo effect will not solve everything. There are still some hard facts in this new age of aging. Since the Kellogg brothers made health a popular topic at the beginning of the last century, thousands of treatments have been tried in an attempt to stay younger. Most have been proven to be worthless, but a few obviously make a difference:

"Today, the average age for someone moving into a nursing home is 81. In the 1950s, it was 65."

"People are living 34 years longer than their great-grandfathers."

"The number of people in the world over 100 years old is now approaching half a million."

The internet is full of such dramatic results, so how does one gain the benefit?  A few simple things make most of the difference.

Avoiding tobacco and limiting solar exposure is good for the skin.  The guy to the left was a life-long truck driver.  He's obviously not British. Tobacco has a similar effect but to all of your skin.

Appearance aside, the most important factors in staying young are still diet and exercise, so keep moving and stay hungry.

Keep Moving

Whether you are overweight, have chronic pain, arthritis, dementia, depression, diabetes, anxiety or fatigue there is one piece of advice that will improve your quality and length of life - "Keep Moving". What's surprising is how this advice not only affects the physical but also your mental health.

ANY physical activity that keeps you moving for at least 30 minutes a day, EVERY day will make a huge difference. That "every day" is the hard part. Success starts with finding something you enjoy. It can be yoga, swimming or walking.  Start slowly and work your way up. Even if it takes a year to do 2 miles a day, after that you've gained 80% of the benefit of exercising in general. The second, fifth and seventeenth years are much easier.  The best exercise is the one that you DO, so it's probably the one you enjoy most.  Find your favorite way to move.

Here is the best summary I've found on the topic, graphically presented.  If you do nothing else about your health this year, at least spend nine minutes watching this video.  It may add years to your life:

23 and 1/2 Hours : What is the Single Best Thing You Can Do For Your Health?

“You don’t deteriorate from age, you age from deterioration.” - Joe Weider 

Stay Hungry

The meaning is obvious. The trick is to not stay too hungry. Just like the exercise part, if you take it to the point of pain you're more likely to return to your old lifestyle. On the other hand, if you eat only what you need, you'll not only stay lean and healthy, you'll enjoy life more.

Have you noticed how much better food taste when you're hungry? Well, at least the first few hundred calories. This is an important hint. When the meal becomes less compelling, stop eating. I know it's easier to say than do for a number of reasons. But if you eat just 100 calories less than you burn each day, you'll lose 12 pounds a year - that's hard science, and it's major progress. Still, it's easier said than done.

The trick is finding how many calories you really NEED. It's probably a lot less than you think. That's because we're used to eating about twice as much as we require. Food is everywhere you turn. There's now even a snack bar at our local DMV. People seem to eat every hour or two. And they eat more than they did a hundred years ago. There's just too much food in our cage. Fortunately, our body is smart enough to send most of those extra calories right down the toilet. But not all of them. Over time, even a few extra calories a day will add to your waistline.

You can use an internet calculator to find how many calories you need per day. You can tell if the number's right by how hungry you are at the end of the day:

Calorie Calculator

Once you know this number, slowly decrease intake until you find that edge between hunger and health. This should become your average consumption target. Avoid grazing. Eat at appointed times, and only planned amounts. Take some of that food out of your virtual cage. And as you decrease volume, increase variety. That's the key to good nutrition.

Another trick is micro-fasting. If you know you'll be having a large dinner, skip lunch. Sure, you'll be hungrier than usual and probably eat a bit more at dinner, but you're already a few hundred calories under your target. Just don't stuff yourself. Keep your AVERAGE consumption just below your need. Take your time losing those extra pounds.

"Staying hungry" will also improve the quality of experience for your other appetites. From sex to alcohol, to Netflix, less can be more if you hone your appetite with a bit of moderation. Find the "sweet spot" and stay hungry in all respects.

Live Longer

If it's that simple, why are only a few truly healthy? It's obvious not everyone is gaining these extra years. Not surprisingly, access to excess noted above and electric grocery carts are the reasons. The majority of people today are actually shortening their lives with calories and the couch. Many are now dying younger than they would have a hundred years ago because of this default lifestyle. And more will follow them into the grave shortly.  Just look around.

Our society has become bifurcated where most people (of all ages) default into less activity and consume more calories. A minority eat less and lead more active lives. What's truly amazing is that this minority is still able to skew the average lifespan upward, while the bulk of America is killing themselves early. That's why a healthy lifestyle may extend one's life even more than the averages indicate. If you live well, your chronological age may not matter as much as you think.

Misrepresenting your age may be a lie, but it's a lie worth living.

"Count your age by friends, not years. Count your life by smiles, not tears." - John Lennon

Even more data:

Consistent with the social bifurcation of watching diet and exercise:

05-08-17 Life expectancy gap between rich and poor US regions is 'more than 20 years'

04-17-13 Here is a demonstrative meta-study of the effects of 50 calorie reduction per day for an entire country! Now if we could just learn to do that as individuals:

The Cuban diet: eat less, exercise more - and preventable deaths are halved

Another example in progress:

02-22-18 Venezuelans report big weight losses in 2017 as hunger hits

06-10-13 Cause or effect?  Fast walkers stay ahead of the game

01-15-15 More data:

Daily walk adds years to your life: Just 20 minutes a day is enough

04-21-15 Or is an hour a day the sweet spot?

The Right Dose of Exercise for a Longer Life

01-20-16 Here's an interesting idea that fits in with the work I've been doing on neuroscience and behavior:

The Hunger Mood

04-09-17 Interesting meta-collection: Peaking

06-08-17 Longevity Illustrator