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Thursday, June 25, 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.



The test described below may well be the turning point in this biological mystery. Sure, the Abbott ID NOW test is quick and simple. It will be used a lot, but more importantly and for the first time, there will be the ability to do large random sample testing over various large populations. This should solve the "denominator" problem. With that information at hand, analysis and local triage and isolation become manageable. The rest is just implementation. Check it out:

Why Abbott's 5-minute COVID test could be a game-changer

04-03-20  Corona WorldOMeter

Look carefully at the curves for each country (or even the world as a whole). These curves are not geometric (becoming ever steeper). Instead, they are flattening. These are pretty typical two-dimensional propagation curves. They are like a forest fire that only burns the weaker trees. This bug is harvesting those with significant comorbid factors in their health.

Yes, some are dying weeks or months before they might have, but most would have died sometime this year. COVID-19 will ultimately kill about the same number as the flu does each year, and in many cases, the very same people. Their death will just be attributed to a different disease. This event is more about a panicked media than a biological challenge. Callous? Of course. But with increasing reports of bankruptcies, domestic abuse, murder, and suicide, there is serious doubt about this disease being worse than the cure. Still, it's a useful dress rehearsal for a much worse bug in the future, and much good will ultimately come from this event.

04-06-20 Fever Map Indicates Dramatic Drop in Temperature

Kinsa Source Health Map

After working with this map for a while I've jumped to the conclusion that this may be the most useful data so far about this whole COVID-19 issue. OK, temperature spikes do not equal COVID-19, but when these spikes correlate to jurisdictions with spiking COVID-19 cases and deaths, probability shifts dramatically in the favor that these temperature spikes ARE caused by COVID-19. If this is true then we should see not just a flattening of the curve, but a dramatic drop in new cases within days, or at most a very few weeks.

How COVID-19 affects humans

04-07-20 It appears in the graph below that about 200 deaths per day in the U.S. may have been misattributed to COVID-19 instead of all other causes of pneumonia. Of course, this is only one of the many comorbidity factors widely associated with this pandemic. If the other factors are added in, it might account for most of the current 1400 deaths per day, except for the geographical distribution of the dead. They are not evenly distributed across the population. They are epicentric in nature, especially in NY and NJ. Yes, there is misattribution but it likely only accounts for a fraction of the cases. The rest must be from the direct biological impact of COVID-19. It IS a real disease. We just don't yet have it well characterized.

04-09-20 Misatribution?

04-13-20 Shit may be the breakthrough we need to solve the denominator problem. Not familiar with the issue? The Worldmeter currently says we have 1,872,825 cases of Coronavirus which has caused 116,037 deaths worldwide. That's a death rate of over six percent, which is patently absurd. If this disease is really killing six percent of those who contract it, it is three times worse than the Spanish Flu, and that's simply not the case. There must be FAR more cases than have been documented. That would change the denominator in the death rate. This work with sewer sludge may ironically clarify our understanding. Next, we need to take on the misattribution issue, and the real scale of the Corona threat will come into focus:

New research examines wastewater to detect community spread of Covid-19

OK, I want to be clear. Corona IS a deadly disease, but only by degrees, and with extremely disproportionate targets. Here is a subgroup I just read about. It is rest home in New Jersey with about 700 rooms which means they have a staff of about 70 per industry average. At this home, 70 residents and two nurses died with a positive Corona test. That sample is consistent with the Diamond Princess - 700 tested positive and 10 dies, many of them were older passengers. In both cases, 10% of the elderly and 2% of the younger (but perhaps not completely healthy) died. This data is a place to start.

04-19-20 A New Statistic Reveals Why America’s COVID-19 Numbers Are Flat

"According to the Tracking Project’s figures, nearly one in five people who get tested for the coronavirus in the United States is found to have it. In other words, the country has what is called a “test-positivity rate” of nearly 20 percent."
This is the first decent "denominator" data I've seen so far. If this 20% number is correct, then Corona with currently 39,000 deaths in the United States has a death rate of 0.06 percent, which is less deadly than the typical flu. Then you have the issue of the under counting because of lack of tests, and the misattribution issue which would effectively over count the dead. All of this new data seems to be homing in on my original assertion that Corona is not nearly as deadly as the media has presented.

04-21-20 Both Santa Clara and Los Angeles counties now of studies showing that from 20 to 80 TIMES more people have positive Corona antibody tests which is consistent with the "Tracking Project" above. Again, this would mean Corona's CFR is comparable to a typical flu. Where are the numbers from the rest of the country? And why is this topic not being addressed in the daily briefing?

Hundreds Of Thousands In LA Infected With Coronavirus: Study

04-23-20 Governor Cuomo just announced that 21% of New York city has a positive antibody test for Corona, yet does not acknowledge what this means for the CFR. Our government has been grossly negligent in managing this "pandemic" and its metrics.

04-26-20 Santa Clara, Los Angles, New York, and Miami are all reporting positive antibody tests many TIMES in excess of reported diagnosed cases. Actually more that an order of magnitude greater than reality. It's time to reassess the nature or Corona.

Miami Joins the Crowd

I won't bother with the bug's official name, COVID-19 anymore. This disease has had so much world wide impact that it will forever be known as the Corona panic. Or perhaps ultimately known as a the media disease instead of a biological one. Like the disease itself, the published perception has been FAR worse than the reality - somewhere between one and two orders of magnitude. Even if this media impact was mostly not deadly (suicide and murder stats will likely show an increase), the financial costs will be enormous, perhaps incalculable.

As for the disease itself, if these antibody test are ultimately validated, and as I originally suggested at the beginning of this post, Corona will not be remembered as a deadly disease, at least not in the same terms as Ebola or HIV, and certainly not on the scale originally feared. It will take years to sort out the misattribution to even discover Corona's true death rate.

Also, the cost of the "cure" will far exceed the social impact of the relatively modest number of dead. In terms of death rate, Corona will likely fall somewhere between an average flu and perhaps, the swine flu, but in it's ability to spread, it will be closer to the common cold which is far greater than the flu.

I will let others with far more knowledge present the details, but it's safe to say that our media and government response to Corona can not be rationalized nor supported when Corona is ultimately compared to the Flu and our historical response to that and other diseases. Still, this panic response has been quite informing and an interesting exercise, even though VERY expensive.


05-04-20 Here's another useful approach to understanding the true impact of Corona:

Excess Deaths Associated with COVID-19


05-05-20

Here's a very quick summary. Corona is both a deadly disease and a common cold, each by degrees, and dependent upon conditions once two issues are defined - the denominator problem and misattritubtion of the causes of death, both over and under stated for various reasons.

So far it appears that somewhere between two and twenty percent of America has antibodies for this disease. A good guess might be about 30 million Americans have already contracted and survived this disease. And that's its most important metric. It means this disease is not very deadly, perhaps not much worse than a bad case of the flu. Characterizing it's mild cases should be relatively easy. Understanding how it kills could be much more difficult as most of those deaths are mired in comorbities and teasing apart cause from correlation will be difficult. With 30% of the deaths occurring in rest homes, Corona will soon be largely managed as another disease of the elderly, while most of the world gets back to work.

The important question is, how much deeper than 10% will this disease penetrate the U.S. population? And how many more will die before this immune base begins to impact the transmission rate?

05-26-20 Misatribution remains a mess:

Beating Up the Numbers:

One example of misatribution:



06-01-20 It will take a while until we learn the truth of Corona but there are a few conclusions that can be drawn now:

Likely beginning in late 2019 Americans began transmitting COVID-19 without even knowing it.

By June 1st, 2020, between two to twenty percent of those living in large U.S. cities have contracted and recovered from Corona without ever knowing it. Somewhat less than one percent had symptoms acute enough to be tested. Approximately three hundredths of this one percent died with a positive COVID-19 test. Some of these deaths were certainly caused by this deadly disease. Many others were not. There has been gross misattribution of the proximate cause of death in both directions. I believe that ultimately, COVID-19 will be seen to have been less lethal than the average flu. Only our response has been exceptional, and perhaps a good simulation for the real thing.

Corona is now mostly a political issue.

06-20-20 Daily COVID-19 Deaths in the U.S. Have Fallen Dramatically Since April

06-22-20 Stanford prof: Median infection fatality rate of coronavirus for those under 70 is just 0.04%

06-24-20 Transmission of disease - Erin Bromage

Erin does not really deal with misatribution which would have a dramatic effect on mortality rates, but there is much good basic information here:

06-25-20 Where Are We Now? - Erin Bromage