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Tuesday, July 07, 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?

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 same. 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 COVID 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 the 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 in the United States, a rate of only abut two per day per million. Or is it even this high? 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 Misattribution?

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 deaths, 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 have studies showing that from 20 to 80 TIMES more people have positive Corona antibody tests which are 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 than an order of magnitude greater than reality. It's time to reassess the nature of 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 its 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


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 comorbidities 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 Misattribution remains a mess:

Beating Up the Numbers:

One example of misattribution:

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 misattribution 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

07-07-20 As of today, COVID-19 has killed 538,933 worldwide of which 130,312 are in the United States. This is an interesting ratio in that one would expect outcomes to be above average in America because of better health resources. So why does 5% of the world's population have 24% of the death? Could it be misattribution of cause of death?

Let's back out that 130,312 questionable deaths as bad data and apply the remaining deaths to the population of the rest of the world. This exercise gives us 408,621 deaths for 7,331,462,517 or about 56 deaths per million. Now it's true that misattribution could be understated in the rest of the world as well as overstated in America, but odds are not 4.8 times. Also, infection rates will vary widely, but will tend to average over such a large base. All things equal, the world number is more likely to be more accurate. And if we apply this death rate back to America, it would be 18,480 deaths to date, far less than the stated 130,312 and almost certainly more accurate.

Finally, if we take our more probable infection rate of 10% instead of the 1% case infection rate, our denominator yields an infection fatality rate of 0.06%, about like a bad flu year. This is almost certainly a better assessment than we have gotten from the World Health Organization or the CDC.

What is all the fuss about?

08-31-20 CDC Excess Death Analysis

10-10-20 JP Video on the NEW CDC Infection Fatality Rates per CDC

Flu = 0.1% 
COVID ages 0-19 = 0.00003%
COVID ages 20-49 = 0.0002%
COVID ages 50-69 = 0.005%
COVID ages 70 + = 0.054%
COVID ages 0-19 = 0.00003%

Now where are these extra deaths coming from?

It seems like the source of these deaths is extremely disproportionate with those in assisted living and non-white which would indicate harvesting (pulling deaths forward) and/or racist or unhealthy lifestyles, or simple misattribution. COVID is not a normal virus or we are measuring something else entirely. The race factor could be a function of job loss, suicide, and domestic abuse with the groups hit hardest by the economic downturn because of income which could be the race factor:

Over 100,000 new cases of COVID in the United States in one day, with some states having "positivity rates" of 30 percent. This means that the disease is rippling out through the general population, but strangely enough, extremely few cases are ending in death or even hospitalization as a ratio of the number of cases. Indeed, the number of cases seems to now be completely decoupled from the number of deaths. In other words, cases are going up exponentially, but the number of deaths remains flat at about 1000 per day. This would indicate that the two are not connected at all, and maybe never were. To be generous, death is VERY loosely correlated with contracting COVID. 

This draws attention to those thousand who are dying each day. Are they really dying from COVID? Or is a thousand per day simply the limit of misattribution for a population of this size? In the long run, we will know.

It's past time to admit that COVID is not nearly as deadly as originally feared, not even within an order of magnitude. Maybe not even within two orders of magnitude of published worst-case scenarios. A large part of America has obviously now already had this disease, more than half of which were never even aware of it. Only a very small fraction of those with COVID required hospitalization, and only a much smaller fraction of those died. This fraction was so small that even determining the true cause of death for these relative few was difficult, and often inaccurate. It's time to post analyze all this data and put this disease in its place - a relatively minor threat to the world in 2020.

11-18-20 FINALLY! The general press is picking up on the denominator issue I first posted in the blog in March. Eight months isn't bad. Oh well.

11-20-20 Misattribution? 

It's becoming clear that the key to understanding COVID is teasing apart which cases would normally be minor for COVID but coincidental or in some way enabled by biological changes brought on by COVID that dramatically impact the risk of existing comorbidities in a way that makes COVID a "harvesting" disease. In any case, COVID is not the threat to humanity presented by the media. It may be a weird disease with some even stranger preference for killing the weakest in our culture. Or perhaps COVID is a disease that rarely kills and what we have is just a bad case of mass hysteria and all of those deaths an artifact of misattribution,  over, or mis-treatment brought on by fear. Yes, this is a radical thought, but COVID is a radically different kind of disease and so this idea needs to be seriously considered:

Death of man who fell off ladder ‘ruled as natural, caused by COVID-19′

11-26-20 Could the true number of COVID deaths actually be ZERO? Not surprisingly, this publication was deleted shortly after it was published, but remaining on the Way Back Machine:

11-27-20 Why is science being deleted instead of being challenged based on underlying data?

Total U.S. Deaths in 2019 - 2,854,838

03-08-21 When I first wrote this post, I believe that at the very least we'd get a useful dry run in case a much more deadly disease reaches our shores. Now, nearly a year later I'm far more concerned that our media and government have destroyed their credibility to the point where we may now be far LESS effective at stoping the next pandemic.

Still, no useful denominator, but these numbers are quite similar to the disease itself, demonstrating once again how lethal this disease wasn't. Hopefully, time and more data will enlighten us as to the true nature of this disease.

07-29-21 - Without addressing nor endorsing his general political conclusions, I include Dr. Yeadon's contrast of COVID science compared to government policy is quite useful, especially his view on misattribution, lockdown, and masks:

It appears from the above study that the vaccine does not decrease the probability of transmission because it has only minor improvements in viral load and window of transmission, and even those effects are short-lived.

The above is "fake news" in that there has been no official revision of the number of COVID deaths in Italy, only the admission that only 2.9% of COVID deaths had no comorbidities. Still, when is a COVID death not a COVID death? Why the special treatment of epidemiology of this particular bug?

That's about 0.15 percent per year of excess death assuming no misattribution. That's about 40 times greater than the 6% fatality rate we were warned about. What would the death rate have been without any special measures taken? We should know in time. Were those lives worth the cost in dollars, and deaths of despair? We will likely never know that answer.

01-18-23 In Retrospect