Covid 9/3: Meet the New CDC

post by Zvi · 2020-09-03T13:40:01.019Z · LW · GW · 9 comments

Contents

    Positive Test Counts
    Deaths
    Positive Test Percentages by Region
    Test Counts
    Center For Disease Control Sorta Partially Walks Back Its Opposition To Disease Control
    Centers For Disease Control Advocates Disease Control
    Health Experts Warn of Dangers of Ignoring Health Experts
    Arizona University Kind of Solves Covid-19
  What About Those Reinfection Cases?
  Physical World Does Not Think Six Feet Is a Magic Distance
  Important Things Are More Important
None
9 comments

This week’s news all centers around policy decisions. The new data contains few important surprises, so attention shifts to what actions will be taken and how that will affect the path we follow going forward. The CDC’s fall and transformation into an arm of the White House reelection campaign is now complete. Others continue to come up with, suggest and criticize various policies. 

Before we get to all that, let’s run the numbers.

Positive Test Counts

Date	WEST	MIDWEST	SOUTH	NORTHEAST
July 9-July 15	108395	53229	250072	20276
July 16-July 22	117506	57797	265221	20917
July 23-July 29	110219	67903	240667	26008
July 30-Aug 5	91002	64462	212945	23784
Aug 6-Aug 12	93042	61931	188486	21569
Aug 13-Aug 19	80887	63384	156998	20857
Aug 20-Aug 26	67545	66540	132322	18707
Aug 7-Sep 2	55000	75401	127414	21056

Only the West’s number here is reassuring. The South’s number here is disappointing but reflects a rebound in the number of tests after a steep decline last week. The Midwest situation continues to get worse. The Northeast has some reason to worry, but the increase is mostly explained by increased testing.

Deaths

Date	WEST	MIDWEST	SOUTH	NORTHEAST
June 25-July 1	858	658	1285	818
July 2-July 8	894	559	1503	761
July 9-July 15	1380	539	2278	650
July 16-July 22	1469	674	3106	524
July 23-July 29	1707	700	4443	568
July 30-Aug 5	1831	719	4379	365
Aug 6-Aug 12	1738	663	4554	453
Aug 13-Aug 19	1576	850	4264	422
Aug 20-Aug 26	1503	745	3876	375
Aug 27-Sep 2	1245	759	3631	334

The Midwest number is bad news, the West and Northeast numbers are excellent news. The South’s is an improvement, but less of an improvement than expected, so it counts as bad news. Deaths are on a clear downward trend in general and that should continue for at least several weeks, as the overall situation continues to improve right now. 

Positive Test Percentages by Region

The Covid Tracking Project’s data has a very strange and very negative number of positive tests from Massachusetts this week, which I’ve corrected to a reasonable number. 

Percentages	Northeast	Midwest	South	West
7/16 to 7/22	2.49%	5.13%	13.29%	8.56%
7/23 to 7/29	2.54%	5.51%	12.32%	7.99%
7/30 to 8/5	2.58%	7.26%	12.35%	6.68%
8/6 to 8/13	2.30%	5.67%	14.67%	6.98%
8/13 to 8/20	2.06%	5.62%	9.41%	6.47%
8/20 to 8/26	1.86%	5.78%	9.93%	5.88%
8/27 to 9/2	1.87%	6.37%	9.38%	4.78%

This makes it clear the Midwest is getting worse and not merely testing more, and the West is rapidly improving. The South’s situation remains ambiguous, but looking at the individual states makes it looks like things are indeed improving slowly. 

Test Counts

Date	USA tests	Positive %	NY tests	Positive %	Cumulative Positives
June 25-July 1	4,352,981	7.1%	419,696	1.2%	0.82%
July 2-July 8	4,468,850	8.2%	429,804	1.1%	0.93%
July 9-July 15	5,209,243	8.4%	447,073	1.1%	1.06%
July 16-July 22	5,456,168	8.6%	450,115	1.1%	1.20%
July 17-July 29	5,746,056	7.9%	448,182	1.1%	1.34%
July 30-Aug 5	5,107,739	7.8%	479,613	1.0%	1.46%
Aug 6-Aug 12	5,121,011	7.3%	502,046	0.9%	1.58%
Aug 13-Aug 19	5,293,536	6.2%	543,922	0.8%	1.68%
Aug 20-Aug 26	4,785,056	6.0%	549,232	0.8%	1.77%
Aug 27-Sep 2	5,042,113	5.5%	606,842	0.8%	1.85%

New York’s positive percentage creeped up substantially this week while the test count continued to rise, especially in the last few days. I am definitely worried that something has gone wrong and we are no longer on a slowly but steadily improving path. If things are suddenly getting worse here now, presumably it is a school problem, and that does not at all bode well.

The national picture here however is quite good. Our test numbers creeped back up a bit and the positive percentage fell substantially. (Recorded) hospitalizations are down as well. Yesterday was the first day in a long time they didn’t decline day over day, but for now I’m treating that as a mere blip.

Center For Disease Control Sorta Partially Walks Back Its Opposition To Disease Control

After taking a pounding from all sides for several days, director Robert Redfield (who, alas, probably can’t be played by the newly retired Robert Redford in the inevitable HBO movie version, but I’m hoping he’ll make an exception because come on) ‘clarified’ the new guidelines that led to last week’s headline.

In a statement, Director Robert Redfield said those who come into contact with confirmed or probable COVID-19 patients could be tested themselves, even if they do not show symptoms of the virus.

“Testing is meant to drive actions and achieve specific public health objectives. Everyone who needs a COVID-19 test, can get a test. Everyone who wants a test does not necessarily need a test; the key is to engage the needed public health community in the decision with the appropriate follow-up action,” Redfield said.

So he allows for the possibility that people who come into contact with confirmed cases could be tested, in theory, I mean it’s a thing that happens from time to time. Very generous of him. And it’s great to hear that everyone who “needs” a test can get a test, especially considering the numerous reports that this is not the case for any meaningful value of getting a test, and the fact that this is not the case is the only good reason to revise the guidelines.

So… Do you feel clarified now? 

Me neither. This does not feel like a walk back to me. It feels like they’re doubling down.

Instead, it seems their strategy is to assert control over… evictions? 

I don’t want to get too deep into the economics of this move. I won’t discuss whether it is completely and totally insane, or how much it will permanently drive up rental costs since renting means the government might decide to seize your property outright and pay you nothing in return, while you maintain it under penalty of law at your own expense in the hopes that the government will one day give it back. 

I will instead say that this is completely and utterly unconstitutional and illegal and in no way something the CDC has any authority whatsoever to do. You are the Centers For Disease Control, not the Centers for Rent Control. 

So you know what? Fine. You did it. Congratulations. Burn it to the ground. CDC Delenda Est. 

Centers For Disease Control Advocates Disease Control

This just in: The CDC has also informed states that they should be ready to distribute one of two vaccine candidates by November 1.

Under normal circumstances this would be both the correct action and great news. It would mean that the two vaccine candidates have a substantial probability of being far enough along to be worth deploying soon, potentially heralding a swift end to the pandemic. Given “medical ethics” and the general overwhelming paranoia about deploying a vaccine by all Very Serious People, I have an extremely strong prior that any deployment would be too late rather than too early.

It’s certainly good news, even in these times, that they have the good sense to tell states to get ready to distribute whether or not there is any intent to actually distribute. We should get ready to distribute long before we expect to need distribution. Things will inevitably go wrong and cause delays, which we can address now before those delays cost lives.

Unfortunately on so many levels, these are not normal times. We have the president we have, who is facing a presidential election… on November 3, two days after the target date. That does not in any way feel like a coincidence.

I would be very surprised if this CDC announcement is not being made under, at a bare minimum, extreme pressure from the White House. This was a political decision, and together with other CDC news, it seems safe to respond as if the CDC is completely captured by the White House and is acting under its direct orders to serve the President’s political interests and whims, rather than as a center for the control of disease.

If we take as given that Trump is planning a big October Surprise, I’ll take ‘issues an order to distribute the vaccine early’ over every other alternative I can come up with, except for the possibility that it might actually work and win him the election.

The thing is, he’s right.

He’s not right for the right reasons. He’s not understanding the situation and doing the Bayesian calculus and realizing that early distribution of a known-to-be-safe vaccine is a huge net benefit to America and the world, and we should follow in the footsteps of China and Russia and get on that. Of course not. That’s not how he thinks. 

He will issue the order, if he issues it, because he thinks it will help him get reelected, full stop, without caring about whether it is a good idea.

That doesn’t make him wrong. If you think he’s wrong, as Tyler Cowen says, show your work.

And if and when he does issue that order, if you are Biden, how do you respond?

If Biden says ‘yes, that was the right thing to do’ then obviously it’s a huge Trump win (and also a win for the world, but in context neither side cares about that).

If Biden says ‘no, that’s not a responsible thing to do’ then Trump is the one who is doing the only action that matters to get us out of that, and Biden is the one not doing it because “medical ethics.” 

Thus, it would be a great play even if there were risks that made it a bad idea – it’s not like those risks could be properly communicated to the public. Nor could a lack of such risks be communicated to the public, especially over the objections of the Very Serious People, but also even with their full support. A huge percentage of Americans don’t want the vaccine, sight unseen, even under the best conditions. 

I wonder why the public has such distrust for public health authorities and doesn’t want to inject strange things into their bodies on such authorities’ say so. It’s not like they are constantly lying to us about pretty much everything.    

Health Experts Warn of Dangers of Ignoring Health Experts

What’s new with those vaccines in Russia and China? I can’t find any news on whether they’re working, but we do have news that the Very Serious People are Very Concerned. 

Whenever people who will always have objections object to something, it’s important to remember that you should not expect to update your beliefs in any particular direction. Health experts will warn about the dangers of doing the thing their ‘ethics’ say not to do, with whatever case they think is the strongest, whether or not they have a good case. So when you see them make their case, you should update based on whether their case is stronger or weaker than expected. If they make terrible arguments that are worse than you expect, you should update in favor of there not being good objections.

In this case, it seems there are two concerns.

The first concern is that the vaccine is based on the common cold. Therefore, those who have had the wrong common cold will already have an immune response ready, and the vaccine won’t work on those people. This might reduce how often the vaccine is effective. 

That’s a reasonably good objection. It’s a great objection if you’re choosing what approach to use. As an objection to deploying the vaccine versus doing nothing, though, it’s rather weak. If often the vaccine does nothing, then the calculus on whether the vaccine is a net benefit is unlikely to change much. Every extra immune person helps, and the costs of deployment are trivial relative to that benefit. What you’re looking for is active downsides, not reduced frequency of upside.

The second objection is that a previous HIV vaccine that used some similar characteristics in its delivery ended up making people more vulnerable to HIV, so they warn that this too could make people more vulnerable to HIV.

I know complete and utter BS when I see it. The previous HIV vaccine put people at risk for HIV because it was trying to be an HIV vaccine and messed up. Not because it so generically forked with the immune system that it happened to make HIV worse. This vaccine is trying to be a Covid-19 vaccine. It could plausibly make Covid-19 worse. But if Very Serious People are talking about HIV risk here, it means they have no cards to play. Update accordingly.

Arizona University Kind of Solves Covid-19

Seriously, it kind of did. Check this out.

It turns out, if you actually care about solving the problem, you can test waste water from each building, and then test everyone in the building when the water tests positive, thus catching cases before they have much chance to spread. Do that consistently, using the quick tests that are actually easy and dirt cheap, and it’s over. That doesn’t mean the University of Arizona is in the clear, because no one else is doing it and they therefore have to constantly worry about reintroduction. But if we all followed this procedure? It would all be over in a month.

This has been your periodic reminder of The Kinds of Things a Functional Civilization Would Do.

As opposed to, say, not telling people when a classmate tests positive. 

What About Those Reinfection Cases?

This week’s periodic panic about lack of immunity was unique because it had actual bad news to consider. Normally people don’t need actual bad news, and mumble something about how we can’t be sure how long things will last in order to sound serious. In the past, this has somehow kept happening while there were actual zero reports of reinfections.

Now there are a non-zero number of reports of reinfections, which led to a moderately larger amount of panic and fear mongering. It turns out that its frequency and intensity does respond somewhat to actual news. So how worried should we be about these new reports?

As usual, the news article starts out with the scariest take it’s willing to dish out, with bullet points like “These reinfection cases demonstrate how immunity to the novel coronavirus is somewhat transient, especially with mild infections.” But overall, I’m actually very happy with the lack of mongering going on here from Business Insider, so positive reinforcement to them. 

They get to the right answer here, which is definitely ‘not very worried.’ 

What these cases show is not that immunity is short lived. They show that a very small number of people don’t get complete immunity when they are infected. 

But that is neither surprising nor particularly impactful. A system of containment doesn’t care much about a 1% failure rate given how this virus works. With a total of 6 known cases worldwide and large incentives to find them, there’s no way the number of people who don’t regain full immunity is enough to be worth worrying about. It shouldn’t impact how anyone lives their life at least until after they have symptoms again. And in most of these cases, the secondary infections were mild anyway. 

What this definitely doesn’t mean is that we now have to suddenly worry about immunity fading quickly. In these cases, the second infection happened quickly, often within a month or so. We know for sure that immunity almost always lasts far longer than that. So this isn’t people who got immunity and then lost it, it’s people part of the small group who were never immune in the first place. Which we’d prefer didn’t happen, sure, but isn’t impactful. 

If we suddenly had six new cases, all of which had their first infection in February or March and their second one in August, then I’d be much more worried that five or six months was enough to start to meaningfully degrade immunity. That’s not what we saw, so six months is insufficient to do this. We can assume that for practical purposes immunity lasts a minimum of seven months, and then apply Lindy, and assume that the end of that is where things begin to be a problem. Which should be enough time to get the vaccine online. Excellent.

This was worse immunity news than I expected this week. But overall, does this week make us think immunity is shorter (because we found some reinfection cases) or longer (because almost everyone stayed immune one more week)? I don’t think that is clear.

Physical World Does Not Think Six Feet Is a Magic Distance

People claiming with presumably straight faces to be ‘researchers’ used that authority to get into the paper that perhaps the six foot rule could use a bit of nuance. That it matters how long you’re there for, indoors or outdoors, poorly or well ventilated, silent versus spoken versus shouting or singing, dense versus sparse crowd. If I had to choose three additional considerations when measuring risk and deciding how far to keep away and whether to require masks, then those are probably the correct variables to consider. And all their directional assessments seem right. So, good job, I guess. As far as it goes.

If it makes people actually think about their physical situations a bit and optimize somewhat, that would be great. Hopefully the nuance is net helpful. 

If you want a lot of nuance on what to be doing and how to measure risk, the microCOVID project is one option. I had the chance to comment on their document and models a bit. They didn’t take every suggestion I made, but they are definitely trying to come up with reasonable answers and provide practical help. If that seems interesting or valuable, check it out for another opinion. 

A note for those who try the microCOVID project is that their basic system of ‘use a budget to allocate risk’ originates in the need to find a policy that roommates can all live with and follow, without anyone feeling cheated or causing anything too perverse. If you have different binding constraints, different strategies will make sense for you.

Important Things Are More Important

Periodically we see outrage like this about the hypocrisy of letting Very Important People like celebrities or the rich get away with doing things that the rest of us are told not to do. It seems that while mostly not allowing concerts, New York allowed the Video Music Awards to completely break a lot of the rules. 

Good. 

If anything, the report shows a decided shortage of such hypocrisy. The event had to be spread out throughout the city, extensive precautions were taken for spots that lasted only a few minutes. I am guessing that everyone involved was tested in advance, probably multiple times. And that was then shown to millions of people. Not my thing, but the same way that sports must go on, other things that bring joy to millions in exchange for the exposure of dozens or hundreds is obviously a trade-off that we want to make.

People are so against doing things that make sense, and so unwilling to deal with ‘hypocrisy’ or ‘inequality’ that they think that you not being allowed to have a private dance party means the VMAs should stop. That we shouldn’t look at the value of an activity in dollars or happiness, and compare it to the risks involved, when deciding what to do, to maybe help make this lockdown liveable for all and helping the economy survive. 

Or that we shouldn’t give extraordinary flexibility to those willing to take extraordinary precautions. If you have the time and money to test everyone and make something safe, I don’t care if it otherwise violates guidelines.

The key is that this needs consensus that the exception is a reasonable exception. That it involves minimal risk given the benefits involved, that precautions were taken, that it is an efficient allocation of risk with a solid story attached. Otherwise, even if it’s a good idea, it decays people’s willingness to follow the rules.

I would hope that the ‘it’s being broadcast to millions of people who want to see it’ rule together with the ‘it’s worth enough to spend what it takes to get everyone tested beforehand and take all the precautions’ rule would cover the right times to make an exception pretty well. 

If both of those apply, do it. If they don’t both apply, respect the rules.

Or, if there’s something you think is too important and has to be done anyway, understand that not doing so will undermine the rules themselves and decide whether it is worth it.

Contrast this with, say, Nancy Pelosi going to a hair salon and not taking precautions. There is zero excuse for that. The outrage is completely justified.

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