Covid 10/1: The Long Haul

post by Zvi · 2020-10-01T18:00:00.848Z · LW · GW · 22 comments

Contents

  Positive Test Counts
  Deaths
  Positive Tests By Region
  Test Counts
  I Herd Some People Had Immunity and Then Lost It, Or Never Got It To Begin With After Being Infected, Except With No Actual Examples
  Obvious Nonsense Paper of the Week
  Florida Says Yolo
  Going Down to Denver, Going To Have Ourselves a Time
  In Other News
  The Long Haul
None
22 comments

If you were watching the so-called ‘presidential debate’ on Tuesday night, first off, you have my sympathies. It was the day after the Day of Atonement. If you watched, no matter what wrongs you may have committed this past year, and no matter who you intend to vote for, no one can deny that you have atoned. Your slate is clean.

Alas, the country is not so lucky. Getting away clean is not a near-term prospect on any level. 

What did we learn from the Covid-19 portion of the debate?

Very little. The focus was on Biden blaming Trump for things being terrible, and Trump saying things are great and blaming Biden claiming that with Biden in charge things would have been worse. No one said anything about any of the real issues except for masks. On masks, Trump decided to dispute that there was agreement on masks, to point out that people changed their mind about masks, and so on, in case his supporters were in danger of protecting themselves or others by wearing one. 

Biden’s criticisms of Trump left out most of the worst things Trump did regarding Covid-19. Biden’s plans, as stated, didn’t provide the help we need to solve Covid-19. Mostly, what we learned is what we already knew. Biden has little interest in talking about the ways to actually solve the problem, and mostly does correct symbolic actions like supporting PPE or small business or wearing masks while blaming Trump for not doing so. Whereas Trump actively gets in the way of solving the problem and lies about, well, basically everything. Not where one hopes the choices to be, but hopefully an easy choice nonetheless.

Biden repeated in the debate the general expectation that another wave of infections and deaths is coming Real Soon Now, and that deaths may double over the next few months, as the rate goes up by a factor of five or more. That’s the new Very Serious Person position. 

Along with the old Very Serious Person position that herd immunity is of course ending Real Soon Now, probably last week. 

Do we see any signs of any of that? Is it justified?

Let’s run the numbers.

Positive Test Counts

DateWESTMIDWESTSOUTHNORTHEAST
Aug 6-Aug 12930426193118848621569
Aug 13-Aug 19808876338415699820857
Aug 20-Aug 26675456654013232218707
Aug 7-Sep 2550007540112741421056
Sep 3-Sep 9472737243910640821926
Sep 10-Sep 16450507526411581223755
Sep 17-Sep 23540258538112773223342
Sep 24-Sep 30554969293210630027214

The Midwest and Northeast numbers are very troubling, as things are clearly headed in the wrong direction. The West is treading water, and the South looks excellent. Test counts are slightly up overall.

Deaths

DateWESTMIDWESTSOUTHNORTHEAST
July 23-July 2917077004443568
July 30-Aug 518317194379365
Aug 6-Aug 1217386634554453
Aug 13-Aug 1915768504264422
Aug 20-Aug 2615037453876375
Aug 27-Sep 212457593631334
Sep 3-Sep 911417712717329
Sep 10-Sep 1611599543199373
Sep 17-Sep 2310168932695399
Sep 24-Sep 309349902619360

More signs that things in the Midwest continue to get worse, but the West and South continue to recover. The Northeast doesn’t look bad either. In total, it’s the best combined number in a long time.

Positive Tests By Region

PercentagesNortheastMidwestSouthWest
7/30 to 8/52.58%7.26%12.35%6.68%
8/6 to 8/132.30%5.67%14.67%6.98%
8/13 to 8/202.06%5.62%9.41%6.47%
8/20 to 8/261.86%5.78%9.93%5.88%
8/27 to 9/21.87%6.37%9.38%4.78%
9/3 to 9/91.97%6.02%8.48%4.13%
9/10 to 9/162.41%5.99%11.35%4.49%
9/17 to 9/232.20%5.96%7.13%4.11%
9/24 to 9/302.60%6.17%6.18%4.27%

Trouble slowly brewing across the Northeast. The South continues to improve.

Test Counts

DateUSA testsPositive %NY testsPositive %Cumulative Positives
July 30-Aug 55,107,7397.8%484,2451.0%1.46%
Aug 6-Aug 125,121,0117.3%506,5240.9%1.58%
Aug 13-Aug 195,293,5366.2%548,4210.8%1.68%
Aug 20-Aug 264,785,0566.0%553,3690.7%1.77%
Aug 27-Sep 25,042,1135.5%611,7210.8%1.85%
Sep 3-Sep 94,850,2535.3%552,6240.9%1.93%
Sep 10-Sep 164,632,0055.8%559,4630.9%2.01%
Sep 17-Sep 235,719,3275.2%610,8020.9%2.10%
Sep 24-Sep 305,857,0975.1%618,3781.1%2.19%

New York is in (medium term, slow moving) trouble. From what I’ve seen, a lot of it is concentrated on areas of Brooklyn and Queens, especially Orthodox Jewish areas that ignored rules during the high holidays, but it’s a big enough effect and trend that the problem is clearly widespread. Things are in no way out of control, but trends continue to be negative and if anything things are opening up more, so until the control systems set in locally, things will get worse.

Nationwide, however, we have a record number of tests, with the lowest positive rate since mid-June. We have the lowest weekly death count since mid-July. 

There’s no sign things are about to clear up. But there’s also no sign of this huge impending disaster the media are once again warning us about.

Yet they continue to do this. Why? 

Some of it is that testing went down then increased again and they’re calling that ‘rising case counts’ again because yes we really are this stupid and dysfunctional. 

You can call Donald Trump and various others whatever you like for suppressing testing in order to make the numbers look better, but the only way to stop such tactics is to stop being fooled by them time after time. I am not optimistic.

The headline from CNN linked above (here it is again) tells us to be alarmed that 21 states have rising case numbers, while testing increases, and doesn’t think we can understand that 21 is less than half of 50.

The other half is that models and those what like to be Very Serious People are making two assumptions to force this pending wave to happen.

They assume that Winter Is Coming means things get worse. And they continue to warn about immunity in all ways.

We need to push back and not leave this to the White House. They’re kind of busy, and rather short of credibility. Atlas disputes Redfield coronavirus vulnerability estimate: ‘We are not all susceptible to infection’ is the White House directly calling out the CDC, and in this case being entirely correct. The idea that everyone who doesn’t test positive for antibodies is ‘susceptible to infection’ is obvious nonsense designed to twist the data into knots and scare people. Unacceptable. Yes, the source in question often lies its ass off in other ways. That only makes this all that much harder.

I Herd Some People Had Immunity and Then Lost It, Or Never Got It To Begin With After Being Infected, Except With No Actual Examples

Alas, an ongoing series. Lots of speculation this week.

Marginal Revolution links to a study pointing out what we already know, that most coronaviruses do not create lifelong immunity. 

Another data point I heard a few people point to is that a previously hard-hit NYC neighborhood is being hit again. Similar data points are cited for European cities and such. 

Thus, the Very Serious Person consensus seems to be that immunity is fading and reinfections are happening all over the place as we speak. They just… can’t find examples of actual people that got reinfected, despite such a story containing a large number of people being an obvious way to get tons of clicks and head the national news, and also scare everyone in a way that such people think is good.

What we know is, it is now October. Lots of people were infected in March, if not sooner. Almost no one is known to have been infected in March, then in September, or anything like that. Which is what you would see, if immunity was fading.

Similarly, we continue to see people equate positive antibody tests with immunity, despite it being rather clear that this is only one of several means of immunity. The immune system has a lot of tools at its disposal, and all that.

So once again, until we see lots of reinfections of particular people, all we know each day is it is another day before serious reinfection chances occur, and our expectation for immunity length goes up by just under two days because of the Lindy rule – however long it has lasted so far, it probably will continue to last on average about that long, then slowly fade, is a reasonable prior for the mean result. 

How do we explain the data we do see?

Obvious Nonsense Paper of the Week

On a related and but different note is this paper that came up this week: Evolution of COVID-19 cases in selected low- and middle-income countries: past the herd immunity peak? 

It’s a textbook example of how deeply the SEIR folly goes. The paper looks at a curve of infections, assumes that everyone is always identical in every way within the country, then uses that to figure out how many people must have been infected in order to cause the reduction in infections! That this proves most people were infected! Then based on that, they point out how low the infection fatality rate was! 

Seriously, this is what passes for serious modeling these days. This got into the news cycle.

The estimated base reproduction numbers, the R0 are estimated as no more than 2. Based on that and the curve, they then claim that this means 50%-80% of people must have been infected. The ‘detection rate’ for infections is then surmised to go from a high of 5% in South Africa, to a low of 0.2% in Kenya. Not death rate, detection rate.

Such utterly obvious nonsense.

The numbers are so utterly crazy. 

Florida Says Yolo

Florida’s Governor has had enough. No more restrictions on businesses. No enforcement of mask mandates by cities. It’s time, he’s saying, to let private individuals make their own choices, and whatever happens happens. His ‘health experts’ agree with this, because if you want to find an expert who agrees with a given position, or at least is willing to say they agree, you can almost always find that expert.

The usual scolds and Very Serious People are out in force about how awful this is and that everyone in Florida should once again prepare to die. Things are bad after all that locking down, the Very Serious People say. Surely you can’t stop locking down now!

The Governor is closer to correct than the Very Serious People.

What is the alternative proposal? To continue to put our lives on hold and our economy into shambles until we finish the vaccinations? 

How long a lock down before it’s better to just get the damn virus already and take your chances, if your risk isn’t that high?

Lethality is down. Hospitals being overwhelmed is highly unlikely to happen, given what happened in the previous wave. We now know how to manage our risk if we want to do so, and can make informed choices. Make trade-offs. It’s time to let people decide what they want to do, and live their lives. It’s not like everyone is going to suddenly go back to normal. Some people will choose to do that. Others won’t. We’ve been over this many times.

There are two counter-arguments. 

One is that the vaccine is coming Real Soon Now, but those same Very Serious People are saying that the vaccine is at least months away plus more months for deployment. If that’s true, then that’s too long for many people, who can make a rational choice not to wait. For those who do want to wait, it’s a reasonable amount of time to deal with a higher outside risk level.

The other is the externality argument at the heart of it all. You taking on risk puts me at risk.

The basic response I have here is that no, it doesn’t, not in a meaningful way. Not anymore, beyond the specific people you choose to have close contact with. 

That’s because there’s a solid range of risk levels, where risk is too high to allow for activities that involve substantial exposure, but not so high as to make it impossible to protect yourself (e.g. it’s not so dense that you’re worried about things like the Manhattan air having persistent miasma.) 

If we had a practical path to getting below that range and sustaining that process, great, that would be worth paying a big price to do. We don’t. This virus isn’t going away short of a vaccine, period.

If we were in danger of rising above that range, or going so high we’d break the medical system, we’d have to think carefully about what we want to do to prevent that. But those days are over. We ran the experiments. The herd immunity we have plus the control systems in place won’t let it get to that point. 

That doesn’t mean this is a zero cost. It most certainly is not. But banning things doesn’t seem reasonable.

I do think that forcibly removing municipal mask bans is still doubleplus ungood, but businesses are still free to require them, and if enough people stay away from those businesses that don’t require them, that is what will mostly happen. It’s bad, but less of a big deal than it sounds like it is.

The big mistake is indoor dining. Indoor dining is a terrible cost-benefit ratio. It’s one of the most dangerous things you can do. The experience is nice, but it’s in no way vital. The reason indoor dining is happening is because without it, the bars and restaurants would die, with long term consequences.

Going forward, of course, if things get bad in Florida they’ll blame it on this, even if things are equally bad elsewhere. If things don’t get bad, they’ll still blame this anyway. Right or wrong, that’s how the Very Serious People roll.

The right answer, of course, is utterly obvious and in front of our face, and has zero chance of happening. It’s to tax. Rarely is banning things outright a good idea. If we put a large tax on indoor dining, ideally as a function of relative safety but a fixed number would do, that’s the logical approach. We could do the same with other risky activities. If people don’t want to pay, then it wasn’t worth doing. If they do pay, then it was worth it, and we can use that money to fund our other efforts.

A number of other states are also in Yolo Mode. I learned this morning that Massachusetts is continuing to loosen restrictions, based on a justification of dropping positive test percentages, despite rising hospitalizations and rising numbers of cases. All metrics matter, but it seems clear what the result will be. 

The question remains, if we’re not willing to do what it takes to stop this, why should we also ruin everything else along the way to not stopping it? 

Going Down to Denver, Going To Have Ourselves a Time

Denver is on it with two feel good stories this week.

First, they were able to detect infection using wastewater, and contain it. This needs to be standard procedure, everywhere.

Second, Denver Broncos fill stadium with South Park cardboard cutouts.

In Other News

CDC pulls coronavirus surveyors out of Minnesota after they reported harassment, racism. Our country might indeed have some problems it needs to confront. Instead, of course, we once again ran away from several of them at once, which seems fitting. We don’t care enough to work through it.

The Long Haul

The great unknown is the frequency and severity of ‘long haul’ Covid. People, including many fully young and healthy people, suffer for months after infection and potentially have permanent damage that could substantially lower their life satisfaction. This may have happened to one of my close friends (that essentially none of my readers would know) who was otherwise healthy. I’m more afraid of the long haul problem than I am of dying from Covid.

All we know so far about ‘long haul’ Covid – estimated to affect 600,000 people in the UK estimates that 12% of those infected have symptoms that last longer than 30 days. That’s a very broad definition of ‘long haul’ on duration and on severity, and I’m guessing this is a large underestimate of the number of actual cases in the United Kingdom. Even fully buying what’s here, we don’t get much of a handle on how to assess our personal risks and decide how much to care about them.

As Their Numbers Grow, COVID-19 “Long Haulers” Stump Experts is even less helpful. I don’t feel any better informed than before from that, as to what I actually need to know.

I wish I had answers here, and encourage those who have any reasonable estimates at all to share them and explain their reasoning. We need to figure this out.

22 comments

Comments sorted by top scores.

comment by G Gordon Worley III (gworley) · 2020-10-02T01:46:03.870Z · LW(p) · GW(p)

There are two counter-arguments. 

To offer a third, one of the problems with opening up and assuming people will make their own reasonable choices is that not everyone has the financial and social security/stability to make a choice based solely on their risk profile. That is, with stronger lockdowns in place, vulnerable people who would otherwise be exposed to higher risk, say because they need to return to a job that puts them at risk above what they would otherwise be willing to tolerate, are protected.

I feel like your argument (and your later argument about taxing activities) ignores the problem of people below some wealth threshold where they cannot act as they would reasonably like to because their alternative is homelessness, malnourishment, etc., thus they must put themselves at risk to stay alive. That's very different from the situation of a person who can, say, choose to avoid risky activities without putting their ability to continue to live a life with basic needs met.

The lockdown is a coordination mechanism that protects those without sufficient individual power to choose. Thus, if we want to lift lockdowns, we must acknowledge that doing so specifically disproportionally puts at risk those most protected by the lockdown who otherwise would find it necessary to put themselves at risk to avoid a larger risk.

comment by maia · 2020-10-02T16:09:35.426Z · LW(p) · GW(p)

This is true, but also, we're not giving people money to keep them afloat while their job is illegal anymore. So having the lockdown might not help that much.

Arguably we should start giving people money again, then lift the lockdowns, to give them the ability to choose.

This is, of course, complicated by the fact that if your old job offers you back your job in-person, you'd presumably be ineligible for unemployment... so we'd have to give people money unconditionally for this to work.

comment by Aiyen · 2020-10-02T18:35:50.174Z · LW(p) · GW(p)

You say vulnerable, low-income people "must put themselves at risk to stay alive", then propose not letting them do so?  A lockdown, by itself, does not give the poor any money.  If you wish to prevent them from working risky jobs to support themselves, you must either offer them some other form of support or assert that they have other, better options ("homelessness, malnourishment, etc."?), but are making the wrong decision by working and thus ought to be prevented from doing so.  Being denied options is only protection if one is making the wrong decision.

Do you think these people ought to be homeless and malnourished?  If so, that's a hard case to make morally or practically.  If not, you should offer an alternative, rather than simply banning what you yourself state is their only path to avoiding this.

comment by G Gordon Worley III (gworley) · 2020-10-03T00:37:26.623Z · LW(p) · GW(p)

Shelter in place orders create common conditions that force government response to these issues. That the current government is not totally holding up that end of the shelter in place bargain is a problem, and an possible counter to this counter argument.

comment by maximkazhenkov · 2020-10-02T11:47:47.911Z · LW(p) · GW(p)

You're also exposed to all sorts of risks if you're "below some wealth threshold where they cannot act as they would reasonably like to because their alternative is homelessness, malnourishment, etc." even before Corona came around. The situation hasn't changed all that much. 

But, as Elon Musk famously said: "If you don't make stuff, there is no stuff".

comment by jmh · 2020-10-01T23:09:46.395Z · LW(p) · GW(p)

The big mistake is indoor dining. Indoor dining is a terrible cost-benefit ratio. It’s one of the most dangerous things you can do. The experience is nice, but it’s in no way vital. The reason indoor dining is happening is because without it, the bars and restaurants would die, with long term consequences.

 

What happens if we say, indoor dining is fine, and even at above 50% occupancy levels as long as the diners can all prove they have been infected and recovered? They all probably still have whatever immunity one gets -- at least I would assume if immunity goes away in 3 or 4 months we would have clear examples of reinfection by now.

In fact, the solution to implementing that approach might go a long ways towards opening up international travel as well. That restriction is significantly impacting a lot of less developed countries. One might thing that is a more robust approach than the idea of the COVID-19 passport which seems to depend mostly on testing for the infection in a very short period prior to departure. 

comment by TheMajor · 2020-10-02T07:21:59.840Z · LW(p) · GW(p)

You want to incentivise people to get positive COVID tests? Ballsy.

On a more serious note, I doubt anybody would be interested in enforcing this. Diners are going out of business due to COVID restrictions, and for many restaurant owners the choice between going out of business or looking the other way when people ask to be seated is clear. Furthermore the goal of all this is to keep the number of people who have contracted COVID as low as possible, your proposed 'fix' would only allow a small minority to work/participate.

comment by jmh · 2020-10-02T15:34:47.546Z · LW(p) · GW(p)

I did recognize that there was an incentive in that direction. I think the question on that point is would this type of policy increase the behavior towards contracting the infection significantly more than currently exists over the benefits of a more open economy that takes some account of the fact some people are not at risk or a threat.

As you note yourself, incentives to defect, and so increase the spread, already exist. The approach I was musing about might offer a middle ground that perhaps counter intuitively actually increases the incentives to comply by producing a safe customer base. Would there be people tying to make their fake "I survived COVID and have (temporary) immunity IDs"? Yes. But it seems to me that with a legal option to operate on a limited scale under conditions that are actually safer than the current limited operations might just get the business to consider looking rather than looking the other way.

Also, broadening the focus towards who has recovered might support some better work place organizational aspect. For instance, if employers do have a growing number of staff that has been infected and recovered and now back at work (or could return to work) having the most at risk employees than have never been infected working in close proximity to the recovered workers and away from those who may become infected is probably a net good for that high risk person.

The point really is not about restaurants and diners but shifting some focus on we do have a large and growing group of recovered people who should pose no risk to others any time soon. The idea that we only have one population of people when looking at business activities and what can and cannot be open, at some point, becomes rather stupid and actually increases the average level of risk compared to what could be achieved I think.

comment by Annapurna (jorge-velez) · 2020-10-14T03:23:31.790Z · LW(p) · GW(p)

As someone who is recovering from COVID-19, my interest on the subject has naturally moved towards long term consequences of the virus and reinfection risk. 

I agree with you that there isn't enough data out there to even get me interested that there are indeed long term consequences of the virus. 

With regards to reinfections, at the moment I believe that the few reinfections reported are anomalies. The Very Serious People are focusing on this reinfection case study: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30764-7/fulltext

I also found a website that tracks reinfections: https://bnonews.com/index.php/2020/08/covid-19-reinfection-tracker/

If you believe the website, there have been 23 reinfections confirmed out of 30+ million confirmed recoveries. I think the odds are pointing towards there being some sort of immunity. 

comment by Alexei · 2020-10-06T21:29:05.647Z · LW(p) · GW(p)

Zvi, what do you think about this paper: https://www.acc.org/latest-in-cardiology/journal-scans/2020/05/18/13/42/variation-in-false-negative-rate-of-reverse

Seems to suggest that the rate of false negatives is actually quite high. If that's true, that has pretty strong implications on a wide variety of issues. Most important for me is if we can invite over a friend who was tested and got a negative result.

comment by Lanrian · 2020-10-02T08:41:11.259Z · LW(p) · GW(p)

From the article you linked:

The epidemiologist said analysis of the app data – from 3.6m UK users – found 12 per cent have symptoms longer than 30 days, and one in 200 for more than 90 days.

Having symptoms after 90 days seems like a far better measure for long-term problems than having symptoms after 30 days, and .5% doesn't sound crazy as an estimate for long-term problems. They say they haven't accounted for sampling bias, though, which makes me doubt the methodology overall, as sampling bias could be huge over 90 day timespans.

comment by tog · 2020-10-10T14:13:41.562Z · LW(p) · GW(p)

They say they haven't accounted for sampling bias, though, which makes me doubt the methodology overall, as sampling bias could be huge over 90 day timespans.

 

Yes, the article doesn't describe the exact methodology, but they could be well deriving the percentages from people who choose to self-report how they're doing after 30 and 90 days. These would be far more likely to be people who still feel unwell. 

As a separate point, and I'm skirting around using the word "hypochondria" here, asking people is they still feel unwell or have symptoms a month or three after first contracting covid is going to get some fairly subjective answers. All in all I don't think this particular study tells us much about the likelihood of covid causing permanent damage.

 

comment by Lanrian · 2020-10-11T08:06:34.997Z · LW(p) · GW(p)

What about as an upper bound? I'm having a harder time generating confounders that make this an underestimate.

comment by tog · 2020-10-21T04:01:07.777Z · LW(p) · GW(p)

Yes, it seems more reasonable to treat it as evidence of upper bound. Still weak evidence IMO, due to the self-reporting of perceived symptoms.

comment by Pongo · 2020-10-01T21:31:06.075Z · LW(p) · GW(p)

That’s a very broad definition of ‘long haul’ on duration and on severity, and I’m guessing this is a large underestimate of the number of actual cases in the United Kingdom

If the definition is broad, shouldn't it be an overestimate?

comment by Zvi · 2020-10-01T21:39:31.557Z · LW(p) · GW(p)

The overestimate I was thinking of was the number of Covid cases period, not the number of long haul cases. Wording could be improved, I've edited original. 

comment by emanuele ascani (emanuele-ascani) · 2020-10-07T16:46:37.751Z · LW(p) · GW(p)

I don't know if this has already been discussed, but why the daily deaths in every European country are 1/10th or less of lockdown levels but daily cases are two or three times higher? In the rest of the world daily deaths still seem to follow daily cases but in the US and Japan (to a lesser extent), in which daily deaths are about half of what they were in May (which is still not as extreme as Europe). I may be unaware of other countries in which this is the case.

comment by Gunnar_Zarncke · 2020-10-04T19:53:04.232Z · LW(p) · GW(p)

Thank you for the update.

Any news about treatments and prophylacticals?

comment by TAG · 2020-10-03T10:25:31.669Z · LW(p) · GW(p)

Biden repeated in the debate the general expectation that another wave of infections and deaths is coming Real Soon Now, and that deaths may double over the next few months, as the rate goes up by a factor of five or more. That’s the new Very Serious Person position.

Other countries have had second waves, so why should the US be exempt? Eyeballing figures isn't a good way to predict second waves, because underlying conditions can change. You can't assume that the same trends will continue after a step change like the opening schools or restarting international travel .

comment by DaveT1000 · 2020-10-04T23:38:40.069Z · LW(p) · GW(p)

Have any countries with estimated cumulative infection rates similar to the U.S. experienced second waves where fatality totals approached earlier peaks?

Going by information at the Worldometer site, for example, Spain, France, and the UK have experienced cumulative reported per capita COVID deaths ranging from about 25% lower than the U.S. level (in France) to about 6% higher. I take that as evidence that the cumulative level of COVID infections in each of those countries is broadly similar to the U.S. In each of those 3 countries, the 7-day average of reported daily COVID deaths during a recent second wave has - at least so far - stayed below 20% of peak levels in the spring.

comment by TAG · 2020-10-05T10:57:11.109Z · LW(p) · GW(p)

So you are arguing about the size of a second wave in the US, not the likelihood?