It’s Going Backwards…

Data uploaded from on 7/26/2020 at 11:00am EST USA

On Saturday, July 26, the US reported 908 deaths. Saturday and Sunday are generally light reporting days because a lot of counties (all US death reporting is done at the county level) take the weekend off. Nonetheless, this level of mortality on a Saturday has not been seen in the US since the last weekend in May, two months previously, and is consistent with the continuous rise in mortality rate since the beginning of July. The 7-day moving average of the mortality rate has climbed to the 900 per day mark from the early July low of 500, and it may only a short time before we revisit the 1000 per day point. Until we develop a vaccine – which it is fairly certain will not be widely available before 2021 – the means our ability to continue opening up our economy depends upon three key factors: (1) State policies, (2) testing rates and (3) public behavior. These three factors are bound up, one with the other, and need to be considered together.

State policies

The question is whether the act of relaxing shelter-at-home policies, and permitting the re-opening of businesses, contributed to the ultimate rising of the mortality rate. Most states began the relaxation towards the end of April through the beginning of May. The mortality rate began to rise again in early to mid-July, a gap of about five to six weeks. This period is beyond the incubation period of the disease, but we know that the infection rates in most states have hovered close to the fine borderline between no growth in infections and very rapid growth. There has been a steady increase in the Rt (measure of the rate of spread of the virus) in most states, and this increase is what is being translated to every higher infections, and ultimately deaths. These next three charts from trace the Rt (the rate of infection) over the last 3 months across all 50 states in a graphic display of how the infection rate has crept up across the US. As a reminder to new readers of this column, the Rt rate is an indicator of the likelihood the disease will expand its spread: below the score ot Rt=1, the disease will cease to spread: above that rate, it will spread. The higher it is above that rate the faster it will spread. States with low rates of infection are better off than those with higher rates of infection, even if they have a higher Rt rate. But what we are indicating here is the trend. The diagrams below show the states in green that are above the Rt=1.0 line for all 50 states.

Rt Rate for all 50 States per 3 months prior (4/25/2020) to current date (7/25/2020)
Rt Rate for all 50 States per 2 months prior (5/25/2020) to current date (7/25/2020)
Rt Rate for all 50 States per 1 month prior (6/25/2020) to current date (7/25/2020)
Rt Rate for all 50 States per current date (7/25/2020)

The trend that we can glean from this progression is that the Rt rate has crept up for most states since the relaxation, indicating that the relaxation has a direct impact on the Rt rate. Under our constitution, each state has a specific responsibility to manage its public health, and the opening of the economy should be down in consideration of testing policies and influence over public behaviour. Failure to manage all three factors in concert will result in a rise in infections, followed by a rise in mortality to unsustainable levels.

Testing rates

Since this column began we have deplored the poor execution of testing: at the outset it was a catastrophic failure of the CDC, to a degree that is yet to be generally understood by the media or the public. This is a failure of public policy that needs to be fully examined once the pandemic is behind us, as it is probably more directly responsible for the situation we find ourselves in than any other single factor. For the moment we have to look at the future, and inexplicably we find that we are still not being well served in this critical area of testing. At this point in the pandemic we should be testing far in excess of the numbers of those infected, such that we have a full measure of the state of the pandemic in a given area – be it a city block, a town, or a rural area. However, we are still a long, long way from there. We know from the mortality rate that infections are at least 100 times the number of deaths, so we know that there are over 100,000 infections a day; yet we are only measuring about 65% of that, or about 65,000 per day. This means that there are 35,000 infection per day that are escaping our attention. Ultimately, unless we are testing enough people to capture a full picture of those infected, we will not be able to contain the pandemic. Below we set out a state-by-state measure, showing those states that are testing only those infected, that is those that have symptoms, resulting in this sorry situation. The graph indicates which states (the green bars) are achieving 5% or less positive results from their testing, indicating that they are testing a wider group, to a level that is considered sufficient to trace infection source.

Failure of states to implement widespread testing regimes may render all their other policies pointless. Before considering the further opening of the economy, states would be well advised to examine – and re-examine – their testing capabilities.

Positivity Testing – downloaded from 7/26/2020

Public behavior

The third factor that will ultimately determine the success in overcoming the pandemic in the absence of an effective vaccine, is public behaviour. The willingness to conform to social distancing, and wear masks, ensured that Germany was able to reduce its mortality to levels of less than 20% of those of the US; in addition they appear to have dodged any “second wave” to date.

The politicization of conforming behaviour has been very regrettable, with very severe negative impacts.

Public behaviour in almost every social sphere – bars (in particular), restaurants, hotels, public gatherings – are full of examples of behavior that flouts the guidelines.

The lack of leadership at the national level and the inability of the States to take the initiative in influencing public behaviour has led to the current situation, which will continue to deteriorate if decisive action is not taken. Re-institution of lockdowns, closing of newly reopened business and activities will inevitably follow when mortality rates rise to politically unsustainable levels, and/or medical facilities become overwhelmed, as they did in New York and several other cities in late April.

We are not calling for a level of conformance and discipline such as that which was enforced upon the Chinese people after Wuhan, although that proved to be very effective. Rather, we are calling for leadership that guides and inspires people toward a responsible public commitment. The US has risen to greater challenges in the past, there is no reason not to do so now.

Vaccines and treatments

There are a number of treatments in late stages of development and approval for COVID-19 that may ameliorate either the symptoms or the death rates. These will become progressively more widely available in the forthcoming months, and ultimately will bring some relief to those who contract COVID-19.

The magic bullet will be an effective vaccine. We have little doubt that one or more will emerge from trials presently underway, and will then become available – if not by the end of this year, then certainly early in the next. It will take some time to manufacture, distribute and administer to the population as a whole before life returns to a semblance of normalcy.

Until that day, we should all be playing a role in dealing with this pandemic.

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