Still No Clarity…

Just one more week with an alarming rise in the COVID-19 infection rate, but again, no sympathetic rise in the mortality rate.

Downloaded from www.Worldometers.info on 7/5/2020 at 16:00 EST

Erroneous reporting (again)

Yesterday, 7/4/2020, saw the USA daily mortality rate reported from COVID-19 decline to a level not seen since March 23rd, and come within a hairsbreadth of penetrating the benchmark of 250 deaths for the day. For the week, total deaths were 3,648, a weekly number lower than any since week ending March 28th, and an increase in the rate of decline week over week from the prior week.

The dramatic rise in infections appear to have plateaued at about 50,000 per day (although Dr. Fauci is talking about a potential rise to 100,000 per day), and this just as the rate of testing is reaching upward toward the 1 million a day mark.

When we began this series of reports on the pandemic, we pointed out that the number of infections were undoubtedly being under-reported by a very significant margin, as the IFR (Infection Fatality Rate) was then (mid-March) being reported as well below 3%, and possibly as low as 1%. We now know that this rate is significantly less than 1% for the population.

It stood to reason in the early days that total infections were in fact many times the number of deaths, rather than numbers being reported. For example, on March 15, 73 new cases were reported, bringing the cumulative number of cases to that date to 310, compared to the 121 deaths to date. We now know with fair certainty that the actual number of infections at that point were more than 12,000.

Just as the statistics pointed to substantial under-reporting of the number of infections in those early days, they almost certainly point to a likely over-statement of concern today. We were bound to report a very significant increase in the number of infections once our testing reached current levels.

The urgent question is how much of the increase is a result of wider testing, and how much is real growth in number of infections; and if it is, will we once again face a rapid growth in the mortality rate?

The Key States

To answer this question, we are tracking California, Texas and Florida. These are the key states experiencing very substantial rises in infections, and they represent a very large fraction of the US population.

The following graph summarizes the historic record for these three states since mid-May. As all three states suffered modest rates of infection, the graph shows a small decline in the 7 day moving average of the mortality rate to the end of May, and an also modest rise in number of deaths back to previous highs by the end of June – again still at modest levels – while the apparent infection rates rise precipitously.

Data uploaded from www.worldometers.info at 16:00 EST

In the forthcoming days, the combined death toll looks set to rise in sympathy with the soaring infection rate, but at a lower proportionate rate if the rise of the last two weeks is a good indicator.

However, the graph is based upon the number of days established in the literature – twelve – between infection and death. What if this is not correct, and the average time between infection and death is longer – say three, or even four weeks? This would mean that the proportionate rise is much larger than indicated in the graph, which is calibrated to the twelve-day delay. We raised this concern last week, but the evidence this week appears to show that the twelve-day lag may be correct.

Hospitalizations

Last week we began tracking the health systems’ ability to deal with growing infection rates, particularly in the states we are following, California, Texas and Florida.

Using the IHME (Institute for Health Metrics and Evaluation, University of Washington) numbers, we summarized the hospitalization statistics for California, Texas and Florida. Our review of the metrics this week show that the IHME have revised downward their estimates of the facilities that may be necessary based on their projections. In all cases, from an analysis of the total resources available, it appears that the states have adequate care for the IHME projected number of patients (percentage utilization required is shown in the table.)

http://www.healthdata.org/covid/updates Downloaded 7/5/2020 16:00 EST

Testing

Last week we featured the Johns Hopkins test tracker. This week we use the tracker to illustrate the continuing improvement in testing, by comparing this week (the image on the left) with last week (the image on the right). Each diagram is easy to understand: states in red are testing far too little, while those in yellow are at optimal level, with varying degrees of orange in between. The colors denote the fraction of those tested that are NOT positive. In other words, it isn’t helpful to control the disease if you are only testing those that are already ill. By testing a wider sample, you are able to track the extent of the spread, and so control it.

https://coronavirus.jhu.edu/testing Downloaded 6/28/2020 16:00 EST and 7/4/2020 16:00 EST

California achieved a significant improvement (as did several other states, including North Carolina), while Texas and Florida remain pink and red (poor and bad) respectively. Improvement in testing in these states would seem to be a way for them to solve potentially serious problems, and to continue to open their economies.

So where are we?

By this time next week we will have much greater clarity of mortality trends against the burgeoning infection rates, as it will have been more than 3 weeks since the climb in the infection rates. Our guess now is that there will be a modest pause in the decline of the mortality rate, but the trend will remain downward. Ultimately, it will be dependent on the states, local leaders, and the general public to ensure that the situation remains in hand and that the pandemic remains under control.

Problems are Looming

This week we revisit the mystery of the falling mortality count, even as the infection rate continues to rise alarmingly in the US. We find some signals in the data that helps explain this paradox, and which indicate that we face some serious problems.

The Mortality Rate

The secular decline in mortality from COVID-19 continued in the US over the past week. There is, in this metric, no detectable signal of an uptick from the dramatic increase in the infection count concentrated the southern and western states that is being widely reported in the press. The mortality rates in those states should have climbed significantly by now, and should be impacting the US wide figures. The graph show however an unbroken and consistent decline, week-by-week, of deaths in the US. The one week trailing average line is declining at a consistent and steady rate.

All data downloaded from www.worldometers.info on 6/28/2020 at 10:00

In March we wrote “…the most reliable statistic is the mortality rate…New case numbers, the ones most frequently quoted in news reports are not only unreliable, but have proven to be materially incorrect.”

We considered last week whether the widespread testing may itself be a contributing factor to the reported level of infections. We published a new chart, showing the rise in infections correlate quite closely to the rise in the testing rate, while the mortality rate continues to decline. Here is an update to that chart.

All data downloaded from www.worldometers.info on 6/28/2020 at 10:00 EST

We have researched this theory and have found several possible reasons why this correlation may not be the reason for the report on increase infections, and that this increase may be real.

The “Pneumonia” Theory

First, we should dispose of one theory that we were alerted to on social media. The claim was that the actual rise in COVID-19 deaths was being hidden in deaths categorized as “pneumonia”. This theory arises due to a misreading of the CDC data, as many COVID-19 deaths occur when there is also a Pneumonia diagnosis. The guidelines require pneumonia deaths, when accompanied by other COVID-19 symptoms to be reported as COVID-19 deaths, regardless of the primary cause of death. This can easily be seen in the total mortality counts, and in the CDC reports of “Excess Deaths” – i.e. the total numbers of deaths in excess of that which is statistically expected. In each case, the CDC adjusts these numbers to compensate for late reporting, and continuously corrects the totals once all reporting is complete. The CDC Excess Death report shows clearly the declining Excess Death rate.

https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

The second set of reports groups death by select causes of death. Covid-19 related deaths may be included in several of these categories that show significant excess death rates for the period. The important issue is that in all cases, the death rate has returned to the levels of 2015-2019.

https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm uploaded on 6/28/2020 at 13:00 EST

The Key States

We are tracking California, Texas and Florida as the key states experiencing a very substantial rise in infections, while at the same time representing a very large fraction of the US population. A brief summary of the historic record for these three states show a recent strong rise in infections, and – just as we observed for the whole US – no apparent rise in the mortality rate.

As we have said repeatedly, there is no clear signal in these numbers. However, the graph is based upon the number of days established in the literature – twelve – between infection and death. What if this is not correct, and the average time between infection and death is longer – say three, or even four weeks? This would mean that we would only begin to see the mortality rate increase in the upcoming weeks, meaning the worst is yet to come. There are some indications that this may be the case.

Hospitalizations

Using the IHME (Institute for Health Metrics and Evaluation, University of Washington) numbers, we have summarized the hospitalization statistics for California, Texas and Florida as follows:

These numbers show that after falling to a low at the beginning of June, hospitalizations began to increase, reaching up to 30% increases by today. These numbers are serious, and indicate that the growing number of infections are accompanied by a growing number of people contracting the illness.

Of greater concern is the numbers that the IHME project for the end of August. This shows a combined number of beds required rising to almost nine thousand by the end of August, and this is despite their projection that California will have declined from its high point in early July. This will place a very significant strain on the healthcare resources of both Texas and Florida.

Opportunities for Action

Actions need to be taken, as the evidence is now clearer that the rise of infections in the southern and western states do mean an increase in COVID-19 cases. It may be that these cases are amongst younger, and healthier people than occurred previously, and this may result in a lower – and perhaps briefly deferred – death toll. However the healthcare resource use is very significant and could once again strain the system.

1. Testing

We have tried to hammer home the appalling state of testing in the US. It still is seriously lacking for want of a national emergency program to force the states and localities to implement a comprehensive program.

The current testing regime has not been able to provide the metrics to properly measure and track the pandemic, and we remain in the dark as to the scope of the disease. Johns Hopkins publishes a test tracker, and the image below is a high level view of this tracker showing the state of testing in our nation.

Downloaded from https://coronavirus.jhu.edu/testing 6/28/2020 15:16 EST

It is easy to understand: states in red are testing far too little, while those in yellow are at optimal level, with varying degrees of orange in between. It is no accident that the problem states are those in bright red to light orange. The colors denote the fraction of those tested that are NOT positive. In other words, it isn’t helpful to control the disease if you are only testing those that are already ill. By testing a wider sample, you are able to track the extent of the spread, and so control it.

The lessons from those countries that have controlled COVID-19 is simple: without the enforcement of an effective testing regime, it is not possible to overcome the pandemic.

This diagram also shows the flaw in the theory that the additional testing was the cause of the discovery of the increase in infections: the states that have shown the greatest increase are those that focus only on testing those with symptoms. So testing is not the reason for the discovery of a large number of cases in those states.

2. Masks and Social Distancing

Masks and social distancing has been demonstrated to effectively reduce infection rates. Despite this, many members of the public, as well as – quite surprisingly – public figures have opposed this. It is difficult to understand the reason for this. We suspect some of it is a combination of various cause: laziness, ignorance, a sense of youthful immunity, and – most inexplicably – political opposition. It seems that a strong, active campaign to encourage these practices is both necessary and urgent.

The way forward

Failure to implement effective, widespread testing of those that are not yet showing symptoms, and using the the simple, but effective controls of masking and social distancing will cause the US severe human, social and economic damage.

Implementing these policies requires leadership, and leadership at every level of the political, social and economic spectrum. If those at the top don’t act, that does not excuse any of us from setting aside our political differences and focusing on implementing solutions rather than pointing at (and sometimes taking delight in) the failures of others in formulating and enforcing policy. There is far too much to lose.

A riddle wrapped in a mystery inside an enigma

Winston Churchill’s famous characterization of the Soviet mind may well be attributed to the nature of the COVID-19 disease. It seems that the more we learn, in some respects the less we understand of the disease. Every expert has a different opinion of policy in regard to the degree of lockdown necessary, and the extent of the spread under different policies. The uneven spread, infectiousness and lethality of the disease has puzzled most of the professionals in the field.

What is laughable is to hear politicians pronounce that they will be “following the science” in implementing policy. The truth is they can find among scientists support for about every position on the spectrum of the degree of lockdown necessary! Unfortunately, in today’s highly charged political climate, it appears that we have politicized even this horrendous disease.

The Numbers

All data downloaded from https://www.worldometers.info/coronavirus 6/20/2020 12:00pm EST USA

In last week’s post we posted a graph comparing the the infection rate of COVID-19 to the mortality rate in the United States, with a lag in mortality by 12 days from the infection date (the estimated time between infection and death).

As will be seen on the updated graph, shown above, we adjusted the scale of infections, causing the peak of mortality and infections to coincide on April 21.

This week, we have added to the graph a line representing the relative number of tests conducted per day.

The most important conclusion is that the mortality rate continues in its secular decline, and at the same steady rate it has experienced since the peak in late April (the slight bump after May 31 is, we believe, due to reporting anomalies around the Labor Day weekend)

It can be also readily seen that the reported infection rate has move steadily upward against the mortality rate, correlating closely to the rise in the testing rate. This correlation has remained steady since the peak in Mid-April.

The conclusion to be drawn is that the rising number of reported infections is due to significant additional testing.

Even with this rising disparity between infection and mortality, we are probably not even beginning to count the total number of actual infections. We can deduce this from the IFR (Infection Fatality Rate) that the current numbers reflect. The IFR of COVID-19 is currently being debated, but there is little disagreement that it is around 1%. (for example: https://www.medrxiv.org/content/10.1101/2020.05.11.20098780v1)

However, if we use the statistics that are being reported to us, then we get an IFR that reached as high as 6% in mid-May, and around 5.3% currently. From this we can infer that the true gap between the rate of infections and the rate of deaths are dramatically greater than that indicated on the graph. Only widespread antibody testing will reveal the breadth of infection that has actually occurred, but we should expect the gap in the graph to continue widening as we detect greater and greater numbers of those infected, compared to those dying, from the disease.

The question the remains: how do we accurately determine whether we are reducing, rather than increasing the death rate, and whether our opening of the economy is placing us in danger?

Consider the Major States

One method is to closely examine the impact of lifting the lockdowns on the most populous states that are reporting rising infection rates.

If we examine the www.rt.live site, we can see that among the largest states a relatively even distribution of statistical experiences in managing the pandemic.

Downloaded from rt.live 6/21/2020 12:00 EST USA

This slide represent Rt in each of the indicated states. To quote rt.live, “These are up-to-date values for Rt, a key measure of how fast the virus is growing. It’s the average number of people who become infected by an infectious person. If Rt is above 1.0, the virus will spread quickly. When Rt is below 1.0, the virus will stop spreading”. The site publishes the continuing change in the Rt from day to day, providing a graphic view of the changing dynamic of the pandemic. Of course, a lot depends on the quality of the methodology, and we are not commenting on its accuracy: instead we are relying on a relative accuracy between the states we examine, and to find those at the highest risk. So we look for the states that lie above the line of Rt=1 in the diagram above. For this reason we selected California, Texas and Florida. These are the largest of the at-risk states, and together comprise more than a quarter of the country’s population, span all of the time zones, and represent a very wide range of demographics. Also, we see a good spread of risk between the lowest risk state – California – the median state – Texas – and the highest risk state – Florida.

California

All data downloaded from https://www.worldometers.info/coronavirus 6/20/2020 12:00pm EST USA

The 7-day moving average of daily new cases continues to climb from its high water mark of last week to a new high this week, reaching above 4,000 cases for the first time. Let’s see the impact on Mortality.

All data downloaded from https://www.worldometers.info/coronavirus 6/20/2020 12:00pm EST USA

Like last week, the 7-day moving average appears largely unchanged, with no indication of the significant and consistent climb in the infection rate. This indicates that the relaxation of the lockdown that started on May 25th has – as yet – little impact on the spread of the disease.

Texas

All data downloaded from https://www.worldometers.info/coronavirus 6/20/2020 12:00pm EST USA

Texas has shown a more dramatic rise in infections than has California, and it is a fact that Texas began the relaxation on April 29th, a month earlier: this is could be an important factor, indicating the potential danger in the relaxation. Let’s view the mortality rate:

All data downloaded from https://www.worldometers.info/coronavirus 6/20/2020 12:00pm EST USA

The mortality rate does not, however, bear any fruit to this argument. If anything, it is slightly lower than it was when the lockdown was eased. By May 7th, a week after the end of lockdown, the death rate peaked at 38: it is now at or around 30, but has been as low as 20. There was a spike after June 16 that bears watching which will have to be reviewed in the coming weeks.

Florida

All data downloaded from https://www.worldometers.info/coronavirus 6/20/2020 12:00pm EST USA

Florida ended its shelter on May 4, and the infection rate remained constant for a month, suddenly beginning a very significant spike in early June, from an average below 1,000 diagnosed infections a day to 4,000 diagnosed infection a day by June 20. This spike exceeds that of other states by a wide margin, and brings into question whether such a disparity could be explained by wider testing. Perhaps an examination of the mortality rate will shed some light.

All data downloaded from https://www.worldometers.info/coronavirus 6/20/2020 12:00pm EST USA

Again, the mortality rate does not seem to reflect the alarming rise in infections. In fact, this graph seemed so counterintuitive compared to the infection rate, that we went back to review the actual numbers, rather the moving average. Deaths for the first three weeks of June were 244, 237, and 219 respectively, showing a DECLINE in the weekly rate! This figure should have been increasing dramatically to reflect the dramatic and persistent increase in the infection rate beginning in the first week of June. However, we need to reserve judgement until the forthcoming weeks, as the deaths could still show up in late June.

Conclusion

We have not yet seen evidence in the global numbers or in the individual states numbers to confirm that there is a second wave, or even an increase in the actual number of infections. Our thesis remains intact: the rising infection rate is a function of the increase in testing, and the very large number of still undetected infections.

Comparison

We end each week with a running comparison between the pandemic experience in the U.S. and in a collection of comparable countries in Europe representing the size and development stage of the US.

All data downloaded from https://www.worldometers.info/coronavirus 6/20/2020 12:00pm EST USA

So…Where’s the Spike?

There is a spike in COVID-19 infections! So we are told in stark headlines on national and local media.

There has been a rising drumbeat of this warning ever since the mortality rate in the major US hotspots, particularly New York, abated.

According to many, we are either experiencing a spike or are about to have one, and it’s all because State Governors have relaxed the lockdown order.

Has there been a spike? And if so, how serious is this spike? And if not, is one coming?

From what we have seen in the data there is isn’t clear evidence of a spike. If anything, there is evidence of a continuing downward trend in the US mortality rate, despite the widening relaxation of the lockdowns.

The big picture

Data downloaded from http://worldometers.info/coronavirus on 6/14/2020 at 12:00 EST

General observations on the Graph

The graph above is based on the weekly graph we publish showing the daily mortality rate in the United States – the solid blue line, together with a seven day trailing average. This trailing average smooths the daily reporting cycle offsetting the lack of reporting on weekends from many counties, which cause low weekend counts, and consequent weekday spikes.

This week’s graph adds a solid orange line which depicts 4% of the daily infections. We choose the arbitrary ratio of 4% because it enables us to align the graphs of the two metrics in a useful way. We understand that the actual mortality rate is significantly less than 4% of those infected, and we will revisit this metric a little later.

Further, the daily infections are shifted forward, reflecting in the graph, the count occurring 12 days before the date on the X-axis. This is done because that is roughly the average elapsed time between the COVID-19 infection being diagnosed and death occurring. (In the non-peer reviewed literature this elapsed time is said to range between 11 and 13 days. – see: Wilson, N., Kvalsvig, A., Barnard, L., & Baker, M. G. (2020). Case-Fatality Risk Estimates for COVID-19 Calculated by Using a Lag Time for Fatality. Emerging Infectious Diseases26(6), 1339-1441. https://dx.doi.org/10.3201/eid2606.200320.)

We have chosen 12 days because it is clearly the best fit for the data, establishing this metric for the US experience with COVID-19.

In the graph we have annotated 3 dates:

  1. April 7: On this date, a little over 5 weeks after the first US death, and two weeks before the historic peak, we can see from the chart that the US reported 2,233 deaths. We can also see that the US reported, 12 days prior, a total of 748×25 infections (remember, our chart only shows 4% of reported infections), that is 18,691 infections, an actual mortality rate of 11.95%. (We know this is far in excess of the mortality rate for COVID-19, even in New York City.) The notation in the blue panel on the chart tells us that we had completed 2.2 million tests by that date, and were testing at the rate of 7,000 tests per million population per day.
  2. May 6: Now 9 weeks into the pandemic, and about two weeks after the peak, the chart shows that we reported 2,531 deaths. We also reported 1558×25, or 25,459 infections, yielding a mortality rate of 6.5%. The infection rate appears to be closer (but not very close) to reality. We see from the blue panel that by this date we had quadrupled the total number of tests to 8.7 million, while we were testing at the rate of 26,000 tests per million population per day.
  3. June 13: this brings us up to date. At this point, the moving average for the 4% infection line has intersected the mortality rate line, meaning that we are at a mortality rate of about 4% of reported infections. At this point we have performed 23.8 million tests and are testing at the rate of about 72,000 tests per million population per day.

Conclusions to be made from the graph

There is a correlation between number of tests being conducted and the ratio of infection rate to mortality rate.

Simply put, the more testing we do, the higher the number of reported infections in proportion to deaths. This may be the cause of the “spike”.

It is also clear from the graph that not only is there a secular downward trend in the mortality rate, there is ALSO a gradual downward trend in the infection rate, despite the increased testing.

We are confident that the infection rate is still significantly higher than is being reported, and that we will see the gap between the infection rate and the mortality rate widen substantially in the immediate future .

Simply put, we will have a continuing apparent increase in reported infections (with attendant press and political coverage), with a simultaneous decline in the mortality rate.

But, what about the States

We are told that several states “opened too early” and they are suffering from a spike in infections, and that the decline in the national mortality is hiding the spikes in the states. Let’s examine the thesis by looking at states frequently mentioned in these reports and which, because of their large populations, could have a real impact on the national numbers. Let’s look at the three major states frequently cited in these spike reports: California, Florida and Texas, since together comprise 25% of the country’s population.

California

California lags many states in relaxing their lockdown, and they have cited “worrying statistics”.

Let’s start by looking at a graph of California’s reported daily new cases, with our standard 7 day trailing average to smooth the reporting anomalies:

Data downloaded from http://worldometers.info/coronavirus on 6/14/2020 at 12:00 EST

The “Daily New Cases” graph above would be very worrying to state officials, indicating as it does a constantly rising number of infections. But, we lay the concerns to rest by looking at the actual mortalities arising from those infections:

Data downloaded from http://worldometers.info/coronavirus on 6/14/2020 at 12:00 EST

We see from the graph of California Daily Deaths a flat, if a slow secular decline in mortality. Daily new cases have reached 3,000 per day, but the mortality rate has fallen from a constant 75 or so deaths per day, down to about 60 deaths per day. The mortality rate of 2% is still, in our opinion, high and so we confidently expect the infection rate to increase without a concomitant increase in mortality.

Texas

Another state cited for its unfortunate rise in infections is Texas. Here is the evidence:

Data downloaded from http://worldometers.info/coronavirus on 6/14/2020 at 12:00 EST

And here, as would now expect, is the refutation:

Data downloaded from http://worldometers.info/coronavirus on 6/14/2020 at 12:00 EST

What is interesting in these graphs is that Texas has a mortality rate approaching 1%, compared to California’s rate of 2%. It is possible that Texas may have more effectively detected infected populations than California.

Florida

Frequently cited as vulnerable, and likely to suffer from spikes because the state was very late to lockdown, and very early to loosen restrictions. Here are the numbers:

Data downloaded from http://worldometers.info/coronavirus on 6/14/2020 at 12:00 EST

Again, we see rising infections, and indeed an alarming “spike” on January 13. Here is the mortality chart:

Data downloaded from http://worldometers.info/coronavirus on 6/14/2020 at 12:00 EST

The jury is still out on this state. It can be seen that the state enjoyed a decline in mortality from May the 8th up to present time despite the lockdown being lifted on may 3rd followed by a small rise in the infection rate from that time.

However, the infection rate start to rise very significantly on June 4th: whether this increased rate of rise will reverse the state’s good mortality experience to date, only time can tell.

Conclusion

When considering all the reports of “Spikes”, color us sceptical. We do not yet see the convincing evidence. We continue to see a steady decline in the mortality, while we see steady – but too slow – progress in testing.

Is the Downward Trajectory at Risk?

Source data downloaded from https://www.worldometers.info/coronavirus/#countries 6/7/2020 at 12pm

The 1-week trailing average of mortality from COVID-19 has plunged firmly below 1,000 per day this week. It had briefly dipped below that marker last week, but only because the week before had been a long weekend, including Memorial Day holiday. Followers of this column will be aware that the weekend reporting of COVID-19 deaths is spotty, leading to a Saturday-Sunday plunge in the numbers. The pattern in evident in the USA Daily Mortality chart above. For this reason, we use the 1-week trailing average, which levels out the weekend dip, and the mid-week spike. We also correlate the numbers each month with “Excess Deaths”, a statistic generated by the CDC that gives us an insight to the relative accuracy of the reported numbers. Ultimately, we have found that the measure used in the graph above is a good indication of the relative death toll, and its progression, rather than an absolute and accurate measure (which may never be known with high accuracy, for reasons we have discussed before, and will devote more focus in a forthcoming column.)

This fall is proceeding at the pace expected; if the curve continues this stochastic path, we could look toward the weekly moving average falling below 500 in the next two weeks, and so forth.  What threatens this outcome is two separate developments: the relaxing of Shelter at Home orders, and other orders restricting movement and commerce, and the burgeoning protest movement.

Relaxing the Restrictions

We have been in strong support of the relaxation of Shelter at Home orders and the limitation of daily activities and commerce. Early experience is indicating an uptick in infection rates in many of the states relaxing limits, but not yet in alarming terms. Each month we publish the chart from rt.live indicating the Rt value in all 50 states. The “early openers” such as Georgia and Florida, have both shown an uptick in infection rates, in most cases – Florida much milder than Georgia, although both are calculated to have an Rt rate above 1.0,  above which infection rate will lead to growth rather than diminishment of the disease. On the other hand, another early opening state, Texas, showed an excursion above 1 shortly after the relaxation ended, but that rate has now fallen below the magic number of 1. All of these changes so far have been marginal, and do not lead us to be concerned.

On the other hand, the social unrest across the country today may significantly alter the dynamic of the pandemic. We have seen photos of protests where protesters have scrupulously observed social distancing, wearing masks, and avoiding person-to-person physical contact. On the other hand, when the crowds reach very large numbers of highly energized people, it becomes impossible to maintain those practices, and may lead to superspreading events.

Philadelphia Protest, June 6, 2020 (Screengrab from NBC News)

Time alone will tell what the outcome will be: we will be keeping track of the statistics over the next few weeks to see if the dynamics change.

Comparing the US COVID-19 Results to Western Europe

Source data downloaded from https://www.worldometers.info/coronavirus/#countries 6/7/2020 at 12pm

Each week we compare COVID-19 mortality data from the US to the five largest European countries, as together they represent roughly the same level of population (US is about 2% more populous). We do this because there is so much misinformation about how poorly the US is managing the pandemic, whereas we are doing not much better, but certainly not worse than Europe. As in Europe, some US states are doing significantly better than the country as a whole, but the US aggregates are comparable, and in some categories, significantly better than those aggregates in Europe as a whole. The pandemic started in the US about two weeks later than in Europe, so the numbers lag by at least that period; we are only recently past the peak in mortality, while much of Europe is well past the peak. The IHME Predicted Mortality shown in the comparison is now over a week old, and we will seek to update it by the next post. The very large variation in “To Date Mortality” per million of population bears some investigation, ranging as it ranges between a low of 105 (Germany) and 596 (UK). While the US reports it’s rate to be 339, New York City has a current rate of 1,566 deaths per million of population. A very sobering number, and one that requires in-depth scrutiny: we will be delve deeper in a future posting.  

It’s Time to Open the Economy

Data downloaded from www.worldometers.info/coronavirus/ 5/30/2020 10:00am EST

Daily mortality rate now below 1,000

As can be seen from the USA Daily Mortality chart above, the 1 week trailing average has, for the first time since early April, slipped below the 1,000 deaths per week mark. We are using the trailing average because it can be seen clearly from the chart that there is a rhythm to the daily reports indicated by the steep drop in the numbers on each weekend. We suspect that many counties close for the weekend, and catch up their reporting by week’s end. The trailing average smooths out these weekend dips, and gives us an insight into the trends in the numbers. These numbers are encouraging, and are consistent with, if a few weeks behind, the decline in mortality across Western Europe. This could be the result of the aggressive Shelter at Home orders across the affected countries, but it could also signify that the disease has a seasonal component. The data does not have clear signals that we have found in that regard. There has been an explosive growth of the pandemic in Brazil, but this seems the only southern hemisphere nation that has suffered badly; time alone will tell on this subject.

Additional important data points

The data that should drive policy conclusions are widely and publicly available. We share some of those data below.

downloaded from https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm on 5/31/2020 12pm EST

Firstly, we look at excess deaths. This is best illustrated by the CDC provisioned diagram above, showing the orange line depicting the “expected deaths” for each of the months from January 1 2017 through to May 16th 2019. The diagram shows the extent that COVID-19 has impacted the rate of deaths, confirming suspicions that the reported deaths are probably somewhat lower than the actual (indicated by the green bars that rise above the orange line. However, the numbers do not appear to be excessive, probably no more than would occur in a higher than usual seasonal influenza mission, as see in the January 2018. It is difficult, given the very localized, county based death reporting, and the understandable variation of interpretation of the rules of reporting.

Last week we published research on the IFR (Infection Fatality Rate) of COVID-19 by Dr. Linus Wilson, Associate Professor of Finance University of Louisiana at Lafayette. This showed an amazing disparity between mortality rates of these age cohorts:

Children between 0 to 17 years old – between 0.001% (for boys) and 0.002% (for girls) – for a combined rate of 0.002%, a fraction of the mortality rate of seasonal flu

Adults from 19 to 44 – between 0.111% (for men) and 0.067% (for women) – for a combined rate of .087%, roughly the mortality rate of seasonal flu

From this point, things go downhill, fast and far: from ages 45 to 64. the mortality rate rises to about 10 times that of seasonal flu, and rise to 100 times that of seasonal flu over the age of 75. Details can be found in https://larrygoldberg.info/where-are-we/

This research is borne out by the following diagrams from the CDC for dates up to May 16 (all images downloaded on May 31, 2020 from: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

Weekly counts of deaths vs prior years, age groups under 25 years old
Weekly counts of deaths vs prior years, age groups between 25 and 44 years old
Weekly counts of deaths vs prior years, age groups between 45-64 years of age
Weekly counts of deaths vs prior years, age groups between 65-74 years of age
Weekly counts of deaths vs prior years, age groups between 75-84 years of age
Weekly counts of deaths vs prior years, age groups over 85 years of age

These graphs show the relative benign nature of the disease for the very young and the young: from above 45 years on it becomes more serious, and above 65 an extremely serious condition, and as we have heard, particularly for those with other health risks.

Conclusions to be drawn

These mortality figures are important considerations for policymakers.

It should now be be apparent to all that we cannot continue the policy of Shelter at Home until a vaccine becomes available, if ever.

There is serious damage to the social fabric of society from the economic consequences. The situation will worsen significantly with even a short period of continuation of the shut downs.

On the other hand, it is clear that while we have to protect our seniors, and those with potential co-morbidities, the vast majority of our society should be functioning at or near normalcy. Sweden have shown, with a mortality rate no worse than the average European experience, that the economy can be kept open, and society function, kids remain at school, while the necessary protections are provided for the elderly and vulnerable.

If we look at the excellent graphs featured by live.rt, we can see that almost every state now has an Rt rate of less than 1 (that is below the point at which the disease will tend to spread).

Uploaded from www.live.rt 5/31/2020 at 9:00am EST

This shows that most states (including New York) are below an Rt of 1; certainly the large majority of the population of the USA is below the Rt of 1, and most other states are hovering extremely close. It’s time to end the Shelter at Home orders, or the social unrest that we are experiencing will lead to far more serious threats than the pandemic ever could.

The comparison between the USA and Europe

We always end the post with the comparison between the USA pandemic experience with that of the principal European countries comprising of a similar population, and we do so again today. The feature of today’s comparison is that it is the first time that the US is shown to have done more tests per 1 million population than the combined European average. This is remarkable, because at the beginning of April the US lagged Europe by about 40%. We originally published this comparison as an indication of the failure of the testing policy, and we have been extremely critical in this regard. The number in the table is cumulative, so the fact that the US has caught up is very impressive, and marks a very big turn around. This bodes well for a change in the Shelter at Howm policy.

All data downloaded from www.worldometers.info/coronavirus on 5/31/2020 at 12:00pm EST

Where are we with COVID-19?

Daily COVID-19 Mortality in the USA at 5/24/2020

We have not published our daily analysis of COVID-19 USA mortality for some weeks now, there being little change in the orderly progression of the pandemics course, as clearly shown in the graph above.

There is a macabre rhythm to the mortality reports, where each Sunday the count drops by up to two-thirds of the prior Monday tally, and the count comes down through the week, until it again reaches a low on the following Sunday. Sundays are apparently a day of rest in many counties. The point, of course, is that most days are significantly lower than that day in the prior week.

The 7 Day trailing average dotted line shows the decline clearly, from the high of over 2,500 per day in the week ending 4/19, to the current approximate 1,250 per day. If the pattern holds, we can shortly expect the mortality rate to dip below 1,000 per day for the week.

The tail of this graph is exasperatingly long, and the expectation of the IHME is that we will see another 50,000 deaths by the beginning of August.

Exploring the Growing Literature  

We have been reviewing COVID-19 SARS-CoV-2 papers from a wide variety of sources (Lancet, IHME, Worldometer.com, other web sites, press). From academia, we are reviewing medRxiv and bioRxiv, preprint servers for academic papers. These are preliminary papers: there is little published material that has yet been peer reviewed, but very large trove of preprint material contains a mass of what the science has been able to discover thus far.

We are selecting from all this material interesting analytics that can help policy makers in this early stage of discovery.  The key statistics we seek are observed infection and fatality rates, as these should govern policy decisions that balance our safety while permitting a resumption of much economic activity. Some of the more interesting resources from this and other internet sites follow.

The R factor

Rt is the measure of rate of spread of the virus: any value greater than 1.0 indicates a spread: the higher the measure, the more rapid the spread. Below that, the spread will be contained, and will abate. https://RT.Live is a web site that Instagram founders Kevin Systrom and Mike Krieger have launched. The site provides interactive tools to sort and select states to understand their performance over time as they open up their Shelter at Home orders. Here is a sample of that site.

Downloaded from rt.live on 5/25/2020 at 2:30pm

It can be seen from the diagram that only five state currently exceed an Rt in excess of one (those that are above the red line and in the red bubble. Of these, Texas has a significant population. On deeper examination of the numbers, it is five Texas counties that are the offenders – Harris, Dallas, Tarrant, Bexor, Travis and El Paso. This is a hopeful sign that the downward trend in mortality and infections will continue US wide.

For policy makers, this is the analytic information that can make a significant difference as we track the situation into the future. It is important to realize that the Pandemic must be fought location by location.

Infection Fatality Rate

The Infection Fatality Rate, abbreviated IFR, tells us how many succumbed of those infected. If we understand the Rt rate for a given strategy, the IFR rates will enable us to estimate the number of likely deaths from that strategy. The problem is that the IFR, like the Rt rate, varies vary widely with circumstance, culture, weather, and other factors that we do not fully understand. However, some evidence is beginning to emerge, and there are several meta-studies of the initial research that was conducted from the first six months of disease spread that is beginning to give us a picture of it’s IFR. Like some other viruses, it is apparently selective – by age and gender – of its victims. The study we found most interesting (and because its findings appear to be similar to other meta-studies we have examined) is entitled “SARS-CoV-2, COVID-19, Infection Fatality Rate (IFR) Implied by the Serology, Antibody, Testing in New York City” by Dr. Linus Wilson, Associate Professor of Finance University of Louisiana at Lafayette. Here is our summary of his findings:

These are very interesting numbers: if true, they indicate that for children age 0 to 17 the fatality rate for COVID-19 is less than 2% of the rate of seasonal influenza (considered by the CDC to be about .1%). To all intents and purposes, it may be regarded as a benign condition to that population. In another study it was found that “there is preliminary evidence that children and adolescents under 18-20 years have lower susceptibility to SARS-CoV-2 infection than adults” (Susceptibility to and transmission of COVID-19 amongst Children and Adolescents – Viner et al – UK-Netherlands-Australia, medRxiv.org). So not only much lower IFR, but perhaps even not susceptible to infection!

In the population from 18 to 44, the Wilson study shows the fatality rate approaching that of seasonal flu only for males at the top end of that age scale. So, the disease is not a threat to those of age 44 and below. From age 45 and up, the fatality rates shoot up rapidly, and far exceed that of seasonal flu, by factors of up to 100 times (males of 75+).

What does this tell us?

There are some important conclusions that we can begin to draw from the early science.

The first is that it is likely that opening schools should be a priority: it appears that this is a relatively safe course of action.

The second is that the measured pace of “opening up” the Shelter at Home orders seem to not have caused a reversal of the improvements we have achieved in the mortality rates, and that we should continue down this path.  

We will be reading more of these papers in the coming weeks to find consistency amongst the analytics, where data can give us confidence in the reality of this disease.

The Need for Testing

We have spoken frequently of the need to expand testing. The US is rapidly catching up to Europe in the field of infection testing (over 300,000 tests per day), but it is still insufficient. As urgent as is the testing for infection, so it is critical that we start very large-scale testing for anti-bodies. This is the key to understanding the real rate of infection in the population at large, and in specific locales. On May 18, Retuers reported of CDC plans to conduct such a testing program (https://www.reuters.com/article/us-health-coronavirus-testing-cdc-exclus/exclusive-cdc-plans-sweeping-covid-19-antibody-study-in-25-metropolitan-areas-idUSKBN22U2TZ).

The plan is to test blood from 1000 donors in each of 25 Metro areas monthly for 12 months. Useful, but only over time. There is an extremely urgent need to rapidly test a large number of random donors across all 25 Metros to verify the validity of the anti-body studies done to date, and the baseline for the linear study proposed.

We are extremely skeptical of CDC promises.  That organization botched the testing at the outset, in early January, when it was the most critical front line defense against the calamity that came. They, and not the politicians of any stripe, are directly responsible for the crisis we are in. The very organization in which we depended on to keep us safe, and in whom we placed so much faith and trust, failed us miserably.

They have not redeemed themselves since.

Comparison between United States and Europe

The comparative impact of COVID-19 on the US and on Europe has been one of interest in the past. We maintain a table of comparison between the two, as given below.

Data uploaded from Worldometer.com 2:30pm 5/25/2020

Is Elon Musk Right?

Originally published in Linkedin 5/7/2020

Unlike many a public company CEO, Elon Musk is not given to guarded, carefully worded statements that hint at his convictions and concerns. He simply calls it as he sees, it, and lets the chips fall where they may.

His most recent broadside at the powers that control the local area in which the main vehicle assembly plant of Tesla is situate – and at the California state government – has got him into a certain amount of hot water. He wants to restart the manufacturing of his best-selling cars again at the company’s Fremont California plant, in its quest to fulfill the lofty mission of the company: “to accelerate the world’s transition to sustainable energy.” The problem is that the authorities – state and local – have imposed Shelter in Place orders, refuse to lift them, and have forbade Tesla restarting their plant, essential to the manufacture of 70% of the company’s 2020 projected output this year.

Elon Musk has generated a tweet storm, and quite a lot of diverse comment, much of it negative. Some of it extends to “millions will die”!

The point is that some…an unknown number (probably not millions!) …of casualties would result from opening the economy. The question is what are the trade-offs, what are the alternatives?

The Alternatives

There are many people that sit on the extremes of the debate. On one side the demand is to continue the lock-down until a vaccine is deployed. On the other, to open without restriction. There are good reasons to reject either of these extremes, and we should closely examine them as they are often ignored in the noise of debate.

Continue the Lock-down Indefinitely (until effective treatment or vaccine availability)

The economic impact of the lock-down has been very serious, bordering on the catastrophic. In the U.S. government has taken a very strong initiative to provide funds for those impacted, but governments are blunt instruments, so the support is both spotty and woefully insufficient to fully meet the impact of the forced halt to the economy.

Is a vaccine coming? Dr. Fauci has sounded a hopeful note, and the politicians talk with conviction about it coming sooner than later. The hard truth is the we have never successfully developed a vaccine against a Coronavirus. Ever. In history. A good example is the common cold. This is a coronavirus that has been with us for a long time, and no vaccine has ever been found.

We believe that any policy based on the presumption of a vaccine – either sooner or later – is folly. It may be possible with the focus and the billions being spent, but to place a bet on it with the risks that we face is not serious policy making.

On the other hand, we have been more successful in developing treatments that ameliorate or completely neutralize the symptoms of coronavirus caused disease. These will certainly form part of our armory and more on that subject in due course.

In the meantime, businesses right across the spectrum are failing, and there are now 22 million unemployed, compared to less than 6 million only less than 3 months ago. A continuation of the lockdown will add many millions to this number, accompanied with a steep decline of economic activity. Such a catastrophic economic decline will have a profound and unpredictable impact on society. In historically equivalent events we have seen widespread misery, a sharp rise in crime, a significant decline in life expectancy, social upheaval, and – at the extremes – war and revolution.

Not a good option.

Immediate and complete removal of the Stay at Home regulations

Completely relaxing the regulations and lift all strictures will result in a very steep increase in mortality from COVID-19. Estimates have been all over the map, because we simply do not know.

It is this unknown that gives us pause: the upper bounds of probability could mean a potentially large number of deaths, reaching into many millions. In the 1918-1919 Influenza Pandemic (“Spanish Flu”), in today’s population numbers, the equivalent of over two million people (in current population terms) died.

While there are reasons to believe that the death toll would not be as high from COVID-19, the potential number is still unknowable. After four months of this disease being widespread, do not know enough about the disease to predict the outcome of allowing it to run its course.  

Even with Shelter in Place orders, in New York City COVID-19 proved astonishingly deadly, killing well over 1,000 people per million of population, while in largely rural states the deaths appear to be less than 100 per million (and in many states less than 25 per million) of population. Not a noticeable blip on the normal mortality rates (and in most cases, less that a bad Flu season.)

The question is what would happen across these diverse locations if the Shelter in Place orders were lifted without any restrictions. At the extreme end – NYC, for example – the results may be intolerable to society, with a resumption of the high mortality rates, and hospitals overwhelmed to the point where they become inoperable. In the more rural areas, it is possible that they escape the worst of the pandemic’s ravages, but they may also succumb. The results are just unknowable, but they are also such an extreme risk that no sensible government would permit this.

Again, not a good option.

The middle path

Which brings us to the middle path. A relaxation rather than a lifting of the Stay at Home order. This is already happening across the U.S. and expected to widen in scope over time. 

Source: New York Times, May 4, 2020 Downloaded 12:00 EST May 5 2020

That this process is already underway is well illustrated by the New York Times diagram above. Many Governors of rural states, and some of the more populous states, notably Texas, Florida, Pennsylvania, Georgia, and many – if not most – of the rural states have either relaxed or have announced pending relaxation of the Stay at Home orders. California, the largest state, has said that a gradual relaxation order is pending.

So, the great experiment has begun.

Each state will experience a different outcome, because of the difference in population characteristics, rules and regulations implemented, and the behavior of the citizens.  

This is a clearly a calculated gamble on the part of each Governor, and even of local officials, and ultimately of each individual citizen. How well each play a role will determine the outcome, down to each individual (whose behavior not only impacts her or his own fate, but that of others.)

Back to Elon Musk

The question we posed was – is Elon correct? Should we have opened earlier? Should we re-open now? Should Tesla be manufacturing cars?

Our answer is yes. It is a qualified yes, as there clearly must be some modifications to the manufacturing processes to ensure a reduction in transmission risk. Tesla is aware of these practices, as they have implemented them in their Shanghai plant with apparent success. But we believe it is time, perhaps past time, to open the Tesla plant, as well as the economies of many states and cities. In short we believe that it is good policy to open the states and cities that have successfully dampened the pandemic to a chronic, rather than a critical state, subject to some guidelines that we believe make sense and that will guard from uncontrolled resurgence.

Local Considerations

If we consider the original Stay at Home orders, their motivation was given as “flattening the curve”. The objective was to slow down the rate of infection to ensure that the available resources – hospital beds, staff, ventilators – were not overwhelmed by a massive increase in the numbers of seriously ill patients.

The notion that we would reach a 1918-1919 situation where people would not be able to be treated was anathema, and while we reached pretty critical situations in several hot spots, and situations that were dire, with an immense strain on the healthcare systems, we were in large measure successful in damping down the peak and never experienced the complete breakdown of the healthcare system that occurred in 1918.

We have thus succeeded in the primary aim. Here are some clear proof points.

Downloaded from https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm  5/5/2020 10:00pm

The above graph is supplied by the CDC, evidencing “excess deaths” during the past three years, based on a rigorous, locality by locality analysis of death rates compared to historic norms, and adjusted for statistical reporting errors and appropriate data variables, up to the week ending April 25th, the latest published to date. We can see the 2018 Flu season impact, which notably had a greater impact than the COVID-19 deaths (detailed by the blue bars) in recent months. We also see the dramatic reduction in the absolute mortality rate as well as the COVID-19 mortality rate in recent weeks. Georgia was the first state to lift the Stay at Home orders, and this graph points to the reason why.

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Downloaded from https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm  5/5/2020 10:00pm

Turning to Florida, in the above graph we see a similar, relatively benign impact of COVID-19, before, during and after the peak of the COVID-19. This provides clarity around the state’s reluctance to impose Stay at Home orders, and the rapidity in the lifting of those orders. The impact was relatively mild, and indications are that there is little to no potential of the healthcare system being overwhelmed in that state.

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Downloaded from https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm  5/5/2020 10:00pm

Compare the previous examples of Georgia and Florida with New York City. It is very clear that the officials from that City (and its State) would be, should be, extremely reluctant to lift any crisis-based orders…they are, in this graph, still in the middle of battle. They are still some way from “flattening the curve”.

We can understand why the Governor of New York said on May 4th: ““How much is a human life worth? That’s the real discussion that no one is admitting openly or freely…”

The Value of a Human Life

In fact, everyone is aware that this is the dominant issue in determining the way forward. It is clear than many more will die from COVID-19 in the future. That is a fact, and there is no government or policy that can protect us from this reality. The emotional perspective on this question will differ, depending on the locale of the respondent – whether in a rural, lightly impacted State, or a primarily urban state, still in crisis.

The question is how many will die from COVID-19, and how can we prevent as many deaths as possible, and perhaps even more importantly, can we prevent what happened in hot spots like NYC, New Orleans and Detroit? Can we continue to maintain the level of infection below the critical point while we revitalize the economy? Notice that we are not asking that the disease be eliminated…that is an impossible requirement as long as no vaccine exists. While hoping against hope, we must assume that will continue to be the case for the foreseeable future.

Cost is also a factor: no society can afford, nor does it try, to save every single life, no matter the cost.

As a society we accept that all human activity is attended by many risks – we drive our cars every day, though around 50,000 people are killed on our roads each year. We place the onus on preventing death on the roads on a set of laws, and behavioral expectations on drivers. We don’t sequester ourselves in Flu season, although that illness takes the lives of between 30,000 and 80,000 people a year. Again, we place an onus on people to behave responsibly, sequester themselves if ill, and we teach ourselves hygiene. We understand that to halt a functioning society to prevent the potential death of 30,000, 50,000 or 80,000 people per year is not acceptable. There are innumerable examples of how we factor risk into our social behavior, our mores and our laws

The question is how to operate economically – and socially – while ensuring that this disease does not re-invigorate itself to a point that overwhelms the health system and ensure that we protect those most vulnerable to the disease.

What about the Long Term?

This disease is now an inescapable fact of life, and will remain so until, or if ever, a vaccine is found.

“It’s tough make predictions…especially about the future”, so we won’t. We will say that the advent of a vaccine in a matter of months would be an almost immediate curative to the situation; however, we have already pointed out that we have never succeeded in developing a coronavirus vaccine, so we must discount that as an immediate probability. We have been somewhat more successful in developing drugs that cure, or significantly ameliorate the symptoms of the disease. It would be extremely helpful if that occurs, and there are currently several promising lines of development. The pipeline for a new drug for this disease will probably prove extremely short due to the urgency of the situation.

But the reality is that we can and must create a livable world, in which we society can function and thrive, even with the presence of the virus. In the immediate term there really is no alternative, however much the politicians will pose and protest.

It is time to begin.

Policy Implications

We have flattened the curve through extraordinary means – how do we return to economic activity without risking a rise in cases that again threatens the health system?

Public Behavior

We can start by looking at the means to limit the disease as far as possible, and to protect the most vulnerable amongst us. We already know that social distancing, wearing masks in public, hand washing, avoidance of face touching, sequestering the infected are the minimum behavioral changes we will have to implement. Modified work processes, office floor plans, and cleaning/disinfection process will all have to be initiated. Seniors, and those who are medically compromised may do best to shelter for a significant period. We need rules to be promulgated, and citizens continually educated and guided in these best practices, with community reinforcement, and where necessary, enforcement.

Testing, testing, testing

If there is any single major failure of policy and implementation of the science at the CDC, and at every level of government, it is in the area of testing.

The disastrous bugs in the protocols and testing kits in first months of the incipient pandemic was just the first failure: the ongoing lack of industrial scale testing on a scale at least equal to, but preferably far exceeding, that of Germany is a scandal.

The facts are simple – U.S. had its first identified case of COVID-19 on January 21st. https://www.worldometers.info/coronavirus/country/us/#first-cases

Germany had its first recorded case of COVID-19 on  January 27th https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Germany

Despite starting later, as at today, Germany has tested about 33,000 citizens per million of population, compared to the U.S., who has tested about 24,000 per million of population.

This is a scandalous situation. Nothing will contribute more to the management of infection and the evolution of the science than widespread testing: right now for infection, but as soon as practical, for anti-bodies. There are numerous reasons this is important. Germany has shown how testing is an important component of the fight against mortality from the disease; The scientist really can’t get a grip on the infection rate, and consequently the mortality rate, without far more data, of which testing can provide the main component. Testing saves both lives and resources.

Opening of Businesses

Given the facts we have enumerated above, good policy should permit Tesla to open their plant under the current circumstances in California. Of course, there should be rules under which they should operate in the circumstances, relating to protection of the workers (distancing, protective clothing, testing, contact tracing, and the like). Similar relaxation of the regulations should be extended to a wide range of enterprises and industries, and the authorities must look to aggressively seek ways to enable businesses to operate within safe strictures. Not doing this would be an abrogation of their responsibilities to their electorate and the publics they serve.

Summary

We believe that Elon Musk is correct, the Tesla plant can and should be opened, and that the data – which we have been following closely in these columns – support him.

In expressing these findings in other fora, we have been told “you are not scientists, you have to listen to the scientists.” That is reasonable advice, but the truth is that the scientists do not yet agree amongst themselves! We have heard opinions on both sides of the argument from a wide range of scientists. Both sides have theories that sound convincing.

The data is all that we have as reliable guidance, and the most important data points are actual experience. Here we point to the graphs in the above column, showing California as having a low rate of mortality, and one that is within normal bounds. This is a very good indicator for a return to economic activity.

Also, and perhaps most importantly, we can point to the experience of Germany, who have successfully kept its manufacturing operations open through the whole course of the pandemic. The Wall Street Journal reports on May 7: “German authorities, unlike those in Italy and Spain, gave all factories the option to stay open through the pandemic. More than 80% of them did so, and only one-quarter have canceled investments, according to a recent survey conducted by the Institute for Economic Research, a Munich think tank” https://www.wsj.com/articles/how-germany-kept-its-factories-open-during-the-pandemic-11588774844?mod=hp_lead_pos5&mod=article_inline

Again, we point out that Germany is experiencing only 40% of the mortality rate per head of population than the U.S.  California, with an even lower rate of mortality than Germany, should be equal to that same policy.

California has shown great leadership in its handling of the pandemic – it now needs to lead the way into managing a future in which COVID-19 is another fact of life.

Larry Goldberg

Cary, 5/7/2020