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.
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.
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