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Sunday, July 5, 2020

Seriously, Don't Shut Down Again!

(NOTE:  This post has been updated several times, see the updates at the end of the post.)

It looks like several states are seeing spikes in COVID-19 in recent weeks following reopening.  While probably most of it is due to increased testing, the very large spikes (and increases in positivity rates) in Texas, Arizona, Florida, California, and some other states also show increases in hospitalization rates, so at least some states are likely seeing real increases.  And those are generally the ones who reopened before even reaching their peaks, while California's early flattening of their curve seems to have merely delayed the bulk of their infection burden.  And interestingly, Georgia had not seen any real spikes until very recently, despite being the first state to reopen.  Meanwhile many states, most notably New York and New Jersey, have not seen any spikes at all despite increased testing and massive protest rallies in recent weeks.  Both were among the first states to have mandatory mask requirements, and were also the earliest and hardest-hit states.

Even the increase in hospitalization numbers may be less than meets the eye.  Given how now they tend to test every patient that darkens their doors regardless of what they initially went in for, that alone will push the numbers up, especially since many new patients are from the backlog of patients when non-urgent and elective procedures were restricted during the shutdown and many people had a fear of going to hospitals due to COVID-19.

Thus, it may not even be due to the timing and pace of reopening at all, but rather due to how many people are wearing masks, and simply that states that were hit harder earlier, the epidemic has largely run its course, while the states that started with milder outbreaks simply still have a ways to go yet.  And overcrowded bars and nightclubs seems to be the biggest culprits in the new hotspots lately.

It is notable that death rates are still dropping nationwide despite the apparent surge in daily cases to new record highs.  Even in the new hotspot states, deaths are generally low and flat or declining, and even Arizona's death rates are still following the same old slow-burn pattern they had before reopening despite being the fastest-growing state in terms of positive test results lately.  Most new cases are coming from younger people (under age 35), a possible reason for the apparent decoupling of infection rates from death rates, and suggesting herd immunity likely occurring sooner rather than later.  Or perhaps we have learned (often the hard way) better ways to treat the disease, thus saving more lives.  Or the virus itself could simply be getting tired and losing its "mojo" after circulating so much for so long.

So even if there is a surge in cases, resist the impulse to lock down ever again.  Doing so once is already one too many times.  Simply require masks to be worn in public, particularly indoors, and tighten limits on building occupancy and large gatherings.  That's it.  Add some temperature checks and you're golden.  Maintain such policies until case numbers drop to a statistically and practically negligible level, then repeat as necessary.  As for a vaccine or cure, don't hold your breath, since a vaccine is likely years away, while anything resembling a (belated) cure would most likely not be much of a game-changer compared to existing treatments (remdesivir, steroids, etc.).

And of course, there is already a certain alternative treatment protocol that has gotten such a bad rap in the mainstream due to grossly improper use (and its infamous guilt by association with certain politicians who promoted it) that some countries have even banned it despite its rather promising effectiveness in saving lives when used early, properly, and under the advice of a qualified physician.  Switzerland briefly banned it and subsequently lifted the ban, effectively creating a natural experiment, and the results speak for themselves in terms of death rates. (The TSAP cautions the reader to always consult a physician before beginning any sort of treatment or prophylactic regimen, especially this one.)

(Also, enter lab-created antibodies, which are of course certainly worth a try in the meantime.)

As for contact tracing, they really need to step it up.  And any supposed shortage of testing capacity (even after having many months to prepare!) is no excuse not to do it, as Japan was able to do retrospective contact tracing successfully with very little testing (2000 tests per day, equivalent to about 5000 per day in the USA), focusing on the larger clusters and thus the "superspreaders" that account for the vast, vast majority of virus transmission in the community.

And perhaps COVID-sniffing dogs will soon become a thing as well.  Apparently they exist. Regardless, all of these aforementioned alternatives are far better than a return to lockdown.  So what are we waiting for?

JULY UPDATE:  It looks like daily death rates finally did begin modestly rising again for the USA, driven by a handful of hotspot states, several weeks after apparent cases had begun rising.  That said, the death rates nevertheless still remain far lower than what they were in April and May, and the case-fatality rate continues to fall.  In other words, the curve has been flattened.  And apparently a good chunk of these supposedly "new" COVID deaths are a simply a result of delayed reporting of deaths that occured back in June, May, or even April, and/or were not even necessarily caused by the virus (e.g. motor vehicle fatalities in which the deceased happened to test positive).  Thus, our argument still stands.

AUGUST UPDATE:  As the ever-insightful J.B. Handley recently noted, there is yet another crucial nuance to this pandemic that has been overlooked.  That is, much like with other seasonal viruses, in the more southern latitudes, the epidemic burns slower and the peak simply arrives later and is smaller (at least in terms of deaths) compared with the more northern latitudes.  And since even in the north (Europe and the northern US states) it arrived about three months later than a typical flu season, it would be even more delayed still in the southern US states as well as Latin America and the rest of the global south, lockdown or no lockdown.  Divide the USA by the 35th parallel and in fact you see two distinct death curves.  This is exactly what the famous epidemiologist Dr. Edgar Hope Simpson would have predicted.  Combine that with Dr. William Farr's famous Farr's Law, and one can predict that the pandemic is almost over.  So yes, much of the surge in cases and deaths in the southern states is all too real,  but even there it will be largely over (that is, no longer at epidemic proportions) in a few weeks from now.  Based on excess weekly all-cause mortality, Handley notes that the predicted end date for the USA overall is August 25, 2020, when such figures return to baseline and there is no longer any signal in the noise (even if there are still some reported cases and deaths from or with COVID-19).

(Same thing happened with its cousin SARS back in 2003, by the way.  It simply arrived and peaked later in the lower latitudes, then eventually disappeared.)

And let's not forget the problem of false positives on the PCR tests as well, which will become increasingly salient as the actual epidemic/pandemic wanes.

SEPTEMBER UPDATE:  Looks like all-cause deaths in the USA by date of death are still elevated (significant excess deaths) as of late August and early September, but declining.   Thus, the prediction by Michael Levitt was simply off by a few weeks due to reporting lags.  The lag for designated COVID deaths specifically is even longer still, with a good chunk of the deaths reported today having occurred weeks or even months ago.  And given all of the increased testing and false positives for cases, what we have now seems to be more of a "casedemic", while the actual pandemic is waning if not already technically over in most places.  A true second wave is thus unlikely.

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