Draining The COVID Fever Swamp

Look out, below! The lockdowns are becoming looser, which may be good. But also, it may be bad. It's good for the short term economy and may save a number of on-the-brink businesses and jobs. It's bad because opening up densely populated areas too soon will very likely cause a resurgence of the virus. And then we go through everything all over again, with gusto! Yay.

(This reminds me of a COVID joke I saw -
"The spread of COVID-19 is dependent on two things:
1 - the density of the population, and
2 - the density of the population.")

Now I know what you're thinking: "Wait, Daily Kibitz, what gives? Your last edition claimed that this next one would deal with how COVID will shade every bloomin' aspect of our lives going forward! The economic portrait you drew was enough to search desperately for silver linings, so where are they?"

OK, I get it. But before getting into my promised visionary take on what the post-COVID world might look like, I kept thinking about the epistemological traits of the virus itself. As we learned in the previous Kibitz post, the post-COVID world might begin in a couple of months... or a couple of years. It depends on the still-mysterious virus and how societies react to it. And while there is cause for optimism (a Korean or Israeli vaccine? Reliable antibody tests?) it's good to temper it with an appropriate amount of cautious skepticism. Otherwise, we march into an unfamiliar black forest under a moonless night with only blind faith to orient us.

So let's take this opportunity to dig in a little to better understand what kind of pickle we are in.

Here is an interesting set of charts that follow the infection rates of countries world-wide, and states within the U.S. Click on it and then you can pass your cursor over any nation or state and see its history. The best charts are the ones at the bottom that adjust the infection rate per million population:

https://91-divoc.com/pages/covid-visualization/

Yep, that's some great information! A number of plateaus, but not many dips. What the hell is Israel doing that's so effective? Big clue: Research at places like the Weizmann Institute of Science!! And this terrific article in Haaretz says it all regarding Israeli researchers' consistent focus and caution while balancing aggressive experimentation:

https://www.haaretz.com/israel-news/.premium-what-we-did-right-israeli-doctors-explain-how-they-beat-coronavirus-1.8849374

Someday, stories like that will be a part of a great book and movie. (TL;DR - don't take hydroxychloroquine!!)

Prefer a spreadsheet for your analysis? Here ya go:

https://www.worldometers.info/coronavirus/?utm_campaign=homeAdvegas1?%20%3Ca%20href=

Yes, according to this data, as of Friday, USA has over 97,000 confirmed COVID fatalities. If we were ghoulish enough to line up victims head to foot in a single line, it would stretch over 110 miles. We'll surely hit 100K by Monday, Memorial Day. And let's not think too much about the unconfirmed fatalities, which may account for the unusually high number of deaths in hard-hit states.

OK, here is a fine article produced by ProPublica. They interviewed the front line public health heads of nations succeeding with COVID and their economies. Their aggregated takeaway is wise:

https://www.propublica.org/article/coronavirus-advice-from-abroad-7-lessons-americas-governors-should-not-ignore-as-they-reopen-their-economies

"We all have to live with Coronavirus for at least a year and probably 2 - 3 years," says one expert. That's the reality. But to squash it down to non-threatening levels, these experts recommend state governors take these actions:

-- Build an army of contact tracers to identify and limit the virus carriers.
-- Be prepared to test constantly while striving to keep the new positive cases test rate under 5%.
-- Isolate people with suspected infections from their families.
-- Protect health workers (and keep them coming back to work, because it's "game over" otherwise).
-- Normal is not the goal. We'll need masks, temperature checks, social distancing, etc. for awhile.
-- Keep vigilant for a Second Wave of infections.
-- Clear and transparent communications about the disease and treatment is critical.

But what about Herd Immunity, I hear some of you say! Why can't we simply "open 'er up" and let the chips fall where they may? Aren't most COVID victims ancient or have pre-existing conditions? Aren't we all going to get COVID at some point anyway? Don't we need to consider the acceptable number of deaths versus the demise of our economy and lifestyle? And aren't church-goers shielded by the blood of Christ?

Yes, I hear all that, often. It's understandable that many people are becoming desperate as their rent becomes due and they see their debit card denied. This is the biggest mess since The Great Depression. But magical thinking won't help. Understanding the situation better will. So let's check out this engaging and excellent article on COVID and Herd Immunity:

https://fivethirtyeight.com/features/without-a-vaccine-herd-immunity-wont-save-us/

The writers present an illness they call "Fictionitis" and ask you to determine its parameters. Using the easy interactive choices, you can create the R0 (transmittable rate), the Mortality Rate, and the Immunity Duration. Try it, it's fun and educational!! All these choices are required in figuring a communicable disease's Herd Immunity threshold.

Currently, experts' best-guess estimate for achieving COVID Herd Immunity is when the virus goes through at least 70% of the population... maybe up to 90%. That means at least 230 million Americans need to get infected before achieving this threshold. Currently, we have 1,642,000 cases, or 0.5% of the population.

Even then, crossing the threshold doesn't mean the end of a disease like COVID. "It only slowly goes down, and on its way down, it infects another third of the population. If you drive a car and suddenly you switch it off, it doesn't stop instantly."

How long would COVID antibody immunity last? According to the article, no one really knows. Patients with similar coronaviruses like SARS and MERS have immune cells present in their bodies for years. But there are researchers who draw parallels to HIV, which creates huge loads of antibodies in patients but doesn't stop it.

"Our bodies could stop short of completely killing off the virus in the first place, allowing it to lie dormant and reemerge later like HIV. It could evolve enough that our old antibodies won't work anymore, whether we got them from natural exposure or vaccine. This is what seasonal flu does, and a part of why we need a new vaccine every year. Or the immune response we produce could just fade too quickly, making us susceptible to reinfection." We don't yet know if "COVID immune" people  could become re-infected, like we see with HIV immune cells.

In determining the fatality rate, accurate tests are essential, including serological tests that detect antibodies. The higher the case count, the lower the fatality rate. Now for comparison, seasonal flu has a 0.1 fatality rate. And from what the authors can conclude from New York City as of mid-May, COVID may have hit 21% of its residents. This places NYC's fatality rate at 1.1%, or 10 times deadlier than the seasonal flu.

If this fatality rate is accurate and plays out across the country, along with an unmitigated "open 'er up" Wild-West style of no restraints and all-in with crossing the Herd Immunity threshold, we can expect a floor of 2 1/2 million deaths. Recall we've only reached a number of 0.5% infected patients on our way to a projected 70%+ population threshold figure. And we cross the 100,000 deaths mark  sometime this weekend.

So whaddaya do? In the immediate end, the uncertainties of this virus remain the biggest obstacle we face. I think most people will continue to err on caution's side and observe CDC guidelines. But there will be abundant crowds of Magical Thinkers who believe that the virus will not affect them.

These folk need to listen to Owen Filer. He's 100 years old. He's been through a few world crises. He thinks this is the worst. But he's not scared. In fact, he laughs a lot. A sharper centenarian you'll never see. He's really great:

If we can live to be 100 years old and display the wit and poise of Owen Filer, we should be so lucky.

That's it for now! Next time, my visionary take on our future, for real...