Thursday, April 16, 2020

Two Differing Views On "Reopening"

As President Trump and the various governors discuss possibilities for reopening the US economy in the direction of where we were before the Wuhan pandemic struck, here are two articles that offer somewhat differing views.

The first is from The National Interest. I like it because it places a lot of emphasis on an area that I think is fundamental, but in which we as a country are not where we should be--transparency:

Coronavirus Death: Who Is This Plague Targeting?
Today, President Trump, leaders of his administration, Congress, and governors are wrestling with fateful choices about when and how to reopen America’s economy. In designing a program to do that, it is essential that they have the clearest possible understanding of who is actually bearing the lion’s share of the additional burden from coronavirus.

Read the whole thing--it summarizes a report that will be coming out from Harvard's Kennedy School for Government. For our purposes I'll just provide the concluding considerations. They're not highly specific, but do provide a general framework for planning for the future.

First, the author--Graham Allison--provides us with a thumbnail on who exactly can be said to be "targeted" by Covid19. It's not complicated:

  • Those over 65;
  • Those who are male (3/2);
  • Those with severe preexisting conditions;
  • African Americans.

Obviously these are overlapping categories, and caveats are required especially with regard to males and African Americans. The Allison does note:

this virus is prejudiced against African-Americans—though not as dramatically as the extreme claims being made.

After setting the stage with basic statistical data, Allison offers some recommendations:

If [the data] now available proves to be roughly right, the implications for what governments at all levels—national, state, and city— should now be doing are profound. 
Today, President Donald Trump, leaders of his administration, Congress, and governors are wrestling with fateful choices about when and how to reopen America’s economy. In designing a program to do that, it is essential that they have the clearest possible understanding of who is actually bearing the lion’s share of the additional burden from coronavirus. Assuming the first draft of the alternative diagnosis of the challenge presented in the report is confirmed, might it be possible to find a way to provide greater protection to those most vulnerable to this killer by sheltering them in ways that preclude contact with potential carriers, on the one hand, while re-opening the bulk of the economy, on the other? If something like this were to prove to be the best way forward, the fact that four in five of those over 65 had already retired from the workforce BC would be an advantage. 
In the hope of kick-starting a debate that will lead to a better diagnosis than the current Washington consensus, our report makes three recommendations.
Our first recommendation should be incontestable. The time is long past for the CDC and its related agencies to release all the demographics they have about age, sex, race, preexisting conditions, and other attributes of those being infected and dying from this novel killer. Congress and the press should demand that it be released now. 
The second recommendation calls on governments at all levels to act to protect those most likely to be victims of this killer. Current choices about the allocation of scarce resources should be reviewed with an eye to differential risks coronavirus is imposing on specific groups. To cite just one example, if males over 65 with preexisting conditions or African Americans are shown to be disproportionately in the crosshairs of this killer, guidelines about who should be at work now and as the economy reopens, and who should remain sheltered at home should take this into account. If they did so, the guidelines the CDC issued last week advising workers in businesses including supermarkets and gas stations who have been in contact with a confirmed or suspected case but now show no symptoms, to return to work (as long as they have no temperature and wear face masks) should not include members of the most vulnerable groups. 
Finally, we recommend radically widening the debate—far beyond the public health professionals and policymakers now driving the Trump administration’s choices. ...

In fairness to the president, I have no doubt that he's already consulting with lots of people beyond "public health professionals and policymakers."

I won't even quote from the second article, which is at the very liberal Vox:

A preliminary Trump administration plan shows how far America is from reopening
The Trump administration’s reported plan calls for aggressive testing. The US is simply not there yet.

If you want to read about the importance of testing--which I personally don't doubt--this is the article for you.

Now, before I stop, I'll link to a final article that again illustrates the difficulties we--potentially--face:

Scientists Discover Alarming Coronavirus Mutation That Could Render Vaccine Useless


  1. I wonder if the conclusions about race based affinity of this virus is not a political conclusion. I haven't read the study, but there is a lot that has to be factored in when concluding race is a determining factor based just on outcome statistics. It could be housing density, or the type of profession that is really the reason for those results. I doubt that the backgrounds of each case of this disease have been investigated in a way to adjust data for other confounding factors.

    The Zerohedge story was one I ready today as well. The headline doesn't really match the quote. The quote goes out of its way to explicitly state "Despite that, we found the spike glycoprotein of SARS-CoV-2 is particularly more conserved..." . This is precisely what a vaccine would target. They saw "a" mutation. We know viruses mutate--this one sprung into human populations only through that sort of process. It bears watching, but the headline seems more alarmist than is warranted.

    1. There are lots of factors that go into the race and male categories. I think the author is actually cautious about that. Re Zerohedge, the headline is more alarmist than the study--yes. I included it simply to highlight the uncertainties that policy makers do face as they move toward "reopening."

  2. As a follow-on post to questioning whether the Zerohedge story was too alarmist, it might actually provide very positive news. The mutation they did find in India tended to weaken how well the virus binds to its target. That sounds like a less deadly virus to me.

    I am sitting in self quarantine right now because I have what I and my doctor believes is likely covid-19, but because I have no risk factors I am not being offered a test. This is how testing is happening per CDC guidelines. It drives down observed case numbers and drives up mortality statistics. If I had serious symptoms, I would have had a higher level of isolation and attempts would be made to contact trace because I could be confirmed with the disease. What this means is mild cases are being allowed to spread uncontrolled, while serious cases are isolated. The way our country is managing testing, diagnosing, and isolating cases would provide a selective pressure on the virus to become less lethal over time. That mutation observed in India and reported in the Zerohedge story could be a result of this pressure since the US is not the only one handling cases like this.

    1. From what I've heard--and this is just me--mutations tend to work in that direction, toward weakening. However it only takes one mutation to make a jump toward something that's more deadly. SARS did that--it was previously unknown.

      Um, I've read similar things about "selective pressure on a virus" to mutate in a certain direction. I have zero idea how that would work on an inanimate object--or however anyone defines a virus. Quasi-animate? Until someone can explain the mechanism, I just don't see our actions influencing development of a virus as if it were an intelligent lifeform.

      Hope you get past this quickly and without discomfort.

    2. I'm doing well. Today is my first day 100% symptom free, so I can go on to regularly not going anywhere like everyone else on lock down :)

      Mutations happen pretty frequently for viruses, some more than others. I've read that corona viruses mutate somewhat less than say the flu does. It depends how error prone their copying process is.

      The reason viruses tend to weaken as you have read is that the most serious cases are noticed. More serious cases are more likely to be isolated to prevent infection of others. Mild cases that do not require medical intervention will spread more easily because there are less effective actions taken to prevent that. The re-transmission rate for the less deadly mutation is then just a bit higher, making it more likely to spread to more people. More dangerous mutations, if they are suppressed through isolation to the point where they reinfect less than one other individual eventually decline to a population of zero.

    3. Glad to hear that. What I meant re mutations was not re how often they occur but that most tend to weaken the virus as a disease agent rather than strengthen it--regardless of whether they're noticed or not.

  3. A mutation that increases lethality is less likely to be passed on simply because death ends the transmission to new hosts. A virus that obtains a mutation that improves its ability to infect cells might make it more transmissible, but that also tends to make it more deadly.

    Human intervention tends to amplify this affect. The plague was eliminated as a persistent threat because despite having no understanding of pathogens, we knew it was deadly and humanity did everything we could to stop its spread. Funny enough, that's another disease that likely originated from China....hmmm.... There's a history lesson there somewhere.

    1. Anon, did you take any treatments during your recovery ?
      I for one am determined to get some hydroxy + z pac + zinc if I catch this stuff. I'm almost 66 but in fine health and not overweight. Plan on working until 72.

    2. I did not take any treatments. My first symptom was shortness of breath. This occurred in the middle of a home exercise routine and made me cut it short--it took me about 15 minutes to recover from a sense of feeling out of breath, but once I did, I did not have that level of discomfort again.

      I think due to my general health, I already had a good lung capacity and so I did not have issues breathing without intense physical exertion. I think someone with low lung capacity may have been affected at a lower level of activity than I was. But I did have mild to moderate lung pain while breathing for 3 days. My only treatment was lots of vitimin C, some extra Zinc, and tylenol and aleve for fever/body aches. From first symptoms to fever breaking was only 5 days. I've felt much worse with a bad flu than this. But I realize there is a wide variability in how people react to this. Most people read that there is coughing, but I had not even a hint of a scratchy throat or congestion and no other respiratory symptoms besides lung pain.

  4. New site that helps to see trends down to a county level.

    I wish it would have an option to include amount of testing done.

    1. Great map! Very informative about reopening, if you think about the info.

    2. What I mean is, if you look at that map and realize how much of the geographic area is of counties with fewer than 100 cases per 100K people, and then realize that that embraces a vast population, then I'd say there are good grounds for reopening huge tracts of the US.

  5. The map confirmed my guess that a local county, Riverside, was increasing a lot. I was not sure, Since the county website was not providing history, and the California state site was not providing county information.

    My guess due to the increases is why riverside county decided to require face coverings.

    Ama omg how fast it’s grown.