Is coronavirus as deadly as they say? (& Economic crash could cost more lives than virus)

March 25, 2020

Tom Gross writes regarding the image above:

In Europe. (Actually the clocks go forward so we lose an hour, but the sentiment of this joke seems real.)

 



And now something away from political news...



 



(This is only a joke, so please don’t bombard me with angry emails.)

 

CONTENTS

1. Uncharted territory
2. Piles of bodies in the corner?
3. Iran expels “Doctors Without Borders” despite worsening epidemic
4. A flight in face masks
5. Don’t forget to exercise
6. Is the Coronavirus as Deadly as They Say? (Wall Street Journal, March 25, 2020)
7. Economic crash could cost more lives than coronavirus, says expert (The Times of London, March 25 2020)
8. Coronavirus may have infected half of UK population — Oxford study (Financial Times, March 24 2020)
9. Private Industry Mobilizes Against the Coronavirus (Wall Street Journal, March 25, 2020)

 

UNCHARTED TERRITORY

[Note by Tom Gross]

I have sent several dispatches on this list highlighting the dangers of coronavirus. Below, by contrast, are some articles from today and yesterday, which, in essence, take President Trump’s view that the cure (of virtually closing down entire economies for a prolonged period) may be worse than the damage caused by the virus.

An opinion article today (not copied below) in the Washington Post, co-authored by the well-regarded epidemiologist Dr. Michael T. Osterholm, says:

“We are in uncharted territory. But the best alternative will probably entail letting those at low risk for serious disease continue to work, keep business and manufacturing operating, and ‘run’ society, while at the same time advising higher-risk individuals to protect themselves through physical distancing and ramping up our health-care capacity as aggressively as possible.

“With this battle plan, we could gradually build up immunity without destroying the financial structure on which our lives are based. Very soon, we may have to acknowledge that attempting to stretch out cases in the hopes of keeping the curve reasonably flat is unworkable.”

 

PILES OF BODIES IN THE CORNER?

Tom Gross adds:

In general most fatalities have been elderly and/or suffering from pre-existing medical conditions, and clearly those populations need protection.

In Israel, for example, the five people who have died of coronavirus all suffered from serious underlying health conditions and were aged 88, 87, 67, 76 and 87.

In some cases, reports of younger people dying of coronavirus have proven incorrect. For instance, Los Angeles County health officials backtracked yesterday on their earlier announcement that a 17-year-old died from coronavirus. (Hours earlier, Gov. Gavin Newsom had cited the death of the teenager as evidence the virus can strike anyone.)

Nevertheless there are reports of younger people dying, for example this 21-year-old in the UK (though we don’t know for sure that she did not have underlying medical conditions):

http://news.sky.com/story/coronavirus-briton-21-with-no-existing-health-conditions-dies-after-contracting-covid-19-11963451

Trump has been ridiculed for his comments calling for a quick end to the lockdown. Bill Gates, for example, said “It’s tough to tell people keep going to restaurants, go buy new houses, ignore that pile of bodies over in the corner.”

It is clear that in places such as Spain (where the death toll now exceeds that in China) and New York City, there are very real problems and tragedies caused by the coronavirus outbreak.

So I attach the articles below as food for thought, not as a criticism of the policy.

 

IRAN EXPELS “DOCTORS WITHOUT BORDERS” DESPITE WORSENING EPIDEMIC

A team of nine doctors sent to Iran by the international medical humanitarian organization Doctors Without Borders (Médecins Sans Frontières) to help with the coronavirus outbreak has today been expelled from the country by the regime, which continues to care little for its people.

The French doctors were planning to set up a 50-bed inflatable field hospital in Isfahan, one of Iran’s worst affected areas.

 

A FLIGHT IN FACE MASKS

On Monday, Israel sent a plane to take home 330 Israelis, mostly students, from the coronavirus hit region of northern Italy. The passengers were required to wear face masks for the entire flight from Milan to Tel Aviv and were served by flight attendants dressed in full-body protective gear. The passengers are now in a two-week quarantine at a hotel provided by the Israeli government.

 

DON’T FORGET TO EXERCISE

On a separate note, for people with younger children stuck at home, here are videos for them to dance (keep doing exercise) to.

https://www.youtube.com/watch?v=ymigWt5TOV8

https://www.youtube.com/watch?v=BwAxvVldU1Y


ARTICLES

IS THE CORONAVIRUS AS DEADLY AS THEY SAY?

Is the Coronavirus as Deadly as They Say?
Current estimates about the Covid-19 fatality rate may be too high by orders of magnitude.
By Eran Bendavid and Jay Bhattacharya
Wall Street Journal
March 25, 2020

(Dr. Bendavid and Dr. Bhattacharya are professors of medicine at Stanford.)

If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there’s little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high.

Fear of Covid-19 is based on its high estimated case fatality rate—2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, two million to four million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.

The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills two million. If the number of actual infections is much larger than the number of cases—orders of magnitude larger—then the true fatality rate is much lower as well. That’s not only plausible but likely based on what we know so far.

Population samples from China, Italy, Iceland and the U.S. provide relevant evidence. On or around Jan. 31, countries sent planes to evacuate citizens from Wuhan, China. When those planes landed, the passengers were tested for Covid-19 and quarantined. After 14 days, the percentage who tested positive was 0.9%. If this was the prevalence in the greater Wuhan area on Jan. 31, then, with a population of about 20 million, greater Wuhan had 178,000 infections, about 30-fold more than the number of reported cases. The fatality rate, then, would be at least 10-fold lower than estimates based on reported cases.

Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That’s more than 130-fold the number of actual reported cases. Since Italy’s case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.

In Iceland, deCode Genetics is working with the government to perform widespread testing. In a sample of nearly 2,000 entirely asymptomatic people, researchers estimated disease prevalence of just over 1%. Iceland’s first case was reported on Feb. 28, weeks behind the U.S. It’s plausible that the proportion of the U.S. population that has been infected is double, triple or even 10 times as high as the estimates from Iceland. That also implies a dramatically lower fatality rate.

The best (albeit very weak) evidence in the U.S. comes from the National Basketball Association. Between March 11 and 19, a substantial number of NBA players and teams received testing. By March 19, 10 out of 450 rostered players were positive. Since not everyone was tested, that represents a lower bound on the prevalence of 2.2%. The NBA isn’t a representative population, and contact among players might have facilitated transmission. But if we extend that lower-bound assumption to cities with NBA teams (population 45 million), we get at least 990,000 infections in the U.S. The number of cases reported on March 19 in the U.S. was 13,677, more than 72-fold lower. These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears.

How can we reconcile these estimates with the epidemiological models? First, the test used to identify cases doesn’t catch people who were infected and recovered. Second, testing rates were woefully low for a long time and typically reserved for the severely ill. Together, these facts imply that the confirmed cases are likely orders of magnitude less than the true number of infections. Epidemiological modelers haven’t adequately adapted their estimates to account for these factors.

The epidemic started in China sometime in November or December. The first confirmed U.S. cases included a person who traveled from Wuhan on Jan. 15, and it is likely that the virus entered before that: Tens of thousands of people traveled from Wuhan to the U.S. in December. Existing evidence suggests that the virus is highly transmissible and that the number of infections doubles roughly every three days. An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.

This does not make Covid-19 a nonissue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical. We don’t know the true infection rate in the U.S. Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial. Nearly every day a new lab gets approval for antibody testing, so population testing using this technology is now feasible.

If we’re right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible. Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. And policy makers will need to focus on reducing risks for older adults and people with underlying medical conditions.

A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lockdowns.

 

ECONOMIC CRASH COULD COST MORE LIVES THAN CORONAVIRUS, SAYS EXPERT

Economic crash could cost more lives than coronavirus, says expert
Keeping the economy going is crucial because there is a link between GDP and life expectancy
Tom Whipple, Science Editor
The Times (of London)
March 25 2020

If the coronavirus lockdown leads to a fall in GDP of more than 6.4 per cent more years of life will be lost due to recession than will be gained through beating the virus, a study suggests.

Philip Thomas, professor of risk management at Bristol University, said that keeping the economy going in the next year was crucial, otherwise the measures would “do more harm than good”.

“I’m worried that in order to solve one problem we’d create a bigger problem,” he said a day after economists predicted we were on course for the worst recession in modern history.

There is a clear link between GDP and life expectancy, in part due to richer countries being able to spend more on healthcare, safety and environmental regulations. This means it is possible to calculate roughly the effect of increased, or decreased, wealth on the health of a population.

In a paper published before peer review, Professor Thomas has offset that figure against the lives saved through going into lockdown for a year while awaiting a vaccine. According to his modelling, just under a million Britons would die if we let the virus run unchecked. Most of those would be elderly and in terms of years of lives lost would equate to the deaths of 400,000 average age adults, roughly comparable to the toll of the Second World War.

“This is not going to be a three-week or three-month problem,” Professor Thomas said of the virus. Assuming our exit strategy is a vaccine, he said, “we’re talking 12 months, and that looks tight.”

This is why he thinks the economy is crucial — not because of a callous belief that lives can be traded for money, but because money and lives are, at some point, the same thing. “We see this very strong correlation between GDP and life expectancy,” he said. In his paper, published on Jvalue.co.uk, he estimates that if global trends can be extrapolated to the UK economy then the “tipping point”, to offset those 400,000 lives, comes when GDP falls by 6.4 per cent.

“If you reduce GDP per head by so much you start to reduce life expectancy considerably. Then what you are doing is cutting back GDP and at the same time shortening all our lives,” he said. “We are facing something very grave and it’s going to be very grave either way.”

The publication of the paper came as business leaders warned of a deep and lasting recession. IHS Markit, which produces the purchasing managers’ index with the Chartered Institute of Management and Supply, found the economy to be contracting at the fastest rate since the index began in 1998. It estimate that Britain’s economy had shrunk by 1.5-2 per cent this quarter, and predicted that following a total shutdown that figure would soon be “dwarfed” by what lay ahead. Some economists estimate we could expect a 15 per cent drop in the next quarter.

For comparison, at the height of the 2008/9 financial crash, the economy contracted by 2.1 per cent in a single quarter. Chris Williamson, IHS’s chief business economist, said, “a recession of a scale we have not seen in modern history is looking increasingly likely.”

The link between mortality and the economy is clear, but not simple. Some studies have suggested that it may be that greater life expectancy itself leads to economic growth, rather than the other way round. Short term effects are also sometimes in the opposite direction. Although suicides are linked to recessions, they can be offset by a fall in deaths caused by pollution and by accidents at work. The strength of the link between increased GDP and longevity also flattens off the richer a country gets.

The publication of the paper came as business leaders warned of a deep and lasting recession. IHS Markit, which produces the purchasing managers’ index with the Chartered Institute of Management and Supply, found the economy to be contracting at the fastest rate since the index began in 1998. It estimates that Britain’s economy had shrunk by 1.5-2 per cent this quarter, and predicted that following a total shutdown that figure would soon be “dwarfed” by what lay ahead. Some economists estimate we could expect a 15 per cent drop in the next quarter.

For comparison, at the height of the 2008/9 financial crash, the economy contracted by 2.1 per cent in a single quarter. Chris Williamson, IHS’s chief business economist, said, “a recession of a scale we have not seen in modern history is looking increasingly likely.”

The link between mortality and the economy is clear, but not simple. Some studies have suggested that it may be that greater life expectancy itself leads to economic growth, rather than the other way round. Short term effects are also sometimes in the opposite direction. Although suicides are linked to recessions, they can be offset by a fall in deaths caused by pollution and by accidents at work. The strength of the link between increased GDP and longevity also flattens off the richer a country gets.

Mr Thomas said that while the government could well have had no choice but to instigate the current policies, the focus now should be on making the economy work even while much of the country is confined to home.

“It worries me when I hear people saying, ‘Well, vital services can be kept going’. An economist would say that all the services we have are important.

“That’s why people spend money on them.

“The size of the problem is clear. You’ve got to find a way of keeping the whole country working.

 

CORONAVIRUS MAY HAVE INFECTED HALF OF UK POPULATION — OXFORD STUDY

Coronavirus may have infected half of UK population — Oxford study
New epidemiological model suggests the vast majority of people suffer little or no illness
By Clive Cookson, Science Editor
March 24, 2020
Financial Times

The new coronavirus may already have infected far more people in the UK than scientists had previously estimated — perhaps as much as half the population — according to modelling by researchers at the University of Oxford.

If the results are confirmed, they imply that fewer than one in a thousand of those infected with Covid-19 become ill enough to need hospital treatment, said Sunetra Gupta, professor of theoretical epidemiology, who led the study. The vast majority develop very mild symptoms or none at all.

“We need immediately to begin large-scale serological surveys — antibody testing — to assess what stage of the epidemic we are in now,” she said.

The modelling by Oxford’s Evolutionary Ecology of Infectious Disease group indicates that Covid-19 reached the UK by mid-January at the latest. Like many emerging infections, it spread invisibly for more than a month before the first transmissions within the UK were officially recorded at the end of February.

The research presents a very different view of the epidemic to the modelling at Imperial College London, which has strongly influenced government policy. “I am surprised that there has been such unqualified acceptance of the Imperial model,” said Prof Gupta.

However, she was reluctant to criticise the government for shutting down the country to suppress viral spread, because the accuracy of the Oxford model has not yet been confirmed and, even if it is correct, social distancing will reduce the number of people becoming seriously ill and relieve severe pressure on the NHS during the peak of the epidemic.

The Oxford study is based on a what is known as a “susceptibility-infected-recovered model” of Covid-19, built up from case and death reports from the UK and Italy. The researchers made what they regard as the most plausible assumptions about the behaviour of the virus.

The modelling brings back into focus “herd immunity”, the idea that the virus will stop spreading when enough people have become resistant to it because they have already been infected. The government abandoned its unofficial herd immunity strategy — allowing controlled spread of infection — after its scientific advisers said this would swamp the National Health Service with critically ill patients.

But the Oxford results would mean the country had already acquired substantial herd immunity through the unrecognised spread of Covid-19 over more than two months. If the findings are confirmed by testing, then the current restrictions could be removed much sooner than ministers have indicated.

Although some experts have shed doubt on the strength and length of the human immune response to the virus, Prof Gupta said the emerging evidence made her confident that humanity would build up herd immunity against Covid-19.

To provide the necessary evidence, the Oxford group is working with colleagues at the Universities of Cambridge and Kent to start antibody testing on the general population as soon as possible, using specialised “neutralisation assays which provide reliable readout of protective immunity,” Prof Gupta said. They hope to start testing later this week and obtain preliminary results within a few days.

 

PRIVATE INDUSTRY MOBILIZES AGAINST THE CORONAVIRUS

Private Industry Mobilizes Against the Coronavirus
The feds don’t need to nationalize the economy to fight Covid-19.
The Editorial Board
Wall Street Journal
March 25, 2020

President Trump can’t do right by some critics no matter what he does. For three years he’s been denounced as a reckless authoritarian, and now he’s attacked for not being authoritarian enough by refusing to commandeer American industry. The truth is that private industry is responding to the coronavirus without command and control by the federal government.

Last week Mr. Trump invoked the 1950 Defense Production Act that lets a President during a national emergency order business to manufacture products for national defense, set wage and price controls and allocate materials. On Tuesday the Federal Emergency Management Agency used the Korean War-era law for the first time in this crisis to procure and distribute testing kits and face masks.

But Democrats want the Administration to take over much more of the private economy. New York Gov. Andrew Cuomo on Sunday tweeted that the federal government should “nationalize the medical supply chain” and “order companies to make gowns, masks and gloves.” He has been echoed by Democratic governors and leaders in Congress.

Yet businesses across America are already chipping in where they can. Aerospace manufacturer Honeywell plans to hire 500 workers at its plant in Rhode Island, which currently produces safety goggles, to make millions of N95 face masks for medical professionals. 3M has doubled its global output of N95 masks and this week is sending 500,000 respirators to hot spots in the U.S.

Corporations including Apple, Facebook, Tesla and Goldman Sachs are donating millions of medical masks stockpiled for wildfires or a biochemical attack. Apparel manufacturers are repurposing textile mills to produce personal protective equipment. Hanes plans to manufacture masks using U.S. cotton at factories in El Salvador, Honduras and the Dominican Republic. Diverse supply chains can help businesses operate more flexibly during a crisis since they don’t depend on any single country for materials or workers. That’s why an America first or America only government supply order would be a mistake.

Maine-based Puritan Medical Products, one of America’s top sources for nose swabs, says it has been rushing to keep up with orders even as some workers have become sick. Directing the company to produce more coronavirus swabs won’t do any good if it can’t get more workers and could create a shortage of flu tests if it has to divert resources from other lines.

Businesses know their workforce capacities and supply chains better than the government—and how to retool them to maximize efficiency. Dozens of breweries and distillers including Anheuser-Busch and Pernod Ricard USA are churning out hand sanitizer. General Electric plans to hire more workers to produce ventilators even while it lays off thousands in aviation. Fuel cell manufacturer Bloom Energy is retrofitting hundreds of old ventilators for the state of California.

Ford said on Tuesday that it would start assembling plastic face shields and work with 3M and GE to make respirators and ventilators. General Motors is also exploring how to use its global automotive supply chain to make ventilators. Ford’s CEO said its ventilators could be available by June, and it isn’t obvious that a government takeover of manufacturing would speed this up.

It might make sense for the federal government to purchase supplies from manufacturers and then allocate them to hospitals and states with the highest need. But it doesn’t make sense to order manufacturers like Apple or GM to make nose swabs or chemical reagents for testing kits if they don’t have the expertise or suppliers to do so.

The U.S. Army Corps of Engineers can also help convert vacant hotels and college dorms into make-shift hospitals, as it is doing in New York. When this pandemic is over, one of the lessons is likely to be that the government should have done more earlier to purchase and surge medical equipment to hospitals.

But dictating to businesses now will lead to bureaucratic snafus and inefficiencies. President Trump said Sunday “we’re a country not based on nationalizing our business.” That’s the right impulse. America needs to emerge from this with a private economy intact and ready to grow again, not nationalized industries subject to bureaucratic and political control.

 

* You can also find other items that are not in these dispatches if you “like” this page on Facebook www.facebook.com/TomGrossMedia

All notes and summaries copyright © Tom Gross. All rights reserved.