Coronavirus dashboard for March 27: (unsurprisingly) voluntary distancing appears to be failing

Here is the update through yesterday (March 26)

In order to succeed in containing the pandemic, I believe that the US needs 2 weeks of China (nearly complete lockdown) followed by at least a month of South Korea (very aggressive and widespread testing).

At minimum, that means at least 50% of the US population under lockdown and a ratio of 15:1 in tests to results showing infection. The recent exponential growth of about 35% per day must be stopped. Those three most important metrics are starred (***) below.

As of now, just over 50% of the population is under total or business lockdown, and the rate of increase in new infections decelerated significantly – but is still growing at near 25%/day. The amount of testing continues to increase, but still is falling far short of what is necessary for a successful regimen.

Number and rate of increase of Reported Infections (from Johns Hopkins via arcgis.com)

• Number: up +16,815 to 86,012 (vs. +16,815 on March 26)

• ***Rate of increase: day/day: 24% (vs. 34.6% baseline and vs. 25% on March 26)

I am using Jim Bianco’s excellent exponential projection of 34.5% growth from March 10 as my baseline. It appears that “social distancing” strategies as well as State-mandated partial and total lockdowns may have begun to put a dent in this, as yesterday’s +25% and Tuesday’s+19% have been 2 of the 3 lowest rates of increase in the past two+ weeks. At the same time, it remains an exponential growth rate.

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This came up on the radar this morning.

PROVIDENCE, R.I. (AP) – The American Civil Liberties Union of Rhode Island is questioning the constitutionality of Gov. Gina Raimondo’s directive allowing state police to stop vehicles with New York license plates to collect information from drivers and passengers in an effort to slow the spread of the coronavirus.

The Democratic governor on Thursday called the measure extreme but pointed out that the New York City area is the epicenter of the disease in the U.S.

While Raimondo has the authority to suspend some state laws and regulations to address a medical emergency, she cannot suspend the Constitution, ACLU of Rhode Island Executive Director Steven Brown said in a statement late Thursday.

“Under the Fourth Amendment, having a New York state license plate simply does not, and cannot, constitute ‘probable cause’ to allow police to stop a car and interrogate the driver, no matter how laudable the goal of the stop may be,” he said.

The governor’s directive is simply to ensure that travelers from New York staying in Rhode Island know they are required to self-quarantine for 14 days, Raimondo’s spokesman said.

Hat Tip CBS Boston, March 27,2020

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I just received this as a text from an ICU worker in a medium size hospital not in NY, CA, Washington, Illinois, nor Louisiana.

Mobile morgue

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Notes on the economy and coronavirus issues

As is obvious, I have stopped reporting on almost all incoming economic data, as anything older than last week is out of date. But once the last important February data is reported tomorrow, I will take one last fond look back at our pre- Coronavirus Recession economy. How close to recession was it?

I also want to write a few more detailed posts on several points. But for now, let me leave a quick note about some important issues going forward.

1. The federal government under Donald Trump is NEVER going to do what is necessary to bring this pandemic under control. Success is only going to be achieved by cooperative action by the States.

2. As I forecast, the increasing urgency of the pandemic has put the States under enormous public pressure to take more effective action. Most, especially the “blue” States and some Eastern, Midwestern, and a few Mountain West “red” States have done so. But Southern “red” States in particular continue to resist, and probably will continue to do so until it is too late – although ultimately they too will respond to pressures from their publics.

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Coronavirus dashboard for March 26: southern “red” States resist effective measures

Here is the update through yesterday (March 25)

In order to succeed in containing the pandemic, I believe that the US needs at least 2 weeks of China (nearly complete lockdown) followed by at least a month of South Korea (very aggressive and widespread testing).

At minimum, that means at least 50% of the US population under lockdown and a ratio of 15:1 in tests to results showing infection. The recent exponential growth of about 35% per day must be stopped. Those three most important metrics are starred (***) below.

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Congress and the Fed Could Ensure Universal Protection During the Pandemic

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A clinical trial of hydroxychloroquine with 30 patients (15 treated 15 controls) has been completed in Shanghai. It is the first genuine randomized trial. It reports no evidence that hydroxychloroquine works at all.

It is true, that given the principal outcome measure defined in advance, the trial has no power. Not low power, 0 power. In a hypothetical, if all patients treated with hydroxychloroquine became healthy immediately with no symptoms and no detectable virus, then the report would be that there was not a statistically significant diference in the principal outcome measure for the treated and control subgroups.

The principal outcome measure was “can virus be detected 7 days after treatment starts”.
the answer was yes for 2 people in the treated group and 1 person in the control group.

Given that 14 out of 15 people in the control group had no detectable virus, the best outcome for hydroxychloroquine would have been 15 out of 15 in the treated group. Again a hypothetical, what if all the treated patients were assessed as cured after a week (best possible value of the principle outcome measure). This would reject the null that the probabilities were the same against the 1 sided alternative that treatment was better at the 50% level. It would reject the null against the two sideded alternative at the 100% level (not a typo).ù

So exactly zero power. Not low 0, zero, nada, niente.

With the benefit of hindsight, the researchers write that they could have designed the trial better. This does not mean that mistakes were made. When in a crisis, one has to act and must not make sure that one doesn’t do anything which is clearly suboptimal with the benefit of hindsight. That would imply sitting around thinking. They didn’t have time for that.

The secondary outcome measures provide statistically insignificant evidence that one is better without hydroxychloroquine. As noted by the authors, none of this evidence is strong enough to affect best practice of medicine (I still think that all patients without counterindications should be given hydroxychloroquine (I am not a doctor)).

The trial

At the clinical trials register, it is tagged “completed”, but the results are not yet uploaded (given the absolutely rigid standard format this takes the time of someone who is probably very busy).

The results are reported here.

p.s.

googling for the link above, I found Hydroxychloroquine Is Ineffective In Treatment Of Patients Hospitalized With Covid-19, According To Small Controlled Trial From Shanghai

To that headline I say no No NOOOOOOO. Failure to reject the null is not a finding that the null is the truth. that would only be the case if all tests had power 100%. Since this test happens to have power 0%, the error is extreme. The error of rejecting the null is universal. It is a simple mistake – a failure to understand the Neyman Pearson framework.

Since I am a big fan of the alternative in this case, it is a delicate time to point out that the headline is simply incorrect. But it is.

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Massive Scandal or a Massive Misunderstanding of Regs and Laws for Orphan Drugs

Most of you know, I have been writing on healthcare for a long time and much of it has been negative about healthcare and the costs. I am not defending Gilead’s marketing of Remdesivir; but, a few articles (Common Dreams, The Intercept, etc.) written and the pundits amongst us appear to have misunderstood the issue for Remdesivir’s status.

I can understand why people would become excited and upset with the actions by the FDA to “designate” Remdesivir an orphan drug “candidate (note the quote notation).” In the past, I have found myself to be distracted by headlines (Intercept) which lead me to believe something bad was to come about only to find out it was not as serious as described in the headlined article. With all the issues we are faced with from COVID 19, the half attempt to mandate a lockdown of us in our homes, people “still” clustering, and our government led by a jackass; it is easy to get agitated.

Some thoughts; Given the pandemic, COVID 19 appears to be the exact opposite of a rare disease and describing a new drug for it as an orphan-drug does sound absurd.

A Little History

The seventies found incentives for profit-making drug companies not aligning with the needs of people having rare diseases. Drug Development of new drugs was expensive even 40 years ago. Companies concentrated on needed new therapies and pharmaceuticals potentially having high customer demand yielding increased profits rather than focusing  on those therapies and pharmaceuticals needed by a handful of patients. In 1983, the Orphan Drug Act was passed to encourage R&D for these drugs.

The FDA was given the power to grant a drug “orphan” status and to compounds without patent protection. If a company got its product “approved” as an orphan drug, it gained a period of market exclusivity of seven years. No one else was allowed to sell the same product to treat that specific disease. Additionally, the costs associated with developing that orphan drug including payroll for scientists, and miscellaneous costs were subject to a tax credit. Under the Orphan Drug Act, more than 800 orphan drugs and biologics have been approved by the FDA out of more than 5,300 applications. The Whys and Whats after the leap   .   .   .

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In case you missed it, here's the recent ad from Republicans for the Rule of Law featuring President Trump's own words on the pandemic. pic.twitter.com/mExr5eGqhr

— Bill Kristol (@BillKristol) March 22, 2020

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Lockdowns work

1. San Francisco (lockdown ordered March 16) vs. New York City (lockdown ordered March 20)

2. San Francisco vs. Miami-Dade County (no lockdown)

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