Relevant and even prescient commentary on news, politics and the economy.

Covid update

I seem to be through the worst of it. My fever is down and my cough is subsiding. If I hadn’t gotten a covid test I would have thought I had a moderately bad cold. With a bit of luck, it’s all over except the quarantine. Thanks to everyone for their good wishes.

Paying people to get vaccinated?

Apparently there are proposals circulating to pay people to get vaccinated. (Summary here.) The pro/con story is familiar enough. Monetary incentives might increase the uptake rate; but they might also increase suspicion and backfire, or at least not be very effective. Given the large cost involved – the number cited in the linked article is $1,000, which could cost well over a hundred billion depending on eligibility – a small increase in vaccination rates might not be worth it.

Here is an alternative suggestive. When people get vaccinated, give them cash cards worth $100 that can only be used to purchase restaurant food for 10 days, beginning 5 days after they get vaccinated. The framing of this might be more positive than a simple cash incentive – we are paying you to go out and help jump start your local economy, especially the businesses that have been struggling so much in the epidemic. It helps to emphasize the pro-social aspect of getting vaccinated. Plus it would be much cheaper than giving everyone $1,000, and support from restaurants might help push it into the end zone in Congress.

I have covid . . .

I’m fairly certain I picked it up this past Tuesday.   Wednesday night I had a slight throat-clearing cough.  Not sure if this was covid related or not.  Saturday I had a fever of 100.5, along with some achiness.  I got tested on Saturday and received the positive test result on Sunday.  Last night was a bit worse than the night before.  I had chills and aches.  When I am not sick I am usually more or less pain free; when I get a cold or flu all my old aches and pains come back for an encore.  That happened last night.  In addition, the cough moved into my lungs and became deeper, and I got just a bit wheezy.  This morning with the help of acetaminophen I feel pretty good – if you dropped me into my body without telling me that I had covid it might take me a while to notice that I was sick.  I don’t have any other symptoms.

My initial reaction to my diagnosis was fairly optimistic.  I thought it was likely I would have a mild case and would soon be able to visit family and friends again, including a favorite uncle who is quite sick.  Having read a bit on disease progression, I think my initial take may have been a bit optimistic.  I am still early in the course of the disease; things could definitely go south over the next 3 to 5 days.  My sense is that I have a small chance (maybe 10% to 20%) of ending up in the hospital, and other than that an even chance of skating through relatively unscathed or spending several days struggling to breath but pulling through at home. Having the cough move to my chest last night was sobering.

Although I hope to get through this relatively easily and to enjoy a real benefit from immunity (I would not be vaccine-eligible for months) I would not have chosen to get sick.  The prospect of gasping for breath for a several days at home is very unappealing, choking to death alone would be oh-so-much worse.  I would rather have waited for a vaccine.  Be careful out there!

The Failure of the Public Health Establishment

Prof. Peter Dorman of Evergreen College writes at EconoSpeak and portrays Matt Yglesias’s retrospective on how the healthcare establishment failed the public when passing information on facemasks, hand-washing, distancing, etc., and how Covid is transmitted.

The direct result of not following these practices or casting doubt upon them is an elevation of Covid cases which strains the capacity and logistics of healthcare facilities, the equipment used on patients, and the supply of medicines.

Matt Yglesias has an excellent retrospective on the absurd reversals over mask usage that arose in the early stages of the pandemic.  You will recall that the public health establishment, amplified by mainstream media outlets like the New York Times, told us all to ditch our masks and concentrate instead on frequent, vigorous hand-washing.  This was transparently absurd at the time, since from the beginning it appeared that coronavirus transmission had something to do with airborne virus exposure.

We were told masking didn’t protect us.

We were told only N95 masks worked, and only if they were taken on and off just so, in a complex procedure us untrained mortals could never execute.

And we were told we had to save these precious masks so health care workers could protect themselves, even though that was in direct contradiction to argument #1.  (Later, Anthony Fauci told us that conserving the inadequate supply of N95’s was the underlying motivation, and the rest was mostly persuasion.)

Should we worry about hospitals being overwhelmed with COVID-19 Patients? Libertarian: Nah.

Our friend Donald Boudreaux is at it again, dispensing misleading statistics that just so happen to favor libertarian outcomes.

Two days ago Boudreaux posted some data on hospital capacity that seem to suggest that we do not need to worry about hospitals getting overwhelmed with COVID patients because capacity utilization over time is flat.  As Boudreaux puts it:

The bottom line is that, when broken down to the state level – at least for the period November 4th through December 4th – there is no evidence that hospitals in the U.S. are close to running out of beds for patients.

Of course, there are other possibilities that Boudreaux does not flag for his readers.  For example, to take a wild possibility at random, it may be that hospitals are not admitting as many sick COVID patients as they fill up. 

Ashish Jha in the Washington Post:

What is happening is pretty simple: As hospitals fill up, they are admitting fewer and fewer people. As any doctor or nurse will tell you, as the demand for beds soars, the threshold for admission rises with it. . . .

One theory that some have advanced is that better treatment is leading to fewer hospitalizations or that more testing is identifying milder cases, and that’s why hospitalization rates are dropping. But outpatient treatment of covid has not changed meaningfully in the past month. The most promising potential outpatient treatment, monoclonal antibodies, has yet to see wide usage. Testing has increased, with more than 2 million tests conducted on some recent days, but case numbers and test positive rates have been rising even more steeply, indicating that we are still missing many more cases — especially mild and asymptomatic cases — so there is no evidence that more testing explains the change in rates of hospitalization.

What is happening is that patients who would have been admitted to hospitals earlier in the year are not being admitted now. Indeed, by my best calculation, between a third and half of covid-19 patients who would have been admitted in the beginning of October are now being sent home instead. This is really bad for patients. Some will get much sicker at home. Some may die there.

And from the Grey Lady:

More than a third of Americans live in areas where hospitals are running critically short of intensive care beds, federal data show, revealing a newly detailed picture of the nation’s hospital crisis during the deadliest week of the Covid-19 epidemic.

Hospitals serving more than 100 million Americans reported having fewer than 15 percent of intensive care beds still available as of last week, according to a Times analysis of data reported by hospitals and released by the Department of Health and Human Services. . . . 

There is some evidence physicians are already limiting care, Dr. Tsai said. For the last several weeks, the rate at which Covid-19 patients are going to hospitals has started decreasing. “That suggests that there’s some rationing and stricter triage criteria about who gets admitted as hospitals remain full,” he said.

We can debate what is happening and how the government should respond.  But Boudreaux just can’t seem to acknowledge that there might, possibly, be a reasonable case for aggressive public health measures to slow the epidemic.  Instead, he keeps the anti-government rhetoric dialed up to 11 (“tyranny!”), and continues to stoke outrage with misleading statistics.  This is especially perverse given the rise in right wing extremism and the fact that vaccines will soon become widely available.  

Coronavirus dashboard for November 30

Coronavirus dashboard for November 3

Total US confirmed infections: 13,383,320*

Average US infections last 7 days: 162,365 (vs. latest low of 34,354 on Sept 12)
Total US deaths: 266,873
Average US deaths last 7 days: 1,430 (vs. latest low of 701 on Oct 16)

*I suspect the real number is 18-19,000,000, or between 5 to 6% of the total US population
Source: COVID Tracking Project

Infections are out of control over much, if not most, of the country. North and South Dakota, the 2 worst States, now have had confirmed infections in over 10% and over 9% of their entire populations (and probably much worse than that since many asymptomatic cases go undetected):

While the earliest hard hit States, NY and NJ, still have had the highest death tolls, 8 more States have suffered fatalities in excess of 1 in 1000 of their total populations:

“with our breathtaking landscapes and wide-open spaces, we’re a place to safely explore.”

South Dakota: the Land of the Free.

Celebrate what makes America great, and experience the Great Faces and Great Places of South Dakota.

This is a bit of old news from September. Both South and North Dakota have emerged as the nations hot spots for Covid infections even though sparsely populated per square mile and with smaller populations than other states. The situation has worsened since this article was originally run by CBS News and if North and South Dakota were countries they would be #1 and #2 globally for cases per million with a death rate per million in the top ten globally. Is there no shame left?

South Dakota Gov. Kristi Noem’s administration announced Tuesday that it is using federal coronavirus relief funds to pay for a $5 million tourism ad campaign aimed at drawing people to the state. The move comes even as the state emerges as one of the nation’s top hot spots (#2 after North Dakota) for COVID-19 infections per million.

South Dakota with ~900,000 people ranks second in the US for Covid cases/million (89,412) and  second only to North Dakota (102,269) with a lesser population of ~800,000. The death rate per million for South Dakota is 1065/million placing it #9 in the US and after more densely populated states in the US.

State Medicaid Reported Enrollment Compared to CMS’s Reports and Covid’s Impact on Medicaid

I get commentary (in my emails) from xpostfactoid who writes on healthcare issues and also does a yeoman’s function not found else in reconciling ACA signups, the differences between the penalty-mandate vs no penalty-mandate, Medicaid signups by state in both expansion and non-expansion states, and lately the impact on Medicaid due to the Covid-19 pandemic. The data and commentary by xpostfactoid for this particular summary by me can be found here; State Medicaid enrollment totals in light of CMS’s (lagging) reports, November 27, 2020

Why track Medicaid numbers? As you well know, unemployment has increased since the start of the Covid-19 pandemic as a result of the shutdowns of businesses and government facilities. The resulting layoffs have caused many people to lose not only their healthcare but also their healthcare insurance. Two ways to qualify for healthcare insurance is on the healthcare exchanges which will still look at annual income or through state Medicaid which looks at “current” income. If you are laid off and have no income (or less than 100% FPL [unless your state says differently] or 138% FPL in expansion states0, you can qualify for Medicaid CMS’s monthly totals of state-by-state Medicaid enrollment growth during 202 as impacted by Covid-19 in 2020 is currently posted Medicaid.Gov through July reflecting:

  • five months of enrollment  as affected by the Covid-19 pandemic and
  • four-plus months in which the suspension of disenrollment mandated by the Families First Act was in effect.

Lord, the Pain of it

The good mayor of El Paso is at wit’s end. He is worrying himself into the grave. The City’s hospitals and morgues are overflowing. Seems that the people have to work to eat, and, if they work, they get the virus and get sick, and, too many die. Damned capitalism is as deadly as the virus; together they are a catastrophe. Maybe, if he would just step across the border into New Mexico, better yet, hop on a plane to San Francisco, better to get as far away from Texas as possible, we could explain the problem to him without being drowned out by the ignorant Texas dogma coming out of Austin; crapola he’s heard his whole life.

In a functioning state, there are dozens of examples, the government would have handed out masks and hand sanitizer, and free food as the need arose. It would have worked out a deal on the rents. The government would have mandated the changes needed to make the workplaces safe. If the government had done these things, had functioned, instead of blithering on about capitalism and the American way, the people could have kept on working without getting sick and dying by the droves; and, the economy could have kept on working. What our government didn’t do is killing us by the hundreds of thousands; destroying the nation.