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Coronavirus, the economy, and the election: the jury is still out on all three

Coronavirus, the economy, and the election: the jury is still out on all three

There is some housing data out today; I’ll probably have a post up about it tomorrow at Seeking Alpha, and I’ll link to it here.

Meanwhile, the jury is still out on the effects of the “reopening” of many States on coronavirus infections.

Here’s a graph of the 7 day average of tests, new infections, hospitalizations, and deaths, divided between the Boston, NYC, Philadelphia metro areas and Michigan on the one hand and everywhere else:

Testing has continued to increase dramatically, while cases “everywhere else” have plateaued or possibly begun to slightly rise again. This still shows hospitalizations and deaths declining.

 

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Mask-less While Standing in A Crowd

This is the same stuff/sh*t, I am seeing in Michigan. I wish I could give them one week of Covid so they could learn. The following is from Digby at Hullabaloo:

I just watched another 60 something mask-less Republican woman in Arizona standing in a crowd of others just like herself tell the news media that she thinks the Coronavirus is not worse than a cold or the flu and she has no fear of it. (She also weirdly said that they don’t even have a name for it yet, which she didn’t explain.)

Maybe she will listen to this fellow:

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COVID-19 progress, take 2

In response to the comment on my last post . . . rolling 7 day average death rates with the peak for each country set to 100.

 

We peaked later than most countries other than Germany, which seems to be making better progress than us.  We may be doing as well (or as badly) as the U.K.  It seems like France and Spain are also outperforming the U.S. on this metric.

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Coronavirus dashboard: emphasis on testing

(Dan here…NDd’s post points to more than the impact of the US catching up in testing only recently, but also points to beginning answers readers have asked in comments about what the statistics show regarding re-opening and where we might be failing to report. )

Coronavirus dashboard: emphasis on testing

I want to focus this edition on testing issues.

While the seven day average number of deaths continues to decline:

The seven day average number of new infections has leveled off:

The average number of daily tests *may* also be leveling off again in the past few days:

What is worse is that the number of new cases in the US has only declined -22% from its peak in the last 45 days. Meanwhile, even hard hit countries in Europe like Spain have seen a -90% decline from peak in new cases over a similar timeframe:

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The Cass County, Indiana, Easter Effect

As noted in my last post, I have been looking at data. This usually causes trouble, and today is no exception.

As anyone who was paying attention predicted, the “Easter Effect”–a large gathering of people (“EC” or Otherwise) in an enclosed area that likely has multiple asymptomatic carriers (and likely a few with symptoms) is a recipe for infection. With a two- to three-week gestation period, that there was going to be an increase in cases at the end of April was well known. The only question was how much. Without running the numbers carefully, it looks as if it was about 10% above trend.

But the overall data covers for a lot of local sins. If you look at the places that have a high percentage of people infected, the relatively large Metropolitan Areas are no surprise: Providence, Worcester (MA), and NYC suburbs and exurbs (think Rockland, Westchester, Nassau, Suffolk, and Orange Counties in NY State; Passaic, Union, Hudson, Bergen, and my own Essex County in NJ).

But Cass County, Indiana, is running at over a 4% infection rate. With a County size of about 38,000 people, they’re reporting just under 1,600 cases.

Will anyone be surprised that those cases were not evenly distributed? Not really convinced this is what people have in mind when they say, “He is Risen”:

My source is the New York Times’s County-level data (h/t Charles Gaba at acasignups.net); their source is probably the Indiana State Deparment of Health, which has been getting an A+ for their data from the Covid Tracking Project.)

Data excerpt attached below.

CassCountyTable

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Hydroxychloroquine After Action Report

I was a vehement advocate of prescribing hydroxychloroquine (HCQ) off label while waiting for the results of clinical trials. I wasn’t all that much embarrassed to agree with Donald Trump for once. Now I feel obliged to note that my guess was totally wrong. I thought that the (uncertain) expected benefits were greater than the (relatively well known) costs.

The cost is that HCQ affects the heart beat prolonging the QT period (from when the atrium begins to contract to when the ventrical repolarizes and is read to go again). This can cause arrhythmia especially in people who already have heart problems. I understood that one might argue that all people with Covid 19 have heart problems but didn’t consider that argument decisive (I probably should have).

The positive expected value of the uncertain benefits was based on strong in vitro evidence that HCQ blocks SARS Cov2 infection of human cells in culture. (this is a publication in the world’s top general science journal).

Already in early May, there was evidence that any effect of HCQ on the rate of elimination of the virus must be small. In this controlled trial conducted in China, the null of no effect is not rejected. Much more importantly, the point estimates of the effects over time are all almost exactly zero. I considered the matter settled (although the painfully disappointed authors tried to argue for HCQ and that their study was not conclusive).

There are now four large retrospective studies all of which suggest no benefit from HCQ and two of which suggest it causes increased risk of death. I am going to discuss the two studies most recently reported.

One is a very large study (fairly big data goes to the hospital) published yesterday in The Lancet. In this study patients who received HCQ had a significantly higher death rate with a hazard of dying 1.335 times as high. The estimate comes from a proportional hazard model with a non parametric baseline probability and takes into account many risk factors including crucially initial disease severity. It is also important that only patients who were treated within 48 hours of diagnosis were considered.

I am, of course, dismayed by this result. I am also puzzled, because it is quite different from the result obtained in a smaller retrospective study published in JAMA

I think the practical lessons are that it seems unwise to give Covid 19 patients HCQ. Also maybe Robert Waldmann should be more humble. After the jump, I will discuss the two studies in some detail and propose an explanation of the difference in results.

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New coronavirus cases vs. testing in “reopened” States

New coronavirus cases vs. testing in “reopened” States

Are new coronavirus infections increasing in States that “reopened” on or about May 1? The jury is still out. The number of infections is up in 4 of the 5 biggest States that have done so, but so are the number of tests. The likelihood that most or all of the increase is an artificial of an increase in testing depends on the date on which you start your comparison.

I haven’t been able to find graphs that nicely show both tests and positives together, so let me just show you 2 separate graphs of the 7 day average in number of new cases diagnosed vs. the 7 day average in testing for Texas, which is the state with the biggest number of new cases.

First, here are new coronavirus infections, which are up 42% from April 30:

Figure 1

But here are new tests performed, which are up 120%:

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Abbreviated coronavirus dashboard for May 19: testing improvement continues

Abbreviated coronavirus dashboard for May 19: testing improvement continues

Here is the update through yesterday (May 18).

As usual, significant developments are in italicsThe downward trend in new infections and deaths has continued. An important issue is whether we are beginning to see an increase in new infections in States which irresponsibly “reopened.” I will look at that separately from this post.

I will restart giving the daily increase in infections if States that have “reopened” start to increase significantly again. The preliminary evidence is that customers are largely staying away from reopened businesses in those States

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Some Comments from Those Who Had Contracted Covid 19

I pulled some purposely unidentified comments from people on a website who have contracted COVID 19. At two months and alive, the virus or dead virus is still lingering, and they are hurting after having survived. My point? It is important you take the necessary precautions to prevent contracting Covid 19. Stay away from crowds and stay home.

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Hi all survivors, I am two months in .  . feel much stronger than 2 weeks ago, even though not 100% myself yet but I am grateful to be able to get on with my daily tasks ( and home working). I still have many symptoms as many of you have : heart rate issues, pins and needles/numbness in the feet / fingers ( they got red and burning).. think my blood circulation is not as good as before. I remain positive and I noticed I smile more and more. One of the things really remind me every day that I have covid is my breathing-SOB.. I have tight chest some days, but most day I have this mild SOB, the feeling of needs to take deep breath ( like I forgot how to breath), when trying to take in deep satisfying breath I just cannot , lit’s like I cannot complete the action, and not get enough air in my lung yet I cannot expand my lungs anymore.. it often helps if I yawn in order to get the air in.. ( I hope you get what I mean) I also noticed on the days I have bad reflux, the breathing seems to get worse  .  .   Do you have similar experience? Can you share hope you cope with it? Or any dr advice from your Experience. Ps . My x ray was clear, blood oxygen level perfect   .   .

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Hi I’m from India. 27 yo M I’m in the same situation as you are in. My symptoms (SOB and fainted once) started in March 13th. Worsened by the end of March. Visited multiple doctors. Got checked by pulmonologists and cardiologists. Reports were normal. Breathing symptoms eased around mid of April. Then the chest pains set in. Had a weird chest pain for 2 weeks. Had an echocardiogram and reports were normal. Now two months in. The SOB still exists. But I am able to lie down flat on the bed from past week. But the chest aches though. I walk slowly everyday for 30-60 mins. My arms become numb sometimes. I find my chest and back (area near my heart) sore. I have severe stomach bloating sometimes. My testicles hurt. All this while i never had fever or cough. And my oxygen remained above 95 throughout this time. I noticed one thing, my resting heart rate dropped from 70 to 60. When i was lying flat it someone’s reached 45 at nights. Maybe my heart rate was always like that. Who knows.

Was on a 5 day dose of azithromycin around mid April. Now I’m only on vitamins.

I hope i can get back to normal soon. Like the way i was before march 13.

I’m glad that you have improved. I wish you a faster recovery and good health.

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