Coronavirus Update VI — Calm Yourselves

All the good stuff, caveats, code, and explanations are linked, some in Update III, and the most important in Update II, Update IV, Update V, and Bayes Theorem & Coronavirus, so go to them first before asking what-about-this-and-that. Skip to the bottom for the latest model. Thanks to everybody emailing me sources. Sorry I’m slow answering emails.

If you can keep your head when all about you
Are losing theirs and blaming it on you,
If you can trust yourself when all men doubt you,
But make allowance for their doubting too…

Save Me!

WATCH LIVE AS PEOPLE PLAY IN THE FRESH AIR EXPOSING US ALL TO DEATH!

Item California police to use Chinese-made patrol drones with night-vision cameras during coronavirus lockdown “It seems a little Orwellian, but this could save lives.” Yes, ladies, it is Orwellian.

CUOMO: “This is not life as usual. None of this is life as usual. We talk about social distancing — I was in these parks, you would not know that anything was going on. It’s just a mistake. It’s insensitive. Arrogant. Self-destructive. It’s disrespectful … and it has to stop.”

As one mathematician put it: “330 million X 80% x 2% mortality rate = 5,340,000 dead Americans”. You heard it here first, friends.

Shut down the world for eight months! Hey, if in Cuomo’s words it “saves just one life”, let alone 5.34 million, it will have been worth it.

Since this is the internet, I am forced to write: Saying do not hysterically overreact is not equivalent to saying do nothing. Wear a mask, wash your hands, don’t be reckless with old folks. Do I have to be your mother? Do not panic.

Achoo!

Maybe you remember how this came upon us, and how scary it was. Here is a recapitulation of events as they unfolded in the United States. This is all information direct from the CDC.

—6 October 2019. The CDC begins receiving news of positive tests of a “influenza-like illness” (ILI). The CDC tracks these assiduously in its “U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet)”. Only 1.5% of all patients tested (at hospitals around the country) had an ILI. This low number did not raise an alarm.

—2 December 2019. The number of patients testing positive for an ILI rises to 3.3%. Still no alarm is raised.

—6 January 2020. The number testing positive soars to 6.2%. Faints bells clang through the media. People begin speculating about reports out of China. Some are already reported to have died from these ILIs in the USA.

—14 March 2020. The number of new patients testing positive for an ILI jumps to an alarming 85,284. The dead body count increases. The full storm is upon us.

The rest you know.

Or maybe you don’t. Because these are not just influenza-like illnesses. These are actual flu illnesses.

Week ending 14 March, “CDC estimates that so far this season there have been at least 38 million flu illnesses, 390,000 hospitalizations and 23,000 deaths from flu.”

Thirty-eight million cases! Nearly 400 thousand supply-chain ICU-stressing hospitalizations! Twenty-three thousand dead bodies! How many more were left permanently scarred from this horrible disease with reduced lung function and other comorbidities? And this is only in the USA!

Not 16,448 dead, our current coronavirus worldwide total (all numbers current as of Monday evening 8 PM EST), but 23,000 dead. And not 23,000 dead, either. That’s only this year. In 2016-2017, and again later in 2017-2018 the number of cases reached official epidemic proportions.

That kind of chart look familiar to you? Shows cumulative hospitalizations by flu season. Our current season is on the high end, but nowhere near the highest (this data is only since 2000). Point is this: over roughly four decades, flu has slaughtered about a million American souls. Mostly 50+ and 0-4 year-olds. What about the children!? A lot of dead kids. Over the entire earth, every two to three years a million souls are given early exits.

Flu will go on killing in horrendous numbers unless we do something about it! What that something is, is obviously this:

Every day beginning in the upcoming flu season (starting September 2020), each new case, from each state and large city should be blared across the headline of every news report. MONDAY: ONE CASE REPORTED. TUESDAY: CASES DOUBLE! WEDNESDAY: CASES SOAR TO FOUR. THURSDAY: WE HAVE GONE EXPONENTIAL.

Each death should receive nonstop coverage. All networks and newspaper should devote time exclusively to the flu. Politicians should issue immediate precautions about washing hands (always a good idea) and social distancing. Businesses not run by oligarchs should be shuttered.

As soon as the number of deaths rises above 10, in a way similar to what happened to COVID-19, full-on panic should become official policy. This should happen by about 15 September, since flu kills so many so effectively. Get ready for it.

By 1 October we’ll have already reached the same point of martial law we are now experiencing.

We’ll have to do this every year forever, too, because there is no other way to save lives taken by the flu.

Yep.

Massaged Numbers

After you get over your the-flu-isn’t-the-same-as-deadly-coronavirus dudgeon, did you notice anything else peculiar about that picture above? If not, go back and stare at it. Stare hard. I don’t want you to miss this.

Every flu season started, ramped up, became exponential, hit in clusters, slowed, trickled out, stopped. All without active interdiction, except for initial vaccinations.

Yes, I’ve made this point before, week after week. But it can’t be overemphasized. It is certain that we can affect the course of disease by our actions or inaction. Put a guy in solitary confinement with a stack of sterilized dry bread and tank of distilled water and he will by this active intervention avoid catching a cold, or any other communicable disease. We can in this case justly award a kudos to the jailer for keeping the prisoner disease-free.

In other cases, it’s not as clear. Keeping a ship off the coast flying the Yellow Fever flag is wise. Locking healthy and sick together in their homes, visited only by the same delivery man going to everybody else’s home—well, it’s not so clear if it’s wise or not.

Even the New York Times—and I am still reeling over this—agrees the current policy of martial law lite is wrong-headed, and likely more harmful than letting all but the chronically unhealthiest roam free.

Ever notice how ebola comes and goes in waves? What happened to all the other diseases that were going to kill us all? Who stopped them? Rather, what stopped them? What’s that? I didn’t catch what you said.

My only point is that we think too well of ourselves. We give ourselves too much grief for the spread of the disease, and we’ll certainly give ourselves far too much credit for stopping it. That should be kept in mind for when the next outbreak happens and the government moves to re-implement its “successful” martial-law-lite policy.

What Numbers

The naive model we have been using, which started as a class project, is confusing some. Rather, the numbers are. What are they?

Reports. Our model is a model of the reporting of numbers. That’s it, and nothing more. To the extent these numbers represent real cases, accurately ascribed deaths, and diligent records, then our model will attempt to describe the real extent of the outbreak. It’s “attempt” because, of course, the model is far from perfect.

Now, even in the case of measurement error in counting cases, improperly ascribed deaths, and chaos and inconsistencies in reporting, the model will still attempt to describe what numbers are being reported. Reporting is a very human process, and that’s what we’re modeling, the process.

How accurate are the numbers in reflecting Reality? It wouldn’t surprise anybody who has worked with medical data over a long period of time to say “not very”. Take Italian reports of deaths caused by coronavirus. It’s become clear that what they are reporting and the true caused numbers of dead bodies are at variance.

One professor said “The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.”

This is that point the pulmonologist Woflgang Wodarg was trying to make (we linked his video last week, but I didn’t do a good job emphasizing it). Having coronavirus and dying of it are different things. Right at the beginning of this we were wondering how many deaths due to flu were being ascribed to coronavirus. We can now say “some”.

Here is an analogy if you don’t understand this: every patient in Italy who died had a sex, male or female. If we ascribed each death to sex, because everybody had it, we would be making a pretty dumb error. The error of ascribing death to coronavirus just because a person has it, when it is not truly the cause of death, is the same kind of error.

The Italian professor said “On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity – many had two or three.”

Some say this is in an exaggeration in the opposite direction. Maybe so. But Italians seem to be prone to keeling over due to the flu, as this paper unearthed by or own C-Marie. “More than 68,000 deaths attributable to flu epidemics were estimated in the study period” over two flu seasons. “Italy showed a higher influenza attributable excess mortality compared to other European countries. especially in the elderly.”

Study claimed “99% of Those Who Died From Virus Had Other Illness“. Not so unusual, given the virus kills mostly the old, and the old often have comorbidities.

In any case, there is zero evidence this bug is wiping out young, healthy individuals.

Theoretical Numbers

Everybody by now has seen by this piece by John Ioannidis: “A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data“.

The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.

Ioannidis, like we did last week, also brought up the Diamond Princess cruise ship: “The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.” The population fatality rate was even lower. The population infection rate was about 18%—in a mandatory lockdown.

There is in decision analysis a technique—which I do not favor—called minimax. It begins by, à la Nassim Taleb, imagining the worst possible scenario, and then moving to minimize that. That’s what we’re doing here.

People look at models like “Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand” by Neil M Ferguson and a slew of others, which conjures all sorts of awfulness. Even in their best theoretical case looking only at the USA and UK they say:

We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over.

The CNBC, always a reliable source, said “The coronavirus could kill millions of Americans: ‘Do the math,’ immunization specialist says“. Here’s another: “A report that helped convince Trump to take coronavirus seriously projected that 2.2 million people could die in the US if we don’t act“.

America is about 5% of the world’s population. If we extrapolate these numbers to the world, we get at least 40 million dead.

That’s a lot of bodies. Where are they?

We’re three or four months into this thing and we only have 16,448. China, the locus in quo, only had about 3,300 deaths. The virus is going to really get to work if it’s going to achieve its potential!

Japan was also supposed to be whacked. They’re further along than the USA, infection-timing wise. “A Coronavirus Explosion Was Expected in Japan. Where Is It?

Japan was one of the first countries outside of China hit by the coronavirus and now it’s one of the least-affected among developed nations. That’s puzzling health experts.

Raise your hand if you’re tired of hearing from “experts”.

Japan did not engage in widespread testing, didn’t confine people under martial law lite. They carried on much as usual, encouraged wearing masks, washing hands, and not freaking out. Japan did not do minimax. Yet they survived.

Germany, you ask? “Germany’s low coronavirus mortality rate intrigues experts.” More experts!

We, on the other hand, minimaxed the hell out of the situation. We did our best WHAT-ABOUT-THE-CHILDREN! maximum death scenario, and then moved an entire country to war footing to avoid this worst case. Don’t forget what Cuomo said: any cost is worth it if we save just one life.

An alternative to minimax is Bayesian, meaning according all relevant information its due weight. And then acting on that cumulative knowledge, not on the worst damn thing that could happen. This is not a do-nothing policy, but a do-only-what’s-likely-necessary policy.

Minimax is effeminate. Our own country used to have hardier stock. Want proof?

Who recalls the 1957-1958 flu pandemic? The CDC said the “estimated number of deaths was 1.1 million worldwide and 116,000 in the United States.”

The 1968 pandemic? “The estimated number of deaths was 1 million worldwide and about 100,000 in the United States. Most excess deaths were in people 65 years and older.”

The wimpy 2009 pandemic had nothing on these guys. “From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States due to the (H1N1)pdm09 virus” and “151,700-575,400” worldwide.

We survived all these. We survived without martial law lite.

Incidentally, those earlier death tolls are worse than they seem because the USA population was much less than now.

Can you even imagine the apoplectic reaction our current leaders and populace would have to an outbreak like the 1957-1958 pandemic today? Hysteria isn’t in it.

Want more evidence panic is official? Fellow names Aaron Ginn published a piece on Medium, “Evidence over hysteria — COVID-19“. Filled with the same kind of thing you get here, but in a lot more colorful detail, and citing all sorts of competent sources. Medium suppressed it. (The link is to an archive.org version.)

My guess is the block is not because the report was inaccurate, which it doesn’t seem to be, but because of the fear of lawyers, which is justifiable. All it would take is some dumb citizen to say they read Ginn’s article, felt hopeful, went outside, and got the virus. The she sues. I, on the other hand, have no fear of lawyers, because I always wear a necklace of pure garlic.

Modeled Numbers

Do yourself a favor and buy this award-eligible book, which you can use to comfort yourself in the quarantine.

Why this model? (Code and data). Because when all this started I saw far too many nervous people fainting over “exponential” increases. It is impossible—not unlikely: impossible—for numbers to stay exponential. If they did, then in just a few weeks everybody would be infected and die. Instead, outbreaks resemble logistic curves. These fit historical data marvelously. Why not try it here?

We saw the last two weeks that our own model was under-predicting, as predicted (if you follow me). It did a great job with the initial peak in China, but only after we were sure we had reached the peak and were on the way down. Another (more prestigious!) fellow found similar results as we did. Model for China did an okay job predicting the timing of the peak, and got close to the number of reported cases and dead in China.

How about the rest of the world? Have we reached the secondary peak yet? Maybe we’re close. Spring is upon us, in many places. With sunshine comes germ-blasting fresh and humid air.

Here’s the overall totals in reported cases and deaths—and not necessarily in actual totals.

There’s that lovely logistic. Again, we’re working with world totals, which smooths out “nations”, where we know nations are not homogeneous. Shutting down all of the USA, for instance, when there are case bumps in a couple of coastal cities as if these cities are representative of everywhere is official policy. Again, as I said last week, everybody expects this virus will be equally destructive everywhere—which never happens.

Anyway, predicted totals by April 19 are 840,000 cases, and 39,000 deaths. Worldwide. If we get to the peak in a few days or a week, these totals are likely to be good guesses.

The model week-by-week, since it has missed the secondary peak, has under-predicted. If the peak is more than a week away, then the model will certainly under-predict again.

Here’s the daily new reported cases, which gives a hint of peakiness.

There’s a seductive bend at the top which may indicate the peak is peaking. But this could be our eye fooling us, by mistaking the model for the data.

On the other hand, take a look-see at this, a new graph:

This is the acceleration of new cases. (Ignore the dashed spikes, which comes from stitching together the two peak models, and is an artifact. The spikiness in black lines comes from chaos in reporting, as previous posts have discussed.)

Daily cases are rate of change of the total. This is the rate of change of that rate of change; hence, acceleration. Which has been decreasing. The predicted peak comes when the acceleration turns negative; i.e. a deceleration. The signal is not strong enough to be perfectly convincing. But it’s strong enough to give some hope.

And here’s the daily new reported deaths.

Same hint of a slow down! A hint or a tease? Look, friends. We have seen predictions of millions slaughtered by coronavirus, yes? These are the actual daily death reports. In order to get two million, this curve has to (a) soar into the skies, adding 500 new deaths per day to the daily per day total (1750 today, 2250 tomorrow, 2750 next day, etc.) for 60 straight days to reach 30,000 per day or (b) get to about 2,000 a day and stay that way for every day for three straight years.

Either of these maneuvers would give a total of about two millions deaths. Either of these look like they’re going to happen given these pictures? Yes, they could happen. But are they likely?

Acceleration, you ask?

Death reporting is much choppier, maybe because the numbers are so much smaller, and smaller numbers are more variable. But if you squint, the same deceleration seems to be happening.

One Last Thing

My friends, I’m going to say something that will seem, to a few of you, harsh. People on the right are posting images and videos of sufferers of coronavirus and saying “This is why we need to take this as seriously as we do.”

This is equivalent to posting pictures of “migrant” kids washed on up on shore and saying “This is why we need open borders”. Which people on the right wisely condemned.

God bless everybody who gets this dread disease, and Godspeed to those who succumb. But we cannot make policy based on sad pictures.

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64 Thoughts

  1. In Australia up to today (3.00PM 24 March 2020)
    They have tested 160,000 people (the official page says they have tested more than 160,000 – so I used that number as I am guessing that it wouldn’t be more than 170,000)
    2136 have tested positive
    8 have died (includes two from cruise ships so not included in above testing numbers)
    Infection rate of those tested is 1.34%
    Death rate of those tested is 0.375%
    Fatality rate per 100,000 of Aussie population .0325

    For reference
    Road deaths in Australia for last month (Feb 2020) 92
    Road deaths in past 12 months 1163
    Annual fatality rate for road deaths 4.6 per 100,000 of population

  2. Aye, kudos for your sane and balanced coverage. Some notes I’ll add from my own reading, which has overlap with your sources:

    Recently there has been something of an ongoing bifurcation between the
    mainstream view of looking at absolute numbers and predicting doom,
    and the data-driven wonks who mine the latest papers — I’m thinking of
    the /r/COVID19 subreddit in particular, where a new consensus is forming
    that the disease is most likely high-R0 and low-IFR, i.e. infectious but
    most cases are mild or asymptomatic with fatalities disproportionately
    clustered among the highly elderly with numerous comorbidities. Which
    suggests we might be closer to herd immunity than we think. So far
    we can’t be sure due to a lack of pervasive antibody testing — our
    current testing regimes are selection-biased towards symptomatic sufferers
    and at-risk people, and the data doesn’t discriminate between ‘has
    SARS-CoV-2 viral loads’ and ‘ultimate cause of death was COVID-19,’ which
    is the same problem with estimating excess deaths from influenza-related
    illnesses — possibly in the tens of thousands annually in Italy alone [1],
    but a speculative number due to no one micro-analyzing and being hysterical
    over flu deaths as over COVID-19 right now.

    Or, as John Ioannidis put it [2]: “The number of tests done depends on how
    many test-kits are available and how many patients seek testing. Even if
    bottlenecks in test availability are eventually removed, the epidemic curve
    may still reflect primarily population sensitization and willingness for testing
    rather than true epidemic growth.”

    Further still, that [ibid.]: “Different coronaviruses actually infect millions of
    people every year, and they are common especially in the elderly and in hospitalized patients with respiratory illness in the winter. A serological analysis of CoV 229E and OC43 in 4 adult populations under surveillance for acute respiratory illness during the winters of 1999–2003 (healthy young adults, healthy elderly adults, high-risk adults with underlying cardiopulmonary disease, and a hospitalized group) showed annual infection rates ranging from 2.8% to 26% in prospective cohorts, and prevalence of 3.3%-11.1% in the hospitalized cohort. Leaving the well-known and highly lethal SARS and MERS coronaviruses aside,other coronaviruses probably have infected millions of people and have killed thousands. However,it is only this year that every single case and every single death gets red alert broadcasting in the news.”

    Speaking of Italy, data from March 20 [3] on fatalities is quite revealing —
    median age of death is 80, 99% are over 50, virtually no deaths below 30,
    high rate of preexisting health conditions among the deceased. Furthermore,
    in addition to Italy’s higher susceptibility to flu pandemics, there are
    major issues with air pollution and deaths from antibiotic resistance as well.
    Plus don’t forget that when we say Italy we mean “Lombardy and Emilia-Romagna,” where something like 85% of the deaths are clustered. Regions like Calabria in the South have negligible COVID-19 fatalities, for instance, but then
    Italy is in lockdown mode so this is obviously decreasing R0.

    If we look at the 110 fatalities in Washington State as of Mar 23 [4], the picture
    is similar — bulk of deaths from people in 70s, 80s and 90s with preexisting
    conditions. Only two deaths from people in their 40s, both in Snohomish
    County. No younger deaths reported. Most deaths (87 of 110) are clustered in
    King County, and in turn 42% of those deaths (37) originate from the same
    nursing home in Kirkland.

    Ditto for recent data from the Netherlands — no recorded deaths below age
    of 54 so far. [5] Keep in mind selection bias towards severe patients, though.

    Still no good data on Spain from what I know.

    The closest thing we have to a controlled experiment — the Diamond Princess
    cruise ship — shows a 73% asymptomatic/mild incidence within an elderly
    patient sample of 104 (median age 68). Given a 15-day observation period,
    it’s incongruent with what we know about incubation rates that symptomatic
    developments were likely after that. [6]

    Face masks do work, but official CDC/WHO advice is geared toward saving
    supplies for medical personnel, hence the disinfo about their effectiveness.
    You don’t even need a surgical mask or N95 respirator if you can’t find any,
    simply tying a cloth around your face will still be moderately effective
    provided it’s washed regularly. It’s possible that widespread face mask
    usage explains part of the better outcomes in East Asian countries. Japan,
    for example, despite also having a low number of tests, an aging population,
    a high rate of smoking and not very strict quarantine measures — nevertheless
    is not having Wuhan-like hotspots as one might expect. [7]

    My suggestions: cover your face, take vitamin C/D3/K2 supplements, maybe
    some anti-inflammatories like curcumin, and otherwise move on. If you could,
    anyway — chances are your benevolent leaders will make sure you aren’t going
    anywhere.

    How long until policymakers adjust to this rather than being motivated by
    public choice concerns of not being blamed for becoming like Bergamo —
    is anyone’s guess. Here’s hoping hydroxylchloroquine works out, that
    the arrival of summer [8] diminishes this, and that judging by prior
    coronaviruses like MERS-CoV and SARS-CoV, deleterious mutations in
    the virus will lead to it being selected for a lower reproduction rate
    in response to selection pressures from the human immune system [9].

    That said, the issue of hospital resources being overcrowded is a real one,
    so even if total lockdown is clearly counterproductive, that’s still a problem
    I’m not sure how to handle.

    [1] https://www.sciencedirect.com/science/article/pii/S1201971219303285
    [2] https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13222
    [3] https://www.reddit.com/r/COVID19/comments/fn0dch/comorbidities_in_italy_up_to_march_20th_nearly/
    [4] https://www.king5.com/article/news/health/coronavirus/coronavirus-covid-19-deaths-cases-washington-state/281-68179a8d-9ea9-461a-9077-1f32675b802b
    [5] https://www.reddit.com/r/COVID19/comments/fnqgut/epidemiological_situation_of_covid19_in_the/
    [6] https://www.reddit.com/r/COVID19/comments/fno919/nonsevere_vs_severe_symptomatic_covid19_104_cases/
    [7] https://www.japantimes.co.jp/opinion/2020/03/21/commentary/japan-commentary/japan-still-coronavirus-outlier/
    [8] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3556998
    [9] https://www.reddit.com/r/COVID19/comments/fl3yqg/some_sarscov2_populations_in_singapore/

  3. Worse than the pictures, is the failure to understand that Covid 19 is NOT a coronavirus. SARS-CoV-2 IS a virus. Covid 19 is the test of whether or not human beings have reached to level of stupidity and sheephood to be destroyed by the evil people of the world, reduced to nothing but fertilizer and those applying the fertilizer. Slavery is what is in our future and if that doesn’t make you panic, I hope you end up applying the fertilizer and occasionally wonder if it’s someone you might have marginally cared about (besides your own back side) and did nothing to protect. No, panic is not the answer. GIVE ‘EM HELL AND TAKE BACK THIS COUNTRY from the terrorists like Pelosi and Newsom and Schumer who will destroy your livlihood and enslave you because you’re too lazy and stupid to breathe and deserve it or learn to say “Yes, Master Pelosi, I can
    go another day without heat or light or food and would be sooo proud to do so”, just like the spineless worthless creature you are. This in NOT about a virus and unless people get that, Hell is arriving because you were apathetic and stupid and lazy and loved the idea of starvation and being abused on a daily basis. The Founding Fathers despise you for not giving a damn about freedom and what you had as result of their work and giving of their lives. Have a crappy day. It’s all you merit.

  4. Opinion/editorials have already appeared proclaiming that reopening the economy will 100% ensure millions of deaths. (Where do those people think their paycheck comes from???)

    What baffles me the most, what/who made the initial zeroth decision(s) that the only way forward was to shutdown the world economy. And what was the factor of the properties and characteristics of the virus that justified those decisions.

    It seems to me that every single person in leadership positions all round the world should have instantly known without even thinking about it that that could not ever be viable.

    Given the large numbers of hospitalizations associated with previous enhanced flu seasons, why do we all of a sudden have a hyper-crisis with hospital beds.

    I remain confused.

  5. I’m not one to engage in speculation about the ‘powers’, but this has a weird feel to it, given that all the Churches just closed up, no questions asked? Sermon over video…

  6. I don’t suppose the concept of “saving even one life” extends to Planned Parenthood? Asking for a potential friend.

  7. Very good collection of thoughts. I am no statistician, and that’s putting it mildly. But I don’t see much use in trying to determine morbidity when we do have a definite number of dead (at least in theory they are dead from this virus, although we don’t even know whether they are counting people who were already fatally ill when they caught the virus, or they have all specifically died from the virus) and we have NO IDEA how many people have the virus.

    I saw a person I follow, a scientist who is normally good with numbers, alarmed at the high number of people testing positive for the virus in NYC — 28%! And hardly anyone tested in South Korea had it! But then I read from people in NYC that they are only testing people with symptoms who are suspected of having it. So, if true, that means more than 70% sick people suspected of having it there don’t have it at all. And that, if I understand correctly, is using a test that has more false positives than false negatives. So it sounds as if there are a whole lot of people in New York City with ordinary flus and colds right now. Or do they? Is it more people than normal? No one is saying.

    I am half convinced that the entire world is committing suicide right now, destroying ourselves in a not-at-all-sane mania to ensure that we never get sick again.

  8. From my reading, I’m beginning to think that the hospital bed and equipment situation exists because this virus leads to severe respiratory problems like pneumonia. On the other hand, I think so does your regularly-scheduled flu.

    Could the situation have been caused by the “Not one life lost” concept and now we’ve run out of ventilators ? Does COVID-19 lead to higher numbers and more severe respiratory problems?

  9. I certainly hope this forecast is correct. However, it should be noted that just 2 (!) weeks ago, the same method predicted “~160,000” total cases:
    https://wmbriggs.com/post/29734/

    As of now, total cases are 334,981 according to WHO. More than double this method’s prediction just two weeks ago. And as stated, the model did well with China *after* the peak. Readers should keep this in mind.

    I’m glad to see more emphasis that actions do in fact matter. Certainly China locked down over 100M+ people to slow the spread (and more strictly than any US state so far). Now the Chinese government has given local authorities financial incentives to report lower numbers, so the numbers are even less trustworthy since two weeks ago: https://supchina.com/2020/03/09/wuhan-to-reward-neighborhoods-with-72000-for-having-no-new-coronavirus-cases/

    I also wonder how the Japanese numbers will evolve now that they have postponed the Olympics.

    But I get it; you are only modeling reported numbers here, which includes whatever financial and other incentives are involved.

    Hong Kong demonstrates what happens when places that have it under control try to resume normal life; confirmed cases doubled in a week recently: https://www.cnn.com/2020/03/23/asia/hong-kong-coronavirus-quarantine-intl-hnk/index.html

    I do think we’ll start to see the US growth rate decline in the next week or two due to all of the actions taken (private distancing actions started even before the government ones), although this may be offset a bit by the mixing and traveling of spring breakers.

    Regarding decisions, I do think there is some option value in taking very cautious actions early. The CDC and WHO don’t even seem to know much about how it spreads; by this, I mean, they don’t seem to know how likely it is to be passed by commonly touched objects, like door handles, vs coughing near someone, etc. If we can take conservative actions to slow the spread until researchers can figure this out and find some effective treatments, then we can find a manageable way to resume normal life in the near future without the risk of overflowing hospitals (or at least ventilator capacity), like we’ve seen in parts of Italy and Spain. I don’t doubt that there are some demographic differences between there and here, but we see confirmed cases here growing more quickly than over there (although the death rate seems to be slower so far).

    One thing’s for sure: no one should be overconfident in any prediction they see on this, high or low.

  10. @Dan Hughes
    ‘Given the large numbers of hospitalizations associated with previous enhanced flu seasons, why do we all of a sudden have a hyper-crisis with hospital beds.’

    Because this thing is NOT the same as flu, nor is the flu same each year. The number of ventilators is the issue. One of the chief CDC guys recently said that we were focusing on the wrong things all along (developing the vaccine), but didn’t think that in the process we need more beds/ventilators.
    Also, the distribution of this virus is different, hitting all at once.
    That is not unusual. In any year, any virus can go crazy and create a panic like this.
    If the Spanish flu virus was around today, it wouldn’t be a big deal, because just about everyone has some immunity to it from prior exposure. But in 1918, it was a novel thing, except for those who were about 78 years old at that time. They did have prior exposure and didn’t suffer nearly as much as the rest of the population.

  11. It is nothing short of amazing the CDC stats have not been memoryholed yet. Even the thickest among us can see the mortality rate is around one percent within the limited data available to the CDC and possibly considerably less if undiagnosed/unreported cases are factored. I was willing to cede the over-the-top responses to panic until the anti-malarial treatments were demonized.

    It’s not the flu, bro. It’s less than the flu.

  12. It would be nice if we had enough face masks to give everyone to wear in
    public which seems the most sensible thing to do despite what the ‘experts’
    tell us. Japanese and Asian societies have been doing this for years
    and if you have cold you are expected to wear a mask in public. For some
    reason this is looked askance at in Western societies and has never really
    been adopted. Masks, hand washing, and self quarantine of vulnerable
    populations would seem to be the most sensible steps to take as opposed
    to shutting down an entire economy.

    Unfortunately we don’t have the option of handing masks out to everyone
    because this has all been outsourced to China which is probably why the
    ‘experts’ are telling us that masks are ineffective despite the fact that they
    are worn in hospitals worldwide to prevent the spread of disease. Who are
    you going to believe your lying eyes, the ‘experts’, or the lying bottom
    feeding scum suckers that shipped everything to China Inc. many of which
    still infest Congress.

  13. I do not take orders from elected officials. And if sheeple want to whine and spout doom and gloom, go for it. I choose to live, and not do as idiots try to dictate to others. People this is a fucking test to see how stupid and gullible you are. I will worry when it surpasses the average flu kill every year. But I have my doubts. Better be ready for the other shoe to drop, because bet your ass they are going to try more. Now what you do is on you, but fuck the people who think they are my betters. I am not in the military any longer. Did I say I don’t take orders from elected pieces of shit officials…

  14. Spetzer86 -I don’t suppose the concept of “saving even one life” extends to Planned Parenthood?

    GOOD ONE!!!!

  15. Anyone seems to know the survival rate of the patients on ventilators? Karl Denninger claims it is ~5%, so if you are on it it is likely that you’ll die… They don’t seem to save lives at any significant level.

  16. “Unfortunately we don’t have the option of handing masks out to everyone
    because this has all been outsourced to China which is probably why the
    ‘experts’ are telling us that masks are ineffective despite the fact that they
    are worn in hospitals worldwide to prevent the spread of disease.”

    I’m not one to utterly trust politicians and “experts”, but I think there is a good reason medical staff wear them that is consistent with the claim that they are ineffective for most people. By “ineffective” the masks don’t work, but that the effect is minimal.

    Medical staff deal with dozens of patients or more a day, and get into very close contact with exactly the parts of their bodies that carry the illness. A mask which, in those cases, protects the wearer from the illness they’d almost certainly get otherwise will not be “effective” at keeping someone from getting it at the store, where they would never have come into contact with it in the air anyway.

    A bit like how wearing a hard hat is very effective for construction workers but not business people.

    I am skeptical that the oriental habit of wearing masks is a net positive. For one, most illnesses require close personal contact to spread, and masks presumably aren’t worn in such settings as they are in public. Second, if the *were* effective, then those who wear them have immune systems which are weaker than the rest of the world for lack of dealing with illnesses. The long-term effects could be devastating. I’m no expert in this particular issue (are there any?) but my suspicion is that it’s a cultural artifact, not a meaningful practice.

  17. The ability of hospitals to provide ventilators to avoid headlines like Italy seems the major concern. Cumo says they procured 7000, but need 30,000 more.
    I haven’t a clue. Waiting and watching and hope to not go bankrupt.

  18. @Dave,

    But higher numbers of cases due to better testing but a steady death rate is good, it means that we already have it widespread but the estimated fatalities aren’t occurring.

    So rising cases isn’t a worry, unless there’s been a rise in death rates or you’re a 3rd world country.

  19. @Becky yes, but we don’t actually know that we will need that many more. Italy did because they already have very few per capita, and more ancient people per capita.

    So unless the demographics of NYC look a lot more like Northern Italy than I’m aware of, it’s likely his prediction of need is wrong.

  20. At a minimum, Cuomo is shilling and angling for the VP slot. It’s so obvious, even a dead, retarded, blindman can see it.

  21. -Josh
    That is the most circular argument I’ve ever heard and though you
    deny your expertise I would award you that hard hat all the same.
    The psychological benefit is enormous, if nothing else, and wearing
    a mask can certainly do no harm and it would probably buy some time
    by retarding the spread if nothing else. But I’m sure we’ll be inundated
    with the logic defying opinions of the wannabe expert class so adept
    at denying the obvious to and ever growing constellation of cognates
    reduced to an oyster like mentality.

    But stock we’re gonna come out of this war rich!

  22. This all seems like a very strange Milgrim study. Why does Amy Acton, MD come out in a white coat every press conference in OH? Given how many MDs have a pretty bad record of iatrogenic effects, call me skeptical. Yep, this isn’t the flu, because that infects and kills people all the time, we have just become complacent with it. People assume that the flu vaccine is 100% effective, but it isn’t because it is all a guessing game about what will come out of China each year. Without all the flu patients in hospital beds, this wouldn’t be the panic we have now.

  23. “That is the most circular argument I’ve ever heard”

    I’d love to see the demonstration of this circularity. For your convenience, here is my argument:

    1. Masks (the right kind, anyway) lower one’s risk of catching a virus that is in the air. Suppose it is a 90% reduction.
    2. When one’s risk of catching a virus that is in the air is very low (0.01%), then wearing a mask doesn’t do very much.
    3. When one’s risk of catching a virus that is in the air is very high (50% – like a medical worker), then wearing a mask can do quite a bit.
    4. Given (1) and (2), a normal person wearing a mask has a reduction from 01.% to 0.001%. Was it worth it? Probably not. They likely wouldn’t have caught it in the air anyway.
    5. Given (1) and (3), a medical worker wearing a mask has a reduction from 50% to 5%. Was it worth it? Yeah, pretty clearly.

    ===
    “The psychological benefit is enormous, if nothing else, and wearing
    a mask can certainly do no harm and it would probably buy some time
    by retarding the spread if nothing else.”

    There’s some shifting goalposts here.

    ===
    “But I’m sure we’ll be inundated with the logic defying opinions of the wannabe expert class so adept at denying the obvious to and ever growing constellation of cognates reduced to an oyster like mentality.”

    Just saying you think I’m an idiot would have saved you time and accomplished the same thing.

    As it turns out, I’m not convinced that only The Sacred Experts are allowed to reason about things related to their fields. But if you’d like to imagine that only The Sacred Experts are permitted to do such things, I’ll have to see your credentials before I accept the legitimacy of your critiques.

    But stock we’re gonna come out of this war rich!

  24. “Here is an analogy if you don’t understand this: every patient in Italy who died had a sex, male or female. ”

    But… but… but… my sociology professor told me gender is a social construct and there is no such thing as male and female… we’re all genderqueer, non-binary, and genderfluid…

  25. The golf course video is hilarious. One or two effeminate men, plus a pilot I suppose, are concerned about two guys who shouldn’t be out, by a politician’s decree, in the middle of a field. It would be better for them to be home infecting their kids and others. Other reports say the magical virus stays airborne for hours and lasts 24 to 48 hours on surfaces. So, the helicopter guys spread their spittle across acres of land and it might not take days for it to settle.

  26. I understand what you are saying about the difficulty of extrapolating from small numbers. But fatalities in Bergamo hit 14x what they were for the first two weeks of March last year. A bad flu season should barely nudge that rate (the flu is a few percentage points of mortality in winter months).

    Situations where you have a dozen times as many corpses piling up as normal are unusual and require explanation.

  27. I can’t wait for the Congress minions they say may be attending in
    hazmat suits, what a hoot you positively can’t make this stuff up.

  28. Thank you, Dr. Briggs. It is nice, if not reassuring, to have a voice of reason during this panic-demic.

    I said before and will again that close to 10,000 people die each and every day in the US. That’s our normal daily death rate. Well, normal in the sense that it includes 2,200 daily abortion deaths of pre-born humans (and some postpartums thanks to the Neo-Libs). Per day. That’s the average daily death count for a 365 day year. This year is 366 days, but that doesn’t change the daily death count significantly.

    So if 100 people die of Corona in the US in a single day, that makes 10,100 deaths for that day. Not great, but not hair-on-fire gobbling throbbing panic wreaking either (I picked 100 because that’s about the average for this year’s flu season).

    If the Panic Lockdown includes locking down the abortion “clinics”, then maybe we are actually saving a lot more than 100 lives per day. There is that silver lining to consider. Assuming, that is, that all the typical 2,200 daily abortions are not merely postponed temporarily.

  29. Have any of the “experts” given us numbers on what are acceptable levels of death?

    You know, like the seasonal flu numbers, where we have only voluntary vaccination and privatized decisions about self quarantine?

  30. @Joel, I agree, in a way. Look back through this post and the more recent updates, theres actually a recent paper studying why Italy has disproportionately more deaths every flu season when other factors are considered, and basically those factors are the reason it only takes a small increase in their already high death rate to overwhelm them.

  31. So if the bell ? curve applied to UK data, then it would support the recent report by a group from Oxford university that half the population had already had the virus,

  32. Most of the comments are wonderful!

    So now, we be patient, do the sanitary measures, keep distances, ask God to keep us and all, pray for healing all round, pray for the medical discoveries that He has for us to be given to those whom He will, be kind, generous, thoughtful, and trust Gd’s Holy Spirit to lead and guide our President and more, and start up our economy again with trust in God our Father to see us through.

    It would be a tremendous help in God helping us in this, and in our receiving His helps, if mothers could not legally kill His children in their wombs and just out of their wombs, in our country. How many millions of American children have gone on to Heaven before they had the opportunity to live here on planet Earth.

    Remember, President Trump went against the “best” advice of all of his advisors, when he at first he partially shut down incoming, and he was so chastised for it, and now we all see the Wisdom in what he did.

    God bless, C-Marie

  33. What if the number of people who die from the normal flu are fake? What if such fake numbers are churned out in an effort to get people to take the flu shot? What if the real number is on the order of 1% of that number? What then would you say about this virus?

  34. An excellent round-up of reality-based health experts’ advice and insights:

    https://off-guardian.org/2020/03/24/12-experts-questioning-the-coronavirus-panic/

    Italy’s deaths? Me excusa! A little mis-counting:

    “Citing this report (in English here), Professor Walter Ricciardi, scientific adviser to Italy’s minister of health said:
    “The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus […]

    “On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity – many had two or three…”

    https://off-guardian.org/2020/03/23/italy-only-12-of-covid19-deaths-list-covid19-as-cause/

  35. @dave
    I think we can quite confidently say that the numbers are probably nonsense, given a few things.

    1. The aggregate global data includes data from countries who are all testing this thing differently, using different criteria to determine who to test and using different criteria to determine what a ‘case’ is. So the data falls flat on its face at the very first hurdle.

    Where I am, there are not enough tests, you have to have both symptoms AND contact with an infected person to even get a test, or have come from a high-risk country. The number of tests are now being doubled, I going to take a bold risk and predict that the number of cases reported is now going to increase up to 2x.

    2. Even the Wikipedia article on this mentions that cases are under-reported. The estimate for the UK was that actual infections are potentially 20x higher than reported. In Italy, the Wikipedia informs us, asymptomatic cases are not even added to the official case number.

    This is not a minor point. It’s completely reasonable to assume that actual cases far exceed reported cases. This means the scary death rates everyone is looking at are complete nonsense, because accurate case numbers are required to get to an accurate figure here.

    A good precautionary principle to apply here is ‘are these death rates in any way accurate enough to make sound policy decisions?’

    What we’re seeing here is one part novel virus pandemic, and two parts paying the band for a few decades worth of window dressing major institutions with people based on traits unrelated to basic competency, cultivating a society that cr*ps its collective pants when someone is offended, putting yes men in positions of influence and marginalizing anyone with any kind of contrarian bent, and therefore most original thinkers in society.

    These people are doing exactly what you would expect them to do. Dithering, looking to each other for direction on what to do next, stampeding in that direction in a herd, and completely failing to consider any serious future repercussions of their actions because they are eternally trapped in the immediacy of their emotional reactions to any unpleasant stimulus.

    The Japanese seem to be different, bless them.

  36. I feel like I’m trapped in a madhouse. The panic and overreaction is worse than anything I’ve seen in my lifetime and it indicates we have no ability to handle real problems.

    People get angry when you tell them that we’re going to have fewer deaths than a bad flu season and that we’re overreacting. “We’re flattening the curve so that we have enough respirators! ” The demand for respirators is vastly overestimated, but even if it wasn’t, why didn’t we build up our supply after the bad 2017/2018 flu season where an estimated 61,000 people died of the flu? How did we get through that without a national panic and shutdown?

  37. Walt-
    Couldn’t agree more this is ginned up to the max but if we had enough
    masks to provide for everyone to wear at work, shop etc. it would cost us
    a good deal less then an eye watering 6 trillion dollars. Quarantine
    was the least effective thing we could do it won’t stop the virus. This is either
    a massive heist, deliberate destruction, or a torpedo to Trump’s election
    prospects. In the end this will turn out to be nothing more than a bad flu
    event but what kind of leadership allows these shortages of basic critical
    equipment to happen after the prior viral outbreaks? I’m not talking about
    Trump here this is the fault of the highly paid leadership at the CDC, WHO,
    and FDA whose responsibility is to ensure these materials are budgeted for
    and on hand. That is one of the most if not the most basic aspect of their
    function.

  38. @Charles, that’s a reasonable point, and one that has occurred to me as well. My assumption is that we are more likely to test people in serious condition, so that deaths are less under counted than total cases. This is one reason why I don’t believe some claims that the true number of cases is ~100X the reported here in the US. Although as Harlecloroquin states above, there are still tight restrictions on testing in most US locations, so there is still under reporting to some degree.

    However, the US deaths are picking up pace in recent days, and the trajectory of deaths in NY is concerning. On the other hand, while total cases are accelerating in NY, they seem to be slowing down a bit overall in the US (for the last three days). So, hopefully the distancing actions / warmer weather are having some effect. Or maybe the people fleeing New York will start outbreaks elsewhere. We’ll see.

  39. RE: Efficacy of Social Distancing

    Do we have any way of quantifying the degree to which people are observing this?

    I’m NOT saying it’s unnecessary or ineffective. I fully support the 15 day wait-and-see approach.

    But I’m concerned that (again) we’re going to “learn” an unsubstantiated circular lesson, to wit: The spread was slowed, therefore every measure we took was significantly effective in slowing the spread.

  40. “ The spread was slowed, therefore every measure we took was significantly effective in slowing the spread.”

    Exactly.

    2020 will be the year of the Post Hoc Ergo Propter Hoc.

    Gotta save face somehow. I suspect much of the continued caution will, in the future, be obviously an attempt to do just that.

  41. Thanx for this post, code and data. I downloaded R, your code abd data and I can run it on my Linux box – makes the same plots you show. (There are a bunch of errors about ‘geo_path). What I am wondering, tho, is where did you get the total cases and total deaths for each day? I went to worldometerand they had slightly different numbers for each day. I updated ypur corona.csv file till 3/25, ran your code and got very similar plots, so the numbers are not too different. Just wondering as to your source.

  42. I am more and more coming to the belief that the warmer weather will slow the spread considerably in the Northern Hemisphere this summer. Singapore shows us it doesn’t stop the spread completely, but it’s perhaps much easier to deal with. A little hard to disentangle their weather from policy.

    However, when it’s warm here, it’s cold in the Southern Hemisphere. So I predict Briggs will need to stitch a third logistic to his model. And potentially a fourth in the fall when it circles back north.

    If the spread does in fact slow that much here, then that will provide a lot of value in preparing for a potential second wave, hopefully.

  43. Is it just late? Am i too tired? Because i just cannot follow this convoluted blog post (rant). Its like you have good points to make that *you* understand clearly inside your head, but you don’t convey them well into the ether, nor just write them out in plain straight forward english.

  44. UK government’s website on “High Consequence Infectious Diseases:”

    “Guidance and information about high consequence infectious diseases and their management in England.”

    “Status of COVID-19

    “As of 19 March 2020, COVID-19 is no longer considered to be a high consequence infectious diseases (HCID) in the UK.

    “The 4 nations public health HCID group made an interim recommendation in January 2020 to classify COVID-19 as an HCID. This was based on consideration of the UK HCID criteria about the virus and the disease with information available during the early stages of the outbreak. Now that more is known about COVID-19, the public health bodies in the UK have reviewed the most up to date information about COVID-19 against the UK HCID criteria. They have determined that several features have now changed; in particular, more information is available about mortality rates (low overall), and there is now greater clinical awareness and a specific and sensitive laboratory test, the availability of which continues to increase.

    “The Advisory Committee on Dangerous Pathogens (ACDP) is also of the opinion that COVID-19 should no longer be classified as an HCID.

    “The need to have a national, coordinated response remains, but this is being met by the government’s COVID-19 response.

    “Cases of COVID-19 are no longer managed by HCID treatment centres only. All healthcare workers managing possible and confirmed cases should follow the updated national infection and prevention (IPC) guidance for COVID-19, which supersedes all previous IPC guidance for COVID-19. This guidance includes instructions about different personal protective equipment (PPE) ensembles that are appropriate for different clinical scenarios.”

    https://www.gov.uk/guidance/high-consequence-infectious-diseases-hcid#status-of-covid-19

  45. It’s not even April and we’re 6,000 short on the your death predictions by April 19. Not looking good. Might be time to ask if any ideological assumptions were fed into the model?

  46. Reading is a difficult task for many, it seems. To quote from above (sans italics):

    We saw the last two weeks that our own model was under-predicting, as predicted (if you follow me)…

    The model week-by-week, since it has missed the secondary peak, has under-predicted. If the peak is more than a week away, then the model will certainly under-predict again.

    Maybe it’s too many things to keep in mind at once. Difficult task, yep.

  47. Dr Briggs,

    Give Mosher a break.

    He’s likely busy homogenizing, adjusting, in-filling, and otherwise preparing for market his BEST temperature “estimates.” How can you actually expect him to read and comprehend your clear explanations.

    Maybe he can share his model predictions of global temperature anomalies in the time of Corona, with a side of snarky condescension–his specialty.

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