Remembering Not To Forget

A brief roundup of corruption and stupidity in the upper echelons of our country’s government, corporate, and media apparatus: The Intercept reports that small business relief money is going to business that are not small at all, but are connected with the President; on the subject of the President, the FDA reiterated its warning about the risks of using anti-malarials (read: the drugs chloroquine and hydroxychloroquine which the President has been regularly promoting, without evidence, since well before he started encouraging the people of this proud country to “inject” bleach) to treat COVID-19; not only is Amazon abusing its workers, but evidently, its also circumventing restrictions on non-essential construction in Greater DC while Bezos’ Washington Post looks the other way; all its pious protestations aside, Facebook continues to promote “pseudoscience” in the name of driving ad revenue; in New York, The Indypendent reports that “As [the] Virus Spreads in Nursing Homes, Gov. Cuomo’s Big Donors Are Immune from Liability”; circling back to bleach, the wife of the brother of that same Governor has been encouraging followers of her “health and wellness platform” to bathe in that caustic household cleaner (as is so often the case, The Onion is both ahead of the curve and painfully hard to differentiate from our absurd reality – thanks to the Tech:NYC newsletter for sharing); and, in a gesture of supreme idiocy, the New York Times opines –in concluding that “The Nude Selfie Is Now High Art” – that “It has become [the nude selfie that is] a way to seduce without touch”; my god! What the fuck did they think it was before?

Okay, dispensing with all that, a brief look at some basic facts as we prepare for a new week. The Hopkins tracker has the US COVID-19 death toll approaching 60,000 as our national confirmed case count approaches 1 million – which, to borrow a framing often used in characterizing the obscenity of our military spending, exceeds the case counts of the five next “leading” countries combined. Some readers will recall that barely two weeks ago, the proclamation of Dr. Anthony Fauci that total US mortality might “only” hit 60,000 was lauded with much optimism, and yet, here we are, two weeks later – with Georgia already “reopening” and other states run by sociopaths considering doing much the same – still in the early days of pandemic, and already on the verge of officially passing that count. Dean Baker rightly asks: “Can We Stop Using the 60,000 Death Projection Number?”

As started to be reported early in the week, and The Washington Post now confirms, “Young and middle-aged people, barely sick with covid-19 [sic], are dying of strokes”; I’ve written at length elsewhere about the tragic number of people across the City and the country who have been dying at home from this disease, and revelations about its pathology give further insight into this sad phenomenon. Owing to immigration status, poverty, lack of (sufficient) health insurance, fear of hospitals – which increasingly look like death traps – and a host of other factors, people have been reluctant to seek care, but the risk of sudden death from COVID-19-related heart attack and stroke obviously heightens the likelihood that people will die without ever seeking medical attention.

I’ve also written elsewhere about the certainty that official figures reflect a vast undercount, both of the number of infections and the number of deaths from this disease. We know public health systems have been gutted both globally and across the US. We understand, further, that politicians have zero incentive to count any more of the dead than they absolutely must. Based on the experience in New York City, I think it’s fair to approximate a 50-100% undercount for the US at the moment, and to make the math easy, I’m going to guess that 100,000 people have already died of COVID-19 in the United States, official figures be what they may.

Ahh, but we also know that case and infection fatality rates (CFR and IFR; this Wikipedia entry differentiates between the two) have also been drastically overstated owing to consistent under-testing and the large number of asymptomatic cases. As I’ve written elsewhere, I think current best estimates put the IFR somewhere between 0.6% and 1% (with an asterisk regarding the possibility that some/many asymptomatic individuals never seroconvert). Using 100,000 as the current US death toll, that would put the total number of US infections to date (say a week or two ago, given the lag between infection and mortality) at between:

100,000 / 0.01 = 10 million and 100,000 / 0.006 ~ 17 million.

Current US population is ~330 million, which – if everyone infected does seroconvert – would put the current seroprevalence in the US at between:

10 million / 330 million ~ 3% and 17 million / 330 million ~ 5%.

I’ve been railing for some time against people – including some with far more expertise than myself – who without being outright COVID-denialists, have mobilized preliminary data in ways that I’d call dishonest to downplay the significance of the threat posed by the disease. Now, taking the high-end of the above range (because it will lead to a lower overall mortality estimate when extrapolated out) we’d expect total nationwide mortality of:

100,000 * 20 = 2 million

were every person in the US to become infected. If, say, “only” 40-60% of people in the US became infected, this line of reasoning would predict total nationwide deaths between:

100,000 * 8 = 800,000 and 100,000 * 12 = 1.2 million.

There are so many unknowns and assumptions built in here I almost don’t feel comfortable putting these numbers out there, but given that preliminary (and widely/rightly-critiqued) serology/antibody surveys are giving results roughly consistent with these prevalence figures (with even hardest-hit NYC showing ~20% prevalence, and communities in California showing ~3-4%), I think it’s fair to estimate that a single-digit percentage of residents of the US have been infected with SARS-CoV-2 to date and that at least a high five-digit number of those people have died from their infections. Even assuming the nationwide rate of infection is already 10%, and using the current figure from the Hopkins tracker of ~55,000 deaths, we would expect hundreds of thousands, and perhaps as many as half a million total COVID-19 deaths in the US by the time we are finally on the other side of this. (Here’s annual US mortality data by cause from the CDC for comparison; in 2017, two leading causes of death, heart disease and cancer, both killed ~600,000 people.) These numbers, in turn, start to look very much like the early “worst-case scenario” predictions which beg the question: What is our scenario now?

The WHO is warning against the introduction of “immunity passports,” stating bluntly: “There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection,” which basically puts us back where we started – at actually committing to public health and the hard work of non-pharmaceutical interventions while we wait and see if an effective vaccine emerges. Other countries, localities, and past versions of our own City have proven that such measures pursued with diligence, sufficient funding, and public buy-in can be highly effective. Let’s commit to that world starting some time ago.

And speaking of public health, this webinar from the American Public Health Association is great. As a New Yorker, I especially enjoyed being so impressed with Jill Taylor who runs New York’s Wadsworth Center, but the whole slate of speakers, and indeed, the whole webinar series has been tremendous. From David Dayen’s daily COVID-19 newsletter, Unsanitized, I learned that the man in the already legendary viral video “A Message to the Government” (to which I linked yesterday) is none other than Vic DiBitetto (aka, Ticked Off Vic). Vic and I don’t see eye to eye on everything, but I thank him for his remarkable contribution to sane discourse in this country.

Fridays for Future (the global movement which has grown out of the work of Greta Thunberg) just put out this (perhaps Billie Eilish-inspired) ad – “Our house is on fire” – that I encourage everyone to watch. To state the obvious, it centers climate crisis and our collective state of (passive) denial, and I suspect it will make your hair stand on end.

Finally, please don’t go crowing, “We are the virus!” or invest any undue optimism (regarding the long-term trajectory of the Earth’s climate system) in the short-term improvement in air quality (as global atmospheric concentrations of carbon dioxide have continued to rise since the pandemic hit), but I was pleased to see New York City add an “Air quality during COVID-19” page to its official data portal. Unsurprisingly, the quality is better, and that, at least, is something that we can all enjoy.