Reality Is Real

And so too is history. A short piece today to remind readers (and myself) of the obvious.

The New York Times headlined this morning: “Coronavirus Cases Slow in U.S., but the Big Picture Remains Tenuous”; have we forgotten everything that Wuhan, Milan, and New York City should have taught us? As prospectuses always warn, “Past performance is no guarantee of future results,” but in this instance, perhaps the warning should be amended to read, “Present performance is no guarantee of future results, but past performance almost certainly is.”

The Times article goes on to proclaim:

The nation has reached a perilous moment in the course of the epidemic, embracing signs of hope and beginning to reopen businesses and ease the very measures that slowed the virus, despite the risk of a resurgence. With more than two-thirds of states significantly relaxing restrictions on how Americans can move about over the last few weeks, an uptick in cases is widely predicted.

So why tell a lie in the headline, given that many people aren’t very good or thorough readers of the news? Even as the Times itself, among other news outlets, has done good reporting on the inaccuracy and inadequacy of official COVID-19 case and death counts – arguing that these counts drastically understate the severity of the disease’s impact in the US and around the world – the paper continues to point to the same flawed and misleading data in its own reportage.

What did the suffering and death in Wuhan, Milan, New York City, and manywheres else show? That having a small number of confirmed cases now tells us absolutely nothing about either how many actual cases we have at present, or how many infections or deaths we can expect in the near future. I’ll now do some very basic math. According to the Hopkins tracker, the United States is currently reporting ~1.5 million confirmed COVID-19 cases to date and ~90,000 deaths. If those figures represented all of the actual infections and deaths, they would give an ~IFR of:

90,000 / 1,500,000 ~ 6%.

That’s very high. We can speculate that the US strains are especially virulent, that the US population is especially unhealthy, that our healthcare system is (for a rich country) especially flawed, etc., but all that strikes me as obfuscation. Based on a growing body of increasingly reliable evidence, it seems likely that the actual COVID-19 IFR is somewhere between 0.5% and 1%. We also have reasonably strong data suggesting that death counts in the US and in many places around the world undercount the death toll by something like 50%. Obviously, the extent of the undercount will vary significantly by jurisdiction, but I’ll use 50% here for simplicity.

If the US death toll reflects a 50% undercount, then closer to 135,000 people in the US have already died of COVID-19. If we err on the high side and assume a 1% IFR for COVID-19, 135,000 deaths would indicate that there have already been:

135,000 / 0.01  = 13.5 million cases.

That would be neither here nor there if we’d actually succeeded in suppressing or eliminating the virus in the US, but we obviously haven’t. This math does make clear that we’re only actually confirming something like 10% (at the high end) of actual infections, suggesting that the new confirmed case counts to which the Times points are – as the Times itself has shown elsewhere – almost totally meaningless.

Let’s say the case counts were meaningful though, which they’re not. We also know that there tends to be a significant lag between infection and confirmation of infection (for people who do manage to get tested): Incubation period is ~5 days; people who require hospitalization often take a week or two before becoming sick enough to seek medical attention; for those able to get tested, there can be a multiple-day lag in receiving test results; etc. All of which is to say, if infection rates started spiking on Monday as many states moved to reopen, we wouldn’t know it yet by the official numbers (and might not know it for another week), and yet we’d be sitting, as a country, on top of a crisis – volcanic and about to erupt – just as we were, as a City, in NYC in early March.

The Times piece actually says as much, but it does so in a mincingly equivocal fashion, while consistently quoting figures (eg, a projected death toll of 113,000 by June 6th) that its own reportage has shown to be misleading at best, patently false at worst. Put simply: The new confirmed case numbers fell modestly over the course of the past week because, until last Monday, most of the country had been under some level of shelter-in-place/stay-at-home order for at least a few weeks, and the hardest hit parts of the country had been under such for significantly longer (though to the Times credit, it does disaggregate New York City case numbers from those for the rest of the US).

How has the Times failed? Now is the time to be raising the alarm, but instead our paper of record is, once again, hedging and playing “both sides,” as if the virus itself understood politics. Reopening prematurely was more or less guaranteed to lead to a spike in infections. The viciousness of our culture/economy – epitomized in institutions like jails and prisons, immigration jails, meatpacking plants, nursing homes, etc. and in the working and living conditions of the poor, especially the undocumented, immigrant, Black, and Indigenous – will almost certainly amplify that national spike.

How long will it be before Senator Rick Scott has to swallow his words? Not very long is my best estimate. The magical thinking is killing us, though disparately, and what is already a national crisis of historic proportions is in the process of growing rapidly much much worse.