Thanks To The People We Don’t See

I watched Outbreak. I watched Contagion. Still, I don’t feel qualified to speak to the significance of the pandemic. I hear what far more knowledgeable people are saying, from Dr. Anthony Fauci to a plethora of docs in the trenches, and I accept that their studies were deeper than the two movies I watched.

Yet, there is a niggling question that lingers in the back of my head. If this pandemic began sometimes between last December and January, it has a death rate of 1% and its growth is exponential rather than linear, why have there not been more deaths worldwide? As of this moment, the number of deaths is 14,756.* That’s nothing to sneeze at and every death matters, but it’s not in the hundreds of thousands, the millions.

There are a variety of factors, from false or inadequate reporting to medical intervention, that could explain some of the rhetorical shortfall, but not all of it. It may very well be that the curve has taken longer than anticipated and will, in short order, reach that point of a million deaths, but given the way exponential increases work, we should have been there already. We aren’t.

While some of us sit home, trying to collect our deepest or wittiest thoughts to save us from tedium, there are others outside doing the work that needs to get done. The most obvious, the health care workers, are rightly extolled as heroes. The less obvious are hidden from sight. The toilet paper doesn’t appear on supermarket shelves by magic. Someone makes it, transports it, loads and unloads it, puts it on shelves for us to snarf up at our will. Food too. Plus the other miscellaneous earthly goods that we don’t really need but would make our sheltering in place less unpleasant.

Are these people, these invisible workers who keep the underground economy moving, risking their lives for minimum wage? Or at least not a salary worthy of risking their lives? There aren’t enough N95 masks (whether in existence or available in storage awaiting FDA inspectors to finish their coffee breaks, according to whom you believe) for hospitals, so it’s not as if guys in warehouses are likely wearing PPE for their safety.

The panoply of people necessary to make this happen is really quite astounding, in ways we rarely consider because it’s not our job to figure out all the folks needed to make a supply chain happen. Truckers can’t truck if there is no place to get gas and eat along the highway. Who’s manning the slushie machine at Exit 132?

To be perfectly frank, I harbor fears of infection when I venture out of the house, when a family member goes to the market and even when the mail arrives (thank you, Joe, the mailmanperson). Granted, as a person of a certain age, I’m supposedly at higher risk than you young folks, though that didn’t do 44-year-old one-time blawger David Lat much good (I’m pulling for you, pal).

But where do I come off feeling justified in my concerns while there are millions of other people out there doing the heavy lifting that allows me to stay home and not starve to death, freeze to death, or be bored to death? Most of us don’t think of the people along the supply chain, from producing the food and goods we still need, still enjoy, to survive who are doing their jobs so we can cower in fear of infection at home. Without them, however, we would be staring at a very different world today.

There has to be some measure of accommodation between the continuation of our economy and our self-protection from COVID-19. Where that line gets drawn, or if it’s a line at all, requires someone smarter than me, as I struggle to understand why the good people who will get up today and go to work so that the rest of us can remain home, some in confusion at to how this will play out, others in quiet panic, do it. Maybe they need the money, even though they aren’t paid their worth under the circumstances. Maybe they realize that society can’t exist without them doing their jobs. Maybe they aren’t as afraid as others.

Whatever motivates those of you who will go out today and do a job that needs doing, and without which your friends, neighbors and thousands of random people who don’t know you exist will have nothing to eat, I thank you. I don’t know your names. Nobody will build a statue of you. You may end up infected by corona virus. You may even die. I don’t know how you do it, or why you do it, but I thank you for doing it.

And if they can do it, why can’t I? It may kill me, but we all have to go sometime. Not that I’m in a rush, but I’m no more special than they are, and society will no more miss me when I’m gone.

*Unless you’re a physician in the trenches or an actual Ph.D. in epidemiology, keep your opinions to yourself. No one wants to hear you regurgitate which news channel’s talking heads you believe is telling the TRUTH!!!

50 thoughts on “Thanks To The People We Don’t See

  1. John Barleycorn

    Why?

    It is a math-s question esteemed one. And you suck at the math-s even when you link the math-s….

    Me bets it might have something to do with those in the process of dying ain’t dead yet and those in the process of recovering ain’t “recovered” yet. But I would have to go ask that dude sitting on the mini-excavator, in the outbuilding out back, at the cemetery coding in python about it.

    Via your link, which should be under a separate SJ “Lets do the Math-s Tab” and will be one day, under a photo of Frank Zappa atop a bulldozer ;), lets do the math-s and see….

    4,923 divided by 343,818 = .0434 or 4.34% (dead)

    99,078 divided by 343,818 = .2869 or 28.81% (“recovered”)

    343,818 – 99,078 – 14,923 = 229,817 (not dead/not “recovered” yet) or 66.85%

    Hold on tight now because for our lesson next week we are gonna have to figure out a way to get the dude on the mini-excavator join us for some statistics and probability shenanigan’s while drunk.

    P.S. Who knew I should have bought a ventilator instead of upgrading the root cellar last fall? I definitely should have talked to the goats about that! Oh well next time…..

    Reply
    1. SHG Post author

      Of all the people in all the world to jump into the breach to explain the numbers, no one is more perfect than you, JB.

      Reply
      1. John Barleycorn

        If you ever stop “picking”: on me 😉 one day I will tell you about the epidemiologist who I used to date who had a thing for tractors and wiskey. 😉

        P.S. The math-s in next week’s lesson will make this “problem” more conceptually informative.
        It gets really, really fun and interesting when you throw in the “undiagonised” probabilities just because you have to do that if you wants-you-some-of-them-there “truth” doodads to juggle atop gopher mounds while messing with the goats.

        Reply
    2. James

      Someone’s dropped a few digits here……

      4,923 divided by 343,818 = 0.0143 or 1.43%

      Keep in mind, it’s probably 10-14 days from signs of illness to death, so deaths are delayed by that same 10-14 days.

      Reply
    1. Guitardave

      Yeah…I’m still around. Me and the Admiral hashed things out.

      Thanks Howl…this reminds me of one of my many ‘fun’ jobs.
      I spent a couple of years in the early 00’s working on a trash truck. It started just driving…an old friend ( a very cool biker called “Trashman”) had been working for years for a one man/one truck operation and got a DUI…he was in a bad spot…i had a CDL and was “in between jobs” so i took the job temporary till he got his license back.
      But I stayed on after he got his license back…we were both in our early 40’s, and loading 6-10 tons of garbage (no hydraulic bin dumpers mind you) every day, 4 days a week, made for wasted weekends, laying around sore and recovering. So we switched off on driving and throwing every other day. I got to see the dirty backside of all you pretty pigs out there.
      Funny/not funny…but as a rule of thumb, the more upscale the customer, the nastier and more thoughtless the trash pile was ( 40gal. bins full of wet grass, dog shit and thorn bush clippings, or not using bags in the bin for food garbage..can you say maggots?.. for ex.) , and to top it off, these were the same people who wouldn’t tip at Christmas time…go figure…little old Grandma, with one or two tidy light bags a week, would throw us a couple of twenties, or a bottle of Jack.
      So i really feel the need to say this to you all. TIP YOUR FUCKING GARBAGE MAN, PIGS.

      Reply
  2. Noxx

    Well.

    If asked directly, most of us would demur and say that the mortgage has to get paid and the kids fed, and that’s the truth, but it’s not the whole of it by a long shot. If I floated to the wife the idea that she just not go to the hospital, she would give me the same look as I would give her if she suggested (perfectly reasonably, probably) I not go run around in the rain fixing pumps and generators. I can’t say if it’s innate or acquired but one way or another the outcome is we can’t just look at a job that needs doing, that we’re qualified to do, and walk away from it so that it lands on somebody else.

    It is no doubt, a uniquely human foolishness. Maybe a sociologist or someone in humanities could speculate on the root of it. All I know is that it’s always been this way. Sometimes the machines eat people, people get exposed to chemicals and diseases and die… but the drum always goes on, and like Walter Miller said in some cheap SF pulp all those years ago, “You gotta build that line”.

    We don’t feel like heroes, but you’re welcome and thank you all the same. Stay safe.

    Reply
      1. cthulhu

        One of the finest songs ever written, and Glen Campbell slays it vocally and with his six-string bass guitar solo. Having grown up in one of the more rural and poorer parts of flyover country, I don’t sentimentalize it but especially now, there are a lot of unsung heros out there. Thanks to Jimmy Webb (an Oklahoma boy) for seeing farther, to Glen Campbell (an Arkansas boy) for singing to the unsung, and to Scott for pointing it out during these trying times.

        Reply
  3. PML

    I think on a personal note, what scares me most is my wife is a Nurse and My son a Physician still working everyday. I know that others out there have family too in the same situation. They would never quit, but it still makes me uneasy everyday they go to work.

    Reply
  4. Solon

    Perhaps you have seen it, but Eugene Volokh posted a similar entry yesterday referencing the Rudyard Kipling poem. It is a helpful reminder.
    For what it is worth, I understood the social distancing to be more about flattening the infection curve (by slowing the spread of the infection) so as to limit the ongoing cases (and avoid overwhelming the health care system) rather than avoiding personal infection in any particular case. If that is the case, our focus should be on not spreading it rather than not catching it. I don’t feel brave for going to court unnecessarily because I might catch it; I feel stupid for going because I might spread it. (I know you don’t care about my feelz, or think they should be a basis for others’ behaviour, but with that bit of gertruding I’m hoping that you will look past that to my point regarding the larger purpose of social distancing.)

    Reply
      1. John Barleycorn

        Should I bring a ruler and candy for next week’s math-s lesson or just a ruler?

        Niggle, niggle….THWACK.

        Even these guys have more math-s than you do…. 😉

        Reply
      2. phv3773

        Perhaps the answer to the niggling question is the time lag between diagnosis and death. For example, suppose the daily number of new cases doubles 4 times in that span. Then the number of deaths on any particular day will be 1% times 1/16 of that day’s new cases.

        Reply
  5. Orthodoc

    As a medical doctor (who is writing from the [thankfully quiet!] hospital), I am almost “in the trenches”. so I hope to be allowed a comment, even though as a bone surgeon I don’t know much, that is to say anything, about virology.
    My small point: you are right to wonder about the death count. It is considerably lower than expected. (I don’t recall if links are allowed here but if you google “ioannidis fiasco” the first hit is this: https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/)

    More to the point, death should be the main, if not only, measure we use for decision making.
    That’s true not only because being alive is what people value the most.
    It is that mortality is the measure least open to influence by human decisions.
    How many people test positive depends on how many you decide to test.
    Is pneumonia in a patient with the virus a COVID case if there is also a bacterial infection? Again, a judgment.
    Even the number of people intubated on respirators is human-influenced, as the decision to intubate is a judgment call, often based on very imprecise parameters (a major one being a PREDICTION that the patient, though fine for the moment, is apt to deteriorate)
    (In fact, because there is some human judgment in whether a given death is a covid death [like pneumonia patient above], we really should be looking at the total deaths in the country. We’d expect something like 50,00 deaths a week without an epidemic. That numbers are big enough, and our data collection systems robust enough, that CDC should be able to tell if we are experiencing any change)
    Looking at death counts here is similar, perhaps, to looking at the homicide rate as the true measure of criminal activity, as many other things might be classified with some bias (though my teacher in residency favored the attempted murder rate, saying “It chaps my ass that Rendell is taking credit for the lower homicide rate when all I see is the same number of gunshot victims but I am better at saving them”)
    And you are right as well to thank every link on the supply chain. I too am grateful

    Reply
    1. SHG Post author

      Sure, why not? At least you’re a doc, as opposed to all the non-docs, some with other qualifications and others with none at all, which doesn’t stop them from spewing whatever crap is in their head. Because of course they must.

      As you can see from the others, everybody has a very (pseudo)sophisticated rationale that ultimately explains squat. But whatever the reason, our response to coronavirus is very different if it ends up producing 50,000 deaths than 5 million, and when we decide whether to hitch up our big boy pants and go back to work or stay home, that’s the number we need to know.

      Nobody doubts its a disease and can kill, but where’s the tipping point between dying from COVID-19 and starving to death? That’s the question all these explanations fail to answer. I know I could die in a car crash any day, but it doesn’t stop me. Maybe this shouldn’t either?

      Reply
  6. Steve White

    You asked why not more deaths. I saw an interview with a Nobel Prize winning life scientist, MIchael Levitt, who did projections for the epidemic which predicted the course of it in Wuhan China and is now predicting we will see a decline in cases in a few months. You can find it in Jerusalem Post which did not require me to pay.
    To the extent I understood it, he believes a high percentage of people had some kind of immunity (caveat – his analysis seems to be based on completely accepting the Chinese govt. statistics) because only 3% of the population got it. That would be too low for highly infectious disease if no one had any resistance, he said.
    But, again if I understand it, his predictions were based on extrapolations from the growth rates over time – and he said the exponential growth rate assumptions do not remain valid as any infected person mostly interacts with the same people every day – once they have gotten it, the exponential spread abates. People do not associate randomly.
    One more point I would like to make – for all Trump’s terrible failings responding to this -he is not entirely wrong to point out it comes from China. This is not just because China had some bad luck, the danger of the Chinese and other wild animal markets have been known to virologists and epidemiologists for a long time – we need to cooperate with them for now but in the long term they must be held accountable – at least to close those places, which are the entry points of zoonotic diseases to the human population.

    Reply
    1. Steve White

      To clarify my post above = you will see estimates of exponential growth which say, for example, each newly infected person will infect 3 more people – and that is true early on in the epidemic – but that number does not hold up over time – Mr. Smith infects his wife and two kids – then the wife and kids would have infected 3 people each – but one of them would have been Mr. Smith, but he is already infected – so they each infect 2 people.
      The other reason we do not have the enormous numbers of dead people worldwide is that the Chinese govts. lockdown of Wuhan saved huge numbers of people from getting infected. It appears other countries are going to do far worse because they are not going to do what is really needed – as individuals and governments – not lockdowns in Florida – spring break still on, pretty much, etcetera.

      The other point I wanted to make clear – a deadly virus can go from an animal host to a human host anywhere, in theory – a bat flies in your mouth accidentally or any other unlikely scenario – but the live wildlife markets create conditions where it is a great deal more likely. The SARS outbreak was traced to wild/exotic animal markets and China shut them down a few months, then, on fairly spurious grounds, allowed them to reopen. They had a lot of warning, Hopefully they will end it for good and help the poorer countries who are going to need vaccines and medicines if any are too be had.

      Reply
  7. SamS

    My answer to your niggling question is that the experts are wrong. The death rate is not one percent and the growth rate is not exponential. If you remember back to the 1980’s when AIDS first came to light: the death rate was supposed to be one hundred percent and the growth rate exponential. To me that meant that some African countries where the infection was greatest should start losing population, but they didn’t. My response was to become more skeptical of experts and their math. Since I’m not a doctor etc, this is just my observation: the human body is a marvelous machine that is wonderfully able to adapt to threats and dangers and able to ward them off.

    Reply
  8. rjh

    I suggest looking at the FT analysis and presentation of the data. It’s at https://www.ft.com/coronavirus-latest and it’s updated daily. It may cover your confusions. They have good statisticians working with their writers to present this material to non-statisticians.

    As a statistician I’ll note:

    1) The growth rate determination needs enough data to remove random fluctuations. The FT starts their country graphs at 100 cases and 10 deaths for this reason.

    2) The growth rates cluster around 33% per day, Some countries are significant outliers and show different trends. These are interesting because they probably represent behaviors or conditions that matter and might be controlled.

    Reply
  9. Ned Freed

    I spent many years doing mathematical modeling as well as teaching this stuff as a professor of mathematics, so let me take a crack at it.

    First, even if you assume expontial growth, you can’t ignore parameters like the growth constant and doubling time. The exponential curve can get pretty flat if these are small and large enough, respectively. Take a look at the many different forms an expontial curve can take in the Wikipedia article on exponential growth and you’ll see what I mean.

    Second, there’s really no such thing as true exponential growth. I’m sure you’ve heard these sorts of examples before, but in case you haven’t: Suppose you have a bateria that divides every hour. Assuming nothing limits this growth, you’ll have more bacteria than there are atoms in the universe in 11 days, give or take. This obviously can’t happen.

    In the real world thse bacteria would experience various forms of negative feedback: They run out of food, hit the sides of the petri dish, etc. Eventually these factors overwhelm the exponential growth.

    The same is true with the spread of diseases, only more so, because we can (and sometimes do) make intelligent choices to limit disease spread.

    Returning to the mathematics, if, say, you assume finite resources limit population growth, your exponential function turns into the logistics function, which rises quickly then levels off just as quickly. Kind of like what’s already happened with the number of Covid-19 cases in China and South Korea – try comparing the curves for those on the JHU web site for those countries with the graph of the logiistics function on Wikipedia.

    Of course the reality is much more complicated and so are the actual models epidemiologists use. Those folks are saying that there’s a strong liklihood of there being multiple waves of infection. I haven’t looked at the math behind this, but I have worked on models for predator-prey populations that end up oscillating back and forth indefinitely, so I have no problem believing multiple waves are a possible outcome.

    Reply
  10. Corey

    We just got the shelter in place order here in Massachusetts though it doesn’t take effect until tomorrow. That means back to the sheetmetal factory again tonight, since industrial lighting fixtures won’t build themselves. Watching corporate put profit ahead of the well being of the employees is certainly a major bummer. Good chance the job won’t even be there once this clears up. Oh and the priest in town tested positive. So things aren’t looking up. Still, i refuse to give up hope. My fellow millenials are clearly preferring a more nihilistic worldview now but i refuse.

    That’s all i have. I have always enjoyed my time in this here hotel as Skink would stay, and i pray and hope that when this is all over the bar is still open and all the patrons return.

    Reply
  11. Mark Brooks

    Dear Mr. Greenfield

    I am neither “a physician in the trenches nor an actual Ph.D. in epidemiology”, but someone who has had to “way up evidence”. Like you, I too have been trying to understand why the infection and death rates are behind the predictions. The epidemiologists when making their models are dealing with a novel virus. As it has never been seen before, they do not yet know the exact “mechanics” of transmission, susceptibilty and other such factors and these then cannot then be included in the modelling.

    The Global Virus Network (GVN) has published a paper, ENHANCED MODEL FOR MONITORING ZONES OF INCREASED RISK OF COVID-19 SPREAD. I know you don’t like URL’s and this might be deleted but it can be found here. The link to the paper (a preprint) itself on the overview webpage
    https://gvn.org/enhanced-model-for-monitoring-zones-of-increased-risk-of-covid-19-spread/

    Quoting “To date, COVID-19, caused by SARS-CoV-2, has established significant community spread in cities and regions along a narrow east and west distribution, roughly along the 30-50 N” corridor at consistently similar weather patterns (5-11 degrees C and 47-79% humidity). The GVN’s simplified weather model illustrates the regions that are potentially at higher risk of significant community spread of COVID-19 in the coming weeks, allowing for concentration of public health efforts on surveillance and containment.”

    Perhaps you will read thru the paper. Suffice to say, for me in Jamaica, it is reasonably good news. Yes we will be affected, but perhaps not severely. For you in New York, perhaps not too good, as it suggests you could see a climbing rate of spread (if no complete lock down) in the next several weeks. Matter of fact it does seem that it started a week ago and this is in keeping with the said GVN model.

    As for susceptibilty, there is mounting evidence that a person’s blood type plays a factor. Persons with “A” type seem to have a higher risk of infection. Persons with “O” type seem to have a lower risk of infection. The other 2 groups “B” and “AB” showing no difference. Here is the URL for the paper.
    https://www.medrxiv.org/content/10.1101/2020.03.11.20031096v1

    While it is a preprint, there was previous research done by a British biochemist, David Grainger, that predicted this. Here is his explantion of why this is so
    https://twitter.com/sciencescanner/status/1240537005949321217
    And here is his research that he references
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1220532/

    My worry, that is not being spoken much of, perhaps because it is not good, is that you cannot continue a “lock down” for an indefinite period of time. The world will “grind to a halt”. How long you can go is the big question. As long as the virus is around, it can continue to spread and cause infections and death. No one has any natural immunity. Until a vaccine is developed, only those who have contracted it and survived (does sounds morbid) will have immunity. What is not known is how long the immunity will last. This will of course affect the efficacy of a vaccine. Will the virus “die out” or as suggested in the GVN paper could survive in a tropical environment and come back to the temperate zones in the fall ?

    I apologise for breaking your rules on posting websites, but I have no other way to show the important information that I am referring to and to demonstrate that it is from credible sources.

    To all those who continue to do the essential work, health care, keeping the utilities going, producing and delivering the necessary goods (food, fuel, medical supplies), you are saluted.

    ” These are the times that try men’s souls. ”

    Kind Regards
    Mark Brooks
    Malvern PO
    St. Elizabeth
    Jamaica

    Reply
  12. PseudonymousKid

    Pops,

    This is complicated and takes experts to explain, which would require too many links to properly lay out. The death toll isn’t final until the pandemic is over. Only then will we have the actual numbers and even then they may be based on projections to some extent. Too bad we weren’t testing early and often. Until the end, everything is conjecture.

    Best,
    PK

    Reply
      1. PseudonymousKid

        Which is exactly why we’re reacting to the threat. Italy has horrific numbers right now. Ours will change as the pandemic progresses and so will theirs. Stay home. Wash your damn hands. Stop hoarding necessities. Follow the experts’ advice. Please?

        Reply
        1. KP

          ” Follow the experts’ advice.” Sounds just like global warming….

          Gentlemen, pick your experts and prepare for battle!

          ..in the end the economic effects will probably kill more people than the medical ones.

          Reply
          1. PseudonymousKid

            I’ve always advocated for old people to die. They eventually have to make room for the rest of us. If that’s all the virus did, I’d be all for it.

            Reply
  13. DanQ

    Excellent post, Scott. In my foxhole, I, too, found myself thinking of the many unsung heroes who allow my family to stay alive. One works for me and moonlights as a pharmacy tech. I have no insights into your ‘niggling question,’ but I feed my statistics-hungry COVID-19 anxieties with data from the interactive site at the link below. YMMV.

    https://www.worldometers.info/coronavirus/

    Reply
  14. Dave Landers

    I appreciate the thanks. I’ve been going to work each day during this pandemic. The economy needs to run and people need to eat. And for my lifestyle I get paid plenty. Wake up in the morning, read SJ, go to work, have a couple of beers at the end. Repeat.

    Life is Good.

    Reply
  15. mb

    I’ve been deemed an “essential service”, so I still get to work, though with some really different policies in place regarding customer interactions. Given that I don’t know what my odds of becoming sick are with vs. without working, nor my likelihood of suffering severe symptoms or death if I do become sick, and that I’m in an area far less affected (at least so far) than where you are, I’m counting myself lucky. I feel bad for the people who are out of work and especially the ones who can least afford it.

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *

All comments are subject to editing or deletion if I deem them inappropriate for any reason or no reason. Hyperlinks are not permitted in comments and will be deleted. References to Nazis/Hitler will not be tolerated. I allow anonymous comments, but will not tolerate attacks unless you use your real name. Anyone using the phrase "ad hominem" incorrectly will be ridiculed. If you use ALL CAPS for emphasis, I will assume you wear a tin foil hat and treat you accordingly. I expect civility from you, but that does not mean I will respond in kind. This is my home and I make the rules. If you don't like my rules, then don't comment. Spam is absolutely prohibited, and you will be permanently banned.