Tuesday Talk*: Is It Soup Yet?

It seems like it was only a week ago that Dr. Deborah Birx told us to expect 100,000 to 240,000 deaths from COVID-19. Yet here we are, with a total (as of this moment) of 10,493 deaths, hardly inconsequential, but hardly in the hundreds of thousands. Whether it was the product of exaggerated fears, a good response by government or the effectiveness of social distancing is a discussion best left to reddit, but two things happened to reflect a paradigm shift.

First, the Dow rose 7.73% yesterday, reflecting the market’s belief that the worst is in the past and we’re now looking forward. Second, the New York Times is now offering a ‘splainer about how we’ll know when it’s over. Playing the “experts say” game, the Times provides “four benchmarks.”

  • Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care.
  • A state needs to be able to test at least everyone who has symptoms.
  • The state is able to conduct monitoring of confirmed cases and contacts.
  • There must be a sustained reduction in cases for at least 14 days.

Notably, there’s no mention of a vaccine or a treatment, but rather a third leg to the pandemic. We started with containment, moved into mitigation and will then shift to suppression.

In suppression, cases will dwindle at an exponential fashion, just as they rose. It’s not possible to set a benchmark number for every state because the number of infections that will be manageable in any area depends on the local population and the public health system’s ability to handle sporadic cases.

Are we at the point where cases will “dwindle” because they’re no longer rising exponentially, as we were told they would? Is that good enough, or will letting down our guard give rise to the next wave of exponential increases while we still have no cure for the disease and no fix for getting infected. Or do we invest in mask futures?

And who decides whether we’ve reached these benchmarks?

“We wanted to suggest criteria that would allow locations to safely and thoughtfully begin to reopen, but what that looks like exactly will vary from state to state,” said Caitlin Rivers, another author of the report and an epidemiologist at the Johns Hopkins Center for Health Security. “We therefore included some flexibility for jurisdictions to tailor these criteria to their local context.”

Some jurisdictions may prove less concerned about reinfection than other issues, and accordingly flex their local muscles even if it means they become the next “hotspot.” What are you going to do when the person touching your tomatoes at the market just returned from such a place?

And then, there’s the curious question of how to deal with the “survivors”?

Gregg Gonsalves, a professor of epidemiology and law at Yale, said: “I’d feel better if we had serological testing, and could preferentially allow those who are antibody positive and no longer infectious to return to work first. The point is, though, that we are nowhere even near accomplishing any of these criteria. Opening up before then will be met with a resurgence of the virus.”

For people who have antibodies, having been unwittingly infected but were asymptomatic, the questions remain how they will know, but more importantly, how others will know they aren’t a threat. Maybe they can sew stylized gold stars to their garments?

A great many questions remain, but the sense that we’re all in a huge rush to get back to normal, to return to work before any of that sweet $2.2 trillion stimulus money shows its face, might push us to move forward with a foolish fearlessness. It was only a week ago that we were doomed. Is it over?

*Tuesday Talk rules apply.

60 thoughts on “Tuesday Talk*: Is It Soup Yet?

  1. Rojas

    Appears they have changed the head on the corpse.
    Suppression is the containment we would have been doing from the beginning had the system functioned.

      1. rojas

        Fair enough, responding to something that was not there. I should have read the source article.

        “We started with containment, moved into mitigation and will then shift to suppression”

        In prior studies such as the Imperial College report, mitigation and suppression have differed by how invasive the treatment is.

        But the usage of suppression in the Time’s piece is not thing to do but a place to be.
        “…..that suppression has been achieved, defined by every infected person infecting fewer than one other.”

        So suppression is achieved by a combination of preventative actions with rigorous containment actions.

        It could happen.

  2. Miles

    I see the “sense” that we’re suddenly over the hump, but it seems more a matter of public/media perception than anything else. Are the ER and ICU docs all going on vacation to Tahiti now or are they still treating patients?

    If only there was some trusted source who could sound the “all clear” siren. But there isn’t.

      1. John Barleycorn

        Tomas Pueyo’s Coronavirus: The Hammer and the Dance.

        Even your guy Radley Balko is citing this on the Twits.

        These guys too:

        Dr. Carl Juneau, epidemiologist, translator of the French version
        Peter Kolchinsky, virologist, MP & RA Capital Management (tweet)
        Andreas Eenfeldt, MD (tweet)
        Dr. Brandon Fainstad, MD
        J. Alegre-Cebollada, Scientist and group leader at Centro Nacional de Investigaciones Cardiovasculares (tweet)
        Trish Greenhalgh, Professor of Primary Care, U of Oxford (tweet)
        Yaneer Bar-Yam, Physicist focused on pandemic dynamics
        Stéphane Debove, researcher in evolutionary biology
        Bill Bowtell AO, Adjunct Professor UNSW Strategic Health Policy Consultant
        Carlos M. Guevara, Doctor in Genetics (tweet)
        Esteban Ortiz, PhD, Medical Researcher (tweet)
        Gonzalo Perez, Cardiologist. Chief Editor at @SIAC_cardio (tweet)
        Franck Ramus, Researcher at the CNRS, professeur @ENS_Ulm (tweet)
        Dr Gopal Ashish Sharma (tweet)
        Mousumi Mukherjee, PhD, Associate Professor & Deputy Director, International Institute for Higher Education Research & Capacity Building, O.P. Jindal Global University (tweet)
        Richard H Ebright, Professor of Chemical Biology at Rutgers (tweet)
        Nirav R. Shah, MD, MPH. Senior Scholar, Stanford University and former Health Commissioner, New York State Department of Health

        Do the math-s, then speculate, then update the math-s when you have more data, you know science. Even you can do it esteemed one. And don’t forget to bring candy.

        1. SHG Post author

          Time to end the math-s thing, whatever that’s supposed to be. It’s neither cogent nor amusing.

  3. Hunting Guy

    We need to laugh in these trying times.

    I ran out of toilet paper and had to start using old newspapers. Times are rough.

    Nail salons, hair salons, waxing center and tanning places are closed. It’s about to get ugly out there.

    Yeah I have plans tonight. I’ll probably hit the living room around 8 or 9.

    1. SHG Post author

      My barber is closed, but I was personally unaware of the status of nail, hair and tanning salons.

      1. Hunting Guy

        For further clarification, the Arizona Governor’s Office determined that “barbers, cosmetology, hairstyling, nail salons, aesthetic salons, tanning salons, tattoo parlors, spas and massage parlors” are not essential businesses and must close by 5:00 PM April 5th.

        I would argue that spas and massage parlors are essential businesses. How else to relieve all the tensions that have built up?

    2. Hunting Guy

      Be careful because people are going crazy from being in lock down!

      Actually I’ve just been talking about this with the microwave and toaster while drinking coffee and we all agreed that things are getting bad.

      I didn’t mention anything to the washing machine as she puts a different spin on everything. Certainly not to the fridge as he is acting cold and distant.

      In the end the iron straightened me out as she said everything will be fine, no situation is too pressing.

      The vacuum was very unsympathetic… told me to just suck it up, but the fan was more optimistic and hoped it would all soon blow over!

      The toilet looked a bit flushed when I asked its opinion and didn’t say anything but the door knob told me to get a grip.😬

      The front door said I was unhinged and so the curtains told me to ……..yes, you guessed it 😝…..pull myself together

  4. B. McLeod

    The market is a poor indicator of anything. With the wild swings we have seen, it could be down as much today as it rose yesterday. All it signifies is a panicked herd rushing back and forth.

    1. SHG Post author

      Trader gonna trade, but then, ever hear the old saying, “put your money where your mouth is”? They do.

  5. Charles

    “A state needs to be able to test at least everyone who has symptoms.”

    They need to be able to treat everyone who has come in contact with anyone who is exhibiting symptoms. If you wait until people start exhibiting symptoms, you’ve waited too long.

    1. SHG Post author

      Who hasn’t come into contact? How would we know? As you correctly note, it’s too late after we’ve already seen symptoms.

      1. Turk

        Well, you asked questions for which there are no answers. We don’t even know how many have died — theoretically the easiest statistic — since many people die at home and aren’t tested.

  6. Turk

    Is it over?

    Looking at graphs of hospitalizations and deaths is like looking at stock market charts: Have we reached the top? Or the bottom?

    And the unsatisfying answer is the same to both: We only know in hindsight.

  7. Chris Halkides

    Biomedomics introduced a serology test roughly a week ago (it is similar in basic principles to a home pregnancy kit). I don’t understand Professor Gonsalves’ comment, unless he means that it will take time to produce and to distribute this test kit in sufficient numbers.

  8. Jeff

    I’m no expert, but all those graphs look to be trending upwards. I don’t see anything plateauing. I don’t know where the experts get the impression that we’re past the crisis, but I don’t believe that to be the case based on the information provided here (not an expert).

    It’s still possible to hit those numbers, isn’t it? It’s possible we won’t reach those levels, but let’s wait a few months before we just declare it over. Otherwise it just sounds like propaganda.

    1. SHG Post author

      Turk opined above about the graphs looking like the stock market, but I don’t see that either. And while the increase may be declining, it’s still an increase as far as I can tell. It’s positive, I guess, but I’m not ready to pop the bubbly, and I’m not convinced that letting down our guard won’t cause the line to renew its rise.

    2. JR

      I’d look at the second derivative, that is acceleration. When it switches from positive to negative we getting over this. We still have a lot more people that are going to get sick at that point, but things will be slowing. My worry is what others have said in one way or another. We get all happy thinking we are in the clear and the flairs up again. Only an effective treatment and/or a vaccine will prevent that from happening.

      1. B. McLeod

        Some of the existing projections anticipate multiple waves of pandemic. This was how things went in 1918 as well. While the virus is still present in the population and we lack a vaccine, mass outbreaks will be a continuing threat until the pandemic has taken its natural course (i.e., practically everyone has been exposed).

  9. PseudonymousKid

    This is far from over. It’s sad the feds are leaving the states to fend for themselves amidst the pandemic. It’s up to the governors to decide for now with or without guidance. Let’s hope they make the right decisions. What else are we gonna do from behind our keyboards stuck at home?

    Until testing is widespread and until the current lack of medical equipment is corrected, I can’t see the point in risking losing the supposed benefits of distancing. It’d be all for naught if we stopped too soon. Let’s take a deep breath and hope that we can make or acquire everything hospitals need first? Please?

    By the way, does anyone have a plug for cloth masks? I’m told I need one now and might have to resort to making my own. The idea of working with sharp objects and with my hands terrifies me. Help.

    1. delurking

      [Not even TT rules allow you to promote commercial websites or products here.]

      Easier to deal with than cutting up a t-shirt, still available lots of places.

    2. SHG Post author

      In one sense, governors area closer to the needs of their citizens and better positioned to make decisions reflecting their circumstances, but the absence of federal assistance in doing so, and leadership otherwise, is . . . unfortunate but not unexpected.

  10. Christopher Best

    Can’t speak for anyone else, but I’m an unhealthy fat slob with a history of respiratory problems going back to childhood. So, barring a positive antibody test or a vaccine, I’m probably working from home indefinitely, no matter what any government official says. It doesn’t even take someone behaving badly to kill me with this thing, they most likely wouldn’t even know they did it. So is it over? Not for me, not by a long shot.

    Surely I can’t be the only person who feels this way.

    1. KP

      Look at it this way- This is just Darwin chlorinating the gene pool, so all the people that modern medicine has kept alive beyond their natural years are going to die. Those that survive un-assisted will breed a better race in the future, while those who are checking out can be grateful & happy for the extra years they’ve had.

      I wouldn’t get too excited about dying, the numbers killed are way down on projections in most countries and there is just a massive hype about it all. We’re at the stage where they were saying 30,000 people were dead in the twin towers, which eventually worked its way down to a few thousand.

      1. Christopher Best

        Speaking as the algae that’s watching the chlorine tablet descend down to the pool he’s been pretty happy in for four decades, I find your point of view hard to appreciate.

  11. phv3773

    I think Gov. Cuomo’s remarks have been reasonable: your choice of a sharp peak, a broad peak or a plateau. He doesn’t mention a long, slow, erratic decline which is what I see in Italy and Spain.

    It’s easy to make a model to track the rise, it’s tricky to call the peak. We will know a lot more in a week. The IHME projections assume stay-at-home orders in every state until the end of May, so even if the’re models are good, the number of deaths will be more than current estimates because of the states that are not with the program.

  12. grberry

    This is an important conversation for scientists, public health officials, and the politicians supervising those health officials to have. The first few ideas won’t be right. So there needs to be time for discussion and evaluation.

    The best hope we have of the media making a positive contribution to the conversation about when and how to reopen is if we first bar all reporters and editorial staff who write/edit about political news/opinion from participating in the coverage of the conversation and restrict it to staff who understand math. That ain’t gonna happen. There are many media organizations where I doubt they have anyone outside the accounting department who understands math. Second best would be if they barred mentioning of politicians names and parties. That ain’t gonna happen either.

    On stats, some are wrong to use, some right. Total cases is of very limited use, because that number will never decline since it counts everyone who ever had the disease including those already dead or recovered. (If it gets to a large percentage of the population it may indicate herd immunity, but if we wait that long reopening the economy in 2021 is looking doubtful already.) Active cases is probably best for HC capacity modelling, and daily new cases best for measuring spread that happened a week or two ago. Total deaths and daily new deaths are sad numbers that can make for clickbait media coverage, but not of great importance to this conversation.

    One flaw I see in the bullet-pointed list is the repeated use of the word “state”. That may make sense for Maryland (where John Hopkins is) and other geographically small states, but it isn’t ideal for geographically big states like California, Texas, and New York. Counties may be much better. No point in shutting down someplace 10 to 12 hours drive from a problem area just because both are in the same state. Nor does hospital capacity that far away help significantly with meeting local need. Similarly, if NYC remains a hot spot, the suburb/commuter counties in the states of New Jersey and Connecticut probably ought to stay shut down, and if any of those counties are a hot spot then NYC probably also ought to stay shut down. (I think towns/cities are generally too small and interconnected, though exceptions exist.) So I think one part of the program ought to be getting county officials to identify which nearby counties they have significant traffic to/from during normal times, and making conditions in every county that is part of that list part of their planning for when to reopen. This will mean establishing ongoing communication with those counties.

  13. Skink

    It was only a week ago that we were doomed. Is it over?

    Some things to help cut through the conflicting reports; by the numbers:

    1. It’s a virus. It continues as it is unless it loses much of its lethality or there is a cure.

    2. The current “stay-at-home” plan is aimed to slow the progression enough to keep hospitals from being overwhelmed and hopefully reduce lethality through slower replication.

    3. The models report an apex or plateau because of “stay-at-home.”

    4. Even with “stay-at-home,” the death rate in the Swamp is just under 2%. That’s 20 times the death rate for influenza, which does not affect everyone. New York and Detroit have much higher rates. The numbers aren’t perfectly reliable for several reasons, but they are all unacceptable.

    5. The 100,000 to 240,000 number is missing a qualifier: time. Remember, the bug ain’t going anywhere.

    I hope this helps when planning a wedding or the next Hotel happy hour.

      1. Skink

        Sorry, I’ll try better. The answer is not for a very long time.

        I had reason to spend two complete days with a national ID doc last month. We discussed the virus at length. At some point, he told me I should think hard before signing a lease extension on my office.

        I just want to be back in a bar, a glass in front of me with bacon sticking from it. Will I ever get to do that again? Or more to our mission: will anyone ever again try a case to a live jury? Will anyone get laid? What ever will happen to all the sex assault employment lawyers?

        Does anyone want to buy some office furniture, cheap?

        1. SHG Post author

          I have no doubt this too shall pass (hey, we got over the 1918 Spanish Flu Pandemic, right?), but like Judge Pinky Carr, some will decide in a week or two it’s over and expect us to appear, while others will cancel the NFL season. Is it a week or two or a year or two? How would anyone know?

          1. Skink

            When I get bacon, you get normal. But that might only happen after the Great Navy of the State of Nebraska has a flotilla.

    1. Jardinero1

      The context that needs to be added to your two percent is average age, co-morbidities, and medical error. Nobody is talking about medical error yet. But, it is a fact that practitioners are flying very nearly blind; and they could be inadvertently killing patients as well.

  14. cthulhu

    I’m in (currently-not-so-sunny) metro SoCal (not LA), and new cases per day has been essentially flat to slightly trending down over the last week. But testing is still woefully short, so this is mostly saying that the number of cases severe enough to warrant a test is constant over the last week. I’m nervous saying that’s really “flattening the curve” yet.

  15. Ayoy

    They only could find five experts? Three weeks of house arrest, there must be millions*.

    *doubling every 3.5 days approximately.

  16. Jake

    Is it over? Not by a long shot. I know the rules. But since lives are on the line, I hope you’ll allow a URL just this once:

    https://covidactnow.org/ indicates down to the county level where your local community is at in its own unique infection cycle with multiple potential outcomes based on different lockdown scenarios.

    In the meantime, my personal posture on a return to society is: You first.

    Stay safe.

  17. Howl

    Twenty years ago we had Johnny Cash, Bob Hope, and Steve Jobs.
    Now we have no Cash, no Hope, and no Jobs.

    PLEASE, DO NOT LET KEVIN BACON DIE.

  18. losingtrader

    I think you’re giving too much credit to the stock market, but then what would I know?

    Credit markets lead equities. There are still a lot of problems in credit markets,.

    Also, it’s become apparent for each fed action there are unintended consequences:
    1) Fed buys MBS driving down rates while lenders , who have hedged rate exposure are unable to deliver loans into their commitments because they are closed or borrower has lost his/her job, resulting in margin callson the hedges, and bankruptcies.
    2) Forbearance requires servicers to advance funds to make MBS payments. No servicer wants to buy servicing on any loan . Forbearance without proof of need results in originators stuck with first payment defaults.
    Try getting a jumbo loan. The market is largely seized up .

    Even AAA housing authorities, which make the most-needed low income loan will need a liquidity facility to cover advances for the MBS, or will be in a “jump to default” situation.

    The permutations are endless, but the 1st quarter was the most profitable in 10 years for traders I know.
    The fed has definitely chosen sides with it’s programs: If you have BBB- or better rating you can sell bonds directly to fed. The rest of the market I screwed.

  19. Trader Bill

    You are forgetting one thing, Loser: Credit markets have no credibility at inflection points. There is where we separate the sheep from the goats. Just ask George Sorrows-breath.
    The fundamentalists are the sheep. The technical analysts are the goats. You are apparently a sheep, but you might be a wolf in sheep’s clothing. Ha.

    In any case, you’re too smart to be a loser, if you catch my drift? Our sources tell us you sold the market short in early March and cleaned up on the way down. Some loser!

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