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Wednesday, April 29, 2020

Covid Update: The Cure Worsens the Disease

On whether COVID-19 deaths may have been under- or over-counted, the CDC's Excess Deaths data strongly indicates they've been under-counted, though it's hard to pin down by how much since every page or view of that data seems to produce different numbers...

They give for the "total predicted number of excess deaths since 1/1/2020 across the United States": 66,081 (including COVID-19) or 32,325 (excluding COVID-19). On its face that would imply they think we're under-counting by a factor of two (not accounting for indirect effects). But for reference, the number of COVID-19 deaths in the US according to John Hopkins as of today is 60,967. Good luck figuring out the impact of reporting delays, differences in coverage of the CDC vs. JH, possible "weighting" of the data, and so on. The main takeaways from the data are that COVID-19 is clearly visible in excess all-cause deaths (even accounting for lives saved in traffic accidents and all that), and that the numbers are likely a fair bit higher than what's been reported so far.

Personally I'm still ballparking the IFR at about 1%, largely because that round number has no pretense of accuracy.

That said, we still need to account for the costs of mitigations, which I suspect most are grossly underestimating.

A lot of people seem to feel like lock-downs are clearly justified as opposed to, say, Sweden's approach. But I rarely hear any discussion of the costs. I want to write about those costs, but every time I consider it, I just don't have the time--so many things!

I will mention one cost right now, because y'all may find it useful information: In our fervor to keep people off the streets, off the beaches, out of the parks, and well frankly just confined to their homes, what's happening to people's vitamin-D levels? What's the impact of that going to be on second-wave deaths? [Update 4/30: To be clear, I think its stupid to discourage people from being outside, and criminal to restrict them from it. But the collective authoritarian mindset has a hard time with shades of grey.]

Take this with a grain of salt:

Something to ponder, anyway.

I've noticed a pattern in the past which feels related: There are people (usually on the left) who see wealth as something moved around, and people (usually on the right) who see wealth as something created and consumed, and a lot about their economic ideologies follows from that difference. I am seeing it here, in that the former group seems to see us as having just stalled the process of passing wealth around, and while we may stumble a bit getting things moving again, things haven't changed that much. The latter group, on the other hand, thinks we may have just breached four or five compartments of the Titanic.

The question about Sweden isn't just about how many people catch SARS-CoV2, and it's especially not just about how many people catch SARS-CoV2 by June. There is a longer game afoot and few are playing it as such.

I'm curious to hear people's predictions about the long run. Whose strategy is going to stand out as the winner two+ years from now?

I hear a lot of credentialed epidemiologists citing herd immunity numbers of 60% or more required to stop COVID-19. I predict that the actual herd immunity numbers will end up being much lower than that, if reached naturally. (And my guess is they'll explain that away as permanent cultural shifts, or they'll just forget they ever made the claim.) I suspect (with lower confidence) when New York City re-opens, we will see bursts of new cases in certain high-R sub-populations, but that it will not take off on a large scale again, even under minimal mitigations.

If that comes true, the rest of the country will be eyeing both Sweden and New York, and there will be much consternation over what is the right path to take. The true costs of both sides of the equation will be more evident with time, and I suspect unfortunately estimates of both may rise.

One likely conflict will be a second lock-down decree, with a substantial population no longer willing to abide. Hopefully we enter that with enough awareness to pre-negotiate a workable compromise rather than seeing militia vs. jackboot.

[Update, May 2: see Individual variation in susceptibility or exposure to SARS-CoV-2 lowers the herd immunity threshold posted today.]

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Simon Funk / simonfunk@gmail.com