Thursday, July 02, 2020

Where We Are Now - and what about July 4?

"Everybody sharing graphs and charts"
 -Steven Page, Isolation

First off, I want to thank everyone who appreciated my prior post, so this follow-up is for you.  I spend a lot of time looking at charts and graphs and I have no illusions that everyone else does that.  So, I wanted to let people know exactly where we are right now.  This coming weekend celebrates when, 244 years ago, “one people” chose to dissolve their prior allegiance and set up a new government - one that, four score and seven years later (87 years), would be described as “government of the people, by the people, [and] for the people”.  While people talk about individual liberties, this country was founded as a group that felt that they could collectively determine their own destiny.  We need to come together as a group to beat this.  To quote Lincoln again:

At what point then is the approach of danger to be expected? I answer, if it ever reach us, it must spring up amongst us. It cannot come from abroad. If destruction be our lot, we must ourselves be its author and finisher. As a nation of freemen, we must live through all time, or die by suicide.

While some might argue that this danger has come from abroad, the result is the same.  We ourselves are responsible for finishing it. 

Let’s see how we’re doing.

First, let’s look at LA County’s numbers.  As of today, July 2, we have been averaging roughly 2400 new cases per day, the highest we’ve ever been (Chart 1).  Back *in early April* I was hoping that we were seeing evidence of recovery, but not only are we not out of the woods, we haven’t even found our peak.  There are over 107,000 people known to be infected.  At a population of 10million, that puts the number of infected at about 1 person in 100.  The CDC says that, due to untested asymptotic carriers (that is, people who are sick and can infect others, but have no symptoms, so they don’t know it), the number could be up to 10x higher.  California is testing a lot, so let’s assume the current infectious pool is 2x-10x higher.  That puts the number of infected between 1-in-50 and 1-in-10.

Think about that.  If you go out to get a coffee today, or pop by the grocery store, did you see 50 people from the time you left your door until the time you got home?  If so, statistically speaking, one of them was infected.  Were you closer than six feet to them?  Did both of you have masks?  When you realize that infection isn’t some abstract concept, but a mathematical certainty, I hope it helps you examine your behavior.  If you are invited to a backyard party this weekend - how many people will be there?  If you *knew* that someone there could get you and your family sick, would you still go?
1 in 100 confirmed; 1-in-50 to 1-in-10 possible.  That is where we are in LA County right now.

Let’s turn to Pasadena (Chart 2).  From the start of this, until the end of May, Pasadena had a real tragedy with cases burning through elderly care centers.  A large, compromised population, in close proximity to one another, was a real tragedy.  However, it also blinded us to the larger danger, and in early June our infection rate dropped.  But that’s not the case any longer.  In the last half of June, infections have been increasing again, this time in the regular population.  Our 7-day average is now over 20 new cases a day, and just like LA, is not slowing down.  It’s easy to dismiss a disease as “only for old people”, but that’s not true anymore.  While the majority of deaths are our elderly population, there’s no indication that young people are immune from getting the disease.  This is happening and it is spreading through our city - affecting your neighbors, your friends, and your family.

By the way, the probability of death is more a function of co-morbidities, than age.  It’s just that older people tend to have more combined diseases.  However, one that isn’t correlated with age is obesity - this is actually killing more *younger* people who get infected.  So, it’s false to assume that younger people are safe.

One other aside before we continue - just because someone who is infected with Covid-19 survives, doesn’t mean that they don’t suffer tremendously.  There’s a large range between “asymptomatic” and “death”, and having permanently scarred lungs, but surviving, isn’t a winning scenario - one faced by many young people who are misled into feeling they are safe.

What about the increased testing?  The argument that increased testing causes increased cases (and, therefore, by extension, we don’t need to do anything) is misleading - however, it highlights why we need to focus on chart 3.  This is the data for all of California, not just LA or Pasadena.  California has been doing a great job in increased testing.  We are fighting an invisible enemy and testing lets us see where it is.  Back in April we tested maybe 20,000 cases per day and recently we’ve been testing over 100,000.  However, in a state of 40 million people, that’s still a small drop in the bucket.

Now, with those tests, if the number of actual infected stays the same, but our testing goes up, then the percent of tests that are new cases should go down.  We want that number to be less than 5%, and then we want to watch as it goes to 3%, 2%, 1%, and then finally zero.  No new cases, we’ve beaten this thing.  If the number is greater than 5%, and if it is going up, then that means the virus is expanding faster than our testing - we can’t find all of the infected, and it’s blowing up.  One week ago it was 5.3%, yesterday it was *11.2%*.  What little control California had is being undone.  This is why the Stay at Home orders are being reinitiated.  We aren’t winning this battle.  We can see it’s exactly the opposite and it is time for people to get serious.

So, what does that mean for this coming weekend?  Our chance to celebrate the document that dictated that we were a group of people, free to self-govern?  I think we should reflect upon our history.  Admiral Yamamoto of the Japanese Imperial Navy is oft-quoted as saying, post the Pearl Harbor attack:

I fear all we have done is to awaken a sleeping giant and fill him with a terrible resolve.

We need to awaken and fill ourselves with resolve that we are indeed under attack, and that the time for half-measures is over.  This whole time, had everyone taken this seriously, we could have ended this in a month.  Support your country by doing what L.A. County Health Director Dr. Barbara Ferrer says - stay home with your family this weekend and keep yourself safe.  You are not a victim of tyranny (we fought that 244 years ago); instead you are a part of the legacy of that effort and by isolating, keeping distant, wearing a mask, and recognizing the truly dire situation that we are in, you, and all of us as Americans - especially this weekend - can be what Lincoln called the “finisher” of this collective threat.

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