Here you go –
Case counts and testing numbers
Uncle Ebenezer asked a good question yesterday:
What’s the best response when Conservatives play the Cases Are Only Rising Because of More Testing card?
There are two answers to this question.
The first is to look at positivity rates. The positivity rate is the number of new confirmed cases divided by the number of new tests.
If we are getting more confirmed cases in the context of more tests being conducted, we look at the positivity rate to gain some insight as to what is happening to the unknown and only indirectly observed state of the infection at a given point in time for a given geography. If the positivity rate is constant or decreasing, the new cases that are being captured by the explicitly observed data is mostly a function of more testing being conducted.
However if positivity rate is increasing, that that is a strong signal that the newly observed cases are at least partially brand new case growth.
We have to make a few behavioral assumptions about testing proclivities. I think there are two facially defensible assumption sets. The first is that testing is fairly random. The second (and in my opinion, more likely) assumption is that testing is non-random. Under this assumption, people who have reason to think that they are COVID exposed are more likely to spend the time, cost, stress and hassle of getting testing than people who personally assess their exposure risk to be low or nil. These two assumptions have slightly different interpretations if there were to be an extra 1,000 tests taken on a given day in the normal workflow of a state. If we assume randomness, an extra thousand people tested won’t change the positivity rate. We’ll be getting background infection rates. If we assume adverse selection, an extra 1,000 people tested will have a slighlty lower incremental positivity rate as the first people in line are more likely to be positive than the last person to get tested with the extra tests.
We can look at two different states and their testing experience over the past two weeks. New York state has increased their daily testing rate by about 3%. During this same time of basically flat testing, positivity rate decreased by 30% (1.5% to 1% of tests came back as COVID positive). We can contrast that experience with Arizona. Over the past two weeks, testing has increased by 40% (14 day rolling average). At the same time positivity rate has increased from 12.7% to 21.2%. This is a very strong hint that the increased case count in Arizona is a reflection of ongoing spread and not just a function of increased revelation of a steady state.
The other way of looking at community spread is to disregard testing entirely. There are a lot of assumptions built into extrapolating an unobserved from a biased observable. Instead we should look at age and demographic (including race/ethnicity) hospitalization rates. Hospitalization rates lag infections by a couple of weeks. Very few people actively like to go to the hospital. Instead it it is bad option that is just superior to the viable alternatives. A hospital admission is a costly, and thus a believable signal.
If hospitals are filling up with people who are infected by COVID, this gives us some insight on the state of spread a few weeks ago. We can get more insight by examining the age and risk distribution. If the marginal patient is old, that tells us one story of disease spread. However, if the marginal patient is comparatively young and otherwise low risk, that implies more spread as a lot more infections are needed to generate a large number of hospitalizations for people under the age of 50.
This approach is not perfect. We can probably assume that a marginal patient admitted when there is 50% capacity remaining is probably healthier than a patient admitted when a hospital has 3% remaining capacity. Comparisons over time are also problematic as we are still in a stage of rapid learning on what does and does not work well clinically. But new hospitalizations on a daily basis and total bed counts are at least directionally useful.
Identifying current community spread is challenging as it is an unobserved function and we must estimate it from known and limited observable information sources but we can make reasonable approximations as long as we acknowledge assumptions and data limitations.
Tuesday Morning Open Thread: ‘Rallying’ in Phoenix
POTUS landing in Yuma, AZ, in the morning~
120 COVID patients now @ Yuma Regional Med Center~CEO Robert Trenschel:
"We've seen a surge…we've stopped all of our elective procedures…we just don't have the staffing available–ICU nurses, floor nurses to staff all of our beds." pic.twitter.com/g5Hf3zHllJ
— Vaughn Hillyard (@VaughnHillyard) June 23, 2020
Per MarketWatch:
Regrouping after a humbling weekend rally, President Donald Trump faces another test of his ability to draw a crowd during a pandemic Tuesday as he visits Arizona and tries to remind voters of one of his key 2016 campaign promises…
First, the president will travel to Yuma to mark the construction of more than 200 miles of wall along the U.S.-Mexico border, an issue that he built his campaign on four years ago. Later, he’ll address a group of young Republicans at a Phoenix megachurch, where event organizers have pledged thousands will attend.
Throughout the trip, the COVID-19 pandemic will shadow Trump. The Democratic mayor of Phoenix made clear that she does not believe the speech can be safely held in her city — and urged the president to wear a face mask.
“Everyone attending tomorrow’s event, particularly any elected official, should set an example to residents by wearing a mask,” said Mayor Kate Gallego. “This includes the President.”…
The “Students for Trump” event will be held at the Dream City Church and broadcast to groups across the nation. It is being hosted by Turning Point USA, a group founded by Trump ally Charlie Kirk. Organizers said health and safety measures still were being finalized and it was not clear if attendees would be asked to wear masks or keep socially distant.
Since late May, Arizona has emerged as one of the nation’s most active hotspots for the spread of COVID-19. Use of hospitals, intensive care units and ventilators has set daily records over the past week…
On the positive side (this is snark), when things go badly (in every predictable & probably some entirely new ways), it might force Charlie Kirk far enough out of favor that he has to get a real job — or at least lie low — for the next few months. Yeah, right — as if a GOP grifter ever suffered ‘consequences’!
Tuesday Morning Open Thread: ‘Rallying’ in PhoenixPost + Comments (263)
COVID-19 Coronavirus Update: Monday/Tuesday, June 22-23
Turning mask-wearing into a new front on the culture was a mind-bendingly stupid thing for anyone to try to do, but it's even stupider if your primary objective is helping Trump. https://t.co/CI2gypJ9pY
— David Watkins (@djw172) June 21, 2020
Two words: Donald Trump. https://t.co/VsoI3GkJuB
— Chelsea Clinton (@ChelseaClinton) June 22, 2020
Despite growing availability of #SARSCoV2 tests & thus ⬆️ testing of less ill people, the confirmed case fatality rate remains >5% both in the US & globally: 1 out of every 20 ppl who has tested positive for the #coronavirus has died of #COVID19. Very sobering. #epitwitter pic.twitter.com/HPDTv4pfDr
— Tatiana Prowell, MD (@tmprowell) June 22, 2020
It took more than three months for the world to record one million COVID-19 infections – but the last million cases came in just eight days, the @WHO says. https://t.co/FZMauxDmIk
— The Age (@theage) June 22, 2020
Despite clear progress in containing the coronavirus in some regions — especially those that saw early outbreaks — globally, the number of new cases has soared in recent days. Hospitals are scrambling to cope in Brazil, Iraq, India and the United States. https://t.co/yUYpFThTRe
— The Associated Press (@AP) June 22, 2020
The @WHO DG @DrTedros this morning:
"It seems that almost every day we reach a new & grim record. Yesterday, >183,000 new cases of #COVID19 were reported – easily the most in a single day. More than 8.8 M cases have now been reported & >465,000 people have lost their lives." pic.twitter.com/CLoyE5xvBv— Laurie Garrett (@Laurie_Garrett) June 22, 2020
Saudi Arabia to hold ‘very limited’ Hajj amid coronavirus pandemic https://t.co/9qvaU2lHWv
— The Independent (@Independent) June 22, 2020
China reports 22 new coronavirus cases, 13 in Beijing https://t.co/l260PRQeK6 pic.twitter.com/94iEtLNVlW
— Reuters (@Reuters) June 23, 2020
How Asia's biggest slum contained the coronavirus https://t.co/TYNWoeUd4k
— BBC News (World) (@BBCWorld) June 22, 2020
"People are still not taking it seriously": Many Pakistanis dismiss the danger of the pandemic and appeals to wear face masks even as virus cases surge and authorities insist they have to lift restrictions to prevent an economic collapse. By @kathygannon. https://t.co/h068vtMi2I
— AP Middle East (@APMiddleEast) June 22, 2020
Are Australia's coronavirus numbers at risk of increasing? https://t.co/s310gVQaIN
— BBC News (World) (@BBCWorld) June 22, 2020
South Sudan was never going to be ready for COVID-19. Five years of civil war and corruption have stripped away much of its health system. As the number of cases grow, one doctor says the situation could spin "out of control at any time.” https://t.co/Wwu9KTbrdG
— AP Africa (@AP_Africa) June 22, 2020
Mexico's confirms 4,577 new coronavirus infections and 759 deaths https://t.co/bHAtLbeu8P pic.twitter.com/I3Wf4lSvBM
— Reuters (@Reuters) June 23, 2020
COVID-19 Coronavirus Update: Monday/Tuesday, June 22-23Post + Comments (63)
Ask The Doctors! Open Thread
Next Tuesday, June 30, at 10 am ET, the Senate Committee on Health, Education, Labor, and Pensions will hear testimony from
- Anthony Fauci, MD – Director, National Institute Of Allergy And Infectious Diseases, National Institutes of Health
- Robert Redfield, MD – Director, Centers for Disease Control and Prevention
- Stephen Hahn, MD – Commissioner Of Food And Drugs, Food and Drug Administration
- Admiral Brett Giroir, MD – Assistant Secretary For Health, Department of Health and Human Services
Do you have questions for any of them? You can contribute those questions here, and they may be used.
And here’s a Sarah Cooper bonus for you!
These Fucking Idiots
Governor asks that Texans wear masks. "Our goal is to keep Texans out of hospitals and to reduce the number of Texans who test positive…COVID hasn't simply gone away. We don't have to choose between jobs and health. We can have both."
— Tony Plohetski (@tplohetski) June 22, 2020
Maybe you should have been urging people to wear fucking masks months ago before it became a huge issue in Texas LIKE ALL THE FUCKING MAYORS BEGGED YOU TO DO.
There really should be a way to sue and prosecute governors and mayors and Presidents for negligence.
Leading is Hard Work
Andrew Cuomo stopped doing daily briefings last Friday, because New York is on the other side of the mountain, as he calls our curve, and the daily briefings were a lot of work. He and his staff did them for a little over 100 days, and during that time we went through hell. His next-to-last briefing on Thursday was a classic:
He’s addressing the the Trumpy governors who are currently screwing the pooch in Florida, Arizona, Texas and elsewhere. The difference between them and Cuomo is that his administration just didn’t have briefings. They marshaled resources and did unpopular things, like having prisoners make “NYS Clean” hand sanitizer, moving heaven and earth to boost our testing capacity to almost 70,000 per day, increasing and consolidating hospital resources, and creating a cautious re-opening plan that has, so far, kept our positive rate under 1%. At Thursday’s conference he announced an executive order that would let the state liquor commission immediately suspend licenses of bars and restaurants that weren’t enforcing masking and distancing.
This is grossly obvious, but it seems to escape Trump & Company: It isn’t just talk. Part of the reason New York’s economy is going to recover (slowly) is that people have confidence that if something goes wrong, the Cuomo administration will clamp down and do the hard work necessary to fix it.
It isn’t just Cuomo. Jacinda Ardern and her government have done an amazing job keeping COVID out of the general population in New Zealand by instituting a mandatory, supervised two-week quarantine for anyone entering the country. Again, this is hard work, and last week two women who were in quarantine were given compassionate leave to see a dying relative, and later tested positive. Those women had contact with other New Zealanders on their trip home. Ardern cracked down, putting the military in charge of the quarantine hotels, and suspending compassionate exemptions. Her announcement of the new measures features a stone face and clear anger:
What she’s done, like a lot of what Cuomo’s done, is unpopular (here’s a good round-up of the impact on migrant workers). But her government’s hard work saved lives.
One of the core characteristics of Trump and Trumpism is a fundamental laziness, both intellectual and physical. The MAGA promise is that a red hat and hating the right people is all it takes to make America great. Turns out that work is required, and no more evidence is needed than the abject failure on display in states run on Trumpist principles.