The Coronavirus Issue 2 1⁄2

Well, I guess we need to talk about coronavirus again. I don't wanna, but I gotta. And yes, that's a Naked Gun reference. You're welcome.

Okay, this is weird, because I just sent the Zero-Politics Issue yesterday and so in 24 hours have gone from “Sorry I didn’t send one of these for 6 months” to “Sorry for sending two in two days”.

Desperate times call for desperate measures.

Over the past couple of days, I’ve seen a lot of conversations about COVID risks re: Thanksgiving pop up in my Facebook feed (yes, I’m checking it again from time to time), and there are a LOT of people getting it wrong.

So I thought I'd drop into your inbox with some charts, graphs, links, and other tasty data so you can make the best possible decisions for you and your family this holiday season.

But before you read on, do me a huge favor: If you can think of someone who would enjoy my totally radical mix of awesomeness and humility:

1. Excess mortality says what?

Because COVID has been so politicized, it's difficult to rely on official death certificate data to get a good picture of how many people have actually died from COVID-19. And some people are sort of latching on to this true fact to call the whole “COVID is a dangerous thing” assumption into question. So what’s going on?

In some states and cities, public health officials have (at least at some points on this crazy roller coaster ride) avoided putting COVID on death certificates to keep numbers low, and of course it's also true that for many people, COVID is just the straw that breaks the camel's back health-wise, and it's not always clear how to classify a cause of death in that case.

This is exacerbated by the unfortunate fact that there is basically a war going on inside the CDC between career epidemiologists and political appointees. This should relax a little now, but in the lead-up to the election, there were definitely attempts to make the pandemic look less bad, data be damned, and so for that reason we don’t really know for sure how accurate the COVID-specific data is.

Which, I mean. What the hell, man!?! We can’t even have a government scientific organization to listen to any more? Exhausting.

Anyway, for a complex combination of reasons, the CDC’s COVID-specific numbers paint a picture that’s bad but not super-duper terrible and we can’t know whether to believe it or not. Are they worse? Better?

Luckily, there’s another way. To get the real scoop, we don’t even have to leave the CDC website! We just have to look at the numbers for excess mortality. What is that? Basically, the number of people who die in the US is a predictable, cyclical thing. Approximately the same number of people die from all causes in any given week as in that same week in any other year. So you can plot total deaths against that average trend and see how crazy 2020 looks since March. Here's the CDC page [CDC.gov, ~5 minutes, interactive] where you can check it out.

Above is a more zoomed-in chart from Our World In Data that shows the stark contrast against the past 5 years of total deaths in the US. Here's the page [Our World in Data, ~5 minutes, interactive] where you play with the data yourself.

It seems very, very clear that despite a LOT of mitigation - lockdowns, masks, social distancing, cancelled travel - COVID has killed or led to the deaths of between 242,990 - 331,985 Americans so far, and with transmission spiking across the country, those numbers are likely to grow quite a bit before the spring.

And actually, that number might be even higher. Why? Because during lockdowns, people drive less, catch fewer other diseases like the flu, and so on. So that scary red line up there doesn’t include all the people that didn’t die in traffic on their way to work this year, or the ones that didn’t get struck by lightning or attacked by sharks.

Hooray? 🎉

2. But it’s nearly over, right? 🤞🤞

No. I’m afraid it isn’t.

In fact, we have enough data now (and reporting rates and the case fatality rate have stabilized enough) that we can reliably predict future deaths from today's cases. In march, 4-5% of reported cases resulted in death. That’s now down to a very steady 1.8%. (Thanks, doctors!) And the average death occurs 22 days after the case is reported.

So that means that, for instance, on November 13th, there were 170,792 new cases reported. And from that we can predict that approximately 3,000 people will die from COVID on Dec. 6th. That’s about how many people died on 9/11, and it’s going to be happening every day for a while. (Maybe keep that happy statistic in your head for dinner conversation this Turkey Day 😉).

Hat tip to blogger Jason Kottke for the excellent write-up of the the methodology and how the numbers have stabilized, here [Kottke.org, ~7 minutes].

So that’s how we extrapolate future deaths: take today’s new official cases and multiply by 1.8% to get the approximate deaths 22 days from now. Fun, except that the new case graph looks like this:

Even if we assume a miracle—that new cases will plateau soon at around 150,000/day, and then gradually fall off again—the above formula still predicts hundreds of thousands of additional deaths before the winter is over. If transmission continues to spike, for instance due to Thanksgiving and Christmas gatherings, it could be even worse.

3. But it’s mostly those other states, right?

Go see for yourself.

If you'd like to estimate the chances that someone at a gathering you're thinking of attending has COVID based on real-time data for your specific county in your specific state, you can use this tool [Georgia Tech, ~2 minutes, interactive].

Looks like as of today there is a 55% chance that at least one person in a gathering of 15 people in Flathead County, Montana has it. So be careful out there.

Check this every day; it updates as new data for your area comes in.

4. But mah stuffing!

Okay, so here’s a complicated statistical and environmental model [University of Denver, ~10 minutes] that tells you exactly how likely you are to get COVID this Thanksgiving, given current infection and transmission rates and depending on whether your family’s celebration is inside, outside, masks on, masks off, etc.

Complicated, but there are pretty graphs!

Here’s the Cliff Notes: Probably don’t sit down for a meal inside with a bunch of people who haven’t been quarantining and aren’t already in your bubble.

It’s really pretty incredible that people are putting this kind of scholarly research out there for the public in such a timely fashion.

5. Seriously, though, you’re cancelling my Thanksgiving?

I’m not, at least not with any conviction. In fact, my wife’s parents (who have been quarantining, sort of) are coming to town. So we’re potentially part of the problem.

But, our extended family has officially cancelled indoors dining and hanging out for the holiday, as well as sleeping in the same house.

I don’t know what the right answer is, honestly. I think if you can cancel your plans without causing any family rifts or really being super sad, you’re probably doing your the country and your local hospital a big favor, and decreasing the [small but definitely non-zero] chances of someone you know dying by some significant amount.

I just want you to have all the information and numbers in your head when you make the call. If we’re going to be putting one another at risk, we need to do it with our eyes wide open.

The Onion, of course, has hit the nail on the head with the above headline. The rest of the [satirical, if you’re not familiar with The Onion] piece [The Onion, ~5 minutes] is really funny as well.

6. So what’s the takeaway?

First and foremost, I don’t want you to be one of the people that North Dakota nurse Jodi Doering has watched die alone while insisting COVID-19 isn’t real [Twitter, ~5 minutes].

And I don’t want you to be one of the people who will transmit something that, sure, only kills 1.8% of people who get it, but is still definitely something that kills 1.8% of people who get it, to someone you love, or someone that is loved by someone you love. Even if you live in the middle of nowhere, at the end of a long dirt road, you can still get this thing, like this lady in West Texas [Texas Monthly, ~15 minutes].

But I also don’t want you to think that a meal outside with your family is a death sentence. It’s not. My take is that if you gather outdoors, sit a little farther from one another than usual, and avoid spit-spewing screaming matches and sing-alongs, you have a decent chance of avoiding the literal plague and a great chance of avoiding a guilt trip from your mother.

But then again, if you go get a bucket of chicken instead, you have a 99% chance of avoiding the plague and a 100% chance of avoiding Uncle Frank.

Life is full of trade-offs.

7. Vaccines?

Yeah, vaccines are happening. Which is pretty stinkin’ awesome. We did it! Science is amazing.

The only problem is that we need one for every person on the planet, and that’s several orders of magnitude more than we have the capacity to manufacture any time soon.

You’ll see numbers in the news that talk about how many doses each country has “reserved”, but that doesn’t mean those doses have been manufactured. They haven’t, at any scale. It takes time (and money), and unfortunately it seems like the current U.S. administration isn’t exactly chomping at the bit to figure out the details.

There will probably be medical workers and other front-liners getting vaccinated starting some time in December, but I don’t think we’ll see widespread distribution in this country until well into the Spring or Summer.

Which means that as painful as it is, we have to keep vigilant for the next few months. One winter of solitude, and we’ll get through to the other side.

Just a few more months of layering [kottke.org, ~3 minutes] all the small, simple, easy, imperfect things we can do to lower the rate of transmission.

8. Okay, that’s all.

What are your plans? What about Christmas?

Hit reply and let me know. I’m very curious.

And if you need an extra Thanksgiving Zoom toast to go with your bucket of chicken, hit me up. I’ll see if I can make it happen.