Sunday, June 7, 2020

One Month Check In

                                                                                                  written 31 May 2020
                                                                                                published 7 June 2020

            On May 1st, when America had 1,091,038 covid-19 cases and 57,266 deaths, president Trump decided to "reopen the economy", and vice president Pence stated everything would be over by Memorial Day.  I write this at the end of May.  American cases increased 66% and deaths increased 85%.  This is not over.
            According to, four countries with the largest number of confirmed covid-19 cases are: USA (1,828,784), Brazil (501,985), Russia (405,843), and UK (274,762).  Trump has handled this with denial, refusal to take charge of the response, and dissemination of false or dangerous information.  President Bolsonaro of Brazil (the Latin American Trump) also denied the risks, disparages his critics, and even pushes hydroxychloroquine, the same discredited drug that Trump touts. Bolsonoro has fired health officials that contradict his anti-science approach to the pandemic, just like Trump. Trump's idol, Russian president Putin, demanded the individual federal districts figure it out for themselves, just like Trump.  UK prime minister Johnson (the European Trump) also dismissed early concerns, delayed national reaction to the pandemic, and made the response worse by prioritizing profit driven capitalist solutions over national health concerns, just like Trump.
            With no treatment or vaccine, the only way to control the spread of infection and prevent overwhelming the health care system is to reduce transmission rates.  This requires the ability to identify those that are already infected, isolate them from the rest of the population, contact trace to identify individuals they might have infected, and isolate them as well.  Since the ability to test was not available when the pandemic began, the first response was to have everyone self-isolate, buying time to create and produce adequate testing capacity.  America under Trump wasted that time and has yet to meet even the modest testing rates he set.  But Trump's concern that the economic impact of the shut-down will affect his chances of re-election prompted him to demand renewed economic activity anyway.  We are beginning to see the results.
            On May 1st, US cases were increasing at an average daily rate of 29,459.  This rate declined to about 21,040 on May 28th, but jumped to 27,946 by May 31th. Over the same time frame, the average daily death rate dropped from 1,800 to 946 on May 26th, but increased to 1,215 by May 31th.
            Looking at national totals is misleading.  Early on, over 50% of US cases were in the New York area, including New Jersey and Connecticut.  But extensive shelter in place rules brought their case and death rates down dramatically, while rates in the rest of the country have steadily increased.
            Since testing is still somewhat limited, and many people can be infected without showing symptoms, most of the confirmed case numbers are the result of people being sick enough to show up at a hospital. Testing in some areas is better, so the case numbers might appear higher.  Deaths are more easily calibrated, although the Russian government wants to keep the numbers low, so many deaths there are not counted as covid-19 related, but attributed to pneumonia or heart failure.  So far, this subterfuge has not become wide spread American policy.  Rather than comparing the total number of deaths between areas, it is more constructive to compare deaths per capita.
            During May, the US death per capita increased 59%, from 197 per million to 314 per million.  Fifteen states (2/3 Democratically controlled) increased at a lower rate, including New York (24%), Washington (29%), and New Jersey (53%). Twelve states (2/3 Republican controlled) had over twice the national rate of increase.  The five states with the most rapid increase in per capita death were New Hampshire (217%), Iowa (206%), South Dakota (179%), New Mexico (171%), and Minnesota (166%).
            California per capita death increased 96% in May, despite having some of the first shelter in place rules.  Again, the state totals are misleading, because 48% of the cases, and 55% of the deaths, are in Los Angeles county alone.  Case load in Mendocino county has increased in May from 12 to 30, with no deaths so far, but community transmission has just been detected.  As the economy reopens, and the tourist economy revives, we should expect those numbers to change.
            We are living an experiment, with no control for comparison.