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Coronavirus (14): Numbers and Narratives

There is real hope that the CORVID-19 pandemic is reaching a plateau in New York state, which leads the United States in all cases. The United States has 420,000+ cases, with nearly 14,500 deaths. New York state accounts for nearly 150,000 of those cases, with nearly 6,300 deaths (and of these, NYC accounts for almost 78,000 cases, with 3,602 deaths). The state suffered its worst single-day, with 779 CORVID-19-related deaths. These statistics are most likely under-representations of the reality, since the state is not mass-testing residents, and many are dying, undiagnosed in their homes. The ripple effects of these numbers on other aspects of healthcare in the city alone have been traumatic to say the least---with a tripling of cardiac calls over the period between March 20 and April 5.

Even more distressing is the disproportionate number of Hispanics and African Americans in the city who have been impacted by this pandemic. Hispanics constitute 34% of all CORVID-19 cases, despite being 29% of NYC's population, while blacks constitute 28% of all CORVID-19 cases, despite being 22% of NYC's population. This is less a racial division than it is a class division, since most of those affected come from poor neighborhoods, who don't have the luxury of relying on working remotely from home.

There are positive things to report, however. Though the daily death toll in the Empire State is likely to increase, the number of new hospitalizations are stabilizing as are the number of ventilators in use. Food establishments---from NY pizzerias to NY delis---are coming to the aid of healthcare workers and first responders, and cities and states throughout the country have stepped up to assist New York in its dire need of medical supplies, even as they face upticks in their own communities.

I do want to address one issue that has been nagging at me from some quarters. If I hear one more time that the "regular" influenza kills more people than CORVID-19, I just might scream. Such folks are trying to downplay the gravity of the situation by pointing out (correctly) that many thousands die of influenza each year, and that most people who become infected with the Coronavirus will most likely be either asymptomatic or will recover completely without any medical complications.

But this ignores a simple truth: If we look at a standard year---2017---we will see that New York state registered 4,517 deaths from "flu/pneumonia", the sixth leading cause of death in the state (behind heart disease, cancer, accidents, chronic lower respiratory diseases, and stroke). But understand that these are statistics covering an entire year. The reason there are makeshift morgues and freezers set up around hospitals like Bellevue and that Randalls Island and Hart Island are being considered as temporary cemeteries to accommodate the growing number of bodies is that the sheer volume of cases and deaths are overwhelming the healthcare system, as would be the case in any natural catastrophe. Funeral homes are being taxed to their breaking point because, since the first two recorded deaths from CORVID-19 on 14 March 2020, there have been nearly 6,300 deaths from the Coronavirus in twenty-six days. Even if, suddenly, these deaths were to cease tomorrow, the tally has already exceeded the typical seasonal total of influenza deaths by almost 2,000 in under a month! This is one of the reasons that the healthcare system has been pushed almost to the breaking point.

Moreover, I've heard from a number of folks who dispute the statistics because, after all, many of the victims may have had pre-existing conditions, and who's to say that it wasn't these pre-existing conditions that did them in? All at once? The point is that even if many with pre-existing conditions are among the most vulnerable populations during this pandemic, the virus may just be the straw that breaks the camel's back, so-to-speak.

The bottom line is that we can't debate these issues with any degree of comfort until such time as more and more information about this pandemic and the deaths left in its wake becomes available. So while the naysayers are busy discounting the virus, we're still counting the bodies at a rate unseen, certainly in my generation.

Finally, I wanted to bring to your attention a new installment on my friend Irfan Khawaja's ongoing "COVID-19 Narratives," in which I was already featured. The newest installment, "A Physician's View of the Front Lines" is a harrowing tale of what life is like within the healthcare industry, as heroic medical personnel are battling a surge of thousands upon thousands of sick people in their Emergency Rooms and hospitals, a tale that has been echoed by so many front line workers that it is becoming horrifically all-too-familiar.

Postscript (8 April 2020): I made a few additional comments on Facebook with regard to this post after being pointed to this video, featuring Professor Knut Wittkowski. I wrote:

I've actually seen this video and also read a number of pieces on Wittkowski on AIER and Hoover. He makes a lot of good points, and certainly brings to bear many questions with regard to the public response to the pandemic. He's certainly not among the fringe group that questions the very existence of the Coronavirus or its impact on the most vulnerable. And I've been impressed as well with his overall logic and its implications for public policy.
But I have to say that there was a serious problem with, for example, keeping the schools open in NYC, where 1.1 million kids may very well have developed "herd immunity"... and still brought it home to older parents and grandparents, who might have pre-existing medical conditions, and therefore would have become susceptible to infection or worse. Not to mention the fact that many older teachers refused to work in such dense conditions in the public schools where they themselves would be put at risk.
Now this may be a good reason to question the wisdom of "herding" kids into large public school systems, but these are, nonetheless, the conditions that exist in the real world of New York City, and I can tell you that I am glad that my sister, for example, who works as the Executive Director of the Brooklyn Technical High School Alumni Foundation, with its office in that school---home to 6,000 kids---is now working remotely from our apartment. She herself has had a history of asthma and upper respiratory problems, and while the kids might have been helped by herd immunity, she may have ended up as yet another NYC statistic.
And the only other point I should raise is that while kids, for example, develop herd immunity, it is no coincidence that the virus is hitting minority communities very hard --- and they are the ones being "herded" into packed subways and mass transit to go to jobs that don't allow them remote access, hence making them far more susceptible to becoming infected, coming down with the virus, or spreading it to those even more at risk at home.
Nevertheless, a worthwhile video to view.

Postscript (9 April 2020): Further discussion ensued on this topic, and I reproduce below some of the key points I made in response to the epidemiological findings of this article, which questions the wisdom of closing schools during the pandemic.

I'm going to be completely forthright ... on this topic. I truly don't know enough to reply one way or the other. But I do believe that the problem here in NYC is compounded because we're talking about 1.1 million kids in public schools, most of whom get to school on mass transit. Somehow, it seems counterintuitive to me that there's not risk involved when 1.1 million school kids join the 8 million or so folks that typically jam the subways and buses during rush hour in NYC...talk about a petri dish! You wouldn't catch me going anywhere under those conditions during this pandemic. I'll play it safe, thankyouverymuch. ;)
I respect that intuition is not a factor in epidemiology. I'm just saying that as a person with serious pre-existing medical conditions, who is, to my knowledge, COVID-19 free at the current time, I don't think I'm being overly cautious in not wanting to mix it up with 8 million people on the NYC subways, even if 1 million of them were noncontagious kids. Not. Gonna. Happen. ... [But] I will be even more forthright. ... I only know that the school system in NYC involves 1,800+ schools, 1.1 million kids, over 75,000 teachers, thousands of administrative assistants and support staff, and given that context, I don't know what else public policy decision-makers could have decided under the circumstances. If I had all the answers, and the power to implement them, COVID-19 would be gone already. (And btw, this doesn't include the populations of parochial and private schools in NYC... which expands the pool of potentially infected people considerably.)
I don't think anybody truly knew that the schools were (or were not) significant factors in transmission. But I've read the eight pages of the study and I don't think it is as definitive as one might suspect at first blush. Quoting from the study:
Models are required because there is little unconfounded experience with school closures during an epidemic, and few analyses of any behavioural changes are empirical. For the USA, and for most states within the USA, κ was not sufficiently high or low to estimate which way a school closure will turnout without more information on β. ... Washington, DC (8·8%, 7·1–10·5), New Mexico (10·0%, 8·6–11·5), and New Jersey (11·2%, 9·7–12·6) might have health-care workers most able to cover their child-care obligations. ... Conversely, school closures might be implemented earlier in COVID-19 outbreaks, which might lead to greater levels of prevented cases. Furthermore, school closures might lead to other adults staying home, which could also reduce cases. These are all important questions when considering school closures.
It's telling that there may be a trade off between school closures and mortality---but it's also telling that all relevant values are not fully known. But let's say we accept the whole argument concerning the impact on parents who need to care for their kids and who still have to maintain a job in order to survive. Then it would still be consistent with closing down the schools and leaving minimal childcare options in place for those children in need of it. I should also note that there is not a single mention of New York state or New York City in the entire study, the epicenter of the pandemic in the United States. Nor do I see a single mention of the conditions specific to the NYC context with regard to the use of mass transit, which, from what I see, has been a true petri dish in the transmission of the virus among minority populations who are traveling still by subway in very large numbers to get to jobs they cannot afford to give up because none involves a remote option. And I should also mention that the New York City school system was among the very last systems to close down, the day after NY state had its first two confirmed Coronavirus deaths (which occurred on March 14th). So from where I sit, the study raises more questions than it answers.
[Moreover,] we still don't know if children, who are asymptomatic, are simply bringing the virus back home to infect older parents and grandparents. This speaks to the video linked above. Herd immunity is good in theory, especially among kids, but once those kids infect adults, all bets are off. It's precisely because kids are not impacted in the same deleterious way as adults that the public schools were closed. The teachers threatened all to call in sick if they didn't close the schools; so not even they would have been available as daycare workers, since many teachers could have potentially been infected by asymptomatic kids. But, truly, I don't have the answer. I only know that right now, New York state has more deaths from Coronavirus than any single country in the world. That's pretty scary. I'm doing what I can do to keep myself and my family safe, and I'm well supplied to hunker down for a month or two, if that's what it takes. The deaths keep mounting, but it does appear that the curve is finally flattening in terms of new hospitalizations.

Postscript (11 April 2020): On another thread I repeated some of the information from this post, with a twist, after a commentator pointed out that 40,000 people died in motor vehicle accidents per year, and nobody says anything about it (compared to this

The only thing I'd like to point out is the obvious: Yes, 40,000 people die in motor vehicle accidents in the US... but this doesn't happen all at once. Since the first US death from Coronavirus on February 29th, there have been 20,455 deaths at last count (out of a total of 528,990 cases. In New York state alone, there have been 180,458 cases and 8,627 deaths ... all since March 14th. That's TWENTY-NINE days. Yes, the numbers seem to be hitting a plateau, and we are all encouraged that the numbers will finally start coming down. But this state has had over 700 deaths per day from this virus for four straight days. This is not an argument for shutting down our lives or giving up our liberties; but it is a reality check on just how destructive this virus has been within a relatively short time. That's why we can't compare apples and oranges. In 2017, a typical year for New York state, influenza/pneumonia was the sixth leading cause of death in which 4,517 people lost their lives... over the entire flu season. This state is approaching double that number in less than a single month; it is one of the reasons why the healthcare system has been overwhelmed here. Again: None of this is an argument for draconian measures; I've written enough about "Disease and Dictatorship" and how crises of this nature fertilize the soil from which greater government control over our lives grows... and becomes widely accepted by the population. But let's not pooh-pooh the scope of the nightmarish toll that COVID-19 has taken on the American people in a relatively short time. Yes, a lot less than some of the "experts" predicted, but not any less horrific...
[O]f course ... One Size Never Fits All. In that sense, we can be thankful for whatever remnants of federalism still exist in the United States. The New York "model" surely does not fit Texas or Alaska or Hawaii. But since it is the center of the pandemic in this country, at the very least, it is encouraging that the numbers are "plateauing" ... and nobody more than this New Yorker is hopeful that the Big Apple will come roaring back much sooner than later.