The Other McCain

"One should either write ruthlessly what one believes to be the truth, or else shut up." — Arthur Koestler

Coronavirus ‘Myths’ and Real Numbers

Posted on | April 4, 2020 | 1 Comment

The stated purpose of stay-at-home orders and “social distancing” guidelines was to “flatten the curve” of the coronavirus pandemic, to prevent a sudden surge of hospital cases that would exceed the available resources. Slowing the spread of the disease, however, does not mean that widespread infection can be permanently avoided, nor does it mean that anyone is “safe” from COVID-19. For example, the state of Minnesota has reported only 789 coronavirus cases in a population of 5.6 million, which is 14 cases per 100,000 residents. Compare that to New York’s 530 cases per 100,000 residents, and you see that Minnesota is relatively “safe.” But over the next few weeks, even with policies to “flatten the curve,” the number of Minnesota cases will increase, so it would be wrong to think that you, as an individual, are “safe” from coronavirus, merely because you live in a region with a relatively low infection rate. This is relevant to discussions of how and when America will be able to go “back to normal.” (Our family is currently “attending” church via videoconferencing software.)

There has been a lot of noise in the media about Republican governors in some states being reluctant to impose statewide stay-at-home orders, and people in rural America failing to follow “social distancing” guidelines. Supposedly, this is a result of their believing “myths” that they are somehow safe from coronavirus, but because I’m not a mindreader, I can’t presume to know what people believe. Certainly there have been outbreaks in rural communities, as in the case of Dougherty County, Georgia, were two large funerals Feb. 29 and March 7 acted as “super-spreading” events, infecting dozens of people, 90% of whom were black.

African-Americans are being disproportionately affected by the pandemic elsewhere. In Michigan, for example, black people “account for 35% of confirmed cases in the state and 40% of deaths from COVID-19,” although black people are only 12% of the state’s population. The disease is also disproportionately concentrated in Detroit (Wayne County) and suburban Macomb County and Oakland County, which combined have 80% of all known coronavirus cases in Michigan. The statewide infection rate in Michigan is 128 cases per 100,000 residents, but the rate is higher in the Detroit metron area, and much lower elsewhere in the state.

It must be understood that risk is a matter of statistical probability. Your infection risk is lower in rural Minnesota than it is in Detroit or in New York City, but being “low risk” is not the same thing as being “safe.” In a pandemic, nobody is at zero risk. But even the most drastic governmental restrictions will not lower the risk to zero. Italy has been under a nationwide lockdown order since March 11. Friday, they reported 4,585 new COVID-19 cases — and that’s good news, because the daily number of new cases has declined 30% since March 21, when Italy reported 6,557 new cases. So, after three weeks of lockdown, Italy has already “flattened the curve” (i.e., the number of new cases has already peaked), but they’re still reporting thousands of new cases daily and people continue to die. That’s simply the reality, and nothing we can do in the United States will prevent our outbreak from following the same trajectory. Once we have passed the crisis point — once the outbreaks in New York, in Detroit and other “danger zones” have passed their peak, straining available medical resources — it’s not as if we will then return to a condition of “safety.”

The pandemic will run its course, and a certain number of people will die, because the death toll for May is pretty much already baked into the pie, so to speak. Once you have imposed the most drastic lockdown measures, there is really nothing more you can do, in terms of “flattening the curve,” but at some point the pandemic will peak — reaching the “apex,” as New York Gov. Andrew Cuomo says repeatedly in his daily briefings — and then you should be prepared to begin a return to normal. Italy has already passed its “apex,” but their hospital system is still overwhelmed and they are still recording more than 700 COVID-19 deaths daily.

Media keep reporting the cumulative number of coronavirus cases, and the cumulative total of deaths, but these numbers are not the most relevant statistics in terms of the “apex” crisis that Cuomo and others are so concerned about. What matters most are (a) the trend in the number of new cases reported daily, and (b) the number of patients requiring hospitalization. As I’ve mentioned before, 87% of known coronavirus patients in Florida have never been hospitalized, and less than 2% of patients have died. This is important, in terms of dealing with the crisis from a public-health perspective. If someone gets the virus, experiences only mild symptoms and recovers without ever being treated in a hospital, that person is counted statistically as a coronavirus case, but has not placed any extra burden on the hospital system.

Dr. Scott Gottlieb produced this chart of Florida’s COVID-19 outbreak:


(Click image to view full-size.) What you see is a rather astonishing increase in the number of known cases of coronavirus — more than quadrupling in a single week — but a much lower “curve” in the number of hospitalizations and deaths from the pandemic. Why is this? It’s because Florida has been testing thousands of people daily. Just in the past three days, April 1-3, Florida has tested 34,724 people for COVID-19. More testing means more cases are being identified, but the number of hospitalizations is rising much more slowly. As of Friday, Florida had 1,386 patients hospitalized with coronavirus, which is only 12.5% of the total number of known cases in the state; the total number of COVID-19 deaths in Florida was 191 as of Friday, which is 1.7% of the total cases.

So far, at least, the coronavirus pandemic has not impacted Florida at anything like the impact in New York or Michigan, and 58% of Florida’s cases are in three counties (Dade, Broward and Palm Beach, with 28.5% of the state’s population) on the southeastern coast. The pandemic has had much less impact in places like Polk County (Lakeland), where there are only 138 cases in a population of 668,671, and Volusia County (Daytona), where there are only 129 cases in a population of 527,634. Given this differential in the risk level, why should folks in Lakeland and Daytona be under the same lockdown regime as people in “danger zones” like Miami and West Palm Beach? Look at Friday’s numbers:

Italy total cases 115,242
Deaths 14,681 (12.8%)

U.S. total cases 266,279
Deaths 6,803 (2.6%)

Washington state total cases 6,597
Deaths 272 (4.1%)

Michigan total cases 10,791
Deaths 417 (3.9%)

Louisiana total cases 10,297
Deaths 370 (3.6%)

New York total cases 102,863
Deaths 2,935 -(2.9%)

Florida total cases 9,585
Deaths 163 (1.7%)

Texas total cases 5,255
Deaths 86 (1.6%)

There is an enormous variation in the death rates, with Italy’s rate being about five times higher than the U.S. rate, and the death rate in Washington State, Michigan and Louisiana being more than twice the rate in Florida and Texas. Will these rates change? Maybe, but the fact is that the same virus is having different impacts in different areas, and the “experts” on TV are doing a bad job of explaining this differential, insofar as they are not completely ignoring it. While I don’t claim to be an “expert,” my hunch is that it probably has something to do with viral load at first exposure to the virus. If you attend a two-hour event with dozens of other people, some of whom are infected — or if you’re on a two-hour commercial airline flight, or riding New York City’s subways on a daily basis — then your initial exposure is likely to be a high viral load. On the other hand, a brief encounter with an infected convenience-store clerk will expose you to a lower viral load, and if you do become infected, your case will probably be milder. That’s not an “expert” opinion, just a common-sense interpretation of what some experts are saying, and one which would seem to fit the available data.

Population density matters in terms of spreading any contagious disease, and the use of public transportation also matters. Every day, millions travel by subway in New York City, which has the greatest population density anywhere in America. Furthermore, New York is a major center of international travel, and we know for a fact that this disease entered our country from overseas. More than 700,000 Chinese-Americans live in the New York metropolitan area, and how many of them traveled to China in January? By February, of course, the disease had begun spreading in Europe, so how many people in New York traveled to Northern Italy — the epicenter of the European COVID-19 outbreak — in February? This is not demonizing Chinese or Italian people, it’s about understanding risk factors that would explain why the per-capita coronavirus rate in New York is so much higher than everywhere else.

Americans are being bombarded by misleading media messages about this outbreak, messages that fail to explain (if they even acknowledge) the variations of risk between different areas. We are told it is irresponsible to view this pandemic in anything other than worst-case scenario perspective, and that we are beholden to “myths” if we suggest that people in Florida, Texas and other (relatively) low-risk areas should not be subjected to strict lockdown orders. We are told that low-risk areas of the country are simply at an earlier point in the pandemic “curve” and that, unless drastic stay-at-home measures are implemented nationwide, these areas would be just weeks away from reaching a coronavirus infection rate comparable to the current rate in New York City.

The “experts” on TV don’t actually know what will happen in the future anymore than any other intelligent person with access to the same data can know what trend the pandemic will take in the future.

We know that the cumulative total of known cases will continue rising everywhere, simply because each new case adds to the total, and no cases are ever subtracted from that total. What actually matters, however, is whether the number of active cases requiring hospitalization exceeds available capacity at any given time. If more than 85% of cases never require hospitalization, then we can disregard those cases, in terms of a crisis caused by a shortage of hospital beds, ventilators, medical personnel, etc. We are not guilty of propagating “myths” about this disease by insisting that the media (and public officials) pay attention to the numbers that provide real metrics of the problem.



One Response to “Coronavirus ‘Myths’ and Real Numbers”

  1. Friday Links | 357 Magnum
    April 10th, 2020 @ 1:25 pm

    […] The Other McCain – Coronavirus ‘Myths’ and Real Numbers. […]