Funmurphys: the Blog

The Triumph of Hope over Experience

Archive for category COVID19

COVID Infects Speech

Jul 1

Posted by Kevin Murphy in COVID19 | No Comments

Spike.

That is a word I used to only hear from volleyball commentators every 4 years when I watched the Olympics. Now we can’t refer to Coronavirus cases without using that term. Apparently, cases can only spike now. Not increase, not jump, not trend upward, only spike. Gone are my data analysis days when a spike was a brief departure from the trend line that returned to trend, either up or down, because the shape of the curve resembled a spike.

You live long enough, you get to hear language change before your very ears.

A Unifying Moment

May 28

Posted by Kevin Murphy in COVID19 | No Comments

Today is different. Today I let someone else talk instead of me. Don’t worry, I will get back to writing indigestible tracks of prose soon. Until then, let me tease you with:

“This should be a unifying moment. No matter whom you can’t abide in American society, they’re feeling the same fear, anxiety, and uncertainty that you do. We can be angry at criminals for their crimes and simultaneously feel the need to save them from unintended and preventable deaths in their prisons. Members of the opposing political party have elderly parents and grandparents in nursing homes, too. People who voted for the other guy can get laid off or lose their businesses, too.”

Let’s Talk About Death, Shall We

May 28

Posted by Kevin Murphy in COVID19, Science | No Comments

I’d like to highlight a huge revision from the CDC (https://www.cdc.gov/coronavir…/…/hcp/planning-scenarios.html) to the USA case fatality ratio for COVID 19 to current estimate of 0.4% overall for symptomatic cases. Not 3.4% which was the WHO’s value from China and what we started the pandemic with. But that number hides just how significantly it changes with age. The value for people under 50 is 0.05 percent, and when you take into account that CDC estimates that 35 percent of cases are asymptomatic, you get a infection fatality rate of 0.0325% for people under 50, and if you factor in the effects of pre-existing conditions and the likelihood that younger people have a higher asymptomatic rate than older people, it’s probably less. If you are under 50 without any COVID preexisting conditions, you’re chance of dying isn’t one in a million but it is getting surprisingly close – heck, if you’re under 25 it may actually be better. 

But let’s compare that to the flu, and we will leave it at the 0.03%. Looking up values for last seasons flu numbers which CDC estimates led to 60,000 deaths in the US (and let me say it’s a very loose estimate- all values from: https://www.cdc.gov/flu/about/burden/2017-2018.htm) for the 18-49 year age bracket we have estimates of 2,803 deaths from 14,428,065 illnesses or 0.02% death rate for that age group, which is 50% higher but sure looks pretty similar especially as they are both estimates. So for the under 50 crowd COVID19 looks like a bad flu. And does anyone remember any lament in the spring of 2018 that the flu season that year had killed more Americans than the Vietnam war?

For the over 65 crowd, you have a 0.86% for the flu in 2017-2018, the number is 1.3% for symptomatic which I’m not going to adjust because at that age I’m not sure how many cases are asymptomatic which again leads to about a 50% higher death rate but at those values doesn’t look too similar. And since the over 65 crowd is estimated to have suffered 51,000 deaths out of the estimated 61,000 that season, you can see how the seniors not only drive the flu numbers but drive the COVID numbers even more. 

Did you know that if you are under 50 your chance of dying from an accident as you go about your daily life is higher than of dying from COVID if you catch it?

If you’re really feeling cheery, dive into the Deaths and Mortality (2017 is the latest) statistics with me (https://www.cdc.gov/nchs/fastats/deaths.htm) where you can see that at 100,000 deaths COVID has passed up flu/pneumonia (55,700 deaths) and diabetes (83,500) – although since diabetes is considered one of those death enhancing preconditions for COVID, which one gets credit if someone dies with both diabetes and COVID – and is closing in on Alzheimers (121,400). Then comes stroke (146,300), chronic lower respiratory disease (160,200 – and same question as diabetes), accidents (169,900) and then the two biggies – cancer (599,100) and heart disease (647,500). I’m hoping COVID doesn’t make it past Alzheimers. When you add it all up, the average death rate for all causes for all Americans in 2018 was 0.87%.

So while on the one hand it’s kind of amazing that COVID can come out of nowhere and become the seventh leading cause of death in roughly 3 months, on the other hand all those others kill people year in and year out without much fanfare from the media or concern on our part.

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Why Are We Not Adapting to New Data?

May 26

Posted by Kevin Murphy in COVID19, Science | No Comments

All the politicians and bureaucrats who are making the rules we live by these days always invoke science and data as the ultimate arbiter for all the rules.   You would be hard pressed to find a bigger fan of science and data than me, and less of a fan of politicians and bureaucrats.  So now that CDC says transmission is primarily through respiratory droplets and not surfaces, how important is it to wash our hands?  (Full disclosure, I still wash my hands for 20 seconds after returning home).  What’s the science and data on the effect of masks?  I think it’s accurate to say not clear and copious.  (Full disclosure, I wear a mask when indoors and around others.)  And how about the magic 6 foot rule?  Yeah, not a lot there either, and if you’re indoors and down fan from a sick person 6 foot isn’t enough.  In most of Europe, it’s 2 meters except Nordic countries where their yardstick is 1 meter.  (Full disclosure, I still try to keep my distance from others, especially indoors).  I think they are all good guidelines, I’m not sure how scientific (as opposed to commonsense) they are.

First data analysis showed no correlation between lockdown timing and cases by state.  Now data analysis shows by and large declining transmission after state reopenings. And not just in the US, but in Europe as well.  And then comes along video from Memorial Day weekend that showed people violating all the rules.  So once again I’m asking we stop focusing exclusively on something and pull back and take a systems look.  Quit focusing on the edicts and look at people’s behavior, in its full spectrum.  Governors etc. have pretty good control over government actions, but much less over citizens behavior.  The better they understood that, the more they would try to persuade and provide data and keep current, as opposed to the current approach of rules, rules, rules that can’t help but be arbitrary whereupon you lose compliance.  What do you see in those videos at the Lake of the Ozarks?  Big signs saying stay 6 feet apart.  So how are those rules and edicts working out for you?

And the news media is not helpful, as ever since they pivoted to coronavirus is not going to happen here to a non-stop unchanging if one solitary virus so much as touches you, you’re dead.  So one half of the country is too terrified to take in new data and the other half has decided since they are still alive the virus must be gone.  

And as the data has rolled in, the picture is changing.  For instance, this virus is a lot less deadly than first thought (see https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html) with an overall infection fatality rate of 0.26%, not the original 3.4% WHO reported.  And the death rate is strongly correlated with age – CDC says 0.003% if under 50 (bad flu territory),  and 0.845% (or higher) if over 65.  When you look at the death statistics, basically the older you are the more likely you are to die.  Keep in mind, these are all estimates in part because there is fuzz on both number of infections and number of deaths.  I did find it interesting that when looking at the length of time in hospital, non-ICU and ICU, time on ventilator, percent that are admitted to ICU and that go on ventilation there is not a lot of variation between age groups.  So other than raw numbers, the disease looks pretty much the same  to healthcare workers regardless of patient age. 

The data on children is very encouraging, as it appears those under 25 don’t contract the disease as much, don’t transmit the disease as much, and have milder cases that result in death only with an underlying condition.  As much as it pains me, for once not only do they feel invincible, they kind of are.

So why are we not adjusting?  Shouldn’t we be less fanatic about sanitizing everything? Shouldn’t we be reopening schools, playgrounds, daycares, summer camps, etc. because the only thing you have to do to keep it safe is keep the over 25 crowd away.   Pools are safe, how many of them are open?

Hospitals have been just crushed by the lockdowns.  We issued suspension edicts because of our fear that there wouldn’t be room for all the COVID patients who never materialized, so why are we not going full open on all healthcare immediately?  Why can’t we trust hospitals, clinics, practices, etc. to manage their own affairs to take care of all the normal issues while keeping enough space, PPE, etc to cover coronavirus cases safely?  It’s one more ball in a hundred ball juggle and why we think governors are able to make a positive contribution is beyond me.

Why is the media not shouting these new numbers from the rooftops?

Why are we not letting everybody manage their own safety based on their own risk factors? Government’s default setting is one size fits all – if the government managed clothing we’d all be wearing muumuu’s.  The only way to make someone responsible is give them responsibility. 

And given how less deadly the disease is for people of working age (i.e. not significantly different than flu), and how much deadlier the disease is for older and those with certain underlying conditions, and extremely so for those in group care settings (AKA nursing homes) where at least 40% of Americans (out of 1.8% of the population) have died from COVID, we should really think about how to protect those who are at elevated risk without causing significant disruption, and increased death rates for those who aren’t.  

PS I  would add a couple of health guidelines, not just for COVID but life in general, take vitamin D and get regular exercise

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You Can Tell Them Apart by the Mask

May 19

Posted by Kevin Murphy in COVID19 | No Comments

Funny how masks became another way we divide ourselves into two opposing tribes. The science and data for the effectiveness of cloth masks on lowering your transmission or susceptibility to viruses, let alone the Wuhan virus, is inconclusive, so I suppose it lets us argue while each side can claim the mantle of science and data. What would be really nice is if we could get some elegant experiments soon enough to guide us.

I come down firmly on the side of I don’t know, I don’t see how it hurts, so I wear a mask indoors but not outdoors. But if I don’t happen to have one and I need to go indoors, I don’t sweat it. Basically, my value proposition is the cost is low and the benefit is unknown but probably there. Full confession, I have a couple of old N95 dust masks so those are the ones I usually wear and I do think their benefit is likely and large despite age and use. So yeah, I cheat.

I do find a few things interesting about the tribes. Back at the start of this, when the recommendation was don’t wear a mask because it doesn’t help and you are depriving heroes from theirs, it was the compliant kids who were all about not wearing the mask while the rebels were all about asking why not – pointing out that people always wore masks in prior pandemics and that asian countries which were doing well against the virus all wore masks and then one day the experts said, hang on, asymptotic spreading changes everything and the whole world flipped upside down on masks. Masks don’t stop you from catching the disease, they stop you from spreading it (no word on what all those medical personnel wearing masks felt about this turn of events). Now the compliant kids are all about wearing the masks, urging others to wear a mask for the sake of their fellow man, not themselves, and the rebels are all like how did cloth become one way so that it lets the virus in my mask but doesn’t let it out of your mask and there’s no data while forgetting about all those reasons to wear one they pointed to before the experts said wear a mask. Strange.

I get the effect of the Trump distortion field on Hydroxychloroquine which means once again we divide up into tribes based on how we feel about Trump. But if you think a medicine is effective or not, or hope it’s proven to be effective or not based upon how you feel about a particular politician, you really should have your head examined. It’s almost enough to make me despair for humanity. The only sane, human, reasonable, caring position is that you hope Hydroxychloroquine is effective against COVID19 (but only rigorous efficacy trials can prove it) so that we have an effective treatment and many lives are saved and much suffering is reduced or averted. I would have preferred that gargling with hot water was effective as a whacked out viral video claimed way back in late February even though that meant that some crazy quack was right because look at how many lives would have been saved and how much suffering would have been averted if only it were true.

When the facts change, I change my mind.

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A Better Way to Act on COVID19

May 14

Posted by Kevin Murphy in COVID19, Current Events | No Comments


We are all in this together, but we are all not the same. The risk of death or serious illness varies quite widely from one person to the next by a factor of like a thousand based on age and certain conditions like diabetes, and our life situations also vary quite widely. For example, my wife and I no longer have parents to take care of (or worry about), while many other married couple our age do have elderly parents. So basing all our actions and policies on some perceived worst case just doesn’t make sense.

I really think we are continuing to make certain mistakes because we are not adjusting to data as it becomes available, and because of the emphasis on statewide common actions. We are citizens, not subjects; we are adults, not children. So the “because I say so” from governors and other politicians, or the “we are all going to die” from my fellow citizens is wearing thin. Why are we not following the American way? By all means, make recommendations, but don’t just issue edicts and claim they are data driven. Provide the data, provide the rationale and inferences, take into account important differences, and let us make informed decisions on the risk we are willing, or unwilling as the case may be, to assume.

Phone data shows people began social distancing and staying at home before any politician issued an edict. We don’t need nannies or nags, we need information and reasoned discussion. Treat us like a adults, and we’ll act like the adults we are. Don’t treat us like children and then be surprised when some act petulantly.

This is a very serious and deadly disease, which means we should tackle it with our best practices which are open and honest communication, frank discussion of options, data, and uncertainty, and the appreciation that while we are all equal we are not all the same and so not only can reasonable people disagree, the correct course of action will be different for people in different situations. The best way to find our way through this challenging and uncertain time is through people doing what they think best and constantly reassessing as data rolls in. And that includes people trying different things and seeing what happens. COVID 19 did not change everything, and we need to stop thinking and acting like it did.