A Bifurcation of Our Society

(posted 6/23/2020) - I don't know how history will record the US response to COVID-19; but it has appeared to me from the beginning of US infections that there are two typical responses to the disease by those who don't feel ill. The majority response (mostly urban / suburban areas) is to be wary; to distance, to wear a mask in closed spaces, to avoid unnecessary contact and to follow public-health protocols. The minority response (mostly rural and small towns) is to discount the infection as a low (or non-existent) risk factor and continue with pre-infection habits. These folks bemoan any external impacts on their lives as an over reaction by local, state, and federal agencies - rather than attempts to reduce infection rates.

It may have been true initially that low density populations were seeing virtually no infection clusters -- but those days ended in Mid-May of 2020. I frankly cannot understand the mindset that believes no attempts to control COVID-19 infections need to be made by city, county, state, and federal agencies. No public-health experts believe that we should not be making attempts to lower the reinfection rate at large.

I link to a brief commentary by Economist Paul Krugman in the NYT op-ed section today as a very good summary of the particular malaise into which we have fallen as a nation. We really seem to be two countries within one border at this point. It is sad.

Note - Here is a link to the op-ed as a PDF file in case you cannot access the original which is behind the NYT subscription paywall.

PS - I've been hearing about declining death-rates in the US (it is being touted by the administration as proof that the federal and state responses are adequate). Unfortunately any unbiased analysis of the combination of reported positives and hospitalizations over the month of July mapped onto existing knowledge of COVID19 infection-to-mortality says exactly the opposite.

Here's why in a nut-shell: As the infection spreads rapidly (due to the relaxation of social distancing) the daily death rate is pushed downward dramatically because of the 3-week to 12-week lag between infections and deaths. This is a dynamic condition of rapidly increasing denominator (infection report) with delayed numerator response (death report). Only now, a little more than mid-way through July, is the death-rate beginning to catch up to reflect the relaxed social distancing policies.

A back of envelope calculation: If as the president has stated 1% of those infected experience serious symptoms; and as hospitals report 4% of those hospitalized die (unless care units are overtopped then the rate rises to 7%); then consider what it means if we average 80K infections / day for the remainder of the year (it will probably increase -- since we passed 77K this week). There are already 3.5 million reported infections -- now add 150*80,000 = 12 million more by end of year. Using the above data by end of 2020 that implies we should expect between .004(.007) * 12,000,000 = 48,000 (96,000) more deaths.

Using another simple calculation -- assume that we continue to lose 950 persons per day for the next 150 days then we would lose another 142,500 people to the virus.

I think it is reasonable to assume that the US will experience at a minimum (baseline) 200K to 300K COVID deaths in 2020. If the contagion reaches 10% of our population these numbers would at least double. At those levels the US health-care system would implode and the death rate would quadruple.