Unsanitized: The Blind Man and the Elephant and Coronavirus

Plus, the importance of masks. This is The COVID-19 Daily Report for June 15, 2020.

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First Response

The past week has seen a reckoning that the gradual reopening of America will not proceed without some rough spots. Florida has set daily highs for coronavirus cases in three consecutive days, and Sunday, while lower than Saturday, was still elevated. Peruse Rebekah Jones’ homemade dashboard, based on data she gathered before she was fired from the state Department of Health, and the numbers are worse. Texas also had three straight days of record case numbers last week, and we’ve already talked about Arizona; cases there have doubled since Memorial Day. Alabama and North Carolina are starting to look like hotspots as well.

All of this is based on what everyone knows to be an imperfect number: positive tests. That data are only as good as the number of tests performed. If testing goes up, cases could go up and the overall spread of the disease could go down, as California officials insist is the situation there. That’s why percentage of positive tests has become seen as a good metric. Florida hotspots have seen cases increase 42 percent and testing only 8 percent; more tests cannot explain the outbreak. But even there, testing does not give the full picture, especially given that asymptomatic individuals probably aren’t being tested. You could plausibly get to cases dropping in a place like Florida if there were a wide enough number of asymptomatic cases before. The R-0 number, meaning how many infections a contracted person causes, is the key to whether the virus is burning up or burning out, and we can only guess at that number.

What matters if cases increase is a functional health system. There are a lot of scary-looking charts going around showing unchecked hospitalizations from COVID-19. And there are definitely more hospitalizations in places like Texas. But hospitalizations are a lagging indicator after cases. This graph of bed usage in Arizona has been only inching up and has stalled out the past few days, and while at a high 79 percent capacity, doesn’t count a potential surge of facilities in an emergency. Hospitalizations could also be tied to reopening, and the return of elective surgeries.

The final piece of data we have are deaths, and the official count has been trending definitively downward. Yesterday’s death toll of 358, according to the COVID Tracking Project, was the lowest of any day since March. But we know that deaths from COVID are routinely undercounted (the COVID Tracking Project still shows under 110,000 because it refuses to add confirmed cases from New York state; Johns Hopkins has 115,732 deaths), typically not adding those found dead at home, and so on.

Read all of our Unsanitized reports

The point I’m making is the one about the blind men and the elephant, who feel around different parts of the elephant’s body and get a completely different mental picture of the animal. The experience of understanding the coronavirus, because of our own limitations of testing and tracing, is subjective. The numbers can be twisted to really show whatever you want, with little or maybe none of it being true. Combine that with a situation where states are at different points on the viral curve, and you have a recipe for statistical torture. We’ve finally found something in an age of Big Data where the data is incomplete. And we have to be humble about how much we can actually say about the virus’ trajectory.

You can take that in one of two ways. You can use the lack of data, while mindful of what the available signals are telling you, to be extremely cautious in your actions. Oregon Gov. Kate Brown is pausing her reopening strategy, and the city of Houston is considering reinstituting the lockdown. Other local officials have delayed reopening, and New York Gov. Andrew Cuomo could reverse reopening just based on public complaints, though that seems aggressively anecdotal.

The other option is to use the slack in the data to downplay everything, ignore warning signs, and encourage people to put themselves in danger. “We can’t shut down the economy again,” noted public health expert Steven Mnuchin said last week. There is no turning back, said California Gov. Gavin Newsom last week, sounding a lot like Mnuchin. The health director in Tulsa wants Donald Trump to postpone his rally there set for Saturday because local cases are surging; there’s almost no chance of that.

It’s one thing for the dysfunctional White House and even policymakers in Congress to be over the pandemic; they can point to the half of states where cases aren’t rising to explain away the other half that are. But for governors to get “quarantine fatigue” and base their decisions on forward momentum and inertia rather than the best science, is abominable. Arizona’s top public health official said last week “We are not going to be able to stop the spread, but we can’t stop living.” Actually, we can stop living, it’s known as dying, and that’s what officials ought to be trying to prevent.

The problem is that we squandered the opportunity during the first lockdown to build the testing and tracing infrastructure that would have allowed us far more sophistication on the nature of the spread. As a result, we’re feeling around an elephant, and making life changing decisions based on whatever piece of skin or tusk we encounter.

Mask Up

This is very preliminary, but we’re starting to learn about the effect of three weeks of large outdoor protest gatherings on the spread of COVID-19. While some experts have cautioned against the risk of infection, there hasn’t been a case spike in cities like New York with the most pronounced protest movement. Minneapolis took this a step further. They tested 3,300 protesters, and early results show that only 1.4 percent of them had coronavirus, nearly three times lower than the average percentage of positive tests in the state.

As I said, it’s early days. But instead of embarrassing claims about the righteousness of the cause pre-empting the risks of the disease, supporters of the protests have some hard data, rooted in how protesters are acting. Most of them are wearing masks and the science is increasingly showing that to be the most important intervention you can make to stop the spread. There’s even evidence that it prevents spread on mass transit. If masking can keep to a minimum the spread of packed outdoor gatherings or subway rides, we could entirely rethink our approach to the virus.

Unfortunately, universal masking has been weirdly linked to the culture wars, and several public health officials have been forced to resign over mandatory mask declarations. The best way to prevent yourself and others from slowly asphyxiating is somehow seen as an attack on personal liberty. The notion of liberty ending when your cough hits my face hasn’t registered. It seems the best thing policymakers can do is to take all that police power tear-gassing protesters and transfer them to giving out citations for not wearing masks. We haven’t had complete chaos everywhere we’ve reopened because of masks. Wear a mask, save a life.

Today I Learned

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