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Shout out to the good work of Doctors/Nurses/Researchers October 16, 2020

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While I have been and continue to be highly critical of public health officials and politicians, we have seen remarkable work and progress from those treating Covid 19. Although there has been a lot of give and take about what works and what doesn’t, the overall CFR (Case Fatality Rate) has dropped significantly in all age groups. I note that 90 year old football coach Bobby Bowden was positive for Covid, went into the hospital and has recovered and is at home all in less than a week. But, of course that is one case. Here are the charts that demonstrate how well medicine is doing with this illness:

Note the graph above. In the first wave, deaths are way above daily cases. Frankly, we were killing people with our care, specifically with the ventilator use. But we got better. The second wave the CFR was 75% lower. Note that the red line, the daily case count, went from half as tall to twice as tall. And now with the third wave, 1 month in, we see the death rate going the opposite direction as the case count. Three cheers for our medical doctors, nurses and researchers.

Here is the daily case count and the current hospitalizations. We start out with the hospitalizations roughly twice as high, the same as the first graph. In the second wave the two lines are basically identical. Now we see a divergence with the case count separating from the hospitalizations. This points to the younger ages of those in the case counts, but also with a better understanding of how to deal with the disease and getting patients in and out of the door faster, like Bobby Bowden.

I thought I would leave this one with you from the CDC. Of the 99,000+ excess deaths listed by categories, 31% of the excess deaths were in the Alzheimer/Dementia category. The next two were hypertension and Ischemic Heart disease, followed by Diabetes. Given that the deaths are so skewed to the older than 70 age group (median age of death 78), this might give some clarity as to who are the vulnerable populations in need of protection.

I won’t add the chart, but we are almost back to the 5 year average death rate after seeing deaths spike in the early months of the pandemic here in the US.

The media continues to put politics over accurate coverage of Covid 19 August 7, 2020

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Another article that calls into question what the media is putting out there and this has serious ramifications for the way people with Covid are treated in the USA.

https://www.realclearpolitics.com/articles/2020/08/04/an_effective_covid_treatment_the_media_continues_to_besmirch_143875.html

Covid Tradeoff July 25, 2020

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So, little is talked about the tradeoff between mitigation of Covid 19 and jobs. But it is clear that there is a tradeoff.

For example, Vermont. The Republican governor, Scott, has been very aggressive with mitigation despite the numbers of infections being low and percent positive on testing being the lowest of all states. Just yesterday he ordered a face covering mandate. This in a state that hasn’t had a death in over a month, has one of the lowest deaths per million (90) and is presently averaging 7 positive tests per day and has 2 people in the hospital in the whole state for Covid.

So how is Vermont doing with jobs? Vermont has lost 13.2% of their jobs due to Covid. Well, they are 5th worst behind Hawaii (15.8% loss of jobs), New York (15.1%), Massachusetts (14.4%), and New Jersey (13.5%).

Hawaii is an outlier because of its dependence on tourism ie people flying from various places. The other 3 states had a severe outbreak of Covid that required the harshest mitigation possible.

What about the current surging states. Well Florida, Arizona, Texas and Utah never had a harsh shutdown and their economy is much better than average. Florida -6%, Texas -5.3%, Arizona -3.3% and Utah lost 2.8% of their jobs. Utah stands out as having 85 deaths per million, one of the lowest among the states. Arizona is 432, Texas is 170 and Florida 263. Of note is that Arizona and Florida have large numbers of older folks living both within long term care institutions and outside of them.

So while the media is screaming because of the surges in those states, the vast majority of people are better off with at least a job to pay the bills. And the vast majority of deaths still is among the elderly with 45-50% of deaths being among nursing home patients.

Again, it’s a tradeoff. But, let the politicians be honest about it. Sacrifice 50 million jobs to attempt to protect elderly folks (and fail at that for the most part). I’m not a proponent of either side, just feel a conversation needs to be had on it for the future.

Good News on Covid July 10, 2020

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Decided to do a comparison from 1 month ago to today. Picked a state that is considered a hot spot and a place I use to live:

Just did a cursory view of hospitalizations from Florida comparing rates from 1 month ago to today: Ages 15-24 Hospitalization rate went from 3% to 1% of positive cases. age 25-34 from 6% to 2%. Age 35-44 10% to 4%. Age 45-54 13% to 6%. age 55 64 19% to 10%. Age 65-74 33% to 19%. So, in the younger age groups it dropped 66%. Middle age groups it dropped 50% and older age groups 40%.

Percentage of cases (due to who they test most likely) Age 15-24 increase from 9% to 16% Age 25-34 increase from 16-21%. Age 35-44 stayed the same 16%. Age 45-54 Dropped 17% to 15%. Bottom line is that hospitalization rates dropped in all age groups, but most acutely in younger age groups. And average age of cases are trending much younger.

So combining the two; the recent surge in Florida is concentrated in the younger age groups where we are seeing significantly less hospitalizations.

Isn’t this good news? I mean really good news…….why isn’t it being covered? Without testing demographics, we can’t state definitively that they are testing more younger people than 1 month ago, but the evidence seems it is more likely than not that they are.

And here is another thought; Since the percentage positive in Florida has gone from 5% to 15% in that time period, doesn’t this mean that Florida is getting to some level of herd immunity protection soon?

For Perspective CDC Mortality Chart July 10, 2020

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Most Recent CDC Mortality Chart

CDC estimates for Infection Fatality Rate May 25, 2020

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https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html

I will save you the math:  .26% IFR for all cases.  But half the cases are from nursing homes, so it is significantly less, perhaps half as much for non-nursing home individuals.

Now will you start to believe me?

On Covid 19; According to the CDC it’s over May 24, 2020

Posted by shaferfinancial in Covid 19, Interesting Reading, paradigm shift, Retirement Income, trust, Uncategorized.
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It’s hard to reconcile seemingly conflicting information/data coming in at the same time. So, I’m sure when people see this, there won’t be much they will find that is believable. But, pandemics go in stages.  1st stage is community spread, where an infected person enters the community and it spreads from person to person.  Then the virus burns out for several reasons some known and some unknown. Seasonal affects. Enough cross immunity is developed. The people who are going to get sick from the virus have already gotten sick. Etc. Finally, there are usually smaller waves that come into a community annually or occasionally. During all this the virus mutates into different forms which usually are less virulent forms of the virus. But it is impossible to predict when and how bad the waves will be.

 

Update: I was wrong.  The waves are very large in several states.  Mostly young and unaffected folks are getting infected and spreading this.  Also some small rural communities of mostly minority population are see high rates of infections, hospitalizations and deaths. Fortunately, overall, the hospitalizations and deaths per infection are going down significantly.  Unfortunately, the fear mongering is not.  Some front line workers and scientist think the virus has mutated to a more infectious, but less virulent form. Hopefully they are correct.

 

nchs-mortality-report.gif (900×580)

 

Look at the above graph from the CDC.  Note the spike in Pneumonia, Influenza and Covid mortality. When we reach the peak of the curve (about 3-4 weeks ago, was when the epidemic in the USA was essentially over. Now we are just dealing with the fallout. Note the sharp decline over the last 3 weeks. That is another indicator that community transmission of the virus was done.

But, how can this be?  Aren’t people still getting infected and dying???

Yes.  Again aftermath of the viral spread. Deaths are 2-4 weeks after infection. When a person tests positive for the viral infection, that is 3-7 days after infection. The majority of new infections are from institutions like nursing homes and prisons.  Doesn’t this mean the pandemic is still going strong?  No, it means that moved to a cluster phase, where people not in the general public or have jobs that get them large viral loading are getting infected.

 

What other proof is there. Well Emergency Room Visits are way down.

 

 

These are the CDC charts for ER visits. Notice the peak was around week 14-15 of the year. So middle of April. Note, that in the second chart that combines all influenza like illnesses (ILI), we are now below baseline. This indicates we are now below normal for emergency room visits for ILI’s. Most of the remaining COVID visits from the first chart are probably from nursing home and prison clusters along with health care workers and prison guards.  This is the last remnants of the viral epidemic that remains.

Please note, we are probably going to live with this virus for a long time, vaccine or no vaccine. Time will tell if it will fade into the tapestry of ILI’s, peaking in the winter and fading into the summer.

 

So, now you are probably pointing to all this and saying look how well the shelter in place is working. Well, there is an increasing amount of evidence that mitigation strategies didn’t mitigate much.  And there seems to be one item they can say by comparing different countries with different mitigation strategies. That is there is no scientific evidence that shelter-in-place worked to avoid the spread of Covid.

And just for fun, here is an article detailing how this strategy came into being in the USA. There is a link to the scientific paper written by epidemiologist of the time (2006).

 

Here is a key paragraph:

“There are no historical observations or scientific studies that support the confinement by quarantine of groups of possibly infected people for extended periods in order to slow the spread of influenza. … It is difficult to identify circumstances in the past half-century when large-scale quarantine has been effectively used in the control of any disease. The negative consequences of large-scale quarantine are so extreme (forced confinement of sick people with the well; complete restriction of movement of large populations; difficulty in getting critical supplies, medicines, and food to people inside the quarantine zone) that this mitigation measure should be eliminated from serious consideration…”

And:

“Travel restrictions, such as closing airports and screening travelers at borders, have historically been ineffective. The World Health Organization Writing Group concluded that “screening and quarantining entering travelers at international borders did not substantially delay virus introduction in past pandemics . . . and will likely be even less effective in the modern era.”… It is reasonable to assume that the economic costs of shutting down air or train travel would be very high, and the societal costs involved in interrupting all air or train travel would be extreme. …”

Finally:

“During seasonal influenza epidemics, public events with an expected large attendance have sometimes been cancelled or postponed, the rationale being to decrease the number of contacts with those who might be contagious. There are, however, no certain indications that these actions have had any definitive effect on the severity or duration of an epidemic.”

Happy reading…….

The 2006 Origins of the Lockdown Idea

 

 

The 1957 Asian Flu May 20, 2020

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In 1957 a pandemic of the “Asian” flu hit the USA. This flu (H2N2) killed 116,000 Americans and millions around the world. It lasted 10 years as a seasonal virus and morphed into the Hong Kong flu in 1968-69. The IFR was estimated at .69%. The virus killed mostly older Americans and pregnant women. At the time the population was 1/2 what it is now. On top of that the USA was much younger and had less obesity/chronic diseases with the exception of smoking related diseases. With our current population that would 232,000 deaths. Note, the IFR was at the top range of what we are experiencing now with Covid 19.

There was common awareness at the time of this pandemic. A few conventions that had a significant amount of older folks were canceled. The media covered it as a medical event. A few schools were also closed down when an outbreak occurred. A vaccine was soon found, but it wasn’t very effective. But here is the big difference, politicians didn’t step in. Media wasn’t constantly reporting exaggerated or false claims. Somehow our 1957 selves were able to muddle through, even our 1957 health care system.

Have we lost the ability to think rationally? Or politically are we so sick as to have weak-minded politicians? How can our politicians not understand to protect the older folks and health care providers, from day 1, when we have history of many large and small pandemics? Where did they get the idea that we could do shelter-in-place and protect grandma????? Note 40%-78% of all deaths around the country are from long term care facilities. 15%-35% of cases are from health care providers (depending on state). I was amused when the NY governor seemed perplexed about over 60% of new cases in NY came from people abiding by shelter-in-place orders. In 1918 it was found that fresh air and sunshine was most helpful for the pandemic victims of that time. We know that these viruses spread in closed areas and that the longer you are in a closed area with infected people the higher the viral loading gets. Yet, our governors told us for a month or longer to stay at home.

Did this protect grandma???? No. Did this prevent folks from getting infected???? No. Did it lower the curve?? Probably. Did this extend the epidemic? Yes. Should there have been shelter in place orders? Yes, but only in a couple of places where the infections were raging so much to put hospital beds in short supply.

Latest update: Some colleges are starting early as to end the semester by Thanksgiving given there is evidence that this will become a seasonal affect pandemic. They hope to not have students on campus at the beginning of winter when the flu season usually starts.

Overall number in the USA remain stubbornly high in high density areas. Most states are starting to open up slowly. The numbers of deaths and cases (highly affected by numbers of tests) are on a downward trend. We are testing 3 times as many as 3 weeks ago. Average positive per test has plummeted (a great sign for our testing program as well as an indication of waning infections). My area has around 1 infection and 0 deaths per day. There has been a total of 3 deaths in my area (population 120,000) and around 110 infections. Was able to sit outside at a restaurant yesterday. That was nice. Beaches still closed, so probably no summer work for my son.

Lot’s of time to think and muse on a variety of topics May 5, 2020

Posted by shaferfinancial in Finance, Mutual Funds for Retirement, Retirement Income.
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I have had a lot of time to read, think, muse of a variety of topics. I just finished a book by Susan Orlean called The Orchid Thief

I loved her writing and found this section on Florida really interesting:

Nothing seems hard or permanent; everything is always changing or washing away. Transition and mutation merge into each other, a fusion of wetness and dryness, unruliness and orderliness, nature and artifice.

Although this was a great description of the state of Florida, I think it also perfectly sums up the finance world. Probably my biggest gripe with the financial planning world, is they try to convince people the financial world can be made orderly and understandable. They try to tell you that their strategies control risk or even in many cases eliminate risk. Just let them manage your money and all will be well. But, in my opinion, nothing seems hard or permanent in the financial world, everything is always changing or washing away. Transition and mutation do merge into each other; unruliness and orderliness mix in weird unpredictable ways.

Instead should we not admit to lacking the ability to predict, to control (risk), to not know when we have unruliness or orderliness and what that means? Are there really a class of individuals that can know the meaning of all the above?

Last year my wife had breast cancer. My business suffered because I suffered. This year it is an unruly virus creating fear and uncertainty. As my son pointed out, the numbers (cancer survivor numbers) make him feel like he had some control over an event that was impossible to process. I find myself digging into Covid 19 numbers now for the same reason. But the numbers are an illusion of control. Just like those pretty charts the financial planners use and the illustrations I use. They may make you feel better, but reality always has plans for you.

The pubic health officials are going through the same awakening. Their models, based on their understanding of how a virus infection spreads, are just an illusion. They don’t seem to get this. Funny, how from week to week, their models need to be changed and give out widely different accounts. Then when reality doesn’t appear to be concerned with their models, they will recalculate again and again, never getting it right. Yet, we are expected to bend to their model’s version of reality instead of what our senses are telling us.

Transition and mutation merge into each other, a fusion of wetness and dryness, unruliness and orderliness, nature and artifice.

Musings on Covid 19 May 1, 2020

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There is so much panic and subterfuge now around Covid 19, that it is close to impossible to write anything based on what the science is demonstrating without having people jump right to criticism and emotional outbursts. Note the craziness over the release of pre-prints of the antibody testing now ongoing. People weren’t willing to allow science to guide their opinions and the outcry and criticism of the Stanford research was laughable. And it turns out that now multiple studies with various sampling methods, many randomized are proving the Stanford researchers correct. USC researchers, University of Miami researchers, Harvard researchers and the state of NY public health researchers all concur that there are many many people out there that have had the infection without symptoms. And the worst part is this is great news. It means the virus isn’t as deadly as we thought.

The 2008-2009 H1N1 pandemic provides an interesting comparison. This influenza A pandemic started in the US and like Covid was a novel virus. It spread to the rest of the world and in its first year it was estimated to have killed 360,000 people. So far, it has been estimated that Covid 19 has taken 233,000 deaths.

But that is where the comparison stops. That strain of H1N1 mostly killed children and young adults. While the average age of death for Covid 19 is around 80. It was thought that the reason for this was that older people had antibodies from a previous strain of H1N1, that occurred many years before. That is why this pandemic was much worse in 3rd world countries, than the US. While we had 12,000 deaths here in the US, countries with larger percentage of the young had much worse deaths. By June, the end of the influenza season the CDC reported more than 1 million cases in the US. 980 schools were closed in early May in places that had significant activity. The pandemic that started in mid-April was essentially done by mid July of that year. It has reappeared yearly since then, but in much reduced numbers. In July of the first year clinical trails started for a test. And by September 15th a vaccine had been made. A second wave started in late September causing school closure again. But that second wave subsided in 2 months. The vaccine was distributed to the public in December of that year and provided significant immunity. This H1N1 infection faded into the background and is still with us today. There were some hospitals that erected tents to treat patients because of overflow from this virus.

Note our response to a virus that was killing children and young adults. It was rational. School closures in hot spots. Erecting tents to provide health care in areas that were overrun with patients.

Now, what we know of the COVID 19 virus is it is killing older people at a much greater rate than the H1N1 virus killed young folks. That is common sense, of course, as 80 year olds are much sicker in general and don’t have reserves to overcome novel viruses or strong immunity systems. And I say this without prejudice or meanness in mind. The life span of someone born in 1940 (80 years ago) was 70. These folks dying of Covid 19 have already outlived their peer group by 10 years or more. And this is what we are seeing. The oldest and sickest people, mostly in long term institutional care, are dying from Covid 19, while each younger segment are mostly recovering and at the youngest age groups showing little or no symptoms.

So that begs the question, Why, like the 2008-09 pandemic, did we not do a vertical integration mitigation strategy? In other words, in the 2008-2009 pandemic we closed schools in heavily impacted areas because the children were the ones most heavily impacted. Why did we not lock down long term care facilities, shelter in place orders for those 65 and older who don’t work, masks for health care workers who work with the elderly, etc.? Why instead did we do a horizontal mitigation strategy, closing down our entire society? And don’t say we didn’t know, because we did from both China and Italy/Spain. We knew who was at risk and how to best protect them. Don’t say in order to protect Grandma, we needed to keep their grandchildren out of school, because that violates all we know about how to stop pandemics and what we have done every time since WW2.

Next post I will take a look at the 1957 flu pandemic.

I hope I have left you with some more understanding of pandemic societal reactions and some deep questions.

Be safe.