You say you can “live with” the virus? What do your kids say?

  

Yesterday, there was both very good news and very bad news. The good news was that the FDA just approved an antigen test for Covid-19, which will be much easier to manufacture and to use, and delivers results in minutes. It does have a higher rate of false positives than the more standard PCR test. This means that any positive result will need to be re-tested with the standard test, before the person should be told to self-quarantine, but that’s tolerable. If the antigen test had a high rate of false negatives, that would be a problem, since nobody could ever trust their negative result without having the standard test as well (and then why bother with the antigen test in the first place?).

Of course, just because the test is approved doesn’t mean it will be available soon in the quantities needed – which are at least ten times what they are today (and that just gets us to the second level of testing, of the three levels that I discussed in yesterday’s post). It also doesn’t mean there won’t be an unforeseen problem when the test is rolled out in quantity. But even then, this is very good news.

However, the bad news is there’s now an even bigger need for more testing. Because children have had very low rates of death from Covid-19 (in fact, very few of them have even shown symptoms, although it isn’t likely they’re infected at a lower rate than their parents are), everyone has assumed that there wouldn’t be a big problem with them.

Last week, I wrote a post about a strange syndrome that was appearing in children in NYC, causing some of them to have to go on ventilators. The day after the post, some health official said not to worry, no children were dying because of this. Well, the next day one child died. And Gov. Cuomo said yesterday that two more have died, plus all three had antibodies for Covid-19. This syndrome has been reported in several other cities in the US, and there are at least 50 cases in Europe now.

The reason these cases are just appearing now is that this might be due to a reaction that gets triggered in children after they’ve recovered from Covid-19. And since NYC was on the leading edge of the pandemic here (they got it from Europe, not China, but since all through February we were only testing people who had come back from China or had been exposed to someone who did – of course, due to the lack of testing capability – it was thought that Seattle and California were where the epidemic started in the US), it’s natural that this would appear there first.

Obviously, it’s still pretty early to draw conclusions from three deaths, but one conclusion that I’m drawing right now is there needs to be massive testing – immediately – of all children, so that all of those who actually have the virus now, or have already had it, can be put on close watch for this syndrome. We’re going to need every one of those antigen tests right away. Can they be delivered tomorrow to every city in the country? OK, how about Tuesday?

This also means that people who think we can live with a certain level of coronavirus in the population are guaranteeing not just a certain level of adult deaths, but also of child deaths. Tell me: If say the current level of adult deaths (1500-2000 a day) is acceptable, what’s the acceptable level of child deaths? You say you don’t think there’s an acceptable level? I certainly don’t either! Yet if we’re to reopen schools and day care centers, we need to know that. And if we’re going to reopen most workplaces at close to their previous staffing levels, we need to either figure this out now or accept the fact that a huge percentage of the work force will never be able to return until a) the virus is completely controlled or a vaccine is available, or b) we decide what’s an acceptable level of child deaths. So which will it be?

The numbers

I first noticed 4 or 5 days ago that there was a regular 7-day cycle in the total deaths numbers; two days ago someone told me why. His name is Royce Howland. He lives in Calgary, AB and he is now posting on Facebook (most recently here) some very good analyses he’s done, as well as short-term projections of deaths and infections, for different countries.

He said that he had also noticed the 7-day cycle, and he attributes that (based on common sense as well as at least one online source confirming this) to the fact that some reporting agencies (mostly local and state governments, of course) slow down their reporting on weekends, when their staffing levels are lower; that causes reported deaths to be lower than they would be otherwise. On Monday, they start to get caught up, and by Wednesday or Thursday reported deaths peak for the week. That explains the peaks I’ve seen, which have all been on Wednesday or Thursday.

For this reason, I have changed how I project out the level of deaths, from basing it on yesterday’s 3-day growth rate to basing it on yesterday’s 7-day rate. This should smooth out some of the up-and-down swings in my projections, although it won’t of course change the absolute numbers. Today, my projections are again down, as they were yesterday. But it’s all relative. Instead of having a Covid-19 death every 31 seconds in May, we’ll have one every 37 seconds. In June, we went from 13 to 17 seconds. Excuse me for not cheering.

These numbers are updated every day, based on reported US Covid-19 deaths the day before (taken from the Worldometers.info site, where I’ve been getting my numbers all along). No other variables go into these numbers – they are all projections based on yesterday’s 7-day rate of increase in total Covid-19 deaths, which was 19%.

Note that the “accuracy” of the projected numbers diminishes greatly after 3-4 weeks. This is because, up until 3-4 weeks, deaths could in theory be predicted very accurately, if one knew the real number of cases. In other words, the people who are going to die in the next 3-4 weeks of Covid-19 are already sick with the disease, even though they may not know it yet. But this means that the trend in deaths should be some indicator of the level of infection 3-4 weeks previous.

However, once we get beyond 3-4 weeks, deaths become more and more dependent on policies and practices that are put in place – or removed, as is more the case nowadays - after today (as well as other factors like the widespread availability of an effective treatment, if not a real “cure”). Yet I still think there’s value in just trending out the current rate of increase in deaths, since it gives some indication of what will happen if there are no intervening changes.

Week ending	Deaths reported during week/month	Avg. deaths per day during week/month	Pct. Change from previous month
March 7	18	3
March 14	38	5
March 21	244	35
March 28	1,928	275
Month of March	4,058	131
April 4	6,225	889
April 11	12,126	1,732
April 18	18,434	2,633
April 25	15,251	2,179
Month of April	59,812	1,994 (= 1 death every 44 seconds)	1,474%
May 2	13,183	1,883
May 9	12,592	1,799
May 16	14,943	2,135
May 23	17,733	2,533
May 30	21,043	3,006
Month of May	72,190	2,329 (= 1 death every 37 seconds)	121%
June 6	24,972	3,567
June 13	29,634	4,233
June 20	35,166	5,024
June 27	41,731	5,962
Month of June	148,168	4,939 (= 1 death every 17 seconds)	205%
Total March - June	284,228

Red = projected numbers

I. Total deaths

Total US deaths as of yesterday: 80,040

Increase in deaths since previous day: 1,418 (vs. 1,694 yesterday)

Percent increase in deaths since previous day: 2% (vs. 2% yesterday)

Yesterday’s 7-day rate of increase in total deaths: 19% (This number is used to project deaths in the table above)

II. Total reported cases

I no longer pay any attention to the reported case number. It is a huge underestimate of actual cases, which is at least 5-10 times what’s reported. This is because of the huge shortage of testing capacity. If reported cases is anywhere near actual cases, we would need to be doing 20-30 million tests a week. I believe the US has done about 6 million tests since the start of the pandemic.

Total US reported cases: 1,349,422

Increase in reported cases since previous day: 31,549

Percent increase in reported cases since yesterday: 2%

Percent increase in reported cases since 7 days previous: 16%

III. Deaths as a percentage of closed cases so far in the US:

Total Recoveries in US as of yesterday: 238,080

Total Deaths as of yesterday: 80,040

Deaths so far as percentage of closed cases (=deaths + recoveries): 25% (vs. 26% yesterday) Let’s be clear. This means that, of all the coronavirus cases that have been closed so far in the US, 25% of them have resulted in death. Compare this with the comparable number from South Korea, which is below 3%. The reason this number is so high is that total reported recoveries are so low. I’ve been assuming since March 26, when the recoveries number was first published, that it would rise, so that this percentage (which was 41% on March 26), would be far lower than it is now. This number is very high, comparable with Italy and France (China’s is 6%).

My guess is the fact that this number is still so high is just another indication of the ongoing shortage of tests, since if a person has clearly recovered, the hospital is unlikely to want to “waste” a test on them. But if it stays close to the current level even as testing capacity increases, this will be an indication of a deeper problem.

I would love to hear any comments or questions you have on this post. Drop me an email at tom@tomalrich.com