COVID-19 Counter-Factuals and Trade-Offs

by James A. Bacon

A recent Columbia University study generated headlines after concluding that 55% of deaths reported as of May 3 could have been avoided if stricter social-distancing controls had been implemented nationally just one week earlier.

Responding to that story, President Trump created a mini-furor by engaging in his usual ad hominem attacks. Rather than addressing the underlying facts and logic in the study, he called Columbia a “liberal, disgraceful institution” — as if labeling the institution ideologically did anything to rebut the rigor of the study.

A nuanced critic of the study might have questioned the validity of using epidemiological models to run counter-factual simulations. The outcome of models like the one used by the Columbia authors depends upon an array of critical assumptions — often debatable — about the relationship between different variables. As the old saying goes, Garbage In, Garbage Out.

Whatever the merits of the particular study in question, the flap revealed that the U.S. academic and media establishments now accept counter-factual simulations as legitimate news. Perhaps someone could build a model to answer a different counter-factual question: Given the fact that most COVID-19 deaths have involved elderly patients with one or more coexisting conditions, how many would have died anyway? Continue reading

Two Faces of the Face-Mask Mandate

by Sidney Bostian

Governor Ralph Northam will announce tomorrow the details of a statewide mandate to wear masks in public spaces and businesses. “We are working through the policy. Obviously it’s an equity issue,” Northam said at his Friday news conference, adding that all Virginia residents would need access to face coverings and that he is examining how to enforce such a policy.

“Wearing a mask could literally save someone else’s life,” Northam said. “That is becoming clearer every day as we move further into managing this virus over the long term.”

The justification cited above — “could literally save someone’s life” — is one of the most interesting “definite maybes” uttered by a public official in recent memory. A careful observer would note that Northam failed to cite his scientific sources for that statement.

Mask wearing in the COVID-19 era has become controversial. Proponents suggest that the coronavirus can be managed only if we compel everyone to wear masks. Opponents to mandatory masks flinch as if they are being asked to wear the “mark of the beast.” Virginians seem evenly divided with about half favoring masks and about half opposing (acknowledging that there are some who don’t care and will swing like a barn door).

Given the passions of the partisans on both sides, it is reasonable to ask that the Governor’s decree meet two tests. First, that there is scientific evidence that universal mask wearing will save lives, and second, that there are few if any citizens who will be adversely affected by long-duration, long-term use of masks. One would hope that Northam, a physician, would affirm the “do no harm” principle. Continue reading

Ralph Northam’s Sovereign Immunity

by Kerry Dougherty

Just as we were eagerly looking forward to a glorious Memorial Day weekend in Virginia Beach, Gov. Ralph Northam dropped a stink bomb.

At his Friday press conference, in his cloying, paternalistic way, Northam said he had some homework for the commonwealth. He wanted everyone to get a mask. Details to come on Tuesday.

Can’t wait. Clearly another authoritarian mandate is coming.

And good luck with your next edict, Governor. No one takes you seriously anymore.

Not after Saturday, anyway, when the whole world saw him frolicking on the Virginia Beach boardwalk, leaning in for selfies with fans and not even pretending to care about social distance.

Northam’s going to have a hard time continuing to whip up COVID-19 panic after this. He demonstrated that he wasn’t worried one bit about the virus. The media made much of the fact that Northam wasn’t wearing a mask on the boardwalk. Of course he wasn’t. Wearing a mask outside is idiotic and unhealthy. Who cares about that? Continue reading

Memorial Day 2020

It can’t all be John Philip Sousa today…. Pete Seeger captured the day best. Thankful that my grandfather, father and uncles, and my brother and son….all came home safe.    SDH

US Cemetery, Normandy, 2017

The Emperor’s New Clothes — or the COVID That Didn’t Happen

by Carol J. Bova

The May 22 UVA COVID-19 Model weekly report says the virus transmission rate dropped below 1.0 in the past week. It had averaged 2.2 prior to March 15. Here’s the explanation of what that means:

Researchers use the transmission rate of a disease, often referred to as R-naught (R0), to measure how fast it spreads. R0 is roughly the number of people one  sick person infects. So a transmission rate of 2.0 means that, on average, one sick person infects two others with the disease. The key number for transmission rates is 1.0. At an R0 above 1.0, the infection will spread. But below 1.0 the infection  will  die  out…

Based on onset date, the R0 of COVID-19 in Virginia dipped below 1.0 beginning on May 10.

The reproductive rate is 0.998 based on an onset date 14 days ending May 10.

Let me repeat that: “Below 1.0 the infection  will  die  out.” Continue reading

The Epidemic is Receding. Why Do We Need a Mask Mandate Now?

by James A. Bacon

As Governor Ralph Northam ponders the details of a statewide order mandating Virginians to wear face masks, he might do well to consider the latest COVID-19 data in his deliberations.

A record number of test results, 11,609, were incorporated into the Virginia Department of Health COVID-19 database yesterday and published on the VDH dashboard this morning. (Only one day, May 1, saw a higher number, and that reflected a major change in reporting methodology.) This is the first time that Virginia has met Northam’s professed goal of a minimum of 10,000 tests daily.

Only 495 new COVID-19 cases were confirmed, the lowest number in more than a month. The percentage of positive tests fell to 4.3%. That was the lowest since March 18, before COVID-19 had reached epidemic proportions. Northam has cited evidence of declining positive-test ratios as an indicator for loosening his Vulcan Death Grip on Virginia’s economy.

But Northam appears to be committed to issuing a mask-wearing edict “especially for individuals going into businesses.” The only thing holding him back is that some issues remain unresolved. One is the “equity” implications of a mandate. Said he: “We want to make sure everyone has access to a mask.” In other words, he wants to ensure that members of poor and minority communities are not prevented by their inability to obtain masks from entering places of business. Another issue, he said, “We also want to talk about how we enforce that.” Continue reading

Why Is Our Governor Ignoring His Own Orders?

By Steve Haner

If the overall case fatality rate for COVID-19 is 4 tenths of one percent, as the Centers for Disease Control just estimated, then perhaps 300,000 Virginians have or have had the disease.  That’s working the math backwards from the 1,200 Virginia deaths reported so far.

The chart below snipped from the CDC’s report shows four possible scenarios and the fifth column is marked “most likely” case fatality rate. As we all now know, age is the key factor, and the death rate for persons 65+ is the highest, perhaps as high as 3.2%. But the CDC thinks most likely it is 1.3% in that group, and as low as 0.05% for those under 50 (5 deaths in 10,000 infections).

Source: CDC. The right hand column is marked as the most likely case fatality rates, with other four columns showing the range. Click for larger view.

Here’s the similar chart from a recently-released antibody study in Spain, with a random sample of around 70,000 individuals. The Fear Mongers point to the conclusion that only 5% of the country’s population shows antibodies, although it is far higher where the disease was more common. But the first column is the calculated infection fatality rate, IFR, very similar to the CDC study.

 

Continue reading

The Nursing Home Industry Responds

Virginia’s long-term care facilities have come under close scrutiny during the COVID-19 epidemic, understandably so, considering that roughly 60% of all COVID-19 deaths in Virginia have afflicted patients living in long-term care facilities. The nursing home industry has remained remarkably quiet throughout the crisis. But yesterday I received a communication from Amy Hewett, vice president of strategy and communications for the Virginia Health Care Association.

Bacon’s Rebellion has been pretty tough on the nursing home industry and its regulators, so I thought it fair and reasonable reasonable to re-publish Hewett’s communication. Here, after deleting prefatory material, is what she had to say. — JAB

As you know, the coronavirus is of a particularly voracious nature. Even with the best infection control, it can spread at nursing homes and assisted living centers, which require high-touch care such as feeding, bathing and dressing residents – especially given the frequency of asymptomatic spread. The people we care for are high risk – not just now, but always. Public health policy must reorient itself to our community’s needs so we can do everything possible to keep our residents safe.

That said, confirmed coronavirus cases account for just 6% of all residents in our care. Long-term care facilities are taking significant steps to prevent further spread. Despite the challenges we face, most residents and staff members who are diagnosed with the virus make a full recovery – many without hospitalization. With the proper resources, we can ensure even more positive outcomes.

I wanted to pass along a few items that I thought would be of interest to you: Continue reading

Latest Data Supports Continued Reversal of Shutdown

The red line shows the number of confirmed and suspected COVID-19 patients in Virginia hospitals. Graph credit: John Butcher

by James A. Bacon

We’re a week into Phase 1 of relaxing the COVID-19 lockdown, and there is no sign of an acceleration of the virus. To the contrary, the virus seems to be receding. It may be too soon to reach definitive conclusions — there is a one- to two-week lag between an infection, the display of symptoms, testing, and hospitalizations — but so far, all signs are positive.

The most reliable indicator is COVID-19 hospitalizations, and the daily number is trending down strongly, as can be seen in the graph (courtesy of John Butcher) shown above. Since May 15, the count of confirmed and suspected COVID-19 patients in Virginia hospitals has declined from 1,511 to 1,384. Meanwhile the number of new hospitalizations yesterday dropped to 36 — the lowest number in 25 days. The number of deaths remains significantly below previous peaks.

The one disconcerting note in the numbers comes from nursing homes. The number of nursing home patients confirmed to have COVID-19 has increased markedly over the past week — from 1,427 five days ago (the first day for which the numbers were reported) to 1,886 yesterday. Whether that reflects an increase in testing at long-term care facilities, an increase in the number of nursing homes sharing data, or an actual spread of the virus is impossible to determine from the published data on public dashboards. Continue reading

Wise King Ralph Rules: Less Choice for the Self-Employed

Wise King Ralph

by James A. Bacon

According to Governor Ralph Northam, the way to ensure access to quality, affordable medical insurance for Virginians is to reject bills that would… expand access to health insurance for Virginians.

Yesterday Northam vetoed two bills passed with broad bipartisan support that would have allowed self-employed people to buy insurance through professional groups such as Realtors’ associations. He also vetoed a third, which would have permitted small businesses to band together to buy group health insurance for employees.

Northam’s logic was that the legislation could undermine the Affordable Care Act by providing an alternative to buying coverage on the state exchange, reports the Washington Post.

“Governor Northam’s administration has worked to expand access to affordable quality care for all Virginians,” said a statement released by the Governor’s Office. “The vetoed bills would address health insurance cost concerns for targeted segments of the population, but in doing so, could increase the cost of insurance for sicker Virginians in the marketplace.” Continue reading

COVID-19 Update

Highlights from the Virginia Department of Health and Virginia Hospital and Healthcare COVID-19 databases based on yesterday’s reporting:

Mortality statistics
COVID-19 deaths: 37
Nursing home deaths: 13
Percentage of deaths occurring long-term care settings: 35%

Testing data
Tests administered: 6,553
% positive: 14.7%

COVID-19 Hospitalization data
New hospitalizations: 52
New discharges: 185
Total COVID-19 patients hospitalized: 1,459 (lowest in 19 days)

— JAB

COVID-19 a Danger to Individuals but Not an Existential Threat to Society


We’ve published variations of this graph in the past, but the perspective never grows old. This data, provided by John Butcher of Cranky’s Blog fame, shows how the COVID-19 virus stacks up against other causes of death in Virginia (using 2017 data, the most recent available). The number is almost as high as it was for the flu and pneumonia.

But… but… but one can argue that if it weren’t for the extreme lockdown measures put into place by Governor Ralph Northam, the COVID-19-related deaths in Virginia would be much higher. That may be true. However that argument takes us into esoteric territory. One could argue that we haven’t “prevented” the COVID-19 deaths so much as displaced them in time. That was precisely the logic behind the “flatten the curve” strategy — to spread out the infections over time to avoid overwhelming the healthcare system. Continue reading

COVID Confusion

by Kerry Dougherty

Looks like it may be safe to lose the grocery gloves. We can take it easy with the Clorox wipes, too.

No longer must we let Amazon packages marinate on the porch for days. Or scrub milk cartons with bleach in case some super-spreader touched it in the supermarket refrigerator case and left invisible viral bits on its waxed surface.

Yep, in a reversal of its earlier hair-on-fire warnings, the CDC admitted this week that it appears the Covid-19 virus is not easily transmissable from surfaces.

The CDC made another key change to its website, clarifying what sources are not major risks. Under the new heading “The virus does not spread easily in other ways,” the agency explains that touching contaminated objects or surfaces does not appear to be a significant mode of transmission, reported The Washington Post.

Now they tell us, 5,000 Clorox wipes later. Continue reading

“The Dog Ate My Homework” Does Not Work for VEC

By Dick Hall-Sizemore

The Virginia Employment Commission has been inundated with unemployment insurance claims. Virginians seeking to file claims have been frustrated at not being able to get through to the agency with their questions and by delays in receiving payments.

All of this was the subject of a meeting and presentation to a Senate Committee on Tuesday as reported by the Daily Press. As has been speculated by Steve Haner in his comments on this blog, the Unemployment Trust Fund is in the hole. According to a presentation by the VEC to the Senate Committee, the trust fund balance has gone from $1.5 billion at the beginning of FY 2020 to a projected -$500 million.

None of that is too surprising. What did intrigue me, however, was an excuse often made by agencies — antiquated technology. A VEC spokeswoman explained that it was put into place in 1985.  As far as the VEC is concerned, that excuse will not suffice.

The 2004 Appropriation Act provided VEC almost $21 million to “upgrade obsolete information technology systems.” Two years later, the 2006 Appropriation Act included language authorizing VEC to utilize $51 million in federal funds “to upgrade obsolete information technology systems.” That identical language was included in every Appropriation Act since then. In a 2020 budget decision package submitted to the Department of Planning and Budget, VEC said that the upgrade “is scheduled to be completed prior to the end of fiscal year ending June 30, 2021” and offered to return $3.2 million of the appropriation.

There may be good reasons why it has taken VEC more than 15 years to upgrade its information technology systems. At the very least, VEC owes the General Assembly an explanation. Going further, JLARC should investigate this delay. Unemployed Virginians deserve better than a shrug and the modern version of “the dog ate my homework.”

A Great Idea from Pennsylvania to Help Nursing Homes

by James C. Sherlock

Perhaps the Governor can call the General Assembly into special session to copy the best idea I have heard for a short-term fix to nursing home medical care.

The Pennsylvania House of Representatives has just passed the “Senior Protection Act” by a vote of 201-1 to appoint the state’s academic medical centers to take over responsibility for infection control, testing, surveillance and medical care supervision in the state’s nursing homes.

Says Pennsylvania Speaker of the House Mike Turzai:

“To ensure consistency of programs, response and study of clinical and public health outcomes, the legislation would establish a coordinated, collaborative public-private-partnership approach of regional health system collaboratives. These health collaboratives would administer/manage personnel, protocols, testing and expenditures to protect the seniors in these facilities.”

A 125-member Virginia COVID-19 Long-Term Care Facility Task Force was established on April 10. Go to https://www.vdh.virginia.gov/emergency-preparedness/ and click on Partner Briefing COVID19 Healthcare Coordination 5/8/2020 to find out what they have done. Continue reading