Time to Get Real

June 30, 2020

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Well, it looks like Donald Trump’s term in office may end very much as it began, with our intelligence community reporting hostile actions by the Russians and the President covering up for them as best he can. Apparently, strong evidence that the Russians put a bounty on the lives of American soldiers in Afghanistan became available several months ago. Not only did the President do nothing about it, but he continued to support his friend Putin in other areas of his agenda, such as joining the G7 nations. Now he claims that he was never briefed. Perhaps not, considering that telling truth to power has never been encouraged in this administration.

Does this story sound familiar? Even before Trump took office, our intelligence agencies had concluded that Russia was interfering in our election process. His response was to dismiss the finding as fake news, accept Putin’s denial, and do his best to obstruct the investigation. He also concocted his own story of election malfeasance, attributing his failure to win the popular vote to fraudulent voting by undocumented immigrants. More recently, when he was caught trying to blackmail Ukraine into discrediting Joe Biden, he dismissed that reporting as fake news too, and once again obstructed the investigation.

When we look back on Trump’s years in office, what we see is a president whose ability to create convenient fantasies is only exceeded by his inability to tackle real problems. He is consistently long on denial and short on leadership.

Do too many Americans lack affordable health insurance? No, the problem in Trump’s mind is the Affordable Care Act itself, which his administration is still trying to get the Supreme Court to declare unconstitutional. He claims to have a better and cheaper plan, which he has never revealed.

Do too many communities still suffer from systemic racism, over-aggressive policing and mass incarceration? No, the problem in his mind is the people who are protesting those things.

Have new technologies destroyed too many good jobs, requiring new investments in education and training? No, the problem in his mind is just foreign competition and immigration, which can be dealt with by trade tariffs and a wall.

Does climate change threaten the future of the planet? No, the problem in his mind is environmental regulation, which interferes with the fossil fuel industry’s aim of producing as much fossil fuel as quickly as possible.

Does the coronavirus pandemic call for strong federal leadership to increase testing, track the infections, equip our health care providers, and promote safe behaviors? No, the problem in his mind is that testing is turning up too many cases, and safety restrictions are depriving Americans of their liberties.

Now that Trump is in real danger of losing the presidency, does voter suppression or further help from the Russians threaten the 2020 election too? No, the problem in his mind is that mail-in ballots—the most sensible way of voting during a pandemic—will fraudulently elect Joe Biden.

In all of his denials and phony claims, Trump has been aided and abetted by Congressional Republicans. He can rely on them to block any serious attempts to deal with the country’s problems, while covering for him when he commits corrupt acts. Senate Republicans acquitted him in his impeachment trial, although many admitted privately or publicly that he had probably done what he was accused of doing. The party in general has evolved to the point where Republicans focus far more of their efforts on retaining control of government than on actually governing. A sweeping generalization, I realize, but I stand by it.

Many of our social problems are ticking time bombs that have great destructive potential. We cannot afford four more years of fantasy.



Living Dangerously (part 4)

May 24, 2020

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As of this Memorial Day weekend, the US death toll from covid-19 continues to rise at a slower rate, both in absolute numbers and as a percentage. This week’s 8,812 new deaths represented an increase of 10%, compared to a increase of 10,239 (13%) the previous week. Slower increase was the story in most states, despite the easing of restrictions on public activity. All ten of the states with the highest percentage increase the previous week (listed in the previous post) had a lower rate of increase this week. A few other states, however, experienced a higher percentage increase this week: Arkansas, Indiana, Kentucky, North Dakota, Rhode Island, Utah and Wyoming. The good news is that no state has been experiencing a sustained acceleration of deaths.

Two words of caution, however. Some states have serious local outbreaks of infection, as in Minneapolis, MN and Montgomery, AL. These have the potential to expand into wider outbreaks. And since death is a lagging indicator of infection, it is too early to conclude that the economy is safely reopening without a resurgence of the disease. Be careful and stay safe this holiday.

Living Dangerously (part 3)

May 17, 2020

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Although total deaths from the coronavirus continue to climb, the rate of increase for the United States as a whole continues to fall. This week’s addition of 10,239 deaths represented a percentage increase of 13%, compared to a 19% increase the week before and a 23% increase the week before that. A month ago, for the week ending on April 18, the weekly increase was 90%.

The Institute for Health Metrics and Evaluation continues to project a gradual decline in deaths over the summer. However, it has once again raised its projection of total deaths from 134,475 to 147,040 by August 4, because mortality is not declining quite as fast as previously projected.

A comparison of state mortality data reveals an interesting pattern. The list of the ten states with the highest total deaths has not changed very much. It now includes New York, New Jersey, Massachusetts, Michigan, Pennsylvania, Illinois, Connecticut, California, Louisiana and Florida. The list was similar a month ago, except that it included Washington and Georgia instead of Pennsylvania and Connecticut.

However, the states with the highest weekly percentage increase in deaths are a completely different group. They include Iowa (37%), New Mexico (36%), New Hampshire (31%), Delaware (29%), South Dakota (29%), Arizona (28%), Nebraska (28%), Minnesota (25%), Missouri (25%), and Texas (tied with Alabama at 24%). This is clear evidence that the epidemic is spreading beyond the coastal cities and posing a greater threat to the interior and more rural regions of the country. Those states need to proceed with caution as they try to promote economic recovery without generating a new spike in mortality.

Living Dangerously (part 2)

May 5, 2020

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Two days ago, I reported that the Institute for Health Metrics and Evaluation at the University of Washington had revised its projection of the ultimate US death toll for this wave of covid-19 from 67,641 to 72,433. Given the number of deaths that had occurred already and the current rate of increase—about 1,700 a day in the preceding week—I didn’t see how that projection could stand up. IHME acknowledged that its model did not yet include increased interactions due to the easing of restrictions on public activity.

Yesterday, the Institute released a more sophisticated model that included greater attention to the mobility of populations as well as some other variables. The result is a dramatic increase in the projected death toll, to 134,475 deaths by August 4. As usual, there is a large margin of error, resulting in a range from 95,092 to 242,890. A death toll of 134,475 would far exceed that of any other country. It is about sixteen times the projection for Germany, although the United States has only four times the population of Germany.

The Institute said that its revision upward “is primarily due to longer peaks and slower declines for locations that have passed their peaks.” In addition, “for a subset of states, the easing of social distancing policies has begun and mobility patterns are on the rise.” Those states include Alabama, Florida, Georgia, Idaho, Louisiana, Minnesota, Montana and Texas.

The Institute did not predict an increase of deaths per day, only a slower decline, from about 1,700 now to about 800 by June 1. There is a much more pessimistic document circulating within the federal government that does project such an increase. Deaths per day would start going up in mid-May, reach 3,000 per day by June 1—that’s like having a 9/11 every day—and continue upward from there. The Centers for Disease Control says that this was only a working model that was not finished or ready for release. But apparently someone is taking seriously the possibility that the relaxation of restrictions will lead to a new surge of exponential growth.

The three scenarios I mentioned remain possible:

  1. The warnings from epidemiologists are exaggerated, and the lifting of restrictions will have little effect on the mortality trend
  2. The lifting of restrictions will raise the infection rate somewhat, but not enough to overwhelm medical systems or increase mortality dramatically
  3. The lifting of restrictions will touch off serious outbreaks with exponential increases in mortality in at least some states

Of the three, #1 looks increasingly unlikely, and the choice now facing the country is between bad and very bad.

Living Dangerously

May 3, 2020

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On a week-to-week basis, the United States as a whole continues to see some decline in new deaths from the coronavirus. The worst increase was during the week beginning April 19, with 18,482 new deaths reported, increasing total mortality by 90%. The following week’s increase was 14,224, increasing total mortality 36%. This past week, we saw 12,527 new deaths, increasing total mortality 23% (from 53,314 to 65,841).

Because mortality is not dropping as fast as expected, the Institute for Health Metrics and Evaluation has increased its total projected mortality from this wave of the virus from 67,641 to 72,433. That means that only 6,592 more deaths would occur, a very low number considering that 12,527 occurred just this week. The institute acknowledges, however, an important limitation of its projection:

Our present modeling framework does not yet capture how the risk for more COVID-19 cases – and potentially deaths – could increase due to increased interaction among individuals. This is particularly true if locations have not fully instituted strong containment strategies like widely available testing and contact tracing.

In other words, the modeling does not yet take into account the rush to re-open the economy. Although the country as a whole has experienced slowing mortality, the trend has been very uneven from state to state. Most of the states that are moving to lift restrictions are doing so sooner than recommended, according to both IHME and CDC guidelines. They are not waiting until new cases in their state have declined for two weeks, or until they have “strong containment strategies like widely available testing and contact tracing.” That suggests three scenarios:

  1. The warnings from epidemiologists are exaggerated, and the lifting of restrictions will have little effect on the mortality trend
  2. The lifting of restrictions will raise the infection rate somewhat, but not enough to overwhelm medical systems or increase mortality dramatically
  3. The lifting of restrictions will touch off serious outbreaks with exponential increases in mortality in at least some states

I don’t pretend to know which of these will occur. We do know that just a few weeks of careful preparation and prudent restraint can make a big difference when dealing with something that moves as quickly as an infectious disease. We should find out very soon which states are doing the right thing.