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Musings Report 2020-44 10-31-20 Prepare for Winter
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Prepare for Winter
It's time to prepare materially and psychologically for a winter unlike any other in our lifetimes.
Here's the view from 30,000 feet:
1. The stock market and the general zeitgeist of optimism have soared based on expectations that the real-world economy and efforts to suppress Covid would also track a V-shaped recovery.
While the GDP did make a V-shaped recovery, GDP (gross domestic product) is a measure of flows and consumption, not a measure of the socio-economic "balance sheet." GDP measures the money flowing through accounts but not the "assets" of a functioning society: functional institutions and infrastructure and the well-being and security of the citizenry.
Thus GDP soars while the real-world economy and society are hollowed out by economic inequality, declining health, financial insecurity, rising prices for essentials, dysfunctional institutions and decaying infrastructure.
Simply put, GDP doesn't measure what's important; it creates destructive incentives to squander resources and borrow staggering sums to support more consumption. This systemic flaw in what we measure has long been recognized by mainstream economists such as Joseph Stiglitz: Measuring What Counts: The Global Movement for Well-Being (Joseph E. Stiglitz et al., Foreign Affairs)
So the recovery of GDP doesn't mean the real-world economy has been restored to pre-Covid settings. It is a deceptively positive metric that masks the structural declines in the real-world economy and society.
2. Just as GDP is a deceptive measure of the economy, counting Covid fatalities is equally deceptive: a declining death count is good news, of course, but that ignores the other effects of Covid, particularly organ damage and "Long-Covid" debilitation, not just in people with pre-existing conditions and the elderly but in healthy middle-aged and even some young people.
As this article from the University of California - San Francisco (UCSF)--one of the world's top healthcare research centers--explains, this is the result of Covid being a hybrid virus. Initially it was thought to be a respiratory virus like influenza, but it is now clear that Covid infects and disrupts many other systems in the body--endothelial, digestive, the heart and other organs.
We Thought It Was Just a Respiratory Virus: We were wrong.
What We Know So Far about How COVID Affects the Nervous System (scientificamerican.com)
Risk for In-Hospital Complications Associated with COVID-19 and Influenza (CDC)
"Patients with COVID-19 had almost 19 times the risk for acute respiratory distress syndrome (ARDS) than did patients with influenza. The percentage of COVID-19 patients who died while hospitalized (21.0%) was more than five times that of influenza patients (3.8%), and the duration of hospitalization was almost three times longer for COVID-19 patients."
The precise pathways and mechanisms of these long-term consequences are under intense study. Initial estimates are that about 1 in 20 people who came down with Covid are suffering some long-term consequences. These consequences--for example, damage to the heart--are typically only identifiable by careful exams and tests.
What is known is that Long-Covid affects females more than males, it affects otherwise healthy people who were previously fit and active, and tens of thousands of people have reported long-term symptoms of extreme fatigue, brain fog, etc.
There are no treatments yet and the prognosis is cloudy. There is no clarity yet on how long these problems may last or if damage to organs is permanent.
So the percentage of people dying from complications of Covid may not be the number that most accurately reflects the disease's toll: the number of people with Long-Covid might be the more accurate reflection of the toll and the seriousness of the challenges ahead.
One in 20 is 5%. That means if 100 million people get Covid, 5 million may suffer some type of organ damage or long-term debilitation. Needless to say, the costs and consequences of this possibility are not even on the radar yet.
At 12, She's a Covid 'Long Hauler' (NY Times)
3. Many see herd immunity as the eventual solution to Covid. History suggests this isn't as neat and tidy as many expect. The first wave of a novel pathogen may appear to reach herd immunity, only to re-emerge a few years later with renewed contagious vigor.
While it's far too early to reach any definitive conclusions, preliminary evidence suggests natural immunity might decay within 6 months. This is supported by documented cases of re-infection, and in some cases the second infection is much worse than the initial infection.
What reinfections mean for COVID-19 (The Lancet)
This evidence suggests herd immunity might not be the solution many expect.
4. A great deal of controversy is being generated by statistics, with claims of over-reporting, under-reporting and so on. But let's review some numbers that are generally agreed upon.
The U.S. is rapidly approaching 10 million cases of Covid. Since many people who get the virus are asymptomatic and therefore have no impetus to get tested, it's widely assumed that the number of infected might be double the cases counted by positive Covid testing.
So perhaps 20 million Americans have been infected by the virus. Setting aside the evidence that immunity might only last 6 months, 20 million is only 6% of the U.S. population of 330 million.
Herd immunity is reached around 60% or higher, which suggests 200 million Americans would need to be infected to reach herd immunity.
The death rate for Covid is low for the entire populace, but it rises sharply for those with pre-existing conditions such as metabolic disorders (diabetes, pre-diabetes, etc.) and age (over 65 and especially over 75 years of age).
The problem is these at-risk populations are not small. There are 34 million people with diabetes, and an estimated 88 million Americans are pre-diabetic (as a general rule, overweight and in poor physical fitness). 53 million Americans are 65 or older, and roughly 20 million are 75 or older.
There is obvious overlap in these categories--people may be diabetic at age 70--but even with the overlap, these at-risk populations are roughly half the entire population (165 million people).
As this article from Nature.com explains, the infection fatality ratio (IFR) rises from near-zero for young people to 3.1% for 65-74 and 11.6% for those 75 and older.
The coronavirus is most deadly if you are older and male — new data reveal the risks (Nature.com)
According to this report from the American Diabetes Association, the data from early reporting indicates the death rate for those with diabetes was 7.3%.
COVID-19 in People With Diabetes: Urgently Needed Lessons From Early Reports (American Diabetes Association)
As a thought experiment, let's apply these death rates to at-risk populations at the "herd immunity" minimum of 60% of the populace:
A. 34 million diabetics X 60% = 20 million X 7% = 1.4 million deaths
B. 65-74 age group (28.6 million) X 60% = 17 million X 3.1% = 553,000 deaths
C. 75-84 group (14.2 million) + 85+ group (6.4 million) = 20.6 million X 60% = 12.4 million X 11.6% = 1.4 million deaths
This adds up to 3.3 million deaths without even counting any deaths in the populace younger than 65 or among the 88 million people with metabolic disorders.
Let's say better treatments and self-isolation will cut the deaths to 2.5 million. That would be extremely positive, but what about the Long-Covid cases? The system has yet to even start collecting data, much less comprehensively. Thus much of the eventual consequences and costs will remain unknown.
These projections are based on readily available data from reliable sources.
5. Hospitalizations are rising rapidly.
Hospitalizations and deaths are also trending upward. Across the nation, more than 46,600 people were hospitalized with the virus on Friday, an increase of about 25 percent over the last two weeks, according to the COVID Tracking Project. (New York Times)
Yet experts warn that the variability may simply end with the virus resurging to high levels across the entire country. "I don’t see any location in the United States that's going to be free of a major increase in cases," he said. "And I think we're just getting started."
When high case counts emerge in communities, the spillover to surrounding populations is rapid, Dr. Osterholm said. The situation, he noted, can be likened to a "coronavirus forest fire."
"A forest fire never burns evenly everywhere," he said. "But if the embers are still around, they ignite again and then that area does burn eventually. And I think that that's what we’re seeing here."
"We're going to see much less evidence of regionalization of this virus over the course of the next several weeks," said Dr. Michael Osterholm, an infectious diseases expert at the University of Minnesota. "I think this is going to ultimately end up being an entire country on fire."
If you look at the chart of hospitalizations, the healthcare system in many locales was experiencing extreme stress at 60,000 hospitalizations, and so any rise above that level could trigger second-order effects which could cascade into a breakdown.
As this report from the CDC explains, a significant number of healthcare workers have been infected and hospitalized, and many died. COVID-19–Associated Hospitalizations Among Health Care Personnel (CDC)
Should the number of healthcare workers who contract the disease or burn out due to extended shifts and exhaustion rise beyond a certain point, the ability to provide care for everyone who is seriously ill may become severely impaired.
So there are two limiting factors on care as the number of hospitalizations soars: the number of beds available in Covid-secure wards and the number of healthcare workers available to provide care.
If either of these limits are reached, death rates may rise as patients are unable to get the care they would have received had cases and hospitalizations not exceeded the capacity of the system.
6. There are lag times in effects and reporting:
--3 weeks: infection-to-death
--4 weeks: deaths reporting
--4 weeks: propagation to older age groups
Note the almost exponential rise in cases being reported. We can anticipate a surge in hospitalizations, deaths and spread to older populations in the weeks and months ahead.
7. Vaccines. I provided an analysis and numerous links on the many uncertainties surrounding vaccines in last week's Musings Report.
Covid-19 Vaccine Protocols Reveal That Trials Are Designed To Succeed (Forbes.com) by William A. Haseltine
8. The virus remains highly contagious.
Wedding and Birthday Party Infect 56, Leaving Nearly 300 in Quarantine (New York Times)
91 person wedding--30 infections; 156 quarantined
80 person sweet 16 party--37 infections; 270 quarantined
50 person birthday party--26 infections; 132 quarantined
All this data is from easily accessed credible sources: UCSF, CDC, Nature, the NY Times, The Lancet, Forbes, Scientific American and the American Diabetes Association.
The projections presented here are basic math, yet few seem to have done the simple math, perhaps because the results are sobering and don't fit the desired "optimism."
Realism must precede optimism or the optimism will collapse as the tsunami of reality comes ashore.
No one knows the future, but current trends suggest all the euphoric expectations of a fast, painless recovery were tragically misplaced.
Highlights of the Blog
Podcasts:
AxisofEasy Salon #28: Today's show is brought to you by the letter K(leptrocracy)
posts:
"Capitalism" Is No Longer Attractive to Capitalists 10/30/20
ALICE Doesn't Work Here Anymore 10/29/20
Flying Blind: Clueless about Risk, We're Speeding Toward Systemic Failure 10/28/20
How Systems Collapse: Reaping What We've Sown 10/27/20
Next Up: Global Depression 10/26/20
Best Thing That Happened To Me This Week
Homemade lilikoi (passion fruit) meringue pie!
From Left Field
How the 15 richest members of Congress made their money (via LaserLefty)
Internal Documents Reveal COVID-19 Hospitalization Data The Government Keeps Hidden (NPR)
The Only Man to Be Buried on the Moon
Shonda Rhimes ditched ABC over a Disneyland pass
Designing Batteries for Easier Recycling Could Avert Looming E-Waste Crisis-- only 5% of highly toxic lithium-ion batteries are recycled.... and that's the supposed "solution"?
Capitalism is double-billing us: we pay from our wallets only for our future to be stolen from us
Why the Pandemic Is Forcing Women Out of the Workforce (NYT) (via A.P.)
Some Covid Survivors Have Antibodies That Attack the Body, not Virus (NYT)
The Untold Technological Revolution Sweeping Through Rural China (NYT)
Let’s talk CROCI -- it all boils down to energy availability and cost...
The Enemies Briefcase: Secret powers and the presidency (Harpers) (via Cheryl A.)
Wind Turbine Blades Can't Be Recycled, So They’re Piling Up in Landfills (Bloomberg)
"Simplicity is the ultimate sophistication." Leonardo da Vinci
Thanks for reading--
charles |
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