As we all know, many states have opened up completely now that COVID-19 vaccinations are ramping up swiftly and mortality rates have dropped substantially. This is not what I'd do if I were in charge. I'd continue to wait another month or so.
At the same time, what these states are doing isn't entirely stupid or irrational. The basic case is pretty simple. First of all, the highest infection rate by far is among the very elderly, especially those in nursing homes. But they were the first to be vaccinated, and since then confirmed cases among nursing home residents and staff have plummeted:
With nursing home residents and workers getting close to fully vaccinated, we can expect the case rate to continue falling. We can also expect the death rate, which is already less than half what it was at the beginning of the year, to continue falling as well.
Second, the mortality rate among other age groups has dropped substantially too. Here are the mortality rates for February:
So the thinking goes like this: We're doing a good job with nursing home residents and there's every reason to believe that will continue. The mortality rate for the elderly outside of nursing homes continues to be fairly high, so they should probably continue to isolate for another month or two. However, just because they have to isolate doesn't mean that everyone should isolate even if their risk is low. And it is: The average death rate for adults under 50 was about 9 per million in February, almost exactly the same as the automobile death rate. And no one suggests we should all stop driving, do they?
This is not the most cautious approach to the pandemic, but neither is it ridiculous—especially with rising vaccination rates almost certain to keep pushing both case and death rates down. (Though in no case does it excuse the pigheaded insistence on removing mandates for masking and social distancing, both of which are minimally troublesome and clearly save lives.)
Overall, then, opening up now makes sense if your willingness to accept risk is just a little higher than average. I imagine that risk acceptance exists on a bell curve just like almost everything else, so it's bound to be the case that some states will open up early, a whole bunch will open up a little later, and a few will be laggards. That's just human nature.
Early opening has precious little to do with epidemiological calculations and aversion to risk if casualties. It’s all about political calculations and risk of re-election
Well in MN our test positivity rate is 3.5% and 70% of our elderly are vaccinated so Walz relaxed restrictions. Since we've generally been an island of coronavirus sanity (we had no new year surge, infections were down since November) surrounded by republican homicides, we'll see how long we last.
Makes perfect sense, EXCEPT we are dealing with multiple variants of Covid. We do not know how all the variants behave.
There is a very good chance different states might have different results from the removal of mask mandates and distancing. They might be suffering from different variants.
There was certainly a very high rate (especially of deaths) in nursing homes in the initial peak, but how do nursing homes explain the late 2020 (third) peak, which was by far the biggest? Presumably the inmates weren't rushing out to bars, but were they being visited for the holidays? Were the staff rushing out to bars or to family gatherings and then coming back to infect the inmates?
My guess is that nursing homes were not involved so much in the third peak, but I don't have the actual data at hand and Kevin doesn't give it. If this is true, then if people do whatever they were doing in late 2020 again, there is great danger of a fourth peak. If would be a good idea if those in charge actually consulted the data to make their decisions, but certainly some governors are not doing so (many never consulted any data at all). It would also be a good idea if pundits and bloggers consulted the complete data, but for the most part they are not doing it either. At the moment there doesn't seem to be any consensus even among experts who are trying to gather and evaluate all the data (an extremely difficult task) as to just what type of behavior and what specific types of places are most responsible for the waves of infection.
I wondered the same so I looked at some local data. In my county (Contra Costa in the Bay Area), during the (second) peak months of June-Aug we had 88 long-term care facility deaths. During the Dec-Feb (third) peak we had 169. Outside LTCF's, those numbers were 94 and 272. So the LTCF deaths nearly doubled in the third peak, whereas outside nearly tripled. We have 75% of our 65+ population vaccinated now, and nearly all in nursing homes who will permit it. So that leaves a fair chunk of our older (but admittedly healthier) population at risk, assuming only a small fraction has immunity from infection. All that being said, I do think there is a possibility of another peak, with likely much less mortality. But I do worry about the long-term effects for people who are younger, and only about 20% of those eligible (above age 16) are vaccinated in our county. I don't think we're atypical. In a state like California, cautious opening in a population that generally has respected the role of masks and distancing (with exceptions) seems to make sense - a calculated risk. In a state where mask aversion is a more common situation and/or vaccination lagging, I think there is a higher risk. If the point is to avoid overload of an already-exhausted healthcare system, I think we may be over the hump in California. That flies out the window if variants negate vaccine coverage however.
"The average death rate for adults under 50 was about 9 per million in February, almost exactly the same as the automobile death rate. And no one suggests we should all stop driving, do they?"
If automobile deaths were contagious and subject to exponential growth, we would have given suspending driving careful thought.
"Can I interest you in a discussion of our Lord, & Savior, Joseph Smi--... I mean, L. Ron H--... no, no, really Elon Musk?"
Only if the Musk guy is wearing a mask.
"The average death rate for adults under 50 was about 9 per million in February, almost exactly the same as the automobile death rate. And no one suggests we should all stop driving, do they?"
Bad analogy. Automobile crashes are not contagious.
Pollen Can Raise Your Risk of Getting Covid,
https://www.rawstory.com/pollen-can-raise-your-risk-of-getting-19-even-if-you-dont-have-allergies/
I live in Texas and Gov. Abbott re-opened the state and dropped the mask mandate. Following KD's reasoning, I can see the re-opening more now. Also, people can choose not to go to restaurants and so on.
However, lifting the mask mandate was a terrible move. To many low-information people here that just says people can stop wearing masks now. In the suburb where a live north of Dallas, people at the grocery store have been really good about wearing masks. But when I went late last evening, even though it was not crowded I saw seven people with no masks. Two weeks ago I would have never seen that.
The store has a big sign out front that you have to wear a mask. People just ignore it. I assume some are Trumpsters who feel they got the green light from Abbott.
"Also, people can choose not to go to restaurants and so on."
but not if that's your place of work. and most likely if you're working, you're not yet eligible to be vaccinated. that's the other side of this.
The idea of basing response to an epidemic on individual responsibility is idiotic.
Epidemics hit populations and are driven by population dynamics. They require a coordinated response. Leaving it up to individuals is inevitably going to fail.
Aw heck no! In Virginia we haven't gotten around to opening up the appointment waiting list to ordinary folks under the age of 65 and there's a huge honking wait list of folks over age 65 and in the various categories allowed to get on the list already. There's little gaming of the system with an efficient statewide waiting list along with Fairfax county's own wait list.
Until we get to having more middle aged folks vaccinated Virginia shouldn't loosen up just yet.
Same report as I just saw from an ~60 year old Northern Virginia resident in my fantasy baseball league who has been teting to get on the list for a month.
My mom keeps nagging me about the vaccine and my sister and we keep having to explain to her that we have to wait our turn, my sister is on the wait list, I can't get on the wait list until they open it up to folks in my age bracket because I'm not an essential worker or somebody with the listed health conditions.
What was going-on in Virginia anyway? For a while there not all that long ago (last days of February through the first week of March) they had a 7-day average of deaths per million per day that would have given each of a Dakotas a run for their money back when everyone and their brother were dumping on the Dakotas. (Ie broadly in the 20s)
Gov. Jolson trying to kill off whomever it was that leaked the 1984 medical school yearbook photos.
Seriously though it was a data backlog, they realized some sort of interface to update the deaths from somewhere or another wasn't working and whoops we gotta manually enter the data.
Aarrrgg! You hit my hot button. I wonder how many people know that wasn’t Northam in the picture:
https://hotair.com/archives/john-s-2/2019/02/04/northams-classmate-party-wasnt-photo/
He admitted the deed before seeing the picture because he knew he had done it while doing an undoubtedly bad MJ imitation at a different time. Had he waited to see the picture he could have called it “fake news” and left his critics with egg on their faces.
Joining Cornpop being a real (real) bad dude & Pete Buttigieg's Nigerian Twitter booster existing is the Blackface Medical Student c. 1984 not being Ralph Northam.
"The average death rate for adults under 50 was about 9 per million in February, almost exactly the same as the automobile death rate. And no one suggests we should all stop driving, do they?" Methinks you should be comparing individual age groups to individual age groups. Heck, it might even bolster your argument.
"But the rest of it makes sense if your level of risk aversion is a little higher than average."
"Your" level of risk aversion, while perhaps a don't care for the odds of others dying in an automobile accident (maybe...) doesn't mean squat when it comes to passing-on a contagious disease.
"I thought, I could wear a condom, but when am I going to be in Haiti again?"
> vaccinations are ramping up swiftly
Not really, especially not in my county. The U.S. is fully vaccinating well less than 1 million people a day, and we're at about 10% of the population fully vaccinated.
And it's not about the 9 per million death rate for those under 50. It's about the 10 times higher death rate for those between 50 and 65. Which we mostly haven't started vaccinating yet. And we mostly know who the 9 per million under 50 are, and they are next on the list to be vaccinated.
It's all about R0. When R0 is above 1, the virus grows exponentially and reaches into the groups of people most at risk. When R0 is below 1, cases are dropping rapidly and we buy time to protect more vulnerable people. With vaccinations, we just barely reduced R0 from just about 1 to just below 1. It wouldn't hurt to wait another week or two to let the reduced R0 further reduce the amount of virus spread across the population before moving R0 back above 1.
+10
+25
I'm in that bunch and getting anxious about when Virginia is going to open the waiting list for appointment to my our age group.
Opening up early in anticipation of better outcomes could make sense, if done sensibly. That has rarely happened. Place have to have low positivity so they know the are getting a more accurate measure of the number of cases, and the case numbers have to be low, or at least not really high, too. That way, when the Ro goes above 1, you are starting at a low level. You can anticipate spring weather helping to lower Ro, which will prevent things from getting out of hand too quickly--giving you time to get the vaccines out to everyone.
What not to do?
1. Michigan. There were doing well, almost down to 10 new cases/day/100K. Then the Republican legislature threw a tantrum, and now case rate has almost doubled, hospitalization is starting to go up and deaths have stopped dropping. And that's with vaccinations at ca. 20% (first shot).
2. NY, NJ, RI--re-opened too early. Cases were falling--then plateaued at 30+, i.e. really high. Hospitalizations and deaths still dropping, i.e. they are trying to vaccinate their way out of the pandemic--but their mask mandate is also helping.
3. TX and any other state removing mask mandates at this time.
Look, restrictions will not be tightened unless is gets really bad. Waiting another week or two before lifting restrictions would have helped immensely--but it's too late now. So we're stuck in the re-opening limbo. Cases loads too high to reopen more, and the loosen restrictions means cases loads won't fall--at least not until vaccinations kick in. Seasonal effects should be helping limit spread in the South and Southwest, and will help in colder climes in April or May. States with lower population density should do better too.
Hospitalization is not going up
On Ted Cruz,
If you discovered a dead pantomime horse wouldn't your first thought be to take a picture of it?
The comments on this thread blow me away the difference between "Euro-liberals" and American Liberals on this disease. I Think European liberals are more socialistic in nature and like the herd being culled. Most people by 75 are retired, even if they didn't start work until 45. In the US, Liberals are more driven by the Christian mother syndrome.
Sun's barely over the yardarm and you're already falling off your barstool, Shootie? Tsk, tsk.
Lol!
yep. the president of the united states is 78; the former president is nearing 75. the top advisor to the president on covid issues is 80. yep cull the herd. those over 75 are used up and have nothing to offer.
Hillary died four years ago at age 68.
Again, most of those people aren't sick. Many people work longer. My first super at a Ohio factory was 72-73 years old and it blew me away the way he was running all over and jumping on equipment. But these people are sick in general and near the end of life. Including younger ones with conditions that will shorten their life. I am sorry I am not a Christian about it. I will never be.
May you be a long term COVID sufferer.
I think using the metric of deaths does not sufficiently capture the long-hauler issue. While the deaths are the most personal and painful loss due to Covid, real economic loss over the long term is all too likely to result from people who survive with medium- or long-term illness due to Covid-19. Perhaps a blended index? You could use hospitalizations as a proxy for long-hauler covid, I think.
KD: “First of all, the highest infection rate by far is among the very elderly, especially those in nursing homes.”
That’s not what the chart shows. In fact, if the rate is really ‘per thousand residents’, the staff infection rate is likely even higher, assuming that the staff:resident ratio is less than 1:1. I think Kevin meant that the _fatality rate_ is highest among the elderly. We are certainly doing much better at infection control in congregate living situations, but most elderly are living in their own homes. Regardless, almost no one is isolated from the situation in the wider community. The idea that all restrictions can end yet at-risk populations can be fully protected, is too optimistic.
No one will be fully protected, ever. Why you can't get that blows me away. Its why "restrictions" especially last summer were overblown. A real failing of the American reform liberal movement and why social nationalism is needed to replace it as the "left". Your Christian mother nonsense needs replaced by Masculinity. Something ever Socialist writer from 1750-1830 would agree with.
???
Forget it Jake....
There are safety belts, airbags, traffic laws, metered intersections and merge ramps, tolls, turn signals and brake lights, crumple zones, collision avoidance sensors, must I continue? The comparison is ludicrous.
I know lots of people think that there will be another big outbreak in states that are opening up, and I doubt this to be the case.
Things that lower R0:
1) People who are at least partially vaccinated, which is inching close to 20% in many states.
2) Previously infected people who carry antibodies and other defensive cells, which is estimated to be as high as 15-20% in many states.
3) Mask usage.
Given that vaccinations are accelerating, it means that we're constantly lowering R0, making it harder to have large outbreaks if we maintain mask mandates.
Therefore, if you're going to open up, at the very least, maintain mask mandates. If not, I would expect smaller outbreaks, but not big ones.
A few random thoughts.
The Brazilian variant know as P1 is more highly contagious than the UK variant. It also attacks those aged 18 to 59 the hardest. The first 4(?) vaccines were found to be ineffective against it.
The Astro Zeneca vaccine is showing great results in preliminary studies however in African studies it is reported the AZ vaccine is causing blood clotting issues. AZ denies this but operation warp speed may be allowing these companies a little too much leeway in developing and testing these vaccines. Interesting that AZ did not take ANY government funding for the development of their vaccine but they, like other companies can skirt previous rules and regs concerning development and testing.
At some point we need to get back to extensive testing of vaccines prior to approval, however with the discoveries of more and more variants I'm not sure now is the time
It is a complex subject and easily goes over my head.
But Asian countries have been using face masks for YEARS either by the sick or the elderly or when flu season starts. Speaking of which - flu season has been the mildest on record due to sanitizing and mask wearing
Is that fact lost on everyone?