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Another “when might this peak” projection

From the Current:

A new study suggests San Antonio’s current shelter-in-place order, which runs through April 9, may not be long enough to ride out the worst of the coronavirus pandemic.

Texas is more than a month away from the peak of the crisis, which is likely to hit the state May 2, according to a state-by-state analysis by the Institute for Health Metrics and Evaluation.

The United States as a whole will hit its peak earlier, on April 15. But that’s still days after the Alamo City’s order expires.

May 2 will mark both the date of the virus’ peak drain on Texas’ hospital resources and the state’s highest number of COVID-19 related deaths, according to the IHME, an independent research center at the University of Washington. It made those projections by modeling statistics collected by the World Health Organization and local and national governments.

[…]

Worth noting: the IHME’s modeling assumes the public is practicing strong social distancing and other protective measures. However, it also assumes Texas Gov. Greg Abbott continues not to implement a statewide stay-at-home order and won’t mandate closure of all non-essential services.

After Texas’ potentially devastating peak, the number of deaths and hospitalizations would drop sharply by the beginning of June, according to IHME’s projections. The virus could run its course by early July.

Even so, IMHE expects 4,150 Texans to die from COVID-19 related causes by August 4. It also predicts more than 82,000 nationwide will succumb to the disease by then.

A previous projection done by UT Health scientists suggested that the Houston area could peak in mid-April, with the pandemic burning out in our area by early May. I don’t know much about epidemiology, but I do know that the assumption of when Day 0 is – that is, the day of the first infection – matters a lot, so a variance of even a couple of days could shift things quite a bit one way or the other. Beyond that, I would recommend taking these different studies and projections with the same level of skepticism and trust one would put into an individual poll result: Illuminating and useful, but still just one data point that doesn’t mean as much as it might without confirmation from other results.

With Dr. Fauci’s estimates of 100K to 200K dead nationwide in a best-case scenario, this seems optimistic to me. Maybe it’s better to think of it as a more formal (if not necessarily more precise) quantification of that best case scenario. Note that the numbers given in this projection represent the midpoint of a range of possible outcomes – those error bars are pretty damn wide. Given the uneven implementation of stay-at-home orders and the lack of a statewide order, I’d be prepared for this to end up being well on the low side. But maybe we’ll get lucky. In the meantime, stay at home. TPM has more.

(You can play with the data yourself here. That’s how I generated the embedded image in this post.)

UPDATE: This Twitter thread from Carol Bergstrom, who is an actual expert, explains the concerns with this much better than I can. His interpretation is similar to mine in that this is a “best case” model, but he posits that the “error bars” are the range of uncertainty for that best case model, not for the entire range of possible outcomes. In other words, if the underlying assumption that social distancing isn’t working as well as we hope, or that we’re not doing it well enough for it to work properly, then the range of outcomes we will get will be considerably worse.

The Republican death wish

It would be one thing if they were just putting their own lives at risk, but that’s not how viruses work.

After Dallas County Judge Clay Jenkins became the first to announce a mandatory stay-at-home rule, conservative groups including Empower Texans began ringing alarms in opposition to Jenkins and to Republican Gov. Greg Abbott, who they say paved the way for the move.

Abbott had said he would applaud local leaders who felt they should issue stay-at-home orders for their communities.

“I’m extremely concerned about what Dallas Co just did, and Abbott’s apparent sanctioning of it,” Empower Texans president Ross Kecseg wrote on Twitter.

So far, Lt. Gov. Dan Patrick is the highest-ranking state official to echo those concerns.

“What I’m living in fear of is what is happening to this country,” Patrick said in a Fox News interview. “I don’t want the whole country to be sacrificed.”

Patrick, who turns 70 next week, went on to say he’d be willing to risk his own life and well-being to help preserve the way of life for other Americans — a statement that drew harsh rebukes on social media and inspired hashtags such as #DieForTheDow.

[…]

Critics of the stay-at-home orders are contradicting the advice of public health authorities at every level of government, from the World Health Organization to the national Centers for Disease Control and Prevention to local health officials. Epidemiologists have stressed that keeping people apart is the best way to fight back against a new virus for which there is no vaccine, and that aggressive early steps are the only way to get ahead of COVID-19.

The discord in Texas mirrors what’s going on at the national level with Republican governors showing more reluctance than Democratic ones, like Cuomo, to shutting down their states, said Timothy Callaghan, assistant professor of health policy and politics at the Texas A&M School of Public Health.

“On the one hand, they certainly want to protect the public health, but they are also afraid about hindering the freedoms of their citizens and they’re also concerned about the economic impact of having society in many ways shut down,” Callaghan said. “It’s a tricky balancing act for many politicians on the conservative side.”

Not only does that send Texans a mixed message but Callaghan said it could also reduce the effectiveness of the orders.

“If you want to see a true impact of flattening the curve throughout the state of Texas, it’s important for it to be a statewide policy,” Callaghan said. “Certainly in those areas that choose to enact some sort of shelter in place policy, you’re going to see some effect, but we don’t know if it’s going to be a smaller effect than if the entire state had chosen to do something.”

See here for the background. It’s not actually clear that they want to protect public health, since everyone who knows anything about public health and epidemiology is practically shouting from the rooftops that these shutdowns are necessary and we risk having literally millions of people die without them. Indeed, rightwing magazines are touting the virtues of deliberately spreading coronavirus, in a ridiculous and dangerous belief that it’s preferable to social distancing. I suspect there’s a certain amount of cognitive dissonance going on, since the one thing that can mitigate the economic impact of the stay-at-home orders is massive government action to put money in people’s pockets to replace the income they’d be losing, and that would seem to be the thing that Dan Patrick fears more than his own death. It’s clear that they’re taking their direction from Donald Trump, because that’s what they do these days and Trump is getting tired of the whole pandemic thing. It will be interesting to see if actual elected Republicans turn on Greg Abbott if he however reluctantly orders a statewide shutdown. In the meantime, I don’t know what there is to say other than there’s one way to get through this without a lot of people dying, and what these Republicans are agitating about is not it.

The weather effect

Maybe a little bit of hope. We’ll see.

Communities living in warmer places appear to have a comparative advantage to slow the transmission of coronavirus infections, according to an early analysis by scientists at the Massachusetts Institute of Technology.

The researchers found that most coronavirus transmissions had occurred in regions with low temperatures, between 37.4 and 62.6 degrees Fahrenheit (or 3 and 17 degrees Celsius).

While countries with equatorial climates and those in the Southern Hemisphere, currently in the middle of summer, have reported coronavirus cases, regions with average temperatures above 64.4 degrees Fahrenheit (or 18 degrees Celsius) account for fewer than 6% of global cases so far.

“Wherever the temperatures were colder, the number of the cases started increasing quickly,” said Qasim Bukhari, a computational scientist at MIT who is a co-author of the study. “You see this in Europe, even though the health care there is among the world’s best.”

The temperature dependency is also clear within the United States, Bukhari said. Southern states, like Arizona, Florida and Texas, have seen slower outbreak growth compared with states like Washington, New York and Colorado. Coronavirus cases in California have grown at a rate that falls somewhere in between.

The seasonal pattern is similar to what epidemiologists have observed with other viruses. Dr. Deborah Birx, the global AIDS coordinator in the United States and also a member of the Trump administration’s coronavirus task force, said during a recent briefing that the flu, in the Northern Hemisphere, generally follows a November to April trend.

The four types of coronavirus that cause the common cold every year also wane in warmer weather.

Birx also noted that the pattern was similar with the SARS epidemic in 2003. But she stressed that because the virus outbreaks in China and South Korea began later, it was difficult to determine whether the new coronavirus would take the same course.

[…]

It will take another 4 to 6 weeks before health officials will have a clearer picture of how weather patterns shape the trajectory of the coronavirus, said Jarbas Barbosa, assistant director at the Pan American Health Organization, the regional office of the World Health Organization that focuses on the Americas.

The fact that local transmission is happening across the global south signals that this virus may be more resilient to warmer temperatures than the flu and other respiratory viruses. That is why World Health Organization officials still urge countries to act urgently and aggressively to try and contain the virus while case numbers are relatively low and close contacts can easily be traced and quarantined.

“One of the big perils in assuming that the virus is less dangerous in warmer temperatures, among particular ages or for any specific group is complacency,” said Julio Frenk, a physician who served as health minister in Mexico and is now president of the University of Miami. “If people fail to heed the warnings and recommendations of public health professionals, the results will be disastrous.”

But because high humidity and heat only align perfectly during mainly July and August in some parts of the Northern Hemisphere, Bukhari cautioned that the effects of warmer weather on reducing transmissions might only last for a brief period in some regions.

This is all very, very preliminary, and the effect may end up being limited in a number of ways. Even if coronavirus does behave like the cold and flu viruses in this way, that doesn’t mean it’s gone away, or that existing precautions like vigilant hand-washing are less necessary. It just means maybe our hospitals will get a break, and maybe give us some headway in getting a better handle on it. Maybe. If we’re lucky. In the meantime, stay socially distant. Kevin Drum has more.

Perspective on the anti-vaxx situation

Maybe it’s not as bad as we think.

It’s certainly true that pockets of vaccine refusal persist in this country, as they have for many years. If those pockets are now experiencing greater numbers of measles cases, it may be on account of dire trends in far-off places.

This global explanation only kicks the can a little farther down the road, however. Measles cases are spreading here because they’re spreading overseas—OK, fine. But why is measles spreading overseas?

[…]

Are vaccination rates really on a downward trajectory? Once again, the actual data complicate this narrative. Global immunizations against measles, like those in the U.S., are at or near an all-time high. Since the start of this century, the proportion of people around the world who have received at least one dose of the measles vaccine has increased by almost one-fifth. Meanwhile, the use of a second dose of the vaccine (which makes it more effective) has more than quadrupled on the global scale. In 2000, just 15 percent of people were getting both shots. Now, that number is up to 67 percent and still rising.

The salutary effects of all this work could not be more apparent. The global number of people who contract measles and the global number of people who die from it have each gone down by about 80 percent since 2000. As recently as 1980, more than 4 million cases of measles were reported every year. Despite massive population growth since then—an uptick of several billion people, worldwide—the annual number of measles cases has dropped to about one-fiftieth of what it used to be, to a few hundred thousand cases per year.

Given all this recent progress, the global measles crisis that’s underway seems somewhat paradoxical.

Basically, the argument is that outbreaks like we’ve seen with measles tend to burn quickly through the susceptible population, then run out of steam, and that the biggest cause of not being vaccinated in the US is not anti-vax foolishness but lack of access to medical care. The author argues that the full picture of the data is often not represented or mis-represented in media stories, which has caused some level of overreaction among vaccine proponents. There’s a lot of detail, so read it all and see what you think.

Our measles risk

Do I spend too much time worrying about stuff like this, or do I not spend enough time on it?

Harris County is one of the nation’s most vulnerable counties to a measles outbreak, according to a new study based on international travel and the prevalence of non-medical vaccine exemptions.

The study, published Thursday in the journal Lancet Infectious Diseases, ranks Harris County as the county 9th most at risk of having clusters of people contract measles, the highly contagious, potentially fatal virus that has re-emerged as a public health threat after having been largely eradicated at the turn of the century. Tarrant and Travis counties also are at high risk of an outbreak, according to the study.

“Texas’ showing is on par with the other 16 states that allow vaccine exemptions for conscientious or personal reasons,” said Sahotra Sarkar, a University of Texas Austin professor and the study’s lead author. “You can expect the state, like other parts of the nation, to see more cases.”

Sarkar said Harris County’s vulnerability is mostly the result of its considerable international travel. The county’s number of non-medical vaccine exemptions was not among the state’s highest in a Texas health department report released earlier this week.

[…]

The new study was conducted by Sarkar and a Johns Hopkins University researcher using risk assessment models similar to one they used to correctly predict that Zika, the mosquito-born virus that can cause serious birth defects, would first affect Texas and Florida after it began spreading from the Southern Hemisphere midway through this decade. It also correctly predicted areas already experiencing measles outbreaks, such as Washington, Oregon and New York.

The authors didn’t consider the locations of measles cases already recorded. Instead, they looked at non-medical vaccine exemptions, international air travel and the incidence of measles in countries from which people came to the United States, particularly India, China, Mexico, Japan, Ukraine, Philippines and Thailand. In all, some 112,000 people have been diagnosed with measles outside the U.S. this year, according to the World Health Organization.

Peter Hotez, a Baylor College of Medicine professor of infectious disease and vaccine advocate, called the new study an advance over research he published last year that identified “15 hotspots” of vaccine exemptions among a subset of states. Harris County ranked seventh on that list.

“I think this is a nice refinement on our first attempt,” said Hotez. “It confirms the high risk of Texas counties to measles, something that we’ll need to consider seriously when planning for epidemics.”

It’s not clear what if anything can be done to mitigate this particular risk, so I’m back to wondering how much I should worry about it. Keep working to close the gap in vaccination rates, I guess. It annoys the crap out of me that we have to worry about this sort of thing in 2019, but here we are.

Two data points on e-cigarettes

The World Health Organization wants them to be regulated more strongly.

Governments should ban the use of electronic cigarettes indoors and in public places and outlaw tactics to lure young users, the World Health Organization said in a report released on Tuesday. It also raised concerns about the role of big tobacco companies in the fast-growing market.

Considering the numerous uncertainties surrounding e-cigarettes, which have been on the market for less than a decade, the United Nations organization said it was appropriate to prohibit their use indoors “until exhaled vapour is proven to be not harmful to bystanders.”

It also called for regulation to ensure the products contain a standard dose of nicotine, as the drug content now varies widely between manufacturers. And to stop children from picking up the habit, it said that e-cigarette sales to minors should be banned and that fruity, candy-type flavorings should be prohibited.

[…]

Electronic nicotine delivery systems “are the subject of a public health dispute among bona fide tobacco-control advocates that has become more divisive as their use has increased,” the report notes. Some experts embrace them as a means of reducing the harm associated with traditional cigarettes while others view them as a threat to the progress that has been made in “denormalizing” the use of tobacco.

Proponents of e-cigarettes argue that they are safer than tobacco, because they do not contain the carcinogens found in tar and other tobacco components. Anecdotal evidence suggests e-cigarettes may hold promise as smoking cessation aids, too. But the World Health Organization report noted that there is scant evidence for their effectiveness in helping smokers give up the habit; the only randomized trial to date to have compared e-cigarettes with nicotine patches “showed similar, although low, efficacy for quitting smoking.”

The organization said e-cigarette advertisers should be prohibited from making any health claims, including on the product’s purported value as a smoking cessation aid, “until manufacturers provide convincing supporting scientific evidence and obtain regulatory approval.”

The report is here. I’ve been following this stuff because while some municipalities are treating e-cigarettes like traditional tobacco products, others like Houston have made no move to amend their existing anti-smoking ordinances. Some jails in Texas are allowing the use of e-cigarettes on the less-harmful-than-tobacco theory, while others aren’t. It’s a coming public debate, and as things stand right now there’s a lack of information about their effects. A lot of entities are waiting to hear more from organizations like the WHO and the Surgeon General.

Also in the news: adolescents who use e-cigarettes are much more likely to try tobacco, according to the CDC.

The morass of conflicting information about e-cigarettes and tobacco use grew deeper Monday, when the Centers for Disease Control and Prevention released a new study showing that adolescents who vape say they are much more likely to smoke conventional cigarettes.

The results show that 43.9 percent of sixth- through 12th-graders who had used e-cigarettes said they intended to light up conventional cigarettes over the next year, compared with 21.5 percent of youth who had never used the electronic nicotine delivery systems.

Overall, more than 263,000 adolescents who had never smoked before used e-cigarettes in 2013, up from 79,000 in 2011, the CDC reported in a study in the journal Nicotine and Tobacco Research. The data come from the agency’s National Youth Tobacco Surveys for 2011-2013.

The study also showed that 21.9 percent of the youth who had never smoked traditional cigarettes intended to give them a try in the next year — almost exactly the same proportion as the 21.5 percent who had never tried an e-cigarette — and that, overall, the percentage of youths who reported an intention to smoke declined “significantly” in the 2013 survey.

We all know that smoking is terrible for you, but we don’t yet know how much, or even if, e-cigarettes are “better” than tobacco. If there is a correlation between vaping and smoking among teenagers, that’s a pretty strong piece of evidence that they’re not any better.