A Bleak Short-Term COVID Outlook, Then Recovery Dawns
Fact is, during the darkest hours before light breaks, dawn is already racing toward us across the surface of the turning world. That’s an image – a reassuring metaphor – that can sustain us now. America’s darkest hours in the COVID-19 pandemic lie just ahead, over the next weeks and months. But, as Ben Hunt worded the situation in an email he wrote to me on November 16, “We can eradicate COVID-19 with a vaccine. Soon. We hope. We can eradicate the Endemic Mindset of learned helplessness with our personal actions. Now. For sure.
“Wear a mask.
Social distance.
Buy local.
Help your neighbor.
Don’t be a jerk.”
Despite the bleak COVID-19 situation in the US right now and in weeks to come (given the virus, a fragmented society, and a gridlocked federal response), we have good vaccine news to look forward to, as Moderna joins Pfizer in reporting excellent results in clinical trials. The Moderna vaccine, the world learned on November 16, has demonstrated almost 94.5% effectiveness in clinical trials and can be stored under normal refrigeration, with first doses available in December (“We can stop COVID-19: Moderna vaccine success gives world more hope,” https://www.reuters.com/article/us-health-coronavirus-vaccines-moderna/we-can-stop-COVID-19-moderna-vaccine-success-gives-world-more-hope-idUSKBN27W1E6). Pfizer’s vaccine is about 95%.
This note is about what we do until we have a broad rollout of a vaccine and widespread participation. It’s about the choices we make and how we make them when we have to protect ourselves because our government at the federal and sometimes at the state level is not protecting us. It’s about the quality of information that guides us and how we make decisions when the information we have is insufficient.
Fact. We still don’t mask consistently as a society, and part of the population won’t do it. Many are arrogant and selfish or gravely misled. Those people are at risk, and they put others at risk. So that is how it is, and we know how we got here.
“Commentary: Mask use breaks down on familiar lines,” https://www.pressherald.com/2020/11/11/commetary-mask-use-predictably-breaks-down-on-familar-lines/
“Some Americans refuse to wear masks even as their hometowns become COVID-19 hot spots,” https://www.washingtonpost.com/health/mask-wearing-coronavirus-hot-spots/2020/10/27/71001546-1883-11eb-82db-60b15c874105_story.html
Lecturing the unmasked doesn’t work. Only after they get sick do some, and only some, learn. Chris Christie is an example of learning. He is a before-and-after case, and he wrote about that in an Op Ed for the Wall Street Journal: “I Should Have Worn a Mask,” https://www.wsj.com/articles/i-should-have-worn-a-mask-11603315968. Christie found fault with the politicization of simple public health guidance: “One of the worst aspects of America’s divided politics is the polarization of something as practical as a mask. It’s not a partisan or cultural symbol, not a sign of weakness or virtue. It’s simply a good method – not a perfect one, but a proven one – to contain a cough or prevent the virus from getting in your mouth or nose. Wear it or you may regret it – as I did.”
He observed, “When you get this disease, it hits you how easy it is to prevent. We are asked to wear cloth over our mouth and nose, wash our hands and avoid crowds. These minor inconveniences can save your life, your neighbors and the economy. Seldom has so little been asked for so much benefit.”
Unlike Christie, who once erroneously assumed the White House to be a “viral safe zone,” others don’t learn, and sometimes they die. South Dakota Nurse Jodi Doering cares for some of these people. She reflected recently on Twitter,
“I have a night off from the hospital. As I’m on my couch with my dog, I can’t help but think of the COVID patients the last few days. The ones that stick out are those who still don’t believe the virus is real. The ones who scream at you for a magic medicine and that Joe Biden is ‘going to ruin the USA.’ All while gasping for breath on 100% Vapotherm. They tell you there must be another reason they are sick. They call you names and ask why you have to wear all that ‘stuff’ because they don’t have COVID because it’s not real. Yes. This really happens. And I can’t stop thinking about it.
These people really think this isn’t going to happen to them. And then they stop yelling at you when they get intubated. It’s like a f****** [edit ours] horror movie that never ends. There’s no credits that roll. You just go back and do it all over again. Which is what I will do for the next three nights. But tonight. It’s me and Cliff and Oreo ice cream. And how ironic I have on my ‘home’ hoodie. The South Dakota I love seems far away right now.” (https://twitter.com/jodidoering/status/1327771329555292162?s=11)
Careless, ignorant behavior means more deaths and more disease than would otherwise be. That is where we are.
Can a change with Biden in January alter that outcome dramatically? I’m not so sure, given a deeply divided nation with differing versions of what reality looks like.
We’ve excerpted below from the summary of an excellent, fact-based (not politically based) COVID information newsletter from Mark Van Sumeren of Health Industry Advisor (http://healthindustryadvisor.com/days.php). “Chronicles of a Pandemic” offers, in Mark’s words, daily “actionable intelligence, free of both the fearmongering and denial perspectives that dominate the general and social media.”
We thank Mark for permission to share this with readers.
Here is a sample report; we have signed up and now read him daily (go to his website link above to sign up).
“May you enjoy a safe and relaxing weekend with family and close friends.
“On Saturdays, we take a look back at the week, observing how we fared with the virus compared with prior weeks. In terms of sheer numbers, it was a challenging week! New cases exploded this week, and are straining our healthcare resources. Fortunately, whether due to lower case severity or improved detection and treatment, pressure on the healthcare system has been spared somewhat.
“Here are highlights from today’s (November 14) report (all data are for the seven days, Saturday-Friday):
· More than 1M new cases were detected in the United States this week, and more than 4M worldwide
o For the second consecutive week, Illinois and Texas reported the highest number of new cases among the states
o Also for the second consecutive week, Illinois reported the largest increase in new cases over the prior week
o Midwest states dominated the list of states with the highest number of new cases this week
· More than 8M COVID-19 active-detection tests were performed in the U.S - the eighth consecutive week that a new record high volume was achieved
o The test-positive rate on these tests continued to climb - as it has now done for six consecutive weeks
o The test-positive rate for the week exceeded the CDC-target for Phase 3 re-openings
· COVID-19 inpatient census increased sharply last week, reaching the highest level of any point during the pandemic
o Currently, 22% of all inpatient beds in the U.S. are occupied by COVID-19 patients; last week, this was 18%
o COVID-19 patients in the ICU and on ventilators also increased this week, and both exceeded previous peaks
· The healthcare situation would be even more dire, if not for lowered case severity
o From mid-July to mid-September, every 100 new cases would result in 80-90+ inpatient days; last week, this rate fell to its lowest level ever - 43
o Even COVID-19 inpatients aren’t as severe as they have been - the %’s of COVID-19 inpatients in the ICU or on ventilators continued their steady declines last week, and are at their lowest levels since the pandemic began
· Deaths with the coronavirus increased again last week – this for the fourth consecutive week
o This pattern follows the upward trend in new cases that began in mid-September (tragically, this suggests that deaths will continue to increase for at least the next month)
o The case fatality rate – deaths from new cases detected four weeks earlier – has been stable for the past two months; this rate had been markedly higher from the onset of the pandemic through mid-summer
o The % of all deaths that are due to COVID-19, pneumonia and the flu have remained lower during this recent case surge than in the aftermath of the June/July case surge and dramatically lower than in the aftermath of the March/April case surge
o During the March/April surge, more the 1-in-4 deaths were due to one of these causes; over the past several weeks, this rate has been closer to 1-in-8
· The other potential risk to the healthcare system is flu season; to-date, it has been mild
o Influenza is typically a major driver of hospital use in the Fall and Winter
o Now in the fifth week of the 2020-2021 flu season, this season has been milder than each of the past eight seasons
o Flu visits this season are running 60-80% lower than the comparable weeks during the 2019-2020 flu season”
The associated PDF report offers charts and data sources in addition to the highlights summary. http://healthindustryadvisor.com/pdfs/COVID-19-2020-11-14-day212.pdf.
We highly recommend Mark Sumeren’s valuable resource.
Now to an opinion (mine).
A radiologist, rather than an epidemiologist or infectious disease expert, has emerged as a dominant voice in our national Coronavirus Task Force. His name is Scott Atlas (“Who is Dr. Scott Atlas, Trump’s New Coronavirus Task Force Adviser?” https://www.nbcnewyork.com/news/local/who-is-scott-atlas-trumps-new-coronavirus-task-force-adviser/2639790/).
Atlas has power and influence and seems to be in confrontation and conflict with science and specifically with epidemiology. The tensions are real and consequential in terms of human lives and cases of long COVID (more coming on COVID’s long haulers). See, for example,
“Trump’s den of dissent: Inside the White House task force as coronavirus surges,” https://www.washingtonpost.com/politics/trumps-den-of-dissent-inside-the-white-house-task-force-as-coronavirus-surges/2020/10/19/7ff8ee6a-0a6e-11eb-859b-f9c27abe638d_story.html,
“Birx cedes White House turf to Atlas while hitting the road to spread her public health gospel,” https://www.cnn.com/2020/10/29/politics/deborah-birx-task-force-scott-atlas/index.html,
“Trump’s comment at rally raises speculation about Fauci’s future at NIAID,”
https://www.foxnews.com/politics/trump-hints-he-may-fire-fauci-after-election, and
“Whitmer: Atlas’ call for Michiganders to ‘rise up’ against COVID restrictions ‘took my breath away,’” https://www.politico.com/news/2020/11/16/michigan-governor-scott-atlas-COVID-restrictions-436743.
The issues are complex. And the debate is obscured and distorted by politicians. But the results are apparent on nightly news, in the form of confirmed cases, confirmed deaths, and confirmed hospital status reports.
In our pursuit of critical information, most disturbing is a reported suppression of national hospital data. “Internal Documents Reveal COVID-19 Hospitalization Data The Government Keeps Hidden,” https://www.npr.org/sections/health-shots/2020/10/30/929239481/internal-documents-reveal-COVID-19-hospitalization-data-the-government-keeps-hid
Failure to report transparent and complete data is a national tragedy, in my view. It remains a tragedy in Florida as well, and we can draw inferences about the Atlas-DeSantis connection.
“Is Florida a test case for coronavirus herd immunity? Experts warn it’s deadly,” https://www.tampabay.com/news/health/2020/11/09/is-florida-the-nations-test-case-for-COVID-herd-immunity/
“‘It’s crap’: DeSantis office ‘leaks’ state records to fuel COVID-19 death ‘conspiracy’,” https://www.miamiherald.com/article246987122.html
The results of an Atlas/DeSantis approach to pandemic management, however, speak for themselves as cases rise amid precautions ignored:
Florida: “Florida COVID-19 hospitalizations up 40%; CDC urges use of face coverings,” https://www.fox13news.com/news/florida-COVID-19-hospitalizations-up-40-cdc-urges-use-of-face-coverings
In the Sarasota-Manatee area, cases have tripled over the course of the last two months (“COVID-19 cases surge in Sarasota-Manatee region,” https://www.heraldtribune.com/story/news/local/2020/11/16/COVID-19-cases-surge-sarasota-manatee-region/6310035002/).
We invite readers to draw their own conclusions.
At this point even the Swedes have now abandoned the “Swedish model” that Scott Atlas has pointed to in the past as a rational approach (“The Doctor Is In: Scott Atlas And The Efficacy Of Lockdowns, Social Distancing, And Closings,” https://www.hoover.org/research/doctor-scott-atlas-and-efficacy-lockdowns-social-distancing-and-closings-1). A four-week ban on gatherings of more than eight people begins in Sweden on November 24. Prime Minister Stefan Lofven, speaking at a news conference, laid out behavior changes needed to curb the spread of the virus: “This is the new norm for the entire society. Don’t go to gyms, don’t go to libraries, don’t host dinners. Cancel.” (“No-lockdown Sweden toughens up restrictions as coronavirus cases rise,” https://www.cnbc.com/2020/11/17/sweden-toughens-up-coronavirus-rules-as-infections-and-deaths-rise.html)
The bottom line is that while cases are rising across the nation, public reporting is incomplete, and federal leadership is driven more by politics than by medical expertise. That is hurting us, whereas a national focus on facts and a data-driven response would have helped us. But statistically inclined data-science adherents are able to draw inferences from the incomplete information and the politically distorted message, regardless.
Readers may decide for themselves in terms of how to proceed until vaccines precipitate a post-COVID dawn. So may the mask-burning demonstrators in Delray Beach, Florida, who protested back in October for their freedom to defy public health guidance that saves lives (“Group marches, holds mask-burning ceremony in Delray Beach,” https://www.youtube.com/embed/MUAMYpnAZ2A).
As for the business meetings and conferences and restaurants and hotels I have frequented in Delray Beach in other years, the mask burners have successfully driven me away. I’m out for this 2020–2021 winter season. In response to Atlas, this year I’m gonna “shrug.”
The US saw a million new coronavirus cases in a single week last week. Some hospitals are overwhelmed; deaths are trending upward with the inevitable lag of a few weeks. Across the nation, states are responding with measures designed to curb the spread of the virus. The New York Times has an overview here: “See Coronavirus Restrictions and Mask Mandates for All 50 States,” https://www.nytimes.com/interactive/2020/us/states-reopen-map-coronavirus.html.
But until the better part of America has received its two shots in the arm, it’s human behavior vs. viral behavior. And wherever we are, risk rises as cases do, however careful we are. Matt Waite of Politifact, who teaches journalism at the University of Nebraska, shared his own family’s story to help us sort out where we are in this moment (https://twitter.com/mattwaite/status/1328053037097693186):
“It’s looking like we’ve turned the corner at my house, so I’m going to tell you a story about love and a pandemic. It starts two weeks ago Monday. I taught class that morning, but by lunch I knew something was up. By afternoon, I knew I was sick.
“Over the next 24 hours, I had a fever, the worst body aches I’ve ever had, and I couldn’t walk to the bathroom without needing a nap. I knew I was in real trouble. My wife is immune compromised, so I locked myself in the basement and scheduled a COVID test for Wednesday.
“After my test, she started feeling sick. And the fear started to set in. But as she was getting worse, I got my results back: Negative. I was still very sick, so I stayed home and managed my classes online. My wife saw her doctor, got tested, and also came back negative. As the days went by, I slowly recovered. Maybe just a cold? But on Tuesday, Nancy had trouble breathing. We went to the ER, and told them what was going on. In less than two minutes, I was ordered out of the room until they got a COVID test back. No goodbye, just get out.
“I sat in the parking lot, unable to get it together because I was overwhelmed with one thought: was that the last time I was going to see my wife? Was that it? I managed to find some strength and drove home to wait. The test took two hours to come back. It seemed like days. All we could do was text. She was having a hard time talking because of the breathing problems, and her heart rate was sky high because the ER basically put her in a room and shut the doors, unsure of what they had. She was scared, and so was I.
“And then it came back: She has COVID. Our worst nightmare. We’ve tried so hard to avoid it. We haven’t been to a restaurant since February. We wore masks everywhere early. Contactless everything. We’d lived in fear because we knew if she got it, it was bad. And here we were.
“Because she is immune compromised, the doctors decided to admit her. It took hours to get her a room. And again, they just threw her in there and closed the door. The nurse said to her that you’re not bad, so don’t expect anything. The only people who came to see her were there for minutes, and wearing space suits. Her bed was broken. It took six hours to find a replacement. She hadn’t had any food since lunch. Hours went by without anything. She was just alone, and scared.
“In the middle of the night, she could hear the patient in the room next to her code out. She could hear them trying to revive the person, heard them taking that patient out. To the ICU maybe? I can’t imagine what she went through that night. It kills me to think about. The next morning, the doctors decided she wasn’t sick enough for COVID drugs, and didn’t need oxygen, so they needed the bed. They discharged her. Nancy told the nurse, I’m scared to go home. The nurse told her ‘You should be scared to stay here.’
“Since Wednesday, she’s recovered some of her strength. She’s isolated in our bedroom. She can move between a bed and a chair without needing my help now. Slowly, she gets a little better every day. We’re managing. My daughter has since tested positive, but is mostly asymptomatic.
“My son tested negative. I’ve never gone back for another test, but it’s pointless: I had it. I had a false negative test. We’ve stayed home since this started, and will for two weeks more.
“I’m slowly driving myself insane trying to figure out where we got COVID. Was it the day I forgot to put on my mask before walking into the college? I went without for maybe a minute. Was it the day I wanted to make fancy tacos so I went into a grocery store one time since March?
“I guess I’m telling you this because I don’t want you to have to ask yourself if that was the last time you’ll see a loved one. There’s no hospital bed for you. Even if they find one, there’s no one to care for you. They only have time for you when you are near death.
“Everyone tells you wear a mask and wash your hands. I did all that. We’re past that point. It’s rampant right now. You need to stay home unless it’s life or death. Don’t be around anyone until this passes. Don’t go to some big family Thanksgiving. Stay home. I can tell you, COVID is bad. It’s going to be a month before I’m over this, if then.
“But worse, much worse, is living every day knowing I put my wife’s life in danger. I had to try and soothe her via text, and it was my fault she was there in the first place. I brought it home. We’re getting past this. She’s recovering. Many, many, many more won’t. Don’t take chances. Don’t ‘live your life’ or spout some bullshit about imagined rights as you don’t wear a mask because of something dumb you read on Facebook. It’s not worth killing someone you love.”
Dear Readers, we wish you actionable information and personal safety as you navigate the Thanksgiving week and next few months. Florida’s economy and the US economy will launch a more robust recovery when better choices begin to prevail and/or vaccines are administered. Meanwhile, we live in the dark ages about curated information in Florida. Sad to have to write it but that’s the way it is.
We close with a compilation of key COVID-related related readings from recent weeks. We hope these resources prove helpful as we chart our personal and investment paths through the coming weeks and months as a post-COVID, vaccine-enabled dawn approaches. There is, of course, considerable legwork and coordination yet to be done to make that dawning happen, and we will pay attention to the details.
I would first encourage readers to follow the COVID Tracking Project on Twitter (https://twitter.com/COVID19Tracking) and at the project’s website (https://COVIDtracking.com.
Here are a few of the data highlights you will find at the website:
(1) Charts capturing a wide variety of US metrics: https://COVIDtracking.com/data/charts/us-all-key-metrics.
(2) Customizable comparisons among states in terms of daily cases (some weeks of increase are already baked in based on current exposures) and the number of people currently hospitalized: https://COVIDtracking.com/data/charts/daily-cases-and-currently-hospitalized
See, for example, a quick comparison of situations in Texas, Florida, and Ohio. Comparing these charts and comparing measures states have taken or not taken can be an illuminating exercise.
(3) US totals, including testing, hospitalizations, and deaths: https://COVIDtracking.com/data/national
(4) Percentage of deaths, by state, that have occurred in long-term-care facilities: https://COVIDtracking.com/data/longtermcare. You can find there, for example, that 26% of deaths in New York have occurred in LTCs, while 39% of deaths in Florida have occurred in LTCs. In North Dakota the percentage is a whopping 74%.
(5) COVID data tracked by state and by race/ethnicity, which leads to clearer understanding of the pandemic’s impact on communities: https://COVIDtracking.com/race/dashboard. It also leads to a clearer understanding of which groups various states track and which become indistinguishable in state data.
The website is a rich resource that many organizations and efforts depend on. Readers who have not mined it may want to spend some time there.
Trevor Bedford, a member of the COVID Tracking Project’s Advisory Board and an associate professor at Fred Hutch (https://www.fredhutch.org/en/faculty-lab-directory/bedford-trevor.html), regularly sorts out an overview of the most recent data compiled at the COVID Tracking Project. He posted a valuable thread, looking ahead, on November 6: https://twitter.com/trvrb/status/1324891866366537728.
Our list continues:
“That Pre-Thanksgiving COVID Test Won’t Really Keep You Safe,”
https://www.wired.com/story/that-pre-thanksgiving-COVID-test-wont-really-keep-you-safe/
“Meet the mRNA vaccine rookies aiming to take down COVID-19,”
https://www.cas.org/blog/COVID-mrna-vaccine
“How Pfizer Plans to Distribute Its Vaccine (It’s Complicated),”
https://www.nytimes.com/2020/11/12/business/pfizer-COVID-vaccine-coronavirus.html?referringSource=articleShare
“Here are the major hurdles ahead for COVID-19 vaccine distribution in the US,”
https://www.theguardian.com/world/2020/nov/16/us-coronavirus-vaccine-distribution-challenges
“Immunity to the Coronavirus May Last Years, New Data Hint,” https://www.nytimes.com/2020/11/17/health/coronavirus-immunity.html
“Exclusive: study of low-risk individuals finds impairments four months after infection,”
https://www.theguardian.com/world/2020/nov/15/damage-to-multiple-organs-recorded-in-long-COVID-cases
“With a meteoric rise in deaths, talk of waves is misguided, say COVID-19 modelers,”
https://www.statnews.com/2020/11/12/with-a-meteoric-rise-in-deaths-talk-of-waves-is-misguided-say-COVID-19-modelers/
“Fear is a more potent weapon than we know in the fight against COVID,”
https://www.ft.com/content/0974a0d3-21be-433e-bc6e-db398071af5f
“Biden COVID advisor says U.S. lockdown of 4 to 6 weeks could control pandemic and revive economy,” https://www.cnbc.com/2020/11/11/biden-COVID-advisor-says-us-lockdown-of-4-to-6-weeks-could-control-pandemic-and-revive-economy.html
“COVID-19 Live Updates: Fauci Warns Against ‘Disjointed’ State-by-State Virus Measures,”
https://www.nytimes.com/live/2020/11/17/world/COVID-19-coronavirus/fauci-calls-for-a-uniform-approach-rather-than-a-disjointed-state-by-state-pandemic-response
“Scientific quality of COVID-19 and SARS CoV-2 publications in the highest impact medical journals during the early phase of the pandemic: A case control study,”
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241826
“‘Breakthrough Finding’ Reveals Why Certain COVID Patients Die,”
https://khn.org/news/breakthrough-finding-reveals-why-certain-COVID-patients-die/
“Recent Increase in COVID-19 Cases Reported Among Adults Aged 18–22 Years — United States, May 31–September 5, 2020,”
https://www.cdc.gov/mmwr/volumes/69/wr/mm6939e4.htm?s_cid=mm6939e4_w
“T-cell response ‘lasts six months after COVID infection’,”
https://www.bbc.com/news/health-54781496
“‘Breakthrough finding’ reveals why certain COVID-19 patients die,”
https://www.nbcnews.com/health/health-news/breakthrough-finding-reveals-why-certain-COVID-19-patients-die-n1247576
“Areas With Mask Mandates Have Lower COVID-19 Hospitalization Rate, Study Finds,”
https://www.forbes.com/sites/alisondurkee/2020/10/28/areas-with-mask-mandates-have-lower-COVID-19-hospitalization-rate-study-finds-tennessee-vanderbilt/
“Data Disappeared: This is an Accounting of the Damage,”
https://highline.huffingtonpost.com/article/disappearing-data/#
Be safe. Happy Thanksgiving week.
David R. Kotok
Chairman of the Board & Chief Investment Officer
Email | Bio
Original commentary went out to subscribers via MailChimp: COVID, COVID, COVID! Recovery?
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