Minnesota Surrenders

by James J Heaney Posted on 21 May 2020
The last helicopter out of Saigon.
America does not always *admit* that it’s surrendering.

In mid-April, Minnesota Governor Tim Walz said this: “The plan to re-open is very, very clear: Test, trace, isolate and then open back up, and continue this until we get a vaccine.”

At the time, many people in the opposition accused the Governor of moving the goalposts. They said that the original goal of the lockdown had been to “flatten the curve” and ensure that our hospitals were not overwhelmed while we learned more about the virus (and how to fight it). Walz’s new goal of test-trace-isolate, they said, had come out of the blue.

Those critics were correct. Gov. Walz’s original goal was to mitigate the covid epidemic, not to suppress it through testing and tracing. He was quite explicit about that. (I’ve been a test-trace-isolate guy from early on, and I was very upset about Gov. Walz’s original strategy.) Walz changed his strategy from “mitigate” to “suppress” in mid-April, and I was ecstatic.

This is important, because your overall strategy makes a huge difference in both the final death toll and the timing of mitigation measures. For example, both “flatten the curve” and “test-trace-isolate” may require periods of overall shutdown, but with very different end points.

Under a “flatten the curve” strategy, you impose a lockdown in order to delay the epidemic. You expect everyone to get infected eventually, but you lock down until you have enough medical supplies to absorb the wave. Then you lift the lockdown and let the wave hit, confident that, while a lot of people are going to die, at least they’ll have a hospital bed to die in — and a fighting chance to live.

By contrast, under a “test-trace-isolate” strategy, you impose a lockdown in order to shrink the epidemic, not just delay it. You keep things locked down until you get your active case count down to a manageable level. Then you use large-scale testing, aggressive contact tracing, and stringently enforced isolation periods to bring your few remaining cases down to zero. Then you hold it near zero, using the same containment strategies, until there’s a vaccine. (The more tests and tracers you have, the bigger the number you can call a “manageable level” of cases.) This is most often referred to as the South Korean model.

Something interesting about this: in a “test-trace-isolate” suppression strategy, you don’t really care too much about what how many hospital beds you have. Your goal is to destroy the epidemic; if you succeed, you won’t need that many beds. Likewise, in a “flatten the curve” mitigation strategy, you don’t really care about tests and contact tracing; since you’re not trying to contain the virus, knowing its progression is helpful but not essential.

On April 9th, Gov. Walz had a decision to make. His initial stay-at-home order was set to expire the next day. He chose to extend it for several weeks, ultimately pushing it out to May 18th. Why did he do this?

When Minnesota first imposed its stay-at-home order, Minnesota had only 235 ICU beds available statewide, and believed that it would need thousands more. Obviously, a delay to get more ICU beds and ventilators was appropriate.

However, by April 9th, when Gov. Walz extended the stay-at-home order, Minnesota expected to need between 2,600 and 4,000 ICU and ventilators beds at peak (in July) — and it already had 2,770 beds up or ready to go. We also had 2,458 ventilators available. With three months left to create another 1,230 beds, there was no strong “flatten the curve” reason to extend the lockdown. If everyone’s going to get it eventually, and you already have enough hospital beds (or you’re at least on course to have enough by peak), then staying in lockdown is not just pointless, but damaging. Lockdowns carry extreme economic and social costs. They have to be for an extremely compelling purpose. If our goal was still just to “flatten the curve,” then there was no justification, on April 9th, for an extension to the stay-at-home order.

But, you may recall, I was agitating very loudly in early April for an immediate extension of the stay-at-home order into May. That’s because my goal was not to “flatten the curve,” but to crush it with testing, tracing, and isolating. And, from that strategy’s perspective, we were in dire shape on April 9th. We were conducting barely more than 1,000 tests per day (in a state of 5.6 million people), and our testing capacity had plateaued there for over a week. Worse, almost 10% of those tests came back positive. If we really had control of our epidemic, only about 2% of our tests should come back positive.

We had no contact tracers beyond Minnesota’s regular contact-tracing staff (equipped for minor outbreaks of HIV or tuberculosis, not this), but over 1,600 cases, with hundreds of thousands of contacts needing tracing. Cases were not at a manageable level. If our goal was to get test-trace-isolate up and running, we had no choice but to extend the stay-at-home order.

Around the same time, the White House endorsed the test-trace-isolate approach with their new CDC opening-up guidelines. The CDC guidelines said that you shouldn’t reopen until you have robust testing and a steady 14-day decline in cases in your state. We had neither.

Gov. Walz extended the order in large part to buy us time to get that testing, get that contact tracing, and get us into that 14-day decline in new cases. If his new plan worked, then we would not just be delaying covid-19; we would be defeating it. This was a noble goal that I completely supported.

He should have explained this pivot to the citizens of Minnesota better. Hell, Gov. Walz should have admitted that the pivot existed at all. (He did not, which in turn fed a lot of suspicion of Walz in groups already primed to distrust him, like Reopen Minnesota.) But I thought it was the right call anyway. Based on Minnesota’s own modeling at that time (as well as most other models based on actual viral characteristics, not to mention the consensus of epidemiologists), suppressing and containing the virus with testing and tracing could save tens of thousands of lives — a meaningful fraction of all the lives in Minnesota.

Fast forward to May 13th. That day, Gov. Walz announced that the stay-at-home order would finally end on May 18th, to be replaced by the much more relaxed “Stay Safe MN Phase I” plan. You might think that this was because Minnesota had met the milestones it had to meet for test-trace-isolate to work, and was now ready to face the virus head-on. But you would be wrong.

As of May 13th, Minnesota did not meet any of the test-trace-isolate milestones. In fact, by almost every measure, we were less prepared for test-trace-isolate on May 13th than we were on April 9th!

On April 9th, we’d had 1,600 active cases. On May 13th, we had over 10,000 active cases, far too many to trace effectively, even with an army of tracers. The CDC guidelines said we should reopen after our new case counts had consistently dropped for 14 days; our cases had consistently risen over the previous 14 days!

On April 9th, we knew we were missing a lot of cases, because 7% of the tests we did came back positive (we needed to get that down to 2-3%). On May 13th, despite a huge increase in testing capacity (from 1,600 tests/day to nearly 5,000), our positivity rate had gone up, to 11%! The increase to 5,000 tests/day had been delayed for several weeks, and that was enough for the virus to get out ahead of us again.

Finally, our urgently-needed army of contact tracers was still stuck in the legislature, where “liberty-minded” Republicans were trying to write conscience clauses into the bill in order to make testing optional, even for confirmed contacts! (Any half-decent Catholic would have reminded them that “There is no true freedom except in the service of what is good and just,” but more on the Republicans later.)

Meanwhile, we had made even less progress on the “flatten the curve” front. Between April 9th and May 20th, the state’s supply of ventilators grew only modestly (to 2,840, with 850 more on back order), and our ramped-up ICU bed capacity appears to have shrunk to 2,385. I didn’t track PPE’s, so maybe we made big progress there, but I doubt it. I received this note from a friend (and all-around terrific person) who is also a nurse serving on the front lines — and I’m going to quote it in full:

1. The hard data. Are the numbers going down significantly? No Pretty steady. [Hospital name] continues to have around 50-60 active cases or rule out cases. We have not ended up like New York, however, so I think people believe it is all going to be fine.

2. We really don’t KNOW that much about this disease yet. We don’t know why some people are asymptomatic carriers and some people die. We know that a person’s comorbitities play a part of it but it doesn’t explain many of the young, healthy people who have succumbed to this disease.

3. Hospitals are actually NOT that prepared to take care of large volumes of covid patients. Our ICUs are filled with them now despite people quarantining. We have two other hospitals, [hospital you definitely know] and [other well-known local hospital] taking overflow COVID patients. What happens when there are no more beds, no more vents, no more masks for the staff. People start dying a lot faster

4. Nurses are actually NOT well protected. I work on a medical surgical floor so I am not issued an N 95 mask. (I bring my own that my family got for me.) N95s were recommended one time but there are not enough of them so the standards were lowered.

5. Staff at hospitals have not been notified when a coworker has contracted COVID. Even when we have been working closely with that person.

6. Reusing equipment: The nurses that actually GET the N95s are told they have to reuse them. There are NO studies showing how effective they are after many days of use.

7. Reusing gowns: The straw that tipped the camel’s back was the new “reusing gowns” standard. The hospital is telling us that when we go in an isolation patient’s room we are so step out of the room when we are done and hang the gown in the hall. It doesn’t take a microbiologist to tell you that will likely start spreading the germs by contact no matter how careful people are. I am currently refusing to do this and [personal details redacted].

I will have to stop here. Please let me know if you have any questions. I would like to help. I am just not sure how much I should talk about on my facebook page by myself vs with the union because I don’t want to lose my job.

Please share it with anyone you want to. Just don’t name me at this point. I’m not fired yet and it’s probably best to keep it that way.

On May 13th, Gov. Walz looked at all these indicators blinking red on his test-trace-isolate strategy, and even at the lack of progress on the original “delay until we have enough supplies” strategy… and he announced that the state would be opening up anyway, in just five days.

On April 9th, we declared war on COVID-19, planning to drive it out of our state. We then spent the rest of April and early May losing that war. On May 13th, Minnesota surrendered.

We are no longer following a test-trace-isolate strategy. We are consciously allowing the virus to begin to grow again, despite the fact that we do not have anything like a manageable case count nor the infrastructure needed to get it there. Our goal is not to contain it, but only to slow it down as it gradually spreads to the entire population. As Gov. Walz put it, “We need to keep this virus at a simmer, not a boil.” But, for a few lovely weeks in April, our goal had been to take the virus off the stove altogether.

In short, covid-19 is no longer invading our state. Gov. Walz has accepted it as an occupation force.

There’s a lot to mourn here.

First and foremost, we should mourn the people who are going to die under the restored “flatten the curve” strategy that takes us toward herd immunity. In the absence of a vaccine or treatment, herd immunity only develops in one way: mass infection and widespread death. Keeping it to a “simmer” only saves a few lives on the margins, whereas we all hoped that full on testing and tracing could protect the great majority of Minnesotans.

Second, we should mourn the small-business owners of Minnesota who spent April suffering needlessly. We were trying to do something really important throughout the month of April. If we had gotten our testing capacity up faster, if we had gotten case counts to fall, if we had gotten contact tracing set up, we could have scored a huge win for Minnesota’s economy by suppressing the virus. But we failed, and now we’ve given up. The virus won, and that will now have significant economic repercussions, in addition to the major damage done by a month of extra lockdown in pursuit of a failed strategy. While the initial three-week stay-at-home order was essential, as far as I can tell, the enormous sacrifices Minnesota business owners made from April 10th to May 18th were for nothing.

Third, we should mourn the idea of Minnesota. We have a deep-seated idea of ourselves as “the state that works.” We understand ourselves to have an unusually functional and responsive state government; our DMV’s are not so bad; we balance our budgets (albeit with a lot of sturm und drang most years) in a more-or-less responsible way; our schools score very high on standardized tests; bipartisan cooperation seems unusually high compared to other purple states; and we have a good track record of weathering recessions unusually well.

Many theories have been offered about why Minnesota works so much better than the rest of the country, but most of us agree that Minnesota is an especially competent state — especially when it comes to medicine. We have the Mayo Clinic! We have Medtronic! We have the U of M’s CIDRAP! And we have 3M, which supplies the whole world with PPE! We had every expectation that we would whip this virus into next Tuesday while the rest of the country would struggle to keep up with us. I sure did.

We failed. Abjectly. In terms of tests per capita, deaths per capita, cases per capita, and degree of social distancing, Minnesota is firmly mediocre compared to our sister states. And this mediocrity cost us a victory over a virus we expect to kill 30,000 people. Now we just have to pray that our models are wrong.

So please do mourn. And please do go ahead and hold it against Gov. Walz that he didn’t level with us about all this. In April, he moved the goalposts toward testing. In May, he moved the goalposts back and gave up on saving a lot of Minnesotans. In neither case did he acknowledge what he was doing.

Somebody on Facebook asked me, “Well, what would YOU have done in Gov. Walz’s shoes?”

“Been honest,” I answered.

I think that’s important, especially when a governor is building his reputation (as Gov. Walz is) on being a straight-shooter. He’s been very good at explaining the things he chooses to explain, yes, and I recognize his schoolteacher appeal. I’d certainly take Walz over Cuomo any day. But, on very broad strategic questions, Walz has been evasive and inconsistent, fueling resentment and resistance that we really can’t afford right now.

Except that wasn’t really what my questioner was asking, was it? He wanted to know what policy I would have chosen if I had been in Gov. Walz’s shoes on May 13th. And… that’s a harder question.

After all, surrender is sometimes the best option. It’s dumb to keep on fighting when you can’t win. When General Lee was cornered near Appomatox Courthouse, he could have turned and fought… but all this would have done is gotten thousands more Confederate and Union boys killed for a war that was already over. Surrender is never easy — you have to wake up the next morning having lost a war, burying dead soldiers who died for a failure — but, sometimes, you can’t justify any other choice. On the other hand, you must take care not to turn into Steward Denethor, who surrendered out of sinful despair. (I confess I often picture Minnesota’s foremost infectious-disease expert, the relentlessly gloomy Dr. Michael Osterholm, with Denethor’s visage.) The costs of continuing to fight must be prudently weighed against the potential benefits.

The costs of the stay-at-home order were extreme. We still don’t know their full impact, but we can already see that (aside from covid itself) they were the single worst thing to happen to American society since at least World War II. Millions are suffering right now. The consequences of the past two months will reverberate for generations.

Minnesota shouldered these huge costs in hopes of suppressing this disease, partly at my prompting, but, I must be honest: we didn’t seem to be making any headway. Despite all our efforts, despite closure and reasonably widespread compliance with social distancing, despite ramp-ups in production, despite close coordination with testing centers, cases were up, positivity rates were up, test numbers were consistently missing our goals, and there was no end in sight.

A test-trace-isolate model requires that the virus be slowed so much that its effective transmission rate (rt) falls below 1 (meaning the average person who catches it infects fewer than 1 other person). According to the U of M’s modeling released during the day on May 13th, even with the full lockdown in place, rt was still over 2.2. (This was partly due to lower-than-expected compliance with the order.) At one point last week, Minnesota topped the standings at rt.live, making us the state with the fastest-growing epidemic in the country — despite setting what seemed to be all the right policies.

Perhaps there was more that could have been done in April and early May to fix this before it was too late. I wasn’t in the governor’s phone calls with testing centers and production sites, I don’t know everything he was privy to. But, faced with the brute fact on May 13th that an extra month of stay-at-home had not gotten us any closer to containment (and had actually taken us further away)… I don’t know quite what I would have done.

It takes a lot to convince me to let a lot of people die. But the evidence available to the public on May 13th was pretty strongly indicating that those people were doomed to die anyway, and that every additional day of lockdown was destroying the livelihoods of other people — apparently, for little reason. I find it hard to be upset with Gov. Walz for abandoning a test-trace-isolate strategy that wasn’t working. Would I have given it another week, maybe two, to see whether a little more time would help us turn the corner? I don’t know. I never will.

I just know that we surrendered to covid, I know that most of the media are talking around the fact that we surrendered to covid, and I know that I’m crushed about it.

In Other News: I have largely been able to ignore the Republicans in this crisis because, here in Minnesota, they haven’t mattered. The Governor is a Democrat and sits at the apex of his enumerated powers due to the emergency. He is protected by a Democrat-controlled State House. Republicans have been mostly sidelined, although they seem determined to neuter the contact-tracing bill.

I don’t want to pay them much attention right now, because they’re such an embarrassment. I wrote a bit the other day about Sen. Scott Jensen, the shameful senator from Chaska. But it’s not just him; it’s the entire MN GOP delegation to Saint Paul. And I think we’ve reached a point where their obstruction and antics are having enough of an effect on Gov. Walz’s political calculus that something needs to be said.

The Minnesota GOP has acted like a caricature of Republicans in a comic book, a comic book written by people whose hatred of Republicans is so reflexive it never occurs to them that they’re painting villains so cartoonish the readers can’t suspend their disbelief in them. It’s like Sen. Gazelka read Alan Moore’s idea of a Republican and said, “Yes! That is what I should be emulating right now!” The MNGOP’s behavior has been infuriating and humiliating and, throughout this crisis, I’ve never been so grateful for their impotence.

They could have been a force for good, critiquing the governor from the pro-life Right (as I did). Instead, they turned into a bunch of libertarian cranks high on conspiracy theories and Facebook memes spread by angry grandmas, talking about imminent herd immunity and assailing models they don’t bother to understand in a vain attempt to justify their rush to reopen everything now. I can hardly believe that the Senate GOP caucus is real, because they are just such a gift to the prejudices progressives have always had about them.

It’s truly horrible to watch. I was never a big uppity-up in the MNGOP, but, back in the pre-Trump days, I was a precinct chair, I served on a district’s recruiting team, I did some conventions, and I was once a voting delegate to the state convention (the contentious gubernatorial nomination fight of 2014). I wasn’t anywhere close to the halls of power, but I was a Republican activist. I was really proud of the MNGOP. And I care about it, even today. But this… derangement… this insistence that we have to both end the lockdowns and avoid taking any actual measures to allow us to control the disease without lockdowns (wearing masks, aggressive contact tracing)… because the whole thing is just a big overblown non-issue we’ll cure through hydroxychloroquine and besides we’ll have herd immunity in a couple weeks anyway… I know you guys. I know you’re not crazy. So why are you acting like this? How is it that, for all my criticisms of his response, Tim Walz is the good guy in this fight?

An Alternative View: My nurse friend tells me that some nurses believe Walz’s decision to reopen at this point is something of a fakeout. People — especially those aforementioned Republicans — have gotten pretty relaxed about this disease, and perhaps (these nurses suggest) Walz’s thinking is that, if he gives into their demands and lifts the stay-at-home order, cases will skyrocket, and the state will be much more prepared to comply with a renewed stay-at-home order.

Personally, I consider this theory unlikely, though not impossible. Walz has acknowledged in the past that the costs of re-imposing lockdown after lifting it would be even more severe than the effects of the first lockdown, and I think he’ll be reluctant to do that unless our hospital system is on the brink of collapse. Yet it’s interesting enough to share, and I found it particularly interesting that it’s a theory that comes from front-line health care workers, who do not seem to share the blithe confidence of Sens. Jensen, Gazelka, et. al.

In any event, by the time cases have increased to a point where a renewed lockdown is politically feasible, true suppression will be completely out of reach. We are truly locked on a herd immunity course now. The only hope I see for test-trace-isolate is if something like “warm summer weather” reduces transmission of the disease so much that it naturally recedes to a point where we can control it. (Or if we’ve somehow completely misunderstood everything about this virus.) Stay tuned, I guess.

Strategy Notes: When we were trying to crush this disease, my goal was to do everything possible to minimize infection in the greater population. I got very annoyed at people who violated stay-at-home orders.

That’s no longer sensible. We are effectively playing a game of Survivor now. ~70% of us are going to get the virus. 30% of us aren’t. We’re all competing now to be in the 30%.

A week ago, I’d say that the packs of Wisconsin college students rushing out to bars when their stay-at-home order got overturned were selfish gits who were hurting everyone around them. Today, I’m more inclined to thank them. I’m grateful to those kids for removing themselves from the game early, since it makes it easier for me and mine to win. Just don’t vote yourselves off the island so quickly that you overwhelm the hospital system, kiddos!

Personally, my current rule is that I only enter sustained close contact (>10 minutes of face-to-face time) with people who can name every node on their social graph. That means, they should know everyone they’ve been in sustained close contact with during the past two weeks, plus everyone those people have been in contact with, plus everyone they’ve been in contact with, out to infinity.

Basically, if you can name everyone you’ve had direct or indirect contact with, and none of them have covid or covid symptoms, then the risk that you are infected is very low. But if you’ve gone and done something like “gone to work” or “got a Great Clips haircut,” there’s very little chance you can identify your entire social graph, and a very good chance it’s quite large. That’s a real risk, and will likely remain so until we are past our biggest peak and approaching herd immunity. I currently expect to continue following this rule through the end of July. But, as with everything, new data may change my plans.

The Good News: This depressing post needed to end on a positive note. Despite our surrender, I think it’s important to note that there are still signs that we might weather the covid epidemic better than expected. Deaths in Minnesota have started falling, for no obvious reason. Perhaps Gov. Walz’s much-belated response to protect long-term care facilities? Could the warming weather be having more of an effect than we expected? Might Minnesotans choose to continue distancing measures privately, in sufficient numbers to further slow the spread? Could our models just be plain wrong? There’s still a lot we don’t know, and a lot of things we may reasonably be skeptical about, and things may just turn out for the best despite the colossal defeat we have suffered here.

After all, in The War of the Worlds, humanity lost the war just as we have… but mankind survived anyway, because the Martians dropped dead of unrelated causes before they could finish exterminating us. I’d rather be victorious than lucky, but I’ll take lucky in a pinch.

So enjoy the beautiful weather, keep yourself and your family safe, and we’ll just have to see what happens next.

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A Covid Drama in Two Acts

by James J Heaney Posted on 18 May 2020

Shot: R.R. Reno, “Phobos and Deimos,” First Things, June 2020.

Chaser: David A Graham, “The Class War Over Social Distancing,” The Atlantic, 15 May 2020.

This has been your occasional reminder — helpful to all of us, no doubt — to never completely buy into sweeping narratives about vast classes of people you don’t know without making a cursory effort to check whether the narrative bears any relationship to reality.

FULL DISCLOSURE: In Spring 2013, I applied for a job at First Things, which I did not get.

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Something Something Post-Truth Society Etc., OR: Sen. Scott Jensen’s Shameful Slander

by James J Heaney Posted on 17 May 2020

A good friend of mine sent me an article this morning asking for my opinion on it. The article, from DeplorableHouseWives.news, is called “Walz Relies on Students to Determine Minnesota Lock Down Model and Wrecks the Economy.” Feel free to read it yourself, but I’ll post a lengthy excerpt here to give you the gist:

Minnesota State Senator Scott Jensen (R-Chaska) revealed recently that University of Minnesota grad students with absolutely no experience in epidemiology developed the models that were used by Minnesota Governor Tim Walz (D) to determine his endless lockdown of the state, putting millions of Minnesotans on house arrest and destroying the state’s economy.

“Marina Kirkeide, a recent graduate and part-time research assistant at the University of Minnesota’s School of Public Health, was tasked by associate professor Shalini Kulasingam, along with two other research assistants, to work “through the day and night” over a weekend to get a COVID-19 model to Governor Walz.

According to a press release from the University of Minnesota, Kirkeide is on a gap year before starting medical school at the University of Minnesota and also works as a lab technician at Region’s Hospital in St. Paul. She is a 2019 graduate of the University’s College of Science and Engineering.

You would think that during something as important as an “pandemic”,  Walz would use the top expert epidemiologists with years of extensive experience to develop comprehensive models and metrics to determine the lives of over 5 million Minnesotans.

Nope!

Walz used students with no apparent expertise in modeling for pandemics, specialized medicine or public health to whip up a model over a weekend to determine his oppressive policies… Think of all that time Kirkeide and Mehta put into this effort! A whole weekend! I’ve seen frat parties last longer than this project!

Was there a peer review for this study? Was there any kind of testing to determine if the data that was slapped together would have any validity? Did the professors who enlisted these students check any of the models?…

Speaking on the floor of the Minnesota senate on May 15, Jensen said sarcastically, “Congratulations, Marina. We have over 650,000 Minnesotans unemployed. We have absolutely imploded our economy. But, I’m really glad you got to participate, especially with your broad breadth of experience in healthcare. I know you’re going to medical school this Fall, but when I looked high and low on the internet for what experience you had in healthcare, I saw that you marched in a May Day Parade dressed up as a cow puppet. And I saw that you made some denigrating remarks about the University of Minnesota research program in regards to how they treated animals, after the University of Minnesota found itself under the spotlight using animals for human research to try to find the answers to diseases so that we can help 5-year-olds to grow up to be 10-year-olds…”

The article then continues in the typical vein of self-styled pandemic “contrarians”: mostly-wrongly accusing models of being “way off” while refusing to account for their own grave errors, assailing professional disease modelers for lack of expertise while citing some random dissenting “medical doctor” (with literally zero modeling expertise) as the be-all end-all of truth, all while making lots of sarcastic asides about “dEsTrOyInG oUr EcOnOmY!” I’m used to that by now.

But the central claim of this article — the central claim of Sen. Scott Jensen (R-Chaska) — is the notion that two unsupervised grad students without expertise plunged our state into lockdown based on code they (no doubt sloppily!) slapped together in a couple of days.

This is breathtakingly disingenuous. I long since stopped being surprised by the eagerness of self-identified “deplorables” to deliberately misinterpret facts to support their predetermined unreality, but I’m stunned and furious that Sen. Jensen stooped to mocking a public-spirited graduate student on the senate floor for transparently manufactured reasons. (He was actually worse than the Deplorables’ article.)

The editor’s note added to the original press release addresses most of the questions raised by these self-styled “skeptics.” (They are not skeptics, for reasons I’ll come to.) I’ll quote the note in full, in case anyone missed it:

Editor’s note: The University of Minnesota was contracted by the Minnesota Department of Health (MDH) to help build the COVID-19 Minnesota mathematical model. The model development was led by U of M School of Public Health Associate Professors Dr. Eva Enns and Dr. Shalini Kulasingam. Enns and Kulasingam are nationally recognized modeling experts and have previously partnered on several modeling projects including studies on pertussis (in collaboration with MDH) and chlamydia in Minnesota.

The initial Minnesota COVID-19 models were created by Enns and Kulasingam. The project team includes faculty colleagues at the School of Public Health who are experts in mathematical modeling, infectious disease epidemiology, and systematic literature reviews. As part of the project team, students and research assistants support literature reviews, and help to check, confirm and expand the R programming code, which is available publicly for researchers and others to review. All work performed by students and research assistants is done under the direction and thorough review of Enns and Kulasingam. (Visit the School of Public Health website to access the R code.)

But only someone who has never had any contact with the model or anything related to its production could think that the whole thing was “developed by a couple of inexperienced grad students.” Here are the credited authors on the model:

  • Eva A. Enns (PhD, professor of public health),
  • Marina Kirkeide (grad research assistant),
  • Abhinav Mehta (grad research assistant),
  • Richard MacLehose (PhD, professor of epidemiology),
  • Gregory S. Knowlton (MS, PhD candidate, biostatistics),
  • M. Kumi Smith (PhD, professor of epidemiology),
  • Kelly M. Searle (PhD, professor of epidemiology),
  • Ran Zhao (Masters of Public Health, current position unclear),
  • Stefan Gildemeister (M.A., Director, Health Economics Program, Minnesota Department of Health),
  • Alisha Simon (M.S., Minnesota Department of Health Access and Cost Containment unit director),
  • Erinn Sanstead (PhD, Minnesota Department of Health, data center staff),
  • Shalini Kulasingam (PhD, professor of epidemiology).

Plenty of these people have published, well-cited, peer-reviewed papers on epidemic modeling, by the by. (Enns and Kulasingham aren’t the only ones. Heck, they’re not even the only ones involved in that pertussis model the editor’s not mentioned!) This is all obvious to anyone who bothers to google their names.

The GitHub commit came from Dr. Enns’ account. (I know this because I tried to contribute some code to the Git repo over the past few days. I can’t imagine Sen. Jensen has ever heard of GitHub, much less spared this repo so much as a glance.) Dr. Enns wasn’t just snagging first-author rights; she handled final deployment of the code. She was also on the press-briefing calls, where she handled the technical questions that were too deep for Mr. Gildemeister. It was clear that she both knew her team’s code and staked her reputation on it.

Of course, grad students were involved, because grad students are involved in anything that happens in a research grad school; their literal function in the research university caste system is to serve professors as a highly-trained but low-paid labor force in hopes of one day becoming professors themselves. But to accuse Marina Kirkeide of single-handedly plunging the state into lockdown and recession, as Sen. Jensen contends, is not merely ignorant, but, I would contend, slanderous.

It’s also frankly astounding that these Deplorable House Wives could whine about a lack of peer review when their side spent the entire week of May 3rd complaining that version 3 of the model had not been released on time. Why hadn’t it been released? Because it was undergoing peer review! This was in the newspapers! Google would reveal it!

Do I blame my friend, who shared the article with me, for not digging into the model’s history before writing about it? No, my friend was a news consumer with no direct stake in the matter, who tagged me specifically to get a second pair of eyes on it. Do I blame the author of the UMN press release? No, whoever wrote the release is a university scut used to writing puff pieces read only by people who have some idea how the research system works, and didn’t anticipate the need to immunize the piece against bad-faith political actors who are not only ignorant, but proud of it.

Do I blame the authors of this article? Do I blame Sen. Jensen? Absolutely. I would not dare publish something directly accusing someone of grave professional malpractice without bothering to do some cursory Google searches about my own alleged evidence! (Longtime readers remember how hard I worked to be sure of my allegations when Wisconsin Right-To-Life and James Bopp lied about Personhood’s potential legal consequences.) It is self-evident that I just did more research fact-checking this news article for a Facebook friend, in order to demonstrate something I already knew — that this was nonsense — than Sen. Jensen did before attempting to character-assassinate a grad student on the floor of the Minnesota Senate.

But who’s going to get more shares? Who’s going to convince more people? Jensen and the genuinely deplorable humans who wrote this article, that’s who. It doesn’t matter that I’ve copied my reply to my friend into a blog post to spread it around, and it wouldn’t matter if William F. Buckley himself came back from the dead and put this correction on the front page of the National Review. All that matters is that people WANT to believe their stupid contrarian narrative, and so they will find some way to believe it — and they will find dishonest scum of the Internet like Deplorable House Wives to manufacture some vaguely plausible but utterly untrue story based on deliberately misinterpreted “sources” to back it up.

This does more than simply deceive news consumers and damage the reputations of people who have done nothing wrong (and much very right!). These absurd accusations also suck the oxygen out of the room for legitimate critiques of and questions about the Minesota model — of which there are several.

(It goes without saying, of course, that the Left does this, too. In fact, the Left routinely does this through the organs of mainstream media outlets, which is even more damaging! But it makes me so much angrier when the Right does it, because we are supposed to have learned something from the sins of the Left. We are supposed to be better than them. And what the age of the Internet has taught me is that we’re not. We are every inch as bad as Sarah “Local Crime Story” Kliff and JournoList; we’re just less empowered.)

It goes without saying that there will be no apology for any of this.I am finding it increasingly difficult to countenance a vote for any Republican in the state legislature this fall. Obviously, I won’t vote for the pro-death Democrats, but I never imagined the Republicans would be so mendacious about matters of life and death as well.

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Weighing the Lockdowns

by James J Heaney Posted on 17 May 2020

I wrote this post on a discussion forum back April 12th, but I never published it here. Even with the stay-at-home orders ending nationwide, I still get plenty of questions about how I stack up their benefits — lots of lives saved — against the economic costs, which are utterly massive. Even now, a month later, with 35 days of hindsight, much of this analysis still makes sense, so I’m posting it even though chunks of it are already dated.

Question:

…So what happens in the real world while we’re waiting for that vaccine to come along? Unemployment skyrockets. As bills don’t get paid, businesses collapse, reducing the number of jobs even available to those unemployed, and it spirals from there. In short, a bad economy on par with some of the greatest depressions in history. I’ve seen unemployment projections north of 30%… that’s unprecedented in the last 120+ years in the US.

Now. Are you willing to argue that “it’s only money and lives matter more”? Or are you willing to acknowledge an economy on that level of bad is going to carry some real human costs and that, as one economist put it “it’s not lives vs. money, it’s lives vs. lives”?

If the former, then I don’t think I can take you seriously, as it leaves you with only your original half-an-argument. If the latter, then there’s the start of a real conversation about what to do.

At what point and in what way do you start factoring quantitative economic considerations and, by extension, qualitative quality of life considerations?

My answer:

This is a fair question, and it deserves something like an answer — even though it’s exceedingly, exceedingly difficult to quantify economic loss, much less quality-of-life loss. This is nearly impossible even after the fact, much less before the fact. But the fact is, not a single one of us would shut down the world like this in order to save 1 life. We wouldn’t even do it to save 100. (If we would, then we wouldn’t allow cars to exist. 37,000 people die in car accidents every year in the U.S. alone.)

On the other hand, there is really very little I would not do if I knew it would save, say, 5 billion people, including half the people I know (possibly including me). Presumably, if this were a plague set to kill 5 billion people, you’d all agree with me. To save 5 billion lives, yes, we would shut down everything for 18 months, lock us in our houses, have police deliver bad food, and arrest anyone who walks out. The alternative is simply too horrible.

The problem with this particular plague is that it lands somewhere in the middle: when all is said and done, unless the data is very wrong (and I hope it is), covid will likely kill between 5 million and 50 million worldwide. You MIGHT get through this epidemic without knowing any victims. We have to figure out where the line is. What are we willing to do for 5 million people that we aren’t willing to do for 5 people? What are we willing to do for 5 billion people that we aren’t willing to do for 50 million?

Complicating this, a great many people simply don’t want to believe this thing is as bad as it is, and are grasping at straws to convince themselves it’s not so bad. (I’m not thinking of anyone on this board, but I still have quite a few Facebook friends in the “models are lying it’s just a flu” camp.)

There is no good way to assign a dollar value to lives lost. But the current consensus is that the average American voter, when making policy decisions, values one life at about $8-9 million. (There’s also a one-year rate.) This calculation is flawed in a lot of ways, but it’s what we’ve got.

The U.S. economy is worth about $20 trillion.

Let’s accept that, regardless of what we do, pandemic makes major recession inevitable. People will die, supply chains collapse, consumer spending will vanish, it’s a nightmare. So let’s say, with the moderate measures Armus suggests, we lose 10% of GDP next year. (That’s several times larger than the Great Recession.) $2 trillion vanished in goods and services, taken from all of us, especially the poorest.

Let’s then assume that taking extreme measures makes things twice as bad. We lose 20% of GDP. It’s three years of the Great Depression all packed into one hell year. $4 trillion gone.

If those assumptions are true (and they’re not — they are at best in the ballpark), then it means that our additional safety measures need to save at least ($2 trillion / $9 million =) 222,000 American lives in order to be economically “worth it”.

At this time, based on currently available data, it appears to be the case that strong stay-at-home orders, nationwide, followed by intense disease surveillance (mandatory testing, contact tracing, quarantines), will save on the order of 1 million lives in the U.S. alone. (That’s compared to a modest mitigation strategy. It is an even bigger number if compared to a do-nothing strategy, which nobody is proposing.)

Recent discoveries about r0 and asymptomatic spread are adjusting that downward somewhat (covid may well be on the optimistic end of fatality estimates), but not far enough to change the math.

Of course, if we are wrong, it’s an exceedingly costly mistake. But that’s true either way. We have to make a call based on the knowledge we have and accept that we will make mistakes and that some future armchair quarterback will mock us for not knowing today what we won’t discover until July. But we have to do what we can to minimize mistakes. Right now, the best we can do is lock it all down until May, reassess based on what we know then… and then probably (but not certainly) renew the lockdowns. Another option would be to lift it in May and reimpose lockdown in June or July as cases start to rise again. The other option appear to be prayer (or hope, if you prefer) — hope for a treatment, for a cure, [for a summer respite,] for absurdly and unexpectedly high asymptomatic infection rates, or for some other kind of stupidly lucky break.

P.S. All the above is very cold-blooded arithmetic. But I admit that I came up with it long after making my decision. The actual, emotional, gut-level moment when I decided, “yes, we have to do this” was when I realized that, if we didn’t do it, the bodies in every single U.S. city and small town would show up so fast, and in such great numbers, that we would have to bury them in mass graves.

So you can talk all you want about my math, and I think that’s probably a good thing — it provides a way of rationally discussing the pros and cons of an impossible situation — but I discovered during this pandemic that my actual line is “mass graves”.

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Expected Daily Covid Deaths in Minnesota (May)

by James J Heaney Posted on 16 May 2020

Version 3 of the Minnesota Model was released a few days ago. The model immediately drew skeptical reactions for its prediction that Minnesota would have roughly 1,440 deaths by the end of May:

[S]ome say the numbers just aren’t plausible… To hit the estimated deaths by the end of the month would require, on average, between 41 and 44 deaths per day for the rest of the month. Minnesota has averaged 22 deaths per day in the last week. (Source)

I grabbed the model source code from GitHub and played around with it. Here is how Version 3 of the Minnesota Model projects the next couple weeks will play out:

DateProjected DeathsActual Deaths
(Daily updates in green)
Before 13 May557614
13 May29.024
14 May30.325
15 May 31.720
16 May 33.117
17 May 34.622
18 May 36.19
19 May 37.717
20 May 39.329
21 May 41.132
22 May 4333
23 May 45.210
24 May 47.617
25 May 50.512
26 May 53.718
27 May 57.433
28 May 61.435
29 May 65.929
30 May 70.730
31 May 75.914
TOTAL1441.11040

Feel free to grab the model yourself and play around with it. (Technical notes: my numbers are from a reconstructed Scenario 5, with parms$end_time_social_distancing <- 1 + 5 + 51 + 21. [UPDATE: repo here, branch “Scenarios5and6.”])

The uncertainty on this seems to be in the neighborhood of +/- 300, based on Slide 12 here. That means anything from 1100 to 1700 deaths should be considered a success for this model.

Back in March, I wrote a very simplistic projection of how quickly covid would spread through the state if we did nothing. I did this to build a case for immediate cancellation of all large gatherings and the imposition of a temporary lockdown.

Today, I’m not writing to advocate anything in particular. These deaths can no longer be stopped. The people who will die of covid-19 over the next couple weeks have, mostly, already been infected, and will die regardless.

…Well, okay, not quite. According to the model, ending the stay-at-home order on May 18th (instead of continuing it into June) does mean an additional 53 deaths, with the first “extra” death most likely occurring on May 24th. But 53 extra deaths on a model with a margin of error of +/- 300 is invisible statistical noise. Besides, even if Gov. Walz reversed course today by extending the stay-at-home order, expectations of re-opening are now so high that it seems unlikely we could actually get back to a strong enough stay-at-home order to save those lives. (I’ll write about Minnesota’s declaration of surrender as soon as I can.)

So why make this post at all?

After I did the March post, I found it useful to have a daily “mile marker” around to check whether covid was beating my expectations or falling short. I checked back regularly to help confirm whether I was overreacting or underreacting. (In retrospect, I appear to have been just-right-reacting.) By the same token, having these “mile markers” for May will help tell us how much stock we should place in the Minnesota model.

If we end up with a death toll significantly above these numbers (above 1700), then it means the model is missing something. Perhaps it underestimated the lethality of the virus, or perhaps it overestimated the extent to which people will continue to socially distance after Sunday’s official end to stay-at-home orders.

On the other hand, if we end up significantly below this death toll (under 1100), then it means the model is missing something in the other direction. Perhaps the new treatments we’ve started receiving are really effective, or perhaps summer weather is having a substantial effect on slowing the virus’s spread. (The Minnesota model does not include weather in any way.) Or, more cynically, perhaps it means people are dying at home and not getting discovered. I’ve become a lot more pessimistic about these things since Minnesota gave up on test/trace/isolate and Virginia got caught cooking its books.

To be frank, I’m optimistic that the reality will indeed end up on the low end of this model. Looking at places like Florida and Singapore, I can’t help thinking that there may be something to this idea that the summer offers a respite from covid — a respite we can use to get on top of this thing after all. It doesn’t hurt my mood that, while I’ve been working out the details of the model, the weather has warmed up and the daily deaths in our state have started going down for the first time in weeks.

But I’ll be watching. And now you can watch with me.

See this blog’s previous analysis of the covid epidemic in Minnesota here.

EDIT: Now that I’m exploring the released version of the Minnesota model for myself, let me know in the comments if there’s anything specific you’d like me to take a look at, and I’ll see whether I can make the time during the next few days.

Minnesota released Scenarios 1, 2, 3, and 4 (described here). I was able to exactly reconstruct Scenarios 5 and 6. I think I can build out the rules to reconstruct Scenario 7. Scenarios 5a, 6b, and 8 are beyond my capabilities right now, because the Minnesota modeling team did not include sufficient (any?) documentation about them.

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Where Are Minnesota’s Tests?

by James J Heaney Posted on 12 May 2020

Some very odd (but potentially relieving?) information in Friday’s Minnesota covid presser.

The thing that worries me most about Minnesota right now, the thing that keeps me up at night, the thing that makes me confused and frustrated and worried that our stay-at-home order will have to last longer than in most U.S. states, is our testing positivity rate.

It’s generally agreed, based on the countries where they’ve got covid under control (South Korea, New Zealand, Australia, Taiwan), that you are doing enough testing to accurately track the epidemic if your positivity rate (the number of positives divided by the total number of tests given) is 2% or lower.

As of Thursday, the median U.S. state or territory’s average positivity rate over the past seven days was 11%. This high number indicates that, as a country, we are still flying mostly blind and have zero ability to get ahead of covid-19 with testing, tracing, and isolation. However, the number has been falling steadily for days, as national testing rises.

Also as of Thursday, Minnesota’s average positivity rate over the past seven days was 17% — and steadily rising. Our daily testing was supposed to hit 5,000/day a week ago (on a steep path towards 30,000), but it has yet to do so, and has instead spent nearly two weeks fluctuating between 3,000 and 4,000. This indicates that we are not only doing far worse than we need to be, but that our control over the epidemic is actually slipping… this despite a set of stay-at-home orders that are buying us limited time to get things under control. We’re also one of the few states right now where, given our official case count, the virus still seems to be growing.

Let’s be clear: once the stay-at-home orders end (and they will have to end within a couple months, if not weeks), we either have the ability to test, trace, isolate, and suppress the virus… or we don’t. If we do, we can get through this without it being too much worse than a real bad flu. If not, brace for impact, because thousands of Minnesotans are gonna die. We don’t get a do-over. We need our positivity rate at 2% or lower YESTERDAY. And we need to start seeing daily case counts and death counts fall very soon if we plan to get it to a controllable point by May 30th (I don’t see how May 18th is viable at this point).

So that’s context for two tidbits from this hourlong Friday briefing that really caught my attention:

(1) Commissioner Jan Malcolm reports early in the call that Minnesota just found out this week that some testing sites are only reporting positive tests, not total tests. This means that the positivity rates for those sites is being recorded as 100% — but that’s not actually accurate. Minnesota is now trying to correct that data. We don’t know how widespread this is, and whether it will have a meaningful impact on the size or direction of our positivity rate, and it’s… surprising… that this reporting error was allowed to persist up until now. But HOPEFULLY, once the data is corrected (SOON PLEASE), we will see that we’ve actually been conducting more tests than we realized.

[UPDATE: Commissioner Malcolm clarified later in the day that this only happens occasionally, and that, on May 7th, only one lab did this. That’s good news for the competence of Minnesota’s data scientists; bad news for all of us who were hoping it could explain away our high positivity rate.]

(2) Even more interestingly, Commissioner Malcolm and Governor Walz answer a question by stating that Minnesota, right now, today, has capacity to test 10,000 people per day. That capacity is not being used. According to Commissioner Malcolm, people are literally not showing up at testing sites to get tested, possibly because of communications months ago that we don’t have enough tests and that mild cases shouldn’t get tested.

This has changed! MILD CASES SHOULD GET TESTED NOW. If you show symptoms of covid-19, get thee to a testing site!

But apparently our own Minnesotan politeness — the same dumb obsequiousness that makes us a joy to grocery-shop with and a nightmare to zipper-merge with — is keeping us from using our full testing capacity, getting a true handle on the disease, and getting out ahead of the rest of the country as we should. (That, or the Governor is not telling us the full story. Always a possibility with government officials.)

Walz and Malcolm vowed to communicate this better. They’d better be quick, because this has been turning into a farrago for Minnesota even as North Dakota whups our butts on testing and cases and deaths.

In Other News: Minnesota has received its first batch of remedisivir, which I still can’t spell after two months. If this thing is capable of cutting covid’s fatality rate by even half, I’ll feel very comfortable about our position, tests or no tests. One of the reasons we locked everything down was to buy time to develop treatments, and now those treatments are finally starting to arrive.

Q&A: Collected from readers over the past few days.

I heard that Minnesota will peak late because we did a good job slowing the spread. Is that true?

I don’t see why this should be true. Peaks happen in one of two ways: (a) achievement of herd immunity forces the disease into decline, or (b) human interventions like vaccination or decisions to stay at home (legally mandated or not) force the disease into decline.

No state has reached herd immunity, not even New York City (where it seems about 20% have been infected; herd immunity is expected after around 75% have been infected).

So all states that have passed their peaks (their first peaks, that is) have done so by staying at home and other measures, like washing their hands and wearing masks. (They will immediately start toward their second peaks when they lift those orders, unless they have some suppression in place OR people continue voluntarily staying home.)

It is very frustrating (and confusing!) that our very similar measures have not had this same effect so far. Hopefully it’s just a bizarre fluke in our relatively weak testing… but, every day that our positivity rate stays high, that becomes less likely.

Are we seeing Minnesota’s positivity rate go up because we have more tests now and are detecting more cases we weren’t detecting before?

We are doing more tests, so we should be detecting more cases — and we are. That, in itself, is not alarming. It should actually be reassuring. The absolute case numbers were bound to go up once we got our act together with testing.

But, if our testing is actually catching up to the virus, our positivity rate should be going down. We should be detecting more cases overall, yes, but we should also be detecting far more negative results as we test more and more marginal and questionable cases. (That’s how you discover all the real cases — by testing everyone who might have it.) We’re not seeing that. The ratio of positive results to negative results has been rising, which indicates that even our increased testing hasn’t kept pace with the spread of the disease.

Are we really doing worse than most other states in terms of testing?

We’re not abysmal. There are other states with much lower per-capita averages, and (if you pull out a spreadsheet and do the math) lots of states with higher positivity rates over the past 7 days.

We in Minnesota are significantly worse than average, both on per capita testing and on positivity rate. To everyone who shares my serene confidence in the competence of Minnesota’s bipartisan government and in the character of its hardy people — confidence that has been consistently rewarded for decades — this is inexplicable.

Remember how everyone took a few days to bash Florida a few weeks ago? I did a bit of this on Facebook, too. Well, they seem to be kicking our butts on both measures.

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Covid and My Inner Skeptic

by James J Heaney Posted on 9 May 2020

I have taken a pretty strong position on covid-19: it will kill a ludicrous number of Minnesotans/Americans unless we shut things down pretty hard until we have the ability to suppress it (either through treatments or through testing and contact tracing). I don’t think it’s possible to remain shut down until we have a vaccine, because we simply don’t have the resources (financial, mental, logistical) for an 18-month lockdown. But I think we will reap the rewards, in both lives and dollars, if we continue lockdown until we have some means of suppressing or defanging this virus.

For once, I seem to be on the side of The Experts about something! Disease experts, from Dr. Gottlieb and Dr. Christakis on the (relative) right to Dr. Lipsitch and Dr. Rasmussen on the (relative) left, have formed something resembling a consensus in favor of this approach.

There’s a Bloomberg article going around lately about what we should learn from coronavirus “skeptics,” who oppose this consensus. A couple of them are experts themselves. I’m not going to link the Bloomberg article, because, even though it’s an earnest, well-intentioned article, it makes some dumb rookie mistakes. Nevertheless, it makes a good core point — there ARE things to be skeptical about in the current experts’ consensus. Some of what we’re doing is based on best guesses that we know could be off.

Here are some of the arguments my inner skeptic has with me:

1. Outdoor transmission doesn’t seem to be a big thing based on the evidence so far. Playgrounds/beaches/mayyyyyyyybe swimming pools could potentially reopen at, say, half capacity.

Why my inner skeptic still loses this argument: I’m waiting for a little more confirmatory evidence before embracing it. My state is starting to see a few playgrounds reopen, and it will be interesting to see how that goes.

***

Continue reading →
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Two Cheers for Governor Walz

by James J Heaney Posted on 19 April 2020

I haven’t been able to find very much time to blog this week. I keep meaning to spend a night on it, and then something comes up in real life.

However, after how hard I have been on Gov. Walz, I really do need to say something about this, even if it’s shorter and less well-researched than I would have hoped:

Gov. Walz is talking sense.

On Monday, the governor said this: “The plan to re-open is very, very clear: Test, trace, isolate and then open back up, and continue this until we get a vaccine.”

He went on to say this: “We need to be testing 40,000 a week, or more. We need to be making sure that the testing and the PPE are there. To do so, we need to be testing 5,000 people a day and that needs to happen as soon as possible.”

There’s also some hot stuff about the need for major contact tracing and isolation of positive cases.

None of this has ever been clear in any of his official plans until now, at least not in the hours and hours of briefings I’ve watched. But I’m not going to prosecute him for inconsistency.

The important thing is, on the most important single question facing a Minnesota lawmaker in the last twenty years, Gov. Walz is now answering the question correctly. Walz has embraced a suppress/test/contain strategy, which is what I’ve been saying he needs to do — and, indeed, I demanded it in a petition a couple weeks ago. Apparently Gov. Walz thinks we’re calling it test/trace/isolate now (Trevor Bedford is doing the same), and I’m fine with that.

This is tremendously hopeful. The way our state’s institutions have responded to Gov. Walz’s “moon shot” has been even more hopeful.

5,000 tests per day might not sound like much, and, truthfully, it may not be enough in the long run. But we’ve only done 44,000 tests total in the state of Minnesota in over a month, and our daily capacity (which needs to keep increasing) has stalled out.

South Korea, often held up as a shining exemplar of test/trace/isolate, has a population of 51 million and the capacity to test 15,000 people per day. (They’re not even using this full capacity right now, as their epidemic is largely under control.) Their positivity rate is about 2%, indicating that they are testing everyone with even mild symptoms and identifying more or less all cases of covid-19.

In Minnesota, we have only 5.6 million people, so we need fewer tests to match South Korea’s testing rates. In fact, on our best days, we are already matching or exceeding South Korea in tests per thousand residents. But our positivity rate for the past week has been hovering around 9 or 10% (source: MDH statistics loaded into a spreadsheet on my computer), indicating that our epidemic is starting to get beyond our capacity to test for it. We need more tests because we didn’t arrest the epidemic as well as South Korea did. (Relative to many U.S. states, however, we’ve done a very good job.) But 5,000 tests per day, if we started running them before the stay-at-home order lifts, when cases should (we pray) be at their nadir… that, combined with the aggressive contact tracing the governor is talking about, would give me a lot of confidence in our ability to keep the virus contained while beginning to ease many of the most economically destructive parts of our lockdown.

Two cheers for Governor Walz. He gets a third cheer when he follows through.

Meanwhile, a great many Republican politicians, I am ashamed to say, are opposing the Governor — not by pressing the Governor to take these sorts of actions, as I have, but by insisting that the Governor end the stay-at-home order prematurely, without testing and other firebreaks in place to prevent a devastating epidemic. Many of these Republicans insist that covid-19 is not as dangerous as we’ve been told, but they are unwilling to wait for data that would prove their claims. They want the economy open now, heedless (indeed, willfully ignorant) of the steep human toll. They are egged on in this by President Trump himself, whose tweets continue to encourage people to act in a manner harmful to themselves and others. (Fortunately, the official policies of the White House have been much better, and actually largely make sense.)

I, for one, am a committed right-wing voter who is writing down the names of state representatives, state senators, and gubernatorial candidates for whom I will never cast another vote. I simply can’t let Jason Lewis near the levers of power again. (Of course, I can’t let Tina Smith near them, either, so that’s going to be a rough election for me.)

On this issue, Gov. Walz appears to be taking the state in the best direction possible under impossible circumstances. Two cheers for him.

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Covid Bombshells at the Minnesota Modeling Presser

by James J Heaney Posted on 13 April 2020

On Friday, Minnesota unveiled a lot of details about its disease model for covid to the world. That press conference featured a number of bombshells, most of which seem to have received little or no follow-up from the media. (Are they distracted? Overworked? Are these revelations not interesting to the general public? Unclear.) I figured I should therefore blog about them, but I’m having a hard time figuring out how to do so efficiently.

Today, I’m giving up. I’m just going to list the revelations with no particular rhyme or reason.

(Here’s the briefing, well worth watching: https://www.youtube.com/watch?v=iDqUjeIib-Q)

ITEM!

The “rule of thumb” for the past few months — a pretty wild guess, frankly, and everyone knew it — was that, for every 1 confirmed case of covid, there were 9 more going undetected. In other words, our covid detection rate was, at a guess, about 10%.

On Friday, Minnesota announced that it believes this rule of thumb is wrong. In fact, Minnesota believes that, for every 1 confirmed case of covid, there are closer to *99* cases going undetected — a detection rate of 1%.

What this means:

We currently have 1,621 confirmed cases in a population of 5.64 million. (0.03% of the state confirmed infected)

Until recently, we believed that 1621 confirmed cases meant 16,210 actual cases. (0.3% of the state presumed infected)

But we now believe that 1621 confirmed cases means some much larger number — something like 162,100 actual cases.

In their technical paper, the Minnesota team explained that they estimate a detection rate of 1%, with a possible range from 0.5% to 5%.

That’s actually (mostly) really really good news. If lots and lots and lots of people have already been infected, that means two things:

  1. The disease is less lethal than we thought. If 20,000 Minnesotans caught covid and 1000 died of it, that’s a fatality rate of 5%. We could expect covid to kill hundreds of thousands of Minnesotans. But if there’s actually 200,000 Minnesotans who’ve caught covid, and still only 1000 died of it, that’s a fatality rate of only 0.5%, and we could expect deaths in the low tens of thousands. (These are numbers I pulled out of a hat to illustrate the point. You can’t actually take current case/death counts and do napkin math with them very easily, because deaths lag cases by several weeks. But there’s no other way to slice it: this is good news, and means fewer people will die.)
  2. Meanwhile, if more people have had it, we’re closer to developing herd immunity than we think. As I have argued strenuously elsewhere, herd immunity is not something we should aspire to, because it means consigning a lot of people to die. But it’s reasonable to expect that we would acquire herd immunity if 75% of Minnesotans caught covid. That’s about 4.1 million people. If 20,000 Minnesotans have had it already, we’re still just a tiny fraction of the way to herd immunity. If 200,000 Minnesotans have had it, then we’re already 5% of the way there. That means that the large peak Gov. Walz is expecting and planning for in summer will come a little faster and be a little lower. Not much lower, but it’s something.

The bad part about the low detection rate is that it implies covid is more transmissible than previously believed. Let’s talk about that.

ITEM!

Until the past week, most estimates of the basic reproduction number (or “r0”) for covid have fallen in the low 2’s. The famous (or infamous, depending who you talk to) Imperial College London report assumed that the r0 for covid was between 2.0 and 2.6, with a median assumption of 2.4. That means that, without intervention, the average person who catches covid will spread it to 2.4 people.

The purpose of interventions like social distancing and stay-at-home orders is to lower the effective reproduction number, or “rE”, from that “natural” rate of r0 to something more manageable. As long as rE stays above 1, that means the average person who catches it spreads to more than 1 person, and the epidemic may be slowed, but will continue to grow. So we’ve been hoping, basically, that social distancing was lowering covid’s reproduction number from something like 2.4 to something like 0.8.

The Minnesota modeling team no longer believes an r0 of 2.4 is plausible. Based on the latest data, which has pointed toward more infections and lower lethality than previously believed, they now believe r0 is at least 2.5, and possibly as high as 4.7 (!), with a median assumption of 3.9. That means the infectiousness of covid is less like the 2009 pandemic influenza (r0 = 1.4-1.6) and more like smallpox (whose r0 has been estimated in the range of 3.5-6).

That means covid may be much, much harder to suppress, test, and contain than previously hoped. Lowering r0 from 2.4 to 0.9 seems plausible, especially with half the state staying home all the time and going out only for groceries. But lowering r0 all the way from 3.9 (or 4.7!) down to 0.9 may be futile. I still think the alternative is so bad that it’s worth devoting extraordinary resources to the attempt — with huge disruption and damage to employees and businesses — but seeing these numbers gives me more sympathy for Gov. Walz’s decision to write off tens of thousands of Minnesotans as doomed to die and focus instead on keeping our hospitals from getting overwhelmed.

There’s bad news here for mitigation, too. If the virus is more transmissible, it’ll take us longer to reach herd immunity. The most naive formula for herd immunity is [(r0 – 1) / r0]. So, if r0 were 2.4, like we thought last week, then we wouldn’t have herd immunity until (1.4/2.4=) ~58% of the population caught covid. If r0 is 3.9, then we don’t acquire herd immunity until 74% of the population has had it — which adds up to another 900,000 Minnesotans getting sick. This isn’t bad enough to outweigh the very good news that the virus is less lethal than feared, but it still means — unless we switch to a suppress, test, and contain strategy — a lot more Minnesotans have to get sick before this goes away.

Just to put in perspective how big a deal this higher transmissibility is: back in January, on Facebook, I shared a Twitter thread by Dr. Eric Feigl-Ding where he cited a Chinese paper that suggested an r0 as high as 3.8. After he was roundly criticized by the entire mainstream media and much of the scientific establishment for way-over-the-top alarmism, I retracted my Facebook post and Dr. Feigl-Ding issued a correction to the thread. And now the State of Minnesota officially considers the r0 to be around 3.9.

To some extent, this is a measure of how much America wanted to stick its head in the sand about covid: at the time, the media wanted us focused on impeachment, which was reaching its climax at the time, and they accused all the marginal right-wing voices who were worried about the “Chinese coronavirus” as alarmists and xenophobes. And, to some extent, it was fair deuce: Dr. Ding’s thread was way over-the-top in several other ways. But it also shows how much we have learned about this disease in just the last 90 days — and how much those of us who aren’t epidemiologists but wanted to keep tabs on the “Wuhan virus” (as it was called back then) were depending on the sketchiest of information mere weeks ago.

SIDEBAR!

There are still some people out there saying things like, “Half of us already had the coronavirus, so we’re actually very close to herd immunity,” or, “Lots of you had coronavirus in December and didn’t realize it.” They will often cite the so-called “Oxford model,” which implied that herd immunity in the U.K. was imminent because only 1 in every 10,000 cases was being detected. Then they’ll tell you about how they (or their godparents’ roommates or whatever) had a really bad cough that just wouldn’t go away a couple weeks before Christmas and wasn’t the CDC saying the December flu season was worse than expected? Surely that was the first wave of the ‘rona!

These people are fools.

We now know, with absolute certainty, that the so-called “Oxford model” is false. We know this because the U.K. has 88,621 confirmed covid cases. If the Oxford model were true, then there would currently be 886 million undetected cases of covid in the U.K., with another 500,000 being infected every day — which represents a problem, because the total population of the U.K. is only 67 million. We are juuuuuust starting to get decent serology tests, and even the sunniest findings suggest that we’re light-years away from the optimism of the “Oxford model.”

We now know, with absolute certainty, that there were no cases of covid-19 in the United States before, at the extreme earliest possible date, 5 January 2020. We know this because we’ve decoded the genome of many different covid viruses from all over the world. Since viruses are constantly mutating very slightly, we’ve compared their mutations in order to create a kind of viral “family tree.” Thanks to this “tree,” we know, with a surprising degree of precision, where each strains of the virus came from and when.

The American infections came from many different sources, some in Asia, some in Europe. But our early infections all came from China, and we know that this particular strain of the disease did not leave China until at least 5 January 2020. There’s simply no way anyone in the United States had the coronavirus before then. Even once it arrived here, it started in only a handful of people, mostly on the coasts, and then started to build. So the odds that you, some random suburban Minnesotan who hasn’t been overseas in a decade, had the ‘rona at any time in January, are not quite zero, but let’s just say it’s more likely that you were struck by lightning.

(This is another body blow to the “Oxford model,” which implies that not only are we missing a lot of cases, but that covid arrived on our shores weeks earlier than could possibly be true.)

Minnesota is saying that it now believes that covid has been spreading more widely than previously expected, that it is less lethal than previously believed, and that we are closer to herd immunity than we thought. This is all excellent news. But don’t confuse this with vindication for those who believe this will turn out no worse than a severe flu.

Minnesota usually has fewer than 100 flu deaths in a year, although we can lose as many as 500 in especially bad years.

Thanks to its higher lethality, higher threshold for herd immunity, and our complete lack of ability to create artificial herd immunity with vaccines (which keeps influenza contained to about 15% of the population every year), Minnesota expects to see not fewer than 9,000 deaths if the stay-at-home order is cancelled, expects 22,000 deaths, and fears 36,000. That’s even with “commonsense” social distancing (keep high-risk people at home, don’t have large gatherings) kept in place after stay-at-home ends.

That’s a lot better than the 50,000 Minnseotan deaths we were talking about a week ago. The State has cut its projection in half. But it would have to cut its projection in half six more times to achieve the hundredfold reduction it would take for us to get down to the “just a flu” threshold. (Bear in mind, also, that Gov. Walz reports that the Mayo Clinic and other hospitals have their own models, and they are not as sunny as the state’s.)

Feel free to hope for further downward adjustments, but don’t count on them.

ITEM!

The State of Minnesota officially believes it will not have enough ICU beds to take care of all patients at peak, which it expects to arrive in June, July, or August. I can’t believe this conference was so full of bombshells that this one only gets mentioned 1500 words in the article, because this, too, is a very big deal. Gov. Walz’s strenuous planning effort (which deserves considerable praise) looks like it’s going to be close to meeting our needs, but close is no cigar. We expect to need somewhere between 2,700 and 4,800 ICU beds. We expect to have only about 3,000 ICU beds available.

We could get lucky, and even our worst-case scenario doesn’t look quite as bad as Italy — but we’re still operating on the expectation that our medical system will be overwhelmed, and that some people who need critical care are going to be left to die, as has happened elsewhere.

The good news for us epidemic hawks is that, unless this supply situation resolves itself in the next couple weeks, Gov. Walz will likely either extend the stay-at-home order further into May. Walz’s whole strategy has been to acquire herd immunity while ensuring that every infected Minnesotan has a hospital bed to die in. Since he doesn’t have the beds, yet, he may not have a choice but to buy more time for his supply chain. That also buys more time for our preferred solution (massive testing, contact tracing, surveillance, and targeted quarantines) to come online as an alternative to waiting for herd immunity.

ITEM!

Gov. Walz and the Minnesota modeling team are still refusing to model what would happen if covid were suppressed with an indefinite stay-at-home order until a vaccine, treatment, or test-and-contain strategy became available. The Minnesota team modeled five different scenarios, but the most aggressive of them merely extended the stay-at-home order to May 17th.

Walz and the modelers should change course and model indefinite stay-at-home.

First, it’s just not a good thing to withhold data about a strategy that lots of Minnesotans are talking about and what to consider… even if it may not be the governor’s preferred strategy

Second, the stupid-but-popular IHME / University of Washington model is based on the assumption of more-or-less permanent stay-at-home orders. When people look at the IHME model, they almost always ask why Minnesota expects 22,000 deaths when the IHME model expects only 656 Minnesotan deaths (at this writing). A very, very big part of that discrepancy is the fact that the Minnesota model assumes the stay-at-home orders are lifted before there’s a treatment or widespread testing available — May 17th, at the very latest — while the IHME model assumes the opposite.

Another reason is that the IHME model is based on an “incredibly optimistic assumptions.” Those are the exact words Stefan Gildemeister used in this briefing. There’s a lot wrong with the IHME model, not just its poor communication. Gildemeister alludes to the unreliable data it depends on. I would point instead to the fundamentally questionable way the model operates: it doesn’t use a real simulation of the epidemic based on what we actually know about it. Instead, it takes observed death counts and tries to fit those deaths to a mathematical curve, then guess where that curve is going next if it follows a normal distribution. (EDIT: We might also point to its horrendous performance, even on its core metric of death counts, to say nothing of its often-outrageous hospitalization projections.)

But it’s still a very, very popular model, probably because it has such a slick interface. A lot of powerful Minnesotans who have absolutely no excuse are depending on IHME’s projections to make sense of what’s going on. Many of them are insisting that, because the IHME model projects so few deaths, we should immediately reopen the economy (which the IHME model says we absolutely must not do, or deaths will skyrocket).

Gov. Walz should model the same thing so that we can directly compare the models — and so he can give lawmakers a clear choice between a prolonged economic closure and relatively few deaths or a shorter economic closure and 10,000-30,000 deaths.

ITEM!

We confirmed in this conference that the State of Minnesota believes we are currently cresting the “first peak” of the epidemic, and that cases (and deaths) will start to decline over the next couple of weeks. We expect very few total deaths at this stage — well under 1,000, if I’m reading the chart right. That’s actually fairly consistent with the IHME estimate.

However, as soon as we lift the stay-at-home order, currently scheduled for May 4th, we begin building toward a much higher “second peak”, with (ultimately) somewhere between 9,000 and 36,000 Minnesotans dying.

(A friend asks: why would the second peak be higher than the first peak? Shouldn’t the second peak be less bad, because more of the population will have immunity? I gave him a long answer, but the short answer is: the first peak was made artificially tiny by our massive stay-at-home interventions — that was the whole point! — and not nearly enough people will have immunity in the second peak to make a significant difference.)

I would have emphasized this “first peak” much more than the State did, since, as soon as case counts start to decline, the fools will start to crow about how the epidemic is over, it was all a huge overreaction, and we should chill out. The fools will be wrong, but it would be smart for Minnesota to get out ahead of their criticism.

So, yeah, extraordinary press conference, lots of huge bombshells.

The next day’s headline was the “feud” between Sen. Gazelka and Gov. Walz, wherein Gazelka made an ass of himself. Because it’s always about the personalities, not the reality. That’s just the world we live in. Hopefully, your desire for more is why you’re reading my blog.

Okay, gotta run for now. Questions or comments to combox or email. G’night!

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Epilogue: A Bye-Ku for Tulsi Gabbard

by James J Heaney Posted on 10 April 2020

Editor’s Note: At the time Tulsi Gabbard dropped out, Anne Maloney was in the hospital. This, therefore, is our series’ swan song.

A Bye-Ku for Tulsi Gabbard

A 2020 guest series by Anne Maloney, inspired by James Taranto.

Dems choose old white guy
Last girl gone. Hillary asks:
Tears shed in Russia?

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