As we stop having earthshaking revelations every week and ease into watchful-waiting mode, I think a low-intensity summary of Where Things Are At might be a helpful thing to have periodically. I don’t know whether these will become weekly or what.
OVERALL:
In Minnesota, covid is still in a valley, not a peak. There are signs that may be changing, but they are developing slowly and aren’t clear yet. Continue enjoying your summer safely, with an emphasis on outdoor activities and small gatherings. Do not visit, e.g., Arizona.
DETAIL:
Case counts definitely trending upward, but still far below April/May peaks. This data lags by (in this case) six days.
Positivity rate is rising in parallel with rising case counts, and my case estimator hates rising positivity rates — but it’s rising slowly enough, and is still close enough to the 2% ideal, that my estimate shows a slope, not a spike. This data also lags by six days.
(For those interested, my daily estimate of “actual new cases” is derived by taking the current 7-day average positivity rate, dividing it by 2% to yield a multiplication factor (minimum 1.0), and multiplying the officially reported non-LTC cases by that factor. This is crude enough that, when positivity is significantly above 2%, the precise numbers may be way off… but accurate enough for us to trust the trendline.)
Hospitalizations are flat, about where cases were two weeks ago in reality. This data is current.
The state reported no data on July 4th (they took the day off for the first time since March), hence the down-spike on the 4th followed by the up-spike in “new” hospitalizations on July 5th. July 5th is simply both days combined:
I wouldn’t be shocked to see hospitalizations rise in the next few days, as new cases start to turn into new hospitalizations. On the other hand, as cases become more concentrated among young people, I wouldn’t be shocked to see hospitalizations hold steady, or perhaps even decline.
Deaths are flat or declining, depending on what slice of data you’re looking at and how hard you squint. This data is current — but remember that it takes several weeks to die of covid, so, if cases go up, you’d expect to see deaths rise in 1-4 weeks.
There’s still no indication in my data that the death count is improving because hospitals are getting better at treating this. By dividing deaths by my estimate for the actual number of cases, I’m able to come up with a rough estimate of infection mortality in Minnesota. It’s been holding steady in the vicinity of 0.5%-0.6% for a while, right in line with global estimates of how deadly covid is.
In other words, deaths seem to be falling solely because cases fell several weeks ago. As cases go up, we should anticipate deaths will go up in a few weeks. On the other hand, as young people become a greater proportion of the infected, we may see deaths hold steady or fall. I know, predicting “anything could happen” is not very bold, but I think there’s too much uncertainty for me — a non-epidemiologist — to be bolder than that.
Reminder: I break these out between long-term care (LTC) and non-LTC residents where possible. Furthermore, I focus on non-LTC because most of the people reading this are not LTC residents, and most of my advice is not applicable to them.
Everything about this picture seems great, except that we don’t have gorgeous ocean beaches in Minnesota.
In Minnesota, covid is slowing down. This is not true everywhere. If the virus gets opportunities and good luck or both, it may not remain true here. But, for right now, we are in a lull–hopefully one that continues for a while.
How can you, the average citizen, take advantage of this? I’ll lead with some math and then pivot to some practical suggestions based on the decisions I’ve been making.
Back in March, I suggested the following equation for deciding whether to attend a social function:
(1 – ( 1 – ( x / y ) ) ^ z ) * 100 = % chance of exposure
Where x = estimated number of actual cases in your nation/state/county/town (the more fine-grained the better)
y = the population of your nation/state/county/town, and
z = the number of people who would be at the gathering
So, back in March, I computed that, assuming there were 10 actual covid cases in Minnesota on March 11th (a substantial underestimate, it turned out; it was likely closer to 1,000 cases), the odds of one of us bringing covid to a 10-person family dinner in Minnesota was:
I placed my personal “this-is-too-risky” threshold at 5-in-10,000 (0.05%) and so deemed the dinner an acceptable risk.
A lot has changed since March!
First, we have a much better idea of how many cases are circulating in Minnesota. Our testing is still not where it needs to be for full surveillance of the disease, but it’s not a complete joke anymore like it was in March. Test results still lag by a solid week, sometimes a bit more, but our positivity rate is at 3% and declining. Getting our positivity rate down to the “gold standard” of 2% will require a huge push (just as much of a push as reducing our positivity rate from 15% to 10% did, because that’s how percents work), plus a little luck, but we are heading in the right direction.
At a 3% positivity rate, it seems reasonable to assume that, for every two cases we detect, there’s–roughly–1 case we don’t detect. (Thanks again to Boise for providing some grounding data for this.) Maybe it’s 3 cases we don’t detect, maybe only half a case, but the point is we’re detecting a large proportion of them. We are no longer in the position we were in in April, when we were having long and very serious arguments about whether we were missing 90% of all cases, 95% of them, or 99%.
This means we can look at recent test results and get a fairly good idea of how many people are infected right now. We simply couldn’t do even a decent job of this until quite recently. We have to exclude the past week of data, because tests from the past 7 days are still mostly not processed, but take a look. Covid runs for about a month in most non-hospitalized people, infection to onset to recovery, so here’s the most recent month of data available today (June 21st):
(You will have to scroll to the right to see the entire table. It’s a big table. Fields marked with an asterisk are taken directly from state data; other figures are my own math based on state data.)
Date*
Tests*
Positives*
Proportion New Cases in LTCFs
Daily Positivity
7-Day Positivity Trend
Reported-to-Actual Cases Multiplier (Estimate!)
Estimated Actual New Non-LTC Cases
7-Day Trend in New Non-LTC Cases
14-May
6,733
793
7.9%
11.8%
11.0%
5.5
4025.9
3445.9
15-May
9,128
799
8.3%
8.8%
10.1%
5.1
3710.9
3215.3
16-May
7,968
343
13.4%
4.3%
9.6%
4.8
1423.7
3171.3
17-May
5,980
311
9.2%
5.2%
9.6%
4.8
1359.3
3180.7
18-May
6,390
973
9.9%
15.2%
9.7%
4.9
4254.2
3150.9
19-May
6,377
857
10.8%
13.4%
9.6%
4.8
3683.1
3070.7
20-May
6,958
767
6.4%
11.0%
9.8%
4.9
3509.7
3138.1
21-May
8,280
981
21.1%
11.8%
9.8%
4.9
3810.1
3107.3
22-May
9,723
790
9.2%
8.1%
9.7%
4.9
3485.8
3075.1
23-May
8,896
396
10.6%
4.5%
9.6%
4.8
1707.8
3115.7
24-May
6,980
358
6.2%
5.1%
9.6%
4.8
1604.7
3150.8
25-May
6,653
408
5.5%
6.1%
8.5%
4.2
1630.4
2775.9
26-May
6,942
787
12.7%
11.3%
8.2%
4.1
2831.4
2654.3
27-May
9,529
680
12.5%
7.1%
7.7%
3.9
2296.4
2480.9
28-May
9,950
576
14.3%
5.8%
6.8%
3.4
1680.8
2176.8
29-May
10,384
457
6.3%
4.4%
6.2%
3.1
1320.9
1867.5
30-May
8,436
168
7.0%
2.0%
5.8%
2.9
455.8
1688.6
31-May
6,882
142
6.2%
2.1%
5.5%
2.7
364.6
1511.5
1-Jun
4,181
579
9.5%
13.8%
6.0%
3.0
1577.0
1503.8
2-Jun
7,669
486
8.3%
6.3%
5.4%
2.7
1206.1
1271.7
3-Jun
15,900
518
9.7%
3.3%
4.6%
2.3
1079.7
1097.8
4-Jun
10,943
402
8.2%
3.7%
4.3%
2.1
788.7
970.4
5-Jun
11,037
409
7.4%
3.7%
4.2%
2.1
787.6
894.2
6-Jun
10,408
163
5.6%
1.6%
4.0%
2.0
309.9
873.4
7-Jun
9,541
137
3.9%
1.4%
3.9%
1.9
254.5
857.7
8-Jun
7,771
476
8.9%
6.1%
3.5%
1.8
766.9
741.9
9-Jun
8,882
457
9.7%
5.1%
3.4%
1.7
709.8
671.0
10-Jun
12,040
405
16.5%
3.4%
3.5%
1.7
586.5
600.6
11-Jun
13,401
338
8.7%
2.5%
3.3%
1.6
503.4
559.8
12-Jun
12,804
306
4.0%
2.4%
3.0%
1.5
448.0
511.3
13-Jun
9,796
151
-2.1%
1.5%
3.1%
1.5
235.8
500.7
14-Jun
5,019
148
6.0%
2.9%
3.3%
1.6
227.6
496.8
Sum up the last column and you get 61,528.5.
This suggests that there are around 60,000 active cases of covid in Minnesota outside long-term care residents. (LTC patients have their own epidemic going on, and a whole different set of risks to face.) Again, and I can’t say this enough times, that 60,000 figure could be well off in either direction, but we can be pretty sure the number’s more than, say, 20,000 and under 200,000.
But how many of those cases do we really need to consider an exposure risk?
If you’re going to, say, the grocery store or the mall, you kinda need to consider all of them. Some of these 60,000 people may be symptomatic but aren’t following stay-at-home rules, and you may bump into them in the grocery line. Some may think they’ve recovered (or have convinced themselves of that) but are still contagious (although how contagious is still an open question). Walk into a crowded building for a protest or rally or worship service, and you’re liable to be in the presence of some of these people. If you’re not careful, they’ll chant or sing or scream that virus right into your lungs.
If you’re in a shopping center with, say, 300 Minnesotans, the odds that one of them has it and will potentially expose you should be computed as:
But what if you just want to see friends or family whom you haven’t seen in months due to social distancing? That changes the math. In that case, you should ask whether your friends or family have shown any symptoms, and whether they’ve been exposed to anyone who has. (You can’t do this with people at a shopping center.)
If you can be confident that nobody’s had symptoms or been around anyone with symptoms (and you’re confident that your friend isn’t lying or minimizing), then you don’t need to worry about all cases of covid in Minnesota at all stages of progression. You only need to consider the possibility that your friend has covid but is pre-symptomatic.
We now have a pretty clear idea that covid can be transmitted during the incubation period before you develop symptoms. But, while the overall incubation period can last two weeks, you’re only contagious for a maximum of 4 days before symptoms begin. (This well-circulated study says 3 days, but I saw one case — which I can’t find now — in a different study where the subject was contagious 4 days prior to symptoms. We’re going with the more cautious number.) We didn’t know this back in March.
We should also consider the very human tendency, even among honest people, to minimize symptoms during the first day or two when they develop.
What this means is that, rather than worrying about every single case of covid in the state right now — an entire month of cases! — for close social contacts who are verifiably non-symptomatic, we probably only need to worry about cases that are in the 6-day window where they are either contagious but pre-symptomatic, or early symptomatic.
That’s a much smaller number. As I write this, on Sunday, June 21st, I estimate that, outside long-term care facilities, there are 3,340.2 contagious Minnesotans who are pre-symptomatic or early-symptomatic. (In the table above, take the final column for the last six rows, add ’em up, and that’s what you get.) Maybe the true number of pre-symptomatics is half that, maybe double, but, however you slice it, it’s a lot less than 60,000 people. I’ll cautiously round 3,340 cases up to 4,000 to emphasize its imprecision.
So if I want to have my friend and his wife over after several months of social distancing (thinking of you here, P & K), and they both certify that they are non-symptomatic and haven’t been exposed to anyone who is symptomatic, then the odds that one of them brings covid into this house may be estimated as:
So the odds that my night with a friend will expose me and mine to covid is a little over 1 in 1,000. That’s not bad at all.
But there’s more good news.
Second, we now have a much better idea of how dangerous exposure is. Back in March, my analysis ended with the above exposure calculations. At the time, all we could do is compute the (rough) odds that you were in the same room as someone with covid. We had no idea what the odds were that, if you were exposed to covid, you would catch it. We had to assume, for safety, that the odds were close to 100%.
We now know that’s not even close to true.
For one thing, we now have high confidence that outdoor exposure, while not impossible, is extremely rare. We’ve suspected this since early April, I mentioned it in early May, and the lack of transmission at the Lake of the Ozarks Memorial Day parties reinforced it, but the Minneapolis George Floyd rallies are confirming it: we should be seeing big case spikes, especially among people who protested, but we aren’t. Those rallies were a petri dish for The Rona, featuring huge numbers of people (at least scores of whom were pre-symptomatic or early symptomatic), poor masking, horrible social distancing, chanting and singing and screaming, tear gas, mass arrests, jailing, and plenty of smoke from the fires, all of which promotes covid spread. There were probably some infections from the protests, but the numbers are small enough that we aren’t seeing it in statewide numbers, nor even in protester-specific testing. That seems like clinching proof: covid spreads very, very poorly outdoors, and apparently only through extended, unmasked, face-to-face close contact.
So even if my risk of exposure to covid at an outdoor gathering like a pool party is very high, my risk of actually developing covid from that exposure seems to be negligible.
For another thing, even indoors, covid transmission is not a sure thing.
You don’t want to be at a restaurant next to somebody who has it, especially if that person is sitting in front of an air vent blowing contaminated air your way. There’s plenty of horror stories in this article, covering everything from indoor beer festivals to family birthday parties, which suggests a lot about exactly how covid spreads in enclosed areas with lots of people. This quite recent article covers some of the same ground, but includes some new cases that weren’t available when the first was written, and it features more rigorous analysis. Bottom line: covid loves spreading around at events with lots of movement, mingling, hugging, and touching.
Covid also spreads very well at dinner tables, hitting something like 50% of people at a 5-10 person table over the course of an hour. A Wall Street Journal article that summarizes a lot of these studies (without actually linking to or naming them!, dang media) mentions evidence that better ventilation can help. This early study suggested a slightly lower dinner-table “attack rate,” at 35%, but exclude meals with more than 15 attendees and non-meals, and the attack rate rises to ~52%, right in line with what we’re seeing elsewhere. So open a window whenever you can and hope for the best!
On the other hand, when one person in a household develops covid, there seems to be only a ~20% chance (confidence interval 15-25%) that someone else in the same household will develop it. (Odds are higher for those older than 60.) That same study shows significantly lower spread if the sick person is immediately quarantined after infection. A second study largely agrees on all points, and also offers some interesting insights about spouses. Both studies also note that children are as much as 4 times less likely to catch covid from an exposure, which is useful! So, within households–by many measures, the closest contacts of all–there seems to be a surprisingly good chance of one person getting sick but not passing it on.
Meanwhile, there are extremely few reported cases of transmission through fleeting contact or from surfaces. You’re not going to catch covid from getting drive-through, or from visiting the megamall. If you stay in one area for a period of time, or spend more than a minute or two in direct face-to-face contact with someone (say, a salesperson), that will put you at risk. We do see shopping mall transmissions in the studies linked above, but they seem to depend on face-to-face interactions with salespeople.
So if I’m interested in having my two friends over to dinner, and they eat with just me, my odds of exposure are still:
Of course, if my wife and/or kids attend the same dinner, the math gets more complicated, because one of us is likely to catch it and that person may spread it to someone else in the house. You can’t forget about those kinds of dynamics when considering your chances.
Third, we have a much better idea of covid’s fatality risks. Back in March, we did not have a clear picture of who died from covid. We did have this 17 February study, which I used, but we already knew it was missing important information, especially from people who had developed only mild symptoms. It wasn’t clear how well the early study would hold up. We had to be cautious, and had to assume that infection meant a high risk of death — considerably higher than the 17 February study indicated. (I, for one, followed this solid rule of thumb: for any data coming out of communist China, use it… but confirm it against non-Chinese data as quickly as possible.)
As it turned out, though, the 17 February study held up pretty well. As far as I know, the Robert Verity infection fatality ratios by age group (last updated on May 2nd; see Table 1 on page 673) have been holding up nicely, and have been more confirmed than modified. The Verity estimates for CFR are right in line the CFR’s from the 17 February study, and its IFR estimates are about half that.
So we are now able to say certain things pretty confidently, like: even if I, a 31-year-old man in good health with no comorbidities, catch covid, my probability of dying is under 1 in 10,000.
On the other hand, hypothetically, if a 61-year-old woman with a chronic kidney condition caught covid, her fatality risk would be around 2% due to her age. But she is a woman, and men account for around two-thirds of covid deaths, so we adjust her fatality down to 1.3%. But the chronic kidney disease is bad news, roughly tripling, and plausibly octupling(!), her fatality risk. When one’s life is at stake, I tend to err on the side of caution, so I would put this hypothetical woman’s odds of death from covid at 1.3% * 8 = about 1 in 10.
That’s a pretty scary number — and it assumes that the hospitals have enough beds to take care of her, which they may not in a bad surge. That hypothetical lady really does not want to catch covid-19.
If you’re my age and healthy, this disease isn’t really something to be terribly worried about. It may be awful to catch, and there’s plenty of stories about how it was like the flu except it dragged on and on and on. I dread the idea of my wife having to take care of the kids by herself for weeks while we’re all quarantined from the world I’m stuck in the basement quarantined from them — but the odds I’ll actually die of covid, even after catching it, are similar to my odds of having a heart attack at 31.
Yet, even if you’re young and healthy, probably know at least a few older or higher-risk people, maybe family, maybe friends. If you are seeing them regularly, especially if you’re sharing a household with them, they’re the people you really need to protect.
So let’s go back to that dinner party. If I want to have my two friends over to have dinner with me alone, my odds of getting killed by that decision (because one of them has covid, I catch it, and I die) are:
These are lightning-strike numbers. I could even go to work (where I have close contacts with 6-7 people in a day, all of whom must daily certify they are non-symptomatic) without a great deal of personal risk:
My fear would be catching covid and then transmitting it on to my dad, a 63-year-old man with no comorbidities (fatality risk: ~2.5%) and whom I see on a very regular basis right now. Because I see him often, I should treat him as a household contact (transmission risk during presymptomatic period: ~15%). So the odds that my visit to work would kill him are much higher:
…which still is not awful. I’ll continue working from home until that number is a lot smaller regardless.
But what if I were a 65-year-old man who went to, say, an indoor political rally with 6,000 people of uncertain symptomatic status and spent all night shouting “four more years,” then came home to my 67-year-old wife with chronic kidney disease? I might give my wife’s fatality odds as:
(My odds of infection here are 75%, hers 15% contingent on my being infected.)
This is a bad risk. Any time your odds of dying from a single interaction go above about one in a hundred thousand (the odds of dying in any given skydive)… don’t take it. This risk is a thousand times higher than that. Don’t go to big indoor political rallies right now! I have the right to tell you that, Trump supporters, even though the epidemiologists mostly don’t. (If the rallies are outdoors, then that’s a whole different story. I still wouldn’t do it, but the risks appear to be miniscule.)
Of course, you can’t boil pandemic risk down into a single simple equation, much as I would like to! It’s simple to compute your exposure and fatality threat from a single interaction, but the world is actually much messier than that.
For example, suppose you are high-risk, and your only close contacts are your grandchildren, whom you see twice a week. They see their other grandparents twice a week as well. One of the other grandparents has continued going to work, which is in a large, well-ventilated indoor area, and has about 30 close contacts per day, all of whom certify that they are non-symptomatic upon entering the work site. Meanwhile, one of your grandchildren has taken a part-time job at a fro-yo place, with only one other employee (her boss) but many fleeting contacts (the customers). What are your odds of contracting (and dying from) covid via your grandchildren over the next six months? And at what point are there enough cases in the state that you need to stop allowing your grandkids to visit?
This situation does not fit neatly into the equation we have developed. Transmission for children are different, the nature and risk of the contacts at this hypothetical workplaces are unclear, and, above all, the serial contact situation (where several people involved are in contact with the same non-household contacts over and over again instead of just once) makes the whole thing tricky. Our equation can offer guidance, but not answers.
Even if the equation gave you answers, it still would be up to you to determine what to do with them. I feel comfortable with a fatality risk of about 1-in-10,000. You might not… or you might be willing to tolerate far more risk.
And even if you felt comfortable with the risk, you’d need to remember that the equation is built on variables that are only estimates, and not even especially strong ones. There’s probably 4,000 or so presymptomatic cases in Minnesota right now, but it could actually be half that or twice that — and that’s not even official state data, so what if I’m wrong? Math helps make everything better, but in the fog-of-war of an ongoing epidemic, it can’t solve all our problems.
So what are you doing, James?
Last month, I told you that my personal rule was to enter close contact (>10 minutes of sustained, face-to-face contact) only with people who could name every node on their social graph — that is, everyone they’d been in contact with, everyone those people had been in contact with, everyone those other people had been in contact with, and so forth. If we knew everyone in that social network, then there was just no good way for the virus to “break in” and start infecting us.
For example, I’ve been spending time with my parents, because we all know that, other than routine and minimized shopping trips (and one trip to a hair salon), everyone in my house and everyone in their house has been isolated from the rest of the world. Practically speaking, none of us could be carrying covid because none of us have spent any time with somebody who could infect us!
This is now being called the “double bubble” strategy, and New Zealand is apparently taking credit for it, although I could have sworn I saw the same strategy discussed under a different name in Scandanavia in April (which is where I got the idea). The “double bubble” is a sensible stay-sane strategy for times when covid is raging out of control and you need to shelter for safety.
We in Minnesota are not in one of those times. We can now afford to be more flexible.
My household is sticking to the same basic model of minimizing outside contacts. We still aren’t going to Mass (we can see for ourselves on the weekly livestreams that most congregations are still singing! which seems unnecessarily risky). But we are sending the kids out to play on playgrounds regularly, and we intend to make use of any outdoor pools or zoos or splash pads that reopen this summer. More significantly, we aren’t holding all of our household contacts to quite the same rigid standard. We’re getting back in contact with people we really miss, even if they’re breaking isolation, as long as they’re doing it in a manageable and sensible way.
Let’s go back to my two dinner-party friends. If they went to an international Magic: the Gathering tournament right now (population: thousands; close contacts: dozens; covid statuses: unknown), then we’d cut them off cold until two weeks had passed. That’s a high risk and a stupid one (besides, all MtG events are cancelled), and we won’t put my parents in its line of fire.
But if one of my friends went to work twice a week, with proper masking and distancing, and could promise us that none of her co-workers were symptomatic… well, given where Minnesota’s at right now, that would be a pretty safe exception to make. We just need to be careful not to make too many exceptions, and only to make them for good reasons, because too many small exceptions adds up to large risk.
So, to sum up, here are some activities I personally consider too risky, not risky, and acceptably risky right now. Few of these are really risky for me, but they are risky for my parents, whom I see regularly… and it’s easier to stop some of these things than it is to stop seeing my parents.
Too Risky
Indoor rallies / sporting events Worship (>20 minutes, esp. if singing) Going to work Spending an hour at the library Eating in restaurants regularly Seeing people who are taking a lot of exposure risks
Acceptably Risky
Non-emergency dental / medical visits
Occasional dinner with friends who are going to work, non-recklessly
Eating indoors in a restaurant very occasionally, assuming proper distancing
Seeing people who aren’t quite as isolated as you are, but who are definitely not around anyone symptomatic
Haircuts, sometimes
Honestly, my head says a sparsely-populated movie theater should be fine if masked, but my heart isn’t up to the stress
Some indoor playgrounds (the more ventilation, the better)
Being in a raucous outdoor crowd for a good and pressing reason (e.g. worship, protest)
Indoor funeral, no singing, maintaining strict social distancing
Not Risky
Playgrounds Pools Beaches Patio/outdoor seating at a restaurant Really anything outdoors without a crowd Grocery store runs Drive-through and takeout at restaurants Visiting the library to grab a book quick Seeing people who are as isolated as you are
Again, this is my own personal judgment. Your mileage may vary. If you are in part of the country where covid is on the upswing, your mileage should vary. If Minnesota’s cases start ticking up again, my mileage will vary.
But I hope, after all that inscrutable math, that it’s a useful illustration of where I think we are in this epidemic right now.
Stay safe! But let your hair down and enjoy the summer. It probably isn’t going to last, and you may as well safely recharge your batteries while you can.
Last time we talked about the covid epidemic in Minnesota, I was trying to figure out why so few people were dying.
Don’t get me wrong, 357 Minnesotans died in the back half of May, in a state where the flu typically kills 191 Minnesotans in an entire year. It’s just that we expected more than double that number to die. I spent the past few weeks buried in spreadsheets (and spent hours and hours looking at Wayback Machine archives of this page) trying to figure out why we aren’t dying quite so fast.
Is it because we’re getting better treatments, reducing our fatality rate?
No. As far as I can tell, our infection fatality rate (percentage of infected people who don’t survive) has held steady for weeks. Don’t trust the actual numbers in this graph, but do trust the trend, which is flat:
The state’s crude cumulative case fatality rate (which counts only reported cases, and makes no attempt to “snapshot” them) has also held steady since the initial wave of deaths:
There are small recent changes on both these charts, but they seem to be related to random fluctuations, increases in testing, and occasional changes in our testing protocols, not actual success in making covid-19 less deadly.
So, if you catch covid, you’re still just as likely to die of it as a month ago. So, if we’re seeing fewer deaths, it must be because there are fewer cases.
Then… are deaths going down because the lockdown was more effective than we thought?
Nope. Deaths are going down, but the timing is all wrong to credit the lockdown:
After weeks of flatness, deaths go into clear decline during the first week of June — three weeks after the lockdowns ended. That’s right around when we would expect deaths to start obviously going up. Once the lockdown ended, the Minnesota Model expected well over 100 deaths per day by early June, rising toward a peak of around 500 deaths per day later this month. Instead, we’re seeing less than 20 per day. And it’s been too long since lockdown ended for us to give the lockdown credit.
Okay, here’s an off-the-wall idea: maybe after the lockdown ended, Minnesotans were so scared they actually did more social distancing than they’d been doing during the lockdown? And all that extra distancing was actually more effective than the official lockdown and bent the curve downward? Seems implausible, since everyone seems to be loosening up rather than locking down, but worth checking anyway. Did Minnesotans reduce covid cases and deaths by voluntarilyincreasing social distancing in late May?
Nope:
While Minnesotans are still distancing, and that’s undoubtedly helping prevent a spike, they’re loosening up slightly. We definitely aren’t distancing more than we were this time last month. So our voluntary distancing doesn’t explain the decline in cases.
Could Gov. Walz’s belated actions to protect long-term care (LTC) facilities be reducing cases in nursing homes — so much that they’re driving down case and death numbers for the whole state? This is an interesting idea I aired last time.
You can kinda talk yourself into it if you’re just looking at deaths:
Deaths are down everywhere, but they’re down a little more sharply in LTC facilities. So Walz’s intervention can perhaps explain the decline in nursing homes; can it explain the overall decline in the state? (When I was looking at this a few days ago, non-LTC deaths were actually going up, which made this question more plausible.)
No. The nursing home death decline is great news. But cases are down sharply everywhere, both in and out of LTCs:
We can’t credit nursing home precautions for this. And, since there are far, far more non-LTC cases than LTC cases, the decline in LTCs would have to be much steeper to begin to explain the state’s overall reduction in cases.
Quick side note: this data is starting to get fairly patched-together. Minnesota changed how it reports LTC case numbers a couple times, and I had to do quite a lot of Wayback Machine dumpster diving to get apples-to-apples numbers to compare across all dates. You’ll notice on the LTC graph that there’s even a day, May 12th when new LTC cases apparently numbered -28. This is not real (obviously). It’s due to a rounding error in the reporting method Minnesota used at the time, corrected when they changed reporting methods the next day. Even with these corrections, I was only able to go back to early April, because data before then just isn’t available. That’s why I again encourage you to take the trends seriously but the specific numbers with a grain of salt. End of side note.
Both the above graphs are based on officially reported numbers. But, for much of May, we didn’t have nearly enough tests, and we can be certain that we were missing a large proportion of cases. (See my mid-May piece, “Where Are Minnesota’s Tests?“) For the entire first half of May, our weekly average test positivity rate hovered above 10%, with a one-day high of 20%. (To know how many cases there really are, it should be 2-3%.) We were undercounting in May by a huge margin.
Minnesota’s test positivity rate is now down to 3% and still heading downward. We aren’t undercounting anymore, at least not by much.
What if we try to account for this? What if we try to figure out how many actual new cases of covid there were in Minnesota each day, not just how many were identified? Well, you get something like this:
Again, don’t take the numbers on the Y-axis too seriously.
I did do my best to ground my assumptions about positivity rates and undercounting in real-world data. I spent a night digging through covid population studies, comparing states’ official covid prevalence and test positivity rate to the actual covid prevalence. This allowed me to form a baseline: if your testing positivity rate is 10%, then you’re probably missing 70-90% of actual cases. If it’s 4%, then you’re probably missing half of cases. And so on. Big thanks to Boise, Idaho and Indiana for making this possible — they both had good studies and, just as important, they had very usable covid-19 websites. (Especial thanks to Idaho for breaking out cases and tests by public health district!)
But, even with this grounding in some real data, the specific numbers are verrry iffy. Please don’t walk around saying that 4,028.6 Minnesotans were infected with covid on May 8th just because this chart (a smoothed average of a guesstimate built on patchy state data) says so. All we can say for sure is that, on May 8th, we detected 723 cases, with a 15% positivity rate, and so there were certainly thousands of cases that day that we didn’t detect. Maybe there were really 4,000 cases, maybe 2,000, maybe 7,000, but it was a lot more than we tested.
Regardless, the trend couldn’t be clearer, and it holds steady no matter how you play with the “undercount factor.” New cases in Minnesota dropped off a cliff at the end of May, precisely when we expected them to be heading skyward. This is true for LTC residents and other Minnesotans alike. I really wanted the nursing home hypothesis to fit, because it made sense of everything. But the data don’t support it.
What if covid is slowing down because we’re acquiring herd immunity?
On the one hand, there’s a certain attraction to this idea. An otherwise-unexplained quick collapse in the disease suggests lower transmission rates, and the gradual build-up of herd immunity gradually reduces transmission rates. Unfortunately, the numbers don’t add up.
If I’m very generous with my undercount estimates, I can just about believe that maybe 600,000 Minnesotans have been infected. Even if that were true, it would only be a little more than 10% of Minnesotans… and we would need several times that many to even begin to see herd immunity effects against covid. (In truth, I think the number of Minnesota infected so far is around 75,000 – 200,000.)
So what is slowing the epidemic down? We seem to have presented one hypothesis after another, only to discredit each one.
It could be a mystery, of course. Sometimes things happen and we don’t have good explanations for them. There always is an explanation, of course, but this is a very new disease, and virology is still routinely making major discoveries about diseases we’ve studied for decades. The real explanation may not be available to us until years from now.
But we do still have one hypothesis left in our quiver. It’s a hypothesis a number of respectable epidemiologists (the non-treasonous kind) have converged on in the past couple weeks–although it seems to me they’ve settled on it more by process of elimination than anything else. Their hypothesis?
It’s summer. Lots of respiratory viruses struggle in summer. They don’t reproduce as well, and/or they don’t transmit as well, and/or people congregate outdoors where viruses don’t have as easy a time spreading. We didn’t think the arrival of summer was going to be a big deal, but… hey, look at those numbers. It’s kind of a big deal.
Dr. Christakis thinks it (and actually this video segment, which he just reposted from way back in March, is worth watching), Scott Gottlieb thinks it, Lyman Stone (not an epidemiologist) is terrified because of it, Minnesota is gradually tacitly accepting it, and, as I’ve mentioned in previous blog posts, the evidence supports modest anti-covid effects from a rise in temperature.
It’s not strong evidence, and maybe there’s still some other factor helping out here, but it’s all I got: covid is weakening in Minnesota because summer.
That doesn’t mean we’re guaranteed an easy summer. A single super-spreader event could kickstart a new outbreak, which could get traction even with the hindrance of summer weather. These things happen, and they are three parts opportunity and two parts random luck. (I believe Dr. Christakis says “stochastic” in his video clip, but that just means “based on random luck.”) Indeed, some areas like Arizona and Florida seem to be already undergoing spikes.
We give the virus opportunities when we reduce social distancing. Fortunately, in Minnesota, social distancing has largely continued post-lockdown. It should continue to continue. I think we can loosen up a little — I’ll write about that as soon as I can — but you should not read this post and then dash off to the pool halls and roller derbies with all your chums because I told you it’s safe. It’s not. Covid’s still here, still contagious, still killing people twenty-five times faster than the flu. We haven’t found a way to reduce the fatality rate. And there’s a good chance (more than 65%, less than 100%) that it will be back in full force this fall.
But it’s giving us a breather. Let’s make good use of it.
We spent the last couple of months being hectored by public health experts and earnestly righteous media personalities who insisted that easing lockdown policies was immoral, that refusing to social distance or wear masks was nigh upon murderous. They even suggested that protests were somehow profane. But now that the George Floyd protests are serving as some kind of Great Awokening, many of the same are saying “never mind” about all of that. Protests aren’t profane, they’re glorious and essential—if they agree with what you’re protesting about.
…if we have a huge spike in cases because of these protests, will they say, “Well, it was worth it to end racism”? Maybe, except they won’t have ended racism. Sure, some will plausibly argue that any COVID-19 comeback was the result of evil Republicans reopening the churches and the barber shops. But that will be dismissed for the partisan hogwash and special pleading it will be.
And, if we don’t see a huge spike in COVID-19 cases after all of this, no one will believe the experts when we head into the fall (when it’s supposed to come back) and they say now we really mean it. So we’ll still have an intolerable amount of racism—at least according to the people who say we have an intolerable amount of racism today—and we’ll have another economy-crushing outbreak on our hands.
And, if—God willing—it doesn’t come back strong in the fall, well, no one will ever take these people seriously again, and for understandable reasons.
Mr. Goldberg is, of course, referring to something that has shut me up cold for the past week and a bit: a very large fraction of the public health “experts” whom I have trusted and defended for the past few months — and to whom I have entrusted you, dear reader — suddenly turned out to be acting in bad faith.
After public health “experts” spent months advocating tough, almost exceptionless lockdowns, openly attacking protesters, George Floyd was killed. (I support the murder charge in his death.) Suddenly, the script flipped. Now protest was not killing people; it was a necessity to show that killing people is bad! Get out there and #SayTheirNames! Very loudly! In a large crowd!
Of course, left unstated in all this is that, if these (predominantly white) public health experts have been right about practically anything, then these protests will, in fact, kill (predominantly black) people. So great job, guys. Black Lives Matter to you so much you’re sending them out into the street to die!
Some of my friends are not as abjectly furious about this as I am. After all, these public health “experts” are “both ‘scientists’ and ‘citizens’,” so they’re entitled to say (as scientists) that protest is dangerous while also saying (as citizens) that protest is worthwhile. They are desperately spinning their special-pleading wheels this week to try and make this case, but their arguments consistently boil down to, “We think that marching for George Floyd is more important than whatever dumb crap you, plebian, think is important.” Maybe they’re right, maybe they’re wrong, but they’re making a judgment that has nothing to do with science.
“Even so, James! Even so! You’re dodging the question! Don’t public health experts have the right, as individual citizens, to make individual judgments about which causes are worth the risk and which ones aren’t?”
No. Public health experts gave up their right to individual judgment the day they took that right away from the rest of us.
The lockdowns these very epidemiologists supported were not jokes. They weren’t optional. If you violated lockdown in a serious way, men with guns came to deal with you — and the people who are now scolding us for insufficient wokery cheered the law on. We didn’t get a “citizen’s exception” to this. We didn’t get to “balance risks.” Epidemiologists I respected were clear about this: lockdowns should continue until test-trace-isolate was possible. Epidemiologists varied on how to respond to people who broke lockdown, but were unified on the main point: unless you needed to leave the house to not die, you should stay home.
Want to see your loved one dying in the hospital? “Too bad.” Want to receive the Blessed Sacrament, the Source and Summit of Christian Life to which we are guaranteed access via the First Amendment? “We sympathize, but it’s a pandemic.” Want to get married after years of planning? “Nope, better put the formation of your family on hold for a few weeks, or months, or years.” Want to go to the funeral of a beloved community leader… or, I dunno, the funeral of your own dad? Your own mom? “We’ll throw you in actual jail!”
Our public health “experts” didn’t bat an eye at any of these policies. After all, these policies were the natural consequence of what these “experts” had been saying all along. When they deigned to offer comments, they applauded these policies. So did I! Quite frankly, given the seriousness of the epidemic, I still do!
But policies have to treat everyone fairly. Instead, we’ve established one standard for Hasidic Jewish funerals and a different standard for woke protesters.
Look, you’re free to say that the George Floyd protests are more important than any of the other concerns I listed. You may even be right! What you’re not free to say is that the thing you care about should be tolerated but everything else punishable by law. The religion of anti-racism does not have greater rights under our law than the religion of Judaism. If you get a citizen’s exception, everyone does.
And what you especially, especially can’t do is suddenly invent a “citizen’s exception,” after months of unwavering loyalty to the party line, on the very day that you need it. Because then everyone knows you were lying the whole time. Even when you try to point to evidence that you supported a more generous approach all along, everybody knows you didn’t. I said a few words vaguely to the effect that, “Since we’ve already surrendered to covid, we may as well reopen everything, including the bars and the streets and the churches,” but I know the rest of you epidemiologists were grousing about reopening right up to the instant it challenged your politics, because I was watching. And some of you have now gone back to grousing!
Everybody knows that those articles from early May don’t say, “We should reopen the churches,” like you’re claiming now, Dr. Marcus, but actually just say, “We should think about maybe someday reopening the churches if we can figure out how.” Everybody knows you still think that, actually, because you still haven’t come out and said, “Yep, it’s time to reopen the churches.” Everybody knows you don’t give a good goddamn about the churches. Or the collapsing businesses. Or the funerals. Or the lost jobs. Or orderly in-person elections. Or anything at all — except your devotions.
This was a betrayal of our entire society. The people who set the rules suddenly violated them. It was like the great disappointment of Neil Ferguson (who orchestrated the UK lockdown) breaking lockdown to have a tryst with a married woman, but on a completely massive scale. Well over half the “experts” turned out to be writing rules for us that they had no intention of following themselves.
But it was a special betrayal of us, the people who supported (and continue to support!) a robust, consistent public health response to covid-19. All of society was betrayed, but we are the ones with the knives buried in our backs… and we are going to pay the price. Minnesota doesn’t need to be in lockdown right now, the end of May proved that, but there’s a reasonable chance (maybe 50-50?) that, at some point in the next six months, we’re going to need to head back into lockdown to protect lives and the economy. We’re not going to be able to. No one will believe us, because these “experts” have destroyed the credibility of their entire profession, and ours as well. After all, as Obi-Wan Kenobi once asked, “Who is more foolish? The fool, or the fool who follows him?” I literally followed most of these experts, and I recommended that you do the same.
Even if most people did believe us, it would be impossible to draw a hard line against those who stubbornly held out. Mass gatherings of any kind would simply designate themselves a “protest against injustice” — like this racetrack did for a racing day featuring 2000 people in the stands — and good fornicating luck getting a court to enforce an order against them after you let the protests grow to hundreds of thousands.
Screw these people. In almost a decade blogging, I’ve never said that about anyone, but screw ’em and the horse they came in on. Any epidemiologist or public health “expert” who encouraged people to protest is untrustworthy and should be totally disregarded going forward — as should anyone who cites them as authorities to impose new policies. To be clear: there’s nothing wrong with angrily denouncing George Floyd’s unjust death (and several other recent unjust police killings), nothing wrong from a public health perspective with saying “Black Lives Matter.” I don’t have any beef with the protesters themselves, who did have the right to make a judgment for themselves because they never campaigned against that right for everyone else.
But if you were a lockdown supporter who suddenly started saying that you support the protests, you should vanish from public life, because you’re a worse hypocrite than Newt Gingrich prosecuting a President for adultery.
So… what are we, on De Civitate, going to do about it?
We can’t do anything here without trustworthy data. I’m just some guy with a blog, not an expert in much of anything, and my function here is to distill large amounts of information down to something you can use. If my information is untrustworthy, then my blog is gonna be untrustworthy, too. I’ve relied on many of these faux-experts to inform me throughout this crisis: Dr. Angela Rasmussen, Obama CDC head Dr. Tom Frieden, Dr. Jennifer Nuzzo, Dr. Eric Feigl-Ding, Dr. Carl T. Bergstrom, and quite a few others. But I can’t anymore.
So what I’ve done is purged my source list. I am no longer getting information from any of these people, and I am discounting it when I see it in other media. For example, I have a public Twitter list which follows the accounts of just about every expert with useful insights into the pandemic. At the start of the week, there were around 40 accounts on this list. It’s down to 19. I’m not sure the purge is over, either. But the ones who are left have, so far, been solid. Trevor Bedford has been honest about the consequences of the protests without advocating one way or another for policies, as has been his practice throughout. Scott Gottlieb and Natalie Dean have done a great job condemning racism without endorsing protests that destroy the distancing measures they worked so hard to flesh out. Nick Christakis (whom you may remember as the guy that deranged Yale mob screamed at) has even politely but effectively critiqued the sudden about-face of so many epidemiologists.
So, while I’m getting much less information now, the information I get comes from people who appear to be honest brokers. They may be wrong, and probably will be, but they won’t lie to themselves — or to me.
Equipped once again with reliable facts, we may return to examining the pandemic. We still need to figure out what to do next. As society-wide social distancing comes to an end, why aren’t cases spiking? And how can we who have faithfully sheltered for months take advantage of that without danger? Those of us who are left will be lonely, with the covid-skeptics on the Right mocking us and the hypocrite-experts on the Left actively undermining us… but we’ll have a much better chance of being correct than we would in either of the Tribes. It’s always good to be correct. It’s especially good to be correct in the face of the deadliest infectious disease the world has seen in most of our lifetimes.
I know we’ve all been distracted by the riots (I know I have), but a lot more people died of covid-19 during the riots than were killed in the rioting. The new coronavirus remains our state’s biggest problem (albeit no longer our most urgent).
A couple of weeks ago, in a short piece called “Expected Daily Covid Deaths in Minnesota (May)” I grabbed the Minnesota Model source code, ran the model, and I told you how many people we expected to die of covid-19 through the end of May.
Well, May is now over, and we have our results:
Date
Projected Deaths
Actual Deaths
Before 13 May
557
614
13 May
29.0
24
14 May
30.3
25
15 May
31.7
20
16 May
33.1
17
17 May
34.6
22
18 May
36.1
9
19 May
37.7
17
20 May
39.3
29
21 May
41.1
32
22 May
43
33
23 May
45.2
10
24 May
47.6
17
25 May
50.5
12
26 May
53.7
18
27 May
57.4
33
28 May
61.4
35
29 May
65.9
29
30 May
70.7
30
31 May
75.9
14
TOTAL
1441.1
1040
As I wrote at the time,
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.
…If we end up significantly below this death toll (under 1100), then it means the model is missing something… 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.
Well, here we are. COVID-19 is not killing people as quickly as it “ought” to be. It’s still offing us at a good clip, to be sure, but the number has held pretty steady during a period when the number should have doubled. (Something similar seems to be happening with our overall case count, although I haven’t subjected it to rigorous analysis.) Why?
I don’t know.
Covid skeptics (who have been saying all along that covid was never going to kill that many people) have argued that, once we realized how many people had already had covid and how close we were to herd immunity, we would also realize that covid was never that deadly to begin with. The high-caliber gun who favors this position is John Ionnadis, but I find him unconvincing for reasons laid out here, here, and, quite loosely, here.
I still quite like the theory that, as summer approaches, covid is simply losing steam. This was a hope we had early on, which gradually faded, but maybe there’s something to it after all. The problem with this theory is that I have very little evidence to support it. It’s basically this Canadian study and not much else.
I don’t find it plausible that Minnesota is missing something like half of all covid deaths. I’m sure we’re missing some, but not to that extent.
I find it plausible but not likely that this was just an outlier outcome. The Minnesota Model always entertained substantial uncertainty, and maybe we just fell a little outside their 95% confidence interval, which should happen sometimes. But the reason we have those confidence intervals is precisely so that, when we fall outside them, we have a signal that something is probably wrong.
Another popular theory among the skeptics is that we aren’t properly adjusting our infection-fatality estimates based on who has mostly been infected so far, namely (according to covid skeptics) old people. I find this more plausible. First, we really don’t have a lot of details on the demographics of who has been infected so far — it’s been hard enough getting seroprevalence studies going that tell us how many people have been infected so far, period. (EDIT: We do have more details than this sentence misleadingly implies. See Minnesota’s infections dashboard, for example.) So there’s not a lot of evidence for this claim that I can find, but also not a lot of evidence against. Second, I find this plausible because a lot of the states with high death rates (including Minnesota) have had a terrible habit of shipping still-infected elderly people back to their nursing homes after hospitalization. And it seems to me, without looking at the figures too closely, that those states started seeing dramatic improvements in their death rates (vs. projections) as soon as they stopped doing stupid things to the elderly like that and started intense testing, tracing, and isolation within nursing homes.
If this hypothesis is true, it’s unclear what it means for the epidemic going forward — are nursing home patients developing herd immunity? Does that mean the epidemic for the rest of us isn’t coming, or is simply coming more slowly? How many casualties can we expect if previous fatality rate estimates were not properly age-stratified? (NOTE: it sure seems to me that previous case fatality rate estimates were properly age-stratified, thinking especially here of the Verity et. al. study that was treated as canonical for a number of weeks… but infection fatality rates maybe not, I’ll have to check.)
Bottom line, though: I don’t know. I just know that Minnesota’s model made a prediction about how this virus was going to spread through the end of May, and the prediction was wrong, which means one or more of its assumptions was wrong as well. No shame in that, that’s science — but we should figure it out as fast as we can, because, in this case, public policy does not have time to wait for the science process to fully play out.
It is inevitable that we will get some things wrong in our response to the pandemic, because we just don’t understand the virus very well yet… but there are enormous costs to getting them wrong, and we must change course immediately if it’s warranted.
Other Silver Linings
Having giant, non-socially distanced riots in the downtown streets gives us a pretty handy natural experiment in covid transmission. If our case load suddenly accelerates over the next three weeks or so, then that tends to confirm some of our fears about the virus. But if our epidemic doesn‘t accelerate, especially compared to other similarly-situated cities that did not experience riots, then that seems to confirm that outdoor transmission of covid is more or less impossible, at least in summer weather. If that happens, we should pretty much throw the idea of outdoor social distancing in the trash bin, reopen the pools, and go about our summer. (It’ll take more than that to make me feel safe indoors with strangers, though.)
Derek Chauvin, who killed George Floyd earlier this week, has been taken into custody and has been charged with third-degree murder and second-degree manslaughter.
My social media feeds immediately erupted with anger that the murder charge is third-degree rather than first-degree. There is a perception that Chauvin is facing a lesser charge than a Black person in his position would receive. Given the 2017 acquittal of Philando Castile’s killer, this perception is not baseless.
However, in this case, it is misguided.
I will focus on the murder charge, since that seems to be what is causing the anger. I’m seeing less discussion of the manslaughter charge.
Minnesota’s murder statutes are on the State Revisor’s website, for first-, second-, and third-degree murder. The Revisor is offline right now, no doubt due to everyone in the country trying to log in at the same time, so here is the Wayback Machine archive for first-, second-, and third-degree murder.
Now let’s walk through those links very briefly, without the legalese.
To be charged with first-degree murder in Minnesota (sentence: up to life), it’s not enough to have just killed somebody. The perpetrator must also be proved guilty of one of committing one of the following crimes during the killing:
Premeditation
Rape
Burglary, robbery, kidnapping, arson, witness-tampering, jailbreak, or certain kinds of drug sales
Killing a law enforcement official
Terrorism
Child abuse, if a “past pattern” of abuse against the victim exists
Domestic abuse, if a “past pattern” of abuse against the victim exists
While you can say many things about Mr. Chauvin, it seems clear that he was not trying rape Mr. Floyd, nor was he committing an arson, and it would be very hard to prove beyond a reasonable doubt that his killing of Mr. Floyd was premeditated. Therefore, a charge of first-degree murder is not supportable.
Second-degree murder (sentence: up to 40 years) requires one of the following:
Specific, clear intention to kill (not simply harm) the victim.
The perpetrator violated a restraining order
The perpetrator was committing a drive-by shooting.
The perpetrator was committing another violent felony not already mentioned.
Again, Mr. Chauvin doesn’t seem to be convictable under this standard. You can argue that, at some point in his long and awful knee-choke of Mr. Floyd, he made up his mind that he was going to kill Mr. Floyd, but I think that would be extremely difficult to prove beyond a reasonable doubt — and, if you charge him with second-degree murder and can’t prove your case, then he walks on the murder charge.
Third-degree murder (sentence: up to 25 years) requires one of the following:
Selling illegal drugs that later kill someone
An unintentional death caused by an act “eminently dangerous for others and evincing a depraved mind, without regard for human life”
Ding ding ding! I think you can probably make and prove a case in court that Chauvin’s knee-choke was “eminently dangerous,” that it was “without regard for human life,” and that it “evinced a depraved mind.” We have found the strongest crime under which Mr. Chauvin can be convicted under the laws of Minnesota.
For anyone concerned that third-degree murder is not punitive enough: it carries a sentence of up to 25 years. Derek Chauvin is, I understand, 44 years old, so any of these sentences would be fairly close to a life prison term. As someone who personally considers our prison system fairly brutal and our current sentencing rules considerably too harsh, I’m not inclined to see 25 years as too light a sentence.
Now that the government of Hennepin County is officially charging it as murder, we can refer to Mr. Floyd’s murder as “murder” without qualification or complication, at least until the court case is finished.
Many people are calling for the other three officers present at the scene to be charged with murder as well. I don’t see how that could happen, and, after walking through these statutes with me, I’m sure you see the same problem. The three officers who stood by and let this happen do not appear to have committed murder under Minnesota state law. But there are many, many other crimes in the lawbook, and one of them may fit the situation. Hennepin County Attorney Mike Freeman seems to think so, as he has stated that he anticipates charges in their case as well.
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 enoughmedical 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 youget 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.
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.
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 wouldnot 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.
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 getplenty 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”.
