In Minnesota, covid is climbing steadily back toward a new peak. Unless something about Minnesotan behavior changes within the next week or two, we are likely to surpass our April/May first peak in about a month.
However, for now, we aren’t there yet. Continue enjoying your summer safely. Squeeze in an outdoor cookout with 10 or fewer of your more responsible friends, go eat on the patio of that restaurant you love, continue not going to bars, and mentally prepare for the reality that life will likely become more restricted again as fall arrives.
A mask mandate is probably coming from Gov. Walz, and that’s probably good.
DETAIL:
As for the past several weeks, case counts continue to trend upward, but remain well below April/May peaks. This data lags by (in this case) six days.
“LTC” is short for “long-term care” (basically, nursing homes). These are non-LTC cases. As I state every week, 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.
In Minnesota, covid is still in a valley, not a peak, but there are growing signs of a second wave. Fortunately, the new wave is coming much more slowly than the last one, and it may still dissipate before developing into much of anything. Minnesota is by no means in the dire straits that some Southern states are currently in, nor is it likely to find itself in the even-more-dire straits that some of the Northeastern states experienced in April and May.
Continue enjoying your summer safely, with an emphasis on outdoor activities and small gatherings — but begin mentally preparing for a possible shift back toward a more restrictive outlook.
A mask mandate is probably coming from Gov. Walz, and that’s probably good.
DETAIL:
As last week, case counts continue to trend upward, but remain far below April/May peaks. This data lags by (in this case) six days.
As I state every week, 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.
The trendline is currently heading up after several weeks of steep decline, and that is bumming me out. On the graph, it doesn’t look like much, because the April/May peak was so much higher… but my estimate indicates that Minnesota’s case count bottomed out three weeks ago, on June 21st, and that the number of cases jumped 50% between June 24th and July 1st. That’s slower than the extremely fast spread we saw in late April… but, if we keep on this pace, we’ll get back to May/April peaks in fairly short order. Hopefully we won’t.
Here is the raw data I use to build this estimate:
I take great comfort from the fact that test positivity rates are still holding under 4%. The ideal is 2%, but 5% is the WHO’s official guideline. That means, even though covid is spreading faster again in Minnesota, it’s likely we’re still catching the majority of our covid cases. States like Arizona, with positivity rate over 25%, are likely catching fewer than 1-in-20 of their actual cases — which makes their high reported case loads all the more alarming.
Unfortunately, this is probably the last week we’ll be able to say that. Preliminary data for July 7th-July 12th is not included in these charts, because it’s preliminary… but I can already see that test positivity is going to be over 4% on at least two days next week. That means there will be a bigger gap between “officially reported” new cases and actual new cases.
Good news, though: hospitalizations are still flat, as they have been for nearly a month. Unfortunately, there are indications in the Southern states currently experiencing an outbreak that more cases is likely to lead to more hospitalizations, so we may see this number tick up in the next week or two — but we haven’t yet, and I’ll take that win.
This data is current as of yesterday at 4 PM:
Deaths, happily, continue to trend downward. This still appears to be simply because we’ve had fewer cases. Now that cases are going back up, we should watch out for deaths ticking up in 2-3 weeks… but, hopefully, the uptick will be just as slow as the growth in cases.
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.
Gov. Walz is expected to issue a mask mandate this week. I’ve said very little about masks on De Civitate, because I’ve been unsure of the benefits. I think it’s quite ridiculous how masks have been turned into a culture war totem — on both sides. The level of mask-resistance and mask-shaming has been absurd, given how little we actually know about masks.
Most studies out there tell us very little about the efficacy of homemade cloth face coverings, and quite a few blithely compare mask mandates in the United States (where nearly everyone’s mask is homemade) to mask mandates in East Asia, where every man, woman, and child walks around in a full-blown N95 respirator as a matter of longtime social custom. These are not apples-to-apples comparisons, and there’s good reason to doubt that masks are going to be all that useful. Our own Dr. Osterholm has made this point repeatedly, but it doesn’t seem to have sunk in with the general public.
I also acknowledge that a lot of people resist masks because they don’t trust the “health authorities” that support masks. That’s extremely fair. Both epidemiologists and the media have been extremely dishonest with the general public at various points in the pandemic. It’s funny when you think about it: 90% of right-wing “conspiracy theories” about covid-19 were mainstream dogma just 1-3 months ago, and you were mocked for doubting them. (I’m old enough to remember when it was the “public health authorities” who were saying “it’s just a flu” and that it was being exaggerated for political gain!) Now they want you to believe the new dogma is true?
You gave the authorities your trust, and they squandered it. However, I’ve always tried to be honest with you, and so have the few epidemiologists I still take seriously.
What they’re telling me, and what the studies I’m reading are saying, is that there’s pretty good reason to believe that masks — even homemade cloth face coverings — do some genuine good in preventing the spread of covid. That’s not a promise that masks will end the epidemic. It’s very clear that continued social distancing and avoiding indoor close contacts are more important behaviors. But, if, for the next year or so, everyone wears masks when in close contact with others, there’s a pretty good chance that will save several hundred (perhaps even several thousand) Minnesotan lives, and it may spare our economy the trauma of another lockdown.
Meanwhile, the costs of masking are very low. Masks are annoying, but so are pants, and I had to wear those to Menard’s even before the pandemic. I would much rather wear a mask than face another lockdown. One sizable pay cut per year is enough for me, thanks.
Because the cost is low and the benefit potentially quite high, I think a statewide mask mandate, renewable every 3 months for up to 24 months, is a good idea.
Four years ago, I confidently informed my readers, in several places, that electors in the electoral college had a solemn responsibility to vote for the American they consider best qualified, not the candidate their party has “pledged” them to. So-called “faithless electors,” I told you, were not faithless at all, but were fulfilling their duty to the Constitution.
I explained why this was the system the Founding Fathers had intended, I cited some solid scholarship in support of this position, and I was greatly heartened when, last year, the 10th Circuit Court of Appeals upheld my position in a landmark ruling.
However, this morning, the U.S. Supreme Court unanimously rejected my position. This is deeply disappointing, because restoring the proper function of the electoral college was one of the diminishing number of ways we might have been able to fix our broken government and electoral system. Of course, the Supreme Court often gets it wrong. Chief Justice Roberts, in particular, is an unprincipled dumpster fire. (Much as it pains me to admit.) But this decision was unanimous… and the devoted textualist Gorsuch, fast becoming my favorite justice, signed on to both opinions giving separate reasons why I was wrong. Maddening though it is, I find it (as usual) difficult to argue with Justice Thomas’s concurrence.
The Supreme Court did not deny that the Founding Fathers wanted a system where electors had freedom and discretion. They did not reject any of the reasons why that system was a good idea. I stand by those. They affirmed that states could give electors discretion if they chose, and I maintain that they should. But the system the Founders wanted is not necessarily the one they legislated, and the Supreme Court determined that the original public meaning of the Constitution does not guarantee discretion to the electors.
I told you otherwise way back when, and I must now retract those statements.
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.
