I was greatly frustrated by this column by Justin Fox at Bloomberg, trying to draw inadequate analogies between New York City and (among others) San Francisco:
As a Manhattan resident, I’ll be the first to admit that New York City in general and Manhattan in particular are not optimally designed for social distancing. People here tend to get around not in their own automobiles but on foot or by bus, subway, taxi or ride-share. We buy our groceries mostly not in giant wide-aisled supermarkets but in cramped little stores. We live cheek-by-jowl in apartment buildings, with elevators usually too small to accommodate the 6-foot rule. Most of us don’t have our own outdoor spaces, meaning that walking the dog or just getting some fresh air requires venturing out in public. And surely Manhattan is the only place in the U.S. where having your own washing machine is such a luxury that even lots of people in the top 10% of income distribution don’t (not because they can’t afford it but because their buildings ban them for fear of overtaxing ancient plumbing).
I am skeptical of the argument, though, that density equals danger in this age of Covid-19. For one thing, a bunch of East Asian cities even more densely populated than New York have successfully withstood the initial onslaught of the disease, indicating that well-conceived and well-executed public-health measures can more than counteract the disadvantages posed by millions of people living on top of one another. For another, New York City’s density is so anomalous in the U.S. context that I doubt its trials tell us much of anything about which other areas of the country are best equipped to fight off a pandemic.
What if population density is a factor but it isn’t the only factor? Consider this:
| New York | San Francisco | Wuhan, China | |
| February | 43° / 29° | 61° / 48° | 51° / 37° |
| March | 52° / 36 | 62° / 49° | 60° / 45° |
| April | 64° / 45° | 63° / 50° | 72° / 56° |
Those are median high and low temperatures for the three cities for February, March, and April. Need I pull out statistics that demonstrate that Los Angeles and Honolulu are both warmer than that? What if the key factors are population density and temperature? Or humidity?
I see all sorts of people wrapping themselves in the mantle of science and making sweeping generalizations. The reality is that we don’t know enough about the virus that produces COVID-19 to make such generalizations.
I don’t know that temperature or humidity have anything to do with the contagion at all. And I don’t think anybody else does, either, but it’s sure a tempting possibility.
What if none of the measures taken anywhere have “lowered the curve”? What if any curve-lowering is due to factors other than testing, isolation, or any other policy measures and all of the claims are simply post hoc propter hoc reasoning?
There doesn’t seem to be a big difference when you get to the hot and dry southwest. What if the disparity is simply due to random factors and patterns won’t show until the infection, sorry, death rate is several thousand times what it currently is?
Be sure to lower the lid on the toilet before you flush. Apparently the corona virus fecal plume will rise six feet and linger on surfaces for days. Just what I read.
We have a very long history of quarantine and isolation for handling contagious, infection disease. I think there is reasonable data to suggest that mitigation efforts work.
OT- Hope you dont mind, but not many people that i have seen are writing about what it is like caring for these patients. Our docs are working hard and we usually get enough credit. I dont think people really realize what the nurses and PCAs are going through. Our AP nurses, all of whom have prior ICU experience are helping in the ICU. Some of them haven’t worked in ICU in 15-25 years, however they are used to dealing with very sick pts and trauma cases. I talked with them to see what they are going through. I got most of the following from Stef, who I think is a nurse goddess. She is just wonderful.
She worked from 7PM-7AM. Took off her N95 once at 11:30 for a drink and again at 3:30 for a drink. That is it. Didnt eat and no break. She and a regular ICU nurse managed 6 very sick patients, all on multiple med drips that need to be monitored and changed depending on the status of the pt. (In normal times an ICU nurse has 2 patients) We are finding that the glucose levels are running high so they need sugars checked every 2 hours, then insulin adjusted. They need suctioning (lungs). They are being run on light sedative doses as heavier doses kill their BP and likely leads to long term cognitive issues. This means they often startle and fight the ventilator for a while. O2Sats drop so nurse needs to go settle them and work to get Sats back up. Some pts are worse about this and can need hours of attention per shift. Labs need to be drawn. Tubings need to be changed at least every 24 hours. (lots of tubing) Pts are on massive amounts of Miralax and other stuff to keep them from getting constipated. This means they all have diarrhea. So they get to clean sh*t every few hours on the patients. Then they have to turn them prone and back on a regular schedule to both help with he pulmonary issues and to decrease risk of pressure sores. Many of these pts are obese. Really obese. They do it with 2 nurses and a PCA. (It is a bit difficult to turn intubated people. If you accidentally extubate them while doing some chance pt dies.)
And they do it this while sort of being wrapped in plastic for 12 hours. And, she volunteered for this, and, she is looking forward to going back.
Dave- Dont mean to soapbox on your blog so just delete if you think this is inappropriate. Just felt like the least I could is tell someone what these people are going through. We really are throwing everything we can think of at these patients hoping something helps, but almost every medicine has some downside and creates its own issues.
Steve
Thank you, steve. Not only do I not mind, I welcome that. I am certain that the other readers of this blog are hungry for just this sort of frontline account.
“I don’t know that temperature or humidity have anything to do with the contagion at all. And I don’t think anybody else does, either, but it’s sure a tempting possibility.”
If it does, that virus is dead meat down here.
In any event, we are still making major policy decisions by anecdote.
We don’t know the CFR because the so called analytical validity of testing is poor. We have low testing percentages, especially of asymptomatics. True cause of death, state by state reporting discrepancies, proper test administration and transport issues all create noise in the data. Data are not age or quality of health system adjusted. Sampling bias. etc (SKorea is help up as a model – does anyone really believe the 30% mortality rate among 20ish yr olds?)
We have built a suspect data base and fed it into models whose predictions vary wildly based upon quality of inputs. What do we get? Draconian Imperial College or Fauci predictions………….soon withdrawn. Ooopsy. And draconian policy prescriptions with enormous costs as we thrash about.
It reminds me of an observation credited to a wise old chap: “The curse of me and my nation is that we always think things can be bettered by immediate action of some sort, any sort rather than no sort.”
“Draconian Imperial College”
It is a shame you are so embedded in the Trump cult that you just cant acknowledge that the original Imperial College model assumed there would be no attempt at mitigation or distancing. The revised estimate assuming mitigation was lower than the Fauci estimate. True cause of death is only an issue in Trump world. Doctors have been filling out death certificates for years.
“In any event, we are still making major policy decisions by anecdote.”
Actually by best available evidence, past experience and input from people who study these issues. We COULD wait for perfect data, but we would need a lot more body bags. (Oh sorry, unfair to point out people actually die.)
Steve
Smoking may be a contributing factor. Half of South Korean men smoke.
“SKorea is help up as a model – does anyone really believe the 30% mortality rate among 20ish yr olds”
If all of the 20ish year olds who got sick were former transplant or leukemia patients, yes, though more likely they just didnt test that many 20 year olds. But, it again points out that contrary to the initial narrative this is not something that affects only very sick people over the age of 80.
Steve
Just to clear the info.
South Korea has reported no deaths on anyone under the age of 30. The mortality rate of < 30 is therefore 0.
http://ncov.mohw.go.kr/board/doFileDownload.do?file_name=Press_Release_(April7)_Afternoon.pdf&file_path=/upload/ncov/file/202004/1586309793837_20200408103633.pdf&seq=3470
LOL, thank you CO. I sometimes, foolishly, take Drew’s rantings seriously.
Steve
The reported case fatality rate in S Korea is 29%.
In any event, steve are you really as dumb as some of your posts indicate?
Do you even realize that the policy I have been advocating is not the one Trump is following? Did that even occur to you when you reflexively pulled out of your ass your typical “Trump cult” tripe? “Trump cult” is so mindlessly robotic, steve. Intellectually weak. You don’t traffic in facts or reality, steve. Just partisanship. No serious person should take you seriously.
As for the technical note. All the models, now failing by multiples, assumed maximum social distancing. And all have overestimated despite that. The models, if not completely useless, have resulted in huge infliction of damage on the country. Cling to them if you like.