COVID-19 Sitrep 4/12/2020

As of this writing we are closing in on 2 million diagnosed cases of COVID-19 worldwide (1,773,112 precisely) with more than 100,000 deaths attributed to the disease (108,471). The U. S. leads the world in number of cases diagnosed, number of deaths, and number of tests administered albeit not in number of cases per million population (San Marino), number of deaths per million population (also San Marino), or number of tests administered per million population (Iceland). Nearly all Americans live in states which have issued “stay at home” directives.

To my knowledge no one has taken any position on what level of compliance with such orders would be necessary for them to have any effect. It’s obvious to me at least that there is some level of non-compliance below 100% which renders such order moot. We’re not going to achieve a compliance rate of 100% on anything.

At this point I am convinced that South Korea, practically alone among countries, has actually managed to “bend the curve”. They have kept their new cases per day to from 25-55 for almost a week now. They have tested nearly 1% of their population, starting in late January, shortly after the first cases began to appear. Their response to the virus has been a combination of aggressive testing, follow-up, and tracing of all positives. IMO and, I believe, in the opinion of just about everyone with an open mind, it’s too late for that strategy in the U. S.

I should add that the differences between South Korea and the U. S. are stark. By comparison it’s small, compact, with generally high social coherence, and conformity with rules. South Korea is already exporting test kits albeit not in numbers sufficient to make a dent in U. S. requirements.

I see few signs of our bending the curve at this point and I think that the predictions I’ve heard of deaths per day peaking today are wishful thinking. In Nate Silver’s piece on ABC’s This Week I thought he was drawing conclusions far too sweeping based on too small changes over too short a timeframe. Reporting errors or delays could account for everything he’s seeing.

We don’t have enough tests or protective equipment yet. I wish President Trump were making more aggressive use of the Defense Production Act.

In the U. S. there are presently competing notions about how to proceed, largely drawn along party lines. I think that both extreme positions (test everybody and stay locked down until the threat passes vs. go back about your business as normal) are nuts. What I would prefer would be a highly organized systematic nationwide sample of tests used to inform lifting or tightening of “stay at home” directives and to optimize the still limited availability of resources. I would characterize such a plan as epidemiological testing. It should be accompanied by serological testing, with much the same objectives.

I am indifferent as to whether such a plan would come from the federal government, from the states working in cooperation, or from the private sector as long as it happens.

We should be paying more attention to the responses of other countries, not just South Korea but, importantly, South Africa. South Africa has put one of the strictest “stay at home” policies outside China in place along with aggressive testing, has a largely sub-Saharan black population, and has a pretty temperate climate, making a transition from its summer to its autumn. Running experiments are difficult in the real world but you can obtain helpful information from the experience of other countries if you’re willing to make a realistic assessment of the differences among countries.

I don’t think we’re receiving any information from China that’s worth considering and I don’t really think that we can learn much from the experience of ethnically homogeneous city-states or their equivalents but I wish that Americans including American scientists and physicians who should know better were not so dismissive of information gleaned from South Korea or any number of other countries with populations over 50 million.