Coronavirus

United States Immigration and Customs Enforcement — the dastardly ICE, for those of you left-scrolling from home — has a surprisingly detailed Covid-19 dashboard (Tab 4). Notwithstanding our obsession with such things, we had not seen it before clicking through a link in an otherwise irrelevant Vox post.

The upshot is that ICE has been testing the heck out of the detainees in its facilities. As of September 11, there are only 20,138 detainees in ICE facilities (down from an average of >50,000 in 2019), and ICE has administered more than 35,000 Covid-19 tests. Recognizing that people cycle through these facilities at varying rates, it is safe to assume that ICE has tested a solid majority of its detainees during the last six months, and possibly the vast majority.

The agency has found 5,810 cases of Covid-19, for a “positivity rate” from testing at an ugly 16.6%. That is the sort of rate that gets journalists screaming at governors, fun banned, and schools firmly virtual.

But only 6 detainees have died of the Covid. That is a case-fatality ratio of… 0.1%. Compare that number to the observed case fatality rates in various countries, which are massively higher. The Covid-19 case fatality rate in ICE detention centers is right in line with the seasonal flu. That made us curious.

There might be several explanations for this. ICE facilities might have excellent health care. Well, maybe, but that would be a narrative-buster of the first order. Indeed, a recent whistleblower has contended that at least one ICE facility has under-reported Covid-19 cases, which would suggest an even lower case-fatality rate than indicated by the dashboard.

Perhaps ICE is under-counting Covid-19 deaths. Again, anything is possible, but the official ICE tally is qualified by a footnote which, again, points the other way: “Detainee deaths” includes detainees who have died after testing positive for COVID-19 while in ICE custody; COVID-19 may not be the official cause of death. That seems like a risk of overcounting, rather than undercounting.

Perhaps ICE detainees are in excellent health in general, and thereby better able to resist disease. The American Medical Association would not agree with that theory, but what do they know? Coastal elite experts, probably.

What about the demographics of the ICE detainee population? Those figures are hard to come by — ICE apparently does not provide them — but an outfit called Freedom for Immigrants came up with data on the age distribution of detainees in 2019 that provides at least a clue:

Through the same link, there seems to be data that says that the median age of people deported from ICE facilities is 30. By comparison, the median age in the United States is about 38. The population in ICE facilities, therefore, is almost certainly significantly younger than the United States in general.

Furthermore, eyeballing that chart above, the ICE facilities seem to have very few people over the age of 70, which represents the preponderance of Covid-19 fatalities in the general US population.

We lack both the inclination and the data crunching skills to line up the ICE fatalities against the US population case fatality rates, and in any case that is a fool’s errand, because (i) we don’t know the ages of the six ICE detainees who have died of Covid-19 to date, and (ii) it is obvious that most ICE detainees have been tested for Covid-19 while perhaps a quarter of Americans have been even now. We can say this, though, looking at the CDC data: As of a couple of days ago, only 1802 Americans under the age of 35 had died of Covid-19, out of 182,095 total dead for whom data had been collected. That’s out of 79,890 deaths from all-causes in the under-35 population of 149,554,018 during the same time.

In other words, if you are under 35 you had a 0.053% chance of dying of anything in the last six months or so, and a 0.0012% chance of dying of Covid-19. Your chances of dying of anything were 44 times your chances of dying of Covid-19.

Under 35ers may be anti-social — there’s a surprise — but they are not knuckleheads, no matter what Phil Murphy says. At least insofar as they have accurately assessed their own risk from Covid-19. From the very legitimate point of view of somebody under the age of 35, the policy and social responses to the pandemic have come at enormous cost in both fun and opportunity for virtually no direct benefit. To the extent that young people are trying to slow the spread of Covid-19 — and a great many of them are — they are sacrificing themselves to save the most vulnerable in our society.

From that perspective, willing or not, today’s young are the new greatest generation, not knuckleheads.

Nothing irritates the Covid-era chattering classes more than redneck mask deniers, so you damn well knew that the annual Sturgis motorcycle rally was going to attract Karens in the professoriate like, well, bikers to Sturgis. Faster than seems possible, a German think tank called the IZA Institute of Labor Economics pumped out a 63 page study, which we may read some day, that purports to show that 266,000 cases of Covid-19 stem from that rally. The study looked at anonymized cellphone location data, tracked the Sturgis migration and subsequent diaspora, and then calculated excess cases in the parts of the country to which the bikers dispersed. The study also estimates that all those Sturgis cases will end up costing more than $12 billion to clean up.

Here’s the more accessible write-up from The Hill for those of you who are as disinclined to read 63 pages as we are.

We have our doubts about cellphone location data studies — the University of Texas epidemiologists have been relying on such data for their own projections, which have been systematically overstated — but that is not the point of this post. Rather, we were riveted by this tidbit:

Health officials have linked at least one death to the rally: a male biker in his 60s with underlying conditions. At least 260 cases in 11 states have been officially connected to the rally by government officials.

Wait, what? Our many thousands of contact tracers have found a grand total of 260 cases, notwithstanding the headlined projection of 266,000 cases?

We respectfully suggest that either the IZA Institute of Labor Economics cellphone study is wildly wrong — by three orders of magnitude, seemingly — or our many thousands of contact tracers are a complete waste of time and money.

If you can think of a third explanation, please suggest it in the comments.

Our last post tackled various of the paradoxes embedded in the development of a Covid-19 vaccine, which in reductionist form come down to these two points:

• Setting everything equal, vaccine trial sponsors will be able to unblind their Phase 3 clinical trials and see if their vaccine is effective sooner if disease is spreading rapidly in the population in which they are studying their vaccine than if it is not. In other words, more cases now gets us the vaccine faster.
• Setting everything equal, vaccines that are less effective will get to a data “readout,” as the biotech folks say, faster than vaccines that are more effective. (The reasons for this are complicated and highly qualified, but the short version is that trials will be structured to read out when a set number of infection cases are registered, in the aggregate, in both the vaccine and placebo arms of the trial. If a vaccine is super effective, the vast majority of the requisite infections for a readout will have to come from the placebo arm. If it is less effective, there will also be a fair number of infections in the vaccine arm — even if still fewer than in the placebo arm — and those will help generate the requisite number of cases for the readout faster.)

With that background in mind, our love for the ironic and our fellow man leads to a number of assertions and provocations.

Assertion: Because Covid-19 is just not that dangerous for most people who get it, Americans are distancing, avoiding family and social life, staying out of crowded indoor places (meaning most fun places, plus church), and wearing masks only because they expect a technological solution — either a vaccine or a reliable treatment — in a matter of months rather than years. Vaccines have gotten by far the most attention, including from both the president and Dr. Anthony Fauci, so Americans are more focused on them than potential transforming therapies. So, it is only the prospect of a near-term vaccine that is sustaining all this social distancing, at least for the many people who are not at high risk of mortality or permanent consequences of Covid-19, or have not been scared in to thinking they are.

Provocation: Looked at this way, the Trump Administration’s Operation Warp Speed is the most important government policy sustaining American compliance, because it dangles the possibility of a near term vaccine. It, er, trumps all the bleatings of all the governors and mayors and scientists, which would not keep Americans away from each other and out of the bars — “Covideasies” would definitely become a thing — for very long if we did not expect a vaccine for, say, the usual 5-10 years.

Assertion: Donald Trump and Anthony Fauci have been more consistently aligned on the prospects for a near-term vaccine than on many, if not most, other issues. We believe that is because Fauci understands that hope for a vaccine is sustaining American social distancing. He probably also actually believes we will get a vaccine quickly, which certainly helps, but scientific reticence and regard for his own reputation might ordinarily restrain him from making aggressive Trump-esque predictions. We propose that Fauci has made those predictions because he believes that believing in a quick vaccine will help fight the disease now.

Assertion: As has been pointed out elsewhere, in the United States we have a profound division, aligned in large part by political tribe, about the purpose of social distancing, rules that shut businesses, and mask mandates. One camp, aligned with the left, believes that public policy ought to work almost without qualification toward the suppression of Covid-19 cases. This “disease suppressionist” camp believes that disease suppression is a necessary precondition to confident social and economic engagement. It further believes that disease suppression is sustainable for a long time via a regime of “testing and tracing,” whereby we test for the disease incessantly, and trace the contacts of people who test positive, presumably to isolate them.

The other camp, aligned with the right, are “flatten-the-curvists,” and believe that the point of social distancing during this pandemic, at least, is only to protect the capacity of the healthcare system to treat both Covid-19 cases and the usual diseases and injuries. The curvists do not support reducing cases of Covid-19 as an end in itself, believing both that “testing and tracing” will not work in the United States because people do not trust government and will not cooperate, and also that most people will in any case be infected eventually at little or no consequence before a vaccine becomes widely available. The curvists look forward to the day when enough people have had the disease or are otherwise immune that the chances that a still-susceptible person gets the disease in any encounter become very small. This is not the same as “herd immunity,” which is a mathematical concept, but the idea is that once infection has spread significantly in a population the number of new cases will dramatically decline regardless of government policy. A leading thoughtful articulation of this position is here. It is a long read, but worth your time.

Provocation: Disease suppressionists want to stamp out community spread of the disease over the long term, but if their policy were implemented and successful in the United States there would be no chance for vaccine Phase 3 trials to read out on anything like the promised schedule. If the political support for disease suppression is in part predicated on the hope for a vaccine sooner than the usual 3-5 years, then disease suppression is an inherently self-defeating policy because it delays vaccine trials.

When we have pointed this out to suppressionists in friendly social media interlocution, they have usually asked whether we could suppress cases in the United States and sponsor vaccine trials in other countries, such as Brazil, that have allowed Covid-19 to spread wildly. While such free-riding on developing world misery might deliver vaccine data quickly, it carries with it a host of practical and moral questions. Among them, would Americans then have the same claim on the first doses of the vaccine, either morally or lawfully? And — sometimes we crack ourselves up — do these mostly left-wing suppressionists who advocate doing vaccine trials elsewhere have a good justification for their rank neo-colonialism?

No, actually that is a real question.

Assertion: If you need spreading disease to conduct an adequate vaccine trial, how is China, which claims to have suppressed the Wuhan virus virtually out of existence, conducting vaccine trials? Partly via the aforementioned neo-colonialism:

Ironically, China is not in a position to test the vaccines on the required scale at home because it’s been so successful at containing the spread of the virus within its borders…

…China has already confirmed it is involved in official, advanced trials of a vaccine on thousands of people in countries including the UAE, Peru and Argentina.

This, however, is the seriously Commie part:

Then there’s unpublicised trials. In what appears to be linked to the emergency powers vaccination experiments, and not the official phase three trials, a group of Chinese miners were refused entry to Papua New Guinea recently after their employer revealed it was using them for vaccine trials.

Some 48 workers were injected in early August, according to a statement from the Chinese state-owned company that runs the mine in the Pacific islands nation.

The PNG authorities were concerned they’d been kept in the dark and that some of the workers may have tested positive for Covid-19.

Now, we are not against running clinical trials in special situations, such as on the employees on the insides of mines. Meat-packing plants or college campuses might be good places to recruit for vaccine trials. However, one might not be faulted for wondering, you know, out loud, whether such imperialist running dog niceties as informed consent mean anything at all when the employees in question work for a business owned by a police state.

Provocation: As the linked article makes clear, the Chinese are very interested in using their vaccine for their virus for geopolitical gain. We’ll say it: We guess that in addition to taking “volunteers” from state enterprises, the Chinese are conducting “challenge trials,” in which vaccine trial subjects are deliberately exposed to the disease. Challenge trials are rarely ethical in running dog countries, but we doubt that a Chinese institutional review board would have many qualms about approving them to speed a Covid-19 vaccine program that is an important project of the state.

Hey, wait a minute! Concentration camps are famously useful for human experimentation. How convenient that China has a few.

Moderna, Inc. today announced outstanding early data for its Covid-19 vaccine candidate, in a trial led by the National Institute of Allergy and Infectious Diseases (most Americans will recognize NIAID as Dr. Anthony Fauci’s agency), which is part of the National Institutes of Health. Key points from the press release follow, with some plain English translation.

Dose dependent increases in immunogenicity were seen across the three dose levels, and between prime and boost within the 25 µg and 100 µg dose levels. All participants ages 18-55 (n=15 per cohort) across all three dose levels seroconverted by day 15 after a single dose. At day 43, two weeks following the second dose, at the 25 µg dose level (n=15), levels of binding antibodies were at the levels seen in convalescent sera (blood samples from people who have recovered from COVID-19) tested in the same assay. At day 43, at the 100 µg dose level (n=10), levels of binding antibodies significantly exceeded the levels seen in convalescent sera. Samples are not yet available for remaining participants.

At this time, neutralizing antibody data are available only for the first four participants in each of the 25 µg and 100 µg dose level cohorts. Consistent with the binding antibody data, mRNA-1273 vaccination elicited neutralizing antibodies in all eight of these participants, as measured by plaque reduction neutralization (PRNT) assays against live SARS-CoV-2. The levels of neutralizing antibodies at day 43 were at or above levels generally seen in convalescent sera.

Translation: The trial is looking for the best dose, and tested three dose levels on 15 patients each, for a total of 45 patients, two administrations of vaccine for each. Every patient developed some antibodies within two weeks of the first dose. Eight patients progressed to 43 days, which is two weeks after the second dose, and all 8 developed antibodies at or higher than levels seen in patients who have recovered from Covid-19.

The vaccine candidate was generally safe and well-tolerated, and a Phase 3 trial (the trial designed to prove safety and effectiveness to statistical significance, which is needed for regulatory approval) will begin in July.

For those of you for whom hope is a strategy, which is most of us, this news is very good.

The prospects for a vaccine against Covid-19 are very good, hedging about the durability of immunity notwithstanding. There are more than 100 other programs working on Covid-19 vaccines around the world, and tremendous pressure, including geopolitical competition, to get to the finish line first.

Following, a fair use excerpt from a Wells Fargo analytical report on vaccine programs (sadly, no link):

Summary. This is the inaugural issue of our Covid-19 Vaccine Tracking Report. In this report, we are tracking a select set of vaccine candidates targeting the novel coronavirus designated SARS-CoV-2. These candidates must meet three criteria: (a) currently in human
clinical trials, or with imminent starts, (b) sufficient capitalization to
carry through multiple R&D stages, and (c) partnerships or
manufacturing plans to credibly release substantial quantities of
vaccine within the next year.

Current Situation. Well over a hundred Covid-19 vaccine candidates
are in various stages of research and development. These vaccine
candidates target the SARS-CoV-2 virus, typically one or more aspects
of that virus’s spike (S) protein. Virtually every vaccine type that has
ever succeeded with some other pathogen (e.g., inactivated, subunit,
vectored) or is viewed as promising new technology (e.g., DNA, mRNA) is being explored. Our three criteria lead us to track ten vaccine candidates being developed by BioNTech, CanSino, Inovio, Johnson & Johnson, Moderna, Novavax, Sanofi, Sinopharm, Sinovac, and the University of Oxford (alphabetically by sponsor)….

Timing: We anticipate that positive data at end of phase 2 trials could
be sufficient to trigger EUA [Emergency Use Authorization] status with national regulators. Based on public statements to date, this could be as soon as late 2020 for several of the candidates. At present, JNJ and SNY project later trial starts and thus later EUA decision points. Presumably, those two companies are assessing how to compress their own development timelines. Once products are distributed under EUA status, some of the highest risk populations can be offered some degree of protection. Meanwhile, data collection will continue, even as distribution broadens, to build the evidence base that would warrant full reviews and approvals from FDA, EMA, and their counterparts
around the world.

For whom: We expect initial supplies of Covid-19 vaccines to be focused on people at highest risk of infection or essential to community function. Some of these will be occupational groups (e.g., healthcare workers, first responders, grocery-store workers, schoolteachers). Others will be social groups (e.g., nursing-home residents, seniors, communities with high attack rates). Starting points for prioritizing vaccine distribution will be similar to those used in previous vaccine shortages (e.g., influenza vaccine in 2004 and 2009)….

Assessment of Production Capacity. Ideally, to assess leading manufacturers’ plans for Covid-19 vaccine production capacity, each company would describe a common set of production goals and corresponding dates. For example, doses to be produced through December 2020, as well as goals for doses per month to be released in June 2021 and in December 2021. In reality, the companies’ public statements provide varying levels of detail, tempered by uncertainties inherent to technology transfer, industrial scale-up, facility repurposing or construction, dosing requirements not yet settled, regulatory approvals, and related factors. A major source of uncertainty will be resolved for each candidate once the human dose is set for the phase-3 trials of vaccine efficacy. The quantity of protein per dose bears directly on how many doses can be produced from any given manufacturing asset (e.g., fermenter).

Bold emphasis added.

The very last point provides some important context for the Moderna trial discussed at the top of the post. Why not just go for the highest safe dose to get the most robust antibody levels? Because that will slow down production and delay vaccination for millions of people. The dose determination needs to be optimized, not for profits — although we certainly expect some ignorant sniping in that direction once the popular press starts focusing on dosing decisions — but to maximize the number of people who can get the vaccine, even if some of those people will not develop antibody levels that confer perfect immunity. Whether there is a magical dose level for any safe and effective vaccine that reliably confers immunity and allows for grillions of doses very quickly remains to be seen.

Stay tuned.

In dramatic lore (and great sportswriting), the Four Horsemen are Famine, Pestilence, Destruction, and Death. In St. John’s original construct, “War” stands in for Destruction. We prefer Destruction, because it captures the many types of war not imagined in Biblical times.

This morning we reread the first paragraph of Barbara Tuchman’s classic work on the worst century in Western history, A Distant Mirror: The Calamitous 14th Century, reproduced below. Tuchman proposed seven horsemen:

Plague, war, taxes, brigandage, bad government, insurrection, and schism. Broadly defined, we’ve got six of them running around the United States right now. “Brigandage,” which involves unemployed soldiers gallivanting around the countryside looting the undefended and disarmed locals, is common in the world but has not been a feature of American life since the years following our Civil War, no matter how you might characterize gun rights demonstrations of recent moment or the violent crime of the ’60s to the ’90s.

Plague? Check. Not literally “plague,” of course, which is a specific disease with a precise cause and an effective remedy, but plague in the sense that people who do not consort with medievalists or infectious disease experts use the word.

War? Nineteen years and running. We even confess to having supported those wars once upon a time, which is more than most people will admit. My guess is that nobody will care so much about terrorism now, so maybe we should generally withdraw and let all those people resume killing each other. But what about “Destruction”? We have made a policy decision (which we admit we supported, for a while) to destroy our material well-being to save lives from plague, and there are those who argue that we need a good deal more destruction still. Maybe that policy choice is yet the most cost effective — we won’t know for several years which choices were best — but all Americans, including especially the WFH overclass, ought to have the courage to call it by its name: Destruction.

Taxes? They are coming hard. Beautiful taxes like you’ve never seen before, in every American jurisdiction.

Bad government? No matter who you are, you have your favorite examples. As we have pointed out, everybody agrees that there have been massive failures of government in the United States. One’s opinion as to the cause of those failures is a Rorschach test for one’s pre-pandemic predilections.

Insurrection? We are closer than we have been for some time. Google “defies.” We have hair salon owners defying judges, mayors defying governors, and governors defying the president, all of which seems weirdly reasonable under the circumstances. Nobody is shooting yet, but we are one out-of-proportion bad judgment enforcement action away from another Ruby Ridge or Waco. Brace yourself for the “national conversation” about that.

Schism? The Papal Schism of the 14th century was so scary because each pope excommunicated the followers of the other. When one believes that this life is the misery one must endure for immortal paradise, excommunication is the equivalent of killing one of Tolkien’s Elves. The loss of immortality is a tragedy greater than mere mortal death, because the sacrifice is so great. Our schism today, which involves profound contempt verging on unqualified hatred for people who have a different vision of the meaning of the United States, destroys the purpose of our country, unique in the world, that moved our extraordinary ancestors to overcome challenges vastly more difficult than Covid-19. That is, or would have been to many Americans of old, a tragedy greater than mere mortal death.

The most profound sentence in Tuchman’s first paragraph may, unfortunately, be the last: “All but plague itself arose from conditions that existed prior to the Black Death and continued after the period of plague was over.”

Let us hope that history does not repeat itself.

We’ve been wondering about the effects of Vitamin D, which one mostly gets more of by exposure to sunshine, on Covid-19 mortality. Yesterday saw new news from Trinity College in Dublin on the point:

Whereas there are currently no results from randomized controlled trials to conclusively prove that vitamin D beneficially affects COVID-19 outcomes, there is strong circumstantial evidence of associations between vitamin D and the severity of COVID-19 responses, including death.

Here’s a recent study from Northwestern that points in the same direction:

Backman and his team were inspired to examine vitamin D levels after noticing unexplained differences in COVID-19 mortality rates from country to country. Some people hypothesized that differences in healthcare quality, age distributions in population, testing rates or different strains of the coronavirus might be responsible. But Backman remained skeptical.

“None of these factors appears to play a significant role,” Backman said. “The healthcare system in northern Italy is one of the best in the world. Differences in mortality exist even if one looks across the same age group. And, while the restrictions on testing do indeed vary, the disparities in mortality still exist even when we looked at countries or populations for which similar testing rates apply.

“Instead, we saw a significant correlation with vitamin D deficiency,” he said.

Google yields more such early data.

Now, in the United States there is a huge range in mortality rates from one state to the next. Using the Worldometers data from yesterday, in the 20 states with the most confirmed cases the mortality rate ranges from 1.67% in Tennessee to an astonishing 8.97% in Michigan. Even a few weeks ago, these disparities were easily dismissed as an artifact of testing rates — some states had high mortality rates because they had insufficiently tested and therefore the denominator was artificially small, the argument went. As testing has risen in to the hundreds of thousands even in the smaller of these Top 20 states, that explanation is weakening.

So why the huge differences in mortality rates?

We compared the mortality rates in the Top 20 states and their average hours of sunshine per year. The results were interesting, albeit subject to the qualifications below the scatterplot:

We did adjust the data in one respect: New York’s “hours of sunshine” calculation was based on readings in Syracuse, which is a very gloomy place. Since most of its deaths are in the tri-state region, we used New Jersey’s number for New York, which is probably a decent quick and dirty correction.

Obviously, there are many limits to this approach, the first being that hours of sunshine in a state is only a very loose proxy for Vitamin D levels. The actual Vitamin D readings for hospitalized patients who do and do not die would tell us a lot, and even better would be the levels from a sampling of mildly symptomatic or even the famous asymptomatic cohort.

There is also the problem that we used the annual hours of daylight, rather than during the two months during which the Covid-19 deaths actually occurred. We reason that the correlation could actually be stronger if we had the urge to unpack the sunshine data for those two months, insofar as many of the high mortality states in the north probably accrue most of their sunny hours in the summer and fall rather than in March and April, but who knows?

No doubt actual scientists could think of many other wrinkles. Regardless, understanding the massive differences in mid-pandemic mortality rates between American states will be fodder for countless graduate students in the years to come.