Keep the Folks Terrified

The NY Times seems to have taken the role of the promoter of abject terror amidst this pandemic. The most reckless one in my opinion is the current article stating that a vaccine will not be available until May 2036. Yes, you heard it, shelter in place for the next sixteen years!

Perhaps the Pulitzer Prize winner should glance at the pictures in Nature. They are cartoon like and may be simple enough for the writer.

Let's take AIDS/HIV. AZT came out in 1987 just 7 years after the Air Canada Patient Zero started his spreading around. That was on top of the fact that the basic science was still in its infancy. David Baltimore had done seminal work on reverse transcriptase but was sidelined by Congressman Dingell in the Congressman's pursuit of haughty scientists. Imagine if there were no Dingell, but I leave that to the imagination.

So from the first infection to the FDA approval was seven years, yet it was not really till 1985 that the epidemic hit full steam.

Go back to polio, for those of us old enough to be part of the Salk vaccine children, that took just a couple of years.

Now what in God's name will take 16 years? Lots of graphics but in my opinion and in my experience no real facts.

This will reverberate for a while and add another layer of terror, perhaps another Pulitzer....

NJ 2020 04 30

Sometimes the data makes no sense. Here we have the deaths for what is supposed to be the past 24 hours. I have been tracking the local OEM reports which also complain about the inconsistencies.

I truly think the data is grossly distorted. This is a massive increase in deaths compared to a massive drop on the weekend. This means to me that the data is grossly corrupted and of little if any use. How is the State to make any decisions based upon this nonsense.

The above is the total testing positive.

The above is the town. One suspects that even here we have a large delayed contribution from Nursing Homes since we have quite a few.

In contrast we have the 14 day running average continue to be negative.

The above is the state prevalence and

the above is the county. Note the continued decline.

The current town stats for the county are above. Again two towns dominate. One epidemiologically should be asking why.

The above is the growth in towns over the tracking period. Most cluster at the bottom. There are per PoP numbers and Dover is a massive outlier dominating all others. Again we ask why?

The above is the 14 day change for state and county. Again we seem to be doing well.

We are now left with the following questions:

1. Why are some towns so bad off when adjacent are not. What is the driver?
2. Why should we not see a dramatic decrease since we have been at this for 7 weeks and that is more than enough to see a sense of closure of the infection. What is keeping it alive?
3. The death rates are massively misrepresented. Why and how do we reflect the truth.
4. If decisions are made on date, call it science if you must, what data are we making them on and how reliable is it?
5. Why is there no transparency with Government?

Overall any recovery must be based on facts and unfortunately the state lacks any such reliable facts. The Gov's committee to open the state appears to lack the competence to achieve this in my opinion. This gross level of incompetence may doom the state in the long run.

Everything is New Again

In the book by Randy Shilts, And the Band Played On, detailing the AIDS epidemic, the author recounts (p 299-300) the release by the AMA of a notice regarding the infection of infants as another path of AIDS transmission. The nature of the infection was assumed by the researcher to be from mother to child in utero, not by a transmission of other means. Shilts writes: 

AMA News Release  For Release Friday, May 6, 1983  EVIDENCE SUGGESTS HOUSEHOLD CONTACT MAY TRANSMIT AIDS Chicago—Evidence suggesting that Acquired Immune Deficiency Syndrome (AIDS) can be transmitted by routine household contact is presented in this week’s Journal of the American Medical Association. James Oleske, MD, MPH, and colleagues report eight cases of otherwise unexplained immune deficiency syndrome among children from the Newark, N.J., metropolitan area born into families with recognized risks for AIDS.“Four of these children have died,” the authors report. “Our experience suggests that children living in high-risk households are susceptible to AIDS and that sexual contact, drug abuse or exposure to blood products is not necessary for disease transmission.” Commenting on the study in an accompanying editorial, Anthony S. Fauci, MD, of the National Institutes of Health, points out, “We are witnessing at the present time the evolution of a new disease process of unknown etiology with a mortality of at least 50 percent and possibly as high as 75 percent to 100 percent with a doubling of the number of patients afflicted every six months.” At first the disease appeared to be confined only to male homosexuals, he adds. Then it became clear that IV drug users also were susceptible, and after that the disease was found among Haitians and hemophiliacs, the latter apparently exposed through transfusion of blood products. The finding of AIDS in infants and children who are household contacts of patients with AIDS or persons with risks for AIDS has enormous implications with regard to ultimate transmissibility of this syndrome,” Fauci says. “If routine close contact can spread the disease, AIDS takes on an entirely new dimension,” he adds. “Given the fact that incubation period for adults is believed to be longer than one year, the full impact of the syndrome among sexual contacts and recipients of potentially infective transfusions is uncertain at present. If we add to this the possibility that nonsexual, non-blood-borne transmission is possible, the scope of the syndrome may be enormous.” 

The author continues:

Arye Rubinstein was astounded that Anthony Fauci could be so stupid as to say that household contact might have anything to do with spreading AIDS. Rubinstein had never been a great admirer of New Jersey’s Dr. Oleske; they had antithetical views of AIDS in children. To Rubinstein, the mode of transmission was fairly obvious and fit quite well with existing epidemiological data on AIDS. The mother obviously infected the child in her womb. The fetus and parent shared blood as surely as an intravenous drug user, hemophiliac, or blood transfusion recipient. The fact that none of the infants in Oleske’s study were over one year old reinforced this notion. In order to interpret this data to mean that “routine household contact” might spread AIDS, an entirely new paradigm for AIDS transmission was needed. Rubinstein’s paper explained it all very easily, though the Journal of the American Medical Association seemed more enamored with Oleske’s specious analysis. In fact, the journal editor at first returned Rubinstein’s paper with the section on intrauterine transmission crossed out. The paragraphs had only appeared because Rubinstein had insisted that they be retained.  What was Fauci’s problem? Upon investigation, Rubinstein learned that Anthony Fauci had not bothered to read his paper [I presume Shilts means Rubinstein’s paper] before writing the editorial. Instead, he just read Oleske’s conclusions and started running off at the mouth.  

 One finds this rather interesting. We see a great deal of this again today. When we hear politicians state they want to have a "playbook" so what is currently happening does not happen again, one wonders if anyone remembers the AIDS epidemic.

NJ 2020 04 29

We start with the 14 day average change. Note that it continues negative for the County as well as the state since 20 April. Again we have not metric from the State to tell anyone what is in their Three Card Monty scheme for resuming anything. I am reminded of Randy Shilts book And the Band Played On regarding AIDS in the early 1980s. In a very similar manner the Government said things but managed to always prove itself incompetent.

Again we show the death count above. The pattern is clear. Little reporting on weekends and a slow roll out of the unreported during the week. This makes any data useless.

The total continues to rise but we are beyond the inflection point. Any epidemiologist worth their salt would now be asking what the causes of the new cases were. After six weeks of lockdown we can or should be able to clearly identify the nature of the new infections. The public should/must be informed. Yet we hear nothing. The echos of Shilts and AIDS ring soundly.

The county 14 day running averages continue negative,

the county prevalence goes down

as does the state. Yet we really should be understanding why still a slow decline. Is it the nature of the infection or truly new infections which we must identify the transmission path. One wonders if anyone is home here!

The doubling time is well above 40 which makes this seem chronic not acute. Hint!

Finally we see a 1.3% penetrance of recorded infections. However we seem to be clueless as to the real prevalence of infected, with symptoms, without, or post infection.

My concern is that the Gov's orders of mandatory state quarantine of anyone deemed infected will drive those with symptoms underground. One truly wonders if they thinks of the consequences. Not to mention the legality.

Amazon: Disintermediation and the Pandemic

An interesting thing happened on the way to the pandemic. I could almost always get whatever I needed on Amazon and for the most part it arrived when they said it would, most of the time.

Since the beginning of this pandemic things have changed, dramatically. Now they tell you that it will take a month, or the say it will arrive and then never does, or they will not sell it to you, etc.

So what? Well as it turns out I have Walmart. Staples, Home Depot and others who will ship, on schedule and free. I found I really do not need Amazon. Also if it is a book, the publisher will sell it to me at the same price and free shipping. It may take a few days but I am not in a rush to get my update on monoclonal antibodies.

Surprise, I can live without Amazon. I wonder if they know that there are lots of Plan Bs? I would be a bit worried if I were Bezos.

NJ 2020 04 28

First we start with what the Gov states is the opening data set. However he never seems to give the data from his perspective so we use the data and do the chart.

Note that Morris has a 14 day negative for 12 days. So what else must the county do? How long must we wait? He wants to quarantine the sick in State institutions leading to God knows what. Free Morris!

The county prevalence drops

the state prevalence drops

The state death rate skyrockets but that is standard messed up data! How in God's name are we to make decisions when data is so messed up. Just look at every weekend. The curve is periodic. I will do an FFT to prove it. Every Tuesday report explodes after a Sunday/Monday collapse. Garbage in and Garbage out!

The doubling time is excellent, the virus is dying out.

The prevalence vs distance from Manhattan is holding up.

The prevalence vs population density also holds up quite well.

Bottom line. If we are to do anything we need honest data not the junk we seem to be getting from the state. Is anyone there or does the Gov want to close the state permanently!

The Plan?

We think it is worth a bit to examine the New Jersey Governor's proposal to reopen the state. Let us go down each step.

Principle 1: Demonstrate Sustained Reductions in New COVID-19 Cases and Hospitalizations

• 14-day trend lines showing appreciable and sustained drop in cases, hospitalizations, and other metrics;

• Hospitals stepping down from functioning under crisis standards of care.

Now as we have been saying for two months, we need metrics, numbers, which we can attach to the process. The problem in the above is twofold. First as we have noted again and again there is no reliability, consistency credibility in the numbers provided. I have given a multiplicity of examples, the death total being a prime example. Second, just what number are we focusing on. This proposal is vague and lacks and form of transparency even if the numbers were valid. We have done a multiplicity of 14 day trends and all seem to be well into the negative range. But, alas, that uses the poor numbers and the metrics I chose. What is the Governor choosing? He is, in my opinion, playing Three Card Monty as are most politicians since they do not have a clue. Finally transparency is critical. People must see the numbers day by day, they must have access to the details, subject to HIPPA, and this Three Card Monty scheme of the government must disappear. Otherwise there is no trust, and people are losing trust very quickly.

By the way, here is the data for New Jersey and Morris County with a 14 day running average by day for changes in new cases. I wonder if this is what they want to measure, if so Free Morris!

If numbers count then what are we counting?

Principle 2: Expand Testing Capacity

• At least double current diagnostic testing capacity;

• Prioritize testing for health care workers, essential personnel, and vulnerable populations;

• Create a flexible testing plan accessible to all residents;

• Expand partnerships with institutions of higher education, private-sector labs, and the federal government.

• Ensure that those who test positive are linked to a health care provider.

This is a no-brainer. I had thought that Rutgers, the state university, had developed and implemented just such a test. If so then where is it? I suspect it is just another academic public relations push, then disappears into the land of being the unreproducible. But apart from that as we had suggested more than a month ago the ability to get testing kits sent to a home, on site testing, drug chain testing and the list goes on. This above looks like some McKinesey chart I have seen many times before. Lots of words and no specifics. The answer is simple; just do it, don't chart it.

Principle 3: Implement Robust Contact Tracing

• Recruit and deploy an army of personnel who will identify and follow-up with contacts;

• Leverage technological data and innovative solutions to increase efficiency;

• Coordinate the approach of local and state health officials, which will have a coordinated county/regional component.

The "army" quote is terrifying. Yes contact tracing must be done, as we do in many highly communicable diseases. Technical approaches are many, none yet proven, and we have discussed these at length months ago. Each has strength and weakness. One should recall how we tried all of this during the AIDS epidemic and there was a bit of a revolt. Perhaps it may be even more of a revolt here as well.

Principle 4: Secure Safe Places and Resources for Isolation and Quarantine

• To the greatest extent possible, provide individuals who do test positive in the future with a safe and free place to isolate and protect others from COVID-19;

• Ensure that quarantined contacts are provided supportive services, if needed.

This one is terrifying, truly. Do they mean that if one tests positive then "shelter in place' of whatever must be abandoned and the state comes in and takes you to a state run quarantine. That in my opinion is a death sentence and hopefully the Constitution still holds sway somewhere. Although one wonders as politicians get more and more power. Quarantine is a term of art. Here the term of art seems to expressly imply depriving an infected person of their freedom without due process and sending them to a quarantine camp, most likely to die. I believe we fought a World War against such people, if memory serves me correctly. Also if people see this putative death sentence if they get tested, then testing may fall by the wayside, since if you get tested and are positive, well you know the answer now. Also, perhaps then the state will demand that everyone be tested, and those they deem positive, and yes there are false positives, are taken from society and sent to the quarantine camps. I wonder who wrote this recommendation?

Principle 5: Execute a Responsible Economic Restart

• Create the Governor’s Restart and Recovery Commission to advise on the process and recommend responsible

and equitable decisions;

• Plan for a methodical and strategic return to work based on level of disease transmission risk and essential

classification;

• Continuation of social distancing measures where feasible and appropriate;

• Leverage any available federal funds and programs to support health care, individual, and small business recoveries.

The above seems to be the prototypical palaver of the politicians. First thing to do when you have no ideas; create a commission.

Principle 6: Ensure New Jersey’s Resiliency

• Learn from the lessons of COVID-19 and prepare for the possibility of a resurgence;

• Ensure hospitals, health care systems, and other health delivery facilities have inventories of personal protective

equipment and ventilators;

• Build our own state personal protective equipment and ventilator stockpile;

• Create a playbook for future administrations for the next pandemic.

Simply stated, the above seems to say that the state should not be caught with its trousers down again. Good idea.

NJ 2020 04 27

Here we go again. Remember that this is day from Sunday at best and often it is often grossly distorted especially in deaths. We start with totals:

Now the deaths are still low but that is a weekend phenomenon.

The county prevalence is dropping:

as well as the 14 day lag numbers:

The above shows a good lag factor but it is slowing due to the slow decline in prevalence.

The above is the doubling time by county. Many are now well above 40 days!

The above is doubling by state and date and we are doing quite well

the above is the county by date. We seem to be getting out of the problem quite well.

this is the 14 day change showing one county with problems.

Finally the mortality by cause as of today.

Shelter in Place - Back Then

Here is an old example showing Dads can "shelter in place" or whatever. I am doing the boards prep while my prep partner is downing a muffin from Pewter Pot.

NJ 2020 04 26

We start with a comparison. The above is the number of deaths per year in NJ from various causes. I have added COVID, Now the data is from 2017 and perhaps many of the COVID deaths would have occurred anyhow but have been classified elsewhere. However the current number ranks thirds as of today.

The above is the total number

and reflected above in 1.2% of the population diagnosed with COVID disease, namely symptoms.

Mortality is above. Unfortunately as we have noted every 7 days on weekends reporting is recklessly deficient and thus we may think things get better and then worse when in reality it is the State's reporting incompetence. If the Gov ever wants to reopen the state based upon facts as he alleges then get the facts correct.

Morris has a long run of negative 14 day rates. This is a reasonable metric but since the Gov fails to provide the target metric we remain in the dark.

the above is state prevalence, plateauing, and

the county above.

One may ask why the plateau? What is the phenomenon that is driving this? Is it the Typhoid Mary syndrome as we suspect, namely infected but without symptoms. I suspect it is that and the carriers are 10-15 year olds who are in large groups and then carry the infects home. I see this especially in Madison where there is not apparent attempt to control.

Past is Not Prologue

In 1940 as WW II was breaking out universities like Harvard and MIT came to the fore to assist in the war effort. Students enlisted in such things as the NROTC and Harvard's alone sent many men to the ensuing conflict. MIT established the Rad Lab in wooden shacks built on the campus, where my own office was in the late 1960s, and MIT recruited some of the best minds to address the issue of radar and building systems to protect the ships that many of the Harvard men sailed in.

Men like Conant, Killian, Vannevar Bush, Oppenheimer, and many others were assembled to lead, manage, direct in a timely and effective manner all of the tasks necessary to win the conflict. For the most part these men volunteered their services to the good and survival of the country, setting aside any political considerations and recognizing that democracy and the American way of life was all too important.

Radar and its related systems were built and the assembled by a team of individuals chronicled in the classic Rad Lab series of books, whose use remains even today, some seventy-five years later.

Now in stark contrast one wonders what has befallen the people in the very same positions today. For both Harvard and MIT were first in line getting what was perceived as their cut of the funds meant for small business survival. One does not see a Conant type in Washington working to help the nation survive, nor is there a Vannevar Bush type leading the charge on the massively complex issue of producing RNA tests and antibody tests.

MIT it seems under the current leadership in my opinion recklessly fails to remember that it was one of the Land Grant Colleges, dedicated to bettering the life of those in the United States. Survival is a fundamental prerequisite for such betterment, and we see that these two institutions seem more interested in getting their cut of the feed bag and not taking a lead in helping our country survive.

It is not because of any lack of competence. MIT and Harvard contain wealth of competence and individuals who could be thrown into the fray. Whereas the Med School folks are the soldiers at the front lines, the Rad Lab teams are sorely lacking. Leadership is missing. No one is stepping up to the bar and taking leadership.

Government is also at fault. But after a long period of outright hostility between the Academy and Government, perhaps the Academy should lay down their stones and do what is right. Unfortunately, it does not seem that we have a Harry Hopkins in the current White House, there is no one to usher in the Academy types to get them to pull together as they had some eighty years ago. Yet the Academy type seem even utterly clueless as to their past, clueless as regards to the true mission they must fulfill.

When we look at the lack of reagents for RNA testing, why do we not have the minds in Chemical Engineering step forth and provide a solution. Just think how many such solutions came in WW II! They came forth in thousands, tens of thousands, and the answers flowed with every increasing rapidity.

In contrast one need just look at the web site for MIT news and the focus is on Earth Day, smart clothing, and arms control. Whatever virus effort is uncoordinated and peripheral at the very best. There is no focus on addressing the immediate needs. Those needs are eminently clear. They are; testing, logistics, and core elements and processes required.

At MIT I fear we have no Vannevar Bush, instead we seem to have Business Professors who claim that Americans are "stupid". Trust then is lost, and trust is then so difficult to be regained.

One longs for the days of the Rad Lab. Leadership from that time made the country explode with success in the 1950s. Lack of any leadership, other than getting to the front of the "free money" line is not a good sign. MIT has the people, the minds, the capability, but it is disconnected, and in my opinion, poorly led. We need a Vannevar Bush to go to Washington with a Conant, to demonstrate that the Academy is a truly productive element of our society, not a voice always critical while at the same time feeding itself off the sweat of the land.