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Near-Term Covid Analyses Point to Risk of Medical System Breakdown, Other Severe Dislocations

Summary:
Some common cognitive biases impede effective responses to looming dangers like Covid. They are disconcertingly apparent as more and more evidence supports the notion that new strains of Covid, like the UK one spreading in the US, are markedly more infectious. That means (unless the UK strain is milder, which so far does not appear to be the case) we will shortly see a big increase the number of hospitalizations. This will take place when medical systems in many parts of the US are already at the breaking point, with even ambulance crews nearing their physical limits. Yet rather than get in front of a near and present danger, the authorities and pundits are acting as if they can hold the present course, when that isn’t working very well in the US and UK. All bets are on Magic Covid

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Some common cognitive biases impede effective responses to looming dangers like Covid. They are disconcertingly apparent as more and more evidence supports the notion that new strains of Covid, like the UK one spreading in the US, are markedly more infectious. That means (unless the UK strain is milder, which so far does not appear to be the case) we will shortly see a big increase the number of hospitalizations. This will take place when medical systems in many parts of the US are already at the breaking point, with even ambulance crews nearing their physical limits.

Yet rather than get in front of a near and present danger, the authorities and pundits are acting as if they can hold the present course, when that isn’t working very well in the US and UK. All bets are on Magic Covid Vaccines making the pandemic go away, when polls show only about 40% are willing to take them now (roughly 20% are anti-vaxxers and another 40% want to hold off to be assured of safety). Even if that cheery view might work out in the longer term, it ignores the cost of potentially catastrophic near-term damage.

Three fresh pieces look at the severity of the ossible downside. One, an interview with Phillip Alvelda originally published at the Institute for New Economic Thinking website, presented some critical facts relatively late in the article, which means they may have escaped the notice of some readers. Another is from MIT Technology Review yesterday, and the third is from Ben Hunt’s Epsilon Theory newsletter, which Hubert Horan kindly forwarded. Hunt’s take is the most comprehensive, so we’ll turn to that last.

The MIT Technology Review article underscores that the higher transmission rate of the UK variant is the real deal and the implications are dire:

If the variant strain, first spotted in the United Kingdom, is as infectious as some suspect, it could dominate US case numbers by March, send covid-19 deaths to unprecedented levels, and collide with the rollout of vaccines, research suggests.

British scientists fear that the new strain, which they say is 50% to 74% more transmissible (meaning the average case generates even more follow-on infections), has put wings on the feet of the pandemic in the UK, where covid-19 case numbers have risen swiftly….

“If the variant becomes common [in] the US,” Tom Frieden, former director of the CDC, said on Twitter, “it’s close to a worst-case scenario.” He says political turmoil, overtaxed hospitals, and an unrelenting new form of the virus could create a “perfect storm.”

The article notes that Danish researchers peg the UK variant at 70% more contagious. And simple models show that the increased infection level will kill more people than a comparable percentage increase in mortality.

Reader CanChemist provided more detail in Links yesterday,: and referred to Slide 22 in new information published by the Government of Ontario as it issued “stay at home” order:

The new strains are terrifying, game-changing developments. That can’t be overstated. The one in particular focus right now is B117 which is actively circulating beyond the UK now into many countries including Denmark, USA, Canada. There has been serious discussion this past week now on Twitter under hashtag #B117 and the projections are extremely grim. The mainstream media has communicated that there is a new, more contagious strain, but not the true implications of that in practice….

Near-Term Covid Analyses Point to Risk of Medical System Breakdown, Other Severe Dislocations

The blue line is the projections of existing covid. The red line is B117 and the gray line is the total of existing + B117. The spread in lines is the probability spread based on different assumptions. This plot matches projections from other countries as well. In a nutshell, B117 is 50-70% more infectious and measures that control existing covid, like lockdowns, have been largely ineffectual so far against it. It means we seem to be on a pathway of “when, not if” to having the pandemic go so far out of control that I can’t even speculate what that looks like.

At INET, Alvelda argued that the UK variant appears to be better at binding to spike receptors, which means it can infect individuals at a lower viral load. He believes it will take only two months before the new variant becomes prevalent, which is consistent with the MIT Technology Review and Ontario estimates.

American failed state tendencies make it pretty much impossible to know where the new strain is spreading and implement aggressive contact tracing/isolation measures. Again from the MIT Technology Review:

Even as new variants threaten to emerge, the US still lacks the ability to adequately monitor changes to the virus, according to James Lu, cofounder and president of the Helix lab. He says the US as a whole has been sequencing about 300 to 400 virus samples a day but needs to sequence around 7,000 each day (or 5% of all tests) to get an accurate picture of what variations of the virus are spreading….

By comparison with other advanced countries, the US sequences a much smaller proportion of cases. According to the Washington Post, the country is sequencing one in every 300, compared with about 60% in Australia, 12% in Denmark, and 7.5% in the United Kingdom.

“We’re off by more than an order of magnitude from a proper level of surveillance,” says Lu. “The goal is to catch it before it before it becomes common.”

However, a second INET article provides correlations that strongly suggest the UK variant is responsible for sudden surges in cities with non-stop connections:

In states that have cities where direct U.K. flights terminate, such as Los Angeles, Houston, Seattle, New York City, Chicago, and Miami, Covid cases are picking up at an alarming rate.

Near-Term Covid Analyses Point to Risk of Medical System Breakdown, Other Severe Dislocations

And back to the Magic Covid Vaccine strategy. If you were paying attention and did a little math based on two doses, you could see that the current level of vaccinations is very far below the rate needed to achieve 70%+ vaccination levels in 2021. From the INET article:

We’ve administered something like 4.2 million doses– and that’s only the first dose. We haven’t fully immunized anyone. As with other Trump policies, he decided to work from the federal level in kind of a minimalist way and left the end point, the last mile of distribution, to the states, which didn’t have the foggiest clue how to manage distribution at that scale.

We’re seeing a supply chain that doesn’t have sufficient cold storage, that doesn’t have enough people, that isn’t organized, that doesn’t have tracking systems, that is just one tenth of the speed that you’d imagine. They didn’t do any testing or preparation for the last mile at all. I think the sad truth is that at the rate we’re going, it’s going to be mid to late 2022 before we start to see the effects of induced immunity from the vaccine.

But take some heart—-the 2022 estimate is if we keep going the way we’re going. I’m confident that the Biden administration will exercise more centralized control and we’ll have some real experts managing the distribution where it’s been largely a political exercise up until now….. My hope is that as more vaccines get approved and some have more relaxed handling requirements, you’ll start to see the rate of vaccination pick up. But I do think that best-case scenario, we’re going to be in this until the end of 2021 maybe slightly into 2022.

Note that the much less fussy Astra Zeneca isn’t expected to be approved until April.

And it isn’t at all clear that the Biden Administration will be able to do all that much better than the Trump Administration. The US is hampered by a fragmented health care system, including public health. States rather than the Feds regulate hospitals and pharmacies, the two main channels for drug distribution. There has yet to be even the teeniest signal that the Biden Administration is even thinking of trying to cut the Gordian knot and building independent channels or using the Defense Production Act to address supply shortages. They are real. Down in Alabama, I was shocked to go to the urgent care center last week to be told they were only doing so many Covid tests per day and I had come after they had hit their maximum. This restriction was clearly driven by test supplies; there was ample manpower in the facility. I went to a nearby merchant to run an errand and grumbled about my test fail. He said patients regularly lined up for hours before the center opened to be sure they’d get a test.

Instead, Politico reported earlier this week on infighting in the Biden Covid team, including Biden chewing out his no-prior-public-health experience Covid czar Jeff Zients over poor vaccination performance. And yesterday, Politico reported that most of Biden’s Covid advisory board has been frozen out on the development of the new Administration’s Covid response, set to be presented today.

The US has invested heavily in the Pfizer vaccine. It require tight coordination of deliveries and competent handling. It’s not as demanding as just in time, but a maximum 30 day hold in those Pfizer boxes and then only 5 days at refrigerator temps. And the high-by-vaccine-level of anaphylatic reactions is creating further distribution problems. And then there’s this, from USA Today:

People who receive a COVID-19 vaccine have to be watched for 15 minutes to ensure they don’t have an allergic reaction. This requires hospitals to set aside space and personnel – both of which are at a premium.

The observation period is 30 minutes for patients with a history of allergic reactions. This need slows down distribution in a hospital, since a nurse can’t trundle from room to room with a cart, delivering shots. It similarly reduces throughput in a pharmacy where another constraint is limited space for the vaccinated to hang out until they are deemed good to go.

In other words, some of the vaccination problems are due to having bet on the Pfizer version, which is difficult to deliver on multiple fronts, and a fragmented, very decentralized health care system is poorly suited to deal with “difficult”. An editorial in Newsday (yes, Dem hostile) describes the chaotic New York City vaccine rollout….and remember that New York, generally speaking, has more competent government and more resources than other jurisdictions (although Mayor De Blasio is widely recognized as performing poorly).

With all of these warning signs, the CDC has chosen to take a big dose of hopium. The CDC’s models show that the agency assumes that 77 million have already had symptomatic Covid. That’s a big multiple of 23 million confirmed cases. That means the CDC assumes over 20% of the population already has immunity…at least as long as immunity lasts.

Now to Ben Hunt (emphasis his):

I believe there is a non-trivial chance that the United States will experience a rolling series of “Ireland events” over the next 30-45 days, where the Covid effective reproductive number (Re not R0) reaches a value between 2.4 and 3.0 in states and regions where a) the more infectious UK-variant (or similar) Covid strain has been introduced, and b) Covid fatigue has led to deterioration in social distancing behaviors.

Near-Term Covid Analyses Point to Risk of Medical System Breakdown, Other Severe Dislocations

A single Ireland event is a disaster. A series of Ireland events on the scale of the United States is catastrophic. If this were to occur, I’d expect to see a doubling of new Covid cases/day from current levels in the aggregate (today’s 7-day average is 240k/day), peaking somewhere around 500,000 new daily cases before draconian economic shutdowns (more severe than anything we’ve seen to date) would occur in every impacted major metro area. Hospital systems across the country would be placed under enormous additional strain, leading to meaningfully higher case fatality ratios (CFRs) as medical care was rationed. Most critically, this new infection rate would far outpace our current vaccine distribution capacity and policy. Assuming that vaccines are preferentially administered to the elderly, aggregate infection fatality ratios (IFRs) should decrease, but the overall burden of severe outcomes (death, long-term health consequences) would shift to younger demographics.

Hunt argues that the CDC position that 77 million have already had symptomatic Covid cases is politically driven, since it’s not credible that so many would brush off Covid indicators as a mere seasonal bug. He continues:

A full-blown Ireland event is driven by both the more virulent UK-strain AND a deterioration in social distancing behaviors… Irish health authorities estimate that their starting point for Covid Re was something between 1.1 and 1.3 (meaning that, on average, one person infected with the SARS-CoV-2 virus would pass it along to 1.1 – 1.3 new people). They blame deteriorating masking/social distancing for the majority of their “event” (say, a 0.9 – 1.1 increase in the Re number), and the UK-variant for the balance (say, a 0.5 – 0.7 increase in Re)…Notably, the UK-variant is, relatively speaking, significantly more infectious than the baseline virus for “close contacts” (not face-to-face, up to 2 meters apart) rather than “direct contacts”, meaning that the UK-variant virus is particularly successful at bridging the air gap between strangers or short-duration contacts in an indoor space…. the UK-variant virus dramatically reduces the margin of error we have with mask wearing and social distancing outside of the home.

And to add to the cheery news, CNBC reports that reserachers have found two new strains, apparently-home-grown in the US, in Ohio. Oh, and they appear to be more infectious that the now-dominant strain in the US:

Researchers in Ohio said Wednesday that they’ve discovered two new variants of the coronavirus that likely originated in the U.S. — one of which quickly became the dominant strain in Columbus, Ohio, over a three-week period in late December and early January.

Like the strain first detected in the U.K., the U.S. mutations appear to make Covid-19 more contagious but do not seem like they will diminish the effectiveness of the vaccines, researchers said….

One of the new strains, found in just one patient in Ohio, contains a mutation identical to the now-dominant variant in the U.K., researchers said, noting that it “likely arose in a virus strain already present in the United States.” However, the “Columbus strain,” which the researchers said in a press release has become dominant in the city, includes “three other gene mutations not previously seen together in SARS-CoV2.”

“This new Columbus strain has the same genetic backbone as earlier cases we’ve studied, but these three mutations represent a significant evolution,” Dr. Dan Jones, vice chair of the division of molecular pathology at Ohio State and lead author of the study, said in a statement. “We know this shift didn’t come from the U.K. or South African branches of the virus.”

Now even if infections do spike, it’s possible that doctors outside hospitals will be forced to get more serious about treatments, a prong of attack that has oddly been downplayed in Covid combat strategies. But will behavior change soon enough in that scenario? Infection spikes worse than what we saw in New York and California last spring, with the medical system already looking like it’s relying on duct tape and baling wire means the remedy is even more stringent lockdowns than we’ve had….and for those to be bearable, that means another round of heavy-duty income support, an idea to which Washington is allergic.

And is the US even capable of serious enforcement? A friend’s significant other just went to Poland to see her family. The drill: 14 day mandatory quarantine. She can’t even go in the yard. Cameras trained on the house plus neighbors enlisted to monitor. First violation is a 5,000 euro fine. The second violation is a 15,000 euro fine and 6 to 12 months of incarceration. The fact that the US is incapable of cracking down on Covid scofflaws means we are setting up the worst outcomes.

Hubert Horan’s assessment via e-mail:

The new issue is the potential for a really massive spike in Covid cases, where medical systems break down completely. So much of the economic/political status quo seemed to depend on the (largely irrational) optimism that followed the initial vaccine approval. If this gets replaced by a universal “OMG we are so fucked” the damage could be catastrophic–stock market, many industries that have been hanging on the edge, rage at media, doctors, politicians–any “voice of authority”. Even if (rationally) it turns out to be a two-month issue that the vaccines could have reversed.

Obviously Biden won’t be up for this challenge but no other current or recent politician would have either. I don’t think events will fit any current narratives, and MSM attempts to spin them will fail. The general public won’t specifically blame either Biden or Trump. But if another 10 million people are suddenly out of work, no one will understand why it suddenly happened, and no one will trust anyone’s ideas about what to do next.

This scenario sounds all too plausible.

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1 One bit of less downbeat news: the INET piece appears to have understated the potency of masks in reducing transmission, and understated the efficacy of surgical masks. Yes, K/N95s are better, but they have to be fitted, and every N95 I’ve gotten leaks on the side just like a surgical mask, albeit less so, so I have doubts that the increase in infection reduction in layperson use is as great at the author suggested. See this comprehensive review of the data on mask efficacy, which Lambert linked to yesterday. The issue seems to be increasing uptake, as well as getting users to wear them properly (none of this below the nose nonsense, or worse, pulling them down when speaking).

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