Apples to Apples

Yes, there will be a followup. I’m just trying to get a grip on what comparisons are valid – and getting you thinking about the same thing.

In trying to find proper comps for America WRT C19, I have to conclude that there are none which are excellent, perhaps not even very good. It is fair to have industrialised nations as our starting point, and places so small that a single one-off event (or lack of them) can change the picture too quickly.  Andorra, San Marino, and Liechtenstein are not comps, whether for good or for ill.  There are Latin American countries – our own hemisphere – which have recently seen many cases, but I can’t see Peru as a serious comp.  We share a border with Mexico, and parts of that country have similarity to parts of this country in more than one way, but “industrialised” seems out of reach.  Ditto Brazil. We are narrowing to Europe and the Anglosphere pretty quickly, I think. Japan clearly qualifies as a first-world nation, though it is very much an island, and was culturally willing to isolate long before any of this. They remain solidly racist and homogeneous, resenting the Chinese and looking down on Koreans and especially Filipinos, so their degree of international contact has never been at European or American levels. Russia, China, and India are powerful economies and have industries but can’t really be regarded as industrialised.

Which leads to the next criterion, degree of international contact. Europeans have both contact with each other, often at places of great population density, and contact with the rest of the world.  America has two long borders, mixed between population dense and sparse population areas.  We have a great deal of international contact, much of it coming in by air. Canada less so, but still considerable. Australia has a great deal of regional contact, New Zealand and South Africa not so much. Even a lot of Europe isn’t in the same league, here. Because many come in by air, the international contact is in many places, well into the heartland.  Somewhat true of Canada as well, though Toronto, Montreal, and Vancouver are the main contact points. Not nearly so many as America or in Europe.  By population it’s a comp, but by area – that is, how much international contact per square kilometer, even if only measuring the southernmost parts – not quite so much.  As both population and area seem to be mattering with CoVid, that’s worth noting.

Because the NYC metro area has so dominated the American statistics, over a third of the deaths, and other major metros have had similar problems, I think the presence or absence of such areas is an important comp. A lot of people have criticised what New York has done, but what would they have done differently?  Not sending infected persons to nursing homes is a biggie, and worth mentioning, but what else?  Close the subways?  Then Ubers upon Ubers. What about elevators?  How do NYC apartments function without elevators?  This is going to weaken a lot of possible comparisons.  France has Paris.  The UK has London, and bonus points for the Midlands cities.  Argentina may work it’s way onto the list simply because of Buenos Aires.  Japan might work it’s way back on as well.  Mexico City is huge, but I think it is usually described as “sprawling.” Amsterdam, Brussels, Stockholm, Berlin, Rome, etc – not so much high-rise, not so much density. Canada has Toronto, not quite a megacity, but plenty of skyline. Montreal a little less. Vancouver probably not.  We are into places that are populous, have skyscrapers and some density, but just not Manhattan or downtown Chicago. Half-credit?

Does ethnicity or racial composition matter, either in terms of disease resistance or willingness to go along with restrictions?  We don’t know.  There was some thought blacks were more susceptible, but there are now studies showing that for equivalent symptoms this is not so. Are there cultural elements of less personal space, less willingness to follow directions, more need for interaction?  Don’t know. I imagine immigrants tend strongly to the habits of their countries of origin, and this dissipates over the generations. I know the Swedes have had large difficulties with the Somalis completely ignoring any restrictions.  Is that true of other Africans?  It’s hard to imagine it having much residue among African-Americans, whose ancestries stretch back centuries here. For that reason, Hispanics are likely mixed in terms of assimilation in terms of public disease-related behaviors. Norwegians, Israelis and the Japanese are highly self-disciplined people, well ahead of Americans, I suspect. If you tell them something is required for the good of everyone I think they pretty much do it. If I try to think of a group that is not especially self-disciplined, that list is long, and I’m not sure we can make it accurate.  What would we measure, and do those things actually correlate with disease behavior?

If there is any such factor, then there is really no comp  for America.  We have more diversity, and more of it recent, and more of that poor, than anyone.  The Canadians have a bit more First Nations, Chinese, Filipino, and South Asian (India), but have few blacks or Hispanics. Some from the Middle East, but not like here. And they are probably the closest in diversity. Europe thinks it has a lot of immigrants because it has gotten them recently, but not even close to American levels. What they think of as a cultural takeover is an average year here. I suppose there might even be some advantage to that, if groups huddle together infecting only each other, but I think it is more likely that such behaviors would create dangerous reservoirs of infection.  Still, I don’t know.  Maybe this last one is a very big deal, maybe it’s a nothing. Measuring rates of minority infection and/or death is going to be difficult to separate from purely urban, population density, shared public transportation factors.

Add to my list, please.  I have an outline of what America’s comps are and what we look like in relationship to them (short answer: mixed), but I’d like to be more confident I am looking at the right stuff.  Make your case.

15 thoughts on “Apples to Apples”

  1. create dangerous reservoirs of infection. ???? I thought you are the assistant idiot ? only the head idiot would consider a normal person infected as dangerous or a danger to anyone other than the elderly with co-morbidities (you know, the folks that already stay away from everyone else)

    you are starting with a lie (that sars-cov2 is dangerous to everyone) and going up from there …

  2. A lot of people have criticised what New York has done, but what would they have done differently

    Not do pre-emptive triage that directly resulted in over 100 extra deaths at home. (Which they “fixed” by reporting deaths at home as COVID-19 deaths, so that alone takes a nice chunk out of their numbers.)

    Kept the subways going at normal levels and at LEAST done Walmart level “spray things with bleach water in a weed sprayer once a day” level cleaning as soon as it was taken seriously, not a month after they peaked and started to decline.

    Considered the obvious problem of air exchanges inside of buildings spreading the disease– plus the negative effects of involuntary confinement on the immune system, and not demanded people self-quarantine when not even known to be exposed.

    Set up actual quarantine stations for those who were known to be infected– which means that they are housed elsewhere, on the dime of those enforcing the quarantine. Is avoids a lot of abuses and prevents people from infecting their house and building mates.

    If you tell them something is required for the good of everyone I think they pretty much do it.

    Don’t think this is a matter of Americans not being self-disciplined. It’s more a matter of telling us a thing does jack-all; you have to persuade us you’re telling the truth, the whole truth, and respect the cost of what you are trying to get us to do.
    Something that has been rather notoriously lacking in this situation, ranging from “go to Chinese New Year even if you judge there’s serious infection vectors involved or you’re a racist” through “do not wear masks” to “shut up and genuflect with a symbolic mask, even if you are not medically able to do so.”

  3. There are certainly cities in China where conditions meet or exceed New York but the available data is suspect at best and sparse. Cities like Taipei and Hong Kong probably offer more reliable and accessible data with obvious limitations on comparability.

    There simply aren’t any comparable countries. You’ll have to narrow down to regions and individual cities. The bigger cities of Canada and Australia probably come closest to our second tier cities like Denver and Dallas. You need to keep in mind the phase difference of the seasons in Australia. I don’t think there are any cities in Europe that compare, the whole structure is just too different.

    The situation in smaller cities and rural areas is probably limited to Canada and Australia as well, nowhere else comes close the matching the combination of distances and high development in our West. They are largely a non issue as far as wuflu is concerned. Some places in rural England and Europe might come closer to rural areas in the Eastern U.S.

  4. It seems to me that you cannot understand how C19 affected the US without noticing that the political left seized upon it as a Marx-given gift to do damage to the Bad Orange Man. They want a high death toll and as much economic damage as possible.

    Thus, multiple democrat governors ordered nursing homes to accept infected patients and banned hydroxychloroquine, despite significant evidence that it is an effective treatment. The state official in Pennsylvania took his mother out of a nursing home before issuing that order, which I take as a sign these folks knew full well what was going to happen.

    New York is famous for killing nursing home residents, but I note also not only did they not shut down the subways, they also didn’t even clean the subway cars for months after all this began. I find that astonishing. They also reduced the number of trains running, which forced the riders into closer proximity, which I expect helped spread the virus.

    And now, having done enormous damage to the economy and perhaps fatally wounding NYC, they spend their time shrieking that it’s all Trump’s fault, because of course they do. Evey fault and failure of the left is someone else’s fault, because shut up.

    As I said in the other thread, these people are fools. But alas that doesn’t stop from obtaining political power and then abusing it with disastrous consequences.

  5. I don’t understand the premise of looking for “comparisons”? So what if Outer Mongolia had more/less cases/deaths than anywhere else?

    If we want a comparison, the one which minimizes extraneous factors (of which there are a huge number) would be comparing USA 2020 with USA 2019, or USA 2018, etc. Total morbidity in the US so far is not far different from the range experienced in other years when there was no Covid-19 and no Lock Downs.

    Bottom line — the Covid-19 virus was comparable to a bad flu season; the Lock Downs are an ongoing unnecessary unjustified disaster. Let’s not obfuscate that real issue by burying it under a mess of highly debatable comparisons.

  6. I’ve pretty much despaired of finding anything approaching useful comparisons for the US, mainly because the data is so poor and our understanding of COVID still rather limited. Having said that, I would point out that the US has seen two distinct COVID waves, the first in the northeast/midwest that was roughly comparable to what happened in western Europe (in timing and the shape of the infection/death curves which I trust more than the magnitudes, which gets into data coding issues), and the second over the summer largely in the south and southwest that looks a lot more like what happened in Mexico and Brazil. This obviously suggests some sort of climate effect driving the spread, and is a big part of why the US curve doesn’t look like anywhere else – there aren’t comparable countries with a similar range of climate conditions.

    So I would strongly suggest not spending much time looking at the US numbers as a whole, instead break it down into a half dozen or so regions (which will be more of a scale to European countries as well). Then I suspect you’ll see the Northeast looking particularly bad, the Midwest looking like a fairly typical European country, and Southeast, Southwest, West Coast and Mountain West looking like something else entirely.

    Good luck with the effort. I’ve toyed with the idea myself but every time I start digging I just get turned off by how superficial most of the readily accessible numbers are.

  7. Well, now that many have defaulted to their priors and gotten that out of their system, maybe we can have a discussion.

    Gavin, in the last thread you said that the death count is an overestimate. It is more likely an underestimate. We have had at least three “unexplainable” spikes in pneumonia deaths. Irritation at a misreported motorcycle death shouldn’t be factoring into this. This time you say the overall death rate is about the same as last year. It is higher, and that in the context of a shutdown that reduced the rate of infection for everything else as well. Unless you want a shutdown every year to keep those diseases that low? Otherwise, this is worse.

    Then thirdly you resurrect the lost idea that it’s like a bad flu season. It is 7x an average flu season, and 3x the worst flu season in the last 20 years. You would have a better logical case by trying to argue that it is still not very many deaths, having an extra 200K, because we have so many people. People might not like that morally, but you would at least have some ground to stand on.

    I predicted in March that if the numbers went high enough so that they could no longer say it was just the flu they would switch to claiming that the deaths were not real somehow.

    @ Phwest – I think you are right that regions and other breakdowns, rather than the overall national numbers are going to tell us more. This is true of other countries as well. I do think there is some value in looking at other countries and what happened in order to understand better. I’m not so interested in the “competition” aspect of who gets to be king of the hill as much as what the data tells us.

  8. I doubt we will ever get honest number but I have doubts about your assertion that It is higher, and that in the context of a shutdown that reduced the rate of infection for everything else as well.

    First, the UK is estimating 30,000 additional cancer deaths as a result of the panic.

    Second, you ignore the fact that the last half of a normal flu season coincided with the Chinese virus.

    I agree the numbers are inflated but it will be difficult to prove. Hospitals got as much as $40,000 per case of Covid admitted. They are not about to give that money back, especially as they were put into financial crisis by cancelling elective surgery. I had lung surgery a month ago and am getting the impression that surgeons, including mine, are frantically busy right now with delayed cases.

  9. We have had at least three “unexplainable” spikes in pneumonia deaths.

    Only unexplainable in light of the new idea that extended wearing of masks and breathing your own air back in, with the associated buildup of bacteria, is not a health risk. (plus ignoring that people cannot go in for normal care, which means they wait until things are an emergency, and also ignoring that everyone is reporting symptoms of trouble breathing, if only because of suggestion)

    It was when I was in the Navy (known issue with CBR and fire fighting) and it was when they studied it before the current fad, but suddenly at some point after they stopped saying masks don’t work, that stopped.

  10. AVI: “… maybe we can have a discussion”

    Let’s start that discussion with a reminder that something like 8,000 people die in the US on an average day. And continue the discussion with a reminder that most of the people whose deaths are officially linked to Covid-19 are old and/or sick.

    Context matters!

  11. @ Mike K – agree on honest numbers. Partially agree that the influenza and early C19 numbers could bleed into each other, but that could cut either way. A lot of folks are trying to get a handle on what the other health costs have been because of rediverting resources to C19, and I agree those are real. I just don’t see anything that more than speculative. Also Foxfier, interesting, but if masks were the issue then we would see a steady heightened pneumonia death rate, not spikes. Back to Mike K – A hospital RN commenting at my site from July, Tom Bridgeland: “Here in Illinois the situation is much improved. Raw numbers are way down, and IMO case severity is down too. We went from 3 full units, ICU, stepdown ICU and a critical care unit (where I usually work) all nearly full of little but Covid patients. Personally I have gone from caring for 5 covid patients a night at the peak, to one, two or occasionally zero… Re recording deaths as covid deaths regardless of other factors. Well, maybe some of that happened. Docs have to put something in that box, and if the patient was admitted for covid, and died drowning in their own fluids, then I am fine with that.” He also notes a personal observation that beefy, muscular, physically active men are having more trouble than he would have thought, though he admits that could be anomalous.

  12. Also Foxfier, interesting, but if masks were the issue then we would see a steady heightened pneumonia death rate, not spikes

    Mask orders haven’t been steady– and demand to be out even with the mask is also not steady, plus there’s the conflating issue of SARS-2 pneumonia.

    I wasn’t able to find anything that could be described as three spikes, unless there’s the ILI visit and pneumonia death chart which has a post-Thanksgiving pre-Christmas spike, SARS-2 spike and SARS-2 after-spike, but that pattern shows up in other years as well. (Which might mean a reporting issue, or it might be a human behavior issue– see the spike in cases after a weekend, and bigger spikes after a long weekend.)

    More information would be needed to build a working theory.

    Without disrespecting a nurse, per the guidelines since April COVID-19 is to be listed if it contributed to the death…and if someone is sick in the hospital with difficulty breathing, when your hospital is about to go out of business because you’re not allowed to do anything but emergency treatments and COVID-19, it’s very easy to justify writing “probable COVID-19” as a contributing factor. Especially when the guidance for that is that they have symptoms (which overlap with any other infection) and COULD HAVE been exposed, especially since you’re going to have to act like they’re infected anyways.

  13. Example of how you can get spikes:

    Two week shelter in place, which has everyone stressed and in each other’s laps, kids come home from college, can’t isolate grandma, etc. Nobody wants to go out for medical care unless they are at the call-911-now stage. As “two weeks” goes into a month+, people either end up in the ER from untreated stuff or say to heck with it and go get treated. Some people use masks anyways, especially if they’re the kind who had them in the first place, and some people star sewing masks and wear them like dust-covers.

    Spike 1.

    The CDC, WHO and half the alphabet decide that masks are useful, now– and in fact should be required for everybody, even at home. Average level of care is what you’d use for a scarf.

    Spike 2.

    After people convey that the thing theoretically for catching germs or spit, depending on justification, is going to be full of germs, folks clean them better and those who were wearing them to make someone else happy find comfortable ways to wear them which can be boiled down to “don’t interfere with breathing.” Deaths drop, but more people find out how medical grade masks work, though not that cloth masks are not the same sport, much less ballpark.

    This is followed by a public hysteria levels of micro-management and demands of questionable legality by both shops and officials requiring a mask to be in public, definitely bypassing those who previously observed the 20 minute rule of thumb or even–gasp!– follow the actual CDC guideline of only wearing a mask when you will be within 6 feet of another person for at least 5 solid minutes. (Not “if you have to walk within six feet of another human being” or “if you are standing eight feet from other people, in a line.”)

    Spike 3.

    Complicating factors:
    SARS-2, various heat waves, dust storms, smoke from fires and various social pressures, plus rates of people being killed by known-infected cases being put in their nursing home.

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