What Do Recent Case Surges Mean?

It’s astounding what can happen in a few short weeks. I’m still pushing back a lot of things I want to talk about as well as some writing on contact tracing, excess deaths, the benefits of having a flexible re-opening policy, and how sparse data can lead us to construct narratives of cause-and-effect in our heads that don’t ultimately have solid grounding.

There is a lot going on in the world these days. But just for today, I want to look at the following topics:

• Caution in Uncharted Waters - These case surges might look like something we’ve seen before, but we are actually in a very different place.

• Outcomes Are Not Assured - We don’t know what the next few weeks will bring and there is plenty of reason to hope for the best.

• Skewing Younger - Is the new case surge due to infections among the young? A careful look at all the data I could find.

• The Future of Journalism - The best essay I’ve yet read on how the COVID crisis is accelerating the trend away from traditional full-time journalism and toward topical citizen journalism.

• Disney Shorts: Goofy’s Glider

Caution in Uncharted Waters

This past two weeks, we’ve watched a substantial COVID resurgence across a number of states, in Texas, Florida, California, most notably Arizona. In many ways, it looks a lot like the initial outbreaks back in March. Especially if we look at increases in case counts, we can see an escalation that looks frighteningly familiar to other dire scenarios. The comparison that everyone fears is that of New York and the surrounding states.

And if we look at raw case counts, it seems like that is a real possibility.

This is New York’s initial case count time-shifted against the current case counts in California, Arizona, Texas, and Florida. This is the kind of visual I’m seeing a lot right now and, as a graphic, it’s pretty compelling. It tells a clean story (there are several potential NY-style hotspot states) with clear visual similarities (our brains quickly interpret visually similar graphs to mean “the same thing is happening”). We feel like we’ve seen this pattern before and that we can map what is happening now cleanly against what has happened before

But that is a very big leap, one that I don’t think is quite justified at this point. There are a few confounding variables that complicate our projections.

First, the case increases we saw in New York were at a time when we didn’t have nearly the testing capacity we needed. As a result, testing priorities were with the symptomatic and hospitalized. This meant that a couple of things happened:

1. There was far less distance between identifying a COVID case and that case ending in death. Early on, most cases were identified either in the hospital from highly symptomatic individuals or post-mortem.

2. The percentage of tests coming back positive were extremely high, over 50% on many days. As a result, case increases were almost directly in line with testing increases. If they could get 3,000 more tests, they found 1,500 more cases, but if they could have gotten 30,000 more tests, they would have found 15,000 more cases.

Indeed, if we look at the corresponding death increases (time shifted in an identical manner as the graph above), we see that the number from New York doesn’t look anything like what we’re currently seeing from any state.

I think a lot of people have already forgotten the horrifying early chaos of this pandemic. We were scrambling for tests and PPE and ventilators, reeling from the seemingly sudden onset of this terrible disease, trying to sort out what the hell was happening and where it was happening. Those were the days when it was deeply controversial to say that it didn’t make sense to chart the US as a whole, we should be looking at regions separately.

That chaos is *still* in the data when we look at case numbers from March and April, though we may have forgotten that fact. We may be looking at the data and thinking “this is an accurate representation of the reality as it happened”. But it isn’t. The data is a representation of what we could gather in the chaos that consumed our country for weeks. Baked into that early data are hidden variables such as tests we had to ration and assumptions we had to make and medical coding that hadn’t even nailed down by the CDC.

We can’t directly compare that data situation to this one. We can’t directly compare those data patterns to the ones we see now. We think we’ve seen this story before, but this is a slightly different story. At least we hope it is.

The Outcomes Are Not Assured

I hate the waiting. I hate how difficult it is to tell friends and family “I don’t know what is going on”. I like to be cautiously optimistic, but the data is giving me very mixed signals and it’s best to come out and simply say what we know.

We know:

• We have massively better testing in place. We are seeing in the data something right now that we haven’t seen: the actual beginning of a COVID surge. This was completely hidden from us in February and March, we discovered it entirely after the fact.

• We have better non-pharmaceutical interventions in place. None of the states are fully open. Mask wearing is much more prevalent, no one is going to theaters, church attendance is sparse and (hopefully) socially distanced, restaurants are at reduced capacity.

• We can deliver a more targeted response because we can see with much clearer vision what behaviors are causing this. I saw that Texas shut down bars and river rafting. That second one stuck me as an odd choice, an outdoor activity that seems easy to maintain distance. The most likely reason is that contact tracing has pointed to river rafting as a high spread event. Perhaps it is van rides or rafters clustering together, but hopefully these targeted mitigations will allow us to get new cases back under control.

• We have more experience treating COVID, with more options available (subscriber only link) as we better understand the impact of the disease.

These case surges do not condemn us to a known future of death. They are bad news, but they are not yet overwhelming bad news. We don’t know what will happen and there is reason for hope that we will learn how to manage these surges.

There will be more surges in our future and that is a fact. We can’t approach every surge with an attitude that we’ve failed or people are being stupid or not doing things the right way. These surges aren’t Team A’s fault or Team B’s fault. Handling them is something we need to become good at. The outcome is not assured, either for good or ill.

Skewing Younger

I had been holding back a little bit with the news that the majority of new COVID cases were among younger patients. That was one of those things that sounds plausible, but I don’t like to share theoretical information that happens to explain what is happening. I would rather share information I know is true, even if it is confusing. I think we can all handle some uncertainty (or if we cannot, it wouldn’t be a bad idea to practice).

The only data source I knew for certain would hold this information is Florida’s case line data, which gives ages for every single confirmed COVID case since this all began. The median age of new COVID cases has dropped drastically in Florida from over 50 to under 35.

Obviously this applies only to Florida, but I’ve been incredibly blessed to be in contact with several people who are following specific regions extremely closely. So I can say this this pattern is similar in the following regions:

Georgia - Cases among 18-29 year-olds are up substantially in the past few weeks. The majority of new cases are now among people under 40. A month ago, they accounted for only a third of cases.

Arizona - I wish I had more details, but according to official statements, people ages 20-44 account for nearly half of all cases.

Texas - Governor Abbot has stated that in some counties a majority of cases are among people under 30.

Oklahoma City - Cases among all demographics have risen, but cases among 18-49 year olds have increased substantially more than cases among older residents.

Minnesota - I had to use the Wayback Machine to look at earlier Minnesota numbers and run the numbers backward, but we see the same trend. The rise in cases under 30 (especially 20-29) has been substantially steeper than the rise in other demographics.

Los Angeles County - From @liora_ (who has been spectacular work covering LA County), we can see that the spike is most pronounced among 18-40 year olds and that new infections in the most vulnerable populations is actually flat even as we see an overall case surge.

This trend has been the same everywhere I’ve been able to check.

EVEN SO! This does not mean that COVID is not a threat or that we don’t need to be careful, but it is good news that we are not (currently) seeing the situation that we saw in March and April. I want to emphasize over and over and over that it could still turn into a very dangerous situation if left unchecked. But we certainly have a lot more warning this time.

The Future Of Journalism

While I often get very frustrated with Twitter, every once in a while it connects me to some really fascinating people. I’ve been meaning to write for weeks about how I think the future of journalism is best exemplified by citizen experts who dedicate themselves to a narrow topical branch about which they can build trust and speak with authority, building bridges with trust-worthy experts.

This has been rattling around in my mind & I have a dozen half-finished paragraphs on this topic. But I’ll probably abandon that since Liora (a project manager in Califoria who has taken to culling her own incredibly detailed repository of LA County data out of the daily press releases) has written a much more comprehensive overview of both the problem with journalism, bad science, and education, as well as proposing some plausible solutions.

You should just read the whole thing, but here she talks about journalism and I recognize exactly these trends:

The reality is that journalists are ultimately professional middlemen, standing between informers and the rest of us, and adding their own spin along the way. Middlemen are not necessarily a bad thing, as we certainly don’t all have time to synthesize the facts on our own, and great journalists make the relevant facts more accessible - but this crisis has shown both how problematic our dependence is, and how far many will go in search of truth.

In response, this crisis has been a boon for citizen journalism. Twitter, Medium, Substack, and Facebook have played an instrumental role. No one’s making a career change; rather truth-seekers of all backgrounds are synthesizing facts and sharing their findings. 

…

Unlike Legacy Media, citizen journalists rarely use a “take my word for it” approach. They go straight to the source whenever they can, because heaven knows they’ll be asked for it - Balaji Srinivasan calls this “reproducible reporting.” Sometimes, they are the source. You get to hear it first-hand, instead of reading a journalist’s spin in an amplified game of “telephone.” And then you get to read the comments, where people can share their experiences and/or disagree.

And on educating our way out of this (which is certainly taking a long-term view):

With schools on hold and misinformation (ie. Plandemic) spreading rapidly, perhaps we’ll take this opportunity to realize what a squandered opportunity K-12 education has become. Thirteen years of school, and we ship most kids off to college without a foundational skill set. We can not expect better societal outcomes if we continue to fail our population on such a fundamental level.

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Ideally, our students spend years engrossed in the scientific method and research, building the muscle and confidence to engage with the material on their own. Just as we don’t stop teaching reading and writing, thinking about science is something we need to reinforce every year to ensure it’s truly absorbed. While periodic tables and physics formulas may be forgotten, learning how to think is much harder to undo, particularly once you realize these are skills that can be used every day, outside of school.

Just great. Pull it up in a tab and read the whole thing.

Disney Shorts: Goofy’s Glider

This is the first of the Goofy instructional shorts. I loved these as a kid and now that I have discovered that these shorts were developed in response to a contract dispute with the Goofy voice actor. The idea was that they had a bunch of stock recordings of him saying random things in Goofy's voice and the cobbled together Goofy shorts with that stock and a great deal of direction from a narrator (bringing in a replacement actor for necessary dialogue).

And now I feel terrible for loving them. But I still do.

In this short, Goofy engages in his hobby of glider flight. The primary obstacle of this particular hobby (it seems) is gaining sufficient velocity to allow the aerodynamics of the glider to propel one into the air. This really is a lovely short, filled with excellent slapstick gags from start to finish. It is the Road Runner cartoon of the Disney world, but with the added twist of a funny contrast between the formality of the narrator's voice and suggestions and the silliness of Goofy's implementation.