Tuesday, October 27, 2020

Literary Corner: Does That Make Sense Now?

Drawing by Mike Luckovitch, via Orlando Sun-Sentinel.

Death, Death—Cases, Cases

by Donald J. Trump

Now it used to be that if you had it, you were immune for life,
right? For life. With me, they say I’m immune for four months.
In other words, once I got it, the immunity went down from life to
four months. I don’t know. They don’t know either. Who the hell
knows? All I know is that for a little while, for at least four months,
I could run in there and kiss everyone, men and women. I’ll kiss
every one of them. I’ll kiss them. No, no. You get over it, then
you’re immune, for whatever period of time. No, it’s true,
though. You heard, for life, you’re immune. Right? That’d be it.
As soon as I got, I said I was immune, they said, “Only for four months.”
They brought it down to four months because that’s the fake news.
They’re fake. The cases are up, but listen to this, they’re all
talking about cases. You don’t see death, death—cases, cases.
You know why we have cases? Because we test so much. And in
many ways, it’s good. And in many ways, it’s foolish. In many ways,
it’s very foolish, because every time you test… Like, for instance,
Barron Trump. Did you ever hear of Barron Trump? He’s a rather
tall young man. He’s tall, and he’s a good kid, and he’s strong,
but he had it. They said, “Sir, Madam, I’m sorry to inform you
your son has tested positive, apparently.” I said, “Oh no.”
Fifteen seconds later, “Sir, your son no longer has it.” No,
it’s true. I said, “How’s Barron doing?” “Oh, he’s fine.
He’s fine.” I said, “What do you mean? You just don’t…”
No, he’s fine. They have a very strong immune system. Ninety-nine
point nine something, right? Ninety-nine point nine. Go back
to the school, North Carolina. Go back to the school. Barron Trump.
A legend. He’s a legend, he got rid of it so fast, but the kids get
rid of it fast. Strong immune systems. The mortality rate is down
eighty-five percent because of the therapeutics and all that they
learned. I mean, they know what to do. In other words, by doing
all of this testing, we’re the best in the world, the most…
I get calls all the time from leaders, “Your testing is the
best in the world.” I said, “Do you test?” “No.” I said,
“You don’t test?” “No.” “That’s why you have no cases.”
Well, very few cases. You know, the cases they have, when
somebody’s sick, they call it a case. I said to one gentleman
that’s very tough, very tough man, runs a tough country,
I said, “Do you test?” “Yes. When somebody comes into the
hospital and throws up all over the floor, we test, but we never
test other than that.” I said, “So you have cases.” “No, we show
very few cases.” So we show more cases because we test. So Barron
Trump, as an example, it’s a case. All the kids are a case. And by the way,
they’re very young now. They’re testing schools and high schools
and this and that and every… And what it does is it gives the
fake news media something to talk about. So they say,
“Cases are up in the United States.” That’s because we test.
India has one point five million people and they do testing. They
test a tiny fraction of the number of people that we test.
So the good is that we know where it is, et cetera, and we
have to protect our seniors, and that’s really the most
important thing. But when you see all this stuff, watch,
they’ll go home, “Cases are up, cases are up.” And I saw it
today, but that’s because of tests. Does that make sense now? If we
cut it in half… And by the way, wasting a lot of money on testing
too We're not allowed to say that. We’re not allowed to say,
“We’re spending millions of dollars on testing.” But if we tested,
half, cases would be half, and they’d have a headline, “Cases
drop magnificently,” but they want us to test, test, test.

(Rally, Lumberton, North Carolina, 24 October)

What can you say? When somebody comes to the hospital and throws up all over the floor, Covid-19 is not the first thing your doctor is going to suspect. Patients may suffer from nausea or diarrhea, but what you're looking for is the fever or chills, dry cough, and difficulty breathing. I wonder if Trump was throwing up all over the floor when he got tested, assuming he did get tested. A lot of people are saying Trump never was infected at all, and when I say a lot of people, I mean a lot of people on Twitter, but they haven't explained clearly what he'd get out of pretending to have been infected. Maybe after his wife and son were diagnosed with the disease he began to worry people would figure out that he's hardly actually been close enough to either of them in an indoor setting to catch a disease since the boy was born, and that would be bad for his image. But the "throwing up all over the floor" line suggests he himself doesn't believe he was infected, or the wife and son either, or that he's actually witnessed anything like Covid-19, because he hasn't seen anything he'd regard as being really sick, with a visible manifestation like vomiting; they're only "cases" because because they were tested.

Or he doesn't believe that testing causes the disease, as we've sometimes thought, but that it causes the "case", which is not the same thing, the way he looks at it. I don't know what he thinks about people who have to go to the hospital or die, and their relationship to the status of being a "case", but I can, as usual, tell you something about the arithmetic, which starts like this: the current positivity rate in the US is 7.3%, which means that for every 1000 tests 73 are found to be "cases". By the same token, the "tough gentleman" in the "tough country" who only tests patients who vomit all over the emergency room (who I assume is fictional) has a theoretical positivity rate of 100%. In fact he fails to find anyone who is not infected, whereas in the US we find 927 people who are not infected—thus, in fact, the more testing you do the more non-cases you find. Which is obviously true, when you think about it. Now we're testing a million people a day, look how many we have who are not sick! But Donald can't wrap his head around this.

Via The Atlantic's Covid Tracking Project, summary US data for 26 October. They're interactive on the webpage, which is how I got the numbers cited below.

Now, clearly some of the "cases" created by testing, as the Emperor understands it, really do get sick, and some of those get sick enough to go to the hospital. How many? That's an interesting question, because the answer isn't obvious at all, but a way of making a quick guesstimate might be in terms of the average hospital stay, which turns out in the US to be somewhere around eight days for Medicare patients (who I suppose are typical patients, since they're by definition of an age that is a risk factor). 

If this is right, then we could get a crude idea by comparing the total hospitalizations to the new cases of a week or so earlier, as on the blue and pink charts above, where at the bottom of the current curve, 11 September, we had 42,000 new cases, corresponding to 29,500 people in hospital a week later on the 18th; and the 57,000 new cases a week ago on 19 October correspond to 43,000 people in hospital today. This suggests that around 70% to 75% of new cases end up hospitalized, which indicates that the chance of a "case" in the United States being really sick is extremely high, and we'd be finding most of them—close to three quarters—whether we tested them or not. (In fact you can bet that a great deal of the testing, probably most of it, is done in the emergency room on people who are there because they're already in bad shape.)

Thus, if it's not obvious, Donald is wrong if he thinks our testing is causing cases that we'd never notice. On the contrary, given that the proportion of cases requiring hospitalization is supposed to be about 20%, it is missing vast numbers of those cases; we should have found 215,000 new cases on 19 October. Including 160,000 or so people who didn't know they were infected and may have infected others, especially if they weren't wearing a mask because FREEDOM, which is a pretty good illustration of how this terrifying new wave has taken place.

And if we "cut the tests in half" we'd miss still more, and the spread would be radically still worse than it is already, and we'd have many more serious cases, and many more deaths than we will as it is. On the contrary, we ought to be testing three times what we are.

Incidentally, when Donald says that "the mortality rate is down 85% because of the therapeutics and all that they learned", it's actually because of testing.

Via WRAL News, Durham.

What he's talking about, in a thing he's been using since early September, is changes in the case fatality rate—the proportion of deaths to confirmed cases—between mid-March and late July, when the raw number of Covid deaths went up from under ten per day to well over 2000 for a terrifying moment in late April to the range around 700-800 where it has been hovering ever since (see below), and what it shows is how the number of daily confirmed cases  rose from around 200 to 30,000 and eventually 40,000, thanks to the increased availability of testing. That's exactly how you lower the case fatality rate. 

Early on, due in part to shortages in testing equipment, only individuals with significant symptoms were being tested, and those patients would be likelier to end up with a fatal case. Later on, Smith said, testing was catching more individuals with mild symptoms or even no symptoms at all, which helped decrease the case-fatality rate.

To make this concrete, on March 19, as the case-fatality rate was peaking, 27,974 tests were taken nationally, according to data from the COVID Tracking Project. By April 27, the number was 196,080 — a seven-fold increase. By then, the case-fatality rate had fallen significantly. The rate fell further by July 22, when the number of tests had risen to 796,439.

The more testing you do, the lower that number is. (Which makes it a lousy number for getting at the death rate, unless the testing rate is held very consistent over a long period of time.)

And it's not a waste of money. If only Donald could have been brought to understand this, that by increasing the number of tests he was making himself look better, he could have made himself look triply better if he'd been willing to triple down. In addition to, you know, saving lives besides his own. But he's too stupid, and can only stew over how those malevolent doctors reduced his personal herd immunity, as if it was their decision, and his kissing privileges.

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