US Coronavirus Outlook

I’m reluctant to make corona predictions in no small part because I am not a big believer in macro models. Nonetheless, there is one trend that I think is revealing: states that peaked early have dropped off in their death rates.

I think this is due to ‘community immunity’. Not perfect immunity, not herd immunity, just a rolling immunity that lowers death rates because even though people might get reinfected they probably have some residual protection that gets ‘reupped.’ My expectation is that community immunity is only realized when there is a relatively short burst of broad infection – as in Sweden or the Ultra Orthodox community of New York.

If the infection rates are kept low then you never achieve this state because the time between infections is too long. Note that I am talking about infections, not diagnosis. Because testing is so variable, the spread between these two can be vast. At the very least, it is often unknown. As we’ve seen from New York’s serological survey’s, the number of undiagnosed cases can be quite high.

The Early Peak States

The states that follow the ‘community immunity’ model would seem to include all those with a peak of over 5 deaths/million/day prior to July 1. Six of these states peaked at over 15 deaths/million/day. New York hit 50. The big later humps for New Jersey and Delaware are deaths added in after the fact to correct for earlier data errors.

I predict these states will hover somewhere at or below 2 deaths/million/day until there is a vaccine.

Louisiana and Mississippi are the exceptions to this rule. According to US News, Mississippi is dead last in quality of medical care and Louisiana is 45th. It is possible the death rate from their first peak was an artifact of medical care, not broad infection. This, combined with the relatively low initial peaks that they experienced, suggests that they may never have experienced the broad infection rates of the rest of their death-rate cohort.

(Click on images to enlarge)

Later Peak States

Second are those states that appear to be peaking now. Nevada still appear to be on the way up and Georgia may be. Nonetheless, these late peakers seem to reach 8-12 deaths per million/day and then make their way down. We are still only in the early stages of the downhill and so the trends aren’t as clear. These peaks are lower than the first set. This probably due to a combination of factors including better care, a less dangerous virus, lower infection doses and better protection of the elderly.


Finally, there are the states that have yet to peak. They all had early bumps, but none above 5 deaths/million. I expect all of these states (unless there is a vaccine) to rise to a future peak. If they don’t then they will continually and slowly rise without ever getting the benefit of community immunity. If they do peak, I expect it will be somewhat lower than the 8-12 range for the states currently peaking. I predict it will be in the 8-10 deaths/million.

Cumulative Deaths

Another way to look at this is cumulative deaths. A short, sharp, rise leads to a leveling off. If this doesn’t happen, the leveling off doesn’t appear to occur.

Eyeballing these charts (no science behind this), I’d expect the Late Peakers to end up in the 5-700 range and the non-peakers that go through a run-up in the virus to end up in that same 3-500 range. Those that don’t could well be higher due to continual re-exposure.

I thus expect the US to have a triple hump with California being the first of that third batch of states.

As I stated at the beginning, I’m not a big believer in macro models so my confidence in the overall picture is low. After all, a vaccine, monoclonal antibodies, dexomathazone or any other number of factors could bring the virus to a halt. It could also get worse, should it mutate into a more dangerous form. I consider this unlikely as a virus spreads more readily if it doesn’t drive its host to isolation or death.

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DRM 3 years ago Member's comment

I can't believe that anyone with a brain can still be worried about C-19. Compared to the annual deaths we have every year in the USA and Globally, C-19 deaths are insignificant. (see deaths below) When will we ever get back to a normal life? The politicians who continue to shut down businesses and enforce lockdowns are idiots! More people are dying from the "cure" than the disease! If only the supreme court would have upheld the US Constitution, these idiots/politicians could not have destroyed the best economy in US history. The worst is yet to come. Wait till Q1-2021.

Worldwide Deaths by Category (2019)

Cardiovascular diseases: 18 million

Cancers: 10 million

Respiratory diseases: 4 million

Lower respiratory infections: 2.5 million

Dementia: 2.5 million

Digestive diseases: 2.4 million

Neonatal disorders: 1.8 million

Diarrheal diseases: 1.6 million

Diabetes 1.4 million

Liver diseases: 1.3 million

Road injuries: 1.2 million

Kidney disease: 1.2 million

Tuberculosis: 1.2 million

HIV/AIDS: 1 million

Suicide: 800K

Flu virus: 650K

Malaria 620K

Homicide 405K

Other causes: 6 million

Dragan 3 years ago Member's comment

Wow, that's quite eye opening!

Michele Grant 3 years ago Member's comment

Perhaps you are correct - I would have thought Covid would have factored into the election more and caused Trump to lose by a landslide. While he'll likely still lose, that clearly didn't happen. And after his lawsuits, who knows who will be in the White House What's your prediction @[DRM](user:130312)?

Joseph Cox 3 years ago Contributor's comment

*My* thought is that Trump loses. The Supreme Court is fragile and can't unless Barrett abstains or votes against Trump, find in his favor. They might even decline to take cases.

On a more general note, my mother used to point out that there has always been electoral fraud. You can only fight it between elections (thus conflicts no Voter ID, Voter Rights Acts, against New York and Chicago Machines, the occasional criminal case....). If you fight it after the election then democracy can't function. After all, they needed a literal mob to force a quorum to vote on the Constitution and the black vote was definitely suppressed. You can't unwind past electoral fraud and suppression. You'll never resolve anything.

You can just make the future better. Short of genuine uncertainty (e.g. hanging chads) and massive irregularity if Trump loses the state counts then he loses the election - and that should be allowed to happen.

Gary Anderson 3 years ago Contributor's comment

So now Trump says the virus is overblown while hospitals are filling up due to wintry conditions. He says we have high case counts because we test more. But that is not true. We are getting more positive tests, with Wisconsin at 16 percent!

Joseph Cox 3 years ago Contributor's comment

I haven't run the data, but I imagine we're seeing the no-peak states pick up - as predicted above.

Susan Miller 3 years ago Member's comment

Sorry to have heard your country is going into lockdown, but at least the recent peace deals should offer some comfort.

Joseph Cox 3 years ago Contributor's comment

The peace deals are wonderful. The lockdown is somewhat 'light.' My son is still going to his basketball practice my wife to work. They have closed schools, customer-facing businesses (to on-premises customers) and limited travel for reasons outside of work. Hopefully it will help the caseload stay within the treatment capacity.

Anne Barry 3 years ago Member's comment

I just saw a report on how the coronavirus is ravaging Israel. The worst in the world. Why is it so bad over there?

Joseph Cox 3 years ago Contributor's comment

Two notes.

One, the Israeli death rate only just crossed 2/million/day. The US peaked at 8. Belgium at 25, Spain at 18. So while we have lots of positive tests part of that is due to lots of testing.

Two, there is a cultural challenge. If you go here and sort by the places with the highest rates:

You'll see Arab and Haredi (ultra-orthodox) places at the top of the list. The vast majority of the top of the list are Arab, but they are smaller places. Despite the government and the press, I think many people want to let it spread in order to move on. I'd be happy to do this too - with better statistical understanding of the remaining cost and with field hospitals and overseas clinicians invited to shore up capacity during the rush.

In round 1, Israel had a death rate of 0.14% per statistically identified case (vs. 1.4% in NY and 5% in Sweden). This number should be updated and the remaining road identified so we can make intelligent decisions about where to go.

Joseph Cox 3 years ago Contributor's comment

Sweden has now had 0 deaths for 14 days straight.

Joseph Cox 3 years ago Contributor's comment

sorry, 5 days

Gary Anderson 3 years ago Contributor's comment

They are a closed society. We have many travelers in the USA.

Joseph Cox 3 years ago Contributor's comment

I don't get it. The charts above show for states that had major peaks those peaks are *done*. Sweden has the same thing. Closed society or not, they had a major epidemic. It is now *not* a major epidemic there. They haven't locked down society. The bug spread fine before, but now they have population immunity.

Interestingly, while their economy contracted, it did far less contraction than the US economy.

Wall Street Jack 3 years ago Member's comment

I'm curious to know what some of you, including @[Joseph Cox](user:127658), @[Moon Kil Woong](user:5208), @[Gary Anderson](user:4798), and @[DRM](user:130312) about the major development supported by the White House and the CDC? They now say that there is NO NEED to test asymptomatic individuals who were in direct contact with people who are confirmed to be infected. Does this not seem insane to you?

DRM 3 years ago Member's comment

Does it really matter? No one in power is using the facts to make intelligent, informed decisions anyway. Lockdowns don't work. They in fact do great harm to society. Very few who have been infected have died. Most of those who have died were very old and/or ill. If every citizen was infected, what would the government do? There's nothing they can do. Viruses happen! Politicians have managed to destroy the greatest economy in US history. How much worse can they make it?

Gary Anderson 3 years ago Contributor's comment

Being old is not a death sentence. You are acting like you have some sort elevated right to live that old people have to forfeit.

DRM 3 years ago Member's comment

Seriously? That's your take on my post? Don't you understand that, being born is a death sentence? Well all die, eventually. Seems no matter how many times I explain and in how many different ways, you just don't get it. One more time, trillions of dollars have been wasted on the overhyped C-19 virus and trillions more will likely be wasted.

Gary Anderson 3 years ago Contributor's comment

Trump's evil dad believed there are killers and losers. That must be close to your philosophy. Right?

DRM 3 years ago Member's comment

No, because many "killers" are "losers". I believe there are winners and losers and most winners are hard workers. Losers are typically lazy.

Gary Anderson 3 years ago Contributor's comment

So I believe all shoud have the same rights. The Republicans want to limit voting to males and property owners!

DRM 3 years ago Member's comment

That's because women are too emotional and renters have no commitment.

Gary Anderson 3 years ago Contributor's comment

Now you must be trolling. Or are you just joking. Those are the two best outcomes of your statement.

DRM 3 years ago Member's comment

Just wanted to see your reaction to a ridiculous comment, like your's above, "The Republicans want to limit voting to males and property owners!"

Angry Old Lady 3 years ago Member's comment

Thanks to Bob Woodward, we know now that even Trump knew how deadly COVID-19 was. Back in January, when he kept telling us it was no big deal, he knew it was airborne and 5 times deadlier than the flu. The opposite of what he told all of us.

DRM 3 years ago Member's comment

No one knows how deadly the Coronavirus is because everyone who dies after contracting the disease is counted, regardless of the actual cause of death. It’s insanity!

Texan Hunter 3 years ago Member's comment

Great comments as always @[DRM](user:130312).

Joseph Cox 3 years ago Contributor's comment

Don't ascribe too much intelligence to Trump's statements at any time. He could now just be trying to make himself look smarter than he was (or is).

Angry Old Lady 3 years ago Member's comment

I don't think #Trump would try to claim he knew more than he did - it would only make his lack of a response worse. Besides, the interviews/recordings go back to December. It's what he actually knew at the time.

Joseph Cox 3 years ago Contributor's comment

He didn't have any information we didn't have. It was obvious to everybody from January that a disease that could spread asymptomaticly could not be stopped beyond the very very early stages. That window closed with the Chinese New Year in Wuhan.

So he *knew* it, but so did everybody else. It was coming, no matter what. Then the question is, what do you do about it?

Even now, the answer isn't so obvious. Sustained mass panic might not be the way to go.

Angry Old Lady 3 years ago Member's comment

I disagree - I followed this virus closely and the first time I ever heard any source say it was airborne was a couple months ago. In January most Americans didn't even know the virus infected. Back then few said it was more dangerous than the flu. But that's not the issue. The point is he KNEW it was more dangerous, but told Americans the flu was more dangerous and that no one does anything proactive to prevent that (e.g. shutting down travel or businesses).

Trump lied to us. And nearly 200,000 Americans died as a result. Worse than most of our wars!

Joseph Cox 3 years ago Contributor's comment

200,000 Americans did not die because of anything Trump said. That's like saying Peru's Vizcarra is responsible for the worst death rate in the world, or Sophie Wilmes is responsible for the second-worst-in-the-world death rate in Belgium. Or Mario Cuomo being responsible for the second-highest death rate in the US (behind NJ).

Different words might have had very little impact. Even different actions, given the existing social and cultural aspects of the United States might have caused more harm than good.

As far as public is concerned, here's an excerpt from my podcast on January 28th:

"You see, the disease was first noticed in early December. Locking down Wuhan was very impressive, but the chances are the horse has already left the barn. Over four million people left the city between the time of initial detection and when they shut the doors. If the disease can be transmitted during its dormant period of up to 2 weeks then millions of people could have left, undetected, as carriers. If the disease is contagious when there are no symptoms, then there’s no way to get a leash on it now."

I had no special briefings, no unique insights.

Here's an early attempt at humor from February 2nd:

"For years, China pushed the One Child Policy. They forced abortions. There were masses of abandoned babies. All of it was a particularly nasty deal. But, then, they realized they were going to suffer a terrible problem. There are going to be, if current demographic trends continue, an enormous amount of old Chinese who are beyond their working prime. A country with the per capita income of Romania was going to have a massive elderly population. There were going to be too many parents. Cue the Corona Virus. The Chinese have just shifted their old policies. Instead of the One Child Policy, they’ve adopted something new. The No Parent policy."

This is not suggestive of a disease that isn't dangerous.

Gary Anderson 3 years ago Contributor's comment

Joseph, we were all duped by Trump including you. You should feel betrayed.

Joseph Cox 3 years ago Contributor's comment

I don't listen to a word Trump says. He's an idiot. I would guess you don't either. You will not find, in all the writing I've done, a single reference to Trump as an authority in *anything.*

That doesn't mean he can't be an effective President but only a small percentage of people (probably somewhat smaller than the number who think Biden has all his marbles) actually think Trump speaks truth. Many more people just don't happen to believe his detractors either and so refer to Trump as an antidote to the accepted truth.

Where I live there are newspapers who job it is to criticize Netanyahu (and others which exist to praise him). When there is no lockdown, they lambaste Netanyahu for not locking down. When there is a lockdown, they attack him for locking down. When there is no peace, attack him for no peace. When there is peace, attack him for peace (this is a clever turn for generally left-wing papers, but they've done it - see below).

I've learned to tune out both the pro-Netanyahu and anti-Netanyahu news.They are driven by personality, not underlying objectives and the focus on personality ends up being tremendously destructive.

I apply the same rule to Trump. I'm not really interested in what either his supporters or detractors have to say - they are both blinded by the politics of personality.


How does the left-wing attack peace?

1) Attack military equipment concessions the UAE got

2) Attack the dishonesty of pretending to want annexation just to give the UAE something to paper over their decision (stopping annexation)

3) Attack the peace deals as being too quick and not perfectly negotiated

4) Attack the peace deals as serving political objectives

5) Attack the peace deals because Netanyahu should be focusing exclusively on Coronavirus

6) Attack the peace deals because the other party aren't very nice people

7) Attack the peace deals because Netanyahu wasn't going to fly commercial to get to DC

All of it is pretty useful for analyzing whether the deals are a good idea or not. If they had been commissioned by somewhat on the left, none of these arguments would exist. Of course, the opposite also applies - if a left-wing PM were to do things the right-wing supports the same kind of attacks would occur.

Joseph Cox 3 years ago Contributor's comment

I have no idea. It has little meaning outside of a broader context. If the idea is that you're isolating people who've been in direct contact but not testing them because contact tracing is meaningless at this point and those who have no symptoms aren't in danger then... fine. That's what happened to me. My kid was in Kindergarten with four diagnosed cases. No symptoms, no test. No reason to test. But we were still in isolation.

My wife was tested, after isolation but that's because she works with old people.

If, however, there is no isolation then that decision would need to be made in context of overall threat to society. I don't think the Ultra Orthodox community would face much danger at this point from exposure - most people have it and re-exposure within a shorter time frame is less dangerous than re-exposure after a three-month delay.

Gary Anderson 3 years ago Contributor's comment

Trump has always said, less testing, less virus. He is a virus.

Rebecca Duncan 3 years ago Member's comment

I find it odd that they chose to have this discussion when Dr. Fauci was unavailable, and then used his name to give it credibility, claiming he endorsed it when he did no such thing.

Have all these independent, non-partisan agencies like the CDC and USPS become politicized?

Susan Miller 3 years ago Member's comment

American ranked dead last in a global ranking of how it handled the coronavirus pandemic:

Joseph Cox 3 years ago Contributor's comment

A *poll* of how people felt about how they handled it. Yes, Belgians, Spanish, Italians and New Yorkers are all impressed by their governments' performance - despite higher death rates. I'm not suggesting the US has done well, of course.

Ayelet Wolf 3 years ago Member's comment

It saddens me to think how much all of this could have been avoided had the US taken even the most basic precautions in the early days.

Joseph Cox 3 years ago Contributor's comment

The first precautions (restricting travel from China) were lambasted as Trump idiocy. Then he didn't restrict travel fast enough. And so on. When policy is decided entirely by *who* your camp likes, it becomes real hard to make sensible decision.

I have the advantage of disliking everybody :)

Gary Anderson 3 years ago Contributor's comment

You can't defend Trump. He did nothing after banning Chinese flights. If he knew so much, why did he back off? Don't defend the clueless.

Joseph Cox 3 years ago Contributor's comment

I'm not going to argue about his cluelessness. He has a political clue, but that's about it.

BUT... his administration did lots of things (aside from crappy messaging).

Maybe not when people wanted but they include:

* Fast-tracking the FDA on test and treatment approval

* Using the Defense Authorization Act to manufacture ventilators

* Apportioning said ventilators so nobody has had a shortage (despite many dire predictions)

* Working with Congress to provide massive subsidies to the economy

* Restricting international travel

* Supported the infrastructure to provide 65 million tests

Is it him? Of course not. It is his administration. But defining all things Trump as either good or bad is a mistake. Trump (or Biden or Obama or...) can't be your benchmark.

Your benchmark has to be: "I want to achieve X and Y, does Z do it?"

Did the Federal government react well? As I said months ago, the Federal Government *never* reacts well. It is a slow, calcified, *broken* bureaucratic monster. It doesn't do near anything well - increasingly not even war. Byzantium would be proud.

It's all okay though. I'm sure the next guy is so capable he'll fix the it all.

That's one reason I don't live in the US anymore.

Sandra Sinclaire 3 years ago Member's comment

Does it really make sense that every state kind of "does their own thing" when it comes to coronoavirus? These aren't separate countries. State borders are porous with people often crossing borders for travel, shopping and work. I would think a comprehensive national plan is what is needed.

Joseph Cox 3 years ago Contributor's comment

People cross borders, but isn't it fascinating how each state manages to map a distinct path. South Dakota has the fewest restrictions but is 10th lowest in deaths/million. California has the strictest restrictions but is pretty much in the middle (23rd). Different places are actually very different and call for different responses.

This is a strength of the Federal system - you can experiment and learn. New York really messed up, but everybody else learned resulting in much better outcomes elsewhere.

Samantha Wolf 3 years ago Member's comment

The first "no peaks" chart looks amazingly like the picture my daughter drew on our wall today. This is my life during the pandemic! Hopefully schools will re-open soon.

Joseph Cox 3 years ago Contributor's comment

Ah you'll look back and cherish the opportunity to remember the hair loss :)

I have six kids, which is enough that they can keep each other busy.

Samantha Wolf 3 years ago Member's comment

Thanks Joseph!

Flat Broke 3 years ago Member's comment

If some crayon on your wall is the worst this pandemic has done to you, count yourself lucky! The Mr. Clean Magic Eraser will solve that problem lickety split. Sadly, for those of us who lost our incomes, homes and/or loved ones, it won't be so easy to fix.

Ayelet Wolf 3 years ago Member's comment

Sorry to hear that your budding Picaso ruined your wall. Perhaps she has a future as a statistician or an epidemiologist!