Antibody Tests and the Asymptomatic

 PCR antigen tests give an indication of the presence of the virus in your system. They are based on swabs and do have a problem with both false negatives and positives. One could for example sample on the wrong side of a mucous membrane. They are not reliable for determining whether you have HAD the virus though in the past. 

The antibody tests sample directly from your blood plasma (serum plasma) and give a measure of your antibody load. This will tell you if you have had the virus or not. In short they capture a greater swathe of the population. By all accounts these seem to show that in most Western countries between 3% to 10% (maybe higher) of the population have had or have the virus. Seems to be far higher in NYC which is consistent with their death rates, Several of these tests have been carried out in various locales for research purposes by epidemiology experts. They have significantly lower false positive and negative rates than the PCR test. They are however more expensive. 

WHO itself has acknowledged that between 2%-4% of the world population likely has antibodies for the disease. This translates to a number somewhere in the order of 200 million people worldwide.
 At present close to 4 million cases worldwide have been reported which begs the question...Where is the rest? 

Two possible alternatives come to mind 1) Under reporting 2) High Asymptomatic Numbers. Under reporting can only hide the shortfall for so long as the exaggerated death rate would highlight this (unless the lethality is even far blower than it is). Asymptomatic Numbers offer an explanation which is consistent with studies of people who developed the Antibodies (showing the detection of virus by the Immune system). 

The consensus now is that those falling into the Asymptomatic category may make up 80-90% of all those infected. They don't EVER show symptoms but will shed the virus during the time when they are infected, It is the presence of said individuals that has greatly spread the virus.

Crazy Debt

Now that Western countries, with the possible exception of Sweden, have decided to blow up their national debts to galactic proportions it may be necessary to ask how we intend to pay for all of this in the future? Currency generating flora are still not yet a reality.

Bond buyers are likely be very scarce, increasing tax rates in a depression like economy is ludicrous and don't even get me started on the dangerous implications of inflating our money supply. Do so and you can kiss a great deal of future wealth goodbye.

Yes we are knee deep in crap. Future generations will undoubtedly judge us harshly (as they indeed should) if the gains from the extended lockdown don't match up well with alternative strategies that are far less intrusive

Why did Rhodesia collapse so much quicker than Apartheid South Africa?

My answer on Quora.

There are a number of reasons.

The Southern African country of Rhodesia unilaterally declared independence from Britain in 1965 (UDI). Source: Rhodesian UDI: 50 years on

a. The Country’s white population was considerably smaller than that of South Africa’s. At its height the Rhodesian white population stood at 300,000 or 8% of the total population. In South Africa the white population at one point numbered close to 19% of the total population. At its peak (1995) the population stood at 5.2 million.

b. The Rhodesian white population was largely comprised of British stock and all too often could make use of their connections with the commonwealth to leave the country, should the going get tough (which of course it did). The majority of South African whites are of Afrikaner stock (mixed Dutch/German/French Huguenot) and do not possess the same safety net. Their culture is also unique to the region. Many are people of the land who see themselves intrinsically linked to the country in a way that makes them more likely to hunker down and fight.

c. South Africa has considerably more mineral wealth and resources than Rhodesia/Zimbabwe has (or had). Consequently there was more push back against regime change that could endanger the control of this wealth.

d. Cold War considerations (especially around Uranium and Gold resources) made South Africa more of an important player in the Cold War. This explains the reluctance during this era by Western Countries to turn the screws on South Africa as they did with Rhodesia.

e. Rhodesia was a landlocked country and could be starved at the ports. This became a stark reality after the Portuguese left Mozambique in 1975. While South Africa helped Rhodesia out in the late 1970s this became less of a priority with the country facing more of its own foreign and domestic challenges.

f. South Africa was the regional superpower with a far ranging military capacity. While Rhodesian troops fought well against insurgent forces their strength was ultimately compromised by manpower considerations.

Source for Population Numbers:

1. White South Africans - Wikipedia
2. Rhodesia - Wikipedia

The Wharton Study and COVID-19 mitigation strategy forecasting

This simulation from Wharton is definitely worth looking into.

Source: Wharton Study

It puts a great deal of the risk analysis with respect to re-opening the economy into perspective. Bottom Line - Four Key options (all based on the US). Deaths mentioned are the total deaths and include realized deaths so far. YOY= Year-over-Year.

Case I - Delay opening until post June 30th
- 117,000 deaths
- 18.6 million job losses
- GDP -11.6% over YOY

Case II - Partially re-opening (Georgia and Colorado model) by June 30th
- 162,000 deaths
- 14.0 million job loss
- GDP -10.6% over YOY

Case III - Full re-opening by June 30th (not a return to normal though....Swedish model)
- 350,000 deaths
- 0.5 million job loss
-GDP +1.5% over YOY

Case IV - Full re-opening. Complete normalcy.
- 950,000 deaths
- +4.1 million job gain compared to May 1st.
- All job loss % since May 1st recovered.

COVID-19 Questions

From the top of my head.....20 Questions about COVID-19 that are worth thinking about. 

1.How is it that the Japanese death numbers are so low considering they have run a measly 1.5K tests per million?

2.What is the true death toll in Iran? Numbers here seem way under reported and are not consistent with 

high population densities and the low level of testing that the country officially reports.

3. Even with a strong lockdown why isn't the community spread in India larger? Is the strain of virus weaker on the sub-continent? Are deaths being overwhelmed by other comorbidities so that they are not registering as significant? The same point applies to Pakistan

4.Why does Portugal have so small a COVID outbreak in relation to its Iberian neighbour Spain?

5. How far along are the Swedes in their limited lockdown with respect to Total infections? Is Stockholm half way to herd immunity?

6. Are the Russians under reporting their numbers or are they just further behind in the COVID surge?

7. What really is the true Chinese death toll?

8. What is the true infection rate globally or locally? How accurate is the WHO estimate from one week ago that it is 2%?

9. Why does the disease have such an astonishingly low lethality in Singapore? Less than 0.1% of Official cases...way less than that if you include unofficial case estimates. The same can be said of Hong Kong and Taiwan.

10. What is the ratio of asymptomatic to symptomatic in the infected pool?

11. What are we locking down until? In most Western countries it does not seem to be a resource issue anymore.

12.What is the effect of warmer temperatures on this virus? Could it help explain the Australian success?

13. What is the impact of Vitamin-D deficiency on COVID lethality rates for those with darker skins living in cooler climates?

14. Has New Zealand really 'eliminated' the virus in their country or are they jumping ahead of themselves?

15. Why have Michigan and Pennsylvania not upped their testing rates faster considering they have been very hard hit?

16.People talk about contact tracing but how is that even possible in cities like New York or Chicago?

17.Why are the recovered rates on the official data so variable and inconsistent?

18. How does the data reported for each country differentiate those who die from COVID as opposed to those died from other issues but had the virus at the time of death?

19.Why does Belgium have such a ridiculously high death rate? Why is this double that of their Dutch neighbours?

20. Why are testing levels so relatively low in France (death rates aren't)? They have one of the most sophisticated medical systems out there after all.

COVID Thoughts as a Teacher

This was my initial take in Early April.

If I didn't know any better I would argue that the powers that be have contrived to turn us all into online facilitators. That is the reality of the teaching. Internet resources can easily turn a Google Classroom into a knowledge oasis and if you play this well 'the medium can indeed deliver the message'. However even with broadband and the luxury of Google Meet and other face-to-face substitutes we are still at a deficit to the real classroom. Humans are social animals (most of us anyway) and online platforms can only approximate the energy of our classrooms.

My Grade 12 students have (at least it seems) come to the realization that teachers will do their best to ensure that their post graduate opportunities will not be jeopardized in the fall. The school boards have systematic workarounds and we as educators are as transparent with the students as we can be. It is a completely different paradigm to what anyone of us are used to and as long as the students know that we are there to support them, then we will navigate through this crisis...somehow.

This was my take in Late April.

Kids are different to adults. They are more forgiving. When I err (usually with a typo on a Google doc) they will point it out but it is usually with a sense that my notes are their notes as well. For many it is a team effort. Most of the school boards if not all have gone with a maxim that the student's marks cannot drop from the 13th of March cut off date (last school date before closure here in Ontario) which has the possible repercussion of encouraging a slacker effect for those that are prone to the minimum. However I haven't noticed that with my students. In fact if anything it has taken off the grade pressure from many of them as they can now focus on merely elevating their mark without the downside of test slip-ups. An added bonus is that a leeway has been built in for improvement based on realistic evaluation.

As a teacher this means that I have more students as a whole focusing on the enrichment that the material brings. Kids are asking me to go further than the curriculum entails which as a lover of my discipline (physics) is a rare blessing that doesn't come along normally in the regularity of the average school year. Students can learn for the sake of knowledge itself and that truly is an unexpected windfall from what could have been a more turbulent educational experience. Tough times albeit with a silver lining.

Enough of this Praise for Cuomo

A large portion of the media has been lionizing New York's governor Andrew Cuomo. While he does have personality traits that make him likable and he appears to say the 'right things' (at times sounding unusually non-partisan) I am not that impressed with the way that his state government has handled the COVID pandemic. Results matter and New York is very short in this department.

As it stand right now the situation in New York State is dismal. The state has 28.9% of the country's total number of 'official' COVID cases and accounts for a whopping 38.6% of all American COVID deaths. New Yorkers only make up 5.9% of the American population.

In terms of deaths per million New York currently sits at 1197.Six and a half times the national average. In fact the New York death average per million is over twice as much as Italy and Spain (both heavily hit nations) and three times the values for France and the UK. Each of which have not weathered the disease well. However it doesn't stop there.

New York's high infection rate numbers have also bled into its Tri-State neighbours - New Jersey and Connecticut - that now have deaths per million of 762 and 583 respectively, These are both higher than the Italian average (that we fretted about so intensely in March). The numbers are obscene.

All three states. together account for almost 50% of US deaths. Remove the Tri-States from the US numbers and American death rates are only slightly higher than Germany. So it isn’t the rest of the country that is problem (although there are a few hotspots elsewhere)

Now the classic retort when bringing up New York is to mention its very high population density. That is certainly true of the five boroughs area, but even with correction multipliers of two or three the numbers are still outrageous. In addition population density by itself doesn't necessarily dictate fate. Seoul. Tokyo, Hong Kong and Tapiei all have high population densities but very low COVID death rate levels.

New York has been a shambles and Cuomo must take a great deal of the blame (not all - the mayor of NYC Bill de Blasio has been awful..the New York subway is a literal COVID petri dish).

For one Cuomo was late on the lockdown (whose original intent if you remember was to flatten the resource curve). The state locked down on March 20th, three or four days after most other states.

In fact as late as March 18^th  Cuolmo had this to say in an interview in the New York Times – “The fear, the panic, is a bigger problem than the virus. Telling New Yorkers they must not leave their homes scares people.". He also said that he will not "approve such edicts in New York City or elsewhere”.

Cuomo’s response was lauded by Reason magazine for not panicking under pressure. Two days later he changed his mind. New York would be in catch-up.

In fact as the number of cases started increasing Cuomo did indeed panic. Big time.

New York State looked wholly unprepared with respect to PPE, hospital beds and ventilators (an obsession with Cuomo) and unlike Gavin Newsom and other governors Cuomo seemed incapable of securing these items from other sources. Why the state was in such a shocking position at the onset of this epidemic? is a question that needs to be asked,

Fortunately for Cuomo the Federal Government stepped in. The ventilators did arrive (for better or for worse...their efficacy is now debated),  Trump bullied those that he could to gain masks for New York’s Health workers,  FEMA stepped in to set up hospital sites in the boroughs and Cuomo could breathe a bit easier. He did thank Trump for his efforts here.

To his credit Cuomo stood up well as the voice of the state but the death numbers continued to mount. Words can only paste over bad results from poor planning for so long.

The worst would follow from a terrible policy directive made earlier in the epidemic involving nursing homes. On March the 25^th Cuomo made a fatal decision mandating that all state nursing homes accept patients for diagnosis regardless of their COVID status. This decision would prove to be a knife into the gullet of one of the state’s most vulnerable population groups. By some accounts almost a third of patients entering these homes were positive for COVID. The consequences have been ugly.

Meanwhile New York state continues to simmer. New COVID cases numbers are dropping but that may be more of a function of New York City closing in on the 60% herd immunity marker than anything else. Death numbers are still very high and the state is still reeling.

Cuomo has weathered it well in the eyes a great deal of the media (would it be the same if he were a Republican?) but the number reality for New York tells a different story. A governor is elected with the mandate to serve as a safety guardian for the state,

 Cuomo tried and I will give him credit for that but there is a great deal he could have done better. At the end it is only results that matter. You don’t gain real kudos for participating with relish. New York has not performed well by any metric and Cuomo must take a great deal of the blame.