A Shameful Act in Five Parts
Partial credit where partial credit is due. CDC has not gone dark and has made some modest overnight improvements in the case reporting information organization. Sympathy to hard working middle level scientists and health care workers faced with a novel threat challenge, and heavily burdened by a political millstone hung on every scientific effort to make Trump.45 look good (optics primum inter pares), or at least not awful. Stay tuned; still one more update this week tomorrow before the expected weekend reporting lull.
The major change today is the addition of a new Act 5 for this production, presumably in partial response to the storms of public and scientific criticism last week about foot dragging and fumbling by top level political authorities. More below.
Act 1
Nothing new to see here from March 4th to March 5th.
Act 2
CDC Daily Update 02 03/04/20
CDC Daily Update 02 03/05/20
The one-day Trump.45 Corona Butcher’s Bill of Cases reported to CDC increased from 80 to 99. That is a 24% increase from Tuesday to Wednesday at 4 PM. Total Deaths increased by 1, from 9 to 10; an 11% increase.
These new daily numbers are too small to compare side by side. But last Wednesday, February 26 Trump.45 gave his first full lean in press conference after the stock market tanked 2 Monday and Tuesday. Pence was anointed Corona Czar. You will remember some of the high points from Trump.45’s reassurances to America.
From DailyKos report (selected):
- Trump says the risk to Americans is “very low” and that there is also a low number of US cases.
- “We started out by looking for certain things,” Trump says of his response to the virus. He says “we’re going to spend whatever’s appropriate,” but hopefully “not too much,” because they’ve been having “tremendous success” in handling this.
- Trump says we’re ready whether it’s a breakout of “larger proportions” or still at this “low level.” He says it’ll soon be down to just five people as people recover. He says Johns Hopkins says the US is #1 most prepared for an epidemic.
- Trump: “I’m going to be announcing exactly right now” that I’m putting “Vice President Mike Pence in charge” (on coronavirus). “And Mike will report back to me, but he’s got a certain talent for this.”
- Trump talked only about the first 15 US cases, calling them “the original 15” and repeatedly referring to them, even though the rest of the government now says there are 60 confirmed cases.
CDC has now given us the one-week post-press conference official state of play. Under Trump.45’s counting regimen US cases jumped from 15 to 99, more than a six-fold increase. Deaths went from 0 to 10. And the rosy billed 15-Cases scenario has flown away into the ether. The virus is here to stay and well-positioned in the short and intermediate term.
Act 3
CDC Daily Update 03 03/04/20
CDC Daily Update 03 03/05/20
As noted above, from March 4 to March 5 using CDC’s reported data reporting structure the total number of new US cases increased by 19 from 80 to 99 (an increase of 24% overnight). What is instructive here is the breakdown of cases by category of origin.
Travel related cases went from 24 to 30; person to person transmission went from 16 to 20; and cases still being investigated from 40 to 49.
From this limited data set, there was a sizable percentage jump in cases day to day, while the relative portion of travel to community spread remained stable at 60/40 at this point in the outbreak. This proportion excludes the initial bolus of 49 cases CDC has segregated from analysis.
This coronavirus situation is evolving so rapidly that no firm conclusions can be drawn. However, the hint is that internal US community spread now comprises about 40% of new cases compared to about 60% from new US foreign travel returnees at this stage of the outbreak. Inside versus Outside sources of infection. Changes in this ratio will help determine the character of the most effective public health responses needed. And where new financial resources can be best applied. Congress today has agreed to spend $8.3 billion new dollars. Let us hope we have a reasonable emergency allocation of funds by an Administration that has proven particularly maladroit so far.
The second new feature of the revised Act 3 is the addition of yet another clarifying footnote, this one a double dagger (‡) or obelisk.* This is quite relevant information since CDC has now officially given the total US coronavirus testing count performed through yesterday at 4 PM. That number is 1,526.
And a scandalously pitiful number it is in America with her 330 million people, and the greatest medical and public health apparatus in the world. Not on this score as of today. It also gives the lie to CDC testimony to Congress earlier this week about 3,600 tests performed, or the fantastical statements by Pence, Azar, and yes even the head of FDA of 1 million tests being available, or 10,000 tests per day performed sometime this week before Friday, etc. The top down messaging was all PR flackery and Trumpian exaggeration unrelated to facts and people getting sick, and severe test rationing to cover up administrative shortfalls.
The good news is that the sunlight disinfectant of publicity has scorched the Task Force’s collective asses such that state health departments and academic centers can now fill the critical gaps, independently of the Jurassic federal pace of reaction. State and local public health testing began this week, and academic and hospital centers will be coming on board to close the yawning gaps in testing availability.
No credit to government leadership here, but gratitude the situation has been partially rectified. I wonder if this double dagger footnote information will be a one-off fossil or be updated in future release. We’ll see, maybe tomorrow.
The numbers are still quite small, but we might note that there are at least 99 positives out of a total of 1,526 patients tested, a positivity rate of 6.49% in the US as of yesterday, counting since January 21. Looking ahead, somebody better cross all their fingers that this rate quickly tamps down as testing numbers in patients with looser criteria ramp up dramatically, or America will be in for one hairy wild ride if tests go up to 10,000 or more per day, for example. Hope for better, prepare for as bad.
Another side comment. The three combined footnotes to this section now take up more presentation space than the primary information offered. As a general rule, that would suggest there may be some flaw in the underlying organization of the data scheme. Still, for complex public health data better complications than glossed over misleading summaries so favored by Trump.45. Here the CDC information group is separating itself from the political wingers. Amen.
Act 4
CDC Daily Update 04 03/04/20
CDC Daily Update 04 03/05/20
Not too much has changed in Act 4 on casual review, except the footnote is a line longer, further emphasizing CDC’s self-imposed retreat from taking responsibility for up to the minute complete national case counts. Let someone else do the job. A slogan Trump.45 can enthusiastically endorse, as he already has in other situations.
There is a nagging and now growing concern about the mapping legend and its component categories. Maybe the CDC staff are just completely overwhelmed, getting hit from all sides political, medical, and viral. There is now a 25-point unmapped zone in the middle between the listed small and large categories.
A new category of 30-40 should have been added to the earlier ones, with a new color assigned. That way, a casual observer wouldn’t be snookered into thinking at first glance nothing about the extent of illness has changed.
This actually appears on close examination to be another example of a common statistical trick, the opposite of slice and dice. This tactical gem is called lumping, adding together disparate groups, often with the goal of diluting potential findings of significance. Please note that there are perfectly legitimate uses in epidemiological analysis for lumping and slice and dice techniques. But they have too often been used to cover up significant findings and mislead naïve general readers, who don’t fully grasp the smoke and mirrors they are being exposed to, as seems to be the case here. Time will tell.
The current gruping assignments are not really scientifically defensible in a map intended for frequent updating during a current crisis. Shame on whomever is planting the thumb of obfuscation on the middle zones. Your grandma likely told you some version of “giant oaks from little acorns grow”, and so it is with epidemic spread.
Come on fellas, you can do better for America’s middle information class, the majority of our fellow citizens.
Act 5
CDC Daily Update 05 03/05/20
What is truly novel today from the CDC’s daily data reporting is the addition of an entirely new section overnight, which we will dub Act 5. Very helpful indeed.
The map and accompanying table shows which US states and territories (50 states, District of Columbia, and 3 US territories: Guam, Puerto Rico, and the Virgin Islands) have either begun coronavirus testing on their own outside of CDC, or are working on it since the go-ahead was given at the end of last week.
The good news for all Americans is that only nine of 54 elements are still not ready. Well done state health departments; 83% are up and running. There are six laggard states: Alabama, Wyoming, West Virginia, Ohio, Oklahoma, and Maine. There is no geographical clustering of the also-rans. Do you see any significant other group correlation among five of the six? Try imposing a state electoral map over this laboratory preparedness map. No comment.
None of these six has reported a case yet, so far as we know. Is it because they have excellent containment, or is it symptomatic of poor underlying public health infrastructure? We will see as the outbreak unfolds in the weeks to come.
The other three unprepared locations are the three US territories: Guam, Puerto Rico, Virgin Islands. This is not a unique stressor for them, as public resources of many kinds are often insufficient for their needs. They may be used to suffering second class resource status, but that will only make the coming impact of viral infections greater when they arrive onshore. These three locations also may have another quiet benefit of relative geographical isolation compared to the 48 contiguous mainland states. This would certainly be expected to slow the introduction of the virus, which has now clearly broken through in the mainland to at least 16 of 48 states.
Summary
The burden of Coronavirus infections in the United is growing stronger every day but is not alarming. It is a serious public health matter that must be addressed with competence and vigor. Political misdirection attempts and false information will only prolong the crisis and make it more severe, especially among low-information Americans who do not adopt sensible personal precautions. Even if the virus is states away, your best defense in the end is to guard your personal welfare beginning right now. Then when the virus passes over your community later as it surely will, it will more likely pass you and your family by.
CDC has not performed well so far, and they need to step up their game yesterday. All of us need them to do their very best and pray that noxious political shackles can be broken with public exposure. Handling the coronavirus unfettered is already more than a full-time job for existing Federal resources.
Stay Safe America. Practice Sensible Personal Precautions Now.
*Yesterday I referred to this footnote marker (†) as a cross. My mistake. Typographers and English editors will have noted my error with displeasure. This symbol is more properly known as a dagger or obelisk. The symbol in the proper context is indeed a Latin cross, but here I think the better term is a dagger, and today we have a double dagger (‡) from CDC to add to it. The underlying point made about the plethora of footnotes of any stipe remains sound.
See a fuller discussion here.