Thursday, April 30, 2020

The Standard for Reopening States is Rigged

The Standard for Reopening States is Rigged

The new White House standard for reopening the economy in various states is rigged to severely prolong the economic strangulation under the current lockdowns. The criterion has been defined as a 14-day period of declining volume in new cases or a 14-day period of declining rates of positivity of those tested.
Testing is ramping up in every state, which if the epidemiologists are right, will produce a lower percentage rate of positivity on the tests since the curve has been bent.  But there is a new factor which throws all of these calculations off so far off that the 14-day standard should be abandoned.
Drive through screening (US Air Force photo)
That factor is the likelihood that there are an enormous number of asymptomatic cases out there that have never been counted (nor tested so far). Early estimates based on sampling in Iceland suggested maybe half of all those infected were asymptomatic. Dr. Fauci estimated 25% of cases might be asymptomatic. Now we have much higher estimates. The Stanford sampling study in Santa Clara County testing for antibodies, a similar study in Los Angeles County, a study in a town in Germany, a study just done in New York State, and testing in an Ohio prison and a Boston homeless shelter, suggest the number of asymptomatic cases are in fact  many multiples of the number of cases already tested positive so far.
This is good news and bad news. The good news is it means many more people have already had the virus or are experiencing it in very mild or totally asymptomatic fashion. This means the real death rate for the virus has a much larger denominator when you divide total deaths by total infected, and hence a lower death rate. It means the country is closer to herd immunity in some places, assuming having had the virus provides some future immunity, so far not known.
The bad news is that it could also mean that some of these many asymptomatics could still be spreading the virus, since how long someone can be a spreader is also not known.
However, because of the now rapid ramp up in testing, which has been the battle cry and demand  of epidemiologists and critics of the steps taken by the Administration so far, many of these asymptomatics will now get tested and their positive infection status added to the daily count of infected in states across the country.  Many of those tested will have antibody tests which do not tell you when someone was infected. That is a huge problem for compiling a daily number of new positive cases.
This almost certainly means that even if the real curve of the number of newly infected in a state has leveled off, the change in the daily testing volume and the huge pool of asymptomatics  and others testing positive with the antibody test available for testing will provide a big boost to case counts and drive them up.  It could also drive up the positivity rate if many of those who tested positive with the antibody test had the virus a while back.  
As a result, this will cause states to delay ending their strict quarantines and partially reopening their economies, since the number of new positive cases reported each day is going up, rather than down.  Asymptomatics may test positive on either an antibody test or the standard virus identification test or both. Those who test positive on antibody tests may not be a risk to anyone, but their number will not be separated from others who test positive and will impede a state from showing the decline in overall new case volume that is the current standard.
There are now many voices calling for a relaxation of the lockdowns in place. If the test for doing that is the one outlined so far, 14 days of declining case volumes or declining positivity test rates, the tests seem rigged, and states will have an excuse for not doing so, claiming that they are following the advice of the scientists, and the epidemiologists who established the 14 day standard.  The cost of delaying reopening parts of the economy or sections of the country because states cannot meet a standard that may be impossible to meet could be a death blow to the American economy and many of the people out of work and businesses which are shut down.  

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