Coronavirus: More thoughts

1. Discrete observations about this virus do not extrapolate well. This was mentioned in the previous post titled "Coronavirus: the uniformity error." If, for example, we tried to extrapolate the experience of California at this moment to the rest of the United States, we would expect to have 192,440 total cases and 5440 deaths. Instead, we note that, while California has 566 cases per million people, New York has 9,233. Texas has 474, Nevada 924, Oklahoma 477 and West Virginia 323.

2. What the above suggests is that the spread of the coronavirus is determined to a great extent how the virus interacts with the environment, beyond simple considerations of population density and mitigation procedures. Social distancing that works in Oklahoma apparently does not do so well in New York or New Jersey. The reason for this is likely to involve many factors: weather, umber of people who live in multi-family dwellings, use of public transportation, hygiene habits, etc. What can be said with some confidence is that run-of-the-mill social distancing precautions that work elsewhere do not have as much effect on high-probability exposures in New York and New Jersey. Another way to look at this is that New York and New Jersey are much more favorable environments for spread of the virus.

3. The caveat about extrapolating applies to isolated observations as well. There appears to be much heed paid to a report from a phlebotomy technician in Illinois that 30%-50% of people tested are positive for SARS-cov2 antibodies, or that 15% of a German village also demonstrate positive antibodies. This is in contrast with San Miguel county in Colorado (which intends to test the entire population there) where less than 1% are anti-body positive.

4. Most places have hit the point of diminishing returns regarding additional social distancing orders. Now such orders are likely do as much harm as good.

5. The risk factors for catching the virus are different than the risk factors for dying from it.

6. Since the French study upon which much of the confidence in hydroxychloroquine is based reported decreased viral shedding as its endpoint, it is reasonable to at least ask if that medicine interferes with the viral testing, and whether this might lead to people being declared cleared when they are in fact still contagious.

7. The incidence of diagnosed cases is still very low, and the mortality in certain places is still very high. Again there is likely an environmental component that has escaped our notice, as well as genetic and cultural factors that we are conditioned to not notice.

8. The rise of coronazis, people who seek to enforce social distancing recommendations beyond all reason, is one of the more depressing non-medical aspects of this epidemic. Common sense tells us what are the most likely behaviors to spread the virus; a battalion of emboldened Gladys Cravitzes is unlikely to provide additional benefit.