Using Stacked Probabilities to Keep Us Safe

Well, we’re in the thick of it now. America has neither returned to normal, nor have we remained in a safe lockdown. Rather, we’re now in this liminal space, filled with cheerleading denial about how we’re “reopening!” and “the economy is coming back!” Meanwhile, in truth, nobody knows what the heck is going on.

However, there is a functional middle ground between complete lockdown and what we have now, which is a devil-may-care complacency about the deaths of 1,000 people a day.

The functional middle ground lays in stacking enough safe behaviors together that the actual risk actually ends up being near zero, and we can get back to normal activities, with precautions in place.

Let’s use sexual behavior in HIV/AIDS prevention as an example:

OPTION #1: ZERO RISK: Abstinence

OPTION #2: LOWER RISK: condoms OR monogamy OR getting HIV status tests

OPTION #3: LOWEST RISK: testing AND condoms AND monogamy

Why is Option #3 better than Option #2? After all, if both partners test negative, you don’t need the other two interventions…right?

It all comes down to probability. Nothing besides abstinence is zero risk. Tests can come back with a false negative. Condoms can break. Partners can cheat.

But if you stack all three risk-reducing behaviors together, your chances of contracting HIV plummet to almost (but not quite) zero. And since life is inherently dangerous, and living without sex forver is unacceptable for most of the population, almost zero is good enough.

Now, I’m going to take a short detour into math to show what almost zero looks like.

Let’s say you flip a coin. What are the chances it turns out heads? 1 in 2, or .50.

Let’s say you throw a die. What are the chances you roll a 6? 1 in 6, or ~.17.

Now draw a card. What are the chances you pick the Ace of Hearts? 1 in 52, or .019.

If your life depended on one of these games of chance, you’d probably sit the game out. One in 52 is improbable, but it’s still highly possible.

But let’s say your life depends on just making sure you don’t get all three simultaneously? That is to say, you’ll be fine unless you get heads AND you roll a 6 AND you pick the Ace of Hearts?

Chance of getting heads:

.50

Chance of getting heads AND rolling a 6:

.50 * .17 = .0085

Chance of getting heads AND rolling a 6 AND picking the Ace of Hearts?:

.50 * .17 * .019 = .0001615

In other words, if you combine the somewhat-low risks of each option, the final risk ends up being .0001616, or roughly one in 6,000.

To put that in perspective, the death rate in 2013 for car crashes was about 1 in 10,000. And we all still decide to get in cars. We’ve decided that the benefits of driving are worth the 1 in 10,000 risk. Not only that, there are risks of not driving, such as being unable to get to jobs, food, healthcare — and they also mean that the benefits are worth more than the risks.

At a certain point, every choice has some risk, so as long as you keep the downside to a manageable number, it’s acceptable.

So let’s look at Covid-19. Right now, we have no silver bullets. We don’t have any drugs like the HIV drug Truvada, which reduces viral load and makes it very hard to pass on the illness. And we don’t even have an effective, available, affordable barrier to contagion that’s as effective as a condom. PPE is in short supply, and even hospital workers who wear it regularly are getting sick.

But what we do have is stacked probabilities. Now, since we don’t have the data yet, I’ll be using “X” and “Y”, but I hope you’ll still be able to see how this works. Remember, the more 0’s after the decimal point, the safer you’ll be:

Chance of contracting Covid in normal interactions: .0X

Chance of contracting Covid when everyone is wearing a mask: .0Y

Chance of contracting Covid when everyone stays 6 feet apart: .0Z

Chance of contracting Covid when avoiding indoor air (outdoors only): .0A

TOTAL CHANCE OF CONTRACTING COVID: .000XYZA

And now let’s look at schools:

Here are some lower-risk changes we can use simultaneously to multiply safety:

  • Fewer kids in classrooms
  • Better ventilation. During temperate weather, keep all windows open, use box fans to circulate air at all times.
  • Better air filtration. Some high-end filters can filter out viruses. It is 100%? No, but one would imagine it’s going to help.
  • Testing as much as possible. If we can test kids / staff on Friday night, we can get results for PCR testing by Monday morning. Even weekly testing would GREATLY reduce risk and spread, so long as it was universal and accurate.
  • Grouping kids into cohorts to keep spread to a smaller potential group.
  • Strategizing about which things really NEED in-person class time. Maybe a teacher can make a video for easy things, and have in-person class for harder things.
  • Allowing kids to learn some subjects remotely, depending on ability. Regular testing to see if they’re keeping up.

I hope we can come up with creative, healthy ways to get schools up and running again. The thing is, all of the best ideas are going to take money. If we teach half the students, we need twice the teachers. If every student is remote half the time, we need money for equipment. If school schedules are constantly changing, then parents can’t work, and they need money to live.

So, we as a community need to push for some of those federal emergency billions to go to the real crisis — education.

Idaho: May 7, 2020

Today I left the apartment for the first time in 2 months. The reason: to go get a very important blood draw.

I agonized about whether the benefit of this test was worth it for weeks. But last week, the number of new diagnosed Covid cases fell to about 1/10th of what it had been in the beginning of April. Meanwhile, our lockdown was about to expire. So I figured that around now would be possibly the most optimal time for the next few months to Not get infected.

Planning my blood draw was like a scene from The Martian. First I tried in vain to find a home health aide or mobile blood draw that would do it. Covid appears to spread mostly in indoor spaces, so if somebody could come here and stand outside, that would be safer. No dice. So then I did it like this:

  • Found local clinic with the least traffice
  • First patient of the day
  • Wore my Cambridge Mask I’d originally bought for the wildfires
  • Wore Wil’s swim goggles and protective glasses over them
  • Put a button-down shirt and a skirt over my clothes, then shucked them off after my blood draw
  • Took a shower as soon as I got home

I was in and out in under 5 minutes, praise be to God.

It’s a very strange thing to go outside when you haven’t been able to. As someone dealing with multiple health problems, it’s certainly an experience I’ve had before, but of course, never like this.

As we drove through Boise, I saw the following:

  • Construction workers downtown, working on a hospital building, standing close together, with no masks on
  • Other construction workers, outside with no masks, talking closely x 2
  • People walking without masks
  • People jogging without masks
  • People biking with masks

The only place I saw masks were at the doctor’s office. I saw ZERO people wearing masks otherwise.

Idaho is stuck in its “Freedom” kick, and I guess nobody is going to legislate wearing masks. If that’s how it’s going to be for the foreseeable future, then I want to get the heck out of any place w/ population density. Which means not living downtown anymore, and maybe even not living in any apartment complex. I can’t deal with this much stupid.

The Science of Human Development

All this education I had, all these facts and figures and logical reasoning, and nobody said anything about Power.

Nobody said, “Of course, if you’re poor, researching the proper treatment for your medical condition won’t save you, because you won’t be able to afford treatment.”

Nobody said, “Of course, being the smartest person in the room won’t get you the promotion if you’re a woman or a person of color.”

Nobody said, “Of course, if you’re a scientist with important recommendations to avoid catastrophe, it won’t matter if your government is too corrupt to care.”

The next ten years have to be about science, but they also have to be about the study of power. Power for the people. Power over our own lives. Different ideas of fair land use and private property — why should apartment-dwellers fearing for a food shortage be unable to plant gardens in the land around their homes? We should starve so that absentee landlords have a pretty lawn? All to satisfy some antiquated idea of what land ownership means. As if anyone, in the end, can really own the earth.

We need to study the science of human development, of teamwork, of unions, of social progress, of empowerment and evolution from below rather than the false promise of revolution — which removes one corrupt government by force only to put a different corrupt government in its place.

The science of human potential must be studied and developed before any hard science will even have soil in which to grow.

What the…

There are a lot of things about the dystopian hellscape that is 2020 I could not have predicted.

The latest trend is people getting arrested for beating people up because their victims weren’t social distancing well enough.

Um…if you’re close enough to hit someone in the face you’re also close enough to get sick from them?

What the fuck is wrong  with people???

How Do Things Get Better? Part II.

In my last post, I talked about how immunity might help us cope by giving us a cohort of immune folks to help society run — and possibly even donate their antibodies — until herd immunity happens.

In this post, I will talk about some other hopeful trends I see on the horizon.

One trend I see is that hacking culture + desperation are attacking the twin shortages of ventilators and PPE.¹ A lot of folks in many walks of life are working on ways to hack, kludge, and gerry-rig our way out of this mess.

Regarding masks, there’s a lot of effort going into “good-enough” solutions. Folks are sharing research showing that any facial covering is better than no facial covering. Folks are sewing masks at home, while others are 3-D printing face shields. People are even doing extremely sophisticated materials and aerosol research on their own dime, and then mass-disseminating information with their findings. For example, just yesterday an article came out that showed that certain shop towels might make very good homemade masks.²

Similarly, there’s other research going on to figure out ways to stretch current supplies of PPE. Commercial ovens may start being used to re-sterilize masks. Others are looking into using things like UV lamps for re-sterilization.

Regarding ventilators, some groups of people are trying to create gerry-rigged low-cost ventilators in various ways, such as re-purposing cpap machines.

Meanwhile, many many MANY medical researchers are working on trying to figure out how this disease operates, and how to fight it.³ While ventilators are necessary, they are also a last resort. By the time a patient gets to the point of needing a ventilator, they have a 50% chance of death. The best thing is to keep a patient from getting sick enough to need one.

Perhaps over the next few months, one treatment or a combination of different treatments will emerge, and these will allow more patients to avoid becoming critical. That would be amazing.


¹ Obviously, the shortages in both areas are nothing less than travesties, brought on by inept, incompetent and often downright malicious government choices. These are horrible and horrifying, and one hopes that in the not-too-distant future, there will be a severe and profound reckoning for everyone who got us into this mess.

² Of course, price gougers are already selling those same shop towels on Ebay for 5 times the usual price.

³ Here is just one article that’s been called “promising.” I can’t claim to understand it myself. But it shows that researchers are leaving no stone unturned to look at different mechanisms by which we can fight this thing.

How Do Things Get Better? Part I.

Hi.

Now that we’re in the thick of things, a lot of folks are wondering, How long does this last? When can we return to normal? etc. etc.

I’m not a soothsayer and I can’t tell you the answer to that — that said, I’m pretty sure that, barring some miracle, the US is going to be on lockdown through the end of the summer at least.

But I can also see some scenarios that will at least allow things to improve.

Factor X: Immunity

The 64 Trillion Dollar Question is: Are you immune once you get the disease? Or can you be reinfected? Most illnesses confer immunity to survivors. However, there are a few that do not. Some survivors of Dengue Fever, for example, are able to get reinfected, and the disease is even worse the second time.

Most medical folks are pretty sure that Covid-19 survivors have immunity. But, there are some questions. There are anecdotal reports coming out of Asia of folks who’ve gotten the illness, left the hospital, and then tested positive again. Why would that be? Is it because the tests are unreliable? Are they testing positive because the test saw virus particles and antibodies? Or are they truly ‘sick’ and truly ‘have it again?’ We don’t know yet.

There are other unanswered questions about immunity. In the worst-case scenario, immunity would only last for a year or two, and would then fade. Or even worse: Covid-19 would mutate to Covid-21 in a year’s time, and just as with the flu, we’d all have to suffer through it all over again.

But I’m going to focus on some rosier scenarios for the time being.

Best-Case Scenario: Survivors are Immune, We Get Reliable Antibody Tests, and Survivor Antibodies are Helpful 

If it turns out that survivors are immune

And we get a shit-ton of reliable, mass-produced antibody tests

Then that will be a game-changer.

Data from Iceland and Vo in Italy are showing that as many as 50% of cases can be asymptomatic. Once we’re able to test the entire population, we could identify all the folks who had it and didn’t know it, plus all the folks who had it but weren’t able to get tested.

All those folks could go back to normal life, and they could help the rest of us, too.

The idea floating around is an “immunity passport.” A QR code, a bracelet, something that identifies you as immune. Once we have a portion of the population that is guaranteed to be immune, we also have folks that are uniquely qualified to do front-line work. They could work in hospitals and medical clinics. They could work with elderly and immune-compromised people. They could work in customer-facing roles or food delivery. They would be the folks who could be guaranteed to be safe, and that is very important thing.

Side note: for some period of time, immune people would also have special bargaining power. We’re already seeing workers at Amazon warehouses and Instacart go on strike. In this desperate time, they are much more at risk than normal, but they also have much more bargaining power and they’re taking advantage of it. Now imagine a bunch of low-income folks who have the immunity superpower. Imagine what kinds of salaries and benefits they could demand if they worked together? This would be a rare time where average folk might have something rich folks can’t buy — immunity. It would be a rare opportunity.

As immunity spreads, I have an image of some limited re-opening of a few bars and restaurants. Almost like speak-easies for the immune. You’d have to show your bracelet to get in, and the immune could party while the rest of us languish inside our homes. It could be a new and different class divide based entirely on luck, albeit a temporary one.

My brother tells me that this image is way too “Philip K. Dick” and is unrealistic. We’ll See.

The second opportunity in identifying immune folks is the possibility that their antibodies can help save patients. There is already research being done on this. If it turns out to be a helpful treatment, our society will by force turn away from an “I’ve got mine” society to one that’s more about working together communally. If rich folks are going to, literally, need the blood of the poor to survive, they’re going to have to start fucking sharing. Medicare for All sounds like a good start. After all, why should someone who’s been denied affordable healthcare for their entire life give away their very life’s blood to a stranger? Something is going to have to give, societally and culturally.

The third opportunity in immunity is of course the old standby, Herd Immunity. At a certain point, slowly or quickly, this disease will work its way through the majority of the population. At that point, the uninfected will be a lot safer, statistically, than they were before.

So these are all things that could make life easier and better while we wait for the Holy Grail, which is a vaccine or highly-effective, safe treatment.

I’ll talk about some other ways thing might improve in Part II.

 

 

Wear a Mask, Everybody

Like many of you, I was told not to wear a mask at the beginning of the outbreak, so I did not purchase N95’s prophylactically. I’ve been kicking myself for this. But it turns out that if everyone wears even a homemade mask whenever they go outside, the rate of spread seems to be a lot lower. Correlation is not causation, but…it sure does seem correlated.

I was going to write a whole essay on why we need to be wearing masks, but this person did a great twitter thread on it instead, so here you go. Click on the “March 25” link for the whole thing.

 

The Next Stage: Hiding Bad Data

A few weeks ago, when we didn’t yet have adequate testing, I started going to individual state public health pages. States are required to make weekly reports about flu activity, and most states also collect “syndromic surveillance” meaning flu symptoms even without a positive flu test. The lingo for this is “ILI” or “influenza-like illness.”

It was a lagging indicator to be sure, as it takes time to compile the data and write the report, but by last week it started to be clear that even without proper testing, things were looking bad in terms of Covid-19 cases in a large number of states. So then I knew.

I knew that as time went on, they were going to have to start hiding the data.

And that’s what appears to be going on. Here’s what happened when I attempted to access the syndrome data for Louisiana’s latest report:

LA lies week 10

Well, that’s ok, because even though they’re hiding the data now on the state website, it’s still visible on the federal fluview website. So here’s what they don’t want you to see — the spike in recent cases:

ILI Louisiana week 11

Bear in mind this is data for “week 11,” which ended March 14th. It’s now March 26th so the data is waaay out of date.

What about Florida?

Well, their reports are still visible, and at first glance they appear to be the same. The charts look similar, and they have the same number of pages. So they’re not hiding anything….or are they?

Here’s Figure 1 from Week 9:

FL week 9 figure 1

And here’s the “same” chart from Week 12:

FL figure 1 week 12

If you just look at the chart, it appears that the numbers of ill people are going down. But if you look at the fine print, they’ve changed the report. The reports for weeks 9, 10, and 11 were for “influenza-like illness,” but for week 12 it changed to “diagnosis of influenza or flu.” Hiding the Covid.

But wait there’s more! Let’s look at this series of graphs. Looks like things are improving since week 9, right?

Week 9:

FL figure 16 week 9

Week 12:

FL figure 16 week 12

Again, they changed the criteria of the report. If they’d kept it about “influenza-like illness,” then floridians could see what is probably a massive uptick in cases. But no, they just quietly decided to change the report instead.

The only place you can get a hint of what’s happening is here:

FL fig 12 week 12

See how “flu” is going down in elder care facilities, while “ILI outbreaks” are increasing? That’s (most likely) Covid.

How hard is Florida trying to hide? Well, I can’t say for sure, but when you go to the National FLU VIEW page, the only state with no ILI data is Florida.

So, to review — Louisiana is putting its latest syndromic surveillance data behind a firewall, while Florida is completely changing its reports to keep the information off the radar. Not good.

Just thought y’all should know. Maybe your state is hiding the data, too.

~Update~

This post is getting a lot of traffic, so I wanted to add some links for those who want to do their own research:

Florida Flu Review Week 9, includes lots of ILI data

Florida Flu Review Week 10, same format

Florida Flu Review Week 11, same format

Florida Flu Review Week 12, most ILI data now missing

Note: I have downloaded all of these reports, so if anything changes later, please let me know.

Feelings

As someone who has suffered on and off with disability and isolation for 10 years, I’m getting an awful lot of feelings right now about how easily the world is moving to accommodate disability and isolation when it happens to, you know, them. 

More on that to come. Just wanted to say: disabled folks are seeing this, and noting it, and being very angry, and very tired, about this.

The Next Wave

My next question is, can folks who have been infected and then recovered still be carriers?

Or do they *not* carry the disease?

There could be a whole job category for them. They could work in the factories making masks and so forth, or delivering food to vulnerable populations.