Health Care

The Unbiased Texas COVID-19 Tracker: October 22, 2020

Posted on by Dave Cox

This Week’s Update for Texas:

To reset things for anyone who is new to reading this, the chart above is something that I created months ago and I update it weekly. I work with statistics in my profession on a daily basis and saw the need to track numbers that are not being presented in the media or government in any kind of unbiased fashion. While I always include my own commentary below, I urge you to take a look and reach your own conclusions.

I am particularly frustrated today, so the commentary is probably going to be more blunt than usual. My frustration was spiked by watching the local news in Dallas last night and this morning (and every morning, so this has been building). I bet 40% of the entire newscast was about the positivity rate increasing, subtle jabs at the bars that have been able to re-open, and warnings of spikes in hospitalizations. It is sensationalism, plain and simple, just as much of this has been for months. Then, there’s the little asides from the local news anchors that add to the panic. I’m fed up with it. Hospitalizations have increased a little in the last week or so. Fine. There is a somewhat arbitrary number of keeping hospitalizations below 15% for this issue. We are currently at about half of that, plus surge capacity is significantly higher. Back in MARCH, we were told to hunker down to “flatten the curve.” That curve flattening was to allow for hospitals to prepare, for therapeutics to be investigated and introduced, equipment to be mobilized, etc.. All of that happened very successfully, yet we’re still here in mid-October, panicking about blips on the chart.

That leads me to this week’s questions to ponder. This time, however, I am writing it as an FAQ section. Feel free to chime in.

1. If we just hide for the next week/month/year/decade, won’t the virus just go away? No, it won’t. That’s not how viruses work and you know that.

2. If we can’t just hide from it, and the curve flattening was successful, why are we still crippling big chunks of our economy and our passions, such as bars, music venues, sporting events, and even family gatherings in some places? EXACTLY.

3. The survival rate per population is 99.942% and even higher among younger and healthier folks, can’t we just take great precautions to protect the most vulnerable, such as older people and those with high risk comorbidities? Absolutely. I am not advocating for putting high risk individuals in danger. I am suggesting that the vast majority of us are able to go about our business with minimal risk. Let’s target any relief funds and programs to those at the highest risk so we can get back to our lives and livelihoods.

4. What about the vaccine? Shouldn’t we just wait for that? Short answer: No. Longer answer: How has that worked out for the flu? There’s likely a very good reason that nobody has ever developed a coronavirus (general term) vaccine. These things morph, change and adapt. A vaccine might help down the road, but if you’re waiting for a vaccine to make you feel 100% safe, you’re going to be very disappointed.

5. What about long term medical issues that might be caused by this that we’re not fully aware of yet? See: Answer to #1. Exercise, get some sun, don’t eat fast food 7 times a week, take vitamins (especially zinc, Vitamin D and Vitamin C). Get yourself as far away from being a high risk individual as possible.

6. Shouldn’t we just listen to the experts and do whatever they say? No. Which experts? Virologists look at this strictly from a medical standpoint. Their vision is extremely narrow because that’s their job. This is much more complex. As our society feels the incredible strain of being shut down for almost 8 months, we also must include experts in psychology, economics, sociology, etc., in order to look at this holistically. For example, if we keep everyone home to hide from the virus, but the suicide rate skyrockets, and the domestic violence rate increases, and more people are forced onto social services due to being out of work, what is the net gain from the lockdowns? We’re just playing a shell game with the numbers by moving them into a different column. Don’t accept any kind of “new normal” without being fully informed. Real information reduces anxiety created by fear of the unknown.

I’ll leave you with this:

The best way to fight this virus is by gathering accurate information and making decisions based on facts – not feelings. When done correctly, that is an active process. Sitting back and waiting for CNN, Fox, or any other media outlet to tell you what to think is lazy. Research from as many sources as possible. Read studies that you disagree with, look at how it is being handled in different places. Would you take on any other major life issue by waiting for someone to tell you what you should think or would you try to become as informed as possible? Sadly, this issue seems to have fallen into a couple of different echo chambers and folks are only listening to what confirms their pre-existing bias. That’s not research. That’s irresponsible.

And, as always, don’t be a dick.

The Unbiased Texas COVID-19 Tracker: October 7, 2020

Posted on by Dave Cox

It’s that time of the week again, where tens of people review my latest Texas update. If you saw last week’s update, the big theme was that things were flattening out pretty dramatically. That trend is definitely continuing this week in every key category. The Positivity Rate (Total) dropped again. This marks 7 consecutive weeks where this has dropped, which is excellent news. It has dropped almost a full percentage point just in the last week. Another important aspect of this is that this was a particularly bad week in terms of backlog dumping by the state. More than 20 counties dumped significantly late positive results amounting to over 1,000 cases that didn’t actually happen in the last week. The quickest visual indicators in this chart are the 3 rows that shoe the per 100K numbers for Total, >65, and <65. They flattened significantly last week and even more this week. The 7-Day change in the Total category is almost half of what it was last week, the >65 category is changed by 70% less than the prior week and the <65 change remains very flat again.


So, what does all of this mean? Week to week comparisons are a great way to see how we’re trending in real time. What did the 7-Day Changes look like back on August 25 when things were still peaking?

  • Positivity Rate 7-Day Change was more than 200% higher on 8/25
  • Deaths (total) 7-Day Change was almost 500% higher on 8/25
  • Deaths (>65) 7-Day Change was more than 500% higher on 8/25
  • Deaths (<65) 7-Day Change was nearly 400% higher on 8/25
  • Check this one out: The positive rate for people tested was 14.213% on 8/25 and it’s 5.747% this week. Think about that for a second. This is the positive rate for people being tested. So today, 94.253% of the people BEING TESTED are coming back negative. Most people are being tested because they are symptomatic or were in contact with someone who was sick and STILL 94.253% of those people test negative.

Another note: The 2019-20 Flu Report just came out so that column is now complete. The survival rate if you got the flu in the 2019-20 season was 99.962%. The survival rate for this disease is currently 99.946%.

As always, interpret any of this however you choose. My opinion, based on the data, is that it is time to responsibly move on from this. We need to continue to protect the people in high risk categories AND people who are high risk or still concerned need to make the right decisions for themselves and their families. Treatments are significantly better now and there are several very successful options. We’re not throwing everyone on a ventilator anymore and very few people need hospitalization at all. This is really the most important piece of the puzzle. Remember back in March and April, the constant theme was “flatten the curve”? The reason for that was to ensure that hospitals weren’t overwhelmed and to allow time to develop treatments. We’ve done all of that very successfully and the stats support that quite clearly. It wasn’t intended to make us hide from a virus until it went away because that’s simply not possible. Now folks are already warning about a “spike” in the winter and there probably will be. Just looks at flu season – it’s consistently worse in cold climates and in the winter. Colds? Same thing and this is a version of a cold. So, even if things spike in the coming months, the truths remain – we have a much better understanding of treatment and even prevention, there are additional treatments reaching the end of their Stage 3 Clinical trials, and multiple vaccines are nearing completion of there Stage 3 Clinical Trials (if you’re planning on going that route). With the flu season, we have Tamaflu and an entire pharmacy aisle of symptom treatments. For most people, that’s what this is about as well – managing the symptoms.

A while back, I think I said something about trying to keep these updates as neutral as possible so each person can decide for themselves. I still feel that way to a degree, because it’s important for people to reach their own conclusions without bias. That being said, in future updates, you might wanna skip the last paragraph if you don’t want my opinion about it.

And, as always, don’t be a dick.

Texas COVID-19 Data Update and Analysis

Posted on by Dave Cox

So, as some of you already know, I started collecting and analyzing the Texas COVID-19 data on my own a while back, largely out of frustration with the way the media (and the state) have been presenting it. There are numbers that stir a sense of fear with no basis for comparison, and there are numbers that can be utilized to compare and contrast in order to make good decisions. Most of us can probably agree that the COVID-19 numbers, in both collecting and reporting, have been dubious at a minimum. We’ve seen questionable death certificate numbers, false positives, false negatives, delayed reporting, and so on. Still, they are the numbers we have, so I wanted to use my background in statistics to at least create a clearer picture of the situation. So here we are…

I decided to include last season’s complete flu data and this season’s YTD flu data as a means of comparison. Yes, the diseases are different, but there has to be come kind of baseline in order to determine how much we need to freak out at any given number. No comparison = no frame of reference = no perspective. I update the YTD flu column weekly as the next report is published by Texas HHS. There are approximately 5 weeks remaining in the current flu season and a 2-3 week lag in the publishing of the reports. I also decided to add a column at the end for the degree of change over the previous 7 days and a directional arrow for quick reference purposes. You might say, “That’s a lot of numbers, nerd! What does this shit even mean?!” That was rude, but I’m still glad you asked! The numbers in the top half of the chart are the raw totals taken directly from the Texas HHS web site. The bottom section is where I earn my pay on this – which is exactly zero dollars. These are the calculations and trends that I believe are the most important. A statistic shown as per 100K people is a great one to follow if percentages and decimal places make your head hurt. It’s an apples to apples way to look at complex data. For example, I have used per 100K people calculations to compare different states as well, since the populations vary so dramatically. I split this out by the overall rate, over the age of 65, and under the age of 65, as a way to slice and dice what is really happening in Texas. I chose 65 because that has been the age category the state uses for flu in recent years, thus making it a quick way to compare all of the data across the rows. The bottom two rows are also good to follow and compare if you like percentages and decimal points. The “Survival Rate/Infection” is the rate of survival if you catch COVID-19 and the “Survival Rate/Population” is your overall survival rate based on the population of the Texas – so it’s your actual chance of dying from it as a resident of the state. That number is currently tracking almost identical to the previous two flu seasons. Even if you (hypothetically) double the number of COVID-19 deaths from the current report, that percentage doesn’t move very much because we have almost 30 million people in the state, which is a good thing when trying to assess severity.

Why did I move this week’s result from my usual Facebook post to my blog site? Well, I normally don’t inject much of my personal opinion into these weekly posts. I like to just present the data that I collect and let folks decide for themselves what it means to them. I still think that is very important because how I assess risk might be different than someone else because everyone’s circumstances are unique. With that being said, I have been crunching these numbers for months now, so I have started to develop my own analysis of the numbers. And that’s why we’re here. I am ready to share some opinions and I needed more paragraphs than what is practical in a Facebook post. Plus, there are probably some folks that don’t really give a shit about my opinion on this but they like to see the numbers, so I added the need to click one more time on Facebook to see this blog post. I’ll still probably post the chart in the comments section when I link to this in Facebook, just in case folks don’t want to see my analysis or opinions.

The Meaty Goodness:

This is not intended to frighten, but perspective is very important. Flu and SARS-COV-2 (COVID-19) are different diseases with some unique situations, but the numbers in my weekly chart still provide some good similarities for comparison purposes. A brand new, fast tracked, SARS-COV-2 vaccine will likely have a similar (or lower) success rate than the flu vaccine that has been around for years and is updated annually, tweaked, and perfected over time. You might also have people getting the new vaccine at a higher rate than the flu vaccine because of the current awareness level, media hype, and social climate. So, what does all of that mean? People will still get sick and there will still be deaths from SARS-COV-2 even after a vaccine is released and widely distributed. That’s just the reality of the situation. There is not a magic bullet and waiting for one is simply unrealistic. Arguably, it is also irresponsible because of the “collateral damage” that we are seeing from depression, suicide, substance abuse, domestic violence, business closures, etc.. Hunkering down to figure out the scope of this disease was the right thing to do. It was new and very unknown. We did need to “flatten the curve” to avoid overwhelming the health system. Now, we are equally obligated to make decisions that minimize the very real collateral damage. New diseases, new types of flu, and new viruses make their way around the planet every year and we mitigate the risk the best we can (wash hands, take vitamins, healthy lifestyle, vaccines, treatments, etc.) in order to carry on with our lives. This disease is no different in that regard. There will be both preventives and therapeutics readily available. Some are available now and some are being vetted out as I write this. Be informed. Look at numbers that matter. Determine your own personal level of risk. Minimize exposure if you are showing symptoms. All of that should be pretty easy because it’s the same thing you would do if we were in the midst of an unusually bad flu season or of there was an uptick in another existing disease in any particular season. Prepare to move on and re-enter the world, maybe not today, but it’s coming. It has to. While there might not be a magic bullet for this new disease, that’s ok! In the grand scheme of things, there isn’t a magic bullet for anything that we encounter in the world, yet we go about our lives and we thrive by making the best decisions possible based on the best information available. We experience the joys and disappointments of life. We celebrate. We win. We lose. Above all, we experience the world around us because that’s what humans do.

As always, regardless of your opinion on this or anything else, don’t be a dick.

OPINION: The Pandemic of Incomplete Data

Posted on by Dave Cox

by Dave Cox

Professor Neil Ferguson of the Imperial College of London was, until very recently, an advisor to the UK government for its COVID-19 response until he resigned that position on May 5th for breaking his own lockdown recommendations to hang out with his girlfriend. He must really think those restrictions are important for everyone’s safety, right? His models at Imperial have also been the foundation for many governments around the world to make their decisions about how to handle the virus. The model used for COVID-19 was developed in 2005 and has essentially gone unchanged in the 15 years since. In addition, Ferguson is the ONLY one allowed to analyze the data, despite having a large team at his disposal at the college. While that’s not necessarily nefarious, it is incredibly arrogant at a minimum, which brings with it its own inherent issues.

How have Ferguson’s prestigious models performed in the past? (He has won awards for at least one of them). I’m glad you asked!

FERGUSON’S PREVIOUS MODELS*

YEARDISEASEPREDICTED
DEATHS		ACTUAL
DEATHS
2001Foot and Mouth Disease (UK)150,000200
2002BSE/Mad Cow Disease (UK)50,000177
2005Bird Flu200 MILLION282
2009Swine Flu (UK)65,000457
2020COVID-19**1.5-2.0 Million (US)83K
(May 12, 2020)
**Ferguson even admitted that his model was based on the spread of an influenza pandemic, which tracks differently than this coronavirus.

When questioned about the disparity in numbers in his COVID-19 model, his reply on April 16, 2020 was, “I much prefer to be accused of overreacting than under-reacting. We do not have a crystal ball.” We do not have a crystal ball?? Then stop being a crystal ball salesman!!

I have also seen people defending Ferguson’s model by stating that his doomsday predictions in the examples above led to actions being taken (X), so clearly his predictions led to the actions that ultimately lessened the impact (Y). That may be the case, but it might not. It ignores the concept of Post Hoc Fallacy: Since event Y followed event X, event Y must have been caused by event X.

Modeling alone is extremely risky. It requires a lengthy list of assumptions to be built into the formulas. Simply put, assumptions create a lot of noise when trying to confidently or accurately predict the future. Even the greatest model ever developed would likely not pass a statistically based validation. Assumptions are inherently biased, not necessarily in a malicious manner, but biased nonetheless because they’re nothing more than an educated guess that forces multiple manipulations of the data processing (think: garbage in/garbage out). If you pile a stack of those into a model (and you must by nature of the process), each level of bias would add another layer of “noise” that compounds itself each time something is off in an assumption. For many years, I have developed and worked with complex statistics every day in the medical device industry, and have done the same in the automotive and defense industries as well (nearly 30 years total). Modeling can be used as a very high level “stab” at what we think might happen, but the decisions must to be made, supported, and justified, by actual proven statistical methods. Companies would never get a product to market using modeling alone. Never. To further that narrative, in today’s world, we could even argue that mass shutdowns, universal shelter in place orders and the upcoming “new normal” (whatever that is going to look like) are all “products” that have been taken to market based solely on predictive modeling.

Predictive Modeling is a still a potentially great tool when it’s used in conjunction with multiple additional tools, including a constant feedback loop to make adjustments based on real data that is coming in – a comparison of the real data to the model data to continuously improve the assumptions and make it more accurate. You also have to look at factors that models do not take into account; like psychology, unemployment, mental stress, economics, domestic violence, suicide, etc., that can’t be accounted for in a laboratory setting. This is why political leaders need to look at the entire picture and make holistic decisions that balance all facets of this very complex situation. Otherwise, wouldn’t we just have epidemiologists as our political leaders all over the world if we believe that disease is the most substantial threat to our existence? We don’t, because that would be a short-sighted and incredibly incomplete view of this crisis that would cause very real, measurable, and catastrophic collateral damage.

This is also why the, “So you think you’re smarter than an epidemiologist? You don’t have any business talking about this topic…” argument doesn’t hold water. You don’t have to be the smartest person in the room to understand that this is not a one-faceted crisis and that all aspects must be thoughtfully considered when making life and death decisions on an unprecedented scale. You need the economists, the mental health experts, the politicians (gasp!), physicians, labor leaders, small and large business owners, and more in order to understand the complete impact of these decisions. You’ve heard the old saying that “Knowledge is Power,” right? Well, willfully ignoring ALL of the knowledge as it relates to this virus is not only irresponsible, but downright dangerous. Ignoring all of the available knowledge is also choosing to live in fear rather than facing it head on and making informed decisions based on the overall calculated risk.

Stay safe. Work hard. Don’t be a dick.

*There are multiple citations available for these numbers