EVEN IF 70 percent of county residents follow all the social-distancing rules, Monterey County will have an astonishing 33,000 people sick with coronavirus in the next six weeks and its hospitals will be overrun with nearly 1,000 seriously ill patients, according to data county health officer Edward Moreno presented to the board of supervisors this week.
But Moreno’s data also show that the county should have about 9,000 cases now and 300 hospitalizations, while his department has counted a total of 108 cases of the virus as of Wednesday, and just 22 people who’ve needed to be hospitalized throughout the crisis.
These are the opening two paragraphs of Kelly Nix, “Health department offers scary projection of infections in county,” Carmel Pine Cone, April 17-23, 2020. The Pine Cone is a small weekly publication on the Monterey Peninsula, but the quality of the reporting is higher than you might expect from a publication that depends solely on ad revenues.
Monterey County’s population is about 434,000.
So how did the 5-member board of supervisors, who are the ones who let Moreno impose the shutdown, react?
Nix writes:
Supervisors did not seem surprised by Moreno’s presentation and did not question the validity of the figures.
READER COMMENTS
Alan Goldhammer
Apr 17 2020 at 4:11pm
A close reading of the article mentions 70% compliance with the shelter in place approach. Having 30% not doing this means that 120K are not and thus open to SARS-CoV-2 infection. When you do the math based on what we know about the infectious nature of the virus and resultant morbidity, the numbers make sense. That they are not seeing that level of hospitalizations indicates that compliance is very high. It’s the same reason why NYC is not using all of the emergency hospital beds that were built out. As my e-signature mantra says these days:
SARS-CoV-2 (AKA, COVID-19): It’s here; we know what to do; and we are doing it!
From my perspective as someone who has been following all this stuff pretty closely, I don’t find anything objectionable about what was written. I also don’t find too much to object to in the White House plan to reopen things other than the big one: lack of testing capacity and leaving all this to the states. I’ll stop here as everyone is tired of reading my pleas for more money to be spent on tests.
Jon Murphy
Apr 17 2020 at 4:35pm
But they don’t make sense with what is actually happening. According to the model, there should be 9,000 cases and 300 hospitalizations currently. Instead, there is 108 and 22, respectively.
AMT
Apr 17 2020 at 9:03pm
Wow, a 20% hospitalization rate! This must be a pretty serious virus, because there couldn’t possibly be a whole lot of infected people that haven’t been tested, in this nation that is renowned for its massive abundance of testing!
Jon Murphy
Apr 17 2020 at 11:47pm
Point of fact: if there are many people who may be infected but have not been tested, then necessarily the hospitalization rate is well below 20%.
AMT
Apr 18 2020 at 10:46am
Exactly my point. Either there are a whole lot more cases, or the virus is extremely serious. You can’t have it both ways.
And if the virus is very serious, that is bad, and it could just mean that the projections could still apply, just further in the future than the model anticipates based on an overestimate of current cases. So that doesn’t mean you should react any differently to the implications, though maybe the timing of policy choices would be impacted.
And if there are a whole lot more cases, then you shouldn’t be criticizing the model for assuming there are a lot more cases than have been confirmed.
Jon Murphy
Apr 18 2020 at 11:33am
How are you defining “serious” here? Is it just by the hospitalization rate based on known cases?
robc
Apr 18 2020 at 7:44pm
That is the most important part of the model.
Mark Bahner
Apr 19 2020 at 12:05pm
Hi Jon,
The model is even worse than that. They report 22 hospitalizations throughout the crisis. The model said that with 70 percent compliance, there would be 300 hospitalizations on that particular day.
So let’s say half of the 22 hospitalizations throughout the crisis had already been discharged, then there would be only 11 in the hospital that particular day. Versus the 300 that the model was saying should be in there that particular day.
And even more ridiculously, the model predicts a peak in *June*. My record on betting on COVID-19 hasn’t been very good so far ;-), but I’d be willing to give 10-t0-1 odds to bet that there will be less than the “954 hospitalized simultaneously” that that model predicts in June…even with 70 percent shelter-in-place compliance.
David Henderson
Apr 17 2020 at 5:04pm
What Jon Murphy said.
Basically, how badly does your model have to diverge from reality for you to abandon your model? I would say that when you’re an order of magnitude off, you should abandon it. Do you disagree, Alan?
Alan Goldhammer
Apr 17 2020 at 6:49pm
I don’t have any skin in the game for any model. My only point is they made a decision based on only 70% compliance. the fact that the number of hospitalizations was so small indicates to me that either the virus did not take in the county which is doubtful or that there was high compliance with shelter in place and social distancing, highly likely.
There is an intriguing pre-print that I just read and will put in my newsletter tomorrow from Stanford researchers. They did serology testing on 3300 people in Santa Clara county which is pretty close to where David lives. The results were astounding!! ”
%). These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases. Conclusions The population prevalence of SARS-CoV-2 antibodies in Santa Clara County implies that the infection is much more widespread than indicated by the number of confirmed cases. Population prevalence estimates can now be used to calibrate epidemic and mortality projections.”
I don’t know what the hospitalization and Mortality rates are in that county. Most papers I’ve read figured out the infection rate was only 10-15 fold higher. “If” these results hold up in other areas it will allow true counting of CRF which I’ve felt all along will max out at 0.3%. If you subtract out all the old people with co-morbidities, it means it will drop way down for young people. There still may be other problems the virus brings on but ‘death’ might not be one of them for most people.
I’m not picking fights with anyone, just looking at the data. It also is looking like remdesivir may not be working.
Jon Murphy
Apr 17 2020 at 11:45pm
That Stanford paper seems to be pretty good evidence toward David’s point. The county is overreacting based on poor information
Alan Goldhammer
Apr 18 2020 at 9:39am
Jon – what would you do if you had to make a decision four weeks ago? I noted in my newsletter today that it is far easier to be a Monday-morning quarterback than to be able to make a rational decision in the ‘fog of war.’ I’m reminded of Donald Rumsfeld’s famous statement about knowns and unknowns.
To your second point, I’ve read the Stanford paper than the work they did was carefully done and quite clever. All the investigators are top flight. They took an off-the-shelf diagnostic test kit from China (one really questions why the US has lagged so far behind here) and did their own validation of clinical sera samples from locally treated SARS-CoV-2 patients. They were careful in their selection criteria as well and included children in the study. I’ve seen a couple of other papers that support their findings.
I totally ignore ‘Medium’ posts these days. At the outset I was spending time reading them but found most to be just polemics with no underlying rationale. I’m already spending 3-4 hours a day reading pre-print abstracts and papers as well as clinical trial data. I’m just trying to make my own small contribution here.
Jon Murphy
Apr 18 2020 at 10:30am
I’m the wrong person to ask. I’m working on a doctoral dissertation and teaching an online class, so my life hasn’t changed a whole lot 🙂
Yes, and this is a very important point you make. However, part of the point of “Monday-morning quarterbacking” is to reflect on what went right, what went wrong, and whether or not the decision(s) made were proper. Then, we can build and improve upon them. In my old job, we called such meetings “After-Action Reviews” (we were run by a retired US Army colonel and I think that language comes from the military).
Part of the point is that it’s not that carefully done. They themselves note many of the problems the Medium article highlights. The Medium article discusses that these issues are plausibly a larger issue than the authors realize.
Besides, just because something is clever and done by top-flight researchers does not mean it is above impeachment. For example, David Card (UC-Berkley) and the late Alan Kruger’s (Princeton) famous conclusion from their 1994 study on Minimum Wage is based on a misinterpretation of the model they use. The assumptions used in the 2001 Acemoglu, Johnson, and Robinson paper on colonialization turned out to be incorrect and thus undermined their conclusions. We must always be skeptical, especially when a study purports to find unprecedented (by far) results.
Jon Murphy
Apr 18 2020 at 12:07am
Medium has an article where a person is doing a live peer-review of that Stanford paper (https://medium.com/@balajis/peer-review-of-covid-19-antibody-seroprevalence-in-santa-clara-county-california-1f6382258c25). One of the things he argues is that it’s plausible all of the positive cases in the paper are false positives given their error bars. That’s pretty troubling. I’ve not gone in depth of either the original paper or this article, but it’s worth looking over.
Alan Goldhammer
Apr 18 2020 at 2:17pm
I’m not going to get into a fight over what is good bad or indifferent about the Stanford paper. The point is they are actually doing something as opposed to someone who is just pontificating (and I honestly don’t think he carefully read the paper). A bigger information set will likely come out of NYC. The Mt. Sinai pathology group has developed a highly specific antibody test and got it approved by FDA. They have a much larger cohort of patients to test than the Stanford group did and will provide data that informs us. In the absence of testing, stuff will open up and then shut down just as what is taking place with the American meatpacking industry where 25% of the capacity is off line right now because of SARS-CoV-2 infections among workers. I don’t know how long this will be off line or whether economic modelers are putting this into some models.
Jon Murphy
Apr 19 2020 at 10:54am
Ok. Let’s assume, for the sake of argument, that the causal inference methods from the Stanford study aren’t an issue here and take it at face value. The problem still remains:
The models are off by an order of magnitude.
The model predicted 9,000 and 300 hospitalizations. It’s 108 and 22, respectively. The possible presence of antibodies in a study conducted via Facebook do not change that fact.
Jon Murphy
Apr 19 2020 at 11:10am
By the way, even if we want to take the Stanford study at face value and use it to claim that the number of cases is underestimated (almost certainly true), the fact that hospitalizations remain so low, and that the purpose of “flattening the curve” is to prevent overwhelming the medical system, the fact that hospitalizations are low by an order of magnitude still matter. Standford does not explain that.
The point remains: the models are majorly incorrect and are being used to justify improper policy
AMT
Apr 19 2020 at 1:08pm
When the assumptions made in the starting point of an exponential growth model are off by an order of magnitude, I disagree that it is of critical importance, when you are modeling an infectious disease capable of fairly rapid exponential growth. As I said before, that might just mean the optimal policy choices of whether to shut down or not to prevent overloading the medical system should be adjusted (delayed) by a couple weeks. But then again, given how it has been a month since the start of the shut downs in many states, and they have only just now, barely begun to level off growth rates, judging the appropriate timeline of when to begin a shut down may not be so easy.
Mark Bahner
Apr 19 2020 at 1:39pm
This particular model isn’t at its “starting point”. From the graph in the Carmel Pine Cone newspaper, the model curve started in mid-March. Here it is, approximately one month later, and the model is off on hospitalizations by more than an order of magnitude. In fact, according to the Pine Cone article, the model predicted there should be 300 hospitalizations on April 15th (even with 70 percent compliance, the highest level evaluated), but there were only 22 hospitalizations “throughout the crisis.” (Italics added.)
AMT
Apr 19 2020 at 3:41pm
Mark,
You clearly do not understand the point. Obviously when I said starting point, that meant the starting point of projecting from today going forward (whether it’s 9000 cases or something else). Otherwise, the “starting point” could logically only be the first infection, so n=1. They clearly are making estimates about the number of actual infections from that point of first infection to the time the model was presented, because we do not have accurate data on that. The point is, how big of a deal is it whether you currently have 900 cases today or 9000, if that number can double every 2 days (as it says in the article)? Here is how exponential growth works: Monday: 900, Wednesday: 1800, Friday, 3600, Sunday, 7200, Tuesday: 14400…
Mark Bahner
Apr 19 2020 at 8:30pm
Yes, Edward Moreno’s model appears to start in mi-March, which is roughly simultaneous with two infections that were apparently found on March 17th.
Where is the evidence that COVID-19 cases were ever doubling every two days in Monterey County? The “stay at home” order was apparently issued on March 17, 2020:
Monterey County shelter in place order issued March 17, renewed April 3rd
Here is what the cases and deaths have been for Monterey County:
date
cases
deaths
3/17/2020
2
0
3/18/2020
2
0
3/19/2020
2
0
3/20/2020
5
0
3/21/2020
11
1
3/22/2020
14
1
3/23/2020
20
1
3/24/2020
20
1
3/25/2020
24
1
3/26/2020
24
1
3/27/2020
27
1
3/28/2020
27
1
3/29/2020
32
1
3/30/2020
36
1
3/31/2020
42
2
4/1/2020
42
2
4/2/2020
48
2
4/3/2020
53
2
4/4/2020
62
2
4/5/2020
62
2
4/6/2020
63
2
4/7/2020
64
2
4/8/2020
69
2
4/9/2020
71
3
4/10/2020
79
3
4/11/2020
82
3
4/12/2020
87
3
4/13/2020
87
3
4/14/2020
100
3
4/15/2020
108
3
4/16/2020
119
3
4/17/2020
119
3
Jon Murphy
Apr 19 2020 at 11:40pm
Any model is necessarily dependent on the assumptions it makes. If your initial assumptions are off by an order of magnitude, your whole model will be off.
AMT
Apr 19 2020 at 11:48pm
Mark,
First, I never said that we should expect cases to double every two days during a lockdown. If you would actually read what I said, I said cases “can” double every two days. Obviously this is far more likely when there is NOT a shelter-in-place order. Even still, multiple days in the data you presented STILL showed a doubling in 2 days (or less), DURING the shelter-in-place order. Look at the model and tell me it predicts a doubling of cases every two days under the 70% compliance projection. (Spoiler alert, it’s nowhere close, quite obviously.) Anyone with even moderate reading comprehension would understand that I implied we should be concerned that we may see very rapid growth (2 day doubling) if we END the shelter-in-place order, not if we maintain it. It has happened in many other areas of the country. So please, stop blatantly misrepresenting what I said. I mean, you literally quoted it!
https://www.washingtonpost.com/graphics/2020/politics/trump-coronavirus-statements/
The fact that measured growth has been lower than the “optimistic” 70% compliance could easily be because these citizens complied much more than officials hoped. But that doesn’t let you conclude very much about what would happen if lockdowns end. And let’s not even get into the disaster that is testing to confirm actual cases, because we obviously don’t have any accurate information on how many cases there actually are. 119? 900? 9000? No one knows.
AMT
Apr 19 2020 at 11:55pm
John I fully agree that the model could be off because we have no idea how many actual infections there are. If they end the shelter-in-place order, the virus growth rate might lag the no social distancing projection by more than a month!
Mark Bahner
Apr 20 2020 at 10:07am
My apologies for the way the Monterey County data ended up being formated. It looked like a table when I hit the “submit comment” button.
But my point of all that was that the “shelter in place” order apparently was issued the very day the first two cases appeared in Monterey County. So Edward Moreno’s claim that cases were doubling every two days before the “shelter in place” order was issued is nonsense…at least for Monterey County. Maybe cases were doubling elsewhere every two days, but not in Monterey County.
A question for David Henderson…though I’m sure I could find the info on the Internet…is Edward Moreno elected, or is he appointed by someone?
Mark Bahner
Apr 19 2020 at 12:28pm
Then why did you write:
?
*If* those results hold up, isn’t it obvious that “we” (meaning you and the people who agree with you) do not know what to do?
And *if* those results hold up, isn’t it obvious that stay-at-home orders are not the right thing to be doing?
David Henderson
Apr 20 2020 at 10:45am
Moreno is appointed.
Mark Bahner
Apr 20 2020 at 4:32pm
Who appoints him? The Monterey County commissioners?
Mark Bahner
Apr 19 2020 at 11:18am
Who is this “we”?
I know what we should be doing. Everyone in close contact with other people indoors should be wearing at least: a) a washable face mask, b) a balaclava/”head sock” that also covers the washable face mask, c) glasses or goggles that cover the eyes, d) washable gloves, and if people work indoors in close contact with a great many other people (e.g. NYC transit workers, nursing home personnel, grocery store clerks), a hat with face mask:
Hats with face masks
I doubt if even 1 in 10,000 people in the U.S. are doing what I know we should do. And what I know we should do would cost less than one percent of the cost of what we’re doing. So please don’t say:
Mark Bahner
Apr 19 2020 at 11:44am
That the federal government, under the 10th amendment, has absolutely zero authorized power to “reopen things”? (I’m guessing that is not going to be your objection…;-))
Perhaps the FDA also should have eased restrictions on cotton swabs before this:
FDA finally loosens restrictions on cotton swabs (announced April 16th)
Phil H
Apr 18 2020 at 3:54am
The public choice point needs to be made. Of course bureaucrats are ignorant. They will always be no smarter or dumber than the rest of the population. They do not have any intrinsic ability to deal intelligently with circumstances far beyond their experience. The only way they can be properly prepared to deal with new circumstances is by embedding them effective, properly funded systems that provide training and explicit instruction. What a shame, then, that Republicans work so tirelessly to dismantle such things.
Mark Z
Apr 18 2020 at 5:49am
It’s easy enough to reflexively blame insufficient funding every time a government fails at something. It’s much harder to explain why they would actually have made better models if they’d had more money, or to even show that increased funding improves the quality of governance. Contrary to the “Republicans have hollowed out the government” canard, funding for the CDC, FDA, most state health departments, etc. has been in a stable or upward trend for a very long time, through administrations of both parties. How much money do they need exactly to be functional? Or is just always “more?’
Phil H
Apr 18 2020 at 5:16pm
“How much money do they need exactly to be functional? Or is just always “more?’”
The answer to that depends on what is meant by functional. The nature of progress does mean that government organizations, and companies, and individuals are constantly being asked to do more. And yeah, that takes more money. You’re right that budgets have to be evaluated and efficiency is an important factor, of course. But we should be clear-eyed about the fact that the health system is required to do more these days.
Technology helps, but in order to get technology, you need things like consistent investment and clarity of vision – not necessarily more money.
David Henderson
Apr 18 2020 at 9:29am
Phil H,
I’m not sure that you mean by “public choice” the same thing that economists steeped in public choice mean. We mean that we can apply the same framework of incentives to bureaucrats, politicians, and voters that we apply to workers, consumers, and businesses in the private sector.
You write,
But in this case, all they needed to do is notice that Moreno’s numbers so far have been off by an order of magnitude. I would think that people who were paying attention during K-12 math would notice that. Certainly reporter Kelly Nix did.
Phil H
Apr 18 2020 at 5:04pm
“the same framework of incentives to bureaucrats, politicians, and voters that we apply to workers, consumers, and businesses”
Yes, that’s what I was trying to do. Part of the framework is the fact that private sector actors are not perfectly rational or infallible. They make mistakes. An argument that says “government worker failed, therefore government action is bad” fails to acknowledge that this truth also applies to the government.
Though, having read the article… it’s not clear to me that Moreno even erred. He presented a model. He explained that it may not be applicable to his county. Those are both very reasonable things to do.
Jon Murphy
Apr 19 2020 at 10:59am
It is not merely that government actors are fallible and make mistakes (though that is part of it. Much of orthodox welfare economics assumes infallibility of government).
Rather, the issue is (among other things), that politicians do not face incentives to either 1) initially get the policy right or 2) respond to mistakes. In markets, people do.
Mark Bahner
Apr 19 2020 at 1:48pm
From the article, it appears to me that *he* ordered the shutdown:
If he actually personally ordered the shutdown, and it resulted in tens of thousands of county residents losing their jobs, it sure appears to me that he erred!
Phil H
Apr 20 2020 at 12:50am
Hi, Mark. Yeah, it’s far from clear to me that a county health officer has the authority to do that. I simply don’t know how legal authority works in California, so I’ll have to pass on that question. Certainly, *if* he made the order, then he is (at least partly) accountable for its results.
And those results, according to DH’s data, are a much lower hospitalisation and death rate than the model predicted. While we can certainly argue about how good/relevant the model is, you haven’t yet shown me any data at all that suggests that Moreno did anything wrong.
Just to recap: Moreno did something that *may* have saved thousands of lives. You say, his model may be flawed, therefore he *should* be blamed for the bad side effects of the shutdown. Neither you nor DH have actually presented an argument that he made a bad decision. Only that you don’t think the standard model he applied wasn’t very appropriate.
Until I start seeing some real data, I’m going to think (1) lockdowns work (see China, New Zealand); (2) proposing the end of lockdowns, with the almost inevitable consequence of tens of thousands of deaths, is disgustingly callous and morally reprehensible.
Mark Bahner
Apr 21 2020 at 1:52pm
Yes, but how do you know the model isn’t a piece of garbage? In fact, the evidence points in the direction that the model *is* garbage. The model predicted that even with “shelter at home” at the highest compliance rate (of 70 percent), there would be 9000 cases and 300 hospitalizations on April 15th. Instead, on April 15th, only 108 cases had been identified, and only 22 hospitalizations had occurred over the entire month from March 17th to April 15th.
Says who? How many “thousands” of lives in Monterey County “may” have been saved? Three thousand? Six thousand? Ten thousand? What is your evidence? What do you know about the subject?
Isn’t it obvious that the model is flawed? And if it’s obvious that it’s flawed, why shouldn’t he be blamed for failing to acknowledge it’s obvious flaws after they became apparent?
If you think the Chinese government reports honestly on bad things that happen in China (for example, the number of deaths that have occurred from COVID-19), I think you’re being very foolish. And if you think that New Zealand, a sparsely populated island nation far into the Southern hemisphere, has any close epidemiological similarity to say, New York and New Jersey, where a large portion of the U.S. deaths from COVID-19 have occurred, then I don’t think you know much about the subject.
2) proposing the end of lockdowns, with the almost inevitable consequence of tens of thousands of deaths, is disgustingly callous and morally reprehensible.
As I’ve written before on EconLog, I’m a single man in my 60s, living next door to and every day helping out my parents, who are both approaching 90. If one of us got COVID-19, there is a strong possibility that all three of us would die. And it seems almost certain that both my parents would die, because they certainly would not allow the separation needed to keep each other from contracting it, and after nearly 65 years of marriage, I doubt either one could live long without the other.
I strongly support ending the lock down in North Carolina by May 1st. I am persuaded by Dr. Johan Giesecke’s arguments that lockdowns probably won’t change the total number of people who die from COVID-19. He may be wrong, but based on what you’ve written on EconLog, it appears that Dr. Giesecke knows far, far more about the subject than you do. (He certainly knows far more about the subject than I do!)
<a href=”https://www.youtube.com/watch?v=bfN2JWifLCY”>Professor Johan Giesecke on COVID-19 lockdowns</a>
And as for your views on what opinions are “disgustingly callous and morally reprehensible,” I have as much respect for your views in that matter as I would have for the views of Joe Biden or Donald Trump…or David Duke or Bernie Madoff, for that matter. Which is to say, frankly, on this matter I don’t give a damn what you think is “disgustingly callous and morally reprehensible.”
Thomas Sewell
Apr 19 2020 at 4:02am
Ah, so all we need is Adam Smith’s “Man of System”, eh?
Which of our enlightened and tireless elites are going to provide the “effective, properly funded systems that provide training and explicit instruction”, then? Haven’t seen many of them around recently, is all…
Phil H
Apr 20 2020 at 12:56am
Sorry, Thomas, I can’t quite understand your argument. I assume that you meant that to be a rhetorical question. But you’ll note that the German health system seems to be standing up to the epidemic extremely well. Britain’s not so well, but neither is it a complete disaster. Taiwan’s obviously performed spectacularly, with effective coordination with other agencies. China avoided stressing its national health system at all, by placing the stress on its other systems through a massive lockdown that ended the epidemic extremely fast…
All of these are systems that performed effectively, as they were supposed to, because they have practice. If we’re going to have systems, we will need men and women in them. Less effective systems will lead to more death. And, to offer my own rhetorical question, you don’t actually want more death… do you?
Mark Bahner
Apr 19 2020 at 1:58pm
I’m not generally in favor of remedies through the courts, but it would be interesting to see what would happen if a civil litigator filed a class action suit on behalf of the “tens of thousands” of people who became unemployed as a result of the stay-at-home order.
Mister Bitcoin
Apr 22 2020 at 6:22am
David Henderson,
I think you will lose your bet with Charley and his friend.
I don’t think there will be 100k deaths unlike in 1957 and 1968 flu epidemics.
MB
Mister Bitcoin
Apr 22 2020 at 6:24am
The Diamond Princess ‘model’ was the most accurate
Rick Ricci
May 2 2020 at 8:00pm
“So how did the 5-member board of supervisors, who are the ones who let Moreno impose the shutdown, react?”
By the Emergency Declaration they approved a month or so ago, the County Supervisors relinquished their management/control/responsibilities regarding the cov 2 disease and gave it to Moreno. By California law, when that happens Moreno dictates orders and his orders carry the force of California law.
In effect, whatever grief the virus inflicts on the citizens of Monterey cannot be laid at the feet of the Supervisors. Because the Emergency declaration wrote that responsibility out of their job description. Moreno calls the legal shots when it comes to the virus. The Supervisors are, essentially, bystanders. Which is why it’s not surprising that at meetings about the virus, the Supervisors say nothing.
Are you the one who organized the protest today?
Comments are closed.