The Nation’s Math Crisis

Lots of people are throwing around statistics about COVID-19, cases, deaths, ICUs, ventilators, even percentages, a challenge for those who forgot long division. And then there are the software/programming types and computer models that project what yesterday’s and today’s numbers will mean for tomorrows.

Keep in mind though that in country as large and opinionated as the United States, tabulating numbers (which depend on people keeping records) is a challenge. For instance:

In his effort to narrow the stunning divide between the U.S. and other industrialized Western nations on the rates at which they incarcerate their respective citizens, Latzer’s argument is limited to people housed in prisons. His analysis thus quite explicitly ignores the almost 800,000 people who are detained, at any given point in time, in city and county jails across America housing half as many prisoners as state and federal prisons do.

Excluding jail inmates in a debate concerning over-incarceration, however, is just as illogical as ignoring foreign-manufactured vehicles from an assessment of the number of automobiles on the road. The place where prisoners are housed (prison versus jail) is just as irrelevant as the place of manufacture of automobiles in arguments over whether we have too many inmates and cars in the United States. To have any real-world significance, each normative inquiry must begin with an accurate appraisal of the empirical phenomenon being assessed. In the case of over-incarceration, that means factoring in the hundreds of thousands of people locked up in jails along with their counterparts in federal and state prisons.

According to the U.S. Department of Justice, “County and city jails in the United States reported a total confined population of 745,200 inmates at midyear 2017.” In that same year, the government reported that prisons contained 1,489,363 inmates. Despite the fact that non-lawyers often use the terms “prison” and “jail” interchangeably, prisons are reserved for persons convicted of felonies and sentenced to more than a year behind bars. Jails, by contrast, house less serious convicts serving custodial sentences of one year or less and persons being held on pending charges not yet adjudicated. People in jails and prisons alike are incarcerated and thus directly relevant to debates regarding over-incarceration.

At a time when we are trying to sort through critical cases of COVID-19, ordinary ones, and asymptomatic carriers, remembering that Americans also have trouble counting people who commit felonies may provide comfort. You can always juke the stats.

Stats May Lie but What about the Words?

Some think Aaron Ginn’s article that debunks the projections for COVID-19’s rates of transmission, infection, and mortality are off. In an era of big data, from Wall Street to Major League Baseball, occupying the lane alone as the only interpreter of statistics looks a tad risky. But okay, Carl T. Bergstrom can have the numbers (though I wonder if he ever questions the graphs that Stuart A. Thompson creates for the New York Times).

What about the text that Ginn also supplied?

One example is from the Wall Street Journal:

A World Health Organization report on China concluded that cases of Covid-19 in children were “relatively rare and mild.” Among cases in people under age 19, only 2.5% developed severe disease while 0.2% developed critical disease. Among nearly 6,300 Covid-19 cases reported by the Korea Centers for Disease Control & Prevention on March 8, there were no reported deaths in anyone under 30. Only 0.7% of infections were in children under 9 and 4.6% of cases were in those ages 10 to 19 years old

Only 2% of the patients in a review of nearly 45,000 confirmed Covid-19 cases in China were children, and there were no reported deaths in children under 10, according to a study published in JAMA last month. (In contrast, there have been 136 pediatric deaths from influenza in the U.S. this flu season.)

About 8% of cases were in people in their 20s. Those 10 to 19 years old accounted for 1% of cases and those under 10 also accounted for only 1%.

This was not a cherry-picked quotation. Ginn could have added:

Trends in South Korea so far look similar. Among nearly 6,300 Covid-19 cases reported by the Korea Centers for Disease Control & Prevention on March 8, there were no reported deaths in anyone under 30. Only 0.7% of infections were in children under 9 and 4.6% of cases were in those ages 10 to 19 years old.

Ginn also quoted a study from the Center for Disease Control

A growing body of evidence indicates that COVID-19 transmission is facilitated in confined settings; for example, a large cluster (634 confirmed cases) of COVID-19 secondary infections occurred aboard a cruise ship in Japan, representing about one fifth of the persons aboard who were tested for the virus. This finding indicates the high transmissibility of COVID-19 in enclosed spaces.

The larger part of that paragraph includes this.

[H]ospital-based transmission has occurred, potentially affecting healthcare workers, inpatients, and visitors at healthcare facilities, which might explain an increasing trend and the elevated CFR estimates. Indeed, thousands of healthcare workers have succumbed to the disease in China (18), a pattern that resembles past nosocomial outbreaks of Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (19,20). During past MERS outbreaks, inpatients with underlying disease or elderly persons infected in the hospital setting have raised the CFR to values as high as 20% (21,22).

Meanwhile, Ginn brought interpretation of statistics — that would be words — from Nobel laureate and Biophysicist, Michael Levitt. Not shabby, right?

Every coronavirus patient in China infected on average 2.2 people a day — spelling exponential growth that can only lead to disaster. But then it started dropping, and the number of new daily infections is now close to zero.” He compared it to interest rates again: “even if the interest rate keeps dropping, you still make money. The sum you invested does not lessen, it just grows more slowly. When discussing diseases, it frightens people a lot because they keep hearing about new cases every day. But the fact that the infection rate is slowing down means the end of the pandemic is near.”

Turns out Ginn was abstemious in his quotation of Levitt:

There are several reasons for this, according to Levitt. “In exponential growth models, you assume that new people can be infected every day, because you keep meeting new people. But, if you consider your own social circle, you basically meet the same people every day. You can meet new people on public transportation, for example; but even on the bus, after some time most passengers will either be infected or immune.”

Another reason the infection rate has slowed has to do with the physical distance guidelines. “You don’t hug every person you meet on the street now, and you’ll avoid meeting face to face with someone that has a cold, like we did,” Levitt said. “The more you adhere, the more you can keep infection in check. So, under these circumstances, a carrier will only infect 1.5 people every three days and the rate will keep going down.”

Quarantine makes a difference, according to Levitt, but there are other factors at work. “We know China was under almost complete quarantine, people only left home to do crucial shopping and avoided contact with others. In Wuhan, which had the highest number of infection cases in the Hubei province, everyone had a chance of getting infected, but only 3% caught it,” he explained. “Even on the Diamond Princess (the virus-stricken cruise ship), the infection rate did not top 20%.” Based on these statistics, Levitt said, he concluded that many people are just naturally immune to the virus.

The explosion of cases in Italy is worrying, Levitt said, but he estimates it is a result of a higher percentage of elderly people than in China, France, or Spain. “Furthermore, Italian culture is very warm, and Italians have a very rich social life. For these reasons, it is important to keep people apart and prevent sick people from coming into contact with healthy people.”

It doesn’t take epidemiological scientist to think this:

To put things in proportion: “there are years when flu is raging, like in the U.S. in 2017, when there were three times the regular number of mortalities. And still, we did not panic. That is my message: you need to think of corona like a severe flu. It is four to eight times as strong as a common flu, and yet, most people will remain healthy and humanity will survive.”

If Carl Bergstrom wants all non-experts to butt out. Fine. But what newspaper, magazine, or news-website will stand in that great day?

Too Small to Succeed (the Health Care System)

Americans may distrust big institutions, and journalists may take most of what Donald Trump says as brummagem, but why aren’t Americans suspicious of the people running the health care system? After all, most times the phrase — flattening the curve — is not about saving lives (as Jay Santos would put it), but about managing the demand for medical care in a hospital. Of course, saving lives is related to access to hospitals, especially in life threatening stages of many diseases and conditions. But flattening the curve also indicates that hospitals are not prepared for a pandemic. That could well be the fault of federal authorities and public health officials. But we are in a privatized system of health care (different from health insurance). And it’s now fairly obvious that hospital CEOs had all sort of financial incentives to handle COVID-19 cases.

Here’s some of the polling data on physicians and research scientists:

The spread of the new coronavirus in the United States comes at a time of low public trust in key institutions. Only around a third of U.S. adults (35%) have a great deal or a fair amount of confidence in elected officials to act in the public’s best interests, and fewer than half say the same about business leaders (46%) and the news media (47%), according to a January 2019 Pew Research Center survey.

Public attitudes are substantially more positive when it comes to another set of participants in the unfolding coronavirus threat: doctors and medical research scientists. In the same survey, 74% of Americans said they had a mostly positive view of medical doctors, while 68% had a mostly favorable view of medical research scientists – defined as those who “conduct research to investigate human diseases and test methods to prevent and treat them.”

Why don’t Pew’s pollsters ask questions about hospital administrators? A story about the differences between non-profit and for-profit health systems indicates that hedge fund types, the folks who gave us (at least partly) the 2008 financial meltdown, may also be responsible for the COVID-19’s economic symptoms:

for-profit health system boards tend to be a blend of investor representatives and community leaders.

At Nashville-based HCA Healthcare Inc., a for-profit health system with more than 180 hospitals, the chairman of the board is Thomas F. Frist III, founder and managing principal of Frist Capital LLC, a Nashville investment firm.

Other members of the HCA board include Nancy-Ann DeParle, a partner at New York-based Consonance Capital Partners, a private equity firm that invests in healthcare companies. Charles O. Holliday Jr., chairman of Royal Dutch Shell PLC, which is headquartered in The Hague, the Netherlands, is also on the board.

Sure, it could be that to make hospitals work, you need bean counters and market watchers and venture capitalists to calculate the allocation of resources. But what if for-profit medicine is not the right model for pandemics?

And what if journalists and Democrats, eager to make the current White House look like a gaggle of idiots (not hard), took a long look not at the way we pay and process paperwork for health insurance companies? What about running stories on the business people who manage and own hospital systems that were interested in profits as much as public health? What about coverage of the sort of contortions imposed on epidemiologists, economists, and elected officials because the people who directly manage and own institutions within the health care system were unprepared for a pandemic? And when will someone point out that again the federal government and its printing presses at the Treasury will save another industry’s CEOs?

The Old Testament Church and Plague(s)

During the blizzard-like conditions of COVID-19’s spread, Christian writers have been thinking about ways to minister during a plague. Some appeal to Luther. Some about the ongoing urgency of preaching the gospel. Some discuss the tension among commitments to love neighbors, serve God, and obey civil magistrates. Some compare COVID-19 to an atomic bomb (seriously). And some describe at great length and with much unction how the church needs to respond redemptively.

Ed Stetzer may be the best example of evangelicals’ historical imagination during a major, worldwide illness. His is exclusively post-canonical:

Sociologist Rodney Stark explored one such one example where during a plague AD 251 swept through the Roman Empire decimating the population. In his Easter letter around AD 260, Dionysius wrote a tribute to the believers whose heroic efforts cost many of them their lives during the plague.

Pagans tended to flee the cities during plagues, but Christians were more likely to stay and minister to the suffering. According to Dionysius: “Most of our brother Christians showed unbonded love and loyalty, never sparing themselves and thinking only of one another. Needless of danger, they took charge of the sick, attending to their every need and ministering to them in Christ, and with them departed this life serenely happy.”

Dionysius added: “The best of our brothers lost their lives in this manner, a number of presbyters, deacons, and laymen winning high commendation so that death in this form, the result of great piety and strong faith, seems in every way the equal of martyrdom.”

In Christians in the Age of Outrage I offered a more recent example of sacrificially living out the gospel in the midst of suffering. During the Fall of 1793, yellow fever gripped the city of Philadelphia. Historian Richard Newman writes that, “from the moment it began, the yellow fever epidemic was a public-health crisis. Thousands of citizens fled, hospitals became overwhelmed, and dead bodies rotted in homes.”

Within this crisis, it was the emerging black church under the leadership of Richard Allen which entered into the suffering. Some assumed that persons of African descent were immune to Yellow Fever, and the free black community was approached to provide help. Spurned by the church they had served and slandered by others, Allen and his church served the sick when others isolated themselves for fear of catching the disease.

…Through both examples, we are reminded that the gospel calls us to live sacrificially in the face of crisis.

If these Christian authors had the Old Testament background to the New Testament more in mind, what might they say about the mother of all plagues, the one that forms the background for the Lord’s Supper, the Eucharist, even the Mass. That plague, as Psalm 78 has it, was also at the center of the Exodus, the Old Testament redemptive historical event that inspired many of the modern world’s social justice activists:

42 They did not remember his power
or the day when he redeemed them from the foe,
43 when he performed his signs in Egypt
and his marvels in the fields of Zoan.
44 He turned their rivers to blood,
so that they could not drink of their streams.
45 He sent among them swarms of flies, which devoured them,
and frogs, which destroyed them.
46 He gave their crops to the destroying locust
and the fruit of their labor to the locust.
47 He destroyed their vines with hail
and their sycamores with frost.
48 He gave over their cattle to the hail
and their flocks to thunderbolts.
49 He let loose on them his burning anger,
wrath, indignation, and distress,
a company of destroying angels.
50 He made a path for his anger;
he did not spare them from death,
but gave their lives over to the plague.
51 He struck down every firstborn in Egypt,
the firstfruits of their strength in the tents of Ham.
52 Then he led out his people like sheep
and guided them in the wilderness like a flock.
53 He led them in safety, so that they were not afraid,
but the sea overwhelmed their enemies.
54 And he brought them to his holy land,
to the mountain which his right hand had won.

If Christians identified more with Old Testament saints than with modern humanitarians, then, would they be more inclined to view COVID-19 as God’s judgment on a neo-liberal, morally indifferent, systemically unjust society and a hypocritical evangelical church? You could even turn in this into God’s judgment on a nation’s president who is entirely without a moral compass.

Then again, invoking God’s righteous judgment on a wicked society is so Pat Robertson (though anti-Trump prophets are hardly Mr. Rogers).