BeenHazy

I got to eyewitness some news with regard to diagnostic testing at work today. A local company has a PCR test that can detect SARS-CoV-2 using an oral rinse and a minimally-invasive nasal swab. It is self-administered under the direction of a professional. It is currently being used to test second-line health care workers at at least one major provider of elective procedures, and will be used on that company's patients starting next week. That's the only client I know of personally, there are probably others. It's interesting that this testing company hasn't gone out of its way to draw attention to its test. Maybe they don't know exactly how good the test is, and this is something of a trial here? Perhaps it's a great test and they don't have enough capacity to benefit from publicity? Is this part of Walz's "Minnesota moonshot"? I wish I knew more about it, but I wasn't in a position to ask too many questions.

Massachusetts is doing something like that.

The most important thing right now is to get the R number (the one Nate Silver calls R-effective in his article) below 1. I think most of the country is there already, even though the numbers don't show it yet. When we're below R1, the number of infections will go down every day. That's the elusive actual number, the one we don't really know right now. In many states, the cumber of confirmed cases appeared to flatten for several days recently. Most of those states have shown small increases day-to-day in the past 5 days or so. But testing has also been increasing, so it seems reasonable to guess that we're really just finding a larger share of whatever cases are out there. Increased testing on top of increasing spread would result in alarming looking day-over-day numbers. We're not seeing that in most states. Here in Minnesota, the testing rate has remained consistent. New cases per day has also been mostly flat, although the highest number so far was announced on Saturday, followed by a smaller but still relatively high report today to make it the worst consecutive-day total yet. But even within a consistent sample size there are still reasons to believe that positives can increase while the true number of infections is falling. The delay from infection to symptoms bad enough to warrant a test is one. The focus of testing on at-risk groups like health care workers is another. It has also been reported that influenza cases have plummeted. This makes sense, as social distancing works against the flu too. Now, consider what happens when there a number of different causes for respiratory distress that produce the same symptoms as COVID-19, and only a limited number of COVID tests available. You're going to find more of what you're looking for when fewer tests are spent on patients with other diseases. I do worry about another scenario. We have divided the country into two distinct groups: The first are those who are truly sheltering at home, only needing occasional runs for food and supplies. This is more than half of the population, including retirees, students, working-age adults who chose not to work, those who can work from home, and people who lost their jobs due to COVID-related shutdowns. The second group is anybody who still leaves the home for work regularly. The R in the first group should quickly fall to near zero. There would be some in-household transmission, but that would end after a generation or two. If that decrease happens at a rate that roughly mirrors any increase in spread among the second group, the overall daily new case numbers should flatten for a time (reduction in first group offsets continuing increase in second), then resume an upward path (reduction in first group no longer possible, increase in second group continues on). If the pandemic keeps spreading through the "essential" population, even with an effective R of just over 1, we're pretty much screwed for a while. It looks like testing as a primary means of control is unrealistic unless the number of infections is brought way down. I don't think we can shut enough additional workplaces to make a difference, mostly because the "essential" but non-critical workplaces that remain open aren't likely hot spots of viral spread (there's Menards and Home Depot and that's about it). On the other hand, if we do turn the corner on new infections I think there are plenty of businesses that could re-open with minimal impact on the R, especially with staff and customers both becoming habituated to good practices. There isn't a lot of close contact at most retail shops. Even restaurants might be okay with less seating and reservations-only policies to eliminate wait lines. There's some wiggle room because an R of .95 is just as good as an R of .3 after active cases are brought to a low enough level.

I looked at the state health department sites for MS, OK and SC. All of those states are having a portion of testing performed by private labs. Those labs are required to report positive results to the state, but not the number of tests performed. In Mississippi, only 451 of the 1073 positives were through the state lab, and in Oklahoma it's 150 of 719. No negative tests by outside labs are being reported. South Carolina isn't breaking those numbers down. I haven't looked closely at the other states with high positives per test. Data this bad isn't even worth tracking. To further queer the data, the COVID Tracking Project isn't even counting the positive returns from outside labs in its total tests performed for Mississippi. Minnesota is at least reporting all tests performed, whether they were done by the MDH or not. It might be a bit of wishcasting on my part, but I don't have any reason to believe that the criteria for who gets tested (either by MDH or Mayo) has changed much over the past two weeks. As long as that criteria is consistent, the results can tell us how fast the disease is spreading in the wider population. The positive rate in this data set should be much higher than in the general population because we know they're including all hospitalized patients with symptoms and the highest-risk group of the population (health care workers), but any trends over time should still track with those in the population. Unfortunately, the Governor and the MDH Commissioner had bad news about the testing situation today. Supply shortages might further restrict testing in the near future. We are apparently nowhere near having the testing capacity to replace the suspension of normal everyday life with a test-and-contain strategy to fight the spread.

It's starting to look like the partial shutdown and social distancing might have averted disaster in Minnesota (and many other states) for now. The business closures and social distancing guidelines issued in the third week of March seem to have pushed the R number to 1, and possibly below that. New confirmed cases per day have leveled out over the past week in much of the country. Colorado shows what a difference a few days could have made. Asymptomatic and presymptomatic people from all over the world brought the virus directly to Colorado, most passing through DIA and the Denver metro before and after hitting the ski resorts in the mountains. As a result, that demographically similar state has had about 5 times the number of COVID-19 confirmed cases, hospitalizations, and deaths versus Minnesota. It was true when the news of Rudy Gobert and Tom Hanks broke and remains so today. They shut down the same group of businesses at exactly the same time as we did, and have also seen their new cases per day level off...but at around 300 per day, versus about 60 here. The really good news is that their health system has so far kept up with those numbers, numbers that Minnesota might not even come close to as long as the R number is kept in check. The big caveat in all of this is the continued lack of adequate testing. We know that only a portion of cases are getting reported - but what is the nature of that portion? Is it drawing on a wide enough sample of the population to accurately detect the overall trend? I think it's probably very close, and if anything would overstate the rate of new cases due to health care workers getting priority for testing. In the near term, this is excellent news. By far the best yet. We're not going to be New York City or Italy! But we can't stay locked down indefinitely, and getting the R number below 1 doesn't mean diddly if we don't have the testing capacity to pursue a test-trace-isolate strategy that can allow us to open things up again. Where is the news coverage of the continued testing capacity shortage?

If only we had time!

The Hammer and the Dance This is the best article I've seen yet concerning our response to the pandemic and what the future can look like. It was originally posted back on March 19, but nothing since has lessened its relevance, even in our fast-changing environment. Thomas Friedman mentioned it in his open letter to Trump yesterday. Terrific stuff, written for a non-technical audience.

Back in my day, most baseball was played without adult supervision.

After tonight, the Twins have hit 26 more home runs than they have allowed. The last time they met or exceeded that number over the course of an entire season was 1969.

WOW, never mind.

They could use the OKC 1st to disappear Aldrich somewhere, leaving just shy of $20M I think. If Millsap wants to reunite with Teague and is only getting offers in the 20-22M range from inferior teams that might be enough. A guy can dream. Bench is Dieng, Bjelica, Tyus, and a veteran minimum wing...not ideal but worth it for that starting five.

Tweet from Frank Isola of the NY Daily News: "Source close to free agent Paul Millsap says Denver and Minnesota have emerged as frontrunners." I doubt the Wolves have enough cap left to grab Millsap on July 6th, but you never know. The good thing about getting Teague (reported 3y/57M) instead of Lowry is it leaves enough space for the Wolves to be one of the best teams that can make a decent offer after the first wave is done, for good players who fall through the cracks.

When your most fleshed-out character is the stiff, you have a problem.

He carves "SG was here" on the wall in Omaha, not "JM was here." He's grieving the loss of Saul and/or reminding himself of who he really is, presumably without a thought for who he was as Jimmy. If you have Netflix, watch the scene where he proposes Wexler McGill to Kim (S2 E7 around 25:00). He says flat out that all that hard work and sacrifice was to please others, not himself.

This isn't about Jimmy getting broken. It's about him finding his groove as Saul. He's progressing, not getting beaten down. My guess is Chuck will have a minor role going forward, and might even be written out completely before the end of this season. It's been a great story, but it feels like it's just about over now. Jimmy apparently kept Kim in the dark about Huell's role in the hearing. That could be a big bump in their relationship, but there is still plenty left to their story. Rewatched BB after BCS season 2 and noticed that Saul spoke of past relationships in a manner that was rueful and perhaps a bit bitter.