I was convinced if the Wuhan Corona Virus was as virulent as advertised we would have already seen evidence of it. My theory that a nasty strain of flu that swept the Rio Grande Valley last December was the S strain of the Wuhan was a SWAG and we can now see I was wrong. I then thought the data driven analysis explained the lack of an outbreak but that too, has been debunked.
New York City has been hit hard, but at least one hospital, Lennox Hill is using HydroxyChloroquin, and they have yet to lose anyone of the 100 plus cases that they are treating. That is encouraging. Although the number of positive tests for COVID-19 will skyrocket there as testing comes on live there has yet to be a flood of pneumonia patients outside of New York City.
That too is encouraging.
One of the most popular videos in my area on the pandemic is this one from Dr Emily Porter, an Emergency Medicine physician from Austin, Texas. In her analysis she assumes a low end infection rate of 45% of the population and then does the math to show how large a catastrophe that would be. I’m certain the forecasted numbers have decreased since she made her presentation and I don’t think we are going to see those kinds of numbers. But again I base that on the assumption that we would already be seeing a surge in emergency room admissions for pneumonia. Maybe I’m wrong and we will see a surge in hospitalizations in the coming weeks. I sure hope not.
Tokyo, despite being one of the most densely populated places on earth, has weathered the Wuhan virus well. The Japanese success at stopping the virus is an excellent argument for taking our shoes off before we enter the house. It’s not a bad habit to adopt these days.
I can no longer traffic in “Do you know anyone with Wuhan?” meme’s because my friend Smari McCarthy, who lives in Iceland, tested positive. He’s going to be OK which is good news. He reminded me about riding out the Swine Flu epidemic in Jalalabad, Afghanistan in 2009. I don’t have the ingredients for the malaria chai though, that needs some #1 hash ghee and a little tincture of opium and those are in short supply in Texas. Helps to have somebody who knows what they’re doing brewing the stuff too.
Without the malaria chai we are left to do little else but stay off the streets, help our neighbors as need and wait to see what happens. The President was quoted as saying he will reassess where we are in two weeks and maybe lift the bans as appropriate.
I still suspect we should have isolated the venerable while protecting our economy but future events may well prove me wrong. I’m just encouraged by each new day that arrives without another cluster overwhelming a local hospital system. As long as that continues we’ll be OK, and if it doesn’t continue I think we’ll see Americans, at the community level, coming together to work through the crisis at hand.
For now the only thing to do is stay at home, look after your neighbors and check up on the elderly folks who are not getting out much to see if they need anything.
The first rule in medicine is to do no harm, but our response to the Wuhan Corona Virus pandemic is doing nothing but harm.
If COVID-19 is as virulent and easily transmittable as the models predict it to be it would have already manifested in a massive health emergency. If it were an aerosol the first sign would have been a high infection rate in airline crews because they spent the most time, in a confined place, with infected people.
My earlier speculation centered on a nasty flu bug that burned through the Rio Grande Valley last December. When it was discovered there are 2 strains of the Wuhan virus, one lethal (L strain) and one not lethal (the S strain) I thought the S strain had arrived first based on the assumption it was a highly contagious disease passed through aerosols.
The 2 strain 1 virus theory appears to be incorrect because the assumption the virus is transmittable via aerosol is not correct. . The most recent data on the bug indicates you need to come in contact with a obviously sick person to catch it.
Yesterday a long, detailed article from Aaron Ginn, a Silicon Valley technologist who is published widely in Tech journals, analyzed the current data for COVID-19. He published in his findings in Medium but his post has been removed and is now “under investigation or was found in violation of the Medium Rules”.
Aaron Ginn applied his analytical skills to the most current data on COVID-19 and what he found was good news. The reason his article is under review was his pointed criticism that the current containment steps are unnecessary. Interesting facts like this caught my eye:
Available modeling data indicate that early, short to medium closures do not impact the epi curve of COVID-19 or available health care measures (e.g., hospitalizations). There may be some impact of much longer closures (8 weeks, 20 weeks) further into community spread, but that modeling also shows that other mitigation efforts (e.g., handwashing, home isolation) have more impact on both spread of disease and health care measures. In other countries, those places who closed school (e.g., Hong Kong) have not had more success in reducing spread than those that did not (e.g., Singapore).
It appears social distancing, travel restrictions, closing schools and businesses etc… will have no impact of the spread of this disease. The CDC guidelines clearly indicate that. The best and only defense is hygiene – hand washing and cleaning of surfaces infected people have touched.
Because the article was removed I’m going to post it below so you can decide for yourself if he has made a convincing argument. The current public health measures in place have little impact on my daily routine, my gym is closed and that’s it. But if I were sitting at home watching my business going under, watching my job go away? And on top of that worried about a killer virus; I would want to know what the data said.
What alarms me also alarms Mr. Ginn; and I’ll let him explain. I put the ending of his piece first, followed by his data and argument. I’ll let you decide if he has made a solid case.
These days are precarious as Governors float the idea of martial law for not following “social distancing”, yet violating those same rules in their press conferences. Remember this tone is for a virus that has impacted 0.004% of our population. Imagine if this was a truly existential threat to our Republic.
The COVID-19 hysteria is pushing aside our protections as individual citizens and permanently harming our free, tolerant, open civil society. Data is data. Facts are facts. We should be focused on resolving COVID-19 with continued testing, measuring, and be vigilant about protecting those with underlying conditions and the elderly from exposure. We are blessed in one way, there is an election in November. Never forget what happened and vote.
You may ask yourself. Who is this guy? Who is this author? I’m a nobody. That is also the point. The average American feels utterly powerless right now. I’m an individual American who sees his community and loved ones being decimated without given a choice, without empathy, and while the media cheers on with high ratings.
When this is all over, look for massive confirmation bias and pyrrhic celebration by elites. There will be vain cheering in the halls of power as Main Street sits in pieces. Expect no apology, that would be political suicide. Rather, expect to be given a Jedi mind trick of “I’m the government and I helped.”
The health of the State will be even stronger with more Americans dependent on welfare, another trillion stimulus filled with pork for powerful friends, and a bailout for companies that charged us $200 change fees for nearly a decade. Washington DC will be fine. New York will still have all of the money in the world. Our communities will be left with nothing but a shadow of the longest bull market in the history of our country.
Total cases are the wrong metric
A critical question to ask yourself when you first look at a data set is, “What is our metric for success?”.
Let’s start at the top. How is it possible that more than 20% of Americans believe they will catch COVID-19? Here’s how. Vanity metrics — a single data point with no context. Wouldn’t this picture scare you?
Look at all of those large red scary circles!
These images come from the now infamous John Hopkins COVID-19 tracking map. What started as a data transparency effort has now molded into an unintentional tool for hysteria and panic.
An important question to ask yourself is what do these bubbles actually mean? Each bubble represents the total number of COVID-19 cases per country. The situation looks serious, yet we know that this virus is over four months old, so how many of these cases are active?
Immediately, we now see that just under half of those terrifying red bubbles aren’t relevant or actionable. The total number of cases isn’t illustrative for what we should do now. This is a single vanity data point with no context; it isn’t information or knowledge. To know how to respond, we need more numbers to tell a story and to paint the full picture. As a metaphor, the daily revenue of a business doesn’t tell you a whole lot about profitability, capital structure, or overhead. The same goes for the total number of cases. The data isn’t actionable. We need to look at ratios and percentages to tell us what to do next — conversion rate, growth rate, and severity.
Time lapsing new cases gives us perspective
Breaking down each country by the date of the first infection helps us track the growth and impact of the virus. We can see how total cases are growing against a consistent time scale.
Here are new cases time lapsed by country and date of first 100 total cases.
Here is a better picture of US confirmed case daily growth.
The United States is tracking with European nations with doubling cases every three days or so. As we measure and test more Americans, this will continue to grow. Our time-lapse growth is lower than China, but not as good as South Korea, Japan, Singapore, or Taiwan. All are considered models of how to beat COVID-19. The United States is performing average, not great, compared to the other modern countries by this metric.
Still, there is a massive blindspot with this type of graph. None of these charts are weighted on a per-capita basis. It treats every country as a single entity, as we will see this fails to tell us what is going on in several aspects.
On a per-capita basis, we shouldn’t be panicking
Every country has a different population size which skews aggregate and cumulative case comparisons. By controlling for population, you can properly weigh the number of cases in the context of the local population size. Viruses don’t acknowledge our human borders. The US population is 5.5X greater than Italy, 6X larger than South Korea, and 25% the size of China. Comparing the US total number of cases in absolute terms is rather silly.
Rank ordering based on the total number of cases shows that the US on a per-capita basis is significantly lower than the top six nations by case volume. On a 1 million citizen per-capita basis, the US moves to above mid-pack of all countries and rising, with similar case volume as Singapore (385 cases), Cyprus (75 cases), and United Kingdom(3,983 cases). This is data as of March 20th, 2020.
Here is a visualization of a similar per-capita analysis.
But total cases even on a per-capita basis will always be a losing metric. The denominator (total population) is more or less fixed. We aren’t having babies at the pace of viral growth. Per-capita won’t explain how fast the virus is moving and if it is truly “exponential”.
COVID-19 is spreading, but probably not accelerating
Growth rates are tricky to track over time. Smaller numbers are easier to move than larger numbers. As an example, GDP growth of 3% for the US means billions of dollars while 3% for Bermuda means millions. Generally, growth rates decline over time, but the nominal increase may still be significant. This holds true of daily confirmed case increases. Daily growth rates declined over time across all countries regardless of particular policy solutions, such as shutting the borders or social distancing.
The daily growth data across the world is a little noisy. Weighing daily growth of confirmed cases by a relative daily growth factor cleans up the picture, more than 1 is increasing and below 1 is declining. For all of March, the world has hovered around 1.1. This translates to an average daily growth rate of 10%, with ups and downs on a daily basis. This isn’t great, but it is good news as COVID-19 most likely isn’t increasing in virality. The growth rate of the growth rate is approximately 10%; however, the data is quite noisy. With inconsistent country-to-country reporting and what qualifies as a confirmed case, the more likely explanation is that we are increasing our measurement, but the virus hasn’t increased in viral capability. Recommended containment and prevention strategies are still quite effective at stopping the spread.
Cases globally are increasing (it is a virus after all!), but beware of believing metrics designed to intentionally scare like “cases doubling”. These are typically small numbers over small numbers and sliced on a per-country basis. Globally, COVID-19’s growth rate is rather steady. Remember, viruses ignore our national boundaries.
Viruses though don’t grow infinitely forever and forever. As with most things in nature, viruses follow a common pattern — a bell curve.
Watch the Bell Curve
As COVID-19 spreads and declines (which it will decline despite what the media tells you), every country will follow a similar pattern. The following is a more detailed graph of S. Korea’s successful defeat of COVID-19 compared also to China with thousands of more cases and deaths. It is a bell curve:
Here is a more detailed graph of S. Korea graphed against the total number of cases.
Here is a graph from Italy showing a bell curve in symptom onset and number of cases, which may point to the beginning of the end for Italy —
Bell curves are the dominant trait of outbreaks. A virus doesn’t grow linearly or exponentially forever (if assuming reasonable assumptions about time). It accelerates, plateaus, and then declines. Whether via environmental factors or our own efforts, viruses accelerate and quickly decline. This fact of nature is represented in Farr’s law. CDC’s recommendation of “bend the curve” or “flatten the curve” reflects this natural reality.
It is important to note that in both scenarios, the total number of COVID-19 cases will be similar. The primary difference is the length of time. “Flattening the curve”’s focus is to minimize a shock to the healthcare system which can increase fatalities due to capacity constraints, as seen in Italy and Wuhan, China. In the long-term, it isn’t pure “infection prevention”, rather it prioritizes lower healthcare utilization. Unfortunately, “flattening the curve” doesn’t include other downsides and costs of execution.
Both the CDC and WHO are optimizing for healthcare utilization, while ignoring the economic shock to our system. Both organizations assume you are going to get infected, eventually, and it won’t be that bad.
A low probability of catching COVID-19
The World Health Organization (“WHO”) released a study on how China responded to COVID-19. Currently, this study is one of the most exhaustive pieces published on how the virus spreads.
The results of their research show that COVID-19 doesn’t spread as easily as we first thought or the media had us believe (remember people abandoned their dogs out of fear of getting infected). According to their report if you come in contact with someone who tests positive for COVID-19 you have a 1–5% chance of catching it as well. The variability is large because the infection is based on the type of contact and how long.
The majority of viral infections come from prolonged exposures in confined spaces with other infected individuals. Person-to-person and surface contact is by far the most common cause. From the WHO report, “When a cluster of several infected people occurred in China, it was most often (78–85%) caused by an infection within the family by droplets and other carriers of infection in close contact with an infected person.
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
Dr. Paul Auwaerter, the Clinical Director for the Division of Infectious Diseases at Johns Hopkins University School of Medicine echoes this finding,
“If you have a COVID-19 patient in your household, your risk of developing the infection is about 10%….If you were casually exposed to the virus in the workplace (e.g., you were not locked up in conference room for six hours with someone who was infected [like a hospital]), your chance of infection is about 0.5%”
According to Dr. Auwaerter, these transmission rates are very similar to the seasonal flu.
Air-based transmission or untraceable community spread is very unlikely. According to WHO’s COVID-19 lead Maria Van Kerkhove, true community based spreading is very rare. The data from China shows that community-based spread was only a very small handful of cases. “This virus is not circulating in the community, even in the highest incidence areas across China,” Van Kerkhove said.
“Transmission by fine aerosols in the air over long distances is not one of the main causes of spread. Most of the 2,055 infected hospital workers were either infected at home or in the early phase of the outbreak in Wuhan when hospital safeguards were not raised yet,” she said.
True community spread involves transmission where people get infected in public spaces and there is no way to trace back the source of infection. WHO believes that is not what the Chinese data shows. If community spread was super common, it wouldn’t be possible to reduce the new cases through “social distancing”.
“We have never seen before a respiratory pathogen that’s capable of community transmission but at the same time which can also be contained with the right measures. If this was an influenza epidemic, we would have expected to see widespread community transmission across the globe by now and efforts to slow it down or contain it would not be feasible,” said Tedros Adhanom, Director-General of WHO.
An author of a working paper from the Department of Ecology and Evolutionary Biology at Princeton University said, “The current scientific consensus is that most transmission via respiratory secretions happens in the form of large respiratory droplets … rather than small aerosols. Droplets, fortunately, are heavy enough that they don’t travel very far and instead fall from the air after traveling only a few feet.”
The media was put into a frenzy when the above authors released their study on COVID-19’s ability to survive in the air. The study did find the virus could survive in the air for a couple of hours; however, this study was designed as academic exercise rather than a real-world test. This study put COVID-19 into a spray bottle to “mist” it into the air. I don’t know anyone who coughs in mist form and it is unclear if the viral load was large enough to infect another individual. As one doctor, who wants to remain anonymous, told me, “Corona doesn’t have wings”.
To summarize, China, Singapore, and South Korea’s containment efforts worked because community-based and airborne transmission aren’t common. The most common form of transmission is person-to-person or surface-based.
Common transmission surfaces
COVID-19’s ability to live for a long period of time is limited on most surfaces and it is quite easy to kill with typical household cleaners, just like the normal flu.
COVID-19 can be detected on copper after 4 hours and 24 hours on cardboard.
COVID-19 survived best on plastic and stainless steel, remaining viable for up to 72 hours
COVID-19 is very vulnerable to UV light and heat.
Presence doesn’t mean infectious. The viral concentration falls significantly over time. The virus showed a half-life of about 0.8 hours on copper, 3.46 hours on cardboard, 5.6 hours on steel and 6.8 hours on plastic.
According to Dylan Morris, one of the authors, “We do not know how much virus is actually needed to infect a human being with high probability, nor how easily the virus is transferred from the cardboard to one’s hand when touching a package”
According to Dr. Auwaerter, “It’s thought that this virus can survive on surfaces such as hands, hard surfaces, and fabrics. Preliminary data indicates up to 72 hours on hard surfaces like steel and plastic, and up to 12 hours on fabric.”
COVID-19 will likely “burn off” in the summer
Due to COVID-19’s sensitivity to UV light and heat (just like the normal influenza virus), it is very likely that it will “burn off” as humidity increases and temperatures rise.
Released on March 10th, one study mapped COVID-19 virality capability by high temperature and high humidity. It found that both significantly reduced the ability of the virus to spread from person-to-person. From the study,
“This result is consistent with the fact that the high temperature and high humidity significantly reduce the transmission of influenza. It indicates that the arrival of summer and rainy season in the northern hemisphere can effectively reduce the transmission of the COVID-19.”
The University of Maryland mapped severe COVID-19 outbreaks with local weather patterns around the world, from the US to China. They found that the virus thrives in a certain temperature and humidity channel. “The researchers found that all cities experiencing significant outbreaks of COVID-19 have very similar winter climates with an average temperature of 41 to 52 degrees Fahrenheit, an average humidity level of 47% to 79% with a narrow east-west distribution along the same 30–50 N” latitude”, said the University of Maryland.
“Based on what we have documented so far, it appears that the virus has a harder time spreading between people in warmer, tropical climates,” said study leader Mohammad Sajadi, MD, Associate Professor of Medicine in the UMSOM, physician-scientist at the Institute of Human Virology and a member of GVN.
In the image below, the zone at risk for a significant community spread in the near-term includes land areas within the green bands.
As of right now reported cases as a function of latitude, about one-third of the world’s population is below 22.5°N yet has not experienced meaningfully high levels of infections.
About 95% of all infections in a latitude band encompassing 55% of the world’s population, which includes a large portion of America.
Infections as a function of temperature and humidity: 90% still in the blue zone
Children and Teens aren’t at risk
It’s already well established that the young aren’t particularly vulnerable. In fact, there isn’t a single death reported below the age of 10 in the world and most children who test positive don’t show symptoms. As well, infection rates are lower for individuals below the age of 19, which is similar to SARS and MERS (COVID-19’s sister viruses).
According to the WHO’s COVID-19 mission in China, only 8.1% of cases were 20-somethings, 1.2% were teens, and 0.9% were 9 or younger. As of the study date February 20th, 78% of the cases reported were ages 30 to 69. The WHO hypothesizes this is for a biological reason and isn’t related to lifestyle or exposure.
“Even when we looked at households, we did not find a single example of a child bringing the infection into the household and transmitting to the parents. It was the other way around. And the children tend to have a mild disease,” said Van Kerkhove.
According to a WSJ article, children have a near-zero chance of becoming ill. They are more likely to get normal flu than COVID-19.
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%.
However even if children and teens are not suffering severe symptoms themselves, they may “shed” large amounts of virus and may do so for many days, says James Campbell, a professor of pediatrics at the University of Maryland School of Medicine.
Children had a virus in their secretions for six to 22 days or an average of 12 days. “Shedding virus doesn’t always mean you’re able to transmit the virus”, he notes. It is still important to consider that prolonged shedding of high viral loads from children is still a risky combination within the home since the majority of transmission occurs within a home-like confined environment.
A strong, but unknown viral effect
While the true viral capacity is unknown at this moment, it is theorized that COVID-19 is more than the seasonal flu but less than other viruses. The average number of people to which a single infected person will transmit the virus, or Ro, range from as low as 1.5 to a high of 3.0
“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.”
What about asymptomatic spread?
The majority of cases see symptoms within a few days, not two weeks as originally believed.
On true asymptomatic spread, the data is still unclear but increasingly unlikely. Two studies point to a low infection rate from pre-symptomatic and asymptomatic individuals. One study said 10% of infections come from people who don’t show symptoms yet. Another WHO study reported 1.2% of confirmed cases were truly asymptomatic. Several studies confirming asymptotic spread have ended up disproven. It is important to note there is a difference between “never showing symptoms” and “pre-symptomatic” and the media is promoting an unproven narrative. Almost all people end up in the latter camp within five days, almost never the former. It is very unlikely for individuals with COVID-19 to never show symptoms. WHO and CDC claim that asymptomatic spread isn’t a concern and quite rare.
Iceland is leading the globe in testing its entire population of ~300,000 for asymptomatic spread, not just those that show symptoms. They randomly tested 1,800 citizens who don’t show symptoms and, as far as they knew, were not exposed to positive individuals. Of this sample, only 19 tested positive for COVID-19, or 1.1% of the sample.
Obviously, this type of viral spread is the most concerning; however based on the level of media attention and the global size of positive infections, it seems more probable we keep looking for a COVID-19 viral trait that doesn’t exist.
Another way of looking at virality and asymptotic spread is the number of flight attendants, airport staff, or pilots that have tested positive for COVID-19. Out of the thousands of flights since November 2019, only a handful of airport and airline staff have tested positive (such as AA pilot, some BA staff, and several TSA employees).
Outside of medical and hospital staff, these individuals are in greatest contact with infected persons in confined spaces. Despite having no protective gear and most likely these people were asymptomatic, airline and airport staff aren’t likely to catch COVID-19 compared to the rest of the population. Those employed in the travel sector are infected at a lower rate than the general population or healthcare workers.
“We still believe, looking at the data, that the force of infection here, the major driver, is people who are symptomatic, unwell, and transmitting to others along the human-to-human route,” Dr. Mike Ryan of WHO Emergencies Program.
If the symptoms are so close to other less fatal coronaviruses, what is the positivity rate of those tested?
93% of people who think they are positive aren’t
Looking at the success in S. Korea and Singapore, the important tool in our war chest is measurement. If we are concerned about the general non-infected population, what is the probability those who show symptoms actually test positive? What is the chance that the cough from your neighbor is COVID-19? This “conversion rate” will show whether or not you have a cold (another coronavirus) or are heading into isolation for two weeks. Global data shows that ~95% of people who are tested aren’t positive. The positivity rate varies by country.
UK: 7,132 concluded tests, of which 13 positive (0.2% positivity rate).
UK: 48,492 tests, of which 1,950 (4.0% positivity rate)
Italy: 9,462 tests, of which 470 positive (at least 5.0% positivity rate).
Italy: 3,300 tests, of which 99 positive (3.0% positivity rate)
Iceland: 3,787 tests, of which 218 positive (5.7% positive rate)
France: 762 tests, of which 17 positive, 179 awaiting results (at least 2.2% positivity rate).
Austria: 321 tests, of which 2 positive, awaiting results: unknown (at least 0.6% positivity rate).
South Korea: 66,652 tests with 1766 positives 25,568 awaiting results (4.3% positivity rate).
United States: 445 concluded tests, of which 14 positive (3.1% positivity rate).
In the US, drive-thru testing facilities are being deployed around the nation. Gov. Cuomo of NY released initial data from their drive-thru testing. Out of the 600~ that was tested in a single day, ~7% were positive. Tested individuals actively show symptoms and present a doctor’s note. This result is similar to public tracking on US nationwide positivity rate.
Last week, the US was significantly behind in testing, near the bottom of all countries worldwide. As of March 20th, a week later, the US is much closer to other G8 and European countries, but there is a long way to go.
Based on the initial results and the results from other countries, the total number of positive COVID-19 cases will increase as testing increases, but the fatality rate will continue to fall and the severity case mix will fall.
In general, the size of the US population infected with COVID-19 will be much smaller than originally estimated as most symptomatic individuals aren’t positive. 93% — 99% have other conditions.
Globally, the US has a long way to go to catch up in testing. As testing expands, the total number of cases will increase, but the mild to severe case ratio will decline dramatically.
1% of cases will be severe
Looking at the whole funnel from top to bottom, ~1% of everyone who is tested for COVID-19 with the US will have a severe case that will require a hospital visit or long-term admission.
Globally, 80–85% of all cases are mild. These will not require a hospital visit and home-based treatment/ no treatment is effective.
As of mid-March, the US has a significantly lower case severity rate than other countries. Our current severe caseload is similar to South Korea. This data has been spotty in the past; however, lower severity is reflected in the US COVID-19 fatality rates (addressed later).
For context, this year’s flu season has led to at least 17 million medical visits and 370,000 hospitalizations (0.1%) out of 30–50 million infections. Recalling that only comparing aggregate total cases isn’t helpful, breaking down active cases on a per-capita basis paints a different picture on severity. This is data as of March 20th, 2020.
Declining fatality rate
As the US continues to expand testing, the case fatality rate will decline over the next few weeks. There is little doubt that serious and fatal cases of COVID-19 are being properly recorded. What is unclear is the total size of mild cases. WHO originally estimated a case fatality rate of 4% at the beginning of the outbreak but revised estimates downward 2.3% — 3% for all age groups. CDC estimates 0.5% — 3%, however stresses that closer to 1% is more probable. Dr. Paul Auwaerter estimated 0.5% — 2%, leaning towards the lower end. A paper released on March 19th analyzed a wider data set from China and lowered the fatality rate to 1.4%. This won’t be clear for the US until we see the broader population that is positive but with mild cases. With little doubt, the fatality rate and severity rate will decline as more people are tested and more mild cases are counted.
Higher fatality rates in China, Iran, and Italy are more likely associated with a sudden shock to the healthcare system unable to address demands and doesn’t accurately reflect viral fatality rates. As COVID-19 spread throughout China, the fatality rate drastically fell outside of Hubei. This was attributed to the outbreak slowing spreading to several provinces with low infection rates.
John P.A. Ioannidis is professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center recently wrote about fatality rates and how our current instrumentation is leading to faulty policy solutions:
“The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.
Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty…”
“Reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.”
Looking at the US fatality, the fatality rate is drastically declining as the number of cases increases, halving every four or five days. The fatality rate will eventually level off and plateau as the US case-mix becomes apparent.
4.06% March 8 (22 deaths of 541 cases)
3.69% March 9 (26 of 704)
3.01% March 10 (30 of 994)
2.95% March 11 (38 of 1,295)
2.52% March 12 (42 of 1,695)
2.27% March 13 (49 of 2,247)
1.93% March 14 (57 of 2,954)
1.84% March 15 (68 of 3,680)
1.90% March 16 (86 of 4,503)
1.76% March 17 (109 of 6,196)
1.66% March 18 (150 of 9,003)
1.51% March 19th (208 of 13,789)
1.32% March 20th (256 of 19,383)
Mapped against other countries, our fatality rate and case-mix are following a similar pattern to South Korea which is a good sign, a supposed model of how to manage COVID-19.
Here are deaths weighted by the total number of cases as of March 20th, 2020. Ranked by the total number of cases, our death rate is closer to South Korea’s than Spain’s or Italy’s.
The initial higher fatality rate for the US is trending much lower than originally estimated. A study of about half deaths within the US (154 of 264), almost all fit a similar demographic profile as the other global ~11,000 fatalities.
Another analysis by Nature, comparing the fatality rate (since revised down) and infectious rate of COVID-19 to other illnesses. COVID-19 is now within range of its less potent sister coronaviruses.
As the global health community continues to gather and report data, the claim that “COVID-19 isn’t just like the flu” (though still severe) is looking less credible as fatality rates continue to decline and measuring of mild cases increases.
It is important to consider case-mix when looking at fatality rates. The fatality rate is significantly higher for patients with an underlying condition.
Comparing case-mix across countries with a wide range of fatality (China and Italy) and those with low fatality rates (S. Korea) reveals a stark difference in age; therefore, underlying conditions also vary significantly across countries. These two factors contribute the most to a country’s fatality rate.
Divided by most at risk and low risk, Italy had significantly more cases of high at-risk patients than Germany or Korea
Based on an initial CDC study of 2,449 COVID-19 cases (almost half of current US cases have missing demographic data), the United States case-mix looks more like S. Korea and Germany rather than China or Italy. Approximately 69% of COVID-19 cases are in the lower at-risk population of under 65, while 31% are older than 65 and in the higher-risk population. This suggests the US will experience a declining fatality rate; however, the US has over 100 million adults with underlying and chronic illnesses that will negatively impact our fatality rate.
An older population skew within the infected population explains most of the disparity in fatality rates between high and low countries. According to a study of the fatalities of COVID-19 cases in Italy, 99% of all deaths had an underlying pathology. Only 0.8% had no underlying condition.
Most of those infected in Italy were over the age of 60, but the median age of a fatality was 80. All of Italy’s fatality under the age of 40 were males with serious pre-existing medical conditions.
This doesn’t factor in a wide variance in healthcare capacity, such as hospital beds per 1,000 citizens which could affect health outcomes; however, this doesn’t seem to be highly correlated with fatality rates at this moment.
S. Korea — 11.5
Germany — 8.3
China — 4.2
Italy — 3.4
United States — 2.9
Singapore — 2.4
So what should we do?
The first rule of medicine is to do no harm.
Local governments and politicians are inflicting massive harm and disruption with little evidence to support their draconian edicts. Every local government is in a mimetic race to one-up each other in authoritarian city ordinances to show us who has more “abundance of caution”. Politicians are competing, not on more evidence or more COVID-19 cures but more caution. As unemployment rises and families feel unbearably burdened already, they feel pressure to “fix” the situation they created with even more radical and “creative” policy solutions. This only creates more problems and an even larger snowball effect. The first place to start is to stop killing the patient and focus on what works.
Start with basic hygiene
The most effective means to reduce spread is basic hygiene. Most American’s don’t wash their hands enough and aren’t aware of how to actually wash your hands. Masks aren’t particularly effective if you touch your eyes with infected hands. Ask businesses and public places to freely distribute disinfectant wipes and hand sanitizer to the customers and patrons. If you get sick or feel sick, stay home. These are basic rules for preventing illness that doesn’t require trillions of dollars.
The best examples of defeating COVID-19 requires lots of data. We are very behind in measuring our population and the impact of the virus but this has turned a corner the last few days. The swift change in direction should be applauded. Private companies are quickly developing and deploying tests, much faster than CDC could ever imagine. The inclusion of private businesses in developing solutions is creative and admirable. Data will calm nerves and allow us to utilize more evidence in our strategy. Once we have proper measurement implemented (the ability to test hundreds every day in a given metro), let’s add even more data into that funnel — reopen public life.
Taiwan is held up as a model for its approach. They embraced both data, tracking, free movement of people, evidence-based prevention, and focused their energy on those most vulnerable — preexisting conditions and those over the age of 65. Here are some of the steps they took:
QR code scanning and online reporting of each person’s travel history
Health symptoms were used to classify traveler infectious risks based on flight origin and travel history in the past 14 days
People with low risk were sent a health declaration border pass via SMS to their phones for faster immigration clearance
Those with higher risk were quarantined at home and tracked through their mobile phone to ensure that they remained there during the incubation period
Taiwan also proactively seeks out patients with severe respiratory symptoms (based on information from a national health database) to see who had tested negative for influenza so that they could be retested for COVID-19
Available modeling data indicate that early, short to medium closures do not impact the epi curve of COVID-19 or available health care measures (e.g., hospitalizations). There may be some impact of much longer closures (8 weeks, 20 weeks) further into community spread, but that modeling also shows that other mitigation efforts (e.g., handwashing, home isolation) have more impact on both spread of disease and health care measures. In other countries, those places who closed school (e.g., Hong Kong) have not had more success in reducing spread than those that did not (e.g., Singapore).
Based on transmission evidence children are more likely to catch COVID-19 in the home than at school. As well, they are more likely to expose older vulnerable adults as multi-generational homes are more common. As well, the school provides a single point of testing a large population for a possible infection in the home to prevent community spread.
Open up public spaces
With such little evidence of prolific community spread and our guiding healthcare institutions reporting the same results, shuttering the local economy is a distraction and arbitrary with limited accretive gain outside of greatly annoying millions and bankrupting hundreds of businesses. The data is overwhelming at this point that community-based spread and airborne transmission is not a threat. We don’t have significant examples of spreading through restaurants or gyms. When you consider the environment COVID-19 prefers, isolating every family in their home is a perfect situation for infection and transmission among other family members. Evidence from South Korea and Singapore shows that it is completely possible and preferred to continue on with life while making accommodations that are data-driven, such as social distancing and regular temperature checks.
Support business and productivity
The data shows that the overwhelming majority of the working population will not be personally impacted, both individually or their children. This is an unnecessary burden that is distracting resources and energy away from those who need it the most. By preventing Americans from being productive and specializing at what they do best (their vocation), we are pulling resources towards unproductive tasks and damaging the economy. We will need money for this fight.
At this rate, we will spend more money on “shelter-in-place” than if we completely rebuilt our acute care and emergency capacity.
Americans won’t have the freedom to go help those who get sick, volunteer their time at a hospital, or give generously to a charity. Instead, big government came barrelling in like a bull in a china shop claiming they could solve COVID-19. The same government that continued to not test incoming passengers from Europe and who couldn’t manufacture enough test kits with two months’ notice.
Let Americans be free to be a part of the solution, calling us to a higher civic duty to help those most in need and protect the vulnerable. Not sitting in isolation like losers.
People fear what the government will do, not an infection
In CDC’s worst-case scenario, CDC expects more than 150–200 million infections within the US. This estimate is hundreds of times bigger than China’s infection rate (30% of our population compared to 0.006% in China). Does that really sound plausible to you? China has a sub-par healthcare system, attempted to suppress the news about COVID-19 early on, a lack of transparency, an authoritarian government, and millions of Chinese traveling for the Lunar Festival at the height of the outbreak. In the US, we have a significant lead time, several therapies proving successful, transparency, a top tier healthcare system, a democratic government, and media providing ample accountability.
None of the countries the global health authorities admire for their approach issued “shelter-in-place” orders, rather they used data, measurement,and promoted common sense self-hygiene.
Does stopping air travel have a greater impact than closing all restaurants? Does closing schools reduce the infection rate by 10%? Not one policymaker has offered evidence of any of these approaches. Typically, the argument given is “out of an abundance of caution”. I didn’t know there was such a law. Let’s be frank, these acts are emotionally driven by fear, not evidence-based thinking in the process of destroying people’s lives overnight. While all of these decisions are made by elites isolated in their castles of power and ego, the shock is utterly devastating Main Street.
A friend who runs a gym will run out of cash in two weeks. A friend who is a pastor let go of half of his staff as donations fell by 60%. A waitress at my favorite breakfast place told me her family will have no income in a few days as they force the closure of restaurants. While political elites twiddle their thumbs with models and projections based on faulty assumptions, people’s lives are being destroyed with Marxian vigor. The best compromise elites can come up with is $2,000.
Does it make more sense for us to pay a tax to expand medical capacity quickly or pay the cost to our whole nation of a recession?Take the example of closing schools which will easily cost our economy $50 billion. For that single unanimous totalitarian act, we could have built 50 hospitals with 500+ beds per hospital.
Eliminate arcane certificate of need and expand acute medical capacity to support possible higher healthcare utilization this season.
My first Apocalypse Not post speculated that the Wuhan Corona Virus had already washed through the continental United States. I based that on my understanding of viral transmission rates combined with the length of time between the arrival of the virus and the start of mitigation efforts. I had no explanation why the virus had passed through the population without sending massive numbers of Americans to the hospital. I have an explanation now.
Population genetic analyses of 103 SARS-CoV-2 genomes indicated that these viruses evolved into two major types (designated L and S), that are well defined by two different SNPs that show nearly complete linkage across the viral strains sequenced to date.
Dr Michael Skinner, Reader in Virology, Imperial College London, explained the findings this way
They speculate that the L form might be more ”aggressive” but that is not an adjective we normally apply to viruses, where we talk about transmissibility, fitness, virulence.
”Viruses have to be able to replicate in each sequential host and transmit serially between them. It is quite possible for one form of the virus to be better at replication, another at transmission.
What he is saying is the L strain is the most aggressive at replication which is why it is a potential killer. The S strain is easily transmittable but less aggressive. The paper went on to note that infection by the S strain provides immunity from the L strain and speculates that only the S strain is transmitted through aerosols.
This would explain the significant lag time between the arrival of the virus and a noticeable surge in hospitalizations. In fact there is still no noticeable surge of hospital admissions for pneumonia in the USA. I just goggled that and found nothing.
There are three facts at play: the first is the virus arrived in the USA long before the first case was diagnosed. The second is there are two strains; one the is easily transmissible but not deadly and one that is not easily transmissible and very deadly. The third is there have been no reported increase in admissions or deaths from bilateral viral pneumonia.
The current panic being stoked by the legacy media and the actions being taken by politicians are based off modeling by highly credentialed experts. The models have predicted that we are on the brink of a massive surge in hospitalizations due to respiratory complications (bilateral pneumonia). These results have to be taken seriously despite knowing the models have serious limitations.
In response the President has started daily press briefing with his China Virus team and they have been trying to talk down the panic with facts. Dr. Deborah Burke, who has been speaking at the daily press briefing with the President, had this to say about models.
Reporter: “Can you speak to the study predicting as many as 2.2 million people in the United States could die if there were not this kind of action taken by the government”.
Dr Burke: “ So I think you know the models are models and are based on input and they’re based on infectiousness without any controls. I can tell you we’ve never seen that level of infection modeled up to 2.2 million in mortality… I have dealt with a lot of modelers in my time, they are wonderful people, but they all have their favorite inputs and they all have their favorite integration functions, so we’re evaluating all of those so we can integrate and create the best model for the United States based on the best data.
The State of Texas has now joined the panic and demanded all gyms, restaurants, and bars close. The damage that will done to our economy is incalculable and remember there has been no surge in deaths or hospital admissions reported yet in the USA.
There is no reason to believe the models without seeing evidence that the models are correct. Tweets like the one below are not helping anyone, Dr. Scott Gottlieb has less observable truth behind his tweet then I do with my two strains, no apocalypse theory.
Each day that ends without a reported spike in viral pneumonia deaths should be raising questions. In this era of diminished corporate media, desperate for clicks and page views, it is difficult to tease out what is important. What is important is an explanation as to why so many senior leaders are taking such drastic action. Is this based solely of computer models and WHO concerns? That is hard to believe but what other explanation is there?
I do not know if the testing being developed for the Wuhan virus can differentiate between the L and S strains. I suspect, just as Dr Burke has said repeatedly, that the number of reported cases will skyrocket as more testing comes on line. I also suspect that there will be no giant spike in COVID-19 deaths because the COVID-19 S strain has already washed through the population.
Time will tell, but if we don’t see a giant spike in hospital admissions soon we’ll know we have dodged a huge bullet thanks to the hyper competitive nature of Mother Nature. Having a mild flu out-compete a deadly flu for hosts, thereby saving the host reservoir for another day…you can’t make that kind of stuff up.
There is something about the current Wuhan virus response that is not adding up. The first case appeared in America on 17th of January, we then stopped direct flight from China on the 31st of January. From the time this pathogen surfaced in November until the end of January, there were daily flights from the Wuhan area to Seattle, LA, San Francisco, New York and Toledo, Ohio. This flu strain is unusually virulent and if that is true (which is not in doubt), by the time it surfaced in America it had already spread across the land.
Farr’s Law, named for British epidemiologist William Farr in 1840, states that epidemics, develop and recede according to a bell-shaped curve. This happens with or without human intervention. Farr’s Law undoubtedly is in play for the Wuhan virus.
Last Christmas my wife and several neighbors had a horrible flu bug that mimicked the Wuhan virus symptoms exactly. She was miserable and did not respond to a Z-pack or a course of Levaquin our family doctor prescribed.
The bug she had was no joke, and when she mentioned my theory that the Wuhan had already washed through the population last Christmas her friends saw it immediately. She started hearing other stories about the Christmas bug that ravaged the Rio Grande Valley for a good four weeks. The stories all matched up to the symptoms for Wuhan virus.
The President’s early attempts to calm the situation were ridiculed as was his suspension of air travel to China. Then the narrative changed on a dime and the cancelations started with, as I recall, the Ivy League Universities leading the way. Once they did that every other major sports league (with the exception of the UFC) did the same.
The various leagues and venues that have closed had no choice, ignoring the experts advice and example would risk a devastating backlash if the Wuhan virus turns out to be as deadly as advertised.
But Ivy League role in starting the current chain reaction of closing public venues is not a coincidence. The very experts who are on the TV daily had just staged a Pandemic table top exercise. The response we are seeing is based off the dire predictions made in that exercise.
On the afternoon of Friday, 18 October 2019, the Johns Hopkins Center for Health Security, World Economic Forum and Bill & Melinda Gates Foundation hosted a Virtual Exercise Called Event 201 and described as:
“a 3.5-hour pandemic tabletop exercise that simulated a series of dramatic, scenario-based facilitated discussions, confronting difficult, true-to-life dilemmas associated with response to a hypothetical, but scientifically plausible, pandemic”.
The pathogen used for the exercise was a COVID virus with properties similar to COVID-19. The exercise predicted that the virus would overwhelm the medical systems in North America resulting in catastrophic loss of life.
Tabletop exercises like Event 201 happen all the time, the fact that this one was played out a month before COVID-19 surfaced in Wuhan China is not that significant. What is significant is how different the current crisis is playing out compared to the one our experts war-gamed.
There were a seven recommendations made following the exercise (they can be found here). Every recommendation focused on the need for international cooperation with the free flow of information and people across national borders which is consistent with the ethos and vision of globalists like the Bill and Melinda Gates Foundation and other major donors, like Open Philanthropy .
But our response to the Wuhan virus has been the exact opposite of the “viruses know no borders” narrative of Event 201. Instead we (and the rest of the world) have closed the borders, rebuffed international offers of help and turned to the private sector to fight the virus ourselves.
The Centers for Disease Control was not up to the task of testing for or tracking the Wuhan virus and they were rapidly sidelined by the President. This was the exact opposite of Event 201 in which the CDC and every other similar international organization performed flawlessly. The ‘experts” may have been surprised the CDC failed so spectacularly but this is expected from those of us who know and understand government bureaucracies.
When the CDC failed the President went straight to the private sector, suspended regulations inhibiting the development and production of test kits and protective wear, and solved the testing problem rapidly. He then held a press conference with these Titans of industry and did a good job of calming frayed nerves. After his poor start briefing the nation last Wednesday night watching him get back into the grove was gratifying.
This is not playing out as the experts who ran Event 201 thought. Then, in another move a blatant dishonesty, on the same day that China launches an IO campaign to deflect criticism from them onto the USA, our legacy media decides the Wuhan virus is now to be called COVID-19. Any mention of the word Wuhan was now racist and news anchors were getting apoplectic about this new muh racism.
As events across the land started to close. Governors and DC mandarins ran to the TV cameras to announce the draconian measures they were going to take. These pronouncements have to moldy scent of Virtue Signalling. The men and women making these decisions have themselves, no skin in the game. Regardless of how long this lasts or how bad it gets the people running Ivy League institutions, the federal legislatures, state governors and the media infotainment complex insiders – all of them will weather the storm just fine. In fact, most of them will make millions off low interest rates while buying blue chip stock at a significant markdown.
You and your family? Not so much.
“I don’t claim to know what’s motivating the media, but, my God, their reporting is absolutely reprehensible. They should be ashamed of themselves. They are creating a panic that is far worse than the viral outbreak. The bottom line, everybody, is to listen to Dr. Anthony Fauci of the CDC [Centers of Disease Control and Prevention]. Do what he tells you, and go about your business.… Stop listening to journalists! They don’t know what they are talking about!” Dr. Drew Pinsky commenting on the media yesterday (17 March 2020)
An anonymous source quoted in The Spectator points out the only salient (and obvious) fact now which is: “We know the numerator (the number of deaths), but we don’t know the denominator, which is the number of people who have been infected by COVID-19. And without the denominator, we have no way of estimating either the spread or the fatality rate of COVID-19.”
That bothers me and it should bother you too, but at the moment there is nothing to be done except hunker down, avoid panic shopping, and wait to see what happens. How long Americans will tolerate these measures will be interesting to see.
There is no reason to think that this time the experts warnings about a catastrophic event are correct. They have a perfect record of being wrong with every prediction in the past because their models are incapable of predicting complex events reliably.
When the people discover that once again, they were manipulated by a partisan press, compromised academic shills, and virtue signalling politicians there is going to be hell to pay. When the dust settles maybe we will de-couple science from politics and even dismantle the narrative driving legacy media.
It is time to keep your head down, and your powder dry. Courage and cowardice are contagions and few of our elected leaders seem to operate with an abundance of courage. Their default is finger pointing, name calling, and blame shifting. The rest of us should refrain from that behavior and focus on helping, not panicking our neighbors. When this emergency passes we may be able to hold incompetents to account but for now all we can do is what we do best; refuse to panic.
Editor’s Note: Chim Chim is back with a post on FRI. It has been over a decade since we last heard from him He is a friend of mine with years of experience in Afghanistan at the higher levels of the U.S. Intelligence community. It is fitting that he once again reaches out to Free Range International to weigh in with some thoughts on the Afghanistan peace deal.
Trust. It’s a mysterious term and rarely understood. Per its definition, key attributes exist such as reliability, truth, ability, and strength. Contrary to popular belief, trust is not earned but rather obtained through a leap of faith. It is natural and can easily be broken. When it comes to the Afghan Peace Deal, trust is non-existent amongst the three players involved—The US Government, the Afghan Government, and the Taliban.
But should one look closely at the situation from an historical perspective, how can trust exist? More importantly, who can be trusted most? Better yet, who SHOULD be trusted most?
During the Russian-Afghan War, the United States was heavily involved in supporting multiple Afghan militias fighting against our greatest adversary. We gave and gave and gave but then, once the Russians were defeated, we put on the brakes. It was arguably one of the most devastating moments in US National Security that would inevitably come back and bite us hard.
We made countless promises to the Afghans and never came through with any of those promises which led to a major civil war between dozens of local tribes and militias. This civil war allowed the Taliban to blossom into a major organization which ruled Afghanistan for many years.
Immediately following 9-11, the United States went into a reactionary mode and was quick to invade Afghanistan on the logic that the Taliban were harboring Al Qaeda. Few realize during this time several nation states were providing safe haven to Al Qaeda during this time as Al Qaeda cells were spread across the globe. Another point of contention is the fact that the Taliban were in talks with Al Qaeda in an attempt to push them out of country instead forcing them into safe-haven in western Pakistan.
Our decision was made and teams of special operators infiltrated Afghanistan initiating America’s longest war. We did this with virtually zero ground truth, meaning, we had no sources or assets for intelligence on the ground prior to our invasion. Many whom we initially engaged in combat operations were nothing more than localized militias whom had little if anything to do with the Taliban (Central) meaning we were fighting tribesmen who would later turn to the Taliban due to our own actions.
Immediately following 9-11, Russia became an American strategic partner. We actually relied on Russia’s past to procure our initial network on the ground in Afghanistan. The one country Afghans despise most, we became strategic partners with.
As time unfolded and upon immediate successes in achieving two goals set forth from US SOF elements (eliminate Al Qaeda’s safe-haven and rid Taliban of government control), a new force was inserted shortly after—the US Conventional military and State Department.
During this time, the United States threw billions of dollars into Afghanistan. It was during this period which continues even today, the United States implementation of a “quantifiable” approach to warfighting which completely overshadows anything qualitative.
America spent billions on programs that had virtually zero oversight. One example is based on school text books in which the United States and our coalition threw an estimated $30 million into the contract however it is estimated less than $1 million worth of product ever entered the country. HeraldExtra.com shows just a portion of the issue in their article titled, Textbooks not arriving in Afghan school.
The vast majority of funds displaced were not displaced. They were handed to local warlords, provincial governors, tribal leaders, etc. But if people want to see who the vast majority of individuals pocketed these funds, just walk down “Millionaire Row” in Kabul where you will find Afghan mansions vacant—vacant because those whom had such homes built have now fled the nation in fear of a Taliban takeover.
Prior to leaving, these local Afghans milked every last penny they could from the United States. It was the easiest way for anyone to get rich fast and rich as in millionaire rich. Simply put, the Afghan power-players created a racket and the United States didn’t care. More interesting is why we did not care.
We did not care about the misappropriations of funds because of the quantifiable war which we created. Those who held the money needed to get rid of it. And they did. And in doing so, they wrote their own tickets of success be it military personnel boasting numbers on OPER’s/EPR’s or State Department, NGO’s, etc fluffing resumes for permanent hire needs upon completion of their time in country.
What the United States did in Afghanistan does not demonstrate reliability, truth, ability, and strength hence, our inept methods in Afghanistan demonstrate how untrustworthy we are in our Afghan mission.
As bad as we were, the locals and politicians also demonstrated a lack of trust.
Afghan leaders saw how much money was going into Afghanistan. They witnessed their pockets flood with cash. They were empowered on a level most Americans should be jealous of. And as crazy as this sounds, many of these Afghans were closely aligned with Russia and Iran.
The Afghan Government was and continues to be incredibly corrupt.
In 2008, an Afghan warlord once said, “You expect us to believe in your own Rule of Law? You want us to trust the newly established Afghan Government’s Rule of Law which you, the Americans implemented? Do you not see how corrupt your own nation is? Look at the case of OJ Simpson.”
Think about this sentiment for a moment. Reflect on what this warlord was saying. You do not need to agree with what was said but think of the perception held. Perception is reality.
Another warlord once explained why the United States tactical intelligence was flawed. He explained that we would hand out cash to “walk-ins” for information about potential Taliban. We would take that information and execute a mission to kill or capture that individual. But what we seldom knew was the “walk-in” was merely in a tribal dispute with the target. And oftentimes, the “walk-in” was actually the one more aligned with the Taliban than the target itself.
The Afghans manipulated the United States every waking chance they could. And, they succeeded in doing what they wished on individual levels as well as within different political parties. Simply put, the Afghan politicians as well as local leaders demonstrated virtually zero reliability or truth which showcases why they were and remain untrustworthy.
The United States knew the Taliban were our enemy in Afghanistan. The Taliban ensured we were never to forget this. Through video’s published online, a plethora of kidnappings, to constantly attacking our assets, the Taliban and the array of Anti-Afghan Forces never led up.
If early warnings existed pertaining a potential attack, the Taliban came through with it. If the Taliban claimed they would allow for a temporary ceasefire, that ceasefire pretty much always happened. If a break of the ceasefire was sent through the air waves, expect the attack. They TOLD us pretty much every single move they were going to make. Their information was reliable, it was constantly set in truth, and they demonstrated over and over again their ability to do what they said. And, their strength came from not just their numbers but rather the constant support they obtained through the Pakistani ISI, Iranian assets, and the Kremlin itself.
If you watch the evening news and see a report on a serial murderer then take a walk in the woods and come across that serial murderer, do you trust the serial murderer’s potential? You would be a fool not to. The point is, trust in an entity you do not like does not mean trust should not exist. Bad people and bad organizations should be trusted to do bad things.
What is difficult to swallow is when we possess trust in something we cherish and realize that which we cherish most should be the least trusted. In the case of the Afghan Peace Deal, maybe, just maybe, it is not the Taliban who should NOT be trusted. Rather, maybe we should be skeptical over the amount of trust we place in the Afghan Government and that of our own.
Secretary of State Mike Pompeo landed in Qatar’s capital city, Doha today for the signing of a peace deal with the Taliban. In a rare demonstration of presenting both sides of a contentious deal the Washington Post opinion section featured dueling pieces that capture this unique moment in time. The peace deal is a clear win for both the Trump administration and the Afghan people. As usual the devil is in the details but it appears we are on the way out of Afghanistan.
Barnett Rubin who is a senior fellow and associate director of the Center on International Cooperation of New York University and non-resident senior fellow at the Quincy Institute, outlines the agreement in his WaPo OpEd.
The agreement provides a timetable for troop withdrawal, counterterrorism guarantees, a path to a cease-fire and a process for political settlement. Implementation would also require dismantling Taliban infrastructure in neighboring Pakistan and assurances by external powers that none will use Afghanistan against others.
Mr. Rubin has considerable time on the ground in the region and his take on the peace deal (which is it is a good deal) is identical to mine.
Max Boot, who is a Jeane J. Kirkpatrick senior fellow for national security studies at the Council on Foreign Relations, took the opposite view. In his WaPo OpEd he outlines three different scenarios for the near future in Afghanistan. He then goes onto to predict the worst case scenario (the Taliban rolling into Kabul and taking over the country) as the most likely. I can tell you unequivocally that is the least likely scenario.
Many of our foreign policy experts and more than a few of my friends caution that the Taliban is not a cohesive monolithic organization, and that negotiators are only speaking for the Quetta, Peshawar, and Miranshaw Shura’s. This is a fact that is true, but means nothing now. The Taliban were able to enforce the peace during last years Eid celebration across the country and I believe they can do so again. Regardless of what I and my friends believe the only thing that counts is how the Afghans feel about the deal.
The Senior Vice President-elect of Afghanistan, Amrullah Saleh, published his opinion on the Time website. I Fought the Taliban. Now I’m Ready to Meet Them at the Ballot Box is the title of his piece and that’s a strong endorsement of the process. Amrullah Saleh is the former head of the National Directorate of Security (NDS), a former Interior Minister and he survived a serious assault on his election headquarters last July. That assault started with a car bomb and was continued by suicide vest equipped assault teams. Amrullah Saleh survived by jumping off the roof of his four story headquarters onto the roof of a neighboring building.
It is reasonable to assume Mr. Saleh had engaged in a running gun battle before escaping to safety, he is that kind of guy.
The recent campaign in Nangarhar is one example. Effective operations by US/Coalition & Afghan security forces, as well as the Taliban, led to ISIS-K losing territory & fighters. Hundreds surrendered. ISIS-K hasn’t been eliminated but this is real progress,” Khalilzad tweeted Tuesday
Remember a few posts back I highlighted this article in the Washington Post about the defeat of ISIS because it failed to mention the Taliban’s direct role? It seem like the first draft of history is up for grabs regarding the defeat of ISIS-K in Eastern Afghanistan. There is little to gain but much to lose in suppression of the truth. I doubt an experienced reporter would have not known about the Taliban’s role in fighting ISIS-K so it is hard to figure out why the WaPo would print such obviously fake news.
Regardless, ISIS is now gone in Eastern Afghanistan and the remaining pockets in the north now the problem of the Taliban. Who seem to be very efficient at rooting them out.
What I cannot determine is how many troops will stay and what those troops will be doing. If the plan is to leave the Combined Joint Special Operations Task Force – Afghanistan (CJSOTF-A) in place to hunt down ISIS and al Qaida that is not going to work. ISIS doesn’t need to be serviced by us any longer and separating al Qaida trainers from Taliban students is impossible.
If Amrullah Saleh is willing to give the Taliban a chance, and they reach an agreement, men like Sirajuddin Haqqani, who have been at the top of the JPEL for years, will be allowed to go in peace. The JPEL is the Joint Prioritized Effects List which is essentially a lethal version of the FBI’s most wanted. Allowing the men on that list to walk free, get passports and travel is going to be a bitter blow to the people who have been hunting them. But that may be the price of peace.
I have to add that CJSOTF-A is not going to be able to operate behind the back of the Senior VP. Mr. Saleh has decades of experience working with the CIA and CJSTOF and he will have a say on what the Americans can and cannot do if they leave CJSTOF-A in Afghanistan.
This deal with the Taliban is how it ends. It is the only way it can end. The only question in Afghanistan was when, not if, we were leaving. The Taliban cannot beat the Kabul government in battle. The Kabul government cannot beat the Taliban in battle. The continued presence of American SF teams, tactical aircraft and trainers brought the Taliban to the negotiating table which is the best they could do. It is up to the Afghans to decide what happens next. It is also time for us to leave.
General John Allen, USMC (ret) who is the president of the Brookings Institute, lashed out at the New York Times for publishing an Op-Ed Sirajuddin Haqqani. His article, Sirajuddin Haqqani, Terrorist was an unfortunate response that reinforces a growing narrative regarding incompetence in the elite, ruling class.
The most glaring mistake in General Allen’s attack on the New York Times was repeating the thoroughly debunked “very fine people on both sides” hoax. That hoax was spread by the legacy media despite the fact that President Trump was talking about people protesting the removal of Confederate battle monuments. He specifically condemned the white supremest’s if you listen to the whole quote. General Allen is the direct descendant of a Confederate Cavalry officer (I forget his name but remember he fought at Culpepper), for which is he justifiably proud and I suspect he , too was not happy about the removal of confederate battle monuments. I know General Allen, he was my boss at the Marine Corps Infantry Officer Course, I respect and admire him greatly so it is disturbing to see him trafficking in hoaxes.
Worse was his endorsement of Forever War by implying we should renege on our Peace Agreement with the Taliban. This is his discussion of the Haqqani group:
This organization was and continues to be a central component of the Taliban, a major connecting file into al-Qaida, and a darling of Pakistan’s ISI. The Haqqanis, the Taliban, and al-Qaida endorse a radical interpretation of sharia that deprives women of any meaningful rights, to include the right to an education, and the freedom to pursue their own wants and interests, such as, for example, the legal profession. Countless lives were lost – and many, many more were wounded and otherwise terrorized – at the hands of this group and its peer terrorist entities, and had they not been formally designated a Foreign Terrorist Organization by the U.S. State Department’s Bureau of Counterterrorism, we would have had little means to diminish their influence and stop their violent activities. And at the very center of this violence was Sirajuddin Haqqani, operational commander of the Haqqani network as well as the #2 of the Taliban.
All of that is true and every bit of it irrelevant if we intend to sign a peace deal with the Taliban. It is none of our business if the Afghans decide to reconcile withTaliban leaders including Sirajuddin Haqqani. Haqqani is a bad man, so is Gulbaddin Hekmatyar, who reconciled years ago, and ran in the recent Presidential election. The notorious warlord General Abdul Rashid Dostum, who has been a member of the Kabul government when he wasn’t in exile dodging human rights tribunals, is a bad man. He was nominally on our side, so he’s a good, bad man, but to the Afghans he’s little better than Haqqani.
What the Afghans do to reconcile the rift in their civil society is their business. If they want to reconcile with and guarantee the freedom of warlords like Haqqani it is their right to do so. There are reasons to doubt Taliban commitment to a more inclusive civil process, but again, it is no longer our concern.
It is important to acknowledge the reality on the ground and that reality is the Taliban cannot win militarily and the same holds true for the Central Government. Given that context I believe it is time to let the Afghans work this out for themselves.
Sirajuddin Haqqani wrote an opinion piece in the New York Times yesterday where he explained the Taliban’s expectations and goals in signing a Peace Agreement with the United States. The piece was professionally written and I do not believe Sirajudin can write so well in English so I doubt he wrote himself. Regardless, the Taliban statement clearly stakes out the moral high ground with sentences like:
“I am confident that, liberated from foreign domination and interference, we together will find a way to build an Islamic system in which all Afghans have equal rights, where the rights of women that are granted by Islam — from the right to education to the right to work — are protected, and where merit is the basis for equal opportunity.”
Sirajudin Haqqani represents the Miranshah Shura and the fact that he’s doing the writing indicates that the various factions in the Taliban are presenting a unified front. Haqqani is also directly responsible for scores of car bombings in Kabul and a laundry list of other attacks that targeted innocent Afghans. There is more than a little hypocracy in his statement but who cares? This communique was addressing the Afghan people and if they want to allow men like Haqqani to reconcile with the government it is their business, not ours.
While the MSM component of the national media waited to see what President Trump would say so they could take the opposite position, the conservative press pounced on this sentence to dismiss the entire missive.
“We did not choose our war with the foreign coalition led by the United States. We were forced to defend ourselves.”
Becket Adams, writing in the Washington Examiner called the claim of self defense “a damnable lie”. Mr. Adams went on to state that “The Taliban 100% chose this conflict with the U.S.” That was true in 2001 but that is not what Haqqani is talking about and from the Taliban perspective we did indeed force them to fight us.
In 2002 the majority of Taliban had surrendered and returned to their villages. There was one group of Taliban and al-Qaida fighters holed up in the mountains of Shah-i Kot which we attacked, willy nilly, with no intelligence or fire support preparation of the battlefield, and no idea how many adversaries we faced. The remainders were turning in their weapons and going home which is exactly what Karzai, when he accepted the surrender of the Taliban government, asked them to do.
What do you do when you are part of a Special Operations Task Force with no enemies to identify or target? What we did was target the enemies of the warlords who cooperated with us and in the south of the country the Warlords we supported would be Karzai and his bitter rival Haji Gul Agha Sherzad. The village of Khas Uruzgan provides a perfect example of how we snatched defeat from the jaws of victory by relying on those two men.
When the Taliban were routed in an epic battle pitting a Special Forces A-team headed up by Maj. Jason Amerine and dozens fast movers (jets) vs. a couple thousand Taliban just outside the provincial capitol of Tirin Kot the local Afghans held jirga’s and agreed to candidates for the positions of district mayor, district chief of police, etc… Unfortunately, the acting president (Karzai) sent one of his friends named Jan Muhammad, to be the provincial governor and Jan Mohammad intended to put his fellow tribesmen (Popalzai) into every paying billet in his province.
In towns like Khas Uruzgan the men selected by the people to govern them moved into the district center and started accepting weapons from surrendering Taliban. Jan Mohammad, who had just been released from the Taliban prison by Karzai himself, moved into the provincial governors compound and promptly appointed his tribesmen to every district governor and police chief billet in the province.
In Khas Uruzgan the man elected by the jirga occupied the district governors compound. Next door was a schoolhouse where Jan Mohammad’s men (representing the Kabul government) set up shop. Both groups were busy dis-arming Taliban and there were a ton of weapons in both buildings.
In late 2002 the U.S. Army conducted a raid on both buildings (which they thought held Taliban), killing several men in the process and yoking up several more for interrogations at the Bagram airbase. Anand Gopal, in his excellent book No Good Men Among the Living describes the results of this raid:
Khas Uruzgan’s potential governments, the core of any future anti-Taliban leadership—stalwarts who had outlasted the Russian invasion, the civil war, and the Taliban years but would not survive their own allies. People in Khas Uruzgan felt what Americans might if, in a single night, masked gunmen had wiped out the entire city council, mayor’s office, and police department of a small suburban town: shock, grief, and rage.
It would be years before the United States admitted they had raided the wrong place. Mullah Abdul Ghani Baradar (the current senior Taliban negotiator) had gone to ground near Khas Uruzgan and our Special Forces decimated not one, but two wedding parties (with AC-130 gunships) in an attempt to catch him. Dozens of children and women were killed in these raids and this is important to acknowledge – to the Afghan people there were two wars, one that drove the Taliban from power quickly and a second one that started when we stayed on in the country to “capture senior Taliban and al-Qaida”. The responsibility of this second war rest solely on the National Command Authority of the United States who failed to define Phase four (what happens when we win).
If you want to read an infuriating account of our own incompetence making us enemies among people who wanted to be allies during that second round of war, read Chapter 5 of No Good Men Among the Living. It is a detailed description of how we were tricked into detaining and/or killing the entire anti-Taliban leadership of Band-i-Timor in the Maiwand district of Khandahar. You cannot make some of this stuff up.
The opinion peace by Sirajudin Haqqani was a masterstroke of Information Warfare and will be hard to refute by the United States. The Taliban leadership, unlike the American leadership, has skin in the game. There is no reason to doubt their commitment to participate in establishing an Afghanistan free of foreign troops and moving towards a consensus on who is governing what. It is now time for the United States to move out of the way and allow the Afghans to determine what their country will become.
In 2002 the Taliban were defeated and al-Qaida already gone to Pakistan. All the fighting since then has not changed a thing on the ground. It is time to pull out, reduce funding to Afghanistan and let them sort out the situation among themselves.
Last week news broke of a possible peace deal in Afghanistan leading to a firestorm of speculation in the media about what’s really going on. The reporting was not consistent but the consensus is the peace deal would call for negotiations between Afghans on both sides of the conflict to start next month, an eventual countrywide cease-fire and a commitment from the Taliban not to harbor terrorist groups like al Qaida, while setting a timetable for the withdrawal of U.S. troops.
A famous quote incorrectly attributed to Winston Churchill dictates “Jaw Jaw is better than War War” (actually he said “Meeting jaw to jaw is better than war” which makes more sense ) reinforces this is (potentially) good news. The devil is in the details and we do not know what “reduction of violence”means to the United States or “withdrawal of U.S. troops” means to the Taliban.
TheTaliban are not a monolithic organization but several competing factions. We have been dealing with the Quetta Shura who is representing, but cannot speak for, the other players like the Miranshah Shura (primarily the Haqqani Network) or the Peshawar Shura. That being said the Taliban did deliver on an Eid ceasefire agreement last year and that ceasefire held.
We can get a reliable read on what the Taliban considers a reduction of violence in this detailed report from the always reliable Afghan Analysts Network. From the linked report:
Another Pakistani newspaper, quoting an un-named Taleban official, reported that the movement had agreed not to carry out attacks in major cities including Kabul and would not use car bombs and that the Taleban had also offered not to attack US bases and US soldiers, and that they wanted the US to cease air strikes in return. The newspaper said it had learnt “that Khalilzad had urged” the Taleban to agree to more measures, including a halt to IED attacks, but that they did not agree “as they have planted IEDs in many areas and it is difficult for them to remove all [of them].” Furthermore, the paper reported, the US also wanted a pause in Taleban attacks on Afghan government forces’ check posts, “which was also a concern of the Afghan government.”
Senior U.S. military officials (speaking off the recored) in Afghanistan stressed that U.S. counterterrorism operations in Afghanistan against the Islamic State group and al-Qaida will continue, separate from the truce agreement. This is problematic for several reasons, not the least of which is that ISIS-K in Nangarhar Province has been defeated.
Their fighters have mostly surrendered to the government or gone to ground. There are ISIS-K cells in the north of the country but they are not large or powerful and are in the sights of the same fighters who rid Nangarhar Province of ISIS and those fighters are Taliban.
The counterterrorism mission in the eastern part of Afghanistan has been focused on ISIS-K (Daesh to the locals) for years. Now that ISIS-K is gone the Special Forces teams are flying around the province conducting ‘Key Leadership Engagements’ like the one I wrote about last week. That occurred in the Sherzad district which is very close to Jalalabad and full of former HiG fighters who have cooperated with the Taliban on and off over the years. They cooperate mostly because Taliban shadow courts settle land disputes quickly and, they feel, fairly.
The time for our SF troops and the Afghans varsity Commandos to be running around district centers meeting with key elders seems long past. The local elders know all about the dysfunctional government in Kabul and are not going to be convinced it has their interests at heart until the government demonstrates it.
With ISIS-K on the ropes trying to separate Taliban connected fighters from al Qaida will be problematic. The remaining senior al Qaida leaders have successfully gone to ground inside the tribal areas of Pakistan and have no need to move anywhere. al Qaida has a presence at Taliban training camps and may even run a few but I have no doubt the Taliban understand the consequences of allowing them to use their territory for international Jihad.
If there no independent al-Qaida formations so if you go after them you are still going after the Taliban.
The incident rate in Afghanistan has plummeted this year. Some of this is due to the pounding the Taliban have taken from American air attacks which increased dramatically in 2019. Some of this can also be attributed to the Taliban winding down operations as the peace talks continued. The stats below come from The Armed Conflict Location & Event Data Project.
Time will tell but it seems that the end to American involvement in Afghanistan is near. But if you pull all the training support mission out and leave a Special Forces task force to continue hunting “al-Qaida and ISIS” it will test, if not break, the fragile peace. We need to pull everyone out and let the Afghans settle things themselves. Continuing night raids and killing bad guys in Afghanistan does not reduce any threats to our homeland. It’s time to admit that and act accordingly.
I just re-posted two stories about doing Key Leadership Engagement (KLE) in the Sherzad district of Nangarhar Province, Afghanistan. Yesterday, two Green Berets were killed and six wounded while (reportedly) conducting a key KLE in Sherzad district. This is disturbing on several levels.
First, it appears the dead and wounded (including the Afghan SF troops with the Americans) came at the hands of Afghan National Army soldiers. From the article linked above:
Additionally, at least six more American troops were also wounded. The high number of casualties (17 as of this reporting) is attributed to the ODA/Afghan combined force coming under fire from a DShK, a Russian designed heavy machine gun which fires a 12.7mm bullet. The wounded have been evacuated to the appropriate field hospitals.
The source explained to Connecting Vets that it is suspected that the Afghan National Army (ANA) was behind the attack, although details are still developing.
From what I can determine they were attacked by a lone gunman with a heavy machine-gun. It is safe to assume (if this proves true) that the lone gunman was Taliban. They got an assassin into the governor of Kandahar’s security force who was able to gun the irreplaceable Gen Raziq. As I wrote the time and will continue to write this is going to happen again. It is obvious that the screening methods in use are not working and, given my experiences in Afghanistan, I suspect will never work.
Second, one is forced to ask why, at this late stage in the game, are we still conducting KLE’s out in the badlands? What did the SF guys believe would be accomplished? I can’t imagine a good answer to that question and I have over eight years of doing KLE’s in Afghanistan and many of them right there in Sherzad district.
It is difficult to get a sense of what is really happening on the ground in Afghanistan in general and Nangarhar province specifically. Nangarhar Province has gone from one of the more safe-ish provinces in the country to the most deadly one for American forces. The army had been losing soldiers over the past four plus years in Nangarhar Province fighting an outbreak of ISIS along the border with Pakistan.
The Taliban got sick and tired of ISIS deprivations before and rolled into Nangarhar and kicked their asses hard in 2015. Last fall the multiple Taliban units returned to Nangarhar (probably from Loya Paktia via the parrots beak which is that finger of Pakistan land jutting into Afghanistan at the bottom of the district map below) and beat ISIS like a drum. ISIS was surrendering to the Afghan government last time I checked and are longer a threat.
Despite ISIS being routed (reported here in the Military Times three months ago) ISIS-K is still being used to justify our continued involvement in Afghanistan. That is ridiculous – ISIS-K was a collection of Pakistani Taliban who were trying to carve out their own little Jihadi paradise in an area that contains the largest talc powder deposit in the world. Threat to the US Homeland? Hardly. al Qaeda is the same – they have gone to ground and remain unmolested in Pakistan for 18 years now and have no need to use Afghan soil for anything. The airport in Peshawar is 10 times better than Kabul International so why would any decent Jihadi move from his decades long home in Pakistan?
ISIS-K is gone, the Taliban now control of most of the countryside in Nangarhar Province where we have troops at the Jalalabad airfield. Those troops would be mostly avation and avation support but there are two different SF compounds there too which are obviously still the home of one or more army ODA teams. I understand the need to be active outside the wire of a firm base like Jalalabad to keep the bad guys at arms reach but I’m not sure what possible use a key leader engagement would be at this stage in the game.
This is exactly the kind of senseless loss that is driving President Trump to wind down our involvement in Afghanistan. How do you justify losing 8 Americans and unknown number of Afghan Commando’s on a chin wagging mission with a bunch of local elders?
As an aside the only main stream outlet to write about this is Fox and their take is focused on the perfidy of Green on Blue attacks. They have (as usual) completely missed the the obvious and the comments section is so clueless it’s depressing. The other outlets are (I suspect) waiting to see what President Trump is going to say so they can say the exact opposite. Watch and see.
Maybe there are great reasons for the mission to Sherzad that we will never know, but I do know there are better ways to conduct KLE’s. It is always better to risk one contractor than it is to risk a dozen highly trained special operators. The counterintuitive thing about that is an experienced contractor traveling alone into Sherzad district, wearing local clothes, and in a local vehicle is much safer than 20 soldiers rolling around in four MRAP’s. That is a lesson we refuse to learn and I think the President, for one, is getting tired of it.