It's all Greek to me.

Richard Feynman, the theoretical physicist who won the Nobel Prize for his quantum electrodynamics genius was infinitely curious about the world and continually setting up fascinating challenges for himself throughout his life that were intentionally and well outside of his area of expertise to see what he was made of, what he thought possible. The one I found most interesting was the time he decided to solve the mystery of the Rosetta Stone with only the materials and knowledge available to Jean Francois Champollion, the archeologist who finally succeeded in deciphering the mysteries of this granordite stele in 1822, thus paving the way for our modern understanding of ancient Egypt.

This iconic black tablet was discovered by accident in 1799 by French soldier Pierre-Francois Bouchard during the Napoleonic campaign somewhere in the desert sands outside of Cairo. It’s inscribed with three versions of a decree written during the reign of King Ptolemy V in Memphis, Egypt around 196 BC. The top and middle texts are in Ancient Egyptian using both Hieroglyphic and Demotic scripts respectively, while the bottom decree is in Ancient Greek.

So for Feynman to figure this stone enigma out, on his own, he would have to first learn Ancient Greek, which from this period is known as Koine Greek or Alexandrian dialect – a challenge in itself like biting the ass off a bear. I’ll give you an inkling of how difficult this really is. In Koine Greek nouns have five cases: nominative, genitive, dative, accusative, and vocative. Verbs have four moods:  indicative, imperative, subjunctive and optative, and are conjugated through seven combinations of tenses and aspect. Some verbs augment, either syllabically or quantitatively; there’s irregular duplication and absolutely not a shred of punctuation anywhere, including, laughably, no separation between words.

Imagine deciphering Ancient Greek with no Google, no YouTube, no Wikipedia –from a dead ignorant standstill, with your only resource a bunch of dusty books still categorized using the Dewey Decimal System in the archives of a university library that’s probably in the next state over or somewhere outside of Boston, Massachusetts. Are you joking? Here’s my analogy: Go to the local farm and get yourself a live chicken. (A capon or rooster’ll do too.) Paint the bottom of her twitchy feet black, which she’ll love. Then set the hysterical hen down and let her claw and frenzy all over your kitchen floor.  What do the scratchings say? What do they mean?

I’m not kidding, that’s about the difficulty of it – Feynman’s intellect and self-deprecating sense of humor is astonishing and practically unbelievable.

In the same spirit (in kind, but not in degree) of intellectual adventure I decided to set off to attend a different church/service every Sunday for a year as I’ve already mentioned and written about. Thanks for coming along on that ride with me – and for your kind comments. The Corona Virus has put that toe-dipping into the baptismal waters of God and my salvation on hold, at least for a while, so I wanted to set a new challenge for myself. I thought I'd dive back in to the classic Western Literary Canon, and decided to start my odyssey with the oldest author known to man, i.e. with Homer, and his prototypical adventurer Odysseus and work my way through the familiar and famous Greeks and Romans hard and heavy for the next several centuries: Sophocles, Socrates, Thucydides, Aristotle (Wit is educated insolence, one of my favorite quotes), Plato, Cato (both Elder and Younger), Cicero, Horace, Augustus, and Plutarch.

Marcus Aurelius, the ideal Philosopher King would bookend the classical era, and then I thought I’d tread lightly and sprightly through the next two millennia starting with St. Augustine (Lord make me chaste – just not yet!), Thomas Aquinas, Montaigne, Shakespeare, Hobbes, Locke, Kant and Hume. And then I’d try to get somewhat up-to-date with Emerson, Nietzsche, and Carl Jung. That was the basic game plan, anyway. I hope to hop around ad hoc – chronologically seemed boring and unimaginative – and find out who was who and what was what as I bumbled along from empire to republic to democracy to dust, and back again.

However, I did start with the Odyssey, since it’s the beginning of everything, and I very quickly realized that this without-question masterpiece is still in print for many good and even more great reasons.

We’ll plunge into this odyssey together next week, but in the meantime I’d like to follow up my buddy JP’s post with a Corona Virus update from his friend Marc, who  has written a personal but comprehensive, detailed and sobering analysis of the crisis so far.

“I'm here in NYC, day 10 of sheltering in place at the epicenter of COVID-19 with many of the symptoms and no way to get tested. NY represents almost half of the cases in the country and 1/3 of the deaths. Many of my friends and colleagues have symptoms as well, ranging from mild to hospitalization and they are all under 50. Coronavirus is no joke. I've been reading everything I can, but it is difficult to make sense of all of the contradicting facts and figures. I find myself contemplating how bad is this going to get? When will it be over? How does Coronavirus compare to the flu? What is the true death rate? What is the real risk for young people? 

I've read the articles and analyzed the stats and found there to be so much bad info out there so I decided to try and make some sense of the facts and thought I would share what I've learned.

In summary, this is not just a little more dangerous than the flu, but it is also not 20-40x as deadly as others claim. The Coronavirus, by my estimate, has a death rate of around .42%. In a normal year the flu has a death rate of approximately .10% and in the bad flu season of 2016/2017 it was .14%. This means Coronavirus is about 3x as deadly as the flu in a bad season. However, since the virus seems to infect older people at a higher rate than younger people and the death rate is higher for that population it raises the overall death rate. When examining how much more deadly COVID-19 is for a specific age group we see that it is less deadly than 3x. 

In addition to the higher death rate Coronavirus is also more contagious. In the tough flu season of 2016/2017, 14.5 percent of the entire population was infected and there were 61,000 deaths. It is hard to know what percentage of the population that would be infected if it went unchecked, but if we use 14.5% at the low end and 80% of the population at the high-end we get a range of deaths of between 200k - 1 million in the US.

This is not a worse case. This is very likely what would happen if we did nothing. We absolutely needed to move quickly and lock things down. But now we need to be much more aggressive with testing. We are behind. 

Based on my analysis, however, if the rest of the country can learn from NYC and lock everything down now (NYC waited too long and is paying the price), we can keep US deaths between 10-25k with rigorous testing and quarantine. And I believe we will be in a position to open small businesses in NYC by the end of April.

I said Coronavirus has a death rate of .42%. That is a lot lower than what you read.  Basic math would suggest a death rate of more like 4.3% since there are currently 378,842 Coronavirus cases worldwide as of March 23 and 16,510 deaths (16,510 / 378,842 = 4.3%). This implies that Coronavirus is 30x as deadly as the flu. That is just wrong.

The primary reason why the death rate isn't 4.3% is simply because people with mild or no symptoms aren't getting tested, so we have a denominator problem. I believe the true number of infected cases is about 10x higher than what's being reported, which translates to a death rate of .42% vs 4.3%. That might sound like a big difference but keep in mind about half of the people with COVID-19 don't even exhibit any symptoms at all. Let me share how I arrive at .42%.

In order to know the true number of cases you need to test everyone. Fortunately we do have a couple of places where we've done that. Although it is a small data set it tells us a lot.

Let's start with South Korea. They have the most advanced Coronavirus testing program in the world. They have tested 320,000 people and have 8,897 cases. That means they tested 36x the number of people who had it. This is the best proxy we have for calculating a death rate when everyone with symptoms is tested. In South Korea there are currently 126 deaths for a death rate of 1.4 percent (126/9137). Since they are seeing less than 100 new cases a day I don't expect the death rate to change very much. 

Although they have a rigorous testing program they likely didn't test those without symptoms and they definitely missed people earlier on before they started testing. They have a population of 51 million people and tested just 320,000 peope. So the question is what percentage of people have the virus and show no sumptoms ? We actually have two data points. On the Diamond Princess cruise they tested everyone and found 47 percent of those that tested positive didn't show any symptoms. Also in the city of Vo Italy they tested all of the residents and found that 70 percent showed no symptoms. 

If we take the South Korea death rate of 1.4% and adjust for 50 percent of people with Corona who have no symptoms that gets you to .70% death rate (1.4% *  50%).  Since it took a while before Korea started testing I tried to figure out how many cases there likely were before they started testing based on the number of deaths and reverse engineering a distribution. I estimate there were another 12,000 or so cases that weren't accounted for making the true number of cases to be more like 30,000. Divide by 126 deaths and you get a death rate of .42%, which is 3x as deadly as the flu in the 2016/2017 season where we saw a death rate of .14%.  Now let's look at a few other examples to pressure test this estimate.

On the Diamond Princess cruise there were 3711 passengers and crew aboard. Everyone was tested and 697 had Covid 19 (18.7 percent of the population. A good example of how fast this could spread), and 47 percent showed no symptoms at all. 9 people died for a death rate of just over 1.3 percent (9/697) which is higher than the .42 percent I estimated earlier. However the 1.3 percent is misleading because of the heavy skew toward older people. All 9 of the people who died were over 70 years old. Since there were 288 confirmed cases for 70+  the death rate for 70+ is 3.1 percent (9/288).  Since the flu death rate for those over 70 is about 1.2% the Coronavirus death rate appears to be 2.5x as deadly as the flu for that age group.  Let's take a look at another example where everyone in a population was tested.

In Vo, Italy where the entire town of 3,300 was tested. 89 had the virus and 70 percent didn't show any symptoms. Of the 27 people that had symptoms 1 person died for a 3.7 percent death rate, but again the population is skewed much older and the individual who died was over 70. That's 3x the flu, but I admit the data sample is too small. That's why we can't look at any one data point. But when you start to make sense of all of the points you can begin to triangulate on a number that has statistical significance. 

Another way to examine death rates is to just focus on death rates of the elderly. There is an interesting difference between the flu and COVID-9 regarding the likelihood of older people contracting the virus relative to younger people. For the flu people over the age of 65 are no more likely to get the flu then younger people. I would have thought the older you are the more susceptible you would be to getting the flu, but the 65+ age group represents 13.3 percent of all flu cases and 13.1 percent of the population in 2016/2017 flu season. It appears to be different for COVID-19.  On the Diamond Princess I looked at the percentage of the population that were infected by age and found an interesting trend. Here are the infection rates by age: Under 50 6.5%,  50-60 7%, 60-70 8.2%, 70-80 9.4%, 80+ 13.4%. There could be other factors at play here but the results would suggest that an 80 year old is twice as likely to contract the virus than someone under 50 assuming equal exposure. So not only is the death rate 3x the flu for over 80, they may also be twice as likely to contract the virus. If this were true and older people are more likely to contract the virus then it would explain why the overall Coronavirus could be 3x as deadly as the flu, but only 2x as deadly for any specific age group.

Let's dig in deeper on age specific death rates. If we examine the 80+ population in South Korea we see a death rate of 9.26%. Remember we adjusted the overall death rate of 1.4% down to .42% in South Korea after adjusting for missed cases and asymptomatic people. If we apply the same multiple to the 80+ age group we get a death rate of 2.78% (9.26% / 3.3). Since the flu death rate in this population is about 1.75% this would suggest Coronavirus is about 1.6x as deadly for this population.

Another way to check this is to look at the death rate for those below age 50. The reported death rate for under 50 in Korea is approximately .05%. No one under age 30 died. And that is before making the correction. If we divide .05% by 3.3 we get .015% for under 50.  The death rate for under 50 for the flu is .013% implying that Coronavirus is about 1.2x as deadly as the flu for those under 50. However it is not just the death rate for this population that needs to be considered. People under 50 are getting very sick and are needing to be hospitalized and put on a ventilator at a much higher rate than we see with the flu.

In conclusion, I believe the true death rate to be .42% or about 3x as deadly as a bad flu season, however for any specific age group it is between 1.2x - 2.5x as deadly.

Where does this leave us with respect to where we are today? With the exception of NY, I believe we caught this in time so the actual death rate will be a fraction of what it could have been.  If you look currently at the US data there have been 43,469 cases as of March 23 and 545 deaths for a rate of 1.25 percent, however the number of deaths would grow even if there were no new cases so the question is how many more. I took each of the daily cohorts of new cases and assigned a probability of dying by day based on what has been observed.  Then I estimated how many deaths there would be if cases ceased today. When I do this I get a death rate in the US of 4% (on observed cases) which is much closer to the current global average of 4.3%. This gives me some comfort the model is working. We know we haven't done the testing, but this proves how little we have actually done because we've established that the actual death rate based on infection is really more like .42% which means the number of true infections in the US is more like 10x what is being reported. I estimate around 500,000 true cases based on today's numbers,  half of which are from NY.  

Based on the modeling I did assuming some period of incubation I estimate that the true number of cases in the US could grow from 500k to between 2-5 million infecting about 1 percent of the population. To put that in context in Vo Italy 3 percent of the population was infected. 

With 2-5 million predicted infections in the US and a death rate of .42% I would expect between 8k - 21k deaths in the US. Remember in the 2016/20117 flu season we had 61,000 deaths. I will continue to update the model as the days pass based on the new information. 

As far as NY goes we are now over 30,000 Coronavirus cases but the true number of infections is more like 200,000 based on the way deaths are materializing. I built a model to predict cases and deaths based on data obtained from the incubation period. The data I have shows that less then 2.5% of people will see symptoms in the first 2.2 days, and 97.5% will see symptoms within 11.5 days. The average number of days to see symptoms once exposed is 5.1 days.  Using this distribution I use reported cases and deaths to work backwards to see if exposures are decreasing. Because of the incubation period and time to get tested we are now at a point, 8 days removed form the lockdown, where we'll know any day if we've slowed the virus.  Each day will give us critical info and I am happy to report that yesterday was a great signal. We will know a lot more after today. If we see the number of new cases in NY remain under 6,000 today  I think we'll be tracking toward 3000-4,000 deaths in NY, which is a lot lower than what people in NY fear.  This equates to around 700k-1m true infections and implies, based on a population of 19.5m in NY, that 3.5 - 5% of the NY State population will become infected. NYC could start to approach 1 in 10 people infected.

What do I think we should do now? It makes sense to shut everything down so we stop the spread, but we need to ramp up testing dramatically. We have 6.5 times the population of South Korea and they tested 320,000 people before they were able to stop it so that means we may need 2 million tests. The quicker we start testing and isolating people the quicker we can get back to life. I expect restaurants and small businesses in NYC to start opening before May 1st given the more aggressive stance NYC has taken on testing and the shutdown according to my model. I have the number of deaths peaking in 8 days at less than 200 deaths a day.

Hope this is helpful. If you have any new data points that I should include please let me know.”
March 30, 2020 — Johnny Mustard