I did not vote for Donald Trump in 2016, but I will in 2020

Now that the 2020 Presidential and Vice-Presidential Debates have concluded, and the election is within ten days, it is time to make a considered decision about voting.  I have decided to vote for the reelection of President Donald J. Trump.  I did not vote for him in 2016, but believe it is the correct choice in 2020.  

Several of my blog readers asked me how I will vote in the 2020 election.  They run the gamut from those who hate Trump and will vote against him no matter what; those who love Trump and will vote for him no matter what; and those who dislike Trump’s personal flaws and methods, but agree with many of his policy actions and find the Democratic Party policy alternatives unacceptable.  I fall into the latter group.  

COVID-19 Pandemic: National and State Performance

The United States' COVID-19 associated death toll passed 200,000 last week - placing the U.S. at  11th from the bottom when compared with other countries.  This blog post analyzes national and state level performance to date, relative to other countries and among states, to try and shed light on why the U.S. holds that unenviable position.   The primary metrics for comparison are COVID-19 related deaths, public health system performance by state, and job losses by state.

Before describing the analysis, it is important to first say that the loss of so many Americans to COVID-19 is a national tragedy and a personal horror for many families and communities.  The nation grieves their loss.  There is no better way to honor those who have died than to rigorously and critically research and analyze the national and state response to this pandemic.  Better understanding the effects of the virus, and governmental responses, can improve outcomes both in the current pandemic, and when (not if) the next pandemic occurs.

The pandemic response is also harming millions through increased rates of depression and addiction relapse, business failures, job losses, and educational disruption. There is still tremendous debate about how to balance the needs of protecting an older generation through public health policy with resuming economic and social activity.  There is a generational divide that must be acknowledged and the concerns of both balanced.  Younger people are generally at much lower risk to the virus and see their economic futures and the educations of their children in jeapordy from public health policy restrictions on their lives.  There is wide variation between states in addressing this balance. 

One method of assessing peformance in mitigating the impact of the pandemic is to compare the U.S. to other countries in terms of outcomes.  Uncovering policies that performed better or worse in these countries may reveal better approaches for the next pandemic.   As a federal republic of sovereign states, the U.S. also has its own laboratory of 51 different approaches that it can compare and contrast to uncover best practices.   Comparison of our nation’s performance against other countries and the comparing of states relative to one another is the primary focus of this assessment.

Federal, State and Local Roles

Early in the pandemic President Donald Trump made statements about his authority to make decisions that could overule the actions of governors. Governors responded vociferously to reject that point of view.   The President eventually backed down. Rightfully so.  The Constitution stepped in.

The president has very little authority to overrule the decisions of governors with regard to public health orders they may put in place.  Fortunately, all parties walked back from the confrontation and began to actually work together cooperatively in April.  This was true even when the most serious political divisions were present.  New York Governor Andrew Cuomo and California Governor Gavin Newsom proclaimed gratitude for the the Trump Administration's support of their efforts.

New Cape Cod Canal Bridges – Yay

The Army Corps of Engineers and the Commonwealth of Massachusetts signed a memorandum of understanding to partner in the planning and construction of two new bridges to replace the Sagamore and Bourne Bridges that now span the Cape Cod Canal.  This is good news. It is another step taken toward a needed change for which many have advocated for decades.  

Despite the news of progress, one must lament the snail’s pace by which such things are achieved.  The quicksand of regulation, litigation, and political and bureaucratic decision-making took so long to arrive at this point.  One fears that the long drawn out process will carry over into the next steps and the two new bridges will not be completed until far into the future - 2050 is not unthinkable.

Assessing State COVID-19 Performance

I perform my own analysis of data from multiple reputable sources to better inform myself about COVID-19.  I share some of that analysis here. I am not an epidemiologist or government official.  My analysis is my own personal pursuit of better understanding in an often unclear and conflicting reporting environment. Some of my blog readers may find it interesting and maybe even helpful.  It is a layman's work, so keep that in mind.  In this specific post I use the following sources:  The Covid Tracking Project : Rtlive ; and the Bureau of Labor Statistics.

First, I created the Venn diagram at right to provide a context for my writing.  As is the normal course in present day America there are those that try and divide by making every issue an either/or binary choice for political alignment.  I reject that.  The COVID-19 pandemic is complex and at least three areas - public health, rights and responsibilities, and economic impact - should be a part of any pandemic policy.  A skeptical public should take responsibility for demanding balance and evidence of efficacy in policy.

The lack of depth in media reporting is what instigates my own analysis.  There is an overwhelming inclination in government and the media to report raw numbers of COVID-19 cases and deaths. Raw numbers tell us little to nothing of value. What does a statistic mean if it is not compared or contrasted with something else to measure its relative impact, value, threat, or risk? It is in comparisons where we find value and knowledge. For example, one can compare states to measure relative performance and gain insights into policy effectiveness or compare a state's performance over time to reveal trends within a state.

Should hard hit states reassess Covid-19 strategy?

Massachusetts Governor Charlie Baker announced this week an extension to his May 18 “Stay At Home" order.  The Mayors of Somerville, Cambridge and Peabody, MA ordered the wearing of masks in public places (indoor and outdoor) with fines for non-compliance of between $300 - $1000.  Is doubling down on a general population lock down strategy the right path going forward? Or does the overall strategy need review?

One can reasonably ask:  Is the strategy of generalized social distancing with increasing restriction appropriate going forward? Would it be more effective to target the virus directly where it is most insidious and deadly, focus resources there, and allow a gradual development of herd immunity in the general population?

Last week the Wall Street Journal reported over 10,000 COVID-19 associated deaths at elder care facilities. This number is likely to go up in both number and percentage terms. The WSJ has built its own database by contacting state departments of health directly because reporting from government sources was rare.   California released data this weekend indicating nearly 40% of its deaths come from nursing home and elder care facilities.  The World Health Organization (WHO) reports half of Europe's deaths from COVID-19 were from elder care facilities.

The Massachusetts Department of Public Health COVID-19 Dashboard indicates nearly 60% of the 3153 MA deaths occurred in long-term care facilities.   This percentage might rise as the definition may only indicate those that die on nursing home property not those that were released to home or died in hospitals after transfer from a nursing home. 

In Massachusetts, the 70 and older age group made up 86% of confirmed COVID-19 deaths with those 80 and older making up nearly 65%.   There have been no deaths in the 0-19 age group and 33 in total for those in age groups under 50.   Ninety-eight percent (98%) of those who died in MA, and for which a full investigation has been completed, had underlying conditions.

COVID-19: Risk Assessment, Model Uncertainty, Unknown Prevalence, Unclear Mortality, Alternative Paths, and State Anomalies

The COVID-19 battle is trending favorably. There is reason to be grateful for lower death rates, less hospitalization, less ICU use, and less ventilator need than was predicted.  Those that directly engaged at great personal risk, from first responders to health care workers, deserve our thanks.  Moving forward vigilance and rigorous critical analysis is needed to understand the risk COVID-19 posed.  There is much we do not know to include:

How prevalent is it in the population?  
What is the mortality rate?
Did uncertain models overly inform and influence narrative and government policy?
What role, and to what degree, did social distancing influence cases and deaths? 

Were there alternative strategies that could have been as effective?

It is important that the nation undertake an investigation to fully understand the risks and realities of COVID-19 and assess whether or not the actions that local, state, and federal governments were in fact necessary and effective.  Shutting down the U.S. economy was an extreme action.  It is an unsustainable action that cannot become part of the standard play book for each new virus threat.  Understanding what really happened in during the pandemic is essential to ensuring future preparedness and viable strategies.

My concern is that harmful policies were taken by federal, state, and local governments that threaten our economic well being and played loose with Constitutional rights based on uncertain predictive models.  Did the governments actions stop nearly 2.2. million deaths?  Or, were the original projections simply wrong?  We do not know. We need to find out.  Our future well being may depend on it.

As the COVID-19 pandemic settles down and election season draws near some politicians are going to be patting themselves on the back for having saved thousands if not millions of lives.   If the total number of deaths by fall is approximately 60,000 President Trump can say his Administration's  actions saved between 1.44 and 2.14 million lives.  This assumes the models were correct in their predictions.  Governors can extrapolate their great success from the same numbers.  A handful of governors will have to explain to their citizens (particularly NY, NJ, MI, MA, LA, IL) why their states were negatively impacted disproportionately.  

Relative percentages to understand state COVID-19 status

President Donald Trump and the White House Corona Virus Task Force released “Opening Up America Again” guidelines on April 16, 2020.  The guidelines provide “Proposed State or Regional Gating Criteria” for proceeding to each of three phases of reduced restrictions on economic and social activity.

“Core State Preparedness Responsibilities” include robust testing and contact tracing capability, adequate healthcare system capacity to include a surge capability, and a plan to protect the health and safety of critical workers, vulnerable populations (e.g. nursing homes), and other related specific requirements.

The guidelines use criteria for transitions through the three phases based on data within a state or even county or city level, as the granularity of data is now available to those levels.  The guidelines do not set dates, but rely on states satisfy criteria to transition through each phase called “Gating.”  Beyond the underpinning Core State Preparedness Responsibilities a state would make decisions about transitioning based on an observed decrease in day to day confirmed cases and  positive tests for the virus over a two week period.

This necessary plan is adequate to begin the process of transition in balancing the risk of economic collapse with public health.  Twenty-two million Americans have now lost their jobs as the result of the Covid-19 pandemic.

I keep my own databases to analyze the risk of Covid-19. I do this to satisfy my own curiosity and analytical bent, but I also feel that there is a weakness in journalism today that forces me to do my own analysis.   I have observed an overemphasis on reporting raw numbers to indicate risk and impact with an emphasis on rounded thresholds (e.g. 1000, 10,000) that make for good headlines.  This distorts impressions and understanding.   I believe a better way to understand virus risk and impact is through relative comparison of a state against other states and the national average by calculating the percentage of a state’s residents that have been tested, have tested positive, have died, and are projected to die with Covid-19.

I set up download routines from databases that are reliable and current.  The COVID Tracking Project hosted at The Atlantic has a data file that I use to track specific numbers tested, hospitalized, and deaths.  The New York Times has a database that tracks similar data, but has an excellent graphic presentation showing the increase or decrease in cases and deaths in a day over day comparison.  The University of Washington IHME database provides model projections for hospital bed and ventilator shortfalls and anticipated number of deaths through August 4^th by state.

Below are some tables I created that are sorted to show different rankings by state and the national average.  I offer these tables to my blog readers in the hope that it will help them better understand the situation in their state and appreciate that all states are different.