A demographic portrait of the pandemic
The chart above is an analysis of the mortality rates of COVID19 in Spain, demonstrating that mortality rates among those over 65 are much higher than for younger populations. These trends could be applied to any other country with the caveat that Spain has a high elderly population when compared to other countries (ranking third in Europe with regards to its elderly population, it is slightly below Italy and Greece) which is coupled with extensive intergeneration social contact. COVID19 fatalities are directly linked to the patient’s age and looking in detail at which age groups are most affected by the pandemic is imperative.
The total deaths in Spain from COVID19 are 27K and can be found in the first row. Government figures quote around 21K deaths, yet I have also added excess mortalities, which account for about 6K more deaths (for excess mortalities see Informe Momo). The official death counts and the total number of deaths are probably the result of limited testing for the virus rather than intentional undercounting (see Imperial College’s report on the number of infections). My estimate is that between now and until the end of the year, the number of total fatalities will double, with a total of 54K. These projected figures are obviously questionable, yet I find value in including not only real figures, but also a projection of how the pandemic could evolve.
In the second row are the statistics regarding people under 65 with 5.4K deaths and a total of projected deaths of about 11K. This translates to 1 in 690 people who have died already from the virus or 1 in 3.4K by the end of the year. The total population for this age group is 37.64 million yet this age group represents only 8% of the total COVID19 deaths.
In stark contrast, people over 65 years of age, make up 92% of the fatalities due to COVID19 and amount to a total of 9.4 million in Spain. This age group has disheartening rates: 1 in 435 have died by now and possibly 1 in 215 will die by the end of the year. When you narrow it down to people over 80, it is possible to see how incredibly lethal this virus is: those over 80 represent 60.4% of the deaths. However, there are only 4.7 million people in this age category in Spain, meaning that already 1 in 271 have died from coronavirus and around 1 in 135 will probably die by the end of the year, unless of course a vaccine is developed or a treatment is found, thus herd immunity would not have to be reached.
In terms of the impact of COVID on those under 50, it is an almost non-lethal virus and the fatalities in this age group represent only 1.7% of the total deaths. To better assess this percentage and get a better idea of what this means we must take into consideration that a person who is 35 years old has a chance of dying of 1 in 500 due to any cause between the ages of 35 and 36. The likelihood of dying from coronavirus for this age group is 1 in 61K which is statistically insignificant. By the end of the year, those under 50 will have a chance of dying from coronavirus of 1 in 30.5K. Essentially, the pandemic is a non-factor for people under 50 who amount to 28 million in Spain.
The age group comprised between the ages of 50 to 60 represent only 3.1% of the total COVID19 deaths, while for the age group between the ages of 60 to 70 the percentage of total deaths is 8.9%. The chances of dying from COVID19 for these age groups are insignificant when compared to the chances of dying from anything else.
Assessing the likelihood of dying from coronavirus and highlighting the high lethality of COVID-19 for older people is essential in order to decide the future steps to follow with regards to the pandemic.
Lessons from Covid in Europe for my friends in the USA
Lockdown only for those over age 45, then slowly lift the lockdown for those aged 45 to 65. Keep those over 65 in lockdown until treatment or vaccine is developed or most of the population is immunised.
The first and most relevant data on Covid that my friends in the USA seem to be unaware of is the age group with the highest death rate: 91% of those who died in Europe from Coronavirus were over the age of 65 and 87% were over 70. People under 40, on the other hand, have a mortality rate of less than 1% and are therefore much less likely to die from Coronavirus. In fact, people under 40 have the same chance of dying from Covid than they do of dying from the regular flu.
Secondly, Covid is extremely contagious and one would need to live a life of tremendous isolation in order not to get Covid. The official European data on how many people have been diagnosed with Covid are not accurate and the reality is probably 50 times greater. This would mean that Italy and Spain do not have a combined amount of 250k people who have been been infected with the virus, they actually have millions each. Imperial College estimates that in Spain, a country with as many people as California, 7 million people are infected.
Thirdly, Covid is nowhere near as lethal as people think. When people read published figures, namely that Spain has 125K infected and 12K dead, they conclude that around 10% of those infected die and thus panic over this high mortality rate. However, if the real numbers follow Imperial College predictions, then Covid actually kills 17 people in one thousand or as many people as a bad flu would. The difference being that bad flus kill children too, whereas Covid in Spain has killed just 2 people under the age of 20 and 10 under the age of 30.
So what should the USA do to fight Covid? It should gradually lift the lockdown according to age groups. First, lift the lockdown for those under 45 years of age (without any pre-existing medical conditions). Though those under 45 do get infected, it is extremely rare that someone without pre-existing conditions die from Covid. Especially with the caveat that the very few under 45 who might develop severe cases of Covid would have access to medical care. In order for the health system to be able to provide medical care to this age group not in lockdown, a complete lockdown with food and medical deliveries to all other age groups over 45 (who represent 99% of the fatalities) must be ensured. Younger people who live with people over 45 will have to be homeschooled for another month until the lockdown for those aged 45 to 65 is lifted.
Achieving herd immunity for those under 45 makes sense because of the incredibly low death rates in that group. Next, the question would be, what to do with those aged 45 to 65? These individuals are a key engine to the economy and an age group that does die more frequently from Covid than from the regular flu. In my view, they would have to wait for those younger than them to obtain herd immunity. This 45 to 65 age group would continue lockdown for another month after those under 45 have become immunised. Once this group’s lockdown is lifted, they will find themselves among two groups of people: older ones, who are still in total lockdown, and unable to infect others, and young ones who have become immunised. This 45 to 65 age group will also find an unburdened health care system as those over 65 have not required it for Covid and those under 45 have already been through the worst.
And what should be done with people over 65? This is an unresolved issue. In Spain, the average age of mortal victims is 80. Therefore, a month after those under 65 have been exposed to coronavirus, the lockdown of those between 65 and 75 should also be lifted. Having said this, I don’t see a way for those over 65 to safely leave lockdown until we have a vaccine or effective treatment. In Europe, it is very rare for Covid to kill a healthy, young person. Even though it has happened, it is extremely rare. We don’t know why this occurs: some speculate it is because of certain genetic predispositions, or because of viral load. What we do know is that once infected with Covid, the chance of dying for this age group is the same as your chance of dying in the next 2 years. So for example, if you are 30, the chances of dying from Covid are the same in the weeks after the exposure as the probability of dying between the ages of 30 and 32 for any medical reasons. And that probability is very low. However, if you are 80, the chances of you dying between the ages of 80 and 82 are quite high, and are similar to the ones that Covid patients of that age have. Therefore, there is no safe way to recommend that a 75 year old come into contact with the rest of society openly. Though this same 75 year old could lead a life where an App based system puts her in contact with those who are already immunised. If my recommendation is followed, there will be plenty of immunised people by the time 75 year olds leave lockdown.
Given the lethality of Covid, if our objective is to save the most lives, why not just keep everyone on lockdown indefinitely? Because the economic devastation of staying indefinitely in lockdown will kill many more people than Covid. Health does not only mean not getting Covid, it is also means not dying from everything else that could occur during lockdown: cancer, heart disease, suicides, murders. The only reason to keep everyone in lockdown would be if we believe that a vaccine is around the corner. But that is not the case. We don’t have a vaccine nor do we have an effective treatment for Covid.
I would like to end with some data on the Covid mortality rate, mixing Imperial College estimates of those infected of Covid with data obtained from the Spanish national Health system, Sanidad, regarding Covid deaths by age group. Imperial College estimates that in a country like Spain for every diagnosed case, there are 50 undiagnosed cases of people who have are asymptomatic or whose symptoms were not severe enough to get tested. This is reasonable because in Spain or Italy your symptom have to be very severe to be tested. In Germany testing is more common and that is why the mortality rate is much lower. Around 10 times more people are diagnosed in Germany than in Italy and Spain, hence the mortality rate of these Southern neighbours is 10% that of Germany. We can therefore estimate that the mortality of Covid in Spain is insignificant for people under 45 (with a total of 47 dead of that age group which is much less mortality rate than a regular flu). It is also very low for those under 65 (a total of 800 deaths for 7 million infected). And it is quite lethal for those 65 or over (a total of 11,200 deaths out of 7 million).
I imagine that when you read that the USA should now consider a lockdown only of those over 45 and the rest should lead mostly normal lives treating Covid as a normal flu (staying home if they are sick, going to the hospital if needed but otherwise taking their children to schools and going to work) you will think that I am exposing that younger population subgroup to tremendous danger. I do hope that after you read this data, you will agree with me.
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Forecasts are a risky business but in this moment of isolation and anxiety I want to share my optimism on the pandemia for Spain. This work is inspired by frantic reading about the pandemia since I first posted about its risks on January 27th and my work for the Spanish government at Coronamadrid.com.
Covid-19 Forecast for Spain
One week from now daily deaths will be down from the around 900 of yesterday. This week we will see peak daily deaths and peak hospitalizations. We will have spare hospital capacity in two weeks and enough supplies including masks.
Two weeks from now Spain will stop some of the most unusual and restrictive isolation measures like never allowing children out and forbidding isolated walking and running. These are allowed in most of Europe now.
Three weeks from now massive testing will arrive in Spain and show that the reason we had so many deaths is that there was a high level of contagiousness before lockdown and some during lockdown. Millions will be surprised to test positive in antibody tests. We will discover that Covid is much less lethal than what we thought in terms of percentage of infected population and mostly a risk to the elderly. We will also discover that social cohesion that had given so much support and care to the elderly and made Spain a world leader in longevity, is what sadly killed so many old in this pandemia: unusual level of contact between young and old.
Four weeks from now lockdown will end for those of working age. Schools will reopen. Those over 70 will remain in isolation as they make 90% of the deaths.
Social distancing and mask wearing will continue until June. Outdoor life will help lower contagiousness.
Weekly testing and isolation of positives will be implemented and managed via a geolocalization app.
By early July Spain will be where Korea is now. Monitoring testing but low deaths and hospitalizations.
Thanks to isolation and implementation of the above mentioned strategies post isolation, total Covid deaths in Spain for 2020 will be around 15k to 25k which is the same or slightly more than total flu deaths in 2019 of 15k.
Spain will win the war against Covid but we will not return to full normal until a treatment or vaccine is developed by 2021.
Spanish 2020 GDP will be down 10%, tourism will be especially hard hit. GDP of 2022 will be equal to 2019 GDP. And in terms of government damage and poor thinking what Pedro Sánchez did to fuel the pandemia by allowing demonstrations and large gatherings he will do to fuel bankruptcies by making it illegal to fire workers. Hence disproportionate economic damage.
Yesterday there was dramatic nonsensical violence in two cities I love: Paris and Buenos Aires.
In Buenos Aires it was an attack of River Plate fans against Boca Juniors players injuring them and destroying the Libertadores final celebration for Argentines and football fans around the world. Now Boca players are rightly fearful that they may suffer further injuries or death should they play against River Plate in their home “Monumental” stadium. The Argentine government is unable to guarantee the safety of the players and frankly of anyone who attends.
In Paris it was the French against themselves, against one of the most beautiful parts of the most beautiful city in the world. Unexplainable violence in a protest that could have been peaceful against a fuel price increase. Demonstrators went wild destroying the cobble stoned streets, restaurants, and scaring tourism off which is an essential part of the livelihood of the French.
Why do the French and the Argentine turn to violence in situations in which most of people in most other countries don’t? Argentines fans are not the only ones that use violence, but they are the world’s most violent. French demonstrators are not the only ones who use violence, but they are the world’s most violent.
In France, in Argentina, why can’t the rest of society condemn these acts? Why can’t there be large demonstration against the use of violence by extremists? In Spain for example when ETA would violently attack there would be huge demonstrations by the rest of society in which people would paint their hands white and say “they are violent we are not”. ETA was defeated peacefully. Why can’t they gather enough peaceful Argentine football fans who can defeat the small minorities who are not? Why can’t there be enough peaceful French who can massively demonstrate against random useless violence? The only solution to radical violent individuals is that the rest of us show them that their violence has no place in a civilized society.
Egg freezing is becoming a must have perk among US corporates. As the founder of Prelude, the company with the most babies born out of frozen eggs, my recommendation to corporates world wide is as follows. Don’t just offer egg freezing! If you offer egg freezing alone you will be perceived as a company that just wants to retain women childless at work. If you offer egg freezing, which is a phenomenal benefit for some women, you must also offer IVF benefits to all, men and women, benefits which show that you care about helping your employees getting to be parents. And once they are, also you should offer paid parental leave and child care benefits. If you combine all four benefits, as many corporates do, then by offering egg freezing you will be seen as a corporate who helps everyone, those who are ready to be parents, those who would like to delay being parents, and those who already are parents. You will be seen as a truly family friendly company.
I am watching Merli on Netflix. Merli is a TV series in Catalan, a coming of age story. I am a citizen of Spain and have been in Spain on and off for 22 years but until tonight, I had never watched any video content in Catalan. What happened to me during the episodes binge was magical. I wish all language learning was like that. On episode one I was constantly reading the Spanish subtitles and could not understand much. Catalan sounded very foreign. But by episode four I wasn’t reading the subtitles anymore. When I realized this, I took the Spanish subtitles off and now I am watching the rest of Merli in Catalan! I wish all Spaniards did the same. Catalan is as easy to learn as Brazilian Portuguese is for Argentines (Argentina is my native country), but while most Argentines I know understand Portuguese I don’t know anyone from Madrid who understands Catalan. This may be because as many problems as South America has, nobody wants to break their own country using their language as a weapon and Argentines just find it fun to learn Portuguese. Portuguese for Argentines is not loaded with politics, it’s just fun vacation time in a happy country.
I wonder how Catalans would react if every high school student all over Spain learned Catalan. Especially if it was done watching a story as beautiful and well told as Merli which would be perfect to keep their interest up. I think that just watching Merli at 15 with the help of a Catalan teacher over 60 days would do the trick.
Love and appreciation would be a small price to pay to save Spain. At first sight Catalan feels like a wall. Merli is a ladder to climb it step by step. Catalans feel there is no respect for their language in the rest of Spain, all Canadians or Belgians study French, why not Spaniards studying some Catalan.
Te recomiendo hacer lo mismo. Fes com jo. If you speak Spanish you are at most 90 days away from understanding Catalan. Having said this there is a paradox with Catalan. If you want to learn Catalan those from Madrid will have a big advantage over those from Mexico or Argentina. As I discovered watching Marli there are many many expressions in Catalan that come from Madrid, or from the Spanish spoken in Madrid. Catalan say words like matxacar, or mola that are meaningless to Latin Americans but very easy to understand for people of Madrid, because that is where those words come from. What helped me understand Catalan was speaking French and using not the Argentine in me but the Madrileño in me.
When I was a child we had vinyl records and CDs but no music streaming services. We had Nikon, Canon and Leica cameras and lenses slow chemical photography, no Instagram. When I was a child we had paper books, no Kindle. No Netflix, to see movies you had to go to a movie theater. When I was a child we had less experiences, but surprisingly, we also had much better quality experiences. Now we live in an era in which everything is accessible in your smartphone or tablet. But the question is, at what quality? For example, people are uploading childhoods to Instagram. But how good will those pictures look when kids grow up? Or you get Alexa to play your music and you have an endless music library with Spotify which is awesome. But the quality of that music? Can you compare an Alexa speaker to a sound systems of the 70s? And now we can watch any movie on Netflix on our iPhone, but how does that compared to going to a movie theater? What we have done is trade quality for convenience in a gigantic scale.
As a result we got a huge backlash, a back to quality movement represented by hipsters. Hipsters see that paper books read better than books on your iPad, or that vinyl records in sound better than a Google Home speaker, or that a picture taken with a reflex camera is better than your Instagram filters on your Samsung. But Hipsters miss out on what is great about mobile, access. Personally I have been thinking about the quality deterioration paradox trying to achieve both, the quality of my childhood with the awesome ubiquity of today. And I have good news here, you can get both!
Examples, we got an amazing projector in our bedroom equivalent to that of a movie theater, a remarkable sound system streaming high quality music. I have been using new digital cameras like the Sony A7 series with old Leica lenses and obtaining great digital photography results. I have been working on projects like Gramofon in which you incorporate digital music streaming to old sound systems and obtain the best of both worlds, an endless music library with great sound. I don’t want to settle for a world in which everything is plentiful but of terrible quality. I think with some work and investment, we can achieve ubiquity and quality.
The failure of education is that during 16 years students live in a world in which every problem has an answer. Then they graduate to find out that the world is not a model. That reality is more complex than any one answer. As they become adults and formal education clashes with reality the result is frequently anxiety or fanaticism. None are good choices.
Education should embrace ambiguity. Teachers should stop pretending to know it all. My father was an astrophysicist. He had a PhD from Harvard. But his best contribution to my education was to explain to me that whatever I learned was but an approximation to an answer. He was a hopeful skeptic. He thought that through science humanity’s understanding of the world would increase. I am a hopeful skeptic as well. And what I teach my seven children is that what we now call knowledge is but a temporary stepping stone to deeper understanding.
Show me a school that teaches that, I have a few kids to send them.
What Trump is doing as a conservative pro business candidate:
Rehash Obamacare without tackling the reasons why health care is so expensive which mainly are outrageous costs and margins for insurance companies, outrageous costs of drugs in the USA, artificially low amount of physicians, inappropriate meddling of liability lawyers into health care.
Attacking China our largest trade partner and biggest buyer of our debt that we need to run the huge deficits we have.
Attacking our third largest buyer of goods Mexico with an irrelevant an expensive project, the absurd wall.
Attacking the government forces that we so need to protect us from criminal activity and terrorism in the USA and abroad, the FBI and CIA.
Degrading our independent judiciary.
Insulting the press we need to keep those in power honest on a daily basis.
Increasing military costs at a time when the biggest threat we face is terrorism that is not solved by the military when the USA already spends more on the military than the next 7 powers combined.
Decreasing the funding of the agency that protects our environment.
Decreasing the funding of the State Department whose diplomacy is needed, in short showing the world that we want to spend more on guns and less on conversations.
Labelling a religion that accounts for one fifth of humanity (there are 330 million Americans and 1.6 billion Muslims) terrorists and banning many of its members from coming to the USA or making it harder for the rest. How is our economy made of 5% of the world´s population going to improve antagonizing 23% of the world´s population?
What Trump could be doing as a conservative pro business candidate:
Promote tax changes that create jobs:
Eliminate capital gains tax for anyone who uses the gains from a sale of real estate or financial assets to invest in private qualifying businesses that create jobs.
Health care changes that require going against the Pharma lobby:
Allow government to negotiate prices from pharma companies similar to those negotiated by European and Asian governments, allow importation of all medication already approved in the USA and manufactured by the same companies operating in the USA who tend to sell the same meds for half in other countries.
Go against certain environmental regulations but for a good reason:
Work with states to reduce environmental regulations for the construction of housing to alleviate the real estate tax that most Americans are paying.
Promote the construction of nuclear plants using newer and safer technologies, the best energy combinations to create a climate change free energy consumption is wind plus solar plus nuclear.
Fight the lawyer´s lobby
Cap lawsuit awards in all areas, litigation, health care.
Fight the medical lobby
Make it easier to become a doctor so in the USA we get to have as many doctors per capita as other developed nations.
Build rational infrastructure:
One example of rational infrastucture would be to build a national energy grid, this would go a long way promoting the development of wind and solar energy.
Legalize all illegal workers in the USA:
There are now 11 million illegal workers in the USA. Declare an amnesty and make those tax paying US residents. At the same time start include pictures into social security cards and turn them into a national id system like other nations have and make it much harder for employers to hire illegal workers. Increase fines for doing so. In short legalize those who are here and make it harder for others to come in not just at the border but as Europe effectively does, at the moment they try to get employed.
Fight crime via cash:
Most criminal activies require cash. A move to 100% electronic money would make the strongest hit on crime and tax evasion imaginable.
Make an alliance with China not Russia
China has a highly complementary economy to that of the USA and is 10x bigger than that of Russia. China and USA share in benefitting from a global free trade agenda.
Give basic health care to everyone, paid health care to those who can afford it
Just like we have a public school system for everyone and private schools for those who can afford it do not promise everyone to get the best level of health care and fail. Come up with a basic level of health care for everyone that will cover the vast majority of treatments but not all and then allow those who can afford it to buy better care. Also make it easier for people to chose to end their lives with dignity as most health care costs consists of end of life treatments many of which would not be chosen by patients or if incapacitated by their families. Promising every American complete choice in health care is something that USA just can’t afford but living some without health care is just criminal.
Note, this post is work in progress, I will be modifying it as I do more research. I do not point out each edit, I just improve the article.
Massive and diverse, tremendous amounts of smart ambitious people.
It is the most beautiful city in the USA with great architecture and tremendous choice for different lifestyles. Every neighborhood has a personality.
Unbeatable cultural and entertainment offer. Fantastic night life.
Great educational institutions at all levels.
Extremely well located for travel to Europe, more central than Miami or Bay Area.
It is a walkable city.
It has tremendous study and work opportunities.
Weather is awful, extremely hot, extremely cold for 8 months of the year, only 4 months of California type weather.
People put too much emphasis on themselves and their careers and less on family and friends.
Too many people are aggressive, arrogant, overworked and stressed out. Even the same people behave this way when they are in NYC and become more sensitive and considerate when they leave even to nearby East Hampton.
Taxes are extremely high and services poor.
It’s very hard to get in and out of the city, reach airports, etc.
Extremely expensive city, housing, transportation, dining, entertainment all unaffordable to many.
Too many lawyers and bankers, some are nice but as a group they are not my favorite people in the world to hang out with.
Bay Area positives:
People are brilliant and kind, a rare combination.
Entrepreneurship is everywhere, people are extremely creative and resourceful at building innovative companies.
Weather in the Peninsula is arguably the best in the world, you get seasons but not extremes, great number of sunny days.
Amazing nature, tremendous amount of green areas close to populated areas. Fantastic for outdoor sports.
Great quality of public services.
Fantastic job opportunities.
Best educational institutions in the world. Best public schools in the world, best universities.
Tremendous availability of VC money to start ventures.
The spirit of California is unique and unbeatable, anything is possible is the mantra.
Bay Area negatives:
Limited cultural and entertainment offer.
Nightlife is practically non existent.
SF weather is awful in the summer.
Incredibly isolated from the rest of the world, 6 hours to the East Coast, 12 hours to almost anywhere else in the world, if you live in California you have to love California because everything else is a day or two of travel away. If you run a global business from SF you will spend your life on a plane. Even if you run a US business you will spend much more time flying than people in NYC or Miami.
Mono thematic, if it’s not tech it’s not relevant.
If you are raising kids it is very hard to find help.
People have time for family and friends and are overall less stressed out, happy.
Fantastic weather 9 months of the year and the other 3 you can leave because kids not at school.
Unlike NYC or Bay Area everything is close to where you live. Except for a few weeks a year there is no traffic to speak of.
Fantastic night life and restaurants.
Easy to move around by bicycle or walking.
Fantastic homes and beach life.
Incredibly busy airport 15 minutes away from Miami Beach with flights to almost anywhere in the world.
Well located to travel to anywhere in the USA and Europe, Latin America and Africa. You can run a global business from here.
Affordable compared to the Bay Area and NYC.
If you are raising kids and can afford it, it is very easy to find help.
Great music, if you love music there are tons of music related events and music festivals.
Fantastic water surroundings, sailing, boating, beach life, water sports.
If you have your own professional path, and don’t depend in a city to give it to you like I don’t, living in Miami is great because when you are not working you can truly relax and have fun.
While many of your friends are probably somewhere else they all like to come and visit you.
Lack of intellectual stimulation.
Emphasis on “show off” shallow values which are bad for raising children.
People are less reliable vis a vis work.
It´s hard to recruit extremely talented people of the kind you find in NYC or the Bay Area.
Limited work opportunities.
During the summer you better find a way to get out, it’s awful.
Lack of great universities and intense intellectual life.
Lack of success stories which are so inspiring in the Bay Area and NYC.
Universities are mediocre.
Too much emphasis on real estate and tourism as the main two industries of the city.
Hurricanes and rising sea level are an imminent threat, you get a sense that this city will be the first casualty of climate change.
Miami Beach, South Beach where we are now is a mostly liberal open minded community. But in deep Florida you find alligators and their political equivalent.