COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.

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STRATEGY: COVID-19 outbreak at White House reminds us this is an asymmetric war
White House COVID-19 breakout is a reminder that the virus only has to be lucky once…
I gave this some thought over the weekend, and my biggest takeaway from the White House COVID-19 breakout is a reminder of the asymmetric war we are fighting against the virus.  Former Secretary of Defense Donald Rumsfeld summarized it best when he said the following about terrorists:


COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: RAND Corporation — I could not find the Rumsfeld quote.


– In other words, the virus only needs one lucky entry into our body and we have the virus. 


Despite the extensive COVID-19 mitigation protocols used by the White House and extensive testing, there is an outbreak.  I don’t agree with those who say the White House has been careless.  Their approach to mitigation was testing, testing, testing and if I recall, wasn’t that prescribed by those so-called experts?

Instead, let’s face it.  COVID-19 is a mysterious disease.  And people catching this are unfortunate because the virus got “lucky” — I think it really borders on self-deception and frankly, a bit contemptuous to blame those catching COVID-19.  Even if we wear masks, we are not 100% safe.  The only way we will be 100% safe is when we have a vaccine or a sure-fire therapeutic. 


In fact, look at the protocols used by Vladimir Putin to avoid COVID-19.  He has an extensive physical barrier before anyone can enter his inner circle.  And those who want to meet him must quarantine for 14 days.  This seems very effective.  But also, this reminds us, most of cannot actually practice this — I cannot require 14 days quarantine from anyone I interact with.  

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


https://nypost.com/2020/10/03/these-are-the-measures-vladimir-putin-takes-to-avoid-covid-19/

Only good will come from this White House outbreak… yup, hear me out again…


I know this is going to sound like a “half-full” view again, but I only see positives from the COVID-19 outbreak at the White House.  Here are the reasons, not in any particular order:

– the outbreak is a result of “lucky virus” not because COVID-19 is getting stronger
– this reminds of the role that super-spreaders and super-spreader events have in this pandemic
– the attack rate of this outbreak is <10% which is consistent with prior studies — not 100% infected
– reminds us that we cannot drop our guard
– masks, while not 100% effective, mitigate risk and as Dr. Murray of IHME noted, is essentially as effective as a vaccine 
– if President Trump recovers quickly, this is a positive case for therapeutics and their important role
– the path of President Trump illness will be more clear in the next few days, but the chances of a worsening outcome are low

If I had to highlight one negative, it is this:
– if Pres. Trump standing in polls worsen, it raises the risk of a “contested election” scenario

But this Time article is a good reminder, that we should not expect the White House to change its approach…
Another positive, but I did not list above, is the potential for the White House to change its views towards COVID-19, taking a more serious approach to mitigation.  But this article by Time Magazine reminded that neither Boris Johnson of the UK, nor Jair Bolsonaro of Brazil, really changed their approach to COVID-19, despite being infected.   

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


https://time.com/5895452/trump-coronavirus-bolsonaro-johnson/


Policy-maker over-reacting would be a worse mistake — witness what DeBlasio is suggesting…
But we also do not want policymakers over-reacting and moving to shut down the economy again.  As we wrote about multiple times last week, the strict protocols used by NYC certainly did not seem to prevent a resurgence of cases.  Yet, Mayor DeBlasio is now moving forward to shut down some areas of NYC.

– I think this is a tragic over-reaction.
– As discussed in point #2, the Rosh-Hashanah surge seems to be ending across the US
– This is a good thing, as this surge does not seem to be leading to an exponential rise in cases

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: twitter.com

In fact, the number of NYC residents getting checked-into a hospital, aka gross hospitalizations, is actually falling.  This was 600 in early October and down to 268 yesterday.  So this is cooling off.

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: NYC Health Dept.


Don’t count Trump out just yet, great chart from JPMorgan
This chart compares market betting odds of a Presidential win for Trump in 2016 and 2020 and aligns days to election day.  Notice how Trump’s poor polling in 2020, while foreboding, is far higher than his tracking in 2016.

– too early to call the election

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.





           
POINT 1: Daily cases flattening vs 7D ago, so post-Rosh Hashanah surge slowing
Daily new COVID-19 cases came in at 36,815, which is +1,805 vs 7D ago. But this figure was likely distorted by >1,000 due to Pennsylvania reporting two days worth of cases on Sunday.

– Ex-PA distortion, daily cases are pretty flat vs 7D ago.

 

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: COVID-19 Tracking Project


Again, the daily change vs 7D ago, in our view, is the leading indicator as it is what influences the 7D moving average.

– Post-Rosh Hashanah surge seems to be ending
– This is good.  Instead of an exponential rise, we are seeing a flattening, though at a high level of cases

 

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: COVID-19 Tracking and Fundstrat 


Daily deaths are trending lower…
Daily deaths continue to trend lower and the moving average is the best since early July.  So, the surge in cases has not led to a commensurate surge in mortality.  This could change, but as we discuss below, this could change in the coming weeks.  But daily deaths falling is a good sign, nonetheless.

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: COVID-19 Tracking and Fundstrat  

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.
COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.
COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


 
Source: COVID-19 Tracking and Fundstrat




POINT 2: The post-Rosh Hashanah surge seems ending, and without an exponential rise in cases…
The surge in cases which coincided with Rosh Hashanah seems to be ending.  That is good.  This means, despite a nationwide surge in cases, it did not lead to an exponential rise in cases.  In other words, it seems stems were taken to mitigate this from happening.

– by tiers of US states, we can see that Rosh Hashanah surge rolling over on daily new cases.
– in FL, CA, AZ, TX, or states with fewer proportionate participants in Rosh Hashanah, those states barely saw a rise in daily cases

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: Fundstrat


Daily hospitalization trends show post-Rosh Hashanah surge ending…
Similarly, the net change in Americans hospitalized also seems to be rolling over.  This is shown by the same tier of states below:

– Americans net change in hospitalizations is not accelerating
– Instead, in NY tristate and 22 Tag Along states, this figure is rolling over

 

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.



Source: Fundstrat


Daily deaths, fortunately, have remained quite muted.  But we also know hospitalizations are a leading indicator of death.  So, this could easily start to rise in the next few weeks.  This bears watching.

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: Fundstrat 




POINT 3: White House breakout reminder of the role of “Super Spreaders”  (or Super spreader events)
The breakout in cases at the White House, which seemed to stem from the reception held for Supreme Court nominee Amy Coney Barrett, is a reminder of the role of super spreaders and super-spreader events.  We thought it worth highlighting again the results of a study from India.  We commented on this last week, but it is worth repeating.


One of the largest ever COVID-19 transmission studies was published last week.  The study was based upon exhaustive and intensive contact tracing of cases in India and is the largest study done so far.  The purpose was to see the factors and causes behind COVID-19 transmission.  The conclusions really interested me.  The study was published in Science magazine (Science.org article) last week.

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: Los Angeles Times


This is the study on Science.org and was led by Ramanan Laxminarayan, who is the founder and director of the US-based Center for Disease Dynamics, Economics & Policy (CDDEP) in Washington, D.C., and a senior research scholar and lecturer at the Princeton Environmental Institute at Princeton University. So, this guy has credentials.


COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: https://science.sciencemag.org/content/early/2020/09/29/science.abd7672


The scope of the study was huge. Over 575,000 individuals were contacted and are 10X largest than prior studies.

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: Los Angeles Times


70% of individuals R0 = 0, 8% of people R0 = 8 or higher….
The team found some useful insights about COVID-19 transmission.  One part confirms what we already know, but the other is quite surprising:

– 8% of individuals accounted for 60% of new infections
– 70% of COVID-19 infected were not linked to new cases

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: Los Angeles Times 


The bottom line, 8% of infected are extremely dangerous, because they are super-spreaders…
The bottom line is that 8% of infected people are super-spreaders.  In other words, COVID-19 is largely are result of super spreaders.  If I simplified this math:

–   8% people –>   60% new infections  -> R0 ~8
– 22% people –>   40% infections          -> R0 ~2
– 70% people –>     0% infections          -> R0   0

COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.

Source: senior year high school photo of Fundstrat employee (unnamed)


The research could not determine what makes someone a super-spreader but they found more evidence it is environmental, rather than based upon the biology of the person. The key environmental factors:

– proximity to infected
– length of contact
– ambient conditions


COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: Los Angeles Times  



Here is the scary thing — if someone meets a “super spreader” the attack rate is 11% — in the right settings…
This statement can easily be misconstrued.  And my own interpretation is not exactly complete.  But look at this sentence from the study:

– “secondary attack rate was 10.7%” (risk of transmission from infected to exposed person)

Yikes.  That means you have a ~11% chance of catching COVID-19 if you are near a super-spreader.


COVID-19 UPDATE: White House outbreak highlights the asymmetric war against COVID-19. Virus only has to be right once.


Source: https://science.sciencemag.org/content/early/2020/09/29/science.abd7672


Fortunately, this is termed to mean being in a risky environment:

– no PP&E
– no masks
– indoors
– exposed for a long time


So bottom line, please avoid these settings, particularly if your superpower is detecting COVID-19 infected.

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