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Day 72: COVID-19 When Will This Be Over?
I listened intently to the President’s briefing Tuesday. This was the briefing in which the President and his team were outlining the compelling data that persuaded the President that the shuttering of businesses remain important through the end of April. The data presented were basically threefold: The alternative looks of the epidemic with and without aggressive measures, the IHME chart on epidemic projections for the US with aggressive measures, and the contrast in case growth (controlled for population) between states that started early on aggressive measures (Washington and California) with states that did not (New York and New Jersey).
@cliffbrown included the video of the briefing in his post:“I’m a cheerleader for America”
Here are screen grabs of the 3 charts:
Featured prominently in Dr. Birx’s presentation was the IHME model from the University of Washington. No doubt many people watching heard about it for the first time. We on Ricochet have been discussing it since I posted Day 68: COVID-19 Comorbidity. As has been discussed there are questions about its predictive power. But for policymakers (in the absence of a better tool), the question becomes is it plausible? Are the predictions of the IHME model plausible even though it has to be refined as more data becomes available?
The White House press corps continues to be a miserable group of ideologically driven numbskulls. If they were doing their job the IHME model would not be new to them and they would have spotted the obvious question that I pose in the title post: When will this be over? And there were hints in the presentation that the press never picked up on. First hint: in the chart that the White House put up to contrast the non-intervention versus intervention case — flattening the curve — the endpoint for intervention stretches the epidemic out in time. In other words, the epidemic burns out more quickly if you do nothing than if you try to intervene. So why would you intervene? The White House says “to save lives” but here they are being a little cagey.
Will spreading out the epidemic reduce the number of people who will die from COVID-19, all things being equal? The answer is technically “no” but all things are not equal. If you had an epidemic for which we were fully prepared with whatever efficacious treatments could be applied, then the death rate would be whatever it would be regardless of how long it went on. What was missing for this epidemic was preparation. On day one there was no universal testing protocol, no vaccine, insufficient PPE for both health workers and the public, and no maximally efficacious treatment protocol. So spreading the epidemic out in time buys us weeks to catch up as best we can. No vaccine, but better treatment protocols and improved PPE for the health workers (and the public at some point).
But in another sense the White House is completely accurate when it says spreading the epidemic out in time will save lives: It will save the lives of people in need of treatment for trauma and from diseases other than COVID-19. If the health system is broken by the demands of the epidemic, then more people die from all causes, not just the epidemic disease. What President Trump, then, was persuaded about was that we need the month of April to save the health care system. And that saving the health system was sufficiently important that the economy should be sacrificed for another couple of weeks.
The second hint about how long the epidemic will go on was in the IHME death data. Again, the chart showed the tail going out into July. Maybe today the press is digging into the data and seeing what I inserted at the top of this post: the IMHE projection of when the last death from COVID-19 will be recorded from this current outbreak.
Will the economy be shut down until no more deaths are recorded? No. The irony is that the state with the worst epidemic response will be the lead indicator that it is OK to start re-opening the economy. New York is projected to record its last death from COVID-19 on May 10; California is projected to record its last death from COVID-19 on July 1. In order to record that last death, there will be a decline in the daily growth of cases and death. For New York, it will be as pronounced in the decline as in the rise because its slope is closer to the non-intervention model. Therefore, the signal for decline will be stronger and sooner. Places like California the signal will be weaker and later.
Whether it is the IHME model specifically that the White House is looking to, or simply its plausibility that is useful, is unknown. But the model has to get better as more data is gathered. In the meantime, the shelter-in-place orders will continue. Locally our County order has been updated and extended to May 3. But…and this is a big but…the clarifications they have made as to what are ESSENTIAL BUSINESSES and what are permitted MINIMUM BASIC OPERATIONS for non-essential businesses portend broader economic activity than what the initial order envisioned.
[Note: Links to all my CoVID-19 posts can be found here.]
Published in General
What is the case for waiting until the last death is recorded?
It has been interesting to watch the IHME projections change as the data is updated each day. But there’s something I’m wondering about.
When I first looked at the charts a few days ago, one of the first things that struck me was that the “Total deaths” chart flatlined just over 84,000 at around the beginning of August. But as of today, that figure now tops out at almost 94,000, but it reaches that point in early July. In other words, they’re now predicting 10,000 more deaths than they were, but also reaching that point almost a month sooner. That’s good news and bad news, I suppose: a quicker end to the crisis, but a worse crisis in the meantime.
That sounds like the opposite of flattening the curve. Does that mean that our social-distancing measures aren’t working?
Is the answer to the lead question “When there’s a vaccine”?
Unclear what your question really is. The economy should be let loose again well before the last death is recorded. It should be let loose when it is apparent that the systems in place are adequate to meet the epidemic without aggravating the death rate from trauma and other diseases. And the virus that causes COVID-19 is now likely endemic in the US as elsewhere in the world so we are dealing with a current outbreak, not the complete defeat of the disease.
My guess is that the issue isn’t whether social distancing is working it has to do with the infection rate in NY/NJ being higher than anticipated, the medical response being more challenged there than anticipated, and social distancing not occurring in NY/NJ and some other locations.
That is why I make reference to the “current outbreak”. We have eliminated some diseases because of vaccines and minimized others. My guess is that we will be minimizing, not eliminating this disease for the future when the vaccine is available.
That sounds plausible, given how much of an outsized influence New York’s numbers have on the national totals.
You know, I’m kinda wishing they would add another view that shows the data for the whole country except New York. Not because I don’t care about New York, but because it’s such an outlier that it makes it hard to judge how things are everywhere else.
I note that the data for my own state, North Carolina, are looking better now than they were a couple of days ago, with a surplus of available hospital beds and only a modest shortage of ICU beds. Without going through all of the other states individually, it’s hard to know whether that’s typical of the rest of the country. Is this really a national crisis, or just a crisis in New York?
I just wanted to reiterate this basic Truth.
I think we will eventually have to recompute optimal population density numbers in terms of municipal services. It’s a standard of living issue more than anything else, I think.
Michigan deaths have been doubling every two days, which may be a faster rate than NY, even. I won’t be surprised if other states of similar population density end up going through a similar period when their turn comes.
I see there’s a petition drive on to close the bridges to the Cape. Never happen, but it’s a sign of the times.
It’s getting bad here. Yup. And I’m not at all sure they won’t close the bridges if the comment section in the Cape Cod Times is any indication of the mood here.
Cape Cod Hospital is officially closed to everything except covid-19 cases.
I’ve stopped watching the numbers. It’s too scary. That said, when I go to the dump, I’m seeing a lot of New York and Florida plates. We’ve known this would happen. Everyone wants to go someplace safe from this horror. I don’t blame the visitors for coming here. And I don’t blame the year-round residents for wishing they would not come here.
Dear Lord, what a mess we are in.
I’ve placed all of my hope in the weather becoming inhospitable for this virus–high humidity and temperatures above 52. I have this written on a piece of paper on my desk. :-)
I don’t like those models at all. This does not end until there is herd immunity. Social separation just delays things. Like the Spanish Flu, this Wuhan Flu will be with us until spring 2021.
I want to see a model that starts from Sept 2019 and fits deaths from flu + pneumonia + C19 and antibody survey data.
Google maintains a database of every person in the world. They have “avatars” for each person and track and model physical locations of all humans (that use Android phones anyway). That is the basis for real world modeling that can be tuned for various social spacing effectiveness. Also, masks and hand washing are better than spacing anyway.
I question any of the statistics. Everything is simply lumped together. In Illinois, Gov. Cheeseburger squeezed every last drop of emotional overload out of a report of a Chicago infant (under 1 y/o) who tested positive and who died. No idea whether the cause of death is the virus, no information regarding anything about the kid. All of that is apparently “under investigation.” But now any statistic is juicy if you can craft the message. How many people who test positive are in ICUs, how many are home, etc. The line I keep hearing is that death “X” is “associated” with COVID-19. Lies, <redacted> lies and statistics. Meanwhile I stay at home. Dutifully.
Once we hit the peak death rate, we will have enough capacity at the downward trend levels regardless. In other words , even if our system is overwhelmed at the peak, the number of critical cases will fall to the point of capacity, whichever is the limiting factor ( ventilators, beds, personnel) and since we are lagging by two weeks, there’s no way the virus can come back sufficiently to overwhelm the system with prudent monitoring. Therefore, as soon as we reach a peak – or shortly thereafter – when it’s clear, we should go back to as much normalcy as possible.
What I’m afraid of when I listen to all this concern for numbers of deaths as the metric is that no one will be willing to be accused of having “blood on their hands” which of course the media badly wants to report.
Doctors actually live in a very rarefied world, not the real world, and they are so focused on advising for health and caution ( also to not be sued) they lose nothing by advising the abundance of caution, and risk everything by advising anything less.
If New York is an outlier skewing every other way of gaining understanding of this pandemic, why are flights out of New York airports to other areas of the country not restricted, or passengers at least screened?
Isn’t this loophole likely to contribute to more infections in areas where otherwise the outbreak had been subsiding?
Or does this promote herd immunity?
Exactly this. We’re kicking the can down the road and buying time to prepare to handle it better, not to lower the numbers. As these authors ask, give us some hard truth about what happens in a few weeks when people venture back out into a world in which the virus still exists and there is no effective treatment.
For those interested.
Stanford has done a study and shown you can sanitize N 95 masks in an oven at 160 deg and 30 minutes.
They say “don’t do this at home”, but if you have no other option available it looks like it will work.
Still heavily concentrated in the Detroit area.
They are shaping the curve to delay cases that will require ventilators so that existing ventilators can be used for more Covid patients over time and more ventilators can be manufactured, ventilators being the long pole in the tent for increasing the number of intensive care beds.
Our technocratic overlords are less articulate in presenting the projected deaths and financial ruin from the severe economic hardship of their idiot plan. Protect the high-risk groups by all means, but let the disease run its course through a low risk population keeping the economy in gear. Warning signs are already blazing brightly that the stress on food production and distribution is building toward crisis, an outcome only preppers could love.
The tone implied, to me at least, in this is questionable. How would we be prepared for a virus not experienced before in the areas of testing (I can see a universal protocol, but not the specific test), vaccine, and I’m not sure about the treatment protocol? It seems some of this is still dependent on the specific virus. And the intensity in New York presents a uniqueness itself.
And on this last point and preparedness, maybe this will move HUD to totally abandon the Obama Administration policy of pushing urban density including high-speed urban rail and disfavoring all forms of rural development. I don’t know that this policy hasn’t already been abandoned but I do know I have a family member trying to build apartments in a small town that has a shortage of low-income housing and is facing enormous hurdles for any approvals for tax-credits or grants in competition with urban projects.
If we could make quick, accurate tests available in mass numbers, combined with increasing hospital/ICU capacity, that might allow us to ease the restrictions without the risk of overwhelming the health care system.
The lack of quick accurate tests has really been a problem here.
I’m a thinking there really at this point not enough reliable data to make any sort of predictions.
We don’t know how effective the testing has been. We don’t know what proportion of the population is asymptomatic . We don’t know how many have recovered. We don’t know how many have been administered the Hydroxycloroquinte cocktail and what the results of that are treatment are.
All that said I am thinking that the situation hopefully will be much clearer in the next few days. Then might be the time to make predictions, but probably not now.
That is a useful reply. I was just wondering what purpose is served by the “last death is recorded” estimates. Seems to me that peak deaths would be more important, and maybe also some indication as to whether the ride down from that peak is similar to the ride up. The “last death recorded” doesn’t seem like it would be very useful in drawing that curve.
FWIW, 28% of the cases in North Carolina are in Mecklenburg County (this is of interest to me, since I live in Union County). It looks like Meck and the surrounding counties have the largest portion of the hospitalizations in the state, which are 204 cases. There are 856 ICU beds available statewide. A number of stats for NC are here: https://files.nc.gov/ncdhhs/documents/files/covid-19/NCDHHS_COVIDDashboard.pdf
Yes, Dr. Birx expressly stated that the UW model is driven by available data, which is heavily skewed by New York and New Jersey. That was the point of the final chart showing all the states. Keep the others from spiking like NY and NJ, keep them all down to the WA or CA level at most, and the overall results shift in our favor.
Except that the numbers suggest that ventilators are the new Russia. We likely have what we will need, under the top end estimate of the UW model, today. AND. Under those same estimates, we face ICU and general bed shortages, including medical manpower shortages, perhaps. I break that down in the post linked in the OP.
NY is an outlier.
ER and ICU doctors have to give their patients hydroxychloroquine and/or remdesivir.
I have a friend, retiree, who lives in Hollywood, Florida who also travels a lot. He carries with him anti-malaria drugs such as hydroxycholoroquine. When I told him about hydrox, he said he already has it!
according to worldometer, the percent of ‘active cases’ that are considered ‘serious’, is 5% globally.
So 95% of ‘active’ cases are not ‘serious’ which (I am assuming) means no hospitalization/ventilators required.
I have also read that Dr Joe Brewer in Kansas City, MO is using hydroxychloroquine in two ways:
The first goal is to get the transmission rate under 1.
Once transmittion rate is < 1, the curve will flatten.
At that point, businesses can gradually re-open.