Day 54: COVID-19 Pandemic

 

149 countries and counting. Europe is now the epicenter of the virus, replacing China.

News updates at Worldometer.com.

Let’s take a look at some good news:

Here are South Korea’s charts —

Our hope (and expectation) is that the US charts will eventually look like this. The only question is where the peaks will be. If you look at the last column on the main chart for South Korea the cases/million is ~160 when the flattening out is occurring. The US is currently at 7.5 case/million. If our path follows S. Korea then we can expect to have over 50,000 confirmed cases before we get flattening. If S. Korea is flattening then I am calculating their death rate is 1.7% of confirmed cases (current deaths (72) plus daily rate of 5 deaths for next 14 (70) days divided by current reported cases (8,086)). If we can flatten at the 50,000 case point with a 1.7% death rate we will suffer ~850 deaths before the number of cases and daily deaths begin to recede. I don’t know whether any public health official will adopt this line because there are too many variables between what S. Korea and the US can or will do. But S. Korea has the drive thru testing that the President announced yesterday, so we are getting ready to mobilize a response more in line with S. Korea and hopefully will get a similar epidemic pattern (scaled for population) and restore confidence that this is nationally survivable although personal tragedies will occur.

[Note: Links to all my COVID-19 posts can be found here.]

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  1. Al French Moderator
    Al French
    @AlFrench

    So, peak in about a month?

    • #1
  2. EHerring Coolidge
    EHerring
    @EHerring

    Went to your source for Diamond Princess numbers, a case with known denominators. The ship can carry 3,074 (2,670 passengers plus crew). 696 tested positive. 7 died.

    • #2
  3. tigerlily Member
    tigerlily
    @tigerlily

    Hi Rodin. Don’t know if you’ve seen this. Sharyl Attkisson has tabulated the first 48 deaths due to the virus here in the US including location, age, sex and as best as possible existing health condition. According to her data, so far only older and/or already unhealthy people have died from the virus.

    • #3
  4. Rodin Member
    Rodin
    @Rodin

    tigerlily (View Comment):

    Hi Rodin. Don’t know if you’ve seen this. Sharyl Attkisson has tabulated the first 48 deaths due to the virus here in the US including location, age, sex and as best as possible existing health condition. According to her data, so far only older and/or already unhealthy people have died from the virus.

    Yes, there is a difference between contagion and mortality. A lot of people will be infected, but healthy young and young-ish people will survive. The blocking visits to nursing homes is a critical strategy because those individuals are at very high risk. What still isn’t crystal clear is precisely what underlying conditions are indicative of greater risk of needing medical intervention to prevent death (if possible). I have read that the COVID-19 is an “inflammatory” disease, so that any underlying condition where adding inflammation puts you at risk of respiratory or other organ failure, is the key underlying condition.

    • #4
  5. Kozak Member
    Kozak
    @Kozak

    Al French (View Comment):

    So, peak in about a month?

    South Korea did everything right.

    We haven’t.

    Look to Italy, not SK for a glimpse at our expected future.

    • #5
  6. Rodin Member
    Rodin
    @Rodin

    Kozak (View Comment):

    Al French (View Comment):

    So, peak in about a month?

    South Korea did everything right.

    We haven’t.

    Look to Italy, not SK for a glimpse at our expected future.

    @kozak, the purpose of citing the SK data is to set expectations for how bad it will get under the best conditions. One can hope.

    • #6
  7. WillowSpring Member
    WillowSpring
    @WillowSpring

    Thanks again for the work you do in putting these posts together.

    • #7
  8. Old Bathos Moderator
    Old Bathos
    @OldBathos

    Can anybody point to some sources to ascertain what the CDC did or did not do based on the lessons of MERS and SARS? I am surprised how flat-footed the agency response was to this outbreak, especially as compared to the Koreans.

    • #8
  9. Hoyacon Member
    Hoyacon
    @Hoyacon

    Kozak (View Comment):

    Al French (View Comment):

    So, peak in about a month?

    South Korea did everything right.

    We haven’t.

    Look to Italy, not SK for a glimpse at our expected future.

    It’s readily apparent that you know far more about this situation than I do.

    But allow me to push back a bit on this.  Northern Italy has a direct travel connection to China/Wuhan and a concentrated population of Chinese.  In addition, the Italian government is a mess and I suspect that the organization and effectiveness of its responding bodies is, at best, very poor.

    Let’s grant that we in the U.S. have made mistakes that prevent us from being SK, but I have my doubts that the worse case scenario that is Italy is necessarily an appropriate analogy.  Certainly hoping that it isn’t.

    • #9
  10. Gumby Mark (R-Meth Lab of Demo… Thatcher
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    Italy was up 20% in past day.  Given the incubation period I expect it will be 5-10 days out before we get a sense of whether their shutdown measures are working.

    • #10
  11. Rodin Member
    Rodin
    @Rodin

    Old Bathos (View Comment):

    Can anybody point to some sources to ascertain what the CDC did or did not do based on the lessons of MERS and SARS? I am surprised how flat-footed the agency response was to this outbreak, especially as compared to the Koreans.

    I can’t answer that question, but here is a summary that was written about CDC’s MERS response. The answer may lie in differences regarding the particular viruses and the way (particularly speed) of spread. The summary includes information about internal organization and procedures. Whether there were changes in the interim that affected the response I do not know.

    The simplest explanation that occurs to me is that maybe CDC did respond exactly the way it did to MERS. And that but for the differences in the viruses (even though both members of the coronavirus family) and the reagent problems in the initial test kits, it might have gone the same way. 

    • #11
  12. Gumby Mark (R-Meth Lab of Demo… Thatcher
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    Rodin (View Comment):

    Old Bathos (View Comment):

    Can anybody point to some sources to ascertain what the CDC did or did not do based on the lessons of MERS and SARS? I am surprised how flat-footed the agency response was to this outbreak, especially as compared to the Koreans.

    I can’t answer that question, but here is a summary that was written about CDC’s MERS response. The answer may lie in differences regarding the particular viruses and the way (particularly speed) of spread. The summary includes information about internal organization and procedures. Whether there were changes in the interim that affected the response I do not know.

    The simplest explanation that occurs to me is that maybe CDC did respond exactly the way it did to MERS. And that but for the differences in the viruses (even though both members of the coronavirus family) and the reagent problems in the initial test kits, it might have gone the same way.

    A quick look at it shows some key differences – there were never any US cases and transmission seems much harder than in the case of COVID-19, so there were months to prepare in anticipation.  After this is all over I think there needs to be a hard look at both the long-term public health failures going back to post 9/11 and, in the short term, the decision making process at the CDC in January and February of this year.

    • #12
  13. Slow on the uptake Thatcher
    Slow on the uptake
    @Chuckles

    Now I have a hard question:  I have a daughter-in-law that has been reading a web site featuring Steve Bannon and as a result won’t go to church, isn’t going out in public at all, wants the wife and I to follow her lead, is convinced that if you get this virus you will have to take HIV medicine “your whole life”.  When I quote the numbers from this conversation I am told the authorities are (depending upon the country) either lying or just ignorant.  (The USA is the latter, China the former.)

    Not any reported cases in my county, reported here in Tennessee are 14 in Davidson county (Nashville) and 10 in Williamson county (just South of Nashville) [edit – theres eight more scattered around] I’m not so persuasive as many of you so – help!  Or, if you think she’s right and I should have bought more TP, tell me why.

    • #13
  14. Snirtler Inactive
    Snirtler
    @Snirtler

    Kozak (View Comment):

    Al French (View Comment):

    So, peak in about a month?

    South Korea did everything right.

    This cannot be repeated enough. If South Korea’s in a relatively good situation, it didn’t happen by magic.

    • #14
  15. DonG (skeptic) Coolidge
    DonG (skeptic)
    @DonG

    Hoyacon (View Comment):

    Kozak (View Comment):

    Al French (View Comment):

    So, peak in about a month?

    South Korea did everything right.

    We haven’t.

    Look to Italy, not SK for a glimpse at our expected future.

    It’s readily apparent that you know far more about this situation than I do.

    But allow me to push back a bit on this. Northern Italy has a direct travel connection to China/Wuhan and a concentrated population of Chinese. In addition, the Italian government is a mess and I suspect that the organization and effectiveness of its responding bodies is, at best, very poor.

    Let’s grant that we in the U.S. have made mistakes that prevent us from being SK, but I have my doubts that the worse case scenario that is Italy is necessarily an appropriate analogy. Certainly hoping that it isn’t.

    Plus they didn’t shut down for Fashion Week. 

    • #15
  16. MarciN Member
    MarciN
    @MarciN

    One case has just been confirmed on Cape Cod. So here we go. 

    I can see vividly how this evil thing multiplies. There have been 14 days of the person’s going about his or her normal life and coming into contact with 20 other people, and those 20 people over those 14 days coming into contact with 20 more each, . . . 

     

    • #16
  17. Gumby Mark (R-Meth Lab of Demo… Thatcher
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    France and Israel have announced they are shutting down all non-essential stores.

    • #17
  18. DonG (skeptic) Coolidge
    DonG (skeptic)
    @DonG

    Rodin (View Comment):

    Old Bathos (View Comment):

    Can anybody point to some sources to ascertain what the CDC did or did not do based on the lessons of MERS and SARS? I am surprised how flat-footed the agency response was to this outbreak, especially as compared to the Koreans.

    I can’t answer that question, but here is a summary that was written about CDC’s MERS response. The answer may lie in differences regarding the particular viruses and the way (particularly speed) of spread. The summary includes information about internal organization and procedures. Whether there were changes in the interim that affected the response I do not know.

    The simplest explanation that occurs to me is that maybe CDC did respond exactly the way it did to MERS. And that but for the differences in the viruses (even though both members of the coronavirus family) and the reagent problems in the initial test kits, it might have gone the same way.

    Yes.  The spread was low for SARS and MERS.  Or at least the detection was low for SARS and MERS.  It is likely that many recovered without ever being tested.  This variety of Corona virus seems to spread as well as normal flu, which is different.   The linked article shows that it took 24 months to accumulate 200 cases of MERS, that is a slow burn.

    • #18
  19. Rodin Member
    Rodin
    @Rodin

    Slow on the uptake (View Comment):

    Now I have a hard question: I have a daughter-in-law that has been reading a web site featuring Steve Bannon and as a result won’t go to church, isn’t going out in public at all, wants the wife and I to follow her lead, is convinced that if you get this virus you will have to take HIV medicine “your whole life”. When I quote the numbers from this conversation I am told the authorities are (depending upon the country) either lying or just ignorant. (The USA is the latter, China the former.)

    Not any reported cases in my county, reported here in Tennessee are 14 in Davidson county (Nashville) and 10 in Williamson county (just South of Nashville) [edit – theres eight more scattered around] I’m not so persuasive as many of you so – help! Or, if you think she’s right and I should have bought more TP, tell me why.

    @slowontheuptake, in fairness to you daughter-in-law no one knows for certain how this is going to go. Governments do have incentives, and rightly so, to characterize things in a way that projects confidence and not panic. So do they lie? Of course. The best thing I can recommend is the concept of scenario planning: you imagine several different ways things can go and then (1) focus on what concrete steps are appropriate in all of them, (2) avoid actions that don’t work out in any of them, and (3) select additional steps that work in more than one of the most probable scenarios as you envision them. If you engage your daughter-in-law in this process there will be clear areas of agreement with some actions she would prefer that you don’t think necessary. It is at that point that you have the discussion about how you want to live your life (accepting certain risks as more valuable than giving up the things necessary to completely avoid that risk). I have a conspiracy-minded sister who I can agree with on a certain level of preparation as prudent for many different potential futures. I just am not going to find and lock myself in a bunker.

    • #19
  20. Rodin Member
    Rodin
    @Rodin

    Gumby Mark (R-Meth Lab of Demo… (View Comment):

    France and Israel have announced they are shutting down all non-essential stores.

    Yes, France’s daily numbers are now in that are missing from the post’s screen grab:

    808 cases and 12 deaths overnight. 

    • #20
  21. ctlaw Coolidge
    ctlaw
    @ctlaw

    The East Asian countries can throttle the epidemic for reasons the West can’t/won’t. They have massive stocks of masks and the will to wear them.

    Largely out of politeness, East Asian people routinely wear light duty surgical masks to avoid infecting others via spittle. Due  to Chinese pollution and dust storms as well as flu and other diseases, they also have a large stock of N95 or better protective  masks. Singapore, Japan, and now the RoK have really cut the spread once the disease became known and mask usage,etc. went up from something like 10% to 100%.

    Trump should have been giving a press conference with everyone wearing surgical masks and giving instructions on  on how to make your own masks using a pillow case, coffee filter, rubber bands and a stapler.

    • #21
  22. ctlaw Coolidge
    ctlaw
    @ctlaw

    Here’s the LA times In January telling us not to worry.

    https://web.archive.org/web/20200124230310/https://www.latimes.com/science/story/2020-01-24/china-coronavirus-panic

    Their graphic does not include Hawaii in the US.

    • #22
  23. Saint Augustine Member
    Saint Augustine
    @SaintAugustine

    https://mises.org/wire/markets-vs-socialism-why-south-korean-healthcare-outperforming-italy-covid-19

    • #23
  24. Rodin Member
    Rodin
    @Rodin

    Saint Augustine (View Comment):

    https://mises.org/wire/markets-vs-socialism-why-south-korean-healthcare-outperforming-italy-covid-19

    Very interesting.

    • #24
  25. Kozak Member
    Kozak
    @Kozak

    Hoyacon (View Comment):
    Let’s grant that we in the U.S. have made mistakes that prevent us from being SK, but I have my doubts that the worse case scenario that is Italy is necessarily an appropriate analogy. Certainly hoping that it isn’t.

    The data would argue otherwise…

    • #25
  26. Kozak Member
    Kozak
    @Kozak

    ctlaw (View Comment):
    Trump should have been giving a press conference with everyone wearing surgical masks and giving instructions on on how to make your own masks using a pillow case, coffee filter, rubber bands and a stapler.

    yeah. Theres evidence that if everyone wears a simple surgical mask respiratory transmission can be cut by 80%

    But we don’t have the masks.  

    Sounds like a great project to figure out what common household items could be pressed into use.

    The coffee filter or even paper towel inside would work. Need some water repellent type fabric on the outside.

    • #26
  27. Hoyacon Member
    Hoyacon
    @Hoyacon

    Kozak (View Comment):

    Hoyacon (View Comment):
    Let’s grant that we in the U.S. have made mistakes that prevent us from being SK, but I have my doubts that the worse case scenario that is Italy is necessarily an appropriate analogy. Certainly hoping that it isn’t.

    The data would argue otherwise…

    [chart above]

    I admit to not fully understanding the lag time, but are these raw numbers unadjusted for population (i.e., not cases per million)?

    • #27
  28. Snirtler Inactive
    Snirtler
    @Snirtler

    Hoyacon (View Comment):

    Kozak (View Comment):

    [chart above]

    I admit to not fully understanding the lag time, but are these raw numbers unadjusted for population (i.e., not cases per million)?

    On the vertical or y-axis of Kozak’s chart are the raw numbers of cases (not cases per million) on a logarithmic scale. Each step on the axis implies multiplying by a factor of 10. Using the logarithmic scale turns the exponential curves into trend lines for each country.

    I did something similar with Worldometer data on the number of US cases through March 12th. The top graph using raw numbers shows the exponential growth–which we would expect to taper off and halt if adequate measures are taken to curb the spread or as more and more of the population gets infected. (And by “exponential”, I don’t mean to make a panicky prediction, I’m simply describing what the curve looks like using the data I found.) The bottom graph is the same numbers expressed as log base 10.

    (Comment corrected a few several way too many times because my grammar and math are failing me)

    • #28
  29. Kozak Member
    Kozak
    @Kozak

    Ok.  An update from the ground.

    I’m semi retired and no longer work ER, I work Urgent Care  part time now.

    We were finally able to start testing for Covid as of yesterday.  Still told by Labcorp limited number of tests available.

    Criteria for testing we have are

    Travel to a high risk area (China, Italy, Iran etc) or contact with known positive

    or 

    High risk (60+ with some chronic illness) and symptoms (fever, myalgia, cough)

    or 

    Physician discretion

    Good. Finally.  About 6 weeks too late.

    Would have tested 1 patient Thursday if I could have, tested 1 yesterday, and sent 2 to the hospital for other reasons where I expected they would probably be tested.  Anyone tested has to commit to self quarantine, keep a log of all visitors and get checked on by the local Health Department.

    But seeing a lot of people with cough, fever etc with negative flu tests that don’t meet the testing criteria, and very hesitant to use the catchall “physician discretion” to avoid overloading the system.

    I hope the local Health Department is doing some random testing of younger individuals to try and get a feel for how widespread the illness is in the community.

    We now have 23 confirmed or presumptive cases in NC.  None in my county yet, but directly North and South of us in Wilmington.

     

    Now for the bad part.  

    We are already almost out of masks.  We went through almost our entire supply in a couple of days.  Ideally, everyone who enters our site wears a mask and all staff wear a mask.  Now we are at the point where we have to be selective, and soon only staff will be masked. Then ?

    We are also running out of gloves.  Those pictures from around the world of workers in Tyvek suits, googles, masks and gloves?  Don’t make me laugh, we never had any Tyvek or googles.

    When I bring this up with management they shrug and “we’re doing the best we can”.  

    I fully expect that within a week or so some of the staff will be sick and we may be forced to shut down.

    • #29
  30. EHerring Coolidge
    EHerring
    @EHerring

    Sam’s Club has food service workers’ gloves. Not the same but better than nothing.

    • #30