Day 58: COVID-19 “Shelter-in-Place”

 

170 countries and territories affected worldwide. Few jurisdictions left not dealing with the virus.

But focusing today on the US: New York had more new cases yesterday than California’s total accumulated cases to date? The Times Union is placing the New York number at 1374, 1106 fewer cases than the Worldometer.com table. According to the Times Union 

Here are the latest virus numbers mapped in New York state. Please note, the figures are based New York Department of Health confirmed cases and Times Union reporting. The counts represent where the affected person is a permanent resident, not where they caught the virus.

So, what is true? Maybe someone from the Northeast can tell us what is going on. [Update: Times Union has now updated their count to 2382 which is now only 99 below the Worldometer.com tabulation.]

There was a kerfuffle between Gov Cuomo and NYC Mayor de Blasio: The Mayor said NYC residents should prepare for “shelter in place”, but the Governor said that was his call and he had no intention of ordering it.

Meanwhile, the Bay Area has solved its traffic problem.

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

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  1. Ed G. Inactive
    Ed G.
    @EdG

    Ontheleftcoast (View Comment):

    Ed G. (View Comment):
    The points remain – Italy appears to be an outlier. If we were to mirror Italy then we should have already seen tens of thousands of deaths.

    Not necessarily. Italy may have been seeded with the virus sooner and more heavily than the US. There are several times as many Chinese nationals per capita in Italy vs the US (due to One Belt One Road, among other things) and a lot of them are in northern Italy which has been particularly hard hit.

    Agreed, which would point to Italy being an outlier. Even compared to the numbers on China (4%) Italy is an outlier, as is Iran. It’s possible that China is lying about the numerator (and denominator); it’s possible that the rest of the world will catch up with bigger increases to the numerator than to the denominator. I think it’s more likely that the denominator will increase. We’ll see one way or the other – the rate will begin to solidify as would be expected for a rate. 

    Also, my comment was in response to the graph put up that in Italy there already over 1600 wuflu deaths in just several weeks vs the flu where there were only 800 deaths over 33 weeks (if that number is even accurate). That suggests that the US should have seen double the wuflu deaths in a few weeks that we saw with regular flu over the whole season. I don’t think that is happening. Perhaps it will yet, but right now it isn’t even close.

    I believe that wuflu is serious, but making faulty arguments like that doesn’t help. 

    • #61
  2. Ontheleftcoast Member
    Ontheleftcoast
    @Ontheleftcoast

    There’s this from Oxford’s Center For Evidence Based Medicine

    Estimating COVID-19 CFR

    Our current best assumption, as of the 17th March, is the CFR in > 70s is approximately 1%. In the total population, it’s about 0.125%.

    How do we arrive at this CFR figure? 

    The current COVID outbreak seems to be following previous pandemics in that initial CFRs start high and then trend downward. In Wuhan, for instance, the CFR  has gone down from 17% in the initial phase to near 1% in the late stage. Current testing strategies are also not capturing everybody: at least 50% on Diamond Princess were asymptomatic who usually wouldn’t get a test; in South Korea, considerable numbers who tested positive were also asymptomatics.  Asymptomatic people and mild cases are likely driving the rapid worldwide spread.  Early CFR rates are subject to selection bias as more severe cases are tested – generally those in the hospital settings or those with more severe symptoms. Mortality in children seems to be near zero (unlike flu) which will drive down the CFR significantly. In Swine flu, the CFR was fivefold less than the lowest estimate in the 1st ten weeks (0.1%)

    Therefore, to estimate the CFR, we used the lowest estimate, currently Germany’s 0.25%, and halved this based on the assumption that half the cases go undetected by testing and none of this group dies. Our assumptions, however, do not account for some exceptional cases, as in Italy, where the population is older, smoking rates are higher and antibiotic resistance is the highest in Europe, which all can act to increase the CFR. It is also not clear if the presence of other circulating influenza illnesses acts to increase the CFR and whether certain populations (e.g., those with heart conditions) are more at increased risk.

    And this:

    …if Chinese authorities had acted three weeks earlier than they did, the number of coronavirus cases could have been reduced by 95% and its geographic spread limited.

     

    • #62
  3. Mendel Inactive
    Mendel
    @Mendel

    Ed G. (View Comment):
    Yes, and flu kills 22,000-55,000 each year per the cdc; that’s seven(!) 9/11’s on the low end. Yet no comparisons to 9/11 and shutting down the economy over regular flu.

    You answer your own in your comment. Or to put it another way: if the flu annually kills many multiples of 9/11, why did we freak out so much more about 9/11? The simple answer is: because overall annual body count is only one factor of many determining our response.

    The other factors are: how concentrated are the deaths/illnesses in space and time? What is the potential for the number of deaths to quickly increase? How well can we predict that potential? Were we prepared emotionally for the deaths? Is there something about the cause of the death that provokes us in an unusual way?

    • #63
  4. Mendel Inactive
    Mendel
    @Mendel

    Ed G. (View Comment):
    I believe that wuflu is serious, but making faulty arguments like that doesn’t help. 

    Ed, this will be my last comment to you on this topic. While you have always been quite respectful on Ricochet, you seem impervious to well-explained arguments by numerous people and continue to insist they are faulty without seeming to grasp several fairly simple points.

    The main flaw in your arguments is that you are looking at the situation from a long-term, global perspective. That would be the proper approach after the pandemic (or any emergency situation) has run its course and we have “total” data. However, since we are likely still at an early phase of the COVID-19 phenomenon, the proper way to interpret any statistics is not to compare them to annual or national data from other diseases, but to look at them in the context of space (i.e. the communities affected) and time (i.e. weeks instead of years).

    For example, Italy is currently reporting around 3,000 deaths. That number has very different connotations if viewed as a static annual figure for the entire country, or as 2,000 deaths in one region (Lombardy) that have occurred in two weeks with no end in sight.

    Your arguments also seem to imply linear, homogeneous spread of the disease with a similar time of onset in most jurisdictions. This is simply not the case. As the famous epidemiologst Penn Jillette once said, “exponential growth will f— up your s—-“. Only one week of the current exponential trend in the US would bring us rapidly in line with the other countries – in other words, Italy would no longer be an outlier. Hopefully that won’t occur in the US, but there is no indication whatsoever that the US would be immune without the harsh measures we are currently taking (or other widespread surveillance measures which we currently aren’t capable of).

    Be well.

    • #64
  5. Ed G. Inactive
    Ed G.
    @EdG

    Mendel (View Comment):

    Ed G. (View Comment):
    Yes, and flu kills 22,000-55,000 each year per the cdc; that’s seven(!) 9/11’s on the low end. Yet no comparisons to 9/11 and shutting down the economy over regular flu.

    You answer your own in your comment. Or to put it another way: if the flu annually kills many multiples of 9/11, why did we freak out so much more about 9/11? The simple answer is: because overall annual body count is only one factor of many determining our response.

    The other factors are: how concentrated are the deaths/illnesses in space and time? What is the potential for the number of deaths to quickly increase? How well can we predict that potential? Were we prepared emotionally for the deaths? Is there something about the cause of the death that provokes us in an unusual way?

    Mendel you’ve lost me. We freaked out over 9/11 because it was a serious act of terrorism, a serious act of war.

    Now let’s get back to my point about oranges (viruses) and leave the apples (terrorism) out of it. It wasn’t my comparison after all. Again I say: I take wuflu seriously but making arguments that are faulty (like the one using Italian wuflu numbers to justify a 9/11-like reaction when we endure far worse annually without any such calls) do not help. 

    If you’re saying that we should react, in a public health policy way, based on whether we were emotionally prepared for the deaths then I disagree. If it’s the other factors you list then my point still stands – why don’t we do this for regular flu? I’m asking for the thread that connects the seemingly disparate reactions to reason. There may be such a thread, but comparisons to 9/11, handwaiving discussions of rates, and using obvious outliers (like Italy) as models for anything don’t help.

    • #65
  6. Ed G. Inactive
    Ed G.
    @EdG

    Mendel (View Comment):

    Ed G. (View Comment):
    I believe that wuflu is serious, but making faulty arguments like that doesn’t help. 

    Ed, this will be my last comment to you on this topic. While you have always been quite respectful on Ricochet, you seem impervious to well-explained arguments by numerous people and continue to insist they are faulty without seeming to grasp several fairly simple points.

    Yes, it’s me. I’m the impervious one. You’re right, I just don’t grasp your fairly simple yet unquestionably correct points. My questioning of the comparison to 9/11 is way out of bounds because it’s not faulty or irrational at all. Nope, it’s not apples and oranges after all. Same with my questioning of the graph implying that wuflu deaths in Italy after only a few weeks were already double regular flu over 33 weeks and that we could extrapolate to the US from this; well now that I grasp your fairly simple points I suppose we better start digging graves for at least 44,000 dead Americans in the next couple days. 

    Yeah, It’s me.

     

    • #66
  7. Ed G. Inactive
    Ed G.
    @EdG

    Mendel (View Comment):
    The main flaw in your arguments is that you are looking at the situation from a long-term, global perspective. 

    No. I’m looking at and responding to specific arguments presented on the thread and pushing back on them. That’s it. I’m not going to just nod along in agreement when it doesn’t actually make sense even if it’s ultimately a reasonable response. The explanations matter. We’re not an authoritarian regime, and our collective response through government deserves deliberation and discussion. Faulty arguments do not help; if not faulty, excatly, then treating speculation as data doesn’t help either. 

    Otherwise, as I’ve said, I take wuflu seriously. I don’t actually know what the correct response is. I do know that there is a big range between doing nothing and increasingly drastic restrictions of movement and economy. I do believe that even with low serious/death rates of those infected that if there is an unusually high spread rate that even a low death % means many more dead than we’ve seen. I do suspect an element of irrational panic is affecting decision making; I don’t know to what degree. I do suspect that some quarters are determined to not waste this crisis and are gladly leading us down an authoritarian path; I don’t know to what degree or even if any of it temporarily aligns with proper public heath policy. 

    • #67
  8. Ed G. Inactive
    Ed G.
    @EdG

    Mendel (View Comment):
    For example, Italy is currently reporting around 3,000 deaths. That number has very different connotations if viewed as a static annual figure for the entire country, or as 2,000 deaths in one region (Lombardy) that have occurred in two weeks with no end in sight.

    Agreed, but I also think that Italy is an outlier. Per the numbers on the thread, it just is. 

    • #68
  9. Ed G. Inactive
    Ed G.
    @EdG

    Mendel (View Comment):
    Your arguments also seem to imply linear, homogeneous spread of the disease with a similar time of onset in most jurisdictions. This is simply not the case. As the famous epidemiologst Penn Jillette once said, “exponential growth will f— up your s—-“. Only one week of the current exponential trend in the US would bring us rapidly in line with the other countries – in other words, Italy would no longer be an outlier. Hopefully that won’t occur in the US, but there is no indication whatsoever that the US would be immune without the harsh measures we are currently taking (or other widespread surveillance measures which we currently aren’t capable of).

    My arguments imply no such thing. I generally haven’t talked about spread. I’ve talked about the serious/death rate mostly. 

    Every life really is valuable. I don’t minimize death, and I don’t intend to come off that way either. However, the rates are the statistics that matter first and foremost for public health decision making. Serious/death rate. Spread rate. Infection rate. 

    Italy is an outlier not because of it’s raw numbers. It’s an outlier because of the rates compared to all other countries. Saying this does not imply that the us won’t face exponential growth in infections or deaths. Again – I was pushing back on a very particular graph and a very particular conclusion being drawn from that graph. And I stand by that pushback. 

    • #69
  10. Goldwaterwoman Thatcher
    Goldwaterwoman
    @goldwaterwoman

    Mendel (View Comment):
    For example, Italy is currently reporting around 3,000 deaths.

    As of today, March 20, Italy is reporting 4032 deaths almost 800 more than China. 

    • #70
  11. kedavis Member
    kedavis
    @kedavis

    Goldwaterwoman (View Comment):

    Mendel (View Comment):
    For example, Italy is currently reporting around 3,000 deaths.

    As of today, March 20, Italy is reporting 4032 deaths almost 800 more than China.

    A point someone else was making earlier, The number of deaths in China could actually be far higher, if their “official” figure only counts people in hospitals who were among the limited number that was even tested.

    • #71
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