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Day 62: COVID-19 “Shelter-in-Place”
Today’s Worldometer.com screengrab is sorted by active cases. I think active cases rather than total cases is a better sort because total cases do not reflect the current and future challenge. And it is the current and future challenge that we need to be focused on. And we cannot assess our current strategies without context and perspective. How are we like Italy and Spain that bookend the USA on the list? How are we different? Are our critical cases fewer only based on time? Is our capacity to handle the number of critical cases seen in Italy and Spain better, worse or about the same?
The President is pulling out pretty much all the stops to deploy medical supplies and therapies to the problem. The Defense Production Act is an awesome power (and expensive) to command commercial entities to work on critical supplies and materials. The Air Force has been flying in test kits and other materials from anywhere in the world they are available.
At the same time, the Governors are closing down states for business. And it is this latter strategy that is now the focus of question of whether the “cure is worse than the disease?”
Both @drbastiat and I posted a link yesterday to Aaron Ginn’s article Evidence Over Hysteria. The website where it originally appeared, Medium, has taken it down. ZeroHedge has now published it. There is controversy over the accuracy of Ginn’s claims. But there is no controversy, in my view, over the questions he raises. As is typical, some of the most interesting information related to any post is found in the comments by Ricochet members. I encourage you to go to that post and read the commentary: Evidence over hysteria — COVID-19 [Updated][More Update].
I should also point out a second article (brought to my attention by @staugustine): A Doctor’s Assessment of the COVID-19 Outbreak. It is authored by Dr. Joel M. Zinberg, an associate clinical professor of surgery at the Mount Sinai Icahn School of Medicine in New York. Dr. Zinberg raises similar issues to those by Aaron Ginn: Are we doing more harm than good? Politicians are amateur sociologists, not research scientists. They react to the moods of the people and their own private predilections. The moods of the people are stirred by media reports that sensationalize threats. Certain politicians never let a crisis go to waste. Is it coincidental that the states taking the most extreme and authoritarian measures are led by progressives?
@jameslileks in a comment on the Ginn article summed it up pretty well:
The disconnect between “it’s going to kill fast swaths of the population and crash the health care system” and “it’s not the Satan Bug and the stats give us good reason to hope” is so wide and profound you do not know what to think. We’re all Jack Nicholson slapping Faye Dunaway here.
I do not get a gut-grip over the number of cases increasing, if that’s a result of increased testing. I watch the mortality stats. Likelihood of contraction from asymptomatic carriers, length of time between infection and manifestation of symptoms, and likelihood of how many infected will have anything other than a crappy fortnight of aches and weariness – that’s what I want to know.
Just so.
(Yes, I know that quoting James likely makes this post ineligible for “post of the day.” He is too self-effacing to designate it thus and make quoting him appear to be a strategy to gain that honor.)
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
Thank you for the periodic statistics updates. I would like more transparency in the stats, and, like most people who aren’t simply accepting over-the-top models and projections, am frustrated by the lack of both data and metadata.
Some things I’d like to know: How many tests are being administered? How are the criteria for test administration changing? How do we actually track the recovery count; how accurate is it? What are antibody tests showing about previously-recovered? How much do results from two or three urban areas skew the entire national picture?
What is the time progression of this thing? That is, if we graphed all of the cases by the number of days infected, how is the median shifting? If so few are reported as “recovered,” does that mean we have a large population of cases aging rapidly toward exiting active status?
I’d like to think the experts are tracking all of this, but fog of war and all that.
U.S. serious/critical cases went from 64 yesterday to 708 today.
I hope these graphs are good news. We’ll know more in a couple weeks. Hard to say at this point. Too early to say, obviously.
But I hope this is a good sign…
Do we know the breakdown of these cases by locality and level of care? Job #1 is to protect the health care capability. If all of the cases require ICU and in one locale that is problematic. If varying levels of care (although at least serious) and different places it remains within our capabilities.
I’m sure it’s a testing artifact.
/S.
Good question. Because worldometer does not give a state by state breakdown of critical cases I’m not sure. My guess would be it is concentrated in New York because 58 of the 86 deaths reported since the yesterday are there.
There must be an explanation, because I find the statistics inconsistent. For example,day 61 case total for the US is 22019. The total for day 62 is 27120, an increase of 5101. Yet the new case number for day 62 is 3076. What am I missing? This is not ah isolated incident, either. How are these numbers determined? Ca anyone enlighten me?
It is the time of day when the screenshot is taken for the post. Worldometer updates throughout the day, so you need to go to its website for the numbers at end of day. According to the site, The day is reset after midnight GMT+0.
For instance current U.S. count on worldometer is 30,291 or 3,ooo more than is shown in the screenshot on this post. 80% of the new cases are in New York.
Daily variations are likely going to be with us for awhile. Ginn’s article came under some criticism for his reference to Farr’s law that posits all epidemics follow a bell curve distribution. That they have a steep acceleration and then a similarly steep drop after they plateau. This criticism seems to be misplaced. Farr’s law is an observation of free running epidemic without intervention and countermeasures. Intervention and countermeasures do affect the shape of the curve. And the best arguments for intervention and countermeasures are the impact that a particular type of epidemic has on a society as a whole and the health care system in particular. The question then is not whether Farr’s law is true, or models this particular pandemic given the interventions that have taken place, but whether the strategies imposed are necessary, sufficient and proportionate to the societal threat.
It would be more helpful, when comparing countries, or even U.S. states, to have a percentage of population.
I’m starting to see some stats on that, but not enough.
An excellent summary.
After reading it, I am more convinced than ever that what is needed as much as vaccines and treatments are the tests to determine those whose genes are paired and functioning so as to make them resistant to this virus and those who have developed an adequate antibody-production response. If we could introduce that certainty to the general public, it would go a long way to calming nerves and reopening our shuttered businesses.
And lots of prayers for those confined to New York City. The odds of getting it within a quarantined area go up considerably. (I know I am wrong because the experts keep telling me I am, but my instincts are telling me, yelling at me, that quarantining people makes it much worse for the people being quarantined and therefore for the people in the concentric circles around the point of quarantine. I also don’t think I have moral right to ask people to assume that risk on my behalf. Whenever people do something that is morally wrong, it comes back to bite them someday.)
I am most interested in watching for an uptick or no uptick from the closing all at once of American colleges and universities that occurred approximately March 15.
I hope (of course they did not) they tested this group before they sent them home to all corners of the globe in one fell swoop so we we’ll be able to watch the spread of the virus in real time. :-)
If we see an uptick around March 30 in active cases around the country, it will probably be the result of more test kits being available and the dispersal of the college students that occurred March 15, most of whom would be the dreaded asymptomatic healthy carriers we’ve been talking about since day one. :-) They’ve been living and working in close quarters with people from all over the world, including the hot zones on the contagion maps.
Important point.
I think one of the most important questions in the controversial Ginn article is the issue of the asymptomatic viral shedding period. Early in the process I was alarmed about the asserted 14 day average with 27 day outliers for asymptomatic virulence. I wish I could do the math, but it should be obvious that stealth spreaders really goose the number of illnesses that will show up. So if asymptomatic spread, as Ginn opines, is really an outlier and not a feature of the COVID-19 causing virus, then the potential spread is greatly reduced. That is a key question that needs to be resolved. The media is unhelpful when a research professional uses the term “outlier” and the media portrays it as typical and likely. Researchers understand “confidence levels”, but media understands clicks and viewers.
Once someone is symptomatic two good things happen from a public health standpoint: (1) the sick person isolates, and (2) people around them are on notice to take care in their presence. Both of these things cut down on transmission enormously.
Can we get some helicopters enlisted to Airvac the serious cases out of New York City to good uncrowded hospitals with adequate PPE and ICUs? President Trump, hello, can you hear me? :-)
Has an antibody test been developed? I have yet to hear of one. This would be huge, in terms of testing much more quickly, hence an almost instant improvement of our understanding of the spread, and in developing a vaccine.
So can anybody tell me? Is there an antibody test out there?
Yes, there is. See FDA gives go-ahead to Maryland bio-firm to accept orders on their COVID-19 Rapid Antibody Test Kit.
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I’ve been noticing the same inconsistencies in these day-to-day numbers.
Please read comment #8 for explanation.
As of right now, we have 340,000 cases in the world, with 75% of those in China, Italy, USA, Spain, Germany, and Iran.
Of the 39,000 cases in USA, 72% of them are in New York, New Jersey, Washington state, and California. And within these states, the cases are not evenly distributed – it’s highly regional within each state.
I don’t know the numbers, but I know that in China, Italy, etc their cases are concentrated in certain regions as well.
So COVID-19 does not seem to be sweeping the globe like a Black Plague or something. At least, not at this point. It appears to be extremely regional, for some reason.
I’ll just make a few point here.
First, we’ve had 50 million cases of influenza in the USA this year. That’s a lot more than the 340,000 cases of COVID-19 so far on the entire planet. Obviously, that could change. But as of right now, after about 4 months, it hasn’t happened yet.
Next, we should try to learn what those hard-hit regions are doing wrong, and what we can do to avoid those outcomes in other places.
Lastly, how much of this is a management issue, in those hard-hit regions? It’s tempting to consider. China and New York City are managed by communists, and Italy is managed by Italians. That probably doesn’t help. But I’m not convinced they are to blame, for lots of reasons. We’ll see, I guess…
I don’t know – what do you think?
Completely agree.
I think this is a lot like a forest fire. We always hear on the news about how many acres a forest fire is burning, like we are now hearing the total numbers of cases/deaths.
But a forest fire can take on many different forms. Often times, wind can blow the main fire outward into numerous small fires that can give the impression that a very large area is under fire, but often times those secondary fires do not burn very hot and are either easy to extinguish or go out on their own.
On the flip side, some fires form an intense core that is so hot and compact that firefighting efforts are essentially helpless.
I think the evidence is pointing to a similar phenomenon with corona: the virus quickly spread to many places around the world, but in most of those it initially replicated only slowly. But in a few places, “community transmission” took hold and some type of critical mass was reached. And once that critical mass is achieved, even the strictest public health measures can’t do much to contain it – Italy has seen about a 50-100-fold increase in deaths since it went into lockdown.
This probably also explains why every single governor and mayor in the US is freaking out – because they’re seeing this data that says if their local infections move from a small brush fire to self-sustaining community transmission, they’re screwed.
None of us know. The situation is too fluid. Let’s revisit in a couple of weeks and we can better tell if it was just a matter of timing of which places in the U.S. were the first to have the seeds of infection planted, due to specific local factors of how it was handled, or associated with the amount of testing being done. If you track the worldometer day by day, case counts are starting to rise rapidly across the U.S., though overall totals still well less than NY. In my part of the world (Arizona) cases doubled in the past two days, though the total is still low (144). My daughter, who is an ER doc here, saw her first COVID patient Thursday night. And it’s not just urban – the Navajo reservation which covers the northeast quarter of the state is in lockdown as cases are occurring there.
It looks this way to me too.
Some State numbers From CNN- the bigger ones:
Huge moves in both NYC and NJ, and big moves in Michigan and Illinois.
—————–Sunday—–Sat.—–Fri.——Thurs. —-( gain from Sat)
New York —–15,168—–8522—- 5298—–4152 (+6,646)
New Jersey —–1914—–884—- 742 —— 742 (+1,030)
Washington—-1793—— 1524—–1376——1187 (+269)
California —— 1224?——1255—- 995——-833 ? Not sure if this is correct
Michigan—– 1035—-554 (+481)
Illinois ——— 1049——585——422——-288 (+464)
Lousiana —–837-——585——- 347 ——- 479 (+252)
Florida ——– 824——563——-426——– 384 (+261)
Georgia ——– 600——-485—–287 ——- 287 (+115)
As I mentioned in another thread, it was stuck at 64 for several days. Prior to that it was stuck at 10 for maybe over a week. During that time there were dozens of deaths. I find it hard to believe that people went from asymptomatic to death so quickly that they never registered as “serious/critical” cases.
That number at Worldometers is suspect. It may finally be correct, but in my view it hasn’t been correct for most of the Duration.
Much is made of the Italians having multi-generational family living. Is it possible that the lockdown actually forced more infected and uninfected people to stay together in close proximity?
I agree that the serious/critical column seems to be a low accuracy. As stated in the OP I am ignoring the Total Cases column as well since Active Cases already nets out recoveries and deaths.
From what I understand, the asymptomatic viral shedding (infectious but not sick) is the major question in COVID-19. The only reason for heavy social distancing is asymptomatic shedding. (Cancelling big events like conventions and sporting events is likely even without a long virus shedding period.) From what I understand, asymptomatic shedding only occurs in people who will develop some level of illness. The length of the period is the question.
By the way, any time you hear something being debated in response to the pandemic, ask them how it will directly address the pandemic or improve response. If they don’t have an answer, then reject it. I support a strong response, but the people who are trying to exploit the crisis for their own power are pathetic, sell-out, scumbags (insert CoC inappropriate terms here)
My mother told me—with, okay, a bit of an edge in her voice—that the Italians are dying because young Italians actually like their grandmothers.
“The kids like you!” I protested.
Okay: I cut her some slack. She’s bored out of her tiny, dandelion-fluffed skull by social distancing that compounds that which the elderly, infirm and terminally ill endure anyway. (Yes, she’s technically already terminally ill, but I’d still rather she didn’t have to die of Wuhan Woo Hoo.)
Okay, now the corollary to the “how do we know how many cases are actually ‘resolved'” question: what constitutes “active?”
Because “active” only nets out recoveries and deaths if we’re counting recoveries accurately. Otherwise, the only truly independent* and reliable numbers would appear to be deaths and actual in-hospital treatment. And I haven’t seen separate numbers for in-hospital treatment.
*The total case count isn’t independent of changing in testing methodology and frequency.
If you look at the data across countries it is clear they use different criteria for serious/critical cases and/or there are differing levels of completeness on reporting of such data.