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Day 74: COVID-19 Italy Has Turned the Corner
The data is starting to be compelling that Italy has reached its peak and the epidemic is beginning to recede:
Deaths are lagging indicators so that when you compare the slopes of the two graphs above they make out a distinct decline in COVID-19 cases in Italy. This, of course, does not mean the illness is over or that the deaths will not continue to mount. But it does mean that there will be less illness and death going forward.
The US, nationally, is about 14 days behind Italy. But our data is heavily skewed by the NYC area. Ironically, the peak for NYC is about 7-10 days away because they do not have a flat curve, while the peaks for other localities that have flattened the curve are some weeks away. Until people see that NYC is over its peak it will be difficult to have the real conversation: when do we let people go back to work?
Apropos of that, the latest scare is that the COVID-19 indeed can be aerosolized and that everyone should be wearing the best face-covering they can manage. But the reporting on this does not address the irony that this represents: If the virus is aerosolized then many more people are exposed/infected than cases confirmed. If many more are exposed/infected then the percentage of all persons suffering serious illness and death from COVID-19 is even smaller than currently envisioned. This changes the risk profile. It also means that simply having a comorbidity is not a death sentence as the numbers of persons with a comorbidity is very large.
That is not to say that the persons who are afflicted with a severe case of COVID-19 are not suffering greatly. There are also some number of persons (as yet undetermined) who will suffer from chronic pulmonary insufficiency even after recovery. There is no need to trivialize the severity of this disease. But from a public policy standpoint, the weighing of health harms between the disease and poverty becomes more skewed in favor of poverty just based on the numbers.
And that is where an excellent article by Craig Medred, an independent reporter out of Alaska comes in. I have referenced his reporting periodically. His latest piece is Fear fear. In it Craig outlines the evolving cost-benefit considerations of lockdowns versus other public health strategies:
“Lockdown is going to bankrupt all of us and our descendants and is unlikely at this point to slow or halt viral circulation as the genie is out of the bottle,” they wrote. “What the current situation boils down to is this: is economic meltdown a price worth paying to halt or delay what is already amongst us?”
The idea has gained some traction in the medical community, but not much. Political leaders, meanwhile, have largely gone in the opposite direction. The United Kingdom suggested it might let the virus spread enough to create what is known as “herd immunity,” but quickly backed away when some scientists and the public protested.
The Dutch suggested the same idea, backed away, but are now studying it. Meanwhile there is the suggestion from many scientists that herd immunity is in some way inevitable.
At that point, the disease becomes unable to easily jump from person to person and fades out. This is herd immunity. Unfortunately, some pathogens – most notably the flu – are able mutate and again return.
Katz and Heneghan have suggested that the best way to get herd immunity might be to shelter those vulnerable to fatal COVID-19 infections and let the disease run much like the flu in the rest of the population.
“The data from South Korea, where tracking the coronavirus has been by far the best to date, indicate that as much as 99 percent of active cases in the general population are ‘mild’ and do not require specific medical treatment,” Katz argued in his NYT op-ed. “The small percentage of cases that do require such services are highly concentrated among those age 60 and older, and further so the older people are.”
But responding to COVID-19 in this way at a population-level generally runs counter to the beliefs of Western societies that prize individuals. The mere possibility that a previously unknown disease could kill younger people – and it has – appears to terrify much of the Western world.
Thus Katz’s suggestion of an alternative approach aimed at protecting the elderly and those at risk because of ill health while putting everyone else back to work has to date gained no political support.
Whether it will ever gain serious consideration is an unknown, but there are more than a handful of scientists who share Katz’s concerns about long term problems inherent in the current strategy.
And so should we all. I am going to make a prediction: by Easter, New York will be past the peak. When that happens, but sadly not much before that, the President can entertain his initial instincts that opening up America for business again needs to happen sooner rather than later.
Italy has turned the corner. China (although its totals are suspect) has done so as well. Spain will turn the corner about the same time as New York. By Easter, most health officials will still be focusing on understanding the disease, but the picture will clearer that the health crisis is receding and the economic crisis has to take priority.
[Note: Links to all my CoVID-19 posts can be found here.]
Published in General
If only.
Fascinating new information. Wow. It really changes the picture, doesn’t it. As always, thanks, Rodin.
I’ve been watching those data at https://ourworldindata.org/coronavirus, but was going to hold off a few more days to make sure the trend continues before saying Italy has turned the corner. But yes, Italy’s numbers have been going in the right direction the past few days.
The highest priority right now should be making the antibody test available throughout the country. It would free up a segment of population who could help others, and it would identify people with helpful plasma for giving to people very sick with it.
I may have already had it, and it’s very frustrating to not be able to confirm that suspicion easily with a test. At this point, we know that millions of people have been exposed to it and don’t know it. If they could be tested and found to have antibodies, they would be free to move about without worry.
I think for the US the problem might be our large geographic area means we could suffer several successive waves of regional outbreaks. It took hold hard in New York which by next week might be on its way out of the crisis, but from there it spread out to surrounding regions and more distant regions as well. Which in two weeks might find themselves in the spot New York was a week ago. As always time will tell. But, it would be the height of folly to lessen containment strategies in places still experiencing rising infection rates just because New York is over the hump. I think for everyone outside of New York the worst is still to come. Let hope it isn’t as bad as it got there or worse.
It seems that the doubling time for NY deaths is now about 3 days, while Michigan’s is about 2.5. So yes, it could be that some of the populous states still need to pass through their New York phase. Still, we could be thinking about what controls should be continued and which we’could relax.
Thanks for the post, as always, Rodin. That’s a bold statement about Italy. The trend line has been favorable in Italy, in the reduction in the rate of increase in reported deaths (and cases), all the way back to the first week in March (even before the lockdown). But the numbers continued to mount until quite recently.
Looking at your two bar graphs, it appears that Italy’s peak in reported cases was around March 23-24, while the peak in reported deaths was around March 27-28. (These weren’t the peak days, but the peaks of an imagined curve fitting the bar graphs.)
It’s very strange that the lag between the two is only around 4 days. We’d expect something closer to 2-3 weeks. In other words, I would expect that once reported cases peaked, reported deaths would peak around 2-3 weeks later. I continue to be puzzled by this.
I’m having a hard time getting this through my head, so here’s some thinking out loud. If a region or country “turns the corner” while under lockdown or similarly harsh measures, should we not consider that the corner turning was related to those measures (certainly at least in part)? So when we try to get back to normal by removing/lessening those measures, isn’t it possible that there’ll be a “second wave”? After all, we aren’t really doing anything to the virus itself yet (e.g.,vaccine).
I’ve been thinking about a separate post on this since yesterday.
Here’s the weird thing. As far as I can tell, the reported incubation period is around 4-5 days typically (though it can range from 2 to 14). That’s the time after infection, and before onset of symptoms. I’d estimate that this means a lag of around 7 days between infection and a case report, presuming that it takes 2-3 days before the person gets tested and the result reported.
I found one data source indicating a lag of 17-19 days between symptom onset and death. (The source is a Lancet article, here.) This is quite preliminary data, based on just 24 deaths in China. I haven’t yet been able to find other data on this (any help would be appreciated).
These figures suggest a lag of 3-4 weeks between infection and death. Our friend Mendel suggested 21 days on another post, which is well within this range.
Here’s the weird thing. This lag time means that we would not expect “lockdown” measures to be effective in reducing the rate of increase in deaths until around 3-4 weeks after the measure was implemented. But this is not what has happened.
Italy implemented a partial lockdown around March 8-9 (in Lombardy on March 8, and nationwide on March 9), and tightened it a few days later. We would not expect such a lockdown to have any effect on deaths for about 3-4 weeks thereafter — which essentially means between around March 29 and now. Yet the rate of growth in reported deaths in Italy was declining consistently throughout the month of March, from around 35-40% daily growth (1st 10 days of March) to under 10% by March 29, and lower now.
I don’t see how the “lockdown” could account for this decline.
the number of serious/critical cases in Italy is 4068 as of now compared to 4053 yesterday.
I agree with @rodin that Italy has passed its peak.
@jerrygiordano, I think two things may explain this: (1) some number of people seem to present with symptoms and die with a couple of days, and (2) not entirely unrelated to (1) is that there is some indication that Italy’s epidemic case/death numbers may be overstated with people who die of other things even though they have been exposed to the COVID-19 virus.
I think “lockdowns” are only effective when applied early. Places where lockdowns are imposed only after things are out of control seem to have only marginal effect at best. Ironically, this is the same argument regarding HCQ: not a lot of evidence of effectiveness once the case gets too severe, mostly effective when administered soon after presentment of symptoms.
UK has 163 serious/critical cases as of now.
Total deaths is 3605.
Maybe their initial strategy of attaining herd immunity with no lockdown wasn’t so crazy.
The number of deaths in California is surprisingly low given:
most populous state
dense areas such as LA and SF
lots of people flying to and from China including Wuhan.
Victor Davis Hanson suspects that California may be close to achieving herd immunity or a large part of the state is immune and/or many got sick and recovered not knowing that it was covid 19.
A friend of mine in Chicago got the flu in November. He was sick for 7-10 days. In October he was staying in a hotel in NYC whose guests included flight attendants and pilots for Al Italia and China Air. I told him he probably got covid 19 and didn’t know it. He is fully recovered now.
Interesting possibility. I hadn’t thought of that one.
Which makes me think what if we avoided or lifted the lockdown and instead told people, wear a mask, maintain your distance and if you have symptoms of covid 19, take HCQ.
Woo hoo!
Maybe.
I sure hope he’s right. I live in California near SF, and I was sick in early December with a fever followed by a nasty cough. Now that I’m over it, it would be great to find out that’s what I had.
I would put little trust in the serious/critical case figures. Another stat that’s being inconsistently reported between countries, if at all.
Not so much I’m afraid. China is having to restart mass quarantine in some areas after the epidemic restarted when restrictions were lifted. And their case and death figures are probably understated by 10x or more.
We’re got to get the antibody testing widely distributed and find out where we actually stand on asymptomatic carriers who gained immunity, if we’re going to try an economic restart without having the same issues.
Powerline posted a graph displaying dates of symptom onset of US cases, which should be the most accurate predictor of the timing of future deaths. We appear to have hit the crest a few days ago, which should put our crest in deaths in the next couple weeks. That’s the good news. The bad news is we’re adhering pretty tightly to the IHME curve.
Also, amazing how that graph of symptom onset coincides so nicely with the mid-March swells in detected fevers around the country at the healthweather interactive map. Check it out if you want to get some insight into the recent fever history of your particular corner of the country.
Understatement of the year.
The data collection is flawed somehow. Either the true number of cases peaked at a different (earlier) time or there’s some other factor we’re missing.
Yeah, seems about right, except that I have no way of estimating 3x, 5x, 10x, or 20x.
Yes!
Apparently the President of Brazil believes Covid 19 is a complete hoax and is ordering his population to ignore all the warnings.
So we will have an excellent comparison of how you take 0 preparations to compare to.
In what sense does he think it’s a complete hoax? There have been 363 deaths in his country so far.
I really can’t ‘like’ that, but yeah, he’s volunteering the Brazilians as a ‘control’.
It’s possible that HCQ has been widely used, and it may be very effective. I don’t think that this has been established yet, but that doesn’t mean that it isn’t true. Your idea about an earlier, undetected peak in cases is plausible, too, though I think that it would have to imply an extremely rapid spread that was undetected.
I live in an area that is neither a hotbed of infection nor a rural outpost far from any city.
So far we have had 6 deaths “from corona virus”. All six have been over 75 years old and at least five of the six were patients in an assisted living facility. One was in hospice care.
So the question I have is: how many deaths attributed to corona virus could be coded as “this person was going to die pretty soon anyway”?
That may sound harsh at first blush but when I hear that 80% to 95% (depending on the source) of people who are put on ventilators for this disease die anyway, it makes me think about things like triage and research priorities. If a significant fraction of the people who die from this infection are near death already, the drastic societal measures are not as important as they may seem. And the acquisition of more ventilators are not as important as it seems.
Change my mind.