Coronavirus outbreak won't peak in every state at once(axios.com)
axios.com
Coronavirus outbreak won't peak in every state at once
https://www.axios.com/coronavirus-states-peak-hospitals-53274e0e-69b8-4dc7-b069-fb27955c559a.html
54 comments
These IHME predictions are actually based on deaths, not on tests. Also, please look at the wide error bars on the original data source: https://covid19.healthdata.org/projections
Of course there are still a lot of variables - one of the better criticisms is that it assumes that states lock down with the same strength, just at different dates. But it's the presentation of this Axios piece that is dangerous here: It strips out all the uncertainty estimates and presents exact numbers as if they were precise.
Of course there are still a lot of variables - one of the better criticisms is that it assumes that states lock down with the same strength, just at different dates. But it's the presentation of this Axios piece that is dangerous here: It strips out all the uncertainty estimates and presents exact numbers as if they were precise.
15 days ago was a different universe of testing capacity. Oregon had done less than 500 tests then and was still using the initial (semi-flawed) CDC tests. We've done almost 13,000 tests since then (I live in Oregon). Not to say we're doing enough yet, but it is a totally different situation today in Oregon and elsewhere:
https://www.deptofnumbers.com/covid19/oregon/
edit: that link is to a site I built to track testing capacity and new case growth.
https://www.deptofnumbers.com/covid19/oregon/
edit: that link is to a site I built to track testing capacity and new case growth.
They should be using death rates to estimate the peak, not confirmed cases. Death counts are very accurate if not perfect representation of the situation.
They're not. For a variety of reasons, many deaths are not being reported as caused by Covid-19, but rather other preexisting conditions which may have been complicated by Covid-19. Additionally, as I understand it, some number of deaths require post-mortem testing to confirm that the victim was indeed infected. Given the varied backlog of testing, the morgue backlog (or soon-to-be) and the lack of testing kits, I'd conservatively expect death counts to be lower than actual by anywhere from 10% to 150%. I wouldn't be surprised if a year from now we realize we were off by a factor of 2 or more.
You can compare normal death rates from previous years to determine if you are having excess deaths. Here is data from a town in Italy for example:
https://www.corriere.it/politica/20_marzo_26/the-real-death-...
“Nembro, one of the municipalities most affected by Covid-19, should have had - under normal conditions - about 35 deaths. 158 people were registered dead this year by the municipal offices. But the number of deaths officially attributed to Covid-19 is 31”
There are some caveats with the data of course - I.e. the town might not have any more deaths for the rest of the year since it’s burned through all the people that would have expired anyway, but it’s interesting reading.
https://www.corriere.it/politica/20_marzo_26/the-real-death-...
“Nembro, one of the municipalities most affected by Covid-19, should have had - under normal conditions - about 35 deaths. 158 people were registered dead this year by the municipal offices. But the number of deaths officially attributed to Covid-19 is 31”
There are some caveats with the data of course - I.e. the town might not have any more deaths for the rest of the year since it’s burned through all the people that would have expired anyway, but it’s interesting reading.
The Corriere article has a major flaw that it's looking at deaths from Jan onwards only.
This year is unusual in that there was no flu season, really. Deaths up until the start of COVID-19 were way lower than normal all winter.
https://swprs.files.wordpress.com/2020/03/italia-mortalita-m...
So even a disease no worse than flu, you'd expect would cause a much higher death rate than normal for this time of year, simply by shifting the curve forward six months. And COVID-19 is likely to be worse than flu.
(I say likely because the data quality here is so poor we really have no idea how dangerous it is)
This year is unusual in that there was no flu season, really. Deaths up until the start of COVID-19 were way lower than normal all winter.
https://swprs.files.wordpress.com/2020/03/italia-mortalita-m...
So even a disease no worse than flu, you'd expect would cause a much higher death rate than normal for this time of year, simply by shifting the curve forward six months. And COVID-19 is likely to be worse than flu.
(I say likely because the data quality here is so poor we really have no idea how dangerous it is)
Can you tell me what your graph is supposed to show?
Bear in mind that Nembro has a population of 11,616 according to google. That would mean an excess death rate of approx 1000 out of 100,000 if we use the 123 excess deaths from the article. Compare that to 40.2 from here: https://pubmed.ncbi.nlm.nih.gov/31401203/
Now I’m not saying that Nembro is typical or even that all my data is apples to apples, it’s just the only data I’ve found where we can compare death rates in any way. The crude death rate for the whole of Italy here: https://knoema.com/atlas/Italy/Death-rate
It’s interesting that you call the data poor - this is exactly the data we should be looking for. I’d love to see this kind of data for the whole of Italy for the last 10 years to compare to the last few months.
The other data coming in is the dangerous stuff to me. We can’t tell if someone died of covid, or simply had it when they died. Every country has different testing regimes. Ultimately the death stats will give us the full picture.
Differing perspectives welcome.
Bear in mind that Nembro has a population of 11,616 according to google. That would mean an excess death rate of approx 1000 out of 100,000 if we use the 123 excess deaths from the article. Compare that to 40.2 from here: https://pubmed.ncbi.nlm.nih.gov/31401203/
Now I’m not saying that Nembro is typical or even that all my data is apples to apples, it’s just the only data I’ve found where we can compare death rates in any way. The crude death rate for the whole of Italy here: https://knoema.com/atlas/Italy/Death-rate
It’s interesting that you call the data poor - this is exactly the data we should be looking for. I’d love to see this kind of data for the whole of Italy for the last 10 years to compare to the last few months.
The other data coming in is the dangerous stuff to me. We can’t tell if someone died of covid, or simply had it when they died. Every country has different testing regimes. Ultimately the death stats will give us the full picture.
Differing perspectives welcome.
The graph is supposed to show mortality vs the 'baseline' (good question how exactly that's calculated, looks like it's probably this one: https://www.euromomo.eu/methods/methods.html).
It shows the impact of prior flu seasons. Winter of 2016 was very bad. 2017 not quite as bad. 2018 about the same. 2019 .... gone. Trend line is below baseline and very significantly so up until the start of COVID-19. There was practically no flu season this year, which means a LOT of people survived the winter who in prior years wouldn't have done.
The problem is Corriere is ignoring that in their analysis. Deaths may be higher than expected now, but how much of that is because it was much lower than expected before?
I suspect in the next week or so you'll start seeing people doing integration on the graphs to try and figure out what the excess 'vulnerable population' was at the start of the epidemic; i.e. people who would in other years have been taken out by flu but survived this year.
The red trend line will shoot up of course. You can see the latest data point all the way at the top right, it's nearly falling off the image.
It shows the impact of prior flu seasons. Winter of 2016 was very bad. 2017 not quite as bad. 2018 about the same. 2019 .... gone. Trend line is below baseline and very significantly so up until the start of COVID-19. There was practically no flu season this year, which means a LOT of people survived the winter who in prior years wouldn't have done.
The problem is Corriere is ignoring that in their analysis. Deaths may be higher than expected now, but how much of that is because it was much lower than expected before?
I suspect in the next week or so you'll start seeing people doing integration on the graphs to try and figure out what the excess 'vulnerable population' was at the start of the epidemic; i.e. people who would in other years have been taken out by flu but survived this year.
The red trend line will shoot up of course. You can see the latest data point all the way at the top right, it's nearly falling off the image.
Lol, I didn’t even see that last point until you mentioned it.
It’s interesting data - where did it come from? I’d like to monitor it too.
It’s interesting data - where did it come from? I’d like to monitor it too.
Italian Ministry of Health
http://www.salute.gov.it/portale/caldo/SISMG_sintesi_ULTIMO....
via https://swprs.org/a-swiss-doctor-on-covid-19/ which has many links
http://www.salute.gov.it/portale/caldo/SISMG_sintesi_ULTIMO....
via https://swprs.org/a-swiss-doctor-on-covid-19/ which has many links
NB: They've since updated the graph in the PDF with a slightly different one. Oddly, the wildly high data point at the end is now gone (wtf) and the COVID-19 period is shaded blue.
Italian death statistics show nothing out of the ordinary at this time. If it's true their infection levels are now stable I don't see how these figures can take the absolutely massive acceleration required to justify current measures. It's still less bad than the flu of 2017.
Italian death statistics show nothing out of the ordinary at this time. If it's true their infection levels are now stable I don't see how these figures can take the absolutely massive acceleration required to justify current measures. It's still less bad than the flu of 2017.
For a variety of reasons, many deaths are not being reported as caused by Covid-19, but rather other preexisting conditions which may have been complicated by Covid-19
Isn't it the other way around? That deaths are being recorded as COVID-19 even when there were severe underlying conditions and the person probably died of that? The latter seems to be the more common issue.
It makes death rates meaningless. What does it mean to say someone died of COVID-19 if they were 89 and had heart disease?
Isn't it the other way around? That deaths are being recorded as COVID-19 even when there were severe underlying conditions and the person probably died of that? The latter seems to be the more common issue.
It makes death rates meaningless. What does it mean to say someone died of COVID-19 if they were 89 and had heart disease?
Deaths are partly unavoidable, but they're also partly avoidable because if hospitals have ICU /ventilator and bed capacity the death rate goes down. Once they're overrun then the death rate spikes.
Good point, may be they should use some custom heuristic that takes deaths + confirmed cases + fudge factor.
Testing will also peak out at the state's capacity to test, whereas people will have a hard time hiding dead bodies, so I think some numbers are better for forming a stable picture.
Number of new cases in Oregon
is flat to slightly down in the past six days...
3/25 57
3/26 50
3/27 98
3/28 65
3/29 69
3/30 58
These are new case numbers. Data source: https://weather.com/coronavirus/l/3e056a178cd9fcb8c8efaa5819...
weather.com case numbers for oregon
3/25 57
3/26 50
3/27 98
3/28 65
3/29 69
3/30 58
These are new case numbers. Data source: https://weather.com/coronavirus/l/3e056a178cd9fcb8c8efaa5819...
weather.com case numbers for oregon
I think the point is if testing is tightly constrained you can't know much about how many cases you really have.
We'd actually want some kind of randomized survey testing in an area to understand the prevalence there, and do it over time to understand the arc, but we aren't doing that -- we still can't test all the people who have a need for am immediate test.
We'd actually want some kind of randomized survey testing in an area to understand the prevalence there, and do it over time to understand the arc, but we aren't doing that -- we still can't test all the people who have a need for am immediate test.
Testing is not that constrained. Here you can see stats for both positive and negative: https://covidtracking.com/data/state/oregon/
Oregon is doing roughly 1400 tests/day, with ~5% positive rate. Places that are more testing constrained see 20+% positive.
Oregon is doing roughly 1400 tests/day, with ~5% positive rate. Places that are more testing constrained see 20+% positive.
Something that surprises me is that while family infection has been identified as an important factor to viral transmission to the elderly, we haven't converted hotels into isolation units and given people hotel credits to spend.
how is a hotel an isolation unit? there are little to no cooking and food storage facilities or others washing facilities in hotel rooms. so your hotel credit now also has to cover 3 meals a day if it is to effectively work as an isolation unit. these must be delivered to residents by someone who could then transmit the disease to lots of elderly at once. these would become defacto old people's homes/care homes but with untrained staff.
Young people would be isolated from their families if sick, and they'd be brought food without contact from staff. Having people cook for themselves is very dubious, so any place that would serve for isolation must also have a kitchen and staff. Staff, boarding, and food -- where would these places be across different cities?
Singapore and other nations are doing the same for foreign travelers and citizens.
Where are you getting this information that this strategy would turn hotels into untrained elderly care facilities?
Singapore and other nations are doing the same for foreign travelers and citizens.
Where are you getting this information that this strategy would turn hotels into untrained elderly care facilities?
The differences between some neighboring states is really interesting. Ohio and Michigan have similar population sizes and demographics, but Ohio is projected to be in good shape at peak, while Michigan is trending towards disaster already.
I'd like to see this data alongside a timeline of when governors and mayors made the decisions to close schools and businesses. Would be interesting if even a delay of a few days made a difference in flattening the curve.
I'd like to see this data alongside a timeline of when governors and mayors made the decisions to close schools and businesses. Would be interesting if even a delay of a few days made a difference in flattening the curve.
This is all just a matter of timing. Doubling time for the spread seems to be around 5 days.
To demonstrate the numbers:
Time 0 - 5,000 peak cases needing ICU
5 days later - 10,000
10 days - 20,000
15 days - 40,000
In an area that has let's say 5,000 ICU beds, those 15 days are the difference between having just enough beds+ventilators, or having only enough beds+ventilators for 1 in 8 critically ill patients.
Imagine a photo of a hospital dealing with situation 0 vs situation 15 days later. Yikes.
To demonstrate the numbers:
Time 0 - 5,000 peak cases needing ICU
5 days later - 10,000
10 days - 20,000
15 days - 40,000
In an area that has let's say 5,000 ICU beds, those 15 days are the difference between having just enough beds+ventilators, or having only enough beds+ventilators for 1 in 8 critically ill patients.
Imagine a photo of a hospital dealing with situation 0 vs situation 15 days later. Yikes.
Original source:
https://www.medrxiv.org/content/10.1101/2020.03.27.20043752v...
Actual detailed predictions by state:
https://covid19.healthdata.org/projections
https://www.medrxiv.org/content/10.1101/2020.03.27.20043752v...
Actual detailed predictions by state:
https://covid19.healthdata.org/projections
It seems like the most critical time to shelter in place is one or two weeks before the date predicted, considering the lag time between peak number of infections and peak medical resources used.
the peak occurs because transmission has been stopped. the reason you come to that conclusion is because the incubation period is 14 days, so once you get widespread isolation/quarantine/shelter in place of the population, then the peak will occur 14 days later. if you dont isolate then your peak is only reached when there are no more hosts, either through killing them off or herd immunity preventing further transmission. of course there would be a considerable difference in the size of the peak between these 2 methods.
so I guess I'm saying you can't say "the peak is in 2 weeks, isolate now" rather it is "if we isolate on $DATE then we will see a peak in $DATE+2 weeks"
so I guess I'm saying you can't say "the peak is in 2 weeks, isolate now" rather it is "if we isolate on $DATE then we will see a peak in $DATE+2 weeks"
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For its population, Houston and Texas for the most part has fared well so far, but I'm careful not to be too optimistic over the long term.
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Not only that but some states will probably see multiple peaks if they relax restrictions too early.
States should close their borders.
I hate to say it but I agree. RI had the right idea. NYC is a mess right now: we are still not taking this seriously. Trains are crowded, grocery stores are crowded, the Staten Island ferry is crowded, parks are crowded. In an especially hilarious twist people were crowding the piers yesterday to watch the USNS Comfort come in.
We need drastic action.
We need drastic action.
If we learned one thing with this Pandemic, it’s that basically whatever is at the edge of your mind needs to happen right away. If you think we need to close state borders, then we probably needed to have done it 2 weeks ago, let alone right now. If you think $1200 is not enough, we probably need a bill on the floor right away for another month of stimulus.
Whatever even pops into our head is already 2 weeks behind.
Whatever even pops into our head is already 2 weeks behind.
I don't recall where I saw the reference, so I can't find the link, but some notable pointed out on Twitter a few weeks ago that with exponential growth rates the time for action is when it feels too early.
That was Paul Graham
https://mobile.twitter.com/paulg/status/1237801364023017472?...
https://mobile.twitter.com/paulg/status/1237801364023017472?...
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I don't think it's something that could really be done in the US. We have a constitutional right to move freely between and among the states.
Can you quote any practicing constitutional lawyers who believe the courts will stop the federal government from restricting cross state movement during the worst pandemic of our lifetime?
Everyone I've read has basically said as long as it's necessary and temporary in a time of emergency it will fly.
Everyone I've read has basically said as long as it's necessary and temporary in a time of emergency it will fly.
That's theory colliding with practice. In theory we can't and the Republican originalists in the rural states would agree because it suits their wordview, but in practice we must because nothing else will save the urban coastal states where the Democratic "living constitution" folks live.
You'd have to go to the courts to get a transportation ban overthrown, and they'd be reluctant to intervene. By the time you were successful, the crisis would (please, hopefully) be over.
Getting 5 people on the Supreme Court to say "no let the pandemic run its course, even if it costs 10s or 100s of thousands of deaths" would be difficult.
According to this take it is well-settled law from previous epidemics that this is constitutional.
"In 1824, the Supreme Court in Gibbons v. Ogden alluded to a state’s authority to quarantine under the police powers. In 1902, the Court directly addressed a state’s power to quarantine an entire geographic area in Compagnie Francaise de Navigation a Vapeur v. Louisiana State Board of Health, where both the law and its implementation were upheld as valid exercises of the state’s police power. A shipping company in this case challenged an interpretation of a state statute that conferred upon the state board of health the authority to exclude healthy persons, whether they came from without or within the state, from a geographic area infested with a disease. The shipping company alleged that the statute as interpreted interfered with interstate commerce, and thus was an unconstitutional violation of the Commerce Clause. The Court rejected this argument, holding that although the statute may have had an effect on commerce, it was not unconstitutional. In a subsequent case, the Court made clear that at least where Congress has not taken action, it is “well settled” that states may impose quarantines to prevent the spread of disease even though quarantines “affect interstate commerce."
Pages 8-9 of "Federal and State Quarantine and Isolation Authority" by the Congressional Research Service (2014) https://fas.org/sgp/crs/misc/RL33201.pdf
"In 1824, the Supreme Court in Gibbons v. Ogden alluded to a state’s authority to quarantine under the police powers. In 1902, the Court directly addressed a state’s power to quarantine an entire geographic area in Compagnie Francaise de Navigation a Vapeur v. Louisiana State Board of Health, where both the law and its implementation were upheld as valid exercises of the state’s police power. A shipping company in this case challenged an interpretation of a state statute that conferred upon the state board of health the authority to exclude healthy persons, whether they came from without or within the state, from a geographic area infested with a disease. The shipping company alleged that the statute as interpreted interfered with interstate commerce, and thus was an unconstitutional violation of the Commerce Clause. The Court rejected this argument, holding that although the statute may have had an effect on commerce, it was not unconstitutional. In a subsequent case, the Court made clear that at least where Congress has not taken action, it is “well settled” that states may impose quarantines to prevent the spread of disease even though quarantines “affect interstate commerce."
Pages 8-9 of "Federal and State Quarantine and Isolation Authority" by the Congressional Research Service (2014) https://fas.org/sgp/crs/misc/RL33201.pdf
It really goes to show how deadly entitled individual rights can be. People in the US and in NYC in this case, whether Right-wing or Left-wing, justify going out, crowding and being selfish on the ground of their individual rights. The ACLU is challenging anti-congregation orders and there are still Trump people who refuse to comply on similar grounds. It's not even political - Americans wish to die for their freedoms.
In some European countries drones are flying around threatening fines and jail time for being out for non-essential reasons.
The individualism versus communitarian debate is in full swing, and Nature chose communitarianism.
In some European countries drones are flying around threatening fines and jail time for being out for non-essential reasons.
The individualism versus communitarian debate is in full swing, and Nature chose communitarianism.
State isn't really best level of granularity. States do provide clear lines of demarcation, which allows for good enforcement, but closing, say, CA as a whole doesn't do much.
You'd really want to go as granular as possible, which is what these stay-at-home orders are about.
You'd really want to go as granular as possible, which is what these stay-at-home orders are about.
With what manpower? States are not set up to have borders closed, there are hundreds if not thousands of small roads to handle, and cases where entire cities straddle land borders.
Plus all the essential aspects are wide-ranging. Interstate goods transport still needs to occur. I know someone who works an essential job in sewer treatment across a state border. What sort of paperwork would he need to go back and forth for that, and what sort of commute time issues would be inflicted with a checkpoint and/or need to re-route past blocked routes?
Plus all the essential aspects are wide-ranging. Interstate goods transport still needs to occur. I know someone who works an essential job in sewer treatment across a state border. What sort of paperwork would he need to go back and forth for that, and what sort of commute time issues would be inflicted with a checkpoint and/or need to re-route past blocked routes?
I’d make things even simpler. If you don’t have a long haul truck, you’re not moving between states.
For essential work, I have no answer.
For essential work, I have no answer.
There are cases in places as remote as central Alaska at the moment. The virus is everywhere, and continuing business-as-usual anywhere is the problem (i.e much of the South and central US), because each state not sheltering in place has its own huge internal transmission vectors.
IANAL, but AFAIK, that would be a violation of the Constitution for the United States. In fact, I think Governor Andrew Cuomo of New York threatened to sue another governor (was it Rhode Island, Vermont, somewhere else?) for attempting to close their borders to cars with NY license plates.
First, let's get every state to order a lockdown and restrict all unnecessary movement and congregation. We aren't even there yet. If people have cause to cross state lines (some people live right on state borders, for example) they should be able to. If people need to travel to a relative, they should be able to.
Remember, we are not trying to kill off the virus with social distancing. We are only trying to dramatically slow the transmission rate. We are succeeding in places that have reasonable shelter at home orders. We need to expand these types of orders to the entire country. Then, closed borders should not be necessary.
Remember, we are not trying to kill off the virus with social distancing. We are only trying to dramatically slow the transmission rate. We are succeeding in places that have reasonable shelter at home orders. We need to expand these types of orders to the entire country. Then, closed borders should not be necessary.
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Logistically it's almost impossible. you know how many side roads there are between NY, NJ, PA, CT, VT, Mass, etc? Tons! What we need is a national quarantine. The President needs to go on the air, tell people he was wrong, the situation is more serious than he thought, and we need to stay home for at least the next 4 weeks, until further notice. That will never happen though.
That defeats the purpose of this being a single United nation. Do you really think it would be healthy to artificially accelerate the rapid fracture of our collective unity?
E pluribus unum. We stand together, or we fall apart. At least, figuratively...it's probably not a good idea to stand too close together at the moment.
E pluribus unum. We stand together, or we fall apart. At least, figuratively...it's probably not a good idea to stand too close together at the moment.
Given those kind of inputs, how can one say with any confidence when Oregon will peak, and how large that peak will be?
Other states have much better testing and thus can be more confident in their predictions. Some have worse. For most, however, I get the impression that this kind of modelling is somewhere between a wild-assed guess and a crapshoot.