Johns Hopkins CSSE Covid-19 Global Case Dashboard
arcgis.com
arcgis.com
Also, here's the John Hopkin's blog post about the dashboard launch https://systems.jhu.edu/research/public-health/ncov/
Does anyone know what the sources are for the data shown here?
I'd surmise that it was the primary source since, at the time, the spread of the virus was still contained within China for the most part.
Https://outbreak.robmellett.com
That chart shows US at 233 confirmed cases.
According to NYT, over 10x that number are self-quarantined in NYC alone [1].
Now it's technically true that those cases aren't medically 100% factually confirmed, because NYC has only performed 35 tests total so far. But it gives a very inaccurate picture of reality. Garbage in, garbage out.
1. https://www.nytimes.com/2020/03/05/nyregion/coronavirus-new-...
https://www.thestar.com/amp/news/gta/2020/03/05/person-who-a...
Garbage out, indeed.
https://www.nytimes.com/2020/03/04/us/coronavirus-new-hampsh...
A very similar test allocation might also be running in America without anyone but a few experts taking notice. Here in Germany it has technically been on the news but it was completely drowned out by the pointless shouting match between "it cannot be worse than a cold" (because it would interfere with my precious vacation plans) and "our healthcare wouldbe just as overwhelmed as in Wuhan" (because, I don't know, maybe I'm just not racist enough to assume that it will somehow only be bad in China)
They are likely waiting for tests to be privatized so then they can claim numbers can't be released because they are private.
Except deaths will be recorded, so this is going to backfire badly, ie. there will only be 1000 tests but 1000+ people will have died. The numbers are going to explode at some point, especially in Washington State
(Disclaimer: all numbers approximate, high uncertainty everywhere.)
[0] https://bedford.io/blog/ncov-cryptic-transmission/ [1] https://bedford.io/projects/ncov-phylodynamics/
South Korea has performed over 100,000 tests. NYC has performed ~ 35. [1]
I'm really curious what possible reason there could be for that. Regardless, there is no reason to believe "tested cases" is going to give a remotely accurate picture of "actual cases."
1. https://www1.nyc.gov/site/doh/health/health-topics/coronavir...
It's right in the page you linked:
> If you are experiencing fever, cough or shortness of breath, and traveled to an area where COVID-19 is spreading, call or go to your health care provider. Your provider will work with the Health Department to determine if you need COVID-19 testing.
Right now, the city is only testing symptomatic people that have been outside the country recently to one of the five nations with widespread cases, and people in direct contact with confirmed cases in the city. It's a (possibly too) conservative rationale, but it is a rationale.
[1]: https://abcnews.go.com/Politics/trump-cut-cdcs-budget-democr...
[2]: https://www.washingtonpost.com/news/to-your-health/wp/2018/0...
Certainly anyone who had that sort of ulterior motive would understand this.
They’re already refusing to test people, and I’m guessing they’ll start to blame the flu and/or fake news at some point.
They’ll probably somehow exceed my expectations, and come up with even more cynical tactics than this. For instance, I’ve seen users in other forums blame liberal china lovers for bringing the disease to the US. I wonder if they’re paid trolls or not.
https://www.cdc.gov/budget/documents/fy2020/fy-2020-detail-t...
Go browse through the weekly bulletins from 2003 regarding the SARS 'epidemic' in the US. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5218a2.htm
You'll read of the hundreds of 'confirmed' and 'probsble' cases and dire warnings and the like.
Then, when the dust settles and years pass, the CDC reluctantly admits the following: ------ In the United States, only eight people had laboratory evidence of SARS-CoV infection. All of these people had traveled to other parts of the world where SARS was spreading. SARS did not spread more widely in the community in the United States. https://www.cdc.gov/sars/about/fs-sars.html#outbreak ----
What you seem to be getting at is that a) this chart doesn't display the total number of tested cases and b) external reports of number of tested cases point to very low number of tests in the US
But that's not a reporting problem, it's a risk/cost analysis problem by the part of the responders. Yes, you could in theory test everyone in the country every two weeks, but it would arguably be very wasteful and impractical to do so, so CDC/hospitals/etc need to figure out what is the right balance as the epidemic unfolds. Whether they are doing a good job is indeed debatable, I agree.
That they’re not doing testing at anywhere near the necessary levels, while countries like South Korea are, is not “debatable,” but evidence of their failure.
Also your supposition about tracking actual cases is false. Singapore has significantly curbed the spread of the disease by doing extensive contract traces, testing, and quarantines.
Btw, I should clarify that when I said the word "debatable", I was using an euphemism.
https://www.latimes.com/science/story/2020-03-06/chaos-at-ho...
If the US isn’t deploying anywhere near the response of countries with demonstrably curbed spreads in places like Seattle and California, what do you think, explicitly, justifies this? You can’t keep appealing to some greater wisdom without providing some concrete example of it.
What you seem to be missing from my point is that things take time to do and larger bureaucratic institutions move slower. While the CDC hasn't formally stated the reasons for delays in test ramp up, it's entirely plausible that they're slow to update their analyses, recommendations and action plans because of broken telephones/bureaucracy/politics/etc. If, as the rumors go, the CDC arm needs money to make test kits but the president says "nah can't be that bad", then yeah you can bet things are gonna move very slow.
With all this said, I'm not sure why you are using the word "justify", as if the involved parties are naughty kids to be spanked. I'm not very interested in armchair judgment.
What a shitshow.
As of 3/6/2020 8:22 am PT: https://imgur.com/a/D0ICvoP
Source: https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html
You are unfair by stating it is garbage and misrepresenting what it shows (confirmed cases vs. estimated cases).
Italy is running 2500 tests a day.
Oregon has the capacity to run a total of about 40.
Georgia, with 50 tests/day and 10,000,000 people is at 0.005 per 1K people.
Oregon, with 40 tests/day and 4,200,000 people, is at 0.0095 per 1K people.
Italy, with about 2500 tests/day and about 60,000,000 people, is doing around 0.04 per thousand people. It's about an order of magnitude more.
The point isn't a pissing match between states, it's that the entire US has not responded well so far. Hopefully things ramp up, so that we stop seeing these situations where people get exposed and have no idea what's going on.
https://www.theatlantic.com/health/archive/2020/03/how-many-...
I do not know why this is, just that it's not going well so far.
The fact that Georgia and Oregon are testing at virtually equivalent rates is what's wrong.
I feel like ~50/day is an appropriate number for GA. I feel like ~50/day is not an appropriate number for Oregon (sandwiched in-between Washington and California).
The federal goverent should be doing a stronger job of quarterbacking this to allocate scarce resources.
If Oregon needs surge capacity of testing labs across the Midwest, then by god make that happen.
Some amount of testing likely needs to happen in every state in order to prevent panic, but the most resources should flow towards the places with the most known infections.
https://www.washingtonpost.com/health/what-went-wrong-with-t...
Trump fired the a big part of the CDC that deals with pandemics back in 2018 and hasn’t replaced them. I don’t think the US government will make any serious effort to contain it, despite the recent theatrics from congress.
Not testing sick people will inflate the official mortality rate. If the disease hits 70% of the population (projection from yesterday), there will be more panic than there should be. Last I heard, WHO (poor testing on average) estimated 3.4%, but in areas with thorough testing, it looks closer to 0.6%.
The stuff blaming it on Trump firing the part of the CDC that deals with pandemics is untrue too. (Though sadly, the testing might have rolled out more smoothly if he had culled the CDC a bit... their in-house facilities seem to have really screwed things up.)
I don't know if this has anything at all to do with firing the pandemic team, but you have to figure that didn't help, either.
Any administration has a lot of competent career professionals working for them. Events like this are the time to let them do their thing without hindrance, and without random commentary from uninformed leaders.
It's statistically incorrect to assume they can be merged and treated as a single data set.
What is more useful is to examine well bounded and vetted subsets of the data.
Once the South Korean cases become more mature in a couple weeks, I think we will have very high confidence mortality data.
Including poor data quality sources will just introduce biases.
So that leaves this one at 10X or more fatalities, however you calculate it.
[1] https://www.cdc.gov/flu/about/burden/how-cdc-estimates.htm
If you know that officially confirmed cases don't reflect reality, and you care about reality, then the dashboard is not useful.
I mention this because it's particularly northern Italy that's hard hit, not southern Italy. I am still planning on travelling to southern France (by car!) around Easter, and I kind of want a more precise map to know which areas to avoid.
(I also think travelling by car is a safer option, both for me and others around me. The plan is to stay at a house in the country, not a hotel.)
Nowhere in Europe is taking these actions at comparable levels, so you’re not going to be able to assess risk using something like this map.
I thought about it because I'll need to drive a long drive in two days (across France). I'm taking throwaway gloves with me...
Inside the car I'll be fine (and people outside the car too) but...
A gas station has to be one of the riskiest place to catch the virus because you are forced to touch the gas pump. And that's the same for everybody who just filled his car. Same with electric chargers for EVs. Anyone with the virus would cough, while driving, and the virus would be on one of his hand. Then that person would fill the car. Then the virus would stay there for hours?
It's a combination of two things: a great many people passing there and all these people being forced to touch something hundreds of people recently touched too. Hence the throwaway gloves.
Not to mention that if anyone in a car has the virus, it's likely that the one driving may have it on its hands (even if he's not infected ?).
I'm very mindful not to touch anything outside the house unless when I'm buying groceries (but at the grocery store when I pick, say, a thuna can, hopefully there haven't been a hundred people touching that on thuna can in the last x hours). At the gas station I know I'll have no choice.
When talking about travelling options, the alternatives are trains and buses. In a train or bus station, the volume of people is several orders of magnitude larger, and you have to be in a confined space with many people for a long amount of time.
There is no risk zero option if you need to travel, but I agree with the original comment that travelling by car looks like the safest one.
Remember: the goal for the majority of people is to help slow the spread of this to protect the vulnerable. Good hygiene goes a long way.
Even with no virus kicking around holding a fuel pump is horrible, your hand stinks afterwards!
"The lipid bilayer envelope of these viruses is relatively sensitive to desiccation, heat, and detergents, therefore these viruses are easier to sterilize than non-enveloped viruses, have limited survival outside host environments, and typically must transfer directly from host to host."
https://www.sciencedirect.com/science/article/pii/S019567012...
It's based on the national health agency figures, publied on their website: https://www.santepubliquefrance.fr/
Unfortunately, those figures are aggregated by region, which covers a relatively large geographic area. I'm not sure whether more precise information is available somewhere else.
It was produced mostly by a highschool student in WA.
https://act.nationalnursesunited.org/page/-/files/graphics/N...
I’ve seen multiple people referencing it to prove the absence of real threat in the US, which seems beyond absurd at this point.
https://www.nationalnursesunited.org/press/nurses-threatened...
And here's why it was already so close to the edge:
https://www.latimes.com/business/la-fi-verity-health-bankrup...
For crisis management and planning, you want a CFR that is comparable to something like the seasonal flu or previous outbreaks. "Confirmed" cases of respiratory illnesses are roughly equivalent to the number of people who present to a hospital with severe respiratory symptoms, minus the base rate. We don't go out and run an assay for any person suspected of having the flu, for example, especially not asymptomatic people. If you do that for SARS-CoV-2, the number of "confirmed" cases will sky rocket and the CFR will drop. But that lower CFR can't be meaningfully compared to anything else, and is pretty much useless except as a curiosity.
So it's understandable that the CDC isn't keen on widespread testing; it'll ruin the data, or at least ruin the characteristics of the data most important for crisis management. What matters now from a public health perspective is knowing whether SARS-CoV-2 is circulating. If you know it's circulating in an area, then you should just assume any respiratory illness is a SARS-CoV-2 and quarantine. Test if and only if it becomes severe and you need to know the cause for treatment.[1] You can calculate a more accurate and consistent CFR later by subtracting the base rate of presented respiratory infections from the outbreak rate.
Identifying a local outbreak does request testing, but the major problem there was a temporary problem with getting assay kits out. But going forward, it doesn't help to test people who aren't presenting with severe symptoms. At least, it doesn't help from an epidemiological perspective.
[1] However, SARS-CoV-2 causes primary viral pneumonia. By contrast, severe symptoms from seasonal flu are caused by secondary, bacterial pneumonia. There's not much that can be done for the former; for the latter you can prescribe antibiotics. So for severe cases it might just make sense to prescribe antibiotics, which would be benign for the viral infection (COVID-19) and even possibly a prophylactic for secondary bacterial pneumonia. In other words, in terms of treating a severely ill patient with a clear case of pneumonia, positive or negative COVID-19 identification might not provide any benefit.
There was also not a “temporary delay” with the kits, there is still nowhere near the necessary testing capacity and they’re throwing out absurd, false numbers like “1 million test kits” that then have to be walked back. And the whole absence of testing is because they rejected the WHO’s test kit and donations of them! We could have began testing immediately.
I’m not sure where you’re getting all this nonsense about the absence of testing being “good for the data”. Every epidemiologist I’ve seen is saying the exact opposite, e.g.:
Michael Mina, Asst Professor of Epidemiology & Immunology & physician @ Harvard School of Public Health/Medicine
> 1 in 6 positive samples in China were asymptomatic and choice was made to not report those. This information is crucial for epidemiological modeling and developing appropriate mitigating strategies. Reporting all positives as symptomatic or not should be standard reporting.
https://twitter.com/michaelmina_lab/status/12343556205575454...
Why are epidemiologists saying that testing and reporting asymptomatic cases is necessary for responding appropriately, counter to what you claim?
Yes, the data can help us more accurately estimate the rate of infections, but that'll take months or years to pin down to the precision that such fine-grained data promises. In the mean time, you can roughly determine the spread of impactful cases by the change in number of presentations of respiratory infections, just as we've done for decades.
You characterize what they're doing as stonewalling, but I'm charactering it as prioritizing. The biggest priority is collecting data on severe cases, and generally following established protocol to minimize unforced errors. The number of asymptomatic cases doesn't help you figure out how many ventilators you might need, at least not in a timely manner. The middle of an epidemic is not the time to revolutionize the practice and science of medicine. If you don't think things through carefully--i.e. the impact of false negatives and false positives of assay kits--you can easily fsck things up.
Researchers want data, but the primary concern right now is juggling medical resources and finding treatments. More data is not always helpful, especially data not directly relevant to the present task.
You're also assuming that hospitals and doctors are itching to run assay kits on every suspected case. Why, because some nurse's complaints went viral on social media? To out-do Singapore? Because "more data"? Doctors not interested in running millions of assay kits aren't going to be the ones complaining, not unless you forced them to run the tests. An assay result won't change the way you treat a patient with characteristic signs of a severe respiratory infection in the middle of a global SARS outbreak.
You can keep making these evidence-free, self-justifying claims, but that’s the sum total of what they are.
You can’t even respond to an epidemiologist saying they’re necessary to put in place appropriate mitigating strategies without espousing straw men like “outdoing Singapore” or “one nurse going viral.”
I guess all these other doctors and nurses, describing chaos in California because of the lack of testing, are just trying to “go viral” too?
https://www.latimes.com/science/story/2020-03-06/chaos-at-ho...
https://www.reddit.com/r/worldnews/comments/fcolqr/livethrea...
I personally also look at worldometer dashboard (as it usually gives source link for every count increase) from there and I find Hopkins dashboard to be lagging behind, on some countries for several days.
https://en.wikipedia.org/wiki/Template:2019%E2%80%9320_coron...
It also shows the doubling rate, which seems to be about 4 days outside China.
Obviously there are mild cases that are never diagnosed, but it seems if you get sick enough for a confirmed diagnosis, your risk is higher than generally reported.
So that death rate is likely far, far lower than what it seems. The flu kills between 15-60k people in the US every year, and it's around 1% fatality rate (and nobody seems overly concerned about that).
If you're sick enough to go to the doctor and be diagnosed with the flu, there's likely an increased chance of it being fatal (in that your symptoms are extreme or you're already high-risk, ie. elderly or in poor health).
Otherwise, like most folks, you just get better on your own in a few days.
With the flu killing 10's of thousands every year, and nobody bats an eye... I'm not particularly concerned about COVID-19. It's mostly a media PR stunt at this point - designed to whip up fear and clicks. Swine Flu anyone?
Knowing that, it seems pretty clear that COVID-19 is more-or-less 10x deadlier[2] than seasonal influenza, as the CFR for seasonal flu is ~0.1-0.2%.
[1] It's a little more complicated with the flu because of underreporting. I guess elderly pneumonia is common enough that doctors don't always care why it developed. So apparently the CDC uses a more complex model (e.g. total number of pneumonia cases minus base rate, non-flu season cases). But what they're trying to estimate is the CFR, which is by definition deaths/confirmed.
[2] At least from an epidemiological perspective, regardless of the percentage of symptomatic cases / infections. At the end of the day what matters is how many will die, not how scared someone should be if they're infected.
This is not true[1]. CDC projects the numbers and estimates total number of cases, because almost all of the actual cases are undiagnosed. So no, COVID-19 is not "more-or-less 10x deadlier" than the common Flu.
Let's be clear. The media frenzy around COVID-19 is not grounded in science, and it purely designed to get panic people, resulting in clicks and eye-balls. Nothing more.
[1] https://www.cdc.gov/flu/about/burden/how-cdc-estimates.htm
This virus is an unknown. It is spreading worldwide very quickly and the growth rate is exponential. Within months, hundreds of millions could be infected without interventions. Today the number of dead is very small. If the virus were to become as common as the flu, it could make infectious disease the leading cause of death, more than heart disease or cancer. We still don't know what the long term health complications are or if you can be re-infected. The science will be in shortly, but in the mean time an abundance of caution would seem to be warranted. I will be washing my hands until then.
That's for a very obvious reason. If 40 million people in the US get Covid, as with the flu, it will probably kill between 500k and 1m people.
That's unlikely to happen based on what we know so far. However if two million people get it, that will kill as many as the flu and produce ~200,000 ICU cases. That's far beyond what the US healthcare system can handle on top of routine circumstances.
Along with a drastically higher mortality rate, Covid also produces a far higher rate of ICU outcomes than flu does. It swamps healthcare systems, as we saw so dramatically in China.
This is a greatly, greatly exaggerated number based on incomplete reporting.
We cannot yet estimate the number of unconfirmed COVID-19 cases in the US. In healthy adults, the COVID-19 symptoms are no worse than the flu. The CDC uses projections to estimate the fatality rate of the flu every year, since actual hard stats are impossible to generate. Time will tell, but this so far seems nothing more than a media frenzy.
Does anyone remember the Swine Flu? How about the West Nile Virus? What was the outcome of those media frenzies? How'd it turn out for all the people hoarding toilet paper and water bottles back then?
> It swamps healthcare systems, as we saw so dramatically in China
I don't think it's even remotely relatable to the US healthcare system, and the general health of the US population.
The undetected case issue can be addressed by intensively studying smaller populations and extrapolating to the general population. The Diamond Princess or other cases where every person in a defined population was tested and monitored would be a good place to start. The exponential growth issue can be solved with cohort analysis, group people by the date of their onset of symptoms and track the resolution for each group.
With a few more weeks of data we should start to see these studies, then we'll know just how serious this is.
The biggest challenge is we only have ~20 mechanical ventilators per 100k people[0]. That means our entire nation's capacity for mechanical ventiation (excluding overload from regional clusters) is consumed with just 200 infections per 100k - or 660k infections of the US's 330 million.
That doesn't account for baseline ICU/vent usage, which is estimated at at ~70% occupancy rate with 3 in 10 currently needing mechanical vents [1].
A fuzzy summary is 500k infections in the use will utilize all existing mechanical ventilators.
[0] - https://www.ncbi.nlm.nih.gov/pubmed/21149215 - this was 2010, but the most recent data I could easily find. [1] - https://www.ncbi.nlm.nih.gov/pubmed/23963122
https://docs.google.com/spreadsheets/d/1Z7VQ5xlf3BaTx_LBBbls...
(Edit) I should note that this sheet's tracking data at the subregion level within affected countries.
https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594...
Why present a splashy tool like this if it just has bad data? This is irresponsible.
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