Coronavirus outbreak won't peak in every state at once
axios.com
axios.com
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.
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
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.
Oregon is doing roughly 1400 tests/day, with ~5% positive rate. Places that are more testing constrained see 20+% positive.
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.
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)
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.
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’s interesting data - where did it come from? I’d like to monitor it too.
http://www.salute.gov.it/portale/caldo/SISMG_sintesi_ULTIMO....
via https://swprs.org/a-swiss-doctor-on-covid-19/ which has many links
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.
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?
https://www.deptofnumbers.com/covid19/oregon/
edit: that link is to a site I built to track testing capacity and new case growth.
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.
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?
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.
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.
https://www.medrxiv.org/content/10.1101/2020.03.27.20043752v...
Actual detailed predictions by state:
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"
We need drastic action.
Whatever even pops into our head is already 2 weeks behind.
https://mobile.twitter.com/paulg/status/1237801364023017472?...
Everyone I've read has basically said as long as it's necessary and temporary in a time of emergency it will fly.
"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 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.
You'd really want to go as granular as possible, which is what these stay-at-home orders are about.
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.
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?
For essential work, I have no answer.
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.