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Comment by aphextron | Hacker News Reader

>If there is no spike in infections within two weeks, from areas which had large public protests in the past week, can millions of Americans be helped by restarting the economy?

Daily new infections have more than doubled here in North Carolina in the last two weeks since "reopening" [0]. We have had more new cases in the last two weeks (2200) than in the entire length of lockdown from March until then (2000). The death rate has massively spiked beginning May 24th, exactly two weeks (the median time from infection to death) from May 9th, the day the governor relaxed restrictions [1]. The dream of this thing just magically going away is absolutely delusional.

[0] https://www.nytimes.com/interactive/2020/us/north-carolina-c...

[1] https://www.nytimes.com/interactive/2020/us/north-carolina-c...

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There are more tests than there were a month ago, and that affects how many positives are seen (by some amount).

Also the increase in deaths you link to is not statistically significant, given it is in the rage of 10-30 over the course of several months in a state with 10 million people.

Those numbers don't prove your point.

> Also the increase in deaths you link to is not statistically significant, given it is in the rage of 10-30 over the course of several months in a state with 10 million people.

A penny doubled daily is $0.64 after a week, $81.92 after two, $10,485.76 after three, and $1,342,177.28 after four.

Upwards movement in cases and deaths in something that spreads exponentially is... not great.

Nothing is doubling every week anymore. Why did you bring that up?

Daily deaths across pretty much all nations are decreasing even as lockdowns are removed. Nit pick all you'd like, be as afraid as you like, but the numbers you supplied don't support your assertions.

> Nothing is doubling every week anymore

Exponential growth of the disease isn't tied to an arbitrary "week" timeline. It's delayed because of a 0.25 - 4.0 weeks. Different environment and behaviors will cause it to spread at different time intervals (not just a different number of recipients per spreader).

> Daily deaths across pretty much all nations are decreasing even as lockdowns are removed.

And COVID death doesn't happen within days of new exposure. It's delayed 3.5 - 5+ weeks after exposure and the people most likely to die aren't the ones walking around in public on the first day of end of SiP.

Your parent comment wasn't as outrageous as you make it seem.

>Your parent comment wasn't as outrageous as you make it seem.

Parent didn't account for vastly increased testing capacity in their assertions, and characterized a statistically insignificant increase in deaths as "massive". I objected to that.

I grant that this is not over and needs to be closely watched. I object to the exaggeration of the threat.

Many states are experiencing continued increase in infection rates. See https://www.worldometers.info/coronavirus/usa/california/, https://www.worldometers.info/coronavirus/usa/texas/, to a lesser extent https://www.worldometers.info/coronavirus/usa/florida/ for example. Deaths will lag that. Doubling time is really only a legitimate factor insofar as we can develop vaccines and treatments in the interim, and that hospital capacity is preserved; otherwise it's just a question of whether mass bad outcomes occur now or later. To be clear, I'm not arguing for continued lockdowns -- that seems fruitless. But it seems premature to assume the worst is behind us.

I wonder what those numbers would look like taking into account that there has been much more testing online in the last several weeks? (so of course the number of detected positives goes up)

I grant that the worst might not be behind us, but I also keep in mind that the experts said from the beginning that most likely outcomes are that this will become another variant of the common cold or flare up some years similar to a bad flue season [0]

I also agree that this needs to be watched, and I appreciate your realistic appraisal of lockdowns despite the possible remaining danger.

[0] https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor...

Not sure I follow. It may become seasonal yes, but comparing it to a cold or flu downplays the severity.

The idea is that it will decrease in severity over time. It may already be doing so. In early March they were tracking a dozen mutations already.

From the linked article [0], quoting a number of infectious disease experts, coronavirus researchers, epidemiologist, etc:

>OC43 and 229E are more prevalent than other endemic human coronaviruses, especially in children and the elderly. Together, the four are responsible for an estimated one-quarter of all colds. “For the most part they cause common-cold-type symptoms,” said Richard Webby, an influenza expert at St. Jude Children’s Research Hospital. “Maybe that is the most likely end scenario if this thing becomes entrenched.”

>Odds: Moderate. “I think there is a reasonable probability that this becomes the fifth community-acquired coronavirus,” Adalja said, something he expanded on in his blog. Webby agreed: “I have a little bit of hope that, OK, we’ll put up with a couple of years of heightened [2019-nCoV] activity before settling down to something like the other four coronaviruses.”

>Odds: Pretty good. What we may be seeing “is the emergence of a new coronavirus … that could very well become another seasonal pathogen that causes pneumonia,” said infectious disease expert Michael Osterholm of the University of Minnesota. It would be “more than a cold” and less than SARS: “The only other pathogen I can compare it to is seasonal influenza.”

(The article had a lot of other interesting and relevant information.)

[0] https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor...

Daily deaths are decreasing while daily new cases are increasing. The areas where most of the new cases are being recorded are rapidly changing, and I think a lot of people aren't paying attention to that. In quite a short time, the western European countries are not at the top of the list of countries with the most new cases, and similarly within the US, NY and NJ are behind Texas, California, Illinois, etc.

Maybe deaths being down means something positive, but it also could be a lagging indicator to some extent. It could reflect different record-keeping in the areas that are becoming more prominent in new cases.

>Daily deaths are decreasing while daily new cases are increasing.

But, as I originally stated, there are a lot more tests being done now, and that could explain why the number of confirmed cases is increasing. Some weeks ago they only tested those requiring hospitalization, and as time went on now anyone can get a test.

It would be nice if there were weekly samples of 20k people to serve as a valid week-to-week measure of the population infection rate.

The places where the new cases are skyrocketing are having more tests done, obviously, but they are places where the number of tests (and cases and deaths) up until now was low.

Conversely, the places that were hardest hit in the first wave are also having more tests done than previously, and at least before full reopening, are not yet having cases jump up.

We need to have another bucket in the covid classification system besides dying and no dying:

https://www.cbc.ca/news/canada/toronto/strange-symptoms-flar...

Is there a dashboard which shows increase in testing capacity over that same period, case demographics, presence of other medical conditions, and asymptomatic cases?

With increased (including employment-related) testing, case count should be increasing everywhere, but some of those could be recovered or asymptomatic.

We know that most hospitals were well below capacity, so new cases can be treated.

>Is there a dashboard which shows increase in testing capacity over that same period

Here's the best resource Ive found for comparing all the relevant data:

http://91-divoc.com/pages/covid-visualization/

Playing around with the data there, it looks like yes NC has had an increase in cases recently, but it tracks an increase in testing. Test positivity rates are about flat. It really is completely pointless to discuss increases in cases without also comparing to increases in testing and positivity rates.

Deaths are up, but as another poster pointed out it's hardly statistically significant. The rolling 7 day average is 2.2/1m now, vs 1.7/1m on May 1st.

>"Deaths are up, but as another poster pointed out it's hardly statistically significant. The rolling 7 day average is 2.2/1m now, vs 1.7/1m on May 1st."

How is a 34% increase not statistically significant?

That's a statistical/maths term[1], not an opinion of the number.

[1] https://en.wikipedia.org/wiki/Statistical_significance

>How is a 34% increase not statistically significant?

Because going from a daily death rate of 0.00017% to 0.00022% is still such a very small number, what might be called statistical noise.

Because we're talking relatively small numbers. It's easy to create large movements in small numbers.

If one person in my town is murdered this year, and 2 are murdered next year, that's a 100% year over year increase in the homicide rate. But it's obviously a meaningless increase.

2.2 out of a million is a small number. More people in NC are dying every day from cancer or heart disease.

Be careful not to swing too far the other way and assume that a flat positivity rate implies a flat actual infection rate. As states increase testing capacity, lower risk individuals will start to become part of the testing pool (e.g. those without severe symptoms, those with only fleeting contact with someone infected, those with no connection at all as part of a disease surveillance measure, etc.). Thus a flat testing positivity rate can very well coexist alongside an actual increase in rate of infection, and given the aforementioned factors we might even infer the latter given the former.

That's a fair point, and definitely something to keep in mind. Thank you for highlighting that.

I know you're not debating NC, but looking again at the state, it was mostly the last few weeks that looked flat. If you compare to the peak in positivity 42 days ago, they've gone from 16% positive to to 7% positive, using rolling 7 day averages. So, if I were in NC I wouldn't be overly concerned.

Testing capacity has been increased. The amount of negative cases is going up. Positive cases are going down.

https://vida.io/dashboards/ck9thqbxl00000umrd0u2pmdj

> Daily new infections have more than doubled here in North Carolina in the last two weeks since "reopening"

Confirmed cases, not infections. The hospitalization numbers are about 30% higher or so which is about-ish how much new deaths have increased. Which is bad, but not 2x bad.

All said, NC may have one of the highest spike of any state (reopened or not). Texas and Florida have flat hospitalizations; Georgia is slightly decreasing.

> The dream of this thing just magically going away is absolutely delusional.

Since we don't really know what's going on yet, almost anything that happens is going to seem kind of magical. Right now we're operating on guesswork and superstition.

Yeah, the 7 day moving average of new cases and deaths is also slowly trending up [1]. I think we all wished COVID would just go away, but that seems unlikely.

[1] https://www.worldometers.info/coronavirus/country/us/

Please post a screenshot of the graph you're referring to, because I cannot see this upward trend on the page you linked.

Regardless, your second sentence is true.

I think they are referring to the uptick seen after May 29 here: https://imgur.com/a/Z9y7cek

Click the "Projections" link, under the "Recovered" count. There you can see the daily trend.

If you look at the "daily new" graphs they have options to see the bars and/or overlay moving averages. Deaths and new infections were coming down, but have since bottomed out and are every so slightly going back up. Still not enough to see an upward trend, but the downward trend seems to have stopped.

Remember the whole point of shutdowns was to "flatten the curve" to keep the hospitals from being overrun. We can't stop the disease and we can't commit economic suicide.

NC has only seen a slight uptick in hospitalizations: https://covid19.ncdhhs.gov/dashboard and it's been flat for the past week.

"flatten the curve" changed once people realized they can use the shutdown as a means to political ends.

Yes, the shutdowns failed miserably if we thought we were going to eradicate infections.

The government failed badly at communicating this.

So now you have half the people saying the shutdowns were useless (cause the virus still exists) and another half saying they have to continue (cause the virus still exists, also)!

If we had realistically wanted to squash this thing, the examples of other countries suggest we would've needed much more aggressive tracing and isolating of people, widespread early mask distribution and wearing, and more tracking.

I fear that the government also may have failed miserably at taking advantage of them to bring more capacity online. Maybe the minimum stuff like masks and clothes and ventilators are taken care of, but we still seem in a very precarious place.

Voluntary changes in behavior persist, though, which will make things very hard to untangle "effect of shutdown" from "effect of people being cautious about high-risk environments."

Can you define what you mean by saying other countries squashed the thing? They may have flattened the curve, drove numbers down, etc. but until they get either a herd immunity or a wide vaccination the infections will likely flare up again as soon as travel restrictions get lifted.

Some countries aren’t planning on lifting travel restrictions, or are planning on having mandatory quarantine for arrivals

Not lifting travel restrictions is not realistic unless you are talking about North Korea. If you do not lift restrictions you are also punishing your own citizens (if you let your own citizens travel they can bring back the gift that keeps giving). We will see. And quarantine where? In many countries for returning citizens it just means "please go home and try to avoid contacts for 2 weeks", which is not super effective and gets treated creatively a lot.

I see friends (US and 2 countries in Europe) who are not affected by job losses booking vacations like crazy to take advantage of low prices to visit places they always wanted. So I suspect there will be a lot of travel again in the near future.

>The death rate has massively spiked beginning May 24th

So it's all right for deaths to spike if the hospitals don't expend their resources dealing with it? What are the hospitals for, then?

Yeah we can't live in bubbles forever. 40 million people are unemployed in the U.S. now and counting. Millions of livelihoods are being destroyed, suicides are up, deaths for untreated non-Covid diseases are up, and if we want to avoid the complete breakdown of civilization we need to get back to work.

But that's not the choice facing us. An exponential spike in deaths is quite a different thing from a linear one!

The government orders aren't the only thing impacting the economy.

Figuring out how to mitigate the virus, and thus making people feel more confident about economic activity, is what the economy needs.

Like good luck with it, but if 95% of Americans started wearing masks in the next couple of weeks, it's pretty clear that this would be a big boost to the economy over the next 6 months. But we don't do group oriented statistical mitigations here.

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