Author Topic: How long can we wait while flattening the curve?  (Read 248220 times)

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2450 on: June 07, 2020, 07:13:18 PM »
I'd question how cases can reach 200,000 a day if you're not running 200,000 tests per day....

In the US, we’re now running near 500 k tests a day.  That’s a remarkable rate.  There is more capacity but people aren’t going to get tested.  Positive rate has been lower than 5% now, cases and deaths continue to go down.  Lowest daily death total in 2 months.  No spike since reopening 1 month ago.  Media trying to get creative to keep the panic monetization gravy train alive.  We won’t hear from those who said there would be a spike that they were wrong.



And here we are 8 weeks post reopening, lowest death total since March 26th.  No nationwide spikes despite mass reopening and mass protest.  Sure, there have been regional spikes, but not nationwide.  In fact, numbers continue to drop.


MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2451 on: June 07, 2020, 07:15:56 PM »
The bulk of those deaths were in New York/ New England. In MOST areas it’s worse than ever.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #2452 on: June 07, 2020, 11:16:49 PM »
There are a few states where cases are increasing on a daily basis. However, the majority of states have plateaued in cases per day. Whatever we are doing currently is working in most areas, but this plateau effect is not uniform. It may represent (as it does on the national level) a decrease in cases at hotspots (large urban centers) with a slow uptick in other areas (that paradoxically have flattened the curve, so are still on the much slower upslope). As long as we don't go too nuts with crowds in these less dense areas, we should be in good shape through the summer. This is primarily due to the population's overall continued social distancing despite rollbacks of formal stay-at-home orders and certain politician's hyperventilation about their liberties. This also does not suggest these orders were unnecessary. Rather, they may have flattened the curve sufficiently in the less populated areas to allow reopening to proceed while maintaining  ICU capacity. Tomorrow will mark two weeks from Memorial Day weekend, and the beginning of any expected spikes in cases from asymptomatic vectors.

A caveat, which is extremely important, is that most of these less urban areas do NOT have the ICU capacity or expertise to deal with this virus. I have seen in my own hospital's ICU, and unfortunately have had a patient die, from the very labile inflammatory response it generates. The patients who are critically ill can fluctuate rapidly over a few hours. They develop secondary infections, and are difficult to stabilize. They are generally not having the "ebb and flow" we normally see with bacterial pneumonias. It is similar to what we see with patients who die of primary viral pneumonia (mostly influenza, but a grab-bag of rarer ones). The difference is the number of cases during what would otherwise be a slow season. ICUs that are not well staffed with residents and large teams of nurses who rotate on and off 24/7 will probably not be able to keep up. Thus, only large community hospitals with significant intensivist programs (such as those with cardiac surgery programs), and academic centers will have the people-power to manage. We should be preparing now for the upcoming fall season to avoid a repeat of the NYC/NJ situation. In addition to those who survive, we will have to decide what to do with those who are long-term disabled. The course of this virus is very rough in hospitalized patients, and they will not return to work soon, even if not intubated. That statistic is yet to be determined, and will be quite relevant to our economic recovery.
« Last Edit: June 07, 2020, 11:24:45 PM by Abe »

boy_bye

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Re: How long can we wait while flattening the curve?
« Reply #2453 on: June 08, 2020, 09:23:25 AM »
i see several hockey sticks rising up in the month of june in these diagrams -- arizona, california, the carolinas, michigan, utah, texas.

thanks for sharing your perspective as a clinician, abe.

v8rx7guy

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Re: How long can we wait while flattening the curve?
« Reply #2454 on: June 08, 2020, 09:29:12 AM »
There are a few states where cases are increasing on a daily basis. However, the majority of states have plateaued in cases per day. Whatever we are doing currently is working in most areas, but this plateau effect is not uniform. It may represent (as it does on the national level) a decrease in cases at hotspots (large urban centers) with a slow uptick in other areas (that paradoxically have flattened the curve, so are still on the much slower upslope). As long as we don't go too nuts with crowds in these less dense areas, we should be in good shape through the summer. This is primarily due to the population's overall continued social distancing despite rollbacks of formal stay-at-home orders and certain politician's hyperventilation about their liberties. This also does not suggest these orders were unnecessary. Rather, they may have flattened the curve sufficiently in the less populated areas to allow reopening to proceed while maintaining  ICU capacity. Tomorrow will mark two weeks from Memorial Day weekend, and the beginning of any expected spikes in cases from asymptomatic vectors.

A caveat, which is extremely important, is that most of these less urban areas do NOT have the ICU capacity or expertise to deal with this virus. I have seen in my own hospital's ICU, and unfortunately have had a patient die, from the very labile inflammatory response it generates. The patients who are critically ill can fluctuate rapidly over a few hours. They develop secondary infections, and are difficult to stabilize. They are generally not having the "ebb and flow" we normally see with bacterial pneumonias. It is similar to what we see with patients who die of primary viral pneumonia (mostly influenza, but a grab-bag of rarer ones). The difference is the number of cases during what would otherwise be a slow season. ICUs that are not well staffed with residents and large teams of nurses who rotate on and off 24/7 will probably not be able to keep up. Thus, only large community hospitals with significant intensivist programs (such as those with cardiac surgery programs), and academic centers will have the people-power to manage. We should be preparing now for the upcoming fall season to avoid a repeat of the NYC/NJ situation. In addition to those who survive, we will have to decide what to do with those who are long-term disabled. The course of this virus is very rough in hospitalized patients, and they will not return to work soon, even if not intubated. That statistic is yet to be determined, and will be quite relevant to our economic recovery.

This is likely just showing the ramping up of testing though... the more you test, the more you find.  If you could show these graphs as number of deaths per state I believe we would see a downward trend for almost all states.

former player

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Re: How long can we wait while flattening the curve?
« Reply #2455 on: June 08, 2020, 09:49:37 AM »
There are a few states where cases are increasing on a daily basis. However, the majority of states have plateaued in cases per day. Whatever we are doing currently is working in most areas, but this plateau effect is not uniform. It may represent (as it does on the national level) a decrease in cases at hotspots (large urban centers) with a slow uptick in other areas (that paradoxically have flattened the curve, so are still on the much slower upslope). As long as we don't go too nuts with crowds in these less dense areas, we should be in good shape through the summer. This is primarily due to the population's overall continued social distancing despite rollbacks of formal stay-at-home orders and certain politician's hyperventilation about their liberties. This also does not suggest these orders were unnecessary. Rather, they may have flattened the curve sufficiently in the less populated areas to allow reopening to proceed while maintaining  ICU capacity. Tomorrow will mark two weeks from Memorial Day weekend, and the beginning of any expected spikes in cases from asymptomatic vectors.

A caveat, which is extremely important, is that most of these less urban areas do NOT have the ICU capacity or expertise to deal with this virus. I have seen in my own hospital's ICU, and unfortunately have had a patient die, from the very labile inflammatory response it generates. The patients who are critically ill can fluctuate rapidly over a few hours. They develop secondary infections, and are difficult to stabilize. They are generally not having the "ebb and flow" we normally see with bacterial pneumonias. It is similar to what we see with patients who die of primary viral pneumonia (mostly influenza, but a grab-bag of rarer ones). The difference is the number of cases during what would otherwise be a slow season. ICUs that are not well staffed with residents and large teams of nurses who rotate on and off 24/7 will probably not be able to keep up. Thus, only large community hospitals with significant intensivist programs (such as those with cardiac surgery programs), and academic centers will have the people-power to manage. We should be preparing now for the upcoming fall season to avoid a repeat of the NYC/NJ situation. In addition to those who survive, we will have to decide what to do with those who are long-term disabled. The course of this virus is very rough in hospitalized patients, and they will not return to work soon, even if not intubated. That statistic is yet to be determined, and will be quite relevant to our economic recovery.

This is likely just showing the ramping up of testing though... the more you test, the more you find.  If you could show these graphs as number of deaths per state I believe we would see a downward trend for almost all states.
In a lot of countries there is one figure for COVID-19 deaths and another, larger, figure for deaths above the trend line - many of which will be unrecognised/untested COVID-19 deaths.  So pick your death figures appropriately.

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2456 on: June 08, 2020, 09:52:26 AM »


This is likely just showing the ramping up of testing though... the more you test, the more you find.  If you could show these graphs as number of deaths per state I believe we would see a downward trend for almost all states.

His second graphic represents death trends, which is trending down across the board with only a couple exceptions.   Another good indicator to watch is % of tests that are positive, this number has also gone down significantly.  Essentially we have gotten significantly better at identifying a higher % of positive cases.
« Last Edit: June 08, 2020, 09:54:21 AM by HBFIRE »

v8rx7guy

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Re: How long can we wait while flattening the curve?
« Reply #2457 on: June 08, 2020, 09:58:03 AM »


This is likely just showing the ramping up of testing though... the more you test, the more you find.  If you could show these graphs as number of deaths per state I believe we would see a downward trend for almost all states.

His second graphic represents death trends, which is trending down across the board with only a couple exceptions.   Another good indicator to watch is % of tests that are positive, this number has also gone down significantly.  Essentially we have gotten significantly better at identifying a higher % of positive cases.

Oops, my bad I did not see the 2nd graphic

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2458 on: June 08, 2020, 02:52:43 PM »
Not sure if this was brought up in the thread, but we had a surprisingly good jobs report here in the US last week. Unfortunately, a correction is apparently coming that will make it not as good, but still better than what we were expected.

We've entertained an awful lot of talk about how the mortality estimates were overblown in this thread. It's only fair to entertain some discussion on the economic catastrophe possibly being overblown too.

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #2459 on: June 08, 2020, 02:59:04 PM »
Agreed, thus far we haven't seen either the 25%+ unemployment that was predicted, nor massive supply chain breakdowns (outside of meat processing, which I personally think the world could stand to stop or massively reduce anyway).

-W

LaineyAZ

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Re: How long can we wait while flattening the curve?
« Reply #2460 on: June 08, 2020, 05:47:25 PM »

Headline:  Arizona state health director tells hospitals to "fully activate" emergency plans as Covid-19 cases climb.

And yet I was out today to a medical appt. where 3 people were chatting for 15 minutes outside the main door, not fully 6' apart, and not wearing masks.  Also stopped by the grocery store where workers are masked but only about 30-40% of shoppers were masked.  I think mid-June here is going to be bad.

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #2461 on: June 08, 2020, 06:18:04 PM »
Not sure if this was brought up in the thread, but we had a surprisingly good jobs report here in the US last week. Unfortunately, a correction is apparently coming that will make it not as good, but still better than what we were expected.

We've entertained an awful lot of talk about how the mortality estimates were overblown in this thread. It's only fair to entertain some discussion on the economic catastrophe possibly being overblown too.

In which case we should limit the amount of free money we throw at the problem since it might not be nearly as bad (death wise and recession wise) as we thought.

mrs sideways

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Re: How long can we wait while flattening the curve?
« Reply #2462 on: June 09, 2020, 12:17:24 AM »

Headline:  Arizona state health director tells hospitals to "fully activate" emergency plans as Covid-19 cases climb.

And yet I was out today to a medical appt. where 3 people were chatting for 15 minutes outside the main door, not fully 6' apart, and not wearing masks.  Also stopped by the grocery store where workers are masked but only about 30-40% of shoppers were masked.  I think mid-June here is going to be bad.

If someone has better information, please correct me, but from what I've read it appears as if masks are pretty darn effective. Not so much to keep you from catching it, but to keep you from spreading it if you're asymptomatic. In the Bay Area we're opening up, but masks are mandatory in stores and almost everyone uses one.

Phenix

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Re: How long can we wait while flattening the curve?
« Reply #2463 on: June 09, 2020, 05:49:50 AM »

Headline:  Arizona state health director tells hospitals to "fully activate" emergency plans as Covid-19 cases climb.

And yet I was out today to a medical appt. where 3 people were chatting for 15 minutes outside the main door, not fully 6' apart, and not wearing masks.  Also stopped by the grocery store where workers are masked but only about 30-40% of shoppers were masked.  I think mid-June here is going to be bad.

If someone has better information, please correct me, but from what I've read it appears as if masks are pretty darn effective. Not so much to keep you from catching it, but to keep you from spreading it if you're asymptomatic. In the Bay Area we're opening up, but masks are mandatory in stores and almost everyone uses one.

Asymptomatic spread of coronavirus is ‘very rare,’ WHO says
https://www.cnbc.com/2020/06/08/asymptomatic-coronavirus-patients-arent-spreading-new-infections-who-says.html

Freedomin5

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Re: How long can we wait while flattening the curve?
« Reply #2464 on: June 09, 2020, 06:54:57 AM »

Headline:  Arizona state health director tells hospitals to "fully activate" emergency plans as Covid-19 cases climb.

And yet I was out today to a medical appt. where 3 people were chatting for 15 minutes outside the main door, not fully 6' apart, and not wearing masks.  Also stopped by the grocery store where workers are masked but only about 30-40% of shoppers were masked.  I think mid-June here is going to be bad.

If someone has better information, please correct me, but from what I've read it appears as if masks are pretty darn effective. Not so much to keep you from catching it, but to keep you from spreading it if you're asymptomatic. In the Bay Area we're opening up, but masks are mandatory in stores and almost everyone uses one.

Asymptomatic spread of coronavirus is ‘very rare,’ WHO says
https://www.cnbc.com/2020/06/08/asymptomatic-coronavirus-patients-arent-spreading-new-infections-who-says.html

The article title is misleading. Further down that same article it says there isn’t enough data to say whether asymptomatic carriers are spreading the virus and that more research is needed.

Quote
She acknowledged that some studies have indicated asymptomatic or presymptomatic spread in nursing homes and in household settings.

More research and data are needed to “truly answer” the question of whether the coronavirus can spread widely through asymptomatic carriers, Van Kerkhove added.

Basically, they Don’t Know if asymptomatic carriers spread the virus, in which case, I’d say better safe than sorry. Wear a mask, folks!
« Last Edit: June 09, 2020, 06:56:35 AM by Freedomin5 »

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2465 on: June 09, 2020, 06:57:35 AM »
The WHO lady offered additional commentary on Twitter but it’s kind of a word salad and while it’s clear they’re distinguishing between asymptomatic and presymptomatic, it’s hard to tell whether those categories are lumped together when describing transmission.
« Last Edit: June 09, 2020, 07:17:55 AM by mathlete »

I'm a red panda

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Re: How long can we wait while flattening the curve?
« Reply #2466 on: June 09, 2020, 09:56:43 AM »
Oooh- presymptomatic throws in a whole new curve ball.  I've always assumed that was where most of "asymptomatic" spread was happening. People shedding the virus who weren't yet aware they had it; but were still going to end up with symptoms.  If we narrow asymptomatic to be "people who never show symptoms" I can see why they might say it doesn't account for much of the spread. (Though without extremely widespread testing, it's difficult to have any idea of how many asymptomatic cases there are at all.)

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #2467 on: June 11, 2020, 08:19:00 AM »
I believe the WHO's position is something like this: people who have no symptoms account for very little of the spread. People who have mild, easily missed symptoms like a mild cough or a runny nose might account for a fair portion of the spread.

JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #2468 on: June 11, 2020, 09:26:36 AM »
Time to start flattening the curve again?

https://apnews.com/feb4c26d9364497cf82ee7c0c1b1b3d5

Texas, Florida, North Carolina, etc... are all having a peak in daily cases AND having a rising Covid positive testing percentage.

Combination of early reopening/never closing, Memorial Day Weekend, minimization of this condition is leading to bad trends. Here we go again.

What will the local politicians do when confronted with this data?

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #2469 on: June 11, 2020, 09:37:44 AM »
Time to start flattening the curve again?

https://apnews.com/feb4c26d9364497cf82ee7c0c1b1b3d5

Texas, Florida, North Carolina, etc... are all having a peak in daily cases AND having a rising Covid positive testing percentage.

Combination of early reopening/never closing, Memorial Day Weekend, minimization of this condition is leading to bad trends. Here we go again.

What will the local politicians do when confronted with this data?

Arizona, too. https://www.marketwatch.com/story/arizona-hospitals-at-83-capacity-as-coronavirus-cases-surge-2020-06-10 The hospitalization rates can't be explained away by increased testing.

The local politicians will do jack-shit. It's the party line that COVID-19 is an overblown hoax. Apparently their party leader is planning a rally in Phoenix later this month, so the state will have to pretend that it isn't happening to keep him from throwing another tantrum about a cancelled rally.

JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #2470 on: June 11, 2020, 09:42:08 AM »
Time to start flattening the curve again?

https://apnews.com/feb4c26d9364497cf82ee7c0c1b1b3d5

Texas, Florida, North Carolina, etc... are all having a peak in daily cases AND having a rising Covid positive testing percentage.

Combination of early reopening/never closing, Memorial Day Weekend, minimization of this condition is leading to bad trends. Here we go again.

What will the local politicians do when confronted with this data?

Arizona, too. https://www.marketwatch.com/story/arizona-hospitals-at-83-capacity-as-coronavirus-cases-surge-2020-06-10 The hospitalization rates can't be explained away by increased testing.

The local politicians will do jack-shit. It's the party line that COVID-19 is an overblown hoax. Apparently their party leader is planning a rally in Phoenix later this month, so the state will have to pretend that it isn't happening to keep him from throwing another tantrum about a cancelled rally.

Yes, disturbing that those states are exactly where Trump is planning to host campaign rallies in the next few weeks.

I would also add that the Black Lives Matter protests will certainly not slow down the spread of Covid19 (as much as I sympathize with the participants), and will likely lead to significant bumps in Covid in the next 2-3 weeks all across the world, frankly.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #2471 on: June 11, 2020, 10:45:52 AM »
Time to start flattening the curve again?

https://apnews.com/feb4c26d9364497cf82ee7c0c1b1b3d5

Texas, Florida, North Carolina, etc... are all having a peak in daily cases AND having a rising Covid positive testing percentage.

Combination of early reopening/never closing, Memorial Day Weekend, minimization of this condition is leading to bad trends. Here we go again.

What will the local politicians do when confronted with this data?


GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #2472 on: June 11, 2020, 10:50:57 AM »
Time to start flattening the curve again?

https://apnews.com/feb4c26d9364497cf82ee7c0c1b1b3d5

Texas, Florida, North Carolina, etc... are all having a peak in daily cases AND having a rising Covid positive testing percentage.

Combination of early reopening/never closing, Memorial Day Weekend, minimization of this condition is leading to bad trends. Here we go again.

What will the local politicians do when confronted with this data?

So far they've been able to pretend that this is a Liberal disease.  We need a few more New Yorks . . . but in Houston, Jacksonville, and Charlotte.  Eventually, even Republicans will be unable to ignore it when the dead start piling up.

Michael in ABQ

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Re: How long can we wait while flattening the curve?
« Reply #2473 on: June 11, 2020, 12:09:59 PM »
Time to start flattening the curve again?

https://apnews.com/feb4c26d9364497cf82ee7c0c1b1b3d5

Texas, Florida, North Carolina, etc... are all having a peak in daily cases AND having a rising Covid positive testing percentage.

Combination of early reopening/never closing, Memorial Day Weekend, minimization of this condition is leading to bad trends. Here we go again.

What will the local politicians do when confronted with this data?

So far they've been able to pretend that this is a Liberal disease.  We need a few more New Yorks . . . but in Houston, Jacksonville, and Charlotte.  Eventually, even Republicans will be unable to ignore it when the dead start piling up.

Houston - Harris County went 54% for Clinton - 42% for Trump - Democratic Mayor
Jacksonville - Duval County went 48% for Clinton - 49% for Trump - Republican Mayor
Charlotte - Mecklenburg County went 63% for Clinton - 33% for Trump - Democratic Mayor

Urban areas strongly correlate with Democrats and most large cities in the US have Democratic mayors and majority city councils, etc.

Paper Chaser

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Re: How long can we wait while flattening the curve?
« Reply #2474 on: June 11, 2020, 12:46:51 PM »
Time to start flattening the curve again?

https://apnews.com/feb4c26d9364497cf82ee7c0c1b1b3d5

Texas, Florida, North Carolina, etc... are all having a peak in daily cases AND having a rising Covid positive testing percentage.

Combination of early reopening/never closing, Memorial Day Weekend, minimization of this condition is leading to bad trends. Here we go again.

What will the local politicians do when confronted with this data?

So far they've been able to pretend that this is a Liberal disease.  We need a few more New Yorks . . . but in Houston, Jacksonville, and Charlotte.  Eventually, even Republicans will be unable to ignore it when the dead start piling up.

Houston - Harris County went 54% for Clinton - 42% for Trump - Democratic Mayor
Jacksonville - Duval County went 48% for Clinton - 49% for Trump - Republican Mayor
Charlotte - Mecklenburg County went 63% for Clinton - 33% for Trump - Democratic Mayor

Urban areas strongly correlate with Democrats and most large cities in the US have Democratic mayors and majority city councils, etc.

To add on to this, cities have dense populations and more things to do socially. They're going to be hot spots for any virus regardless of partisan politics. From the quoted article above: "That’s a 42% increase in patients since Memorial Day weekend, when beachgoers swarmed Texas’ coastline and a water park near Houston opened to big crowds in defiance of Republican Gov. Greg Abbott’s orders."

So a waterpark in a heavily Democratic area opens against the Republican Governor's orders, but the blame for the uptick falls only on one side of the political aisle? Seems to me like people in general are done with lockdowns and extreme distancing regardless of who they vote for. Wrong or right, we saw evidence of increased travel weeks before restrictions started to be lifted:
https://www.reuters.com/article/us-health-coronavirus-google/google-travel-data-show-lockdown-fatigue-in-u-s-australia-other-countries-stay-home-idUSKBN22D6AX

dougules

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Re: How long can we wait while flattening the curve?
« Reply #2475 on: June 11, 2020, 03:02:27 PM »
There are a few states where cases are increasing on a daily basis. However, the majority of states have plateaued in cases per day. Whatever we are doing currently is working in most areas, but this plateau effect is not uniform. It may represent (as it does on the national level) a decrease in cases at hotspots (large urban centers) with a slow uptick in other areas (that paradoxically have flattened the curve, so are still on the much slower upslope). As long as we don't go too nuts with crowds in these less dense areas, we should be in good shape through the summer. This is primarily due to the population's overall continued social distancing despite rollbacks of formal stay-at-home orders and certain politician's hyperventilation about their liberties. This also does not suggest these orders were unnecessary. Rather, they may have flattened the curve sufficiently in the less populated areas to allow reopening to proceed while maintaining  ICU capacity. Tomorrow will mark two weeks from Memorial Day weekend, and the beginning of any expected spikes in cases from asymptomatic vectors.

Thanks for posting those state curves.  It's weird how clearly you can see the exponential behavior in a lot of them.  If you showed me those curves with no context, I would assume they were oscilloscope traces.  Math is math whether the system is electrical, mechanical, or epidemiological. 

New York shows a nice exponential decay.  Pennsylvania and Rhode Island are not as steep but still classic exponential decay. 

Look at Nevada, Missouri, and Georgia, though. A plateau is not good in systems with exponential behavior.  It means that you're teetering on the edge of an exponential rise, and very small change in your coefficient can make the system unstable again like almost all of them were in March.

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #2476 on: June 11, 2020, 03:09:08 PM »
Time to start flattening the curve again?

https://apnews.com/feb4c26d9364497cf82ee7c0c1b1b3d5

Texas, Florida, North Carolina, etc... are all having a peak in daily cases AND having a rising Covid positive testing percentage.

Combination of early reopening/never closing, Memorial Day Weekend, minimization of this condition is leading to bad trends. Here we go again.

What will the local politicians do when confronted with this data?

This is what media driven fear mongering looks like. "A spike in cases!" It completely ignores the long term downward trend. A spike for one day when the overall trend is down is meaningless.

And yet, that's what all of these are. Let me know when we're approaching March levels.

v8rx7guy

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Re: How long can we wait while flattening the curve?
« Reply #2477 on: June 11, 2020, 03:21:45 PM »
Is my reasoning sound that increased testing in AZ could also explain increased hospitalizations, despite what the experts are saying?  My thought is that when an increased number of people know they have COVID-19 they are much more likely to seek help at the hospital for a symptom they normally wouldn't be going to the hospital for.  If it were me and I found out I had COVID and was coughing a bunch, I would be 100x more likely go to the hospital immediately because I would not want things to go in a bad direction, vs. the if I developed a cough in any other year or while knowing I don't have the virus.  And are they going to turn me down at the hospital if my symptoms aren't severe enough?  Probably not, especially since hospitals are hurting and get funding for COVID patients.  What I am trying to say is that I feel even hospital admittance is not necessarily a strong indicator of how bad COVID is spreading or is not spreading in a given city... deaths are really the only true indicator.  Cases and even hospitalizations can be a result of increased testing.  Thoughts?

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2478 on: June 11, 2020, 03:52:54 PM »

This is what media driven fear mongering looks like. "A spike in cases!" It completely ignores the long term downward trend. A spike for one day when the overall trend is down is meaningless.

And yet, that's what all of these are. Let me know when we're approaching March levels.

Yes, the media is in 5th gear this year and people are falling for it hook line and sinker.

2sk22

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Re: How long can we wait while flattening the curve?
« Reply #2479 on: June 11, 2020, 03:54:01 PM »
Is my reasoning sound that increased testing in AZ could also explain increased hospitalizations, despite what the experts are saying?  My thought is that when an increased number of people know they have COVID-19 they are much more likely to seek help at the hospital for a symptom they normally wouldn't be going to the hospital for.  If it were me and I found out I had COVID and was coughing a bunch, I would be 100x more likely go to the hospital immediately because I would not want things to go in a bad direction, vs. the if I developed a cough in any other year or while knowing I don't have the virus.  And are they going to turn me down at the hospital if my symptoms aren't severe enough?  Probably not, especially since hospitals are hurting and get funding for COVID patients.  What I am trying to say is that I feel even hospital admittance is not necessarily a strong indicator of how bad COVID is spreading or is not spreading in a given city... deaths are really the only true indicator.  Cases and even hospitalizations can be a result of increased testing.  Thoughts?

I actually had Covid in early April and although I was coughing a lot, I did not have any breathing difficulties so I never came close to seeking hospitalization. Mere coughing is not enough - no hospital will admit you unless you have breathing difficulties - as measured with a blood oxygen monitor (or some other serious symptom)

mrsnamemustache

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Re: How long can we wait while flattening the curve?
« Reply #2480 on: June 11, 2020, 03:58:45 PM »
Is my reasoning sound that increased testing in AZ could also explain increased hospitalizations, despite what the experts are saying?  My thought is that when an increased number of people know they have COVID-19 they are much more likely to seek help at the hospital for a symptom they normally wouldn't be going to the hospital for.  If it were me and I found out I had COVID and was coughing a bunch, I would be 100x more likely go to the hospital immediately because I would not want things to go in a bad direction, vs. the if I developed a cough in any other year or while knowing I don't have the virus.  And are they going to turn me down at the hospital if my symptoms aren't severe enough?  Probably not, especially since hospitals are hurting and get funding for COVID patients.  What I am trying to say is that I feel even hospital admittance is not necessarily a strong indicator of how bad COVID is spreading or is not spreading in a given city... deaths are really the only true indicator.  Cases and even hospitalizations can be a result of increased testing.  Thoughts?

I'm not in medicine, but I don't think this is right. People may be more likely to go to the hospital if they know they have COVID, but I don't think they are more likely to be admitted. The decision to admit is made by the doctors (based on objective indicators). I'm sure there is plenty of nuance and room for variation across clinical contexts, but I don't think this theory is likely to be supported. 

GardenerB

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Re: How long can we wait while flattening the curve?
« Reply #2481 on: June 11, 2020, 05:51:15 PM »
Is my reasoning sound that increased testing in AZ could also explain increased hospitalizations, despite what the experts are saying?  My thought is that when an increased number of people know they have COVID-19 they are much more likely to seek help at the hospital for a symptom they normally wouldn't be going to the hospital for.  If it were me and I found out I had COVID and was coughing a bunch, I would be 100x more likely go to the hospital immediately because I would not want things to go in a bad direction, vs. the if I developed a cough in any other year or while knowing I don't have the virus.  And are they going to turn me down at the hospital if my symptoms aren't severe enough?  Probably not, especially since hospitals are hurting and get funding for COVID patients.  What I am trying to say is that I feel even hospital admittance is not necessarily a strong indicator of how bad COVID is spreading or is not spreading in a given city... deaths are really the only true indicator.  Cases and even hospitalizations can be a result of increased testing.  Thoughts?

I'm not in medicine, but I don't think this is right. People may be more likely to go to the hospital if they know they have COVID, but I don't think they are more likely to be admitted. The decision to admit is made by the doctors (based on objective indicators). I'm sure there is plenty of nuance and room for variation across clinical contexts, but I don't think this theory is likely to be supported.

On the topic of hospital visits - yes you would get turned back if you were not deemed serious enough.  This is a main 'finding' some countries found was a big mistake.  The US, UK, Sweden etc. had directives to send even elderly COVID patients back to their care homes if they were not critically ill, causing more spreads and more deaths (large majority of deaths in the >75 year olds).

I am not arguing any way here it's 'just a bad flu' of course, but 'influenza-like illness' trackers are handy.  In general for hospital visits (this is for the whole US so NY state would obviously look worse), there is a tracker from CDC 'ILInet', used in a preprint to show COVID19 peaked and was on its way down well before the lockdown was implemented.  (Not that I am advocating Wittkowski's entire pre-print, but chart is from https://www.medrxiv.org/content/10.1101/2020.03.28.20036715v5)

But of course before lockdown, people were already sufficiently scared and distancing, many large gatherings cancelled etc.  It shows that COVID19 hospital visit rates were similar to the previous years' worst flu seasons (2009-2010 and 2017-2018).

For 2019-2020:  "Between October 1, 2019 and April 4, 2020, there have been 39 million - 56 million flu illnesses, 410,000 - 740,000 hospitalizations, and 24,000 - 62,000 deaths from flu, of which 169 are pediatric, according to the CDC."

That range of 39-56 million is an estimate only (which with 24000-62000 deaths yields the 0.1% IFR that people sometimes use/compare to).  IFR would be lower if many more had no symptoms.  Yields hospitalization rate of 1.3%.  There's also the vaccine factor for the yearly flu, and estimates from CDC indicate it helps reduce hospital visits by 50%.  (https://www.rochesterregional.org/news/2020/01/flu-season-2020)

I assume later in the year or next we would have similar estimates and stats for COVID19 (infection rate estimates, etc.), but so far the rate for hospitalization is 1 to 2%, similar to influenza.

https://www.cdc.gov/flu/weekly/


GardenerB

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Re: How long can we wait while flattening the curve?
« Reply #2482 on: June 11, 2020, 05:57:07 PM »
And again on that topic, are there any US or North American bodies providing their own data analysis for the public, similar to David Spiegelhalter of the UK?

https://twitter.com/d_spiegel/status/1270663827617710081

GardenerB

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Re: How long can we wait while flattening the curve?
« Reply #2483 on: June 11, 2020, 06:17:49 PM »


This is likely just showing the ramping up of testing though... the more you test, the more you find.  If you could show these graphs as number of deaths per state I believe we would see a downward trend for almost all states.

His second graphic represents death trends, which is trending down across the board with only a couple exceptions.   Another good indicator to watch is % of tests that are positive, this number has also gone down significantly.  Essentially we have gotten significantly better at identifying a higher % of positive cases.

It is easier and more important to view by comparing rates per 100,000 versus absolute numbers.  IHME has added this so you can use the 'compare' tool for any State or country for deaths, infections, etc.  However I don't know how accurate their Hospital Utilization figures are (total beds available etc.)

Attached sample with Texas, Arizona, USA highlighted as an example - all trending downwards but some interesting 'predictions' out past August.

https://covid19.healthdata.org/united-states-of-america/texas

« Last Edit: June 11, 2020, 06:26:58 PM by GardenerB »

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2484 on: June 11, 2020, 07:55:04 PM »
US Hospital census data


Abe

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Re: How long can we wait while flattening the curve?
« Reply #2485 on: June 11, 2020, 08:02:11 PM »
In my county, new cases per day have slowly increased, as have hospitalizations (probably a better marker of disease progression in the area) while testing has been flat/decreased slightly. These are 7-day moving averages, not spikes. We’re using about 25% of our total icu capacity for covid patients alone, so we may have to shut down the ORs again. In other news, the county health office resigned because people were threatening her for ordering masks wearing in public. This place is nuts.

In the county I’ll be moving to, icu capacity is at 15%, and the same trends of increasing hospitalizations with decreasing/flat testing.

These counties have 7 million people between the two of them. Does not look good for urban areas and the surrounding suburban/rural areas dependent on them for critical care.

I do agree the media is sensationalizing it to some extent. If they reported these facts people could make their decisions.
« Last Edit: June 11, 2020, 08:04:20 PM by Abe »

js82

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Re: How long can we wait while flattening the curve?
« Reply #2486 on: June 11, 2020, 08:11:48 PM »
Time to start flattening the curve again?

https://apnews.com/feb4c26d9364497cf82ee7c0c1b1b3d5

Texas, Florida, North Carolina, etc... are all having a peak in daily cases AND having a rising Covid positive testing percentage.

Combination of early reopening/never closing, Memorial Day Weekend, minimization of this condition is leading to bad trends. Here we go again.

What will the local politicians do when confronted with this data?

This is what media driven fear mongering looks like. "A spike in cases!" It completely ignores the long term downward trend. A spike for one day when the overall trend is down is meaningless.

And yet, that's what all of these are. Let me know when we're approaching March levels.

That's why I like this link:

https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

It's a pretty good one-stop-shop to look at the long-term trajectories, broken down with enough geographic and time resolution to make an assessment of what's a blip and what's a trend.

From where I'm at, I expect the next 3-6 months to be a very long, very very flat tail to "the curve", with a few smaller upwards bumps.  The total death toll will probably approach 200k, but it's going to be more like 15k/month over many months, as opposed to the >2k/day numbers we were seeing in April.
« Last Edit: June 11, 2020, 08:19:13 PM by js82 »

Abe

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Re: How long can we wait while flattening the curve?
« Reply #2487 on: June 11, 2020, 08:23:24 PM »
I agree with your assessment and also recommend the NY Times’ website. I’ve been using their raw data for my state-by-state graphs. The summer will be manageable, the fall may not be. I’ve resigned myself to that and am holding into N95s for the fall.

JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #2488 on: June 19, 2020, 08:38:38 AM »
As the Covid19 pandemic surges in the Southeast, South, and Midwest, as well as California and Oregon, I'd just like to remind everyone of the crisis in Latin America.

The US is a rich country. As much as we don't want to, we are lot more likely to be able to afford to stay home and ride this out then Third World Countries.

The following is a well written AP story about folks in more dire straights, and it gave me some perspective this morning.

https://apnews.com/259e35cdd2eb479d0b49cfcfb0cc936a

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #2489 on: June 19, 2020, 08:46:18 AM »
Yeah, at some point the risk of mass starvation becomes worse than the risk of Covid. India has already pulled the plug (mostly) on their shutdown because of this problem.

-W

Shane

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Re: How long can we wait while flattening the curve?
« Reply #2490 on: June 19, 2020, 11:17:05 AM »
When a friend who grew up in the Philippines once told me that in his small village on Mindanao, "nobody ever got cancer," I was intrigued. How, I wondered, could that be possible? Was it maybe their diet, or something in the water, or because the people there gots lots of fresh air and exercise? Turns out, the reason nobody in my friend's village ever died from cancer is because they are all too poor to be able to afford to go to a hospital to get tested. In my friend's village people get sick all the time. Either, they get better, or they die but, usually, nobody knows for sure why. Wonder how many people around the world have already died from covid, but nobody knows it, since they never got tested?

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2491 on: June 19, 2020, 01:06:38 PM »
When a friend who grew up in the Philippines once told me that in his small village on Mindanao, "nobody ever got cancer," I was intrigued. How, I wondered, could that be possible? Was it maybe their diet, or something in the water, or because the people there gots lots of fresh air and exercise? Turns out, the reason nobody in my friend's village ever died from cancer is because they are all too poor to be able to afford to go to a hospital to get tested. In my friend's village people get sick all the time. Either, they get better, or they die but, usually, nobody knows for sure why. Wonder how many people around the world have already died from covid, but nobody knows it, since they never got tested?

A few links that take a stab at answering that very question.

https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html
https://www.washingtonpost.com/investigations/2020/05/02/excess-deaths-during-covid-19/?arc404=true
https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm


Shane

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Re: How long can we wait while flattening the curve?
« Reply #2492 on: June 19, 2020, 01:36:48 PM »
When a friend who grew up in the Philippines once told me that in his small village on Mindanao, "nobody ever got cancer," I was intrigued. How, I wondered, could that be possible? Was it maybe their diet, or something in the water, or because the people there gots lots of fresh air and exercise? Turns out, the reason nobody in my friend's village ever died from cancer is because they are all too poor to be able to afford to go to a hospital to get tested. In my friend's village people get sick all the time. Either, they get better, or they die but, usually, nobody knows for sure why. Wonder how many people around the world have already died from covid, but nobody knows it, since they never got tested?

A few links that take a stab at answering that very question.

https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html
https://www.washingtonpost.com/investigations/2020/05/02/excess-deaths-during-covid-19/?arc404=true
https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
Thanks for the links. Seems like that strategy - looking at deaths in excess of the norm - is a good one. It takes away personal bias. If, after this is all over, 200K Americans are dead, who would normally be expected to still be alive, then we'll know that's what our strategy, or lack thereof, cost us as a country.

Laserjet3051

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Re: How long can we wait while flattening the curve?
« Reply #2493 on: June 19, 2020, 02:04:29 PM »
US Hospital census data



You should know by now, that facts dont matter. How dare you challenge the current deluge of histrionics.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2494 on: June 19, 2020, 02:09:16 PM »
Simple hospital census data does not tell the whole story. The hospital census in my state is overall down, too, but the total COVID positive hospital census is the highest it's ever been, including when we were at our "peak" in April.

Wolfpack Mustachian

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Re: How long can we wait while flattening the curve?
« Reply #2495 on: June 19, 2020, 02:39:17 PM »
Simple hospital census data does not tell the whole story. The hospital census in my state is overall down, too, but the total COVID positive hospital census is the highest it's ever been, including when we were at our "peak" in April.

Is that simple census data? If so, the graph is labeled wrong.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2496 on: June 19, 2020, 02:43:40 PM »
That graph was t showing up for me when I originally replied, but that data represents lockdowns being effective. The graphs for areas without closures or with too-lenient or short closures are not as nice.

Wolfpack Mustachian

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Re: How long can we wait while flattening the curve?
« Reply #2497 on: June 19, 2020, 02:54:05 PM »
That graph was t showing up for me when I originally replied, but that data represents lockdowns being effective. The graphs for areas without closures or with too-lenient or short closures are not as nice.

Fair enough, not arguing against your overall point.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2498 on: June 20, 2020, 11:49:04 AM »
Whenever you point to a graph and say, "the media" in absence of anything else, somewhere out there, a ton of boomers on Facebook erupt in applause before sharing more bootleg snoopy memes. 

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2499 on: June 20, 2020, 11:54:41 AM »
Also minion memes with baffling text