Category Archives: Ramblings & BS

Pennsylvania: Are We Flattening The Curve?

Pennsylvania Department of Health Declares There is “No Sign of Slowing”

As of 12:01 AM 4 April 2020 Pennsylvania exceeded the 10,000 case milestone.

The majority of cases in Pennsylvania are in the Philadelphia and Eastern Pennsylvania region along the Boston-Washington commuter corridor. As this is a major thoroughfare connected to New York, Connecticut, and New Jersey, and transit systems only recently began reducing service along this route, this is not a surprise.

source: https://theburgnews.com/news/positive-covid-19-cases-exceed-10000-in-pennsylvania-almost-1600-new-cases-today

The Pennsylvania Health Department released the following statistics on positive SARS-CoV-2 cases within the state:

  • Nearly 1 percent are aged 0-4
  • Nearly 1 percent are aged 5-12
  • 1 percent are aged 13-18
  • Nearly 8 percent are aged 19-24
  • 41 percent are aged 25-49
  • Nearly 29 percent are aged 50-64
  • Nearly 20 percent are aged 65 or older.

There have been no pediatric deaths, unlike Illinois.

What Is Preventing The Curve From Flattening?

Philadelphia vs. Pittsburgh

A few factors are unique to Pennsylvania, one such being the presence of a large religious population known for participating in religious exemption. In the broader southeastern corner of the state, outside of Philadelphia (the eastern bottom edge of the state) these populations live beautiful lives.

In the western part of the state, an additional area is being hit – Allegheny County, home of Pittsburgh. Pittsburgh has its own unique culture. It is a very social city where strangers talk to each other and it is not hard to make friends if you want to go out. Social distancing presents a challenge here. We also run into the poverty and rural hospital problem in western and central Pennsylvania.

Places of Worship

At this time places of worship in Pennsylvania are continuing to operate. Recently, places of worship are coming under scrutiny as major sources of coronavirus infection. I will be addressing this more in another post.

Adoption of Social Distancing

Source: https://www.unacast.com/covid19/social-distancing-scoreboard

Unacast has rated Pennsylvania as a C- based on two factors.

Source: https://www.unacast.com/covid19/social-distancing-scoreboard 25-40% Decrease in Average Distance Traveled Per Person; 60-65% Decrease in Non-Essential Travel To Non-Home Location

The majority of trouble is in small towns in rural areas. This is not surprising, but it is important to those that we need to behave as though coronavirus is spreading through an asymptomatic or minimally symptomatic reservoir host. This means that all it takes is one person in town and the whole town could get COVID-19 very quickly.

Pittsburgh and Delayed Outbreak

In 1918, Pittsburgh’s influenza outbreak was a full 3 weeks behind that of Philadelphia’s. Pennsylvania was one of the hardest hit states during 1918, and Allegheny County was no exception. Let’s remember how even within the past 10 years, new, previously unknown mass graves from 1918 are still being found throughout the state, and particularly in western Pennsylvania [1, 2, 3].

Is Pennsylvania Really Showing No Signs of Slowing?

I decided to break this down into 2 milestones: 100 cases and 1000 cases. I then compared the growth in cumulative cases to present from each.

source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit?usp=sharing

Based on the growth of cumulative cases since the 100th case, Pennsylvania is predicted to reach 100,000 cases as of 14th of April, 2020.

Source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit?usp=sharing

If we look at just the cumulative cases since the 1000th case, the 100,000th case is predicted closer to 12th of April, 2020.

So, yes, the health department is 100% correct. Pennsylvania is showing no signs of slowing.

Healthcare Systems Overwhelmed

The healthcare system in Philadelphia is overwhelmed, but not for the initial reasons one might think. Out of state patients from New Jersey and New York are heading to Philadelphia hospitals for treatment. This does reduce the resources available for those living in the local area. This also introduces additional vectors of disease to the Philadelphia area.

To better address the growing need to hospitals, cities are attempting to reopen those that have closed, particularly in poorer areas. There is an empty hospital in Philadelphia that the city is attempting to reopen. One massive barrier is that the building is privately owned by a California investment banker. This is only one hurdle.

Large hospital networks across the country are shifting spending while furloughing employees in preparation for outbreaks, including patient care workers. This is also occurring in Philadelphia. The argument for reducing staff is one of finances and the increased costs of each coronavirus patient amid bidding wars for supplies. These privately owned large hospital networks operate in multiple states, resulting in the shifting of resources affecting those where the outbreaks will eventually hit next.

Milestone Forecasting

In 100 years we gained the ability to monitor the disease, albeit imperfectly, and make predictions. Disease forecasting based on mathematical predictions was used primarily in agriculture when I was in school. With agriculture, we use satellite imagery to look for indications of disease by looking at light reflection/absorption patterns. Crazy right?

I discussed forecasting in the post about New York. Please ask questions and I can go into the mathematics of these models more.

Are we at the peak yet?

No. Pennsylvania will likely have 2 peaks – one for each major city. We can examine milestones and projections for changes overtime to try and guess when these will be. Milestones can be used in the process of forecasting for making quick decisions.

At this time Pennsylvania is projected to hit its 100,000th case on 14th of April 2020. That said – this is a graph based on many data points that can be broken up.

There’s a lot of hope in that graph shape if you think about how much impact the actions of individuals can have. The slope can change and extend out that milestone if everyone starts taking this seriously. If we look at only the last few days, we have moved closer how long it takes to reach that 100,000 cumulative case milestone to the 12th of April 2020.

With the actions of every day people, such as social distancing, staying at home, adopting public mask wearing, and hygiene awareness, we can flatten the curve.

This post is dedicated to my friends currently in Pittsburgh, Pennsylvania. I love you. Please stay safe. I owe all of you hugs the next time I see you.

TL;DR

  • Pennsylvania is not flattening the curve. If the curve does not flatten more, we could hit 100,000 cases by around 12th of April 2020 unless things improve.
  • At this time it does not look like Pennsylvania is hitting a peak. There will likely be 2 peaks
  • To help flatten the curve: practice social distancing, stay at home, adopt public mask wearing, and remember hygiene awareness. We can flatten the curve. Flattening the curve now will hopefully protect Pittsburgh later.
  • People are still sick with heart disease, cancer, bacterial infections, influenza, autoimmune disorders, tumors, and everything else under the sun and because the medical system is overwhelmed, those people aren’t getting sufficient care.

Thank you to anyone that reads this. Without you I’m just shouting into a void.

New York: Are We Flattening The Curve?

When Hospitals Are Overwhelmed Emergency Services Cut Low Likelihood Resuscitation

As of 1 April, 2020 EMTs in NYC have been instructed to not resuscitate cardiac arrest patients if they cannot get a pulse at the scene.

ABC 7 New York explained the reasoning behind this call best: “

“When you’re doing the CPR, you’re pushing really hard on the patient’s chest and they’re expelling some air in the process as well, so if they are COVID patients, they’ll be spreading it all around,” said Dr. Vinayak Kumar with the Mayo Clinic. “This is the risk-benefit math you have to take into account.”

The orders to stop CPR in the field is shocking to veteran doctors who are used to doing whatever it takes to save a life.”

Fire

Why is New York City doing this?

source: https://coronavirus.1point3acres.com/en (New York City is located in the center of the most red area)

Healthcare Systems Overwhelmed

The healthcare system in New York City is overwhelmed. Cultural barriers have impacted the use of masks publicly, the adoption of social distancing, and the nature of SARS-CoV-2 allows it to spread silently in a densely populated city.

Source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit?usp=sharing

New York City is flattening the curve too late to have not overwhelmed their medical system. This is the city in the United States that has been argued to have the best medical care. With the actions of every day people, such as social distancing, stay at home orders, adopting mask wearing, and hygiene awareness campaigns, they are finally flattening the curve.

Social Distancing

Source: https://www.unacast.com/covid19/social-distancing-scoreboard

Unacast rates the state of New York at a B- in Social Distancing. Their grade is based on the following:

40-55% Decrease in Average Distance Traveled Per Person in the state; 65-70% Decrease in Non-Essential Travel To A Non-Home Location

At this time the majority of social distancing is focused in the City of New York. But COVID-19 is spreading up Long Island. As this virus spreads up into the rural areas away from the city, we need to assume that it is being carried by asymptomatic reservoir hosts or minimally symptomatic. The rest of the state of New York is mostly rural. In this case, we run into the rural hospital problem or we run into poverty in smaller dying former industrial cities, such as Buffalo.

Milestone Forecasting

But are we at the peak yet? No. But we can examine milestones and projections for changes overtime. Milestones can be used in the process of forecasting for making quick decisions.

New York’s current projection based on past 14 days.

At this time New York is projected to hit its 500,000th case on 12 or 13 of April 2020. That said – this is a graph based on many data points that can be broken up.

There’s a lot of hope in that graph shape. The slope is changing. If we look at only the last few days, we have extended how long it takes to reach that 200,000 cumulative case milestone to the 13th or 14th of April 2020 – the same timing as what the previous graph projected would be the timing for the 500,000th case.

New York’s projection based on past 6 days.

This post is dedicated to my friends currently in New York City. I love you Elly, Liz, Greg and Naomi. Please stay safe. I owe all of you hugs the next time I see you.

TL;DR

  • New York is flattening the curve. If the curve does not flatten more, we could hit 500,000 cases by around 13 April 2020 unless things improve (remember that testing backlog?). At this time it does not look like New York is hitting a peak.
  • Keep up the social distancing if you can. Adopt mask wearing if you can and have to go out (this will link to another piece I’m writing later). Thank anyone working because they can’t social distance.
  • People in New York City will be dying because resuscitation is no longer safe for emergency medical workers. This is tragic.
  • People are still sick with heart disease, cancer, bacterial infections, influenza, and everything else under the sun and because the medical system is overwhelmed, those people aren’t getting sufficient care.

Thank you to anyone that reads this. Without you I’m just shouting into a void.

How Behaviors Impact Coronavirus Spread & Confirmed Case Reporting

Part 1 – Introduction to Issues

This is a pretty loaded topic. Breaking this one up into several parts. In this post I’m addressing limitations to medical accessibility, such as uninsured rates, caregiving, and religious exemption from government advised or required disease control practices, such as social distancing. Let’s talk about human behavior and how that may impact the vulnerability of your location in the United States to coronavirus.

Accessibility, Uninsured Rates, and Alternative Medicine

Source: https://www.census.gov/data-tools/demo/sahie/#/?s_searchtype=s&s_agecat=1&s_statefips= You can play with this viewer too! Go play with census data and learn about the United States.

There are many reasons Americans are uninsured. Being uninsured will ultimately lead to limited access to healthcare. Due to decisions that were made regarding how to implement mandated healthcare, the poor were punished for not being able to afford exorbitantly priced healthcare. I don’t care who you blame for it not working. Point is, it didn’t, and now we’re sunk. You may notice a similarity between the map above and the maps in my previous post on the closure of rural hospitals and poverty. Texas and Oklahoma are currently set up to be the two of the hardest hit states by coronavirus because these are uninsured populations that feel they cannot seek already-limited healthcare (because hospitals closed). This means that they turn to alternative medicine at home and don’t call a doctor due to the cost. Alternative medicine, though potentially complementary (waiting on research), doesn’t involve providing ventilators to people drowning from their own viral lung inflammation. Alternative medicine doesn’t necessarily involve reporting confirmed cases to the state, either.

Luckily, telemedicine is slowly stepping up the game at reducing costs and improving accessibility, but until we have Point of Care testing that allows for mass screening that could be distributed to a population via the health department – good luck. The FDA still strictly prohibits self administered tests. This is one of the major outstanding limitations preventing telemedicine from serving our most underserved and vulnerable populations in the United States during this pandemic.

Religious Exemption

Source: http://childrenshealthcare.org/?page_id=24

Religious exemptions for medical care are a real thing. I know there are people reading this that are going to think, “but no one in their right mind is thinking that now!”

Oh honey, I wish I could say that was so. Let me first introduce you to What’s The Harm. Even without coronavirus, people are and will be dying due to lack of access to medical care in part because their families opt out via religious exemptions. When this is combined with alternative methods gone wrong and cultural factors, the vulnerability of this population is amplified by pre-existing public health issues.

Part of the states’ Stay At Home orders have meant the discontinuation of standard church gatherings and not everyone is taking it so well. Across the United States, churches are challenging these orders by stating that they are restricting freedom of religion. The continued in-person gatherings of worship services and other church functions result in COVID-19 outbreaks within communities. The Palmer Grove Baptist Church in Burke County, Georgia is one example from today, 31 March 2020. Another example: a choir practice when there were no positive cases reported in the county lead to an outbreak due to asymptomatic transmission. In Arkansas, California, Florida, Louisiana, Oklahoma, South Carolina, Tennessee, Texas, Washington, and Wisconsin, churches have risked or spread COVID-19 to members through gatherings or other church related events. As long as church closures are seen as a threat, these communities will be at higher risk for impacts from COVID-19.

I’ll be making a separate post dedicated to addressing the religious exemption issue in a culturally sensitive manner. Stay tuned for part 3.

Home Care For The Sick

One of the most wonderful things about America is that we are a country of caregivers. By acting as a caregivers we enter others’ homes or share homes with them to ensure their wellbeing. Remember that map from this other post on poverty and rural hospital closures?

When we care for the sick at home, a variety of other factors come into play that may delay or prevent access to medical intervention or reporting. Cultural norms around illness, including distrust of the medical system, preference for home care, and family caregiving will play their roles in the spread of COVID-19.

Source: https://www.cdc.gov/aging/caregiving/caregiver-brief.html

This means that children and older family members that do have symptoms may not have access to medical intervention, documentation, advice, or have sufficient care or separation from family members. While these deep-rooted beliefs come from a nurturing and caring place of love, it is important that cases at least be documented. These practices currently put families and communities at high risk of having the virus spread within them. While we do have recommendations for caregivers and home care instructions for coronavirus patients, they are not practical options, nor sufficient for the average family in America.

Home Burials

Source: https://www.romemonuments.com/home-burials – great website. Highly recommend reading more there!

In Part 2 – Home Burials and Funeral Industry

Thank you to anyone reading these commentaries and predictions. Without you I would be shouting into a void.

Poverty And Coronavirus: How Bad Could It Get?

Source: https://www.census.gov/library/visualizations/interactive/2014-2018-poverty-rate-by-county.html#

Let’s talk about poverty and how it plays a role in pandemics (specifically covid-19 and the current state of things in the US).

First, to get this out of the way ,

Poverty does not mean someone is…
dirty
diseased
uneducated
deserving of their position
being punished
has made mistakes
is suffering consequences
or any of that B.S.

Now that that’s out of the way. Let’s move on.

Source: It’s a zoomed in version of the map above, y’all. I’m from the Chesapeake Bay and you can see West Virginia, Tennessee, and Kentucky at high risk just by consideration of poverty.

Impoverished areas tend to have worse health care with low availability than areas of higher average income. And it has only gotten worse over the past 4 years. This means that in these areas everyone is of a much higher risk category when it comes to having community impact from covid-19. There are a couple factors playing into this, but let’s start with the accessibility question.

Closure of Rural Hospitals

Rural hospitals often serve impoverished areas. Because healthcare in the United States is privatized it is not secure. Based on whether or not a larger medical network parent hospital corporation thinks a hospital is profitable, a hospital can be closed down. This is not a new problem. It’s been going on for the past decade, quietly, while everyone else focused on all of the other aspects of healthcare. Except for rural communities where we banded together and started figuring out Ag worker clinics and other ways to cover vitals needs. But guess what: that can’t do crap against the coronavirus.

Since coronavirus entered the United States, West Virginia saw the closure of Fairmont Regional Medical Center at the hands of California owned Alecto Healthcare Services. Other hospitals across the United States are closing and laying off workers to reduce costs and shift resources within these greater hospital networks, like Alecto Healthcare Services. This reduces the resources available to impoverished or communities that might not make these networks as much money. Another example is Missoula, Montana where Western Montana Clinic laid employees ahead coronavirus in a similar way.

Source: https://www.bloomberg.com/news/articles/2020-01-09/hospital-bankruptcies-leave-sick-and-injured-nowhere-to-go

Bloomberg reported back in January that hospital closures were becoming a concern prior to the coronavirus hitting the United States media’s attention. The article references hospital networks taking these actions as a means of weeding out “weaker facilities”.

“Some of the more recent closings are the result of large health systems weeding out weaker facilities. That’s the case with hospitals run by Community Health Systems Inc. and its spin-off, Quorum Health Corp.

All of the areas where these hospitals once were are at much higher risk of having their remaining healthcare systems overwhelmed.

Source: https://www.bloomberg.com/news/articles/2020-01-09/hospital-bankruptcies-leave-sick-and-injured-nowhere-to-go

Under the Trump economy, hospitals have suffered immensely as measured by the Polsinelli TrBK Health Care Services Distress Index (tracks bankruptcy filings in health-care). Not only has this president set our healthcare system up to fail during his entire time in office, he is now trying to deny all responsibility. I don’t identify with a political party in the United States, but seriously.

Essential Employees

Essential employees include delivery drivers, manufacturing employees, gas station workers, grocery store check out clerks, health care workers, government workers, and all of these low-paid minimum wage jobs. Who makes minimum wage?

Source: https://policy-practice.oxfamamerica.org/work/poverty-in-the-us/us-minimum-wage-map/ Darker areas of map represents the concentration of workers being paid under $10.10/hr.

Many of the essential employees that are still going to work are the same ones making minimum wage. They are also the ones living in low income areas where healthcare is suboptimal, easily overwhelmed, and is far away. Assuming they can afford it at all.

Notice something that will make your heart break? Where did all of the hospitals close?

Update: as of 31 March 2020

Source: https://coronavirus.1point3acres.com/en (8:49 PM MST) – Where’s all of Oklahoma’s testing?

I’m not a religious person, but I ask if you read this to pray for those communities. This is where flattening the curve is both most important and least likely to happen. For further reading on how the US is doing with that check out this post here.

Happy to update this and answer questions, plus dress this up with additional research.

Thank you for reading – without you these would just be shouts into the ether.