It is really cool to watch the things start to flatten. But is that flattening from New York City? Unlikely. As of 5 April 2020, we pushed the 500,000 milestone out to 6-7 of April from what was predicted to be 1 April 2020 based on the early spread. Most likely it’s being contained and squashed in small communities via quarantines successfully and that is preventing the further spread at this time. In 1918, this drive to reopen cities and lift restrictions resulted in second outbreaks in many cities.
Let coronavirus be eradicated from your small town.
Hot Spots
Update 5 April 2020:
Source: https://coronavirus.1point3acres.com/en try to keep in the back of your mind that the cases are concentrated mostly in one central hotspot right now.
I’m going to start breaking down the specifics for each state to develop forecasting. It sounds like coronavirus is going to be with us for a long time, so we might as well figure out a way to predict these ebbs and flows that accounts for human behavior as well. Part of each post will be a regular update showing how the forecast is changing. By seeing that our actions have impact maybe I can provide a bit of positive feedback for people that need encouragement.
If coronavirus is with us, that means it has found its reservoir population. This is bad. This means it hangs out in those people and does nothing except infect others until their body maybe figures out something is going on. West Nile Virus and Dengue Fever hang out in mosquitoes this way, kind of. It’s more complicated than that. This sounds like another post.
Social Distancing Score
I don’t agree with all of their measures and I will explain why I think they are only accurate in certain parts of the country in another post. That said, I do think that it is a useful tool for awareness and contemplation on the score.
As of 5 April 2020 the United States is still struggling with the concept of social distancing and these example struggles are leading to serious consequences. Do I think the above scoring system makes sense? No. But it’s better than nothing and I will address each state individually over the coming weeks while updating the rest of these.
TL;DR
We’re watching the curve flatten nationally, but I hypothesize that this is actually the accumulated effect of rural areas and low exposure areas quarantining and eradicating COVID-19, not New York City.
In 1918, this drive to reopen cities and lift restrictions resulted in second outbreaks in many cities. Let coronavirus be eradicated from your home town before we reopen everything.
Social distancing is hard to measure and important to be aware of. I will discuss this more.
New York City is a visible hot spot and may have an undiagnosed reservoir population that is asymptomatic or minimally symptomatic. We need accurate testing.
Thank you to anyone reading this. These are shouts into a void without you.
The New Jersey Health Department is carefully tracking cases (image below). The majority of deaths and cases have been in the New York City metropolitan area. Cases have shown need for medical intervention – see below.
New Jersey is a special state. From the Jersey Shore through Hoboken to the rural borders with Pennsylvania and the beautiful southern parks and rural areas along the Atlantic Ocean and bay – New Jersey is a unique state that saw no action during the Civil War, and is filled with a unique mix of immigrant heritage through history. This mix shares deep rooted values in family, multigenerational gatherings, faith, and the importance of extended family as caregivers, making New Jersey vulnerable to coronavirus.
Parts of the state of New Jersey are taking social distancing very seriously. Parts, surprisingly close to Philadelphia, are not. The tourist areas of New Jersey are taking social distancing more seriously, and have issued advisories urging those with vacation homes not to come.
The C in decrease in average distance traveled is not surprising with a rural population in the state. As I do analyses on state like Arizona and Montana I will argue against that measure because in Montana we’ve been doing social distancing since before it was cool, but we have to drive 5 hours to get anywhere.
Overall, New Jersey, keep up with the social distancing and work on the Philadelphia side of things hopefully.
New Jersey and 1918
In 1918 the Influenza Pandemic spread out from Philadelphia to New York City, not from New York City to Philadelphia. Due to this lack of congruency and the increase in connectedness of both cities via mass transit, it is more likely that New Jersey will see 1-2 peaks entirely dependent on those of New York City and Philadelphia. The visibility of that separation is entirely dependent on the state of New Jersey flattening the curve between those two outbreaks.
Is New Jersey 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.
Based on the growth of cumulative cases since the 100th case, New Jersey has had 2 changes in their cumulative growth since their 100th case (I round up due to reporting error). On 20th March 2020 and 26th March 2020 something happened. Given that SARS-CoV-2 has an incubation period of up to 2 weeks, what events could have caused these surges?
Based on the model above, New Jersey is predicted to reach 100,000 cases as of the 12th of April, 2020. This does not take into account the backlog of tests nor daily processing capabilities of labs for these tests.
If we look at just the cumulative cases since the 1000th case, the 100,000th case is predicted closer to 15th of April, 2020. This does indicate curve flattening because this milestone is being pushed out.
This means that the citizens of New Jersey are acting as vectors of disease to the Philadelphia and New York City areas (or anywhere else they are traveling). But there’s a reason patients are seeking help elsewhere.
According to NJ.com, “State Health Commissioner Judith Persichilli said 12% of all hospitalizations in the state are now due to COVID-19. Of those, 41% require ventilators to stay alive.”
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?
No. New Jersey will likely have 1 – 2 peaks – one shared across New York City and Philadelphia. The separation between these two peaks will depend on social distancing, hygiene practices, and the adoption of publicly wearing masks. We can examine milestones and projections for changes overtime to try and guess when these will be – if we reach a peak before Philadelphia has reached its peak, then yes, there will be a second peak for New Jersey. Milestones can be used in the process of forecasting for making quick decisions.
The slope is changing. If we look at only the last few days, we have moved farther out how long it takes to reach that 100,000th cumulative case milestone to the 14-15th of April 2020. The acts of individuals allows us to flatten this curve more.
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.
If you currently live in New Jersey, I love you, please stay safe, and isolate if you can.
TL;DR
New Jersey’s Peak is Following New York. If the curve does not flatten more, we could hit 100,000 cases by around 14-15th of April 2020 unless things improve.
At this time it does not look like New Jersey is hitting a peak. New Jersey is kind of flattening the curve. There will be 1-2 peaks dependent on New Jersey’s ability to flatten the curve in between New York and Philadelphia’s 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 New Jersey when Philadelphia peaks 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.
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.
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.
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.
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.
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.”
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.
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.
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.
