Recovery: If 1 million Americans get coronavirus, what will the recovery look like?

Success With Flattening the Curve

I posted this on twitter last night after the briefing.

Remember how we were projected to have 2.5 Million cases? We have reduced the projected number of infected Americans by 1.5 Million to only 1 Million. 1 Million is not great, but that’s a big change. That is called flattening the curve and everyone should be thinking that is really amazing (I know I am). They did not mention the number in the briefing (frustratingly). But forecasting has gotten a bad rep in the past.

For those who are math nerds – that’s a linear fit to 1,000,000 (switch from exponential), which some dude in the early 20th century proposed was when the growth in the number of reported influenza cases was hitting it’s predictable rounded peak forecasted the maximum cumulative cases (the limit). I’ve been trying to go through my notes to remember more about how this all works because I don’t remember the name of who came up with all of this and I’m trying to find the paper. I will update this and replace this rambling text when I do.

Recovery in the US

Recovery is not a guarantee that you will not get SARS-CoV-2 again. There are recorded cases of reinfection internationally. We do not have enough data to know if this is reactivation of latent virus or if this is true reinfection. That said, we are finally looking for asymptomatic, both recovered and not, individuals.

A vaccine would be able to address this by using adjuvants designed to induce helper T cell immunity in addition to antibody based immunity. Vaccines take time. Realistically a good vaccine will be on the market in March 2021 at the absolute earliest. Anything before that I will be floored if it has sufficient efficacy to help.

In New York City, 40-50% of patients experiencing severe acute respiratory distress will be placed on a ventilator. If recovery required a ventilator, the testimonies from survivors do not suggest a population able to return to the workforce tomorrow. Shortness of breath, weakness, and other long term effects of hypoxia threaten the be permanent disabilities in this portion of the population.

But what if you do have immunity? You’ll be able to test that. What if you’re one of the lucky ones? I guess that’s up to you.

We’re in this together.

source:https://coronavirus.1point3acres.com/en

At each of these state clusters there is at least one urban center that has the dominant reservoir population. Once movement between urban centers (New York -> Chicago -> Houston -> Miami -> Atlanta -> Boston -> Dallas -> L.A. -> San Francisco -> Chicago -> Orlando -> Pittsburgh -> (etc. etc. etc.)) stops then there will no longer be additions of infected individuals into the populations. This is why non-essential planes need to be grounded.

I live in Montana. I am so blessed. I want to make it clear that we still need to behave. It only takes 1 person to infect 10.

My family and people I love live in Washington, Idaho, Oregon, Montana, California, Texas, Alabama, Louisiana, Florida, Virginia, New York, New Jersey, Massachusetts, New Mexico, Arizona and Maine. I’m terrified for everyone.

We’re going to gradually come to a new normal. Ask me questions and I’ll eventually address them in updates on these original posts.

As a change of pace, I’m going to stop writing about the coronavirus for a while unless there’s something people specifically think of graphs or other things that would be useful questions to be answered in something new instead of an update. I still have a backlog of a couple posts that will still get done though.

I will be starting to write short stories and weird little memoir style posts so people can enjoy my writing separate from the reviews.

Thank you for reading. Without you this is a shout into the void.

Coronavirus US Curve Update: How’s That Flattening Going?

The start of April 2020 has been hard for the United States.

Forecasting Cumulative Case Totals

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

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.

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

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.

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.