Tag Archives: Flatten The Curve

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 and 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.

New Jersey: Are We Flattening The Curve?

New Jersey Surge Approximately 1 Week Behind New York

As of 4 April 2020 more citizens of New Jersey have died of SARS-CoV-2 than died in the 9/11/2001 attacks.

The eastern part of the state of New Jersey abuts New York City, whereas the western part abuts Philadelphia. If we assume that New York City is the reservoir – or major source of infections that spread out into surrounding areas – New Jersey sits between New York City and Philadelphia. They’re shielding in some regards. New Jersey is predicted to be 1 week behind New York’s recent infection surge. Philadelphia may follow, with Pittsburgh 2 weeks after that based on the 1918 model.

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

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.

What Is Preventing The Curve From Flattening?

Factors Unique to New Jersey

Source: https://www.nj.com/coronavirus/2020/04/these-charts-and-map-show-how-coronavirus-pandemic-is-spreading-across-nj-saturday-april-4-2020.html Play with this one – it’s interactive!

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.

Places of Worship

I get that we need to think about Easter. Stay home if you can. All places of worship are closed in the state of New Jersey.

Social Distancing

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

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.

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

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.

Source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit?usp=sharing – We can see that there are changes going on. Do you like the new style of graph? Tell me in the comments. I can go back and update other posts.

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?

20th March 2020 was when New Jersey ordered limitations on business operations. And look at how that curve flattened. It’s almost as if there was a huge testing backlog. If we look 2 weeks prior to that, New Jersey only had 4 reported cases of coronavirus on 6 March 2020. More likely social distancing behaviors began when the first cases were being diagnosed on 6 March and it requires a full two weeks to see the impact of this change in behavior. On 26th March 2020 NJ.com reported that as of that day the number of SARS-CoV-2 cases of unknown origin outnumbered those of known origin in every county of New Jersey. It is more likely that the change in the graph is associated with the state ordered limitations.

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.

Source: https://docs.google.com/spreadsheets/d/1c-wa_OpRaa0a3uzpZv_e7aA08ibALjDvB-asLZmFJv4/edit#gid=245520383

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.

Healthcare Systems Overwhelmed

Patients from New Jersey are heading to Philadelphia and New York hospitals for treatment in addition to those in New Jersey. New Jersey’s healthcare resources:

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.”

That said, centers specializing in pediatric covid-19 patients are becoming available. There are at least 144 pediatric patients in the state at this time.

To help prevent the spread of coronavirus, rules are being implemented in maternity wards that ban expectant partners from being present during the birth. This is in line with the rules adopted across the country banning visitors.

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. Ask questions and I can go into the mathematics of these models more.

Are we at the peak yet?

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.

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.