We’re On An Adventure

Rainbows everywhere

Today we did something crazy. We drove from Missoula, Montana to Eureka, Montana and back to give a friend a ride back to civilization from their family’s compound after they tested negative for COVID-19. What a great chance to show everyone this amazing place I live!

I did say rainbows

Beautiful Montana

These are all from today

I am blessed to live in a place of wide open spaces and the optical illusion that creates a bigger sky

Where glaciers collide with clouds

Flathead Lake is always a welcome sight

Flathead Lake is a gem

We hit a bit of rain on our way, but it eventually subsided.

As with any good Montana road trip you have to stop for the wildlife.

Don’t worry – they move eventually

You’d never believe this is one of the major shipping routes across the US border into British Columbia, now would you?

Nearing Eureka as it begins to get darker

Blue sky still visible at 9 PM? Not for long!

Near Trego, Montana the last bits of day find their way into this beautiful night

We managed to catch the sunset on our way in to town

As I’m pleased to share with you some of the magnificent clouds we witnessed about 15 miles south of the Canadian border at the port of Roosville

As we return from Eureka we see signs reminding us to social distance and stay close to home. Missoula County and Lincoln County both have 0 active cases. Our friend safely in tow, they are also high risk, have been isolating, and need to get to Missoula for a doctor appointment that cannot be done over a video chat.

Whitefish looks desolate. There’s no one on the roads here. It makes sense – Flathead County is among the hardest hit in the state – every case that’s been traceable has been connected to travel. Flathead County is where the airport for West Glacier and Whitefish is. We head south toward Kalispell.

So helpful

We stop in Kalispell to charge the car and use a disposable barrier for handling the charging cable. Charging will require a couple of hours.

It’s dark, so the pictures aren’t going to be very interesting for the rest of tonight. We will be safely back in Missoula soon.

And there’s your Montana road trip during this crazy time. The world is a mess. Stay safe – hold your family close.

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.

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.