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.

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.