In the first week of May, I argued that that we bought a lot of health with systemic social distancing and mobility slow-downs:
physical distancing bought at least four doublings avoided. And that probably means we bought the hospitals a chance in hell of not being overwhelmed.
April bought learning from both overwhelmed hospital systems in metro New York City as well as from systems that are not being overwhelmed. New techniques and procedures are being tested, evaluated and disseminated to clinicians who have enough time and mental energy to learn instead of fighting fires with a garden hose.
We’re going to be cashing in those earnings right now.
Rt.Live tracks the (R)eproductive Rate of the virus in each state. An R above 1.0 means the epidemic is growing as one person newly infected will infect more than one person on average by the time that they cease to be infectious. An R below 1 means it takes multiple people to infect one new person and thus the epidemic will shrink.
Below is a four screen image of RT.Live as of last Friday and 1, 2, and 3 months before:
My colleagues at CovidExitStrategy.org have looked at how states have been approaching the re-opening gating criteria laid out by the White House from late May to this weekend.
We had achieved success in suppressing disease spread by late April and testing had been ramping up throughout May. And now most of the country excluding the metro NYC area and New England is on fire.
Cheryl Rofer
This is not good
Cheryl Rofer
Cheryl Rofer
There were also numerous anonymous or poorly-sourced graphs circulating on Twitter that called out a point just past the flattened peak as “This is where everyone decides to go out to the bar.” And they had the point just about right.
And, of course, the Pandemicist-in-Chief has been egging it all on. It’s not going to get better until January 21, 2021.
Shawn in Showme
The Great American Experiment cannot survive re-fighting the Civil War every 30 years. At some point the Confederacy has to surrender.
gene108
I wonder how closely states with R < 1 correlates with mandatory mask requirements, when being indoors, like shopping.
debbie
Every time I hear one of these idiots obfuscate by claiming that cases are up because of more testing, I want to smash whatever I’m listening to against the wall.
Baud
@debbie:
Try to stay away from babies when listening to the news.
OzarkHillbilly
Finished TFY.
Ohio Mom
I’ve said this before, the fall and winter head cold season is going to be high anxiety for those of us who take keeping ourselves from catching Covid seriously.
Every scratchy throat, cough, sneeze, headache, muscle ache, that I or someone in my household experiences is going to completely upend me. It will go from my usual, “Crap, there goes the next week to a cold,” to “YIKES! Is this IT?!”
All the while knowing that it didn’t have to be this way.
Baud
@Ohio Mom:
Someone said that with the mask wearing and social distancing, flu and cold cases took a nosedive in the early months of this year.
Jeffro
Jesus…hang in there Virginia! 0_0
Jeffro
@Baud: It’s funny, I remember telling friends and family the same thing…that we were likely to ‘accidentally’ kill off some other bugs just by locking down for a while.
Ah well, good times.
Kristine
@Ohio Mom: Yup. This has been a bad allergy year for me, and when I have flares I suffer symptoms also associated with COVID.
Soprano2
I like the charts on the different measures. One small quibble is I wish the headers could “lock” so that as I go down the chart I could still see them. It’s good information, though. In MO the situation is highly variable, as some counties still have zero cases while others like McDonald County where Tyson has two poultry processing plants are rising rapidly.
rikyrah
jl
Can’t go out to the bar if they’re closed.
I missed the news that California allowed 15 counties to open up bars. Now, IIRC, 8 counties have been told to close them back up, and 7 have been given ‘recommendations’ to close them. What a blunder. Should have told all them to close their bars.
rikyrah
There had been no moment where I ache for a President Hillary Clinton than I do now. You can’t tell me that 125,000 people would be dead if she were President ??
I won’t believe you.
OzarkHillbilly
@Soprano2: The last I checked, Hickory county is the last CoVid free county in Misery. McDonald is a disaster at 2,170.90/ 100K with Newton and Jasper not far behind. I notice today that Barton is feeling left out and wants to join the pack. Keep your head down.
Comrade Scrutinizer
@Shawn in Showme: “Hell no, Ah ain’t furgittin!”
Enhanced Voting Techniques
Interesting that Nevada has the worst infection spread rate in the country, a lot of retired people there.
cmorenc
Here’s a positive sign that the locals in the red-ish leaning coastal area of extreme southeastern NC, just above the Myrtle Beach area – are now taking masking far more seriously than they did just 2-3 weeks ago. At the very busy local grocery store most locals and vacationers use, the Sunset Beach Food Lion, back around Memorial Day weekend, mask compliance was at best only around 40-50%. But after we returned to our beach house a couple of weeks later, even 3-4 days *before* Gov Roy Cooper’s executive order re-establishing stricter guidelines went into effect – over 90% of Food Lion patrons were wearing masks. I didn’t just pull this 90%+ estimate out my butt – at least a couple of times when I accompanied my wife to the store, I actually counted masked vs unmasked patrons we passed going up and down aisles and in cashier lines.
Of course out on the beach strand itself, virtually *no one*, including ourselves is wearing masks – but the situation is not as dire-risky as it sounds, at least from a stranger-to-stranger encounter standpoint, because although superficially from a snapshot view the beach is crowded with beach-goers, in actual practice nearly all of the family or friend group clusters are setting up at least 15-20 ft apart from each other, as is the usual distance of folks walking up and down the beach from clusters of folks or other walkers. The one risky exception is the area within a couple of blocks either side of the pier, because that area is more dangerously crowded due to its proximity to the only parking areas available on the island if you’re not staying at one of the on-island beach houses.
We have a house on-island, and usually hang out at the house during the times when the strand is most densely populated, near high tide and mid-day (when it’s hot as Hell in summer anyways), and save our trips out to the strand during more spread-out low-tide times or less populated late afternoon times.
jl
OK, just checked the handy-dandy Our World in Data. So many countries doing one or two orders of magnitude better than we are. Thing is that even now, with good policy, things can be turned around. At least they should be in some parts of the country.
Deaths per million in Switzerland and US the same at beginning of April: around 5.25. Today the US is 2.5, Switzerland is .03.
But you need to plan your work and work your plan. US doesn’t even have a plan.
jonas
@Enhanced Voting Techniques: The casinos were packing ’em in by the busload a few weeks ago. No spacing, no masks anywhere except maybe on floor staff. This is no surprise.
jl
@OzarkHillbilly: Don’t have to go far to see a country that can do what Switzerland did compared to US. The two countries were converging to be in similar bad shape through beginning of May. Death rates per million, US: 5.2, Canada: 4.5. Now, US between 1.8 and 2.5, Canada: 0.4.
That is the infuriating and tragic thing, seems to me. Despite the dooming and glooming in the US, sometimes from experts, more and more countries showing the disease can be controlled. If you can get the prevalence of new infections low enough, you have room to do a lot, if you can’t, then you can do nothing. US insists on exploring the latter option.
jonas
@debbie: It’s incredible what people can get away with by relying on the fact that huge swaths of the population are completely innumerate.
satby
Update from the libertarian hellscape that is the South Bend Farmers Market: mask usage among vendors has dropped more as the consequences for not wearing them continue to be non-existent. Mask usage among customers increased slightly, so my guesstimate was about 70%. Amazing thing, to me anyway, is the number of people older and with chronic health conditions who still refuse to wear them. Boggles my mind.
jl
@debbie: Some places it is, others it isn’t. I think it is more true in California than in other places. The overall trend in confirmed cases follows the trend in testing fairly closely in CA. Or it did until last ten days or so.
But, even so, that kind of talk is senseless. Cases are cases, if you find them by testing, just means you have a better idea of the size of the problem to solve. They are still there whether you test or not. But, if people want to think like Trump who seems to think if an infectious person is different whether you test them, or not, or only find out how many cases you have when the health system crashes, it’s a free country.
Llelldorin
@rikyrah: Actually, it might be, if defying public health orders caught on as a way to stick it to the Clinton Administration.
jl
One thing that hasn’t been mentioned enough is the inability of the US to get workplaces under control. Big outbreaks in workplaces in CA, even in SF Bay Area. I hear about them on the news almost every day, 20 here, 30 there, 40 in another place. And CA corrections didn’t do recommended testing in a transfer of prisoners to San Quentin. The current outbreak there will probably end up over 1000 people.
The surge in CA started in SW San Joaquin and Imperial Valleys in agricultural work crews. Ain’t no punks on the beach in those places. I think the lawlessness of US business may be as important as bad attitudes in the population, and blunders like opening up bars.
dmsilev
@jl: In CA, I’ve been following the trends in hospitalizations more than raw case count (The LA Times has a good tracker of all the state stats, including county breakdowns). Flat or slightly decreasing for the last couple of months, and then a couple of weeks ago started increasing significantly.
Matt McIrvin
@Baud: Remember that Kinsa map from the networked fever thermometers that got a lot of publicity early in the pandemic? It became useless almost immediately, because the background level of fever it was assuming as normal for winter/early spring got smashed flat by the shutdowns. The typical seasonal flu just went away.
jl
@dmsilev: I think the upswing in hospitalizations started in the big agricultural outbreaks in SW San Joaquin and Imperial Valleys. Prevalence of confirmed infections in Imperial Valley is zooming past that in NY and NJ. They’ve sent cases to hospitals all over the state (which does not please me in SF Bay, I read we have a number of them). Newsom ordered it to go into shut down again. But what is Newsom going to do about lawlessness in some industries? People can hide under their beds forever, but if the businesses that grow the food can do whatever they please, then what good will it do?
One problem with this epidemic is that it is running a lot of problems the US has ignored for decades into each other headlong. We need state and national governments that can see the connections and tackle enough of them to make a difference. Disastrously, Trump and GOP think that we can ignore the epidemic problem just as we have ignored half a dozen other problems for years.
Heard an epidemiologist, Maldonado from Stanford, today. She said regular sensible business openings (not bars!) and protests have not seem to have contributed much, at least in SF Bay. The contact trackers are getting named contacts for between 70 and 90 cases, from county health department stats I’ve seen, between 25 and 40 percent of cases ID’d through case tracking, so at least here, I guess they have a rough idea. It’s large workplaces, construction sites, and people getting lax at home get togethers, and apparently, bars.
Feathers
@rikyrah: It would be under 5,000 dead and there would be impeachment hearings and “Clinton Death Count” tickers on CNN and MSNBC and far worse on Fox.
Of course, the real wild card is would the full CDC, including the person who got pulled out of Wuhan, have kept this a near miss, something very scary, that stayed in a place we had never heard of. I don’t think so, as it spread to Europe very quickly, but it might have been fat more contained.
jl
@Feathers: I don’t know if it could have been contained. There were solid articles out in last week of January and first week in February that pretty much laid it all out. One from Jan 25 said that the patterns of spread indicated that it was on its way around the world, and countries needed to prepare for a pandemic. Also, it has graphs of timing of onset, time to next transmission that indicated a big potential for asymptomatic and presymptomatic transmission. This was in Lancet for NEJM, I forget which, not some obscure place.
So, everyone who can read those journals should have had known to prepare for the next disastrous pandemic asap.
Edit: here’s one,
Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study
Prof Joseph T Wu, PhD *
Kathy Leung, PhD *
Prof Gabriel M Leung, MD
Lancet Jan 31, 202
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30260-9/fulltext
Another Scott
@jl: Agreed there was a lot of information about the Wuhan outbreak early. What still flabbergasts me is that the world saw what Wuhan had to do – lock down everything – until they had some understanding of what was happening. But the US and the world just sat back and tut-tutted and acted as if it couldn’t happen here. Or that if it did happen, we’d somehow get better outcomes by doing nothing, because, after all, we can’t lock down the economy and do contact tracing because freedom.
And too many still have that attitude.
Grrr…
Cheers,
Scott.
Matt McIrvin
Numbers are up a little in Massachusetts. Hard to say whether it’s the effect of people getting a bit lax here, the effect of the ongoing protests finally starting to show up, or infected people coming in from places where COVID is exploding. Probably a little of all; my money would be on the last being the biggest effect. They ramped up testing a bit so they could track cases induced by the protests.
Anonymous At Work
Florida perspective, courtesy of Robert Redford:
https://www.youtube.com/watch?v=iEz2gMBRDqE
Mallard Filmore
@Kristine: From a post here:
https://democraticunderground.com/100213657947
it ends with:
8) Number one symptom? DIARRHEA. Every single person who has one or more symptoms has it. Headache also huge. So many people say “it started like this tickle in my throat.”
9) NOBODY HAS A FUCKING FEVER. I counted less than five cases where someone has a fever. And I think I’ve talked to almost 100 people. If anyone says they’re taking temperatures to check for COVID? RUN AWAY. 9 times out of 10 there will be no fever. Ask people if they have a raging headache and shit their pants.
In conclusion: MASKS, ISOLATION, MASKS, NO BARS, MASKS, DIARRHEA, MASKS. Thanks for your time.
trollhattan
@rikyrah:
Truth.
In other public health news, a potential blow against Big Nicotine.
Felt obligated to look it up–Gray is a Dem and evidently does his paymasters’ bidding as though that were an “R” by his name. Disappointing.
Feathers
@Matt McIrvin: The restaurant openings just seem to be a bad behavior license to people. Hanging out at tables, no masks, chatting away. Probably family visits as well. Mask use nearly universal, as far as I’ve seen. Saw two women without masks in Harvard Square, one with none at all, the other with it down around her neck. Was somewhat relieved to overhear them talking and realize they were German, or perhaps Scandinavian.
trollhattan
@jl:
We’ll sadly never know. My last day at the office was March 12. After the governor told vulnerable populations to stay inside that night I called in the next morning (Friday) and told my boss I would either work from home or take a leave day, depending on what policies work would put in place. Over the weekend they determined we would be switching to remote work and now, here we still are.
Did it help? The last time we were told anything, the entire staff of several thousand had reported no infections while key functions requiring staff be present continue operations.
Had they waited another few weeks, we would have had plenty of infections to be sure. As things stand, with the uptick here of the last two weeks I sense the arc of the spread will have us working remotely through 2020. My kid’s new college is planning classes in August and I have my doubts. What about kids flying in from hot states and countries?
Mel
@jl: That’s a big part of the problem. There is no sound, coordinated, widespread, enforced set of guidelines. When there is, the curve flattens. Look at Ohio before the idiots pushed Dr. Acton out.
Clear, simple, mandatory measures to slow the spread and lower the RT number work. Piecemeal approaches, “strong suggestions”, and “recommendations” just don’t work. The minute that it stops being mandatory, the Magats go feral again.
Matt McIrvin
@Mallard Filmore: I wonder if the difference between that and earlier reports is that this is how it manifests in a younger population.
Most of the papers I’ve seen on this say that high fever exists in maybe 70-80% of cases. But those may have been biased toward the severe cases. My friend who almost certainly got COVID back in the spring had no fever.
Matt McIrvin
@Mel: I go to the grocery store every 2-3 weeks. My first trip after things started getting bad, I was wearing an old T-shirt wrapped around my face and I think 2 other people in the entire store were masked.
Second time, there was an advisory out strongly recommending masks. Maybe 60% of the shoppers were wearing them and almost none of the employees, maybe two people.
Third time, the town had announced masks were mandatory and they were checking at the door. 100% compliance. It was a huge difference.
Now, later on, things seemed to slip and I started to see maybe 5% of people with the mask not covering their noses, or hanging off one ear by the time they were done. It takes being a hardass over the long term. But the vast majority of people were still wearing them.
Miss Bianca
@rikyrah: What we can tell you is that however many people ended up not dying under President HRC, she would be getting way MORE shit for deaths and general handling of the crisis than Trump has.
Mel
@jl: Absolutely agree! Crowded, unsafe work conditions are an enormous driver of infection spread.
Businesses failing to set or to enforce basic measures (making employees wear masks, and wear them correctly, providing and monitoring for consistent use of real sanitizing supplies like ample sanitizing wipes, gloves, hand sanitizer, etc) is another enormous problem in our area.
Saying that there’s a “mask policy“ doesn’t mean a damned thing if the employees only wear the masks over their mouths and not their noses, or let them dangle from one ear, indignantly saying, “but I’ve got my mask on…”
I feel heartsick when I think about businesses forcing individuals who are at high risk of severe complications back to work by reporting them as committing “unemployment fraud“ by obeying doctors’ orders to avoid high risk situations. When the decision of how to handle such cases is left up to individual states, who pass the buck and the control to businesses by saying, “we trust our businesses to do the right thing”, well – shit, meet fan.
Mallard Filmore
@Matt McIrvin: This guy is a contact tracer. Maybe the fever shows up later in the illness, by which time you should think about a rush trip to the hospital?
frosty
@rikyrah: Hillary would have been impeached convicted and removed by now. Kaine too. The Republican House Speaker would now be President.
different-church-lady
@Mallard Filmore: Well, that and the New York magazine article pretty much confirms it. I had it, and I stayed away from the hospital for a week because the CDC self-check website didn’t say anything about diarrhea, and I never felt feverish.
satby
@Mallard Filmore: A month ago a friend’s 30- something godson had no fever and mildish cold symptoms and a headache. They sent him home with no covid test because he didn’t seem to match the criteria for a (then still in short supply) test. Told him to take OTC symptom relievers and come back if he felt worse because they did presume he had it. He never got the chance, he was dead within two days. Never ran a fever unless it was in the hours before he died alone in his apartment.
debbie
@satby:
Same with a teammate at work. She was feeling a little flu-ish and got tested, but was negative. They did find a blood clot in her lung and were arranging for hospitalization when she suddenly died.
I just hate that all this is learn-as-you-go-along.
Matt McIrvin
@Mallard Filmore: That’s possible. This kind of perspective may be the only way to see how the infections really progress over the whole population.
satby
And as far as the charts up top go, I don’t believe the stats coming out of Indiana for a minute. The R governor is smarter than Pence was, and once he decided to open the state, the statistics have shown as flat or decreasing in spite of being surrounded by states that have been increasing. I call bullshit.
different-church-lady
@frosty: Now let’s be fair here: they’d impeach Hillary even if there were zero deaths.
different-church-lady
@debbie: In too many places, it’s don’t-learn-as-you-go-along.
RSA
Responding to someone on Facebook, I tried to put it in simple if not simplistic terms:
The U.S. has 5% of the worldwide population. If we were doing an average job dealing with the pandemic, we’d have 5% of COVID-19 infections and 5% of COVID-19 deaths. But no. We have 25% of COVID-19 infections worldwide (2.5 million / 10 million) and 25% of COVID-19 deaths worldwide (128,000 / 500,000).
We’re not average compared to the rest of the world, or a little worse than average. We’re five times worse.
Matt McIrvin
@RSA: I suspect our share of worldwide infections is somewhat overstated because there are likely many places where the undercounting of cases is far more severe than here–testing in the US is not great, but it’s actually happening, even in states where the case rate is high. That said, we are doing very poorly for a rich country.
debbie
@different-church-lady:
Far easier when it’s other lives at stake. //
Another Scott
@satby: :-(
Wuhan really ramped up CT scans early on – that seems to be the best way to actually know if someone has it. Look directly at the lungs, because there are continuing issues with testing (availability, accuracy) and such a wide variety of symptoms, and because death can come so quickly.
We need to learn and apply best practices faster!
Grrr…
Cheers,
Scott.
Uncle Cosmo
@satby: @debbie: It doesn’t surprise me all that much that some of the severest cases of COVID-19 have not been associated with fever. IIUC basal temperature starts to rise when a threat is detected and the immune system goes into overdrive manufacturing antibodies to attack it. Anyone whose immune system doesn’t recognize the threat (& remember, this is a novel virus for most of us) might never have it kick into gear before it’s too late.
Tim C.
@rikyrah: Upshot of Clinton being president is that we would absolutely have fewer deaths and a much better response.
Downshot is in that version of the multiverse is that she’s getting impeached for the 15,000 deaths from covid along with the conspiracy theories being openly approved of in the NY Times about how it’s all a Death-Panel plot.
Geminid
@Shawn in Showme: “At some point the Confederacy has to surrender.” Well, at least Virginia has finally surrendered. And it feels great. I’m hoping North Carolina surrenders soon.
Jamey
@Shawn in Showme: …again.
RSA
@Matt McIrvin: Yes, I think you’re right.
WhatsMyNym
This just seems to be a lagging indicator, not very useful. The outbreaks in WA have been in new areas, unrelated to the very slow and careful reopening of business (shelter in place really was not a thing).
Let’s not forget that the metro NYC area and New England were a disaster, and have a long way to go until this ends.
Matt McIrvin
@Mallard Filmore: “tickle in the throat” is such a rich source of hypochondria for me, since my allergies mean I’ve had that tickle in the throat continuously since March except when it’s raining.
debbie
@Uncle Cosmo:
Right. The caterpillar thinks the wasp has flown off and has no idea what those parasitic wasp egss growing inside have in store for it.
jl
@debbie: Yuk! No wasp parasite anologies, please!
debbie
@jl:
Yeah, gives me nightmares too, but still the best analogy.