We're #1 !!! - Printable Version

We're #1 !!! - Printable Version

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RE: We're #1 !!! - BostonCard - 11-11-2020

With today's 1346 deaths, the seven day average for deaths just crossed 1000/day, up from a trough of about 700. The thing is that deaths are a lagging indicator, and there is no evidence that the leading indicators (new cases or hospitalizations) are slowing down, so we are probably looking at daily deaths moving past the 1500/day mark in the next couple weeks.

BC

RE: We're #1 !!! - magnus - 11-11-2020

I hope this projection is wrong

[Tweet]https://twitter.com/trvrb/status/1326404893863776256?s=20[/tweet]

TB is the one who broke the news about WA spread after linking the first WA case to the second WA case a month later using genomes.

If the ratio is correct, there's not much we can do to prevent 2000 deaths in 3 weeks because most of those 2000 are already infected. =(

RE: We're #1 !!! - M T - 11-11-2020

In California, 8 counties moved into more restrictive categories (ie, more widespread infection) this week (2 into purple), with 20 counties in danger of moving to a more restrictive category next week (including SCC). No county moved into a less restrictive category and no county had better numbers than their current category. This is despite California increasing last week the maximum downward linear adjustment of cases/100K for the county's testing rate relative to the state average.

I hope the increased restrictions will slow the growth of cases, but my opinion is they won't slow it much.

Another bad sign, the 7-day moving average of the number of daily new patient cases in California Skilled Nursing Facilities has jumped by more than a factor of 2 in the last 7 days (1-Nov to 8-Nov, from 41 (the lowest since Apr. 2) to 97 per day), while the overall daily number of cases for the general population jumped 25%. Currently, about 8.7% of cases in SNFs in CA result in deaths. (The number of cases in SNF health care workers jumped similarly. The ratio of patient cases per HCW cases remains about 1.3.)

When I look at the shape of the curve of SCC cases for the 2nd wave and compare it to recent numbers, Nov. 2 (latest 7-day avg when I looked) looks like June 15, the end of a slow rise, except 3x as high. After that, we had 5 weeks of steep growth before we got enough control. The 2nd wave never got down to even the peak of the first wave. If cold weather is a factor, I'd think the growth wouldn't stop in 5 weeks without more drastic measures.

RE: We're #1 !!! - Farm93 - 11-11-2020

The California numbers have been relatively good for a number of weeks now.
California is #30 on the state list of deaths per capita even though CA has far greater urban density in its cities than the other states in its range.

At some point though this is like marveling over your neighborhood's brush fire prevention efforts while a massive fire is sweeping across your town. It is just a matter of time. It is not "your" fault, but too many residents in your town just didn't care. You asked authorities to crack down on people that carelessly tossed cigarettes out of cars or launched paper lanterns at parties. Now though it is just too late, as the fire is just a few blocks away.

That's our deal. CA residents have been doing a lot right for months, but it really just doesn't matter if other people in the USA have not worn masks, have attended large gatherings, and are now just a few days away from driving to CA to spend Thanksgiving week with relatives.

It is no longer good enough to just ask people to take sensible preventative steps. It is time for citizens to prepare for a very tough 12-20 week stretch, even those that worked so hard to prevent this very scenario.

RE: We're #1 !!! - M T - 11-11-2020

Nov. 10: Mayor London Breed announced San Francisco will have to roll back reopening plans and eliminate indoor dining, reduce gym capacity and reduce movie theater capacity starting on Friday due to an uptick in COVID-19 cases.
(SF is still Yellow in CA's measurements, but its numbers would have earned it an Orange this week. If they are still Orange next week, SF will move from Yellow to Orange. I believe the Mayor has seen the numbers and know it is coming.)

SCC, currently in Orange, had Red-level numbers this past week. Nothing has been announced at their website yet. If the numbers are Red again next week, SCC will move into the Red Tier. For SCC, these were the things relaxed when SCC moved from Red (Tier Two) to Orange (Tier Three), so these will GO AWAY:

Quote:Tier Three restrictions are different from Tier Two restrictions (which were previously in place) in the following ways:
Indoor pools may now open

Indoor movie theaters may now operate, but they must limit their capacity to the lesser of 25% of normal capacity or 100 people

Indoor worship services are now allowed, but they must limit their capacity to the lesser of 25% of normal capacity or 100 people

Indoor dining operations and wineries may now operate, but they must limit their capacity to the lesser of 25% of normal capacity or 100 people

Bars, brewpubs, and breweries may now operate outdoors

Some family entertainment centers may now operate indoors, but only those facilities used for naturally distanced activities (such as bowling alleys and climbing walls). These facilities must limit their capacity to 25% of normal

Cardrooms may now operate indoors, but they must limit their capacity to 25% of normal

Indoor shopping malls no longer have a capacity limitation, but common areas must remain closed. Note that the Mandatory Directive for Dining does not allow food courts in shopping malls to open any indoor dining areas

Retail businesses and Libraries no longer have a capacity limitation

Gyms and fitness centers may increase their capacity limit to 25% of normal. This also applies also to indoor sports and dance facilities (e.g., gymnastics, martial arts, fencing, and Zumba facilities)

Museums and zoos may increase their capacity limit to 50% of normal

San Mateo county is Orange, and had Orange numbers this past week (so not at risk of moving to Red for at least 2 weeks).

Because of testing levels, cases in SF only counted as 0.5 cases in the adjusted case-rate computation; In SMC, 0.544; In SCC, 0.639.

RE: We're #1 !!! - BostonCard - 11-11-2020

https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-coronavirus/

Maybe they should re-scale the map. If I am reading the map right, the only two states not undergoing an outbreak are Vermont and Hawaii.

BC

RE: We're #1 !!! - chrisk - 11-11-2020

(11-10-2020, 02:46 PM)magnus Wrote:
(11-10-2020, 02:35 PM)BostonCard Wrote: Didn't want to do an update for every state, but here's the view from Ohio.

[tweet]https://twitter.com/SeanTrende/status/1326276306263273474?s=20[/tweet]

(Sean Trende is kind of the Nate Silver for RealClearPolitics, so not exactly some lefty Cassandra; he's also a native Ohioan).

BC

Are any of these counties shutting down elective surgeries? That seems to be the one difference between hospitalization pct numbers in April vs now.

Despite Ohio State being located in hard-hit Franklin County, it was COVID cases at Maryland that caused their football game Saturday to be cancelled.

RE: We're #1 !!! - BostonCard - 11-11-2020

[tweet]https://twitter.com/COVID19Tracking/status/1326681970051411968?s=20[/tweet]

Today's update is grim. Record number of cases. Hospitalizations are up by 15,000 just since election day. Deaths are approaching the peaks seen in the summer and look set to rise further.

And since I know Teejers, especially, keeps track of the hospital data:

[tweet]https://twitter.com/COVID19Tracking/status/1326682878999101443?s=20[/tweet]

Our total hospital bed capacity is about 900,000, so since November, we've been filling up hospital beds at a rate of over 1% per week. Average census is about 600,000 (higher in winter), so we are going to start seeing widespread hospital capacity issues in a couple months unless we can slow down the virus. We are already seeing localized capacity issues.

BC

RE: We're #1 !!! - teejers1 - 11-11-2020

(11-11-2020, 06:32 PM)BostonCard Wrote: [tweet]https://twitter.com/COVID19Tracking/status/1326681970051411968?s=20[/tweet]

Today's update is grim. Record number of cases. Hospitalizations are up by 15,000 just since election day. Deaths are approaching the peaks seen in the summer and look set to rise further.

And since I know Teejers, especially, keeps track of the hospital data:

[tweet]https://twitter.com/COVID19Tracking/status/1326682878999101443?s=20[/tweet]

Our total hospital bed capacity is about 900,000, so since November, we've been filling up hospital beds at a rate of over 1% per week. Average census is about 600,000 (higher in winter), so we are going to start seeing widespread hospital capacity issues in a couple months unless we can slow down the virus. We are already seeing localized capacity issues.

BC

I am in favor of modifying rules based on capacity or anticipated capacity constraints - so long as they are legitimate (i.e., based on numbers - and not some generalized fear). Thus, I'm fine with areas re-clamping down, if hospital concerns recommend/mandate it. Contrary to recent posts here predicting doom for SCC, I think the county's hospital numbers remain in decent shape:

https://www.sccgov.org/sites/covid19/Pages/dashboard-hospitals.aspx

BTW, I would love to see the second color-coded graph for the entire period of the pandemic. THAT would be interesting/useful information. It's too bad you cannot click on a date modifier for the graph provided (as you can, for example, with the ND dashboard).

P.S. And as stated previously, I believe our views on Covid, need for closures, risk-tolerance, etc. are all based on personal priorities and experience. I want my 3 kids back in school - freely admit that drives my thinking. Separately, I have an 87 year old aunt, who has dementia, is in a home in southern California, and has not been well for the better part of two years. She contracted Covid and we all thought: "this is it" (while also thinking - "it may be a blessing"). Well, she got through it. And I wondered - if she survived Covid, what is the health profile of those who don't? I know this single anecdote is as informative as any other single anecdote - i.e., not at all - but I admit that it colors my thinking. And of course, you never read about these kind of stories - or even stories about really sick/terminal people kicking "of Covid." Despite all the numbers out there, I'm not sure there is a good handle on the profile of typical Covid Decedent. I know when the numbers are at 200K+, it is somewhat silly to think of a particular profile, and many/most will say "what does it matter - those numbers are scary." I get that and largely agree - but I still think better profile information would be illuminating.

RE: We're #1 !!! - Farm93 - 11-11-2020

(11-11-2020, 07:13 PM)teejers1 Wrote:
(11-11-2020, 06:32 PM)BostonCard Wrote: [tweet]https://twitter.com/COVID19Tracking/status/1326681970051411968?s=20[/tweet]

Today's update is grim. Record number of cases. Hospitalizations are up by 15,000 just since election day. Deaths are approaching the peaks seen in the summer and look set to rise further.

And since I know Teejers, especially, keeps track of the hospital data:

[tweet]https://twitter.com/COVID19Tracking/status/1326682878999101443?s=20[/tweet]

Our total hospital bed capacity is about 900,000, so since November, we've been filling up hospital beds at a rate of over 1% per week. Average census is about 600,000 (higher in winter), so we are going to start seeing widespread hospital capacity issues in a couple months unless we can slow down the virus. We are already seeing localized capacity issues.

BC

I am in favor of modifying rules based on capacity or anticipated capacity constraints - so long as they are legitimate (i.e., based on numbers - and not some generalized fear). Thus, I'm fine with areas re-clamping down, if hospital concerns recommend/mandate it. Contrary to recent posts here predicting doom for SCC, I think the county's hospital numbers remain in decent shape:

https://www.sccgov.org/sites/covid19/Pages/dashboard-hospitals.aspx

BTW, I would love to see the second color-coded graph for the entire period of the pandemic. THAT would be interesting/useful information. It's too bad you cannot click on a date modifier for the graph provided (as you can, for example, with the ND dashboard).

P.S. And as stated previously, I believe our views on Covid, need for closures, risk-tolerance, etc. are all based on personal priorities and experience. I want my 3 kids back in school - freely admit that drives my thinking. Separately, I have an 87 year old aunt, who has dementia, is in a home in southern California, and has not been well for the better part of two years. She contracted Covid and we all thought: "this is it" (while also thinking - "it may be a blessing"). Well, she got through it. And I wondered - if she survived Covid, what is the health profile of those who don't? I know this single anecdote is as informative as any other single anecdote - i.e., not at all - but I admit that it colors my thinking. And of course, you never read about these kind of stories - or even stories about really sick/terminal people kicking "of Covid." Despite all the numbers out there, I'm not sure there is a good handle on the profile of typical Covid Decedent. I know when the numbers are at 200K+, it is somewhat silly to think of a particular profile, and many/most will say "what does it matter - those numbers are scary." I get that and largely agree - but I still think better profile information would be illuminating.

Teejers, the problem with clamping down based on hospital availability is it is a very late lagging indicator.

To stop when we are at 100% of ICU capacity, for example, is a problem because for 3 or 4 weeks that area will climb well above 100% capacity.

The catch is to find an indicator that reveals you will be in trouble 3-4 weeks later. The problem is that too many Americans will squawk and say it is too early, alarmist, too restrictive, etc. By the time it is clear to that crew, it is way too late.

It is a tough deal but what has been very clear is the USA has only jumped when it is far too late. We've already done it again with this wave. The case ramp, the hospitalization ramp and the death ramp are all racing up. Cases and hospitalizations are already at new all time highs.

India, with 4 times our population, was slowly catching the USA in total cases, but now we are going to be able to keep our claim for overall cases.

So per the original subject line we are #1, and it looks like we have a lot of officials determined to keep that title.

RE: We're #1 !!! - magnus - 11-11-2020

(11-11-2020, 08:37 PM)Farm93 Wrote: It is a tough deal but what has been very clear is the USA has only jumped when it is far too late. We've already done it again with this wave. The case ramp, the hospitalization ramp and the death ramp are all racing up. Cases and hospitalizations are already at new all time highs.

Have we "jumped" (i don't mean counts)? We have a lot of noise from the less conservative leaning news outlets, but not much action from governments. I guess CA is doing some restrictions, but what are most states doing? I looked at Fox News last night and I couldn't find a link to a Coronavirus article until the bottom of the page (then again, their layout is wacky, so maybe i missed it) Today, I saw a couple links halfway down. FoxNews might be reflective of how 30-50% of the country views the virus. If so, like many other indicators, forget winter, this is going to be a bad autumn.

RE: We're #1 !!! - BostonCard - 11-11-2020

Teejers, the data is available here.

https://covidtracking.com/data/national

From that, you can generate this figure:

[Image: jpDTeNL.png]

The data is noisy, but the 7-day average is exceeding the number of net new hospitalizations we had in the summer and is about what we saw at the beginning of April. The next couple weeks will make or break our system.

BC

RE: We're #1 !!! - 82 Card - 11-11-2020

(11-11-2020, 02:05 AM)magnus Wrote: I hope this projection is wrong

[Tweet]https://twitter.com/trvrb/status/1326404893863776256?s=20[/tweet]

TB is the one who broke the news about WA spread after linking the first WA case to the second WA case a month later using genomes.

If the ratio is correct, there's not much we can do to prevent 2000 deaths in 3 weeks because most of those 2000 are already infected. =(

That would put us at about the same level as the April peak in 7 day average for deaths. However, that's not likely to be the peak.

RE: We're #1 !!! - BostonCard - 11-12-2020

[tweet]https://twitter.com/COVID19Tracking/status/1327044583755280388?s=20[/tweet]

Today's update is not reassuring. We broke the 150,000 case barrier, not long after we broke 100,000 for the first time. This is out of 1.5 million tests, so that's a nation-wide positivity of 10%. Hospitalizations are at an all-time high, and rising. Deaths are close to our summer peak and rising (and, will continue to rise, as they lag hospitalizations and hospitalizations haven't hit their peak).

Quote:Cases nationwide are trending up more quickly than at any point in the pandemic. Today’s 7-day average—nearly 130k—is 54k more than two weeks ago, a growth of 71%.

Uh. Not good.

BC

RE: We're #1 !!! - BostonCard - 11-12-2020

https://www.washingtonpost.com/health/2020/11/12/covid-social-gatherings/

Here's the problem in a nutshell:

Quote:But public health officials nationwide say case investigations are increasingly leading them to small, private social gatherings. This behind-doors transmission trend reflects pandemic fatigue and widening social bubbles, experts say — and is particularly insidious because it is so difficult to police and likely to increase as temperatures drop and holidays approach.

And honestly, this is the sort of thing that is going to be most difficult to try to prevent. It's one thing to close bars and restaurants. It's another to restrict people from having friends over. The best approach is probably going to be educating people and doing a public awareness campaign and hoping for the best. If you try to issue an public health edict, it will go over like a lead balloon.

BC

RE: We're #1 !!! - dabigv13 - 11-12-2020

When local hospitals reach NYC/Italy levels, people may mitigate their actions. But probably only in some locales. It will be a bad winter. Let's pray the vaccines come soon!

RE: We're #1 !!! - Goose - 11-12-2020

(11-12-2020, 08:24 PM)BostonCard Wrote: And honestly, this is the sort of thing that is going to be most difficult to try to prevent. It's one thing to close bars and restaurants. It's another to restrict people from having friends over. The best approach is probably going to be educating people and doing a public awareness campaign and hoping for the best. If you try to issue an public health edict, it will go over like a lead balloon.

BC

While you may be correct that it will go over like a lead balloon, it may be the only way. Education isn't going to work. People know what the situation is. They just don't believe their Thanksgiving dinner with 30 people can possibly be an issue. As long as they believe they have a choice, that won't change. I do however doubt that there are many politicians who will even consider enforcement, and as long as that is so, we are well and truely doomed IMHO.

RE: We're #1 !!! - Mick - 11-13-2020

(11-12-2020, 09:48 PM)Goose Wrote: While you may be correct that it will go over like a lead balloon, it may be the only way. Education isn't going to work. People know what the situation is. They just don't believe their Thanksgiving dinner with 30 people can possibly be an issue. As long as they believe they have a choice, that won't change. I do however doubt that there are many politicians who will even consider enforcement, and as long as that is so, we are well and truely doomed IMHO.

One of the prominent consultants in my field wrote a book titled "Strategy and the Fat Smoker." This was a Hahvahd MBA-trained individual who made education his career, and in this book, he essentially admitted that it didn't work. As you may glean from the title, strategy and education over ceasing smoking and following a better nutritional path is of extremely limited success. I sense the same is true for social distancing, wearing masks, keeping one's hands clean, not touching one's face, etc.

RE: We're #1 !!! - BostonCard - 11-13-2020

We are at the point where people are going to do what people are going to do. You can see it all over the place. We lost the sense of shared sacrifice about 6 months ago, and no one is going to sacrifice their own activities if they don't see others also taking steps to follow guidelines. This is particularly true for low risk (young otherwise healthy people) who will likely suffer minimally if they catch COVID-19, but have the potential to be a vector for the disease that could infect and and possibly kill someone else.

BC

RE: We're #1 !!! - Goose - 11-13-2020

(11-13-2020, 09:17 AM)BostonCard Wrote: We are at the point where people are going to do what people are going to do. You can see it all over the place. We lost the sense of shared sacrifice about 6 months ago, and no one is going to sacrifice their own activities if they don't see others also taking steps to follow guidelines. This is particularly true for low risk (young otherwise healthy people) who will likely suffer minimally if they catch COVID-19, but have the potential to be a vector for the disease that could infect and and possibly kill someone else.

BC

While I agree with 100% of what you say above, I think it is important to realize that essentially NO society operates on a "shared sacrifice" principle. Social norms certainly play a role. People behave a certain way because if the do not they will be ostracized or the like. However, when a big change in behavior is required, social norms only help a bit, because the desired behavior is not ingrained in the population. In some societies, it isn't as big a change, because they have seen this before and there is an accepted social response. In the USA, it is a total change and we don't know, as a society, how to do it.

Some countries/societies have a social norm to follow governmental rules, whatever they may be, liked or disliked. We in the USA had a bit of that in the first half of the 20th century, but only a bit. It has steadily eroded to the point we now have almost none of it. As a result, even in WWII rationing didn't work because of shared sacrifice. It worked (to the extent it did) because they enforced it. While many people joined the military after Pearl Harbor out of a sense of patriotic duty, most people joined to avoid the draft and an infantry MOS. That didn't always work. Lots of draftees ended up infantry even though they thought by joining up they would avoid it. Didn't matter, nothing they could do. Unless and until our local, state, and federal government takes COVID-19 seriously enough to actually attempt compelling responsible behavior, we aren't going to get it.