Why the massive difference? - Printable Version
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Why the massive difference? - lex24 - 07-22-2020
NY and NJ with a combined population of approximately 29,000,000 have about 48,000 Covid deaths.
Calif with a population of about 41,000,000 has a little under 8,000. Of those over 4400 are in LA (pop 10,000,000). A little under 700 in the 9 Bay Area Counties (7.3 Million pop).
I’d like to see an analysis as to the reasons for the major differences. Both as to NY/NJ opposed to CA. And LA as opposed to the Bay Area.
Has anyone seen anything on that?
RE: Why the massive difference? - chrisk - 07-22-2020
(07-22-2020, 05:30 PM)lex24 Wrote: NY and NJ with a combined population of approximately 29,000,000 have about 48,000 Covid deaths.
Calif with a population of about 41,000,000 has a little under 8,000. Of those over 4400 are in LA (pop 10,000,000). A little under 700 in the 9 Bay Area Counties (7.3 Million pop).
I’d like to see an analysis as to the reasons for the major differences. Both as to NY/NJ opposed to CA. And LA as opposed to the Bay Area.
Has anyone seen anything on that?
I haven't seen a formal article but I have heard the following reasons:
- the virus had been spreading uncontrolled for several weeks and the resulting surge overwhelmed the hospital system
- people afraid of getting hospital care (due to spread, lack of insurance, immigration status, etc)
- lack of testing and contact tracing
- seniors in and out of nursing homes were not protected (age of cases skewed older than California)
- the use of ventilators actually worsened the condition in many
- lack of drugs like remdesivir
RE: Why the massive difference? - 2006alum - 07-22-2020
I would add heavier use of public transportation and reliance on shared occupancy rooms/offices with HVAC systems. Much of the bay area lacks AC, way fewer people use public transportation these days, and the weather is neither too hot nor too cold to stay outside or keep the window open. LA in July and NYC/NJ in March are not great for open windows and no central air/heat.
RE: Why the massive difference? - qwerty49 - 07-22-2020
Well, Calif had the advantage of watching NY/NJ become the first epicenter in the USA, then locked down relatively hard.
I'm also guessing it's just relatively easier to quarantine in Calif than NY/NJ, especially with a job infrastructure in Calif that's more likely to accommodate remote working than in NY/NJ. Ditto for Bay Area vs SoCal, w/r/t early shutdown and remote working.
Also way less population density almost anywhere in Calif than in NYC.
RE: Why the massive difference? - OutsiderFan - 07-22-2020
Just being logical, the population density and hospitals being overwhelmed had to play a very large role in the discrepancy. Another variable was that the tri-state dealt with crushing numbers when there was little understanding of how to treat patients.
You have to give people like my infection control nurse friend a lot of credit for stopping the spread and deaths in LTCF after April. I don't think his facility has had a Covid case since May. They got their results after creating Covid and Covid quarantine areas away from other residents and ramped up testing like crazy.
CT has gone two straight days with zero deaths! Though we did have +127 confirmed infections today after averaging about 50/day over last four days.
RE: Why the massive difference? - akiddoc - 07-22-2020
Far more infections in the older population in New York vs California. Thus the higher mortality rate.
RE: Why the massive difference? - BostonCard - 07-22-2020
That is probably the biggest reason. Another reason is that New York's peak occurred early in the pandemic when we had a piss poor testing regime, so a lot of people with COVID-19 never got tested, so we vastly underestimated (probably by at least an order of magnitude) the number of infected people in New York, thus overestimating the case fatality rate. The wave in California seems to be cresting now, and while testing is still pretty bad, we are catching a greater share of the people with COVID-19, so we are underestimating the number of infected by a lower margin, making the case fatality rate a lower overestimate.
BC
RE: Why the massive difference? - Treefence - 07-22-2020
I think the biggest issue is population density. I think the virus spread like wildfire in the metropolitan east coast areas. LA is a decently dense city as well, but nothing like New York and New Jersey.
RE: Why the massive difference? - Snorlax94 - 07-22-2020
From what I have seen, Feb-Apr was just a bad, bad time to get hit by Covid. One stat I’ve watched are fatalities for people 40-50 in Santa Clara County.
By early April, 4 people 40-50 died of Covid in SCC
Then, i think 1 person in their 40s passed away in May.
It stayed at 5 for a long, long time, then it finally rose to 6 about a couple weeks ago.
All throughout, there have been lots of people in their 40s testing positive, so even if many people weren’t getting tested in March, the number of positive cases May-July is much much higher, yet most of the deaths for people 40-50 occurred in March and April.
The why I will let the doctors answer (and they have been), but it’s clearly becoming a better and better time to get sick (although that may end if the system is swamped during the flu season).
I may have a different takeaway from this as you — to me, the data *supports* a stricter shelter-in-place now. Why should people be getting sick now when there’s a major development in repurposed therapeutics like every month? Why get sick now when all the new doctors are in the teaching hospitals (as has been discussed before, fatalities in hospitals increase in July).
To me, there’s a better chance of life getting back to normal before next summer from repurposed therapeutics than from a vaccine. So I feel it’s wise to be cautious when so many promising treatments could be coming. Many of the therapeutics thus far have been for severe cases — you might survive but by that point there could be lifelong damage. But imagine what happens when we have proven, cheap, ubiquitous treatments people can take at onset to avoid severe cases. We may have already found one (neubilized interferon beta). That’s why all the current hospitalizations are even more tragic — many thousands of people could survive with lifelong damage and they literally could have been months away from a treatment that could have likely averted that damage. Just imagine being the athlete who dreamed of playing pro, or the active social butterfly, who may survive, but whose life may be severely shortened and greatly limited after a tough hospitalization. Just imagine living with that pain the rest of your now reduced days wondering, if only the country had demonstrated a little more patience and a little more common sense, like pretty much all the other developed economies in the world except Sweden.
RE: Why the massive difference? - teejers1 - 07-22-2020
(07-22-2020, 09:52 PM)Snorlax94 Wrote: I may have a different takeaway from this as you — to me, the data *supports* a stricter shelter-in-place now. Why should people be getting sick now when there’s a major development in repurposed therapeutics like every month? Why get sick now when all the new doctors are in the teaching hospitals (as has been discussed before, fatalities in hospitals increase in July).
Under this reasoning, strict SiP should have been instituted at the jump in effect until major development in repurposed therapeutics is realized (presumably on a widespread basis). I mean, why risk death or serious long term injury when a viable therapeutic is only 3/6/12 months away (is there any difference using that controlling consideration)? That's certainly one take - and it has the benefit of consistency. But I'm on the other end - do as much as you reasonably can allow, with hospital capacity being the driver of what is and is not acceptable acitivity.
BTW, is Sweden's death rate among population <60 that much worse than other countries? It very well could be, as I haven't been following things beyond my county (and to a lesser extent, state). The reason I ask is that I understood Swedish officials admitting that if they clustered their approach with the older demographic, and if they had been more restrictive with that group, the countries numbers would be much better.
P.S. BC, what is generally accepted herd immunity percentage? A friend relayed to me that some data scientist (with medical training) thought NY had essentially contained virus due in no small part to herd immunity. He said that 20% did the trick. Putting aside whether such an assertion is valid or not, what I'm wondering is does that figure sound right? Or is it more likely the 20% figure the guy used meant the percentage of population reporting positive testing, which when multiplied by some factor to account for the number of untested positives gets you closer to the real threshold approaching some form of herd immunity? Just curious.
RE: Why the massive difference? - BostonCard - 07-23-2020
The formula for herd immunity is derived from the fact that the Rt = R0*(1-i) where i is the proportion of the population that is immune. Since you need RT to be less than 1 to stop spread of the virus, you can set h as the proportion of I that leads to RT being less than 1. Thus R0 * (1 - h) < 1, so solving for h gives you h > 1 - 1/R. This makes sense, as the higher the reproductive number, the more people have to be immune in order to get herd immunity. I have seen estimates of R0 for COVID-19 in the 2.5 range, so if you plug it in, you need 60% of the population to be immune in order to get herd immunity. If R0 is more like 2, then you need 50% of the population immune, which is where the guideline that to get herd immunity we would need 70% efficacy of a vaccine with 70% of the population taking it (gives you 49% immunity).
Social distancing measures in place right now have driven R(effective) down to less than 1.5, so in those getting to 33% immune is enough to get you herd immunity.
Note that once you get up to 20% immune, that probably is enough to have a measurable effect on how fast the virus propagates. Think about it, that’s 20% of potential transmission chains snuffed out by immunity.
BC
RE: Why the massive difference? - Goose - 07-23-2020
(07-23-2020, 12:16 AM)BostonCard Wrote: Social distancing measures in place right now have driven R(effective) down to less than 1.5, so in those getting to 33% immune is enough to get you herd immunity.It also shows that if our contact tracing effort was finding even 1/3 of the people who had been exposed and quarantining them the disease level would be steady-state or better. This really shows how badly we have failed at this. I really do not understand why the public is so passive in accepting that our plan to flatten the curve and then drive it down has totally failed.
Note that once you get up to 20% immune, that probably is enough to have a measurable effect on how fast the virus propagates. Think about it, that’s 20% of potential transmission chains snuffed out by immunity.
BC
It has failed in Northern California because our tracking and tracing has failed. SCCs numbers make that clear. Only about 20% of the cases are contacts of other cases, and it is not specified how many of those were even contacted. We are now apparently trying to figure out a way to survive community spread with an R(effective) > 1. We may manage to do it but the damage to our society is already great and grows daily. We are relying on keeping up social distancing and masks at the current levels of effectiveness, increasing herd immunity, better treatments for acute cases, and/or a vaccine to save us before we finally, inexorably, overload our hospitals. Yet the public seems not to care at all. Neither does CNN or anybody else in the news media. It should be a local and national scandal but we hear dead silence.
RE: Why the massive difference? - OutsiderFan - 07-23-2020
(07-23-2020, 06:24 AM)Goose Wrote:(07-23-2020, 12:16 AM)BostonCard Wrote: Social distancing measures in place right now have driven R(effective) down to less than 1.5, so in those getting to 33% immune is enough to get you herd immunity.It also shows that if our contact tracing effort was finding even 1/3 of the people who had been exposed and quarantining them the disease level would be steady-state or better. This really shows how badly we have failed at this. I really do not understand why the public is so passive in accepting that our plan to flatten the curve and then drive it down has totally failed.
Note that once you get up to 20% immune, that probably is enough to have a measurable effect on how fast the virus propagates. Think about it, that’s 20% of potential transmission chains snuffed out by immunity.
BC
It has failed in Northern California because our tracking and tracing has failed. SCCs numbers make that clear. Only about 20% of the cases are contacts of other cases, and it is not specified how many of those were even contacted. We are now apparently trying to figure out a way to survive community spread with an R(effective) > 1. We may manage to do it but the damage to our society is already great and grows daily. We are relying on keeping up social distancing and masks at the current levels of effectiveness, increasing herd immunity, better treatments for acute cases, and/or a vaccine to save us before we finally, inexorably, overload our hospitals. Yet the public seems not to care at all. Neither does CNN or anybody else in the news media. It should be a local and national scandal but we hear dead silence.
Rachell Maddow is the only corporate media platform I've seen consistently nail the truth and call out the failures with passion. Last night she had renowned immunologist and AIDS researcher Dr. David Ho on. Here she is talking about what he presented on April 3, the options we had, what would and did happen following the path we chose, and what we could have done that would have been less damaging.
https://www.msn.com/en-us/news/politics/why-trumps-failure-to-lead-national-response-prolongs-coronavirus-crisis/vi-BB175ffh
I know people will say it would be "politically impossible" to shut down the whole country at once. To that I call absolute bullshit. If say Dr. Fauci and Dr. Ho would have been embraced to lead a federal response, we'd be out of this mess already. All you need to do is look at virtually every other country in the world to prove the point.
RE: Why the massive difference? - lex24 - 07-23-2020
(07-23-2020, 06:52 AM)OutsiderFan Wrote:(07-23-2020, 06:24 AM)Goose Wrote:(07-23-2020, 12:16 AM)BostonCard Wrote: Social distancing measures in place right now have driven R(effective) down to less than 1.5, so in those getting to 33% immune is enough to get you herd immunity.It also shows that if our contact tracing effort was finding even 1/3 of the people who had been exposed and quarantining them the disease level would be steady-state or better. This really shows how badly we have failed at this. I really do not understand why the public is so passive in accepting that our plan to flatten the curve and then drive it down has totally failed.
Note that once you get up to 20% immune, that probably is enough to have a measurable effect on how fast the virus propagates. Think about it, that’s 20% of potential transmission chains snuffed out by immunity.
BC
It has failed in Northern California because our tracking and tracing has failed. SCCs numbers make that clear. Only about 20% of the cases are contacts of other cases, and it is not specified how many of those were even contacted. We are now apparently trying to figure out a way to survive community spread with an R(effective) > 1. We may manage to do it but the damage to our society is already great and grows daily. We are relying on keeping up social distancing and masks at the current levels of effectiveness, increasing herd immunity, better treatments for acute cases, and/or a vaccine to save us before we finally, inexorably, overload our hospitals. Yet the public seems not to care at all. Neither does CNN or anybody else in the news media. It should be a local and national scandal but we hear dead silence.
Rachell Maddow is the only corporate media platform I've seen consistently nail the truth and call out the failures with passion. Last night she had renowned immunologist and AIDS researcher Dr. David Ho on. Here she is talking about what he presented on April 3, the options we had, what would and did happen following the path we chose, and what we could have done that would have been less damaging.
https://www.msn.com/en-us/news/politics/why-trumps-failure-to-lead-national-response-prolongs-coronavirus-crisis/vi-BB175ffh
I know people will say it would be "politically impossible" to shut down the whole country at once. To that I call absolute bullshit. If say Dr. Fauci and Dr. Ho would have been embraced to lead a federal response, we'd be out of this mess already. All you need to do is look at virtually every other country in the world to prove the point.
“Truth”. She’s positing opinions. And putting on those that advance her position. Maybe she’s right. Maybe she’s wrong. But she’s presenting viewpoints. And she’s doing so from her strong left position. Your “truth” is based on your own biases. As is everyone’s.
As for shutting down the country at once - first had Trump suggested it there would have been massive opposition from Democrats. Because that is where we are today. Second, and more importantly, he can’t actually shut down states constitutionally. . Had he tried there would have been a hue and cry about his acting as a dictator.
He could have and should have had a stronger, better, clearer message. And a quicker response. But he cant shut down states. Any more than he can open them up. You may remember that he suggested he could order states to reopen - and was immediately rebuked (rightfully) by many governors.
RE: Why the massive difference? - Goose - 07-23-2020
(07-23-2020, 06:52 AM)OutsiderFan Wrote: I know people will say it would be "politically impossible" to shut down the whole country at once. To that I call absolute bullshit. If say Dr. Fauci and Dr. Ho would have been embraced to lead a federal response, we'd be out of this mess already. All you need to do is look at virtually every other country in the world to prove the point.To be accurate, if you look at the EU you actually see countries that are lots better off than we are but who are also far from out of this mess. Nobody is going to be out of this mess for a while, and one misstep can lead to a surge of cases. Things are not "business as usual" there. I wish they were, as it has greatly affected my business.
I really don't understand why you constantly worry about the federal response as the main problem. Listen to what Dr. Fauci said during his talk with Stanford medicine. He pointed out that we had let our State and County Health services atrophy out of existence, and that that was the real problem. If he were "in charge" of the federal response, what he would have done is help reconstitute the County and State Health Departments. It would have been nice if the federal response had lead there, but it isn't like Newsom and the Counties didn't know what they needed to do, as did NY State and NYC etc. The have all apparently failed to do it, and it isn't because they lacked the money. If it were, we would have heard about it.
Why did this track and trace effort fail? I don't know for sure, but I THINK it is because neither the State or the County have the will to enforce any isolation or quarantine, or even cooperation with the track and trace program. Given that, they realized their track and trace efforts were doomed to fail and didn't much worry about them. I have been getting the run-around from San Mateo County Health for months. I still have no idea how effective they are in getting contacts and tracking them. The Board of Supervisors also doesn't know, or they are fibbing to me about it. That isn't a federal problem, but boy does this stink IMHO.
RE: Why the massive difference? - M T - 07-23-2020
There are over 3000 counties in the United States. If each is trying to do contact tracing and failing, maybe it isn't because there are 3000 sets of incompetent efforts.
What are the features that might be making it ineffective?
1. Too many cases. You can't catch every rain drop in a storm. However, I believe almost all current hot spots were not so bad 1.5 or 2 months ago.
2. Lack of cooperation. I'm sure there are some cases that don't want to cooperate. I'd bet that is less than 10%.
3. Hands tied: HIPAA. I think that telling Bill that he was exposed by Adam would be helpful, and bring it home to people. But I don't think that is most of the problem.
4. Closing the barn door too late. It is abundantly clear that contact tracing can't be effective with the kinds of delays we are seeing in doing the tracing after the delays in noticing the disease, testing for it, getting the results back, and then getting the info to the county, then they get contact info, and the tracers then actually get in touch with the contact. The infectee would already be sick and know it. You may catch some asymptomatic cases, but clearly that isn't helping.
4. Attacking the wrong problem. We are trying to tell Bill that he was exposed by Adam, but by then, Bill has already been exposing others. We should be asking Bill who he might have exposed, and telling them.
5. Misunderstanding of the spread mechanism. When I think about the seemingly universal failure of contact tracing in the US, I keep coming back to this. No doubt that if you stand next to someone for 15 minutes who is shedding virus, you have a good chance of getting the disease. But is this a good model of who CAN AND DOES get the disease? If Adam walks in a crowd or into a grocery store, how many non-close contacts may get infected by him. The half-life of the virus in an aerosol is an hour. That's plenty of active virus for hours after he walks in for whomever inhales it. Alternatively, the model that we are safe outdoors isn't really true.
Maybe this is like bolts of lightning. Stand out in a field in a lightning storm. If you stand there longer, your chances of getting hit get higher. If there is more lightning strikes, your chances of getting hit are higher. But, even if there is only one lightning strike, and you happen to be in the wrong place at the wrong time, you can get hit. If there is a crowd of 1000 people in that field, there's a roughly 1000x higher chance that one of them will be hit.
Maybe all it takes is one viron getting to a cell that somehow is not where the immune system can notice it & respond to it effectively. That's the lightning strike. It starts churning out virus, and spreads.
In the various well-documented spreads, it was never that everyone within some radius got the disease. It was spotty even up close. But there were people that got it many times further than the nearest one that didn't get it.
I don't know exactly how the probabilities would work. The obvious thing is that the guy that took 450 breaths within 6' of you would be exposed 45x as much as the person that walked by for 20 seconds and took only 10 breaths. But maybe you don't shed virons equally with every exhalation and they don't exist in some cloud with a density proportional to the distance from your mouth. Maybe sometimes you "clear" your throat, or you say "Suffering succotash" and expel more virons in the aerosol from your breath or speech. The warmth of your breath may take the aerosols up into the air above your heads, and where it cools & happens to ride an air current into someone's breathing space, nobody knows.
(Hmmm... I wonder if anyone has looked at the height of people that get the disease. I wonder if tall people are more likely to have their heads in clouds of virus-laden aerosols than shorter people.)
RE: Why the massive difference? - Goose - 07-23-2020
(07-23-2020, 03:25 PM)M T Wrote: There are over 3000 counties in the United States. If each is trying to do contact tracing and failing, maybe it isn't because there are 3000 sets of incompetent efforts.It is true that the case count can overwhelm the tracing capability. However, we aren't being told that is the case. San Mateo County and San Francisco County have explicitly stated it is NOT the case in their jurisdictions. SCC has been a bit coy. For sure I expect LA County isn't keeping up.
What are the features that might be making it ineffective?
1. Too many cases. You can't catch every rain drop in a storm. However, I believe almost all current hot spots were not so bad 1.5 or 2 months ago.
Quote: 2. Lack of cooperation. I'm sure there are some cases that don't want to cooperate. I'd bet that is less than 10%.I would take that bet. As others have pointed out the contact tracers rely on the telephone. If you are like most of us, you just don't answer unless you recognize the caller. You aren't "intentionally" not cooperating, but it has the same result. At least in NY, the unwillingness to help by giving out contacts has been an issue.
Quote: 3. Hands tied: HIPAA. I think that telling Bill that he was exposed by Adam would be helpful, and bring it home to people. But I don't think that is most of the problem.I think this is a non-issue. If you reach the Bill on the phone, it probably doesn't matter to him who gave him the disease. Knowing who it was may jog the contacts memory, but beyond that I don't think it matters.
Quote: 4. Closing the barn door too late. It is abundantly clear that contact tracing can't be effective with the kinds of delays we are seeing in doing the tracing after the delays in noticing the disease, testing for it, getting the results back, and then getting the info to the county, then they get contact info, and the tracers then actually get in touch with the contact. The infectee would already be sick and know it. You may catch some asymptomatic cases, but clearly that isn't helping.You are correct that the delays will greatly reduce the effectiveness of contact tracing. But that isn't the problem. If it were, we would still see lots of cases where the person was listed as a contact (if only in retrospect). At least in SCC that isn't happening, as the number of cases who are contacts is now 19.2% and still dropping. SF and SM are unknowns, because they don't report this data.
Quote: 4. Attacking the wrong problem. We are trying to tell Bill that he was exposed by Adam, but by then, Bill has already been exposing others. We should be asking Bill who he might have exposed, and telling them.Not quite. We tell Bill that he was exposed, and that he must quarantine and must get tested immediately. If he does test positive, he becomes a case and the others he has exposed become contacts by natural causes. If he doesn't test positive, we got lucky. He isn't shedding virus and couldn't have infected anybody yet. If Bill does start shedding virus later it won't matter because he is in quarantine. If Bill has already got sick and been tested (because of excessive delay in contact tracing process) that is certainly bad, but the contact tracers should record that statistic as well to show the effect of slow reporting.
Quote: 5. Misunderstanding of the spread mechanism. When I think about the seemingly universal failure of contact tracing in the US, I keep coming back to this. No doubt that if you stand next to someone for 15 minutes who is shedding virus, you have a good chance of getting the disease. But is this a good model of who CAN AND DOES get the disease? If Adam walks in a crowd or into a grocery store, how many non-close contacts may get infected by him. The half-life of the virus in an aerosol is an hour. That's plenty of active virus for hours after he walks in for whomever inhales it. Alternatively, the model that we are safe outdoors isn't really true.The question you are asking comes down to who is a contact. If you got the virus via a stray viron from a guy riding by on a bike, contact tracing isn't going to work in that event. However, it does come down to probabilities. We do know from the events in Taiwan and Korea that contact tracing can work. Germany has also had success in this effort. You don't need to get everybody. You just need to get a high enough percentage that you can drive R below 1. It hasn't been easy, but the contact tracers have been relentless. Consider the gay nightclub guy in Korea. Despite people lying on their contact information, they mostly got traced down.
Maybe this is like bolts of lightning. Stand out in a field in a lightning storm. If you stand there longer, your chances of getting hit get higher. If there is more lightning strikes, your chances of getting hit are higher. But, even if there is only one lightning strike, and you happen to be in the wrong place at the wrong time, you can get hit. If there is a crowd of 1000 people in that field, there's a roughly 1000x higher chance that one of them will be hit.
Maybe all it takes is one viron getting to a cell that somehow is not where the immune system can notice it & respond to it effectively. That's the lightning strike. It starts churning out virus, and spreads.
In the various well-documented spreads, it was never that everyone within some radius got the disease. It was spotty even up close. But there were people that got it many times further than the nearest one that didn't get it.
I don't know exactly how the probabilities would work. The obvious thing is that the guy that took 450 breaths within 6' of you would be exposed 45x as much as the person that walked by for 20 seconds and took only 10 breaths. But maybe you don't shed virons equally with every exhalation and they don't exist in some cloud with a density proportional to the distance from your mouth. Maybe sometimes you "clear" your throat, or you say "Suffering succotash" and expel more virons in the aerosol from your breath or speech. The warmth of your breath may take the aerosols up into the air above your heads, and where it cools & happens to ride an air current into someone's breathing space, nobody knows.
(Hmmm... I wonder if anyone has looked at the height of people that get the disease. I wonder if tall people are more likely to have their heads in clouds of virus-laden aerosols than shorter people.)
What is different in all these other nations is that the people do isolate when they test positive and that they do provide contact data (at least in the main). The contacts do get tested and do quarantine. The contact tracers do visit your place of quarantine. If you get caught not meeting your responsibilities, you get locked up. We don't have/do any of those things, and that is why we are failing IMHO.
Unless and until people know the have to cooperate and do so, either willingly or otherwise, contact tracing isn't going to work. Being very slow in contact tracking could be an issue, but as of now we have no evidence that it is a problem. If contact tracing was working well but too slowly, the tracers would know it.
RE: Why the massive difference? - teejers1 - 07-23-2020
(07-23-2020, 08:20 AM)Goose Wrote: I really don't understand why you constantly worry about the federal response as the main problem. Listen to what Dr. Fauci said during his talk with Stanford medicine. He pointed out that we had let our State and County Health services atrophy out of existence, and that that was the real problem. If he were "in charge" of the federal response, what he would have done is help reconstitute the County and State Health Departments. It would have been nice if the federal response had lead there, but it isn't like Newsom and the Counties didn't know what they needed to do, as did NY State and NYC etc. The have all apparently failed to do it, and it isn't because they lacked the money. If it were, we would have heard about it.
Why did this track and trace effort fail? I don't know for sure, but I THINK it is because neither the State or the County have the will to enforce any isolation or quarantine, or even cooperation with the track and trace program. Given that, they realized their track and trace efforts were doomed to fail and didn't much worry about them. I have been getting the run-around from San Mateo County Health for months. I still have no idea how effective they are in getting contacts and tracking them. The Board of Supervisors also doesn't know, or they are fibbing to me about it. That isn't a federal problem, but boy does this stink IMHO.
IMO, the above answers your question on why national media hasn't been all over track and trace failures: because they know that, at bottom, that is a local job and they can't easily blame Trump & Co. for those shortcomings. By no means is this meant to exonerate Trump in any fashion - the federal "response" has been a miasma of mixed/conflicting signals, denial, and general cluelessness. An unmitigated disaster.
Still, when it comes to effective track and trace, that just has to be done at local level. To be sure, that big job could have been made more "doable" with better/consistent federal messaging and $$, but I fundamentally agree with your take that the locals - especially in our neck of the woods - haven't been on top of it as much as they could have/should have.
RE: Why the massive difference? - lex24 - 07-23-2020
(07-23-2020, 05:01 PM)Goose Wrote:(07-23-2020, 03:25 PM)M T Wrote: There are over 3000 counties in the United States. If each is trying to do contact tracing and failing, maybe it isn't because there are 3000 sets of incompetent efforts.It is true that the case count can overwhelm the tracing capability. However, we aren't being told that is the case. San Mateo County and San Francisco County have explicitly stated it is NOT the case in their jurisdictions. SCC has been a bit coy. For sure I expect LA County isn't keeping up.
What are the features that might be making it ineffective?
1. Too many cases. You can't catch every rain drop in a storm. However, I believe almost all current hot spots were not so bad 1.5 or 2 months ago.
Quote: 2. Lack of cooperation. I'm sure there are some cases that don't want to cooperate. I'd bet that is less than 10%.I would take that bet. As others have pointed out the contact tracers rely on the telephone. If you are like most of us, you just don't answer unless you recognize the caller. You aren't "intentionally" not cooperating, but it has the same result. At least in NY, the unwillingness to help by giving out contacts has been an issue.
Quote: 3. Hands tied: HIPAA. I think that telling Bill that he was exposed by Adam would be helpful, and bring it home to people. But I don't think that is most of the problem.I think this is a non-issue. If you reach the Bill on the phone, it probably doesn't matter to him who gave him the disease. Knowing who it was may jog the contacts memory, but beyond that I don't think it matters.
Quote: 4. Closing the barn door too late. It is abundantly clear that contact tracing can't be effective with the kinds of delays we are seeing in doing the tracing after the delays in noticing the disease, testing for it, getting the results back, and then getting the info to the county, then they get contact info, and the tracers then actually get in touch with the contact. The infectee would already be sick and know it. You may catch some asymptomatic cases, but clearly that isn't helping.You are correct that the delays will greatly reduce the effectiveness of contact tracing. But that isn't the problem. If it were, we would still see lots of cases where the person was listed as a contact (if only in retrospect). At least in SCC that isn't happening, as the number of cases who are contacts is now 19.2% and still dropping. SF and SM are unknowns, because they don't report this data.
Quote: 4. Attacking the wrong problem. We are trying to tell Bill that he was exposed by Adam, but by then, Bill has already been exposing others. We should be asking Bill who he might have exposed, and telling them.Not quite. We tell Bill that he was exposed, and that he must quarantine and must get tested immediately. If he does test positive, he becomes a case and the others he has exposed become contacts by natural causes. If he doesn't test positive, we got lucky. He isn't shedding virus and couldn't have infected anybody yet. If Bill does start shedding virus later it won't matter because he is in quarantine. If Bill has already got sick and been tested (because of excessive delay in contact tracing process) that is certainly bad, but the contact tracers should record that statistic as well to show the effect of slow reporting.
Quote: 5. Misunderstanding of the spread mechanism. When I think about the seemingly universal failure of contact tracing in the US, I keep coming back to this. No doubt that if you stand next to someone for 15 minutes who is shedding virus, you have a good chance of getting the disease. But is this a good model of who CAN AND DOES get the disease? If Adam walks in a crowd or into a grocery store, how many non-close contacts may get infected by him. The half-life of the virus in an aerosol is an hour. That's plenty of active virus for hours after he walks in for whomever inhales it. Alternatively, the model that we are safe outdoors isn't really true.The question you are asking comes down to who is a contact. If you got the virus via a stray viron from a guy riding by on a bike, contact tracing isn't going to work in that event. However, it does come down to probabilities. We do know from the events in Taiwan and Korea that contact tracing can work. Germany has also had success in this effort. You don't need to get everybody. You just need to get a high enough percentage that you can drive R below 1. It hasn't been easy, but the contact tracers have been relentless. Consider the gay nightclub guy in Korea. Despite people lying on their contact information, they mostly got traced down.
Maybe this is like bolts of lightning. Stand out in a field in a lightning storm. If you stand there longer, your chances of getting hit get higher. If there is more lightning strikes, your chances of getting hit are higher. But, even if there is only one lightning strike, and you happen to be in the wrong place at the wrong time, you can get hit. If there is a crowd of 1000 people in that field, there's a roughly 1000x higher chance that one of them will be hit.
Maybe all it takes is one viron getting to a cell that somehow is not where the immune system can notice it & respond to it effectively. That's the lightning strike. It starts churning out virus, and spreads.
In the various well-documented spreads, it was never that everyone within some radius got the disease. It was spotty even up close. But there were people that got it many times further than the nearest one that didn't get it.
I don't know exactly how the probabilities would work. The obvious thing is that the guy that took 450 breaths within 6' of you would be exposed 45x as much as the person that walked by for 20 seconds and took only 10 breaths. But maybe you don't shed virons equally with every exhalation and they don't exist in some cloud with a density proportional to the distance from your mouth. Maybe sometimes you "clear" your throat, or you say "Suffering succotash" and expel more virons in the aerosol from your breath or speech. The warmth of your breath may take the aerosols up into the air above your heads, and where it cools & happens to ride an air current into someone's breathing space, nobody knows.
(Hmmm... I wonder if anyone has looked at the height of people that get the disease. I wonder if tall people are more likely to have their heads in clouds of virus-laden aerosols than shorter people.)
What is different in all these other nations is that the people do isolate when they test positive and that they do provide contact data (at least in the main). The contacts do get tested and do quarantine. The contact tracers do visit your place of quarantine. If you get caught not meeting your responsibilities, you get locked up. We don't have/do any of those things, and that is why we are failing IMHO.
Unless and until people know the have to cooperate and do so, either willingly or otherwise, contact tracing isn't going to work. Being very slow in contact tracking could be an issue, but as of now we have no evidence that it is a problem. If contact tracing was working well but too slowly, the tracers would know it.
Size and mobility also, I believe, play a role. S.Korea is about the size of Indiana. Germany - Montana. I do believe it’s easier to control a Pandemic and engage in contact tracing etc when you are dealing with a significantly smaller geographic area. Relative homogeneity and cultural norms that respects and follows authority also helps.
RE: Why the massive difference? - Nan3cy - 07-23-2020
I confess I get to a point where all this discussion is unutterably depressing, but I'd like all you folks to know how much I appreciate the intelligence of the conversation. I do like listening to smart people.