[M T]

I hadn't noticed before, but San Diego County has a set of triggers for tightening up (ie, modifying the health officers orders).  These are public and available in a dashboard.

While I have issues with some of their methodology, and the (lack of) responsiveness the plan has, at least the guidelines are visible.   Part of my issue is with the opaqueness of their language.   Here are their criteria and the numbers they have posted next to them as of the last data (4 days ago, 6/12/20).

All the criteria have a green check mark by them, which I presume means that the individual item is not triggering.

Health Officer Order will be modified when any of the following three criteria are met*: 2. Community Outbreaks, 7. ICU Capacity, 9. PPE Supply
Or one or more of the remaining criteria in at least two of the following three categories is met: Epidemiology (Surveillance), Healthcare (Hospital Capacity), Public Health (Response)

Epidemiology (Surveillance)
1. Case Count
Increase new case counts of at least 10% for five consecutive days above a stable baseline without substantial increase in testing: -18%  (ie, negative)
2. Community Outbreaks*
Seven or more new outbreaks in community settings in a 7-day period: 4
3. COVID-Syndromic
Upward trajectory of COVID-like syndromic cases reported within a 14-day period: 1%
4. Influenza Like Illness
Upward trajectory of influenza-like illnesses (ILI) reported within a 14-day period: 1%
Healthcare (Hospital Capacity)
5. Hospital Capacity
Approach 80% capacity for all hospital beds in the county: 66%
6. Increasing Hospitalizations
Average change >1% in number of confirmed COVID+ patients currently hospitalized, measured as a 3-day rolling average and compared to the prior 3-day average: 0%
7. ICU Capacity*
<20% availability of ICU beds: 31%
8. Limited Ventilator Capacity
<25% availability of ventilators: 50%
9. PPE Supply*
≤50% of hospitals have at least a 15-day supply of PPE: 71%
Public Health (Response)
10. Cases
Greater than 8% of positive tests as a percent of total tests within a 14-day period: 4%
11. Case Investigation
70% or less of investigations are initiated within 24 hours of notification over a 7-day period: 97%
12. Contact Tracing
Make first contact attempt for 70% or less of close contacts of new positive cases within 24 hours of identification: 88%
13. Homeless Population
Temporary shelter available for less than 15% of homeless population: 42%

I've yet to figure out what #1 really is measuring.  What is this stable baseline?  If you look at SD cases, they've been going up for 6 weeks.  What is this negative value?   One contributing factor may be the 5 day feature.  It is absolutely clear that any 5 days of cases is going to be very different if it includes one or both days of the weekend.  (I found a copy of the page's data as of 6/8.  On that date, #1 had 46%.  Four days later it has -18%.   This doesn't seem like a good measure, whatever it is supposed to be.

#2 doesn't clarify what an outbreak is. Is 1 case an outbreak?

#3, #4:  1% gain seems like an upward trajectory.  If they wanted to say that 1% is ok, then they could have  better defined what is the trigger.

#5, #7:  I think they mean that 66% of the beds are in use, and 31% of the ICU beds are available.  If so, why invert the use?  If not, why "approach 80% capacity" and "<20% availability" ???   (Ah, the state required #7.  Maybe the state's wording was  at odds with the county's wording.  They should fix this.

#6:  I'm not sure what they mean.  Does this mean that if you go from 99 patients for Sunday, Monday, Tuesday to 100 patients for Wednesday, Thursday, Friday, then you've triggered this?   That seems pretty tight & short term & not tied to how many beds are left

These criteria generally require a 2 week increase.  Add that to a week's incubation, and probably a week to announce a change, If cases are back to growing at the rate of the early days (active cases doubling in less than 10 days), you've got an 2x2x2 = 8x increase in activity in 28 days.  Given that, their 20% cushion on beds and ICU seem potentially inadequate.

Criteria	June 8	June 12
1,Case Count	47%	-18%
2.Outbreaks	4	4
3.COVID-syndromic	1%	1%
4.Influenza-like illness	2%	1%
5.Hospital capacity	64%	66%
6.Increasing hospitalizations	-2%	0%
7.ICU capacity	36%	31%
8.Limited ventilator capacity	50%	50%
9.PPE supply	76%	71%
10. Cases	4%	4%
11. Case investigation	97%	97%
12. Contact tracing	84%	88%
13.Homeless population	42%	42%

[M T]

I hadn't noticed before, but San Diego County has a set of triggers for tightening up (ie, modifying the health officers orders).  These are public and available in a dashboard.

While I have issues with some of their methodology, and the (lack of) responsiveness the plan has, at least the guidelines are visible.   Part of my issue is with the opaqueness of their language.   Here are their criteria and the numbers they have posted next to them as of the last data (4 days ago, 6/12/20).

All the criteria have a green check mark by them, which I presume means that the individual item is not triggering.

Health Officer Order will be modified when any of the following three criteria are met*: 2. Community Outbreaks, 7. ICU Capacity, 9. PPE Supply
Or one or more of the remaining criteria in at least two of the following three categories is met: Epidemiology (Surveillance), Healthcare (Hospital Capacity), Public Health (Response)

Epidemiology (Surveillance)
1. Case Count
Increase new case counts of at least 10% for five consecutive days above a stable baseline without substantial increase in testing: -18%  (ie, negative)
2. Community Outbreaks*
Seven or more new outbreaks in community settings in a 7-day period: 4
3. COVID-Syndromic
Upward trajectory of COVID-like syndromic cases reported within a 14-day period: 1%
4. Influenza Like Illness
Upward trajectory of influenza-like illnesses (ILI) reported within a 14-day period: 1%
Healthcare (Hospital Capacity)
5. Hospital Capacity
Approach 80% capacity for all hospital beds in the county: 66%
6. Increasing Hospitalizations
Average change >1% in number of confirmed COVID+ patients currently hospitalized, measured as a 3-day rolling average and compared to the prior 3-day average: 0%
7. ICU Capacity*
<20% availability of ICU beds: 31%
8. Limited Ventilator Capacity
<25% availability of ventilators: 50%
9. PPE Supply*
≤50% of hospitals have at least a 15-day supply of PPE: 71%
Public Health (Response)
10. Cases
Greater than 8% of positive tests as a percent of total tests within a 14-day period: 4%
11. Case Investigation
70% or less of investigations are initiated within 24 hours of notification over a 7-day period: 97%
12. Contact Tracing
Make first contact attempt for 70% or less of close contacts of new positive cases within 24 hours of identification: 88%
13. Homeless Population
Temporary shelter available for less than 15% of homeless population: 42%

I've yet to figure out what #1 really is measuring.  What is this stable baseline?  If you look at SD cases, they've been going up for 6 weeks.  What is this negative value?   One contributing factor may be the 5 day feature.  It is absolutely clear that any 5 days of cases is going to be very different if it includes one or both days of the weekend.  (I found a copy of the page's data as of 6/8.  On that date, #1 had 46%.  Four days later it has -18%.   This doesn't seem like a good measure, whatever it is supposed to be.

#2 doesn't clarify what an outbreak is. Is 1 case an outbreak?

#3, #4:  1% gain seems like an upward trajectory.  If they wanted to say that 1% is ok, then they could have  better defined what is the trigger.

#5, #7:  I think they mean that 66% of the beds are in use, and 31% of the ICU beds are available.  If so, why invert the use?  If not, why "approach 80% capacity" and "<20% availability" ???   (Ah, the state required #7.  Maybe the state's wording was  at odds with the county's wording.  They should fix this.

#6:  I'm not sure what they mean.  Does this mean that if you go from 99 patients for Sunday, Monday, Tuesday to 100 patients for Wednesday, Thursday, Friday, then you've triggered this?   That seems pretty tight & short term & not tied to how many beds are left

These criteria generally require a 2 week increase.  Add that to a week's incubation, and probably a week to announce a change, If cases are back to growing at the rate of the early days (active cases doubling in less than 10 days), you've got an 2x2x2 = 8x increase in activity in 28 days.  Given that, their 20% cushion on beds and ICU seem potentially inadequate.

Criteria	June 8	June 12
1,Case Count	47%	-18%
2.Outbreaks	4	4
3.COVID-syndromic	1%	1%
4.Influenza-like illness	2%	1%
5.Hospital capacity	64%	66%
6.Increasing hospitalizations	-2%	0%
7.ICU capacity	36%	31%
8.Limited ventilator capacity	50%	50%
9.PPE supply	76%	71%
10. Cases	4%	4%
11. Case investigation	97%	97%
12. Contact tracing	84%	88%
13.Homeless population	42%	42%

[M T]

The above triggers may be better understood after reading California's county data monitoring documents (and particularly, Step 1: Active Data Monitoring)  Some of the improvements in that document are better definitions of when data should be used, avoiding distortions caused/allowed by using recent but incomplete data.

Hopefully, this will avoid actions such as Orange County's (desperate?) calculation of % positive as 7.95%(where 8% would be too high) on page 5 of their variance attestation dated May 18, but using data for the week ending May 19, covering only 52% of the tests now showing for the week.   Orange County does not post their % positive results that I have found.  Calculating the ratio of newly diagnosed people divided by total tests (not individuals) gives them 4.5% for that week.   OC's web site says: "Effective May 6, 2020, counts of Orange County COVID-19 tests performed replaced the count of people tested for COVID-19. This change more accurately reflects testing conducted by Public Health, clinical and commercial labs."
A calculation done this way is what is being alleged that Florida is doing with their public numbers. 


Also, in San Diego County's data is a weekly graph of confirmed cases by 20-year age group.  The changes in those numbers over time are interesting. 

It does show an original (and long lasting) very small percentage of cases in 0-19, but that number has come up to be roughly 40% of the 40-59 age group (roughly equal population in both groups).  The other 3 age groups (20-39, 40-59, 60+) are roughly in line with their population (using data before the incomplete period).

San Diego population age demographics:
0-19: 817.3K 25.21%
20-39: 1029.7K 31.76%
40-59: 832.6K 25.68%
60+: 562.9K 17.36%

More detailed San Diego numbers can be found here.

[M T]

The above triggers may be better understood after reading California's county data monitoring documents (and particularly, Step 1: Active Data Monitoring)  Some of the improvements in that document are better definitions of when data should be used, avoiding distortions caused/allowed by using recent but incomplete data.

Hopefully, this will avoid actions such as Orange County's (desperate?) calculation of % positive as 7.95%(where 8% would be too high) on page 5 of their variance attestation dated May 18, but using data for the week ending May 19, covering only 52% of the tests now showing for the week.   Orange County does not post their % positive results that I have found.  Calculating the ratio of newly diagnosed people divided by total tests (not individuals) gives them 4.5% for that week.   OC's web site says: "Effective May 6, 2020, counts of Orange County COVID-19 tests performed replaced the count of people tested for COVID-19. This change more accurately reflects testing conducted by Public Health, clinical and commercial labs."
A calculation done this way is what is being alleged that Florida is doing with their public numbers. 


Also, in San Diego County's data is a weekly graph of confirmed cases by 20-year age group.  The changes in those numbers over time are interesting. 

It does show an original (and long lasting) very small percentage of cases in 0-19, but that number has come up to be roughly 40% of the 40-59 age group (roughly equal population in both groups).  The other 3 age groups (20-39, 40-59, 60+) are roughly in line with their population (using data before the incomplete period).

San Diego population age demographics:
0-19: 817.3K 25.21%
20-39: 1029.7K 31.76%
40-59: 832.6K 25.68%
60+: 562.9K 17.36%

More detailed San Diego numbers can be found here.

[burger]

I praised Newsom earlier, but as we move into outbreak 2.0, I think he's screwing up big time. 

First, letting counties decide what to do is dumb.  Some of these county health officials have been skeptical about the virus from day one and are more interested in reopening the economy than protecting public health.  Sacramento County's public health officer, for instance, has had much more to say about the economy than the people dying from the virus all along.  He gave an interview today seeing he is not concerned about any of the increasing numbers because we haven't hit the state criteria yet for un-relaxing the stay at home orders.

Second, and related, these criteria are awfully, awfully weak.  If cases spike quickly, it will take a while for the 14-day running average to get up to 8%.  And 8% is too high anyway.  Florida, currently having maybe the second worst outbreak in the US, is only at about 6% over the last two weeks.  The contact tracing criteria are a joke.  I'm guessing they are counting "left a message on voicemail" as a first contact.  I get so many robocalls that I don't even bother playing my messages from unrecognized numbers--I just go through and delete them en masse every so often.  And there are a lot of people younger than me who don't even use their phones as a phone anyway.  Are they going to get the messages?  Hospital capacity is a trailing indicator of cases.  It takes a couple of weeks at least to go from infection to hospitalized.  So the criteria for hospitals should be set very conservatively so that the momentum of new cases does not overwhelm a system that was already near capacity when the criteria for closing things down kicked in.

This whole thing seems designed to only reverse the reopening if things get truly awful.  Shouldn't the point be to stop before things get that bad? 

I'm increasingly convinced that the second go around of covid in the US is going to be much worse than the first, even in the states that did things well the first time around.

[burger]

I praised Newsom earlier, but as we move into outbreak 2.0, I think he's screwing up big time. 

First, letting counties decide what to do is dumb.  Some of these county health officials have been skeptical about the virus from day one and are more interested in reopening the economy than protecting public health.  Sacramento County's public health officer, for instance, has had much more to say about the economy than the people dying from the virus all along.  He gave an interview today seeing he is not concerned about any of the increasing numbers because we haven't hit the state criteria yet for un-relaxing the stay at home orders.

Second, and related, these criteria are awfully, awfully weak.  If cases spike quickly, it will take a while for the 14-day running average to get up to 8%.  And 8% is too high anyway.  Florida, currently having maybe the second worst outbreak in the US, is only at about 6% over the last two weeks.  The contact tracing criteria are a joke.  I'm guessing they are counting "left a message on voicemail" as a first contact.  I get so many robocalls that I don't even bother playing my messages from unrecognized numbers--I just go through and delete them en masse every so often.  And there are a lot of people younger than me who don't even use their phones as a phone anyway.  Are they going to get the messages?  Hospital capacity is a trailing indicator of cases.  It takes a couple of weeks at least to go from infection to hospitalized.  So the criteria for hospitals should be set very conservatively so that the momentum of new cases does not overwhelm a system that was already near capacity when the criteria for closing things down kicked in.

This whole thing seems designed to only reverse the reopening if things get truly awful.  Shouldn't the point be to stop before things get that bad? 

I'm increasingly convinced that the second go around of covid in the US is going to be much worse than the first, even in the states that did things well the first time around.

[OutsiderFan]

burger, or anyone else, can you riddle me this?

What creates a "2nd wave" exactly?  I mean we have the tri-state area clearly on a downward slope of declining numbers across the board. But across the country there hasn't been a decline as much as a plateau.

In the 1918 pandemic, it went away in late Spring, but started coming back in August before raging in October. If we are to see say the tri-state area have a second wave, how would it come back, assuming the numbers are way down in Summer?  Does the virus re-emerge in people who have already had it?  Does it lie dormant in people who haven't had it yet, and get triggered by something in the environment?

In simple terms, what makes the virus go away, and what makes it come back?

[OutsiderFan]

burger, or anyone else, can you riddle me this?

What creates a "2nd wave" exactly?  I mean we have the tri-state area clearly on a downward slope of declining numbers across the board. But across the country there hasn't been a decline as much as a plateau.

In the 1918 pandemic, it went away in late Spring, but started coming back in August before raging in October. If we are to see say the tri-state area have a second wave, how would it come back, assuming the numbers are way down in Summer?  Does the virus re-emerge in people who have already had it?  Does it lie dormant in people who haven't had it yet, and get triggered by something in the environment?

In simple terms, what makes the virus go away, and what makes it come back?

[BostonCard]

It's entirely arbitrary.  Some people are saying that this isn't a "second wave" so much as a continuation of the "first wave".

BC

[BostonCard]

It's entirely arbitrary.  Some people are saying that this isn't a "second wave" so much as a continuation of the "first wave".

BC

[OutsiderFan]

I’ve said for months I don’t see any such thing as a second wave. Only the continuation of the initial outbreak.

If the virus doesn’t go away as much as stops spreading only when people are distanced, there is no reason to think the cases won’t again explode again when distancing is relaxed. Mask wearing is part of that distancing.

[OutsiderFan]

I’ve said for months I don’t see any such thing as a second wave. Only the continuation of the initial outbreak.

If the virus doesn’t go away as much as stops spreading only when people are distanced, there is no reason to think the cases won’t again explode again when distancing is relaxed. Mask wearing is part of that distancing.

[Farm93]

I’ve said for months I don’t see any such thing as a second wave. Only the continuation of the initial outbreak.

If the virus doesn’t go away as much as stops spreading only when people are distanced, there is no reason to think the cases won’t again explode again when distancing is relaxed. Mask wearing is part of that distancing.

I would have thought a second wave would happen if cases dropped to near zero in the USA and then in October or November bounced back up thanks to people coming from the Southern Hemisphere.

I believe VP Pence noted today in an OpEd that we won't have a second wave, and I believe POTUS45 is working hard to make that a true statement.   The Tulsa MAGA rally and then the MAGA rallies throughout the summer should keep our first wave strong for several months to come.

[Farm93]

I’ve said for months I don’t see any such thing as a second wave. Only the continuation of the initial outbreak.

If the virus doesn’t go away as much as stops spreading only when people are distanced, there is no reason to think the cases won’t again explode again when distancing is relaxed. Mask wearing is part of that distancing.

I would have thought a second wave would happen if cases dropped to near zero in the USA and then in October or November bounced back up thanks to people coming from the Southern Hemisphere.

I believe VP Pence noted today in an OpEd that we won't have a second wave, and I believe POTUS45 is working hard to make that a true statement.   The Tulsa MAGA rally and then the MAGA rallies throughout the summer should keep our first wave strong for several months to come.

[burger]

I’ve said for months I don’t see any such thing as a second wave. Only the continuation of the initial outbreak.

If the virus doesn’t go away as much as stops spreading only when people are distanced, there is no reason to think the cases won’t again explode again when distancing is relaxed. Mask wearing is part of that distancing.

Looking at the data a little more, you're right.  I think I was mostly thinking about my county's case numbers, where we are into a second outbreak of sorts.  But looking at the data for other states and regions shows that most places are either 1) coming down from their first outbreak or 2) still in the increasing phase of the first one.

[tweet]https://twitter.com/ASlavitt/status/1273299296004255746/photo/1[/tweet]

[burger]

I’ve said for months I don’t see any such thing as a second wave. Only the continuation of the initial outbreak.

If the virus doesn’t go away as much as stops spreading only when people are distanced, there is no reason to think the cases won’t again explode again when distancing is relaxed. Mask wearing is part of that distancing.

Looking at the data a little more, you're right.  I think I was mostly thinking about my county's case numbers, where we are into a second outbreak of sorts.  But looking at the data for other states and regions shows that most places are either 1) coming down from their first outbreak or 2) still in the increasing phase of the first one.

[tweet]https://twitter.com/ASlavitt/status/1273299296004255746/photo/1[/tweet]

[dabigv13]

California has been posting big case numbers for a while, while hospitalizations seemed pretty flat. That looks like it's changing. Hospitalizations, ICU usage, and vent usage all increasing, and the rate of increase seems to be getting steeper. 

I'm guessing we are looking at some sort of reimposed lockdown measures within the month.

[dabigv13]

California has been posting big case numbers for a while, while hospitalizations seemed pretty flat. That looks like it's changing. Hospitalizations, ICU usage, and vent usage all increasing, and the rate of increase seems to be getting steeper. 

I'm guessing we are looking at some sort of reimposed lockdown measures within the month.