[Farm93]

Gotta love the experts who point to a low fatality rate as if covid survivors could bounce back to health just like flu survivors.  That we don't refer to people recovered from the flu as survivors shows you the difference between flu and covid...

When this all started, I thought deaths would be the best indicator of what's happening because cases were basically a function of testing rates, and hospitalization data was hard to come by.  Now, IFRs and CFRs seem to be dropping (a good thing if true), but that's giving people like this med school guy false confidence that we don't need to worry about current growth in cases.  As fullmetal pointed out, there will still be a lot of negative consequences short of death for many people.

A good analogy is the 2nd Iraq War.  IIRC, fatality rates in combat were much lower than in previous US wars, but that was only because soldiers who would've died in previous wars were being saved by modern medicine.  Many of those saved ended up with major disabilities.  The point being that death rates alone can give a false sense of what's happening.

I'm thinking now that hospitalizations may be the best measure going forward.  This should be insensitive to both testing effects (hospitals get first dibs on tests regardless of availability) and death rates.  California does a great job of reporting hospital numbers for the state and by county:  https://public.tableau.com/views/COVID-1...VizHome=no

Death rate today was devastating in CA.   So sad to see. 

The Bay Area is doing great, but not the rest of the USA.   It is really hard for me to imagine Stanford holding classes with people from all over the USA in ~2 months given the current trends. 

I remember when Gov Newsom wanted to keep going slowly but the pressure from the rural counties and major industries was too much.    We are very focused on the economic impacts but have done an awful job addressing the underlying health care crisis.   

A number of European and Asian countries were very concerned the USA was going too fast and without enough testing and tracing back in late May.   I doubt many of those critics even considered the idea that Americans would insist on not wearing masks, or would insist on doing non-essential activities.

Like everyone else I can see the red state v blue state trends available in many places, but one noteworthy variable to me has been the summer temperatures in different locations.  In northern USA states people spend a lot of time outside in the summer.   In southern states people usually spend a lot of time indoors in the summer.   In 1918 that type of geographic difference likely wouldn't have been applicable as this is the first global pandemic to really be influenced by A/C.

AC has probably helped sustain the first wave of the virus, and will leave us in a vulnerable position with a high rate of COVID activity when that second wave hits the USA in ~3-4 months.

[Farm93]

Gotta love the experts who point to a low fatality rate as if covid survivors could bounce back to health just like flu survivors.  That we don't refer to people recovered from the flu as survivors shows you the difference between flu and covid...

When this all started, I thought deaths would be the best indicator of what's happening because cases were basically a function of testing rates, and hospitalization data was hard to come by.  Now, IFRs and CFRs seem to be dropping (a good thing if true), but that's giving people like this med school guy false confidence that we don't need to worry about current growth in cases.  As fullmetal pointed out, there will still be a lot of negative consequences short of death for many people.

A good analogy is the 2nd Iraq War.  IIRC, fatality rates in combat were much lower than in previous US wars, but that was only because soldiers who would've died in previous wars were being saved by modern medicine.  Many of those saved ended up with major disabilities.  The point being that death rates alone can give a false sense of what's happening.

I'm thinking now that hospitalizations may be the best measure going forward.  This should be insensitive to both testing effects (hospitals get first dibs on tests regardless of availability) and death rates.  California does a great job of reporting hospital numbers for the state and by county:  https://public.tableau.com/views/COVID-1...VizHome=no

Death rate today was devastating in CA.   So sad to see. 

The Bay Area is doing great, but not the rest of the USA.   It is really hard for me to imagine Stanford holding classes with people from all over the USA in ~2 months given the current trends. 

I remember when Gov Newsom wanted to keep going slowly but the pressure from the rural counties and major industries was too much.    We are very focused on the economic impacts but have done an awful job addressing the underlying health care crisis.   

A number of European and Asian countries were very concerned the USA was going too fast and without enough testing and tracing back in late May.   I doubt many of those critics even considered the idea that Americans would insist on not wearing masks, or would insist on doing non-essential activities.

Like everyone else I can see the red state v blue state trends available in many places, but one noteworthy variable to me has been the summer temperatures in different locations.  In northern USA states people spend a lot of time outside in the summer.   In southern states people usually spend a lot of time indoors in the summer.   In 1918 that type of geographic difference likely wouldn't have been applicable as this is the first global pandemic to really be influenced by A/C.

AC has probably helped sustain the first wave of the virus, and will leave us in a vulnerable position with a high rate of COVID activity when that second wave hits the USA in ~3-4 months.

[g1313]

Teejers wanted to make sure you saw this as it has been posted a few times - the number of available ICU beds in every county in California is available at https://public.tableau.com/views/COVID-1...VizHome=no

Why can’t we get this (I’ll use SCC as an example: Santa Clara County has a total of X hospital beds. Of those Y are ICU beds.  On April 15, ___ on the beds were in use___  were Covid Patients. ____ICU beds were in use.____.  On May 15 (put in numbers) June 15 (put in numbers. July 15 put in numbers. 



That should be done countywide and statewide. It shouldnt be that difficult.

San Mateo county does that, though it doesn't report the data for all hospitalizations (we know from the link below that 55 patients are hospitalized with COVID, but it doesn't have the numbers for non-COVID patients).

https://www.smchealth.org/coronavirus-health-data

On July 8, 38 out of 110 ICU beds were in use; 15 of those beds were in use for COVID patients.  The data in the dashboard goes back to June 30.  I agree it would be helpful to have more historical data readily available and more data about total hospitalizations.

BC

the bummer for this SCC resident is that Santa Clara's dashboard used to have this info readily available - and in an easily digestible, color-coded bar chart.  But alas, the powers that be, removed that data . . . strange.

This page looks like it has most of what you seek:

https://www.sccgov.org/sites/covid19/Pag...itals.aspx

I never saw what it used to offer, but it gives you COVID hospital bed use,  ICU use, and ventilator use and availability.  So are you worried that you don't have a picture of how many beds are being used by non-COVID patients and the total number of beds available?

BC

Yes, which was previously available.  I think that data is very useful and informative, and am having a hard time understanding why it was removed.

[g1313]

Teejers wanted to make sure you saw this as it has been posted a few times - the number of available ICU beds in every county in California is available at https://public.tableau.com/views/COVID-1...VizHome=no

Why can’t we get this (I’ll use SCC as an example: Santa Clara County has a total of X hospital beds. Of those Y are ICU beds.  On April 15, ___ on the beds were in use___  were Covid Patients. ____ICU beds were in use.____.  On May 15 (put in numbers) June 15 (put in numbers. July 15 put in numbers. 



That should be done countywide and statewide. It shouldnt be that difficult.

San Mateo county does that, though it doesn't report the data for all hospitalizations (we know from the link below that 55 patients are hospitalized with COVID, but it doesn't have the numbers for non-COVID patients).

https://www.smchealth.org/coronavirus-health-data

On July 8, 38 out of 110 ICU beds were in use; 15 of those beds were in use for COVID patients.  The data in the dashboard goes back to June 30.  I agree it would be helpful to have more historical data readily available and more data about total hospitalizations.

BC

the bummer for this SCC resident is that Santa Clara's dashboard used to have this info readily available - and in an easily digestible, color-coded bar chart.  But alas, the powers that be, removed that data . . . strange.

This page looks like it has most of what you seek:

https://www.sccgov.org/sites/covid19/Pag...itals.aspx

I never saw what it used to offer, but it gives you COVID hospital bed use,  ICU use, and ventilator use and availability.  So are you worried that you don't have a picture of how many beds are being used by non-COVID patients and the total number of beds available?

BC

Yes, which was previously available.  I think that data is very useful and informative, and am having a hard time understanding why it was removed.

[M T]

  Now, IFRs and CFRs seem to be dropping (a good thing if true), but that's giving people like this med school guy false confidence that we don't need to worry about current growth in cases. 

I'd like to clarify something.  One way to drop IFR and CFR is to add more cases that weren't there before.  For IFR, you can find about a factor of 10 between some lower estimates to higher estimates of uncounted asymptomatic cases that are then used in the denominator.   (Of course there are measures of entire populations, some with  0% infections and some  with 94%(IIRC) infections, but those are generally non-representative samples.)
With CFR, wider testing has increased the denominator, adding in very mild or fully asymptomatic cases.  The early CFR numbers were totally bogus because they usually had a denominator full of cases that weren't yet known to be fatalities or not.  AND, in the US at least, we had suspected cases that weren't counted because they weren't tested.

So, I don't think either IFR or CFR are really good numbers for comparing now to earlier (or now to future).

But, I did see one good number at the CDC site a couple of days ago re Mortality.

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 9.0% during week 25 to 5.9% during week 26, representing the tenth week of a declining percentage of deaths due to PIC. The percentage is currently at the epidemic threshold but will likely change as more death certificates are processed, particularly for recent weeks.

In other words, 5.9% is not complete, and looking at the previous week's numbers now versus this week's numbers is not right either.  But if the new, incomplete numbers each week are dropping, or the 1-week old numbers are always dropping, that's a good sign.
(I suppose it could also be that a backlog of deaths is being cleared out, and there is less to clear out.  Bummer if that's it.)
PIC = pneumonia, influenza, covid-19


Also I'll note that excess deaths are those in excess of the normal deaths.  However, since April 1, I'd guess that the number of flu deaths are far below normal, so our "normal death rate" for April (etc) is higher than it would be for non-COVID deaths.  I take it flu deaths are the cause of the wave in the line above.

[M T]

  Now, IFRs and CFRs seem to be dropping (a good thing if true), but that's giving people like this med school guy false confidence that we don't need to worry about current growth in cases. 

I'd like to clarify something.  One way to drop IFR and CFR is to add more cases that weren't there before.  For IFR, you can find about a factor of 10 between some lower estimates to higher estimates of uncounted asymptomatic cases that are then used in the denominator.   (Of course there are measures of entire populations, some with  0% infections and some  with 94%(IIRC) infections, but those are generally non-representative samples.)
With CFR, wider testing has increased the denominator, adding in very mild or fully asymptomatic cases.  The early CFR numbers were totally bogus because they usually had a denominator full of cases that weren't yet known to be fatalities or not.  AND, in the US at least, we had suspected cases that weren't counted because they weren't tested.

So, I don't think either IFR or CFR are really good numbers for comparing now to earlier (or now to future).

But, I did see one good number at the CDC site a couple of days ago re Mortality.

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 9.0% during week 25 to 5.9% during week 26, representing the tenth week of a declining percentage of deaths due to PIC. The percentage is currently at the epidemic threshold but will likely change as more death certificates are processed, particularly for recent weeks.

In other words, 5.9% is not complete, and looking at the previous week's numbers now versus this week's numbers is not right either.  But if the new, incomplete numbers each week are dropping, or the 1-week old numbers are always dropping, that's a good sign.
(I suppose it could also be that a backlog of deaths is being cleared out, and there is less to clear out.  Bummer if that's it.)
PIC = pneumonia, influenza, covid-19


Also I'll note that excess deaths are those in excess of the normal deaths.  However, since April 1, I'd guess that the number of flu deaths are far below normal, so our "normal death rate" for April (etc) is higher than it would be for non-COVID deaths.  I take it flu deaths are the cause of the wave in the line above.

[burger]

  Now, IFRs and CFRs seem to be dropping (a good thing if true), but that's giving people like this med school guy false confidence that we don't need to worry about current growth in cases. 

I'd like to clarify something.  One way to drop IFR and CFR is to add more cases that weren't there before.  For IFR, you can find about a factor of 10 between some lower estimates to higher estimates of uncounted asymptomatic cases that are then used in the denominator.   (Of course there are measures of entire populations, some with  0% infections and some  with 94%(IIRC) infections, but those are generally non-representative samples.)
With CFR, wider testing has increased the denominator, adding in very mild or fully asymptomatic cases.  The early CFR numbers were totally bogus because they usually had a denominator full of cases that weren't yet known to be fatalities or not.  AND, in the US at least, we had suspected cases that weren't counted because they weren't tested.

So, I don't think either IFR or CFR are really good numbers for comparing now to earlier (or now to future).

But, I did see one good number at the CDC site a couple of days ago re Mortality.

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 9.0% during week 25 to 5.9% during week 26, representing the tenth week of a declining percentage of deaths due to PIC. The percentage is currently at the epidemic threshold but will likely change as more death certificates are processed, particularly for recent weeks.

In other words, 5.9% is not complete, and looking at the previous week's numbers now versus this week's numbers is not right either.  But if the new, incomplete numbers each week are dropping, or the 1-week old numbers are always dropping, that's a good sign.
(I suppose it could also be that a backlog of deaths is being cleared out, and there is less to clear out.  Bummer if that's it.)
PIC = pneumonia, influenza, covid-19

Also I'll note that excess deaths are those in excess of the normal deaths.  However, since April 1, I'd guess that the number of flu deaths are far below normal, so our "normal death rate" for April (etc) is higher than it would be for non-COVID deaths.  I take it flu deaths are the cause of the wave in the line above.

I agree with what you said about IFR and CFR.  I probably should have restricted my comment to IFR--I was thinking of a comment I saw from a doctor who said that the survival rate for covid patients on ventilators had increased from 25% at the start of all this to 75% now (I have no idea where I saw this--I might even be misremembering, so take with extra salt).

Speaking of change in denominators due to more testing, some modelers think that the actual numbe of infections right now is basically at the same level as it was in March/April despite the reported cases being far higher now:

[tweet]https://twitter.com/NateSilver538/status/1281372870589939712[/tweet]

As for the mortality data, there is always a lag of like 6-8 weeks before the deaths are fully reported.  So any decrease recently could be an artifact of incomplete reporting.  We were seeing this back in April and May; people would look at the latest CDC numbers and declare things were almost over when it was just missing data.

[burger]

  Now, IFRs and CFRs seem to be dropping (a good thing if true), but that's giving people like this med school guy false confidence that we don't need to worry about current growth in cases. 

I'd like to clarify something.  One way to drop IFR and CFR is to add more cases that weren't there before.  For IFR, you can find about a factor of 10 between some lower estimates to higher estimates of uncounted asymptomatic cases that are then used in the denominator.   (Of course there are measures of entire populations, some with  0% infections and some  with 94%(IIRC) infections, but those are generally non-representative samples.)
With CFR, wider testing has increased the denominator, adding in very mild or fully asymptomatic cases.  The early CFR numbers were totally bogus because they usually had a denominator full of cases that weren't yet known to be fatalities or not.  AND, in the US at least, we had suspected cases that weren't counted because they weren't tested.

So, I don't think either IFR or CFR are really good numbers for comparing now to earlier (or now to future).

But, I did see one good number at the CDC site a couple of days ago re Mortality.

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 9.0% during week 25 to 5.9% during week 26, representing the tenth week of a declining percentage of deaths due to PIC. The percentage is currently at the epidemic threshold but will likely change as more death certificates are processed, particularly for recent weeks.

In other words, 5.9% is not complete, and looking at the previous week's numbers now versus this week's numbers is not right either.  But if the new, incomplete numbers each week are dropping, or the 1-week old numbers are always dropping, that's a good sign.
(I suppose it could also be that a backlog of deaths is being cleared out, and there is less to clear out.  Bummer if that's it.)
PIC = pneumonia, influenza, covid-19

Also I'll note that excess deaths are those in excess of the normal deaths.  However, since April 1, I'd guess that the number of flu deaths are far below normal, so our "normal death rate" for April (etc) is higher than it would be for non-COVID deaths.  I take it flu deaths are the cause of the wave in the line above.

I agree with what you said about IFR and CFR.  I probably should have restricted my comment to IFR--I was thinking of a comment I saw from a doctor who said that the survival rate for covid patients on ventilators had increased from 25% at the start of all this to 75% now (I have no idea where I saw this--I might even be misremembering, so take with extra salt).

Speaking of change in denominators due to more testing, some modelers think that the actual numbe of infections right now is basically at the same level as it was in March/April despite the reported cases being far higher now:

[tweet]https://twitter.com/NateSilver538/status/1281372870589939712[/tweet]

As for the mortality data, there is always a lag of like 6-8 weeks before the deaths are fully reported.  So any decrease recently could be an artifact of incomplete reporting.  We were seeing this back in April and May; people would look at the latest CDC numbers and declare things were almost over when it was just missing data.

[lex24]

Gotta love the experts who point to a low fatality rate as if covid survivors could bounce back to health just like flu survivors.  That we don't refer to people recovered from the flu as survivors shows you the difference between flu and covid...

(Of note, there are several cases of Olympic or pre-elite athletes contracting this disease, and they are reporting very long recovery times before they can return to training.)

I keep tabs on Houston because I have family there (one doctor) and am adjacent.  Their sustainable surge capacity was helped when Texas Children's opened up their facility to adult patients.  The last of the granular data reporting showed that there were twelve days before sustainable surge capacity was exhausted and TMC would be moving into unsustainable surge capacity (not sure how fungible beds are between the different hospitals in TMC).

Shortly after that data was reported, there were...political consequences.  The TMC CEOs put out a joint statement saying there was no reason to worry. I believe the governor got involved.  TMC has revised their verbiage and changed their charts such that neutral words and blue/gray color schemes now dominate despite the same data being presented.  

The message was clear: don't make this state look bad.  Mayor Sylvester Turner just yesterday ordered next week's in-person GOP state convention to be canceled.  All the prominent keynote speakers had decided to deliver their address via teleconference anyway (ha!).  Today, the state GOP has filed a lawsuit against the city of Houston.

Thankfully, TMC bed usage is still within the sustainable surge capacity and their curve might be bending ever so slightly right now.  It's perhaps not an entirely good sign: An increase in people dying at home suggests coronavirus deaths in Houston may be higher than reported

Tulsa is seeing an uptick in cases as well, and authorities are pointing to the late June political rally as a likely cause.  Houston should fight hard to ensure that the same thing doesn't happen in Texas.

“Gotta love the experts who point to a low fatality rate as if covid survivors could bounce back to health just like flu survivors.  That we don't refer to people recovered from the flu as survivors shows you the difference between flu and covid...“

Nah, what it really shows is the difference in the use of language.  “Survivors” simply has a broader use now than in the past.

[lex24]

Gotta love the experts who point to a low fatality rate as if covid survivors could bounce back to health just like flu survivors.  That we don't refer to people recovered from the flu as survivors shows you the difference between flu and covid...

(Of note, there are several cases of Olympic or pre-elite athletes contracting this disease, and they are reporting very long recovery times before they can return to training.)

I keep tabs on Houston because I have family there (one doctor) and am adjacent.  Their sustainable surge capacity was helped when Texas Children's opened up their facility to adult patients.  The last of the granular data reporting showed that there were twelve days before sustainable surge capacity was exhausted and TMC would be moving into unsustainable surge capacity (not sure how fungible beds are between the different hospitals in TMC).

Shortly after that data was reported, there were...political consequences.  The TMC CEOs put out a joint statement saying there was no reason to worry. I believe the governor got involved.  TMC has revised their verbiage and changed their charts such that neutral words and blue/gray color schemes now dominate despite the same data being presented.  

The message was clear: don't make this state look bad.  Mayor Sylvester Turner just yesterday ordered next week's in-person GOP state convention to be canceled.  All the prominent keynote speakers had decided to deliver their address via teleconference anyway (ha!).  Today, the state GOP has filed a lawsuit against the city of Houston.

Thankfully, TMC bed usage is still within the sustainable surge capacity and their curve might be bending ever so slightly right now.  It's perhaps not an entirely good sign: An increase in people dying at home suggests coronavirus deaths in Houston may be higher than reported

Tulsa is seeing an uptick in cases as well, and authorities are pointing to the late June political rally as a likely cause.  Houston should fight hard to ensure that the same thing doesn't happen in Texas.

“Gotta love the experts who point to a low fatality rate as if covid survivors could bounce back to health just like flu survivors.  That we don't refer to people recovered from the flu as survivors shows you the difference between flu and covid...“

Nah, what it really shows is the difference in the use of language.  “Survivors” simply has a broader use now than in the past.