
State projections for Covid-19 - jamest
http://covidactnow.org
======
sbuttgereit
This is all fine and good. And I should state that I am on board with the
actions (in San Francisco/California) taken so far. However, I'm not
unconditionally so.

I get that right now we're buying time. My current understanding is that we're
trying to slow the spread of the disease because the existing health care
system was going to quickly collapse under the weight; whether or not that
should have been the case or not is a discussion for another day. I also
understand that we are -not- trying to contain the disease, just "serialize"
its progression (so to speak) through the population.

Assuming that understanding is sufficiently correct, what I'm not hearing
enough of is what is being done with the time we're buying. Many in the Hacker
News audience likes to talk about "externalities" and how the wise appreciates
those externalities in their actions. Shutting down the economy has
externalities; those externatlities can be life or death as well. If the
strategy of those implementing the "shelter in place" is one of just waiting
it out: then I'm going to be off the wagon fairly quickly. I want to start
hearing strategies that start to address the issues of how we minimize impacts
of this problem. I want to know what we're buying for the pain that we're
being sold on. I want to know when people estimate that the societal damages
of the illness start to be outweighed by the damages of our response.

I see the admin of the site suggesting we're buying time for these things. I
want to start hearing this from the officials making policy.

~~~
eric_b
It is terrifying how fast reasonable people have jumped on board with China-
level lockdown policies that will decimate life-as-we-know-it after they end.

I've been reading every whitepaper and journal publication I can find on this
disease.

The picture that I'm seeing is that this disease is both more infectious
(higher R0) and less deadly than previously thought.

In light of those facts I am fairly convinced the lockdowns and resulting
economic impacts will be worse than just isolating the most vulnerable and
letting the rest of the population go about their business.

[https://www.medrxiv.org/content/10.1101/2020.02.12.20022434v...](https://www.medrxiv.org/content/10.1101/2020.02.12.20022434v2)
(Suggests the R0 is much higher and IFR much lower than reported)

[https://www.epicentro.iss.it/coronavirus/bollettino/Report-C...](https://www.epicentro.iss.it/coronavirus/bollettino/Report-
COVID-2019_17_marzo-v2.pdf) (shows that the people dying are very old and very
sick already. Also given the fact that part of the population is so impacted
strongly suggests the disease is much more widespread)

Also, all of the celebrities, politicians and athletes that are testing
positive are proof, in my opinion, of how wide this has gone.

~~~
76543210
I'm with you.

We will all catch this unless we stay locked up until the vaccine comes.

So, expect everyone to catch it.

~~~
lutorm
_Whether_ we catch it is not the issue, the vast majority of us will. It's
whether when you do and have complications, you can go to the hospital or die
waiting for an ambulance that never comes because the system is overwhelmed.

------
cwzwarich
This site openly admits the obvious flaws in their model:

\- R0s for interventions are guesses, in some cases informed by data. There is
no historical precedent for what is going on right now to draw from.

\- The default R0 used in this model is an average. The model does not adjust
for the population density, culturally-determined interaction frequency and
closeness, humidity, temperature, etc in calculating R0.

\- This is not a node-based analysis, and thus assumes everyone spreads the
disease at the same rate. In practice, there are some folks who are “super-
spreaders,” and others who are almost isolated. Interventions should be
targeted primarily at those most likely to spread the disease.

Are there any epidemiologists using less naive statistical models who are
producing easily readable results like this? The "average R0" logistic
function model seems better suited for examining historical epidemics than
estimating risk to inform decision-making for ongoing epidemics.

~~~
AndrewStephens
I agree. The graphs are very pretty but would look very different if the R0
was even slightly modified. The mortality rates probably varies widely by
state demographics as well.

That said, the implication that strict isolation should be maintained is
almost certainly correct.

~~~
maxwhenderson
Hey guys - owner of the model in question here. Thanks for your feedback, and
yes, the model isn't perfect. Idea is just to give some forward-looking
picture for policy-makers to use to make decision.

Interestingly, the model is not nearly as sensitive to R-values as you would
think, until they get under 1.5 (half the current observed number in most
places).

See here: [https://www.researchgate.net/figure/Doubling-time-Average-
do...](https://www.researchgate.net/figure/Doubling-time-Average-doubling-
time-dots-and-95-CI-vertical-lines-as-a-function-of_fig5_258956572)

~~~
ahnick
Really appreciate you putting this together.

------
taeric
I still feel there is compelling evidence that lung damage from things such as
exposure to local pollution is a big driver in serious cases.

I say this as someone that thinks they had it a month ago. I was on steroids
for a week, then a respirator, then steroids for another week. Worst asthma
attack of my adult life. I live in Seattle... (And yes, i had fevers)

I did not get tested, but having a hard time shaking that I had it. And if I
did, so has my family. With my kids all having fevers, but no shortness of
breath.

Edit: I hasten to add that I am socializing this as a call for what am I
missing? I am _not_ encouraging inaction.

~~~
jrs235
So, if a lot of people have already had it, which I see a lot of people
thinking they did, we need to find out if you can get reinfected.

~~~
yardstick
Yeah this point has been bugging me for a while now. What’s the reinfection
rate / immunity rate? I know there are some reinfections but does that mean
everyone can be reinfected or is it just a fraction that don’t gain immunity?

~~~
aivosha
lots of “reinfections” were debunked as false positives. search on r/COVID19
for details.

~~~
SpicyLemonZest
And it should be emphasized that 100% of reported reinfections were just news
reports saying "hey this person tested positive after testing negative" \-
there was never tremendously strong evidence for it.

------
axaxs
I don't get it, because these measures can't last forever. Let's pretend USA
completely extreme isolates...step foot outside and you get arrested. Fine,
the virus disappears in a month or two. Then what? Unless every single person
on the globe does the same thing, you have to effectively keep your borders
closed forever. This isn't a solvable problem at the state or national level,
it's a completely global thing. We can attempt to slow it, but it's just gonna
rear its ugly head again when we let our guard down.

~~~
Diederich
These actions are for the ~5-10% of people who get this bug and who require
intensive care in order to survive. The death rate is pretty low even for
those who end up with severe symptoms if the full weight of modern medical
technology and care can be applied to their recovery.

Right now, as I type this, many hospitals in the United States have had all of
their excess intensive care capacity used up by Covid-19 cases. Not all, but
many.

Once large groups of hospitals reach capacity, then there will be no choice
but to black tag people who could otherwise be saved and leave them to die in
the hallways.

Click this graph, then click Logarithmic at the top:
[https://mackuba.eu/corona/#united_states](https://mackuba.eu/corona/#united_states)

You're right to note that this is a global problem. Given that, the vast
majority of human to human contact is NOT cross border.

This bug is probably going to end up infecting most of the people in the
United States. The main thing we can do at this point is to keep hospitals
from being too overwhelmed, to keep the number of black tagged people, dying
in the hallways, to a minimum.

~~~
nate_meurer
> _Right now, as I type this, many hospitals in the United States have had all
> of their excess intensive care capacity used up by Covid-19 cases. Not all,
> but many._

Do you happen to have a source for this? I haven't heard much about hospital
problems yet.

~~~
Diederich
Anecdotal: my wife and I are friends with two ER nurses, one in Maryland and
one in St. Louis, and my reports mirror what they're telling us.

------
tomerico
The projections are ignoring a very important datapoint - there is significant
evidence that COVID-19 does not have a positive R0 in warm climates. This
means that in many areas, there is no need to flatten the curve - it will
flatten naturally in the next month or two. On the contrary, by aggressively
shutting down the spread now, we are leaving ourselves more vulnerable to
winter outbreak which will be hard to stop.

Now the really terrible part is that the economic effect of the mass closure
is going to grow exponentially. So layoffs start small and grow more massive
week by week. And unlike COVID-19, that economic effect will not subside with
the warming weather...

Here is some evidence:

Compare the slow growth in cases per day (green line) in CA and FL (warm) vs
NY and WA (cold):

[https://covid-19.direct/state/CA](https://covid-19.direct/state/CA)

[https://covid-19.direct/state/FL](https://covid-19.direct/state/FL)

[https://covid-19.direct/state/NY](https://covid-19.direct/state/NY)

[https://covid-19.direct/state/WA](https://covid-19.direct/state/WA)

See for example how in Malaysia there was an outbreak due to a very large
Muslim gathering with foreign travelers, that seems to diminish every day
(indicated an R factor < 1) -
[https://www.worldometers.info/coronavirus/country/malaysia/](https://www.worldometers.info/coronavirus/country/malaysia/)
The same is true for Qatar.

Same examples all over the world for warm countries:
[https://www.worldometers.info/coronavirus/](https://www.worldometers.info/coronavirus/)

~~~
tcbawo
How can you reliably use confirmed cases to suggest a trend given the
disparity between states in test availability, population density, and
timeline of introduction?

~~~
tomerico
We are looking just at the trend. And the testing methodology that different
states take is just a multiplicative constant of the confirmed cases. And
exponentially growing function will make it negligible.

------
Merrill
Sheltering in place would be less necessary if everyone would stay at least 2
meters apart, wear masks, wear gloves, not talk unnecessarily or cough/sneeze
at anyone, and wash up with soap when they get home. Some people seem unable
to stay away and feel compelled to get in your face and talk.

------
pwaivers
[https://covidactnow.org/state/CA](https://covidactnow.org/state/CA)

This is missing a HUGE point. At the very end of the California "shelter-in-
place" plan, the numbers will go up. What it doesn't show is that this will
merely delay the epidemic to 3 months in the future. The chart useless with
only a 3 month time horizon.

~~~
klodolph
Keep reading. This footnote is attached to the California-style scenario:

> * A second spike in disease may occur after social distancing is stopped.
> Interventions are important because they buy time to create surge capacity
> in hospitals and develop therapeutic drugs that may have potential to lower
> hospitalization and fatality rates from COVID-19. See full scenario
> definitions here.

~~~
pwaivers
Thanks. I did see that, but it should more than a (literal) asterisk at the
bottom of the page.

~~~
klodolph
There’s a balance here between insight and precision. As you make information
more precise, you often make it less understandable.

If you put the information in the footnote into the table, it makes the table
harder to read.

As it is, the footnote is right below the table (not at the bottom of the
page) and the information about the second spike is BOLD. That stands out to
me.

------
alexandercrohde
I guess the operative detail is whether shelter-in-place will get us to a
"23%" total infection rate vs 70%.

I wonder if that's accurate. I also wonder if this is recurring in the fall,
and every year, and whether physical distancing will be mandatory every year?

~~~
OJFord
How many recurrent seasons would it take for countries/society to adapt and
cope (whether that's hugely more full-time remote workers, or blanket
acceptability of it part-time/during such occasions, or something else) I
wonder?

~~~
ars
Just one I think. People are already coping, and it's barely started. If
people knew a 3 month shelter-in-place was a yearly rule, we could plan for
it.

~~~
umanwizard
People with either cushy office jobs or enough savings to be long-term
unemployed are coping. The millions of service industry employees either
aren’t, or soon won’t be.

~~~
ars
I would assume there would be changes to how unemployment works if this was a
regular thing.

~~~
int_19h
The problem is that those changes are highly politicized, because they hit a
bunch of culture war buttons about "socialism".

And it's been a while since American legislators have considered the
possibility of torches and pitchforks, so they still prioritize their
electability (especially in the primaries, where ideological purism is more
important) over social necessity.

------
ansmithz42
Here let's do some numbers since this group likes numbers: Population of
China: 1.4B Population of USA: 330M China Population/USA Population ~= 4.5
Case Count China: 81250 Case Count USA: 19285 China Case Count/USA Case Count
= 4.2 Given the current rate of increase and the lack of action, the USA is on
track to be in a worse situation than china and is still trying to figure out
what to do. Best to look to countries like Taiwan, Japan, S. Korea, Singapore
and maybe learn from their actions because the current approach is clearly not
working.

------
olalonde
Stupid question: why do all the curves go down way before reaching a large
percentage of the population? For example, California's curve peaks at
~900,000, only 2% of its population (and only a bit more if you consider
cumulative hospitalizations). I guess 2% is not enough for herd immunity to
kick in so what is it?

Edit: Oops, brain fart. Those numbers don't include all cases, just
hospitalized ones.

~~~
dak1
Those are hospitalizations, not infections.

------
frenchyatwork
Site is broken for me. The url
[https://covidactnow.org/data/wa.7.json](https://covidactnow.org/data/wa.7.json)
is returning an HTML document with the text "You need to enable JavaScript to
run this app." and there's a JSON.parse error in the console.

~~~
jamest
thanks for this, looking now

~~~
maxwhenderson
sorry about this! Hopefully fixed shortly.

------
LargeWu
So, this projects 3-months out. But what about after that? The graph for my
state (MN) showed 3 months of sheltering in place would keep infections down,
but then start to rise immediately afterwards. Then the graph ends. I think
super-extended voluntary isolation is going to be a tough sell.

~~~
maxwhenderson
Hey guys - owner of the model in question here.

Yes, that's exactly right, but 3 months (or even 1 month) may be enough time
to prevent unnecessary deaths by preparing hospitals, getting more
ventilators, rolling out testing, and hopefully finding a therapeutic drug
(vaccines are probably farther off).

Nobody can predict the future, though.

~~~
int_19h
3 months is definitely not enough to grow the hospital and ICU capacity 7x,
which is what's necessary to prevent deaths due to lack of healthcare
availability. It'll improve some, and that will save some lives, but not most
of them.

Pervasive testing looks like the best short-term hope right now - it's easier
to drastically ramp up test manufacturing, and you don't need a full-fledged
hospital for mass testing.

------
chipotle_coyote
Naive question: in the states I looked at, the "California-style shelter-in-
place" line consistently goes _up_ again toward the right side of the graph
(end of June to July), whereas none of the other approaches have that second
lift. Why is that?

~~~
salmon30salmon
Because the first wave is enough to develop herd immunity and reduce the
R-rate of the virus

~~~
chipotle_coyote
But the second lift suggests the model is showing the R-rate going _up_ after
a drop, which is what I'm asking about. The other curves -- which presumably
also involve herd immunity to some degree -- are pretty much bell curves.

------
jwally
This was just used to trigger a shelter in place in Dallas. Thanks to whoever
built this!

[https://www.dallasnews.com/news/public-
health/2020/03/22/hos...](https://www.dallasnews.com/news/public-
health/2020/03/22/hospitals-will-run-out-of-beds-by-late-april-if-gov-abbott-
doesnt-order-texans-to-stay-at-home-hospital-group-warns/)

------
gok
This seems to be treating number of positives test results and number of
hospitalizations as the same thing? That seems...wrong...

------
foogazi
This is what worries me:

> Our models show that it would take at least 2 months of Wuhan-style Lockdown
> to achieve full containment. However, it is unclear at this time how you
> could manage newly introduced infections.

When will Wuhan accept travelers from Spain or Italy ? Or are we going to live
with border controls & quarantines forever?

------
tunesmith
It appears this assumes a doubling rate of 3-4 days? That's pretty pessimistic
compared to what the science-heads are saying, right? I've heard 5-6 days, 6.2
from another source.

EDIT: I'm talking about the doubling rate of the actual cases, not the
confirmed cases.

~~~
Retric
The US has averaged over 30% daily increases in infections for the last 20
days. 1.3 x 1.3 x 1.3 = 2.2x growth every 3 days making that 4 day doubling
optimistic.
[https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t...](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_the_United_States)

New infections are modeled to noticeably slow down once ~1/5 of the total
population is infected, but at that point things have already fallen apart.

~~~
gpm
The US has also been ramping up testing, assuming number of infections is a
linear function of known cases is a mistake.

~~~
Retric
We are not doing 16,000 / 42 = 380x more tests per day on March 20th vs March
1st. It’s not even obvious if we are overlooking a larger fraction of
infections today than back then.

Also of note that 30% daily increase I spoke of underestimates the difference
between March 1 and March 20th.

------
war1025
In my opinion this page isn't terribly informative unless you happen to live
in Texas or California.

Basically every state has measures in place already. None of that is reflected
here, and there is no way to tell where it fits relative to the scenarios
shown.

------
patches11
Where is this data coming from?

I have not seen any numbers to indicate Utah was at 96 hospitalizations as of
yesterday. Are other state's number correct? Was California at 952
hospitalizations as of yesterday?

Is this just using number of cases as hospitalizations?

------
Leary
So according to these models, we should be Wuhan-ing our states?

~~~
yumraj
Well I still have a fundamental question, what happens when China, or anyplace
else, un-Wuhan's?

They seem to be opening stores, starting flights to SFO, but surely China is
not clear of the virus. So, are we expecting a pick up in infections now. And,
if not, please explain why not.. I'm really curious..

~~~
rojobuffalo
Here's an expert discussing that: [https://www.youtube.com/watch?v=EpQmMkPj-
mE&t=3m8s](https://www.youtube.com/watch?v=EpQmMkPj-mE&t=3m8s)

I get the impression that it's BS to say "look at South Korea and China,
they're beating the outbreak and will soon be able to relax because they have
lots of testing and transmission tracing". I haven't heard a single expert
suggest that a "second wave" is avoidable at this point. It might have been
avoidable if the whole world had reacted quickly and decisively in the early
stages, but that ship has sailed.

The CDC also suggested that China was reporting falsified data in January (not
surprising). Why should we trust their numbers now?

------
turdnagel
This would be a lot more helpful if there were a line with actual daily
hospitalizations as well.

------
devy
Is there an accumulative data chart for the entire nation?COVID-19 has no
state boundaries!

------
torgian
Having read some of the comments here, I want to say that I think I fall in
the "cynical" portion of the population. Then again, my family is Russian, and
we all typically think we're all gonna be screwed somehow.

The most optimistic outcome, for me, is that remote work becomes a bigger
possibility when companies realize they're wasting tons of money on too much
office space.

People already know that we can live with less. _Businesses_, however, do not
realize this. I hope businesses ( especially big ones ) realize this.

Shortcomings in our economy and health care ( not just America, but world-wide
) will be realized and fixed.

However, I do not think any of the above will become true. Humans have short
memories. I think once the crisis is over, business as usual will resume and
we will have made no progress. Other than another vaccine.

------
djzidon
would like to be able to look at a whole country projection, if possible

~~~
jwally
Not sure how much effort you want to put into it, but the raw data is in JSON
files on the site under the following pattern:

[https://covidactnow.org/data/{{state_abbreviation}](https://covidactnow.org/data/{{state_abbreviation})}.{{scenario_number}}.json
(where scenarios go from 0 - 7)

~~~
djzidon
very cool, thank you

------
senordevnyc
I see a lot of rumbling in this thread about how we need to ask ourselves if
the costs of a shutdown is worth it, or what happens after a shutdown?

My question is this: what would _you_ propose we do? If we don’t lock
everything down, we’ll overwhelm the hospitals and the death rate will
skyrocket. And then the deaths will be less skewed towards the elderly,
because virtually all causes of mortality will shoot up when we no longer have
a functioning medical system to treat anyone for anything except this.

Are you really proposing we just let hundreds of millions of people all over
the world die over the next 6-12 months? So we’ll all just go back to work and
to restaurants and on vacation while 5% of the population is gasping their
last breaths in a hospital somewhere? We’ll just say goodbye to a huge chunk
of our parents and grandparents and aunts and uncles and coworkers? Because
the economic cost is just too high?

It’s easy to complain about this course of action. It sucks. But unless you
can lay out a plausible alternative, this still seems like the best one to me.

~~~
taeric
Nobody is proposing we just let people die. At least, nobody credibly that I
have seen.

There are some questions on if there was really going to be a curve to
flatten. Such that, if we flatten it now, was it the social distancing we did,
or was it going to flatten anyway?

These are not reasons to abandon caution. They do seem valid questions,
though. Especially considering the costs of the actions we have taken.

~~~
Diederich
> Nobody is proposing we just let people die.

Agreed, but a lot of people are arguing for the thing that will almost
certainly lead to a lot more deaths.

Right now, as I type this, many hospitals in the United States have had all of
their excess capacity filled with Covid-19 cases. Not most, but many.

Now, please click this link, then click Logarithmic on the top.

[https://mackuba.eu/corona/#united_states](https://mackuba.eu/corona/#united_states)

Once large groups of hospitals reach saturation, people who could otherwise be
saved will be black tagged and left to die.

Two women my wife is Facebook friends with, after two weeks of a mild fever,
malaise and a moderate, unproductive cough, started having a hard time
breathing. They went in and were both positive for Covid-19. They were placed
on ventilators, and were soon in critical condition. One of them died this
morning, the other is clinging on to life.

Neither of these people are old; neither of them have any substantial medical
history or other comorbidities.

This bug is dangerous for all of us; it's extremely dangerous for some of us.

It's true that few people are soberly thinking about the mid and long term
economic cost of this pandemic. In my opinion, there's a good chance we're
facing something on the order of the great depression.

Be that as it may, lives must come first.

~~~
lsh123
> Right now, as I type this, many hospitals in the United States have had all
> of their excess capacity filled with Covid-19 cases.

Today Santa Clara county has 65 people hospitalized:

[https://commons.wikimedia.org/wiki/Data:COVID-19_Cases_in_Sa...](https://commons.wikimedia.org/wiki/Data:COVID-19_Cases_in_Santa_Clara_County,_California.tab)

In comparison, Stanford hospital has 600 beds:

[https://facts.stanford.edu/about/hospital/](https://facts.stanford.edu/about/hospital/)

~~~
yiyus
Ok, maybe not yet. But once you start the lockdown, exponential growth
continues for a couple of weeks (at least). If it grows at the same rate as in
Europe, at the end of those two weeks Santa Clara county will need to
hospitalize more than 15000 people.

~~~
lsh123
I strongly suspect that the epidemic spread will be very different between
large and small cities, suburbs, and country side. Plus Santa Clara county has
very different demographic than Italy.

BTW, with the amount of people going back and forth between Bay Area and
China, I have hard time believing that we had no cases in Jan/Feb. I
personally know two people (and I met with both within a few days after their
return) who came back from Wuhan in Dec and early Jan. A lot of people were
sick in late Dec and early Jan with very similar symptoms.

