
Coronavirus outbreak won't peak in every state at once - JumpCrisscross
https://www.axios.com/coronavirus-states-peak-hospitals-53274e0e-69b8-4dc7-b069-fb27955c559a.html
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nkoren
The primary point isn't wrong, but I am deeply deeply deeply skeptical of
this, since the underlying data is of such varying and often miserable
quality. A friend of mine in Oregon exhibited all the C19 symptoms, and went
to get tested. It took _15 DAYS_ for her sample to be tested. The test came
back negative, but the lab said they had no confidence in this result, given
the age of the sample. This is apparently the default testing situation in
Oregon.

Given those kind of inputs, how can one say with any confidence when Oregon
will peak, and how large that peak will be?

Other states have much better testing and thus can be more confident in their
predictions. Some have worse. For most, however, I get the impression that
this kind of modelling is somewhere between a wild-assed guess and a
crapshoot.

~~~
fermienrico
They should be using death rates to estimate the peak, not confirmed cases.
Death counts are very accurate if not perfect representation of the situation.

~~~
xyzzy_plugh
They're not. For a variety of reasons, many deaths are not being reported as
caused by Covid-19, but rather other preexisting conditions which may have
been complicated by Covid-19. Additionally, as I understand it, some number of
deaths require post-mortem testing to confirm that the victim was indeed
infected. Given the varied backlog of testing, the morgue backlog (or soon-to-
be) and the lack of testing kits, I'd conservatively expect death counts to be
lower than actual by anywhere from 10% to 150%. I wouldn't be surprised if a
year from now we realize we were off by a factor of 2 or more.

~~~
thebruce87m
You can compare normal death rates from previous years to determine if you are
having excess deaths. Here is data from a town in Italy for example:

[https://www.corriere.it/politica/20_marzo_26/the-real-
death-...](https://www.corriere.it/politica/20_marzo_26/the-real-death-toll-
for-covid-19-is-at-least-4-times-the-official-
numbers-b5af0edc-6eeb-11ea-925b-a0c3cdbe1130.shtml)

“Nembro, one of the municipalities most affected by Covid-19, should have had
- under normal conditions - about 35 deaths. 158 people were registered dead
this year by the municipal offices. But the number of deaths officially
attributed to Covid-19 is 31”

There are some caveats with the data of course - I.e. the town might not have
any more deaths for the rest of the year since it’s burned through all the
people that would have expired anyway, but it’s interesting reading.

~~~
thu2111
The Corriere article has a major flaw that it's looking at deaths from Jan
onwards only.

This year is unusual in that there was no flu season, really. Deaths up until
the start of COVID-19 were way lower than normal all winter.

[https://swprs.files.wordpress.com/2020/03/italia-
mortalita-m...](https://swprs.files.wordpress.com/2020/03/italia-mortalita-
marzo-14.png?w=1200&h=686)

So even a disease no worse than flu, you'd expect would cause a much higher
death rate than normal for this time of year, simply by shifting the curve
forward six months. And COVID-19 is likely to be worse than flu.

(I say likely because the data quality here is so poor we really have no idea
how dangerous it is)

~~~
thebruce87m
Can you tell me what your graph is supposed to show?

Bear in mind that Nembro has a population of 11,616 according to google. That
would mean an excess death rate of approx 1000 out of 100,000 if we use the
123 excess deaths from the article. Compare that to 40.2 from here:
[https://pubmed.ncbi.nlm.nih.gov/31401203/](https://pubmed.ncbi.nlm.nih.gov/31401203/)

Now I’m not saying that Nembro is typical or even that all my data is apples
to apples, it’s just the only data I’ve found where we can compare death rates
in any way. The crude death rate for the whole of Italy here:
[https://knoema.com/atlas/Italy/Death-
rate](https://knoema.com/atlas/Italy/Death-rate)

It’s interesting that you call the data poor - this is exactly the data we
should be looking for. I’d love to see this kind of data for the whole of
Italy for the last 10 years to compare to the last few months.

The other data coming in is the dangerous stuff to me. We can’t tell if
someone died of covid, or simply had it when they died. Every country has
different testing regimes. Ultimately the death stats will give us the full
picture.

Differing perspectives welcome.

~~~
thu2111
The graph is supposed to show mortality vs the 'baseline' (good question how
exactly that's calculated, looks like it's probably this one:
[https://www.euromomo.eu/methods/methods.html](https://www.euromomo.eu/methods/methods.html)).

It shows the impact of prior flu seasons. Winter of 2016 was very bad. 2017
not quite as bad. 2018 about the same. 2019 .... gone. Trend line is _below_
baseline and very significantly so up until the start of COVID-19. There was
practically no flu season this year, which means a LOT of people survived the
winter who in prior years wouldn't have done.

The problem is Corriere is ignoring that in their analysis. Deaths may be
higher than expected now, but how much of that is because it was much lower
than expected before?

I suspect in the next week or so you'll start seeing people doing integration
on the graphs to try and figure out what the excess 'vulnerable population'
was at the start of the epidemic; i.e. people who would in other years have
been taken out by flu but survived this year.

The red trend line will shoot up of course. You can see the latest data point
all the way at the top right, it's nearly falling off the image.

~~~
thebruce87m
Lol, I didn’t even see that last point until you mentioned it.

It’s interesting data - where did it come from? I’d like to monitor it too.

~~~
thu2111
Italian Ministry of Health

[http://www.salute.gov.it/portale/caldo/SISMG_sintesi_ULTIMO....](http://www.salute.gov.it/portale/caldo/SISMG_sintesi_ULTIMO.pdf)

via [https://swprs.org/a-swiss-doctor-on-covid-19/](https://swprs.org/a-swiss-
doctor-on-covid-19/) which has many links

~~~
thu2111
NB: They've since updated the graph in the PDF with a slightly different one.
Oddly, the wildly high data point at the end is now _gone_ (wtf) and the
COVID-19 period is shaded blue.

Italian death statistics show nothing out of the ordinary at this time. If
it's true their infection levels are now stable I don't see how these figures
can take the absolutely massive acceleration required to justify current
measures. It's still less bad than the flu of 2017.

------
threatofrain
Something that surprises me is that while family infection has been identified
as an important factor to viral transmission to the elderly, we haven't
converted hotels into isolation units and given people hotel credits to spend.

~~~
celticninja
how is a hotel an isolation unit? there are little to no cooking and food
storage facilities or others washing facilities in hotel rooms. so your hotel
credit now also has to cover 3 meals a day if it is to effectively work as an
isolation unit. these must be delivered to residents by someone who could then
transmit the disease to lots of elderly at once. these would become defacto
old people's homes/care homes but with untrained staff.

~~~
threatofrain
Young people would be isolated from their families if sick, and they'd be
brought food without contact from staff. Having people cook for themselves is
very dubious, so any place that would serve for isolation must also have a
kitchen and staff. Staff, boarding, and food -- where would these places be
across different cities?

Singapore and other nations are doing the same for foreign travelers and
citizens.

Where are you getting this information that this strategy would turn hotels
into untrained elderly care facilities?

------
testplzignore
The differences between some neighboring states is really interesting. Ohio
and Michigan have similar population sizes and demographics, but Ohio is
projected to be in good shape at peak, while Michigan is trending towards
disaster already.

I'd like to see this data alongside a timeline of when governors and mayors
made the decisions to close schools and businesses. Would be interesting if
even a delay of a few days made a difference in flattening the curve.

~~~
tuna-piano
This is all just a matter of timing. Doubling time for the spread seems to be
around 5 days.

To demonstrate the numbers:

Time 0 - 5,000 peak cases needing ICU

5 days later - 10,000

10 days - 20,000

15 days - 40,000

In an area that has let's say 5,000 ICU beds, those 15 days are the difference
between having just enough beds+ventilators, or having only enough
beds+ventilators for 1 in 8 critically ill patients.

Imagine a photo of a hospital dealing with situation 0 vs situation 15 days
later. Yikes.

------
cs702
Original source:

[https://www.medrxiv.org/content/10.1101/2020.03.27.20043752v...](https://www.medrxiv.org/content/10.1101/2020.03.27.20043752v1)

Actual detailed predictions by state:

[https://covid19.healthdata.org/projections](https://covid19.healthdata.org/projections)

------
silverdrake11
It seems like the most critical time to shelter in place is one or two weeks
before the date predicted, considering the lag time between peak number of
infections and peak medical resources used.

~~~
celticninja
the peak occurs because transmission has been stopped. the reason you come to
that conclusion is because the incubation period is 14 days, so once you get
widespread isolation/quarantine/shelter in place of the population, then the
peak will occur 14 days later. if you dont isolate then your peak is only
reached when there are no more hosts, either through killing them off or herd
immunity preventing further transmission. of course there would be a
considerable difference in the size of the peak between these 2 methods.

so I guess I'm saying you can't say "the peak is in 2 weeks, isolate now"
rather it is "if we isolate on $DATE then we will see a peak in $DATE+2 weeks"

------
bdcravens
For its population, Houston and Texas for the most part has fared well so far,
but I'm careful not to be too optimistic over the long term.

------
joshstrange
Not only that but some states will probably see multiple peaks if they relax
restrictions too early.

------
sroussey
States should close their borders.

~~~
ng12
I hate to say it but I agree. RI had the right idea. NYC is a mess right now:
we are still not taking this seriously. Trains are crowded, grocery stores are
crowded, the Staten Island ferry is crowded, parks are crowded. In an
especially hilarious twist people were crowding the piers yesterday to watch
the USNS Comfort come in.

We need drastic action.

~~~
elliekelly
I don't think it's something that could really be done in the US. We have a
constitutional right to move freely between and among the states.

~~~
macintux
You'd have to go to the courts to get a transportation ban overthrown, and
they'd be reluctant to intervene. By the time you were successful, the crisis
would (please, hopefully) be over.

~~~
JamesBarney
Getting 5 people on the Supreme Court to say "no let the pandemic run its
course, even if it costs 10s or 100s of thousands of deaths" would be
difficult.

