CNN was showing stats that ICU patients and ventilator usage are both up by over 100% in Miami-Dade county
It’s like Christmas, and Santa knows if you’ve been naughty or nice, but instead of coal in your stocking you get the grim reaper going buck wild in your community. It’s a very dystopian Christmas.
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NY daily confirmed COVID hospital and nursing home deaths since peak (from Cuomo press conference)
April 8: 799
…
May 1: 299
…
June 1: 58
…
July 1: 10
July 2: 3
July 3: 11
July 4: 8
July 5: 9
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We’re 99% sure my dad has Covid. He started feeling bad yesterday, running a 103 temp and sleeping all day and today his work called and told him that a guy in the van that takes him to work tested positive
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Is your dad able to get tested and is there anything you can do for him, or is it just something he has to ride out for now?
Yeah I tend to get allergy/asthma problems for a day or two after casino poker sessions in casinos with a long walk to the poker room, due to having to walk through a lot of smoke to get to the poker room. I’m thinking in the future, assuming we ever get live poker back, I’m going to wear a mask on the walk through the casino.
How good of a source is raw story?
Update from the DC data modeler. In short, reaffirms everything we know here on UP, and ain’t nothing good coming.
JULY 4th COVID UPDATE – Is There Now a Secondary Rise as Predicted on June 7th?
SHORT VERSION: It sure looks like it. The upcoming loss of life will be severe, practically unimaginable, and was 100% avoidable. Happy birthday, America. You blew it.
tl;dr as ever – drink ‘em if you’ve got ‘em, another really bad update coming up. Worst one yet.
Back on June 7th, I provided an explanation as to how we might expect to see new COVID-19 cases and new deaths arising from a perfect storm of then-emerging state relaxations of mitigation efforts, Memorial Day shenanigans, and/or the massive protests and counter-protests that had arisen about a week later as a result of the heinous murder of George Floyd. In that update, I concluded that if these events were to create an increase in cases and deaths, those should start to be visible in the case data around the middle of June, in hospitalizations around June 27th, in the mortality data regionally starting around the 4th of July – today – and in the national mortality around the 15th of July.
If we were to see these things, they would collectively suggest that the “Memorial Day” model that I’ve been projecting is coming to pass. I’ve called this a “second wave” to make it easier to understand, but in point of fact, this would really be what we statisticians call a step function. You can also think of this as a secondary rise in which the death rate declines, but never really approaches zero. Since death rates have continued to climb (although at a decreasing rate), it wouldn’t be exactly correct to call what we’re seeing a “second wave.” The May 15th Equilibrium Model, which I published on May 17th, has been remarkably accurate, even down to the daily numbers of reported COVID deaths. Neither the May 15th Equilibrium Model nor the June 7th Memorial Day Model have been updated since.
Let’s start by laying out how I arrived at the models, and then I’ll take you through the model performance to date and finally talk about what the current data suggest about a secondary rise event.
A few notes about what we understand about the virus to level set. Typical incubation period for COVID-19 is 5 days, with virtually everyone who becomes symptomatic doing so by day 11. About 80% of cases are understood to be mild or entirely asymptomatic. Infected individuals with minor symptoms or no symptoms may not know they are infected and further may be completely unaware that they have been in contact with an infected person. These individuals are still infected and probably contagious but may not be taking steps to protect others in the absence of that knowledge. It is also believed to be the case that even during the pre-symptomatic phase, some people shed enough virus to be contagious. The upshot here is that THE OVERWHELMING MAJORITY OF INFECTED INDIVIDUALS HAVE NO IDEA THEY ARE CONTAGIOUS WHILE THEY ARE CONTAGIOUS. There is little scientific consensus on the overall mortality rate of COVID-19, with estimates between 0.25% and 1.5% being the most common.
So back to what we might expect to see if recent potential spread events resulted in new disease epicenters. The first thing to bear in mind is that most of the potential spread events involve younger people. Memorial Day parties tended much younger than the general population. Polling suggests (mine and others) that younger people have been far more likely to resume activities that more vulnerable populations might avoid. These include activities such as going back to restaurants, bars, getting haircuts, etc. Finally, the people out at the protests have also appeared to be much younger on average than the general population. This isn’t to say that everyone at these events will be young, but it’s likely that more will be than a random draw from the population. Especially vulnerable populations (sick, elderly, immuno-compromised) are also much less likely to venture out. These same young, healthy demographics are the least likely to show up at hospitals or to end up dead – they also the most likely to be asymptomatic while contagious if infected.
As a result, the first wave of infections from the potential spread event was likely to originate from asymptomatic individuals and be spread to individuals among the least likely to become symptomatic. It was probable, therefore, that this first new generation of spread would not create a sufficient number of symptomatic test requests, hospitalizations, or deaths to show up in reporting.
These newly infected individuals return to their homes and their daily lives unaware that they’ve been infected and will likely become contagious within a week with or without symptoms. They will be able to transmit the disease to anyone they come in contact with, but most effectively to the people they live with. This second generation of infections from the spread event will include a more representative swath of the population and those folks will start showing up in test cases, hospitals, and, unfortunately, the morgues. Before that happens though, they will also have an asymptomatic contagious period during which they will create a third generation of infections. The third generation creates a fourth and so on and this is pretty much what happened in the beginning phase of COVID-19 in the United States and led to the lockdowns.
The reproductive rate of COVID-19 appears to be somewhere between 1.5 and 4 without mitigation, meaning that the average diseased individual infects that many new people if no precautions are taken to prevent it. In potential super spreader event scenarios, such as those we saw on Memorial Day or during the protests, the reproductive rate can be much higher.
Think about a realistic but hypothetical spread event in which one of the large Memorial Day (May 25th) events had 2,000 revelers interacting with limited mitigation as occurred all over the country. Let’s further assume that approximately 2% of attendees were infected and of those, half were contagious at this event meaning 20 contagious individuals. Let’s further assume a more conservative spread of 10 new cases per infected individual, much less than the 50 in the Chorus example where people were probably spending more time with the same infected individual. Please don’t get too hung up on the assumptions, this is just to help understand the math of the spread. Spread could be considerably less or more depending on conditions. Finally, let’s assume a mortality rate of 0.75%
In this example we have 200 new infections (1st gen) on May 26th who will become contagious in about five days on average. Because of the demography described above, very few will develop any symptoms, probably less than 10% (20) and of those, symptoms may be minor with zero mortality or close to it. By May 31, these 200 infected individuals become contagious and, because mitigation efforts within households is very rare, will begin to infect their families, roommates, friends, etc. If we assume an average reproductive rate of 3, there will be an additional 600 cases (2nd gen) between June 5th and June 11th. This group will start to become contagious on June 10th and spread to an additional 1,800 people (3rd gen) who will start getting sick around June 16th. At this point, people in the second generation will start showing up for testing and in hospitals. This would be the time that communities would, one hopes, start contact tracing and quarantines to reduce the reproductive rate of the virus. Around June 19 the first noticeable increases in COVID-19 deaths would start to occur from the 2nd generation. About a week later the deaths from the 3rd generation would start to appear. Assuming mitigation efforts get the reproductive rate down to two infections per infected individual after folks start showing up in hospitals, we would see an additional 3,600 infected people in the 4th generation around June 21st who will become contagious around June 26th. It is at this point (June 26-July 1) when the increase in death rates should start showing up from the 3rd gen and will begin to look like a statistically valid increase. In that single month, excluding the initial 200 in the first generation of the new outbreak, there will have been 6,000 new cases of whom about 45 will eventually die. Until and unless additional mitigation efforts are undertaken, this number will double weekly.
Some events were bigger than this hypothetical and most were smaller, but there were hundreds of Memorial Day events across the country, hundreds of protests, and many states were opening large indoor gatherings to resume.
SO DID WE SET OFF A SECONDARY RISE? Are there noticeable increases in daily cases regionally from re-openings in some states by mid-June and discernible mortality cases by the 4th of July? It’s virtually certain that we did. Will we see the spread in the national mortality data by the 15th of July? We’ll know very soon, but at this point it would be shocking if we didn’t.
Among the earliest reopenings were Texas, Florida, and Georgia. All three were, by mid-June, seeing clear increases in case data. By the end of June, all three states have also been setting record numbers with Georgia at about double previous records, Texas at triple previous records, and Florida closing in on TEN TIMES their previous records. Florida is close to passing New York’s worst single day records.
In Georgia there has yet to be an increase in deaths, but in Florida and Texas we are now seeing clear indications of an increase in mortality. The last week in both of those states had higher numbers of deaths from COVID-19 than they’ve seen since early May, and they appear to be rising. Texas and Florida have both achieved record numbers of COVID hospitalizations, and hospitalization rates are rising wildly throughout the American South. Nationally, case numbers have exploded, but national mortality has yet to show any increases, as there are regional declines in death rates in the Northeast where rates had been the highest. As of today, COVID-19 cases are increasing in all but 10 states. Confirmed coronavirus cases are rising in 40 of 50 states | AP News
As mentioned previously, the May 15th Equilibrium Model has been exceptionally accurate predicting both daily and cumulative deaths. As you can see from the second table attached, as the Memorial Day Model (increasing rate of deaths) begins to deviate from the Equilibrium Model (deceasing rate of deaths), the daily death totals have been erratic, bouncing between the two, but never below. This appears to be the result of regional spikes and reporting timelines. It’s too early to say 100% that we will proceed toward the Memorial Day model, but at this point, there is very little doubt left.
The problem we face right now, is that these are all events that HAVE ALREADY HAPPENED. The community spread is in at least it’s sixth generation. There is nothing we can do about those. It is far too late for any form of containment to be possible through contact tracing or quarantine. We have squandered the hard work and economic toll from the early months of self-quarantine and for what? The only tool that will is left in the playbook for stopping the increased spread is to reengage broad closures, announce mask requirements enforceable by law, and potentially again to stay at home. Those will take at least a month to work if followed. The additional death toll to this “second wave,” if it behaves the way the initial run of the pandemic did, could be almost 175,000 more dead Americans by the end of 2020. God forbid if we have a fall wave as well, the death toll could be nearly a half million in total by end of year. And the virus will not evaporate on January 1st.
So, we can watch the numbers, make sure we’re not part of these new generations by wearing our masks and distancing, but it’s already too late to do anything about stopping them. These events and policies have initiated a new spread of COVID-19 and we’re ALREADY in the middle of it.
Finally, I’d like everyone to consider a vital point. We are now, and have been since the beginning, ONE MONTH from having this pandemic under control. We wear masks whenever in public, avoid gatherings (especially indoors), and exercise proper hygiene. That’s it. It’s not magic, or even that hard. ALL THAT’S REQUIRED IS TO DEVELOP THE COLLECTIVE WILL TO DO IT. Instead, we have tossed aside our hard work and sacrifice, sentenced our neighbors to death, and somehow managed to make a pandemic a partisan whipping dog. We’ve put our basest needs and worst instincts ahead of our desire to take care of one another and keep America safe. We’ve killed our neighbors and continue to do so. This is a very different kind of American Exceptionalism than the one we learned about in school. America is no longer Reagan’s Shining City on a Hill. We’re a damnable leper colony.
I’d really like to end this on a positive note, but I can’t find one. The death toll we’re meandering into, almost gleefully, is obscene and there’s no longer any way to avoid it.
This is America. We are and can be better than this. There are no blue states or red states in this pandemic – only Hosts for the Plague. Apologies for the language in advance, but I do have one final piece of advice:
PULL YOUR SHIT TOGETHER AND THINK ABOUT YOUR FELLOW AMERICANS. Think about your elderly neighbors and relations. Think about your friends with invisible vulnerabilities like diabetes and asthma. Think about the immune-suppressed children you are sentencing to death for a haircut and a hamburger. WEAR A MASK. Wearing a mask doesn’t take any more of your rights away from you than driving on the right side of the street. AVOID LARGE GATHERINGS. You can live without a movie, a night at the bar, a rodeo, or a political rally for a little while. WASH YOUR HANDS. Seriously, that part shouldn’t even be new.
For everything you do, think about whether your mother, your father, your community and/or your God would be proud or ashamed of what you’re doing. Think about whether you are putting others at risk. Think about whether your actions could lead to the death of an immune-suppressed or asthmatic six-year old child. Make sure you are making decisions you can live with.
As a reminder from the June 7th update, here’s a description of the various models. Be aware I have removed the models for full mitigation as they are no longer relevant. I’ve left them as dotted lines so you can see the excess death associated with our collectively missed opportunities.
MEMORIAL DAY MODEL
In this first, and worst case of all the scenarios here, there is a rapid acceleration in the reduction of mitigation efforts in addition to the multitudes of mass gatherings over the Memorial Day weekend. Asymptomatic infected revelers will infect massive numbers of fellow partiers during these events, and then carry the disease back to their home communities sparking new breakouts NATIONWIDE. This scenario takes us back to where we were in the curve in early late February, but with patient zeros in population centers across the country and an exhausted, depleted health service. If these conditions occur, it will lead to a second massive wave which will be noticeable in the confirmed cases numbers my mid-June, much too late to be managed by containment. At this point there will be no choice but to shut down the country again. This scenario would begin to show up in the death tolls by end of June and create a nightmarish July & August in which about 130,000 more Americans die – more than have died to date. During those two months, we would average just over 2,000 dead each day instead of the 460/day estimated in the equilibrium model.
FALL WAVE MODEL
This scenario starts with a continuous reduction of the mitigation efforts currently in place, leading at first to the equilibrium state as described above, and then after some time, like with the Spanish Flu in 1918, people broadly cease nearly all of these mitigation efforts resulting in a widespread reopening across the country all at once – in this scenario, in September. Because there will be no herd immunity, we will have created a virtually identical environment to the one we found ourselves in at the end of February, only now with a depleted and exhausted health service PLUS an emerging seasonal flu. Given the current political environment, especially the upcoming election, it is possible that mitigation measures will be even slower to be adopted than they were in March and we will see an equivalent or larger spike across the country to the one we’re currently passing through. The epicenters are likely to be in urban centers outside of NY/NJ given their recent experience but Would be devastating elsewhere.
EQUILIBRIUM MODEL
This model is based on no significant second wave, but rather dozens of community outbreaks across the nation at any given time, with some growing as others fall. This would create a dynamic equilibrium of COVID-19 hot spots that will feel like a slow simmer. Based on the lack of national direction, states and localities are making uncoordinated decisions, and more often than not based on a political basis rather than sound economic or public health reasoning. What this is likely to mean is a relatively dynamic state of outbreak and remission until either there is a clear, centralized and enforced response to the problem or there is a vaccine. This scenario probably plays out as a lower rate of death nationally punctuated by regional spikes. I’ve run a series of models looking at this, and they tend to center around a steady state of about 460 deaths per day on average that continues more or less in perpetuity. That’s much better than the average daily deaths over the last few weeks (~1,500 deaths/day) but with no end in sight.
FULL MITIGATION MODEL
The last model, what I’m calling the Full Mitigation model, is the rosiest of what I believed could be the most likely paths the disease could follow from here. Unfortunately, it is a long-foregone conclusion that this won’t happen. Nearly every state has been lifting shelter-in-place orders and lifting restrictions. [A reasonably complete list can be found here: This is where all 50 states stand on reopening In this scenario, the reopening of the country leads to new hot spots which are widespread across the US prompting a national response in which strong mitigation efforts are enacted, enforced, and broadly followed until the rate of new cases drops to nearly zero. Those efforts are maintained until a vaccine is available and distributed.
Remember, I’m not a medical professional or epidemiologist - just a professional statistician who’s passable good at math. If anything I say contradicts the advice of credible medical professionals or the scientific community, take their word not mine. Seriously.
On the topic of whether the increase in COVID testing is responsible for the rapid recent increases in new COVID cases. Testing has increased in a linear fashion over time, during both the periods of rapid increases in confirmed cases and declines. Take a moment to look at the difference in the rates of increase of cases vs. the constant rate of increase in testing. It would defy logic to suggest that the recent rapid increase in confirmed cases is explainable by increased testing based on these data.
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.001 % 358/ 350k of my county tested positive in one day
I really appreciate these posts, Fatboy. Thank you.
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No problem. I’ll keep posting them as long I keep receiving them. I think I’m one person removed from the author. A coworker sends them to me when he gets them.
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They typically re-post articles from the Times or the Post in condensed versions or take the lede from a blue check mark on twitter.
They are definitely left leaning.
This story, for example, was taken from the health official from Florida who was fired for not falsifying Covid data on the state’s dashboard.
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Ty buddy
Covid Dilemma:
It looks like commercial flights will not go from Nicaragua to the United States anytime soon, so it looks like I’ll have to take one of the repatriation flights, which seem to go about every two weeks. Only problem is they only fly to Miami of all places. I’ve been here for almost 4 months, away from home 9 months now, so it would be really nice to see family and friends sometime soon, but man Florida is the last place I want to set foot in, and then having to take a 3 hour flight to Chicago with possibly a bunch of pozzed ppl. Shiiiiiiit. I’m still considering it though, because if nothing changes, then that will still be my only option come August or September, so maybe I should just get it over with now? Hmmm.
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Just talked to my mom and they’re getting tested on Friday, that’s the earliest they can get in, and then 3 days afterwards to wait for the result. Basically they’re not going to find out until next week. Jesus Texas get your testing act together
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Get the best masks u can and get it over with. We are not getting better any time here and u def wanna beat any more dangerous second wave later this year. Could u give a brief NICA Covid TR if u have time please?
Mask attitudes
Hospitals
Population taking it seriously
Politicizing it
Etc
The story had me at Florida
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I’d suggest trying to rent a car when you get to Miami, then you could try to drive to a state that’s taking this seriously, but you’d probably end up having to drive all the way to chicago. It would suck, but getting on a full plane with people from Miami would be pretty terrible too.
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