Coronavirus outbreak won't peak in every state at once

https://www.axios.com/coronavirus-states-peak-hospitals-53274e0e-69b8-4dc7-b069-fb27955c559a.html

56 49 6 years ago

sroussey• 6 years ago

States should close their borders.

ng12• 6 years ago

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.

runawaybottle2• 6 years ago

If we learned one thing with this Pandemic, it’s that basically whatever is at the edge of your mind needs to happen right away. If you think we need to close state borders, then we probably needed to have done it 2 weeks ago, let alone right now. If you think $1200 is not enough, we probably need a bill on the floor right away for another month of stimulus.

Whatever even pops into our head is already 2 weeks behind.

elliekelly• 6 years ago

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.

mancerayder2• 6 years ago

It really goes to show how deadly entitled individual rights can be. People in the US and in NYC in this case, whether Right-wing or Left-wing, justify going out, crowding and being selfish on the ground of their individual rights. The ACLU is challenging anti-congregation orders and there are still Trump people who refuse to comply on similar grounds. It's not even political - Americans wish to die for their freedoms.

In some European countries drones are flying around threatening fines and jail time for being out for non-essential reasons.

The individualism versus communitarian debate is in full swing, and Nature chose communitarianism.

jmull2• 6 years ago

State isn't really best level of granularity. States do provide clear lines of demarcation, which allows for good enforcement, but closing, say, CA as a whole doesn't do much.

You'd really want to go as granular as possible, which is what these stay-at-home orders are about.

leggomylibro• 6 years ago

That defeats the purpose of this being a single United nation. Do you really think it would be healthy to artificially accelerate the rapid fracture of our collective unity?

E pluribus unum. We stand together, or we fall apart. At least, figuratively...it's probably not a good idea to stand too close together at the moment.

danans• 6 years ago

There are cases in places as remote as central Alaska at the moment. The virus is everywhere, and continuing business-as-usual anywhere is the problem (i.e much of the South and central US), because each state not sheltering in place has its own huge internal transmission vectors.

ptrhvns• 6 years ago

IANAL, but AFAIK, that would be a violation of the Constitution for the United States. In fact, I think Governor Andrew Cuomo of New York threatened to sue another governor (was it Rhode Island, Vermont, somewhere else?) for attempting to close their borders to cars with NY license plates.

syntheticnature• 6 years ago

With what manpower? States are not set up to have borders closed, there are hundreds if not thousands of small roads to handle, and cases where entire cities straddle land borders.

Plus all the essential aspects are wide-ranging. Interstate goods transport still needs to occur. I know someone who works an essential job in sewer treatment across a state border. What sort of paperwork would he need to go back and forth for that, and what sort of commute time issues would be inflicted with a checkpoint and/or need to re-route past blocked routes?

runawaybottle2• 6 years ago

I’d make things even simpler. If you don’t have a long haul truck, you’re not moving between states.

For essential work, I have no answer.

standardUser• 6 years ago

First, let's get every state to order a lockdown and restrict all unnecessary movement and congregation. We aren't even there yet. If people have cause to cross state lines (some people live right on state borders, for example) they should be able to. If people need to travel to a relative, they should be able to.

Remember, we are not trying to kill off the virus with social distancing. We are only trying to dramatically slow the transmission rate. We are succeeding in places that have reasonable shelter at home orders. We need to expand these types of orders to the entire country. Then, closed borders should not be necessary.

icedchai• 6 years ago

Logistically it's almost impossible. you know how many side roads there are between NY, NJ, PA, CT, VT, Mass, etc? Tons! What we need is a national quarantine. The President needs to go on the air, tell people he was wrong, the situation is more serious than he thought, and we need to stay home for at least the next 4 weeks, until further notice. That will never happen though.

nkoren• 6 years ago

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.

michaelangerman• 6 years ago

Number of new cases in Oregon is flat to slightly down in the past six days...

3/25 57

3/26 50

3/27 98

3/28 65

3/29 69

3/30 58

These are new case numbers. Data source: https://weather.com/coronavirus/l/3e056a178cd9fcb8c8efaa5819...

weather.com case numbers for oregon

jmull2• 6 years ago

I think the point is if testing is tightly constrained you can't know much about how many cases you really have.

We'd actually want some kind of randomized survey testing in an area to understand the prevalence there, and do it over time to understand the arc, but we aren't doing that -- we still can't test all the people who have a need for am immediate test.

threatofrain3• 6 years ago

Testing will also peak out at the state's capacity to test, whereas people will have a hard time hiding dead bodies, so I think some numbers are better for forming a stable picture.

fermienrico2• 6 years ago

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• 6 years ago

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.

mancerayder2• 6 years ago

Deaths are partly unavoidable, but they're also partly avoidable because if hospitals have ICU /ventilator and bed capacity the death rate goes down. Once they're overrun then the death rate spikes.

bengebre• 6 years ago

15 days ago was a different universe of testing capacity. Oregon had done less than 500 tests then and was still using the initial (semi-flawed) CDC tests. We've done almost 13,000 tests since then (I live in Oregon). Not to say we're doing enough yet, but it is a totally different situation today in Oregon and elsewhere:

https://www.deptofnumbers.com/covid19/oregon/

edit: that link is to a site I built to track testing capacity and new case growth.

nod• 6 years ago

These IHME predictions are actually based on deaths, not on tests. Also, please look at the wide error bars on the original data source: https://covid19.healthdata.org/projections

Of course there are still a lot of variables - one of the better criticisms is that it assumes that states lock down with the same strength, just at different dates. But it's the presentation of this Axios piece that is dangerous here: It strips out all the uncertainty estimates and presents exact numbers as if they were precise.

threatofrain3• 6 years ago

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.

celticninja2• 6 years ago

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.

threatofrain3• 6 years ago

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?

cs702• 6 years ago

Original source:

https://www.medrxiv.org/content/10.1101/2020.03.27.20043752v...

Actual detailed predictions by state:

https://covid19.healthdata.org/projections

testplzignore• 6 years ago

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• 6 years ago

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.

bdcravens• 6 years ago

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.

silverdrake11• 6 years ago

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.

celticninja2• 6 years ago

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"

joshstrange• 6 years ago

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

Coronavirus outbreak won't peak in every state at once

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