Tag Archives: Covid-19

COVID-19: Don’t Just Flatten The Curve, but also, do this….

Is Washington State leveling off?

Are mainly Republican states seeing the greatest increases in COVID-19 infections (outside of New York)?

Is the NOLA effect an explainer of the the distribution of COVID-19 outbreaks?

What is the difference between flattening the curve and pushing the curve, and why is the latter what we need to be doing?

These and other questions….

Washington State is especially interesting because until New York muscled it out of the way, it was a US epicenter of Covid-19 infection. Over the last several days, the percentage increase in cases in Washington look like this:

16
11
18
11
11
11
4

Before getting too excited about that “4” we must digress to examine the “ever trust the last datum rule” in epidemiology. If you have been following the progress of COVID-19, you’ll notice that on many day — most days, really — the current situation always looks a bit rosy because the exponential rise in new cases is less for the most recent reading than for the previous readings. This is almost always an artifact of the nature of the data. Ignore the last day.

Having said that, it remains true that over the last several days the state of Washington’s new case number has not gone up as a percent of total cases. Washington is still in trouble, but measures being taken there may be helping.

It has been suggested that Republcian run states are going to have disproportionately more trouble from COVID-19 than Blue states, because Democrats pay attention to science and Republicans spend their days punching hippies and making liberals cry. This characterization of Democrats vs. Republicans is pretty much unassailable, but the effect on COVID-19 right now is a bit more complicated. Population size and density and other factors probably matter more, and it is possible that all the different virus related factors come together in the New York City Metropolitan area (which, to the surprise of Federal health authorities, includes about 10-12 counties, not four as they have been saying) to make that a hot zone no matter what.

Otherwise, the data, as shown in the following graphic which has a smudge on each state with the most rapid recent increase in COVID-19 infection, speak for themselves.

Sometimes, when data speaks for itself, it mumbles.

Not shown on that graphic because things are happening too quickly is the sudden and dramatic increase in cases, and deaths, in Louisiana. It thought that COVID-19 was active in that state during Mardi Gras. Contagious carnivalians were literally parading around on floats throwing the virus (on beads and such) to innocent revelers. There might have been some other forms of exposure. Right now, this morning, it appears that Louisiana has the second highest infection rate in the US, second only to New York and Washington, but possibly rising at a meteoric rate soon so surpass everyone.

And, of course, all those people who went home after Mardi Gras took it with them. I want to see travel to and from NOLA and other carnival sites mapped against infection outbreaks. Globally; Mardi Gras is only one carnival of many.

Flattening the curve is a nice idea, but there are two problems with it. First, it is probably very difficult to do unless cases are truly isolated prior to multiple infections. The idea of flattening the curve is to reduce R-naught, the number of people, on average, that are infected per infected person. Social distancing can help, but the only way to make a huge difference is to identify ill individuals very early in the course of their infection, and take them totally away from society. Social distancing does not do that enough. One can somewhat attenuate the curve, but mere social distancing is not going to do what happened in South Korea, Singapore, and China.

Moving the curve is somewhat difference. This involves recognizing that a spike will happen (though maybe a lower one than otherwise), but one moves the spike about two to three weeks ahead in time. Why? Because a given region probably has about 1/10th (or maybe in better scenarios, 1/5th) of the ICU beds needed to save most lives of the critically ill.

Flattening the curve is, explicitly, making the maximum infection rate low enough to duck under the bare of ICU bed number. Like this:

If the curve flattens a bit but fails at this objective, it was not flattening the curve, but rather, failing and losing to the virus. Like this:

Pushing the curve to later, which would probably reduce the amplitude of the peak but mostly result in the same huge increase in number of cases, allows the build up of ICU bed number. Like this:

That is what we are doing in Minnesota. We expect thousands of people to require ICU beds, no matter what happens. We are partly locked down, and increasing the lockdown on Friday. We are building new ICU facilities, apparently, at a sufficient rate to handle the eventual need.

Communities that are just flattening the curve, and that expect it to work, may run into trouble if they are not building out infrastructure now. We can argue about what the best approach is, but trying different methods in different states or regions is a hell of a way to test a hypothesis.

I learned yesterday that about 15% of the ventilators used in the US are made in Minnesota. We have about 2% of the population. So we’re good.

COVID-19 Conversation: Updates and meanderings

Updates

Spain has had a major surge in Covid-19 numbers. India has more people locked down right now than any other country. Trump intends to “open up” the economy by Easter. Fortunately he is powerless to do so. The best available information suggests that Covid-19 is not mutating much, suggesting that once a vaccine is developed, it can work widely and be more effective.

Things are bad in Iran. According to Arash Karami, “Iran’s confirmed corona cases is now 27,017 with 2,077 deaths. In the last 24 hours there have been 2,206 new cases and 143 deaths. In total 43 doctors and nurses have died from corona.”

Yesterday, March 24, is the day Trump told us we would have zero cases of Covid-19 in the US. The actual number was 53,478.

I hear chest freezers are flying off the shelves.

Covid-19 is Partisan in the US

Example of the effects of social distancing on a symptomatic indicator of Covid-19, suggesting it is working well at least in some place.
The default behavior of the Covid-19 virus has almost the same pattern of spread and increase everywhere — exponential increase with a fairly high exponent, for a virus.

How different societies or regions attempt to “flatten the curve” seems to result in very different specific outcomes, but in several areas there has been real success.

It is probably true in the US that the federal response has been pretty much perfect, from the point of view of the Virus. Trump is treating Covid-19 much like he treats Putin. “What can I do for you, sir?” But fortunately, locally, it does not work that way.

Broadly speaking (with too few exceptions) Republican executives are literally supporting the virus in this manner. They want it to spike. Democratic executives are ordering serious responses and it is working to varying degrees. In states with Republican governors, Democratic (usually) mayors are responding despite what the Governors are saying, and that is working locally.

So, yes, Covid-19 response is partisan, and one of the parties is acting like a Death Panel determining that the aged, infirmed, and the less privileged be sacrificed for the benefit of the economy. The other party is trying to help. Republicans vs. Democrats.

The response in Congress is also partisan, but the Republican response is so awful that Democrats are winning out of sheer shame on Republicans. Plus at the moment, more Republcian Senators are down with the virus than are Democrats, so that seems to shift the balance of power.

In my own neighborhood, I’ve seen the Deplorable Housewives of Minnesota (yes, that is a thing) congregating in groups at the grocery store and loudly yammering about Nancy Pelosi and how she hates America, spreading viruses onto each other as they wander like a pack of hapless Gollumoids through the produce section.

(In the past the Senate Republican leadership has always been against remote voting. Now that it is in McConnell’s interest to have remote voting, expect his situational ethics to resituate.)

Bad News

The mother of NBA player Karl-Anthony Towns is very ill with Covid-19, as of this writing. Amy Klobuchar’s husband is in the hospital on O2 and quite ill. Minnesota’s Lt. Governor’s brother has died of complications of Covid-19. A minor youth in Los Angeles has died. Prince Charles has been diagnosed positive. There is a long list of famous people from Jackson Brown to Natalie Horner to Prince Albert II diagnosed. Terrence McNally dies of Covid-19. These folks happen to be famous, and the tends of thousands of non-famous victims do not exist on a lower plane. But having famous names across the spectrum of how people know them and what people think of them is, perhaps, to this pandemic what a set of really bad hurricanes is to climate change, if you get my drift.

Watching an interview with a former official from the Louisiana Health Department last night, we got two reminders. One is that Mardi Gras happened at just the right time and place to be a major incubator of the disease, and probably accounts for a lot of sick people. The number of cases in NOLA has skyrocketed. The other reminder: Official Atlantic Hurricane season starts June 1st, but actual hurricanes or tropical storms can show up in May. Gulf Coast and Eastern Seaboard hospitals and communities night have an interesting year.

Here is an interesting history of the N95 mask. An outtake:

In the fall of 1910, a plague broke out across Manchuria… “It’s apocalyptic. … It kills 100% of those infected, no one survives… within 24 to 48 hours of the first symptoms,” …

What followed was a scientific arms race, to deduce what was causing the plague and stop it. “Both Russia and China want to prove themselves worthy and scientific enough, because that would lead to a claim of sovereignty,” …

The Chinese Imperial Court brought in a doctor named Lien-teh Wu to head its efforts. … after conducting an autopsy on one of the victims, Wu determined that the plague was not spread by fleas, as many suspected, but through the air.

Expanding upon the surgery masks he’d seen in the West, Wu developed a heartier mask from gauze and cotton, which wrapped securely around one’s face and added several layers of cloth to filter inhalations. His invention was a breakthrough, but some doctors still doubted its efficacy.

“There’s a famous incident. He’s confronted by a famous old hand in the region, a French doctor [Gérald Mesny] . . . and Wu explains … his theory that plague is pneumonic and airborne,…and the French guy humiliates him . . . and in very racist terms says, ‘What can we expect from a Chinaman?’ And to prove this point, [Mesny] goes and attends the sick in a plague hospital without wearing Wu’s mask, and he dies in two days with plague.”

On Twitter

One way schools could help with the Covid-19 response

Most schools have science classes. Among the science classes there are some that occasionally use nitrile or latex gloves (“surgical gloves”). While it may be perennial true that science classes are low on gloves, there is a good chance that there are a few unopened boxes in the cabinet somewhere.

Schools will not be using these gloves for the rest of the school year, because there is not going to be in class instruction for the rest of the school year.

So, figure out how to get these gloves to an appropriate medical facility.

If you are not a teacher you may not understand this part: The science teachers may have had to promise their first born to even get these gloves, and other important scientific equipment, in the first place. They may be unwilling to go up against the bursars to give these gloves up now and fight later. Indeed, it would be technically illegal for them to unilaterally root through the cabinets and gather these gloves together.

The word has to come from the top. Call your local school’s principals or superintendents. Or email them. Make the suggestion. They’ll make a call or send out an email and it will happen.

I mentioned above “unopened boxes.” I assume previously opened boxes are less of interest to medial facilities, but I might have that wrong. Anybody know?

Anyway, try it, it may help.