Coronavirus

[Oil4AsphaultOnly]

If the rest of the country was on lockdown then maybe. But people have been flying, traveling and otherwise business as normal up and down the East Coast, the South and the MidWest until very recently. Unfortunately I expect to see "hotspots" multiply across the US in the next 4-8 days.

Once we get consistent stay at home orders in the entire US then we can start the 2-4 week countdown.

Until then we are going in the wrong direction, not the right one.

My estimate was based on the availability of masks (which I'm hoping/expecting to be generally so by next week). If they're still not available after a month, then business can't safely resume and shelter-at-home should continue. Afterall, how else is the medical staff able to treat covid-19 patients? Once everyone can protect themselves, then the porous state borders won't be as big of an issue. It's the masks and hygiene procedures that protects people, not lockdown (yes, I'm aware that lockdown slows the growth rate of the infection, but not the point).

 

[MC3OZ]

With these sorts of diseases as soon as people are allowed to congregate, it will come back. The 1918 flu had two rounds, the second round was much worse. This disease has factors that make it more spreadable than the 1918 flu.

The Chinese may cover it up as much as possible, but it will almost certainly come back there too.

You can never eliminate disease entirely.

For a return to work, good hygiene, risk reduction, screening, testing and treatment, needs to be in place.

So a high level of organisation and discipline must be retained, and pro-active management must be retained.

There is no evidence either way about whether or not the Chinese would cover it up..

But when a country gets new internal cases down to zero, mostly they need to do is mange the risk of incoming travellers.

I don't see how the world can get new cases down to zero without mass screening of most of the population, it only takes one infected person to slip through the net.

So our ability to live with it over the medium term is all down to how well we manage risk. Catch any new out breaks early and the damage can be somewhat contained.

 

[FoverM]

The JHU site now has the US broken down by county. And yes, the south and mid-west aren't looking good. Click on US in the left column to show only US data by county.

Very nice.

Is there anything we can learn from the current distribution of cases now that we have the county level details? Some questions:

1. One thing that immediately jumps out to me is the wide distribution of the virus. It mostly follows population density, which you'd expect, but can we get an idea of how long it has been here based on the spread?

2. Why so many cases in Colorado???

 

[power.saver]

Very nice.

Is there anything we can learn from the current distribution of cases now that we have the county level details? Some questions:

1. One thing that immediately jumps out to me is the wide distribution of the virus. It mostly follows population density, which you'd expect, but can we get an idea of how long it has been here based on the spread?

2. Why so many cases in Colorado???

Look at airport hubs. Chicago, Atlanta, Denver, DFW, NY, etc. I believe a major spreader is airplane travel, both domestic and international. Now mostly domestic, but continues to be a problem.

Also, on the bottom right graph, note how the increase in the number of cases in US is steeper than Italy or Spain. We are headed for a serious crisis very soon.

 

[Causalien]

I’ve noticed that the people you regularly report about talking to for information have a clear tendency for negative/worse case information.

My analysis has always leaned towards the negative side and as a precaution I speculate on the outcome of the two extreme sides to see if it breaks anything. I remember mentioning this a couple of years ago. But if my negativity is showing, I can assure you that the actual info I got was downright horrifying as most of the stuff I post here are filtered.

In any case, I am here to see through my final prophecy. It sucks that the answer to the question I asked back then is COVID19

 

[Buckminster]

So what is the plan for China? They are opening up the economy but keeping on masks etc. How long will they have to keep that up? Until ~50% of the population is vaccinated in ~18 months?

 

[Norbert]

It's safe to take Korean stats as a mature dataset at this point, right? They've been stable for more than a week and it's safe to say deaths have caught up to cases making the 1.24% mortality rate reliable. These guys tested more broadly and thoroughly than anyone by far.

Now....in a country of 51M people, do we honestly think only 8,961 people have contracted cv? Step back and take a look at Korea's 111 total deaths and tell me the true mortality rate of this thing won't be .2% or lower when all is said and done.

Doctors are estimating 40+% of people will contract this virus(similar to the 20-30% that got SARS). If that's even remotely close to true and mortality is over 1%, why are there only 111 deaths in Korea? How can anywhere hit heavily by this, regardless of response or quarantine, have only 111 deaths if mortality is so high?

Perhaps I'm making a glaring logic error as well?

This has been covered. 111 deaths in a country of 51M does not equal anywhere near a 1% mortality rate, regardless of what kind of spread you assume.

Makes sense now. You think in a country of 51M there are only 9,250(111/.012) infections by a virus that spreads as bad or worse than any flu strain. Gotcha.

Indeed there must be a "glaring logic error".

If your argument is based on there only being 111 deaths in a country of 51M, then it will be refuted by Wednesday, since then the US will have more than 700 deaths in a country of about 330M.

And I guess you agree that it won't stop Wednesday.

 

[Norbert]

Earlier today NY report 11000 new cases, but now it's back down to 5500. Were they double counted originally?

On here:
United States Coronavirus: 32,356 Cases and 414 Deaths - Worldometer

I think you were first looking at the US numbers, and then the NY numbers.

 

[wdolson]

You can never eliminate disease entirely.

For a return to work, good hygiene, risk reduction, screening, testing and treatment, needs to be in place.

So a high level of organisation and discipline must be retained, and pro-active management must be retained.

There is no evidence either way about whether or not the Chinese would cover it up..

But when a country gets new internal cases down to zero, mostly they need to do is mange the risk of incoming travellers.

I don't see how the world can get new cases down to zero without mass screening of most of the population, it only takes one infected person to slip through the net.

So our ability to live with it over the medium term is all down to how well we manage risk. Catch any new out breaks early and the damage can be somewhat contained.

Some diseases are extinct. Smallpox is the most notable. As far as we can tell SARS and MERS are probably too. This may go extinct if it doesn't mutate into new forms like the flu and the common cold and enough of the world gets it.

We have a world economy with massive trade moving around the most of the time. Most of it is goods which wouldn't carry the virus, but there are people in the supply chain too. There is also still a refugee crisis driving illegal immigration all over the world.

The number of people passing through US immigration control (US citizens returning as well as foreign nationals visiting) at airports each year is huge. In 2019 Seattle-Tacoma alone had about 5 million people pass through customs. More traffic comes across the Canada and Mexico borders each year.

Forcing everyone coming into the US to either isolate for 14 days or go through a COVID-19 test would be very cumbersome and/or expensive. People who were just infected will also test negative for COVID-19 and will test positive later.

This spreads so easily, there are ways to slow it down, but it will be impossible to stop without shutting down movement like we have now.

This reminds me of Edgar Allen Poe's The Masque of the Red Death. I read it in high school and it illustrated the futility of stopping a virulent epidemic by pulling up the drawbridge. The entire short story is here:
The Masque of the Red Death - Poe's Works | Edgar Allan Poe Museum

 

[ev-enthusiast]

Italian army currently flying some corona patients to Germany for ICU.
Very proud of European countries helping each other in such a mess.

 

[NicoV]

My thinking is starting to evolve. Given the current restrictions in place, I'm thinking most of the US will come through this OK, with the exception of a few hot spots like NYC. I have a feeling that sentiment may change positive market-wise by the end of this week in anticipation that the economy won't be shut down everywhere for that long. Thoughts?

I think images from New York with patients lying on the ground because there are no beds won’t improve the market sentiment.

 

[alloverx]

Italian army currently flying some corona patients to Germany for ICU.
Very proud of European countries helping each other in such a mess.

Would seem to be logical that the EU would work to help member states where reasonable.

 

[Buckminster]

Worth a watch.

 

[AlanSubie4Life]

Gov Imdumb finally announced a lockdown for WA state. Only about a month too late but oh well. Now we wait and see how our case load goes after it's been spreading around all this time.

In fact, Inslee and the companies in the Seattle area have been instrumental in showing that the curve can be flattened. (And the crucial info from the Seattle Flu Study indicating there were hundreds of cases when the first community spread was identified provided the actionable intelligence.) Far from out of the woods, but that early action was key to seeing the results they are seeing now. I expect it will be a very positive story by the end of the week, though cases will still be increasing.

This additional action will serve to really take that last step to cut the spread and make contact tracking start to be manageable.

The news is trending well for death rates, but all the disruption is still ahead of us as cases hit over the next 3-5 weeks.

Trending well? The death rates right now are fantastically high for this stage in the ramp (normally with this case ramp the cases would not have fully converted into fatalities yet), suggesting extreme case undercounting. We're at 1.3% death rate in this country (590 deaths with 46k reported cases), when you would expect to see a rate of no more than about 0.3% at this stage of the extreme ramp.

That suggests our actual number of cases is probably closer to 4*46k = 184k in this country RIGHT NOW. (This is not a surprise at all, as about 5 days ago a good estimate was about 80k.) Everything is going exactly as according to expectations - this is certainly no surprise to anyone here I am sure. These are the numbers that you'd expect based on Trevor's best estimates from a couple weeks ago.

It looks like with the continued inaction up to this point we're probably looking at peaking at 500k cases now in this country (rather than my prior estimate of 350k cases I made a couple days ago assuming immediate correct policy action), again assuming we take action tomorrow and lock everything down. If we wait another day, we'll probably max out at 650k. Wait until the end of the 15-day period to take effective action, and we'll top out at a cool 1 million at least. There are about 140k people around the country who have not been identified, spreading around the virus, so it would be nice if they were kind of locked in place, stat! You know, like the experts say.

Deaths are a bit tricky to predict, but by the end of this week I'd expect we'll be over 2000 deaths in the United States (about 0.6% of the 300k cases outstanding at that point in time - the remaining 2000+ deaths to tick up to 1.2% attributable to those 300k cases will occur over the next couple weeks). If we continue to not do anything to actually address this issue, I would expect we should hit 10k deaths by the following weekend, easy (and we'll top out at over 2 million cases if the status quo is kept until that weekend). This is assuming the hospitals don't run out of vents. If we do, let's call it 20k deaths by the following weekend.

My thinking is starting to evolve. Given the current restrictions in place, I'm thinking most of the US will come through this OK, with the exception of a few hot spots like NYC. I have a feeling that sentiment may change positive market-wise by the end of this week in anticipation that the economy won't be shut down everywhere for that long. Thoughts?

I'm all for optimism, but we don't have many restrictions in place except in a few places. I think it's going to be a tough week in the market overall. I'd expect a bounce from the passing of the stimulus (some of that won't be priced in probably). On Thursday we'll have the worst unemployment report of all time, which will be interesting. And then we'll have something like 500-600 deaths on Friday.

Here are our restrictions - not a pretty picture at all!

On the positive side, we'll probably see the curves continue to bend effectively in California and Washington. New York not so much since they were late and the situation is so gravely out of control there. Also, Italy will likely finally see good curve bending.

MERS are probably too.

MERS still shows up from its host from time to time.

without shutting down movement like we have now.

We have not done that yet except in isolated locations.

 

[Remus]

For starters, we're not using Swedes...

Only a little bit kidding. In the US, even if you tell someone they will absolutely 100% for sure be responsible for murdering someone, they still won't follow rules unless those rules come at the end of a gun.

We talk about an Italian culture "furbizia". The U.S is even worse - we just have better policing here. When rules are followed in the US it is only because they come with the threat of deadly force. Without that, nobody would follow them. There is absolutely zero culture of "social responsibility" here.

I thought you were describing China.

Seriously when I first came to the states from China I am really surprised that cars stop ten feet away from me as soon as I show the intention of crossing the road. Such thing never happened in China.

 

[Norbert]

Not if the consensus is that overall mortality is less than 0.5%. Then you would be wrong even if entire population was infected. For instance Germany with a relatively high testing rate is reporting 0.3% mortality. But the rate will drop further when truly asymptomatic carriers are included.

Germany's low coronavirus mortality rate intrigues experts

The Germany number appears to be based on a faulty calculation !!!

It compares death numbers with total positive test results from the same day. But it must be compared with infections 2 weeks ago. The testing rate may be relatively high, but not that high, since two weeks ago the number of known cases was only about 1,500. With the current number of deaths about 120, that's about 8%.

The completely meaningless 0.3% calculation is a result of comparing a number form the very beginning of the spread with an advanced one.

 

[AlanSubie4Life]

The completely meaningless 0.3% calculation is a result of comparing a number form the very beginning of the spread with an advanced one.

Yeah, people keep on insisting on making this mistake; it is very strange. You can see from Korea's data that the CFR is 1.3% or so. With some modest undercounting, that likely puts the true IFR at about 1%. No reason to think Germany will be any different unless they are using novel therapeutics.

I still question how we're not weighing the negative effects with our response. We'll learn in time.

The continued insistence that there is another way seems odd to me. I can guarantee to you that as a 42-year-old male in excellent physical health, I would refuse to return to work until this virus is eliminated, testing is widely available to maintain low infection numbers, and masks are readily available. I would not be the only one. Many people will not work. It's just not worth it.

Also, since the countries that have been successful in beating this all use masks,

Yes, that and extensive testing, and contact tracing once the case load gets to a manageable level.

You know, gearing up to manufacture masks right now isn't a bad idea.

In fact, it's absolutely essential as part of the medium-term exit strategy. Instead, we're apparently taking our eye of the ball and equivocating about whether we should continue (actually start) the lockdown. And no discussion of massive testing increases to millions a day and how to achieve that. It's pure insanity.

Long term the only robust solution is a vaccine or some sort of miracle drug.

 

[bkp_duke]

Some diseases are extinct. Smallpox is the most notable. As far as we can tell SARS and MERS are probably too. This may go extinct if it doesn't mutate into new forms like the flu and the common cold and enough of the world gets it.

We have a world economy with massive trade moving around the most of the time. Most of it is goods which wouldn't carry the virus, but there are people in the supply chain too. There is also still a refugee crisis driving illegal immigration all over the world.

The number of people passing through US immigration control (US citizens returning as well as foreign nationals visiting) at airports each year is huge. In 2019 Seattle-Tacoma alone had about 5 million people pass through customs. More traffic comes across the Canada and Mexico borders each year.

Forcing everyone coming into the US to either isolate for 14 days or go through a COVID-19 test would be very cumbersome and/or expensive. People who were just infected will also test negative for COVID-19 and will test positive later.

This spreads so easily, there are ways to slow it down, but it will be impossible to stop without shutting down movement like we have now.

This reminds me of Edgar Allen Poe's The Masque of the Red Death. I read it in high school and it illustrated the futility of stopping a virulent epidemic by pulling up the drawbridge. The entire short story is here:
The Masque of the Red Death - Poe's Works | Edgar Allan Poe Museum

The only thing that will stop this virus is going to be a vaccine. Everything else is just mitigating the curve to keep the peak from overwhelming hospital capacity.

Even in the 2nd and 3rd phases of infections, it's going to be about controlling the numbers.

 

[skivi]

It looks like that switzerland has peaked on friday. On sunday it got a delay in cases on worldometers, that's the reason it was yesterday near the peak. So in the last three days we had a small declining.
The data for today will be interesting.

 

[wdolson]

I'm all for optimism, but we don't have many restrictions in place except in a few places. I think it's going to be a tough week in the market overall. I'd expect a bounce from the passing of the stimulus (some of that won't be priced in probably). On Thursday we'll have the worst unemployment report of all time, which will be interesting. And then we'll have something like 500-600 deaths on Friday.

On the positive side, we'll probably see the curves continue to bend effectively in California and Washington. New York not so much since they were late and the situation is so gravely out of control there. Also, Italy will likely finally see good curve bending.

We will probably see a big flare in new locations in the next two weeks. Florida was crammed with college kids on spring break last week and they were all sent home. With most colleges closed, many are back with their families and the infected are spreading it to them.

The Kinsa map today noted that their map may be becoming less accurate because of the lockdowns in places like the west coast.
US Health Weather Map by Kinsa

MERS still shows up from its host from time to time.

I didn't know that, but it isn't a spreadable as COVID-19 is.

We have not done that yet except in isolated locations.

Sorry, I wasn't completely clear. But my point was the only way we have now to slow this down is social isolation.

The only thing that will stop this virus is going to be a vaccine. Everything else is just mitigating the curve to keep the peak from overwhelming hospital capacity.

Even in the 2nd and 3rd phases of infections, it's going to be about controlling the numbers.

Or enough people get it before the vaccine that it dies out for lack of hosts. I agree this is going to likely go in waves with restrictions slowing the spread, then flaring up again when restrictions are lifted. This is a tight rope to walk between strangling the economy and driving people nuts from isolation and letting the virus spread.