Yes and no. If only asymptomatic people are getting it, you can't make the assumption that today's infections are tomorrow's ICU cases. Theoretically, if you confine infections to a certain demographic, very few if any cases go to ICU. However, both the pure numbers and infection rate tell us how many more people are getting it and seems indicative of the overall likelihood of spread to people we do need to worry about.

To the extent people get wrapped up in the first part of that - pure numbers don't really tell us anything about severity - I do get the point, so I think further context around other indicators should be part of the story.

Right. They'd have to report what percentage of positive tests are asymptomatic. Heck, if that number is 1% (obviously it's not,) then we should be celebrating every positive test as a step closer to herd immunity with extremely low likelihood of serious consequences.

But the headlines keep blaring about raw test numbers with no useful context at all.

I'm still much more interested in the death counts. The testing and infection numbers should give us a sign of where the death count is heading, however, if the death count stays in a meaningfully stable number, then we're seeing growth, but also successful treatment along with an overall increase in cases per deaths than we were seeing before. In that case, the case counts from earlier should show that we were vastly undercounting the actual infection rates based on the death numbers.

We can look at the infection rates, and should be able to infer some expected death rates. Where those numbers transition to from there, should give us a better indication of what works and what doesn't, from a social/mask level down to a treatment in the ICU level.

Prior to the first wave, they had built a couple of sets of temporary field hospitals in different parts of town. I'm guessing they can be set up again.

SI

It appears we're about 7-10 days ahead of where I thought we'd be on the second wave. I wonder if there is any more news on the impact of heat than what I've read, but I'm back in 'I thought this would be bad and it's worse than expected' mode.

Can we even really call it a second wave? Seems to me other parts of the country are just getting hit.

For us in Texas, it's all one giant continual wave that keeps getting worse

SI

We have a winner! Yeah, we need to understand as a country there are only a few countries that are larger than us by either population or land mass. We need to factor that in to our expectations of weathering events like this.

Everything is bigger in Texas right? Including covid waves?

I think there's both going on. The projections in Georgia right now very much look like a second wave. A lot of other states aren't there yet but headed in that direction. It's also true that a number of places where they didn't get hit much before the spring shutdowns will really get their first hard taste of it.

I won't say 'winner', but I will say 'partial credit' :p

NJ just announced schools will be open in the fall. Masks mandatory for all faculty and staff. Strongly encouraged for students if social distancing can't be maintained. Staggered cafeteria, social distancing on busses and in classrooms if possible. If not students all facing one direction. Staggered recess. Possible keeping of students in pods where they are with the same group of kids all day.

Where my daughter is planning on going to college, that county has had 5 cases. The town the college is located in has about 21000 people.

Im not sure, but it seems like it is, obviously, a metro area issue. Rural areas are not being hit.

On another note, I was talking to one of our asst supt of our schools in my town and they have been in contact with doctors at a St Louis childrens hospital, they were using Australia as an example, where that were no cases being transmitted in school, if a child turned up positive, it came from home. Take that with a grain of salt of course.

Any information on # of kids per bus. That seems like one place social distancing will be hard. In our district you sometimes get 3 elementary kids per seat.

What they said was it is up to the bus driver to enforce mask wearing on the bus. That leads me to believe there may not be a number but masks would be mandatory on the bus.

I haven't dug down on the bus much because I have already made the decision I am going to drive them everyday. I am a stay at home dad so its not a huge inconvenience. I also have a good friend close by and our girls are the same age and play together so maybe do a carpool deal.

Re: Positivity rate: it is an indicator of how widespread you test relative to the size of the breakout. If it's 15% it indicates a lot of tests are people coming to you because they are sick and have symptoms. In Arizona 1000 people come to the ER every day because they suspect they have Covid19 per their health departmebt Dashboard. Countless more go to the testing stations or their doctor.
At 5% a lot more tests will be of contacts of patients or just on a hunch than 15%.

So unless tracking rapidly improved in 3 weeks, those states having way more cases AND way higher positivity rate indicates a larger percentage of symptomatic patients of all severity (and rising hospitalisations is a 3rd indicator). Asymptomatic carriers are harder to identify, so if it were mostly them because you activels look for them, the 'success rate' should go down, not up.

Upshot

That does not sound like contact tracing accounts for lots of tests.

Remember a large number of daily tests are simply healthcare workers who get tested regularly and (hopefully ...) by now should be having good PPE and low rates.


Age plays a part, too. We know the average age of cases is going down (which makes sense. Given the Option, younger folk will take more risks on average). So if deaths are holding steady you'd have to look at ages of people dying as well. 600 deaths of which 300 are under 70 isn't necessarily better than 900 of which only 100 are under 70, if that makes sense ... And while treatment improved, this might still not mean many more people recovering fully. Apparently a lot of recovered patients actually walk out needing a kidney transplant, had a stroke or heart attack or of course lung damage.

And average age of hospitalisation at least in Arizona has gotten a lot lower it seems looking at the age brackets. There's a much higher percentage of 20-44 years olds (23%) than we had in europe in april for example from what i recall (and not al keep that data)

ADHS - Data Dashboard

What we do already know though is that hospitals are filling up in quite a few states and quite significantly. On average (!) american hospitals apparently operate at roughly 65% capacity throughout the year (and likely more in winter than other months, at least in europe) so if now you have them operating at 80-90 that is a lot. Especially since some folk will still postpone elective procedures by themselves (and TX and Arizona are stopping them by default now if i read it right).
Ari went from 60% to 88% in a pretty short time, Texas almost double the people currently hospitalised for Covid19.

• Hospital occupancy rate U.S. 1975-2017 | Statista

Arizona Doc: Hospital Strains With Staff Shortage as Beds Fill Up | Phoenix New Times

Texas coronavirus positivity rate exceeds “warning flag� | The Texas Tribune

And remember, even in normal beds a covid patient takes up that bed a while potentially, even more so in ICU where you have them taking up beds and ressources (nurses can't just clone themselves and also can't necessarily switch between Covid/non-covid day to day, hour to hour due to fears of them spreading it). And you also can't move one or two patients elsewhere within the hospital like with other stuff when beds get scarce in a ward/station. You can only do it whole, meaning clear a ward/station and then bring in covid. Or use makeshift hospitals (which again hurts ressources you need to divide).

Id deaths go up it might be 3-4 weeks after the cases started to surge (really about 10 days ago). 1) dying from covid on average takes a while and 2) if it is young people now, do they spread it only to other young people or are there enough to 'migrate' into other demograpics ? This is what happened in the early going*. It first spread among younger people (not necessarily only 20 or 30 year olds, but not Seniors) because those were the one bringing it with them from Holiday and then first infecting Peers attenting the same social event (you meet way more people similarly aged than much older). Then eventually it really infiltrated older demografics and 3 weeks later, boom ...

Granted, those are likely more careful now (as are their kids or grandkids) and homes are shielded better. So it will not happen to the same extent.

* Tough to look at data here though because tests did increase rapidly and 4 weeks before deaths were surging there were almost no tests made in any of the hard hit countries.

Does it count if it's a man-made second wave? Because in Georgia we totally opened back up too early, causing this bump back up.

Time to open back up the speakeasies.

So Florida's statewide experiment on whether a bunch of drunk 25 year olds will observe social distancing to avoid a virus that they have been told repeatedly affects only old people is over?

What were the results?

Also, testing still sucks here. Friend of the family had an extreme fever spike and went to the emergency room. They refused to test her because they will only test people who are admitted. WTF?

Heads up fellow Floridians. The panic buying has begun once again.

I don't see it as a second wave. This country is big enough that it's just now migrating to the places where it had been shut out with the previous lockdowns. A second wave implies that there was a first. Seems to me, that the definition needs to be narrowed to more geographically similar areas before we go defining if it's one or two.

Ya, the antibodies test results in my state a month or two back told me that we, and probably other states outside the northeast, had much less prevalence of COVID than I assumed by that point. We're all just later in the game of the progression of this.

I don't think it's so much that NYC has some degree of "herd immunity" yet and these other states don't, but instead, the vulnerable people in states like mine - the bar hoppers, the party goers, the people in big families, the medical providers, etc, didn't get it before because it really wasn't here yet. Now they're starting to get it.

Of course these states being hit now had the advantage of knowing what was coming, and didn't take advantage of that. The quarantines in March might have been pointless in retrospect, and maybe counterproductive since it started that clock of peoples' ability to live like that too early. Countries in Europe locked down just before their COVID peaks, and then started lifting restrictions a couple of months later. Some states in the U.S. started quarantining when the virus hadn't even arrived yet. Either they were going to have to continue that indefinitely, much longer than Europe did, or they were going to get increased infections whenever restrictions were lifted.

My preferred supermarket still has stacks of 'emergency' Toilet Paper (some no-brand stuff) bought to replace all the stuff bought by panic buyers in march. Those stacks have been just sitting there clogging up the way to the frozen foods section since end of April, barely been getting smaller those piles despite price being dropped multiple times :D Plus now they started stacking the regular brands again in their regular aisles, so it might sit there untouched until someone in management blinks and just gives up and gives it away or stores it in back.

Texas, too

SI

That was one of the frustrations a lot of us had with the early US response. I mean we even said things like "we're 2 weeks behind Italy, why aren't we doing anything". We had all the warnings signs but we didn't heed them. At every turn, we're told "that's overreacting" and yet this virus continues to remind us "nope".

SI

This is the chart that I think best captures the extent of the US debacle. It adjusts both for population and for the fact that the US surge started later. And it's damning pic.twitter.com/h1AtMRw3EI

— Paul Krugman (@paulkrugman) June 25, 2020

A second surge requires the end of a 1st one and I doubt our half assed effort to contain it qualifies.

We were regularly having 2k deaths a day. For an extended period we've been down to a few hundred. That's a big difference, I don't see why you would need to get down to zero or whatever for it to be a second wave when it boosts back up.

That's pretty telling.

You may be right, I think it depends on how you define a second wave, but I think the decline in deaths when compared to the rate of infection is just showing who is getting it now versus early on when everyone was staying home (ie, more young healthy people who are ignoring social distancing guidelines while older, higher risk adults are continuing to stay home).

One of the responses - heh:

As a Canadian, I think we might need a border wall for when the violent caravans start making their way north. 😬
— Loss For Words 🇨🇦 (@speechless_14) June 25, 2020


SI


It also is too early to know what the outcome of this surge is. Looking at the 7-day average (imo a must due to the quirks of reporting) it really only started to significantly rise nationally on June 15th, aber being roughly on a similar level (both cases and positivity rates) the 3 weeks prior and going down before that.
It won't hit 2k again, but i'd wait another 3 weeks to see if it stayed highly concentrated in this younger population or has or will trickle upwards via family gatherings or work/health care contacts.
I mean, just because now you have 40k of which 25k are under 50 this would not be better than 20 of which 10 were under 50. (Totally made up numbers !)

Contact tracing looks to be a shamble btw, the USs opaque and fractured structure and skepticism towards agencies does not help ...


Maricopa County isn't following CDC guidelines for COVID-19 contact tracing


Contact tracing for the coronavirus pandemic isn't working - Axios

Amid coronavirus surge, Texas has a contact tracing problem: reporting cases by fax


UK has similar issues, they would overall be my bet for "first major country in Europe to have a major resurgence".

Watching CNN, and Houston is terrifying right now. Hospital ICUs getting slammed. And Florida's cases, holy shit.

Sent from my Pixel 4 XL using Tapatalk

That might be true, but there's no way it lasts even if it is. Said young healthy people will eventually transmit it in significant numbers to older, high-risk ones and ... there we go again.

Even more fundamentally though, deaths are a lagging indicator. They would be expected to come several weeks after a spike in cases.

Exactly, I don't see a scenario where we are not seeing record deaths on a daily basis in a couple weeks or so based upon case numbers and the continued growth. Hope I'm wrong.

Just depends on demographics. This will happen eventually if the sheer numbers outweigh any younger-skewing demos. I'd be careful if I was on Twitter promising terrible numbers in 2 weeks. It may take more time than that.

I think that's the critical data point that we're missing. We need to know if treatments and care have improved since we started this mess. I think it's a given that deaths will rise, but maybe the rate won't be as high as we saw earlier this year? Pure optimism. Deaths are still coming.

I don't think there is ans doubt it has improved, but there is no way to quantify it, especially given the chaos early on in the hard hit states. That specific datapoint (what happened in march/april in epicenters) is one i don't think you can reconstruct or, if you could, really use for comparison due to special circumstances.
Not to mention that specifically measuring "effectivenes of avoiding death" is just not really feasible with an infectious disease in real time. Too many factors you would have to account for, especially if you want to do it for a wide area and not, say, a single hospital or a small city.


One thing i also feel needs mentioning: it can't be right to put the onus of this entirely on those at risk living like hermits for a year. Or force retirement homes to limit visitation down to nothing.(those working in healthcare likely also on average limiting themselves way more than others, at least the once i know are)

Even if the young people themselves avoid older people like relatives it can work over a go-between.

In Michigan meanwhile at least 85 people are thought to have contracted it at a bar over a period of about a week. This might really have to do with ventilation or some factor like that ... And then likely a couple employees spreading it every night. Anybody know if the employees are required to wear masks specifically ? Articles say venue adhered to guidelines, but no mention of masks.

Patrons are asked to self-quarantine after about 85 people who visited a Michigan bar get Covid-19 - CNN

Also: NOW the bar is installing air purifiers ... Maybe that would be Money well spent for everybody, maybe make it tax exempt or sth ?

A couple of family members have already been told to get their work from at home setups ready once again.

I would say it was unbelievable but that would be a lie.

Worldmeters has global death toll passing 500k today.

Yes, all employees in those establishments are required to wear masks in Michigan. Required with zero enforcement, voluntary compliance, etc. but they are still required.

I live in a low impact area as of now and we were told on Friday we are working from home until at least Labor Day. Just not worth having 2,000 people in the same building.

We’ve been told we are to work at home until informed otherwise. Apparently at the national level, management hasn’t even informed the union of their plan for coming back to work - which is required and comments have to be sent and then some back and forth. And whereas we were informed to work from home by region, we’ll be told to back into the office by national order. We have a regional office in Dallas and a district office in Miami. I doubt we’ll be told we are going back into the office before Labor Day.

We had initially been told people were coming back in waves starting after 4th of July, so this 2 month shift is a big deal.

My office was to open back up July 6th, but that has been postponed till mid August. I'm thinking that is merely the first postponement. Same thing nationwide. I can't see us getting back to the office while the virus is raging. We had between 5 and 10 percent of the staff express a desire to go back in that first wave of openings.

So with this forthcoming second wave during summer, what does this mean for the theory that coronavirus will slow down with the heat?

I'm not convinced that heat significantly slows it.

Good news! COVID in Houston is solved!

Page not found - Texas Medical Center
By, which I mean, they removed the page showing ICU occupancy in the med center:

TMC leaders: COVID-19 surge is not eclipsing Houston hospital capacity - Houston Chronicle
I'm sure this was in response to the national attention it was getting and how they had to have a press conference to basically say "no, no, no: 100% isn't 100%!" Despite the fact that anyone who could read a PowerPoint could see that we have now exceeded 100% ICU beds and are into surge capacity.

But, hey, if we can't see the information, then the problem must be solved. We went from being one of the most open and transparent cities to removing the most critical stats as soon as the crisis reached critical mass.

SI

I was hoping this would be the case but Texas and Arizona have killed that optimism.

The terrifying thought is that most scientists still agree it is slower than it will be in the fall and winter simply due to the high outside/inside contact ratio. South of the US the super high temperatures and more people indoors with shoddy ventilation might be part of the problem.



And even 90% over a long time seems way too much already. Hospitals usually operate at 65/70ish % and the whole system likely is designed for that. Illnesses (same as deaths) are amazingly consistent, so 'surges' generally are rare, regional and short (usually a few weeks in winter or a heat wave crazy weekend etc). Plus, the extra patients from covid often need a lot of care on average from different groups of healthcare workers. Who are also struggling.

This opinion piece from a young doctor (but already high up the chain) in Arizona touches on that as well:

https://www.nytimes.com/2020/06/26/o...hospitals.html


As of now is on 14 straight shifts without a day off.

Looking at the % change in deaths per 100K over the last week there are a few states over 15%:

Arizona: 19%
Alaska: 17%
Deleware: 17%
New Jersey: 16%
Arkansas: 15%

Update: this caught a lot of attention so they've had to update the website with this message:



We'll see if the metrics are the same as before of it the political pressure causes a significant alteration to the slides.

The raw numbers for all of SE Texas can be seen here:
Microsoft Power BI

After bumping around at 300 COVID ICU patients for about a month, we're up to 701 as of yesterday.

That also doesn't include the "suspected" cases in isolation beds. If you look at slide 7, we've gone from about 200-300 in May to 1400(!) as of yesterday.

SI