The shutdowns worked!



The Washington Post yesterday published a story about two studies that showed how important the shutdowns were a couple months ago. The first was an “accelerated article preview” of an article by a group of epidemiologists, to be published in Nature Magazine. The article estimated that the shutdowns in the US prevented 60 million cases (meaning our number would be 62 million now, vs. the 2 million mark that it passed yesterday).

The article didn’t estimate deaths that were prevented, but using a very conservative case fatality rate of 1% (vs. the “measured” rate as of yesterday, which was 13%. See the very end of this post), this means a minium of 600,000 lives were saved, although - given that even countries like South Korea have measured rates of at least 3% - 1.8 million is probably a much better estimate. (Note on June 9: In the original version of this post, I got my decimal point wrong and said 6 million lives were saved. Either one is a lot, of course).

 Unfortunately, the shutdowns weren't universal and weren't maintained long enough for the US to get the virus under control, meaning all cases would be known and quarantined in isolatoin, and their contacts would be identified and quarantined if need be. This couldn't happen without adequate testing as well as an army of contact tracers and lots of hotels for quarantining people. We're getting better on at least the first two of those items now, but of course there's no longer any serious question of going back into shutdown mode.

 That is, until the next wave in the fall. If that's serious enough, we'll have to go back into lockdown. If it's as serious as the current one or even less serious, we might get by without lockdowns, but we'd have to be intensely focused on testing ,contact tracing and quarantining all cases. In either case, it will be very discouraging to people - but it's the price we'll probably pay for not getting the virus under control now.


The numbers
These numbers are updated every day, based on reported US Covid-19 deaths the day before (taken from the Worldometers.info site, where I’ve been getting my numbers all along). No other variables go into these numbers – they are all projections based on yesterday’s 7-day rate of increase in total Covid-19 deaths, which was 6%.

Note that the “accuracy” of the projected numbers diminishes greatly after 3-4 weeks. This is because, up until 3-4 weeks, deaths could in theory be predicted very accurately, if one knew the real number of cases. In other words, the people who are going to die in the next 3-4 weeks of Covid-19 are already sick with the disease, even though they may not know it yet. But this means that the trend in deaths should be some indicator of the level of infection 3-4 weeks previous.

However, once we get beyond 3-4 weeks, deaths become more and more dependent on policies and practices that are put in place – or removed, as is more the case nowadays - after today (as well as other factors like the widespread availability of an effective treatment, if not a real “cure”). Yet I still think there’s value in just trending out the current rate of increase in deaths, since it gives some indication of what will happen in the near term if there are no intervening changes.

However, it’s 100% certain that deaths won’t stop at the end of June! They might decline some more this summer, but Drs. Redfield (CDC head) and Fauci both predict there will be a new wave of the virus in the fall, and one noted study said there was a good probability the fall wave would be greater than the one we’re in now, as happened in the 1918 pandemic.

Week ending
Deaths reported during week/month
Avg. deaths per day during week/month
Deaths as percentage of previous month’s
March 7
18
3

March 14
38
5

March 21
244
35

March 28
1,928
275

Month of March
4,058
131

April 4
6,225
889

April 11
12,126
1,732

April 18
18,434
2,633

April 25
15,251
2,179

Month of April
59,812
1,994 (= 1 death every 44 seconds)
1,474%
May 2
13,183
1,883

May 9
12,592
1,799

May 16
10,073
1,439

May 23
8,570
1,224

May 30
6,874
982

Month of May
42,327
1,365 (=1 death every 63 seconds)
71%
June 6
6,544
935

June 13
6,478
925

June 20
6,852
979

June 27
7,248
1,035

Month of June
29,118
971 (= 1 death every 89 seconds)
69%
Total March - June
135,315


Red = projected numbers

I. Total deaths
Total US deaths as of yesterday: 113,106
Increase in deaths since previous day: 635 (vs. 370 yesterday)
Percent increase in deaths since previous day: 1% (this number was close to 0% yesterday)
Yesterday’s 7-day rate of increase in total deaths: 6% (This number is used to project deaths in the table above – it was 6% yesterday. There is a 7-day cycle in deaths, caused by lack of reporting over the weekends from closed state offices. So this is the only reliable indicator of a trend in deaths, not the three-day percent increase I used to focus on, and certainly not the one-day percent increase, which mainly reflects where we are in the 7-day cycle).

II. Total reported cases
Total US reported cases: 2,026,869
Increase in reported cases since previous day: 19,338
Percent increase in reported cases since yesterday: 1%
Percent increase in reported cases since 7 days previous: 9%

III. Deaths as a percentage of closed cases so far in the US:
Total Recoveries in US as of yesterday: 773,505
Total Deaths as of yesterday: 113,106
Deaths so far as percentage of closed cases (=deaths + recoveries): 13% (vs. 13% yesterday)
For a discussion of what this number means – and why it’s so important – see this post.


I would love to hear any comments or questions you have on this post. Drop me an email at tom@tomalrich.com

Comments

  1. Royce HowlandJune 9, 2020 at 12:17 PM

    Tom, I very much believe the studies that indicate how large a scale of immediate disaster was avoided by the lockdowns we did have. The SARS-CoV-2 virus is more infectious than influenza. For all those who keep saying, "we don't lock down society because of the flu or pneumonia" -- yes, exactly! That is EXACTLY the point!

    As bad as influenza and pneumonia are, as many people as they kill, we don't lock down society because those illnesses don't represent the same kind of catastrophe. COVID-19 vs. other common infectious diseases is not just a difference of degree, it is a difference of KIND. Just like the Spanish flu of 1918-9 was nothing like the influenza (even H1N1) of today.

    Our lockdowns were not that timely, complete, consistent or all that long-lasting (regardless of how people feel). Still, they made the difference between about 10,000,000 total infections today (based on my estimate) vs. many 10's of millions. Also the difference between about 127,000 deaths (based on my estimate, including both confirmed COVID-19 deaths and unaccounted excess deaths far above normal levels) and 100's of thousands dead -- as originally warned in the early models.

    Of course, as we both have pointed out so often, lockdowns were not the preferred choice. Mass testing, contact tracing and targeted quarantines of the infected were the preferred choices. Enacting those measures very quickly would have been more effective at containing the outbreaks with far lower loss of life, and far less need to for large-scale, economy-damaging lockdowns.

    Sadly, the continued lack of a proper approach to the whole testing regime means we remain at risk from following waves. The infections avoided to date, and the lives saved to date, are still threatened in the near future. Lockdowns are a brute force response, like calling in "danger close" artillery on your own coordinates when you've been overrun by the enemy. No supposed war-time commander, as Trump fancies himself, fights with this as the main tactic. Now that we have had to do it, we should immediately prepare far better.

    The best possible followup after getting our numbers down after all the chaos and loss since January, would be to take the opportunity to put a robust, full testing regime in place. We need to get ready for what is coming. Because there is more coming. Just look at what Brazil, Mexico, India and others are going through right now for a taste of what our next wave easily could be.

    ReplyDelete
  2. Royce HowlandJune 9, 2020 at 12:41 PM

    Tom, one other note on this. The USA fatality curve is coming way down. But the reported case curve is not. It has plateaued, or possibly is starting to inch back up. The reading of this is that the total infection load, for months, was far higher than the reported cases showed. We knew that. I would say actually a majority of fatalities to date have come from infections that were not on the radar because testing had never identified them, or their vectors of spread.

    Following lockdown measures that were successful in allowing a huge number of infections to "burn out" of the population without continuing to spread themselves, we've now seen the fatality counts come down at last. There are weeks and weeks of lag times built into this disease.

    But the fact is that the daily reported case count -- which still likely is an under-count of confirmed net new infections -- continues to 7-day average over 20,000 per day. This remains a huge cause for concern. We're vying with Brazil over which country can add 140K or more new infections per week. (Russia and India are distant thirds.)

    There's no way for any political or public health official to spin this that things are under control. They're not. 100K new infections every 5 days is still a fire waiting to rage out of control again given access to a new source of fuel...

    ReplyDelete
    Replies
    1. Tom AlrichJune 9, 2020 at 2:09 PM

      Thanks for the two notes, Royce. Both excellent! I'll point out that the reported new cases count is in the 20-30,000 a day range that it's been in since early April, although a couple days ago it hit 45,000. And it passed 2 million a day or two ago, as I noted in the post. So even though deaths are trending down, I take that to mean that reported cases are closer to actual cases than they've ever been - which of course is good news, since it means the testing program is finally gearing up (with still a long way to go, of course).

      And as you point out, we're well positioned to have a huge new wave of infections and deaths in the fall.

      Delete

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