Read this and weep

Unfortunately, the deaths number yesterday was much higher than it should have been to maintain the current slow downward trend in deaths. As a result, my projections show deaths to be 1300 higher for August than I said yesterday, and about 4,000 higher for September. This isn’t a good sign, especially since new cases turned up modestly yesterday, to their highest level in a week.

In writing yesterday’s post, I saw a link to the op-ed below, dated February 4 and title “Stop a U.S. Coronavirus Outbreak Before It Starts”. It was written by Dr. Scott Gottlieb, Trump’s FDA Commissioner from 2017 to 2019 (and a frequent critic of the administration’s response to the pandemic), and Dr. Luciana Bario, who was director for medical and biodefense preparedness policy in Trump’s National Security Council, 2017-19 (before that unit was disbanded at John Bolton’s insistence. Thanks a lot, John! You let us down then and you let us down again when you demanded a subpoena to testify in the House impeachment investigation. You’re a great patriot…).

The piece speaks for itself. Had somebody taken it to heart (and it was definitely read at the White House, although of course Trump will plead ignorance of it, as he does for everything except his kids’ names), the course of history would have been much different. The authors mention that the CDC was about to come out with a test to distribute to labs and were placing a lot of hope on that. Of course, we know that rollout proved a failure, and rather than immediately grab an available test like the WHO’s, the CDC wasted three precious weeks when the virus could have been controlled with more available testing – and then they came out with a fix that just involved changing procedures, can could have been applied right up front.

And of course, St. Anthony Fauci undoubtedly understood this, yet he didn’t pound on the table then. He’s just not a table-pounding guy, I guess.

The Wuhan coronavirus continues to spread at an alarming rate. More than 20,000 cases have been confirmed in China, with another 23,000 suspected. Many in China aren’t even being tested due to a shortage of diagnostic supplies. The true number infected is likely much higher than reported. The virus has turned up in 28 other countries, including the U.S. A pandemic seems inevitable.

The U.S. government has moved quickly to try to delay the spread throughout America. As of Feb. 2, most foreign nationals who have traveled in China in the preceding 14 days aren’t able to enter the country. Americans and their immediate family who recently traveled to China are subject to medical screening and quarantine.

These travel measures may stall a U.S. outbreak. But they’ll become less effective as more cases appear outside China. It’s clear that China waited several weeks to tell the world about the outbreak. Meanwhile, roughly 250,000 Chinese nationals traveled to the U.S. People with only mild symptoms can spread the virus to close contacts.

So far the 11 known U.S. cases are recent travelers to Wuhan and their household contacts. But it’s highly probable that dozens of other cases have gone undetected. The first sign of an outbreak will be a cluster of patients in one community stricken with unexplained pneumonia. The priority should be identifying this community transmission early, so that public-health authorities can intervene and prevent spread throughout the U.S. That will require several steps.

First, doctors must be on high alert. The Centers for Disease Control and Prevention should expand its guidance to doctors: Be suspicious of anyone with unexplained pneumonia who tests negative for common viruses, even if the patient has no connection to China.

An expanded sentinel surveillance system—detailed data collected from a network of high-risk locations—could help spot unusual clusters of illness that might be the beginning of an outbreak. If only 10% to 20% of people develop serious symptoms, then for every person diagnosed there may be eight or nine who elude detection.

Second, these expanded criteria should translate into broader screening. It’s crucial to identify cases of secondary spread, in which someone catches the virus from another person who hasn’t recently been to China.

CDC currently recommends testing only those with a clear and known risk factor, such as travel to China or close contact with an infected or exposed person. The patient must also be showing symptoms, such as fever and shortness of breath. This strategy will miss illnesses coming from a potential outbreak in which the index case—the person who traveled to China, for example—is two or three steps removed from the people who show up at the hospital with pneumonia. It’s time to start testing more people, even if they haven’t visited China or been in contact with someone infected.

Containing the virus will also require more labs that can perform diagnostic tests. Right now only the CDC is running tests, and the agency is showing signs of strain. It’s taking CDC about 36 hours to turn around results, even with strict limitations on who should be tested. Expanded screening will further stretch the agency.

CDC is planning to distribute test kits as soon as this week that would allow designated public-health labs to run the test. Private test developers need clearance from the Food and Drug Administration to distribute or use tests. But that will take some time. Developers need access to samples to be sure their tests are reliable, and companies have to submit paperwork for FDA review.

Many major medical centers in the U.S. already have the capacity to run tests. The test is based on polymerase chain reaction, or PCR, that screens for bits of the coronavirus RNA. Most major hospitals have sophisticated labs that can conduct these tests. This type of test is relatively cheap, technically straightforward and routinely used by doctors. CDC can help by giving hospitals more access to positive controls and reference material.

If the virus is silently spreading among people without a connection to China, and if only a fraction of the ill develop pneumonia, then it might take dozens of infections to notice an outbreak. By that time, an epidemic will be hard to prevent.

Yep, they hit that nail on the head!

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 the projected numbers – they are all projections based on yesterday’s 7-day rate of increase in total Covid-19 deaths, which was 4%.

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 significant intervening changes.

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	1,474%
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	71%
June 6	6,544	935
June 13	5,427	775
June 20	4,457	637
June 27	6,167	881
Month of June	23,925	798	57%
July 4	4,166	595
July 11	5,087	727
July 18	5,476	782
July 25	6,971	996
Month of July	26,649	860	111%
August 1	8,069	1,153
August 8	7,153	1,022
August 15	7,556	1,079
August 22	7,735	1,105
August 29	8,082	1,155
Month of August	32,921	1,062	124%
September 5	8,444	1,206
September 12	8,822	1,260
September 19	9,217	1,317
September 26	9,630	1,376
Month of Sept.	38,285	1,276	116%
Total March – September	227,977

Red = projected numbers

I. Total deaths

Total US deaths as of yesterday: 179,221

Deaths reported yesterday: 1,783

Yesterday’s 7-day rate of increase in total deaths: 4% (This number is used to project deaths in the table above; it was 4% two days ago. There is a 7-day cycle in the reported deaths numbers, 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: 5,798,138

Increase in reported cases since previous day: 51,604

Percent increase in reported cases since 7 days previous: 6%  

III. Deaths as a percentage of closed cases so far in the US:

Total Recoveries in US as of yesterday: 3,127,418

Total Deaths as of yesterday: 179,221

Deaths so far as percentage of closed cases (=deaths + recoveries): 5%

For a discussion of what this number means – and why it’s so important – see this post. Short answer: If this percentage declines, that’s good. It’s been steadily declining since a high of 41% at the end of March. But a good number would be 2%, like South Korea’s. An OK number would be 4%, like China’s.

IV. 7-day average of test positive rate for US: 6.3%

For comparison, the recent peak for this rate was 27% in late July, although the peak in late March was 75%. This is published by Johns Hopkins (recent rate for New York state: .8%. For Texas: 15.8%. For Florida: 14.5%.  For Arizona: 8.6%).

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