More than ever, we’re on our own

Leana Wen, a physician and former public health commissioner for Baltimore, wrote another great op-ed piece for the Post today entitled “We’ve reached 200,000 deaths. Our response has gotten even worse than it was at 100,000.” It makes the stark point: By the most important measures of public health, we’re doing worse on a national scale than we were in late May, when the US passed 100,000 Covid deaths. Here are some of her points:

“In late May, we had about 20,000 new infections per day. Now we are at double that, with around 40,000 new daily infections. This is a high baseline to have entering the fall and winter, when the combination of quarantine fatigue and cold weather could drive people to congregate indoors and substantially increase transmission.”

“In addition, restrictions keep getting lifted, even in states with surging infections. The nearly 2 million students returning for in-person instruction will surely lead to more outbreaks, as some college towns are already emerging as new coronavirus hot spots. In 27 states, the number of infections this week is higher than it was last week. In 14, the test positivity rate is in the double digits, which means the true infection rate is much higher.”

“We are also further from implementing the basic public health measures necessary to stave off outbreaks. The president himself holds large indoor rallies, sometimes in open defiance of local ordinances against mass gatherings. Masks have become a partisan symbol. An influential model predicts that if 95 percent of Americans wear masks, we could save 100,000 lives by the end of the year. This doesn’t seem likely, unfortunately — the same model estimates current national mask usage to be 45 percent.”

“So, the burden of disease is much higher. We’ve gotten worse at using the tools at our disposal. Add on top of that an extremely worrisome development: The one critical institution needed to fight this pandemic has been cut off at the knees.” Of course, she’s referring to the CDC.

In the above, I find it most appalling that, despite the fact that there would be a huge reduction in deaths if a universal mask mandate were imposed, we’re far from that – and the president and some governors do their best daily to undermine what mandates there are. When I first started writing these posts in March, it never occurred to me that not only would the national response to the virus be slow, inept and marked by corruption – after all, those are almost points of pride of the current administration – but we would have the appalling specter of the administration actively trying to undermine the inadequate response that is in place. But, in the words of our president, “It is what it is.”

So what can we do about this? “There’s a lot that a competent federal administration would do now. Announce a national strategy. Scale up testing. Take the muzzle off scientists, and let our government’s top public health experts lead. I’m afraid none of this will happen during this administration. That means we have to take matters into our own hands.”

“The same public health measures we’ve been discussing for months are still our best defense. Being around others outdoors is much safer than gathering indoors. Wear masks when you can’t keep a six-foot distance outdoors; when indoors with those not in your household, maintain as much distance as possible and keep masks on to reduce aerosol transmission. Avoid crowds. Wash your hands. Keep in mind the concept of cumulative risk: Just because you are doing one activity that has risk doesn’t mean you should do others.”

Yup, we’re on our own to fight the novel coronavirus. Until January 20.

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 2.6%.

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 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	7,552	1,079
August 29	6,675	954
Month of August	30,970	999	116%
September 5	5,961	852
September 12	5,310	759
September 19	5,696	814
September 26	5,353	765
Month of Sept.	23,091	770	75%
October 3	5,494	785
October 10	5,638	805
October 17	5,786	827
October 24	5,938	848
October 31	6,094	871
Month of Oct.	25,481
Total March – Oct.	236,313

Red = projected numbers

I. Total deaths

Total US deaths as of yesterday: 209,177

Deaths reported yesterday: 737

Percent increase in total deaths in the last seven days: 2.6% (This number is used to project deaths in the table above. 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: 7,287,561

Increase in reported cases since previous day: 43,206

Percent increase in reported cases in the last seven days: 4.5%  

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

Total Recoveries in US as of yesterday: 4,524,108

Total Deaths as of yesterday: 209,177

Deaths so far as percentage of closed cases (=deaths + recoveries): 4.4%

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: 4.9%

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. As of 9/15, rate for New York state: .9%. For Texas: 7.9%. For Florida: 12.3%.  For Arizona: 6.9. For California: 3.3%).

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