How are we going to get out of this coronavirus pandemic? One thing is for certain, we're not going to social distance this virus out of existence. I don't know if the public at large thought that if we social distanced ourselves the virus would eventually go away. No, that is not the point of social distancing. Social distancing was meant as a measure to help prevent our healthcare system from being overwhelmed. The actual act of of social distancing is preventing us from really moving forward with battling the virus. That's not to say that all social distancing measures should be removed right now, it's just saying that the longer a population uses social distance as their primary means to battle this virus... the longer you're going to be practicing social distancing.
A few things to look at before going in-depth with all of this:
Why are 80% of the people that are being tested coming back as negative (don't have the virus) in all of the molecular (active) tests? I don't have anything to compare this to and I'd love to know how this stacks up against other viruses and diseases testing. This may in fact be the expected behavior. But just the number... seems high to me. Are we testing too many people that don't need to be tested? Is the virus not that contagious? Is this molecular test really that accurate? Are we double dipping too much in the number of tests administered? Are unique individuals being tested twice, thrice, or even more often? Keep in mind... just because an individual tests negative for the virus, that doesn't mean they won't contract it later. It just seems to me that a lot of people are being tested and coming back as negative.
The governments (United States) of the country have been ridiculed for their lack of response to this. Some of that is warranted. Although, from best I can tell, the ridicule comes from the lack of these molecular tests. But I would argue that the ridicule should be aimed at the lack of planning in response to this virus. A widespread molecular test would only be feasible if you could test EVERYONE in the country at the same time. That would be 320 million+ tests all done at largely the same time. This was never going to be possible - the governments (federal, state, local) should have realized that this was never going to be feasible. Instead the goal of the government should have been focusing on reliable antibodies testing. Money should have been thrown at developing and testing a reliable antibodies test so that you could push that testing out widespread, 6 to 8 weeks after this all started. Antibodies testing may or may not mean immunity... but it would at the very least tell you how widespread the virus has reached. If a percent of your population has the antibodies but never experienced any symptoms or had very mild symptoms, then that would alleviate some of the fear that goes along with this virus. And just to note, the fact that 80% of people that are being tested come back negative for this virus would seem to contradict some of the antibodies studies that suggest that this virus is more widespread, that is something that needs to be studied.
Further the governments should have recognized that basing this test at a state level was much to broad. A state level test might work in the smaller states of New England, but as you get more and more out towards the Midwest, the testing needs to be a bit more finer. Doing it by county is much too small (there are over 3,000 counties in the United States). I would suggest doing it by US congressional districts - mainly because these are already defined. It's not exactly fair to take a state like Texas and treat it all as one. Is it fair to the residents of Pecos, TX to have to suffer through restrictions because the number of cases are high in Houston? This is another miss from how the governments should have been planning for this.
Just to be clear, this is not a political issue. I'm not saying either party is to blame for this. There are states with governors from both parties and none of them would appear to have done any planning like this. I'm saying the governments as a whole failed in this planning. But also to be fair... hindsight is 20/20.
The problem we are facing right now is an extreme lack of data. We've social distanced ourselves to the point that no new data is coming in. Are people immune to it? Is the virus as contagious as we once believed? Are the symptoms that bad? We're not going to get any new information until we change things up a bit.
Now, seeing as how a widespread reliable antibodies test is probably not viable - at least in the short term, how can this situation be remedied? I would focus my attention to the percentage of hospitalizations of confirmed cases. Or if you really wanted to take it a step further, the number of people in the ICU of confirmed cases. The number of confirmed cases isn't telling us a whole lot right now. You can have a confirmed cases, but not affected by it very much. You could have a case of the virus, but not be confirmed (because you didn't get tested). You could have a case of the virus and not be showing any symptoms. You could have had the virus weeks ago and be recovered. But if you're in the hospital - or specifically in the ICU - and you have the virus, then you have a really bad case of the virus. That's not to say that it's peachy having it while you self-isolate at home. But if you've got it, and you're able to stay at home, then at worse it's probably like a really bad case of the flu.
Then to add on to this, I would again look at this data in terms of US congressional districts. Again, this would have ramifications in how to potentially treat a town like Pecos, TX vs. Houston, TX. If you've got a better way of dividing this up - I'm all ears.
I would also weigh in hospital capacity (or probably more specifically ICU capacity) in those divided areas and how much excess capacity those areas have.
All of this together would tell you which areas could potentially be opened back up. If an area has a relatively low percentage of hospitalizations - then it stands to reason that that area is not experiencing a widespread outbreak. If that area also has excess hospital and ICU capacity, then this would seem to be a prime area where things could be cautiously opened back up. That doesn't mean that an outbreak won't happen in that area. But that area would appear to have hospital capacity to treat people if the number of cases start to rise. And if a large outbreak then happens, it may require the area to be closed down again. But either way, it tells you something. It gives you more data that you can feed into the model about this virus.
To attempt to model some of this, I took data from the John Hopkins website - from April 21st - and tried my best to fit this into a useful display of information. There's a few deficiencies with the JHU data. Mainly, it doesn't give data for active cases in each state. It only gives information about confirmed cases in each state. It also does not give information about recovers in each state. Calculating active cases should be a simple matter of (confirmed cases - recovered cases - deaths). Also the JHU website lists deaths by counties or city and not so much by state. Since I don't have recovered cases and deaths for each state (and this could easily be a reporting issue and not necessarily with how JHU presents the information), what I did was took a percentage of active cases to confirmed cases from the total US population and applied that to each state's confirmed case number. (816,240 total US confirmed cases at the time I took this information, 44,228 deaths, 75,177 recovers ... subtract all of that out and you get 696,835 ... 696,835 divided by 816,240 equals about an 85% active case rate. Multiply each state's confirmed case by 0.85 to get a "guess" at how many active cases exist in each state. Kentucky had 3050 confirmed cases, multiplied by 0.85 equals 2603.83 "active cases guess"). This is fudging the math I know - but it's all I've got to work with. If there's a website that gives me the an accurate number of active cases and the number of active cases in the hospital for each state, that would definitely be preferable. I also took a snapshot of the hospitalizations from JHU for each state one day (April 16) and then again on a later date (April 21) and in some states the hospitalizations decreased... this told me that the hospitalizations figures JHU is reporting is a function of active cases and is not a growing number of total hospitalizations ever within the state - although I suppose that information could be a reporting issue explaining the reduction. The bottom line of it, I really need more accurate and better defined data to build this... but this is the best I've got. Also, some states did not report hospitalizations on the JHU website, so I had to remove them - I think Indiana was one such state - there were others but that's one I remember.
The information looks like this:
Now, looking at this table, this shows that Kentucky is actually faring pretty poorly with 40% of their cases being hospitalized. But also likewise, Washington state only has 4.71% of their cases in the hospital, but that's still 503 people. Does Washington state have the hospital capacity to handle 503 (presumably ICU) patients with excess capacity? (I really don't know). Again, this is probably why a more granular data set would be preferable... like US congressional districts, but this is the information I have to work with. I would arbitrarily consider any state that has less than 20% of their cases in the hospital and less than 100 total hospitalized would be areas that could potentially handle being opened up a bit. That would be the states of: Alaska, Montana, Wyoming, Hawaii, West Virginia, North Dakota, Vermont, South Dakota, and Guam (not a state, but the information was there). Maybe the "under 100 total hospitalized" is way too low... I don't know, I'd leave that up to people with a bit more knowledge of this information. And again, if this was divided up in congressional districts then this might yield different results. While the hospitalization rate in Kentucky is at 40% for the whole state, that might not be true for the far western end of the state where there's not a lot of densely populated areas. Again, I'm kind of assuming that all hospitalizations are ICU cases - that may not be the case and having a true number of ICU cases would probably be better.
As those states or areas open up, see what happens. Monitor those areas for 2 weeks or 4 weeks, what happens in those areas? No doubt the number of confirmed cases will likely go up, but to what degree? And is it manageable? And then you start to roll this out to other areas, which hopefully have seen their hospitalization numbers decrease while this monitoring is going on. Or hopefully you get reliable antibodies testing available by then and you could start to base this opening up on which areas have seen a widespread number of cases.
This would be what my plan for opening things up would look like. And this is where the lack of planning by the governments seem to be hurting. But I just don't see where the governments really had any plans to combat this. And again I want to point out that the actual numbers I used may not be the best numbers to use - but it's all I had. The logic behind using those numbers (whatever they might actually be) still remains the same. More accurate numbers is going to lead to a more accurate model.
A few things to look at before going in-depth with all of this:
Why are 80% of the people that are being tested coming back as negative (don't have the virus) in all of the molecular (active) tests? I don't have anything to compare this to and I'd love to know how this stacks up against other viruses and diseases testing. This may in fact be the expected behavior. But just the number... seems high to me. Are we testing too many people that don't need to be tested? Is the virus not that contagious? Is this molecular test really that accurate? Are we double dipping too much in the number of tests administered? Are unique individuals being tested twice, thrice, or even more often? Keep in mind... just because an individual tests negative for the virus, that doesn't mean they won't contract it later. It just seems to me that a lot of people are being tested and coming back as negative.
The governments (United States) of the country have been ridiculed for their lack of response to this. Some of that is warranted. Although, from best I can tell, the ridicule comes from the lack of these molecular tests. But I would argue that the ridicule should be aimed at the lack of planning in response to this virus. A widespread molecular test would only be feasible if you could test EVERYONE in the country at the same time. That would be 320 million+ tests all done at largely the same time. This was never going to be possible - the governments (federal, state, local) should have realized that this was never going to be feasible. Instead the goal of the government should have been focusing on reliable antibodies testing. Money should have been thrown at developing and testing a reliable antibodies test so that you could push that testing out widespread, 6 to 8 weeks after this all started. Antibodies testing may or may not mean immunity... but it would at the very least tell you how widespread the virus has reached. If a percent of your population has the antibodies but never experienced any symptoms or had very mild symptoms, then that would alleviate some of the fear that goes along with this virus. And just to note, the fact that 80% of people that are being tested come back negative for this virus would seem to contradict some of the antibodies studies that suggest that this virus is more widespread, that is something that needs to be studied.
Further the governments should have recognized that basing this test at a state level was much to broad. A state level test might work in the smaller states of New England, but as you get more and more out towards the Midwest, the testing needs to be a bit more finer. Doing it by county is much too small (there are over 3,000 counties in the United States). I would suggest doing it by US congressional districts - mainly because these are already defined. It's not exactly fair to take a state like Texas and treat it all as one. Is it fair to the residents of Pecos, TX to have to suffer through restrictions because the number of cases are high in Houston? This is another miss from how the governments should have been planning for this.
Just to be clear, this is not a political issue. I'm not saying either party is to blame for this. There are states with governors from both parties and none of them would appear to have done any planning like this. I'm saying the governments as a whole failed in this planning. But also to be fair... hindsight is 20/20.
The problem we are facing right now is an extreme lack of data. We've social distanced ourselves to the point that no new data is coming in. Are people immune to it? Is the virus as contagious as we once believed? Are the symptoms that bad? We're not going to get any new information until we change things up a bit.
Now, seeing as how a widespread reliable antibodies test is probably not viable - at least in the short term, how can this situation be remedied? I would focus my attention to the percentage of hospitalizations of confirmed cases. Or if you really wanted to take it a step further, the number of people in the ICU of confirmed cases. The number of confirmed cases isn't telling us a whole lot right now. You can have a confirmed cases, but not affected by it very much. You could have a case of the virus, but not be confirmed (because you didn't get tested). You could have a case of the virus and not be showing any symptoms. You could have had the virus weeks ago and be recovered. But if you're in the hospital - or specifically in the ICU - and you have the virus, then you have a really bad case of the virus. That's not to say that it's peachy having it while you self-isolate at home. But if you've got it, and you're able to stay at home, then at worse it's probably like a really bad case of the flu.
Then to add on to this, I would again look at this data in terms of US congressional districts. Again, this would have ramifications in how to potentially treat a town like Pecos, TX vs. Houston, TX. If you've got a better way of dividing this up - I'm all ears.
I would also weigh in hospital capacity (or probably more specifically ICU capacity) in those divided areas and how much excess capacity those areas have.
All of this together would tell you which areas could potentially be opened back up. If an area has a relatively low percentage of hospitalizations - then it stands to reason that that area is not experiencing a widespread outbreak. If that area also has excess hospital and ICU capacity, then this would seem to be a prime area where things could be cautiously opened back up. That doesn't mean that an outbreak won't happen in that area. But that area would appear to have hospital capacity to treat people if the number of cases start to rise. And if a large outbreak then happens, it may require the area to be closed down again. But either way, it tells you something. It gives you more data that you can feed into the model about this virus.
To attempt to model some of this, I took data from the John Hopkins website - from April 21st - and tried my best to fit this into a useful display of information. There's a few deficiencies with the JHU data. Mainly, it doesn't give data for active cases in each state. It only gives information about confirmed cases in each state. It also does not give information about recovers in each state. Calculating active cases should be a simple matter of (confirmed cases - recovered cases - deaths). Also the JHU website lists deaths by counties or city and not so much by state. Since I don't have recovered cases and deaths for each state (and this could easily be a reporting issue and not necessarily with how JHU presents the information), what I did was took a percentage of active cases to confirmed cases from the total US population and applied that to each state's confirmed case number. (816,240 total US confirmed cases at the time I took this information, 44,228 deaths, 75,177 recovers ... subtract all of that out and you get 696,835 ... 696,835 divided by 816,240 equals about an 85% active case rate. Multiply each state's confirmed case by 0.85 to get a "guess" at how many active cases exist in each state. Kentucky had 3050 confirmed cases, multiplied by 0.85 equals 2603.83 "active cases guess"). This is fudging the math I know - but it's all I've got to work with. If there's a website that gives me the an accurate number of active cases and the number of active cases in the hospital for each state, that would definitely be preferable. I also took a snapshot of the hospitalizations from JHU for each state one day (April 16) and then again on a later date (April 21) and in some states the hospitalizations decreased... this told me that the hospitalizations figures JHU is reporting is a function of active cases and is not a growing number of total hospitalizations ever within the state - although I suppose that information could be a reporting issue explaining the reduction. The bottom line of it, I really need more accurate and better defined data to build this... but this is the best I've got. Also, some states did not report hospitalizations on the JHU website, so I had to remove them - I think Indiana was one such state - there were others but that's one I remember.
The information looks like this:
State | Active (Guess) | Hospital | Percent | State | Active (Guess) | Hospital | Percent | |
Kentucky | 2603.83 | 1059 | 40.67 | District of Columbia | 2644.80 | 402 | 15.20 | |
Wisconsin | 3948.42 | 1211 | 30.67 | Arizona | 4487.12 | 637 | 14.20 | |
Minnesota | 2191.48 | 602 | 27.47 | Wyoming | 373.93 | 52 | 13.91 | |
Oregon | 1710.84 | 465 | 27.18 | Michigan | 27888.25 | 3374 | 12.10 | |
Maryland | 12116.75 | 3158 | 26.06 | Tennessee | 6179.18 | 730 | 11.81 | |
New York | 220566.24 | 57103 | 25.89 | Connecticut | 16916.33 | 1919 | 11.34 | |
Ohio | 11717.22 | 2653 | 22.64 | Massachusetts | 33843.76 | 3804 | 11.24 | |
Oklahoma | 2396.37 | 541 | 22.58 | Hawaii | 498.57 | 55 | 11.03 | |
Kansas | 1823.53 | 405 | 22.21 | Idaho | 1482.05 | 157 | 10.59 | |
Georgia | 16972.68 | 3702 | 21.81 | Delaware | 2502.23 | 256 | 10.23 | |
Colorado | 8631.90 | 1880 | 21.78 | West Virginia | 775.17 | 77 | 9.93 | |
South Carolina | 3789.63 | 776 | 20.48 | North Dakota | 549.79 | 53 | 9.64 | |
Mississippi | 4026.11 | 819 | 20.34 | Utah | 2814.69 | 268 | 9.52 | |
Virginia | 8221.26 | 1581 | 19.23 | New Jersey | 76748.83 | 6986 | 9.10 | |
Maine | 758.10 | 138 | 18.20 | Pennsylvania | 30072.05 | 2701 | 8.98 | |
Florida | 23472.85 | 4172 | 17.77 | Louisiana | 21218.19 | 1794 | 8.46 | |
New Mexico | 1682.67 | 291 | 17.29 | Texas | 17302.21 | 1411 | 8.16 | |
Arkansas | 1698.89 | 291 | 17.13 | Rhode Island | 4695.42 | 331 | 7.05 | |
Missouri | 5176.92 | 873 | 16.86 | Vermont | 698.34 | 49 | 7.02 | |
Alaska | 280.87 | 46 | 16.38 | Iowa | 3108.37 | 214 | 6.88 | |
Illinois | 28222.91 | 4599 | 16.30 | North Carolina | 6077.59 | 373 | 6.14 | |
New Hampshire | 1235.32 | 201 | 16.27 | South Dakota | 1498.27 | 87 | 5.81 | |
California | 28990.40 | 4674 | 16.12 | Washington | 10672.27 | 503 | 4.71 | |
Alabama | 4466.63 | 699 | 15.65 | Guam | 116.11 | 3 | 2.58 | |
Montana | 373.07 | 57 | 15.28 |
Now, looking at this table, this shows that Kentucky is actually faring pretty poorly with 40% of their cases being hospitalized. But also likewise, Washington state only has 4.71% of their cases in the hospital, but that's still 503 people. Does Washington state have the hospital capacity to handle 503 (presumably ICU) patients with excess capacity? (I really don't know). Again, this is probably why a more granular data set would be preferable... like US congressional districts, but this is the information I have to work with. I would arbitrarily consider any state that has less than 20% of their cases in the hospital and less than 100 total hospitalized would be areas that could potentially handle being opened up a bit. That would be the states of: Alaska, Montana, Wyoming, Hawaii, West Virginia, North Dakota, Vermont, South Dakota, and Guam (not a state, but the information was there). Maybe the "under 100 total hospitalized" is way too low... I don't know, I'd leave that up to people with a bit more knowledge of this information. And again, if this was divided up in congressional districts then this might yield different results. While the hospitalization rate in Kentucky is at 40% for the whole state, that might not be true for the far western end of the state where there's not a lot of densely populated areas. Again, I'm kind of assuming that all hospitalizations are ICU cases - that may not be the case and having a true number of ICU cases would probably be better.
As those states or areas open up, see what happens. Monitor those areas for 2 weeks or 4 weeks, what happens in those areas? No doubt the number of confirmed cases will likely go up, but to what degree? And is it manageable? And then you start to roll this out to other areas, which hopefully have seen their hospitalization numbers decrease while this monitoring is going on. Or hopefully you get reliable antibodies testing available by then and you could start to base this opening up on which areas have seen a widespread number of cases.
This would be what my plan for opening things up would look like. And this is where the lack of planning by the governments seem to be hurting. But I just don't see where the governments really had any plans to combat this. And again I want to point out that the actual numbers I used may not be the best numbers to use - but it's all I had. The logic behind using those numbers (whatever they might actually be) still remains the same. More accurate numbers is going to lead to a more accurate model.