Posted on 03/19/2020 6:03:01 PM PDT by gas_dr
Good Evening all: Here is the 48 hour update on the data presented below. The data has been fast changing and as for all data sets there is some good news, some bad news, and some interesting news. I am adding the UK to the analysis. I will post the incremental 48 hour data points under each country. In terms of the data, the Worldodometer uses 2400 GMT to measure the 24 hour period, so I am convinced this is standardized appropriately. From the High level view, Italy is going off the rails, Germany and France appear to be on course with the predicted, the UK seems ahead of the curve. China reported no new cases (again, take with a grain of salt). Iran is passed its peak (again, take with a grain of salt based on the country). As for our beloved United States,
Additional advanced analysis; A growth rate under 10% suggests non-exponential growth, and over 10% places exponential growth factor. In all cases, all countries are under 1.5 growth factor and 3 countries are under exponential growth.
I have spent the last several days like most Americans somewhat baffled, perplexed and even a little nervous at the rapidly unfolding events as to CoVID-19. The community seems to have been divided into two groups, those who are advocating that there is nothing more than the common flu here and that there is vast overreaction, and those that advocate that this is a serious illness that for the safety of all requires drastic measures in order to prevent mass death and tragedy. If one looks closely, it is possible to find everything from death rates calculated at 0.1% - 14% and beyond.
Fair warning, I tend to fall in the previous camp and think that this is likely an overblown situation that appears to be gathering inertia, and I have gotten into several heated and admittedly emotional arguments about this current situation. For full disclosure, I am a critical care physician practicing in the United States, and the fear of the unknown probably drives to a small degree my emotion. So this evening, I have decided to put emotion aside, and truly conduct a retrospective analysis of the data that is present in a multivariant system and see where the data lead us.
I have discovered something interesting, and will simply present the data without commentary. I have analyzed from the worldometer website six countries: China, Italy, United States, South Korea, Spain, and France. I have been curious as to the timelines and increase in daily cases in countries that appear to have rampant disease, and countries that have flattened the curve.
Methodology: Utilizing a base case rate of 100 infections, I standardized the time to 6340 infections, which happens to be the current report of United States infections updated at 1800 EDT. Datasouce: Worldometers.info
CHINA: Time to equivalent cases of United States infections: +7 days. (571 cases -> 7,711 cases). Time to Peak of newly reported cases (2nd inflection point) +15 days from current US case load. After inflection point, total new cases fell dramatically
UPDATE: For sake of completeness: No new cases reported for first time today. If accurate, the length of the time in population was eight weeks.
South Korea: Time to equivalent cases of United States Infections: +15 days (100 cases - 6593 cases). Time to peak of newly reported cases (2nd inflection point) +4 days. After inflection point, total new cases fell dramatically.
UPDATE: New infection remain LOW, however there was an increase in the last 24 hours from 94 - 150 cases. Although this is low level, there is some thought that there may be second wave infections from people either retuning home or coming to South Korea now that the rate has fallen so much. In either event it will bear watching if this is anomalous noise, or something that trends back up., However, given their excellent containment as the first country to flatten the curve, my suspicion is that if this trends, it will be quickly dealt with
Italy: Time to equivalent cases United States Infections: +15 days. (75 - 6,387). Time to peak of newly reported cases +7 days. This is where the data may become predictive. Between March 15, 16, and 17 there was a relatively flattening of new cases and decline in the last 24 hours reported period. What will be a test of this model is what happens to the cases in this 24 hour period. According to the other models, this should be the peak.
UPDATE: Italy remains an outlier in the model, for unknown reasons. After trending according to the model, Italy has gone off the tracks at day +8 and +9 with a day over day increase of 20%. This suggests an exponential growth factor of 1.5 What its interesting is that the recovery to death ratio is diverging instead of converging. This is one of the nuanced findings that the peak is approaching. Unfortunately, given being at +8 and +9 exponential growth, there are large numbers. I hope this region cools down soon.
United States: Time from 100 cases - 6340 cases +15 days. If this model is predictive, we can ascertain in the next 4 - 7 days based on number of cases and shape of curve if we appear to follow South Korea numbers, or Italian and China Numbers. The current acting head of HHS repeatedly states out numbers track South Korea.
UPDATE: Time constant +1 and +2 days -- ongoing exponential growth (which was forecast). 2548 (day #1) - 4588 (day #2). Tomorrow will be day #3. If there is containment, then days 4 - 7 will show substantially less growth. Look for Under 10% growth sustained to demonstrate the peak and then drop of cases. If it goes out to day seven, the delta will be between 16000 cases and 100,000 cases which will certainly cause additional fear and panic. I still hope given what was heard today that we will reach peak and flatten the curve starting March 21, however if this model holds even at day seven, there will be a flattening of the curve. CAVEAT: We have growing numbers of testing, so there may be an interesting issue of saturated testing that becomes unsaturated. Will attempt to account for it in oncoming days.
Spain: Time from 75 cases - 6391 cases +13 days. Today is day +2 from the relatively time constant 100 -> 6500 cases period.
UPDATE: Spain is +2 days from Time constant -> 6000 Cases. There was an increase of cases that was substantial consistent with the exponential rise On day +1, +2, and +3. Look for Tomorrow data and then if curve flattens.
France: Time from 100 cases - 6633 cases +16 days. Today is day +1 from relative time constant too >6000 cases.
UPDATE:France remains +3 day today with anticipated growth, they start the theoretically cooling off phase tomorrow. We shall evaluate this data closely over the next 3 days to see if they have successfully flattened the curve.
NEW COUNTRY: UK: They are currently on Day +13 from 100 cases. Interestingly the curve for UK flattened today. It is unclear if there is some pent up data not recorded, or if this actually occurring. We will know more in the next 24 hours. Recalling that there is a pretty constant +15 days to 6,000 cases, on Day 14 there are only 3000 total cases. In some of the other countries there was a small pause before major upticks to 6,000 cases, but the UK its behind the United States in terms of time line. If the new cases remain FLAT tomorrow, it COULD portend that the UK has flattened the curve before most major acceleration. Will watch closely.
NEW COUNTRY: Iran: I had not included this in the analysis given I trust the Iraniaian government about as much as I trust the Chinese numbers. However for the sake of completeness....Iran made it from 100 - 6000 cases the most quickly (+12 days). Assuming they have poor mitigation strategies, what is fascinating about these numbers is on day +5 from time constant to today which is day +10, the new cases have been flat or decreasing suggesting that Iran has started on the deceleration of the disease in this country,
OVERALL Analysis: I am sorry, I did this quickly tonight as I am pretty busy with some other things. BUT the OVERALL model appears to be holding ACCEPT in Italy. So what is different about Italy? We know they were stretched in terms of resources, and we also know the population is the second oldest in the EU, and there is a high proportion of Wuhan Chinese in Lombardy. We additionally know that the smoking rate, and there presumably the chronic lung disease rate is high. We also know that this is still REGIONAL in Italy, and not spread over the entire Peninsula]
We have new treatment. Plaquinil + Azithromycin appears to be both viralcidal and viral static,. Think of this treatment as the Tamiflu of Corona -- it decreases severity an length, but unlike Tamiflu, it appears that there is some viralidal activity. President Trump referred to this as a game changer, and I tend to agree., The literature publishes both a dosing for active disease and prophylaxis. If this indeed works, then we should see rapidly falling numbers as the treatment penetrates the hot areas.
What we also know is that there are now 10,000 deaths world wide in approximately 14 weeks, on and total of 244,919 cases. So, in my judgment the forecasts of a million deaths in America in the next 6 weeks are irresponsible as this would require that we would have to have 25M cases ASSUMING worst case death rate of 4% which also appears to be overstated. I In order to get to 25M cases, the rate in America would have to be 100x the current case rate worldwide. I see this as a very remote possibility.
I look forward to discussion on the data, and particularly to the next 4 days as I hope we will see a better picture that allows improved forecasts.
Good evening, stay safe, and stay prayerful.
Interesting.
Countries aren’t homogenous.
Northern Italy got hammered first. Then the thing spread elsewhere. I also think that while most of the data is garbage (Maybe not Japan and SK) the Italian data is relatively good.
Washington state (Seattle et al.) was hammered first. Washington has been looking relatively good for a while.
NYC is getting murdered. First case was March 1st.
Canada, which I’ve been following closely, has had almost no community cases. But that is shifting in Toronto, likely out of the bottle. I don’t know how they are doing in B.C., but I’d hate to be near Seattle, although Seattle appears to have the non-L strain and NY has the L, so if it is a choice between Seattle and the NE corridor, Seattle is probably the better choice.
Too bad there is no way of breaking out L at this point.
I think the numbers will rise rapidly, but not because the spread is increasing but rather the testing will reveal more infected. The current confirmed cases in the U.S. has risen to 13,680, as of 8:16 P.M. Central time.
Spain, France and Germany are also worrisome. No sign of inflection I can determine. Italy scares me.
Either we adopt South Korean tactics, or just treat new cases with off-label drugs and hope for the best.
thanks so much for these updates...
The reported numbers of Recovered in the U.S. seem to be exceptionally low in comparison to other countries.
Do we have more stringent criteria, like multiple negative tests required to declare someone “Recovered”?
what about Vancouver BC?...there is a huge majority Asian component there IIRC.....not just Chinese, but Korean, etc...
nobody is afraid where I live...eastern washington....except that there is not much to do, its rather calm....
https://laist.com/latest/post/20200317/coronavirus-qa-how-long-am-i-contagious
In this article, Dr. Shruti Gohil with the University of California Irvine Medical Center (who’s helping lead the effort to prepare the hospital for COVID-19) says:
“But it’s encouraging to know that while asymptomatic individuals can get sick, their ability to spread the disease is far less than those who are actively symptomatic, who have secretions, who are coughing, who can take this virus and spread it around to other people.”
So it might explain why it’s been so bad in Wuhan and northern Italy. The people there got much worse cases because their lungs were bad, and the people old and had other medical conditions. And since they got worse cases, they were more infectious. And so more got sick and it spiraled out of control.
Directly extrapolating their numbers and rates to other places where the populations are different in regards to their initial health, etc, may not be valid - which would be encouraging news (except to regions where the populations are more like northern Italy).
Why not Hong Kong?
Thanks for putting this together.
For the moment, Asia is cut off, so nothing new should be getting in.
The U.S.-Canadian border is never going to be sealed in the same way.
The U.S. cases, esp. Seattle., matter a good deal more. No where along the Northern Border will you find more closely related major cities. The second closest pair would be Detroit and Windsor.
In Asia, there is one province in China that was hit hard. Knock out that province and Italy has close to twice as many cases as all the rest of Asia combined—if the Chinese (and North Korean) stats are to be trusted. The U.S. already has more than the rest of China if you leave out Wuhan, at least according to the official stats.
I think a good chunk of Vancouver’s Chinese community is Hong Kong East. Provided they don’t have too many ties to Wuhan specifically, they are good.
The Koreans did awesome, esp. if, as is likely, they were the subject of an impromptu bio-attack.
Doc, thank you.
The numbers from China and Iran are bogus and have no predictive value, IMO.
I don’t disagree but it is a large enough sample to include
Always compelling and interesting analysis.
I personally think that the Chinese numbers are part of psych-ops, but that’s just me.
Scary how much freedom we gAve up so easily to over a virus
I admire you, Gas Dr!
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