5. How are the U.S. States Doing?

(3/22/20) Washington State has gotten control, California is making progress, but New York is concerning

The United States has the 6th largest death rate among countries in the world due to the corona virus, but how are we doing? Let me say again that deaths are a lagging indicator since these events represent infections 2-3 weeks ago. But it is the only hard data we have, so our strategy is to monitor the trend in deaths in order to extrapolate the death and the prevalence from 2-3 weeks ago to today and further into the future. The U.S. looks to be spiraling out of control in terms of accelerating number of deaths (which again reflects incidence of infections 2-3 weeks ago) and number of confirmed cases (which is meaningless because it mostly represents the amount of testing and not new cases). Let’s look at the Plots below for what we know in terms of cumulative deaths and death rates (daily) for the three most affected states, Washington, New York, and California.

These data show accelerating (increasing curves) deaths for NY and CA, but less so for WA. The equations that are fitted to the data, in order to forecast to the present and the future with regard to actual prevalence of cases (vs. reported confirmed cases), are binomial equations. This represents our upper limit for forecasting and a linear fit (not shown) represents our lower limit. The Table below summarizes death totals and rates today and what we forecast for up to 3 weeks from now. We also present a calculation of prevalence and incidence 3 weeks ago reflecting death statistics today and then calculate prevalence and incidence today.

The key observations are as follows:

  • Total deaths are calculated as the geometric mean of the low and high estimates discussed above [sqrt(low x high)]. The trend is increasing approximately linearly in WA, but accelerating significantly in NY and CA, with NY totaling about a factor of 4-5 greater than CA.
  • The margin of uncertainties for total deaths are also given in the Table and you can see they are least for WA and greatest for NY and not surprisingly increase with time into the future.
  • The calculated prevalence is significantly greater than the reported confirmed cases that we all read about. Our calculation of prevalence is based on a 1% mortality rate in NY and CA, but 3% in WA given that we know the vast majority of deaths there were for the elderly.

Conclusions:

  • Reported confirmed cases of prevalence and incidence are misleading indicators as they represent a fraction of total and new cases.
  • WA appears to be containing their epidemic.
  • NY and CA are increasing at similar rates; however, CA is at a level of about 20-25% of NY and therefore will have an easier time containing the epidemic than NY because the probability of exposure is proportionately less.

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