(3/24/20) Still no evidence of a turnover in the death and infection rate, but we’re only one week into serious social distancing in the U.S.
In this post we update our death and prevalence/incidence statistics of a week ago (Post 3). This post has a lot of data so don’t get intimidated or bogged down in the detail. I will summarize the key points and refer you to where in the Tables and Figures to look. At the end of this post are plots of the cumulative reported deaths each day for eight countries and a description on how they lead to the values in the Table below.
– Forecast based on low and high estimates from binomial (low) and trinomial (high) functions fitted to the cumulative death plots (below)
– Prevalence for 3/23/20 accounts for recovery, which is approximated by prevalence 3 weeks ago (3/2/20)
– Mortality rate is assumed to be 1% for the U.S., China, and S. Korea; 1.5% for France, U.K. and WW; and 2% for Italy, Spain, and Iran. These values are estimated based on the quality of healthcare at this time.
Before we begin our worldwide assessment from the above Table, let’s look at the conditions in the U.S. as exemplified by the plots below.
In just one week the cumulative deaths in the U.S. have increased from 69 (3/16/20) to 471 (3/23/20). This is nearly a 7-fold increase and represents a doubling about every 2.5 days. Further the daily rate is increasing at a staggering clip with a daily death rate now exceeding 100. With these trends in mind we can now summarize the above Table. Key observations are:
- The number of deaths in the U.S. is forecasted to exceed 1,000 over the next week and if no downtrend in the incidence of COVID-19 occurs due to social distancing and other government interventions, the death rate will double each week for another two weeks.
- Acceleration of death rates is still occurring for the 8 countries tracked here except for China and S. Korea, who appear to have successfully contained the outbreak.
- The above Table also shows deaths per million people, with numbers ranging from 90.6 for Italy down to 1.4 for the U.S.
- Spain is accelerating at the rate of Italy, but delayed by 11 days. This is cause for great concern.
- Because social distancing started in earnest about a week ago, we expect to see a de-acceleration of deaths in 1-2 weeks (which assumes that infection precedes death by 2-3 weeks; we use 3 weeks in our models).
- The Table above gives prevalence calculated for 3 weeks ago from the cumulative deaths today assuming mortality rates in the footnote to the Table. Based on the death growth rates we then forecast prevalence today correcting for recoveries, which are assumed to be close to the 3-week-old prevalence numbers. Most troubling is Italy and Spain where we forecast an infection rate of about 1 per 60-70 people. This high density of infections will make social isolation less effective than for other countries.
- Also shown are the reported prevalence of active cases. It can be seen that our forecasts based on reasonable assumptions are typically about a factor of 10x greater than reported, except for China and S. Korea. This indicates that lack of testing is a serious shortcoming to understanding the true extent of the epidemic and reported case values should simply be ignored as not being connected with reality. All forecasts need to be connected to hard data, namely deaths.
- The incidence forecast similarly is a few to >10x greater than reported new cases for the same reason described in the above bullet.
The big question is whether social distancing and other government interventions are working outside of China and S. Korea. Depending on the fortitude of each nation to adhere to these strict measures we should see improvement. Turnover in new cases, due to social distancing, may already be occurring, but it won’t show up in the data for new cases because of the backlog of existing cases that have yet to be confirmed by tests. In fact, the term new cases is a misnomer because they more represent new detection of old cases. There are no reliable leading indicators or current measures to tell us whether we are succeeding. We must wait 2-3 weeks for the death statistics to show this of which we are about 1 week in for the U.S. and maybe a little more for Italy.
Conclusions:
- Our analysis, based on death statistics and trend analysis, provides a more realistic assessment of the scope of the COVID-19 epidemic vs. reported cases, which vastly understates the true prevalence.
- At this time, we do not yet see any evidence of de-acceleration of deaths and therefore incidence, but it may be happening, just that we are still be 1-2 weeks too soon to see this in the death statistics.
- The success achieved by China and S. Korea gives us hope that containment will ensue throughout most of the world.
Hi Jack – please put me on distribution. Thanks for doing all this analysis.
“The number of deaths in the U.S. is forecasted to exceed 1,000 over the next week and if no downtrend in the incidence of COVID-19 occurs due to social distancing and other government interventions, the death rate will double each week for another two weeks.”
We had 100+ deaths on Sunday. It looks like we will break 200 per day on Thursday (maybe Wednesday?). So doubling deaths-per-day is not taking a full week, but just 4 days. I suspect you might be undershooting the death projections. I also think the deaths-per-day will accelerate when ventilators run out for critical care (among other things), something you should see in the Italy data.
Exponential growth is evident over the next few days at least as can be seen from the plots for the U.S cumulative and growth rate. Indeed on 3/25, two days later we are at 780 up from 402 in just 2 days. So the 1,000 mark will probably be broken on 3/27 rather than my extrapolation to 3/29 or 3/30. Though aware of this continued near term exponential growth I am more concerned in trying to forecast 2-3 weeks out believe a polynomial will be a better predictor though not for the near term.