Month: December 2020

(12/27/20) Whether it is seasonal or behavioral fatigue or both, Covid-19 continues to rage on around the world. It is painfully evident that the severity of Covid-19 around the world and within the U.S. states is highly dependent on government leadership or lack thereof.

Snapshot

The tables below provide a dashboard view of per capita cumulative deaths and weekly death rates. These are indicators of total magnitude and current severity, respectively, of the epidemic in various populations ranging from local to international. To note trends I’ve added a 4^th column showing the direction and magnitude of changes in Covid-19 severity relative to the previous reporting period (one month ago).

Europe got hit again at comparable levels as in the first Spring time wave. However, aside from the UK, Europe seems to be recovering. Once again fortitude wins. The U.S. continues to compete among the deadliest countries. Perhaps this is correlated with the abysmal neglect of Covid-19 by our current Administration. It will be a dark January. Stateside please avoid AZ if you are thinking of a golf vacation. But don’t go to the Dakotas or surrounding areas either as they continue to be some of the deadliest places on the planet.

Here are the latest death rate plots for the U.S. and CA.

The main observations are:

• The U.S. is now surging to unimaginable case and death rates now exceeding the 1^st major wave. No lessons learned for this country.
• CA is exploding in all measures with current 3^rd wave death rate (shown above) so far doubling the record levels previously set during the 2^nd wave. The only consolation is that this is still below the per capita national average.
• If the seasonal model for Covid-19 holds then CA’s late Fall/Winter will eventually catch up to the rest of the country for reaching peak carnage.
• The most infectious states in the U.S. are ND, SD, NE, WI, TN, MT, IA, MN, KS, RI, IN with active cases of at least 1 per 30 people (RI, IA, NE, UT, IA) a staggering proportion.
• Around the world, the currently deadliest region is Europe. Inexplicably Brazil has noticeably dropped in death rate, but is appearing to rise again. The rest of Latin American has also turned a corner suggesting that a seasonal effect may be real.

The Local Scene

Below are hospitalization and death rate plots for Los Angeles County (LAC) and Orange County (OC).

The things to look for in these LAC and OC plots are the evident three waves (1^st wave muted for OC) and the 3^rd wave greatly exceeding the severity of the earlier waves. LAC and OC are mirroring CA in general (above). It is also evident that cases are a leading indicator followed by hospitalizations and then deaths as a lagging indicator. The case and hospitalization rates are soaring exponentially with only a hint of some deceleration in the case rate. The big take home is that the number of new cases has risen ten-fold in both LAC and OC from just two months ago! Governor Newsom was right to have invoked restrictions when he did (though I don’t fully agree with the ban on outdoor dining). In the case rate data, there does appear to be a peaking and rollover, which would be a much welcome sign, but we have yet to see the impact of Christmas and New Year’s.

Here is a sobering reality. Because new cases have risen 10-fold in two months that means that despite being just as careful with masks and distancing as you were two months ago you are still 10x as likely to get infected as before. That is why it is so important for government to mandate restrictions to nip the coronavirus in the bud.

If we assume that a new case remains infectious for 2 weeks then we can compute the prevalence of total active cases per capita. When we do this, we find that in LAC and OC, about 1 in every 60 and 70 people, respectively, have active COVID-19. CA computes to about 1 in 70 also. Now consider this. The probability of getting infected on any given day in OC is:

P_infection = P_transmission x (# contacts/70)

Let’s say on average you make some contact with 5 non-household individuals in a given day (e.g., at work, stores, etc.). If one practices safe behavior the probability of transmission is low, but not zero. If the transmission probability is reduced to just 10% per contact then at current case and contact rates that calculates to a 5% chance (10% x 5×7/70) of getting infected every week! In just 10 weeks that is a 50% chance. BE REALLY CAREFUL!

LAC is showing a classic correlation of cases to hospitalizations to death with about a 1-2 week lag between each measure. OC shows this trend for cases and hospitalizations; however, the death rate appears much lower than statistics would indicate. This can be interpreted as a much lower death rate vs. hospitalizations. We have seen this statistic behave oddly in the past. Below are the hospitalization death probability plots that I have shown in some previous posts. They are very illuminating in showing trends. Whereas LAC has shown steady probabilities in the past, there is a noticeable increase in death rates for ICU patients increasing from 6-8% to around 10% in the last few weeks. OC on the other hand has headed in the other direction where a month of greater than a 10% ICU death rate is now down to less than 5%. Some of this may be statistical and reporting flukes of some sort, but they still tell a story and not one that is obvious at this moment.

The Nation

Below are death rate plots for some representative U.S. states.

Key observations are:

• NJ and NY (not shown) have increased case and death counts; however, the surge is not as great as around most of the country perhaps because of their experience and determination to not relive the horrible 1^st wave again, or because they might have achieved some herd immunity given that 25-30% of these populations have had Covid-19 and therefore are presumed to be immune.
• AZ and TX, two states that avoided the 1^st wave, but had large 2^nd waves due mostly to government neglect are now showing a comparably intense 3^rd wave indicating continued lack of government intervention.
• CA is showing one of the worst 3^rd wave surges relative to the second wave among the more populous states. The Figure below shows that the proportion of U.S. deaths attributable to CA is growing again and is headed to the percentage of the overall U.S. population of 12%.

In my last monthly post (5 weeks ago) the U.S. death toll was about 250,000 and now it is 330,000. That is 80,000 deaths in about a month. The Covid-19 forecasting model from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington now forecasts 529,000 deaths by March 1, up from 471,000 5 weeks ago. This number drops by almost 40,000 deaths over the next two months if we implement a universal mask mandate. This is the price we Americans pay for an Administration that has totally abandoned its responsibility to protect its citizens. We are in for a tough January. Total deaths by the IHME model are forecasted to well exceed 600,000 by mid next year even with the dispensing of vaccines. This is comparable to the total U.S. deaths from the Spanish Flu of 1918-19 (675,000) as well as the total combat deaths from all American war’s going back to the Revolutionary War (666,000).

If the above is not enough to shock you, let me update my shock-a-thon table below for you. The death equivalents have increased from 8 to 15 plane crashes a day in the last month. How does this not shock people into better behavior? We are now experiencing the mortality of a Pearl Harbor or 9-11 every single day due to Covid-19.

International

The situation is dire around the world and particularly in Europe. The initially worst hit countries, e.g., Italy, Spain, France, U.K., Belgium reached similar levels of carnage in the 3^rd wave, but now appear to be getting over the hump. Of course, we may see a rebound again from the holiday season.

Some observations:

• Iran has shown a staggering decline, which is hard to explain given its poor control of the pandemic in the past. Suspicious.
• The death rate for worldwide (WW) is at about 12,000 per day. The U.S. accounts for about 25% of these deaths despite accounting for only 4% of the world’s population.
• Brazil is rising again, which runs counter to a notion of a seasonable effect since South America is moving into the summer months.