Month: January 2021

(1/25/21) Vaccination is our only hope as Americans have surrendered to Covid-19. However, we cannot expect more than 10% of the population to get inoculated per month meaning we have several more months to worry about.

Snapshot

The Tables below give a dashboard view of per capita cumulative deaths and weekly death rates as indicators of total magnitude and current severity, respectively, of the epidemic in various populations ranging from local to international. The 4^th column shows the direction and magnitude of changes in Covid-19 severity relative to the previous (one month ago) reporting period.

There are no bright spots to speak of. There is some improvement in Europe (Belgium, Italy), but the U.K. is accelerating due to the new more infectious virus strain. The U.S. continues to get worse, but the death rate is starting to flatten, though not for AZ or CA, which remain very deadly by any measure. CA may finally be peaking and rolling over (data below); we can only hope. Just today Governor Newsom lifted the stay-at-home orders restoring the previous color-tiered local-risk system perhaps prematurely like last time.

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

Before covering the globe next, it is important to note that society needs to fight this virus, not just to reduce deaths now, but because the faster it spreads, the faster it mutates. We need to slow down these new more virulent strains or risk undermining the effectiveness of these new vaccines.

The Local Scene

I wrote just last week about CA and particularly Los Angeles County (LAC) and Orange County (OC). Below are updated plots.

The bad news is that the third wave of the epidemic is about 5x worse than the previous ones. The encouraging news is it looks like CA has hit its peak and is now declining in case counts. You can also see that hospitalizations are now declining, and we should then expect to see soon a corresponding decrease in the death rate. It is hard to say how far this trend will progress, but epidemic waves for some reason usually recover to a fraction of their peak. But as we have seen twice before, they can reoccur quickly and intensely. Governor Newsom’s stay-at-home order has indisputably helped reverse the third wave, but his announcement today to restore the previous local-risk rating may be premature.

An argument against complacency is that CA now accounts for about 17% of all U.S. deaths despite comprising 12% of the population. That figure was 4% just two months ago, so we have gone through a wicked third wave.

The Nation

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

Key observations are:

• AZ is now the nation’s most infectious and deadly state, no surprise given the government’s defiant refusal to implement even the most basic safeguards. So, people are paying with their lives for this foolish political grandstanding.
• TX, another Covid-19 defiant state, is flaring up and will soon join AZ in the ranks of uncontrollable outbreaks.
• MI is one of the few (larger) states in the U.S. that has actually reduced cases and deaths over the last month.

My monthly updates have reported the cumulative U.S. Covid-19 deaths, which have gone from 250,000 (11/20/20) to 330,000 (12/25/20) and now to almost 420,000 deaths (1/22/21). The Covid-19 forecasting model from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington now forecasts 517,000 deaths by March 1.

Next, we update the grim statistics representing number of deaths in terms that we can all relate to. The death equivalents have increased to 19 plane crashes a day. We are now experiencing the mortality of a Pearl Harbor or 9-11 more than once a day. Stop and think about that!

International

The situation is still dire around the world with the worldwide death rate continuing to increase. The initially worst hit European countries, e.g., Italy, Spain, France, U.K., Belgium reached similar levels of carnage in the 3^rd wave. But most now appear on the downside of the peak, with the glaring exception of the U.K. who is battling the new more infectious variant of SARS-CoV-2.

Other observations:

• The death rate for worldwide (WW) has increased from 12,000 to 16,000 per day in just the last month. The U.S. accounts for about 20% of these deaths despite having a population of about 4% that of the entire world.
• Brazil is rising again, which runs counter to a notion of a seasonable effect since South America is now into the summer months.
• Iran has shown a staggering decline, which is hard to explain given its poor control of the pandemic in the past, which raises doubt about the accuracy of their current reporting.

(1/18/21) CA and particularly Los Angeles County are exploding exponentially and are now among the hottest spots in the world for Covid-19. Orange County is not far behind.

It feels so long ago when COVID-19 first broke out. When I first started this blog in mid-March 2020 Europe was just beginning to go through what became an unimaginable outbreak only to be exceeded by the carnage in the northeastern United States. California and particularly Orange County were relatively spared the initial wave of the pandemic. At that time New York City had experienced 1,985 deaths per million people (about 1 in 500) while CA was at 51 and OC at 16. No one thought it could ever again be as bad as it was for those deadly hot spots. Wrong. Today we focus less on total deaths (that is the past) and instead on death rate, which has now grown to 161 per million people in Los Angeles County and 88 per million people in OC per week! By comparison, CA is at 94 and the US is at 70, so all of CA is above the US death rate, which is only exceeded for major countries worldwide by the U.K. (110 deaths per million per week). So, CA including OC are now among the deadliest spots in the world and LAC is off the charts! Not sure I can put enough exclamation points on that statement.

So, I will give the local statistics and provide commentary below. But first I need to get on my soapbox. Let me start by saying that, although I am a staunch supporter of social restrictions, I do not agree with all the government health advisories. The problem is we are told what we can’t do rather than what we can do. But let me also say that we need to stop being deniers. That behavior is foolish, selfish, and will kill you. Before COVID-19 I used to counsel people to take care of their health and get checked out whenever any health issue small, but unusual occurs. I have known many intelligent people who were too busy to heed the warning signs only to find out too late that they have a terminal disease. That is a wrenching way to die knowing that it was avoidable. I call those stupid deaths. Don’t die stupid! Well, that is happening now at inconceivable frequency. You’ve heard of people saying on their death bed that they wished they took COVID-19 more seriously. Even worse are the young people who now account for a large percentage of elderly deaths and have to live with the guilt for the rest of their lives of having caused the death of a family member. Don’t let that happen!

Well yes, this column so far is a real downer, but the point is to try to save lives. Fortunately, it is not that hard. There are two ways to reduce the virus transmission by over 80%, taking the vaccine and wearing a mask. What can we do now? Wear a mask! Don’t be stupid. So, what about social isolation? Anyone who drives down PCH on any given day knows that people are not going to stay home and hibernate. So, if you have to go out then take basic precautions. Wear a mask, keep reasonable distance, always keep a hand sanitizer with you, …. and enjoy the outdoors! There are a lot of fun things you can do safely. Just don’t be stupid!

OK, so how bad are things? The Figures below show the infection (case) rate, total hospitalizations, and death rate for LAC and OC.

The first thing you notice is wholly cow, that looks really bad right now. Yes, it is! Here are some other key observations:

• One can see the three waves of the epidemic.
• OC and to a lesser extent LAC avoided the first wave of the epidemic that viciously hit Europe and the northeast US from March through May. We can thank Governor Gavin Newsom for rapidly implementing social distancing mandates.
• The second wave hit both LAC and OC in July and August as social restrictions were perhaps lifted too soon.
• The second wave diminished to relative tranquility in September and October, but then burst into an intense third wave starting in December with case rates, hospitalizations and death rates currently about 10 times greater than 2 months ago.

If you look closely at the third wave you’ll notice that cases rise first, then hospitalizations, and then deaths. Maybe encouragingly we are seeing a peak and rollover in cases and hospitalizations and hopefully that will translate into a similar rollover in the death rate in the next couple of weeks.

The main takeaway is that infections in LAC and OC are 10 times greater than they were just 2 months ago. There is currently an infected and contagious person for every 50 people in LAC and 70 people in OC. That is a lot of exposure. That means no matter how safe you continue to be you are still 10 times as likely to catch COVID-19 as you were 2 months ago. It is that bad out there!

The percentage of hospitalized COVID-19 patients who die tells a gloomy story. The Figure below shows this percent for total and ICU COVID-19 hospitalizations for two 4-week periods. In less than 2 months the death rate in LAC has about doubled for all hospitalized patients and those in ICU, the latter reaching a staggering 60%. I should caution that this type of data is not reported, but I calculated it based on hospitalization and death rates and an assumption for average days in the hospital. So, the absolute number is uncertain but the trend can be trusted. One can only surmise that the reason for this increase in mortality is due to a patient load that has so overwhelmed the medical staff that the level of care has either deteriorated or hospitals are having to turn away the less ill or both. Don’t let anyone tell you that the jarring reports of besieged hospitals is a media exaggeration!

So, what now and will vaccines save us? Yes, but…. We have all been reading how slow vaccine deployment has been. This will improve, but at best no more than 10% of the population will get vaccinated each month. We need to get to over 50% vaccination to add to about 10% of those who have already caught COVID-19 and are now immunized. That will still not get us to herd immunity, but it will slow down the epidemic enough to help restore some semblance of normal life. I am not making any predictions when we will return to full normalcy because society will always find a way to prolong the problem.