20. What’s Going on in California?

(6/14/20) CA continues to be a bad performer relative to the rest of the country in terms of reducing infection and death rates. However, is it really that bad? Here are some arguments that it is not.

There is little question that the epidemic is growing in CA and Orange County (OC) is becoming a prime villain. Anyone who lives here knows that people are going out and being less cautious. My favorite statistic is deaths, but as said before that is a lagging indicator by about 2.5 weeks from infection. A less lagging indicator are hospitalizations and I am starting to follow that more since they are real data. The press seems to have also latched onto that statistic. Cases are still reported, but that continues to be a misleading indicator because of persistent under-testing. The unreliability of case data is evident in the hospitalization data and also a source of misleading reporting of the latter. The plots below are hospitalization data for Los Angeles broken down by totals and ICU and also positive (confirmed) and suspected COVID-19 patients. This creates four plots and the sum of confirmed and suspected bumps it up to six plots:

There are many things to observe here:

  • In April you can see that positive hospitalizations were rising dramatically and there was a lot of alarmist reporting about that. However, if you look at suspected hospitalizations you see a similarly dramatic fall. Well this is what happens when increased testing starts to move patients from the suspected to the positive category. So, you need to take the sum of these two numbers. The CA health sites that report these statistics don’t do that for you. I do.
  • The published data only starts on 4/1/20, but you can be sure there was a huge rise in March and that you are now seeing a leveling off and even a lowering of hospitalizations for LA. I’m not sure why this is dropping because you will see shortly that the death rate is not dropping.

Now let’s look at the same data for OC:

Key observations are:

  • There is the same trend in April for rising positive hospitalizations, but when you sum that with suspected patients you find there was actually a period of decline. Wishful thinking!
  • That period of decline reversed and is now climbing fairly significantly, particularly for the ICU. In this case the hospitalization rises are mirroring the rise in death rate in OC as you’ll see next.

So here are plots of the daily death rates for LA and OC and for all of CA:

Data are smoothed by a 7-day average to remove the large daily fluctuations.

The key observations are:

  • You can see a multitude of waves certainly for OC, but for all of CA. It looked like CA was peaking around April 20, which is consistent with social distancing. But things relaxed and a 2nd and 3rd wave developed possibly due to the phased easing of social restrictions, but may also be skewed by clumping of data from elderly care facilities, which account for about half of all deaths in CA and OC.
  • LA accounts for at least 50% of CA deaths and OC started out negligible, but now is at about 10% of CA deaths, more in line with having 8% of the state’s population.
  • LA hospitalizations are declining slightly and the death rate is stable so they somewhat track. OC hospitalizations are increasing and so is the death rate, so they are tracking too.

So, all doesn’t look good in CA and the worry is the cavalier attitude of us sun-baked pleasure seekers. However, let’s put this in perspective compared to other states (albeit past and current hot-spots). The plots below are for death rate per week (current and at its maximum) and cumulative deaths (current and forecasted total) per capita.

Now you see that CA is not heading toward doom (yet). Everything is relative. NY and NJ have made exceptional progress in reducing their death rate, but per capita they are still greater than in CA. NY hit a peak of 450 deaths/week per million people, whereas in CA that number is 14 (so far). So, the conclusion to draw here is decide for yourself whether it is safe to socially ease in CA. My belief is it is possible to start socializing more, but always wear a mask when near people and wash your hands often. And always abide by the rules of the establishment you’re in.