Tag: covid19-hospitalization

32. Monthly Update: The U.S. is in an Extraordinary Recovery while Most of the World Stumbles

(4/14/21) There is no doubt that vaccines work and the stepped-up effort by our Administration to achieve widespread vaccination is saving tens of thousands of lives. Unfortunately, most of the world is seriously lagging and it correlates directly to the effectiveness of their vaccination programs.

Snapshot

At each of these monthly (or longer) interludes I hope (pray) that there will be no further need for these updates given the reality of this recovery. But things are never that simple and coronavirus is very much alive in most of the world. But the trends are good.

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 4th column shows the direction and magnitude of changes in Covid-19 severity relative to the previous reporting period (6 weeks ago).

Cumulative death and death rate data for select populations around the world (as of 4/9/21).

In this short period of time CA and particularly Orange County and Los Angeles County have enormously reduced cases, hospitalizations, and deaths. OC and LAC have reduced the death rate to near zero. The U.S. has also made great strides with some exemptions, such as MI. The rest of the world, however, is stumbling along. Whereas the UK, ground zero for a new variant, has astonishingly beat (for now) their recent severe wave, other European nations, e.g., Italy, France, and Belgium are suffering through yet a new 4th wave. Brazil remains a basket case and continues as a world leader in government indifference. So, what accounts for these disparate trends? Vaccines! The UK aggressively deployed vaccinations and they did what I recommended months ago by maximizing the number of people getting first shots and delaying the second booster shot. This strategy worked incredibly well as you will see shortly in the more detailed discussion below. [An article in the NY Times yesterday, 4/13/21, recites experts who are now advocating for the single dose approach to maximize the inoculated population.] Israel is another great example of the success of aggressive vaccination.

The U.S. vaccine distribution program has progressed from total ineptness to becoming a world leader in just a couple of months. The EU was too bureaucratic to implement emergency measures and consequently late to procure vaccines and put a distribution plan in place. Perhaps Brexit was a blessing in allowing the UK to implement a rapid response plan without the bureaucratic drag of the EU.

Here are the latest death rate plots for the U.S. and CA as well as the US daily case rates.

Daily death and case rate data for the U.S. and CA. The case rate for the U.S. (middle plot) just covers the time-period for the third wave. Red line is 7-day moving average.

The U.S. and CA are on a clear downward trend with death rate down to 1/3 and 1/5 from their peaks for the U.S. and CA, respectively. U.S. case rates are also significantly down but notice there is now a clear rebound. I do not view this as very serious and in fact predicted this in my last update 6 weeks ago. This is because there are two opposing forces operating. Our country is tired of the pandemic and there is clear social relaxation everywhere in addition to the spread of new more contagious and maybe more potent virus variants. This upward pressure on cases is mitigated by an effective vaccination program to reduce the susceptible population. So, if you multiply a positive going function by a negative going function you get a function that looks like a hump. The size of that hump depends on how quickly we reduce the susceptible population by vaccination. So, I think the U.S. hump will be small. But you will see shortly that the hump will be, if not already, very big in countries where vaccine deployment is slow.

The Local Scene

In southern CA you couldn’t hope for better progress than what you see in the figures below. The rate of new cases and deaths for LAC and OC is just a few percent of its peak values just 2-3 months ago. This is not due just to social restrictions, though Gov. Newsom should get some credit here! It is also due to a high percentage of these populations becoming immune from having caught Covid-19 (perhaps 20% in OC and 33% in LAC) and even more so to effective vaccination deployment. To put this into perspective your chances of getting infected if you are not yet immune are only a few percent of what they were just a few months ago when I alerted that more than 1 in 100 people in both counties were infected and contagious at any given time. When I first heard Newsom say that June 15 will mark a full reopening, I thought this might be premature. But given the current positive trends and assuming it is more likely to get better than worse, then I agree, given there must be an easing date eventually, that this is not too reckless a date.

Cases, hospitalizations, and death rate for Los Angeles County (as of 4/9/21). Red line is 7-day moving average.
Cases, hospitalizations, and death rate for Orange County (as of 4/9/21). Red line is 7-day moving average.

A small mystery in the above plots is why hospitalizations due to Covid-19, though significantly lower than their peak, are not as close to the baseline as the case and death rates would suggest. The plot below shows hospitalization death rates for all and for intensive care unit (ICU) patients. These rates, which hovered around 2% and 6% for most of the pandemic are now decreasing. By the way, if anyone says that hospitals were not overtaxed by the most recent severe outbreak in CA just look at the hospitalization death probabilities that peaked to 20% and 15% for ICU in LAC and OC, respectively. This is because the level of care was extremely strained and that patients, other than the most severe, were turned away for lack of beds and resources. This was an especially dreadful time for hospital workers, the patients, and their families.

Hospitalization death rates. Solid lines are 2 week moving averages.

The Nation

Below are death rate plots for the same representative U.S. states we have shown before in case anyone is comparing.

Death rate plots for select U.S. states (as of 4/9/21). Red line is 7-day moving average.

Key observations are:

  • The situation around the U.S. is looking promising notwithstanding the case rebound seen in some states.
  • Some of the hardest hit states, e.g., FL, AZ, TX, that were lax on social distancing measures have recovered significantly from their peaks perhaps due to high immunity from pervasive infections in their states.
  • MI is reporting a severe new outbreak based on new case data. Oddly the death rate, though trending up, is still well below its wintertime peak. Deaths are a lagging indicator so we expect the daily rate to climb for another few weeks before recovering as vaccinations increase.

My last four monthly updates have reported the U.S. Covid-19 death 250,000 (11/20/20) to 330,000 (12/25/20) to 420,000 (1/22/21) to 510,000 deaths (2/26/21). Now 6 weeks later we stand at 560,000 with a chance we never see 600,000. However, that does not mean we should become complacent. The death rate even at 1/3 of its peak is still at about 1,000 deaths per day, which looks very grim when compared to historically huge tragedies in our nation’s past.

International

The world is mostly in recovery but with some disturbing hot spots. Death rate plots are presented below for selected countries that we have been following before.

Death rate plots for select countries and for worldwide (as of 4/9/21). Red line is 7-day moving average.

Key observations:

  • The EU has struggled to implement an effective vaccination program, which is evident in the slow recovery from the 3rd pandemic wave that peaked in Dec-Feb. and is now leading to a 4th wave spurred mostly by new virus variants and fatigue in continuing with lock downs. In terms of death rate Italy is suffering the worst of the rebounds followed by France, Belgium, and Spain (above plots and further above tables). However, looking at new case rates in the figure below one sees that per capita the order starting with the worst is France, Italy and Spain.
  • The UK being ground zero had one of the worst recent outbreaks in the world. However, unlike some its previous tepid responses, this time they put in herculean effort to combat the outbreak. Perhaps one of the most judicious decisions was to deviate from the prescribed vaccination protocol of giving individuals two shots and instead decided to spread single shots to the maximum number of people. As you can see from the plot above the UK smothered an out-of-control outbreak in just two months. Perhaps Brexit deserves some credit by freeing the UK from the series of missteps by the EU commission in vaccination planning that now plagues the rest of Europe.
  • One has to sympathize with Brazilians for being victims of a government that sneers at Covid-19 and makes little attempt to protect their citizens. They are by far suffering the greatest death rate of any country in the world and now exceed the records set by the U.S. This neglect is compounded by having entered the Fall season, typically an accelerator of flu transmission. They are destined to reach herd immunity by having the great majority of their population catch Covid-19.
  • We have focused on our perennial countries as I don’t have the time to delve into other countries. However, it is worth noting that India is now accounting for much of the uptick in worldwide cases. Also, the total reported deaths in Russian are very short of the number obtained by looking at the increase in total deaths relative to the same time period in prior years.
New cases per week per 100,000 inhabitants in Europe (as of 4/13/21). Data from Statista and Johns Hopkins University.

27. Monthly Update: Europe Raging Again and the U.S. Not Far Behind. California Relatively Mild but Escalation Looming.

(11/23/20) Covid-19 continues its seasonable acceleration reaching exponential growth much like its first wave in March. The U.S. is showing a bimodal pandemic where states with least restrictions have uncontrollable outbreaks and those with most restrictions are far milder. Sadly, this bimodality correlates with gubernatorial politics.

Snapshot

Here again is a dashboard view of Tables of per capita cumulative deaths and weekly death rates as indicators of total magnitude and current severity, respectively, for the Covid-19 epidemic in various populations locally and internationally. The death rates of Belgium, Italy, France and the U.K have jumped at least four-fold since our last update just a month ago. The U.S. and Spain have more than doubled. Domestically, MI has more than tripled and TX and AZ have about doubled in the last month. Later we show that these are not the worst states by far. Stateside LA death rate is up 50%, but OC and CA have declined over the last month. But ….

Cumulative death and death rate data for select populations around the world (as of 11/20/20).

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

Daily death rate data for the U.S. and CA.

The main observations are:

  • The U.S. is surging and showing exponential growth again, frighteningly similar to the original outbreak that started in March.
  • Also frightening is that Europe is about a factor of 2 worse than the U.S.
  • CA for all the fear and loathing and new restrictions imposed is far better than most states in the U.S. However, this is not time for complacency as cases and hospitalizations are swelling again and we are probably only lagging the seasonal surge due to warmer weather.
  • The deadliest states in the U.S. are ND, SD, WY, NE, WI, MN, IA, MN, KS, IN all with greater than 50 weekly deaths per M population, which is more than the states listed above and comparable to Europe (more coverage below).
  • Around the world, the currently deadliest region is Europe. Inexplicably Brazil has noticeably dropped in death rate. The rest of Latin American has also turned a corner suggesting that a seasonal effect is real.

The Local Scene

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

Cases, hospitalization and death rate plots for Los Angeles County (LAC).
Cases, hospitalizations and death rate for Orange County (OC).

These are good examples of what are leading vs. lagging indicators. As you know, I have not been a fan of case statistics because in the early days they were vastly understated because of the lack of testing. Testing may still be at inadequate levels but at least they are administered fairly stably so I expect the relative trends to be informative. In the pecking order then, case incidences are leading indicators followed by hospitalizations and then deaths. These trends are clearly seen in the plots for both LAC and OC. Cases are soaring exponentially, which is horrifying if not reversed immediately. This rise is starting to show in the hospitalization rates also increasing exponentially and now we are seeing the first hint of the death rate increasing commensurately. Where this goes is hard to predict. However, Governor Newsom is right to invoke restrictions now rather than wait a couple of weeks when it might be too late to reverse the trend.

At least the trends are now making sense. For nearly two months, as we discussed in previous postings, the statistics for OC were bizarre where hospitalizations were declining but death rates were staying high and even surging. We posed some postulates, but I now think it was due to reporting anomalies whereby death reporting was playing catchup and the surges were not real but just clustering of data. Evidence of a return to normal reporting is that the percentage of hospitalizations that lead to death has come back down to about 2% for all hospitalized patients and about 6-8% for ICU patients and this percentage applies to LAC as well.

Death rate vs. hospitalizations for LAC and OC

I finally mention that I now commend people in OC who months ago were resistant to wearing masks but are now nearly all wearing masks around town and in places of business. Keep it up!

The Nation

The death toll in the U.S. now stands at greater than 250,000. Arguably the most widely accepted Covid-19 forecasting model is that from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington (https://covid19.healthdata.org/united-states-of-america?view=daily-deaths&tab=trend). (Recall in the early days that my forecasting model was shown to be somewhat superior to this one, but over time a team of 10 beats my part-time efforts). IHME forecasts that by March 1 the total U.S. death count will be 471,000 based on current government mandates for social interventions. If only mask mandates were universally implemented that number goes down to 406,000. That is 65,000 future deaths could be avoided by governments and people rising above politics and selfishness and just mandating masks!

Below is a death equivalent Table that if it does not shock people to reason then probably nothing will. This shows that the current daily Covid-19 death rate is equivalent to 8 plane crashes a day. Can you imagine if there really were 8 plane crashes a day? No one would ever fly on a plane! So why are we so cavalier and careless about Covid-19? Humans can be very irrational. Just to punctuate the atrocity of this pandemic, the daily death rate is equivalent to a Pearl Harbor every day and a half and a 9-11 about every two days.

So, above I showed the benchmark states that I use to get a snapshot of how the states are doing. Well in fact now none of them are in the top 12 hottest states. Those are listed below along with CA for comparison. And in case you are fuzzy on where in the country they are, just look at the map below and figure out which two states are not on the top 12 table (CO and MO are 14 and 17)! In fact, a new infection happens faster than you can say Sturgis Dakota Motorcycle Rally! That’s right that hedonistic, selfish event is responsible for 260,000 Covid-19 infections (as of 9/9/20) and counting (https://khn.org/morning-breakout/sturgis-biker-rally-linked-to-260000-covid-cases/). These 12 states account for 39,000 Covid-19 deaths. If we reasonably attribute half of these to the Sturgis rally then it begs the question: is a Covid-19 death a fair trade for every 20 bikers enjoying a week of drunken debauchery? Here’s another one for you. News articles in the NY Times and LA Times reported on a Stanford study that stated that 18 Trump campaign “events are connected to 30,000 infections and 700 COVID-19 deaths …”

In case you didn’t notice the Dakota’s are experiencing over 140 weekly deaths per million population. This is the highest death rate in the world. By comparison the worldwide average is 9 and CA is at 11 (more than 10x less deadly per capita). Yet South Dakota Gov. Kristi Noem reiterated in a tweet last week, “We already know that lockdowns DON’T stop the spread of the virus.” So, no mask mandates, no nothing, just 150 more caskets every week in a population less than a million.

If this all sounds too outrageous to ignore, then I can no longer maintain my moratorium on political commentary because this carnage is due to the Administrations pressure on states of certain political persuasions to turn a blind eye. The NY Times identified groups of states corresponding to control measures that were tightest, intermediate, and fewest (https://www.nytimes.com/interactive/2020/11/18/us/covid-state-restrictions.html?campaign_id=154&emc=edit_cb_20201120&instance_id=24284&nl=coronavirus-briefing&regi_id=119519801&segment_id=44995&te=1&user_id=946571b79386ac1020594361ac6960b3). The Table below stratifies these groups in terms of the governor’s political affiliation. Only 7.6% of Republication governments have implemented tightest controls (vs. 33% Dems) and only 8.3% of Democratic governments have implemented fewest controls (vs. 62% for Reps!).

The NY Times also plotted these states for number of cases and deaths vs. degree of control measures and to no surprise it follows a diagonal line with fewest controls corresponding to greatest Covid-19 outbreaks and tightest controls to least. Since I am on a good rage now, I assert that these politicians (starting at the top) are treating American lives as pawns for their own self interests. This makes their actions or lack of them more hideous than the most vicious mass murderers in history. Why do we Americans allow this to happen!

International

The situation is dire around the world and particularly in Europe. After taking Herculean measures to curb the pandemic when it first hit exponential growth in March and astoundingly knocking it down it is sad to see this recur on a population that is utterly fatigued by Covid-19. I won’t provide the commentary above because I am less familiar with government interventions overseas other than to note that it is taken far more seriously there than here. The Figures below highlight some of these countries.

Death rate plots for select countries and for worldwide.

Some main observations include:

  • France, Italy and Belgium in less than a month have accelerated to nearly their previous death rate levels.
  • Sweden has renounced its previous lax strategy and is implementing strong social intervention.
  • Brazil has actually declined, no thanks to President Bolsonaro. This means either that Brazil is reaching herd immunity or a seasonal effect is making the virus less infectious, probably a combination of both.

24. Biweekly Update: Is California Really Improving and What’s Up with Spain?

(9/8/20) California hospitalizations are on a steep decline so why isn’t the death rate following? Spain is getting a case of U.S.-itis with government neglect fueling another outbreak.

Snapshot

Whereas I thought I was lapsing into monthly updates, I find myself back after two weeks and living up to the Biweekly label. Covid-19 is still very dynamic with population changes occurring daily. I will continue to lead with per capita data for cumulative deaths and weekly death rate as an indicator of total magnitude and current severity of the epidemic in various populations ranging from local to international. In this snapshot one can see that the current per capita death rate places the U.S. second worst in the world behind Brazil though a number of Latin American countries are nipping at the bud.

The main observations are:

  • The benchmark worst in the world is Brazil and is exceeded by at least 3 U.S. states; even more disturbing is that Orange Country CA is suffering a similar death rate.
  • The U.S. is on track to exceed all major countries except Brazil as the deadliest nation for Covid-19.
  • It is easy to get desensitized to the magnitude of Covid-19 deaths in the U.S., however at recent rates of about 1,000 deaths a day, this is comparable to 5 airplane crashes a day or two 9-11’s every week. And to think it was 2-3x worse back in April.
  • The good news is that the recent U.S. outbreak states appear to have reached a death rate peak.  But hitting a peak means the downward trek will account for at least as many deaths as the way up.

Because I like to show death rate plots (no I am not morbid) here is the latest data for the U.S. and CA.

Daily death rate data for the U.S. and CA.

The Figure below shows the percent of all U.S. deaths that occurred in California. CA was once the model state, but the resurgence over June-August has now placed it on-par for the U.S. with a steady 12-13% of the deaths with about 12% of the population.

Relative daily deaths in CA as a percentage of the U.S.

The Local Scene

The last update (23. Biweekly Update – The U.S. has Given Up) gave a lot of hospitalization and death rate plots and these are still worth reading about. Below we show total hospitalization (which closely mirror ICU, which is about 1/3 of all Covid-19 patients) and death rate. There is an alarming disparity developing. Over a month ago on 8/3/20 (in Daily Rumblings – II) we first reported an incongruity in the hospitalization and death rate data such that the predicted decline in death rate following a 1-2 week lag from hospitalizations was not yet evident. We postulated that the lag might be longer and would manifest itself shortly. One month later that has not happened as you can see from these plots for LA and OC.

Hospitalizations and death rate for Los Angeles.
Hospitalizations and death rate for Orange County.

One can only surmise for what accounts for this contradiction. A possible explanation that I’ve voiced before is that patients may be getting released from hospitals earlier than usual thereby reducing the steady-state level of hospitalizations. Once again, the only true measure of the magnitude of an epidemic is death rate as that is hard to misreport. Cases are susceptible to inadequate testing and now hospitalizations may be susceptible to some new bias. The following Figure plots hospitalization mortality rate of all patients and ICU patients in LA and OC. It is clear that in just one month this percentage has increased alarmingly ranging from 56-92%. This is a mystery that has not to my knowledge been recognized let alone explained. I’ll be digging more into this for sure.

Mortality rate for hospitalizations in LA and OC.

The Nation

I lament when every two weeks I see that the Covid-19 situation is not improving. However, this time there is a reassuring reduction in death rate over the last few weeks and that bodes well for a recovery. Still the biggest hot spots in the nation of the more populous states haven’t changed in the last two weeks and continue to be FL, TX, AZ, GA, NC and CA bringing up the rear, but again almost all states are reporting declining death rates. The death rate plots were given in the last update on Aug 22, 2020 (23. Biweekly Update: The U.S. Has Given Update). The U.S. plot is given above.

Nice not to have to chastise too much this time.

International

Similar to the update for the U.S. states not much has changed internationally though there may be signs of a downward trend for the worst of the nations, e.g., Brazil and the U.S. The biggest hot spots in the world for the more populous countries in approximate order are still Brazil, U.S., Mexico, Peru, South Africa, Columbia, Iran, and Argentina. Russia and other countries may be under-reporting. Please refer to the daily death rates in the last update (Post 23.) to observe plots for early hotspots that recovered (Italy, Spain, France, U.K.) and countries that are having rebounds or first-time outbreaks (U.S., Brazil, Iran, and worldwide).

The Tale of Spain: We were more prescient than expected in sounding an early warning on Spain. I made the following comment (Post 23.) on 8/22/20:

“Spain has abdicated federal response and given control to regional governments, which could bite back.”

Shades of the U.S. lack of strategy, which is distressing since Spain worked so hard to snuff the virus out. Below is the death rate plot for Spain next to that for Worldwide. Spain is going through another outbreak with deaths approaching an average of 100 per day. Again, a warning about premature easing and abandoning leadership. From the WW plot it is evident that thevirus is still raging in many new hot spots around the world.

Death rate plot for (L) Spain showing a new outbreak and (R) Worldwide.

16. Can Orange County, CA Begin Opening this Week?

(5/13/20) I am grateful to have been invited to write a feature on COVID-19 in California and Orange County (OC) in the Orange County Business Journal for the prestigious back page OC Leader Board. There is a lot going on in OC and like everywhere strong sentiment to begin easing social restrictions. Gov. Gavin Newsom is implementing plans to relax restriction, but contingent on meeting certain metrics regarding rates of decreases of active cases and minimum testing requirements. Nearly all counties do not meet them yet, but of course we are seeing open rebellion, Tesla being the most covered example.

California has been doing very well compared to other states in the union and OC better than most CA counties. However, the numbers, e.g., death rate, cases, and most particularly hospitalization rates are not declining as expected and this vulnerable population is still prone to a major outbreak, particularly as LA is reaching epidemic proportions. Rather than repeat what I have written, please check out the article. Here is the article and a link to download: