16 ms·

State projections for Covid-19

254 points by jamest 7y ago

alexandercrohde 7y ago
I guess the operative detail is whether shelter-in-place will get us to a "23%" total infection rate vs 70%. I wonder if that's accurate. I also wonder if this is recurring in the fall, and every year, and whether physical distancing will be mandatory every year?
- OJFord 7y ago
  How many recurrent seasons would it take for countries/society to adapt and cope (whether that's hugely more full-time remote workers, or blanket acceptability of it part-time/during such occasions, or something else) I wonder?
  - maxwhenderson 7y ago
    Hey - admin of covidactnow here. I don't think anyone has any idea if this will recur, mutate, etc. The key is to buy time, now. To add hospital capacity, develop therapeutics and vaccines, and learn more about the disease...
  - ars 7y ago
    Just one I think. People are already coping, and it's barely started. If people knew a 3 month shelter-in-place was a yearly rule, we could plan for it.
    - umanwizard 7y ago
      People with either cushy office jobs or enough savings to be long-term unemployed are coping. The millions of service industry employees either aren’t, or soon won’t be.
      - ars 7y ago
        I would assume there would be changes to how unemployment works if this was a regular thing.
        int_19h 7y ago
        The problem is that those changes are highly politicized, because they hit a bunch of culture war buttons about "socialism". And it's been a while since American legislators have considered the possibility of torches and pitchforks, so they still prioritize their electability (especially in the primaries, where ideological purism is more important) over social necessity.
  - smacktoward 7y ago
    If you expect it to spread at the rate this thing spreads, after a couple of years nearly everyone will have been exposed to it and thus have developed an immunity (or died). From then on it mostly becomes a childhood disease, like measles. The goal thus becomes to spread out the exposures enough so that people who need medical help to survive their exposure can reliably get it. Of course the above assumes that immunity really does develop after one exposure, and that the virus doesn't mutate into some sufficiently different form to reset the immunity counter to zero again. The evidence seems to indicate positive things on the immunity front, but it's still preliminary. And as for mutation, who can say?
frenchyatwork 7y ago
Site is broken for me. The url https://covidactnow.org/data/wa.7.json https://covidactnow.org/data/wa.7.json is returning an HTML document with the text "You need to enable JavaScript to run this app." and there's a JSON.parse error in the console.
- jamest 7y ago
  thanks for this, looking now
  - maxwhenderson 7y ago
    sorry about this! Hopefully fixed shortly.
  - jamest 7y ago
    fixed
  - maxwhenderson 7y ago
    Fixed!
- hermitdev 7y ago
  Washington wasn't working for me, either. Just a blank page. And I do have javascript enabled. Other states work fine, like Illinois.
deleted 7y ago
[deleted]
taeric 7y ago
I still feel there is compelling evidence that lung damage from things such as exposure to local pollution is a big driver in serious cases. I say this as someone that thinks they had it a month ago. I was on steroids for a week, then a respirator, then steroids for another week. Worst asthma attack of my adult life. I live in Seattle... (And yes, i had fevers) I did not get tested, but having a hard time shaking that I had it. And if I did, so has my family. With my kids all having fevers, but no shortness of breath. Edit: I hasten to add that I am socializing this as a call for what am I missing? I am not encouraging inaction.
- jrs235 7y ago
  So, if a lot of people have already had it, which I see a lot of people thinking they did, we need to find out if you can get reinfected.
  - yardstick 7y ago
    Yeah this point has been bugging me for a while now. What’s the reinfection rate / immunity rate? I know there are some reinfections but does that mean everyone can be reinfected or is it just a fraction that don’t gain immunity?
    - aivosha 7y ago
      lots of “reinfections” were debunked as false positives. search on r/COVID19 for details.
      - SpicyLemonZest 7y ago
        And it should be emphasized that 100% of reported reinfections were just news reports saying "hey this person tested positive after testing negative" - there was never tremendously strong evidence for it.
  - taeric 7y ago
    There is also the question of why is it so severe in places? And could it get that severe elsewhere? Studies of SARS showed that regions with high pollution were significantly more at risk for death from it. If that is the case for this, the severity expected in many parts of the world will be considerably lower than projected. Again, stay home. I am not encouraging breaking self distancing. The panic message is worrying me because everyone seems to only be looking for reasons to panic.
cwzwarich 7y ago
This site openly admits the obvious flaws in their model: - R0s for interventions are guesses, in some cases informed by data. There is no historical precedent for what is going on right now to draw from. - The default R0 used in this model is an average. The model does not adjust for the population density, culturally-determined interaction frequency and closeness, humidity, temperature, etc in calculating R0. - This is not a node-based analysis, and thus assumes everyone spreads the disease at the same rate. In practice, there are some folks who are “super-spreaders,” and others who are almost isolated. Interventions should be targeted primarily at those most likely to spread the disease. Are there any epidemiologists using less naive statistical models who are producing easily readable results like this? The "average R0" logistic function model seems better suited for examining historical epidemics than estimating risk to inform decision-making for ongoing epidemics.
- aivosha 7y ago
  this
- termain 7y ago
  That's generally what you should do with a scientific model: state your assumptions and methodology clearly. And most if not all scientific and engineering models spread properties across a group of objects and use averages. R_0 is an average. And it's the average behavior that matters here In a well tested population, you might be able to focus interventions on infected people and their contacts. In the US population, the people most likely to spread the disease are those who interact most with other people. That means getting those people to reduce their interaction rate. It's a semi-empirical model, as are many if not most models used to make decisions.
- AndrewStephens 7y ago
  I agree. The graphs are very pretty but would look very different if the R0 was even slightly modified. The mortality rates probably varies widely by state demographics as well. That said, the implication that strict isolation should be maintained is almost certainly correct.
  - 7y ago
Leary 7y ago
So according to these models, we should be Wuhan-ing our states?
- ars 7y ago
  You don't need these models to tell you that. It's self evident that if you keep people from contacting each other you can stop things. It's just not so clear it's possible to do such a lockdown in non-Authoritarian, free, countries.
  - jfkebwjsbx 7y ago
    It is possible and in fact it has happened already in a lot of European states.
    - int_19h 7y ago
      Enacting a lockdown is possible, but having the populace respect it - or enforce it otherwise - is another matter. Besides, the worst lockdowns have only just begun recently. There are a lot of people who will go ahead with, say, a 2-week lockdown, but will balk at 3 months. The true test for the ability to maintain things that way is still ahead for Western countries.
    - Rapzid 7y ago
      It's happening in a lot of United States!
- yumraj 7y ago
  Well I still have a fundamental question, what happens when China, or anyplace else, un-Wuhan's? They seem to be opening stores, starting flights to SFO, but surely China is not clear of the virus. So, are we expecting a pick up in infections now. And, if not, please explain why not.. I'm really curious..
  - joshfraser 7y ago
    They're starting to open up now. It works fine as long as you have broad testing & can identify everyone who has been exposed to it. Exponential curves are easy to stop as long as you catch them early.
tunesmith 7y ago
It appears this assumes a doubling rate of 3-4 days? That's pretty pessimistic compared to what the science-heads are saying, right? I've heard 5-6 days, 6.2 from another source. EDIT: I'm talking about the doubling rate of the actual cases, not the confirmed cases.
- Retric 7y ago
  The US has averaged over 30% daily increases in infections for the last 20 days. 1.3 x 1.3 x 1.3 = 2.2x growth every 3 days making that 4 day doubling optimistic. https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_the_United_States https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t... New infections are modeled to noticeably slow down once ~1/5 of the total population is infected, but at that point things have already fallen apart.
  - gpm 7y ago
    The US has also been ramping up testing, assuming number of infections is a linear function of known cases is a mistake.
    - Retric 7y ago
      We are not doing 16,000 / 42 = 380x more tests per day on March 20th vs March 1st. It’s not even obvious if we are overlooking a larger fraction of infections today than back then. Also of note that 30% daily increase I spoke of underestimates the difference between March 1 and March 20th.
- joshfraser 7y ago
  It's doubling even faster right now, but that may be more related to increased testing than anything. Unfortunately, the US is further along the curve than all these sites are showing due to the fact that we didn't have any testing in the beginning (and still don't have enough).
- stevenwoo 7y ago
  New York City doubled in one day - yesterday simply by having the capacity to do more tests.
djzidon 7y ago
would like to be able to look at a whole country projection, if possible
- jwally 7y ago
  Not sure how much effort you want to put into it, but the raw data is in JSON files on the site under the following pattern: https://covidactnow.org/data/{{state_abbreviation} https://covidactnow.org/data/{{state_abbreviation}}.{{scenario_number}}.json (where scenarios go from 0 - 7)
  - djzidon 7y ago
    very cool, thank you
LargeWu 7y ago
So, this projects 3-months out. But what about after that? The graph for my state (MN) showed 3 months of sheltering in place would keep infections down, but then start to rise immediately afterwards. Then the graph ends. I think super-extended voluntary isolation is going to be a tough sell.
- maxwhenderson 7y ago
  Hey guys - owner of the model in question here. Yes, that's exactly right, but 3 months (or even 1 month) may be enough time to prevent unnecessary deaths by preparing hospitals, getting more ventilators, rolling out testing, and hopefully finding a therapeutic drug (vaccines are probably farther off). Nobody can predict the future, though.
  - LargeWu 7y ago
    I sure hope so. Thanks for your effort educating people.
  - int_19h 7y ago
    3 months is definitely not enough to grow the hospital and ICU capacity 7x, which is what's necessary to prevent deaths due to lack of healthcare availability. It'll improve some, and that will save some lives, but not most of them. Pervasive testing looks like the best short-term hope right now - it's easier to drastically ramp up test manufacturing, and you don't need a full-fledged hospital for mass testing.
Merrill 7y ago
Sheltering in place would be less necessary if everyone would stay at least 2 meters apart, wear masks, wear gloves, not talk unnecessarily or cough/sneeze at anyone, and wash up with soap when they get home. Some people seem unable to stay away and feel compelled to get in your face and talk.
olalonde 7y ago
Stupid question: why do all the curves go down way before reaching a large percentage of the population? For example, California's curve peaks at ~900,000, only 2% of its population (and only a bit more if you consider cumulative hospitalizations). I guess 2% is not enough for herd immunity to kick in so what is it? Edit: Oops, brain fart. Those numbers don't include all cases, just hospitalized ones.
- dak1 7y ago
  Those are hospitalizations, not infections.
- maxerickson 7y ago
  The graphs are the number of cases requiring hospital care.
chipotle_coyote 7y ago
Naive question: in the states I looked at, the "California-style shelter-in-place" line consistently goes up again toward the right side of the graph (end of June to July), whereas none of the other approaches have that second lift. Why is that?
- salmon30salmon 7y ago
  Because the first wave is enough to develop herd immunity and reduce the R-rate of the virus
  - LargeWu 7y ago
    The second lift would suggest that isn't true.
  - chipotle_coyote 7y ago
    But the second lift suggests the model is showing the R-rate going up after a drop, which is what I'm asking about. The other curves -- which presumably also involve herd immunity to some degree -- are pretty much bell curves.
- foota 7y ago
  Because herd immunity isn't acquired with effective quarantine, so after quarantine ends people become infected again. This doesn't happen with the two weaker options since herd immunity is effective, and I guess they assume complete elimination of the virus with a totalitarian lockdown.
sbuttgereit 7y ago
This is all fine and good. And I should state that I am on board with the actions (in San Francisco/California) taken so far. However, I'm not unconditionally so. I get that right now we're buying time. My current understanding is that we're trying to slow the spread of the disease because the existing health care system was going to quickly collapse under the weight; whether or not that should have been the case or not is a discussion for another day. I also understand that we are -not- trying to contain the disease, just "serialize" its progression (so to speak) through the population. Assuming that understanding is sufficiently correct, what I'm not hearing enough of is what is being done with the time we're buying. Many in the Hacker News audience likes to talk about "externalities" and how the wise appreciates those externalities in their actions. Shutting down the economy has externalities; those externatlities can be life or death as well. If the strategy of those implementing the "shelter in place" is one of just waiting it out: then I'm going to be off the wagon fairly quickly. I want to start hearing strategies that start to address the issues of how we minimize impacts of this problem. I want to know what we're buying for the pain that we're being sold on. I want to know when people estimate that the societal damages of the illness start to be outweighed by the damages of our response. I see the admin of the site suggesting we're buying time for these things. I want to start hearing this from the officials making policy.
- threeseed 7y ago
  Buying time: a) Saves millions of lives. b) Allows researchers to develop, produce and distribute a safe vaccine.
  - deleted 7y ago
    [deleted]
  - pfranz 7y ago
    There's even more, though. It gives us an opportunity to replenish masks, hand sanitizers, tests, and other supplies we have an immediate need for. Once this plateaus and stockpiles replenish, we can take some small steps to normalcy. Medium term, we can more properly organize and distribute medical resources, assemble temporary hospitals, learn more about current anti-virals to better manage it, etc. Allowing even more steps towards normalcy. The vaccine is immensely important, but there are major steps before then that we don't have to be completely locked down waiting for.
devy 7y ago
Is there an accumulative data chart for the entire nation?COVID-19 has no state boundaries!
pwaivers 7y ago
https://covidactnow.org/state/CA https://covidactnow.org/state/CA This is missing a HUGE point. At the very end of the California "shelter-in-place" plan, the numbers will go up. What it doesn't show is that this will merely delay the epidemic to 3 months in the future. The chart useless with only a 3 month time horizon.
- klodolph 7y ago
  Keep reading. This footnote is attached to the California-style scenario: > * A second spike in disease may occur after social distancing is stopped. Interventions are important because they buy time to create surge capacity in hospitals and develop therapeutic drugs that may have potential to lower hospitalization and fatality rates from COVID-19. See full scenario definitions here.
  - pwaivers 7y ago
    Thanks. I did see that, but it should more than a (literal) asterisk at the bottom of the page.
    - klodolph 7y ago
      There’s a balance here between insight and precision. As you make information more precise, you often make it less understandable. If you put the information in the footnote into the table, it makes the table harder to read. As it is, the footnote is right below the table (not at the bottom of the page) and the information about the second spike is BOLD. That stands out to me.
- zzleeper 7y ago
  If done correctly, it doesn't have to be like that. See Korea, etc
  - int_19h 7y ago
    Korea could test their way out of it, because they started early enough to contain it. US is past that point now - the scale of testing that we need to catch all the heretofore undetected cases is much bigger. And we need to find those cases to switch from blanket measures to targeted ones. In the end, that's likely what we'll have to do anyway. But it'll take longer than 3 months.
axaxs 7y ago
I don't get it, because these measures can't last forever. Let's pretend USA completely extreme isolates...step foot outside and you get arrested. Fine, the virus disappears in a month or two. Then what? Unless every single person on the globe does the same thing, you have to effectively keep your borders closed forever. This isn't a solvable problem at the state or national level, it's a completely global thing. We can attempt to slow it, but it's just gonna rear its ugly head again when we let our guard down.
- maxwhenderson 7y ago
  Hey - owner of the model in question here. The idea here is to buy time; time to roll out testing (so only those that test positive need to isolate), prepare beds and ventilators, and develop therapeutics (vaccines are likely quite a bit farther off).
  - vlozko 7y ago
    The frustrating challenge to this is how long symptoms take to appear. Isolation will stop the spread from the individual but only after the virus has been spread around quite a bit already. So, sure, much of what you said about localized preparedness will need to happen but we won’t be able to do the kinds of things we did with diseases like Ebola to limit its spread.
    - nomel 7y ago
      One study shows around 18% of those that test positive show no symptoms [1]. Perhaps this reduces the infection rate. [1] https://www.forbes.com/sites/brucelee/2020/03/18/what-percentage-have-covid-19-coronavirus-but-do-not-know-it/#7a5c90187e90 https://www.forbes.com/sites/brucelee/2020/03/18/what-percen...
- ssully 7y ago
  The measure's are to get a hold on the explosive number of cases. Once we get a grip on it, then you keep it contained with aggressive testing + targeted isolation.
patches11 7y ago
Where is this data coming from? I have not seen any numbers to indicate Utah was at 96 hospitalizations as of yesterday. Are other state's number correct? Was California at 952 hospitalizations as of yesterday? Is this just using number of cases as hospitalizations?
gok 7y ago
This seems to be treating number of positives test results and number of hospitalizations as the same thing? That seems...wrong...
senordevnyc 7y ago
I see a lot of rumbling in this thread about how we need to ask ourselves if the costs of a shutdown is worth it, or what happens after a shutdown? My question is this: what would you propose we do? If we don’t lock everything down, we’ll overwhelm the hospitals and the death rate will skyrocket. And then the deaths will be less skewed towards the elderly, because virtually all causes of mortality will shoot up when we no longer have a functioning medical system to treat anyone for anything except this. Are you really proposing we just let hundreds of millions of people all over the world die over the next 6-12 months? So we’ll all just go back to work and to restaurants and on vacation while 5% of the population is gasping their last breaths in a hospital somewhere? We’ll just say goodbye to a huge chunk of our parents and grandparents and aunts and uncles and coworkers? Because the economic cost is just too high? It’s easy to complain about this course of action. It sucks. But unless you can lay out a plausible alternative, this still seems like the best one to me.
- whb07 7y ago
  Because everyone keeps parroting what you're saying. We are effectively now in a fear bubble. So now everyone's mindset is "stop the world lets hunker down and cower in a corner for the impending doom. Nothing positive or new data can change my mind." In a couple weeks/months they'll start testing people to find out if they did have the virus. The tests right now only show if you currently have it. Once the real numbers come out I am confident it will be a massive over estimate for the CFR. The fear bubble is causing people to underlook the data in places like SK, SG, Japan, Germany and overlook the data in Italy, China, Iran. It could be quite possible that a mixture of smoking, age, over reporting causes, and bad healthcare (gasp not in Italy where socialized medicine is world beating) is being overlooked. So what we get now is stopping of society and the economy, millions of people will go through displacement and a host of negative things. People's savings will be depleted, not to mention teacher's/public servants/ pension and 401ks will take a MASSIVE hit. Oh and add to that more trillions of USD to the debt.
  - clwg 7y ago
    The alternative to over reaction is under reaction. I'd rather take extreme precautions and deal with the economic fallout then under react and deal with the situation that italy is currently in. I think in this situation fear is good, it ensures urgency and assists with decisive action making, coupled with humility to change course when your wrong. Apathy is much scarier than fear in these situations.
tomerico 7y ago
The projections are ignoring a very important datapoint - there is significant evidence that COVID-19 does not have a positive R0 in warm climates. This means that in many areas, there is no need to flatten the curve - it will flatten naturally in the next month or two. On the contrary, by aggressively shutting down the spread now, we are leaving ourselves more vulnerable to winter outbreak which will be hard to stop. Now the really terrible part is that the economic effect of the mass closure is going to grow exponentially. So layoffs start small and grow more massive week by week. And unlike COVID-19, that economic effect will not subside with the warming weather... Here is some evidence: Compare the slow growth in cases per day (green line) in CA and FL (warm) vs NY and WA (cold): https://covid-19.direct/state/CA https://covid-19.direct/state/CA https://covid-19.direct/state/FL https://covid-19.direct/state/FL https://covid-19.direct/state/NY https://covid-19.direct/state/NY https://covid-19.direct/state/WA https://covid-19.direct/state/WA See for example how in Malaysia there was an outbreak due to a very large Muslim gathering with foreign travelers, that seems to diminish every day (indicated an R factor < 1) - https://www.worldometers.info/coronavirus/country/malaysia/ https://www.worldometers.info/coronavirus/country/malaysia/ The same is true for Qatar. Same examples all over the world for warm countries: https://www.worldometers.info/coronavirus/ https://www.worldometers.info/coronavirus/
- tcbawo 7y ago
  How can you reliably use confirmed cases to suggest a trend given the disparity between states in test availability, population density, and timeline of introduction?
  - tomerico 7y ago
    We are looking just at the trend. And the testing methodology that different states take is just a multiplicative constant of the confirmed test. And exponentially growing function will make it negligible.
  - tomerico 7y ago
    We are looking just at the trend. And the testing methodology that different states take is just a multiplicative constant of the confirmed cases. And exponentially growing function will make it negligible.
foogazi 7y ago
This is what worries me: > Our models show that it would take at least 2 months of Wuhan-style Lockdown to achieve full containment. However, it is unclear at this time how you could manage newly introduced infections. When will Wuhan accept travelers from Spain or Italy ? Or are we going to live with border controls & quarantines forever?
torgian 7y ago
Having read some of the comments here, I want to say that I think I fall in the "cynical" portion of the population. Then again, my family is Russian, and we all typically think we're all gonna be screwed somehow. The most optimistic outcome, for me, is that remote work becomes a bigger possibility when companies realize they're wasting tons of money on too much office space. People already know that we can live with less. _Businesses_, however, do not realize this. I hope businesses ( especially big ones ) realize this. Shortcomings in our economy and health care ( not just America, but world-wide ) will be realized and fixed. However, I do not think any of the above will become true. Humans have short memories. I think once the crisis is over, business as usual will resume and we will have made no progress. Other than another vaccine.
war1025 7y ago
In my opinion this page isn't terribly informative unless you happen to live in Texas or California. Basically every state has measures in place already. None of that is reflected here, and there is no way to tell where it fits relative to the scenarios shown.
ansmithz42 7y ago
Here let's do some numbers since this group likes numbers: Population of China: 1.4B Population of USA: 330M China Population/USA Population ~= 4.5 Case Count China: 81250 Case Count USA: 19285 China Case Count/USA Case Count = 4.2 Given the current rate of increase and the lack of action, the USA is on track to be in a worse situation than china and is still trying to figure out what to do. Best to look to countries like Taiwan, Japan, S. Korea, Singapore and maybe learn from their actions because the current approach is clearly not working.
jwally 7y ago
This was just used to trigger a shelter in place in Dallas. Thanks to whoever built this! https://www.dallasnews.com/news/public-health/2020/03/22/hospitals-will-run-out-of-beds-by-late-april-if-gov-abbott-doesnt-order-texans-to-stay-at-home-hospital-group-warns/ https://www.dallasnews.com/news/public-health/2020/03/22/hos...
turdnagel 7y ago
This would be a lot more helpful if there were a line with actual daily hospitalizations as well.

254 points by jamest 7y ago

I guess the operative detail is whether shelter-in-place will get us to a "23%" total infection rate vs 70%. I wonder if that's accurate. I also wonder if this is recurring in the fall, and every year, and whether physical distancing will be mandatory every year?

OJFord 7y ago
How many recurrent seasons would it take for countries/society to adapt and cope (whether that's hugely more full-time remote workers, or blanket acceptability of it part-time/during such occasions, or something else) I wonder?
- maxwhenderson 7y ago
  Hey - admin of covidactnow here. I don't think anyone has any idea if this will recur, mutate, etc. The key is to buy time, now. To add hospital capacity, develop therapeutics and vaccines, and learn more about the disease...
- ars 7y ago
  Just one I think. People are already coping, and it's barely started. If people knew a 3 month shelter-in-place was a yearly rule, we could plan for it.
  - umanwizard 7y ago
    People with either cushy office jobs or enough savings to be long-term unemployed are coping. The millions of service industry employees either aren’t, or soon won’t be.
    - ars 7y ago
      I would assume there would be changes to how unemployment works if this was a regular thing.
      - int_19h 7y ago
        The problem is that those changes are highly politicized, because they hit a bunch of culture war buttons about "socialism". And it's been a while since American legislators have considered the possibility of torches and pitchforks, so they still prioritize their electability (especially in the primaries, where ideological purism is more important) over social necessity.
- smacktoward 7y ago
  If you expect it to spread at the rate this thing spreads, after a couple of years nearly everyone will have been exposed to it and thus have developed an immunity (or died). From then on it mostly becomes a childhood disease, like measles. The goal thus becomes to spread out the exposures enough so that people who need medical help to survive their exposure can reliably get it. Of course the above assumes that immunity really does develop after one exposure, and that the virus doesn't mutate into some sufficiently different form to reset the immunity counter to zero again. The evidence seems to indicate positive things on the immunity front, but it's still preliminary. And as for mutation, who can say?

frenchyatwork 7y ago

Site is broken for me. The url https://covidactnow.org/data/wa.7.json https://covidactnow.org/data/wa.7.json is returning an HTML document with the text "You need to enable JavaScript to run this app." and there's a JSON.parse error in the console.

jamest 7y ago
thanks for this, looking now
- maxwhenderson 7y ago
  sorry about this! Hopefully fixed shortly.
- jamest 7y ago
  fixed
- maxwhenderson 7y ago
  Fixed!
hermitdev 7y ago
Washington wasn't working for me, either. Just a blank page. And I do have javascript enabled. Other states work fine, like Illinois.

deleted 7y ago

[deleted]

taeric 7y ago

I still feel there is compelling evidence that lung damage from things such as exposure to local pollution is a big driver in serious cases. I say this as someone that thinks they had it a month ago. I was on steroids for a week, then a respirator, then steroids for another week. Worst asthma attack of my adult life. I live in Seattle... (And yes, i had fevers) I did not get tested, but having a hard time shaking that I had it. And if I did, so has my family. With my kids all having fevers, but no shortness of breath. Edit: I hasten to add that I am socializing this as a call for what am I missing? I am not encouraging inaction.

jrs235 7y ago
So, if a lot of people have already had it, which I see a lot of people thinking they did, we need to find out if you can get reinfected.
- yardstick 7y ago
  Yeah this point has been bugging me for a while now. What’s the reinfection rate / immunity rate? I know there are some reinfections but does that mean everyone can be reinfected or is it just a fraction that don’t gain immunity?
  - aivosha 7y ago
    lots of “reinfections” were debunked as false positives. search on r/COVID19 for details.
    - SpicyLemonZest 7y ago
      And it should be emphasized that 100% of reported reinfections were just news reports saying "hey this person tested positive after testing negative" - there was never tremendously strong evidence for it.
- taeric 7y ago
  There is also the question of why is it so severe in places? And could it get that severe elsewhere? Studies of SARS showed that regions with high pollution were significantly more at risk for death from it. If that is the case for this, the severity expected in many parts of the world will be considerably lower than projected. Again, stay home. I am not encouraging breaking self distancing. The panic message is worrying me because everyone seems to only be looking for reasons to panic.

cwzwarich 7y ago

This site openly admits the obvious flaws in their model: - R0s for interventions are guesses, in some cases informed by data. There is no historical precedent for what is going on right now to draw from. - The default R0 used in this model is an average. The model does not adjust for the population density, culturally-determined interaction frequency and closeness, humidity, temperature, etc in calculating R0. - This is not a node-based analysis, and thus assumes everyone spreads the disease at the same rate. In practice, there are some folks who are “super-spreaders,” and others who are almost isolated. Interventions should be targeted primarily at those most likely to spread the disease. Are there any epidemiologists using less naive statistical models who are producing easily readable results like this? The "average R0" logistic function model seems better suited for examining historical epidemics than estimating risk to inform decision-making for ongoing epidemics.

aivosha 7y ago
this
termain 7y ago
That's generally what you should do with a scientific model: state your assumptions and methodology clearly. And most if not all scientific and engineering models spread properties across a group of objects and use averages. R_0 is an average. And it's the average behavior that matters here In a well tested population, you might be able to focus interventions on infected people and their contacts. In the US population, the people most likely to spread the disease are those who interact most with other people. That means getting those people to reduce their interaction rate. It's a semi-empirical model, as are many if not most models used to make decisions.
AndrewStephens 7y ago
I agree. The graphs are very pretty but would look very different if the R0 was even slightly modified. The mortality rates probably varies widely by state demographics as well. That said, the implication that strict isolation should be maintained is almost certainly correct.
- 7y ago

Leary 7y ago

So according to these models, we should be Wuhan-ing our states?

ars 7y ago
You don't need these models to tell you that. It's self evident that if you keep people from contacting each other you can stop things. It's just not so clear it's possible to do such a lockdown in non-Authoritarian, free, countries.
- jfkebwjsbx 7y ago
  It is possible and in fact it has happened already in a lot of European states.
  - int_19h 7y ago
    Enacting a lockdown is possible, but having the populace respect it - or enforce it otherwise - is another matter. Besides, the worst lockdowns have only just begun recently. There are a lot of people who will go ahead with, say, a 2-week lockdown, but will balk at 3 months. The true test for the ability to maintain things that way is still ahead for Western countries.
  - Rapzid 7y ago
    It's happening in a lot of United States!
yumraj 7y ago
Well I still have a fundamental question, what happens when China, or anyplace else, un-Wuhan's? They seem to be opening stores, starting flights to SFO, but surely China is not clear of the virus. So, are we expecting a pick up in infections now. And, if not, please explain why not.. I'm really curious..
- joshfraser 7y ago
  They're starting to open up now. It works fine as long as you have broad testing & can identify everyone who has been exposed to it. Exponential curves are easy to stop as long as you catch them early.

tunesmith 7y ago

It appears this assumes a doubling rate of 3-4 days? That's pretty pessimistic compared to what the science-heads are saying, right? I've heard 5-6 days, 6.2 from another source. EDIT: I'm talking about the doubling rate of the actual cases, not the confirmed cases.

Retric 7y ago
The US has averaged over 30% daily increases in infections for the last 20 days. 1.3 x 1.3 x 1.3 = 2.2x growth every 3 days making that 4 day doubling optimistic. https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_the_United_States https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t... New infections are modeled to noticeably slow down once ~1/5 of the total population is infected, but at that point things have already fallen apart.
- gpm 7y ago
  The US has also been ramping up testing, assuming number of infections is a linear function of known cases is a mistake.
  - Retric 7y ago
    We are not doing 16,000 / 42 = 380x more tests per day on March 20th vs March 1st. It’s not even obvious if we are overlooking a larger fraction of infections today than back then. Also of note that 30% daily increase I spoke of underestimates the difference between March 1 and March 20th.
joshfraser 7y ago
It's doubling even faster right now, but that may be more related to increased testing than anything. Unfortunately, the US is further along the curve than all these sites are showing due to the fact that we didn't have any testing in the beginning (and still don't have enough).
stevenwoo 7y ago
New York City doubled in one day - yesterday simply by having the capacity to do more tests.

djzidon 7y ago

would like to be able to look at a whole country projection, if possible

jwally 7y ago
Not sure how much effort you want to put into it, but the raw data is in JSON files on the site under the following pattern: https://covidactnow.org/data/{{state_abbreviation} https://covidactnow.org/data/{{state_abbreviation}}.{{scenario_number}}.json (where scenarios go from 0 - 7)
- djzidon 7y ago
  very cool, thank you

LargeWu 7y ago

So, this projects 3-months out. But what about after that? The graph for my state (MN) showed 3 months of sheltering in place would keep infections down, but then start to rise immediately afterwards. Then the graph ends. I think super-extended voluntary isolation is going to be a tough sell.

maxwhenderson 7y ago
Hey guys - owner of the model in question here. Yes, that's exactly right, but 3 months (or even 1 month) may be enough time to prevent unnecessary deaths by preparing hospitals, getting more ventilators, rolling out testing, and hopefully finding a therapeutic drug (vaccines are probably farther off). Nobody can predict the future, though.
- LargeWu 7y ago
  I sure hope so. Thanks for your effort educating people.
- int_19h 7y ago
  3 months is definitely not enough to grow the hospital and ICU capacity 7x, which is what's necessary to prevent deaths due to lack of healthcare availability. It'll improve some, and that will save some lives, but not most of them. Pervasive testing looks like the best short-term hope right now - it's easier to drastically ramp up test manufacturing, and you don't need a full-fledged hospital for mass testing.

Merrill 7y ago

Sheltering in place would be less necessary if everyone would stay at least 2 meters apart, wear masks, wear gloves, not talk unnecessarily or cough/sneeze at anyone, and wash up with soap when they get home. Some people seem unable to stay away and feel compelled to get in your face and talk.

olalonde 7y ago

Stupid question: why do all the curves go down way before reaching a large percentage of the population? For example, California's curve peaks at ~900,000, only 2% of its population (and only a bit more if you consider cumulative hospitalizations). I guess 2% is not enough for herd immunity to kick in so what is it? Edit: Oops, brain fart. Those numbers don't include all cases, just hospitalized ones.

dak1 7y ago
Those are hospitalizations, not infections.
maxerickson 7y ago
The graphs are the number of cases requiring hospital care.

chipotle_coyote 7y ago

Naive question: in the states I looked at, the "California-style shelter-in-place" line consistently goes up again toward the right side of the graph (end of June to July), whereas none of the other approaches have that second lift. Why is that?

salmon30salmon 7y ago
Because the first wave is enough to develop herd immunity and reduce the R-rate of the virus
- LargeWu 7y ago
  The second lift would suggest that isn't true.
- chipotle_coyote 7y ago
  But the second lift suggests the model is showing the R-rate going up after a drop, which is what I'm asking about. The other curves -- which presumably also involve herd immunity to some degree -- are pretty much bell curves.
foota 7y ago
Because herd immunity isn't acquired with effective quarantine, so after quarantine ends people become infected again. This doesn't happen with the two weaker options since herd immunity is effective, and I guess they assume complete elimination of the virus with a totalitarian lockdown.

sbuttgereit 7y ago

This is all fine and good. And I should state that I am on board with the actions (in San Francisco/California) taken so far. However, I'm not unconditionally so. I get that right now we're buying time. My current understanding is that we're trying to slow the spread of the disease because the existing health care system was going to quickly collapse under the weight; whether or not that should have been the case or not is a discussion for another day. I also understand that we are -not- trying to contain the disease, just "serialize" its progression (so to speak) through the population. Assuming that understanding is sufficiently correct, what I'm not hearing enough of is what is being done with the time we're buying. Many in the Hacker News audience likes to talk about "externalities" and how the wise appreciates those externalities in their actions. Shutting down the economy has externalities; those externatlities can be life or death as well. If the strategy of those implementing the "shelter in place" is one of just waiting it out: then I'm going to be off the wagon fairly quickly. I want to start hearing strategies that start to address the issues of how we minimize impacts of this problem. I want to know what we're buying for the pain that we're being sold on. I want to know when people estimate that the societal damages of the illness start to be outweighed by the damages of our response. I see the admin of the site suggesting we're buying time for these things. I want to start hearing this from the officials making policy.

threeseed 7y ago
Buying time: a) Saves millions of lives. b) Allows researchers to develop, produce and distribute a safe vaccine.
- deleted 7y ago
  [deleted]
- pfranz 7y ago
  There's even more, though. It gives us an opportunity to replenish masks, hand sanitizers, tests, and other supplies we have an immediate need for. Once this plateaus and stockpiles replenish, we can take some small steps to normalcy. Medium term, we can more properly organize and distribute medical resources, assemble temporary hospitals, learn more about current anti-virals to better manage it, etc. Allowing even more steps towards normalcy. The vaccine is immensely important, but there are major steps before then that we don't have to be completely locked down waiting for.

devy 7y ago

Is there an accumulative data chart for the entire nation?COVID-19 has no state boundaries!

pwaivers 7y ago

https://covidactnow.org/state/CA https://covidactnow.org/state/CA This is missing a HUGE point. At the very end of the California "shelter-in-place" plan, the numbers will go up. What it doesn't show is that this will merely delay the epidemic to 3 months in the future. The chart useless with only a 3 month time horizon.

klodolph 7y ago
Keep reading. This footnote is attached to the California-style scenario: > * A second spike in disease may occur after social distancing is stopped. Interventions are important because they buy time to create surge capacity in hospitals and develop therapeutic drugs that may have potential to lower hospitalization and fatality rates from COVID-19. See full scenario definitions here.
- pwaivers 7y ago
  Thanks. I did see that, but it should more than a (literal) asterisk at the bottom of the page.
  - klodolph 7y ago
    There’s a balance here between insight and precision. As you make information more precise, you often make it less understandable. If you put the information in the footnote into the table, it makes the table harder to read. As it is, the footnote is right below the table (not at the bottom of the page) and the information about the second spike is BOLD. That stands out to me.
zzleeper 7y ago
If done correctly, it doesn't have to be like that. See Korea, etc
- int_19h 7y ago
  Korea could test their way out of it, because they started early enough to contain it. US is past that point now - the scale of testing that we need to catch all the heretofore undetected cases is much bigger. And we need to find those cases to switch from blanket measures to targeted ones. In the end, that's likely what we'll have to do anyway. But it'll take longer than 3 months.

axaxs 7y ago

I don't get it, because these measures can't last forever. Let's pretend USA completely extreme isolates...step foot outside and you get arrested. Fine, the virus disappears in a month or two. Then what? Unless every single person on the globe does the same thing, you have to effectively keep your borders closed forever. This isn't a solvable problem at the state or national level, it's a completely global thing. We can attempt to slow it, but it's just gonna rear its ugly head again when we let our guard down.

maxwhenderson 7y ago
Hey - owner of the model in question here. The idea here is to buy time; time to roll out testing (so only those that test positive need to isolate), prepare beds and ventilators, and develop therapeutics (vaccines are likely quite a bit farther off).
- vlozko 7y ago
  The frustrating challenge to this is how long symptoms take to appear. Isolation will stop the spread from the individual but only after the virus has been spread around quite a bit already. So, sure, much of what you said about localized preparedness will need to happen but we won’t be able to do the kinds of things we did with diseases like Ebola to limit its spread.
  - nomel 7y ago
    One study shows around 18% of those that test positive show no symptoms [1]. Perhaps this reduces the infection rate. [1] https://www.forbes.com/sites/brucelee/2020/03/18/what-percentage-have-covid-19-coronavirus-but-do-not-know-it/#7a5c90187e90 https://www.forbes.com/sites/brucelee/2020/03/18/what-percen...
ssully 7y ago
The measure's are to get a hold on the explosive number of cases. Once we get a grip on it, then you keep it contained with aggressive testing + targeted isolation.

patches11 7y ago

Where is this data coming from? I have not seen any numbers to indicate Utah was at 96 hospitalizations as of yesterday. Are other state's number correct? Was California at 952 hospitalizations as of yesterday? Is this just using number of cases as hospitalizations?

gok 7y ago

This seems to be treating number of positives test results and number of hospitalizations as the same thing? That seems...wrong...

senordevnyc 7y ago

I see a lot of rumbling in this thread about how we need to ask ourselves if the costs of a shutdown is worth it, or what happens after a shutdown? My question is this: what would you propose we do? If we don’t lock everything down, we’ll overwhelm the hospitals and the death rate will skyrocket. And then the deaths will be less skewed towards the elderly, because virtually all causes of mortality will shoot up when we no longer have a functioning medical system to treat anyone for anything except this. Are you really proposing we just let hundreds of millions of people all over the world die over the next 6-12 months? So we’ll all just go back to work and to restaurants and on vacation while 5% of the population is gasping their last breaths in a hospital somewhere? We’ll just say goodbye to a huge chunk of our parents and grandparents and aunts and uncles and coworkers? Because the economic cost is just too high? It’s easy to complain about this course of action. It sucks. But unless you can lay out a plausible alternative, this still seems like the best one to me.

whb07 7y ago
Because everyone keeps parroting what you're saying. We are effectively now in a fear bubble. So now everyone's mindset is "stop the world lets hunker down and cower in a corner for the impending doom. Nothing positive or new data can change my mind." In a couple weeks/months they'll start testing people to find out if they did have the virus. The tests right now only show if you currently have it. Once the real numbers come out I am confident it will be a massive over estimate for the CFR. The fear bubble is causing people to underlook the data in places like SK, SG, Japan, Germany and overlook the data in Italy, China, Iran. It could be quite possible that a mixture of smoking, age, over reporting causes, and bad healthcare (gasp not in Italy where socialized medicine is world beating) is being overlooked. So what we get now is stopping of society and the economy, millions of people will go through displacement and a host of negative things. People's savings will be depleted, not to mention teacher's/public servants/ pension and 401ks will take a MASSIVE hit. Oh and add to that more trillions of USD to the debt.
- clwg 7y ago
  The alternative to over reaction is under reaction. I'd rather take extreme precautions and deal with the economic fallout then under react and deal with the situation that italy is currently in. I think in this situation fear is good, it ensures urgency and assists with decisive action making, coupled with humility to change course when your wrong. Apathy is much scarier than fear in these situations.

tomerico 7y ago

The projections are ignoring a very important datapoint - there is significant evidence that COVID-19 does not have a positive R0 in warm climates. This means that in many areas, there is no need to flatten the curve - it will flatten naturally in the next month or two. On the contrary, by aggressively shutting down the spread now, we are leaving ourselves more vulnerable to winter outbreak which will be hard to stop. Now the really terrible part is that the economic effect of the mass closure is going to grow exponentially. So layoffs start small and grow more massive week by week. And unlike COVID-19, that economic effect will not subside with the warming weather... Here is some evidence: Compare the slow growth in cases per day (green line) in CA and FL (warm) vs NY and WA (cold): https://covid-19.direct/state/CA https://covid-19.direct/state/CA https://covid-19.direct/state/FL https://covid-19.direct/state/FL https://covid-19.direct/state/NY https://covid-19.direct/state/NY https://covid-19.direct/state/WA https://covid-19.direct/state/WA See for example how in Malaysia there was an outbreak due to a very large Muslim gathering with foreign travelers, that seems to diminish every day (indicated an R factor < 1) - https://www.worldometers.info/coronavirus/country/malaysia/ https://www.worldometers.info/coronavirus/country/malaysia/ The same is true for Qatar. Same examples all over the world for warm countries: https://www.worldometers.info/coronavirus/ https://www.worldometers.info/coronavirus/

tcbawo 7y ago
How can you reliably use confirmed cases to suggest a trend given the disparity between states in test availability, population density, and timeline of introduction?
- tomerico 7y ago
  We are looking just at the trend. And the testing methodology that different states take is just a multiplicative constant of the confirmed test. And exponentially growing function will make it negligible.
- tomerico 7y ago
  We are looking just at the trend. And the testing methodology that different states take is just a multiplicative constant of the confirmed cases. And exponentially growing function will make it negligible.

foogazi 7y ago

This is what worries me: > Our models show that it would take at least 2 months of Wuhan-style Lockdown to achieve full containment. However, it is unclear at this time how you could manage newly introduced infections. When will Wuhan accept travelers from Spain or Italy ? Or are we going to live with border controls & quarantines forever?

torgian 7y ago

Having read some of the comments here, I want to say that I think I fall in the "cynical" portion of the population. Then again, my family is Russian, and we all typically think we're all gonna be screwed somehow. The most optimistic outcome, for me, is that remote work becomes a bigger possibility when companies realize they're wasting tons of money on too much office space. People already know that we can live with less. _Businesses_, however, do not realize this. I hope businesses ( especially big ones ) realize this. Shortcomings in our economy and health care ( not just America, but world-wide ) will be realized and fixed. However, I do not think any of the above will become true. Humans have short memories. I think once the crisis is over, business as usual will resume and we will have made no progress. Other than another vaccine.

war1025 7y ago

In my opinion this page isn't terribly informative unless you happen to live in Texas or California. Basically every state has measures in place already. None of that is reflected here, and there is no way to tell where it fits relative to the scenarios shown.

ansmithz42 7y ago

Here let's do some numbers since this group likes numbers: Population of China: 1.4B Population of USA: 330M China Population/USA Population ~= 4.5 Case Count China: 81250 Case Count USA: 19285 China Case Count/USA Case Count = 4.2 Given the current rate of increase and the lack of action, the USA is on track to be in a worse situation than china and is still trying to figure out what to do. Best to look to countries like Taiwan, Japan, S. Korea, Singapore and maybe learn from their actions because the current approach is clearly not working.

jwally 7y ago

This was just used to trigger a shelter in place in Dallas. Thanks to whoever built this! https://www.dallasnews.com/news/public-health/2020/03/22/hospitals-will-run-out-of-beds-by-late-april-if-gov-abbott-doesnt-order-texans-to-stay-at-home-hospital-group-warns/ https://www.dallasnews.com/news/public-health/2020/03/22/hos...

turdnagel 7y ago

This would be a lot more helpful if there were a line with actual daily hospitalizations as well.