19 ms·

"The number of deaths per day and hospitalized patients, however, has remained flat for weeks, down from their peaks in mid-April. That is beginning to change,

• danhak 6y ago
  Of course cases will go up as testing becomes more widespread. As you point out, headlines mention case numbers as those are the high, eye-catching numbers. The more important numbers to watch are positivity and hospitalization, which are starting to tick up after several flat weeks.
  • taborj 6y ago
    This article goes so far as to flirt with the testing numbers without actually siting them. I really don't see what's so hard for news outlets to throw the total number of tests alongside the total number of positive results.
• kop316 6y ago
  > I always thought, based on what I've read/heard, that one of the big reasons, maybe the biggest reason we're doing all this is to flatten the curb so hospitals don't get overwhelmed. This was my understanding as well, and it is what is shown in Wikipedia: https://en.wikipedia.org/wiki/Flatten_the_curve https://en.wikipedia.org/wiki/Flatten_the_curve The bigger thing that I have chatted about with several other is that the area under the curve is the same, i.e. the same amount of inidividuals will still get sick.
  • snug 6y ago
    Exactly this, in fact we did such a good job, that people who were sick for other reasons didn't seek medical help and health care professionals have been laid off https://calmatters.org/health/coronavirus/2020/05/health-care-workers-layoffs-california-coronavirus-nurses-furloughs-pay-cuts-hospitals/ https://calmatters.org/health/coronavirus/2020/05/health-car...
  • zzleeper 6y ago
    afaik not true; google for "epidemic overshoot"
    • arcticfox 6y ago
      that's in the case that we even have to arrive at herd immunity through infections. By far the bigger factor here are the dozens of vaccines and treatments (eg monoclonal antibodies) in development, if any of them work in time, the "area under the curve is the same" idea is blown out of the water to the tune of millions of preventable deaths.
      • noobaccount 6y ago
        Millions of preventable deaths? Do you have a source handy? I’m wondering how that aligns with the latest data.
        • lllr_finger 6y ago
          (number of uninfected that need to be infected to achieve herd immunity) * (case fatality rate) = future deaths With the assumption that every vaccinated person counts towards herd immunity and isn't likely to die, you can plug in your own numbers to the equation above. Even with really conservative estimates, it's easy* to get into the millions when you consider the entire planet. *Barring some highly effective treatments that may or may not surface.
          • dragonwriter 6y ago
• djohnston 6y ago
  Gotta get those clicks
  • mikeyouse 6y ago
    I love how reporting on the increasing number of cases in a pandemic that has caused over 120,000 American deaths can somehow be "for the clicks".
    • taborj 6y ago
      Any news article that mentions the number of new positive cases without mentioning the number of new tests is doing it for the clicks. One is fairly useless without the other. 150 cases out of 150 tests? Yikes! 150 cases out of 150,000 tests? Yawn.
      • mikeyouse 6y ago
        The second metric is obviously more important, but when a pandemic as an Ro of more than 1, any increasing number of cases is a huge issue. Hence why the hospitalizations are on the way up, which is also reported in that article..
      • jiveturkey 6y ago
        you've actually got it backwards. 150 cases out of 150 tests mean that testing isn't indicative of the infection rate, and is a yawner because the test itself is telling us almost nothing.
      • ihumanable 6y ago
        This tool is useful https://coronavirus.jhu.edu/testing/individual-states https://coronavirus.jhu.edu/testing/individual-states California has been increasing raw number of tests but the positive tests percentage has been holding relatively steady around 4.5% https://coronavirus.jhu.edu/testing/individual-states/california https://coronavirus.jhu.edu/testing/individual-states/califo... Florida is a much different story, as their cases have increased the testing has not kept up, and the positive test rate has gone from 2.3% at the end of May to 12.2% https://coronavirus.jhu.edu/testing/individual-states/florida https://coronavirus.jhu.edu/testing/individual-states/florid... One thing that everyone should keep in mind, even if you could attribute all of the increase in confirmed cases to testing, tests don't give anyone the coronavirus. The only thing increased testing can do is give you a more accurate picture of how bad the situation is, it can't make the situation worse.
• devalgo 6y ago
  Flatten the curve was meant to spread the infections across time to decrease stress on the healthcare system. Our lockdown was ineffectual because of lax enforcement and the public's apathy. So it achieved none of its goals. Places like Italy, Spain, New Zealand have "won" against the virus using lockdowns and are now on track to be back to normal. In NZs case they are already back to normal. Without another lockdown it's almost assured at this point that we will reach the breaking point of our healthcare system. It's inevitable unless a miracle vaccine arrives very soon.
  • rlt 6y ago
    But... we did flatten the curve enough to avoid overwhelming the healthcare system. To suggest it wasn't enough now is moving the goalposts.
    • mnm1 6y ago
      To revise science and drop ideas not proven to work while adopting ideas proven to work can also be called "changing the goalposts" by people who simply don't understand how science works.
      • deleted 6y ago
        [deleted]
      • JungleGymSam 6y ago
        I, for one, welcome our science-understanding overlords.
      • thrown2020 6y ago
        you are fucking stupid
    • dragonwriter 6y ago
      > But... we did flatten the curve enough to avoid overwhelming the healthcare system Well, the curve had somewhat flattened (but was still trending upward among the noise) before reaching the point of overwhelming the system before we started reopening and it unflattened. I think it was premature to say that it had been flattened enough to avoid rather than delay that outcome, though it's kind of immaterial anyway since we abandoned the effort to keep it flat and are heading straight for overwhelming the system.
• DiogenesKynikos 6y ago
  > we're doing all this is to flatten the curb Different people have different goals. One goal would be to reduce the rate of new infections to a level that hospitals can handle. A different strategy is to reduce the rate of new infections to a much lower level, so that contact tracing and containment is possible, and then open things back up. If a vaccine is available at some point in the next year, the latter strategy saves many lives. It requires a sharp, relatively short (4-6 weeks) shutdown. Afterwards, it requires a high level of testing, quarantine for infected people, widespread use of fever checks in public places, a ban on large events, and extensive contact tracing. Many countries have now successfully deployed this strategy. The US is stuck in limbo. Some states locked down hard, others didn't lock down enough. Things opened up too quickly, without the systems in place to contain the epidemic, and people are largely acting as if SARS-CoV-2 didn't exist any more. The consequence is that new infections never went down to a level where contact tracing is possible, and the rate of new infections is on the rise again.
  • SpicyLemonZest 6y ago
    Different people have different goals, but it's pointless to measure California's status against goals it's not trying to meet.
  • parliament32 6y ago
    >widespread use of fever checks I've never understood this fascination with fever checks. I've never had a fever where I couldn't tell I had a fever -- everyone with a fever perfectly well knows they have a fever. The problem is people trying to hide it, I guess? And if they suppress it with medication, your forehead scanner will be useless anyway. The solution for that is to make quarantine less painful. Here's a list of grocery delivery services, here's a guarantee your employer can't punish you for taking time off work, here's a nursing service that'll call you to check in daily, etc. Enjoy your vacation.
    • barneygale 6y ago
      I've never seen a toupée that I couldn't tell was fake.
• pbreit 6y ago
  The obsession with total cases is maddening. First, they are driven significantly by amount of testing. Secondly, whether they lead to complications is significantly impacted by age and health. The recent article routinely fail to acknowledge that age of infection has fallen drastically (from 65 to 35 in Florida, for example). The people getting infected now, the out-and-abouters, are much, much lower risk of complications. Which is why death rates continue down (lowest in US since March).
  • buhhh 6y ago
    > The obsession with total cases is maddening. First, they are driven significantly by amount of testing. I think more significantly they're driven by total cases. Are you suggesting we test less? Also you seem to have a very black and white view of outcomes. It's not clear cut between alive or dead. There's many things that we still don't know about this virus and the harm it causes. https://www.bbc.com/future/article/20200622-the-long-term-effects-of-covid-19-infection https://www.bbc.com/future/article/20200622-the-long-term-ef...
    • catawbasam 6y ago
      Cuts on the confirmed cases by age group and to some extent race/gender will help understand upcoming hospitalization and death.
    • pbreit 6y ago
      There have been 10 million confirmed cases and probably 10x that many infections with very few reports of longer term adverse impacts.
      • bluGill 6y ago
        Long term effects can take a long time to show up. We don't know what they might be. Of course this is a case where no long term effects are something we are only sure of after currently young people die of old age.
      • piva00 6y ago
• chiefalchemist 6y ago
  Yes, flatten the curve is to prevent chaos. In that context, total cases is close to meaningless. Active case would be a far better metric. Cases that have "completed the process" have no value - other than fear-mongering. Then you break active cases down by area (read: hospital) and carrier profile (e.g., age, pre-existing conditions, etc.). The point is, not everyone who tests positive is high risk. Not everyone who shows symptons will end up at hospital. Not everyone who ends up at hospital will need a ventilator. And so on. As it is, this whole event has been a text book case of how not to use data and statistics properly.
• sesuximo 6y ago
  Will be interesting to see what happens in the next two weeks. Certainly most places have handled the bumps well so far, but some have not e.g. Texas hospitalizations are up
  • tunesmith 6y ago
    They say a 28-day lag between infection and death. So I'm curious about the last two weeks of July, if we'll have more deaths in that period than we've had over the last two weeks. I currently suspect we will, but I've been wrong about the south before.
• rsynnott 6y ago
  > but I don't get why (from what I've seen) hospitalizations don't seem to be all that important when reporting on COVID numbers in general. To an extent, by the time the hospital numbers are going up sharply, it's too late, and the hospitals will inevitably be overwhelmed, so it's not a good guide of policy. New case count is the only vaguely timely indicator we have.
  • catawbasam 6y ago
    "inevitably be overwhelmed" now looks less likely than it did in March. There is less use of ventilators and ICU usage has been less than initially anticipated.
    • mehrdadn 6y ago
      Was that not precisely because of the stay-at-home orders?
      • austhrow743 6y ago
        At one point ventilators had a 90% fatality rate or something like that. I think they found that in a lot of cases they either weren't helping or were hurting.
    • rsynnott 6y ago
      To be clear, I mean that hospitals will inevitably be overwhelmed once you see a sharp upswing in hospitalisations; by the time you see that the pipeline is likely already primed and nothing you can do will change the trajectory of the upswing much for days. If you see a sharp upswing in cases, though, swift action can maybe deal with that (assuming you have decent observability). Most the the cases will never see the inside of a hospital, but they provide a somewhat useful proxy for the future of hospitalization. If you need to pick a metric on which to reinstitute lockdowns, hospitalization isn't really very useful; it's better than nothing but if you use it you're probably going to overshoot.
    • kaitai 6y ago
      One difficulty is that while there have been improvements in treatment resulting in less ventilator and ICU usage, and we've substantially increased number of ICU beds in many areas, we're still seeing staff attrition. In my metro, major hospitals have been diverting cases to further-out hospitals not because of equipment shortages but because of staff shortages. Staff are getting sick, and then they're out for a while. Their training can't easily be replaced -- you can train other medical folks to do sort of a half-assed job in an emergency, but you'll see higher mortality in that situation.
• ccktlmazeltov 6y ago
  Exactly, if we want to achieve herd immunity then increasing the number of infected is a goal we want to achieve, keeping hospitalization levels steady is needed to not increase the amount of death (covid related or not).
  • buhhh 6y ago
    herd immunity in the way that you're advocating for is akin to genocide.
    • ccktlmazeltov 6y ago
      unfortunately that's the current implied strategy, that people like it or not.
      • buhhh 6y ago
        guess we have no choice but to advocate for it then! /s
  • SomeoneFromCA 6y ago
    Never understood the point of herd immunity through deliberate infection with a potentially deadly disorder. I mean what the point of getting sick now, instead of later. I can kinda get a point that second could be potentially deadlier, but what if it never happens? SARS-CoV from 2003 never gave a second wave.
    • ccktlmazeltov 6y ago
      > but what if it never happens The problem is that if covid doesn't kill you, stopping the economy will (or at least will make it worse for a large part of the population). There might be a right trade-off of making heavy use of masks and preventative measures, but this is not currently the implied strategy of the government (as masks are not really enforced). The difference with SARS-CoV-1 from 2002-2004 was that symptoms were much more aggressive and quick, and thus it was much more easy to trace and quarantine people. With the current one we have a mix of issues: lots of asymptomatic people or symptoms take time to develop.
• adamjcook 6y ago
  > maybe the biggest reason we're doing all this is to flatten the curb so hospitals don't get overwhelmed. I think the other, possibly just as important, reason to lower the infection count is that medical professionals are yet unsure of the long-term, chronic health impacts of this disease and that there appear to be some preliminary signs of significant respiratory and pulmonary issues that can effect many age groups - perhaps even in those not necessarily requiring hospitalization. It would appear that medical science has a few additional treatments in their toolbox now (as compared to, say, March or April) that lower the severity of the disease and helps prevent death in some populations, but still, many concerning unknowns remain. At least that is what I have seen here and there from several medical professionals that I have seen on Twitter over the past few weeks...
  • erik_seaberg 6y ago
    They say any vaccine would take at least a year, and I don't think we have the fear and determination to protect the majority from this for so long.
    • zwily 6y ago
      If everything goes perfectly, there are a couple vaccines that could start being given out in Q4 this year. Experts are being realistic and conservative though and not playing those timelines up.
• vmception 6y ago
  COVID Articles start with a random selection of cases, tests or deaths over a random selection of time frames and areas. Then halfway through the article it randomly changes to a different combination of cases, tests or deaths or a different time frame and different larger or smaller area. And then finally it switches again, but about a totally different country or worldwide statistics. Now you can procedurally generate multiple articles all day! "Wow engagement is so high", said the Product Manager. "Our KPIs are through the roof, keep doing more of that our customers must love us."
• logicNSci 6y ago
  There was an NYT article saying ventilators only give a 12% additional survival rate. This is the service hospitals provide. Sure oxygen can be given at a hospital, but if we are overwhelmed, you can easily do oxygen at home. Anyone have a different understanding?
  • pas 6y ago
    My understanding is that just the most severe cases are put on ventilation, and understandably alas a lot of those people die. But the overall effectiveness of intensive care and general hospitalization is likely much higher, but I haven't seen a chart about this.
  • jhayward 6y ago
    There are many more therapies than just oxygen that hospitalized patients receive. Lots of monitoring of e.g., blood values that indicate stress on one organ or another, or danger of crisis due to many different processes. Drug therapy and supportive treatments are varied in response to those. It's not as simple as "welcome to Wendy's, would you like the oxygen today, or can we supersize you to a ventilator?"
  • jschwartzi 6y ago
    I'm not sure what you're arguing for here. There's a very short period of time between when a patient starts drowning in their own fluids and when they die. So you need to be oxygenating in a clinical setting because you need people immediately available to intubate in case your oxygenated patient starts drowning in their own fluids, which they do often. That's why it confers a 12% survival rate. If you've progressed to the point where supplemental oxygen doesn't work then you're pretty close to dying. I'll take 12% over 0% any day of the week. As always you should look past the statistics to what actually needs to happen in those situations. Statistics provide very little assistance in determining whether an individual patient needs to be hospitalized or not. You can't look at someone and go "oh this guy is one of the X% that will eventually need a ventilator." You have to assume that any one patient that needs supplemental oxygen may be one of that X%. So sending people home with supplemental oxygen should be a last-ditch effort if the hospitals become completely overwhelmed, not a routine activity. And to facilitate that, we should absolutely be trying to keep people from getting sick so our hospitals remain open for the unavoidable cases.
• baxtr 6y ago
  Great observation. I see the same pattern in other countries, too. One reason for this I believe is the lack of “goal clarity”. What’s the goal we’re aiming for? I see several options: 1) we want to eradicate the virus from our population => total cases matter and should be 0 sometime soon, I think that was and is China’s goal 2) we don’t try to eradicate the virus, but we want to keep the stress on the health system manageable => total cases don’t matter that much, bed capacity is the relevant indicator. This seems to be the goal of the “flatten the curve” thinking 3) we don’t care that much, let the virus spread like wildfire so we will have herd immunity asap => I am not sure, but from outside it seems like Brazil is trying to do this I think the reason you and I are confused is because it’s seems to be unclear if we are trying to achieve 1) or 2). It’s not communicated. Maybe it’s unclear to policy makers, too.
  • kelnos 6y ago
    I think the goal a couple/few months ago was #2, but in the meantime we've learned that there might be some bad long-term consequences to contracting the disease that weren't previously known, like possible permanent respiratory damage. Without that, then we shouldn't be too worried about getting the disease as long as we keep transmission rates low enough so hospitals don't get overwhelmed. But if some people end up with long-term respiratory issues after contracting the disease, now there's a reason to keep people from getting it, period, regardless of hospital capacity. But it would be nice to hear these goals actually articulated by public health officials. I'm not sure if my above paragraph is actually what any public health officials are thinking or are worried about (I'm just guessing), but it would be nice to know, because I agree with you that there seems to be a lack of "goal clarity" at this point.
    • SpicyLemonZest 6y ago
      All American public health officials I've heard have been pretty clear about their goals: we're trying to titrate our social distancing, finding the least severe restrictions necessary to keep cases from spiraling out of control and then staying there until a vaccine. There were some early proposals to drive the pandemic extinct before reopening, but they've been uniformly abandoned in the US because they weren't working.
• reaperducer 6y ago
  For some reason headlines always seem to be number of cases or positive test results, and maybe then the number in the hospital is mentioned The problem is that in a lot of places, the information about hospital use isn't available, isn't timely, or isn't reliable. Hospital owners and their lobbying groups have blocked some states and county health departments from reporting such information, claiming it's "proprietary information." One of the Las Vegas newspapers had a series of articles about it. The hospital lobbying group actually somehow "prohibited" the state from releasing the information, as if hospitals have some kind of authority over the government.
• dnprock 6y ago
  Hospitalized Increase is being tracked. The good news is it hasn't increased with positive cases. That is likely because the younger infected cases. https://vida.io/dashboards/ckbk04mht00000ul63lr6m53w https://vida.io/dashboards/ckbk04mht00000ul63lr6m53w
• kaitai 6y ago
  I think it's purely a media thing. When the public health folks I know have been modeling, they've been modeling with a primary eye toward number of ICU beds needed and number of ventilators needed. For instance if you look at https://mn.gov/covid19/data/modeling/index.jsp https://mn.gov/covid19/data/modeling/index.jsp which has a pretty decent model (on Github at https://github.com/MN-COVID19-Model https://github.com/MN-COVID19-Model) you can see all their pdf slides predict peak infection, number of ICUs/vents needed, and then mortality. But that's not what gets headlines, as you observe. It is certainly true that survival rates have improved as treatments have changed based on experience. I think folks know better how to manage things at home, to some extent. Earlier testing also allows earlier intervention, which allows treatment that may avoid ventilator usage. Vent usage corresponds with pretty poor outcomes, although that too is improving.
• newacct583 6y ago
  > Could it be the people getting the virus now are less likely to end up in the hospital so that number won't keep going up to the point of causing trouble? It could. Or it could be simply getting out of control (though specifically California is in much less trouble than Texas, Florida or especially Arizona at the moment). The point is that (1) it's fundamentally impossible to tell the difference until the bodies are counted and (2) the boundary between "well under capacity, we're fine" and "well over capacity, tens of thousands needlessly dead" represents just a week or two of growth. We don't have time to wait and see, we need an answer now. And we can't get it until the demographics is done postmortem. So what is supposed to happen is that we all behave conservatively until the outbreak shrinks to the point where it can be contained via contact tracing. And... that almost worked. It worked in Asia and Europe, It almost worked here, at least in the hardest hit areas with the early outbreaks. But... it didn't take. Half the population decided they didn't need to bother with this stuff (largely because of reasoning like yours) and walked back into enclosed indoor spaces. And now we're right back where we were in March. Effectively no progress. While the rest of the industrialized world is finishing this off and coming back to life, we're having to talk about new lockdowns. It's so deeply frustrating.
  • SpicyLemonZest 6y ago
    You have a mistaken perception of what the rest of the industrialized world is doing. South Korea is talking about new lockdowns, China has imposed them, and much of Europe still hasn't really opened up. Only a very few countries believe they're "finishing this off".
    • newacct583 6y ago
      Rolling lockdowns are part of control. No one's expecting miracles until a vaccine is available. Still, Europe is clearly winning this battle. Italy and Belgium had BY FAR the worst outbreaks in the world in March. Now they have a lower new case rate than any state in the US. Any of them, including Hawaii. They are sitting at about 10% of the new case rate of Oregon. Arizona has them beat by more than two orders of magnitude. And again, a month and a half ago we were on the same trajectory. And we gave it all up, because MAGA, I guess.