5 ms·

On number 2: that makes a lot of sense; yet in places that have had peaks (e.g. new york, italy, UK, spain) the peak observed fatality moment is barely shifted

by emn13 6y ago

On number 2: that makes a lot of sense; yet in places that have had peaks (e.g. new york, italy, UK, spain) the peak observed fatality moment is barely shifted vs. the peak positive testing moment - maybe more like a week or so, normally? In all the data it's a little hard to spot trends, especially with testing rates scaling up, but still the graph peaks are not even close to a month apart, even where testing rates don't appear to be too variable. One comparison: https://datagraver.com/corona/#/?regions=italy:hex005FA2,spain:hex7FAB60,united%20kingdom:green&logScale=false&perCapita=true&cutYaxis=true&cumulative=false&types=1,2,4,3&mappingType=date&mappingMaxDays=120&mappingStartNumber=100&mappingNumberStyle=absolute&mappingEventType=lockdown&mappingDate=2020-3-1&smoothening=undefined&description=Tool%20for%20comparison%20on%20Covid%2019%20development%20for%20countries%20and%20regions https://datagraver.com/corona/#/?regions=italy:hex005FA2,spa... Massachusetts has fairly well defined peaks too: https://covidtracking.com/data/state/massachusetts https://covidtracking.com/data/state/massachusetts What's causing this discrepancy? Clearly the disease progression isn't that fast, so... what then? Maybe the more vulnerable groups tend to get hit more quickly, and as cases ramp up either die earlier or lock down more rigorously or both, such that the less-vulnerable form an infection peak after the death peak has passed? Or is it simply that people get tested late in the disease progression? Given how little the MA testing rate has varied, and that the positive rate peaks also are much closer than a month apart from the fatality peak, I don't think testing changes seem likely to be a primary cause of the (to me) unexpectedly short period between case peak and death peak.

lubujackson 6y ago
The big difference is testing capabilities. All places hit by big waves early on suffered from poor testing and public awareness, so testing happened in a burst as the deaths were starting to become problematic. And generally those getting tested at peaks were the symptomatic/hospitalized. NYC is estimated to have been around 20% infected, so the actual infection count was highly undereported. It is important to also recognize that every location hit hard was met with immediate lockdown, generally followed well by scared populations. The situation is far different now, with a good chunk of people actively rejecting even basic distancing measures. If you look beyond positive test numbers at the % positive you can see the rates are rising even faster beyond our testing capabilities. And the idea that only 20-30 year olds are getting the disease is wishful thinking - the highest risk situation is from household transmission, at over 80% likely. Combine high infections with a general disregard of safety and those older populations are bound to be infected as young spreaders interact with their families, at offices, supermarkets, etc. I think this is why the death spike lags a fair bit further than expected.
- irq11 6y ago
  ” And the idea that only 20-30 year olds are getting the disease is wishful thinking - the highest risk situation is from household transmission, at over 80% likely. Combine high infections with a general disregard of safety and those older populations are bound to be infected as young spreaders interact with their families, at offices, supermarkets, etc. I think this is why the death spike lags a fair bit further than expected.” Three things: 1) It’s been over a month since case count started to grow in the southern states. Hospitalization and deaths by day are not growing at all in FL or AZ, and only hospitalizations are growing slowly in TX: https://covid-19.direct/state/FL?tab=daily https://covid-19.direct/state/FL?tab=daily https://covid-19.direct/state/TX?tab=daily https://covid-19.direct/state/TX?tab=daily https://covid-19.direct/state/AZ?tab=daily https://covid-19.direct/state/AZ?tab=daily 2) It isn’t “wishful thinking”; the age distributions of positive results out of Texas clearly show that most of the people testing positive are younger, and it seems to be true in FL as well: https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/3f048ced32804271aafe8b9640bcb4a7 https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#... https://www.google.com/amp/s/www.news4jax.com/news/florida/2020/06/19/gov-desantis-median-age-of-florida-covid-19-patients-declining/%3foutputType=amp https://www.google.com/amp/s/www.news4jax.com/news/florida/2... 3) It’s not very common to see multi-generational households in the US. Maybe it’s true that this surge will eventually make it’s way to the high-risk, but it’s been over a month already, and that doesn’t appear to be true yet. At some point, predictions of the future have to be tempered by current evidence.
jhayward 6y ago
Although treatment has definitely improved outcomes, IMO, at least some of this effect has to be due to the changing demographics of testing. In the early days patients essentially had to be far along in the progress of the disease to be tested, we simply had very little testing capacity. Now we are doing many times more tests against a much wider set of subjects. So it is inevitable that we are getting more of the milder cases and cases earlier in their development. This also accounts for the so-called “shift” toward many more young patients. The disease hasn’t changed. Current testing is sampling a different distribution of patients than previous months had been.
- emn13 6y ago
  https://coronavirus.jhu.edu/testing/individual-states https://coronavirus.jhu.edu/testing/individual-states the positive rate of testing is indeed much lower now, suggesting testing is meaningfully broader. On the other hand, it's only a factor 3, which is certainly nothing to sneeeze at, but still remarkable that that's enough to so strongly decouple mortality from infection, compared to earlier.

by emn13 6y ago

lubujackson 6y ago

The big difference is testing capabilities. All places hit by big waves early on suffered from poor testing and public awareness, so testing happened in a burst as the deaths were starting to become problematic. And generally those getting tested at peaks were the symptomatic/hospitalized. NYC is estimated to have been around 20% infected, so the actual infection count was highly undereported. It is important to also recognize that every location hit hard was met with immediate lockdown, generally followed well by scared populations. The situation is far different now, with a good chunk of people actively rejecting even basic distancing measures. If you look beyond positive test numbers at the % positive you can see the rates are rising even faster beyond our testing capabilities. And the idea that only 20-30 year olds are getting the disease is wishful thinking - the highest risk situation is from household transmission, at over 80% likely. Combine high infections with a general disregard of safety and those older populations are bound to be infected as young spreaders interact with their families, at offices, supermarkets, etc. I think this is why the death spike lags a fair bit further than expected.

irq11 6y ago
” And the idea that only 20-30 year olds are getting the disease is wishful thinking - the highest risk situation is from household transmission, at over 80% likely. Combine high infections with a general disregard of safety and those older populations are bound to be infected as young spreaders interact with their families, at offices, supermarkets, etc. I think this is why the death spike lags a fair bit further than expected.” Three things: 1) It’s been over a month since case count started to grow in the southern states. Hospitalization and deaths by day are not growing at all in FL or AZ, and only hospitalizations are growing slowly in TX: https://covid-19.direct/state/FL?tab=daily https://covid-19.direct/state/FL?tab=daily https://covid-19.direct/state/TX?tab=daily https://covid-19.direct/state/TX?tab=daily https://covid-19.direct/state/AZ?tab=daily https://covid-19.direct/state/AZ?tab=daily 2) It isn’t “wishful thinking”; the age distributions of positive results out of Texas clearly show that most of the people testing positive are younger, and it seems to be true in FL as well: https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/3f048ced32804271aafe8b9640bcb4a7 https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#... https://www.google.com/amp/s/www.news4jax.com/news/florida/2020/06/19/gov-desantis-median-age-of-florida-covid-19-patients-declining/%3foutputType=amp https://www.google.com/amp/s/www.news4jax.com/news/florida/2... 3) It’s not very common to see multi-generational households in the US. Maybe it’s true that this surge will eventually make it’s way to the high-risk, but it’s been over a month already, and that doesn’t appear to be true yet. At some point, predictions of the future have to be tempered by current evidence.

jhayward 6y ago

Although treatment has definitely improved outcomes, IMO, at least some of this effect has to be due to the changing demographics of testing. In the early days patients essentially had to be far along in the progress of the disease to be tested, we simply had very little testing capacity. Now we are doing many times more tests against a much wider set of subjects. So it is inevitable that we are getting more of the milder cases and cases earlier in their development. This also accounts for the so-called “shift” toward many more young patients. The disease hasn’t changed. Current testing is sampling a different distribution of patients than previous months had been.

emn13 6y ago
https://coronavirus.jhu.edu/testing/individual-states https://coronavirus.jhu.edu/testing/individual-states the positive rate of testing is indeed much lower now, suggesting testing is meaningfully broader. On the other hand, it's only a factor 3, which is certainly nothing to sneeeze at, but still remarkable that that's enough to so strongly decouple mortality from infection, compared to earlier.