We look at the disease and how it's consumed the world
By Anthony Lee, MD
Faculty, Harvard Medical School
As we make our way through this pandemic, many of us are wondering about its scale and what's in store for the future. Objectivity is lost in the swamp of catastrophic thinking, conflicting opinions, and political agendas. To regain our objectivity, we must examine the numbers.
Many different sources supply us with numbers describing past, present, and future trends in various places around the globe. These numbers tend be focused regionally and are often used in conjunction with info relating to Italy as the de facto standard.
This makes sense, given that data should be relevant to local needs and that Italy has been through the worst of it. Hospitals are using this information to predict how this pandemic will affect their areas locally and allocate resources accordingly. Public policy should also be driven by this data.
Like most authors, I have included Italy in the mix, and I've highlighted the effects of its lockdown on March 9th in terms of cases and deaths. I've added Belgium because it locked down 9 days after Italy, and it would be useful to see if their results resemble Italy's.
The UK's situation is an interesting one; initially it just let things happen so that herd immunity would develop, then later mandated social distancing followed by a relative lockdown. Ireland and Northern Ireland were added separately to represent progressively smaller scale versions of the UK only in terms of when they started social distancing (March 23-24) and eventual relative lockdowns (March 26-27).
New York State was included because it carries approximately 36% of all cases in the US and roughly 10% of all cases in the world. Finally, Sweden is noteworthy because it enacted measures very late (March 29). But when it did, the measures were significantly less restrictive than those of other countries.
The charts used below present data as cases vs. time, or deaths vs. time. With this presentation, it appears that the US has the most cases, and that things must be terrible here. In places such as NY State, it is.
But keep this in mind: the population of the entirety of the US is 331 Million, while the population of NY State and NYC is 19.5 Million and 8.6 Million, respectively. While the US has about 422,800 cases in total as of today, NYC has roughly 78,000 cases.
If these numbers were expressed on a per 100,000 population basis, you'd get a clearer picture of specific geographic severity. For example, the US situation is better expressed as 128 cases per 100,000, and NYC's very concerning 903 cases per 100,000.
By comparison, Italy, a known hot spot for the COVID pandemic, has 139,442 cases today with a population of 60.48 Million. That's 230 cases per 100,000 people. Therefore, for charting both the number of cases and deaths with respect to time, the values will be expressed as per a 100,000 population basis.
Due to time differences, US data reports lag behind the UK and European countries. Therefore, US plots are likely to be limited to the day before a report is published. In some cases, late reporting from European countries and the UK may also limit plots to the day before.
Figure 1. Cases per 100,000 population by location and correlated rate of change.
Looking at Figure 1, we can see the effects of lockdowns and social distancing. It took Italy 10 days to finally reduce the number of daily new cases (basically, the rate of change curve has flattened). This trend has continued for the last 20 days, producing the trailing edge of Italy's pandemic.
Within 9 days Belgium reduced the number of daily new cases and continued on a downward trend for the last 12 days. It took Ireland 6 days of lockdown to reduce their daily new cases, and this trend has continued over the last 6 days. Northern Ireland took 7 days of lockdown to reduce their daily new cases, and this trend has continued over the last 5 days.
Despite loose social distancing, Sweden continues on a low and flat trajectory. Perhaps this can be accounted for by lack of testing.
Due to the setting of social distancing policies, the UK remains on a low and flat trajectory.
Despite a shortage of testing NY State and NYC cases are rising dramatically. Testing has increased in Massachusetts over the last 2 weeks, and this is reflected in the figure. While NY has been about 5-8 days behind Italy over the last several weeks, Massachusetts has been roughly 21-23 days behind.
Although both NY and Massachusetts started their social distancing advisories at the same point in time. Relative to Italy's social distancing, Massachusetts had a roughly 2-week head start on NY. This may have caused the relative flattening of new cases in Massachusetts over the last 6 days. This may change, however.
Rates-of-change plots appear in surges or waves. In locations that are improving, each subsequent wave is smaller than the previous one. This forms the trailing edge of the pandemic in a given location. In locations that are worsening, each subsequent wave is larger than the previous one, forming the leading edge of a worsening pandemic.
Figure 2. Deaths per 100,000 population by location and correlating rate of change.
In Figure 2, we can see the rising deaths by location.
In the rates-of-change chart, the number of daily new cases flattened are delineated by date.
From the point of delineation rightward, we can see when daily deaths begin to decrease. This lag time varies with locations. For Italy, this lag time was 8 days. For Ireland, these reversals were basically at the same time. For Northern Ireland, the lag time was 1 day.
For these countries, the time between lockdown/social distancing and reduction of daily deaths was 18 days for Italy, 6 days for Ireland, and 8 days for Northern Ireland.
I will update and discuss these charts in future installments of this series.
Sources of data: Worldometer.com, Spectrum News NY1, Massachusetts Department of Public Health, HSC Public Health Agency
Look on our works, ye mighty, and despair!
There is a saying that it is easier to imagine the end of the world than to imagine the end of capitalism.
Entrenched systems of power have established bulwarks against the kind of institutional reform that younger Americans have recently been pushing for. By controlling the political conversation through lobbying, control of mass media, regulatory capture, and authoring of legislation, the ultra-wealthy maintain the status quo in a way that makes changing it seem impossible. The problem is that change is desperately needed if we are going to maintain any semblance of civilization.
While political dynamics have become so rigid that the boundaries of what we can achieve begin to feel impenetrable, the COVID-19 pandemic has revealed that the vital structures of our society—a society that is superficially so robust—have been so weakened that a collapse in one form or another is inevitable. We are the world's superpower, yet faced with a slightly more contagious, slightly more lethal virus than the flu, we are powerless. How did it get to be this bad? How were we so blind to it?
To clarify, depending on the part of the country you live in, it could seem like I'm exaggerating. It may not seem "so bad," or like we're on the verge of collapse. Not long ago the president and many of his loyalists on Fox News and AM radio were still calling dire forecasts around the coronavirus a hoax. At the time it seemed reckless but not unhinged from current events—which were still largely unaffected. In much of the country there is little cause for alarm, so few people are doing much to change their behavior. That's about to change, and the areas hit worst will soon be making the dire choices that Italian hospitals were recently faced with—which patients are we going to hook up to ventilators, and which are we going to allow to die. We are already started on a path that leads to overflowing hospitals in every major city.
A makeshift testing facility in Seattle, Washington Getty Images
The problem is that our entire economy is set up around the same kind of short-term thinking that drive publicly traded corporations. The mentality that "government should be run like a business," leads to cost-cutting measures that only look to the current budget, with minimal consideration given to the kind of intermittent crises that we are bound to face—like a viral pandemic. If it's not particularly likely to happen before the next election cycle, it's better not to even worry about it. This is the kind of thinking that led Donald Trump's administration to push for cuts to the CDC and to disband their global health security team in 2018.
But the systemic issues go much deeper than that and started long before Trump took office. Trump and his ilk can't be blamed for the fact that the US has two hospital beds for every 1,000 citizens. Nor are they responsible for the fact that almost every aspect of America's critical infrastructure receives a near-failing grade from the American Society of Civil Engineers. This includes airport congestion—which has already become an issue with the current pandemic—and important shipping routes that we will rely on to maintain the movement of necessary goods as conditions around the country worsen.
Add to those issues the fact that we have a massive population of prisoners sharing tight quarters with poor sanitation, a substantial homeless population with no way to quarantine, a dearth of worker protections like paid sick leave, and it becomes hard to imagine how we'll get through this unscathed. And, of course, this is still ignoring the elephant in the room—a for-profit healthcare system that discourages millions of uninsured and underinsured Americans from seeking medical advice or treatment until it's too late.
Meanwhile, the economic hardships imposed by the necessity of social distancing are being exacerbated by an economy that is heavily reliant on the whims of financial speculators who create an echo chamber of divestment that heightens every crisis. The stock market, in other words, is going crazy in the worst possible way. It's too soon to say how thoroughly the weaknesses in our system will be tested by the developing pandemic, but even in the best case scenario they are going to be strained to a terrifying extent.
Fortunately, there are efforts underway to shore up some of the most obvious breaking points so we can avoid complete societal collapse. They may turn out to be too little too late, but even if they get us through this current disaster, how long will it be before the next one hits? The best models of climate change predict that we are nearing an era that will be ruled by powerful natural disasters and refugee crises that will threaten economic stability and critical infrastructure and may heighten the threat of infectious diseases. Temporary, reactive measures cannot save us if the next crisis hits a little harder or when multiple crises overlap.
A strong social safety net like the one the US tried to develop under FDR would serve to mitigate the damage from this kind of crisis. But modern American politics has worked for decades—in an effort that became an object of worship under Ronald Reagan—to whittle the welfare state of the New Deal and the Great Society down to a fragile bare minimum.
We need to take seriously the voices of politicians like Bernie Sanders and Alexandria Ocasio-Cortez who have called for the kind of broad, sweeping legislation that stands a chance of upending the rigid political dynamics that maintain the status quo. The Green New Deal would be a good start. The alternative, one way or another, is the end of our civilization and the world as we know it.
This year's flu virus is still slated to be a bigger threat.
It's believed that Chinese officials have not exactly been forthcoming about the true extent and severity of the coronavirus, a respiratory illness whose death toll in mainland China has now exceeded that of S.A.R.S. The Chinese foreign ministry has criticized the U.S.'s response of temporarily banning foreign individuals who had traveled in China from entering the country. Chinese officials initially said that U.S. health officials "inappropriately overreacted" and spread unnecessary fear. However, on Monday (February 3) China's elite Politburo Standing Committee admitted that there were "shortcomings and difficulties in the response to the epidemic," according to China's Xinhua news agency. The government said it "urgently" needed medical supplies, such as protective suits and masks.
When the World Health Organization (W.H.O) declared the virus a "public health emergency of international concern," they said its organization "continues to have confidence in China's capacity to control the outbreak." They stated that their concern is about the virus' potential to reach countries with poor health care. In such an environment, the disease could spread rapidly, "infecting millions of people and killing thousands," according to The New York Times.
With over 20,000 cases reported in China and 170 more reported in over 25 other countries, the Centers for Disease Control and Prevention (C.D.C.) has been rapidly updating their findings on the respiratory disease. 11 cases have been confirmed in the U.S. (including 3 in California, 2 in Illinois, 1 in Arizona, 1 in Massachusetts, and 1 in Washington). More cases are currently under review. As of this writing, three New York cases have been sent to the Center for Disease Control and Prevention Laboratory in Atlanta, which is currently the only facility that can confirm a case of coronavirus. The New York City health commissioner has called the virus's presence in the city "inevitable."
But what does that really mean?
The coronavirus is distinct in a few ways, originating in animals in Wuhan, China but demonstrating the ability to spread from person to person once someone is infected. Symptoms present as common flu symptoms, including fever, dry cough, shortness of breath, aching muscles, and fatigue. There have been indications to suggest that individuals infected with the coronavirus are contagious before they show symptoms, but that has not been widely confirmed.
Out of over 20,000 confirmed cases spread across more than two dozen countries, there have been fewer than 500 deaths, with two deaths occurring outside of China so far. Most people infected have been elderly or those with compromised immune systems, and there have been full recoveries from the virus.
In fact, the first American patient confirmed to have the coronavirus has been released from the hospital and is staying in isolation in his home. "I am at home and continuing to get better," the nameless man said in a statement, "I ask that the media please respect my privacy and my desire not to be in the public eye. I would like to thank the doctors, nurses, and entire team at Providence who cared for me. I appreciate all of the concern expressed by members of the public, and I look forward to returning to my normal life."
The flu is more dangerous.
Meanwhile, public health officials underline that the coronavirus presents a low health risk to Americans. More dangerous is influenza B, or the common flu. The C.D.C. reports that 68 children have died of the flu this year, along with an estimated 10,000 adults! Todd Ellerin, the director of infectious diseases at South Shore Health in Massachusetts, told Mother Jones that the flu is "massively outstripping" the spread of the coronavirus in the U.S. He added in a a blog post for Harvard Medical School, "In the US, the average person is at extremely low risk of catching this novel coronavirus. This winter, in fact, we are much more likely to get influenza B—the flu—than any other virus: one in 10 people have influenza each flu season."