Bacon's Rebellion

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COVID-19 Update: March 20

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by

James A. Bacon
in

The latest count reported by the Virginia Department of Health at noon: 114 confirmed cases of the coronavirus — up 20 from the day before. The number of new cases is increasing each day. Is that evidence that the viral spread is gong exponential? Are Virginia’s social-distancing measures working? 

On the other hand, consider this. Due to the shortage of testing kits, tests have been reserved for patients who seem most likely, based on their symptoms, to have a COVID-19 infection. These aren’t hypochondriacs, or random people coming off the street. For the most part, they have fevers, dry coughs and other tell-tale symptoms. even so, of 2,325 people tested to date, only 114 actually have the virus. Only 5% have tested positive. That suggests to me that community spread of the virus has yet to take off. Am I missing something?

— JAB

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24 responses to “COVID-19 Update: March 20”

  1. CrazyJD Avatar
    CrazyJD

    You’re missing the problem of using test kits on those who are already symptomatic. See Neeraj Sood’s (USC professor for Health Policy and Economics) article in WSJ Mar 15

    “Testing only sick or symptomatic patients will not get us to the truth. To see why who we test matters, consider the flu. Its mortality rate is around.1% – meaning that of everyone infected with the flu, tested or not, 1 in 1000 dies of it. If we only tested people who are hospitalized with flu-like symptoms, the mortality rate jumps 75 fold. … the way to learn the truth is to test a random sample of the population in major cities with an outbreak. ”

    Consider also, that testing someone who has flu does not change the result; the treatment is the same, at least so far as we don’t or can’t use that malaria drug.

    1. LarrytheG Avatar
      LarrytheG

      I think I might agree with Crazy – if we had enough test kits and we started early on.

      but you’d have to keep repeating random – what ? almost daily ?

      and when you did that and found infected – you’d think look for who they had contact with and quarantine all? That would take a LOT of test kits and a LOT of manpower and a LOT of places to put people, no?

  2. djrippert Avatar
    djrippert

    “For the most part, they have fevers, dry coughs and other tell-tale symptoms. even so, of 2,325 people tested to date, only 114 actually have the virus. Only 5% have tested positive. That suggests to me that community spread of the virus has yet to take off. Am I missing something?”

    You could be missing something. New York state is 2.3X more populous than Virginia. New York has done 13.8X more tests. In one night (last night) they performed more than 3X the number of tests that were performed in Virginia since the start of the epidemic.

    How many people who have presented themselves with symptoms in Virginia have been told that they don’t fit the profile for testing? New York has federal permission to do its own testing and seems to be very aggressive in doing its own testing. Where are we on that?

    Moreover you may be asking the wrong question. Even if community spread has not yet taken off in Virginia is there any reasonable chance that it won’t take off? People are still going to stores, getting “to go” from restaurants, etc.

    New York has tested 0.16% of its population. Virginia has tested .027% of its population.

    For all of my criticism of The Washington Post they seem to have dropped their paywall for coronavirus articles. If I am right – good for them. Here is an excellent article – Is NYC the epicenter because they have more density or because they have done more tests?

    https://www.washingtonpost.com/politics/2020/03/19/new-york-city-is-epicenter-coronavirus-us-is-this-due-density-or-testing/

    1. LarrytheG Avatar
      LarrytheG

      re: WaPo.. yep .. haven’t even heard TMT call them a lying sack of excrement lately…

  3. Atlas Rand Avatar
    Atlas Rand

    The New York Times has also removed its paywall for all Coronavirus related content. Had a good deal the other day of $1 a week for all content as well.

  4. Acbar Avatar
    Acbar

    Thank you, Jim, for the daily updates. I think everyone should simply study this chart, from the WaPo:
    https://arc-anglerfish-washpost-prod-washpost.s3.amazonaws.com/public/SS7EVNGK4NEQZOGGDCVXJDSB7E.jpg
    Read more about this in the source article: https://www.washingtonpost.com/health/2020/03/19/coronavirus-projections-us/ The one important, unstated assumption underlying these graphs is that social distancing is assumed to remain in full effect until the end of August, then arbitrarily is assumed to cease across the board. Realistically it probably would be a more gradual phase out.

    1. Steve Haner Avatar
      Steve Haner

      Great. I just moved the Rhine cruise from June to October. Now it looks like I have to call back and move it to ’21….

      I see those charts, and I can’t help but think, why not just get it over with? Why draw out the pain and economic destruction? And again, I say that as part of the “65+ with some kind of condition” cohort…..We can build the bed capacity (China did) and they are working on treatments that shorten the down time and lessen the chance you’ll need a ventilator.

      1. djrippert Avatar
        djrippert

        I’m starting to agree with you. At some point people know the risks. Let the businesses reopen. If people want to self-isolate then that’s what they should do. If they want to practice general social distancing then that’s what they should do. According to these graphs we will be multiple times above the surge critical care bed capacity no matter what we do. I also wonder about people who have recovered. I assume they are immune to COVID-19. Why should they be restricted?

      2. Acbar Avatar
        Acbar

        There is a real argument for “get it over with.” The UK actually considered that as deliberate policy: let it spike and saturate the population to the point of herd immunity going forward. Unfortunately the overwhelmed medical services during the spike (thereby compromised for everything else they treat in ICUs also), the higher death rate of diagnosed (let alone actively-symptomatic) people with no hospital to take them (4-5% versus <0.4%), the total number of dead, was simply unacceptably larger on the get-it-over-with path. Mitigation at least is the only way. Take a look at these statistics and charts if you’d like to get a more in-depth picture of the options and how they compare (this paper concludes for the opposite extreme, supression [a la S. Korea] as quickly as possible . . . now circulating among my daughter and her medical friends). https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56 Of course, whether it’s mitigation or suppression, we must have testing, testing, testing!

        1. LarrytheG Avatar
          LarrytheG

          You can do that – but a lot of people are going to die.

          And we’re really already at the point where it might happen anyhow since we’re maxed on our medical supplies ……

          China got through it and so did South Korea but South Korea was much better prepared than us…

          We’re pretty pitiful. We fail to plan and react then we blame each other.

          geeze.

        2. Acbar Avatar
          Acbar

          Agreed, we fail to plan, we have been incompetent up to now — but now is now and we have to beat this from where we stand today. It’s just pathetic to run out of face masks! Where are those damned tests — yes, those tests, the ones the VP promised millions of, available for anyone to access, last week?? What really is the Virginia situation on reserve respirators? Some frank and transparent talk, some leadership, concerning where we really are in getting these supply chains up and running would help my anxiety, for sure.

          1. LarrytheG Avatar
            LarrytheG

            failure to plan has consequences that we may not be able to fully remediate. Even the US might be unable to make it all up and some of us will die…

            The thing is we saw China and Italy but we also saw South Korea and we essentially did nothing until when, March?

            We’ve scrounged around in our workshop and found some masks and vinyl gloves… and we have a supply of bleach and alcohol… but no luck on TP yet…and not sure if napkins and paper towels go into a septic tank.

            I fear public places if the contagion goes high order and thousands are infected and more actively being infected. You don’t want to be around public places then unless you have absolutely no choice and even then you may well be risking your life. That 10 person limit may well drop to 5 or 2 or go away.

  5. cjbova Avatar
    cjbova

    On top of the fact that doctors are not testing mild cases, but sending them home to self-isolate for 14 days,* how much is VDH “managing” the daily reports to keep from showing spikes? I read about three cases in the news before noon yesterday, but Accomack, Gloucester and Norfolk weren’t in the count until today. Gloucester’s was announced by Three Rivers Health District and on the news at 10:21 a.m. https://www.wtkr.com/news/first-pediatric-coronavirus-case-reported-in-gloucester-co .

    Does it matter in the long run if the daily counts are understated? Are predictive assessments based on them valid? Would higher numbers change people’s behavior?

    I saw a chart yesterday with the cases by locality identified as travel-related, from personal contact, and unidentified. Couldn’t find it today. But those unidentified numbers sure looked like there was community spread involved.

    There are potential sources of contact I haven’t seen cautions about reminding people to use sanitizer after using keypads for debit card purchases or the handles of hoses at the gas pump. Great ways to pass it on in the community!

    *From my own doctor’s office update today about the limited number of tests they have available, and why not everyone with a cough or other symptom gets tested: “If a patient is only having mild symptoms and is a low risk patient, it is it best to just self isolate – stay home. Honestly, there isn’t anything we can do except recommend to get rest, drink lots of fluids, and take decongestants. If, however, symptoms are more severe or getting worse, such as shortness of breath or high fever, we will likely advise you to go to the hospital. There still is no treatment.”

    1. James A. Bacon Avatar
      James A. Bacon

      If I recall correctly, there is a 19-hour delay in reporting the COVID-19 data. VDH wraps up at the end of the business day, spends time confirming the data, then publishes the updated data the next day at noon.

      1. Acbar Avatar
        Acbar

        Since we know the data under-reports the number of cases out there that amount of delay probably has no significance; but when (if!) we ever get to on-site drive through testing and the like, that long a delay is going to become an impediment. How did S. Korea speed it up? We don’t have to reinvent the wheel here.

        1. LarrytheG Avatar
          LarrytheG

          here’s one:

          How South Korea Triumphed, and the US Floundered, Over the Pandemic

          Testing, national health care, and transparency saved the day.

          https://www.thenation.com/article/world/coronavirus-south-korea-america/

  6. LarrytheG Avatar
    LarrytheG

    I think we’re finding out some things:

    1. – govt is not perfect, in fact, sometimes is downright incompetent

    2. – there is no backup to govt – it’s what we got

    3. – We have something going on right now that apparently was inconceivable to a lot of folks including those in govt – not just Washington, all the states, and most other countries..

    4. – we have no established approach/plan/process/contingency for what is happening..

    5. – most folks ARE listening to the scientists…

    6. – there are STILL some “anti” types on the right…

    7. – Our world is much more fragile than many thought

    8. – I’ll not make the claim but others will with respect to whether Global
    Warming has similar potential for calamity.

    1. djrippert Avatar
      djrippert

      “6. – there are STILL some “anti” types on the right…”

      Wasn’t it Mayor Comrade de Blasio that kept the largest school system in America open long after many other entire states closed their systems? He was concerned that some less affluent people might have to purchase daycare. Now his city is the American epicenter of the COVID-19 disaster.

      Lots of dimwits in the world Larry, some on the left, some in the middle, some on the right.

    2. Steve Haner Avatar
      Steve Haner

      I guess the contrarian comment I added above makes me suspect, right Larry? But it seems like X number are going to get sick, either over two months or over ten, so why not push through it? Trump’s discussions the other day of the proposed treatments (which actually have been widely used overseas) was met with politically-driven derision. But they are science based. I first read about them on WattsUpWithThat and you and others would reject it just because of the source! Science was probably less politicized in the time of Galileo….

      As to this being “inconceivable,” the military has been thinking about “germ warfare” for a long time, planning and preparing. And the public has been well conditioned (too well) by years of Zombie movies and Walking Dead reruns….I’ve already mentioned reading King’s “The Stand” 30 years ago. No, we’ve been conceiving this for a long time. (Did they run out of TP on Walking Dead? Is that why everybody is hoarding that?)

      1. LarrytheG Avatar
        LarrytheG

        feeling a tad bit guilty? 😉

        I’ve had similar thoughts…oh bite my tongue.

        Trump is an idiot – no two ways about it. The science people on the stage with him did NOT concur and I’m sorry I’ll believe what a science person says any day over the week over the offal that comes out of this POTUS pie hole.

        You’re frustrated – and I’m with you. I do not understand why this particular emidemic is so different from the prior ones. We have no real explanation – over than this one is “novel” as if that means anything so why haven’t we had to do all what we have to do now – before?

        what’s different?

        This challenges all of our leaders and none of them have had much good training for this particular emergency. Translation – mistakes are going to be made but we are at the mercy of the folks in charge and truth be known I wonder the same about how far overboard is too far – but we could be very wrong – we just don’t know.

        If it were JUST the politicians telling us this stuff – I’d be suspicious, but we have almost all scientists saying it so that’s either real or a massive, massive conspiracy.

        And I can’t help but see some parallels with Global Warming.

      2. Acbar Avatar
        Acbar

        Steve, re “it seems like X number are going to get sick, either over two months or over ten, so why not push through it?” — I addressed that above so won’t repeat the citation there, but basically there are three reasons: many times higher death rate due to a higher proportion of people sick while the system is overwhelmed and can’t help them; the chance of Deus Ex Machina the longer we can wait (drugs that mitigate the infection; new treatments and/or drugs for the pulmonary effects; and eventually a vaccine); and a greater chance of economic recovery before irreparable harm (if we could suppress the infection growth curve below R=1, enough to get people back to work as quickly as they have in China and S. Korea).

  7. cjbova Avatar
    cjbova

    I could have the wrong idea about VDH and their numbers, but does the low availability of testing, and non-testing of mild cases mean we don’t know where to target hardcore efforts or recognize areas whose medical facilities can be overwhelmed by a surge in serious cases early enough to make a difference?

    “The Hammer and the Dance” paper Acbar gave us the link to asks,
    “Do you think this virus targets rich countries? Or is it more likely that rich countries are better able to identify the virus?” But another question is whether it’s that wealthier countries have more people able to travel world-wide, and we failed to track, isolate, and test enough of the travelers on their return–including military with a history of international travel.

    Military Times:
    “As of Friday morning, there are 67 service members battling COVID-19, according to Pentagon data, as well as 15 DoD civilians, 26 dependents and 16 contractors.

    “That’s about a 31-percent jump for troops — 51 cases were reported yesterday — and more than a 60-percent jump for dependents over Thursday’s totals. The military health system had tested more than 1,500 samples as of Thursday.”
    “One of the challenges with any infectious disease is when it becomes testable,” Lt. Gen. Ronald Place, director of the Defense Health Agency, told Military Times Thursday, when asked why the services were not doing more widespread testing. “What we’ve found — at least the current information — is asymptomatic people, even if eventually becoming positive wouldn’t screen positive at that time.”
    https://www.militarytimes.com/news/your-military/2020/03/20/number-of-coronavirus-cases-among-troops-jumps-nearly-25-percent/?utm_source=clavis&utm_expid=.dI5pu9xDQ5yC0HSsOtrcsw.0&utm_referrer=

    1. LarrytheG Avatar
      LarrytheG

      cue the “shit-hole” countries! All kinds of bad stuff happens to them and we never know or want to know!

      Although, we might be adding China and Italy to that list.

      good questions you ask.. sorry I’m such a cynic but yes, those countries with better reporting systems are more on top of
      issues like this – in my view.

  8. TBill Avatar
    TBill

    Fairfax Co. (Jeff McKay) gives daily list of positive cases (16 today) with age and source of contact. For example Nile River Cruise is 4 cases. Cases #14 and #16 they do not know the source as yet.

    Tidbit: McKay mentioned yesterday, re: COVID communication challenges, 40% of Fairfax Co. does not speak English at home.

    DC is saying schools resume April 27. I wonder if that will stand.

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