"On April 20, less than two weeks ago, Donald Trump predicted the ultimate coronavirus death toll would be between 50,000 and 60,000. At the time, the bet, however grotesque morally, seemed relatively safe politically." (1/x) nymag.com/intelligencer/…
"But on Wednesday, the total death toll crossed 60,000, on a day that represented a new peak in single-day American deaths from COVID-19: 2,700."
"Though the public narrative is that the country has turned the corner and gotten a handle on things, enough to begin slowly 'opening up,' the data tells a different story."
"A new daily peak means that even if deaths declined as rapidly now as they grew earlier this spring, when in a month total deaths grew from 3,834 to 62,860, we would be due for at least as many more deaths as we’ve had to this point. In other words, another 60,000 people."
"A peak is not an end; it is, in optimal circumstances, a midpoint."
"Considering we just reached that new peak, it is not a foolproof assumption that deaths won’t grow again. And even if we do assume it, there are many reasons to think the decline from that peak will be slower than the ascent—meaning considerably more than 60,000 more deaths."
"Through April, the projections from epidemiological models kept shrinking, producing a wave of 'good news' updates and a whole narrative among COVID skeptics that the projections were criminally alarmist. But the death figures have simply not cooperated with that optimism."
"The IMHE model, in particular, has come under increasing criticism — 'It’s not a model that most of us in the infectious disease epidemiology field think is well suited,' Harvard’s Marc Lipsitch told Stat News."
"Earlier in April, IMHE had revised its estimates downward, first from 93,531 to 81,766, then to 60,415. More recently, its projections have ticked back up with a present estimate of 72,433 deaths by August 4. If the country stays on pace, it will hit that number by May 4."
"For the last two weeks, the country has been on a roughly flat trajectory of 2,000 deaths per day. If it stays on that plateau through August 4, it would mean not 12,000 more deaths, but 180,000. And the pandemic wouldn’t simply end on August 4 just because the modeling does."
"Of course, we may well not stay on that pace, but decline. How quickly?"
"According to a survey of five major models, all project a quite rapid decline. In fact, a model based at the University of Texas now says with 100 percent certainty that the country has passed its peak — this despite the fact that just on Wednesday we reached a new peak..."
"...and despite the likelihood that no more than 5 percent of the country, at most, has been exposed to the disease."
"So, what is happening? Why is it that all efforts to project the future of the pandemic seem unable to see more than a week into the future? Why are they almost unanimous in projecting a precipitous decline that is almost every day contradicted by the number of new deaths?"
"There are two big explanations. The first is that even under present conditions, in which the spread of infection is being dramatically constrained by shutdowns, the disease is not behaving as we expected."
"It takes a little less than a week from the time of infection to the arrival of real symptoms; another week or so until those symptoms become serious enough to require hospitalization; and a week or two from there until those who ultimately die will die."
"That means the full life cycle of the disease, as we understand it, is about a month. A perfectly effective quarantine would therefore reduce practically to zero the number of new cases within a month of being implemented."
"By March 30, the overwhelming majority of U.S. states had issued stay-at-home directions. Which means that by April 30, one month later, anyone who had caught the disease before the lockdowns began should have already passed through the entire life cycle of the disease..."
"...and that all the new cases we are currently seeing are the result of infections since the shutdown. On April 30, after a month in which new cases ranged between 25,000 and 30,000, there were 29,500 new reported cases."
"It is not entirely clear what accounts for this. It could be there is some feature of the disease we do not yet understand, or something about how long it incubates which we have failed to recognize... "
"It is possible the disease remains infectious even after a patient has recovered, perhaps for a significant amount of time. ... "
"It is possible that sheltering at home is a flawed quarantining method, since family members can infect one another, and that some meaningful share of the new cases come from within quarantines. ..."
"It is possible that some meaningful share comes from within hospitals, with doctors and nurses and administrators all serving as vectors of the disease. It is possible that some meaningful share comes from the 50 million exposed front-line workers."
"Quite likely, a few of these factors, and possibly all, are contributing, to some degree. Together, they are preventing anything resembling a decline of deaths or cases as rapid as the ascent a month or so ago."
"Instead, under conditions that you might have thought, in theory, would bring the caseload close to zero in this amount of time, national deaths and caseloads have merely flattened out."
"But there is a second, more fundamental problem with nearly all the models you may have encountered, in one form of media or another over the last few months."
"Each is processing data—positive cases, hospitalizations, deaths—produced under those extraordinarily stringent social conditions. Each is generating a curve based on that data, which is to say, those conditions—the lockdown from which you are probably reading this story."
"Seeing a flattening in the number of cases or deaths, the models project a decline, even if the flattening is not a function of the disease itself but the extraordinary social conditions we have imposed on it."
"This is fine, so far as it goes, because it is useful to know the trajectory of infection under conditions of quarantine if you are under conditions of quarantine. But it only goes so far — as far as the quarantine goes."
"And that reopening is already starting, which means the conditions which have produced those elegant (and encouraging) curves are ending. Georgia’s reopening has already produced a thousand new cases in a span of 24 hours and is expected to double deaths by August."
Other places could see an even more dramatic spike with only a partial, or “midway,” return to nonessential business.
Even in those states where there has been relatively little spread, the reopening is taking place from a much, much higher baseline of current infection than is optimal—or, I think, assumed. Take Texas, for instance.
"And while some states are taking a more cautious approach, the disease isn’t very easily quarantined. 'That’s like having a peeing section in the swimming pool,' as Seattle public-health official Jeffrey Duchin put it recently. 'It doesn’t stay where you started.'”
"In all likelihood, the future course of the disease won’t follow an unmitigated trajectory — at least some amount of additional testing will allow us to control the spread a little more effectively, and presumably treatments will arrive that will at least lessen lethality."
"And so it is possible, perhaps even probable, that we will not again exceed the peak of daily deaths reached just this week, even after 'opening up.'"
"But while they have dominated talk about the state of COVID so far, peaks are less important the height than the area underneath the curve as it stretches out not just through the summer but into the fall and possibly into 2021 and even 2022."
"'That’s the risk we face here,' Scott Gottlieb said this week, 'that this doesn’t really go away because we don’t get rid of this round. That the mitigation steps weren’t quite robust enough, as painful as they were, and we continue to have spread right into the fall.'"
"On April 30, NBC News reported the federal government, even while signaling optimism about the course of the disease, had ordered 100,000 new body bags." (x/x)
"According to a survey of five major models, all project a quite rapid decline. In fact, a model based at the University of Texas now says with 100 percent certainty that the country has passed its peak — this despite the fact that just on Wednesday we reached a new peak..."
"...and despite the likelihood that no more than 5 percent of the country, at most, has been exposed to the disease."
"So, what is happening? Why is it that all efforts to project the future of the pandemic seem unable to see more than a week into the future? Why are they almost unanimous in projecting a precipitous decline that is almost every day contradicted by the number of new deaths?"
"There are two big explanations. The first is that even under present conditions, in which the spread of infection is being dramatically constrained by shutdowns, the disease is not behaving as we expected."
"It takes a little less than a week from the time of infection to the arrival of real symptoms; another week or so until those symptoms become serious enough to require hospitalization; and a week or two from there until those who ultimately die will die."
"That means the full life cycle of the disease, as we understand it, is about a month. A perfectly effective quarantine would therefore reduce practically to zero the number of new cases within a month of being implemented."
"By March 30, the overwhelming majority of U.S. states had issued stay-at-home directions. Which means that by April 30, one month later, anyone who had caught the disease before the lockdowns began should have already passed through the entire life cycle of the disease..."
"...and that all the new cases we are currently seeing are the result of infections since the shutdown. On April 30, after a month in which new cases ranged between 25,000 and 30,000, there were 29,500 new reported cases."
"It is not entirely clear what accounts for this. It could be there is some feature of the disease we do not yet understand, or something about how long it incubates which we have failed to recognize... "
"It is possible the disease remains infectious even after a patient has recovered, perhaps for a significant amount of time. ... "
"It is possible that sheltering at home is a flawed quarantining method, since family members can infect one another, and that some meaningful share of the new cases come from within quarantines. ..."
"It is possible that some meaningful share comes from within hospitals, with doctors and nurses and administrators all serving as vectors of the disease. It is possible that some meaningful share comes from the 50 million exposed front-line workers."
"Quite likely, a few of these factors, and possibly all, are contributing, to some degree. Together, they are preventing anything resembling a decline of deaths or cases as rapid as the ascent a month or so ago."
"Instead, under conditions that you might have thought, in theory, would bring the caseload close to zero in this amount of time, national deaths and caseloads have merely flattened out."
"But there is a second, more fundamental problem with nearly all the models you may have encountered, in one form of media or another over the last few months."
"Each is processing data—positive cases, hospitalizations, deaths—produced under those extraordinarily stringent social conditions. Each is generating a curve based on that data, which is to say, those conditions—the lockdown from which you are probably reading this story."
"Seeing a flattening in the number of cases or deaths, the models project a decline, even if the flattening is not a function of the disease itself but the extraordinary social conditions we have imposed on it."
"This is fine, so far as it goes, because it is useful to know the trajectory of infection under conditions of quarantine if you are under conditions of quarantine. But it only goes so far — as far as the quarantine goes."
"And that reopening is already starting, which means the conditions which have produced those elegant (and encouraging) curves are ending. Georgia’s reopening has already produced a thousand new cases in a span of 24 hours and is expected to double deaths by August."
Other places could see an even more dramatic spike with only a partial, or “midway,” return to nonessential business.
"Even in those states where there has been relatively little spread, the reopening is taking place from a much, much higher baseline of current infection than is optimal—or, I think, assumed. Take Texas, for instance."
"And while some states are taking a more cautious approach, the disease isn’t very easily quarantined. 'That’s like having a peeing section in the swimming pool,' as Seattle public-health official Jeffrey Duchin put it recently. 'It doesn’t stay where you started.'”
"In all likelihood, the future course of the disease won’t follow an unmitigated trajectory — at least some amount of additional testing will allow us to control the spread a little more effectively, and presumably treatments will arrive that will at least lessen lethality."
"And so it is possible, perhaps even probable, that we will not again exceed the peak of daily deaths reached just this week, even after 'opening up.'"
"But while they have dominated talk about the state of COVID so far, peaks are less important the height than the area underneath the curve as it stretches out not just through the summer but into the fall and possibly into 2021 and even 2022."
"'That’s the risk we face here,' Scott Gottlieb said this week, 'that this doesn’t really go away because we don’t get rid of this round. That the mitigation steps weren’t quite robust enough, as painful as they were, and we continue to have spread right into the fall.'"
"On April 30, NBC News reported the federal government, even while signaling optimism about the course of the disease, had ordered 100,000 new body bags." (x/x)
