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Let's talk the latest Orange County (Calif.) SITREP.

As the county prepares to re-open, and the county health dep't website has this greeting (pic), several indicators are moving in the wrong direction.

short thread.
Orange County, Calif.:

— 249 hospitalized COVID cases (near high for the epidemic)

— of which, 101 are in ICU (high for the epidemic)

— 25% of all COVID mortality to date has occurred in the last three days

— 6.1% of latest batch of samples tested positive.
Santa Ana & Anaheim are worrisome:

Lots of things here are moving in the wrong direction. We are above the State's 6% criterion (i.e., we do not meet it).

I'm all for smart re-opening, but Orange County, we're really pushing the envelope here.

Stay safe, everyone!

(Costa Mesa, I'm talking to you. 😝)
Santa Ana, cumulative incidence per capita: 280 per 100,000.

Los Angeles County: 425 per 100,000.

So... we're still doing better than the large county to our north.

But... that county is the worst in the State, so...

(L.A. County has about 17% more tests per capita than O.C.)
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More from @AndrewNoymer see all

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Andrew Noymer
@AndrewNoymer
The "demic" in epidemic/pandemic comes from the ancient Greek δήμος, people.

Important not to forget that it's not all about the SARS-CoV-2 virus, but also about the *people* it infects.

People... who are social and form societies.

THREAD.
cont'd ...

If a vaccine is not imminent (spoiler alert...) then we need to consider *why* we are flattening the curve.

One principal reason is to avoid Lombardy-style hospital crushes.
cont'd ...

This should remain a guiding principle and any loosening should include provisions to re-tighten if we start heading in that direction.

As I have said #OnHere repeatedly, re-opening should be slow, staged, + w/ steps *at* *least* 10 days apart, to permit monitoring.
Read 6 tweets
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Andrew Noymer
@AndrewNoymer
Let's talk influenza and COVID mortality (again!).

THREAD.

People keep bringing this up so I'd like to put this to bed once and for all (I hope).

It is often said there are 60,000 flu deaths in the United States. e.g.:

cdc.gov/flu/about/burd…
Now, 60k is closer to the upper bound than the central estimate. But, whatever. 60k it is — for flu.

We are approaching 60,000 COVID deaths for the USA and I expect we will get there on or before 1 May. So — at that point — it will have equaled the flu season, right? WRONG.
Measuring mortality by cause is a tricky business.

Our working number for flu is 60k, but there are *not* 60,000 USA death certificates per year that list "influenza" as the cause of death. Typically, it's at most ¼ that number:

doi.org/10.1080/194855…
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Andrew Noymer
@AndrewNoymer
If you think 100–200k is a lot, consider this "gut-check math", or what @sinafala correctly described as a heuristic for one scenario. It's growing and now stands at over 500,000.
Let's consider how realistic this approach is. First, it uses daily cumulative-total deaths. This is pretty well measured, in one sense. Thread, linked below, gets down in the weeds of some of the ways it's not right, however. (Spoiler: undercounts.)

Next, it uses (deaths/cases) as a naïve estimate of the case fatality rate, but uses an adjustment factor to convert it to an infection fatality rate — viz., including asymptomatic and/or unidentified cases. This adjustment factor is discussed below.

The naïve CFR estimator...
Read 15 tweets

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