Dave Blake, PhD Profile picture
Sep 25, 2020 9 tweets 2 min read Read on X
Rt vs percent infected, and Cases per Fatality vs percent infected, for all 50 states. Faint lines on the Cases per Fatality plot are isocountours of equal disease burden, and are spaced apart at 2x changes in burden. A methods thread 1/ ImageImage
For these plots, percent currently infected is 3.8 times the number of new cases in the past 10 days. 3.8x is the difference between national CFR and CDC claimed IFR. It is an estimate scaled from cases per capita. 2/
Rt is a 10 day windowed sum of new cases, ratioed to a similar sum 14 days earlier, and then pro-rated to a 5.2 day period. A 6.5-7.5 day period would be better, but I am staying consistent and using an April number. 3/
Cases per Fatality is a 14 day sum of new deaths, ratiod to a 14 day sum of new cases time shifted 20 days earlier. It is a laggy measure!!! You can remove the lag by relating it to the fraction of new cases over age 65 (an exercise for the reader). 4/
Cases per capita, and Cases per Fatality, together, capture ALL the cross-region variance in disease burden measured by death (by definition). On the Cases per Fatality plot, I draw faint lines at each 2X change in disease burden. They are curved. 5/
The implication is that states with high Cases per Fatality will be over-represented when people try to find states in trouble using cases per capita. This prediction is born out particularly well. What is Cases per Fatality? 6/
Because SARS-COV-2 is so age sensitive, Cases per Fatality is sensitive to the ages of people getting infected. If you have nursing home problems, or an older age demographic (larger % over age 65), you will have a lower Cases per Fatality. 7/
Cases per Fatality also goes up when you test the less vulnerable (younger) people better, and find infections better. Good testing finds infections. Low test positivity is demonstrably good at finding people who are NOT infected. Which one do you want in your state? 8/
Any reasonable comparison of disease burden across regions REQUIRES considering both cases per capita and cases per fatality. 9/9

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More from @_stah

Jan 3, 2023
Sorry for those who really want the COVID-19 graphs, I am checking them. We have a disease burden about 50% higher than a normal flu season (most active 3 months), and we are likely close to our seasonal high in the next week or two. Hospitals are not like last year.

1/
What can an individual do?

1) Get vaccinations up to date. These are REALLY high cost/benefit shots. I got my fourth about six week ago.
2) Wear an N95 in crowded indoor settings. Especially homes (which are by design poorly ventilated).
2/
3) Use MERV-13 filters designed for the airspace. The combination of N-95 respirators and air filters can reduce the chances of infection 100-fold in most circumstances. If you wear a mask, you can expect 20-fold reduction in risks.

3/
Read 4 tweets
Sep 1, 2022
Atlanta Medical Center is closing. This choice, by their owners, occurred because it is not profitable, and it is not profitable because it provides free health care to too large a portion of uninsured Georgians.
1/
This profit/uninsured problem exists because hospitals must serve people in need regardless of their ability to pay, and in some cases 40% of a hospital's patients will be uninsured. So hospitals play games to try to minimize their uninsured patient fraction.
2/
In 2014, Obamacare passed. It included a Medicaid expansion. The federal reimbursement rates for procedures would be cut. And, the federally funded Medicaid expansion would reduce the number of uninsured by about a factor of two. It was a breakeven proposition.
3/
Read 8 tweets
Jun 20, 2022
US COVID-19 cases, census, and deaths. In this plot, these three lines were aligned in amplitude for their peaks in January. The idea is that shifts between cases, census, and deaths, would show by relative line height today. We are near the national peak for this wave.
1/
Census is up a little for this wave, the ratio between deaths and cases are about the same as late January. Case Fatality Ratio is also about the same.
2/
State by state, we are not seeing the census push system-wide hospital stress (would be over 50 on this plot), although some areas are having issues. Some of our divisions have multiple attendings out right now with case positives.
3/
Read 4 tweets
Feb 27, 2022
@JasonSalemi I think the CDC move is actually in the right direction. Omicron featured huge problems, but among the positives were a five-fold decline in CFR. Which implies a five-fold reduction in disease burden per case.
1/
@JasonSalemi Which doesn't matter much when cases are several times higher than prior peaks.

But what happens when cases drop precipitously to levels below prior peaks? That five-fold reduction in disease burden per case really starts to matter.
2/
@JasonSalemi It implies hospital burdens, caused by cases today, will be quite negligible in most of the US, which reduces the value of protections. Everything would be scaled down.

Five-fold.
3/
Read 6 tweets
Feb 26, 2022
Interesting thoughts on Sars-COV-2. As the pandemic progressed, people generated ever increasing proportions of the population that needed resistance to generate an Rt under 1 (a temporary herd immunity), because it was assumed R0 was rising.

What if they were mostly wrong?
1/
The evidence is now emerging that MOST of the increased transmissibility of Sars-COV-2 came from shorter intervals from a person infected to a secondary attack (the next person in the transmission chain).
2/
For example, estimates for the April 2020 transmission were an R0 of 2-3, and a serial interval of 5.2 days.

Alpha had a serial interval of 4.5 days

Delta was 3.3 days

Omicron was 2.2 days.
An R0 of 2 at 2.2 days would look like an R0 of 5.1 at 5.2 days.
3/
Read 6 tweets
Dec 27, 2021
US COVID-19 cases, census, and deaths. Again. Rt for hospitalizations is nearly one, about to decline. Some states with delta outbreaks and early omicron outbreaks are shown in thread.
🧵 1/
New York state. Census was climbing over a month before omicron onset, and is now preparing to turn. It is important to distinguish census from hospitalizations (of which there are many). The hospital average length of stay for omicron is MUCH shorter.
2/
CT, same story.
3/
Read 4 tweets

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