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The Nooner for Monday, April 6, 2020, presented by SYASL Partners
Images are important to have on today related to the COVID-19 story as I'll refer to charts and a graph (click "Display Images" in Gmail, etc.).
Happy Monday! I am the most positive as I have been in three weeks, and not just because I finally put new bedding on my bed that I bought in January with money from mi papa. Best night of sleep in weeks and I woke up to good news! I think you'll be happy as well, although we're not out of the woods.
There's a reason the stock market is up big and it's because of Washington. Not THAT Washington, but rather the University of Washington. Go Huskies!
Before I get started, let me be clear. We may have reasons to be hopeful and start to see rays of light through the end of the tunnel, we have lost 349 Californians and will likely lose around 2,000. That is somber. Those are people's loved ones and we can not dismiss that.
You won't see me jumping up and down saying "we won!" We've all lost something. I've lost thousands in ad revenue and, perhaps like many of you, had to sell my limited depressed investments to pay rent. Most important to me though as I have written, my grandmother's 100th birthday bash in Portland that would have been a mini family-reunion was canceled. My mom, aunt, and uncle sang "Happy Birthday" to her through a window.
Further, even if COVID-19 never touched America's shores, the devastation in Asia and Europe is incomprehensible. Italy's economic devastation is warlike and I need not tell you that it's something the country has been through before.
We also are not out of the woods. New viruses are S.O.B.s and "novel coronavirus" means we don't know W.T.F. COVID-19 will do. But, based on the knowledge of experts, we have some reasons to be optimistic on this Monday morning.
TURNING THE TIDE? There is some very good news out overnight. If you can't tolerate words, I offer bullets below, but the words are more important than those I usually put in this space.
The University of Washington's Institute for Health Metrics and Evaluation model was rerun and posted overnight (which had been expected Saturday night). This is considered the top model in the country and is used by state public health and political leaders from governors to The White House. I'm not sure when the latest data were posted, but I think I refreshed it about 10pm last night and didn't see it. So, I woke up around 5am to this very good news.
The California peak resource use day is now April 14 rather than April 26 in the previous model, likely because the strong Stay at Home order was issued three days before New York (tri-state area) and four days before the hard-hit Louisiana. Michigan, now a focus, issued its stay at home order five days after California. More importantly, it is not accelerated because of a steeper peak that is taxing resources, but appears to be as much because of reducing overall infection rather than just "flattening the curve."
In talking about the physical distancing orders, it is worth noting also is that the Bay Area counties preceded the statewide orders on gathering by three days. The Bay Area this far has been the hardest hit area in California, likely because of the commercial and personal relationships with Asia. The statewide actions in California were far before any other part of the country other than the tri-county area around Seattle. A few days may not sound like a lot but when the virus was doubling every few days, each 24 hours matters.
The model relies nationally on full social distancing (closed schools, stay at home) through the month of May, and doesn't adjust the social distancing period for each state as the peak resource date changes. So, while there was thinking that physical distancing can be relaxed 30 days after the peak resource date, the model doesn't specifically provide that guidance.
As I understand it after spending way too much time on this subject the importance of the peak resource date in an epidemic/pandemic is that it measures when the need for hospital beds, ICU beds, and ventilators (in the COVID-19 case) are needed. When the demand for these resources exceeds the supply, the disease spreads faster and there are more fatalities. Additionally, health care workers are more likely to be infected as resource supply exceeds demand and the contagion spreads further as asymptomatic health care workers continue to expose non-infected people. While the data are not available on personal protective equipment (PPE), this supply/demand issue also affects health care worker (including first responders) infection rates.
That's what we saw in Italy, Spain, and New York City, where serious infections far exceeded health care resource capacity. Let's look at the peak resource projections of New York and California, from the UW institute's latest model.
New York (peak: April 8):
California (peak: April 14):
Of course, the two states are not apples-to-apples. California is twice the size of New York, while New York's population is far more densely populated. Thus, the beds (standard and ICU) should be much higher in California, while the contagion can be expected to be greater in New York. What's important is the first column of "all beds needed" and "ICU beds needed." In all beds, California's projection number is one-fifth that of New York. Of ICU beds, New York's requirement is 9 times higher (ventilators largely track the same pace). New York's projected updated peak resource date is this Wednesday.
Everyone is going to want to talk about the numbers of confirmed cases. While that is not unimportant, that is as much a function of the breadth of testing as anything else. The data above are far more important. You and I may be COVID+ while . I went to farmers market yesterday and assumed I was and assumed everybody else was. For the Nooner newbies, I have a history of serious pulmonary and immune system problems (think two cumulative years in the hospital growing up), so I take this stuff seriously.
Many experts say that finding out who has had it and recovered it while being asymptomatic at this point is more important. That is determined through serology (blood) testing for antibodies. When a sufficient percentage of the population (I've heard 50-70%) have antibodies, the phenomenon of "herd immunity" arrives and the nasty little bug finds it hard to find new hosts.
Think of it as one of those "America Ninja Warrior" games where contestants have to jump among small posts in water that are increasingly spread further apart. At some point, even the best contestant can't jump from one to another. That's the same situation as with the virus. Experts think that's 6 feet, the length that droplets of water can travel from a sneeze. Even if an infected person has a monster sneeze with three people around them within 6 feet, if those three people have antibodies, the virus is unlikely to spread. The science may sound complicated and the "rules" for social isolation arbitrary, but it's actually pretty basic.
That was the importance of Governor Newsom's announcement on Saturday that Stanford had developed a serology test for which FDA approval was expected soon. Other researchers, including at UCSF, are working on similar tests. Unlike pharmaceutical approvals that require phased trials that can take a year or more, diagnostic tests can be quickly approved once the validity is confirmed.
Even without testing the entire population, a broad demographic and geographic sampling, an identification of a degree of herd immunity would provide a scientific basis for returning things to normal. In the same press conference, when asked by Ron Brownstein of The Atlantic about President Trump's suggestion that pro sports should return quickly, Newsom responded that he would listen to the facts and experts. Test results of antibodies suggesting herd immunity would be among the best facts provided by experts that can be relied upon.
Things are moving in the right direction in California as indicated by the models. But, they rely on the continued vigilance with physical distancing. The above charts assume we continue, as does the very important chart below. Click on it to see it in full size as it's impossible to show fully in an email box.
This is the graph of the numbers contained in the California chart that we saw above. The horizontal solid lines are supply. The dashed lines are demand. The shaded areas (really you only see is all beds available) are the range that the model shows. In all cases -- all beds, ICU beds, and ventilators -- the demand size CURRENTLY appears well below the supply lines.
This is why California is lending 500 state-owned ventilators to the national stockpile for redistribution to where they needed the most, knowing that we may need resources for this or other diseases, floods, fires, or earthquakes in the future.
Again, while there has been talk about multiple models, from my knowledge, this is the one that is being relied upon by most health and political leaders. There may have been earlier ones, but what we are seeing is like the hurricane track models once they largely come in to agreement.
At this morning's press conference, a frustrated Governor Andrew Cuomo (D-NY) said "California has leveled off," before blasting residents who defied social isolation and spent the weekend in public parks basking in spring sunshine. Showing photos of them, he announced that he was increasing the fine for violating the order from $500 to $1,000.
From Twitter wars, I know that there can be a debate of what "leveling off" means. It does not mean fewer new cases. It means neither fewer hospital nor ICU admissions. It means the daily rate of change, which I displayed at the top. As I have discussed, cases are a function of testing and are somewhat irrelevant. I've added the hospitalizations and ICU admissions to the data above and will start adding the rate of change now that the California Department of Public Health is displaying them. Data has been a real challenge based on methodology (CDPH, WHO/CDC, or those plus county health department announcements that precede them). I just work to be consistent.
This morning, Lieutenant Governor Eleni Kounalakis was on CNN to discuss California's response to the pandemic and I thought did a fantastic job. Frankly, going back in California political history that I have both experienced and studied, she came across as part of the team with Governor Newsom more than any other elected LG has in California, where the LG is elected separately than the governor (unlike several states). I hope the two continue to work as a team beyond the current crisis.
A few articles (Important note: many articles had deadlines before the new UW model results discussed above came out last night):
Okay, I'm after 6.5 hours sitting here, it's time to crawl under my desk to take a nap. Who am I kidding? Governor Newsom will be speaking in a few followed by daily The White House table with the media.
BALLOT UPDATE: With the deadline to count ballots extended to 4/24, there are 67,748 ballots remaining among eight counties.
cakeday and new classifieds after the jump...
CAKEDAY: Happy birthday to Fielding Greaves, Nick Hardeman, Gus Khouri, Phil Paule, and Ann Ravel!