Not So Fast-Here We Go Again

[gailwinters]

My Tennessee county is in the top 3 for positive cases, and another county with a much larger population is way down the list. Part of the reason is testing. Our county has done almost 4 times as many tests.

 

[harllee]

I am in North Carolina and I am concerned about our trends, especially the hospitalizations going up and up and our ICU beds going down. Our Governor tried to be cautious and do a limited reopen but he is being sued and ignored by many businesses. Churches were suppose to do a limited reopening but they sued and got a Judge to agree with them so they got to reopen with no limitations, a big mistake. Bars and Fitness Centers are not suppose to open yet but many did so any way and others are now suing. A stock car race venue defied the Governor's order, opened to the public, had 4000 in attendance with no masks. The Governor went to Court and has now shut the place down but the damage is done--that area of the state has had a big spike in cases.

 

[Midpack]

All told that doesn't sound that bad?

Hospitalizations for the novel coronavirus are on the rise in at least eight states, in what experts and officials said was in part an expected consequence of states reopening their economies, but also made worse by some people who have begun to disregard social distancing guidelines and aren't appropriately wearing masks.

ABC News' analysis of state data compiled by the COVID Tracking Project, a volunteer project launched by The Atlantic, further showed that five states had mostly flat hospitalization rates, while the majority of states, 37, saw a downward trend.

 

[Midpack]

I am in North Carolina and I am concerned about our trends, especially the hospitalizations going up and up and our ICU beds going down. Our Governor tried to be cautious and do a limited reopen but he is being sued and ignored by many businesses. Churches were suppose to do a limited reopening but they sued and got a Judge to agree with them so they got to reopen with no limitations, a big mistake. Bars and Fitness Centers are not suppose to open yet but many did so any way and others are now suing. A stock car race venue defied the Governor's order, opened to the public, had 4000 in attendance with no masks. The Governor went to Court and has now shut the place down but the damage is done--that area of the state has had a big spike in cases.

Hospitalizations in NC are going up slowly, now at 812 for SARS2, not what we'd hope for but not alarming yet? But deaths are not increasing. And I wouldn't be too concerned yet with 812 hospitalizations in a state with over 3500 ICU beds and over 23,000 staffed hospital beds. The overriding objective is not overwhelming our health care resources, and that's doesn't appear to be an issue so far. It depends a lot on how citizens behave re: masks, distancing, etc. - it's not just what the Governor does.

 

[Dtail]

Mask wearing in FLA appears to be a higher percentage in the larger central and southern city type/large suburban areas.

 

[Doribe]

From early in the article:

"ABC News' analysis of state data compiled by the COVID Tracking Project, a volunteer project launched by The Atlantic, further showed that five states had mostly flat hospitalization rates, while the majority of states, 37, saw a downward trend."

So doing some quick math, there are about 8 states where things are getting worse, presumably the 8 states featured in the article.

I think there is an attempt by news organizations to develop a narrative here. If most states are opening up, and most states are seeing a downward trend, then logic would say that opening up is generally OK. Unless the states that are opening up faster or more are correlated to the states that are having more problems, which the article didn't seem to attempt to try to do from the portions of it that I read.

Further, there are counterexamples, such as my own state, where states are opening up and not seeing second waves (yet). Since most states are reopening, and in 37 states the trend is downward, it seems like there would easily be 8 states or even more where things are getting better and they are opening up. But they didn't interview health experts in any of those states.

The other thing I wonder about and would like to ask here: When should we expect to see the second wave? In my state, we've been opening up for approximately six weeks, and yet the curve has clearly been flattening (https://covid19.healthdata.org/united-states-of-america/idaho). One could even, based on the data, make the nonsensical assertion that reopening has resulted in a slowdown in cases. After all, the reopening has been occurring and after that point in time the slowdown occurred.

I can understand the idea that there would be some lag between infections and cases, but I think we should have seen it by now. Idaho's recommendations - and I think these are common across many portions of the rest of the world - are for quarantines to last 14 days. I know that's a somewhat arbitrary number, but it seems like a good proxy for the lag period.

The article talks about people's practices as distinct from the reopening guidelines as a possible explanation. I think this could be part of the explanation. My state has seen an uptick in activity, and a drop off in mask-wearing and social distancing compared to the lockdown period. But we've also, like everywhere else, started installing plexiglass all over the place, and there still is distancing and mask wearing among maybe half of the population. I think most people have been mostly compliant with the state's orders.

I know I'm being a tad contrary, but I'd really like to understand how the second wave theory applies to my state, to see what I may be missing in my understanding of the situation. So thanks in advance to anyone who answers, I really do appreciate it.

I'm not expecting any kind of second wave. The explanation that it happened in 1918 is not good enough.

There might be a peak when the kids go back to school (and lots of parents go back to work). If there is contact tracing to shut down outbreaks, there shouldn't be a second wave.

 

[harllee]

Hospitalizations in NC are going up slowly, now at 812 for SARS2, not what we'd hope for but not alarming yet? But deaths are not increasing. And I wouldn't be too concerned yet with 812 hospitalizations in a state with over 3500 ICU beds and over 23,000 staffed hospital beds. The overriding objective is not overwhelming our health care resources, and that's doesn't appear to be an issue so far. It depends a lot on how citizens behave re: masks, distancing, etc. - it's not just what the Governor does.

Midpack thanks for the more positive info on NC. Help me understand the numbers--on the ICU bed situation the Raleigh News and Observer reported this morning that NC has 14% of ICU beds available down from 15% last week--so less than 500 ICU beds available--that is what is most concerning to me. I guess many ICU beds are being used for patients other than COVID 19 such as heart attacks and strokes. Can the regular hospitals beds be converted to ICU beds pretty quickly?

In addition the increase in hospitalizations in NC is also concerning to me--from 600 hospitalizations 3 weeks ago to 812 hospitalizations now, an increase of 35% in hospitalizations in 3 weeks. That trend looks bad to me.

 

[Car-Guy]

I'm surprised "that anyone is surprised" that we are seeing the virus continue to spread and even increase in some areas. Of course increased testing is giving us a much better picture of what's really out there. Increases in hospitalizations and deaths in some areas is disturbing but it seems I remember hearing from the experts that this was to be expected as the country reopens.

Hopefully we won't see any March/April New York City outbreaks anywhere.... That would be bad.

 

[Red Badger]

Sheez, at this rate, I'd better stock up on toilet paper again.

Bidet. Worth every cent for many reasons (including the above).

 

[Amethyst]

Have you accounted for death rates trailing hospitalization? I believe patients may linger up to a month before expiring.

Hospitalizations in NC are going up slowly, now at 812 for SARS2, not what we'd hope for but not alarming yet? But deaths are not increasing. And I wouldn't be too concerned yet with 812 hospitalizations in a state with over 3500 ICU beds and over 23,000 staffed hospital beds. The overriding objective is not overwhelming our health care resources, and that's doesn't appear to be an issue so far. It depends a lot on how citizens behave re: masks, distancing, etc. - it's not just what the Governor does.

 

[Amethyst]

I have one. But the drying time is kind of a sticking point. It's not exactly like one of those powerful hand dryers.

Bidet. Worth every cent for many reasons (including the above).

 

[Helen]

I have one. But the drying time is kind of a sticking point. It's not exactly like one of those powerful hand dryers.

Just as well, that might be a bit much.

 

[martyp]

The virus is here with no treatment and no vaccine. People will get sick. Increased hospitalizations is to be expected. It is only when the hospital capacity is saturated that there is a problem. It is probably more important to report the remaining hospital capacity.

 

[harllee]

The virus is here with no treatment and no vaccine. People will get sick. Increased hospitalizations is to be expected. It is only when the hospital capacity is saturated that there is a problem. It is probably more important to report the remaining hospital capacity.

You are correct, we should definitely be concerned about hospital capacity. Here in North Carolina today the local paper reported that the state has about 14% of its ICU beds remaining, around 500 total ICU beds remaining in the entire state. To me that is very concerning.

 

[Leo1277]

The virus is here with no treatment and no vaccine. People will get sick. Increased hospitalizations is to be expected. It is only when the hospital capacity is saturated that there is a problem. It is probably more important to report the remaining hospital capacity.

I recently found this site to be very informative; it accumulates information from various official sources, and processes it. It shows ICU free capacity, and growth in cases, but unfortunately not hospitalization numbers.

https://www.covidexitstrategy.org/

 

[Leo1277]

At this stage it’s probably more informative to look at individual cities or metropolitan areas, but there doesn’t seems to be much data. It would also help to look at hospitalization rates.

For a view of states, this chart from rt.live shows the current reproduction rate. https://rt.live/?fbclid=IwAR0hQymjJc9DFqZIK7d0VQUJmKvQ090mHIgyuI3gbIu9O42CzT5l4KE_Li8

There is another interesting site that shows estimated reproduction rates, it's the third map from the top at https://covid19-projections.com/maps/ One can hover over each state and get more detailed information. They show many more states with R(t) greater than 1 than rt.live; I have tried to dig into what the difference in methodology is, but couldn't really resolve the issue. In addition to maps with R(t) for US States, at the bottom there are also links to worldwide maps and maps of Europe. I found these to be very illuminating as well. I am including today's R(t) for the US and for the World. Orange and red mean R(t)>1.

One take home about the World situation is that everybody is talking about Brazil, but the much bigger disaster brewing will be India. They have a much higher R(t) and 6 times the population of Brazil, and they are opening up again, hoping to minimize economic damage. Their numbers are rising more quickly, they just have started later.

 

[Leo1277]

Hospitalizations in NC are going up slowly, now at 812 for SARS2, not what we'd hope for but not alarming yet? But deaths are not increasing. And I wouldn't be too concerned yet with 812 hospitalizations in a state with over 3500 ICU beds and over 23,000 staffed hospital beds. The overriding objective is not overwhelming our health care resources, and that's doesn't appear to be an issue so far. It depends a lot on how citizens behave re: masks, distancing, etc. - it's not just what the Governor does.

I recently by accident came across this news article about NC, and it contains graphs that are still being updated: https://www.newsobserver.com/news/coronavirus/article243180746.html . It shows a rise of hospitalizations starting around May 15, and hospitalizations have increased by 1/3 give or take. It also shows an increase of deaths starting around May 25, so with an offset of 10 days give or take, with an increase of also about 1/3. (Note though that the death numbers for the last few days are lower again, perhaps they aren't all reported yet?)

 

[cyber888]

I am in North Carolina and I am concerned about our trends, especially the hospitalizations going up and up and our ICU beds going down. Our Governor tried to be cautious and do a limited reopen but he is being sued and ignored by many businesses. Churches were suppose to do a limited reopening but they sued and got a Judge to agree with them so they got to reopen with no limitations, a big mistake. Bars and Fitness Centers are not suppose to open yet but many did so any way and others are now suing. A stock car race venue defied the Governor's order, opened to the public, had 4000 in attendance with no masks. The Governor went to Court and has now shut the place down but the damage is done--that area of the state has had a big spike in cases.

I'm in NC too. People do not want to listen to the Governor. It's crazy.

 

[Midpack]

I'm in NC too. People do not want to listen to the Governor. It's crazy.

Sad. I’m still wearing a mask in public indoors and maintaining distance, but I’m increasingly in the minority. We still wash our hands or use hand sanitizer as often as possible. I’m glad the economy has reopened. But why so many people won’t take such simple precautions that will definitely reduce SARS-2 cases is beyond me, but I don’t plan to preach about it. We’re ALL going to pay for this directly and indirectly...

In stores and restaurants I’m seeing more and more employees wearing masks below their noses, and pulled below mouths when they’re talking. Some even have them hanging from one ear.

 

[martyp]

Just in case someone doesn’t yet have enough information about the benefits to everyone of wearing a mask here is another academic study

https://royalsocietypublishing.org/doi/10.1098/rspa.2020.0376

 

[harllee]

I recently found this site to be very informative; it accumulates information from various official sources, and processes it. It shows ICU free capacity, and growth in cases, but unfortunately not hospitalization numbers.

https://www.covidexitstrategy.org/

Thank you for this site, very informative. Many states appear to have low ICU availability, including mine. I am assuming most Covid patients need ICU--is that correct? Does anyone know if it is possible to turn regular hospital rooms into ICU type rooms?

 

[Leo1277]

Thank you for this site, very informative. Many states appear to have low ICU availability, including mine. I am assuming most Covid patients need ICU--is that correct? Does anyone know if it is possible to turn regular hospital rooms into ICU type rooms?

It seems many Covid patients don't need intubation, which is the main reason for being moved to an ICU, while it has even been shown to have particularly bad outcomes with Covid compared to other uses. Covid patients can often be ok just with supplemental oxygen, and perhaps breathing assistance via BiPAP (or CPAP). That can be done in a regular hospital room, or even at home if the patient has capable family members. Since there still aren't any fully convincing drugs, and we just heard that they are going to run out of Remdesivir at the end of the month, most of the treatment is to support the symptoms but not curative from what I understand.

P.S.: To clarify my earlier post, I said the site doesn't show hospitalization numbers; that's only partly right since as you mention it shows ICU availability percentages. What I really meant to say is that I'd love to see a site that shows say a 14 day history of hospitalizations, similar to the way this site shows a 14 day history of "cases". The "cases" are less meaningful since they depend on how tests are administered.

 

[Aerides]

I am assuming most Covid patients need ICU--is that correct? Does anyone know if it is possible to turn regular hospital rooms into ICU type rooms?

I don't think most Covid patients wind up in the ICU, but I haven't looked at those detailed stats.

While I'm sure some hospitals have, or plan for, some make-shift ICU expansion, no you can't just convert a regular room over. Totally different setup, equipment, protocols, security, etc.

 

[gwraigty]

There is another interesting site that shows estimated reproduction rates, it's the third map from the top at https://covid19-projections.com/maps/ One can hover over each state and get more detailed information. They show many more states with R(t) greater than 1 than rt.live; I have tried to dig into what the difference in methodology is, but couldn't really resolve the issue.

rt.live shows the trends over time. I find that useful. Also, a statewide number isn't as useful as regions within the state. For the first time yesterday, DeWine revealed the numbers per region for Ohio.

New Ohio data shows spread of COVID-19 still manageable in most regions

Only the Dayton area shows R0 values above 1, and only marginally. DeWine said on average, Ohio falls just below a R0 value of 1, which means the virus is being effectively controlled and perhaps even slowly eradicated.

DeWine also said there was a brief uptick over a 3 day period in one of the regions before the number settled back down. A Cincinnati doctor told DeWine that they believe it was caused by Mother's Day.

 

[Spock]

Thank you for this site, very informative. Many states appear to have low ICU availability, including mine. I am assuming most Covid patients need ICU--is that correct? Does anyone know if it is possible to turn regular hospital rooms into ICU type rooms?

No. Most covid patients do not need ICU. ~35% of cases (positive test) show now symptoms at all. Another big % manage their mild symptoms at home.
Of the patients that are hospitalized:

Among all hospitalized patients, a range of 26% to 32% of patients were admitted to the ICU

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html