# But the flu…

Too much write-up to not share here, but someone had asked why we cared about COVID19 deaths right now, considering influenza had around 730k hospitalizations, and 61k deaths.

I’ll take a stab at it. The 730k and 62k look like preliminary estimates of the 2017-2018 flu season in the US. Flu season is October through February, or 5 months. To translate that into a hospital burden, we need to know that mean influenza hospitalization is 5.4 days. That totals 3,942,000 hospital days over what was the highest flu season in the last several years. That amounts to 17,600 hospital days per calendar day.

By comparison, the average COVID19 hospital days is 10 per patient, which is almost double what influenza needs. In the first three weeks of US COVID19 hospitalizations, we had a cumulative 400 hospitalizations. 10 days per hospitalization, so that’s 4000, over 21 days, so 190 hospital days per calendar day. Almost nothing. Who cares, right?

In the fourth week, we had 2200 additional hospitalizations. Ok, that’s something. 2200 times 10 is 22k, divided by 7 days (a generous suppression of the 7th peak day), and we get 3143 hospital days per calendar day. That’s something, but it’s still only a 5th of the flu.

In the fifth week, we had 17,200 additional hospitalizations. That puts us at 24,571 hospital days per calendar day. Again, generously ignoring that the last day in the week is about 4x the first day, we still are 50% over influenza’s peak highest peak week in the last 10 years.

We’re finishing up week 6 on Monday, April 6. On that day, we’ll have 48k cumulative hospitalizations, or 28,200 additional from the prior week. That’s 282,000 additional hospital days committed, or 16x influenza’s highest peak. Any errors in my math or assumptions simply go away at this point.  Even if I’m off by half or double, we have blown past the flu by a gargantual margin.  Also, we have not reached the peak yet for COVID19.

Since we do not have any sort of partial herd immunity, and because its incubation period is about 3x that of the flu, without quarantine or treatment to reduce the serious and mortal cases, this sweeps through the nation in such a way that it does not slow down until we have 60% immunity, a quarter of the nation is sick at one time, and about 9.8 million US citizens die, mostly over the course of 2 months. It’s just more than our system can handle.

Back to the death portion of the influenza equation, the deaths happen over a certain span, such as week 48 to 23 in 2016-2107, or 42 through 22 in 2017/2018. 2017-2018 was a particularly rough year, though 2018-2019 had a longer flu season, week 41 through week 37. 2019-2020 is not fully recorded yet, and will be muddied by COVID10 this year. Either way, flu season is about 32 weeks, with a peak of 12% of the deaths in one week. It’s pretty consistent that way.

That means the worst week in the worst seasonal influenza cycle in the last decade had around 1100 deaths per day for one week, and everything else is an pretty steep, inverted bell curve. COVID deaths happen around day 20, and detection happen around day 12. That means we have 8 days of latency in the statistics.

The simple and accurate way to look at that is to project the death rate ahead by 8 days, and that’s what you will actually have. Anything further, and you might have a big fall off of cases that you cannot see yet. Also, +1 day because the official numbers always report the next day, with the WHO posting at 4am CDT, and JHU posting at 8pm CDT, and some other stats posting at 4pm EDT.  Alternatively, you can look at today’s hospitalization cumulative counts, and that is what your death count will be in 8-9 days.  That’s just how is has aligned, and is not because all of these people die.  As things slow down, that shortcut will no longer apply.

Well, April 2 formal number was 1100 deaths just for that day. We have already reached the peak influenza deaths per day, and our hCOV19 infection rates are still growing by 15% per day, and death rates still growing by 20% per day. That’s compounding, like a bad payday loan. So, we look ahead 8 days, and that’s 48k deaths, with 10k on April 11. That is nine times the peak influenza deaths per day.

Also, the deaths and hospitalizations don’t just suddenly stop. It’s not 10k one day, and zero the next. We’re on board for at least 100k deaths this year from COVID19. That assumes we have no further flare-ups. No new outbreaks. No new hot zones. None of the hospitals overload and have their death rates go up by 2-4x… You know, like NY/NJ/MA area which is already at capacity, and planning for who to refuse service to because they simply do not have beds, equipment, and staff to handle.

Deserving of mention is ventilator days, but that’s about 10 days for both patient types. Influenza is about 60% death from ICU and COVID19 is about 86% death from ICU, but that doesn’t matter so much as the raw numbers above.

What does matter is that if we listened to everyone who said “it doesn’t matter”, or “we’re overreacting”, or “there’s nothing we can do”, or “the flu is worse”, then in about 4 weeks, we will have a single day that had as many new cases and as many new deaths as the entire influenza season combined. At that point, the naysayers would say “Oh golly, why didn’t THEY do something about this!

So, what’s happened is that they have done something about it. They have chosen a reaction level which skirts the edge of how many people will refuse to comply, vs how many people can die without their re-election campaigns being affected. If it were up to the medical experts, then restrictions would have happened weeks earlier.  It’s not unpredictable, nor a surprise.  We knew China was not being forthcoming.  We knew this was coming.  The naysayers simply suppressed mitigation.

The WHO and the CDC are not able to control disaster funds on that level, nor financial packages to help prevent everyone from losing their houses in a lockdown. They also don’t have the authority. They had to wait for the governing bodies to make those decisions, and grant additional power by delegation. Some countries were faster, and better at reacting. We see those with low infection and death rates, and they are still open for business.

Others, who did like us, are suffering pretty heavily right now, many of them simply unable to report how many people died from the disease, because it overwhelmed their systems. We will have to count the deaths, cremations, burials, etc. after the fact, and subtract the normal amount year to year to find the excess deaths. Not every death will be from the disease. Many will be people who could not get medical care, or supplies, or suicides from the stress.

A common argument is “but Italy has an older population” and a variety of other issues. Yes, they do. That accounts for why their death rate is more than double what China’s was (both went into hospital overload). In the unconstrained mode, doubling happens every 2.2 days, so that is really not a good argument.

Some sources for various claims above:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603361/ – Mechanical ventilation demand estimates for an influenza pandemic

https://www.ncbi.nlm.nih.gov/books/NBK63484/ – Length of hospital stays for the flu

https://www.cdc.gov/flu/about/burden/index.html – Number of deaths per year from the flu in the US

https://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html – pediatric mortality by week, which I’m using as a proxy for all mortality.

If you want to know what the healthcare community is doing to prepare for and handle the hot zones that exist now, and the ones that will sprout up over the next couple of weeks, check out this site:
https://www.elsevier.com/clinical-solutions/covid-19-toolkit

This site is my favorite for easy to understand visualization of the spread of the disease. A straight line 45 degrees up on a log scale means it’s not getting better, and each unit up is 10x the previous unit. Horizontal means no more spread.
http://91-divoc.com/pages/covid-visualization/

If you want to play with the raw data yourself, you can get daily detail reports, as well as tables showing each day in a single row for confirmed cases, and confirmed deaths. Check here for JHU’s data:
https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data

Similar data for testing rates, hospitalizations, ICU usage, ventillator usage, etc is here:
https://github.com/COVID19Tracking/covid-tracking-data/tree/master/data

Unfortunately, there is no formal estimate on how many unreported cases there are out there, but it is probably somewhere between 3x and 10x the official counts. That dilutes the relative mortality rates to somewhere around 0.2% and 1.0%, compared to influenza which is somewhere around 0.05% according to the sources above.

EDIT: Fixed hospital-days math, and corrected spelling/grammar.

# US death rates

US death rate is low and falling. It is so far lower than everywhere else, I strongly suspect that the dead are not being tested for the virus, and only if they were already tested would they be considered a SARS-2 death.

In reality, the death rate we’re looking at is per infected person, and that is a false-low. Plenty of infected people have time yet to die. You have to plot it based on deaths per recovered person to get a true value. Since we are not done with the outbreak, and the US is still pretty early into the big numbers, that mortality rate is artificially high. China is 4.0 for mortality per all, and 4.37 for mortality per recovered. The US is 1.28% and 62.4% respectively.

It is more likely that the US infection rate is so high that not enough people have had time to die. I think in the next week, we’ll begin to see larger numbers of US CV19 patients dying. Also note that the US infection rates have dramatically risen the last 2 days. This may reflect an improvement in testing ability and reporting.

The alternative is that we’re accelerating due to people disbelieving the quarantine. I still see that locally in the Flower Mound area. Mid-week, people were still gathering for group meals, and group outdoor exercise. 6 foot spacing is not sufficient when you’re downwind from someone, such as when you are moving 10-15mph in a straight line.

```Where            Cases   Deaths Recovered  Mort/A   Mort/R
World          272,167   11,299    87,403   4.15%   11.45%
China           81,250    3,253    71,266   4.00%    4.37%
Non-China      190,917    8,046    16,137   4.21%   33.27%
Italy           47,021    4,032     4,440   8.57%   47.59%
US              19,101      244       147   1.28%   62.40%
Texas              394        1        0    0.25%  100.00%
France          12,632      450       12    3.56%   97.40%
United Kingdom   4,014      178       67    4.43%   72.65%```

Mortality rates all vs recovered are 3.56/97.4 for France, and 4.43/72.65 for UK. More in line with everyone else. Again, too early for the mortality per recovered person to make much sense.

Current 7-day average daily change rates for deaths in US, FR, and UK are 145.75%, 174.69%, and 160.33% respectively.

```Daily Change   Avg 7 Days
World             113.75%
China             100.18%
Non-China         121.04%
Italy             116.38%
US                145.75%
Texas             133.33%
France            174.69%
United Kingdom    160.33%```

Current 7-day average daily change rates for confirmed cases in US, FR and UK are 157.69%, 118.24%, and 125.30%. In other words, the US is spreading the infection at double the rate of the UK, and three times France.

```Daily Change  Avg 7 Days
World            112.54%
China            100.09%
Non-China        119.46%
Italy            114.74%
US               157.69%
Texas            150.91%
France           118.24%
United Kingdom   125.30%```

That is in line with predictions that our death rates look lower because we’re spreading faster, and people have not had time to die yet.

# Laura McCracken

For those who knew Laura (WebWawa or Lawawawa or just Wawa), she passed today.

She had been struggling with adenocarcinoma for a while. Initial chemo, and then Tarceva maintenance gave her several more years. It re-metastasized and got into her brain. She’d had surgery and stereoscopic radiation treatment, which seemed to help at first. Then, they found two rapidly growing tumors near her vision center in her brain, and she elected to go through whole-brain radiation treatments. Ultimately, this, like any other massive radiation, was a big burden on her blood cell counts. That lead to infections and weakness, that ultimately led to her passing.

Laura was very sweet and had a great smile. For a while, she had bring pink hair, which was fun. She was always happy, and creative. She was blessed to have a very supporting family and a loving husband. Their loss will be great.

It pretty much sucks all the way around, but she was wonderful and made lots of people feel happy. We were all lucky to know her.

You will be missed. :(

Ref: https://www.facebook.com/webwawa/posts/10151957588592251
38 minutes ago

Dear Friends,

This is Laura’s sister, Leslie. It is difficult for me to write this and I am sure it will be difficult for you to read, but I need to let you know that Laura passed away around 3:30 this afternoon.

The doctors in Dallas determined that Laura had necrotizing fasciitis and her body was not able to defend itself against such a voracious disease. My mom and I both made it to Dallas in time to be there with Trey and her wonderful oncologist, Dr. Nadler, when she passed away. She left this world with the same grace and peace she exuded each day that she lived in it. The loss of Laura leaves a void in our lives that I can only hope we will be able to fill somehow with all of our wonderful memories of her.

We will not be having a traditional service for Laura because Laura was not a traditional girl. Our thought right now is to do something simple at the Bonnie J. Addario Lung Cancer Foundation walk on Saturday, May 3 in Dallas. She was really looking forward to walking this event with her team of Wawa’s Warriors. We will now be walking in her memory. I will post info as I know it.

If you would like to register to join her team to walk or make a contribution to the walk in Laura’s memory, below is the link to her personal page. I hope it works. I don’t know how to work Laura’s samsung phone very well.

http://ynsitc.kintera.org/faf/donorReg/donorPledge.asp?ievent=1093667&lis=1&kntae1093667=AB4A795E103F4F629267F43107DAAFB6&supId=351272737

Thank you all for your love and support. Each and every one of us is a Wawa Warrior in some way.

Love,
Leslie on behalf of my mom, my dad, and Trey

# Nuclear Dream

I was at a school in south Arlington. So many little details about the school snd people. It was probably the 1950s but not really. Something happened politically and a small atomic bomb went off to the east.

My mom and I knew it first because we already saw it happen and came back in time to stop it. Unortunately, we could not do anything about it.

My mom had time cloned herself and her clone was going to sacrifice herself. She was calling herself Penny. I was sad, because a already knew that both of them would die.

The school was directly in the wind path, and we could not get anyone to leave. After the blast, it was about sheltering in place.

The VIP room was having breakfast for people who arrived that day. Mom and I had breakfast yesterday, but the selection was better today. McCaffrey’s family was there, and a grandmother who was social, but would reach over and stir someone’s food with her finger, then splash the food, when they were not looking.

I was sad, because I was stuck here, in a second iteration of this horrid day.

I left to go help people, but it was too close. Everyone was doing the same things as last time. A gathering to talk about the conflict, then the boom in the distance.

I walked. I knew my mom was dead, and I figured I could teleport or jaunt home. I couldn’t. I was outside and saw the mushroom cloud on the near horizon, drifting slowly towards us. Maybe it was my upset, or the people around me, but I realized I could not teleport anymore because my mom was dead. Both of them.

I walked home. I had not veen tgere in a long time. I saw transit bussed all along, but they were too slow. Soo many stops. No one knew about the blast but a few people called out that it sort of looked like a mushroom cloud. It was.

I walked into a house that looked like my mom’s, but expanded, rearranged, and renovated very nicely. A nice, big, friendly dog was there. A lady wa on the phone and I mouthed “sorry” to her as I left. No problem. The dog followed me out the screen door.

I was sad, but would be okay.

So I woke up, and it sucked. I was going to call my mom and tell her about it.

Then I remembered she is really dead in real life as of 2005-12-26. It was like a nuclear bomb went off. I don’t think I’ll ever “get over” the death of my mom. I don’t think anyone ever really does. She is the anchor, until she’s not.

But you learn to move on. By now, most days are fine, but once in a while, I’ll indulge the sadness and the memories for a minute. This dream had all of the emotions.

Mom would have loved to see the kids growing up.

# Worst dream ever

Worst dream ever. Khai got caught up in some sort of program and refused to cooperate because he was tired and cranky. Because of this, he was given the choice of life in prison or death. He was still just a kid but he was pissed and chose death.

I had to leave because it was bedtime. I kept trying to call to make him make sure that was really what he wanted, but we could not get through because it was a new utility area with lots of construction. I was hacking a digital power distribution panel to try to get the computer to make the connection for us. There were maybe 8 of up, plus several kids.

Max was beside himself with grief the the rest of us were in shock. It was the first time he hugged me in 2 years. He was 14.

When I got to talk with Khai in person in the morning, he was really scared and did not believe it. He didn’t even remember the situation or making the choice. This is where I woke up. My chest hurts and I don’t want to go back to sleep.

UPDATEHad 2-3 other bad dreams while falling asleep, but decided to reset sleep vs log them then.

#2 was that I was at Josh Ellis’s house, and he was sitting at the bar. He got quiet and pale, and wouldn’t respond. I walked over to check on him and he started to fall. I had to lay him on the ground and perform CPR. I called the police on my cellphone, gave the address on speaker phone, “need an ambulance. Cardiac arrest”. Someone else was in the back (maybe one of his kids?) and I told them to unlock the front door. “I’m going to have to break your ribs” to him, and “his ribs” to Margie, because CPR can do that, and he’s my size. In the dream, he was just about 50, which would also be roughly 2 years in the future. To my real, semi-awake self, that part was spooky, in that both dreams pointed to something in 2015.

I don’t remember dream #3, but it was only a few seconds… Also bad. There was a 4th, but I fell all the way asleep and didn’t really store any of the events of it. All of this was between 1:34 and a little after 2am.

So, this morning, both kids gave me big hugs. Max and I had good chats, and Khai told Erica how much he liked me. Makes me a little teary eyed, and I feel better.

UPDATE2Makes me wonder if I was waking up from some other cause, and the dreams just matched it. (ie, maybe I was having palpitations, or maybe my airway was obstructed.) Because, you know, the wake-up dreams when I have to pee always have something to do with trying to find a bathroom, and being lost, frustrated that I can’t get there…