Overrun Planning

Stats for Sunday, Monday, and predictions for Tuesday, and Texas hospital overruns.

03-22 Sunday

  • 7-day Projection: WW 262771/11285; PRC 81266/3324; NON 259371/14696; IT 78550/8986; US 25567/280; TX 521/21. plus or minus 25%.
  • 1-day Projection: WW 340729/14895; PRC 81360/3265; NON 260988/11728; IT 61049/5774; US 34015/386; TX 857/5.
  • Actual Numbers: WW 335955/14632; PRC 81397/3265; NON 254558/11367; IT 59138/5476; US 33272/417; TX 627/8

03-23 Monday

  • 1-day Projection: WW 370630/16503; PRC 81489/3271; NON 290297/13301; IT 65275/6215; US 43432/566; TX 627/13. TX Deaths is Still early and erratic
  • Actual Numbers: WW 378287/18600; PRC 81496/3274; NON 296791/13223; IT 63927/6077; US 43667/552; TX 758/9. IT is slowing, which is good. JHU new dataset.

03-24 Tuesday

  • 1-day Projection: WW 425,953/18,600; PRC 81,595/3,283; NON 346,031/15,382; IT 69,104/6,744; US 57,310/731; TX 916/10
  • Actual Numbers: To be determined.  Infection spread for US is fluctuating slightly.

The following major milestones assume no gross change in testing rates nor confirmed infection rates.  Stage 1 is over standard capacity.  Stage 2 is over worst case reserve capacity.  Stage 3 is over best case reserve capacity.  This does not cover additional production, but does cover identified lower-function and out-of-date equipment from federal, military, and major hospital stockpiles.  At Stage 1, alternative locations are getting converted for use by patients, such as closed medical buildings.  At stage 2, we’re relying on medical and nursing students as front-line caregivers, and MASH style pop-up tent hospital expansions start getting deployed where possible. At stage 3, we’re draping parking garages, and getting scouts with first-aid badges to help.  Elderly or anyone with comorbidities will be comforted, but won’t get access to mechanical ventilation.  Only those with the best chance of survival with, and a high risk of death without, would get advanced care.

  • 04-05 33k TEXAS ICU OVERRUN STAGE 1 / 28.7m pop; 2.9 beds per 1000 (83230); 32% unoccupied (26633) / 11% are ICU (2929); 6.7% ventilators (1787) and 10% limited function ventilation (2663) / 5-15% conf need hosp(532k-177k @ overrun); 2-10% ICU (29k-146k); 1-5% need vent (36k-178k)
  • 04-06 45k TEXAS VENT OVERRUN STAGE 1 / 28.7m pop; 2.9 beds per 1000 (83230); 32% unoccupied (26633) / 11% are ICU (2929); 6.7% ventilators (1787) and 10% limited function ventilation (2663) / 5-15% conf need hosp(532k-177k @ overrun); 2-10% ICU (29k-146k); 1-5% need vent (36k-178k)
  • 04-10 150k TEXAS VENT/ICU STG2 & Hosp STG 1 / 28.7m pop; 2.9 beds per 1000 (83230); 32% unoccupied (26633) / 11% are ICU (2929); 6.7% ventilators (1787) and 10% limited function ventilation (2663) / 5-15% conf need hosp(532k-177k @ overrun); 2-10% ICU (29k-146k); 1-5% need vent (36k-178k)
  • 04-13 366k TEXAS VENT/ICU STG3 & Hosp STG 2 / 28.7m pop; 2.9 beds per 1000 (83230); 32% unoccupied (26633) / 11% are ICU (2929); 6.7% ventilators (1787) and 10% limited function ventilation (2663) / 5-15% conf need hosp(532k-177k @ overrun); 2-10% ICU (29k-146k); 1-5% need vent (36k-178k)
  • 04-15 660k TEXAS Hosp STG 3 / 28.7m pop; 2.9 beds per 1000 (83230); 32% unoccupied (26633) / 11% are ICU (2929); 6.7% ventilators (1787) and 10% limited function ventilation (2663) / 5-15% conf need hosp(532k-177k @ overrun); 2-10% ICU (29k-146k); 1-5% need vent (36k-178k)

The inflection point for R0 of 2.2 is 60%. Current reporting rate is 12-15%. Assuming we keep testing by same criteria, the Tx inflection point is about 400k confirmed. We may not reach this numerically due to testing/infrastructure failure. eg, we may reach stage 3 while our confirmed rate is much lower, but still around the same day, and still around the same number of actual infected.  Also, there are different groups between spreaders and isolators.  I don’t know the balance of those two groups. They could be 20/80 or 50/50.

Barring major changes, the model is +/- 25% per week.  That is +/- 1.5 days for stage 1. That is +/- 2.5 days for stage 2. That is +/- 3.5 days for stage 3.

If the Pandemic declaration helped, then 03-24 will be at least 2% low for US and TX. If the Emergency declaration helped, then 03-25 will be at least 2% low for US and TX.  Either of those should show a continual downward trend.  We have had a lot of people ignoring expert and government recommendations, so I do not expect an abrupt change.

If we did abruptly fall to, say, 112% on 03-24 and stay there, then Stage 1 starts April 23-26; then Stage 2 starts May 7-11; Stage 3 may never happen due to average disease cycle of 20 days, and ICU cycle of 30 days.  This would be a dream scenario, and is unlikely.  More likely to see a 5% drop several days in a row.  It’s unlikely to see the clam-down go below 110% until it looks really bad (and then it’s too late).

Texas is about 9% of the US capacity and slightly more capacity than average.  Look for 11x numbers in the US column for similar problems.

  • 33k -> 363k on 03/30 Stage 1 ICU
  • 45k -> 495k on 03/31 Stage 1 Vent
  • 150k -> 1650k on 04/04 Stage 2 / Stage 1 Hosp
  • 366k -> 4026k on 04/07 Stage 3 / Stage 2 Hosp
  • 660k -> 7260k on 04/09 Stage 3 Hosp

112% projections:

  • 112% ICU Stage 1 is 04/10
  • 112% Vent Stage 1 is 04/12
  • 112% V2 / Hosp Stage 1 is 04/23
  • 112% V3/H2 is 05/01
  • 112% H3 is 05/06
  • 112% numbers are +/- 3, 5, and 7 days.

This is all bistromath, and really, anything more than a week out is just guesswork. A lot can change in a week, and I’m expecting substantial changes over the next 3 days based on the activities 10-14 days ago.

The Spreadsheet has been updated. JHU replaced some data sources, so it was a little annoying, and a little more manual entry.

https://drive.google.com/file/d/1vocCN445AZyVBBLsv0kJR8ZDP9DM0UST/view


Projection Spreadsheet

Google link is https://drive.google.com/file/d/1vocCN445AZyVBBLsv0kJR8ZDP9DM0UST/view View/comment only. I don’t know what broke yet, or if everything works right.


Tsunami

I have been maintaining projections on omnitech.net/blog and fb.com/xaminmo .

Basically, it is time to hide from society right now. There are a lot of people still spreading it because it is their right to be free. If you get it now, there will be no resources to help you if you get very sick.

Projections may change by Wednesday, since that is 12 days after the national emergency was declared. If we cut our spread in half, then we get almost an extra week of respite.

Except, I know groups of people who were congregating for public meals as recently as Wednesday, and group exercise just Friday. 6 feet at 14mph is not enough. I don’t have the ability to get people to trust me. Either they see, or they don’t. Plenty actively disbelieve. It’s core to their being to believe exactly opposite of me.

We got complacent, because we’re “not like Italy. Look, they are older, and we were infected sooner. We’re so much better, and our death rate is lower.”

Italy started at +25% per day, and brought it down to +12% per day.

The US started at +5-10%, but for weeks has been spreading at +35% per day. Texas, my state, has to do it bigger. We’re spreading at +47%.

So, April 2, Texas ICU reserve capacity is overrun. A week later, all Texas hospital reserve capacity is overrun. I don’t know where in there we run out of trained medical professionals and supplies to treat safely.

If we did a great job when the pandemic was declared, we get 4-6 more days. A week prior, it will look like a normal day, a little busy, and probably still no toilet paper.

I wish it were not so, but the window of opportunity to change this course is almost closed, and we seem to be accelerating towards it, not slowing.

A tsunami is coming, and we have not even felt the tremor yet.


SARS2 not from a lab

Two bits of info indicating extremely unlikely that this was engineered in a laboratory: A) Computer models show the binding function would be very poor for how it binds; B) The core code of the virus matches animal versions, not versions known to make humans sick.

Here's why: SARS-CoV-2 is very closely related to the virus that causes severe acute respiratory syndrome (SARS), which fanned across the globe nearly 20 years ago. Scientists have studied how SARS-CoV differs from SARS-CoV-2 — with several key letter changes in the genetic code.

Yet in computer simulations, the mutations in SARS-CoV-2 don't seem to work very well at helping the virus bind to human cells. If scientists had deliberately engineered this virus, they wouldn't have chosen mutations that computer models suggest won't work.

https://www.livescience.com/coronavirus-not-human-made-in-lab.html

This evidence for natural evolution was supported by data on SARS-CoV-2’s backbone – its overall molecular structure. If someone were seeking to engineer a new coronavirus as a pathogen, they would have constructed it from the backbone of a virus known to cause illness. But the scientists found that the SARS-CoV-2 backbone differed substantially from those of already known coronaviruses and mostly resembled related viruses found in bats and pangolins.
https://www.scripps.edu/news-and-events/press-room/2020/20200317-andersen-covid-19-coronavirus.html


Mortality vs Economy

Some discussions around the risk of increased mortality from the economic shutdown, vs the increased risk of mortality from COVID-19. This seems like a relevant answer: “Of the six causes of death accounting for over 2/3 of mortality during the Great Depression, only suicides increased.”

https://www.pnas.org/content/106/41/17290


Projection Spreadsheet

Here’s the spreadsheet (attached).  It’s not super sophisticated.

On “Projection”, yellow is projection, blue is confirmed from JHU, green is confirmed from some other agency such as the WHO, or a medical report that maybe didn’t make it into the stats in time that day. Coloring is all set manually.

I manually update the last three sheets by cut/paste from their GitHub project.  I created dynamic tables at the top of each of those three pages.

That is what I cut/paste into “Projection” (transpose/transform on paste).  I do it manually so I can copy down projections, and because that’s a bit complicated for my Excel skills.

As a day on “Projection” is updated, the calculation cells between confirmed and dead are manually copied down one row to replace the yellow/grey lines.  That way they reflect actual percentage changes rather than projections still.

The graphs just got updated to dynamic.  As columns are added to the tables on the last two sheets, it should update the chart, but I’ve not tested it yet.

UPDATED: SARS-COV-2_COVID-19_Projections_c


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.


CV19 March 20 Update

US +6000 each of 2 days. It is throwing off the projections. Is this the new rate, or catching up on deferred testing/reporting?

03-20 Proj: 274102/11148 WW; 81210/3257 PRC; 195048/7975 NON; 47150/3893 IT; 24034/339 US; 391/8 TX

03-20 Real: 272166/11299 WW; 81250/3253 PRC; 190916/8046 NON; 47021/4032 IT; 19100/244 US; 394/5 TX;

I expect the US death count to jump soon, but that’s only because I do not know why the death rate is so low in the US. (Nationalistic zeal,. eg we are better than them because…, is probably not the cause.)

Projection for today’s report:
03-21 Proj: WW 305,199/12,939; PRC 8,344/3,257; NON 225,617/9,782; IT 53,880/4,774; US 26,673/298; TX 597/5.

The 7 day projection is coming up on 03-22, and WW we have already exceeded that. The guess was +/- 25%.

03-22 OLD: 262771/11285 WW; 81266/3324 PRC; 259371/14696 NON; 78550/8986 IT; 25567/280 US; 521/21 TX.

03-22 NEW: 329353/14176 WW; 81380/3270 PRC; 264408/12015 NON; 63076/5862 IT; 36287/368 US; 843/8 TX.

The new US numbers are questionable as stated above.

Chart of SARS2 stats

Chart of SARS2 stats updted for JHU’s March 20 numbers.


US must be testing

Must have been a lot of testing. US count doubled yesterday. Everything except China showed up as higher than projected infection rates. US and TX death rates are still low. Italy death rates are still high. Here are the numebers for 2020-03-19. Today’s numbers release sometime in the next 2-3 hours.

Where     Cases   Deaths  Recovered  Mort/A   Mort/R
World   242,713    9,867     84,962   4.07%   10.41%
China    81,156    3,249     70,535   4.00%    4.40%
NonPRC  161,557    6,618     14,427   4.10%   31.45%
Italy    41,035    3,405      4,440   8.30%   43.40%
US       13,680      200        108   1.46%   64.94%
Texas       260        1          0   0.38%  100.00%

Today’s numbers release sometime in the next 2-3 hours. The estimates for today’s numbers (03-20) are 274102/11148 WW; 81210/3257 PRC; 195048/7975 NON; 47150/3893 IT; 24034/339 US; 391/8 TX

Data source is Johns Hopkins University repository here:
https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data/csse_covid_19_time_series

Projections are just Excel, divide today by yesterday to get the change day to day, then use a 7-day average to guess what tomorrow might be, and do that again for each row.

In the US, first and second hand reports show that people are tested for seasonal influenza first, and if they test positive, they are not tested for SARS-2. This is conserve the the limited number of tests. It’s less likely for people to have both COVID19 and influenza at the same time. This may change as testing capability increases. According to Trump, Rosche, Quest, Labcorp, and Wal-Mart may be rolling out rapid testing capability starting in April.

In the US, it looks like the confirmed cases are about 13% of the actual infected. The actual death rate for non-overwhelmed places tends to be about 4.5% of the confirmed cases, when there’s ~14% testing (PRC and WW average).

The real mortality rate will therefore be that much less, which puts it in the same order of magnitude as seasonal influenza, but without the ability for people to get vaccinated, and a higher infection rate due to longer infectious incubation period.


0317 Projection Update

Estimate for today was within 1% again, except Italy was 2% lower on both infections and deaths. That is two days of increasingly lower rates than projected. GOOD JOB ITALY! Their March 22 numbers are on track to be less than the original 1week projection. Death rates are still high, at almost 8%. It’s hard to bring that down, especially since their population is 9 years older than the US, China, South Korea, etc.

The US has been consistently higher than projections. Authorities won’t test for COV19 if you test positive for influenza first. It’s likely the US reporting rate is less than the 14% that China had. On March 22, the US will be higher than the original 1week projection. Death rates are at 1.68%, which is suspiciously low. I am concerned that perhaps deaths are being attributed to other things, or testing is being avoided so that the stats look better. It could also be a new strain of the virus, but I would think that would get a lot of promotion from the government.

I’m having a discrepancy between World vs PRC + nonPRC, with WORLD going high. This may be a random error, but I’m wondering if China’s +30/day is false information. They have kicked out foreign press, and are in a propaganda war with the White House over who’s at fault. The difference is bigger than I would expect could come from the US’s reporting anomalies.

Because of reporting deficiencies, the real number infected is 6-8x the formal numbers, and that typically equates to about a week into the future as a SWAG for real but unreported cases. If you are still going out of the house with non-family members for recreational purposes, you are being selfish, and are a menace to society. If you are doing so to provide essential services, then please be extra careful.

Some of you may have noticed that, if the detection rate is only 14%, then that means the mortality rate is also a sixth of what we think. Yes, but it still spreads too fast, and the absolute numbers of people needing hospital care to survive still would overwhelm hospitals, leading to much higher death rates. So, even if the mortality rate is a flat 0.5% for everyone under age 64, and hospitalization needs are still only 2%, we still need to flatten the curve. At the current rate, and assuming 14% reporting rate, the US is on track to have the whole population infected in one month, with 6 million needing hospital care, and about a million needing external ventillation. We have about a million beds, and about 100k ventillators, with another 60k of old and less effective types. Also, if everyone is sick, who can be the caregivers?

Projections for tomorrow are WW 214086/8769; 81083/3243 PRC; 134076/5591 Non-PRC; 35476/2903 IT; 8901/137 US; 142/1 TX. I think we can expect the US to be 1-2% above projection, and Italy 1-2% below projection. Texas should have additional deaths any day now, but both TX and the US are still tracking substantially lower death rates than expected. I’m hoping to see a slow-down for the US next week. It seems a lot of people got the message for today, and have been reducing their out-of-house socializing.