Covid-19 Peak Projections and Ventilator Shortfalls

[bluehende]

I know they are not available in Boston. My son who is a manager in a research facility got a call from their janitor. He had all the symptoms and had just come back from the ER. He was told they were only admitting critical patients and the tests they had were reserved for health care workers. It is scary that he was sent home and to assume he had it and told to return if his symptoms got worse. These were not slight problems. Their lab has been closed for 2 weeks thank god.

 

[JanT]

I'm so sorry for the loss of your aunt. May God bring you peace and comfort.

My aunt just passed away in a hospital this weekend. Her son was only allowed to visit after her covid test had come back negative and she was on her deathbed. Just heartbreaking.

 

[JanT]

Please tell your wife that she is an angel and that so many are praying for all medical and other essential personnel that are on the front lines. And thank her a million times over from this TUGGER.

I don't believe their numbers. I feel to many in USA are working that are not essential. The curve cannot be flattened when many nonessentials are working and spreading the virus. Front line health care workers are being overwhelmed by

My wife has been reallocated to the hospital where ever they need her. She has come home over the last few days with a heavy heart . Very sad to hear that many are isolated from families and friends when they are needed the most for comfort..

 

[Sapper]

I would certainly trust a healthcare worker that has seen confirmed Corona to know it when they see it, but that raises a question - if the test never happened, would that death be a tick mark under Corona or undetermined?

This may change as medical examiners become inundated, however, if you keel over right now and looked like you were having any trouble breathing prior to expiring (or coughing up pink bubbly blood), the ME is going to open you up and take a look at your lungs. My understanding is the damage to the alveoli from this is specific enough that an ME can call it based on what they see. Why would they care after you are gone? To make contact with anyone you may have been around so they can be quarantined.

 

[geekette]

Just heard about this handy data tool. It is interesting and scary.

IHME | COVID-19 Projections

Explore forecasts of COVID-19 cases, deaths, and hospital resource use.

covid19.healthdata.org

 

[dgalati]

Please tell your wife that she is an angel and that so many are praying for all medical and other essential personnel that are on the front lines. And thank her a million times over from this TUGGER.

Thank you I will pass this along to her.

 

[chellej]

I know that the Georgia statistics published by the GA DPH just added a table with age, gender, and whether there are any underlying conditions (just a Y/N) for all COVID deaths in the state. I did note by skimming that almost all of the deaths of younger (say, <60) individuals involved an underlying condition. I don't know if other states are beginning to publish data to such a granular level.

Washington is going to start "tracing" cases. The hope is to complete 1000 cases a day for the next month and collect and share the data with the epidemiologists. They hope this data will slow things down and should give a better overall picture of whats going on

 

[geekette]

This may change as medical examiners become inundated, however, if you keel over right now and looked like you were having any trouble breathing prior to expiring (or coughing up pink bubbly blood), the ME is going to open you up and take a look at your lungs. My understanding is the damage to the alveoli from this is specific enough that an ME can call it based on what they see. Why would they care after you are gone? To make contact with anyone you may have been around so they can be quarantined.

I think that between my death and getting to a coroner, it would be far too late to qt anyone, even before volume delay. They are either already aware of my sudden illness and death or already sick.

I would think that autopsy would only be done if requested or mysterious? But, yes, I had heard that there were indications in the lungs.

 

[Sapper]

I think that between my death and getting to a coroner, it would be far too late to qt anyone, even before volume delay. They are either already aware of my sudden illness and death or already sick.

I would think that autopsy would only be done if requested or mysterious? But, yes, I had heard that there were indications in the lungs.

Sorry, I could have phrased my earlier response better. I did not mean you specifically.

Secondary cases would be time dependent from point of contact. Just a hypothetical here, person A thinks they have a cold, goes to the local pharmacy for NyQuil. Person A interacts directly with the sales clerk. Person A expires five days later. ME does an exam the next day, it takes a day for someone to figure out person A went to the pharmacy and contacts the sales clerk. The sales clerk has another seven days at the outside to present symptoms. If they can let the clerk know to self quarantine, that would help to reduce exposure to others. I can see it going in different ways, person A shows up at the ER two days after the pharmacy trip, and one of the first things they are asked is who they have interacted with. Does the ER nurse go ahead and make the call to the clerk with out a COVID positive test? I am assuming no HIPPA violation as no identifying info of person A would be given. Actually, now that I am thinking about it, this hypothetical is making me think about how exposed the folks are that are working as a checkout clerk, a bagger, the Amazon or pizza delivery person. Then how much of a vector they are because that person continues to interact with x# more people.

I doubt a full autopsy would be required, just a quick look to verify lung tissue damage (endoscope).

 

[geekette]

Sorry, I could have phrased my earlier response better. I did not mean you specifically.

Secondary cases would be time dependent from point of contact. Just a hypothetical here, person A thinks they have a cold, goes to the local pharmacy for NyQuil. Person A interacts directly with the sales clerk. Person A expires five days later. ME does an exam the next day, it takes a day for someone to figure out person A went to the pharmacy and contacts the sales clerk. The sales clerk has another seven days at the outside to present symptoms. If they can let the clerk know to self quarantine, that would help to reduce exposure to others. I can see it going in different ways, person A shows up at the ER two days after the pharmacy trip, and one of the first things they are asked is who they have interacted with. Does the ER nurse go ahead and make the call to the clerk with out a COVID positive test? I am assuming no HIPPA violation as no identifying info of person A would be given. Actually, now that I am thinking about it, this hypothetical is making me think about how exposed the folks are that are working as a checkout clerk, a bagger, the Amazon or pizza delivery person. Then how much of a vector they are because that person continues to interact with x# more people.

I doubt a full autopsy would be required, just a quick look to verify lung tissue damage (endoscope).

Nah, it's cool, I was not disturbed. I made myself the example. Could be. Well, not really, since I haven't been within 6 ft of anyone since Thursday, Feb 27.

I just think we are far past tracing possibility, but curious about autopsy or even every body going to ME? I don't know much about that kind of thing. Quincy, and the Kay Scarpetta novels by Patricia Cornwell.

But, thank you for the big reminder to all of how much danger the essential workers are in. Every single day. Dr Fauci has been serious about Stop Going Out. Delivery drivers are being run ragged as well. Americans can't seem to stop ordering stuff nor leaving home.

 

[WalnutBaron]

But, thank you for the big reminder to all of how much danger the essential workers are in. Every single day. Dr Fauci has been serious about Stop Going Out. Delivery drivers are being run ragged as well. Americans can't seem to stop ordering stuff nor leaving home.

Yesterday, the President's COVID-19 team announced that, by the time this has passed, they expect between 100,000 to 240,000 deaths in the U.S. The total today is a little over 4,000. If you take the midpoint of the team's estimate, it means we're only about 2.5% into this. We've barely begun. April is going to be a hellish month, so we all should heed the warning, as geekette has repeated: Stop Going Out. Batten down the hatches. We have only felt the outer bands of the hurricane that is about to sweep over us.

 

[WVBaker]

Yesterday, the President's COVID-19 team announced that, by the time this has passed, they expect between 100,000 to 240,000 deaths in the U.S. The total today is a little over 4,000. If you take the midpoint of the team's estimate, it means we're only about 2.5% into this. We've barely begun. April is going to be a hellish month, so we all should heed the warning, as geekette has repeated: Stop Going Out. Batten down the hatches. We have only felt the outer bands of the hurricane that is about to sweep over us.

Tragedy is a tool for the living to gain wisdom, not a guide by which to live. - Robert Kennedy

 

[chellej]

I have been watching Washingtons daily update of cases and find the shift interesting....we now have the same number of cases in the 20-39 age group as the 60-79...each at about a quarter of the cases. The 40-59 age group has a third of the cases. 80 and up have only 12% of the cases but 54% of the deaths.

Hospitalization rate has gone from 1% to about 4.6% Only 7 % of the tests come back positive.

Previously almost all the cases were 60 and above. It is a big spike in the 20-39 and 40-59 groups

 

[T_R_Oglodyte]

The IHME site is now updated with data through today (April 5).

IHME | COVID-19 Projections

Explore forecasts of COVID-19 cases, deaths, and hospital resource use.

covid19.healthdata.org

Our situation in Washington is looking much better. According to their projections, we're "going over the hump". We've gone past the peak for required hospital resources and peak deaths are about about two days out. Shelter-in-place is still in effect until May 1, but if these projections are good, that might be when we can start to get back to normal. Of course, we need to remember that when restrictions are relaxed there is likely to be a second wave of infections. However, "flattening the curve" isn't about preventing infection; it's about spreading infections out over a longer period so that the health care system can manage the caseload.

Remember - until a vaccine is developed, almost all of us will be infected. We're just trying to manage the "when" and, optimistically have identified more effective treatment measures.

 

[CalGalTraveler]

Below is a comparison to the figures published one week ago on Mar 30 compared to today's projections on Apr 6

https://covid19.healthdata.org/projections

(Mar 30) Florida is projected to have a shortfall of 2029 ventilators, 843 ICU Beds and 6766 Covid-19 deaths to Aug 2019
(Apr 6) Florida is projected to have a shortfall of 2095 ventilators, 769 ICU Beds and 6770 Covid-19 deaths to Aug 2019

(Mar 30) California is projected to have a shortfall of 1252 ventilators, 0 ICU beds and 4306 Covid-19 deaths to Aug 2019
(Apr 6) California is projected to have a shortfall of 678 ventilators, 0 ICU Beds and 1763 Covid-19 deaths to Aug 4 2019 (a significant reduction in deaths)

(Mar 30) Washington is projected to have a shortfall of 352 ventilators, 110 ICU Beds and 1670 Covid-19 deaths to Aug 2019
(Apr 6) Washington is projected to have a shortfall of 157 ventilators, 0 ICU Beds and 632 Covid-19 deaths to Aug 2019 (a significant reduction in deaths)

(Mar 30) NY is projected to have a shortfall of 8855 ventilators, 10,352 ICU Beds, and 15,546 Covid-19 deaths to Aug 2019
(Mar 30) NY is projected to have a shortfall of 5664 ventilators, 5,946 ICU Beds, and 15,618 Covid-19 deaths to Aug 2019

(Mar 30) USA Overall projected to have a shortfall of 26,753 ventilators, 15,103 ICU beds and 82,141 Covid-19 deaths to Aug 2019
(Apr 6) USA Overall projected to have a shortfall of 24,848 ventilators, 16,323 ICU beds and 81,766 Covid-19 deaths to Aug 2019
(not much change as a nation but significant improvement in early hotspots such as California and Washington with worsening in other areas.)

 

[T_R_Oglodyte]

Washington shipped 400 non-COVID ventilators to other states, primarily New York. These won't work for COVID cases, but they will free up other ventilators that can be used for COVID cases.

As noted, the base prediction is that Washington is now past peak hospital resource use. But there's still enough uncertainty in the numbers that we could still be a week from the peak.

 

[T_R_Oglodyte]

The website has now been expanded to provide estimates for many countries in the world.

 

[CalGalTraveler]

Below is a comparison to the IHME figures published over the past few weeks compared to updated projections as of Apr 13

IHME | COVID-19 Projections

Explore forecasts of COVID-19 cases, deaths, and hospital resource use.

covid19.healthdata.org

(Mar 30) Florida is projected to have a shortfall of 2029 ventilators, 843 ICU Beds and 6766 Covid-19 deaths to Aug 2020
(Apr 6) Florida is projected to have a shortfall of 2095 ventilators, 769 ICU Beds and 6770 Covid-19 deaths to Aug 2020
(Apr 13) Florida is projected to have a shortfall of 968 ventilators, 0 ICU Beds and 4748 Covid-19 deaths to Aug 4 2020(a significant reduction in deaths) {Peak May 3)

(Mar 30) California is projected to have a shortfall of 1252 ventilators, 0 ICU beds and 4306 Covid-19 deaths to Aug 2020
(Apr 6) California is projected to have a shortfall of 678 ventilators, 0 ICU Beds and 1763 Covid-19 deaths to Aug 4 2020
(Apr 13) California is projected to have a shortfall of 412 ventilators, 0 ICU Beds and 1483 Covid-19 deaths to Aug 4 2020(peak projected April 17)

(Mar 30) Washington is projected to have a shortfall of 352 ventilators, 110 ICU Beds and 1670 Covid-19 deaths to Aug 2020
(Apr 6) Washington is projected to have a shortfall of 157 ventilators, 0 ICU Beds and 632 Covid-19 deaths to Aug 2020
(Apr 13) Washington is projected to have a shortfall of 216 ventilators, 0 ICU Beds and 855 Covid-19 deaths to Aug 4 2020 (Peak Apr 5)

(Mar 30) NY is projected to have a shortfall of 8855 ventilators, 10,352 ICU Beds, and 15,546 Covid-19 deaths to Aug 2020
(Apr 6) NY is projected to have a shortfall of 5664 ventilators, 5,946 ICU Beds, and 15,618 Covid-19 deaths to Aug 2020
(Apr 13) NY is projected to have a shortfall of 5246 ventilators, 4,854 ICU Beds, and 14.542 Covid-19 deaths to Aug 4 20 (peak Apr 8)

(Mar 30) USA Overall projected to have a shortfall of 26,753 ventilators, 15,103 ICU beds and 82,141 Covid-19 deaths to Aug 2020
(Apr 6) USA Overall projected to have a shortfall of 24,848 ventilators, 16,323 ICU beds and 81,766 Covid-19 deaths to Aug 2020
(Apr 13) USA Overall projected to have a shortfall of 13,851 ventilators, 7,369 ICU beds and 68,841 Covid-19 deaths to Aug 4 2020 (Peak Apr 10)

 

[Cornell]

The IHME model has proven to be one where lots of holes can be poked at it. If you dig deeper into their model, their confidence intervals are so incredibly wide around their estimates that you can't take the estimates seriously.

 

[Monykalyn]

The IHME model has proven to be one where lots of holes can be poked at it. If you dig deeper into their model, their confidence intervals are so incredibly wide around their estimates that you can't take the estimates seriously.

I just read some something about that too-that there are 5 areas where if input is off tiny amount the model has huge range changes.

 

[Cornell]

@Monykalyn The IHME website uses the terminology "uncertainty intervals" , but it's the same as a confidence interval that you learn about in Stats 101. I haven't read the entire thread in this post , so this may have been mentioned but the IHME model accounts for social distancing.

So when you hear people say "Oh ! Look how successful social distancing works b/c we've beaten all the projections", it's a false argument , b/c this model accounts for that already.

 

[CalGalTraveler]

Although the CI is wide what I find helpful is tracking the actual results over the past few weeks as a trend line against the confidence interval going forward to provide an idea of where we stand relative to the projections.

 

[Cornell]

A few examples of how bad the IHME model has been:

1) If you had used their projection on 4/1 for the estimates of the # of hospitalizations in TN, it would have said to prepare for 12,000. Actual number n=567,

2) Two weeks ago, their model predicted between 135,000-375,000 hospitalizations in the US. In reality, n=50,000.

And yes, this is the model that out gov't has been using to formulate its decisions / policies.

 

[T_R_Oglodyte]

A few examples of how bad the IHME model has been:

1) If you had used their projection on 4/1 for the estimates of the # of hospitalizations in TN, it would have said to prepare for 12,000. Actual number n=567,

2) Two weeks ago, their model predicted between 135,000-375,000 hospitalizations in the US. In reality, n=50,000.

And yes, this is the model that out gov't has been using to formulate its decisions / policies.

And your better model is????

 

[Old Hickory]

And your better model is????

First, do no harm?