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Social distancing and shelter in place - working or not?

Mongoose

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Here is a series from a data scientist exploring whether the curve is flattening in the SF Bay Area. As you may know, the Bay Area was one of the first regions to adapt Shelter in Place across multiple counties. As you know NYC was enacted later with several adjacent states with NYC commuters enacting SIP only recently. Los Angeles also adopted later and has experienced a mushrooming of cases. Of course...early data, more testing but interesting data points no less.

https://swell.life/article/rMYhMFSUJ7LO/is-the-bayarea-curve-flattening (as of Mar 26)

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Original Article Mar 24

NY is following the Italy Curve. CA and WA are more closely tracking the South Korea Curve. We should all learn from what works (South Korea) and what does not (NYC).
 

Mongoose

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The data for today, March 26, was close to the worst that could have been expected. Instead of a continuing flattening of the curve, today's data put us back on the exponential curve that started March 1. Unless things severely turn in the next couple of days, these data suggest that "social distancing" isn't cutting it as a measure to "flatten the curve".


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I think this spike has more to do with increased testing. The cases were there, just not identified. Social Distancing works if people comply. However there are plenty of stories where recklessly people who feel invincible are out and about making things worse. Case in point Spring Break Beach Parties and COVID-19 House Parties.
 

T_R_Oglodyte

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And here is the updated forecast from the people who are actually expert at this sort of thing. Still a lot of uncertainty, but it says here in Washington we're supposed to peak next week.

 

Sandy VDH

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Population density is an important consideration. Why, it exponentially increases your risk of exposure. Public transportation use it also a higher risk factor.

Houston, the 4th largest US metroplex, has a very low density compared to NYC. We have some public transportation but it is not the primary mode of transportation. We have very spread out communities within the city.

This washington post article has some visual demonstrations of virus spread. While it is not covid-19 specific it give you a visual appreciation for what Shelter in Place is attempting to do.

 

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With the significant lack of testing, pre- and post- distancing, nobody really knows because nobody can know. My state is still not testing many, still under 7000 total. But our deaths are higher than some states with fewer cases. There is no random sampling, pretty much only health care workers (if them) and those already in the hospital get a test. If you are in the hospital, you still might not get a test. There could be people that died before the first test made it to their state.

Blind projection is all that can be done from dirty data.
 

T_R_Oglodyte

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With the significant lack of testing, pre- and post- distancing, nobody really knows because nobody can know. My state is still not testing many, still under 7000 total. But our deaths are higher than some states with fewer cases. There is no random sampling, pretty much only health care workers (if them) and those already in the hospital get a test. If you are in the hospital, you still might not get a test. There could be people that died before the first test made it to their state.

Blind projection is all that can be done from dirty data.
The data aren't completely dirty. These people have a lot of experience modeling outbreaks using similar data - Ebola, for example. There wasn't a lot of test data from that, so they work it out from morbidity and mortality data, which is more accurate. And that's what they are primarily using here.

The places where I think there is uncertainty in the model, where assumptions need to be made because there is less inferential data from other epidemics, are things like infectiousness and the effective control measures that haven't been deployed on this scale.

And they do state there is a lot of uncertainty. But I wouldn't call them blind projections.
 

geekette

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The data aren't completely dirty. These people have a lot of experience modeling outbreaks using similar data - Ebola, for example. There wasn't a lot of test data from that, so they work it out from morbidity and mortality data, which is more accurate. And that's what they are primarily using here.

The places where I think there is uncertainty in the model, where assumptions need to be made because there is less inferential data from other epidemics, are things like infectiousness and the effective control measures that haven't been deployed on this scale.

And they do state there is a lot of uncertainty. But I wouldn't call them blind projections.
Population health before this matters, too. Some places have more cancer or obesity, higher maternal death rate, diabetes, etc. The co-morbidities matter big on this one. Anyone that had upper body radiation impacting lungs is simply higher risk for big complications.

Yeah, I know, they have their ways, but for me, it's like polls. You won't really know until it's in the rear view and it can be much different than what it looked like ahead of time. The sample sizes just aren't big enough, the data on deaths aren't complete. People found dead at home may never be tested nor counted in this.
 

CalGalTraveler

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Interesting chart of hot-spots based on cases per 100,000 population as of today Mar 27. California doesn't look so bad when you factor in the high population. NY looks really bad - high population and high cases. (Would love to see an overlay of testing density - It's ramping up but many areas still untested.)

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Panina

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Interesting chart of hot-spots based on cases per 100,000 population as of today Mar 27. California doesn't look so bad when you factor in the high population. NY looks really bad - high population and high cases. (Would love to see an overlay of testing density, although it's ramping up, many areas still untested.)

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In the states that have not done lots of testing the chart can definitely be inaccurate. In the coming weeks we will know better. In my state I cannot even find out how many have been tested.

In my neighboring state N.C. there have been almost 900 cases but only 13,000 tested. Just a few days ago it was much less. To me that means because of the lack of testing we are missing how bad it is. Another week it will be more apparent.
 

dioxide45

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I think the only way we can get away from social distancing and shelter in place is to have mass testing and mass antibody testing. I don't see us getting to that point anytime soon. Perhaps the infection and death rates would have been the same without the SIP and SD, we would never know. In places without high population density, I don't know if it matters as much. Places like NY with mass transit and high population density, I think social distancing and SIP probably have a bigger impact.
 

bluehende

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And here is the updated forecast from the people who are actually expert at this sort of thing. Still a lot of uncertainty, but it says here in Washington we're supposed to peak next week.

Thanks for posting.
 

Panina

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goaliedave

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Of course it works. But only in places where people comply. It works best with threat of jail, as in many countries currently but unlikely in USA.

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WVBaker

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Of course it works. But only in places where people comply. It works best with threat of jail, as in many countries currently but unlikely in USA.

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And just how and where are we going to construct these jails? The current ones are full or near capacity.
 

presley

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I am dreading the day that the President tells everyone to get back to work because that will be the end of me working from home.
[Redacted]No matter what [the President] says, our Governor still reigns supreme for California. I do not think Newsom will tell people to go back to work anytime soon. Whenever I see him talk, I see a man full of anger at those lacking social distancing and fear of the entire state being sick at the same time. He looks like he feels responsible.
Of course, the county or the city can come up with something different than the state and we have to do whatever that is, but I just can't imagine California getting back to normal anytime soon.

My daughter in Los Angeles county got a shelter in place order yesterday that goes through April 19th.
And just how and where are we going to construct these jails? The current ones are full or near capacity.
I wonder if they could use those ankle bracelet monitors to keep people at home as a first level of arrest.
 
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WVBaker

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I wonder if they could use those ankle bracelet monitors to keep people at home as a first level of arrest.
Interesting concept however, in most cases the individual pays, sometimes $25.00 a day, for the convenience of wearing one.
 

T-Dot-Traveller

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Nevada- Nonessential businesses closed (or work from home) including casinos: The Las Vegas Strip is closed
....I know here in Nevada the decision to do......... it was based on the number of ICU beds, vents and other healthcare resources. We have about 420 cases now and 10 deaths in Nevada, far fewer than many places. But already nearly 80% of ICU rooms and over 30% of our ventilators are being used.......from yesterday: https://nvhealthresponse.nv.gov/wp-content/uploads/2020/03/3.25.20-Sit-Rep.pdf
Private businesses are collaborating with government to try to get more PPE for healthcare workers, .....

I feel like my state's efforts have definitely helped slow down the spread here in the Vegas area. If they hadn't shut down the Strip then......I believe if Nevada had waited another week to act, our death toll would be much higher now than it is.
I believe all the Canadian provinces implemented similar changes based on ICU / Hospital Ventilator capacity.
-while all hospitals are non profit & each province is the single payer [Federal participation is a $ transfer / similar to USA highway trust fund transfers to states] - CAPACITY is a always an issue because efficiency saves taxpayer dollars .

Canada’s first cases were primarily Canadians returning from Wuhan where they had family . Then returnees from Iran , Italy and other places .Many of those used good judgement and did self isolated in a family setting .The next group - were often those in close contact to those who had been out of country .
Canada is moving into community transmission - but did implement rules & social distancing before this exploded..
Newfoundland -(population 500,000 ) now has a cluster of 70 / out of 100 total) Covid 19 cases that shows the risks of waiting .
March 15-17 - A funeral home had 2 memorials - an asymptomatic person who had recently travelled
was an attendee . People mingled and hugged = 70 cases ( so far ) of Covid 19 .

********
As far as I understand a valid scientific comparison trial should involve comparison of different options .
How different USA states - Canadian provinces - Mexican States implement - will likely give some valid comparison on what options have the most success in North America and in comparison to other jurisdictions world wide .
 

Mongoose

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And just how and where are we going to construct these jails? The current ones are full or near capacity.
They won't be arresting them. Hopefully people will obey, those that don't can faces fines up to $5,000 each. Did you see where the police and National Guard in RI are going door to door looking for NY'ers and instructing them to shelter in place.

 

WVBaker

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They won't be arresting them. Hopefully people will obey, those that don't can faces fines up to $5,000 each. Did you see where the police and National Guard in RI are going door to door looking for NY'ers and instructing them to shelter in place.

Unlike China and many other countries, we're not a command-and-control society. The U.S. operates under a fundamentally different governmental structure. That structure places constitutional limits on the powers wielded by state actors, whether or not they are operating in an emergency capacity.

These orders, which bar all “nonessential gatherings of individuals”, pose a direct challenge to religious and political gatherings, and curtails the ability of individuals to petition their government by appearing for testimony before public bodies, for instance. The First Amendment, as well as comparable provisions in state constitutions, protect such expressive activities against governmental interference

Granted, there is Supreme Court case law that permits certain “time, place, and manner” restrictions on First Amendment gatherings. Keep in mind that it will only take one case where it's decided that these orders do not meet constitutional standards, and are not enforceable in a free society. Any reasonable person understands that challenges to these orders are inevitable. In fact I read where there is already a group of citizen activists and religious leaders in the midst of challenging certain New Hampshire executive orders that impact political and religious gatherings.

On the federal level, the DOJ has asked Congress to provide it with the authority to ask certain district court judges to halt court proceedings during a national emergency, as well as to detain individuals without trial during government declared “emergencies.” This request is a direct challenge to the criminal procedural protections set out in the federal Bill of Rights, which include the “right to a speedy and public trial.”

The orders issued by states are being followed closely and there will be challenges as to there constitutionality.
 

CalGalTraveler

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Devils advocate: As taxpayers why are we handing $1200 checks to people in rural/low disease areas who are not impacted by corona and whose state and local governments don't see the need to put in place SIP measures? Why are these people getting a free government handout and can delay paying their taxes etc. when they are not significantly affected, still have their jobs and can go about their daily business?
 
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WVBaker

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Devils advocate: As taxpayers why are we handing $1200 checks to people in rural/low disease areas who are not impacted by corona and whose state and local governments don't see the need to put in place SIP measures? Why are these people getting a free government handout when they are not significantly affected?

Similarly, for those in affected SIP areas perhaps making anyone who significantly violates SIP ineligible for the $1200 or unemployment relief?
Because doing so would be a logistical nightmare. Which state has not been affected by some type of executive order?
 

CalGalTraveler

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Because doing so would be a logistical nightmare. Which state has not been affected by some type of executive order?
True but that has never stopped the government from doing so before. Look at our hairball of a tax code.
 

WVBaker

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True, but which other government "free handouts" should we eliminate? That could be quite a list depending on one's prospective.
 
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