Before we revisit the mortality projections, let’s take a look at the big picture. As I have said many times, each disaster has its progression in time. Earthquakes are measured in seconds, hurricanes in hours to days, pandemics in weeks (and foreign policy or environmental disasters often in years to decades from their roots). For example, while it might seem longer, the sharp rise in positive test ratios (again, not an increase in the number of tests, but the percentage of those tests coming back positive) in states like Florida, Arizona, Louisiana, South Carolina, and to a lesser extent Georgia, began about 20 days ago. If the pandemic follows the experiences in the Northeast and Europe, the upcoming 10 days will see a significant increase in mortality across these states.
Georgia is an interesting case. If the data can be trusted (and I’m somewhat skeptical), Georgia was in a “slow burn” both during the “shutdown” (which was a bit porous), then opened earlier than other states. Georgia’s mortality “curve” was not as flat as other states, but the increase in positives and hospitalizations has not been as sharp either. Here is what the curves for positives looks like (again, we don’t have a good “case” count because of all the asymptomatic cases and lack of comprehensive, random testing):
And here are the mortality curves (remembering these tend to lag 20 to 30 days behind the positive curves):
If you blend in all of the various data (positivity rates,hospitalization rates, mortality rates, complications among those who have recovered, and so forth), what we are seeing is a mixed picture.
So let’s revisit the graph from about a week ago, with the forecast for deaths in Georgia. I’ve added two other lines. The first is an optimistic projection, in yellow. While I never saw advocates of that position put their forecasts in to hard numbers, I used their stated assumptions (that the vast majority of new positives were among young people, and their mortality rates were uniformly lower based on the early mortality data among those groups). The second new line, in green, is the pessimistic assumption, that the observed rates will persist as the virus expands into a younger population with only marginal improvements. The orange line is the “balanced” projection based on the May 30th data and trends, the blue line are the reported deaths.
To state the obvious, the pessimistic line is way off. Clearly improvements in treatment, as well as the increasingly younger patients showing up in the hospitals, has meant the mortality rate has come down. Yet, not as much as the optimists (the yellow line) were arguing/hoping. The “balanced” projection is doing better, but is still high, although the divergent trend in the last couple days might be due to the weekend. The upcoming week is critical both from a policy standpoint as well as seeing into the future, as we see how the increase in positive tests 20 days ago (and increasing hospitalizations) translate into mortality. Will it stay in that middle ground, increase, or decrease? We should know in about 10 days (weekends screw up the data in Georgia and many other states due to reporting issues).
So what does that all mean? From a personal action standpoint, not much. Get a mask and wear it properly in the appropriate situations – inside with people outside your family, outside where close contact (less than six feet or so) is unavoidable. Keep in mind masks do you some good – but mostly prevent you from spreading if you have it – and remember you might be and not know it. Use good hand hygiene. If you think you might be sick stay home. The same stuff that has been said for weeks.
From a societal standpoint it’s complicated. Because the COVID19 data is mixed, and it’s not either an “in your face” catastrophe or an equally obvious “nothingburger”, it makes it easy for partisans to argue either way and pretend their policy options are “right.” Compromise is essential – but sadly that doesn’t seem to be in the short term political interests of either side trying to create advantage for the upcoming election. In my opinion reimposing shelter in place orders is not practical and is causing more damage than good. The reason is that unless you enforce it uniformly across the country, there will always be brewing pockets ready to spread as soon as you release the restrictions. The only way to beat this thing is by personal responsibility and encouraging, even mandating it, but figuring out a way to do it that without damaging our increasingly fragile civil rights. What about schools? That’s a really hard one. I think it is important to restart in-person instruction – most independent studies show virtual instruction just isn’t as effective as in-person classes. But I don’t see how you can do it unless students are required to wear masks and aggressive steps taken to protect staff. Ideally classes would be kept together, which is practical with elementary school but increasingly problematic in the upper grades. It’s a hard problem, and public health and educators need to be working in close cooperation to figure out creative solutions.
In short, everyone needs to be reasonable and try to solve this rather than score points. You’re not being a sheeple to wear a mask and being careful; likewise, it’s not heartless to say we need to try to get our economic, educational, and social lives back to normal. Balance.