{"id":671,"date":"2020-04-02T17:47:00","date_gmt":"2020-04-02T17:47:00","guid":{"rendered":"https:\/\/covidqanda.org\/?p=671"},"modified":"2020-11-09T17:50:28","modified_gmt":"2020-11-09T17:50:28","slug":"last-week-you-described-measures-we-would-use-to-see-if-our-social-distancing-was-working-now-that-a-week-has-passed-what-do-those-indicators-show","status":"publish","type":"post","link":"https:\/\/covidqanda.org\/?p=671","title":{"rendered":"Last week you described measures we would use to see if our social distancing was working. Now that a week has passed, what do those indicators show?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\" id=\"0870\"><strong>Question:<\/strong>&nbsp;Last week you described measures we would observe to see if our social distancing was working. Now that a week has passed, what do those indicators show?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"2e41\"><strong>Answer:&nbsp;<\/strong>Thanks for remembering! In my opinion, it\u2019s still too early to tell whether social distancing is working. But since we have more data now, let\u2019s take a look! Back in the&nbsp;<a href=\"https:\/\/medium.com\/@madeleinefabic\/covid-19-questions-and-answers-ee65d2f749e7\">Q&amp;A of 3\/25<\/a>, I described three indicators we should be tracking to understand how successful we\u2019ve been in containing the epidemic. Those measures are:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Number of patients hospitalized (daily, weekly, cumulative) [Update: I originally wrote admissions, but I think daily hospitalized patients is a better measure]<\/li><li>Number of ICU patients (daily, weekly, cumulative); [Update: I originally wrote admissions, but I think daily ICU patients is a better measure]<\/li><li>Number of deaths (daily, weekly, cumulative)<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"5b2b\">Thanks to Governor Cuomo\u2019s daily press briefings, we have these data points for New York. First, looking at&nbsp;<strong>Figure 1<\/strong>,we see that the number of hospitalized patients, ICU patients, and deaths continues to increase on a daily basis and has increased unabated since reporting began earlier this month. That\u2019s bad news, but it is not unexpected news.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"bffb\"><strong>Figure 1. Daily Number of New York Hospitalized Patients, ICU Patients and Deaths Continues to Increase.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/miro.medium.com\/max\/2160\/1%2ALB89UHJFkFPr35AyLjjocQ.png?w=723&#038;ssl=1\" alt=\"Image for post\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"5444\">Now look at&nbsp;<strong>Figure 2,&nbsp;<\/strong>which shows the rate of increase in hospitalizations. Good news! The growth rate (e.g. doubling time) has slowed since March 27th. This is an indication that social distancing measures \u2014 put into place state-wide on March 18th (educational facilities closed), March 20th (non-essential biz closed), and March 22nd (mandatory stay-home order) \u2014 seem to be working. If these trends hold, it means that we are slowing the pace of the epidemic. All that said, I\u2019m still not sure how much I\u2019d hang my hat on that assessment. Based on findings from China (described in&nbsp;<a href=\"https:\/\/medium.com\/@madeleinefabic\/covid-19-questions-and-answers-ee65d2f749e7\">Q&amp;A of 3\/29<\/a>), we expect folks to know they are sick within about 5 days of infection and to seek medical treatment (hospitalized care) within 7\u201313 days of symptom onset. So, presumably, we\u2019d start seeing growth rate in hospitalizations begin to slow about 15 days after social distancing begins. If we start the clock at March 18, then we wouldn\u2019t expect to see growth rates in hospitalizations slow until on\/about April 2nd, and that\u2019s a pretty early estimate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"32a3\"><strong>Figure 2. The rate of increase in hospitalizations has slowed; doubling time is now estimated to be 6 days rather than 3.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/miro.medium.com\/max\/2160\/1%2AZB4bQoFi2who8Qd5DvBrFg.png?w=723&#038;ssl=1\" alt=\"Image for post\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"d582\">Now, if we look at New York\u2019s deaths in a cumulative way (rather than daily as is shown in&nbsp;<strong>Figure 1<\/strong>&nbsp;above), we see that the increase continues along an exponential trend \u2014 per&nbsp;<strong>Figure 3<\/strong>, look at that steep slope since late March! \ud83d\ude1e&nbsp;<a href=\"https:\/\/covid19.healthdata.org\/projections\">Institute for Health Metrics and Evaluation\u2019s COVID-19 model&nbsp;<\/a>estimates that New York won\u2019t hit it\u2019s peak daily number of deaths for another 8 days. And if we look at crude mortality rates over time, we find them getting worse (<strong>Figure 4<\/strong>), which is obviously not a good sign.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"9093\"><strong>Figure 3. Cumulative COVID-19 Deaths in New York are Increasing at an Exponential Rate, totaling 2,372 as of April 2nd.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/miro.medium.com\/max\/2160\/1%2ArkINiI01p0b5t-0IXFPSXw.png?w=723&#038;ssl=1\" alt=\"Image for post\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"908f\"><strong>Figure 4. Crude Mortality Rate in New York State Seems to be Worsening. Today it is 2.6%.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img data-recalc-dims=\"1\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/miro.medium.com\/max\/2160\/1%2AIh7s_5GGDKbacwVxo_R6QA.png?w=723&#038;ssl=1\" alt=\"Image for post\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\" id=\"ad98\">Finally, looking at how New York data compare with the data coming out of China, per the&nbsp;<a href=\"https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/who-china-joint-mission-on-covid-19-final-report.pdf\">WHO report<\/a>, we find that clinical outcomes are quite similar. [Note: Given how limited testing is in other areas of the US, I wouldn\u2019t try this analysis on a national-level. Since NY has been doing such a comparatively good job of expanded testing, it offers a good opportunity to check.] Among positive cases in New York, about 20% are hospitalized (as of April 2, 92.3K total positive, 19.5K total hospitalized), which aligns with what China experienced too. Of those who are hospitalized, about 25% are in intensive care. Put another way, about 5% of all cases in New York thus far have required intensive care.&nbsp;<strong>And as to mortality rates, we\u2019re finding a crude rate of approximately 2%. All of this aligns with China\u2019s data. But if the trend in crude death rate continues, we will be worse off than China \u2014 either a reflection of fewer tests conducted among folks with minor illness, a reflection of a faltering health health system, or a combination thereof.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Question:&nbsp;Last week you described measures we would observe to see if our social distancing was working. Now that a week has passed, what do those indicators show? Answer:&nbsp;Thanks for remembering! In my opinion, it\u2019s still too early to tell whether social distancing is working. But since we have more data now, let\u2019s take a look! [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":672,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[93,47,46],"tags":[68,112,117,141,53,14,123],"class_list":["post-671","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-models","category-states","category-trends","tag-cfr","tag-data-availability","tag-hospital","tag-ihme","tag-new-york","tag-reopening","tag-social-distance","fallback-thumbnail"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/i0.wp.com\/covidqanda.org\/wp-content\/uploads\/2020\/11\/April-2.png?fit=1080%2C720&ssl=1","_links":{"self":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/671","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=671"}],"version-history":[{"count":1,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/671\/revisions"}],"predecessor-version":[{"id":673,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/671\/revisions\/673"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/media\/672"}],"wp:attachment":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=671"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=671"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=671"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}