COVID-19 Megathread 4: Grandma Got Run Over by the Dow Jones

[Del Tachi]

Surprised this hasn't been talked about yet in the thread, but Walmart an Target are rolling out new social distancing measures tomorrow limiting stores to 20% capacity.

https://twitter.com/NPR/status/1246277075100749824

Cities and counties are also starting to implement similar guidelines, like these new ones in Terrebone Parish, Louisiana (pop. 115k) that, among other things:

• All retail stores, including grocery stores and pharmacies, limited to 20% of fire marshal capacity
• Retail stores only open from 6AM to 8PM
• Shopping trips should only be made for "essential" items
• Only one person per family should go to the store at a time, if possible
• A 10PM to 5AM curfew is already in effect

I just don't understand the calculus here.  It's just a constant escalation of restrictions.  You can always find a way to be more aggressive in social distancing, but after a certain point the marginal costs exceed the marginal benefits.  Unfortunately, the sensationalist media and #FlattenTheCurve cultists will have these sorts of restrictions as their main raison d'etre by the middle of next week.

Panic buying is already a *major, major problem (and so far is actually a bigger problem than anything we've seen on the healthcare side).  Now the police are going to start enforcing a 20% limit?  What's the logical outcome here?  A bunch of people waiting several hours in line to buy groceries, contributing only to further panic and more runs on the supermarkets (which will lead to even longer lines in the best case scenario, violence in the worst).

Not to sound too alarmist here - but this is the *truly worrying stuff, not ICU/ventilator shortages.  The role of government in this situation should be to step-in and make sure essential retail operations remain open and accessible to all Americans.  If that means making people assume a bit more risk when they go out shopping, its a risk that's actually worth it in this case. 

[Del Tachi]

Surprised this hasn't been talked about yet in the thread, but Walmart an Target are rolling out new social distancing measures tomorrow limiting stores to 20% capacity.

https://twitter.com/NPR/status/1246277075100749824

Good, the grocery store seems to be the one place you can't avoid people who don't have a mask & blatantly disregard social distancing protocols.

No.  Bad.  Very, very bad.  This will just lead to more panic buying, which means more people will turn up to shop, which will now translate into long lines outside grocery stores (4 hrs wait for milk and eggs?), which means even *more panic buying.

This is the truly apocalyptic, society-ending stuff.  Not having to share a ventilator.

[Del Tachi]

Surprised this hasn't been talked about yet in the thread, but Walmart an Target are rolling out new social distancing measures tomorrow limiting stores to 20% capacity.

https://twitter.com/NPR/status/1246277075100749824

Good, the grocery store seems to be the one place you can't avoid people who don't have a mask & blatantly disregard social distancing protocols.

No.  Bad.  Very, very bad.  This will just lead to more panic buying, which means more people will turn up to shop, which will now translate into long lines outside grocery stores (4 hrs wait for milk and eggs?), which means even *more panic buying.

This is the truly apocalyptic, society-ending stuff.  Not having to share a ventilator.

The hoarding days have already pass (at least in my area). People have realized that they can still get stuff from (essential) stores even when under lockdown, so the hoarding seems to have stopped pretty quickly, evidenced by their thinking sensibly rather than panic buying.

Yes, people have stopped hoarding (mostly, some staple items seem perpetually low) but that's only because they've seen stores stay open and their access hasn't been an issue.  As soon as people have to start waiting in actual breadlines that sense of security will be completely erased.

[Del Tachi]

Surprised this hasn't been talked about yet in the thread, but Walmart an Target are rolling out new social distancing measures tomorrow limiting stores to 20% capacity.

https://twitter.com/NPR/status/1246277075100749824

Good, the grocery store seems to be the one place you can't avoid people who don't have a mask & blatantly disregard social distancing protocols.

No.  Bad.  Very, very bad.  This will just lead to more panic buying, which means more people will turn up to shop, which will now translate into long lines outside grocery stores (4 hrs wait for milk and eggs?), which means even *more panic buying.

This is the truly apocalyptic, society-ending stuff. Not having to share a ventilator.

Are you trolling? “Sharing a ventilator” can mean multiple tickets to death, especially when the patients are in critical condition. It’s only being done now because of the shortages. Sharing a ventilator means that both patients have to be in a similar condition continuously. It can be done, but not in the long term. Having to wait to buy toilet paper is now worse than suffocating to death because you couldn’t get a ventilator to support your own lungs? Okay.

People will die, that's inevitable and is already happening.  People panicking and food distribution chains getting disrupted?  That's a way more serious and escalatable situation that's more complex for the government to correct.

Like I said, you can always find a way to be more aggressive in social distancing.  But at a certain point the marginal costs do start overwhelming any additional benefit.  Is there really going to be a noticeable epidemiological benefit to limiting stores to 20% capacity (at this point no less, after several weeks of sustained community transmission) compared to the current recommendations?

[Del Tachi]

Surprised this hasn't been talked about yet in the thread, but Walmart an Target are rolling out new social distancing measures tomorrow limiting stores to 20% capacity.

https://twitter.com/NPR/status/1246277075100749824

Good, the grocery store seems to be the one place you can't avoid people who don't have a mask & blatantly disregard social distancing protocols.

No.  Bad.  Very, very bad.  This will just lead to more panic buying, which means more people will turn up to shop, which will now translate into long lines outside grocery stores (4 hrs wait for milk and eggs?), which means even *more panic buying.

This is the truly apocalyptic, society-ending stuff.  Not having to share a ventilator.

The hoarding days have already pass (at least in my area). People have realized that they can still get stuff from (essential) stores even when under lockdown, so the hoarding seems to have stopped pretty quickly, evidenced by their thinking sensibly rather than panic buying.

Yes, people have stopped hoarding (mostly, some staple items seem perpetually low) but that's only because they've seen stores stay open and their access hasn't been an issue.  As soon as people have to start waiting in actual breadlines that sense of security will be completely erased.

Do you have any data/evidence to back those assertions or are they more of those famed speculations (AKA "Hunches")?

I don't guess you've ever lived through a hurricane or other large, natural disaster where supply and distribution chains are actually disrupted and looting/violence become problematic.  Living through Hurricane Katrina hasn't afforded me the same opportunity.

[Del Tachi]

Panic buying is already a *major, major problem (and so far is actually a bigger problem than anything we've seen on the healthcare side).

Sometimes I read these things and wonder.

A temporary shortage of toilet paper or eggs is a bigger problem than people dying?

Hmmm.

I guess when it really comes down to it, when the going gets tough, and when push comes to shove, when you turn 100 years old and look back on your life, what really maters in end is not actually friends and family, but whether you always had enough toilet paper and whether you had to go even a single week without a carton of eggs.

Panic buying is a huge problem insomuch as people are *panicked and thus become more likely to do stupid things, and supply/distribution chains are already under extreme stress due to disrupted production, reduced transit, fallen commodity prices, and close to 10 million newly unemployed in the U.S. alone.

I'm not worried about a "temporary shortage of toilet paper or eggs".  I've been dealing with that for weeks.  I'm worried about the reaction masses of people will have to decreased access to grocery stores and supermarkets, and how that reaction could escalate beyond the so-far relatively stable social conditions we've been seeing.  If you can't understand the difference then that's on you.

[Del Tachi]

Panic buying is already a *major, major problem (and so far is actually a bigger problem than anything we've seen on the healthcare side).

Sometimes I read these things and wonder.

A temporary shortage of toilet paper or eggs is a bigger problem than people dying?

Hmmm.

I guess when it really comes down to it, when the going gets tough, and when push comes to shove, when you turn 100 years old and look back on your life, what really maters in end is not actually friends and family, but whether you always had enough toilet paper and whether you had to go even a single week without a carton of eggs.

Panic buying is a huge problem insomuch as people are *panicked and thus become more likely to do stupid things, and supply/distribution chains are already under extreme stress due to disrupted production, reduced transit, fallen commodity prices, and close to 10 million newly unemployed in the U.S. alone.

I'm not worried about a "temporary shortage of toilet paper or eggs".  I've been dealing with that for weeks.  I'm worried about the reaction masses of people will have to decreased access to grocery stores and supermarkets, and how that reaction could escalate beyond the so-far relatively stable social conditions we've been seeing.  If you can't understand the difference then that's on you.

> "I've been dealing with [a "temporary shortage of toilet paper or eggs"] for weeks."

> "the so-far relatively stable social conditions we've been seeing"

Pick one.

Can you really not see the distance here?  Panic buying is a problem now, but we've blunted it from getting out of control by keeping stores open and allowing people to move about them (largely) as normal.  People see the store open, people feel confident that they can go and get what they need.  The minute that people are put in the position of having to wait not just to buy highly in-demand staples (i.e., flour, canned veggies, toilet paper, whatever else) but also any potential immediate needs then the economically rational thing to do is drop everything you're doing and go to grocery store now because you have no idea about what waits might be like in the future.  That creates additional lines and additional waits, thus adding to the urgency of the situation - driving even more people to show-up and wait.  The increased transaction costs of the whole ordeal also encourages people to over-buy even more ("I waited an hour to get in today, so I need to buy everything I might possibly need so I can avoid having to wait 4 hours next week").

[Del Tachi]

https://twitter.com/AlexBerenson/status/1246825831864963073

Alex Berenson, a retired NYT reporter, has been tweeting a lot comparing daily case numbers with the predictions from the University of Wisconsin model (which is the model that motivated a lot of the current restrictions since it came out on March 26).

In short, it looks like new hospital admits for COVID-19 (a leading variable) are severely under-performing the model's predictions not just in New York, but around the country.  In a lot of areas, ICUs are actually less full then they were a week ago.

[Del Tachi]

Wow, look at the tracker today. Nearly every state seeing decreases in new cases compared to yesterday. Looks like the tide has turned more quickly than anyone expected and Trump has saved the country from disaster, expect a big approval bump.

That tracker you're citing may not be entirely accurate:

Coronavirus death toll: Americans are almost certainly dying of covid-19 but being left out of the official count

As if we ever come close to to accurately counting deaths from the flu or other respiratory viruses that primarily kill older folks with serious preexisting conditions.  There’s an almost unanswerable argument here about how to code these deaths in people who are really sick - does blaming the coronavirus or the flu (or anything else) for the death of someone who would have died in a few days from a severe underlying illness make sense? 

[Del Tachi]

Wow, look at the tracker today. Nearly every state seeing decreases in new cases compared to yesterday. Looks like the tide has turned more quickly than anyone expected and Trump has saved the country from disaster, expect a big approval bump.

That tracker you're citing may not be entirely accurate:

Coronavirus death toll: Americans are almost certainly dying of covid-19 but being left out of the official count

As if we ever come close to to accurately counting deaths from the flu or other respiratory viruses that primarily kill older folks with serious preexisting conditions.  There’s an almost unanswerable argument here about how to code these deaths in people who are really sick - does blaming the coronavirus or the flu (or anything else) for the death of someone who would have died in a few days from a severe underlying illness make sense? 

With your “logic” I should be able to shoot up a ward of terminally ill cancer patients and not be classified as a murderer.

Differences in how deaths are coded could be a big reason why case fatality rates appear so different across countries - from less than 1% in Germany to over 8% in Italy.  Italy was apparently very generous in coding deaths from COVID-19 during the outbreak.

[Del Tachi]

Wow, look at the tracker today. Nearly every state seeing decreases in new cases compared to yesterday. Looks like the tide has turned more quickly than anyone expected and Trump has saved the country from disaster, expect a big approval bump.

That tracker you're citing may not be entirely accurate:

Coronavirus death toll: Americans are almost certainly dying of covid-19 but being left out of the official count

As if we ever come close to to accurately counting deaths from the flu or other respiratory viruses that primarily kill older folks with serious preexisting conditions.  There’s an almost unanswerable argument here about how to code these deaths in people who are really sick - does blaming the coronavirus or the flu (or anything else) for the death of someone who would have died in a few days from a severe underlying illness make sense? 

The article does actually explain it... you can calculate a fairly accurate death toll by simply comparing the number of people dying over a time period versus the number of people you would normally expect to die over the same time period. So someone who was already terminally ill wouldn't get included in that sort of calculation if they already would have died within the time period during which the epidemic occured.

Yes, but that isn't happening yet and the CDC isn't even requiring positive identification of COVID-19 for it to be listed as a cause of death.

You're exactly right that we'll see the true scope of the pandemic only when looking at total mortality numbers.  What is total mortality saying now compared to a year ago?

[Del Tachi]

https://twitter.com/NateSilver538/status/1246909791680770050

Flattened? It's gotten steeper. Yes it's not accelerating as much, that's not flattening. I hope he just had a brain fart here.

"Not accelerating as much" is flattening.  You'll never see decreasing numbers of total cases/deaths, only flattening.

I hope you just had a brain fart here.

[Del Tachi]

https://twitter.com/NateSilver538/status/1246909791680770050

Flattened? It's gotten steeper. Yes it's not accelerating as much, that's not flattening. I hope he just had a brain fart here.

"Not accelerating as much" is flattening.  You'll never see decreasing numbers of total cases/deaths, only flattening.

I hope you just had a brain fart here.

Flattening would be fewer cases per day. That wasn't happening in recent days. Cases/day had an increasing slope.

Testing capacity is still ramping-up, so we should expect more positive tests as a result of expanded testing.  As Nate Silver says:

https://twitter.com/NateSilver538/status/1246919689416122369

Only 6k more new cases over last Sunday, and that's in-spite of a more than 40% increase in testing.

[Del Tachi]

https://twitter.com/NateSilver538/status/1246909791680770050

Flattened? It's gotten steeper. Yes it's not accelerating as much, that's not flattening. I hope he just had a brain fart here.

"Not accelerating as much" is flattening.  You'll never see decreasing numbers of total cases/deaths, only flattening.

I hope you just had a brain fart here.

Flattening would be fewer cases per day. That wasn't happening in recent days. Cases/day had an increasing slope.

Testing capacity is still ramping-up, so we should expect more positive tests as a result of expanded testing.  As Nate Silver says:

https://twitter.com/NateSilver538/status/1246919689416122369

Only 6k more new cases over last Sunday, and that's in-spite of a more than 40% increase in testing.

Any chance that this means that there is a light at the end of the tunnel by earlier than mid-June?

Yes.  We’re definitely not seeing the exponential growth the UW model thought we’d be seeing.  Even New York is looking better in terms of # of hospitalizations/ICU patients then initially predicted. 

[Del Tachi]

https://mobile.twitter.com/MarkLevineNYC/status/1246911781198495745
From a member of the NYC Council health committee.

Could also be people dying at home because....people are being told to stay home?

Irresponsible to attribute these deaths solely to COVID in an effort to inflate numbers and spread panic. 

[Del Tachi]

The updated numbers for COVID-19 in the U.S. are in for 4/5 per: https://www.worldometers.info/coronavirus/country/us/

I'll be keeping track of these updates daily and updating at the end of the day, whenever all states finish reporting for that day. The percentages represent the daily increase from the last report.

3/26:

• Cases: 85,390
• Deaths: ±1,200

3/27:

• Cases: 103,798 (+18,408 | ↑21.56%)
• Deaths: 1,693 (+493 | ↑41.03%)

3/28:

• Cases: 123,428 (+19,630 | ↑18.91%)
• Deaths: 2,211 (+518 | ↑30.60%)

3/29:

• Cases: 142,178 (+18,750 | ↑15.20%)
• Deaths: 2,484 (+273 | ↑12.35%)

3/30:

• Cases: 163,490 (+21,312 | ↑14.99%)
• Deaths: 3,148 (+664 | ↑26.73%)

3/31:

• Cases: 187,917 (+24,427 | ↑14.94%)
• Deaths: 3,867 (+749 | ↑22.84%)

4/1:

• Cases: 215,003 (+27,086 | ↑14.41%)
• Deaths: 5,102 (+1,235 | ↑31.94%)

4/2:

• Cases: 244,433 (+29,430 | ↑13.69%)
• Deaths: 6,070 (+968 | ↑18.97%)

4/3:

• Cases: 276,965 (+32,532 | ↑13.31%)
• Deaths: 7,391 (+1,321 | ↑21.76%)

4/4 (Yesterday):

• Cases: 311,357 (+34,392 | ↑12.42%)
• Deaths: 8,452 (+1,061 | ↑14.36%)

4/5 (Today):

• Cases: 336,327 (+24,970 | ↑8.02%)
• Deaths: 9,605 (+1,153 | ↑13.64%)

So the rate of new diagnoses has slowed everyday since 03/27 despite the steady improvements in testing availability?

[Del Tachi]

I don’t think we can convincingly say the worst is over until we see week-over-week decline. 

This Sunday the US had 1165 coronavirus deaths. 
Last Sunday the US had 363 deaths. 

So we definitely aren’t there yet.

Deaths are always a lagging indicator though (its the last thing to happen to people who got COVID 2-4 weeks ago)

Do we have any good, granular data on new COVID-19 hospital admits?  This indicator should lead deaths, while not being influenced by the availability of testing.

[Del Tachi]

https://mobile.twitter.com/MarkLevineNYC/status/1246911781198495745
From a member of the NYC Council health committee.

Could also be people dying at home because....people are being told to stay home?

Irresponsible to attribute these deaths solely to COVID in an effort to inflate numbers and spread panic. 

Or just maybe to get a better idea of how many deaths are actually occurring.  Don't automatically assume a conspiracy.

Can I point out that it’s not a conspiracy to say that people who pushed panic measures have an interest in making the death toll look as high as possible?  A conspiracy is “Xi cooked up COVID-19 in a lab”.   I was trying to make a broader point about the apparent political/social dynamics. 

[Del Tachi]

NYC vs. the rest of the country (including SF which also has high public transit commuting, dense housing, and a large homeless population and is rather amazingly doing fine) makes me wonder if closing schools might be the single most important intervention?  Japan closed schools very early and while they are having some issues now (2nd wave?), they seem to be doing very well vs. the free world average.  

One relevant point to consider when talking about density is that the highest concentrations in the NY area are not in NYC on a per capita basis, but rather in Westchester and Rockland Counties north of the city, followed by Nassau County, and only then by the Bronx and Queens. Even within the city, the per capita rate doesn't follow density; Manhattan is by far the densest borough but has the lowest per capita rate of the five boroughs and is lower than multiple suburban counties (those mentioned above and also Orange and Suffolk Counties and Bergen County, NJ, which all also have higher per capita rates than Brooklyn).

This all suggests that NYC's severe outbreak relative to other cities is mostly down to bad luck (perhaps some early super-spreader cases) rather than density.

The varying rates within the Metro might come down to demographics - with suburban counties being older than the relatively young City.  

I suspect this a density story through-and-through.  NYC is 60% denser than SF and more transit-centric (55% of households in NYC don’t have a car, only 30% in SF).

[Del Tachi]

The varying rates within the Metro might come down to demographics - with suburban counties being older than the relatively young City. 

I suspect this a density story through-and-through.  NYC is 60% denser than SF and more transit-centric (55% of households in NYC don’t have a car, only 30% in SF).

You should be required to post a warning with each post that you've been proven wrong on every count over the past month. Impressive bullsh**tting though.

Care to inform me which counts I'm wrong on here?


NYC is younger than its suburbs, as well as denser/more transit-dependent than San Francisco. 

These factors would explain why New York was hit first and hit harder than other American cities.

[Del Tachi]

NYC vs. the rest of the country (including SF which also has high public transit commuting, dense housing, and a large homeless population and is rather amazingly doing fine) makes me wonder if closing schools might be the single most important intervention?  Japan closed schools very early and while they are having some issues now (2nd wave?), they seem to be doing very well vs. the free world average. 

One relevant point to consider when talking about density is that the highest concentrations in the NY area are not in NYC on a per capita basis, but rather in Westchester and Rockland Counties north of the city, followed by Nassau County, and only then by the Bronx and Queens. Even within the city, the per capita rate doesn't follow density; Manhattan is by far the densest borough but has the lowest per capita rate of the five boroughs and is lower than multiple suburban counties (those mentioned above and also Orange and Suffolk Counties and Bergen County, NJ, which all also have higher per capita rates than Brooklyn).

This all suggests that NYC's severe outbreak relative to other cities is mostly down to bad luck (perhaps some early super-spreader cases) rather than density.

The varying rates within the Metro might come down to demographics - with suburban counties being older than the relatively young City. 

I suspect this a density story through-and-through.  NYC is 60% denser than SF and more transit-centric (55% of households in NYC don’t have a car, only 30% in SF).

Shutting down early is just as important. SF is denser than LA but LA has been less successful at bending the curve than SF. The Bay Area shut down just a few days earlier than the rest of California and took it a bit more seriously than the rest of California as well as the country, and the results show.

So far the # of cases in the population looks pretty consistent between SF and LA.  1:1515 in SF, 1:1585 in LA County.  By what metric is SF doing much better than the rest of California?

[Del Tachi]

The American Academy of Family Physicians estimates that as many as 58k family physicians might be out of business or forced into retirement as a result of COVID-19 closures.

[Del Tachi]

The American Academy of Family Physicians estimates that as many as 58k family physicians might be out of business or forced into retirement as a result of COVID-19 closures.

I'm admittedly not going to take the time to read this article because it's pretty dense, but offhand I'm rather surprised considering one would think Physicians are the one area of business that would be booming now ( assuming they can stay healthy and not catch coronavirus in the process)

In most places outside NYC/NJ, hospital/ER intakes have actually been down compared to before the beginning of the pandemic.  People are either deferring non-essential checkups and procedures or too afraid to go in due to the virus.  A 511-bed Hospital in Oklahoma City is temporarily closing due to a lack of patients.  I imagine private practice GPs are getting hit even harder. 

[Del Tachi]

Is there anyone here who still maintains that the US is on an Italy-type disease trajectory?  Or can we all reasonably agree that the United States looks like it will be one of the "success stories" of the global pandemic?  If so, can we talk about what factors have influenced the U.S. emerging relatively unscathed from this?  Better testing, more docs/ventilators, lower population density, younger demographics, warm weather, etc.

[Del Tachi]

Seems like really discouraging numbers out of Italy, with new cases and death up again.  I realize they still down from their actual peak, but how have they not made more progress after being under national lockdown for a full month?  Maybe the deaths will still lag by a month, but how can they still be getting so many new infections?

New cases are a function of testing.  The high percentage of positive test results in Italy indicates they haven't upped testing capacity as much as needed, and their "peak" lags due to the unavailability of tests.