California vs. Florida - Approachs to COVID?
First, STAY HOME AND STAY SAFE until further notice:
On March 19, California had 1,000 confirmed cases of coronavirus. That same day, it was the first state to issue a stay at home order for the whole state.
Three days later on March 22, Florida also hit 1,000 confirmed cases of coronavirus. It did not issue a stay at home order until the Governor reluctantly did on April 3. It was one of the last states. (Although 7 never did.)
Florida has been widely criticized for its late response. Florida (Miami) was supposed to be one of the next "hot spots" after NYC. It has also been criticized for allowing church services, wrestling, massage parlors as "essential businesses." Anecdotal evidence from the internet indicates many people in Florida are still moving about, without masks, etc. On the other hand, California was praised for its quick response.
Both states continued to see an increase in cases over time, but then....
Florida appears to have flattened its curve.
California appears to have flattened its curve.
Both states appear to be past the peak according to the IHME model (which also indicates Florida has done less distancing measures). (Of course, models are only as good as what you know at the time.)
It is hard to see how one approach has been significantly better than the other after a month. Is there more to it?
California has more cases and more deaths, but it also has more people. Florida is filled with more elderly people, but its hospitals have not been overrun as predicted.
Is it possible that regular social distancing alone is enough? Why hasn't there been a bigger difference to date? Shouldn't four weeks tell us something or is it too early to tell?
As states begin to re-open, shouldn't we examine how different approaches have been effective?
Anyway, STAY HOME AND STAY SAFE until further notice.
April 22nd, 2020 at 10:21 AM ^
There is clearly an inconsistency in what data is saying about NYC and the West Coast. Some of the west coast data seems to suggest a lower number of deaths relative to the assumed number of people infected. I would argue that both sides in this debate have a responsibility to acknowledge that. As much as I know you’d just like to pint to CA and say, see, scientists say it wasn’t that bad there, you can’t ignore what has happened and is happening in NYC and some of the other hard hit areas. Similarly, those like myself who are still concerned about the significant potential future health impact need to acknowledge the data from places like California.
The low end of what these numbers suggest (mortality rates of 0.1%) seems inconsistent with what we’ve seen in NYC (where a rate that low is inconsistent with the number of deaths already seen). That can mean at least 3 things:
1. The data is not in fact as inconsistent as it seems at first blush. (Note that there is significant overlap with #2)
2. People looking at the data are misunderstanding it, overstating the uncertainty in it etc.
3. There is something really different between NYC and some of the other areas that have been hard hit and California. Some studies seem to suggest that the west coast has been hit more with something directly from China, while NYC’s came via Europe. Could there have been a mutation that made the european/NYC strain more dangerous? That seems like a question for health scientists. If it were true, it is far from clear to me that would be a good thing. The more the virus mutates, that seems to make it harder to mitigate through medication and vaccination.
Focusing more on a combination of 1 and 2, If the mortality rates are more in the range of 0.2 to 0.4, that probably is not inconsistent with the data from the antibody testing in CA given the level of uncertainty about quality of testing and representativeness of sampling. It is also not inconsistent with the numbers being seen in NYC.
With exponential growth, it gets more challenging to explain the early spread in CA with the impacts in NYC. While it seems entirely reasonable to assume that there is a slower rate of transmission in CA, it does seem that it would have to be very much slower compared to New York for that to explain all of the differences.
How would you explain them? I don’t think it can all be explained by density and mass transit because by just about any metric, NYC has been hit way harder by this than the regular flu, so it seems it must be something else.
it is much easier to explain the differences between SC and NYC than NYC and CA.
Every state and area has been accused of having problems with their "death numbers"
No reason Florida would be different than CA,
Also, if you look at the Florida link it appears they started tracking the deaths of residents and non-residents together. That is an old article.
My NP friend says that deaths have been way undercounted, at least in Michigan. Cause of death listed as pneumonia with no pre or postmortem covid test.
But it was covid.
Per my wife’s cousin (an MD in Alabama) they’re seeing the same thing.
Neither state is doing very much testing.
Humidity, population density, idk. Florida has 54% more cases per million people. 30% more deaths per million people. Florida has been testing at twice the rate in terms of population as well.
I live in FL and most of the cases are in the Miami area. I live an hour South of Tampa and there aren't very many cases here as compared to Miami. I still do not know anyone who has it or had it. Someone told me alot of NY'ers go to Miami so perhaps that is how it became a hot spot.
i'm guessing a lot of europeans travel to miami vs tampa or anywhere on the gulf side.
I'm in FL, haven't left the house other than going to the grocery store so my observations are limited, but it sure doesn't feel any different when I've gone out in terms of how many people there are. ¯\_(ツ)_/¯
I did read a headline the other day that multiple studies have found that the virus does not do well in hot, humid areas, in addition to a couple other points I can't recall. If that's true I'm sure it's a factor, difficult to say how much though given the variables in measuring the situation. Plus, a lot of cities implemented some kind of lock-down before the state-wide one.
I read a headline the other day, but didn't bother to look it up for when I referenced it today too. The difference I'm using it to shame you, but you are trying to spread the information contained in it. Cite your sources.
Nah I'm good. I neither presented it as true or untrue, simply as a hypothetical. I'm sure someone as intelligent as yourself would have no problem typing it into the search engine of your choice.
Edit: Here you go Champ! Not the exact one, but based on the same study. I would take it with a grain a salt as there are other studies that indicate the opposite. But such a smart guy like you is probably well aware of such things. I'll defer to your massive cognitive abilities.
Florida also had a bunch of spring breakers and people who flew down from NY and the rest of the northeast.
When this all settles out, people will be very surprised at what the actual infection numbers were and for how long it was in the U.S. Many more will be angry at what was sacrificed in the response.
You're getting down-votes, but I do think you're right. A lot was sacrificed in the response, and the true mortality rate will likely be well well under 1%.
Fauci, himself, even stated as much nearly a month ago. In the March 26 New England Journal, he stated
"If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively."
Those are much harder to transmit though, is the thing.
The scary diseases are high lethality combined with highly communicable. COVID-19 is extremely communicable (including from those who are not yet symptomatic) and pretty lethal. Something like 10 times more lethal than the flu is the most consistent number the data is citing so far. But just as easily spread.
And it will have all seemed like huge overkill...which the experts in science have been saying from the get-go.
Only if we knew it from the start that it will be well well under 1%. Dang. Missed opportunity.
people will gravitate to the narrative on either side depending on their viewpoint. no matter what happens each side will say the other fucked up.
There are so many variables involved that pair comparisons like this are almost meaningless.
Only meaningless to those who don't get off on smashing (with down votes) those who disagree with their opinion.
Some of these debates of sickness and death in abstraction remind me of statement (attributed, perhaps mistakenly, to Stalin) that one death is a tragedy, a million deaths a statistic.
When people get around to minimizing or abstracting life and death, the right question is, what is the right number, the acceptable number of dead mothers, fathers, sisters, brothers, children, and which of these and how many others close to you is acceptable for you to lose personally?
One. I have one black sheep in my family.
This is why we need leaders. People who make policy judgments, not personal judgments.
No one wants to lose a friend or family member. If you thought about ti like that, you would keep us locked up forever. We are saving lives everyday by staying indoors.
No death is acceptable on a personal level, but these decisions are not being made on a personal level. They affect everybody.
You are not deciding what you would do, you are deciding for everybody, so you need to keep everybody in mind.
3 million people die in the US each year. Each death is tragic individually.
First time in global history healthy people are locked in their homes. Agree with being safe but when I have people walking by me outside... outside of all places ... that run into the street with their mouths closed. That's an overreaction that comes from bad media information and no science.
First as you’ve noted, people are going outside, they are not locked in their homes. Second, during the spanish flu many US cities employed stay at home strategies.
There is no comparison to the Spanish flu. That thing was really deadly and serious.
No one is minimizing deaths. And you're no hero for saying you don't want people to die. You're just being Obvious Guy. Your argument is childish and easily refuted by saying "well, if you want no one to die, then don't ever 1) drive cars again, 2) go outside and risk getting the flu again, 3) get on a boat again, 4) eat anything but a carrot ever again, 5) swim in a pool, 6) or a lake, 7) no swimming, 8) allow skateboarding, ... infinity) do all the things that make us human ever, ever again. OH?! You want to do some of those things?!!! WELL PICK YOUR MOM OR SISTER THEY'RE GOING TO DIE ASSHOLE YOU'RE MINIMIZING!!!!!"
It's the Lowest Common Denominator to one side of the debate. Your mirror image on the other side is saying "Those would give up liberty to secure a little safety deserve neither" and screaming about government control. Please continue shouting at each other in another room, and invite your echo chambers to join you.
There is an important debate here to be had about how to handle the county's affairs going forward, and it's best done with partisans (who won't see reason in either direction, and won't be convinced not matter the facts either way) absent.
The difference in the choices you offered and the choices at stake here is personal choice of actions and policy choices by detached individuals affecting millions.
The childish approach is your ad absurdum and red herring arguments. The only people who are facing consequences for their own individual conscious behavioral choices are health and safety professionals dealing with known infected individuals, and the people who congregate unprotected with individuals whose infectious status is unknown. People in both groups are being infected and getting disease. The second group includes people who are making their own risk choice (and making it for family members) and people who have been compelled to congregate, such as workers being coerced to work and people like the voters in Wisconsin compelled to vote in person.
It's a problem when a segment of society abstracts death in support of a position that serves economic interests that have near-term alternatives and fails to understand the effects that will be seen in subsequent days, weeks, months and even years that have no alternatives once committed.
The people absent from policy discussions should be people condemned with your inability in analysis, but unfortunately, that isn't the case.
Policy choice is what I do for a living and I'm good at it.
I certainly hope they're not important policy choices.
You're pretending you're a good guy because you care about people, and others are bad guys because they care about the economy. If you actually cared about people, you'd understand that the economy is about people.
I'll reiterate that it's an LCD argument with people like you pretending to superior morality. Childish and farcical.
Really, that's your argument? I know you are, but what am I? Really?
Have a nice day.
By the way, you didn't answer the question:
What's the right number of dead?
Who close to you is ok to die?
How many people are you willing to let die from depression and suicide? How about people who will die because they delay health care? How about poverty and suffering?
What if one of those people were someone you knew?
The rhetoric of an idiot.
I also work in public policy and I have to say, what is the right number of dead is not the way I generally see policy being developed. Usually it is a weighing of many factors but will often boil down to, how much are we willing to pay to save a life. We could set higher safety standards for cars and save more lives, but we’ve made the decision that the current requirements properly balance cost and health benefits. We do the same with environmental policy, food safety etc. We rarely, if ever seek to minimize health risk at the cost of all other considerations.
Can someone please help me understand how anyone is able to assess the relative efficacy of economic lockdown vs. no economic lockdown? We don't know what would have happened if there was no economic lockdown. Mortality rates could have been much higher than what we're seeing now. That's why I don't understand the argument that the mortality rate is XYZ so therefore we did not need or may no longer need the lockdown.
that's going to be the debate for months or years to come. i don't think anyone (except the stupid) is advocating full lockdown until a vaccine is developed or anyone (except the stupid) that nothing at all was needed, it was just the flu. a vaccine may be many months or years away.
the analysis is where should the bar have been set. perhaps lockdown in the big cities and hotspots. and emphasize or even require masks, more hand sanitation and some other social distancing measures everywhere else.
that's the debate, imo.
why don't you answer that question?
Because I can’t. I don’t know the answer.
The answer is "it depends". We lose 3,000,000 a year, which is about 275,000 a month, so whatever number you come up with has to be in relation to that sobering statistic. The other is "who".....I'm ok losing 80 year olds, they've lived longer than anyone else in the history of humanity (on average) but I'm not ok losing large quantities of <30 year olds.
It's interesting .... we send our young and brave to die in war without thinking anything of it but willfully collapse the economic future of our children when 80 year olds die a few months before their time.
Over the entire course of the Vietnam war, which spanned roughly 8 years, there were about 58,000 American casualties. We will do that with Covid in about ~4 months, and it wouldn't surprise if we are double that by year end (the 60K number from the IHME study is through August), and that's with only a small percentage of the population infected and significant measures to stop the spread of the virus.
We're experiencing an acute issue right now (and are by almost every measure handling this among the worst of any developed country), but the acute economic pain would be far, far worse without mandated social distancing. Without government intervention, you would still get a large amount of social distancing, but would trade a marginally smaller economic hit from distancing (do you want to go to a sporting event right now with 50,000 people side by side? sit next to a table of 5 at McD's? - all those business would still either shutdown or go out of business), but you would also have larger economic hit from overwhelmed hospitals, people being out sick from work, and economic impacts from greatly increased mortality (most likely only 2-3 % of the US population has been infected at this point, multiply current death/hospitalization numbers by 20-30% to get to herd immunity)
Also and we're going to see this next as we open, the government forcing an opening won't necessarily improve economic outcomes in the short term, especially without testing. Many businesses will still have massive economic impacts and be effectively dormant for a long period (travel, hospitality, restaurants), but the government removing stay-at-home orders also likely removes the protection of Force Majeure on things like leases/rent, while exposing employers to liability for sickness/death resulting from returning to work. I work in IT and we've been able to save jobs by not paying our lease while this is ongoing, that protection disappears when the government order is lifted, and our liabilities resume while our revenues are depressed. Think how much worse that will be for retail/restaurants/etc.
You totally get it, Yogi.
When you come to a fork in the road, take it.
I disagree.... based on just the reaction to FL beaches opening up again I think we see flood of activity once the doors are open so I think revenue comes back stronger than most anticipate.
On the subject of landlords - who are you going to get to replace your existing tenants in this environment? No one....so you're better off working with existing tenants and giving them time to ramp back up if you can.
Employers are not exposed to liability for covid, I'm not sure where you got that, so that's not an issue either.
I’d love to believe that, and while I think Americans are going to return to work faster than other places (partly out of optimism/stupidity/partisanship and partly because Unemployment and other benefits will run out), there’s a difference between going for a walk the on the beach and boarding a plane, sitting in a crowded theatre, or going to a jags game. The places globally that didn’t lock down hard like Japan are now having second or continuing outbreaks that are going to hit the economy harder than the first. While i think we can likely operate with much fewer restrictions than now, I actually expect that given the Florida beach issue, we’re probably going to open up too fast, and the rebound spikes will hit America harder than in other places.
For us we pay 30k in rent a month for our office, and I expect due to social distancing we’ll likely need to spread desks etc which means we’ll get maybe half of the staff back in. I expect many will actually switch to working from home full time, but now I’ve got an office for 3 more years that only holds half the capacity it used to for likely another 6+ months. I can negotiate with my landlord, but is he going to cut rent in half? Not likely, and if he did, rents will be deflating across the city, hitting their revenues, hitting their loans/banks etc, and we get a nice deflationary cycle. Breaking a lease also not a fun or risk free option.
I’d also love to say there won’t be workplace health/liability issues, and maybe in Florida or other states there won’t be legal recourse, but i wouldn’t make that call before talking to both the government and my insurance company both in terms of worker’s compensation and medical benefits in addition to general liability.
April 21st, 2020 at 11:44 PM ^
You are precisely right. What the people who bitch about the lockdown being an overreaction don't grasp, because they don't want to grasp it, is that the big death projection was what would happen if we don't lock down right now. After way too much foot-dragging, most everyone locked down. Then, bingo, the death projection drops. Why is this so hard to understand?
Regardless, more than 100K Americans will die from this in a matter of months -- and that's not counting a potential and quite likely second wave that may well hit in the late fall. If states hadn't locked down, god only knows how big the death toll would be right now.
So, you want to make qualitative decisions on who is worth saving and who we can afford to lose? Really? We put enormous sums into preserving life and have worked for centuries to come to value trade-offs on what we can or will do to preserve life. Most deaths are ones we've come to accept because absolutely nothing can be done, regardless of cost. Another number includes deaths we invest great sums to avoid. In this case, we have invested a few months, squandered some portion of the time available, and some are saying, well, that's enough, it isn't worth saving a few more.
Of the 330 million people in this country, we have 800,000 known positive, 3.4 million tested negative, some of whom may be sero-positive and possibly immune. We have some serology studies that say maybe the positive number is understated by 50x -- let's say there are 50 million positive in the country, or around 15% of the population, mostly concentrated in and around higher-density areas. Actions taken there have taken growth rates from 1.35 per day to under 1.0 in some of those areas. What happens next is movement to lower density areas, in which growth rates (number of interactions times probability of transmission per interaction) will be lower because the numbers of interactions are lower.
So broader areas, like states rather than metro areas, won't likely see the 1.35 numbers but they will see persistent lower numbers of growth rate until either testing is ubiquitous so we can segregate the herd, or more than 70% of the herd (231 million people) is immunized either through infection or vaccine. For just the US, from our 50 million likely positives, we have 180-odd million people to infect or vaccinate. Treatments may lower the severity of illnesses, but time to test in clinic and availability at the right time for the right patients (say, like ventilators) will be needed to lower morbidity and mortality. Producing 180 million vaccine doses is going to take a lot of time, even after we get past making sure we don't produce vaccines that are more dangerous than the disease.
Several states are already seeing early second bumps as the pandemic moves to more rural areas. Some more rural states have growth rates that are above 1.1, and the population tends older and less healthy. Death rates among the infected will go up. Authorities may take measures to limit growth rate, like distancing, masks, closures, etc that they may not yet have done. A few weeks or months will go by, and they'll be pressured to open up. And the growth rate will resume. It'll take a few cycles of that until the herd immunity is achieved, as I said, via infection or vaccination.
Here's the perspective:
We are at the first turn of infections that have been mostly a plague of dense urban areas. Those are flattening out. That good news gets projected onto the entire population, including the naive population that do not live in areas with any significant exposure -- counties with 50,000 people and maybe a few positives. With that first turn of the pandemic, without looking at the future, a lot of people want to loosen things up, let people start traveling and doing business freely. We still have 180 million people to infect or vaccinate -- we get a bunch of dead moms, dads, etc.
To make it personal, until you know that you are immunized (infected and no longer shedding virus, or vaccinated) or you know that roughly 70% or more of the people around you are also immunized, you have a high probability of getting the virus and spreading it. And until 200 million tests are available and performed inside of about 5 weeks, you won't know until you or someone around you is sick, possibly critically so.
So, you want to make qualitative decisions on who is worth saving and who we can afford to lose? Really?
Have you heard of actuarial science? Do you know how lawyers and judges come up with settlements in wrongful death suits? These calculations are done across multiple industries DAILY. Someone out there has your life value pegged to the penny as we speak.
In this case, we have invested a few months, squandered some portion of the time available, and some are saying, well, that's enough, it isn't worth saving a few more.
If the cost of keeping an 80 year old alive one more year had to be paid by you personally, would you do it? If not, why do you expect society at large to do it? Do you have any idea what it costs to keep an 80 year old from dying in an American hospital - it's millions of dollars a year per person. Is that where we want our money going?
Is there no amount of money worth spending to keep people alive even if their quality of life is terrible or they are likely to die in the short term anyway?
And until 200 million tests are available and performed inside of about 5 weeks, you won't know until you or someone around you is sick, possibly critically so.
Are you suggesting we will have 200 million tests performed over the next 5 weeks? That is not going to happen anytime soon so what are the realistic options you're suggesting here? Should we all stay home until a vaccine - 18 months from now - GUARANTEEING we are all economically ruined so the longest living generation in history can keep going another 3 months to a year? Or, can we maybe open up while keeping THEM quarantined another 6-8 months? I choose the second option.
NY Governor said, "if everything we do saves just one life, I'll be happy."
Does anyone really believe that?
morons say that a lot.
OP (PeterKlima): We get it. You'd like to "open her up." Taking that position is fine in this uncertain environment. Very infrequently you state your desire honestly (rather than being a weasel and building innumerable little sand castles in support of your argument). This is a weasel post. Others have already addressed your shaky conclusion, so I won't bother.
I think you're the COVID-19 Maizen. Superficially more polite, though. I haven't seen you really crack yet.
Side note: Western_ is back! Nothing about Vitamin C and Agenda 2030 yet ....
Every politician is trying to figure out a way to "open back up" and it doesn't matter your political affiliation.
I think the key is keeping abreast of the new info we learn about the virus and what works. We need to follow science is opening back up. Not just cower in fear or brazenly start licking people's faces.
Why do you call me a weasel for a measured approach? Is this what internet forums hate the most... trying to use facts to find a reasonable middle ground?