How does what is happening in NYC factor into your thinking about Covid-19
We’ve had a post that focused on why Sweden shows that the US took the wrong path and over reacted to Covid-19. I think that the facts on the ground tell the other side of the story.
For me, what is happening in New York City affirms the decision for large scale stay at home orders. But clearly, most of the US is not seeing the same level of impact. How does what is happening in NYC factor into the thinking of others on the board? Did social distancing avert widespread deaths similar to New York City across much if the country or do you think shutdowns were justified in NYC and maybe a few other places, but not for so much of the US? Or do you think that even in NYC, the costs of the stay at home order to the economy are to great to justify the stay at home orders? Do you think that people are over reacting to what is happening in NYC either because it is not all that bad or because NYC is a unique situation and it is unlikely other parts of the US could be hit as badly? If you think orders should have been issued more judiciously, how would you have set criteria absent more test data?
I have also provided some information about what is happening in New York City.
The current population is about 8.3 million. As of Sunday afternoon there were about 6700 deaths, including 531 in the last 24 hour reporting period.
To provide a bit of context for those numbers, NYC averages about 150 deaths a day. Last Tuesday NYC reported over 800 deaths due to Covid-19, more than 5 times the average number of deaths. At the apex of the Spanish Flu Epidemic of 1918, NYC was seeing about 400 to 500 deaths per day. The population was about 5.6 million, adjusted to today’s population that would be about 600 to 750 people per day. In a typical flu season, NYC has about 2000 city residents die (so in the last 30 days there have been 3 times as many Covid-19 deaths in NYC as there are in an entire typical flu season).
New York City has seen about 800 deaths from Covid-19 per million residents so far and the number continues to climb. This compares to Italy which has about 329 deaths per million and Spain which has has 368. Statewide New York has 478 per million. As a whole the US has 67 per million. Eight States, including New York and Michigan (149 per million) are above the national average. On the opposite end of the spectrum in the US, there are 9 States with less than 10 deaths per million.
There are many reasons to explain why New York City was hit so badly. It has the highest population density of any large US city at about 27,000 people per square mile. San Fransisco is second at about 17,200 per square mile. It has the most use of public transit with over 56% of commuters using mass transit. Washington DC is second at about 37%. JFK airport has the most international flights at over 15,000. LAX is second at about 11,000. Mew York did not act as quickly as some other places did. San Fransisco had a stay at home order on March 16. New York did not issue one until almost a week later (March 22).
While these facts and figures may explain why NYC got so bad so fast, I personally don’t think we have any reason to expect that other areas of the country aren’t also susceptible to significant Covid-2019 outbreaks, even though it may have taken more time for it to spread. It would have been great if we’d had more information to be more targeted in our approach, but it is not clear to me how we could have done that. What say other mgobloggers?
It is this and many other factors. International airport, poor inner city population, this years political primary crowds, spring travel back from Florida etc.
Again, not sure how judgment at any level is made.
Need to learn from this and move on. A start would be bringing medical supplies & equipment chains back into the country, development of a strategic capacity scaling plan of the Mfg. base in these situations, approach to port of entry and travel management without judgement and more.
Positive simple changes ... Ongoing use of PPE in public and work at home acceptance when ill. Improved sterilization of the business and household environments.
April 13th, 2020 at 12:28 PM ^
The political primary suggestion doesn’t make much sense to me. The candidates and their staffs were the only out of state people here for the primaries. Are any of them sick? Iowa has been having primary activities for months and they don’t have our rates.
April 13th, 2020 at 12:52 PM ^
The Iowa primary was on February 3. Good chance there was no local spread at that time. The Michigan primary was on March 10. Good chance there was already community spread and multiple rallies and crowded polling places exacerbated it,
I Illinois primary was March 17th after the stay at home order. .
April 13th, 2020 at 10:25 AM ^
What about LAX? SFO? Seattle? Chicago? All are significant airport gateways to Asia, most probably have much larger passenger volumes than DTW.
April 13th, 2020 at 10:29 AM ^
Washington and CA instituted stay at hime orders earlier. That makes a big difference.
Exactly. I have seen the "DTW has an abnormally large number of Asia flights" argument as the primary reason for the large number of cases in the Detroit metro area. But so many other US airports have larger trans-Pacific passenger volumes than DTW, including Chicago O'Hare. This pandemic is a complex multi-variate issue, so blaming Detroit's issues primarily on DTW seems overly simplistic.
April 13th, 2020 at 10:51 AM ^
How do you know they were getting cases in January? (It wouldn't necessarily surprise me.)
Also, don't forget European travelers. They were supposedly a big factor in NYC's numbers.
April 13th, 2020 at 12:45 PM ^
I'm not sure whether this has been proven or not, but I recall reading about a week or so ago that doctors think that the infections that have hit NYC and SE MI so hard came from Italy, not China (obviously it was in China originally).
Yes, but not exactly, the strain hitting the Eastern U.S. (including Detroit) has been sourced to Europe, which differs from the Asian strain that has mainly hit the West Coast. You referenced Detroit Airport (Delta's second largest hub), but crucially left out the massive flight volume from Europe. Pre-lockdown, DTW had several daily flights from hard hit places like London and Paris, as well as Amstedam and Frankfurt, by late January/February, flight volume from China was significantly reduced, as were flights from Seoul and Tokyo -it was flights from Europe that were coming through with passengers unchecked for any symptoms (my parents flew back to Detroit from India via Paris on March 4th and weren't asked/checked for anything)
The unfortunately timed primary is a likely culprit with all of the rallies in the preceding week.
Add the pre-existing health issues in Detroit and you had a tinderbox waiting for a match.
April 13th, 2020 at 10:22 AM ^
There's a certain amount of randomness to all of this. In France, the city of Mulhouse (pop. 109,000) has been the epicenter. Why? Because there was an evangelical church meeting in February there, and by chance one attendee was a patient zero which turned the event into a super-spreader.
But there is a bit of logic to Detroit being a hotspot. Not only is DTW a big airport hub but it's now thought that the virus came to Metro Detroit from Italy. Recall that Chrysler has a partnership with Fiat, located in northern Italy...
NYC locked down late and many flouted the rules even continuing to ride public transportation in crowded subway cars and buses. Bars and restaurants stayed open. I saw a photo of a packed farmer's market two weekends after the shutdown. I don't think that there are a lot of lessons there.
I feel like the lockdown was a good thing, but all good things must end. They've bought us the time to understand the disease, educate the public on social distancing and develop therapeutic approaches that will minimize the death rate going forward. We've also developed good tests and will be rolling out the antibody tests soon.
We know that the respiratory disease comes in two types (H and L). 70-80% of people get Type L which is not amenable to ventilation. Putting them on ventilation is more often than not a death sentence. This information is maybe a week old.
The lockdown bought us needed time, but keeping it locked down past the end of the month will mean that there is much less to restart afterwards. If you think that the government can keep conjuring trillions of dollars out of thin air for 12 - 18 months waiting for a vaccine, you are sorely mistaken.
Lastly, this is the new normal. Pinning our hopes on a vaccine is a mistake. Where are the vaccines for AIDS and Ebola? How many Coronavirus vaccines have ever been successfully developed? (Hint, zero). We will adapt and go on ...
I have not heard of the H vs L tidbit. Can you provide a reference or article? I’d like to learn more. Thanks!
Go to https://www.medcram.com/courses/coronavirus-outbreak-symptoms-treatment
That is a site maintained by a Pulmonary disease specialist. He has been adding new blog entries designed as educational videos for health care professionals almost daily with the latest research on the disease. They start on January 29th and the most recent one (#53) was a couple of days ago which addresses the ventilate or not ventilate question.
Another good resource is this updated treatment guidance from the Eastern Virginia Medical School. The first 5 pages are fascinating. It is a PDF.
I like the first line of that document: URGENT! Please circulate as widely as possible. It is crucial that every pulmonologist, every critical care doctor and nurse, every hospital administrator, every public health official receive this information immediately.
April 13th, 2020 at 10:06 AM ^
Where are the vaccines for AIDS and Ebola?
There is in fact an Ebola vaccine - just approved recently.
April 13th, 2020 at 10:49 AM ^
Thanks for the reference. I knew that they had been working on one, in fact, remdesivir is a failed Ebola treatment being re-purposed for coronavirus.
But, 2 decades in development? Sheesh ... Hope for the best, plan for the worst I guess.
April 13th, 2020 at 11:07 AM ^
I think part of the issue there was that the general public kept losing interest in Ebola pretty soon after each outbreak because it doesn't end up affecting too many people beyond its source.
IIRC there was a similar problem with SARS - we were making headway and then the funding dried up as the public stopped caring.
In the case of covid-19 I'm pretty confident there will be a vaccine at some point in the next 12-24 months, simply because there is far too much at stake. A ton of money is going to be thrown at this thing and it will be the discovery of the century.
April 13th, 2020 at 12:33 PM ^
I am inclined to agree. I think that it'll be sooner than 12 months given the advancements in technology and genomics. But, having said that, we should be prepared for it to go longer and have a sustainable approach. That means that we can't shut down the country indefinitely.
April 13th, 2020 at 12:44 PM ^
And how long did the process take to develop, test and approve?
April 13th, 2020 at 10:06 AM ^
Your last paragraph says it all. Yes, "we will adapt and go on..." Amen to that.
Although I think it's trending towards too far here in Michigan, the stay-in-place order was definitely needed. Just wish it was enacted a few days sooner. We needed testing here sooner than we got it. It's obvious from the numbers that we had more cases in Michigan than Ohio did prior to the first confirmed positive case. They were able to get a positive test first and start the process that we have pretty much followed to a tee. The problem is we weren't 12-24 hours* behind. Probably more like 2-3 days behind.
[edit]
Yes important to stay in place unless you want to go to a Union meeting or church. Or to buy liquor or legal weed. But don't try to visit a plant nursery or use a motorized boat. But by all means let's keep public transportation running.
Stay at home orders are fine. But this.
"The Michigan Chamber of Commerce had specifically asked Whitmer to adopt the new federal guidance.
Instead, the state's new guidance “doubles down” on freezing Michigan’s approach to identifying what businesses can operate to mid-March, said Rich Studley, president and CEO of the chamber.
"We have one of the most difficult, complicated and hard-to-understand stay-at-home orders in the country,"
It isn't a black and white case that locking down does everything, or that starting the economy back up will destroy everything (re: where we stand with COVID). It's both - its always some middle ground, where both sides have some say. Nobody can put a timeline on this - you can't just say 'restart the economy on May 1', or 'stay locked down until mid-May, then restart'. You can't just arbitrarily pick a date and move on. There has to be a plan to get things going safely, so another NYC doesn't flare up on that magic date.
Testing, and anti-body testing, MUST be widely available for pretty much anyone that wants it, so that we can easily identify positive cases and trace/isolate the individuals involved. Short of that, opening up on a mass scale is Russian Roulette. I don't care about the '2.8M tests, though' crowd - testing is in short supply, four months after we knew we'd need them. It's disgusting that some people say 'we lead the world in testing', when it's inordinately clear that we lack the capacity to test everyone with symptoms, let alone those they have frequent contact with.
I don't have a say in whether we play Russian Roulette going forward, or not. Just understand that if we aren't massively testing, it is very much a gamble on where the next NYC is located.
Agree. Not like the country has any experience with a virus like this. It wasn't even named until Jan.
I can only guess what the reaction would have been to shut the whole country down on Feb. 1. Not even sure what data that would have been based upon.
Also, being a Monday AM QB for a pandemic isn't the right approach. Although there will be valuable learnings.
I just follow The Huge Show's daily posts on facebook and his commenters, and see what they have to say with their Huge opinions
April 13th, 2020 at 10:02 AM ^
The short answer is that our nation is very diverse in terms of population density. There are huge discrepancies and regional difference on where and how people live. The NYC cases tells me about people living on top of each other. The Detroit cases tells me about lower income and multi-generational families living together in one home.
The rate of spread of this virus in these two cases also confirms on how a virus can spread given the right conditions for it. Urban areas are more likely to have a large number of cases per 10,000 residents. Washtenaw county is a good case of social distancing plus that many (not all) folks know how to take care of themselves and personal hygiene.
There is no correct answer and mine is only my opinion.
April 13th, 2020 at 10:02 AM ^
"Dr. Scott Jensen: Right now Medicare is determining that if you have a COVID-19 admission to the hospital you get $13,000. If that COVID-19 patient goes on a ventilator you get $39,000, three times as much. Nobody can tell me after 35 years in the world of medicine that sometimes those kinds of things impact on what we do"
I'd say this has more of an impact than anything....follow the money....may not apply everywhere...but this has and will always be the "American way"
April 13th, 2020 at 10:17 AM ^
Good morning, sir! I see you're posting true to form today.
Who's "Dr. Scott Jensen?" Well, not just any doctor:
https://www.foxnews.com/media/physician-blasts-cdc-coronavirus-death-count-guidelines
Planning on posting a contrasting take this morning? No? Didn't think so ...
By the way, I think you make a generally good point about $ and medicine. It would be naive to suggest that it never affects decisions. It's a distraction here, though.
April 13th, 2020 at 10:25 AM ^
Yeah I don't fit the "sheepole" herd mentality...I accept that COVID is a big deal. I abide by social distancing I purchase household goods weekly on a need basis rather than gluttonous hording...I respect elderly people for their increased vulnerability...but I've worked many jobs, I've seen many things in this world to know enough...the political shitstorm backing this entire pandemic smells badly of a money standoff...YES people are sick...many hundreds of thousands....but I also know there is a huge alarmist group with motivation.
April 13th, 2020 at 12:30 PM ^
You have shared half a thought. Where's the half that says what the motivation would be for these alarmists or how they would benefit?
Generally on any issue there are people with strong motivations (sometimes financial, sometimes a desire to accumulate power, sometimes a myopia focused on their area of expertise, sometimes altruistic). This case is no different, with some groups focusing in the health risk more than the economic, some denying any issues at all, some focusing on the economic risk. Even after all the facts were in, people are going to have to decide who was too alarmist (and about what) vs who wasn’t alarmist enough.
April 13th, 2020 at 11:29 AM ^
I agree. That's why you see more people testing positive and are being admitted and put on ventilators. It's the money. This is also why Bill Gates is pushing for a vaccine so badly and his ultimate goal is to have every American get it. He is going to profit big time off a vaccine.
April 13th, 2020 at 12:20 PM ^
He is going to profit big time off a vaccine.
Dude, everyone will benefit from having a vaccine for this virus. There is no real downside to making a deadly virus a lot less deadly.
April 13th, 2020 at 10:03 AM ^
There are number of things we can say definitively, so let's start there. (1) It's a once in a century virus and uniquely troublesome with so many asymptomatic people and long incubation periods. (2) China covering up the virus for over a month screwed the whole world. (3) The CDC botched testing. (4) The CDC has not actually faced any real budget cuts thanks to congress. (5) Trump did contribute to the dismantling of the NSC pandemic preparedness team and removed a key person from China's CDC (5) After H1N1, huge stocks of respirators, ventilators, etc. were depleted and not replenished by either the Obama or Trump administrations.
To have mitigated the situations in NY, Detroit, and Louisiana, there would have had to have been far more testing in February, which then may have led to earlier social distancing policies. The other issue was also supplies, primarily masks and ventilators.
NYC aside, things have not been as bad as initially forecasted. Last I read was maybe 60k to 100k deaths for the country, which is comparable to the 2017-18 flu season, and 1-2 orders of magnitude lower than some early predictions. Of course, things would be much worse if we had done nothing a la Sweden, and we have social distancing and shut downs to thank for this. Even still, health care systems are over-stressed in many areas outside NYC and Detroit.
But due to policies now in place, increased testing, and slowly developing herd immunity, it seems the worst is over or is happening right now. I think most experts agree things should start looking much better by May, and then the question is how to proceed without creating another big uptick in cases that overwhelms the health care system again.
April 13th, 2020 at 10:09 AM ^
The latest death rate projections I saw went from 80k to 60k - I am sure much of that is due to the lockdowns and social distancing. But a long way from the millions and several hundred thousand that was initially projected.
Yes, the social distancing and extreme State measures have prevented deaths from beings millions or several hundred thousand. A competent Federal response early would have mitigated or at least diminished the need for extreme State measures.
Except for the fact that a federal response would have been a blunt axe where we need a scalpel. Many rural states and areas are not fully locked down or have much lighter restrictions than others. We need a nuanced approach to address something that affects different areas in different ways at different times.
What happens when Iowa City is sick of the lockdown in a month and lets up, only to discover it is coming there later and they need another lockdown. Why have the whole country lockdown when NYC gets big? It makes no sense. As long as people plan on traveling between states over the next 18 months, the virus will be in our country. We also need to open up the borders at some point as well.
The idea we could solve this all with a big federal lockdown at one time and not get infected and need another lockdown in the future is stupid. The whole world is our pool (as the idiotic meme goes about peeing in the pool). We just have to worry about the places withoutbreaks AT THAT TIME and have them flatten the curve.
April 13th, 2020 at 10:09 AM ^
Let me add to the reasons blueindc offered, which distinguish New York City from other places (plus a personal response to the question).
First, Broadway theater is not just "seeing a show" but a major NY industry based on people getting together, millions of people, 2/3 of them from other cities, other countries. Shows and related businesses — shops & restaurants dependent on Broadway — contribute a billion dollars to NY's economy, and rely (relied) on crowds.
Second, most people taking public transportation must do it to get to work, so they can't do social distancing.
My personal response: a video consultation in NYC with my doctor told me two things. That my respiratory problem was allergies, not the virus, and that he'd be leaving his office to care for COVID patients, without tests or enough protective gear.
It hit home that my doctor was putting his life on the line for other people.
April 13th, 2020 at 10:15 AM ^
Best visual to understand NYC is NOT a benchmark for rest of the country
April 13th, 2020 at 11:44 AM ^
That helps explain why it spread so fast. It doesn’t actually provide any evidence as to whether it could have as much spread (albeit at a slower rate) in other parts of the country.
April 13th, 2020 at 10:21 AM ^
Is it any surprise that NYC has so many cases after De Blasio told people under 50 to go out and enjoy their lives?
April 13th, 2020 at 11:46 AM ^
De Blasio is a goddamned idiot whose actions on a local scale were every bit as reprehensible as those taken (or not taken) by the federal government.
April 13th, 2020 at 12:29 PM ^
Couldn’t agree more. Even if he didn’t want to be first, no excuse for being more than 24 hours later than San Fransisco.
April 13th, 2020 at 10:21 AM ^
I think it shows what can happen in big cities if we decide to reopen the economy too fast. If social distancing and quarantining restrictions are lifted too fast, then every big cities in the US can become as infected as NYC
April 13th, 2020 at 10:47 AM ^
I don't have much to offer other than saying that I logged in to comment that I'm impressed with the level of discourse here and that it hasn't degraded into the partisan shitshow that most of these covid related posts have.
It's refreshing to see people that, I seem to gather, fall on opposite side of the political spectrum are able to realize that "their side's" solution probably isn't a one size fits all perfect solution and that there are concerns and solutions from each side that are valid and beneficial.
I think people that have been on both extremes are perhaps seeing that there is no easy answer to these questions. How do we reopen the economy without going right back to where we would have been if the stay-at-home orders had not been issued? I'm getting somewhat alarmed by the lack of good answers to this question, and I believe others are as well. We still don't have good testing availability, don't have a treatment, don't have adequate equipment/PPE, and, while the hospital/ICU capacity has generally been bolstered to some degree, in many areas of the country it won't be enough to deal with the peak they will be dealing with. But, as someone said above, the government can't keep pulling trillions of dollars out of its hat to keep people and businesses afloat.
April 13th, 2020 at 11:03 AM ^
TL DR.
What is happening in NYC doesnt factor into my thinking. There is a reason I dont live in a major metropolitan area. I chose to live in South Dakota for a reason. When you choose to live on top of 8.3 million people, this is part of the consequence.
Similarly if a zombie outbreak starts I won't focus on the people in big cities as they will be dead.
Out of all 50 states - South Dakota currently has the LOWEST doubling rate. E.g., cases are growing faster (on a percentage basis) there than anywhere else.
Take that FWIW.