I’ve got to admit that the logic of Illinois’s public officials’ policies and public statements eludes me. The Chicago Tribune reports:
Gov. J.B. Pritzker on Tuesday said models are now predicting the new coronavirus won’t peak in Illinois until mid-May, weeks later than previously projected.
During an interview on The Washington Post Live, Pritzker noted that Illinois was the second state to issue a stay-at-home order and that because people have been abiding by it, “for the most part,†the anticipated peak of the outbreak in mid-to-late April has changed.
Meanwhile, Chicago Mayor Lori Lightfoot said on a conference call with reporters that she expects Pritzker’s stay-at-home order could extend into June.
State officials reported 1,551 new known COVID-19 cases on Tuesday, as the total number of known infections reached 33,059. There were also 119 additional deaths reported, bringing the toll since the start of the outbreak to 1,468.
I simply don’t understand. Is the policy succeeding, failing, or will it continue whether it succeeds or fails?
The number of new cases and new deaths in Illinois continue to increase. To the extent that there is any trend, it is up. It looks to me as though the actual changes are smaller than irregularities in reporting. They are not declining.
Has the Governor or anyone shared what their internal calculations of R (i.e. how many people are being infected by every carrier?).
If it peaks in May, given the very slow decline seen in New York and Washington State, he’s hinting a lockdown into July possibly.
Here’s the question — how would you know if the current policy is failing, and if it is failing, what would you do?
Those are the very questions I have been asking.
Here in Colorado, the stay at home order is being scaled back starting next week. This will be mean that some businesses can open back up as long as they utilize social distance measures.
My neighbor who is an ICU nurse said about half their beds are empty and the caseload at their hospital is slowly declining.
It is the lack of additional things to try that worries me.
There is no shortage of ideas, but for whatever reason almost all of them have been rejected.
I’ll repeat a question I asked earlier. Why is operating at 50% of capacity better than operating at 75% of capacity?
CuriousOnlooker:
There are plenty of other alternatives but none of them are egalitarian or are completely risk-free. The questions are who bears the risks and how much risk can they tolerate?
IMO the risk equation changes with the passage of time. As time elapses risks shift from the weakest and poorest to the richest. That’s why I expect a push by political leaders of both parties to start the reopening process where the risks are lowest.
Another serology test in Boston.
https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus
This one showed 33% in a suburb of Boston have had the virus. That number is so high that false positives and non-random sampling are unlikely to explain the results.
That would also indicate a mortality rate of about 0.3%.
I think that we are going to end up with a mortality rate of about 0.3%-0.4%. I also think that if look at mortality rates early vs late in the pandemic we will see a significant improvement. Proning has done wonders to keep people off the ventilator. A little concerned about long term sequelae. Seeing more people end up on dialysis. A lot of need in the hospital with AKI but it looks like it is pushing some people with CKD into permanent dialysis.
Steve
“I simply don’t understand. Is the policy succeeding, failing, or will it continue whether it succeeds or fails?â€
If you don’t know where you are going, any road will get you there.
If the only acceptable risk level is 0, then it doesn’t make any difference whether the mortality rate is 3%, .3%, or .003%.
“If the only acceptable risk level is 0”
Who is pushing the idea that only 0 is acceptable?
Steve
At the risk of putting words in his mouth I think Dave is pointing out that the supposed original intent of mass quarantine was to “flatten the curve” to avoid exceeding the capacity of the health care system, and to stretch it out until a vaccine was available.
The goal posts seem to move daily. Whether its the numerous stories in the press, press inquiries in White House briefings, or the musings of politicians and any epidemiologist one can dig up the standard now seems to be any death is too many. Maybe you are working too hard; but that’s the theme.
This brings us full circle to my original criticisms of the strategy, and apparently the government of Sweden. The strategy implementation has devastating side effects. It can’t really be implemented because of non-compliance. And it is just delaying the inevitable. The truth is this has largely been a tri-state NY area phenomenon. No one wants to admit that, but include three counties in SE Florida and the rest of the country looks rather close to a normal “bad” flu season. This is not to say this isn’t a very bad bug for some, although that’s always the case.
If this was occurring in “flyover country” I guarantee you there would not be the same hullabaloo. I lived too long in that area to not know the NY-centric nature of the people. So this is transformed into the plague. The interesting questions for the future will be to understand why NY metro was hit so hard, and why certain individuals were hit so hard, while others were mostly unscathed.
Oh, and a case study in folly and hysteria……….
Isn’t that implicit when a policy has been held in place for five weeks without achieving its presumed objectives? That’s certainly the case here in Illinois. If the “stay at home” directive were going to be effective, shouldn’t it have been effective by now?
Thanks Drew. So in fact no one (of any consequence) is pushing for 0.
” pointing out that the supposed original intent of mass quarantine was to “flatten the curve†to avoid exceeding the capacity of the health care system”
Which really hasn’t changed. The goal posts are not moving, you just wont acknowledge where we really are, I suspect because you believe everything your leader says. The facts are that the health system mostly just made it through this round. If we have another round too soon we dont have the PPE to handle it. We dont have the testing to try to predict if we are seeing an increase in infections. We dont have the staff to trace if we decide to try that option.
“a normal “bad†flu season. ”
In 8 weeks instead of 20 and with many more people needing hospitalization, ICU care and intubation/ventilation. In a bad flu season we dont need to shut down the OR so that we can have enough ICU beds. We dont need extra morgue space. We dont have many more people dying at home. All of that with a lockdown, social distancing etc.
What is really going on is that governors are re-opening but at a measured pace depending upon the conditions in their state.
Just out of curiosity what do you really think would happen if they just said OK, everything is open again, go at it. No social distancing, no masks and forget washing your hands. Everyone has all of their rights and liberty. No big government telling them what to do.
Steve
“directive were going to be effective, shouldn’t it have been effective by now?”
That is why I said before you need to define effective. I thought the goal was to flatten the curve so that the health care system didnt get overwhelmed. Is the system in Chicago/Illinois overwhelmed? I dont really follow that area. If it is not overwhelmed how are they on PPE and staffing? Are they ready for another surge if going back to normal does produce another surge? Do they need to empty out more? How is testing availability there?
We are past our peak but we have been holding steady at total admissions about 50 below our peak. Number of pts on vents is way down from peak. However, we arent seeing the tail drop that fast. What is Chicago seeing?
In our state we have already begun gradually opening. I am fine with that. I am guessing we have made major steps by mid-May.
Steve
No one has presented any evidence that is happening or that continuing the “stay at home” directive will have that effect.
They continue to complain about not enough testing. Presumably, that’s contingent on the “test everybody” strategy which is not simply “test everybody” but is really “test everybody repeatedly”. I wonder when people will realize there is no realistic prospect of that happening? Billions of tests run every day requires a heckuva lot of resources. Time, materials, transport, personnel.
“Presumably, that’s contingent on the “test everybody†strategy which is not simply “test everybody†but is really “test everybody repeatedlyâ€.
I am not sure why you assume that. As I keep telling you, we dont have enough tests that I can reliably have my own staff tested. We are planning on what to do when we re-open the OR for elective cases. Part of the plan would be to test people having elective surgery, but we dont have enough testing ability.
“No one has presented any evidence that is happening ”
It is clearly happening in NY, NJ and here in PA. I dont follow Illinois numbers. Besides, I already asked you the stuff you need to know. How are your hospitals faring? The ICUs overwhelmed?
Steve
Because I don’t see any other viable conclusion one can draw from what’s being said.
The U. S. has already conducted more than 4 million tests. We have conducted more tests relative to our population than South Korea and if the resources for all of those tests were being devoted to sampling it would be more than enough for that. That is clearly not the present strategy.
I have no way to tell. The information is not being reported publicly.
At this point it all looks like tiger repellent to me. How do you distinguish between a plan that is working and one that was based on alarmist premises to begin with?
Update
Is this the info you’re looking for? It sure doesn’t look like “bending the curve” to me. It looks more like “bad assumptions”.
“I’ll repeat a question I asked earlier. Why is operating at 50% of capacity better than operating at 75% of capacity?”
According to my neighbor, it’s a reduction from near-capacity utilization. At least for that one hospital, it’s a proxy for a drop in severe Covid cases in the local area.
This seems to be replicated in many other parts of the state which is why the governor is rescinding the stay-at-home order.
“This seems to be replicated in many other parts of the state which is why the governor is rescinding the stay-at-home order.”
Dont tell them that Andy. They are having so much fun whining about how states are refusing to move toward opening up because we want to have zero risk. We, PA, opened up some businesses that were closed but we are still at home otherwise. We are right next door to NY and NJ. Plus, we are plateaued more than dropping.
“The U. S. has already conducted more than 4 million tests. ”
Yes, but those have in no way been distributed evenly. I keep telling you that we have trouble getting enough just for our clinical needs.* Plus, in other countries this is organized at a national level, which kind of makes more sense. We have no consistent approach.
* I guess like Drew you have decided that we have no clinical use for the tests anymore but we actually do need to use a fair amount. As I am planning on how we can safely open our OR for our pts and staff ( I shouldn’t be doing this should I? I should be waiting until we have zero risk and try to live up to some stereotype) it would be helpful if we could test patients having surgery. Based on some early studies, it looks as though pts who are positive for Covid at the time of surgery (these were fairly routine, mostly elective surgeries) had much worse outcomes.
Steve
Steve: Glad to see you say that you seem to have plateaued out and that your ventilator use and ICUs have declined.
Interesting how you mention that patients undergoing surgery that tested positive fared badly afterwards. I guess the stress of surgery and/or anesthesia might have had a particularly deleterious effect.
It would be interesting to know where the supposed tons of test kits are going. To states and areas screaming the loudest? I agree they should be targeted towards the personnel and patients most at risk, not a blunderbuss application except for a specific study.
I’m afraid the whole reaction to the epidemic has been a study of ad hockery strongly influenced if not completely driven by no holds barred partisan gotcha politics. The worst part will be is if there is a reoccurrence in the fall the screaming and blame-casting we see now will look mild in comparison due to the pending election. However I strongly suspect the country will be much better prepared to combat it than we did the first time around.
My understanding is that there is a guess that one of the novelties in the “novel coronavirus” is that its mechanism resides in clotting which, apparently, is unusual in a respiratory virus. That could be an issue in surgical consequences and it might be one that goes far beyond the critically ill.