The big news story in Chicagoland yesterday was that Cook County has become the single county in the U. S. with the most diagnosed cases of COVID-19. The Sun-Times reportage on this:
Cook County has surpassed Queens County in New York as the U.S. county with the most coronavirus cases based on Sun-Times analysis of the latest public data.
There have been 58,457 total cases of COVID-19 recorded in Cook County, which includes all of Chicago and many of its suburbs, after officials added 2,051 new cases in the last 24 hours. Queens, by comparison, added only 336 cases over the same time frame to bring its total to 58,084.
Cook County still has a lower rate of COVID-19 per capita given its population (5.1 million) is more than twice as large as Queens (2.25 million). But Queens also has a much higher population density with 20,500 people per square mile compared to 5,500 per square mile in Cook County, which can make social distancing measures more challenging to maintain.
furnishes a little context for this but not nearly enough. Let me try to remedy that. Cook County is second only to LA County in population in the U. S. Not only is it twice as populous than Queens, it is nearly ten times the size in total area and land area.
According to the IDPH, the mortality per million population in Cook County is about 700. I don’t know the exact mortality rate in Queens but my back-of-the-envelope calculation suggests it’s no less than 2,100/million—at least three times that here. Despite that there’s an opinion piece in the NYT today claiming that population density is unrelated to the prevalence or mortality of COVID-19. That’s balderdash. It’s density, folks. Population density is not the only factor but it’s an important one.
Cook County is the home to more than half of the deaths due to COVID-19 in the entire state. Not including Cook County Illinois’s mortality rate due to the virus would be about the same as Iowa’s or Wisconsin’s which is to say quite low.
I also think that there’s a lot less to the reported statistic than meets the eye. A lot more tests for SARS-CoV-2 have been conducted here, too. You’re bound to find more cases that way. Cook County’s health care system is more likely to be overwhelmed by the rash of shootings on the South and West Sides of the city than it is by COVID-19.
And density is situational.
One man crew lumberjacks who pack into a lodge once a month to drink dance fight meet girls are as bad as subway riders.
Or line-workers at the packing plant.
Basically Illinois/Chicago has never been that good or that bad. When the outbreaks were concentrated on the West Coast, it was second tier, and the same when it was later concentrated on the East Coast. According to the benchmarks created by Harvard’s Global Health Institute, Illinois’ “outbreak has been mild relative to the state’s population size” and the main issue is not enough daily testing.
https://www.npr.org/sections/health-shots/2020/05/07/851610771/u-s-coronavirus-testing-still-falls-short-hows-your-state-doing
For those curious about which states were not deemed to have had mild outbreaks (in ranked order):
Severe: New York, New Jersey, Connecticut, and Massachusetts
Moderate: Louisiana, Michigan, District of Columbia, Rhode Island, and Pennsylvania.
Metaanalysis of PD’s comment:
Severe: the NYC metropolitan area + Boston
Moderate: a superspreader event during Mardi Gras, NYC diaspora, Michigan (?), DC (?)
Also, ranking global outbreaks in descending order of severity:
New York
New Jersey
Connecticut
Massachusetts
Belgium
Spain
Louisiana
Italy
Washington, DC
UK
Rhode Island
France
Half of U. S. states have had outbreaks less severe than Germany’s which was lower than any other major European country—so low I don’t believe it.
Compared to Eastern Europe (Hungary, Poland, Czechia, Slovenia, Romania, Bulgaria, Latvia, Estonia, Greece); Germany looks terrible.
Eastern Europe is the impressive standout.
Much like Utah, Wyoming, Montana. Almost makes you think that climate and circumstances are more important than policy.
“Much like Utah, Wyoming, Montana. Almost makes you think that climate and circumstances are more important than policy.â€
The policy prescription is, accordingly, very clear. Shut down the economy and throw 30 million out of work, and bail out states with huge pension liabilities. Who could argue?
‘The policy prescription is, accordingly, very clear. Shut down the economy and throw 30 million out of work, and bail out states with huge pension liabilities. Who could argue?’
And the rabid advocates for these policies want you to permanently vote them into power (permanently through legislatively passed mail fraud, ballot harvesting, fractional voting, ballot bot stuffing or software jiggery). Go figure.
“rash of shootings”
Wouldn’t “steady diet of shootings” be more accurate?
The studies quoted in this article wouldn’t qualify as rigorous analytical pieces of work. More like data samples. However, unless you want to make the case that testing produces mostly false positives (so what’s with all the calls for testing?) or that the asymptomatic judgment borders on fraud, (I would say the fraud is in the blanket diagnoses of coved deaths) this lays to waste the heavy lockdown approach. The last sentence queries essentially “so what’s the purpose of this strategy.†The answer clearly, at least at this point, is not public health.
https://www.conservativereview.com/news/horowitz-now-know-majority-contract-covid-19-asymptomatic-changes-everything/
The IFR, even accounting for asymptomatic, is between 0.5 and 1.5; in the broadest studies to date. Why do people point to the diamond princess when the excess deaths in NYC already exceed 0.25% while 20% were infected?
The factors beyond immediate human influence like density; location; age structure are important. But human agency is equally important.
For example, the WSJ implies Cuomo’s nursing home policy probably costed > 1000 lives. Given the exponential nature of the outbreak, a shelter in place policy in NYC started 2 weeks earlier would reduce the toll by 1/2. Or at the Federal level; if Trump had imposed a travel ban on Europe as soon as Italy imposed a lockdown — like he did with China when it lockdown Wuhan; that probably could have saved 10000 of lives. Or look at Sweden; whose policies have led to mortality tolls several times their neighbors.
Could any human action kept the toll under 10000; unlikely. Could it have been cut by half (40000), quite possibly. Could it have been worse — yes; wrong actions or inaction could have led > 250000 deaths.
I don’t think we presently can say confidently whether human agency is as important as factors beyond immediate human influence, 10% as important, .01% as important, 10 times as important, or 100 times as important. I doubt we will know before the crisis is no longer a crisis.
WRT NYC, I don’t know whether a reasonable person who knew what was known at the time would have imposed a shelter in place directive there or not. I do think that Trump should have imposed the same travel ban on all international travel that he did on China when he imposed the travel ban on China. The operative question is whether it would have made a difference? IMO if a complete international travel ban had been imposed on December 15 it would have made a major difference. Such a ban imposed on December 31 would have made much less difference. I don’t believe a reasonable person who knew what was known in December would have imposed such a ban.
Gov Cuomo locked down New Rachelle on March 10; he only locked down NY state on March 20. Was it a smart to put measures in place for an exurb of NYC while not doing much for NYC itself?
And SF locked down with less cases then New Rochelle had.
As for reducing travel from Europe earlier and whether it makes a difference the answer is probably. The genome studies show most cases in the US (now) came from the EU. A reduction in the number of seeding events makes a huge difference in the exponential phase of the outbreak.
“I do think that Trump should have imposed the same travel ban on all international travel that he did on China when he imposed the travel ban on China.”
So what makes you think that Americans were incapable of bringing the virus back to the US?
Steve
From Drew’s piece.
“Initially, the “experts†used the fear of asymptomatic transmission as a means of pushing for universal lockdown. But that only makes sense if the number of asymptomatic are a minority and we are at the beginning of the transmission phase, in which such lockdown could work.”
This is incorrect. It doesnt matter if it was a minority or majority. Also, the author should try to be consistent when making up arguments. He note that initially the CDC thought that disease could not be transmitted by asymptomatic people with Covid. The lockdown where advocated regardless of symptomatic state and whether or not they were infectious. If more people are both asymptomatic and infectious, then you ned a lockdown even more if the goal is to stop spread.
Steve
I get confused when someone complains Americans were allowed coming back from China.
The policy was Americans / permanent residents were allowed back but they had to observe a 14 day home isolation.
That it was not a centralized facility / self enforced can be criticized to ALL cases in the US, domestic or foreign. I have been suggesting voluntary out of home isolation for weeks but no one else seems to think it is realistic. I welcome advocating for compulsory out of home quarantine.
And we cannot legally close the borders to citizens or permanent residents either. Even in an emergency they have the constitutional right to come home.
From the genome studies — spread from China itself to the US is minimal. Most cases that can be traced to direct China to US travel are from Seattle; and that can be traced to travel before the travel ban. What you see in most of the country can be traced to travel to Europe in Feb.
It’s pretty good evidence that the travel ban from China was effective in limiting direct spread from China to the US.
Link goes to the proclamation. It says that people who may have been exposed should quarantine. It did not quarantine all Americans returning. As has been discussed, thee is asymptomatic spread so there was no way to really tell who had exposure. Finally, the first identified case in the US, until recently, was a US citizen who had traveled to China. We didnt see a surge of Chinese tourists showing up in our hospitals.
The best you can say is that the (partial)China tavel ban was too late to make a big difference so it didnt matter whether it had only partial restrictions.
https://www.whitehouse.gov/presidential-actions/proclamation-suspension-entry-immigrants-nonimmigrants-persons-pose-risk-transmitting-2019-novel-coronavirus/
Lets fact check this.
The Presidential proclamation was the legally enforceable part on non-citizens.
The part that did affect citizens is detailed here (with instructions in the Federal register)
https://www.dhs.gov/news/2020/02/02/dhs-issues-supplemental-instructions-inbound-flights-individuals-who-have-been-china
Here is the key part of the instructions.
“Additionally, U.S. citizens who have been in Hubei province within 14 days of their return will be subject to up to 14 days of mandatory quarantine to ensure they are provided proper medical care and health screening. U.S. citizens who have been in other areas of mainland China within 14 days of their return will undergo proactive entry health screening and up to 14 days of self-quarantine with health monitoring to ensure they have not contracted the virus and do not pose a public health risk.”
The Government is clear returning citizens from China but not been to Hubei should go into isolation. But that it is not a legal obligation. People who had been to Hubei were mandated into quarantine (they did go to military bases).
Or look at the CDC, their travel advisory for returning from international travel is here.
https://www.cdc.gov/coronavirus/2019-ncov/travelers/after-travel-precautions.html
It states, “Stay home for 14 days from the time you returned home from international travel”.
If you are complaining it is voluntary — then I agree and point out that home isolation for cases in this country is mostly voluntary.
Up to 14 days (sounds like up to 90% off) left it as discretionary and it was contingent upon health screening, in a disease with asymptomatic spread. So the question remains, was it actual Chinese visitors bringing in the disease or US citizens bringing it back. Link goes to report on the first 12 pts with Covid in the US (thought to be first at the time.) None of them are Chinese citizens visiting here. The two they found later from California thought to be the actual first were probably community spread.
I have not been able to find reports of Chinese citizens admitted to our hospitals with Covid early in the outbreak. If they were the real source we should have some, probably quite a few. What we do have are early pts who were US citizens who traveled to China.
https://www.medrxiv.org/content/10.1101/2020.03.09.20032896v1
Steve
Thank you for admitting you were wrong.
From the evidence the travel ban was effective.
The main cluster of cases in the US that are traced to China and not from an intermediate country is the Seattle cluster; where the index patient arrived before the travel ban.
Most cases in the country can be traced to travel to China -> EU -> US. Notice the EU did not have a travel ban to China — and they cannot trace their cases to a third country (for example the US). If the US travel ban was ineffective; the EU should have been seeded with many cases from the US; which is not what we see.