Relative percentages to understand state COVID-19 status

President Donald Trump and the White House Corona Virus Task Force released “Opening Up America Again” guidelines on April 16, 2020.  The guidelines provide “Proposed State or Regional Gating Criteria” for proceeding to each of three phases of reduced restrictions on economic and social activity.

“Core State Preparedness Responsibilities” include robust testing and contact tracing capability, adequate healthcare system capacity to include a surge capability, and a plan to protect the health and safety of critical workers, vulnerable populations (e.g. nursing homes), and other related specific requirements.

The guidelines use criteria for transitions through the three phases based on data within a state or even county or city level, as the granularity of data is now available to those levels.  The guidelines do not set dates, but rely on states satisfy criteria to transition through each phase called “Gating.”  Beyond the underpinning Core State Preparedness Responsibilities a state would make decisions about transitioning based on an observed decrease in day to day confirmed cases and  positive tests for the virus over a two week period.

This necessary plan is adequate to begin the process of transition in balancing the risk of economic collapse with public health.  Twenty-two million Americans have now lost their jobs as the result of the Covid-19 pandemic.

I keep my own databases to analyze the risk of Covid-19. I do this to satisfy my own curiosity and analytical bent, but I also feel that there is a weakness in journalism today that forces me to do my own analysis.   I have observed an overemphasis on reporting raw numbers to indicate risk and impact with an emphasis on rounded thresholds (e.g. 1000, 10,000) that make for good headlines.  This distorts impressions and understanding.   I believe a better way to understand virus risk and impact is through relative comparison of a state against other states and the national average by calculating the percentage of a state’s residents that have been tested, have tested positive, have died, and are projected to die with Covid-19.

I set up download routines from databases that are reliable and current.  The COVID Tracking Project hosted at The Atlantic has a data file that I use to track specific numbers tested, hospitalized, and deaths.  The New York Times has a database that tracks similar data, but has an excellent graphic presentation showing the increase or decrease in cases and deaths in a day over day comparison.  The University of Washington IHME database provides model projections for hospital bed and ventilator shortfalls and anticipated number of deaths through August 4^th by state.

Below are some tables I created that are sorted to show different rankings by state and the national average.  I offer these tables to my blog readers in the hope that it will help them better understand the situation in their state and appreciate that all states are different. 

We need an exit strategy – now!

Data indicates the U.S. is achieving the goal it set out to accomplish.  The national objective was as follows:

The United States’ immediate and primary objective in response to the COVID-19 pandemic is to compress the peak of infections (commonly called “Flattening the Curve”) in order to avoid denying critical care to the afflicted as a result of insufficient hospital staffing, hospital beds, Intensive Care Unit (ICU) beds, and ventilators.  Social distancing is the primary strategy to achieve this objective.

Data tracking indicates the curve of COVID-19 illness is flattening in many countries of Europe and in the United States.  In the U.S., hospital beds, ICU beds, and ventilator capacity are meeting need and improving as the number of patients requiring these services is declining and options for treatment expand. Production of personal protective equipment and ventilators is increasing to meet need.  Care capacity to treat infected patients is increasing as hospitals reallocate resources, old hospitals and other spaces are converted to active service, field hospitals are opened, and hospital ships are deployed.

The U.S. objective stated above assumed a very high risk that healthcare capacity would be exceeded responding to the SARS-CoV-2 virus that causes Coronavirus Disease 2019 (COVID-19).  Models indicated the virus would spread wider and faster than other viruses, its symptoms would be more debilitating, and it would be more deadly than other viruses.   The models were just that – MODELS. 

Post-COVID-19 research and analysis will determine how accurate those predictive models were.  For now, gratitude is in order that the virus impact is less severe than was originally predicted.  Whether that results from our social distancing strategy, or the virus is just not as vicious as predicted, or seasonal weather change is having the same impact on SARS-2 as it does on many other viruses is fodder for another day.  For now, cautious victory can be declared, and cautious and prepared gradual rescinding of many social distancing restrictions can begin.

Maintaining social distancing to the extent it is currently in practice can cause tremendous social harm.  The “Disaster Distress Helpline” at the Substance Abuse and Mental Health Services Administration last month saw call volume increase 9 times over March 2019 and officials are warning of a national mental health crisis.   The National Suicide Prevention Lifeline set a record last month for call volume.  Those saved and sustained by addiction programs such as AA and NA are at greater risk of relapse despite attempts to move support online.  The United Nations this past weekend called for “urgent action to combat the worldwide surge in domestic violence.”

Nursing homes need greater focus in COVID-19 battle

It is clear that age is a major factor in COVID-19 morbidity.  It is clear that underlying health status is a major factor in COVID-19 morbidity.  It appears the place one resides (SETTING) is also a major factor.  Specifically, reporting indicates nursing homes and other elder care facilities are the major setting source for COVID-19 outbreaks leading to death.  Data collection and reporting must increase immediately to identify and report the setting in which COVID-19 is contracted and immediate policy implemented to prevent and mitigate vulnerability in the short term.  In the long term, the nation must dramatically change and improve residential elder care or rethink the current model.

There are about fifteen thousand nursing homes with nearly 2 million licensed beds in the United States.   These facilities "appear" a hotbed for COVID-19 deaths.  “Appear” because there is no available repository of data to validate this hypothesis.  The Centers for Disease Control (CDC) does not release the names of nursing homes or the number of residents who have contracted COVID-19 when outbreaks occur - but it should.  There is some media and state reporting from which one can extrapolate the extent and severity of the problem.

The first such case occurred at the Life Care Center of Kirkland in King County, Washington where 81 residents, 34 staff members, and 14 visitors contracted COVID-19.  Of these cases, 23 patients and visitors died.  A more recent example is unfurling at the Commonwealth of Massachusetts’ state run Soldier’s Home in Holyoke, MA where 21 have thus far died.

At least 400 nursing homes across the country have COVID-19 outbreaks.  The number is increasing daily.  No doubt, there will be a correlation between this growth and a climbing number of deaths reported from COVID-19.

A Trump vs Sanders contest may be needed

A general election contest may be necessary between President Donald Trump and Senator Bernie Sanders in 2020.    The United States is going through a tumultuous rejection and realignment of its political culture that may well climax with the 2020 presidential election.   Pitting the two non-party populist candidates with opposing political philosophies in a head-to-head contest will break the two major political parties and determine if the political center of American culture will be reset much further left or remain a conservative right majority.  The fight is a necessary one to conclude a rejection of two parties that are more similar than not in creating division and failing to address the interests of the American people.

Let’s rethink nuclear power

Nuclear power will play an essential role in the energy future of the United States and the world.  There is an increasing recognition by scientists, entrepreneurs, and policy makers that it offers unique characteristics that can provide an abundant, safe, and clean energy source indefinitely.  Despite a decline in the existing nuclear power industry, a renaissance is underway in new safe nuclear reactor designs and technologies to fuel the next century, while rapid advances in fusion power research portend a revolution to begin within the next two or three decades in the nuclear industry.  Now is a pivotal time for leadership, a national focus, the allocation of resources, and a revamping of federal and state regulatory models to accelerate development that will transform the energy portfolio of the U.S. and the world.

Many people in the United States reject nuclear power based on fear.  It is time to face that fear and reconsider nuclear power as a primary contributor to the nation’s energy portfolio.  Now is the time to reassess because there is both vulnerability and opportunity looming.   The vulnerability - existing nuclear power infrastructure is old and presently unprofitable – causing decline in a major component of our nation’s energy portfolio.  The opportunity - there is a tremendous amount of innovation taking place around modern, safe, and small fission nuclear power design that is very promising.  In addition, progress in fusion research is real and substantial, and accelerating.

Syria - deja vu all over again

Almost one year ago I posted "Goodbye Syria and good riddance" on this blog.  President Donald Trump had ordered a withdrawal from Syria in what seemed to many to be a non-consultative rash and reactionary move.  His then Secretary of Defense Jim Mattis disagreed and ultimately resigned in large part because of the decision.  

At that time I agreed with the President's decision and continue to support his efforts to withdraw from these interminable military deployments.  Last year I was critical of the way in which the decision was made.  It reportedly lacked consultation with allies and even within the President's own Administration.   Trump eventually relented to across the board pressure to remain though there was a decrease in the number of forces by half.

The same arguments are being made that the decision this time was made hastily without adequate preparation and consultation.  A lot of the criticism is simply the knee jerk reaction of the President's haters.  No matter what he does it is wrong and they seek political advantage.   But as in December of last year, there is significant opposition from two other sectors - Republican leaders and the defense bureaucracy. 

Senate Majority Leader Mitch McConnell wrote an Op-Ed this past weekend in the Washington Post titled: Withdrawing from Syria is a Grave Mistake. McConnell says, "It will leave the American people and homeland less safe, embolden our enemies, and weaken important alliances."  I am familiar with these arguments from advocates such as McConnell, John McCain, and Lindsey Graham.  They are hawks of the traditional "America as the indispensable leader" believers.  I understand their arguments, but I ask: "At what cost?"  

The election in 2016 was decided in no small part by people who have had it with the endless wars that expend blood and treasure for questionable objectives and results.  In fact, the one sure way for Donald Trump to loose reelection is to engage in another such adventure.  The Iranians are trying to provoke him to do just that.  The defense bureaucracy would have reacted as would normally be expected but for the President saying no in reaction to the shoot down of an unarmed drone by the Iranians.  Though the President has approved further deployments to Saudi Arabia as a deterrent in response to attacks on Saudi oil facilities he has not taken the bait to engage in yet another military adventure.

Below is the post from December of last year.  It remains relevant.  Everything below this line was written in December, 2018.  Note it sounds just like this past week one year later.  I have made some additions in bold.  The original post with comments is linked here. 

2020 Prognostication – Trump wins – for now

If pressed to predict the winner of the 2020 presidential election today I would predict that President Donald J. Trump will be reelected.   The prediction is based on Professor Allen J. Lichtman’s “Keys to the White House” model.   The model is a proven predictor that uses measures that are more objective than polls and pundits.  The model predicted the Trump victory in 2016 while all other methods failed.  But the prediction is only a marker in time - the present - and a lot could change.

The Democratic Party has avenues to change indicator status and the outcome in the remaining year.  However, barring a major collapse of the economy, they may only be able to change the indicators on the margins.  In that case they will need to provide a very strong candidate as an alternative to President Trump.   Can the leading Democratic Presidential candidates provide that alternative?  Read on.   

Will these be the the two candidates in 2020