Making Better Decisions Based on Updated Covid-19 Numbers

We are still being inundated with a host of numbers that may or may not be telling us something important. Painfully, we are being asked to make individual and collective decisions that can easily be life and death, based on what passes for guesses about the underlying indications. This is a quick update to remind us of what we don’t know from the numbers that we see every day and a critical understanding of what we need to know to choose more wisely.

“New Cases”

Reminder — this number is not to be confused with how many people are infected. It is, more exactly, the number of positive tests that have been recorded each day. The actual number of people who have the virus is by definition higher since even with the recent increase in testing only about two percent of the country has been tested. Most estimates have the actual number of infected people at between 3 and 7 times greater than what has been reported.

At present, we are seeing reported cases continue to increase by 30,000 per day, give or take about 10%. This number is somewhat perplexing, given the knowledge that we are testing dramatically more people each day than even a week or two ago. According to the COVID Tracking Project, over the past five days we have issued an average of around 250,000 tests per day while seeing that 30,000 new cases average… but if we go back a couple of weeks to mid-April, we averaged around 150,000 tests while gaining the same 30,000 new cases per day. There are any number of simple explanations, from the different parameters of who gets tested, to the different reporting mechanisms for every state, to the fact that some reporting is about tests, and others relate to patients… so, one infected person being tested repetitively would indicate as if they were several patients. At the end of the day, this number lacks even usefulness for trending purposes because of the constantly changing reporting metrics.

“Deaths”

Reminder — Each state has a unique method for what it considers a virus-related death. Also, a number of states are acknowledging significant delays in reporting, while others are reassessing causes, particularly in nursing homes and other collective residences. Finally, the different reporting agencies use different cut-offs for their calculations — some do it at midnight, some at 4:00 pm, and some at noon — causing differences between reports. That said, the death total may be the closest thing that we have to a useful number in understanding trends.

Deaths are staying relatively stable at about 1,500 to 2,000 per day nationally. As New York has improved, other states have begun to pick up the proverbial slack, with New Jersey recently passing New York in absolute terms. The past three weeks show a slight recent improvement, with last week at 1,805 per day, the week before at 1,930 per day, and the week before that at 1,981 per day… but note that the reduction shown is well less than the improvement in NY, meaning that the rest of the country increased during that period.

“Testing”

Reminder — what constitutes a test is particularly unclear at present. According to the COVID Tracking Project, the definition of a test can vary from a test issued to a test returned, to (infrequently) a patient tested based on who is reporting the number and from what source (public, commercial, CDC, etc.). To make matters worse, the definitions continue to change in process, leading to little value for historical purposes.

Currently, as noted, approximately 250,000 tests per day are being reported. This is a significant increase over the past by any count, and the total of tests registered is now over 7 million since testing began in earnest in mid-March. Again, that total does not mean that 7 million people have been tested, only that there have been 7 million tests… patients who test positive are tested repetitively to assess their status. If we assume that the number of people is 75% of the number of tests — a fully unscientific guess — then we would have tested about 5.25 million people or about 1.6% of the population. It is important to know that most of the government agencies suggest that we would need to test at least five times that number (the 250,000) daily in order to understand the spread of the virus nationally and to support the reopening of some of the economy.

General Notes

What little we can discern from these numbers includes the following:

1. There is no clear direction for the spread of the virus on a national basis. As was the logical outcome, each section in each state is following its own path, and its own schedule for the rise and fall of this first round of the virus. As one area wanes, another surge… the country as whole seeming to be somewhat flat is a misperception; regional evaluations are the critical metric.

2. Based on “death” trends, it appears that the CDC’s initial estimate of 100,000 to 200,000 deaths appears to be a useful range. At present rates, we will pass the 100,000 bottoms of that range around the 20th or 21st of May, no responsible source suggests that the virus will be resolved — either by vaccination or by herd immunity — before sometime next year at the earliest. If the pace remains above 1,500 deaths per day, we’ll hit the upper end of that range — 200,000 — by around August 1st.

3. The rapidity of the virus spread, and the resulting fatalities, is impressive. We have now seen the last 50,000 deaths occur in less than a month; given the delay in deaths from the time of infections, and based on the number of hospitalizations, we will likely see the same number in the same period moving forward.

4. Comparisons to the flu are now — as was obvious before — fully exposed as meaningless. Despite the extreme measures being taken to mitigate this virus, Covid-19 will take about as many lives every three weeks as the flu typically takes in a full year without such measures. That said, a normal flu season beginning this fall will greatly impact the available resources for the virus, which is anticipated to still be around well through that period.

At the end of the day, regardless of their accuracy, the numbers tell only a partial story. As a country, we are not set up to take the draconian steps of some other nations who had more success in curtailing the virus. We could have, should have done better… and we can do better than we’re preparing to do now that our collective patience has waned, and our government has made its intentions clear. The inevitable outcome will be a significant loss of lives in exchange for a possible easing of the economic crisis, with those benefits not assured; what you individually can use an understanding of the numbers for is to make your own decisions about risks and rewards, and to act accordingly.

It is clear that the disease is as lethal as promised, and that it will be around for many months to come. Take care, stay safe, and do your best not to appear on the next of these updates, or to cause even more anguish to our heroic first responders and medical professionals, who sadly have no evident relief in the near future.