Tag: health

Last week I wrote about how we were seeing new cases continuing to rapidly decline. This week we can say cases are still declining, but perhaps a bit less rapidly than earlier.

The charts above show that slowdown in the tail at the right of the chart. First some points to note, Delaware reported that several hundred cases had not been entered into their database, and so we saw a one-time spike midweek. But note that after the spike, the numbers continue to trend down. In other words, the rapid decline was probably a bit less rapid than we saw, but it was still a decline.

Pennsylvania’s chart has a problem of your author’s own design. Now that I’m fully vaccinated I was able to leave the flat this weekend and the Pennsylvania data wasn’t ready by the time I left on Saturday. But by the Sunday data, it was and so the 2500 new cases is probably split somehow between those days—accounted for by the seven-day average. This points to a broader question for which I do not yet have an answer: as life increasingly returns to normal, how much longer will I continue to update these charts?

I started these graphics as a way for myself to track the spread of the virus in my home state and the state where I still have a large number of friends. At the time, there were few if any visualisations out there doing this. Now most media outlets have them and my work at home led to a similar project at work. The reason I continued to make these was you, my readers here and in other places where I post this work. Your comments, messages, texts, and emails made it clear you valued the work. First, I know there are still many people left to be fully vaccinated, nearly half the population, and due to bias, some of the people most likely to follow these posts are those most likely to get vaccinated as early as possible. But please let me know, readers, if you’re still getting value out of these graphics.

But back to the data, in two of the remaining three states, Virginia and Illinois, we saw numbers continue to decline. New Jersey, however, shows a tail with a slight uptick in the seven-day average of new cases. This will be something I follow closely this coming week.

Deaths finally appear to be dropping.

Not by large numbers, no, but in Virginia and Illinois we saw declines of 5 deaths per day. Pennsylvania was even greater with a decline of 7. We are still above rates we saw last summer, but it does appear that finally we have hit the inflection point we have been waiting for the last several weeks.

Finally we have vaccinations. These charts look at the cumulative number of people fully vaccinated.

And in that the number keeps going up, and that’s good. But they can also only keep going up. But if you look closely at the right tail of the curve, you begin to see it flattening out as the rate of daily vaccinations begins to drop. Unfortunately we’re well below levels we think we’d need for herd immunity. But, to try and look at the positive, we’re almost halfway there and that is certainly playing a role as we can see with the rapid decline in numbers of new cases. But we need to keep trying to get more people vaccinated.

Credit for the piece is mine.

Last week I wrote about how, for new cases, we had seen a few consecutive days of increasing cases. Were we witnessing an aberration, a one-off “well, that was weird”? Or was this the beginning of a trend towards increasing new cases?

A week later and we have our answer. Just a one-off.

If we focus on just the seven-day average, in just one week the numbers in New Jersey have fallen by half. In Pennsylvania, Virginia, it’s by one quarter. Illinois is a little less than that, as is Delaware. Across the board, numbers are falling and falling quickly.

When we move to deaths, we’re beginning to see an improvement. As the lagging indicator, we would expect these to begin to drop a few weeks after new cases begin to drop. We have begun to see what might be the peaks of deaths in a few states.

Over this coming week, I’ll be closely watching these numbers to see if we can finally begin to say authoritatively that deaths are in decline.

Vaccinations drive all of this. And we continue to see the total number of fully vaccinated people climbing in Pennsylvania, Virginia, and Illinois. But, that rate is slowing down. Most likely we are entering a phase where those eager for their shots have largely received them. Now begins the challenge of vaccinating those who might lack easy access or have reservations.

But to be clear, we need those people to become fully vaccinated before we can truly begin to return to normal. Whatever normal is. It’s hard to remember anymore.

Credit for the piece is mine.

I didn’t write a post last Monday, but this Monday I am. A few things may have changed in the Covid situation. The most important is that we may have finally seen the peak of this current wave’s surge of new cases.

For the last few weeks we’ve seen cases rising in the five states. Only New Jersey of late had shown a return to declining cases. About the middle of the week before last, we began to see those numbers decline. And so in this past week we did begin to see cases decline in all five states.

The thing to watch this week will be that at the very end of last week, new cases ticked up slightly for two or three days in a number of states. It could be an aberrant one-off, but with full vaccinations still well below herd immunity and cases still at high levels, it isn’t difficult to imagine a scenario where the virus begins to surge once again.

Deaths on the other hand, they continue to climb. We aren’t seeing massive increases, instead these are largely marginal. But they are increasing all the same.

Encouragingly, if cases can continue to decline, deaths will begin to fall. As a lagging indicator, they will be the last metric we see decline. Consequently, it’s a question of when, not if, deaths begin to decline. On Saturday, we did see a small decline in deaths, but one day before the weekend is insufficient to determine whether or not we’ve seen the inflection point, after which deaths would fall.

Vaccinations remain a broad set of positive news. All three states are now reporting just over 30% of their populations as fully vaccinated. However, the rate of vaccination has begun to slow.

And that worries me and the professionals, because we are still far from herd immunity. Until we reach that level, the virus can easily spread among unvaccinated populations. The charts above don’t show the decline, as they look only at the total, cumulative effect. But the charts that I see make it quite clear the decline over the last week or two.

Moral of that story is, if you haven’t been vaccinated yet, please register to do so or visit a location that allows walk-up vaccinations.

Last week I wrote about how we may have been beginning to see divergent patterns in new cases, i.e. how New Jersey in particular had seen its new cases numbers falling whilst other states continued with increasing case counts.

One week later, that may still broadly hold true.

Emphasis on may.

If we look at the new charts, we can see that broadly, New Jersey did continue its downward trend as Pennsylvania and Delaware experienced significant rises in new cases. Virginia remained fairly stable, but with a slight trend towards increasing numbers of new cases.

But New Jersey and now Illinois present some interesting trends to watch this coming week. Illinois reminds me of New Jersey in that despite rising numbers most of last week, the last few days (and of course the weekend) saw numbers lower than preceding days. You can see from the slightest of dips at the tail of the line the trend has flipped direction. Will the direction hold, however, once we start receiving weekday reporting figures starting Tuesday?

Back to New Jersey, though. The downward trend continued most of the week. But, the last several days could portend a reversal of sorts. For most of the last week, the state saw daily new case numbers increasing day after day. But the trend line, as it should, remained heading downwards. Until just a few days ago. If you look at the tail of the line there, you will see a slight uptick. This too will be something to watch in the coming week.

Deaths also need careful attention this week.

Last I asked the question, will deaths follow rising cases? After a week of data, the answer is unmistakably yes. However, unlike new cases, the increases are largely of a marginal number. Look closely at the ends of the lines for Pennsylvania, New Jersey, Delaware, and Illinois and you will see last week’s shallow rise continued.

Virginia bucked the trend with decreasing numbers of deaths. And of course marginal increases could easily give way to marginal decreases. Now I try not to mention too many daily numbers in these posts because I take the weekly view, but I will be closely following Pennsylvania this week. For the last several weeks, the Commonwealth regularly reported deaths on Sunday and Monday in the single digits. Yesterday Harrisburg reported 40. Is this a one-day surge of reports? Is the state resuming reporting more deaths at the weekend? Or does it portend something worse, a mores significant rise in the number of deaths?

Vaccinations continue apace. Although, I would expect to see some slowdown as the Johnson & Johnson vaccine pause ripples out across the vaccination programme.

For now though we continue to see increasing numbers. Indeed, the three states I track have now all reached or should reach today 25% of their population as fully vaccinated.

One, that is good news.

But, two, this is just the beginning.

Last week in some tense questioning about when we can expect resumption of “normal”, Dr. Fauci provided a figure of 10,000 new cases per day across the US. (Currently we are about at 60,000 or so.) Vaccines will impede the transmission as they become ever more widely administered and fully implemented—remember that a first dose of a two-dose regimen does not mean you should be heading out and socialising.

At present, we have Pennsylvania averaging 5,000 new cases per day. In other words, Pennsylvania alone represents half of Dr. Fauci’s target. We are clearly far from that reopening level.

What I will be curious about in the coming weeks though is that interplay between new cases and vaccinations. If Illinois does begin to see a downward trend in new cases this week, how much of it is due to the state being 25% fully vaccinated?

That’s a complex question to answer, but at some point, increasing vaccinations will force new cases to reach an inflection point. First they will begin to bend downward, increasing more slowly instead of exponentially. Then with even more vaccinations a second point will be reached at which this new surge begins to finally turn and new cases drop.

The question is when.

Credit for the piece is mine.

This time last week I wrote about how we should not be surprised at rising levels of coronavirus in the states of Pennsylvania, New Jersey, Delaware, Virginia, and Illinois. After all, our elected officials reopened economies despite data saying they should do otherwise. On top of that, people have been engaging in reckless behaviour and seemingly abandoning the very behaviours that had been leading to declining rates. With those two failures, our last hope is that vaccines will come quickly and be widely taken by the public.

A week hence.

Well, we are beginning to see some divergent patterns, especially with new cases.

Last week there was some evidence that New Jersey might be bucking the trend and headed downwards after weeks of rising new cases. And now that appears to be a more sustained trend as the line for the Garden State’s seven-day average clearly began headed the right direction this past week.

That’s the good news. The bad news is that we continue to see rising numbers of new cases in Pennsylvania, Delaware, and Illinois. Although if we want to try and find the positives in the bad, we can see that Delaware’s upward trend remains fairly shallow. Illinois, while steeper, is rising from a lower base as the Land of Lincoln managed to reach low, summer levels of new case spread earlier this year. And in Pennsylvania, there is a bend in the curve, an inflection point, that could indicate growth in the number of new cases is slowing. We still need to see it turn negative, but slowing growth is better than increasing growth.

Virginia splits the difference between those sets. It remains at an elevated level of new case transmission, but the upward tick we saw—unlike the other states—was not followed by a general surge in new cases. The little rise we did see, in fact seems to have perhaps shifted back downward.

One of the big questions in this current wave of new cases is will deaths rise? We are seeing increasing numbers of new cases and hospitalisations, but will deaths follow? The hope is that we have vaccinated enough of the most vulnerable populations to prevent them from suffering the most serious of results.

So far so good. While death rates remain slightly elevated over summer levels, we do not yet see any signs of rising numbers of deaths. The only possible exception is Virginia, where cases bottomed out after the state added delayed death certificates from the holidays, but have risen in recent days.

Finally we have vaccinations. Here is the best news at which we can look. We can now say that at least 20% of the populations of Pennsylvania, Virginia, and Illinois are fully vaccinated. To be clear, that is still a long way from herd immunity levels, but that’s 20 percentage points more than we had four months ago.

One big outstanding question is how much, if at all, can vaccinated people spread coronavirus? This is why we need to continue to wear masks and socially distance even those who have been vaccinated. But at some point—I don’t know when—these increasing levels of full vaccination should begin to flatten the new case curves. Could that be what’s flattening the curves in New Jersey, Virginia, and Pennsylvania? It’s too early to say, but one can hope.

Credit for the piece is mine.

Last week I wrote about how the inevitable rise in new Covid-19 cases was occurring in Pennsylvania, New Jersey, Delaware, Virginia, and Illinois. Now, one, in the last week, we saw no evidence of states preparing to reinforce their public health and safety restrictions. And two, whilst we have no data on people not following guidelines, anecdotally a large group of people threw a party in my building’s common amenities space so it does seem like people are feeling less inclined to wear masks, socially distance, and isolate to their own households.

Those two conditions, of course, do not help reduce the case count. Instead they add to it. So it should come as no surprise that Covid-19 continues to rapidly spread in our five states, though some are doing worse than others.

New Jersey and Pennsylvania arguably performed the worst. If we look at the peak to trough decline from early winter’s surge to late winter’s nadir, we can see that New Jersey has reached 40% of that peak. Pennsylvania enjoyed a better decline and so has a large gap, but is still nearing 20% its previous peak.

Illinois is also remarkable—again not in a good way—as its peak to trough fall was even greater than Pennsylvania’s, however it’s also now clearly rising. The Land of Lincoln, however, did manager to reach late summer levels of new cases—good. But those are now rising—bad. Delaware too is seeing a rise, albeit at a slower rate than its two tristate neighbours.

Only Virginia’s rise remains slight, barely discernible in the chart.

Deaths, while not exactly good news, aren’t exactly good news either. Last week I mentioned how they had stalled out and stopped declining. That is better than rising death rates, but the levels of deaths per day is still higher than we saw last summer. In other words, things could be significantly better even in pandemic terms.

Last week? Deaths continued to stubbornly persist at those elevated levels. We remain vigilant, looking for any indication that deaths will follow the rates of new cases and hospitalisations and begin to climb.

The hope, of course, is that we have vaccinated enough of the most at risk populations to prevent a surge in deaths. But, we just don’t know yet. The only good news is that vaccinations continue to progress.

Illinois has surpassed 18% of its population being fully vaccinated. Virginia is not far behind at 17.75%. Pennsylvania, because of the bifurcated nature of its data reporting, remains unclear. It sits at 17.8% fully vaccinated, but Philadelphia has not posted updated data since late Thursday. It’s likely that the Commonwealth has joined Illinois in surpassing 18%, but it’s not fully certain.

Also this past week, the CDC updated its guidance for the fully vaccinated, saying that it was safe for them to travel. I take some issue with this, primarily on the messaging front.

First, we need to be clear about what fully vaccinated means. It means two weeks after your final dose. For Johnson & Johnson’s vaccine, that means two weeks after your shot as you only receive one. For both Pfizer and Moderna, you are only fully vaccinated two weeks after your second shot—not before. And keep in mind with Pfizer you need to wait three weeks between first and second dose. With Moderna it’s four weeks. In other words, with J&J you need to wait two weeks after your first (and only) shot before you can begin to follow the loosened guidelines. If you receive Pfizer’s, you need to wait five weeks from your first shot, assuming you do receive your second three weeks later, and with Moderna it’s six weeks, again assuming the recommended four week gap.

The problem is that only about 20% of the US population is fully vaccinated. And with the virus spreading at high rates and at high levels, it poses a significant risk as the newer, more lethal, and more infectious variants could take root in the United States and overwhelm the healthcare systems of the 50 states. We do not yet know if fully vaccinated people can spread the virus if they do become infected.

I think the advice should have remained to refrain from all but essential travel until we reached a high percentage of fully vaccinated folks. I ballparked earlier this week something like 2/3 the estimated amount of full vaccinations required for herd immunity (est. at 75%). In other words, keeping restrictions on travel until at least 50% of the US becomes fully vaccinated.

We remain several weeks away from that milestone, unfortunately. I understand the desire/urge people have to get out and do things and enjoy spring after a year of isolation. Sadly, if winter was the darkest/hardest part of the pandemic, I think that makes spring and early summer the most challenging. Because we see progress, we see the light at the end of the tunnel, and it coincides with warmer weather and we want nothing more to get out and do things and see people. But that is the last thing we need to be doing at this point.

I’ve often described the vaccination as the marshmallow test. In a study, scientists presented kids with a marshmallow. They could eat the marshmallow immediately, but if they waited 15 minutes, unsupervised, they could then have an additional marshmallow. We are all just grabbing that first marshmallow whilst the promise of a more normal summer is ours if we can wait just 15 minutes.

Credit for the piece is mine.