Sunday, March 29, 2020

The Case for Staying Home - The light at the end of the Italian tunnel

From Lord of the Rings, Fellowship of the Ring

Aragorn: Are you frightened?

Frodo: …Yes.

Aragorn: Not nearly frightened enough.  I know what hunts you.

I posted a little over a week ago, and I wanted to update everyone.  I included this quote because not enough people in California are abiding by the restrictions (they *finally* had to shut down the Rose Bowl loop and parks because people just didn’t get it).  And nationally, as of Friday, 27 states still did not have *any* stay-at-home restrictions.  To those governors, this is all a big joke.  So, this post has three purposes - 1) to share some good news out of Italy and to project what that means for LA; 2) to encourage people to continue to follow the isolation policies and to explain how much more there is to come, and 3) to ask you to implore your loved ones who live in the half of the country not under these restrictions to self-isolate regardless.  They are going to be slammed hard.

1) Ok, let’s start with the good news out of Italy.  Many people have been watching Italy to see what it tells us about the path ahead.  Data from China is near useless, and the only other major country (South Korea) to have gotten through this employed massive testing to prevent an explosion.  We did not.  So, the tragedy of Italy (and Germany, Spain, etc) gives us the best look ahead for our fate.

The virus can have a 14 day lag from the time a person is infected until they show symptoms.  In theory, this means that we should expect a 14-day delay from the time of shutdown until the peak of infection (roughly - people don’t follow the shutdown perfectly, and the time to symptoms varies from person to person).  After the peak “new cases”, the number of new cases should begin to drop off (the rate of drop-off being related to the effectiveness of the self-isolation).  Well, Italy initiated their shut-down on March 10, and therefore by March 24 they should be at their peak.  The fantastic news is that is almost exactly what has happened:

Now, Italy’s peak was really lumpy, and it’s possible that it will shoot up next week and all of this optimism is misplaced.  However, I’m going to optimistically project that they are on the other side of this.  They haven’t had a day with more than their peak (6,557 new cases) since March 21, and it really looks like they are on the way down.  Now, we don’t know what the second half looks like.  However, a safe assumption is that they will see at least another 14 days of decline, and then by mid-April will have zero new cases.  Let’s hope that follows through.

The other piece of good news for Italy is the accompanying decline in their infection rate.  This is also shown on the graph.  They’ve managed to get their infection rate down from 25%/day to *5.6%/day*.  It seems hard to believe that Italy isn’t looking at the light at the end of the tunnel, which is great news for us.

2) So what does this mean for Los Angeles?  We initiated a shut-down on March 19.  However, we did it 7x sooner than Italy (at 0.002% infected, rather than 0.015%), so hopefully our peak will be much lower than that of Italy.  If we also see a peak at the 14 day mark, that would put it at April 2 (this Thursday) and possibly even earlier (the chart implies that we might be in it now, but we should see how the next few days play out).  There are a million reasons that this might not happen, but it is tracking that way.  Now, even with that good-news proclamation comes the warning - there are *many* people in LA who still don’t understand the seriousness of this (the Rose Bowl loop was finally closed because people weren’t distancing).  People need to understand that they need to stay indoors to stop the spread.  However, if that’s not enough motivation, then stay indoors to protect yourself.  Just like Frodo, people aren’t nearly frightened enough.  Stay away from each other!

I’ve included the LA chart, just for the completeness of being updated, but it’s really hard to confirm a slowing yet.  However, it is important to note that LA has far fewer people than Italy, and therefore the data will be much noisier (also, we’ve kept this much lower - we’re still 10x lower on a per capita basis than Italy, which is fantastic).

3) What about the US as a whole?  Ok, this is the real horror story.  People are talking about Washington, New York and California.  I don’t want to turn this into a political discussion, but I will say this.  The power of the Republican party is in their ability to stick to a unified set of actions.  It is extremely difficult for any Republican governor to defy President Trump.  Right now, Trump is focusing on a message of blaming others (the China Virus, blaming New York, etc).  This results in 27 states not even starting to self-isolate, while maintaining a narrative that this is a Democrat hoax, no more serious than the flu, we should lift all restrictions by Easter, etc (although, he’s walking that one back).  I implore you, if you have loved ones in a state that has not shut down, to tell them that they need to isolate to save themselves.  Health care in remote, rural areas, is even less capable of dealing with this epidemic than urban areas are.  Georgia has 2600 cases, Tennessee has 1500, Florida has over 4200.  These are numbers California had only a couple of days ago.  On a per capita basis, much of the country is in a much worse position than California.  And yet nobody is doing anything.  Here’s a map from Business Insider from March 27 (it’s a little out of date - my understanding is that Alaska has now shut down).  You can see a huge swath of the country is still not taking this seriously.

Ok, so what does that mean for the rest of the US?  If California (and New York and Washington state, and others) start to peak this week, and then begins to decline in the first half of April, we will still see a horrific explosion in the rest of the states.  The US added over 20,000 cases on Friday.  While the US infection rate is declining, this is because New York is dominating.  Once Florida and Louisiana explode, they will continue to push up that curve.  If you have loved ones who have not sheltered in place yet, in a state that is not responding, for their sake they need to protect themselves.

I’d like to close by sharing a video from Science Insider.  There are two take-aways.  The first is that when people say that 80% of cases of Covid-19 are mild, this is true.  However, a “mild case” is defined as any case that doesn’t require *oxygen*.  That’s the definition of mild.  Anything more severe and you are looking at hospitalization.  Now, what’s the second case?  The pathway for death is something called Acute Respiratory Distress Syndrome (ARDS).  I had a very close family member pass away from ARDS, and we spent a month watching him die, watching his lungs get weaker and weaker as we hoped against hope, until it was over.  This is not “just the flu”, this is not mild, and you don’t want anyone you know to go out that way.

So, let’s recoup.  Italy is our best predictor and they look like they are half-way through.  If we follow that path, we (Los Angeles) will peak this week.  However, people aren’t distancing enough, and that’s because they don’t take this serious enough.  If you don’t care about saving others, save yourself - stay home.  Finally, at least we here in California have solid leadership from at the state and local level.  That’s not happening in over half the country.  If you know or care about someone in one of these states, please have them stay at home for the same reason, or we’ll see horrific numbers just as New York, California, and Washington are recovering.

We can see the light at the end of the tunnel.  It’s a long way off, but I think we can see it.  Stay home and stay safe. 

Remember - we know what hunts us.

The case for staying at home (March 24)

I posted this to a local group on back on March 24.  A lot has changed since then, but I'm posting this now to be a background for an update that I will post next.

Hello neighbors. I realize that we're all going through a very difficult time. However, it seems that many people in California don't fully understand the benefit of social distancing, or why we need to stay indoors. I have been tracking data from Johns Hopkins, and I thought I would share. 

The first case to look is Italy. Outside of China, Italy is the most infected country in the world with 63,927 cases on March 23 (let's not get too happy - we're at 46,332). They were growing at a rate of 33%/day (like pretty much every country other than Japan). However, when 0.015% of their population was infected, they implemented a country-wide shutdown. This was on March 10. It's now been two weeks, and we can see the results in the graph. 

Their growth rate started dropping - 25%/day, 20%/day, 18%/day, 15%/day, 10%/day, and then yesterday they grew at 8%/day. The last two days showed fewer new cases than the day before. Two weeks after a national shutdown, they *may* be over the half-way point. If their infectivity keeps dropping, they might only see 15,000 deaths. 

However, if we compare their results to the US, we see a few things. Italy shut down at 0.015%, Spain shut down at 0.014% and LA shutdown (Eaton canyon and beaches aside) at 0.002%. The US as a whole will burst past 0.015% tomorrow, and instead President Trump is talking about *lifting* any restrictions. Ok, so how are those restrictions doing for us? 

The second graph shows Italy, the US, Los Angeles (LA), and Canada and it plots the new cases each day (as a percent of population). You can see Italy's recent downturn. But you can see how the US has exploded nationally (over 11 thousand cases were added *yesterday* - a week ago the entire country only had 4,661). 

So, what does this second graph tell us? Well, the US is where Italy and Spain shut down, and the federal government is still not doing that (although multiple states and cities are acting on their own to do so). Secondly, we're just where Italy was about 10 days ago, but growing much more rapidly. Third, you can see a significant difference between LA and the rest of the US (note, these figures already have population factored in, so don't make the mistake of thinking that LA has fewer people than the US - this has been accounted for). 

So, we *NEED* to shut down. It does work. It is working. We need to stay away from each other. Group with your family, but don't go near anyone else. We must freeze this in its tracks, and the benefits are there. The quicker we shut this down, the shorter we'll be stuck in home. The US as a whole is growing at 35%/day. Unabated, this will be close to ONE MILLION people infected by early April. We cannot let that happen, and this is why everyone is saying this is as serious as it is. I hope this data has been helpful. You can see it yourself at Johns Hopkins ( 

Stay safe. Help your neighbors. Let's get through this.