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Coronavirus, Pandemic Designation, and Exponential Growth

zzz

Senior Member
Messages
675
Location
Oregon
A few hours ago, the WHO formally designated the novel coronavirus a pandemic. For a full account of this declaration, see WHO declares coronavirus a pandemic, citing ‘alarming levels of spread and … alarming levels of inaction’ .

For many people, it is a bit confusing why the coronavirus, which so far has infected far fewer people the annual seasonal flu and caused far fewer deaths, is being taken so much more seriously than the flu. For example, here in the US, the CDC estimates that for this year's partial flu season, running from October 1, 2019, through February 29, 2020, there have been between 34 and 49 million cases of the flu, and between 20 and 50 thousands flu deaths. When contrasted with the current number coronavirus cases, which is 1275 as of this writing, and the number of coronavirus deaths, which is 37, there seems to be no comparison; there are about 40 thousand times as many flu cases, and a thousand times as many flu deaths. Why is the coronavirus causing so much more concern than the flu?

The answer is manifold. First, so much about the coronavirus is still unknown, or only tentatively known. An excellent survey of these unknowns can be found in the article The unknowns of the coronavirus nearing a pandemic.

Second, the long-term responses of countries around the world is unknown and hard to predict. The way countries respond to this pandemic will have a huge effect on how severe it becomes.

Third, there is no vaccine for the novel coronavirus, and large-scale production of such a vaccine is at least 12 to 18 months away.

In light of this situation, exponential growth of the number of cases of the virus can be expected either until the virus is brought under control by massive governmental efforts and possibly the release of a vaccine, or until a large proportion of the population has been infected. The latter case, which is near the worst case on the spectrum, is what happened in the 1918 influenza pandemic (the Spanish flu), which infected about half a billion people, or about 27% of the world's population, and which caused an estimated 50 million deaths. It is useful to remember that the current world population is about four times the size of the 1918 population. Also, travel both internationally and within countries is far more prevalent today for the general population than it was in 1918. It is for this reason that German Chancellor Angela Merkel has warned that up to 70% of the country's population could contract the coronavirus; similar percentages could well apply in large numbers of countries.

How does exponential growth work, specifically in the case of viral spreading, what factors influence it, and what are the upper and lower bounds predicted by such growth? Also, what affects the rate of exponential growth? I have found the following video to be extremely helpful in answering these questions. Only a grade-school knowledge of math is required to understand it; no knowledge of exponential growth is required. Here it is:


I have found that the information gleaned from this video can be combined with current coronavirus statistics to get a good idea of where things are headed in the near future. The sources I have found useful for coronavirus statistics are Coronavirus Update (Live), which presents worldwide coronavirus data updated in real time, as well as broken down by country; Coronavirus Cases: Statistics and Charts, which gives a more detailed breakdown on the worldwide situation; and the individual country pages referenced in the first link in this paragraph, such as United States Coronavirus, which supplies detailed statistics for a given country. (Only a mall number of countries have their own pages.) On the US page, in figures such as "Total Coronavirus Cases in the United States" and "Daily New Cases in the United States", the shape of an exponential curve can clearly be seen, especially in the last week. This exponential growth can most easily be seen in countries with larger numbers of cases that have reliable reporting. It's not clear how reliable the reporting from China is.

I am posting this not in any attempt to create alarm, but rather to give people time to make plans for dealing with this virus, especially if governmental efforts fall short (as the WHO announcement indicated it believed was happening). We really don't know for sure what the effect of the coronavirus on PWME will be, but by all indications, we can expect to be on the more severe end of the range of reactions. Fortunately, a lot of us who are most at risk have been effectively self-quarantining for quite a while (though not by choice), and many of us have also learned how to avoid infection-spreading contacts, which can be quite dangerous for us just on a normal level. Combining these practices with frequent and thorough hand washing can go a long way toward minimizing our chances of acquiring this virus, which has a high mortality rate among people in poor health. Although no coronavirus cases have been identified within a hundred miles of me, they will come, and I have been preparing myself by assuming that everyone I come in contact with has the virus. I have found this to be very helpful in developing habits that will prove useful when the virus eventually makes its way down to this part of Oregon.

Good luck to everyone in dealing with this situation!
 

Rufous McKinney

Senior Member
Messages
13,467
My entire family story- involved a death in 1919 from the Spanish Flu.

It will change the family stories. It will change fate.
 

andyguitar

Senior Member
Messages
6,657
Location
South east England
The latter case, which is near the worst case on the spectrum, is what happened in the 1918 influenza pandemic (the Spanish flu), which infected about half a billion people, or about 27% of the world's population, and which caused an estimated 50 million death
Yes so if 27% of the population got infected 73% didnt. And it hasnt come back.
 

Wolfcub

Senior Member
Messages
7,089
Location
SW UK
My grandmother got that 1918 flu when she was 22 and recovered, and she was not a strong young woman. She went on to have 3 children and lived not to a great age, but until 1966.
My grandad who was in the trenches in Europe from 1914, never caught the flu at all! And returned home in 1918!
 

Wolfcub

Senior Member
Messages
7,089
Location
SW UK
this year's partial flu season, running from October 1, 2019, through February 29, 2020, there have been between 34 and 49 million cases of the flu, and between 20 and 50 thousands flu deaths. When contrasted with the current number coronavirus cases, which is 1275 as of this writing, and the number of coronavirus deaths, which is 37, there seems to be no comparison
That is definitely something to think about. Thanks for the figures @zzz
I wonder if we are more concerned because this is a new "novel" virus?
 

zzz

Senior Member
Messages
675
Location
Oregon
In the last few hours, the US has surpassed both Italy and China to become the country with the most confirmed coronavirus cases in the world. This is just a day after the US passed 1000 total deaths, and occurs as the total global number of cases passes 500,000, also today. Below is a list of all the the countries with the number of confirmed cases of 10,000 or greater. The full list containing all countries in the world can be found at https://www.worldometers.info/coronavirus/#countries.

4zd9141.png


Notice that the US is the only country in this list (and in the world) with more than 10,000 new cases; no other country has even half as many. The number of daily cases in the US is expected only to grow for the foreseeable future.

If you click on the country name, you will end up on a country page with much more statistical information about the country. Of particular interest are the graphs and charts of the cases and deaths for each country. For example, for the US, here is a graph of the total confirmed cases, followed by a chart of the new daily cases. These figures are updated at the end of each day (GMT time), so today's figures are not reflected here. Nevertheless, a clear pattern of fairly pure exponential growth can be seen here, and today's figures from the chart above merely confirm that trend. There is no indication that this trend is beginning to turn at all yet.

prsBS7l.png


For more context about how exponential growth works and what it means for the future spread of this disease, I would again recommend the following YouTube video, which was referenced in my post at the top of this thread.

 

zzz

Senior Member
Messages
675
Location
Oregon
With all the data about the spread of COVID-19 coming out daily, it's often hard to see what's going on and what the underlying trends are. I have found the video How To Tell If We're Beating COVID-19 to be extremely helpful in displaying these trends in a way that is easy to see and understand:


Once you have viewed the video, you can go to the Covid Trends Web site, which will draw a new chart in real time, just as in the video. Data is completely up to date as of the end of the previous day. For example, here is the completed chart as of the end of April 1st:

2NiO6Cr.png


[If the image is less than full sized, you can click on it to make it bigger.]

Note that in the time since the video was created, the US has pulled out well ahead of all other countries. The slope of the US curve has been declining just a little bit recently, but the curve is still pretty close to straight exponential growth. There are no traces in the US curve of the changes in slope that show up in the curves of Italy and Spain, for example, which does not bode well for the near future of COVID-19 in the US.

As you can see, on the right you can select as many or as few countries as you want to be shown on the graph. The end of a country's curve is always associated with a red dot, with the country's name nearby.

When you have more than a few countries, such as in the chart above, the plain display may make it difficult to see the full curve for any given country. Fortunately, if you hover your mouse over any part of the curve for a particular country, the country's full curve is highlighted in red, and a popup appears with the name of the country, the date over which the mouse is positioned, the total number of confirmed cases, and the total number of weekly cases. For example, in the above chart, it is a bit difficult to see how the UK is doing. By highlighting part of the UK's curve, the progress is much more obvious:

EZjsAOt.png


Note that the "Customize" section in the upper right can also be very useful. For example, instead of "Confirmed Cases", you can display "Reported Deaths":

fCDEIER.png


Again, the US and UK have some of the straightest lines on the graph, which means that exponential growth is continuing here. Reported deaths tends to be a more reliable statistic than confirmed cases, mainly because deaths tend to be reported on or very near the day they occur, while cases of COVID-19 are typically reported a couple of weeks after infection, or not at all in asymptomatic cases. Furthermore, even symptomatic cases of COVID-19 are often not reported if the symptoms are mild.

Also, the "World" selection can be customized to one of a few countries that are subdivided into states or provinces. For example, here is the US chart of confirmed cases divided by state:

K1mA4v5.png


Note the New York is the one state that is starting to noticeably bend its curve. All the other states are pretty much straight lines, which means that exponential growth is continuing in the rest of the country. As with the country display, you can add or subtract states on the right as you wish; the results are shown immediately.

You can also do any of these plots using a linear scale instead of the default logarithmic scale. Here is the original country chart using a linear scale:

Ku8XJ9N.png


As you can see, the linear scale can often make the differences between countries or their subdivisions even more obvious. In this case, the difference between the US and the rest of the world shows up quite dramatically.
And interestingly, due to the way the axes are defined, even though they are linear, exponential growth still shows up as a straight line.
 
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pamojja

Senior Member
Messages
2,434
Location
Austria
The exponential growth of infected cases is inherent in the exponential increase of testing:

1585906077053.png


The actual percentage of infected cases found, between 10-20%, has been consistently the same. The few studies who tested for coroanaviruses years before this 'outbreak' have always been in that same range.
 
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zzz

Senior Member
Messages
675
Location
Oregon
The exponential growth of infected cases is inherent in the exponential increase of testing

This only applies if the total number of cases is much greater than the total number of tests. And if this is the case, how did the number of cases get so high in the US starting from zero just a little more than two months ago if not by exponential growth? So the results shown in the charts you included may simply be indicative of the fact that the number of infections in the population far exceeds the available testing.

Furthermore, tracking the number of deaths shows the same exponential growth, even though tracking deaths does not require testing. Determining the number of active infections is difficult, especially since many of them are asymptomatic, but tracking deaths is much easier and much more accurate, although not perfect.
The actual percentage of infected cases found, between 10-14%, has been consistently the same.

This would simply seem to suggest that the number of infected cases is very widespread compared to the number of tests given.
The few studies who tested for coroanaviruses years before this 'outbreak' have always been in that same range.

Again, this does not account for the exponential rise in the number of deaths, or the way that hospitals in hot spots like New York have become overwhelmed. The same cases would have shown up at these hospitals regardless if the coronavirus pandemic had been announced or not; these people were very sick and dying. If you listen to the interviews with hospital workers such as nurses and doctors, they all say that they have never seen a disease like this sicken and kill people so fast. (The only exception is some medical personal who worked in Africa during the Ebola epidemic, even though the two diseases are obviously very different.)

By putting "outbreak" in quotes, you seem to be expressing skepticism that the current outbreaks are real. If so, how do you explain the 54,226 deaths that have occurred from this disease, and which are still growing exponentially? (See Coronavirus Death Toll and Trends - Worldometer for a large set of data on coronavirus deaths.) This is from a virus that did not exist in humans six months ago.
 

andyguitar

Senior Member
Messages
6,657
Location
South east England
Again, this does not account for the exponential rise in the number of deaths, or the way that hospitals in hot spots like New York have become overwhelmed.
One of the reasons some hospitals are having difficulty coping might be that the vast majority of covid patients have pre-existing health problems. These need to be managed at the same time as the infection so more resources are being used per patient.
 

pamojja

Senior Member
Messages
2,434
Location
Austria
Again, this does not account for the exponential rise in the number of deaths, or the way that hospitals in hot spots like New York have become overwhelmed.

I go by the officialy available statistics, for example here: https://healthweather.us/?mode=Trends

Trent_US.png

Trent_USb.png

1585915282625.png


Same if you look at offical numbers in graphs for other affected countries. The years before all had a much higher death toll from infuenzia and pneumonia combined. Worst affected Italy for age 65+ mortality:

1585915692172.png
 

pamojja

Senior Member
Messages
2,434
Location
Austria
These need to be managed at the same time as the infection so more resources are being used per patient.

Additionally upto a quater of medical stuff (in Italy) have been quarantined due to testing positiv without symptoms. If one knows how the situation was already before this outbreak, such can only lead to further catastrophs.

  • A report in the Italian newspaper Corriere della Sera points out that Italian intensive care units already collapsed under the marked flu wave in 2017/2018. They had to postpone operations, call nurses back from holiday and ran out of blood donations.
  • An Italian study of August 2019 found that flu deaths in Italy were between 7,000 and 25,000 in recent years. This value is higher than in most other European countries due to the large elderly population in Italy, and much higher than anything attributed to Covid-19 so far.
  • We have also received the following message from an observer in Italy, who gives further details about the dramatic situation there, which is obviously due to far more than a virus:
„In recent weeks, most of the Eastern European nurses who worked 24 hours a day, 7 days a week supporting people in need of care in Italy have left the country in a hurry. This is not least because of the panic-mongering and the curfews and border closures threatened by the „emergency governments“. As a result, old people in need of care and disabled people, some without relatives, were left helpless by their carers.​
Many of these abandoned people then ended up after a few days in the hospitals, which had been permanently overloaded for years, because they were dehydrated, among other things. Unfortunately, the hospitals lacked the personnel who had to look after the children locked up in their apartments because schools and kindergartens had been closed. This then led to the complete collapse of the care for the disabled and the elderly, especially in those areas where even harder „measures“ were ordered, and to chaotic conditions.​
The nursing emergency, which was caused by the panic, temporarily led to many deaths among those in need of care and increasingly among younger patients in the hospitals. These fatalities then served to cause even more panic among those in charge and the media, who reported, for example, „another 475 fatalities“, „The dead are being removed from hospitals by the army“, accompanied by pictures of coffins and army trucks lined up.​
However, this was the result of the funeral directors‘ fear of the „killer virus“, who therefore refused their services. Moreover, on the one hand there were too many deaths at once and on the other hand the government passed a law that the corpses carrying the coronavirus had to be cremated. In Catholic Italy, few cremations had been carried out in the past. Therefore there were only a few small crematoria, which very quickly reached their limits. Therefore the deceased had to be laid out in different churches.​
In principle, this development is the same in all countries. However, the quality of the health system has a considerable influence on the effects. Therefore, there are fewer problems in Germany, Austria or Switzerland than in Italy, Spain or the USA. However, as can be seen in the official figures, there is no significant increase in the mortality rate. Just a small mountain that came from this tragedy.“​
 

ellie84

Senior Member
Messages
120
Location
Italy
I don't know who this "observer in Italy" is, but he's saying some gross lies... just as examples, there is no law about compulsory cremation and there are no "Eastern Europan nurses", those are not nurses.
 

zzz

Senior Member
Messages
675
Location
Oregon
One of the reasons some hospitals are having difficulty coping might be that the vast majority of covid patients have pre-existing health problems. These need to be managed at the same time as the infection so more resources are being used per patient.

Although it's true that a lot of COVID-19 patients have pre-existing health problems, this is not one of the reasons cited by health professionals for the problems faced by hospitals in places such as New York City. Instead, it is the sheer number of patients, along with the lack of crucial medical supplies, specifically personal protective equipment (PPE), that is causing them problems. It is for this reason that abnormally large numbers of health care workers in hospitals have been coming down with COVID-19.

Please see the short video Nurse: I'm 28 and writing my will to hear a number of nurses speak for themselves. A lot of them are afraid of dying, and it isn't because of anything they've been told; it's because of what they see day in and day out.

A shortage of ventilators has not become a problem yet, but will be in the near future.
I go by the officialy available statistics, for example here: https://healthweather.us/?mode=Trends

Yes, it's very true that the US COVID-19 deaths are a small fraction of the flu deaths from this year's flu season (6000 vs. about 43,000). This is not news to anyone. Misunderstanding these statistics is one of the big reasons that a lot of people refused to take the COVID-19 pandemic seriously a while ago. But the flu season is almost over, while COVID-19 deaths are still growing exponentially. Although there are only about 6000 deaths currently, we are getting about 1000 new deaths per day, and that number will continue to rise. The current US estimates are for a total of 100,000 to 240,000 deaths in the next few months if we do everything right (which we aren't); deaths would go into the millions if all restrictions were lifted now. This is simple math.

The current relatively low figures for COVID-19 deaths would not be a problem if we had a vaccine for the virus. But we don't, and a vaccine that is ready for use is at least 18 months away. This is the single biggest reason that this pandemic is so dangerous.

I don't know who Stephen McIntyre is, but the tweet from him that you posted shows his ignorance of the field. He says:
I finally located US total and pneumonia deaths on weekly basis. Data is from https://www.cdc.gov/flu/weekly/#S2
csv: https://www.cdc.gov/flu/weekly/weeklyarchives2019-2020/data/NCHSData11.csv … and up to week 10 (w/e Mar 6). Latest values in CDC sheet implausibly low. Weekly deaths typically exceed 50,000.

As was pointed out in a tweet in response to his, the 50,000 figure is for annual deaths - not weekly. I'm not sure why you included this tweet in your post.

So yes, if COVID-19 deaths were to stop where they are now, or even a fair amount higher, then it would make sense to treat this disease much like we treat the flu. But the exponential rise in cases and deaths shows no sign so far in the US, and just a bit more exponential growth will bring us death tolls in the six or seven figures. This is what the best infectious disease specialists and epidemiologists in the world are telling us, and when I do the math, I get the same results.

Rather than continue to debate this topic back and forth endlessly, I suggest we wait a few weeks and see what things look like then. I think it will be much clearer by then what trajectory we're on.
 

pamojja

Senior Member
Messages
2,434
Location
Austria
I suggest we wait a few weeks and see what things look like then. I think it will be much clearer by then what trajectory we're on.

That's what I did the last 2 weeks. No real increase in Europe yet. Though the meassures now taken - if lasting too long - will definitely bring a higher death-toll.

..just as examples, there is no law about compulsory cremation and there are no "Eastern Europan nurses", those are not nurses.

'Nurses' was maybe a mistake in translation. It is well known that most 24-hours care-assitant services is done by low wages Eastern Europen nurses (also in all other European countries and not only in Italy; Germany tries to pass laws to allow at least those, along with harvest-workers back in). Some are not, but there are a lot who just didn't get their foreign certifications approved by local authorities. And those left, however one calls them, leaves no other choice than bring those elderly in need of 24-hours carers to hospitals.

From a quick search it seems, there are local regulations in place everywhere - you as Italian from a different region might not yet heard about. (http://www.ritolaico.com/en/funerals/law.html)

Do you consider the study and news-paper report about the Italian situation before the outbreak also 'gross lies'? Or the statistic of the Italian ministry of Health, which shows 2017 saw much more deaths?
 
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ellie84

Senior Member
Messages
120
Location
Italy
That's what I did the last 2 weeks. No real increase in Europe yet. Though the meassures now taken - if lasting too long - will definitely bring a higher death-toll.



'Nurses' was maybe a mistake in translation. It is well known that most 24-hours care-assitant services is done by low wages Eastern Europen nurses (also in all other European countries and not only in Italy; Germany tries to pass laws to allow at least those, along with harvest-workers back in). Some are not, but there are a lot who just didn't get their foreign certifications approved by local authorities. And those left, however one calls them, leaves no other choice than bring those elderly in need of 24-hours carers to hospitals.

From a quick search it seems, there are local regulations in place everywhere - you as Italian from a different region might not yet heard about. (http://www.ritolaico.com/en/funerals/law.html)

Do you consider the study and news-paper report about the Italian situation before the outbreak also 'gross lies'?
It's not done by nurses in Italy, they are not nurses, they don't have any educational qualification. If they have a nursing diploma or degree they simply don't work as "badanti".
About cremation, that link doesn't say anything about a supposed law enforcing cremation for coronavirus victims, simply because there's no such law. It just describes how cremation works in normal circumstances. In the most hardly hit areas they're cremating because there's no space left in the cemeteries, that's it.
Actually, every single one of those paragraphs is full of lies and clearly written by someone who isn't Italian and has no idea about Italy, but, hey, one believes what one wants to believe, so I'll stop here.
The study and newspaper about the flu epidemic have nothing to do with the rest, I have nothing to say about that. I don't see how they have anything to do with what is reported by this obviously not unbiased "observer" about the current situation.
 

pamojja

Senior Member
Messages
2,434
Location
Austria
Actually, every single one of those paragraphs is full of lies and clearly written by someone who isn't Italian and has no idea about Italy, but, hey, one believes what one wants to believe, so I'll stop here.

There are only 2 statements: One is that 24-hour care-assitants left the country causing additional overwhelm in hospitals and deaths.
And two, the army had to step in for various reasons: Too small crematories due to catholic traditions, fear of funeral directors, and allegdedly a regional law.

Its is not at all that one believes what one wants, but what can be accertained with different sources. To claim 'those paragraphs is full of lies' without even one source, just expecting us to believe you who believes the scare-mongering mass-media, is a little bid to little assurance.

The first statements could come true for Austria too. Because almost all 24-hour care-assitants are foreighners. And the second in a sequel as well. Why is Italy so different to your neighboring country, Austria? We exploit foreigners for too low wages too, and are just as much catholic.

And why this exaggeration? There are only these two statements.
 
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