We all now know that the coronavirus is loose in the community and anyone could be unknowingly spreading it. We’ve all seen the terrifying exponential growth curves that project need for hospital beds peaking well above available supply. And we understand that by social distancing, we can bend the disease curve down, lower the peak hospital demand and gain time so that the hospital system has more time to prepare.
What we don’t know is whether we have done as much as we should to check the spread of the virus and what the benefits of additional measures would be. Tomas Pueyo has written one of the more widely read analyses of our current uncertainties: The Hammer and the Dance. His basic argument is that we should be coming down as hard as we can on social distancing initially to buy time (the “hammer”), and that after a few weeks of maximal social distancing, we can let up some while doing widespread testing, contact tracing, and isolation to make sure we don’t reignite community spread (the “dance”).
At the end of his piece though he acknowledges precisely the uncertainty that political leaders are now facing: No one actually knows whether any particular combination of measures will be enough to squelch community transmission.
The rate of transmission depends on a range of hard to measure factors, including the virus, social customs, patterns of economic activity, and on how a society is physically put together. If all of us lived together in one room, we’d all be sick already. If each family had its own island complete with a one year stock of necessities, maybe no one would get sick. The public health challenge is to cut the transmission rate. If the number of persons that each infected person infects is below one, then the number of people sick will start going down.
Early in an epidemic, when spread of a new infectious disease first starts, there is an opportunity to bring the transmission rate below one by aggressively testing, identifying people who are infected, tracing their contacts and isolating everyone who is at risk. This may have been successful in Korea. It’s hard to get direct visibility into the effectiveness of our contact tracing and isolation efforts in Massachusetts, but at this point, it appears likely that the volume of the epidemic has overwhelmed our tracking and isolation efforts.
That is essentially the conclusion reflected in the Governor’s series of social distancing orders: Since community spread has already taken hold and unidentified people are spreading the virus, we have had to go to the next step and try to reduce everyone’s social contacts, not just the contacts of those known to be exposed. To that end, we have radically restricted social and economic activity. We have taken the measures recognized as most difficult in Pueyo’s article, closing many institutions and businesses. I fully support the Governor’s orders, but the question I keep asking myself is: Have we done enough to bring the transmission rate below one and squelch the peak of epidemic? Is our list of essential businesses too long? Could we enforce social distancing more effectively in grocery stores? Only time will tell.
The Governor’s major orders rolled out from March 13 to March 24. There is a 5 or 6 day lag from infection to symptoms and people might not seek immediate testing. Moreover, although the test turnaround is improving, some test results may take days to come back. As of March 30, the full impact of our distancing efforts is only beginning to affect our positive test rates. As we expand availability of testing some reduction of new cases might be masked by our expanded testing.
Massachusetts COVID-19 Tests Results
Over the days to come, we will all be watching the numbers anxiously for clear evidence of slower disease spread
Massachusetts’ efforts to control the epidemic sit in a national context. By now, all states have begun to take action. Schools are closed statewide in 47 states and subject to local closures in the other three. Yet the closure of non-essential businesses is not universal. In Mississippi, next to Louisiana where the epidemic is raging, only restaurants are closed. While we don’t have the data to be sure, it appears likely that continued delayed response in other states will lead to persistence of the epidemic as infected people move across state lines. If we had strong federal leadership on the disease, it would help a lot, but since much of the power to protect public health resides with the states, our country may be unable to mount the swift and maximal response that some other countries have achieved.
For now, we know this much:
- Nothing is more critical than ramping up production and distribution of the Personal Protective Equipment that is in short supply for health care personnel and first responders.
- We also have to do a better job protecting those workers still deemed essential, especially those in roles that bring them in contact with many people, like grocery store workers.
- We have to focus on controlling among the most vulnerable populations — our elderly in nursing homes, our homeless, our prisoners — those who may be unable to achieve the social distancing that many of us can.
- We have to roll out relief to the small businesses that our orders have shuttered and to the many who have been working paycheck to paycheck and now no longer have an income.
And we have to keep listening to the data, to the experts, and to each other.
Nicely spelled out. I will read the article. Based on just pictures during good weather and my daily walk at various dog parks I am afraid we have not been vigorous enough with social distancing. Unfortunately it was hard on a personal level to understand the magnitude of this until it was very late in the game. And that is going to get more challenging if the weather gets nicer. Let’s pray for a rainy April. On the other hand I am proud of the way Massachusetts has stepped up. We have good rational leadership and that is comforting.
This morning I watched a woman let her little girl out of a stroller, then watched like a dumb cow as the girl played in a neighbor’s yard, touching their door handles and trash can lid. Both neighbors are around 70. Earlier, this same girl had coughed into her hand as she passed our house.
As far as I am concerned that suburban wine mom is a mass murderess. No different from someone who gets blind drunk and then drives down the wrong side of the road at 90 mph.
At minimum the state is failing to use its bully pulpit properly. From packed crowds outside certain grocery stores to snotty children’s hands combing through the apples at the market, this behavior needs to be called out.
Nice article; however, my PCP warned me in early February about the virus. I am on chemo so she was being careful, but I also knew about the virus because I read international sources. PLUS … after Marburg, Ebola, SARS, MERS, West Nile Virus, etc. how could we not have paid more attention? Do we really think oceans around us can protect us? Two professionals who analyzed the response to Ebola wrote an article in the Harvard Business Review, 7/13/18, “An Ebola outbreak has just been stopped …” by Dhillon and Srikrishna. If you don’t have a subscription ….
But here is a good link showing how many plagues have occurred in the historic past; Wikipedia has some: https://en.wikipedia.org/wiki/List_of_epidemics
Another problem is our inability to learn from the past. Many plagues have occurred in the historic past; Wikipedia has some: https://en.wikipedia.org/wiki/List_of_epidemics. Our inability spans generations.
Will, thank you for your thoughtful comments and your concerns. I would also say that we need our medical researchers to try to figure out issues about contagion and immunity as soon as possible. If asymptomatic patients are contagious when do that contagion begin — is it from the moment of exposure or later? If a patient has had COVID-19 are they immune to future infection (and, if so, for how long)? And furthermore, even if immune, could those individuals still carry contagion via contact with those who are still ill to infect healthy individuals? There is so much that we need to learn!
These are all good questions:) Epidemiologist Dr. Larry Brilliant has a great TedTalk about how he helped eradicate Smallpox. There have since been updates on ideas.ted.com. He believes that if you’ve already had Covid-19, you most likely have some immunity to it. Dr. David Ho of Diamond AIDS Research Ctr. has developed a Covid-19 (finger prick) antibodies test. Via plasma collection, we can inoculate, and those who have been identified as positive can go out in the world and help. We simply need to push for these tests as community spread is hard to control. On another note about grocery shopping. Everyone should be wearing masks, (or covering mouths and noses) and gloves. I went all geared up yesterday to Whole Foods. Great care was taken to separate people, wipe down carts etc… However, a young family stood in line with their child without any protective coverings. The child was climbing all over a cart etc… I couldn’t help but think that one of the parents could have stayed home while the other shopped. Also, none of the people working wore masks. Can’t Jeff Beezos supply these for his employees? Thank you Willfor the opportunity to discuss.
The state needs to act NOW to quickly set up a system to “license” people who test positive for antibodies and are fully recovered. These people will be the backbone of economic recovery at the start.
Parents do need to be read the riot act, as I said earlier.
Courtney — Excellent points! We’ve been told not to wear masks, yet healthcare workers are told it’s critical for them to.
Theres a great article here and an explanation of why the answer to “should I mask up” is somewhat “fuzzy” (Hint: it’s based on incomplete data and spotty studies, so the answer is not clear, but this is largely due to the methodolgy):
https://qz.com/1826717/do-masks-protect-against-coronavirus/
In the absence of any real data I’m certainly in the “Mask and gloves in stores” crowd.
The Lancet agrees
https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930134-X
As does the Czech government: the Czech Republic took the uncommon step last week of making nose and mouth coverings mandatory in public spaces, prompting a grassroots drive to hand make masks.
https://www.sciencemag.org/news/2020/03/would-everyone-wearing-face-masks-help-us-slow-pandemic#
I am attaching a very informative video regarding the need to wear masks to beat the pandemic.
https://youtu.be/BoDwXwZXsDI
Homemade masks are sufficiently effective to protect people in most cases.
I agree too — trying to wear mask more.
Unfortunately, it has been virtually impossible to purchase masks for weeks.
I think the CDC is about to change it’s recommendations on masks. Here’s a no-sew homemade mask https://blog.japanesecreations.com/no-sew-face-mask-with-handkerchief-and-hair-tie
I think we can look to other countries for some of this information. I don’t believe that we will be given the truth here. My daughter lives in Leipzig Germany and has told me about a 1,000 person study they are undertaking in a community with a high case level. It will be addressing several of the issues you raise. Thank God for the internet!
Thanks, Will. I’m concerned about our immigration population, particularly the undocumented.
I am as well. I have several students who are dealing with extreme anxiety for the future now, as neither they nor their parents are working. They are also scared to go to the hospital to get tested if they do not have health insurance.
We always appreciate you sharing your knowledge and advice with us! It really does (especially now) help is to all feel connected!
Thank you, Will.
Thanks for the thoughtful direction and commentary, Will.
I am concerned about childcare. Many of our medical workers have young children who are being cared for by their grandparents while their parents are at work, then the children return to their parents at the end of their shifts. What is being done to safeguard the grandparents and to assist the young medical workers in this very difficult matter? I heard that Boston University medical students are helping their faculty. That’s wonderful, but should/could we do more?
The state is pushing to organize child care for health care workers.
Thanks God for our Health Care workers…On the front line of a giant battle….Lets pause and give thanks to all those who do that work…They risk their lives savings others…
Amen.
We all need to distance and to stop the spread. Thanks for the data and the updates. The data may show us what is working. Thanks, Will.
Hi Will,
Thanks as ever for your thoughtful communication.
What is Massachusetts doing to protect those workers due to central, and by extension, everyone they come in to contact with? I’m particularly concerned about low paid grocery store and pharmacies staff, keeping themselves safe and the store disinfected in between every customer.
Maybe not enough — basically guidance. We may need to push employers harder.
Agreed. Just sent messages to both Trader Joe’s & Market Basket, two of the grocery stores I frequent, to do more for their employees. Specifically:
– hand sanitizer &/or wipes for all employees as needed
– disinfectant spray to use between customers (and in sight of customers) to wipe all ‘high touch’ surfaces
disposable gloves (debatable – maybe better to leave them for front line health care staff if they’re part of the PPE shortage)
install cough / sneeze guards at registers, as some chains have done
The more people who similarly reach out to places they shop at could help push employers to make these changes – same with Amazon, Instacart ‘contracters,’ etc.
Your thoughts and writing give me confidence in our political system when I had almost given up.
How do we get the message of social distancing benefits to those who party on the esplanade and Revere Beach?
Of course this pandemic must be stopped, but we should be aware that shutting down so many things also has an effect on health.
For example, people’s regular physical exams and procedures are being cancelled.
There are other obvious health effects too.
Dee, A lot of exams are being done over the phone. Then a decision is made if they have to see the Doctor in person.
Advice on safe grocery debagging from the CDC:
https://youtu.be/sjDuwc9KBps
That video is interesting and the narrator sounds well informed but it is not put out by the CDC. Unfortunately, we’re all left to our own devices to evaluate inconsistent sources of information.
As a grocery store worker what would you say should the state do to help us. The store I worked for do try to help customers so they don’t get infected but sadly there’s little the store can do to protect us if a customer with it comes in contact with us. Thank you for keeping us updated on what is happening.
Thanks as always for inviting thoughtful conversation, Will!
I think we still lack sufficient data on most aspects of the virus to know how well we’re doing at containing it. We still cannot adequately describe its patterns of spread through our community because of the limited and very select subset of people who have been tested. We also don’t yet know for sure whether recovery after exposure provides long-lasting immunity against recurrence or whether those who seem to have had initial asymptomatic exposure are at risk of becoming ill at a later time. It will take time and a lot more testing to gather knowledge on those points.
In the meantime, picking up on some other commenters’ points, I would like to be more confident that low-paid workers who are sick are not going to work (wish they had a better deal from their employers). I also lament that those whose jobs require frequent contact with the public do not currently have the protective equipment they need, and I am not confident that they all have had the training to use it properly (based on my observation of a cashier at one grocery store recently). I also wish that people would take the physical distancing guidelines a lot more seriously–thinking not only of those partying in parks etc but of those I see not respecting distances while waiting in lines at checkouts or browsing aisles in shops etc. I personally find it frustrating to see so many people (general public) out and about wearing face masks while my colleagues who have to care for patients are being forced to reuse theirs or work without sufficient protection. I realize that I don’t know those people’s individual circumstances and whether or not they have reasons to be extra cautious, but I can’t believe that the majority of them do. I can’t help but worry that wearing the surgical masks that technically don’t really add much to their protection give a false sense of protection that causes them to let their guards down in far more essential ways (such as hand hygiene and not touching their faces–something they could very well do when taking the masks off!). I think it will be valuable to continue to communicate very clear guidelines about essential vs less essential measures for the general public to take to do our parts in limiting the spread of this infection without sequestering protective resources that only those at highest risk of exposure need.
I’m actually in the everyone should wear masks camp. Health care workers should have the highest grade protection, but everyone should wear what they have or can make.
My concern is that we have 2 positive tests for people at Middlesex HOC & jail, 1 positive at Shirley jail and several positives in the DOC & it’s not likely to be completely isolated in large facilities so concerned they could result in serious illness or death for many. This article shows transfer without touching, coughing or sneezing (perhaps by singing or even talking?) https://www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak Thanks for all you are doing. Glad the testing is ramping up and getting faster.
Why are there so many more cases in Middlesex County? Is it simply because it’s the most populous, or are there/were there other factors?
Not sure on that — it does seem ahead of some others.
Some smaller pharmacies and grocery stores are taking orders by phone with a credit card. You can then pull up out front and have your package put in the car. If more places did this particularly for those people over 60 or otherwise more at risk, it would help the vulnerable AND help workers.
Will– thank you so much for your hard work on our behalf. My research is in public health ethics, and one thing I know that’s very important for those working on the front lines (and you are one of those people) is to take good care of yourself. It’s going to be a very long haul to get to the post-pandemic stage of government and civic life, and we need leaders like you to be there and be healthy. Please pace yourself through this. And, you don’t have to do it alone. We are here and you can reach out for help, as it is our community too, and we should work to preserve it and help others.
Thanks, Catherine!
Thank you for this update!!
I would like to also see small businesses be able to conduct business in a “safe” manner. In this way, small business could bring in business, customers could support them and they could put “protections” into place to operate in a safe manner for all. (e.g., limit the number in the store, wear masks and gloves).
This way, it isn’t an “all or nothing”.
Will-
As always you are a leader, thanks! I remain quite concerned about the lack of PPEs for our first responders and others, but know that this is a federal issue and you are working hard to get people what they need.
I am very worried about prisoners and staff of prisons. I have heard by letter from a man in longterm solitary (DDU in Walpole), he says all movement has ended, so 24hrs/day in his cell every day! He is finding it very hard and anxiety on his tier is ultra high.
Thank you for this, Will. When you say we need to push for the antibody tests developed to be made available, what does this mean? Us? You? Who needs to push whom? These tests will really help more accurate stats and decision making.
Steve mentioned antibody tests, not me. But that is one of the thing the biotech companies can be leading on. They would certainly help. I don’t think this needs any political push — the basic incentives are strong to develop.
I agree that a hard two-week do not leave your house policy should be mandated, except for groceries and medical needs. This must be done at both the National and State levels. Every two weeks assess the spread and ease restrictions as it becomes prudent.
Grocery stores and other retailers pose the biggest risk for continued spread the virus. There needs to be MUCH tighter control over these areas.
Because this virus can remain active on surfaces for days, all mail, packages and groceries that come to us are sanitized before it enters the house. Most people will not go to that level of effort. Here are some ideas that might help reduce the spread:
• Ration shopping days to once a week based on street address to reduce contact in stores.
• Online order/curbside delivery if possible for all retail operations.
• Sanitary procedures training for all employees.
• Six-foot distancing minimum in all areas of the business.
• PPE for all employees. Gloves, sanitizer at a min, masks for high contact (e.g., cashiers)
• Self-checkout only or Plexiglas barriers between cashiers and customers.
• Sanitize all shopping cart and basket handles upon retrieval for redistribution
• Disposable gloves or sanitizer provided and required for customers upon entry.
• Sanitizer provided to customers upon exit.
Things the State can do would include obtaining/manufacturing and providing hand sanitizer to every household who needs it. Everyone should have a 2-oz squeeze bottle of sanitizer for going out in public.
Here are DIY recipes:
Method 1: Using Alcohol
• 2/3 cup 91+% rubbing alcohol (isopropyl alcohol) or 190-proof grain alcohol
• 1/3 cup pure aloe vera gel or glycerin, to help spread and prevent hands from drying
• 8 to 10 drops essential oil, such as lavender to reduce alcohol smell (optional)
Method2: Using Witch Hazel
• 1 cup pure aloe vera gel or glycerin
• 1 1/2 teaspoons witch hazel
• 30 drops tea tree oil
• 5 drops essential oil (optional)
Please ignore Method 2 using Witch Hazel. It is not effective against viruses. Stick with Method 1 using Alcohol.
I’ve watched the debate between fighting the pandemic and rescuing the economy. To me it looks like those essential-service portions of our economy are fragile: for 20 years, supply-chain management has optimized for just-in-time delivery of everything, at a time when anti-trust rules have enabled the rise of a single dominant player in each industry niche.
The bottom line is that we risk not only the pandemic, but a major famine along with hyper-inflation within 3-6 months. And I think the distancing measures will need to stay in place longer than that. We do have the resources now to fight both battles in parallel, by seeking ways to safely isolate people when working in essential services.
Right. We need to do both. Can’t save the economy without curing the epidemic though.
Thanks for your comment Richard. I too have worried about JIT along with the racing to the bottom manufacturing. Maybe this pandemic will shift this idea of optimizing for efficiency out of the professional managers’ mindset. Efficiency does eliminate waste, but it also removes resiliency and happy accidents.
Instead of judging how well physical distancing is working by tracking positive tests perhaps we should be judging by the number of hospital admissions for Covid-19. Positive tests are skewed by the number of people tested. Hospital admissions is the number we are trying to keep down anyway.
Following the link you posted you can see hospital admissions. It’s worth noting that Saturday there were 81 new hospital admissions and Sunday only 49. And where deaths were running 9 or 10 per day for the last several days on Sunday we had only 4. It’s too early to say but maybe we are starting to see some results from physical distancing.
The hospital admissions are even further lagged to date of infection than the test results — perhaps two weeks. But yes, it also makes sense to look at them. The data isn’t as good — note that the DPH data include many “under investigation” as to hospitalization status.
Testing, testing, testing. There’s no way we’ll really know whether we’re past this without widespread testing.
A friend in Singapore does not understand why Americans don’t wear masks to prevent spreading the disease. Understanding that we are short on supply of high grade masks, it does seem that basic masks would help those of us ‘essential’ workers to prevent spreading the disease unknowingly.
Temperature tests and contact tracing were their other key efforts. The big data folks (Facebook, Google, etc.) already track our location, could that work for contact tracing well enough to protect civil liberties? It is said that the missing link for contact tracing is workforce, but there are many who are at home right now who could help. Or, people could voluntarily allow personal location tracing on a temporary basis by installing an app, which would be removed after the emergency.
Yup. We should be wearing masks. Supply is the issue. I think most of us should be improvising masks now.
Like the app concepts too; lots of potential there.
Google is already on it apparently:
https://www.engadget.com/google-covid-19-community-mobility-reports-095050862.html?guccounter=1
Why don’t more government people talk about getting more tests made and distributed? I agree with all that you’ve written in terms of distancing and the extreme urgency of getting PPE to worked who need it but lets get more tests made and deployed.
The testing is really going up rapidly. A lot of private resources have been coming online. The real barrier lately has been the necessary swabs to collect the test samples. Lots of eyes and hands working on the testing problem. PPE is probably the biggest hole right now and that’s why you hear people talking about it.
Another vote of thanks for another one of your thoughtful, informative posts, which has the added benefit of inspiring intelligent, informative responses. This conversation is a heartening instance of civic exchange.
Another thought for the long term. Currently self-employed people are required to pay the employer portion of Social Security contribution in the “self-employment” tax. I am wondering if in the future, Massachusetts might require self-employed people to also pay unemployment insurance. How much of a burden would that be?
It’s a huge conversation — complicated financially — but we need to go there somehow. Clearly self-employed can become unemployed.
What’s being done to those who are coughing and not covering their mouths. I’m an essential employee and I’ve seen it on the B,C and D trains. I’ve seen people doing it in Whole Foods, Star Market, Trader Joe’s, CVS and on the street. I’ve seen them doing it at the Chestnut Hill Reservoir. No one does anything to those people. They need to be held accountable. Most just look at you and smile when they do it. They do it intentionally to scare and harm others.
Thanks Bill for sharing your thoughts.
I truly believe people should be required to carry ID when leaving their homes and walking here and there. Those who are wondering around for non essential reasons should be given a ticket. That is the only way to get people to stop walking
everywhere and carrying their kids for a stroll down the road or to a park, etc. This is a very unusual time in history and we need unusual temporary measures to stop the spread even if we think those steps are against our liberty and hard to do. We can learn a bit from other countries doing the same.
I Like your Story about the Coronavirus I very Much hope this Coronavirus will be over very Soon in Massachusetts . So that everyone can go back to there Regular Job’s and everyone will be happy .
Thanks Matt.
Our prisons and jails are incubators for infectious disease. Many in our prisons are old and sick and eligible for medical release. The majority of our incarcerated people in county houses of correction are not even convicted of anything. They are held for inability to pay bail or on technical violations of probation (e.g. missed appointment or fee payment). It is astonishing that Massachusetts is doing nothing. The Federal Bureau of Prisons is beginning to release people with just a year or two left on their sentences. We are being outdone by the Trump White House, of all things. The state of Vermont which routinely has around 150 women incarcerated is down to 87, as they have released dozens. Massachusetts has not released a single woman. Women are rarely, rarely judged to be dangerous in a dangerousness hearing. Most are held without conviction. Even if one doesn’t care about the incarcerated, there is a public health risk of keeping so many in such close contact, cycling in and out of jail and back into our communities. If we can release those who don’t need to be there, it benefits them, us, and even those left behind who can then better practice social distancing. Please act on this, Senator. We cannot believe the degree to which Massachusetts is lagging behind others.
I think the biggest next step the state needs to be taking is to find ways to increase the supply of PPE. While heathcare workers are clearly the highest priority, we could do a lot to decrease the spread of the disease by pushing PPE into the broader populace. Anything the state can do to facilitate the increase the supply of masks, gloves and disinfectant should be done.
I feel everyone is doing all they can on this. Very strong leadership effort. Not perfect — like the army in wartime, messy, but very motivated.
my son and I have both been sick for two weeks after coming back from NYC. We have signs and symptoms of COVI-19 and our doctors assume we are infected. We don’t meet current MA criteria though for testing, as there is only enough testing material to test front line health care workers and hospitalized patients. Please, how can we allow more people such as ourselves to be tested?
The general public needs to feel empowered to tell small groups in the streets that much more stringent adherence to distancing is in everybody’s interest. That seems presumptuous to many of us, yet it would be of great service to our neighbors. An encouragement from the authorities and representatives would help.
As an afterthought: advice how one neighbor can say this to other neighbors without appearing presumptuous would also be valuable.
I’d refer to the public health guidance on distancing.
I believe the city is doing the best they can with the resources that they do have I have seen this in many circumstances. My major concern is the what seems to be the lack of testing kits. As we are told to Screen through 311 if we are symptomatic but do not go to the hospital and as well that the testing kits are for the critically ill First Responders and medical staffing so that makes it very clear to me that there aren’t enough test kits. I believe that as we do get the test kits in in the general population begins to start testing we will find that the number is significantly higher than we actually have in front of us now. I look forward to when our economies in our social activities return to normal because those are the best days of our lives being with family and friends in walk and Social Circles. As well I look forward to the conclusion of this and the availability for test kits for all residents who are symptomatic so we can truly nip this in the bud. Till then be kind to your neighbors recognized the ones in need and assist where you can.
Please treat workers, such as garbage collectors, truckers, delivery and grocery personnel, as essential workers and push that they be provided and mandated to use, PPEs. They do much to maintain the public health and well being, and should be protected.
Amen.
Another well-written article, Will.
When one looks at a graph of the rates of infection, the total over time for China and South Korea have been essentially flat for a significant period, indicating that they *have* managed to limit the spread of infections (and and also have fewer deaths). We need to look beyond our borders and learn from these countries what their strategy has been, and adopt (and adapt) it very quickly to address our urgent national crisis.
Will wrote:
> the question I keep asking myself is: Have we done enough to bring the transmission rate below one and squelch the peak of epidemic?
Comparing the percent of daily positive test results may be a reasonable early indicator of the impact of preventative measures, even though it’s subject to the biases of delayed results and non-random testing. If test results were timely, then this indicator would come earlier than deaths per capita, which many have referred to as the indicator that’s most comparable across populations.
Using the Mass. daily (delayed) test data that’s the source for Will’s chart, the percent of tests results that are positive is still climbing:
20200329 17.38%
20200328 17.91%
20200327 14.31%
20200326 15.13%
20200325 11.23%
20200324 7.91%
20200323 4.65%
20200322 14.61%
20200321 9.44%
20200320 8.86%
20200319 8.36%
20200318 7.42%
Unless we’re now testing people that are more likely to be positive, that percentage needs to come down substantially before we should consider that we might be doing enough. Eyeballing from the NYT chart of S. Korea at nyti.ms/2QS3kP5, it appears that South Korea had a daily positive result rate of about 6% when the number of positive cases started to level out then decline to under 1%. 6% is clearly not sufficient alone because Mass.’s rate was near that in mid-March, albeit on a much smaller number of tests.
I welcome critiques of this indicator.
Good point. I think that’s an important indicator and, I agree, not encouraging. Overall, the result of expansion of testing availability that has occurred should be lowering the share positive, as the criteria for testing people loosen. However, the fact that the share positive is increasing despite increased availability does tend to support the idea of increased spread at least so far. At a minimum, it argues against the possibility that increasing availability is masking a decline in the rate of infection.
We’re still making little progress on this metric. Here are recent 3-day moving averages, which smooth out daily fluctuations a bit:
20200419 27.46%
20200418 26.04%
20200417 28.11%
20200416 28.38%
20200415 29.05%
20200414 29.83%
20200413 29.95%
20200412 30.01%
20200411 28.54%
20200410 27.45%
20200409 27.55%
Why aren’t Mass. % positive test rates coming down, despite social distancing recommendations and slow but steady increase in testing? We’re still stuck above 25%, while Georgia apparently fell below 5% after doubling testing on Saturday (@ 1.1 tests/100K pop./day vs. 4.6 for Mass.). Mass. contact tracing commitment is impressive, but much more testing is needed for it to be effective.
On 3/30 Michael Ryan, WHO Exec. Dir. said, “We would certainly like to see countries testing at the level of ten negative tests to one positive, as a general benchmark of a system that’s doing enough testing to pick up all cases.”
20200425 26.14%
20200424 N/A
20200423 26.38%
20200422 29.81%
20200421 26.53%
20200420 N/A
20200419 27.89%
People are not social distancing. As I drive home from work as a nurse at Boston Medical Center I see people walking their dogs with their kids stopping to chat with their neighbors. I see too many people close together walking/running around Chestnut Hill Reservoir (not 6 feet apart). The lines in the grocery store checkouts out too close (not 6 feet apart). I could go on and on.
I am working to keep you healthy, so stay at home unless you need to go out and then stay at least 6 feet apart!
Thanks Will! This information is useful.