What COVID-19 metrics should we be following?

I get that it’s important, from a public health perspective, to track the total number of active COVID-19 cases over time. Having a sense as to how many people have been diagnosed at a given point in time, should, in theory, give you a sense as to what you might expect a week or two down the line, as individuals recently infected by those diagnosed today begin to show signs of illness and seek treatment. [It’s currently thought that the basic R0 of COVID-19 is around 2.5, meaning that, on average, everyone with the disease passes it along to about 2.5 others. The R0 of the common flu, by comparison, is roughly 1.3, or about half.] So, if we had robust testing, and a decent understanding of social dynamics during this period of quasi-lockdown, one would imagine that we could model the progression of the virus fairly well, allowing us to plan accordingly, etc. But, when we aren’t really testing all that much, I don’t understand the purpose of tracking the number of confirmed cases. And I know that I probably don’t have a lot of epidemiologists in the audience right now, but, as I’m curious, I thought that I’d throw it out there for discussion anyway.

Maybe it’s because I keep hearing first-hand accounts of people seeking tests, who are being told to just go home and self-quarantine until such time that they either get well or begin to have trouble breathing, as there’s really nothing more that can be done for them until such time that they need respiratory intervention. And, if that’s the case — if people who likely have COVID-19 are being sent home without tests, as there’s really nothing that can be done for them anyway — I’m wondering what the value is in publishing the daily number of confirmed cases. [Might it give some a false sense of security?] I know it’s interesting, and that we feel obliged to look each day, but what does it really tell us? I’ll probably still continue to quote the daily number of confirmed cases — it’s now 7,615 in Michigan, by the way — but I have no idea what good that number actually does anyone.

It seems to me that the number of the dead, given that it’s more certain, is probably the metric that’s more predictive of what’s to come, right?

As for the number of people who have died from COVID-19 in Michigan, we’re now at 259, which, as of today, is the third highest in the country. I’m not, of course, an epidemiologist, but if we assume an average fatality rate of 1.4%, that means we’ve got roughly 18,500 with the disease presently, which is more than double the number of presently confirmed cases. I know that age of the population, weight, environmental factors, etc, all influence these numbers, and that no model is perfect. If it’s true, however, that we’re seeing something like a 1.4% fatality rate here in Michigan, then our 259 deaths would seem to indicated that we’ve got a lot more sick people out there than we’ve identified through testing.

Again, I admittedly know very little about this stuff. I’m just genuinely interested to know what useable information we get from the metric like “the number of diagnosed cases” when our testing still appears to be seriously flawed. I don’t know if the number of dead, the number of hospitalizations, or the number of people on ventilators is a better metric to pay attention to, but I have to think that all of them would be better than diagnosed cases.

Oh, and because I apparently still have a few minutes before falling to sleep, I might as well respond to recent comments by Mitch McConnell about how Donald Trump couldn’t respond as aggressively as he would have liked to the coronavirus threat because of his impeachment trial. As others have noted, Donald Trump still found time to golf and hold his rallies during the impeachment trial. If he had the time for those things, he could have found the time to respond responsibly to the threat… which we know that he was warned of as early as January in his intelligence briefings. Instead, however, he not only refused to act on the warnings for months, but played the threat down in public. So, no, Senator McConnell, this was not the fault of those bad Democrats and their reckless campaign to save the Republic. And even if they hadn’t tried to remove Donald Trump from office for having tried to coerce another world leading into launching a politically motivated investigation into a domestic opponent, chances are the same exact thing would have happened. When you allow family of Florida grifters to hot-wire party and take it for a joy ride, these are just the kind of things that should be expected.

OK, because I still can’t sleep, here’s Donald Trump admitting to the fact that, if we made voting easier in this country, the Republican Party would never win another election. Seems like an important admission, doesn’t it?

This, of course, was in response to an attempt on the part of Democrats to pass vote-by-mail legislation that would allow Americans to vote from home, instead of having to go to polling places next November, during what could be another deadly cold and flu season. The Republicans pushed back because the last thing they want is more people voting, for the very reasons articulated above by Donald Trump.

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35 Comments

  1. Frosted Flakes
    Posted April 1, 2020 at 12:21 am | Permalink

    “that means we’ve got roughly 18,500 with the disease presently“

    I apologize because I don’t know the lingo but you can’t come to a meaningful mathematical conclusions by assuming static conditions/ variables when we know that the virus and its outcomes are part multipke interacring dynamic processes, that occur over an unknown (And varying) span of illness, that terminates in death, recovery or never even manifests itself as a disease in the first place…You can’t calculate the amount of infected by starting with the current number dead even if you know the correct death rate. You could come up with a minimum infected if you knew the correct death rate ,but you can’t know that, so I don’t see the point of speculating. As of today about 35% of those tested are testing positive in Michigan. It is a horrible ratio relative to other states. Anonymous tried to explain that it is a number that might get washed out as longer term test results are returned from the milder cases but I don’t know….It still seems like the neg/pos ratio for MI has been consistently horrible over the last 3 weeks. You can bet your ass a lot more are infected that the number of confirmed cases. Depending on your mindset that is either good news or bad news. It is better stay optimistic I think.

    Experts: Please feel free to correct me or explain it better.

  2. iRobert
    Posted April 1, 2020 at 4:50 am | Permalink

    I think you said it pretty well, FF.

    Essentially, there is little meaning in confirmed cases and deaths at this point. There is such a lag in the time between contraction and confirmation or death, the numbers we’re seeing now say more about the situation two weeks ago than today’s.

    It’s important that everyone understand that lag in consequences to our actions today. It would have helped had everyone understood that two or more months ago as well.

    We know the stay-at-home orders and advisories have dramatic dampening effect on the spread, but it is impossible to measure the degree to which they do. That makes estimating numbers all the more difficult to estimate or predict.

    Massive mobilization to the point of overkill is the best strategy and focus now. The health care workers need massive support and equipment, and there are a number of ways we all can assist in that.

  3. Jean Henry
    Posted April 1, 2020 at 5:17 am | Permalink

    FF is right. Obviously, we don’t actually know the death rate without knowing confirmed cases. That number appears to be both changing and variable across locations. It would be impacted by quality of care varaibles and volume of treated cases, as well as the general health of a population in an area (no surprise there are more severe cases in cities with large populations of poor and otherwise marginalized citizens), etc etc. Not an epidemiologist, but it seems we need more data not less. If we can extrapolate from the death rate to a presumption of the number of cases, then we can also extrapolate from the number of tested cases to a presumptive number of cases. Heck we could even triangulate the two cases.

    Not an epidemiologist, nor is anyone else here. But if we need more data, we simply need more data. I understand the need to mitigate fear. And maybe we don’t need all this information because the public so distorts findings– and maybe we did that here– but I’m all for more data. So much more data. We are flying a bit blind and tossing assumptions into the vaccuum of information as people are wont to do– that’s a great misinformation cocktail and we know those are very dangerous. Absence if information only serves the president’s disinformation campaigns. There’s abundant evidence of that here.

    On a side note, the question of whether convalesced patients are immune or how immune is also important and an unknown factor. in part because of severely limited testing. Obviously an anti-body test is still needed too.

    https://www.newyorker.com/news/news-desk/can-survivors-of-the-coronavirus-help-cure-the-disease-and-rescue-the-economy

  4. Jean Henry
    Posted April 1, 2020 at 5:35 am | Permalink

    I found this very useful information (and a bit calming) re keeping ourselves and our families safe. From a doctor working on a Covid-19 ward in an almost exclusively covid-19 dedicated hospital. It’s a bit long but you can do something else like comment on MM.com while listening.

    https://vimeo.com/399733860?fbclid=IwAR3cy-Imm9OOaoGcbZbvAa-1oHjCmJQL-IHN4MuLx_fgZg9IUT8ZC0_jo2k

  5. Anonymous
    Posted April 1, 2020 at 6:27 am | Permalink

    This is an accurate summation of where testing is. We are somewhere between what’s happening in California and what’s happening in New York. Only a handful of hospitals have some internal capability to test a limited amount of patients quickly while the rest have to wait. To be clear, the state’s brain trust institution, Michigan Medicine, was not the first. I believe it was the fourth to go online clinically. Very disappointing.
    https://www.theatlantic.com/health/archive/2020/03/next-covid-19-testing-crisis/609193/

  6. Jean Henry
    Posted April 1, 2020 at 7:04 am | Permalink

    Relevant: https://fivethirtyeight.com/features/why-its-so-freaking-hard-to-make-a-good-covid-19-model/?fbclid=IwAR1ZleG57YoT-FbeQFd14UNOwzba5Jcb6Fk0t8Zz1BzECxfHw6–5sPt7yM

  7. John Brown
    Posted April 1, 2020 at 7:06 am | Permalink

    Agent orange will now proceed to convince us that the measure of success is that he allow any of us to survive the next couple of months.

  8. Jean Henry
    Posted April 1, 2020 at 7:44 am | Permalink

    “I’m sure everybody is enjoying it. … Everyone is positive and hopes for the best.” — Trump at last press conference

  9. NorthItaly
    Posted April 1, 2020 at 8:15 am | Permalink

    I’m an Italian living in the US (and very appreciative of this blog), so let me tell you about Italian data monitoring–which is more useful than the American at the moment. Yes, the number of confirmed cases is helpful but not that telling: the United States is still not performing enough testing, even on the sick, and many cases are asymptomatic, hence untraceable at the moment. The number of deaths is not very helpful either to progress improvement, because the sick tend to stay in intensive care for weeks, so the real impact of the virus is delayed. What is emerging is that the most telling data is the daily number or percentage of people admitted in hospitals and in ICUs. That curve has been decreasing steadily and significantly for a week in Italy, so here’s my hope that the measures that states are taking are going to show results.

  10. I bet HW that McCabe wouldn’t be fired and all I got was this stupid name
    Posted April 1, 2020 at 8:51 am | Permalink

    Aloha, American exceptionalism at work. It is like the Chinese experience did not happen. They learned very quickly that social distancing was inadequate to contain virus. They tested and quarantined all positive individuals separated from families. They learned that Sending infected individuals home until they needed hospitalization guaranteed continued spread of virus to families and others.
    We have failed to contain, all that us left is mitigation. I fear a growing bifurcation of society/world between those who survived infection and those who have not been exposed.

  11. Hyborian Warlord
    Posted April 1, 2020 at 9:28 am | Permalink

    It doesn’t matter how many tests are done when Donald Trump is President. There will never be enough tests to satisfy you. His travel ban can’t have started soon enough. There can’t be enough ventilators and masks and temporary facilities and giant floating hospitals.

    If Blinton had won there would be nothing she could do wrong. If hundreds of millions of people died because she refused to lock down then it would be a holy miracle she was able to save milions from the greatest scourge the world has ever known. You would worship her on your knees.

  12. Sad
    Posted April 1, 2020 at 9:34 am | Permalink

    I think pretty much any President in office when hit with the first world wide pandemic would fail and be criticized.

    Who though would want to be president next year as we start the greatest global economic depression ever?

  13. Anonymous
    Posted April 1, 2020 at 10:34 am | Permalink

    Look at Michigan’s deaths compared to those in other midwest states. The difference is staggering.

    https://www.bridgemi.com/michigan-health-watch/why-did-coronavirus-spread-so-fast-michigan-compared-neighbors

  14. Lynne
    Posted April 1, 2020 at 11:01 am | Permalink

    I think if Clinton had won, there would be a lot of folks like HW criticizing her for spending too much money on early testing and acquiring extra medical supplies when clearly the problem is in China and Europe. One of the problems of really good governance is that people don’t often consider what might have happened had certain decisions not been made.

  15. Frosted Flakes
    Posted April 1, 2020 at 11:46 am | Permalink

    But Cassandra, we don’t need to rely on your made up hypotheticals that exist in your mind, that is filled with convenient assumptions, that you try to use to misrepresent others for the purpose of smearing. All we need to get a sense of the truth is to compare the Dem accusations with the actual words and deeds of Dem leaders.

    Video from February 24:

    https://www.google.com/amp/s/www.nbcbayarea.com/news/local/nancy-pelosi-visits-san-franciscos-chinatown/2240247/%3famp

  16. Lynne
    Posted April 1, 2020 at 11:48 am | Permalink

    FF ,Haha. I still think it is funny that you don’t understand what it means to be a “Cassandra”

  17. Lynne
    Posted April 1, 2020 at 11:52 am | Permalink

    It would be interesting to know what information Pelosi had at the time. But of course, I was talking about HRC and not Pelosi so not sure why you are bringing her into this other than that you seem to see all powerful women in the same light. Powerful women are often very scary to weak men.

  18. Frosted Flakes
    Posted April 1, 2020 at 11:59 am | Permalink

    Cassandra for the second time tells me I don’t know what I mean when I call her “Cassandra”—and I still do not believe her.

    Perfect Cassandra! Just perfect!

    Note what your sense humor often depends upon. Keep laughing it up, Cassandra.

  19. Lynne
    Posted April 1, 2020 at 12:07 pm | Permalink

    No, Thank You, FF! You and that Tiger King guy are certainly keeping me entertained!

  20. Sad
    Posted April 1, 2020 at 12:19 pm | Permalink

    Could you define what you mean by Cassandra FF?

    Feel free to use as many words as you’d like.

  21. Jean Henry
    Posted April 1, 2020 at 12:22 pm | Permalink

    You really don’t understand the Cassandra myth FF.
    There’s no reading of Lynne’s comments (even the most derisive) in which that analogy makes sense.

    Cassandra told the truth.
    She was not believed.
    It’s not super complicated.

    Or am I ruining beautiful things for you again?
    Are you going to spend 1000 words now countering my 7 word explanation of the myth?
    Please don’t scare off our nice new Italian visitor. It’s so great to see new commenters.

  22. Frosted Flakes
    Posted April 1, 2020 at 12:31 pm | Permalink

    Fascinating!

  23. Jean Henry
    Posted April 1, 2020 at 1:36 pm | Permalink

    Even more fascinating:
    https://www.npr.org/transcripts/648781756

  24. Lynne
    Posted April 1, 2020 at 1:42 pm | Permalink

    Thanks JH! I really like Shankar Vedantam but somehow missed this one!

  25. Anonymous
    Posted April 1, 2020 at 4:58 pm | Permalink

    Maybe Tiresias would be more relatable.

  26. Posted April 1, 2020 at 8:15 pm | Permalink

    Deaths in Michigan are approaching the same trajectory as those in New York, close to doubling every two days. Here’s the most recent chart from the Financial Times.

  27. Jean Henry
    Posted April 1, 2020 at 9:18 pm | Permalink

    I wonder if anyone ever called Tiresias a dumb bitch.

  28. Anonymous
    Posted April 2, 2020 at 5:06 am | Permalink

    The New Orleans epidemic has been tied to a large mass gathering at the beginning of March. What large mass gathering happened in metro Detroit in early March? Hint: we probably all went because it was our civic duty.

  29. iRobert
    Posted April 2, 2020 at 7:20 am | Permalink

    Yes, Anonymous, the Michigan presidential primary may have been a significant contributing factor in the early and rapid spread of COVID-19 relative to other states in the region. It looks like Ohio was wise to postpone their primary.

    Florida went ahead with theirs and had relatively high turnout, and the reported cases of COVID-19 are now reflecting that.

  30. Frosted Flakes
    Posted April 2, 2020 at 8:35 am | Permalink

    Something happened in Michigan to cause our bad numbers but I would guess voting is lower risk than most public gatherings.

    Feeling better yet iRobert? Were you able to get tested?

  31. Frosted Flakes
    Posted April 2, 2020 at 9:03 am | Permalink

    Jean seems to get very upset when I follow her lead.

  32. Jean Henry
    Posted April 2, 2020 at 9:11 am | Permalink

    Not even slightly upset FF. I was laughing when I made all comments here.

  33. Frosted Flakes
    Posted April 2, 2020 at 9:19 am | Permalink

    When I follow Jean’s lead she finds it funny.

  34. iRobert
    Posted April 2, 2020 at 10:51 am | Permalink

    Thanks for asking, FF.

    I’ve been feeling pretty good the last couple days, though I sometimes experience slight congestion in the early morning. That usually goes away soon after I get up.

  35. iRobert
    Posted April 2, 2020 at 11:07 am | Permalink

    FF, have you seen an accounting of where the medical equipment and supplies the federal government had has been distributed?

    I’m seeing a lot of claims that most of it went to Florida. Any truth to that?

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