Yesterday, Governor Jay Inslee issued a full, statewide “stay at home” order for Washington State. Up to this point, home-stay was recommended and did not have the force of law. Now it does.
Thank goodness. When I first glanced at the percentage of new positive cases per day (Washington State), I felt optimistic. After reflection, I decided. “Yes, it’s good that the percentage is not increasing rapidly, but even no change is still bad.” Even a constant flow of new patients into the health care system will eventually overwhelm it. A linear curve, as opposed to an exponential curve, merely postpones the day when we exceed capacity.
Someone might say, “Oh, linear isn’t bad.” Yes, it is and here’s why. It’s not like an acute care patient arrives, is given some magic cure and is sent home. Mean duration of hospitalization in Chine was 12.8 days. [Please see “Clinical Characteristics of Coronavirus Disease 2019 in China” in the New England Journal of Medicine.] Even with a so-called linear curve, acute care patients are admitted and stay. Most hospitals are “right sized” during normal times by administrators interested in efficency. So, it doesn’t take long before capacity and staff are exhausted.
China had hospitalization rates ranging from 15% to 20%. In the Chinese epidemic, 41.3% of patients received oxygen therapy and 6.1% received mechanical ventilation.
There is only one advantage to a linear curve vs. exponential — it gives hospitals and other facilities an opportunity to ramp up for the influx of acute care patients. The availability of respirators and ventilators is a critical concern as well as temporary beds and infrastructure for convalescence and recovery.
We need to push the number of new COVID-19 cases downward through social distancing and good hygiene. I’m glad that Governor Inslee has issued a full stay-at-home order. Now, we all need to listen to it and act.
New York City
Governor Cuomo of New York was visibly more alarmed today. I pulled together a quick table of new case and new testing statistics for New York City (NYC).
I’m alarmed, too.
New York City (NYC)
Cum New Cum New Percent
Date Positive Positive Tests Tests Ratio Hospital
------ -------- -------- ------ ------ ----- --------
Mar 20 4408 1939 14386 4852 40.0% 18%
Mar 21 6211 1803 19463 5077 35.5% 15%
Mar 22 9045 2832 26389 6927 40.1% 13%
Mar 23 12305 3260 33003 6614 49.3% 13%
Mar 24 14904 2599 38390 5387 48.2% --
Mar 25 17856 2952 44076 5686 51.9% 12%
Mar 26 21393 3537 51031 6955 50.9% 14%
Mar 27 25398 4005 57954 6923 57.9% 15%
Mar 28 29766 4368 65902 7948 55.0% --
Mar 29 33768 4002 73104 7202 55.7% 14%
Mar 30 37453 3685 -- -- -- 14%
24% of hospitalizations are ICU patients (March 23)
23% of hospitalizations are ICU patients (March 24)
24% of hospitalizations are ICU patients (March 26)
24% of hospitalizations are ICU patients (March 27)
24% of hospitalizations are ICU patients (March 29)
25% of hospitalizations are ICU patients (March 30)
The percentage of new positive cases per day (which takes the ever-varying number of tests into account) for Washington State is around 6.5%. The ratio for New York City is 6 times higher than Washington. (Update: Washington State calls this ratio “Positivity Rate.”)
I fear that NYC is already in the weeds. Folks, NYC is the largest financial center in the United States. So, even if all you care about is money, this is the wrong time to lift restrictions and to restart the American economy. Plain and simple, that’s crazy talk. And, immoral.
Stay distant and stay healthy — P.J. Drongowski
Update quoting CNBC News:
New York and New Jersey are seeing coronavirus attack rates at least five times higher than other parts of the country, a U.S. official in charge of the White House’s pandemic response efforts said Monday.
“The New York metro area of New Jersey, New York City, and parts of Long Island have an attack rate close to one in 1,000,” Dr. Deborah Birx, a physician and the White House coronavirus response coordinator, said at a press briefing Monday evening. The attack rate is the percentage of a population that gets the disease.
She said roughly 28% of the specimens submitted in that region have tested positive for COVID-19, while less than 8% have tested positive for the disease in the rest of the country.
New York is currently the hardest-hit state in the country, ahead of New Jersey, California and Washington state. New York City, alone, accounts for 12,305 of the 20,875 confirmed infections in the state as of Monday morning.