How bad is it, really? *

“Now we have tested over 40 million people. But by so doing, we show cases, 99% of which are totally harmless.” – DJ Trump, 7/4/20

“I think we are going to be very good with the coronavirus. I think that, at some point, that’s going to sort of just disappear, I hope.” – DJ Trump, Interview with Fox News, 7/1/20

This is our president’s message to the loved ones and families of the 132,318 people who have died so far from COVID-19. It is his idea of empathy for the 249,539 people in the U.S. who have been hospitalized. So, on the fronts of truth and empathy and humanity, it is really, really bad.

But how bad is it in terms of coronavirus metrics — cases, fatalities, hospitalizations, etc?

As SDT1 shows, California cases have grown by 112% over the past 30 days. But this is far better than AZ, with 303% growth, OK, with 131% growth, and TX, with 173% growth. Case doubling days in CA are not good, at 28 days, but that number has worsened only slightly. Meanwhile, AZ’s doubling day number declined by 1/3, from 24 days to a scary 16 days. Florida is even worse, down to 14 days from 42 days a month ago. GA is the only state out of the 30 day zone, at 34 days. Daily cases in CA have grown 157%, from 2,716 to 6,987. That’s a small increase, though, compared to FL, where a month ago they had 999 cases and today they have 8,434, a 744% increase. NV, OK, and TX aren’t doing much better, all with increases over 300%.

The one bright spot is that in some states, at least, the daily death rate is even or declining. In CA, for example, it only increased by 2%, and in GA and OK it decreased by 59% and 13% respectively. This is not the case in AZ (+74%), FL (+26%), NV (+48%) and TX (+51%). While the fatality doubling day numbers are almost all near 60 days, as cases increase, it is very possible the fatality doubling number will go back into one month territory.

Just a quick point on Trump’s preposterous assertion that all these new cases are from testing alone. SDT2 breaks this down. The most significant factor here is that positivity rates increased from 5% to 7%. That doesn’t happen when tests increase faster than cases.

On to the county level.

I’m still fine-tuning the Zorgi Score, but already it’s yielding some benefits for me. It makes me ask why? when I see things that I probably would have otherwise overlooked. For example, look at today’s CD4 chart. Santa Barbara way up at 17.4? Whaaaat? So then I look at where the most points came from. There’s a 475% increase in daily cases. A 7% decline in case doubling days. An 18% decline in fatality doubling days. Now, I may adjust the calculation over the next few weeks as I get more experience with it, but I can almost guarantee I would have missed a lot of this if it had been buried in the mass of statistics I gather.

Or what about LA County at 9.5 and SD county at 8.7, while Orange is at 15.5? Is this just an anti-Orange sentiment? Again, we look at the biggest contributors to that score: daily cases in Orange up by 412%, compared to 83% in LA and 261% in SD. Orange’s doubling days decreased by 35%, while SD’s decreased by 9% and LA’s increased by 18%. In almost every other metric, Orange fared worse than LA or SD, so it’s higher score makes some sense.

More importantly, if we look at CD1 and CD2, it is not a clear cut situation where any one county is an absolute and total disaster. Imperial for example, had abysmal increases in total fatalities (245%) and daily fatalities (371%), but their daily case rate declined by 21%, from 167 to 133 a day. Contrast this with Orange, where it went from 174 to 888, a 412% increase.

Hospitalization data is a mixed bag as well. Imperial improved in HUR, going from 63% to 31%, and even improved in IUR, from 72% to 65%. Still that is the highest IUR of any SoCal county. LA for all the big headlines, is at 11% HUR and 17% IUR.

Just to show how dynamic the situation is, I threw in a couple of colorful charts, CGS1 and CGS3. On CGS1, compare the situation 1 month ago, where the columns from Imperial crowd out every other county, vs. today, where Imperial is 1/4 of the horizontal axis. However, when we look at daily fatalities per 1M people, Imperial takes up 2/3 of the axis, and has been consistently rising.

So what in my mind would constitute a real improvement in the situation? I would like to see all the Zorgi Scores around 7.0. I think at that level, there would be some real hope of dealing with this pandemic effectively.

Notes on my new website, zorgi.me

It’s been about 12 years since I set up a website, and I forgot about SSL Certificates, Keys, etc. Yesterday, many of you reported to me the warnings you got when you tried to go to the site. I’m happy to say these appear to be all worked out now.

Here are some of the things you will find on the site:

  • Data sources for all the charts and tables I use in the updates
  • FAQ’s
  • Complete explanation of Zorgi Score metrics and how the ZS is computed
  • Definitions and abbreviations
  • Interactive charts on COVID in CA. I’ll be adding to this as I go along, but right now there are charts on CA, LA County, SD County, Encinitas and Carlsbad
  • And, of course, every update I’ve done, all the way back to #1 on March 29. On posts with an asterisk in the title, you’ll find comments from readers and my responses.

Thanks again to everyone for your great feedback, your Reddit awards, your critiques and your suggestions. You’re helping me get through this pandemic with some semblance of sanity.

Stay safe and healthy, everyone!

Comments from Readers & My Responses

The following are some of the comments from readers on Reddit and other social media platforms where I regularly post. Reader comments are in italics and color. My responses are in plain text. If there is more than one commenter without a response, they are separated by different colors.

One confounding variable that I’m having trouble reconciling is access to testing. Back in March so few could get a test and now everyone can get a test. I think the only constant is death rate but even that may not be a good metric to compare since medical procedures have adapted since then.

Anyway was curious if you had any thoughts on this. Great work as usual.

There may be easy access to testing now, but if cases explode, that may no longer be the case. It certainly isn’t in AZ. We still don’t have a particularly good national infrastructure for testing and all the logistics that go with it.

All the metrics involved with this pandemic are “fuzzy” so you just have to take them for what they are. Death rates are probably undercounted throughout the country, as documented by the NY Times. Testing numbers include unique individuals, total diagnostic tests, and serological tests in one number. Cases are based on testing. I do have a bit more confidence in CA’s hospital numbers, simply because they come from hospitals all over the state, and hospital admins generally have to know how many beds they have, how many COVID patients they have, and how many are in the ICU.

The true death rate based on cases (CFR) won’t be known until after the pandemic is over, but I suspect it will be somewhere south of 1%. That’s still an awful lot of people.

“The ICUs aren’t overwhelmed and there’s still plenty of hospital beds!” I read this on the internet far too much.

The situation is certainly pretty bad in the ICUs. My wife, an ICU nurse here in San Diego, is already badly burned-out. Sure, the ICUs are not at maximum capacity, but just dealing with multitude of COVID-19 patients in a safe manner is exceptionally taxing, both on the hospital-wide level, but also for the individual medical professional. My wife has been caring for COVID-19 patients for nearly 4 months now. In the beginning, it was frightening and so much was unknown. Now, the situation is less frightening, but it is absolutely draining.

With the exception of UCSD, all other San Diego hospitals are still struggling to maintain an adequate supply PPE and normally single-use PPE is being recycled and rationed… both because of supply issues, but also because of cost. My wife’s unit used to have a technician who could disinfect PAPR hoods and other equipment between COVID-19 patients, but that’s now been cut-back, and my wife has to do that herself. You’d think this wasn’t a problem anymore, but it still is.

I look at your data graphs or the more simple daily hospitalization data on the California Health and Human Services website, hoping to catch the start of the sustained downward trend in COVID-19 hospital census and ICU census. In a way, I’m looking for that first sign of the light at the end of the tunnel…

However, even when things looked to be getting slightly better a few weeks ago, my wife was enduring some of the worst shifts in her 10-year career working in a critical care setting… and each shift is progressively getting worse.

She’s talking about stepping away from the ICU because it’s gotten so bad. She’s not the only one who feels this way as a number of her coworkers have already left the ICU or quit altogether. Her hospital is trying desperately to recruit med/surg nurses, or those from other specialties, and push them through a 1.5-long crash course in critical care ICU nursing, even though it takes typically takes 6 to 9 months to transition someone from another specialty to the ICU.

Regrettably, data cannot convey to the general public just how bad the situation is in the ICUs here in San Diego. Even if it did, there’s an unfortunately large group of people who probably wouldn’t care anyway. I get that there are a lot of people struggling on account of lay-offs or business closures. However, sometimes I feel like folks working in the ICU, like my wife, have to suffer because of all of the indifference and apathy of those packing bars, hosting house parties, or disregarding safety guidelines in some other way.

You raise such good points. My wife was a teacher, and it’s always easy for the public to think there’s not much of a difference between a class with 25 kids and 35 kids. They don’t realize that people reach a breaking point when they never get a break.

I really, really feel for your wife. Our health care system is a complete mess, and people like her have to pay the price for it. ]

Someone who had family in Bergamo told me that people there were just like here at first — going to bars, hanging out with each other, etc. Then it really hit, and they learned their lesson the hard way. It looks like that’s where we’re headed as well.

If we had a national plan and a president who gave a damn, we might have a chance. Without that, we’re fighting a battle on a thousand fronts with no commander.

Your wife and people like her are the real heroes in this battle. We owe them so much. People who don’t take this thing seriously, who refuse to wear masks — they are so disrespectful of the very people who will be called to save them one day.

Thank you for your very important message.

The scary part now is that from what I’m reading online, many hospital facilities in the US are pushing new grad nurses to take care of COVID patients because of what you mentioned. Also the NCLEX (national test to be taken in order to become a nurse) temporarily lowered the standard amount of questions to get nurses to take the test and hopefully pass. From a nursing standpoint and depending on your location, were getting fucked.

As a fellow icu nurse I definitely sympathize with your wife. These are some extremely challenging times and the government allowing out of ratio assignments on top of everything is one of the biggest problems right now. For those not familiar with the life of a hospital worker, imagine being forced to take on 50% more responsibility every shift at work for the same pay while no longer getting lunch breaks, short breaks for your 12 hour shift with no support staff either (because staffing is so short). Working 12 hours with no reprieve, essentially in a high alert state, is a struggle and no nurses signed up to do this for 4+ months straight. Most colleagues that I work with care too much for the well-being of others and their communities which is why they are still working in ICU since if they quit there’s nobody left to replace them.

As /u/liftlovelive suggested, stepping away to a different specialty is probably a good idea. Even taking some time off would likely be significantly beneficial at this point. Management probably is not approving PTO hours at this time, but just call in sick for a bit because it’s not like they can afford to fire nurses at this time in socal. Your last point is absolutely correct btw, while the majority of people are doing their best for the public good, there’s unfortunately a significant amount of people recklessly socializing. Can’t really blame those that are just following the re-opening allowances from state and local government, but really wish people were more sensible during these times. Mask deniers get no sympathy from me though. Nurses are wearing masks for 12+ hours a day and some of these people refuse to even wear a mask for a few minutes to protect others.

Best wishes, stay safe.

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