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Australia, Italy, the USA...…

So many of you will wake up this morning and find out that the USA is #1 in a list that we do not want to top. We are the epicenter of COVID-19 in the world and there is no evidence yet of it slowing down.


I want to discuss three situations right now, Australia, Italy, the USA (in order below; note the axis difference for Australia and USA) .

Australia: Your numbers are increasing, people are getting sick, but you are doing much better than most of the world. As expected the numbers are marching higher, but in most cases, the newly diagnosed cases are from travel (Grey in pie chart) or contact with a person who has travelled (Blue). Unknown (orange), or under investigation (Pink) are <20% of your cases. We expected numbers to get higher from all the expats returning, your major concern is community transmission, which is increasing but still relatively low. Remember, Australia is testing for COVID-19 at a record pace, I believe that testing has captured a good portion of your infected.


A great sign that things are working for you is the trajectory of confirmed cases. They are not increasing exponentially, in fact, they seem to be stabilizing, and it appears the outbreak is losing steam (see red line in the second figure). Australia never really made the 33% increase in cases per day that other countries saw, and now there is a clear break in the trend.

The more extreme social distancing measures that were put in place at the beginning of this week will only help reduce the growth rate further. Remember, it needs 2 weeks for an effect. Things to look out for: we want to see new cases per day stay at around 200-300 for the next 2 weeks, then we want to see that number decrease.

Bottom line: it sucks what you are going through, and I'm no ScoMO fan. But what the Fed and State Governments are doing, is working. As soon as the numbers of travel imported cases drops (now that borders are closed), you will have a much better handle on the on-ground situation. Keep doing what you are doing and you will emerge on the other side of this much sooner than other countries.

Italy: The deaths will continue to march higher (roughly 10% case to fatality ratio), but they should stabilize in the coming weeks. Thankfully, it is now clear that Italy has turned the corner of the outbreak. They no longer have exponential increases in daily cases, and while they are not dropping yet, they have at least stabilized at about 5k cases per day. This is a result of the extreme physical distancing they have used (the nationwide lockdown). The stabilization of cases is almost exactly 2 weeks after the nationwide lockdown.

Why aren't they dropping? As discussed in my earlier posts, for 2 weeks after lockdown community acquired cases will still emerge at an exponential rate (those infections are the ones you got while walking around in the community). For weeks 2 through 4 after lockdown you will see the emergence of cases acquired inside your home. So at the moment, the community-acquired cases have stopped (no more exponential growth), but now the household infections are emerging. These too will drop in the coming few weeks, but I hope you can see that from a nationwide effective lockdown, it takes at least 1 month for cases to significantly drop.

The USA: I am frustrated beyond belief.

  • We a deadly pandemic spurring mass layoffs in a country that insists on tying healthcare access to employment. Let that sink in.

  • We are the richest country on earth and our healthcare workers are wearing garbage bags and home made masks in an effort to protect them self.

  • One of my great fears was for our healthcare workers. I wake up this morning to the announcement that 100 healthcare workers in three Boston hospitals have COVID-19.

  • We have a leadership that is inept and have taken a fragmented approach to dealing with a self made crisis of historic proportions.

Here's where we stand. There are well publicized outbreaks right now; NYC, Seattle, and California. But embers are burning all over the country. For example, NYC residents escaping the city will spark a New England wide fire of small outbreaks as they move to their second homes. The Mardi Gras in LA, has obviously sparked a new outbreak in the south. But one of the most concerning is Florida and Spring Break.


The map shows the data from people using home based thermometers that are connected to the cloud. Red means there is a lot of people using the thermometers that have a fever. We can see NYC is bright, but look at Florida! Clearly something is going on down there.

Now the first two weeks in Florida were Spring vacation, where people from all around the country came to FL to party. Well these people came, they partied, they left.

When we look at cell phone geolocation from a single beach on a single day in Fort Lauderdale, and then track where those phones end up in the coming week, we see the following. Those phones (bright color on map), and those people holding those phones, ended up all around the country.

I know this is really big brotherish, but if you want to look at the data visualization, see here. https://twitter.com/i/status/1242628347034767361

Basically, those people partying in FL, have now transported whatever is brewing in that state to the rest of the country. This is a big part of my frustration. In NE we have been doing wonderfully on our stay-at-home mantra. Boston streets are empty! But the fragmented nationwide response is hampering and delaying our recovery.

As we can see with the response in China and now Italy, we need 2 full weeks of nationwide extreme social distancing to stop exponentially growth, and we need another 2 weeks after that to get over the in-house spread. Florida, Louisiana, and other states who are not testing and not trying to control the spread are only going to make this last longer and be worse for the entire nation. We were on track in MA to see some normalcy in life somewhere in May. But, while embers burn around the country, that can't happen.

We need a nationwide organized response to this pandemic. Tamp it down over the next month with stay at home orders, and then have massive testing along with physical distancing in place to stop a new outbreak occuring. In lieu of federal leadership, please show leadership in your house. Minimize your 6ft contact with others while out. We really want to see numbers of new cases drop in the next 2 weeks.


Stay home when you can, so that others that have to go out can do their job.

I promise to post something more helpful, later.



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