Explain why this is wrong...
May 2, 2020 9:55 PM   Subscribe

I feel like the is US is going to have a giant spike in coronavirus within two weeks. Explain to me why this is incorrect.

So, a bunch of states just lifted or will be lifting this week their shelter in place orders, so people will be gathering together again. Meanwhile the news is full of protesters gathering in groups, people refusing to wear face masks, churches still meeting, beaches covered with people...and all of my rando-facebook groups with people from across the country (think crochet-kitten-lovers and funny-memes-for-moms) have been discussing sneaking their grandparents back into the mix for childcare, taking road trips (without stopping too much!) and so on. So...basically shelter in place is coming to a crashing end, as far as I can tell. So, wouldn't it reason that we will see a large spike within the next two weeks of coronavirus, even with some states continuing to SIP? Furthermore, could this be potentially worse than the first on our already taxed economy and supply chains?

Explain to me what is wrong with my thinking...
posted by Toddles to Health & Fitness (26 answers total) 17 users marked this as a favorite
other than it might take 15 days, there is all likelihood that that is exactly what will happen
posted by OHenryPacey at 10:02 PM on May 2, 2020 [18 favorites]

You are exactly correct. We will have a huge number of cases within the next two weeks.

I think the thinking going on behind Georgia and the like is the whole "save the economy, sacrifice the people" idea.
posted by jenfullmoon at 10:05 PM on May 2, 2020 [7 favorites]

Anecdata but the same relaxing happened in Denmark, and, while there was a slight uptick in cases, there has been no huge spike. It seems that a) the weeks of lockdown really did reduce the number of people infected with COVID-19, so you could have more face-to-face contact without transmission, b) enough people were still on lockdown and freaked out that things stayed under control, and c) things people thought would massively spread COVID-19 (like re-opening daycares and elementary schools) just didn’t.

I am sure that AskMe will step in to say how this is wrong and doesn’t apply to the U.S.... but when things started re-opening in Denmark and people started getting “dangerously” sloppy about social distancing, a lot of Danes basically wrote your exact AskMe post (minus the protestors) on Facebook, to the newspaper, etc. Basically, “How is this going to work?!” But so far, no spike.
posted by whitewall at 10:06 PM on May 2, 2020 [18 favorites]

Explain to me what is wrong with my thinking...

Nothing, really, with the exception that this spike could take 2-5 weeks to appear and/or peak, because not all states or areas are even coming from the same social distancing starting point - hell, some of the the more rural areas haven't hit their first peak yet, as far as we know - and depending on how various places continue to voluntarily maintain some semblance of social distancing it could take a while to spread.
posted by soundguy99 at 10:11 PM on May 2, 2020 [9 favorites]

Also, I wonder if the greatest increase in cases will be from people who have to go back to work because their workplaces open up and they have no choice but go out to be there.
posted by amtho at 10:16 PM on May 2, 2020 [11 favorites]

I expect a bump, but nothing massive. If everyone who is going out has been in quarantine for more than two weeks then we’re effectively resetting back to the beginning of the original spread, which if you’ll recall was pretty slow.

One caveat: the fact that we have testing now means that we’ll see more accurate (i.e. higher) numbers as the virus spreads again.
posted by Tell Me No Lies at 10:52 PM on May 2, 2020 [3 favorites]

In my answer to this recent childcare-related Ask, I rounded up some recent articles with quotes about what public health experts are saying about the ongoing lack of adequate testing, the lack of sufficient contact tracing, and the risk of a new wave of infections. I don't think there is anything wrong with your thinking, and this recent opinion piece suggests that you have the kind of empathetic response that is important for helping to mitigate this public health emergency: My grandfather died of covid-19. More empathy from everyone may have prevented such deaths in this pandemic. (William Liakos, WaPo Perspective)
As a medical student, I’ve absorbed many lessons in empathy. Still, it took this deep personal loss to fully bring home to me the pandemic’s effects. Now I understand much more clearly what I saw months ago in the videos from China, which showed doctors dying of the virus and lockdowns choking off normal life. Now I also can feel, in a visceral way, the pain, fear and grief that the people in those videos must have felt. I know that countless others now share this massively heightened sense of urgency about the coronavirus. But I keep wondering what factors blunted our awareness at first. I’ve concluded that a major deficiency in our country’s early response was a lack of empathy. It seems to me, looking at the big picture, that the defining response in the United States was an inability to put ourselves in the shoes of someone else who lived across the globe.

What if we’d imagined ourselves living the plight of Chinese residents trapped in Wuhan during the first stages of the pandemic, or of the Italian doctors forced to triage ventilators and deny them to people over a certain age? Might a deeper sense of empathy and urgency actually have led us to put together a response that was more pragmatic, and more effective? [...] Amid this crisis, I believe that we as a nation need to choose between two conflicting impulses: to turn inward and blame “outsiders” for our current troubles; or to come together as a member of the global community and to reach out and embrace the experiences of other people in other nations, through empathy and compassion.
But I don't think shelter-in-place is coming to a crashing end, because there are people who will continue to stay at home as much as possible to protect themselves and the community, and lawyers are filing lawsuits, and at least one court has already ruled in public health's favor.
posted by katra at 11:03 PM on May 2, 2020 [14 favorites]

I don’t think it will be a giant spike, or everywhere. I think it will be a slower rise than the first time for a variety of reasons - international travel restrictions, lack of travel/shopping/etc for fun, huge gatherings and so on. I mean if you don’t have Covid 19, and I don’t, we can’t infect each other so it’s not like we are going to immediately have death before us.

I actually think this is part of the problem, mathematically...you need to respond before there’s a massive impact and convince people to re-shut down on a gentle rise. Depending. It depends on whether there’s community spread or if it’s in congregate settings, and how good your contact tracing is. Because it’s not necessarily about the first few infections, it’s the steps from there.

That’s why I find the Danish restart promising but not definitive. I mean kids in school learning outdoors and distanced aren’t the biggest vector, plus say a few are just starting to become asymptomatically sick...if it’s a small number and they’re not being aggressively tested, It could take a while for a few of them to spread it to a few teachers and parents who then have to develop symptoms...problem is that you are risking seeding low grade community spread. If one of those parents happens to infect someone else who is then a super spreader, you’ve messed up. If all of those parents are caught early and don’t keep passing it along, you won’t get a spike, just a rise and a fall. This goes for hairdressers too...in a shop with inadequate measures for PpE gets a client with it, if the first person infected gets really sick and the shop shuts down, hurrah. If that person is asymptomatic and spreads it for a while, boo.

Living in Toronto, I think we’ll be closed almost longest and have more risk of a spike for a long time. We have a dense, transit-taking population. Some of that is controllable (test, trace, proper distancing, masks) and some of it will come down to luck. But I think big areas of New Brunswick might never see a spike even if people are cavorting in groups naked.

So...I think areas in the US are rolling the dice. It’s unlikely to my mind that that will immediately show up as a massive peak. But it may mean the next wave is harder to manage down the road.
posted by warriorqueen at 11:21 PM on May 2, 2020 [11 favorites]

I can't say you're wrong when the virus spreads excellently and asymptomatically. Because you are correct.

Unfortunately, people are not forward thinking.

But I don't think shelter-in-place is coming to a crashing end,

hi from iowa but yes it is
posted by OnTheLastCastle at 11:33 PM on May 2, 2020 [19 favorites]

I will add that I personally believe that a) sick days, b) seriousness of approach and c) lack of “it’s just the flu” is going to be a big post-lockdown driver and parts of the the US may fare badly here (as well as parts of Canada.)

If I wear a mask a fair bit, then get a headache and immediately call in sick and go get (assuming I can) a Covid 19 test and don’t go in until it’s negative, even if I’m out in the community on those pre-symptomatic days, I may not spread my virus particles as far as I would have in early Feb this year. If everyone is like me, again - no spike.

But if I believe it’s just a flu and don’t change my habits, I’m out insisting on my civil liberties, worried that I’ll lose my job for calling in sick with a cold, and taking the bus without a mask, chugging cough syrup again, it’s a different story.

I wish for all of us expert, political, and business leaders who open with that level of education. I dunno if this is happening down there.
posted by warriorqueen at 11:37 PM on May 2, 2020 [7 favorites]

Furthermore, could this be potentially worse than the first on our already taxed economy and supply chains?

Many thousands of Americans are already going to die between now and two weeks from now, because the federal and many state governments chose not to act or have chosen to ignore the danger. The next spikes — two weeks, and beyond, as various areas of the country get seeded and reseeded with infection — will be worse as more health systems across the country go over capacity — if they aren't already — and they will have fewer resources and healthy people to provide care. Tax revenue to pay for treating the uninsured, buy PPE, pay for testing, contact tracing, etc. will gradually decline as the full effects of mass unemployment kick in.
posted by They sucked his brains out! at 11:48 PM on May 2, 2020 [2 favorites]

Ed Yong offers insight that may be relevant to your question in Why the Coronavirus Is So Confusing (Atlantic, Apr. 29, 2020) A guide to making sense of a problem that is now too big for any one person to fully comprehend, particularly in the final section's discussion of risk assessment.

hi from iowa but yes it is

I had meant to link to Yong's article and the hopeful polling I had previously quoted, because I had been thinking of that, as well medical advice I got recently, so I was also thinking about 'higher-risk' groups that will continue to stay at home as much as possible. But it is not an accident that I am often commenting about unemployment insurance, because I am very worried about people who may feel like they have no choice but to work in an unsafe environment, and I try to share information and links to resources (MeFi Wiki) to try to support efforts to stay at home.
posted by katra at 11:56 PM on May 2, 2020 [5 favorites]

The big spike will not take place in 2 weeks, it will take a few 10 day cycles of transmission to get the ball rolling. So I'd bet seeing a spike due to relaxed SIP rules will happen in 2 months or so, sooner in the states with no robust social distancing rules (most Trump-loving governors).
posted by benzenedream at 11:57 PM on May 2, 2020 [4 favorites]

Well the U.S. is supposed to have peaked yet instead of declining as models suggest we are plateauing.

We live in a large area geographically. And this is no longer a specifically urban thing.

States that thought they escaped the worst are finding out other wise. States that are "opening up" will be our bellwethers, for good or ill.

This is gonna be here a long time and it ain't gonna be pretty.

"Most will not die but look at the market!" is a pretty piss poor campaign slogan, but it's all the masters of the universe have right now.

We already hear less about NYC or New Orleans and more about meat packing plants in relatively small communities in rural areas of various states.

This will continue.
posted by Max Power at 11:57 PM on May 2, 2020 [5 favorites]

I wish I could... but I believe this, too. Might be 10 days, might be 3-4 weeks... but the American do as I damn well please attitude is NOT a positive right now. We're going to pay for it.
posted by stormyteal at 12:10 AM on May 3, 2020 [10 favorites]

You may very well be right, but here are some ways in which you could be wrong. As a disclaimer: I am not saying this isn't a big deal, that it's the flu, that lockdowns were wrong or should end now, etc. I don't believe any of that; I think opening up slowly is not a bad idea but the haphazard way in which most states are opening is, so in practice I am in favor of continued government action to stop the spread. I'm thinking of these as possible answers to the very narrow question of "What are some reasons there might not be a huge spike two weeks from now?" (I am not necessarily endorsing them, but I am also trying not to include transparently false ones.)

1. Opening will not mean a return to the status quo because the demand is not going to be what it was before. Even if, say, 60% of people just stopped doing social distancing entirely—I find that unlikely, for what it's worth—it would mean a significant reduction in "Wave 2" cases compared to totally naive spreading of the disease. Restaurants will be emptier, people who can work from home probably still will. Lots of indoor spaces are going to be empty for supply reasons, too—big movies are postponed, sports leagues aren't playing and won't be allowing fans any time soon, concerts are canceled. International travel is not happening and domestic air travel is basically not happening.

2. It is extremely possible that the most dramatic stories—beaches and parks filled with people, in-person voting in Wisconsin—are confounded by things, like the apparent difficulty of outdoor spread vs indoor spread, we do not yet understand entirely. So far, coming up on a month later, 400,000 people voting in person in Wisconsin (something I was very against, to explain my perspective here) does not appear to have caused the outbreak many smart people feared. (The Milwaukee Journal-Sentinel article I read on this most recently, which interviewed some local epidemiologists, is behind a paywall, but you can find it in the comments here.) It seems like extended close contact, or close contact by way of an air conditioner breeze, might be important to spreading; we need to take into account the possibility that the things that look the worst, and (hopefully) the things that people are most likely to do when they start moving around again, are not actually what caused the initial huge outbreak. (Taking that possibility into account does not mean acting as though it's true, because the risk on one end dramatically outweighs the benefit.)

3. Dramatically more mask-wearing is happening than was happening in March and February. Unfortunately (and very confusingly, because masks are the best friend a pro-opening person could have) this is becoming a partisan issue, but even in places I would not expect to see them at all I'm seeing at least 30-50% of people covering their face indoors and in public, the most important place for it to happen. I know a number of people who talk a big game about hating SIP, finding it unconstitutional, making fun of social distancing, etc., who are nevertheless covering their faces in public.

4. US testing capacity is now high enough to create scary numbers that will continue to influence public behavior (~200-250k a day); a lot of social distancing happened well before "shelter in place" orders/lockdowns because people were independently afraid for their own health. Based on what I've read I would feel comfortable going to, say, Best Buy (wearing a mask to protect others and [to a lesser extent] myself, maintaining a safe distance, not staying in close contact with any one person for any length of time) after my home state's lockdown ends and they can open up. In one sense that is a person leaving their house after a lockdown for a non-essential reason; in another it is me making a way more conservative judgment about what's safe and healthy for me to do than I would have made in February, because there's no way I'm, say, going to sit down and eat at a restaurant at that point. I'll go to a park, but not a movie theater. etc.

My retiree parents are Fox-News-adjacent scofflaws on this stuff—they've been to the store way too much and it drives me nuts—but their behavior last year... well, left to their own devices they'd be eating out a couple of nights a week, going on cruises, etc. Now they keep going to the grocery store to get one ingredient, but at least they're wearing a mask and not dawdling there. The ingredients are still there for them to get themselves sick, but they're way less likely to be super-spreaders now than they used to be.

5. The protests etc. you are seeing do not necessarily represent the views of all or most Americans. Protests are made visible to you for a number of reasons, not all of which are even for the same reason—pro-opening people want to show there's a groundswell of support for it, anti-opening people (I am one of these, except that I think significant restrictions on outdoor activities are probably counterproductive) want to show dangerous scenes of unsympathetic idiots licking each other, etc.—and that can't be reduced to "well, I happened to look here and this is what I saw." That is, they're selected from reality for reasons other than their frequency to make you feel a certain way. I'm not casting judgment on that obviously, just providing a contributing reason for "the news to be full of" what it's full of.
posted by Polycarp at 1:49 AM on May 3, 2020 [51 favorites]

We haven't had many cases locally and have a fairly low population density and very few people traveling. Typical of a lot of the US. Although we are opening back up I'm not expecting it to get bad here for a few months. I figure it'll take that long to achieve critical mass.
posted by fshgrl at 2:33 AM on May 3, 2020 [1 favorite]

With respect to the relaxation of lock-down, I think it is important to cross reference the figures with the daily number of new confirmed cases. World In Data provide this graph in which I've shown the data for the USA, UK (out of self interest) and China (feel free to swap China for any other country which has been successfully easing its lock-down in your view).

It would seem that, to have a successful easing of lock down, you need to bring your daily tally of new recorded cases to zero (or very near) for a couple of weeks. If you can do that then most of your remaining cases that occur can be readily tracked and traced - and you can quarantine all arrivals. Saying that you can lift lock down merely when your number of new cases has plateaued - seems unlikely to cut it.

If a country has been locked down for a several weeks and is still seeing new cases then these are probably mostly coming from those who have not been able to socially isolate for one of 4 reasons:
1. Economic: people cannot afford not to work.
2. Occupational: people work in jobs which require them to work in non-isolating environments without proper (or any) PPE.
3. Living space: people live in places where there is not enough chance to be isolated from other large groups.
4. Political: people who choose to not (or no-longer) socially isolate.

The UK and USA both seem to show this trait, for example. Until people in these categories are specifically targetted for testing and support, new cases will continue. If lock-downs are lifted too early, then it is hard to say exactly how steep the spike will be - but there will definitely be an up-tick in cases.
posted by rongorongo at 2:40 AM on May 3, 2020 [10 favorites]

The biggest silver lining I've seen is that while the basic death rate is about what we feared, the hospitalization rate is much lower, around 5% or less vs. the 15-20% most models anticipated. Even the hardest-hit areas in NYC had slack in the system. If it holds this will greatly reduce excess mortality from people dying for lack of care because the hospitals are over capacity.
posted by Rhaomi at 8:03 AM on May 3, 2020 [3 favorites]

I live in Savannah, GA. I go for a walk every morning and to the grocery store every ten days or so. Traffic is back to normal. Tourists from other states are flooding the downtown historic district. So far we've had a fairly low rate of Covid-19 illness. My friends and I are convinced that's not going to last and we're in for a dramatic upsurge in the next few weeks.

I'm semi-retired and have been working part-time remotely since March. My contract ends May 15 and I'd been hoping to drive soon after that to see my kids and grandkids in Ithaca, NY. I don't think that's going to happen in May. One daughter-in-law is a nurse practitioner and my sister is an MD and I am deferring to them about whether I should travel, and about whether I'll have to quarantine for two weeks when I get there. At this point both of them are telling me to wait until June at the earliest.

If you can, continue to isolate. If you cannot, be very careful.
posted by mareli at 8:07 AM on May 3, 2020 [3 favorites]

Covid Act Now makes predictions on a state-by-state and county-by-county basis. For states not fully embracing restrictions it estimates R=1.1, which means cases will double or triple until they reach a peak in the summer. R was estimated as high as 2.5 in March, so while transmission has slowed it hasn't gone < 1.0 which is needed for cases to subside.
posted by RobotVoodooPower at 8:21 AM on May 3, 2020 [14 favorites]

My county beaches reopened for sitting and lounging yesterday. Previously, they were closed and then they were for walking, jogging, fishing, and surfing and sitting was not permitted. Now that sitting is permitted, the rules are groups of six or less with a distance of 10 feet between groups.

I can see where if your state opens beaches, and restaurants at 25 percent capacity, people may start to relax their precautions overall. For instance, the house behind me had a big party last night and I saw a few groups at the beach yesterday that were not family groups, but obvious young (20s) friend groups.

If these type of scenarios are happening at a larger scale, there will be an increase in cases. Will there be a spike or an overwhelm? I am not qualified to say. It goes without saying that every time more people go out and come in some prolonged contact with other people there will be an increase in cases.

If 50 percent or more of us are going to contract the virus eventually, and if your area has a capacity to treat, what is the point of staying inside, especially in now and in the summer if the experts are saying this virus has seasonality? The beaches are the least of our worries for transmission. I don't blame the people of Newport Beach who were trying to get some air and sunshine.

Unfortunately this virus has become political in the USA. On one side you have people waving flags and protesting over a virus, and on the other you have people condemning state and local governments for opening economies in a limited capacity and painting them as evil. If vaccines usually take a long time to develop (5-10 years is not uncommon) and some vaccines are never developed, what can we do other than open with public health guidance even with an inevitable case increase?
posted by loveandhappiness at 11:39 AM on May 3, 2020 [3 favorites]

Between vastly more people wearing masks and keeping social distance, plus people "recovered" the spike may be reduced. We do not know if recovered do not transmit but it's not unlikely from other virus behavior.

What may be bad is populations that due to geographic isolation (just fewer flights from Europe to Duluth than NYC) there could be pockets that have not seen much effect -- that open up -- and the virus is injected invisibly after it seems like the curve is over. So the spike may come not in a few weeks but very strong in 2-5 months. Perhaps that's the scenario that they are talking about of fall being a flu season + covid-19 becoming even worse.
posted by sammyo at 12:14 PM on May 3, 2020

Furthermore, could this be potentially worse than the first

We're still in the first: "The political conversation is also shifting to benefit the president in a second way: the now repeated warnings that the coronavirus might have a “second wave” and peak again in the fall. Here’s the thing: we never finished the first wave. Our highest daily number of deaths was… yesterday, when 2,909 Americans died. We are still very much in the heart of this first wave, but by shaping this conversation as looking ahead to concern in the future, it rhetorically accomplishes what Trump set out to do just a week ago—convince us that we have successfully lived through the worst part of the pandemic and that it is safe to reopen the economy. [...]

"It is impossible to overlook that the people demanding states ease restrictions are overwhelmingly white, when both African Americans and Native Americans are badly susceptible to Covid-19. In Chicago, for example, 32% of the population is African American; 67% of the dead have been black. Further south, the Navajo Nation is behind only New York and New Jersey for the highest infection rate in the US. White supremacists are celebrating these deaths, and calling for their supporters to infect minorities with the virus. But even those who insist they simply want society to open up again are demanding policies that will disproportionately kill some Americans at higher rates than others." - Heather Cox Richardson, Letters from An American, May 2, 2020

Sources at the link. (Second paragraph included because I don't think the US is going to be as fortunate as Denmark, as another poster speculates, for reasons beyond the population size disparity between the US, at 330.7 million, and Denmark, at 5.8 million.)
posted by Iris Gambol at 12:28 PM on May 3, 2020 [7 favorites]

Completely anecdotally and in no way based on scientific observation or reasoning, BUT I strongly believe that the number of individuals who have been exposed is on a higher level than currently known or even accounted for. In my area of New Orleans, the virus likely swept through initially at or just after Mardi Gras - which ended February 25 and our lock down did not start in earnest until March 16. I know of numerous people - family, friends, co-workers - who had some "mysterious flu-like illness" around that time. Some tested negative for flu (including my husband). I don't think there will be a giant second wave because April was the second wave. The first wave started in February.
posted by tafetta, darling! at 5:46 PM on May 3, 2020 [2 favorites]

If we all went out tomorrow and licked the faces of everyone we met, we would be increasing R. That is the rate of infection. The number of people newly infected on a given day is R times the number of people already infected, which in this face licking future are also all out on the streets licking faces.

Given the incubation time, that means there won't be a detected spike initially, but a small increase in the number of infections, say 10% more people are infected on day one than would have been in lockdown. One day two, it will be that 10% plus a bit more and so on. So if we assume it takes two weeks to identify the new infections, and if we spot that 10% daily uptick within a week and shut everyone in cages at that point to avoid the face licking mayhem, the spike, if it occurs, will actually occur at five weeks afterward. You can change the numbers around; R affects the size of the peak, as does the time to spotting the infection. If R doesn't make it above 1 - if face licking is an inefficient means of transmission, perhaps, or we only lick every tenth person - then we should find that the daily new infections continue to go down, albeit more slowly than before.

In general, we're probably not going to be licking each other's faces in most states. Probably. We'll probably not be as friendly and close with the people we were, and some people will probably keep themselves to themselves, and many people who think they are infected will stay at home, so in fact R should be lower than it was in the early days of the infection - the question is whether that's lower than or higher than 1. I'd bet on a bit above, to be honest, but not very much above, so we'll see an unwinding of progress and a fairly modest second peak as long has we spot the problem early and act on it.
posted by How much is that froggie in the window at 11:37 PM on May 3, 2020 [2 favorites]

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