Today we’re going to talk about Knox County opening, some thoughts on fighting COVID-19 from Singapore and Hong Kong, then go over the numbers

Knox County – Open for Business, Kinda

May 1st Tennessee essentially throws open its doors to business, (at 50% capacity at any rate), with only a handful of industries still closed everyone else is allowed to open. Knox County is taking a phased approach that is significantly more measured and has materially more amounts of guidance to date. So, is it safe to go back out?

East Tennessee is as different a story to the rest of the state as Tennessee is to the nation as a whole. While Knox County cases have risen in the last couple of days, as a whole, they’ve been incredibly slowly steady over the last 6 weeks. This heatmap from Tennessee Department of Health shows how different the cases are in and around Memphis and Nashville:

While each person ought to and needs to take their own risk factors into account, the next two weeks are probably about as safe to head out in Knox County as we’ve had since February. Our cumulative positivity rate was 3.4% on Tuesday in Knox County, with about 1.4% of the population tested. Those are both fairly robust numbers with such a low rate of overall cases.

With all of that said, at JM Addington — and personally — we don’t plan to change behavior in the next month. (You can see our operations plan here). The primary driver behind this is that if, as a community, we open up too fast and spread coronavirus faster than expected we won’t fully see the impact in the numbers until the 3rd or 4th week of May. Somewhere between May 15th and May 25th we’ll re-assess and see if we feel it’s prudent to loosen our own internal restrictions.

Until then, we’re aren’t increasing our shopping trips at home and we’re mostly working from home with only essential trips to client sites. We need a haircut as badly as anyone else, but, at least your author, won’t be getting one in the first half of May.

In a broader context we are actively planning on a second wave hitting, even though that is an unknown currently. That potentially gives us two to four months between waves to work on things corporately and personally before hunkering back down again. We hope to post on this more fully soon.

Hong Kong & Singapore

The New York Academy of Sciences held a free COVID-19 webinar today featuring Dr. Gabriel Leung of University of Hong Kong, Dr. Vernon Lee from the Singapore Ministry of Health and Dr. Jennifer Dowd from the University of Oxford.

For comparison, Hong Kong has over 7 million people in a land area that fits inside Nashville, including portions being population-dense as Manhattan. Singapore has 5.8 million people with a higher population density than Hong Kong. Singapore has a total fo 16,000 cases (about where Indiana is at today) and Hong Kong just over 1,000 cases.

In both cases, but especially Hong Kong, case-targeted approaches were used first and population-based measures second. (Scholarly source on Hong Kong) For example, Hong Kong started by requiring temperature checks of all inbound travelers in January and only cut off non-Hong Kongers in late March. Testing and contract tracing were also in place late January but bars only closed in late March (and restaurants, incredibly, are still open). Amusements parks and sports closed early but nightclubs much later

There is nuance, to be sure (see the NEJM article for details), but both Kong Kong and Singapore seemed to favor precise tools first and hammers second. We suspect our US public health experts would agree with that style of approach, however, we clearly didn’t implement the more precise approaches in a level that even can contest with Hong Kong or Singapore.

“This will be over one day, but it is a marathon. The exit strategy is science… that is our best and only exit strategy.”

Dr. Gabriel Leung

Numbers

The national numbers continue to be… the same. We have slowed the growth, but barely, and the we’re testing better, but still need to do significantly better.

The biggest thing that doesn’t show on these charts is the geographic movement of cases. While New York continues to lead the way, New Jersey, Massachusetts, Illinois, California, Pennsylvania and Michigan all have over 40,000 cases. It’s not even clear that COVID has peaked in these places.

Positivity rate

The number of confirmed cases divided by total tests performed. This gives one an idea on if enough tests are being performed. Dr. Fauci has indicated that he’d like to see the US at 10%.

US New Cases by Day

US COVID-19 Cases and 7 Day Rolling Average, April 30th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

CA, IL, MA & PA Cases by Day

CA, IL, MA, MI, and PA COVID-19 Cases and 7 Day Rolling Average, April 30th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

US COVID-19 Positivity Rate by Day

US COVID-19 Positivity Rate, April 30th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

US Cumulative COVID-19 Cases & Deaths

April 30th, US Total Cases and Total Deaths from COVID-19 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

It’s hard to even detect a decline in the cumulative cases and deaths. Deaths are actually ticking up, which is concerning.

Tennessee continues to fare better than the national trends, although we put a marker back in today’s graph to remind ourselves about where things were the last time that we were eating out, around March 15th. It would be three days later that we posted our first public article on COVID-19, writing, “For those of you in East Tennessee, no new cases today. Statewide we’re at 98 up from about 78 yesterday. Those are focused around Nashville right now.” Tennessee COVID-19 cases are up over 100x since that first post, 6 weeks ago.

TN New Cases

TN COVID-19 Cases and 7 Day Rolling Average, April 30th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

TN Positivity Rate (about 5%)

TN COVID-19 Positivity Rate, April 30th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

By the way, if you want to see the same graphs for your state click here, we pull nearly all of our own visuals from this report. Typically updated at the same time the evening’s post goes up.

Here are GA new cases.

Also, you can do it on your phone but it is much easier to navigate on a bigger screen.

Knox County continues to have very low new cases, with eight new cases today, and 232 overall.

April 30th, 2020 Knox County, TN New COVID-19 Cases
Source: Knox County Department of Health

Area cases are ticking up at a similar rate.

We’ll give Governor Lee the last word today, as we think it makes a big difference on how the next 30 days go:

Tennesseans have to stay committed to social distancing.

GOVERNOR Lee, April 28th, 2020

These posts helpful?

Then go ahead and share them where you saw them once or twice a week.

Get In Touch

Need help thinking this through? Access to more data? Help getting your technology in order to handle what’s here and what’s coming? Contact us today.

Other

Thanks to those that have shared kind words or liked these posts. We’re doing out best to put out data-driven analysis, each one of these takes about 2 hours. It’s helpful to know that they are being read.

If you want copies of the Excel sheet and PowerBI Reports we use to put these together email us, info@jmaddington.com. Right now, our PowerBI combines data from JHU, NYT, COVID Tracking Project, IMHE and the TN Department of Health. Most sets are updated daily.

Today we’re going to go over interpreting data, the numbers and news.

Torturing Data

First, we want to remind everyone, this is us humanity vs COVID-19. This is every person that you love, every person on this big blue marble fighting a germ we only see under a microscope. No one on your Facebook feed is trying to mislead you.

But some people still are. One of the first things you learn in statistics 101 is that if you torture the data enough it will tell you what want to hear.

“Torture the data, and it will confess to anything.”

Ronald Coase, Economics, Nobel prize Laureate

This becomes of particular concern when the consequences are serious and the issues complex. To add to it in our present situation, our knowledge is limited.

Be very skeptical of any “hot takes” in your news feeds that claim to tell you what no one else will, that are “breaking,” anytime someone “destroys,” someone or a point of view. Even the experts in infectious disease and epidemiology don’t agree on the specifics of COVID-19, they do have a consensus of its contours.

We present all of our sources so you can track them down. We offer up our reports for free so you can play with them yourself. We keep the graphs and calculations simple, because if you take data that isn’t accurate and then perform a bunch of steps to turn it into another metric you just get multiplied garbage. It is perfectly clear to anyone in the field or anyone tracking the data that it is imperfect. It’s also the best that we have.

When my kids were younger they thought that they could just throw some flour, yeast, salt and water together to make bread. The proportions didn’t matter to them.

Nothing useful was produced.

And that, friends, is what happens in most of the posts that hype misinformation.

Numbers

US Cases are still pretty much flat nationally since peak in mid April. The 7-day average of new cases per day is only down to 29,000 from 31,000. We’ve successfully stalled the acceleration of growth but we’re not reducing the size of the epidemic, it’s on cruise control.

If there is good news in the charts below it is that we are beginning to test better. We’re not doing great, just better.

Positivity rate

The number of confirmed cases divided by total tests performed. This gives one an idea on if enough tests are being performed. Dr. Fauci has indicated that he’d like to see the US at 10%.

US New Cases by Day

US COVID-19 Cases and 7 Day Rolling Average, April 28th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

US COVID-19 Positivity Rate by Day

US COVID-19 Positivity Rate, April 28th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Balancing out the spike in cases is a flat-ish positivity rate. At 5% positivity rate (6.2% cumulative) Tennessee: we make up 2.72% of all US tests and 1% of all US COVID-19 cases.

TN New Cases

TN COVID-19 Cases and 7 Day Rolling Average, April 28th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

TN Positivity Rate (about 5%)

TN COVID-19 Positivity Rate, April 28th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

For comparison, you have the US positivity rate up top, or below, Nebraska and Minnesota. Nebraska is clearly headed in the wrong direction, with an outbreak at a rural beef meat packing plant that appears to be driving up the cases, and hence the positivity rate. Minnesota’s new cases appear to be outpacing new testing (not shown, see MDH website).

NE Positivity Rate

NE COVID-19 Positivity Rate, April 28th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

MN Positivity Rate

MN COVID-19 Positivity Rate, April 28th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

By the way, if you want to see the same graphs for your state click here, we pull nearly all of our own visuals from this report. Typically updated at the same time the evening’s post goes up.

Here are GA new cases.

Also, you can do it on your phone but it is much easier to navigate on a bigger screen.

Alright, so why look at Minnesota and Nebraska? Mostly to again indicate that there isn’t just one way to monitor COVID-19 in the US or one testing number to hit. Nebraska probably felt good about their testing until outbreaks in rural areas (their metro areas are faring much better, right now).

It’s interesting — and sad — by itself, but also instructive for every other state: rural areas are not spared.

April 28th, 2020. COVID-19 Cases in NE By Date
Source: Data by New York Times; Chart by JM Addington

We’re using a different chart for Knox County today, the only time series data we have is in tabular form is from the New York Times, which occasionally disagrees with KCHD’s website on any given day. As a whole, it’s accurate. However, looking at just the last 21 days gives you a better feel for just how gradual the growth is here.

Short of no new cases it is hard to imagine us doing any better.

Knox County total cases by day

April 26th, 2020 Knox County COVID-19 Cases
Source: Data from The New York Times; Chart by JM Addington

Nine county area cases by day.

April 28th, 2020 COVID-19 cases for Anderson County, Blount County, Grainger County, Jefferson County, Knox County, Loudon County, Roane County, Scott County, Sevier County and Union County
Source: Data from The New York Times; Chart by JM Addington

A Look at the Week Ahead

We said yesterday that the US would hit 1,000,000 cases, today we did.

President Trump signed an executive order ordering slaughterhouses to keep working. It’s a complicated issue, immigrants make up a disproportionate share of workers, Jeff Bender (UMN, Professor Division of Environmental Health Sciences) said today on a webinar that more than 20 languages were spoken at one of the recently closed plants. It doesn’t seem possible to physically distance and the plants and many of the works live in residences where physical distancing is difficult.

When you combine that with a hold on immigration for 60 days, ensuring that there even are workers available seems like it could be challenging.

Governor Lee issued Executive Order 30, which repealed most of his other orders. Gatherings of 10 or more or still prohibited (but churches, weddings, funerals, etc. are allowed). Gyms are allowed to open Friday at 50% capacity.

This order explicitly overrides any other county or city level orders except Davidson, Hamilton, Knox, Madison, Shelby and Sullivan counties.

Still Closed

  • Bars
  • Salons/spas
  • Night clubs
  • Bowling alleys
  • Concerts
  • Others similar to the above

Tennesseans have to stay committed to social distancing.

GOVERNOR Lee, April 28th, 2020

Governor Lee also confirmed that healthcare providers in Tennessee treated uninsured persons will be reimbursed by a combinations of federal and state funds.

Dr. Piercey spent a couple of minutes going over the importance of cloth masks, guidance we endorse.

Life Care Center in Athens is confirmed to have 51 ceases. All residents have been tested, all associates have testing available. This will almost certainly result in a lot deaths. The fatality rates go up significantly with age (see yesterday’s post).

Unemployment

Dr. McCord confirmed today that “if you don’t have a clear reason not to go back [to work],” you are not eligible for continued unemployment benefits. If you have a specific reason (i.e., you are a high-risk individual, that will be looked at on a case-by-case basis.

See the video for briefing highlights today.

https://youtu.be/X2sSnLQLxmo
Highlights of state and Knox Coutny briefings toay

As you head into Monday and May 1st remember what side you’re on: our side, humanity’s side. Think about what you can do to stay safe and protect others — a one-size-fits-all answer is probably the wrong one.

These posts helpful?

Then go ahead and share them where you saw them once or twice a week.

Get In Touch

Need help thinking this through? Access to more data? Help getting your technology in order to handle what’s here and what’s coming? Contact us today.

Other

Thanks to those that have shared kind words or liked these posts. We’re doing out best to put out data-driven analysis, each one of these takes about 2 hours. It’s helpful to know that they are being read.

If you want copies of the Excel sheet and PowerBI Reports we use to put these together email us, info@jmaddington.com. Right now, our PowerBI combines data from JHU, NYT, COVID Tracking Project, IMHE and the TN Department of Health. Most sets are updated daily.

This post skips numbers completely, we will have an abbreviated post later for that. Instead, we focus 100% on Knox County’s plan for re-opening.

Spoiler: we like it.

Knox County Phased Reopening Plan

The plan brings together guidance primarily from CDC and OSHA to present a unified re-opening plan for Knox County. The plan is more detailed and more conservative than the Tennessee Pledge.

There Knox County Plan outlines three Phases, each of which much last at least 28 days. Only Phase One is detailed at this point and all three phases commit to what the plan calls the Five Core Actions:

  1. Physical Distancing
  2. Wearing Cloth Face Coverings
  3. Handwashing
  4. Cleaning Surfaces
  5. Staying home if you are sick or instructed to stay at home
The plan authors see the plan as being nested inside larger guidance

The phased reopening is not a return to pre-pandemic normal. As an illustration, we are currently on an unsafe highway that was shut down to through traffic so resurfacing supplies and equipment could be gathered. The phased reopening is not a return to high-speed travel on I-40. The phases serve as different degrees of construction warnings. The reduced speeds and restricted lanes protect both the driver and those working on the road. Some degree of warning and modified lanes will exist until it is safe for both drivers and workers for the road to fully reopen at previous speed limits.

A Community Strategy for Phased Reopening, Knox County & City of Knoxville

In our own post yesterday, we noted how it would take a couple of weeks to observe the effects of re-opening. Each phase of this plans lasts a minimum of 28 days to give leaders time to observe the results of re-opening and make changes as necessary.

Each phase can also be adjusted mid-stream. For example, a phase may change seating capacity in a restaurant without entirely changing phases.

Local Benchmarks to Move through the Phases

Sustained reduction or stability in new cases for 14 days. “A sustained reduction or stability in new cases for 14 days is an indicator for movement towards the next phase.” Two things to note, the plan calls this an “indicator,” not an absolute, and, an increase in cases continues to be expected because of our low initial case count.

(We’ll also note that plan focuses on new cases, not cumulative cases, a metric we’ve followed for a few weeks for the same reasons the plan states)

Our community demonstrated success in flattening the curve before it truly started. Due to this initial success, future phases will result in increased numbers of active case counts. This alone is not a reason to revert to a previous phase or not advance to the next phase.

A Community Strategy for Phased Reopening, Knox County & City of Knoxville

[T]esting should prioritize those with symptoms, people who have been in close contact with a confirmed case, suspected cases in congregate living sites and health care workers.

A Community Strategy for Phased Reopening, Knox County & City of Knoxville

Community-wide sustained and increased diagnostic testing with consistent or decreased test result reporting turnaround time. The target is 24 hour turn-around time for tests (again, something we’ve said here for a few weeks) but acknowledges we can’t be there today.

Sustained or increased public health capability to rapidly interview new cases, identify close contacts, and ensure that isolation and quarantine are effective. In short, we need to be able to do contact tracing quickly. The plan calls for interviewing all new persons infected within 24 hours and notifying the people that they were in contact with withing 48 hours.

It is anticipated that employers and medical facilities will be asked to assist with contact tracing and monitoring for the benefit of the public.

A Community Strategy for Phased Reopening, Knox County & City of Knoxville

Health care system capabilities remain within current and forecasted surge capacity. If it looks like a surge of COVID-19 cases would push us over healthcare system capacity we can’t move forward. (This, more than anything, was the bedrock reason for lockdown in the first place).

Sustained or decreased COVID-19 related death rate for identified positive or probable cases. I.e., if a lot of new COVID-19 related deaths occur, we can’t move forward to the next phase.

A note on deaths and new cases, KCHD will consider clusters in context. For instance, if there was a spike in deaths in a contained place or geography that alone would not prohibit Knox County from moving to the next phase.

The plan balances capacity with disease burden; illustration by Chip Addington

For Organizations

Each organization should have its own COVID-19 coordinator.

Signage to enforce public health and safety should be put up.

An email list (listserv) will be available by May 1.

A COVID-19 recognition program will be available by May 1, to demonstrate that your organization is committed to the health of your employees and customers.

Key qualities of a coordinator include someone who will take action to implement the recommended measures, stay aware of changes to recommendations through the official communication channels on the website, and has the authority to reinforce the need to follow the measures on an ongoing basis throughout the reopening phases.

A Community Strategy for Phased Reopening, Knox County & City of Knoxville

Phase One

Every industry should:

  • Clean everything between uses
  • Put up signs and barriers (signs to remind people socially distance, wash hands; barriers like what you see at Kroger, etc. now)
  • Wear masks when unable to physically distance (stay 6′ apart)
  • Telework when possible
  • Close common areas
  • Screen employees daily for symptoms
  • Require COVID-19 infected employees to stay home (you do not need a negative test to return to work, see plan for details)

What’s Open

  • Offices
  • Restaurants at 50% capacity
  • Salons/spas/tattoo parlors by appointment only and only for services where a face covering can be worn
  • Retail at 50% capacity and only for services where a face covering can be worn
  • Gyms at 5 patrons per 1,000 square feet, only when staffed, patrons must stay 6′ apart, and patrons must be wearing masks at all times
  • Theaters, museums, etc., at 50% capacity
  • Childcare facilities
  • Schools
  • Parks, trails, dog parks, but not their playgrounds
  • Zoo but not classes or the petting zoo
  • Golf courses
  • Skate parks
  • Buses
  • Airplanes
  • Taxies and rideshare
  • Religious “core services” at 50% capacity. (All of page 24 addresses religious institutions. It references WHO guidance, which your author has previously read and believes is quite insightful)

What’s Closed

  • Concerts
  • Sports
  • Summer Camps
  • Pools, splashpads, beaches
  • Playgrounds
  • Libraries
  • Community centers, except as needed to provide social service support to individuals (for example, food distribution)
  • Senior Centers
  • Religious related gatherings except for “core services”
  • Trade shows, conferences, workshops and retreats
  • Festivals, carnivals, conventions
  • Rallies, parade, speeches
  • Potlucks, youth group, etc.

Other

  • Gatherings such as birthday parties: no more than 10 people
  • Higher ed: follow state and federal guidance
  • Residence halls and other overnight programs: follow state and federal guidance

High Risk Individuals

…individuals must consider their personal risk and determine whether to increase their interactions in the community as phases progress… In Phase One and Phase Two, [the guidance is] to stay at home as much as possible. In Phase Three, this means resuming public interactions with physical distancing…

A Community Strategy for Phased Reopening, Knox County & City of Knoxville

Higher-risk individuals include those over the age of 65, and those with serious underlying health conditions, such as high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised.

A Community Strategy for Phased Reopening, Knox County & City of Knoxville

One editorial note here: mortality risk starts increasing closer to 50 years old [1] rather than 65. We assume that case complications (i.e., negative outcomes that aren’t death) also increase with age.

New York City COVID-19 Deaths by Age, April 26th, 2020
Source: New York City Health Department

Phases Two & Three

Further guidance will be released; today, the plan is pretty scarce here. Phase two allows gatherings up to 50 people, and phase three up to 100. Other than that, phases two and three say to keep doing all of the other things (cleaning, physical distancing, hand washing, etc.)

The following [indstury specific guidance for phases two and three] will be added by amendment following a collaborative community process. This process will allow our community to address emerging challenges and … allow our community to incorporate new state and federal guidance. The COVID-19 coordinator email listserv will be the main way employers and others can contribute ideas for the development of Phase Two and Phase Three…

A Community Strategy for Phased Reopening, Knox County & City of Knoxville

Our Take

This is an incredibly balanced approach and is we’d expect to have seen from the state or federal level: it’s much better than what else is out there. Cities and counties across the state or the nation can and should model their own plans in a similar fashion. The benchmarks do a good job balancing our capacity to handle COVID-19 with the spread and burden of COVID-19.

Our Guide

You can download a copy of our own internal operations guide on this page.

Get In Touch

Need help thinking this through? Access to more data? Help getting your technology in order to handle what’s here and what’s coming? Contact us today.

Other

Thanks to those that have shared kind words or liked these posts. We’re doing out best to put out data-driven analysis, each one of these takes about 2 hours. It’s helpful to know that they are being read.

If you want copies of the Excel sheet and PowerBI Reports we use to put these together email us, info@jmaddington.com. Right now, our PowerBI combines data from JHU, NYT, COVID Tracking Project, IMHE and the TN Department of Health. Most sets are updated daily.

[1] This is even more clear in other datasets, such as this.

It is the eve of Tennessee opening up, kind of, and the beginning of the US opening up, kind of.

As we head into we are seeing both cases and testing go, but positivity rates decline. We’ll break some of that down. After that

Numbers

Both the US as a whole and Tennessee are seeing new cases per day rise. The positivity rate (positive cases/number of tests) in the US has ticked down in recent days, now close to 12%. We’ll note that we use a rolling 7-day average for positivity rate, other outlets use total numbers, which will yield very different results. A rolling average only measures the last week and is biased towards how testing is going now, a cumulative approach will bias the rate towards when their were the most positive cases and least testing, which would be around late March.

We’re biased towards the average approach because we believe it does a better job of explaining where things stand today, but, remember we’re IT guys and not epidemiologists.

Also, to put this in context, Dr. Fauci stated over the weekend that he’d like to see a 10% positivity rate to think that we’re doing enough testing, he thought that our national testing would need to about be doubled.

Click on any image to see it larger.

US New Cases by Day

Source: Data from The COVID Tracking Project; Chart by JM Addington

US COVID-19 Positivity Rate by Day

US COVID-19 Positivity Rate, April 26th, 2020 by JM Addington Technology Solutions`
Source: Data from The COVID Tracking Project; Chart by JM Addington

Tennesse spikes in cases for a fourth day. The first two of these were, “expected,” according to Dr. Piercey last week. We don’t know what is driving the weekend numbers: test results take at least 2-3 days to get back to patients and sometimes longer to get back to the state, so it is not this weekend’s testing drive pushing cases up.

Balancing out the spike in cases is a flat-ish positivity rate. At 5% positivity rate (7% cumulative) Tennessee: we make up 2.72% of all US tests and 1% of all US COVID-19 cases.

TN New Cases

Source: Data from The COVID Tracking Project; Chart by JM Addington

TN Positivity Rate (about 5%)

TN COVID-19 Positivity Rate, April 26th, 2020 by JM Addington Technology Solutions`
Source: Data from The COVID Tracking Project; Chart by JM Addington

By the way, if you want to see the same graphs for your state click here, we pull nearly all of our own visuals from this report. Typically updated at the same time the evening’s post goes up.

Here are GA new cases.

Also, you can do it on your phone but it is much easier to navigate on a bigger screen.

The Knoxville area continues to see a slow growth in cases. New cases in several of the surrounding counties, Sevier has more than Knox Saturday.

Knox County total cases by day

Source: Knox County Health Department

Nine county area cases by day.

April 26th, 2020 COVID-19 cases for Anderson County, Blount County, Grainger County, Jefferson County, Knox County, Loudon County, Roane County, Scott County, Sevier County and Union County
Source: Data from the New York Times; Chart by JM Addington

A Look at the Week Ahead

The US will hit one million total cases this week, probably Tuesday or Wednesday. Keep in mind that this number can’t go down. New cases are a useful metric, total cases less so.

New PPP starts tomorrow, Monday, April 27th. Expect this round of funding to go fast.

Get your paperwork in order today and be working with a bank that wants to help you.

In Tennesee, counties that are overseen by the state health department open restaurants tomorrow and retail Wednesday. Knox County and Knoxville will hold a press conference tomorrow to discuss their plan, which is expected to be close to the state’s plan.

There is a rhythm to the COVID-19 news cycles. In the middle of March things changed so quickly that, as a business, information that was accurate at 10:00 AM could completely different by noon — no exaggeration. By early April pretty much everything was shut down and there was a lull in the actual news being reported.

As things open up, expect change to come rapidly and for news to be contradictory.

Also, keep in mind that we won’t be able to judge how opening up affects cases for a couple of weeks. The median time from exposure to symptoms is four to five days (NIH), test results take anywhere from two to five days to turn around. (4 to 5) + (2 to 7) = 6 to 12 days before early results come in.

“The lockdowns cannot go on forever. They buy us time… in themselves they are not an exit strategy.”

Jeremy Farrar, Director of the Wellcome Trust (UK)

“We may not get it right the first time. We may not get it right the second time. But I fear we’re going to have multiple opportunties to get it right.

Dr. Osterholm

We have one overriding thought as we enter a busy and possibly contentious week, here it is:

There isn’t Team Open and Team Stay Home.

This isn’t Red vs Blue.

This is us against the virus.

This is COVID-19 vs humanity.

Even when we’re under lockdown we have to go out and even as we venture out we’ll have to stay home from many things.

As you head into Monday and May 1st remember what side you’re on: our side, humanity’s side. Think about what you can do to stay safe and protect others — a one-size-fits-all answer is probably the wrong one.

Get In Touch

Need help thinking this through? Access to more data? Help getting your technology in order to handle what’s here and what’s coming? Contact us today.

Other

Thanks to those that have shared kind words or liked these posts. We’re doing out best to put out data-driven analysis, each one of these takes about 2 hours. It’s helpful to know that they are being read.

If you want copies of the Excel sheet and PowerBI Reports we use to put these together email us, info@jmaddington.com. Right now, our PowerBI combines data from JHU, NYT, COVID Tracking Project, IMHE and the TN Department of Health. Most sets are updated daily.

Today will be a short post. We’ll hit the main numbers and then hit primary headlines for the day.

Before we get to get any of that, the National Academy of Sciences is holding their 157th Annual Meeting online this year. You can register for Saturday and Sunday sessions for free.

The 2:00-3:30 EDT session is on COVID-19 and includes Dr. Faucci (schedule permitting), Dr. Jeremy Farr and the Director-General of the Chinese CDC.

Register here.

If you’re reading our updates we literally can’t imagine why you wouldn’t want to hear from these guys.

Numbers

The US as a whole is just flat. The US positivity rate continues to drop, a sign that, maybe, national testing capacity is going to where it needs to be.

Click on any image to see it larger.

US New Cases by Day

US COVID-19 Cases and 7 Day Rolling Average, April 23rd, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

US COVID-19 Positivity Rate by Day

US COVID-19 7-Day Average Positivity Rate, April 23rd, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Tennesse spikes in cases for a second day. Dr. Piercy indicated that this was expected and a result of testing a correctional facility. The positivity rate didn’t go up, which is a good thing. Also, Dr. Piercey stated that the weekend testing positivity rate was less than 2%. So, that’s not anywhere near a controlled study or randomized sample size, but the low rate is most likely a good indicator Tennessee as we move towards opening up.

TN New Cases

TN COVID-19 Cases and 7 Day Rolling Average, April 23rd, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

TN Positivity Rate (about 7%)

TN COVID-19 Positivity Rate, April 21st, 2020 by JM Addington Technology Solutions`
Source: Data from The COVID Tracking Project; Chart by JM Addington

By the way, if you want to see the same graphs for your state click here, we pull nearly all of our own visuals from this report. Typically updated at the same time the evening’s post goes up.

Here are GA new cases.

Also, you can do it on your phone but it is much easier to navigate on a bigger screen.

The Knoxville area continues to see a slow growth in cases. New cases in several of the surrounding counties.

Knox County total cases by day

Source: Knox County Department of Health

Nine county are cases by day.

April 23rd, 2020 COVID-19 cases for Anderson County, Blount County, Grainger County, Jefferson County, Knox County, Loudon County, Roane County, Scott County, Sevier County and Union County
Source: Data from the New York Times; Chart by JM Addington

National/International News

The biggest piece of news today is that a New York serological study (antibodies) estimates that nearly 14% of residents have had COVID-19. Real epidemiologists on Twitter believe that this is in line with their expectations.

The CDC director publically said that 19-20 states may be ready to re-open by May 1st. He didn’t name Tenessee specifically.

“There are a number of states – 19, 20 states – that really have had limited impact from it. So I think we will see some states that are, the governors feel that they’re ready, we’re poised to assist them with that reopening,

Dr. Robert Redfield

The House passed the stimulus package the Senate has already passed which includes over $320bn for the Paycheck Protection Program. We assume that it is headed for reconciliation before hitting the president’s desk.

Get your paperwork in order today and be working with a bank that wants to help you.

We spent part of the day helping another small business get their application done. We’d be glad to help you too, however we can.

Bloomberg is reporting that meat is headed for a shortage. Pork output is down 25% and beef down 10%. We wrote about this yesterday and Monday.

Pork could be a long shortage because farmers will have to decide soon if they need to kill their current piglets, or try to raise them when there aren’t plants to slaughter and package them in the future. Farmers are more likely to keep cows, but that doesn’t address the shortages in bee production, or the increasing amount of beef purchases as pork output slides.

“What people don’t realize is in the coming months, that’s going to be one the biggest issues out there is getting the meats and provisions, for not only restaurants, I hate to say it, but grocery stores as well,” said Peter Cancro, chief executive officer of Jersey Mike’s Franchise Systems Inc

Bloomberg

Poultry can ramp up the fastest, however, the plants all share a common problem of simply being set up for physical efficiency: physical distance was never the goal when designing the slaughterhouses, so COVID-19 can spread easily in these settings.

Meat prices are already low and feeding animals that can’t sell along with competition from meat imports will continue to hammer farmers who are already hurting. Finally, if North Carolina has the same problems with its pork plants then the meat issues supply chain disruption will get worse.

Two of the top ten pork slaughterhouses are in NC.

NC New COVID-19 Cases by Day

NC COVID-19 Cases and 7 Day Rolling Average, April 23rd, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Knox County News

Out of today’s health briefing this exchange was the most interesting:

Dr. Buchanan on opening up: “I think there are a couple of things going on that make us feel comfortable with taking this step. One is that we never had a big peak. We had a slow increase in the number of cases and that’s pretty much stayed the same. We haven’t had any big shift in that.”

“So we believe that it’s safe to re-open, we’ll continue to see that slow increase, hopefully not have a peak. If we do we’ll have to take measures to adjust the re-open.”

Also, to be honest, closing down businesses was never a long-term solution to keeping the COVID-19 numbers down. Its really important for us to do contact tracing, getting folks who are at risk out of the population so we can stop that transmission. When you look at other countries where they’ve had to do these things related to HIV or Ebola, getting those people that might make other people sick out of the general population is really how you stop that chain of transmission. That’s what my team and our community is working to do.”

Dr. Osterholm’s weekly podcast came out yesterday and made a similar case (broadly, not specific to Tennessee).

“We have to understand: we’re going to open up. We cannot exist in a closed down mode for how many many months before we get a vaccine that could, in a sense, rescue us from this virus.”

Dr. Osterholm, Osterholm Update: COVID-19 Episode 5: Living with the Virus April 22, 2020

“We’re only maybe in the second inning of this ballgame.” He views this as a gradient where we open some, close some, open some, close some.

“We may not get it right the first time. We may not get it right the second time. But I fear we’re going to have multiple opportunties to get it right.

Dr. Osterholm

Likewise, he points out that there isn’t (or shouldn’t be) Team Open and Team Stay Closed. We’re all doing our best to get through this together, and we will.

Osterholm Update: COVID-19 is available on Apple PodcastsSpotify and Google Play.

“It’s us against the virus.”

Dr. Osterholm

“At the same time we have to face the reality of what this virus can do and how it does it. It is not going to go away… therefore, what we have to figure out is how we let it exist with us so that we try to suppress it so that we hope to get to a vaccine at some point, but at the same time release people into the public.”

Dr. Osterholm

Get In Touch

Need help thinking this through? Access to more data? Help getting your technology in order to handle what’s here and what’s coming? Contact us today.

Other

Thanks to those that have shared kind words or liked these posts. We’re doing out best to put out data-driven analysis, each one of these takes about 2 hours. It’s helpful to know that they are being read.

If you want copies of the Excel sheet and PowerBI Reports we use to put these together email us, info@jmaddington.com. Right now, our PowerBI combines data from JHU, NYT, COVID Tracking Project, IMHE and the TN Department of Health. Most sets are updated daily.

Today we will hit the numbers, briefly, they look the same as yesterday. We will hit the same core numbers for GA that we hit for Tennessee, today. Then we’re going to hit a scattershot of news items.

Numbers

The US as a whole is just flat. The US positivity rate dropped, a sign that, maybe, national testing capacity is going to where it needs to be.

Click on any image to see it larger.

US COVID-19 Cases and 7 Day Rolling Average, April 22nd, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington
US COVID-19 7-Day Average Positivity Rate, April 22nd, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

To add some subtly to this data, if we take out NY & NJ where we are probably post-peak the US new cases are going up and new deaths are mostly up, not peaked. Without digging in too far, it looks like MA, CA, IL, PA & CT are pushing up the cases. CA, CT, IL, MA, PA and LA are pushing up on deaths.

US 7-Day Averages of New COVID-19 Deaths and Cases by Day
Source: Data from The COVID Tracking Project; Chart by JM Addington
US 7-Day Averages of New COVID-19 Deaths and Cases by Day without NY & NJ
Source: Data from The COVID Tracking Project; Chart by JM Addington

Tennessee continues to look a lot like the US a whole, more flat than really down. We make up such a small sliver of deaths that you can’t find us on the last chart.

You’ll see a spike in cases today (and corresponding the positivity rate), Dr. Piercy indicated that this was expected and a result of testing a correctional facility.

TN New Cases

TN COVID-19 Cases and 7 Day Rolling Average, April 22nd, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

TN Positivity Rate (about 7%)

TN COVID-19 Positivity Rate, April 21st, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Deaths by State

April 22nd, Total US Daeths of COVID-19 by State; Chart by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Georgia looks a lot different than Tennessee. New cases are barely down from the peak and currently headed up. Deaths are sharply up since cases peak, and the positivity rate is over 20%. We haven’t been following GA closely or watching their briefings so maybe there are great reasons for all of this. This is why you see polite scientists puzzled over GA opening up in two days and rude ones incredulous.

The opening plan is also quite different than Tennessee’s.

Gyms, nail salons, bowling alleys, hair solans, tattoo parlors. It feels like they collected a list of the businesses that were most risky and opened those first.

Dr. Scott Gottleib, co-author of AEI paper on opening up US

So what? The national media don’t always report on Tennessee and Georgia differently; it is important that regionally we understand the stark differences in the data and plans of each state. Additionally, if this goes poorly for Georgia it could affect neighboring states in the same way we see the New York outbreak affecting the entire New England region.

GA New Cases

GA COVID-19 Cases and 7 Day Rolling Average, April 22nd, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

GA Positivity Rate (almost 20%)

GA COVID-19 7-Day Average Positivity Rate, April 22nd, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

By the way, if you want to see the same graphs for your state click here, we pull nearly all of our own visuals from this report. Typically updated at the same time the evening’s post goes up.

Here are GA new cases.

Also, you can do it on your phone but it is much easier to navigate on a bigger screen.

The Knoxville area continues to see a slow growth in cases. That’s actually Anderson County pushing up the regional graph. Again, one day is not a trend.

Knox County total cases by day

Nine county cases by day.

April 22nd, 2020 COVID-19 cases for Anderson County, Blount County, Grainger County, Jefferson County, Knox County, Loudon County, Roane County, Scott County, Sevier County and Union County
Source: Data from the New York Times; Chart by JM Addington

National/International News

Today is a lot of small and important things.

A Boston physician wrote in The Washington Post about how it is nearly impossible to quarantine at home and not infect your family.

The SBA had a data breach and leaked data of at least 8,000 loan applicants. Typically, in the IT world, we see those estimates rise, not fall. Our director of operations got a text message on his personal cell purporting to be from the bank we got the EIDL processed at.

The IT industry has also seen a steep rise in COVID-19 scams: we personally know people that have lost nearly $2,000 in gift card scams. Typically, an spoofed acquaintance or supervisor texts or emails a friend or colleague and asks them to buy gifts at a retail store, scratch off the codes and send photos of the back of the cards. This is a scam every single time.

President Trump announced that National Parks will be re-opening. We hope that this means the Smokies are open again soon.

Tyson is closing its largest pork planet, in Waterloo, IA in response to an outbreak there. They will be closing a second pork plant in Indiana by end of week. A different Tyson plan in IA came back online after being shut down earlier this month.

We probably won’t keep reporting on meat plants every day. Like the state shuts down in late March we expect the biggest news to be when they get a handle on COVID-19, not when another one shuts down. And yes, expect shortages (pork, beef, then poultry) but not an apocalypse.

There are reports of COVID-19 causing blood clotting in patients, and strokes among people in their 30’s and 40’s. First, signs of a stroke are something you should always take seriously, COVID or no COVID. Second, don’t draw conclusions until the scientists have done so. The widespread nature of COVID-19 means that lots of other issues are going to naturally be present in the infected population.

The CDC director warned that a second wave of COVID-19 may be coming. We really dislike headlines with “may,” however, another leading scientist, Dr. Osterholm, made the same point on a webinar today. He cautioned that of the last ten pandemics, all of them had a second wave about six months after the first wave regardless of when they first were introduced.

Multiple sources are reporting that Santa Clara County in the Bay area had its first COVID-19 death on February 6th. This is a full 21 days earlier than what was though to be the earliest death from COVID-19. Given that death lags initial exposure by 2-3 weeks, COVID-19 may been circulating in the US mid January.

Knox County News

The Mayors of Knox County and each county that adjoins it held a press conference today to speak about opening up. The mayors of Knoxville and Faragutt were also in attendance. Only the Grainger County was missing, unable to attend.

Each mayor spoke off of the same set of talking points:

  • We can’t let social distancing
  • It’s time to get back to work
  • We support Governor Lee

Other than their work on presenting a unified front no news came out of the press conference.

“We are under no illusions COVID-19. It is here and is something we will have to deal with for the foreseeable future. We encourage everyone to adhere to the prescribed health guidelines and to act responsibly to keep yourselves, your loved ones, and your community healthy.”

Knox County Mayor Jacobs

“I basically just want to get up here and say ‘ditto.'”

Union County Mayor Jason Bailey
Knox County Mayor Glenn Jacobs speaks at press conference on regionally opening-up

“We define that as prolong contact with a confirmed case. Or being less than six feet [apart] for more than ten minutes… Exposure is not just walking by someone in a grocery store or stopping by and staying 6 feet away and saying hello. That does not count as an exposure.”

Charity Menefee, Director, Communicable and Environmental Disease and Emergency Preparedness, Knox County

We would like to prioritize testing for people with COVID symptoms. Those are really people that have cough, fever, shortness of breath. They may have bodyaches, headaches, sore throat. They may have loss of taste or smell… we also want to talk about people who have been in close contact to confirmed cases of COVID-19 and healthcare workers.

Charity Menefee, Director, Communicable and Environmental Disease and Emergency Preparedness, Knox County

Likewise, the KCHD daily briefing had few new insights, other than a concise definition of exposure by Director Menefee.

KCHD has identified ZIP code 37915 as having the fewest tests by ZIP code in Knox County. We note that is it is mostly black, with a $12,000 per capita income. KCHD will be holding a free walk-in or drive through testing event Saturday, 10 AM – 2PM at The Colosium.

Yesterday the state announced a task force to focus on racial and ethnic discrepancies in health care in the face of COVID-19.

The Tennessee briefing, likewise, was light on new news. TDH will begin releasing numbers on cases and deaths in long term care facilities. Governor Lee took the first several minutes to go over how Tennessee stands in regards to the White House’s Gating Criteria.

We think it was great for Lee to address this directly. Our detailed post yesterday holds up well, with Lee adding some numbers to criterion #3 regarding hospitals.

Again, both Lee & Piercy talk about Tennessee’s slow growth rate of new cases which isn’t actually one of the criteria. However, as we noted on our live post on the topic, we don’t think that Dr. Piercy and Governor Lee are looking up the opening criteria on the White House website when they have a direct line to VP Pence. It’s not an issue that they chose to use a different criterion, it would be clearer if that just said as much.

Here is our live post on the briefing if you want more details, or watch it on YouTube here.

“For the past three weeks both flu like symptoms and COVID symptoms have steadily declined within the vast majority of our hospitals.”

Governor Lee, explaing that Tennessee clears criterion #1

“Over the last 19 days we have had a steady decline in the growth rate of new COVID-19 cases in Tennessee.”

Governor Lee, explaing that Tennessee clears a proxy value for criterion #2

“Here we look at the ability of our hospitals to both treat all patients without crisis care or relying on surge capacity. To date, we’ve had 775 of our 7840 hospitalized. Through these hospitalizations, we’ve kept a close watch on the capacity of every one of our hospitals and they continue to deliver on care without a change in their normal operations.”

Governor Lee, explaing that Tennessee clears criterion #3

Finally, a friend of mine posted a story her battle with COVID-19 on Facebook. Her case was not typical of someone her age. Neither is it uncommon.

It’s a long post, sharing some of my story. This may be difficult for some to read, so please hide this post if it’s too…

Posted by Lexie Goertzen on Tuesday, April 21, 2020

Get In Touch

Need help thinking this through? Access to more data? Help getting your technology in order to handle what’s here and what’s coming? Contact us today.

Other

Thanks to those that have shared kind words or liked these posts. We’re doing out best to put out data-driven analysis, each one of these takes about 2 hours. It’s helpful to know that they are being read.

If you want copies of the Excel sheet and PowerBI Reports we use to put these together email us, info@jmaddington.com. Right now, our PowerBI combines data from JHU, NYT, COVID Tracking Project, IMHE and the TN Department of Health. Most sets are updated daily.

Today we will hit the numbers, briefly, they look the same as yesterday. We’re going to go over a couple of brief news items and then dive into Tennessee opening up – -again. On this final topic we’ll jump into the specific gating criteria that the White House has issued and Governor Lee’s take on where we are on it.

Numbers

The US as a whole is just flat. In one big what this isn’t a surprise: mobility data from Google and Unacast both show the US plating on social distancing in late March. If confirmed cases lag exposure time by two to three weeks then our confirmed cases roughly match the change in our behavior.

Click on any image to see it larger.

Source: Data from The COVID Tracking Project; Chart by JM Addington

Here is the same chart set to the last 21 days. The peak is still visible but the falloff looks very horizontal.

Source: Data from The COVID Tracking Project; Chart by JM Addington
Source: Unacast
Source: Google

Tennessee isn’t that much different, just on a much smaller scale. We’ve been saying for weeks that the situation in New York, New Jersey, etc., is not the same as the US as a whole and the data continues to bear that out. Four states make up over half of the total US Cases of COVID-19 to date. NY & NJ make up about half of the total deaths.

Notably, it seems that most of the arguments on social media completely ignore the data and make arguments based on New York, or the entire US and apply it to a specific geography. In many ways, it makes sense to consider each state as its own country when trying to make comparisons.

TN COVID-19 Cases and 7 Day Rolling Average, April 21st, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington
Last 21 days: TN COVID-19 Cases and 7 Day Rolling Average, April 21st, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington
April 21st, Total US Cases of COVID-19 by State; Chart by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Tennessee, too, had massive differences in caseload from one region of the state to another. The entire area around Nashville is affected, while the outlying counties of Shelby County remain relatively low — compared to Shelby.

Source: Tennessee Department of Health

By the way, if you want to see the same graphs for your state click here, we pull nearly all of our own visuals from this report. Typically updated at the same time the evening’s post goes up.

Here are GA new cases.

Also, you can do it on your phone but it is much easier to navigate on a bigger screen.

The Knoxville area continues to see a slow growth in cases:

April 21st, 2020 COVID-19 cases for Anderson County, Blount County, Grainger County, Jefferson County, Knox County, Loudon County, Roane County, Scott County, Sevier County and Union County
Source: Data from the New York Times; Chart by JM Addington

Knox County specifically, looks the same. We’ll give you the Health Department’s ZIP-code based map with some major caveats:

  • This could reflect access to testing more than actual cases counts
  • ZIP codes are made for mail delivery, not geography
April 21st, 2020 COVID-19 Cases in Knox County by Knox County Public Health Department
Source: Knox County Public Health Department
April 21st, 2020 Knox County COVID-19 Cases by ZIP Code, by Knox County Health Department
Source: Knox County Health Department

We’d be surprised if the Knox County cases did not jump by late this week of early next. KCHD added 800 tests to the total in the last two days but has a lag of at least four to five days to get results. If the positivity rate continues to be above 5% that’s at least 40 “new” cases from two days of testing. That will look pretty big on a bar chart, it doesn’t mean anything changed except our perception of reality.

Also, all 800 of those people are supposed to be self-isolating. If you’re sick enough to get tested you’re sick enough to be at home.

Knox County News

Dr. Buchanan does a great job at these press briefings. She is always calm and steady. Today, she announced that Knox County will new renew the stay-at-home order but instead follow the plans that the state lays out.

“Re-opening is not a return to pre-pandemic levels of activity.”

Dr. Buchanan, KCHD

Testing demand was high enough at the drive-through location that KCHD has made testing by appointment only (call 865-215-5555). KCHD ran out of testing supplies, at the state briefing Dr. Piercey confirmed that more supplies would be delivered by Thursday.

Could churches resume normal services this weekend? “Not at this time.”

“[Flattening the curve is] not about no new cases.”

Dr. Buchanan, KCHD

“Closing things down was not a long term solution.”

Dr. Buchanan, KCHD

Dr. Buchanan went out of her way nearly every other answer to emphasize that social distancing must continue and that this is an everybody effort not a governmental effort.

Subscribe on YouTube here if you want to see the briefings live.

“A lot of this rests on the community… everybody has to do their part.”

Dr. Buchanan, KCHD

National/International News

Hong Kong, the population of TN inside the footprint of Nashville, went from zero new cases yesterday to four today and responded by extending their social-distancing rules. Also, their restaurants are still open.

“This is not the time to be complacent,” Lam warned. “If we relax, the good work that we have done will be in vain. That’s why the bans, that would have expired on April 23, will now be extended by two weeks.”

The South China Morning Post

Singapore is in a similar boat, with 5.7m people they’ve extended a partial shutdown through June 1. With over 9,000 cases they have many more than Hong Kong, but four in five of them are in dormitories for migrant workers.

“To our migrant workers, let me emphasise again: we will care for you, just like we care for Singaporeans.”

Singapore’s Prime Minister Lee Hsien Loong

The US Senate has reached a deal with the White House to deliver $500bn more in “interim” COVID-19 aid (The House has not voted on it). You can click on the link for details. If you have not applied for the EIDL and PPP find a bank today to work with and get your financials ready today. We’ve done both, been approved for the PPP and would be glad to offer assistance.

Today we received both our “forgiven” EIDL advance ($6,000) and our PPP funds (about 10 weeks worth of payroll). I want to thank Chester at First Horizon Bank and all of the staff at Mitch Reed & Associates for their combined help. This is the only time in my life I’ve gotten non-automated emails from banks at midnight, or 6:00 AM on a Sunday.

We got our financials ready early, before there was a PPP. We probably wrote about it a month or so ago. It was worth it.

Tennessee Opens Up, in a Week

Today’s briefing state-level was something else, with more educated questions from reporters than I have heard yet.

Governor Lee promised more guidance on what businesses could open up on Monday before the end of the week. He went out of his way to emphasize that social distancing, working from home, cloth masks and hand washing all need to continue.

He said that the state is providing $10m in relief for rural hospitals and that at least $7m is expected from the federal government.

The rest of this post is going to get heavy into numbers, definitions and the White House’s gateway criteria. If you like all of that read on. If not, Tennessee only kind of meets all the criteria and that is probably OK.

“While we want to have everything open as soon as possible we will continue to discourage social gatherings of ten or more and will continue to restrict visitors at nursing homes and hospitals until further notice.”

Governor Lee

Gateway Criteria and Tennessee

Yesterday we quoted a Harvard paper that we believe that White House guidance was based on, today we’ll actually look at the official White House guidance on opening up.

SYMPTOMS [Criterion 1]

Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period

AND

Downward trajectory of covid-like syndromic cases reported within a 14-day period

White House Proposed State or Regional Gating Criteria

The White House here is referring to symptomatic surveillance. This is, in short, getting doctors’ offices and other care providers to report on cases where a patient shows a certain set of symptoms. We do this with the flu already [ILINet]: we’re not going to get everyone tested, but by getting providers to report “flu-like” symptoms we can gain a macro-level view of how it’s spreading.

Helpfully, the CDC already has data and maps available to see flu-like cases around the country, here is last week. Tennessee has moved from “High” at the beginning of the month to “Low” last week.

So, Tennessee is a go on the flu-like symptoms.

COVID-19 symptoms? We have no idea. If that’s being tracked in the same way we haven’t found it yet. The CDC page for COVID-19 surveillance actually shows the same map as the flu page.

Also: keep in mind that “surveillance” is being used in a technical sense here. There is probably a PR reason that the White House avoided using it.

Source: CDC

HOSPITALS [Criterion 3]

Treat all patients without crisis care

AND

Robust testing program in place for at-risk healthcare workers, including emerging antibody testing

White House Proposed State or Regional Gating Criteria

We’re going to define “Crisis care” to begin:

“Crisis standards of care” is defined as a substantial change in usual healthcare operations and the level of care it is possible to deliver, which is made necessary by a pervasive (e.g., pandemic influenza) or catastrophic (e.g., earthquake, hurricane) disaster.

National Academy of Sciences (2010)

We can’t speak for the whole state, as far as we know Tennessee is meeting this criterion. However, probably only a handful of people in the state could speak authoritatively on it, as each hospital would have its own standards for operating in this mode or not.

“Robust” [PCR] testing: We clearly have enough tests and capacity in Tennessee to meet this criterion. The only catch is that Dr. Piercey said that labs are taking 2-3 days to get back to patients, which is 1-2 days too long. Assuming that they are prioritizing healthcare workers so results can be delivered in 24 hours we’d be in good shape here.

“Emerging antibody testing,” I don’t think this means anything, today. Serological testing is the term and only a single test claims to have a specificity high enough to make it valuable. As Dr. Scott Gottleib put it to CNBC, with a 5% (real) infection rate a test with a 95% specificity rate would return more false positives than true negatives. There are no published peer-reviewed studies on COVID-19 serological testing right now.

The one study that has been done and claims a proper specificity was widely panned by epidemiologists on Twitter.

It’s probably too early to have an informed opinion on serological testing other than to say we don’t know that we know a good test exists anywhere in the world.

That means Tennessee is a go on the third criterion, let’s return to the second.

CASES [#2 Criterion]

Downward trajectory of documented cases within a 14-day period

or

Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests)

White House Proposed State or Regional Gating Criteria

So, there are two ways you can interpret that first statement, ACTIVE cases (Total cases ever, subtract people who recovered or died) or New Confirmed Cases. From other published literature we believe that this second interpretation is correct.

We’ll go ahead and look at both numbers.

“Downward trajectory of documented cases within a 14-day period”: Tennessee technically meets this, if you look at just the start and end date. We had 256 7-day average of new cases on April 9th and 224 7-day average of new cases today. Saturday, April 19th we were still at 252 for the average, and April 13th we were at 258.

So, on this one, it may depend more on your definition of “trajectory” than anything else.

TN COVID-19 Cases and 7 Day Rolling Average, April 21st, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

We’re going to address a data quibble here. Dr. Piercey and Governor Lee do themselves no favors when they continue to mention 18 sustained days of single percentage increases in new cases. First, it confuses everyone because only Tennessee alludes to this as some sort of criterion, it certainly isn’t in the official guidance.

Secondly, a percentage where you add roughly the same amount to the numerator and denominator every iteration will naturally decline. If we add 250 cases each day and measure our “day on day percentage increases” we’d have 50% on day 1, 33% on day 3, 25% on day 4 and so on.

That quibble aside, both Lee and Piercey clearly have a handle on the other numbers which are more meaningful. We’ll continue.

“Downward trajectory of positive tests as a percent of total tests within a 14-day period”, this is positive tests divided by total tests, called the positivity rate.

The positivity rates is an indicator of (1) if you are doing enough testing, and (2) how many more cases you may find if you test more. [Edit: For context, the US is over 20%, South Korea is 2%, Germany 7% and Tennessee about 6%. That puts us at well below the national rate but above where we would be in a perfect world. Georgia is over 20% as well.]

Like new cases, this is technically a pass, or it depends on what “trajectory” means, if you just look at April 9th (14 days ago) and today. If you look at April 15th and 17th things are flat overall, and yesterday we were still basically the same.

In both cases, the data today say that our trajectory is more horizontal than downwards vertical.

TN COVID-19 Positivity Rate, April 21st, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Our Current Interpretation of the White House Criteria and Tennessee

It’s clear that both Dr. Piercey and Governor Lee have a handle on the numbers as a whole. Even the Governor was able to answer a question off the cuff yesterday on Tennessee’s COVID-19 numbers.

“Social distancing… is way more important than the numbers on a chart.”

Dr. Piercey

Second, the criteria are intentionally very broad and open to local interpretation. Let’s look at NY & TN on the same graph for once.

State and local officials may need to tailor the application of these criteria to local circumstances (e.g., metropolitan areas that have suffered severe COVID outbreaks, rural and suburban areas where outbreaks have not occurred or have been mild).

White House Proposed State or Regional Gating Criteria
Source: Data from The COVID Tracking Project; Chart by JM Addington

You have to zoom in to even see that the dark blue line that is Tennessee is not the X-axis. The point is that the application of the criteria will and should vary.

Finally, and both of these points cannot be repeated enough: the end of the lockdown doesn’t mean an end to social distancing the lockdown was never about stopping COVID-19, it was and is about not overwhelming our healthcare system.

This is a higher bar. As Vanderbilt has said, our current state is “fragile,” and it won’t take much to return to a pandemic level. Tennesseans also aren’t social distancing more today than we were two weeks ago, it’s not clear that the lockdown continues to be effective to this end. Likewise, whatever progress we have made and will make come from social distancing measures and fantastic hygiene not a mandated lockdown.

A vaccine is still 18-24 months out, that is the optimistic view. The pessimistic view? It’s never. We don’t have vaccines for any other Coronaviruses.

We will be living with COVID-19 for a long time. We will always be balancing. The day when we have the balance perfect will never arrive. We believe that this is a rational next step for Tennessee at this time.

(Georgia? That’s a much harder case to make).

Get In Touch

Need help thinking this through? Access to more data? Help getting your technology in order to handle what’s here and what’s coming? Contact us today.

Other

Thanks to those that have shared kind words or liked these posts. We’re doing out best to put out data-driven analysis, each one of these takes about 2 hours. It’s helpful to know that they are being read.

If you want copies of the Excel sheet and PowerBI Reports we use to put these together email us, info@jmaddington.com. Right now, our PowerBI combines data from JHU, NYT, COVID Tracking Project, IMHE and the TN Department of Health. Most sets are updated daily.

We have very little in the way of actual news today, so we will dispense with what we do have as fast as we can.

Big picture: new cases are down in the US as a whole, and in Tennessee. Knox County showed a notable jump with 14 new cases. We’re hesitant to interpret that number on its own: we’ll see what the county health department says at tomorrow’s briefing. The first look we’ve had at a phased US re-open basically looks like the shutdown in reverse: the last things to close will be the first to open, etc. Social distancing remains. We have a couple of thoughts on that at the end.

Numbers

We have changed our chart format at the US and state levels to better reflect the most useful numbers. Only new cases are below (columns) with a 7-day rolling average (line). While we won’t totally give up on total cases it is less interesting because it can only go up. New cases tell us more about where this thing is going than total cases.

Source: Data from The COVID Tracking Project; Chart by JM Addington

On the whole, new cases are clearly trending downward. Zooming into TN you see what we’ve mentioned before, things are mostly flat. This is mixed news. On the one hand, it’s great that new cases are not growing, and, of course, our absolute number of cases is less than than the new cases for the state of New York on any given day this in April.

At the same time, it would be much better to see that line taking a steeper slope downward.

Source: Data from The COVID Tracking Project; Chart by JM Addington

By the way, if you want to see the same graph for your state click here, go to the fourth page and select your state on the left.

Here is MN.

Also, you can do it on your phone but it is much easier to navigate on a bigger screen.

Screenshot of JM Addington created PowerBI COVID-19 Report

Pretty much no one is willing to say that we are past the apex, as a whole because, (1) they don’t want people to let their guard down, and (2) it takes 10-15 days of data, on the low end, to make that call responsibly.

We don’t want to be irresponsible, but we’ll note that —broadly — the IMHE model (03/27 version) seems to have held up rather well. This model predicted a national mid-April peak.

Source: IMHE 03/27 model; Deaths data from The COVID Tracking Project; Chart by JM Addington

The Knoxville area continues to see a slow growth in cases:

Source: Data from the New York Times; Chart by JM Addington

Knox County is still the bulk of the area cases, and today it jumped. There was no briefing today so we haven’t heard if KCHD thinks anything of it. It is equally possible that we had a notable increase or that Knoxvillians took seriously the call to go and get tested.

Source: Knox County Health Department

News

The SBA Paycheck Protection Program ran out of funds, as expected.

The Washington Post ran a story today about how COVID-19 has become the second leading cause of death for Americans, a point we made when it was in third place, on April 2.

Multiple outlets are reporting about a nursing home in New Jersey that was so overwhelmed with deceased it was putting bodies in an outdoor shed. It isn’t surprising, these same types of care facilities were overrun with deaths in Italy and Spain. In Tennessee, 71+ make up nearly 60% of COVID-19 deaths (TDH, as of today).

The US has officially lost more jobs in the last month than were gained in the last 10 years. To us, this is viewed, equally, from two perspectives. One, the downside economics of COVID-19 are awful. Two, awful is relative, we have as many jobs in 2020 as we did in 2010. This level of jobs was once called, “normal.” That isn’t to minimize the pain, especially if you lost your job. We can and will come back, the question is: when?

Initial Thoughts on Opening Up

We’re going to focus on Tennessee here but the broader application works anywhere.

Vanderbilt released their own predictive model, especially for Tennessee, on April 10th with an update today. One of its findings was that in mid-March each infected Tennessean would go on to infect another five people (the transmission number). [1] Another takeaway was that they estimated that it only took ten positive cases in Tennessee to launch the epidemic here. (Scroll back up and see what the new cases line looks like for TN from March 15 to April 1).

By last week that number had dropped to 1.4, and by this week, “about one.” A transmission number of 1 means that cases are neither increasing nor declining. The transmission number has to go below one for us to actually make progress against COVID-19, not just battle it to a draw.

The descriptive analyses above highlight an essential takeaway: Tennessee’s recent progress, while real and positive, is fragile. Our analysis of the recent data indicatesthat without further changes to the transmission number, Tennessee may be settling into a “simmer.”

Vanderbilt COVID-19 Modeling Report for Tennessee April 16, 2020

It seems possible to have a phased re-opening, as is being suggested, without a massive increase in cases, but everything has to go right. We can’t imagine that it will. Instead, we believe it is likely that things are going to go up and down for a while. The transmission number will stay steady or decrease, and then jump in certain geographies as we open up too fast. Those areas will end up going in a stricter lockdown, either mandated or voluntarily.

We mostly think that the math determines this: if the transmission number goes back up to 2.5 or 5.0 then you are looking at a two-to-fourfold increase of cases inside a week, and a four-to-sixteenfold increase inside of two or three weeks. That’s where we were at mid-March as things began to shutdown. That was only a month ago.

It’s also just the way people work. Our models are static and only show lines doing one thing. People react to a changing environment. We’re quite sure that no one wants to go back into a state-wide mandated lockdown so it is likely that voluntary compliance with social distancing will be higher in May than it was in March. In the US we had 40 cases March 1st, and 4,902 by March 15th. [2] We don’t expect to see jumps that high, but in large part, because people believe that it will happen now.

You could sum up our thoughts as this: we are equally confident that we’ll come out of lockdown and that we’ll mess it up in the process. And we’ll get through it.

Get In Touch

Need help thinking this through? Access to more data? Help getting your technology in order to handle what’s here and what’s coming? Contact us today.

Other

Thanks to those that have shared kind words or liked these posts. We’re doing out best to put out data-driven analysis, each one of these takes about 2 hours. It’s helpful to know that they are being read.

If you want copies of the Excel sheet and PowerBI Reports we use to put these together email us, info@jmaddington.com. Right now, our PowerBI combines data from JHU, NYT, COVID Tracking Project, IMHE and the TN Department of Health. Most sets are updated daily.

[1] Dr. Pearcy of TDH today said that number was closer to 2.5 or 2.6.

[2] TN had 52 cases on March 16th and 2,683 on April 1st for a comparison.