How would you like it if I recommended products to you based on the prizes and SPIFFs I would get in return? I hope you’d be pissed.

Yet, exactly that is rife inside the IT industry. Just last week I got an email from a vendor that would enter me into a contest to win a Tesla Model 3 every time I signed up a new customer for one of their products. I.e., every one of our clients we sold this widget to would count towards a Tesla entry for me.

Friends: this is a terrible way to do business and we won’t play that game. If you want my stamp of approval there is one rule: you and your product need to be so good that people thank me for recommending it. In short, you need to be a rockstar for my clients.

Also, this means that if I recommended someone or something to you I meant it.

If I wanted a Tesla I’d buy it myself.

Today is primarily East Tennessee, we’ll zoom out to Tennessee briefly at the end.

In short today: this won’t ever be the 19218 pandemic. That doesn’t mean that it can’t get a lot more painful.

Today we are just looking at East Tennessee. Our primary data source (The COVID Tracking Project) has made some significant technical changes that it is going to require us to reconfigure a number of our reports.


The most important things to know go beyond the headline numbers and require additional context.

First, deaths and hospitalizations are arguably the most important numbers for us to track. However, (quality) hospitalization data is updated is weekly or bi-weekly. Also, hospitals don’t take patients from a single county. So, our local hospitals serve a region larger than just Knox County. As of July 14th, the hospitals systems in and around Knox Coutny had over 100 COVID-19 patients. As of today, 44 Knox County residents are hospitalized, or about 1 per 10,000 residents are actively hospitalized with COVID-19.

A few weeks ago we were told that we were posting scary graphs to social media. The graph below is a concerning graph. You can see hospitalized cases start rising significantly from mid-June. Hospitalizations lag infections by a week or two, so these July 14th numbers represent infections occurring the first week of July, when new cases per day in Knox County were probably in the 20-40 range (accounting for test lag times).

Of course, hospital capacity matters as well, as of July 14th there were a total of 690 beds available (22% capacity) in the area systems but only 24 ICU beds (9% capacity).

Those aren’t great numbers.

By the way, a note on the “surge capacity” plans on the Knox County website: those numbers were developed in March when there were no elective procedures allowed. While every hospital spokesperson we’ve heard has said that there is still capacity, the real “surge” numbers are something below what is listed online. The hospitals are currently working on updating the plan.

Our known cases are headed dramatically in the wrong direction as well, currently the 7 day average is about 100 new cases/day. A week ago we were at 72 cases/day and we were at 48 cases/day on July 7th, meaning we are doubling new cases roughly every two weeks.

But that is known cases, i.e., test results are back. Lag times in tests are so bad that last Wednesday Dr. Buchanan of the Knox County Health Department said that there were getting some results back so late that people had already finished their isolation periods! That completely undermines the idea of testing and contact tracing.

But it’s not just cases, people are dying in Knox County, too. You can see it pick up dramatically in July when supposedly only the “safe” demographic have been contracting COVID-19.

Knox County has had a pronounced shift in cases towards the 21-30 year old age group over the last few weeks. This is good news in the sense that the disease burden is significantly lower in this demographic and it has a very low hospitalization rate and death rate. However, if our total cases are quadrupling each month (two 14 day doubling periods) it won’t take long to to fill those remaining 24 ICU beds.

You can sum up the situation as this: we aren’t in an emergency today. We aren’t Florida, Texas, California, Arizona or New York. But we’re on the way there if we don’t do something to slow things down.

This isn’t a courageous position to take: in the last three weeks the governor’s office, the CDC, the Knox County Health Department and the Knox County Board of Health have all spoken about Knox county becoming a hotspot now. (The White House is also calling Sevier County a “red zone”)

The one thing that has really stood out to us since the early days of the pandemic has been the slower speed of growth Tennessee, and especially East Tennessee, than in other places. We may be doubling cases every two weeks but that’s far better than every few days, which the east coast struggled under during the spring. We still have time to improve or stabilize the situation. But don’t expect that to happen on its own.

To zoom out, the decacounty area doesn’t look much better than Knox County, however, Knox county looks like the primary driver here.

This really mirrors the growth we are seeing across the state as a whole.

Deaths continue to slowly grow, from 4/day in March and 14/day today:

Tennessee News

Governor Lee signed executive order 54 allowing mayors in Tennessee’s 89 rural counties to introduce their own mask ordinances. The governor’s office implicitly believes that the other six counties already have this authority.

The Tennessee state of emergency currently goes through August 29th. This allows for remote notaries, electronic government meetings among other such measures.

The next Knox County Board of Health meeting is July 22nd, from 5:00-7:00pm, watch it at http://www.youtube.com/KNOXCOUNTYTN

How We Are Adjusting

We are transitioning to our Work Safe Level 2 this week, which is a more conservative stance from Level 1, where we are currently at.

Personally, we continue to get most groceries delivered and won’t inside restaurants. These numbers, for your author, rule out anything less conservative. Restaurant patios are also out for now, although curbside pickup has been great.

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.

[1] The COVID Tracking Project stopped giving new deaths by day as a data column; we are presently unable to show this as a graph.

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 NYT, COVID Tracking Project, and the TN Department of Health. Most sets are updated daily

Over the last several years I have learned to have a love/hate relationship with my smartphone. It allows me to get business done from virtually anywhere, but it also is a constant source of interruptions throughout the day. I have had to intentionally take back my attention from my phone to my work.

Here are the two things I do that help keep me focused throughout the day.

1. Turn off all email notifications

I own a business, I have approximately 938,239.3 emails an hour which comes out to 260 notification per second. I don’t need a notification that I have a new email, there is always a new email.

If you use Outlook on an iPhone you can disable these notifications by:

  1. Going to settings
  2. Tap notifications
  3. Tap Mail/Outlook/Gmail (whichever program you use)
  4. Turn off all notifications
  1. Opening up Outlook
  2. Go to Settings from the left slide out menu
  3. Tap on Notifications under Mail
  4. Tap on Notifications and choose None

If you use Outlook on an Android you can disable only email notifications by:

This will allow calendar notifications through without interrupting you for email notifications.

2. Make Liberal Use of Do Not Disturb Mode

My cell phone practically lives on Do Not Disturb mode. On my Android I typically set it to DND for an hour or two at once. After that time, it will come back off of DND automatically, in the rare event I actually forgot it was there.

On iPhones you can choose to turn DND on for an hour at a time as well by opening the Control Center, tapping the moon icon, and then choosing “For 1 hour.”

I’ll leave my phone face up off to the side so I can see it light up if a call is coming in, however, all the breaking news notifications, Facebook/Twitter/Instragram, weather forecasts, Amazon shipment notifications, etc., etc., no longer get to interrupt my flow during the workday.

Don’t be a slave to technology

Most of your tech and apps are designed to fight for you attention. It’s up to you to stay focused on what matters.

The short version of today’s post? Infections are up.

Worldwide infections topped 9 million today. CIDRAP reports, “It only took 6 days for the pandemic total to rise from 8 million to 9 million cases, 2 days less than it took for the number to rise from 7 million to 8 million.” The US far outpaces the rest of the world in total deaths, although per capita we fare better.

Source: South China Morning Post

For the last couple of weeks we’ve noted that US cases have stated within a relatively narrow band of variation. Today, we are way past that, with a 7-day average of over 27,000 new cases per day.

Source: The COVID Tracking Project; Chart by JM Addington

That’s a steep curve upwards friends.

There are some circles advocating that this is due to increased testing. Testing is increasing, but new cases are increasing at a faster rate, show in the positivity rate:

Source: The COVID Tracking Project; Chart by JM Addington

That rate is in an OK place, it used to be north of 20% and now we’re closer to 5%. However, it certainly does not indicate over-testing.

The good news is that deaths per day are headed down. So while we are seeing more cases we are seeing fewer deaths. [1] Deaths lag new cases, it isn’t clear if we’ll see in uptick in deaths in a week or two after this increase.

Below is a complex graph: it shows the new cases per day by state. So, early on you can see New York in the green making up the biggest chunk of cases. Now you can see TX (blue, top), FL (teal, near the bottom), AZ (reddish, near the bottom), and CA (pink, neat bottom) pushing up cases.

The takeaway should be this: the COVID-19 pandemic is the United States is moving not ceasing.

Source: The COVID Tracking Project; Chart by JM Addington

Moving to Tennessee, we also see numbers continuing to rise, you can see a rough trend line we overlaid.

Source: The COVID Tracking Project; Chart by JM Addington

The map below shows the last 14 days of cases by county in Tennessee.

Source: Data from TN Department of Health; Chart by JM Addington

It is critically important to realize how cases are attributed: cases get assigned to the infected person’s county of residence. So, you travel to Memphis and get sick there it will still be attributed to Knoxville. Likewise, if a tourist travels to Sevierville and gets COVID-19 it will not be counted against Sevierville. (There is an out-of-state category that we don’t typically report on.)

If we look at the Knox County area you can see both Sevier and Knox counties driving an increase in cases:

Source: Data from TN Department of Health; Chart by JM Addington

Again, we’re seeing a really steep increase in cases.

State officials haven’t given an explanation for Sevier County’s case increase, however WBIR noted that the Smokies saw over 800,000 visitors during the partially opened month of May.

We don’t have solid data that shows what is behind the increase. Still, we’re willing to speculate that opening up that area to tourism again is a likely explanation. If you’ve been to Sevierville and Gatlinburg you understand that outside of the park proper it is not setup for social distancing.

Moving to Knox County, we’re up to an average of 19 new cases per day. A new high, which has KCHD “concerned.”

Source: Data from TN Department of Health; Chart by JM Addington

In addition, COVID-19 regional hospitalizations are up and ICU capacity is headed down. The health department said that the share of “younger” people with COVID-19 is increasing. In absolute numbers both the area and Knox County cases are low. However, the trend lines are truly concerning. In particular, if what we are seeing are new cases from infections that occurred 5-10 days ago, there is the possibility that we’ve had that much more spread before we even saw the uptick.

How We Are Adjusting

We are likely to transition to our Work Safe Level 2 this coming week, which is a more conservative stance from Level 1, where we are currently.

Personally, we continue to get most groceries delivered and won’t inside restaurants. These numbers, for your author, rule out anything less conservative. Restaurant patios are probably also out for now, although curbside pickup has been great.

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.

[1] The COVID Tracking Project stopped giving new deaths by day as a data column; we are presently unable to show this as a graph.

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 NYT, COVID Tracking Project, and the TN Department of Health. Most sets are updated daily

On Monday the Knox County Health Department announced that they had learned from the county law office that the Knox County Board of Health was required to create policy.

In other words: the phased re-opening plans put out so far have no legal basis because they were put out by the health department instead of the Board of Health.

After nearly an hour and a half of discussion, the board of health unanimously voted to follow the Tennessee Pledge instead of writing local guidance. Knox County will continue on the current guidance for two weeks to give KCHD staff time to re-train on the state guidelines.

The board will continue to meet every two weeks to review the benchmarks KCHD has created and make recommendations as needed.

The Real Quick Take

You want our fastest take? It doesn’t matter. We wrote a post on May 20th that said:

This is a realpolitik — short of turning into a police state the governmental shutdowns rely primarily on voluntary compliance…

The public orders matter far less than what people choose to do, on their own, voluntarily. It also remains up to individual persons to wear masks, wash hands, physically distance while out, etc. It also remains up to them to choose to dine-in, or do curbside pickup, at their favorite restaurant…

JM Addington May 20th, 2020 Post

By Memorial Day Knox County was already moving faster than its own plans dictated, we believe, because that is simply what people were doing in real life.

A Quick Analysis

Dr. Buchanan was actually the one to introduce the idea into the meeting. Her primary concerns were, (1) many businesses operate both in Knox County under one set of guidelines and in another county under a separate set of guidelines (every adjacent county), (2) this frees up her staff to focus on their core activities, which do not include writing community guidance at this level, and (3) she believes that the state staff has better capacity to write out guidance for a variety of businesses.

Those are solid points.

In particular, as a business owner who works primarily with other businesses it can be crazy trying to stay in compliance with different levels of guidance. Our May 20th post also went over how the economics will naturally push everyone towards the lowest common denominator.

For now, Knox County voluntarily gives up the power to put in place our own local policies. However, the board can always overrule itself and put more or less restrictive policies in place in the future.

We highly suspect that this decision is driven by Knox County’s low caseload. It would be a more difficult decision to make if we had caseloads such as Davidson, Shelby or Hamilton counties. We also believe that a higher caseload would pressure the board to put more restrictive measures than what is in place statewide. At the beginning of the COVID-19 crisis Knox County did just that and it may be a big reason cases stayed so low in East Tennessee.

Is this more or less restrictive?

Dr. Buchanan maintained that the state’s guidance was close enough to Knox County’s to make it relatively easy to switch. We are not familiar enough with the Tennessee Pledge to say one way or another for specific industries.

The biggest change is probably enforcement. The Knox County phased plan had “musts” in it. The Tennessee Pledge is filled with “shoulds” and “mays,” and Governor Lee was clear at his press conferences that he was going to rely on voluntary compliance over enforcement. The Knox County Board of Health did not discuss this, however, like the Governor, Dr. Buchanan has expressed more interest in voluntary compliance than enforcement.

The Final Take-Away

The guidance, the orders, everything is close enough as things currently stand that it’s hard to think that it will make a real difference in caseload, especially in the near term. The real test will most likely come with the fall, when COVID-19 is widely expected to flare up again. However, how we do then depends more on our planning today and over the summer than the minutia of guidance.

I’m sure that there are more headlines that we could reference here. We’re doing out best to give a broad overview today, largely focused on news that will be relevant for more than 24 hours.

SBA has announced the EIDL & PPP loans applications are available again.

These loans may be used to pay debts, payroll, accounts payable and other bills that can’t be paid because of the disaster’s impact, and that are not already covered by a Paycheck Protection Program loan.  The interest rate is 3.75% for small businesses.  The interest rate for non-profits is 2.75%.

SBA

You can barely find a mortgage at those rates. We’re glad to help you with the application if needed.

Arizona is being reported as a hotspot with over 1,000 new cases yesterday. The same day, the South China Morning Post called an outbreak in Beijing, “explosive.” Beijing had 79 cases Thursday-Monday. How does China respond to 79 new cases?

Authorities have locked down 21 residential estates in Fengtai and the northern district of Haidian, which is also home to a big food market. Access to the areas is strictly controlled and mass coronavirus testing is under way.

The South China Morning Post

We’ll probably keep highlighting the differences between how Asia and the West respond because the American media does a very poor job explaining how vast the gap is. The Asian countries that have the virus under control consider a couple of dozen cases serious. In the US, a couple of dozen cases seems like magical realism. In China, they will lock down harder over 100 cases than the US locked down at the peak of the outbreak.

It also means that it is very difficult for us to learn about public policy responses from watching China.

FDA has ended allowing the use of hydroxychloroquine and chloroquine as a treatment for COVID-19. This isn’t a surprise, there isn’t solid science to backup that it helped and those drugs are needed by other people who have non-COVID medical conditions.

Ars Technica has an excellent article on a topic we’ve touched on: early research is showing that 10-20% of infectious people are responsible for most of the Sars-Cov-2 spread. In one study, 70% of people didn’t pass it on to anyone. Take all of this with a grain (or box?) of salt: these studies are still early and biased towards Asian data. As we’ve mentioned, the Asian response has been vastly different from the US response.

The Washington Post is reporting that those with underlying conditions have a mortality rate 12x higher than others. However, separate studies show similar increases in mortality due to race alone.

“Policymakers’ natural instinct is to think this correlation is because of income disparities, or having health insurance, or diabetes, obesity rates, smoking rates, or even use of public transit,” Knittel said. “It’s not. We controlled for all of those. The reason why [Black people] face higher death rates is not because they have higher rates of uninsured, poverty, diabetes, or these other factors.”

STAT News

It’s worth understanding how hard it is to tease out these separate variables. There is enough research into the effects of race and the inequalities that came with being non-white on health that we don’t doubt that race is a significant component, by itself. However, it will probably be years before we have solid science behind the effects of race on COVID-19 outcomes: we just don’t have enough quality data.

24 Hour Fitness is filing for chapter 11 (restructuring bankruptcy) and closing 130 locations. The same article notes that, “Financial services company Moody’s had already downgraded 24 Hour Fitness’ status in December 2019 before the onset of the pandemic…” You can call weak corporate finances a comorbidity for business outcomes, in our opinion.

Arizona is getting blistering criticism for it’s handling of Coranvirus. They are clearly on the upswing:

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

The growth rate here is really high: that’s a 7-day average of >1500 new cases per day. It looks like AZ is on the exponential curve up. A key consideration: these numbers probably are close to reality, compared to New York at it’s peak when the actual cases were likely multiples higher than what was being tested.

Their cases are concentrated around Phoenix, however, the northeast counties have much higher rates per capita:

Arizona COVID-19 Case by County
Source: ARIZONA DEPARTMENT OF HEALTH SERVICES
Arizona COVID-19 Case RATES by County
Source: ARIZONA DEPARTMENT OF HEALTH SERVICES

Those would be the Navajo and Apache counties with the highest case rates per capita.

Parts of Europe are re-opening, with France re-opening borders this morning, and other countries opening borders or easing other restrictions.

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 NYT, COVID Tracking Project, and the TN Department of Health. Most sets are updated daily

There is a lot of news out there, today we’ll focus on numbers and we’ll return for news later this week.

Back in April we began reporting on how there wasn’t a single COVID-19 narrative to find, there were several. In the middle of June we solidly there. The COVID-19 stories are regional at best, and often state by state. Let’s start by looking at this estimated R_t map from covid19-projections.com, which we will take a proxy for COVID-19’s current growth rate:

Source: COVID19-Projections.com

Tennessee is flat, Alaska is in great shape, California and Arkansas don’t look great. We won’t take a deep dive into all of these states, we have a deep belief that more context is required in each instance to really understand what is happening. And we don’t have time to digest how each state is handling COVID-19.

Across the board, you can see that the US continues to stay in a narrow band, with the 7-day average of new cases staying between about 20,000 and 22,500 per day. A reminder, we rely on the 7-day average because daily reporting seems to be affected by non-diagnostic criteria. I.e., there are dips on Mondays that are most likely the result of weekend-induced reporting delays, not that COVID-19 is a Monday slacker.

Source: Data from the COVID Tracking Project; Data by JM Addington

In addition, we can see that growth rate of new deaths per day compared to new cases per day is dropping:

Source: Data from the COVID Tracking Project; Data by JM Addington

It’s hard — maybe impossible — to know the cause. Maybe people most vulnerable to COVID-19 are staying home more; maybe we are testing better; maybe test variances in some states are artificially inflating positive numbers.

Tennessee continues to see greater new cases per day.

Source: Data from the COVID Tracking Project; Data by JM Addington

Unfortunately, here we see deaths tracking very closely with cases. For a rough comparison, if we extrapolate from current deaths over 90 days (483) and annualize it we get about 1,900 deaths over a year. In contrast, Tennessee had about 1,100 traffic fatalities in 2019. (Don’t take the analogy too far: crashes are not contagious.)

Source: Data from the COVID Tracking Project; Data by JM Addington

Tennessee won’t give us a single narrative either. This map by JM Addington shows the 2-week total of new COVID-19 cases by county in Tennessee. Shelby (1729) and Davidson (1613) counties are clearly continuing to be hit hard with the broader Nashville metro area also showing higher than most counties. Hamilton County (859) is also high. Knox & Sevier Counties are both at 161.

Source: Data from Tennessee Department of Health; Map by JM Addington

Regionally, Knox and Sevier counties are driving up the daily average significantly.

Source: Data from TN Department of Health; Chart by JM Addington

Knox County remains about as high as we’ve ever been, but as high as we ever were wasn’t that bad (13 new cases/day average).

Source: Data from TN Department of Health; Chart by JM Addington

What does it all Mean?

So, for context, cases are dropping nationally, deaths are dropping faster even as economies re-open and protesters hit the streets in major cities across the US. Maybe COVID-19 is just going to go away?

We’re super skeptical of that. The most optimistic theory would be that we’ve figured out how to live with this virus without it destroying us. The most pessimistic theory would be that all of our efforts only had a minor impact and, like 1918, a second, larger wave awaits us.

We believe that no one can say for sure what the coming months look like. Internally at the company, and your humble author, continue to do our best to prepare as if the fall is going to be as bad or worse both from a medical and an economic perspective. (1) There are only upsides to us being wrong about that, (2) September is too late to prepare for an October wave.

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 NYT, COVID Tracking Project, and the TN Department of Health. Most sets are updated daily

Today is mostly a news day. The headliner of the day is definitely the jobs report, showing that unemployment went down in May instead of going up. This was pretty shocking. Nobody seems to disbelieve it, but we can’t find anyone who saw it coming.

We sure didn’t.

EIDL loans are still being processed for those who were already in the pipeline. We got our final confirmation today. The loans are currently capped at $150k.

Congress has passed some changes to the PPP loan. For those not familiar with it, this is a loan aimed at small businesses. Basically, a small business can get 10 weeks worth of payroll money and have it all forgiven as long as 75% of that loan was spent on payroll in 8 weeks. The intended effect was to keep employees on payroll and off of unemployment.

The new guidelines drop the 75% down to 60% (really important for some industries, like restaurants) and allow up to 24 weeks to use the money. At JM Addington we were actually scrambling to find ways to make sure that we used 10 weeks worth of payroll monies in 8.

Medicine for COVID-19 fall into one of two camps: prophylactic (prevent an infection) and therapeutic (treat an infection).

The NIH’s “Operation Warp Speed,” project, aimed at rapidly developing a COVID-19 vaccine, has announced that there are currently 5 candidates. One of these is already in phase 2 trials of which is typically 3 phases. Most of the sources we are tuned into expect that more than one vaccine will eventually be available and, necessary. In all likelihood, there will be no single vaccine safe for all 8 billion people on earth or capable of being manufactured that quickly.

For context, there are over 130 COVID-19 vaccines under development wordwide.

Hydroxychloroquine was seen as a potential therapeutic early on but evidence is quickly showing that it is not effective This week has also seen news: one study that showed it caused harm was retracted while another simply showed no benefit. Remdesivir, in contrast, has been shown to help treat COVID-19.

We also spent time this week listening to Dr. Osterholm and his take on the inflammatory syndrome seen in some children who have had COVID-19. Here are the two takeaways: first, it’s really rare. Second, it’s very similar to other inflammatory issues that we’ve seen follow virus infections for decades.

With news out of the way we’ll take a look at numbers but we are going to be brief today.

Numbers

Last week we say an uptick in cases for the first time since April. That trend hasn’t changed much, having only slightly backed off. We’ve highlighted 20k-22.5k cases/day to give you an idea of the range we’re simply sitting in.

Source: The COVID Tracking Project; Chart by JM Addington

Current events are most likely impacting the data: Minnesota has seen cases drop precipitously since May 23rd, when they were previously rising. This most likely reflects either a lack of testing, or a slow down in the time it takes to get results due to protests and riots going on there.

Deaths continue on a slow, downward trend. We are almost exactly at the 50% mark from the peak, which holds true even if New York is removed.

Source: The COVID Tracking Project; Chart by JM Addington

Tennessee also continues to trend upwards. Our new daily cases (average) at the April low point were 224/day, today they stand at 492/day.

To repeat a point from April, this is one reason we really don’t like focusing on the growth rate (new cases divided by total cases) because it can distort the overall picture: we’re at double new cases/day compared to several weeks ago.

We don’t know what is driving the increase. The state no longer holds regular briefings on COVID-19 and our state and local media aren’t digging deep into the topic. (We’d love a hookup with KCHD or TDH communications, if anyone reading this can help.)

Source: The COVID Tracking Project; Chart by JM Addington

If there is a bright spot it is that our deaths have remained very steady and relatively low.

Source: The COVID Tracking Project; Chart by JM Addington

Regionally, cases also continue to rise. Today’s average represents the highest we’ve seen yet.

Source: The COVID Tracking Project; Chart by JM Addington

Knox County, specifically, is basically in the same place as our previous peak. Approximately 25% of all Knox County COVID-19 cases are from the last 14 days. 20% of all Knox County cases, ever, are currently active.

Source: The COVID Tracking Project; Chart by JM Addington

Testing turn around times are still above 3.5 days and regionally our non-surge ICU bed capacity is at 34, or 12.5% of available beds.

KCHD has said in their briefings that there are more clusters being found, however, they certainly haven’t stated that this is what is driving the increase in cases.

How JM Addington is Adjusting

Our internal response plan calls for a change to a more conservative posture at 75 new cases per week in Knox County. We are treading that line, however, we believe that enough of the new cases are attributable to clusters outside of our typical contact zones that we haven’t made that move. If the upward trend continues for a few more days we’ll move forward with the more conservative stance.

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 NYT, COVID Tracking Project, and the TN Department of Health. Most sets are updated daily

Where to Begin?

It’s hard to know where to even begin today. This week the US saw it’s 100,000th COVID-19 death and yet a single death, George Floyd’s, (rightfully) consumes the nation. The two numbers, 100,000 and 1 are deeply related by the racial inequalities that exist in our nation.

Blacks in America die at a higher rate from COVID-19 than whites and already had a lower expected lifespan. Those who make under $40,000/year much more likely to have lost their jobs; Black Americans earn significantly less than their white counterparts.

Data on co-morbidities, access to healthcare, access to testing are all clear that COVID-19 has a higher impact on black communities than white ones.

In other words, the inequalities that amplify the effects of COVID-19 are the same ones that COVID-19 in turn amplifies (life span, jobs, access to healthcare).

It is impossible to imagine that a virus that amplifies the inequalities that amplify it will not make both the virus and these inequalities worse at the same time. And not just long term: this summer. Higher cases, higher deaths, higher job losses, higher co-morbidities due to lack of healthcare access due to job loss. It’s a nasty spiral.

It is unclear what impact the nationwide protests will have on the COVID outbreaks. COVID-19 research is increasingly looking at indoor settings with poor ventilation as primary locations for virus spread. At the same time, we haven’t had Americans coming together, in such close contact, for so long, day after day since mid-March. Of course, in Minneapolis, the epicenter of the riots and the protests, so many stores and businesses are closed that a different type of social distancing is now in pragmatic effect.

Numbers Going into June

For the first time in 40 days we are seeing an increase in the 7-day average of new cases per day. It is not significant on its own, but we are seeing the 7-day average of new deaths per day also begin to level off. California, Texas and Virginia seem to be driving this upward tick.

We want to be clear that this is not a major reversal from a statistical perspective. However, when the trends for new cases and new deaths aren’t headed in the correct direction and there is widespread civil unrest that is likely to make things worse we aren’t optimistic for the next few weeks.

Source: COVID Tracking Project; Chart by JM Addington
Source: COVID Tracking Project; Chart by JM Addington

Tennessee is also at a 10-day increase in new cases per day, although that number still remains low in absolute terms. It is also unclear to us what affect targeted testing has had in Tennessee that could skew this upward.

Source: COVID Tracking Project; Chart by JM Addington

The 10-county area continues to stay between 10 and 20 new cases per day. That’s mostly great.

Source: Tennessee Department of Health; Chart by JM Addington

Less great is Knox County. After dipping significantly right before Memorial Day there has been a steady rise since then. Like Tennessee, our absolute number of cases remains low, however, the convergence of less social distancing and longer test times (see below) become a trio of data points that suggest a likely rise in cases.

Source: Tennessee Department of Health; Chart by JM Addington

In addition, test result turn-around times have increased from two and a half days (4/26/2020) to nearly four days (5/17/2020). Fast tests are absolutely critical to contact tracing which in turn is critical to keeping a “slow burn” rate from turning into a hockey-stick like graph.

We don’t have great data on what is driving this in Knoxville, but we’ll move into prognostication. We’ve been mildly dismissive of “opening up,” because social distancing data plateaued well before the “lockdown,” ending. Unacast’s data shows Knox County, in particular, picking up movement by May 5th and continuing through May 26th, the last date data is available for. Those three weeks represent 1.5 “full” incubation periods or about 4 median incubation periods. In other words, the cases appear to pick up after Knoxvillians interact more, which is exactly what is expected.

Source: Unacast

Other News

Three separate unpublished studies are showing that somewhere between 1% and 20% of infected people are responsible for 80% of the overall spread. In other words, many people may barely spread COVID-19 when sick at all, a handful spread it widely. This is not new to Sars-Cov-2. Explainer video.

The CDC is warning that serological tests (antibody tests) are not accurate for any given person. This is important for Knoxville where we’ve seen advertisements for individual antibody tests. These tests are accurate a population level, not for a specific person. For instance, if you wanted to know the overall percentage of Knoxvillians infected so far a random sample of +/- 1,000 people will give you an overall percentage. But for any one person:

…less than half of those testing positive will truly have antibodies.

CDC

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 NYT, COVID Tracking Project, and the TN Department of Health. Most sets are updated daily

Let’s take a few minutes today to talk about cloth masks. This article is not a red/blue black/white article.

The central conclusion right up front: we don’t know. We don’t know if they help, we don’t know if they hurt, we hardly know a damn thing about cloth masks and SARS-Cov-2.

Alright, let’s dive in with a refresher that is really important.

Science Moves Fast; Sciences Moves Slow

From Hippocrates nearly 2,400 years ago until the late 1800’s there were nearly no advances made in clinical medicine. [1] Until the 1600’s there wasn’t even a scientific method used to figure out if our theories on how the world worked were even right!

In a nutshell, the scientific method is as follows:

  1. Define a question
  2. Gather information and resources (observe)
  3. Form an explanatory hypothesis
  4. Test the hypothesis by performing an experiment and collecting data in a reproducible manner
  5. Analyze the data
  6. Interpret the data and draw conclusions that serve as a starting point for new hypothesis
  7. Publish results
  8. Retest (frequently done by other scientists)

Do not skip over #8. At the point where you can reproduce a study (steps 1-7) and get the same or similar results is that point at which your hypothesis (#3) becomes theory and part of accepted scientific knowledge. A single published study does not a scientific fact make.

We live in a world where due to increased communication, resources and technology we are able to make advances in science faster than ever before. At the same time, this typically happens over years (or decades) of running the questions through the scientific method. #8 rarely, if ever, happens in weeks. Which, compared to 2,400 years of Hippocratic stagnation isn’t bad.

The Discussion

Between #7 and #8 there is really a step #7b, where scientists basically rip apart each other’s work. Often, this is a sign of respect, your study was good enough to draw attention from other top scientists. This is the point where uncertainty is identified (not resolved) and typically more questions are thrown into the mix to be answered when the next person goes to try to reproduce the study. This discussion, while transparent in scientific journals, is typically done without the public realizing it happened at all.

This is normal. However, at present, this discussion is playing out with much more public visibility than we are used to.

The Tests & Data (#4 & #5)

Outside of medicine and other sociological fields this is pretty straightforward. You need to gather data and test a hypothesis on mice? Not hard to come by mice or do your test. Medicine constantly raises thorny ethical issues and sometimes you just don’t have data available even if the ethics are laid aside. Sometimes, you need to wait for an opportunity to appear to test appropriately.

Cloth Masks & SARS-Cov-2

Which brings us to cloth masks. You know what we have in western countries? We have N95 respirators and surgical masks in great supply…. up until January 2020. You get easily get an N95 mask at The Home Depot for your own home improvement project up until a couple months ago. They were cheap and plentiful.

Given that high quality masks were cheap and in great supply (and well tested) you know what we didn’t look at? We didn’t even think to the 100 different ways laypeople could create, wear and implement cloth masks. Just wasn’t an issue.

The first paper we at JM Addington even saw on it was titled, “Rapid Expert Consultation on the Effectiveness of Fabric Masks for the COVID-19 Pandemic.” Rapid means, “we did this as fast as we could,” “Expert consultation means,” we didn’t actually do a study — we looked at some other stuff.

This paper had, in our view, two primarily conclusions. Conclusion #1:

Therefore, we have only limited, indirect evidence regarding the effectiveness of such masks for protecting others, when made and worn by the general public on a regular basis. That evidence comes primarily from laboratory studies testing the effectiveness of different materials at capturing particles of different sizes.

I.e., we don’t know much, and what we do know is not from real world scenarios.

Conclusion #2:

The evidence from these laboratory filtration studies suggests that such fabric masks may reduce the transmission of larger respiratory droplets.

In short, “cloth masks maybe help based on looking at some fast non-real world studies but we really aren’t sure.

And we’re not even diving into into the issues of:

  • Small samples sizes
  • Wearing masks right/wrong
  • Whether blocking large droplets is effective in reducing transmissions [2]
  • No reproduction of results (step #8)

Are Cloth Masks Bunk?

A well-trained scientist would probably say that wearing a cloth mask or not wearing one is not even wrong yet. To say, “we don’t have evidence,” means that we don’t have well-designed controlled studies that have been re-produced to show that we know we are right. Scientists don’t like to say that they know until they know that they know that they know.

So: cloth masks: the jury is still out.

What about Particle Sizes?

We’ve seen a number of posts proclaiming that cloth masks can’t work based on the size of the gaps in the mask versus the size of Sars-Cov-2 particles. First, this argument completely bypasses the scientific method where we test ideas. Second, it still isn’t sufficient to render masks useless. To steal an analogy, imagine an NFL team trying to run onto the field through a bedroom-sized door: while they can each fit through they can’t all run out together at the same speed. Masks don’t need to be 100% effective in blocking virus particles to still prevent enough from getting through to reach the level needed to infect another person.

Why Are We Being Asked to Wear Cloth Masks?

Cloth masks are wholesale thinking, not retail. The goal isn’t to protect any one person: it is to drive down the effective reproductive number, aka Rt. Rt measures what the current transmission rate of the virus is across a population. (It is not the same thing as R0.) In the early stages of an epidemic, the goal is typically to contain the epidemic before it gets bigger and becomes a pandemic. For examples, SARS, MERS and Ebola have all been effectively contained epidemics.

At this point, public health strategy has turned to mitigation, trying to slow the virus’ growth. Stopping it outright has become effectively impossible.

No one mitigation method will be or needs to be a silver bullet, the strategy is that if enough of the population practices enough of the measure you can drive the Rt number low enough that the epidemic locally either stays stable or actually decreases. Mask wearing is one of these measures. It doesn’t need to be anywhere near 100% effective by itself in order to drive the Rt number low enough in combination with other measures to make a real difference.

Should I Wear a Cloth Mask?

If we got into the amount of uncertainty that exists around social distancing, what the Sars-COV-2 is going to do on its on you’d feel really crazy by the end. We don’t pretend to have an answer.

Your author will give his personal view. It doesn’t hurt me to wear a mask, and I believe that I have one of the better ones that could reduce transmission at any rate. The purpose of all the things we are doing, social distancing, masks, limited retail/restaurant/church capacity is meant to slow SARS-Cov-2 so that the overall pandemic stays flat or goes down. No one thing other than God himself eliminates it.

If wearing a mask inside Target, Kroger, my church, at my clients’ places of businesses, helps to keep the virus manageable so that we can continue to live normal-ish lives I’m all for that. I own a business that makes more money in a normal economy, I have eight kids, I don’t like being sick, I like eating out at restaurants. For all these reasons if keeping the virus in check is important to me. Physically and financially.

If you look at the data and think it doesn’t make enough of a difference to wear one I also don’t begrudge you. You are right, the jury is still out.

At the end of the day, it is our collective responsibility to remember that it is humanity against the virus: not dems vs reps, red vs blue, or mask vs no-mask. It is up to all of us to do our part to fight this damned thing from hell however we see fit and condemn the virus and love our brothers and sisters.

[1] The Great Influenza: The Story of the Deadliest Pandemic in History

[2] I haven’t seen anyone who thinks a cloth mask significantly reduces aerosol transmissions, but it isn’t clear what role these smaller droplets play in transmission.