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First, we will go over the top two COVID-19 views we believe are being left out of the public discussion, second, hit national and regional headlines and finally go over numbers.

If this page is too long for you, read until “News” and stop there.

One Theme in Two Areas

The public discourse this week is starting to look at the longer view of COVID-19 in both health terms and economic terms. The most balanced view and, we believe, most correct view is that these are intractably the same thing. The worse the health outcome, the worse the economic outcome. (If you haven’t read our post from Sunday that goes over three major COVID-19 scenarios we’d encourage you to visit that section now.)

This week we’ve seen Dr. Fauci warn that states that “skip over” opening criteria risk longer-term setbacks. Dr. Fauci has been nothing if not consistent in articulating this, here he is three weeks apart discussing states skipping steps as they open up:

This should be viewed as an economic setback as much as a health outcome. This isn’t crazy talk, the official criteria boil down to, “COVID isn’t getting worse and your state’s healthcare system can handle the cases;” if COVID is getting worse and your healthcare system can’t handle how can you actually expect the economy to produce?

Today, the chair of the federal reserve cautioned that, “the recovery may take some time to gather momentum,” which is economist speak to say that things are going to be bad for awhile. How long and how bad? That’s still hard to say, “the scope and speed of this downturn are without modern precedent…”

“Without modern precedent,” is a statement we 100% agree with: modern economics more or less date back to the founding of America and the modern economy with globalism, worldwide capitalism, interlinked economies, etc., dates back decades not centuries. So for as much as COVID-19 is the first modern health pandemic of this scope and size, so is the economic downturn.

So, to the extent that we can’t get COVID-19 under control both nationally and globally we’re going to have trouble getting the economy going.

The best COVID-19 current models have things getting better, but very, very slowly. We had a steep tick up, like a roller coaster climb, but we are missing all of the dramatic fall.

We’ve said before and we’ll say it again: we’ll all get through this, this isn’t likely to turn into the next Great Depression. But getting a handle on COVID-19 sure would put us in a better economic state.

Economic Data

We hit unemployment Sunday, and it’s bad, at nearly 15% with the real number likely closer to 25%. Quarter one GDP (overall economic activity) dropped nearly 5%, assuming that most of the drop occurred in March as stay-at-home orders first hit we’re probably looking at a 15% decline in economic activity inside a single month.

Tennessee released revenue figures for April, yesterday, May 12th. These figures largely reflect changes in March as March sales generate April income in taxes. (As a business, any sales tax we collect has to be paid by the 20th of the next month.) Sales tax, specifically, is down 6% from a year ago

Keep in mind that economic data lags real life, so it is likely that we’ll see the worst economic numbers at the same time we’re seeing the best health numbers.

News

Tennessee is going to lead our news today. First, Vanderbilt came out and updated their COVID-19 report for Tennessee. Here are the top takeaways and our brief analysis:

  • Hospitals are not above capacity: Keeping the healthcare system inside capacity was the biggest driver of lockdown, so this is critical.
  • Tennessee is either plateaued or barely declining: This is mostly good. However, the decline is so slight that we don’t have room to mess it up right now.
  • Their first report was overly pessimistic: Modeling is hard when you deeply understand the disease and have great data. No one in the world has more than 5 months of experience with COVID-19 and 6-10 weeks of data is not a lot of data for modeling. The Vanderbilt team has done a great job using their expertise, staying humble about what they know and being transparent about what has changed.

May 8th, the Tennessee Lookout reported that police and sheriff’s offices across the state have access to the names and addresses of people have who have tested positive with COVID-19. Yesterday, the City of Knoxville quickly discontinued the practice of receiving this information from the state while the Knox County Sheriff’s Office doubled down.

This is not one of the things Tennessee is getting right.

  • Law enforcement should be treating every encounter as if it is with a COVID-19 positive person
  • It doesn’t help Governor Lee’s mantra of, “if in doubt, get a test”
  • It is likely to discourage testing among some communities where testing is needed most

I still believe in having access to that list. I think it has huge benefit… But… I think if it kept people from getting tested it was not worth it.”

Eve Thomas, Knoxville Chief of POlice

Thailand, the second country to deal with COVID-19, has no new cases today. Thailand has a population of nearly 7 million and has recorded only about 3,000 COVID-19 cases, a quarter as many as South Korea and about a fifth as many as all of Tennessee.

A new study on hydroxychloroquine, from New York City, shows it to essentially be ineffective for COVID-19.

Numbers

Numbers are not materially different from Sunday, so we are just going to show two charts, national cases and Tennessee. While the US continues to show a downward trend in new cases it continues to be a very slight decline discounting New York. Adjusting for the results from mass prison testing, Tennessee is essentially flat over the last 6 weeks (unadjusted data shown).

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

What Happened to the IMHE Model?

That seems to have quickly fallen out of favor with many (most?) medical professionals. It overestimated deaths on the way up and underestimated them on the way down. We’ll show you how their second round of modeling did, but, at this point, don’t see a reason to continue to reference it. That said, IMHE has also done a world-class job in modeling transparency around their modeling, we just believe that there are better models out there right now.

The pink line should be tracking the middle blue line:

Source: Data from The COVID Tracking Project and IMHE; 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.

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

First, we will go over the top two COVID-19 views we believe are being left out of the public discussion, second, hit national and regional headlines and finally go over numbers.

If this page is too long for you, read until “News” and stop there.

View 1: It is a Long Road Ahead

As things begin to “open up” it is easy to get lost in the feeling that we’re somehow over the hump or the worst of the virus. This is, at best, half true.

First, US cases and deaths, if you discount New York, are either plateaued or showing a mild decrease — and then for only about a week. (See Numbers below)

Globally, cases and deaths simply continue to rise.

Second, there is no indication that COVID-19 will slow its spread in a permanent way until we hit 60-70% of the population infected. If you assume that about 5% of the US population has been infected and consider our current death toll (~75k for our napkin math here) you end up with:

(60% / 5%) x 75,000 deaths = 900,000 deaths left to go, give or take.

(The most optimistic estimate would be about 300,000 deaths total, the most pessimistic about 1,000,000 deaths total).

Or, simply consider how many more “Aprils” we have to go through.

Global COVID-19 Total Cases and Deaths
Source: Worldometers

Three of America’s leading epidemiologists, Kristine Moore of the University of Minnesota, Marc Lipstich of Harvard, Michael Osterholm of the University of Minnesota and John Barry — a historian of the 1918 flu pandemic, co-wrote a paper that goes over the three scenarios that they think are the most likely for increased infection.

In Scenario 1, we continue to go through, “a series of repetitive smaller waves
that occur… over a 1- to 2-year period, gradually diminishing sometime in 2021.”

This, “Peaks and Valleys,” scenario doesn’t assume that all places experience COVID-19 equally. While the first “wave” hit New York, Chicago, Louisiana, etc., a second wave may hit Denver and Austin, a third Atalanta and Minneapolis, etc.

Source: COVID-19: THE CIDRAP VIEWPOINT

In the second scenario, COVID-19 actually lets up over the summer (the second dip in the graph) and “is followed by a larger wave in the fall or winter of 2020 and one or more smaller subsequent waves in 2021.”

This is what was seen in both the 1918-1919 and 1957-1958 flu pandemics. Dr. Osterholm describes this as the worst scenario, and one where we possibly have the heath care system overrun.

Source: COVID-19: THE CIDRAP VIEWPOINT

In the third scenario, our current spring peak “is followed by a “slow burn” of ongoing transmission and case occurrence, but without a clear wave pattern.”

This scenario, like the first, assumes that different places experience their own outbreaks at different times.

Source: COVID-19: THE CIDRAP VIEWPOINT

The report ends with the one thing we wish every American was aware of right now:

[W]e must be prepared for at least another 18 to 24 months of significant COVID-19 activity…

COVID-19: The CIDRAP Viewpoint

This is critically important if we want to learn how to live with the virus, opened-up. Planning on the family level, the work level, the city/county/state/country levels are all crucial to us going forward as we get through this instead of finding ourselves frozen.

View 2: Unlit Powder Still Explodes

In places such as East Tennessee, among others, it feels right now like we dodged a bullet, that things are safe now. You can see it most clearly when people don’t take advice from public health authorities. With about 1 case for every 2,000 people it is an easy view to take.

It’s also incredibly wrong.

We are in a storeroom of 50 dry gunpowder kegs where a handful of them have exploded, just not ours. However, the fire still smolders and we are still a keg of dry powder.

And that’s the state we live in until the fire is out.

News

The most important news item of the last few days goes to a new antigen test that the FDA has granted emergency approval for. It looks like it’s great for reporting positives, for negatives a PCR test is recommended to confirm. I.e., it can tell you if you have COVID-19, however, if you test negative there is still a 1/5 chance you have COVID-19. Cheap, 15 minute turn-around times. Of course, it still needs to be mass-produced.

Unemployment is up to nearly 15% and Treasury Secretary Steven Mnuchin said, “the reported numbers are probably going to get worse before they get better.” Our guestimate is that it wouldn’t be surprising to see that double in the short term (2-3 months). Remember, we asked everyone to stay home for a few weeks: these numbers aren’t yet surprising.

Vice President Pence’s press secretary and at least one other White House aid tested positive for COVID-19. It will be interesting to see how this type of low-level exposure will affect leadership at all levels of governments, and organizations. Do top leaders need to self-isolate every time they have had potential contact with a COVID-19 positive person? (Pence is not) If the leader never gets infected, that is potentially a never-ending string of self-quarantines. (True for any person, not just leaders.)

According to Harvard, Tennessee is one of 7 states doing enough testing. They use the same positive test ratio that we’ve referenced here, a 10% positivity rate. Also, they use 7-day rolling averages for tests and new cases as we have.

Note: Tennessee could easily go over 10% this month because of the targeted testing that the state is conducting. This is where context becomes incredibly important: if 15,000 Tennessee inmates test positive in a matter of 2-3 weeks but most of them are asymptomatic, is 10% still the right target number? Or do you keep the 10% target for community transmission but not prison transmission? We expect to see state leaders approaching these as separate topics from a health perspective.

Restaurants open tomorrow in Nashville.

Tennessee is testing all of their prisons after one prison tested positive at a 50% rate; 98% were asymptomatic.

The Friday KCHD briefing confirmed that elective surgeries (non-emergency surgeries) will resume in a phased-in manner, starting with outpatient surgeries. Dr. Buchanan also said that Knox County is working through several cluster events (at least 2 COVID-19 cases together) but attributed all of them to families.

An asymptomatic employee at Wampler’s Farm Sausage in Lenoir City, TN tested positive for COVID-19, Friday. We’ll see what happens here, clearly, meat processing plants have been a major source of outbreaks in other areas of the country.

Numbers

Nationally cases appear to be declining — and they are — but, as we’ve reported for weeks here, the story in New York is different than the story elsewhere.

US COVID-19 Cases and 7 Day Rolling Average, May 10th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

If you remove New York completely, we are maybe beginning a decline. There certainly is not enough of a streak to say that definitively. Sounds like what we said last week.

US without New York COVID-19 Cases and 7 Day Rolling Average, May 10th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Deaths look pretty much the same: the curve is very, very flat, and about tied for the leading cause of death in the United States. (If you included probable deaths it would be the current leading cause of death far and away.)

US New York COVID-19 Deaths and 7 Day Rolling Average, May 10th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Like cases, taking out New York takes out any notable decline:

US without New York COVID-19 Deaths and 7 Day Rolling Average, May 10th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

There are many different correct ways to look at this chart of deaths. Here are what we think are the most important:

  • Going back to our beginning analysis, it’s a long road ahead
  • The overall situation isn’t better than it was a month a ago, it just isn’t worse either
  • Until a vaccine comes this is what the path to herd immunity looks like: a new killer of Americans

For the first time in our reporting the positivity rate in the US has fallen under the 10% threshold.

US COVID-19 Positivity Rate, May 10th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Moving on to Tennessee, which remains an outlier (aka unlit powder keg):

TN COVID-19 Cases and 7 Day Rolling Average, May 10th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

And as we reported above, testing is a real bright spot for how Tennessee has handled COVID-19 so far. We believe that jump is a set of results from a prison coming back, otherwise we might be lower. However, Tennessee is handily beating the 10% target currently.

TN COVID-19 Positivity Rate, May 10th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Sub-regionally our case count is steady, a very low burn. Yes, it appears to take an impossible step back. Typically this happens when a case is incorrectly registered inthe wrong county and then subsequently “transferred” to the correct county.

May 10th, 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 numbers:

May 10th, 2020 Knox County COVID-19 Cases
Source: Knox County Health Department

Knox County Health Department is also releasing much more data on their website, this one shows the lag between when a test is taken and when the result is returned. It is down to 2.6 days, the right direction but still a day and half too long:

Knox County Test Result Lag Times
Source: Knox County Health Department

Finally, we have cases by ZIP code in Knox County, a map we show because you want to see it. Take it with an entire salt shaker, results may be as much about population density and testing access as bona fide cases or disease burden.

May 10th, 2020 Knox County COVID-19 Cases by ZIP Code
Source: Knox County Health Department

Of course, even with those caveats, it’s hard to imagine that opening up won’t bring more cases, and deaths.

Knox County remains in its own little world. One of the most important aspects of our low growth in the absolute number of new cases today is that our health department has enough to staff to do testing and contact tracing. After you get above a certain point your percentage growth rate can be slow, or even negative, but you still don’t have enough people to fight it. The cat is still in the bag here.

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.

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

Today we’re going to go over the two main types of testing, and why we can’t just jump to serology testing.

How does increased testing affect New Cases?

Let’s start with a point we made yesterday:

There are two primary reasons that we test in public health:

  1. To find out if a specific individual is sick. In the case of COVID-19 this would be to ask them — and anybody that they have been in contact with — to self-isolate to prevent further spread
  2. To find out how widespread a disease is in a community or geography (city, county, state, prison, hospital, nursing home, etc.)

There are two primary types of tests for COVID-19, at this point, essentially, one for each.

Test Types

This first time of testing makes up all of the confirmed cases that we know about in the US and is done exclusively (right now, as far as we know) by RT-PCR. This is the test where they put a swab far enough up your nose to tickle your brain, then use chemicals (reagents) to transfer the sample to a test tube or similar. After that, chemicals are added to convert virus’ RNA to DNA. Finally, the DNA is “amplified,” — increased — until there is enough of it to identify.

The RT-PCR test typically has a high degree of accuracy of identifying a sample where the virus really does exist, and successfully not identifying samples where the virus does not exist.

The RT-PCR test mostly tells you if you are sick right now. The RT-PCR testing is limited right now because the world doesn’t have enough of all of the supplies required — swabs, PPE, reagents, etc. — to test as many people as we’d like.

The RT-PCR test is also critical to contact tracing: finding everyone that has been exposed to someone currently infectious. If I expose you and the health department tests me positive and then calls you right away to let you know that you have been exposed you can stay home and stop the spread. Other tests — to date — don’t offer this kind of immediate payoff.

The type of test you may have heard about in the news — the antibody test or serology test — is a blood test that looks for antibodies, proteins that your immune system creates to fight off invading viruses and bacteria. The antibodies stick around after an infection, sometimes for a little while sometimes for the rest of your life.

The serology tests that we’ve seen so far are typically in the 95-98% accuracy range. To use an example from Dr. Osterholm, if the test is 95% accurate, and 5% of a population is infected, then testing 100,000 people will result in 5,000 who either were told that they were sick but weren’t, or were told that they were not sick and are/were

At this point we haven’t seen any serology tests accurate enough to use for a specific person. However, those levels of accuracy are good to enough for a population. For instance, if you wanted to know what percentage of Knoxvillians had been exposed to COVID-19 a serology test would work great, but it wouldn’t be very reliable on a per-person basis. [1]

The PCR tests are accurate but we don’t have enough supplies to test everyone. Also, they are snapshot of who is infected now. The serology tests, by contrast, can be done more widely (we have enough supplies) and tell us, broadly, who has been infected, ever. (Ever = up to this point, we don’t know how long COVID-19 antibodies will stick around as the virus itself has only been around for a few months).

There are other tests being thrown around, saliva based tests, antigen tests, but we haven’t seen any that are far enough along to report on, much less be useful in the real world. Eventually, you can expect to see a combination of PCR and serological tests being used to help inform the policy response and understand where we are at with COVID-19.

Bonus points: The best epidemiological models for COVID-19, to date, appear to be based on SEIR: Susceptible (people), Exposed (people), Infectious (people) and Recovered (people, which includes those who died). PCR can tell you about Infected, serological can tell you about Susceptible.

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.

[1] We are simplifying. This article goes over the accuracy in more detail and proper terminology. There are serological tests claiming higher accuracy but we haven’t seen any that have passed through peer review at those higher levels of accuracy.

Today we’re going to go over a question we got today, which will be our focus.

If you want to see cases and deaths see yesterday’s post, there are not material changes.

How does increased testing affect New Cases?

We had one question come in asking how increased testing would affect new cases. The expectation by public health experts and JM Addington is that increased testing will lead to an increased number of confirmed cases. In fact, the Knox County Health Department is considering pulling back from some of their events because they aren’t finding enough new cases.

There are two primary reasons that we test in public health:

  1. To find out if a specific individual is sick. In the case of COVID-19 this would be to ask them and anybody that they have been in contact with to self-isolate to prevent further spread
  2. To find out how widespread a disease is in a community or geography (city, county, state, prison, hospital, nursing home, etc.)

Clearly if you test more you are going to find more so the question becomes how much testing is enough and at what point does your level of concern go up?

One of the simplest ways is to look at the positivity rate, the number of total cases divided by total tests. In short, the positivity rate will give you an idea of (1) if you are doing enough testing, and (2) if the disease is spreading regardless of the number of confirmed cases. Both Dr. Fauci and Dr. Gottlieb have said the that US should shoot for a 10% rate. (See this article for a more in-depth discussion)

The typical way to calculate this is to take total cases, ever and divide by total tests, ever. For Tennessee, we get a 6.26% positivity rate.

We’re going to admit to playing armchair epidemiologist here and show you how we look at it, which is to look at the last 7 days of new cases and divide by the last 7 days of tests, which gives Tennessee a 2.03% positivity rate.

The US has a total positivity rate of 15.84% and 7-day positivity rate of 10.85%.

The first metric — total cases/test — will bias your rate towards whenever you had the most cases and the most testing, so you may end up measuring more where you were than where you’ve been. Taking a more recent set of data will tell you about where you are now.

We’re going to show you this data for the last 3 weeks, then we’ll talk about using it in conjunction with two other important metrics.

TN COVID-19 Positivity Rate, May 5th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

Note the y-axis changes scale here

TN COVID-19 Positivity Rate, May 5th, 2020 by JM Addington Technology Solutions
Source: Data from The COVID Tracking Project; Chart by JM Addington

The relatively low positivity rate in Tennessee is one of the reasons we’ve said that the data in Tennessee supports re-opening.

Of course, the positivity rate can be gamed: if you test a bunch of people that are not sick it will go down. The real question is how is the positivity rate moving with the total number of tests, the number of new cases and the number of new deaths?

You must combine data points to to look for the trend. These data points are cardinal directions, north vs south, not specific headings, 357′ vs 356′.

If cases are going up but the rate and deaths are stable or declining then it is likely you are simply doing a good job testing and the situation is stable or improving. If the rate is high, and stable or increasing then an outbreak may be getting ahead of you. If deaths, cases and positivity rate all increasing you’re in a world of hurt.

In a perfect world you will see cases, deaths and positivity rate all trend down as the situation improves. Nationally, the positivity rate (see above) is dropping faster than new cases or new deaths per day, which would be indicative that our testing is getting better but the situation is still static overall.

US COVID-19 new Cases & Deaths by Day
Source: Data from The COVID Tracking Project; Chart by JM Addington

In Tennessee, you see news cases per day jump mid-April and then plateau to where we are today, along with deaths. With a rising positivity rate this would be indicative of the situation worsening overall, if only slightly at this point.

TN COVID-19 new Cases & Deaths by Day
Source: Data from The COVID Tracking Project; Chart by JM Addington

…but…

Even all of these numbers together don’t do a good job at telling the story anymore. If anything, they are just enough to give you an arrow indicating direction.

Tennessee is testing all prison populations this week and already began testing all long term care facilities, both populations that have a lot of cases. So your tests and your positivity rate are going to go up because of the more targeted tests. This doesn’t mean that community-wide transmission has changed.

For better or worse, we think that this is going to increasingly be the case across the nation. Even the most in-depth numbers you have on testing, cases and deaths will only tell you part of the story. We’re not sure how keeping up with the numbers alone can be useful.

News

Building on yesterday’s news of a patient in France retrospectively being tested with COVID-19 on December 27th, 2019, is now bolstered by a peer-reviewed study showing that COVID-19 was circulating widely earlier than initially believed.

Tennessee is finding large amounts of asymptomatic cases in its prisons. Public Health Commissioner Dr. Piercey acknowledged as much during the briefing today but didn’t add any color to it. Combined with yesterday’s story of similar testing in a meatpacking plant, it challenges some of what we believe to be true about COVID-19.

Zoo Knoxville is set to re-open May 18th.

A Knoxville firm, one of Tom Boyd’s, is working on COVID-19 antibody testing.

Governor Bill Lee announced that Tennessee has procured 5,000,000 cloth masks and will be distributing them, free, via public health departments (from today’s briefing).

Infrared thermometers are available for Tennesseans only at tennesseepledge.com, $33/ea.

Dentists are allowed to open in Tennessee’s 89 rural counties, tomorrow.

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.

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.

[1] We are simplifying. This article goes over the accuracy in more detail and proper terminology. There are serological tests claiming higher accuracy but we haven’t seen any that have passed through peer review at those higher levels of accuracy.

Today we’re going to talk about the biggest news today, and then go over numbers, which are less encouraging nationally that we’d hope.

Missouri, Italy & France

Early this morning CNN posted an article that a pork processing plant in Missouri had 373 workers test positive for COVID-19 and all were asymptomatic. Now, we’re taking this with a small grain of salt because it goes so far against the other data that we have, the idea that a single cohort could test this congruently positive while asymptomatic is hard to believe, it would necessarily raise a lot of questions about what we know about COVID-19.

A paper in the International Journal of Antimicrobial Agents says that doctors in France retrospectively found a patient that tested positive for COVID-19 on December 27th, 2019. Doctors routinely keep samples at this hospital, so that back-tested some of them against COVID-19 and found one. For context the WHO’s website still states that the first recorded case outside of China was in Thailand, on January 13th.

On March 20th, we wrote:

A little something to watch, one report of out Italy suggests that the Coronavirus was there as early as November or December. If so, that would mean that the virus was circulating weeks before anyone knew it existed and possibly two months before anyone knew it was going to be a big deal.

JM Addington Technology Solutions, 2020-03-20 COVID-19 AM Update

This adds to the possibility that COVID-19 really was circulating in Italy far earlier than confirmed.

It is impossible to go into the implications of these reports, if they pan out, without diving into some pretty deep and poorly-vetted prognostication.

Today there are dire headlines about internal White House projections of deaths per day hitting new peak levels in June, etc. We certainly don’t want to discount that possibility, however, selected leaked White House papers typically do little to further science or an objective understanding of reality. The White House (and the Pentagon) plan for everything. You will find plans in their archives that range from spot-on to absolutely crazy. It will matter if it turns out it was the consensus plan and not a “just a possibility” plan.

J. Crew is going to file for bankruptcy. (1) Bankruptcy doesn’t mean going out of business, (2) the fashion/clothing/retail sectors have been in a bad spot for years, (3) because of (1) and (2) we expect to see more of these filings: it is a “forced opportunity” to take an action that was already likely.

Gap, Tesla and Victoria’s Secret are among the nearly 5,000 store closings already in 2019

CNBC, nearly 15 months ago in 2019

Finally, Tyson says to expect more meat plan closures. We’ve been on this for a couple of weeks now. Please remember that a shortage doesn’t mean an outage.

Numbers

We’re just going to skate over these today because they can be summed up easily: the US declining in cases, but barely. Tennessee is increasing in cases, and that’s looking iffy. The Knox County region sees about the same growth we have seen.

US COVID-19 Cases and 7 Day Rolling Average, May 4th, 2020 by JM Addington Technology Solutions
Source: The COVID Tracking Project

There really isn’t a way to interpret this as a good news, other than that it doesn’t seem like our healthcare system has been overwhelmed on a national level, the avoidance of which was the primary rationale for the lockdowns.

If you remove New York completely, we’re still on the upswing.

US w/o NY COVID-19 Cases and 7 Day Rolling Average, May 4th, 2020 by JM Addington Technology Solutions
Source: The COVID Tracking Project

Not shown are deaths, which at over 60,000 total are already past the optimistic numbers put out in mid-April as New York began to get its crisis under control but before outbreaks were as prevalent elsewhere. President Trump yesterday put the possible deaths number at as high as 100,000. At our current rate of about 1,700 new deaths/day we’ll hit that before the end of May. It’s really not clear to us how we’d slow down deaths/day if cases are increasing, and are expected to increase more as we open up.

We are switching our source for most Tennessee specific data to the Tennessee Department of Health as they have finally given us data on par with the COVID Tracking Project. Better late than never.

TN COVID-19 Cases and 7 Day Rolling Average, May 4th, 2020 by JM Addington Technology Solutions
Source: Tennessee Department of Health

Again, for Tennessee the balance is that things are trending the wrong way, even allowing for the clusters we know about (i.e., prison testing). What does this tell us about opening up? Nothing, right now. These trends most likely reflect exposures in late April, that were tested when Tennessee began to open up. Mid to late May is when we learn about how opening up affects us.

You certainly can read this data as giving you great pause and caution before heading outside your home and that isn’t an unfair reading of the data. However, as we have again noted for weeks, Tennessean social distancing plateaued in early to mid-April.

Tennessean social distancing plateaued in April

Of course, even with those caveats, it’s hard to imagine that opening up won’t bring more cases, and deaths.

Knox County remains in its own little world. One of the most important aspects of our low growth in absolute number of new cases today is that our health department has enough to staff to do testing and contact tracing. After you get above a certain point your percentage growth rate can be slow, or even negative, but you still don’t have enough people to fight it. The cat is still in the bag here.

May 4th, 2020 COVID-19 Cases in Knox County by Knox County Public Health Department
Source: Knox County Public Health Department

We’re going to leave you this excellent map that focuses on trends a the county level.

Source: Here

A month ago New York was driving COVID-19 data so much we’d actually show graphs here with and without it. Today, there are a number of states on its heel. The COVID-19 story is about to get much more complex

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.

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 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.