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

Numbers

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

Click on any image to see it larger.

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

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

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

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

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

TN New Cases

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

TN Positivity Rate (about 7%)

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

Deaths by State

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

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

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

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

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

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

GA New Cases

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

GA Positivity Rate (almost 20%)

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

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

Here are GA new cases.

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

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

Knox County total cases by day

Nine county cases by day.

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

National/International News

Today is a lot of small and important things.

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

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

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

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

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

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

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

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

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

Knox County News

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

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

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

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

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

Knox County Mayor Jacobs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Governor Lee, explaing that Tennessee clears criterion #1

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

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

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

Governor Lee, explaing that Tennessee clears criterion #3

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

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

Posted by Lexie Goertzen on Tuesday, April 21, 2020

Get In Touch

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

Other

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

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

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

Numbers

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

Click on any image to see it larger.

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

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

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

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

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

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

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

Source: Tennessee Department of Health

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

Here are GA new cases.

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

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

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

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

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

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

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

Knox County News

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

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

Dr. Buchanan, KCHD

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

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

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

Dr. Buchanan, KCHD

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

Dr. Buchanan, KCHD

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

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

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

Dr. Buchanan, KCHD

National/International News

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

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

The South China Morning Post

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

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

Singapore’s Prime Minister Lee Hsien Loong

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

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

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

Tennessee Opens Up, in a Week

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

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

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

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

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

Governor Lee

Gateway Criteria and Tennessee

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

SYMPTOMS [Criterion 1]

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

AND

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

White House Proposed State or Regional Gating Criteria

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

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

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

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

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

Source: CDC

HOSPITALS [Criterion 3]

Treat all patients without crisis care

AND

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

White House Proposed State or Regional Gating Criteria

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

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

National Academy of Sciences (2010)

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

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

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

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

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

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

CASES [#2 Criterion]

Downward trajectory of documented cases within a 14-day period

or

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

White House Proposed State or Regional Gating Criteria

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

We’ll go ahead and look at both numbers.

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

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

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

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

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

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

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

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

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

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

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

Our Current Interpretation of the White House Criteria and Tennessee

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

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

Dr. Piercey

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

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

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

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

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

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

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

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

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

Get In Touch

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

Other

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

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

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

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

Numbers

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

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

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

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

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

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

Here is MN.

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

Screenshot of JM Addington created PowerBI COVID-19 Report

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

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

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

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

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

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

Source: Knox County Health Department

News

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

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

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

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

Initial Thoughts on Opening Up

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

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

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

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

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

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

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

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

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

Get In Touch

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

Other

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

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

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

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

Some of our data has changed notably from yesterday’s post. Specifically, yesterday had data lagging when we were making the charts and today we have current numbers (today’s) in, which typically lag 24-48 hours.

Also, it is common that some days show greater increases than others, based on when testing is available and reported back. It’s another reason we post primarily in graphic form, so you can visually identify the trend above any given day or week of data.

Numbers

Yesterday we said we were at four days of decline. Unfortunately, with updated data that is no longer the case. New York is showing a large increase today, of the 30,000 odd new cases today New York is 11,000 of them.

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

Deaths are also up. NY, NJ, CT, MI and MA make up 2/3rds of the new deaths so far today.

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

For context, we’re still tracking between the lower estimate and mean estimate from the March 27th IMHE model.

Looking at just Tennessee the data shows a downward trend over the whole month but the last week is about even. Tennessee is about to massively expand testing efforts (see below). If successful you can expect to see these new cases continue to rise. If that happens, it is likely the result of more testing, not a faster rise in new cases.

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

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

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

Knox County is still the bulk of the area cases, and you can see that growth in new cases hasn’t changed notably since April 9th. Today, Dr. Buchanan was finally able to say, ” “We’re beginning to flatten the curve.”

Source: Knox County Health Department

News

Some of us got our personal stimulus funds today, it appears that those are widely rolling out for those with bank account numbers on file with the IRS.

The Paycheck Protection Program is widely expected to be out of funds today. Our take: it doesn’t matter, too much. No one we know has received funds yet and Congress will most likely approve an increase in funds. However, Congress is effectively in recess right now until May 4th. [1] So, it will be at least three weeks before more funds are appropriated.

Germany is beginning to lay out plans to lift lockdown. The EU announced advice on how to relax quarantines, which looks a lot like Tennesse’s (see below).

ABC News has a story about 100 cases and 44 deaths at a veteran’s long-term care facility in Massachusetts. The risk in these populations is extreme: people in LTC facilities typically are older and have underlying health conditions. Spain and Italy both had significant issues in keeping residents of such facilities safe from the COVID-19.

Science magazine has a paper from Harvard that says we may need to social distance into 2022. The authors include Marc Lipsitch, one of the world’s leading epidemiologists. We’ve written the same thing. This doesn’t mean we are at home for 2 years, it means that it is not business as usual for 2 years.

To avoid [exceeding critical care capacity], prolonged or intermittent social distancing may be necessary into 2022.

Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period

New York City has begun to report probable COVID-19 deaths. These are tracked separately but help to show, (1) the real scale of the outbreak in NYC, and (2) the difference between testing and reality.

Our take: the probable number looks better than expected. Some thought that testing could be off by a factor of 10.

Some rough math: NY state has about a 5% case fatality rate (1/20), if we take NYC’s confirmed+probable deaths (10,900) and multiply by 20 we end up with just over 200,000 cases, compared to the 111,000 confirmed cases.

Don’t do anything sciencey with that or assume you can extrapolate to other states. It is simply an exercise that gives us some rough estimates of where confirmed cases are (which we know we undercount) compared to actual cases (which is unknowable).

Source: Screenshot from New York City Department of Health Confirmed and Probable COVID-19 Deaths: Daily Report

More importantly: use the confirmed+probable to understand the scope of the tragedy and situation.

Tennessee

Governor Lee officially recommended today that schools stay closed through the end of the year but declined to make it an order. Education Commissioner Schwinn said, ” “We will open schools next year and students will enter their new grades.”

Tennessee is going to expand its testing efforts, testing more people and testing more broadly. 15 drive-through sites will be run by the National Guard this weekend, you can find ta full list of weekend testing sites here. Find test sites for Knox County here.

Dr. Pearcy also promised that tests would be free, we think she meant department of health and drive-through tests, private providers can still charge.

If you think you need a test, we will test you.

Dr. Pearcy from TN Department of Health

Governor Lee was asked if the state would be open May 1st:

“We are waiting on the recommendations. That’s our goal, to open in May… that depends on the recommendations of the health care community, the business community… the most important thing is Tennesseans’ lives are protected and safe.”

“Tennesseans have been incredibly responsive to the [guidance] out there… It’s working, our curve has flattened. We need more confirmation of those numbers in the right direction, that haven’t been turned downward… we need some of those hospitalization numbers to not only stabilize but turn downwards.

Governer Lee, April 15th, 2020 media briefing

This is the most specific we’ve heard him be so far.

The Tennessee Department of Health also promised to step up contact tracing, the process of tracking down anyone that has been in contact with someone who tested positive for COVID-19. Dr. Pearcy plans to hire another 150 people to work on this. For some context, Ars Technica says that there are only 2,200 people doing contact tracing in the US right now. Massachusetts is trying to hire 1,000 people for this right now.

Testing and tracing is essentially the plan we’ve seen followed by places such as Hong Kong, Singapore and South Korea, all of which have been more successful than most western countries in fighting COVID-19. Also, to be clear, social distancing doesn’t go away with this: it is something of a compromise between a lockdown and full-open. The testing and tracing plan is also the backbone of a number of other plans to re-open the US economy. There is skepticism from some corners that it is possible at the scale we need it at. We’re not epidemiologists, so we are just going to note that those disagreements exist.

Economics

To add some more color to what we wrote yesterday, Goldman Sachs is predicting that the economic downturn will be the worst in history, while the upturn will be the best. That sounds sensationalist in one regard, to us IT folks it sounds a lot like, “we turned it off and back on again.”

The Wall Street Journal has an article via MSN about how layoffs are affecting white-collar workers. We mention it here to reduce surprise: of course, there are going to be layoffs in virtually every sector of the economy. This is the natural result of asking pretty much everyone to stay at home and stop working. It doesn’t mean that those jobs will not come back.

We mentioned yesterday that the IMF is predicting the greatest recession since the Great Depression. Today, Axios reports that is the optimistic version:

The coronavirus pandemic will bring about the worst economic downturn since the Great Depression, the IMF predicted Tuesday in its latest World Economic Outlook — and that is its optimistic outlook.

Axios

For the first time since the Great Depression both advanced economies and emerging market and developing economies are in recession. For this year, growth in advanced economies is projected at -6.1 percent… Income per capita is projected to shrink for over 170 countries. Both advanced economies and emerging market and developing economies are expected to partially recover in 2021.

IMF

We share this so you can plan, see yesterday’s post.

A 3% contraction will be painful. a 6% contraction would feel absolutely awful. A lot of jobs are going to be gone.

And yet, even a 10% reduction in US GDP per capita leaves us above 2010 levels [2]. The balance is understanding that life will get worse and we think — right now — we’re not headed for the dustbowl. Even the much worse 1918 influenza left the economy in place. We’d have to destroy it ourselves a few years later.

US GDP per Capita, 1947 – 2019

Source: The Federal Reserve of St. Louis (FRED)

Finally, we could be wrong on all of this. There really isn’t a precedent to compare to. However, we’ll continue to give you what we believe are the most balanced takes available.

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] The Senate is not fully recessed, holding pro forma sessions in which nothing gets done, or is supposed to, but prevents the President from making recess appointments.

[2] Income equality, which has risen recently, in the US, however, means that people will feel this drop very differently. That is a different post.

Today we’re going to briefly hit the numbers at the national, state, regional and county level, hit a couple of news items and then spend a little bit of time talking economics.

Numbers

Nationally, we are looking at a fourth straight day of a decline in new cases. Today is not shown yet but it is looking to be another day with fewer new cases than yesterday. We have horizontal lines showing the 7-day average for new cases and the level as of March 15th, a date we’ve chosen because it seems to be about the time the public realized that COVID-19 was going to be an issue.

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

New US deaths is down three of the last four days but probably up today, with over 1800 new deaths reported so far. This is, of course, the metric that matters the most: we’re more concerned with the number of people dying from COVID-19 than who are sick. Deaths lag cases. Also, keep in mind that (1) we need more than 4 days of data to call it a real trend either way, and (2) we’re really looking at both new deaths and new cases together to determine which way things are going.

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

New Jersey is up to 65,000 cases, making up over 10% of the US total.

Looking at just Tennessee the data shows a downward trend over the whole month but the last week is about even:

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

We’ll note that the data we have above is substantially different than what the TN Department of Health shows, however, our new case data totals are about the same as what the state is reporting, we conclude that the state reports new cases on a lag.

Tennessee has 10 long term living facilities that report at least two cases between staff and residents. Three in Franklin, two in Gallatin, and one in each Nashville, Knoxville (Williamsburg Villas), Lafayette, Cookeville and Memphis.

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

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

Knox County is still the bulk of the area cases, and you can see that growth in new cases hasn’t changed notably since April 9th:

Screenshot from KCHD

Data from Unacast and Google show social distancing to be pretty much leveled off in the state, including Knox County. It will be interesting to see if new cases per day continue to drop over the month if social distancing stays at its current level. The most interesting question, to us, is how will people react come May 1st if new cases are constant, regardless of plans to re-open?

Neither the county nor the state have briefings online right now (5 PM EST). It’s not clear why.

You can find a map of places to get tested for COVID-19 here.

Knox County released a phased in plan for restarting the economy. The county health department has called it a draft, stating, “The draft proposal was created by Mayor Jacobs in direct response to a request from Governor Lee who asked city and county mayors from across the state for their thoughts regarding a phased re-opening.”

Screenshot from KCHD

News

We personally know people that have the stimulus hitting their accounts. No word on actual PPP funds hitting accounts, other than some owners who have received fraction and believe that their bank simply advanced the money. Multiple states are announcing their plans to re-open, starting with California. However, timelines are not part of the plans yet.

Economics

JP Morgan is predicting, “a fairly severe recession,” unemployment claims have topped 13 million in three weeks with more expected, the IMF has said that they expect a recession far worse than the 2008 financial crisis.

So, is the economic world ending?

First, no one knows. There isn’t a playbook for turning the world economy off and back on again. The closest thing to COVID-19 economic data we have is China, a country still officially communist. The Federal Reserve has made a good case that this recession will look more like one that follows an awful hurricane than a typical recession.

It is an analysis that we agree with, to date. First, a typical recession comes slowly, it often isn’t clear in the moment what is driving it and there are underlying economic problems that took years to build up and take years to fix. The COVID-19 recession came suddenly and with clarity. The massive job losses you see are businesses acting quickly to preserve themselves and future job capacity. Your local retailer or restaurant may have laid off staff today but if they still exist in July (some) jobs can return.

In a typical recession, businesses all grab for the money at once to preserve their capital. Today, businesses are acutely aware that if everyone acts that way that their own customer base will implode, with their business along with it. Practically: if Wells Fargo didn’t let people defer mortgages they would have a bankruptcy problem in 90 days that far outweighs the cost of mortgage deferments. The same is true with rent, credit cards, etc. We aren’t saying that no one will act this way, but broadly, industry understands that dropping the hammer will cost the one who dropped it as much as the one it lands on.

The federal government has also reacted with breathtaking speed (for the federal government). The Paycheck Protection Program, the stimulus checks and several other actions by the federal reserve have been reactions that in the past would have been done in months or years, not weeks.

All of this is to say that the coming recession looks a lot, lot different than anything else we’ve gone through in the modern economy. It is entirely possible that things will turn up much faster than other recessions.

It is also true that this will cut deeper in many areas, and a “return” is measured in months and not weeks.

The President of the Federal Reserve Bank of Atalanta said today that the recovery could begin in the third quarter, and we think that is the optimistic view.

Unemployment will get worse before it gets better, and will only slowly get better. We could be at double digit unemployment for most, or all, of 2020. Hotels, restaurants, concerts, churches, retail, etc., cannot get back to normal until COVID-19 is virtually gone, and that is an 18-24 month horizon. It is likely that travel restrictions stay in place for months.

And we don’t have time today to touch on industries like airlines, tourism, cruises, amusement parks, etc.

It’s going to be a rough ride for a while.

As your author and business owner, I am still supremely confident that we will get through this. The recessions that stay with us have been ones that we made, the storms that have come upon us have passed, and we’ve recovered from.

How Your Author is Adjusting

Let me get personal with you for a little bit. I assume that our family’s personal income will be down by at least 25% for a while, maybe this whole year. The stimulus will help us more than most (we have 8 children). We’ve managed to cut personal expenses by 25% and I believe we can keep them cut at that level for the rest of 2020.

Any cash that we are able to save and keep on hand, we are. It’s possible that some of it, maybe a lot of it, will go back into the business.

Instead of going out, my wife and I have spent the last several Fridays perfecting our stir-frying together.

Fun and nice groceries are mostly out right now, we buy essentials. We ate a lot of rice and beans before, now we eat more. We’ve switched over our youngest baby to cloth diapers we already had.

I don’t know yet if my seven year old will return to gymnastics this year.

I’m spending a lot more time working than I was a month ago, not less.

And, finally, no one ever sets the thermostat more expensive than it needs to be.

JM Addington Stir Fry Solutions

And it’s all going to be alright. 2020 and 2021 are not going to look like what I had pictured and that is OK. We’ve created safe spots at work and at home for many and, Lord willing, will continue to grow those spaces to include more people.

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.

Governor Lee just finished his daily media briefing during which he stated two important things:

  1. He will extend the stay-at-home order through April 30th
  2. He plans to re-open the economy in May, presumably May 1st.

Let’s dig into #2 a little bit.

This does not mean an end to social distancing. A point we’ve made a few times.

Social distancing will be a way of life for Tennesseans [until we have a vaccine]

Governor Bill Lee

Six feet apart is going to remain the name of the game for the foreseeable future, as in until we have a vaccine. What we have been doing is to halt a pandemic, but that doesn’t get rid of the underlying virus.

The bottom line is, that staying at least six feet away from other people makes it very hard for this disease to be transmitted. We have to continue social distancing in public even as certain restrictions are relaxed.

Governor Bill Lee

Before the stay-at-home executive orders there were already limits on gatherings of large numbers of people. Restaurants were already limited to takeout/delivery, gyms were closed and nursing homes were closed to visitors. (Executive Order 17, March 22) Non-essential medical care had been suspended (Executive Order 18, March 23), barbershops, nail salons, bowling alleys, etc., etc., were also closed (Executive Order 21, March 30).

Beginning in May, we begin a phased reboot of our economy. Between now and then, we’ll create industry-specific guidance so that businesses can be fully prepared to operate safely and to protect their employees and their customers.

Governor Bill Lee

“Re-opening the economy” does not mean we go back to normal.

Lee made sure that he left a lot of room to define what re-opening the economy would be mean.

Defeating this disease once and for all requires specific advances, scientific advances, that are many months away. But until that time, we have to find new ways of living our lives and operating our businesses that will allow us to function as safely as possible while balancing a number of goals that sometimes may be in conflict.

Governor Bill Lee

On May 1st we will have a lot of plans. At the state level, the county level, the city level, the organizational level, and the personal level. However, the reality of the virus will drive the reality of the implementation of our collective plans. We believe that Governor Lee recognizes this, and that today’s speech was more about laying down a marker for when something would change, not about when everything will change.

Rough transcript of initial remarks

This is your author’s rushed transcript of Governor Lee’s remarks as a state-released transcript was not readily available to us.

We’re not out of the woods yet, and it could be some time. But it is clear that the actions we’ve taken at the state, combined with the local level, most importantly with the determination of our citizens and the bravery of our first responders and our healthcare workers on the front lines, those efforts have saved countless lives across Tenessee. And for that we are thankful.

However, until a treatment is widely available, we have to remain vigilant to incorporate social distancing and good hygiene in our daily routines or we have a very serious risk that this disease will come roaring back ad erase all the progress we’ve made to date. Until a vaccine or a therapy is widely available to Tennesseans this virus will be a present reality to us for us to manage and consider whenever we’re making decisions.

However, its clear that our economy cannot stay shut down for months on end. So we’re left with a clear but complicated task: we have to re-imagine how to conduct business and a society so that we can operate our economy safely and confidently while continuing to suppress the spread of COVID-19.

We need Tennesseans to go back to work. But we also need everyone to recognize that physical distancing must continue for the foreseeable future. Unemployment claims have been 25 times their normal rate, with more than 250,000 initial claims in the last three weeks.

In cooperation with guidance from the White House, we’ll extend our stay-at-home order until April 30th and plan to begin reopening our economy in May. Until that time, our unified command team will continue to consult with experts, analyze all the available data and monitor CDC recommendations for the remainder of this month.

Beginning in May, we begin a phased reboot of our economy. Between now and then, we’ll create industry-specific guidance so that businesses can be fully prepared to operate safely and to protect their employees and their customers.

In early March, I started work with industry leaders to understand how businesses would be impacted during this pandemic. We pulled together an advisory council that includes leaders from the Tennessee chamber, hospitality, transportation, and the grocery industries to ensure that we kept a close watch on the health of our state’s economy. While these early efforts have helped us to stay informed its time to move to a planning and implementation phase.

I’m formalizing an economic recovery group, to be led by tourism commissioner Mark Ezell, that will work in coordination with legislative leadership, local mayors, health care professionals and representatives of impacted industries. By formalizing an economic recovery specific group, this will ensure that the unified command group will continue their focused effort on disease management, improving hospital and testing capacity and increasing our PPE supply chain. Unified command group will also be making recommendations to me about exactly when and how to begin our phased-in reopening of our economy.

Defeating this disease once and for all requires specific advances, scientific advances, that are many months away. But until that time, we have to find new ways of living our lives and operating our businesses that will allow us to function as safely as possible while balancing a number of goals that sometimes may be in conflict.

Our economy cannot operate normally until these advances are made, and yet, an open-ended economic shutdown is unsustainable for Tennessee families. The middle ground will create some discomfort, but more than every Tennesseans must come together to keep each other safe by taking concrete actions and establishing new routines. The bottom line is, that staying at least six feet away from other people makes it very hard for this disease to be transmitted. We have to continue social distancing in public even as certain restrictions are relaxed.

We also want to strongly encourage the simple things, wearing cloth masks in public, touch as few common surfaces as you can, wash your hands frequently throughout the day. Most importantly, stay home if you are sick or symptomatic. And get tested if you believe you have COVID symptoms or if you have been exposed to any who have. These precautions are for everyone., And the elderly or those with underlying conditions will need to take even further precautions.

More details regarding our new normal will be released in the coming days, but I implore Tennesseans to stay consistent in your efforts to flatten the curve. Our ability to successfully relaunch our economy requires every Tennesseans to step up and adopt new habits.

Today is mostly a summary type of day. We have may have a second update later in the day if significant news comes out, especially from the TN daily briefing.

All in all, new cases are going down but lots of small problems are popping up. Welcome to the beginning of the new normal.

As a whole, new cases and deaths in the US are both down with about 29,000 new cases yesterday. For comparison, on March 22nd we had about 32,000 cases in the US in total. So, the good news is that adding as many cases as we had in a single day three weeks ago is better than where we were last week.

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

New York continues to completely dominate US cases.

If you take out NY & NJ you get a much more even distribution of cases across the US:

Source: The COVID Tracking Project; Chart by JM Addington

We think that there are two ways that you can read this data. First, the outbreak in New York makes the situation there different than in the rest of the county as a whole. Second, it’s still clear that there are other majors areas at risk for outbreaks.

Source: The COVID Tracking Project; Chart by JM Addington

If you break down those totals MA new cases are going up, MI is stable, PA is down three days in a row in cases but not deaths, IL is trending up, LA and FL are trending down. The point is that there isn’t an even response to COVID-19 across the US. We’d also like to note that one of the world’s leading epidemiologists recently stated that he doesn’t even trust the data unless there are at least ten days of trend behind it.

To give you another way to visualize it, here are new cases and new deaths by day across the US, with horizontal lines representing the levels at specific days. The purple one that lies just over the X-axis is 780 new cases/day, where we last were at on March 15th, which was one to two weeks before shelter-in-place orders became commons across the US. We’ve got a long way to drop.

Source: The COVID Tracking Project; Chart by JM Addington

East Tennessee & Knox County Numbers

New cases in Knox County are leveling off. To put that in context, they are around where we were at when the Knox County Safer at Home order went into place. We assume that the county wants to see cases below that point before re-opening.

KHCD also released a zip-code based map of cases, based on symptoms that were present as of April 4th. That’s 37919 highlighted. Dr. Buchanan of the Knox County Health Department said that it wasn’t clear if the differences in zip codes were due to differences in cases or availability of testing. Zipcodes with fewer than five cases are not identified due to privacy concerns.

The New York Times data, which doesn’t track with local data exactly (the state data also doesn’t always track with local data) show the nine-county region somewhere between stabilizing and living off in new cases.

As always, take a few days worth of data with a grain of salt. (See Dr. Buchanan’s remarks on this specifically below.)

Source: The New York Times; Chart by JM Addington

Notable Tennessee News

At today’s KCHD briefing Dr. Buchanan stated that she and Mayor Jacobs were not ready to limit the restrictions on travel and social distancing if Governor Lee allows his executive orders to expire (tomorrow at 11:59 PM). To consider lifting these restrictions KHCD would want to see a trend, more than a couple days of data.

“Where are we on the curve? That’s easy, we’re at the beginning. We’re still on the upslope of the curve… We need to see that for several days. One day of fewer cases does not mean that we flatten the curve, at all.”

Dr. Buchanan, April 13th, 2020 KHCD daily briefing

To get a test locally, the county has expanded qualifying symptoms to include loss of smell, loss of taste and “some GI symptoms,” beyond the more typical flu-like symptoms. KHCD is also prioritizing people at highest risk for complications, such as those with chronic medical conditions or healthcare workers that can’t otherwise be tested. Results from KHCD are currently being turned around in 3-4 days.

Mayor Indya Kincannon signed an extension of the City of Knoxville’s Safer at Home Order.

An employee at Target North in Knoxville was found to be positive with COVID-19. Given that, (1) most people are contentious before they are symptomatic (a 5-7 day lag), and (2) you can’t get tested without being symptomatic in most cases it seems likely that we’ll see some more cases come out of this.

19 staff cases of COVID-19 were found at two Tennessee correctional facilities. On Thursday during the TN daily briefing, it was announced that there would be mass testing at these two facilities, of staff only. The decision to test staff only is puzzling to us, given the lag in symptoms and confirmed cases we just mentioned we don’t understand how the offender population wouldn’t have cases as well. The state is issuing cloth masks, which haven’t been shown to be effective.

A Tyson plant just north of Nashville is being investigated for a possible outbreak of cases, no updates have been posted on this since Friday.

US Testing

US testing remains on a pretty much a straight line, i.e., we are not ramping up testing. The chemicals needed to run the tests are in short supply. That means we can’t expect to see the number of new tests per day increase until we figure out how to increase the supply chain.

Also, as Dr. Osterholm notes, many of the “re-opening” plans rely on widespread testing. There isn’t any evidence that we can actually accomplish wide-spread testing, right now.

Source: The COVID Tracking Project; Chart by JM Addington

The turn around time of the tests is also a major concern. As Bill Gates noted on CNBC’s Squawk Box, the test results are most valuable within the first 24 hours of the test. The longer you take to test the more you’ve allowed the virus to spread.

Any time the queue [test result time] is over 24 hours that’s complete mismangement because the value of the result is far less worthwhile… the best case is [the test] goes positive before you’re symptomatic or infections; and then you can act in such a way that don’t infect anyone else.

Bill Gates, Squawk Box, April 9th, 2020

The Food Supply Chain

A fantastic article on Medium explained how the toilet paper shortage is more about supply chains than hoarding. In short, “the average household will use 40% more toilet paper than usual [at home],” under social distancing. The single-ply toilet paper you have at your office, hotel, conference center, etc., literally comes from different factories and they can’t just flip a switch to make the double-ply stuff you buy at Kroger instead. We believe that this insight explains a lot of empty shelves at grocery stores, beyond TP.

Indeed, there are multiple reports about the disruptions coming in the food supply chain. First, the supply chain needs to change. Restaurants and hotels don’t need nearly as much food as they did before, grocery stores and food shelves need lots more. But it’s more complicated than just changing where trucks deliver their goods, the type of food changes as well. Second, slowing immigration (due to COVID-19) will make it difficult to let in the immigrants who come to harvest our crops.

Third, the factories that produce our food — especially meat — have to cope with COVID-19 as well, and they simply aren’t set-up for social distancing. 5% of pork production in the US was cut today with the idling of a single plant. Fourth, there are inter-dependencies that are not well-understood outside the food industry. One expert told us about how cutting sports was going to affect animal feed:

So, there’s an ingredient called wheat middlings. It is essentially the leftover stuff after you make white flour. White flour is used mainly in hotdog and hamburger buns, which aren’t being eaten at the same rate because sporting events are closed. Same with restaurants. First thing you get on the table is bread. We aren’t eating as much as a nation. These wheat middling are used in most animal feed as an energy source as well as a pellet binder (The feed usually comes in pellet form.)

No baseball, no buns, no flour mills making white flour, no middlings.

We’ve personally seen this, where local grocery stores are out of essentials (flour, meat, toilet paper, etc.) it is still available to us from the commercial supply chain.

What Does it Mean to Re-Open?

We released our own whitepaper on what we believe next few weeks will look like, to be clear, there will only be a new normal for months not a return to old normal. Vox.com reviewed four of the re-opening plans and summarized them all:

…there is no normal for the foreseeable future. Until there’s a vaccine, the United States either needs economically ruinous levels of social distancing, a digital surveillance state of shocking size and scope, or a mass testing apparatus of even more shocking size and intrusiveness. […] All of them then imagine a phase two, which relaxes — but does not end — social distancing while implementing testing and surveillance on a mass scale. This is where you must begin imagining the almost unimaginable.

Ezra Klein, Vox.com

Axios has their own summary which reads a lot like our own, “The future will come in waves — waves of recovery, waves of more bad news, and waves of returning to some semblance of normal life.”

You need to be seriously considering how your business, non-profit, family will operating inside this new normal. We’ll get through this, but getting through it successfully will require planning and effort.

Financial

IRS Stimulus Check Registration Tool: read about it on Forbes, you probably don’t need to use it.

BlueCross of Tennessee sent us an email stating that they are waiving all member costs for COVID-19 treatment:

As part of our mission to serve your employees, we’re removing their barriers to receiving care. From now until May 31, 2020, we’ll waive member cost sharing for COVID-19 treatments, including hospitalizations.

If your employee or one of their dependents is diagnosed with COVID-19, they won’t pay out-of-pocket costs for treatment from in-network providers, including inpatient treatment.

BlueCross of Tennessee

International

Spain is lifting its strictest two-week lockdown. “That means that the majority of the population of Spain remain in their homes – schools, bars, restaurants, cultural venues and leisure centers all remain closed – but the economic activity that was halted with the hibernation decree will restart.”

Singapore, a country that has done very well to date, is under a partial lockdown as its cases jump.

The South China Morning Post reports that “China is taking extra measures to stem the influx of imported cases of coronavirus, particularly from Russia after a small border city reported a dramatic jump in new cases among arrivals.”

Cloth Masks: A Brief Side Note

Earlier we alluded to a paper in the National Academy of Sciences, Engineering, and Medicine that said, “The current level of benefit [of wearing cloth masks], if any, is not possible to assess.” In large part, because there are very few studies done on the effectiveness of cloth masks, especially homemade ones. We will, for now, continue to use them out in public. However, there are two important caveats, (1) any benefit from cloth masks are to the public, not the wearer (it doesn’t protect the wearer), (2) it’s not a public policy response.

How JM Addington is Adjusting

Our thoughts and plans are shifted towards June and July. We believe that our financials are sound enough that we can bear front wave of the storm. The next part, learning to operate in our new normal will take more careful planning:

  • How do we keep our team safe?
  • How do we keep our customers safe?
  • What new services from us are our customers going to need?
  • Which if our customers are going to be negatively affected in 90 days? Which will see an uptake in business?
  • How is the competitive landscape going to change? Will price matter more in an economic downturn, or provider capacity to respond quickly and turn on a dime?

These are some of the questions we’re grappling with right now.

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.

See the Data

We are releasing the backbone of the graphs we’ve been using, a Microsoft Power BI Report linked to data from The COVID Tracking Project, The New York Times, TN Department of Health and some of our own calculations of those data. It’s much better on a computer or tablet than a phone.

We update the data when we can, typically the NYT updates around 11 AM EST and CTP updates after 5 PM EST. We then import the data and re-upload it to the report.

Thank you to those beta tested this for us and gave us early feedback.

Nationwide, new cases and new deaths are both set to be down or steady for the third day in a row. We’ve talked a lot about the issues with the quality of the data (it’s not great). At JM Addington we focus on the trends of the data and we’re optimistic that we are seeing both of those headed in the downward direction.

The data currently supports the IMHE model (on a national scale) that COVID-19 is peaking in the next week.

Tennessee is up to 4,600 cases and 94 deaths, a 2% mortality rate of known cases. The new cases and deaths are both up compared to yesterday. By comparison and warning, New York added 10,000 cases and nearly 800 deaths yesterday.

New York alone has more cases than the next highest country, Spain. New Jersey would be 10th on that list, if US States were counted as countries.

If you compare Tennessee directly to New York you almost can’t separate TN from the X-Axis.

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

And that would be true of most states. NY, NJ and MI make up half of the total cases in the US. LA, CA, MA, PA, FL, and IL all have more than 10,000 but less than 20,000 cases.

The significance to us is twofold: first, COVID-19 is playing out so differently in different parts of the US that they are almost different worlds. The reporting doesn’t always make that clear, but for most of us, COVID-19 isn’t what is shown on the news.

At the same time, it’s cautionary that it can get a lot worse. This is how exponential growth works, if you stop something doubling at say, 100 cases, it makes a huge difference compared to stopping the doubling at 1,000 cases.

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

Tennessee

Tennessee’s board of education voted on new rules that drop credits for graduating seniors. Students cannot have grades lowered during distance learning, but they can increase. It’s not official until the Attorney General official approves of it. The TN Department of Education (TDOE) requested public feedback by end of day Monday on how to spend dollars earmarked for education from the CARES Act. This money won’t arrive soon: the feds won’t take the state applications until at least mid-April.

TDOE has also partnered with PBS to release 30 hours of educational programming for students in 1st – 8th grade. You can find the schedule here and their YouTube channel here. They have even released student packets and teacher lesson plans for parents.

During today’s conference call with reporters Governor Lee declined to give a date that he decide whether or not to renew his stay-at-home executive order, “data changes quickly,” he said. That order remains in place through the end of Tuesday, April 14th, currently. During the call Lee also expressed that the state continues to plan for a surge of COVID-19 cases, although the timing and size of that surge was unknown.

Vanderbilt is expected to release a model specifically for Tennessee tomorrow. There has been some early reporting on it but no details until Friday.

Yesterday Lee issued executive order 25 which explicitly bars dental clinics (and related fields) from any non-emergency procedures, requires the postponement all of elective procedures, and, “encourages,” non-hospital healthcare workers to donate their PPE to the state. This order merely makes official much of what has already been done voluntarily.

Financial

We know some business owners who have been officially approved by their banks for the PPP loans. No one has seen money hit their bank account yet.

While we were writing this update we approved for the PPP, “awaiting instructions on funding.”

The president, as we write, is announcing new loans for larger businesses and work on increasing the funding available for the PPP loan. The PPP loan initially had $350bn behind it, which is widely expected to run out.

BlueCross of Tennessee sent us an email stating that they are waiving all member costs for COVID-19 treatment:

As part of our mission to serve your employees, we’re removing their barriers to receiving care. From now until May 31, 2020, we’ll waive member cost sharing for COVID-19 treatments, including hospitalizations.

If your employee or one of their dependents is diagnosed with COVID-19, they won’t pay out-of-pocket costs for treatment from in-network providers, including inpatient treatment.

BlueCross of Tennessee

International

Italy clearly has a hold on this, a great sign for the rest of the world. There is a long way to go, but things are headed where they need to be.

Source: Worldometers
Source: Worldometers

Spain made progress and then plateaued:

Source: Worldometers
Source: Worldometers

Both German and French data are noisy. New cases and new deaths aren’t moving together as clearly as Italy and Spain.

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.