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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.

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 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.