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Interestingly, there's a study going on in California investigating my very hypothesis (I don't take any credit for it - it's kind of obvious when you think about it)
It's possible that WA and CA already had spikes in COVID-19 way before widespread testing was available, but it was misdiagnosed as "influenza" or a "severe upper respiratory infection". In fact, the CDC data on influenza cases in WA, OR, and CA spiked in December and January
If you play with the map for the end of 2019 and beginning of 2020, all of the West Coast was dark red. Now not all of these might be COVID-19 related, but I'm willing to bet some of them are. But if anything, if what I think is true, then the rest of the country's curve should flatten like California and Washington has within the next 2-3 weeks.
Now, how this will help with the 2nd wave, I'm unsure. Could this mean the 2nd wave hits the West Coast sooner? Perhaps but only time can tell.
I could see that being possible. But still, where are the thousands and thousands of deaths that CA should have experienced? If NY is over 7k deaths in just a few weeks with extreme social distancing and basically empty subways and trains and office buildings and nobody packing our small bars and restaurants anymore, that has to mean that tens of thousands of Californians must have died from COVID-19, but it was diagnosed as something else. Are there any records of an abnormally deadly flu or respiratory illness in CA in the Fall/Winter?
Also, flights have basically shut down nationwide at this point. Wouldn't have NYC and North Jersey also been equally as exposed? I mean, people travel for business and vacation between CA and NYC all the time. LA and NYC are a huge revolving door of business and familial/friendship connections. There are, I believe, around 1 million Chinese people living in the Tri-State, and the majority of those are in NYC itself. Chinatown is in the middle of huge commuting zone, so if we're to blame Chinese nationals and tourists and their friends/family for spreading the virus through CA to provide herd immunity, how did NYC not get it when millions of people ride subways through Chinatown all the time. Plus, Flushing is a massive Chinese population connected to the 7 Train. Shouldn't most people who take the 7 have some type of immunity at this point? Wouldn't there have been a large number of Queens residents dying earlier than now? Also, the 7 goes along the edges of Elmhurst. Elmhurst is kinda an epicenter within the epicenter (NYC) right now, especially considering its large public hospital. But the residents of Queens are getting hit extremely hard right now, meaning they didn't have herd immunity, even though Flushing is a heavily Chinese area and the 7 Train normally has a lot of Chinese people on it headed to/from Flushing and both JFK and LGA are located in Queens (so kinda throws the whole airport connection theory into question). And it's not like LAX and SFO are the only places that see a lot of Chinese tourism. Chinese tourism is huge in NYC as well, whether or not their port of entry is EWR JFK LGA. If they connect through LAX/SFO, they're still walking the streets of NYC and riding our subways.
And yes, a lot of us were sick back in November/December. But did any of us know dozens of people dying from this? Does anyone have a friend or family member who died of an upper respiratory illness? Any indication of doctors/nurses/EMTs getting unusually high sick/death rates? Because you would think with absolutely no social distancing policies back then, our infection and death rates would have been absolutely massive.
And no, this can't just be the fact of NYC taking public transit. Millions of people ride LAMTA buses/subways/light rails every day. It has the largest bus transit system. SFMUNI/BART/Caltrain may not have the ridership of MTA/NJT/PATH, but millions still rely on MUNI/BART/Caltrain every day for work so people in the Bay should have been dropping like flies if the Bay was already so heavily exposed to COVID-19 back then.
Overall, I just think it would have made news if tens of thousands of Californians were dying of respiratory illnesses back in Fall 2019. Plus NYC would've gotten the same herd immunity since we also have a massive Chinese population and attract millions of Chinese tourists.
I could see that being possible. But still, where are the thousands and thousands of deaths that CA should have experienced?
Very good post, and I agree with all of it, but this question is the one that will take years to answer but this is the important question that I don't think we'll ever answer because we'd have to comb through thousands and thousands of death certificates in CA, OR, and WA over the last 5 months to make sense of it. And even then, how many "undetermined" deaths are there that could be COVID or be something like a stroke in the middle of the night?
All we know are the numbers right in front of us right now. I do think that there's more to it than just "people flying in and out of Asia" since COVID is now worldwide. Just possible explanations for the huge number discrepancy out of the West Coast vs East Coast
1) Testing really isn't nearly as aggressive out on the West Coast than East Coast - but now that there's a COVID cause of death and of course, media scrutiny, unless the West Coast is pulling a CCP and just lying about it.
2) Maybe the early lockdowns have worked in flattening the curve a bit. I dunno why people (not on here, but elsewhere on the internet) hate this explanation, but its the one easily most controllable.
3) Herd immunity, which has been discussed before
Very good post, and I agree with all of it, but this question is the one that will take years to answer but this is the important question that I don't think we'll ever answer because we'd have to comb through thousands and thousands of death certificates in CA, OR, and WA over the last 5 months to make sense of it. And even then, how many "undetermined" deaths are there that could be COVID or be something like a stroke in the middle of the night?
All we know are the numbers right in front of us right now. I do think that there's more to it than just "people flying in and out of Asia" since COVID is now worldwide. Just possible explanations for the huge number discrepancy out of the West Coast vs East Coast
1) Testing really isn't nearly as aggressive out on the West Coast than East Coast - but now that there's a COVID cause of death and of course, media scrutiny, unless the West Coast is pulling a CCP and just lying about it.
2) Maybe the early lockdowns have worked in flattening the curve a bit. I dunno why people (not on here, but elsewhere on the internet) hate this explanation, but its the one easily most controllable.
3) Herd immunity, which has been discussed before
I personally think its all of the above.
After thinking about it more, I've come up with this idea for myself.
1) I don't believe herd immunity did anything. There were probably far too few cases in China that it wasn't really expanding the way it is now as compared to when it first started. It may have been spreading in Wuhan, but it's not the same as it spreading through Beijing, Shanghai, or Hong Kong, which are far more international for business and tourism travel.
2) I don't think density matters because then other East Asian cities would be much worse off. I mean, it sorta matters, but that is prevented by #3.
3) Shutdowns and social distancing do help. It slowed the spread out of the major hotspots. It was just able to spread throughout a place like NYC way more quickly so that by the time we realized the severity, it was too late to stop it from getting this bad in NYC.
4) Speaking of East Asia. I'm pretty sure other East Asian cities/countries acted more quickly and more severely on banning travel to/from China, right? East Asian cities were quick to shutdown and start testing, whereas the US a whole waited way too long, and NYC had to bear the brunt of this delay due to its population density (spread way more quickly even if exposed at the same time as other places), and European flights (see #5).
5) The incoming flights from China were banned way before travel from Europe was restricted, right? While CA gets probably the largest portion of flights from China, NYC gets tons also. On top of that, NYC is probably the most common port of entry for flights from Europe. So even after China was blocked from the US (and likely saved CA mostly), flights from Europe continued into mostly NYC and probably Chicago, Detroit, and Atlanta also. NYC, Chicago, and Detroit are major hotspots in the country, so flights from Europe would make sense. Atlanta isn't a hotspot officially, but I'm sure that has more to do with a lack of testing + lack of will on the part of the state government in GA. Though even with its lack of testing + lack of will, it still has pretty high numbers (10th highest in the country in raw # and by far the lowest tests per million in a state with over 1k positive cases per million).
6) Still, a lack of testing on the west coast. Yes I get that only those with severe enough symptoms are getting tested right now, so maybe the west coast doesn't have as many positive tests because it doesn't need to run as many. But I highly doubt that the numbers are that low in CA. Social distancing measures in the Bay before the rest of the country may have helped some. Flights stopped from China may have helped the entire state have somewhat lower numbers. But these numbers are just far too low to make sense. CA has tested the 4th fewest amount of people per million, just ahead of VA TX and KS. If they're only testing the absolute worst of the worst, it would make sense. But then that still isn't getting to the real numbers. Regardless, the hospitals likely never would've ended up like NYC for various reasons. But, I doubt that CA can be testing those with the same level of symptoms of NY/NJ. Are they doing the same level of family and workplace cluster testing? Public transit alone doesn't explain NYC because millions still take public transit in SF and LA.
After thinking about it more, I've come up with this idea for myself.
1) I don't believe herd immunity did anything. There were probably far too few cases in China that it wasn't really expanding the way it is now as compared to when it first started. It may have been spreading in Wuhan, but it's not the same as it spreading through Beijing, Shanghai, or Hong Kong, which are far more international for business and tourism travel.
Yeah herd immunity, especially this early out from the onset of the virus, is hard to measure because how many people have to get the virus and recover before they are immune? Also, do we even know if someone gets COVID once, is it proven that they can't get it again? Especially because the virus keeps mutating as it goes from person to person.
However, there are studies not only from California, but in Germany exploring the herd immunity idea, which could actually help figure out a vaccine for Corona.
2) I don't think density matters because then other East Asian cities would be much worse off. I mean, it sorta matters, but that is prevented by #3.
3) Shutdowns and social distancing do help. It slowed the spread out of the major hotspots. It was just able to spread throughout a place like NYC way more quickly so that by the time we realized the severity, it was too late to stop it from getting this bad in NYC.
I'm extremely skeptical when it comes to numbers coming out of China right now. I don't think millions of people are dying but I think way more have died and are dying than what is being reported out of there. So I take that with a grain of salt - especially since funeral urns have been sold by the thousands while only "20-30 people" die.
I think the numbers out of Hong Kong, Seoul and Japan are much more telling. However, Hong Kong is already experiencing a second wave, Japan finally went on lockdown (theory is they kept numbers down to get the olympics to start running, but now that isn't a factor, they can lockdown), but South Korea is the one country we could all learn from.
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4) Speaking of East Asia. I'm pretty sure other East Asian cities/countries acted more quickly and more severely on banning travel to/from China, right? East Asian cities were quick to shutdown and start testing, whereas the US a whole waited way too long, and NYC had to bear the brunt of this delay due to its population density (spread way more quickly even if exposed at the same time as other places), and European flights (see #5).
In general, the US acted so slowly with the coronavirus. From the government to the average person, we didn't exactly take it seriously because I think most people looked at the death rate and belived "well, that isn't so bad". Without realizing yes, even 2-3% mortality rate means potentially 10-12 million people dead in the USA alone. Think of every single awful crime wave, and multiply that by say...1000. That's what this is.
I keep explaining to people that even if this was just the flu, its not like people stopped going to the hospital for other reasons. No, its corona virus on top of everything else that we have going on a day to day basis. It's not like the seasonal flu or heart attacks suddenly stopped happening while people were getting sick from COVID-19.
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5) The incoming flights from China were banned way before travel from Europe was restricted, right? While CA gets probably the largest portion of flights from China, NYC gets tons also. On top of that, NYC is probably the most common port of entry for flights from Europe. So even after China was blocked from the US (and likely saved CA mostly), flights from Europe continued into mostly NYC and probably Chicago, Detroit, and Atlanta also. NYC, Chicago, and Detroit are major hotspots in the country, so flights from Europe would make sense. Atlanta isn't a hotspot officially, but I'm sure that has more to do with a lack of testing + lack of will on the part of the state government in GA. Though even with its lack of testing + lack of will, it still has pretty high numbers (10th highest in the country in raw # and by far the lowest tests per million in a state with over 1k positive cases per million).
I think NYC had a myriad of factors, including international travel, that helped spread the virus. It's not one thing alone - its not "density, public transportation, international travel" etc. by itself that helped the virus along. It's all of the above.
But now that there are hotspots within the United States, domestic travel too has helped spread the virus. I think this actually worked more to the detriment of NYC, being in the center of a densely populated Northeast corridor, than anything on the West Coast, where it takes a lot more effort to get to from the rest of the country given the relative isolation of the cities from one another.
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6) Still, a lack of testing on the west coast. Yes I get that only those with severe enough symptoms are getting tested right now, so maybe the west coast doesn't have as many positive tests because it doesn't need to run as many. But I highly doubt that the numbers are that low in CA. Social distancing measures in the Bay before the rest of the country may have helped some. Flights stopped from China may have helped the entire state have somewhat lower numbers. But these numbers are just far too low to make sense. CA has tested the 4th fewest amount of people per million, just ahead of VA TX and KS. If they're only testing the absolute worst of the worst, it would make sense. But then that still isn't getting to the real numbers. Regardless, the hospitals likely never would've ended up like NYC for various reasons. But, I doubt that CA can be testing those with the same level of symptoms of NY/NJ. Are they doing the same level of family and workplace cluster testing? Public transit alone doesn't explain NYC because millions still take public transit in SF and LA.
Yeah, I think the lack of testing has played a role in the numbers being low too. Like you said, I think its the fact that testing is limited to those who have symptoms, which makes sense because if the number of tests are limited, you'd want to test those who have symptoms first before testing those who are asymptomatic.
Really everyone should be tested, but until that becomes cost effective, we won't see it. And by the time it becomes cost effective, most likely there'll be a vaccine of some sort.
Last edited by Bubb Rubb; 04-10-2020 at 11:27 AM..
The death rate of this thing is not anywhere close to 2%. A lot of research shows that there are potentially as many as 70 times more cases than the "confirmed" numbers.
The death rate will likely be similar to the flu at the end. That said, covid is certainly much more contagious than flu (likely similar to the common cold), which makes it something we need to handle seriously to avoid spiking the healthcare system.
The death rate of this thing is not anywhere close to 2%. A lot of research shows that there are potentially as many as 70 times more cases than the "confirmed" numbers.
The death rate will likely be similar to the flu at the end. That said, covid is certainly much more contagious than flu (likely similar to the common cold), which makes it something we need to handle seriously to avoid spiking the healthcare system.
The true death rate more than likely isnt anywhere near 2%. There are, more than likely, hundreds of thousands of cases we dont know about. While we may not have a proper count on everyone who has died of COVID-19, the number probably isnt very high of deaths we dont know about. Certainly nowhere near the unreported cases.
The problem is that we wont know what it is until the first phase of this pandemic is over and we can do a postmortem on it. The estimates Ive seen from epidemiologists are around .8%-1.0%.
5) The incoming flights from China were banned way before travel from Europe was restricted, right? While CA gets probably the largest portion of flights from China, NYC gets tons also. On top of that, NYC is probably the most common port of entry for flights from Europe. So even after China was blocked from the US (and likely saved CA mostly), flights from Europe continued into mostly NYC and probably Chicago, Detroit, and Atlanta also. NYC, Chicago, and Detroit are major hotspots in the country, so flights from Europe would make sense. Atlanta isn't a hotspot officially, but I'm sure that has more to do with a lack of testing + lack of will on the part of the state government in GA. Though even with its lack of testing + lack of will, it still has pretty high numbers (10th highest in the country in raw # and by far the lowest tests per million in a state with over 1k positive cases per million).
This is probably a factor. Two recent studies of the genome of SARS-CoV-2 (the virus that causes COVID19) showed that the strain circulating in the East Coast is identical to the one circulating in Europe, but has some small changes from the original strains in China. So, likely most of the cases on the East Coast came via Europe rather than directly China (although they obviously came to Europe from China in the first place).
Since travel wasn't banned from Europe until later, and way more European flights go to the East Coast than the West, that is probably a much bigger factor than any of the others Bubb Rubb listed.
The death rate of this thing is not anywhere close to 2%. A lot of research shows that there are potentially as many as 70 times more cases than the "confirmed" numbers.
The death rate will likely be similar to the flu at the end. That said, covid is certainly much more contagious than flu (likely similar to the common cold), which makes it something we need to handle seriously to avoid spiking the healthcare system.
In absolute numbers, COVID-19 is killing many more people than the flu. Putting aside the "there could be 332 million asymptomatic cases in America argument," influenza hasn't killed 10,000+ people in a single week since 1918. Last week's death toll was significantly higher than the combined number of influenza and pneumonia fatalities in 2018, which was the deadliest influenza season the U.S. had experienced in the preceding 50 years.
It's hard to compare the extent of flu mortality to COVID mortality because we essentially allow the flu to run wild (fewer than half of Americans receive a flu vaccine each year) while we impose relatively draconian measures to mitigate CV-19. To know for sure whether CV-19 is deadlier than the flu, we'd need to let people go back to business as usual and then count the body bags.
It should also be stated that we won't have a true count on CV deaths until some time from now. For example, in 2009 there were only 3,433 confirmed H1N1 related-deaths, meaning deaths among people who had tested positive for the virus. The estimated death toll--which is the figured that gets tossed around in the media--was several times higher than that. It could be the case that the estimated number of COVID-related deaths ends up being much higher than the recorded count.
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