COVID-19 models chart dire scenarios for California hospitals

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When Governor Gavin Newsom this week presented a disastrous view of the out-of-control spike in coronavirus cases and hospitalizations in California, he referred to projected patterns of future death and misery which he said were becoming “alarmingly ” more precise.

If that’s true, then over the next four weeks state hospitals could overflow with 75,000 patients – about five times the current level – and an average of 400 people will die each day.

Hospitals were on the verge of being overrun with nearly 15,000 coronavirus patients when Newsom made the announcement on Tuesday. The hospitalization projection is based on cases that continue to rise at the current rate of infection without people taking extra precautions to prevent the spread of the virus.

On that trajectory, it doesn’t take long before the state is in dire straits, said Marm Kilpatrick, an infectious disease specialist at the University of California, Santa Cruz.

“One thing that is worrying is that for a while in California we have had an exponential growth in hospitalizations and cases, despite recent restrictions,” Kilpatrick said. “It’s pretty terrifying. ”

Models posted online by the California Department of Public Health largely show a key indicator – the rate of transmission – improving in recent days. But that number always stays at a point where each person infected with the virus infects more than one other person, resulting in an uncontrollable spread.

The state uses several models to try to predict hospitalizations. When combined into a “big picture” projection, the total is less dire but still shocking as of mid-January: over 33,000. That would still create an overwhelming burden on hospitals.

The increase in deaths model does not include an estimate based on the current rate of infection. But an average of dozens of different models shows that deaths have risen by about 25% from the current figure to almost 27,000 as of Jan. 9.

Other models on the chart predict a range of deaths as low as 22,000, which the state broke on Friday, to a high of 43,000 in about three weeks.

The country’s most populous state, which for months maintained a very low number of infections per capita amid criticism of other states, is facing its own crisis with record numbers of cases and deaths on a daily basis .

On Thursday, a record 379 deaths were recorded. There have been over 1,000 deaths in the last five days and over 100,000 new confirmed cases in just two days this week.

Most models posted on the state’s website show the situation worsens before an improvement, as the fallout from Thanksgiving gatherings and travel is borne by hospitals that have already started to run out of beds.

“Our modeling is getting more and more precise, which is alarming,” Newsom said Tuesday when he also announced that 5,000 more body bags had been ordered and that more than 50 refrigerated trucks were ready to serve as temporary morgues.

At the start of the pandemic, some models indicated that if no health security measures were put in place, the result would be disastrous.

In March, Newsom said the state of nearly 40 million people was on track to record 25 million cases of COVID-19 in two months. Nine months later, after a series of stricter and more lenient restrictions, the state has recorded more than 1.7 million cases, the highest in the country but a fraction of the earlier forecast.

The large variation in some models is due to the use of different formulas and mathematical data, including models of mobile phone mobility and demographic data such as population density, as well as the weighting of some more data. strongly.

Bradley Pollock, an epidemiologist at the University of California at Davis, said recent models were more accurate. He said the value of models is that they help guide public policy, showing likely trends unless action is taken.

“What we are seeing right now is exactly what we predicted,” Pollock said. “The main use of models is to tell you what might happen and not what will happen. ”

As cases have exploded since November, Newsom has taken action that has upset businesses and frustrated some residents. He put most of the state under a new stay-at-home order that cut restaurant meals and put an end to haircuts and manicures, and shut down many other types of businesses. The capacity of retailers has been reduced.

If these prescriptions have an impact, it will likely take weeks to show up in the number of cases and even more in hospitalizations, as there are delays between infection and detection to the point where an illness is severe enough to result in a stay in hospital and usually even longer for death to occur.

Some Stanford University models incorporate home controls and also explain the increase in Thanksgiving cases. They project several scenarios that show hospitalizations start to decline by the end of the year, although deaths would continue to increase until at least January 20.

While the models have been useful to public health authorities, they could be more accurate and useful to the public if they compiled a larger group of available data which could then be presented almost like weather forecasts so that people could better assess their risks, said Dr. Eric Topol, director of the Scripps Research Translational Institute in San Diego.

Topol criticized for not having a national approach to tackling the virus in the United States and said that extended to not taking a tiered approach to collecting data for modeling. He called the various efforts “solo acts”.

He said there was so much data available that could be used to create better models – granular data on the mobility of phones and smartwatches down to street level that shows whether home orders are being followed. to data pulled from smart thermometers to see where fevers are recorded to even sample sewage where virus peaks can be detected days before cases are reported.

“The modeling is based on so many assumptions without complete data,” Topol said. “You have raw data to see that people are in big trouble. ”


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