May 7 - COVID-19 in Westchester County, NY

Our leaders are finally starting to act on the data.  Yesterday the county started testing everyone in nursing homes in Westchester, residents and workers.  From the beginning it was obvious that the elderly with underlying conditions were most vulnerable.  Forty percent of the deaths in Yonkers (a city in Westchester County) are in nursing homes.  In fact, several nursing home deaths from weeks ago are being recategorized as COVID-19 related, so that percentage will go up. The number of deaths reported today is unusually high and is believed to contain these prior deaths. The last three weeks of death data can be approximated by a linear decay (not a Bell Curve!).

The number of active cases in Westchester, the number hospitalized, and the number of positive cases continue to decline. There is noise in the data -- for example yesterday experienced a data dump of test data -- but the filtered data are trending down.

It is a good time to revisit the suggestions I made on this blog four weeks ago on April 9.  I had only one condition for starting the reopening by region -- hospitalizations drops to near normal -- not the complicated 7 metrics required by Governor Cuomo.  Much of the data I used to come up with my suggested actions to reopen have not change in the last four months. 

May 6 - COVID-19 in Westchester County, NY

New cases in Westchester fell to their lowest levels since March 18 (red line).  Bergamo, Italy is into their third day of reopening.  Their new cases fell to 12! (green line)

Deaths in Westchester have been at 15 for two days in a row.  Hospitalizations continue to decline.

The percent testing positive continues its predictable decline.  There is very little noise in the data from NYC, Nassau, and Westchester. They are all declining in unison.  In the next two or three days, the percentage will drop below 10 which will be in line with with other areas of the country with mild epidemics.

All is preceding well with Bergamo's 'reopening.'  The restrictions on travel are still very high.  Police have set up roadblocks to inspect vehicles for proper papers for travel. Italians cannot travel outside of their region without a legitimate business reason. They cannot travel outside the region to family or second homes.  Only 3% were cited for "being outside the home for reason not among those granted."

As mentioned in prior blogs, Bergamo is a province of about 1MM residents and has much in common with Westchester. However, their population of elderly is very high.  As a result, their fatalities per capita are much higher than Westchester.   The number of deaths in Bergamo in March was more than five times the number of deaths in March 2019.

In March, 5500 Bergamo residents over 65-years-old died from COVID-19.  A normal year would have claimed only 750. (Westchester total deaths is currently at 1116.  About 80% of those are over 65.) Demographic data states that 30% of Bergamo is over 65, so the chances of dying from COVID-19 is still less than 2% for that age group.

Bergamo Deaths for Men and Women

May 5 - COVID-19 in Westchester County, NY

New York announced the 'Gating' criteria for reopening regions yesterday.

Strangely, Westchester was not grouped with the New York City region which shared a similar epidemic and with which Westchester is tied by heavily traveled commuter train lines.  Instead, Westchester is grouped with the 'Mid-Hudson Region' which includes the less populous and lesser effected counties of Rockland, Orange, Sullivan, Ulster, Dutchess, and Putnam.

Each region must meet the gating criteria to enter 'Phase 2' which allows some low-risk/high-value businesses to open. Because Westchester was the first county in New York with a cluster (New Rochelle) it is ahead of the other counties on the epidemic curve.  I have not studied these counties (yet) in detail, because they are not similar to Westchester.  My early guess is that they will delay the opening of Westchester.

The criteria and the current conditions in Westchester are summarized below.

1. 14 days of decline in total hospitalizations (rolling 3 day averages)
The hospitalization data for Westchester is not published. The county executive usually gives the number in his daily briefing.  From his accounts Westchester meets this criteria. As I have stated in prior blogs, I do not believe the '3-day averaging' does an adequate job of eliminating noise in the data.  Much of the noise comes on weekends, so a 7-day average is needed.

2. 14 days of decline in deaths (rolling 3 day average)
Westchester deaths have been declining for three weeks, but there are not 14 consecutive days of decline due to the noise.  Even a 3-day rolling average does not remove the noise (as mentioned above). The green line is the 3-day rolling average.  The last three weeks can be approximated by a linear decay (orange dashed line). That decay predicts Westchester could have a '0' day by May 17.  For practical matters Westchester meets this criteria, but the criteria are poorly writtern.

3. less than 2 new hospitalized patients per day per 100K population
For Westchester this mean less than 20 patients per day. Currently less than 10% of the new cases are hospitalized and there are about new 200 cases per day.  Westchester is borderline in meeting this criteria, but the hospitals are not taxed and the hospital population is dropping. This criteria is not meaningful if hospitals are not stressed! I am not sure why they threw in this criteria? It is redundant.

 4. >30% hospital beds available
Westchester has 3000 beds and only about 700 are being used for COVID-19.  That number continues to drop. Criteria met.

5. >90days of PPE supply
I am not sure what this mean? 90 days supply based on future estimated hospitalizations?  Or is this some unrealistic supply based on a worse-case scenario? This seems a bit like they are just trying to slow things down.  Who has a 90-day supply of anything?

6. >30 tests per 1K per month
This criteria means 1000 tests per day for Westchester.  Westchester has been testing about 2000 per day for the last month.  Criteria met.  If 10% of tests are positive, that results in 200 new cases per day in Westchester (10% of 2000 tests) leading to about 20 new hospitalizations (see Criteria #3). Currently Westchester is running ~15% positive, but the trend will put it at ~10% in one more week.

7. >30 tracers per 100K (300 for Westchester)
This just means Westchester needs to hire 300 lackies.  I have explained in previous blogs why 'Test and Trace' is a fool's errand for a virus where 90% of the cases are asymptomatic.  [Antibody tests show at least 15 % of  Westchester has been exposed, but there are only 2.5% confirmed cases.]  Critieria met.

May 4 - COVID-19 in Westchester County, NY

Westchester Daily Cases are compared with Bergamo, Italy below.  Bergamo begins ending their lockdown today.

The percent of the NYC Metro area testing positive continues to go down. At 15% it is getting close to the national average.

The deaths in Westchester are going down very slowly.

Strangely, NYC deaths, which should be lagging Westchester, appear to have the traditional epidemic curve??

NYC Deaths per Day

May 3 - COVID-19 in Westchester County, NY

I have been comparing the Province of Bergamo, Italy to Westchester County. The epidemic curves below may not appear similar, but there are some similarities.

Bergamo Province is about the same population as Westchester (~1MM). Bergamo borders the largest metropolis in Italy (Milan) as Westchester borders NYC. From the graph it appears that Bergamo had fewer cases than Westchester (confirmed cases are 11394 in Bergamo and 29626 in Westchester), but this is just a result in the difference in the availability of testing.  10% of Westchester has been tested, while only 4% of Lombardy (the Milan region that includes Bergamo) has been tested.  Luckily the deaths are not comparable....Bergamo has 11291 deaths so far vs. 1067 in Westchester. Almost 1% of their population has died vs 0.1% of Westchester! [In the city of Bergamo 30% are over 65, more than double the 15% in Westchester. Bergamo province is less dense...1 MM people spread over 1000 sq.mi. vs 450 sq. mi. in Westchester.]

The lockdown in Bergamo started on March 9.  Westchester had a Containment Zone around New Rochelle on March 12.  All of Westchester was essentially closed by March 14, but the stay-at-home order did not officially go into effect until March 22. It is hard to judge the epidemic starts and peaks from the chart above, but Westchester trails Bergamo by 2 to 3 weeks.

Bergamo moves into Phase 2 tomorrow. Even in Phase 2 the restrictions are very high.  It is not much different than what Westchester is currently practicing.

The 7-day average (this cuts out any noise caused by the weekends which I have noticed is substantial) of New Cases is showing a favorable downturn.

The stream of new infections despite social distancing confirms how contagious this virus is.  Antibodies have show that about 40% of the Bronx (borders Westchester on the south)  have been exposed. Westchester is about 15%, but I am sure that varies across the county.  I live in a town in Westchester that abuts the Bronx and it would not surprise me if my town was closer to 40% exposed.

Ninety Eight percent of those infected do just fine.  If we did not know who the 2% vulnerable were, this would be scary.  But we know almost excactly who the 2% are!!!  Why don't we just act on that!!!

May 2 - COVID-19 in Westchester County, NY

Westchester County reported 262 New Cases of COVID-19 yesterday. It was only the second time since March 21 that the number has been less than 300.

A better indication of the reduced transmission of the virus is the Percent Testing Positive. This number has been less than 20% for four of the last five days.

Deaths per Day have fallen below 20 for only the second day since early April.  

Remdesivir gets FDA Emergency Use Authorization for treatment of COVID-19 patients.

Raoult publishes full article on Hydroxychloroquine.

May 1 - COVID-19 in Westchester County, NY

The beginning of May signals the start of reopenings across the US and Europe.  I hope someone is collecting the data!  Quick analysis and feedback will be needed to assist countries that are just a few weeks behind the leaders.  Each state in the US is following a differenct path. Comparisons of approaches and results will be interesting.

I have been comparing Westchester to Bergamo, Italy (as well as NYC and Nassau County).  I will continue to try and do that, but I do not currently have access to the Bergamo metrics that I think are important.

What are the important metrics in 'reopening'?  Here is my list.
1. The hospitals should not be overutilized.  This should not be a difficult metric to hit as most of the hospitals in the US were nowhere near capacity during the worst of the epidemic.  Bergamo was  overrun as were some hospitals in NYC.
2. Protect the most vulnerable.  From the very start it was obvious that those over 65 and those with underlying conditions were at highest risk (although most states ignored this in their executive orders). Is there anything we can give them prophylactically? Where are the studies on prophylactic hydroxychloroquine? As most of the deaths are in this group, the metric can be deaths per day.  Keep it less than 3 in 10,000 on an annual basis (0.03%) .  This is about the death rate for regular flu.
3. Economic health metric. This could be measured in unemployment rates.  GDP has too great of a lag to be a metric.

As I have repeated almost daily, this pandemic does not follow a Bell Curve.  It has a very long tail.  See Bergamo below.  Does this mean the virus continues to spread, despite social distancing?  Or does it mean that actions on Day 0 have implications over several months?  The latter would make if very difficult to make adjustments to a faulty reopening plan.

Almost six weeks after their peak, Bergamo will be entering Phase II on Monday, May 4.  For the first time since their stay-at-home order on March 9 they will be able to see relatives if they maintain 6 feet and wear masks.  They can run and bike outside and go to the park, maintaining 6 feet and wearing masks.  Gyms, cinemas, restaurants, hair salons, museums, churches, and playgrounds are still closed. Travel to second homes or to other regions of Italy is still not permitted. Public or private gatherings are not permitted with the exception of funeral parties of 15 or less, preferably outdoors with masks and 6 foot distancing. People with fever or respitatory illness must quarantine regardless of diagnosis. Businesses will start reopening in a staggered fashion.  Schools are closed until September.

Both the New Case curves and the Death Curve shown below are not following the classical Bell Curve of an epidemic.

Bike Sunday on May 3 in Westchester appears to be a go (with masks).  Bike Sunday is a 6.5 mile shutdown of the Bronx River Parkway for four hours on Sundays in May, June, and September. I guess I should be grateful that our Phase I in Westchester does not appear to be as restrictive as Phase II in Italy.

A recent 'random' antibody test estimated that 15% of Westchester had been exposed to the virus. The actual confirmed prevalence in Westchester is about 3%.  About 10% of Westchester has been tested for the virus.  On a personal note, my antibody test was negative. I suffered for eight weeks from late February to early April with a sinus virus. I am convinced I got it from the pool at my local gym. My point is that there are all kinds of viruses out there, most have not been identified, named, and given media coverage. If only 20% of the people tested for COVID have it, what are the other 80% suffering from? Who knows when an infection is going to be life threatening? Should I avoid my gym? What risks will I be willing to accept in the future?