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You are here: Home / Anderson On Health Insurance / Success is the 2nd derivative

Success is the 2nd derivative

by David Anderson|  March 30, 20208:42 am| 58 Comments

This post is in: Anderson On Health Insurance, COVID-19 Coronavirus

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The New York Times has some comparative good COVID-19 news from Washington State:

While each infected person was spreading the virus to an average of 2.7 other people earlier in March, that number appears to have dropped, with one projection suggesting that it was now down to 1.4…

Washington State’s coronavirus figures have continued to grow steadily, but not as fast as other states’. The death toll has been doubling about every eight days in Washington, compared with every two or three days in New York, Michigan, New Jersey and Louisiana.

Washington State shut down hard and shut down fast compared to the rest of the country. This is what success looks like right now. The death rate is still increasing, the infection rate is still increasing, but the rates of increases are slower than the rest of the country. This is success on the second derivative.
As I mentioned in my first post this morning, most of the people who are are hospitalized this morning were infected at least two weeks ago. Washington State has been able to shrink the number of people who were exposed and infected two weeks ago with aggressive and early public health measures that were several doubling cycles ahead of many regions shutting down.

Washington State is what success could look like for the next month or two, and it is still going to be rough.

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58Comments

  1. 1.

    zzyzx

    March 30, 2020 at 9:07 am

    I’ve been saying that if we get through this with minimal damage, there need to be statues everywhere of Jay Inslee, Dow Constantine, and Jenny Durkan for providing early leadership and giving everyone a path to follow.

  2. 2.

    guachi

    March 30, 2020 at 9:08 am

    US cases have increased at about 18-20,000 cases per day over the last three days, so that seems like a good thing, unless it’s just because testing can’t keep up.

  3. 3.

    MattF

    March 30, 2020 at 9:13 am

    @guachi: Always the question. Testing will increase exponentially at first, and then experience the same second-derivative drop-off as new cases.

  4. 4.

    zzyzx

    March 30, 2020 at 9:17 am

    @guachi: one thing that King County is giving is the rate of hit rate with tests. The overall rate is 7% but recently it’s been closer to 12%. I don’t know if that shows increased spread or if doctors are better at identifying who needs to be tested.

  5. 5.

    MattF

    March 30, 2020 at 9:19 am

    @zzyzx: If they had only performed their duties in a reality-show format, then the Orange Asshole might have understood sooner.

  6. 6.

    WereBear

    March 30, 2020 at 9:21 am

    Geez, people, I make ONE grocery run and set up our weekly brisket and get everything put away and take my shower and there’s like a dozen posts and a zillion comments.

    Shopping report: Appearing at the big grocery store as soon as they open is working for second week in a row. (I go out once a week, one store.) One of three customers, better social distancing, and while I was one of 2 people wearing a mask, that’s better than last time. (My mask is leftover from Mr WereBear’s airbrushing days.)

    Fully stocked with everything, as far as I can tell… except toilet paper!?!? Honestly, people, get a GRIP.

  7. 7.

    schrodingers_cat

    March 30, 2020 at 9:23 am

    @WereBear: I went yesterday but an hour after the stores opened. I got almost everything I wanted except shrimp (was on sale), milk powder and flour.

    ETA: And of course no toilet paper either.

  8. 8.

    WereBear

    March 30, 2020 at 9:25 am

    NY is testing more than any other state right now, and I understand this is a talking point for the GOP; but it shows they don’t understand how this works.

    It’s everywhere! People shouldn’t be traveling unless it’s essential; and I consider snowbirds leaving Florida, a HOT SPOT, for their homes in NY, to be a problem that won’t be solved…

  9. 9.

    MattF

    March 30, 2020 at 9:29 am

    @schrodingers_cat: I can’t help doing a daily quick extrapolation of my TP usage, and have consistently found that, barring a fecal tsunami, I should be OK. And yes, I avoided writing ‘quick-and-dirty’.

  10. 10.

    YY_Sima Qian

    March 30, 2020 at 9:31 am

    Decreasing R0 from 2.7 to 1.4 is great, particularly in comparison with many of the other states in the US. That is even better if you are starting from a low base, that is how you flatten the curve early in the epidemic. However, if you are already at a high baseline, then R0 of 1.4 is still exponential growth that will overwhelm the medical care system, just at a slower pace. If the medical care system is running at or exceeds capacity, then R0 of 1 is just treading water. Need to get R0 < 1 to actually provide relief.

  11. 11.

    Geoduck

    March 30, 2020 at 9:35 am

    As as Washington State resident, we joke that the real reason it’s dropping is because we’re all a bunch of chilly standoffish snobs. Seattle Freeze for the win!

  12. 12.

    WereBear

    March 30, 2020 at 9:36 am

    @schrodingers_cat: It’s going to be different everywhere.

    Last time I went to big, cheapest, store, they were out of half of what I needed (still no TP!) and no one was distancing except me, who had to act like I had a leper bell.

    So I’m not going there right now; I’m paying more but it may turn out to be worth it :)

  13. 13.

    MattF

    March 30, 2020 at 9:36 am

    @WereBear: I also have a suspicion that the virus was circulating in the US a few weeks before anyone was really aware. It will be a long while before that initial condition can be analyzed.

  14. 14.

    Zzyzx

    March 30, 2020 at 9:37 am

    @Geoduck: yeah, “don’t invite people into your house to hang out” is pretty much the Seattle way already.

  15. 15.

    Aurona

    March 30, 2020 at 9:38 am

    Seattleite here; got bamboo toilet paper (cloudpaper.co) from a local company online only ($30/24 rolls/individually wrapped/3-ply/every 90 days/1 person – or more) and got it in one day, but that was two weeks ago. It’s a bit longer now, but that saves a ton of stress.

    I go out daily only for dog walks, once a week to grocery stores (diet issues/celiac disease) and my whole neighborhood has stuffed bears in the windows, ‘hang in there’ post-its on telephone poles, etc. and no one on the block is sick. Inslee, Constantine and Durkan and are actually killing it with these great practices and we are infected with good habits now. Here’s to Month #2 which we hope to flatten like a pancake.

  16. 16.

    WereBear

    March 30, 2020 at 9:41 am

    @MattF: Exactly my thoughts.

    It seems the hardest concept to sink in is that we are “on a satellite phone to Mars.” What we do NOW won’t actually show results for, what, 2-3 weeks?

    A lot of people just can’t get that.

    Plus, they all act like this the Zombie Virus from The Walking Dead. They are not understanding how it works, so they just run around and get hostile…

  17. 17.

    Fair Economist

    March 30, 2020 at 9:46 am

    1.4 isn’t good enough though. That’s the “mitigation” level per Imperial College, and it means 500,000 dead – if healthcare holds up, which it won’t. A lot better than 2.7, sure, but still awful. Maybe with masks we can get to suppression levels.

    @guachi: Testing is probably limiting. It’s been constant over the period. A big influence is NY going back to testing hospitalized only because they were overwhelmed.

  18. 18.

    BR

    March 30, 2020 at 9:52 am

    Anyone here in Florida, and know anyone who works at a university / research lab / in medicine?  We need genetic sequencing of samples of coronavirus in Florida right away.  There are currently no sequenced results from Florida despite there being many from other states.  And Florida is on the verge of a big outbreak.  Maybe the universities in FL have the ability to do sequencing in house and just haven’t bothered?  They could probably do it and submit it to this project:

    https://twitter.com/trvrb

    The urgency of this is due to the gambit underway to try to blame the entire US outbreak on New York City/State, thereby deflecting blame from the white house and complicit governors (like Florida’s).  My reading indicates that it came from many sources, mostly from folks returning from vacation in Italy, and now it’s to the researchers to prove it and get that out to the non-Fox media.

    So if any of you know someone who does lab work or research or medicine or have second-hand connections like that in Florida, can you reach out right away and ask them to start sequencing and submit results / samples / data to Trevor Bedford’s project in Seattle?

  19. 19.

    zzyzx

    March 30, 2020 at 10:00 am

    @Fair Economist: except that we can see it working.

    Seattle was 10 days behind Italy when we started putting in our measures. Now we’re at least 3 weeks behind if not more.

    I assume at some point the strain on the local health care system will be too much, but the path we were on had us there days ago.

  20. 20.

    MomSense

    March 30, 2020 at 10:09 am

    I’m feeling a little better today.  Still fatigued.  I had a very low temperature last night.  I think I just have a cold/allergies, but I admit I was a little freaked out.

  21. 21.

    Gin & Tonic

    March 30, 2020 at 10:14 am

    @Geoduck: So here in New England we should be good, then. “Good fences make good neighbors.”

  22. 22.

    A Ghost to Most

    March 30, 2020 at 10:16 am

    @zzyzx: Congratulations to WA, this is how it’s done. I’m confident Jared Polis is paying attention.

    The Great Comeuppance can’t come soon enough.

  23. 23.

    Amir Khalid

    March 30, 2020 at 10:21 am

    @MattF:

    And yes, I avoided writing ‘quick-and-dirty’.

    Fortunately, you did not. ;-)

  24. 24.

    dmsilev

    March 30, 2020 at 10:23 am

    @MattF: There’s a website for everything: https://howmuchtoiletpaper.com

  25. 25.

    Ohio Mom

    March 30, 2020 at 10:24 am

    At the first Democratic two-part mega-debate, Jay Inslee spoke and I said to myself, “He’s it! The person I want as my next president.”

    Needless to say, ‘twas not to be. But can I dream of Biden putting him to work on climate change?

  26. 26.

    zhena gogolia

    March 30, 2020 at 10:26 am

    @MomSense:

    I hope you keep feeling better.

  27. 27.

    zhena gogolia

    March 30, 2020 at 10:26 am

    @Ohio Mom:

    Yes, I am sure you can.

  28. 28.

    danielx

    March 30, 2020 at 10:28 am

    Grocery run at 7, got TP, paper towels, flour*, and ground chuck. I felt like a caveman dragging home his kill for family consumption. Toilet paper and paper towels were one per customer.

    One of my neighbors is aggressively extroverted and a Trump supporter to boot, started to walk up to the spousal unit when she was outside doing yard work yesterday. She said, hey, back off (politely) and he said oh, they’re lifting that (the state declaration) tomorrow – “they” are not, so I don’t know where he got that information. He has been going downtown to his office every working day and said hey, you have to live your life. At this point I have no problem saying ‘fine, but if you living YOUR life means me LOSING mine…back off, motherfucker’. He’s a nice enough guy, but he just…doesn’t…get…it.

    ETA: first time Kroger has had flour on the shelf in three weeks when I’ve been there.

  29. 29.

    A Ghost to Most

    March 30, 2020 at 10:28 am

    @dmsilev: Wood pulp or bamboo?

  30. 30.

    gene108

    March 30, 2020 at 10:31 am

    @WereBear:

    I live in NJ. My upstairs neighbor has been doing the snowbird thing to FL the last few years.

    I hope she stays put.

  31. 31.

    glc

    March 30, 2020 at 10:33 am

    copy-edit: comparatively

  32. 32.

    L85NJGT

    March 30, 2020 at 10:34 am

    The various PCR tests have varying sensitivity and hit at different viral loads – so that’s a factor.

  33. 33.

    Miss Bianca

    March 30, 2020 at 10:46 am

    @A Ghost to Most: Seems to me that our measures in CO are similar to what’s going on in WA. Is there anything Inslee has put in place that Polis hasn’t called for?

    *note to self* – go look up latest info on CO COVID-19 web page

    ETA: How’s your wife doing?

  34. 34.

    WaterGirl

    March 30, 2020 at 10:51 am

    @L85NJGT: PCR tests?

  35. 35.

    MattF

    March 30, 2020 at 11:08 am

    @WaterGirl: Polymerase Chain Reaction. Used to amplify small ‘signals’ from immune system.

  36. 36.

    Kim Walker

    March 30, 2020 at 11:10 am

    This is OT, but I have an insurance question, if you can answer it, or point to a good source. My son-in-law was laid-off, but his employer is still paying a portion of the health insurance benefits. SIL’s portion is $800 per month (also for my daughter, who has a slew of prescriptions), which he will now have to pay out of unemployment benefits. Can he just decline the benefit and go to medicaid expansion or something on the exchange? They line in Oregon and have Kaiser. Sorry to be clueless, I live in Canada, so have not followed the insurance industry changes.

  37. 37.

    Xenos

    March 30, 2020 at 11:32 am

    Interesting to see when the results of seclusion take effect.

    Here in Luxembourg it took 10 days, after seclusion, for the relentless 50% daily increase to waiver even a bit.

    From day 11 to 14 growth varied between 20 to 40% growth – each step forward was followed with a bad day that was within view of being back in the neighborhood of 50%.

    Day 15 marked a change – we were under 20%

    Day 16 was at 10%

    Day 17 was at 6%

    Today was Day 18.  2% growth.  This number includes patients brought in from hospitals in France.

    There is a way through this for our communities.

    Maybe everyone has seen this already.  It is a very calm and effective way of explaining how to adapt – we all know most of this, but having someone clearly discuss it really helps.

    Dr. David Price of Weill Cornell Medical Center in New York City shares information in a Mar. 22 Zoom call with family and friends on empowering and protecting families during the COVID-19 pandemic

    https://vimeo.com/399733860

  38. 38.

    WaterGirl

    March 30, 2020 at 11:33 am

    @MattF: Thanks.  So these various tests are like apples and oranges?  Not measuring the same thing?  So how can any valid conclusions be drawn?

  39. 39.

    ziggy

    March 30, 2020 at 11:53 am

    Glad to see a spotlight on WA and how things are going here, I think it is a ray of hope. Even though the case load is still growing at RO 1.4, we’ve been able to keep deaths fairly low (175 over several weeks)–the vast majority of those have been in nursing homes and similar facilities. I think that is a reflection of older people going into isolation at home quite early on. Because the deaths are lower, the hospitals have been able to manage them so far. Hopefully soon we will begin to see the effects of the mandatory state-wide business shutdown, which has been brutal on so many.

    Many things in our favor–a high proportion of tech and other workers who were able to shift to at-home work quickly, a poor public transportation system, few areas of concentrated population, a high value on scientific knowledge and thus behavior guided by that, etc….and of course Inslee being willing to step out and go first with social distancing measures.

  40. 40.

    piratedan

    March 30, 2020 at 12:05 pm

    our hospital system is still cautiously optimistic (Tacoma and Spokane areas), while we have seen a slow uptick in patients in house, we’re not seeing the capacity exceeded what was planned against.  Testing availability has increased somewhat, so positive identifications are significantly higher but as yet, that’s not translating into resource overload (as of yet).  Still have about another week worth of “sky is falling” potential to wade thru with fears that success in keeping people from being treated in hallways will lead to people thinking that the worst is over.  Hopeful its a step towards returning to a resemblance of normal but at least testing is available now and awareness of the dangers are certainly more prevalent as seeing that it can happen here does make people take notice.

  41. 41.

    ziggy

    March 30, 2020 at 12:07 pm

    @zzyzx: I don’t know if that shows increased spread or if doctors are better at identifying who needs to be tested.

    I think it may be a combination of both. It will be very interesting when the results of the SCAN study (a testing of the general public) start coming out.

    https://publichealthinsider.com/2020/03/23/introducing-scan-the-greater-seattle-coronavirus-assessment-network/

  42. 42.

    WaterGirl

    March 30, 2020 at 12:14 pm

    @ziggy:

    …and of course Inslee being willing to step out and go first with social distancing measures.

    Respect.

  43. 43.

    Mikeindublin

    March 30, 2020 at 12:19 pm

    Italy has finally plateaued and is now decreasing in new cases.  Total is still growing but with with another week that number should start going down quickly as more recover and/or pass away.

    They went into lockdown 21 days ago to give some perspective.

    The site I use.

    https://www.worldometers.info/coronavirus/

  44. 44.

    David Anderson

    March 30, 2020 at 12:52 pm

    Medicaid income eligibility is conditional on monthly income.  The new federal resources (including the $600/week payments) for unemployment insurance don’t count as income for Medicaid.  It would not hurt to apply and be rejected while still holding onto his current insurance OR looking at the ACA exchanges.

  45. 45.

    WaterGirl

    March 30, 2020 at 12:55 pm

    @Kim Walker:

    I believe that David’s comment at #43 is directed toward you.

  46. 46.

    Geoduck

    March 30, 2020 at 1:05 pm

    @WaterGirl: There were a lot of people here in-state griping that he didn’t move even faster with the restrictions, but I understand that he’s got more than one issue to deal with here.

  47. 47.

    Fair Economist

    March 30, 2020 at 1:24 pm

    @Xenos: It’s good that seclusion appears able to arrest things, but that means that jurisdictions will continue to see increases until 2 1/2 weeks after they impose seclusion, and most of the US isn’t even there yet.

    Also, unless the decline becomes fairly rapid, we are looking at a very extended seclusion period, probably months. That creates its own problems even though it’s far better than a sweep.

    @zzyzx: The Washington orders have reduced growth, yes, but at 1.4 it will still sweep the population, just somewhat more slowly. The healthcare system will be overwhelmed, if less so, with all the extra deaths from that. Granted it gave Washington the time to go to a shelter in place order, which is *probably* enough to arrest growth, although we can’t yet be sure.

  48. 48.

    Goku (aka Amerikan Baka)

    March 30, 2020 at 1:33 pm

    @Geoduck:

    I know some on places like Reddit were asserting he’s in Boeing’s pocket and that’s why he won’t shut them down after several employees have tested positive

  49. 49.

    Zzyzx

    March 30, 2020 at 1:44 pm

    @Fair Economist: we basically had shelter in place before we had it officially. We didn’t call it by that name but we did 96% of it. The only distinction was that we were trusting people and when the first nice weekend meant that we couldn’t, we said that it’s not legally enforceable.

  50. 50.

    ziggy

    March 30, 2020 at 1:55 pm

    @Zzyzx: we basically had shelter in place before we had it officially

    That’s my take on it also. I didn’t see much difference here after the official announcement, especially as there are so many “essential” exceptions. But I do think it made some people take this much more seriously. A “we are all in this together, do your part” feeling.

  51. 51.

    Zzyzx

    March 30, 2020 at 2:07 pm

    And we had most big companies starting work from home before that. Mine was a tad behind the curve and we’re just about done with week 4 of enforced WFH.

  52. 52.

    CedWest

    March 30, 2020 at 2:58 pm

    It is a welcome improvement, but spreading the virus to more than one people (Ro going from 3 to 1.4) is still an exponential growth unfortunately. You want Ro < 1 to stop the virus' propagation.

  53. 53.

    WaterGirl

    March 30, 2020 at 3:00 pm

    @CedWest: But 1.4 is a hell of a lot better than 3!

  54. 54.

    CedWest

    March 30, 2020 at 3:22 pm

    @WaterGirl: Indeed! But it may hint that more drastic measures are needed until we get it below 1. Or that there is a lag and that Ro will keep decreasing as we wait a bit longer. Hopefully the latter.

  55. 55.

    Kim Walker

    March 30, 2020 at 3:57 pm

    @David Anderson: 
    Thank you so much!

  56. 56.

    Ceci n est pas mon nym

    March 30, 2020 at 5:06 pm

    Re: the title. I’ve started tracking the data on worldometer.info, and I’m seeing evidence of that second derivative decreasing nationwide. If you look at the number of new cases per day, over the last couple days there has been less increase (sorry, this is a little geeky). Still growing, but the growth rate is slowing down.

    I also looked at the trends for other countries. South Korea for instance. If you look at the daily new cases, you see they hit their peak, got past it, and are now back down. But you also see that there’s kind of a long tail. There are still a steady 100-odd new cases every day, a month past the peak. That kind of thing makes me very uncertain about when I will feel comfortable having normal outside interactions again.

    Also in this country we still have idiot deniers, like the Mississippi governor and that megachurch pastor in Tampa. Miss, like many red states, is just beginning their upward rise but still not instituting lockdowns and so they’ll probably contribute to a whole new wave of cases just as the coastal blue states are beginning to recover.

  57. 57.

    terry chay

    March 30, 2020 at 6:40 pm

    Surprised nobody is bringing up Bay Area. Implemented shelter in place earlier (both in terms of spread and in absolute times) than Washington State. Noticeable decline in new cases vs state as a whole which is among the slowest growing caseloads.

    The thing is per capita testing rate is still very low here, but our local twitter is noting our medical system has not had the rush that other areas have had.

    Is it because our medical system didn’t collapse that nobody is taking about us? Because when we became the first area in the nation to implement a six county shelter/in-place, the right wing media was rich with posts laughing at it.

    https://projects.sfchronicle.com/2020/coronavirus-map/

  58. 58.

    Dan B

    March 30, 2020 at 7:56 pm

    @terry chay: We’ve been noticing the Bay area here in Seattle.  Inslee was slow to mandate an official shelter in place but it was obvious he was heading in that direction.

    Another point in the Ro is that the growth has been occurring outside the Seattle metro area.  Rural areas seem to have ignored the words of the “liebrul” government.  This coukd get nasty because of the limited number of hospitals in many rural areas.

    My partner’s family is in Bellingham and his sister is acriss the street from the catholic hospital that fired the doctor for criticizing their shortage of PPE.  And Bellingham is mostly liberal and educated.

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