Monthly Archives: April 2020

Number of COVID cases in Ontario declines for the first time – where to from here?

I had an entire update written up last week around the situation around the world, but to be honest, it seemed a bit boring, so I didn’t post it. Things are proceeding more or less as expected, with the German speaking countries kicking ass while southern Europe is starting to see the light of day. I thought I would concentrate closer to home, and write something when there was something of note to write about. Well today, for the first time since this pandemic hit Ontario, we’ve actually seen a decrease in active cases!

How has that been missed in the headlines? Well, everyone likes to concentrate on the scary new cases number, which in this case came in at a relatively unremarkable 437, but 491 people recovered and 24 died, which means the number of confirmed active cases dropped today by 78. This active case count is important because these are the people currently known to be infected and able to infect others. If this continues to trend down, all else equal, eventually new cases will as well.

We’ve come a long way, and the good news is this is not due to some trickery with reduced or inadequate testing. The number of tests being done per day has more than doubled since mid-month with the province getting its act together.

While the rate of positives coming out of those tests has dropped.

If there is a Goldilocks scenario when it comes to COVID, this is pretty much it. Having said that, it’s all because of the social distancing measures in place, and the scaring of the general public. This can and will reverse rapidly should anything be relaxed, or should people become less afraid, and we’ve seen the return of the spread happen in both BC and Alberta over the past week.

So where to from here? I do expect the active cases to continue falling, and in fact the fall should accelerate over the next couple of weeks. We will likely be talking about relaxing some rules around the middle of May, but I really think we need to learn the lessons of other countries that have done this successfully. I know many do not want to hear this, but in every country where the rules were relaxed, but the virus did not come back, there was some type of electronic/phone based contact tracing in place. In countries where the rules were relaxed without such tracing the virus has come back with a vengeance. Once we are down to double digits of new cases we can relax most restrictions, but we have to quickly and efficiently isolate each new case and all their contacts. There is no way this can be done without technology the old fashioned way. Interviewing people and then alerting contacts is simply much too slow and too unreliable.

I understand the privacy concerns, and the fact that this is an infringement upon our rights and freedoms, but it will be a choice between phone tracing or being quarantined for 18 months. I would count quarantine as a far more intrusive infringement on my rights and freedoms. There is also the reality that most people have “location services” on in either their Android or iPhone, which is far more intrusive than what is being suggested for contract tracing, and I would argue seeing reviews on a new local restaurant has less value than being able to return to normal’ish life.

Anyway, here is a good article on this topic, Apple and Google address privacy concerns on contact tracing, and let me know what you think in the comments section. Would you be willing to enable contact tracing if it means you can get back to normal life sooner?

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The pace of COVID spread halves again

Another week brings another set of numbers proving this pandemic is not anywhere near going exponential. This is important because pretty much all public projections are assuming some level of exponential growth in infections.

The adjusted values include all the adjustments I’ve been making to smooth out the numbers (not including China during its disproportionate decreases, or the US during its initial acceleration due to under testing, or France when they “forgot” to count their cases). Adjustments or not though, this is not what exponential growth looks like.

The situation in the EU is even better, showing that social distancing really does work, though I would have lost my bet on which country would show a decrease this week.

I would have thought Italy would be the one, but its actually the Germanic countries that are showing decreases, and Spain did show it’s first day-over-day decrease in active cases this Friday.

In the anglo-saxon world Australia is the star, with Canada far behind in second place, but maybe surprisingly US and UK not doing all that bad.

There is an important caveat here though, and that is the % of positive tests per total number of completed tests within the US and the UK.

The rate of positives is something I’m keeping a close eye on as per last weeks post and the WHO recently suggested that any country where the % comes in above 10% is simply not doing enough testing. Australia is clearly testing more than enough people to get an accurate view of their situation, Canada is doing the bare minimum with Ontario specifically is dragging the overall number down, but the US and UK are not yet out of the woods. The optimistic looking deceleration in daily case increases in those countries may yet turn out to be due to under testing. After all, the less you test, the less you find, all other things being equal.

To end this post on a positive note, I think the pandemic will wind down quicker than currently expected, but the lowered expectations may be paradoxically helping make that possible. We just have to make sure we have a solid plan in place for when active cases start decreasing, but that’s a whole other discussion.

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The spread is slowing – and it’s decelerating even quicker than last week

I am all for scaring the living daylights out of people if that is what is necessary to keep them at home and isolating. I believe that was the purpose of the release of death projections by the Ontario government this past Friday, and boy, did it ever work. The streets and parks looked like a complete ghost town on a gorgeous April weekend that would normally be a cause for packed beaches and patios.

Having said that, this weeks virus spread numbers across the world have come in even better than I expected. I included the pace from two weeks ago as well just so the scale of deceleration is more obvious.

Week over week changes of active cases per country
March 27->April 3
Filtered on countries with 500+ cases

CountryWeek ending April 3rd paceWeek ending March 27th paceAcceleration of trend in active WoWWeek ending March 20th pace
South Africa23.11%463.37%-95.01%741.67%
Dominican Republic151.61%697.14%-78.25%1300.00%
New Zealand130.82%536.54%-75.62%N/A
Saudi Arabia56.00%217.26%-74.22%450.82%
Hong Kong65.35%162.34%-59.75%201.96%
Bosnia and Herzegovina134.65%162.07%-16.92%N/A

The deceleration in the pace of increase in trouble hot spots such as Italy and Spain is especially note worthy as it pushes down the overall spread of the virus across the world.

Italy went from a 153% increase week ending March 20th, to a 75% increase week ending March 27th, then down to just a 28% increase this past week. This equates to an average daily increase last week of just 3.66%. I fully expect Italy to start outright decreasing its number of active cases for the first time this coming week with healthy recoveries driving this reduction.

The French numbers look far worse than they really are because France decided to finally include all cases handled outside of hospitals (eg. long term care facilities) in their count. Why that wasn’t included in the first place baffles me, but it also messes with trend analysis, since many of the cases were actually discovered weeks ago, but they are counted in this weeks numbers. This makes the past week look far worse than it really was, and yet even then, the week was pretty much at par with the one preceding it.

For that reason I added a line in the aggregate chart which excludes the artificial impact of that French case adjustment:

RegionWeek ending April 3rd paceWeek ending March 27th paceAcceleration of trend in active WoWWeek ending March 20th pace
Total less China91.15%159.77%-42.95%213.70%
Total less China/US71.17%125.49%-43.29%189.92%
Total less China/US/France65.19%124.45%-47.62%N/A

It’s clear the “excluding China” adjustment no longer makes any difference, so I will remove it next week along with the France adjustment, leaving only the “excluding US” line because I don’t think we’ve seen the worst there yet. The US now accounts for a full 1/3rd of the world active cases, and the rate at which people are testing positive indicates we’ve still only scratched the surface.

We can see that on aggregate the rate of spread of the virus is slowing significantly and is poised to continue to do so going forward.

In future posts I want to share the detailed stats on Canada broken down by provinces that I started collecting a bit over week ago, and maybe dive a little deeper into my favorite statistic, the % positive of tests, which is now easier than ever to calculate since Worldometers started publishing test numbers per country.

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Is 1 million tests good?

The US hit a major milestone in terms of testing yesterday, as per the Covid Tracking Project over 1 million covid tests have been conducted in the country. This is by far the most of any country that reports these numbers, and considering how late the testing started, it is truly an impressive feat. However, does this mean that we have a good idea of the spread of the virus in the US? There are a few statistics I track that might give us a better indication than just a pure top line number.

Country# of testsTests per 1M in pop% positive
S. Korea395,19477132.18%
# of tests completed as of March 31, 2020 – various official sources

The first obvious thing to do is to scale the number of tests by the size of the population. If I’m in Luxembourg 1 million tests would mean I’ve tested my entire population, twice, but if I am in China that’s not a significant percentage of the population. The US has so far tested approx. 3,200 people per 1M in population, which is the same as saying it’s tested 0.3% of its population. Given that they only started testing a couple of weeks ago, which is far later than all the other countries in the list above, that’s a pretty impressive pace, but in the end it still falls short of where it should be. There is a lot more work to do to get a good sense of where the pandemic is.

Canada is testing at about the same pace as the US per 1M in population right now (roughly increasing by 500 ppl per 1M per day), but we’ve had a solid few weeks in terms of a head start, so we are in a much better shape overall at 6,500 people tested per 1M in population.

The other key statistic to track is the % of positives identified across all cases tested. In general the countries that are testing sufficiently and are able to contain the outbreaks have lower positive rates. This makes sense because they are testing more people who have symptoms but are not covid positive, which in turn means they are not just testing the sickest of the sick but have the capacity to test beyond that. Additionally if the sample can be assumed to be somewhat random, the positive % should be relatively lower for countries where the virus is not as wide spread.

We can see that Italy has a very high positive % despite having tested a large portion of its population. This is not good because it implies they either don’t have the testing capacity to reach the symptomatic people that would test negative, or the country is in fact that infected. The situation there is improving daily, and the rate is starting to come down slightly, so I expect we’ll know the answer soon.

On the other hand the US positive % rate is almost as high as Italys, and it is still increasing daily, which are both very troubling signs. However, as bad as the overall US rate is, the NY state rate is close to 40%!! That means that for every 2 people that get tested in NY state, 1 of them tests positive for covid. That’s truly frightening, and I believe the other major cities in the US are not yet testing enough, so unfortunately I think the worst is still to come.

The situation in Canada is not all roses, as the positive test rate is still climbing, but at 3.52% overall and 6% in worst hit Quebec, I think it’s relatively speaking under control. We will know more when the backlog of test cases is cleared, which is on schedule for the end of this week or latest early next week. I’m cautiously optimistic, but a jump in the positive rate would be an early worrying sign.

Photo by CDC on Unsplash

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