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When Governor Gavin Newsom gave a terrible look at the runaway spike in coronavirus cases and hospitalizations in California this week, he was referring to projection models of future death and misery that he said were becoming “alarmingly” accurate.
If so, in the next four weeks state hospitals could be overcrowded with 75,000 patients – about five times the current level – and an average of 400 people die each day.
Hospitals were on the verge of being overrun by nearly 15,000 coronavirus patients when Newsom made the announcement on Tuesday. The hospital projection is based on cases that continue to increase with the current rate of infection, without people taking extra precautions to prevent the virus from spreading.
That way, it won’t be long before the state is in a very bad place, said Marm Kilpatrick, an infectious disease expert at the University of California at Santa Cruz.
“One thing that is worrying is that, despite recent restrictions, we have seen exponential growth in hospitalizations and cases in California for quite some time,” said Kilpatrick. “It’s kind of terrifying.”
The models published online by the California Department of Health largely reveal one key indicator – transmission rate – that has been improving in recent days. However, that number remains at a point where each person infects the virus more than any other, causing the spread of it to run out of control.
The state uses several models to predict hospital stays. When they are combined into an “Ensemble” projection, the total is less bad by mid-January, but still shockingly high: more than 33,000. That would still create an overwhelming burden on hospitals.
The model for the increase in deaths does not include an estimate based on the current infection rate. However, an average of dozen different models shows that as of January 9, the number of deaths had increased by about 25% from the current figure to nearly 27,000.
Other models in the chart forecast a number of 22,000 deaths, which the state surpassed on Friday, to a high of 43,000 in about three weeks.
The most populous state in the country, which had very low numbers of infections per capita for months while other states were slammed, is dealing with its own crisis as it has record numbers of cases and deaths every day.
379 deaths were recorded on Thursday. There have been more than 1,000 deaths in the past five days and more than 100,000 newly confirmed cases in just two days this week.
Most of the models posted on the state’s website show that the situation will worsen before improvement, as the effects of Thanksgiving gatherings and travel are borne by hospitals that are already running out of beds.
“Our modeling is becoming alarmingly accurate,” Newsom said Tuesday as he announced an additional 5,000 body bags had been ordered and more than 50 refrigerated vehicles could serve as temporary morgues.
At the start of the pandemic, some models suggested that the outcome would be dire if public health safety measures were not taken.
In March, Newsom said the state, with nearly 40 million, is well on its way to seeing 25 million cases of COVID-19 in two months. Nine months later, after a series of tougher and milder restrictions, the state had more than 1.7 million cases, the highest in the nation but a fraction of the earlier prediction.
The large differences in some models are due to the use of different mathematical formulas and data, including mobile phone mobility patterns and demographics such as population density, as well as an increased weighting of some data.
Bradley Pollock, an epidemiologist at the University of California at Davis, said the latest models were more accurate. He said the value of the models is that they guide public policy and identify trends that are likely if no action is taken.
“What we are seeing right now is exactly what we predicted,” said Pollock. “The main use of models is to tell you what could happen, not what will happen.”
With cases exploding since November, Newsom has taken measures that have rioted businesses and frustrated some residents. He put most of the state under a new stay-at-home ordinance, which stopped eating at restaurants, stopped haircuts and manicures, and closed many other types of businesses. Retailer capacity has been reduced.
If these instructions work, it will likely take weeks to show up in the number of cases and even longer in hospitalizations, as there is a delay from infection to detection until a disease is severe enough to warrant hospitalization lead, and usually longer, until death occurs.
Some Stanford University models include stay-at-home orders and also explain the surge in Thanksgiving cases. They project several scenarios where hospital stays will decrease by the end of the year, although deaths will continue to rise until at least January 20.
While models have been helpful to health authorities, they could be more accurate and useful to the public if they put together a larger set of available data that could then be presented much like a weather forecast to help people better assess their risks, said Dr. Eric Topol, director of the Scripps Research Translational Institute in San Diego.
Criticized that there is no national approach to fighting the virus in the US, Topol said that it also aims to not have a layered approach to data collection for modeling. He referred to the various efforts as “solo acts”.
He said there is so much data available that could be used to create better models – from detailed mobility data from phones and smartwatches to street level showing whether home stay orders are being followed to data that come from smart thermometers when fever is recorded to even take sewage where peaks in the virus can be detected several days before cases are reported.
“The modeling is based on so many assumptions with no complete data,” Topol said. “You have some rough data to see that people are in big trouble.”
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