New York City is emerging as the hot spot in America similar to Lombardy in Italy. Why this is so is one of those mysteries that we may never find out the answer to but that is not my main focus. My main focus is on three main questions that seem to be freaking people out. As best as I can tell they are as follows…..
1. How many people already have it?
2. Why are so many young people in the hospital?
3. How far away is the peak?
As far as question #1 goes, the answer of course is that we can’t know. But we can do better at guessing then a lot of people out there. The first thing to remember is that the number of reported cases means nothing. It drives me nuts to see headlines like “Coronavirus cases doubling faster in the U.S. than any other country, report says.” This is purely an artifact of US ramping up testing and trying to catch up to other countries. It tells us nothing about how fast it is spreading in the US. Anyone with half a brain should be able to understand this but apparently brains are in short supply these days. One thing we can do is look at death rates. Assuming they are pretty well reported, they should be able to give us a better idea of infection rates. The main problem with using death rates is that they are backwards looking and are likely to misleading for countries that are just getting started. Nonetheless, a quick look at death rates can be instructive if we make an effort to compare like to like.
For example, using the data from this site we see that that Germany has had 72 deaths and some 20 thousand confirmed cases. On the other hand, France has 450 deaths and only some 12 thousand confirmed cases. Looking at these numbers we have to say that either Covid is lot deadlier in France or France is way under detecting COVID cases. France being France and Germany being Germany, I am inclined to believe that France is not keeping tabs as well as Germany is.
So what is a reasonable figure of COVID cases per death? If we look at the Diamond Princess it is 89 symptom showing COVID case per death. In South Korea it is 86 cases per death. Based on those two numbers, I looked at various areas reporting COVID deaths and multiplied that number by 90 to see how large a number of cases they were missing. In France’s case it means they have only located a little 25% of the cases and it could be even worse then that if they are at an early stage of their curve. Germany on the other hand would only have a little over 6 thousand cases based on their death rate. So either they are early in the curve or COVID is less deadly in Germany. Assuming Germany is early in the curve but at roughly the same place on the curve as France, that would mean that France has almost a 130,000 cases and they have only caught roughly a 10th of that. We can play this game with a lot of countries. Italy for example should have about 360,000 thousand cases even though they are only reporting just under 50 thousand. And that is assuming they are far along on their death curve. If they are earlier then South Korea, they will have a lot more cases out there.
But what we really care about is New York. According to John Hopkins data (which lags behind the times a bit) New York had 42 deaths and 8310 confirmed cases. That works out to about 200 cases per death. That is a lot lower death rate then the Diamond Princess or South Korea. However, let us assume we are at the same place in the curve as Germany. That would mean we have about 120 thousand cases out there and have only counted roughly 80 thousand of them. If those cases don’t grow (unlikely) it means New York would see around 134 deaths to be at roughly the same rate as South Korea. If we are like Italy (no reason to think that yet) we could see as many as 5 thousand extra deaths in New York over the next 6 months. That sound like a lot, but by way of comparison there is typically over 3 thousand opioid over-dose deaths in New York and those deaths are concentrated in the young and otherwise healthy. Overall, there are almost a million deaths ever year in New York from all causes so even 5 thousand deaths is not going to move the needle very much. Particularly since a lot of deaths from Covid will be people with poor health that might have caused them to die in the near term anyway.
All of the above does not mean much as there are too many unknowns. But it gives you a context to put the various numbers the media throws around into.
So on to the second question, why are there so many young people in New York Hospitals? This is a pretty easy question to answer—- The average age of people in New York city is about 37. This is far younger on average then most of places in the world that have been suffering from COVID up to this point. Judging by data from the Diamond Princess, people in there 30s and 40s do not have a special immunity from COVID, they are just a lot less likely to die from it. So while the media is trying to hype up the number of young people in the hospitals in New York City, this is not really surprising given the demographic profile and data from Diamond Princess. If we have a high death rate per confirmed cases of COVID in New York city that might be surprising (assuming testing is wide spread) but right now that is far from being the case and testing is far from being widespread in New York City. Given the likely under counting of cases, we are nowhere even close to having a high death rate from COVID in New York as of yet. Granted, it is early, but do keep in mind that we have a death rate that is more like Germany then it is Italy so far.
One thing that will be interesting to see is if America’s high rates of obesity lead to greater death rates among the young in the US. But right now, there is nothing in the data that makes it seem like COVID is doing anything different in the US then it has in other countries.
Last question, how long will it take COVID to peak in New York? Again, this question can’t really be answered as there are to many unknowns. People are throwing around a 45 day figure for Covid to peak. If we go by hospital admissions, COVID really started to take off in the beginning of March in New York. So if we use March 1st as a start date, the peak in deaths should come around the middle of April for New York and go down from there.
Obviously, this is all based on very limited information. But I hope it puts things that they are reading in the media in perspective for people. Based on the data from other countries, we are doing pretty well in comparison. That could change as it progress, but right now we are no where near as bad as it could be based on what has happened elsewhere.