I expect deaths to trend back up starting this week or next. We have had 9 consecutive weeks going down.


Daily average by week:

2,143.57
1,884.00
1,799.14
1,384.00
1,224.29
983.00
899.57
775.86
636.14
589.29

PJYoung said:

---

I expect deaths to trend back up starting this week or next. We have had 9 consecutive weeks going down.


Daily average by week:

2,143.57
1,884.00
1,799.14
1,384.00
1,224.29
983.00
899.57
775.86
636.14
589.29

---

I expect the same. The interesting part will be to see the rate of increase and ultimately the seriousness.

CowtownAg06 said:

---

Memorial day was 5 weeks ago yesterday. The biggest George Floyd protest in Houston was 4 weeks ago today. We should have already seen the uptick in deaths related to those events. The only explanation is we are that back logged in reporting, but I feel like it would have leaked anecdotally from hospitals.

---

Agreed, Dallas has had almost double the cases in June vs May, and while hospitalizations have gone up ICU and deaths have remained flat.

Texas had 33000 positives in May and over 100,000 in June, and the trend seems to be the same, hospitalizations up but deaths and ICU flat. Probably a combo of younger people, better treatment, catching asymptomatic, and possibly even weakening.

CowtownAg06 said:

---

Memorial day was 5 weeks ago yesterday. The biggest George Floyd protest in Houston was 4 weeks ago today. We should have already seen the uptick in deaths related to those events. The only explanation is we are that back logged in reporting, but I feel like it would have leaked anecdotally from hospitals.

---

Not necessarily:

Quote:

---

Among those who die, the final outcome can come as quickly as two weeks after symptoms start, or up to eight weeks later. Add a possible 14-day incubation period, and the longest likely scenario, then, is 10 total weeks from the time of infection to a person's death.

---

Old Buffalo said:

---

PJYoung said:

---

I expect deaths to trend back up starting this week or next. We have had 9 consecutive weeks going down.


Daily average by week:

2,143.57
1,884.00
1,799.14
1,384.00
1,224.29
983.00
899.57
775.86
636.14
589.29

---

Why? We've had 9 weeks of trending down. Why is it just going to tick up?

---

More infections = more deaths, even with the IFR trending down with time. Maybe the younger data set will offset that enough to flatten the death curve as well.

However, we are (barely) up thru the first two days of the week compared to last week. That's the first time that's happened (trending up) during this 9 week period. We will see what today's #s show compared to last Tuesday.

Dallas county reported record number of deaths today at 20. All will be born out over time whichever is correct.

it takes several generations of spread to reach the epidemic we're seeing now

deaths are still lagging

Quote:

---

At one of our hospitals, we have started giving patients portable pulse ox's so that they can monitor themselves at home.

---

just now?

that should damn near be outpatient standard of care IMO

Are we still looking at upper respiratory issues as being the main reason for admission? Also are you seeing any trends in the younger patients like obesity, high blood pressure, etc. that are more prevalent?

cone said:

---

Quote:

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At one of our hospitals, we have started giving patients portable pulse ox's so that they can monitor themselves at home.

---

just now?

that should damn near be outpatient standard of care IMO

---

Remember it was hard to get them for a while, hospitals needed to make sure they had enough for there in-house patients if there was a surge like now.

that said, the serology points at a hospitalization rate at around 4%

so the urgent care/freestanding doc is probably going to be seeing the typical case tbh

Of the younger patients (<50) requiring admission, most are obese along with HTN and diabetes.

EDIT: Also missed your first question. The primary reason for admission is hypoxia.

Agreed, but no one is talking about typical cases. Of course the large majority that get this will be fine The numbers we care about are number of hospitalizations, number requiring ICU, number requiring ventilators, and number of deaths given that hospital beds and ventilators are finite resources.

Double

HTN?

Sorry, hypertension

agreed

you want to stay out of epidemic spread

but the resources should stretch much farther than we anticipated back in March, based on the hospitalization rate being much lower than we projected then and (as of now) a younger cohort getting sick

if it's going to burn anywhere, let it burn through the young

but you can't let it burn for long and there's no way to keep the spread from hitting the olds, eventually

VKint said:

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Hard to give much credibility when in the tweet the guy mentions giving antibiotics and steroid shot to outpts with a viral infection.
Personal pet peeve.

---

Lol that really irked me the wrong way too. There is little that angers me more in medicine than spending 10-15 minutes explaining why a patient's viral infection doesn't need antibiotics, only to do a chart review later and realize your colleague saw them the next day and wrote for a zpack and discharged them all within a minute of seeing them.

So true and so frustrating. Its lazy bad medicine. Some Drs and pts really love that Zpack + steroids quick fix. Always a bad idea but inexcusable now.

This isn't quite true. This assumes everyone who was going to get exposed all got exposed at the same time at those single time points. That isn't really how it works. Those events initiated many small new rounds or new waves of spread in their respective communities. That initial bump in exposures associated with those single dates takes time and repeated exposure events over time to become a significant outbreak.

In my lab (texas med center), we saw a small bump in positive percentage around June 10th (~4% to ~6%). That held steady for about a week and we saw another bump around June 17/18 (~6% to ~9%). That also held steady for about a week. Then we saw an enormous jump in positive percentage rate on June 23/24 (~9% to ~25%+) and it's remained high since. My lab reported out 682 tests yesterday and the positive rate was 24.5%.

Additionally, for someone who gets infected and is ultimately going to die, the mean time to death is around 3 weeks from infection. Reporting of that death is another 2-3 weeks (or more...) after that. Speaking about Houston, any deaths from the recent spike, where hospitalizations began to increase ~12-14 days ago, won't begin to hit the books so to speak until the end of July.

Hopefully the recent increase in hospitalizations is not followed by a proportional increase in deaths. I personally don't think that it will, but who knows.

DFWTLR said:

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PJYoung said:

---

CowtownAg06 said:

---

Memorial day was 5 weeks ago yesterday. The biggest George Floyd protest in Houston was 4 weeks ago today. We should have already seen the uptick in deaths related to those events. The only explanation is we are that back logged in reporting, but I feel like it would have leaked anecdotally from hospitals.

---

Not necessarily:

Quote:

---

Among those who die, the final outcome can come as quickly as two weeks after symptoms start, or up to eight weeks later. Add a possible 14-day incubation period, and the longest likely scenario, then, is 10 total weeks from the time of infection to a person's death.

---

---

Most are 3-5 day incubation period, the 14 days is for .05%, the average from infection to death is no where near 8 weeks, that's an outlier.

---

From Hotard:

Quote:

---

It's worth mentioning again that the deaths being reported every day are reporting deaths from up to 2 months ago. In the past, I have posted the Houston Health death reporting every day and in the last week there were several deaths reported that happened in April and early May. I will save you guys the wall of text of showing it again, but just keep in mind that there's an lag not just between infection and death but also between death and reporting death.

---

Example:

PJYoung said:

---

Old Buffalo said:

---

PJYoung said:

---

I expect deaths to trend back up starting this week or next. We have had 9 consecutive weeks going down.


Daily average by week:

2,143.57
1,884.00
1,799.14
1,384.00
1,224.29
983.00
899.57
775.86
636.14
589.29

---

Why? We've had 9 weeks of trending down. Why is it just going to tick up?

---

More infections = more deaths, even with the IFR trending down with time. Maybe the younger data set will offset that enough to flatten the death curve as well.

However, we are (barely) up thru the first two days of the week compared to last week. That's the first time that's happened (trending up) during this 9 week period. We will see what today's #s show compared to last Tuesday.

---

Where are you getting your numbers from? According to Worldometers we are down from last week by over 10% for the first 2 days of the week.

I know Worldometers also places historical adjustments in the past. So when New York added 692 historical deaths to their count on Monday of this week, those deaths were not shown as occurring on Monday. I believe the New York Times and others just show the date the deaths were reported which can make it look like the numbers are increasing even though the deaths may have occurred months ago.