Will NE FL be COVID-19 guinea pig?

The Department of Health has estimated that an influenza pandemic could result in Florida of up to 10 million persons infected, with 5 million chronically ill. An estimated 3 million persons may require outpatient care with an additional 71,000 hospitalizations and up to 18,000 deaths. Demands on health care services under these conditions would overwhelm the state's delivery system. Shifts in human and material resources that are normally executed during other natural disasters will not be possible since outbreaks are expected to occur simultaneously throughout much of the U.S.                       Florida Department of Health, Pandemic Influenza website (March 29, 2020)

Cases of, and deaths from, COVID-19 rise at a scary rate. Yet the President and apologists liken it to the flu, which CDC estimates will kill 24,000 to 62,000 this season. In the conservative National Review, Andrew McCarthy explained why the analogy is false and gave a readable guide to COVID-19 data, at the national level. The President further confused things by arguing a new "data-driven" approach will allow some Counties to relax "social distancing and other mitigation measures". CDC can't even monitor the flu by County, just by State and with a model based on 8% of the US population. The only nationwide source for County-level COVID-19 data is the New York Times; which reports how flawed the data are.

Like his claim to have ordered production of "hundreds of thousands" of ventilators "right now", Mr. Trump is "aspirational" when he imagines a monitoring system can allow local relaxation of safeguards. Yet, if you had phoned the St. Johns Town Center or visited its website through March 29 you would have learned it planned to reopen March 30. Implicitly, the President had sounded the all clear for Counties with low prevalence rates. Fortunately, the COVID-19 Task Force got him to recommend social distancing through end-April. Overnight, the Town Center website added a banner, "Temporarily Closed by Government Mandate". There is no such mandate; just a change in Trump messaging.

Unfortunately, the President's aspiration remains County-level relaxation of safeguards. The "real time" reaction of St. Johns Town Center to a Presidential mood swing shows North East Florida (NE FL) is likely to be first to test relaxed safeguards. Only Florida got all requested Federal supplies for the pandemic. It is governed by Trump supporters. It seems best equipped to meet Dr. Fauci's caveat about having "the tools in place in real time" to monitor the disease. Its COVID-19 website is by County; updated twice a day; with details like age distribution of case, glaringly missing for other States. Its weekly FLU Review shows our Department of Health would monitor not only "outbreaks" but also impacts on health care services. For these reasons, it is worth imagining what opening the Town Center might have done.

The Lancet reports China's transmission rate was about 2 before travel restrictions; meaning a carrier infects two others, on average. An outbreak transmitted by opening Town Center March 30 could have made the current pace of under 50 new COVID-19 cases a day, in NE FL, a fond memory. Thermometer readings in NE FL over the last few days are near normal. By this metric, the curve will have flattened by end-April since, as one expert explained, "virus shedding could continue for days up to three weeks after a person recovers". However, that leaves an unknowable number of asymptotic carriers spreading the virus naturally, through normal activities like visiting the local mall.

Federal sources are shy with specifics of their models predicting such unknowables but they are clearly behind the President's muddled comments suggesting social distancing cuts expected US deaths from the pandemic, from 2.2 million to perhaps as little as 100,000. This is in line with the New York Times model, discussed by Forbes in an article about economic costs of not maintaining current safeguards.

If the pandemic spreads evenly across the US and the optimistic outcome happens, Florida's 12% of US population would mean 12,000 deaths. That is below the 18,000 in our Department of Health models for a generic pandemic (quoted above) yet well above the 4,357 COVID-19 deaths projected for Florida by August 4, in the IHME model recently referenced by Dr. Birx. The IHME model assumes safeguards slow it down yet the virus spreads, naturally, unless a cure is found and people use it-soon.

Much has been made of 'travel' as the primum mobile for spread of COVID-19. Travel is a useful fact in tracking transmission, which Florida reports it has been able to do for barely a quarter of its cases. The share of cases where travel has been confirmed has fallen steadily from 48% on March 19 to 18% today. Moreover, detailed reports show almost half of 'travel' cases for NE FL only involve travel within Florida. A recent study in The Lancet finds 4 or more COVID-19 cases means a place has "more than 50% chance the infection will establish within that population." The virus has probably established in and spreads naturally through two-thirds of Florida Counties, including all those in Figure 1. This is a higher County spread than the half of all US Counties in New York Times estimates, with 4 or more COVID-19 cases. It is time to pay more attention to how a virus spreads naturally; and stop 'othering', blaming outsiders.

Counties differ markedly in population density, arguably the single most important factor in explaining why "flattening the curve" of disease transmission isn't the same across Counties.  

The effects of mistakenly seeing COVID-19 as a problem of the old becomes clear as cases stack up. That is hard to see in even in cases/million; as in Figures 1-3. Those matter most to health care providers since most places have systems proportionate to their population--more capacity where there are more people. Since the virus is spreading, we must also consider its growth rate; place by place. A good case in point is the graphs for global cases and deaths on worldometer. You can toggle them between arithmetic and logarithmic scales. The latter shows both we are still at a stage of fairly constant growth rate, after a lull back when nations first hit (China, South Korea, etc.) clamped down. 

It is important to emphasize the IHME model assumes (emphasis added),

...enactment of social distancing measures in all states that have not done so already within the next week and maintenance of these measures throughout the epidemic, emphasizing the importance of implementing, enforcing, and maintaining these measures to mitigate hospital system overload and prevent deaths.

Florida has not implemented let alone enforced such safeguards. The likelihood we exceed the model's death toll is therefore high. The risks to NE FL seem even higher because the local Republican machine seems ready to sound the all clear at the earliest possible moment-and turn our area into the object lesson for why this is wrong. 

Our logarithmic curve by late Summer would then look like the worldometer graph does today.