Riding the CV Roller Coaster: When Will It End? 

This will end.

Getting to a time when the coronavirus doesn’t dominate every aspect of our lives won’t be easy, the way forward is not clear, and the stakes could not be higher. Still, that one incontrovertible, glorious fact remains: This will end.

But for now, it isn’t some J.R.R. Tolkien quest or a video game. It’s real. And at stake are the lives of the people in our community — our friends, our neighbors, our family.

It will end slowly. The release of coronavirus (and this cursed social distancing) will be as slow as spring wriggling from the grip of our dreadful, gray winter. Until that glorious moment when we can hug each other and shake hands again, we’re living by the numbers. We’re living on a statistics curve. If that curve is a roller coaster, we’re still riding up that first big hill, one click at a time.

The number of COVID cases is growing every day. So is the number of deaths. At some point, we’ll peak. We’ll hit the maximum number of virus cases and the maximum number of deaths. But we probably won’t know we were at the peak until we’re well past it.

After the virus’ peak, we’ll start to descend, except on the corona-coaster, the ride down is slow, too. People will still be getting sick. People will still be dying.
For now, the numbers still tell us it’s best to stay home. So, for everyone’s sake, stay at home, if you can be at home. If you’re out, get what you need and get back home. If you are at work, hopefully you’re out there fighting for all of us in an essential job.

If you’re out mingling in big groups because you wanted to party a little, you should be ashamed of yourself. Mayor Jim Strickland has called gatherings like these “selfish,” and that’s what they are. The longer we meet up and spread this thing, the longer it’s going to take for it to go away. Those are the numbers talking.

The fact is, the numbers rule our lives right now. Remember last week, when Governor Bill Lee finally mandated everyone to stay home? He did it, he said in a statement, because he knew many Tennesseans were not staying home, based on numbers pulled from our cell phone data: “In recent days, we have seen data indicating that movement may be increasing, and we must get these numbers trending back down.”
click to enlarge Governor Bill Lee
  • Governor Bill Lee

Numbers and data. Is Governor Lee watching our cell phones? Maybe not, exactly, but a company called Unacast is. They know how many trips you’re taking every day and how far you travel. They compared that information with how many new virus cases were announced each day. And they could tell that Tennesseans weren’t staying home like they should. And, boom — home order required.

Those White House Numbers
You’ve probably seen these figures by now: President Trump and his task force spokespeople said last week that the COVID-19 virus could claim somewhere between 100,000 and 240,000 American lives before it’s through.

Deborah Birx, the physician heading up the White House coronavirus task force, showed those figures on a line graph. The estimated number of cases and deaths were based on a federal model of the disease based on what Birx claimed was reliable data. Sounds solid, right? Maybe.

“Leading disease forecasters, whose research the White House used to conclude 100,000 to 240,000 people will die nationwide from the coronavirus, were mystified when they saw the administration’s projection this week,” read a follow-up Washington Post story from William Wan, Josh Dawsey, Ashley Parker, and Joel Achenbach.

They quoted some of those forecasters whose model was used to inform the White House coronavirus model as saying they had no idea how the White House task force came up with its predicted death toll. The researchers’ own model showed much lower death toll estimates. The White House did not release any of the confirming information or cite the models it used to come up with its 100,000 to 200,000 deaths estimate, and the federal virus model has not been released to the public. So, is the White House raising the number of projected deaths for political reasons? Or do they know something no one else does?

Birx referenced a virus projection model done by the Institute for Health Metrics and Evaluation (IHME) at at the University of Washington’s School of Medicine. That model projected somewhere between 49,431 and 136,374 total deaths in the U.S. as of August 4th.

Good News?
The figures used in the University of Washington School of Medicine’s  IHME model (which has become a go-to for local agencies, including Shelby County) changed dramatically for the better, as of Monday this week.

Before Monday’s updated projections, the IHME model projected that on April 19th — the then-predicted peak day of the virus here — the state would be short 7,806 hospital beds, 1,799 ICU beds, and would need 1,943 new ventilators. That projection had 3,422 Tennesseans dying from the coronavirus by late May.
click to enlarge INSTITUTE FOR HEALTH METRICS AND EVALUATION (IHME)
  • Institute for Health Metrics and Evaluation (IHME)

The IHME’s brand-new projections are considerably rosier. The total death toll for Tennessee is projected to be 587. Will those numbers stand? Good question.

By now you’ve probably heard of the “surge.” That’s the point when the patient load peaks. That’s when hospitals will be busiest and probably overloaded, and when the most people will die.
According to IHME’s new figures, Tennessee’s surge will begin next week. On April 15th, for example, 25 deaths are projected for the state. Earlier projections showed the state’s hospitals would be nearly 7,000 beds short of what they needed and that there would be massive shortages of ICU beds and ventilators. Now, however, the IHME says the state will need a max of 2,387 beds, well below its statewide total of 7,812 beds.

The surge is expected to peak on April 18th and begin to abate around April 25th. It’s projected that by May 24th, no Tennessee hospital beds will be needed for coronavirus patients. The last Tennessee citizen is projected to die from the first phase of the virus around May 11th.

For now, these may be the best numbers we can get. State officials aren’t sharing their models. Lee has only said publicly that we need 7,000 additional hospital beds and that we are making space for them [more on that below].
click to enlarge SHELBY COUNTY HEALTH DEPARTMENT
  • Shelby County Health Department

The Local Response
Statistical modeling is a key effort of the Shelby County COVID-19 Task Force. Doug McGowen, the city’s chief operating officer, said crunching those numbers are vital to the county’s response.
click to enlarge Doug McGowen
  • Doug McGowen

“Part of the task force work is that predictive analysis about when the surge will come, so that we’ll know not just when it gets here, but how high the peak will be,” McGowen said last week. “Part of that analysis is determining how many people will need ICU beds and how many people will need ventilators. That work is happening today.”

Shelby County estimates weren’t in as of late last week. But McGowen said an early look showed the surge won’t be as bad in Arkansas and Mississippi as it will be in Tennessee. One of the states (he didn’t say which one) will likely not run out of hospitals beds; the other will probably have enough ventilators.

As of Thursday, McGowen said the city was “not near critical.” In coronavirus modeling, distinctions like that one boil down to three key pieces of data: how many hospital beds a city has; how many ICU beds it has; and the number of ventilators it has.

Manoj Jain, a Memphis physician working with the Shelby County COVID-19 Task Force, said last week that state figures showed Tennessee needs 15,600 inpatient beds to respond to the surge. We have 7,800. The state needs about 2,400 ICU beds. We have 629. Also, Tennessee needs 1,943 ventilators but did not say how many we have now. The numbers are grim, but Jain noted that they aren’t set in stone.

“This is a predictive model but that doesn’t mean that that is what is going to happen,” he said.

Monday’s projections make clear how tenuous such predictive statistics can be.
At the governor’s daily news briefing Friday, Lisa Piercey, the Tennessee Department of Health Commissioner (TDOH), said 35 percent of the state’s inpatient hospital beds were available, 34 percent of ICU beds were available, and 71 percent of the state’s ventilator capacity is available.
To prepare for the surge, Lee announced last week that sites across the state will be turned into temporary health-care facilities. The massive Music City Center convention center in Downtown Nashville will transform into a coronavirus-positive environment with 1,600 patient care spaces. Convention centers in Chattanooga and Knoxville will also house patients.

In Memphis, the Gateway Shopping Center on Jackson will house overflow coronavirus patients. Other sites here are also under evaluation as possible sites to become temporary health-care facilities.

A piece of data that Piercey said she was proud of is the state’s testing figures. As of Friday, 34,611 had been tested in Tennessee. Piercey said the state is testing at an “unprecedented rate” and that we are “pulling away from other states. That will help us better identify cases and mitigate our risk and prepare accordingly,” Piercey added.     
click to enlarge Dr. Manoj Jain
  • Dr. Manoj Jain

The End? An Interview with Dr. Manoj Jain
Memphis Flyer: When is this over?
Manoj Jain: Obviously, everyone’s going to tell you the first thing is, we don’t know. The second thing they’ll tell you is that it depends on how we respond and react to the epidemic right now.

In our reaction response, the single most important element is how much we separate from each other, how much we don’t allow the virus to go to another person. The virus is very infectious, three times as infectious as the flu. We need to try to make sure that it does not go to a lot of other folks. That’s the key that will determine the trajectory of the epidemic.
What numbers have to change before we can even think about going back to a restaurant again?
The single most important piece of data that one must pay attention to is the number of new cases per day. Now, that’s not a perfect reflection of what’s happening with the epidemic. It’s somewhat delayed because you’ll want to go back and see when the symptoms started on the that individual.

If the reporting pipeline is not perfect, if it’s clogged up, then it might be a few days late. But we can move it up a little bit and say this was reflecting what we are seeing a few days before.

If you look at the number of cases each day and if they are climbing and at what rate they are climbing; that number gives you a very good reflection of where we are on an epidemic curve. This is like all infectious diseases — it will follow a bell-shaped epidemic curve. You will have a surge or an increase of cases and then it’ll come back down after a period of time. Once we begin to see a decline in the number of cases and sustained declines, that’s when we will know that we are getting this under control.

So, it won’t be until we have sustained declines?
Correct. That would be best. Otherwise, you’re going to see a surge again. Different people have a different take on this. But a study [by Scott Gottlieb, Mark McClellan, Caitlin Rivers, Lauren Silvis, and Crystal Watson] from the American Enterprise Institute called the “Roadmap to Re-Opening” does a fairly good job of defining it. They talked about a sustained reduction in cases for at least 14 days [before restrictions could be lifted].

In the beginning, health officials here said we wouldn’t really know if social distancing was working for a month or two. Are there any early indications that it’s worked?

I think it is because we’re not seeing such a huge uptick in cases and an astronomical rise each day. Yes, we are seeing a more clear number of cases per day but that is not an astronomical rise from the previous day. So, I think we did — with social distancing — blunt the surge. However, is it sufficient enough? We don’t know. How long will it last? We don’t know.

Is there anything we left out or that you want to add?

People need to be very clear that what determines how soon we end the epidemic has a lot to do with what they do now and how that is reflected in the numbers 14 days from now. The more action they take right now in social distancing will reflect in an earlier re-opening. It will lower the surge and dampen the number of cases, and it is going to save many lives.
So we’ll know this virus storm is moving on out when the number of cases decline for two weeks in a row. That’s the health-care side of it. But how will that translate to our day-to-day lives? That will be the government response to the health-care data.

Preparing For the End
In Memphis, officials are already planning for the end. Citizens stuck at home may call it the end, but McGowen calls it the recovery part of the process. Health data will trigger the loosening of some restrictions.

“We don’t have anything close to what I would suggest is the automatic trigger, when things would return to normalcy,” McGowen said. “What I think people should realistically expect is just as we began to put restrictions into place, and they became more and more and more restrictive, that the return to normalcy will be the same. Those restrictions will lift one at a time.

“That is the consistent theme that we’re seeing in the planning and that’s how we intend to approach that return to normalcy.

“But I just want to caution everybody, there is no date certain when that will occur. We need to err on the side of caution to make sure that we don’t just lift everything at once and we get another — maybe even bigger — spike in the future.”

It’s a bitter pill to swallow. Just when this virus passes and Memphians can once again greet friends at their local watering hole, the virus may come back — and we may all go back home. There is still no vaccine, and social distancing is the only thing we know that works.
In Wuhan, China, the epicenter of the pandemic’s origin, restrictions have been lifted. But late last week, officials warned residents to stay inside and strengthen protection measures in an attempt to ward off a second wave of the virus, especially as travel restrictions fall away and international travelers return to the city.

Dr. Scott Strome, executive dean of the College of Medicine at Memphis’ University of Tennessee Health Sciences Center (UTHSC), said sometimes “the second wave is worse than the first.”

“We don’t anticipate that [with coronavirus here],” Strome said. “The things that work against a second wave being worse than the first are if folks have developed an immunity and if we have better tracking systems in place to isolate folks who are positive.

“We have to get through this first outbreak. But it’s incredibly important that we also be thinking about the second, the third, and the fourth because without a vaccine, they go like ripples through the water.”

Strome said he and his team have developed a plan to deal with the virus in all of its waves. They’ve shared it with the city and will soon be posting on the school’s website for the public.

Strome also said a UTHSC team is working with other academic partners on a number of clinical trials. Though he could not give any specifics of the project, he said “there is some hope there.”

A new test from UTHSC now allows results within 24 hours. Strome said with it they can test between 1,000 and 1,500 people per day with an ability to scale up beyond that soon. They are also developing a number of new diagnostic tests that will allow people to know if they’ve been exposed and whether or not it is safe for them to go back to work.

In China …
Last Saturday was a somber day across China. At 10 a.m., everyone stopped and bowed their heads. Sirens blared. Trains, cars, and ships all blasted their horns for three minutes in a national wail of mourning.

According to the South China Post, Chinese President Xi Jinping led the country in a day of mourning for those who died in the months-long coronavirus pandemic. He and other party leaders wore white chrysanthemums to symbolize grief during a state-sponsored event.

For the first time in weeks, Xi and other leaders did not wear masks, aligning with new guidelines from the Chinese government. A similar event was led by party leaders in Wuhan, the epicenter of the virus.

That city will fully emerge from its quarantine this week. Many restrictions have already been lifted. The malls have opened, according to a report by Bloomberg.com. Factories have cranked back up. But there’s still an abundance of caution. The malls aren’t bustling. The factories aren’t at full capacity. 

But there are plenty of signs of life. Lily Kuo, a Shanghai-based reporter for the Guardian newspaper, did what we might think of as unthinkable — she went to a bar. She visited Shanghai’s 44KW nightclub, where “life almost feels normal again.” Groups sat close together without face masks, Kuo said. Bartenders in masks mixed cocktails. A DJ played disco. In other parts of China, shops had reopened. Sidewalks were packed. Food shops were thriving. Chinese leader Xi Jinping ordered urgency in re-opening the economy. According to Kuo, he stated, “in low-risk areas production and normal life ‘must be fully restored.’”

But it took months, until the country rode the statistical peak all the way to the bottom. For now, China reports maybe one or two new cases of the virus each day. Some days there are none reported.

For now, we’re still climbing the corona-coaster peak in Memphis and Shelby County. It’s slow and scary. All we can really do is to act responsibly and watch the numbers.

But it will end.

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