Levan Babukhadia
- Jun 8, 2020
- 8 min read

New York Phase One - Lessons Learned

The dynamic of the spread of Covid-19 in the State of New York is clearly signaling the end of Phase One here. While there is no 'official' delineation of phases, given that New York City is re-opening today after nearly three months of unprecedented stay-at-home orders, it is natural to treat June 7th as the end-date of Phase One in NYS. It is also symbolic that today marks the 100th day from the first officially identified Covid-19 infected individual in NYS.

Covid-19 Cases & Deaths

We have come a long way from nearly 800 daily Covid-19 deaths occurring at the peak of the pandemic in NYS to under 50 for the past few days. To set a scale, it is worth noting that daily deaths pre-Covid-19 averaged to ~400 in NYS.

The daily number of new Covid-19 Cases (i.e., those positively tested for the infection) has decreased more than ten-fold from ~10,000 down to under 1,000.

( New York vs. California ) vs. Taiwan

Cumulative number of deaths in NYS is simply staggering at ~30,500 at the time of this writing [1]. It is hard to resist making a comparison with the state of California. The pandemic took off at about the same time in California and in NYS. By March 16, there were ten reported Covid-19 deaths in NYS. By March 17, California had seen twelve deaths. But today California has only ~4,600 deaths [1]. In other words, per capita, NYS experienced whopping ~13 times more deaths than California!

There are various theories attempting to explain this dramatic difference. One is that virus got introduced to NYS predominantly from Europe in much higher numbers than in California where it seems to have been introduced mostly from China, also helped by early ban of flights from China. Also, at the onset of the pandemic, the nursing homes in NYS were impacted hugely; the other states seem to have learned from the mistakes experienced here.

However, the leading cause for the much higher death toll in NYS than in California appears to be early actions taken by respective governments. Unfortunately, NYS got fixated on dramatically increasing hospital capacity and the number of ventilators, while California seems to have acted on closing down the state earlier and more swiftly; NYS was closing down for few days, first 25%, then 50%, then 75%, and only then issuing full stay-at-home order.

Of course, the predictive models from reputable institutions employed by the policymakers are to be blamed for this too, at least partially. All these models made ridiculous predictions, especially at early stages of the pandemic. It is one thing to have a bad model from the start. But it is simply inexcusable to put forth models that are not highly adaptable to the fluid, fast developing pandemic circumstances. We have written open letters to the IHME regarding their infamous model and its rather poor predictive powers [2].

However, at the time when the model predictions were being used by the policymakers, it was already very well known that only one in ten patients survived ventilators once intubated. So then it should have been clear that only increasing the number of ventilators and hospital beds would not provide adequate solution and could lead to a lot of deaths! What was needed was ways to slow down the spread, as quickly as possible.

Quarantine is not the invention of the XXI century. Far from it! And there were also examples of South Korea and Taiwan and other countries who were successfully shielding off the spread of the virus.

Besides, given much more densely populated NYC compared to, say, Los Angeles, it should have been clear that physical distancing measures should have been put in place that much more quickly and that much more aggressively to even hope to achieve good results. Unfortunately, this did not happen, not in time anyways. And in the end, almost all expanded hospital and ventilator capacity was practically unused in NYS and, rather sadly, it ended up with at least ten times more deaths than California.

The comparison with Taiwan is even more painfully mind boggling. A country with a population of ~26 million, only ~50 kilometers from China, with thousands of monthly flights to and from China, ends up with only 443 cases and 7 deaths [1]! Put it another way, per capita, Taiwan has done ~1,000 times better than California and ~3,400 times better than NYS!

Attack Rate

The number of daily Covid-19 tests in NYS has been increasing dramatically from ~20,000 at the start of April to over 60,000 nearly every day after May 27th. This then translates into the reduction of the Attack Rate from rather alarming levels for ~40-50% down to ~1.2% yesterday. This is great news and indicates a marked reduction in the spread of the infection.

However, it is not apparent why the number of performed Covid-19 tests have been increasing so much lately? From the start, only those with symptoms or risks of exposure were being tested for Covid-19. It is hard to believe that that the number of people with flu-like symptoms is increasing so dramatically, especially with warmer weather settling in. If testing now encompasses also those without symptoms, then the interpretation of the rate of positives as an Attack Rate of the infection looses its meaning.

Growth Rates

Day-over-day growth rates of both the number of Cases and the number of Deaths show daily percentage growth in the number of new cases and new deaths.

An exponential growth would have a constant growth rate. These actual curves clearly show that, following the inflection point on the path of faster-than-exponential growth towards the peak, the growth dynamic has been characterized by a strongly decreasing rate of growth.

The daily growth rates have come down dramatically and are now in the range of ~0.2-0.3%.

Case & Infection Fatality Rates

For each date on the x-axis, the total number of deaths (up to and including that date) is divided by the total number of positively tested (up to and including that date) and this ratio is shown as a percentage on the y-axis. This is the Case Fatality Rate.

At any given moment of an ongoing pandemic, CFR can be very different and higher than the Infection Fatality Rate (IFR). The Lancet study put Covid-19 IFR lower than 1%, namely at ~0.66% (0.39-1.33) [3].

Following the steady rise, the CFR in NYS plateaued at ~7.2%. For comparison, in the USA it plateaued at ~5.9% and is about to start going down while for the World it had peaked at ~7% and is now at ~6.1% [4].

How Many Are There Actually Infected In NYS?

Given SARS-CoV-2 IFR of ~0.3-0.5% and the number of reported deaths, it is straightforward to estimate the number of infected. We have been pointing out from early on (see e.g. [5]) that the number of observed deaths in NYS implies a much higher number of infected than the reported number of Cases (i.e., positively tested) might suggest.

Indeed, if the IFR for Covid-19 is at or below ~1%, then the observed deaths would imply ~x10 more infected than there are reported positives! Thus, the observed ~380,000 positives may in fact mean ~3.8 million infected in NYS.

In fact, serology tests for SARS-CoV-2 antibodies in NYS later on confirmed that at least ~20% of the State's population might in fact be infected [6].

Phase One

We will finish off by showing the plot that clearly demonstrates the end of Phase One in NYS. Below, daily numbers of Cases (i.e., positively tested) and Deaths are shown as a function of Cumulative Number of Cases on a log-log scale.

Such a presentation of the pandemic dynamic is characterized by idiosyncratic "drop-off" towards the end of the pandemic and this is clearly seen here for both the number of Cases and the number of Deaths in NYS.

For comparison, we also show similar analysis for a few countries some of which adopted physical distancing measures early on (South Korea, Taiwan, New Zealand, Georgia) and some of which unfortunately did so only later on (Italy, Germany, the USA). The results are self-evident.

What's Next?

While we most likely will need to revisit this question in the future, and perhaps not once or twice, it is still worthwhile touching on it here if only briefly. For whatever it may be worth, this will summarize our current understanding of possible outlooks.

Will the novel coronavirus become less lethal and more adapt to us humans as time passes on? That seems to be unlikely given its unusually long RNA sequence as a result of which it also seems to be equipped with self-correction mechanisms atypical of RNA viruses.

But, on the good side, its IFR seems to be rather low, perhaps even comparable to that of seasonal flu. Its victims age profile seems to be rather strongly skewed towards predominantly older population with comorbidities.

So, perhaps the best scenario is what I might call 'natural vaccination' with actual coronavirus. There seems to be accumulating evidence that the virus load is decreasing in the swab tests performed of late. This is probably due partially to the lockdowns but probably more so due to physical distancing measures that many more are now adhering to than they previously used to. Wearing masks, washing hands frequently, avoiding large gatherings, etc., etc., are seemingly having a rather positive effect.

This positive effect is that the high risk population seems to be much better shielded off now. Those out and about are younger and healthier. They are either able to easily shed off the virus with no apparent symptoms or only with minor complications. Healthier people either don't get sick or get less sick than those in higher risk groups. And healthier people are less likely to infect others with high doses of virus because they have either completely or partially subdued it. And if this novel coronavirus is not received in high doses from the start, when the body has no prior immunity to this novel or any other coronoviruses, then it appears to be rather easily managed by the host.

Thus, in the ideal scenario, low dose spreading or immunization may now carry on slowly but surely without much damage in terms of serious complications or deaths.

Hopefully, the lockdowns were lifted in time to not interfere with these natural processes with warmer weather settling in the Northern hemisphere. The novel coronavirus naturally has a harder time spreading outdoors, in warmth and in sunlight. If so, then perhaps there will be no second wave in the fall/winter. If, on the other hand, the lockdowns were carried on for too long and thus would not allow sufficient time for natural immunization to spread from now until the fall, then we may have the second wave later in the year. Even so, under the circumstances of this particular pandemic, one would expect the second wave to be less severe than the first one.

However, given that the countries like South Korea and Taiwan were able to withstand the first wave of the unknown so well, it is beyond me to understand why so many doctors and virologists are so keen to hype up the issue of the second wave? Why can't the USA and the many other counties who for various reasons failed during the first wave so miserably, be in a position to handle the second, most likely weaker wave of the virus having accumulated all the experience of their own as well as that of the rest of the World?

P.S. This will conclude regular updates regarding the spread dynamic of the novel coronavirus in NYS. The analysis as well as any future updates will continue to be hosted at the same location.