COVID-19 Update: Hospitalizations Surge

Wrong reaction, lady, your hands should not be touching your face!

The Virginia Department of Health has updated its statistics to reflect yesterday’s numbers. The big movers: hospitalizations and deaths, both of which surged 26%.

Total confirmed COVID-19 cases: 1,484, up 234
Total hospitalizations: 208, up 43
Total deaths: 34, up 7
Total tests: 15,344, up 1,943

Here are John Butcher’s latest calculations for the “doubling” rate for key metrics:

Confirmed cases: 3.2 days
Hospitalizations: 3.7 days
Deaths; 2.9 days

The hopeful news is that the doubling rate for hospitalizations shows signs of stretching out. It makes a substantial difference if it takes 3.7 days for hospitalizations to double compared to 3.0 days. A top public health challenge is to “flatten the curve” — to prevent Virginia hospitals from getting overwhelmed with COVID-19 patients at one time.

I question, however, how well the VDH data reflects the reality in hospital wards and emergency rooms. Bon Secours Mercy Health, which operates 11 hospitals in the Richmond and Hampton Roads regions, announced yesterday that it has furloughed 700 full-time employees across seven states and 12 markets, reports Virginia Business.

The furloughs come as a result of fewer people seeking primary care, outpatient and surgical services. Most health car services being performed are related to COVID-19. Stated the press release:

In response to this unprecedented situation … our ministry is acting quickly to redeploy or temporarily furlough associates who are unable to work due to temporary closure, cancellation and low census in primary care, outpatient and surgical services. This will also affect many support services associates who are not directly working on COVID-19 activities. We are also suspending hiring for any positions not directly impacting our COVID-19 and care responses. …

The efforts of our entire team, combined with the tough decisions we are making today, will enable us to continue to focus on the COVID-19 response, which we expect to escalate in the coming weeks.

It is not known how many of the furloughs reflect medical conditions Bon Secours is facing here in Virginia. The nonprofit Catholic hospital chain has facilities located in Florida, Maryland, Michigan, Pennsylvania, South Carolina and Virginia. But this is powerful anecdotal evidence that the coronavirus may be stressing Virginia’s hospitals far more than would be indicated by the officials “hospitalization” number of 43.

— JAB

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26 responses to “COVID-19 Update: Hospitalizations Surge

  1. With the shortage of medical personnel in NYC, and predictions that we’ll not have enough medical personnel at some point, I’m shocked.

    Finally – at the POTUS level – actual science is being allowed to tell the truth about the reality we face with actual real model data presented at the press conference.

    And acknowledgment that the truth about models – none of them are dead-on 100% correct but that does not mean they are “wrong”. They mean bad news is ahead but all we reall know is approximate high/low ranges not the exact numbers.

    That’s the best the scientists can provide and even though a lot of folks are now convinced – there are still those who are not.

    Thank gawd, we don’t see a bunch of folks “interpreting” these models and claiming the science is wrong.

    • All models are wrong. Some models are useful. Some of these are very useful, and the charts Birx was showing last evening apparently swayed POTUS. The amazing difference between California and New York is another huge question that will be addressed “after action.” You are just as guilty as the rest of us of cherry picking science at your convenience. Tired of that lecture…get another one.

      • Here’s another. how data is reported – or not. does that make a difference in comparing New York or California or China or South Korea?

        How is the state level VDH getting that data?

        We seem to rely on these numbers but how do they get sourced? Is every lab and every medical provider and every health care facility supposed to gather this data and send it somewhere? In Virginia, does it go to the local VDH folks and they, in turn, deliver it up the food chain and finally VDH releases it?

        That kind of thing goes on in every state, right?

        And each state, more than likely, has different reporting processes.

        When they all end up combined on one chart – it may well be like those models.

      • Some are better than others, but try analyzing without them and you are no better than someone standing at a lectern saying, “I think,… I feel,… I believe… This is like the flu,… gone by spring… soon it will be one case…”

      • California freely admits that it does not aggregate and publish all Coronavirus testing data. When you look at the BuzzFeed aggregation of The COVID Testing Project data you’ll see …

        “* The numbers for states with bars shown in gray are incomplete, either because they are not reliably reporting negative test results or they are not reporting tests run in commercial labs; % positive is not calculated for these states.”

        California is in gray. Virginia is not. In fact, six of the nine states testing at a lower per capita rate than Virginia are in gray. To me this implies that Virginia might be in even worse shape on per-capita testing than I thought.

    • I agree with SH, all models “are wrong” — or perhaps more accurately, all models produce outputs that may be and often are wrong, which is why they usually produce a range of outputs with various confidence levels. There can be problems with not only the algorithms themselves but also GIGO and all that. BUT — if that’s all you’ve got to assist your planning, shouldn’t we use a model instead of just “winging it”? Isn’t that better than gut instinct? Especially gut instinct overlaid with a heavy dose of personal political bias or worse?

      I don’t think we disagree about that. Yes, models can be useful. They can also be used to mislead. And that’s my problem with the VDH forecasts Jim is referring to. Thanks, Jim, and John B, for reporting and critiquing them. Again, again, where is the Governor on this? Where is his common sense advice to the public applying his own interpretation to these forecasts and reassuring the public what lies ahead and how the State is dealing with it? Why is it I see news clips and interviews nearly daily with Larry Hogan next door, but zilch with Ralph Northam? Only remote edicts pronounced from on high? Yes, we’re stuck depending upon State leadership, given the current federal absence of it — so where is that leadership? Who is shaping public opinion and reassuring public confidence in Virginia? What about transparency, Mr Northam?

      • “Why is it I see news clips and interviews nearly daily with Larry Hogan next door, but zilch with Ralph Northam? Only remote edicts pronounced from on high? Yes, we’re stuck depending upon State leadership, given the current federal absence of it — so where is that leadership? Who is shaping public opinion and reassuring public confidence in Virginia? What about transparency, Mr Northam?”

        Exactly right. The political culture in Virginia is that of the plantation elite looking down their noses at the little people. It’s been that way for centuries. Our political leaders don’t engage because they see no reason to engage with the unwashed masses. When you have the worst state for partisan gerrymandering, off year elections and unlimited campaign contributions the voters become somewhat irrelevant.

      • All models are wrong – true statement but are they “close” enough and who do you trust to interpret them if you don’t know how?

        There ARE indeed “good” models and bad “models” and again – how do we determine if one is good or bad?

        The world goes around on models – most just do not realize it.

        Anyone that uses GPS – in a car or on a phone is using models. Anyone that drives a car with safety features is using equations that are derived from modelling. The tires on your car are designed and manufactured according to modelling data. Bridges and highways are build according to models.

        Nothing that “measures” or uses a sensor is 100% correct. There is ALWAYS an error and models are one way to quantify the errors.

        PI is not 3.14159 it’s
        3. 14159265358979323846264338327950288419716939937510

        and even that is not 100% precise and it does matter, for instance, a probe is sent to Jupiter… the error of dozens of digits can translate to hundred of miles.

        Take a look at hurricane models – not a single one of them is “right” :

        ?resize=700%2C465

        but we totally depend on them and yes, we do evacuate thousands and thousands of people – that did not have to be… in theory.

  2. Reserves?

  3. Cases per capita would be the best way to compare competing strategies. Then again, normaling by other criteria, e.g., icu beds, should be done too.

    • That only works if testing is at a constant rate. That’s not even close to being the case. If Virginia stopped testing today the only new cases would be deaths confirmed as COVID-19 by autopsy.

      The only reliable statistic right now is deaths per capita. However, that is a very lagging indicator.

      Widespread testing would have given these models much better predictive power but widespread testing has not happened. Not across the country and definitely not in Virginia.

  4. I seem to remember reading that the hospitalization data is cumulative. Therefore, without covid-19 hospital discharge data, we don’t know how many beds are currently being occupied by covid-19 patients.

    • Absolutely correct. That’s a key limitation to the data — another worrying sign that Governor Northam might be flying blind.

      In a similar vein, it would be extremely helpful to know the average length of stay of a COVID-19 patient. That directly impacts the number of patients that a given hospital can treat.

      It would be interesting to know if anyone is trying to fill these holes in the data.

      • Cuomo is really good at “providing” the data. Who really knows the QUALITY of that data?

        There are dozens, hundreds of hospitals, labs, providers, etc flung across New York and New York City.

        Take one hospital. Is there a person in charge of collecting it and transmitting to someone at the State level? Does it have to be transmitted on the hour or once a day or what interval?

        On the receiving end – is data coming in like a firehose from across the state? Is a second person or office double checking it ? Are they validating that it is consistent with other data?

        For a somewhat similar comparison – look at how votes are tabulated on election day. It’s not exactly a error-free process…nor a timely one.

        So what Cuomo knows that Northam does not apparently is that the public wants numbers – and he gives them to them. Whether they are “good” or not is an entirely different thing but if the public has a choice, they’ll love Cuomo for his data and hate Northam for his lack of data.

  5. Another piece of bad news: DOC has reported covid-19 cases in one of its prisons. It is at the women’s correctional center in Goochland. Three offenders have tested positive, as well as three employees and one contractor. I saw an earlier report that a contractor nurse had tested positive, so I figured it was only a matter of time before offenders came down with it.

    • Any idea of how that might be handled Dick? Can they easily separate folks from each other or move prisoners without close contact with staff?

      • I don’t know and the RTD article did not provide any details. But I can guess. I don’t have ready access to population figures like I used to, but I assume that they cannot be kept at the Goochland facility due to most beds being occupied. The only medical facility there is a 3-4 bed sick call unit. And that prison has been pretty much filled to capacity. Fluvanna Correctional Center for Women (not too far from the Goochland facility) has a large medical unit with the capability of providing the care. Even better, that facility has a large mental health unit comprised of two cell blocks. When I last saw it, one of the mental health units blocks had a lot of empty beds, meaning that it was not being used to capacity. DOC could move all the MH patients to one unit and use that other unit for the covid-19-stricken offenders. That would pretty much isolate them from other offenders and staff. Another possibility: Depending on how sick the offenders are, they could be kept at Goochland or Fluvanna in the “restricted housing” (DOC-speak for isolation) cells. If I find out what they actually did, I will post it.

  6. Jim says: “Absolutely correct. That’s a key limitation to the data — another worrying sign that Governor Northam might be flying blind.”

    Yes. And there are holes opening up in the data all over the place, expanding and contracting. And there is data rapidly proven wrong and ever changing all over the place too. Like ventilator needs change wildly up and down, even down a lot in New York. This apparently is the nature of this beast. Even most conscientious, careful, and informed, easily get caught up in misinformation, or lack of right information trap. This should be humbling for us all.

  7. data is NOT necessarily, much less always, “information”. it can and does deceive but much of the time, that’s on us to figure out… that’s called due diligence and yes. we got lots of skeptics… probably justifiably so.

    I strongly suspect that the collection of data with respect to COVID-16 is all over the map with some of it incomplete, inaccurate and even haphazard and other pretty good – but we don’t know which is which. Not at all surprised that different states show different graphs. There are dozens of ways it could be different. Would be almost a miracle if it were 100% dead on correct for all states.

    But we all like graphs and data because we think it is informative – and that’s where we get ourselves wrapped around the axle.

    Most of us buy gasoline every week or so. The octane numbers on the pump, we rely on but how accurate are they, is it really 87 or 89? Or if the pump says 19.2 gallons, how do we know it’s not 19.1 or 19.8? We just look at those pumps and confidently think we know the octane and number of gallons.

    Oh.. and just waiting to hear someone say… “hey, the government makes sure those numbers are correct”… uh huh.. this coming from folks who say the govmint is corrupt, incompetent, liars, etc, etc…

    • Well, Larry, if someone shows up to fill a 5-gallon gas can and the pump says that they put 6 gallons in, that might be a clue that that pump is screwed up.

      Or, if someone has a vehicle that they know has a 17-gallon tank and the pump says they put 18 gallons in…there’s another clue that the pump has a problem with it’s accuracy.

      Point is–with gas pumps–it’s very easy to verify the accuracy of the reading. So easy, in fact, a government employee can do it, probably without screwing it up, at least most of the time.

  8. easy to do – yep. How about that octane?

    • Octane, not so easy, but those who own vehicles that actually need high octane will know if the 93 isn’t really 93.

      The Commonwealth of Virginia certainly doesn’t check that the stated octane is actual.

  9. Truth is – you don’t know and you rely what’s posted on the pump. My point is you don’t really know these things – but we trust and believe what we’re told.

    You really don’t even know how many gallons you actually got. Yes, it can be checked but do you? Nope. And filling a 5 gallon can won’t tell you if 17 gallons is correct either.

    these are things that are “measured” by devices that themselves have errors – known errors + or – , but you and I do not know that. We rely on information given to us to be correct. Just like most things we receive
    from others… whether it’s a weather forecast or how much fat is in our burgers or the stuff in your prescription drugs.

  10. Larry:

    Between the trip computer, the odometer, and keeping track of how many gallons go into the car at each fillup, I get a sense of how many gallons should be going into the car.

    I don’t know or care if you pay attention to those things (probably not), but I do. And if I find that suddenly my car got 25MPG on a tank when before it got 30MPG, then I either have a mechanical problem or a gas pump is miscalibrated. It’s not real tough to figure out which is the case.

    As to your assertion that filling a 5-gallon gas can won’t tell you if the pump is accurate at a 17-gallon delivery, exactly how do you think the little part in the gas dispenser that counts the gallons works? All it does is send an electrical pulse per X quantity of fuel delivered to a computer which counts the pulses to calculate and display the gallons delivered.

    If the fuel counter sends X pulses for 5 gallons you can be sure it will send X * 3 pulses for 15 gallons and X * 3.4 pulses for 17 gallons. (Unless the fuel counter is in the process of failing and stops sending pulses entirely–not likely).

    Therefore any error that is apparent at 5 gallons will be apparent at 17 gallons, at exactly the same percentage. If it’s .05% off at 5 gallons it will be the same at 17 gallons.

  11. If you know how electrical components “work” , you also know that when they malfunction , sometimes it’s only at a high or low range so the device no longer works consistently at all ranges. Mechanical pumps have similar issues as gaskets and seals may partially fail, etc, etc.

    the point is that most of us can’t conceive of these things because we just take for granted that it all works all the time while doubting what science tells us…. we just don’t think science every had anything to do with some things – and they do… our world is based on science… 24/7.

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