Northam Is Using the Wrong Metric to Guide Lock Down

by James A. Bacon

Governor Ralph Northam says he won’t begin phasing out COVID-19 lockdown measures in Virginia until he sees a decrease in the number of coronavirus cases for two full weeks. “We are nowhere near 14 days,” he reminded everyone in a virtual town hall yesterday.

Here’s the rub: The Governor has no idea whether the number of COVID-19 cases is increasing or shrinking. The state’s capacity to administer tests is so inadequate — Virginia tests per million population lags that of 49 other states, even Guam, says Jim Sherlock in a previous post — that the Governor has appointed a working group to fix the problem. He has provided no estimate of when the shortfall will be resolved to his satisfaction.

But there is another set of metrics — a more reliable and, arguably, a more useful set — that could guide the Governor should he choose: Hospitalization data. As can be seen in the graph above, taken from the Virginia Hospital and Healthcare Association COVID-19 dashboard, the number of confirmed COVID-19 patients in hospitals has reached a plateau and is increasing very slowly. The number of severely ill patients in ICUs and on ventilators has actually decreased over the past two-three weeks.

The Virginia Health Department COVID-19 dashboard indicates that the results of 3,740 more tests were registered yesterday. That was a near record and a substantial improvement from the past two weeks. But it doesn’t come close to providing a representative sample of Virginia’s population. Testing by the VDH and hospitals is guided by strict protocols that prioritize patients showing unmistakable COVID-19 symptoms, health care practitioners in the front lines of the medical fight, and potential hot spots such as nursing homes and correctional facilities. Random testing in other states and countries suggests that the actual number of people infected by the virus could be ten times higher. Thus, the number of “confirmed cases” in Virginia reflects (1) the number of test results that make it to VDH inboxes and (2) state testing protocols, and tells us almost nothing about the incidence of the virus in the population at large.

It’s not clear what level of testing would make Northam comfortable with loosening the draconian restrictions he has put on Virginia’s economy. It’s not even clear what kind of tests he would deem acceptable. For instance, would he consider tests that detect the presence of COVID-19 antibodies? Whatever he decides, the level of testing he wants is likely a much bigger than what we’re seeing now, which means Virginia could be weeks or months away from meeting his criteria for relaxing the lock down.

Remember, the original justification for imposing the lock down was to “flatten the curve” and protect hospitals from being swamped by COVID-19 patients. We didn’t want to become Italy. Northam’s restrictions have bought Virginia’s hospitals time. Hospitals have canceled elective procedures, made more beds available, expanded ICUs and stocked up on ventilators. The shortage of personal protective equipment is still an issue but it’s easing. Nowhere near full capacity, Virginia hospitals can handle many more patients, if need be.

The best thing about hospitalization data is that it’s hard data. It may not be perfect, but it’s not a shot-in-the-dark number like the number of confirmed COVID-19 cases.

Northam should be using hard hospitalization data to guide his decision on relaxing the lock down, not the number of VDH-confirmed cases that tell us almost nothing.

But Northam has moved the goal posts. He is hardly alone in doing so — other elected officials and the media have done the same. The media relentlessly tracks the total number of deaths. Today’s VDH dashboard tells us that 372 Virginians have died from the disease so far. Reminder: That compares to roughly 70,000 Virginians who die from all causes every year. (The exact number was 69,353 in 2018.) The media message can be summed up as: Panic! Hyperventilate! Panic! Hair on fire!

But it is folly to focus on COVID-19 deaths to the exclusion of everything else. We cannot risk the collapse of our economy, the bankruptcy of thousands of businesses, and the layoff of hundreds of thousands of employees. Wholesale economic destruction has healthcare consequences, too. We may not measure them, but they’re just as real. The Governor must shift to a more relevant set of metrics and move more aggressively to remove the shackles from Virginia’s economy.

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19 responses to “Northam Is Using the Wrong Metric to Guide Lock Down”

  1. Steve Haner Avatar
    Steve Haner

    That metric is still not going down, though….It lags the infection rate, obviously, as it can take a while to develop symptoms. Hence the federal guideline for 14 uninterrupted days of improvement. That was put out by Trump during daylight hours, but at night the other Trump appears and pushes for the exact opposite. Polling I’ve seen complains about mixed messages. What a surprise….

    1. True, the hospitalization rate is not going down. But hospitals have ample capacity. What happened in Italy will not happen here. We have ample leeway to begin loosening the restrictions through a series of carefully calibrated measures allowing the resumption of the least risky activities.

      1. Nancy_Naive Avatar

        Wait, so your goal is to run the hospitals at just under capacity?

        Do you redline before shifting? Bet your wife and kids enjoy riding with you.

  2. I just came across this datum from “Roadmap to Pandemic Resilience,” published by Harvard University, which proposes “massive scale testing, tracing, and supported isolation as the path to pandemic resilience for a free society”: “We need to deliver 5 million tests per day by early June to deliver a safe social reopening. The number will need to increase over time (ideally by late July) to 20 million a day to fully remobilize the economy.”

    Assuming that Virginia, with 1/40th of the nation’s population, also would require 1/40th the number of tests, that implies Virginia will need 125,000 tests daily by early June, and 500,000 tests per day by late July.

    Yesterday, according to the Virginia Department of Health, 3,740 new tests were registered.

    Virginia does not yet have a plan to ramp up testing. Governor Northam has appointed a “work group” to address the testing shortage. If Northam uses the same standards as this Harvard group, it looks like we’ll be waiting a long, loooooooong time before he reverses the lock down.

    1. LarrytheG Avatar

      If you do not have contact tracing – you’re playing Russian roulette.

      Those who want to “open up” are twirling the tumbler before pulling the trigger.

      No one likes this at all but Cuomo had it right “Don’t be stupid”.

      1. Yeah, Cuomo’s is a real role model. Only 15,000 deaths in New York City.

        Heck of job, Andrew!

        1. LarrytheG Avatar

          I’ll take Andrew ANY DAY over your average blogger or Trump!

          Andrew does not lie nor change his mind every other day or blather about drugs he knows nothing about, etc, etc, ad nauseam

        2. djrippert Avatar

          The retrospective documentary on Cuomo will star Jim Baker in an angel of death costume as New York’s Governor.

          Comrade Mayor deBlasio and Cuomo didn’t close the schools early enough in New York City and bada bing – fiasco.

          1. Reed Fawell 3rd Avatar
            Reed Fawell 3rd

            Cuomo ripped off his disguise today.

            Sad to say, what was left for all to see was some old Cuomo “pre we got existential crisis, and need 40,000 ventilators immediately”.

            You want to job, get an essential one in gov. or shut up.

  3. LarrytheG Avatar

    Is Virginia using a different criteria than other states?

    How many states are doing surveillance testing? That’s testing
    randomly in a statistical framework to how many “positives” are actually out there – the caveat as NN has pointed out that these tests may not be as accurate as we’d like them to be but still if the state had a consistent week-to-week random testing that detected overall numbers in the “wild” it might be a better metric.

    But I trust Northam, a Doctor and actual science from real scientists over bloggers with respect to what should be or not.

    Too many armchiar types who really don’t have a proper background to understand data and now we got some governors who think they know the data better that scientists – so perhaps we’re gonna find out but
    most scientists are saying it’s a pretty big gamble. On the other side are folks who say scientists do not understand the economy.

    As some of the scientist are saying – the virus is dictating what happens and only about 12% of the population according to the latest poll – agree with what Jim is saying here.

  4. And we all know that Abingdon is exactly the same as Arlington and both must be treated exactly the same.

    1. LarrytheG Avatar

      I don’t think that at all but I do ask what are the proper metrics? Do we know or are people just bailing on prudence?

      The big problem is how do you control people from other areas coming to that area?

      How do you deal with that?

      If Abingdon “opens up” and says Barter Theater and restaurant are OPEN again – ya’ll come… is that good?
      All over Virginia, folks from Arlington head down that way?

  5. I do not see any level off. Just because today’s hospitalization number was slightly less onerous does not yet make a trend. Agree that we seem to have moderated the peak, which presumably means we spread it out.

    Gov Hogan of MD today said cases still increasing in MD and he is looking at ways to conduct contact tracing. Of course yesterday CT, NY, NJ announced a pact for contact tracing. One wonders why DMV is not working together on contact tracing yet.

  6. LarrytheG Avatar

    re: ” Just because today’s hospitalization number was slightly less onerous does not yet make a trend”

    Yes, the premise that because we’ve hit the “plateau” that Northam is being “irresponsible” and we should be opening up is breathtaking in it’s lack of prudence.

    Twelve percent. That’s the percentage that are saying that Northam is needlessly damaging the economy and demanding that he “do something”.

    And they’re all “conservatives” – not a liberal in the bunch!

    In fact, NOW – the folks that support prudence and not being stupid – they’re ALL “liberals”… all 70% of them!

  7. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    I agree that the VDH numbers are not a good indicator of the extent of COVID-19 in Virginia nor the trend. There does not seem to be a requirement that all tests be reported to VDH. So, even the limited testing that has been done is not consistently reported. The administration has got to do a better job of testing and tracing. Even the Virginia Mercury is on the Governor’s case.

    Without a firm baseline the accuracy of which is widely accepted, the administration cannot know for certain when new incidents of the virus decrease. The hospital data may be a reasonable substitute for positive tests, but as others on this comment stream have noted, it is still increase, although at a slower rate.

    The new data from DOC illustrate the value of more widespread testing. The total total number of inmates testing positive in yesterday’s report was 149, with 8 in a hospital. Today’s report shows a total of 204 positives with 8 in the hospital. The increase is accounted for by 52 offenders at Deerfield testing positive in today’s reports, whereas there was only 1 yesterday. The increase is not surprising, however, because DOC announced at the beginning of the week that it was going to test all offenders and staff in Deerfield. According to press reports, that testing was completed Wednesday night. The new numbers showed up in today’s report, which included all results as of 5 p.m. yesterday.

  8. LarrytheG Avatar

    Here’s what I WOULD support – is a business roundtable that would work to establish parameters for opening up.

    I’d have larger companies who have their workforces at stake and a
    professional HR and legal staff with some really small businesses who are not so desperate to open that any plan will do.

    And I’d make sure the grocery chains had a seat – they’re actually doing some of this right now.

    The answer is not one test. It’s a combination of tests and other factors together in a testing regime… and it may well include some kinds of tests for customers.

    Too many people are too frustrated, they just what a green light – yes or no. Oh they say stuff like “all appropriate safeguards” but most of them are just arbitrary things – with no science behind them, just whatever seems right.

    And most important – what’s the “go back now” test?

    how close to disaster are we if we open up and then realize it was a mistake – can we control the outbreak ?

    If I saw such a plan and it came from or had the approval of the business community – it would carry weight AND it would shift the focus of the “open up now” folks from Northam to the businesses themselves.

    There’s a belief that the businesses would all just open up if Northam relented. I’m not convinced at all that is the case. When I hear McDonalds or Cracker Barrel say they want to open… I’ll put some
    stock in it.

  9. Nancy_Naive Avatar

    Spain canceled “The Running of the Bulls”.
    Germany canceled Oktoberfest.
    Georgia opens the tattoo and massage parlors.

    Now, who looks smarter, and who do you want Virginia to emulate?

  10. DeptOfTyranny Avatar

    Thankfully this is just a full economic shutdown and not a government shutdown, with the resulltant media parade of paperstampers that can’t pay their bills

    1. Dick Hall-Sizemore Avatar
      Dick Hall-Sizemore

      Obviously, you don’t know what most government workers do if you think they are just “paper stampers”.

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