docs/updates/day21.R

In eeholmes/CoV19: Eli's package for figures and data on CoV-19 epidemic

#Update 21 Opening Up

Here's the White House/CDC guidelines on when states can start planning to open up:
https://www.whitehouse.gov/openingamerica/
  
There are 3 basic elements:
1. Cases (new positives, hospitaliztions, ICU cases) have been declining for 14 days.
2. Hospital and health care capacity are sufficient. This will include PPE.
3. Testing and tracing capacity is in place and sufficient

I'm following 4 states and how they are handling this.

WA: That's where I live.
FL, NY, CA, TX: The 4 largest economies in the US.

In terms of the basic elements above, WA, NY, and almost TX meet the 14-decline in new cases and deaths criteria. CA is not there due to Southern California.

I don't watch the govenor's briefings every day (ha! I'd never get work done), but I am trying to watch the ones where they are starting to lay out plans and justifications.

Here's a few:
WA: Lots of data here on the issues that states need to balance as they start to plan re-opening and where WA stands. 
https://www.governor.wa.gov/sites/default/files/4_29_DataVisualizations.pdf
4 phase opening plan: https://southseattleemerald.com/2020/05/01/gov-jay-inslee-extends-stay-home-order-to-may-31-unveils-phased-reopening-plan
Phase one, with some restrictions on construction and outdoor recreation eased, retail business curbside pickup, auto sales, car washes, and drive-up spiritual services. Phase Two will reintroduce camping with five people or fewer, new construction, in-store retail purchases, and a reopening of barber shops and salons. 10 counties with very low cases can apply for variance.

We have a couple issues that constrain the opening up timeline: 
1. Our tracing capacity can't handle 200 new cases a day. Also all those contacts have to go into quarantine. That's quickly overwhelming and disruptive.  Gov Inslee's slide talk much about our testing capacity and don't say whether we have the needed capacity. But looking at slide 13 where the test capacity by region is shown, it looks like this might be an issue. We have very little testing capacity in rural areas. Though testing happens in urban laboratories and the slide doesn't list collection sites. We know that the virus can become entrenched in rural communities and that the agricultural industry introduces some high-risk elements (the packing plants with high density) for those communities.
2. Looks like overall our hospital and ICU capacity is good, though the slides don't break that out by region. 

FL: Apr 29 briefing by Gov DeSantis has lots of data on what is happening in FL.
https://www.youtube.com/watch?v=b1yRn5pA1-s
New cases per million is about 25 has been dropping for 3 weeks from a high of 50. For context, FL, WA+OR+NorCal and OH are the only high GDP areas that both contained the epidemic well below a peak of 100 new cases/million and drove new cases/million down to near 20/million in a month. 

Summary of the FL plan
Phase 1 reopening outlined by Gov DeSantis: elective surgeries resume, restaurants at 25% capacity with outdoor seating, retail with 25% capacity and distancing (face masks). Everything else stays closed. Noteably, waiting on gyms until other states go first and they see how that works out, lol. Face masks, should be used in any stores and encouraged outside.
No discussion of Phase 2 and timeline for that. Opening up does not include South FL (Miami-Dade, Palm Beach) where the majority of cases have been.
Note: Alternate view says testing has not been sufficient and rural areas in danger in FL. https://www.miamiherald.com/news/health-care/article242399481.html

NY: Apr 29 briefing. https://www.youtube.com/watch?v=cCv63fuOdDE
Although cases are going down, they are a long ways from having a lower new cases per day to make testing and tracing feasible. Still focused on lowering transmission and reducing transmission among essential workers. 

Some good articles that I've read this week:
https://www.theatlantic.com/health/archive/2020/04/pandemic-confusing-uncertainty/610819/
  
Info on flu statistics and how they differ from death reports (like what we are getting for COVID-19) https://blogs.scientificamerican.com/observations/comparing-covid-19-deaths-to-flu-deaths-is-like-comparing-apples-to-oranges

https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html

More fun with data: Hospitalization info https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html