WHITE PAPER ON COVID-19
Uploaded April 5th
COVID-19 PREVALENCE AND ESTIMATED SPREAD IN NH
By: Mindi Messmer*, CG PG, Collin Coviello, BA Biology, Nora Traviss, PhD, Environmental Studies
Projection of Positive COVID-19 Cases in NH:
Projection of Intensive Care Bed Need: Based on data from China, it is possible that 5% or 2,500 of the positive NH cases (estimated from the 50,000 people by rounding up 47,900 above) will require intensive care treatment within 30 to 45 days. According to the NH Hospital Association, the state has a total of 3,051 staffed hospital beds.
Projection of Mortality: The Centers for Disease Control (CDC) has determined that risk factors for mortality from COVID-19 include age and comorbid conditions.
With such high transmission rates, the State of NH needs to shift to containment and mitigation measures immediately.
The situation in South Korea indicates that quick, consistent, and clear action will likely flatten the curve and lower incident cases to prevent deaths. However, the healthcare system will be overwhelmed in less than 30 days and steps need to be taken right now in NH to prepare for the eventuality.
Infectious outbreaks are usually tracked by incidence rate to understand whether mitigation efforts are effective. In the case of the COVID-19 virus, the spread is so fast it is more informative to track the prevalence or the number of people living with the virus to understand the trajectory (the spread) and the impact to our medical system. According to the Centers for Disease Control (CDC) every infected person infects approximately 2 to 3 others.
On March 2nd, 2020, NHDHHS confirmed the first case of COVID-19 in NH. As of March 15th, 2020, there are 13 (3.4%) confirmed cases of COVID-19 out of 380 tests in NH. The State is waiting for results from an additional 100 tests. According to publicly available information, about 11,000 of the approximately 1.3M people have been tested for COVID-19 in NH which represents a rate of 0.8%.
About 4,500 to 8,000 children live with their grandparents, in part due to the opioid epidemic. This is why school closures are important in NH because we think children are carriers for the virus and are likely to bring it home, without symptoms, to their elderly caregivers. NH has taken action to limit the transmission rate by closing public schools on March 15th, 2020, for three weeks.
Prevalence data collected from online news reports for China, South Korea, New York, Italy, and New Hampshire. Trendlines were used to project 10- and 15-day estimates of positive cases.
In all cases, positive cases of COVID-19 began exponential increase 20 days or less from the initial case identification causing an inflection point (Figures 1a and 1b) The transmission rates for each of the countries follow approximately the same rate of increase after the inflection point among these locations.
Using these rates, it is estimated that the positive COVID-19 cases will range from 200 to over 300 by March 25th (Figure 1a) and up to 1,400 cases by March 30th, 2020. By April 15th, it is possible that over 120,000 people would theoretically test positive for COVID-19 in NH (Figure 1b).
Importantly, reduced incidence of COVID-19 in South Korea appears to be slowing the rate of infection as shown on Figures 1a and 1b. It is likely that steps taken to mitigate the spread of the virus including widescale testing and strict social distancing and protective measures have been successful.
South Korea has implemented the most comprehensive testing program. On February 26th, South Korea implemented drive-through testing that has resulted in about 109,600 citizens tested. However, only approximately 0.2% of the over 51 million South Koreans have been tested. Therefore, the prevalence rates may not be truly representative of the population rate.
Approximately 4.4% (4,812) of the tests were positive COVID-19 for South Koreans tested. Of the testing conducted by to date in NH on April 2, 6.7% of the 7054 results were positive for COVID-19. This is higher than the rate observed for South Korea but likely due to the fact only critical cases are being tested in NH. To move forward with planning, we need expanded testing quickly to understand the true prevalence of COVID19 in NH.
Even though South Korea has achieved the highest test rate, it is unlikely that the testing has fully identified all positive cases, and it is likely that the current prevalence is much higher than realized. South Korea has combined testing with aggressive contact tracking of identified cases to make sure they remain in quarantine for 14 days.
The citizens of NH need to understand how critical it is to minimize transfer of this deadly virus and carefully implement social distancing and self-quarantine. The Centers for Disease Control (CDC) has said that transmission has occurred over a few hours during a small dinner gathering.
With testing rates so low in NH and the US overall, others have suggested that true COVID-19 prevalence may be 10 to 100 times higher than realized. In this case, the true number of COVID-19 cases could be approximately almost 50,000 as of April 2, 2020 and would spread to the entire State within about 45 days. The State of NH is currently monitoring 1700 people with a backlog of 3600 with tests pending; therefore, this estimate may be realistic.
Based on data from China, it is possible there are 5% or 2500 positive cases (estimated from 50,000 COVID19 positive in NH as of April 2) that will require intensive care treatment within 30 days. According to the NH Hospital Association, the state has a total of 3,051 staffed hospital beds.
The CDC has determined that risk factors for mortality from COVID-19 include age and comorbid conditions. The mortality (death) rates for people in China who are critically ill is 49% or higher. This would equate to more than approximately 1,250 deaths of critically ill people in NH based on the projections above.
Eighteen percent (234,000 people) of the NH population is over the age of 65 or about 1 out of every 5 people are in the high-risk group for age. Using the 1% mortality rate from NH, and 60% infection rate, that would equate to 1404 deaths in people over the age of 65 in NH.
Mortality rates for cases from China for people over the age of 65 range from about 4 to almost 15% (see Figure 2). The World Health Organization has indicated an overall mortality rate of approximately 3 to 4% which would equate to 4,200 people in NH.
All estimates from different approaches and data sources point to a level of mortality and hospitalization that is unprecedented in NH history. Our recommendations are
made to blunt these numbers downwards as much as possible.
Overview Article by N. Traviss on COVID19 in the Monadnock Region, published 3/25/2020
The science is clear: keep your distance, for all our sake
March 25, 2020
Nora Traviss, printed in The Keene Sentinel
Things are changing with the COVID19 pandemic every day in the United States and in New Hampshire. Recently, a Keene State employee was diagnosed with COVID19. This makes it clear the disease is not isolated to far-away lands but is here in our region.
The global number of cases is now over 400,000 people. Yet, COVID19 is a new disease caused by the coronavirus (SARS-CoV-2) that emerged from China in December 2019, only four months ago. COVID19 is disrupting life in America and in the Monadnock Region. By the time you read this, there may be another 1,000 cases in the U.S. and possibly 150 cases in N.H. It’s impossible to predict these numbers exactly, because in the U.S. the pandemic is in the exponential part of the growth curve where cases are doubling every 2 to 4 days.
Now that everyone is realizing that COVID19 is here in Cheshire County, what does that mean? While understandably concerning, it’s important to keep key facts in mind. Infectious disease experts say we need to adjust to a new normal in the short term, so we keep the number of new cases within our existing health care capacity.
While we don’t have the population density issues of urban areas, social distancing is a critical tool for all of us to proactively do. Not just for ourselves, but for others. Social distancing means staying home, working from home, keeping a 6-foot distance from others, not gathering in large crowds, and avoiding all nonessential travel. The emphasis here is that each of us do our best possible effort in all the ways we can do so. Some of us may still have to go to work every day, but we can all avoid nonessential social gatherings, because this will protect our community health.
The coronavirus is easily transmissible through coughs and sneezes, and survives on metal surfaces for days. The main symptoms are fever, cough, and shortness of breath. We don’t have natural immunity to it, unlike seasonal Influenza (“the flu”) which also has a vaccine; a vaccine for COVID19 is at least a year away. The “true” fatality rate of COVID19 is unknown but almost every scientist in the world agrees mortality is 10 to 30 times higher than seasonal flu.
Severe cases cause much distress to the lungs and heart (including extended time in ICU’s) – these cases have the capacity to completely overwhelm our local medical systems very, very quickly, as in Italy.
While the elderly and those with pre-existing conditions are most at risk, this virus has taken lives in every age bracket. But it’s the potential (for Italy, the reality) of the virus to cause an unmanageable surge in cases that has everyone concerned, and which must be avoided at all costs. This is why scientists have been sounding the alarm so loudly for over a month, even before the first COVID19 case was reported. We wanted to keep the horse in the barn.
Because of the potential to overwhelm our local health care workers, it was critical that our local and state public officials listened to scientists about the case doubling, and took strong action to close public schools, restaurants, bars, and limit large gatherings. Now we are all practicing “social distancing” which feels very weird to do. But these aggressive social distancing tactics are backed by science: they are the most important tools we have left in our toolbox to flatten the curve.
In 1918, St. Louis closed their schools soon after their first case was identified, compared to Philadelphia and Pittsburgh, which did not. Tens of thousands of people in Pennsylvania died because of that fateful decision. In New Hampshire, we enacted extreme social distancing quickly as St. Louis did, in a very proactive and precautionary way to avoid this fate. It is critical we continue to stay this course, even though it is hard and uncomfortable, to minimize the impact on our first responders and health care workers. The horse may be out of the barn, but we are building the fence to keep it contained.
What happens next? Times will be hard but we have faced hard times before, like 9/11. We have to come together as a community, help each other, and avoid scapegoating and blame. And we must come together while we stay 6 feet apart. We help by staying home, cleaning surfaces that are touched, going outside for a walk, reading a book, going for a run or staying in our yards.
This absolutely feels unnatural but this is the number #1 thing we can do to slow and hopefully stop the pandemic. But we also have to call out the enemy for what it is – a virus – and a virus is not going to take down the internet, electricity, or water. We must stop our panic runs on supermarkets so everyone can access food (and toilet paper) again!
We cannot stigmatize people who catch it through no fault of their own. We must support our health care workers on the front lines. We self-monitor and call our physicians if we have symptoms; we don’t overrun the Emergency Rooms. We must recognize some people have to continue to work – we need to keep them healthy, and our whole community healthy.
“Everything we do before a pandemic will seem alarmist. Everything we do after will seem inadequate.”
– Michael Leavitt
Governor Sununu issued an order for New Hampshire's non-essential businesses to close at midnight, Friday March 27. Here is the link to the official COVID-19 page in the State's Department of Health and Human Services.
Here are some science-based websites:
US Government Centers for Disease Control (CDC)
New England Complex Systems Institute website endcoronavirus.org
Data describing the growth of the pandemic. OurWorldinData.org
More coming soon
I heard the coronavirus is an RNA virus and it does not have DNA, but the PCR test used is a DNA test. How does that work?
Check out this article for a simple explanation of the complex science.
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