I don't know why you think we came out so far different from expectations - New York hospitals were overwhelmed, they hadn't shut down in time to prevent a large wave of cases - other locales that have gotten lucky or shut down have avoided feeling that wave so far... Changing course doesn't seem advisable as growth rates haven't subsided into the negative except in small locales.
New York was the exception to the rule. Most hospitals were not overwhelmed. In fact, many hospitals flirted with financial disaster when governors prevented elective procedures. I can speak specifically to AZ which outside of some very small Indian Reservation medical centers, is well below capacity[1]
Seattle's Army hospital closed without a single patient[2].
Growth rates, especially in AZ, were never large to begin with.
I would be cautious about using the past tense. New case rates have not come down much from peak - and I expect them to spike in the next few weeks as people let their guard down and things reopen.
Deaths lag infections by several weeks. Over 2200 people died yesterday.
I agree that with re-opening, we will see a bump in infections, and therefore deaths. However, there is only one path out of this and that is herd immunity. We can accelerate herd immunity via vaccine, but either way its herd immunity. That means that we want as many people sick as our hospital system can handle, but not more. That means playing a game of optimization. Further, different states (New York vs. Arizona) should have different plans because their situations are vastly different (population density, current herd infection status, etc).
Further, we can't just optimize for Covid19 deaths, we have to look at the whole situation, which includes suicides due to shelter-in-place orders, child abuse and other domestic violence, malnutrition due to hunger from unemployment, negative impacts of poverty.
this will certainly be a case study for future generations.
> That means that we want as many people sick as our hospital system can handle, but not more.
This would be the optimal situation, but it requires at least:
* Widespread testing available to any who need it for any reason;
* Careful, centralized monitoring and resource allocation;
* Plenty of PPE, critical care equipment, and disposable goods;
* A cooperative public willing to follow a constantly shifting set of recommendations.
And the country as a whole has basically none of those things. California is better-resourced and managed (for this particular thing) than other states, so they're gonna give it a shot. The rest of the country is just gambling.
This disease does not cooperate with this kind of response because of the lag time from initial infection to critical illness. Reports on this vary from like 3 days to 20-odd days. Coupled with the disease's high rate of infection, this means that a hospital can go from 50% full to 150% full very quickly. If a state government with an impossibly obedient population set a tripwire at 50% hospital capacity and shut everything down the minute they hit that mark, then they're still going to overflow a couple of weeks later as symptoms progress for those that were infected just before the shut-down.
The virus needs to be studied in further detail before we haphazardly aim for herd immunity. There is still no proof that the immunity gained from it, lasts more than a few months.
Imagine the fall out if a government pushes for herd immunity, knowingly sacrificing 5-10% of the population, and it turns out that country gets wave after wave of fatalities due to the herd not having a lasting immunity.
Growth rates are dependent upon testing, which is inadequate. And what little testing has been done by AZ shows a very large growth rate[1]. And the graph of growth rates by the AZ governor makes the same mistake in excluding the last 4-7 days of the graph's range. It's nonsense.
Some hospitals in NYC were overwhelmed, but that was limited to Queens and Brooklyn: the NPR piece notes that Javits Center, which was turned into a hospital in Manhattan, treated about 1100 people total, after being built to handle 1900 at a time. The three other NY field hospitals on that list, all close to NYC, treated zero patients. One of those is in the same county just north of NYC that had the initial outbreak here.
I think there's no question that COVID-19 has been a disaster here, but it's going to be heavily debated whether the lockdown saved us or just made things worse on net.
The low occupancy rate of field hospitals is evidence that either the lockdown worked, or that it was unnecessary. It excludes the case in which the lockdown was obviously necessary and just barely worked, since that's the case in which those field hospitals would themselves have been overwhelmed or nearly so, as well as the existing ICUs.
Without regard to the actual effectiveness, the fact that the field hospitals went mostly empty will fuel acrimonious debate about said effectiveness.
Yup, makes me wonder why Cuomo didn't shut down the subway system (or at least limit use based on some sort of need)? The media's given him props for leadership in his briefings, but ignored this massive sources of infections. Meanwhile, various narratives swirl about why NYC is being hit so much harder than elsewhere, like it's some sort of mystery.
I'm not sure that the data bear that out. Manhattan is the best-served borough, but the least infected. Just this week, Cuomo mentioned some surprising findings: essential workers and homeless, who make up most people on the subway, do not make up a significant number of infected showing up at hospitals, but those do who had been sheltering at home (self-reported, I imagine).
Not sure what data you're referring to. The article I saw in early March said that ridership was down over 70% in Manhattan vs only 15-20% in Queens and Brooklyn. Those numbers have now apparently fallen much further, but I've not seen a breakdown by Burrow.
New York hospitals weren't happy by any means, but their peak load was an order of magnitude less than what local leaders said they were preparing for.
