[05/29/20 Update: More details from April 27th update by governor Cuomo relative to antibody testing results pushing results from 21% to 25%: almost-a-quarter-of-nyc-residents-test-positive-for-covid-19-antibodies-cuomo]
It’s time for New York City to get back to work. The White House/CDC plan [Guidelines for Opening Up America], which gradually introduces various practices into our daily lives, is measured and prudent. The plan opens the country gradually, from Phase I, which retains many restrictions, through Phase 3, which lifts many limits, and finally back to normal life. This plan has statistical support in the data garnered from both international and domestic studies.
Sweden provides the best statistical example of this plan. Sweden did not impose mandatory quarantines. Museums, bars, restaurants, gyms, schools, nightclubs, casinos and even ski resorts have remained open for business. The government has encouraged sick workers to stay home, voluntary social distancing, 50-person limits on public gatherings, and use of good personal hygiene. Such measures would be somewhere between Phase 1 and Phase 2 of the CDC plan.
Although Sweden has suffered more deaths than some of its neighbors, those deaths are a function of the disease prevalence a month prior to Sweden’s mortality peak, since it takes about that long from onset to death of the average non-surviving COVID-19 patient. In fact, one month after imposing its moderate measures, Sweden has bent its COVID-19 mortality curve (deaths per million citizens) as much as Norway and Denmark [Sweden FOHM COVID-19 Dashboard], which have imposed very strict limits. Commentators are either ignorant of the time-course of the disease or misinterpret the data to portray Sweden as awash in COVID-19 deaths: it is not.
Scientists and investigators have acquired crucial data which allows us to model [Covid Planning Tool Model] the possible outcomes of Phase 1, 2, or 3 for New York City. We have developed a sophisticated and much more dynamic predictive model than that employed by IHME and other organizations which have proven woefully inadequate to the job. (Consider that on April 1 IHME offered a range of peak deaths per day in New York State between 224 and 2824 per day, which is useless for practical purposes.)
We have applied the model to New York City. Our model reliably depicts the mortality rate in New York City and now predicts that it is safe to implement the CDC multiphase plan because of several factors that decrease the COVID-19 death rate.
First, in New York City, reports are that 25% of the people have already been exposed to the virus [CBS 1 in 4 NYC residents had COVID-19]. This means there are two million fewer vectors of the disease. Second, behaviors have changed since the outbreak. Compared to the pre-COVID-19 era, there will be much more voluntary social distancing, hand-washing, nursing home protection, and telecommuting, as well as fewer sick employees going to work.
Third, and much underappreciated, is the sunshine effect: the virus does not seem to like sunshine and warm weather. Every country south of the equator has markedly lower mortality rates than the United States (Australia’s is 2% of the US). The warm weather states, with the exception of Louisiana (which had the super-spreader Mardi Gras celebrations) are doing well in terms of COVID-19 mortality rates. Hawaii has lowest COVID-19 mortality rate in the US -– just .6% of New York’s rate – even though it is the 15th most densely-populated state.
Our model, even based on conservative estimates, predicts that Phase 1 of the CDC plan will result in residual deaths from pre-Phase 1 existing infections but the new infections and deaths will continue to quickly decline [New York City Recovery Model]. During Phase 2 and 3 of the recovery, from July through October, there should be 5-7 coronavirus deaths a day. The post-recovery period, from this November to June 2021, will result in about 3800 deaths. But even at peak mortality, from January to March the COVID-19 daily mortality rate is similar to that of influenza during this period. By early 2021 we should have reached herd immunity under our model.
We would recommend and our model assumes, continued protection of the most vulnerable post-Phase 3. Nursing homes, rehab centers and assisted-living facilities in particular must have PPE and sufficient safeguards; other vulnerable people will need to avoid exposure by telecommuting and otherwise limiting contacts with others. If such protections for the vulnerable are not continued, there will be more than a small increase in cases in late fall-early winter. We assume our society will continue these measures through next winter.
Our model makes a number of conservative assumptions. Among several, if the rate of asymptomatic carriers is higher than our conservative estimate (50%), we will likely tamp down the mortality rate further and get to herd immunity even faster. Our model also assumes that no therapies are developed between now and next winter, which hopefully will prove false. Over 70 drugs are currently being tested. We assume a modest improvement in the care of ventilated patients between now and winter, and a very conservative estimate of the sunshine effect.
As long as the rate of infection and hospitalization rates do not markedly increase, we can continue with the plan. If the rates increase, we can reinstate some restrictions of the prior phase until reasonable control is achieved. If we find that crowded events, such as large sporting events or concerts, etc., lead to increases, then these may have to be suspended. But this must be data driven.
We must keep some perspective. If the actual COVID-19 mortality rate in NYC is 0.5% [April 23rd brief by Governor Cuomo], more than 99.5 percent of those who contract the infection survive. The burden on the vast majority of people suffering through our COVID-19 economic halt is multiplying, creating financial, social, psychological and medical consequences that are rapidly increasing. It is time to expend our resources to protect that vulnerable 0.5 percent while allowing everyone else to get back to work.