The experts appear to have gotten through to Trump. He began touting a higher projection of the possible death toll from the pandemic — up to 2.2 million Americans — a number he used to frame a more likely and much smaller possible toll as something of a victory.
Tuesday’s briefing by the White House coronavirus task force marked the end of the initial 15-day period in which it advocated strong measures aimed at stopping the spread of the virus. Members of the task force, particularly Deborah Birx, promised a review of the available data once the initial period had ended and a reconsideration of the government’s recommendations. At Tuesday’s briefing, she walked through the data in five often alarming graphs, presumably ones similar to what were presented to Trump — and which might have impressed upon him the need to retain the measures that were already in place.
Here’s what the graphs showed.
The first graph was a formalized version of one with which we’re now quite familiar: the difference between “flattening the curve” and letting the virus spread unchecked. The box at the bottom explains the idea: Slow the spread, reduce the load on hospitals as cases in a region spike and reduce the number of overall fatalities. The goal is to move away from the dark curve and into the shaded one.
While the curves themselves are somewhat abstract (the axes aren’t labeled, for example), the estimates of outcomes were based on various models identified by Birx. The range is broad in both the mitigated and unmitigated spread scenarios, and neither is set in stone.
Birx and fellow task force member Anthony S. Fauci explained that even the upper and lower bounds of the estimates are subject to change.
“What we do is that every time we get more data you feed it back in and relook at the model. Is the model really telling you what is actually going on?” Fauci said, adding, “Models are as good as the assumptions you put into them, and as we get more data then you put it in and that might change. So even though it says — according to the model, which is a good model — that we are dealing with this is full mitigation as we get more data, as the weeks go by that could be modified.”
Birx’s next slide showed a short-term projection for the toll the virus might take on the United States. Using a model from the University of Washington, it indicates that the number of deaths in the country each day may peak in the middle of April with more than 2,200 deaths on April 15.
What’s more important here is probably the shaded area, which represents the level of uncertainty in the model. It’s possible, according to the model, that the peak in deaths could come a week earlier and be substantially lower, maybe about 1,500 deaths a day. Or it could climb past the middle of the month, reaching nearly 3,500 deaths each day by late April. The difference in those possibilities is stark in both human and mathematical terms, meaning a difference of tens of thousands of deaths this month alone.
The model uses “the experience around the globe to really understand how this information that we have from Italy and Spain and South Korea and China could really help us get insight into the hospital needs, the ventilator needs, and, really, the number of people who potentially could succumb to this illness,” Birx explained. “It is this model that we are looking at now that provides us the most detail of the time course that is possible."
“But,” she added, “this model assumes full mitigation.”
Repeatedly, Birx and Fauci articulated two paths forward for states. Densely populated New York and New Jersey — which together constitute half of the confirmed cases in the United States — were slow to implement measures aimed at containing the spread of the coronavirus. California and Washington better managed its spread despite being the states in which the coronavirus first emerged.
The difference between the lower and upper bounds of the expected death toll could be explained by the path taken by various cities over the next few weeks, Birx explained.
“It just has to do with if you had more New Yorks and New Jerseys — you know, Chicago, Detroit, L.A., Dallas, Houston, all of our major cities modeled like New York, that is what gets us into trouble,” she said. “But I am reassured by looking at the Seattle line, by looking at the L.A. line, by looking at what California has been able to do."
The worst case, she said, “is not something that I don’t believe that is going to happen. That is the outside case of having 10, 15 metros like New York and the New Jersey metro area.”
Brix then presented the same data as above, but with each of the 50 states. The intent was to show how New York and New Jersey stand out.
By showing the data relative to the day of the month, Birx may not have been conveying the actual performance of each state in controlling the virus. As when she last week downplayed the spread of the coronavirus in smaller states by noting nearly 20 had fewer than 200 confirmed cases (only seven still fit that criteria), the graph above makes New York and New Jersey look particularly problematic.
If we show the same data relative to when the state saw its 10th confirmed case — in other words, when the virus actually appeared and began to noticeably spread — New York and New Jersey stand out in a different way.
You can see here the problem Birx mentioned with other metropolitan areas. Louisiana (thanks to New Orleans) and Michigan (thanks to Detroit) have seen growth similar to where New York was relative to its 10th case, though, happily, the lines for those states are less steep, meaning the rate of growth is slower.
This presentation has another advantage: Washington and California stand out here as having controlled their outbreaks.
Italy has long served as a warning for where the United States might end up, given how quickly the coronavirus spread in that country. On Tuesday, Birx used it as an example of optimism.
“This is the case finding in Italy, and you can see that they are beginning to turn the corner in new cases,” she said. “They are entering their fourth week of full mitigation and showing what is possible when we work together as a community, as a country to change the course of this pandemic together. It is this graphic and the graphic of many of the states that gives us hope of what is possible with continuing for another 30 days.”
The problem here is that our graph doesn’t look like that.
The hope is that it will, sooner rather than later. By conveying both the worst-case scenarios and the above alternatives to the president, Birx and Fauci may have saved hundreds of thousands — or millions — of lives.
Explore the data
This interactive allows you to explore and compare daily data from various countries and states.
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Lines are colored relative to how the selected metric has changed over the past seven days. Darker red means a faster rate of growth. Grays and blues, slower.