Look at State by State outcomes: visit Covid Act Now
Its an excellent display of modeled outcomes across the US*. Click on each state in the US to find out predicted death tolls and the day hospitals will be overwhelmed with too little action.
Dear readers, get out of the way of this virus. My advice is to stay home. Order online. Wear masks if you have to venture out. Keep kids home from school. Don’t visit anyone or allow visitors in to your home who have not strictly quarantined for the last two weeks. We started this last week.
h/t Bill in Oz.
Eg It’s too late now for New York State to avoid losing control of hospitals
But they could still Crush the Curve and save a lot of people, but even that action now will have far higher death tolls that it would if it had been started last week.
New York State has a population of 20 million. So the figures in the table below are directly comparable to Australian outcomes with a population of 25m (with the hope that lower population density, warmer weather, and two weeks warning could be an advantage.)
New York outcomes.
There are four levels of action modeled here (from March 19th). The final death tolls are very different.
New York outcomes.
The advantage of “Crushing the Curve” now means we can wait to find out which treatments work. It’s always possible to ease up on the level of quarantine and pick the higher death toll options, but it isn’t possible to choose the low death futures if we do too little too late. If we are headed for the Wuhan Style lockdown anyhow, sooner is better, and we can release it later when extra hospital beds or drugs or treatments are available. Figure that even if we choose “Social distancing” now, once people see the lists of obituaries and queues of coffins, and desperation in hospital wards as awful choices are made, many people will voluntarily stay housebound. The CCP was ordering workers to go back to work, but they didn’t want to.
Eg. California needs to act this week
California outcomes.
…
California outcomes.
*All models are still wrong. But discuss the assumptions, don’t shoot the messenger.
______________________________________________
Coronavirus Background: ☀ The Demographics: the severity increases with age, and slightly more for men than women. ☀ The Ro is 2 – 3 and exponential curves are steep. How Coronavirus kills: why the number of ICU units matters so much. ☀ Illness progression: Dry coughs and Fevers, Aches. In 15% of people, by day 5 breathing trouble starts. In 3% (?) by day 8 they may need an ICU (intensive care unit). ☀ The good case of Singapore but the ominous calculations of how fast the ICU beds may run out. ☀ Proof that viruses don’t have wings and we should have stopped all flights so much earlier. ☀ The story of how American Samoa avoided Flu Deaths with quarantine in 1918. ☀ The story of Vo, the Italian town that stopped the virus. ☀ Delay = Death, statistics show mortality rates rise tenfold if hospitals are overwhelmed. ☀ Projections of all US States death tolls depending on quarantine levels and the date that hospitals could be overwhelmed ☀ One doctor describes his “Holy S***” moment ☀ ☀ ☀
We must Crush the Curve to save lives and the economy.
Economics: ☀ The huge impact on the Chinese economy ☀ the awful case of Iran.☀
Beware UN advice: ☀ Ethiopian WHO chief was part of China’s debt trap diplomacy ☀
Stats and Data: ☀ John Hopkins Live Map ☀ Worldometer ☀ Coronavirus data in Australia ☀
It is interesting to see how China was pilloried for their response, particularly how it handled the early phases. I can remember the barely concealed smirking in the media about how civil liberties were being trampled, and the pictures of the enforced shutdown.
Italy (and the US and Australia) all had plenty of time to prepare but Italy’s result is much much worse than China’s particularly on a per capita basis.
Strange we are not seeing any comments in the broadcast media about loss of civil liberties in Italy (and the US and Australia)
65
I don’t remember that Peter. I remember everyone being very understanding about the steps taken, but being outraged as things like disappearing people and punishing people who blew the whistle, to get the attention of the Chinese people and the world.
I remember a lot of disgust that mass gatherings and mass travel for Chinese New Year proceeded even though it was already clear this was a very bad idea. I remember a lot of disgust at the nature of Chinese wet markets. I especially remember a lot of disgust that lethal viral research centers were in the heart of a city of and region of 60 million people.
I don’t remember a lot of outrage at the quarantine though.
130
Perhaps you need to widen you news sources,
https://www.theatlantic.com/health/archive/2020/01/china-quarantine-coronavirus/605455/
https://edition.cnn.com/2020/03/22/politics/fact-check-trump-coronavirus-false-claims-march/index.htmlhttps://edition.cnn.com/2020/03/22/politics/fact-check-trump-coronavirus-false-claims-march/index.html
and a Chinese view
https://www.youtube.com/watch?v=R0GPfTEQGuI
To your point – all ture – but did the west do anything differently? After all we had China as an example
33
Apparently you’re more preoccupied with the CCP’s PR image but I didn’t care Pete, sorry, not a fan. My sympathies are with the poor sods suffering under their despotic regime.
60
you’ll have to wait – i’ve been quarantined – probably because I included links to prove my point
34
Welding doors shut you must admit seemed a little primitive, Peter.
What I don’t get is why Australian epidemiologists, Dr Murphy and our
politicians never learned the same lessons as Singapore, Hong Kong, Taiwan and South Korea.
Worse, from this aspect was, those States were experiencing the viral onslaught and had
virtually gained control over it before Australia really got going. Why didn’t we look
closer even then? Indeed,this has been the problem with the entire Western response.
Is it because we don’t understand that these countries have education standards that leave
us for dead? We think we know it all?
90
There seems to be a great deal of trust put in “models” – much like climate alarm.
Let’s give more thought to the economic fallout and how we will be able to cope with destroyed economies, social structure and unemployment as leading world economies face depression, social and trade collapses with little hope of repair for several generations.
I think we should take a deep breath and perhaps consider more moderate methods of riding this crisis out.
Motl’s Reference Frame blog makes some excellent points and I invite your comments…
https://motls.blogspot.com/2020/03/great-viral-depression.html
42
Lank,
Thanks. I read it. I wasn’t impressed.
He’s tapping into the segment of society that loves to hate. Hates government. Hates people. Hates tough decisions. And, that is nowhere better expressed by him than where he writes the following comment about one of the people who had the temerity to disagree with him:
I’ve never visited his site before. I can do without his claptrap. I won’t be visiting it again. These sorts of sites are two-bob-a-dozen on the Internet.
He’s nothing more than an ignorant and arrogant egoist without any saving grace. Essentially, a fool.
30
Lank, I think that’s exactly why we have a problem now.
Our leaders and powers that be have been too concerned WITH THE ECONOMICAL effects
of taking action. That has destroyed our chances of quickly dousing this virus by
harsh methods that might initially be painful, but quick such that our internal economy could have
picked up earlier and we would control our borders heavily.
The answer to your man is to say: Quite right! Just look at Italy! We all want to be Italy!
Don’t we? Know our loved ones are sealed off behind closed doors and dying. Never to be touched,
spoken to, seen, kissed ever again and end up stored in a church morgue.
30
Lank, we can’t have a healthy economy without health first.
Fix the virus and the economy will be able to fix itself.
40
Jo, I hope so but my fear is that the economy will not be able to ‘fix itself’. Easier said than done. Many businesses that shut down now may not regenerate, mine included.
11
Lank,
Had a scan through the link material and then read the following comments by Jo, Sam and Doc.
I found the Lubos comment interesting and thought provoking and not objectionable. The responses here seem to contrast with what I got out of it.
We do need to define the problem.
We then need to get the best expert assessment to guide us forward.
We Must avoid doing additional harm over and beyond the basic problem.
We Must eliminate the politically induced stupidity that seems to infest all public action in the West and treat the problem without creating Massive side effects.
Balance in applying the remedy is essential or we risk everything worthwhile in life; hope, human contact, connection.
Observe. Think. Plan, and Act.
At present Australia has a politicised response to incessant and ill informed Media Hype of the Tripple JJJ variety.
Is that really the mature approach.
We can define a path to take that will address the problem and leave our society still able to function after the crisis period is over. Let’s do it.
KK
10
they need to start rolling out the Hydroxychloroquine, fast.
50
Indeed your Lordship,
I asked my chemist yesterday whether he had any chloroquine. He said No. He gave me the tradename (Plaquenil)
An internet search provided the following:
Plaquenil is supplied in Australia by:
sanofi-aventis australia pty ltd
12-24 Talavera Road
Macquarie Park NSW 2113
Tel: 1800 818 806
I don’t know where it is actually made. I think our government should seek manufacturing rights under licence and get going ASAP as you suggest.
I was given the drug as a child to prevent malaria. It seemed to work for that. Perhaps it can help prevent Covid19 as well.
40
If you know a compounding pharmacy you might give them the recipe:
Active Ingredient
Each Plaquenil tablet contains 200mg hydroxychloroquine sulfate.
Other ingredients
Calcium Hydrogen Phosphate Dihydrate
Starch-Maize
Magnesium Stearate
Water-Purified
hypromellose
Macrogol 400
Titanium dioxide
Polysorbate 80
Carnauba Wax
Black Ink
I have some carnauba wax in my garage and some black ink in my desk drawer. Unfortunately I do not have the other ingredients.
Amazing what goes into a pill as filler!
40
Yep. Chloroquine kept 5 of us from getting malaria for 3 years. That was expected, and there were very mild side-effects, but the interesting thing was, we didn’t get anything else either. No colds, no flu.
50
🙂
10
I suspect there isn’t anywhere near enough to treat even those Australians who currently have the infection. That’s 1,717 as at March 23, 2020, 12:55 GMT. Per:
https://www.worldometers.info/coronavirus/country/australia/
I hope I’m wrong. I’d take a bet, however.
10
“Coronavirus in N.Y.C.: Region Is Now an Epicenter of Global Pandemic
New York City and its suburbs account for roughly 5 percent of global cases, forcing officials to take urgent steps to stem the outbreak”
https://www.nytimes.com/2020/03/22/nyregion/Coronavirus-new-York-epicenter.html?referringSource=articleShare
Anticipate NY state will be locked down within a day or few, Its spreading quickly
30
Jo says “. If we are headed for the Wuhan Style lockdown”
JoNova, I agree with your post, but please consider to say ‘South Korea style lockdown”. I ask this because the Wuhan lockdown was a form of democide. ( Death by government)
So China should not receive credit for doing anything correctly.
China’s 4 quarantines…
1. Positively Infected
2. Symptomatic. ( Flus colds and Cov19)
3. Possibly exposed.
4. Likely not exposed.
2 and 3 are an incubation disaster, as they place mostly not infectious with the infectious, thus certain to excellerate the R-naught throughout the population. ( One way to shorten the time duration of the curve)
“Under the measures, individuals deemed to be high risk — either those with signs of the virus, or those who have come into close contact with confirmed cases — are removed from the population and placed into hundreds of temporary isolation centers set up across the city.”. ( Most with zero walls, common air, common restrooms)
“Wuhan officials were replaced earlier this month amid seething public anger over the government’s alleged mishandling of the outbreak. They were replaced by two hardliners, parachuted in from outside the province, both with extensive backgrounds in law enforcement.
Almost immediately after Wang Zhonglin’s arrival in Wuhan to replace the city’s party chief, quarantine measures were escalated.
Wang, who rose through the ranks as a police officer, ordered a city-wide, three-day roundup of people possibly sickened with the coronavirus.”
The Dragnet ended on Wed February 19th.
Wang warned sternly that district party bosses and governors would be held responsible if any confirmed or suspected cases were found at home after the dragnet ended on Wednesday, the state-run Changjiang Daily reported Tuesday.
The stringent searches are designed to corral all infected patients under self-quarantine into medical facilities for treatment. The move followed an online outcry over infected people who couldn’t get admitted into hospitals and were dying at home or infecting other family members.
Patients with mild symptoms were put in the so-called Fangcang hospitals, stadiums and exhibition halls converted into makeshift hospitals where doctors and nurses perform basic medical care.
(They claimed confirmed, yet had I capacity or time to test many if not most if these)
As of Tuesday, more than 8,500 patients have been admitted into 12 Fangcang Hospitals across the city, according to state-run news agency Xinhua.
Suspected cases, close contacts of confirmed cases and patients with fevers were put in temporary quarantine centers set up in requisitioned hotels and university dormitories.
As of Wednesday, police in Wuhan have helped transfer more than 22,000 people from their homes to hospitals and quarantine centers, according to China’s Ministry of Public Security.
More then 500 seperate quarantine centers, plus 20 major temporary.
Conditions…
“Conditions on the ground, however, appeared different. Bags of garbage, including unfinished meals and used masks, were piling up on the floor, and no medicine or treatment were provided to patients apart from daily temperature checks, according to Wang. “Here, two doctors are in charge of 200 patients,” she said.
There was no central heating inside. Instead, heated blankets were provided to patients to keep them warm. Rows of portable toilets and shower rooms were located outdoors, in the biting cold. “The condition here is tough,” Wang said, adding that she did not dare to use the showers, fearing cross-infection.”
”
The Fangcang Hospitals are only supposed to handle confirmed coronavirus patients with mild symptoms. However, Wang said she and fellow patients who said their test results were negative were taken to these facilities by mistake.
“I think now (they are carrying out this) one size for all sweeping policy,” Wang said, referring to the government behest to “round up everyone who should be rounded up”. “They would rather wrong 10,000 people than miss that 100”
https://www.cnn.com/2020/02/22/asia/china-coronavirus-roundup-intl-hnk/index.html
80
It was far worse in China then admitted to.
https://www.scmp.com/news/china/society/article/3074991/coronavirus-chinas-first-confirmed-covid-19-case-traced-back
The first case of someone in China suffering from Covid-19, the disease caused by the novel coronavirus,
can be traced back to November 17, according to government data seen by the South China Morning Post.
Chinese authorities have so far identified at least 266 people who were infected last year, all of whom came under medical surveillance at some point.
Some of the cases were likely backdated after health authorities had tested specimens taken from suspected patients.
Interviews with whistle-blowers from the medical community suggest Chinese doctors only realised they were dealing with a new disease in late December.”
So with a start date of November 17th 2019, the Corona Virus began its march through China.
The first report of a test developed for this was January 20th 2020, this was more then two months of uninterrupted spread.
https://www.technologynetworks.com/diagnostics/news/researchers-develop-first-diagnostic-test-for-novel-coronavirus-in-china-329537
————–
Worldmeter for China says there were 224 cases on January 22 and 8 deaths by January 23rd.
Yet hospitals were overrun before January 20th, and Cov19 was running free for at least 65 days.
Running the exponentials on that with no defensive protocols concludes at least one, and most likely two magnitudes beyond the reported numbers. China had this from the world while it propogated in a giant central hub, one of the busiest international airports in the world.
A government that throws out all observers, arrests and or just disappears dozens of reporter whistleblowers, is not owed blind faith in their claims. The nightmare tales of Chinese citizens deserve an audience.
All the best…
71
Agree…accidentally hit down vote due to fat finger syndrome.
Can’t trust figures from China. Putting up wuhan style lockdown as gold standard is folly. Also check out possibility of S and L strains. One far more deadly and self implodes. Secrecy by China means that will need to play out for those already infected. Ie rag trade in Milan, etc.
10
David A. Good point, but the graph refers to “Wuhan Style”.
Yes, as was possibly leaked through TenCent – remember that awful night in early February when it appeared that someone inside China was leaking the real death tolls out. The CCP seem to have two lists of numbers — the real ones and the fake “official” ones which were a simple ratio smaller — this has been borne out by analyzing the virus death toll and severity rate in other countries. It appears China was allowing us to see the true ratio (that they were aware of) in terms of percent to die, but they hid the scale.
http://joannenova.com.au/2020/02/coronavirus-huge-ghost-statistics-mysteriously-come-and-go-a-hint-of-much-worse/
60
Thanks Jo, I just wish reporters would ask the difficult questions. I guess real reporters are an endangered species these days.
BTW, I wish worldometer had a column for Cov19 tests, daily and total as Without that information it is very difficult to get an accurate picture.
All the best…
40
Agreed again.
Thanks for the reminder. At no point do I ever wish to do things Wuhan style.
30
It seems to me that the Chinese numbers today simply aren’t possible if, in fact, the original five week or so & 5,000,000 or so were true.
Very roughly, half of China is part of the civilized world that we deal with, and half is a less developed country.
The Idea that folks from Wuhan didn’t go back to ancestral homes in some numbers…..
Well, no matter. Piling on China won’t help. Their near term cultural future may resemble that of Japan/Germany after WWII for a bit.
30
“Every day matters. See which day each US state loses the chance to protect thousands”
OR DOES IT?
“President Trump Tweets 15 Day Deadline To Restart U.S. Economy….
Posted on March 23, 2020 by sundance
Nancy Pelosi’s legislative stunt has revealed that the coronavirus panic is likely a well coordinated political stunt. If it were as real as claimed, Pelosi wouldn’t have the time to organize a political spending scheme…. ergo, it’s more likely a planned hoax to bring the economy to a standstill and create a self-fulfilling prophecy.”
https://theconservativetreehouse.com/2020/03/23/president-trump-tweets-15-day-deadline-to-restart-u-s-economy/
11
Carton at
http://www.smalldeadanimals.com/index.php/2020/03/22/hating-trump-still-top-priority-for-the-dems/
30
It doesn’t for a different reason.
The US is Very diverse.
There are no subways in Idaho.
There are no tenaments in Wyoming.
If there are homeless in Nebraska they are camping solo in a cornfield.
There is no Times Square in SouthDakota, where it can be 50 miles between stoplights.
20 per cent of the population lives in 2% of the geography
30
How come we always have to look to America.
I am sure our States have similar data, but we do not know (not allowed to know) what it is.
One brighter note; At present we seem to be following the business as usual curve. If so the crisis should be over by the end of April, one way or the other.
That might encourage those who have decide to lock themselves down.
20
Peter, I assume that with 330m people there are just more teams to pore over the data and assemble it into great graphic displays.
Appears to be a bunch of high powered specialists from both uni and corporate world. They want more specialists too,
https://covidactnow.org/about
10
Your “Covid act now” link just gives me a blank screen.
00
Loads ok for me Scott !
00
NY has done 30% of all the testing done in the entire USA. NY has done 5 times the testing of other locations compared to its population.
Of course NY has more confirmed cases than other places!
https://www.businessinsider.com/new-york-state-coronavirus-testing-compared-to-other-countries-2020-3
I think this is being done to purposely increase the COVID19 stats in NY so NY will get more federal funding than other states.
If the same testing was being done uniformly across the US, imo, the rate of COVID19 would also be uniformly high in all large cities.
I think its too late to stop the spread anywhere in the USA and the mayor and governor of NY are testing as fast as possible only to get greater federal funding.
It has nothing to do with public health and everything to do with political power. Never let a crisis go to waste and always make every crisis appear worse.
Looting scum.
20
Lord help the United States of America.
But — Coronavirus does hit the elite airport-bound the first. Does make sense if it hit hard in CA and NY.
30
Interesting Perspective from a U.S. Epidemiologist. A bit long.
“”As an infectious disease epidemiologist (although a lowly one), at this point I feel morally obligated to provide some information on what we are seeing from a transmission dynamic perspective and how they apply to the social distancing measures.
Like any good scientist I have noticed two things that are either not articulated or not present in the “literature” of social media.
I have also relied on my much smarter infectious disease epidemiologist friends for peer review of this post; any edits are from peer review.
Specifically, I want to make two aspects of these measures very clear and unambiguous.
First, we are in the very infancy of this epidemic’s trajectory. That means even with these measures we will see cases and deaths continue to rise globally, nationally, and in our own communities in the coming weeks.
This may lead some people to think that the social distancing measures are not working.
They are.
They may feel futile. They aren’t.
You will feel discouraged. You should.
This is normal in chaos. But this is normal epidemic trajectory. Stay calm. This enemy that we are facing is very good at what it does; we are not failing. We need everyone to hold the line as the epidemic inevitably gets worse.
This is not my opinion; this is the unforgiving math of epidemics for which I and my colleagues have dedicated our lives to understanding with great nuance, and this disease is no exception. I want to help the community brace for this impact. Stay strong and with solidarity knowing with absolute certainty that what you are doing is saving lives, even as people begin getting sick and dying.
You may feel like giving in. Don’t.
Second, although social distancing measures have been (at least temporarily) well-received, there is an obvious-but-overlooked phenomenon when considering groups (i.e. families) in transmission dynamics. While social distancing decreases contact with members of society, it of course increases your contacts with group (i.e. family) members.
This small and obvious fact has surprisingly profound implications on disease transmission dynamics. Study after study demonstrates that even if there is only a little bit of connection between groups (i.e. social dinners, playdates/playgrounds, etc.), the epidemic trajectory isn’t much different than if there was no measure in place.
The same underlying fundamentals of disease transmission apply, and the result is that the community is left with all of the social and economic disruption but very little public health benefit.
You should perceive your entire family to function as a single individual unit; if one person puts themselves at risk, everyone in the unit is at risk.
Seemingly small social chains get large and complex with alarming speed. If your son visits his girlfriend, and you later sneak over for coffee with a neighbor, your neighbor is now connected to the infected office worker that your son’s girlfriend’s mother shook hands with. This sounds silly, it’s not. This is not a joke or a hypothetical. We as epidemiologists see it borne out in the data time and time again and no one listens. Conversely, any break in that chain breaks disease transmission along that chain.
In contrast to hand-washing and other personal measures, social distancing measures are not about individuals, they are about societies working in unison. These measures also take a long time to see the results. It is hard (even for me) to conceptualize how on a population level ‘one quick little get together’ can undermine the entire framework of a public health intervention, but it does. I promise you it does. I promise. I promise. I promise. You can’t cheat it. People are already itching to cheat on the social distancing precautions just a “little”- a playdate, a haircut, or picking up a needless item at the store, etc. From a transmission dynamics standpoint, this very quickly recreates a highly connected social network that undermines all of the work the community has done so far.
Until we get a viable vaccine this unprecedented outbreak will not be overcome in grand, sweeping gesture, rather only by the collection of individual choices our community makes in the coming months. This virus is unforgiving to unwise choices. My goal in writing this is to prevent communities from getting ‘sucker-punched’ by what the epidemiological community knows will happen in the coming weeks. It will be easy to be drawn to the idea that what we are doing isn’t working and become paralyzed by fear, or to ‘cheat’ a little bit in the coming weeks. By knowing what to expect, and knowing the importance of maintaining these measures, my hope is to encourage continued community spirit, strategizing, and action to persevere in this time of uncertainty.
2.1K claps
Jonathan Smith
WRITTEN BY. Jonathan Smith
Infectious disease epidemiologist focusing the dynamics of disease transmission. PhD en route at Emory, Lecturer at Yale.
30
Kalm Keith, so what is your perspective on the R-naught of this in a location like Wuhan, population 15 million, extremely dense, very unsanitary habits, start with one infected, then 65 days of growth, basically unfettered by defensive protocols until the last few days, and then about 4 million leaving the city.
Keep in mind that in about 3 weeks, two of which were in a poorly done quarrantine, the Diamond Princess haf 20 percent infected.
30
David, while I have a good background in stats I have no idea what R nought refers to. Unfortunately with CV19 stats I have switched off because from what I see of the stats it’s a completely incoherent mess.
Two examples which I’ve mentioned before;
Italy, has had open borders for decades and I suspect poor control of “immigrants” and foreign “hidden” workers from China.
USA similarly has had open health borders with the guest workers and the added stuff like New York’s recent boost in testing which has shown a remarkable increase in CV19 in parallel.
In Australia by comparison we have done very well with infectious disease control at the borders until recently.
Combining stats from even just those examples is possibly meaningless but certainly dodgy.
Having said that, I’m not sure what you mean by that statement and question.
KK
10
“”R0 tells you the average number of people who will catch a disease from one contagious person. It specifically applies to a population of people who were previously free of infection and haven’t been vaccinated. If a disease has an R0 of 18, a person who has the disease will transmit it to an average of 18 other people, as long as no one has been vaccinated against it or is already immune to it in their community.””
00
Great perspective KK!
We need to throw every possible effort to find a vaccine/cure.
Almost all the talk is about chloroquinine etc ‘trials’ taking ‘years’. Under the current circumstances couldn’t we allow labs to jump some protocols and try to save chronic ill patients?
$168 billion spent by the AUS government on population ‘support’ but only a small fraction is focused on vaccines. Every research lab in the country (planet) should be focused on COVID19 vaccine and medical cure and communications between research teams must be improved.
10
Airports of entry, and extensive mass transit.
NY, LA, Seattle, all are ports of entry, and relatively unique in America in dependence on mass transit. Density and geography.
They share other features one would not find in Indianapolis, Tampa, Albuquerque, or Charlotte, (and hordes of other cities) which in turn are vastly different
in the ways and places in which people congregate.
We had kids on the beaches for spring break, ignoring the rules. Now some are positive. I hope they survive. I hope they went home without visiting their grandparents.
00
Travel within the US (air and ground) including cities with airports of entry has been unrestricted and
there are many other international airports in the US.
Business people and vacationers by the tens of thousands to and from international gateways within the US have spread the virus.
The spread to and within other cities has already happened. One look at the map from JHU shows it.
In the next few days testing in other cities will prove that there are more than a million COVID19 cases in the US.
00