Innovative Solutions National changes Social Distancing

Election Season

Election season is upon us! Milwaukee was the first to hold an in-person election during the COVID19 pandemic. Scientists just (July 31) published a case study on COVID19 spread at this Milwaukee election.

What happened?
March 3: CDC published health and safety guidelines for state elections
March 13: 1st ever COVID19 case popped up in Milwaukee
March 25: Stay-at-home statewide policy implemented in Wisconsin
April 7: Election day
April 9-21: Incubation period (that is, IF people were infected at the polls, this is when their symptoms would start). 
May 5: Marks 4 weeks after the elections (i.e. that is, IF people were infected at the polls, this is when we should see deaths by)

What did they find?
• Cases did not increase after the election. Of the COVID19 infections seen throughout Milwaukee, 28% occurred BEFORE the election and 21% occurred AFTER the election (within the incubation period). 
• Deaths did not increase after the election. Of the COVID19 deaths seen throughout Milwaukee, there were 36 deaths pre-election compared to 24 deaths post-election (within the lagged death timeline)
• Hospitalizations also did not increase post-election compared to pre-election

Milwaukee made key changes to mitigate COVID19 spread during their election:
• Public messaging campaigns to limit in-person voting (people who voted by absentee mail-in ballots in Milwaukee increased from 4% in 2016 to 68% in 2020; Voting while remaining in vehicle increased in Milwaukee from 4.7% in 2016 to 12.2% in 2020)
• Polling site safety (employing PPE and environmental cleaning to lower transmission risk at in-person polls)
• CDC also recommends: longer voting periods, and other options such as increasing the number of polling locations to reduce the number of voters who congregate indoors in polling locations

All cities can learn from this case study. We can still have an election season while mitigating COVID19 spread and, thus, medically benefit the community. 

Love, your local epidemiologist

Data Source: Figure by me. 
Data from: Paradis H, Katrichis J, Stevenson M, et al. Notes from the Field: Public Health Efforts to Mitigate COVID-19 Transmission During the April 7, 2020, Election ― City of Milwaukee, Wisconsin, March 13–May 5, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1002–1003. 

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Cell Phone Tracking

Using cell phones to track movement.

Tracking the way in which humans moved before and during the pandemic has been a very innovative way in which epidemiologists have been able to describe (and predict) COVID19 spread. Specifically, many scientists are using cell phone data to track movement.

Yesterday, the Lancet (a highly reputable scientific journal) published a study in which they wanted to answer… HOW strong IS the relationship (i.e. correlation) between movement and COVID19 spread. Spoiler: VERY strong.

We can see this visually too. For example, as of today, there are 14 hot spot states. These states have very similar patterns in movement to non-essential businesses (Figures). The blue line indicates change in movement to non-essential buisnesses. For example…

In Texas, at the peak of the stay-at-home orders (April 8), there was a 70% reduction in movement to non-essential places. In other words, people moved 70% less to non-essential buissness than before the pandemic. Which was great; it worked to curve spread. However, since then, people have been moving more and more to non-essential businesses. In mid-June, Texans only moved 15% less than before the pandemic. This means they were almost back to “normal”. This was followed by exponential increase in COVID19 cases.

We see the same with AZ, FL, and CA (although CA is not as dramatic).

This is CA… forgot the label

As a comparison, I also included NY. Movement to non-essential businesses stayed constant for almost 2 months, then once cases were down, SLOWLY started to increase. The highest NY has gone is 55% reduction in movement. They haven’t even gotten close to the 15% reduction like we see in Texas.

Translation: Your movement to non-essential places MATTERS! We can all reduce our movement to keep this pandemic under control.

Love, your local epidemiologist

Lancet study:…/PIIS1473-3099(20)3055…/fulltext…

Mobility data and graphs: From UnaCast. A really fun site to play around with:…/social-distancing-scoreboard…

Social Distancing Texas update

Reopening of Texas

Because this is important regarding Texas’ policy decisions today.

The reopening of Texas was done in a phased approach. The purpose of this is to, ideally, evaluate COVID19 spread BEFORE going to the next phase. Unfortunately, this wasn’t done in a consistent, data-driven manner and we may be seeing the impact now. Let me explain…

Note: Remember, we have to give policies at LEAST 2 weeks to even start to evaluate their the impact on COVID19.

Phase I: Two weeks after Phase I was implemented, COVID19 spread increased very slightly, but not in a meaningful way. This is okay (it would have been great if this went down). But time to move on to Phase II.

Phase II: This phase gets messy. Within two weeks after Phase II was implemented, there was also Memorial Day and protests/demonstrations/riots. The combination of these three was followed by exponential growth. Parsing out which caused which is impossible. The ONLY way we can do this is IF we had a comprehensive, state-wide contact tracing program. Which we don’t. If we did, we could see who got the disease where and how they spread it. Nonetheless, given this exponential spread, we should have never moved on to Phase III.

Phase III: But we did. It has now been three weeks since Phase III was implemented. We’ve never seen so much COVID19 spread across the state of Texas. Ever. So, we aren’t going to Phase IV (as of today).

Translation: Stopping Phase IV is the right call. However, it’s after a series of wrong calls. The disease has spread and, unfortunately, we may have to go back.

Love, your local epidemiologist

Data Source: DSHS. Graphs created in collaboration with my biostatistical rockstar colleagues, Drs. Yamal and Yaseen.

Innovative Solutions National changes Social Distancing

COVID19 National Policies

Because this was the first pandemic in modern time, the shutdowns were unprecedented. No one knew the potential financial, social, and medical impact. The financial costs of the shutdowns were obvious- closed restaurants, job furloughs, job loss, food pantry lines, etc. However, like most everything in public health, the health benefits were invisible. It’s hard to show the impact of infections and deaths that never occurred.

A VERY recent scientific study showed how the U.S. policies (and in other countries) impacted COVID19 spread. And, more interestingly, WHICH policies were most effective and which policies had NO impact on disease spread.

This figure comes directly from the preprint of the Nature article. See below for proper reference. In short, any horizontal line that does NOT cross the vertical line had an impact. So social distancing, quarantining, and working from home all WORKED. However, any horizontal line that DOES cross the vertical line had NO impact. So, for example, schools closing did not have an impact on COVID19 spread in the US.

Translation: Our sacrifices are/were worth it in regards to slowing down COVID19. Specifically, by social distancing, quarantining, and working from home, we were able to prevent 4.8 million diagnosed cases and 60 million actual cases. For the next wave or next pandemic, we can use this information to shut down more effectively.

Love, your local epidemiologist

Source: This was a peer reviewed article published in Nature, which can be found here:…/s41586-020-2404-8_reference.pdf. The full reference is… Hsiang et al., (2020) The effect of large-scale anti-contagion policies on the COVID19-pandemic. Nature.