States across the Union are re-opening. The future is uncertain and unpredictable. But we have models that can tell us what the future will look like based on how many new COVID infections occur.

It appears that the Feds have abrogated responsibility to the States. Statewide policies do not account for the different expressions of the pandemic in the different pockets of the state.

Here in Austin we are lucky. We have coordination between the City government, Austin Public Health, the medical school and the medical community, the hospital systems, and the University of Texas. With this cooperation there is daily updates on the number of hospital admissions, occupied ICU beds, patients on ventilators, and the number of newly positive tests. Bonus: we can analyze this data real time.

Dr. Lauren Meyer of UT gave an excellent talk discussing our local policy and how the situation on the ground influences it.

The attached graph shows the DefCon like nature of how “open” our city is. Notice at the left that it is entirely influenced by the rotating 7 day average daily hospital admission. Right now we are running roughly 10 new admissions a day which puts us at Stage 3 (which I like to call DefCon 3). If we get over 20 admission/d we’ll go to DefCon 4 which is very close to what we’ve done from mid-March to end of April.

Using cell phone data, researchers at UT can gauge how much movement there is in the community. On April 20, 2020 there was the least amount of movement. The reproductive rate of the virus at that time was less than 1. (Reproductive rate means how many people does one infected person infect– less than one is great and the end of the virus is coming, greater than one is bad and growth of infections will be exponential). Right now we are slightly higher than our low at 1.1.

When creating policy, decision makers have to have a clear cut practical end point. There is no threshold of COVID deaths or infections that makes sense. So the threshold is hospital capacity. It would be lovely not to have more patients requiring hospitalization than there are hospital beds for them.

So projections:
1) If transmissions increase by 50% compared to our low, then we can expect a surge in late summer lasting until the end of the year. We’ll likely experience 3000 new COVID related deaths, and endure 3 to 4 short term stay at home periods each lasting 3-4 weeks.

2)If we have only 25% increased transmission, we will still exceed hospital capacity but it will be in the fall. There will be roughly 2100 COVID deaths. Schools would open but with precautions.

3) If we had 100% (double) the transmission, we would reach capacity by June, with over 6000 COVID deaths, and likely be at DefCon 5.

So the take home message: Be Safe! We all have a direct impact on this transmission rate. There is believed to be not only the pre-symptomatic spreaders of infection but also the asymptomatic spreaders of infection. Some just don’t get ill but spread the virus. So everyone’s behavior impacts the entire society. Our kids’ ability to physically go to school in the fall is directly and negatively impacted by the those that flout social distancing, wearing masks, and washing hands.

Of course I’ve heard the news stories of beaches and bars filled with people who flout these mandates, but I take heart by seeing pictures of people in Austin and other places going out and enjoying the weather while still practicing safety measures.

We have to continue to educate the public that We Are In This Together. All of us. Let’s re-open, let’s be safe, let’s end this pandemic.