Massachusetts should shut down immediately

Massachusetts’ coronavirus numbers appear to be less concerning than the other three states with over 100 cases (California, Washington and New York)—they are lower and growing more slowly. However, Massachusetts has been running about 30x fewer tests than those states, and appears to have been extremely tardy in responding to a super-spreading event at the Biogen conference.

As a result, in a worst-case scenario, MA cases could be understated by a factor of 2-3 relative to other states by now. If so, we’re near the point where only near-complete social distancing (including shutdown of non-essential businesses) can avert a Wuhan-level epidemic.

Yuri and I made a scenario visualization where you can look at what happens to your region with strong or weak quarantine measures: Don’t Be Italy.

To help us avoid being Italy, call Gov. Baker and your reps today.

Update: just after publishing, Gov. Baker shut schools and restaurants and banned 25-person events. This is good progress, but we’re still not as locked down as Daegu.

Summary of claims

• Massachusetts’ presumptive-positive cases are likely substantially under-reported, because since Tuesday, we have been running 30x fewer tests than the other states with over 100 cases.

  • MA: 100/day (see below) for ~5m metro area

  • CA: thousands/day¹ for ~8m metro area (SF, containing half of CA cases)

  • NY: ~3,000/day² for ~22m metro area

  • WA: ~3,000/day³ for ~2.5m metro area

  • At 100 tests/day, it’s difficult to determine whether or not the spread has been controlled, because in the uncontrolled case, after a few days of growth (33% daily growth) the number of new cases per day would surpasses the number of daily tests MA could possibly run.

• We could have been experiencing undetected, uncontrolled spread since Tuesday, when MA testing became a bottleneck, because it is likely that there was substantial community transmission stemming from the Biogen conference.

  • The community transmission likely involved a number of Marriott Long Wharf employees, although DPH has refused to comment on this.

  • In general, recent evidence suggests that COVID-19 can exhibit substantial asymptomatic spread⁴—in some environments, this accounts for the majority of spread. In MA in particular, Biogen employees were asymptomatic during the conference in which they infected ~50 coworkers.

  • Both Biogen and Marriott employees worked as normal for days to weeks before being asked to work from home.

  • Quarantine numbers suggest that Biogen or Marriott employees were not placed under quarantine unless/until they tested positive.

• Successful cases of COVID-19 mitigation have seen cases rise around 100-fold even after ultra-strict mitigations (massive testing plus near-total lockdown) are implemented.

  • Mitigation measures typically take about one week to affect the epidemic’s apparent growth rate at all, because today’s confirmed cases started incubating one week ago.

• If Boston’s true cases have been growing at the uncontrolled rate (33%/day) since Tuesday, we might expect 500 true cases by Monday.

  • Wuhan went into full lockdown at 600 known cases, and ended with 60,000.

  • Daegu went into near-full voluntary lockdown plus massive-scale testing at ~100 cases, and growth slowed after 10,000 cases.

  • In the epidemic case for Boston, a full lockdown on Monday would arrest the epidemic around 50,000 cases—near Wuhan-level catastrophe, but no worse.

  • Delaying the full lockdown to Thursday would arrest the epidemic around 100,000 cases—twice as severe as Wuhan’s.

• Thus, caution advises the strictest possible lockdown measures immediately.

  • Once additional testing capacity comes online, if it demonstrates that the epidemic was in fact controlled, the lockdown can be lifted.

What you can do

First, call Gov. Charlie Baker’s office and ask for measures that have bent the curve elsewhere:

• Shut down all non-critical businesses.

• Require employers to move to remote work except where it makes their business impossible.

• Introduce fever monitoring in the remaining high-traffic areas (grocery stores, apartments, etc.).

• Begin improving healthcare capacity now by suspending elective surgeries, procuring ventilators, and planning temporary hospitals.

All of these measures can easily be reversed once the epidemic is contained. If we don’t contain the epidemic, we’ll really wish we’d done them a week ago.

Next, call your legislators and tell them the same thing.

Last, sign this petition to shut down MA as much as possible.

Finally, it’s still not time to panic—if we respond in time, you’ll still be less likely to die of covid-19 than of a car accident this year. It’s important to act soon, but the situation isn’t yet irreparable.

Further reading

• Coronavirus: Why You Must Act Now “The only way to prevent this is social distancing today. Not tomorrow. Today.”

• What your country can learn from Italy on coronavirus “In Italy we’re readapting cruise ships to hospitals. Yes, that’s how much we need beds. Prepare in advance.”

Timeline of events

Wed, Feb 26

• Biogen conference begins at Marriott Long Wharf. The conference has 175 attendees,⁵ of which around 50 ultimately contracted COVID-19.

• No employees were reported to have displayed symptoms during the meeting.⁶

Sat, Feb 29

• First Biogen exec starts showing symptoms. The next day, the exec requests a coronavirus test from MGH, but is denied.⁵

Mon, Mar 2

• Biogen employees resume work as normal, including attending a Cowen conference at the Marriott Copley Place. Several Cowen attendees from Biogen later tested positive for COVID-19.⁵

• Biogen employees continue to be denied testing.⁵

• As mentioned above, recent evidence indicates that a significant portion, perhaps the majority, of COVID-19 spread is asymptomatic.⁴

Tue, Mar 3

• Biogen informs Mass. DPH of the cluster of symptomatic people; “Those officials were told that the cases did not satisfy requirements for testing”⁵

Wed, Mar 4

• Two European conference attendees are confirmed to have COVID-19.⁵

• Around 10 Biogen employees walk into MGH requesting COVID-19 tests; some, but not all, are tested. Biogen requests employees not to walk into MGH to avoid disruptions.

• As of 10am today, 719 people have been subject to DPH self-quarantine.⁷ There’s no indication that any Biogen or Marriott employees have been subject to quarantine at this point.

Thu, Mar 5

• Biogen advises all conference attendees to work from home.⁵ There is no indication that any similar advice was given to Marriott Long Wharf employees.

Fri, Mar 6

• 60 “people from the Marriott hotel”—likely staff who worked during the Biogen event—are sent to Brigham and Women’s for testing.⁸

• DPH reports 5 new presumptive positive cases relating to the Biogen conference.⁹

Sat, Mar 7

• DPH announces 5 additional presumptive positive cases. 3 relate to the Biogen conference, 1 is travel-related, and for 1 there is “there is no current known linkage to the Biogen conference or foreign travel.”¹⁰

• Despite the case with “no current known linkage,” Boston.gov continues to report that there is “no community transmission in the City of Boston” until at least Thursday, 3/12.¹¹

Sun-Mon, Mar 8-9

• DPH announces 15, then additional presumptive positive cases relating to the Biogen conference, bringing the total to 31.¹²

Tue, Mar 10

• DPH announces 50 new presumptive positive cases, bringing the total to 91.¹³

• Public Health Commissioner Monica Bharel states that “Person-to-person spread of the virus is beginning to occur among individuals without identifiable risk factors.”¹⁴

• Bharel reports that 400 tests total have been run since testing began two weeks ago.¹³¹⁵ It’s later clarified that she misspoke and only 200 individuals had been tested.¹⁶

• Bharel also states that as of this day, the state has increased its testing capacity to “over 100 a day.”¹³

  • If 100 tests were run Monday, then those tests came back around 50% positive, while overall, tests were coming back 25% positive, indicating that testing has ramped up more slowly than COVID cases.

• Bharel states that ‘the lab was running 24 hours a day and had “adequate supplies and adequate staffing” to meet demand at this time.’¹⁵

Wed-Fri, Mar 11-13

• On Wednesday, DPH reports 1083 individuals subject to quarantine, an increase of 364 since last Wednesday.¹⁷

  • On average, ~4 individuals were quarantined per case discovered since last Wednesday. DPH stated that Biogen employees were asked to self-quarantine,¹⁸ but I can find no evidence that Marriott employees were asked to self-quarantine.

• During these three days, DPH runs 90 tests per day (per calculation on Saturday, Mar 14).

  • Compare this to the testing capacity advertised as “200 per day.”¹⁹

• These tests discover (respectively) 3, 13, and 15 presumptive positive cases.

  • If tests were equally distributed, these correspond to positive rates of 3%, 14%, and 16% respectively.

  • Other epidemic states are achieving much lower positive rates, for instance Washington achieved a rate of 1.5% on 3/14.²⁰ South Korea achieved an overall positive rate of under 0.5%²⁰, and daily positive rates would be even lower still since they start out high and get lower once testing scales up.²⁰

Friday, Mar 13

• Mass. DPH releases updated guidance stating that there is “initial evidence of community spread” of COVID-19.²¹

• Boston Public Health Commission and Mass. DPH remove sentences about “no community spread” from their websites.

• Marriott Long Wharf is shut down due to “facts obtained through confirmed cases connected to [the] hotel and contact tracing to identify close contacts of those cases.”²²

  • “The health commission did not say what the contact tracing revealed or what this new information means for guests who have been at the hotel in the past two weeks.”

  • This likely indicates that COVID-19 transmission was ongoing at the Marriott despite sanitary measures.

• Gov. Baker “repeatedly declines” to state how many COVID-19 tests have been performed, calling it a “fluid number”²³

• State allows patients to be tested without prior DPH approval and without a history of close contact with a known case.²⁴

Saturday, Mar 14

• Morning: Sec. HHS Marylou Sudders says 475 tests total have been run.²⁵

  • This indicates a testing rate of 25/day over the past three days, based on Bharel’s original claim that 400 people had been tested on Wednesday 3/10.

  • On Sunday, officials noted that Bharel misspoke on Wednesday, and the actal number of tests run through Wednesday was 200, not 400. This indicates a testing rate of 90/day over the past three days.

• Afternoon: cases rise from 123 to 138. Of the 138, 11 have been hospitalized and 22 have a hospitalization status of “under investigation.”

Sunday, Mar 15

• Morning: “health officials” say that 799 tests have been run, up from 475 yesterday, indicating that 325 people have been tested today. MA testing is now running only 10x slower than other epidemic states.

• Afternoon: DPH reports 26 new cases of COVID-19, 18% growth.²⁶

• Since testing accelerated significantly faster than cases, this is some evidence that Boston is not in a worst-case epidemic scenario.

• (It’s not full evidence because it’s possible that the relaxation of DPH testing criteria ²⁴ created a backlog of tests and that there are still more positive cases waiting to be discovered. DPH isn’t currently disclosing its testing turnaround.)

Thanks to Eve Bigaj, Will Brownsberger, Will Poff-Webster, and Dan Luu for reading a draft of this post.