BAY AREA & NATION, CURVE NOT MASTERED (yet!)

BAY AREA & NATION, COVID-19 CURVE NOT MASTERED (YET!)

TIME FOR CAUTION AND SOBRIETY, NOT IMPATIENCE

BAY AREA & NATION, CURVE NOT MASTERED, (YET!)

Summary:

1. "Conventional wisdom" now says, for both San Francisco Bay Area and Nation, that social distancing efforts have successfully flattened "the" curve. Regional and National COVID-19 curves, however, may not behave as theoretically modeled. There is no "one" curve possibility or trajectory, as has been proposed. There are "three" main possibilities. The situation is also fluid. Our further actions can increase the probability of one of the curves happening. Our future actions can cause one curve form to morph into another pattern. Of the several possibilities, the 2-Wave Curve, which "conventional wisdom" and "group think" is betting on, is the least probable of the three.
2. Making wrong assumptions about where this curve is going may have catastrophic consequences. The two other possible main curve patterns do not yield as rosy an outcome as the 2-Wave curve, that people are assuming we will see.
3. If either of these other two curve patterns ends up the actual path going forward, policy relaxing shelter-in-place, social distancing and mask use will have catastrophic consequences.
4. A full dialogue and careful consideration is needed before any such decisions are enacted. Rash or unwise hasty decisions may not be reparable later once the error is noticed. The country is very vulnerable right now and the next step needs to be correct.
5. Suggestion: Become aware that there are three possible wave patterns, not one. Encourage open debate regarding which curve patterns are the most likely and why. Let objectivity, rationality, logic and appropriate risk-management govern decision making, not assumptions, "conventional wisdom" and "group think."

Group Think

 Before we rush to open the Bay Area and Nation back up for business, we need to better evaluate and assess the presumptions regarding the future trajectory of the COVID-19 curve. A great deal of misery was caused by accepting faulty assumptions. Failure to objectively look at all data and entertain diverse points-of-view with regard to community masking were the main point of failure. Did we learn nothing from that WHO debacle regarding the great risks of group think? To be clear, the risks posed by an incorrect decision about this curve have greater consequences than the incorrect recommendation regarding community masking.

Present All Cases

Are we making any large missteps in regard to this COVID-19 curve assessment? Are we just assuming the curve will do what we want to, because that's what makes us feel good and that is what is needed for the economy? That curve has and will have a mind of its own. Its up to us to follow and adjust strategy continually, not betting the farm on our opinions, hoping that we made a correct choice in the past. It is like buying a stock "knowing" that it is going to rise. How often does the stock do what you want it to do? How often is that movement linear? What are the inherent risks with our rationale and with each of the three possible curve trajectories that we may see? Lets hear all sides.

 2-Wave Linear Curve (Conventional Wisdom & Group Think)

 If this COVID-19 curve is indeed a simple a 2-wave linear curve model, as is the current "conventional wisdom" suggests, then proceeding a return to work may go fairly well. The curve will likely continue to the right and slowly slope down to a successful resolution. A linear 2-wave curve, however, is not the only possibility of what we might expect with regard to COVID-19. It is not even the most likely possibility. The other 2 are much more ominous and statistically probable.

2-Wave Linear Curve

Moveover, even if we are in a 2-Wave linear curve, our actions and the timing of them can distort the right side of the curve. By coming out of restrictions too soon, we may cause a large hump to form in the right side of this curve, just as it did in St. Louis in 1918 with the Spanish Flu.

 Apples and Oranges

Check our assumptions. Where did this current 2-Wave Covid-19 curve idea come from in the first place? Does anyone know? Most likely it came from the St. Louis Spanish Flu curve chart. Spanish Flu was caused by and Influenza virus, H1N1. Influenza has a shorter incubation period and asymptomatic carrier rate than Covid-19. Influenza effected and killed a greater percentage of middle-aged people having a W-shaped age pattern. Covid-19, in contrast, primarily effects the elderly and spares the young in general. There is no obligation for Covid-19 to act like Spanish Flu as they are distinct entities.

Keystone

Comparing the two is like comparing the behavior of a cow to a bear because they both look a little similar in some ways' four legs, mouth, ears, nose, tail etc. Making predictions for Covid-19 based on Influenza data from 110 years ago is not highly valid. Designing your Covid-19 curve based solely on Influenza places the entire edifice you construct on top on unsteady ground. To have a strong edifice, the keystone has to be solid. The Influenza curve transferred to Covid-19 is not such a stable fixture.

Biological Systems

Biologic systems rarely move linearly. They are usually more complex in every manner. They tend to move in waves. Those waves can decide to change frequency. The stock market, while it seems non-biologic, is heavily driven by human sentiment on many different time frames, making it strongly biologic. Viruses, because of their potential exponential growth, are even less apt to move in linear directions, but will tend to move in waves.

Elliott Wave Theory

One of the more useful tools for assessing and reassessing where a market or stock curve is heading is Elliott-Wave-Theory (EWT), which is used in tracking individual stock and index curves. It has been one means to track curves since 1930. Elliott Wave Theory (EWT) is not voodoo nor is it a crystal clear ball that spits out the right answer 100% of the time. It is just another tool for assessing the complex and ever changing, and putting some order into chaos and guesswork. Elliott Wave Theory (EWT) does not provide certainties, it provides probabilistic odds only, based on wave patterns that frequently repeat themselves. If a curve does not "do as it should" or as you want or hope, a reassessment is made in real time to track the next most likely probable scenario. This is done continually. EW analysts are neither bear nor bull, but follow what the market is saying at any given point in time, trying to ride the curve appropriately.

2-wave curves

2-wave curves for biologic systems, whether stocks, markets or other biologic systems are possible, but fairly rare. This is based on observation and experience over decades. More often, curves move in 3-waves or 5-wave patterns.

 Current Covid-19 Curve Model

 "Conventional wisdom" anticipates a 2-Wave curve with Covid-19. We may not be in a simple 2 wave-cycle with COVID-19. It is really too early to tell according to Elliott Wave Theory. The data is insufficient at this point in time. To get caught in a single line of thinking, using guesswork rather than data will often lead to error. Masking, case in point. What happens if the conventional wisdom model curve, which all have assumed will gently slope down, does something else? What rationale do they then fall back on at that point? They have no game plan for that possibility. To not have a plan for all contingencies and to expect the world to fit perfectly into your box, for your convenience is to set yourself up to failure.

 Alternative View: Wave-II Flat/Base

 We may, instead of a simple 2-wave pattern, be in a what is called a Wave II flat or basing pattern. The Wave-II base is slowly and patiently building, waiting for start of a 3rd-wave upward. Many stocks behave this way, having a long basing period before shooting higher. The third wave is usually the largest and most powerful segment of any 3 or 5-wave cycle. If we assume we are in a simple 2-wave pattern and come out of social distancing and shelter-in-place, and this is really a 3-wave pattern, the relaxation of the pressure on COVID-19 will act like releasing of a coiled spring. When we hit the point the 3rd-wave was destined to start, the curve will shoot up dramatically. It will shoot higher than it would have, had social distancing not been removed. The removal of social distancing would be like an anabolic steroid for the COVID-19 curve. The speed with which such a surge would hit and the damage delivered would be severe. After a 4th wave pullback, if a 5th wave follows in this scenario, damage may be catastrophic across the country . What is their plan at those points?

 Worthy of Discussion

 Given the consequences of predicting and picking the wrong curve model, its worth a sober discussion on whether the COVID-19 curve is a simple 2-wave, or a part of a more complex 3-wave or 5-wave wave. This discussion has to occur before any national or State move.

National decisions regarding return to work will be "fire-and-release" with much difficulty reversing if things do not go your way. Learn your lesson with WHO masking. Assess all points of view. Hear all arguments both for and against. Let logic and reason and the power of persuasion carry the day, not "conventional wisdom" and "group think". Weigh risk ratio with any step forward.

East Bay San Francisco

 With the nice weather this Easter and the recent and the broadly announced media opinion that the COVID-19 curve has "successfully fattened", area youngsters decided unilaterally that it was time to end shelter-in-place, social distancing and mask use (not that many young adults were doing so anyway).

 Risk to Elderly

 Young people, because they actively move around society and often do not have any symptoms, are the ones who unwittingly bring Covid-19 to the at-risk and elderly. It was the healthy travelers who spread COVID-19 around the world. Young people interacting with other young people, some of whom are no doubt infected without symptoms, results in rapid viral transmission. The newly infected, unwitting youth, like a Trojan horse, bring the infection into households. The elderly are especially vulnerable now in San Francisco Bay Area. They are in more danger today than last week. If you have an elderly person in your home, do not let your guard down. It is time for even more vigil.

  Master of Your Destiny

 Enclosed below is the technical argument for the curve being either a 3-wave or 5-wave curve. Everyone needs to make up their own minds (which should always be the case). The established entities and authorities that have been handing down policy have proven how fallible they are. To be fair, this is a novel virus and they are doing the best they can under circumstances where full and accurate information is patchy. Take home message, with COVID-19, there are no experts.

 Put your faith in your own logic, reasoning, and instinct, not titles. Choose wisely!

 OPINION REGARDING SAN FRANCISCO BAY AREA COVID-19 STATUS

1.  DEPARTMENTS OF PUBLIC HEALTH SHOULD RE-EMPHASIZE SHELTER-IN-PLACE, SOCIAL DISTANCING, MANDATE UNIVERSAL MASK USE. No want wants this, but declaring premature victory is dangerous
2. WARN SENIORS AND AT-RISK COMMUNITIES of the INCREASED CURRENT DANGER More young people now have COVID-19 than is appreciated.

 3. A LARGE 3RD-WAVE IS MORE LIKELY THAN NOT, DUE SOON in the BAY AREA. AN EXPONENTIAL RISE IN CASES IS POSSIBLE. DATA IS INSUFFICIENT AT THIS MOMENT, BUT WITH EACH DAY THAT PASSES WILL BECOME MORE CLEAR

 4. THE CURVE COULD MORPH INTO A 5-WAVE STRUCTURE IF THE PRESSURE OF SOCIAL DISTANCING MEASURES REMAINS OFF  

  Current Direction

 Media nationally have heaped praise on San Francisco's early shelter-in-place policy and widely announced it as the "City That Flattened the Curve". With the declaration that the COVID-curve was "successfully flattened", much of the East Bay and San Francisco culture decided to declare a full "victory over COVID-19". They unilaterally end shelter-in-place and social distancing. Mostly young adults were the ones our celebrating.

 Easter

Easter Sunday, there were crowds on side-walks and the Iron Horse Trail in Danville, CA. 7 of 100 counted wore masks. 97% were not masked. Almost no one complied with social distancing. No one seemed to have a care.

 Historical: Spanish Flu

 Historically, based on the Spanish Flu curve we have all seen repeatedly, social distancing both flattens the curve and shifts the the center-of-the-curve to the right, temporally.  See Spanish Flu Kansas City vs Philadelphia charts. The shift of the center-of the-curve to the right may be as much as 100% in time, as with the case of Spanish Flu. The massaged versions of the data show a curve that takes a "nice even linear line" to its final destination.

1. Which curve is Philadelphia 1918 Spanish Flu?
2. Which, if any, of these curves is St. Louis 1918 Spanish Flu?
3. Can you guess on the right two curves the point in time when an easing of social distancing lead to a bump in cases?

 4. Which city, if any, does the green curve above represent?

Curve Massage

 For illustrative and comparative purposes, curves such as those presented in the Spanish-Flu St. Louis and Philadelphia comparison papers are heavily massaged to smooth out peaks and valleys. It is just those peaks and valleys that provide the best evidence of where a curve is going and its current wave count. That smoothing gives a false sense of stability and predictability.

Answers

1. Top left of the 4 is Philadelphia.
2. Bottom right of the 4 is St. Louis. Does that really look like the red curve in the graph above. Each are St. Louis. Curve massage does the rest.

3. An ease in social distancing occurred in each of the right side curves just before they lost control of the curve.

In the top right, they had almost defeated the curve only to slide back up severely. This was San Francisco! NB we are not even to the curve mid-point yet in SF or US for COVID-19. Any easing of social distancing will result in a large deflection up, worse than if it came after the mid-point.

In the bottom right, they were past what appeared was going to be the mid-point and shot back up higher than ever. NB we are not even to the mid-point yet in SF or US and any easing of social distancing will result in a large deflection up, worse than if it came after the mid-point.

4. The green curve represents no city. The curve was just constructed for media instructional purposed regarding shift to the right.

NB: Bottom left top 4: NYC

 Peaks and Valleys

Real-life, un-massaged, chart curves are more like the Italian example that looks like a craggy mountain range with twists and turns that are much less predictable than an artificially-smoothed-out linear curve. Just because the massaged Spanish Influenza Flu curve looks like it goes straight, that does not mean that the Covid-19 curve is obligated to do so. In fact you may anticipate that it will not do exactly as you want.  It will have peaks and valleys of variable magnitude that make predictions and tracking more challenging. Elliott Wave Theory provides a means to ride that turbulence.

 Italy: NO Social Distancing

With Spanish Flu, Philadelphia did not socially distance and had a more-peaked curve. With Covid-19, countries like Italy, similarly did not socially distance or mask initially. The Italian curve was fairly steep, like Philadelphia. The first case in Italy was in Rome in January 31. February is not shown on the curve above. The curve seen on the chart begins March 1, and cuts a month off the true curve's visual picture, possibly leading to misinterpretation and miscalculation. The peak of the Italian curve was March 21, 50 days after the first case in Rome.

 Adjusted Italian Curve: Theoretical Projection with Social Distancing

 If (and this is an assumption) the same relationship between social distancing exists between Spanish Flu and Italian Covid-19, the center-curve / peak anticipated with social distancing may shift-to-the-right up to 100%. This would put a start-to-peak at about 100 days.

 Bay Area Chart Specifics

 In the East Bay, the first case of Covid-19 was around March 1. As of April 15, we are only 46 days into the curve. If we apply the same assumption of the adjusted Italian curve to Bay Area curve, the Bay Area curve should be 100 days start to center-curve. The center-curve / peak would be around June 7th. Today date is April 15. 53 days short. We are not even 1/2 the way to the center-curve. Much can still happen along the way. The second half of the ride up to June 7th may be expected to be steeper than the first. It will be more volatile and more sensitive to any outside influence.

May 1 Update

This California curve of 5/1/20 has a number of ominous characteristics. The steady range from about April 1 to April 10 has been broken.  2 cycles of larger, high volatility swings occurred, the first with a peak of April 15 and second about April 20. This volatility is not a good sign for those who expect the curve to go smoothly and meekly to the right. The 3 lowest spikes from about April 12 to April 25 for a series of higher lows, which indicate upward movement. The highs formed during this period form higher highs, an indication of upward movement.  These signs all suggest a larger peak is coming. We are already likely in the early stages of the 3rd wave up.

Estimated Wave 3 Height

While the more aggressive masking likely helped and is helping, it will not prevent a 3rd wave up. How large it becomes is hard to say for sure, but both Italy and South Korea had waves 3.5 the height of the 1st wave. The first wave here in CA was recorded at 1500 new cases per day. If the curve is true to prior form the 3rd wave will top out at over 5000 (5250-ish). Testing criteria in April was rigid and restricted. Family members of known infected individuals were not tested despite symptoms given that they would have to quarantine anyway. Actual number of cases that would have been measured with less stringent criteria may actually be double at 3,000 cases per day. If that is the case the peak could top out at 10,500 or more.

Action Items for Public

For those at-risk, this is a time to hunker down and shelter-in-place.  Everyone else need obey strict social distancing. Wash hands. Every one mask at all times. Young adults do not congregate with your peers and stay away from the elderly and at-risk. Fill your fridge and pantry, it may be a rough few weeks or longer to the top and then more weeks back down. With luck, continued measures will keep pressure on the curve down and limit the curve to a 3-wave pattern.

5th Wave?

If measures are loosely followed, Covid-19 gets favorable weather, or other factors work against us, a 5-wave pattern is still a possibility (25% or more chance). What would a 5 wave pattern look like. After the aggressive 3rd wave top, the curve would descend into a 4th wave. That descent may be up to 2/3rds of the height of the wave 3 ascent. The 4th wave is the least predictable and variable of the Elliott Waves. It is usually is longer in duration than the wave 2 retrace, and is marked by high volatility with deep swings up and down. It may form and extended base over months giving many the impression that the curve has lost steam. As with what happened with wave 2, that descent may stall and flatten and slowly start curving back up. The curve is just building strength for another run. Alternatively it may form a series of higher lows and lower highs forming a pennant facing to the right. Something usually "happens" at the tip of the pennant, either the curve breaks sharply up or sharply down. Given the current momentum of the curve, if a pennant forms, odds are that it will break upwards.

 Trajectory

As with any object in a trajectory, the earlier you effect it along its flight path the greater the displacement from the original final destination. Slight forces at an early position on the curve can lead to big changes in your presumed destination. The concept is similar to discussion about intercepting earth-threatening asteroids early. Minute early displacements can lead to much more pronounced deflection than much larger displacements later. The earlier something perturbs the Covid-19 curve (abolition of social distancing, masking) the greater the instability and alteration of final presumed destination. You may even convert what would have been a simple 2-Wave curve back into a mountain-peaked 3-wave curve.

  Curve Detail

 The latest San Francisco Bay Area curve shows an initial sharp spike up in wave I, followed by a decline and flattening in wave II. The bottom of Wave II is forming a base. This flattening has been interpreted as a flattening of the "entire curve" from here on in to the end. The “conventional wisdom expectation” is a slow gradual drop to the right as shown in dashed lines (the DPH Model).  Only 46 days in to this curve, less than half way through to the center-of-the-curve, victory has been declared. For reasons stated, there is a high probability this is inaccurate. Any perturbation this early can convert this back into a mountain peak 3-wave curve, not continuing linearly. A 5 wave monster could even be spawned. Following this COVID-19 curve will be like tracking a Hurricane, with projected areas of landfall that need to be adjusted along the way. Try to pick the spot in the US that a hurricane will hit when its 4 days off shore, and you likely will be incorrect. Even the magnitude of the storm can be a challenge to estimate. You can get a CAT 2 or CAT 5. Nature does not care about following your model.

 Real World

 Looking at a real world view, the battle has not been easy anywhere with Covid-19. The Chinese and Asians are a disciplined, tough and resourceful people, with cultural experience fighting SARS ans MERS. From day 1 they threw everything they could at Covid-19: mask mandates with good compliance, mask police, thermal imaging police in apartments, social distancing police, UV-C treatments of buses. Their ordeal started in December and the battle goes on 4 months later. Shanghai is still in masks. Do we really think Covid-19 is that simple to defeat given the Chinese experience? One Northern area of China that tried to return to work has already seen a second wave.

 Chinese Advantage

The Chinese do not have the same concentration of elderly people living together as in the US. The elderly typically live with their families until death (effectively socially distancing themselves from other at-risk elderly people). The elderly communities in the US represent a banquet for COVID-19. The Chinese have less obesity. The Chinese have a society more accustomed to follow directives with uniformity.

 Playing Possum

Given the advantages the Chinese have and the levels to which they have taken the fight, should the US assume this battle is won only 46 days in? Mission not accomplished US. This is a very slow and patient virus. It is a crock-pot contagion, not a fast food one. It lulls communities with short attention spans to sleep by coming in a little soft in a first wave, then backing away. Nothing happens. Every one then drops their guard and stops precautions. As when the ocean suddenly recedes after an earthquake, beware.

 Elliott Wave Analysis

  Italy

 The Italian curve is at least a 3 or 5-wave form, with Wave II bottom at March 11, 40 days from the first case in Rome. The structure and shape at the top or the curve is a little irregular. It may have been influenced by a shift in later community mandates or behavior, such as masking or shelter-in-place.  Its not entirely true that Italy did not do any social distancing, they just did it very late. They may have improved their own trajectory by doing so. Without late social distancing the wave peak around March 28 may have been otherwise higher than the peak on March 21. If the Italians were able to positively effect their peak late with social distancing, why would we not do so through that same period in the US as well. Covid-19 is a very tough opponent. Why get such a dangerous opponent down with effective distancing measures and then release your foot of its neck, so that it may rise again?

 SF-East Bay

 The San Francisco - East Bay the early curve shows 2-waves. It could be a simple 2-Wave or it may be a Wave II flat/base. Shelter-in-place has been effective. People are celebrating final victory prematurely, however. While this can be a simple 2-wave curve, 2 wave curves in Elliott Wave Theory are very rare. Statistically a curve is much more likely to be a 3 or even 5.  Italy was at least a 3 wave, maybe a 5 wave. 

Too Much Mercy

Assume flattening has successfully converted the Italian mountain peak curve to the desired simple 2-wave. It was only a 2-wave because of social distancing/shelter-in-place. With many defensive distancing measures removed, it is entirely possible this curve will revert back to the 3-wave mountain-peak of Italy. Measures were relaxed much too soon, putting everyone are risk. What is needed is constant prolonged pressure?

Easter

All the people outside Easter, through the rest of the week, etc will add fuel to that launch. The East Bay picked the exactly wrong time to loosen social distancing.  Changes in behavior will magnify any rapid rise, that was going to happen on its own, in a Wave III. Such rapid abolition of social distancing could not only cause a reversion to a 3-wave, it could cause a shift from a 3-wave to a 5-wave pattern. Think CAT 3 hurricane vs CAT 5.

No Gasoline on a Fire

 Think of sprinkling water on a roaring fire and reducing the flames to glowing coals. Miscalculate and think the fire is out. You then pour gasoline on those glowing coals prematurely. We needed to wait longer, at least toward June before considering changes in a social distancing / masking policy that appears to have been working. Do not make any policy change that will alter the trajectory so early. Do not let this deadly opponent off the mat to wreak havoc.

COVID-19 Growing Guide

 The weather may also impact this issue. Covid-19 dislikes both heavy rain (washes away virus) and strong prolonged sun (UV kills). It is a surface dweller so hot metal, glass or cement surfaces baked out in the sun likely kill those virus on that surface. Reports from other locals indicate that the worst break outs occur after cool-moderate, cloudy or foggy weather, followed by some sun. Foggy, cloudy weather may in some way “activate the virus” During the foggy period, the virus gets ready and wakes up out of a “relative dormancy”. Sun comes out and people come out. COVID-19 “pounces”. 

 Recent Easter Weather, No Friend

The Saturday, Easter Sunday and Thursday in the Bay Area were foggy in the morning. When the fog rolled out Easter afternoon, a multitude of younger people went out with no regard for social distancing or any other directive, since we had successfully "flattened the curve". Newly thriving, activated virus came into contact with a large number of unwary young people who, think the battle is over. Many will blissfully and unknowingly go home, infecting loved ones at a high rate, many of whom may be in high-risk groups. This Trojan Horse strategy is key to COVID-19s success. Many elderly will be expected to die in the aftermath, given the proclivity of COVID-19 to attack that age group.

Tainted Data

 To confound things further, the Covid-19 data being used for models is tainted. Testing protocol has changed over course of the curve. The curve measures new cases, as confirmed by test. It does not include suspected cases not confirmed. Due to limited test availability, the criteria / threshold) to trigger testing has become less sensitive / higher, respectively. Families where one member tests positive often do not test remaining members. They are told that testing would not change protocol, because all members would require quarantine. These other members are not counted in the curve data. Some free testing walk in centers have shut down, like Hayward Firehouse 7. Their data is no longer being added to stats.

Undercount

If this is happening across the board broadly, then many cases are being missed. As criteria has changed, the curve may even be sloping up on the right side and we may not be seeing it due to incomplete data capture. No one knows anything for sure at this point. We could even be in an early phase 1 of wave III. The tainted data blinds. Like riding into a hurricane with not GPS or radar. Even worse, the radar you have is not accurate and is telling you the weather is clear.

 Mission Not Accomplished

 This premature declaration of victory by the young masses needs to be halted immediately. While this curve going forward could be a more rare 2 wave curve, odds do not favor it. The risks of loosening social distancing are enormous. The center-point of the curve is likely at least a month away based on the shift to the right. The risk of catastrophic results with continued abolition of protocol is high. The fuel of favorable viral weather may be expected to accelerate whatever is going to happen. Should we see 3 or 5 waves, the elderly will become sick in droves and hospitals will be swamped. 

Stick to What Was Working

The downsides of reemphasizing shelter-in-place, social distancing and return to mask use are small in comparison. Its tough to turn that ship around, but the alternative is to drive right into the storm head on. We need to try to take some momentum out of the situation. Even more aggressive measures are needed than one week ago to suppress the damage that has been done by relaxation of measures. One of the few options available, in addition to reissuing shelter-in-place and social distancing, is mandatory mask use.

 Timing

Given a 5-7 day incubation period, after several virus-favorable days, we may start to see the leading edge of a surge of elderly patients starting late April This is not a guarantee and further boluses may be needed to hit a certain threshold for a surge. We are getting closer to that point, however. We still may be able to change subsequent boluses, tipping point and ultimate magnitude of that surge. If by providence we are to avoid a large wave up, we would need to wait a month or two to be able to give that alternative a higher probability.

Summary

Elliott Wave observation is that a simple 2-Wave pattern in biologic systems are rarely observed. The odds that the COVID-19 curve is a simple 2-Wave curve are low, perhaps less than 10-15 %, as this is not an exact science. While it is certainly "possible" the Bay Area may only see a 2-wave structure and shelter-in-place and social distancing with a brief period of masking did the job, it is not the high probability play.

Across the world that has not been the experience. The point we are at now is not even 1/2 way to an expected center-point. The sudden abolition of social distancing / masking may convert what would have been a lower grade curve to higher ones at every level. Do not release the pressure on COVID-19, no matter how much you "predict" and "think" you have successfully flattened the curve. Be patient and sustained in efforts and that time may come.

  CONCLUSION

 This is a perfect COVID-19 STORM for San Francisco:

 Novel virus where we are unaware of its routines and habits. Cannot assume it will act like Spanish-flu or anything else

 Refusal to learn from overseas and even US experience

 Very patient and stealthy virus with long quiescent set up period

 Long incubation period and high rate of asymptomatic carriers

 Never had hospital, county, State mandate for universal masking

 Breakdown of already weakly observed shelter-in-place, social distancing, “recommended” mask use guidelines since Easter

 Behavior by a large number of young adults who think the coast is clear

 Model assumptions of simple 2-Wave curve are likely wrong

 Failure to consider right center curve shift and timing with social distancing reduction

 Minor alterations during upward boost phase cause large change in trajectory and final destination

 Failure to apply Elliott Wave Theory to viral growth models to assess possible alternatives to simple 2-Wave model

 Due for 3rd wave up anyway given highest probability Elliott Wave Model

 Weather activation of virus at optimal time for infection of young adults

 Flawed data obscuring modeling accuracy

 Virus loves to attack the herd’s most vulnerable at-risk members

 Huge elderly population in Contra Costa and other counties, living in close proximity at nursing homes and retirement centers represent a Covid-banquet

 Limited warning from health groups to at-risk patients 

 Little general community outreach due to failure to recognize significance

Decision makers either unaware of social behavior or overconfident they have succeeded in flattening the curve with shelter-in-place

 No single entity that directs medical policy and response. “Not my job”

 Supply line disruption from China, little US production

 Less than optimal inventory of masks, across State and many hospital systems

 No defined plan as yet for high-capacity sterilization of N-95s for reuse if need be

 Hospital facility numbers of beds, ICUs, ventilators that can not multiply themselves as quickly as a virus (exponentially)

 What could go wrong?

Based on risk profile,

 RECOMMENDATIONS

 San Francisco

1.  Reemphasize shelter-in-place & social distancing, mandate if able
2. Start mandated universal mask use to try to blunt the damage done since Easter 
3. Warn elderly and communities. Warn other communities and States to learn from observations here and use Elliott Wave Theory to help predict curve path. Do not get lulled into sleep by Covid-19 and assume a prolonged wave-II is the same as successful curve flattening. Do not declare victory until Covid-19 is defeated locally late in the curve
4. Failure to act accordingly may result in unintended curve patterns that result in hospitals getting swamped, unnecessary community death, provider overload (not necessarily our own deaths) and deaths of provider at-risk-loved-ones
5. In a best case scenario, we likely need a month or two wait before being able to declare “all is well” Probability of such a benign curve 10-15%.
6. Moderate case scenario  3-Wave, could be as bad as New York. Probability 55%
7. Worst case scenario: 5-Wave: worse. probability 30% and growing if no measures taken

Nation: Early the week of April 13, 2020, the US as a nation announced it considered the curve to be "successfully flattened". Before taking one more step, all eyes need be on San Francisco which may be a bellwether for the rest of the US. Also, just because the curve does something in San Francisco, does not mean it will do that everywhere. Each locale has it own unique attributes that can alter curve shape and locale-specific curve should be generated

 Further Suggestions:

 No change in shelter-in-place, social distancing or masking should be undertaken for a minimum of a month or more. Getting into the community is the best way to take the steam out of the surge. Email, mail, community service messages, phone/video visits. Every patient you better educate is one less that may need hospital care. Controlling youth spread of disease, they are the vectors that cause trouble. Better and more consistent data collection based on uniform criteria are needed to give the best guidance on curve trajectory. Many more test kits are needed, without testing you fly blind. Elliott Wave Statisticians may be able to provide tools and general probabilities about various curve patterns, as we all attempt to predict curve direction. Engage all diverse opinions of various types of statisticians, epidemiologists and analysts. Let the power of reason and logic triumph, rather than wishful thinking, assumption, politics, economics, "conventional wisdom" or group-think. These things can all cloud judgement at a time clarity is essential.