COVID-19 Update - 07/03/2020

My own workup | 07/03/2020 | DoughtyOne

[DoughtyOne]

PING LIST - Please contact me as needed...

COVID-19 Update # 107

As of 07/02/2020 23:15 PDST     United States CDC - Provisional Numbers
As of 00/00/2020 23:45 PDST     Johns Hopkins University - Capture Nations Informaton
As of 00/00/2020 23:45 PDST     Johns Hopkins University - Capture Counties Information
As of 00/00/2020 23:46 PDST     Johns Hopkins University - Process JHU Data
As of 00/00/2020 23:59 PDST     WorldofMeters - Document Core Numbers
As of 00/00/2020 23:59 PDST     WorldofMeters - Capture Nations Information
As of 00/00/2020 23:59 PDST     WorldofMeters - Capture States Information
As of 00/00/2020 00:00 PDST     WorldofMeters - Data Processing begins...
As of 00/00/2020 ??:?? PDST     Publish COVID-19 Update - 00/00/00

Thank you for stopping by to check out the COVID-19 Update.

Here you can find...

Section: 01     Commentary, Special Reports, COVID-19 Update Info, & System Notes
Section: 02     the United States Situation
Section: 03     the Global Community Situation Outside China
Section: 04     the Global Community Situation Including China with reservations
Section: 05     the Mortality Report
Section: 06     Miscellaneous Reports of Interest
Section: 07     the United States, Counties (alphabetical / case no descending)
Section: 08     the United States, States Ranking, Provisional Numbers, & Territories
Section: 09     the United States, Ranked with Other Nations
Section: 10     the End of this COVID-19 Update
Section: 11     Data Sources and a Link to My Own Spreadsheet
Section: 12     Linked Spreadsheet: Counties, States, Provisional, Territories, & Nations
Section: 13     Links to Other Resources

Section: 01

Commentary, Special Reports, and COVID-19 Update Information²
Interesting Tid-bits (hopefully)

U. S. New Cases and the Fatality Rates

We're experiencing our hightest level of New Case declarations since COVID-19
invaded the U. S. We're now approached daily New Cases that compare to our
previous highs at 150%. At the same time, we have dropped below 1,000 daily
Fatalities for nearly a month now. Our Fatalities today are marginally lower
than they were last week. As long as our Fatalities remain in this range
the Herd Immunity theory will gain strength. Even if our Fatalities did rise
a little, it still could. It will be interesting to watch how this turns out.

The uptick in New Cases, is not cause for real concern absent a significant
increase in Fatalities.

China Decides to Play the 'Who Did the Most Testing Game?"

Around 06/23, China started putting out it's testing numbers. I thought
they were suspect. The number they put out was 90,410,000. Ours and most
everyone else's numbers are specific. For instance on 06/28, our number of
of tests at the ned of the day was 32,592,368. That specificity separates it
from the number China put out. It was rounded to the 10 thousandth place. In
addition, China has not updated that number once. So I do not inlude China in
the Nation's Comparison Sort regarding Testing, and any place that reports out
global testing numbers for a tally.

Section: 02

The Following Addresses the Numbers Here in
the United Staetes of America

Here we go...

There you go, our highest single day of New Cases (again).

Concept of adding in Active Cases and Serious Critical here, courtesy of amorphous

Here are more of our numbers...

Active cases continue to climb.

Our Slice of the COVID-19 Pie

The growth of our slice of the pie has been dropping recently.

Here are the numbers I've been tracking, Globally Declared and Active Cases.

After falling for a period of time, we are now seeing our slice of the global
pie grow again. This had been one of a few metrics that were making it look
like we had turned the corner. Now it no longer does. It should be taken into
consideration the types of testing they are doing, and how they are lumping them
in though.

This Update doesn't seek to give all the answers. It is presented
for a base level understanding of where we are, and there are a number of
impactful reports out there that can fill in the gaps. I encourage folks to
read up on what is being reported out.

I know I don't have to tell 97.5% of you this, but there still seems to be some
folks in these parts who haven't the brain cells required to realize you are
well aware of the dynamics of all this.

Active Cases in the United States / Chart

Unlike some of the other charts here, we should see a good rise and
fall at some point withone.

Note that this presents the one day and then 7 and 14 day averaging versions.

Remember, these are not new Declared Cases. These are remaing Active Cases.

Clearly the single, seven, and fourteen day lines are moving way up.

Testing and New Case Figures
Requested by stocksthatgoup

Some folks have shown an interest in seeing the COVID-19 Test figures compared
to the New Cases being declared. The following Data addresses that.

Testing was high again yesterday. It is 40% higher than the average several weeks
back. Our New Cases totalled 57,236, but if divided by 1.40, the case number would
have been 40,960. I think that's worth mentioning. That daily percentage rate
is not something I want to see.

That being said, one theory out there assumes the higher level of positives, the
better. The more of the herd that has been exposed and survived, the better for
defeating this disease.

We can see what I consider to be data noise on the end of that trail. Several
days back, we had a large number that was unrealistic reported out.

The U. S. Stats / w 10 Day Averaging / Fr: 03/17
Requested by: Texas Eagle

This data and chart presents things in a little different way. In the
chart it is easy to see the relationship of these numbers.

The Chart will use the data all the way back to 03/17, but the data displayed
here will only go back one month.

Here is the chart to match.

These seemed to be getting closer each day, but the Active Cases is veering
back up.

Section: 03

The Following Addresses the Global Numbers
without Mainland China

Here is the first set of Data for the Global Outside China
Territories

There's a high number. Sadly, Friday's may be higher.

Fata.lities, Recoveries, Resolved, Active Cases, and
Serious/Critical Cases - Globally, Excluding M/L China
Concept of adding in Active Cases and
Serious/Critical here, courtesy of amorphous

Here we go...

For your review...

How is the Global Community Outside China Doing,
Without U. S. numbers?

Let's see...

This metric subsided a bit yesterday.

New Cases fell off yesterday, globally. Our new cases set a new record for the
day. The blue columns tell the story.

These charts are now not only seeing growth internationally, but domestically
as well.

The Active Cases outside China Globally / Chart

As in the U. S. version of this, we should see a good rise and fall at
some point these two.

Note that these present the one day and then 7 and 14 day averaging versions.

Remember, these are not new declared Cases. These are remaing active cases.

Global Active Cases returned to growth again yesterday.

Special Section on France, Germany, Italy, Spain, and the U. K.
Case growth.

Jim Noble mentioned he'd like to see the US numbers added here. I added them
in on 06/21/2020. I did not add them to the chart because it would have
dwarfed the European nations chart lines. (they would have been reduced to
about 15% of their normal size)

Let's Look at Some Numbers in Five Day Increments:

Hard to miss the correction in the direction of the U. K. there. I double checked
the data, and this had been the number spit out by my two last reports for
the day. It is accurate. Unless a correction occurs, the U. K. just changed
direction. One wonders if the U. K. just found they weren't using the same
counting and reporting guidelines other nations were.

Sweden and It's Neighbors, Who Has the Best Tactic Against COVID-19?

Sweden is doing its own thing with regard to isolating. I think most people
are aware of it by now.

Here are some numbers to help us look at this issue.

Sweden still remains a hot topic, and it's tragectory IS NOT looking good
on that Chart. In it's own group, it's not good at all. If you compare it
to some European Nations, it looks no worse.

Movers and Shakers...

I will present the top fifty nations with the most New Cases and New
Fatilities.

Here we go...

Some good and bad there. Remember, our testing was at 140% compared to a couple
of weeks ago. If the testing was at the same level, yesterday's number would
have been around 40,960.

Global osChina Stats / w 10 Day Averaging / Fr: 03/05
Requested by: Texas Eagle

This data and chart presents things in a little different way. In the
chart it is easy to see the relationship of these numbers.

The Chart will use the data all the way back to 03/05, but the data
displayed here will only go back one month.

Here is the chart to match.

I like being able to follow the movement of these stats visually.

Section: 04

The Following Addresses the Global Numbers
including Mainland China*

Mainland China's numbers are 0.010% of today's total global numbers.

A Look at Declared, Resolved, and Active Cases, Includes M/L China

End of day figures follow:

The percentage missed my target dates of 06/25-26 and then 06/27-28, but I think
we are lucky to see that Recolved Cases number above 60% at this time.

Fatalities, Recoveries, Resolved, Active, and Serious/Critical
Cases Globally, Including M/L China
Concept of adding in Active Cases and
Serious/Critical here, courtesy of amorphous

For your review...

Section: 05

the Mortality Report

Here is the data for four entities...

Here are the figures for the growing case totals for four entities.

We hear all sorts of stories about how these figures are wildly off. The CDC
has studied them and seems to think they may actually be on the low side of
things. I am providing the CDC Provential Numbers down below. Not sure if
anyone has a rock solid number. I doubt it is possible. This is what is
reported out by WoM and JHU. Check out the CDC numbers too.

Charts like this one only show growth. That's why I recently took the advice
of a FReeper and added in a new chart for the U. S. and Global outside China
regions.

Here are figures revealing the daily growth for those four entities.

US Fatalities continue to remain in sub-1,000 territory.

We have looked very good in this area recently, but I am very concerned what we
will look like in a week, what with the growth in new cases. IMO < deaths are
about to join New Cases in growth. Who knows, maybe I'll be surprised by no
growth.

Here, let's look at data for the U. S. broken out by itself.

In the lasts 27 days, we have looked very good in this area. I'm not sure we've
had even one clean count day over 1,000 out of those 26 days.

New York, New Jersey, I'm sure you'll have a very hard time figuring out where
they botched things... /s

Section: 06

Population Saturation

Here are figures revealing how many people in each population base represent one
case. I'm also showing what percent of each population base is infected at this
time.

We're still slipping here, and I'm looking forward to better numbers.

Nations With Lots of Cases

At the end of the day yesterday, there were:

It's hard to belive there are that many nations with massive numbers.

Daily Case Report Evaluation

I'll be keeping tabs on the daily tallies for days of the week for a while. Folks have
noticed some patterns of larger and smaller data entry on certain days, and on Fridays
sometimes the numbers get noticeably larger because of it.

And we now know Thursdays have potential to break out also. Yikes!

IMO Let's check out the numbers and a chart.

Those numbers are pretty impressive, but if Fatalities remain low, the Herd
Immunity folks will score points. Let's see how it goes.

Section: 07

The Top 200 Counties in the U. S., by Number of Cases

This little report lists 200 Counties in the United States in declining Case numbers.
There is also a listing that is alphabetical. This report list only the entities
and the number of Cases in the two different sorts.

It will also be available as a downloadable Excel file in Section 12.

Section: 08

States of the Union and the District of Columbia, Compared to Each Other

Each of these pages is sorted differently. Look at the red header above
the columns to see which column was used for the sort on any given page.

For your review...

For your review...

For your review...

For your review...

For your review...

For your review...

For your review...

For your review...

For your review...

If this area interests you, please use this LINK to the source, and review
the lengthy description and explanation of it's development process.

There are two reports. The presentation above comes from the second one,
and the detailed segmented information below it, may interest you.

These can now also be found under the states on the Alphabetical list. The
states and these entity's numbers should be combined to match that of the
U. S. figures each day.

Section: 09

The United States, Where it Ranks With Other Nations?

Each of these pages is sorted differently. Look at the red header above
the columns to see which column was used for the sort on any given page.

The U. S. will be highlighted red here so we can find it easily in the list.
There was 215 nations on this list last night now. I didn't want to post
seven lists with 215 nations on it, so I picked the top 50. Coincidentally,
one report category had the U. S. at 41st, so it wasn't showing up on the
list with the 31 top nations on it. That wasn't the reason why I extended the
list length, but it did work out well.

I work on the nations right next to the states on my spreadsheet. The
states with the District of Columbia come in at a total of 51 lines.
I decided to keep the international reports near that length, and 50
was good enough.

Here we go... for your review.

For your review...

For your review...

For your review...

For your review...

For your review...

For your review...

We spent a number of days in the 26th slot, but now we're stuck in 27th place.

Progress...

Section: 10

Here is what it is all about. From January 20th to the present.

This concludes our look back at yesterday's data. Take care...

Court Sesy of: foldspace

Section: 11

Data for this Report Sourced From:

LINK   WorldoMeters

LINK   Johns Hopkins University
               The Center for Systems Science and Engineering (CSSE)

LINK   United States Center for Disease Control - Provisional Numbers

Listed in the order of current utilization...

LINK   You are Invited to Review My COVID-19 Spreadsheet (XLSX)
               There is not an XLS version available for distribution at this time.

Section: 12

Other Features:

LINK   US Counties²⁰⁰, States & DC⁵¹, Territories & Other Entities¹¹, Nations²¹⁴,
                and the CDC Provisional Counts⁵³
                Five Excel Spreadsheet datasets you can sort for your own studies...

Section: 13

Links to other resources:
I cannot vouch for these sites. Please use your own judgement.

LINK   Adventist Health Coronavirus Resource Hub - Scroll down for useful info

LINK   Antibiotic Vitamin, the (Vitamin D)
               Good article on Vitamin D's likely role in prevention of infection. Thanks Blam.

LINK   CDC Data for Download - Scroll down - Excel required. Includes death stats.

LINK   CDC National Center for Health Services
               Provisional deaths as determined by review of vital documents. Much lower...

LINK   CDC Secondary Data and Statistics - Portal Entry / Look around

LINK   Coronavirus (COVID-19) Map

LINK   Coronavirus infection risk may be reduced by Vitamin D
               by Former CDC Chief Dr. Tom Frieden

LINK   Coronavirus Spread Quickly Around the World in Late 2019, Study Shows
               the University College London Genetics Institute

LINK   COVID-19 Deaths Broken Out by Thirds, 05/07/20 Map of US Counties
               Very revealing display of Concentrated Death Zones - thanks hoosiermama

LINK   COVID-19 First U.S. Case, Treatment, features Remdesivir
               New England Journal of Medicine article

LINK   Cytokine Storm, med Actemra, Physician near death saved

LINK   Diamond Princess Review at 634 Case Point of Eventual 712

LINK   Hydroxychloroquine Article: International Poll
               Daily Mail Reports, Most Effective Treatment According to 6,000 Physicians

LINK   Hydroxychloroquine Has about 90 Percent Chance of Helping COVID-19 Patients
               the Association of American Physicians and Surgeons, reports 91.6% of patients improved clinically

LINK   IHME - Institute for Health Matrix and Evaluation

LINK   National Institutes of Health - Cornavirus (COVID-19)

LINK   Nasal Irrigation is the Key, COVID-19 Related

LINK   New York City - interesting breakdown, borough, age, sex

LINK   On the Origin of CCP Virus, A Documentary Movie (turn up the sound)
               Epoch Times: I highly recommend this very well documented report.

LINK   R_t COVID-19
               Calculates and displays the R_t Factor for each state. Thanks FreedomPoster.

LINK   World Health Organization

[DoughtyOne]

[familyop]

"As long as our Fatalities remain in this range the Herd Immunity theory will gain strength."

It will gain strength, thanks to the anarchists leading the way for the radical left with a flood of disinformation to manipulate oblivious conservatives. Except for the vaccine on the way after Democrats take all three branches of government by way of this propaganda campaign, we wouldn't see any benefit from "herd immunity" for years.

Here's one example from the torrent of misinformation.

Numerous studies by dozens of scientists show that masks and social distancing have no effect.
(by Denis Rancourt)
https://www.freerepublic.com/focus/f-chat/3861704/posts

So I posted...

Denis Rancourt
Wikipedia

The stated reason for the University of Ottawa's actions was Rancourt's assigning of A+ grades to all students in his fourth-year physics courses in the Winter 2008 term. These courses include Quantum Mechanics (a required course) and Solid State Physics.[30]

Rancourt states the administration's actions in general, and his dismissal in particular, are influenced in part by the Israel lobby and the military-industrial complex.[31][32][33] He has stated that his dismissal may be related to his political views, specifically his position on the Israel-Palestine conflict,[34] and wrote in his blog that university of Ottawa president (and former Minister of Justice) Allan Rock appears to be "a point-man of the Israel lobby at the University of Ottawa."[35]...

During the hearings the University accused Rancourt of "inciting students to violence", and put a YouTube music video about anarchism into evidence.[42][43][44]...

On 26 October 2007, American Senator James Inhofe (R-OK) referred to the blog by Rancourt during a floor speech aimed at disputing evidence advanced by climate scientists. He noted that "Rancourt--a committed left-wing activist and scientist--...

The following article from was another report from the drug infested gutter of the left. Fox News was duped into running the piece. I dissected it to show what we're up against.

Mother whose son died of a drug overdose during coronavirus lockdown: 'We’re in a crisis right now'
https://www.freerepublic.com/focus/f-news/3861354/posts

[DoughtyOne]

When someone presents a study to me, I recall the thousands
of scientists state... line of reasoning, when it came to
global warming.

I used to have people present studies to me. Two people
could take a look at one issue, both present reasoned
studies and both be right.

Studies aren’t worth the paper they are written on all
too often.

I wear a mask. I’m not going to lose sleep over what others
do.

[cherry]

long and the short of it, there's a virus going round....long and the short of it, the world will have to get to 2 million deaths to equal relatively to the Hong Kong flu...

and its amazing to me that NOTHING shut down then...nothing....

and will all our international travel, with all our illegals coming and going, with our food and med supply coming from foreign countries, we should all be dead by now....

yet we aren't....I go out and nobody seems to be upset or panicked...

I know of only one single person that got stay at home covid...no family, no friends, no neighbors, no coworkers....I bet I'm not alone....

question to settle it all.....why haven't the homeless been wiped out?....why....

end this siege.....open my country....stay home if you're afraid....

[cherry]

long and the short of it, there's a virus going round....long and the short of it, the world will have to get to 2 million deaths to equal relatively to the Hong Kong flu...

and its amazing to me that NOTHING shut down then...nothing....

and will all our international travel, with all our illegals coming and going, with our food and med supply coming from foreign countries, we should all be dead by now....

yet we aren't....I go out and nobody seems to be upset or panicked...

I know of only one single person that got stay at home covid...no family, no friends, no neighbors, no coworkers....I bet I'm not alone....

question to settle it all.....why haven't the homeless been wiped out?....why....

end this siege.....open my country....stay home if you're afraid....

[cherry]

sorry for the double.

[DoughtyOne]

Thanks for voicing my opinion so nicely.

[familyop]

“Old Lives Matter” T-shirts. :)

https://www.amazon.com/s?k=old+lives+matter+shirt&ref=nb_sb_noss

I don’t buy from Amazon any more, but the home sites of some of the vendors can probably be tracked down.

[familyop]

I wear one when going indoors in a crowded business, which is often necessary. By the way, nearly no one is wearing a mask, Democrat or Republican. I see hundreds of them at a time on most days, and they’re from all over the country (nearby interstates).

[Badboo]

CDC changed the definition of cases to include probables. And they vastly expanded probables. See:

https://theconservativetreehouse.com/2020/07/02/explosive-about-all-these-new-positive-covid-cases-state-health-departments-manipulating-data-changing-definitions/#more-195940

Our WV dashboard now notes this and it still tracks positive test cases and probables separately but it adds in the probables for total cases per CDC

Other states may not keep them separate now. And given the expanded definition of probable it may add alot.

[Presbyterian Reporter]

Here is the latest from Florida-—nothing much has changed over the past two weeks. New cases are high-—deaths are low.

45% of new cases in Florida are in the 15 to 35 age group (AKA The Invincibles)

10% of new cases in Florida are in the above 65 age group (AKA The Vulnerables)

What are other FReepers seeing in their state?

I started tracking Florida Hospitalizations by age group today. In a couple more days I will have something or nothing to report.

[bgill]

All of the deaths in my county have been after TX reopened in May and our cases have gone through the roof this past month.

[Paul R.]

My observation: Slight uptick in mask wearing by customers @ Wally World yesterday (here in the mid-south US): By my count it was up to 23%, from a low of 19% several days before. Both visits were mid-afternoon weekdays. The latter was a shorter visit (only ~20 minutes) — in any event all my “masks worn” numbers should be taken as anecdotal and with a grain of salt.

[lightman]

If you are afraid go hibernate yourself.

Don’t expect me to subsidize your miserable existence—and I write “existence” because that certainly isn’t a lifestyle in any sense of the word “life”.

“It is better to die free men than to live as [masked and muzzled] slaves”

T. Jefferson, 1775.

[steve86]

My count in stores today was 100%. Outdoors, such as people walking on the sidewalk by the store, maybe 20%.

[Paul R.]

I follow CA and TX loosely as I have a brother in each, and we are all 60 or older. Ditto for FL, except that's for business reasons and friends there.

My state (IL) is not doing badly except that it's economy is even more crushed than before.

CA and TX are doing poorly. TX is seeing a strong rise in daily new cases and a solid, sustained increase in daily fatalities. (Are FReepers going to attack TX for "playing" a numbers game of increases?) CA is also seeing a big rise in cases, by itself not necessarily an immediate concern, and has "flatlined" on fatalities for a few weeks now. This assumes a new data glitch* is not hiding an actual beginning of an increase in fatalities in CA and nationally.

FL is also showing strongly increased cases and an uptick in fatalities that never really declined much from their maximum to begin with.

If we sort of split the US into states doing well, and states doing poorly, a potential problem becomes obvious: The declining fatalities in states doing well at present are sort of "cancelling out" the increasing fatalities in states like TX. However, the states doing well will soon run out - well, "run low", anyway, of deaths to substantially reduce further. For the states doing poorly, potential increases have yet to be seriously tapped. It is reasonable to suspect that left alone, the latter trend will overwhelm the former in coming weeks. Of course, it won't be "left alone", but that causes all sorts of other problems.

*Of note: Worldometers reported 616 fatalities from COVID-19 in the US today, so this week appears to follow the trend of declining fatalities, but with a slowing rate of decline recently. Even setting aside the prior paragraph, I'm still calling it a 50 / 50 chance that the fatalities curve has bottomed out or is bottoming out. My point is, though, WOM ALSO states: California: Los Angeles County has not reported data today ""Public Health will be improving our data processing systems and will not report data beginning on Friday, July 3rd until Monday, July 6th."

LA County is quite significant: It is over 1/2 of CA's fatalities.

Last, on a sustained basis, a bit over 500 fatalities per day nationally is hard for me to accept. If maintained over the next 8 months, and added to 3/1/2020 - 6/30/2020, that puts us at roughly 330,000 fatalities in 1 year's time. That's a pretty grim number.

[Paul R.]

How does that look vs. available ICU capacity? Not that I’m convinced pushing 100% ICU capacity is a good thing!

[Paul R.]

We never got anywhere near 100% except in establishments that required customers to wear masks. Maybe 2/3 (guess - I was not doing actual counts, then.) Granted that cases around here were and so far are staying low.

[exDemMom]

That being said, one theory out there assumes the higher level of positives, the better. The more of the herd that has been exposed and survived, the better for defeating this disease.

I don't know of a gentle way to say this, but hopes for herd immunity are based on false assumptions. With its R0 around 2.5 (this is not an exact number, but falls within a range), around 60% of the population would have to have immunity in order for herd immunity to kick in. In terms of the US population, this would require 198 million people to be infected with Covid-19, at a cost of 9.2 million deaths (at the current death rate of 4.63%).

However, a recent study Sanche S, Lin Y, Xu C, et al. High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2020;26(7):1470-1477. doi:10.3201/eid2607.200282. estimated that the median R0 is 5.7. (I have doubts about their methodology, but will take it at face value for the purpose of discussion.) According to these authors, with R0=5.7, 82% of the population would have to be immune in order to achieve herd immunity. That would require 270.6 million US infections, with 12.5 million deaths. I should also point out that as cases increase and the health care system becomes increasingly overburdened, the death rate will also increase. Note: I am using a population of 330 million US persons for the purpose of calculations.

Oh, to determine required herd immunity from the R0 number: herd immunity is 1 – 1/R0.

1-1/2.5=0.6

1-1/5.7=0.82

Never in history has herd immunity ever stopped the spread of a naturally circulating disease. We have achieved this through the use of vaccines for several diseases, but there is no Covid-19 vaccine. Furthermore, there are too many uncertainties in vaccine development to have any confidence that a vaccine will be available any time soon. A normal vaccine development timeline is ten years, but that only happens when all of the stars align, which they rarely do. Covid-19 is a special case, in that there is urgent interest in getting a vaccine through FDA approval as soon as possible, but there are still realities about vaccine development that can't be rushed, no matter what the urgency.

I know that people don't like wearing masks and staying 6 feet apart. I get it, I'm particularly claustrophobic about wearing masks myself. But for now, those are pretty much the only tools we have to limit disease transmission. And they do work; several studies have already been published on that matter.

As for testing, it is a valuable tool for the control of disease spread. Ideally, as the number of tests increases, the rate of positive results decreases. Identifying and isolating infected individuals until they are no longer contagious is a key factor in containing the disease.