Scenarios and

Projections for COVID-19

in Arizona: Update 2
Tim Lant, PhD, MAS; Megan Jehn, PhD; Esma Gel, PhD; Anna Muldoon, MPH;
Heather Ross PhD, DNP, ANP-BC
4/8/2020; Revised 4/20/2020
Arizona State University
DRAFT materials prepared for the
Arizona Department of Health Services – Modeling Working Group
AZ Situation Update: Data and
Modeling WG
Impossible to know if contribution to increased cases is due to increased testing or spread of
disease.

Change in testing criteria on 3/28 – no longer testing symptomatic.

Increased severity of social-distancing measures 3/16, 3/21, and 3/31.

Estimates for undetected cases in the US are currently around 1 in 11 (9%-14%).

ADHS has assembled this modeling working group to prepare projections for state.
April 20, 2020 Situation Update

• Daily forecasts derived

from ADHS and
commercial lab testing
data
• Monitor testing data
and public health
interventions as the
basis of estimates
AZ Situation Update
• COVID-19 Testing Results for April 20

20-Apr Positive Negative Deaths Total

ADHS 5,064 31,838 187 54,500
COVID tracking
(daily) 2,489 1,038 3 21,125

Total 5,064 49,436 187 54,500

Estimating Undetected Cases
COVID-19 CLINICAL SEVERITYPYRAMID -Arizona
8-Apr-20
Detected Total

Deaths: 1.61% 80 50

Ventilator: 6.45%

ICU Bed 7.34%

Total HospitalizedCases: 16.3% - 3,587

Total Symptomaticbut 2,726 14,347

UnhospitalizedCases: 65.2%

Total AsymptomaticCases: 18.5%

4,071

Credit: Tim Lant, Arizona StateUniversity

2,726 22,005

Current estimates from J. Shaman (2020) and A. Perkins (2020) that 9% - 14% of
infections are detected.
Epidemiology Signal Arizona COVID-19 Testing
6000

4/19: Still increasing at

approximately linear growth

• Growth is rapid, but has 5000

slowed 4/8: Growth is slowing down.

3/16 limited gatherings; 3/20
4000 bars and restraurants close;
• Doubling times 3/31 stay-at-home.

• March 17-24: 1.7 days 3000

• March 25-April 8: 5.3

days 2000

• Does not include 1000

undetected cases
0
20 20 20 /2
0
/2
0
/2
0
/2
0
/2
0
/2
0
/2
0
/2
0
/2
0
/2
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/2
0 20 20 20 20 20 /2
0
/2
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/2
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/2
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/2
0
4/ 6/ 8/ 10 12 14 16 18 20 22 24 26 28 30 1/ 3/ 5/ 7/ 9/ 11 13 15 17 19
3/ 3/ 3/ 3/ 3/ 3/ 3/ 3/ 3/ 3/ 3/ 3/ 3/ 3/ 4/ 4/ 4/ 4/ 4/ 4/ 4/ 4/ 4/ 4/

Positive Pending Deaths

Testing Signal
Rolling weekly positive COVID-19 test rate
• Information about 8000

4/20: Positive test rate has increased

0.8

negative tests results 7000 steadily over time to over 12%

indicating higher burden of COVID-19
0.7

released March 27. 6000

disease in population. If Arizona
were well past the peak, this would
0.6

• Positive test result drops to

fall quickly.
5000 0.5

<10%. 4000 0.4

• Range of 8%-10% is 3000 0.3

consistent with other US 2000 0.2

cities with community 1000 0.1

spread 0 0

4/1/20
4/2/20
4/3/20
4/4/20
4/5/20
4/6/20
4/7/20
4/8/20
4/9/20
3/10/20
3/11/20
3/12/20
3/13/20
3/14/20
3/15/20
3/16/20
3/17/20
3/18/20
3/19/20
3/20/20
3/21/20
3/22/20
3/23/20
3/24/20
3/25/20
3/26/20
3/27/20
3/28/20
3/29/20
3/30/20
3/31/20

4/10/20
4/11/20
4/12/20
4/13/20
4/14/20
4/15/20
4/16/20
4/17/20
4/18/20
4/19/20
4/20/20
Tests Positive %
Transmission
AZconfirmed cases- logscale
• Early stochastic effects 9

• Fast exponential growth 8

Early contact based
spread. Limited
• Slowing growth 7
transmission and contact
tracing. Beginnings of
6
community infection.
Reduced transmission
5 due (hopefully) to
social distancing and
4 increased testing.

Undetected disease
2 transmission,
sustained community
1 spread, and cases
increase in severity.
0
3/7/20
3/8/20
3/9/20

4/1/20
4/2/20
4/3/20
4/4/20
4/5/20
4/6/20
4/7/20
4/8/20
4/9/20
3/10/20
3/11/20
3/12/20
3/13/20
3/14/20
3/15/20
3/16/20
3/17/20
3/18/20
3/19/20
3/20/20
3/21/20
3/22/20
3/23/20
3/24/20
3/25/20
3/26/20
3/27/20
3/28/20
3/29/20
3/30/20
3/31/20

4/10/20
4/11/20
4/12/20
4/13/20
4/14/20
4/15/20
4/16/20
4/17/20
4/18/20
4/19/20
4/20/20
 Model1 Details
6 days

IA
R
18.5%

3 days
S E

Ihome ICU
2 days
IP IS REC
20% 6 days
2 days 3 days Ihosp 45% ICU D
22%
Transmission Dynamics:
Beta_A = 0.55 * Beta_S
Beta_P = 0.55 * Beta_S 6 days 8 days
Beta_S = 0.30
Beta_home = 0.20 * Beta_S
Beta_hosp = 1 * Beta_S 0.1=0.45*pD => pD=22%
Beta_ICU1 = 0.20 * Beta_S
Beta_hosp = 0.20 * Beta_S Results in an overall mortality of 2% among symptomatic individuals
 Pyramid of Disease Severity
• The assumed parameters in the
model are all sourced from recent
results
DEATHS:1.61%
• The top of the pyramid implies
VENTILATOR: 6.45%
significant healthcare resource IN ICU: 7.34%
requirements
TOTAL HOSPITALIZED CASES: 16.3%

TOTAL SYMPTOMATIC BUT

NONHOSPITALIZED CASES: 65.2%

TOTAL ASYMPTOMATIC CASES: 18.5%

Assumptions & Parameters
Assumptions & Parameters
Scenarios and projections
• We considered five scenarios to provide a range of projections on
• Total number infected – includes asymptomatic and pre-symptomatic
• Total symptomatic patients – includes all patients who are non-hospitalized
• Hospitalized patients – patients in regular hospital beds and ICU
• Patients in ICU
• Patients on a ventilator
 Scenarios:
Scenario Description

Scenario 1. Best case scenario. Assumes “high” effective social distancing with an low effective transmission rate (beta = 0.15). Assumes that
asymptomatic transmission is negligible with a 1X unconfirmed multiple. A beneficial Summer effect is modeled by reducing beta by half (to
0.075) on May 1.

Scenario 2. Moderate transmission; no underreporting. Assumes continued social distancing with moderate compliance (beta = 0.25) Summer effect
is modeled by reducing beta by half on May 15.

Scenario 3. Best fit: Assumes undetected cases are 4X known cases and can transmit asymptomatically (beta = .20). Summer effect is modeled by
reducing S by half on May 15. Assumes no additional mitigation, but high compliance with current social distancing orders. This scenario is
the current best fit to the data.

Scenario 4. Limited re-opening scenario. Limited asymptomatic transmission, limited re-opening. This scenario assumes a slightly increased
transmission consistent with limited re-opening and congregation of small groups(beta = 0.25). Assumes 4X undetected cases as initial
infections. Summer effect is modeled by reducing S by half on May 15. Same as scenario 3 with increased transmission.

  Late testing scenario: Assumes a high number of infectious, undetected cases (11X) that would be consistent with rolling out testing in the
Scenario 5. middle of a large outbreak (similar to Wuhan or Italy). Current social distancing (beta =0.2). Summer effect of reduced transmission rate,
beta to 0.10 after May 15.
 Total Infected
• Total infected includes asymptomatic and pre-symptomatic individuals, who
may be transmitting the disease
• The sharp decline in Scenario #5 due to the reduction in transmission rate
due to summer effect Confirmed Infected Cases

• Assumes May 15 for reduction 45000

40000

In transmission 35000

• Summer effects not yet known 30000

25000

20000

15000

10000

5000

5/1/20
5/4/20
5/7/20

6/3/20
6/6/20
6/9/20

7/3/20
7/6/20
7/9/20
Date
4/10/20
4/13/20
4/16/20
4/19/20
4/22/20
4/25/20
4/28/20

5/10/20
5/13/20
5/16/20
5/19/20
5/22/20
5/25/20
5/28/20
5/31/20

6/12/20
6/15/20
6/18/20
6/21/20
6/24/20
6/27/20
6/30/20

7/12/20
7/15/20
7/18/20
7/21/20
7/24/20
7/27/20
7/30/20
Scenario1 Scenar io 2 Scenario 3 Scenario 4 Scenario 5
Symptomatic Infections
• A large number of the symptomatic infections will recover at home
• Due to social distancing measures, we assumed that these individuals with
transmit the disease at a lower rate
 Hospitalized Infections
• A portion of the hospitalized infections are in ICU, which we track separately due to the
significant resources need to care for ICU patients
Hospitalizations by scenario
1400

1200

1000

800

600

400

200

0
1
4
7
10
13
16
19
22
25
28
31
34
37
40
43
46
49
52
55
58
61
64
67
70
73
76
79
82
85
88
91
94
97
100
103
106
109
112
115
Scenario1 Scenario 2 Scenario 3 Scenario 4 Scenario 5
Patients in ICU
• ICU resources can be critical to save lives
• In particular, several sources have pointed to longer ICU stays by patients that
eventually recover
• ICU stays can be as long as 14+ days for these patients
ICU - All scenarios
700

600

500

400

300

200

100

0
5/1/20
5/4/20
5/7/20

6/3/20
6/6/20
6/9/20

7/3/20
7/6/20
7/9/20
Date
4/10/20
4/13/20
4/16/20
4/19/20
4/22/20
4/25/20
4/28/20

5/10/20
5/13/20
5/16/20
5/19/20
5/22/20
5/25/20
5/28/20
5/31/20

6/12/20
6/15/20
6/18/20
6/21/20
6/24/20
6/27/20
6/30/20

7/12/20
7/15/20
7/18/20
7/21/20
7/24/20
7/27/20
7/30/20
Scenar io1 Scenario 2 Scenario 3 Scenario 4 Scenario 5
Projected Infections: Low, medium,
high Projected Infections: High, Med, Low
(Estimate Made 4/20)
50,000

45,000

40,000

35,000 current

30,000

25,000

20,000

15,000

10,000

5,000

Low Inter ventions Hi Interventions

Projected Hospitalizations: Low,
medium, high Projected Hospitalizations: High, Med, Low
(Estimate Made 4/20)
1,400

1,200

1,000
Current
800

600

400

200

0
4/8/20 4/15/20 4/22/20 4/29/20 5/6/20 5/13/20 5/20/20 5/27/20 6/3/20 6/10/20 6/17/20 6/24/20 7/1/20 7/8/20 7/15/20 7/22/20 7/29/20

Low Inter ventions Hi Interventions Min interventions

Projected ICU visits: Low, medium,
high Projected ICU visits: High, Med, Low
(Estimate Made 4/20)
800

700

600
current
500

400

300

200

100

Low Inter ventions Hi Interventions

Projected Ventilator Use: Low,
medium, high Projected Ventilation Use : High, Med, Low
(Estimate Made 4/20)
700

600

500 current

400

300

200

100

0
20

20

20

20

20
0

0
/2

/2

/2

/2

/2

/2

/2

/2

/2

/2

/2

/2
8/

6/

3/

1/

8/
15

22

29

13

20

27

10

17

24

15

22

29
4/

5/

6/

7/

7/
4/

4/

4/

5/

5/

5/

6/

6/

6/

7/

7/

7/
Low Inter ventions Hi Interventions

Assumes 88% ventilator utilization for ICU patients

Model Comparison: All scenarios
Forecasts of peak week and peak resources - COVID-19 Arizona

• Our model predicts

1,000,000

infections will peak around 100,000

the middle of May

• Model is highly-sensitive to 10,000

social distancing and 1,000

increased temperature
• A wide range (1-2 order of 100

magnitude) in outcomes is
still feasible with 10

uncertainty in undetected 1

cases 15-May 16-May 17-May 18-May

Total Infected
19-May 20-May

Hospital Beds
21-May

ICU
22-May

Vents
23-May 24-May 25-May
Recommendations:
1. Adopt a baseline planning scenario
with “low” and “high” excursions. 700,000
COVID-19 Current Infections (estimate made 4/1/20)

2. Discuss & reach consensus on 600,000

importance of predicting peak week. 500,000

400,000

Axis Title
3. Update forecasts based on new 300,000

information weekly(?) 200,000

4. Prioritize additional analysis

100,000

0
4/2/20 4/9/20 4/16/20 4/23/20 4/30/20 5/7/20 5/14/20 5/21/20 5/28/20 6/4/20 6/11/20 6/18/20 6/25/20 7/2/20 7/9/20 7/16/20 7/23/20 7/30/20
“This is unlike other disasters - hurricanes, earthquakes,
floods. They happen, they're fast, they're over, you start
rebuilding...This is ongoing & the duration itself is
debilitating & exhausting & depressing.”

-New York Governor Cuomo

About the author
Timothy Lant, PhD, MAS
Dr. Timothy Lant is the Director of Program Development for the Knowledge Enterprise at Arizona
State University where he supports the identification and development of research funding
opportunities for the Biodesign Institute and other university initiatives. Dr. Lant is an expert in
pandemic modeling and response.
 
Between 2012 and 2017, Dr. Lant served as the Director of the Division of Analytic Decision
Support within the Biomedical Advanced Research and Development Authority (BARDA) of the
Department of Health and Human Services.  Dr. Lant led a team of scientists and subject matter
experts to predict the medical and public health consequences from infectious diseases –
including the 2013 H7N9 Influenza outbreak in China, the 2014 Ebola outbreak in Western Africa,
and the 2016 international Zika outbreak – and terrorist attacks with chemical, biological,
radiological, and nuclear weapons.  Dr. Lant also led the Interagency Modeling Coordination
Group and directed the development of the HHS Innovation Lab, located at HHS Headquarters in
Washington, D.C., which includes a state-of-the-art modeling and visualization hub to coordinate
interagency modeling activities during times of public health response. 

From 2005 – 2012, Dr. Lant served as Research Director and Assistant Research Professor with the
Decision Theater at Arizona State University. Dr. Lant holds a Ph.D. in Applied Mathematics from
Arizona State University, a Master of Actuarial Science, and a B.S. in Mathematics from Georgia
State University. 
Backup Slides
Model Comparison: External models
Forecasts of peak week and peak resources - COVID-19 Arizona
10,000,000
Tim Lant -
healthdata.org Tim Lant
Middle
1,000,000 Joe Gerard Scenario

100,000

10,000

1,000

100

Act now -
10 worst case

1
1-Apr
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Total Infected Hospital Beds ICU Vents deaths
Model Comparison: External Models
Forecasts of peak week and peak resources - COVID-19 Arizona
1,000,000

• Our model peaks later

than other predictions. 100,000

• Range of overall infection, 10,000

hospitalization, and deaths

can differ by 1+ order of 1,000

magnitude between
Act now -
models 100 worst
case

• All models suffer 10

healthdata.org

limitations of testing and Joe Gerard

reporting 1

1-May
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Total Infected Hospital Beds ICU Vents deaths