The latest depressing numbers

I realize I’ve fallen into a regular routine since Saturday: Get up. Read the papers online and talk to people on email. Discover something that I find very disturbing about the coronavirus pandemic. Write about it. Go about my day job. Repeat the next day. I’d love to say this routine will end starting tomorrow – meaning I won’t have anything new to say. But that sure didn’t happen today.

The first number I looked at was the reported Covid-19 cases in the US this morning, which was 3100. This confirms that the reported cases doubled in the last three days, as has been happening for about a week (the reported cases were much more than doubling every day for the first week, of course, but that’s because they were starting from zero. Keep in mind that, as of March 3, there were six reported cases in the US).

So is this good news? You might at first say it is, since this means that the high estimate for total cases – reported and not – in 3 weeks will be about 1.9 million, as I said yesterday. And it should probably be much lower than that, given the huge shutdowns of school systems, restaurants, and offices so far – and the fact that just about any office, school system or restaurant in a US city will be shut down within days – although business will be booming at the hospitals!...OK, that’s probably not a great joke to make at this time.

And I saw another number this morning that blew me away: China has 80,680 total infections as of today. Since the number has been going up by around 10 or even fewer new infections a day for at least the past week, that means they have successfully contained the epidemic, after a bad start in Wuhan. Remember all those hospitals they built in ten days? They’re closing them now. Does this augur well for the US? Unfortunately not.

Remember the scenario in China:

1. The virus first appears in Wuhan around New Year’s Eve. The government reacts very slowly, and by late January it’s out of control in Wuhan, and Hubei province in general.
2. The national government locks down all of Hubei province and bans residents from travelling outside of the province (of course, 5 million or so had already left).
3. The government doesn’t think it’s finished at that point. Instead, it launches a very aggressive campaign to a) find everybody who’s infected in the country; b) trace and test all of their contacts (they had 1800 teams of five people doing nothing but that day in and day out); and c) quarantine all contacts of everybody who had tested positive.
4. We’re now seeing the fruits of their efforts, with the virus contained in the whole country, including Hubei.

Now let’s look at the US:

1. In early February, a couple weeks after China locked down Hubei province, the US government banned all travelers from China (or who had been there recently). I’ll admit I was skeptical about this, but now all the pundits agree this was the right move. It bought us maybe a month to prepare for an onslaught here.
2. However, instead of preparing, the US government sat on its hands and did very little, when it wasn't actively belittling the idea that there was a crisis. They should have ramped up a huge testing program to try to find cases that were already here. Instead, they went under the assumption that, if they banned all travel from China and traced contacts of people who had recently come from China, they would find literally all of the cases in the US. They wouldn’t even allow anybody to be tested who hadn’t been to China (so in the first identified community spread case - in California – the person wasn’t tested for about five days, even though her doctor believed she had the virus and was clamoring for a test). At the same time, they reassured the public that the virus was under control here, since all of the identified cases had originated in China! A bit ironic, no?
3. However, there’s a lot more they should have been doing, most of which was outlined in a very prescient Wall Street Journal article on Feb. 20 (Note: This might be behind a paywall. If you’re not a WSJ subscriber and want to read it, drop me an email and I’ll send you the text). In it, two medical doctors (one an FDA commissioner from 2017 to 2019, of course appointed by president Trump) noted that there were 15 reported cases in the US at that time, and the number hadn’t changed in a week. They pointed out that there should be testing of all patients with unexplained lung infections. That would have undoubtedly identified a number of “community spread” cases, whose contacts could then have been traced and contained, as was done in China. That was probably the last time true containment was an option in the US.
4. The authors didn’t just advocate testing. The other things they advocated (including social distancing and helping hospitals about to be overburdened) now ring very true, and should make everybody wistful that not a single person in the CDC, DHS, or White House didn’t go into their boss’s office, throw the article on their desk, and demand that every suggestion in the article be implemented today, not tomorrow (and I regret that I didn’t bring the article to people’s attention then, since I was impressed by it and ripped it out of the paper the day it appeared. But I went on a weeklong business trip and decided the next weekend that this wouldn’t do much good - although I suspect my real motive was that I didn't want to be made fun of, had the whole crisis turned out to be nothing at all). Of course, that person would probably have been fired, which is why it didn’t happen. But the fact remains that the US would be in a much better position today – less than a month later - if the recommendations had been immediately taken seriously (as they were in some other countries earlier, like Singapore, Taiwan and China itself outside of Hubei). Remember, as I pointed out in the first post on the epidemic on Friday (which seems like last year at this point), if the Chinese government had locked Wuhan down just one day earlier than they did, there would have been 20,000 fewer cases.

So here we are, with reported cases doubling every three days, but more importantly there are a huge number of unreported (i.e. untested) cases out there – and since those people don’t know they have the virus, they’re spreading it to everybody else.

And here is why there is a big difference between the US experience and China: Wuhan was literally ground zero for the worldwide epidemic. When the Chinese government locked Hubei province down and instituted aggressive containment in the rest of the country, they could be very sure they knew about close to every case, because they were testing every contact of every infected person. And after the US shut off travel from China in early February and traced contacts of people who had come in earlier, some in the government (unfortunately, this was people at the very top) obviously believed they knew of every case in the US. But this depended entirely on the assumption that there had been no spread outside China to any other third country – and thus to the US. It probably also depended on the mistaken (although at this point “mistaken” seems far too kind. “Criminally deliberate” would probably be better) belief that, even if there had been a little spread to third countries, the odds of more than a few people in the US being infected were very low. This might be true for other diseases like the flu, but not for coronavirus, given the speed with which it spreads. This is inexcusable, because the evidence of this speed was very plain in Wuhan.  

So the big difference between China at the end of January and the US today is that there are undoubtedly multiple “ground zeros” that need to be contained here (New Rochelle, NY may be one) – if containment were still an option. But it isn’t, because we haven’t expanded testing (remember, as of Saturday only 20,000 tests had been performed in total, and since a number of those probably had to be repeated to get a good reading, the number of people tested is much lower than that. Meanwhile South Korea can test 15,000 people a day), so we don’t even know where most of those ground zeros are located.

So with multiple ground zeros, but all but one of them (Seattle) still unidentified, the whole of the US is effectively one big Hubei province now. And instead of exponential growth in one area like in China, there will be exponential growth in many areas. The only thing we can do at this point is social distancing, and that isn’t going to turn this thing around right away. 

The 80,000 total infections in China – which is very unlikely to grow much, absent a huge resurence of the virus somewhere  – now provides a stark contrast to the US. It’s very possible that there are already that many infections here. And using the simple math in my last post (i.e. expecting reported infections to double every three days), we’ll be at around 1.6 million reported cases four weeks from today. And the biggest problem with this is that currently, reported infections are without doubt a small fraction of total infections. Hopefully (and this isn't a great hope, given the previous lies we've been told about the rollout of testing), in four weeks the availability of tests will have caught up with demand, so that reported infections will be very close to the actual number, and 1.6 million is close to the maximum we’ll have – which is to say, twenty times China’s total infections. 

However, this isn’t too realistic a hope, unless the tests catch up to demand in the next three weeks (very unlikely). This is because it’s too late to do complete contact tracing, so lots of people who have been exposed but haven’t themselves felt the need to be tested are still going around infecting other people. Since it can be 14 days before symptoms appear, only two weeks after the supply of tests has caught up with demand will we be able to say we know about almost all cases (maybe you see now why increasing the supply of tests is so important, and the fact that this wasn’t done in early February is going to haunt a lot of people for a long time, along with the ghosts of the people who died because of this criminal negligence).

I heard another 80,000 figure yesterday. That was the low end of an estimate of total US deaths due to coronavirus; the high end was 1.7 million. I heard (or read) an epidemiologist say last week that his best guess of total US deaths was 400,000, vs. 3,217 so far in China. Of course, the latter number will go up somewhat, since some people now sick in China will die. But even if the number ends up at 4,000, it’s very likely that 100 times more people will die in the US than in China due to coronavirus. And using the low-end 80,000 figure for US deaths, that’s still 20 times the figure for China. 20 times more is disgraceful; 100 times more is a catastrophe (i.e. if that happens, more than 100 times the number of people who died on 9/11 will die of coronavirus).

In other words, the US may very well be the country hardest it – in both per capita and total deaths – of any country in the world. And that's because we’re the country with the slowest response, especially given the resources we could have thrown at this, but didn't until the hour was very late.