We need to act!

Comment from Tom at 5:20 PM. The US now has 82,547 Covid-19 cases. This surpasses both Italy and China, and makes us number one in the world. And I don't see anyone coming close to us in the future, since this will continue to grow exponentially.

Yesterday’s numbers (as of about 6 PM EDT)

Total US confirmed cases (from Worldometer): 68,594

Increase in cases since previous day: 13,653 (vs. 11,160 increase yesterday)

Percent increase in cases since yesterday: 25%

Percent increase in cases since 7 days previous: 641%

Minimum expected cases 7 days from yesterday (March 29): 460,944 (up about 44,000 from yesterday)

Minimum expected cases 14 days from yesterday (April 5): 3,097,491 (down about 140,000 from yesterday)

Total US deaths as of yesterday: 1,036

Increase in deaths since previous day: 252

Percent increase in deaths since yesterday: 32%

Minimum expected US deaths over course of pandemic: 2,058 (assumes no new cases starting today, and case mortality rate of 3%. Based on yesterday’s figures)

Minimum expected US deaths 7 days from yesterday (April 2): 13,828 (same number as above, but calculated 7 days ahead. Note this means the number of total US pandemic deaths anticipated 7 days from now, using the same assumptions as above. Note it isn’t the number of deaths I expect to see reported 7 days from now – I can’t estimate that through purely mathematical means)

Minimum expected US deaths 14 days from yesterday (April 9): 92,925 (ditto, but 14 days ahead. This is up 25,000 from yesterday)

Note I’ve inserted the word “minimum” in front of “expected deaths” wherever it appears above. This has always been true, but I’m trying to emphasize that this number is based on a wildly optimistic assumption: that on the day in question (either the day before the post was written, or 7 or 14 days after that), a minimum 14-day total lockdown is imposed on the country and it’s 100% successful – meaning the virus is stopped cold in its tracks.

I’ve also changed the way I project total pandemic cases (and thus deaths) 14 days out. I have been computing the growth rate over the past 7 days, and assuming that will go forward for at least two weeks. This might make sense if there were some sort of trend in those growth rates, but I’ve found there really isn’t. Since I started measuring them on March 9, they’ve moved up and down, between a low of 545 and a high of 839. I decided to take an average of all the 7-day rates since March 9, and project that forward. The numbers above reflect this.

To be honest, even if I used a somewhat lower rate to project growth forward, it wouldn’t make much difference, because when you’re talking about exponential growth, any decline in the rate of increase just pushes back the date at which a certain level will be reached – it doesn’t mean that level won’t be reached.

Let’s say the 839% 7-day growth rate (the highest of the observed rates) continues through the end of April. This leads to our having more total cases in the US than population (obviously an absurd result) on April 23. But if we set the rate at 545% (the lowest of the observed rates), that date advances to April 28. So we’ve given ourselves five days before we reach Armageddon. Big deal, huh?

But let’s say the rate drops to 300% and stays that way. Then the cases surpass the population on May 18. Of course, total cases doesn’t change, since the exponential growth in cases continues. And total expected deaths over the course of the pandemic (in the US) also doesn’t change. But given that we now have a few additional weeks to play with (and more if we could get the rate of increase below 300% a week), we can get the hospitals more prepared for the surge in cases than they are now. We’ll also “flatten the curve”, so that hospitals are less likely to get overwhelmed.

And speaking of overwhelming, New York City’s 1800 Intensive Care Units are going to be full tomorrow, and the real onslaught of cases will start next week. So it looks inevitable that there will be a lot of deaths due to this situation (and of course, the fact that they need 30,000 more ventilators than they have now). In fact, I’m sure there are unnecessary deaths being caused now, to judge from stories of hospitals in the Bronx and Brooklyn in the NY Times today.

How do we flatten the curve? By massive social distancing, much more than we have now. We need a nationwide lockdown, as well as a steep curtailment of transportation – basically limited to vital shipments or trips only. We would have had other options (isolating all cases and close contacts of cases) if we’d had widespread testing available in early February, but we didn’t. This is the only possible course now.

Italy has given the world a good example of the cost of not doing this right away. They initially tried some halfway measures, but the virus just blew them away – again, exponential growth. So they moved to a total lockdown of the whole country a couple weeks ago (even though the outbreak was mainly in the north – they wanted to keep it that way), and now the growth rate of new cases is declining – although it’s certainly not zero yet.

That’s why we need an immediate change of direction. If we put in place a total lockdown today and it’s 100% successful, we’ll have 2,058 total deaths. If we wait a week to do that, we’ll have 13,828. If we wait another week, we’ll have 92,925. If we wait another week (to April 15), we’ll have 624,444 expected deaths over the pandemic. If we wait until April 22, the number of deaths is over 4 million. And, of course, it goes up from there.

And my deaths figure is based on a 3 percent case mortality rate, which assumes some amount of hospital overcrowding. Maybe it can be somewhat less than that – it ended up at 1.4 percent in Wuhan, so if you want to use that number, you can; then just divide the above death figures in two. But remember, Wuhan put in place a total lockdown – much more total than we’ll ever get in the US; it’s just being lifted (partially) now. Bottom line, if we do a pretty good lockdown in the next week – but not perfect, which is very likely – we won’t reduce the growth in total cases to close to zero, but maybe we’ll keep it under 100,000. That’s if we move in not much more than a week.

Now to Mr. Trump, since I called for him and Mike Pence to be pushed aside from the virus response effort yesterday. There are two data points this morning that I find very relevant:

First, the Administration announced that they’re working on a plan to loosen up the already very inadequate social distancing in place now by Easter (April 12). If you think that’s good news, you haven’t read the above.

Second, Fed Chairman Powell said that getting the economy started again requires defeating the virus first. And it just makes sense: nobody is going to want to come back to an office or factory if they think there’s a decent chance they’ll catch a disease that will kill them; and no corporate counsel will let an office reopen unless there’s no real chance that multiple people will develop Covid-19 and then sue the company for opening too quickly.

People worry about killing the economy, but the economy has mostly been killed already. We need to keep it on ice (a medically-induced coma, as someone called it) so we can identify everyone who is infected, and then quarantine them and all of their contacts. Remember, we wouldn’t have to do this if we’d had adequate tests available early enough. And we won’t be able to reopen the economy until there are adequate tests available. Trump should be focusing all his efforts on getting tests made and finding more ventilators, not on planning for an Easter reopening which is never going to happen.

But as I said yesterday, I don’t see him doing that until he’s forced to. So the death total (for the whole pandemic, not just deaths so far) is going to keep climbing exponentially, until someone with sense forces him to completely step aside from the virus response and bring in someone who can at least change course from the disastrous path we’re on now. I heard the suggestion of Bill Gates for that position, and I think that would be a good choice, but there are others as well.