Dr. Roger
Alexander of Schweitzer Engineering Labs sent me this
link about 20 hours ago, describing it as “sobering”. I didn’t even look at
it until 1 ½ hours ago. It’s a long article that took me an hour to get through
(carefully), but there’s a very real possibility that this saved my life. You
need to drop everything and read it, certainly before you leave your home for
any sort of trip that isn’t absolutely essential.
Here are the
main points I got out of the article; but – again – I want you to read the whole
thing. There’s a lot of stuff that I’m not including here, which is almost as
important. Don’t get intimidated by the fact that it’s filled with a lot of
graphs. I’m one person who will often skip over a graph if I think I already
know what it says, but you need to ponder each of them carefully (none of them
require any sort of advanced statistical background to understand. The author
is an entrepreneur, not a scientist or medical professional).
First: The
number of actual Coronavirus cases in the US, and in almost every community (unless
you live somewhere where nobody has traveled beyond the city limits since
January), is without doubt a big multiple of the reported cases (and if there
are zero cases now, there won’t be for long); this can be easily computed by
looking at the total reported cases later and extrapolating back, since
symptoms take about a week to appear. For example, in the Bay Area - as of
March 10, when the article was written – there were 86 reported cases, and
probably 600 true ones. In France, where there were 1,400 reported cases, there
were likely between 24,000 and 140,000 true cases. In the Communidad de Madrid region of Spain, there were 600 reported cases and
between 10,000 and 60,000 true ones.
Second: Countries
that aren’t prepared for the big onslaught (which will probably hit parts of
the US in the next 1-2 weeks) will have death rates that are 5-10 times higher than those of countries
that were prepared – but still had a significant number of cases. The biggest determinant of fatality rates will
be whether or not the hospital system is overwhelmed, forcing doctors to triage
all serious cases (whether due to coronavirus or anything else, like regular
flu), as is happening in Italy now. So is the US hospital system prepared or
unprepared for this?...OK, stop your cynical laughter. Yes, the US is woefully
unprepared. For example, we have only one percent of the masks for healthcare
workers that will be needed.
Some
countries have done a great job of preparation. For example, Taiwan – which is
of course very tied to China – had fewer than 50 cases as of 3/10, and Singapore
and Hong Kong were also very well prepared for Covid-19. Interesting enough,
China outside of Hubei Province (where Wuhan is) used the month or so before
the onslaught to thoroughly prepare, and came out of it very well, relatively speaking.
This is partly because of their experience with fighting SARS, which is also a
Corona virus. The US, on the other hand, also had a month’s notice, yet we as of
today have only tested about 10,000 people (with 16,000 tests, since it usually
takes more than one test to get a good reading); while South Korea has been
able to test over 10,000 people a day for several weeks.
Third: Given
that there’s no way the US healthcare system can be made ready for a devastating
surge of cases (which could happen in weeks, not months), the only remedy is
social distancing, practiced ruthlessly, both on a community-wide and an
individual level. The author graphically illustrates this by using data from
the 1918 flu pandemic, when cities that instituted social distancing (like St.
Louis) had much better outcomes than ones (like Philadelphia, where I was born)
that didn’t. In comparing those two cities, the author says that instituting
social distancing 20 days earlier in St. Louis led to halving the mortality
rate.
Fourth: It’s
too late for containment – where the country knows every case within its
borders and tracks contacts for all of them, putting those people into
isolation. Or for prevention – closing the country’s borders to inward travel.
As the author sarcastically points out, “The recent US announcement that most
travel from Europe was banned is a containment measure for a country that has,
as of today, 3 times the cases that Hubei had when it shut down, (and) growing
exponentially.” The enemy is here, folks. The author shows data that estimate
the Chinese ban on people leaving Hubei only slowed the spread in China as a
whole by 3-5 days.
So what’s to
be done in the US? Social distancing is the only good option. It’s already
being put into place in various places (Illinois just closed all of its schools),
but it needs to be draconian (the author provides a list of measures taking by
the Italians as an example of that. They were taken late, but at least they’re
being taken).
The author
concludes with the most powerful chart, which he created himself but which is
loosely based on the experience in Hubei. It shows that, without social
distancing, the cases will continue to increase exponentially. And then there
are two cases, one with social distancing starting 20 days after the first
infections, and one that starts 21 days after the first infections. What is
amazing is the difference that literally one day makes – one day leads to
literally 40% fewer cases. So in Hubei (which declared the lockdown on Jan.
23), if the lockdown had taken place just one day earlier, it would have led to
20,000 fewer cases! (BTW, Hubei is a
big province, for any country other than China. It has about 40 million
people).
So social
distancing is the only answer, and it needs to be implemented as soon as
possible. And that might mean in hours, not days. Of course, most of us can’t
directly influence local authorities, but we can certainly influence our
companies, churches, synagogues, schools and other organizations, as well as ourselves.
There’s no time to waste!
I think
Thomas Pueyo, the author, has done everybody a great service in writing this
article. The only issue I have is that I think he should change the second
sentence of his short bio, which reads “Creator of viral applications with
>20M users.” Somehow, ‘viral applications’ seems to be a poor choice of words
at this point. I'm not sure we need more viral anything!
Sobering stuff - we're staying put
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