“There’s
tremendous hope as we look forward and see light at the end of the tunnel.”
Donald Trump, March 24, 2020
Trump said this
yesterday, but I just realized he said it a week ago as well. His use of these
words shows we’re really in trouble. For those of you who weren’t
politically engaged during the Vietnam War, this phrase has a very special
resonance (and it’s amazing that none of Trump’s advisers, or Trump himself, remembered
this): In 1967, at the height of the Vietnam War, when we were losing troops at
the rate of hundreds a week in some weeks, Gen. William Westmoreland (the
general in charge of the whole Vietnam fiasco during the years when we built up
to 500,000 troops on the ground) said exactly this to the American people. This
was just one of a string of rosy projections and misstated facts on the part of
Lyndon Johnson and his administration.
Of course, by 1967
there was a huge movement to end the war, and that statement was ridiculed by
many – including me, except I was just a high school student at the time.
However, general support for the war continued until February 1968, during the big
Tet (lunar new year) holiday, when the North Vietnamese army and the Viet
Cong launched a devastating insurrection in all cities in South Vietnam and
penetrated the US embassy in Saigon. They were ultimately defeated, but after a
long fight and thousands of US military losses – and over 100,000 South
Vietnamese losses.
But the “victory”
by the US and South Vietnamese turned into a defeat on the home front, since
the US population realized they had been lied to and there was no light at all,
except perhaps at the end of a much longer and bloodier tunnel than they had
ever thought to be likely. From then on, the only question was when the US
would pull out of Vietnam.
And unfortunately,
it looks like this phrase is once again being used to mask a much bleaker picture
than the public one. Yesterday, Trump and Dr. Fauci outlined a study from
University of Washington that said the coronavirus may kill 100,000 to 240,000
people. And this is assuming there will be massive social distancing; the
number could be 2.2 million if that doesn’t happen. Nationwide distancing will
be put in place next week (and be completely successful), and this will result
in new infections turning down around April 15.
Are these
realistic numbers? Absolutely, given the assumptions. But I want to point out
some observations I made when I updated my spreadsheet of projections this morning
with yesterday’s numbers (and for a discussion of my methodology, see yesterday’s
post):
- The social distancing in place now – mainly due to some state
governors taking the initiative to lock down their states, not due to the
Federal voluntary guidelines, which the report itself doesn’t deem very
effective – has had a real effect so far. The 3-day growth rate in total
reported cases has fallen from 74% two weeks ago (when most of the
statewide lockdowns were put in place) to 32% yesterday. The latter is the
number I used for today’s projections of cases (and total epidemic deaths)
going forward.
- However, for the last three days, the growth rate hasn’t changed.
Does this indicate that we’re not going to get much more improvement from
the limited distancing that’s in place now (limited because a lot of
states aren’t doing it)? I don’t know, but I’m not going to assume any
more improvement until the 3-day growth rate continues to go down.
- If we implement a total national lockdown today (with ending non-essential
interstate travel) and it’s 100% successful, we’ll have 100,000 deaths
over the course of the epidemic.
- There’s no way total new infections will turn down on April 15,
but at least the rate of change will start falling again if we lock
down next week, from the 32% 3-day rate that was recorded yesterday.
- If we wait until April 10 to do this, that number is 242,000. And
interestingly enough, that’s basically the assumption of the UW study –
that total social distancing will be in effect by the end of next week. So
the 240,000 maximum deaths in the UW study is my minimum number, assuming
that a total lockdown is put in place next week.
- If we wait until April 19, total deaths goes over 500,000. If we
wait until April 30, it goes to 1.7 million. Remember: exponential
growth.
- I’m also projecting actual deaths, not just total deaths over the
course of the epidemic. The latter number if based on the number of cases,
whereas the former is just a projection of the current growth rate of
reported deaths (as of today, that is 82% every three days). That number
will be 100,000 by April 15. So the idea that we could still have
100,000 deaths over the course of the pandemic is pure fantasy.
But here’s the
problem: The assumption that there will be a total lockdown next week is going
to require Trump to do something that he has so far been very reluctant to do:
Order all states to lock down, whether or not they want to do it, and cut off
all non-essential interstate travel by any means. Of course, cutting off air
travel is fairly easy, but ground is very hard. Moreover, I’m assuming the
lockdown and transportation shutdown will be 100% successful, which they
clearly won’t be, for many reasons.
This isn’t to say
Trump won’t change his mind if persuaded, but that job will fall to Dr. Fauci
and Dr. Susan Birx. Dr. Birx doesn’t even try very hard to change Trump’s mind,
as exemplified by her assertion last Thursday that there’s no shortage of
ventilators; so she will be no help in this. If Dr. Fauci can’t convince Trump
to do the right thing, probably nobody else will (although there’s one other
person who might be able to. I’ll discuss him tomorrow).
Unfortunately, Dr.
Fauci is clearly not suited for this particular task, for two reasons. The
first has to do with the lack of testing capacity starting in early February,
when other countries – at least in Asia – were already testing many of their
people. Dr. Fauci isn’t directly responsible for the lack of testing – the CDC
and FDA are – but, assuming he was making internal efforts to get the problem
fixed, his efforts were distinctively unsuccessful. He finally admitted to
Congress in late February that testing was kinda sort a problem. If we had
gotten testing going when other countries did (perhaps because Dr. Fauci would
have made a big public statement about this), we would probably be looking at in
the hundreds or low thousands of deaths now, rather than hundreds of thousands
or millions.
Two days ago, Dr.
Fauci convinced Trump to extend his national guidelines through the end of
April. Isn’t this a partial success? It may have some small effect on the
growth rate of new cases, but it doesn’t change anything. We need a total
nationwide lockdown with widely available testing, for three reasons:
- The economy will never fully restart unless a) all people with the
virus have been quarantined and b) new infections have been reduced to
zero. Otherwise, anyone who goes into an office or factory is risking
getting infected from the person next to them, who doesn’t even know they
are infected.
- A total lockdown is the only way to count total cases. Not having
adequate testing available in early February means that the virus is
probably everywhere now, and still rapidly growing – epidemiologists have
said there are between five and ten times real coronavirus cases in the US
today as in the official count (meaning there are between one and two
million total cases today). Testing is still very spotty, and it will
never catch up with the actual spread of the virus unless we have a total
lockdown. This means that the only way to find out who is infected is to
lock everybody down – and it really needs to be by individuals as much as
possible, not family groups (since they will just end up infecting each
other). At the end of the lockdown period, we will be fairly sure that anyone
who isn’t already sick is disease-free.
- Yet even after the lockdown, there needs to be massive testing
available. Think about restarting a company. Won’t you want all your
employees to be tested before they go back to work? And if there might be
any untested cases out there (which is almost certain, no matter how
close-to-total the lockdown is), wouldn’t you want your workers to be
re-tested every week at least? And if your company doesn’t want to do
this, would you continue to work for them?
If we don’t get a
total lockdown with testing widely available, every time we lift the lockdown,
even partially, growth will spring back exponentially. The fact that growth has
been drastically reduced for a short time means nothing – within a month we’ll
be back where we are today. Remember, at the beginning of March, there were 100
infections reported nationwide; on April 1, there are 200,000. This means we’ll
never defeat the virus – and it will remain a major drag on the economy –
without a total lockdown.
This is why Trump’s
extension of his guidelines for a month means very little (and the UW report
itself implies that). Unfortunately, by getting Trump to make this grudging
concession, Dr. Fauci has pretty well precluded coming back in a day or two and
saying “You know what? I need you to do much more. I need you to impose a total
lockdown.”
Nevertheless, he
has to do it. Dr. Fauci, there’s still time this afternoon. Please demand that
Trump see you and give him this message: We need a total lockdown. Today if
possible, but tomorrow at the latest.
And if you aren’t
going to do that, you should resign. By making the public believe that the
administration is listening to a real expert, you’re just perpetuating the “light
at the end of the tunnel” lie.
Yesterday’s numbers (from Worldometers, as
of about 7 PM EDT March 31)
Total US confirmed cases: 188,647
Increase in cases since previous day: 24,212
(vs. 21,689 increase yesterday)
Percent increase in cases since yesterday: 15%
(vs. 15% yesterday)
Percent increase in cases since 3 days
previous: 32% (vs. 33% yesterday)
Total US deaths as of yesterday: 4,059
Increase in deaths since previous day: 884
(vs. 686 yesterday)
Percent increase in deaths since previous day: 28%
(vs. 28% yesterday)
“Set in stone” US deaths over
course of pandemic: 91,699 (based on 4%
case mortality rate)
*This number assumes a) Total cases
grow by 32% into the future (= yesterday’s 3-day growth rate in cases); b) New
cases drop to zero on April 29, because of the lockdown; and c) case mortality
rate = 4%. To consider a 6% mortality rate, multiply each projection by 1.5.
For 8%, double it. For comparison, Italy’s case mortality rate is currently 11.75%.
Projected as of April 8 (7 days from today):
Total expected* cases: 335,830
Total deaths set in stone** over course of
pandemic: 201,499
*Expected cases assumes a) Total
cases grow by 33% into the future (= yesterday’s 3-day growth rate in cases);
b) we wait until April 8 to impose a total lockdown; c) New cases drop to zero
on May 5, because of the lockdown
** Deaths set in stone = expected
cases X case mortality rate of 4%. To consider a 6% mortality rate, multiply
the figure by 1.5. For 8%, double it. For comparison, Italy’s case mortality
rate is currently 11%.
Projected*** number of actual deaths on
4/7 alone: 1,700
*** Projected deaths = previous
day’s death number, grown by the 3-day percentage growth rate. Note this is
calculated completely differently from the deaths set in stone.
Projected as of April 15 (14 days from today):
Total expected* cases: 755,996
Total deaths set in stone** over course of pandemic:
367,479
*Expected cases assumes a) Total
cases grow by 32% into the future (= yesterday’s 3-day growth rate in cases);
b) we wait until April 15 to impose a total lockdown; c) New cases drop to zero
on May 13, because of the lockdown.
** Deaths set in stone = expected
cases X case mortality rate of 4%. To consider a 6% mortality rate, multiply
the figure by 1.5. For 8%, double it. For comparison, Italy’s case mortality
rate is currently 11%.
Reported case mortality rate so far in the pandemic
in the US:
Total
Recoveries in US as of yesterday (3/29): 5,211
Total
Deaths as of yesterday: 2,489
Deaths
so far as percentage of closed cases (=deaths + recoveries): 38%
Projected*** number of deaths on 4/15
alone: 17,653 (equal to about five times total deaths on 9/11. And this is
the reported deaths in a single day)
***
Projected deaths = previous day’s death number, grown by the 3-day percentage
growth rate.
Date on which 100,000
deaths will be set in stone: April 1
Date on which 200,000
deaths will be set in stone: April 8
Date on which
500,000 deaths will be set in stone: April 19
Date on which 1
million deaths will be set in stone: April 26
“Set in stone” means that on that date, a total lockdown will
be put in place. It will be 100% effective (0 new cases) 28 days later.
No comments:
Post a Comment