This morning, the Washington Post carried this op-ed written by Richard Danzig, who served as secretary of the Navy under President Bill Clinton; James Lawler, an infectious disease physician and co-director of the Global Center for Health Security at the University of Nebraska Medical Center; and Thomas P. Bossert, who served as homeland security adviser under President Trump.
They
start with a warning: “On the present trajectory, before we inaugurate a new
president and before we deploy vaccines, the United States will experience
unprecedented trauma from the coronavirus.” Why do they say this? Just look at
the daily new infection numbers. They were around 30,000 at the height of the
first wave in April. They were around 60,000 at the height of the second wave
in August. Yesterday and the day before, new cases were about 140,000.[i]
In other words, the third wave is already more than four times as high as the
first wave, and more than twice as high as the second.
But
it’s not going to stop there. They say “On the present course, by Inauguration
Day we can expect to see 400,000 Americans infected each day, a rate equal to
that recently
experienced in Belgium and the Czech Republic. Even with the lower
fatality rates witnessed over the summer, such increases could result in deaths
on a scale not seen since the 1918 influenza pandemic.” In other words, by
January 20 daily new cases will be, if we keep on the current course, close to
three times as high as the current level, and more than six times as high as
the peak of the second wave. And of course, the authors chose January 20
because it’s Inauguration Day, not because they think that will actually be the
peak of this wave.
What
does this mean for deaths? While death is hardly the only serious consequence
of Covid-19, it is certainly the most visible one. I have been following deaths
as a percentage of closed cases since Worldometers.info started publishing the
latter number in late March. At that time, the ratio was above 40%, meaning
four of every ten Covid cases ended in death. Yesterday, the ratio was 3.6%,
meaning fewer than four of every 100 cases ended in death.
Why
has the ratio fallen so much? Two reasons: huge advances in treatment and much
less hospital overcrowding. Is the ratio likely to keep falling in the near
term, so it might be much lower on January 20? Not at all. Yesterday, about
65,000 people were hospitalized in the US, about the same as at the peak in
April, and hospitals in some states like Utah and North Dakota are essentially
full. Given how quickly new cases are increasing, we’ll soon (probably within a
couple of weeks) see a lot of the dreadful phenomena we saw in New York in April,
including ERTs being forced to triage sick people at home, deciding on their
own whether they could be saved if they were brought to the hospital.
Most
harrowing of all, we’ll see the refrigerator trucks lined up at hospital doors,
waiting for their inevitable grim cargo. In fact, that is already happening in El
Paso.
So
what are the authors calling on the country to do? Are they advocating another
sweeping lockdown (although even in April the lockdown was hardly that, in many
states)? No. “Increased testing, contact tracing, isolation and quarantine,
more personal protective equipment, and other interventions are important, but
they will not address the immediate challenges of the surge. In addition, they
require spending authority and complicated logistical
improvements.”
They’re
not calling for anything that can’t be implemented with just a little will, and
especially with a nudge from Washington:
“As a
foundation for emergency response actions, the emphasis should be on three
interventions, executed in concert, in any region with case counts over 20 per
100,000 persons per day. These are to temporarily 1) restrict all indoor
gatherings of adults to no more than 10 people; 2) close indoor
restaurants, bars and clubs; and 3) mandate universal mask-wearing in public.
These steps
will not eradicate the coronavirus. But by reducing super-spreading events,
they could reverse the present trajectory of community transmission, halving
(or better) the growth rate between now and Inauguration Day, and buying time
for additional interventions and vaccines.
Such a plan
would require sacrifices, but the president-elect and Congress could alleviate
the necessary pain by subsidizing affected businesses in a targeted way as part
of a coronavirus relief act. Without that assistance, the practical economic
needs of affected individuals will compete with the collective needs of the
public health.”
Will
this happen? It’s going to take a change of hearts in the White House and
Congress, for sure. But I would hope the needs of the country would now take
precedence over what are (wrongly, to be sure) considered to be the political
interests of one party and one person.
I would love to hear any comments or questions you have on this post. Drop me an email at tom@tomalrich.com. If you would like to see my other posts on the pandemic, go here.
[i]
According to Worldometers.info.
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