I am neither a
scientist nor a medical professional.
Nor am I even a professional statistician. But I do have some facility with numbers –
and the coronavirus numbers scare me.
My goal here is
not to cause panic. But I do believe
that in order to make the best possible personal decisions, both for ourselves
and for the common good, we all need to understand the math.
Let me share
some data with you.
We now have over
2,000 cases of the coronavirus in the United States – 2,144 as of yesterday. On March 1, just about two weeks ago, we had
42 cases. That is a growth rate of 42% per day. If that
rate persists, we’ll hit the 100,000 cumulative case mark on March 24 – in 10 days
-- and the 1,000,000 mark one week later.
In reality the
daily growth rate has slowed down a bit in the past few days. Over the last three days it has been 29%, 33%
and 34%. Let’s say it continues at 30%. That pushes those dates back a bit: 100,000 cumulative cases by March 28,
1,000,000 by April 5.
Let’s say the
daily trend continues to decline, with the impact of the cancelled events,
social distancing and common sense taking hold. Let’s drop it to 20%.
That takes it to 100,000 cases by April 4, and 1,000,000 by April 29. How about all
the way down to 10%? May 17 and June 10. And 5%? May
31 and July 17.
Let’s look at the
trend in Italy. Italy, as you know from
the headlines, is having a terrible time with the coronavirus. But looking at this chart, you can see that
our trend is right with Italy -- just about eleven days behind them. Their growth rate is in the 20%+ range, and
they are up to more than 15,000 cases.
Rates of change
persist until something happens to slow them down. And the Italian government basically shut down
the entire country three days ago. All shops in the entire country have
been shut down, with the exception of supermarkets,
pharmacies and a few others. They had
already banned travel within the country (except for work or health reasons),
and shut down all the schools. (Spain
and France just announced, minutes ago, that they are taking similar steps.)
We have not
taken any actions remotely resembling that – in fact we have taken little
federal action at all within our borders; almost all of our shutdowns have been
done voluntarily on a local basis by governors, mayors, or businesses (such as
the NBA).
Days
|
Italy
|
USA
|
||
Cumulative Covid-19 Cases
|
% Change Per Day
|
Cumulative Covid-19 Cases
|
% Change Per Day
|
|
Day Zero >>
|
Feb 22
|
Mar 3
|
||
1
|
9
|
85
|
||
2
|
76
|
744%
|
111
|
31%
|
3
|
124
|
63%
|
175
|
58%
|
4
|
229
|
85%
|
252
|
44%
|
5
|
322
|
41%
|
352
|
40%
|
6
|
400
|
24%
|
495
|
41%
|
7
|
650
|
63%
|
643
|
30%
|
8
|
888
|
37%
|
932
|
45%
|
9
|
1128
|
27%
|
1203
|
29%
|
10
|
1689
|
50%
|
1598
|
33%
|
11
|
2036
|
21%
|
2144
|
34%
|
12
|
2502
|
23%
|
||
13
|
3089
|
23%
|
||
14
|
3858
|
25%
|
||
15
|
4636
|
20%
|
||
16
|
5883
|
27%
|
||
17
|
7375
|
25%
|
||
18
|
9172
|
24%
|
||
19
|
10149
|
11%
|
||
20
|
12462
|
23%
|
||
21
|
15113
|
21%
|
What is my
point? Apart from the fact that we should be prepared for more
drastic government action on the horizon, we have to take proper
precautions ourselves. We have to limit
our contacts, each and every one of us, to only those that are necessary. We are
seeing entities take action, state by state, city by city, event by event. Now it has to be person by person.
We have
to understand that the best way to combat COVID-19 is to cut out any but the
most essential of human contact. I
cannot pass judgment on those who need to show up to work to earn a living, apart
from asking you to lobby to work from home if your job is capable of being
done remotely, and to take precautions at work with hygiene and social distancing.
But
there is really no good reason to be going to restaurants, the movies, the
mall, the museum, the gym, and the like, or traveling anywhere for pleasure (or in the mistaken belief that it is
safer elsewhere – you may just be bringing the darn thing there).
The only way to
battle this is to, yes, “flatten the curve.”
We have to attack the rate of change. The more we can slow down the rate of new cases, the greater the chance
that we will not overwhelm our health system at some point. Any personal decision that reduces the risk
of spread is a good one.
The decision by
the NBA to cancel their season was a jolt for our society, but we appear to
need another jolt or two, one that governs our own actions. We cannot wait for the federal government to
tell us what to do. We must take
personal responsibility – and stay home as much as we can.
Let me quote
from yesterday’s The New York Times – the basic point is that we CAN affect
those rates of change to avoid horrible scenarios. But we have to act.
“The assumptions fueling those
scenarios are mitigated by the fact that cities, states, businesses and
individuals are beginning to take steps to slow transmission, even if some are
acting less aggressively than others. The C.D.C.-led effort is developing more
sophisticated models showing how interventions might decrease the worst-case
numbers, though their projections have not been made public.
'When people change their behavior,' said Lauren Gardner {Ed.: No relation}, an associate professor at the John Hopkins Whiting School of Engineering who models epidemics, “those model
parameters are no longer applicable,” so short-term forecasts are likely to be more accurate. 'There is a
lot of room for improvement if we act appropriately.'
Those actions include testing
for the virus, tracing contacts, and reducing human interactions by stopping
mass gatherings, working from home and curbing travel. In just the last two
days, multiple schools and colleges closed, sports events were halted or
delayed, Broadway theaters went dark, companies barred employees from going to
the office and more people said they were following hygiene recommendations.”
The key here to
is be very aggressive in how we define “appropriate action.” Don't be content with halfway measures.
So please – for
all of us – stay home as much as you can.
The scary scenario of Italy came home as I heard of them triaging people at hospitals, sending "survivable" home, caring for those whose underlying conditions and hospitalization would most likely make a difference, and putting the old and the medically compromised aside as too resource intensive, allowing them to die.
ReplyDeleteThen, I read "Could U.S. ICUs Handle 45,000-Bed Coronavirus Load? — Here's what a pandemic could look like"
https://www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/84845
Written in mid-February, so the estimated numbers are not what they appear to be now. But doing the math in the same way, with numbers we now see in the United States, the notion of being overwhelmed becomes frighteningly clear.
And of course, the nation wide averages in the article are not real -- NY Gov. Cuomo said their inventory found 600 available ICU beds in the state. Colorado Dept. of Public Health and Environment spokesperson had a news conference today -- and did not know how many beds were available in Colorado.
A more detailed model is available at https://qventus.com/blog/predicting-the-effects-of-the-covid-pandemic-on-us-health-system-capacity/
The "moderate" scenario spelled out there has predicted outcomes:
* At peak, there will be a shortage of 9,100 ICU beds and 115,000 Med-Surg beds nationwide. At typical staffing ratios this would require 325,000 additional staff, which would be a key constraint in a situation where childcare, infection concerns and quarantine will already place a strain on existing staff availability.
* There could be roughly 200,000 deaths caused by COVID-19"
Great reasons to minimize exposure and transmission possibilities.
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