Posted on 03/06/2020 10:19:16 PM PST by ProtectOurFreedom
Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate.
We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts.
We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go.
As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population.
What does a case load of this size mean for healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted.
The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc).
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By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.)
If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd.
If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption.
As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now.
Alright, so that’s beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing).
There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.)
As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day.
One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused.
How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas...again, predominantly from China.
Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor.
Now consider how these 2 factors – bed and mask shortages – compound each other’s severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix.
HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above.
We could go on and on about thousands of factors – # of ventilators, or even simple things like saline drip bags. You see where this is going.
Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works.
Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.
I’m an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I’ve been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan.
Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we’re seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong.
But I have no reason to think they’ll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don’t mock decisions like canceling events or closing workplaces as undue “panic”.
These measures are the bare minimum we should be doing to try to shift the peak – to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system.
And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared? 28/n Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out.
One more thought: you’ve probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year.
Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population.
But take the scenarios above (full beds, no PPE, etc, at just 1% of the US population infected) and stretch them out over just a couple extra months. 32/n That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we’re talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge.
This is not some hypothetical, fear-mongering, worst-case scenario. This is reality, as far as anyone can tell with the current available data.
That’s all for now. Standard disclaimers apply: I’m a PhD biologist but *not* an epidemiologist. Thoughts my own. Yadda yadda. Stay safe out there. /end
[[We’re looking at about 1M US cases by the end of April]]
Yeah, but who cares- mike bloomberg is gonna take $500 million of his own money and make every person a millionaire
(See previous article on FR about Brian Williams)
Well if it finally gets hospitals and insurance to actually charge realistic prices for procedures and meds, and stops them hiking up charges on your bill to cover nonpayers,
I say maybe this is the reset to the idiotic hcare system we have that we’ve all been waiting for.
[[Ms. Sprecht is right that people do not understand exponential growth. This is truly frightening information.]]
Been saying it for awhile now- We’re just in the very beginning stages right now, and people are getting all panicky about a few 1000 cases- IF this virus really takes off- the numbers will be in the millions- in a very short period- then people will really begin panicking- but that’s a big if-
BUT- let’s not forget, that viruses TEND TO burn themselves out pretty rapidly once they hit peak and begin declining in numbers of new cases- so it might not be too bad- Remember the bird flu? People panicked about that too- and while it was bad, it didn’t reach the pandemic levels that people were predicting
HOWEVER, that doesn’t mean that this virus won’t reach pandemic- it could- and if it does- it will very very rapidly get much worse, and there is no way we will ever be able to contain it- too many people can’t afford to take time off from work-
There are/won’t be enough hospital staff to keep hospitals running at
full occupancy. Hospital workers will refuse to come to work.
I’m not worried. If I get Corona Virus, I’ll just hook up with someone that has Lyme Disease.
Most won't know they have it.
and thanks for working out the math- gives a proper view of what ‘could happen’- were this virus to expand rapidly-
And lots of healthcare workers themselves will be sick and out of commission for a few weeks. They face a huge viral load in hospitals and clinics.
Thank Ms. Sprecht, the author. She did a great job breaking down the numbers.
[[Most won’t know they have it. ]]
Absolutely- That too- and parents will send their sick kids to classes- not wanting to take time off from work to care for them unfortunately- People also won’t give up their season passes for ball games, they won’t give up their long planned vacations etc etc- and sick people will take mass transits while sick-
ANY Virus has a potential to become a pandemic very quickly IF it doesn’t burn itself out before it really gets going-
oh sorry- i sped read it- thought it was your article-
As far as ramping mask production up, the government has a contract with 3M to produce 36 million masks a month.
That’s not enough, but if the CV patients can be isolated from other patients, not all 18M healthcare workers will be needing masks. In fact a lot of them might never need to see a CV patient.
I’m sure 3M will be planning on more demand than just the feds. And I’m also sure other companies will be producing masks.
One of the ramifications of CV, might be stress on health insurance companies, unless the FED steps in an absorbs the cost.
If we did get 1,000,000 cases, and 15% of them needed hospitalization, that’s 150,000 cases at $1500/day
hospital stay for 3 weeks. That’s $675 million hit.
If the cost is $3000 that’s $1.3 Trillion. ICU is $4k a day.
Are health insurance companies going to go bankrupt?
Are they going to start denying care, because they just can’t pay?
I am Doctor. Please to help this. Drink all the alcohol on your place. Please do this. Emergency. Faster drink. Faster Cure.
How much does a hospital overflow tent cost? $1500.
What about a Coronavirus Hotel? (Seattle bought one, but it’s got legal troubles already)
so are you of the opinion that China has not limited the virus spread over the past couple of weeks anywhere near as much as claimed?
“IF this virus really takes off- the numbers will be in the millions- in a very short period- then people will really begin panicking”
No, the people who don’t die will learn to live with it.
The panic is the fear of the unknown.
This thing is coming soon, to your town, maybe your street, maybe your house. It might even kill you. Or me. When it gets here, we’ll deal with it as best we can.
Ha ha.
“Risk of systemic health care failure.... due to massive incompetence and excessive government meddling!”
Fixed it!
well people are already panic buying- stores are out of lysol, purell, other hand sanitizers, toilet paper, masks, bleach etc- If it takes off- it’s gonna get much worse-
The risk management pencil pushers never factored in a Black Swan, because it can’t be factored in, by definition.
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