COVID-19

There has been a great deal of discussion about how serious the Covid-19 virus is and how we should respond to it.  I decided to take a look at this issue by taking the information that we have now and extrapolating the implications of that information to guide my thinking and response to the pandemic.

The most recent statistics of the World Health Organization (WHO) gives Covid-19 a reproductive number of 2.0 -2.5.  This is the number of secondary infections that can be anticipated from each infected person.  Using the lower number, (2.0) one can extrapolate how quickly the infections can spread in a very short time. 

Day  1    1  infection
Day 2      2 infections   (multiplying by a factor of 2)
Day 3     4
Day 4    8
Day 5    16
Day 6    32
Day 7    64
Day 8    128
Day 9    256
Day 10    512
Day 11    1,024
Day  12    2,048
Day 13    4,096
Day 14    8,192
Day 15    16,384
Day 16    32,768
Day 17    65,536
Day 18    131,072
Day 19    262,144
Day 20    524,288
Day 21    1,048,576
Day 22    2,097,152
Day 23    4,194,304
Day 24    8,388,608
Day 25    16,777,216
Day 26    33,554,432
Day 27    67,108,864
Day 28    134,217,728

When those numbers are added together, it indicates that the potential number of individuals who can be infected in a four week period is well over 250 million individuals.  There are mitigating factors such as social distancing, quarantining, etc. 

The other factor is the number of deaths.  Flu has a mortality factor of .1%.   That means that one out of every thousand cases is deadly.  The mortality factor for Covid-19 is between 1.0 and 3.4%.  If we can extrapolate that to 100 million cases nationally, it will mean that between 1 million to  3.4 million people will die from this pandemic, mostly aged and those with compromised immune systems. 

There are other health implications of this pandemic.  The biggest being the availability of care for the seriously ill.  Approximately 80-85% of those who develop this virus will have relatively mild symptoms and can be treated at home.  15% or upwards 15 million people will need more advanced care.  The United States currently has 925,000 hospital beds with an annual admission rate of 36,000,000 individuals.  We have 98,000 Intensive Care beds.  If 15 million people require hospital care it will represent a 30-40% admission increase to our hospitals and it has the potential of stressing our healthcare system to the breaking point.  I do not have the expertise to figure out what the implications will be for ICU beds, but can assume that they will be at a premium.  This will also be complicated by two other factors.  First, health care workers are on the front lines of this fight and will have a much higher exposure rate.  We might experience a shortage of healthcare personnel.  Second, other necessary hospitalizations will be stressed.  Individuals with serious illnesses, victims of accidents, etc. will be triaged in order to deal with the stresses of this illness. 

While these statistics are sobering, we need to recognize that there are a number of factors which can adversely affect them. 

First, panic and baseless fears can be destructive.  Hoarding of sanitizing supplies, food, and other items deprives others of needed protection.  Remember, this virus has entered the community stage and needs to be treated from a community perspective.  Panic also leads to blaming and scapegoating.  This pandemic is not caused by Asians, Italians, and other Europeans.  We are all in this together. 

Second, poor information and mixed messages are deadly.  The people who have committed their lives to studying epidemics and those who are committed to community health are the best sources of information.  Downplaying or minimizing the implications of this pandemic is foolhardy with deadly implications.  We need to prepare for the worst and hope and pray for the best. 

Actions I plan to take: 

 Hand washing.

2.  Social Distancing.  We live in a vacation community which makes us a bit more vulnerable to exposure.  We will not quarantine ourselves (unless we become infected), but will limit our forays into potential areas of infection.  We will be preparing our own food in our home, take sanitary precautions when visiting stores for food, etc.  Avoid shaking hands, etc.  Part of our reason for social distancing is that we do not wish to expose others if we have been exposed.  We will not, however, practice isolation.  We will continue to take our walks, etc. but will do so with necessary precautions. 

3.  If Karen or I develop symptoms, we will endeavor to care for ourselves at home.  Hopefully testing will be available at that point.  We will self quarantine.  We have made preparations to be able to do this for 2-3 weeks.


What I wish that government authorities would do:

 Start testing!  If social distancing, quarantining, etc is to be effective tools of mitigation, we need to know where the outbreaks are.  This testing needs to massive in scale.  We need to know who has the virus, but also who doesn’t so that we can pinpoint the limited resources that we have. 

2.  The public face of those dealing with this crisis should not be elected officials.  In this politicized environment they are not the most reliable sources of information.  The response to this pandemic needs to be led by public health officials.  In short, we need to be led by those with expertise. 

3.  I hope that we will be readying mobile hospitals, mobile testing centers, and other care facilities to respond quickly to outbreaks of the virus as they occur.

4.  There needs to be coordination between all levels of government.  This virus attacks blue states and red states. It attacks Republicans and Democrats.  We cannot politicize our response based upon past political animosity.  Because it is a pandemic, it needs a coordinated national response that is in cooperation with the international community. 

5.  When this thing is all over, we need to have a bipartisan commission to study and critique the causes and the response to this pandemic.  For years epidemiologists have been predicting a pandemic of this type.  We need to take a hard look at our preparations and our response.  Is it adequate?  What do we need to do in the face of future pandemics (they will occur!)?  Is our healthcare delivery system with multiple insurers and networks adequate to meeting the realities of such pandemics? 
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Sources: 
1.  World Health Organization, Corona Virus Disease, 2019 (Covid-19)  Situation Report #46
2.  American Hospital Association, Fast Facts on U.S. Hospitals, 2020