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Page added on March 14, 2020
This Will Get Worse The grim math of a coronavirus future.
arch 10 was just a few days ago, but it already feels very far away — before the NBA season was suspended, Tom Hanks tested positive, and a national state of emergency was declared. On that date, Think Global Health, which is a project of the Council on Foreign Relations, produced a report that includes a data table that tells us how many people in the U.S. might ultimately die from COVID-19 under a variety of different assumptions. In the top-left corner, the table shows a scenario where 0.1 percent of people in the U.S. contract the virus and 0.1 percent of those die from it, leading to a bit more than 300 deaths. That’s the best corner of the table. We like that corner. What we don’t like is the bottom-right corner of the table, which contemplates 50 percent of the American population contracting the virus and one percent of those dying. If we end up in that corner, about 1.6 million of us will die.
We could land anywhere in the table. Beyond that, unfortunately, I can’t offer much more specific guidance — in fact, depending on which experts you ask, we could land outside the table, too. But our knowledge about our lack of a knowledge is a kind of knowledge. The coronavirus endgame depends on a series of unknowns. We keep getting more data, but we still don’t know how inherently infectious or deadly this virus is. We don’t know how well we as Americans will respond and are responding to those risks of infection and death: how effectively we will reduce its spread, ensure that our hospitals are capable of handling a flood of sick patients, and heal those who are in the hospital. The early public response was abysmal, but we don’t know how quickly, or dramatically, that is changing. And, in large part because of the appalling failure of the Centers for Disease Control and Prevention to ensure an adequate supply of usable testing kits, we don’t know how bad the virus outbreak in the U.S. is already. However bad it is, things will get worse.
So let’s talk about what we know about some of those known unknowns.
Roughly, there are two ways to address an epidemic that threatens to spiral out of control and infect much of the world. Plan A is to stop it by imposing public-health measures that reduce the rate of transmission, such that each person who gets infected ends up infecting less than one person on average, and the epidemic begins to die out. Dr. Cyrus Shahpar, one of the creators of the table that tells us so much about what we don’t know, told me the more benign outcomes proposed in its leftward columns are based on the apparent success China has had in doing that: Outside the Wuhan area, infections so far have made up less than 0.1 percent of the population. In the Wuhan area, the disease has hit approximately 0.5 percent of the population. In both areas, new infections are declining, not trending toward half the population.
But there are good questions about whether this success can be replicated in other parts of the world and even whether it can be maintained in China itself. China’s measures to slow the spread of the virus have been draconian, and the country is seeking to ease up on them and return to normal. But since most of the population has never been infected, most people remain “naïve” to the virus — they don’t have antibodies and are vulnerable to a resurgence of the epidemic, at least until there are effective antiviral treatments or a vaccine available. And over time, practices that shut down large fractions of the economy and society are likely to prove less sustainable.
It is possible, as countries ramp up their testing and surveillance capacity, we will increase our capability at managing the outbreak by identifying and isolating individuals with the infection, allowing us to reduce our reliance on population-level containment measures — this has been key to South Korea’s success at slowing the growth of new infections with less-severe restrictions on social activity than we are seeing in China or Italy. On Friday, the president held a press conference to tout expanded testing but dodged a question about when those tests would actually become available. And even at South Korean levels of social disruption, epidemic containment would require a more intense and prolonged change to the American way of life than a lot of people and even policy-makers have yet to recognize.
The even less palatable option is to try to let it run its course in the most orderly manner possible. After a large fraction of the population is infected — 40 to 70 percent are the numbers I tend to hear thrown around — many people will have developed antibodies, making it increasingly difficult for the virus to find vulnerable hosts to infect and causing the epidemic to ebb naturally. The big problem with this outcome is that it would entail a very large number of deaths even if the infection fatality rate proves to be on the low end of the estimates.
And then there is the Italy problem. There, as in the U.S. and everywhere else, hospitals have limited capacity to treat patients with severe lung illnesses. If the health-care system gets overwhelmed with an enormous number of COVID-19 cases requiring intensive care, the quality of care will deteriorate and a larger fraction of patients will die than would die in a well-functioning health-care system. This is why people keep talking about the need to “flatten the curve”: Merely slowing the growth of the epidemic, even if it doesn’t reduce the ultimate number of cases, would lessen the pressure on the medical system is considerably. But as I have reported this story, I have gotten an increasingly sinking feeling about the “flatten the curve” discourse for reasons that have to do with the other variable in the table: the fatality rate per infection.
U.S. hospitals contain about 900,000 hospital beds, of which fewer than 100,000 are for critical care. Of course, most of those beds are already in use for people with other medical problems — U.S. hospitals admit approximately 36 million patients annually. If 165 million Americans ultimately contract the novel coronavirus, how much would we need to “flatten the curve” to fit all those who need hospital care into properly equipped beds to avoid a situation like in Italy, where patients are being denied treatment for lack of available resources?
Justin Lessler, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, told me he believes that flattening the curve will only work to manage hospital capacity if the fatality rate from COVID-19 is on the low end of the range of estimates. “I was discussing this with a colleague, and I had been operating under the idea that maybe the infection fatality ratio was around one in a thousand,” Lessler told me. “And under that, things are very, very bad, but you can envision a world where we spread out the epidemic and slow it down and never overrun our ICU capacity.
“My colleague was saying he thought the evidence was closer to one percent. If that’s the case, that’s ten times as many, and then it’s hard to envision a scenario where health systems are not overrun. ”
Available critical-care capacity is not a totally fixed figure. The Johns Hopkins Hospital, for example, has the capability to provide critical care in non-ICU areas. As feasible and medically appropriate, it will free up ICU space by moving patients to standard floors. The hospital will delay elective surgeries, reducing demand for the surgical ICU and allowing for redirection of resources.
Still, there are limits, and the uncertain timeline is also a problem: We don’t know how long the epidemic will place additional strain on hospitals and the extent to which that time could outrun the sustainability of some of these measures. As Dr. Robert Scott Stephens, an ICU physician at Johns Hopkins, noted to me, elective surgeries eventually cease to be elective.
If the lethality of this virus turns out to be on the higher side of estimates, Lessler says the only public-health response that seems likely to keep any country’s hospitals from being overwhelmed is one that is “very, very, very, very intensive,” using whatever infection-control measures are necessary to keep the rate of new infections per new infection below one. Countries that take early and effective action, like South Korea, may be able to achieve that with more moderate social-distancing measures, while those that wait too long or fail to take the right steps may find themselves in the same position as Italy, with a complete lockdown as the only viable option to get a handle on the spread of the disease.
What position are we in, I asked? Is it still early here?
“It’s earlier than it will be,” he said. We had this conversation on March 11.
This public-health crisis will also produce an economic crisis of some scale. The stock market has fallen more than 20 percent from its record highs in February. Disruptions caused by efforts to slow the spread of the virus are having particular impacts on the transportation, hospitality, and energy sectors. United Airlines announced Tuesday that net bookings for domestic travel — new bookings minus cancellations — had fallen by about 70 percent in recent days. Net bookings to Europe and Asia had fallen 100 percent, meaning as many people were canceling trips as were booking them, and that was before Wednesday, when President Trump announced a policy restricting travel from most of Europe to the U.S. With fewer people expecting to travel, demand for oil has weakened and prices have fallen sharply. A recession in the U.S. has gone from improbable to very likely in a period of weeks.
As for what happens next to the economy, I can’t tell you. As New York’s business columnist, I have devoted a lot of time to thinking and writing about the economic-policy responses this crisis will require, but it wasn’t until March 10 that I realized both I and the economists I routinely check in with had been making an error in thinking about responses to the crisis: We’d been focusing on the light- to medium-bad versions of how this epidemic might go, without giving much thought to the bottom-right corner of that infernal table, in which this epidemic is worse than any other we’ve seen in our lifetimes.
“The more I think about this, the more this reminds me of post-9/11,” said Doug Holtz-Eakin, a former top economic adviser to George W. Bush and John McCain, when I put the worst-case-scenario question to him. “You had to respond to the terrorist attack by attacking terrorism, and so the analogy here is we have a public-health mission that I continue to think is not robust enough. I think they ought to be giving the states a lot of money for test kits and ventilators and beds and lodging and all sorts of stuff — first responders’ protection. But you also then have to essentially harden the economy against the impact of the threat in the future, and in the case of 9/11, that took years.”
As with any crisis, there is also overreaction among the population. But on balance, there is still more underreaction. There is also the problem of delayed reaction. Lessler, the Johns Hopkins University epidemiologist, noted a way in which this epidemic tricks people into panicking when it’s too late. “If people are only going to start taking the actions they should when they start to see a lot of people dying around them, it’s already too late,” he says. When you combine the substantial period from infection to death with exponential growth in infections, the number of deaths you see around you is likely far lower than the number of deaths you are about to see. The people who stand to die within the next 30 days may not even be very sick yet. And when they get very sick, the hospitals may be overwhelmed and ill-prepared to respond. This is the corner Italy backed itself into. We might be headed there, too.
31 Comments on "This Will Get Worse The grim math of a coronavirus future."
Abraham van Helsing on Sat, 14th Mar 2020 3:22 pm
“America’s hospitals will be overrun with coronavirus in just EIGHT DAYS: Obama’s Medicare boss issues dire warning as doctors say as many as 500,000 are already infected and 10 MILLION will need care“
https://www.dailymail.co.uk/news/article-8112063/America-braces-coronvirus-collapse-100-00-ICU-beds-10-MILLION-hospitalized.html
“Trump says he HAS been tested for coronavirus and is waiting for results despite his OWN physician saying he did not need one, as White House starts temperature checks for people around Trump“
https://www.dailymail.co.uk/news/article-8112479/Trump-tested-coronavirus-waiting-results.html
Anonymouse on Sat, 14th Mar 2020 3:26 pm
Clogghiem, your Europe is already overrun with the
Virus but you don’t have much to say about that jewturd.
Abraham van Helsing on Sat, 14th Mar 2020 3:49 pm
That was short! “Special relationship” lasted two days:
https://www.rt.com/news/483144-us-travel-ban-uk-ireland/
“US to suspend all travel to UK & Ireland from Monday night due to pandemic“
world grater supreamcist muzzies lovin assn on Sat, 14th Mar 2020 4:46 pm
supertards
please change ur underewear after 5 days, my goal is 4.
oh btw, spring is comingand it means mating season and aggression.
look for long posts from supertard theedrich and resident eurosupertard cloggie
when you’re out and the muzzie “allah akbar” he’s not saying “have a good day” to you. yep, the people who bought a lot of lib urns actually advised you that. in all cases where muzzies allah akbar he went after ur neck.
so keep yoru luke in good working order and pay attention to supremacist muzzies allah akbaring you
be safe out there
Abraham van Helsing on Sat, 14th Mar 2020 4:53 pm
Look Donnie, this is how you keep the enemy out:
https://youtu.be/IP8XxUppJAA
https://youtu.be/ghjd5kRGF84
Davy on Sat, 14th Mar 2020 5:01 pm
Pretty sobering stuff if the west wants to get this outbreak under control. Forget about your rights and dignity, you will be processed into a system like cattle and make it or not.
“How a country serious about coronavirus does testing and quarantine”
https://tinyurl.com/s9ltl7b msnbc
“Donald McNeil, science and health reporter for the New York Times, talks with Rachel Maddow about how China handles a person who may have contracted the novel coronavirus, with an eye on breaking the chains of transmission and protecting hospitals from being overwhelmed, and with a process that stands in stark contrast with the U.S. for its competence.”
world grater supreamcist muzzies lovin assn on Sat, 14th Mar 2020 5:18 pm
On This Day…
Mar 14, 2006: Qayyarah, Iraq
The Islamic State buries alive dozens who refuse to fight: 24 Killed
ht supetrad glenn roberst thereligionofpeace
makati1 on Sat, 14th Mar 2020 5:58 pm
As of yesterday 64 cases, 5 dead here in the Philippines.
Metro Manila in semi-quarantine for 30 days. That means you meed an ID saying you work in the city and/or provide a necessary service to travel in and out. Schools are closed for 30 days. Not much else changes.
Davy on Sat, 14th Mar 2020 8:18 pm
Mak, tell us about how the flu is so much worse again. Tell us about testing because 64 cases doesn’t mean much unless testing is widespread.
Duncan Idaho on Sat, 14th Mar 2020 8:34 pm
GOP LAWMAKER WHO VOTED AGAINST PAID SICK LEAVE IN FLORIDA TAKES PAID LEAVE FROM CONGRESS
(sorry for the caps)
https://theintercept.com/2020/03/12/matt-gaetz-florida-paid-sick-leave-coronavirus/
Repugs are a sick bunch of sociopaths.
makati1 on Sat, 14th Mar 2020 9:57 pm
Davy, better look at your own failing country as far as tests are concerned. The US cannot even manufacture one that works. The Philippines gets theirs from China, where they are proven to work. The US, not so much.
There are hundreds of thousands of coronavirus cases in the US undetected…yet. Thousands may have already died and never been tested. Not knowing does not make them disappear.
Hypocrisy is the US slogan. Lie and deny, just like you. China is recovering. The US, and the West, is still sliding down that slippery slope into the sewer. Fun to watch…from 6,000 miles away.
I’m fine and not worried. I don’t have to go to the city. I’m prepared to sit it out for a year, if necessary. I don’t have to leave the house, if I don’t want to. Are you prepared? You say you are but…lies? From what I am reading, the police state is coming to your neighborhood soon. Buckle up! LMAO!
Duncan Idaho on Sat, 14th Mar 2020 10:22 pm
“They’ve got the watches, we’ve got the time. “
Davy on Sat, 14th Mar 2020 10:49 pm
OK mak. looks like you won another debate agin. Theres likely millions of cases in America already. And no hope in hell of a lockdown.
were REAL fucked over hear. And Italy, my plan B, is even worse
All the best to you!
(old friend)
makati1 on Sat, 14th Mar 2020 11:12 pm
Nice try, JuanP. ^_^ Not the response that the real Asshole Davy would male, but, yes, I am correct in my assertion. It is only beginning in the US so I hope you are prepared.
FuelShortageComing on Sun, 15th Mar 2020 12:46 am
Makati1 is a stupid idiot that is fat and ugly. He believe in global warming and he is too stupid to actually look at the real data and make his own conclusion.
He is fats,ugly and he is lacking social skills. He is an old pervert that like fucking young girls. This is why he is in Philippines. He is a pedo fucking underage girl.
Davy on Sun, 15th Mar 2020 5:35 am
“Davy, better look at your own failing country as far as tests are concerned.”
Mak does his deflecting again but the question was not answered. makato and juanPee have for weeks said this virus is nothing and the flu so much worse. What do you like to say, makato:
NUFF SAID
Davy on Sun, 15th Mar 2020 5:40 am
“Davy on Sat, 14th Mar 2020 10:49 pm OK mak. looks like you won another debate agin. Theres likely millions of cases in America already. And no hope in hell of a lockdown. were REAL fucked over hear. And Italy, my plan B, is even worse All the best to you! (old friend) makati1 on Sat, 14th Mar 2020 11:12 pm Nice try, JuanP. ^_^ Not the response that the real Asshole Davy would male, but, yes, I am correct in my assertion. It is only beginning in the US so I hope you are prepared.”
LOL, makato admits to juanPee ID theft. Lots egg on the face lately from juanPee and makato. JuanPee is an irrelevant lunatic and makato a brain dead senior I compare to sleepy joe biden. The both have been moderated and neutered. What has either said in the past year that was right? ZERO. It is not hard to moderate dumbass. VICTORY
Davy on Sun, 15th Mar 2020 5:42 am
“He is fats,ugly and he is lacking social skills. He is an old pervert that like fucking young girls. This is why he is in Philippines. He is a pedo fucking underage girl.”
fuel shortage, he likes boys and monkeys. juanPee likes boys and dogs.
Davy on Sun, 15th Mar 2020 6:20 am
“No State Is Prepared” – Mapping Where Hospitals Will Run Out Of Beds First If Virus Cases Spike”
https://tinyurl.com/wsc7zsy zero hedge
“A USA Today analysis of American Hospital Association (AHA) hospital bed data shows that if confirmed Covid-19 cases and deaths follow similar growth curves as in China, Italy, and Iran, there could be six patients for every existing hospital bed. This means that no hospital system in the US is prepared for a pandemic…The fast-spreading virus could overwhelm the US’ healthcare system if confirmed cases and deaths surge in a 2-3-week period, as it did in China, Italy, and Iran. Currently, Italy’s health care system has been crippled with the lack of hospital beds and respirators. The result of not providing ICU-level treatment to the most critical patients has resulted in the country’s extraordinarily high 6.8% mortality rate. The doomsday scenario that could play out in the US is an overburden healthcare system, where the most vulnerable cannot get ICU-level treatment, leading to a mortality rate comparable to Italy. “When hospitals become much more crowded, literally stretched beyond capacity, if I have a heart attack, will I be able to get care? If I have an auto accident, will I get care? How do we triage that?” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “We can’t approach this like I approach a game of checkers with my 10-year-old grandson,” he added. “We have to approach this like a chess master thinking 10 to 15 moves down the board.”… During the next outbreak, USA Today notes that many West Coast states would experience 20-24 seriously ill patients per available hospital bed. The odds of getting a bed are significantly higher in Rocky Mountain and Plains states… containment measures for all major metro areas have been missed by over a month. It’s only now preventive strategies to mitigate community spreading are being implemented, and even then, most people are ignoring the warnings to conduct social distancing, which all means cases are likely to increase in the coming weeks…”Whenever you have an outbreak that you can start seeing community spread … when you have enough of that, then it becomes a situation where you’re not going to be able to effectively and efficiently contain it,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told a House committee Wednesday. “Bottom line, it’s going to get worse,” Fauci said. How much worse is the billion-dollar question. As far as what we can see, the peak crisis has yet to arrive. Containment windows have been missed across major metros, implying that hospital systems could begin experiencing an influx of cases in the weeks ahead. If hospitals get overwhelmed, the US could be the next Italy with high mortality rates.”
Sissyfuss on Sun, 15th Mar 2020 9:53 am
This is just a prelude to a much worse scenario. Arctic News Blogs latest research says we have already passed 2C and will hit 3C by 2021 where exponential runaway warming will begin. They use the correct start of Ind Civ beginning in 1750 when the Coal Age began to ramp up, not the cherry picked 1850 or 1950. Covid-19 is a precursor but the real fun begins with growing season abnormalities and wet bulb massacres. Call me a doomer but I find the science irrefutable and immiserating.
Duncan Idaho on Sun, 15th Mar 2020 10:44 am
“Add to that, “South Korea has 12.3 hospital beds per 1,000 people. The US has 2.8,” Vox reports. And that extraordinary private sector? After for-profit HCA Healthcare took over our hospital system here, complaints have spiked and the quality of care has rapidly declined. “
Duncan Idaho on Sun, 15th Mar 2020 10:51 am
Late-stage capitalism primed us for this pandemic
(A decimated welfare state and a government that serves only the rich created the perfect conditions for coronavirus)
https://www.salon.com/2020/03/15/late-stage-capitalism-primed-us-for-this-pandemic/
Davy on Sun, 15th Mar 2020 11:01 am
“Add to that, “South Korea has 12.3 hospital beds per 1,000 people. The US has 2.8,” Vox reports. And that extraordinary private sector? After for-profit HCA Healthcare took over our hospital system here, complaints have spiked and the quality of care has rapidly declined. “
Well, yea, Idaho, but how about intensive care unit beds….different story. Why do you hate America and Americans so much again?
https://tinyurl.com/yx76bqrg
Davy on Sun, 15th Mar 2020 11:04 am
“Late-stage capitalism primed us for this pandemic”
More like globalism and the way of life you and your extremist liberals are preaching primed us for pandemics. How about those open borders and rich liberals traveling the world on their bucket list. WTF Idaho, you are one of the rich bitching and whining about what you are doing. My Fucking God this site is hilarious.
supremacist muzzie lovin inc on Sun, 15th Mar 2020 11:04 am
the world is being cleared “the screwfly solution” style racoona sheldon to make way for younger moar intense muzzie lovers
Simon Says on Sun, 15th Mar 2020 3:54 pm
You are going down too, DavyScum. I cannot wait for one of your deplorable neighbors to plant a clawhammer into the back of your head once times start getting tough.
Talk about just desserts.
Simple Simon Says on Sun, 15th Mar 2020 4:26 pm
You are going down too, juanskum. I cannot wait for one of your mentally ill neighbors to plant a clawhammer into the back of your head once times start getting tough.
Talk about just desserts.
Davy on Sun, 15th Mar 2020 4:30 pm
juanPee, are you so so depressed and upset because I kicked your fucking ass yet again. Try to come on here as JuanP and tell us the virus is nothing. You won’t because you will look like a complete moron. Your stupid friend makato1 won’t even mouth off anymore! VICTORY is sweet
The DavyScum Meaning of Life on Sun, 15th Mar 2020 5:27 pm
The DavyScum finds meaning by declaring himself victor in an imaginary war of his own widdle creation. Many would define you as a sad widdle clown who spends day and night driving around in a widdle clown car while beeping his clown horn at the world in a pathetic bid for attention. If this is not the deffinition of a meaningless life, then what is,
I am Scum
I am DavyScum
Hear me beep my widdle horn.
Davy on Sun, 15th Mar 2020 6:06 pm
Poor juanPee is so so depressed and angry. He got his ass kicked just like the makato1 did. Notice how subdued makato1 is. He struggles to do his AsiaUp routine these days. juanPee is even worse he is completely lunatic and crazy. Stupid socks that are obviously an alter jaunPee lunatic personality are manifested daily. Notice no JuanP comments on how this virus isn’t shit and the flue is so much worse. Two complete fuckups and a pair that deserves each other. BTW, where is their other fucknut friend Annon the annoymouse?? I guess he is feeling stupid too.
REAL Davy on Sun, 15th Mar 2020 6:36 pm
Poor DavySkunm is so depressed and delusional. He got his ass kicked just like he always does. Notice how subdued delusional davy is. He struggles to do his exceptionalist routine these days. Davy is the worst. He is a complete lunatic and crazy. Stupid socks that are obviously an alter dumbass lunatic personality are manifested daily. Notice no davy comments on how his hypocrisy is shit and his bully-boy routine is so much worse. A complete fuckup and a blot on this place that deserves better. BTW, where is davys other fucknut socks? I guess even davys socks are feeling stupid too.