“Boy, that escalated quickly.” – Ron Burgundy, Anchorman
Joking aside, it did escalate quickly, didn’t it?
Last Monday, I flew home from an annual guy’s trip to Spring Training in Florida. By Wednesday evening, there were no professional sports leagues playing anymore, the kids were being shut out of school for a month, and the grocery stores were crowded and picked clean in a way that was part Christmas Eve and part ‘day before a blizzard’.
There had not been a significant uptick in new COVID-19 cases diagnosed in the United States. Some states still had not tallied their first confirmed case. So, what changed?
Why the nearly overnight transition from near-normal to post-apocalypse?
The COVID-19 Response Team at the Imperial College in London used Infectious Disease Modelling to extrapolate the spread of the disease and to examine the impact of non-pharmaceutical interventions on the slowing of the spread and lowering of the potential mortality. You can read that full report here.
UPDATE 3/18/20 4:20 PM: The U.S. Government has now also released a COVID – 19 Response Plan. You can read that full plan here.
In layman’s terms, the scientists used centuries of collected data on epidemics and pandemics to create a model, plugged-in the rates of infection and death from the earliest countries impacted (China, Korea, Italy) and then ran a simulation to see what would be the likely outcome of the virus in the United States if nothing were done, in other words, if we just went about our daily lives as we had been to that point.
They ran the simulation a second time using mitigation strategies like isolating the symptomatic, quarantining those who came in contact with the infected, and enforcing strict social distancing for those at high risk like the elderly and those with pre-existing conditions which could place them at greater risk.
Finally, they ran the simulation a third time with a suppression strategy, which included all the mitigation strategies but also enforced social distancing for all citizens, a ban on public gatherings, the closing of most schools and many workplaces, basically the option America settled on.
So, let’s look at Scenario 1, the ‘Do Nothing Plan‘.
Under that scenario, 80% of Americans would contract Coronavirus. Just under 1% (more than 3 million) would die. It would be worst for the elderly as somewhere between 4% to 8% of them would die. There would not be enough hospital beds, or medical professionals, or ventilators. Approximately 2.2 million Americans would die from the virus itself. The rest would die because our healthcare system lacked the equipment and manpower to save them.
Four times as many people in the United States would die of Coronavirus than died fighting in the Civil War. If allowed to play out on a global scale, more than 90 million would die.
For comparison, World War II lasted six years and claimed 60 million lives. Coronavirus could claim 1.5 times that globally in just six months.
How much better would Scenario 2, the ‘Something Is Better Than Nothing Plan‘ be?
The idea of this plan is to ‘flatten the curve’ rather than to prevent the spread of the disease.
Picture doing a cannonball in a small backyard pool. Massive splash. Massive waves.
Then, picture doing a cannonball in an Olympic sized pool. Smaller splash. Small waves. The same body mass is entering the water in the same position but with dramatically lower effects.
This would make a significant difference on the spread and mortality of the disease. The mortality rate from the disease would be cut in half, but it would still kill 1.1 million Americans. The shortages of hospital beds, medical staff, and ventilators would be greatly reduced, but demand would still exceed supply by eight times (instead of thirty in the first scenario) leaving 2 million Americans dead and 45 million dead globally.
The real winner is the ‘Win At All Costs Plan‘ which is what we have implemented.
Following this plan, the mortality rate in the United States peaks within weeks instead of months. We would have enough hospital beds, medical personnel, and ventilators. What had the potential to be the single greatest mortality event in America’s history is reduced to little more than a typical flu season.
There is a catch though, and it is a big one.
If we stop suppression before scientists have developed a vaccine and immunized the entire population like we do with Measles and Pertussis, the COVID-19 virus comes right back like it never left and we would be back to the outcomes of the ‘Do Nothing Plan‘.
What will need to happen is a staggered pattern of suppression and relaxation where we repeat the isolations and quarantines for a month or two, then take a month or two to enjoy normal lives, followed by a return to suppression. This process would repeat over and over for as long as 18 months if it takes that long to develop, test, and implement a vaccine.
What complicates matters further is that, as a society (and as one that wants a functioning economy), we cannot afford to do nothing.
But if suppression works, there are sure to be claims that we overreacted and spent nearly two years suffering for nothing as the infection and mortality rates will remain quite low.
Stay safe out there. Use good common sense. Take care of each other. Wash your hands.
We will get through this together.