An acquaintance of mine, who is a Trump supporter and apparently gets much of his news from the talking heads on Fox News, recently sent me an email asking for my thoughts on the coronavirus. We had previously agreed not to discuss politics, but I could tell where this was coming from.  His question went something like this. Now that we are doing more testing in this country, the percentage of the people dying from the virus is going down as expected, the death rate might be as low as 1%. So why the panic? That many people die from the flu.

I have been interested in the numbers which underlie the medical experts warning that if we don’t take step quickly to slow the spread of the coronavirus, the number of cases could easily overwhelm our medical facilities causing a huge number of deaths.  I decided to get the raw numbers and do the necessary calculations to personally understand the threat and share it with him. The result was an email which contained much the same narrative as you see below.  It then occurred to me that others might want the same information.  I just edited the original email text to make it a bit more understandable and updated the virus numbers as best I could with the latest I could find. (The data used below was current as of 5:19 pm, Tuesday, 3/31/20.)

My answer:

So then why the panic?  You’re right, the more people that are tested, the more we will identify those who test positive for the virus who have few or no symptoms.  Those numbers will be added to the total number of cases, but since they are probably not going to die, they won’t ever be added to the number of people who have lost their lives to the virus.  Therefore, the death rate from the virus (which equals people dying from the virus divided by total number of people who test positive) is going to go down as we test more people, but probably only  initially.

However, we need to remember that we are still early on in this pandemic.  So far everyone who is seriously ill from the virus with very few exceptions are still getting the very best care available. Things are changing rapidly in the nation’s hot spots, but so far it appears that no one is yet dying unnecessarily because there aren’t enough ICU beds, ventilators, or medical personnel to treat to them.

However, if our “stay at home” orders are not issued in time, or aren’t obeyed, doctors will be faced with the unthinkable decisions of who gets life saving medical care and who doesn’t. That’s when the death rate could skyrocket. Look at countries whose distancing measures were not put into effect early enough.  China initially let their virus situation get out of control before they took extraordinary measures to clamp down on the spread of the virus. Their death rate is 4%.   Italy’s death rate, where doctors are still making those extremely difficult decisions every day, is 10.8%

I think we also need to remember that people aren’t dying the first day they have the virus or even the first day they are admitted to the hospital so it would seem that the infection rate will rise first, and the death rate will rise a bit later.  That said I have absolutely no idea how that plays into the current figures.  However, the latest figures I can find for the US are: Total cases: 183,588  Total deaths: 3,780 = 2.06% death rate. It may turn out to be higher or lower than that, but let’s assume that the ultimate death rate is conservative 1%.  The death rate for the common flu is 0.1%, which is 10 times lower.

I have heard a couple of the infectious disease experts state that their models estimate that ultimately 40% to 60% of the population of the US will  eventually be infected without intervention.  Based on early US figures there was a 20% hospitalization rate. However, I suspect that is high again because of inadequate testing as well, but I think that we can agree the hospitalization rate is still going to be significant because the hot spots are already having trouble coping with the influx of the new patients. Of course, what we have been hearing from all of the medical experts is that we are trying to “flatten the curve” with the extraordinary “don’t socialize” measures so all of the people who will eventually be hospitalized don’t hit the medical facilities at nearly the same time.

Here is estimate of what would happen if we don’t “flatten the curve”:

The US population is about 327,000,000.  Let’s take the lower infection rate of 40% and a hospitalization rate of only 10% instead of the 20% now being reported..  40% of 327,000,000 is 130,800,000 people.  10% of 130,800,000 is 13 million – that is the number of people who will eventually be hospitalized.  In the entire US we only have approximately 664,000 total hospital beds and somewhere between 46,800 to 64,000 medical intensive-care unit (ICU) beds. We are also in the middle of the regular flu season, people are still having heart attacks, getting hurt in accidents, etc. so a lot of those beds are already taken. For instance during normal times on average 66% of our intensive care beds are occupied at any one time.

So with the possibility of 13 million people eventually needing hospitalization it easy to see how our hospital system could be overrun if we don’t spread out the rate at which people become infected and are hospitalized.  However, that situation is even worse than those number suggests.  The problem is that we have hot spots such as NYC, New Orleans, Washington St., etc.  The hospital and ICU beds in Iowa and Montana aren’t available in the hot spots so they have an even bigger problem in those locations than the numbers would suggests. We don’t want doctors to have to decide who gets lifesaving treatment and who doesn’t, but it will come to that if we don’t flatten the curve.

Then there are the real serious problems – deaths.  Assuming 1% death rate of those who become infected and the lower 40% infection rate:  40% of 327,000,000 is 130,800,000 people. 1% of 130,800,000 is 1,300,800 people who will no longer be with us. That is a lot of human lives lost.  But remember that 1% rate is occurring now before our hospital are overrun and while the very sick are still receiving the very best  care available.

Hopefully no one has died unnecessarily yet from this pandemic.  However, that probably will not be the case for much longer if we again don’t slow down the spread of this virus using the sections of the US where the medical facilities are overrun, the death toll will be much higher than 1,300,000 people.  In addition, the infection rate in the US is still very low compared to what it will be.  So far with only some exceptions we have been able to keep the virus out of nursing homes where the truly vulnerable live.  However, with more and more people getting infected every day that probably isn’t going to last.

The problem is that in this country we aren’t yet doing a good job of slowing the spread this disease across this country because our national leaders wasted the two months of warning which came out of other countries, downplaying the threat instead of preparing for the worst. We are trying to shut the barn door long after the horses are gone. According to the World Health Organization, so far China has had 81,394 cases of coronavirus and now that country has only a few or no new cases for at least a week or two.  At last count in the US we already have 181,326 cases and our number is doubling about every three days.

For comparison purposes the population of China is approximately 1,437,000,000 while ours is approximately 237,000,000.  So China, where the pandemic started, has 6 times our population but we now already have more than 2 times the number of coronavirus cases and that number is growing daily.

Of course, during early days when the virus first hit Wuhan Province the Chinese government pretended it didn’t exist and thus let it get away from them, and that helped infect the rest of the world.

However, they the eventually instituted draconian measures, as only a totally totalitarian country can, which ultimately slowed and then stopped the spread in their country while the virus continued to spread abroad.  They now have essentially killed the spread of the virus in China while here it is still totally out of control.  And yet Trump and a number of Republican governors have thus far failed to make the measures necessary to slow the spread of the virus mandatory.

One of the questions most asked is when will we be able to pull back on the drastic measures we have implemented.  Unfortunately not until we can test everyone who might have the virus, isolate those who test positive and then further test all those who they might have infected. We are not even close to arriving at that point.

That’s “why the panic”, or at least why the medical experts are extremely concerned.

Maybe my friend isn’t drinking all of the Trump Kool Aid.  His reply was:  “Thanks for your analysis.  I agree – it’s for real. In fact, the enemy is massing at the gate.”

Cajun     3/31/2020