Some COVID-19 Thoughts

If you still doubt that COVID-19 will be a much bigger deal in the US than China and kill less Americans than 10x that of influenza this year, I'd like to share some data and arguments to change your mind:

If you read just one short thing:

"1/ Many of you ask me why I take the COVID-19 outbreak so seriously. Current numbers of cases and deaths are not why. A thread on why I’m worried and what I do personally in this situation." - Max Roser

If you read just one longer article:
ourworldindata.org/coronavirus

Insightful Threads

• "Everyone else will be Italy in 9-14 days time." - Mark Handley

  • What's Italy like? --> An inside view from Italy
  • "Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest."

• "I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math." - Liz Specht

• "If we want to understand how powerful an opponent SARS-CoV-2 (COVID-19) is, let’s take a look what has been required to stop it in China. The Chinese government has essentially used a social nuclear weapon in its efforts. Let’s talk about this, to understand what US is facing." - Nicholas A. Christakis

Predictions

From Dr. James Lawler, a professor at the University of Nebraska Medical Center in the presentation, "What healthcare leaders need to know: Preparing for the COVID-19".

96,000,000 infections

4,800,000 hospitalizations

1,900,000 ICU admissions

480,000 deaths

vs flu in 2019:

35,500,000 infections

490,600 hospitalizations

49,000 ICU admissions

34,200 deaths"

From Marc Lipsitch an epidemiology professor at Harvard University

I think it is likely we will see a global pandemic. If a pandemic happens, 40% to 70% of people world-wide are likely to be infected in the coming year. What proportion is asymptomatic, I can't give a good number. @mlipsitch

More expert opinions and predictions.

The Severity of Symptoms

• Critical cases: Critical cases include patients who suffered respiratory failure, septic shock, and/or multiple organ dysfunction/failure.

• Severe cases: This includes patients suffer from shortness of breath, respiratory frequency ≥ 30/minute, blood oxygen saturation ≤93%...

• Mild cases: The majority (81%) of these coronavirus disease cases were mild cases. Mild cases include all patients without pneumonia or cases of mild pneumonia.[src]

Case Fatality Data

• by age

• by prexisting health conditions

But I'm young and healthy, why should I care?

Yes, the majority of cases in young and healthy people have not been severe, but we don't yet know of the long-term possible consequences of a COVID-19 infection.

Some have a binary mental model: either you die, or you live & all is well. But with SARS & MERS, many patients had long-term respiratory issues. This paper urges follow-up imaging to see if COVID19 is similar - Balaji S. Srinivasan

Further, at least some people are shedding and spreading the virus during their incubation period, before they are aware of symptoms [src]. If you catch COVID-19, you are statistically likely to transmit it to other people. After all, the average infection is leading to over 2 other infections. Each of these people are likely to in turn, spread the virus to over two other people, etc. Given expected doubling rates (country COVID-19 growth data), it's plausible that spreading the virus to an additional person counterfactual in the next couple months, in expectation, leads to at least an additional death.

Flattening the Curve

To minimize deaths, the goal is to not only reduce the absolute number of infections over time, but lower the rate of infection so that the epidemic is spread out over time and the peak demand for the health care system is lower.

One of the better ways you can help flatten the curve is to not catch COVID-19, and especially not catch it and unknowingly transmit it to others. Washing your hands and not touching your face go a long way, but this coupled with social distancing before you have any reason to suspect you have been exposed to COVID-19 is your best bet.

Don't forget about hand washing, but at the same time we've got to get people to understand that if you don't want to get infected, you can't be in crowds...Social distancing is the most effective tool we have right now...COVID-19 is spread simply through breathing, even without coughing. - Michael Osterholm, PhD, MPH

More links

• Why does soap work so well on the SARS-CoV-2?

• From LessWrong, Coronavirus: Justified Practical Advice Thread

• Coronavirus is the wake-up call we need