There have been a ton of angles by which the recent spread of the Covid-19 coronavirus can be analyzed. I’ve been following the story for well over a month at this point – from the earliest days when only a few hundred cases had been reported.
As soon as Wuhan (the epicenter) and Hubei (the region around it) were put on lockdown, it became clear that this was something to watch and that global impacts were possible. Fast-forward to today, and we are seeing exponential growth outside of China (below). It took a while, but the cat is now out of the bag:
To put the above in context: cases doubled over the past four days. Viral spread is inherently exponential, since each person who has it can act as a vector to spread the disease. Thus, without substantial interventions (as we saw in China), this doubling rate will continue. Let’s consider what that means:
March 15: 80k cases
…
March 31: 1.28 million cases
…
April 30: 231 million cases
This trend will likely slow as people who have it (hopefully) become immune and as people take precaution. So while you should not take this as a prediction, you should take this as a warning: things could get very bad very quickly.
I am, of course, not a doctor. But I have been following many reputable ones and seen their interpretations. While Twitter has many not-so-great things, it also has some incredible resources providing much better insight than traditional media, which has been at least a week behind and regularly off target.
We’ll examine the fascinating revelations on information (and misinformation) at a later time. But for now, I want to answer some common questions about the virus in a fairly straight-forward way about what it means for you.
How bad was the virus in Wuhan and the Hubei region?
Really bad – substantially worse than the reported numbers. Why shouldn’t we trust the reported numbers, you might ask? Well even China admits the numbers don’t capture everyone – many people got sick at home and some even died at home without ever getting a chance to go into one of their packed hospitals.
But aside from that, it is never wise to trust the Chinese government. Government Analysts and Financial Analysts who review Chinese data know this well – it’s much better to look at the actions the Government takes rather than the words that it puts out. Those actions include:
Locking down the entire region, then adding other regions to total almost 750 million people at its peak.
For Hubei in particular – keeping all residents in their homes for over a month (with no set end date)
As recently as February 22nd, announcing the construction of 19 new makeshift hospitals to accommodate those who are sick
China shipped 20,000 medical staff from other regions into the Hubei region.
These are well documented facts (sources below). And it doesn’t take a rocket scientist to figure out that this means that there were substantially more people infected than the 40,000 reported there. Beyond that, there is the harder-to-verify videos that were circulated before China cracked down on its digital firewall: videos of people collapsing in the street, videos of apartment buildings being welded shut, and videos of huge machines disinfecting the streets.
Frankly, we don’t know how bad it was in Wuhan. But the numbers shared present a best-case view, and it isn’t out of the range of possibility that it was 10x worse.
Statistically, how bad is it?
Most estimates suggest the fatality rate is between 1% and 3% and significantly higher for older (>60 years old) people. But it is still dramatically worse than the flu at all age ranges. For reference, the flu averages 0.1%, but is also higher with the elderly.
This number is hard to measure since low/no symptom cases may not be caught, and we may be dividing the number of deaths by only a subset of extreme cases. Deaths may be higher as well, especially considering China obscured information. That said, there’s pretty broad consensus that this is substantially more deadly than the flu. Maybe it is twice as deadly, but it’s more likely that it is 5, 10, or even 20 times more deadly.
It is also more contagious. Early estimates put the rate of spread, or R0, between 2 and 3, meaning each person will infect 2-3 other people. This is also greater than the flu, which is estimated around 1.3.
Both of these factors are tough to measure though, as they both depend on all cases being identified, which we are not doing. The rate of spread is also affected (hopefully reduced) by measures taken to combat the spread, as we saw in China. So it is not an unbiased number.
Put simply, anyone who says “this is just the flu” or “the flu kills more people” lacks a fundamental understanding of the dangerous potential this virus carries. Do not pay attention to them.
Can it get that bad here?
Absolutely. We can take a look at Italy – where there are now already 5,883 cases and 233 deaths (3.9% mortality) despite aggressive measures (quarantining a large chunk of the country, closing schools nationwide). South Korea is up to 7,000+ cases but with only 48 deaths (0.7% mortality) again despite aggressive containment measures (and testing efforts to try to catch every case). Iran has 5,800+ cases and 145 deaths (3%) but this is also an optimistic estimate based on information coming out of the country.
What we’re seeing now in the US is community transmission in various metros: Seattle, San Francisco, and New York. This makes sense given their international presence, and is a bad sign. Seattle looks particularly precarious: they already have 70 known cases and 11 deaths, despite the US having done scandalously limited testing so far.
Most notably, this virus can be transmitted even before people develop symptoms. This in particular makes it incredibly hard to stop. It spreads before the first cough is made.
Is the case count the only factor to worry about?
No. Approximately 15% of cases so far have required hospitalization with a good portion of them requiring patients to be put on a respirator to help breathe. This puts enormous stress on the medical system. Doctors and nurses also run the risk of being exposed to the virus which creates additional pressures on the system. This feedback loop can greatly exaggerate the impact and lead to more deaths if people who need respirators and medical care can’t get them.
Why is our testing levels scandalous?
Oof, that’s a long story. But you can pin it on unnecessary bureaucracy and incompetent political leadership. The CDC had made tests and shipped them out, only to realize that they were faulty. They were taking a long time to fix this, despite the fact that labs could easily synthesize their own tests. However, the FDA would have needed to approve this, and they weren’t. With political leadership absent, this dragged on for weeks until things were finally opened up late last week. We are only starting to uncover the cases that have already been brewing here in the mean time. Here’s a recent Washington Post article summarizing the issues.
Will warm weather solve this for us?
It will not solve it. It will help, but we don’t know to what degree. Heat and humidity both inhibit the spread of other viruses, so it is reasonable to assume it’ll do so with Covid-19 as well. We also have seen much slower (i.e. manageable) spread in Singapore, Malaysia, and Indonesia – countries we would have expected to see outbreaks in given their proximity to China.
That said, the flu is a seasonal virus, and this one runs a high risk of roaring back in the fall (potentially with new, dangerous, mutations) if we don’t get it under control.
What about treatments? Vaccines?
So some good news – the medical and research communities are doing a ton to figure out treatments and preventative vaccines. Some of these are even going into trial already! The pace of development and of research being shared is also tremendous – new papers are coming out daily on the spread, treatment options, and more.
But the bad news – these could still be months away from general availability, especially if we reach a point where millions are infected. Hence, delaying the spread of the virus as much as we can is very important.
Given what we know about the spread, what will happen in the U.S.?
Many people have been poo-pooing the potential impact of the Coronavirus on the U.S. As I alluded to above, this is unwise and shows an inability to understand exponential trends. The American Hospital Association recently put out a slide that takes all of these assumptions into account. What’s the best estimate currently?
96 million cases
4.8 million hospitalizations
1.9 million ICU admissions
480,000 deaths
This represents 10X a normal flu season, and assumes we’d be able to handle almost 2 million ICU admissions and keep the case fatality rate on the low-end: 0.5%. Both of these are optimistic, and if Hospitals and ICUs do get overrun, the death rate could be substantially higher.
The remaining option is that we can limit the spread, but this requires hard measures similar to what China did. This would have dramatic impacts to our economy that is already on fragile ground. Put another way, we’re between a rock and a hard place.
I’d very much like to be wrong, but I believe we’re just at the beginning of a historical event. There are easily ways that I could be wrong: we may find an effective treatment or vaccine, it may burn out as warmer weather comes in, it may become less contagious as we take precautions.
That said, we can’t assume any of these will have an impact on a virus that has been almost unstoppable thus far. There hasn’t been a pandemic this dangerous since 1918, so none of us really know how to process what is happening. But it is certainly wrong to assume that nothing bad can happen because we haven’t seen this in 100 years. There are once-in-a-generation events that will debunk all the lived experience we have. They are rare, but they can and will happen.
Right now, the evidence is certainly pointing to a wakeup call for humanity about just how dangerous new infectious diseases can be. If it isn’t slowed down, we will almost all be touched by this virus personally, financially, and societally. Imagining the realistic downstream consequences of an pandemic like this simply make it too big to ignore.
So please: stay informed, be hygienic, prepare for the disruption of basic services, and avoid large gatherings. Being personally responsible will help slow the virus and allow medical personnel to respond as best they can.