What's the Big Deal? It's a Cold Virus
Updated: Apr 29, 2020
I'm not an epidemiologist, nor an expert on public health and infectious disease management, but I do work for a healthcare organization and was tasked with crafting our organization's Business Continuity Plan last year. Like most organizations, we had vague plans for responding to a pandemic. Two weeks ago we started kicking around possible worst-case scenarios and I've been closely monitoring any and all news relevant to COVID-19 non-stop.
Medically speaking, this virus will be a trivial event for 95% of us. To date, zero infected children have died. They have all recovered. The most vulnerable populations are in the 65-85 age group where the case fatality rate (CFR) is about 4% (globally). Other vulnerable groups are those with pre-existing health complications (diabetes, respiratory conditions, cardiovascular conditions, etc) and those who are immuno-compromised.
So, what's the big deal? Wash your hands, avoid touching your face, limit social activities, and avoid large public gatherings. Easy-peasy, right? That has been my line of thinking until this week.
The greatest public danger of COVID-19 is a rapid infection rate that would overwhelm the healthcare system. What are the chances of that happening? It all depends on how much of that vulnerable 5% we can keep out of the hospitals at any given time.
There are about 900,000 hospital beds total in the US. Of those, about 90,000 are ICU beds that at any point in time during non-pandemic conditions are 60-70% occupied. That leaves about 40,000 ICU beds and ventilators to service the populations that will have the hardest time surviving this virus. That’s not you and me. It’s our parents, our grandparents, those who have comorbidities, and those who are immunocompromised. It’s the difference in the case fatality rate of .01% and 2-3% which is the difference between 15,000 and 4.5 million.
That’s why SXSW was canceled. It’s why the NBA and NHL just suspended their seasons. It’s why the NCAA men’s basketball tournament is in doubt, schools are closing, and why almost all public events from concerts to festivals to business conferences have been canceled. The 2nd to last line of defense for slowing the infection rate is voluntary social distancing.
If voluntary social isolation doesn’t slow the infection rate enough to keep the healthcare system from being overwhelmed the last line of defense will be mandated by the CDC. We will see cities and/or regions quarantined. Keep in mind, diagnosed cases do not accurately reflect infection rate. The virus spreads before people show symptoms. In Washington, it was spreading for weeks undetected. We won’t know for two weeks how effective today’s containment efforts have worked, and we’re two weeks behind accurately understanding how many people are infected today. At the moment, the rate of infection is expected to double every 6.2 days. In China, South Korea, and Iran, those rates increased exponentially until drastic quarantine measures were taken.
That’s why Italy went from 12 deaths in three weeks to over 60 in one day this week. That’s why this virus is a big deal now in the US. We can improvise hospital beds and stand up emergency facilities, but we can’t manufacture more mechanical ventilators fast enough to save thousands of people if we don’t get the infection rate contained.