Coronavirus: Just how bad is this about to get (March 8th, 2020 Edition)
This post was originally published to my personal Facebook on March 8th, 2020. Facebook is marking some of my longer posts as spam, so I’m republishing them on Medium and will publish here moving forward. I’m leaving the post intact as it was published on March 8th, though the situation is evolving rapidly.
A COVID-19/Novel Coronavirus update: Just how bad is this about to get?
Thanks for everyone who read and commented on my post last week about COVID-19 and what to know. (Available here, if you missed it.) Now I want to provide a bit of a thought experiment about: just how bad is this potentially about to get?
Bad! Pretty darn bad! If something significant doesn’t change momentarily, I think that it’s safe to assume that the economic impact of the virus is going to be significant, and that most of us will feel it in some way.
TLDR:
* The rate of spread is astonishing and will quickly get out of hand if containment efforts are ineffective
* The mortality rate amongst high-risk cohorts is HIGH and that means this is worth trying to stop
* Trying to stop this means taking some aggressive measures we’re not used to being asked to take, but it DOES appear possible
* These measures (closing shops, limiting travel, cancelling events, etc.) have the potential to have a VERY REAL AND SIGNIFICANT ECONOMIC IMPACT on you and your loved ones
* There’s still a chance that our efforts and some help from the changing seasons slows or stops this thing, but…
* The cryptic (silent) spread is scary in the sense that it may already be a bit too late to contain
* So make sure you have an emergency fund and can cover a month or two of rent if you were to find yourself furloughed or out of work, if at all possible
In more detail:
I understand the feeling of many people that we’re (the general public, the news media, etc.) overreacting. That’s because it _feels_ like we are, on a gut level — people are going about their business, things are working, there are only a few dozen cases here in the US… But we are also given the benefit of math and a crystal ball of sorts (in the form of the other countries further into this than us) to be able to predict what’s possibly about to happen.
I’ll caveat this entire post by stating that I am not trying to be an alarmist or some sort of lunatic. I am also desperately NOT trying to incite panic, but rather preparation, and a greater understanding of what’s _possible_. I’m also seeing a lot of people treat this as an abstraction, and something that isn’t going to affect them, when the reality is that the situation has the potential to change incredibly quickly and in profound ways. (Imagine that you receive a call from the local health dept telling you that you were exposed to a confirmed case and asking you to self-quarantine for two weeks. Are you prepared for that?)
So far, the virus is appearing to spread at such a rate that it doubles about every three days. If you’ve ever done any math with exponential growth, you can model this out pretty easily. (It’s extremely important to know that the ham-fisted limitations of testing by the CDC and the criteria for testing as a moving target make some of these numbers difficult to come by, and we’ll get into that in a bit.)
Essentially, if nothing changes and aggressive measures aren’t taken (or are proven ineffective), the 417 infections that stand today in the US [1] will result in 3,069 infections one week from now… but 22,600 infections two weeks from now, 166,350 3 weeks from now, and… uh… 1.2 million cases 4 weeks from now.
That’s a lot of cases! For context, H1N1 infected as many as 50 million people in the US, but it’s estimated R0 was only 1.4–1.6 [2] and again, by all accounts, the COVID-19 R0 is expected to be higher. That means it’ll likely impact more people if nothing changes, and faster.
So we’ve lived through a pandemic before, and relatively recently, without the economy cratering. What’s different now?
Well, COVID-19 is almost certainly more fatal. The Case Fatality Rate of H1N1 was a mere 0.03%: actually about 3 times LOWER than the typical seasonal flu! The CFR is extremely hard to track with COVID-19 because we simply aren’t testing enough and we are clearly underreporting the number of actual infected. Since the CFR is reported on confirmed cases, that makes it look worse than it is. Probably.
But COVID is tricky: it is disproportionately and wildly more fatal for the elderly and people with compromised respiratory systems or underlying medical issues. In those cases, we’re seeing fatality rates approach 10%-20%, which is bad, especially because COVID seems to allow for “cryptic spread”: transmission in communities not yet aware it’s being transmitted. Public health agencies have a responsibility to attempt to arrest this continued spread and growth of the virus and hopefully cut it off in its tracks. But an important point here is that it may already be too late for that.
Even worse, if this hits in waves, it may quickly overwhelm the healthcare system as people require hospitalization and we find ourselves lacking the necessary equipment, staff, and beds to accommodate them. Roughly 5% of cases apparently require hospitalization for critical care. [3] Remember how China built those several-thousand-bed hospitals in just 13 days? We won’t be quite so lucky.
So what’s this all mean for you?
Italy is presently attempting to quarantine 18 million people in the northern parts of the country, to attempt to further tamp down the spread of the virus. China’s draconian measures appear to have helped significantly reduce the spread, such that the new case numbers are now decaying each day, but those measures may only be possible in an authoritarian state. (And ironically, China is now worried about _importing_ the virus back to them once they lift their quarantine. [4]) So China’s efforts appear to have been effective, if their numbers are to be believed (and the WHO says they believe them). That means its growth and spread can be stopped. But it may require measures and lifestyle changes that Americans just aren’t willing or don’t believe they should have to accept.
For more on just what China was able to put into place (and what sort of steps might be necessary), read this fascinating account from a WHO doctor who was in China:
https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html
In the US, large tech companies are having their entire staff work from home when possible. (Amazon, Microsoft, Facebook, and Google are all working from home in the Seattle area.) Conferences and conventions (like South By Southwest or Google I/O) have been cancelled. These are preventative moves, understanding that large conferences that import visitors from dozens of countries are probably not a great idea right now. But if Seattle turns into a true hotspot, and the public health agencies start to attempt to implement significant control measures, what do we think that looks like?
Assume a worst case scenario where a US city declares public gatherings of more than 200 people to be unlawful. Quarantine/containment looks like at least temporarily closing movie theaters, malls, churches, sporting venues, concerts, amusement parks, museums, galleries, and other retail establishments or gathering places.
If we step back for a minute and play the thought experiment of a city putting those restrictions into place (as we’re seeing occur in Italy right now), what does that look like for the workers of those establishments? For the supply chains that feed those establishments? It’s probably not reasonable to expect most small businesses to continue to pay their employees through a four week quarantine if they have to remain closed the entire time, though I’m sure many would try.
So, another tipping point: attempts at containment, even if they come at great short-term economic cost, or a transition to mitigation, or as you might think of it: acceptance. We may be closer than you think to simply having this declared _endemic_ (not merely a pandemic, which implies a global outbreak) where the assumption becomes that this is here now, we’re stuck with it (like the flu, but way worse), and we should instead move our resources to managing the cases and hopefully finding a vaccine and treatment.
I don’t think we’re quite there yet. That approach is admitting defeat, and likely hundreds of thousands of people would die if we just lean into it that way.
But here’s the paradox: even if we’re all wrong about the severity, we’re already seeing these containment efforts take an economic toll. If you’re working somewhere that’s connected to retail, travel, or entertainment, I would strongly consider making your savings a priority. While I’d love to think we live in a society where the government might step in with a special bridge or unemployment program to help people who are finding their hours slashed because of quarantines, I don’t know that that’s the case.
I’m already hearing real, actual stories of people who are going to be significantly financially impacted just by the cancellation of South By. Now imagine that all NHL and NBA playoff games are played in front of empty arenas, and all MLB games are played in empty stadiums. Imagine that people start de facto avoiding retail establishments and airports, cancel their travel plans, don’t stay in hotels, don’t attend concerts (or find them cancelled), etc.
The toll on human life is more important, but my point here is to make sure that the potential economic impact on you and your family should not be ignored, and now would be a good time to make sure you have a proper emergency fund.
I’ve also heard people take the defeatist “why don’t we just get on with it then” approach, which I admit I’ve thought as well. But if the virus fatality rate DOES end up being significantly higher, and the hospitalization rate of cases DOES persist at these high levels, the damage we may experience by not attempting to arrest it could drag us into a recession. Or worse.
If COVID-19 ends up as an endemic disease, that will also be a game-changer. SARS and MERS were so deadly that they killed themselves off before they could establish a foothold. (Though it should be noted that SARS lives in bats in a Chinese cave just a few miles from a village and could strike again. Fun fact! [5]) COVID-19 just may have the staying power to keep circling the globe and hitting every winter, just like the flu. That also means that it may die down in the summer, only to come back with a vengeance this winter. The 1918 flu pandemic followed that exact model, and the second wave was significantly worse than the first. And remember, no humans have ever been exposed to this virus before. We don’t have any form of known immunity to it. And we also don’t have a great understanding of how long someone may remain immune after having contracted the virus. If the immune system isn’t able to confer say, season-long immunity after having been hit… yeesh. Just imagine getting this multiple times in a season. That’s a true worst-case scenario, but we just don’t know yet. That’s why it being “novel” is so scary in that sense.
I want to end this by noting that I’m of course deeply hopeful it doesn’t quite come to this. There is speculation (but debated) that the warming summer months will help slow things down, the same way as happens with the flu. (In the flu’s case, the encasement of the viral DNA is cold-hearty, but melts and causes the virus to break down in warmer weather, for example.) I also hope to see some of these containment efforts work to help stem the spread here. I hope that I come back to this post in a month and say “wow, I sure wrote a lot about how bad it could get and that sure seems silly now, we’re all fine!” It’s still _possible_ that it burns itself out here and this is much ado about nothing.
But it’s important to start thinking of how we’ll respond and how prepared we are for a quarantine/limit travel/limit gathering type of order, if we find ourselves under one. It’s also important, for the sake of people who are at risk, to start practicing better social distancing and making smart choices NOW, even though it may feel premature if you live in a city (like Phoenix) that “only” has 5 cases right now. Because in 4 weeks, those 5 cases could be 15,000 or more.
I also think it’s important to still live your life, though. This isn’t as simple as “letting the terrorists win” here, but start making smarter choices, wash your hands (with soap! often!), stay home if you get even a little bit sick, stop shaking hands (elbow bumps instead), DO NOT practice social kissing (which is part of why Iran is being hit so hard), clean your phone often, set some money aside, and let’s get through this together. Oh, and probably don’t get on a cruise ship if you’re over 70 right now. [6]
[1] http://www.cidrap.umn.edu/news-perspective/2020/03/us-covid-19-cases-top-400-including-first-dc
[2] https://www.ncbi.nlm.nih.gov/pubmed/19545404
[3] https://www.evergreenhealth.com/coronavirus
[4] https://www.cnn.com/2020/03/05/asia/china-coronavirus-imported-cases-overseas-intl-hnk/index.html
[5] https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome?#Outbreak_in_South_China
[6] https://travel.state.gov/content/travel/en/traveladvisories/ea/covid-19-information.html
