Why We Quarantine: A Data Driven Love Letter to You and the Loves of Your Life

Let me begin by saying I am not an epidemiologist. I have no credentials modeling pandemics. But I, similar to you, am trying to wrap my head around everything that is happening around coronavirus, aka COVID-19. I’ve read countless articles and have put together my own analysis, attempting to tie together what this means for the US, for healthcare, and what you (yes YOU!) can do to help mitigate deaths in the US.

Why I’m Writing this

1. For the love of others: I write this as a data driven love letter to you, knowing the immense amount of love I have for my own parents who are more at risk than I, my cousin who is fighting this on the front lines as a nurse manager, my friends that have sisters and boyfriends working as nurses, my friends that are trying to sieve through the mass amount of information and confusion, and the med device company I work for that is trying to keep us financially stable and employed. I am so grateful to feel so much love towards so many people in my life, and understand that I am not alone in this experience, and that is what binds us together through this pandemic. I understand the love you have in your life, and think that if you were aware how much your own actions are impacting others, you would be enacting your own serious quarantine measures

2. For Clarity: I’ve read about broad concepts like flattening the curve and differing social distancing measures by country, the one thing I haven’t seen is how do we apply this curve to our own healthcare system and our own population? What do all of the different estimations really looks like? What could this mean for companies?

Context to the Model:

There are three general concepts that come into play:

1. Herd Immunization: There is a certain % of the population that needs to be immune to stop the disease from spreading. You become immune by vaccination or by getting the disease and recovering. Currently, there is no vaccine for COVID-19. Different viruses have different herd immunization percentages before they slow down, but projected herd immunization for COVID-19 is “somewhere between 20% and 60%” according to Harvard epidemiologist Marc Lipsich
2. R0 (pronounced R naught, also called basic reproduction number): Value that shows how contagious a disease is. An R0 of 2 means each infected person will spread to 2 other people. COVID-19 R0 value is 2.3. In relation, the flu is about 1.5 and measles is 12–18
3. Protective measures: social distancing, closure of schools, government mandated lockdowns, etc

You’ve seen #flattenthecurve, right?

This is representing the daily number of new cases of the virus over time. Based on herd immunization, the total number of people in the pink and grey curves are the same, but when you put in protective measures, you are transforming the pink curve into the grey by slowing the rate that the virus is spreading, allowing us to provide adequate care to those infected because we remain below the health care system capacity line

Social distancing measures vary, and we can look to different countries to see the effects:

The chart above is showing the trend of new cases per day by six different locations: China, Iran, Italy, South Korea, Spain, and the US.

We have seen both China and South Korea slow their new cases per day, but through different measures. Because of the way China’s government is run, they are able to quickly shut down and isolate the infected. South Korea did not have as strict quarantine policies, but they have been testing at a rate FAR beyond everybody else, so they are able to quickly identify, treat, and quarantine the infected population.

That’s why new cases per day in these two countries are declining:

On the other hand, you have countries like Iran, Italy, Spain, and the US that are growing in their number of cases. Iran is likely a different case because of the government sanctions the US has put on them that make it harder for them to fight this, but its clear all four countries have growing cases:

Based on the way we test and actually social distance, the US is much more of an Italy than a South Korea. If we are able to suddenly enact extreme measures nationwide (mass testing, shelter in place) to reduce our infection rates, hopefully we would be able to slow the rate of infection.

The Model: How Does This Impact The US Health System & Population? And What Can You Do?

I’ve developed four models based on the US population of 330M people, three of them with government intervention and varying levels of herd immunity, one with no government intervention. The herd immunity models range from 30%-60%, again, meaning that 30–60% of our US population will be infected. These output a total population infection rate anywhere from 98.1M to 212.3M people.

Now let’s overlay what different experts in the field have said (just to prove my model isn’t totally batshit crazy). This is just saying that all of the total infection numbers of my model fall into the bounds that different experts have thrown out. The CDC worst case infection rate is anywhere from 160M to 214M. Congress said anywhere from 70M to 150M, and an epidemiologist out of Nebraska, Dr. Lawler, said 96M would be infected:

So now we take the total infection rate and assume a portion of that is hospitalized. So far, about 20% infected need to be hospitalized, but the CDC has also built in a 3% hospitalization rate into some of their models. My 20% estimates are high based on what they have reported as those needing hospitalization, but we will still look at both:

Now let’s apply the total number of patients hospitalized to the “flatten the curve” chart. There are 924,107 hospital beds in the US, representing our capacity.

This is what 20% hospitalization looks like:

And this is what 3% hospitalization looks like:

I know there is a range of what could happen here, but this is how you should think about the charts:

1. The overburden to hospitals lasts for about 2-3 months and is projected to seriously hit in Q3.
2. At its peak, you can see hundreds of thousands or millions of new patients infected every day
3. Even though new patient rates eventually fall, that doesn’t mean we should be coming out of quarantine immediately. That means quarantine is working. So don’t go out to the bars or lift any quarantines just because new patients rates are falling! It just means we are being effective!
4. When we have a number of hospitalized patients beyond what we can manage, there isn’t enough care for people. This forces our system to literally choose who they are going to care for. People are going to go untreated and a greater % of the people are going to die because our system can’t take care of them. Again, this is why you need to follow strict quarantine. Italy is ahead of us in this and telling us firsthand

Now, here is the most sobering part of this analysis, and this is just using different death rate ranges of 0.25% to 1.5% of those infected. We could see hundreds of thousands, potentially millions of people die

When I ran these numbers, I just began to cry thinking of all of the pain it would cause; not only for those in death but for their loved ones as well. The numbers are staggering, but not ENTIRELY out of our control. IF WE TAKE THE APPROPRIATE MEASURES WE CAN SAVE HUNDREDS OF THOUSANDS TO POTENTIALLY MILLIONS OF PEOPLE. And I know its hard, and I know quarantine/social distancing sucks, but if we all work together this can save so many lives, but it requires that each individual does their part.

Some local governments are ordering shelter in place, which requires strict quarantine measures. It feels insane I know, but this is SO good. If your own local government hasn’t enacted such a strict policy, I would ask you to consider everything you have learned and really weigh the things that matter. The earlier we shut down and impose strict quarantines, the better. And maybe you have read some articles that are telling you everything is fine, no one is worried…but this thing moves so quickly. I mean day to day things can look drastically different, so pay attention to how old your news is.

And if you are a 27 year old like me, in all likelihood you aren’t going to die. But this isn’t about us as individuals, this is about all of us. This is about recognizing all of the loves in each others lives and doing our best to take care of them and each other as one humankind.

Okay, okay, I get it, I’ll stay home… but what about the impact to the healthcare system?

So we have gone through the initial models for hospitalization, but what does it mean in terms of whats happening at the hospitals? Let’s just start with the idea that 20% are hospitalized. We know we are going to be burdened and constrained by the availability of hospital beds, so some hospitals are in the midst of cancelling non urgent procedures to make room. That means companies that sell products used in surgeries are getting their revenue pushed out until there is capacity once again.

The next wave is when the number of new patients exceed the capacity of the hospital, so they must make a choice of who to treat. During this time, I would imagine all non-urgent procedures are pushed to at least Q4

The last wave is when we have ridden out the virus, when enough of the herd is immune that our new patient rates drop to levels hospitals can once again resume scheduled surgeries

But based on this model, that doesn’t happen until the end of Q3. That means companies that rely heavily on disposable products tied to surgical case volumes will be hit incredibly hard until cases can resume again.

Of course this model is subject to change if there is a vaccination or if we put in stricter quarantine measures in place across the country, but based on our current policies and people in charge, this is my best projection at what may happen.

Closing Thoughts

I don’t write this to spread fear or anxiety, I write this to share what I think may happen so that you can validate it yourself and plan accordingly. I’m not even saying I’m right, I’ve just taken the information available and tried to make sense of it.

Either way, I hope this has helped you in some way and that you are doing alright in these crazy times. I hope you have someone to lean on or talk to, and that you have the space to feel whatever these events make you feel.

And I hope we all take the appropriate measures to look out for one another, share our knowledge, and come together to get through this.