You should be terrified of COVID-19

Ain’t no one got time for an intro. 

No it isn’t the flu

Let’s start by clearing up a common myth. COVID-19 is NOT the flu. Comparing it to the flu is foolish for a whole host of reasons. First, COVID-19 is a lot more deadly than the flu. The Case Fatality Rate (CFR) for COVID-19 is between five and forty times that of the flu. It is also a lot more contagious. The R0 (how many new cases each infection causes) is over twice that of the flu. Each also presents a different risk. The flu is a systemic risk. The flu has been around a long time. It happens every year. We’re prepared for it and expect it. We understand it. Our healthcare system is prepared for it. We have preventative measures against it and effective ways to deal with those who have it. Essentially, it’s baked into the cake. We have none of this knowledge or preparation for COVID-19. It’s an idiosyncratic risk. We did not expect for people to die from it. The difference between systematic and idiosyncratic risk is why we act so intensely to tragedies like 9/11 or school shootings even though other things like heart disease or HIV kill so many more people. Lastly, these are not comparable because they have different growth rates. The cost of the flu today isn’t comparable to the cost of COVID-19 today but COVID-19 down the road. 

Exponential growth is a nightmare 

On February 15, the world outside of China had 685 confirmed COVID-19 cases. One month later, on March 15, there were 81,700 confirmed cases. That is approximately seven doublings in one month, or one about one every four days. That’s called exponential growth. That phenomenon is happening in the US. When most people think of COVID-19 spreading, they think of it spreading in a linear way– a constant slope or addition. But that’s not what’s happening. COVID-19 spreads exponentially– additions at the same rate are bigger and bigger in total terms. In the US, that means our cases are doubling every three days. If the trend holds, our total number of cases will approach and pass 100,000 by the end of the month. As Dr. Nick Jewell– an infectious disease epidemiological statistician– told the New York Times, “this is just mathematics.”

Flatten the curve

The good news is we can fight the math! 

Let’s examine the above graphs. The X-axis is the number of days since the first case. The Y-axis represents the number of cases. The line going horizontal from  the Y-axis represents how many cases the healthcare system can treat. If COVID-19 grows exponentially we will experience the red graph. That’s when the infected population grows so fast that is surpases the helathcare systems ability to cope with it. But that can be stopped by flattening the curve. Through quarantines, social distancing, canceling large gatherings, ect. we can slow the spread of COVID-19 so the healthcare system is either less overwhelmed or can handle the crises entirely. 

COVID-19 has been flattened in other countries  

The bad news is we are probably either too late or not authoritarian enough to fight the math effectively here in the US. Italy failed to flatten the curve and their healthcare system has been swamped since. Jewell was asked about if the crises in Italy could happen in the US he said: “Yes. Tell me one reason it shouldn’t. I see no reason.” The measures we have done– travel restrictions, closing schools, limiting gatherings, ect– have bought us time but are far from enough. 

Few places have shown how to successfully slow COVID-19. South Korea (13 day doubling time), China (33 day doubling), Hong Kong, Taiwan, and Singapore (14 day doubling time) have all slowed the doubling time to two weeks or longer but the actions they took would be dramatic for the US. China used their military to shut down cities the size of New York. Such a dramatic use of government power would be unheard of in post-WW2 America. It should also be noted we don’t know what will happen once the mandated quarantines are finished. There’s a real possibility that cases in China spike back up. 

Other countries like Singapore and South Korea have recent histories with SARS which prepared them for a viral respiratory breakout. They also quickly implemented travel restrictions, mass quarantines, and pushed social distancing and hygiene. For example, Hong Kong has still quarantined almost 25,000 people and Taiwan fines those who violate isolation orders $33,200.  

The best estimates

Epidemiologists have given us a glimpse of what that red curve would look like. The CDC ran four different models of what would happen without any intervention to slow down COVID-19. Their worst case scenario was 1.7 million deaths from COVID-19 while their best case scenario was 200,000 deaths. The same models showed 2 to 21 million people would require hospitalization. There are less than a million hospital beds in America– although we obviously have emergency plans that can add some extra capacity. The American Hospital Association also estimated almost 5 million hospital admissions, just under 2 million ICU cases, and nearly half a million deaths. Thankfully steps have been taken to mitigate the impact and move us closer to the blue curve but it seems very unlikely that they have been enough. 

American hospitals 

Can American hospitals handle the incoming influx? Probably not. At the peak of the Wuhan outbreak, there were 259 patients requiring intensive care per million. John Hopkins researchers estimate 214 ICU beds per million people available after taking into account current use and possible surge expansions. That’s a massive under supply. The same story applies to ventilators. 

Yes, panic 

Things are going to get real bad over the next few months. The above discussion only talks about our hospital capacity and the impact of COVID-19 on it. In that discussion is an implied reality: our medical resources are relatively fixed. It takes time to add doctors, equipment, rooms, ect. Every COVID-19 case will take away from non-COVID-19 cases. What will happen when every hospital room is taken? When every ICU bed is occupied? When there are no more ventilators? And doctors are working 24/7? What will happen to car accident victims? To people who need cancer care? To someone who had a stroke? 

Just to give one more indicator of how serious COVID-19 is. Vaccine developers are skipping steps in the testing process to cut the 1-2 decade development and approval time to 1-2 years. 

Public policy solutions 

I don’t know everything that can be done to help mitigate the coming crisis but here are a few ideas. 

1. Don’t worry about the national debt. The IRS should not collect payroll taxes for the rest of the year. Cut checks to every American and their dependents so they don’t have to worry about working sick or not having a job. Also help businesses that close for the duration of the crises. We need a massive fiscal stimulus. 

2. The Fed needs to add liquidity into the economy. Lowering rates are a must and restarting QE is likely necessary (Note: both of these were done after the article was written). 

3. Closes schools, restaurants, movie theaters, and any other large gathering. Limit domestic and international flights. 

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