CDC update and Corona math

Daegu, South Korea (Source)

From the CDC website (emphasis added):

Risk Assessment

Outbreaks of novel virus infections among people are always of public health concern. The risk from these outbreaks depends on characteristics of the virus, including how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (for example, vaccine or treatment medications). The fact that this disease has caused illness, including illness resulting in death, and sustained person-to-person spread is concerning. These factors meet two of the criteria of a pandemic. As community spread is detected in more and more countries, the world moves closer toward meeting the third criteria, worldwide spread of the new virus.

While there is still much to learn about the unfolding situations in California, Oregon and Washington, preliminary information raises the level of concern about the immediate threat for COVID-19 for certain communities in the United States. The potential public health threat posed by COVID-19 is very high, to the United States and globally.

At this time, however, most people in the United States will have little immediate risk of exposure to this virus. At this time, this virus is NOT currently spreading widely in the United States. However, it is important to note that current global circumstances suggest it is likely that this virus will cause a pandemic. This is a rapidly evolving situation and the risk assessment will be updated as needed.

Current risk assessment:

For the general American public, who are unlikely to be exposed to this virus at this time, the immediate health risk from COVID-19 is considered low.
People in communities where ongoing community spread with the virus that causes COVID-19 has been reported are at elevated though still relatively low risk of exposure.
Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure.
Close contacts of persons with COVID-19 also are at elevated risk of exposure.
Travelers returning from affected locations internationally where community spread is occurring also are at elevated risk of exposure.

CDC has developed guidance to help in the risk assessment and management of people with potential exposures to COVID-19.

What May Happen

More cases of COVID-19 are likely to be identified in the coming days, including more cases in the United States. It’s also likely that person-to-person spread will continue to occur, including in communities in the United States. It’s likely that at some point, widespread transmission of COVID-19 in the United States will occur.

Widespread transmission of COVID-19 would translate into large numbers of people needing medical care at the same time. Schools, childcare centers, workplaces, and other places for mass gatherings may experience more absenteeism. Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths. Other critical infrastructure, such as law enforcement, emergency medical services, and transportation industry may also be affected. Health care providers and hospitals may be overwhelmed. At this time, there is no vaccine to protect against COVID-19 and no medications approved to treat it. Nonpharmaceutical interventions would be the most important response strategy.

I found this conversation with Donald G. McNeil Jr., a science and health journalist at the New York Times, most interesting:

donald g. mcneil jr.

OK, this is not like the annual flu. The annual flu, in a bad year, has a death rate of around 0.1 percent. So we’re talking about 20 times as bad.

michael barbaro

That’s very meaningful.

donald g. mcneil jr.

When people were going around saying, oh, not to worry about this. You should get a flu shot because the flu is a bigger threat. Yes. At this moment, the flu is a bigger threat, definitely, in the United States. But don’t think you have nothing to worry about. One thing that might happen is it might not get here in a big wave until the fall. That happened in 1918. There was a spring wave that was scary, and then the virus mostly disappeared in the summer, because a lot of viruses don’t like hot weather. But then when it came back in the fall and winter, that was the real killer wave. And that’s when a lot of people died. But we conventionally say that if the 1918 flu came back today, it wouldn’t be as deadly.

michael barbaro

Because it’s not 1918.

donald g. mcneil jr.

Because in 1918, we didn’t have antibiotics, and a lot of people died of secondary bacterial pneumonias. We didn’t have mechanical ventilators to put people on. We didn’t have the steroids that cuts down on lung inflammation. We have a lot of things in modern medical care that we didn’t have then. But what’s disturbing about what you see happening in China is that a lot of people are going into hospitals and they are getting antibiotics, and they are getting Tamiflu, and they are getting antivirals, and they are getting steroids, and they are getting put on ventilators. And they still die. And that’s unexpected, and it’s quite spooky. […]

donald g. mcneil jr.

Some big chunk of the country — 30, 40, 50 percent — are likely to get a new virus when it blows through. And if you don’t get it in the first wave, you might get it in the second wave.

michael barbaro

And 2 percent lethality rate of 50 percent of the country. I don’t want to do that math. It’s really, really awful.

donald g. mcneil jr.

It’s a lot of people. It means, you know, you don’t die. 80 percent of people have mild cases. But you know somebody who dies.

I’ll do that math. It means, if 30 percent of the country gets infected with coronavirus, and the virus has a 2% mortality rate, that some 2 million people die. But, you know… just the flu, bro.

Now, I don’t know where McNeil Jr. gets those “big chunk of the country” estimates. But a basic reproduction number (R0) of 2.0 to 2.5 for this virus (source) means that it is relatively contagious, much more so than the seasonal flu, which has an R0 of 1.3 (source).

The big problem is that there is very little slack in our health care system, as John Robb details in his latest Global Guerrillas Report. He points out that the US had about 1.5 million hospital beds in 1975, whereas now it has about 0.9 million despite the population being 50% higher. Run the numbers – it would only take a surge of as little as 100,000 patients to overwhelm the system.

The flu results in between 140,000 and 960,000 hospitalizations each year (source).

Presumably, the US healthcare system is better equipped to handle a severe virus outbreak than the Chinese one. A Chinese contact said that her grandmother had a heart attack last week and was taken to the hospital, which told her that she could only be admitted after she tested negative for coronavirus. The hospital give her some pills and told her to go home and wait 14 days. She had a second heart attack this week and the hospital finally agreed to admit her.

More from the NY Times podcast:

donald g. mcneil jr.

Well, in any bad flu season, hospitals put people on all their ventilators. We have a National Strategic Stockpile, which has a lot of stuff in it — masks, gowns, gloves, drugs, even some ventilators. But you can’t stockpile enough ventilators to put — a ventilator is like a cost of a car. It’s $25,000 to $50,000. Hospitals can’t go out and order an extra hundred of those. And if they did order an extra hundred of those —

michael barbaro

It would take awhile.

donald g. mcneil jr.

It would take awhile. And also you need at least three people to staff that ventilator with the patient on it around the clock. And that’s a lot of trained respiratory technicians and things. So if we get hit with a gigantic epidemic of a lot of people with pneumonia needing to be on breathing machines, we’re not prepared for that.

michael barbaro

What about preparations beyond ventilators?

donald g. mcneil jr.

What happened in China, with the shutdown of Wuhan and Hubei province during Tet, during New Year, was the equivalent of shutting down Chicago and most of that surrounding part of the Midwest at Christmas time and telling people, you are now going to stay in Chicago. You can’t leave. You can’t see your families. All the flights are canceled. All the trains are canceled. All the highways are closed. You’re going to stay in there. And you’re locked in with a deadly disease. We can do it.

michael barbaro

Would we do that?

donald g. mcneil jr.

We can do it, but we’re not used to being controlled from the top down the way people have been in China. So I don’t know what’s going to happen in the United States. We’re not mentally prepared to fight a sort of people’s war against an epidemic, which is what happened in China.

The US may have a stockpile, but this message from the US Surgeon General is hardly reassuring:

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