I bet that by the end of the calendar year, the number of deaths that can clearly be attributed to the disease will be greater than 100,000.
Note that he hopes he loses his bet, as do we all.
Think of 100,000 as 10 million cases times a 1 percent death rate.
Why might we get more than 10 million cases? First, it is possible that the number of cases that have not been officially detected is 100x the number of official cases. Because some infected people do not have symptoms, some who have symptoms are not going to get tested, and some who want to be tested have been, until recently, turned away.
Even if the true number of cases in the U.S. is only 10,000 today, if that were to double ten times we would be at 10 million. If the doubling time were a week, it would take only ten weeks to be over 10 million. And as of now the doubling rate is faster than that in many European countries and in the U.S.
But given the sharp reduction in travel and large gatherings that has taken place, I expect that the doubling rate will slow down. Suppose that, after these changes have been in place for a few weeks, we find that it is taking a month or more to double the number of cases. That would make it less likely that we hit the 10 million total by the end of the year. (Although, again, it is hard to know where we are starting from.)
We might also find that we have a lower death rate. Compared with other countries, we have less smoking and more capacity in our health care system. And the steps that we take to protect at-risk populations from the virus may prove effective.
This might be a time to update the status of two hypothetical bets of mine. First, I hypothetically bet that no centrist candidate would arrive at the Democratic convention with more than 40 percent of the delegates. That now looks like a bad bet.
More recently, I hypothetically bet that the number of Covid-19 cases in the U.S. would be more than 12,000 by the end of this week. As of Tuesday evening, the total was over 6000, and it appeared to be doubling every two or three days. Unfortunately, it looks like I will turn out to be correct on that one.
The case numbers can be misleading. ncov2019.live is a simple data dashboard for worldwide cases. A large jump should be expected when there was such as a large lag in testing. Canada is always a simple 10x comparison and it’s 592, slightly lagging, cases should put the lowest best case estimate at 6000 for the U.S.
These numbers include a majority of travel cases, the echoes of global uncontrolled community spread. Americans should be obsessed with new home grown community spread like what occurred in Seattle. The Lockdown-Lite indirectly addresses Cough Isolation but we are dancing around the straight forward approach.
The Four C’s of COVID-19: Coughs, Contacts, Communication, and Calm:
1. Cough Isolation: watch each new cough for 3 hours, isolate immediately for 14 days if persistent
2. Contact Tracing: Carefully trace your contacts from the moment of your first 3-hour persistent cough for the critically contagious first 5 days, and for a cautious full 14 days to make sure.
3. Communicate Transparently: phone your public health officials, tell your close contacts of your Self-Isolation, and tell anyone in your Contact-Tracing list to Self-Isolate as a precaution.
4. Calm: very few people get very sick but the true danger is people ignoring the first three C’s and causing undetected Community Transmission. Even with widespread Community Transmission, following the first three C’s will first slow then stop the spread.
The lag in available testing certainly has caused some of the jump in confirmed cases. The fact that we see a lag between confirmed cases and “actual” cases (cases contracted but not yet symptomatic) also will and currently is causing some of the jump in confirmed cases. Unfortunately, we can’t separate the two effects. We should not minimize our view of the jump because of lags in tests. I’ve mentioned this paper before:
https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
Chart 7 demonstrates the point I’m trying to make.
We may go a couple of weeks with the number of new cases increases and the total cases still increasing with a greater than 1 exponent. One can only hope that the general population will not conclude that self isolation doesn’t work. If they do reach that conclusion, look out.
We have to stop making decisions based on hypothetical models when we have real world examples that are carefully documented. The Diamond Princess, other cruise ships, the Wuhan evacuations, numerous airline flights, Japan, Taiwan, South Korea, and Wuhan 2.0 (only incoming travel cases) keep showing that magical asymptomatic transmission is not occurring.
Cough droplets are the primary vector. Stop the vector.
Diamond Princess “Experiment”: Lock 3,700 people in an enclosed environment and test Covid-19 infection and mortality rates and ensure poor hygiene practices to mimic “real world” conditions.
Total Test Subjects: 3,700
Infected: 710
Deaths: 8
Infection Rate: 710/3,700 = 19.19%
Mortality Rate (Infected): 8/710 = 1.13%
U.S. Population: 327,000,000
Assumptions: No social distancing and no closures.
Projected Infected: 327MM x 19.19% = 62,748,648
Projected Deaths = 707,027
The problem with your model is that the 1% death rate only applies when 100% of acute cases get ICU care.
So far all evidence suggests that ~5% of cases that present require that. Using your math, that’s 3.1M ICU hospitalizations of 1-3 weeks’ duration. The US today has about 100,000 ICU beds, and they’re often filled with victims of all the illnesses that existed before March.
If you generously assume 1 week is enough ICU time then you are looking at 100% of US ICU capacity for the next 7 months. That works if we can perfectly schedule every infection, because if two people need one bed at the same time then one is getting left on the ice floe.
And that is only accounting for the most severe cases. Another 10-15% require hospitalization but don’t need the ICU. In an uncontained outbreak these too will get strained and we will see more losses. Then there is the issue that we can reschedule facelifts and knee replacements but not the strokes and heart attacks that usually fill the ICU.
If you think the public has collectively lost its $#@! over a few thousand dead, explain what you think will happen when that happens every two hours. Or perhaps you agree with Stalin about tragedies and statistics.
That is a great point. Suppression has to be the strategy and the question of the optimal suppression strategy can be refined as we learn more. The importance of the Diamond Princess data, in my view, is that it demonstrates the worst case uncontrolled community transmission numbers, and those numbers assume a functioning health system as The Snob rightly emphasizes.
Another day with limited good data and I continue to find nuggets of new information. The Manitoba chief medical dude (title?) , in a press conference yesterday, said that very few of the people that self-quarantined alongside confirmed case self-isolated spouses/family and up with any symptoms so everyone in the household emerges “safe” after 14 days.
Here is an interesting stat: In 2019, there will be an estimated 1,762,450 new cancer cases diagnosed and 606,880 cancer deaths in the United States.
Okay, so 600,000 people will die from cancer in the United States in 2020. Life goes on. I guess another 600,000 or so will die in 2021. And every year after that.
In contrast, Covid-19 will probably be a serious Grim Reaper once, but only once, and after that exact a small toll—– if we allowed the population to be inoculated against the virus through natural infection.
Explain to me again why we are destroying our economy.
All the evidence shows that people self-quarantine (i.e. asymptomatic self-isolation) due to fear and panic when the health care system collapses and this occurs long before any significant immunity occurs. Rather than quickly infecting the herd, killing off the weak, and continuing on with a happy economy with a new-found appreciation for Neo Darwinism, your naive plan will result in what Tyler Cowen is calling an “Epidemic YoYo” of indefinite length.
We don’t die of old age, in old age we mostly die of cancer and heart disease. Comparing COVID-19 deaths to raw cancer deaths is misleading.
The easiest, cheapest, and simplest approaches are all the same: Cough Isolation. Cough Isolation works now, works when the economy is jump-started again, works with new respiratory diseases. The downside is that it also happens to stop all Influenza Like Illnesses (ILIs) so some people will be denied the previous widespread practice of coughing on anyone they choose.
I don’t see how it makes sense to model “doubling rate” as a constant. If we’re lucky here in Seattle, it will become a halving rate for a while, the number of infections will drop a great deal. Like Hubei.
Then restrictions will be relaxed (they will have little marginal value, and always large marginal cost), and we will resume the doubling until the next time.
The US death toll for the Asian flu of 1957-58, when adjusted for growth in population, equates to approximately 200,000 deaths today. The death toll of the 1968 Hong Kong flu equates to approximately 50-60,000 deaths. If we could not identify the Covid-19 virus we would probably think that we were experiencing an unusually severe flu/pneumonia season.
I think, in the counterfactual that we could not identify such viruses, that this might be a below average flu/pneumonia season, and many of the measures we are taking now might be status quo. But that is a counterfactual world.