Today is Sunday, March 8th, 2020 and it’s 1500 hours PST as I write this. This is important because at the end of this, I’m going to make some predictions and I want to make sure everybody can reference this so y’all can laugh at me if I’m wrong. (Which I dearly hope that I am.) I know your cousin Bob, who once banged a nurse who told him everybody was overreacting and the regular flu is much worse, believes that the news media are the ones driving this panic in an attempt to undermine his Savior, Donald Trump, but I’m hoping to show you why he’s wrong.
It has now been just three months since a newly mutated virus began sickening people associated with a live, wild-animal, “wet market” in the city of Wuhan, China. This virus was quickly identified as “novel” – a new strain of Coronavirus, a family of viruses that cause respiratory sickness in animals and humans. Coronaviruses themselves are not new – we’ve seen them migrate from animals to humans in outbreaks like MERS and SARS in the last couple of decades. None of those previous outbreaks have been as dangerous as this new one, now called COVID-19. (which is simply short for Coronavirus Disease 2019)
I’m writing this because of the incredible amount of disinformation that keeps getting shoved into the faces of the public on social media platforms. I should state up front, that I’m not an alarmist. I didn’t worry too much about MERS, SARS, H1N1, Ebola, or any other outbreaks of infectious disease in my lifetime. I’ve never bothered to get a flu shot. I went to the doctor last month for the first time in twenty years. I just simply don’t worry about many of the things normal people do. When I first began tracking this latest outbreak while it was still confined to China and there were not yet any cases in the rest of the world, I wasn’t any more concerned than I had been from any of the previous viral outbreaks.
Right up until the end of January when I first heard the rumblings that this virus could possibly spread asymptomatically. This made it immediately different.
Asymptomatic spread of a virus is rare, unusual, and deadly. It’s the kind of scenario that doomsday books like The Stand are based on. I took a few basic steps. I stocked up on supplies, began washing my hands multiple times a day, disinfected doorknobs, remotes, and light switches, made plans to get out of Las Vegas if I needed to, and began warning loved ones that this virus had the potential to be a pandemic. It’s not that I had any inside information, just that I had the time to actually study all of the first-hand reports coming out of Wuhan, and I extrapolated information from the suspicion that it was incredibly likely China was not being completely forthcoming with statistics.
As of this writing, there are now more than 500 confirmed cases of COVID-19 in America, and more than 100,000 around the world, with deaths having just reached 3500. Big deal, right? As many, many people have loudly informed me, influenza, the common flu, kills many times more people than that each and every year, yet we hear nothing about that, we don’t worry, we don’t stockpile toilet paper, and the stock market doesn’t crash. These people ultimately come to the conclusion that this is nothing more than media-generated hype and unwarranted panic. There are so many problems and fallacies with that line of thinking that I’m astounded at the naivete of otherwise smart people who keep spouting it. Here are the problems with comparing this virus to influenza:
The problem with comparing COVID-19 to other viruses such as Influenza:
One of the biggest problems here is that influenza tends to kill only those who are already very sick or immune-compromised. It’s very difficult to actually catch it if you’re a healthy person who takes even the slightest of precautions. We also have a vaccine for it. It’s called the flu shot, and doctors have been recommending that people get it for decades. We have NOTHING to stop the spread of COVID-19, and most doctors agree that a safe, tested, effective vaccine is at least a year to eighteen months away.
The mortality rate of influenza is about .1 percent. That means one person will die for every 1000 who contract the common flu virus. The mortality rate of COVID-19 is probably around 2%, however, estimates vary greatly between 1.5% and 3.5%. (more on this later) This means COVID-19 kills at a rate at least 20 times that of the common flu, and that alone should be enough to scare you. (virologists say the death rate of the flu in the U.S. last year was more like .05%, which means COVID-19 is at least 40 times more deadly.) However, people rightfully point out that the death rate of SARS was about 10%, and the death rate of MERS was a terrifying 35%. This means that the death rate of COVID-19 is really unconcerning to them. So, why do I think this is a dangerous and naïve way to think about this?
It has to do with what’s known as the R-naught (R₀) rate.
R-naught is a complicated mathematical formula that takes many factors into account and derives a number that signifies the number of people a sick person will infect. For influenza, the R₀ is 1.3, so each infected person will infect 1.3 people on average, however, R₀ really only applies when a population is completely vulnerable to the disease, meaning nobody has been vaccinated and there’s no way to control the spread of the disease. This doesn’t really apply to the common strains of the flu virus, so this number is a bit misleading.
It DOES apply to COVID-19 though, as it is a new (novel) Coronavirus that has never before been seen. Nobody has immunity to it, and there is no vaccine. The R₀ rate of COVID-19 is estimated to be in the range of 2.2 to 3.0. This means every infected person will pass the Coronavirus on to between 2.2 and 3 other people.
THIS IS WHAT’S MOST TERRIFYING ABOUT THIS OUTBREAK.
To put this number into perspective, H1N1, the Swine Flu in 2009 had an estimated R₀ of 1.4-1.8.
H1N1 ended up infecting one-fifth of the entire population of the world.
The only reason many of us are alive to read this today was that the mortality rate of H1N1 was about .02 percent, meaning that even though more than 1.5 billion people caught the virus, only about 2 in every 10,000 died.
If a virus like H1N1 can infect one-fifth of the world with an R₀ of 1.6, imagine how many people will be infected from a virus with an R₀ that might be double that?
An argument that many people make when faced with some of these numbers is that the numbers must be off because China has controlled the spread of the virus with relatively few deaths. And, if we assume that China is being forthright (which they probably are…WHO doctors are in the epicenter and are now confirming most of China’s numbers) these people have a point. However, here’s what China did to control the spread of COVID-19.
- They built two brand new Coronavirus-only hospitals in the epicenter of Wuhan in just over one week. These hospitals added 2300 dedicated beds and were staffed with hundreds of healthcare workers from all over the country.
- They initiated an ambitious and aggressive plan to account for every single person who had contact with every single known infected person. This involved at least 1800 teams of 5 or more persons whose sole responsibility was to track down every single person an infected person had had any contact with, interview them, test them for the virus, and isolate them if they had symptoms or tested positive. By most accounts, these teams were able to track down and test more than 99% of the people who had any contact with an infected person. In some jurisdictions they found every single contact, 100% of them.
I need to repeat that because it’s incredible. More than 1800 teams of at least 5 people per team tracked down more than 99% of all contacts from each infected person and gave them instant tests. They have administered more than 100,000 instant Coronavirus tests to date and continue to implement this strategy.
- They instituted compulsory lockdown and quarantine of more than 60 million citizens. This lockdown was enforced by police, military, and a bunch of government tracking apps that exist in China. These apps are widely used by Chinese citizens and utilize a traffic light type system of color codes, green, yellow, and red, that lets guards at checkpoints, railways, bus depots, airports, metro stations, etc., immediately see if that person is supposed to be out and about or is restricted from traveling.
- They implemented aggressive and forced social distancing measures for anybody not under quarantine that kept people from congregating. They canceled sporting events, shuttered theaters, and closed schools and holiday celebrations. They forced anybody who had to go outside to wear masks, utilizing an incredible stockpile they had on hand.
Can you imagine any of these things happening in the United States? I can’t. So, when you tell me that China was able to control the spread of the virus so the U.S. ought to be able to do at least as good a job as they did, it makes me literally laugh out loud. At the risk of being compared to Bernie Sanders’ love of authoritarian dictatorships, there are some benefits to having full government control of a population. We will never be able to implement the draconian measures we see the Chinese doing, and constitutionally, I’m not sure we’re even legally capable of some of them, regardless of the state of emergency we may find ourselves in. We aren’t remotely implementing any of the steps they took so quickly, despite our advanced knowledge of the problem. While China and Italy are locking down their citizens in a panic to stop the spread of this disease, hippies in California are meeting to decide whether or not Coachella should still happen!
Talk about denial. We aren’t tracking down any contacts of infectious persons except in the most severe cases. We aren’t testing anybody unless they’re admitted to the hospital with severe symptoms. As of last week, symptomatic people were being denied testing because there still weren’t enough tests available, and all tests needed to be confirmed by the CDC, a process that took days. We can’t even get people to quarantine themselves even when the health department orders it. Just today there was a report of a quarantined person who decided to leave his house to attend a school function for his child, and nothing happened to him legally! There’s little doubt in my mind that we will soon have a significantly worse outbreak than China ever saw.
Part of the problem for the U.S. is that our leadership is downplaying the significance of this threat, and too many people take that at face value. In Italy just in the last few days, they’ve implemented forced quarantines and lockdowns of infected areas, measures that are considered mostly unthinkable in democratic countries, but something that is absolutely necessary if we’re to avoid disaster. Remember, H1N1 infected one-fifth of the world with an R₀ rate that’s probably half what Covid-19 has. Even if Covid-19 has the same R₀ rate of 1.6 and it ONLY infects one-fifth of the globe, the mortality rate of H1N1 was 1/100th the (conservative) estimated mortality rate of Covid-19. H1N1 killed an estimated >200,000 people worldwide. Based on these numbers, Covid-19 might kill as many as 20 million people in the next year.
So, I’m healthy, young(ish) and probably not going to be one of the ones who dies if I contract Covid-19. The virus mostly only kills the elderly, immuno-compromised, or the already sick, so why am I worried?
Well, it’s been shown so far that approximately 20% of the people who contract the Coronavirus require hospitalization. Of those, 25% need full-on respirator life-support function, and the other 75% need supplemental oxygen. Since we refuse to accept the severity of this outbreak and we can’t even test people who want to be tested, or enforce any kind of quarantine, it won’t be long before we have thousands of people on respirators in isolation ICU’s around the country.
The doubling rate for infections for this disease seems to be about every six days. There’s little doubt in my mind that a reported confirmed case number of 550 in the U.S. when we’re only testing those who are admitted to a hospital, signifies an actual number of infections that’s at least 10 times that. Let’s say there are 5000 infections currently, and that doubles every six days. By next Saturday, March 14th, there will be 10,000 infected persons (though the official number will be much lower, we aren’t testing anybody not in a hospital right now.) By March 20th there will be 20,000, by the 26th, 40,000, and by the end of May there will be 80 million people infected in this country. This is the power of exponential growth that so many people undervalue, sort of like that game you played as a kid where you told your buddy, “I’ll give you a million dollars in thirty days if you give me one penny and double it every day for a month” and the moron jumped at that chance and still owes you millions of dollars today.
Doubling can’t happen forever of course, so let’s say that there are only 10 million cases by the end of May. Two million of them will need to be hospitalized. How many of you think our health care system can handle an influx of two million people (conservatively) in the next two months? The U.S. has about one million hospital beds total. At any given time, about 65% are in use. That means there are approximately 350,000 beds available at any given time. With the numbers above, we can expect hospitals to start turning patients away sometime around the end of April, right when things are reaching their most dire. Not a good time to be in need of a respirator, that’s for sure.
Of those 10 million infections, approximately 250,000 will die, and that’s before we take into account the thousands more who will die because they can’t get the life support they need because hospitals have had to resort to taking only the most dire cases, leaving many thousands to die gasping for breath, or of other diseases that might have otherwise been treatable in saner times.
Still think the regular flu is worse?
In addition to this, our economy will collapse. The stock market is already in a slump and the Fed pulled the plug on a 50 bp drop that was designed to stop a crash but was premature, not well thought-out, and completely ineffective. There aren’t many bullets left in that chamber, and besides, there’s no way they’ll keep up with the exponential growth we’re going to see with this infection.
Earlier I claimed I would talk more about the wide spread in the mortality rate, estimated at between 1.5 and 3.5 percent. This rate is so wide because we don’t have very good numbers of infections. Many of the infections very well may result in only mild symptoms and can easily be mistaken for a bad cold, or for the common flu. Many of the symptoms of Covid-19 mimic those of the regular flu, and it isn’t until severe respiratory symptoms set in that many people end up being admitted to the hospital and given the actual test. Since most of the people who get infected don’t have symptoms severe enough to be admitted to the hospital and get tested, the number of infections are almost certainly much higher than reported, which means that the mortality rate is lower. Our hope is that the mortality rate is much lower. Anything under 1% would be a godsend. If it truly is as high as 2 or 3 percent, we’re pretty much fucked.
So, what’s going to happen?
Here are my predictions, bold, loud, and public. (Dear God, I hope I’m wrong about all of these.)
- The WHO will declare Covid-19 a global pandemic by the end of this week, middle of next week at the latest.
- Within two weeks, the U.S. will begin prohibiting all public gatherings of greater than some random number like 500 or 1000. This means that sporting events, including March Madness, NBA games, MLB games, PGA tour events, etc., will be played for TV only, with no audience. Festivals like Coachella will be cancelled. The World Series of Poker will be postponed, probably until August to start, in the hopes that the warm weather of summer helps to control the spread of the virus.
- The U.S. will pass China in number of confirmed infections by April 15th.
- The Summer Olympics in Japan will be postponed until next year.
- The stock market is going to crash. I predict it will lose 1000 points tomorrow (Monday, March 9th, 2020) and 3500 points by the closing bell on Friday. I predict it will be down 10,000 from its current price of 26,000 by the end of May.
- We will officially be in a recession by the 15th of April.
- Globally, we will be in a depression by June 1st as markets everywhere crash.
- Summertime in the northern hemisphere will greatly curtail the virus and numbers will begin to decline. The economy will begin to recover.
- The democrats will defeat Donald Trump in November, a man whose only real redeeming quality has been the economy, and whose administration has massively bungled and downplayed the response to this epidemic, a big swing from the incredible foresight that went into prohibiting entry to all travelers from China so early in this disaster. The polarization in his decision-making here is actually kind of astounding.
Like I said, I really hope I’m wrong about all of this, because this could be the worst pandemic in living memory, possibly as bad, or worse, than the Spanish Flu, another H1N1 virus in 1918 which infected about 27% of the world, and may have killed as many as 100 million people at a time when the global population was one-quarter of the population of today.
I really hope I’m wrong, but in case I’m right, are you at least as prepared as OJ Simpson?