Many people are asking today why seemingly healthy people should follow COVID-19 guidelines for social distancing and stay at home directives. Why not just have the most vulnerable of the population follow those guidelines and directives while everybody else got on with their lives and went about their normal routines?

There are a number of problems with this approach of just letting people out because they want to “get on with our lives,” even setting aside the, let’s call it “questionable morality” of human sacrifice to the gods of capitalism.

First, who are you going to define as “the most susceptible among us”? Some "perfectly healthy" people are also getting sick, some of them critically. How are you going to determine who is at risk and who isn’t? By what criteria will you decide who is locked in their home and who is allowed to go free?

Keep in mind that about a quarter of the infected are both asymptomatic and contagious at the same time. They appear fine. And we don’t have effective rapid tests for this disease yet that are not prone to false positives or negatives.

So, if you just go with those that seem healthy, you will spread this virus like wildfire, just as you are starting to see with states that didn’t issue stay at home directives. They reported their first cases relatively recently, and they are seeing exponential progression of new cases and deaths. The people there aren’t taking it seriously enough because right now, those numbers still seem low, especially compared to New York and New Jersey, and the number of cases aren’t progressing very rapidly.

But that’s largely because they are several weeks behind those early-impacted states. The problem with exponential progressions is that in the very early stages, they appear to increase about the same as linear progressions. And then they go up. Fast.

The flu generally becomes symptomatic within 24–96 hours of infection and an infected person usually stops being contagious 5–7 days after the end of major symptoms, and are fairly low risk for shedding the flu virus about 24-36 hours after the end of fever, vomiting, or diarrhea so long as coughing and sneezing are at a minimum. There generally just aren’t a lot of asymptomatic carriers that are also still contagious with the flu.

This coronavirus, on the other hand, is particularly nasty because of this very characteristic. The incubation period is ten to fourteen days, and a person can be contagious during that incubation period. Worse, about 25% of infected persons are both asymptomatic for their entire infection period and contagious at the same time. The CDC guidelines right now say that it’s about twice to three times as long from the end of symptoms as the flu to the point where an active case is at a lower contagiousness risk, 72 hours minimum, and 14 days past initial symptoms. (So, if you get a mild case and you recover quickly, stay in isolation for 14 days from the onset of symptoms, not 72 hours from the end of symptoms.)

That long period of contagiousness, combined with the high rate of asymptomatic contagious carriers, is a big piece of why this got out of control so much worse than the seasonal flu usually does. Add in the fact that we are still working on rapid tests that are not prone to false positives or negatives (unlike the flu) and this just gets ugly because it’s very hard to tell who does and does not have it, and again, you might have it, be contagious, and not even know it.

That’s why social distancing is so incredibly important.

New York reported its first case at the end of February, 50-some days ago. On March 15, there were under 800 cases and three deaths. On March 20, there were 7,102 cases and 46 deaths. On March 30, there were 66,497 cases and 1,218 deaths. On April 10, New York alone stood at 161,504 cases and 7,067 deaths. Only five days later, on April 15, that has increased to 214,648 cases and 11,586 deaths, and believe it or not, that is the good news. That means it’s only doubling around every seven to ten days, rather than the three to five days it was.

But that also means in less than forty days, approximately six weeks, New York went from three deaths to over eleven thousand. In just the last three weeks, New York saw over 10,000 deaths. But in the first three weeks, New York only saw fewer than sixty deaths.

Florida didn’t shut down beaches and continued to allow college kids to have their spring break. There are now dozens of confirmed cases that contact tracing shows that’s where they picked it up, and those people passed it on and spread it further. And that’s the thing about exponential progression. Even if every person only goes on to infect two other people, and then those people infect only two other people, in two weeks, just that first person contributed to over 16,000 new cases.

Scientists call this the “R” value. The current estimated R value with only some compliance with precautionary measures is around 2.5. That means in two weeks, one initial case becomes almost 375,000 cases.

And that’s precisely what we’re seeing.

There were thousands of people on those beaches.

There is no way to tell for sure, but in just two weeks, there is full reason to believe that those spring breakers may have contributed over a million new cases. At just 1% fatality, that’s 10,000 dead, right there. Just from “perfectly healthy people” who thought they were in a low risk category “getting on with their lives.”

There are, as of 8:30 PM CDT, April 15, 2020 (as I write this), approximately 644,000 confirmed cases and 28,500 deaths from COVID-19 in the United States. Because of lack of efficient and effective widespread testing, most epidemiologists believe there is probably an order of magnitude more cases out there that are unconfirmed. That’s nearly seven million people.

Just twenty-one days ago, and there were just over of 15,000 deaths worldwide at that time. Today? It just surpassed 134,000. And again, believe it or not, that’s actually good news. That means instead of doubling every 3–5 days, which is what it was doing, it’s doubling more like every ten days. That's amazing, and a testament to how well measures like social distancing early on are working, worldwide.

The same is true of cases. Where stay at home orders were not issued until recently or not taken seriously, cases are still doubling about every 5 days. That means in about ten days to two weeks, we’ll see the results of that. There’s a lag in time because of the incubation period. But where stay at home orders have been issued and complied with, such as Minnesota (which is absolutely crushing it right now), they are seeing doubling more like every 15–25 days. That is fantastic.

We are nowhere near out of the woods on this one. We are generally doing the right things, but that means we have to keep doing them or we’ll get slapped with a second wave where infections start redoubling every 3–5 days again and then you’ll see deaths follow that doubling pattern about ten days to two weeks later and we’re right back to square one.

So, you let people “get on with their lives” today, and about mid-May you can expect the same huge surge in deaths from this rather than in mid-April as was originally going to happen without doing something.

But we’re not done here, either, because this directly impacts the second problem.

People are still getting sick and dying of regular things. It’s not like every ICU bed and ventilator was unoccupied going into this. Hospitals generally operate around half to 2/3ds capacity normally. People are still going to have heart attacks and break their legs and get sick from other stuff and have cancer and everything else that occupies hospital and ICU beds.

Every case of COVID-19 adds to that load. That’s what makes doing nothing so dangerous. It might feel like this is going to drag on forever, and it will, but if we just turn it loose and it surges to a peak at the end of April or May, tens or hundreds of thousands more people will die just because there isn’t enough medical care to go around. More people will die of heart attacks. More people will die because of pulmonary failure. More people will die because of cancer. More people will die because of everything that they already die of, just because the system is overloaded.

That’s why we have to “flatten the curve.” It’s not just about fewer people getting sick and dying of this thing. It’s about making sure we don’t overload the capacity of our medical system so that people die of every other thing on top of it.

If you released everyone that didn’t seem sick today, by August, I’d bet we’d be looking at something like 7–10 million deaths in the United States. Conservatively. That’s a little less than 3% of the U.S. population. That’s assuming that it only infected half of the U.S. population and including the extra deaths from the overloaded healthcare system.

Worst case scenario, if you get to Italy’s levels of overload on the healthcare system, you’re looking at 8–10%. 10% of the U.S. population is approximately 33 million people. That’s when you include the COVID-19 related deaths and the extra people who will die because there isn’t enough hospital space to go around.

By the end of July or August, given those rates, with only minimal precautions, it’s not unrealistic to expect over five million total deaths. In months.

Now, I’m not an epidemiologist. Or a statistician. This is all guesswork based on simple mathematics. It could be a lot more. It could be a lot less.

But the folks who do have this expertise are telling us the same thing.

If we do everything right, and we do it right now, and we do it very well, 100,000 to 250,000 dead in the United States is our optimistic scenario.

If we do nothing or we have poor compliance, it’s millions.

Why shouldn’t we just try to quarantine some old or immunocompromised folks and let everyone else roam free?

Because that’s a death sentence for hundreds of thousands of people.

Now, let’s say you’re good with that, because some people are. Let hundreds of thousands, if not millions, die for the sake of the economy, right? The needs of the many outweigh the needs of the few, right? The cure can’t be worse than the disease, right?

We just have to sacrifice a few virgins to the volcano as the cost of doing business, really. Some folks would say this is abhorrent, but screw ‘em. The Great God Commerce must be appeased.

And you’re bored and you’ve already watched Tiger King and every rerun you can think of. You’ve learned how to bake bread and everything else, besides.

Do you know what the economic impact of a million or more people exiting the economy is? A million or more people not spending money and not buying things and not working? It’s a lot. The best way to grow the economy is to keep people in it and the best way to send it into recession is to take a lot of people out.

The economic impact of not doing this right is a lot worse than everyone staying home for a couple months.

If we try to reopen things too soon and we end up with a crushing second wave of this, it’s a lot worse than doing it right for a longer period of time. If you try to aim at two birds at once, you will end up missing both.

Trust the public health experts who have been preparing for this for decades. Listen to them. They are considering the economic impacts as well as the health impacts.

Stay home. Wash your hands. Wear a mask if you go out for essentials, and wash everything when you get back.

Do your part to make this safer for everyone.

Everyone.