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
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
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
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
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
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
three weeks, New York only saw fewer than sixty
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
There were thousands of people on those
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
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
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
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
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
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