Hello John and Doves,
Liz Specht is a biologist and engineer. She is currently the Associate Director of Science and Technology at The Good Food Institute. She holds a PhD from UCSD. She posted a long series of tweets regarding the spread of the Coronavirus and the limitations of America's healthcare system.
Coronavirus | Bacon's Rebellion
Risk of systemic healthcare failure.
My notes on her tweets:
I think most people aren't aware of the risk of systemic healthcare failure due to COVID-19 because they simply haven't run the numbers yet. Let's talk math.
Let's conservatively assume that there are 2,000 current cases right now in the US, today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We can expect that we'll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies) Here I mean "actual" cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts..
We are looking at about 1M US cases by the end of April. 2M by May 5, 4M by May 11 and so on. This is how exponentials work.
As the healthcare system becomes saturated under this case load, it will become increasing harder to detect, track and contain new transmission chains. In absence of extreme interventions, this likely won't slow significantly until hitting >1% of susceptible population.
What does a case load of this size mean for the healthcare system. We'll look at hospital beds and masks.
BEDS:
The US has 2.8 hospital beds per 1,000 people With a population of 330M, is is about 1 M beds. At any given time, 65% of those beds are already occupied. That leaves about 330,000 beds available nationwide (perhaps a bit lower this time of year with flu season)
About 10% of cases are serious enough to require hospitalization, using Italy's numbers. Keep in mind that for many patients, hospitalization lasts for weeks...turnover will be very slow as beds fill with COVID-19 patients.
By this estimate, by about May 8, all open hospital beds in the US will be filled. This says nothing about whether these beds are suitable for isolation of patients with a highly infectious virus.
If we're wrong by a factor of two regarding the fraction of severe cases, that only changes the timline of bed saturation by 6 days in either directions. If 20$ of cases require hospitalization, we run out of beds by May 2nd.
If only 5% of cases require it, we can make it until May 14th. 2.5% gets us to May 20th. This assumes that there is no uptick in demand for beds from "other' (non COVID-19) cases,
At healthcare system becomes increasingly burdened, RX shortages, etc. people w/ chronic conditions that are normally well-managed may fine themselves slipping into severe state of medical distress requiring intensive care and hospitalization.
MASKS:
National stockpile of 12 million N95 masks and 30M surgical masks per the feds.
18M healthcare workers in the US... Say only 6M work on any given day.
These healthcare workers would burn through the N95 stockpile in 2 days if each only got one mask per day.
We saw this happen in China - healthcare workers stuck in their PPE for 6 hours straight - no breaks as would have to suit up again.
How quickly could we ramp up production of mask? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in the US, the raw materials are predominantly from overseas...predominantly from China.
Keep in mind that all countries globally will be going through the exact same crisis and shortages simultaneously.
Now consider how these 2 factors - bed and mask shortages - compound each other's severity. Full hospitals + few masks + healthcare workers running around between beds without proper PPE = very bad mix.
Healthcare workers are already getting infected even w/access to full PPE. This will only get worse with shortages. And healthcare workers will drop out of the workforce as they get sick, are quarantined.
We could go on and on about thousands of factors - # of ventilators or even simple things like saline drip bags. You see where this is going.
Importantly, I cannot stress this enough, even if I'm wrong - even VERY wrong - about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential grown in an immunologically naive population works.
Undeserved panic does no one any good. But neither does ill-informed complacency. It's wrong to assuage the public by saying 'only 2% will die". People aren't adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.
I'm an engineer. This is what my mind does all day. I run back-of-the-envelope calculations to try to estimate order-of-of magnitude impacts. I've been on high alarm about this disease since, Jan 19 after reading clinical indicators in the first papers emerging from Wuhan.
Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we're seeing abject refusal of many countries to adequately respond or prepared. Of course of these estimates will be wrong, even substantially wrong.
But I have no reason to think they'll be orders-of-magnitude wrong. Every if your personal risk of death is very, very low, don't mock decisions like canceling event or closing workplaces as undue 'panic'.
These measures are the bare minimum we should be doing to try to shift the peak - to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the healthcare system.
And yes, you really should prepare to buckle down for a bit. All services and supply changes will be impacted. Why risk the stress of being ill-prepared?
(end notes)
Pray for the peace of Jerusalem!
Maranatha!
Chance