It’s hard for many to grasp the potential impact of coronavirus spreading through the population, particularly in countries that either haven’t had as many cases yet, or don’t have adequate testing to confirm just how much it’s already spread.
Experts have warned that despite COVID-19 having an estimated 2% fatality rate, the issue that will complicate matters tremendously is if too many people catch it at once and overload the healthcare system in a given country. But still, it’s difficult to imagine what that looks like, as it’s not something most of us have lived through before.
But biologist Liz Specht took the time to break down the numbers on Twitter recently, to show people just how important it is to do what we can to stop the disease from spreading rapidly.
First, she puts forth the idea that there were probably around 2000 cases in the US as of March 6th.
Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate. 2/n
— Liz Specht (@LizSpecht) March 7, 2020
The CDC’s failure to provide adequate testing to people displaying symptoms has made it impossible to confirm just how many Americans are infected, but Specht hazarded a guess of 8x the number confirmed at the time.
She also says this number will likely double every 6 days, putting us at one million infected by the end of April, in the United States alone.
We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go. 4/n
— Liz Specht (@LizSpecht) March 7, 2020
And that’s when our healthcare system will start to collapse.
“As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track and contain new transmission chains,” she writes. “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 healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted. 6/n
— Liz Specht (@LizSpecht) March 7, 2020
Specht explains that the U.S. only has 2.8 hospital beds per 1000 people, or about one million beds—around 65% of which are full at any given time for reasons unrelated to coronavirus, leaving 330,000 beds available. With a projected 10% of coronavirus cases requiring hospitalization lasting weeks, this means our hospitals will be at capacity by May 8th.
Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients). 8/n
— Liz Specht (@LizSpecht) March 7, 2020
If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd. 10/n
— Liz Specht (@LizSpecht) March 7, 2020
The increasing demand on our healthcare system will have a ripple effect that could make things even worse.
“As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization,” Specht writes.
As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now. 12/n
— Liz Specht (@LizSpecht) March 7, 2020
There’s also the issue of running out of supplies for medical staff to safely treat patients without becoming infected themselves.
The government says there’s a stockpile of 12 million N95 masks and 30 million surgical masks — which, as Specht points out, are not ideal but they’re better than no masks at all.
There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.) 14/n
— Liz Specht (@LizSpecht) March 7, 2020
If only 6 million of the 18 million healthcare workers in the U.S. are working on any given day (and it’s likely to be more), it would only take two days for them to use up the entire supply of N95 masks in the country if they were only given one a day.
One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused. 16/n
— Liz Specht (@LizSpecht) March 7, 2020
And with the entire world facing the same crisis, we’re limited on how quickly we can get more.
Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor. 18/n
— Liz Specht (@LizSpecht) March 7, 2020
It’s easy to see how the overcrowded system and a shortage of masks will lead to healthcare workers getting sick. And then there will be even fewer professionals to take care of sick people, when we likely already won’t have enough.
HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above. 20/n
— Liz Specht (@LizSpecht) March 7, 2020
Specht says her warning isn’t intended to cause panic, but to help people become prepared for what is likely to come.
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. 23/n
— Liz Specht (@LizSpecht) March 7, 2020
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 prepare. Of course some of these estimates will be wrong, even substantially wrong. 25/n
— Liz Specht (@LizSpecht) March 7, 2020
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 HC system. 27/n
— Liz Specht (@LizSpecht) March 7, 2020
Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out. 29/n
— Liz Specht (@LizSpecht) March 7, 2020
Her timeline fits with what experts have been telling us.
Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population. 31/n
— Liz Specht (@LizSpecht) March 7, 2020
That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we’re talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge. 33/n
— Liz Specht (@LizSpecht) March 7, 2020
That’s all for now. Standard disclaimers apply: I’m a PhD biologist but *not* an epidemiologist. Thoughts my own. Yadda yadda. Stay safe out there. /end
— Liz Specht (@LizSpecht) March 7, 2020
It’s enough to make anyone want to stay home.
