Coronavirus Diary
Now the teaser. “If it takes the lily pads 48 days to cover the pond completely, how long will it take for the pond to be covered halfway?”
The answer is 47 days. Moreover, at day 40, you’ll barely know the lily pads are there.
That grim math explains why so many people — including me — are worried about the novel coronavirus, which causes a disease known as covid-19. And why so many other people think we are panicking over nothing.
She said scoffers are fond of saying that more people have died from the seasonal flu, etc.
But go back to those lily pads: When something dangerous is growing exponentially, everything looks fine until it doesn’t. In the early days of the Wuhan epidemic, when no one was taking precautions, the number of cases appears to have doubled every four to five days.
Read it all. It’s going to be invisible to most of us … until seemingly overnight, it isn’t.
The Wall Street Journal has the chilling tale of Marc Thibault, 48, an American who caught coronavirus in Europe, fell ill back home in America, and was so sick that a priest came to the hospital to give him last rites. What’s so chilling about it is that Thibault is not an old man, and he says he exercises regularly, and rarely gets sick. And yet:
He says the virus now hit him “like a hurricane.” He was weak and had trouble breathing. The hospital whisked him into the ICU, where nurses donned hazmat-style suits to enter his room.
They inserted a breathing tube, and put another tube down his throat for medicine to deal with pneumonia that developed in his lungs, he said.
Gagging and coughing, Mr. Thibault said he felt scared. His lungs would fill with saliva and nurses would dash in and clear them out, only to have to do it again two hours later.
“The feeling of choking. That was the worst part,” he said. “You feel like you’re asphyxiating, and you’re panicking because you can’t breathe.”
The agony went on for days.
He very nearly died. As the Journal reporter points out, four out of five infected people will have only mild to moderate symptoms. Those who get very sick are disproportionately aged 60 and older. But relative youth is no guarantee that this will leave you unscathed. [UPDATE: Someone points out that he has asthma, which made him more susceptible. — RD]
Some people find comfort in the fact that other European nations have much lower numbers of infected than Italy — the thought being that there is something particular to Italy that makes it so bad there. That does not seem quite sound. German Chancellor Angela Merkel said today that 60 to 70 percent of Germans will eventually be infected. And:
France recorded a 70 per cent rise in cases over Monday night, with more than 1,200 patients now known to have caught the deadly infection.
Here, from Worldometer, is a chart tracking the French outbreak:
Same chart for the US, from the same source. Keep in mind that these are only the cases that we know about. Widespread testing is still not available:
In other coronavirus news today, some regional leaders in Lombardy, the hardest-hit Italian province, are calling for a total Wuhan-like curfew there to save the hospitals.
Here’s an excellent Spiegel interview with Harvard epidemiologist Marc Lipsitch. Excerpts:
DER SPIEGEL: You predict that up to 60 percent of adults could become infected with the novel coronavirus. Isn’t that alarmist?
Lipsitch: I don’t think so. It’s of course a projection and, like any projection, it could be wrong. But if you have a reproductive number of an infectious disease of around two, which seems to be the estimates that we’re getting right now (Eds: meaning that, on average, each infected person transmits the disease to two other people), then at a minimum, half the adult population needs to become infected before the spread can stop permanently. This is not an ungrounded estimation, but simply the basic math of epidemics.
More:
DER SPIEGEL: Japan closed schools nationwide, Italy closed its universities. Is that a good public health measure?
Lipsitch: It’s really hard to know. We have never dealt with an epidemic where the role of children was so unclear. Most infected kids don’t show symptoms, but we don’t know if they are still infectious. Closing schools countrywide even where there aren’t a lot of cases seems to be a measure that is hard to sustain. But in places where we saw community spread, it definitely makes sense.
DER SPIEGEL: You did extensive research on the influenza pandemic between 1918 and 1920, which killed more than 650,000 people in the United States alone. What did we learn from the flu pandemic?
Lipsitch: American cities reacted quite differently then. Philadelphia didn’t respond until two weeks after the first influenza case when it closed schools and canceled public events. St. Louis, on the contrary, put in interventions early on, after two days. The peak death rate in Saint Louis was only one-eighth that of Philadelphia. The study showed that if cities intervened early and implemented aggressive social distancing, the epidemic slowed down and was less deadly in general.
The Washington Post has a really informative story on why “social distancing” is such an important disease-fighting strategy. Excerpt:
Disrupting everyday life is more easily said than done, with effects that will ripple through individual families and the global economy. Much to the consternation of health officials, it is already creating dissonance and conflicting messages, starting at the very top. President Trump argued on Twitter on Monday that even though the flu killed 37,000 people last year, “Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!”
Particularly for people who are young and healthy, disruptions may seem to be excessive — alarmist restrictions. But graphics comparing the speed of spread of epidemics with and without social distancing provide a powerful visual illustration of the importance of what experts call “flattening the curve.” It’s the difference between a viral outbreak that has the profile of Mount Everest, exploding vertically, vs. one that unfolds over time — a long, low hill.
“The idea is that the sooner you stop that transmission chain, you are actually limiting an exponential growth,” said Yvonne Maldonado, an infectious-disease epidemiologist at Stanford University. “That’s really important, because instead of preventing 1,000 cases, you might be preventing 100,000 cases — and a matter of days can make a difference.”
An early study, not yet peer-reviewed, of two cities in China suggested the potential difference. The Wuhan outbreak reached its peak quickly, and a similar growth curve “would fill our ICU” beds with coronavirus cases for the United States, tweeted Marc Lipsitch, a Harvard epidemiologist.
Guangzhou, which intervened in the epidemic earlier than Wuhan did in its own case, had a smaller peak of hospitalizations.
On the excellent coronavirus subreddit, an anonymous UK infectious disease critical care doctor caring for COVID19 patients — his identity was verified by Reddit admins; he has to be anonymous per NHS regulations — answered some reader questions. Link to the thread is here. The first one was about whether or not the UK would see an Italy-style outbreak, or whether the virus was contained in Britain. The doctor answered:
The consensus amongst my colleagues in general is yes, it will get much worse, and it is likely to reach Italy levels. We are preparing for such but there is only so much we can do from within a hospital.
As a health system, the UK runs at or over capacity. It is worth remembering that the background population of critically ill does not decrease in an outbreak.
There was a feeling a week or two ago, when we started seeing community clusters, that population measures needed to be taken. The feedback we have gotten from colleagues in public health or those involved in government advisory positions has been that there is a question of balancing short term economic burden against a predicted mortality.
I personally think this government response has been short-sighted.
We have very good case-studies, in Italy, showing what is likely to happen if delaying measures are not taken early; vis-a-vis South Korea showing what can happen when strict measures are taken in a timely fashion. The key is to prevent healthcare demand from being overwhelmed. This is the point where mortality rises.
Again, my personal opinion, is there is a problem in the UK amongst decision makers with denial, and concern about the political optics of early population measures that affect the economy. The problem is, with outbreaks like this, you won’t see that you are about to be overwhelmed until the day before, and you needed to have taken action at least two weeks before that. Lessons from China, from South Korea, and current lessons from Italy and Iran are not being listened to.
A reader sends this in from Dr. Ellen Eaton, an infectious disease specialist:
Close the schools now — flatten the curve!
Meanwhile, a National Review editorial quite reasonably faulted Trump’s handling of the coronavirus crisis. Excerpt:
In a serious public-health crisis, the public has the right to expect the government’s chief executive to lead in a number of crucial ways: by prioritizing the problem properly, by deferring to subject-matter experts when appropriate while making key decisions in informed and sensible ways, by providing honest and careful information to the country, by calming fears and setting expectations, and by addressing mistakes and setbacks.
Trump so far hasn’t passed muster on any of these metrics. He resisted making the response to the epidemic a priority for as long as he could — refusing briefings, downplaying the problem, and wasting precious time. He has failed to properly empower his subordinates and refused to trust the information they provided him — often offering up unsubstantiated claims and figures from cable television instead. He has spoken about the crisis in crude political and personal terms. He has stood in the way of public understanding of the plausible course of the epidemic, trafficking instead in dismissive clichés. He has denied his administration’s missteps, making it more difficult to address them.
This presidential behavior is all too familiar. It is how he has gotten through scandals and fiascos for more than three years in office. But those were all essentially political in nature, and most were self-created. The country has been lucky in the Trump era, largely avoiding the sorts of major, unforeseen crises that make the greatest demands of the modern presidency. That luck has now run out, and this demands a new level of seriousness from the president and those around him.
I was talking today with a political scientist, who agreed that Trump has been terrible in this thing, but who also said that this is a Chernobyl for the US public health system, which was not ready for the pandemic. Trump has to bear a big share of the blame, but a failure of this magnitude is systemic. I told him that my concern is that after this is all over, a lot of people who failed will be eager to scapegoat Trump — who will certainly deserve intense criticism — as a way of offloading their own faults.
Finally, I heard from a reader who talked about how people where he lives are starting to lose jobs as the economy slows down because of coronavirus. He mentioned two individuals he knows, one who is being laid off because the local tourism economy has crashed because of the outbreak, and the other losing his job as a truck driver, because the goods he normally transports are either sitting on a dock in China, or weren’t made in the first place. The reader writes:
Trump is being a complete imbecile about this. This is an economic dislocation, and is not going to be easily fixed. Constantly yelling at the Fed for monetary intervention is really stupid, as it will do nothing at this time. The problem is people are not buying anything. They are either in lockdown, or the things they would have bought are not here because they are stuck in China. The big layoffs are right around the corner.
The feast of consequences is on the way, and there are still many many people in this country who think this is all being made up. They will not know what hit them.
He adds that the two people he knows are both the sole breadwinner in their families. Not sure how the president’s proposed payroll tax cut is going to help those who are no longer on a payroll.
Best unemployment numbers in the history of our Country. Best employment number EVER, almost 160 million people working right now. Vote Republican, unless you want to see these numbers obliterated!
— Donald J. Trump (@realDonaldTrump) March 10, 2020
UPDATE: A reader posted this from Sunday. The man in the video is the pastor of an Evangelical megachurch in Cincinnati. His message is: “Chill out about the virus. American middle-class life will not be affected. Let’s make fun of this thing.”
Coronavirus is the latest thing in culture that has us paralyzed with fear. As @BrianTome explains, we are commanded not to fear, but to keep moving. #coronavirus pic.twitter.com/ADBYBh3q5H
— Crossroads (@crdschurch) March 9, 2020
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