OK, here it is: SARS-COV2 continues to mutate and the mortality rate increases for younger demographics, with the whole population mortality exceeding 10%. The economic spiral rapidly accelerates into a financial system collapse, and a global depression results. As social unrest spreads, various state and non-state actors seek to exploit the situation, and a peer-on-peer nuclear exchange is ultimately triggered. The surviving fraction of humanity is reduced to a mad-max style existence. This is not a joke or exaggeration, this is what some of the models and associated analyses are currently forecasting as our near term future. However …
The world I usually operate in during real time disasters is the “bad case” – the worst scenario that you can do something about when it starts to become evident that things are going wrong. This scenario makes the most sense for planning, balancing the disruption of acting with the consequences of doing nothing, in light of the odds. I also do a lot of “most likely case” – what’s probably going to happen – to put that in perspective. And of course you have to explore worst case scenarios for context. However, even when they have a reasonable probability of happening (and there would be a run what little remaining toilet paper there is if I told you the odds of the above end-point happening, even without COVID), by the time the situation is in progress there is often little you can do about it. Humans have a hard time planning for next week, much less next decade. The groundwork to prevent the “worst case” usually takes decades, and politicians and business people (much less the average person) has little incentive for that when things are going well. When you tell them the worst case, they usually scoff. But in the “bad case” there are things you can do to mitigate the impact, the odds are high enough to get the attention of decision makers. And again, once the event is in progress, there is often little you can practically do to mitigate a “worst case” scenario beyond what you can reasonably do for the “bad case”.
In my experience, trying to scare people in to action with the “worst case” rarely ends well. It might be good for ratings, and work a few times, but when there starts to be large gaps between what happened and what you told people might happen, credibility suffers, and eventually people stop acting on your guidance. This is a problem in the hurricane world right now. The pandemic world can get away with scary scenarios because they haven’t been as frequent, but if, as is still likely, this turns out to be not so bad for most people, the next time when action is needed folks might not take it. As most of you know, I believe in laying out the best scientific facts and estimates, and work with decision makers (and the public) to do what needs to be done, protecting against both the upside *and* downside. That balance has been lacking in the approach to this problem so far; it has swung from “do nothing” to “shut down”.
The New York Times and associated outlets have been running some stories about a leaked CDC “worst case” scenario of COVID19. They even have an article with a cool slider thingee you can play with. These are not actually “worst case” because they fail to account for the fact that if those medical scenarios come to pass, society might well collapse and a few, or even a lot, of sick people won’t be at the top of the list of problems. There are a lot of other factors that were apparently not accounted for in the modeling presented, that they used uncertainty bounds from very early in the outbreak, and/or were set to their worst values. The NYT did put in some caveats, but others repeating these scenarios are not, and it’s causing some unnecessary fear and angst. Once scenario that was presented as “conservative” in the article was in the US 96 Million “infected”, 5 million require hospitalization, and 480 thousand deaths. In my opinion that’s not a “conservative” estimate; based on the data as of this morning it is something like an upper 90 or 95% bound – in other words, fairly extreme. Do hospitals (who were the target for that estimate) need to think about how they would react if that happened? They should have been planning for that years ago, but, yes, in context. Do you? Probably not. There’s no “right” number to use for every situation.
In the last two weeks I’ve prepared various scenarios for a range of government, NGO, and private sector organizations. I’ve been surprised and horrified that specific information has not been supplied to local and regional planners. The most likely outcome for the US, based on the data as of this morning, is that we are looking at 56 million “infected” (would test positive if tested), 31 million would be symptomatic (most very mild). About 400,000 will need hospitalization, and 28 thousand deaths. For “bad case” planning purposes that I use for planning purposes, the “75th percentile” of outcomes just about double those numbers (800,000 hospitalized, 60,000 deaths; about the same as the 2017 flu season BUT coming in a much shorter period of time and thus presenting horrific stress on the health care system). That’s pretty bad – but in total deaths, still less than a bad flu season. As I’ve said many times the problem is less that we aren’t taking this virus too seriously but that we fail to take influenza more seriously. So as long as everybody stays reasonable, most people will at worst be inconvenienced by this thing. Yes, sadly, some will succumb to this, but not catastrophic numbers. I think that in the western world we’ve done a terrible job preparing for this, both in the short term (since January) and especially in the long term (since SARS, in 2008). That’s a discussion I hope we have once this calms down. Even better would be some serious leadership to address the long term problems, but the way things are going, I’m not optimistic on that front.
Do some planners need to use the tail of the distribution (the extreme, even “worst” cases?). Sure. Do you tell the general public? That’s an interesting question. I have no problem in principle discussing worst case, but only in the context of the most likely, and the “worst you can reasonably expect” or “bad” case that you should be preparing for or, as we virtually never do, for long term planning. Besides, trying to keep them secret usually doesn’t work – they leak out, and people think you’re hiding something. The problem with what I am seeing with a lot of the COVID19 pandemic, like the coverage of hurricanes, is that it is mostly the extremes being discussed.
So what should you do? By now I hope you know …
Wash your hands, don’t touch your face (except to wash it after washing your hands like this dude), social distancing as needed, stay home if you don’t feel good. Usual reminder that the CDC web site has consolidated information and links on the current situation, what actions various at-risk groups should do, as well as what the general public can do to help stop the spread to those groups. Remember unless you’re in one of those groups, this mostly isn’t about you. Other than the lack of toilet paper 😛