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 …
Some argue COVID19 is like the flu. Others scream in outrage that it isn’t at the slightest implication that it is. Both are right, yet dangerously wrong.
Those who say it’s nothing like the flu are right. In many ways the SARS-COV-2 virus that causes COVID-19 is potentially much more dangerous, especially to certain segments of society. It is especially devastating to the health care system for two key reasons: it spreads quickly, and while the total numbers becoming seriously sick appear smaller than influenza it has a much higher complication rate for those who do get sick with it. If we don’t take action, the US we will run out of respiratory support equipment (and people trained to use it) quickly, and it’s going to get ugly. South Korea has four times the hospital beds per capita than Italy – 12.4/1000 vs 3.4/1000. Most areas of the US are under 3 per 1000. South Korea is farther along the progression than Italy, yet has a hospitalized/identified mortality rate of less than 1%. Italy is currently at 6.6%.
But those who say “worse than the flu!” are also wrong in a very dangerous way. In societal terms, the hospitalization and mortality rates are comparable to influenza. As of yesterday evening, those numbers in the outbreak areas in China and South Korea are still converging to the same range as influenza. In areas that are still in the “exponential” part of the curve, Italy, Iran, and now Seattle, the day to day increases are scary, but are progressing in about the same way. (As an aside, beware mathematicians who extrapolate the exponential expansion numbers: that is only one phase of the progression and doesn’t last forever …) This is manageable with some common sense: concern is justified, appropriate and measured action is justified, fear and over reaction is not. The societal and economic impacts of fear are significant, and our economy in particular has a number of fault lines (especially in the areas of liquidity) that this has the potential to cause a major recession or worse.
Those who say it is similar to influenza also have a point, in general terms. As noted above, the overall number of people who are getting sick, dying, etc. are about like bad influenza year. In total number terms, based on what we saw in China and are seeing in Italy, about 400 thousand Americans will need hospitalization, and sadly about 30,000 will die. But, again, the H3N2 influenza out break of 2017, against which the vaccine was only partially effective (and only 37% got anyway), hospitalized 810,000 and killed 61,000. But, saying “it’s just the flu” misses the point just as badly as saying “it’s a bazillion times worse than the flu!” for the reasons noted above: it’s moving faster, and a greater strain on the health care system that doesn’t handle the annual flu outbreaks well.
This is a fascinating exercise in how people deal with risk. It is also yet again a depressing example of a major societal threat we knew was coming, that experts warned about for many years, and recommended plans be made to deal with it. But the short-sighted leadership class (of all political stripes) utterly failed in their responsibilities to get ready for it, and are now failing to react appropriately. And it’s the average person who pays the price for that failure. Sigh.
Usual reminder that the CDC web site has consolidated information and links on the current situation, and as to 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.
Before the numbers, a question: Is the COVID19 pandemic a crisis, or not? In the US how you answer that seems to break along political lines. But the answer isn’t really a simple “yes” or “no,” and that is a source of conflict and confusion in a society that demands simple, sound bite style answers that hopefully break down along party lines. In many instances, the question “is or is not” (“to be or not to be” as some English dude wrote) is the wrong question. The Buddhists call this “dualistic thinking”. In the COVID crisis, the answer to the question above is a firm “it depends.”
The short version (and you know the longer version is below!) is that this is not a crisis for the vast majority of people. Even if you get it, it’s not as bad as many of the influenza strains going around. HOWEVER: if you are in a vulnerable population, it is as much as 10 times deadlier than the flu. In addition, because of the rapid progression, lack of immunity, and severe respiratory distress of patients who present for treatment, it is a potential catastrophe for our health care system, which does not have the capacity to deal with this. Thus the contradiction and conflict: for most people it’s not a big deal, but for the health care system it risks overload, and for vulnerable populations, it’s deadly. So how do you balance all that, prepare, but not scare people and wreck the economy? Clearly, not how we’re doing things at the moment …
The US is now well in to the mode where state and local leaders are having to take key decisions on COVID-19 with respect to closures. It’s a difficult situation. The dilemma is that the available data indicates this has no more implications for the general population than a bad influenza strain. That’s not to minimize COVID19; the problem is we don’t take influenza as seriously as we probably should. The 2017 H3N2 strain hospitalized 810,000 people and killed about 61,000. The current modeling indicates that COVID19 will hospitalize 378 thousand, and kill about 20,000. Big numbers, but smaller than the flu. However …
One of my major frustrations with the “news” media is how they treat numbers. In a situation like we are facing with the COVID-19 outbreak, the data is very fuzzy, and we are apparently seeing wild swings in the numbers. Headlines like this one in the New York Times are facing folks as they wake up this morning: Cases and deaths surge in Italy as its north is locked down. So we should panic, right? Maybe not.
As previously noted, I’m using data from the nCoV-2019 Data Working Group data base, Epidemiological Data from the nCoV-2019 Outbreak: Early Descriptions from Publicly Available Data as well as the current (9 March 2020) World Health Organization database. I’m also indirectly using other sources of information to cross check these data.
As someone who deals in data (usually sketchy, fuzzy data), I’m totally frustrated at how people are drawing conclusions and doing extrapolations on the COVID19 data. It’s causing panic and bad decision making, and as I have been saying for a couple of weeks the panic is potentially worse than the pandemic (and make no mistake, despite the reluctance to use the word, this is a pandemic, but as has been pointed out by myself and others, pandemic does not automatically mean widespread death and the collapse of society). When I look at the COVID19 data (just the data, not the reaction to it), I see reason for concern by the health care community and some sectors of the population, but not the population at large. Here’s the latest on what you should do, what the numbers are, and what they mean …
I didn’t really plan to do daily updates on this (and probably won’t unless things change), but I did listen in on the CDC briefing that just wrapped up at a few minutes ago (1:30pm ET) as well as some earlier telcons. All told, I didn’t hear anything that changed my view that:
a) Most people getting COVID19 have mild symptoms and many probably don’t even know it or confused the symptoms with a normal cold, flu, or (if you live in the south), allergies from the god-awful pollen coating everything in sight;
b) The usual vulnerable populations (over 65, anyone with health issues) need to be especially cautious and use good hygiene; So does everyone else.
c) Panic is still a bigger threat than the virus.
d) The Medical Community needs to prepare for a spike in respiratory distress cases even if total case counts stay manageable and below normal influenza rates;
e) The economic and political impacts of COVID19 will be disproportionate to the medical impacts.
The bottom line is everyone needs to practice good “flu” season behavior, as much to protect the vulnerable since if we can limit the spread it limits the opportunity for vulnerable people to be exposed. If you feel bad, stay home. Don’t spread the joy. If someone is sick, it’s safe to take care of them, just frequent hand washing, vigilant surface cleaning, etc. There are some indications are this isn’t quite as communicable as thought, but be sensible. You’ll hear the phrase “social distancing.” That’s doing things like not shaking hands, touching people, etc. Ditching Facebook might help – can’t hurt, and might make you more sane 😛 …
First, the CDC briefing teleconference “on hold” music is terrible.
Normally I try to post something after the CDC briefing, but it has been postponed, and I may not have time to follow up with a post this afternoon. They are also in the process of updating their guidance, no doubt in response to new information such as the fact the virus has almost certainly been in the US, and spreading, for at least 6-8 weeks, as well as other developments such as new cases and other data.
We’re in the scary phase of this, where there are now local outbreaks, and speculation is far outrunning information. The key problem now, as throughout this event, is that the lack of accurate testing has prevented us from getting a handle on several key variables: how many total people have been exposed, how many got sick and to what degree, and how many became seriously ill and needed hospital level medical intervention. There is some reason to be very cautiously not pessimistic (I wouldn’t say “optimistic” yet) that the first two numbers are such that the third number, those who “crash” with this, is statistically small enough to make the pandemic manageable. So while there is still no reason to panic, the truth is we just don’t know for sure yet, and the medical community is wise to continue to prepare for various scenarios even while “go about your life, being aware this may or may not require action” is still the word of the day. In economics, as usual avoiding the extremes of “irrational exuberance” or “suicidal depression” is always the challenge …
As always, if you want the latest facts and recommendations, go to the the CDC COVID-19 web site. Click “CDC Recommends” for access to specific guidance for health care providers, etc. Most of what you need to do is just common sense (hand washing, don’t buy all the TP and beef jerky, etc.) For general “how to prepare” guidance on both this and other potential disasters, the DHS/FEMA “Ready.Gov” site has checklists and suggestions. Maybe pick up a couple of extra items each trip to the store until you have a small stash. Then swap out items over time so they don’t expire. It’s good habit to be in since … HURRICANE SEASON IS COMING! Or earthquakes. Or something.
One of the major problems with disaster planning is that you have to strike a balance between “likely” scenarios, “bad case” scenarios, and “worst case” scenarios. When I’ve taught emergency management classes, I always remind the attendees that there are rarely any “no risk” options: there will likely be lives disrupted and lost either way. It’s depressing, but the idea is to minimize that and, like the Hippocratic Oath says, “First, do no harm.” And that’s where it gets tricky. Often the consequences of the “bad case” scenarios are drastic, but can be minimized with equally drastic measures. When do you trigger those plans? And what and when do you tell the public to do something, knowing that those actions have consequences, and can easily create a disaster worse than if you had done nothing?
The health care community is rightfully worried about COVID-19, and are examining a lot of “what if” scenarios. IF the “bad case” scenarios come to pass it COULD get bad. IF the virus spreads (which is likely already happened). IF lots of people get sick (less likely, but possible). IF that is true quarantines and closures would be required to slow the spread (not that likely). IF lots of people get sick to the point of needing medical care and overwhelm the medical system (that is even less likely, based on what we know). THEN it gets bad. Likewise, as discussed previously, there is the possibility of supply shortages, quarantines, school closures, etc. kick in during these scenarios.
In my first job I traveled a lot between world capitals, often spending weeks at a time on an airplane supporting senior government officials and their teams. One of them was an especially interesting guy, extensive experience in business, politics, and government, and had a set of “rules” he would would give out. They really weren’t rules per se, but a collection of quotations and reflections based on his experiences, some funny, some thoughtful, that covered working in the White House and government, business, and how to stay sane in life in general. As a young officer I found them very valuable – I still have my signed copy. Later on he became (in)famous for saying ..
…because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know. And if one looks throughout the history of our country and other free countries, it is the latter category that tend to be the difficult ones.
That is a restatement of something developed in the mid 1950’s known as the Johari Window. As a concept it’s been around for a while, especially in the intelligence and aerospace communities. The basic idea is that the things that you don’t know you don’t know are the ones that have the potential to cause you the most trouble. It’s a useful tool for assessing information and decision making. Recently several sociologists have suggested adding another category: things we do know, but don’t believe for one reason or another. And I think that is the most dangerous category of all, and what we are facing at this moment in several areas such as with this virus. People are thinking and acting like some information is unknown, when it is in fact known – but for various reasons don’t want to believe it.