Dear Friends,
Several of you have expressed support for the belief that COVID-19 is no more
deadly than the flu, and/or expressed support for anti-lockdown protests.. To
these among you I ask a simple question, and then present some stats.
The question: How many times in the last 100 years have you heard of New York
City’s hospitals being completely overwhelmed by a flu? Detroit’s? Milan’s?
Once—only this year. In other words, it’s an extremely rare occurrence.
If so, the probability that Covid-19 is just like any other flu would be close
to 1%.
The stats:
1. How lethal is Covid-19 compared to flu? Here are CNN's stats on the annual
flu burden in the U.S. since 2010 from a cogent 3-minute interview of Dr.
Sanjay Gupta:*
Range of the number of illnesses in a year: 9,000,000-45,000,000
Range of the number of hospitalizations in a year: 140,000-810,000
Range of the number of deaths in a year: 12,000-61,000
Conclusion: The lethality of the flu in the U.S. during this period has been
0.13%.
2. The Lancet estimated Covid-19’s lethality is 5.7%, and could be as high as
20%.** This is 48-154 times as deadly as flu.
3. How easily does Covid-19 spread compared to flu? Here are CNN's stats from
a cogent 2-minute report*** on R0 ("R-naught”, the reproduction number), a
measure of how many people each patient will infect:
For Measles at the upper end, R0 = 12-18, so each person with measles will
infect 12-18 others.
For Ebola at the lower end, R0 = 1.5-2.5.
Flu varies year to year, but one study reports its R0 averages 1.2.
For Covid-19 the CDC reports the R0 = 2.2-2.7.****
Conclusion: Covid-19 is twice as contagious as the flu.
4. Combining the fact that Covid-19 is 48-158 times as lethal as the flu with
the fact that Covid-19 is twice as contagious as the flu, Covid-19 is 96-316
times as deadly. That’s not "just like the flu!"
5. These facts justify a response to Covid-19 that has correspondingly greater
urgency than the flu. That response is especially urgent in the U.S. because:
The world’s population is 7,800,000,000 and the U.S. population is 327,000,000.
According to Johns Hopkins,***** the world has 2,561,044 confirmed cases, or
328 cases per million.
According to Johns Hopkins, the U.S. has 823,786 confirmed cases, or 2,519
cases per million. That is 8 times worse than average for the world.
According to Johns Hopkins, the world has 176,921 deaths, or 23 deaths per
million.
According to Johns Hopkins, the U.S. has 44,845 deaths, or 137 deaths per
million. That is 6 times worse than average for the world.
6. I’m not a doctor or epidemiologist, and the following statement is less
rigorous and more simplistic than the above sets of facts, and I could be
wrong: I’d say the primary ways of dealing with a new virus—until vaccinations
are available—are Containment, Tests, Contract Tracing, and Social Distancing.
In the U.S., the opportunity for Containment lapsed in February.
In the U.S., the Tests are way behind the nation's need.
Harvard researchers estimate “We need to deliver 5 million tests per day by
early June to deliver a safe social reopening."******
Harvard researchers estimate the U.S. needs "20 million tests a day (ideally by
late July) to fully remobilize the economy."
According to Johns Hopkins, the U.S. has tested a total of only 4,155,178 since
testing began.
According to Johns Hopkins, the U.S. tested only 151,627 in the past 24 hours.
Contact Tracing can’t begin to be effective until the tests are sufficient.
Until the U.S. ramps up its Tests and Contract Tracing, Social Distancing is
all that’s left.
These are reasons for my reluctance to watch videos that encourage Americans to
dismiss social distancing and protest anti-lockdown measures. Until Covid-19 is
contained by much more tests and contract tracing—especially as set forth by
Harvard below—such advice will not only multiply our death count, but prolong
and deepen our economic contraction.
Sincere best wishes,
Dick
* Link:
https://www.cnn.com/videos/politics/2020/02/27/trump-coronavirus-flu-news-conference-sanjay-gupta-newday-vpx.cnn
<https://www.cnn.com/videos/politics/2020/02/27/trump-coronavirus-flu-news-conference-sanjay-gupta-newday-vpx.cnn>
** Global mortality rates over time using a 14-day delay estimate are shown in
the figure
<https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30195-X/fulltext#fig1>,
with a curve that levels off to a rate of 5·7% (5·5–5·9), converging with the
current WHO estimates. Estimates will increase if a longer delay between onset
of illness and death is considered. A recent time-delay adjusted estimation
indicates that mortality rate of COVID-19 could be as high as 20% in Wuhan, the
epicentre of the outbreak. These findings show that the current figures might
underestimate the potential threat of COVID-19 in symptomatic patients. Link:
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30195-X/fulltext
*** Link:
https://www.cnn.com/videos/health/2020/03/03/how-viruses-spread-lon-md-orig.cnn
<https://www.cnn.com/videos/health/2020/03/03/how-viruses-spread-lon-md-orig.cnn>
**** Link: https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
<https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article>
***** Link:
https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
<https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6>
****** Link:
https://ethics.harvard.edu/files/center-for-ethics/files/roadmaptopandemicresilience_updated_4.20.20.pdf
<https://ethics.harvard.edu/files/center-for-ethics/files/roadmaptopandemicresilience_updated_4.20.20.pdf>
Very Important Note: Harvard’s "Roadmap to Pandemic Resilience” is amazingly
credible and strong. It concludes:
We have no time to waste. We can save lives, save our health infrastructure,
mobilize our economy, protect our civil liberties, and secure the foundations
for a resilient constitutional democracy. We can be democracy’s bulwark against
this existential threat if we elevate our ambitions and determine to act
swiftly and with purpose.
OUR ANCHOR RECOMMENDATION IS THIS:
Between now and August, we should phase in economic mobilization in sync with
growth in our capacity to provide speedy, sustainable testing, tracing and
warning, and supported isolation and quarantine programs for mobilized sectors
of the workforce. We do not propose a modest level of testing, tracing, and
supported isolation intended to supplement collective quarantine as a tool of
disease control. We recommend a level of TTSI ambitious enough to replace
collective quarantine as a tool of disease control.
We need to deliver 5 million tests per day by early June to deliver a safe
social reopening. This number will need to increase over time (ideally by late
July) to 20 million a day to fully remobilize the economy. Achieving these
numbers depends on testing innovation. We acknowledge that even this number may
not be high enough to protect public health. In that considerably less likely
eventuality, we will need to scale testing up much further. By the time we know
if we need to do that, we should be in a better position to know how to do it.
[From its Introduction: “(T)he cost of such a testing and tracing, or TTSI,
program—$50 to 300 billion over two years—is dwarfed by the economic cost of
continued collective quarantine of $100 to 350 billion a month. Furthermore,
this calculus neglects the lives being lost every week among workers in
essential sectors and the vulnerable populations they serve who remain exposed
to the virus even when stay-at-home advisories are in place. It also neglects
the fraying of the social fabric created by extended collective quarantine.”]
An effective strategy of pandemic resilience requires the following:
• Innovation in testing methodologies.
• A Pandemic Testing Board established by the federal government with strong
but narrow powers that has the job
of securing the testing supply and the infrastructure necessary for deployment.
• Federal and/or state guidance for state testing programs that accord with
due process, civil liberties, equal protection, non-discrimination, and privacy
standards.
• Readiness frameworks to support local health leaders, mayors, tribal
leaders, and other public officials in establishing test administration
processes and isolation support resources.
• Organizational innovation at the local level linking cities, counties, and
health districts, with specifics varying from state to state.
• Federal and state investment in contact tracing personnel, starting with an
investment in 100,000 personnel (recommendation from JHU Center for Health
Security).
• Clear mechanisms and norms of governance and enforcement around the design
and use of peer-to-peer warning apps, including maximal privacy protection,
availability of open source code for independent and regulatory audit, and
prohibitions on the use of any data from these apps for commercial purposes,
ideally achieved through pre-emptive legislation.
• Support for quarantine and isolation in the form of jobs protections and
material support for time in quarantine and isolation as well as access to
health care.
• An expanded U.S. Public Health Service Corps and Medical (or Health)
Reserves Corps (paid service roles), and addition of Health Reserves Corps to
the National Guard units of each state.
• National Infectious Disease Forecasting Center to modernize disease tracking
(recommendation from Scott Gottlieb, AEI).
Consensus is emerging about what we need. How to do it is beginning to come
into view. The time for action has arrived.
