Millions of Americans dead, thousands more waiting to die
for want of medical equipment in short supply, and all because a few blithe
revelers wanted to go to the bar.
A
recent study by Imperial College London paints a truly frightening picture
of what could be.
But is this even possible?
In short, not likely, although we may come close if we’re
not careful.
An Axios-Harris poll found that somewhere between 1 in 3 Americans and 1 in 4 Americans fear death from contracting COVID-19, the disease caused by the new coronavirus.
The good news for them is that high-end estimates for mortality is
4%, and a random individual almost certainly will not die from this
disease. However, this is little comfort to the families of those who do die.
The figure most often cited is the 2.2 million Americans who may die as a result of 81% of the population being infected if no control measures are put in place.
As we have seen, measures to suppress and mitigate the
spread of COVID-19 have been implemented throughout the U.S. It is unlikely
that we will realize the 2.2 million deaths that the study projects, but that
doesn’t mean that we can rest easy.
With mitigation efforts, policies designed to slow the
spread of infection rather than fully prevent infection, the study projects
half the number of deaths due to the infection. That would be tremendous
progress, except that it means that 1.1 million Americans would die.
This would occur because even with mitigation efforts, the study projects the number of infected Americans who need to be hospitalized still would exceed the capacity of intensive care unit beds by a factor of eight.
With regards to COVID-19, critically ill patients are unable
to adequately breathe on their own and require a ventilator. Any of these
critically ill patients who do not receive a ventilator assuredly will die.
This is the unfortunate
situation already facing Italy as that nation’s number of critically ill
patients has exceeded their critical care capacity.
Doctors in Italy have been forced to have to choose to
reserve ventilators for younger, relatively healthier patients who stand a
better chance of living. As a result, the death
toll in Italy has surpassed that of China, where this global pandemic
began.
As of this writing, New York state leads the country in confirmed
COVID-19 infections, with over
5,000 cases. The state maintains a stockpile
of 2,000 ventilators, so if the number of cases grows much more, officials
may find themselves in a similar situation similar to Italy’s.
The study shows that the best hope for maintaining disease
levels below America’s critical care capacity is to follow a suppression
strategy.
Suppression seeks not to slow the spread of disease but to
reduce the current number of cases. Strategies to suppress infection are more
comprehensive, with the aim of eliminating human-to-human contact to make
transmitting the virus nearly impossible.
But how accurate is this study?
Like all projections and models, it is only as good as the
assumptions and data that goes into it. Imperial College London built a good
model. It is based on models built for pandemic influenza and simulates the
activity and infectiousness of hundreds of millions of individuals.
The model takes into account age, household size, population
distribution, and even the average school class size and staff-student ratio in
each community.
The Imperial College researchers then simulated the spread
of COVID-19 through normal interactions at home, at work or school, and in the
community, based on observed rates of transmission for the disease.
Researchers simulated strain on health care system based on
observed rates of hospitalizations and average durations of those hospitalizations.
By now, we have an unfortunately large amount of data available for COVID-19,
so the Imperial College model is very good.
That said, it mainly paints the worst-case scenario. Researchers
derived the 2.2 million deaths from the highest transmission rate along with a complete
lack of mitigation or suppressive efforts.
That is, the coronavirus at its most virulent combined with
Americans at our most blasé will result in up to 2.2 million dead. Obviously,
neither of those conditions is true.
Also, the researchers determined that 30% of hospitalized
patients would require an ICU bed. According to the Centers for Disease Control
and Prevention, the proportion of hospitalized patients who would require
critical care ranges between 20% and 30%. Since the study was meant to inform
public policy, researchers used the high-end estimate—the actual rate likely will
be lower.
Finally, one weakness of all models is the research subject.
Human beings are notoriously unreliable creatures and nearly
impossible to model accurately. Researchers simulated transmission of the coronavirus
by counting opportunities for contact within a setting (home, school or work,
in the community); each mitigation strategy eliminated one or several potential
settings for contact.
The model can’t account for those working actively against
the spread of the disease. For instance, a simulated individual who potentially
was exposed to the virus but washed his hands before being able to inoculate
himself with the virus would be spared from contracting the disease.
Even within
a household, families may prevent transmitting the virus with physical
distance and by vigilantly disinfecting surfaces.
Imperial College developed a sophisticated model informed by
a tremendous amount of data. It paints a grim picture if policymakers don’t implement
aggressive public health efforts similar to California’s
statewide lockdown.
In the U.S., the Centers for Disease Control and Prevention has provided simple and effective guidance for all to follow.
President Donald Trump is asking us all to help buy the country time to get ahead of the virus:
This afternoon, we’re announcing new guidelines for every American to follow over the next 15 days as we combat the virus. Each and every one of us has a critical role to play in stopping the spread and transmission of the virus.
For younger Americans who are less likely to develop a life-threatening disease, Trump had this to say:
It’s important for the young and healthy people to understand that while they may experience milder symptoms, they can easily spread this virus. And they will spread it indeed, putting countless others in harm’s way. We especially worry about our senior citizens.
Americans can defy the projections by taking responsible
actions to prevent the spread of COVID-19.
Source material can be found at this site.
