Corona Lockdown

The "novel corona virus" (a.k.a. COVID-19 or SARS-CoV-2) has sent most of the world home to "shelter in place" for a month. So here we sit in eerie isolation, trying to figure out how to make sense of a world teetering between a medical catastophe and financial ruin. The following is my understanding of the medical reality.

What is COVID-19 ?

• two that cause the symptoms that we call "the common cold", i.e. a runny nose, sneezing and a mild fever
• two that cause the deadly diseases called SARS (Sudden Arrest Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).

SARS and MERS caused deep anxiety when they showed up a few years ago. Most of the patients infected developed a rapid-onset pneumonia and would die unless they could be supported in an intensive care unit until the pneumonia subsided. In the end, they went away fairly soon, because they killed their victims before the could spread the disease very far.

COVID-19 is much worse, because

• 80 percent of the infected have only mild symptoms similar to common cold or influenza. Thus, they can go around and infect others for a couple of weeks.
• 20 percent have symptoms bad enough that they may require hospitalization.
• Of these 20%, three quarters (15% of the total) will be very weak, but can survive with ordinary supportive care.
• The last 5% will require the heroic measures of an intensive care unit; most of them must be put in a medically induced coma, and intubated, so that they can be sustained on a ventilator (respirator).

It takes about a week for symptoms to become evident, but the patient is infectious well before that. Once the symptoms appear, they will gradually get worse, and after about a week, they will either get better or rapidly advance to respiratory arrest.

The "natural" course of a COVID epidemic

If allowed to spread without serious intervention, each i tected person can infect two more every day, so a single case turns into a thousand in 10 days, a million in 3 weeks and a billion in a month.

While only half of the population may get infected, that will still put about 2 to 3 percent in the ICU; but there are not that many ICU beds, so after the second week, those patients will all die.

• 2-3 percent of Denmark is 100,000 people.
• 2-3 percent of the USA is 6 to 8 million people.

The only good part is that it will be over pretty soon: It will sweep through even the largest countries in a month, and two weeks after that, there are no more people to infect, so as the sick ones either die or heal over a couple of weeks, it will be over.

Flattening the curve

The "social distancing" protocols that have now been pretty uniformly adopted, aim to slow down the infection rate, so that it takes three or four days for the number of cases to double. That means that it takes a month to get from 1000 cases to a million cases, and by then, many of the early cases have healed, their hospital beds are freeing up, and an increasing percentage of the people they come in contact with have already healed and have immunity.

Under these circumstances, it may take 3 to 6 months for the infection to pass through the population, but there may be ICU beds and ventilators for most of the severely ill patients, at least in the wealthier countries, so the death toll will be much lower. Just how much lower depends on many factors that we do not yet know, but for the USA, it is projected to be between 100,000 and 250,000 - compared to 3 to 6 million without these precautions.

Some other options that we missed out on

If we had plenntiful and reliable tests before the first infections, we could have done what South Korea and Iceland did:

• Screen everyone coming into the country from areas with the disease.
• Divert everyone with the infection to a quarantine area, and release them only ofter the two-week incubation period expired, further directing everyone with symptoms to isolation hospitals.

If followed diligenty, these measures might maintain a situation where the virus is not circulating in the community.

Once the virus is circulating in the community, this option no longer exists.

What went wrong in the USA ?

So many things went wrong in the U.S.:

• The Federal government had dismantled the planning functions that had previously maintained planning functions for what to do if a pandemic were to appear, verify that needed supplies and equipment were on hand and how to procure them fast if more were needed.
• The warehouses full of supplies (face masks, disposable gowns, ventilators, portable hospital units, etc) had stopped being maintained. Some supplies had been dispersed, building leases discontinued etc. Equipment such as ventilators had not been maintained (batteries replaced, periodic functional checks etc).
• The political top tiers of many government agencies were populated by people that did not believe that government was useful, and who fundamentally wanted to dismantle the agencies they were leading.

We shall see if the next election cycle will flush out this dysfunctional leadership.

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