‘Rapid acceleration’: US in new virus phase
US hospitals are expecting 96 million coronavirus patients and 480,000 dead, even as President Donald Trump touts his "success" in containing the virus.
"We have to implement broad mitigation strategies," former US Food and Drug Commissioner Dr Scott Gottlieb told the CBS news service last night. "The next two weeks are really going to change the complexion in this country. We'll get through this, but it's going to be a hard period. We're looking at two months probably of difficulty."
Business Insider has obtained a copy of a February 26 presentation by the American Hospital Association (AHA). Its topic: what to expect with the looming outbreak. Its message: expect a pandemic that's ten times worse than a bad flu season.
The numbers are sobering.
#COVID19 - storm in US has begun. Rapid action needed to reduce impact, save lives. Immediately: restrict visits to nursing homes & make sure ill staff don't work - paid sick leave. Steps all of us, medically vulnerable, health care, & society can take at: https://t.co/KTk59K0Iax— Dr. Tom Frieden (@DrTomFrieden) March 8, 2020
Every sufferer will infect, on average, 2.5 other people.
The number of cases appearing is likely to double every 7-10 days.
Some 5 per cent of these will need hospitalisation. Up to 2 per cent will need intensive care.
In raw numbers, that translates to 96 million sick in the US.
Of those, 4.8 million will be hospitalised.
Some 1.9 million will need intensive care. Projections predict 480,000 deaths.
The data these numbers are based on is two weeks old. But any updates are likely to be a refinement rather than a significant change.
But there is one big question unanswered: Can the US healthcare system cope?
That depends on government response.
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Just as epidemics start from seemingly nowhere, they eventually fade away. The rate of new infections in between is known as the epidemic curve.
It's this curve that could cause health systems to collapse.
Now the @splette curve in motion by @SiouxsieW @XTOTL @TheSpinoffTV and the call to action. In the U.S., we're not doing nearly enough towards social distancing, still having big gatherings, not learning from the countries that have achieved flattening. pic.twitter.com/IyOiJZaQUc— Eric Topol (@EricTopol) March 8, 2020
If it's tall, there will be more patients than hospitals and clinics can handle.
If it's bulbous, the epidemic lasts longer - but with fewer sufferers at any one time.
And that's why the World Health Organisation's consistent message has been for the world's governments to do what they can to slow the spread of COVID-19 and use the time that buys to prepare.
And that may be just a matter of days.
Just two weeks ago, Italy reported only nine cases. Yesterday, it was 1247.
#publichealth actions for #COVID19 are not primarily meant to protect the individual, but to reduce the number of hospitalised cases, IC-admissions and deaths. + to reduce the burden on our healthcare systems and healthcare workers. @EANBoard #EPIET @ECDC_EU @CDCgov #WHO pic.twitter.com/ux4J3N0aGF— Alma Tostmann (@AlmaTostmann) March 8, 2020
"(The US is) entering that period right now of rapid acceleration. And the sooner we can implement tough mitigation steps in places we have outbreaks like Seattle, the lower the scope of the epidemic here," Dr Gottlieb said.
And lowering that epidemic curve will hurt, he adds.
I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math. 1/n— Liz Specht (@LizSpecht) March 7, 2020
"Close businesses, close large gatherings, close theatres, cancel events. We need to think about how do we provide assistance to the people of these cities who are going to be hit by hardship," he said.
"I think no state and no city wants to be the first to basically shut down their economy. But that's what's going to need to happen. States and cities are going to have to act in the interest of the national interest right now to prevent a broader epidemic."
DEVIL IN THE DETAILS
The AHA webinar projections were compiled by Dr James Lawler of the University of Nebraska. Its members - thousands of hospitals across the US - were being told how to prepare for the pandemic.
And warn them of what to expect.
"Some people get a mild, moderate disease and some people get very sick," Dr Gottlieb said. "But for the people who get very sick, this could be a very dangerous disease."
So, there is an emerging consensus among colleagues that the time for social distancing is now. There is no advantage to being a late adopter, you get all the downsides (e.g. disruption) with none of the upsides (e.g. mitigation of spread). 1/— Gregg Gonsalves (@gregggonsalves) March 7, 2020
Dr Lawler's assessment of the available statistics pointed a rapid increase in vulnerability to COVID-19 in ages above 40 years. Between 40 and 49, the risk is 0.4 per cent. A 1.3 per cent fatality rate has been identified among 50-59-year-olds. This rises to 14.8 per cent for those over 80.
Especially at risk are those with pre-existing conditions. Sufferers of cardiovascular disease are recording a 10.5 per cent fatality rate. People with diabetes are also vulnerable, at 7.3 per cent. Those suffering chronic respiratory disease, hypertension and cancer come in around 6 per cent.
People with no pre-existing conditions have a 0.9 per cent rate of death. Seasonal flu, in comparison, has 0.1 per cent.
Generally, the course of COVID-19 from infection to death appears to take between three and six weeks.
And all of the above is dependent upon receiving the appropriate medical care.
SOUNDING THE ALARM
Dr Lawler isn't the only one attempting to rouse his health system into action.
More and more epidemiologists and health experts are speaking up.
Many are not happy with what they see.
"Without an effective vaccine, I don't know how this ends before millions of infections," epidemiologist Nathan Grubaugh at the Yale School of Public Health epidemiologist told Vox.
"Once it was established this virus was spreading efficiently between people … we immediately should've realised that this was not going to be containable," Johns Hopkins Center for Health Security senior scholar Amesh Adalja said.
"At that point every country in the world should (have begun) pandemic preparation. This would include scaling up diagnostic testing, preparing hospitals, and crafting public health messages."
Priorities for #US #Health #Community Responding to #COVID19— Andrew Henreid (@AjHenreid) March 4, 2020
‣Review Plans of earlier #Epidemics
‣Prepare #Hospitals & #Clinics
‣#Diagnostic Testing Expanded
‣#PublicHealth Actions to Slow Spread of #Epidemic@JAMANetworkOpen | #Coronavirushttps://t.co/zphQ4V2ZSs pic.twitter.com/tkdcY9bZiX
In the US, at least, that appears not to have happened.
"There is no systematic plan for when a city should close schools, when they should tell businesses that they have to telework, when they should close movie theatres and cancel large gatherings," Dr Gottlieb said.
"We have a narrow window of opportunity to implement tough measures to try to push down the scope of the epidemic.
"What you want to do is you want to put in place mitigation steps to reduce the peak number of cases - you have to get them below the point at which the health care system gets exhausted. Because what happened in Wuhan, China, was the health care system got exhausted and fatalities rose quickly."
Jamie Seidel is a freelance writer | @JamieSeidel