My colleague Bill Washinski compiled some data on the COVID-19 crisis and shared his thoughts. Enjoy!
—Charles
It’s hard to find anyone who does not have a take on COVID-19. The impact is unprecedented. I never imagined living in a world that has seen countries implement nationwide quarantines. Its impact on the world has been nothing to take lightly from the enormous economic impact and the danger of overloaded hospital systems. There is still a lot of fear and uncertainty surrounding COVID-19, with the two that seem most prevalent being how long the crisis will last and why the heck does it cause people to hoard toilet paper?
Okay, the second obviously is not as prevalent, though its more mysterious. One has a better chance to prove Fermat’s Last Theorem, but the good news is that there is more to data to make informed speculations about how long the crisis will last.
How far away are we from COVID-19 crisis ending?
The U.S. exceeded China in the number of cases on March 26 – reaching 83,836. In monitoring the trajectory of testing in the U.S. over the last week; we’ve seen the enormous upticks in both cases (945%) and deaths (925%). The U.S. testing response has been a little slow, as just a week ago the confirmed cases was less than 8,000 (118 deaths) which does give perspective to those percentage increases. We simply do not know what the actual number of infected persons there were s prior to the increased level of testing.
As the U.S. has now surpassed 1,200 deaths, it’s hard to get a real estimate on where this is going and whether we begin to look like Italy, particularly in New York.
Surgeon Dr. Marty Makary from Johns Hopkins University has stated “The virus is following the playbook, this is playing out exactly as predicted in all the models and projections” and speculates that “we are probably still about 3 to 4 weeks away from its peak.”
COVID-19 – Endgame
The initial death rate estimates on COVID-19 by the World Health Organization was 3-4% though that number is now disputed. The UK has already declassified COVID-19 as a high consequence infectious disease as the death rate was significantly lower than expected.
Different countries have handled it better than others. China took draconian measures to Flatten the Curve, South Korea had a system in place to respond quickly due to its experience with the MERS outbreak in 2015, and Italy had numerous factors that have placed it at higher risk.
WHO Expected Death Rate too High?
That 3-4% number comes from a case fatality rate which has a numerator and denominator. The numerator represents the number of people who have died from COVID-19, which is very easy to see and measure. The denominator should be the number of people who have been exposed to and got the virus. The problem is that the test being used is a test of RNA content to see if you have the virus actively in you. However, what if you had COVID-19 and recovered? At that point the virus is gone, and you have the antibodies to it and are likely immune.
A far more useful number is a denominator for both those populations (those who actively have the virus and those that have the virus and are cleared of it.) The central piece of scientific information is the zero prevalence (the proportion of the population that has antibodies to the virus). With that information we could know the true death rate and how extensively it has spread. Another missing number in the denominator represents people who are symptom free and have the virus, so there is no factual way to know if the disease is as deadly as initially forecasted. The problem is that not knowing this data leads to uncertainty as there is no obvious best course of action to take.
Antibody Testing – The Solution?
We need to expand our capacity on antibody tests very rapidly and the scientists that want to measure the problem do it and find funding to pay for it. The FDA itself was a hurdle and only recently approved the first antibody test for use in the United States. If antibody testing can prove successful and you are immune with no risk of spreading it, then we can systematically get people back to work and end the lockdown faster.
Lockdown – The Solution?
With the absence of data to determine what the actual rates are and lacking a miracle cure, the only apparent way to halt the pandemic was to starve it. The goal referred to as “Flattening the Curve” referred to avoiding a sharp increase in cases in favor of a lengthier outbreak that stays within the bounds of what the healthcare system can handle.
The decisions going forward are critical. Often characterizing the lockdown and resulting $2 trillion in stimulus as a choice of dollars vs. deaths, it’s important to take into consideration that economic depression leads to people dying too. It’s impossible to determine how well the lockdown has been successful in preventing excess cases and deaths – which is an example of the uncertainty in practice.
There aren’t obvious answers, or at least not yet. But opinion makers — even in traditionally left-leaning publications like the New York Times, are at least starting to ask the right questions.