Dissident Veteran For Peace

Don't be deceived, COVID-19 is more lethal and more infectious than the normal annual influenza outbreaks. As one example, in roughly three weeks COVID-19 has already killed almost as many people in the Seattle area (King, Snohomish, and Pierce counties) alone as have died so far from the flu (lab-confirmed cases) in the entire State of Washington during the 2019-2020 flu season and COVID-19 shows no sign of slowing down yet. In part, this is because almost no one has any natural or vaccine-induced immunity to COVID-19 as it is "novel" and there is no vaccine for it.

Everywhere that COVID-19 has infected large numbers of people it has quickly overwhelmed the local health care system. That means the death toll from COVID-19 is added on to the existing, more routine causes of death from heart disease, cancer, influenza, accidents, etc. and the rapid influx of those sick from this new disease impairs the health care system's capacity to manage more typical cases of disease and trauma.

If unchecked by effective public health measures or natural immunity COVID-19 has exponential growth rates of infection and death (see also here and here and here) although the death curve is much flatter because the disease does not kill at nearly the same rate as it infects or sickens people. As of today, the global COVID-19 fatality rate (deaths divided by aggregate confirmed infections) is about 4.1%.

We know that the actual fatality rate is probably significantly lower than 4.1% because not everyone who has been infected has been tested. In South Korea, where there are high rates of testing and a very successful public health response, the fatality rate is about 1.2%. By contrast, the US 2018-2019 influenza fatality rate was about 0.1%. (There are a lot of factors, such as quality of the health care system, mean population age, smoking rates, etc., that influence fatality rates.)

Below, from the University of Washingon Novel Coronavirus (COVID-19) Infection Map, are two images (click to enlarge) showing the exponential growth of COVID-19 infections and deaths in the US and Italy.



The graphic below demonstrates that exponential growth of infection and death from COVID-19 can be arrested. South Korea had its first confirmed COVID-19 death on February 21 and in about three weeks it had stopped the initial exponential growth of infections. The number of COVID-19 deaths there is currently 102. China, too, after early missteps has reportedly stopped local transmission of COVID-19 altogether.



We did have earlier warnings to alert us to the potential of a dangerous viral pandemic. In addition to the Spanish Flu (1918; 25,000,000 - 100,000,000 deaths), there was the Asian flu (1957; 1,000,000 - 2,000,000 deaths), Hong Kong flu (1968; 1,000,000 - 4,000,000 deaths), SARS-CoV (2002; 774 deaths), H1N1 flu (2009; 151,000 - 575,000 deaths), and MERS-CoV (2012; 862 - 912 deaths). MERS is notable because it has a high fatality rate (~37%) and continues to infect and kill people every year. With few exceptions, the media, public health community, and politicians of all political stripes failed to alert Americans to the very real dangers of a viral pandemic and the country is, thus, woefully unprepared.

Unfortunately, I am afraid the progression of the COVID-19 in the US will likely resemble Italy's trajectory more closely than South Korea's or China's. I hope I will be proven mistaken in this.

American individualism is, in many ways, pathological and more communal attitudes and behavior are not necessarily antithetical to freedom or a healthy individualism. Whatever their downside, a more community-oriented culture was one factor that evidently contributed to the successful Chinese and South Korean responses to COVID-19.

If competently led, adequately staffed, and sufficiently provisioned, I think America's decentralized health care system could have responded in a coordinated and effective manner. This was not the case, however, and one result has been the very slow roll out of widespread COVID-19 testing that would have enabled the early isolation of infected people. The US also has a warped, hollowed out industrial base that has left it dependent on the importation of key health care supplies—masks, drugs, reagents, gloves, ventilators, etc.—that were seemingly not stockpiled and/or aren't being distributed in sufficient quantities.

Chinese health officials were able to successfully confine the COVID-19 outbreak to primarily one region of the country and then bring the resources of the rest of the country to bear in order to tamp down the disease. Unfortunately, for reasons described above, the US has failed to keep the outbreak of disease concentrated in one or two regions.

The result is that the COVID-19 is now, apparently, spreading exponentially in every US state. The first US death from COVID-19 was on February 29, 2020. Since that time Washington has had 82 more deaths, New York 43, California 24, Louisiana and Georgia 14 each, New Jersey 11, and Florida 10. COVID-19 deaths have been reported in several other states, too. The wide geographic dispersion of infections in the US will likely make it immensely difficult to bring COVID-19 under control quickly. Again, I hope I am proven wrong in this.

By the end of next week we may start to see how effective efforts to flatten the curve have been in Washington state. However, even if they have been effective the state has already fallen far short in comparison to South Korea. Consider the table below based on the 2018 populations.


So what is to be done? For those on the medical front lines of the struggle and those directly supporting them the path is pretty clear. The rest of us need to support those folks and each other. Don't panic, don't hoard. Don't worry about getting sick but do take scientifically supported steps to help prevent it.

For those who are able to do so, physical distancing and staying home as much as possible is probably the most critical task now. If you're not concerned about your own well-being then think about the others you might expose if you do get sick or the health resources you might take up that could have been used by someone who had a heart attack or a child hit by a car.

See also: "A Few Thoughts on COVID-19 - Part II"

Labels: COVID-19, government, health, medicine, politics, science, statistics