The story of the man at the U. C. Davis Medical Center who was confirmed to be carrying the SARS-CoV-2 virus on Wednesday is sadly familiar. He had already been hospitalized for some days and was on a respirator before doctors at U.C. Davis asked the CDC about testing their patient for COVID-19. The CDC turned them down—ostensibly because the patient didn’t meet the CDC’s guidelines for potential coronavirus cases, but more practically because the CDC has so few test kits at this point that they’re using them in only in the most likely situations. It took another four days of the patient’s declining health before the CDC finally agreed to a test, and three days after that before results came back.
These misfires and delays, which mean not only that agencies are not out there looking for potential sources and tracking down connections, but also that health care workers are unnecessarily exposed, are a repeat of stories from Italy, South Korea, and Taiwan. Again and again, health care systems have failed to get out in front of this issue because they always think it’s under control … until it isn’t.
Wednesday marked a milestone in the course of the COVID-19 pandemic—and despite the reluctance to use that term, that’s exactly what this is: a pandemic. China, Italy, and Iran have all shared the virus with at least half a dozen countries each. That’s what a pandemic is: an epidemic with multiple epicenters across multiple nations. We are there.
In the last 48 hours, COVID-19 has ceased to be what many were calling “a China thing.” Yes, of the 82,588 cases now counted, 78,500 are in China. But in the last two days, the number of new cases outside of China has exceeded those inside China’s borders. In fact, overnight South Korea alone reported more new cases than did all of China.
But South Korea is not alone. The number of cases continues to grow in Italy, where the total has topped 500 and earlier hopes that cases had been contained within “red zones” have proven to be unfounded. And Iran has admitted to another hundred cases—while piling up more deaths than anywhere outside of China. That underreported mass of virus in Iran is also dragging along infections across the whole Middle East: Bahrain, Kuwait, and Iraq are all seeing a run of new cases that are coming in so fast that if there were a COVID-19 Geiger counter, it would be buzzing like a hive of bees.
So no matter how nice the following chart may look in showing a declining number of active cases, it’s also deceptive.
That chart is deceptive because the total number of cases in China represents a huge pool from which “recoveries” can be drawn. Those recoveries are swamping the new cases outside of China, making the overall world count of active cases go down even as new cases are coming in from all directions.
One thing that varies wildly around the world at the moment is the number of tests that have been conducted. Shortages of tests—and clearly inadequate testing criteria—have resulted in only 445 people being tested in the United States, with almost all of those being passengers from the Diamond Princess cruise ship, those who came back from Hubei on earlier flights arranged by the State Department, and those directly associated with known cases. In comparison, the United Kingdom has conducted over 7,100 tests to clear citizens and tourists who came in from areas where the virus was known to be active, and to check an extended set of contacts around each known case.
Italy has conducted over 9,000 tests, and in fact the Italian government announced on Wednesday that it is going to be tightening the rules for conducting tests because it’s concerned that—and this is painful—the high number of cases that Italy is showing compared to other nations in Europe is the result of it conducting too many tests. In other words, even at this point, some members of the Italian government appear to be more concerned with looking bad than with actually identifying cases. Why would that be? Here’s Italian Italian Minister of Cultural Heritage and Activities Dario Franceschini to explain it (as translated by Google Translate and Daily Kos): “The sector most directly impacted by the coronavirus crisis is tourism. We are considering immediate measures, and together we will revive the image of Italy, a revival that I am sure will be rapid." No one ever said that the United States had a monopoly on stupid government decisions.
One thing that Italy is doing that is definitely worth modeling: A program is being established that will protect people in affected regions from having their insurance cancelled, their utilities cut off, or their mortgages threatened during the epidemic. Someone write that one down.
Another harbinger of things to come is fresh out of Japan, where all the schools are closed. All of them. Japan takes its six-days-a-week schools Very Damn Seriously. That it has now closed all public schools until after the spring break is a sign of just how much emphasis the government there is placing on trying to contain the spread of the virus. Schools join a long list of public gatherings and private events that have been cancelled as Japan crosses its national fingers and hopes that the coronavirus is under control in time for the summer Olympics (even though, sadly, many are beginning to concede that this is unlikely).
As with yesterday’s graph of this type, I’ve had to leave off an ever-longer tail of nations where there are one or two cases. At this point, the nations not on the chart are as scary as those that are, because not being on the chart is probably a pretty good indicator of not having a national health care system out there doing active testing. You can bet that right now, in Kyiv or Nairobi or Christchurch, there is a patient sweating with COVID-19 in an examination room while a doctor scribbles “seasonal flu” on a chart. And when health care professionals are already dealing with millions of cases of seasonal flu … how can you really expect anything else?
As before, Iran remains the great unknown—not in the sense that there are thousands of cases there—that much is obvious. But to what extent Iran is now the actual epicenter driving cases around the planet isn’t clear.
Finally, it’s impossible to get out of here without mentioning … the Pence conference. That is, the conference at which Donald Trump mumbled his way with perfect incoherence through downplaying the threat represented by coronavirus, ignoring the fact that he already knew there was at least one case of community spread within the United States, and tossed this hot potato to the most expendable member of his White House … Mother’s husband.
There is a reason why stock market futures flipped from positive to negative during that speech. This wasn’t a moment that required all that much from Trump. He could have shoved CDC officials to the microphone, assured the nation that the top professionals were on the case, and vanished behind the curtain. Instead, Trump repeatedly undercounted the known cases, fumbled every discussion of events around the world, and, in handing it over to Pence, gave the clearest sign possible that he believes this bomb is going to explode.
Wall Street may not be able to tell the future, but it could certainly smell the bullshit wafting from the White House briefing room.
Resources on novel coronavirus
World Health Organization 2019 Coronavirus information site.
World Health Organization 2019 Coronavirus Dashboard.
2019-nCoV Global Cases from Johns Hopkins.
BNO News 2019 Novel Coronavirus tracking site.
Worldometer / Wuhan Coronavirus Outbreak.
CDC Coronavirus-2019 (COVID-19) information site.
Information on preparing yourself and your family
Some tips on preparing from Daily Kos.
NPR’s guide to preparing your home.
Ready.gov (which was actually down as I entered this … so, that’s nice.)