The two reports that seem to be driving the current policy toward 2019 novel coronavirus in the United States paint a bleak picture. They don’t just describe a spiral toward an overloaded health care system and a breakdown of transportation and supply. The report from Health and Human Services includes this little gem: “as federal response to COVID-19 evolves beyond a public health and medical response, additional federal departments and agencies will be required to respond to the outbreak and secondary impacts ...” Following, as it does, a paragraph indicated there will be “significant shortages” to consumers, it’s easy to read that sentence as, “The government has to be ready to use force to maintain control.”
But there may be an alternative. It’s one that demands an extraordinary effort, but has the advantage of possibly working: conduct a “virus census.” That means test everyone.
As of a day ago, the United States had tested just 25,000 people. Some other reports may list numbers around 50,000 tests, because that sounds better, but most people require two or more tests for confirmation. In comparison, South Korea has conducted over 270,000 tests and even beleaguered Italy has done 130,000.
The U.S. failure on testing—from the slow start, to the test kit foulups, to claims about a “million kits” that always seem right around the corner—has been at the center of why cases across the nation are now exploding unchecked, with multiple states now reporting more cases in a single day than the entire nation did just a few days ago. And even as the wealthy and celebrities and f#cking Matt Gaetz rate a test right away, people who have the most horrific and clear exposure can’t get a test. So moving from that to testing at a rate several times that of South Korea’s peak of 20,000 tests in a day may seem like something of a stretch.
On the other hand, the option apparently offered by the current government plan is patently unworkable. Not only do the HHS and Imperial College plans call for an extreme lockdown of ordinary activities lasting at least 18 months, they seem to assume that people and institutions at all levels will somehow dust themselves off at the other end of this experience and just … move on. That’s an absolutely miserable assumption. If the United States survives the kind of experience being described in the HHS report, it will be as fundamentally different two years from now in ways that we can’t pretend to forecast. And the idea that people can provide financial advice on how to deal with 401(k)s, or predict the job market in six months, is utterly laughable.
Worse still, the predictions indicate that all of the effort extended, all of the combination of mitigation and suppression listed in these plans, “might reduce peak healthcare demand by 2/3 and deaths by half.” It’s one thing to have some knucklehead on a blog suggest that the projections call for hundreds of thousands to millions of deaths. It’s another thing to have the HHS paint this as the best possible outcome, even if extreme sacrifices are made.
On the old stages of grief scale, the HHS plan falls somewhere between denial and bargaining, with a dash of anger on the side. While it may be a plan where 98% of Americans survive, America cannot survive this plan … not in any real sense. There has to be an alternative to hunkering down and waiting for things to fall to ruin.
Here it is: a Viral Census. Conduct widespread screenings for fever. Collect basic contact information on every case, even when there are 10,000 or 100,000 cases. Do drive-through testing, send mobile testing facilities to communities, send out nasal swab kits by the millions. Over 25 million people have spit in a tube for 23andme. We can get 100 million to stick a swab up their nose to save America. Turn every business that can manufacture kits into a kit manufacturer. Turn every lab that can test kits into a test regulator. Set a goal of 1 million tests processed a day. Then make it 10 million.
Text everyone their results as soon as they are in, and immediately instruct everyone who tests positive to self-isolate and report contacts. Keep a database of those self-isolated to make sure they have shelter, supplies, and access to medical care if they become one of those whose symptoms become critical.
Through testing and retesting of all 3,300 inhabitants of the town of Vò, near Venice, regardless of whether they were exhibiting symptoms, and rigorous quarantining of their contacts once infection was confirmed, health authorities have been able to completely stop the spread of the illness there.
Just because we screwed up testing to this point does not mean that testing is not the answer. In fact, there is no answer other than testing. Without measurement, we cannot hope for improvement.
Yes, it’s early in the day to be posting the U.S. results, since there are many hours ahead. However, enough data is in to see that this is absolutely not the day when things begin to look better. In fact, even the modest level of testing being done is pushing up the curve in the United States at a rate that may be higher than the actual transmission rate of novel coronavirus. In other words, we’re not just finding new cases, but uncovering the pool of cases that has existed for days or weeks.
In fact, you can add 200 more cases to the United States graph above; those came in the time between when the graph was posted, and the time it took me to write this paragraph. At present, the U.S. stands at 8,215 cases and 133 deaths. The doubling rate for both those numbers is less than three days. Nowhere has been hit harder than New York, where the case count is closing on 2,500. The health care system there will be under significant stress … now. And likely to need 25% more ICU beds than it has by the weekend.
On that topic, The New York Times took a quite detailed look at the need for hospital beds across the nation in different scenarios. There is no scenario that doesn’t require at least a doubling of beds in some regions. But a sharper curve includes many, many areas that would need at least 10 times as many beds … and presumably 10 times the doctors, nurses, etc. to staff them. This makes a huge difference in the outcomes. The reason Germany is still showing a case fatality rate of less than 1% and Italy is showing a rate of 8% is all about the available facilities. The more the system is overwhelmed, the closer the overall case fatality rate approaches the percentage of people needing critical care—which is between 15% and 20%. Italy has about half of what it needs right now, so … 8%.
After the initial epicenter in China, the next round of outbreaks came in South Korea, Iran, and Italy. Those secondary sites were the primary feeders for a third round of epicenters in the U.S. and Europe. In that third group, the easy movement between Italy and other European nations—and better testing regimes—served as the basis of Trump’s ban on travel to Europe a week ago. However, as tests are finally rolling out across the United States and the scope of the cases becomes clear, the U.S. appears set to overtake France, and perhaps Germany, in the next couple of days (and no, having a bigger population here doesn’t give the U.S. an edge; so long as the virus is unconstrained, it’s just the transmission rate that defines the curve).
On the Italy front: I’d like to give good news, but I don’t have any. After four days in which the count of new cases hovered between 3,000 and 3,500, giving the impression that Italy might be about to bend the curve downward, on Tuesday it reported 4,200 new cases and 475 more deaths. Despite all the actions taken to suppress the coronavirus … that sucks.
But here is some genuine good news—and if you read all the way down here, you definitely deserve it. Over the last weeks, there have been a thousand rumors about different drugs or combinations of drugs that might affect the outcome of severe case of COVID-19. Whether it was advice on painkillers, high blood pressure meds, or some novel combo of over-the -counter meds, none of it seems to be backed up by real data. However, this appears to be the real thing. Medical authorities in China are reporting that favipiravir, a Japanese antiviral originally developed to be used against the flu, had improved recovery outcomes, reduced lung damage, and even a complete reversal in some cases. The Guardian reports that in a test involving 340 patients, those given the medicine appeared to clear the virus from their system seven days faster than those who did not get it, and have improved outcomes all around. The drug was approved just last month as an experimental treatment for COVID-19, and seems to be exactly the sort of therapeutic treatment that many have been hoping to find in advance of a vaccine becoming available. One note of caution: it needs to be applied early, as those patients in severe condition seemed to get little benefit.
Believe me, I’ll be looking for more stories like this. In the meantime … the government should test everyone. And remember: Wash your hands, minimize social contact, grab an extra canned item or two so you can maybe skip a grocery run in the future, don’t panic, and keep planning.
Personal note: In the original posts I made on this topic back in January, I referred to 2019 novel coronavirus as “Wuhan virus.” That was a terminology in wide media use at that time, but I certainly apologize for anything my posts may have done to forward this term or promote that idea that any city, nation, or region is “to blame” for the emergence of a new disease.
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 / COVID-19 Coronavirus Outbreak.
CDC Coronavirus-2019 (COVID-19) information site.
European Centre for Disease Prevention and Control.
Information on preparing yourself and your family:
Some tips on preparing from Daily Kos.
NPR’s guide to preparing your home.
Ready.gov