Disclaimer: I’m not an epidemiologist. I’m a former pediatrician that now teaches Chemistry, AP Chemistry, and Anatomy & Physiology. I’m also hacked off, ticked, angry. Call it what you will.
It’s a unique time to have my feet in my new career but still have a brain that’s been trained medically. I keep wanting not to get P.O.’d by things I see online, but I’m amazed (still) at how uneducated my country (the USA) is at science. I tell my current students that even imperfect models are useful, if they help build understanding. There’s a blog that’s EVENTUALLY coming about how our impact is limited – and social media inflates our sense of impact. I’m fully aware of that – and in all likelihood, what I write here will probably have limited impact (if any at all).
Having said that, in an effort to use simple math and keep the model simple, I will do my best to explain why we’re still in danger – and what I would like to see our local leaders do.
In full disclosure – about 2 weeks ago, I was on the record (talking to a student) stating that coronavirus would be like having a very, very, very, very, VERY bad second influenza season (not in terms of symptoms, but in terms of numbers and deaths). Per the CDC (https://www.cdc.gov/flu/about/burden/index.html), our worst influenza season in the last decade was 2017-2018, with 45 million illnesses, 21 million medical visits, 810 K hospitalizations, and 61 K deaths (directly attributable to influenza). I’m afraid I might have been underestimating things at that time. (This is a case fatality rate of 0.14 %)
There are plenty of great resources that review viral diseases and this one in particular – you don’t need me to go over viruses in a Microbiology 101 course. This is a great link: https://www.cdc.gov/coronavirus/2019-ncov/faq.html
As of March 19, 2020 at 5:30 PM Central Time, here are the numbers I can quote for the United States (and depending on your source, which states report what and what time, numbers vary a little bit. Don’t lose the forest for the trees!) At this time yesterday, all these sources were reporting around 7,000 to 8,000 people with coronavirus. Numbers increasing like that should get your attention.
Source – Cases – Deaths Case Fatality Rate (CFR – deaths per # of cases)
CDC – 10,442 – 150 – 1.44%
NY Times – 10,822 – 172 – 1.59%
CNN – 11,639 – 170 – 1.46%
Two things. I want to 1) use Italy as my main frame of reference (as much as I’d like to use China, I can’t. We won’t build a hospital in 10 days like they did. Here’s a video to watch: https://www.youtube.com/watch?v=3Sh7hghljuQ We aren’t a totalitarian dictatorship, which is great. But as far as stopping this virus in its tracks, the measures that we’re doing NOW should have been done 2 weeks ago. I’m not arguing civil liberties – that would be preposterous. But in terms of fighting a disease, we’re woefully behind – and it’s preposterous to argue that point). 2) I want to focus on the CFR.
To contradict myself – but to show how CFR vary (and because China had to get a handle on things at first) – China had roughly 80,900 coronavirus cases and 3,200 deaths (https://www.washingtonpost.com/world/2020/03/18/coronavirus-latest-news/) giving a CFR of 3.96%.
Italy has a population of a little over 60 million people. As of writing this, Italy had 41,035 cases and 3,405 deaths. (https://www.npr.org/2020/03/19/817974987/every-single-individual-must-stay-home-italy-s-coronavirus-deaths-pass-china-s) This gives a case fatality rate of 8.30%. That’s not great. Per reports, Italy has a great healthcare system – they are just slammed; overwhelmed. No place to put all the people. They tried to slowly shut their society down – and it didn’t work. They tried to tell people to voluntarily restrict movement. Then restrict nonessential travel. Then don’t go to cafes. Only when things got BAD did they shut it all down.
Last weekend in St. Louis, you could still go to a bar. People in the county just down the street can still grab a beer at a watering hole until midnight tonight. Our governor feels as though things are best left to a local decision – and you get widely different decisions getting made. Last time I checked, it was easy to live in one county and work in another. This seems to be bafflingly short-sighted (and that’s being kind).
I won’t talk about spring breakers and Florida. Ahhh, Florida. When we need something dumb being done, we can count on you being open for business. You never disappoint. Yes, it’s mostly out-of-towners doing the stupid right now. The fact that you are OPEN is completely on you.
As of late last week, people still wanted to go to Disneyland. Really?
Friends, we are a nation of a little over 330 million people. That is 5.5 times larger than Italy. Until recently, we’ve done the same, “C’mon public, make good decisions!”
I still see people mad on social media when a school shuts down for the remainder of the year. “Kids need school.” Yes, yes, they do. I’m a teacher – I’m acutely aware. I’ll address this in a bit. Let’s deal with the public health issue.
The kicker is trying to figure out how many people will get coronavirus. Yes, I’m aware that some people will get the virus and never get tested. This means that if you get sick and never get tested, our reported numbers OVERESTIMATE the CFR.
However, it takes 10 people getting the virus that get sick and don’t show up in “the system” to bring the CFR down by a factor of 10. So, in other words, let’s use the CDC numbers from my table. In order to drop the CFR from 1.44% to 0.144%, you need 104,420 cases with 150 deaths. We currently have 10,442 cases with 150 deaths. That means you need 93,978 people that are sick RIGHT NOW with coronavirus that haven’t been tested. I’m sorry, I’m just not buying that. I’m sure there are people that have coronavirus that we’re missing. But if you think we’re missing 9 times the people that we’re catching, then watch me slam dunk a basketball over James Harden (bad example, he doesn’t play defense….) I picked that 0.144% on purpose, because that’s the CFR for the 2017-2018 influenza by the CDC numbers.
This is a long way of saying this: because we haven’t taken measures like we should have, this is going to get worse, in terms of total cases and deaths, before it’s over. There’s a great article on the New York Times that gives estimates on how many people we can expect to be exposed and potentially die if we don’t take appropriate mitigation measures.
The longer we wait to shut EVERYTHING down, the closer to these numbers we’ll get. Whether it’s the low end (and hopefully we don’t even hit those, if we have acted decisively enough) or the high end (God forbid, I don’t want to imagine 1.7 million people dying – that’s more than some small states in the Union), is to be determined.
Put this more simply.
Let me run with the low end of the “dire” projections. I’ll go lower. 30% get the virus, 1% die. Keep the numbers simple so the math is easy.
330 million Americans.
330 million x 0.3 = 99 million. That’s how many get the virus. 5% need extensive medical care (roughly), like hospitalization and ICU care.
99 million x 0.01 = 990,000 thousand people die.
Let me make this personal.
I currently have 335 Facebook “Friends”.
335 x 0.3 = 100.5 (About 100 to 101 of my friends will get sick from this; by the way about 5% of people currently need hospitalization….) Sorry, can’t visit.
100.5 x 0.01 = 1.005 (all you need to know is this → that number is bigger than 1). Mathematically speaking, I should expect one of my friends to die.
One person on my friend list – gone, from us not paying heed to a public health measure.
I didn’t even address “flattening the curve” so we don’t run out of hospital beds.
I didn’t address the fact that if these numbers hit, we’ll run out of ICU beds, ventilators, and things needed to keep people alive.
I didn’t address the fact that people will get sick WITH OTHER THINGS while this is going on, so we’ll run out of resources. Mortality – death – from other treatable illnesses will rise in this time.
Where do I fall in this debate? It’s easy for me. Shut everything down. Two weeks ago.
We should have done it when Italy did. We saw the train coming, and we waited.
There will likely be another pandemic in our lifetime. The world is connected now. What I hope is that when another comes – one with a similar or worse CFR – is that leaders REMEMBER this and act early and decisively.
It’s impossible to have a plan for everything. It is possible to have courage to act and do what’s right, even when it’s unpopular. Quite frankly, the complaints of, “it’s too early to close things” is utterly false, selfish, and wrong. Yes, this will be hard. It is hard already. It just has to happen.
Let me address the education portion of this now.
Yes, kids need school. Someone much smarter than I am (Mauri Friestleben in Minnesota) had astutely pointed out on Facebook how much society relies on schools for things other than education. We’ve now been exposed by this. In a time of crisis, we’ve poured extra responsibility on to schools – and now what do we do? Let alone educate children – district by district, there are technology disparities that limit (or make it difficult) to have any equity in learning. If you have limited income – how do you feed your children? If you work – face it, from 7 AM until late afternoon, the schools have your children. If your children need safety – the school is usually safe. Even if they aren’t – the teachers and the counselors look out for them. (I can’t tell you how many times on a weekly basis I’m a therapist, a counselor, just talking to students. My lunch half-hour has several students in my room as a de facto “safe space” for students.)
Let’s talk about technology and supplies. The fact that my classroom has much of anything comes from 1) my fundraising and grants 2) my generous private donors and 3) my wallet. So, over my “spring break”, I’m researching video conference platforms, video editing, how to make video lectures with slides, and working on packets to post online. And I know not all my students can get them. But I HAVE to have them because a) many of my students will take college level classes with me next year; even if grading stops, they need the challenge b) My AP Chemistry students still will likely have the AP test to take – there’s no indication that exam is off and c) we still have two months to go – education has to mean SOMETHING.
It would be nice if my students had those devices. It would be nice if I didn’t have to figure out a plan B all on my own. Gee, if more public school districts had the funding, maybe we wouldn’t be in this spot. It’s like if we, as a society, took better care of everyone – and FUNDED essential services – we wouldn’t be fighting with one arm tied behind our backs right now. There might be other avenues for tracking and feeding at risk kids. Sure, it would still be hard. But, we put all our eggs in one basket – the school, and now look where we are? It’s a lot easier to adapt when you have a base of something semi-funded to start from.
It’s simple, folks. Digital learning can be meaningful, and I’m going to work my tail off to make it meaningful for my students (I’m uploading videos, cutting lectures on Google Slides with Screencastify, working demonstrations, uploading pdfs, you name it.) But it helps A LOT if more students have access to the same materials.
It helps if more agencies can get students food if they need it.
It helps us all if we have a healthcare system that can identify and test people for infectious diseases when they are actively sick.
It helps everyone if they can seek medical care and not have it ruin their life savings in the process.
It’s great to see on social media that people are willing to work and band together in a crisis. Why then, do we forget to PLAN for these times, so we don’t MAKE people vulnerable. We can do better and help more people, more often. We lack the will to plan for it and then to stick to it. It’s not all on the leaders – we have plenty of bad ones and they don’t help. It’s us, too.
If I sound angry, I am. Here’s what we need to do in the short term.
Shut it down. All of it. The academic years should be over – at least gathering in school. We do the absolute best we can for the next two months, and I for one will work like mad to make it meaningful.
People – don’t go out unless it’s essential. Food. Doctor’s appointments. Go for a walk by yourself. No play dates. No meet-ups at bars. No weddings. No birthday parties; no birthday weekends. If I lose my vacation in July, so be it.
We come back to school in the late summer. We lick our wounds. Then, as the public, we hold ourselves and our leaders accountable. To each other, because we need it and deserve it. And we start to plan and think about what our towns, our cities, our schools need to look like to be successful. If you don’t like how your town looks in this crisis (“my kid doesn’t have a device”, “we don’t have after school programs”), then look at what you prioritize. You might need to change what you look for in a leader. You might need to change how you vote. It’s probably more important to make local changes first.
If you don’t like being tied up in a crisis – then we can do something about it. But we all will have to change. Otherwise, this pain will happen again – and we’ll have proven that we didn’t learn a damn thing.