Quick primer on why we’re in this mess, and how free “Test and Trace” can help us get out of it
Many people are already doing incredible work analyzing the inception and spread of COVID-19, the danger it poses to individuals and our healthcare system, and what scientists and the government should be doing to get us out of it. I’ve linked which resources I’ve found most helpful at the bottom of this post and wrote up a long synopsis of what I’ve been reading.
In this post, I have summarized my key takeaways to serve as a quick primer, as well as a recommendation that we rapidly embrace “Test and Trace” as a policy: test everyone, isolate all infected people, repeat this with everyone they’ve been in contact with, and let everyone else leave their house.
I’m hoping your takeaways by the end of reading this will be:
Holy shit I’m personally more at risk than I thought even if I’m young, and regardless of how at risk I believe I am personally, most of the world would get it and a lot of people will die if we don’t all stay home now
Phew, there’s hope that I won’t have to stay at home for too long! America better ramp up testing quickly
I want to, as soon as possible, live in a world where everyone gets free coronavirus testing frequently as a prerequisite to going outside
What Coronavirus does to you
From the World Health Organization: “Coronavirus disease (COVID-19) is a new strain [of virus] that was discovered in 2019 and has not been previously identified in humans. Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.”
Here’s a nice visual of what you’re likely to feel if you’re infected and symptomatic (before stratification):
Source: Our World in Data
Want to stoke your imagination? Read this NYMag (fictional but factually accurate) narrative.
Exponential growth is scary
Regardless of how you may be personally affected if you have coronavirus, there is consensus that everyone who makes contact with the virus, even if they never feel any symptoms, become infected and can pass it onto other people.
How it spreads
If you’re infected, coronavirus spreads to others primarily through standing within 6 feet of others, and through respiratory droplets produced from coughing and sneezing
The virus is also extremely persistent on a variety of surfaces:
Source: Journal of Hospital Infection; Medscape
How fast this will grow if unchecked
If people like this person in South Korea and this person in Uruguay continue to pop up: extremely fast and extremely far.
Research has shown so far that, when left unchecked, an infected person passes the virus on average to 2.4 other people. Those newly infected people would also on average pass the virus on to 2.4 more people, and so forth…
Let’s run through an example of how quickly this could spread without preventative measures:
Suppose a country has already reached 100 cases (most countries have reached this point already).
Let’s assume this country doubles their total cases every 4 days. So four days after 100 cases we have 200 cases. Then 400 cases four days after that. Then 800 cases. Then 1,600…
That means that within 22 “doubling periods” (in this example, 88 days in total), we will have over 400 million people infected. Let’s just call this 330 million instead so that it matches the US population.
Since people infected with coronavirus have a 20–31% chance of needing to be hospitalized, let’s conservatively say 66 million people would need to be hospitalized.
With a conservative 3.7% case fatality rate (confirmed deaths divided by confirmed cases), 12 million would die.
America and the rest of the world is starting to take this more seriously, so I wouldn’t expect it to get that bad, but we haven’t been doing well so far. Check out the charts below, keeping mind that these are only based on confirmed cases/deaths, which is directly related to how much testing coverage we have across the entire population (not just people who are symptomatic)
Note: since most countries are only now starting to ramp up testing efforts, the rateof growthof actual cases is likely lower (and absolute number of actual cases should be higher)
Source: Our World in Data
Why all of us should care
Who is at risk
Short answer: everyone. Not just old people or people with pre-existing conditions.
Here’s why:
The people most at risk thus far have been the elderly, people with pre-existing conditions, and the LGBT community…
…but research is already starting to show that younger people are more susceptible than previously thought (CDC data)…
…and either way, healthcare system collapse means none of us can get sufficient treatment for anything, not just coronavirus
Let’s explore that last part a bit more:
There are an estimated 46,500 medical ICU beds in the United States, or 178 per million people. This could potentially be doubled by repurposing other space and equipment, so let’s round up to 100,000.
There are an estimated 160,000 ventilators across the United States’ healthcare system
Remember how we were just talking about there being a 14–20% chance of needing to be hospitalized, and that big number 45.8 million… well even if you’re in the lucky demographic that is likely to survive coronavirus, you might still need medical care that won’t be available because our healthcare system got overwhelmed.
This doesn’t even begin to account for the fact that coronavirus isn’t the only reason people need medical attention, and that 70–80% of ICU beds on any given day are already in use…
Why we’re all stuck at home right now
You’ve probably seen some variation of this already:
The takeaway is clear — to not overwhelm our healthcare system, we need to take preventative measures and keep the rate of growth slow enough such that at any point in time, the amount of people in need of care can be met by our healthcare workers, ICU beds, ventilators, etc.
This has led to some governments like the UK and the United States enacting what can mostly be referred to as “mitigation” policies. Strong recommendations to avoid bars/restaurants and groups of 10+ people that aren’t fully enforced (though at least in the US, some cities/states like California have taken stricter measures).
Only problem is, the reality of flattening the curve looks more like this this:
That flat line at the bottom is our healthcare system’s capacity.
To flatten that curve down low enough to prevent mass death, we have to be extremely strict on both policy and enforcement. No leaving the house except for essential reasons like acquiring things that you need to not die and working jobs that ensure other people don’t die.
Which would look more like the green line here:
Except… you see how that green line jumps up towards the end of the year? That assumes measures are lifted in the summertime, people go back to life as usual, and then the virus rears its ugly head in the fall and goes back to that scary exponential growth.
Which would then imply that our only viable strategy is to stay at home, indefinitely, until we have a vaccine. Which is currently expected to take 12–18 months (C-SPAN video).
The fastest way out of this: “Test and Trace”
Stricter policies buy us time to ramp up testing
That last chart assumes we have two options: make everyone stay at home or let everyone wander about, with a spike of deaths either now or later. But there is a third option: “Test and Trace”.
Imagine the following scenario:
A hypothetical smartphone app that tells you every morning if you are infected with coronavirus, even if you’re asymptomatic
If you test positive, everyone you’ve been in contact with since becoming infected gets notified that they may have also become infected
If you’re in either of these groups, you can’t leave your home until you’ve tested negative
Everyone else can go back to their social and work lives
Some variation of this would enable most of society to restore relative normalcy while containing and resolving the problem at hand. And staying at home now buys time for such a system to get set up.
Not a world I’d want to live in forever, and we should ensure trace measures don’t extend beyond this pandemic, but this option sounds infinitely better to me than millions of deaths or not leaving the house for 12–18 months!
Don’t expect a lightning-fast smartphone app test, but existing testing methods are getting cheaper to manufacture, faster to run, and have already enabled measures that have been able to curb spread in other countries like South Korea, Singapore, Taiwan, and soon Israel and Germany.
Tests and treatment need to be free too, because so long as we see huge bills like what this patient got slammed with, we won’t be able to convince people without insurance or savings to get onboard, which will lead to more asymptomatic carriers continuing to infect everyone else.
As a next step, our energy should be spent right now getting our governments and companies to invest as much energy as possible in ramping up free testing across the country. We seem to be moving fast on producing tests; next up is ramping up capacity to facilitate all those tests, minimizing the turnaround time to get results, and iterating to maximize test accuracy.
We’re still slow to test; let’s catch up.
Source: Our World in Data. Side note, I’m REALLY worried about India and Brazil