The Terminology of Keeping Distance

 

The terminology comes from the public health field but most of us struggle to comprehend the exact meaning and what should be applied in our own situation.

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“Social Distancing: This Is Not a Snow Day.” To slow the coronavirus, wrote Dr. Asaf Bitton, we must act quickly and start “making daily choices to stay away from each other as much as possible.”

Social distancing is ultimately about creating physical distance between people who don’t live together. It means closing schools and workplaces, canceling concerts and Broadway shows. For individuals, it means keeping six feet of distance between you and others and avoiding physical contact.

It means no dinner parties, no playdates, no birthday parties even with a few friends.

Who should do this? Everyone.

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This means stay home. Don’t leave the house unless you absolutely have to. Don’t socialize with people outside your family. Don’t go to a friend’s house for dinner or invite a trusted friend over.

You are allowed to go outside for essentials (groceries or prescriptions) but you should limit those trips to no more than once a week if possible. People with essential jobs — public safety, medical, sanitation or grocery worker — can still go to work. And you can visit someone if you are their caregiver.

You can walk the dog or exercise outside as long as you keep a six-foot distance from others.

 

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Who should do this? Everyone who lives in an area with a mandatory shelter-in-place order (Northern California and possibly, soon, New York City). But many infectious disease experts say that everyone else should voluntarily shelter in place.

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Checking your temperature,  and watching for signs of coronavirus infection (fever, shortness of breath and coughing, flu-like symptoms.) A person who is self-monitoring should already be staying home and limiting interactions with others.

Who should do this?those with possible exposure to the virus but had only distant contact with the infected person.

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This term is used to separate and restrict the movement of someone who is well but who recently had close contact with a person who later was diagnosed with the virus. A person in self-quarantine should follow all the rules of sheltering in place, except they should avoid going to stores or interacting with the public even on a limited basis for a 14-day period. (A friend should bring you groceries.)

A person in self-quarantine should sleep in a separate space from other family members.

Who should do this? Persons without symptoms, but with a contact history (with someone who later became ill.)

 

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Isolation is used to separate a person who has a diagnosed case or someone who has distinct symptoms including a cough, fever and shortness of breath, but hasn’t yet been tested or received test results. A person in isolation should be confined to a separate room with no or minimal contact with the rest of the household (including pets) and use a separate bathroom if possible. Most of the time, a sick person will feel a bit miserable, but he or she can pick up food trays left at the door. Sanitize a shared bathroom after using it.

Who should do this?  Anyone with a confirmed case of Covid-19, a person waiting for test results or a person with obvious symptoms who is still waiting to be tested. Everyone else in the household should self-quarantine.

 

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A government-imposed lockdown on a community, as has happened in Italy, in which movements are severely restricted. People can still go out for essentials and to get fresh air, but they can do so only under strictly controlled conditions or on a specific schedule imposed by public safety officials.

Who should do this? Everyone who lives in an area under quarantine. “We haven’t seen this in the U.S.,” according to Dr. Bitton, but certainly in Wuhan, Hubei, Italy, and other countries.

Posted in Coronavirus, Health Care, Uncategorized | Tagged , , , , , , | 1 Comment

The Economic Impact of the Virus

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A monument near the office where I worked in Washington, D.C., until Sunday bears this quote by the Argentinean Jose Narosky: “In war there are no unwounded soldiers.”

We can say the same thing about the warlike shock of the COVID-19 pandemic. Many of us have suffered already. We will all suffer in some way. If we learn from the record, however, we can take steps to minimize the impact.

My basic message is that there is a trade-off. Slowing the spread of the virus will extend the period in which the virus is present and may not reduce the number of people who are infected. What isolation will do, however, is reduce the death rate by lessening the overwhelming of Suffolk County hospitals and clinics. Britain is a week or more ahead of the United States, and the hospitals are pulling in final-year medical and nursing students; they are also bringing back recently retired doctors, including my own sister, who are at higher risk because of their age.

We want to avoid getting to Italy’s desperate situation, where crowded hospitals are making hard triage decisions, not accepting patients over 80, who are left to be cared for, and often die, at home. Staying at an understaffed hospital with too many diseased, highly contagious patients could be a death sentence anyway. They may be better off at home.

When I was chief economist for three New York City comptrollers, under Mayors Dinkins, Giuliani, and Bloomberg, I prepared the official estimates of the economic impact on New York City of the terrorist attacks on the World Trade Center in 1993 (nearly $1 billion) and Sept. 11, 2001 (approximately $90 billion). The 9/11 attacks resulted in a $20 billion package for New York City, and large investments and annual expenses in public security, including security stops at airports.

When a major shock happens, governments need to act as soon as possible. Yet officials need time to process the challenge so that they prepare in the right way. Beds in New York City hospitals, for example, were emptied out and fully staffed to care for injuries after the 9/11 attacks, but the wounded never came. This time, the COVID-19 trauma will indeed require hospitals and personnel. Their preparedness will determine the number of deaths.

The lesson from the crash of 2008 is that the emphasis should be on putting money in the hands of consumers so they can keep the wheels of commerce turning. Senator Mitt Romney has suggested giving every American $1,000 to address the coming recession. He has the right idea.

For more than a year, I have been senior economist for the Joint Economic Committee of the Congress, including when Representative Carolyn Maloney was vice chairwoman. I prepared a report on Trump’s China tariffs, the impact on the U.S. retail supply chain, and the plight of that sector. This made me an early student of the economic impact of the coronavirus.

In early March, the World Bank was still projecting 2.5-percent global growth in 2020, above the “post-crisis” low in 2019. The International Monetary Fund also forecast growth, but at a slower rate. Morgan Stanley predicted that even with a pandemic, growth would exceed 2 percent; the Organisation for Economic Co-Operation and Development projected that a pandemic would cut the growth rate in half. The verdict of the stock and bond markets since then has been profoundly negative. In round numbers, the Dow peaked at 29,400 on Valentine’s Day. By the morning of St. Patrick’s Day the Dow was struggling to stay above 20,000. One-third of the value of this market was lost in a month. Three years of growth in the Dow disappeared.

On Monday, Gregory Daco of Oxford Economics said, “We’re calling the recession.” A Financial Times survey of economists was headlined “Global Recession Already Here.” The Federal Reserve’s two rate cuts, down 1.5 percentage points, just seem to have added to the financial panic.

The United States is fortunate that Asia and European countries faced the virus first. Italy’s experience is shocking because the death rate is much higher than China’s. China was able to build a new hospital in Wuhan in just 10 days. Italy was slower to act and has a considerably older population.

A model popularized by Nicholas Kristof of The New York Times shows why early action is crucial. It assumes 100 million U.S. infections by the coronavirus. With early intervention, the number of U.S. deaths is kept to 324,000, a death rate of 0.3 percent. If action is delayed, however, the number of deaths triples to one million, a death rate of 1 percent of infections. This is a conservative estimate based on what happened in Italy, where as of Monday the number of reported cases was 27,980 and the deaths 2,158, a frighteningly high death rate of 7.7 percent. Italy’s slow action was especially dangerous for its elderly population; it has the second-highest percentage of elderly people in the world. Japan has the highest.

France (2 percent) and Spain (3 percent) have lower death rates in part because they learned from Italy and have taken extreme measures and because their population is younger. Death rates are well below 1 percent in two countries that acted decisively to slow the spread of the disease — Germany (0.2 percent) and South Korea (0.9 percent). These may be the models to follow.

By Monday, more than 183,400 people had been reported infected with the coronavirus worldwide and 7,200 had died from it. In the United States more than 3,800 cases have been reported nationwide and 60 deaths, of which one-third were residents and staff in one nursing home near Seattle. The numbers for New York State were 1,374 reported cases as of Tuesday and 12 deaths.

The numbers could not be clearer. Active intervention saves lives. Governor Cuomo and Mayor de Blasio are doing the right thing by closing schools, restaurants, and bars. Intervention is already too little, too late, especially the lack of testing kits. What is needed now is effective mitigation — decisive action to slow down the spread of the virus.

Economically, Suffolk County is vulnerable because jobs here have not been growing in the past year, despite the fact that New York State is performing above the national average. The coronavirus and the stock market crash that it (and the return of excessive risk-taking by financial institutions) caused have not been helping. Even if the Fed’s cuts in interest rates to .25 to 0 percent help the market over time, public attitudes toward the market and the economy have shifted negatively.

East Hampton will benefit economically in the short term from the fact that many New Yorkers want to get away from the city ASAP, so rentals should be strong for the spring. When they get here, however, they will probably want to self-isolate. Year-round residents may be just as grateful if well-traveled out-of-towners stay in their homes. It will be many weeks before our retail stores, restaurants, and bars return to 2019 levels of activity.

How badly the East End and Suffolk County will be affected will depend on how well this area slows down the spread of the disease and increases the capacity of its hospitals and other health-related facilities. Imagine a scenario in which three times more patient beds and equipment such as ventilators are required than East End hospitals and clinics can at present provide. What kinds of planning and actions must we do now to provide for new isolation centers? How does one feed and care for the overflow while protecting those who are caring for this population? What facilities exist now that in April and May could be used as auxiliary care facilities?

If a patient decides to stay home, what kinds of help are needed? Do we need to have more people trained on an emergency basis to look after homebound patients? What equipment will they need? What substitutes can be prepared if ideal equipment is not available? Stay tuned to The East Hampton Star, which will doubtless get answers to these questions from local medical staff.

In a war on a disease, we must all be soldiers.


John Tepper Marlin, Ph.D., has been a Springs resident since 1981.

Posted in Coronavirus, economy, Health Care, Trump, Uncategorized, Zeldin | Tagged , , , | Leave a comment

COVID-19: What is the Best Mitigation Strategy?

Interesting and thorough paper on COVID-19 disease modeling in the UK and the USA with an emphasis on analysis of each mitigation strategy (quarantine, closing schools, etc) or combination of strategies.  It is a 20-page paper.  So I am reprinting just one figure which shows that the most effective strategy to reduce the need for ICU beds is a combination of

  • Case isolation
  • home quarantine
  • social distancing for those over 70

 

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There is a lot more in this paper!

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Logarithmic Progression of COVID-19 Creates a Problem

This is a long post to basically say that we are going to run out of hospital beds, ICU beds and ventilators if we don’t enact very strict social distancing/isolation rules immediately.  It is based on the known exponential growth of infected persons: that number doubles every 3 days.
97 known cases today in Suffolk County x 10 (because 90% of cases are unrecognized) x 1024 (2 exp 10th) = 993,280 cases in Suffolk county by April 17th
15% can be expected to be serious cases requiring hospitalization:

993,280 x 0.15 = 148,992 (hospital beds needed in Suffolk County)
21280 x 0.15 = 3192 in East Hampton
Gov. Cuomo:The entire state has only 53,000 hospital beds statewide — and they are, on average, 80% occupied, Cuomo said. That leaves 10,600 available hospital beds in the state. The state has only 3,000 ICU beds, the governor said, with 600 available as of Saturday.

The following is by
Author:  Jason Warner


This is a long post addressing two underlying issues with the current response to the pandemic that leave me concerned.  

For those of you not taking action, or believing the pandemic to be “over hyped”, you can make fun of me as much as you want

For those of you who don’t know me well, I am analytical and metered.  I don’t freak out nor do I respond emotionally.  I also don’t post a bunch of bullshit or political or controversial stuff on Facebook.  I founded and am CEO of a successful software company that provides SaaS based data, analytics, and dashboards to recruiting departments at companies we all know.  As you would expect, I am data driven and fact based.  Before founding my company I held executive roles leading very large recruiting teams at some of the world’s fastest growing companies such as Starbucks and Google.  At Google I was fortunate enough to report to Sheryl Sandberg before she took the Facebook COO role.  I was a Chemical Engineering major in college and have a business degree from a top undergraduate business school.  I am not one for hyperbole or histrionics.  My bullshit factor is close to zero.

I share all this personal information only to help solidify that this post may be worth reading and sharing with others. I would encourage you to forward or share this post at your discretion. 
Many people do not understand what is happening with the pandemic to the degree required which is why I took the time to write this and share this on Facebook.

Now that I’ve gotten the introduction out of the way, here are two issues I want to bring to everyone’s attention.  

ISSUE ONE:  SOCIAL NORMS ARE POWERFUL MOTIVATORS AND GETTING IN THE WAY OF PEOPLE TAKING THE RIGHT STEPS IN RESPONSE TO THE PANDEMIC:  

One of the current problems with addressing the pandemic is the social pressures of taking action today. It’s awkward, and feels like an over-reaction. The reason it feels like an overreaction is that most people OVERWEIGHT the currently reported cases and inherently UNDERWEIGHT the mathematics of how the virus is spreading and what will happen in about 30 days time. This is because our brains tend to think linearly as opposed to logarithmically.  It’s the same reason many people don’t save for retirement or understand compound interest.

To create a new social norm, human beings like to see behavior modeled.  This serves as a signal that says, “oh, someone else is doing it so I should do it also.”  

SO HERE IS A SOCIAL BENCHMARK FOR REFERENCE – THIS IS WHAT I’VE DONE FOR MY FAMILY TO DATE:

I have already isolated my family. We have canceled EVERYTHING. We have canceled previously scheduled doctor visits.  Social get togethers.  Normal routine meetings.  Everything has been canceled.  It’s difficult and socially awkward. Some of you think I’m crazy, but I’m doing it not because I am afraid, but because I am good at math (more on that in part 2).  I had to have my 16 year old daughter quit her job coaching junior gymnasts at the local gym, with one day’s notice and also tell my kids they can’t attend youth group at church. Both of those were tough discussions.  I told a very close friend he shouldn’t stay at my house this weekend even though he was planning to and had booked his flight from the Bay Area.  I canceled another dear friend’s visit for later this month to go snowboarding on Mt Bachelor.

We are not eating out.  Our kids are already doing online school so we don’t have to make changes there.  I would not send my kids to school even if they were in public or private school.  We have eliminated all non-essential contact with other people.  We will only venture out to grocery shop when required.  We will still go outside to parks, go mountain biking, hiking, and recreate to keep ourselves sane and do other things as a family, just not with other people.  We have stocked up on food and have a supply for ~2 months.  We have stocked up on other goods that if depleted would create hardship, like medicines and feminine hygiene products.  We have planned for shortages of essential items.

THE REASON I HAVE CHOSEN THIS ROUTE FOR MY FAMILY IS MULTI FACETED: 

1.    Although my family is considered low risk (I’m 49 in good health, Angi is 46 and in good health, and our kids are 14 and 16), we must assume that the healthcare system cannot help us, because the hospitals will become overwhelmed very quickly.  Most American hospitals will become overwhelmed in approximately 30 days unless something changes.  More on this in part 2 below.  So although we are in great health and unlikely to become gravely ill, the risk is greater if you do not have access to the medical care that you need.  This is something for everyone to consider.  As a society we are accustomed to having access to the best medical care available.  Our medical system will be overwhelmed unless we practice social distancing at scale.  That said, the medical teams in Italy are seeing an alarming number of cases from people in their 40s and 50s.

2.    It’s not a matter of if social distancing will take place, it’s a matter of when.  This is because social distancing is the only way to stop the virus today.  As I will explain in part 2 below, starting now is FAR more effective than starting even 2 days from now or tomorrow. This has been proven by Italy and China (and soon to be France and other European countries who have been slow to respond.).  Wuhan went on lockdown after roughly 400 cases were identified (and they had access to testing that America has systematically failed to do well to date).  The US already has more than 4 times this number of known infected cases as Wuhan did when it was shut down, and our citizens are far more mobile and therefore spreading the virus more broadly when compared to Wuhan.  Yet our response is tepid at best.  

If hand washing and “being smart” were sufficient Italy would not be in crisis.  So I pray the draconian measures are coming from our government, because they are required to stop the spread of the virus.  It’s better to start sooner than later as the cost is actually far greater if we wait.  I pray they close all schools and non-essential services the way that Italy and China have done.

3.    Spreading the virus puts those in the high-risk category at much greater risk.  This is the moral argument.  It’s a strong argument because there are only two ways, as of today, that the virus can be stopped:   let it run its course and infect 100s of millions of people, or social distancing.  There is no other way today.*  If you don’t practice social distancing, people downstream from you that you transmit the virus to will die, and many will suffer.

4.    The risk of infection is increasing exponentially, because the quantity of infected people, most who will not show symptoms, is doubling every three days.  So the longer you wait to self-isolate, the greater the chance of you or someone you love becoming infected and then you infecting others because more of the population is becoming infected.  There are twice as many infected people today as there was on Tuesday.

5.    The virus is already in your town.  It’s everywhere.  Cases are typically only discovered when someone gets sick enough to seek medical attention.  This is important as it typically takes ~5 days to START showing ANY symptoms.  Here’s the math: *** For every known case there are approximately 50 unknown cases.  This is because if I become sick, I infect several people today, and they infect a few people each tomorrow (as do I), and the total count of infected people doubles every 3 days until I get so sick I get hospitalized or get tested and become a “known case”.  But in the time it takes me to figure out I am sick 50 others downline from me now have the virus.  So every third day the infection rate doubles until I get so sick that I realize I have the virus an am hospitalized or otherwise tested.  Harvard and Massachusetts General Hospital estimate that there are 50x more infections than known infections as reported (citation below).  The implication of this is that the virus is already “everywhere” and spreading regardless if your city has zero, few or many reported cases.  So instead of the 1573 reported known cases today there are likely 78,650 cases, at least, in the United States.  Which will double to 157,300 by this Sunday.  And this will double to 314,600 cases by this coming Wednesday.  So in less than 1 week the number of total infected in the United States will quadruple.  This is the nature of exponential math.  It’s actually unfortunate that we are publishing the figures for known cases as it diverts attention away from more important numbers (like the range of estimated actual cases).

6.  Some people cannot, or will not, practice social distancing for a variety of reasons and will continue to spread the virus to many people.  So everyone else must start today.  

The reasons above are why I have begun to practice social distancing.  It’s not easy.  But you should do it too.

The hospitals will be at capacity and there are not enough ventilators. You will hear a lot about this issue in the coming few weeks… the shortage of ventilators. 

ISSUE TWO:  MANY PEOPLE ARE FOCUSED ON THE WRONG NUMBERS:

Yes, the virus only kills a small percentage of those afflicted.  Yes, the flu kills 10s of thousands of people annually.  Yes, 80% of people will experience lightweight symptoms with COVID19.  Yes the mortality rate of COVID19 is relatively low (1-2%).  All of this true, but is immaterial.  They are the wrong numbers to focus on…  

The nature of exponential math is that the infection rates start slowly, and then goes off like a bomb and overwhelms the hospitals. You will understand this math clearly in the next section if you do the short math exercise.  Evergreen hospital in Seattle is already in triage. I have heard credible reports from people on the ground that they are already becoming overwhelmed.  And the bomb won’t really go off for a few more days.  Probably by Wednesday, March 18th (next week).  In just a few days from now we will hear grave reports from Seattle hospitals. 

You should assume the virus is everywhere at this point, even if you have no confirmed cases in your area. 

YOU SHOULD DO THIS SIMPLE 2 MINUTE MATH EXERCISE (NO REALLY TAKE TWO MINUTES AND DO IT):

To further understand exponential growth, take the number of confirmed cases in your area and multiply by 10 (or 50 if you believe Harvard and Massachusetts General estimations) to account for the cases that are not yet confirmed. If you have no confirmed cases choose a small number.  I’d suggest 10 cases in your city, if no cases are yet reported.  But you can use whatever number you like.  This number of infected people doubles every ~3 days as the infection spreads. So literally take your number, and multiply by 2. Then do it again. Then do it again. Then do it again. Do this multiplication exercise 10 times in total. 

2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x (the number of estimated infections in your city today (not just the reported cases)).  
97 cases today in Suffolk County x 10 x 1024 = 993,280 cases in Suffolk county by April 17th

This result is the estimate for the actual cases in your area 30 days from now.  The math will take 30 seconds to complete with a calculator and it’s worth doing the math to see how it grows.  This end number is the number of cases in your city 30 days from today if a large percentage of the population do not practice social distancing.  

2 to the 10th power is 1024.  When something doubles 10 times, it’s the same as multiplying by 1024.  The infection rate of the virus doubles every 3 days. 
Next, divide the final number (the scary big one) you just calculated by the current population of your location (Suffolk county population in 2018:  1,493,350) and you will be able to get the percentage of people who will be infected 30 days from now: 
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993,280/1,493,350 = 66.5%
For East Hampton (population 32,000 in 2010) that means 21,280 infected persons.

Next take 15% (multiply by 0.15) of that final 30 day number of total infected people. This will provide an estimate of the serious cases which will require acute medical care:
993,280 x 0.15 = 148,992 in Suffolk County
21280 x 0.15 = 3192 in East Hampton
and compare it to the number of beds and ventilators available at your local hospitals:
Gov. Cuomo:The state has only 53,000 hospital beds statewide — and they are, on average, 80% occupied, Cuomo said. That leaves 10,600 available hospital beds in the state. The state has only 3,000 ICU beds, the governor said, with 600 available as of Saturday.

 

Google the “number of beds” and the name of your local hospital now.  It takes 2 seconds and the number of beds is easy to find.  65% of beds are already occupied by patients unrelated to the coronavirus.  St Charles in Bend, Oregon where I live, has 226 beds and the town is roughly 100,000 people.  Most hospitals have on average, 40 or fewer ventilators.  

These numbers you just calculated are the problem:  Too many patients, not enough beds, and a serious shortage of ventilators (the biggest problem) if we don’t immediately begin social distancing.  More on this biggest problem related to the insufficient quantity of ventilators is below.

COUNTRIES THAT GET OVERWHELMED WILL HAVE A MUCH GREATER MORTALITY RATE BECAUSE THEY WON’T BE ABLE TO ADEQUATELY CARE FOR THE SICK.  

And by sick I mean not just coronavirus patients.  Your son or daughter that needs acute care surgery this May for his badly broken leg will be attended to by an orthopedic doctor that has been working at maximum capacity and working 18 hour shifts for 7 days every week for 6 weeks because it was required to care for all the coronavirus patients at her hospital.  Or the orthopedic surgeon will be sick with the virus and your son or daughter will be operated on by a non-expert or a member of the National Guard.  Your elderly Mom that has diabetes and goes into acute distress next month may not receive ANY care because the doctors are consumed and have to prioritize patients based on triage handbooks filled with success rate probabilities.  Your sibling’s family that are all injured in a terrible car crash in June will have diminished care.  If one of them needs a ventilator there will be none available because all of them will be in use by critical coronavirus patients.  Your young friend with cancer and a compromised immune system from treatment will succumb even though the cancer was curable and the treatment was working, because their body was too fragile to combat the coronavirus due to the chemotherapy and they couldn’t receive the customized, acute care required due to the hospital being overwhelmed.  All of the above is currently happening in Italy, who had the same number of infections we have today just 2 weeks ago.  You must start today.

The count of actual virus infections doubles every ~3 days. The news and government agencies are lagging in their response. So we hear that the US only has 1573 cases today (3/12/20), ( see https://www.worldometers.info/coronavirus/) and it doesn’t seem like a lot.  It would be better to report the estimated actual cases, since reported cases don’t tell us much.  However, we know from China that the actual number of cases are at least an order of magnitude greater than the reported cases, because people get infected and do not display symptoms.  In math, an “order of magnitude” means ten times difference, or put another way, a factor of 10.  100 is 10 times greater than 10, so it’s an order of magnitude greater.  

Harvard Medical School / Massachusetts General Hospital just released their estimate (recording is here:  https://externalmediasite.partners.org/Mediasite/Play/53a4003de5ab4b4da5902f078744435a1d) that the actual cases are 50x greater than the reported cases.  So we likely have 75,000 cases in the United States already.  The number of reported cases is not that important.

But let’s assume the current number of cases is only 10,000 ACTUAL cases in the United States just to be conservative and model out what will happen:

If we don’t stop the virus from spreading, in 30 days we will have 2 to the 10th power more cases of infected people because the infection count doubles every 3 days (the virus doubles every 3 days and there are 10, 3 day periods in 30 days).  

The math: 2 to the 10th power means 1,024 times as many cases as we have today (2 times 2 repeated 10 times).  

This number is a catastrophically big problem for all of us:  We will have 10 million+ actual cases (10,000 actual cases today x 1,024) in the United States in just 30 days’ time if we continue without extreme social distancing.  10 million people with the virus.  And it will keep doubling every 3 days unless we practice social distancing.

15% of cases require significant medical attention, which means that 1.5 million people will require significant medical attention if 10 million people get infected (15% of 10 Million total infections = 1.5 million people requiring hospitalization).  

1.5 million hospitalizations is about 50% more than we have beds for at hospitals in the United States.  And 65% of all beds are already occupied in our hospitals.  But patients with the virus need ICU beds, not just any old hospital bed.  Only about 10% of hospital beds are considered intensive care.  So we will have a huge bed shortage, but that is not the biggest problem, as we can erect temporary ICU shelters and bring in more temporary beds, as Italy has already done, and California and Washington hospitals have already done.  Evergreen Hospital in Seattle has already erected temporary triage tents in the parking lot as of 3/13/20.  All regular beds are full at Evergreen Hospital as of yesterday.

Once the government of China, Norway, and Italy came to understand this math, they reacted accordingly and shut EVERYTHING down.  Extreme social distancing is the only response available to stop the virus today.  The United States is not responding well nor are other countries like France or the UK.  Countries that do not respond well will pay a much larger, catastrophic price.

But hospital beds are not the big problem.  The lack of ventilators is the big problem.  Most estimates peg the ventilators in the United States at roughly 100,000 to 150,000 units.  See https://www.ncbi.nlm.nih.gov/pubmed/21149215 (admittedly dated) and https://theweek.com/speedreads/900850/doesnt-have-enough-icu-beds-ventilators-deal-even-moderate-coronavirus-outbreak

The primary and most serious comorbid (comorbid is a medical term that means co-existing or happening at the same time) condition brought on by the Coronavirus is something called bilateral interstitial pneumonia which requires ventilators for treatment of seriously ill patients.  So if 1.5M people of the 10 million infected 30 days from now require acute care (15% of the 10M estimated total infections), 1.3M may not get the care that they need because we don’t have enough ventilators in the United States.  And remember, this is only if ALL OF US EFFECTIVELY start social distancing by April 11th (30 days from today).

BUT IF WE START EXTREME SOCIAL DISTANCING BY MARCH 23 (12 days from this writing), WE AVOID OVER 1.4 MILLION PEOPLE GETTING CRITICALLY ILL AND OVERWHELMING THE HOSPITALS:

If everyone takes extreme measures to social distance, and the United States can dramatically reduce the spread of the virus 12 days from now, the math is very different, as the exponential growth will only be 2 to the 4th power (12 days divided by the doubling rate of every 3 days equals the exponent of 4):

2 x 2 x 2 x 2 = 16

So instead of 10 Million cases in the United States if we wait 30 days, if we act 18 days sooner, we will have only 160,000 cases (16 times the estimated 10,000 actual cases as of today), of which 15% are likely to require critical care.  This is 24,000 critical patients (a huge difference compared to 1.5 million acute patients).   The difference between taking extreme measures now, versus waiting even a few days, is very large due to how exponents work in math.

***THE OUTCOME IS EVEN BETTER IF WE TAKE ACTION IN THE NEXT 6 DAYS:  If the vast majority of the population self isolates and implements social distancing in only 6 days from now the exponential math is 2 to the 2nd power (6 days divided by the 3 days it takes the virus to double means the exponent is only 2).  In math this is “two squared”.

2 x 2 = 4  

Multiplied by the estimated 10,000 ACTUAL cases as of today (3/12/20) that means only 40,000 total cases will develop, 15% of which may be critical which is 6,000 critical patients.

This is why you should share this post broadly.  If people begin social distancing in the next 6 days it will greatly reduce the impact on all of us.  It’s why they say a “post goes viral”.

SOCIAL DISTANCING WILL REDUCE THE FINANCIAL IMPACT TO YOU AND YOUR FAMILY:

Finally, the longer everyone waits to practice significant social distancing the greater the economic hardship will be on all of us.  Lost jobs.  Mortgage defaults.  Closed businesses.  Bankruptcies.   All will be minimized if you start social distancing today.

Some of the reasons the economic impacts will be reduced are worth mentioning:  If we stop the virus now the overall duration of the outbreak will be far shorter.  The stock market will normalize more quickly and recover more quickly.  Businesses and people will be able to survive a shorter duration outbreak vs a longer duration outbreak.  More companies will avoid bankruptcy if we begin to practice social distancing now.

This is a big financial reason to begin social distancing if you are employed by any company:  if companies see that the virus is being slowed, they will be less likely to conduct layoffs.  You will be more likely to be laid off or experience a job-related event if we don’t practice social distancing immediately.  As an HR executive, I’ve been involved in many, many layoffs.  It’s the last thing companies want to do.  But if they see that the pandemic will be shorter lived vs long and drawn out, they are less likely to make the permanent decision of laying off staff.

The overall economic impact that hits your bank account will be greater if you wait or you don’t practice social distancing.   This is why Norway acted now, because it’s less economic impact to take drastic measures early than to do them later, and it saves a lot of lives and suffering by doing so.  And Norway has only one confirmed death as of this writing.  

START TODAY.  I CAN’T STRESS THIS ENOUGH.  YOU MUST START TODAY.  

Finally, the article that I posted yesterday written by Tomas Pueyo has been read 7M times in the last 24 hours and has been updated with new information.  It’s worth reading again.

Here’s that link.  

https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

Other up to date data I frequently consult regarding the pandemic is here:

https://www.worldometers.info/coronavirus/

I hope this is helpful and useful.  My brain focuses on the math and I try and be fact based in my analysis and interpretation of how I should respond.

THERE IS MORE INFORMATION IN THE COMMENTS BELOW WORTH READING AND I WILL BE UPDATING THIS POST, AND THE COMMENTS, WITH MORE INFORMATION, (AS OPPOSED TO CREATING NEW POSTS).

MY FINAL PARTING THOUGHT:  Please share or forward this post at your discretion.   If everyone shares this post and two of your friends share this post and so on, we use the power of exponential math to work in our favor, which seems appropriate given the virus is using that same exponential math against us.  

HOW YOU CAN REALLY HELP:  If you know people who have large numbers of followers, or people in the media, please leverage your personal relationship with them and ask them to amplify this post by sharing it.  

For people not on Facebook you can email or text the link.   If you know people in government this fact-based post may help inform them to make the best decisions.  

It’s time for us humans to go on the offensive against the virus.  We must fight back.  

There is only one way to do so:  Social Distancing.  

Do it today.

NOTE:  Anyone, including the media, is free to use this post, any related content, in all or in part, for any purpose, in any format, with no attribution required. Please direct message me if you have other ideas for how to raise awareness.
Posted in Coronavirus, Health Care, Uncategorized | Tagged , | 4 Comments

The Cry for National Leadership

By Perry Gershon

Posted

 

As President Trump flails in his attempts to lead our country through one of the most severe challenges in our nearly 250-year history, and our local congressman, Lee Zeldin does little more than cheerlead, Governor Andrew Cuomo and County Executive Steve Bellone have displayed the leadership we crave. Good leadership requires empathy, honesty, transparency and the ability to admit your mistakes so that you can fix them. One must tell the truth and be willing to display self-sacrifice when demanding sacrifice from others.  To date, President Trump has completely failed – he bears responsibility for how we got to our current place and must own it if we are to believe his solutions going forward. And we must get there.

Trump’s initial failures in taking the coronavirus crisis seriously continue to impede his ability to effectively gain our confidence or to guide us as a country. At his recent Friday afternoon press conference, the President still refused to admit responsibility for our testing failures. On Sunday he insisted that the crisis is “under control.” Trump’s words fall flat while states and cities are closing public schools, bars and restaurants, and the number of Americans testing positive for the coronavirus is increasing exponentially.

The coronavirus responsible for our current worldwide pandemic, was first reported to the World Health Organization (WHO) in December, 2019.  By January 30, 2020 WHO declared the virus to be a global emergency and by February it was distributing tests to over 60 countries. For inexplicable reasons, Trump’s administration rejected the WHO test and instead decided to make its own – a disastrous process to date and is likely the cause of a dangerous shortage of tests available in the U.S. The Trump administration’s decision in 2018 to fire our entire pandemic response team from the National Security Council without replacing them further limited our ability to respond to this pandemic.

Epidemiologists and other scientists tell us that the key to containing a pandemic is rapid identification. Failure to test people for the coronavirus has created an environment that is ripe for the virus to spread through our community rapidly and undetected. In fact, we remain unsure just how many of us may be carrying the virus and spreading it to others. Large scale testing is the only way we will contain this health crisis. South Korea, which appears to have its epidemic under control, is testing 20,000 people daily.  As of this writing, the high side estimate for total tests administered in the US is a similar number. We will never be in front of the problem until we are testing thousands of individuals a day.

Which brings me back to leadership. Trump’s failures so far are obvious and undeniable – we are missing the boat with testing, and we squandered 45-60 days of advance notice instead of preparing for this pandemic. Rather than warn us of the impending danger, Trump defended his own response and repeated false claims that the viral outbreak is winding down, that he had the situation was under control.  As Congress moved to pass safety measures to take care of those most affected, Trump’s mind focused unilaterally on our financial and corporate markets. Harry Truman’s motto, “The Buck Stops Here,” is totally foreign to this president.

But all of that is past history and we must move forward. It is not too late for Trump to rise to the challenge of one of the most basic tenets of his office. To lead us through this time of uncertainty. Be straight with the American public about what he got wrong and how he is fixing it. Take responsibility for where we are and vow to make it better. There will be a light at the end of the tunnel, but the person delivering that message must have credibility if Americans are to accept it.

And Zeldin might decide that now is the time to open his communication channels with all of us.  Zeldin has not held a true, open invitation town hall since April 2017. This would be a great time to initiate open, online communications.  My congressional campaign has hosted monthly town halls since September 2019, and we are switching to online format this week to avoid public assembly.  Zeldin might want to follow our model.  As of this writing, Suffolk County had over 50 confirmed cases of coronavirus, and that number has no doubt grown significantly.  What is the federal response going to be?  Cuomo has requested that the President mobilize the military to help fight the epidemic – where is Zeldin’s role in this process? There is clear assistance that could come from the Army Corps of Engineers and the National Guard providing both hospital beds and logistics.  We will certainly need it.

America must unite to get to the other side of this health crisis. I believe in Americans and I have no doubt that we will. But it will be much easier if we have a president who will lead us to that other side.

Posted in Coronavirus, economy, Health Care, Trump, Uncategorized, Zeldin | Tagged , , , , | 2 Comments

Hospital Beds Will Run Out

This is a great tool to check the future availability of hospital beds in your area.

On Eastern Long Island we will nearly certainly run out:

 

Screen Shot 2020-03-17 at 6.13.16 PM

Infections are supposed to peak by early May which puts us in the 6 months category.  Estimates are that up to 50% of the population may be infected and therefore up to 10% of the population may need a hospital bed!   That means about 2000 beds for East Hampton Town!

Headlines from today: Suffolk Coronavirus: 3 Dead; 97 Cases; Drive-Thru Testing Coming

A hospital bed and ventilator shortage exists statewide and new closures may take effect to flatten curve, Cuomo says.

 

There should be contingency plans to create makeshift hospitals such as in schools, or meeting rooms, or large halls (LTV in East Hampton).

Posted in Coronavirus, East Hampton, Uncategorized, Zeldin | Tagged , , | Leave a comment

Velocity of COVID-19 spread

This is a measure of how fast the COVID-19 virus is spreading in different countries:

from the Financial Times by Steve Bernard, and

PHOTO-2020-03-15-23-06-30

The steeper the slope, the faster the virus is spreading.  When the slope levels off, as for Hong Kong, Singapore, Japan and S. Korea, that is good news.  Note the probable causes for containment of the virus such as aggressive quarantine and mass testing.  Also, note that absence of data (people not getting tested) can make it appear that the virus is contained when it really isn’t (Japan?).

One of the steepest slopes, right on par with Italy and Spain, is the US!  S. Korea was able to change their COVID-19 progression by mass testing and strict quarantine.  So all hope is not yet lost for the US.  But we may be in for stormy seas.

In a large country like the US, local measures (such as strict quarantines) can be effective locally and the outcome of the epidemic can vary considerably from one town to another.  A classical example comes from the 1918 Spanish Flu pandemic. Philadelphia delayed crowd control measures.  They did not cancel the Liberty Loan Parade, a patriotic wartime effort.  But St. Louis, canceled its parade. In the end, the death toll in St. Louis did not rise above 700, but was greater than 12,000 in Philadelphia.  It’s an example of what not to do during a pandemic, according to CDC’s Division of Global Migration and Quarantine.

Please take public health measures seriously!  Lest we end up like Wuhan: video on the earliest phases of the COVID-19 outbreak in Wuhan, China

 

Posted in Coronavirus, Health Care, Trump, Uncategorized | Tagged , , , , , , , , | 4 Comments