2020-03-19 COVID-19 Update

United States Data

Here is today's update regarding the spread of COVID-19 in the United States.

US Confirmed Cases:10,848
US Confirmed Deaths:154
US Death Rate: 1.44%

The five-day moving average of the doubling period has reduced slightly to 2.4 days. (This is not what you want to see – we want the doubling period to increase so it takes longer for cases to double.) Based on today's date, number of confirmed cases, and the current doubling period, here are today's projections:

10,000 Cases: March 19 (today - as predicted)
50,000 Cases: March 24 (five days from now)
100,000 Cases: March 27 (eight days from now)
1,000,000 Cases: April 5 (about seventeen days from now)
10,000,000 Cases: April 12 (about four weeks from now)

I Expect the US Death Rate to Increase Unless Social Distancing Becomes More Widespread and Effective

Right now, the death rate in the US continues to fall, from 3.5% on March 10 to 1.4% today. This is good news and to be expected for several reasons:

In the early phases of an outbreak, only people with severe symptoms report to the hospital, and these people are at a later phase of the illness. Therefore, more of the early confirmed cases result in death.
Prior to widespread testing for COVID-19, and widespread concern about the disease, we can assume that many early cases are misdiagnosed as something else and are not treated until late-stage symptoms appear. These people are also more likely to die.
As time goes on, medical providers learn how to more effectively treat the disease to prevent deaths, and testing finds people at earlier, more treatable stages of the illness. Therefore, later cases have a lower death rate.

Unfortunately, I expect the death rate to go up in early or mid April, although as a human being I truly, truly hope I am wrong about that. Here's why I expect the death rate to rise:

MANY PATIENTS REQUIRE HOSPITALIZATION AND ICU: The experience from China and Italy shows that ten to fifteen percent of patients who contract this disease require hospitalization. This report released yesterday by the CDC shows the rate of hospitalization in the United States is 12%, in line with the experiences of other countries. About 3% of all cases required ICU admission.

WE HAVE A FINITE NUMBER OF HOSPITAL BEDS: If we assume that patients are hospitalized not because they feel really bad but because doctors believe it is necessary to preserve life, then we can expect the US death rate to rise when we begin running out of hospital beds, particularly ICU beds. According to the American Hospital Association, there are 924,000 staffed hospital beds in the United States, and roughly 65,000 ICU beds.

TOTAL CASES CONTINUE TO DOUBLE EVERY 2.5 DAYS: For planning purposes, if we assume that half of all hospital beds are occupied for other reasons (vehicle accidents, gunshot wounds, late-stage cancer, etc.) then that gives us 32,000 available ICU beds. If 3% of all COVID-19 cases require ICU admission (per the CDC report,) then when the total number of confirmed cases goes over one million (roughly 1,066,666,) we can expect to run out of ICU beds. With the current doubling period, we are projected to reach that number shortly after April 5. We should therefore expect to see the death rate begin rising shortly thereafter. (This math also assumes that the ICU treatment takes many weeks, as seen in other countries, and that even earlier cases admitted to ICU are still occupying beds in early April – i.e., no significant number of ICU beds are being "freed up" by persons recovering from COVID-19.)

There are several mitigating factors that might prevent or delay this scenario from coming true (running out of ICU or hospital beds and therefore seeing more deaths):

Social distancing will become serious, widespread, and effective, and we will begin to see the doubling period of total cases going down.
Earlier and more widespread testing will catch treatable cases before they reach the point of requiring an ICU bed, so that 3% figure will go down, and we will run out of ICU beds later.
New treatments are found in the next couple of weeks that drastically reduce both the number of people admitted to the hospital and the length of those hospital stays.
Someone finds a super-effective cure and can produce it in large quantities and get it to hospitals and clinics.
Someone finds a super-effective vaccine and it can be rolled out to everyone in the United States quickly.

Unless you are a medical researcher or front-line medical practitioner, item #1 in that list is the only one you can personally influence. That is why I provide these daily updates and why you should both take social distancing seriously and encourage other to do so as well. To prevent widespread death, we have to hunker down while it still seems premature, unnecessary, or ridiculous to do so.

Positive News

In an effort to provide some relief from the endless stream of scary news about COVID-19, these daily updates will include links to any available positive news related to this disease. Here are today's links:

LeeCo Blog – Lee Edwin Coursey

Thursday, March 19, 2020