I wasn’t planning to make the next post yet, but now it seems like a good time because our governor just announced a “Stay Home” order. First of all, +10 points for not calling it “shelter in place”. I don’t know about you, but for me that term means there’s rampant mobs or zombie mosquitoes. It feels weird to people to “shelter in place” and then say “walks around the block with your family are ok.” And secondly, kudos for making this proclamation. Now I await actual enforcement of the order because until we do that, I don’t see how this is going to end. Think I’m crazy? Let me walk you through my thought process and we can see where we diverge.
Do we all agree that it’s bad if this spreads unabated? There are plenty of papers talking about the percentages of mild, severe and critical cases. Let’s take the bottom end of estimates and say that 5% of cases require hospitalization. There are 924,000 hospital beds in the US. So if all the cases in the US were evenly distributed (they’re not) and all the beds were capable of helping COVID-19 patients (they’re not), then that means once 46 million people have this, we’re going to overflow the hospitals. That 46 million number might sound rosy (it’s not… it’s only 3.5 weeks away, but more on that later) but it’s wildly optimistic because one of the real shortfalls is the number of ventilators. You may only have hundreds of those in your area. The federal government has some for emergencies but that number is around 10,000. Who cares about having a bed if you can’t breathe? There are already stories about Seattle hospitals being full and out of ventilators. Italian doctors were picking who they would try to save with the equipment at hand. I hope we can agree that this is bad if it spreads unabated.
Do we all agree that this spreads very quickly when we don’t do anything about it? Again, the math isn’t too hard to calculate but exponential growth can be hard to internalize. In my last post I guessed we’d be crossing 500k worldwide cases sometime around today. I probably missed that by a day or two because my formula didn’t take into account enough of the countries that are getting this under control, but I wasn’t off by that much. How can we make those predictions? It’s because when COVID-19 is spreading freely, the rate of cases increases by 35% every day. Whether it’s China, Italy, New York, Seattle or anywhere else, you get 35% more cases every day. Once more restrictions go into place, the growth slows to 22% and if you’re in a warm weather country then it grows at 14%. This is exponential growth and the best way to view exponential growth is on a logarithmic scale. A straight line on a logarithmic scale is exponential growth while linear growth looks like a downward curving line. We need to start seeing a change from exponential to linear before we can feel like we’re winning the fight. The best COVID-19 site I’ve seen is by a guy named Mark Handley. All this data is on github so you can draw your own charts, but it’s hard to tell the story more clearly than he does. I’ll just choose one chart that shows the growth per million inhabitants with some alignment of when the outbreaks started in each place:
You thought Italy was bad? We are getting more cases than they did and we aren’t slowing down yet either. So we’re all in agreement that this spreads very quickly in similar climates and that if we do nothing, we’ll stick on this 35% daily increase? That would put the US at 500,000 cases by April 1, one million by April 3 and 10 million by April 11 and by April 22, everyone in the US has gotten it.
Ok, so it’s bad if everyone gets it, and it’s bad if we don’t try to stop it. How can we stop it? Right now the only tool we have is staying home. More and more states are enacting “stay at home” guidance, but how closely it’s followed varies widely. The only successful examples of reducing interaction are countries like China, Singapore and South Korea who have much stricter policies in place. Washington had the first big outbreak in the US so we’re a bit ahead of everyone else in shutting things down and over the last few days, it has looked like we’re finally slowing to the 22% rate. It’s good to see the improvement but we have to slow it a lot more. Whether you live in an area with a rule or not, stay home! We need to starve the virus of new hosts. The Washington Post has some great visuals to help explain the effect of staying home.
I hesitate to use the “flatten the curve” hashtag here, but time really is our friend. Even if we all eventually get sick, the longer we can stretch that period out, the better. Test kit production and ventilator production is being pushed to the limits. A vaccine is 18 months off but research is under way. Treatments are coming sooner than that but we’re still months away from that as well. It feels like our biggest hope is that once we’re swimming in test kits and those tests can be done in-private at home then we’ll really be on a good path for getting back to “normal”. And once we’re a couple months down the road, temps will be warmer which Cliff Mass thinks will help too. For even more hope from a disease expert, read Bill Gates’s Reddit AMA or read the lightly condensed version on Tech Crunch.
Ok, so it’s bad if everyone gets it, and it’s bad if we don’t try to stop it, but we are working to stop it and there is a lot of hope for the future. This will end and it’s not going to end in the downfall of civilization. We’ll pull through this and this data will spawn thousands of doctoral papers for years to come about how to handle these situations in the future. Is it going to be destructive to the economy? Absolutely. Is it going to be tough on individuals? Absolutely. But we will pull through this.
The Time of Grace website has been one of our favorites in this house and after watching Pastor Herrmann’s devotion on Sunday, we happened to catch Pastor Novotny’s live stream from his house. I recommend you watch it as it has really stuck with us. God is here. God is with us. God has this under control. God is working this for our good. We’re not alone. Remember the words of Paul from the book of Philippians as he was imprisoned (or forcefully quarantined?):
4 Rejoice in the Lord always. I will say it again: Rejoice! 5 Let your gentleness be evident to all. The Lord is near. 6 Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. 7 And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.
8 Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things.