What Would It Take?

If you want to heighten your concern about the coronavirus outbreak, a good place to start would be with Risk Management Systems’s two blog posts on the subject:

The Coronavirus Outbreak: Part One – Modeling “Spotting”
The Coronavirus Outbreak: Part Two – Self-Isolation and Quarantine

If anyone has access to an unfirewalled copy of the company’s report on this topic, I’d be very interested in reading it. I don’t know whether the professional catstrophists at RMS are just acting from an abundance of foresight or overreacting but it’s certainly interesting.

To me they’re bringing up a question. Based on the admittedly unreliable information at hand, the number of confirmed cases of COVID-19 is doubling every couple of weeks. Let’s not talk about mortality. Let’s just talk about cases. How many cases would it take before it overwhelms our health care system?

21 comments… add one
  • CuriousOnlooker Link

    The answer depends on what is the goal.

    If it is total eradication by quarantine — then yes, the limit is dependent on many people can be traced and isolated due to contact with a contagious person. It becomes infeasible as the number of cases go hundreds to thousands.

    If it is to simply give quality care to anyone who is sick – that is determined by the number of ICU and hospital beds. The studies so far show 20% of cases require hospital care and 5% require ICU.

  • Greyshambler Link

    Ours?
    Not much just panic. Anyone who arrives at the ER must be seen and treated by law. Wouldn’t take too much to trigger a panic, just news reports.

  • I’m thinking just quality care. My recollection is the total number of hospital beds in the U. S. is about three quarters of a million and the number of ICU beds 100,000. Staff is probably a more serious problem.

  • GreyShambler Link

    Iran reports 47 cases/12 deaths. I’d be willing to bet that numerator is way off.

  • bob sykes Link

    The number of new cases in China has been declining for the last couple of weeks. That is due to the extreme quarantine in China. Outside China it is still in the early stages of spreading, so we don’t know what will happen. I expect some sort of vaccine and/or treatment will be available before we get a pandemic.

  • How do you know that? How do you know any of that?

  • CuriousOnlooker Link

    The WHO believes the decline in new cases inside China is real. Through the WHO loses some credibility by looking like it lets the Chinese government run its PR.

    At the very least we know it is not getting worse outside of Hubei — there are no announcements of rush hospital construction, surging of medical staff from other provinces, etc.

    As for treatment – the WHO says the is only 1 potential treatment – the experimental drug from Gilead. Vaccines are years away – is there a vaccine for any members of the coronavirus family- SARs, the common cold?

  • The WHO believes the decline in new cases inside China is real. Through the WHO loses some credibility by looking like it lets the Chinese government run its PR.

    There was an article in Bloomberg the other day which I haven’t had the time to comment on urging the WHO to stop looking at its pocketbook and start toughening up on China. Said another way, maybe we can rely on WHO reports and maybe we can’t.

  • GreyShambler Link
  • Andy Link

    Dave,

    I emailed you what I think might be the report you’re looking for.

    And here’s a good article on the virus and what makes it different and more concerning:

    https://www.theatlantic.com/health/archive/2020/02/covid-vaccine/607000/

  • Thanks, Andy.

    IMO the reason that concern is warranted is pretty easy to articulate. The disease appears to combine the transmissibility of the flu with a significantly higher virulence.

  • walt moffett Link

    FWIW, poked around fema.gov, according to their annual report, about 22% of the states, tribes, etc could medically handle a “worst possible” disaster and about a third could handle the dead bodies.

    So, will take a lot but fixating on pronouns, sharia law, etc takes priority.

  • steve Link

    Who knows where we end up with this virus, but if it isn’t this one it will be another which becomes the next Spanish flu. We need standing teams and facilities to be prepared. Instead everything will be defunded as soon as we have a few years without problems.

    If you include university and government beds I think we have close to one million. Occupancy rates tend to be high the in the US so we dont have tons of extra capacity. True ICU capacity is difficult to judge as the ICUs in a lot of small hospitals are pretty limited in what they offer. They are usually staffed by hospitalists, not people with critical care training. Those places won’t have the training to care for severe respiratory illnesses. They won’t be able to ship out really sick pts like they do now if the larger hospitals are full. Sick pts in those places will just die.

    Steve

  • GreyShambler Link

    @Steve: In general, what CAN hospitals do for patients of corona virus above and beyond comfort, wait and watch , IYO, please.

  • steve Link

    Not being an expert on coronavirus per se, I would assume that we would do the same stuff we do for flu patients. That pretty much amounts to supportive care. IV fluids, nutrition, meds to support BP, advanced nursing care, etc. In the extreme we occasionally also use ECMO but that is a very limited, expensive resource. Needs a lot of specialist care. A lot of flu patients also develop superinfections that can overwhelm the body since their immune system is already kind of shot. (That just means another infection, usually bacterial, on top of the existing flu.) We treat those with antibiotics but the really sick pts get overwhelmed. A nice, accessible read at the link. We dont really have drugs that directly affect the virus (it sounds like there are some vague hopes out there but nothing definite) so we will mostly end up hoping we can keep them alive until they get better based on their own immune response. (This is why old people and very young kids are usually most susceptible. However, there have been flu variants that affected the young and healthy. I dont think we know for sure why that happened but while it could have been an exaggerated immune response, the explanation many used to favor, I think later research is favoring environmental conditions which lead to worse superinfections.)

    https://www.scientificamerican.com/article/how-does-the-flu-actually-kill-people/

    Steve

  • A lot of flu patients also develop superinfections that can overwhelm the body since their immune system is already kind of shot.

    I presume those are what people infected with COVID-19 are succumbing to. IIRC they are what made the Spanish flu so deadly, too.

  • steve Link

    That seems to be what most people think now. There were some people who believed the problems was a big SIRS response (massive inflammatory) but I think most believe it was superinfections. I can personally attest that it can be incredibly rapid. I will never forget the 15 y/o I had years ago he was playing baseball on a Tuesday night, got sick Wednesday and died Thursday. He was super infected everywhere. Every organ was affected.

    Steve

  • GreyShambler Link

    Thanks for the link. I’m now 66, with COPD and figure I get this shit I just go along for the ride. It’s not like you can will yourself to survive.
    My mother tried to will her survival against Alzheimer’s and it was a tough thing to watch.

  • GreyShambler Link

    Should we even trust news reports? Everything is political.
    The brother of the CDC’sDr Nancy Messonnier, is the corrupt disgraced previous DAG Rod Rosenstein.
    Even disease the powerful and political marry one another.

  • In the post on this subject at Legal Insurrection there’s this lament:

    One of the challenges I face in analyzing reports about the Wuhan coronavirus is determining propaganda and reality. While I do not believe the Chinese have fully disclosed the number of deaths, I had not anticipated a member of the Center For Disease Control and Prevention (CDC) would use her platform to distort the risks associated with the pathogen to undermine the administration.

    My take is a little different from that. I don’t think we have the information to determine whether her remarks are alarmist or understated. Everything depends on the information coming from China which I don’t believe anybody thinks is reliable.

  • GreyShambler Link

    Trying to alleviate some concerns, it should be noted that mortality rates, (China) are almost double for men than women. Correspondingly 50% of adult males in China smoke cigarettes, 2% of women do. Also, air quality (particulates) is poor in most Chinese cities.
    http://aqicn.org/city/wuhan/

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