Containing COVID-19

Dr. Anthony Fauci of the CDC, You don't make the timeline, the virus does CNN 03/25/2020:

It's not often mentioned in the reporting I've seen. But Fauci will turn 80 in December of this year. He's obviously a sharp guy. And while he has to put some effort to stroke the Orange-Clown-in-Chief's immense ego, he doesn't seem to be at all intimidated by him. He seems to be focused on his professional duty and doesn't actually care what the Mad King actually thinks about him.

This article from Wednesday about the situation in New Orleans (Andrea Gallo et al, 'It's like a war zone': Fighting coronavirus, limited ICU beds, bracing for chaos in New Orleans Nola.com 03/25/2020) provides a good illustration of what not having a "flattening curve" on new COVID-19 infections means. People get sick from the virus and need hospital care. Hospital capacity gets overwhelmed - projected for New Orleans by April 4, the end of next week - fewer people can get the treatment they need, more people die. The better the containment is - which relies most heavily on social distancing - the less likely the health care sytem's capacity is to to overwhelmed, the fewer people die.

"With hospital beds quickly filling up, workers being forced to ration critical supplies like N95 masks and Gov. John Bel Edwards warning federal officials that a rising tide of coronavirus patients will likely overwhelm the New Orleans area’s hospital systems by April 4, Louisiana’s health care workers are bracing for chaos."

Faimon Roberts III et al also report, Louisiana officials identify 6 coronavirus nursing home clusters; only 3 publicly named Nola.com 03/25/2020.

Sara Chodosh has a helpful article on interpreting COVID-19 displays in the press, Why so many of the COVID-19 graphs you see are misleading Popular Science 03/24/2018. This is a critical point, that the accuracy of the information researchers and authorities have depends on how extensive the testing is:

Iceland is perhaps the most interesting. As a country of only about 365,000 people it would be easy to assume it’s only on this list by virtue of its small size, but the truth is that Iceland has the highest testing rate of any country in the world right now. South Korea has tested about 5,200 people per million, and that’s twice as high as any other country, Iceland excluded. But Iceland has achieved double South Korea’s rate. That means they’ve found far more cases than anywhere else because they’ve tested an enormous number of asymptomatic people and found the coronavirus lurking in places few other countries are even looking.

And that brings up another major issue with looking at pure case counts: You’re only ever looking at confirmed cases. Most places aren’t testing a huge number of people right now, which means there are certainly many more folks infected than the stats suggest. And because of the massive variation in testing rates, it’s close to impossible to compare case counts between countries (or sometimes even within one) because our ability to detect mild cases is so low in some areas." [my emphasis]

Sara Goudarzi reports for Scientific American (Lessons from Past Outbreaks Could Help Fight the Coronavirus Pandemic 03/23/2020):

“Past influenza pandemics give some sense of what the overall [trajectory] of a virus like this would be because the reproductive number of this virus” - defined as how many people each infectious person transmits the disease to in a completely susceptible population - “is pretty similar to that of a pandemic flu,” says Marc Lipsitch, a professor of epidemiology and director of the Center for Communicable Disease Dynamics at Harvard University. Although it is difficult to determine exact figures for an emerging disease, reports put the reproductive number of COVID-19 between 2 and 2.5. The median reproductive number for the 1918 flu pandemic was around 1.8. Lipsitch estimates that between about 20 and 60 percent of the global population will ultimately become infected with the novel coronavirus, or SARS-CoV-2. ...

The most effective class of nonpharmaceutical control measures were those related to social distancing: canceling public gatherings, closing places of worship, schools, bars and restaurants, isolating the sick and quarantining those they came in contact with. (Many cities around the world have adopted such measures in the current outbreak.) “In my opinion, that is probably the most important single class of things to do, as quickly as possible, to slow the spread” of a pandemic, Lipsitch says. “Waiting until you can see that you have a problem is waiting too long, because there’s a delay in seeing the fruits of the measures.”

By undertaking these steps early, populations can also prevent peak demands on their health care systems and flatten the pandemic curve - that is, have a gradual increase in cases over time rather than many all at once. This slowdown is especially important because it can take two or three weeks before those infected with SARS-CoV-2 are sick enough to require intensive care, so demand could spike quickly. In a 2007 Proceedings of the National Academy of Sciences USA paper, Lipsitch and two other researchers showed that during the 1918 influenza pandemic, cities that intervened early and intensively to slow transmission through social distancing, such as such as St. Louis, Mo., had slower epidemics with smaller peaks, compared with those that waited longer to act, such as Philadelphia. [my emphasis]