This Will Get Worse

https://nymag.com/intelligencer/2020/03/coronavirus-will-get-worse-in-america.html


coronavirus 5:49 P.M.
This Will Get Worse
The grim math of a coronavirus future.
By Josh Barro


March 10 was just a few days ago, but it already feels very far away — before the NBA season was suspended, Tom Hanks tested positive, and a national state of emergency was declared. On that date, Think Global Health, which is a project of the Council on Foreign Relations, produced a report that includes a data table that tells us how many people in the U.S. might ultimately die from COVID-19 under a variety of different assumptions. In the top-left corner, the table shows a scenario where 0.1 percent of people in the U.S. contract the virus and 0.1 percent of those die from it, leading to a bit more than 300 deaths. That’s the best corner of the table. We like that corner. What we don’t like is the bottom-right corner of the table, which contemplates 50 percent of the American population contracting the virus and one percent of those dying. If we end up in that corner, about 1.6 million of us will die.

We could land anywhere in the table. Beyond that, unfortunately, I can’t offer much more specific guidance — in fact, depending on which experts you ask, we could land outside the table, too. But our knowledge about our lack of a knowledge is a kind of knowledge. The coronavirus endgame depends on a series of unknowns. We keep getting more data, but we still don’t know how inherently infectious or deadly this virus is. We don’t know how well we as Americans will respond and are responding to those risks of infection and death: how effectively we will reduce its spread, ensure that our hospitals are capable of handling a flood of sick patients, and heal those who are in the hospital. The early public response was abysmal, but we don’t know how quickly, or dramatically, that is changing. And, in large part because of the appalling failure of the Centers for Disease Control and Prevention to ensure an adequate supply of usable testing kits, we don’t know how bad the virus outbreak in the U.S. is already. However bad it is, things will get worse.


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It is possible, as countries ramp up their testing and surveillance capacity, we will increase our capability at managing the outbreak by identifying and isolating individuals with the infection, allowing us to reduce our reliance on population-level containment measures — this has been key to South Korea’s success at slowing the growth of new infections with less-severe restrictions on social activity than we are seeing in China or Italy. On Friday, the president held a press conference to tout expanded testing but dodged a question about when those tests would actually become available. And even at South Korean levels of social disruption, epidemic containment would require a more intense and prolonged change to the American way of life than a lot of people and even policy-makers have yet to recognize.

The even less palatable option is to try to let it run its course in the most orderly manner possible. After a large fraction of the population is infected — 40 to 70 percent are the numbers I tend to hear thrown around — many people will have developed antibodies, making it increasingly difficult for the virus to find vulnerable hosts to infect and causing the epidemic to ebb naturally. The big problem with this outcome is that it would entail a very large number of deaths even if the infection fatality rate proves to be on the low end of the estimates.

And then there is the Italy problem. There, as in the U.S. and everywhere else, hospitals have limited capacity to treat patients with severe lung illnesses. If the health-care system gets overwhelmed with an enormous number of COVID-19 cases requiring intensive care, the quality of care will deteriorate and a larger fraction of patients will die than would die in a well-functioning health-care system. This is why people keep talking about the need to “flatten the curve”: Merely slowing the growth of the epidemic, even if it doesn’t reduce the ultimate number of cases, would lessen the pressure on the medical system is considerably. But as I have reported this story, I have gotten an increasingly sinking feeling about the “flatten the curve” discourse for reasons that have to do with the other variable in the table: the fatality rate per infection.

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As with any crisis, there is also overreaction among the population. But on balance, there is still more underreaction. There is also the problem of delayed reaction. Lessler, the Johns Hopkins University epidemiologist, noted a way in which this epidemic tricks people into panicking when it’s too late. “If people are only going to start taking the actions they should when they start to see a lot of people dying around them, it’s already too late,” he says. When you combine the substantial period from infection to death with exponential growth in infections, the number of deaths you see around you is likely far lower than the number of deaths you are about to see. The people who stand to die within the next 30 days may not even be very sick yet. And when they get very sick, the hospitals may be overwhelmed and ill-prepared to respond. This is the corner Italy backed itself into. We might be headed there, too.