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Tuesday, March 24, 2020

Hospitals fail or economy fail? You choose.

The CoronaVirus / aka Covid19 Catch-22

You can’t have your cake and eat it too.

This is a long post because the issues are not simple.

The coronavirus has created an impossible situation for governments around the world.  They must choose between health care and the economy.  It is impossible to have both at the same time.

It doesn’t matter if you have universal healthcare or private healthcare.  The issue isn’t how healthcare is financed.  China has government healthcare.  Italy has universal healthcare.  The coronavirus overwhelmed both.

Here is the problem in a nutshell.  The virus spreads very quickly.  With an R0 of between 2 and 3, it “explodes” quickly.  See the comparison chart.

About 20% of the people who get sick must be hospitalized and provided acute care - think ICU.  These patients currently average about 21 days from entry to exit.  That is 21 days that hospital bed cannot be used for any other purpose.   No country has sufficient hospital beds available IF too many cases happen at the same time.

The only way to lower the number of patients needing these ICU beds is to lower the number of patients, especially those who are at higher risk - elderly and those with preexisting conditions like diabetics.

The only way to lower the number is to keep people separated.  The virus needs a new person to infect to be able to spread.  Without a new victim, it will die. 

 If it was possible to place each person in the USA in a separate room for 15 days, the virus would probably be history.  The sick people would either die or recover, but there would be no new cases to continue the spread.

But that isn’t feasible.

So we instead focus on trying to separate the known sick people from those who appear to be healthy.

The problems are (1) without testing, we cannot know who all are infected.  A person can be infected without having any symptoms.  Some show symptoms between 2 and 14 days of being sick.  However it seems some may never show symptoms.  And (2), We don’t have the ability today to test every citizen.

This is a new virus.  No person has any natural immunity.  To gain immunity, you must either first get sick and recover OR have a vaccination.  There is no vaccine yet so option two isn’t an option.

Scientists say the virus will continue to spread until at least 60% of the population have immunity.  At that time the virus will have trouble finding new hosts and may die or may become a seasonal illness like the flu is today.  

In order to reach that point and NOT have the hospitals overwhelmed, it is necessary to slow the spread - we can’t stop it - so the number of sick at any point in time is within the hospital’s ability to provide good, quality care.  We must lower the peak.

That is why social (physical) distancing is required.

So to have good healthcare we need to shutdown the economy.

If people are distancing themselves sufficiently to prevent the spread from overwhelming the hospitals, people are not able to work.  That means businesses and the economy fail.

To have a healthy economy, you must have people working.  If people are working, people aren’t keeping an adequate distance so too many get severely ill and the hospitals fail

Hospitals fail or economy fail?  You choose.

So it becomes a balancing act.  Enough social distancing to limit the spread so those who get sick can get proper medical treatment but enough time working to keep businesses and the economy afloat.

The study in the UK suggests that to defeat the virus initially would require a very long period of shutdown.  I think they say at least 5 months.

Obviously economies won’t survive 5 months of shutdown.

So the idea is to probably have alternating periods of work / closure.  For periods of time, societies will isolate and shutdown activities to slow the virus followed by periods of back to work during which cases will again increase.  They talk about waves of infection and spread followed by shutdown.  Alternating health / economy.

This would continue until the population develops enough immunity that hospitals are no longer threatened during the peak.  That will require either a vaccine being developed and deployed OR 60% of the population getting sick and recovering.

So when President Trump says the government will revisit the current social distancing  / business shutdowns in 15 days, this is what he is talking about.  

Following is now my view (not scientific studies):

China shut down Hubei from January 23 until now (Wuhan is still mostly shutdown).  The rest of the country for 30 days.  BUT China had a single known source to focus on containing.  Other countries are not in that position.

Initially the US could focus on limiting the virus from entering the country from China.  That worked so long as the virus was contained to China.  Then it spread to Japan, South Korea, and Singapore.  These countries detected the virus early so it was still possible to prevent th entry into the US by monitoring and controlling who entered the country.

BUT then Italy and Iran.  The virus entered those countries undetected and spread.  By the time the world knew those countries had a problem, it had already spread beyond those countries.  No possibility of tracing contacts.  People had it who didn’t know they had it who transferred it to others who ….

Now it was in the USA and other countries in multiple locations, spreading undetected.

That is the world as it exists today.  Countries can’t focus on closing 1 area as China could.

Back to the science:

Since we can’t afford to shutdown for months, at some time the governments must allow the virus to start spreading again by letting people return to work.  This will be a second wave.  However, during the second wave, a portion of the population will now have immunity from being sick during the first wave.  This means some will not be able to get sick nor transmit the virus so the rate of spread should be slower than in the first wave. (NOTE:  This should be reversed in China since 90% of first wave was in Hubei; the rest of China will have a higher rate).  Also it means some may be able to keep working since they won’t be at risk.

How long will immunity from being sick and recovering last?  Scientists don’t know.  We only have about 3 months of data.

 Hospitals fail or economy fail?  It’s going to be a balancing act.

PS:  We can hope that the virus is influenced by Summer but we can’t depend on it.  Even if it is, that just gives the Northern Hemisphere a longer breather since it means the Southern Hemisphere would be hit harder during that time and in the autumn it would hit the US again probably. 

During the lulls, hopefully science will find medicines that help the ill recover faster, hospitals can expand ICU capacity, medical equipment can be manufactures, and vaccines can be discovered.

Buy Time

The scientific study is located here:   but others have issues similar opinions.  If you want recommendations on scientists / doctors to follow on Twitter, let me know.

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