# The Math on WuFlu

I’m finding myself in a shrinking minority with respect to my view of the WuFlu.  To me, it still appears to be an irrational panic.  Heather MacDonald still seems to be on my side, at least as of yesterday (article here).  But even the Daily Wire guys have been convinced that there is something serious to fear, other than fear itself.  By Monday, MacDonald and I may be the only skeptics left standing.  (I would find her to be good company in such an event.)

I’ve done a bit of digging into the facts, and I still can’t understand the cause for alarm.  I would particularly value the input of our Ricochet docs and other medical professionals, as I certainly realize that I could be wrong.

I.  The Severity of the Symptoms

In round numbers, based on the Chinese experience thus far, it appears that about 80% of WuFlu cases are mild, about 15% are “serious,” and about 5% are “critical.”  The main problem with the WuFlu seems to be pneumonia. My impression is that “serious” cases might require hospitalization and oxygen treatment, while “critical” cases might require ICU treatment such as intubation.  My source is here, from the same Worldometer site that our friend Rodin is relying upon for his daily posts.  These estimates are based on information from China through Feb. 11.

Even these figures seem too high to me.  Rodin’s daily post today (here) generally shows lower rates of serious/critical cases than the 20% combined figure noted above.  In Italy, it is less than 10% (1,518 serious/critical out of 17,750 active).  In South Korea, it is less than 1% (59 serious/critical out of 7,300 active).  In the US, it is less than 0.5% (10 serious/critical out of 2,395 active).

My suspicion is that the rates of serious or critical illness is much lower, and that the rates appear high because very few people have been tested.  This makes sense, as I would expect that initial testing would be limited to people exhibiting WuFlu symptoms.  South Korea seems to have done the most extensive testing to date, and its very low rate of serious/critical cases is consistent with the hypothesis that wider testing will show a higher prevalence of the WuFlu, with the vast majority of cases being so mild as to be almost unnoticeable.

II.  The Math on the Hospital Bed Crisis

I’ve seen news reports that the WuFlu has overwhelmed the health care system, in Italy in particular.  Here is an article from The Atlantic on Wednesday, March 11, stating:

Today, Italy has 10,149 cases of the coronavirus. There are now simply too many patients for each one of them to receive adequate care. Doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air.

This NYT article from Thursday, March 12 similarly claims, in its headline:

We don’t have enough ventilators and I.C.U. beds if there’s a significant surge of new cases. As with Italy, the health system could become overwhelmed.

I know that I’m just a country lawyer, though I did once study math through the graduate level, with a focus on probability, statistics, and mathematical modeling.  But it doesn’t take grad-level math to question these figures.  It takes middle-school algebra.

The NYT article linked above says that Italy has 3.2 hospital beds per 1,000 people (and the US has only 2.8 beds per 1,000 people).  Italy has a population of about 60 million, so this implies about 192,000 hospital beds.

As noted above, the number of serious or critical WuFlu cases reported in Italy, according to Rodin’s post today, is 1,518.  That is 0.79% of the number of hospital beds in Italy.

Think about that.  We’re supposed to believe that an influx of about 1,500 new patients has overwhelmed the medical system of a nation that has 192,000 hospital beds.

Put this in perspective.  Let’s round up the Italian number to 1% — that is, assume that the number of serious or critical WuFlu cases in Italy is equal to 1% of the country’s hospital beds.  Imagine that you run a hospital with 200 beds.  This means that you can expect two (2) extra patients as a result of WuFlu.  Are people seriously suggesting that a 200-bed hospital will be “overwhelmed” if it has to take in an additional two patients?

You all can believe anything you like.  I’m staying in the skeptic camp with Heather MacDonald, at least for the moment.

Now let’s apply these figures to the US.  Recall that, according to the NYT article linked above, the US has 2.8 hospital beds per 1,000 people.  With a population of 327 million, that’s about 915,000 beds.

How many serious or critical cases are there in the US?  Ten (10), according to Rodin’s post today.  But let’s assume that the WuFlu spread rapidly in the US over the next month.  How rapidly?  Well, China has had 80,000 cases over several months, so let’s make the extreme assumption that the US has 100,000 new cases over the next month — a vastly faster spread than in China.  And let’s use the Chinese figures for serious and critical cases, rather than the much lower figures from South Korea (more than 20 times lower).

So if the US has 100,000 new cases over the next month, 15% will be serious (15,000) and 5% will be critical (5,000), for a total of 20,000.  This would be about 13 times the number of serious or critical cases currently existing in Italy.

20,000 new cases in the US would represent about 2.2% of the hospital beds in the country.  A hypothetical hospital with 200 beds would have to take in about 4 new patients over the next month.

Is the medical profession seriously maintaining that their capabilities are so marginal, their ability to adapt so limited, as to be unable to cope with an increase in their patient load of about 2%?

I fully understand the graph about the capacity of the health system.  Here is one example:

I do not dispute this graph in theory.  I dispute the dashed red line about the “healthcare system capacity.”  Based on my calculations above, the dashed red line is nowhere near as low as indicated.  It is far, far higher — literally off the chart, in this graph.

As noted above, I don’t just understand mathematical modeling.  I am a lawyer.  I know how to mislead — in my case, I endeavor not to mislead myself, but I am ever vigilant about how my opposition can mislead.  This is precisely the way that one can generate a panic — with a graph that is correct in theory, with just one small misleading element.

I see no evidence whatsoever of any serious danger that the WuFlu will overwhelm our healthcare system capacity, even with no protective measures.

Another way to mislead, incidentally, is to assume that the number of cases will continue to grow exponentially.  The very early stages seem exponential, but the number of cases eventually follows an S-curve.  Continuing to project an exponential growth rate — say for an entire month — is contrary to the facts, and will lead to a vast overestimate of the number of cases that we can expect.

III.  Expanding capacity

The calculations above assume that we have no ability to increase our capacity to handle patients needing hospitalization.  Obviously, we have such capacity.  I haven’t looked into the precise figures, but my recollection from the hospitalization of family and friends over the years is that most hospital rooms are either single or double occupancy.  In a crisis, it does not seem, to me, that it would be difficult to add an additional bed in each room.  This would probably increase the availability of hospital beds by 30-40%.

This would be enough to hospitalize every American needing it, even if the number of cases increased to about 900,000, and even assuming the very high, 20% rate of serious or critical cases based on reporting from China, and not the rate of about 1% in South Korea and 10% in Italy.

This suggests that we could handle, without too much trouble, the health care needs of Americans even if the WuFlu spreads 10 or 20 times faster in the US than it has spread in China.

And we haven’t even talked about setting up emergency medical facilities.  You know, schools are closing.  Why not set up temporary hospitals in school gyms or auditoriums?  How hard could it be?  Bring in about 100 beds and some oxygen masks.  Have 4 nurses or orderlies monitor the patients, administering oxygen when necessary.  They could check each patient every 30 minutes or so.  If there aren’t enough pulse oximeters for each patient, have the nurse carry it around.  Patients who need critical care could be sent to a hospital.

As I understand it, even the serious WuFlu cases are essentially moderate-grade pneumonia.  Patients may need an oxygen mask, but they won’t immediately die without it.  They can take the mask off to eat, or to go to the bathroom.  They can basically lie there, in relative comfort with an oxygen mask, and watch TV.  Except that they can’t watch March Madness.

Actually, perhaps these hypothetical WuFlu patients will be able to watch March Madness.  Because, it seems to me, the term is being redefined.

I was expecting to watch March Madness on CBS Sports and ESPN.  It was going to involve a bunch of college basketball players.  Now, I seem to be watching a different kind of March Madness on CNN, MSNBC, and Fox News.  It involves a bunch of talking heads, politicians, and medical experts telling me that we’re all going to die unless we shut down the world.  I find this extremely unlikely.

I would appreciate any corrections to my analysis.

If I turn out to be correct, I am going to prepare a huge plate of crow for everyone who disagreed.  :)

Published in Healthcare
This post was promoted to the Main Feed by a Ricochet Editor at the recommendation of Ricochet members. Like this post? Want to comment? Join Ricochet’s community of conservatives and be part of the conversation. Join Ricochet for Free.

1. Member
Ontheleftcoast
@Ontheleftcoast

I’m finding myself in a shrinking minority with respect to my view of the WuFlu. ….By Monday, MacDonald and I may be the only skeptics left standing. (I would find her to be good company in such an event.)

Isn’t @iwe a big skeptic?

iWe, if you should see this, I would love to be reminded of the terms of that bet you made.

I remain a huge skeptic. I bet @Kozak that 1 Feb 2020-1 Feb 2021, the flu (and its complications as normally aggrandized by the CDC) will kill more than the Corona.

I remain certain that I will win this bet.

This is a bet @kozak would rather lose.

2. Member
Hoyacon
@Hoyacon

I’m finding myself in a shrinking minority with respect to my view of the WuFlu. ….By Monday, MacDonald and I may be the only skeptics left standing. (I would find her to be good company in such an event.)

Isn’t @iwe a big skeptic?

iWe, if you should see this, I would love to be reminded of the terms of that bet you made.

I remain a huge skeptic. I bet @Kozak that 1 Feb 2020-1 Feb 2021, the flu (and its complications as normally aggrandized by the CDC) will kill more than the Corona.

I remain certain that I will win this bet.

The interesting thing about this is that the preventative measures that some skeptics are decrying as “panic” may help you win your bet.  A true test would be to do little (i.e., not “panic”) and see how the bet turns out.

3. Member
Scott Wilmot
@ScottWilmot

4. Coolidge
OldPhil
@OldPhil

Just a couple of points.

The issue isn’t hospital beds, it’s ICU beds of which a large, 500 bed hospital has maybe a couple of dozen. The term “ICU bed” encompasses all the highly trained people and special things needed to keep people with very severe illnesses alive. For example, we have about 80,000 ventilators in the USA and most of them are already in use. We are not likely to be able to get more of them quickly.

The numbers of infections in the USA are increasing exponentially as they have been for the last two weeks, from 71 on March the first to 2976 now. I’ve been hoping to see evidence that growth was slowing, but none has materialized so far. How much longer can we expect to see this kind of growth in the numbers of infections? I have no idea. I’m just hoping to see some effect of the measures being taken and of the warming weather.

I’ll be the first to admit I’m no math whiz, but I keep seeing the term “exponential growth” in relation to the virus. So if there were 71 cases on March 1, shouldn’t there be a heck of a lot more than 2,976 two weeks later? Like 20 bazillion?

Now I’ll just scurry away and wait for the actual mathematicians to correct me.

5. Coolidge
Marjorie Reynolds
@MarjorieReynolds

One glaring problem with your analysis: You are counting generic hospital beds. An acute case needs an ICU (intensive care) bed, plus staffing. Those are two very different things.

And enough ventilators. A scenario where only the young can be intubated is a terrible prospect.

I don’t know your level of expertise. Do you actually know this? Do you have figures on the percentage of WuFlu serious or critical cases that need to be intubated?

My impression is that this is probably not necessary, even for most critical cases, though it will be necessary for some. I suspect that we’re mostly talking about a small oxygen mask — maybe just a nose-mask, like my CPAP — for most of the serious or critical cases.

It also occurs to me that, if we don’t have enough intubation-type ventilators, some people will have to settle for a regular hospital bed, with an oxygen mask, rather than intubation in the ICU.

I don’t know what capacity you have in the US. But I do know that Irish hospitals struggle with demand and capacity without the addition of a novel virus. I know that in Albania they have only something like 150 ventilators in the whole country, so even though they only have 40 reported cases they have taken great measures to prevent spread like banning private car use etc.

As regards Italy, Italians living in Ireland have been warning us about the situation there and why we shouldn’t be complacent.

6. Member
The Reticulator
@TheReticulator

Marjorie Reynolds (View Comment):
so even though they only have 40 reported cases they have taken great measures to prevent spread like banning private car use etc.

That’s strange. I’d think private cars should be preferred over mass public transit.

7. Inactive
Mendel
@Mendel

To the OP:

As somebody who sort-of works in this field (and will be involved in the local public health response to corona in my hometown starting tomorrow), I’ll give you a little feedback, even those most of these points have already been made by others.

The biggest problem with your calculations is the denominator. As you correctly point out, the real question we want to answer is whether our healthcare system has the capacity to absorb the potential onslaught of the minority of patients who require hospitalization. However, using the percentage of serious cases among total cases is a fairly useless statistic here since each country is deploying a different breadth of testing. But it doesn’t matter whether the percentage of severe cases is 0.1% of all infected with 10% of the population being infected, or 1% of all infected with 1% of the total population infected – either way, the number of hospital beds required is the same.

Similarly, using country-wide figures (as the JH tool does) is also of little utility since the spread of the virus is very non-homogeneous within each country affected.

The most relevant number we want is how many cases of serious Covid-19 (i.e. requiring hospitalization and/or mechanical ventilation) were there per community among the communities affected. And this is because the community is the level at which health care systems around the world function. Yet that data is nowhere to be found in your numbers, which is why most of your post is of little value.

The best figures so far are in the link posted by Snirtler several pages back analyzing hospital bed utilization per 10,000 residents in Wuhan at the peak of the outbreak, and those figures paint a bleaker picture.

8. Inactive
Mendel
@Mendel

Jerry Giordano (Arizona Patrio&hellip; (View Comment):
I mean, don’t the Italians have ambulances and vans? Can’t they just transport the few infected people to Turin, or Venice, or Florence, or Bologna, or Rome?

My impression is that this is probably not necessary, even for most critical cases, though it will be necessary for some. I suspect that we’re mostly talking about a small oxygen mask — maybe just a nose-mask, like my CPAP — for most of the serious or critical cases.

Jerry, I’ve read quite a few of your posts over the years and they show you to be both a very smart and a very caring man, so I say this with respect: you are the poster child for why experts shake their heads at amateur public health sleuths.

You obviously put quite a bit of time into crunching numbers and making graphs, but couldn’t be bothered to look up basic medical information about a) what types of respirators are required for severe respiratory distress and b) how feasible it is to transport patients with severe respiratory distress by automobile for several hours? Did you not think those facts might be key to the argument you’ve put quite a bit of effort into making?

In any case, both of your wild-guess assumptions are wrong. My best friends are both ICU doctors in a European city with a fairly major coronavirus outbreak. When patients get to the point at which they require intensive care, transporting them to a distant city is very difficult if not impossible and the infrastructure for mass movements doesn’t exist. And your suggestion of a CPAP-style device is laughable – anybody who would benefit from that is probably healthy enough to survive without any ventilation, whereas it would be as helpful as a rotary fan for patients in genuine peril.

These two facts are a main reason why I said in my previous post that the relevant geographical unit is the community, a point others have also made.

9. Inactive
Mendel
@Mendel

Jerry Giordano (Arizona Patrio&hellip; (View Comment):
The vast majority of those who die in the US from the WuFlu will be the elderly and infirm, chiefly people vulnerable to opportunistic infections, and likely to have died of something else in the near future (like the regular flu).

I imagine this attitude goes a long way toward explaining your belief that the entire reaction to corona is overblown.

This is obviously a subjective and not a scientific topic, but I think it’s not getting anywhere near enough attention. Based on fairly consistent data from around the world, it’s safe to say that the fight against corona is indeed really a fight to save old people with already-weak bodies. What price are we willing to pay to protect them?

I’m sure you read Prof. Rahe’s post a few days ago in which he essentially said “I’m heavily at risk and I don’t want to die yet; please do whatever you can”. Would you be willing to tell him your son’s robot fair is more important than trying to prevent him from dying somewhat earlier than he otherwise might? I’m not trying to provoke or troll you, there’s no clear answer to this question. But it’s one we shouldn’t sweep under the table.

10. Inactive
Mendel
@Mendel

For the record, I’m far from certain that corona will cause more deaths than flu this year. I’m fairly confident it would if we left it unchecked, but even then I’m not convinced the mortality would be orders of magnitude greater than the mortality caused by the flu. Conversely, I’m also far from convinced that this is a nothingburger.

The real truth is that we simply don’t know enough about this virus to gauge its potential, and anybody saying we do or that they are certain is overconfident or lying. I’ve worked peripherally on several other outbreaks (including bird flu and swine flu), and there are simply too many known unknowns and even a few unknown unknowns that prevent us from predicting the properties of this pandemic (unchecked or otherwise) with the level of confidence we would like to have.

The real question is: does enough evidence exist to suggest that Covid-19 has the potential to cause a much higher level of mortality than the status quo? And here I think the answer is clearly yes. Nonetheless, potential still implies probability, not certainty. There’s a very high chance that we are overreacting and that the “cure” will end up being more harmful than the disease.

The way to view the measures being taken is as an insurance policy. The entire reason insurance is feasible is because most people actually lose money on their insurance and would have been better off (in retrospect) had they not gotten covered. Yet insuring important risks is the mature thing to do.

11. Inactive
Mendel
@Mendel

Finally, just because I think taking greater precautions than we would during a normal flu season is proper doesn’t mean I agree with all (or even many) of the specific measures taken. From my view and the view of other public health professionals I know, shutting down all non-essential business in an entire county due to 5 cases is truly overkill. Where I live, we have a much higher density of cases with no store closures and the virus isn’t running through the populace like wildfire.

Similarly, I find the general panic mood to be fully counterproductive. The challenge for all of us over the coming weeks will be to take these measures in stride: understand that the virus does not pose a direct risk to most people, but that the tail risk for some populations is still unclear enough that we are taking an abundance of caution.

Above all, understand that nobody has enough facts to make the best choices, everyone is acting under duress, and some mistakes will inevitably be made. Getting piping mad at those decision-makers for their inevitable fallibility only makes a difficult situation worse. That doesn’t mean fealty, but it does mean that everyone needs a good dose of respect and humility in this situation.

12. Reagan
Roderic
@rhfabian

Just a couple of points.

The issue isn’t hospital beds, it’s ICU beds of which a large, 500 bed hospital has maybe a couple of dozen. The term “ICU bed” encompasses all the highly trained people and special things needed to keep people with very severe illnesses alive. For example, we have about 80,000 ventilators in the USA and most of them are already in use. We are not likely to be able to get more of them quickly.

The numbers of infections in the USA are increasing exponentially as they have been for the last two weeks, from 71 on March the first to 2976 now. I’ve been hoping to see evidence that growth was slowing, but none has materialized so far. How much longer can we expect to see this kind of growth in the numbers of infections? I have no idea. I’m just hoping to see some effect of the measures being taken and of the warming weather.

I’ll be the first to admit I’m no math whiz, but I keep seeing the term “exponential growth” in relation to the virus. So if there were 71 cases on March 1, shouldn’t there be a heck of a lot more than 2,976 two weeks later? Like 20 bazillion?

Now I’ll just scurry away and wait for the actual mathematicians to correct me.

The way it is going so far the total doubles every three days, so if there are 100 today tomorrow there will be 126, the day after that 159, and then 200 on the third day.  Six days hence there are 600.  In 9 days there are 1200, and then in 12 days 2400.  In 15 days, about where we are now, it’s up to 4800.

I hope it slows down soon.

13. Member
The Reticulator
@TheReticulator

Roderic (View Comment):
I hope it slows down soon.

New spectator sport: I watch the lower-righthand graph on this page from Johns Hopkins.  As @Rodin suggested, it would be good if Europe were now to be broken out as a separate line on the graph.

14. Member
Bob Thompson
@BobThompson

Mendel (View Comment):
Above all, understand that nobody has enough facts to make the best choices, everyone is acting under duress, and some mistakes will inevitably be made. Getting piping mad at those decision-makers for their inevitable fallibility only makes a difficult situation worse. That doesn’t mean fealty, but it does mean that everyone needs a good dose of respect and humility in this situation.

I can’t like this stance enough. Human ability to solve problems comes from mistakes, recognition, and correction. This takes place when there is effort by people to produce. Let’s remember failures and mistakes are an essential part of the learning process that yield success.

15. Inactive
Mendel
@Mendel

OldPhil (View Comment):
I’ll be the first to admit I’m no math whiz, but I keep seeing the term “exponential growth” in relation to the virus. So if there were 71 cases on March 1, shouldn’t there be a heck of a lot more than 2,976 two weeks later? Like 20 bazillion?

Not necessarily. Exponential growth simply means the rate of growth itself constantly increases, but both the underlying rate and the increments can still be small.

For example, compound interest on a savings account is a form of exponential growth, yet most people never make it to a gazillion dollars in their account.

16. Member
Ontheleftcoast
@Ontheleftcoast

Just a couple of points.

The issue isn’t hospital beds, it’s ICU beds of which a large, 500 bed hospital has maybe a couple of dozen. The term “ICU bed” encompasses all the highly trained people and special things needed to keep people with very severe illnesses alive. For example, we have about 80,000 ventilators in the USA and most of them are already in use. We are not likely to be able to get more of them quickly.

The numbers of infections in the USA are increasing exponentially as they have been for the last two weeks, from 71 on March the first to 2976 now. I’ve been hoping to see evidence that growth was slowing, but none has materialized so far. How much longer can we expect to see this kind of growth in the numbers of infections? I have no idea. I’m just hoping to see some effect of the measures being taken and of the warming weather.

I’ll be the first to admit I’m no math whiz, but I keep seeing the term “exponential growth” in relation to the virus. So if there were 71 cases on March 1, shouldn’t there be a heck of a lot more than 2,976 two weeks later? Like 20 bazillion?

Now I’ll just scurry away and wait for the actual mathematicians to correct me.

Doubling time for Kung Flu is about 6-7 days, give or take. 71 cases on March 1 (it’s a near metaphysical certainty that this is a low estimate by 2-3 orders of magnitude – meaning that the reality was more like 7,000-70,000 cases on March 1) would have meant 484 (28,000-280,000) cases two weeks later. If the doubling time were 14 days instead of 7, that would then mean from 7,000 to 14,000 cases in 2 weeks rather than 1 and so on.

The doubling time depends on

• the number of interactions a carrier has with susceptible individuals

• how contagious the virus is (how likely various forms of exposure are to transmit the disease)

• how virulent it is (how sick do you get and how fast do you get that sick) and hence how long it takes a newly exposed person to begin to spread it

It is to the virus’ advantage not to make people too sick to get around so rapidly that they can’t spread it effectively.

It is usually to a human population’s advantage to slow the rate at which a disease spreads; quarantine does this. It definitely improves the likelihood that the society and culture will not collapse to slow the rate of spread (increase the doubling time; see graph in OP)

We will know if warming weather slows the spread of this disease in hindsight; we ought not to plan on it. What’s happening now in the southern hemisphere may be an indication.

17. Coolidge
OldPhil
@OldPhil

Just a couple of points.

The issue isn’t hospital beds, it’s ICU beds of which a large, 500 bed hospital has maybe a couple of dozen. The term “ICU bed” encompasses all the highly trained people and special things needed to keep people with very severe illnesses alive. For example, we have about 80,000 ventilators in the USA and most of them are already in use. We are not likely to be able to get more of them quickly.

The numbers of infections in the USA are increasing exponentially as they have been for the last two weeks, from 71 on March the first to 2976 now. I’ve been hoping to see evidence that growth was slowing, but none has materialized so far. How much longer can we expect to see this kind of growth in the numbers of infections? I have no idea. I’m just hoping to see some effect of the measures being taken and of the warming weather.

I’ll be the first to admit I’m no math whiz, but I keep seeing the term “exponential growth” in relation to the virus. So if there were 71 cases on March 1, shouldn’t there be a heck of a lot more than 2,976 two weeks later? Like 20 bazillion?

Now I’ll just scurry away and wait for the actual mathematicians to correct me.

The way it is going so far the total doubles every three days, so if there are 100 today tomorrow there will be 126, the day after that 159, and then 200 on the third day. Six days hence there are 600. In 9 days there are 1200, and then in 12 days 2400. In 15 days, about where we are now, it’s up to 4800.

I hope it slows down soon.

OK, but I never understood “exponential” to mean “doubling.”  An exponent was always the teeny little number (I know, technical) next to the base number. So 100 to the 2nd power would be 10,000. And 10,000 to the second power would be 100,000,000. Pretty soon we’d be into Michael Bloomberg-type money and we’d all get a million dollars.

18. Member
Jerry Giordano (Arizona Patrio…
@ArizonaPatriot

Mendel:

Many thanks for your comments above.  These indicate that the real problem is ventilators, not hospital beds.  This is very helpful.

Here is a report from the Society for Critical Care Medicine on the issue, apparently just released Friday.  Some highlights:

• It estimates that we have about 97,000 ICU beds and another 535,000 acute care beds.
• It states that there are 62,000 full-featured mechanical ventilators.  Older models add another 99,000 to the supply, but are not “full featured.”  The older models include about 23,000 noninvasive ventilators, 33,000 automatic resuscitators, and 9,000 CPAP units (suggesting that my CPAP idea wasn’t quite as naive as your comment indicated).
• The feds have another 9,000 ventilators available for emergency deployment; states and private sources have more, but this is not quantified.
• The total number of ventilators, including anesthesia machines, is “possibly above 200,000 units.”
• There are staffing concerns, estimating the number of fully qualified staff (including board-certified intensivists) to limit treatment capability to 135,000.  (Of course, in an emergency, I would think that other docs and nurses could fill this gap.)

This Politico article states that about 2% of WuFlu cases require ventilators.

If we have 100,000 cases, we would require 2,000 ventilators, which seems well within capabilities.  Even Italy, the current source of the horror stories, has about 21,000 cases at present.  The US has about 3,000.

The SCCM report linked above is based on an American Hospital Association estimate projecting that 4.8 million patients would be hospitalized, about 20% of which would require ventilation (960,000).  This suggests about 50 million cases in the US.  Certainly this would overwhelm our medical resources, but how likely is this?

19. Thatcher
Bryan G. Stephens
@BryanGStephens

Mendel (View Comment):
That doesn’t mean fealty, but it does mean that everyone needs a good dose of respect and humility in this situation.

Amen.

20. Member
Randy Webster
@RandyWebster

Apparently, some MIT students have created a low cost (\$100) ventilator that can replace the \$30,000 ventilators in hospitals for all but the most severe cases.

https://phys.org/news/2010-07-students-low-cost-portable-ventilator.html

21. Member
Jerry Giordano (Arizona Patrio…
@ArizonaPatriot

Just a couple of points.

The issue isn’t hospital beds, it’s ICU beds of which a large, 500 bed hospital has maybe a couple of dozen. The term “ICU bed” encompasses all the highly trained people and special things needed to keep people with very severe illnesses alive. For example, we have about 80,000 ventilators in the USA and most of them are already in use. We are not likely to be able to get more of them quickly.

The numbers of infections in the USA are increasing exponentially as they have been for the last two weeks, from 71 on March the first to 2976 now. I’ve been hoping to see evidence that growth was slowing, but none has materialized so far. How much longer can we expect to see this kind of growth in the numbers of infections? I have no idea. I’m just hoping to see some effect of the measures being taken and of the warming weather.

I’ll be the first to admit I’m no math whiz, but I keep seeing the term “exponential growth” in relation to the virus. So if there were 71 cases on March 1, shouldn’t there be a heck of a lot more than 2,976 two weeks later? Like 20 bazillion?

Now I’ll just scurry away and wait for the actual mathematicians to correct me.

Doubling time for Kung Flu is about 6-7 days, give or take. 71 cases on March 1 (it’s a near metaphysical certainty that this is a low estimate by 2-3 orders of magnitude – meaning that the reality was more like 7,000-70,000 cases on March 1) would have meant 484 (28,000-280,000) cases two weeks later. If the doubling time were 14 days instead of 7, that would then mean from 7,000 to 14,000 cases in 2 weeks rather than 1 and so on.

I do not think that “doubling time” is the appropriate measurement.  This assumes continued exponential growth.  As I understand it, epidemics generally follow a Sigmoid curve (S-curve), which is similar to the exponential at first, then reaches and inflection point and either hits a peak, or approaches a maximum value asypmtotically.

22. Member
The Reticulator
@TheReticulator

Jerry Giordano (Arizona Patrio&hellip; (View Comment):
I do not think that “doubling time” is the appropriate measurement.

It’s a useful way of expressing the measurement, and for understanding the lower portion of the sigmoid curve, which is very useful to understanding whether the rate will not flatten enough to avoid overwhelming our medical resources.  I can’t think of anything inappropriate about it unless someone takes it to mean that it will continue that way forever.  If you’re measuring infections, the exponential phase cannot last forever, because at worst case everyone will have been infected.

23. Member
DrewInWisconsin, Influencer
@DrewInWisconsin

The question is, how many of our 3,000 cases are requiring hospitalization.

At the always-referenced Worldometers chart, of 3,000 cases, 10 are listed as “serious/critical.” How many of the 3,000 cases are just recovering at home and do not need hospitalization? I can’t find any figures on that.

24. Member
Jerry Giordano (Arizona Patrio…
@ArizonaPatriot

Jerry Giordano (Arizona Patrio&hellip; (View Comment):
The vast majority of those who die in the US from the WuFlu will be the elderly and infirm, chiefly people vulnerable to opportunistic infections, and likely to have died of something else in the near future (like the regular flu).

I imagine this attitude goes a long way toward explaining your belief that the entire reaction to corona is overblown.

This is obviously a subjective and not a scientific topic, but I think it’s not getting anywhere near enough attention. Based on fairly consistent data from around the world, it’s safe to say that the fight against corona is indeed really a fight to save old people with already-weak bodies. What price are we willing to pay to protect them?

I’m sure you read Prof. Rahe’s post a few days ago in which he essentially said “I’m heavily at risk and I don’t want to die yet; please do whatever you can”. Would you be willing to tell him your son’s robot fair is more important than trying to prevent him from dying somewhat earlier than he otherwise might? I’m not trying to provoke or troll you, there’s no clear answer to this question. But it’s one we shouldn’t sweep under the table.

I did read Prof. Rahe’s post.  It seemed quite panicked to me.  It assumes continued exponential growth, which is not the correct model in these circumstances, as I understand it.  We’re expecting an S-curve.

You are trivializing my concern a bit.  I’m not concerned about a single robot fair.  I’m concerned about shutting down the life of the nation — multiply the robot fair by 330 million, for the personal cost, and add the financial cost of a significant economic shut-down, which I have not quantified well, but could be in the hundreds of billions or more.

I did quantify the costs a bit, in one of the comments above.  If we have a 10% economic shut-down, it will cost about \$170 billion per month.

For the personal cost, read Adam Levy’s post yesterday (here).  He has actually been laid off.  He has no source of income.  He is facing a genuine personal catastrophe, while Prof. Rahe is projecting an extraordinarily unlikely worst-case scenario, reacting with extreme fear that I think is unjustified — and demanding the sort of extreme measures that have placed Mr. Levy (and doubtless many like him) in serious financial distress.  I don’t know how difficult Mr. Levy’s circumstances are, but he may well be wondering how he’s going to make his next mortgage or rent payment.

I’m not advocating doing nothing.  I’m advocating that we consider the cost, and logically evaluate the risks.

25. Member
Locke On
@LockeOn

The question is, how many of our 3,000 cases are requiring hospitalization.

At the always-referenced Worldometers chart, of 3,000 cases, 10 are listed as “serious/critical.” How many of the 3,000 cases are just recovering at home and do not need hospitalization? I can’t find any figures on that.

That number (10) hasn’t changed in several days, strongly suggesting it isn’t being updated and was probably invalid to start.  Some other countries are reporting the serious/critical category, or seem to be since it updates, so I assume they are keeping the column in the chart for that reason.  It would be better to just delete the ’10’ for the USA.

26. Member
Locke On
@LockeOn

Jerry Giordano (Arizona Patrio&hellip; (View Comment):
I did read Prof. Rahe’s post. It seemed quite panicked to me. It assumes continued exponential growth, which is not the correct model in these circumstances, as I understand it. We’re expecting an S-curve.

There’s two ways to get an S-curve.

One is where the population becomes saturated with the infection, and it naturally burns out.  For the implications of that, see above, stated by some professionals in the field.

The other way to get the S-curve is artificial mitigation measures, to reduce the network effect and consequently the spread velocity until either external factors intervene (hopefully warmer weather attenuates the virus) or some form of treatment/vaccine is developed (unlikely to appear in time, it seems).  The measures you are criticizing are aimed at this form of mitigation.

27. Member
GrannyDude
@GrannyDude

According to the Daily Wire, an Italian journalist has written an op-ed for the Boston Globe about the costs of not doing enough:

“We of course couldn’t stop the emergence of a previously unknown and deadly virus. But we could have mitigated the situation we are now in, in which people who could have been saved are dying. I, and too many others, could have taken a simple yet morally loaded action: We could have stayed home.

What has happened in Italy shows that less-than-urgent appeals to the public by the government to slightly change habits regarding social interactions aren’t enough when the terrible outcomes they are designed to prevent are not yet apparent; when they become evident, it’s generally too late to act. I and many other Italians just didn’t see the need to change our routines for a threat we could not see…”

…He explained that Italy is 10 days ahead of France, Germany, and Spain in the epidemic progression and 13-to 16 days head of the U.K. and U.S.

“That means those countries have the opportunity to take measures that today may look excessive and disproportionate, yet from the future, where I am now, are perfectly rational in order to avoid a health care system collapse,” he wrote.

“The way to avoid or mitigate all this in the United States and elsewhere is to do something similar to what Italy, Denmark, and Finland are doing now, but without wasting the few, messy weeks in which we thought a few local lockdowns, canceling public gatherings, and warmly encouraging working from home would be enough stop the spread of the virus. We now know that wasn’t nearly enough.”

28. Member
philo
@philo

Locke On (View Comment): That number (10) hasn’t changed in several days, strongly suggesting it isn’t being updated

Last week someone noted that numbers from some entities are not updated over the weekend. Seems like, under the circumstances, this tradition might be temporarily waived.

29. Member
Tim H.
@TimH

The questions about the Italian hospital situation are interesting.

My daughter’s college roommate, Kay, is in Naples for this year on a Fulbright.  Some time ago (daughter told us two weeks ago, and it happened at least several weeks before that—so, well before the coronavirus was out of control in Italy), Kay had some health problems and visited the doctor.  He didn’t tell her what was wrong but sent her straight to the hospital there in Naples.  She did not get put in a room but was on a gurney in the hallway.  She spent three days in that situation without being given any attention by the doctors or nurses.  When she finally had them come work on her, they would not tell her what was wrong.  They would not tell her what her test results were.  She eventually called her ex-boyfriend back in the States who is originally from northern Italy and had him speak to the doctors in Italian, pretending to be family (her dad’s side is Italian), before they would tell her anything about her case.  It turned out to be a kidney infection.  She spent maybe a week at the hospital, never getting a room or a bed, and rarely being told anything about her condition.  And keep in mind, she is 23 years old.  I understand her parents eventually came and got her out.

Now, that is one case—merely anecdotal.  But it gives me the impression that Italy’s hospitals might be more easily overwhelmed than ours due to poor management.

That doesn’t mean ours can’t be.

I’m on the side of moving the schools online immediately, to the extent we can, and convince everybody to keep at least six feet from other people.  Wash our hands and the things we touch thoroughly and regularly.  Epidemics spread exponentially in this phase, and we can be overwhelmed, too, if we don’t take action to limit the spread RIGHT NOW.

Yes, the young and otherwise healthy are likely to survive a case.  But we all know elderly people and those with poor health.  Many of them are at great risk of serious problems or death if they catch it.  My parents are right there in the high risk category, and I want them alive.  Avoiding people when you show symptoms is not good enough.  You can be contagious for 5-12 days before symptoms appear, so we all have to behave as if everybody else out there is spreading it around.

In the long term, I believe our best hope lies in a vaccine, and I’ve read that an experimental one is being moved to human trials right now.  But it will still take time to get a successful one to market, and for now, we need to change our personal behavior to limit this disease while we have the chance.

30. Member
Jerry Giordano (Arizona Patrio…
@ArizonaPatriot

According to the Daily Wire, an Italian journalist has written an op-ed for the Boston Globe about the costs of not doing enough:

“We of course couldn’t stop the emergence of a previously unknown and deadly virus. But we could have mitigated the situation we are now in, in which people who could have been saved are dying. I, and too many others, could have taken a simple yet morally loaded action: We could have stayed home.

What has happened in Italy shows that less-than-urgent appeals to the public by the government to slightly change habits regarding social interactions aren’t enough when the terrible outcomes they are designed to prevent are not yet apparent; when they become evident, it’s generally too late to act. I and many other Italians just didn’t see the need to change our routines for a threat we could not see…”

…He explained that Italy is 10 days ahead of France, Germany, and Spain in the epidemic progression and 13-to 16 days head of the U.K. and U.S.

“That means those countries have the opportunity to take measures that today may look excessive and disproportionate, yet from the future, where I am now, are perfectly rational in order to avoid a health care system collapse,” he wrote.

“The way to avoid or mitigate all this in the United States and elsewhere is to do something similar to what Italy, Denmark, and Finland are doing now, but without wasting the few, messy weeks in which we thought a few local lockdowns, canceling public gatherings, and warmly encouraging working from home would be enough stop the spread of the virus. We now know that wasn’t nearly enough.”

I do not know the source of this information.  I’m doing my own analysis of this, based on Worldometer data, and I do not think that he is correct in his comparisons.  France, Germany, and Spain are about 8-9 days behind Italy (not 10), the US is about 10 days behind (not 13-16), and the UK is about 12 days behind (not 13-16).  These may seem like small differences, but with growth modeled at this stage of the curve with a daily increase of about 33%, a few days make a big difference.

Based on reported cases, Italy is no longer increasing exponentially.  It appears to have reached the inflection point — as occurred in South Korea.

I’ve been crunching the latest numbers this morning, and plan a separate post on the issue shortly.