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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.
IV. About That 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. :)