The Virus By the Numbers

I'm writing this because there's some really insane stuff that's being said by people who should really know better, and I'm sick of discussing it one post or email at a time. So, this is my One Big Post that I'll point people toward rather than bringing it up again and again.

In case you haven't noticed, we're in the middle of a pandemic. Just so that we're all using the same terminology: 

• The virus is Severe acute respiratory syndrome Coronavirus 2. It's usually abbreviated SARS-CoV-2. It's a brand new kind of Coronavirus, so for a while, before it had this awkward name, people were calling it "novel coronavirus". (For the non-English speakers and D students, "novel" is another word for "new".)
• The disease that the virus causes is called Coronavirus Disease 2019, and it's usually abbreviated COVID-19. It's called that because it was discovered in 2019.

This came out of nowhere in China in late 2019. Because it was new, it caught people by surprise. Worse yet, most of the world underestimated it despite experts screaming about it almost from the beginning. People just don't understand exponential growth.

When this broke loose and people finally did start to take it seriously, the big concern was overwhelming the hospitals. The phrase of the day was "flatten the curve". You've probably seen a picture like this:

The idea was that IF we stayed at home for a little bit, we could slow (NOT stop) the growth of the virus enough to avoid overwhelming hospital emergency rooms. It worked both because people weren't getting infected and because they weren't doing dangerous things like driving. And, aside from a few places like Northern Italy and New York, it mostly worked. It bought us a precious month or two to ramp up supplies, train people, and make the shifts to infrastructure so that home delivery services, home internet, and telecom infrastructure could handle the change.

Well, it worked that way in most of the world. In a few places, people denied the problem and turned a public health issue into yet another divide between the reality-based community and conspiracy theorists. Fortunately, in most of the world, the conspiracy theorists were shouted down or ignored outright. But it led to a refinement of that graph:

We're now in the blue part of the graph in Switzerland. The US is still in the purple part. We survived the initial rush. We HAVE NOT survived the whole course of the virus. Because staying at home WORKED, people are claiming that it was overreaction.

But now we need to think about the long term. And people are almost as bad at that as they are at math. So, let's lose the whole audience by using math to think about the future.

Right now, there is no vaccine. The world best time for developing a new vaccine is 4 years. In theory, it could be as little as a year from now, but that assumes a bunch of "win the lottery while being struck by lightning" levels of unlikely. Pretty much every drug company and qualified government agency in the world is working on this, but they all know that it's a longshot. We MUST start thinking about this as something that we live with for YEARS.

Why is this virus so dangerous? It comes down to two things:

• Most of the time, when you get sick, you have symptoms within a day or two. You know it and, if you're a responsible adult (and your boss is, too), you stay home until you recover. You might expose your coworkers for a day or two, but it's limited. However, with SARS-CoV-2, you can be sick AND CONTAGIOUS for up to 14 days without showing symptoms. If you're infected, you roll around infecting everyone around you for two weeks without even knowing it. So, every person who catches it infects a lot more people than they would with a regular cold.
• COVID-19 (the disease that the virus causes) is A LOT more dangerous than the flu if you catch it. A lot more people end up in the hospital, and a lot more people die. The current best estimates are that it's about 10x more deadly if you catch it.

So, with these problems and no vaccine, we basically have three options for dealing with the situation:

• Option 1: Stay hunkered down until there's a vaccine. This could take years. It would save millions of lives, but it would require us to restructure major parts of the world's economies and governments and cost a lot of people a lot of money.
• Option 2: Resume normal operations as much as possible. When it gets bad and there are no free hospital beds, go back to lockdown until it's under control again. This is sometimes called "the hammer and the dance". Repeat this lock-unlock cycle until we either have a vaccine or enough people have been exposed for us to develop herd immunity. Downside: A LOT more people will die. Upside: We know how to do this. No major changes necessary. I suspect that most of the world will go with this option.
• Option 3: Resume normal operations and keep things open no matter what. Squander the win we've had and just let the bodies stack up, no matter how bad it gets. We'll get to herd immunity much faster, but we'll get even more death than option 2. So much so that dealing with all of the corpses will be a major challenge. But, Karen from the suburbs will be able to get her hair dyed, so for some reason, we have to seriously consider that trade-off.

A lot of people are skeptical about the body count with options 2 and 3. Let's talk about Option 2 (the hammer and the dance), and let's assume the most wildly optimistic scenario.

• World population: 7.59 billion people. The US population is 324 million people. The US is home to 4.3% of the world population.
• Herd immunity usually requires a MINIMUM of 60% of the population to get sick and recover. It can be up above 90%, and if the virus mutates too fast, the count is reset. But let's be optimistic and call it 60%.
• The percentage of people who are dying from COVID-19 is somewhere between 5% and 0.5%. There's a lot of uncertainty because we still don't have enough tests to test healthy-looking people to see if they're sick or antibody tests to determine whether they've already been sick. But, again, let's be optimistic.

With just those 3 numbers, assuming that we let this unfold slowly enough that we don't overwhelm hospitals, and we take the most optimistic numbers, here's how the math works out IN THE BEST CASE:

• World deaths: 7.59 billion people * 60% * 0.5% = 22,800,000 additional deaths worldwide from COVID-19
• US deaths: 324 million people * 60% * 0.5% = 973,000 additional deaths just in the US from COVID-19

Now, let's be realistic but just a little bit pessimistic. We'll still assume that enough people stay home and wear masks to keep the hospitals from being overwhelmed, but we'll assume that we don't get herd immunity until we hit 90%, and we'll assume that the death rate is closer to 5%. These are both just as plausible as the optimistic numbers above. Now the numbers look like this:

• World deaths: 7.59 billion people * 90% * 5% = 342,000,000 additional deaths worldwide from COVID-19
• US deaths: 324 million people * 90% * 5% = 14,600,000 additional deaths just in the US from COVID-19

If we want to be even more pessimistic, we need to think about that initial "flatten the curve" graph. The whole reason for that was because hospitals don't have a ton of extra beds. In fact, there were some pretty severe shortages before COVID-19 came along. This means that most of those COVID-19 patients end up stacked in hallways and in overflow emergency shelters receiving substandard care with whatever equipment can be scrounged and whatever hospital staff are still healthy and awake enough to take care of them. Along with all of the people with "routine" emergencies like heart attacks and car crashes and broken limbs who are in the same situation and receiving the same substandard care.

You know what. I'm not going to look up those worst case numbers. I just can't stand the thought of it. 14 million unnecessary, additional deaths is bad enough. I can't believe that people are seriously proposing making it WORSE because they're bored and their governments don't give enough of a shit about them and they don't care enough about their fellow human beings to help them through this. "I need to risk my life because I can't afford food if I don't" is so screwed up in so many ways that it hurts to think about it.

Oh, I should probably also mention something about masks. Wearing a mask doesn't protect you very much. The mask protects everyone around you in case you are sick. It sucks, but you do it because you're an adult and you possess some amount of decency and compassion for your fellow humans. If masks are encouraged where you live, and you see someone who's not wearing a mask, one of two things is true:

• They may be very poor and unable to afford a mask. This is a tragedy. These people should be helped.
• They are a selfish sociopath who thinks that their comfort is worth more than your life. These people should be treated with utter contempt.

Personally, I think the appropriate way to deal with this is for authorities to carry extra masks. Offer one to anyone not wearing one. If they refuse, take them to jail. If they're going to put a gun to everyone else's heads by being selfish, they deserve the exact same treatment that any other attempted murderer receives. 

All we need to do to beat this is stay home. Watch a lot of TV. Listen to the radio. Or go with Netflix and Youtube and Facebook if you prefer the internet. When you go out, you're playing Russian Roulette with everyone else around you. Play as few rounds as possible. Go out if you have to, but stay at home the rest of the time. It's not hard. And yet, somehow, we're failing.