The Biggest Scare

I haven’t looked at any data in detail lately for a couple of reasons. First, I needed to reach some closure with the death of my father. The funeral was a few days ago and was another surreal experience because of social distancing.

More importantly though, I will admit I was afraid of what I might find in the data. Unfortunately, my instincts were correct. The current case fatality rate (CFR) globally is 6.88% and still appears to be climbing. To provide some context, the estimates for the CFR for the Spanish Flu in 1918 ranged from about 6-8%.

I will add though that I still think this might be high because of our lack of a true understanding of the denominator because of the lack of adequate testing. South Korea gives us a little bit of hope in that regard, where the CFR is currently running at 2.21% However, it’s best to plan for the worst, so I will discuss further under the 6-8% assumption and at 20% attack rate.

The estimated total global mortality in 1918 from Spanish Flu was 50-100 million, although some experts believe that the higher number is more accurate. The estimated global population in 1918 was 1.8 billion. Today it is about 8 billion. Assuming we match 1918 and adjusting for the current global population, that means that we can expect somewhere around 222-444 million deaths worldwide from COVID-19. Even if the CFR is only 2%, that still means about 74-148 million deaths globally. However, it’s important to remember that this is a very different disease. One model of transmission for the Spanish flu estimates the R-naught at 1.36-2.07. It’s also important to note that there is a MUCH longer period of asymptomatic transmission before symptoms begin with COVID-19 than influenza as well as that the R-naught for COVID-19 is currently estimated at 2.2-2.7. That leaves me thinking that we will experience a higher attack rate than 20% with COVID-19.

A number that large is very hard to grasp. To provide some perspective, here’s a table of the estimated populations of the 25 largest countries in the world:

China	1,439,323,776
India	1,380,004,385
United States	331,002,651
Indonesia	273,523,615
Pakistan	220,892,340
Brazil	212,559,417
Nigeria	206,139,589
Bangladesh	164,689,383
Russia	145,934,462
Mexico	128,932,753
Japan	126,476,461
Ethiopia	114,963,588
Philippines	109,581,078
Egypt	102,334,404
Vietnam	97,338,579
DR Congo	89,561,403
Turkey	84,339,067
Iran	83,992,949
Germany	83,783,942
Thailand	69,799,978
United Kingdom	67,886,011
France	65,273,511
Italy	60,461,826
Tanzania	59,734,218
South Africa	59,308,690

I’m going to relate this to the US since that is where I live and where most of the readers of my blog are from. Imagine EVERY PERSON in the US dead. That’s the scale of death that we face on the global scale. As much as I’ve tried to impress on people what is developing, I still don’t think people understand it.

While the data seems to show that we are hitting the top of the curve for incidence, I firmly believe that is ONLY due to the social distancing and stricter measures being taken by governments around the world.

The big risk we are facing right now in the US is complacency. Just because we have a stabilizing incidence, people seem to think that we can go back to things as usual. That’s a major fallacy. Rashly reopening everything will take every state back to a point of needing to start at day one again with social distancing. Governors who are opening their states up quickly are going to be doing so at great peril to their populations.

There’s an even bigger problem though when those types of resets need to happen. Globally, we have been burning through medical supplies, pharmaceuticals, and staff at an alarming rate. Granted, production has increased for many of those items, but we are there are many others where production has not been increased to meet demand.

For example, as we lose healthcare workers, they can’t just be manufactured in the matter of a few weeks. Fewer caregivers means lower capacity for patients in hospitals. That also means that the surge capacity of hospitals drops for subsequent waves, which increases the chances of death from COVID-19 but other causes as well, which become what I’ve referred to earlier as secondary causes of death.

Another secondary cause of death will stem from the shortage of pharmaceuticals. Currently, the main reported shortage is albuterol sulfate, which have been used extensively in the treatment of COVID-19, and is also the active ingredient in inhalers to treat asthma. That means that we could easily start to see secondary deaths among people with asthma who are unable to get inhalers who have a major asthma attack. This is one of the reasons I urge people who need life sustaining medications to try to get a three month supply.

I honestly hope I’m wrong and am accused of being an alarmist. However, I would much rather we act appropriately and not need to than to do nothing and wish we did.

People wonder why this gives me anxiety and I lose sleep. This is just part of the reason. The possible tertiary and quaternary impacts are still on the horizon as well unless we take this seriously. We’ve learned that we have a lot of selfish, uneducated people with loud voices in the US who will make things worse.

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