The Future?

I haven’t written for awhile because it seems like people have become entrenched in their beliefs about the pandemic. I had been writing this most of the year in the hopes of convincing some people of just how serious this would become and to take precautions to limit the spread. That seems almost for naught now.

I’m concerned that what has been reported as a downturn is yet another illusion, as is the narrative that there wasn’t a spike related to Thanksgiving.

My thinking has to do with both the media and behavioral psychology. The data from the two weeks leading up to Thanksgiving were confounded by people both behaving more carefully because of intention to travel and also getting tested with that intention. In addition, media attention also raised awareness, which likely drove improved behavior.

The drop in cases over Thanksgiving is pretty self explanatory. Where it gets interesting though is the more recent drop. If people had been being more careful in preparation for Thanksgiving, that should also show up as a decrease three weeks later.

The vertical green line is two weeks before Thanksgiving, indicating where I guessed testing and caution would increase. The yellow vertical line is three weeks later, when that behavioral change, even for a short time, would have an impact. The red vertical line is three weeks after Thanksgiving, where I would have expected the holiday to have an impact. All of these interpretations are supported by the three week red curved case slope line, which is a measure of how fast these are accelerating or slowing, depending on how far above or below it is from the black dotted line. It’s fair to assume that the same kind of behavior would play out for Christmas.

The problem is that with people thinking that this represents a true decrease, those behaviors will reverse, causing another acceleration in the number of cases. Combining that with the most recent round of travel, the data suggests another major acceleration in case numbers around January 14th. This had me hoping that the harsh reality that was coming would finally convince those who have been denying this to start taking it seriously which might have had this under better control by March.

Unfortunately, two curve balls have come into the mix. Southern California (and other parts of the country) already have no ICU beds available and are having to be creative for additional regular hospital beds as well. Conversations around rationing care have already occurred around the country. Earlier this year, there were shortages of albuterol, and decisions had to be made around how to ration ECMO devices, which can simply be thought of as a bedside heart/lung bypass. California is experiencing problems with oxygen supplies as well as endotracheal (breathing) tubes. We are coming up against a breaking point soon from a supply chain for medical devices and pharmaceuticals as this continues to get out of control.

The other problem is the new strains that have been reported in the United Kingdom and in South Africa. The UK strain seems to have a much higher rate of transmission. It would be interesting to know the genetics of the current cases in California and Tennessee to determine the rapid rise in cases in those areas are the same strain.

The strain that has emerged in South Africa seems to affect younger populations much more adversely that what has been seen so far. That would also mean a greater need for hospitalization.

The biggest problem then lies with having the possibility of both of those strains superimposed on what we already have been experiencing. If that occurs, that means that the demands on healthcare will accelerate even more rapidly, bringing much of the country to the point that California has reached very quickly. That suggests that the worst of this may not begin until February or March, but of course, that’s just conjecture. There are so many variables in play now that it’s really anyone’s guess, but my money is on the worst winter most people have ever experienced. Wider vaccine availability cannot come soon enough.


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