38,000 cases in Oregon within 30 days? Thoughts on COVID-19, March 4

My disclaimer: I’m not a healthcare worker, an epidemiologist, or a public health official. I am smart, educated person, measured in my thinking, a good researcher, and someone who can easily see things from a systems perspective. I have been following the COVID-19 developments closely since the middle of January. These are just my thoughts. I write to wrap my head around things that are big and important. Please do your own thinking, and listen to your local and state health officials.

Updated March 6, 2020 9:42am.

Today I read the WHO report from their visit to China. If you are science-literate, please read it. Several things that struck me, as I understand them (again, not a doctor, but I do understand health terminology and statistics to a large extent):

  • The “mild” cases that account for 80% of cases INCLUDES people who did not get pneumonia as well as moderate cases who did get pneumonia but did not move into the severe category. (so “mild” can still mean pretty darn sick…). The severe category (roughly 20% of cases, based on China numbers), are people who are needing medical intervention to keep their blood oxygenated at acceptable levels, or needing some similar level of intervention. 13% of those cases were the severe cases–things like septic shock and multiple organ failure (p. 12 of report). That’s a lot of sick people.
  • Another interesting note about asymptomatic confirmed cases: most of those people went on to develop symptoms. Truly asymptomatic cases were rare. (Translation: people can test positive for the disease before they start having symptoms, but most people will go on to develop symptoms). (p. 12 of report)
  • China’s response to the virus was big, quick, widespread, and severe. The WHO report determines that the severe measures and enormous governmental response was the only thing that has slowed down the spread of the virus in China. Just to trace contacts of confirmed cases, in Wuhan alone, they had 1800 teams of epidemiologists, with at least five members on each team (that’s a minimum of 9,000 epidemiologists, folks) working meticulously to find and follow through with contacts of confirmed cases. While China’s numbers have steadily decreased since the middle of February, the WHO report determines that the only way that decrease was possible was by the country using aggressive and drastic measures, including using state surveillance, big data, and AI to track potential cases (including tracking citizens who bought over the counter cold and flu medications online or at a pharmacy), locking down multiple cities, closing schools and businesses, restricting movement outside private residences, closing public transportation, limiting the number of people allowed to leave their home at a time, building multiple hospitals in just two weeks, etc. At this point, it is hard for me to imagine the US pulling off an effort anywhere close to that.

3. State health officials and epidemiologists in Oregon and Washington concur that there are at least 300-500 undetected cases in each state because community spread has been occurring for about six weeks, and testing criteria was too narrow for too long. Here is today’s update from Governor Kate Brown and Oregon Health Authority. While we still only have three confirmed cases in this state, I expect that to drastically change in the next few days. My wife and I did the math last night, playing out the numbers of how many cases could be in Oregon thirty days from now. If the testing issues continue, most of these cases would not be confirmed. We used the most conservative estimates based on what the research shows so far. These estimates are based on how things played out in China, so these predictions inherently assume that the measures taken by the federal and state government would somehow be as successful as China in slowing the spread of the virus through the population.

Assumption #1: There are currently 300 cases in Oregon (undetected)

Assumption #2: R0 (Reproductive number)= 2

Assumption #3: Incubation period= 5 days (every five days, each new case infects two new cases)

Assumption #4: 20% of cases are severe, requiring hospitalization

Assumption #5: 3.4% mortality rate

  • Projected Cases in Oregon
  • Day 0 (today): 300 cases, 60 severe
  • Day 5: 900 cases (300 original + 600 new infections), 180 severe
  • Day 10: 2,100 cases (900 + 1200 new infections), 420 severe
  • Day 15: 4,500 cases (2,100 + 2400 new infections), 900 severe
  • Day 20: 9,300 cases (4,500 + 4,800 new infections), 1,860 severe
  • Day 25: 18,900 cases (9,300 + 9,600 new infections) 3,780 severe
  • Day 30: 38,100 cases (18,900 + 19,200 new infections) 7,600 severe, 1,292 deaths

The numbers above are a quick and dirty estimate on the number of infections, not the number of cases that will be confirmed. Right now, Oregon only has the capacity to test 80 people a day, and 1,500 tests total. This scenario is just what might happen in one state, while the rest of the world deals with their own outbreaks, their own overwhelmed healthcare system, their own lack of beds and protective equipment. Obviously, I hope those numbers prove to be wrong. There are clearly lots of variables I did not factor in. This is just one possible scenario, based on the values we gave for the five assumptions above. I hope we can find a way to keep the virus from spreading at that rate. How many hospital beds are there in the state? Based on available data on Wikipedia, we did a rough estimate that there are about 17,000 beds in the entire state. I’m assuming that the majority of those beds are filled already, especially during flu season. If reality ends up being anywhere close to this projection, we’re in for a shit show. The impact of this on the healthcare system, how it will displace other needs and tie up local systems is the biggest threat to us.

4. I heard some people today in my community downplaying it as “it’s just a flu.” It’s not. Ignorance (both willful and unwillful) can be just as dangerous as panic and fear-mongering. Please educate yourself from reliable sources of information, and then please spread the information that this is not “just the flu.” Base reason: Basic biology–these are two different types of viruses. Reason one: As of right now, COVID-19 appears to have a higher mortality rate than the flu. Reason two: No one has immunity or has been vaccinated against it, so there is no benefit from ‘herd immunity.’ Reason Three: We’ve been studying influenza since 1933 when it was first identified. We know what flu does. The virus that causes COVID-19 is new and still largely unknown.

5. I’m waiting for the librarians to do some clever PSAs about the “novel” coronavirus. C’mon witty librarians, bring it.

6. In the back of my mind, I’m constantly thinking about what small steps I can do to help reduce the spread of COVID-19. It’s not just about protecting myself and my family, but also knowing that each person could unwittingly spread it to someone who will not be as resilient to the disease. Today, I took these steps:

  • I have a pack of disinfectant wipes in the car, and I wipe my hands every time I get in the car. Same for my kids. I wash my hands as soon as I get home, as well as many many other times per day. Here’s how many times you should wash your hands each day.
  • We’re being more insistent with hand washing with the kids at home before meals and after going to the bathroom. We talk about it in terms of keeping other people safe from germs, not just ourselves.
  • I went to the library and got two bags of books to read to the kids. I got home, put on some gloves, and wiped each book’s cover with disinfectant wipes.
  • I’m avoiding crowded places and going out in the public far less than normal. This is just good prevention for everyone right now. It doesn’t have to be full-on isolation, just try to reduce the amount of time you are in public spaces as much as you are able. Some people will not be able to remove themselves from the public sphere. Be kinds to bus drivers, healthcare and home health workers, teachers, front desk people, sanitation workers and cleaners, especially.

Let’s hope for the best, but it looks like we’ve missed our window of opportunity to slow this down. We have no choice but to just ride the wave now. Please do what you can to prepare yourselves, your family, and your community. Please do it, like, yesterday.

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