Wait - why is Jason talking about COVID-19? And why are these written like FaceBook posts? There’s a longer explanation here but the short version is that my day job for the past 15 years has been developing models of human health effects and medical response for chemical injuries and biological illnesses, including pandemics. I’ve been making these posts on FaceBook and I was asked to put them in a more shareable manner. I’m linking to the posts on the explanation page. These are the original, unedited posts. I’ll continue until I run out of things to say.
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Originally posted here on March 18th.
It’s been busy here. Adjusting to teleworking but, also, as mentioned in my previous COVID-19 posts, I literally specialize in developing models of human health effects and medical response in mass-casualty scenarios so whereas I’m not directly working COVID-19, it’s been interesting to see how this pandemic is influencing my current projects. Also, I’m spending a lot of time answering folks questions the best I can. So, as I’ve said, it’s been busy here.
We have a pretty dark sense of humor at my day job. You have to – because when you first start doing this kind of planning, the anxiety becomes pretty overwhelming. You eventually have your first “nuclear nightmare,” as we call it. Mine is a recurring one – I’m doing something mundane and there is a nuclear blast out the window. I realize that someone I love is on the other side of the cloud. On the good nights, I wake up. On the bad nights, the dream plays out. In a way, this ongoing pandemic is the dream playing out, but a lot slower. I have family in NYC, family in Buffalo, family further down in VA, even friends just a couple of miles away, and there’s a cloud between all of us, and I don’t know what’s going to happen.
Thankfully I can communicate with all of them – this isn’t the nuclear scenario – our phones are working, the internet is working. I actually do know how they’re doing. My therapist is doing teletherapy. My job and home projects are keeping me busy. But I’m writing all of this because I want you all to know that, on some level, I completely empathize with your anxieties. I have felt them and compartmentalized them and turned them into dark jokes when I had to for the past 15 years. So whereas I talk a lot about math in these posts, I just want to let you all know that I am actually available if you want to chat. I will try and find the time. I have become TERRIBLE at email but I’m on hangouts (jrodinator) or, if you want, you can message me for my number and we can text or talk on the phone.
I’ve had 15 years to work through the feelings some of you are feeling everyday right now. And this is something that I can offer – some truth, some perspective, and hopefully a little levity.
With that said…a little math.
Later this week I’m going to do a longer post about asymptomatic and presymptomatic transmission (folks who are infectious without showing symptoms and folks who are infectious before showing symptoms, respectively) and try to put that into perspective because there’s a lot of news about it. But that’s for tomorrow, maybe. For now, just stay home to the fullest extent that you can. We’re posting up for two weeks starting this past Friday. Today’s the most likely day for us to exhibit symptoms if we got sick out there, but it really can pop up a couple of days to another whole week from now. So be vigilant and stay home.
But let’s talk about severity, because that seems to be the main driver of anxieties.
Yes, this disease has the possibility to become extremely severe and, yes, it does that primarily in elderly populations. Immunocompromised people also have a higher likelihood of a severe infection. Interestingly, out of both China and Italy we’re seeing more men die than women. My personal belief, and I’ve seen some folks postulate this as well, is that the higher fatality among men has to do with smoking. You need strong lungs for this one, and lifetime smokers are at a disadvantage.
You’re also seeing a lot of other things I talked about play out right now. In my very first post I said that case fatality rate (CFR, the percentage of people who die that are confirmed illnesses) is highly dependent on resources, and how it's malpractice to talk confidently about one as a pandemic is first taking off. Italy and Korea are two case studies on CFRs and resources. As of this morning, South Korea has 8,413 cases and 84 deaths. That’s the 1% you hear sometimes, and that’s the best case scenario. Italy, on the other hand, has 31,506 cases and 2,503 fatalities. That is an 8% CFR. That is a terrifying number. If you lived in South Korea, one out of every 100 people you knew would succumb to this disease, statistically. If you lived in Italy, one out of every 13 people you knew would succumb. What’s the difference between the two?
South Korea launched an extensive COVID-19 testing program that was symptom independent. Everyone could drive up, get tested, and find out if they had the disease. If they did, they had to isolate themselves – remove the infectious from the susceptible as I said in my first post. If they were elderly or immunocompromised, they could receive supportive care and treatments early in the process – not from the moment they would need a ventilator. Mathematically speaking, the extensive testing also lead to a bunch of confirmations in age groups that weren’t necessarily susceptible to severe infection, so the denominator in the CFR calculation was inflated, decreasing the CFR but…it wasn’t going to hit Italy’s 8%. A bunch of things are going wrong over there.
In Italy they only tested symptomatic people. Asymptomatic, mild, and moderate infections still went about their day, shedding virus particles on doorknobs and ATM keypads. Those particles were picked up by susceptible people who went on to develop severe infections. Since the testing was slow, they didn’t start to receive supportive care until later in the process. Since they don’t have enough ventilators, crisis standards of care were enacted and there were people who had to die without the care they needed to fight the infection (I talked about crisis standards of care in my last post. The denominator was lower in the Italy case, so the CFR is a bit inflated, but the undeniable fact is that thousands of people have died there and will continue to die there. At the ~14,000 case mark, a study was done on the CFR. 0.6% of the people between 50 and 59, 2.7% of the people between 60 and 69, 9.6% of the people between 70 and 79, 16.6% of the people between 80 and 89, and 19% of the people above 89 succumb to the disease for an overall CFR of 5.8%. Starkly, of the 14,000 cases, only two people younger than 50 succumbed. But those numbers were when Italy was on the initial cusp of crisis standards of care. I haven’t seen a new report yet, but I have to imagine the influx in deaths are in the 80 and up group. There aren’t enough ventilators.
As I said in my last post, we have some positives going for us. We have the Strategic National Stockpile that holds ventilators in reserve. We have Title 32 and Title 10 which will allow the National Guard, Reserves, and other military assets to build field hospitals under the direction of FEMA and dispatch additional military resources. Those resources need to be employed, and it doesn’t seem like they have yet, but they do have rapid response times so they can go up fast when needed. But right now, without those assets, I’d say we’re following the Italian model. Communities are stepping up, which is great, and folks are self-quarantining, which is also great – I just really hope you all are making sure that everyone in your life is doing the right thing right now.
Anyway – this wasn’t a lot of modeling, more of a check in. Stay vigilant. Stay inside. Practice good hygiene. Support your neighbors! Donate to food banks! Check in with your loved ones and friends (I need to do more of this, myself). Make people smile when you can.
I’ll post more as I can, and as long as folks seem to be getting something out of these.
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These are my opinions and thoughts and analyses - I am not representing any government agency or my company. More disclaimers on the main page.