Things are getting far more serious by the day in Italy, France and Spain, as well as several other European countries. This country’s virus caseload is also rapidly rising- with over 700 new cases identified per day. When I wrote an article 5 days ago, US caseload was just over 1,000. Today it will surpass 4,000. This is not surprising, since there has been little testing to date, and many of those with the disease were never diagnosed. When testing becomes more widespread, expect a very large jump in case numbers and then a growth rate at least for a period, more similar to what has been seen elsewhere. Hopefully, the social distancing measures taken to date will slow the daily growth rate.

Image: CDC/Alissa Eckert, MS; Dan Higgins, MAMS via NPS

Quite a few articles and lectures have been flying around about where we will wind up in case volume and fatalities due to the compounding that could result from an exponential growth rate in the number of cases. Some forecasts are for half the population to be impacted, and at least 1% to die of those infected. This would result in a death toll of over a million, with a case volume over 100 million. These numbers seem high to me, mainly because I think there is a point at which extreme measures that limit growth will occur and they will not be voluntary.  Many articles argue for the need to bend the curve -- essentially using social distancing and all the shutdowns of activities to greatly reduce the growth rate in new cases (fewer people spreading the disease). If this is successful, many people may still get the disease, but not as quickly, which could relieve some of  the extreme pressure that a massive surge in cases  can create for the health care system.

This article is one of the most detailed and comprehensive looks at the experiences in China and other countries, and how social distancing and quarantines work to lower caseloads, and fatality rates.  In essence, instead of one infected person transmitting the disease on average to 2 or 3 others, the average could drop closer to 1 or even below 1. The impact of a slower growth in new cases, is less strain on the health care system, which produces a far lower death rate. Germany has a death rate so far of 0.2%. South Korea is below 1% with a significant number of cases, and China outside of Wuhan also has a death rate below 1% of those infected.

In the US, other than a nursing home in Kirkland, Washington, the US so far has a death rate of about 1%. On the other hand, Italy, Iran, and the Wuhan area, have death rates of 5% or higher. The author of the above linked article thinks it is likely that the death rates may drop in the high death rate areas to a 3-4% rate after the virus passes. As I have noted a few times, death rates are far higher among those 80 and over and those with serious medical conditions.  Median age of nursing home residents is in the mid-80s, and those who are residents of these facilities have limited life expectancies in most cases, even without a coronavirus hitting. A fair number of the deaths that will occur from coronavirus will be among this population. In Italy, doctors are choosing among patients to provide care given limited resources. Bending the curve is designed to prevent this type of approach from becoming common here.

This is also s good article making the case for social distancing.  Acting earlier can have a significant impact on case volumes and mortality. Illinois has almost 100 cases today, a bit over three times the number 3 days ago. Keep doubling the number every 2 days, and numbers get quite large very quickly --1000 times larger in three weeks. There are still regrettably people who choose to blather on about President Trump, and this or that failing. People who are obsessed with anything or anyone tend to get boring quite quickly. President Trump is not the reason Europe is in a crisis state at the moment. If someone wants to do something to help future patients, practice social distancing now. We will do better as a country when a large number of the people here begin behaving responsibly to limit the spread of the disease, not because of anything done in Congress, or any speech  delivered  by the President.

This is an interview (video embedded below) with an infectious disease expert from the University of Minnesota. The professor is plain spoken and serious without being apocalyptic. But he says things will be difficult for a few months, that this is not a two-week exercise and things are back to normal. One of his interesting comments is that it may be a mistake to close public schools. He argues that 38% of the nurses in America have school age children. If they have to stay home to take care of them, a real breakdown of the health care system could follow. So, cancelling schools to achieve social distancing is great, so long as there is some other solution so vital workers can still show up for work. In China,4,000 of the 80,000 who came down with the coronavirus were health care workers. The doctor thinks that once China relaxes some of the very strict rules and quarantines in effect in the area surrounding Wuhan, their caseload could start to build agin.

This is more ominous: some in China who had the disease and recovered, seem to have gotten it again:

Israel is a densely populated country. Outside of the Negev, density is roughly 2,000 per square mile. That is a target-rich area for a rapidly spreading virus. The country, in addition to its significant commitment to vaccine development for the virus, is also taking aggressive steps to slow the growth of the disease in the country, now about 200 cases.