The Covid-19 virus is already on six continents. The primary reasons are ease of travel, easily crossed borders, and asymptomatic carriers that can have the virus and spread it for at least 7 days and as long as 14 to 27 days.
As of today, more than 82,000 cases and 2,772 deaths have been recorded. Questions have been raised about what is the worst-case scenario with regards to the pandemic. Two epidemiologists have given their thoughts.
Epidemiologists Forecasts for Covid-19
Marc Lipsitch, a Harvard epidemiologist, was interviewed by WSJ and he said, “it’s likely we’ll see a global pandemic” of coronavirus, with 40 to 70 percent of the world’s population likely to be infected this year.3
Prof Gabriel Leung is the chair of public health medicine at Hong Kong University. He played a significant role in the Sars outbreak in 2002-03. Prof Leung works closely with other leading scientists at Imperial College London and Oxford University.
In a paper published in Lancet, “Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modeling study,” Prof Leung and his coworkers said,
In our baseline scenario, we estimated that R0 was 2·68 with an epidemic doubling time of 6·4 days.
Outbreaks were likely to be “growing exponentially” in cities in China, lagging just one to two weeks behind Wuhan. Elsewhere,“independent self-sustaining outbreaks in major cities globally could become inevitable”
R0 stands for R naught. An R0 value of 2.68 means that 1 person can spread the virus to 2.68 people on average.
In an interview with the Guardian, Prof Leung talked about the real-world meaning of the R naught numbers. He and most experts thought that each person infected would go on to transmit the virus to about 2.5 other people. That gave an “attack rate” of 60-80%.
“Sixty percent of the world’s population is an awfully big number,” Leung told the Guardian in London, en route to an expert meeting at the WHO in Geneva on Tuesday.
Knowing those projections, it is not surprising that schools are closed, major sports events are canceled, and international travel is limited in some countries.
Crunching the epidemic numbers
Lets put those numbers into the context. The US population per Worldometer is 330 million. Using the lower estimate of 40%, the potential number of infected people will be 132 million.
Among the infected, most will have minor symptoms and can stay home. However, in severe cases, they will need hospital admission. Recent data about the total number of cases, deaths, and severe illnesses can be seen at Covid19.app and shown below. The Covid19.app gathers data from BNO news, the Chinese government, the Hubei province, and Reddit r/Coronavirus.
Using the table above, the percentage of serious cases is 8,468/82,417, which is 10.27%. On Feb 23, it as high as 14.6%.
10% of 132,000,000 cases is 13,200,000 or 13 million serious cases.
Severe cases need life-support.
Severe cases may need a mechanical ventilator, dialysis or extracorporeal membrane oxygenation, or ECMO. ECMO is a way to provide oxygen to the blood when the oxygen level is not normalizing even with mechanical ventilation. Not all hospitals have ECMO.
To use these life-supporting technologies, there should be adequate hospital beds.
How many staffed hospital beds are in the US?
According to the American Hospital Association, for 2020, the staffed beds in community hospitals are only 792,417.
Community hospitals are defined as all nonfederal, short-term general, and other special hospitals. Other special hospitals include obstetrics and gynecology; eye, ear, nose, and throat; long term acute-care; rehabilitation; orthopedic; and other individually described specialty services.
Community hospitals include academic medical centers or other teaching hospitals if they are nonfederal short-term hospitals. Excluded are hospitals not accessible by the general public, such as prison hospitals or college infirmaries.
It is plain to see that 792,417 beds cannot accommodate 13 million severe cases. Intensive care unit beds are much smaller in number.
What does a staffed hospital bed mean?
Furthermore, “staffed” means there are nurses available, and nurses aides with expensive appropriate protective personal equipment (PPE) like gloves, masks, and gowns. What if they ran out of PPEs? A news article from The Washington Post said,
Some hospitals have just a week’s inventory of the N95 face masks
What happens when doctors and nurses need to take care of their sick loved ones? What if they start to get sick and die? In China, 3,000 health care workers got sick. Then those available staffed hospital beds will begin to decrease. The decrease will coincide with the rise in cases as the epidemic drags on.
Not all 132 million will need a hospital bed at once. I have not seen any US models to forecast the numbers. However, the CDC has said that community spread will be inevitable.
Currently, without an epidemic, hospitals are always full to capacity, especially with the flu season. When I was in the emergency room, it is not unusual to have non-ICU and ICU patients in the ER waiting for an in-patient bed.
What to do now?
Stay healthy. I will avoid crowded places, wear a mask if I’m sick, and wash my hands frequently.
If I have medical illnesses like diabetes, heart disease, and cancer, I will take my medicines, avoid sweets, and increase my physical activity.
Be prepared. Don’t Get Sick!
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