It’s March 18th, COVID-19 keeps spreading, and the world’s reactions are deepening. Global infected numbers passed 180,000 and deaths near 9,000, reportedly (and there are doubts about numbers). There are more infections and deaths outside of China than in, according to WHO, who maintains a global risk assessment of “very high.” The coronavirus is racing through Europe, throwing Italy into a nationwide quarantine and medical horrors. Spain is next up. France and Germany have tightened their borders. In fact, most of Europe is raising border shields. The British government is reconsidering its herd immunity plan after a high profile report thought it could lead to up to hundreds of thousands dying. Some leading US politicians are referring to COVID-19 as a “China virus” while some Chinese representatives blame it on the US or Italy. Canadians (of course) are calling for caremongering. The disease is heightening economic inequality. Sex workers are losing business.
In the US, there are 3,487 infections and 68 deaths, according to the CDC. The stock market is in chaos after the worst fall since the Cold War; some finance people have gone beyond fearing recession to muttering about the d-word. Trump now seems to take things seriously, calling on Americans to avoid gatherings of more than 10 people, and even agitating for a yuge stimulus bill, but most people don’t believe him. More than a dozen Congresscritters have quarantined themselves as is the outgoing White House chief of staff. New York State’s governor called for federal troops to expand that state’s medical capacity. San Francisco imposed a shelter in place edict and New York City is thinking about it. Medical workers are starting to get infected. Sports are shutting down and celebrities are getting sick, which means This Is Now Real for a lot of folks. Alamo Drafthouse movie theaters closed up. One vaccine is being trialed in Washington state, appropriately.
In this post I’ll share a series of forecasts. This may give you insights on how to plan for what’s next, as well as give a sense of how futures work can be done during a major crisis.
(The numerical order below is arbitrary)
FORECAST 1 Amesh Adalja (Johns Hopkins University Center for Health Security) offers a less frightening vision than most in an interview with Sam Harris. Adalja thinks the case fatality rate (CFR) is actually much lower than others have found. His 0.06 rate is six times more lethal than seasonal flu, but far less homicidal than other rates I’ve seen.
Adalja emphasizes several factors in creating that rate. Data collection so far has often been skewed by comorbidities and what he calls a “severity bias.” Adalja relies on South Korean data, which he deems the most robust. He fears state overreaction causes some medical problems, including capacity shortages and extraneous deaths (pointing to China and Italy). Additionally, COVID-19 is not that strong a virus materially, having a delicate fatty layer that, dried out, kills the thing.
As a result of this low CFR, the coronavirus should play out like a bad flu season over the next few months: a good number of infections, a small number of deaths suffered by susceptible people.
I recommend listening to the whole podcast. Harris asks good questions and Adalja answers with admirable concision.
FORECAST 2 On March 6th Business Insider shared a “leaked” slide from an American Hospital Association webinar. The presenter was Dr. James Lawler, associate professor of medicine at the University of Nebraska’s Global Center for Health Security.
The slide forecasts the course of a coronavirus outbreak in the US over two months:
First, some caveats from the BI article:
The slide does not give a particular time frame.
The slide represents “his interpretation of the data available. It’s possible that forecast will change as more information becomes available,” a spokesman for Nebraska Medicine told Business Insider in an email.
The American Hospital Association said the webinar reflects the views of the experts who spoke on it, not its own.
I’d add that we don’t know the rhetorical situation. Was this a worst case scenario? Was he trying to soothe or freak out the audience?
Second, a few clarifying attempts. R0 is reproductive rate, how many people a given infected person will infect. Community attack rate: I think that’s the proportion of a population who get infected. ICU: intensive care unit. CFR: case fatality rate, or what proportion of people the virus kills. PPV: I don’t know.
Third, some discussion. Dr. Eric Feigl-Ding has a good Twitter thread raising issues about key points. The CFR is on the low side, as is the ICU number (Italy’s seeing 10%). It presumes no public health measures. Degradations to health services through staff getting sick, supplies running low, or competition for scarce beds (see below) don’t play a role.
All of that said: this single slide gives us one way to think ahead about COVID-19. It introduces non-experts to key terms. It uses statistics. The result is a kind of thin scenario, a glimpse of how things might unfold. Rhetorically, it can spur us to action: to learn, to take public health seriously, etc.
FORECAST 3 Dr. Liz Sprecht fired off a Twitter thread exploring how the outbreak/ pandemic might stress medical services. Then she developed the thread into an article. She’s associate director of science and technology at the nonprofit Good Food Institute.
What drives this instance of futures thinking is the extrapolative method:
We can expect a doubling of cases every six days, according to several epidemiological studies. Confirmed cases may appear to rise faster (or slower) in the short term as diagnostic capabilities are ramped up (or not), but this is how fast we can expect actual new cases to rise in the absence of substantial mitigation measures.
That means we are looking at about 1 million U.S. cases by the end of April; 2 million by May 7; 4 million by May 13; and so on.
Sprecht focuses her exercise on two crucial medical metrics: available beds and masks. Read through to see just how bad she thinks it’ll get.
I want to give the author additional credit for showing ways her extrapolation could vary, based on different numbers:
If I’m wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by six days (one doubling time) in either direction. If 20% of cases require hospitalization, we run out of beds by about May 4. If only 5% of cases require it, we can make it until about May 16, and a 2.5% rate gets us to May 22.
Why do these two metrics matter? It’s clearly horrible that hard-working medical staff may suffer, and some will die. On top of that, let Eric Feigl-Ding explain:
Vicious cycle of spiraling worse care with epidemic: Why does CFR differ so much & why is it higher in extreme epicenters? Cuz hospitals+ICUs get overloaded, doctors/nurses are overworked/quarantined out of commission ➡️ this yields a vicious cycle of worsening care. #COVID19 pic.twitter.com/0ROBnZTM1Q
— Eric Feigl-Ding (@DrEricDing) March 8, 2020
FORECAST 4: Another forecast Twitter thread comes from infectious disease scientist Stephen Riley, who wants us to think ahead at a social scale. First, he urges us to recognize COVID-19 will be with us for a long time:
#COVID19 is now a part of our world and things are different. Things will get back close to the old normal only when most people have immunity. We have two ways to get immunity – natural infection or vaccination, but vaccines don't yet exist. (1/n)
— Steven Riley (@SRileyIDD) March 8, 2020
As a result, massive and sustained quarantines means changes to our societies:
It may be then that most of us will acquire immunity via natural infection, but I do not accept that. I think it is worth the most incredible coordinated human effort to create slightly different societies in which the virus cannot spread widely. (2/n)
— Steven Riley (@SRileyIDD) March 8, 2020
No metrics here. Just a forward glance at the likelihood of social transformation.
To sum up: four different views of COVID-19’s future, each using a different approach.
Coming up: more forecasts from other people, then some of my own.
(thanks to Steven Kaye and many others; stay uninfected, you all)