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When the virus now known as SARS-CoV-2 surfaced in Wuhan, China last December, the response was unprecedented. Roads were destroyed to prevent movement, apartment buildings were welded shut and factory production halted by as much as 70%. Over the next two months, over 780 million people in China faced quarantine or travel restrictions.
What would cause one of the world’s superpowers to take such drastic actions to contain a virus, efforts that would put their entire economy at risk?
When gauging the intensity of a viral outbreak, virologists and epidemiologists use available data to determine the case fatality rate (CFR) and the R0 number (pronounced R naught). The CFR represents the percentage of those who died as a result of contracting the disease. The R0 indicates how contagious the infectious disease is.
While a viral outbreak is running its course, both the CFR and R0 values can be a topic of ongoing study and debate. In the case of the SARS-CoV-2 coronavirus, these numbers are greatly affected by the accuracy of the data being released by the country where the disease originated, in this case China.
Now that the virus has taken hold in the United States, a wide range of opinions can be seen and heard concerning how we should respond as a nation. Among them, a common theme has been comparisons to seasonal influenza and its annual effect on our population.
In comments on social media and across discussion forums, many Americans have questioned the severity of this outbreak and what it means for the United States. Some have ridiculed the national response, calling it an “overreaction.” Others have made comparisons to Influenza by asking, “How many have died from flu,” in an attempt to downplay the potential effects of SARS-CoV-2 and COVID-19.
To better understand the potential threat to the United States, we look to Italy. On January 30, 2020, Italy announced their first cases of COVID-19, stemming from two Chinese tourists. On February 21, the country announced their first death from the disease. At that time, Italy had recorded a total of 17 cases. Just 24 hours later, Italy announced an increase to 59 confirmed cases across the country. On February 23, the country confirmed 73 new cases, bringing the national total to 153. A week later, on February 29, Italy had recorded 1,128 cases and 29 deaths.
As the exponential spread continued, cracks began to appear in the foundation of Italy’s health care system. By March 7, doctors at hospitals in the Lombardy region, considered to be among the best in the world, were reporting a shortage of beds, with ICU patients being kept in hallways or where available space allowed. The next day, Italy quarantined approximately 16 million people in the northern regions that were most affected. The following day, a national lockdown was announced, essentially barring any unnecessary travel or public gatherings anywhere in the country.
On March 9, a tweet by UK anesthesiologist Jason Van Schoor claimed that due to health care workers being overwhelmed, patients under 65 were not being attended to when go through sudden cardiac arrest. Two days later, associate professor Yascha Mounk from Johns Hopkins University published translated extracts from the “most extraordinary medical document I’ve ever seen,” in which Italian doctors suggested age being a factor in deciding whether treatment for COVID-19 would be given.
Today, just a few short weeks after their epidemic began, Italians are living in a new reality, with travel restricted and access to food and healthcare in question. A crisis management document released yesterday suggests that Italians over the age of 80 should be denied intensive care, in order to help mitigate the lack of resources.
As of this writing, Italy has confirmed 21,270 cases of COVID-19 and 1,441 deaths, for a 6.8% CFR.
Many have questioned why Italy’s CFR is so high compared to South Korea’s current rate of under 1%. Several factors have been promoted as possible causes. First, Italy has the second-highest population of elderly residents in the world. Italy has 3.2 hospital beds per 1,000 people, compared to 12.3 in South Korea. South Korea leads the world in testing for this strain of coronavirus, which means that their statistics may be more accurate at this point. South Korea is also reporting a high degree of success with chloroquine, a drug used to fight malaria and some autoimmune diseases.
If Italy’s situation represents a possible worst-case scenario for the United States, one may want to take into account the opinions of our own experts and doctors working on the front lines, before reducing the COVID-19 threat to “just the flu.”
- Harvard epidemiologist Marc Lipsitch told The Wall Street Journal that he expects COVID-19 to infect between 40% and 70% of the United States.
- A recently leaked presentation for hospital administrators directed them to prepare for 100 million infected, with 4.5 million hospitalizations and approximately 500,000 dead.
- A recent thread by Liz Specht, Associate Director of Science and Technology at The Good Food Institute, revealed that a complete breakdown of the U.S. healthcare system is possible by early May, based on current numbers.
- Dr. Marty Makary, a medical professor at Johns Hopkins University, has made repeated claims that the number of infected in the United States is likely already far greater than what’s being reported. Dr. Makary also claimed in a recent interview, that he believes the real number of dead in Wuhan to be as high as 100,000 to 200,000.
- The United States has only 2.8 hospital beds per 1,000 people (less than Italy). In a recent tweet by New York Times columnist Nick Kristof, he purports to be in receipt of a memo from a Seattle hospital in which doctors have suspended elective surgery, are down to a 4-day supply of gloves, and believe their “COVID-19 trajectory will be similar to Northern Italy”.
The real danger is not that you will die from SARS-CoV-2, it’s that this virus has the potential to overwhelm the U.S. healthcare system and fill every hospital bed in America within a matter of weeks. When that happens, normal access to emergency services will be hampered, and many routine medical matters will become another casualty of “just the flu.”