Wednesday, April 22, 2020

Some Grim Guesses on COVID-19

(I may well be wrong about all of these things! I would love to be wrong.)

Here is the only not depressing prediction: I think that the true net death rate for coronavirus in an adequately supplied care environment, when we finally compare excess mortality to serology, will be around 1%, no more than 2%, probably pretty close to the rates observed where there is a competent response, i.e. Germany and South Korea.*

I think the current fatalities are at least twice and maybe three times what is reported (looking at excess mortality). That's 95,000 deaths as of today. If our terrible healthcare system has a CFR of 2%, that's 4.7 million cases already- ONLY, I will note, 5x as many as reported. Most epidemiologists estimate that we are under counting by a factor between 10 and 40.
(4/23: looks like way more than this.... already.)

I think at least half the country will get sick eventually, which is roughly 165 million people.

I think the second wave will be even worse. I think we will see widespread mask orders coupled with a weak, heartless federal response that will disproportionately impact those living in poverty. I think outbreaks in densely populated areas, i.e. cities, will burn faster and therefore be worse overall. (This one is barely even a prediction; look at NYC.) (6/8: Ta da!!)

I think over half the nursing homes and prisons will have outbreaks and tens of thousands of these vulnerable populations will die.
(4/23: this one is now barely a prediction, too.)

I think there will be an absolute minimum of 200,000 confirmed covid deaths, and it will be closer to half a million in reality (US alone, that is.)

I think that the odds of any individual person not getting sick are very poor indeed. A 4-million person outbreak is a wildfire. How long can you stay in your house, never going in a store or office? Is it 18 months?

I think colleges and schools may not open in the fall and many colleges will have severe financial difficulties. (I think if schools don't open I'm going to call the governor's office every damn day.)

I think that most states won't have the political will to keep stuff closed through August and will have large outbreaks soon.  (6/8: Ta da!!)

I think that some of the places (like NZ) that have done the best containment are screwed in the absence of widespread testing - even worse off than NYC- because the moment anything reopens it will spread very fast. If nothing is happening now to prepare for that, they're just making people suffer and delaying the deaths until later. (6/8: New Zealand and South Korea have all managed to actually by-gum quarantine all arrivals - with strict enforcement- and are containing their cases! Most other places..... not so much. My sisters were going on about how great Israel was doing....) (6/20: South Korea, China, and Australia are having resurgent outbreaks now. New Zealand is basically the only place that's okay and I think the island thing is helping.)

I think the US outbreak is un-containable, that a safe and highly effective vaccine will not arrive in time, and that we will see both seasonal transmission and domestic animal reservoirs.

I think that our government is run by sociopaths** who, at any moment, COULD do something (more tests, more aid, more ventilators) but choose, every day, to do nothing.

*I am not, in any way, arguing that this is a good and happy number! And it will kill a lot of elders. This is bad.
**A word I used at dinner and then had to define in a way appropriate for a five year old.


  1. I'm sorry to say I agree with your predictions. I've been watching the APHA-NAM webinars and the one last night on our testing deployment strategies was the scariest of all. I might slightly amend your statement to "incompetent sociopaths" but other than that, it is pretty much my dinner conversation last night.

    1. True, I definitely forgot both malicious and incompetent.

  2. You left out predictions on what is going to happen after November!! (I didn’t think this was pessimistic. It seemed pretty spot on, actually. I was telling my dad a few days ago that I didn’t think it would be safe for him to leave the house again for several more years.)

    1. Who even effing knows. Second wave, then third wave in September, then record influenza deaths, then a new SARS-2 serotype.

  3. Unfortunately I agree with pretty much everything here except this part confused me a little: "I think if schools don't open I'm going to call the governor's office every damn day."

    Did you *want* them to open in the fall?

    I know the numbers in CA are currently reasonably low compared to the truly worrisome predictions a month ago, but I'm already bracing for a second wave in the fall.

    *Singing Everything is Awful*

    1. We can't keep all the businesses closed through August- people will literally starve to death- and containment is a lost cause. Look at the pictures of beaches in TO and VA and tell me we won't have a second wave by the end of the summer - and the second wave will be worse. AND, it's inhumane to ask people to work for six months (which is happening RIGHT NOW) while simultaneously running school, and it's extra inhumane to have people to back to work without reopening schools. I think the benefit of school closure to slow transmission will largely be gone by then, so it's pointless AND inhumane! (This will not prevent idiot governors from opening, then closing, then reopening schools, for maximum disruption and also for maximum kids in unsafe childcare situations.)

    2. P.S. California will have a second wave in a month.


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