I am not an epidemiologist. But you don’t need to know the details of how the virus works, to understand the public health statistics. I am an educated layperson with more than four decades experience in statistics, and from that perspective, I want to share my thoughts on what we are going through and how to listen to the public health professionals. As a disaster scientist, I also look at what we should expect going forward.
First, let’s look at why we are “social distancing.” The facts are:
- This Corona virus is new, so essentially everyone is susceptible to it.
- The virus spreads easily. It is more contagious than the flu although less contagious than chicken pox or measles.
- According to health officials in China, about 80% of the cases are “mild” (meaning the patient does not need to be hospitalized), so people are spreading the virus without realizing they have it, or before they are really sick.
- Many people are dying from Covid-19, with over 9,000 reported deaths and over 220,000 confirmed cases worldwide, as of Thursday 3/19. The real death rate depends on how many cases are being missed, an unknown, but all of the estimates are at least 10 times as deadly as the flu.
This situation — a virus that easily is transmitted and a completely susceptible population — leads to exponential growth. This means the number of cases doubles in a set period of time. At this point in the United States, that time seems to be about 3 days. This may not scare you, but it terrifies me. By Easter Sunday, April 12, at this rate, confirmed cases will have doubled eight times. That is 2x2x2x2x2x2x2x2 = 256 times more than the 10,000 confirmed cases the US has right now. That means there will be 2.5 million cases in the United States by Easter Day.
The Chinese experience suggests that 20% of those 2.5 million people will need to be in the hospital. That means 500,000 people needing to be hospitalized by Easter. In 24 days.
A vaccine could stop this, but it will not come in time. The only way we can slow down the transmission is by keeping carriers from interacting with other people. And because we all could be carriers and not know it, our only hope is to keep everyone apart. This is social distancing.
With social distancing, we can reduce the doubling time. If it is 6 days instead of 3, we would only have 160,000 cases instead of 2.5 million in 24 days. If we get it to stretch out to 8 days, we have only 80,000 cases by Easter. As we reduce the interactions, people have time to recover and stop being contagious before they infect others.
A great visual demonstration of this has been published by the Washington Post (https://www.washingtonpost.com/graphics/2020/world/corona-simulator/) and shows how social distancing can really slow the progression.
Some people wonder why we don’t just let the disease run its course. The problem is: our health care system doesn’t have the capacity to handle this many sick people at the same time. Many more people will die from this disease if they cannot be hospitalized. In Italy, where the health care system has been overwhelmed, over 8% of the 36,000 confirmed cases have already died. In South Korea and Taiwan, where aggressive testing and isolation have kept the disease in check, the death rate is only 1%. The lives of many, many people depend on spreading out the infections so not too many are sick at the same time.
The next question is: how long will this continue? I wish I could give a definitive answer, but there are too many unknowns. It could go on until we have a vaccine. It is too late to confine the disease, so until most people are immune, either from having contracted the disease or from a vaccine, the danger is with us.
What Is Next?
So, what does this mean for all of us going forward? We humans have more control over our behavior than a virus does, so I cannot predict everything that will happen. We will be making choices that determine the outcome. But we can look at what has happened during natural disasters – another type of social crisis – to get some idea.
First, like in earthquakes, most of us will live through this, but our reactions are driven by our personal fear of dying. The development of human intelligence was a response to our need to survive in a world filled with bigger and stronger predators. We evolved to respond to danger by trying to make a pattern that would allow us to make safer choices. When we could make the connection between movement in the grass and a hidden predator, or between our gastrointestinal distress and the mushrooms we just ate, we were more likely to survive to have children.
The problem is that our need for patterns is so strong, that we create them even when they do not exist. The transmission of the viruses, like the timing of earthquakes, has a very large random component, so we cannot predict when or if we will be hit. This is so unbearably stressful, that we create patterns to give us the illusion of control. Traditionally, humans have attributed random disasters, including pandemics, to the gods. This gives us a pattern to believe in that cannot be proven wrong. And it gives us someone to blame.
As human thought has matured and the fallacies of the divine retribution model become more obvious, we have moved on to find something else to blame. We blame FEMA for failing to respond, we blame builders for making bad buildings, we blame the government for not having tests – and many of our complaints have an element of truth, that the disaster could have been less with appropriate preventative action.
One of the most common and most problematic human reactions is to blame the victim. “If I can believe that the victims brought this on themselves, then maybe I can avoid the same fate.” We respond to a cancer diagnosis with speculation on lifestyle choices. We blamed the residents of New Orleans for the losses in Katrina and created a false narrative of the breakdown of social order to absolve ourselves of the guilt in how we responded to their need. Now, some are blaming individual Asians, many of whom were the first victims, and looking for ways to say it was their fault. Finding someone to blame is human nature. Recognizing that we are invoking this instinctual, irrational response is the first step in moving to a more rational, compassionate outlook.
We also need to recognize how the need to blame the victim colors our response to poverty. We have a strong need to believe that poor people somehow caused their own problems because otherwise, we have to believe that it could happen to us. And Covid-19 is making poverty much more likely for many of us. One silver lining might be that this experience will help many of us have more compassion for the poor.
Which brings me to the final point. Just like in other natural disasters, what is most at risk now is not an individual life, but the health of our communities. The next few months will strain the social fabric, as we have to face our fears in physical isolation. Our choices will matter. What can we do?
First and foremost, we need to take social distancing seriously. The lives of many people depend on it. Without social distancing, we are looking at millions of American victims within one month.
Second, we need to listen to the experts and support the governmental actions. For many decades, government has been called the problem. But now we are seeing how much we need our government. Public health systems that have been underfunded or cut completely have the expertise to help us get through this. They are telling us which actions can reduce the risk. It is too late to do many of them, but it is not too late to start respecting their expertise. We need the government to enforce the social distancing to save our lives and the buffering to help our economic system not collapse. Government is the mechanism by which we work together to support the shared community.
Finally, we need to help each other emotionally even as we stay physically distant. No one likes uncertainty and just about everything is uncertain right now; our physical, emotional and economic security are all threatened. But in our modern era, we have the tools to stay connected. Every day, you can call someone you know who may be feeling isolated.
Right now, we need to remember that we are all in this together.Edit