NCS:

I sent out an update yesterday on the Covid19 outbreak, regarding an excellent article posted on ZeroHedge regarding the impact of this epidemic.  The author had done some analysis of the numbers of people affected, and what that meant in the context of the current US health care system.  Here is what I said about that-


https://www.zerohedge.com/health/all-hospital-beds-us-will-be-filled-coronavirus-patients-about-may-8th-according-analysis

I hate it when I am right. Washington State, (and NY, and CA, and other places,) case counts are rapidly increasing, both from more testing and more infections.  Confirmed case counts now are just the tips of a whole field of icebergs we are just starting to be able to see.

The low number of confirmed cases in these presently united States is due to lack of testing, not lack of infections, and now that more testing is starting to be done the numbers of cases may be expected to rise significantly, right up to the limit of testing capability.  The reported case count will continue to be limited by testing as the real number of infections doubles every 4-7 days, possibly faster.

And here is the ugly thing.  Right now, with seasonal flu in full swing, HOSPITALS ARE ALREADY FULL.  At my hospital, we routinely have to wait for discharges for ill patients to get a bed.  Our census is 100%, the IP nurse is already swamped, and staff shortages are already an issue.  When this virus hits, (and there is no reason to think that the present rapid expansion in case numbers is going to slow down for at least several months,) we will have NO BEDS.  As staff infections increase, and they will, we will have fewer nurses to treat more patients, which is not sustainable.  Hospitals are going to close or go on bypass.  Surgeries, if any, are going to be restricted to emergency only.

The Life Center in King County is just the first of the horror shows we will see in long term care facilities.

Bottom line:

If you are not already prepared to treat your family members at home, you are behind the curve. Do not be that person.

Historian”

So, I got a reply from one person which said-
“CFR rate estimates aren’t 2%.  

 
 

https://news.yahoo.com/coronavirus-mortality-rate-1-percent-less-us-173432468.html

The implication apparently was that because the CFR was lower than that engineer’s estimate that the impact would be much less.  Here is my lengthy response to that:

Dear XXXXX:

If true, that would mostly be good news.  Hopefully it is, and the thesis makes sense, but CDC has no way to prove that this hypothesis is correct.  They cannot test enough to even verify that the clinical cases now in hospitals are infected, despite days of pleading for testing by the HCWs in the field.   CDC’s lack of testing is part of the problem we face, and you will understand my reluctance to interpret this latest from the Federales as anything but a bunch of happygas designed to blunt the understandable outrage from the public and the professionals both of whom they screwed.  (I was particularly impressed by the pronouncement that filter masks would not protect the public, but were needed for healthcare workers, who they would protect.)

The effects upon those who get severe versions of this disease will not be much different, and the data there are not in much doubt.  What that 1% number would mean is that the real percentage of severe cases is probably less, about 8-10 percent of the total, instead of around 16-20%, and that the mild/asymptomatic cases are ~90% instead of ~80% fo the total.  The bad news would be, if this is true, WRT Washington state for example, that the mild asymptomatic cases are twice as many, meaning that the disease has already spread faster and more quickly than expected. This will chop about a week or more off the estimate from that Zero Hedge article.  The other bad news is that those in the general population who are more likely to find themselves with severe cases are more likely to be exposed sooner to, and infected by, an asymptomatic case.

Another problem is that there are presently several clades of the virus, one family of which has mutated to be nastier and more aggressive, and as an RNA virus, this bug is unstable and liable to frequent change to better adapt to the host.  This is exacerbated by the propensity of immature genengineered virii to be unstable anyway. Worse, infection by the mild clade may not confer immunity from the nastier ones as has been reported in the literature.

Bottom line, it really does not matter whether the CFR is 1/2 of a percent, or 3.4%.  That is irrelevant.  The relevant piece is that with even a small fraction of the population infected, the health care system is going to be flattened, as the original ZeroHedge author stated.  As flat as a squirrel squashed by a semi. Let me show you what I mean- see spreadsheet attached

If only 20 percent of the people in your state get infected, and only 8% of those are severe cases then 360,000 people will get it, and  about 28,800 people will need hospital/ICU care ( isolation rooms, ventilators, O2, etc.) over about a 1-4 month, possibly longer, period.  Average stay for a severely ill Covid19 patient is probably two months, give or take. 1% CFR means about 3600 across the state will die, but that is not the problem. Real world is that the disease may come in one or more waves, and each wave of cases is likely to present as something like a normal bell-curve, with a fat tail.  It will start with just a few cases, as we’ve seen so far, but the count will grow exponentially at first, again as we’ve seen, then decrease after the peak.

On average, ICU beds typically are about 5%-10% of the total beds in a hospital at most.  The hospital I work at has 3 iso rooms in the ED and we have 4 ICU iso rooms,  and others throughout the hospital.  My hospital, which is 5 star ranked, is far above average; most hospitals nationally do not meet these standards.  Anyhow, your state has about 6000 licensed beds in the whole state,

https://www.ahd.com/states/

and if the census in your state is currently about the yearly national average,  that means that about 25% of these beds are vacant, or about 1500 beds statewide.  This time of year, however, most hospitals are running around 85% or more full.  (Right now my hospital’s census is 100% with around 15-20% of the cases serious flu patients on O2 and/or vents.) Of those 6000 beds, let’s assume that 10% of these are ICU beds, and 10% of those are iso rooms.  That optimistic estimate  means we have about 60 isolation ICU rooms in the your entire state with probably about another 200 isolation rooms without ICU capability. Locally, the tiny hospital in your community has 25 beds;  there are about another 150 beds within an hours drive of your home.  Those 175 beds serve a resident population around of around 100,000 people.

Anyway, lets say that this Monday we see 2 cases, later confirmed as Covid19, somewhere in your state, with severe symptoms. Right now, cases seem to double around every 4 days;  people seem to die about 2 weeks to 6 weeks from Covid19 infection;  there are a peak of early deaths from elderly patients with co-morbidities; the initially healthy patients with severe cases hang on longer. It seems to take longer for recovery;  I’d guesstimate that on average that takes 4 weeks, but there are plenty of folks still using o2 and respirators 2 months after being infected.

After about three weeks, your state will have run completely out of isolation rooms, even assuming there were no isolation patients already in them, and assuming all the cases are evenly distributed, with 254 patients presented.  By day 36, we will have overrun the 1500 beds available, with 2046 severe cases presented.  Some of the early cases will have died, and a few have recovered, but the hospitals will be over-run in just over a month, and probably around 5-10% of those will be doctors and nurses. By day 44, six weeks into the outbreak, 8000+ patients will have presented.

On Day 48, which will probably be the peak of our estimated 20% attack rate epidemic, about 16000+ cases will have presented, 41 will have died, and 116 have recovered. With only 6000 beds total statewide, and only 1500 at best available for Covid19 patients, the other 14,500 cases will not be in hospitals.

Now obviously, this is a very simple model.  You can change the assumptions WRT doubling time, etc., (which I have done) but all that does is slightly extend the time to overload.  The point is that it won’t take very long for a very infectious bug like this one to wreak havoc on the health care system in this country, just as it did in China.  And that does not take into account the need for PPE, now not being produced in China, as it was.  Every patient in isolation will require a minimum of 6 N95 masks per day per patient, more likely double that. If the average stay is 4 weeks, that is 168 masks per patient, more likely 300 plus, or 4.8 million N95s for all the infected in your state alone. If the average stay is longer, that number grows.  Even if we figure that only 6,000 people will be treated statewide in hospitals, that’s a bare minimum of 1 million needed. In your small state! The national stockpile, last I heard, was about 12 million masks;  the Federal Government has ordered 500 million, but that will take a long time to get- by the time we see those masks, this pandemic will probably have run its course in this country.

And that was an optimistic, best case scenario.  More likely, this epidemic will infect half to 3/4 of the people in these presently united States, because it will NOT be possible for everyone to isolate themselves for long enough to break the back of the epidemic and stop transmission.  Keep in mind that there could be another mutation, leading to another wave of infection, as happened with the H1N1 pandemic in 1918-1020.  In any case, my best estimate is this will be probably be worse than the 20% example above. A wise person will prepare for this.

With regard to all who serve the Light,
Historian

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