All Hokie, All the Time. Period. Presented by

The Lounge Board

bulab

Joined: 09/19/1998 Posts: 35961
Likes: 3539


My current read on the situation


These are some general conclusions looking at stats on various countries and the same media reports as the rest of you. Disclaimer: I've been wrong before.

* The case fatality rate seems to be around 1%, probably a touch less, in places where there is widespread testing and social distancing. This is the best case scenario, the upper limit, indeed the goal, for any country, until a vaccine or better treatments appear. This is still much, much worse than the flu.

* About 20% of people get sick enough to need hospital care.

Of these, about 14% require simply a "floor bed" as they are referred to in medical circles--where oxygen can be administered but have no ability to intubate or handle intubated patients (on ventilators). These 14% get oxygen for a few days to a week until they recover and are discharged.

About 6% require intubation. Of those, some die, usually if they have other illnesses. The rest stay intubated (on mechanical ventilation) for a few days to a week until they recover, then transition to a floor bed for a few days, and then they are discharged after recovery.

* If an area runs out of ICU beds, the case fatality rates go up to 2%. Patients who would ordinarily survive after a week of intubation will instead die.

* If an area runs out of hospital "floor" beds, the case fatality rates go up to 4% or more. This is because everything gets backed up. Patients who would ordinarily survive in a floor bed cannot get into one and lie in the hallways as some scenes in Spain have shown.

The hospital staff have to make tough choices of who to give ICU beds to--the young person who needs to be intubated but will likely survive or the 82 year old with hypertension and obesity who will likely not survive intubation.

* In other words, the underlying dynamics are "bursty". Bursty systems are very challenging to handle. Amazon became a trillion dollar company largely in figure out how to handle the burstiness of the Chrismas shopping season, and then how to handle the burstiness of server demand, not just during the Christmas season, but day-to-day, and selling that capacity to the rest of the world.

Healthcare systems, like most things, are not able to handle burstiness.

* The goal of any US policy should be to handle burstiness. I don't think most places will get bursty. I don't think Southwest Virginia or even most of Arizona will get bursty. Places where there are densely packed people who stay indoors in cool/cold climates will be bursty. The most highly populated place in Arizona is Phoenix, and it's basically a giant suburb. (These last few sentences are simply guesswork on my part--the current situation in Spain, for example, does not quite fit.)

* Thus, I'm looking at how NYC does in the next 10 days for an upper limit of bad this thing could get basically anywhere in the world. Things are going to get UGLY there, but if NYC shows it's turning a corner after 10 days, there will be tremendous hope in the world and the economy.

* A lot of people are saying, "We already have millions more cases than we know about because we simply have not tested everyone, and 80% do just fine. Thus, the actual severity of the disease is overblown."

I do not agree because of the above: there are pockets of burstiness that overwhelm the local healthcare systems in certain geographies even if the majority of people and places will do okay.

* All of the above is under the assumption that there will be no treatments or vaccines emerging anytime soon, which I think is unlikely. If a treatment can be shown to, let's say, bring the CFR down to 3-4% in age 80+, that will be a huge sign that we can handle this thing.

Posted: 03/24/2020 at 4:14PM



+21

Insert a Link

Enter the title of the link here:


Enter the full web address of the link here -- include the "http://" part:


Current Thread:
 
  
My current read on the situation -- bulab 03/24/2020 4:14PM
  Lead time bias - mortality may climb... -- The Gobbler 03/25/2020 09:54AM
  I have no idea -- bulab 03/24/2020 9:15PM
  As a not-medical professional IMHO -- Beerman 03/24/2020 7:15PM
  Good stuff. ** -- ColoVT82 03/24/2020 4:47PM
  Well done on burstiness. ** -- HokieSignGuy 03/24/2020 4:23PM

Tech Sideline is Presented By:

Our Sponsors

vm307