March 2020 ~ Corona Virus Pandemic and What To Do TODAY
EVERYTHING WE DO BEFORE A PANDEMIC WILL SEEM ALARMIST.
EVERYTHING WE DO AFTER WILL SEEM INADEQUATE
~ Michael Leavitt https://www.nancymd.com/blog/covid19
March 2020 ~ Corona Virus Pandemic and What To Do TODAY
From Jason Warner https://www.facebook.com/jason.scott.warner
written March 12, 2020, shared with permission
This is a long post addressing two underlying issues with the current
response to the pandemic that leave me concerned. It’s the longest post I’ve
ever written.
For those of you not taking action or believing the pandemic to be "over
hyped," you can make fun of me as much as you want now or when this is
over. You can make me the subject of memes and post it everywhere. I will pose
for the picture. I am not trying to convince you, but I do feel compelled to
share information that I deem critical to all of us, which is why I am posting
this at all.
WHY YOU SHOULD TAKE 5 MINUTES TO READ AND CONSIDER THE INFORMATION I AM
SHARING:
For those of you who don’t know me well, I am analytical and metered.
I don’t
freak out nor do I respond emotionally. I also don’t post a bunch of bullshit
or political or controversial stuff on Facebook. I founded and am CEO of a
successful software company that provides SaaS based data, analytics and
dashboards to recruiting departments at companies we all know. As you would
expect, I am data driven and fact based. Before founding my company, I held
executive roles leading very large recruiting teams at some of the world’s
fastest growing companies such as Starbucks and Google. At Google, I was
fortunate enough to report to Sheryl Sandberg before she took the Facebook COO
role. I was a Chemical Engineering major in college and have a business degree
from a top undergraduate business school. I am not one for hyperbole or
histrionics. My bullshit factor is close to zero.
I share all this personal information only to help solidify that this post
may be worth reading and sharing with others. I would encourage you to forward
or share this post at your discretion. Many people do not understand what is
happening with the pandemic to the degree required, which is why I took the time
to write this and share this on Facebook.
Now that I’ve gotten the introduction out of the way, here are two issues I
want to bring to everyone’s attention.
ISSUE ONE: SOCIAL NORMS ARE POWERFUL MOTIVATORS AND GETTING IN THE WAY
OF PEOPLE TAKING THE RIGHT STEPS IN RESPONSE TO THE PANDEMIC:
One of the current problems with addressing the pandemic is the social
pressures of taking action today. It’s awkward and feels like an
over-reaction. The reason it feels like an overreaction is that most people
OVERWEIGHT the currently reported cases and inherently UNDERWEIGHT the
mathematics of how the virus is spreading and what will happen in about 30 days
time. This is because our brains tend to think linearly as opposed to
logarithmically. It’s the same reason many people don’t save for retirement
or understand compound interest.
To create a new social norm, human beings like to see behavior modeled.
This
serves as a signal that says, "Oh, someone else is doing it so I should do
it also."
SO HERE IS A SOCIAL BENCHMARK FOR REFERENCE - THIS IS WHAT I’VE DONE FOR MY
FAMILY TO DATE:
I have already isolated my family. We have canceled EVERYTHING. We have
canceled previously scheduled doctor visits. Social get-togethers. Normal
routine meetings. Everything has been canceled. It’s difficult and socially
awkward. Some of you think I’m crazy, but I’m doing it not because I am
afraid, but because I am good at math (more on that in part 2). I had to have my
16 year old daughter quit her job coaching junior gymnasts at the local gym,
with one day’s notice and also tell my kids they can’t attend youth group at
church. Both of those were tough discussions. I told a very close friend he
shouldn’t stay at my house this weekend even though he was planning to and had
booked his flight from the Bay Area. I canceled another dear friend’s visit
for later this month to go snowboarding on Mt Bachelor.
We are not eating out. Our kids are already doing online school so we don’t
have to make changes there. I would not send my kids to school even if they were
in public or private school. We have eliminated all non-essential contact with
other people. We will only venture out to grocery shop when required.
We will
still go outside to parks, go mountain biking, hiking and recreate to keep
ourselves sane and do other things as a family, just not with other people.
We
have stocked up on food and have a supply for ~2 months. We have stocked up on
other goods that if depleted would create hardship, like medicines and feminine
hygiene products. We have planned for shortages of essential items.
THE REASON I HAVE CHOSEN THIS ROUTE FOR MY FAMILY IS MULTI FACETED:
1. Although my family is considered low risk (I’m 49 in good health, Angi
is 46 and in good health and our kids are 14 and 16), we must assume that the
healthcare system cannot help us, because the hospitals will become
overwhelmed very quickly. Most American hospitals will become overwhelmed in
approximately 30 days unless something changes. More on this in part 2 below.
So although we are in great health and unlikely to become gravely ill, the
risk is greater if you do not have access to the medical care that you need.
This is something for everyone to consider. As a society, we are accustomed to
having access to the best medical care available. Our medical system will be
overwhelmed unless we practice social distancing at scale. That said, the
medical teams in Italy are seeing an alarming number of cases from people in
their 40s and 50s.
2. It’s not a matter of if social distancing will take place, it’s a
matter of when. This is because social distancing is the only way to stop the
virus today. As I will explain in part 2 below, starting now is FAR more
effective than starting even 2 days from now or tomorrow. This has been proven
by Italy and China (and soon to be France and other European countries who
have been slow to respond.). Wuhan went on lockdown after roughly 400 cases
were identified (and they had access to testing that America has
systematically failed to do well to date). The US already has more than 4
times this number of known infected cases as Wuhan did when it was shut down
and our citizens are far more mobile and, therefore, spreading the virus more
broadly when compared to Wuhan. Yet our response is tepid at best.
If hand washing and "being smart" were sufficient, Italy would
not be in crisis. So I pray the draconian measures are coming from our
government, because they are required to stop the spread of the virus. It’s
better to start sooner than later as the cost is actually far greater if we
wait. I pray they close all schools and non-essential services the way that
Italy and China have done.
3. Spreading the virus puts those in the high-risk category at much greater
risk. This is the moral argument. It’s a strong argument because there are
only two ways, as of today, that the virus can be stopped — let it run its
course and infect 100s of millions of people or social distancing. There is no
other way today. If you don’t practice social distancing, people downstream
from you that you transmit the virus to will die and many will suffer.
4. The risk of infection is increasing exponentially, because the quantity
of infected people, most who will not show symptoms, is doubling every three
days. So the longer you wait to self-isolate, the greater the chance of you or
someone you love becoming infected and then you infecting others because more
of the population is becoming infected. There are twice as many infected
people today as there was on Tuesday.
5. The virus is already in your town. It’s everywhere. Cases are
typically only discovered when someone gets sick enough to seek medical
attention. This is important as it typically takes ~5 days to START showing
ANY symptoms. Here’s the math: For every known case there are approximately
50 unknown cases. This is because if I become sick, I infect several people
today and they infect a few people each tomorrow (as do I) and the total count
of infected people doubles every 3 days until I get so sick I get hospitalized
or get tested and become a "known case." But in the time it takes me
to figure out I am sick, 50 others downline from me now have the virus. So
every third day, the infection rate doubles until I get so sick that I realize
I have the virus and am hospitalized or otherwise tested. Harvard and
Massachusetts General Hospital estimate that there are 50x more infections
than known infections as reported (citation below). The implication of this is
that the virus is already "everywhere" and spreading regardless if
your city has zero, few or many reported cases. So instead of the 1,573
reported known cases today there are likely 78,650 cases, at least, in the
United States. Which will double to 157,300 by this Sunday. And this will
double to 314,600 cases by this coming Wednesday. So in less than 1 week, the
number of total infected in the United States will quadruple. This is the
nature of exponential math. It’s actually unfortunate that we are publishing
the figures for known cases as it diverts attention away from more important
numbers (like the range of estimated actual cases).
6. Some people cannot or will not, practice social distancing for a variety
of reasons and will continue to spread the virus to many people. So everyone
else must start today.
The reasons above are why I have begun to practice social distancing. It’s
not easy. But you should do it too.
The hospitals will be at capacity and there are not enough ventilators.
You
will hear a lot about this issue in the coming few weeks... the shortage of
ventilators.
ISSUE TWO: MANY PEOPLE ARE FOCUSED ON THE WRONG NUMBERS:
Yes, the virus only kills a small percentage of those afflicted. Yes, the flu
kills 10s of thousands of people annually. Yes, 80% of people will experience
lightweight symptoms with COVID19. Yes the mortality rate of COVID19 is
relatively low (1-2%). All of this true, but is immaterial. They are the wrong
numbers to focus on...
The nature of exponential math is that the infection rates start slowly and
then goes off like a bomb and overwhelms the hospitals. You will understand this
math clearly in the next section if you do the short math exercise. Evergreen
hospital in Seattle is already in triage. I have heard credible reports from
people on the ground that they are already becoming overwhelmed. And the bomb
won’t really go off for a few more days. Probably by Wednesday, March 18th
(next week). In just a few days from now, we will hear grave reports from
Seattle hospitals.
You should assume the virus is everywhere at this point, even if you have no
confirmed cases in your area.
YOU SHOULD DO THIS SIMPLE 2 MINUTE MATH EXERCISE (NO REALLY TAKE TWO MINUTES
AND DO IT):
To further understand exponential growth, take the number of confirmed cases
in your area and multiply by 10 (or 50 if you believe Harvard and Massachusetts
General estimations) to account for the cases that are not yet confirmed. If you
have no confirmed cases, choose a small number. I’d suggest 10 cases in your
city, if no cases are yet reported. But you can use whatever number you like.
This number of infected people doubles every ~3 days as the infection spreads.
So literally take your number and multiply by 2. Then do it again. Then do it
again. T hen do it again. Do this multiplication exercise 10 times in total.
2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x (the number of estimated infections
in your city today (not just the reported cases)).
This result is the estimate for the actual cases in your area 30 days from
now. The math will take 30 seconds to complete with a calculator and it’s
worth doing the math to see how it grows. This end number is the number of cases
in your city 30 days from today if a large percentage of the population do not
practice social distancing.
2 to the 10th power is 1024. When something doubles 10 times, it’s
the same as multiplying by 1024. The infection rate of the virus doubles every 3
days. In thirty days, there will be 1,024 times the number of infected people in
your area as there is today if your community does not immediately put social
distancing into practice. One thousand and twenty four times as many infected
people as there is today, in just 30 days.
Next, divide the final number (the scary big one) you just calculated by the
current population of your city and you will be able to get the percentage of
people THAT YOU KNOW PERSONALLY who will be infected 30 days from now.
Next take 15% (multiply by 0.15) of that final 30 day number of total
infected people. This will provide an estimate of the serious cases that will
require acute medical care and compare it to the number of beds and ventilators
available at your local hospital. Google the "number of beds" and the
name of your local hospital now. It takes 2 seconds and the number of beds is
easy to find. 65% of beds are already occupied by patients unrelated to the
corona virus. St. Charles in Bend, Oregon where I live, has 226 beds and the
town is roughly 100,000 people. Most hospitals have on average, 40 or fewer
ventilators.
These numbers you just calculated are the problem: Too many patients, not
enough beds and a serious shortage of ventilators (the biggest problem) if we
don’t immediately begin social distancing. More on this biggest problem
related to the insufficient quantity of ventilators is below.
COUNTRIES THAT GET OVERWHELMED WILL HAVE A MUCH GREATER MORTALITY RATE
BECAUSE THEY WON’T BE ABLE TO ADEQUATELY CARE FOR THE SICK.
And by sick, I mean not just corona virus patients. Your son or daughter that
needs acute care surgery this May for his badly broken leg will be attended to
by an orthopedic doctor that has been working at maximum capacity and working 18
hour shifts for 7 days every week for 6 weeks because it was required to care
for all the corona virus patients at her hospital. Or the orthopedic surgeon
will be sick with the virus and your son or daughter will be operated on by a
non-expert or a member of the National Guard. Your elderly Mom that has diabetes
and goes into acute distress next month may not receive ANY care because the
doctors are consumed and have to prioritize patients based on triage handbooks
filled with success rate probabilities.
Your sibling’s family that are all injured in a terrible car crash in June
will have diminished care. If one of them needs a ventilator, there will be none
available because all of them will be in use by critical corona virus patients.
Your young friend with cancer and a compromised immune system from treatment
will succumb even though the cancer was curable and the treatment was working,
because their body was too fragile to combat the corona virus due to the
chemotherapy and they couldn’t receive the customized, acute care required due
to the hospital being overwhelmed. All of the above is currently happening in
Italy, who had the same number of infections we have today just 2 weeks ago. You
must start today.
The count of actual virus infections doubles every ~3 days. The news and
government agencies are lagging in their response. So we hear that the US only
has 1,573 cases today (3/12/2020), (see https://www.worldometers.info/coronavirus/) and it doesn’t seem like a lot. It would be better to report the
estimated actual cases, since reported cases don’t tell us much. However, we
know from China that the actual number of cases are at least an order of
magnitude greater than the reported cases, because people get infected and do
not display symptoms. In math, an "order of magnitude" means ten times
difference or put another way, a factor of 10. 100 is 10 times greater than 10,
so it’s an order of magnitude greater.
Footnote: 3/15/2020 9:40 AM: The
USA is showing Total Cases at 3,120 today – almost double the number he quotes
on 3/12, 3 days ago.
As of 3/18/2020 1:04 PM, PDT, the USA is showing Total Cases at 8,020 - more
than 5 times what it was 6 days ago.
Harvard Medical School / Massachusetts General Hospital just released their
estimate (recording is here: https://externalmediasite.partners.org/…/53a4003de5ab4b4da5…)
that the actual cases are 50x greater than the reported cases. So we likely have
75,000 cases in the United States already. The number of reported cases is not
that important.
But let’s assume the current number of cases is only 10,000 ACTUAL cases in
the United States just to be conservative and model out what will happen:
If we don’t stop the virus from spreading, in 30 days we will have 2 to the
10th power more cases of infected people because the infection count
doubles every 3 days (the virus doubles every 3 days and there are 10, 3 day
periods in 30 days).
The math: 2 to the 10th power means 1,024 times as many cases as
we have today (2 times 2 repeated 10 times).
This number is a catastrophically big problem
for all of us: We will have 10 million+ actual cases (10,000 actual cases today
x 1,024) in the United States in just 30 days’ time if we continue without
extreme social distancing. 10 million people with the virus. And it will keep
doubling every 3 days unless we practice social distancing.
15% of cases require significant medical attention, which means that 1.5
million people will require significant medical attention if 10 million people
get infected (15% of 10 Million total infections = 1.5 million people requiring
hospitalization).
1.5 million hospitalizations is about 50% more than we have beds for at
hospitals in the United States. And 65% of all beds are already occupied in our
hospitals. But patients with the virus need ICU beds, not just any old hospital
bed. Only about 10% of hospital beds are considered intensive care. So we will
have a huge bed shortage, and that is not the biggest problem, as we can erect
temporary ICU shelters and bring in more temporary beds, as Italy has already
done and California and Washington hospitals have already done. Evergreen
Hospital in Seattle has already erected temporary triage tents in the parking
lot as of 3/13/2020. All regular beds are full at Evergreen Hospital as of
yesterday.
Once the government of China, Norway and Italy came to understand this math,
they reacted accordingly and shut EVERYTHING down. Extreme social distancing is
the only response available to stop the virus today. The United States is not
responding well nor are other countries like France or the UK. Countries that do
not respond well will pay a much larger, catastrophic price.
And, hospital beds are not the big problem. The lack of ventilators is the
big problem. Most estimates peg the ventilators in the United States at roughly
100,000 to 150,000 units. See https://www.ncbi.nlm.nih.gov/pubmed/21149215
(admittedly dated) and https://theweek.com/speedreads/900850/doesnt-have-enough-icu-beds-ventilators-deal-even-moderate-coronavirus-outbreak.
The primary and most serious comorbid (comorbid is a medical term that means
co-existing or happening at the same time) condition brought on by the Corona
virus is something called bilateral interstitial pneumonia, which requires
ventilators for treatment of seriously ill patients. So if 1.5M people of the 10
million infected 30 days from now require acute care (15% of the 10M estimated
total infections), 1.3M may not get the care that they need because we don’t
have enough ventilators in the United States. And remember, this is only if ALL
OF US EFFECTIVELY start social distancing by April 11th (30 days from
today).
BUT IF WE START EXTREME SOCIAL DISTANCING BY MARCH 23 (12 days from this
writing), WE AVOID OVER 1.4 MILLION PEOPLE GETTING CRITICALLY ILL AND
OVERWHELMING THE HOSPITALS:
If everyone takes extreme measures to social distance and the United States
can dramatically reduce the spread of the virus 12 days from now, the math is
very different, as the exponential growth will only be 2 to the 4th
power (12 days divided by the doubling rate of every 3 days equals the exponent
of 4):
2 x 2 x 2 x 2 = 16
So instead of 10 Million cases in the United States if we wait 30 days, if we
act 18 days sooner, we will have only 160,000 cases (16 times the estimated
10,000 actual cases as of today), of which 15% are likely to require critical
care. This is 24,000 critical patients (a huge difference compared to 1.5
million acute patients). The difference between taking extreme measures now,
versus waiting even a few days, is very large due to how exponents work in math.
THE OUTCOME IS EVEN BETTER IF WE TAKE ACTION IN THE NEXT 6 DAYS:
If the vast majority of the population self isolates and implements social
distancing in only 6 days from now, the exponential math is 2 to the 2nd
power (6 days divided by the 3 days it takes the virus to double means the
exponent is only 2). In math, this is "two squared."
2 x 2 = 4
Multiplied by the estimated 10,000 ACTUAL cases as of today (3/12/20) that
means only 40,000 total cases will develop, 15% of which may be critical, which
is 6,000 critical patients.
This is why you should share this post broadly. If people begin social
distancing in the next 6 days, it will greatly reduce the impact on all of us.
It’s why they say a "post goes viral."
SOCIAL DISTANCING WILL REDUCE THE FINANCIAL IMPACT TO YOU AND YOUR FAMILY:
Finally, the longer everyone waits to practice significant social distancing,
the greater the economic hardship will be on all of us. Lost jobs. Mortgage
defaults. Closed businesses. Bankruptcies. All will be minimized if you start
social distancing today.
Some of the reasons the economic impacts will be reduced are worth
mentioning: If we stop the virus now, the overall duration of the outbreak will
be far shorter. The stock market will normalize more quickly and recover more
quickly. Businesses and people will be able to survive a shorter duration
outbreak vs a longer duration outbreak. More companies will avoid bankruptcy if
we begin to practice social distancing now.
This is a big financial reason to begin social distancing if you are employed
by any company: if companies see that the virus is being slowed, they will be
less likely to conduct layoffs. You will be more likely to be laid off or
experience a job-related event if we don’t practice social distancing
immediately. As an HR executive, I’ve been involved in many, many layoffs.
I ’s
the last thing companies want to do. But if they see that the pandemic will be
shorter lived vs. long and drawn out, they are less likely to make the permanent
decision of laying off staff.
The overall economic impact that hits your bank account will be greater if
you wait or you don’t practice social distancing. T his is why Norway acted
now, because it’s less economic impact to take drastic measures early than to
do them later and it saves a lot of lives and suffering by doing so. And Norway
has only one confirmed death as of this writing.
START TODAY. I CAN’T STRESS THIS ENOUGH.
YOU MUST START TODAY.
Finally, the article that I posted yesterday written by Tomas Pueyo has been
read 7M times in the last 24 hours and has been updated with new information.
It’s
worth reading again.
Here’s that link.
https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
Other up to date data I frequently consult regarding the pandemic is here:
https://www.worldometers.info/coronavirus/
I hope this is helpful and useful. My brain focuses on the math and I try and
be fact based in my analysis and interpretation of how I should respond.
THERE IS MORE INFORMATION IN THE COMMENTS BELOW WORTH READING AND I WILL BE
UPDATING THIS POST and THE COMMENTS, WITH MORE INFORMATION, (AS OPPOSED TO
CREATING NEW POSTS).
MY FINAL PARTING THOUGHT: Please share or forward this post at your
discretion. If everyone shares this post and two of your friends share this post
and so on, we use the power of exponential math to work in our favor, which
seems appropriate given the virus is using that same exponential math against
us.
HOW YOU CAN REALLY HELP: If you know people who have large numbers of
followers or people in the media, please leverage your personal relationship
with them and ask them to amplify this post by sharing it.
For people not on Facebook, you can email or text the link. If you know
people in government, this fact-based post may help inform them to make the best
decisions.
It’s time for us humans to go on the offensive against the virus. We must
fight back.
There is only one way to do so: Social Distancing.
Do it today.
NOTE: Anyone, including the media, is free to use this post, any related
content, in all or in part, for any purpose, in any format, with no attribution
required. Please direct message me if you have other ideas for how to raise
awareness.
Internet Resources
Graphic from the Boston doctor conference - shows the difference in taking
action between the city of Philadelphia and St. Louis during the 1918 flu
epidemic - originally from a 2007 study, printed in the Philadelphia Inquirer
on March 10, 2020:
About our resource
links: We do not endorse or agree with all the beliefs in
these links. We do keep an open mind about different viewpoints and
respect the ability of our readers to decide for themselves what is useful.
EVERYTHING WE DO BEFORE A PANDEMIC WILL SEEM ALARMIST.
EVERYTHING WE DO AFTER WILL SEEM INADEQUATE
~ Michael Leavitt https://www.nancymd.com/blog/covid19
Lessons from Nature - from https://www.facebook.com/rlmartstudio:
- Stay aware
- Support those most vulnerable
- Limit exposure
- Wash frequently
- Spread calm
- Check in on each other
- Offer healing support
- Rest
- Accept your feelings
- Organize for a better future
April Fool's Day is cancelled for this year 'cause no made up prank could
match the unbelievable stuff that is going on in the world right now.
Some reminders:
- Conversations will not be cancelled.
- Relationships will not be cancelled.
- Love will not be cancelled.
- Songs will not be cancelled.
- Reading will not be cancelled.
- Self-care will not be cancelled.
- Hope will not be cancelled.
- May we lean into the good stuff that remains.
 Recorded Meditation for
Healing and Health https://fccdl.in/MwTDQlzxOv
3/24/2020 lead by Barbara Taylor. May be freely shared.
Do what you can, when you can, where you can. And that will be
enough
~ Michael
If you have comments about this month's topic, please let us know or take our
newsletter survey. If you would like
to receive free notices of the topics, please sign up for our mailing
list. See our Privacy Policy.
Page updated: March 25, 2020
This page is http://www.itstime.com/mar2020.htm
| 
The Lighter Side