When do you think virus-related disruptions will end?

[Angelo Farina]

Angelo, I'd be curious for your take on this paper, published back in November:

Investigating the impact of influenza on excess mortality in all ages in Italy during recent seasons (2013/14–2016/17 seasons) - ScienceDirect

It suggests that in 2016/17, there were 25,000 fatalities in Italy due to the regular flu (it was a bad flu year).

At the moment, Italy has had fewer than 10,000 deaths due to COVID. There are reports that Italy is nearing the top of its steep COVID fatalities curve. If that is true, one might expect the total number of fatalities in Italy to be under 25,000 before the pandemic subsides in your country. In other words, the number of fatalities due to COVID would be consistent with a bad year of the regular flu.

Normal flu in Italy usually takes a toll of 4000-8000 deaths per year, considering all the indirect cases. The direct ones are around 400.
2016/2017 was truly anomalous.
It is yet quite too early for counting the number of deaths caused by COVID-19. If we continue this complete shutdown, the infection will slow down significantly, but of course you cannot keep the people reclused in their home for long periods, already now we are close to the bearable limit... And the economic impact will be unsustainable.
So I suppose that in 2-3 weeks the severe limitations to personal mobility we have now will be relaxed. And this will cause the number of infected and of deaths to raise again, with a stable number of new infections per day, perhaps with some oscillation.
We hopefully could manage to keep the situation stable for more than one year accepting that every day a number of newly infected people is processed by our health system, which in meantime will be empowered, so that it will not be in crisis as now.
But the situation will continue going on, until most of the population will be passed through being infected and healing. And we know that 20% of the infected need medical assistance, and 5% needs artificial breathing support.
We are 60 millions. Let be optimistic, and assume that only 50% gets infected: 30 millions. Of them 80% will be asymptomatic or with minimal inconvenience (just a normal cold), but leaves 6 millions which will need to be hospitalized. It is a HUGE number.
And the average time spent in the hospital is 3 weeks. We hope to spread this in one year or more, but in the end at least 5% of these 6 millions is going to die. It is 300,000 deaths, which is by far much more than any flu in the past, with the exception of the Spanish flu, which killed 600,000 people (in 3 years).
So I do not see anything going easy here in the next future...
Nor in the rest of the world, I fear...

 

[Angelo Farina]

Any businesses are essential to people who depend upon them for their livelihoods, and among other things will lose their health insurance if they can't work.

This is entirely true (in US; not here, luckily), and can cause more deaths than COVID-19:
The only good thing of this sad situation is that, perhaps, it will be the trigger for Americans for understanding how unjust and expensive is the insurance-based health system, and finally accept that the only correct way is to have a national health system free for everyone, as here in most European countries...

 

[W W Meixner]

To clarify a few points:

I don't live in Florida, and I am a lifelong member of the other political party, so he's in no sense "my" Governor.

I also think spring breakers being shown on cable news are drunken mindless idiots.

However, we shouldn't be so quick to label businesses "non-essential." Any businesses are essential to people who depend upon them for their livelihoods, and among other things will lose their health insurance if they can't work. That includes dive shops. I have no stake in the dive business, other than as a consumer, but I personally don't see why dive shops should shut down, except in areas that are experiencing a sharp rise in COVID cases.

I recognize that coronavirus is more serious than the regular flu, but it is by no means the only health threat for the very elderly or for people who are immunocompromised. It is, however, the only health threat for which we are taking the very drastic action of shutting down the global economy.

I get the need to flatten the curve, and I have no problem teleworking rather than going to my office of 2,000 people, because my job allows me to do that. I've only left my apartment three times over the last two weeks, to buy groceries or go to the hardware store. I also have no problem with avoiding handshaking, using my elbow to press elevator buttons, and sneezing into my sleeve.

However, I don't think we should stop diving, or going to the beach, or to national parks, or playing tennis, or for that matter, stopping off for an ice cream, provided we keep appropriate physical distance and take common sense precautions. Because the idea of flattening the curve is to spread out the number of cases over time -- not to reduce their overall number or to stop the virus altogether, which is not possible anymore (because it really is a pandemic, and we have no natural immunity).

I imagine that I would probably feel very different if I was living with someone who was immunosuppressed. I do live across the street from my 81-year-old mom, who stubbornly insists on going to supermarkets to shop for food, even though I offer to do that for her. She is in generally good health, but she's still 81 years old, and I do worry about her. But I don't think we should set policy based on emotion. And right now we are in the grips of a massive emotional reaction. So I for one would not hesitate to go shore diving right now. And while I steer clear of cattle boats generally, I wouldn't hesitate to go diving in a six pack.

NM...

I won't even begin to argue...I agree with a few of your points...and vehemently disagree with others...dive shops never have been or never will be under any circumstances...''essential businesses''...anymore than any other ''hobby shop'' is...

And if anyone's primary/only employment is to crew on a charter boat...my sympathies in their career choice...any Government subsidized correspondence course...can lead to a career...offering a real future...even for those whose knuckles drag on the ground as they're walking upright...

Leaving non-essential businesses open in low case areas...only offers an open door for low case areas to become high case areas...

I'll concede...and agree to disagree...

W.M...

 

[Jcp2]

I work in a hospital. Two weeks ago we only had a couple of known patients for COVID-19. Now, my hospital is near capacity for these patients. The case doubling time for our area of service has been around 3-4 days. The ER is a war zone with pending patients lying in cots waiting for a bed upstairs. Our morgue is near full. Our health system is one of three in state with the capability to test suspected inpatients and have a result back the next day. There is no capacity to test anybody else who is not going to be hospitalized, although we hope to have increased testing capacity within a couple of weeks. At least we can sort patients into appropriate confinement. State lab results are taking 4-5 days to come back and commercial private labs are now close to 2 weeks. As bad as it is on my campus, I can't imagine what it is like at any neighboring hospital without the capability to test in house. I have no idea how they are sorting out the patients appropriately so as to not infect other non-COVID-19 patients. It just hasn't made the news yet because we are 2 doubling times behind from where New York is now.

 

[nippurmagnum]

I work in a hospital. Two weeks ago we only had a couple of known patients for COVID-19. Now, my hospital is near capacity for these patients. The case doubling time for our area of service has been around 3-4 days. The ER is a war zone with pending patients lying in cots waiting for a bed upstairs. Our morgue is near full. Our health system is one of three in state with the capability to test suspected inpatients and have a result back the next day. There is no capacity to test anybody else who is not going to be hospitalized, although we hope to have increased testing capacity within a couple of weeks. At least we can sort patients into appropriate confinement. State lab results are taking 4-5 days to come back and commercial private labs are now close to 2 weeks. As bad as it is on my campus, I can't imagine what it is like at any neighboring hospital without the capability to test in house. I have no idea how they are sorting out the patients appropriately so as to not infect other non-COVID-19 patients. It just hasn't made the news yet because we are 2 doubling times behind from where New York is now.

Normal flu in Italy usually takes a toll of 4000-8000 deaths per year, considering all the indirect cases. The direct ones are around 400.
2016/2017 was truly anomalous.
It is yet quite too early for counting the number of deaths caused by COVID-19. If we continue this complete shutdown, the infection will slow down significantly, but of course you cannot keep the people reclused in their home for long periods, already now we are close to the bearable limit... And the economic impact will be unsustainable.
So I suppose that in 2-3 weeks the severe limitations to personal mobility we have now will be relaxed. And this will cause the number of infected and of deaths to raise again, with a stable number of new infections per day, perhaps with some oscillation.
We hopefully could manage to keep the situation stable for more than one year accepting that every day a number of newly infected people is processed by our health system, which in meantime will be empowered, so that it will not be in crisis as now.
But the situation will continue going on, until most of the population will be passed through being infected and healing. And we know that 20% of the infected need medical assistance, and 5% needs artificial breathing support.
We are 60 millions. Let be optimistic, and assume that only 50% gets infected: 30 millions. Of them 80% will be asymptomatic or with minimal inconvenience (just a normal cold), but leaves 6 millions which will need to be hospitalized. It is a HUGE number.
And the average time spent in the hospital is 3 weeks. We hope to spread this in one year or more, but in the end at least 5% of these 6 millions is going to die. It is 300,000 deaths, which is by far much more than any flu in the past, with the exception of the Spanish flu, which killed 600,000 people (in 3 years).
So I do not see anything going easy here in the next future...
Nor in the rest of the world, I fear...

Thanks for your thoughtful response. I hope you're ultimately wrong in your calculations, and in your comparison to the Spanish flu. When the Spanish flu hit Italy, the population of your country was half of what it is now, so the 600,000 victims of Spanish flu would be four times as bad as the number of COVID victims (relative to today's population), not twice as bad (per your calculation). Also, at the time of the Spanish flu there were no antibiotics, nor an understanding of even what a virus was or how it was transmitted. You are also assuming that the fatality rate seen at the outset of the outbreak will remain steady, which is not realistic, because the virus will have a tendency to pick off the more vulnerable people in the population first, so the fatality rate should naturally drop over time. But mainly I hope you're wrong because the scenario you paint is bleak indeed.

 

[nippurmagnum]

This is entirely true (in US; not here, luckily), and can cause more deaths than COVID-19:
The only good thing of this sad situation is that, perhaps, it will be the trigger for Americans for understanding how unjust and expensive is the insurance-based health system, and finally accept that the only correct way is to have a national health system free for everyone, as here in most European countries...

You will get no argument from me on that point! Sono assolutamente di accordo.

 

[michael-fisch]

Thanks for your thoughtful response. I hope you're ultimately wrong in your calculations, and in your comparison to the Spanish flu. When the Spanish flu hit Italy, the population of your country was half of what it is now, so the 600,000 victims of Spanish flu would be four times as bad as the number of COVID victims (relative to today's population), not twice as bad (per your calculation). Also, at the time of the Spanish flu there were no antibiotics, nor an understanding of even what a virus was or how it was transmitted. You are also assuming that the fatality rate seen at the outset of the outbreak will remain steady, which is not realistic, because the virus will have a tendency to pick off the more vulnerable people in the population first, so the fatality rate should naturally drop over time. But mainly I hope you're wrong because the scenario you paint is bleak indeed.

Actually, worldwide the Spanish flu killed off 50 million people, out of a worldwide population of 1.8 billion.
Assuming that before herd immunity takes control 60% of the population must have either gotten Covid19 or been immunized (no immunization yet) and the current death rate stays at 5% of the infected (which is probably very optimistic, because so far the infected have had access to medical treatment, worldwide that would no longer hold true) we are looking at 214 million people dieing.

That is more than the number of people who have died in all wars since 1900

Look around you and try to imagine that every 3rd person over 70 will be dead next year, and a lot of younger people too.

Michael

 

[michael-fisch]

Since I assume that the supply of treatment spaces is going to remain smaller than the need, a triage system will need to be implemented, how to save the most with the last use of resources. Older patients, infirm and those with underlying health problems consume too much of the limited resources. So it'll boil down to do I save 4 by avoiding treating the 2 who really need it. Or do I condem 4 to death in order to save the lives of 2 older patients that have already lived a full life.
And that folks is a Triage explained in the classical way.

Michael

 

[Jcp2]

Thanks for your thoughtful response. I hope you're ultimately wrong in your calculations, and in your comparison to the Spanish flu. When the Spanish flu hit Italy, the population of your country was half of what it is now, so the 600,000 victims of Spanish flu would be four times as bad as the number of COVID victims (relative to today's population), not twice as bad (per your calculation). Also, at the time of the Spanish flu there were no antibiotics, nor an understanding of even what a virus was or how it was transmitted. You are also assuming that the fatality rate seen at the outset of the outbreak will remain steady, which is not realistic, because the virus will have a tendency to pick off the more vulnerable people in the population first, so the fatality rate should naturally drop over time. But mainly I hope you're wrong because the scenario you paint is bleak indeed.

I am from Michigan.

 

[Angelo Farina]

But mainly I hope you're wrong because the scenario you paint is bleak indeed.

I agree entirely. Let's hope it does not go that way.
South Korea did proof that, with proper management and tracking, it is possible to control the spreading. I really hope that we manage to do the same.