Wednesday, April 29, 2020

Oh, For Pity's Sake...

     The "It's no worse then the flu"/"They're cooking the books on the death count" crowd has just about convinced me to leave F*cebook for good.

     Cause of death is a complex thing and like Achilles and the Tortoise, every time you think you've caught up with it, it has moved a little bit ahead: if you've got an pre-existing condition, say COPD, heart disease or extreme old age, and you come down with COVID-19 and develop a severe case, your pre-existing condition is likely to be the thing that directly kills you, months or years earlier than it would have if you didn't have COVID-19.  It's probably going to get recorded as a coronavirus death.

       You can pick nits over defining those stats all day long (and still miss the person dying of a quiet stroke in the ER waiting room, overlooked because the hospital is too overwhelmed with COVID-19 patients), but that's not a useful analysis; the real measure is the raw death rate in an area with a coronavirus outbreak.  All deaths, by any cause; add 'em up and compare to the same period in previous years.  If it's higher, you've got a problem.  We won't have even those numbers for awhile, but we have a proxy: how full are the morgues?  How busy are the funeral homes?  And the answer is, in the hard-hit areas, they're swamped.  That's not something that can be faked, not in a city crawling with newspaper, radio and TV reporters with too much free time and a lot of competitive pressure.

     SARS-CoV-2 is worse than the flu.  A lot worse -- and likely far more communicable.

     Which leads to the other line of addled thinking; I keep seeing, "They say we're all going to get it, so why not open everything back up, catch it and get it done already?

     The problem with that approach is, if we all get it at once in some city or region, you get a replay of New York City or Northern Italy.  Those places don't have an unusually low number of hospital beds per capita; they're about average or even a little better.  Yes, where you live isn't as densely populated as NYC, but on a per-person basis, it's got the same number of or fewer doctors and hospital rooms; on a per-capita basis, it's got the same square footage of grocery stores and big-box stores and other places where you can get right up close and personal with your neighbors -- and whatever viruses they've got.  One percent of Manhattan's population, in one percent of the space, with one percent of the doctors, hospitals and common spaces is not one percent of the problem.  It's the same problem, overworked medical personnel, high death rate and all.

     If you're in a rural area, you do get a break: the spread will be slower.  If you and your closest neighbors (dozens of miles away) are only in town once every two weeks, the virus won't spread as quickly in an outbreak; but given that some infected people are spreading the virus for two weeks before they show symptoms, it will still spread -- and medical services tend to be few and far between in such areas. You'll all end up in the same dinky county hospital and it will be just as busy as Big City General would be, despite the smaller scale.

     That gets us to another problem, one that haunts medical facilities, especially overworked ones.  It's a version of The Sniper Problem: there you are, in an area with only fair cover and concealment, and there's a sniper hidden some distance away.  You have to stay out of sight of the sniper all of the time but the sniper only has to get a clear shot at you once.  It's an unfair contest -- and it is exactly the fight between healthcare workers and a highly infections illness: they have to get PPE exactly right every time, but the virus only has to get through one time.  And it's not just patient-to-provider transmission, but patient-to-patient via provider: hospitals (and other patient-care facilities) can easily become centers of infection.

     So there are good reasons to remain isolated, to restart non-essential commerce slowly and cautiously, and to remain ready to pull back when and where there are outbreaks.

     Many people are saying the risk doesn't matter, that we have to restart the economy to prevent a recession or worse.  Too late.  We're going to have a recession and maybe a depression.  It can't be avoided.  There are going to be economic readjustments and they're going to hurt.  Just getting supply chains untangled from Red China is going to be disruptive, and that may be the smallest effect.

     Our choice is to have a bad economic slump and huge numbers of overloaded hospitals (with all that entails), or to just have a bad economic slump.

     Better buckle up.  It's going to be a bumpy ride -- and lying to yourself about it won't help a bit, no matter how loud you are.


John Peddie (Toronto) said...

Good, and valid points.

Those in a rush to re-open things should remember that dead people don't shop much, nor do hospital-bound patients.

RandyGC said...

Most people don't understand how hard (and exhausting physically and mentally) proper use of PPE can be. Particularly when you have to decontaminate and change gear several times a day as medical personnel have to.

The most I ever had to do it with military MOPP (chemical warfare) gear was a few hours and that was plenty. (although the gear was nice and cozy during a Korean winter ;-) )

I've usually heard the "they only have to be lucky once" in connection to terrorism (I believe that was the message to PM Thatcher from the IRA). I had never heard your description of the sniper problem before.

I actually had to deal with the "sniper problem" once during an exercise. An AC-130 gunship demonstrated the difference between concealment and cover and fixed the problem quickly ;-)

Roberta X said...

A friend of a friend found this link to CDC death stats, with graphs comparing 2020 to the previous five years, over the first four+ months of the year in hard-hit areas.

I have not published comments arguing with my description of NYC hospitals as "overwhelmed." Here's why: on one side, there's Some Guy On The Internet, repeating things he has seen here and there; on the other side, first-hand accounts from doctors and paramedics who have been working there through the pandemic -- *not* news reports but actual descriptions from actual people who are actually there. I know which side I believe. YMMV, but if it does, you're wrong.