COVID-19, Lord of the Rings, & ‘Merica

You’ve seen the headline, “The U.S. now has the most confirmed COVID-19 (“coronavirus”) cases in the world.” This was a sad, but inevitable stage in the war against COVID-19 given America’s lag in testing capabilities and quarantine policies over the past 2 months. If there was any silver lining, I now believe “most” Americans are taking social distancing more seriously. Even some of the tanned Gen Z’ers (“Zoomers”) who recently returned from Florida spring break are expressing their regret. My only problem with the aforementioned clickbait headline is that it lacks a certain context and perspective to actually have an educated debate about policies moving forward. This blog attempts to provide that much needed Je ne sais quoi.

The downside of this whole story is that I still believe we’re in the beginning stages of the battle. If this was The Lord of the Rings trilogy, I’d imagine we’re still in the first movie, but April may just become the Battle at Helms Deep in hospitals across the country… We need more personal protective equipment (PPE), more nurses and doctors, and more testing. I also wish we’d implement a federal stay-at-home order for all non-emergent activities / solo exercise for the next month or two, to at least limit border-to-border community spread.

However, I do understand the reluctancy for a nationwide stay-at-home order for fear of sacrificing the economy and jobs. As someone who studied public health, I know financial health is tied directly to medical health. I also understand we’re in an election year and due to Citizens United v. Federal Election Commission, 558 U.S. 310 (2010), corporations and Wall Street do influence policy priorities. In my opinion, the only thing that will significantly change this shift is if we reach a point where everyone knows a “friend of a friend” who has been diagnosed and/or died with COVID-19. That has yet to happen yet, but could be coming soon.

Let’s take the state of New York, where NYC is being held together by duct tape and superheroes (hospital workers, grocery stores, pharmacies, first responders). Governor Cuomo’s state has identified more cases than the next 10 largest COVID-19 states combined so far! That’s 59.6K for New York v. 54.4K for the next 10 states. Now too be clear, California’s testing capacity has been extraordinarily poor, while states like New Jersey, Florida, Michigan (boo my parents live there) and Louisiana have recently begun to see a rapid acceleration in the past week. This is a microcosm for why many Americans are not yet seeing their communities impacted in real-time.

It’s also critically important to remember the sheer size of the red, white, and blue nation. The United States spans 3.8 million mi2, from sea to shining sea. If that’s too hard to wrap your head around, Americans eat a whopping 100 acres of pizza per day or ~350 slices per second. Compare that with Italy or Spain, the two other countries in the running for the “worst 2020 due to COVID-19.” USA is 7.0x larger than Spain and 5.4x larger than the birthplace of pizza, Italy (Naples).

Now this population size disparity is critically important, otherwise you’re comparing apples-to-jackfrut. To take account, I first adjusted the reported COVID-19 cases by each country’s population size. Otherwise, you will see a graph like below that shows we’re “winning” the race between Spain and Italy. And by winning, I mean doing awful.

To take size into account, I first adjusted the numbers by each population size to create a case rate per 100,000 lives. Then I picked a reasonable starting point where all three countries had similar case rates per 100,000. This starting point hovered around 0.30 per 100,000 lives (0.26 for Italy, 0.30 for USA, and 0.35 for Spain). Moving forward 20 days in time from this starting point (counting day 1) and I arrived at the March 29th in the USA. On this date, the USA had 43.9 cases per 100,000 lives. This case rate put us right in the goldilocks position, between Italy at 29.2 and Spain at 61.7 on the same number of days after the ~0.30 per 100,000 date. It’s good news we’re not on Spain’s horrible trajectory, but we can’t be pleased about outpacing a country that is rationing ventilators and ICU treatment (Italy).

All-in-all, there’s so many more factors required to accurately estimate community spread in other cities. Density, adherence to social distancing, travel patterns, demographics, income, transportation, behaviors, and baseline health. I am certainly not the expert here. But to make a really rudimentary estimate, in 7 days, if we rise to Spain’s trajectory, we could have 561,000 COVID-19 cases. And if we drop to Italy’s trajectory over the next 16 days, we’ll have 528,000 cases. Either way, I hope the April showers actually bring May good news flowers.

Andy Mychkovsky is the creator of Healthcare Pizza. Follow him on Twitter (@AMychkovsky) and LinkedIn for future thoughts and updates.

Andy
 

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