This article discusses the state of our nation with respect to the Covid-19 virus, what our government is doing, and what they could be doing.

When people are talking about “Flatten the Curve” and the “S-curve”, what they’re talking about is the result of a differential equation with a boundary condition. Here’s a video by 3blue1brown that explains this very well:

So, initially the infections increase exponentially until more than half of the people that are going to get infected get infected, and then it slows down because everyone has already been infected and become immune. A good metric for the exponential increase is the length of time it takes to double the number of cases. Here’s a plot showing the number of cases versus time for many different countries.

With the exceptions of South Korea, Japan, Singapore, and Hong Kong, the length of time it is taking to double the number of cases is between two and three days. That is, with strict measures, the number of cases double every three days, and with lackadaisical measures, the number of cases double every two days. Singapore is a small city-state with a small population and a strict government (the punishment for dealing drugs in Singapore can be death [1]). So, to control a pandemic, they have an advantage. Japan is probably not testing enough to accurately determine the number of cases that they have. I don’t believe any news from China, so I don’t trust the numbers from Hong Kong. That city was erupting in protest just a month a go; I do not believe that they even could determine the number of cases if they wanted to. The spread seems to have slowed in South Korea. I’m not sure why.

Here’s another way to look at the same thing:

The big take away for me, from the above plot and table, is that it doesn’t really matter what governments are doing. Unless the government institutes house arrest (as they have done in China), then the number of cases double every two-to-three days. (That is, the slopes of the above graphs are about the same.) We’re going to get the disease; it’s time to accept that.

Ok, so the number of cases seems to double every two-to-three days. How about deaths? The death rate was initially reported at about 3%, but that was the media sensationalizing the WHO’s statement. Using simple probability, I estimated the death rate to have an upper bound of 0.5%. We now know that that’s about right [2,3,4] (which we can see from the number of people dying in South Korea from the disease). Shortly after my last blog post, the American Hospital Association estimated an upper bound on the number of deaths to be 0.5% fo the US population, which jives with my number [5]. The good news is that’s MUCH BETTER than the originally reported 3%. The bad news is that 0.5% of the US population is 1.6 million people!

There’s a great deal of talk about flattening the curve. People show picture like this:

Is this accurate? Can we flatten it enough so that our healthcare system can address the number of cases? Can we use social distancing well enough so that the number of people that die decreases? It looks like the answer to all of these questions is “No”. The clue in the above graph is that there aren’t any numbers on the graph. It’s just an idea, and few have given it any real thought. Here’s an article that does [7]: https://medium.com/@joschabach/flattening-the-curve-is-a-deadly-delusion-eea324fe9727

In the above article, he shows the following (slightly more accurate graph):

The limit is assumed to be the number of ventilators. Just to address the number of people that would need ventilators, we would need to flatten the curve out to ten years. That isn’t going to happen. At current infection rates, hospitals in most major cities will be overwhelmed in about a week. We have many more infections to go after that.

I have a friend who is an ER doctor in Seattle. They are already overwhelmed. Medical staff was initially sent home once they were exposed to the virus. But now, it’s all hands on deck. Medical staff doesn’t get sent home until their systems become preventative to their ability to treat effectively. The pandemic is just beginning, and they don’t have enough ventilators. All operating rooms have been closed because they need the ventilators. And hospital administration is meeting to discuss ventilator criteria, meaning they’re deciding who they have a good chance at saving with a ventilator, and who will get oxygen and have to hope for a miracle. They’re triaging and it’s just beginning.

Trump is failing. It was good that he closed travel to China as soon as he did, and it was good that he closed travel to Europe. This gave us a little bit of time to ramp up, manufacture more equipment, and become prepared. And then he did extremely little. The $8 billion in congressional funding has not been spent in meaningful ways. And he’s too busy blaming other people and (it seems) too reactionary to properly address the situation. Here’s are a series of his tweets (in chronological order):

And there’s the Trump trend: deny then blame. He’s still blaming Obama and Biden for federal shortcomings 3 YEARS INTO HIS OWN PRESIDENCY! And if that fails, he’s blaming state Governors.

What should the government be doing? As Katrina Mulligan points out, Trump could use the Defense Protection Act to prioritize domestic production of hospital protective equipment (e.g. face masks, gloves) and ventilators [7,7.1]. And ventilator manufacturers can increase production to achieve higher output (though it would take three months to achieve maximum production) [8]. And Trump hasn’t done so!

I suspect there are multiple reasons why he has remained inactive.

He’s not a politician and politics is complicated. He probably doesn’t even know about the Defense Protection Act. He’s relying heavily on his advisors, who get information from lobbyists.

The insurance companies lobby heavily. To a health insurance company, an old person is a liability. An old person represents decades of healthcare costs without recovery. A virus that preferentially kills the old and sick is an economic gift to a health insurance company.

The government is using the distraction of the Coronavirus to pass through totalitarian measures. In California, Governor Newsom is making it illegal to evict people during this time even if they can’t pay rent [9]. Mortgage payments will not have the analogous moratorium, so any landlord that relies on rents to pay the mortgage will go into foreclosure; that will be an economic gift to the banks. The Congress is pushing through the “EARN IT” act; a rider of this act will make encrypted communications illegal in America (which iMessage, WhatsApp, GMail, and several other communications currently use). And FISA, the authority that was previously used to spy on all Americans without consent and revealed by Edward Snowden, is not going to get meaningfully reformed in spite of previous governmental promises [10].

We’re all too worried about the Coronavirus to care about any of this.

Unsurprisingly, it turns out that we’re quickly realizing many Federal regulations are obtrusive and unnecessary. The Federal government is doing something (though little) to get out of the way of manufacturers [11,11.1]. Even so, production is struggling. When the pandemic began, I looked into starting a company to create and sell hand sanitizer (something that I am more than capable of doing). However, in order to sell it, you need FDA approval. And that was the end of my efforts. In Australia, a high school science teacher had his students make Daraprim, a medicine that currently costs $750 per pill, for $2 per pill in supplies [12]. There are no patents on the medication, and it could be sold generically. But to get that production through FDA approval costs between $3 and $10 million, and few have this available for investment. If you do invest that money, it’s likely that you won’t recover the costs (for the market for Daraprim is too small to do so). So the pill’s price remain exorbitant largely due to Federal regulations. Most of our generic medicines are made in China! We can’t even make penicillin anymore [13] (the last American lab that did closed in 2004).

What’s the current plan? The current plan, if you can call it that, is to limit social distancing (e.g. closing schools) until April and hope the summer months somehow magically address the disease. Then, hope that by the end of the summer there is a vaccine for the disease. I hate this plan.

“Developing based on hope that it will never happen is not good engineering practice.” -Mike Acton

If I had the power, what would I do? A huge problem right now is that our medical staff will get sick at the same time as our population. So we will fall short with medical staff at the same time that the we need them most. People are staying at home and schools are currently closed in an effort to slow the spread of the disease.

I would use this time to purposefully infect a percentage of medical staff that are healthy enough to be treated effectively. (Note: I would not force anyone, but would just make the infection available to any medical staff willing to accept it.) Thus, they would get sick now and be done with it by the time the rest of the population gets sick. By infecting them now, we would have plenty of ventilators to treat them if we get surprised by any staff that needs more care than expected.

Once medical staff is treated and over the disease, I would infect a portion of the young and healthy population that are likely to experience minor symptoms. Again, let them get over it, get back to work, and keep the shelves stocked with goods.

Simultaneously, I would use the Defense Protection Act to ramp up American production of medical equipment (especially ventilators).

Provide medical professionals temporary permission to work across state boundaries.

Encourage anyone that is able to exercise (e.g. go for walks). Have informative presentations from physical therapists regarding aerobic exercise publicly available. This is an attempt to build up lung capacity quickly.

Enforce more stringent requirements on cleanliness in public gyms (including for-profit gyms). Limit the number of people in gyms to small numbers.

I would eliminate useless and obtrusive FDA requirements immediately and let innovation take place quickly.

The Federal Government is not doing much of that.

May you and your family stay safe and cared for.

Here is more information from a professor at the University of Minnesota much more knowledgeable than I regarding disease:

[1] https://www.tripsavvy.com/drug-laws-in-singapore-1629780

[2] https://www.insidermonkey.com/blog/coronavirus-fatality-rate-or-death-percentage-the-most-accurate-estimate-817752/

[3] https://www.businessinsider.com/coronavirus-death-rates-by-age-south-korea

[4] https://www.bbc.com/news/world-asia-51836898

[5] https://www.washingtonpost.com/health/coronavirus-forecasts-are-grim-its-going-to-get-worse/2020/03/11/2a177e0a-63b4-11ea-acca-80c22bbee96f_story.html

[6] https://www.npr.org/sections/health-shots/2020/03/13/815502262/flattening-a-pandemics-curve-why-staying-home-now-can-save-lives

[7] https://twitter.com/NatSecMulligan/status/1239223799452782595?s=20

[7.1] https://twitter.com/NatSecMulligan/status/1239589421151854592?s=20

[8] https://www.forbes.com/sites/baldwin/2020/03/14/ventilator-maker-we-can-ramp-up-production-five-fold/#a4e91bb5e9a5

[9] https://www.sacbee.com/news/politics-government/capitol-alert/article241148446.html

[10] https://www.nationalreview.com/2020/03/no-to-fisa-reform/

[11] https://reason.com/2020/03/15/tired-there-are-no-libertarians-in-a-pandemic-wired-there-are-only-libertarians-in-a-pandemic/

[11.1] https://reason.com/2020/03/15/tired-there-are-no-libertarians-in-a-pandemic-wired-there-are-only-libertarians-in-a-pandemic/

[12] https://www.usnews.com/news/health-care-news/articles/2016-12-01/australian-students-reproduce-martin-shkrelis-daraprim-drug-for-2-per-pill

[13] https://www.nbcnews.com/health/health-care/u-s-officials-worried-about-chinese-control-american-drug-supply-n1052376