That UCSF panel didn’t break new ground with the information it was sharing, but it was starkly straightforward in presenting the information that many news accounts continue to tiptoe around.

At this point, coronavirus is past containment. “Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak to … ‘flatten the curve’” and buy time for the healthcare system to respond.

We don’t know the true extent of infection in the United States. No one knows.

In the next 12-18 months, 40-70% of the U.S. is likely to be infected, because it takes that kind of number to develop any “herd immunity” that will prevent further epidemic outbreaks. At the moment 0% of the population is immune.

Not only is the U.S. just days behind Italy, but there is no reason to expect that things in the U.S. will not follow the same trends displayed in Italy.

Those numbers, combined with a 1% case fatality rate, mean 1.6 million could die in the next year. Italy is currently experiencing a case fatality rate of 5%.

The reason that number is so terrible in Italy was detailed this week by The Atlantic. When Italy was experiencing a few hundred cases two weeks ago, each of those patients was getting the attention they needed, including respiratory specialists and specialized equipment. A week later, over 2,000 COVID-19 patients were still getting access to artificial ventilation for breathing difficulties.

But a week after that, over 10,000 patients had overrun available ICU beds in northern Italy. Not only were there no longer enough respirators to go around, but there also weren’t enough doctors. Or beds. Patients were left gasping for air in waiting rooms, and there was absolutely nothing that could be done for them.

In fact, the death rate directly attributable to COVID-19 doesn’t reflect the real scope of the problem. It wasn’t just that the number of patients meant that not all those infected with coronavirus could get the treatment they needed. Those beds were also full for patients coming in with heart attacks, strokes, and trauma caused in car accidents. The survival rate for every serious medical issue plummeted because of novel coronavirus.

Italian doctors have been forced into a terrible position of triaging patients based not on the seriousness of their illness but on their age and prospects for “remaining life years.” In some locations, patients over 65 or with additional medical complications such as diabetes or heart disease are simply being left to die. That’s not happening out of cruelty. It’s happening because there are other, younger patients at the same hospital who need the respirators … or they would die.

This is only getting worse. Not just because since that article was written, the number of cases in Italy has soared past 15,000, but also because younger victims who initially tried to handle their illness at home are now struggling into hospitals after their symptoms have worsened. Doctors there are now faced with the challenge of not just refusing treatment, but stopping treatment so they can deal with patients with potentially better outcomes.

It’s an insidious, awful math—and a crushing moral burden—that no doctor wants to face. And, unfortunately, it could be coming very, very soon to a town very, very near you.