Any call for allowing the nation to move forward without every possible effort to restrict the spread of COVID-19 is profoundly foolish. For those who value their stock portfolio over their friends and relatives, it may seem like an obvious solution: Just pretend the disease isn’t there, send everyone back to work, and let God (and Adam Smith) work it out. But it won’t work. Because it can’t.

There are a plethora of reasons why this is both cruel and unforgivable, but there’s something that all the Money Men should notice—the numbers. The numbers show that this is simply an unworkable plan, one that would be far, far worse for the economy than the most locked-down lock-down. And, if anyone cares, it would also irrevocably destroy the nation’s soul. To understand the issue, let’s walk all the way back to the basics of an epidemic disease: rate of transmission, susceptibility, and outcome.

Transmission

Transmission rate is simply the number of people who are likely to be infected by someone carrying a contagious disease. It’s also known as R0 (pronounced “R zero”). For the seasonal flu, this number is around 1.3. For COVID-19, multiple efforts to calculate that number have placed it between 2 and 3; probably somewhere around 2.4.

This may seem like an esoteric number, but here’s a very simple example of what it means. Let’s start by looking at a theoretical virus, one that has an R0 of exactly 2. The time between when someone becomes infected and when they begin to infect someone else is about five days. This means that one infected person can be expected to infect two others. Five days later, those two are ready to infect four others. It looks like this:

The math of one becomes two, two become four, and four become eight seems simple—though the idea that this would generate 4,096 cases starting from a single person in under two months may not be immediately obvious. This is exactly what is meant when it’s said that the growth of an epidemic is following an “exponential curve.” The value is going up following an exponent of the R0 value—2, 22, 23, and so on.

Now, let’s change the R0 value to 3. That doesn’t seem like a big change, but let’s see what it means over the same period.

Even if you have a good calculator in your head, you might not have seen that bottom line coming. What seem to be small differences in the starting conditions of diseases make huge differences in outcome.

Now, back to COVID-19. The time period for the next generation of victim to become infectious can be as short as a couple of days, or as long as a week. So the time interval in the zombie slides above is about right. Here’s the real-world result: A single COVID-19 victim can lead to around 36,000 new cases in the space of two months if no effort is made to restrict the spread of the disease.

That may seem like a theoretical worst case, but it’s almost exactly what happened in China. The first human infection with the novel coronavirus happened sometime in early December. Two months later, China had 40,000 cases. And that was despite early efforts to limit the spread.

Susceptibility

That transmission rate can only be sustained if there are enough susceptible people on hand to become infected. Unfortunately, from the perspective of the novel coronavirus all the world’s a stage. Everyone is susceptible. Young, old, black, white—none of us have immunity. None. The body of every single one of us is prepared to become a factory for this mindless, living-not-living thing.

With other diseases there are vaccines, or there are portions of the population that had the disease in the past and are still protected by lingering immunity. Neither is true in this case. Humanity is standing here with arms thrown open wide, welcoming this invisible bastard to come feast on our cells.

Outcome

Obviously, no one would be worried about COVID-19 if the worst thing that happened was sniffles. (Pro tip: Sniffles are one of the things that seem to actually be extremely rare with this virus. If your nose is running, it’s probably not COVID-19. Probably.) But what happens with this disease follows a sliding scale from moderate to severe, where a very good portion of severe equals dead.

Trump has insisted on making supposedly favorable comparisons between the 2009 H1N1 “swine” flu epidemic and the current situation, so let’s take a quick look back at that one.

The virus may have actually moved from pigs to humans at a farm in Mexico owned by U.S. producer Smithfield Farms, but if so, it gave little warning before it was in the United States and spreading. The first case was actually identified in San Diego, the next in Texas.

When the first death happened a month later, there were already cases in 36 states. Until that first death, scientists had hoped this new flu would turn out to not represent a public health threat and the CDC had been optimistic that it was not a severe illness. By the time anyone realized this wasn’t the case, it was everywhere.



For epidemiologists, this was a nightmare scenario—here was a disease that had turned out to be deadly only after it had spread across the nation, and it had completed a coast-to-coast spread in just a few weeks. There was no way to contain the virus to a state or region.

Fortunately, the CDC had responded to that first case by crash-developing a test kit for the disease in two weeks. Before the first death, the CDC had already deployed 25% of the nation’s stockpile of protective gear and antivirals to the states. Two days after that first death, the FDA announced that it had already secured a facility to begin growing seed materials for a vaccine against H1N1 flu, and every agency of the federal government was preparing flu responses. On that same day, test kits were available in every state.

President Obama was prepared to issue a national order closing all schools, but it was May, and two things happened almost simultaneously: First, all those schools went on summer vacation anyway. Second, the flu really did subside to a low level of cases for the summer. Even so, a steady, slow drumbeat of cases and deaths continued. H1N1 had definitely not gone away.

As with COVID-19, most hopes while waiting for a vaccine were pinned on a therapeutic solution. With H1N1, it was the antiviral drug Tamiflu. Through the summer, this showed great effectiveness in many cases. But by August, cases of H1N1 appeared that were Tamiflu-resistant. As the flu came roaring back, President Obama declared a national emergency to focus funds on rapid production and distribution of the vaccine that had been in the works since May.



On October 14, the first 11 million doses of vaccine became available. By the end of October, 30 million doses had been distributed and vaccination increased going into November. By November 20, cases of H1N1 were in sharp decline. At the start of December, the CDC declared the H1N1 epidemic over, though it continued to urge that everyone get the vaccine.

And now the big numbers: Over the course of the H1N1 epidemic, there were 60.8 million cases, 274,000 victims were hospitalized, and 12,469 Americans died from complications directly related to the disease. This gives us a very good basis to use for comparing the disease to COVID-19.

The transmission rate for the H1N1 flu was between 1.4 and 1.6.

The hospitalization rate for the H1N1 flu was 0.5%.

The case fatality rate for the H1N1 flu was 0.02%.

On every one of those values, COVID-19 is enormously worse.

When the H1N1 flu epidemic came under control in December of 2009, there were at least 110 million Americans who were immune to the virus, either because they had already had it, or because they had been given the vaccine. This wraps right back around to two of the topics we already hit—susceptibility and transmission rate.



Those 110 million Americans—about 35% of the population—made enough road blocks in the transmission chain to lower the transmission rate from 1.4 to below 1. That is, to the point where each person who was infected with the H1N1 flu infected fewer than 1 new person. That’s what “herd immunity” means—throwing enough immune people in the way so that the disease simply can’t sustain itself.

Herd immunity and COVID-19

Where a vaccine was a key component in providing herd immunity for the H1N1 epidemic, there is no such vaccine available now. The only way to confer herd immunity for COVID-19 at this point is to simply infect enough Americans to bring the transmission rate below 1. That’s what it means to “reopen” America—stop trying to slow transmission through isolation and count on immunity to do the job.

But the scope of that proposal is far bigger and far more awful than it seems, and it already seems plenty awful. Where the H1N1 flu had a transmission rate of about 1.4, with COVID-19 that value is more like 2.4. This means that a much higher percentage of the population will need to be immune to effectively contain the spread of the disease. Probably more like 60-70% rather than 35%. In other words, over 200 million Americans would need to be infected before the transmission chain could be broken in this way.

And where the hospitalization rate with H1N1 was about 0.5%, with COVID-19, that number is around 15%. Taking this approach would require 30 million hospital beds. That’s 29.1 million more than we have.

And while it’s tempting to simply map the current U.S. fatality rate of around 1.4%, or the current world fatality rate of around 4.5%, and say that taking this approach would lead to between 3 million and 9 million deaths in the United States, that’s not true. Because the truth is that it would generate something much higher. Something very close to 29 million. Because it would so overwhelm the national health care system that the system might as well not exist.

What Donald Trump is suggesting isn’t a cull of people in nursing homes. It’s the outright and absolutely preventable slaughter of 1 to 10% of the entire U.S. population. This isn’t just economically unsupportable—it’s an action that would be on the same scale as the holocaust. It would represent a level of depravity and disregard for human life that should immediately be rejected by any rational person, and any civilized nation.

Moving forward on this proposal wouldn’t mean putting America back to work. It would mean the end of America.