I hope you and yours are doing okay.
In this email I’ll cover progression of the disease in an imaginary 100 people; talk about keeping ourselves safe for the next six to nine months (at least) until we get a vaccine; and then offer a number of hand-picked links for more in-depth reading.
Consider 100 People
Numbers will vary, but as a rough guide, consider 100 people who come down with COVID-19 in the US.
20 people will have no symptoms, and they won’t even know they had it.
64 people will get sick but won’t need to go to the hospital (so, somewhere between “light cold” and “really bad flu—you don’t want to catch this”).
10 people will get really sick with pneumonia (can’t breathe, low oxygen) or other problems and will end up in the hospital.
5 people will go to the ICU, with respiratory failure, shock, or multi-organ dysfunction.
1 person will die. (I picked “1” here partly because it’s a whole number. Maybe it’ll be 0.5. Maybe it’ll be 3 or more. Don’t press your luck, especially if it’s life or death for you or someone else.)
Some of the people who get really sick will have COVID-19 for months. (What it’s like to have COVID-19 for months.)
Some of the people who get sick will have months—possibly years—of chronic health conditions related to the damage COVID-19 did to their body. (What it’s like to live with a chronic health condition.)
Let’s Keep Each Other Safe
To keep from getting COVID-19—and to keep from being one of the 20 people who gets it and then spreads it to others—we avoid crowds, we avoid closed spaces with poor air circulation, we wear cloth masks when we’re near others (by the way, really, it’s more like 12 feet than six feet).
Our goal is to reduce death, long-term disability, and especially, to avoid too many people being sick at once and overwhelming your local hospitals. The 15 people who got hospitalized but didn’t die up there? A lot more of them would have died if the hospital was full.
We do all of this until there are safe and effective vaccines, and there are enough people getting them. (Consider that some people are anti-vaccine, and some people will have been duped by disinformation campaigns. It may be harder to convince some people to get vaccinated, and look how hard it turned out to be to get some people to wear masks.)
Simple. Excruciatingly boring, if you’re not one of the people who gets sick. It turns out that it’s hard to stay vigilant for months, particularly without clear leadership. We have to do it anyway.
[I apologize, I don’t have easy answers for schools, restaurants, bars, etc. But whatever solutions people come up with, if they involve a lot of people getting sick, they’re not good solutions.]
Resources
“Covid (@UCSF) Chronicles, Day 108” (Bob Wachter) — This is a long and interesting Twitter thread from a seasoned doc at UCSF, with the takeaway quotes, “It’s easy to be vigilant for a few weeks, but keeping it up for months is tough, and people fall off the wagon,” and, “Another lesson from industrial safety: over time, people begin taking short-cuts. And if they get away with them, they cheat more.”
“Drafting A Makeshift Playbook for Living Through the Pandemic” (New York Times) — They suggest “5 rules to live by during a pandemic”:
Check the health of your state and community
Limit the number of your close contacts
Manage your exposure budget
Keep higher risk activities as short as possible
Keep taking pandemic precautions
“An analysis of three Covid-19 outbreaks: how they happened and how they can be avoided” (El País in English) — a graphic visualization of COVID-19 spread in enclosed spaces, and how to avoid similar outcomes.
“COVID-19 Can Last for Several Months” (Ed Yong, The Atlantic) — “The disease’s ‘long-haulers’ have endured relentless waves of debilitating symptoms—and disbelief from doctors and friends.”
“Covid-19 vaccines are possible, but we need a public-health mind-set to make the most of them” (Peter Kolchinsky, City Journal) — Kolchinsky has a ton of material on COVID-19. This is a good summary discussion about COVID-19 vaccines. Note, he starts off the article by writing that he think’s it’ll be 18 months until we have a vaccine; elsewhere he amended that to 12 months.
“All my #COVID19 explainers in one place” (Peter Kolchinsky, April 2020) - More from Kolchinsky. He is a virologist and biotech investor, in vaccines, drugs, and diagnostics.
“A Monster Awaits” (Sayed Tabatabai) - A story of an intubation, from a doc in San Antonio.
“United States Resource Availability for COVID-19” (Society of Critical Care Medicine). “In this report, we address the most current [May 12, 2020] data and estimates on the number of acute care, ICU, and step-down (eg, observation, progressive) beds; ICU occupancy rates; mechanical ventilators; and staffing. We also seek to provide context to the data.”
“Micro droplets suspending in air” — a video demonstration of suspended micro droplets from a sneeze. There is still debate about whether or not aerosols carry COVID-19; I would suggest we should err on the side of caution.
For my imaginary 100 people above, I used a chart from RA Capital, where Kolchinsky is a managing partner. Note, their numbers are 20-64-11-5-<1, instead of my 20-64-10-5-1. I wanted to use an integer “1,” and while their numbers seem generally (plus or minus) in line with other sources, I think “1” is not out of bounds, especially in the context of what this email is trying to present. The chart is in the upper left corner of their “Latest Map”. Note that the map is a large PDF, which may give your PDF reader app problems. If you have problems, try closing other applications or rebooting to get more memory, or try a different PDF reader. Before you dig into the map, consider reading their “Strategic Overview & How to Use The Map (Read First),” which explains the legends for all the different information about vaccines.
For numbers with more precision, see, for instance:
“Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020, Table 3” (MMWR)
“Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19), Clinical Course” (CDC). In this, in the version from June 30, 2020, note that the running text refers to footnotes 36 and 37; I think they mean 38 and 39 in the actual footnotes.