This is Going to Suck (a COVID-19 Analysis)

You think things are bad now? Just wait.

The coronavirus that causes COVID-19 is a big deal, and I'm going to tell you why. I hope you'll stop pretending it doesn't matter, or that it's overblown, when you finish reading.

I don't think most people fully understand how bad things could get.

So many people have said things like, "it's just the flu," or "more people die from X or Y or Z every year, but life goes on, so big deal." I see it in the media. I hear it from friends. I see it on Facebook and Twitter and LinkedIn, in emails and everywhere else.

COVID-19 is not the flu

Yes, people die from the flu every year.

Somewhere between 12,000 and 61,000 Americans die from the flu every year. Globally, influenza kills up to 650,000 each year.

But 1 billion people get the flu every year. That's a death rate of 0.07%.

The map above, in the header of this article, comes from TheBaseLab.

It roughly tracks data on sites like Harvard's HealthMap, Worldometers, and nCoV2019.live.

The big numbers, averaged across these sites:

• 350,000 infected globally
• 15,000 deaths
• 100,000 recovered cases

This is after three months of spread for a novel virus for which humans have no immunity and no vaccine. By comparison, recent pandemics were much less dangerous:

• SARS (2004): 8,100 cases, 775 deaths
• H1N1 avian flu (2009): 24% of the global population, 284,000 deaths
• Ebola (2014-2016): 28,650 cases, 11,325 deaths

Yes, H1N1 caused quite a few deaths, but considering it infected a quarter of the world, its fatality rate was just 0.2 percent. SARS inspired a fair bit of panic, but in the end, it was rather controllable. Ebola, while extremely deadly, is also harder to transmit because it's not an airborne disease. Death rates are high, but geographically limited.

So far, COVID-19 is killing about 4.4% of those known to be infected. If it manages to infect 24% of the planet before it's brought under control, the death rate could be as high as 339 million people. The 1918 flu pandemic killed about 2% of those infected.

What we have from Worldometers shows these death rates:

• China: 81,093 cases - 3,270 deaths -- 4.0% mortality rate
• Italy: 59,138 cases - 5,476 deaths -- 9.3% mortality rate
• USA: 35,075 cases - 458 deaths -- 1.3% mortality rate
• Spain: 33,089 cases - 2,206 deaths - 6.7% mortality rate
• Germany: 26,220 cases - 111 deaths - 0.4% mortality rate
• Iran: 23,049 cases - 1,812 deaths -- 7.9% mortality rate
• France: 16,481 cases - 1,812 deaths -- 4.1% mortality rate
• South Korea: 8,961 cases - 111 deaths -- 1.2% mortality rate

How fast is COVID-19 spreading?

The problem is, we don't really know how deadly COVID-19 is, because so few countries have done anything close to comprehensive testing. The closest we've got is Iceland, which is currently testing at a higher rate than any other country. Crucially, Iceland is also testing asymptomatic people not known to have been in contact with the infected.

Iceland has tested 4,197 people through its healthcare system, and another 5,571 tests have been conducted by deCode Genetics. There are 425 Icelanders infected with COVID-19, or about 4.4% of the tested population with the disease. However, only 48 people -- 0.9% of those tested -- were positive in deCode's testing, which focused on asymptomatic people.

The coronavirus has a reproduction number of about 2.5. This means every infected person will transmit the virus to 2.5 other people. That's roughly twice the transmission rate of a seasonal flu, which as we already saw, 1 billion people get the flu each year.

A reproduction number above 2 is exponential, especially with airborne transmission. We're already seeing this in the reported statistics, which show the classic exponential growth curve in new cases, especially outside of China, where governments can't be quite as draconian in their preventive efforts.

With no preventive measures, COVID-19 will quickly spread EVERYWHERE.

The first U.S. case was reported on January 19. We didn't pass 100 confirmed cases until March 3, which is roughly a 6-week lag between the first report and the 100th case.

Since then, we've gone hockey stick exponential.

200 cases on March 5. 289 on March 6. 401 on the 7th, 504 on the 8th, 663 on the 9th, 949 on the 10th, 1,248 on the 11th, 1,625 on the 12th... as of yesterday, there were 32,949 confirmed COVID-19 cases in the United States. Today there are 35,418 cases.

Every day, there are 32% more cases than the day before.

If this keeps going, we'll see...

• 46,752 cases tomorrow...
• 61,713 cases on Wednesday...
• 81,461 cases on Thursday...
• and about 107,529 cases by Friday.

If everyone were to go about their daily lives like nothing's wrong, the coronavirus will keep spreading, and spreading, and spreading. Today's report is a rare spot of good news, because cases only increased by about 7.5% over yesterday. However, the long-term average growth rate is still above 32% per day.

At that rate, there will be 326,000 cases by the end of March, and effectively the entire population of the United States will be infected by April 25th.

Let's say we can slow things down to only get 10% growth in new cases every day.

We'll still cross 100,000 cases on April 3, reach 1 million cases on April 28, and surpass 25 million cases by the end of May.

At a 1.3% mortality rate, we're looking at 330,600 deaths from those infections. Just by the end of May. If the real mortality rate in the U.S. winds up being closer to the 4.4% global average mortality rate, more than 1.1 million Americans will die from COVID-19 by the end of May. Remember, no more than 61,000 Americans die from the flu each year.

Controlling the spread is critical

We could easily pass 61,000 COVID-19 deaths by mid-May if we don't do anything -- or if we don't do enough to slow the spread in any appreciable way.

That's why it's so important to practice social distancing, to be safe, to avoid crowds and try to not transmit this virus without concern for others.

The graphic below shows both the baseline assumptions for transmission, and the impact of social distancing and safety measures:

Every day we fail to address this issue is another day of unrestrained spread. Most people will be asymptomatic for weeks. The number of infected people has doubled roughly every three days, and will continue to do so as long as people act like nothing's wrong.

Here's a more in-depth article on the numbers behind the pandemic. Read it.

People have a hard time understanding exponential growth. It's difficult to comprehend the possibility that something so dangerous could infect twice as many people every day or two.

Someone pointed out to me that almost 800,000 people die from AIDS each year, so why should we freak out over a few thousand COVID-19 cases? This isn't really comparable, not least because AIDS isn't an airborne disease.

The first year of reported AIDS cases was 1981, in which 270 people had the disease in the U.S. It took AIDS five years to go from 270 cases to 38,000 worldwide -- that's the difference in U.S. coronavirus cases between March 6 and March 23, just 17 days.

I hope this helps you understand why social distancing and quarantines are so important. Most of us will survive COVID-19. Many will not. The difference between doing nothing and controlling its spread as best as we can will mean a difference of many thousands, if not millions, of deaths.

Someone you know will get COVID-19. If nothing is done, just about everyone you know will get COVID-19. If that happens, someone you know will die of COVID-19. It might not be your grandpa or your elderly neighbor. It might be your brother or cousin. Young people don't die at the same rates as the elderly, but otherwise healthy young people are impacted by COVID-19, and some of them are dying.

The healthcare pandemic

People aren't happy about being stuck inside, for obvious reasons. The reason we're self-distancing and quarantining ourselves isn't simply to slow the spread of the disease, but to allow the healthcare system to cope with the surge of new patients COVID-19 creates.

See, the healthcare system (in any country) only has so much capacity. The U.S. actually has a lower capacity than many other developed nations:

That's hospital beds per 1,000 people. The U.S. has 2.8 beds per 1,000 people, lower than Spain (3.0 per 1,000), Italy (3.2 per 1,000), France (6.0 per 1,000), Germany (8.0 per 1,000), and Korea (12.3 per 1,000). Canada and the U.K. are in pretty bad shape too, as each country has just 2.5 beds per 1,000 people.

The U.S. has more intensive care beds in hospitals than many EU countries, but those will quickly be overwhelmed by even a moderate pandemic. Conservative estimates show that six seriously ill people would need beds for every actual bed available. This is a best-case scenario where every bed is empty. Most are already occupied, which leaves one bed for every 17 sick people. Where are the other 16 people going to go?

We stay inside to help the healthcare system cope. This is called "flattening the curve," and it's meant to spread the outbreak over a longer period of time, so more sick people can be properly treated and recover from COVID-19.

Without preventive measures, hospitals will be overwhelmed. More doctors and nurses will get sick, further reducing the available healthcare personnel to treat COVID-19 patients. People with other diseases or ailments won't be able to get admitted, and may get sicker or even die without proper care.

The cost of doing nothing doesn't just fall on high-risk COVID-19 patients. It falls across the entire healthcare system, with great risk to anyone who needs urgent treatment or emergency care but can't gain admittance because hospitals are overflowing with COVID-19 cases.

Doctors will have to start performing triage, which means they'll have to make literal life-or-death decisions about who to treat and who to leave to suffer. This is already happening in some COVID-19 hotspots.

This can be addressed by building temporary hospitals and treatment centers, but it's not a certain thing, and it's harder to do in Western countries with a strong NIMBY sensibility.

All this, of course, leads to another serious issue...

The economic pandemic

Let's start with the immediate economic problems.

The global economy has ground to a virtual halt overnight. There could be 2.4 new million unemployment claims this week in the U.S. That's NEW claims -- 2.3 million layoffs. The previous record was 700,000, set in 1982.

This is what happens when you shutter a good part of the economy. Retailers are closed. Gyms and health clubs are closed. Restaurants and bars are only offering takeout or delivery. No one is staying at hotels, going to casinos, flying anywhere, buying anything. The only part of the economy still active is the part that can work from home, and that part still depends on clients in all those other shuttered sectors.

The economy could shrink by up to 24% in Q2.

That's like squeezing the entire Great Depression into 3 months.

The economy shrank by 5% during the 2008 recession, and that took a year and a half. The initial part of the Great Depression ran from 1929 to 1932. Even then, people went shopping, used services, traveled, ate out, and so on. They just did it less often.

The modern economy is not at all ready for a pandemic. We're not ready to shut everything down and stay inside. The economy depends on people buying stuff, sending stuff, doing stuff, paying for stuff. All of that is grinding to a halt while everyone holds their breath. The total box office take last week was ZERO. For the first time in history. There are almost 170,000 people employed by movie theaters in the U.S. Or at least, there were.

Millions of people can't work from home. They can't really work at all now, because no one's allowed outside. But they're trying anyway, and these people should now be considered high-risk carriers of the coronavirus who'll be most likely to get sick and be hospitalized. Many of these people -- restaurant workers, delivery drivers, "gig economy" freelancers -- have no safety net, minimal employer loyalty, and no real sick leave or paid-time-off policies that might help them recover in the event they become infected.

The longer everyone's forced to stay inside and avoid contact due to shelter-in-place and social isolation mandates, the more revenue these traffic-dependent businesses will lose, the more people they'll lay off, and the more damage it will cause to the economy.

These are the direct, easily observable impacts of the pandemic. Millions of people, many at the lower end of the income scale, are at risk of losing their livelihoods, defaulting on bills and rent or mortgage payments, and even potentially losing their homes -- though some government measures are being pushed to avoid the latter effect.

In many cases, people will lose weeks or months of income to the pandemic, and they're not likely to get it back. You think a $1,000 check from the government is really going to matter when someone can't work for three months? It'll be spent in days. Food costs money. Rent costs money. Bills don't just disappear because you can't go to work for fear of a virus.

Let's talk about the other economic effects of this pandemic.

The costs you don't see (until it's too late)

Where is your food coming from?

In many cases, agriculture -- especially in the U.S. -- is sustained by a large workforce of migrant laborers, in this case from Mexico. Late March is planting and growing season for many crops, but the labor isn't here, because no one's issuing visas to the Mexican laborers we need to work the fields.

The consulates in Mexico that typically issue these visas are indefinitely closed, and while there's some noise from the State Department that this will be addressed, the Trump administration's history of extreme prejudice against Mexico makes it seem unlikely that this will be prioritized in time to get people on the fields.

Without necessary labor, crops can't be grown and harvested, and the entire U.S. food supply chain withers on the vine. This will be felt most keenly in the summer and fall, by which time we may have been under quarantine for months, surviving on canned beans and other emergency food.

The entire food supply chain is an intricate, international network of thousands of farms, processors, vendors, and grocery stores. Corn from Iowa feeds hogs and cattle in Texas, which are then shipped to processing plants in Missouri to be chopped up for supermarkets. No corn, no feed, no cattle, no meat.

The agricultural bottleneck is just one major problem with an ongoing worldwide quarantine. It's hardly the only one.

Do you think things will go back to normal after the quarantines end?

Not likely.

As long as one person remains infected, coronavirus will remain a threat. In time, we're going to have to choose between our desire to avoid contagion and our need to work and restart the economy, because the world simply cannot function if large portions of its workforce can't do their jobs.

This means we're not so much flattening the curve as slimming down the spike of COVID-19 cases that will crop up over and over again until an effective vaccine can be developed.

This is a chart from Imperial College London, which recommends a period of extreme social distancing (the blue areas) every time COVID-19 cases spike (the orange line). Under this assumption, we might deal with recurrent pandemics well into the end of 2021.

Much of the U.S. has been under some form of social-distancing mandate for about 2 weeks now. Millions are already filing for unemployment. If these projections are accurate, we could be dealing with quarantines for months at a time, over and over, until things are finally brought under control.

It's hard to see how any business dependent on foot traffic will survive that long. Stimulus money can help, but how long can the government continue to spin out trillions of dollars every time it forces people back into their homes?

One suggestion I've seen, which has already been implemented in Singapore, is mass surveillance. By tracking everyone, identifying the infected early, and using various apps and technologies to trace their contacts, governments might be able to better control outbreaks and allow uninfected citizens to return to some semblance of normalcy.

There aren't any good options here.

Eventually, we'll have a vaccine, and we won't have to live in fear of COVID-19. Until we get there, we're going to have to make a lot of difficult choices.

Will we decide to value freedom of movement over the health of our at-risk populations?

Will we accept government tracking in exchange for an end to quarantines?

Can we restructure our economy for a world of minimal human contact?

I know there's much more to cover, but I've done my best here.

What do you think?