Wednesday, March 25, 2020

Coronavirus: Interpreting the numbers

The daily coronavirus statistics have led to interpretations that pretty much span the realm of possibilities: It will infect 80% of the people; 80% are already infected; it will die out in warmer weather, it will not die out in warmer weather; It will get worse before it gets better; it will get much worse before it gets better; it is getting better; etc.

The month of March has provided significant data with which to consider the course and nature of the coronavirus epidemic. Significant events in March include peaking of the growth rate in South Korea, Flare up of the virus in Spain, and the dramatic flare in New York that began significantly affecting the data on March 13, 2020. What these data suggest is that:

1.) The virus does not spread easily. It is not that a whole lot of people are immune, it is more likely that there is a wide variation in susceptibility to infection among people who are not immune, presumably due to factors to be found in the upper airway and pharynx, rather than in the lungs.

2.) The risk of death depends not only on the risk of infection, but also upon the risk of pneumonia once infected. This likely involves a different set of risk factors.

3.) Most infections are not spread by airborne pathogens.

4.) The primary concern regarding "collapse of the healthcare system" is whether everyone who needs a ventilator has access to one. A key determinant of this is the length of time a person who requires mechanical ventilation remains on a ventilator, and these data are at least as important in forecasting severity of the epidemic as are total number of cases or deaths.

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