COVID 19 in Nevada

A real life pandemic is upon us and will upend our lives for some time to come.  What can we look forward to? What can we do about it?

The pandemic

Anyone reading this blog likely follows the latest news feeds so repeating headlines is a waste of our time.  What might be more useful is looking at the trajectory of the COVID 19 crisis and its associated after-effects in an effort to foresee what is to come.  Let's start with the disease itself since this seems to be something science can help us with.

The COVID 19 outbreak is moving from continent to continent and is just beginning in North America.  In China where it began, the published data suggests  it took approximately 18 days for new cases to peak but that the strain on the medical system peaked about a month after the outbreak.

   
 South Korea is widely reported to have handled their outbreak well: quickly isolating the point sources, testing widely to determine the full extent of the outbreak, and implementing effective measures to damp it down.  Here is what their epidemic (epi) curve looks like (Helen Branswell):

In South Korea, it took about 14 days for new cases to peak.   By all reports, their medical system was not swamped by new cases and their mortality rate was consequently lower than in China.

In the public interest, I think I'll repeat the arguments about "flattening the curve" before turning to effects.  Person-to-person outbreaks have epi-curves that look like your classic bell curve with a tail  except that they vary in amplitude (maximum number of new cases reported) and how tight the curve is.  Here is a cartoon describing this (Economist):

Without effective public health measures, an epidemic spreads quickly and a large number of new cases are reported daily until the epidemic burns out.  With effective public health measures, the spread of disease is slowed and the duration of the epidemic is extended.  In the best case, the number of daily new cases never strains the health care system beyond its capacity and everybody gets effective treatment.

This did not happen in China or Italy and is likely not happening in Spain.  The death rate curves tell the story (Coronadaily March 11):

You can draw your own conclusions on how America is doing; my read is that there is hope that the outbreak won't be as serious as it was in China but these are early days.


I think the World Health Organization daily situation reports are probably the best source of up-to-date information on what is going on.  Here is the epi curve showing new cases (excluding China) in the March 14 report:

It looks like the epidemic really got going in North America around March 9 but it may have been earlier because of a lack of testing, particularly in America.  The incubation period ranges from two to 14 days, with an estimated median incubation period of five to six days, according to the World Health Organization   In a worst case scenario, if it did really take off on March 9, we can expect new reported cases to peak about the end of March and the health care system to feel the maximum strain about the third week of April.

Available evidence suggests that this respiratory disease is most dangerous to the elderly and those with underlying cardiovascular conditions.   There is a lot of misinformation circulating and I've found it hard to get reliable data.  I think the mortality summaries from Wikipedia might be trustworthy:

  Can we make an estimate of how bad it might get?   There are an awful lot of different and some scary numbers being thrown out there.  Let's assume that it is entirely as bad as has been reported in China.  If we make the liberal assumption that Chinese government figures are under-reported by a factor of 5, we might see 15,000 to 20,000 deaths in America and perhaps 300,000 people requiring hospitalization or serious medical care.   The CDC reportedly has a more pessimistic view.  According to a New York Times article.  Their worse case scenarios suggest between 160 and 214 million people will be infected, as many as 200,000 to 1.7 million people could die and between 2.4 and 21 million people could require hospitalization, swamping our nation's health system with only 925,000 hospital beds. A very important caveat to this estimate is that it doesn't take into account the effect of public health measures currently underway which could reduce these estimates dramatically.  Finally, an interesting point they raise is that this epidemic could last as much as a year with local resurgences.
   
So, in summary, it appears likely the current COVID 19 outbreak could peak in America by the end of March in terms of new infections by mid to late April with respect to the pressure on the health system.  If we are lucky in the first pass, our health system may not be overtaxed and hopefully the death toll will not be over 10,000.   But this won't be the only or perhaps the most serious effect on American's in the weeks to come.

The infodemic

American news and other media got interested in COVID 19 about the time the epidemic peaked in China in early February.   The story continued at a slow boil throughout February until early March when the extent of the epidemic in Europe became apparent.  Since then the story has gone ballistic (Social Media Matters):

 The recent spike occurred when the number of COVID 19 cases in America began to accelerate and the epidemic looked like it was well established.   But wait.. there's more:

The stock market has corrected sharply, originally in response to the COVID 19 outbreak but later exacerbated by the Saudi - Russian oil price war.  The price war has has led to a credit crunch requiring the Federal Reserve to inject liquidity into the banking system as it did following the 2008 financial crisis.  The airline, tourist and entertainment industries have already taken a big hit with mass layoffs at some airlines already as air traffic has plummeted.  All in all - a perfect storm.  Until the epidemic crests - again hopefully by early April - there may be big losses on both Wall Street and Main Street.

In Nevada  

So what can we expect in Nevada?   Here's a guess:

• Serious slowdown in the gaming / entertainment industry, hitting Las Vegas pretty hard in about 2 weeks.   We've already seen signs of it with Delta cutting flights by 40% and other airlines noting booking slumps similar to 9/11.  Event cancellations multiplied last week and there might be a race for the exit as no organizer wants to be responsible for holding an event that spreads serious illness. 
• School shutdowns - similar to that being mulled over in Clark County.  With closures already announced in Washington, California and Ohio don't count this out.  I think these are likely within the next 2 weeks, starting first in Las Vegas and then in Reno.
• Public facilities closures, likely announced along with school closures.
• Steadily escalating hospital admissions with elective surgery being cancelled.
• Continued run on some stores for groceries and essentials.
• A general business slowdown with consequent layoffs as people hunker down and avoid many smaller social events.  

It could be bad for at least 6 weeks ahead; hopefully we will see improvement by then but we should expect this to drag on for a while afterwards.

So what should we do?

We owe it to our families, neighbors and community to do our bit to fight this epidemic.  The Center for Disease Control has laid it out for us, using the best currently available information:

• Practice good personal hygiene:
• Wash your hands frequently with soap and water; there's a proper way to do it. 
• Don't touch your face; the virus enters the body through the nose, eyes and mouth.
• Wash items you handle that could become contaminated with disinfectants containing at least 70% alcohol or strong bleach.
• Cough / sneeze into the crook of your elbow not your hands.
• Avoid hand shaking and other personal contact.

•  Avoid large public gatherings and keep about 6 feet apart from others in most situations.

• Especially avoid contact with the elderly or people with underlying health issues.

•  Watch for the symptoms you might have it:
• Fever
• Dry cough
• Difficulty breathing

• If you do think you have it:
• Wear a mask to avoid spreading it.
• Rest
• Stay at home and away from others to avoid spreading it.
• Get tested, if available.
• Seek medical attention if it gets serious and you see:
• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face
• Other symptoms of concern (this list isn't exhaustive).

All this sounds and perhaps feels a little weird but the good news is that these small measures will help immensely by slowing the spread of the disease and giving our health care system time to deal with what will likely be quite a case load.  

Above all, we should not let this crisis bring out the worst in us.  Fear can lead to either nastiness or irresponsible neglect.  There are going to be tough economic times ahead in the near term and we will all feel the pinch; who among us will remain generous?  David Brooks made an interesting point in his weekly PBS session with Mark Shields on PBS.  In reviewing the history of the 1918-1919 Spanish Flu Epidemic which killed between 500,000 and 675,000 Americans he noted the lack of sources and the reticence of people to talk about it.  He attributed this in large part to shame; individually and collectively we did not deal well with this event and it left real scars.  We have a chance to avoid this here.

On a personal note, I can tell you this is real and coming soon.  At the end of February, I attended a large mining industry convention in Toronto, Ontario with 23,000 other delegates.  There was hand sanitizer at every booth, attendants continually washing the escalator rails and elbow bumps or waves instead of hand shakes all round.  Nonetheless, one case of  COVID 19 was reported almost immediately after the convention.  I went up to the Yukon in northern Canada afterwards and had dinner on Monday with a friend who had also been at that convention.  He developed a fever on Thursday and tested positive for the virus along with his daughter on Friday.  I won't be able to travel back to Goldfield anytime soon; Canada issued a blanket air travel advisory today which voids my health insurance if I return to Nevada.  This virus has probably been circulating in North America for many weeks and is just starting to break out.   There is no vaccine to prevent this disease; all you can do is to prevent yourself from being exposed to it.

I am confident this will break in a few weeks but things will be interesting until then with plenty of alarms and challenges.  With prayer, preventative measures and practical charity I feel we will weather this as our ancestors have weathered similar and worse crises throughout our history.

 -- Mike Power