This is going to be a long read, so I’d like to start with some facts to help grab your attention.
- The Spanish Flu had a fatality rate (case-fatality rate) of ~2.5% .
- The currently understood fatality rate for COVID-19 ~2.3%.
- The seasonal flu by comparison has a typical fatality rate of less than 0.1%.
- Conservatively, COVID-19 is 23 times more lethal than the seasonal flu.
- This morning, 2/27/2020, a New York Times health reporter who’s covered epidemics his entire career said he’s seeing COVID-19 as roughly on par with the 1918 Spanish Flu. It’s a great podcast, and you should listen. A chilling quote was:
I’m trying to bring a sense that if things don’t change, a lot of us might die. If you have 300 relatively close friends and acquaintances, six of them would die in a 2.5 percent mortality situation.
I’ve had my eye on the Wuhan originated coronavirus (now named COVID-19) since the first reports popped up in early January of 2020. I’ve always prided myself on being somewhat of a prepared person, stemming I believe from being a Boy Scout, then a sailor, now living in a rural area. While fully acknowledging the benefits that a society brings, sometimes you don’t have that societal structure around to help and you’re on your own.
I also tore my rotator cuff in early January so I had a lot of time to sit around on the Internet and read things. I managed to do a few productive tasks like pass my amateur radio general license exam, which left me feeling that my time wasn’t totally wasted.
Years ago I had read the biological-spooktacular classics: The Hot Zone (about Ebola), The Demon in the Freezer (about smallpox), and Lab 257 (about Lyme disease, but so much more). These were entertaining and terrifying, but there really wasn’t much actionable at the time. Still, I highly recommend them.
Starting in January I wanted to know more about pandemics, in particular ones that we might experience again. So I read John Barry’s seminal work on the 1918 Spanish Flu, The Great Influenza. If Barry’s book is heavy on research at the cost of entertainment, Julie Halpbern’s Get Well Soon swings in the other direction. Again, I’d recommend both.
Last night my daughter and I were watching Parks and Rec and the Internet connection dropped for about 1 minute. Every waking member of the family noticed and was interrupted: for one person their job and for two others their entertainment. Looking back at 1918 it is hard to imagine much in common with these black and white single dimensional people.
One century later we have (mostly) self driving Teslas available. We can talk to people around the world with ease. We have validated theories on the fundamentals of space time. But our biology remains unchanged and viruses still impact us the same way. The Spanish Flu never really went away and remains incurable. Other terrifying illnesses like encephalitis lethargica are still around, uncured, popping up every now and then.
On a day-to-day basis we don’t really need to entertain these issues and can live our lives in relative peace. Which is about the same for folks living in 1916, two years before the Spanish Flu showed up.
Reading up on the Spanish Flu the anti-alarmist tones from a century ago echo today. Spain was the only country to openly discuss their epidemics, most other countries (including the United States) downplayed the infection largely because of politics. At that time it was about World War 1, making sure that families felt fine sending their children off on crowded troop transports and attending war bond rallies.
There are many concerns about a global pandemic and how it will impact you, me, and our families and friends. It’s hard to wrap our heads around what might be coming. One particular area though that concerns me is the strain it will put on resources. Yesterday, the first community-spread infection was believed to be discovered in the United States, only a couple of hundred miles away from me.
One element in the news report caught me eye and reinforced my concerns about limited resources:
The patient arrived on a ventilator, and special protection orders were issued “because of an undiagnosed and suspected viral condition,” according to the email.
There are 52 ventilators per 100,000 people in US healthcare facilities. That’s combining pediatric and adult-only ventilators, and the data is 8 years old, but let’s go with it. 80% of cases of COVID-19 are mild, and 20% are serious including organ failure and requiring intensive medical care, which often means ventilators.
There are roughly 330 million people in the United States. Looking at the Spanish Flu, it infected roughly 27% of the population. That varied widely between geographies. But some quick math: 27% of 330,000,000 = 89,000,000 infections. If 20% of those people are critical, that is (rounded down) 17 million serious cases. There are ~63,000 ventilators in the United States.
Granted, not everyone will get sick at the same time needing the same medical services. But also you may not live anywhere near a ventilator, or you could live near a hospital that only has two. And remember that many of these ventilators are in use now, treating current patients. It’s not like 63,000 ventilators are hanging around waiting for just COVID-19 patients. Some of these ventilators are fully utilized, keeping patients alive for days or even years.
And even spreading out those 17 million serious infections across 23 months (the length of time the Spanish Flu was epidemic in the United States), that’s 739,000 serious cases per month. We have less than 10% of the ventilators needed for that.
People seem good at dealing with no threats or current mortal danger. The problems in the middle we’re not so good at. Look at type 2 diabetes or heart disease. For the most part we know how to avoid these things but if you eat a candy bar or a steak today it’s not like a guy shows up to your house with a gun to shoot you: the threat is too far away for it to seem real so many Americans sort of punt on it until it’s too late.
I’m not advising anyone to build a bunker with 500 pounds of rice and beans and go be a hermit. The Spanish Flu was in peak epidemic status for 23 months in the United States alone. If COVID-19 is similar, and that’s a big if, it will be here longer than you can just wait it out in total isolation. Like diabetes and heart disease, this will require us to continue to live our lives but make decent changes to our daily habits.
You will still have a rent or mortgage payments during COVID-19’s run in the United States. You will still have birthdays, anniversaries, and holidays. I’m still planning on going climbing, backpacking, and mountain biking.
But like other serious health issues, I’m planning on changing my behaviors to accommodate this problem. There are some alterations to your current life that you may want to consider. Those modifications are a huge topic on their own, but I would advise you start doing research into it. This public health communications person is a good start. Some people like myself might look seriously at home schooling our kids, for others without school aged children that won’t be a concern. Some things that I, a lowly EMT, would advise to anyone:
- Try to get any prescriptions filled a few months in advance to avoid supply chain disruptions. Many physicians are doing this now and insurance companies are contacting physicians asking for the same. It is much cheaper to take medications than to stop and end up with an acute emergency.
- Be extremely serious about hand washing, not touching faces, avoiding sick people, and yes, wearing an n95 mask if you can still find one.
- Try to go to crowded places when they are not crowded. Grocery stores are normally empty at 6:00am.
- Work remotely if possible.
- Purchase enough otc medication and food that you see is reasonable. Particularly with these, consider that you’ll probably go through these items anyway. Instead of 10 cans of soup that you might buy for a month, consider 20 or 30. You’ll use them up before the shelf life and you’ll minimize the amount of time you’ll need to go to the store.
Lastly on a very conspiratorial note. Nearly all of us shape our language when discussing tricky topics. Reading the history of the 1918 influenza, many officials were flat out lying. The Dow Jones has shed nearly 4,000 points in only a few days. There is a presidential election coming up in only a few months. Understand that there will be attempts to calm and pacify people so that we do not panic buy, curtail spending and alter voting habits.
Much of that gets into politics and you can see it how you wish.
But please, take this seriously. If the New York Times reporter was accurate, and we have no reason to doubt it, this will kill a lot of people.