Category: Health

Apologies for the macabre subject, but with everyone freaking out about the coronavirus, I’m wondering if it makes sense to step back and ask why the Diamond Princess wasn’t a worst-case scenario. The ship held 3,700 people. The virus spread all around the ship before anyone knew what was going on. Then everyone on board was kept on board, all breathing from the same ventilation system, eating food from the same kitchen (almost surely prepared by at least some workers who had the virus, but didn’t know it). Out of 3,700 passengers and crew, 6 have died (Business Insider).

That’s a death rate of 1/6th of 1 percent (0.16 percent), and concentrated among people whose immune systems were weakened due to other factors (i.e., people who might have died a year later from the flu).

The U.S. overall is not more crowded than a cruise ship. Why should we expect more than 0.16 percent of Americans to die when this is all over? That’s unfortunate, of course, and a huge number when multiplied by 330 million: 535,000. But it is not an economy-ending or country-ending number. And, since our country is not in fact as densely populated as a cruise ship, the real number might be far less than this upper bound. It might be closer to the 80,000 who died from the flu in 2017-2018 (source). And there might not be that many additional deaths because the same people who get killed by the flu are also susceptible to COVID-19.

One factor that could explain how the death rate could be higher: as the disease spreads, hospitals and other health care resources will be spread thin. But, on the other hand, knowledge about how to treat the infection will improve. If these two factors cancel out, we’re back to the Diamond Princess being the worst-case scenario. Finally, consider that the cruise ship demographic is older and more fragile than the general population.

Related:

• “The Strongest Evidence Yet That America Is Botching Coronavirus Testing” (Atlantic): “I don’t know what went wrong,” a former CDC chief told The Atlantic.
• “Why the CDC botched its coronavirus testing” (Technology Review): The first testing kits from the Centers for Disease Control had a simple fault, and red tape prevented other labs from creating their own.

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The Black Death: The World’s Most Devastating Plague” by Dorsey Armstrong, a professor at Purdue, talks about places that were spared from most of the waves of plague that swept through Europe starting in 1348.

If we don’t want to die from coronavirus, what can we do?

Iceland was an example of a place that escaped plague for more than 50 years. It took a long time to reach Iceland by ship so asymptomatic carriers of the plague couldn’t walk off into port in Iceland. More likely they, and all of their crewmates, would die before reaching Iceland.

People today travel by plane, however, which is nearly instantaneous. So the “far away by ship” advantage does not seem likely to be realized by any country today.

Finland remained substantially plague-free, says the author, despite having land borders with Sweden, Norway, and Russia, as well as being integrated into the sea trading network of the time that had spread the disease so quickly throughout the Mediterranean and to the British Isles. The secret in Finland was low population density.

Wikipedia says, regarding the influenza pandemic of 1918: “In the U.S., about 28% of the population of 105 million became infected, and 500,000 to 675,000 died (0.48 to 0.64 percent of the population).” Our population is more than 3X the 1918 level and therefore our population density is more than 3X the 1918 level. So the Finland trick cannot work for Americans in general. But maybe for an individual American it could. Move to a non-urban area of a spread-out state, e.g., Alaska or Wyoming. Follow Barbra Streisand and the rest of the Hollywood #Resist crowd to Canada (or pick a different low-density country, such as Argentina).

The professor says that governments that shut down or severely restricted links to the outside world ended up saving most of their citizens and/or subjects. So maybe North Korea or a similarly restricted nation will be comparatively safe?

The professor says that cities with good sanitation did not escape the plague, but death rates were lower. So Japan and Switzerland might have fewer cases of coronavirus? “Mortality burden of the 1918–1919 influenza pandemic in Europe” says that Switzerland was not significantly different from France (but sparsely populated Finland suffered only half the death rate).

Integrating what we know from the Black Death and present-day statistics and conditions, Iceland and New Zealand seem like the most obvious places to run for a re-enactment of the Decameron. They’re islands. They have lower population densities than the U.S. They have comfortably high living standards. However, we need to cross Iceland off the list due to the fact that it operates an international airline hub. People from more than 50 different countries might show up on a typical evening. That leaves… New Zealand.

Fun fact: We get the word “quarantine” from the Venetian government’s requirement that ships coming into Dubrovnik wait at a nearby island for 40 days before coming into contact with the townspeople.

At least we’ll never have to worry about plague per se, again, right? Actually… the bacterium has evolved antibiotic resistance in Madagascar (CDC) and the fleas that carry it have evolved insecticide resistance.

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From a forthcoming chapter in Medical School 2020:

“I don’t think people realize what is coming. The virus is reported to have almost a 20 percent infection rate. On the cruise ship, one asymptomatic person infected 600 people. Our health system covers about 1 million people. We have 54 ICU beds. The numbers just don’t work.” He continues: “On top of this, this will be a supply crisis. Our health system reverts back to the medieval when we don’t have common medications. Penicillin is not made in the US anymore. There is going to be a huge shortage of needles. China supplies everything, and they are shut down.” Is he stockpiling? “Oh yeah.”

This conversation occurred last week. Our anonymous hero was shadowing the radiologists.

Separately, I was at a dinner party on Friday evening in a West LA house that Zillow estimates is worth $3.6 million. The guests on previous occasions spent about 90 percent of their time displaying their virtuous concern for others: Trump-hatred, wanting to help the vulnerable, social justice, etc. During this dinner, however, 90 percent of the conversation was about the rich white guests’ personal fears of contracting the coronavirus, whether to modify travel plans to minimize the risk, etc. (They mixed in a bit of Trump hatred by talking about how the $5 trillion/year Federal government would be powerless to do anything regarding coronavirus due to incompetent leadership by Trump and Pence. They have almost total faith in the power of the Federal government to solve problems, but only if the correct President and VP are installed at the top.)

[At least one Bernie supporter from 2016 had moved into the Elizabeth Warren camp. To judge by the dinner crowd, Warren’s appeal is strongest to women who don’t work and feel aggrieved that some people earn and/or have a lot of money. Bernie’s message is fundamentally about optimism that a slightly tweaked government (just one little tax on billionaires!) can deliver on every American’s dream while Warren is skimming off the most resentful subset of Bernie 2016 supporters?]

Given the large number of destitute people wandering around Los Angeles and/or camping on the sidewalk, I’m not too surprised that rich white people in LA have their personal welfare as Priority #1. But until coronavirus hit, there was some kind of social taboo about giving voice to this priority. Fear of death, apparently, has caused people to abandon any feeling of shame regarding selfish concern.

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From a Mexican’s point of view, American counter-service restaurants and ice cream stands do something completely unsanitary: the person handling the cash is also the person handling food.

At least in the Shanghai region, I noticed that the Chinese usually separate food-handling from customer-handling (not really “cash handling” since WeChat is the typical method of payment.)

I’m wondering if Americans will get fewer colds as we transition to a cashless economy. If everyone who goes to a counter pays by inserting a credit card into a machine or waving a phone, shouldn’t there be less chance of an infection being passed from customer-to-clerk-to-customer?

I couldn’t find good research on this subject. China would be an interesting case study since they have gone mostly cashless in a short period of time. Anecdotally, it was rare to see someone (Shanghai in November) suffering from a cold and I never got any hint of food poisoning.

But maybe this isn’t interesting because the effect will be small and swamped by increased transmission of disease due to increasing population density (from (a) population growth, (b) migration and urbanization).

Related:

• “Catching Flu From Money” (NYT): “The influenza virus can survive on paper money for 10 or more days”

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