Why the US infection pattern is both better and worse than it seems.
Note: Since the publication of this story, the situation in New York/New Jersey has become even more dire, as the story below said could happen. Urgent action is needed…see here.
As of the evening of 3/17, there are well over 6K cases of coronavirus in the US, with around a hundred deaths. This is right around where Italy was nine days ago, on 3/8, though Italy had 366 deaths at this point. The implication is that we will be where Italy is in a little over a week, but reality is more complicated. I’m not a medical doctor, but I am a numbers guy, and this is what I see.
First the “good” news. As of now, Italy has mostly one big area in the North centered on Milan that is the epicenter of the outbreak. So far, Rome, Naples, and the South have less infections, though they are growing as well. The medical system in the most affected provinces is near breaking, or has already broken. It’s hard to tell if this is contributing to the larger mortality rate, or if there are actually vastly more cases out there than have been reported, or if the mortality is a function of the older population.
The situation in the United States is different. The US has multiple outbreak clusters in different regions. (I follow the New York Times map for rough distribution, use Worldometer for overall cases since it seems to update the quickest, and also check state health department websites.)
New York and New Jersey together have around 1600 cases with about 15 deaths. This was Italy around the first of March. Washington sits around 900, Italy at the end of February, and may be starting to level off, or at least its not growing as fast as New York/New Jersey. In California, infection is concentrated in the Bay Area, with numbers like Italy’s around Feb 26th.
On a regional basis, the United States is really more like 2–3 weeks behind Italy.
That said, Italy didn’t go on full lockdown until March 9th, leaving restaurants, bars, and cafes empty. Italy may have been reluctant to take this step as it is a huge disruption in the Italian way of life. Quick stops in the coffee shop for a morning cappuccino or afternoon espresso are routine, and dining can be a marathon event.
Italians can’t just switch to driving through Taco Bell or getting take-out. They don’t have the fast-food infrastructure that Americans take for granted.
Maybe we are getting started earlier with widespread distancing, closure, and cancellations. Maybe the northern California ‘Shelter in Place’ order will tamp down the growth rate enough to spare the hospitals. Maybe the measures we are taking now will have more time to work. Maybe.
Now the bad news. Each of the three most active regions in the US has the potential to become an Italy. The top three areas could easily reach the same size or larger as the Milan outbreak. There are also clusters around a half dozen other metro areas, each region with 100 or more cases. Denver, Atlanta, Chicago, South Florida, Washington D.C., Boston, and New Orleans are all on the cusp of explosive growth. Every one of these could be ANOTHER miniature Italy.
The US also has other population centers that have had small numbers of cases, but could pop at any time; consider the potential of Dallas, Houston, San Antonio, Indianapolis, or Phoenix. The number of cases will jump once we get a handle on testing, but the country mustn’t wait for confirmation.
The best hope is that these areas are far enough behind on the exponential growth curve that current emergency measures can have an effect. Given the diagnoses and deaths still coming in after Italy’s lockdown, we can’t start early enough and we can’t isolate ourselves too much. Localities can’t wait until they have a few dozen cases identified; by then there are hundreds in the wild.
A year from now the world will provide examples of countries that were successful at containment, like South Korea or Japan, and countries that experience tens of thousands of deaths. It’s too early to tell which the United States will be.
Wash your hands, avoid crowds, keep your kids out of school if your schools are open, and telework if you can. Don’t shake hands, don’t touch your face, and don’t dine in restaurants.
Hundreds of thousands of senior citizens are depending on you.