This is a legitimate question that many are asking. Some are asking it from a macro-economic perspective because they are investors who want to get the bull running again. Others are asking from a much more personal perspective because they lost their jobs, they are watching their retirement plan drop in value, or they need to feed their kids or get them in a safe environment such as school. No matter what, there will be massive economic impact globally and personally from this pandemic. A better question could be - "When will we know how many people are sick in the United States?" It implies more compassion for the sick, the families of the deceased, the workers on the front lines. This question might be better as the answer is necessary before "when can we open up America again?". Unfortunately, we can't answer this due to our inadequate response to this pandemic. We are woefully behind on testing by losing almost the whole month of February and barely starting to get it together by the end of March with a patchwork of local self-organization. This is all well-documented in How the Coronavirus became an American Catastrophe.
On March 20th, a friend who is a nurse shared the mixed messaging that was coming from Iowa health officials on testing when Iowans were being denied testing with the messaging of "not everyone needs to be tested" which I believe is disingenuous as it is hiding the broader truth and obscuring the real problem. A better message could have been - "...we only have Y tests available per day and we have to prioritize. Given your current symptoms, you do not meet the cutoff for our prioritization. We hope to remediate this problem soon by X date but unfortunately this is what we have to do until we get more..." A message like that may create more empathy for the situation and highlights the root challenge of us not being able to effectively ramp testing services and kits. Note that as of this morning, only 4,673 tests have been performed in Iowa with 298 positives and 3 deaths. Since we are restricting testing so much, we can only see a tiny surface area of risk (in this case, 4,673/3,150,000 = 0.1%).
When you look at the broader United States, you have only 801,416 tests given (or 0.2% visibility, self-selected to the most sick) and a positive finding in 122,166 people which creates a 15.3% positive rate. Since we are only testing the most sick, let's make an assumption that the actual positive rate if we did random sampling would be 25% of that which would lead to a 3.8% positive rate. This would lead to a rough estimate of 12 million affected in the US. If you use existing death rate percentages you get a range of 219,000 using the current US death rate to 1,250,000 assuming system-collapse death rate of 10%. If you use the global death rate of 4.65%, the estimate would be 581,724. This range is a terrible range and is increasing over the last week. The range is also tightening as US death rates are increasing.
Testing rates are ramping up. California was woefully behind last week and has now ramped up significantly but still way behind. Faster test kits, more test kits, and more coordination in the distribution of test kits seem to be one of the most important things we can do to make good decisions about opening up America again. I don't agree with politicians who pick a date out of thin air (e.g. "Easter") since the data is dynamically changing and must be analyzed on at least a daily basis.
on by X date but unfortunately this is what we have to do until we get more
It has been six days since my last blog when I expressed that I hope the pandemic will not increase separate-ness in the world. Since then, I have been watching the news of Italy, New York, Spain, and the harrowing stories of health care workers on the front lines talking about running out of PPE, ventilators, and surges on emergency rooms. I am unable to reconcile those stories with the hopeful picture painted by most politicians and most of the media so I decided to just start tracking trends myself using publicly available data. Here is some simple modeling of potential impact using today's data:
Metrics as of March 25th, 2020, 8:42 PM PT
If the current death rate holds, which it won't, and we estimate with current hit rate, then we will have 85K deaths, a terrible number that is hard to comprehend and 7 times the annual number of flu deaths. Since we know that we are self-selecting tests to the most sick and assume 25% of that, you still have 21K deaths on the low end. I believe that estimate is much too conservative, however, since our death metrics will trail 1-2 weeks behind the positive test case metrics.
If we use the global death rate with the current hit rate in the US, we get 2 million deaths. If we estimate system collapse death rate of 10% (what is happening in Italy), then you get 4.4 million deaths. If we apply the same 25% ratio due to self-selecting only the sickest to get tests, then we still have deaths from 500,000 to 1,000,000 people in the US alone.
I sure hope that our measures of self-isolation will stop the exponential rise of cases and deaths and we are able to bring these estimates much closer to the thousands, not millions. I will try to update this regularly with the latest testing data.
Times have changed. Society will change. In a short period of time, we see massive business, societal and family disruption. I am grateful to be able to work from home and still be effective. My heart and gratitude goes out to the health care workers, security teams, people on the manufacturing line, the drivers, the cooks, the bartenders, the small business owners that are provide continuity to my life and business. I wish them the best.
Cases are doubling in the United States every four days. We are at 13,690 cases in the US, 200 deaths, and only 103,945 tests given. We don't know the surface area because we are testing so little due to our aging and inefficient systems. We testing the most sick, who are exhibiting symptoms while asymptomatic folks are carrying the virus to new areas and people. There will be significant economic impact and small businesses will file bankruptcy. I believe the health, societal, privacy and security impacts will be even more impactful. I believe we are learning from Italy and China, not yet competent in our response. There is time for retrospective later, we should focus on response now.
I hope we do not use this situation to create further separate-ness between us. I believe we can create more one-ness from this. I see parents spending more time with their kids and others spending less time because they are on the front lines. I see neighbors and team members supporting each other. I see anxiety about the future and good people being creative and figuring it out.
I have been working from home for about two weeks now out of an abundance of caution. I am grateful for the ability and opportunity to have a job that allows me to do this. In fact, my company starting mandating it as of March 12th. I was getting some cabin fever and decided to take a short overland camping trip in the truck. I picked Liebre Mountain up by Gorman and packed up the truck for an overnight, wet trip as it has been raining for four days. Only took an hour to get to the trailhead. Then it was a beautiful switchback unimproved road for about six miles to the top of the ridge-line.
Once at the ridge-line, it got really windy and was raining sideways. I stepped out for a minute to check out some camping spots and it got cold quickly! I went to Bear Camp but it was so windy I decided to move on to Sawmill Campground. Bear Campground is definitely worth checking out some other time as it has some cool tucked away sites and is right next to the Pacific Crest Trail. Gotta get back there sometime.
Sawmill campground turned out to be cold, windy, and rainy but it was my last option so I set up camp and tucked myself into the tent to see if the rain would die down. I sat there for a couple hours, writing in my journal, watching Netflix, and trying to warm my toes up in my sleeping bag. At about 4 PM I checked the weather report which told me that it was only getting worse. I made the decision to come home and hang with my family rather than sitting in a cold tent for 12 hours in the darkness. Great idea as I was able to get a little adventure in, was able to test the truck, and still able to spend the night with my family.
The ride out was really pretty as the sun came out and lit up the valley. I had a beautiful drive down. The trail was not technical but did have a lot of rock and tree fall, running water, and huge puddles. The trail is washing out pretty bad in this recent rain but it never felt unsafe. I only saw one other person ( in a Jeep of course) on the mountain. The campsites were empty, the roads were empty and the freeways were free sailing. In these crazy times, it is good to remind ourselves that there are some amazing places out there that are being under-appreciated right now. Get outside and have some fun!
Eric is a traveller, hacker, and experimenter who is currently researching how to become a happier, calmer, and more compassionate human being.