The Institute for Health Metrics and Evaluation (IHME) is an independent population health research center at UW Medicine, part of the University of Washington, that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. While there is no shortage of models to look at, IHME’s infectious disease modelling for estimating the COVID-19 pandemic growth rate and basic reproduction number (R0) for the United States has been among the best.
With that in mind, here are two reasons for hope this Easter Sunday 2020, although the payoff will only come later, so be prepared to wait until at least June, maybe even July, because this is going to be a case of delayed gratification, measured in months, not days:
- It has been one day since projected peak hospital resource, including all beds, intensive care unit (ICU) beds, and invasive ventilators in the United States on April 11;
- It has been two days since the projected peak in daily deaths on April 10 of 1,983 deaths (the actual number was slightly higher, 2,056);
While models differ on peaks, the United States is close to its peak of the novel coronavirus disease, Food and Drug Administration Commissioner Dr. Stephen Hahn said on ABC’s This Week earlier today.
Canada’s pandemic is in earlier stages. Many countries reached their first 500 cases before community transmission started in Canada.
Like any mathematical model, there are caveats and disclaimers to be noted. The Institute for Health Metrics and Evaluation model prominently notes that it is making its “COVID-19 projections assuming full social distancing through May 2020.” Assuming “full social distancing” from now through May 31 strikes me as one very big assumption. Still, the U.S. government’s early modelling suggested that only 50 per cent of Americans would observe the stringent federal social distancing guidelines, currently in effect until April 30, when in actuality U.S. Surgeon General Dr. Jerome Adams said last week that a much larger number – 90 per cent – were observing the guidelines.
My best guess is the United States will reboot the economy too quickly in early May, against public health advice, and there will be a resurgence of COVID-19 cases, but the resurgence, while regrettable and wholly unnecessary, will be a temporary setback, delaying, but not wiping out the gains being made right now through social distancing, and shutting down the economy, with the exception of “essential” work, whatever that really means from state-to-state, community-to-community.
I wrote a piece Jan. 23 headlined, “The fire this time? Pandemic prose, and waiting and watching for the ‘big one’ (https://soundingsjohnbarker.wordpress.com/2020/01/23/the-fire-this-time-pandemic-prose-and-waiting-and-watching-for-the-big-one/) where I wondered, “How quickly we could we make a trip back to a modern-day equivalent to the Dark Ages of the 5th to 11th centuries?” I think the early evidence we have seen in the 10 weeks since then suggests not so very long, and that the best parallel in modern times will turn out to be the “Spanish Flu” influenza pandemic of 1918, although it killed about 675,000 people in the United States, compared to COVID-19, which will likely kill about 10 times less than that. The Institute for Health Metrics and Evaluation in Seattle projects 61,545 COVID-19 deaths by Aug. 4. Well less than then the 1918 influenza pandemic, but a greater number of Americans killed than in the Vietnam and Afghan conflicts combined.
The National Center for Medical Intelligence (NCMI) at Fort Detrick, Maryland warned as far back as last November that a contagion was sweeping through China’s Wuhan region, changing the patterns of life and business and posing a threat to the population. The report was the result of analysis of wire and computer intercepts, coupled with satellite images.
The medical intelligence (MEDINT) cell within Canadian Forces Intelligence Command (CFINTCOM) gave a similar warning in January.
In the summer of 2005, the Center for the History of Medicine at the University of Michigan in Ann Arbor was asked by the Defense Threat Reduction Agency (DTRA) to conduct research into and write a report on American communities that had experienced extremely low rates of influenza during the infamous 1918-1920 so-called “Spanish Flu” influenza pandemic.
They selected seven communities that reported relatively few if any cases of influenza, and no more than one influenza-related death while non-pharmaceutical interventions (NPI) were enforced during the second wave of the 1918-1920 influenza pandemic. The communities were:
- San Francisco Naval Training Station, Yerba Buena Island, California;
- Gunnison, Colorado;
- Princeton University, Princeton, New Jersey;
- Western Pennsylvania Institution for the Blind (WPIB), Pittsburgh, Pennsylvania;
- Trudeau Tuberculosis Sanatorium, Saranac Lake, New York;
- Bryn Mawr College, Bryn Mawr, Pennsylvania;
- Fletcher, Vermont
Over time, it will be interesting to see what, if any, COVID-19, outliers there are in the United States. Internationally, there are a few countries in Africa that still have no cases, but the bulk of COVID-19-free countries are in the Pacific. Nations such as Vanuatu, Palau, Solomon Islands, Tonga and Samoa have been protected to date by their remoteness.
According to the most recent Institute for Health Metrics and Evaluation projections, subject to the caveats and disclaimers mentioned earlier, deaths per day should drop to 976 in the United States by May 1; 47 on June 1, and none after June 19, as a dread spring gives way to a summer of hope.
Here in Canada, the Public Health Agency of Canada says that ‘Prior to stronger public health measures, each infected person (case) in Canada infected 2.19 other people on average.” When each COVID-19 infected person infects fewer than one person on average, the pandemic will die out, the agency says. “Models cannot predict what will happen, but rather can help us understand what might happen to ensure we can plan for worst cases and drive public health action to achieve the best possible outcome.”
Any backsliding, of course, in April and May on physical (social) distancing, self-isolation of cases, quarantine of contacts, and preventing importation of infection from other countries internationally through border controls and nationally through domestic travel restrictions, and all bets are off.
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