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COVID 12.0

As the cases explode up it’s critical to remember that this is not all exponential growth. It’s more like getting a census of where we are. That’s what mass testing does for you. The US leads the world in testing and therefore leads the world in cases. Makes perfect sense.

When the H1N1 pandemic started we did the same thing. Once we realized it was so prevalent we stopped testing and began using estimates. This disease is prevalent but likely has been for weeks, maybe months. We will never find all cases because mild and asymptomatic people escape notice altogether. Probably thousands of recovered people walking around now as well. If we use estimates like we do for flu our denominator is more reflective of how the death and severity rates actually play out. As Dr Fauci said likely more in line w a severe flu. I think that’s actually an average of extremes though, some much milder, some much worse. The worse ones hit our ICUs and hospitals hard.

It’s very hard to model anything without knowing the base. The idea that the cases are increasing only because the disease is spreading rapidly is flawed.

There are a fixed number of people w blue eyes in the US. We identify one person and then begin to look for others. We find more and more of them every day because they were always there not because there are new people w blue eyes. That’s a lot but certainly not all of what we are seeing w COVID numbers. No doubt it’s spreading too, more where there were more to start with like urban areas. Also places you would expect spread because of population density. Our hope has to be that the vast majority of the newly discovered will remain mild and not need our hospitals.

What we see from here will tell us how effective the strategy that has cost so much will be. With H1N1 we didn’t do any of these interventions . Cases dropped in the spring w the weather getting warmer, then spiked in the fall. They finally declined after rapid rise in the fall from herd immunity, use of antivirals and eventually a vaccine. I think the COVID drop will be dramatic when it starts probably in a week or so as that long incubation period begins to wind down from when we started. It had better because we have to get back to normal. That gray curve again is fall 2009. Thats what we want to see now but even steeper, like a rocket to zero. IMG_1865

Once the decline is evident (likely regionally first, then nationally) we can breath a giant sigh of relief and thank the people who fought the fight, made the plan and won. This is the first battle. We threw shock and awe at it. Very American. We took a big hit though as a result. As we asses the victory and recover from the damage it cost, we will need an ongoing surveillance and mitigation plan that is more conventional, less nuclear. Let’s hope we get there soon.