Wrong. Unless you're talking about the entire world, instead of the USA, there are not ten million unknown COVID-19 cases. There're probably about one million, in the United States.
In an average year, the seasonal flu infects 30-40 million Americans, and has a case fatality rate of about 0.13%. As of this afternoon, the naively calculated COVID-19 case fatality rate in the USA was 14,463 deaths / 422,369 cases = 3.42%, and rising. There are distorting factors which both increase and decrease that number:
● On one hand, on the basis of the fact that half of the 704 Diamond Princess infected passengers were asymptomatic, plus the fact that even patients who become symptomatic are usually asymptomatic for at least a few days, we can guess that it is likely that as many as two-thirds of infected Americans remain as yet undiagnosed, causing an overestimate of the case fatality rate, by as much as a factor of three. (But that's not good news, because that very large population of undiagnosed & often asymptomatic "Typhoid Marys" is the reason it's so difficult to prevent additional infections.)
● On the other hand, most of the currently confirmed cases remain unresolved. The deaths so far are from a confirmed case population which was much lower (i.e., more than a week earlier), causing an underestimate of the case fatality rate by considerably more than a factor of three.
The combination of those two factors strongly suggests that the true current case fatality rate is even worse than it currently appears to be. In other words, the COVID-19 mortality rate is more than twenty times worse than typical seasonal flu.
That might change, but we don't know which direction. It might improve, or it might worsen.
● On one hand, if any of the treatments currently in trial for this disease prove effective, the case fatality rate will presumably drop.
● On the other hand, if hospitals run out of beds and ventilators, the case fatality rate will increase. In Italy, where that has already happened, the naively calculated case-fatality rate is now at 12.67%, and still rising.
The key to stopping progression of any epidemic is to reduce the reinfection rate “R” (a/k/a "R0") below 1.0 reinfections per infected person. Unfortunately, with this disease, the average reinfection rate with moderate "social distancing" precautions is still very high.
My estimate is R=10. How do we know that? Well, we don't, precisely. It's a rough estimates. The current lack of comprehensive testing makes precise determination of the true number of infected people impossible, which is what we would need to know to calculate those figures exactly. But we do have some clues.
From the Diamond Princess cruise ship data -- a population which was fully tested, repeatedly -- we know that about half of the infected people never showed symptoms. With current testing restricted to symptomatic patients, and sometimes their known contacts, that suggests that perhaps two-thirds of those who are infected are undiagnosed. They are the unknowing carriers who make controlling the spread of the disease so challenging.
From the fact that spouses can begin to show symptoms a few days (4-5) after their spouses do, we can infer that a person can become at least slightly contagious just a few days after his own exposure. But from the fact that it takes about two weeks before the effects of a lock-down become apparent in the case number statistics, we can infer that peak infectiousness probably averages around ten days after exposure. (I.e., average time to reinfection, T ≈ 10 days.)
Additionally, we know that with only moderate social distancing to slow the infection rate, the case numbers and death counts in a typical population increase by about 26% per day (doubling in three days, and increasing by a factor of ten in ten days).
The combination of those three facts (50% asymptomatic, average T = 10 day reinfection "generation" time, and +26% exponential increase per day) imply:
R ≈ 10. The reinfection rate R w/ moderate social distancing precautions is roughly 10 first-generation reinfections.
R=10 and T=10 days are consistent with the observed daily case increase of about 26%, when only moderate social distancing is employed:
● 1.26^3≈2, so doubling every three days
● 1.26^5≈3, so tripling every five days
● 1.26^10≈10, so a 10x increase in ten days
To get a +26% per day increase in number of infections, with about a ten day average "generation length" before reinfection occurs, requires R ≈ 10.1.26^10 = 10.
That's obviously approximate. If the average "generation length" between initial infection and reinfection is twelve days, instead of ten, that would mean R ≈ 16. If it's only eight days, instead of ten, that would mean R = 6 to 7. Those are approximately the extremes of the plausible range.
So, to reduce R below 1.0, and thereby halt the worsening of the epidemic, requires reducing the reinfection rate by at least five-sixths, and probably by nine-tenths.
Think about that. Do you think you can be ten times as careful as you are now, to reduce your chance of infection by 9/10-ths, without knowing who is infected and who is not?
It's probably impossible with merely more stringent social distancing precautions for the general population. It means we will ONLY manage to bring the epidemic under control with vastly expanded testing, to find out who has the disease, and who does not, so that we can keep them apart.
Not only is this disease much more deadly than a typical seasonal flu, it is also much more infectious.
When the seasonal flu runs its course, only about 10% to 12% of Americans typically contract the disease. The fact that there's no vaccine for this disease, combined with this disease's higher inherent infectiousness, suggests that if COVID-19 were allowed to "run its course," like we do with the flu, at least two-thirds of Americans would be infected.
The arithmetic is easy, and frightening; 20 times as deadly, and 5 times the number of infection: 20×5 = 100.
That is why we cannot treat this like the seasonal flu.
Eventually, R must fall below 1.0, simply because the disease will run out of new patients. But if that’s how it happens, it will be a catastrophe worse than any living American can remember. A 2% case fatality rate applied to two-thirds of the nation's population would leave several million Americans dead.
That is why we MUST lower R below 1.0 before so many people become infected.
Unless a cure is found, there's only one solution. What is urgently needed is comprehensive testing (perhaps combined with aggressive contact-tracing). We need to test everyone in America, repeatedly, to find & isolate all the undiagnosed carriers of this disease. It will not be possible to reduce R below 1.0 without employing comprehensive testing, of both sick people and apparently-healthy people.
There is sliver of good news.
Fortunately, testing for the presence of the virus is easy. Many different labs have created tests, with more announced almost every day. These days, microbiologists are very, very good at that sort of thing. Here's a paper about it:
doi:10.1373/clinchem.2015.245829
EXCERPT: "RPA has high specificity and efficiency (10⁴-fold amplification in 10 min)..."
Yes, you read that correctly. In just ten minutes they can multiply the target molecule from a patient swab by a factor of 10,000!
That's how these tests can produce results in 15 minutes or less. Viruses aren't "alive," so they don't need to be "cultured" to "reproduce" like bacteria. Instead, scientists use "recombinase polymerase amplification" (RPA) technology, which is beyond my ken, but which quickly multiplies the target molecule in the sample, so that it can be detected.
Comprehensive testing might sound expensive, but the cost would be a tiny fraction of the $2.2 trillion coronavirus stimulus bill. If a test is generously estimated to cost $100, 330 million tests would cost $33 billion, which is 1/67-th the price of the $2.2 trillion stimulus/bailout.
When we can test EVERYONE, we can get back to normal. Until then, we need to be extremely careful to avoid contact with other people.
BTW, that $100/test price is a very generous cost estimate, though it might be realistic for future tests which detect antibodies (to find out who has acquired & recovered from the disease, and so is presumably immune). The "Medicare reimbursement price" of current COVID-19 tests, which only detect presence of the virus, is $36 to $51.
Misplaced skepticism about this pandemic is deadly.
One deadly exacerbating factor in this pandemic is that some people still do not take it seriously.
A major reason is the many self-anointed "experts," and their sycophants in the press, who have been "crying wolf" about climate change. As a result, many scientists, and other astute observers, who’ve learned that manmade climate change is actually modest and benign, and that climate activists and their "renewable energy" bankrollers are perpetrating a scam, have understandably developed the dangerous habit of discounting warnings about supposed public emergencies. So now, when we have a real emergency, some of them are understandably reluctant to believe it's as bad as claimed.
The promoters of the fake "climate emergency" are to blame for that. They already had a lot of blood on their hands, and now they have more. In South Korea, one 61yo woman, whom they're calling "Patient 31," ignored the social distancing rules, and then even when she felt ill she ignored her symptoms, and went on living her life as normal, while infected. I don't know why she was in denial about her disease, but many people think like she did because of the fake "climate emergency" scam. South Korean contact tracers have counted about 2500 other infections which are the fault of Patient 31. Please do not risk being the "Patient 31" in your town.
In summary, COVID-19 is far, far worse than any flu in the last hundred years.
There are four main reasons COVID-19 is a catastrophe:
1. It’s much more infectious than typical seasonal flu,
2. There's no vaccine for it (unlike flu, for which almost half of Americans are typically vaccinated),
3. It’s often infectious even without symptoms, and
4. It’s about 20× as deadly as typical seasonal flu. (COVID-19 apparently has a case fatality rate ≥ 2%, compared to a case fatality rate ≈ 0.1% for typical seasonal flu.)
The coronavirus’s extreme infectiousness (reason #1) is why, absent a draconian lock-down, it has an explosive reinfection rate of about R=10. When one person contracts the disease, on average he infects about 10 more people over the next 4-20 days (peaking around 10 days). [That's why we see the characteristic exponential growth curve (in both cases and deaths), roughly +26% / day: doubling in 3 days, tripling in 5 days, and increasing by a factor of ten in 10 days.]
That, plus the lack of a vaccine (reason #2), means that if the disease were allowed to "run its course," with only minor precautions to slow the spread, like we handle seasonal flu, at least two-thirds of Americans would probably eventually become infected. Only 10%-12% of Americans typically contract seasonal flu in an average year, or 20% in a very bad year, so if COVID-19 were treated like seasonal flu, we could expect at least five times as many cases.
The asymptomatic carriers of COVID-19 (reason #3) are why we cannot stop the spread by isolating only people with symptoms.
The other statistic which keeps epidemiologists awake at night is COVID-19’s deadliness (reason #4). It is apparently at least 20 times as deadly as typical seasonal flu. A typical seasonal flu kills about 30,000 to 35,000 Americans, over the course of a year. 20 × 5 = 100, so were COVID-19 allowed to “run its course,” and potentially infect 5× as many people, it could kill several million Americans.
Since there’s no vaccine or cure, so far, there's only one feasible solution, and that is TESTING. We must TEST EVERYONE, repeatedly. That is the only way to identify and isolate the “Typhoid Marys” (asymptomatic carriers), without also isolating everyone else.
That sounds expensive, but when you do the arithmetic it’s a tiny fraction of what we’re already spending. If one test is generously estimated to cost $100 (which is much more than the current $26-$51 Medicare reimbursement price), we could test all 330 million Americans six times, for less than one-tenth of the price of the $2.2 billion stimulus/bailout.
The United States should be pouring resources into an all-out effort to ramp up testing capacity. We need a network of drive-thru testing centers in every town, where you can get your nose swabbed or finger pricked, and 15-30 minutes later receive a text message or email with the results. To enter most stores and restaurants you should have to show evidence of a recent negative test result, or of serologic immunity (from having recovered from the disease).
With that system in place, we could reduce the epidemic to a minor nuisance in 2-3 weeks, and end it completely in a few months. Businesses could reopen, instead of going bankrupt.
Unfortunately, it appears that few people in government “get it.” We used to have a brilliant physician in the U.S. Senate, Sen.Tom Coburn. He was the best and wisest man in Congress, and maybe in the entire federal government. He would have understood this situation, and how to handle it. But he retired from the Senate in 2014 due to progressing prostate cancer, and a few days ago he died from it.
