The Sober Math Everyone Must Understand about the Pandemic
Mar 16 · 1
This post is too long. It takes 19 minutes to read according to Medium. It has been viewed 1.9M times in less than 24 hours. You should read it, too.
I wrote this post on Facebook on Thursday Night, March 12th 2020. Since I wrote it, the post
been shared 160k times and I’ve been asked to repost it here so people
can share on Twitter and other platforms. Please distribute freely.
It’s reposted in its entirety here, with no edits.
This
is a long post addressing two underlying issues with the current
response to the pandemic that leave me concerned. It’s the longest post
I’ve ever written.
For
those of you not taking action, or believing the pandemic to be “over
hyped”, you can make fun of me as much as you want now or when this is
over. You can make me the subject of memes and post it everywhere. I
will pose for the picture. I am not trying to convince you, but I do
feel compelled to share information that I deem critical to all of us,
which is why I am posting this at all.
WHY YOU SHOULD TAKE 5 MINUTES TO READ AND CONSIDER THE INFORMATION I AM SHARING:
As
of 3/15/20 at 9 am PST this post has been shared over 50k times since
it was posted 2 days ago. So a lot of people find value in the post and
although it’s a long read, I believe you will find this information
valuable too.
For
those of you who don’t know me well, I am analytical and metered. I
don’t freak out nor do I respond emotionally. I also don’t post a bunch
of bullshit or political or controversial stuff on Facebook. I founded
and am CEO of a successful software company that provides SaaS based
data, analytics, and dashboards to recruiting departments at companies
we all know. As you would expect, I am data driven and fact based.
Before founding my company I held executive roles leading very large
recruiting teams at some of the world’s fastest growing companies such
as Starbucks and Google. At Google I was fortunate enough to report to
Sheryl Sandberg before she took the Facebook COO role. I was a Chemical
Engineering major in college and have a business degree from a top
undergraduate business school. I am not one for hyperbole or
histrionics. My bullshit factor is close to zero.
I
share all this personal information only to help solidify that this
post may be worth reading and sharing with others. I would encourage you
to forward or share this post at your discretion. Many people do not
understand what is happening with the pandemic to the degree required
which is why I took the time to write this and share this on Facebook.
Now that I’ve gotten the introduction out of the way, here are two issues I want to bring to everyone’s attention.
ISSUE
ONE: SOCIAL NORMS ARE POWERFUL MOTIVATORS AND GETTING IN THE WAY OF
PEOPLE TAKING THE RIGHT STEPS IN RESPONSE TO THE PANDEMIC:
One
of the current problems with addressing the pandemic is the social
pressures of taking action today. It’s awkward, and feels like an
over-reaction. The reason it feels like an overreaction is that most
people OVERWEIGHT the currently reported cases and inherently
UNDERWEIGHT the mathematics of how the virus is spreading and what will
happen in about 30 days time. This is because our brains tend to think
linearly as opposed to logarithmically. It’s the same reason many people
don’t save for retirement or understand compound interest.
To
create a new social norm, human beings like to see behavior modeled.
This serves as a signal that says, “oh, someone else is doing it so I
should do it also.”
SO HERE IS A SOCIAL BENCHMARK FOR REFERENCE — THIS IS WHAT I’VE DONE FOR MY FAMILY TO DATE:
I
have already isolated my family. We have canceled EVERYTHING. We have
canceled previously scheduled doctor visits. Social get togethers. No
play dates. Normal routine meetings. Everything has been canceled. It’s
difficult and socially awkward. Some of you think I’m crazy, but I’m
doing it not because I am afraid, but because I am good at math (more on
that in part 2). I had to have my 16 year old daughter quit her job
coaching junior gymnasts at the local gym, with one day’s notice and
also tell my kids they can’t attend youth group at church. Both of those
were tough discussions. I told a very close friend he shouldn’t stay at
my house this weekend even though he was planning to and had booked his
flight from the Bay Area. I canceled another dear friend’s visit for
later this month to go snowboarding on Mt Bachelor.
We
are not eating out. Our kids are already doing online school so we
don’t have to make changes there. I would not send my kids to school
even if they were in public or private school. We have eliminated all
non-essential contact with other people. We will only venture out to
grocery shop when required. We will still go outside to parks, go
mountain biking, hiking, and recreate to keep ourselves sane and do
other things as a family, just not with other people. We have stocked up
on food and have a supply for ~2 months. We have stocked up on other
goods that if depleted would create hardship, like medicines and
feminine hygiene products. We have planned for shortages of essential
items.
THE REASON I HAVE CHOSEN THIS ROUTE FOR MY FAMILY IS MULTI FACETED:
1.
Although my family is considered low risk (I’m 49 in good health, Angi
is 46 and in good health, and our kids are 14 and 16), we must assume that the healthcare system cannot help us, because the hospitals will become overwhelmed very quickly. Most American hospitals will become overwhelmed in approximately 30 days unless something changes.
More on this in part 2 below. So although we are in great health and
unlikely to become gravely ill, the risk is greater if you do not have
access to the medical care that you need. This is something for everyone
to consider. As a society we are accustomed to having access to the
best medical care available. Our medical system will be overwhelmed
unless we practice social distancing at scale. That said, the medical
teams in Italy are seeing an alarming number of cases from people in
their 40s and 50s. Triage tents are already going up in the parking lots
at many hospitals close to the epicenters in the United States.
2. It’s not a matter of if social distancing will take place, it’s a matter of when. This is because social distancing is the only way to stop the virus today.
As I will explain in part 2 below, starting now is FAR more effective than starting even 2 days from now or tomorrow. This
has been proven by Italy and China (and soon to be France and other
European countries who have been slow to respond.) [updated as of 3/14
France is now on lockdown mandated by the government]. Wuhan went on
lockdown after roughly 400 cases were identified (and they had access to
testing that America has systematically failed to do well to date). The
US already has more than 4 times this number of known infected cases as
Wuhan did when it was shut down, and our citizens are far more mobile
and therefore spreading the virus more broadly when compared to Wuhan.
Yet our response is tepid at best.
If hand washing and “being smart” were sufficient Italy would not be in crisis. So
I pray the draconian measures are coming from our government, because
they are required to stop the spread of the virus. It’s better to start
sooner than later as the cost is actually far greater if we wait. I pray
they close all schools and non-essential services the way that Italy
and China have done.
3. Spreading the virus puts those in the high-risk category at much greater risk. This is the moral argument.
It’s a strong argument because there are only two ways, as of today,
that the virus can be stopped: let it run its course and infect 100s of
millions of people, or social distancing. There is no other way today.
If you don’t practice social distancing, people downstream from you that
you transmit the virus to will die, and many will suffer.
4. The
risk of infection is increasing exponentially, because the quantity of
infected people, most who will not show symptoms, is doubling every
three days. So the longer you wait to self-isolate, the greater
the chance of you or someone you love becoming infected and then you
infecting others because more of the population is becoming infected.
There are twice as many infected people today as there was on Tuesday.
5. The virus is already in your town. It’s everywhere. Cases
are typically only discovered when someone gets sick enough to seek
medical attention. This is important as it typically takes ~5 days to
START showing ANY symptoms. Here’s the math: For every known case there
are approximately 50 unknown cases. This is because if I become sick, I
infect several people today, and they infect a few people each tomorrow
(as do I), and the total count of infected people doubles every 3 days
until I get so sick I get hospitalized or get tested and become a “known
case”. But in the time it takes me to figure out I am sick 50 others
downline from me now have the virus. So every third day the infection
rate doubles until I get so sick that I realize I have the virus an am
hospitalized or otherwise tested. Harvard and Massachusetts General
Hospital estimate that there are 50x more infections than known
infections as reported (citation below). The implication of this is that
the virus is already “everywhere” and spreading regardless if your city
has zero, few or many reported cases. So instead of the 1573 reported
known cases today there are likely 78,650 cases, at least, in the United
States. Which will double to 157,300 by this Sunday. And this will
double to 314,600 cases by this coming Wednesday. So in less than 1 week
the number of total infected in the United States will quadruple. This
is the nature of exponential math. It’s actually unfortunate that we are
publishing the figures for known cases as it diverts attention away
from more important numbers (like the range of estimated actual cases).
[Update as of 3/15/20 — I’ve been sent more research that may add
clarity to the ACTUAL cases vs CONFIRMED cases and will update this post
with any conclusions]
6. Some
people cannot, or will not, practice social distancing for a variety of
reasons and will continue to spread the virus to many people. So
everyone else must start today.
The reasons above are why I have begun to practice social distancing. It’s not easy. But you should do it too.
The
hospitals will be at capacity and there are not enough ventilators. You
will hear a lot about this issue in the coming few weeks… the shortage
of ventilators.
ISSUE TWO: MANY PEOPLE ARE FOCUSED ON THE WRONG NUMBERS:
Yes,
the virus only kills a small percentage of those afflicted. Yes, the
flu kills 10s of thousands of people annually. Yes, 80% of people will
experience lightweight symptoms with COVID19. Yes the mortality rate of
COVID19 is relatively low (1–2%). All of this true, but is immaterial.
They are the wrong numbers to focus on…
The
nature of exponential math is that the infection rates start slowly,
and then goes off like a bomb and overwhelms the hospitals. You will
understand this math clearly in the next section if you do the short
math exercise. Evergreen hospital in Seattle is already in triage. I
have heard credible reports from people on the ground that they are
already becoming overwhelmed. And the bomb won’t really go off for a few
more days. Probably by Wednesday, March 18th (next week). In just a few
days from now we will hear grave reports from Seattle hospitals.
[update as of 3/15/20 — see the comments section below for an update
from a staff member at Evergreen Hospital in Kirkland, WA]
You should assume the virus is everywhere at this point, even if you have no confirmed cases in your area.
YOU SHOULD DO THIS SIMPLE 2 MINUTE MATH EXERCISE (NO REALLY TAKE TWO MINUTES AND DO IT):
To
further understand exponential growth, take the number of confirmed
cases in your area and multiply by 10 (or 50 if you believe Harvard and
Massachusetts General estimations) to account for the cases that are not
yet confirmed. If you have no confirmed cases choose a small number.
I’d suggest 10 cases in your city, if no cases are yet reported. But you
can use whatever number you like. This number of infected people
doubles every ~3 days as the infection spreads. So literally take your
number, and multiply by 2. Then do it again. Then do it again. Then do
it again. Do this multiplication exercise 10 times in total.
2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x (the number of estimated infections in your city today (not just the reported cases)).
This
result is the estimate for the actual cases in your area 30 days from
now. The math will take 30 seconds to complete with a calculator and
it’s worth doing the math to see how it grows. This end number is the
number of cases in your city 30 days from today if a large percentage of
the population do not practice social distancing.
2
to the 10th power is 1024. When something doubles 10 times, it’s the
same as multiplying by 1024. The infection rate of the virus doubles
every 3 days. In thirty days there will be 1,024
times the number of infected people in your area as there is today if
your community does not immediately put social distancing into practice.
One thousand and twenty four times as many infected people as there is
today, in just 30 days.
Next,
divide the final number (the scary big one) you just calculated by the
current population of your city and you will be able to get the
percentage of people THAT YOU KNOW PERSONALLY who will be infected 30
days from now.
THIS PART IS IMPORTANT: Next
take 15% (multiply by 0.15) of that final 30 day number of total
infected people (the number you calculated by multiplying by 2 ten
times). This will provide an estimate of the serious cases which will
require hospitalization, and compare it to the number of beds and
ventilators available at your local hospital. Google the “number of
beds” and the name of your local hospital now. It takes 2 seconds and
the number of beds is easy to find. 65% of beds are already occupied by
patients unrelated to the coronavirus. St Charles in Bend, Oregon where I
live, has 226 beds and the town is roughly 100,000 people. Most
hospitals have on average, 40 or fewer ventilators. 5% of patients
require ICU treatment. There are very few ICU beds compared to regular
beds in hospitals. There are very few negative pressure areas in any
hospital to deal with the containment of airborne diseases.
These
numbers you just calculated are the Big Problem: Too many patients, not
enough beds, and a serious shortage of ventilators (the biggest
problem) if we don’t immediately begin social distancing. More on this
biggest problem related to the insufficient quantity of ventilators is
below.
COUNTRIES
AND CITIES THAT GET OVERWHELMED WILL HAVE A MUCH GREATER MORTALITY RATE
BECAUSE THEY WON’T BE ABLE TO ADEQUATELY PROVIDE MEDICAL CARE.
And by medical care I mean not just coronavirus patients. Your
son or daughter that needs acute care surgery this May for his badly
broken leg will be attended to by an orthopedic doctor that has been
working at maximum capacity and working 18 hour shifts for 7 days every
week for 6 weeks because it was required to care for all the coronavirus
patients at her hospital. Or the orthopedic surgeon will be sick with
the virus and your son or daughter will be operated on in a tent in the
hospital parking lot by a non-expert or a member of the National Guard.
Your elderly Mom that has diabetes and goes into acute distress next
month may not receive ANY medical care because the doctors are consumed
and have to prioritize patients based on triage guidelines based on
success rate probabilities. Your sibling’s family that are all injured
in a terrible car crash in June will have diminished care. If one of
them needs a ventilator there will be none available because all of them
will be in use by critical coronavirus patients. Your young friend with
cancer and a compromised immune system from treatment will succumb even
though the cancer was curable and the treatment was working, because
their body was too fragile to combat the coronavirus due to the
chemotherapy and they couldn’t receive the customized, acute care
required due to the hospital being overwhelmed. All of the above is
currently happening in Italy, who had the same number of infections we
have today just 2 weeks ago. You must start social distancing today.
The
count of actual virus infections doubles every ~3 days. The news and
government agencies are lagging in their response. So we hear that the
US only has 1573 cases today (3/12/20) [update as of 3/15/20: 3115
confirmed cases), ( see https://www.worldometers.info/coronavirus/)
and it doesn’t seem like a lot. It would be better to report the
estimated actual cases, since reported cases don’t tell us much.
However, we know from China that the actual number of cases are at least
an order of magnitude greater than the reported cases, because people
get infected and do not display symptoms. In math, an “order of
magnitude” means ten times difference, or put another way, a factor of
10. 100 is 10 times greater than 10, so it’s an order of magnitude
greater.
Harvard Medical School / Massachusetts General Hospital just released their estimate (recording is here: https://externalmediasite.partners.org/…/53a4003de5ab4b4da5…)
that the actual cases are 50x greater than the reported cases. So we
likely have 75,000 cases in the United States already. The number of
reported cases is not that important.
But
let’s assume the current number of cases is only 10,000 ACTUAL cases in
the United States just to be conservative and model out what will
happen:
If
we don’t stop the virus from spreading, in 30 days we will have 2 to
the 10th power more cases of infected people because the infection count
doubles every 3 days (the virus doubles every 3 days and there are 10, 3
day periods in 30 days).
This math is familiar if you did the exercise above. If not, go up and do the math exercise. The math: 2 to the 10th power means 1,024 times as many cases as we have today (2 times 2 repeated 10 times).
This number is a catastrophically big problem for all of us:
We will have 10 million+ actual cases (10,000 actual cases today x
1,024) in the United States in just 30 days’ time if we continue without
extreme social distancing. 10 million people with the virus. And it
will keep doubling every 3 days unless we practice social distancing.
15%
of cases require significant medical attention, which means that 1.5
million people will require significant medical attention if 10 million
people get infected (15% of 10 Million total infections = 1.5 million
people requiring hospitalization).
1.5 million hospitalizations is way more than we have beds for at hospitals in the United States. And
65% of all beds are already occupied in our hospitals. But many
patients (5%) with the virus need ICU beds, not just any old hospital
bed. Only about 10% of hospital beds are considered intensive care beds.
So we will have a huge bed shortage, but that is not the biggest
problem, as we can erect temporary ICU shelters and bring in more
temporary beds, as Italy has already done, and California and Washington
hospitals have already done. Evergreen Hospital in Seattle has already
erected temporary triage tents in the parking lot as of 3/13/20. All
regular beds are full at Evergreen Hospital as of yesterday.
Once the government of China, Norway, and Italy came to understand this math, they reacted accordingly and shut EVERYTHING down.
[update as of 3/15/20 now France has done the same lockdown]. Extreme
social distancing is the only response available to stop the virus
today. The United States is not responding well nor are other countries
like the UK. Countries that do not respond well will pay a much larger,
catastrophic price.
But hospital beds are not the big problem. The lack of ventilators is the big problem. Most estimates peg the ventilators in the United States at roughly 100,000 to 150,000 units. See the study from last month: http://www.centerforhealthsecurity.org/…/200214-VentilatorA…
The
primary and most serious comorbid (comorbid is a medical term that
means co-existing or happening at the same time) condition brought on by
the Coronavirus is something called bilateral interstitial pneumonia
which requires ventilators for treatment of seriously ill patients. So
if 1.5M people of the 10 million infected 30 days from now require
hospital care (15% of the 10M estimated total infections), 1.3M may not
get the care that they need because we don’t have enough ventilators,
beds, and ICU beds in the United States. And remember, this is only if
ALL OF US EFFECTIVELY start social distancing by April 11th (30 days
from today). This increases the mortality rate significantly.
BUT
IF WE START EXTREME SOCIAL DISTANCING BY MARCH 23 (12 days from
original writing), WE AVOID OVER 1.4 MILLION PEOPLE GETTING CRITICALLY
ILL AND OVERWHELMING THE HOSPITALS:
If
everyone takes extreme measures to social distance, and the United
States can dramatically reduce the spread of the virus 12 days from now,
the math is very different, as the exponential growth will only be 2 to
the 4th power (12 days divided by the doubling rate of every 3 days
equals the exponent of 4):
2 x 2 x 2 x 2 = 16
So
instead of 10 Million cases in the United States if we wait 30 days, if
we act 18 days sooner, we will have only 160,000 cases (16
times the estimated 10,000 actual cases as of today), of which 15% are
likely to require hospitalization. This is 24,000 critical patients (a
huge difference compared to 1.5 million acute patients). The difference
between taking extreme measures now, versus waiting even a few days, is
very large due to how exponents work in math.
THE OUTCOME IS EVEN BETTER IF WE TAKE ACTION IN THE NEXT 6 DAYS:
If the vast majority of the population self isolates and implements
social distancing in only 6 days from now the exponential math is 2 to
the 2nd power (6 days divided by the 3 days it takes the virus to double
means the exponent is only 2). In math this is “two squared”.
2 x 2 = 4
Multiplied
by the estimated 10,000 ACTUAL cases as of today (3/12/20) that means
only 40,000 total cases will develop, 15% of which may be critical which
is 6,000 critical patients.
This
is why you should share this post broadly. If people begin social
distancing in the next 6 days it will greatly reduce the impact on all
of us. It’s why they say a “post goes viral”.
SOCIAL DISTANCING WILL REDUCE THE FINANCIAL IMPACT TO YOU AND YOUR FAMILY:
Finally,
the longer everyone waits to practice significant social distancing the
greater the economic hardship will be on all of us. Lost jobs. Mortgage
defaults. Closed businesses. Bankruptcies. All will be minimized if you
start social distancing today.
Some
of the reasons the economic impacts will be reduced are worth
mentioning: If we stop the virus now the overall duration of the
outbreak will be far shorter. The stock market will normalize more
quickly and recover more quickly. Businesses and people will be able to
survive a shorter duration outbreak vs a longer duration outbreak. More
companies will avoid bankruptcy if we begin to practice social
distancing now.
This
is a big financial reason to begin social distancing if you are
employed by any company: if companies see that the virus is being
slowed, they will be less likely to conduct layoffs. You will be more
likely to be laid off or experience a job-related event if we don’t
practice social distancing immediately. As an HR executive, I’ve been
involved in many, many layoffs. It’s the last thing companies want to
do. But if they see that the pandemic will be shorter lived vs long and
drawn out, they are less likely to make the permanent decision of laying
off staff.
The
overall economic impact that hits your bank account will be greater if
you wait or you don’t practice social distancing. This is why Norway
acted now, because it’s less economic impact to take drastic measures
early than to do them later, and it saves a lot of lives and suffering
by doing so. And Norway has only one confirmed death as of this writing.
Many
people have suggested they want to support local restaurants and other
businesses, who have seen sales drop by 50–90%. Stopping by and visiting
them won’t save them. What will save them is social distancing and what
you do after the pandemic is over. If you are concerned, call them and
buy a gift certificate over the phone.
START TODAY. I CAN’T STRESS THIS ENOUGH. YOU MUST START TODAY.
Finally,
the article that I posted yesterday written by Tomas Pueyo has been
read 30M times in the last few days and has been updated with new
information. It’s worth reading again.
Here’s that link:
Other up to date data I frequently consult regarding the pandemic is here:
I
hope this is helpful and useful. My brain focuses on the math and I try
and be fact based in my analysis and interpretation of how I should
respond.
THERE IS MORE INFORMATION IN THE COMMENTS ON THE FACEBOOK POST WORTH READING AND I WILL BE UPDATING THAT POST, AND THE COMMENTS, WITH MORE INFORMATION, (AS OPPOSED TO CREATING NEW POSTS).
MY FINAL PARTING THOUGHT: Please
share or forward this post at your discretion. If everyone shares this
post and two of your friends share this post and so on, we use the power
of exponential math to work in our favor, which seems appropriate given
the virus is using that same exponential math against us.
HOW
YOU CAN REALLY HELP: If you know people who have large numbers of
followers, or people in the media, please leverage your personal
relationship with them and ask them to amplify this post by sharing it.
It
would be useful to get the post on Twitter and LinkedIn. If you know
people in government this fact-based post may help inform them to make
the best decisions. I am not active on Twitter.
It’s time for us humans to go on the offensive against the virus. We must fight back.
There is only one way to do so: Social Distancing.
Do it today.
NOTE:
Anyone, including the media, is free to use this post, any related
content, in all or in part, for any purpose, in any format, with no
attribution required. Please direct message me if you have other ideas
for how to raise awareness.
Finally,
I can no longer keep up with friend requests given how much this post
has been shared. To receive updates or follow me, please use the
“Follow” button on Facebook. My page Facebook page is here, or follow me here on Medium (or both!).
My facebook page: https://www.facebook.com/jason.scott.warner
If anyone wants to translate this into any other language please do so and contact me and I’ll repost it in that language.
3/16/20:
I am preparing a second post, now that 4 days have gone by since the
first post. To receive it please follow me on FB. I can not keep up with
the friend requests.
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