COVID 19 and Pascal

Kevin Patterson at The Walrus has a great piece on the coronavirus. It's different than the flu, faster, and our high-density living spaces aren't helping contain it:

"Famine and war routinely bring civilizations low, but though he trots closely beside those two, the horseman who carries off the most has always been pestilence. . . . Many familiar pathogens are lethal on a broad scale . . . Seasonal influenza . . . It is monitored carefully and understood well enough that vaccines may be prepared that are usually effective at reducing disease incidence and severity. . . . While the best-case scenario for influenza each year includes many deaths, we also have an idea of what the worst-case scenario is. The downside risk is not infinite. With novel pathogens, this is not true. The worst-case scenario is undefined . . . some of them do prove to be catastrophic—and doctors don’t know, when one emerges, what course it’s going to take. . . .  

The story of this pandemic is, in many ways, a story about speed . . . the rapidity with which it was observed to leap to humans and the rate at which it was seen to disseminate among us has almost no parallel in modern medicine. . . . In the intensive care unit where I work as a critical care physician . . . even a handful of extra patients requiring high-level care can put unsustainable pressure on the system. . . . In retrospect, after 2009 H1N1—as well as after SARS and the other recent near misses, to say nothing of the fifteen-century history of pandemics—the surprising thing is how little was done subsequently to prepare for the next disastrous outbreak. . . .  

 One point that needs more emphasis is that epidemics have diminished in much of the Global North for good reason. . . . A large part of this is due to affluence and, to a qualified and recently diminishing degree, justice. . . . Tuberculosis in most of Canada is almost gone. But, in Nunavut, which has Canada’s highest poverty rate, the incidence was recently comparable to Somalia’s. . . . But the reasons for anxiety are compelling too. A vaccine is at least a year away. . . . We live, worldwide, mostly in cities and now in densities that make us profoundly vulnerable. . . . We must now contemplate how much we need one another. The instinct to recoil would be the worst possible response because doing so would ensure that the most vulnerable among us are consumed. . . . Rarely is the argument for mutual devotion so easily made."

And Tomas Pueyo explained, in a Medium article, with many graphs and math, how absolutely vital it is for cities to shut down at the first signs of confirmed illnesses. It's like cockroaches: Once one illness is confirmed, it's likely there are about 800 others unconfirmed and spreading exponentially. Pueyo worries about politicians afraid to take action, restrained by concerns for the economy,

"But in 2–4 weeks, when the entire world is in lockdown, when the few precious days of social distancing you will have enabled will have saved lives, people won’t criticize you anymore: They will thank you for making the right decision."

Martin Makary, MD, says, in MedPage Today, warns about discounting the threat because we're healthier or more advanced on this side of the pond,

And even though other countries have enacted very strict quarantine practices, including martial law and a shutdown of schools, there is a misleading perception that the U.S. would have less community transmission because of a better health care system and better hygiene. Another barrier has been the exaggerated notion that COVID-19 is only a danger to old people and that young people are entirely resilient. . . . Based on the current trajectory of the pandemic, all U.S. schools are at risk and may need to be closed, public gatherings like NCAA tournament games may need to be postponed, businesses should have their employees work from home whenever possible, and hospitals should staff up. I don’t like it, but that’s what the data are telling us to do. , , , It’s time we dispel the notion that this virus is somehow contained. It is at large.

If we use Pascal's wager to decide what to do, it looks like this: We can shut down a city after just one confirmed case and, if we're wrong and there's no spread, then we have to apologize for costing some businesses money and causing massive headaches for many citizens. But if we're right, and we find out there were 800 cases we didn't know about until partway through that 2-week shut down - the length of the incubation period - then we're heroes for stopping the spread!!  But if we don't shut down a city after just one confirmed case and, if we're right and there's no spread, then no harm no foul. But if we're wrong, and 800 people have all infected colleagues and friends and conference attendees and other fans of the same concerts, then we're screwed!

I don't know about you, but I'd rather risk embarrassment and potentially save many of my citizens, than go with the status quo and risk allowing a spread of a virus that, while it only kills a small percentage of people, also ends up putting many more in the hospital, which sucks up resources from all other medical needs. This thread on the experience of doctors in Italy explains the ramifications of one disease taking all the time and resources from doctors and nurses throughout the hospital. Now experts are saying Italy shut down way too late.