Actionable COVID-19 Statistics

Please pardon me as I diverge from my usual communication to you about the relationship between our food choices and our disease and death. In future newsletters, I will return to that subject.

In addition to this newsletter, the usual way we try to get the word out about the importance of nutrition is by workshops that people attend in person. If you are reading this, there is a good chance you have attended one of our workshops. We have suspended them during the time of the COVID-19 lockdown, and I have been monitoring the statistics to see when we might be able to safely hold workshops again. Like most of you, I see many figures mentioned in the news but have found it challenging to figure out how I should act based on the numbers. Here is my attempt to get actionable conclusions from the numbers.

There is a lot of public disagreement as to how we should act. A lot of government officials are telling us to wear masks in public and maintain social distancing. Other people are outraged at this intrusion into their freedoms and insist they should not have to wear masks or maintain distances. Which of these is the proper way to act? It depends on the numbers. If it is a near certainty that going to the beach without a mask will kill someone, then it is quite clear to most people that we should not do that. On the other hand, if the odds of a beach trip causing a death due to COVID-19 are so low that they are less than the chance of a death due to a car accident on the way to the beach, then the chances are so low we probably need not concern ourselves much. In this case, let’s go to the beach and forget the masks. So, the statistics matter. Let’s have a look at them.

How bad is it?

About this time last month (early June 2020), L.A. County had over 1,000 new cases per day of coronavirus detected through testing. But there are always more cases than the testing catches. Estimates of actual number of new cases vary widely, but some experts expect there are about 5 times as many actual cases as reported because most people are not tested and therefore most cases are not reported. Thus, one might estimate that there were 5,000 new cases that day. If one assumes that an infected person is infectious to others for about 20 days, this will mean that there were 20*5,000 = 100,000 infectious people in L.A. County at that time. The total population is about 10,000,000 so this means that about 1% of the L.A. population is infectious to others. We will look at this as an equation below. But if these numbers are true, then if you were to meet up with a random person in L.A. County, the chances would be about 1% that they were infected with the coronavirus and able to transmit it to you if you aren’t careful enough.

The number of new cases has been rising and during the last half of June, many days had over 2,000 new cases. At this rate, it is twice as bad as it was a month ago. So, by the same calculation, that would mean that instead of 1 in 100 people infectious, that 2% or 1 in 50 people in L.A. County could transmit the disease to you. Today (July 6, 2020) on the front page of the LA Times, it stated that on Friday there were over 3,200 new cases reported. I have not been able to confirm this number from official health department web sites, but with the fallout from the protest movement and business reopenings, it would be prudent to expect that this number will only get worse.

The point is that now is not the time to relax. This is the time to be even more diligent in our efforts to protect ourselves, our families, and our community. It is best to keep social distancing from everyone not already in your daily face-to-face group. But it is especially important to avoid larger groups.

Group statistics

If you had a random group of say 35 people in L.A., with an individual infectiousness rate of 2%, the chances that one or more of them is infectious is about 1-(0.9835) = about 51%. So, the odds would be better than even that someone in this group could infect you. I hope that you would much prefer to avoid this situation.

Now you can look at this analysis and claim that for you it isn’t this bad. Maybe my estimate of the ratio of untested infectious to tested infectious is too high. Maybe the people you meet will be much better than the general public about wearing masks, cleaning surfaces, and social distancing and so their individual risk may be lower. And you may be right. Although if they were so great at social distancing, why would they be meeting in this group?

For me, at our current LA infectious rate, I am not comfortable with us meeting face to face unless absolutely necessary. In my company, we are doing everything we can to keep people working at home and scheduling one at a time in our lab. When vaccines become available or if the new infections in L.A. County gets down to 100 or so new cases per day, I would feel the risk is low enough to start having many of us in the same building at the same time. Based on my observations of rebellion against masks, pushing hard to reopen restaurants, lack of social distancing at beaches and protest rallies, I only imagine the infection rate will go up before it goes down. And a vaccine could be years away.

Equations and actions

So, the equation that I think can help guide us, as in my examples above is this:

Daily New Cases x Undetected to Detected Ratio x Days of Infectiousness / Population x 100 = Percent Infectious Now

You can fill in the data for your region and current time and as the Undetected to Detected Ratio and Days of Infectiousness get better known, you can adjust them yourself in this equation. But for now, I am using 5 for the Undetected to Detected Ratio and 20 for the Days of Infectiousness. Then for LA County, with a population of about 10 million, the equation becomes:

Daily New Cases x 5 x 20 / 10,000,000 x 100 = Percent Infectious Now

Combining some of the numbers we get a simpler equation for the LA County region:

Daily New Cases / 1,000 = Percent Infectious Now

So, each day, you can look up the Daily New Cases for LA County, and for each 1,000 you get 1% of the population infectious now. So, if there are 2,000 new cases in a day, there is about 2% of the population that could pass the disease to you at this time. Keep that number in mind as you decide whether you want to go to your favorite restaurant or the beach and whether you want to keep your mask on or not. When I was in the grocery store recently, I could easily see about twenty customers, and I estimated there were about 100 people in the entire store at that time. At a 2% infectiousness rate, this suggests that there could easily be a couple infectious people in the store at the same time I was. Fortunately, they all wore masks and kept their distance. And you can bet that I wore my mask and kept my distance.

I hope this quick calculation can help guide your decisions and that if you don’t live in LA County that you can adapt the equation for your situation.

How long will this last?

A couple weeks ago I heard some sobering news from a biologist. When asked how long he thought it would take to get a vaccine, he said the most relevant data would come from a similar virus, SARS, which was rampant in 2003. How long did it take to come up with a vaccine? It wasn’t long before companies entered testing with vaccine candidates, however none of them worked. How long did it take to get a vaccine that worked? Now, 17 years later, we still don’t have one!!!

Now we are all hoping for a technical miracle. There are over 100 companies working on vaccines and there is no question that like in the case of SARS, there will be many candidates that just don’t work. It may not be a good idea to try some of the early candidates. But we still hope that someone will come up with a vaccine that works and is safe and that some time later, there will be enough supply of this vaccine to reduce or eliminate COVID-19.

Other mitigation strategies

Even if a working vaccine doesn’t appear, there are other possible solutions for mitigation. One solution could be to work on treatments for infected people to reduce the death rate. Lots of scientists are working on this approach with existing drugs and new drugs. Some small progress seems to be being made here, but no breakthrough yet.

Another mitigation solution could be a massive amount of high-sensitivity testing. Some labs claim that their testing is sensitive enough to show positive for coronavirus before a person has become infected enough to spread the disease to others. If we could test enough people often enough, we could detect the disease before it spreads and get each infected person into quarantine. With a U.S. population of 330 million, it will be a daunting task to ramp up testing to the level needed to shut down the coronavirus.

A mitigation strategy that we should try to avoid is that of herd immunity. If enough people have been infected and assuming that they can no longer be infected (not yet proven), then eventually the coronavirus can’t find enough victims in order to continue spreading. I have heard estimates ranging from 45% to 85% of the population will need to have been infected in order to get herd immunity. The death rate is currently hovering around 4%. Some would argue that this rate is high because of the preponderance of elderly and immune compromised patients and that the death rate of the general public would be much lower. For argument’s sake, let’s say it could be 1% for the general public. On the high side, 4% of 85% of 330M people would mean 11 million deaths. On the low side, 1% of 45% of 330M people would mean only 1.5 million deaths. While much better than 11 million, 1.5 million is still a lot of deaths. I hope we can find a mitigation strategy that doesn’t involve over a million of us dying.

Let’s stick with it

So, let’s not abandon our masks, hand sanitizers, and social distancing just yet. I understand that after months of lockdown, there are many factors pushing to loosen up. But I urge you to stick with the strategies to slow down the spread of coronavirus for the safety of yourself, your family, and your community.

I still have high hopes for a technical solution. There are a lot of smart people working the problem. And we have more powerful biological tools than we did 17 years ago with SARS. But we must give scientists time to work out these solutions. Let us be selfless with our masks, hand washing, and social distancing to give our technologists the time they need to work their miracle.

 

Thanks,

 

John Tanner
07-06-2020

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