In the US, Covid has gotten much worse in the past four weeks, especially in the Upper Midwest. While there’s some good news, the odds of a non-linear disaster are the highest they’ve been since New York’s first surge.
In the past two weeks, the number of people I know with Covid in the US has gone up massively. As I write, 10 people in my close group of friends or their direct families have active Covid. Most of them took precautions. Luckily, most look like they will escape serious primary health issues. Two look to be pretty sick.
Since March, I’ve been lucky to be able to isolate during this pandemic. The longest I’d spent in one location in a row since from June 2015 until March 2020 was six weeks. Now I haven’t moved in 8 months.
I was going to fly to spend winter in a warmer location. I saw the new numbers, especially the sobering Covid Risk Map, which said that in Wisconsin, there’s a ~95% chance there’s at least one active Covid case in a random group of 25 people, implying ~3-5 active Covid cases on my flight. My friends parents got Covid flying from Florida to Wisconsin. I stayed in Wisconsin.
The US has a big group of people trying to stay safe, but need to work to support their families. We have some Covid-deniers, but we also have another group of people who mean well, and believe that doctors, nurses, hospitals and ICUs will be there to take care of them if we’re one of the unlucky people who get seriously sick from Covid. That assumption seems to be close to the breaking point.
The good: Things to be optimistic about
- There are multiple vaccines that look like they’re going to work and might be significantly rolled out in Q1/Q2/Q3
- Death rates are down up to 75% because of better medical care and therapies
- A Biden Administration is coming, which will hopefully have a unified policy for states and more aid for individuals and businesses
- Some areas of the US are doing pretty well and learned lessons from their first surges
- Some Republican-controlled states are reversing course and putting in mask mandates post election
The bad: Things have gotten significantly worse in the past 4 weeks
- Cases: The 7 day moving average is up 3x from ~50k per day, to ~150k today
- Deaths: The 7 day moving average is up 60% from ~700 per day, to ~1100 today
- The counties near me in Wisconsin have a higher per capita death rate than New York
- Many people seem to have given up and are going back to normal
- Hospitals in the hardest hit areas are on the brink of rationing care.
- Doctors, nurses and medical techs are burning out, starting to quit, getting sick. At least 1375 are dead in the US.
The Potential Ugly: Why the next 6-12 weeks could be the worst of the pandemic:
- Hunting Season, Thanksgiving, Christmas, New Years mean travel, big gatherings and more spread.
- Cases: If current growth continues, we’ll be at ~300k cases per day in 2-3 weeks and ~600k-1M cases per day sometime in early January
- Deaths: If current growth continues, we’ll be at ~2000 per day in 2-4 weeks, potentially reaching ~4-5k per day by the end of the year. That’s without any degradation in medical care
- Doctors, nurses and hospitals may get overwhelmed. They’ve been fighting this day in, day out for 5-8 months.
- Each person had 10-25 years of training. There are no replacements coming when someone burns out, quits, or dies in the line of duty.
Am I predicting a worst case scenario? No.
Best case scenario is the US gets another reality check from places like El Paso, North Dakota, South Dakota, Wisconsin and more, and understands this is real. We head off the growth rate and peak at ~2,000 deaths per day again and start to go down. We get a good vaccine that starts to make a dent in Q1 and big progress in Q2.
The worst case scenario is hard to predict, because nobody knows when healthcare systems will degrade, have to ration care or not have enough beds. Rationing is currently happening in El Paso
It’s a non-linear problem. A small shift in the ability to take care of people in an overwhelmed medical system could reverse much, if not all, of the gains doctors, nurses and drug companies made reducing Covid mortality. That’s where real potential disaster happens.
Worst case, people don’t take Covid seriously, we double again in 2-3 weeks to 300k per day, and then again in 4-6 weeks to 600k. We could even hit 1M cases per day.
I can’t imagine hospital care levels don’t go down materially in the next 6-12 weeks if we don’t stop daily cases from doubling again to over 300k per day. Maybe doctors and nurses are heroically able to withstand 300k-600k cases per day. Maybe care doesn’t degrade materially. But we’ll still have 3-5k dead per day, if not more.
What am I doing?
I’m lucky, I can work remotely, I don’t have kids. I have terrible health insurance with a $25k deductible and I haven’t lived the healthiest lifestyle traveling every six weeks for the past 5 years.
- Wear a mask anytime I go indoors somewhere outside of my house
- Wear a mask outside if I’m near people. It’s cold in Wisconsin, I don’t see a downside.
- Curbside or delivery groceries, restaurants, cafes (and not doing much of that either)
- Skipping extended family gatherings, or doing them outside if possible
What should government be doing?
We’re taking Covid too seriously on one hand by restricting relatively safe outdoor activities. We’re not taking it nearly seriously enough on another, by not mandating masks and allowing full bars and restaurants at the expense of schools and hospitals. The lack of a national policy and common sense rules is killing people.
- Prioritize keeping schools and hospitals open.
- Be very clear on what is dangerous and what is not. Outdoor activities seem to be pretty safe, indoor seem to be fairly dangerous if more than 10-15 minutes. Get rid of nearly all restrictions on outdoor activities.
- Mandate a mask anytime you’re indoors. It’s a cheap, easy, non-linear fix that should never have been politicized. It’s all upside, little downside besides being a tiny bit uncomfortable. But it needs widespread usage. Read Taleb from June.
- Give money directly to small businesses like restaurants, gyms, bars that are affected by Covid to incentivize them close, do take out or alternative options.
- Interview frontline healthcare workers daily on the news and social media to get the word out
- Get at home rapid tests approved and distributed quickly