Reality Straight Up!

Thoughts & Observations of a Free Range Astrophysicist

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After COVID’s First Wave

No getting back to normal

Even after COVID-19 kills hundreds of thousands in the U.S. over the coming weeks, we will still be almost as vulnerable to the pandemic as we are today. We’d all love to “get back to normal” after that, but the price could be a second wave, worse than the first. Some see us facing either economic Depression or allowing vast numbers of preventable deaths, but that is a fool’s choice. There are better options if we have the will to find them.


A thousand years ago, by which I mean last week, the White House finally confronted the fact that a hundred thousand people or more are going to die ghastly deaths between now and mid June, “even if we do things perfectly.” It’s hard not to focus on those numbers, but there’s another question that we need to be talking about, and talking about now:  what comes next?
 
In a long overdue and unprecedented move this White House based its predictions on actual science, including epidemiological models like those from the Institute for Health Metrics and Evaluation (IHME). After four decades as an astrophysicist one thing that I’ve learned is that such complex models always come with fine print. Sure enough, when you read the fine print of COVID-19 models you run into some curious stuff, like for instance the phrase “deaths through the first wave of COVID-19.”
 
White House projections of COVID-19 deaths.

Projections of deaths released by the White House last week show only the first wave of what COVID-19 could do.

“First wave?” you might ask. “What do they mean by first wave? If this is the first wave, does that mean they are expecting more waves?” Therein lies the rub, or the sucker punch below the belt as the case may be.
 

Millions, with an “M”

To understand what “through the first wave” means we have to go back to basics.  COVID-19 is a novel virus, which means that when it jumped from bats to pangolins (probably) to people, no one on the planet was immune. When the virus lays siege to your lungs, your body’s internal health care system doesn’t recognize the threat and has no good way to fight back. Ironically it’s not the virus that kills you, it’s your body’s botched attempt to defend itself.
 
When COVID-19 reached U.S. shores it found 330 million scrumptious all-you-can-eat human buffets ready and waiting. We even provide taxi service, carrying the virus around and delivering it to its next meals. If the mortality rate from COVID is 1%, which is in line with current estimates, that means that if it ran unchecked through the population it could kill something like 3.3 million people.
 
Things aren’t quite that bad. Not everyone has to have the disease before it stops spreading efficiently. Herd immunity helps. Instead of 330 million illnesses and 3.3 million dead, left to its own devices COVID-19 might only infect 250 million people and kill 2.5 million.
 
Wait a minute! Did I really say 2.5 million people dead? Like “million,” with an “M?”  That’s right, millions of dead. With an M. That’s what happens if we just let the virus do its thing, unchecked.
 

The first fire doesn’t burn the whole forest.

That’s where social distancing, lockdowns, and all that inconvenient stuff come in. Mitigation efforts deprive the virus of its meal-to-meal taxi service. As I wrote about the other day, we know that lockdowns and social distancing work. Had we gotten serious about it even as late as a week ago (like the models assumed we would) we might have kept the body count down to under 100,000. Unfortunately, that ship has probably sailed. I’ll leave that for another day.
 
For now let’s take the predictions at face value and say that 100,000 people will die between now and June. If the fatality rate is 1% (in line with current estimates), then when the first wave has passed, 10 million people will have suffered through the disease, give or take.
 
The Spanish Flu swept through in multiple waves in 1918 and 1919.

Pandemics are not one-off events, as is apparent from the effects of the Spanish flu pandemic on Britain over a 23-month stretch in 1918 and 1919. Mitigation of COVID-19 today can save perhaps millions of lives, but only if restrictions remain in place beyond the first wave of the pandemic until effective vaccination and treatments are available.

Ten million seems like a big number, especially when talking about victims of life-threatening illness. It’s certainly enough to overwhelm much of our health care system. But here’s the kicker. If 10 million people in the United States will have had COVID-19 by June, that means that 320 million will not have had COVID-19. Between now and June the number of people vulnerable to COVID-19 will only drop from 330 million to around 320 million. That’s only a 3% reduction in COVID-19’s available feeding grounds. If that doesn’t sound like a big difference, it’s because it’s not.
 
When the implications of that sink in, you are going to say “Aw, shit!”  You may say lots of other things, too, but “Aw, shit!” will definitely be on the list.

Second verse, same as the first.

As far as our nation’s vulnerability to COVID-19 goes, not a heck of a lot is going to change over the next few months. Yes, hundreds of thousands of people will die. Yes, millions of people will have suffered through the disease, and many of those will have their lungs so badly damaged that their lives will never be the same. But as far as COVID-19 is concerned, the first wave of the pandemic is only an appetizer.
 
Of course, after the bodies stop piling up like cordwood a lot of people are going to think, “Whew! I’m glad that’s over!” We are already hearing promises from high places that by the middle of summer it will be back to business as usual. What can I say? Those promises are bald faced lies.
 
The truth is that if come June we “get back to normal,” then by July or August we will be right back where we are today. There will be exponential growth in cases, exponential growth in deaths, overwhelmed medical systems, refrigerated trucks to store the bodies, and the whole nine yards. That second wave could easily be worse than the first.

I’m not an epidemiologist, but I can count.

I get it. Right now you might be wishing you hadn’t read this far. Ignorance is bliss, and all that. You really, really want me to be wrong. (Hell, I really, really want me to be wrong!) I wouldn’t be surprised if you are calling me all sorts of names hoping to convince yourself that come July you’ll be back at the ballpark rubbing elbows with screaming fans, eating bad $12 hot dogs and rooting for the home team.
 
“Hester’s an astrophysicist, not an epidemiologist!,” you might be saying.  “He doesn’t know anything! Why should we listen to him?”  The thing is I never claimed to be an epidemiologist, but I can count.
 
Removing work and social restrictions before vaccination leads to more explosive growth.

Models by epidemiologists at Imperial College, London show what would happen in the U.S. if we did nothing to suppress COVID-19 (white curve at the left). Quoting their findings, “In total, in an unmitigated epidemic, we would predict approximately… 2.2 million [deaths] in the US, not accounting for the potential negative effects of the health systems being overwhelmed on mortality.” The much lower curves in the red shaded areas show predictions of the first wave of the pandemic assuming that effective stay-at-home orders, school closures, social distancing and other mitigation strategies are in place. This is what we are facing in the coming months. The curves in the green-shaded area at right show what will happen if those restrictions are lifted after the first wave of COVID-19 has passed. The resulting second wave would be far more devastating than the first, approaching what we would have seen had there been no effort to contain the virus at all. (Figure from Ferguson et al., 16 March, 2020).

The quick and dirty run through the numbers I just took you on is what we astrophysicists call a “back of the envelope calculation.” (OK, other people call it that too. Spoilsport.) Back of the envelope calculations (often really beer-stained napkin calculations) are the life blood of a lot of science. They help you quickly wrap your head around a problem and get a handle on what the answer is going to look like. But you still have to do the problem right. To do the COVID-19 problem right, let’s turn to professional epidemiologists and see what they have to say.
 

This back of the envelope calculation hit the mark.

For decades epidemiologists have solved tons of equations, written millions of lines of computer code, published untold thousands of peer reviewed papers, and tested their ideas against all the data that armies of graduate students could gather. They have also put their models to work on the front lines against more disease outbreaks than you can shake a stick at. They know of what they speak.
 
Some of the best epidemiologists in the world are at the MRC Centre for Global Infectious Disease Analysis at Imperial College, London. They started following the COVID-19 outbreak from the very earliest cases in China. When they used their best-in-the-world state of the art computer models to calculate what a COVID-19 outbreak in the United States could mean they found, and I quote:
 
“In total, in an unmitigated epidemic, we would predict approximately 510,000 deaths in GB [Great Britain] and 2.2 million in the US, not accounting for the potential negative effects of the health systems being overwhelmed on mortality.”
 
COVID-19 is not slowing in the United States

While nationally-mandated lockdowns have slowed the spread of COVID-19 around the globe, the number of deaths in the United States continue to grow more rapidly than anywhere else in the First World. And as of April 2, there was no sign of it slowing. (Figure taken from live updates compiled by The New York Times.)

Their sophisticated epidemiological model predicts that 2.2 million people would die in the U.S. without mitigation. My back of the envelope estimate was 2.5 million, which is basically the same number. After 40 years of doing this kind of stuff it’s good to know that the back of my envelope hasn’t lost its touch. Fancy model calculations can almost seem like magic, and since people don’t really understand them they are easy to dismiss. But if you followed what I went through above you’ll understand why the conclusions here are awfully hard to escape.

We’re in this until we have a vaccination or a cure.

Had the nation listened to scientists in February when they were raising alarms about what was coming, we could have avoided what is about to happen. Going forward, scientists are the only ones who can get us out of this needless mess. The only path that I can see that leaves us with our basic humanity intact is to stay locked down until the development of a vaccine or a cure. Until that day, here’s the bottom line:
 
If we try to go back to normal after the first wave of COVID-19, we face hundreds of thousands or even millions more deaths.
 
Did you catch that? Did it sink in? Here, let me turn up the volume a bit. If we try to go back to normal after the first wave of COVID-19, we face hundreds of thousands or even millions more deaths.
 
Still not listening? If we try to go back to normal after the first wave of COVID-19, we face hundreds of thousands or even millions more deaths.
 
Trump and the talking heads on Fox News might convince people for a while that everything is OK, but eventually even Trump’s most ardent supporters will notice that the bodies are piling up again. Throwing rhetoric at physical reality is always a losing proposition. Reality just laughs in your face (metaphorically, of course), then runs over your sorry ass. Just at the moment, “reality” is spelled “C-O-V-I-D-1-9.”
 

Would we really knowingly kill the population of a city the size of Houston to prop up the Dow?

There is a lot of human empathy and concern out there about the overwhelming numbers of sick and dead. But in some quarters that pales in comparison to the outright panic about the economy. Texas Lt. Governor Dan Patrick went so far as to suggest that seniors should be happy to die in service of the almighty dollar.
 
Triggered Suppression leads to multiple peaks

This model out of Imperial College shows what they refer to as “triggered suppression.” This is what happens if restrictions are lifted when COVID-19 numbers get low, then locked back down again when deaths again start to accumulate. In this model, holding subsequent waves to the size shown would require returning to nationwide restrictions for about 2 months out of every three. The net effect would be to “pay” two months of lockdown and tens of thousands of lives for each month without restrictions.

The first problem with Patrick’s rather ghoulish perspective is that COVID-19 is not just for seniors. As the numbers grow it’s turning out that an awful lot of those I.C.U. beds and make-shift morgues are filling up with folks under the age of 55. Patrick may gleefully throw Grandma to the wolves to keep Wall Street happy, but how does he feel about tossing his kids in after her?
 
A second problem with the Lt. Governor’s grisly notion is that caring for a couple of hundred million sick people, many of whom require critical care, is an expensive proposition in its own right. When we start killing people in the holy name of the economy, are Brother Bob and Cousin Mary just supposed to curl up in the corner by themselves and die? Or are we going to spend the trillions of dollars that it would cost to care for them? COVID-19 is expensive any way you slice it. You don’t fix that by shouting “everybody back in the pool!” and letting it rum amok.
 
But even if it were just the over 60 crowd at risk, and even if we seniors all decided to die quietly and cheaply, I still find myself agreeing with author and preacher John Pavlovitz’s sentiments. “Call me strange, but I don’t think the sick and the elderly are expendable just so Republicans can hold the presidency or so some already wealthy people can become even wealthier.”

There’s a better way.

I plan to write later in the week about the economic opportunities that COVID-19 could bring, and the possible silver lining in the aftermath of the coming carnage. COVID-19 could hasten a move from the moldy leftovers of the Twentieth Century to an economy that is better suited to the Twenty-First. Given computer and communications technologies, new ways of working, AI, automation, hyperproductivity, and on down the line, our economy has been poised for a radical realignment for a while now.
 
But we have to stop worrying about “getting back to normal.” This is a war on our home soil. It is an attack on our nation and on us as a people. We have to start thinking of it in those terms. You don’t win a war by grabbing all you can get and letting your neighbors hang. You win a war like this by coming together and choosing to do things that a short time ago might have seemed impossible. We have the resources in this nation to remain fed, sheltered, healthy and whole for the duration. No one has to starve, or live on the streets. That’s not the problem. And there is absolutely no question in my mind but that we could build a COVID and post-COVID economy that is more vibrant, more sustainable, more resilient, and more humane than what it replaces.
 
Whether we rise to that challenge depends in part on our ingenuity, which I am absolutely certain that we have. But mostly it depends on our political  and national will. It depends on who we are as a people. Can we set aside personal interests and come together around goals and visions that are more important than anyone’s bank account, or stock portfolio, or political ideology, or ego? That is what I worry may be beyond us.
 
What will it be? Will we choose to ride the coming wave, or will we let ourselves be turned under and slammed against the rocks?  Only time will tell.

After COVID’s First Wave ^ No getting back to normal  © Dr. Jeff Hester
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  • The Mind’s Siren Call  Being certain is a primrose pathPosted in For Your ConsiderationUnreasonable Faith
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  • Entropy Redux  Why our universe isn’t boringPosted in For Your ConsiderationUnreasonable Faith
  • Entropy’s Rainbow  The statistically likely path to complexityPosted in For Your ConsiderationUnreasonable Faith
  • Now is not the time for scientists to be circumspect and silent. We are on the short end of a battle over whether truth even matters. If scientists do not stand up for what is real, who will?

  • The morning cyclist in my neighborhood may not be standing in the Michigan Statehouse carrying a gun and demanding her right to spread contagion far and wide, but she may as well be.

  • You know those nice charts and graphs that make it look like we are over the hump of COVID-19 and that things are about to get better? Those predictions are dead wrong, with an unfortunate emphasis on “dead.”

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  • There is a lot of information about COVID-19 out there, much of it misleading. When looking at the future, start with what the science really says.

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    This article originally appeared in my Astronomy Magazine column, For Your Consideration.

  • Once seemingly incomprehensible, the origin of life no longer seems such a mystery. Most of what once appeared as roadblocks are turning out to be superhighways.

    This article originally appeared in my Astronomy Magazine column, For Your Consideration.

  • Being certain lights up our brains like a junkie’s next hit. Literally. Unfortunately, being certain and being right are two very, very different things.

    This article originally appeared in my Astronomy Magazine column, For Your Consideration.

  • The unique worlds we each consciously inhabit – the only worlds we will ever experience – are constrained hallucinations, products of hypothesis testing by our predictive brains.

    This article originally appeared in my Astronomy Magazine column, For Your Consideration.

  • A month’s worth of sunlight could pay the entropy bill for a billion years of biological evolution. Entropy is evolution’s best friend.

    This article originally appeared in my Astronomy Magazine column, For Your Consideration.

  • Entropy is often maligned as the enemy of order. In truth, without the inexorable march of entropy, the universe would be a very boring place.

    This article originally appeared in my Astronomy Magazine column, For Your Consideration.

Over his 30 year career as an internationally known astrophysicist, Dr. Jeff Hester was a key member of the team that repaired the Hubble Space Telescope. With one foot always on the frontiers of knowledge, he has been mentor, coach, team leader, award-winning teacher, administrator and speaker, to name a few of the hats he has worn. His Hubble image, the Pillars of Creation, was chosen by Time Magazine as among the 100 most influential photographs in history.
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