The fittest [is] not the strongest, but the most adaptable.
-- I Nai, possibly paraphrasing Leon Megginson definitely summarizing Charles Darwin
COVID-19 Hospitalization Rates = SHTF = TEOTWAWKI
This looks like it could very well be the Big One. I'll present the doomer case, followed by a glimmer of cautious hope.
Combining official figures published by the CDC and WHO, the estimated number of persons who will be infected and require hospitalization are staggering. Death rates are likely to rise dramatically as healthcare systems are overwhelmed.
Here's how it breaks down:
- Of the world's total population of about 7.8 billion (7,800,000,000), leading epidemiologists estimate that 40 to 70% of world population will become infected, or about 3.12 to 5.46 billion people.
Note: Dr. Lipsitch appears to have first released this estimate (WSJ article ref) and has been widely quoted by CDC officials. Other estimates are similar, some going as high as 80%.
Note: If there is a very large group of infected persons who have not been detected (vs. known cases), these stats may fall to some degree. However, estimates of eventual infections would rise. It's not known which way the overall data would trend. Numbers remain high in any scenario.
- Of the known infected, Chinese data (which appears to be supported by emerging global data) indicate that about 20% (1 in 5) will suffer severe (14%) to critical (5%) symptoms, requiring hospitalization and ICU, respectively. That is to say that;
624 million to 1.092 billion would require hospitalization... roughly 1 in 16 to 1 in 8 of the global population.
- Of the infected with severe symptoms, 2+% are dying at current rates. That's 12.48 to 21.84 million souls dead at current rates.
Note: The current mean global fatality rate is 3.4%. For updates go to this site (Johns Hopkins Dashboard) and divide TOTAL DEATHS by TOTAL CONFIRMED to find the global fatality rate among confirmed cases since onset. This method will be improved over time... this value is likely high by quite a factor.
Any substantial fraction of this case load will certainly overwhelm current and likely foreseeable health care capacity. As advanced care fails to keep pace with interventions, due to resource limits and exhaustion, the death rate will certainly rise. The upper limit is likely to approach the 20% of infected requiring but not receiving advanced care (624 million to a billion).
As healthcare resources are overwhelmed, fatality rates for other conditions, not directly related to the virus will rise.
Absentee rates due to isolation measures, illness and death would be very large, bringing production, supply-chains and economies to a standstill. We are already seeing large-scale economic effects in this early stage of pandemic.
We are presently in the early stages of what David Korowicz describes as Trade-OFF in such papers as this one, which specifically considers a pandemic scenario. In it, cascading failures propagate throughout the global industrial economy (contagion), resulting in Collapse.
Eventually, the system cannot adapt, one or more tipping points are reached and catastrophic failure ensues.
Throughout, the exponential growth rate - expressed as doubling times of confirmed covid19 infections - is critical. The disease spreads not arithmetically (1, 2, 3, 4, ...) but exponentially (1, 2, 4, 16, ...). Be aware that the rate of change is accelerating. Current doubling rate of infections outside China is every 4 days(!).
A Faint Glimmer of Hope
It may be that the Chinese experience is worse than elsewhere.
The Chinese epicenters of the virus suffer some of the worst air pollution in the world. Any air pollution makes respiratory symptoms worse, and constitute an important factor raising hospitalization and fatality rates. Less polluted areas may have lower rates.
First indications from other countries with lower levels of air pollution are not encouraging. At this writing, global fatality rates appear to fall between 1 and 4%, depending on the local state of healthcare available.
Today's averaged global fatality rate is 3.4% (discussion here).
The world is beginning to move in reaction to the virus. Health care (including hospital care) can be ramped up if will and time are available. To date, such escalation is beginning, but moving in fits and starts.
China - which appears to have slowed or halted new infections - took strident measures relatively early, while there were only limited epicenters. Outside of China, strident measures have yet to be taken, and the number of epicenters is multiplying exponentially.
One way or another we are entering global TEOTWAWKI. Whether that is temporary or permanent remains to be seen.
The window for measured preparation is closing.