Wait - why is Jason talking about COVID-19? And why are these written like FaceBook posts? There’s a longer explanation here but the short version is that my day job for the past 15 years has been developing models of human health effects and medical response for chemical injuries and biological illnesses, including pandemics. I’ve been making these posts on FaceBook and I was asked to put them in a more shareable manner. I’m linking to the posts on the explanation page. These are the original, unedited posts. I’ll continue until I run out of things to say.
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Originally posted here on March 13th.
Continuing with these COVID-19 posts.
This is the part you’re going to really hate. Let’s talk about resource limited care, crisis standards of care...whatever you want to call it, it’s a discussion on the reality of how we treat people when there aren’t enough critical resources to meet the needs of those affected by a mass casualty event.This is one of the main thrusts at my day job, and this is the reason I have recurring nightmares. In case you don’t want to read the whole thing, I want to put the bottom-line up-front: stay home and don’t get others sick, because if things get too bad too fast, there will not be enough critical material to meet the demand. You’ve been seeing this around the internet as “Flattening the Curve.”
In my original COVID-19 post I talked about an analysis I did with my team in 2008. In that analysis I showed the customer two curves and a line. The line was how many available hospital beds we currently had in an area and how many could be brought in over time. One curve was the number of active cases if nothing was done, one was the number of active cases if response was immediate. The first curve went well over the line, meaning if nothing was done, we were not going to have enough beds and we were going to lose a lot of people. We didn’t call it flattening the curve then but I love that phrase now - it’s simple and effective. Let’s put some math to it.
Let’s assume there are three triage categories for 100 patients. The first triage category has 50 people with mild to moderate symptoms who will most likely get better on their own but could use supportive care to feel better. The second triage group has 45 people with severe symptoms, and 20% of them will die without treatment and none will die with treatment. The third group has 5 people with very severe symptoms, and 100% of them will die without treatment and 60% of them will die with treatment. Who do you treat?
You treat all of them! Only 3 people will die out of 100!
Now, let’s assume it takes 10 minutes per day/per person to treat the mild-to-moderate people, a half hour per day/per person to treat the severe people, and 2 hours per day/per person to treat the very severe people. And you need to allocate 24 hours of treatment time. Who do you treat?
If you treat the very severe people, that’s 10 of your 24 hours. 60% of the five people will still die, so that’s 3 deaths, 2 people saved. You have 14 hours left, so you treat 28 severe people and they all live! But there are 17 severe people you don’t treat and 20% of them die. None of the mild-to-moderate people die. In the end, you have 6-7 deaths and you saved the rest.
However, if you treat the severe people first, you save all of them! It will take 22.5 hours of your 24 hours. You now have time to treat three-quarters of a very severe person (but we’ll say one) . We’ll flip a coin and say treatment was successful. In the end, you have 4 deaths and you saved the rest.
Here’s the question - which strategy do you chose?
I’ll tell you what - answering that question isn’t my job. My job is to let someone know what options they will face. I will tell you, in my opinion, option 2, where you save more lives, is the preferable one. But now here’s the real kicker: of the five very severe people, which one do you treat? Without getting into socioeconomic things because, “first, do no harm,” which four people do you tell, “Sorry, but you have to die so more people can live?”
I’m not answering that. I’ll let you think about it.
But now here’s the thing - what if this is a pandemic, and those mild-to-moderate cases stayed home? Well, that means the next day and the day after that will likely see fewer and fewer severe and very severe cases. And doctors wouldn’t have to make decisions on which ones die. And the answer, “You treat all of them!” holds. And in that case, you may have a situation where there’s 20 severe people and 4 very severe people. You can treat them all and have 6 hours to spare.
That is the math behind flattening the curve. In our current reality, respirators seem to be the limiting resources. Respirators are big. They require a bed. They require doctors. Anecdotal evidence coming out of Italy is that respirators are the choke point. Thankfully we have a good amount of ICU beds in the US, stockpiled respirators, and Title 32 and Title 10 which will allow the national guard and the military, respectively, to set up field hospitals and expand our medical frontlines. But that is reactionary, and we won’t be able to provide top care to millions of people, so flattening that curve, reducing infection in the community, is the proactive thing we can do.
That’s why everything is being canceled. That’s why you’re being asked to stay home. It’s so a doctor doesn’t have to tell your mom or your grandpa or whoever else, “Sorry, we have to let you die so two people can live.”
So stay home. Wash your hands. Quarantine for expected contacts, isolate for any respiratory symptoms and call the urgent care clinic. Do not interact with the elderly or immunocompromised if you have anything as mild as a sore throat.
Stay safe, and I’m sending you all my love.
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These are my opinions and thoughts and analyses - I am not representing any government agency or my company. More disclaimers on the main page.