So what makes this an informed analysis? Most of me fellow Boarding Area bloggers know my military level, but let’s just say I am a senior leader. What many do not know is that I am a senior leader at the Army Corps of Engineers. That coupled with the fact that my daughter is a resident doctor working in New Orleans, makes me pretty informed about the Covid crisis. I still go to work each day on the deserted streets of D.C. because the Corps of Engineers is a key part of our national response. I am learning more about pandemics than I could ever have predicted.
Disclaimer: None of what is written below constitutes the official view of the U.S. Government or military. These are strictly my personal views and opinions.
Quite a few of the blogs I read try to put the perspective of this pandemic in terms of 9/11 which I think falls quite a bit short. A better analogy is that this is Pearl Harbor. We have just been attacked by a vicious enemy which we knew of, but didn’t prepare enough against. We know there are going to be years of sacrifice and toil, but we vow to beat it in the end. American and other nations will turn their industrial might towards beating the enemy regardless of cost. This is a fight for survival and cost is not something to weigh the fight against. THIS IS WAR. We will fight and many will fall in the battle, but we need resolve to see this through. This is a long fight and we will win some battles, but lose others, and the people need to have confidence that in the end we will prevail.
I see a lot of misinformation out there, even amongst my fellow bloggers and other media; I want to put that to rest. Let’s start with some basics.
What is a global pandemic?
Pandemics have been a part of all human history. People are all educated on the Black Plague which killed 25% of the population in Europe. These used to ravage populations up until the period just before most of you were born. As a personal example, my father was rendered a paraplegic by the polio epidemic of 1952 due to his volunteering to help in a polio ward prior to going to medical school. The 1952 epidemic killed over 3,000 and paralyzed over 20,000. We have grown complacent to such occurrences due to the advances in medicine creating vaccines to most of the epidemic killers.
Vaccines to prevent the common cold and flu have proven elusive. The common cold because it actually is a group of over 200 different viruses which cause similar symptoms during the fall and winter (that’s why we call it a cold) and for some reason the human body does not develop a long term immunity. Note that about 15% of the colds you catch are caused by one of the four coronavirus strains other than SARS, MERS and COVID-19, so coronavirus is not new to you. The flu (influenza) is a problem because it continually mutates and therefore immunologists have to guess what strain will be present in a given year and make a vaccine (flu shot) that hopefully is against the common strain for that year. That’s why you will hear a percentage value on how effective the flu shot was for a given year. Development of a vaccine depends on Covid-19 not mutating and our having a sustained immunity.
Let’s look at the last pandemic of flu that caused enormous deaths, the Spanish Flu of 1918. This flu strain is thought to have originated in Kansas and spread overseas due to Soldiers being sent to fight in World War. It was called the Spanish Flu somewhat unfairly as Spanish government was neutral during the war and thus reporters could publish reports on it, where they could not in most of Europe due to wartime censorship. The important lesson you need to understand in shown in the graphs of deaths over the three years of the pandemic – yes, three years – remember that.
These three waves are typical of pandemics. Each of the lull periods occurred during the spring/ summer. Respiratory diseases have much harder time spreading when the air is humid and droplets cannot travel as far and the sun is out to kill the germs. One of our key hopes is that Covid-19 operates similarly and dies down during the coming warm weather to give us space to raise the bar and increase our capability for handling a resurgence during the fall/winter.
Note that the Spanish Flu never did really go away. It is an H1N1 virus which last was a deadly pandemic in 2009.
So you’re in a global pandemic, what should you do?
Let’s start with what everyone has heard – you need to flatten the curve! What are we really talking about here?
The below chart is from the school of medicine at U of Michigan.
The blue curve is the exponential spread and decline if we simply let nature take its course. However, that would mean overwhelming the current health care system capacity, shown by the bar across the middle which results in many more deaths due to a lack of beds, doctors, equipment and supplies. You can do your part by practicing social distance and other sanitary practices. Note that the area under the curve is the same (bring back memories of Calculus?) we just need to spread out the rate of infection in order not to overwhelm our medical capability.
The local, state, and federal governments are simultaneously working to raise that bar by providing greater capacity to respond by addressing three factors: sites, supplies and staff. Sites means setting up Alternative Care Facilities (ACF) meaning additional beds that can handle non-Covid patients to relieve the hospital normal burden or handle the actual Covid patients themselves. Supplies means getting more equipment and medicines, and staff means pushing military medical personnel into the fight along with retired medical personnel. We can create more sites, industry will respond and create more supplies, but staffing is hard. It takes enormous time and effort to create doctors and nurses!
Masks vs. Respirators
Here is a basic lesson – masks provide a fabric barrier to catch your own sputum, i.e. droplets, respirators filter the air. N95 is a designation meaning that the respirator filters 95% of particles. How you tell the difference? A respirator is a form-fitting design to try and provide a tight seal against your face and filter the air reaching your mouth and nose. Masks are simply a direct barrier to exhaling particles. Here is the key takeaway – YOU DO NOT NEED A RESPIRATOR! Save those for the nurses, doctors and first responders, like my daughter, that have to face 50 infected patients a day. You are wasting a precious resource by wearing them as you do not need that level of protection. Masks are primarily to PREVENT YOUR OWN GERMS FROM INFECTING OTHERS. You are very unlikely to catch Covid-19 from breathing in the air around you. This is NOT an airborne disease, it spreads through being in liquids that an infected person excretes, primarily in droplets through sneezing, coughing, or even just talking. We have all noticed occasionally when talking a drop of saliva launches out of your mouth, imagine that that is happening all the time on a microscopic scale that you don’t see. These droplets are affected by gravity and fall to the ground or other surfaces where they last for a variable length of time depending on the surface material. Your most likely vector to catch this disease is touching an infected surface and then touching your face.
My first tour of duty was in Korea in 1986 and I saw people wearing surgical masks occasionally. I learned that northern Asians routinely do this when they are sick to prevent spread in the tightly spaced population groups they have over there. We are finally learning that this is a good practice with this current pandemic. Northern Asian countries credit this practice with their effective containment efforts so far. As you may know, that guidance has officially been given recently. Even the military will start wearing masks whenever they are outside starting next week. Again -masks, not respirators. My daughter says they only avoided running out of Personal Protective Equipment (PPE) at Tulane due to a timely donation from the Cajun Navy. PLEASE HELP WITH THIS PROBLEM. I still see lots of people walking around with respirators! Use an airline sleeping mask before resorting to a respirator. If you let our doctors and nurses go down, who is going to save you when you get sick?
Peaks and Valleys (Warning – Involves Math)
I think everyone is tracking that this will get worse before it gets better. Most things in nature involve a parabolic curve. Never mind what parabolic means – think of throwing a ball in the air. If you throw the ball almost straight up, it goes high, but not far. If you throw the ball at a low angle it goes far. The Institute for Health Metrics and Evaluation (IHME) is measuring the various aspects of Covid-19 in order to predict whether we are going to go high (high numbers of infections at once) or low (low number of patients at a given time). Here is a recent chart on predicted deaths for all the U..S.:
You may say, “I get the line, but what is the shaded area?” Think of hurricane tracks. You know the path up to a certain point. After that each day it can go a little left or right. The most likely case is that the moves left or right cancel out and the median line is the likeliest path. However, the lefts or rights could all add in one direction or another which is what the shaded area represents. It is the area of possible outcomes. According to the chart shown, we should peak in mid-April at a little over 2,500 deaths in a single day. However, it could go to almost 4,500 deaths or less than a thousand. This is the projection for the entire U.S., but what is more important is the projection for your state. You can find that here and clicking on the green bar. This should give you information on when to spend the most time staying indoors and avoiding others while also telling you when it should die down. Very importantly, keep your preventative measures going until that line is almost down to zero or people will precipitate a second wave early.
I will also specifically note the “Swedish Method” of isolating only the vulnerable population and otherwise letting life go on as normal. As you can see from the Johns-Hopkins site, that is not working out for them. They have a death rate of 40 per million population while their neighbors are much less. Even the death rate in the U.S. is only 33 per million which is much less than the 47 per million Sweden currently experiences. Everyone social distancing and wearing masks is the only proven method for lowering infections.
If you want to know how things are going in the U.S. or in your state, here is a great site to show whether social distancing is flattening the curve. These are log curves of infections vs. days past the 20th day of infection. If your are interested, compare the curve for China vs. the curves for most countries.
Thanks for All the Information, but What Does it All Mean?
Here are my predictions, based upon the available data. Planning is what I did for most of my career, so hopefully my analysis is fairly on point. In general, things will look much better by June and most people will think this is over, when if fact, it is the summer lull period. People will start to go back to work, but with the changes discussed below which will limit economic recovery as fewer transactions will take place. The vulnerable population will continue to isolate and teleworking in most fields will be a common practice and workplaces will still feel fairly empty. An antibody test will be developed and people who test positive (some who never knew they had the virus) will start carrying around a certification that they have immunity and use this as an excuse that they don’t have to follow social distancing rules.
Airlines: As the curve flattens, there will be more travel on business travels that all is safe and to get back to flying, at least domestically or to countries where the virus is not an issue, such as Asia. The airlines will entice travels by promising middle seat blocking, possibly including blocking off adjacent seats in First Class. Cruel airlines will offer Basic Economy three to a row and paid upgrade to the middle seat blocked Premium Economy. Airlines will offer great prices to get the public back on the planes with an idea to eventually raise prices to the point where they cover the additional costs of cleaning. Vulnerable travelers (over 65, immuno-compromised individuals, and others with underlying conditions) will be encouraged by their families or own fear, not to travel, and relate that condition to their employers. Leisure travel will be slower to start up, but will quickly shut down when the fall wave starts. Airlines will emphasize the extra cleaning done for each flight. Airline meals will come with plastic covers like microwave meals. Travel to China will be extremely cheap for years as they will carry the stigma of the place where new diseases are born. Bare feet on armrests and bulkheads will finally be banned. Overall travel will take years to recover to last year’s level and airlines will have to adjust their workforce and plane orders at some point in the near future.
Restaurants and Clubs: Will reopen, but severely limit the people allowed inside at a given time. Food will be ordered rather than being a buffet. Half the seats will be removed to encourage spacing. More emphasis on providing meals in disposable trays or paper rather than plates. Sealed silverware provided similar to airline meals.
Hotels: Going back to individual containers for toiletries (be happy Gary!). A lot of advertising on a heightened level of cleaning. Emphasis on room service so guest do not need to interact with others. Early on may advertise that guests will only occupy every other room or floor. For hotels converted to ACF hospitals, will fight a stigma after being restored to normal use, especially if they housed Covid patients.
Cruises: I don’t see how they make a meaningful comeback for years. When they do they will need to demonstrate extreme steps as to why they will not be areas to spread viruses. They will be extremely cheap if you feel brave enough.
TSA Checkpoints: No change, except for forcing people to space out when standing in line.
Open Office Design: Dead, no one wants to be in a space where germs can spew everywhere. Cubicles will make a big comeback. This also means “hoteling” is dead. People do not want to sit where someone they don’t know sat the day before. Yuck!
Theaters: Will reopen but block off every other seat. This will ultimately fail as people realize they would rather watch first run movies on streaming where they can pause the movie and talk whenever they want. Your grandchildren will not understand that you went to a crowded place to sit quietly and watch a movie.
Public Transit: Will install clear plastic screens to establish the equivalent of “sneeze guards” between sets of seats. Still ridership will be down and more people will choose to drive themselves to work.
Beaches: Life Guards will stroll along and enforce six feet distances between family groups. Some beaches may lay out a checkerboard pattern grid and no group will be allowed to sit adjacent to another.
Facemasks and Gloves: Entrepreneurs will design fashionable lines of reusable facemasks for adults and fun ones for kids – “Johnny do you want to be a puppy today or Thor?” These will be common things when going to a crowded locations and mothers will strictly enforce their wear on playgrounds or school. Younger kids will think they are cool and teenagers will immediately remove them once out of sight of their parents.
OK, I know that is probably the longest post I have ever written, but I wanted to get the right information out there to help others. We’ll see if my predictions come true, but take the current information to heart and monitor the sites I have linked to in order to be informed and make informed decision about your future.
If you have questions, I will do my best to answer them in the comments.