COVID-19: Latency, Spread and Fatality

As I write this essay on April 3, 2020, more than 1 million people have been infected globally (1,032,184 according to and 54,294 have died. In the United States, 245,442 have been infected, and 6,098 have died so far.

I wrote before about “The Perfect Storm”, and why this pandemic is going to be so bad for the United States. I thought I would add some information about the disease itself, and why this is going to get much worse in the next three months.

Latency: People who are infected with COVID-19 don’t know it right away. It sometimes takes two weeks (average 5-6 days) until someone who is infected with COVID-19 begins to experience symptoms. That means that infected (and contagious) people are walking around supermarkets, shopping malls and family situations without knowing that they are infected and contagious.

Contagiousness (Spread): On average, each infected person infects approximately 2.5 other people. Because of the latency (see above), an infected person may spread the disease to others, and neither person will know they are sick for several days.

I wrote about the contagiousness in an essay a few days ago called “The Doubling Curve”. Read it.

The Fatality Rate: For some reason, this disease has a reputation of “not that bad”, or “a low fatality rate”. I don’t know where that comes from. The current global fatality rate is 5.3% (54,294 fatalities/1,032,184 infected).

As of last Saturday, March 28, a total of 1717 Americans had died of Covid-19. 1321 died today.

Remember that is takes a week or so from the time of infection until symptoms, and then a week or so from symptoms to severe illness. So fatality numbers trail diagnosis numbers by two weeks or more. If you look at current U.S. numbers (6098 fatalities/245,442 cases, or 2.5% fatality rate) that is very misleading. 150,000 of those cases have been diagnosed in the past 6 days.

For a more realistic outlook on what the U.S. may face, it probably helps to look at western countries whose healthcare systems have been overwhelmed by this pandemic: Italy, Spain and France. The fatality rate in Italy is 12.1% (13,915 fatalities/115,242 infected), in Spain it is 9.3% (10,935/117,710) and in France it is 9.1% (5387/59,105).

The eventual fatality rates in those countries may be higher, because the timeframe from diagnosis to death may be several weeks. In other words, the people who die from this today were diagnosed weeks ago. The patients who are diagnosed today won’t begin dying for a week or more.

The United States healthcare system will become overwhelmed with this virus (it is already). We are a country that will likely experience a 10% fatality rate. So the next time someone says “low fatality rate”, or “it’s not that bad”, my response is “how is a 10% fatality rate a month from diagnosis a low fatality rate?”

The Illness: This part is devastating. In case you haven’t been paying attention, there are hospital ships in the ports of New York City and Los Angeles, and a portable (outdoor) field hospital set up in Central Park.

As soon as you are admitted to a hospital with COVID-19, you are placed in isolation. That means no visitors, no friends, no family. No contact at all with your loved ones. If you require a ventilator (and if one is available), you are placed on a machine that requires that you first be paralyzed, because there is no way to insert a breathing tube down your throat and through your vocal cords unless you are temporarily paralyzed. Because the tube goes through your vocal cords, you lose the ability to speak. If you are conscious, your only method of communication is to write brief notes to the nursing staff.

For a preview of what this looks like, do a search on the disease in Italy or New York City. If you die, you die alone. Remember-no visitors allowed, you are in isolation. If you die, you may not get a funeral. Remember, gatherings in most places are now banned. Funeral homes are providing memorials online. In New York City, so many people are dying in some of the hospitals that their morgues have filled up, and bodies are being stored in refrigerator trucks outside of the hospitals.

Why do I write this? Because people I know are still not taking this seriously. Stay at home. Wash your hands. Keep staying at home. Call me at the end of June and we can discuss when it will be ok to interact socially again. And go read “The Doubling Curve” to see what April and May will look like if we don’t Stay At Home.

If I can help one person to stay inside and stay alive, I will have done my job.


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