Dr. Luks on Covid-19 Personal Risk vs Systemic Risk

The following is a post from orthopedic surgeon Dr. Howard Luks, MD, on Facebook about the difference between the personal risks of the novel coronavirus and the looming systemic risk. Most people have a pretty low personal risk to worry about the virus, but the systemic risk of an overwhelmed health care system is danger in itself.

COVID-19 Update: 3/8/20; 6AM

Confusion and messaging…. Personal v Systemic Risk:

Many people have had trouble grasping the issues we have covered as they try to make sense of it in the context of what they see on TV or read in print media.

Much of what the experts have been discussing is in fact accurate. Your “personal” risk remains very low. The risk to your children’s health is very low. So, their messaging is accurate… but incomplete. The message should be clear… your personal risk is low… period. No one is debating that. The issue that you’re not reading about is “systemic risk”.
The AHA or American Hospital Association is starting to discuss the systems side … see the second picture below for their estimates.

Personal risk aside, the issue that we need to confront, and soon, is the concept of systemic risk. I am referring to the healthcare system. Let’s dive into this again.
An example … Here are some numbers out of Italy:

10 % Lombardy doctors are infected.
At least 1060 patients are self-isolating at home
At least 2394 are hospitalized
At least 462 are in intensive care
197 have died.

The Italian Society of Intensive Therapy declared today: “It might be necessary to limit the age of people who can enter intensive therapy to preserve resources for those having more chances of surviving”. In other words, people who are more at risk will be left to die.

THIS IS WHAT SYSTEMIC RISK LOOKS LIKE.

~ Doctors/nurses getting sick: fewer to care for high numbers of patients.
~ 462 in an ICU…. and we are still very early in the spread of the infection stage. Italy will shut down large cities soon… but it will be too late. How many ICU beds do you think we have available in your community?
~ 2400 hospitalized. In the US, on average, hospitals run 65% full. In many regions of the country, mine included, that number is far higher.
~ Let’s conservatively assume that there are 2,000 current cases in the US today, March 8th. This is about 8x the number of confirmed (lab-diagnosed) cases. We just do not have the ability to test people. Period.
~ Given an R0 of 2( meaning that one person infects two people), and a doubling time of 6 days (one infection becomes two, two becomes 4, etc)
~ That means we’re looking at about 1 Million US cases by the end of April, 2 Million by ~May 5, 4 Million by ~May 11, and so on.
~ yes… math is wonky. and exponential math even more so.

Here are the current models from the AHA: Assumptions are actually conservative. Fatality rate assumption only 0.5%, etc. If that rate rises due to strained resources ….

96,000,000 infections
4,800,000 hospitalizations
1,900,000 ICU admits
480,000 deaths

Compare that to the numbers for the flu ..

35,500,000 infections
490,600 hospitalizations
49,000 ICU admissions
34,200 deaths

This is NOT the flu. Again… yes, your personal risk is low. However, the systemic risk to our healthcare system is huge. So we can change this trajectory… keep reading.

Assume there are~ 1 Million hospital beds in the US, therefore ~ 300,000 hospital beds (not ICU beds) are available in the US (assuming 65% of capacity)
~ It does not take long before our beds are full, and our resources are under strain.

To recap… your personal risk IS currently very low. If you are a young healthy adult your risk of dying from COVID-19 is lower than your risk of driving around today. That risk increases in people with diabetes and hypertension. Men are at slightly higher risk than women, and people over 80 have the greatest risk of dying (~15%).

So the messaging that you are viewing or reading is in fact accurate. Your personal risk is low. No need to panic.

Hospitals are not full right now… hospital resources are available to you. Only a few physicians, nurse, and health care workers are sick. So if you become infected now you will likely do fine.

What happens in a month when 2 Million people may be infected? Our healthcare system may not be able to offer the same level of care to those who need it. Therein lies the risk. This is systemic risk. This is why we need to stretch and bang down the “epidemic curve” or the rate of spread. The healthcare system CAN deal with many sick people arriving over a longer period of time. So we need to stretch the time course out. See the first picture below.

Why we should close schools and dramatically limit social contact via gatherings, events and conferences. It boils down to math… and the need to flatten the epidemic curve.

This is a great article that goes into the numbers and models with respect to lives saved by closing schools, working from home, cancelling gatherings, etc. It is well worth the 5 minutes it takes to read. The third picture below shows the detailed math of how closing schools etc will save lives.

https://www.linkedin.com/…/whats-your-risk-dying-covid-19…/…

So if your school district closes… don’t get on their case. It’s in the best interest of community as a whole. The risk to your child’s health in all of this is negligible. This is not a personal risk issue! I’m watching my own town’s facebook page explode with fear, personal attacks and political rants. It’s a shame. This is not a time for political wrangling. This is the time to act to keep our healthcare system running and our healthcare workforce well to be able to care for you when you or a family member becomes ill.

Yes, hand washing is critical … but it’s time to consider what else we can do to slow the spread. For your communities sake.
– we shouldn’t be going to indoor tournaments
– we shouldn’t be going to concerts
-conferences should be cancelled
– etc
Again… not because your individual risk is high… but because we need to slow the spread to minimize the risk of a systems failure.

For those interested in a deeper dive into the mathematical modeling of the spread of COVID and how it will affect our resources you can read this thread … https://threadreaderapp.com/thread/1236095180459003909.html