Primary care

Here are a few reasons why I doubt the coronavirus in the US will be as bad as it has been in China (though, of course, that's not to suggest it'll be no problem):

1. Primary care. From what I understand, China has no primary care system. At least not any significant one with much presence. However, we have a very significant primary care system in the US. One of the best. The very best. As Trump might say.

Think of it this way. There's the general public and there's hospitals. In China, the general public goes directly to hospitals for their health care.

We're different because primary care stands in-between the general public and hospitals. In general, the public will seek to utilize primary care services (e.g. urgent care, primary care physicians) before they'll seek to head to the hospital.

As such, our primary care system is like a sieve. It stands in-between the general public and hospitals and catches all the cases that primary care physicians, PAs, nurses, and other health care providers working in primary care are able to handle.

2. Lead-time. Moreover, we've had weeks if not months of lead-time to prepare for the onslaught of the coronavirus, unlike China. It's like witnessing a storm system gathering off the coast; we can take shelter because it hasn't made landfall. Many if not most hospitals by now have done their level best to scale up care to meet the expected surge in patients (e.g. Stanford).

Of course, we'll see how it goes, it's still quite possible for hospitals to be overwhelmed, but at the very least I'm suggesting we're in a far better position than China. In fact, arguably better than most other nations in the world. We're better off than China since we weren't the first hit. We're better off than the Asian nations neighboring China, yet several of the democracies have responded very well to the coronavirus (e.g. South Korea, Hong Kong, Singapore, Taiwan). We're better than developing nations that have limited health care resources as well as personnel. We're better off even than Europe which has had less time to prepare (e.g. Italy).

Perhaps the only other nations which have similarly good healthcare systems as well as lead-time like we've had are Canada, Australia, and New Zealand.

3. Population density. Transmission rates between asymptomatic people just walking around outside are estimated to be approximately 0.5%. By contrast, transmission rates between household contacts are estimated to be approximately 10.5%. Of course, it's common sense to know that we're at much higher risk from people we are in close contact with every day. These represent (almost) two extremes.

Now I bring this up in light of the fact that much of the US has a significantly lower population density than China. Pace places like Manhattan, we tend to be more spread out. We have more space. If I'm not mistaken, a majority of Americans live in the suburbs and small towns vs. the cities, which I presume would be the most population dense sectors of the US. And even Europeans tend to live more closely to one another than we do (e.g. "Why are European cities so dense?").

4. Rule, Britannia! Finally, at least we're not doing this, as far as I know! On a serious note, I likewise hope it's not true.

1) Hoping this is not true 2) If it is, hope UK Gov reconsiders 3) If UK Gov won't reconsider, our #vaccine already manufactured, uses an established technology (recomb protein similar hep B vaccine) just needs to be vialed, accelerated thru clinical testing, can donate for free https://t.co/psOIn5QXrV

— Prof Peter Hotez MD PhD (@PeterHotez) March 14, 2020