Saturday, March 14, 2020

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.

4 comments:

  1. I just read an article claiming that Britain isn't really taking a radically different approach but rather just delaying the timing of shutting schools, etc., because they are afraid that people won't stand for it as long as needed if they start now and that it will be more needed later just when the natives are getting restless and starting to gather in groups again. I gather they think the ideal time for shutting down large gatherings in Britain is later rather than right now. I have no idea if this is right or not.

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    1. Thanks, Lydia. That's interesting. With that perspective in mind, it does make more sense. I mean, I don't know if I'd agree with it, but I'm not British so my opinion counts for very little. But I like Doctor Who if that counts for anything. ;)

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  2. See also: https://www.calcalistech.com/ctech/articles/0,7340,L-3800632,00.html

    ///The statistics led him to the conclusion that, contrary to the grim forecasts being branded about, the spread of the virus will come to a halt. … His forecasts turned out to be correct: the number of new cases reported each day started to fall as of February 7. A week later, the mortality rate started falling as well. … “The rate of infection of the virus in the Hubei province increased by 30% each day—that is a scary statistic. I am not an influenza expert but I can analyze numbers and that is exponential growth.” At this rate, the entire world should have been infected within 90 days, he said.

    But then, the trend changed. When Levitt started analyzing the data on February 1, Hubei had 1,800 new cases each day and within six days this number reached 4,700, he said. “And then, on February 7, the number of new infections started to drop linearly and did not stop. A week later, the same happened with the number of the deaths. This dramatic change in the curve marked the median point and enabled better prediction of when the pandemic will end. Based on that, I concluded that the situation in all of China will improve within two weeks. And, indeed, now there are very few new infection cases.” ///

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    1. The problem with Michael Levitt is that, as smart as he is, this isn't his field of expertise. Just being able to "analyze numbers" as a physicist isn't the same as doing the work of an epidemiologist. In fact, Levitt reminds me of this SMBC cartoon about the lifecycle of a physicist:

      https://www.smbc-comics.com/comic/2012-03-21

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