COVID-19 Spread: Updates from the Washington Post - Updated

When a novel virus spreads, it's important to have access to trusted sources of information. Here's an article from the Washington Post regarding the spread of the COVID-19 virus around the world. This article will be updated from time to time.

Here's the link: https://www.washingtonpost.com/world/2020/01/22/mapping-spread-new-coronavirus/?arc404=true

One more thing ... if you take a look at the end of the article, there's a table of history of various diseases. One of the things that I did, was from the data provided to determine the death rate of COVID-19. Using the reported numbers, the death rate is 3.46%. (86013 inflected and 2977 deaths.) That could be high because not all COVID-19 cases are likely to have been detected. 

I updated the parameters in my quick model to 1) number of persons that an infected person would infect = 2 and 2) death rate = .0346. Number for multiple generational points = 75. 

This is what the model produced:

Generation	0	1	2	3	4	5	6	7	8	9	10	11
Number infected in Generation	1	2	4	8	16	32	64	128	256	512	1,024	2,048
Running total infected	1	3	7	15	31	63	127	255	511	1,023	2,047	4,095
Total deaths	0	0	0	1	1	2	4	9	18	35	71	142
Multiple Origination Points Infected	75	150	300	600	1,200	2,400	4,800	9,600	19,200	38,400	76,800	153,600
Running total infected	75	225	525	1,125	2,325	4,725	9,525	19,125	38,325	76,725	153,525	307,125
Total deaths	3	8	18	39	80	163	330	662	1,326	2,655	5,312	10,627

UPDATE: Of note, I reported the COVID-19 death rate as 3.46% based on the numbers supplied by the Washington Post in the article shown above. I reported that value as a death rate with caveats. However, about a week after I stated the above COVID-19 death rate, the World Health Organization (WHO) reported a death rate of 3.4%. I was about to alter my death rate to 1% based on recent reporting. But for now I'm not going to update what my model has predicted with respect to the number of deaths until I receive an updated number from WHO or the CDC.

Changing the number for multiple generational points to 42, here's what you get:

Generation	0	1	2	3	4	5	6	7	8	9	10	11
Number infected in Generation	1	2	4	8	16	32	64	128	256	512	1,024	2,048
Running total infected	1	3	7	15	31	63	127	255	511	1,023	2,047	4,095
Total deaths	0	0	0	1	1	2	4	9	18	35	71	142
Multiple Origination Points Infected	42	84	168	336	672	1,344	2,688	5,376	10,752	21,504	43,008	86,016
Running total infected	42	126	294	630	1,302	2,646	5,334	10,710	21,462	42,966	85,974	171,990
Total deaths	1	4	10	22	45	92	185	371	743	1,487	2,975	5,951

So based on the assumptions embedded in the model (and these are speculative assumptions ... please note that fact) the current state of spread of and the number of deaths from the COVID-19 virus has 42 points of origination, spread over 10 generations where the person-to-person infection rate is 2.0 and the death rate is .0346. 

This also suggests that the spread to the next generation could result in a substantial jump in the number of cases (5 figures to 6 figures) as well as well as in the number deaths. But as with all things monitoring the data and updating the model with the new data is essential.

Update

From NBC News, I received a new person-to-person infection rate and the seemingly minor change makes a pretty significant change in the numbers. Here are the parameters: 1) person-to-person infection rate = 2.2, 2) death rate remains at .0346 and the number of origination points = 39 (to match up with current data). Here's the table:

Generation	0	1	2	3	4	5	6	7	8	9	10	11
Number infected in Generation	1	2	5	11	23	52	113	249	549	1,207	2,656	5,843
Running total infected	1	3	8	19	42	94	207	456	1,005	2,212	4,868	10,712
Total deaths	0	0	0	1	1	3	7	16	35	77	168	371
Multiple Origination Points Infected	39	86	189	415	914	2,010	4,422	9,728	21,402	47,083	103,584	227,884
Running total infected	39	125	314	729	1,642	3,652	8,074	17,802	39,204	86,287	189,871	417,755
Total deaths	1	4	11	25	57	126	279	616	1,356	2,986	6,570	14,454

To reach the current number of reported infected people with 39 originating people is the 9th generation as opposed to the 10th generation. Also the jump in numbers to the next generation suggest that approximately 18,000 more people will be infected than in the previous table. 

The point I want to make is that even a slight uptick in the infection rate can have significant consequences.  This is why testing is so important. Keeping the infection rate down makes the epidemic more manageable. This is why informing the public regarding what they should be doing to not become or lower the chances of being infected is so important. This is why having competent people managing this public health emergency is so important. 

The Trump Administration

However, it seems that at the level of the Trump Administration, we have people who have no idea of what to do. Who have been denial for weeks about the likely spread of the virus outside of China and into the US. Trump's recent decision to restrict travel to and from Iran, Italy and South Korea in addition to China is not only short sighted, but utterly inane. The virus is in the US, it is spreading in the US. It's too late for travel restrictions to have any real effect. And besides, travel restrictions only buy you time to prepare, something the Trump Administration neglected to do in it's state of denial about how the virus could spread to the US. 

Quick Model of the Predicted Spread of the Corona Virus

To satisfy my own curiosity, I created a simple model of the multigenerational spread of the CoronaVirus. I'm not an expert on public health so I'm not certain of the assumptions and process of a spreading virus but I know the mathematics is correct. 

Anyway, here's a snapshot of a table based on the following assumptions:

• Generational disease spread originating from one person over 11 generations. (I have no idea if 11 generations is reasonable, but I wanted to provide some sense of how widely the disease could spread.) 
• Each infected person spreads the disease to 3.8 other people. 
• Mortality rate is .02 (2% or crude rate of 2000 per 100,000)
• I guessed that it would take 36 hours for each person to spread the disease to the 3.8 other people. I don't take my timescale all that seriously but it provides some sense of how fast a disease could spread.

The table below shows the spread from single origination point and from 50 origination points. The number of days that it would take to generate these numbers based on my timescale assumption is about 17 days. (These tables have been updated. The death rate in my original tables was .03 not .02. These tables have a death rate of .02.)

Generation	0	1	2	3	4	5	6	7	8	9	10	11
Number infected in Generation	1	4	14	55	209	792	3,011	11,442	43,478	165,216	627,821	2,385,721
Running total infected	1	5	19	74	283	1,075	4,086	15,527	59,005	224,221	852,043	3,237,763
Total deaths	0	0	0	1	6	21	82	311	1,180	4,484	17,041	64,755
Multiple Origination Points Infected	50	190	722	2,744	10,426	39,618	150,547	572,078	2,173,896	8,260,805	31,391,059	119,286,025
Running total infected	50	240	962	3,706	14,131	53,749	204,296	776,374	2,950,270	11,211,075	42,602,134	161,888,159
Total deaths	1	5	19	74	283	1,075	4,086	15,527	59,005	224,221	852,043	3,237,763

I have to admit, I gasped when I saw these numbers and thought, I hope this isn't the case. But if the government takes action to stem the infection rate from 3.8 to 2, here's what you get:

Generation	0	1	2	3	4	5	6	7	8	9	10	11
Number infected in Generation	1	2	4	8	16	32	64	128	256	512	1,024	2,048
Running total infected	1	3	7	15	31	63	127	255	511	1,023	2,047	4,095
Total deaths	0	0	0	0	1	1	3	5	10	20	41	82
Multiple Origination Points Infected	50	100	200	400	800	1,600	3,200	6,400	12,800	25,600	51,200	102,400
Running total infected	50	150	350	750	1,550	3,150	6,350	12,750	25,550	51,150	102,350	204,750
Total deaths	1	3	7	15	31	63	127	255	511	1,023	2,047	4,095

The situation becomes far, far more manageable. In addition, the actions the government should take should reduce the number of generations the virus is allowed to spread to others. 

Having seen these numbers, it makes sense to me why South Korea is doing mass testing. The faster you can get infected people out of the environment where they can infect other people, the more manageable the epidemic becomes. In addition, this suggests that barriers and changes in people's behavior to slow the spread of the virus would significantly assist in stemming epidemic.

What Should You Do to Protect Yourself, Your Loved Ones and Your Fellow Citizens?

I prefer not to provide anyone with advice regarding what you should do. However, I'll happy to provide you with expert resources. So ...

Here's the CDC website for the CoronaVirus: https://www.cdc.gov/coronavirus/2019-ncov/index.html

Here's the website for the National Institute of Health: https://www.nih.gov/health-information/coronavirus 

My Comments Regarding the Trump Administration

Now, let's see if in the US, the Trump Administration is able to get it's act together. That news conference on 26 Feb 2020 was not all that reassuring. It was clear that Trump himself is completely clueless about the situation he and his administration are facing and what to do about it. Putting Pence at the head of the effort wasn't reassuring at all. As Governor of Indiana, Pence's policies lead to an outbreak of HIV in southern Indiana. And it took Pence far too long to respond and take actions that addressed the epidemic.(https://www.washingtonpost.com/politics/2020/02/27/mike-pence-hiv-indiana/) 

Let us all continue to monitor the situation going forward.

I'll admit that I have an intense dislike of Trump and the growing group of servile sycophants that surround him. This Administration is corrupt and incompetent, and headed by someone who requires obsequiousness, but careless nothing about competence and truth. 

My opinion has only been reinforced by the Trump Administration's statement that all information, interviews and and statements regarding the CoronaVirus must be cleared through Pence and thus filtered through the administration. In other words, the Administration just muzzled Dr. Anthony Fauci and others. This should scare everyone. Public health should never be politicized, but it appears that it now has. 

I can admit to you that I didn't like the Bush Administration either for a whole host of reasons beginning with lying to get the US into a war with Iraq. But, I can say when it came to concerns about public health, both nationally and internationally, they were not all that bad. 

I feel that I give Administrations credit where credit is due and criticize them when their actions and policies do damage. And from what I have seen, Trump and his Administration has done little to make things better and done lots of damage. And things are only getting worse.


Here's an article from the Washington Post regarding a newly filed whistle blower complaint: https://www.washingtonpost.com/health/2020/02/27/us-workers-without-protective-gear-assisted-coronavirus-evacuees-hhs-whistleblower-says/

Public Health Alert -- Foreign Policy: Trump Has Sabotaged America’s Coronavirus Response by Laurie Garrett, January 31, 2020

If you don't know Laurie Garrett and her works regarding disease transmission, epidemic and public health policy, you should. Her expertise in these areas is renown and she knows more about these areas than nearly every practicing physician. I venture to guess that if you look in the library of many physicians, you'll probably see at least one or more of her books. If you have any interest in public health, particularly when it comes to the spread of disease, then I suggest that you read one or more of her books. 

Here is the link to Laurie Garrett's article in Foreign Policy: https://foreignpolicy.com/2020/01/31/coronavirus-china-trump-united-states-public-health-emergency-response/

 Trump Has Sabotaged America’s Coronavirus Response

Under President Obama, the US infrastructure and ability to respond to pandemics was unparalleled. It took years to create the organizational and management structures and put the systems put in place to manage a pandemic and protect Americans as well as others throughout the world. Trump on the other hand destroyed everything that President Obama had created for addressing pandemics, but has gone further to downgrade the capabilities of our public health systems including the Centers for Disease Control (CDC). 

Here are a few quotes from her article:

• In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure.
• In the spring of 2018, the White House pushed Congress to cut funding for Obama-era disease security programs, proposing to eliminate $252 million in previously committed resources for rebuilding health systems in Ebola-ravaged Liberia, Sierra Leone, and Guinea. Under fire from both sides of the aisle, President Donald Trump dropped the proposal to eliminate Ebola funds a month later. But other White House efforts included reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. And the government’s $30 million Complex Crises Fund was eliminated.
• In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10.

Comparing the CoronaVirus to Something Similar that We Know and Have Experienced

As a means of comparison, the death rate from those infected by common and yearly influenza virus strains is about 1 in 1000. (.1%) In a recent interview, Laurie Garrett stated that the death rate for the Coronavirus is at 2 in 100 (2% or crude rate of 2000 in 100,000) and in some places in China, some have reported a death rate at closer to 6 in 100 (6%). The death rate in the influenza pandemic of 1918 was something on the order of 2 to 3 in 100 (2 to 3%). And if you have don't any sense of just how bad that pandemic was, there are many books and articles (printed and online) that discuss it and several documentaries that are available. One of the complicating factors that assisted the spread of the virus. This outbreak occurred during World War I and as part of US policy, the Federal Government did little or nothing to respond to stem the spread of the virus. The rationale was that the lack of a strong public health response was to continue to maintain the US's war fighting capability. It was feared that public health measures result in the reduction in war materials production and in the recruitment and training of troops. Also, there was concern that a public health response could create panic, thus also affecting the ability to prosecute the war. In fact the Federal Government actively suppressed information about the epidemic and the measures to take to prevent its spread.

There's a great deal of controversy regarding whether the actions or lack of action taken by the Federal Government was this was a good idea. The lack of a public health response created a situation where replacement troops from the US infected troops already in the field, thus reducing unit combat effectiveness and leading to field hospitals being overloaded and caregivers over taxed. Also, the lack of information and direction from the Federal Government created fear and panic. Providing the information and direction on ways to suppress the spread of the virus would have actually helped the war effort.

Finally, if you look at the responses by the Federal Government to the possibility of a Coronavirus epidemic hitting the US, the responses are uncoordinated, scattered and filled with both good and misinformation. The "head in the sand" approach taken by the White House and the President ("everything is fine, nothing to worry about here, the virus will disappear by April ...") is at odds with the statements from the CDC and the World Health Organization about the likely spread of the Coronavirus to the US.

What the US does to deal with this epidemic will be important. In 1918, the actions the US took actually aided the spread of the virus around the world. What the US did with other organizations such as Doctors without Borders (I should note that I make a monthly donation to Médecins Sans Frontières, Doctors without Borders) in 2014 to stem and contain the spread of the Ebola virus was important. What the US does in response to stem the spread of the Coronavirus will be important ... for better or for worse.