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Last updated: September 24th, 2020, 11 AM PST
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Figure 1: Estimated deaths by calendar date. From University of Washington.
U.S cases: 6,999,985 cases | 203,723* deaths, 14 September, 2020.
Sources: Johns Hopkins, 1Point3Acres
* Includes probable deaths.
(Figure 1) APRIL IS GOING TO BE 👉🏽👉🏽👉🏽 BAD 👈🏽👈🏽👈🏽
As many as 90,000 dead by May 1
On a single day of April 15, we expect 2,271 COVID-19 deaths.
By May 1, there will be a shortfall of by 61,509 beds and 26,753 ventilators (see Figure 2).
Figure 2: Estimated shortfall of hospital and ICU beds by calendar date. From University of Washington.
Map of US showing predicted case burden by state from New York Times
Expect pandemic to be a marathon like World War II. But we’ve got this: 100 things to do during social distancing, good art vibes from art community, 🆕👉🏻👉🏻👉🏻 Learn from an astronaut how to survive isolation👩🚀🚀. 🆕Understand grief. See our mental health tips.
Exercising before becoming infected can improve outcomes. Healthcare system in current overhaul to enable patients to visit doctor remotely. Gratitude journals improve mental health. See how to quarantine or what to do if you are sick.
Create a 90 day financial plan to stay at home for 90 days. See financial health section for ideas.
Best online source for what to do during COVID-19: Consumer Reports. They accept no advertising and have great articles.
How quickly can COVID-19 spread?
How social distancing can slow COVID-19
COVID-19 and hearing loss with links to ASL resources
COVID-19 (Coronavirus Disease 2019) is a pandemic coronavirus that is similar to virus that caused the SARS outbreak in 2002. It is a respiratory virus not related to the viruses that cause flu. COVID-19 did not come from a bioterror lab.
There are signs that COVID-19 causes heart damage. The CDC has great COVID-19 resources.
COVID-19 has a case fatality rate (CFR) of 7 in 1000 (0.7%) overall—almost 10 times more than flu. But this is when the healthcare system can provide a good care to all patients. See below “Risk to the Healthcare System” below to see how a burdened healthcare system affects the CFR.
If you have COVID-19, you have approximately 15% risk of being hospitalized and 5% risk of requiring ICU care.
Mortality risk increases with age, chronic illness, and being immunocompromised (see bar chart to right). Pregnant women don’t seem to be at direct risk, but should use similar caution as at-risk groups.
This only describes your risk of dying if you catch COVID-19. People discharged from critical care and ICUs often have health that is permanently changed for the worse. This is a particular concern for high risk patients.
Virus spread occurs exponentially. One person infects 2-3 others, and the spread doubles every 3 days. Monday could have 5 cases, Thursday 10, Sunday 20, and so on. Seattle has experienced almost an entire 6 month season of flu deaths in the span of 1 week.
There aren’t enough hospital beds for COVID-19 and other illnesses. The approximately 95,000 ICU beds in the U.S are mostly filled with non-COVID illnesses—only 29,000 are available.
Conservatively, 1 out of 3 Americans will become infected with the virus (105 million infections). About 15 out of 100 require hospitalization. This amounts to 14.4 million hospitalizations, and about 5 in 100 of these will need critical/ICU care. That is 720,000 admissions to the ICU 25 times the capacity that we have.
The healthcare system cannot handle these admissions all at one time. Remember the run on groceries and toilet paper? Imagine that, but for hospital and ICU beds. The CFR of COVID will increase with burden to the healthcare system. This is seen in other countries. Italy is currently overburdened, increasing the CFR approximately 11 times to 8%. Singapore and South Korea acted swiftly, and the CFR is approximately 0.7%.
To decrease the rate of infections, i.e. “flatten the curve” (see figure), practice social distancing and hygiene (see below). This will spare our hospital capacity and give us time to develop a vaccine.
Social distancing has worked in democracies like Hong Kong, South Korea, and Taiwan who all learned from SARS in 2002.
Animated figure showing how social distancing can “flatten the curve” to prevent overburdening of the healthcare system.
Social distancing lowers the rate of COVID-19 infections so that hospitals don’t get overwhelmed and start rationing care for all diseases.
One person transmits COVID-19 to 3 other people. Social distancing saves lives!
The degree of virus spread in the U.S. is unknown. Testing has not been widespread due to regulations at the federal level. These regulations have been changed and testing expected to rapidly become more widespread.
Animals and pets do not seem to become infected. It is unknown if they can transmit disease. See this FAQ from the American Veterinary Medical Association.
Figure showing common symptoms of COVID-19 compared to cold and flu symptoms
Check the CDC’s COVID-19 symptom checker. Most people will not have symptoms. The most common symptoms are fever, cough, and shortness of breath. Rarely diarrhea, stomach upset, and loss of smell can occur. It is hard to tell what’s COVID-19 versus some other cold or flu.
If you have symptoms, presume that you are sick and see below for a summary of the CDCs recommendations.
Practice social distancing (more in depth link) and prepare for an outbreak. Consumer Reports is a great resource.
If you have diabetes or problems with your lungs, heart, or blood pressure, you are at higher risk. See the CDC’s recommendations.
There is currently no preventative or therapeutic medication for COVID-19.
No change to outpatient blood pressure medications recommended.
Avoid NSAIDs like ibuprofen/Advil for symptoms and use acetaminophen/Tylenol instead.
Viral shedding after recovery from COVID-19 is not currently thought to be transmissible. Generally patients are thought to be unable to transmit virus 3 days after symptoms resolve or are improving. See “when to discontinue home isolation.”
Stress can show up in a variety of ways. See American Psychological Association recommendations to maintain sanity and good spirits during social distancing. This non-medical article is a great to-do list for establishing routines and activity suggestions. See therapist’s James Guay’s COVID-19 Survival guide.
If you are thinking of harming yourself, please contact the National Suicide Prevention Hotline at 1-800-273-TALK (8255).
How banks, lenders, and landlords will handle the COVID-19 cash crunch is rapidly evolving. See FDIC and SBA resources below.
Expect to stay in place for 3 months.
Create a 90 day financial plan:
It will be one of the finest hours of America, as the public healthcare system worked. Asian countries are ahead of the U.S. on COVID-19 because they learned from SARS in 2002. Because of COVID-19, we will be able to learn from this and apply to pandemics in the future.
Coronavirus disease 2019 (COVID-19) from Up To Date
CDCs guidelines on reusing masks
COVID-19 from Internet Book of Critical Care
A Seattle Intensivist’s One-Pager on COVID-19
Critical care medicine for the non-intensivist from SCCM.
UCSF Algorithms for COVID-19 management
U Washington Emergency Med COVID-19 Guide
COVID-19 Pages at top authorities: CDC, BMJ, Lancet, JAMA, Nature, NEJM, Science
Specialty Specific COVID-19 Sections: Am Assoc Fam Practice, Am Assoc Pediatrics, Am Acad Otol, Am Coll Surg
Social Media Resources: Facebook Critical Care COVID-19, Twitter #covid4mds, Reddit /medicine subreddit
Under construction:
Telemedicine resources: Otolaryngology
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