The US has about 924,100 hospital beds (2.8 per 1000 people). California has only 1.8. Countries like Germany have 8. South Korea has 12. (Their hospital system got overloaded nonetheless.) Most of these beds are in use, but we can create more, using improvisation (for instance using hotels and school gyms) and strategic resources of the military, national guard and other organizations.
Based on Chinese data, we can estimate that
about 20% of COVID-19 cases are severe and require hospitalization.
More important is the
number of ICU beds, which by some estimates can be stretched to
about a 100,000, and of which about 30,000 may be available.
About 5% of all COVID-19 cases need intensive care, and without it, all of them will die.
An important part of the equation are ventilators. Most of the critically ill COVID-19 cases die of an infection of the lungs that makes it impossible to breathe and even destroys so much tissue that the blood can no longer be sufficiently oxygenated. These patients need intubation and mechanical ventilation to give them a chance of survival, or even an ECMO machine, which oxygenates the blood directly.
About 6% of all cases need a ventilator, and if hospitals put all existing ventilators to use,
we have 160,000 of them. In addition, the CDC has a strategic stockpile of 8900 ventilators that can be deployed in hospitals that need them.
If we take the number of ventilators as a proximate limit on the medical resources, it means
we can take care of up to 170,000 critically ill patients at the same time.
Without containment, the virus becomes endemic, and leading epidemiologists like Marc Lipsitch (Harvard) and Christian Drosten (Charité Berlin) estimate that
between 40% and 70% of the population get infected until we develop some degree of herd immunity.
In a population like the US (327 million), that means between 130 million and 230 million. Let’s assume that 55% of the US population (the middle ground) get infected between March and December, and we are looking at 180 million people.
Of the 180 million, 80% will be regarded as “mild” cases...About 20% will develop a severe case and need medical support to survive...And about 6% may need intubation, because they can no longer breathe on their own.
The brown line near the bottom: that’s our limited supply of ventilators and intensive care beds! The red curve does not contain all cases of COVID-19, but only those 6% that will die if we cannot put them on a ventilator for something like four weeks.
This is how our normally distributed curve looks like when it contains 10.8 million patients, of which no more than 170,000 are ill at the same time:
Dampening the infection rate of COVID-19 to a level that is compatible with our medical system means that we would have to spread the epidemic over more than a decade!
But the point of my argument is not that we are doomed, or that 6% of our population has to die, but that we must understand that
containment is unavoidable, and should not be postponed, because later containment is going to be less effective and more expensive, and leads to additional deaths.
China has demonstrated to us that containment works: the complete lockdown of Wuhan did not lead to starvation or riots, and it has allowed the country to prevent the spread of large number of cases into other regions....Wuhan, the epicenter of the outbreak, now observes less than 10 cases per day.
For some reason, Western countries refused to learn the lesson. Italy thought they could get away with letting the virus spread, until their hospitals collapsed under the load, and older people or those with a history of cancer, organ transplants or diabetes were excluded from access to critical care. The US, UK and Germany are not yet at this point: they try to “flatten the curve” by implementing ineffective or half hearted measures that are only meant to slow down the spread of the disease, instead of containing it.
This means that some countries will stomp out the virus and others will not. In a few months from now, the world will turn into red zones and green zones, and almost all travel from red zones into green zones will come to a halt, until an effective treatment for COVID-19 is found.