By now you’ve all seen the report that the US has surpassed the rest of the world in numbers of COVID-19 cases. That’s pretty scary. It demands our attention and a plan of action to stop the spread.

It also needs a denominator.

Remember population size. Of the top 10 countries for numbers of cases, only China has more people. We have almost 4x the number of people in the next most populous countries. As of today, in the US, our infection rate is 252 cases per million people. Italy has 1332 cases per million people.

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Source: JHU

We’re testing more, we’re going to get more cases. We want more tests. But be prepared to see that huge spike in our curve. Don’t let it scare you.

As of March 26, 12.5% of the US cases have required hospitalization. That means 87.5% have not. It’s not clear how mild the illness has been for these 87.5%, but we know they’re not sick enough to go to hospital.

And this is where we stop the spread. If we isolate those positives — people with mild illness or no symptoms, they’re not able to pass it on. Mostly, we tell these individuals to “go home and isolate.” What happens if home includes high risk individuals? We risk spreading the disease to a vulnerable population. We need options for these individuals to stay while they’re in “isolation” — away from contact with high risk household members.

That means being prepared to set up dorms or hotels with sufficient nursing care to monitor for symptoms. That requires investment and resources, but could mean the difference between crashing our hospital system and keeping it viable.

For those who may not have high risk household members, we need to discuss how to organize their home environment to minimize contact with other household members. Is there a room with a bathroom they can use for the duration? Maybe a room with an outside entrance? That’s a tall order for many households, but at the very least we all need to have a plan in place to isolate a positive household member.

Otherwise, we risk a huge jump in case-fatality. And we know what that means: devastation for our hospitals.

As of today, the U.S. has a case-fatality rate of 1.44%. Way too high for me, but nowhere near Italy’s 10.2%.

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We could approach that if we end up with a surge on hospital systems. This is why isolating positive cases who are not severely ill is essential. Identifying potential cases means they can’t spread COVID-19 to others.

Testing, tracing, isolation. Let’s be like Germany.

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