Why we must maintain extreme social distancing
We’re staring down the barrel of an overwhelmed health care system
Here’s what we know about COVID-19: About one out of every five adults who becomes infected will get really sick. The older the person, the higher their chances of being hospitalized or dying. But young people are not in the clear. A recent study of more than 2,400 people with COVID-19 in the U.S. showed that people ages 20-54 ended up in the hospital 14-28% of the time.
This means that, if you’re between the ages of 20 and 54, you have between a 1-in-7 and 1-in-3.5 chance of being hospitalized if you get COVID-19. Not great odds.
Data from several other countries suggest that about 30% of people with COVID-19 who need to be hospitalized will also need critical care, and those people will likely be in a hospital bed for at least two weeks.
Here’s what else we know: We have a finite number of critical care hospital beds in the United States.
Of course we don’t want anyone to get sick with COVID-19, but what we really want to avoid is a) people getting hospitalized with COVID-19, b) people dying from COVID-19, c) not having enough hospital beds for everyone who needs one, and d) people dying because we didn’t have enough hospital beds for everyone who needed one.
To figure out exactly what we need to do to avoid these scenarios, researchers with the COVID-19 Response Team at the Imperial College London used data from COVID-19 cases in China and other countries, along with census and other data from the U.S. and Great Britain, to examine a variety of different approaches, alone and in combination, to stop COVID-19 spread, including:
- Case isolation: keeping individuals with COVID-19 at home for 7 days
- Voluntary home quarantine: all household members of individuals with COVID-19 stay home for 14 days
- Social distancing of those age 70+
- Social distancing of entire population
- Closure of schools and universities
First, the researchers explored what it would take to slow down the epidemic. Not try to stop it, just minimize its impact. Of the strategies they explored, the one that most slowed the epidemic required isolating individuals with COVID-19 for 7 days AND quarantining their household members for 14 days AND imposing social distancing for people older than 70 – all for three months. This is the approach advocated by David Katz in a March 20 New York Times op-ed, of “preferentially protecting the medically frail and those over age 60, and in particular those over 70 and 80, from exposure.”
But the Imperial College COVID-19 Response Team’s results indicated that such an approach would, “result in an 8-fold higher peak demand on critical care beds over and above the available surge capacity in…the U.S.”
This means that, if we try to slow down this epidemic for three months by isolating only the sick, their household members, and people over 70, we would still end up with eight sick people for every one available critical care hospital bed. No good.
Overwhelming our health care system means that health care providers would have to choose who would live and who would die, not because the sick were beyond reach of medical help, but because we didn’t have enough critical care hospital beds (with all the required equipment, supplies, and personnel) to save them.
By the way, in my field of global health, we call those kinds of deaths “stupid deaths.” (Paul Farmer, a leading global health physician, often uses this Haitian phrase). Most stupid deaths happen in poorer countries, where there just aren’t enough resources to provide health care to people who, in wealthier countries, could otherwise have survived.
It’s shocking that we are talking about the possibility of “stupid deaths” from COVID-19 in the United States.
But we do have an option. One option. In the same paper that demonstrated the impossibility of effectively slowing down the COVID-19 epidemic in the United States without overwhelming the health care system, the authors explored a different approach: stopping the epidemic altogether. They found that, if we isolate people who are sick with COVID-19 AND practice social distancing of the entire population AND household quarantine AND close schools and universities for FIVE MONTHS, we can keep case numbers low enough that there should be enough critical care hospital beds for everyone who needs one.
These robust findings, done using real data from the COVID-19 outbreak in China and other countries, means that we should all plan to be at home, out of school, working remotely, staying away from others (at least six feet) for months. Not for two weeks. Not until Easter. Months.
Otherwise, we’re staring down the barrel of an overwhelmed health care system and lots of stupid deaths, right here in the United States, one of the wealthiest nations in the world.
I’m no economist, but I know that the federal government can intervene to stimulate the economy and help people who need and deserve financial support in this extremely challenging time. But governments can’t bring back the dead.
If federal officials call to relax the social distancing measures that have been put in place by states and localities, knowing what they know now, then that will be an eyes-wide-open choice to stand back and watch people die preventable “stupid deaths.” Such a decision, a politically-motivated decision ignoring clear evidence, would generate costs and long-term damage in the form of lost American lives that no economic stimulus package or corporate bailout or campaign rally can replace.
Kristina Talbert-Slagle, PhD is Assistant Professor, General Internal Medicine at Yale University School of Medicine; Director of the Yale College Global Health Studies Program; and Associate Director, Yale Institute for Global Health.
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