Coronavirus - Flatten the curve

Is America headed down Italy's path ? Italy healthcare system is crashing !! 

This is an example of what the situation in Italy looks like. 
This is what we can do

Context

I published a post 1 week back(on March 1) claiming that California Coronavirus cases will go from 0->100 in a week(by March 8). I also published another post comparing this Coronavirus situation to a "Black Swan Event". Needless to say that it has happened. I am very sad that some of the predictions came true because this involves some ones wife/husband/son/daughter that fell sick. I am super sad and more worried about the one that did not.

Recap :

1. 100 cases in california - True (currently 105)
2. Clusters of infected areas evolve - True (King County in Seattle, Santa Clara in bay area, NYC are all clusters)
3. Some town in the west coast gets quarantined - False

What is the goal of this post? 

I can make further predictions from hereon

1. Santa Clara county in Bay area alone will have 100 cases by next week given it has 25 now
2. UK will cross 500 cases by next week given it has 200 cases at the time of this writing
3. NYC will have 400 cases by next week
4. Washington will have 500 cases by next week
5. California will have 400 cases by next week

I hope you all understood what exponential growth looks like. 

This post is not about further predictions that went right. It is about the prediction that did not go right - some town in the west coast gets quarantined. Why did I get it wrong and what should be our way at preventing this catastrophe. But before we get there, lets see how this week went and some disclaimers.

What is explicitly not the goal of this post?

The goal is not to create panic. I strongly believe that when it comes to public health, honesty is better than hope. 

Disclaimers

Like I wrote in my last post, these are not my employers views. I am no expert in biology or rather in anything. I think nobody knows what is going on right now. I know a thing or two about startups and have seen some hockey stick curves in the past. That said, there are lot of false news on the internet. Use your judgement. Don't use this post or anything on my blog for any material decision in your life before doing your due diligence. 

How did the week go and what did I learn ? 

On March 1, I claimed in my blog that Coronavirus is growing exponentially with a CFR(Case Fatality of 3.4%)  and I urged people to take this seriously and WFH,not take trains, avoid public gatherings, etc to protect themselves, their families and their community. This blog has been widely shared after that and lot of the readers have taken some of this to heart. I am overwhelmed by your response. This post is for those people. This is for those who fought back when some one said "this is just a flu", "only the old or people with underlying conditions are dying".

Learnings and worries

1. At the time of that writing, I was not completely aware how ill-prepared the CDC was and that they were testing 100 people per day. UWash has come up with new testing kits in the mean time which are testing samples at ~7% on average. But we are still far from full testing capacity across the US. This is the biggest point of concern.  In last 10 days Italy diagnosed 95% of total cases they now report; South Korea 85%. 2 weeks ago, Italy had just 9 cases. 7 weeks ago, China reported 50 cases. The point: once the epidemics are discovered, they’ve been underway. I fear we will find a lot more cases in the US in the coming week, hoping that we raise our game in testing. I just hope that the US learns and can turn this graph around. 
2. Past recessions have looked like Financial Loss -> Job Loss -> Depression -> Health Loss. This time, it may be different. It may look like Health Loss due to coronavirus -> Depression -> Job Loss -> Healthcare loss -> Financial Loss. Basically, things may happen in the reverse order. Given American's have no sick leaves and a lot of them are underinsured or dependent on their job for insurance, they are the most vulnerable. 
3. If you had a hard time understanding what exponential growth looks like from my post, here is a much more explicit breakdown. The calculations may be off by days or weeks, but hope you get the point about why this discussion is so important for public health.
4. India is right in the early phases of the spread and it is home to more than a billion people. I am very worried at this stage about how things will pan out in the next 2 weeks. I hope to be wrong, but if India also reaches 100 cases by next week, things could get really bad. 

Recommendations

1. As you may have heard Italy is about to quarantine 10 million people in Lombardy. At this point our goal should be to reduce the total number of cases at the peak of the epidemic. Besides quarantine, there are several measures : reduce public transport, cancel public events, stop non-essential travel, stop gyms, move schools to online classes being some. Here are the CDC guidelines on preventing community spread. 
2. Our healthcare system is going through a denial of service (DOS) attack. This is what delaying/reducing it may look like from the economist
3. 
4. This is the first epidemic that the world is facing in the time of social media. Some social/medical/mental health implications beyond the disease from Ground Zero in China .

A chart from how the situation in italy looks like

Some other readings 

1. Why soap works well against viruses ?

Hope

1. The fact that some of the companies have declared WFH, lot of the companies have cancelled conferences are a positive step towards reducing that R0 and reducing that spread. We need to aggressively quarantine cities and reduce that R0 and reduce the load on the healthcare system to mitigate the disease. I dont want to introduce complacency in this post, this is as bad as it gets.
2. I hope some of the secondary predictions I make here in the post are actually wrong and the government can mitigate using some of the strategies mentioned here.