Coronavirus in the bay area

Context : At the time of writing March 1(Sunday) , there were 3 cases in Bay Area and 5-7 in Washington.

Prediction by March 8(next Sunday), we will have

1. 100 cases in california
2. Clusters of infected areas evolve 
3. Some town in the west coast gets quarantined

Outcome(Edited on March 7, Saturday)

This is what we can do to flatten the curve

Disclaimer : I am no bio expert. These are learnings I accumulated from reading blogs. Please use your own judgement. Not everything you read on the internet is true. I am just posting the summary of my learnings here and some predictions drawn from that. 

Why am I posting this ?

Lots of friends are asking me whether to work from home and whether they should get supplies stocked up or not. I see a bunch of people clueless about the situation and lot of panic. Also people are not sure whether they should use bart/caltrain/public transport. Wanted to share some of the research that I did over the weekend.

Summary of my learnings and some numbers

Disease -> Spread -> Metrics -> Virality -> Infrastructure hotspots

1. Coronavirus may have spread in the seattle area for weeks as gene sequencing results suggest
2. The virus has a 14 day incubation period
3. The test in the hospital takes 2-3 days 
4. This results in a delay in detection of around ~15 days
5. Thus there are way more people around affected than we know
6. Detection of peak will be delayed after the actual peak
7. As we see from italy, the government will have no way other than quarantine a whole city by the time they detect a cluster where the virus is spreading
8. The disease has a CFR(Case Fatality Rate) of ~2.3%, that means that 23 out of 1000 people affected will die
9. The disease has a R0 of ~2.5, that means that 10 affected people will spread it to 25 people. R0 is a measure of how infectious a disease is and is heavily used for planning strategies to mitigate the spread(R0 calculation is an ongoing task here and it lies between 2 and 3.5). This is what makes it an exponential rate of increase
10. A very good read to learn more about R0 and CFR and to put things into perspective, and how different diseases(measles, flu, rabies) compare against each other on these two dimensions
11. Inspite of the low CFR, this disease is a strain on the medical infrastructure due to clustering around particular locations. 
12. California has 1.8 hospital beds per 1000 people
13. As you can see, that given the CFR, if the disease spreads, we will only be able to care for the critically ill patients only. This is also something that has been observed in the past in other countries. Non-critical patients have been asked to stay home
14. Couple of factors that could test USA: lack of paid sick leave and some people not having healthcare. The high population density in the bay area may expedite things too
15. This will effectively create a Denial of Service(DOS) attack on our healthcare system
16. This could very well put the world into a global recession where rate cuts may not really help
17. Summer is still 1 month away. 

What steps can we take as individuals to prevent/protect themselves

1. Please watch the government video : https://www.youtube.com/watch?v=nnz95Ssgt3k

References

1. Cryptic transmission of novel coronavirus revealed by genomic epidemology by Trevor Bedford
2. Why am I concerned about the coronavirus : applying a viral growth data metric to a viral crisis by Ed Baker - ex Uber and ex Facebook.
3. How to decide when to take precautionary action on coronavirus - an analytical model by Adam Gries
4. Coronavirus dashboard
5. Bill Gates blog post on how to respond to coronavirus now and to epidemics in the future
6. The virus is coming - In public health honesty is worth a lot more than hope - The Economist
7. Harvard FAQ

Update 

1. At Mar 2, 2.30pm PST 16 people are affected across the state of california - 6 people die in Washington
2. Mar 2, 5.20pm PST - 100 cases of coronavirus in the US
3. Mar 3, 10.30am PST, 24 people are affected in california
4. Mar 3, 11.45am, Seattle times has taken down their paywall https://www.seattletimes.com/seattle-news/health/coronavirus-kirkland-seattle-updates-tuesday/
5. Mar 3, 11.45 am New cases in washington looks like doubling every 6 days
6. Mar 3, 2.20pm - 45 cases in california
7. 
8. March 4, 11.28am 58 cases in california, 1 person sadly dies
9. 
10. Mar 5, 10.45pm update : Coronavirus - Black Swan of 2020
11. Leaked presentation in hospitals show that they are prepared for millions of hospitalizations
12. 
13. March 7, 3.09pm, 104 cases in California. The predictions came out true. 
14. 
15. If you have read till here, this twitter thread breaks down what exponential growth looks like. 
16. Please stay healthy and stay safe for yourself, your family and your community. 

1. Must watch video from NYC ER doctor - author of superbugs, race to stop an epidemic