COVID-19: Brace For Impact

Thursday, March 12

This post was written by Tornus (who has no professional qualifications but has an extensive amateur interest in epidemiology) and Dr Smartypants, who is a physician and infectious disease epidemiologist with extensive experience working at the CDC and public health departments. We have endeavored to provide accurate, concise, and actionable information here. However, the best source of information about COVID is the official CDC page. You should trust the CDC more than us (or anyone else).


Since our last writing, the situation has deteriorated much faster than we anticipated. This is clearly going to be the worst global pandemic since the 1918 flu and people you know will probably die.

We want you to understand two things:

  1. COVID-19 is going to be devastating
  2. We can substantially reduce the damage through immediate and decisive social distancing

Please act now. If we wait until things get bad, it will be far too late

What does a pandemic look like?

This is what’s happening in the Lombardy region of Italy:

“We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.

Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.”

Let us translate the medical jargon: he’s saying that if you’re over 65, intensive care is too overloaded to treat you. ICU staff won’t assess you, they won’t intubate you, and when your heart stops beating they won’t respond.

That isn’t the worst-case scenario. That’s what has already happened, in the early phase of the epidemic. The known infection rate in Lombardy is now 0.06%, but it will probably rise to at least 10% and maybe as high as 70%. The overload could easily get 100 times worse.

What about the US?

Italy is a couple of weeks ahead of the US on the infection curve, but there is no reason to think our experience will be any different.

On March 10, Tom Frieden (who used to run the CDC) wrote a piece about COVID-19 titled Could Coronavirus Kill a Million Americans? Spoiler: the answer is yes, although if you read the article, you’ll see that his plausible worst-case calculation is actually 1.6 million US deaths.

The storm is coming and we have a very short amount of time to prepare for what’s coming. There are things you can do that will make a tremendous difference, and it’s critically important that you start doing them now. We’ll talk about that in our next piece.

Further reading

Coronavirus Disease 2019 (COVID-19)
The CDC’s excellent information hub for COVID-19.

Jason Van Schoor: report from a Lombardy physician
“My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV. PLEASE STOP, READ THIS AGAIN AND THINK.”

Silvia Stringhini: report from another Lombardy physician
“Cases are multiplying, we arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing.”

Think Global Health: Could Coronavirus Kill a Million Americans?
Written by the former head of the CDC, this piece calculates a plausible worst case scenario of 1.6 million American deaths.

Coronavirus (COVID-19) cases in Italy as of March 10, 2020, by region
A breakdown of COVID-19 statistics in Italy.

Full Circle Kink on COVID-19

We wrote some earlier pieces about COVID-19:
COVID-19: What to Expect
COVID-19: General Advice
COVID-19: Specific Advice