30
have reported this story, I have gotten an
increasingly sinking feeling about the “flatten
the curve” discourse for reasons that have to do
with the other variable in the table: the fatality
ra te per infection.
U.S. hospitals contain about 900,000 hospi-
tal beds, of which fewer than 100,000 are for
critical care. Of course, most of those beds are
already in use for people with other medical
problems—U.S. hospitals admit approximately
36 million patients annually. If 165 million
Americans ultimately contract the novel coro-
navirus, how much would we need to “flatten
the curve” to fit all those who need hospital care
into properly equipped beds to avoid a situation
like in Italy, where patients are being denied
treatment for lack of available resources?
Justin Lessler, an associate professor of epi-
demiology at the Johns Hopkins Bloomberg
School of Public Health, told me he believes
that flattening the curve will only work to
manage hospital capacity if the fatality rate
from covid-19 is on the low end of the range
of estimates. “I was discussing this with a col-
league, and I had been operating under the
idea that maybe the infection-fatality ratio
was around one in a thousand,” Lessler told
me. “And under that, things are very, very bad,
but you can envision a world where we spread
out the epidemic and slow it down and never
overrun our ICU capacity.
“My colleague was saying he thought the
evidence was closer to one percent. If that’s
the case, that’s ten times as many, and then it’s
hard to envision a scenario where health sys-
tems are not overrun. ”
Available critical-care capacity is not a totally
fixed figure. The Johns Hopkins Hospital, for
example, has the capability to provide critical
care in non-ICU areas. As feasible and medi-
cally appropriate, it will free up ICU space by
moving patients to standard floors. The hospi-
tal will delay elective surgeries, reducing
demand for the surgical ICU and allowing for
redirection of resources.
Still, there are limits, and the uncertain time-
line is also a problem: We don’t know how long
the epidemic will place additional strain on hos-
pitals or the extent to which that time could
outrun the sustainability of some of these mea-
sures. As Dr. Robert Scott Stephens, an ICU
physician at Johns Hopkins, noted to me, elec-
tive surgeries eventually cease to be elective.THIS PUBLIC-HEALTH CRISIS will also pro-
duce an economic crisis of some scale. The
stock market has fallen more than 20 percent
from its record highs in February. Disruptions
caused by ef forts to slow the spread of the virus
are having particular impacts on the transpor-
tation, hospitality, and energy sectors. UnitedAirlines announced Tuesday that net bookings
for domestic travel—new bookings minus
cancellations—had fallen by about 70 percent
in recent days. Net bookings to Europe and
Asia had fallen 100 percent, meaning as many
people were canceling trips as were booking
them, and that was before Wednesday, when
President Trump announced a policy restrict-
ing travel from most of Europe to the U.S. With
fewer people expecting to travel, demand for oil
has weakened and prices have fallen sharply. A
recession in the U.S. has gone from improbable
to very likely in a period of weeks.
As for what happens next to the economy,
I can’t tell you. As New York’s business colum-
nist, I have devoted a lot of time to thinking
and writing about the economic-policy
responses this crisis will require, but it wasn’t
until March 10 that I realized both I and the
economists I routinely check in with had
been making an error in thinking about
responses to the crisis: We’d been focusing on
the light- to medium-bad versions of how this
epidemic might go, without giving much
thought to the bottom-right corner of that
infernal table, in which this epidemic is worse
than any other we’ve seen in our lifetimes.
“The more I think about this, the more this
reminds me of post-9/11,” said Doug Holtz-
Eakin, a former top economic adviser to George
W. Bush and John McCain. “You had to respond
to the terrorist attack by attacking terrorism,
and so the analogy here is we have a public-
health mission that I continue to think is not
robust enough. I think they ought to be giving
the states a lot of money for test kits and ventila-
tors and beds and lodging and all sorts of stuff—
first responders’ protection. But you also then
have to essentially harden the economy against
the impact of the threat in the future, and in the
case of 9/11, that took years.” As with any crisis,
there is also overreaction among the popula-
tion. But on balance, there is still more under-
reaction. There is also the problem of delayed
reaction. Lessler, the Johns Hopkins University
epidemiologist, noted a way in which this epi-
demic tricks people into panicking when it’ s too
late. “If people are only going to start taking the
actions they should when they start to see a lot
of people dying around them, it’ s already too
late,” he says. When you combine the substan-
tial period from infection to death with an expo-
nential growth in infections, the number of
deaths you see around you is likely far lower
than the number of deaths you are about to see.
The people who stand to die within the next 30
days may not even be very sick yet. And when
they get very sick, the hospitals may be over-
whelmed and ill-prepared to respond. This is
the corner Italy backed itself into. We might be
headed there too. ■our greatest LGBT heroes sought
sexual pleasure in abundance, and that
slut shaming of any kind is effin’ stupid.
Unfortunately the arrival of the
Coronavirus is currently giving a lot of
members of our community flashbacks
to the early ’80s during the HIV/AIDS,
a time when sluttiness was villainized,
community sex spaces were forcibly
shut down by the city—something
we are still fighting against today—and
a slutty flight attendant was falsely
smeared as an evil Patient Zero who
spread HIV all over the world.
“It’s for this reason that I was initially
reluctant to cancel NYC Inferno next
week. The folks who run the Inferno
dungeon and I had many conversations
about not giving into fear and whether
or not giving guidelines for attendance
would be sufficient. Within 24 hours, my
view on this—resistant to canceling—
completely reversed itself, after I was
engaged in dialogue with a group of
gay virologists, scientists, and biologists
who are tracking the situation.”Mandy Moore sings to an
empty audience on Jimmy Fallon’s
The Tonight Show.NBC’s Lester Holt, introducing the
nightly news: “We’re moving
into uncharted territory, practically
by the hour.”FRIDAY, MARCH 13^
At least 154 confirmed cases.The New York Public Library
announces all branches will close.Louisiana delays the state’s
April 4 presidential primary election
until June.New York City’s teachers union calls
on the city to close public schools.
“We recommend that New York City
follow the example of affected
jurisdictions around the region, the
nation and even the world in closing
our public schools.”Conversation at a Manhattan
hair salon:
“What do you think?”
“So pretty! Too bad no one’s
gonna see it.”A Zoom video-conferencing invitation
sent from a Manhattan ad agency
to 47 co-workers:
subject: Virtual Happy Hour
Hey! Let’s get together for a virtual
hang at the end of the day. Bring
a favorite beverage and let’s
raise our glasses to getting through
a particularly weird week.Trump declares a national state
of emergency.reporting by irin carmon, brock colyar, chris crowley, charlotte klein, katy schneider,
matthew schneier, anna silman, chris smith, carl swanson, and james d. walsh.● ● ● ● ● ● ● ●
THE FIRST 13 DAYSTRANSMITTED
________ COPY ___ DD ___ AD ___ PD ___ EICTRANSMITTED0620FEA_Corona_lay [Print]_36899495.indd 30 3/13/20 9:55 PM30
havereportedthisstory,I havegottenan
increasinglysinkingfeelingaboutthe“flatten
thecurve”discourseforreasonsthat havetodo
withtheothervariableinthetable:thefatality
ra te perinfection.
U.S.hospitalscontainabout900,000hospi-
talbeds,ofwhichfewerthan100,000arefor
criticalcare.Ofcourse,mostofthosebedsare
alreadyinuseforpeoplewithothermedical
problems—U.S.hospitalsadmitapproximately
36 millionpatientsannually. If 165 million
Americansultimatelycontractthenovelcoro-
navirus,howmuchwouldweneedto“flatten
thecurve”tofit allthosewhoneedhospitalcare
intoproperlyequippedbedstoavoida situation
likeinItaly,wherepatientsarebeingdenied
treatmentforlackofavailableresources?
JustinLessler,anassociate professorofepi-
demiology at theJohnsHopkinsBloomberg
SchoolofPublicHealth,toldmehebelieves
thatflatteningthecurvewillonlyworkto
managehospitalcapacity if thefatalityrate
fromcovid-19is onthelowendoftherange
ofestimates.“I wasdiscussingthiswitha col-
league,andI hadbeenoperatingunderthe
ideathatmaybetheinfection-fatalityratio
wasaroundoneina thousand,”Lesslertold
me.“Andunderthat, thingsarevery, very bad,
butyoucanenvisiona worldwherewespread
outtheepidemicandslowit downandnever
overrunourICUcapacity.
“Mycolleaguewassayinghethoughtthe
evidencewasclosertoonepercent.Ifthat’s
thecase,that’s tentimesasmany, andthenit’s
hardtoenvisiona scenariowherehealthsys-
temsarenotoverrun.”
Availablecritical-carecapacity is nota totally
fixedfigure.TheJohnsHopkinsHospital,for
example,hasthecapability toprovidecritical
careinnon-ICUareas.Asfeasibleandmedi-
callyappropriate,it willfreeupICUspaceby
movingpatientstostandardfloors.Thehospi-
tal willdelay electivesurgeries,reducing
demandforthesurgicalICUandallowingfor
redirectionofresources.
Still,therearelimits,andtheuncertaintime-
lineis alsoa problem:Wedon’t knowhowlong
theepidemicwillplaceadditionalstrainonhos-
pitalsortheextenttowhichthat timecould
outrunthesustainability ofsomeofthesemea-
sures.AsDr. Robert Scott Stephens,anICU
physicianat JohnsHopkins,notedtome,elec-
tivesurgerieseventuallyceasetobeelective.
THISPUBLIC-HEALTHCRISISwillalsopro-
duceaneconomiccrisisofsomescale.The
stockmarkethasfallenmorethan 20 percent
fromitsrecordhighsinFebruary. Disruptions
causedbyef fortstoslowthespreadofthevirus
arehavingparticularimpacts onthetranspor-
tation,hospitality, andenergy sectors.United
AirlinesannouncedTuesday that net bookings
fordomestictravel—newbookingsminus
cancellations—hadfallenbyabout 70 percent
inrecentdays.NetbookingstoEuropeand
Asiahadfallen 100 percent,meaningasmany
peoplewerecancelingtripsaswerebooking
them,andthatwasbeforeWednesday,when
PresidentTrumpannounceda policy restrict-
ingtravelfrommost of EuropetotheU.S.With
fewerpeopleexpectingtotravel,demandforoil
hasweakenedandpriceshavefallensharply. A
recessionintheU.S.hasgonefromimprobable
toverylikelyina periodofweeks.
As forwhat happensnexttotheeconomy,
I can’t tellyou.AsNewYork’s businesscolum-
nist, I havedevoteda lotoftimetothinking
and writing about the economic-policy
responsesthiscrisiswillrequire,butit wasn’t
untilMarch 10 that I realizedbothI andthe
economistsI routinelycheckinwithhad
beenmakinganerrorinthinkingabout
responsestothecrisis:We’d beenfocusingon
thelight-tomedium-badversionsofhowthis
epidemicmightgo,withoutgivingmuch
thoughttothebottom-rightcornerofthat
infernaltable,inwhichthisepidemicis worse
thananyotherwe’veseeninourlifetimes.
“ThemoreI thinkaboutthis,themorethis
remindsmeofpost-9/11,” saidDougHoltz-
Eakin,a formertopeconomicadviserto George
W.BushandJohnMcCain.“Youhadto respond
totheterroristattackbyattackingterrorism,
andsotheanalogyhereis wehavea public-
healthmissionthatI continuetothinkis not
robustenough.I thinkthey oughttobegiving
thestatesa lotof money fortest kitsandventila-
torsandbedsandlodgingandallsortsof stuff—
firstresponders’protection.Butyoualsothen
havetoessentiallyhardentheeconomy against
theimpactof thethreat inthefuture,andinthe
caseof9/11,thattookyears.” As withany crisis,
thereis alsooverreactionamongthepopula-
tion.Butonbalance,thereis stillmoreunder-
reaction.Thereis alsotheproblemofdelayed
reaction.Lessler,theJohnsHopkinsUniversity
epidemiologist,noteda way inwhichthisepi-
demictrickspeopleintopanickingwhenit’ s too
late.“Ifpeopleareonlygoingtostarttakingthe
actionsthey shouldwhenthey starttoseea lot
ofpeopledyingaroundthem,it’ s alreadytoo
late,” hesays.Whenyoucombinethesubstan-
tialperiodfrominfectionto deathwithanexpo-
nentialgrowthininfections,thenumberof
deathsyouseearoundyouis likelyfarlower
thanthenumberof deathsyouareabouttosee.
Thepeoplewhostandtodiewithinthenext 30
daysmay notevenbevery sickyet. Andwhen
theygetvery sick,thehospitalsmay beover-
whelmedandill-preparedtorespond.Thisis
thecornerItalybackeditselfinto.We mightbe
headedtheretoo. ■reportingbyirincarmon,brock colyar, chris crowley, charlotte klein, katy schneider,
matthewschneier, anna silman, chris smith, carl swanson, and james d. walsh.THE FIRST 13 DAYS