Thread by @adapt_able

@cody84887998 @MackayIM Also worth noting the # of hospitalized/ICU cases. Was ~20% hospitalized (5% ICU) in China.

Even if 1/4 that, 5% hospitalized of 66 million is 3.3 million. We have 1 million hospital beds in US.

And high initial CFR in Wuhan was bc of lack of definive care.

@cody84887998 @MackayIM Biggest problem of COVID19 isn't what happens to people who get it in functioning medical systems (though that's bad enough). It's the fact that it will overwhelm healthcare system. We don't have enough respirators, ECMO machines, beds, doctors. Small fraction of capacity we need

@cody84887998 @MackayIM ...to generate best outcomes. That's why folks like @jonst0kes are recommending people prepare to shelter at home & take care of self as much as possible. Only way to reduce burden on HC system anywhere close to manageable level is dramatic social distancing/quarantines.

@cody84887998 @MackayIM @jonst0kes As Wuhan illustrates, outcomes from COVID-19 with no medical care are much, much worse, and CFR could be much worse than China if healthcare system overwhelmed. They rapidly built capacity- we might struggle to build capacity as quickly, particularly since we haven't started yet

@cody84887998 @MackayIM @jonst0kes We have ventilators in the Strategic National Stockpile (roughly 9,000), so we do have some flex capacity, but that's still relatively far from what we might need. I've seen ICU rates of 5-6% from cruise ship infected. That would be 3-4 million needing ICU if 20% infected.

@cody84887998 @MackayIM @jonst0kes Here's a study from 2017 looking at preparedness & the stockpile. They estimated 50% of ICU needed ventilation. Don't know rate for COVID. But that's 1-2 million ventilators.

wwwnc.cdc.gov/eid/article/23…

@cody84887998 @MackayIM @jonst0kes That study noted under a "severe" flu scenario, 9.9 million hospitalized & peak of 25% needing ICU for ave of 10 days each.

With COVID-19, could be similar to severe flu, but studies have found pts needed ventilation for about double that.

& that study found capacity was

@cody84887998 @MackayIM @jonst0kes *well* short of what would be needed for severe flu- about half of ventilators needed for Texas. Even if entire stockpile were used by Texas, would still be about 5% short. And there are 49 other states.

So yeah, this is bad. Tough to say exactly how bad, but bad.

@cody84887998 @MackayIM @jonst0kes (Note: just found CDC study saying roughly 50% of hospitalized required mechanical ventilation, so about same).