The US has had a two month head start on the Chinese to prepare for COVID-19 caused by the new Coronavirus, but it is poorly prepared at this moment.  Ever since the Chinese government warned the world about the new virus and published its genetic code in early January (1/11), the world knew something big was coming that could severely test the healthcare and economic systems of countries worldwide.  The US has chosen to downplay the threat and now that it is on US soil, the US is not well prepared.

It did do one thing right at the beginning on February 2nd, imposing a travel ban on foreign nationals who had traveled through China recently, and requiring 14-day quarantines for returning American citizens.   In the interim it should have build up a robust testing, tracking, and quarantine system to accommodate future patients.  It should have gotten additional funding to make sure that the 70 million or so under-insured Americans are covered to meet this crisis.  Without this safety net there will be big incentives for citizens to avoid testing.  Finally, it should have put into place a set of policies to deal with an epidemic that might require the kind of draconian quarantine set up by the Chinese for Wuhan but that few Americans would accept voluntarily.  Now we see the CDC is not prepared to test the number of potential patients that have hit our shores.  Having lost precious days and weeks, hopefully the government will be able to recover to meet this historic challenge.

In the meantime this is how the number of infections in the US has grown over the last 2 months.  From the first positively identified case on Jan 21st, it stayed below 15 until Feb 16th, grew slowly (including 49 repatriated cases from Wuhan and Diamond Princess) until Mar 1st when wider availability of test kits from the CDC exploded the number of confirmed cases nearly exponentially.

Feb 1st marked the death of the first American due to COVID-19.  Since then the number of deaths has grown to 22 (on 3/8).  The apparent fatality rate in the US appears to be 4% (=22/538) as of March 8th, but the real rate could be as high as 10% or as low as 1%.  To find the fatality rate one has to adjust the apparent rate lower due to under testing of the real population of infected patients in the US that could be as high as 2,200 (on 3/8) or 220 (on 3/2).  Dividing the number of deaths (22) by 2200 yield 1%, while dividing 22 by 220 yield 10%.  The real number of infections 6 days prior makes more sense to use as a denominator than the coincident case number because COVID-19 appears to take up to 14 days to resolve itself after diagnosis.   Another way to estimate the real fatality rate is to compare deaths to total number of resolved cases which on Mar 8th amounted to 30 (=22+8 recovered).  We believe this percentage, ~70%, is unusually high currently due to CDC’s prior policy to limit testing to very serious cases – sometimes after the patient has already died.

No matter how you slice this, it is clear that the COVID-19 situation is very serious and requires a very serious, immediate, coordinated response by the government to prevent huge numbers of unnecessary deaths in the US.