The corona virus, COVID-19 is already a lot worse than SARS, and it’s likely to get even worse. As of today, there are 78,993 known cases and 2,444 deaths. By comparison, from the first appearance of SARS about December 1 2002, there have been a total of 8439 cases and 813 deaths. It seems the first COVID-19 patient was also about December 1, but the COVID-19 infection moved much faster. Both are viral infections, but it seems the COVID virus is infectious for more days, including days when the patient is asymptomatic. Quarantine is being used to stop COVID-19; it was successful with SARS. As shown below, by July 2003 SARS had stopped, essentially. I don’t think COVID-19 will stop so easily.

We see that COVID-19 started in November, like SARS, but we already have 10 times more cases than the SARS total, and 150 times more than we had at this time during the SARS epidemic. If the disease stops in July, as with SARS, we should expect to see about a total of 150 times the current number of cases: about 12 million cases by July 2020. Assuming a death rate of 2.5%, that suggests 1/4 million dead. This is a best case scenario, and it’s not good. It’s about as bad as the Hong Kong flu pandemic of 1968-69, a pandemic that killed 60,000 approximately in the US, and which remains with us, somewhat today. By the summer of 69, the spreading rate R° (R-naught) fell below 1 for and the disease began to die out, a process I discussed previously regarding measles and the atom bomb, but the disease re-emerged, less infectious the next winter and the next. A good quarantine is essential to make this best option happen, but I don’t believe the Chinese have a good-enough quarantine.

Several things suggest that the Chinese will not be able to stop this disease, and thus that the spread of COVID-19 will be worse than that of the HK flu and much worse than SARS. For one, both those disease centered in Hong Kong, a free, modern country, with resources to spend, and a willingness to trust its citizens. In fighting SARS, HK passed out germ masks — as many as anyone needed, and posted maps of infection showing places where you can go safely and where you should only go with caution. China is a closed, autocratic country, and it has not treated quarantine this way. Little information is available, and there are not enough masks. The few good masks in China go to the police. Health workers are dying. China has rounded up anyone who talks about the disease, or who they think may have the disease. These infected people are locked up with the uninfected in giant dorms, see below. In rooms like this, most of the uninfected will become infected. And, since the disease is deadly, many people try to hide their exposure to avoid being rounded up. In over 80% of COVID cases the symptoms are mild, and somewhat over 1% are asymptomatic, so a lot of people will be able to hide. The more people do this, the poorer the chance that the quarantine will work. Given this, I believe that over 10% of Hubei province is already infected, some 1.5 million people, not the 79,000 that China reports.

Also making me think that quarantine will not work as well here as with SARS, there is a big difference in R°, the transmission rate. SARS infected some 2000 people over the first 120 days, Dec. 1 to April 1. Assuming a typical infection time of 15 days, that’s 8 cycles. We calculate R° for this stage as the 8th root of 2000, 8√2000 = 2.58. This is, more or less the number in the literature, and it is not that far above 1. To be successful, the SARS quarantine had to reduce the person’s contacts by a factor of 3. With COVID-19, it’s clear that the transmission rate is higher. Assuming the first case was December 1, we see that there were 73,437 cases in only 80. R° is calculated as the 5 1/3 root of 73,437. Based on this, R° = 8.17. It will take a far higher level of quarantine to decrease R° below 1. The only good news here is that COVID-19 appears to be less deadly than SARS. Based on Chinese numbers the death rate appears to be about 2000/73,437, or about 3%, varying with age (see table), but these numbers are overly high. I believe there are a lot more cases. Meanwhile the death rate for SARS was over 9%. For most people infected with COVID-19, the symptoms are mild, like a cold; for another 18% it’s like the flu. A better estimate for the death rate of COVID-19 is 0.5-1%, less deadly than the Spanish flu of 1918. The death rate on the Diamond Princess was 3/600 = 0.5%, with 24% infected.

Backing up my value of R°, consider the case of the first Briton to contact the disease. As reported by CNN, he got it at conference in Singapore in late January. He left the conference, asymptomatic on January 24, and spent the next 4 days at a French ski resort where he infected one person, a child. On January 28, he flew to England where he infected 8 more before checking himself into a hospital with mild symptoms. That’s nine people infected over 3 weeks. We can expect that schools, factories, and prisons will be even more hospitable to transmission since everyone sits together and eats together. As a worst case extrapolation, assume that 20% of the world population gets this disease. That’s 1.5 billion people including 70 million Americans. A 1% death rate suggests we’ll see 700,000 US deaths, and 15 million world-wide this year. That’s almost as bad as the Spanish flu of 1918. I don’t think things will be that bad, but it might be. The again, it could be worse.

If COVID-19 follows the 1918 flu model, the disease will go into semi-remission in the summer, and will re-emerge in the fall to kill another few hundred thousand Americans in the next fall and winter, and the next after that. Woodrow Wilson got the Spanish Flu in the fall of 1918, after it had passed through much of the US, and it nearly killed him. COVID-19 could continue to rampage every year until a sufficient fraction of the population is immune or a vaccine is developed. In this scenario, quarantine will have no long-term effect. My sense is that quarantine and vaccine will work enough in the US to reduce the effect of COVID-19 to that of the Hong Kong flu (1968), so that the death rate will be only 0.1 – 0.2%. In this scenario, the one I think most likely, the US will experience some 100,000 deaths, that is 0.15% of 20% of the population, mostly among the elderly. Without good quarantine or vaccines, China will lose at least 1% of 20% = about 3 million people. In terms of economics, I expect a slowdown in the US and a major problem in China, North Korea, and related closed societies.

Robert Buxbaum, February 18, 2020. (Updated, Feb. 23, I raised the US death totals, and lowered the totals for China).