You didn’t resign, Dr. Fauci. Here’s Plan B.

Dr. Fauci (although I’d prefer to call you Saint Anthony, if that’s OK), you once again didn’t follow my advice to resign yesterday. To be fair, I said you should do that because Trump was about to fire you, whereas yesterday Trump stated flatly that he wasn’t going to fire you.

So far, so good. But you didn’t let it stand like that. You felt compelled (perhaps were compelled is better wording – it really doesn’t matter at this point) to take back what you had said on Sunday that got Trump and his far right friends so mad – that (to quote ABC News) the administration "could have saved lives" had firm social distancing guidelines been enforced earlier, but there was "pushback about shutting things down." Of course, the truth of what you said on Sunday was no more deniable than a statement that the sun might not rise tomorrow, but you managed to deny it anyway! So once again, you’ve given Trump a clean bill of health for all of the mistakes (a few due to malevolence, but most due to pure incompetence, which has been the one unifying trait of his administration from the start of his presidency) he’s made so far during the crisis.

At this point, my big concern isn’t assigning blame for the mess we’re in – there’s plenty of time later to do that. But I am concerned about finally putting a stop to the daily “mistakes” in the White House that are making things worse. And the biggest of these is that Trump continues to believe he’ll be able to open up the economy very soon, even if the governors don’t want to do that (and the majority of them don’t. But there are a few who wouldn’t object at all, like the wacky governor of South Dakota. She refuses to lock down her state, but instead intends to “do something” about the coronavirus by instituting a statewide test of hydroxychloroquine, the miracle drug Trump has been touting as the cure for Covid-19. She’s doing this even though a test of choloquine – closely related to it – on 89 Covid-19 patients in Brazil was halted because a number of them developed irregular heart rhythms and 11 of them died by the sixth day of their treatment. I’m sure the people of South Dakota will be very pleased to sacrifice one eighth of their number to help prove their governor’s loyalty to Trump).

Of course, Trump won’t be able to open the country up. The Constitution clearly gives these powers to the states, and as late as Sunday, Trump was saying the governors were responsible for the coronavirus response in their own states. Clearly he wouldn’t have any leg to stand on if he even tried to do this. Even the current Supreme Court majority will without a doubt confirm that, if it even comes to them to decide (which it won’t).

But here’s another reason why Trump won’t be able to “open up” the economy whenever he wants: Even in states where the governor hasn’t implemented a near-total lockdown, the people are locking themselves down! They’re not going to malls, restaurants, movie theaters (if any of those are still open in the US today. Probably not), etc. And businesses are trying to have their employees work from home as much as possible. People and businesses in these states have decided that their own lives are perhaps more important than trying to make Trump look good, so that he can continue to assert that life can go on as normal in the face of an existential threat. It can’t. Period.

Yet Trump is wasting valuable time on pushing for a reopening, when the tasks he should be accomplishing are being neglected:

1. Testing is still woefully short of what is required to begin to restart the economy. I read yesterday that people – who are clearly sick with the virus – are getting in line in the middle of the night for “drive through” testing in New Jersey, on the hope they’ll be tested the next day before the supplies run out (which they do every day). Testing kits are more available now, but they rely on supplies that aren’t readily available at all. Had there been…you know…planning in February and March, when it became clear that the coronavirus was here and spreading quickly, the government could have figured out other sources for these supplies (the reagents and the prepared cotton swabs), and if there were none readily available, used the Defense Production Act to compel them to be produced. Until everyone in the US can be tested say at least once a week if they want to (since companies will need to do that for everybody who comes in to work, if for no other reason than to protect themselves against lawsuits if people die), the economy can never be opened up.
2. There needs to be a whole industry for contract tracing set up, since for every person who tests positive, all of their recent close contacts need to be identified and quarantined. In Wuhan alone, the Chinese deployed 1,800 teams of five people to trace contacts. Given the much larger scope of our problem, we probably need 500,000 or more people just doing contract tracing. This would be a great way to create work for people who are laid off. Are we doing anything about this now? If so, I haven’t heard of it. But again, there’s no way we can possibly open up the economy until the workforce for contract tracing is trained and in place.
3. As everyone knows, our ultimate salvation will be a vaccine. And as everyone except Trump knows, this will probably take 18 months to be developed and tested. But even when that happens, it’s going to need to be manufactured in enough quantity that literally every person in the US will receive it. That’s going to take a lot of factory capacity, and since no drug company builds a manufacturing facility just on the off chance that it might be needed some day, the government will have to either place firm orders for certain factories to be ready to produce the vaccine when it’s approved, or they will need to arrange for new ones to be built. Is any of this going on now? If it isn’t and that’s not corrected soon, we’ll be in the same position for the vaccine as we are for the virus itself – scrambling around to put in place facilities that we should have (and other countries did) put in place as soon as the gravity of the situation became clear a couple months ago.

There are more things he should be doing, of course. But the point is that Trump is wasting time on planning something that will never happen until he does the stuff he’s not currently doing. This would be comical were it not that the American people will pay a huge toll in deaths for every day that Trump delays doing these things.

And what is that daily toll? My “set in stone” numbers are a projection of total US deaths over the course of the pandemic, based on the day’s total reported cases. They’re based on the idea that a total lockdown will be put in place as of the day the calculation is made (you can read the full set of assumptions below). Obviously, no total lockdown will be put in place anytime soon, so these numbers are a projection of minimum deaths over the course of the pandemic.

As shown below, the set in stone number for today is 179,000. The same number for tomorrow is 9,000 higher, and of course the difference itself keeps growing day by day (remember, exponential growth). But let’s use the 9,000 figure. This is the minimum number of additional deaths, over the course of the pandemic, that are caused each day that Trump delays doing the right thing. So the cost of a one-week delay? 63,000 deaths at a minimum.

And this is the real problem, Dr. Fauci. By giving Trump cover not to do what needs to be done, and to waste his time advocating and planning for something that will never be done as he intends, you are costing the US 9,000 deaths each day.

But I’m not even advocating you resign, Dr. Fauci. Just go back to your National Institute of Allergy and Infectious Diseases, and make sure all of the workers there are properly protected. Don’t make any more statements of any kind, and don’t even visit president Trump anymore. You have a great excuse for this – social distancing!

Now, the Numbers:

All numbers below are based on yesterday’s reported figures of total confirmed cases, total deaths and total recoveries, published on Worldometers.info. I’m happy to send my spreadsheet that calculates all of these to anyone who wants to check the calculations, although they follow the assumptions described below.

Note on April 14: This is the first day that I’ve used my new estimate of the case mortality rate: 7%, vs. the 4% estimate I was using. I did this as a result of a little spreadsheet “experiment” I did on Sunday, which seemed to show that 7% was a much better estimate. But if you think that’s too high, I’ll just point you to the actual case mortality rate we have so far (discussed at the end of this post): It’s 39% as of today. So if you think 7% is unrealistic (and it probably is), then it would be best to go with 39%. That will require multiplying all of my “set in stone” estimates of deaths (not the other death projections) by 5 ½ times! I hope that makes you feel better.

Date on which the number of new deaths on that day will probably exceed the toll of Sept. 11: April 20

Actual number of deaths during week ending April 11 (Saturday): 12,126

Projected* number of deaths during week ending April 18 (Saturday): 14,541 (i.e. >2,000 per day)

Projected* number of deaths during week ending April 25 (Saturday): 24,503 (i.e. >3,000 per day)

Projected* number of deaths during week ending May 2 (Saturday): 44,218 (i.e. >6,000 per day)

Projected* number of deaths during month of April: 83,440

Number of new deaths on May 1 alone: 6,118  

* Projected deaths for each day equals the previous day’s deaths, grown by yesterday’s 3-day percentage growth rate in new deaths, which as of today is 39%. The weekly number is the sum of the projected deaths for the 7-day period. Note that my estimated case mortality rate doesn’t affect these projections at all.

I. Numbers based on total cases, actual and projected

Total US confirmed cases: 587,173

Increase in cases since previous day: 26,740 (vs. 29,938 increase two days ago)

Percent increase in cases since yesterday: 5% (vs. 7% two days ago)

Percent increase in cases since 3 days previous: 17% (vs. 23% two days ago)

“Set in stone” US deaths* over course of pandemic:  179,381 (based on 7% case mortality rate)

*This number assumes a) Reported cases are a fairly accurate estimate of total cases; b) Total cases grow by 17% into the future (= yesterday’s 3-day growth rate in cases); c) We impose a massive lockdown, with prohibition of all non-essential travel, today; d) New cases drop to zero in 28 days, because of the lockdown, but they continue to grow at the current projected rate up to the 28^th day; e) testing and contract tracing are widely available by the 28-day mark; and f) the case mortality rate = 7%.

Projected as of April 21 (7 days from today):

These numbers answer the question: What would happen if we wait seven days to totally lock down the US, based on the assumptions below (which frankly are themselves wildly optimistic).

Total expected cases*: 897,597 (vs. 936,345 expected two days ago)

Total expected deaths set in stone** over course of pandemic: 270,455 (vs. 255,707 expected two days ago, using 4% case mortality rate)

* The expected cases number assumes that total cases grow by 17% every three days, for the next 7 days (= yesterday’s 3-day growth rate in cases).

**This number assumes a) Reported cases are a fairly accurate estimate of total cases; b) Total cases grow by 17% into the future (= yesterday’s 3-day growth rate in cases); c) We impose a massive lockdown, with prohibition of all non-essential travel, on April 21; d) New cases drop to zero in 28 days because of the lockdown, but they continue to grow at the current projected rate up to the 28^th day; e) testing and contract tracing are widely available by the 28-day mark; and f) the case mortality rate = 7%.

Projected as of April 28 (14 days from today):

These numbers answer the question: What would happen if we wait 14 days to totally lock down the US, based on the assumptions below (which frankly are themselves very optimistic)?

Total expected cases*: 1,287,346 (vs. 1,500,882 projected two days ago)

Total deaths set in stone** over course of pandemic: 393,285 (vs. 418,516 projected two days ago, using 4% case mortality rate)

* The expected cases number assumes that total cases grow by 23% for the next 7 days (= yesterday’s 3-day growth rate in cases).

**This number assumes a) Reported cases are a fairly accurate estimate of total cases; b) Total cases grow by 23% into the future (= yesterday’s 3-day growth rate in cases); c) We impose a massive lockdown, with prohibition of all non-essential travel, on April 18; d) New cases drop to zero in 28 days, because of the lockdown, but they continue to grow at the current projected rate up to the 28^th day; e) testing and contract tracing are widely available by the 28-day mark; and f) the case mortality rate = 7%.

Date on which 500,000 total pandemic deaths will be set in stone: May 3  

Date on which 1 million total pandemic deaths will be set in stone: May 16

Number of deaths set in stone on April 30: 433,164  

II. Numbers based on total deaths, reported and projected

(All of the numbers below are based on reported deaths, not reported cases - as the set in stone deaths numbers above are. There’s general agreement that reported cases are some fraction of actual cases, meaning that the set in stone numbers are a fraction of what total pandemic deaths will actually turn out to be. So the projections below are going to be much more accurate estimates of deaths than the ones above, at least in the shorter term for which they're intended)

Total US deaths as of yesterday: 23,644

Increase in deaths since previous day: 1,529 (vs. 1,819 two days ago)

Percent increase in deaths since previous day: 7% (vs. 10% two days ago)

Yesterday’s 3-day rate of increase in total deaths: 26% (vs. 39% reported yesterday)

III. Reported case mortality rate so far in the pandemic in the US:

These numbers are also unaffected by the increase in assumed case mortality rate to 7%.

Total Recoveries in US as of yesterday: 36,948

Total Deaths as of yesterday: 23,644

Deaths so far as percentage of closed cases (=deaths + recoveries): 39% (vs. 40% two days ago) Let’s be clear. This means that, of all the coronavirus cases that have been closed so far in the US, 39% of them have resulted in death (compare that to the 7% mortality rate I’ve now using to calculate the “set in stone” total pandemic deaths numbers). Of course, this number will come down as time goes on and more cases are closed in which the victim recovered. But this number has gone down and up since Worldometers started publishing the recovery rate on March 26 (when it was 41%), and on about half the days, it’s gone up; there is still no sign of a downward trend. I’d say it’s more likely my 7% mortality rate will turn out to be too low, after the pandemic’s over and all of the bodies have been counted, than it will be too high.