My last article (Part 1) focused on sounding the alarm bell on the brutal trajectory of the Delta variant of Covid-19. I’m glad that understanding is now more widespread.
I wish I could say my outlook for the coming months has improved but that article has already proven to be overly optimistic since we hit 40,000 daily new cases in the United States on July 16, well ahead of my original projected August 1st date. On July 22 we hit 61,650. At this point, 100K by August 1st is likely.
With Delta now dominant, the growth curve has accelerated because we’re not masking Delta’s rapid growth with the decline of other variants. It’s essentially an all-Delta pandemic from this point forward.
One of my key conclusions has since been reinforced by Scott Gottlieb, former head of the FDC, when he said he was expecting the coming peak to crest in late September. He also said on July 18 that he anticipates that most unvaccinated people will end up getting Delta.
I chose in my first article to focus first on hospitalization risks as it appears that is the most significant short-term risk from a rapidly spreading wave, especially after what we witnessed in India.
Hospital overwhelm is already happening in southwest Missouri. To get a full sense, read this Atlantic article. That article’s most important point is the following quote: “In previous phases of the pandemic, both hospitals took in patients from other counties and states. ‘Now we’re blasting outward,’ Coulter said. ‘We’re already saturating the surrounding hospitals.’’
Essentially, as hospitals get overwhelmed in low vaccination and high spread areas in America (more rural and more conservative initially) they will move patients to surrounding regional hospitals and eventually to other states until we simply run out of hospital space, even in highly vaccinated parts of the country.
Florida, for example, is now hitting medical system overwhelm in multiple areas.
It’s human nature to want to see these things happening “over there” and wish that they won’t happen here. But they will, without adequate intervention, as the spread of Delta has been relentless. Missouri and Florida are a glimpse of our future. It’s just a matter of how long until we get there.
This Forbes article puts some specific numbers on the current capacity of the American health system. On July 17, there were 21,695 coronavirus patients in the hospitals, occupying 3.2% of the nation’s beds, which sounds like we’re doing just fine. It also notes that our normal occupancy runs at 72% of beds and 68% of ICUs.
Basically, that means there’s about 32% of surge capacity in the system for a crisis.
If Covid-19 patients, driven by the Delta wave, were to occupy 32% of the available bed spaces (10x from July 17), we will have effectively maxed out the system nationwide and we will need to start putting people in field hospitals, hotels, hallways, or turning people away. In Indonesia, which is much further down the Delta growth curve than we are, most people are now dying at home as the hospitals are maxed.
Our daily new caseload surpassed 40K on July 16. If and when it surpasses 400K new identified cases per day, that should translate, within a week or two, into around 10x the total patients. Effectively, at a 400K cases/day peak (which I think is optimistic as I chronicled in Part 1), we will have used EVERY available hospital bed and ICU space in our country.
Since we hit 40K new daily cases on July 16 and 60K on July 22 and are doubling faster than every two weeks, that means August 1st will be more like 100K, August 15th is 200K, and August 29th is 400K, well before Labor Day (Sept. 6).
That is, of course, without mass intervention, but for many reasons (summer exuberance, pandemic fatigue, political polarization, resistance to lockdowns, and the difficulty of updating our mental models of the risks posed by Delta), it’s going to be very hard to get enough of a mass change of behaviors soon enough to flatten the trajectory substantially.
A CBS Newspoll showed that while 72% of Vaccinated Nation (to use my term from Part 1) are concerned about the Delta variant, only 48% of Unvaccinated Nation are. So the folks who are most likely to catch, spread, and be hospitalized with Delta are currently the least concerned.
Which is why, in Florida, cases doubled in only a week.
The truth is that Delta, if neglected, can grow much faster than doubling every two weeks. In the Netherlands, they actually increased cases 500% in a week after an exuberant re-opening that also left 1050 people infected after a single outdoor music festival (over 5% of all attendees).
Just let that sink in: in an outdoor event with reasonably good Covid protocols, 5% of EVERYONE was infected in a single weekend. That’s how infectious this is.
CDC Director Dr. Rochelle Walensky says the Delta variant makes it one of the most infectious respiratory diseases they have ever seen.
Consider that and then look at the roster of events, shows, and restaurant activity still happening around the United States.
Since redder counties in the United States have lower vaccination rates and less concern about Delta, the rate of growth is likely to be closer to 2x per week (as it now is in Florida), which only moves up the peril of hitting hospital load limit . In fact, our overall national caseload grew 66% in the last week and 145% in the last two weeks, faster than the growth I had been projecting and we’re not even at full saturation with Delta nationally yet (the last estimate is 83%).
With medical personnel already deeply fatigued from the last year and nowhere to draw additional personnel from in a situation of hospital maximums, it’s going to be absolutely brutal for healthcare workers and dangerous for anyone else who might need normal medical services, not to mention the hospital personnel.
That’s why I have concluded that my analysis last week, as grim as it was, is already proving too optimistic.
Basically, we’re headed for system-wide hospital overwhelm sooner than we think without larger-scale interventions that will prove politically and socially difficult to enact.
The risk is even higher when we consider that breakthrough infections that are happening in vaccinated individuals could well be leading to more infections than with previous variants.
Here’s a New York Times article and a key few paragraphs:
“Additional data is emerging from the Covid-19 Sports and Society Workgroup, a coalition of professional sports leagues that is working closely with the C.D.C. Sports teams in the group are testing more than 10,000 people at least daily and sequencing all infections, according to Dr. Robby Sikka, a physician who worked with the N.B.A.’s Minnesota Timberwolves.’
“Breakthrough infections in the leagues seem to be more common with the Delta variant than with Alpha, the variant first identified in Britain, he said. As would be predicted, the vaccines cut down the severity and duration of illness significantly, with players returning less than two weeks after becoming infected, compared with nearly three weeks earlier in the pandemic.’
“But while they are infected, the players carry very high amounts of virus for seven to 10 days, compared with two or three days in those infected with Alpha, Dr. Sikka said. Infected players are required to quarantine, so the project has not been able to track whether they spread the virus to others — but it’s likely that they would, he added.”
So let’s think about this. What we know, for sure, is that
Viral load with Delta is 1000 times higher
Vaccinated people are getting some breakthrough illnesses
Vaccinated people who get breakthroughs are carrying high amounts of virus for a longer period (7-10 days) then with previous variants
The symptoms of Delta are closer to a common cold (headache, runny nose) in its mild form
While the media messaging about Delta tends to focus on the lowered personal risks for vaccinated people, what hasn’t penetrated yet is that not only are the unvaccinated spreading to unvaccinated, it appears highly likely that the vaccinated are as well.
Basically, the vaccinated, who typically have more mild cold-like symptoms and have been told no masks are necessary, may well be an unknowing vector that infects the unvaccinated.
It still is a very strong argument for vaccination, since the results are far better if you are vaccinated and get it than not (25x less likely to be hospitalized).
But it lowers the likelihood of reaching herd immunity any time soon. If vaccinated people can get it and spread it, and previous infectios only give partial protection, it becomes increasingly difficult to see a clear pathway to herd immunity that doesn’t involve infecting the vast majority of unvaccinated and a good portion of vaccinated.
Simply put, even if we vaccinate close to everyone, we may not be able to shut down the spread.
That is very, very, very sobering.
I personally hate the idea of being a mild-symptom carrier who brings a deadly disease to someone who hasn’t chosen to vaccinate. Which is part of why I am masking.
The Second Tsunami: Long-Covid
While short-term hospital overwhelm is dangerous and headline-grabbing, the long-term human cost from the Delta surge is perhaps more likely to come in the form of massive amounts of long Covid, ranging from brain fog to diminished breathing to organ damage.
We don’t yet know how much more likely long Covid is with the Delta wave but the 1000x viral load is troubling as it is the virus itself that tends to cascade through our bodies and weaken systems from our brain to our heart.
In the last waves, current estimates seem to be that about 1 in 8 infections leads to long Covid (according to Tomas Pueyo’s analysis).
Running the numbers on this next wave, the increasing likelihood of the vaccinated spreading some as well makes me think we’re going to have infection of 70-80% of the unvaccinated before it dramatically slows, plus a smaller percentage of breakthroughs in vaccinated people.
Instead of 50M infections in this wave, we may even be talking about closer to 100M (70% of unvaccinated and let’s say 15% of the vaccinated). While the death rate may never climb to the same levels as in the past because we have already vaccinated a much higher percentage of people who are 50+ or at risk, that is still a recipe for massive hospital overwhelm and perhaps even 10M more cases of long Covid to navigate
Current estimates with long Covid are that 10% of people experience symptoms more than three months after recovery and it can be an incredibly arduous ordeal, as this journalist chronicled. I encourage you to read that last article as it’s from a young and previously healthy journalist who has been debilitated for 9 months. It’s important for us not to get fixated just on mortality or hospitals statistics but realize the real, long-term cost of this pandemic is far more likely to be mysterious and untreatable long Covid that undermines our health and well-being for a long time to come.
This is not a wave we should blithely let pass through our culture. It’s a wave of serious illness that we need to take seriously and protect those we love and cherish. Masking up isn’t just about self-protection. It’s about protecting others from the Roulette of getting long Covid.
The only good news I can see is that so far, I’m not seeing evidence of elevated risks for the young. Kids are at a very low risk overall from Covid-19 complications, which is a hell of a blesing.
In summary, my analysis so far points to:
a 3-4 month Delta surge that begins to hit crisis levels by mid-August, moves in to national emergency by September and dwindles by the end of the year
40-80M infections in the unvaccinated in the United States and a smaller number of mostly milder but potentially spreadable infections in the vaccinated.
Completely overwhelmed hospitals in September and October with patient loads that exceed past peaks.
Death rates that may be a bit more manageable than the last wave because of vaccination.
An increasingly small chance that we can shut down transmission completely, even with close to 100% vaccination rates, due to higher viral load in vaccinated breakthrough cases.
Millions with long Covid that eats away at their health and well-being for some time to come.
Globally, the situation will be far, far worse, with developing countries that have low vaccination rates paralleling India’s trajectory. The latest excess death calculations peg India’s actual toll of mortality at 3.4 million since the start of the epidemic. That’s about 1 in 400 citizens.
The vast majority of developing countries that have lower rates of vaccination than are going to see a massive surge of sickness, death, and long-term effects from long Covid. If the 1 in 400 death rate from India extrapolates to the lower-vaccinated rest of the developing world (about 2.6 billion more people outside of China), that starts to look like 6.5M more deaths, not to mention the deaths in the developed world (lower due to vaccination) and China, depending on how it navigates the Delta Wave. But basically, it projects out to something like 10M more deaths in the next 4 months, a global tragedy.
The Delta wave is also likely to lead to global instability, as we’ve seen in the South African riots. Resentment against wealthy countries hoarding vaccines could create lasting damage to international relations.
It is a terrible picture.
So what can we do?
Vaccinate ASAP if you haven’t yet. This wave is coming fast and it takes a full month to get all the protective benefits.
Raise awareness and resume indoor masking, keeping even more social distance outside than we did last year as it spreads more outside as well.
Avoid anything that might be a super-spreader event.
Urge those who are most at risk in your life to protect themselves with vaccination, sharing this article and whatever personal stories you think might move them. Avoid judging them but keep them as informed as possible.
Get as healthy as you can with sleep, good food, immune-strengthening herbs, supplements (vitamins D & C in particular), and meditation.
Create a safe pod of folks with rigorous protocols to ride out the next few months and try not to travel if you can.
Design your job and lifestyle such that if you need to take time off, life can keep moving. The course of Delta seems faster this time but you could need a couple weeks if you get it.
Lobby political leaders to enact mask mandates as soon as possible to flatten the curve and minimize the hospital overwhelm.
I wish I had something better than that.
I know some folks are great champions for things like ivermectin but it was used extensively in India and didn’t stop their Delta wave. While the jury is still out, it doesn’t quite seem to be a miracle drug based on the meta-analyses that exclude the Egypt study.
So I’m not sure that we can really stop this wave but simply slow it down, protect whoever is willing to be protected, and focus on building health and resilience with the tools we have available to us.
Thank you for your comprehensive article. We must all do everything possible to stop the spread. This is a critical time in our growth as a species. Can we finally learn to love another as ourselves? Vaccinate and mask, please.
I really appreciate the two articles, it is sad to hear but good to be informed. As we move through this wave, what/who are you reading to find well informed unbiased information on its progress? Also will you be updating us with other articles?