Lori Walsh: Since we first learned of confirmed cases of COVID-19 in the United States, Americans have been focused on models for disease progression. We learned how our behavior could flatten the curve, meaning keep more people healthy for longer so healthcare workers could prepare for surges at local hospitals.
Surge modeling has not been without controversy or confusion. Dr. David Basel is Vice President for Clinical Quality with the VERA Medical Group and he joins us now to help us understand the models and what they're telling us. Dr. Basel, welcome. Thanks for being here.
Dr. David Basel: Good morning. Thank you for having me.
Lori Walsh: All right, let's just start with, for so many people, these models and these charts and these curves were brand new to begin with, and we tried to understand the things that were immediate. Now we're several weeks into this, a couple months into this. So when you explain these models to people, tell us the overview of how we should look at some of this information. What exactly is surge modeling?
Dr. David Basel: So really what surge modeling is based off of, and it's been around quite a long time based off of looking at things like influenza, SARS, MERS virus, Ebola, all of those types of things, and they've been refined at looking how those spread. And they're really based off of kind of the concept of how many people does one positive person transmit it to? And then how long does it spread to that individual group of people and then how long does disease last after they get it?
Because the how exponential will this grow over a period of time and how fast will that happen? Because number one reason or thing that we're trying to use the surge modeling for is, are we going to overwhelm the hospital systems or not? Are we going to fill up the ICUs, are we going to fill up the beds? Are we going to have enough of everything healthcare related to care for these individuals? What do we have to do to keep underneath that level?
Because as you talked about when we ran those first models, looking at the rate of spread entries and even the initial outbreaks on the coast here, that number a person gives it to was really pretty high, in that two and a half a person that you spread it to on average. And that puts us over hospital capacities in almost all areas type of thing. And we saw that here locally through the second half of March and the first half of April. We were doubling every three, four, five days, which is on that same trajectory that we were all getting rapidly concerned.
And that in time, then the response to that is, we can't allow the hospital system to get overwhelmed. That's when all of the sling and all of the kind of unprecedented measures took place to prevent that from happening. And wonderfully, they were widely successful. And so we're able to drop that number of people that each person spreads it to down from that two and a half range, probably down to more like a one and a half range and really slow this disease down and give us time for the hospital systems to get their feet under them. And so one of the confusion now is how come we didn't hit those numbers because we were successful at stopping the spread of this and getting it under control at this point and so.
Lori Walsh: I think that's an important point to make here because many people coming off of the 2016 election were looking at poll numbers and then after the election said, "Oh, the poll numbers were wrong," and they remember that this is an entirely different thing. Those model numbers weren't wrong. They changed because we changed our behavior. So talk a little more about that, that the model will continue to change and that's a good thing. Hopefully it could be a good thing, but it also could go the other way. Right?
Dr. David Basel: Right. It's remarkable how much of a difference it makes. You think the difference between I get sick today if I give that to on average two and a half people versus one just less person that I come into and I only give it to one and a half people, I mean it's like money. It makes such a huge difference that that one person changed, totally flattens out the curve, and a lot less of a hump when you do that. It doesn't sound like much, but a little changes like that just have a big impact on how long it takes us to grow and gives us the ability to almost chart it out. And so now we're in a situation that I talk about because of those changes, we haven't eradicated COVID. An analogy I've started using now is that we've got all these smoldering fires of COVID, burning underneath the surface a little bit here and there.
We're going to keep seeing these flares, and I say you're going to have like a flare up of a dumpster fire here, and a dumpster fire there flare up and another dumpster fire over here. And if we can recognize those dumpster fires early, get in there with good contact tracing, good measures on the more localized effort wherever that flare up is, get it tamped back down, then we're going to be good.
If we aren't able to do a good job of that, all those dumpsters fires are going to coalesce and go back into a full fledged prairie fire again, which would be bad. And so that's kind of the new kind of analogy that I'm using is we're going to see these, these players, this community has a flare, or this part of this community flares, or this little side population kind of flares. Can we get that back under control quickly enough before it spreads, else that's going to be the new fight for us.
Lori Walsh: What are we seeing about the peak in South Dakota of cases? And before we talk about that, it's important also, I think to make the connection. And here's my question. How closely is the death rate tied to the surge capacity? Because in some ways, it's easy to get stuck thinking, well, if the hospitals can meet the need, does that lower the death rate, then if hospitals can meet the needs significantly, that's a broader measuring stick than I think most people realize.
Dr. David Basel: Right. And so a couple of assumptions here is that we probably won't see a vaccine for probably 18 months, most likely. And so yes, we think at 18 you go slow or fast. It's not the same percentage of people will get infected with this over time. That probably means that the same number of people will die whether we go slow or fast, unless you start to overwhelm the hospital systems because that's when there's not enough ventilators to go around, if there's not enough nursing staff to go around. That's when things start to break down. And then we have a lot more deaths than we would have had otherwise.
And that's that whole surge protecting, don't get near to the capacity of the hospital system when things start to break down. If you keep it underneath that, and you're right, the overall mortality's still going to be high. I mean, it's going to kill five to 10 times as many people as a regular flu year. These are incredible and unprecedented steps we've taken here. It's still going to kill five or ten times as many as flu. We just can't get away from that. But we don't want to have to have it kill more than it needs to, I guess I'd say.
Lori Walsh: Hmm. All right, so what do we know about the coming cases and when we might see a peak? What are we looking at today?
Dr. David Basel: Yeah, so that's a good question. It's a lot harder to predict today than a month ago because now we don't know as things get opened back up, how much have we changed the public? How much social distancing is now ingrained, and how much are we going to stay away from our neighbors or how much, when we talk to our neighbors, are we going to be talking from six feet away instead of one feet away when we talk to them, how much less are we going to be shaking hands and stuff, even though as we're going back to work and stuff, and that's the thing that we just don't know, and that's what's going to make the difference on whether we have these little dumpster fires or [inaudible 00:09:23] a true prairie fire surge.
And that's, at this point, going to be very difficult to say. And it takes two or three weeks on every one of these changes, probably more like three before you start to see how effective steps taking and how fast do we start back up again. I'm sure we're going to see numbers rise again, with everything opening back up again. It's a matter of how high, and that depends on how good people are at what social distancing you can still do when you're going back to work and everything.
Lori Walsh: Hmm. When you said five to 10 times as many people will die as with a regular flu season, how many, and when you look at the data today, how many people are going to die? What are those numbers? What are we projecting?
Dr. David Basel: So regular flu season is about 20 thousand in the U.S., And so most of the numbers I've looked at are somewhere north of a hundred thousand. I think we're already up around 50, 60,000 right now. I haven't looked at the numbers in the last couple of days. It'll be north of probably a hundred thousand in the U.S..
Lori Walsh: And in South Dakota?
Dr. David Basel: Yeah. I don't have those numbers in front of me. I probably should have looked at those. So it's still, what do we usually have, a hundred people die of influenza a year. I'd better not spout something.
Lori Walsh: Right. Well, we won't guess. Yeah, we won't guess with those numbers, but I guess my question gets at the heart of not forgetting that this is a pretty significant thing because as the weather gets nice and as people figure out things they can do and they can not, we're having a hard time making decisions because we don't know what's at stake behind some of these decisions. So what's your recommendation for people who are kind of lost in the data a little bit and trying to figure out, "Well, does that mean I can go to the store? Does that mean I can't go to the park?" How do you balance the science of this with daily living?
Dr. David Basel: Yeah. And so I've always been, because of the uncertainty and how much of these changes you're going to be, I've always been a proponent of let's do this in stages, and and so what I've done with my own family right now as opposed to going from weeks where my kids have seen nobody else in the neighborhood, we've gone to, okay, for the next couple of weeks, up our circle of friends to a select group of people, and, okay.
So my sister-in-law and her family live three blocks away. We'll open up to them, and get the kids one or two friends that they can play with each, but not going to allow them to go to some big sleepover or something like that. We're going to go to the grocery store, but I'm going to wear a mask, and I'm going to try to go not at a peak time when there's fewer people around.
And so try to take some of those common sense things. Give that about three weeks. See what the numbers, it seems like we've got enough social distancing, the numbers aren't rising too fast. Then we can take a next step and a little bit more adventure for them. So that's kind of how I'm approaching it with my family and with my employees and stuff. We're trying to do it in a stepwise fashion. Give it a little bit of time, see what the effect of that is overall and then take that next step from there as we see how this goes.
Lori Walsh: Any advice before I let you go, Dr. Basel, about the different models that are coming out and people not really knowing everything from the South Dakota Department of Health that they would like to know. Some of our questions have not been answered about the assumptions that are being made for that modeling. And meanwhile, there are models from the University of Washington and Columbia University and other organizations. Where should people look to get that information and feel confident about the surge modeling that they're looking at to make decisions about South Dakota.
Dr. David Basel: So really the most objective thing that we have to follow and what I pay the most attention to myself is the hospitalization count because how many positive tests you have depends on how many people you test, and so that number can vary widely depending upon what the current testing strategies are and what the supply of tests are and things like that. I don't pay as much attention to the number of tests. I pay the most attention to the number of hospitalizations that most information of what's going on in the community at any given time and what direction things are heading.
Most of the models are based off of, as well, the hospitalizations. And so I would say if you want to see where things are trajectory-wise, follow the number of hospitalizations in the state and entities within the state because that's going to tell you what trajectory we're on, at least in the next two, three, four weeks out type of thing.
But it takes probably three weeks for a number of hospitalizations to start to adjust as we open things up and stuff. So with the governor's press conference last week, it's going to be another good at least two weeks before we start to see how much hospitalizations increase and increase in response to that. And so we'll just have to watch that and follow. Check the hospitalizations, my advice.
Lori Walsh: Yeah. Dr. David Basel is vice president for Clinical Quality with the VERA medical group. Thank you so much for being here. We look forward to talking to you again.
Dr. David Basel: All right. Thank you for having me.