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LizSpecht's profile
Liz Specht
Liz Specht
Liz Specht
@LizSpecht

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Liz Specht

@LizSpecht

VP of Science & Technology @GoodFoodInst. Supporting alternative proteins for a sustainable food future. Finding signal in the noise.

San Francisco, CA
gfi.org
Joined November 2011

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    Liz Specht‏ @LizSpecht 6 Mar 2020

    I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math. 1/n

    5:03 PM - 6 Mar 2020
    • 37,306 Retweets
    • 96,083 Likes
    • Christy has some concerns Anna #GetVaccinatedGA Nicole Manning BigRedRobotNinja Alicia Byrne Morgan Walters Nicole Hancock Lydia Gardner 25 🌞🌼🌻🌸🌺
    3,218 replies 37,306 retweets 96,083 likes
      1. New conversation
      2. Liz Specht‏ @LizSpecht 6 Mar 2020

        Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate. 2/n

        142 replies 1,469 retweets 8,912 likes
        Show this thread
      3. Liz Specht‏ @LizSpecht 6 Mar 2020

        We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts. 3/n

        114 replies 1,367 retweets 8,101 likes
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      4. Liz Specht‏ @LizSpecht 6 Mar 2020

        We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go. 4/n

        330 replies 2,300 retweets 9,248 likes
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      5. Liz Specht‏ @LizSpecht 6 Mar 2020

        As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population. 5/n

        40 replies 1,200 retweets 7,283 likes
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      6. Liz Specht‏ @LizSpecht 6 Mar 2020

        What does a case load of this size mean for healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted. 6/n

        31 replies 1,006 retweets 6,368 likes
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      7. Liz Specht‏ @LizSpecht 6 Mar 2020

        The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc). 7/n

        82 replies 1,668 retweets 7,566 likes
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      8. Liz Specht‏ @LizSpecht 6 Mar 2020

        Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients). 8/n

        89 replies 1,254 retweets 7,117 likes
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      9. Liz Specht‏ @LizSpecht 6 Mar 2020

        By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.) 9/n

        104 replies 1,724 retweets 7,722 likes
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      10. Liz Specht‏ @LizSpecht 6 Mar 2020

        If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd. 10/n

        40 replies 1,131 retweets 6,467 likes
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      11. Liz Specht‏ @LizSpecht 6 Mar 2020

        If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption. 11/n

        23 replies 940 retweets 6,026 likes
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      12. Liz Specht‏ @LizSpecht 6 Mar 2020

        As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now. 12/n

        35 replies 1,061 retweets 6,334 likes
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      13. Liz Specht‏ @LizSpecht 6 Mar 2020

        Alright, so that’s beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing). 13/n

        31 replies 854 retweets 5,385 likes
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      14. Liz Specht‏ @LizSpecht 6 Mar 2020

        There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.) 14/n

        23 replies 818 retweets 5,288 likes
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      15. Liz Specht‏ @LizSpecht 6 Mar 2020

        As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day. 15/n

        51 replies 1,234 retweets 6,135 likes
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      16. Liz Specht‏ @LizSpecht 6 Mar 2020

        One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused. 16/n

        18 replies 1,011 retweets 6,150 likes
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      17. Liz Specht‏ @LizSpecht 6 Mar 2020

        How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China. 17/n

        68 replies 1,203 retweets 6,477 likes
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      18. Liz Specht‏ @LizSpecht 6 Mar 2020

        Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor. 18/n

        23 replies 883 retweets 6,017 likes
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      19. Liz Specht‏ @LizSpecht 6 Mar 2020

        Now consider how these 2 factors – bed and mask shortages – compound each other’s severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix. 19/n

        20 replies 966 retweets 5,682 likes
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      20. Liz Specht‏ @LizSpecht 6 Mar 2020

        HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above. 20/n

        18 replies 920 retweets 5,600 likes
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      21. Liz Specht‏ @LizSpecht 6 Mar 2020

        We could go on and on about thousands of factors – # of ventilators, or even simple things like saline drip bags. You see where this is going. 21/n

        25 replies 754 retweets 5,270 likes
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      22. Liz Specht‏ @LizSpecht 6 Mar 2020

        Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works. 22/n

        40 replies 1,450 retweets 8,092 likes
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      23. Liz Specht‏ @LizSpecht 6 Mar 2020

        Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease. 23/n

        85 replies 3,401 retweets 13,214 likes
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      24. Liz Specht‏ @LizSpecht 6 Mar 2020

        I’m an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I’ve been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan. 24/n

        112 replies 1,260 retweets 10,355 likes
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      25. Liz Specht‏ @LizSpecht 6 Mar 2020

        Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we’re seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong. 25/n

        34 replies 1,079 retweets 7,794 likes
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      26. Liz Specht‏ @LizSpecht 6 Mar 2020

        But I have no reason to think they’ll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don’t mock decisions like canceling events or closing workplaces as undue “panic”. 26/n

        34 replies 1,969 retweets 12,058 likes
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      27. Liz Specht‏ @LizSpecht 6 Mar 2020

        These measures are the bare minimum we should be doing to try to shift the peak – to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system. 27/n

        13 replies 1,338 retweets 8,330 likes
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      28. Liz Specht‏ @LizSpecht 6 Mar 2020

        And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared? 28/n

        27 replies 1,027 retweets 6,986 likes
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      29. Liz Specht‏ @LizSpecht 6 Mar 2020

        Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out. 29/n

        76 replies 928 retweets 9,152 likes
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      30. Liz Specht‏ @LizSpecht 6 Mar 2020

        One more thought: you’ve probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year. 30/n

        69 replies 1,399 retweets 6,637 likes
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      31. Liz Specht‏ @LizSpecht 6 Mar 2020

        Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population. 31/n

        166 replies 764 retweets 6,131 likes
        Show this thread
      32. Show replies

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