Lotta buzz overnight about this figure from yesterday’s press conference with Gov. Mike DeWine, which is good. Scary numbers drive home to people how serious this is.

But the number didn’t make sense to me intuitively. Since 80 percent of people with the disease experience mild symptoms, 20 percent should logically require medical intervention. If 100,000+ Ohioans have it, there should already be a glut of patients at ERs needing oxygen, ventilators, and so on. There are no reports of that yet.

So how can one percent of the population be infected?

“We know now, just the fact of community spread, says that at least 1 percent, at the very least, 1 percent of our population is carrying this virus in Ohio today,” [Ohio Department of Health Director Amy] Acton said. “We have 11.7 million people. So the math is over 100,000. So that just gives you a sense of how this virus spreads and is spreading quickly.”…

“Our delay in being able to test has delayed our understanding of the spread of this,” Acton said.

Seemed suspicious to a dummy like me, but it also seemed suspicious to people who do this for a living. Trevor Bedford is a scientist in Seattle who specializes in viruses and has been studying the spread of COVID-19 there. If his name sounds familiar, it’s because he’s the person who was sounding the alarm several weeks ago about undetected community spread in Seattle based on the similar genome of the viruses found in two different local patients weeks apart. Bedford noticed this 100,000+ figure out of Ohio yesterday and scratched his head.

Wuhan as a city had seen 1000 severe cases and 300 deaths at this point (https://t.co/0IbxHzcj93). Thus, given the severity of this disease I don't see how it's possible to reach 100k infections and not notice it in deaths and hospitalizations. 3/5

— Trevor Bedford (@trvrb) March 13, 2020

I don't doubt community spread is happening Ohio and it's highly difficult to do these prevalence estimates well without wider surveillance efforts, but I think this is certainly a strong overestimate. 5/5

— Trevor Bedford (@trvrb) March 13, 2020

Some readers tweeted at him that maybe coronavirus infections in Ohio are being “disguised” as flu or pneumonia cases right now. We’re barely even testing for the disease, after all; isn’t it possible that patients are coming into the ER and being misdiagnosed? Not really, said Bedford. The CDC tracks pneumonia cases. There’s been no big uptick recently. He notes that Ohio officials have cited a 2017 CDC report on viruses in claiming that “Whenever you know of 2 people that have it due to community spread, then you can assume that 1% of your population has it.” But obviously, per the hospitalization rate, that’s just not true right now.

Check back in a few weeks, though.

The most encouraging information online today about COVID-19 is this interactive graph at the Times, which lets you see how strategies to combat the disease like “social distancing” are projected to affect its spread. There’s an enormous difference based on timing alone. Anyone who thinks the U.S. is acting too soon in shutting everything down should play with the graph and see how the number of infections and deaths changes when you wait as little as a week or two to ramp up.

Wider testing will also dramatically affect the spread. That testing is coming online, verrrrrrry slowly, but it’s coming; that’s the good news. The bad news is that it’s come slowly enough that experts like Scott Gottlieb think our chances of “pulling a South Korea” and largely stamping this fire out before it’s had a chance to roar are gone. Even in the Times model’s very best-case scenario, in which we institute “aggressive” countermeasures today, the disease is projected to infect half a million people and kill 50,000.

THREAD: In U.S. we face two alternative but hard outlooks with #COVID19: that we follow a path similar to South Korea or one closer to Italy. We probably lost chance to have an outcome like South Korea. We must do everything to avert the tragic suffering being borne by Italy 1/10

— Scott Gottlieb, MD (@ScottGottliebMD) March 12, 2020

In some respects our fate rests on the entities that are capable of sharply ramping testing and distributing the services nationally. Academic labs can serve their institutions. Only big national clinical labs like LabCorp and Quest can fill the void. A lot rides on them now 3/10

— Scott Gottlieb, MD (@ScottGottliebMD) March 12, 2020

3. We need to create surge capacity in hospitals. Congress must support the effort. Patients and providers can too. Elective procedures should be postponed for next few months. Hospitals should lower volumes everywhere they can. We need to prepare for an influx of cases. 8/10

— Scott Gottlieb, MD (@ScottGottliebMD) March 12, 2020

We’ll get through this. It’ll end. We have two hard months ahead of us. We need to sacrifice some of the trappings of normal life to reduce the scope and severity of what’s ahead. We must protect the vulnerable. We must act collectively in common interest. We must work together.

— Scott Gottlieb, MD (@ScottGottliebMD) March 12, 2020

The very worst-case scenario projected by the CDC is 160 million and 214 million Americans infected over the next year with somewhere between 200,000 and 1.7 million dead. Those numbers assume “business as usual” with socialization, though. We’ve already shifted from business as usual in mass public gatherings, so that’ll bring the numbers down. That’s the point of the interactive graph above.

On the other hand, there’s not a ton of evidence yet that people are practicing widespread smaller-scale “social distancing,” which leaves me to assume that the best-case scenario isn’t in the offing either. Given how close to full capacity U.S. hospitals operate even in normal times, my impression from the reporting is that we’re likely to end up with an Italy scenario in which patients are being triaged to some degree in one or more cities before we get a handle on this. “The estimated 45,000 intensive care unit beds in the United States would be swamped by even a moderate outbreak of about 200,000 in need of I.C.U. admission,” the NYT reports. Given that we missed our opportunity to test early in a volume sufficient needed to contain this thing, how do we avoid so much as a “moderate outbreak” now?

Time to start thinking about who gets to cut the line at the ER. Exit quotation: “The priority should be health care workers; police, firefighters and other emergency workers; and those who keep water, electricity and other necessary systems functioning, because they can save the lives of others.”