Why doctors and epidemiologists worry about the spread of coronavirus, as viewed from an Indian fable.
An Indian fable tells of a man Sessa, who seeks an audience with the King Ladava. Received by the king, Sessa presents him with a new game of Chaturang he invented, which you and I know as chess. Delighted by the gift, the king offers Sessa anything from the royal treasury. Sessa asks that he be paid in grains of rice, one grain for the first square on the board—a chess board has 64 squares—two for the second square, four for the third square, eight for the fourth, and so on, doubling the amount of grains of rice with each square, until the 64th square. King Ladava believing the request is modest grants it. The king subsequently discovers that through simple doubling, the hidden exponential growth, that by the 32nd square, only halfway through the chess board, the king has given away his kingdom, over 2 billion grains of rice. By the 64th square the king has given away 18 quintrillion grains of rice, more then on Earth. The king then does what many kings would do, he has Sessa killed.
With coronavirus or COVID-19, its Basic Reproductive Number (more on that in a moment) is believed to be 2 to 2.5, which means one person with coronavirus will infect two people, those two people will infect two more each giving four, those four will infect four more giving eight, and so on, doubling with each generation. From the chess board parable above, by the time you reach the 16th square there are 32,000 infected and by the 24th square 8 million infected and by the 30th square 536 million infected and upon reaching just two more squares of doubling, the 32nd square, halfway through the chess board there are two billion people infected. The image to the left from The Conversation shows how quickly doubling pushes the curve.
The Basic Reproduction Number of an epidemic is the spread rate from one person to another. In the 2011 film Contagion, there is a scene in the film where the strikingly beautiful and talented Kate Winslet’s character Dr. Erin Mears—pictured here—used a dry-erase board to explain the reproductive rate of an epidemic to a bunch of bureaucrats. In the medical literature, the Reproductive Number it is designated or denoted as the R0, the “R” for “Reproductive” and a lowercase “0” pronounced “naught” from the British word for “zero”, so together “R0” is pronounced the “R naught”.
The day this blog was posted, March 16, 2020, this graph to the left from Worldometer is the current arithmetic curve of coronavirus worldwide. The trajectory is self-explanatory. Since there is currently no vaccine to COVID-19, the only measure we have to slow down the viral spread is to give the virus nowhere to go. Best practice hygiene and reasonable social distancing is all we have right now. Viruses are sort of like parasites and if you don’t give them the next victim they can’t extend their lineage. Additionally, slowing down viral spread will flatten the curve, it won’t be as steep as pictured above, allowing healthcare providers and hospitals to handle the severely ill. Otherwise hospitals will be overwhelmed and more lives will be lost waiting to get treated.
More to come…
John Bershof, MD
John Bershof, MD is a plastic surgeon who has been in private practice for over 25 years. He is the author of numerous medical articles as well as the first textbook of medicine for mobile phones, entitled skynetMD 2005-2015. An essay entitled Gin & Tonics, Clerics, and Dr. Livingstone, I Presume?, which was extracted from one of his future as yet published books was featured in The Antioch Review.
While working on the medical textbook skynetMD for mobile phones, Dr. Bershof, perhaps not too surprisingly became more interested in the backstories of medical history, like who was Lou Gehrig, what is Lou Gehrig's disease, what was his lifetime batting average for the New York Yankees—.340, nineteenth overall—and who invented baseball anyway. Questions such as these piqued Bershof's interest. Having read At Home 2010 by Bill Bryson, his engrossing narrative journeys room-by-room through his Victorian English countryside home, a former rectory, where each room is a chapter about domesticity, about home. It occurred to Dr. Bershof that in similar vein he could take the reader disease-by-disease as jumping off points into human history, science, medicine—his canvas blank, no subject not within reach—and learn a little medicine along the journey.
The ability of a book that is heavily fortified with science and history to connect with a general readership can be challenging; Dr. Bershof through storytelling, humor, jumping off points and personal anecdotes, accomplishes it, written in a language fleeced of the jargon that normally accompanies such narratives. The first two books, The First History of Man published in 2020 and The Second History of Man published in 2021 are available in print, ebook and audio. The Third History of Man is in final stages of editing to be published in 2022, with more volumes to come after that.