First of all, let me say I’m not a doctor, not an epidemiologist, and I have no expertise in this subject matter at all. I’m an attorney and demographic researcher who reads the news, has a calculator, and wanted to get some sort of back-of-the-envelope estimate of what we’re facing in the next months or year.

Second of all, if someone who does have this expertise wants to come tell me that I’m being too alarmist, please do. I am very alarmed.

I wanted to determine the scale of the pressure that coronavirus could put on our health care system, our economy, and our society. I started with a very basic number: the estimate that it could ultimately infect 40–70% of people, made by a Harvard epidemiologist here.

I assumed that infection rates in the U.S. are roughly equal to infection rates elsewhere. This could be a faulty assumption, but I couldn’t see any reason why transmission (as opposed to say, mortality) would be much lower in an advanced nation with a lot of economic activity.

I used the lower end of the 40–70% range. (It’s not really necessary to go all the way to 70% to start producing really alarming figures, anyway.)

Okay, so if 40% of the population gets infected, how many are going to have serious health problems?

According to various news sources, including this New York Times article, China reported that about 19% of cases are either “severe” or “critical.” Severe cases featured “shortness of breath, low blood oxygen saturation or other lung problems.” Critical cases, which comprised about 5% of all cases, caused much worse problems: “respiratory failure, septic shock or multiple organ dysfunction.” In China, about half of patients with a critical case died. I assume both types of case require hospitalization — in the former instance, simply to ensure it does not progress to the latter, if nothing else.

Assuming 40% of Americans ultimately contract the virus, that implies we will face approximately 25 million severe cases, and 6.5 million critical cases.

At present, the United States has about 930,000 hospital beds. Many are occupied. The first question this raises is “Where are we going to put 25 million severe coronavirus cases?”

Of course, a lot seems to depend on the pace at which cases manifest. If 10 million people fall severely or critically ill in a month, that places a much greater strain on our health care system than if they fall ill over the course of ten months.

That leads to the second problem: how do you slow the spread of cases to ensure that infections spread at a manageable rate? China seems to have stemmed the spread of the disease, at least for the time being, but that required draconian quarantine measures that effectively amounted to a complete economic shutdown. At first glance, it appears we face a tradeoff: impose extraordinary economic damage by implementing long-lasting social isolation measures, or allow the disease to spread much more rapidly, potentially overwhelming the health care system with many millions of severe cases.

All of this is before you consider the effect of the death toll itself. 6.5 million severe cases suggests a final death toll in the millions.

Finally, there is the question of politics. The choice to slow the disease by imposing harsh, economically disruptive measures is immensely difficult, from a political standpoint. You are making a visible sacrifice for an unseen benefit. Without a doubt, many would complain that measures are too harsh, that the disaster is not so bad, and that unnecessary damage is being done. People would make these complaints because they would not be able to see the alternative scenario, in which the virus spreads uncontained, causing massive suffering. To make this choice would require extraordinary political will in the face of widespread pressure — a faith in the necessity of the decision, and a desire to protect lives at personal political cost.

Now consider our current national leadership. And that’s why I’m afraid.