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We Have Met the Enemy and He Is Us
This year in the USA we’ve had around 35 million cases of influenza with around 35,000 deaths, for a fatality rate of 0.1%. That’s a pretty typical year, although a couple of years ago we lost 80,000 people one flu season. That was considered to be a bad year, but it barely made the papers. After all, it’s influenza. It happens.
Meanwhile, we’ve had a grand total of 282 deaths from COVID-19 so far and not only has this made the papers, we’ve essentially shut down our society and our economy. This has struck me as odd from the beginning. I’ve had the feeling that I simply must be missing something. So I’ve spent the last few weeks reading all the data I could find on this topic from the World Health Organization, the CDC, and various other data sources. Today I read an outstanding article from Aaron Ginn. I know a lot more about COVID-19 now, but I’m still confused.
Let’s consider three countries and their experiences with COVID-19:
- Italy has 778 cases per million population, with a fatality rate of 8.5%.
- South Korea has 172 cases per million population, with a fatality rate of 0.1%.
- The United States has 67 cases per million population, with a fatality rate of 0.1%.
Italy has essentially locked down its entire country. South Korea has done very little in terms of public policy but has encouraged common-sense personal hygiene practices, like hand washing. The United States is somewhere in between. So suppose you’re a politician and you’re trying to explain the benefit of draconian government actions in response to this virus. How would you present your argument, based on those numbers?
The best controlled study group we have available for this disease is The Diamond Princess. From an infectious disease standpoint, this was close to a worst-case scenario. During its two-week “quarantine,” it turned into essentially a floating petri dish. It had 3,711 people on board, including staff and passengers. It started out with ten COVID-19 cases. Two weeks later, it had 705 cases, and seven of them died. What a fiasco.
But let’s stop and think about that for a moment. First of all, with 705 cases and 7 deaths, that means a fatality rate of 1%. And remember that this is an extremely elderly population, away from their homes, under living conditions that were far from ideal, in a closed environment that was absolutely flooded with the COVID-19 virus. Health care facilities were woefully inadequate. The average age on the Diamond Princess was 58, and 33% of the passengers were over 70. All seven of the deaths were in those over 70.
There were no children on board, to skew the numbers toward the more mild form of COVID-19 that children get. Only old people. Old people who are traveling, tired, away from home, and spending two weeks sitting in their tiny cabins in a floating petri dish being flooded with the COVID-19 virus. And of those 3,711 people, there were 7 deaths.
So of the 3,711 (mostly elderly) people trapped in that worst-case scenario, 0.2% of them died.
Surely we can do much, much better than that 0.2% fatality rate here.
The American population is much younger and healthier than the Diamond Princess passengers, we are not cooped up in a floating petri dish for weeks at a time, we have good health care facilities, and we can respond to problems much more quickly and intelligently than they did.
Plus, huge segments of our population are not seriously threatened by COVID-19. Children, for example.
An article in JAMA from February pointed out that of the 45,000 cases of COVID-19 in China at the time, only 2% were in children, and there were no deaths in children under 10. So far this flu season, we’ve lost 136 children to influenza. But COVID-19 does not seem to threaten kids. On March 8, the Korean Centers for Disease Control and Prevention reported that South Korea had 6,300 cases of COVID-19, but no deaths in anyone under 30.
The World Health Organization has been studying COVID-19 all over the world for months now, and reports: “Even when we looked at households, we did not find a single example of a child bringing the infection into the household and transmitting to the parents. It was the other way around. And the children tend to have a mild disease.”
So children do not seem to act as a vector to give this disease to older family members. And if older family members give the disease to children in the home, children get only a mild form of the disease.
So why are we closing schools? Not due to data or evidence, that’s for sure. “Just to be safe.” Or “out of an abundance of caution – it’s all about the children.”
Ok, but these actions are not without consequences. Much of the hoarding and other unhelpful behaviors we’re seeing right now are not due to fear of the COVID-19 virus, but rather due to fear of ever-increasing government crack-downs on personal liberties.
As Mr. Ginn states, “Infection isn’t our primary risk at this point.”
I’ve spent an enormous amount of time reading, and trying to figure out why we’re responding this way to this virus. I now know a lot more about COVID-19, but I still don’t understand our response.
As I mentioned in a previous post, I think a big part of the problem is that we, as a society, have lost the ability to consider risk-benefit ratios with any semblance of reason or logic. The herd mentality and panic-mongering on social media don’t help. The conventional media earns a living on advertising dollars, so they endlessly repeat the scariest scenarios they can think of, to attract viewers. Politicians, of course, want to exaggerate every problem so they can portray themselves as our indispensable saviors.
There really is no one who is motivated to present a more reasoned perspective. No one.
Plus, people naturally love bad news and are skeptical of good news. A patient can come to me with a headache, I can do a complete history and physical, complete with labs and X-rays, and then finally tell the patient, “You’re fine. Go home and take some aspirin.” And they’ll respond, “Are you sure? I think something’s really wrong…”
Or I can have the exact same patient come in, with the exact same headache, and I can just walk in the door and holler from across the room, “You’ve got brain cancer. You’re gonna die.” And the patient will respond, “I knew it. I just knew it.” They don’t even question me. Because people love bad news.
So, in summary, I think we have a serious problem here, which has no clear solution. A very, very serious problem.
And it’s not COVID-19.
It’s us.
Note: I thank Aaron Ginn for his outstanding article. Please read the whole thing. Some of my writing above was based on (or in a couple of cases, shamelessly plagiarized from) his work. He covers a lot of topics that I skipped, he does a good job citing his sources, and he explains his logic clearly. It’s very long, and I was afraid that most would not read it, so I compiled the above summary. But please read Mr. Ginn’s article. It’s worth your time.
Published in General
It takes several weeks to activate those Hospital ships and most of the beds are not ICU beds.
I have no doubt that it could; therefore, a couple of weeks doesn’t concern me. What concerns me are the statements/predictions that things could/should/will have to go on like this for months. That, I fear, would be something we couldn’t bear – at least a large majority of us couldn’t.
Edited to clear up some grammar mistakes.
Serious question: What’s the difference between an ICU bed and a regular bed? Why does it matter? Can’t regular hospital beds be used the ICU?
There seem to be several causes. S Korea had fewer initial cases concentrated in a smaller area, and they reacted very quickly. None of those applies to the US at this point. It could easily have been very different, if China hadn’t lied for weeks.
China Lied (and continues to lie), and People Died.
I recall that the evacuation flight from Wuhan put the people at March Air Force Base, and that other people brought back by the government were in strict quarantine.
ICU beds also involve specialized equipment – ventilators, etc – and staff.
To paraphrase what I always heard was an Abraham Lincoln quote, “Calling a bed an ICU bed, doesn’t make it one.”
This is primarily my position as well. We simply don’t know enough to make a confident prediction either way.
All we can describe right now are plausible scenarios.
I truly don’t know how I would decide were I governor of, say, Kansas.
Still a lot of possible statistical shenanigans. If someone turned up infected during the quarantine, or after, were they counted as “ship infections?” If not, why not?
Ventilators are integrated into ICU beds? I thought they were freestanding equipment.
An “ICU bed” is not a “bed.”
An “ICU bed” is “the bed, plus the equipment and the people needed to make it an ICU bed.”
It’s the entire system, not the frame and mattress.
Or Louisiana.
Statewide stay at home order (mostly and starting tomorrow night) even though 43% of Louisiana parishes have 0 cases. Only 12% of parishes have cases in double digits or more. 2/64 parishes have triple-digit cases.
I would have liked to be more detailed, but I ran out of word-count.
Of course, without some kind of statewide measure how could you even hope to prevent spreading beyond current locations?
Also, those case numbers are just the KNOWN cases. Unless you’ve tested EVERYONE, you don’t know how many cases actually exist, or where they are. Some locations might have a lot, but if they haven’t been able to test anyone, their “number of cases” is zero.
This may be paranoid, but is anyone suspicious of the WHO report on COVID-19 that came out of their visit to China? It said that transmission needed close contact and mainly occurred within family groups. Yet here we have stories like the meeting of 56 people in Skagit County Washington where there are now 11 confirmed cases and 32 people with symptoms. Obviously this Washington case is just an anecdote and one would hope solid epidemiology went into the WHO report.
But the WHO has been soft on China all along….
I generally agree. Particularly since the largest outbreak location (New Orleans) just wrapped up Mardi Gras. People travel for that. Makes contact tracing hard.
The order expires on Sunday, 12 April. I do think that 3 weeks will reveal the known cases.
Yes, WHO has been in China’s pocket for a while, along with the US media and the NBA.
I don’t recall seeing any numbers detailing instances of patients needing ventilators but none available. Or, for that matter, any numbers that say how many patients were on ventilators but died or how many came off and have recovered. Are there any data like this available?
If it weren’t for cousins who live there I could easily decide what to do about California. Kansas would be more difficult.
I’ll answer this part of your fine response.
I would not say that the situation in Lombardy is catastrophic, at least until you present some figures. The case rate not increasing exponentially, as I’ve repeatedly demonstrated in my other posts. Things are certainly difficult in Italy, and especially in Lombardy.
Why do you claim that the death rate is increasing exponentially? This isn’t backed up with either data or a citation — and on several occasions, I’ve gone and actually check the data, and the claim is wrong. (This isn’t directed specifically at you, Mendel. There have been many people making this mistake, including Dr. Savage.) The increase in the daily death rate, in Italy, has averaged 17.0% over the past 5 days, 19.8% over the 5 days before that, and 34.2% over the 5 days before that. Today’s rate of increase was 13.5%.
That’s precisely the decline that I’ve been repeatedly demonstrating, for about a week now.
I don’t see any evidence for the claim that “Doctors are routinely choosing which patient gets a respirator and which one dies”? I saw Kozak’s video — which was pretty calm, given the description — and it said that it was the hardest-hit hospital in all of Italy, and there was no indication that any doctor was making any such decision.
Data, data, data. I can’t make bricks without clay. (That’s from Sherlock Holmes.)
There’s a lot of misinformation out there. I think that it’s important that we focus on facts that are verifiable and reliable.
3 weeks may be enough to reveal the known cases of people who were initially infected up to now. People initially infected AFTER now, may require ANOTHER 3 weeks AFTER that… and so on…
Then it gets to how seriously are they infected. If 99% of the coronavirus cases are light to no worse than the average winter flu, do we go about identifying the most likely demographics to be susceptible to COVID-19 and continue to isolate them, while letting everyone else get on with their lives, knowing the infection risk + the severity on average so far to patients infected? Or do we extend the blanket restrictions out through the spring and possibly into summer and fall because of the virulence of the virus in certain individuals.
It’s going to be a decision that has to be made, and if the decision is made to relax the current rules, people need to realize that some people after that are going to die of COVID-19, just like people die of flu viruses every year. If the goal is going to be virtually zero deaths in the United States from COVID-19 before the restrictions are relaxed (and if the media is going to hype every death like it’s the JFK assassination), we’re going to be in safe distancing and self-quarantine for a long, long, long time.
Here you go, from the NY Times (a former Newspaper) dated March 12 and updated March 17.
Did you even attempt to go look? I googled it, which brought up Snopes (I know, but since it isn’t about Trump I went ahead) which led to the NYT article.
As it presents evidence against socialized medicine I think you attorneys call that an admission against interest.
I don’t see where this presents as ‘routinely’.
This sounds pretty routine to me at least for this circumstance. “what to do in a period” sounds like routine for now.
It was in the quote above. It certainly doesn’t sound like first come first serve medicine.
How does ‘it presents evidence against socialized medicine’ find application in a period bordering on wartime ‘catastrophe medicine’?
If this is true, we agree:
Israeli doctor in Italy says the standing orders are now not to offer mechanical ventilation to anyone over 60.
because age limit replacing triage is how socialists ration care.
Yes, but according to the Johns Hopkins map, Venezuela has zero deaths so far. Those socialists must be doing something right.
Or they’re doing like China reportedly did, they’re not counting “corona deaths” unless people get into a hospital and test positive before dying. If they keep people out of the hospitals, or just don’t test anyone – or at least anyone who MIGHT test positive – then they can socialistically say “we have no corona deaths.” Even if they are, as another expression goes, “stacking up bodies like cord-wood.”
That was my dig at AP