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The Wuhan Coronavirus in Michigan
For the last few weeks, I have been—for the most part—hunkered down at home in south-central Michigan. I drive to my office on the Hillsdale College campus two or three times a week to teach my seminars (“Machiavelli, Erasmus, and More” and “The American Constitutional Convention”) via Zoom. I would like to be able to report that I have used the time I have not spent traveling to deliver talks and participate in conferences in Pittsburgh, at Arizona State, Louisiana State, Harvard, Boston College, and in Portland, ME, to write articles and book chapters and get a start on my next book. But I haven’t. Instead, I have begun reading Decameron with my wife; I have watched season three of “Babylon Berlin”; and I have read article after article on the internet.
I will have to confess that I have not learned much that I did not already know. Xi Jinping and his minions lie and are more than willing to sacrifice the lives of their fellow Chinese in a vain attempt to avoid embarrassment, and the like can be said of the Ayatollah Khamenei, of Vladimir Putin, and of their minions. The CDC is incompetent. The FDA is so wrapped up in red tape that it cannot respond to a genuine crisis. The World Health Organization is profoundly corrupt. The models that epidemiologists construct are not necessarily more reliable than those employed by climate scientists. Donald Trump tends to say the first thing that comes into his head. Michael Bloomberg is a stooge for Xi Jinping. Bernie Sanders is crazy. Joe Biden is senile. Nancy Pelosi and Charles Schumer are attempting to take advantage of a public health crisis to push a partisan agenda, and they resolutely attack the President for foolishness they are guilty of themselves. And, yes, the mainstream press is so irredeemably corrupt that their antics would be an embarrassment to the yellow journalists of yesteryear. I knew all of that before I entered my confinement.
I wish that I could say that I now know a lot more about the Wuhan coronavirus than I knew before the lockdown. But that is not true. Reading what the “experts” say about this epidemic is like reading what the “experts” say about the likely trajectory of the stock market. Those of us who are advanced in age are anxious about both, and there is no consensus about either. In the latter case, prognostication is for the most part always guesswork. In the former case, there are too many unknowns, and guesswork and anecdote are close to all that we have to go on.
Sure, the coronavirus is exceedingly contagious and we cannot rely on herd immunity. But how contagious? Here expert opinion differs, and the evidence is scanty. The same goes for the number of those infected and for the mortality rate. The statistics that we have are not reliable – even where the authorities who compile these statistics are thoroughly honest and decent. We are caught in the same sort of “fog” that we would be trapped in if we were at war, and it is virtually impossible to make intelligent public policy decisions in these circumstances. How much worse is this epidemic likely to be than the worst of the recent flu epidemics? If we only knew . . .
Still, there are a couple of things that one can discern, and here I wish to deploy the evidence from Michigan (such as it is). Take a look at this map. With your cursor, you ought to be able to touch on the various counties and learn how many Michiganders have been diagnosed with the coronavirus and how many have died with it (if not necessarily from it):
As you can see, something like 80% of those diagnosed with the disease and 80% of those who have died live in three contiguous counties – Wayne, Oakland, and Macomb – and most of the rest reside nearby or in the vicinity of Grand Rapids. What the three counties mentioned above have in common is proximity to the Detroit Airport, which is a major hub with a host of direct flights to Asia and to Europe. Southeastern Michigan would appear to be an epicenter for the disease for the same reason that New York City and the nearby counties on Long Island, in upstate New York, and in New Jersey form an epicenter. Had we cut off all international travel earlier than we did and had we shut down domestic air travel early on, this epidemic might have much more easily been contained – and we might have been spared the economic travails now underway. I do not mean to cast blame on anyone – except for Xi Jinping and his stooges at the World Health Organization who bamboozled us. I mean only to point to the conduit by which this epidemic spread.
There are two other patterns worth noticing. In Michigan, men with the disease are far more likely to die than women. The numbers change daily, of course, but the proportions – 57% men, 43% women – are stable. Moreover, senior citizens are especially vulnerable. As of 6 April, those over 60 made up 24.2% of the state’s population and 61% of the fatalities, and the median age of those who die is, as of yesterday, 75 (it has gradually crept up from 71). The fact that women over that age greatly outnumber men over that age adds to one’s impression that men are much more vulnerable. The reason is, I presume, genetic.
There is one other pattern that is evident. A disproportionate number of those who die are African-American. Blacks make up 17% of the state’s population and 40% of those who die from the disease. The local liberals in these parts trace this to racism, but that makes little sense. If anything, there is discrimination here in favor of African-Americans, not against them. The discrepancy no doubt has something to do with place of residence and a lack of social distancing. There is a large African-American population in Detroit, which is densely populated. It may also have a genetic component. The propensity to succumb to particular diseases often does have such a component. Eventually, we will know.
Nothing that I have said here should be surprising. The same patterns are evident elsewhere. Like the flu, the Wuhan coronavirus spreads through social networks, and the older and more decrepit one is, the more likely that, if infected, one will die.
Published in Healthcare
A model is a guess plus an algorithm, and when I heard that Neil Ferguson of Imperial College didn’t want to share his code because it’s thirteen years old, my cynicism spiked.
Professor – can you share a review on Babylon Berlin?
Superb summary. I’m looking forward to this reaching the Main Feed so that I can share it with friends.
lololololo…
Its spelled SChumer Professore….sChumer ala sChmuck…
Dr. Rahe-great post! I discovered that my “free books” app has Decameron, and I have downloaded it to read at my leisure (of which I will have more, after the end of April when I leave my job as a casualty of the virus). We visited last October for the 175th Anniversary and chapel dedication, and I am looking forward to my next job as a Hillsdale Associate here in the Pacific Northwest. I am 71 and supposed to be vulnerable, and cowering at home to avoid getting infected. I am in excellent health, and disinclined to cower, regardless of what the so-called “experts” say.
For some reason, our medical experts are not demanding hydrochloroquine, an anti malarial which is being utilized in every nation from Switzerland across Europe and down to the ultra rich nation of Bahrain.
A lot of hand wringing over the USA’s lack of ventilators, when the health officials in other nations are clearly establishing that early treatment with hydrochloroquine prevents a patient from getting ill enough to require a ventilator.
It also seems that once a person is placed on the ventilator, their chances of survival go way down.
That is a very informative report on the COVID statistics in Michigan, the location of the most afflicted counties, and your observation about international flights. Thank you for posting your insights.
There is no good evidence that HCQ is effective. It was widely touted, and many people seemed to be interested in looking into it, but I haven’t seen anything reported recently. Here is a very recent article from Scientific American summarizing the status of HCQ investigations. It has not been established that HCQ is ineffective, either, so it appears that it remains in the “promising but unproven” category.
I may be quibbling about your last sentence, and I suspect that we agree. I don’t think that ventilators are harmful, and they sometimes help. I think that you are correct, if you mean that once a person needs a ventilator, his chances of survival are not very good. It would definitely be a great thing if there was a drug, or other treatment, that prevented such a progression. HCQ may do so, but I don’t think that we know yet.
How did you like Babylon Berlin Season 3?
I really missed Peter Kurth (Bruno Wolter) as the good bad guy detective from Seasons 1 & 2. What a great role. But he couldn’t credibly do the Superman thing and survive the train explosion.
And the music wasn’t as good. The music in Seasons 1 & 2 were great. (“Zu Asche, Zu Staub” is haunting. And the music from the period was well woven into the story.)
Still worth seeing, but not as good.
But Dr. Rahe, do we now know anything about our great governor that we didn’t know before?
Since COVID 19 is a brand new illness, it’s true we do not have extensive studies about HCQ with relationship to treating COVID patients.
Be that as it may, one of the premier information gathering sites out there, Sermo, is releasing its collection of reports from med clinics, hospitals and doctors around the world (Mainly Europe.)
New York, NY
Largest Statistically Significant Study by 6,200 Multi-Country Physicians on COVID-19 Uncovers Treatment Patterns and Puts Pandemic in Context
April 2, 2020
Sermo Reports on Hydroxychloroquine Efficacy, Rise in Prophylaxis Use; Over 80% Expect 2nd Outbreak
New York, NY– April 2, 2020 – Widespread confusion, conflicting reports, inconsistent testing, and off-indication use of existing/experimental drugs has resulted in no single source of information from the frontlines. To create a centralized and dynamic knowledge base, Sermo, largest healthcare data collection company & global social platform for physicians, leveraged its capabilities to publish results of a COVID-19 study with more than 6,200 physicians in 30 countries.
The study was completed in 3 days. Data covers current treatment and prophylaxis options, timing to the outbreak peak, effectiveness of government responses, and much more. Results of the 1st wave can be found at sermo.com. Multiple study waves including a deeper dive into treatments will be conducted over next several weeks. Sermo is calling all physicians globally to participate.
Key findings; Sermo Real Time Barometer*:
https://www.sermo.com/press-releases/largest-statistically-significant-study-by-6200-multi-country-physicians-on-covid-19-uncovers-treatment-patterns-and-puts-pandemic-in-context/
Treatments & Efficacy
Three most commonly prescribed treatments amongst COVID-19 remedies are 56% analgesics, 41% Azithromycin, and 33% Hydroxychloroquine
Hydroxychloroquine usage amongst COVID-19 treaters is 72% in Spain, 49% in Italy, 41% in Brazil, 39% in Mexico, 28% in France, 23% in the U.S., 17% in Germany, 16% in Canada, 13% in the UK and 7% in Japan
###
Part two on Sermo’s collect4ed data on HCQ:
Hydroxychloroquine was overall chosen as the most effective therapy amongst COVID-19 treaters from a list of 15 options (37% of COVID-19 treaters)
75% in Spain, 53% Italy, 44% in China, 43% in Brazil, 29% in France, 23% in the U.S. and 13% in the U.K.
The two most common treatment regimens for Hydroxychloroquine were:
(38%) 400mg twice daily on day one; 400 mg daily for five days
(26%) 400mg twice daily on day one; 200mg twice daily for four days
Outside the U.S., Hydroxychloroquine was equally used for diagnosed patients with the
mild to severe symptoms whereas in the U.S. it was most commonly used for high risk
diagnosed patients (My comment – those health practitioners operating overseas are using it early on, and the early use of HCQ for patients seems to prevent the need to treat more serious cases.) Full article can be read in Link Offered in Part One of my two comments.
Who Is Sermo?
Reinventing the curbside
Sermo is a “virtual doctors’ lounge” that facilitates medical collaboration and crowdsourcing. From sharing challenging patient cases to asking tough questions, physicians come to Sermo to get the answers and support they need in real time. Today, we have over 800,000 verified doctors spanning 150+ countries – and we’re growing every day!
Could you tell us more about the Michigan protest movement and yesterday’s Lansing protest? Today in Wisconsin, governor Evers extended his stay at home order to May 26th. The protest movement here is organizing and growing quickly.
Good to know people are waking up.
I was amazed to learn on a FB group desiring to end the quarantine here in Calif, that in our state county Public Health officers have a legal right to quarantine sick people, but not healthy people. This means every county in Calif has been in an illegal state of lockdown.
Professor, I’m also in Michigan with relatives working in health care, one in Detroit.
Obesity and diabetes are huge risk factors; strangely it doesn’t seem lung problems are as great. Alcoholics also have high risks/low immunity. And Blacks are over represented in deaths.
Wayne (Detroit) is a high poverty poor heath area to start with and high incidences of both conditions. Wayne rates 83rd of 83 counties in health outcomes in good times, and is the highest concentration of Medicaid in the state. They also have a great health system in Henry Ford. They are using both ventilators and oxygen, and using Hydroxchoriquine but the jury is out. No one is going without care. Everyone who goes to the hospital is treated as a potential COVID case with proper precautions
Hospitals are losing money, even Henry Ford, which is busy busy, because hospitals make money on surgeries, which are way down.
Another aspect of Detroit Metro is that Homeland Security designated them as one of two midwest destinations for people returning from China in February, when screeners did not have testing.
Looking at the 7 health regions of Michigan (cumulative data on the state site), you can see the large difference in cases, ventilator/icu/ bed/ ppe/use and over 80% is in the south heavily populated counties.
The governor seems indifferent to the fact that large areas of the state have been sitting waiting for a big wave of cases/ deaths, and the longer it goes on without evidence the exercise is worth it, the more angry people become. The governor is willing to risk our savings/businesses to save the cities from this virus, and treats us like children.
This paragraph is the best summary of where we are that I have seen lately!
May 26? That’s over a month away. If there’s anything that can be predicted that far in advance, it’s that control freaks will continue to be control freaks.
There’s a Facebook group that some Wisconsinites formed yesterday to organize protests that already has 53,000+ members. It had 31,000+ when I first looked at it at 3pm earlier today.
I wish we had such limits on state power here in Wis. that you have in California. We will make our voices known, though.
I the absence of anything else, isn’t “promising” worth a try given all the other unknown unknowns?
It’s ridiculous. It’s over a week longer than New York’s extension. It’s all the more ridiculous when you look at some of the COVID-19 statistics for Wisconsin:
Total Population of Wisconsin: 5,822,000
Total Number of COVID-19 diagnoses as of 04/16/20 according to worldometers.info: 3875
Percentage of Wisconsin residents diagnosed with COVID-19: 0.067%
Total COVID-19 deaths in Wisconsin as of 04/16/20 according to worldometers.info: 197
Percentage of Wisconsin residents who have died from?/with? (distinction unknown) COVID-19: 0.0034%
Aurora Healthcare, which operates 15 hospitals and more than 150 clinics in Wisconsin, admitted today (because the information was going to be leaked anyway) that it has 112 hospitalized COVID-19 patients total in all of its care facilities. That’s not just Milwaukee, but 112 total in the entire state! Other healthcare providers have patients as well, but it takes a whistleblower/leaker to get that information to the public. Meanwhile, people needing/wanting to see their doctors for other types of healthcare issues are having their appointments, procedures, and surgeries postponed or cancelled by the healthcare companies in Wisconsin because they’re saving all those beds for the spike in coronavirus patients that has yet to appear.
*edited to correct the number of hospitalized COVID-19 patients in Aurora Healthcare facilities (I had it as 106, it’s 112), and I provided a link to my source on that figure (Mark Belling, host of Newstalk 1130 WISN late afternoon show).
Can anyone explain why this did not go directly to the Main Feed? I am a contributor (though not listed as one on this post), and in the past contributor’s contributions went directly to the Main Feed. I looked for a way to write to the editor but could find nothing.
When I see Wayne and Genesee counties, I think poor & urban. I don’t think the airport has anything to do the hot spots.
Here is Oakland County by zipcode (top 2/3 of Oakland County has money). Freep has city-by-city data for Tri-County area.
I have now figured this out. The blunder was, indeed, mine, and I have emailed the editor. So this should get fixed.
I just submitted a piece (this time for the Main Feed) on Governor Whitmer — “The Wicked Witch of the Midwest” –and her recent blunders. It does not describe the Lansing protest. It does provide context.
The big three are located in the Detroit area, and Chrysler is an Italian co., and the Chinese own some auto plants, like Nexteer in Saginaw. According to one engineer, Chrysler’s HQ in Auburn Hills (N of Detroit), see over 10,000 people a day going in and out.
Detroit has international travelers because of the auto industry alone, and as I said earlier, Detroit was an airport designated by Homeland Security to bring people back from China in February for screening.
ask jon gabriel the editor in chief
Great post
I didn’t read the post I looked at the heat map.
The quarantine in the 4 dark red counties ‘may’ be justified.
There is no reason to lock down the rest of the state.
Unless you are Governer half-wit…mer
Regarding the high death rate among blacks in Michigan, my guess is blacks tend to have higher rates of obesity, hypertension, coronary artery disease, smoking Newports, drinking malt liquor (or beer), etc.
Age is a factor but overall health and immune system is more important.
A 99 year old woman in Arkansas recovered after being treated with hydroxychloroquine.
See my new post.
I’m not an epidemiologist, or even a statistician (nor do I play one on TV) but I read somewhere that Ferguson got his initial estimate of the death toll in various countries, including the United States, by looking at the death toll from the 1918 flu epidemic, and then applying the proportion of fatalities to the size of the population then, to what it would look like if the 1918 epidemic hit today. Thus, 675K fatalities, and population of about 103M in 1918, and 2.2M fatalities in a population of 330M in 2020. And somehow, that figure, which apparently factored in no differences between “then” and “now” other than population size, was cast in cement and used to scare the United States out of what remains of its wits and into total lockdown.
And I always thought I couldn’t understand the concept of imaginary numbers. I’ve been in the wrong line of work all my life. If that’s all it takes to be an internationally respected, well-funded, and storied researcher, even I could’a been a contender.
It would have been easier to list the positives. That is shorter to list the positives.