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.

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  1. Ilan Levine Member
    Ilan Levine
    @IlanLevine

    Weeping (View Comment):

    Ilan Levine (View Comment):

    Thanks @drbastiat and @mendel.

     

    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.

    I assume that on the month time scale we will have more PPE, more partially trained staff to assume some of the less detailed work in ICUs, better understanding of how to care for the patients, temporary relocation of some docs & nurses from healthier locales to help docs & nurses in harder hit ones, better executed routine safe behavior by the public, possibly new uses of old medicines will prove helpful, etc., that we will be able to ease off the scale of current measures and start allowing the economy to recover.

    • #151
  2. Barry Jones Thatcher
    Barry Jones
    @BarryJones

    Weeping (View Comment):

    Barry Jones (View Comment):

    Instugator (View Comment):

    kedavis (View Comment):
    So it doesn’t mean that it might take 51 million COVID-19 cases to “swamp” the US healthcare system Just a little over 100,000 at once, could do it.

    I looked at ICU census rates a couple of days ago. There are 95K ICU beds in the US. According to a study in 2005, the vacancy rate on those beds was about 32% or about 30K beds nationwide.

    Problem is, those beds are distributed over the entire country – a pretty big place. So, like what is happening in NY today you don’t really need that many excess cases to overwhelm a particular locality.

    I guess that is why one of the USN hospital ships is heading to NYC Harbor, bringing about 1K extra beds with it.

    It takes several weeks to activate those Hospital ships and most of the beds are not ICU beds.

    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?

     

    The Hospital ships have 80 ICU beds the other beds are open ward type beds(many beds in one large open room) which is generally not the best idea for a highly infectious disease. Open ward beds generally do not have the equipment associated with ICU beds (monitors, ventilators, etc). Also, ICU beds require more staffing per patient than open wards.

    • #152
  3. Full Size Tabby Member
    Full Size Tabby
    @FullSizeTabby

    Barry Jones (View Comment):

    Weeping (View Comment):

    Barry Jones (View Comment):

    Instugator (View Comment):

    kedavis (View Comment):
    So it doesn’t mean that it might take 51 million COVID-19 cases to “swamp” the US healthcare system Just a little over 100,000 at once, could do it.

    I looked at ICU census rates a couple of days ago. There are 95K ICU beds in the US. According to a study in 2005, the vacancy rate on those beds was about 32% or about 30K beds nationwide.

    Problem is, those beds are distributed over the entire country – a pretty big place. So, like what is happening in NY today you don’t really need that many excess cases to overwhelm a particular locality.

    I guess that is why one of the USN hospital ships is heading to NYC Harbor, bringing about 1K extra beds with it.

    It takes several weeks to activate those Hospital ships and most of the beds are not ICU beds.

    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?

     

    The Hospital ships have 80 ICU beds the other beds are open ward type beds(many beds in one large open room) which is generally not the best idea for a highly infectious disease. Open ward beds generally do not have the equipment associated with ICU beds (monitors, ventilators, etc). Also, ICU beds require more staffing per patient than open wards.

    My anecdote is now 25 years old, but when my father spent several weeks in Intensive Care (bacterial infection), the staffing was one nurse per two beds, while the general wards had one nurse per 6 or 8 beds. 

    • #153
  4. kedavis Coolidge
    kedavis
    @kedavis

    And I heard a caller to a radio show talking about how her whole class of nursing school was shut down just before they all would have graduated and been able to go to work.

    It would be nice if certain exceptions could be made.

    • #154
  5. Weeping Inactive
    Weeping
    @Weeping

    kedavis (View Comment):

    And I heard a caller to a radio show talking about how her whole class of nursing school was shut down just before they all would have graduated and been able to go to work.

    It would be nice if certain exceptions could be made.

     

    • #155
  6. Jules PA Inactive
    Jules PA
    @JulesPA

    If thus crisis and shutdown isn’t resolved by Easter, it will appear like a unique tree ring in the workforce because of what has happened in schools, training centers, and colleges. 

    PA legislature just waived the 12-week internship for teachers. Student teachers have lost 50% of their practicum. 

    Sadly, a better solution might have been to create a provisional certificate for those affected, with a requirement to have close mentorship and supervision for a year.

    For now, those hiring those issued any kind of Spring 2020 professional certification would do well to provide close supervision for 1 year. 

    Mark your calendar.

    • #156
  7. Phil Turmel Inactive
    Phil Turmel
    @PhilTurmel

    Jules PA (View Comment):
    Sadly, a better solution might have been to create a provisional certificate for those affected, with a requirement to have close mentorship and supervision for a year.

    Or abolish teacher certification entirely.  Let schools fire the bad ones.

    • #157
  8. Gumby Mark (R-Meth Lab of Demo… Coolidge
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    Phil Turmel (View Comment):

    Jules PA (View Comment):
    Sadly, a better solution might have been to create a provisional certificate for those affected, with a requirement to have close mentorship and supervision for a year.

    Or abolish teacher certification entirely. Let schools fire the bad ones.

    Most public schools can’t.  At the local and state level, the worst public policy decision of the 20th century was to allow public employees to unionize.

    • #158
  9. Bob Thompson Member
    Bob Thompson
    @BobThompson

    Gumby Mark (R-Meth Lab of Demo… (View Comment):

    Phil Turmel (View Comment):

    Jules PA (View Comment):
    Sadly, a better solution might have been to create a provisional certificate for those affected, with a requirement to have close mentorship and supervision for a year.

    Or abolish teacher certification entirely. Let schools fire the bad ones.

    Most public schools can’t. At the local and state level, the worst public policy decision of the 20th century was to allow public employees to unionize.

    This is the NEA monster again. The NEA is perhaps the greatest facilitator of progressive Marxism in America.

    • #159
  10. Gumby Mark (R-Meth Lab of Demo… Coolidge
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    Bob Thompson (View Comment):

    Gumby Mark (R-Meth Lab of Demo… (View Comment):

    Phil Turmel (View Comment):

    Jules PA (View Comment):
    Sadly, a better solution might have been to create a provisional certificate for those affected, with a requirement to have close mentorship and supervision for a year.

    Or abolish teacher certification entirely. Let schools fire the bad ones.

    Most public schools can’t. At the local and state level, the worst public policy decision of the 20th century was to allow public employees to unionize.

    This is the NEA monster again. The NEA is perhaps the greatest facilitator of progressive Marxism in America.

    Yes, but bigger than that.  No public employees of any type should ever have been allowed to unionize.  Even FDR in the 30s recognized that would be a problem.

    • #160
  11. Randy Webster Inactive
    Randy Webster
    @RandyWebster

    Gumby Mark (R-Meth Lab of Demo… (View Comment):

    Bob Thompson (View Comment):

    Gumby Mark (R-Meth Lab of Demo… (View Comment):

    Phil Turmel (View Comment):

    Jules PA (View Comment):
    Sadly, a better solution might have been to create a provisional certificate for those affected, with a requirement to have close mentorship and supervision for a year.

    Or abolish teacher certification entirely. Let schools fire the bad ones.

    Most public schools can’t. At the local and state level, the worst public policy decision of the 20th century was to allow public employees to unionize.

    This is the NEA monster again. The NEA is perhaps the greatest facilitator of progressive Marxism in America.

    Yes, but bigger than that. No public employees of any type should ever have been allowed to unionize. Even FDR in the 30s recognized that would be a problem.

    JFK legalized public sector unions with an executive order.  Even Trump doesn’t have the balls to end them, even if the courts would let him.

    • #161
  12. Gumby Mark (R-Meth Lab of Demo… Coolidge
    Gumby Mark (R-Meth Lab of Demo…
    @GumbyMark

    Randy Webster (View Comment):

    Gumby Mark (R-Meth Lab of Demo… (View Comment):

    Bob Thompson (View Comment):

    Gumby Mark (R-Meth Lab of Demo… (View Comment):

    Phil Turmel (View Comment):

    Jules PA (View Comment):
    Sadly, a better solution might have been to create a provisional certificate for those affected, with a requirement to have close mentorship and supervision for a year.

    Or abolish teacher certification entirely. Let schools fire the bad ones.

    Most public schools can’t. At the local and state level, the worst public policy decision of the 20th century was to allow public employees to unionize.

    This is the NEA monster again. The NEA is perhaps the greatest facilitator of progressive Marxism in America.

    Yes, but bigger than that. No public employees of any type should ever have been allowed to unionize. Even FDR in the 30s recognized that would be a problem.

    JFK legalized public sector unions with an executive order. Even Trump doesn’t have the balls to end them, even if the courts would let him.

    He did it at the federal level where they are a problem but not nearly as bad as at the state and local level which was done by the states and municipalities starting in the 50s.

    • #162
  13. Instugator Thatcher
    Instugator
    @Instugator

    Barry Jones (View Comment):

    Instugator (View Comment):

    kedavis (View Comment):
    So it doesn’t mean that it might take 51 million COVID-19 cases to “swamp” the US healthcare system Just a little over 100,000 at once, could do it.

    I looked at ICU census rates a couple of days ago. There are 95K ICU beds in the US. According to a study in 2005, the vacancy rate on those beds was about 32% or about 30K beds nationwide.

    Problem is, those beds are distributed over the entire country – a pretty big place. So, like what is happening in NY today you don’t really need that many excess cases to overwhelm a particular locality.

    I guess that is why one of the USN hospital ships is heading to NYC Harbor, bringing about 1K extra beds with it.

    It takes several weeks to activate those Hospital ships and most of the beds are not ICU beds.

    So my original comment was on 22 March and the USN Comfort just sailed into NY harbor. 

    • #163
  14. Bob Thompson Member
    Bob Thompson
    @BobThompson

    Instugator (View Comment):

    Barry Jones (View Comment):

    Instugator (View Comment):

    kedavis (View Comment):
    So it doesn’t mean that it might take 51 million COVID-19 cases to “swamp” the US healthcare system Just a little over 100,000 at once, could do it.

    I looked at ICU census rates a couple of days ago. There are 95K ICU beds in the US. According to a study in 2005, the vacancy rate on those beds was about 32% or about 30K beds nationwide.

    Problem is, those beds are distributed over the entire country – a pretty big place. So, like what is happening in NY today you don’t really need that many excess cases to overwhelm a particular locality.

    I guess that is why one of the USN hospital ships is heading to NYC Harbor, bringing about 1K extra beds with it.

    It takes several weeks to activate those Hospital ships and most of the beds are not ICU beds.

    So my original comment was on 22 March and the USN Comfort just sailed into NY harbor.

    Any sailor worth his salt would have recognized several weeks ago that these hospital ships might be needed.

    • #164
  15. Stad Coolidge
    Stad
    @Stad

    MarciN (View Comment):
    I wish his advisers would read your comment here and pull back on the quarantine measures that are killing the economy. Killing jobs and businesses will have longer-lasting dire effects than the virus will.

    Even if that happens, it’s the governors who are putting severity into the restrictions.  Trump could give a green light tomorrow, but the New York vs. Rest of New England lawsuit will go forward, restrictions in place . . .

    • #165
  16. Bob Thompson Member
    Bob Thompson
    @BobThompson

    Stad (View Comment):

    MarciN (View Comment):
    I wish his advisers would read your comment here and pull back on the quarantine measures that are killing the economy. Killing jobs and businesses will have longer-lasting dire effects than the virus will.

    Even if that happens, it’s the governors who are putting severity into the restrictions. Trump could give a green light tomorrow, but the New York vs. Rest of New England lawsuit will go forward, restrictions in place . . .

    You can observe the weakness in some career politicians and some bureaucrats when it comes to decisions related to controlling the pandemic versus destroying the economy. The mayor of NY told New Yorkers to go out to the movies  in early March. The New York Public Health Administrator told New Yorkers in late February that the coronavirus should not keep anyone from gathering at the Chinese Festival, I guess for the New Year. The mayor of New Orleans said the federal government did not advise her to cancel Mardi Gras. These decisions were made in favor of the economy. In Texas there was a music festival in Austin and a rodeo in Houston that were canceled in favor of the virus. But as soon as President Trump suggests we need to open the economy, watch the media.

    • #166
  17. Instugator Thatcher
    Instugator
    @Instugator

    Bob Thompson (View Comment):
    The mayor of NY told New Yorkers to go out to the movies in early March.

    Hey, No fair telling us what de-commie-oh said before.

    /Sarc off

    • #167
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