Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Day 68: COVID-19 Comorbidity
The Institute for Health Metrics and Education at the University of Washington has published a prediction for the progress of the COVID-19 pandemic in the US. They are estimating that the peak demand on the health care system will be on April 14. On that date, they are predicting that the death count will be 31,615 and that eventually 81,114 deaths from the disease will be recorded around August. The website also lets you see predictions by the individual states.
Peak demand for healthcare for New York is projected as being on April 6; for California on April 24; for Florida on May 14.
Whatever the accuracy of these predictions at least they are focusing on the right questions: when does our health system need to be ready for the worst strain? what is that need likely to be? how many people will the disease kill? Death is the “sunk cost” of this epidemic. It is terrible, it is tragic, it needs to be minimized, but it is inevitable. Our national strategy has to involve how to get beyond the deaths that will be recorded. Our personal strategy is to reckon with our own risk. And that leads to the subject of comorbidity — thought of the day. (Because there are so many days and so little thought.)
@brianwatt, had an excellent comment on my post about Day 66:
Where is the data of CV-19 deaths by location – people in their homes…people in nursing homes…people in hospitals…people in ICUs – by age and whether they had other underlying or active medical conditions – like cancer, respiratory conditions, diabetes, heart disease, kidney issues (on dialysis) or other health- or immune-compromising issues?
Unless that specific data starts to become published, then universal numbers that treat all segments equally only serves to propagate a panic narrative.
There is a reason that Italy has been adversely affected and why the virus ran rampant in a nursing home in Seattle – because nearly all of the victims were elderly with other underlying conditions and in a facility where the virus could easily and quickly propagate amongst the staff and introduced by visitors who were relatively resistant to the effects of the virus.
We have heard a lot about “underlying issues” and “underlying conditions” that make getting COVID-19 more severe/deadly. One of the tweeted criticisms that Professor Bergstrom focused on Aaron Ginn’s Evidence Over Hysteria, was:
And that is what Brian Watt was talking about. And it needs to be done if we are to get the nation back up and running. Slicing and dicing the data so we know who is most at risk and what we can and should do about it.
And it starts with comorbidity. That is, in medical terms, the presence of an existing disease to which the new disease, COVID-19, is added making the person’s condition worse: accelerating the death-dealing nature of the prior morbidity or creating a new condition, e.g., viral pneumonia, that did not exist in the absence of the new disease. And this is why professional diagnosis, care and/or intervention is required.
A lot of people have some form of existing chronic disease, or morbidity. That fact may or may not place them at greater risk of severe illness or death if they contract COVID-19. But the public needs a better picture of what does. For example, take diabetes. 86 million people have what is called “pre-diabetes” for which they may have been prescribed medication to control it. People with pre-diabetes are at risk to progress to Type 2 Diabetes which, in turn, may progress to a need for insulin injections, kidney dialysis, and/or kidney transplant. Type 1 diabetes starts in children as something they were born with and requires insulin and stringent dietary controls to preserve life.
There are about 1.2 million Type 1 diabetics in the US. I could not find a statistic with regard to the number of people who have been diagnosed with Type 2 diabetes, but given the number of pre-diabetics, that number has to be substantially higher than Type 1 diabetics. And then there is “gestational diabetes”. Between 2 percent and 10 percent of pregnant women develop diabetes during their pregnancies. If they do it predisposes them to develop Type 2 diabetes within 10 years of their pregnancy. All told one can estimate that about 100 million people in the country have some stage of “diabetes.” We hear the experts say that people with diabetes are at greater risk. What does that mean? Disaggregate the data for us.
The same goes for “heart disease” and for “kidney disease” and whatever other comorbidities that alarm the health community with respect to COVID-19. We live our lives by “rules of thumb.” Are we dealing with Category A, Category B, Category C, etc.? In my professional life, I was sometimes nervous about definitive answers. Lawyers are always issuing so many caveats that sometimes a client doesn’t know what actually is the advice. Doctors are doing it, too. Medicines (and TV commercials about medicines) have a long fine print of “don’t use this drug if” list.
I recognize that there is uncertainty, a confidence level that is reflexively modifying the statements of researchers and physicians. But now is the time that everyone just does their best, gives clear guidance and accepts that there will be bad outcomes when someone falls in the margins between Category A and B. As a public we need to accept it so our politicians and health care professionals can accept it.
The perfect is the enemy of the good. Or in this case — what we need to do to get through this.
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
Interesting site, I could wish for more description of the model. They are apparently still loading data, so numbers may change. For instance, my state of Idaho was still listed as having no control measures in force, though there was a partial stay-at-home order last week for the worst county, and then total this week.
OK, finally found the right button to push to see their modeling methodology.
Bad news is that it’s curve fitting, rather than any sort of mechanistic model, with some fairly simplistic assumptions about the impact of various social distancing measures.
Good news is that they’ve used available US and Italian data, with some early Wuhan data, for fitting in a way that seems to make sense. They should be able to improve their model as data comes in, so the site will be worth repeat visits assuming they do so.
Re the remainder of the post, I get the impression that everyone in the healthcare scene is pressed too close to their limits right now to worry about stratifying data in real time. Probably in the retrospective analysis (post mortem doesn’t seem the right phrase just now…)
Rodin, that’s very useful information and a quite encouraging report. Thanks.
The data is available for download, so I’m going to do some analysis and report back, probably in a separate post. The analysis appears quite sophisticated, and is done on a state-by-state basis. There appear to be wide variances between states. Here are a few examples (more to come):
Total US bed shortage 49,292 — 35,301 in NY alone, zero in AZ and CA.
Total ICU bed shortage 14,601 — 6,949 in NY alone, 300 in AZ, 299 in CA.
Total projected deaths 80,114 — 10,243 in NY, 1,687 in AZ, 6,109 in CA.
I want to further analyze the projections by state, which will take a bit of additional time.
State by State Coronavirus numbers for today ( states with high infections)
State/territory
Confirmed cases
Deaths
New York (inc. 1459 3.2%) (deaths 16.1%)
46,094
603
New Jersey (inc. 1949 28.3%) (deaths 33.3%)
8,825
108
California (Inc. 780 19.0%) (deaths 24.3%)
4,885
102
Washington (inc. 518 16.1%) (deaths 15.8%)
3,726
175
Michigan (inc 778 27.0%) (deaths 29.0%)
3,657
92
Massachusetts (inc. 823 34.1% ) (deaths 40%)
3,240
35
Florida (inc. 721 29.1%) (deaths 64.1%)
3,198
46
Illinois (inc. 491 19.3%) (deaths 25.9% )
3,029
34
Louisiana no change? Deaths no change?
2,746
119
Pennsylvania (inc. 127 5.7% ) (deaths 4.5%)
2,345
23
Comments:
•New Jersey: the rate of new infections and deaths is still high although
the info out of NJ has been consistently erratic.
Starting a few days ago, According to the Worldometers site, recovery numbers in the U.S. started a sharp increase and jumped 1,000 per day for the last two days. I would love to see that graphed, but most sites tracking this don’t seem to be tracking recovery numbers (perhaps because it’s not as sensational as deaths?) and Worldometers only shows the previous day’s numbers.
Face masks would have solved most of this contagion problem. This virus is spread by coughs.
The historians will have much to ponder when they study this chapter of American history. Their most perplexing questions will be these: Why couldn’t the most prosperous country the world had ever seen produce enough face masks to protect their people? Why weren’t masks as ubiquitous as disposable latex gloves? The country’s microbiologists certainly understood how upper respiratory diseases are spread. They knew that SARS and MERS and other pneumonia bugs were circulating everywhere. How could they invest as much as they did in health care and preventive medicine without investing in a supply of face masks for their citizens?
Interesting since Worldometers is graphing recoveries for Italy:
Rodin, your best post yet, which is saying a lot. Thank you.
I saw a chart on Reddit. It showed that 20% of emergency room visits are from seasonal flu (approximated by respiratory visits) at its peak. It is also past the peak, which is good.
I heard, but have not confirmed that the famous report out of Imperial College of London now projects 83K deaths, but 3/4ths of those people would not survive 6 months anyway, because of other illnesses.
How could they invest as much as they did in health care and preventive medicine without investing in a supply of face masks for their citizens?
The Obama Administration by law was to stockpile the N95 masks but after the H1N1 epidemic they decided not to, and of course most of that mask production went to China. The basic answer is our health care bureaucracy is incredibly corrupt and politicized and should not be relied upon to do their job at this point.
So were the Bush and Trump administrations. I have yet to see whether this was because the administrations did not submit budget requests, whether Congress failed to approve the appropriations, or whether the funds were appropriated but not spent.
If the Washington study proves relatively accurate it then raises another question. It is based upon an assumption that the intervention measures will have an impact on making the peak sooner, lower, and with a step decline. However, if not enough people gain immunity, what happens once restrictions are eased?
I would be very careful with the US recovery numbers. For instance, I know where the numbers from my state are posted, and they don’t even track recoveries AFAICT. My guess is that what you are starting to see is discharges from hospitals in places where that is tracked, but I’m quite dubious that anyone is tracking those who test positive, are sent home to recuperate, and never present again.
. . . which would suggest there are more recoveries than are being tracked?
But I gather that when you’re sent home to recover, you are also told to quarantine — I mean, no going anywhere — and you aren’t released from that until you can show you ain’t got it. So while obviously recoveries are going to be a lagging indicator, they will naturally have to start increasing two to four weeks after the first surge of cases.
But if you’re just going to say “Look, you’re wrong and we’re all gonna die,” then I’ll leave this thread now, because what I need more than anything right now is positive news.
At least in these parts, IIUC, you are told to self-quarantine for two weeks or until symptoms disappear, whichever comes later. Considering the testing shortage, I don’t think they are retesting.
All I’m saying is that 1) recovery stats between US and other countries are probably not comparable, and 2) it might be more relevant to compare our recovery numbers against serious cases / hospital admissions rather than total positive tests.
Maybe not a Freudian slip, but a Freudian pirouette:
Not as easy to define, even if every country and locality was tracking it the same, or at all. Deaths are easier. Dead is dead, for the most part.
Gumby:
“So were the Bush and Trump administrations. I have yet to see whether this was because the administrations did not submit budget requests, whether Congress failed to approve the appropriations, or whether the funds were appropriated but not spent. “
Please wake up, Gumby. People are dying by the droves because of the criminally negligent behavior of our thoroughly politicized Leftist bureaucracy, and you are trying to excuse their disgusting behavior. The Trump administration has faced a bureaucracy that has repeatedly defied the President’s orders at almost every turn and has stymied the critical response to this COVID-19 crisis. That is a fact only one with Leftist ideological blinders on can’t see.
BTW, please cite verified examples of where the Trump did not respond appropriately to requests for needed supplies. I really question whether you can. Please give no examples from the lying leftist media of CNN, NBC,ABC, CBS, NY Times, Wall Street Journal or the Washington Post. Those media sources have been found to have repeatedly fabricated stories to try to embarrass Trumps and should not be referred to as a reliable reference.
I have no idea of the answer, nor do you. Did I say Trump did not respond appropriately? No, you are making that up. I am not trying to excuse anything but rather simply asking logical questions based upon the information we have, rather than jumping to your ideologically driven conclusions.
I don’t find the finger-pointing about masks to be helpful. We’re Americans, and it’s unlikely that we’d be willing to wear masks, even if President Trump (or Obama) had climbed down each of our chimneys to give us a pack of 100.
We will probably learn from this, and may keep masks handy in the future. I’ve heard (anecdotally) that this was the practice in many Asian countries, which might explain why the outbreak was far smaller in places like South Korea, Japan, and Singapore. It may not have had much to do with aggressive tracing or testing (though it might — this is just speculation). It might have to do with masks.
I don’t put this responsibility on the government. It’s up to us. Perhaps when this is all over, we’ll each keep a supply of masks handy, just in case. With the emergency reserve toilet paper supply, I imagine.
It might also have to do with more reserved cultures. I’ve never visited the Orient, but my impression is that people are more reserved. They tend to bow at you, from about 6 feet away, at least in my (very limited) experience.
Italians, on the other hand, are all about hugs and kisses on the cheek. This part I know.
The French seem to do the cheek-kissing thing. I also had a report, many years ago, from a co-worker who was assigned to France for a while. He described an interesting social practice at the particular French office where he worked. It was considered very important to shake hands with each co-worker, each day, the first time that you saw them that day. We don’t generally do that in the US.
I believe the initial comment was about N95 masks, needed for medical care, not surgical masks which can also be used by the general public. The same stockpile issues exist for face shields and other PPE needed by medical personnel.
We stopped shaking hands on the golf course about 10 days ago. First it was elbow bumps, now it’s a little wave and “nice round.”
BTW, I had four birdies yesterday and shot 77.
@thereticulator, thanks for that. I edited, although I debated. There are those that defend the “all tolled” formulation given a perception that tolling is a form of count. But in the end I accept the meaning of “tolled” as relating solely to the sonic.
The state incidence rates do not seem to correspond to the dates of quarantine/distancing orders—earlier action does not seem to matter much. The more lax Swedes and Dutch do not appear to be any worse off than their more active neighbors.
Thanks so much, @rodin. This post especially has been very helpful, since I live in FL. I so appreciate all the work you’ve done.
This. Do you imagine Americans walking around in masks the way they do in some Asian countries? There’s no way. I can totally see people steering clear of strangers during an outbreak, but that’s about all.
I agree I can’t imagine it but it’s too bad. Numerous studies have shown that the mass wearing of masks in places like Japan has been effective in controlling the spread of the flu. It would make it easier and faster to let people go back to work if they wore masks. I wore one for the first time yesterday.
By the way, while Japanese do tend to be more reserved and quiet, Chinese are much more boisterous and outgoing so while mask wearing does have something to do with culture I’m not sure being reserved is the reason.
I’d prefer wearing masks to the lockdown. If this meant that from now on, whenever I have a cold or the flu, I don’t go out in public without a mask, I probably could adjust. It’ll be easier than adjusting to the results of the $2Trillion bill to socialize our economy.
I much prefer our culture. And I’d rather have the occasional flu than wear a mask all the time. It makes sense for people with serious health problems, but not as a cultural thing.
Speaking of masks….
I got a call from my Chinese Wireless Equipment supplier on Friday. They are sending me a few thousand face masks to help equip my staff.