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Day 72: COVID-19 When Will This Be Over?
I listened intently to the President’s briefing Tuesday. This was the briefing in which the President and his team were outlining the compelling data that persuaded the President that the shuttering of businesses remain important through the end of April. The data presented were basically threefold: The alternative looks of the epidemic with and without aggressive measures, the IHME chart on epidemic projections for the US with aggressive measures, and the contrast in case growth (controlled for population) between states that started early on aggressive measures (Washington and California) with states that did not (New York and New Jersey).
@cliffbrown included the video of the briefing in his post:“I’m a cheerleader for America”
Here are screen grabs of the 3 charts:
Featured prominently in Dr. Birx’s presentation was the IHME model from the University of Washington. No doubt many people watching heard about it for the first time. We on Ricochet have been discussing it since I posted Day 68: COVID-19 Comorbidity. As has been discussed there are questions about its predictive power. But for policymakers (in the absence of a better tool), the question becomes is it plausible? Are the predictions of the IHME model plausible even though it has to be refined as more data becomes available?
The White House press corps continues to be a miserable group of ideologically driven numbskulls. If they were doing their job the IHME model would not be new to them and they would have spotted the obvious question that I pose in the title post: When will this be over? And there were hints in the presentation that the press never picked up on. First hint: in the chart that the White House put up to contrast the non-intervention versus intervention case — flattening the curve — the endpoint for intervention stretches the epidemic out in time. In other words, the epidemic burns out more quickly if you do nothing than if you try to intervene. So why would you intervene? The White House says “to save lives” but here they are being a little cagey.
Will spreading out the epidemic reduce the number of people who will die from COVID-19, all things being equal? The answer is technically “no” but all things are not equal. If you had an epidemic for which we were fully prepared with whatever efficacious treatments could be applied, then the death rate would be whatever it would be regardless of how long it went on. What was missing for this epidemic was preparation. On day one there was no universal testing protocol, no vaccine, insufficient PPE for both health workers and the public, and no maximally efficacious treatment protocol. So spreading the epidemic out in time buys us weeks to catch up as best we can. No vaccine, but better treatment protocols and improved PPE for the health workers (and the public at some point).
But in another sense the White House is completely accurate when it says spreading the epidemic out in time will save lives: It will save the lives of people in need of treatment for trauma and from diseases other than COVID-19. If the health system is broken by the demands of the epidemic, then more people die from all causes, not just the epidemic disease. What President Trump, then, was persuaded about was that we need the month of April to save the health care system. And that saving the health system was sufficiently important that the economy should be sacrificed for another couple of weeks.
The second hint about how long the epidemic will go on was in the IHME death data. Again, the chart showed the tail going out into July. Maybe today the press is digging into the data and seeing what I inserted at the top of this post: the IMHE projection of when the last death from COVID-19 will be recorded from this current outbreak.
Will the economy be shut down until no more deaths are recorded? No. The irony is that the state with the worst epidemic response will be the lead indicator that it is OK to start re-opening the economy. New York is projected to record its last death from COVID-19 on May 10; California is projected to record its last death from COVID-19 on July 1. In order to record that last death, there will be a decline in the daily growth of cases and death. For New York, it will be as pronounced in the decline as in the rise because its slope is closer to the non-intervention model. Therefore, the signal for decline will be stronger and sooner. Places like California the signal will be weaker and later.
Whether it is the IHME model specifically that the White House is looking to, or simply its plausibility that is useful, is unknown. But the model has to get better as more data is gathered. In the meantime, the shelter-in-place orders will continue. Locally our County order has been updated and extended to May 3. But…and this is a big but…the clarifications they have made as to what are ESSENTIAL BUSINESSES and what are permitted MINIMUM BASIC OPERATIONS for non-essential businesses portend broader economic activity than what the initial order envisioned.
[Note: Links to all my CoVID-19 posts can be found here.]
Published in General
There really are. We should all get together and hang out!
Oh.
Never mind.
Anyway… I think people are putting too much stock into hydroxychloroquine as a cure. Don’t get me wrong, I won’t mind at all if it turns out that it works in a preventative way, since I already take it every day. But I will be more than just unhappy if we run out of it, since I do have to take it every day. It’s not a cure in the sense that it attacks the virus itself, but it’s certainly possible that it can treat the symptoms. It’s not going to make the virus go away though.
Apropos my point. New York orders EMS workers to not bring cardiac arrest patients to hospital if they lack a pulse. These are people that under normal circumstances might have been able to be treated, that are now being subject to triage, because of COVID-19.
Iceland has been doing random testing in addition to testing people through contact tracing. In 9000 tests, they found 1% (90 people) who had the virus and had not been identified by contact tracing. Studies in South Korea also showed that there is not a large, undetected population with the Novel Corona virus.
Data from S Korea has placed the asymptomatic rate at approximately 30%. The sample size in S Korea is nearly 10,000 active cases. However, S Korea labels cases as Severe (0.29%) and Very Severe (0.51%) with no mention of lesser designations.
The Iceland data shows that of the 90 people found via random testing, 45 had no symptoms at the time they were discovered (50% asymptomatic, again – at that time.).
In South Korea, ~60% of total cases have been resolved, with ~58% being discharged from isolation and 1.7% fatality rate.
I think it should be relevant also that we on the West Coast are much more dependent on our personal vehicles for transportation, whereas NYC denizens are more dependent on public transportation. The comparative case of Japan could be instructive, but I’m thinking they don’t get the same exposure to travelers from China as we do. But they are managing with social distancing and face masks.
My wife has rheumatoid arthritis. She has been taking HC for three years now. She takes 300 mg a day. No side effects. The recommendation is 400 mg bid x 1 day, then 200 bid x 7 days. Harmless. I would suggest 200 mg bid for prophylaxis if exposed, like a nurse or doctor. My son is diabetic and a paramedic. I prescribed some for him before the pharmacies ran out. I recommended he only take it if somebody in the family (he has 3 teens) gets symptoms. He doesn’t do many medical calls anymore. He is an engineer (drives the firetruck). If he did a call on a COVID case, I would recommend he do the 7 day course.
Different population density and probably a different population.
There is an unusual side effect on the EKG in some cases. If someone had a history of heart trouble, I would watch the EKG with a Holter monitor.
https://www.ncbi.nlm.nih.gov/pubmed/30400791
No serious cardiac adverse effects were recorded in malaria clinical trials of 35,548 participants who received quinoline and structurally related antimalarials with close follow-up including 18,436 individuals who underwent ECG evaluation. While these findings provide further evidence of the rarity of serious cardiovascular events after treatment with these drugs, they also underscore the need for continued strengthening of pharmacovigilance systems for robust detection of rare drug adverse events in real-world populations. A standardised approach to measurement and reporting of ECG data in malaria trials is also needed.
My niece who is an OR nurse on the Liver Transplant team at Rush Medical in Chicago, has been partly laid off. Now working two days a week.
Just got off a CDC Webinar on clinical treatment of critical Covid 19 patients.
People are not going to be happy with the following recommendation by the panel.
if someone dies from a heart attack, that is acceptable.
but god forbid that anyone dies from covid 19… or is it covid 1984?
hydroxychloroquine helps your immune system fight the virus.
if you test the people who have recovered after taking hyroxychloroquine, the test result will be negative.
an antibody test will show that they have recovered from the virus.
Lesson from this pandemic: ignore the CDC
Well, OK. Taking it if exposed might be a reasonable precaution.
unreal… I guess a liver is less important than testing for covid 19
Would like to see a URL for that.
Thank you, Dr. Kennedy, a man who practiced medicine for over 40 years in ER and ICU in Los Angeles and Orange County and also taught at USC medical school.
I highly recommend his book.
He was also the first ricochet member I can recall who recommended chloroquine, hydroxychlorquine and Remdesivir as viable treatments for covid-19 long before anyone knew what these drugs were.
I still can’t spell or pronounce these drugs correctly.
you still trust the CDC after they botched the test kits and sat on a 2005 report demonstrating the efficacy of anti malaria drugs against the corona virus known as SARS?
who decided that it was insufficient?
I would like to interrogate this individual.
I am a statistician by training which means I can detect p-value BS and ‘statistics, lies and damned lies’
as you wrote before, zip code matters for measuring medical outcomes
i thought cars are evil because they cause climate change and global warming
the Italian model of rationing
covid 1984
One way to avoid trips to ICU is take hydroxychloroquine when you feel sick, fever, unproductive cough, etc.
It may work, it may not work, but it’s worth a shot.
One last thing about clinical trials as conducted by FDA:
Well, yes, of course. That’s why we have the Obama policy instituted formally at HUD to promote increasing the density of major urban areas and building high-speed light rail for traveling for work and leisure in cities like New York. Construction loans and grants and tax-credits are garnered by those applicants who build in the urban areas because they are awarded by accumulating points for various features that almost insure that all will go to projects in the urban metro cities. Ah ha! Covid-19/New York City is what you get.
No offense @kozak, but if I accepted every comment you’ve made on this subject as true, I think I’d be hospitalized with depressive psychosis. Paraphrasing Colonel Nathan Jessup, maybe I can’t handle the truth but I believe there are other possible outcomes because I believe in the human spirit.
Man doesn’t crumple into a heap when faced with a seemingly insurmountable challenge. G-d has blessed man with many gifts which emerge when confronted with an impossible situation. These include instinct, ingenuity, the ability to rise to a challenge, the spark of genius, indefatigability, resourcefulness, the ability to collaborate, and most of all the gift of faith and the power of prayer.
I’m not saying you don’t have the same underlying beliefs and I admit I have less than zero knowledge of the subject but it’s my sincere belief that we will find our way out of this without catastrophic results.
community organizer = central planner
Stephen Smith, a specialist in infectious disease, just completed a trial with patients entering the trial with Covid-19 symptoms, the control group got no drugs and the test group got hydroxychloroquine and azithromycin. At the conclusion of the test (5 days, I think) the record showed significantly better results for fever reduction, cough cessation, and pneumonia presence for the test group as compared to the control group.
,
Did I say I trust the CDC?
I was reporting what was said in a webinar run by the CDC.
The clinicians who are currently treating Covid patients made the presentation. You know, actual patients and recent experience.
They were ICU patients, so they were very ill.
They tried using antivirals and hydroxychloroquine because there isn’t much else that can be done. They didn’t see any miraculous effects.
I’ll just post this and say, we should be getting a very good grip on the mortality rate, that really is and should be the final arbiter….but alas;
Then there’s Italy. There are now nearly (or over, depending on when you read this) 60,000 cases in Italy, and some 5,476 had died as of this writing. The Italians, it’s said, didn’t lock their economy down and are paying an enormous price. And America must lock its economy down or else suffer Italy’s fate.
Really?
You already know about that official study that said 99 percent of the deaths from the Wuhan virus in Italy involved people who already had serious illnesses. It turns out the Italians are tossing as many deaths onto the coronavirus pile as they can; only some 12 percent of the total number being attributed to the virus can be identified as primarily dying of it. In other words, people on death’s door in Italian hospitals are testing positive for this and dying from it, and they’re using the virus as a catch-all, all the while essentially giving up on all their coronavirus patients who are 60 or older, like any good socialized medical system can be expected to do. It was the Italian experience that got policymakers elsewhere in the West and particularly here ready to believe that cockamamie study from Imperial College London, which predicted four million deaths from something the death rate of which continues dropping precipitously the more people are tested for it.
At one point the death rate in the United States was 5 percent. Now it’s barely more than 1 percent, which is a function of testing rather than medicine. Test more people and you’ll find more cases, but the virus will kill whom it kills. Assuming, of course, that those deaths are accurately attributed to the virus, which isn’t really true in Italy, apparently, and certainly isn’t true in China, where they’ve lied about everything having to do with their pandemic.
We’ve gone from testing 7,174 people on March 14 to testing 44,068 on March 21, and — try not to be shocked at this — we’ve seen a giant increase in the number of cases despite a pretty small increase in deaths. By March 28 we’ll likely be testing 100,000 Americans a day, and we’ll end up with huge increases in cases. That’s a known thing, and it’s a good thing, but our mainstream media has proven they can’t handle it responsibly. We will see story after inflammatory story claiming a massive explosion in cases, making for the necessity of an ever-more draconian lockdown of the economy and capturing all of us as prisoners in our homes. Every politician in America will be carried along in this wave of panic, so much so that it will soon be, if it isn’t now, outside of the Overton Window to call for a scaleback in the velocity of the overreaction. Just leaving things in their current stranglehold will be considered by the clowns in the press as “inaction” as the caseload increase produced by the testing mounts.
https://spectator.org/how-many-lives-is-our-national-lockdown-going-to-cost/
Do you trust the CDC and any webinar run by the CDC?