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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
are these private sector clinicians? or do they work for CDC or public sector?
do you have names of these clinicians?
where were these trials conducted? NYC? Michigan? NJ?
how does the CDC quantify ‘insufficient’?
I saw what looked like a statement by the panel – not shown as a recommendation. The above additional information may explain why they got no positive results – treatment too late to have a strong enough effect.
Edited to add: The trial described in #87 was conducted in the first or second day of the patients testing positive with symptoms before they would have entered an ICU.
Hydroxychloroquine should be first line of defense, i.e. before going to hospital/ER/ICU
I did an edit on my #87.
what was the median age of the patients studied?
and in what country or state?
This is what I fear and why I keep asking when will it all end? Where will we draw the line and let the chips fall where they may? Society can’t continue like this forever.
This website has a lot of good data for Michigan. https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173—,00.html
I believe it is update at 3pm every day. You can find the male/female, age cases and deaths, and it also breaks it down by race.
There’s a good case to be made that the line could be drawn in some parts of the country–perhaps the majority of the country geographically.
But, adding yesterday and today only, there have been 55,000 new cases in the U.S. Yes, I know, New York, New Jersey, etc. But people in those areas migrate and it’s still a lot of infections. Let’s at least keep that in mind when we start drawing lines.
Thanks for the link. This has good information. except for one part. Hispanic/Latino have had zero deaths in Michigan???
I wonder if Michigan is providing sanctuary for illegal aliens from Latin America.
what is a non-hispanic Latino?
Tell you what here’s the link to the 1 hour webinar.
Watch it yourself
Presenters
CAPT Tim Uyeki, MD
Clinical Team Lead
COVID-19 Response
Centers for Disease Control and Prevention
Michael Bundesmann, MD, FCCP
Medical Director of Respiratory Therapy
Pulmonary and Critical Care Medicine, EvergreenHealth
Kirkland, WA
Waleed Alhazzani, MD, MSc, FRCPC
Associate Professor,
Department of Medicine, McMaster University
Hamilton, Ontario, Canada
Clinical Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)
And you know that for a fact.
No, but every doctor that has promoted the idea of its effectiveness from their experience has suggested that it is effective in the first days of symptoms and not effective in the seriously ill in ICU or on ventilators.
Here:
Ingraham’s ‘Medicine Cabinet’ on effectiveness of …
One with a father of Central European extraction who kills a black man in self defense.
Michigan governor Whitmer reversed herself and is now requesting HCQ from national stockpiles. From Fox today:
https://blogs.webmd.com/my-experience/20200331/i-am-a-healthy-31-year-old-with-no-medical-issues-covid19-hospitalized-me-for-8-days?
spoiler alert: she was given hydroxychloroquine and z-pak
do you believe in miracles?
Do you believe one patient is real evidence?
I thought you were a math guy?
we are literally dropping everything for covid 19, this is absolute lunacy
one day we will look back and say we endured covid ‘1984’
Me too. I noticed the two charts are first by race, then ethnicity. I’m behind on knowing my labels.
Standard CDC. Randomized controlled trial will validate the seat of the pants decisions of doctors sometime in 2022.
“Helps” could be defined loosely. Penicillin helps your immune system by killing Gram + bacteria.
A good reason to start the drugs before the patients are in ICU.
The Michigan governor banned HCQ until today. Do you mean the doctors were defying her orders ? Just kidding.
I should be more specific. my limited understanding is that when a virus enters your body, your immune system will sometimes go into overdrive. hydroxychloroquine ‘calms’ your immune system so it can kill the virus or prevent virus cell replication.
I’ve seen it explained this way. Zinc is an element in the treatment. Zinc ions stop the virus from replicating but to do this the zinc ions must find a gateway into the cell. Zinc ions by themselves are not able to penetrate the cell membrane. The hydroxychloroquine is a zinc ionophore that enables passage by the zinc across the cell membrane so the zinc ions then stop virus replication.
Yes, they were defying/ignoring her orders. I was glad to see that, given that I live in Michigan.
That sounds like something I read when Michael Kennedy first pointed us to some links about hydroxychloroquine. (Way back in the stone age, when we made our microscopes out of rocks, I took a microbiology class with a bunch of intense pre-med students. And I once was asked by our genetics professor to teach the genetics lab when he was away. So I appreciate learning a bit more detail than one can get from the average news article. But a lot has been learned since those days and I’ve been away from it for a long time. It’s easy for me to get overwhelmed by too much detail, too.)
Well, here’s some more detail, this is where I got that explanation:
Coronavirus Epidemic Update 34: US Cases Surge, Chloroquine & Zinc Treatment Combo, Italy Lockdown
That presented some information I hadn’t seen before. Thanks.
I still have not seen that anywhere else.