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Day 84: COVID-19 Re-Open America; Safely but Soon
Those of you who have been following this series of posts (Day X: COVID-19….) know that I have been following this story since before the virus escaped the confines of China. The “Day X” reference is back to when the first reported case occurred somewhere other than China — signaling the potential for a pandemic. In the series of posts to date, I have marked the progression of the disease and underscored the fundamental lack of information to guide policy makers even as the demands on the health care system and the sudden deaths made some action imperative. The response of politicians was understandable and predictable –indirectly controlling the disease by directly controlling people. That is an evergreen solution for government regardless of the harm they are seeking to avoid.
The US has fallen prey to this same inclination. But at least our President finds people control abhorrent and seeks solutions to problems that reside within people, not that control them. He needs to be encouraged to continue to do so even as he is getting back-pressure from progressive politicians and their allies and other politicians fearful that people-based solutions will not work.
Tomorrow the President names and officially kicks off a task force to re-open America. That group will be considering a lot of different strategies for doing so. The one I hope they will give support to is the one that Steve Hilton, host of Fox News’ The Next Revolution is promoting. His nine-minute monologue describing it can be found here. But the plan is neatly summarized in three screen grabs from the program:
In Hilton’s monologue, he contrasts this approach with other competing ideas based on more virus testing, virus surveillance and contact tracing, and controlling people with active virus. This virus centric program involves massive population control with periodic (if targeted) lockdowns to suppress contagion. It is complicated, it is expensive, and it will continue adverse economic effects. That is why it is a progressive’s dream come true.
In contrast, the plan that Hilton is promoting focuses on prevalence testing — how many people get infected — and what specific conditions lead to serious illness and deaths. I have addressed the lack of information regarding both of these in prior posts: Day 82: COVID-19 The Missing Chart and Day 68: COVID-19 Comorbidity. No appropriate public policy can be formed without this information — how bad is the disease and who suffers the most? And yet 84 days into the pandemic these are unsettled questions.
But help is on the way if we will accept it. Hilton’s program Sunday night featured the work of academics from Stanford as well as private sector entrepreneurs who have been working on antibody tests and testing to determine the prevalence of infections in the population. If, as is beginning to be suggested by the few places that have attempted antibody testing of populations without regard to them being symptomatic or not, infection is wide-spread, then the risk of serious illness is low, maybe extremely low to a given population. If true, suppression is impossible and wrong-headed. Instead, as Hilton recommends, focus needs to be placed on identifying and protecting the truly vulnerable.
Who are they? We’ve been told without precision that they are the immuno-suppressed and the old with comorbidities. But when those comorbidities are described we don’t know whether they are talking about 100,000 or 100,000,000. @theleft coast referenced in a comment the start of a more precise description:
Ontheleftcoast (View Comment):
Study of over 400o patients looking for criteria linked with bad outcomes from COVID-19:
In the decision tree for admission, the most important features were age >65 and obesity; for critical illness, the most important was SpO2<88, followed by procalcitonin >0.5, troponin <0.1 (protective), age >64 and CRP>200. Conclusions: Age and comorbidities are powerful predictors of hospitalization; however, admission oxygen impairment and markers of inflammation are most strongly associated with critical illness.
“The chronic condition with the strongest association with critical illness was obesity, with a substantially higher odds ratio than any cardiovascular or pulmonary disease,” write lead author Christopher M. Petrilli of the NYU Grossman School and colleagues in a paper, “Factors associated with hospitalization and critical illness among 4,103 patients with Covid-19 disease in New York City,” which was posted April 11th on the medRxiv pre-print server. The paper has not been peer-reviewed, which should be kept in mind in considering its conclusions.
This is a start, but much more work needs to be done. For one, the analysis reported above needs to be converted to laymen’s language. Is “obesity” simply a BMI calculation that any of us can make? Or is it some set of conditions that overweight hints at and is confirmed by other testing? After all, according to Wikipedia —
The obesity rate has steadily increased since the initial 1962 recording of 23%. By 2019, figures from the CDC found that more than one-third (36.5%) of U.S. adults[5] and 17% of children were obese.[6] A second study from the National Center for Health Statistics at the CDC showed that 39.6% of U.S. adults were obese as of 2015-2016 (37.9% for men and 41.1% for women).
The IHME model is currently predicting that with aggressive control over the population only 61,545 people will die of COVID-19. Even if you assume that without controlling the population 100x as many would die, this would be a fraction of the US population that is obese. When you factor in the probability that the IHME prediction is high, this probability disconnect between obesity in the population and COVID-19 death becomes more pronounced. We need a more precise understanding of the comorbidities that when coupled with COVID-19 result in serious illness or death.
When we know that, it will be a much smaller group in need of protection through extreme means. And that is Hilton’s point. Rather than surveil 300 million Americans (the Gottlieb-Apple-Google approach) through their smartphones, focus on what are likely to be under 3,000,000 persons truly at risk and implement voluntary controls to protect them. The nursing home population is about 1.3 million. They reside in controlled locations and protocols can be implemented to minimize the risk to this population. The remainder are persons who can be identified and counseled regarding their risk and decisions can be made with respect to how they will live their lives.
This is a sensible, and American approach. Controlling the lives of all Americans is not.
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
I keep thinking about this: what stopped SARS? I don’t think anyone really knows. It just kind of died out. It’s a coronavirus. Other coronaviruses are common colds and seem perpetual. So which will it be? Again, nobody knows.
With the 2.2 trillion dollar stimulus bill allowing for up to $ 300K to go to a state who has a patient that has been considered to be COVID – you can only imagine how many hospital admins in places like Nebraska will be falling all over themselves to ensure most patients are pronounced victims of the dread disease.
I mean, why have a one or two alarm fire when you can have a three alarm event? Or have a regular old flu case when you can stamp it COVID? There is money to be made, and the CARES Act hillsides are flush with gold!
Steven, it sounds to me that he is not advocating for anything. He is merely explaining how the games are played.
I live some mile and a third from a fire house here in California. My landlord was easily able to keep his insurance due to the fire house proximity he can point to. Two neighborhoods away, people are losing their fire insurance. (Although that won’t kick in til next year, due to emergency regulations now in place.)
You better believe that when it comes to local political offices, people are now voting their pocket books, which involves protecting the ability to insure their homes and businesses.
You seem to be overlooking the fact that the anti malarial hydroxychloroquine is available and should be utilized should an individual get infected with COVID 19. It is criminal that this $ 20 remedy is being pushed aside, mostly at the whim of Big Pharma controlled Dem governors, while people who are suffering from COVID 19 need it.
The drug is used routinely by lupus patients and other with various auto immune diseases. it is also used by many vets who suffered with malaria due tyo being stationweed in Vietnam or othe rplaces where malaria is rampant. opne expposed, you can have re-occurrences months and even years later.
So for people who supposedly have taken a Hippocratic oath to swear up and down we need months long testing of this anti malarial is an abomination.
It is also an abomination that bill gates is leading the way on the testing, because he has already screwed the pouch with regards to how he set up the placebo.
He is also bringing up a discussion of herd immunity, a concept that we were all told in the 1950’s we did not need to consider if we got a vaccine to prevent us being infected with an illness.
Somehow in the 1950’s, missionaries and intrepid travelers could get a series of vaccines and then know that regardless of where they went, they would not be afflicted with polio, smallpox or other items they had been vaxxed against. People who had their jabs could visit Africa, India, the Far East, and South America with confidence even though those places had a mere ten percent vaccine rate for their populations.
Now in a huge effort to continuously make money Big Pharma chortles that a vaccine only works if there is “herd immunity.” Which is absurd on the face of it as it totally twists the entire concept of herd immunity, as well as the principles that lie behind vaccines, on their heads.
Successful isolation of infected persons is given the credit, I think. What works with one virus doesn’t necessarily work with another. It helps if you can easily identify those who are infected.
You are not the only one counting on the vaccine to save our society from total meltdown, but I should point out one glaring fact. Influenza has a vaccine, in fact many of them that they keep tweaking every year, yet tens of millions of Americans still get flu every year and tens of thousands die from it every year. We have never even remotely considered shutting down our private workforce because of it. Pneumonia also has a vaccine that is 45%-80% effective and we still lose somewhere in the range of 50,000 people each year to the disease in the U.S. Common Cold – No vaccine, and an estimated 4,500 die from it every year.
According to my wife’s boss, who is a notable expert in the world of pathology:
He said the SARS virus mutated itself into a harmless microbe during its rampage, in effect committing suicide. I don’t know if that means that there is a harmless version of it moving around the human species today or not.
I am trying to figure out my plans for the summer:
Aesop’s latest:
Then this:
A typical COVID-19 distribution of illness and mortality. The article concludes: “[older] workers could be prioritized to work in lower-risk settings such as telemedicine or clinics for non-COVID-19 patients.“
Great post Steven.
I would add that the vax we have for pneumonia only tangles with one of the dozen or more types of pneumonia – so that vax is only 45 to 80% effective against the one variety.
During this last winter, 2019 to 2020, some 89,000 Americans died from either pneumonia or the flu. But apparently Bill Gates did not feel it was necessary to bribe the WHO into declaring this season’s regular old flu a pandemic. Because vax manufacturers already have that market tied down.
However the COVID 19 vax market is wide open for Gates. So all thinking individuals have to wonder, if he was such a humanitarian, wouldn’t he he be shouting to the skies that COVID 19 patients should be given hydroxychloroquine? (But that anti malarial costs 95% less than the coming vaccine.)
That is my hypothesis. There is plenty of reason to believe that this will happen…
(here’s one: https://www.nejm.org/doi/full/10.1056/NEJMc2009316)
Obviously, the widespread anti-body testing will help with that. But at the end of the day, the biggest sign will be that this thing disappears without giving us much warning. As controversial as it has been to say this, my view of what we’ve seen supports that hypothesis. First, we did all of this social distancing and locking down, which was supposed to flatten our curve and stretch the illness… but in most places, the epidemic seems to have sharply peaked and receded (or is receding) in defiance of our best efforts. In that sense, despite its differences with SARS, it may end up being much closer than we imagined. (and yeah, yeah, I know there are a lot of reasons to say I’m wrong. Time will tell.)
@dannyalexander, correct me if I’m wrong but didn’t you tell us that you came extremely close to losing your mother a few years ago when she contracted a flu that was severely complicated by her pre-existing respiratory problems?
I don’t mean to be callous but why do you feel that the country needs to or can ensure that persons with compromised immune and/or respiratory systems will not suffer or die with COVID-19 when this can happen every year with the various strains of influenza. I can sympathize because I lost my mother 6 years ago in January after she developed pneumonia after contracting the flu but I understand this to be an inevitable situation when dealing with persons over 65 and and those with significant commodities.
We simply can’t wait for a vaccine next year some time. People’s lives are being destroyed right now.
I’ve sent “pre-payments” to my hairdresser and dog groomer (who is raising four, young OPK (other people’s kids)) hoping to help them with their cash flow issues. These are small businesses and I imagine it’s going to be nigh impossible for them to make the rent for their store front. Oh, yeah, they can get “loans” — which have to be paid back. Where’s the money coming from? We can’t live like this.
I have vulnerable kids with serious health conditions. We’re being careful, but Mr. C is still going to work (considered essential services). If he gets furloughed and we lose our insurance, even temporarily? We’re screwed. We have pharmaceutical expenses in excess of $20k/month. We just got a $900+ bill for Little Miss Anthrope’s last 3-month MRI.
It’s our responsibility to do everything we can to protect our kids and ourselves and we’re doing it. I scored more bleach yesterday; we’ve been sewing reusable, washable masks; I have spray bottles of rubbing alcohol and bleach solution on my kitchen counter that I use multiple times per day; and we practice sterile technique every time new things come into the house. It takes me longer to unload the groceries than it does to shop for them. I put the mail on the glass cook top for ease of cleaning and to burn off anything I might have missed. The kids aren’t going anywhere — all their appointments are either by telephone or internet. We’ll live this carefully as long as we need to, but this country has got to get back to work. And soon.
Life has a 100% mortality rate. You do the best you can and adapt in difficult circumstances. That’s all anyone can do, and the government can’t do it for us.
#73 jeannebodine
A key (perhaps *the* key) difference this year is the virulence level — this thing is hyper-transmissible.
See Ontheleftcoast’s comment a short ways up on this thread: Nationally we’re on track to hit the numbers for flu deaths in a bad year but inside of 12 weeks.
With even The Washington Post finally coming around to accepting the high probability that this virus resulted from a lab accident in Wuhan, rather than from some kind of zoonotic event in the main Wuhan “wet market,” the virulence-level issue becomes all the more salient.
Why?
Because researchers into bat-derived coronaviruses at both the China CDC Wuhan branch lab and at the Wuhan Institute of Virology spent the past several years frenetically amassing and cataloging a massive array of heretofore undiscovered coronaviruses from the wild — one estimate puts the CDC lab’s haul at approximately 2000 new coronaviruses collected, for instance.
To me, the significance of this is that I believe the researchers had a mandate from Beijing to find a naturally-occurring coronavirus that could be stealth-deployed among older-generation Uyghurs, presently held in concentration camps in Xinjiang province, for ethnic cleansing purposes with plausible deniability.
In other words, the researchers were tasked with determining which coronavirus in their expanding collection could be optimized for several deployment parameters: They *selected* a novel coronavirus for optimal naturally present transmissibility and lethality attributes — and then they went and goofed up the whole evil genocidal scheme through negligent biosafety practice that turned their tool on Wuhan itself.
So where the risk to my mom’s survival is concerned, by my lights, this time is markedly different.
@Danny Alexander, your Mom seems like a very special person. You are lucky to have her and she’s fortunate to have such a loving son.
Danny- as a hypothetical, let’s say your mom was not at risk, but someone else was. And furthermore, let’s say your mom’s retirement was being reduced to nothing and her job was at stake if this lockdown continues. I think your priorities would change. As Jeanne says, your mom sounds lovely, and she is very lucky to have such a devoted son. But this is about the country as a whole, and there is a lot more to consider. My Dad is 68 and works in a hospital. I pray that he will stay safe. But he goes to work every day because staying 100% safe at all costs is simply not how we are able to thrive as a society or as individuals.
Based on your own post, which …
You have now elaborated on. Still not self-isolation by current (insane) standards, standards you seem to be insisting on for the rest of us.
Still not excusing your demand that the rest of use suffer to prevent exposure of your mother to excess risk.
You seem to be wholly investing, emotionally, in the idea that we should all cower in our homes until a vaccine is available. My point is that life must go on, even without a vaccine, as has been true of all epidemics and pandemics through all the millennia of human history.
Your insistence upon this is entirely understandable, given your circumstances, even though others who have already lost more are capable of still considering the benefit of society as a whole.
And with that, I’ll leave you to your plaintive cries.