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First, Do No Harm
I do some work for a national corporation that provides various consulting services for medical practices and other medical businesses all over America. We had a big Zoom meeting today, with an update on COVID-19. This corporation has spent an enormous amount of time and money tracking COVID data, partially to assist their clients with planning and management of the crisis, but also to look for business opportunities in all this chaos. I will not share the name of the company, because this meeting was not public. But I’ll share some of their findings because they’re in the public domain and I find them remarkable.
First, the speaker pointed out that physician retirements are way up, and they anticipate that, by the end of 2020, thousands of physicians who were not expected to retire yet will do so. The quarantine has also limited the training of medical students and residents, so there may be a doctor shortage for some time. Also, since we’ve cut way back on joint replacements, MRIs, cosmetic surgeries, bypasses, and so on, hospitals have taken a huge financial hit. He listed hundreds of American hospitals and other acute care facilities that are expected to close and not re-open. Naturally, he saw that as an upcoming opportunity in the market. But that’s his job. Anyway, that’s all interesting, but his death statistics were even more concerning.
If you track the number of American deaths from suicide, alcoholism, drug overdoses, homicide, and similar things, America has a certain number of deaths per month. Since COVID-19 started, we’re over our predicted number by 100,000–250,000 deaths.
We are also anticipating increased deaths from pneumonia, cancer, etc., because of delays in screenings, elective procedures, vaccinations, delayed chemotherapy, and so on. That is a more difficult number to predict, but their best guess was 200,000–400,000 deaths more than would have been expected. Those numbers are large because these are very common causes of death, which is why we put so much time and effort into prevention and early treatment in those fields.
Or, at least, we usually do.
Heck, I had an elderly woman die of a bladder infection because she was scared to come into my office. She thought she was playing it safe, avoiding COVID-19 in a medical office. And a week later, she dies in the ICU of urosepsis. The week before, I could have fixed that with five dollars worth of antibiotics. But she didn’t call. Again, she thought she was playing it safe.
When we limit access to health care, things go wrong sometimes.
Let’s just take those two categories of deaths, and take the midpoint of each range. So, 175,000 additional suicides, drug overdoses, etc. Plus 300,000 additional deaths from pneumonia, cancer, etc., that might otherwise have been prevented. Together, that’s nearly a half a million avoidable deaths, caused by our response to COVID-19. 500,000 people are dead, which would not have been dead otherwise. 500,000 people. Dead. And they’re never coming back.
That’s equivalent to every man, woman, and child in Atlanta. If the Chinese nuked Atlanta and killed every resident of that city, we’d be peeved. But the Chinese didn’t do that.
We did.
Of course, sometimes drastic action is necessary. Which is why I never want to be president. But sometimes, some people must be sacrificed to save many more others. Life is messy.
So how many deaths have been prevented by our response to COVID-19? Probably some. I think. Although I’m really not sure.
Someone on the Zoom call asked that question, and the speaker answered that is was simply impossible even to guess at this point. And he’s right.
Many countries around the world have taken many different approaches to this, with varying levels of competence and compliance, and their death rates don’t seem to correlate to their response. So does national response affect death rates? I would think so. But based on the data we have, it’s really hard to say.
Ok, suppose we can’t figure out how many deaths from COVID-19 we’ve prevented. Fine. How about this – have we avoided more than 500,000 deaths? Perhaps. That’s possible.
But geez – I don’t know.
Note that none of this considers the economic devastation and emotional impact that this has had on hundreds of millions of people. A couple of weeks ago, a patient of mine died alone because the hospital wouldn’t let his wife in the room with him. All I could think was, “There had better be a [expletive] good reason for this…” And perhaps there is.
But geez – I don’t know.
And no one else knows, either. Our data is a mess. Lots of presumptions, guesses, and extrapolations. It will be years before we sort all this out. And we may never really know what happened.
I’m not criticizing our leaders, because they’re trying to make impossible decisions with faulty data. Good luck. I doubt I could do any better.
And I’m not saying that we should have ignored this virus. I’m just wondering how effective our response was. Again, I doubt I could have done any better.
But I predict that 10-20 years from now, when medical students are studying this episode, a lot of our responses are going to look pretty ridiculous in retrospect.
We’ve killed around 500,000 people. So far.
And for what? I’m not exactly sure.
Again, I can understand why these decisions were made, based on the information they had. And I certainly agree that the benefits may have outweighed the price we paid. Perhaps. That’s possible.
But geez – I don’t know…
I keep thinking of the ancient teaching of Hippocrates that is drilled through every medical student’s skull for years:
First, do no harm.
Published in General
Unfortunately I am feeling extremely cynical and depressed today so I am going to say to ensure a political outcome favored by the media. I know that is probably not being fair or public spirited and I’ll probably regret this feeling at some point but there it is.
I hope so. If not, it means we didn’t learn anything.
When I’m not feeling quite as cynical as @raxxalan I blame society’s media-trained tendency to obsessively focus on one topic and one topic only at a time. Over the past decade or so the rapid-fire instantaneous media has trained many people to focus all attention on the topic of the moment, and not to think of other things until the next topic of the moment arises on which to obsess. In the case of the Wuhan virus, the virus was the topic, so it was the object of obsession, and all those other deaths and other consequences and trade-offs are “mere inconveniences” (Dr. Fauci) of no great consequence and not worthy of distracting from the obsessive focus on the virus. We are still seeing it in the going to school debate. All focus is on the virus. No thought to be considered to the tradeoffs of child social, emotional, or educational development, or even really to the actual virus risk profile for children and relatively young teachers.
When like I am feeling rather cynical, politicians and media working together saw an opportunity to soften up the population to be more receptive of their goal of a totalitarian government.
[edited because somewhere between my initial typing and posting I lost most of the text of my comment.]
Thomas Sowell tells an interesting story about this. There was a an airplane that had some trouble landing and a very young child died. Some people thought that maybe airplanes should have seat belts. They hired some mathematicians to crunch the numbers and they figured that the extra ten bucks per ticket for the safety stuff would result in more people and driving would case many more deaths.
Math isn’t very cuddly but it’s real.
Man, I hope it’s real. That’s The goal, of course…
How much of that faulty data is/was due to politics? First, there was the Chinese CCP’s attempt to hide their culpability, both from the world and to their own people. Then there was WHO’s attempt to placate the CCP by helping them obfuscate the data. The CCP has continued to deny investigators the access they need to track down the source of the virus.
Then there was the whole masks will/won’t help misinformation here in the States – driven, at least in part, by a desire to keep masks available for healthcare providers. We’re still in the middle of a debate over the efficacy of hydroxychloroquine – Trump supporters say it works, Trump detractors say it doesn’t.
There is also some concern that federal dollars went to COVID treatment and vaccine researchers based on their influence rather than whether there was solid science behind their proposals.
This whole debacle doesn’t give me a warm fuzzy feeling about government’s ability to deal with difficult issues without letting politics rule. Perhaps the biggest lesson we can learn is to give individuals the best information possible and let them figure out how best to deal with the problem.
These numbers are similar those put out in the UK about NHS avoidance and delays. This is a media driven panic. A panic that can easily be defeated by a strong steady voice by doctors, but very few are speaking out against the panic and those in official positions (eg, Dr. “Death” Fauci) are actively feeding the fear.
I don’t worry about a doctor shortage. The limitations on doctors is artificial and created by the AMA. We can probably break through and legalize tele-doctoring and interstate licensing, which will provide the supply and lower the price while easing access. The Medical industry is very inefficient.
You knocked it out of the park in this discussion of the effects of COVID. Thank you.
This is information every American is entitled to know. Especially for people in states where many people have to self quarantine for three weeks while awaiting the results of their corporation insisted upon COVID testing, with an additional 2 weeks of quarantine after that if the test comes back positive.
It’s the problem of the “seen” versus the “unseen.”
In the airplane vs. car calculation, airplane crashes make headlines and are therefore seen because generally a bunch of people are involved at once. Car crashes of people who chose to drive rather than fly are widely distributed over geography and time, and so we only rarely see in the news those deaths. Also, the car crash deaths of people who chose to drive instead of fly are distributed among the many other types of car crash deaths.
Here the deaths due the virus are counted and tracked and publicized, sometimes because they are concentrated, and also some government agencies seem to encourage the counting as a virus death any death that can in any way be connected to the virus. But the increased deaths from suicide, alcoholism, drug overdose, despair, etc. due to isolation are not specifically tracked, nor are the deaths now and in the future of heart disease, cancer, etc. due to delayed diagnosis and treatment. Plus those extra deaths are mixed in with all the expected (“normal”) deaths from suicide, alcoholism, drug overdose, despair, heart disease, cancer, etc., so they are not readily visible to us.
We see the deaths due to the Wuhan virus. We do not see the excess deaths due to isolation.
Ridiculous and unnecessary. Even when the mostly nationwide clampdown was first started, the peak didn’t happen until the last week in April.
This is based on speculation, but you seize on it as reality.
Here’s more speculation: Efforts to suppress the pandemic have saved millions.
Entirely possible.
But I’m not sure.
Average age covid death > average life expectancy
the original objective was to flatten the curve so hospitals were not overwhelmed
now we panic if we have an increase in positive cases
https://www.americanthinker.com/articles/2020/07/could_face_masks_be_spreading_the_coronavirus.html
I agree with much of your statement, but I think it is incorrect to place the blame on the AMA and doctors. Compared to the insurance industry, doctors are relatively impotent. The insurance industry, largely through the federal government, pretty much controls the practice of medicine in the United States. We would be much better off individually — financially and in terms of health care — if third-party health insurance had never taken over health care. When we each paid out of pocket for our health care, either via personal insurance policies or in cash, we were careful about how that money was spent and had a personal relationship with our caregivers because we were, in fact, their customers. Now we are most often just a time slot on their schedule, and they spend most of the time during the interview communing with the computer monitor rather than with the patient. Of course, this state of affairs was greatly worsened by Obamacare.
I firmly believe if major truths are explained to the next generation of medical students, then the actual fraudulent complicity of all the various players inside The Medical Global Mafia receives some needed sunlight, so the notion that Bill Gates is a benevolent philanthropist will be replaced with a full understanding of his evil.
As Vindana Shiva stated several years ago, Gates is one of a handful of ultra wealthy, ultra powerful humans who relies on the maxim that wealth increases exponentially in relationship to the ability of one’s money to make normal everyday activities illegal.
So it was that about 12 years ago, Gates helped Monsanto get its foot in the door over in India. He or someone he appointed helped fashion legislation inside the Indian government to ensure that Monsanto could distribute its GM cotton seed, with a regulation stipulating that seed could not be saved from the fall harvest to be used in the spring time planting the following year. So that essential normal annual activity was outlawed, with a result that millions of Indian farmers were reduced to bankruptcy, and over 200,000 ended up killing themselves.
It’s not surprising that with Gates having so many proxies inside various governmental agencies & heading up states of The Union, that the normal everyday activity of opening a storefront and having customers is now illegal. So we in America are now having an epidemic of depression, suicide & worse to come, as the actual economic fallout is still a bit postponed by people now using their retirement accounts, or their savings to survive.
Gates has been most patient & savvy in the way he’s set this up. His foundations look to the public as though he is charitable. In reality one purpose the foundations serve is to let him avoid paying his wealth away to the state & fed governments. Then he uses money nestled inside the foundations to support such ventures as Media Matters, thus helping nudge the “legacy media” into offering him continual, warm hearted “interviews” on shows like Good Morning America and Ellen.
In earlier days of COVID,when I could still bear to watch M$Media news, it was interesting to hear some proclamation made about the absolute scientific knowledge of COVID being a 3.4% across all cases Killer Epidemic.
For most Americans, it must have been reassuring to have the media then trot out a Johns Hopkins’ researcher to tell the public the dire news on COVID was accurate. Few Americans realize that Gates had donated 1.2 billions of dollars to Johns Hopkins since 2005, so they amount to a mere subsidiary of Bill Gates.
I love Monsanto. Where it legal, would marry the company and become a geneticist.
Sorry but this is nonsense. The AMA has nothing to do with medical education and it has little to do with anything else in US Medicine. It could have had but the Board of Trustees sold out years ago.
The insurance industry wrote Obamacare. The lobbyists were aided by a bunch of 25 year old lawyers on Pelosi and Schumer’s staffs.
Yep. A Stanford group made similar estimates. In particular, they looked at life-years lost and the number caused by the shutdown was several times that lost in total by the virus.
I went to a one-year post surgery follow up with an orthopedic surgeon in May. I asked him how his practice was doing. He gave me a look that I will never forget as he said, “I’ve been operating on 5 percent income.” He is part of probably the largest orthopedic practice in Illinois. Five percent. He is a compassionate and talented surgeon and if he doesn’t retire now I would be entirely surprised.
I get so sick and tired of government types hyping the number of people in intensive care. How the heck do you think hospitals make any money so they can operate and pay the nurses, orderlies, janitors, etc.? They need the rooms and surgeries occupied by patients. Patients, not clients. But that is another rant.
I just read an article describing the results of voluntary online mental health screenings over the past few months. It contained this gem,
I wonder how much of that burgeoning psychosis is caused by all of the people staying home and smoking plenty of newly-legal weed.
Weed wouldn’t help any, but I would wager the stress could do it all by itself.
I’ve been reading Tell Your Children by Alex Berenson. Lots of evidence that weed can trigger psychosis in some people.
In some people you say. Does THC have differing effects in different people?
Years of life lost due to:
https://thehill.com/opinion/healthcare/499394-the-covid-19-shutdown-will-cost-americans-millions-of-years-of-life
4 authors are:
John R. Birge is a professor at the University of Chicago Booth School of Business.
Ralph L Keeney is professor emeritus in business at Duke University and in engineering at the University of Southern California.
Alexander Lipton is a visiting professor and dean’s fellow at the Jerusalem Business School of the Hebrew University of Jerusalem.
Scott W. Atlas is a physician and senior fellow at Stanford University’s Hoover Institution. Follow him on Twitter @SWAtlasHoover
Or not getting their medications refilled – either out of fear of going to the doctor, lack of money, or lack of insurance because they’ve been furloughed or fired.
Possible but not likely. Also impossible to prove or disprove. This is what makes policy based on speculation dicey . . .
Russ Roberts interviewed Paul Romer on his EconTalk podcast back in May. Romer presented numbers on lockdown side effect deaths very much like the ones you quote from your Zoom conference. Among other things, Romer was adamant that we should have re-opened the schools after that first two weeks of lockdown.
Highly Recommended:
https://www.econtalk.org/paul-romer-on-the-covid-19-pandemic/
My complaint about the politicians entrusted with leading this effort is that they haven’t led all that much. They’ve deferred to one set of experts, but not others. This response has not been well rounded.
Even the politicians in Sweden actually hid behind their head epidemiologist, who later said he was wrong regarding Sweden’s approach and in effect threw the political leaders under the bus.
Yet Sweden is looking pretty good now.
Jon Gabriel and James Lileks @jameslileks and Bethany @bethanymandel, Dr. Bastiat is presently occupying the top four spots on the Main Feed’s most popular list.
I think it’s time to invite him to be a Contributor to our website. :-) :-)