This letter from our local hospital ER doc has been circulating on social media in my town. It is applicable for anyone, anywhere, to read and heed. Note “the surge” section – Anthony
Dear Butte County and all the folks who may under the care of Enloe Medical Center,
I am one of your local Emergency Medicine docs at Enloe Medical Center. So I’d like to take a moment to explain Covid-19 and how and why it is impacting our community.
Specifically, I’d like to go through the basics of the illness and (as a consequence) what Enloe Hospital is doing to meet the coming crisis.The first thing I will mention is that the Covid-19 disaster is an extremely dynamic and changing situation.
Every day at the hospital we are meeting constantly and changing policies–directions from world, federal, and state programs change multiple times per day. This is an unheard of pace of change.Here are the basics about the Covid-19 illness. The virus is highly contagious. It is predicted that eventually, nearly everyone will be exposed and been infected.
A very few very lucky people may not develop any symptoms at all. The vast majority of people will get a mild syndrome of variable symptoms including “flu”–fevers, achy-ness, upper respiratory congestion (ie nose and throat symptoms). Then they will get over it. And probably wonder what the big fuss about it was. Younger children may have an even milder syndrome.
However, during the typical 7 days of mild disease and then another 7 days later, all infected patients will be spreading this virus. If you turn up to the Emergency Department with mild illness, you will be screened (important factors such as vital signs and your oxygen saturation percentage), and likely sent home with 2 important instructions: signs of worsening illness, and strict self-quarantining precautions.
However, if you are unlucky, after the initial mild syndrome, instead of getting better, you may get worse. You may develop worse “flu” symptoms and then pneumonia–filling of the lungs with infected fluid.
These are the patients that will be admitted to the hospital for general care and observation. Once again, the majority of these moderately ill patients will get better.
However, if you are very unlucky, over the next day or two, instead of getting better, some patients will turn for the worse and will develop a form of ARDS (Acute Respiratory Distress Syndrome) whereby the lungs will become completely saturated with fluid and will need to be placed on “life-support”, that is a mechanical ventilator. They will be transferred to the ICU (Intensive Care Unit) until their lungs can recover.
A large proportion of these patients will eventually recover, but some will not.There are some clear risk factors for ending up in the ICU. Older age and baseline medical illness (diabetes, chronic heart disease, chronic lung disease) make it much more likely to go on to ICU-requiring Covid-19 illness. However, even perfectly healthy adults can develop serious illness. Fortunately, younger children are almost entirely spared.The overall picture of this sort of illness is NOT new to the medical community. Most of what I have described above (mild/moderate/ICU levels of illness) can be applied to the Influenza virus, which we have been dealing with for years.
The concerning difference is the infectivity of the Covid-19 virus, and mathematics.Using some basic simplified statistics will yield math that is causing everyone in the hospital to enact drastic measures.
Enloe Medical Center covers roughly 300,000 people in Butte and surrounding counties. As I mentioned everyone will get Covid-19. If only 0.5% of patients who get Covid end up in the ICU, that will be 1,500 patients requiring an ICU. Prior to our Covid planning, Enloe had only 20 ICU beds. 1,500 patients will not safely squeeze into 20 beds. This, my friends, is the SURGE. This was what overwhelmed the hospital systems in China and Italy.
Make no mistake the surge is coming.
So pretty much everything we are doing- all this “social distancing”- is to even out this massive surge of patients and spread them out over time, as opposed to having all of them show up at our hospital at once.And the analysis of China and Italy has produced a clear message. The most effective strategy to mitigate the surge is strict quarantining. Not disease testing. Not experimental medications or specific treatments. Quarantining, social distancing, whatever it takes to slow (not stop, not cure) the spread of disease.
So take quarantining and social distancing seriously, because it will save lives.
And it may be hard to take seriously, because as I mentioned the vast majority of people will only get mild illness. And then they may ask themselves, why did I go through so much trouble, not being able to go to my favorite bar.
Even more seriously, the economy is heading downhill and many people are not getting paychecks. For a mild “flu”. Again, the answer is that all of the sacrifices are NOT for the mildly ill, but for the unlucky ICU bound. And that may be you or your loved one. Picture this:
Scenario One–your loved one is developing ICU level pneumonia. The team of doctors, nurses, and care-givers identify this, treat your loved one and move her to the ICU.
Scenario Two–your loved one is developing ICU level pneumonia. But there is no room in the ICU and she is put on a jury-rigged breathing contraption for life support in the hallway outside of the Emergency Department. Next to 60 other patients in the same situation.
And the message from China and Italy and other countries has been specific–the most effective strategy to avoid Scenario 2 is aggressive quarantining of the mildly ill and EVEN asymptomatic.Employing strong individual efforts to prevent contracting Covid-19 will slow the progression and buy time to smooth the ICU surge– and it may also buy time for doctors and scientists to develop and test treatments and vaccinations.Some common questions that I have been asked–Why can’t I be tested for Covid?
Every day, the hospital is attempting to obtain methods for rapid testing of Covid, but as you might imagine the supply of testing materials is a lot more rare and much more expensive than toilet paper.Another common question is: Does it seem that the hospital is over-reacting? The answer is “We hope so!”
And–don’t forget that hospital workers are at highest risk for exposure and spreading the illness. Which is why we are trying to be so meticulous about infection prevention–don’t be surprised if you end up in the Emergency Department, respiratory issues or other standard ER problems, staff are wearing gowns, masks, and greeting you from a distance. If a hospital worker starts to show symptoms of infection, this will remove him or her from a very limited working pool for a long period of time. And we need every hospital worker we have.
Another comment I would like to make: If you have an elderly family member or loved one with advanced illness, please take the time to appreciate them. And then discuss the possibility that they might develop severe Covid-19 illness. No decision at this time has to be final, but it is better to understand where everyone stands prior to the storm hitting.
Here is another question: When? This is a tricky one, because we do not locally have quick testing for Covid-19. The current wait time to get a test result back is over 1 week. Our first official Covid positive test in Butte County was on Saturday March 21. As of today (Mar 25) there are at least 4 documented positive cases in Butte County, though likely there are many more people who are infected but have not been tested, due to the shortage of testing kits and assays. So people in our community are right now progressing through the contagious but mild symptom stages. We anticipate pneumonia and ICU patients declaring themselves within the next few weeks.
Thank you for reading, and thank you for keeping Chico safer,
Ivan Liang
MD FACEP FACMT
https://www.enloe.org/find-a-doctor/find-a-doctor?id=232
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Perhaps my interpretation is incorrect but looking at Willis’ excellent set of virus graphs by country I do not see a gigantic surge coming in the next two weeks. Using Italy’s data as a reference in the past five days their number of deaths has less than doubled. From 6820 to 10023. The number of daily deaths are fairly stable around 900 a day.
Italy is a week ahead of us from their inception so if the US death rate trend is similar to Italy’s we should expect to see at most a doubling of deaths this week to around 5,000 but nowhere near the 100,000 the experts are forecasting.
I have been following a US projection site to see how accurate it was.
Note US didn’t hit numbers for March31 so this is running high
https://covid19.healthdata.org/projections
Projected peak is 15th April interesting to see if it gets it right.
Because they have been on lockdown for weeks.
People with hypertension have a worse course of Covid-19. Ask your doctor.
Obesity is also risk factor in COVID-19 as it is with hypertension and many other diseases.
Many with hypertension are on ACE inhibitors or ARB medication which messes with the ACE2 receptor where the virus attacks.
Obese people probably have high serum glucose. Glucose competes with vitamin C ( dehydro ascorbic acid ) absorption and interferes with immune response.
Expect to see some Darwinian selection.
Even with treatment?
Just don’t stop taking your medication if you use it all the time.
One of the difficulties in trying to get an accurate picture is that different countries have very different reporting standards. In the UK and in Germany, for example, almost no-one is in “recovered” status. And the German stats have varied wildly. Changes in reporting procedures, perhaps?
If we look at the South Korean experience, from the day the virus becomes a significant problem to the “worst” day in terms of daily cases seems to be pretty much 3 weeks. About 8 days beyond that, the total of “active cases” starts to go down. Of course, few countries are taking the follow-every-case measures the Koreans have. Are there other, better strategies? No-one knows.
From a UK perspective, a repeat of the Korean experience would put the “worst” around April 2, and the El Alamein moment about April 10. There’s still a lot of mopping-up to do after that, of course.
I have spent the last few days gathering data from sources like WorldoMeter, Statista, Covid Tracking Project (US), and numerically reported news from places like NYC and NOLA.
Best place to start analysis is South Korea. Now over 370k tests, over 9600 positives, over 5200 recovered, 158 deaths, new cases down to about 100/day thanks to very aggressive contact tracing, testing, and quarantine. Viral Attack rate with social distancing, widespread testing after contact tracing, and strict positive 14 day quarantine is 2.6%. 20% of positive asymptomatic cases remain asymptomatic after 14 day quarantine; bad news in general, Implies a higher attack rate elsewhere. CFR yesterday ( we know numerator and denominator) was 3.0%—was 3.4% 3/17. It will drop further when you look at yesterday’s active and reported serious/critical (s/c) cases. Will end somewhere around 2%. In Korea up to mid last week, s/c was running a steady 11% of positives.
To understand US or UK potential, some higher end attack rate assumption is more likely, but in what follows I key off SK’s optimistic 2.6%. US population about 327.2 million* 0.026 attack rate* ~2% CFR is ~170 thousand fatalities. Lower than High end of Dr.Fauci’s Saturday range.
There is a second way to back into deaths without knowing CFR, using US data from NYC and NOLA from late last week. First is to know % serious/critical: for NYC 12%, for NOLA 12.6%, both a bit higher than SK. I use 12%. Then you need to know the % that progress to critical (ventilator) because that is where deaths occur. Averaging a Wuhan doctors estimate of 26%, NYC last Thursday 29%, NOLA last Friday 35% gives 30%, 0.3 multiplier. The lead NOLA critical care pulmonologist says about 50% on ventilator under his care are dying. It was 80% in Wuhan. Fatalities multiplier 0.5.
Out of sample multiplier test—as of 3/30, California reported 1034 hospitalizations (s/c) and 138 deaths. 1034*0.3*0.5=155. That is a good enough result because deaths relate to past hospitalizations, which are growing.
Full ‘model’ validation. US presently has 155969 cases and 2854 deaths. 155969*0.12*0.3*0.5=2807 predicted deaths. 98.4% model to actual is good enough for government work.
Future ‘model’ estimate. US has 327.2 million citizens (about, dunno illegals). At SK’s attack rate, future Wuhan virus deaths will be 327200 thousand (k) *0.026*0.12*0.3*0.5= 153k. The middle of what Dr.Fauci estimated on Saturday. If US attack rate is just 25% higher than SK at 0.0325, then expected deaths are about 200k—exactly Dr. Birx most recent Sunday ‘if everything goes nearly perfect’ estimate.
Bad news, and mathematically showing why ‘bending the curve’ to avoid the NYC surge as this physician pleads for is essential.
The president made the right call yesterday, as economically painful as it is.
“Bad news, and mathematically showing why ‘bending the curve’ to avoid the NYC surge as this physician pleads for is essential.
The president made the right call yesterday, as economically painful as it is.”
So, it looks like Dr. Fauci’s numbers are in the ball part, which ought to be an answer for people who seem to think the economic pause was not necessary. Dr. Fauci’s number of 2,200,000 deaths from Wuhan virus if no action was taken to mitigate is probably accurate. So the choice is do what we are doing and hold the number of deaths down to 100.000, or do nothing, let the economy roll, and suffer 2,200,000 deaths.
It looks like a no-brainer to me. I think the economic pause is worth saving 2,100,000 American lives.
Tom
I sent you the links you wanted and you didn’t read them. What’s that all about?
I don’t know what happened, Simon. I refreshed the article you would have put those links in and there was no post from you regarding that. I have no idea why it didn’t show up, if you say you posted it.
So, post it here, and I’ll look it over. But, I should modify my request: I don’t want a link to the New York Times or the Washington Post because all I will get from that is a biased opinion of what Trump said by a leftwing reporter.
The links I want are Trump’s actual words. A transcript or a video. That’s the only time Trump’s words are not distorted, when you hear them from his own lips, and nowhere else.
Trump isn’t perfect, but he’s not nearly as bad as leftwing reporters and you make him out to be.
Transcirpts and videos, please.
Tom
I am not sure why you can’t go back to the original thread which is here:
https://wattsupwiththat.com/2020/03/29/fight-the-virus-not-carbon/#comment-2950575
I don’t really want to duplicate everything and clog this thread, but if you want a clue that all is not well for Mr Trump at this time read this article from National Review (which I am sure you will agree is right wing).
https://www.nationalreview.com/2020/03/president-trump-needs-to-step-up-on-the-coronavirus/
I did go back, Simon, and there was your post!
Well, I see you have provided “quotes” from various news organizations, which, no dobt, have been twisted, or taken out of context. I don’t have time to research every quote and debunk it.
As for your National Review article, here’s the money quote:
“The failures of leadership at the top, however, show no sign of being corrected. In a serious public-health crisis, the public has the right to expect the government’s chief executive to lead in a number of crucial ways: by prioritizing the problem properly, by deferring to subject-matter experts when appropriate while making key decisions in informed and sensible ways, by providing honest and careful information to the country, by calming fears and setting expectations, and by addressing mistakes and setbacks.
Trump so far hasn’t passed muster on any of these metrics. He resisted making the response to the epidemic a priority for as long as he could — refusing briefings, downplaying the problem, and wasting precious time. He has failed to properly empower his subordinates and refused to trust the information they provided him — often offering up unsubstantiated claims and figures from cable television instead. He has spoken about the crisis in crude political and personal terms. He has stood in the way of public understanding of the plausible course of the epidemic, trafficking instead in dismissive clichés. He has denied his administration’s missteps, making it more difficult to address them.”
I completely disagree with that. You’ll notice the writer of the article didn’t point out any specific failures of the president, and as far as I’m concerned, the president has not failed in any aspect of this crisis. You may want to point out specifics, yourself. What does “properly empower his subordinates” mean in this context? I bet you can’t answer that question. This is an opinion piece by someone who obviously doesn’t understand the situation or is deliberately distorting the picture.
As for the “Get it yourself” article in the Hill, here’s the quote:
“Beseeched by governors to use the power of the federal government to get and deliver Coronavirus tests kits, N95 masks, protective gloves and gowns, and ventilators to their states, President Trump declared, “Try getting it yourselves. We will be backing you, but try getting it yourselves. Point of sales, much better, much more direct if you can get it yourself.”
His response — and his approach to the greatest public health crisis in American history — reveals a willful ignorance of, contempt for, and determination to hide behind “federalism,” which along with the separation of powers among the executive, legislative, and judicial branches of government, is a foundational principle of our democracy.”
This is a complete distortion of the facts. Trump did tell the governors to try to get the medical supplies they needed themselves because Trump said it would be quicker for them to do it that way. In other words, it was beneficial to the States to do it this way. You’ll notice the article didn’t point that out, instead it tries to make it look like Trump is refusing the governors or avoiding taking action. Both of which are lies, Simon.
Simon, you are putting too much faith in the opinions of leftwing and Trump-hating journalists.
Btw, the Democrat meme is now that Trump didn’t take action fast enough to quell the Wuhan virus and blood is on his hands. The facts are President Trump set up the public/private network to combat this disease about two days after the first infected person was discovered in the United States around Jan 21. That was about the same time all the Democrats were complaining about Trump’s travel ban of China, which was put in place Jan 31, and Nancy Pelosi was out encouraging people to go to Chinatown and other Democrats were telling New Yorkers they had nothing to worry about from the virus.
Trump was on top of it from the beginning and he is still on top of it. The only thing Democrats were on top of was trying to remove Trump from Office, and opposing him at every turn, during a national crisis. That shows where their priorities are. It has nothing to do with the people of this country, and everything to do with their own political power. Anyone who would vote for a radical Democrat is a fool. And just about all the Democrats are radical Democrats.
I hope that satifies you, Simon. You know, I used to go on Usenet (alt.politics) with article after article from the leftwing news media and I would put the entire article in the post and then I would proceed to debunk every lie in the article. I did that for years because I thought the lying leftwing news media was the most dangerous organization in the nation because of all the lies they constantly tell and the distortion of reality they create, and I thought people ought to know that.
Nothing has changed between now and then, except there are a whole lot more people who are wise to the lies of the leftwing news media now. The leftwing news media’s credibility is in the toilet, and that’s a very good thing. You should be angry at them, Simon, for misleading you.
Btw, I don’t know if WUWT is messing with the comment software, but I have had a couple of posts just disappear lately, and that never happened in the past.
I saw a post this morning where a person said they had a “like” button on their screen, and another person said they had a “more” button on their screen, but I don’t see anything like that.
Of course, I do employ script blockers, but that didn’t prevent me seeing the updated comment software that was installed in the past, so I don’t think it would stop me from seeing changes now, especially since I allow both WUWT and WP.
Oh well, the text is the most important part and I get all that, so it’s all good.
Fauci’s 100 to 200 K deaths is a worst case scenario. He didn’t estimate 2.2 million. That was a UK doc, who backtracked, then backtracked on the backtrack.
About all that can be said now is that the US might suffer more deaths, largely among the old and already sick, with WuFlu (not necessarily from it) than with the 2009 swine flu pandemic, ie 12,000. Whether the toll will be on the order of ten times that bill or not, only time will twll.
“Fauci’s 100 to 200 K deaths is a worst case scenario. He didn’t estimate 2.2 million. That was a UK doc, who backtracked, then backtracked on the backtrack.”
I don’t think that is correct. I think those numbers are the ones Dr. Fauci came up with based on the data he has collected.
Dr. Fauci stated that without mitigation the deaths were estimated to be between 1.6 million and 2.2 million, so he did estimate and publicly state 2.2 million and I doubt that he is using a study that has had doubt cast on it.
Correct me if I’m wrong.
There was no backtrack. The 2.2 million was the figure estimated if NO mitigating action were taken. That is unchanged,
Using the Italy numbers on the US I am going for 50K deaths just based on US ventilator numbers and curve. On current projections you won’t have to make decision not to ventilate certain groups like Italy has. So I expect lower death rate than Italy. New York is supposed to peak April 8-9 so I might revise then.
I hope it will substantially lower with the aggressive use of Drugs.
Unlike you theb people in the Uk are not allowed to use the drugs unless it is for a clinicla trial.
But what is even worse there is none of those drugs available, they appear to have been sequestered by the government.
So Malaria & Lupus sufferers are having a great deal of trouble getting it.
We have watched people talk about the future with Climate Change. Now we are watching it in the medical field.
The problem is that the future is unknowable. And the small amount of data that we can gather about the present is often compatible with a wide variety of possible futures.
For all we know, some unknown tipping point in the climate MIGHT suddenly bring us into a ‘Day after Tomorrow’ scenario. Very unlikely, but no one could rule it out 100%. With Covid it COULD mutate into a much more damaging illness, and that’s probably more likely than the Climate disaster.
The problem that we have is of balancing relative unknown risks. Dr Liang does not have that problem. He has one issue on his mind – he does not want to be working in an overloaded ER where he will have to decide who lives and who dies. So to him, any disruption to society is preferable to placing him in that awful position.
The rest of us will have to make our own minds up about where the balance lies. We might note that bad flu epidemics kill people on their own, and by hospital overflow, in precisely the way that he expects Covid-19 to do. Does this mean that we should shut down our economy each heavy flu winter? Perhaps – I am sure that we could adapt our economy to handle lock-downs if we so wished. But we do not do this at the moment – we don’t even prioritise the one palliative which Dr Liang does not mention – medicines to minimise the worst symptoms without hospitalisation. Perhaps we ought to do that?
I will be watching the mortality stats with considerable interest. It seems to me that the press are hysterical and the experts are responding to them rather than trying to produce a balance. The Imperial College projections were a major example of this. I suppose that we should hope that Dr Liang’s warning is similarly exaggerated, while preparing for it not to be.
There are some things in all this which are quite obvious, Re: “Bending the Curve”.
Other than that trying to make projections based on different countries data is really not usable because THERE IS NO GLOBAL PROTOCOL FOR DATA COLLECTION AND VERIFICATION.
You could be way out in left field and not even know it before the right handed batter sends one the opposite way.
If there is one thing the planet can learn from this virus is how to assess the quality of reported data.
At the moment, it is absolutely not there.
It may be a problem which is resource constrained with fuzzy answers as the only solution, but it is worth admitting and focusing on a better way to report.
In Culpeper Va. the medical center and emergency rooms are nearly empty. They’ve canceled all elective procedures and routine appointments. Small towns and outlying communities have a significant surge capacity. Governors need to use this wisely.
Tom Kennedy
” In Culpeper Va. the medical center and emergency rooms are nearly empty. ”
What a lucky corner… Well, if you have time and money enough to do…
What about visiting those hospitals in Italy and France which are so overloaded that the most vulnerable COVID-19 patients are brought from there to Germany by plane so that they do not have to die?
This is not a joke, I am really serious.
J.-P. Dehottay
Italian ICUs are close to max every winter. They collapsed during the 2017-2018 influenza outbreak. Sounds like they have an endemic capacity problem, but every bozo extrapolates their problems to the rest of the world.
Seriously, when is the next flight to Italy and France?
Really ? Numbers, sources ?
Last I heard Germany had offered to take 45 cases from Italy ( but not straight away ).
Anthony Watts
Thank you very much for publishing Ivan Liang’s impressions, experiences, thoughts and advices, even if imho few of your readers will take them serious.
I read upthread things like
“When Covid numbers start to resemble those of influenza then I’ll consider taking real notice.”
and I’m simply stunned.
Here we have for the current seasonal flu a tiny bit over 300 deaths for … far over 150,000 cases. This is 0.2 %, to be compared with our COVID-19’s death/case ratio of 0.87 for yesterday (1.74 % for the US… and 6.5 % for France).
Hmmmh.
Rgds
J.-P. Dehottay in Germany
A rich country, oh yes, in which a hospital director recently had to provide his medical staff with missing protective clothing and masks – on his own initiative !!! – because neither the federal government in Berlin nor his state government were able to do so in due time.
I agree. Very good letter to print. Everyone needs to read this. I have a daughter who is a doctor and she tells me the next two weeks will tell the tale. Clearly Trumps advisors have convinced him. Good on him for listening.
“Clearly Trumps advisors have convinced him. Good on him for listening.”
Good on you for saying that, Simon.
If you are just looking for flu on the death cert. that is probably at least an order of magnitude too low. Influenza is rarely the actual cause of death, most commonly pneumonia or other complications.
Influenza outbreaks lead to thousands of excess deaths for the year but only hundreds get directly attributed.
You insist on dividing concurrent cases and fatalities, which is NOT the way to work out mortality. You should be a climatologist.
That is my quote. Why not properly cite me? We have had closer to 23,000 influenza deaths (per the CDC) than 300. Covid deaths are just about 3000 (and I don’t believe that number). We disrupt our entire culture for 3000 lives but not 23,000? Huh?
I am an RN with 30 years experience, 12 of those in various ERs. I’ve been on the ‘front lines’ of flu epidemics and I have never seen this kind of over the top response, because it has never happened before. As you are stunned at my take on the issue I am stunned at your ignorance.
By ‘we’ and ‘our culture’ I mean the US. The comparison of influenza deaths between the US and Germany simply underscores the fruitlessness of comparing one nation’s statistics with another’s.
Sorry for all repliers, tired old nurses included.
The yearly death toll for seasonal flu was this year until now 323 by March 29.
The 2017/18 season was heavy, with about 21,500 deaths:
https://www.aerzteblatt.de/nachrichten/106375/Grippewelle-war-toedlichste-in-30-Jahren
Thus, you all see that in Germany the people establishing death certificates are not quite as dumb and ignorant as you ‘suggested’. They really CAN make the distinction. Incredible, n’est-ce pas?
You Americans are really arrogant and think you know everything better. We will see in a few months how your comments then will look like.
Look at Canada’s way of collecting stat for flu and pneumonia (row 6), and you will understand why I have some doubt about your claims concerning flu vs. pneumonia:
https://www150.statcan.gc.ca/t1/tbl1/fr/tv.action?pid=1310039401
I collect the Worldometers data every day at:
https://www.worldometers.info/coronavirus/#countries
Let me just tell you that on March 23, the COVID-19 death toll / case ratio for the US was 1.26 %; for yesterday March 30 it is at 1.93 %.
Again according to Worldometers, the ratio for the seasonal flu in the US is… 0.2 %.
Wether or not you believe in their data and numbers does not interest me at all: this blog is over and over full with comments made by people doubting about everything (their own meaning excepted, of course).
Wait and see, guys ‘n dolls. I don’t feel the need to convince you. That is your job.
Best regards from Germoney
J.-P. D.
Where did it say in the article you linked that those figures came from death certs. ? That is in your head. You are not even aware that you are looking different stats. Your science and understanding does not go beyond reading headlines and “worldometers”. You then start doing your own stats with zero knowledge and think it means you can correct everyone else.
Still waiting for you source of the claim that the sickest in Italy are being flow to Germany and the numbers involved. Last I heard it was a few dozen and “not straight away”.
Compare US stats with a cluster of European countries (Italy, France, Spain, Germany, UK, Switzerland) with the same total population. Current stats 19h45 GMT:
333 314 cases and the US 158 290 (47.5%)
24271 deaths and the US 2930 (12%)
Michael in Dublin
I’m sorry, but your comparison is a bit dangerous, as you mix countries with a low death toll per case ratio (Germany, USA) and such with a high ratio (France, Spain, Italy):
29.03.20 | Cases | Deaths | Dths/Cs
Germany | 62435 | 541 | 0.87
USA | 142460 | 2484 | 1.74
*
France | 40174 | 2606 | 6.49
Spain | 80110 | 6803 | 8.49
Italy | 97689 | 10779 | 11.03
The point more interesting imho is: why is this d/c ratio in the US twice that of Germany?
My layman guess: the column missing (number of tests performed on ‘day – 10’) might explain a lot.
J.-P. D.
It is meaningless to divide today’s cases by today’s fatalities ! That is not you work out mortality of an illness. This can only be done in retrospect when all infected patients have reached an outcome: they either made or they didn’t.
Even more so when the number of *detected* cases is almost directly proportional to the number of people you are testing ( ie test kit availability and use policy ). UK can’t even manage to test it’s own front line staff. It’s a joke.
Greg
” It is meaningless to divide today’s cases by today’s fatalities ! ”
Again 1: thanks for ‘teaching’. Reminds me pretty good ‘Temperatures do not add!’…
Again 2: not the number is of interest, but how it develops over time.
J.-P. D.
Bindidon
While we should try and compare apples with apples, there are grounds for comparison. Outside of areas like NY, there are cities with very low numbers of reported cases in the USA. However, the USA with all its states is like the EU with its many countries. As the percentages of deaths varies between European countries so it varies between states.
The fact is that 51% of coronavirus cases and over 71% of deaths are in 18 countries in Europe. The USA just has about 20.6% of cases and 8.2% of deaths. It may be useful to consider why these differences and whether these would indicate that it may not be as bad in the USA. We will know in a year or two looking back but this may help to temper rash and hasty decisions now.
Hopefully, all of these scenario “projections” are not using the same computer programs that determine global warming scenarios? \sarc off
Is it OK if I am skeptical of this “letter”? It is supposedly written by someone with a Russian first name and Chinese last name living and working in a state known to be inhabited and run by INSANE Leftists bent on supporting ANTI-social behavior and oppressing anyone expressing rational thought.
Most Chinese-Americans have given names from Indo-European or Semitic languages.
Presidential candidate Andrew Yang’s first name is the English version of a Greek original. Former WA governor Gary Locke’s last name is even anglicized.
I was just trying to be a bit humourous. I’m amazed at how many “Hispanic” names there are in South Carolina. Until you do a bit of research and find that the Spanish had settlements along the coast and one of the first … (can’t recall offhand but don’t have time to look it up) was Spanish. Fought in the Revolutionary War I believe.
For those commentators who are all the time looking at one or two numbers, and say
“Oooh! Less people died yesterday than the day before. All is well, the decline started.”
Here is a little stat, showing for five countries, starting with March 23 and ending with March 29:
– cases
-deaths
– deaths per cases ratio ( in %)
If you think that the number for France, Spain and Italy are exaggerated or faked: simply look away.
23.03.20
Germany | 29056 | 123 | 0.42
USA | 43734 | 553 | 1.26
France | 19856 | 860 | 4.33
Spain | 35136 | 2311 | 6.58
Italy | 63927 | 6077 | 9.51
24.03.20
Germany | 32991 | 159 | 0.48
USA | 54881 | 780 | 1.42
France | 22304 | 1100 | 4.93
Spain | 42058 | 2991 | 7.11
Italy | 69176 | 6820 | 9.86
25.03.20
Germany | 37323 | 206 | 0.55
USA | 68211 | 1027 | 1.51
France | 25233 | 1331 | 5.27
Spain | 49515 | 3647 | 7.37
Italy | 74386 | 7503 | 10.09
26.03.20
Germany | 43938 | 267 | 0.61
USA | 85435 | 1295 | 1.52
France | 29155 | 1696 | 5.82
Spain | 57786 | 4365 | 7.55
Italy | 80589 | 8215 | 10.19
27.03.20
Germany | 50871 | 351 | 0.69
USA | 104126 | 1696 | 1.63
France | 32964 | 1995 | 6.05
Spain | 65719 | 5138 | 7.82
Italy | 86498 | 9134 | 10.56
28.03.20
Germany | 57695 | 433 | 0.75
USA | 123578 | 2221 | 1.80
France | 37575 | 2314 | 6.16
Spain | 73235 | 5982 | 8.17
Italy | 92472 | 10023 | 10.84
29.03.20
Germany | 62435 | 541 | 0.87
USA | 142460 | 2484 | 1.74
France | 40174 | 2606 | 6.49
Spain | 80110 | 6803 | 8.49
Italy | 97689 | 10779 | 11.03
As you can see, the major number – deaths/cases ratio – is nowhere decreasing, excepted for the US from March 28 to March 29.
So let us all keep patient, and wait for better numbers. They will come, even if certainly not… tomorrow.
*
Btw: the current deaths/cases ratio for the 2019/20 edition of the seasonal flu in Germany is… 0.02 %.
Rgds
J.-P. Dehottay
Typo
Read
‘ in Germany is… 0.2 %.’
instead of
in Germany is… 0.02 %.’
Germany doesn’t test the dead, so its figures aren’t comparable to those of nations which do.
In Italy, whether you die from or just with Wuhan virus, you’re counted, as Willis has pointed out.
What do you mean with
“Germany doesn’t test the dead…” ??
Some explanation for this brilliant claim? I’m interested.
J.-P. D.
Some countries test those who have died – without a previous coronavirus test – to see if they were infected. I believe Italy ascribes death to the virus even if there is no causal link and they died of another existing medical condition. This, besides the fact we have no idea of the number who have contracted the virus with no or very mild symptoms, complicates comparing numbers. Perhaps only when we have a reliable test of whether someone has been infected and a cross section of the population is randomly tested we will get a much better idea
J.P., I have read elsewhere that when the pandemic broke out Germany had something like 3 or 4 times more ICU beds available in their hospitals than did the UK (as a comparison).
Is this the reason Germany has managed to keep their death rate so low?
Guess what got FDA approval? https://www.washingtonpost.com/business/2020/03/30/coronavirus-drugs-hydroxychloroquin-chloroquine/
That is going to cause a problem for some on here .. we probably need to sort out if we attribute deaths due to the drug to Covid19 or not.
The data in this report reflect events and activities as of March 30, 2020 at 10:30 AM.
All data in this report are preliminary and subject to change as cases continue to be investigated.
These data include cases in NYC residents and foreign residents treated in NYC facilities.
https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-daily-data-summary.pdf
As of yesterday, there are approx. 4000 cases in Italy described as ‘serious or critical’ (source: https://www.worldometers.info/coronavirus/country/italy/) this is at the peak, which has continued at this level for about a week. The population of Italy is about 50 million, which means about 1 in 12,500 are serious or critical, in the country which is right now the hardest hit anywhere. By extrapolation, you will need, at peak, 24 ventilators for a population of 300,000. (This assumes all cases that are ‘serious or critical’ need a ventilator.) Telling the people in your community and those across the country that they need 60 times more ventilators than they actually do is simply causing unwarranted panic. I’m sure you mean well, but please do a bit of research before painting unrealistic apocalyptic pictures.
Italy’s population is 60.5 million, with an unknown number of illegal immigrants as well.
While March 27 was the high death day so far, as Italy reports mortality, the trend since March 20 has been essentially sideways. The disease is concentrated in the north, and has predominantly killed the old and already sick.
Lombardy, like New York, has hundreds of thousands of recent Chinese immigrants, with direct flights to and from Wuhan.
There is some useful information in this story but some fundamental mistakes. The main one is a claim that 100% or nearly 100% will get the virus during this outbreak. That essentially never happens during outbreaks of new diseases. It really isn’t feasible. CoVID does appear to be highly infectious and the perception of large numbers of people potentially spreading it with little or no symptoms is gaining traction. Regardless, there are many factors that limit spread of such a virus to a much smaller segment of the population. These may include inmate immunity by way of genetics, acquired immunity (which might include the role of exposure to other related viruses), and a lot relating to behaviours and environmental factors dictating exposure. We won’t know real numbers till after the fact when we have serologic testing.
“inmate immunity by way of genetics”
Does that assume that criminality is a genetic trail or that we lock people up based on genetic traits such are race? Oops.
Yes sorry. Poor typist and proof reader. Innate immunity.
In the essentially free-range 2009 swine flu pandemic, US infections were estimated at under 60 million, ie fewer than one in five Americans.
With 12,000 people dying with the flu, not necessarily from it. As with WuFlu, mainly the old and already sick.
From the article: “Even more seriously, the economy is heading downhill and many people are not getting paychecks.”
I don’t think it should be put that way. The economy is in a pause. It is not heading any direction right now.
If the economy gets moving soon enough, within the time that out-of-work people are still collecting payments from unemployment or from their employers, then there will be very little harm to the American economy.
Consider that 75 percent of US GDP is generated internally with Americans doing business with other Americans. The other 25 percent of GDP is made up of foreign trade, half of which is between the US and Canada and Mexico. So about 90 percent of the US GDP is generated “locally”.
A couple of months ago everyone had money in their pockets and the economy was booming as a result, and then the Wuhan virus reared its ugly head and the US economy was put on pause. And it’s not really on pause, either, there are a lot of people doing work right this minute.
So, assume a positive scenario, and we find that some of the treatments for Wuhan virus are effective enough to allow the American population to go back to work.
So what has changed between the time the economy went on pause and the time it starts back up? I would submit that not much has changed as far as the American consumer is concerned.
If the U.S. government manages to keep everyone financially viable until the economy opens back up, then American consumers will still have the same amount of money they had to spend when the economy was going good, and they will spend that money and the economy will respond.
No doubt the economic pause has caused numerous disruptions but so far, it hasn’t taken the spending money out of the American consumer’s pocket, and that’s what counts most.
Of course, this will not work for a long period of time. The U.S. government can’t afford to keep everyone whole for too long a period because there won’t be enough money to pass around. The government has put enough money into the system to sustain us for a couple of months, but beyond that, then we are talking about serious damage to the economy.
Get the economy up and running by June 1, and we will be in good shape, imo. The American economy is like a coiled spring ready to be sprung.
There is no such thing as “being on pause”. It costs trillions to run a country, that bit is never “on pause”. If you revenue stream is “on pause” you’re screwed.
Neither is just like putting video on pause while you go grab a beer. Infrastructure collapses rapidly, when you release the “pause” button a lot businesses simply won’t be there to magically switch back on again.
Once you go into repo on your home, no one is going “pause” for you. The blood suckers at the bank will want their pound of flesh.
Perhaps not on pause but there is no underlying structural weakness to the US economy at the moment. While the lost GDP can’t be made up I believe we will recover very quickly.
US is running deficits your projected Fiscal Year 2021 U.S. budget deficit was to be $1.1 trillion. I haven’t seen the number since the stimulus anyone know it?
You can make back the GDP but there is an underlying issue the US like most other countries is hooked on importing junk from China just because it’s cheap.
We have been running deficits forever. While I agree with your point our addiction to deficit spending does not mean that the underlying economy isn’t sound.
“You can make back the GDP but there is an underlying issue the US like most other countries is hooked on importing junk from China just because it’s cheap.”
I think if Trump gets elected in November, and gets a majority in both the House and the Senate, they I would bet money that Trump will address the budget deficits and the national debt. He has talked about the “Penny Plan” or something like that on more than one occasion, so he is thinking about it. The Penny Plan would cut one penny out of every dollar for every government agency. This would exclude the military and probably some other programs, but even so, following a Penny Plan would eliminate the debt in a reasonable amount of time.
If the Democrats hold any political power such as holding on to the House, then you can forget abut reducing budgets. That is not in their DNA.
I think the importing of junk from China is going to change drastically. I heard Nigel Farange say last night that when he goes to buy something in the future, he is going to look to see if it is made in China, and if it is, he is not going to buy it. I think a whole lot of people are going to have that attitude.
I also think the U.S. and probably a number of other nations are going to be moving their supply chains out of China in the future.
China’s leadership screwed things up royally. There will be consequences for them, perhaps even domestically. Some Chinese are so fed up with their leadership that they are calling them liars in public. The head of Wuhan’s hospital said recently the Chinese leadership had misled the world about the Wuhan virus, and now she has disappeared. The Chinese leadership has a lot to answer for, to a lot of people.
If Americans have the same amount of money in their pockets after the pandemic as before, and they will with the stimulus package just passed by Congress, then they are going to resume spending that money and the economy will take off, and all those deficits will be fixed eventually.
The American economy is strong. We can’t find enough workers to fill all the jobs available. Energy prices are very low, and regulations have been cut and that’s why the economy was booming in the first place, and nothing has changed along those lines other than oil is even cheaper now than it was then.
Let Americans out of their houses soon and this economy will resume right where it left off.
I am one of your local Emergency Medicine docs at Enloe Medical Center.
First off, I want to thank Dr. Liang (and others like him) for the difficult work he does. I doubt I would last even 5 minutes in that job.
But (and you knew there would be a but) I wonder if people in that type of job always see the worst possible outcomes. Like the reformed alcoholic who foresees disaster when friends are enjoying a few beers at a local tavern. I’m not saying that’s the case here, I’m just wondering…
“I doubt I would last even 5 minutes in that job.”
Ditto and even being a GP you’d have to ask yourself why is everybody I meet crook or falling to bits?
OTOH I can be out driving somewhere and spot a building and remember building that one. The missus being a retired JP teacher has them calling out to her with prams, toddlers and adolescents in tow nowadays. So each to their own and the docs have to concentrate on the ones that go home fixed I guess. Haven’t had any buildings fall down on me and the missus doesn’t get to meet any of her charges in prison or worse unlike the docs I suppose.
Funny what you fall into or keep climbing out of as I’ve had a few changes of direction and some might say ADHD. Some like the roller coaster and some prefer the quieter merry-go-round for a bit of philosophy.
The 100% infection prediction is absurd. It would be the first disease in recorded human history to do that. The 1918-1920 Spanish flu infected only around 27% of the world population, in much worse hygienic conditions and far less medical support than we have now. During the Black Death in the Middle Ages, it’s unclear what percentage were infected, but certainly not everyone.
Northern Italy has terrible air pollution — https://www.worldnomads.com/travel-safety/europe/italy/pollution-other-health-hazards-in-italy
Thank you for the information. Really the first time I’ve read someone lay out an infection scenario. Being a student of history, I’ve read about the horrific Spanish Flu pandemic and black plague. Isolation and containment appears to be critical in halting massive infections. Patience is needed in enduring this outbreak. As for lethality and spread, I’ll leave others to comment.
Lesson #1 Stay away from the hospital.
Early detection and treatment with malaria drugs, doctors that are familiar with their use, are having good results.
What alerted the Chinese to using malaria drugs against the Wuhan virus was when they saw that lupus and arthritis patients who were being treated with the malaria drug, hydroxychloroquine, were not getting infected with the virus.
It looks like this drug does have the ability to keep one from getting infected. There is a clinical trial for using this drug as a preventative going on right now.
A 101 year old Italian woman reportedly was released from a hospital in Italy 2 days ago after having the Wuhan virus. And a 102 year old Italian male likewise reportedly recovered from the Wuhan virus & went home yesterday.
Maybe these 2 cases are actually the same person being confused by news service press releases. I have no knowledge about the veracity of either case.
If any case is true then I think the factor is immunological genetics. The salient feature in the genome of the extremely old is supposedly related to immunity.
Hispanic flu broke out in May 1918. Don’t count on the Covid-19 epidemic ending quickly. Hispanic flu was also supposed to be “mild flu” when it appeared.
High galactic radiation is conducive to epidemics.
GCRs were low during SARS.
But, who knows? Maybe clouds promote pandemics.
When you have Covid-19 symptoms do not stop taking the medication you are taking. Consult your doctor immediately by phone.