Confronting the COVID-19 Virus: An ER Doctor’s Thoughts

The insistence on not holding services (from a doctor in Ontario, Canada) isn’t very helpful for a congregation in Nampa, Idaho (where there are only 12 cases statewide and none in our county). FWIW, only one, maybe two of those cases involves hospitalization. When it comes to holding services, at least in (so far) lightly affected areas, we should see more grace from people (doctors or otherwise) with an opinion. Also, Italy’s situation isn’t analogous to the U.S. situation, so naming it as a factual predicate isn’t persuasive. As I understand it, Italy’s infection started with Chinese travelers returning from China, so there was no preparation, no social-distancing, no nothing to limit the initial spread, and my understanding is that their medical system isn’t as good as ours.

As of yesterday the death rate in Germany with over 16,000 plus confirmed infections (plus many more unconfirmed infections) and 44 deaths is .27 of 1%, meaning that in Germany for every 400 confirmed infected persons one will die. The average age of death for Covid-19 is 80. The rate in Italy is much higher because they have one of the oldest populations in the world, a high concentration of old men in Northern Italy where many of the deaths occurred, chronic smoking by the older Italian men, and regular greeting of one another with kisses on the cheek. 75% of all the deaths in Italy were in patients with two or three current chronic illnesses. 24 % of all deaths were in patients with one chronic illness. .08 of 1% of deaths in Italy were in patients with no on-going chronic illness. Also, Italy has single-pay universal health-care which is woefully inadequate for the country already, demanding rationing of health care. The media loves to talk about Italy and totally ignores Germany. We will most likely be closer to Germany or South Korea than Italy when all is said and done. Draconian financial measures will themselves cause hundreds of thousands of deaths. The Cure in some cases could be worse than the Curse. Measured, sensible responses are in order, not panic-driven 24 hour-a-day news broadcasts that cherry pick their info. I have discussed this matter with numerous doctors and health-care officials both in my church and in my family. We are following all our State mandates on the issue and will continue to do so. I pray that all our leaders will see the big picture here. In America we average 38,000 deaths per year from the flu, 39,000 deaths per year by car accidents (many of which are caused by alcohol abuse), 60,000 plus deaths per year in Opioid abuse, thousands upon thousands of murders in our big cities like Chicago and Detroit where I grew up and now live, 800,000 plus abortions per year, countless deaths through alcohol abuse and smoking per year. We just need some perspective here and put numbers in their larger contexts.

Here’s what it looked like a few days ago. As far as I can tell, we are still in the “linear” realm on this graph, and since it’s linear-log (x-y), that means that the epidemic is still growing exponentially. The slope is lower than in Spain, Italy, and Iran, and that means that our Ro (# of people infected by each person who becomes infected) is lower than theirs, but still is > 1. Think standard geometric series, for the math minded, and that’s how (with some modifications) it grows exponentially. As Mike notes, Italy, Spain, and Iran are classic “worst cases” with aging, smoking populations with a lot of personal proximity.

When the curve starts trending concave down (lower rate of increase of deaths), that means that Ro is decreasing as people do what it takes to reduce the infection rate—fewer personal contacts, and lower risk of transmission in each contact. I am watching the data for the U.S., and as of yet, I don’t see this. My take is that we’ve got to keep our foot on the throat of this as much as possible until the curve has turned “concave down” emphatically, as in China. Very grateful that I can work from home as I do this—I think I’ve cut down my personal contacts outside my family by a factor of 3-10, and the likelihood of transmission is down as I distance myself for those contacts I have.

(I’m not an epidemiologist or anything, but this is a fascinating numerical problem for an engineer like myself)

The thing we can do to really throttle Ro; help people understand what drives it, and let them come up with creative ways of “social distancing” that don’t get people killed via things like suicide/depression due to isolation.

I wouldn’t trust the official reported numbers to represent the disease at all. Most places have practically given up on getting testing. The testing failed for this virus. Who knows how many people have coronavirus.

Just this morning LA county announced they are recommending not even trying to test unless knowing really matters.

….and yes, we ought to be raising H*** with those who would sweep the data under the carpet, refuse to test people with obvious symptoms, and the like. But that noted, the data we have indicate that the progression of numbers is the roughly exponential trend we’d expect of a disease that could end up being really brutal. Might as well take it seriously so we can throttle it in its crib.

They don’t have the tests, people, equipment, Etc.

Do you pay attention and read the news at all Bert? Or do you just post stuff?

I just wanted to help you out.

If that’s your version of help, Mark, stop “helping”. Regarding the notion that “most places have given up” on testing, 15 miles from where I sit, the Mayo Clinic is processing thousands of kits per day. You can look it up. Overall test capacity is over 40,000 per day and rising as the CDC gets out of the way and the private sector takes over.

Maybe get some different sources? As I read things, even accounting for the fact that tests are imperfect and not completely available, the data we have indicate an epidemic with classical exponential growth and hence an Ro > 1, not controlled at all. Maybe we should act on this and throttle COVID-19 in its crib.

Dr Birx said unless you had symptoms bad enough to warrant needing to have a diagnosis to get specific treatment, don’t even bother trying to get a test. That was at the President’s daily press conference.

She just got a test for COVID-19 when all she had was a low grade fever. Moreover, six days ago, she noted that there was a “dramatic ramp” in testing capability, but that testing could not guarantee low risk. Which is, after all, what anyone who was awake during health class in high school and remembers the stories learned in history class about how smallpox, the plague, and other diseases sickened and killed almost seemingly without warning.

What you’re doing, Mark, is confusing the ordinary process of triage—the process by which nurses differentiate people who are likely to have serious issues from hypochondriacs and people lesser issues—with a lack of ability to do ordinary tests. Read for understanding, Mark.

I have a 20 year old student in the hospital with pneumonia, with a tube in them to drain their lungs. That’s how bad it is. They took a sample on Thursday to test for COVID. As of this morning no results back…. That is the point. Most people cannot get access to the test, and even if they do take it, they can’t get results. The system is broken. That was and still is the main point.

…as usual, is nonsense. Six times more tests are being administered than COVID diagnoses are being given. The tests are available to those who need them; it’s a process of triage. Yes, in Kansas, you do not have the luxury of having Mayo, Johns Hopkins, Cleveland, and the like in your backyard. It is going to take a day or two to get results back. This is simply how it works for any new disease, or for that matter any disease where the pathology techniques are limited to the “big dogs” like Mayo. You take the sample, prepare it, mail it, let the tests be run, and they send the results back. There is no surprise in what you note here.

Moreover,your student is getting the best care available—the only thing that can be added at this point is some experimental drugs like the antimalarial if indeed he is diagnosed. Take a deep breath, and remember that the best thing we can do at this point is to do our best to limit our social contacts and reduce the risk of transmission at each contact. Those who compare the current status of COVID-19 to the final status of the Spanish flu (etc..) need to get a clue about how epidemics work.

Next step; maybe we need to review our culture’s love of big assemblies of people (petri dishes) like cruises on monster ships, monster hotels, monster cubicle farms in office spaces, public transit, monster buildings like dorms with shared HVAC (we’ve known about Legionaire’s Disease how long and we haven’t figured this out?), and the like.

Never mind… you missed the entire point. But there is no point in continuing.

For completeness, here was the point: You tried to extrapolate numbers you saw somewhere to disease rates. I said the numbers were not reliable because they are not testing widely enough for those numbers to be reliable. I used the LA county health department’s statement to stop testing unless it really mattered to treatment as evidence. I then stated Dr. Birk stated the same thing. I noted they had stopped testing unless the diagnosis really matters. Thus, the official numbers are not reliable as they do not represent the population at all.

As for me living in hick-ville, yes. But I would think a person in the hospital with a tube to their lungs to drain it could get a test result after 5 days. But they cannot. So… this is why I stated they have stopped testing in many areas because the testing is not working.

I didn’t miss the point, Mark. It’s just that out of one side of your mouth, you’re saying that the situation is totally out of the control of our medical system, and out of the other, you’re saying that the controls being placed to reduce the spread of the disease are overkill. Only one of these can be true.

Regarding the claim that the numbers are meaningless, the first response is “and then your numbers would be as well.” The second, more important response is that even incomplete measurements can be quite valuable if they’re tracked as an epidemiologist would track them—as a time series.

And regarding that, COVID infections and deaths are, once again, up on a day by day basis. It is, sad to say, the trend that any person familiar with epidemics would predict if the means of containment (e.g. quarantine) are not working.

Perfect measurement? Of course not. But it’s consistent with what we know about epidemics, and quite frankly, corpses are pretty darned hard to hide.

Joeb, are you trying to say that the LA County health department did NOT SAY to not bother being tested, as I stated? Or that Dr. Birx did not say the same thing? Yes, I know Dr. Birx herself was tested, but that is another point about the hypocrisy of this whole testing thing. Some people get results right away, others wait forever. That is why I clearly stated the testing is failing. But Bert won’t accept that obvious fact.

I saw on the news last night in Virginia it takes 5-7 days to get test results… So they are not doing it unless it really matters to the diagnosis.

How am I wrong in any of that?

And as of this morning my hospitalized friend still does not have test results!

My point was that Bert came on here and made the tremendous analysis that epidemics act like… well epidemics. Brilliant observation sir! Bert misunderstood everything I said. My point was the virus infection rates are worse than detected, but he thinks I am saying it is less.

My point is the testing is so slow and poor that there is likely 10 times or more the infection than the test detects. In other words, probably more than 500,000 people have the virus and it is not being detected. That is my point.