What I told my students this evening about COVID-19

Dear students:

“Facts are empowering. Even when the facts are discouraging, not knowing the facts is worse.” — Gov. Andrew Cuomo, New York

 

Data as of March 30, 2020

 

 

Good news:

Some very good things have happened, although very belatedly, since last week:

  1. As of yesterday, President Trump accepted the advice he has been getting for over a month from experts, about the size of the pandemic (at least 100,000 deaths at best), the inadvisability of having different rules for different parts of the US, and the need to extend rigorous social distancing at least until April 30th. He is no longer calling for the churches to be full on Easter Sunday (April 12th) as he did last week.
  2. Diagnostic tests that report results in 5 to 15 minutes have been developed by several laboratories; they are also easier and safer to perform than previous tests. It is possible that massive increases in testing will happen in the next week or two. Promising tests for whether you have had the virus should be available soon. Human (Phase 2) studies are looking at treatments (antibodies from recovered patients, antiviral drugs, etc.) and at vaccine candidates. These are months to over a year away.
  3. The navy hospital ship Comfort has docked today in New York City with 1000 hospital beds and 1200 trained health care professionals. They will take non-COVID-19 patients, allowing hospitals to focus on those with the virus and reduce the spread to other patients. Smaller ships are going to New Orleans and elsewhere. Quite good hospitals have been or are being built in huge convention centers, parks, and fairgrounds in a number of hard-hit cities. Some of these will take COVID-19 patients.
  4. The logistics (supply chain) of ventilators, N95 masks, and other personal protective equipment (PPE) was brought under a nationwide command, including: manufacturing many more of all these; making sure they get where they are most needed, when they are most needed; importing large numbers of needed items from across the world; and figuring out how to sterilize and otherwise safely use them for more than one patient simultaneously (ventilators) or in succession (PPE).
  5. Increasingly effective social distancing throughout the country.

It might be true to say that all these things are “too little, too late,” but I prefer to put the emphasis on “better late than never.” In fact, much better late than never.

Bad news:

  1. The President has continued to spread misinformation that, like his previous misinformation, may be deadly, and to do other things that put people in danger. Yesterday he said it was a mystery how hospitals that used to need 10,000 to 20,000 masks now need 300,000, and strongly suggested something “worse than hoarding” as the reason. Here is the reason: doctors who routinely needed masks for 1 of the 20 patients on their shift now need masks for 19 out of 20. You do the math. Two days ago, he said he had told the Vice President not to return calls from Michigan’s governor because he doesn’t like the way she talks about him. How many people will die in Detroit in the next week or two because of those delays?
  2. Massive widespread testing both for having the virus now and for having had it and gotten over it are needed right now and not yet available.
  3. Military resources for treatment, logistics, and public health measures are still woefully underused. If you say it’s a war, act like it’s a war.
  4. Command and control measures at Federal government disposal for increasing the manufacture and distribution of needed equipment have still not been properly deployed. Many hospitals are already overwhelmed, and more will be. If you say it’s a war… (see above).
  5. Social distancing remains spotty in many places. Some houses of worship (not most) are holding crowded live services. Dense groups of young people are hiking together in Georgia national parks. Some entertainers are holding concerts and encouraging rebellion. Experts say if we do everything right, we can keep the deaths in the US to as few as 100,000-200,000. We are not doing everything right.

We were supposed to “flatten the curve” to save the health care system. Now the peak is coming April 15th or so in the first states. The overwhelming of hospitals will start then (actually, it’s started already) and spread like a wave throughout the country. We must proceed with mitigation and be as ready as we can for those peaks.

Check out the graph. This is what “American Exceptionalism” means today.

See you tomorrow,

Dr. K

 

 

 

3 comments

  1. Misha Pless says:

    At some point I could tell you what we did here in Switzerland, which is a compromise between the early, fast, draconian measures adopted by Korea and China, and the disaster lived in Italy and soon, sadly, the US.

    There is a very interesting statistic regarding Switzerland. This country has the highest ratio of affected/population probably of any country in the world, but one of the lowest fatality rate/positive rate. One can look at this statistic in various ways. One of them oft quoted, is that the Swiss are very organized, emptied hospitals of regular patients, increased the ICU capacity massively to prevent disasters, and have managed to prevent fatalities by advanced modern intensive care. The other is that the distancing/hygiene measures were taken seriously by a very discilined population (minus the young folks who are still roaming around as it nothing is the matter), but also a very early, if gradual, slow introduction of the lockdown, quite early indeed. But the statistics is quite impressive. No chaos here. Society still functions pretty well, despite the fact the Swiss are so to speak sandwiched between two terrible situations, France and Italy, knowing that there is a lot of traffic north-south that “infected” Switzerland, possibly explaining the very high infected population here. To its advantage, Switzerland has a disciplined – and small population. We are even taking care of patients from Italy and France (probably a good political move by a regularly shunned Switzerland by virtue of its relative isolationist tendency. Austria has alos a low fatality rate but also a very low case incidence. Posslby due to the fact they closed their borders hermetically very early.

    One day we will talk about the repercussions of the various models vis-a-vis the various rates, fatality, infection, transmissibillity, etc: isolationism, dictatorship, liberalism, etc.

    In the meantime I will be probably on call to take care of patients with the virus.

    Hugs!

    • Mel says:

      Misha, sorry I missed this. Your report on Switzerland is very important. May I share it with my students? Or an update? Hugs back, Mel

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