I think that the opening of Daniel Henninger’s Wall Street Journal column has it about right:
The threat in March of a Covid-19 apocalypse worked: From coast to coast, the $21 trillion U.S. economy essentially shut down. Today in all 50 states, the experience with coronavirus has peaked, plateaued or fallen, and the time has arrived to start identifying lessons learned.
The past week’s events have revealed one rule of thumb: Whether the order comes from political leaders, epidemiologists or the media, you can get away with forcing the U.S. to shut down for about three months, but that’s it. Then the tides of human nature will push past the voices of authority. For better or worse, that’s just the way it is.
all of which should have been foreseen back in March. And consider this:
In New York, total deaths are 29,730. In Missouri, they are 697. For all the attention California and Gov. Gavin Newsom have received, its death rate per 100,000 population is 10, one more than Vermont’s.
As Mr. Henninger points out the experience with COVID-19 has varied tremendously across the country with most of the country experiencing only minor outbreaks. Here in Illinois if your gauge is hospital bed, ICU, or ventilator utilization, a meltdown of the healthcare system due to COVID-19 has never been a threat. As I asked some time ago, how much better is 30% excess capacity than 40%? It does have a cost. The state’s hospitals now have about eight times as many ventilators as COVID-19 patients on ventilators, the ventilators aren’t free, and they have a shelf life.
In other news, Camilla Stoltenburg of Norway’s Public Health Care System noted that “R” was actually 1.1 at the time of lockdown, making the policy almost irrelevant. In the US it has been noted that 43% of all deaths occurred in .62% of the population, those residing in nursing and assisted living facilities, crying for a focused approach on the most vulnerable, if, of course, one had an ounce of common sense. (Note: Andrew Cuomo was unavailable for comment.)
However, in man on the street interviews a man identifying as “steve” noted haughtily that he reads “expert” reports, so these people are idiots. However, another person interviewed, identifying as “Guarneri” just said. “I told you so.”
OT: Illinois Sheriffs are suing the Governor for not accepting convicts that have been sentenced to prison.
A few weeks ago the Governor asked the State Police how many people had been arrested for violating his emergency orders. A quick survey, came up with zero. They don’t know how to enforce it. They didn’t think the State’s Attorneys will prosecute the cases and they didn’t think the Sheriffs will accept any prisoners. So part of the issue appears to be inter-governmental conflict in which state government is trying to reduce costs in its prison system (and health risks) by either releasing non-violent convicts or by keeping recent convicts in local jails without reimbursing the locals.
Its all been interesting to watch from the standpoint of how divided government works; we usually think of the three branches of government, but we have a lot of contrast between federal, state and local powers going on here.
Except they didn’t limit those released to those who’d been convicted of non-violent crimes. Some of those released had been convicted of assault, even gun crimes. Additionally, with plea bargaining and judicial discretion sometimes you don’t know what the underlying crime actually was.
Man of Science Drew remains unwilling or unable (both?) to answer a couple of basic questions. What is his age cut off for targeting the vulnerable population? According to his literature about 5% of those infected between 50-64 need hospitalization. Second, what is this targeted plan? No one seems to have one.
https://www.tallahassee.com/story/news/local/state/2020/05/27/coronavirus-florida-state-scrambles-stem-covid-19-outbreaks-elder-care-facilities/5265563002/
Steve
Another Lancet study has shown an increased risk of death when you use hydrochloroquine, this time when combined with Azithromycin. This was a study of cancer pts who also had Covid. Retrospective, but well done and large enough to have meaningful numbers. Again, just one study but the trend seems to be leaning towards HCQ not working or actually being harmful. Looks like the old rule of avoiding taking drugs on the word of some celebrity is going to hold true. Too bad we cant jail or at least sue these people. From Laetrile, to false claims about vaccines and autism and now to HCQ uninformed celebrities advocate for treatments and fans blindly follow them with bad results. I cant think of a single instance where this has gone well.
https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31187-9.pdf
Steve
Here is a breakdown by state as to the percentage of COVID deaths that have occurred in either nursing homes or assisted care facilities:
https://www.forbes.com/sites/theapothecary/2020/05/26/nursing-homes-assisted-living-facilities-0-6-of-the-u-s-population-43-of-u-s-covid-19-deaths/#27e356d474cd
As Guarneri points out, nationwide it is over 42%, but in Ohio it is 70%. Also, it is essentially a New York City metro area pandemic, with a few outliers like Chicago and Detroit.
These data put into question whether lockdowns served any purpose.
The extremely high population density of the NYC area probably explains most of their cases, but keeping the subways and buses open was a major blunder. The El is running in Chicago, and the MBTA in Boston.
No state has a serious lockdown, if the public transit system is open.
By the way, the Asian Flu of 1957 killed 116,000 Americans out of a population of 170 million. COVID would have to kill at least 230,000 to reach that mark. Right now, COVID is the third worst pandemic to hit the US since the end of WW II.
One possible strategy would be to quarantine those living in assisted living and skill nursing facilities along with their caregivers. That reduces the introduction of infections into the facilities.
In just about every state the largest city is the nexus of diagnosed cases. There’s more than one reason for that including that it’s easier to find your keys under a lamplight.
The case mortality rate in Chicago and Cook County is a fraction of what it is in any of New York City’s boroughs. Between a third and a half of all fatalities due to COVID-19 have been in the NYC metro area. COVID-19 is largely a New York problem and to whatever extent it is not it is an urban problem.
Steve, it is a bad idea to repeat the claims of the Lancet study on hydroxylchloroquine.
Researchers have found instances of massive data fabrication in the study. These include prominent skeptics of hydroxychloroquine and the Guardian doesn’t publish random claims.
https://www.google.com/amp/s/amp.theguardian.com/world/2020/may/29/covid-19-surgisphere-hydroxychloroquine-study-lancet-coronavirus-who-questioned-by-researchers-medical-professionals
The lancet should be ashamed for publishing a paper like this without doing peer review.
It does a lot of damage to the cause of skeptics (like the Lancet) of hydroxychloroquine that such a study is accepted unreservedly. Skeptics of hydroxychloroquine are willing to accept fake data if it proves their beliefs.
I don’t know whether HCQ in combination with zinc and AZT is effective or not and I honestly don’t have a dog in that hunt. I do wonder why we’re so quick to dismiss the South Koreans’ use of it out of hand.
I have not commented on HCQ until now; only sane thing was to wait for the double blind – randomized control trial.
Internationally; South Korea used it a bit; Turkey gave it to everyone; and Italy gave it starting in early April and ending last week.
The study Steve highlighted to criticize the effectiveness of HCQ, in the Lancet, has had dubious reviews. For some reason, there has been a real push to discredit and devalue this antiviral from being a valid alternative to treating COVID, during the current lull where there is a dearth of other remedies. BTW, the El Salvador President is using the HCQ cocktail as a preventative measure, asserting that most world leaders were following the same medical regime.
Personally, I have lost confidence in some of the major players taking center stage in the infectious diseases, epidemiology community, calling the shots from the onset of COVID to the present. There have been so many false predictions, followed by over-reactive responses, flip-flops in guidelines, wrangling over the efficacy of medications, deliberate injections of fear in order to insure public compliance, augmented by 3 months of coronavirus blinders that have all but ignored all other social, medical, economic miseries exploding around this elongated forced shutdown.
Fundamentally, it’s been a toxic brew of confusing policies, governor overreach and tyranny, and egregious opportunism being demonstrated by progressive politicians who see this crisis as an opening to implement more of their leftist agenda.
..very discouraging.
Its interesting that HCQ has a loaded social-political context in Europe, without having anything to do with Trump. In France in particular, it was long embraced by non-establishment political movements, that believe that the low-fatality rate in Marseille was because an outspoken doctor is giving it to all his patients. People who tend to think Macron is an empty-shell resent the central government trying to prevent it being given by their doctor.
Could you expand on that a bit, PD? Is there actually anybody in France who doesn’t think that Macron is an empty shell?
True, I guess the context here appears to be that Macron is isolated from other political groups, including those who voted for him last time solely as the non Le-Pen candidate. But his natural constituents, the bureaucrats, were not happy that Macron met with the lead doctor, which they believe was an implicit endorsement, whereas Macron wanted to appear to be an active, inquisitive leader that is open to considering anything. There is an establishment / non-establishment argument in which Macron was not effectively on either side.
1) The letters of complaint are not about the study I cited. It was an earlier and larger study which I did not quote. It has some issues, but alto of those are technical details. The authors actually acknowledge a lot of those within the paper and note that it is an observational study so that it has limits. I have yet to see any dubious reviews about the actual paper I cited and I am close to 100% sure that jan cannot find any even though she claims they exist as she is probably thinking of the earlier study. Please note that the study that started the HCQ craze was based on 40 pts and was incredibly flawed. The paper CO is talking about is a work of art in comparison.
An RCT study will take months. So just like we all went ahead and used HCQ in a rush, these observational and retrospective studies are going to bee rushed out to give us some idea of issues. Again, note that neither the one I cite or the one CO cites suggesting doing away with HCQ. Both acknowledge that they say nothing about the use of HCQ for prophylaxis. They suggest that continued use of HCQ in the hospital setting should continue, but within clinical trials.
So far from being bad science, this is what we should hope to see. I tis timely, which we desperately need, so it has deficiencies, but it openly acknowledges its problems.
2) Jan- Name the false predictions. They should be real and not straw men.
3) Back to the study which I actually cited, it also acknowledges its shortcomings. Still, it is useful as it seems to continue a trend of negative findings. It also supports what we know about the illness. Covid does attack the heart muscle, blood vessels and the kidneys, areas negatively affected by these two drugs. Those of us who deal with acute cardiovascular disease had some qualms about HCQ, but we have all hoped its benefits outweighed the potential risks. Potential as we didnt know if they would occur in Covid pts.
So we wont know for sure until the better RCTS are out the true story on HCQ. It wouldnt surprise if it has a modestly positive effect for some pts and negative effects for others and we just need to figure out which population benefits and which doesnt. Until then I will stick with one of my basic rules of medicine. One of the older ones I mentioned is that all diet studies are wrong. If it looks good there is probably something wrong with it. The next rule is never buy or use a medicine or therapy being pushed by some celebrity. OK, Jon Voight doing an ad for Lipitor is not what I am talking about, though you can be pretty sure a name actor pitching a name drug like that means it is a “me too” drug and probably isn’t a great value. (Note that you dont actually see many of those anyway.) Nope, I am talking about the endless stream of celebs who show up at night pushing drugs you have never or only vaguely heard of. The ones where the “Doctor” expert looks like a sleazy illegal drug salesperson. Never trust the celeb.
Steve
Like Dave, I do not have a side on the HCQ issue.
“An RCT study will take months”. Yes, but its the gold standard for figuring out drug effectiveness without letting our cognitive biases get in the way.
If I look at the study — the study is focused on cancer patients with COVID, and the authors admit this key limitation themselves,
“This combination was commonly
used in patients who met the composite endpoint,
possibly on the basis of the non-randomised study by
Gautret and colleauges. Therefore, hydroxychloroquine
plus azithromycin might not be the cause of increased
mortality, but instead were given to patients with more
severe COVID-19.”
The original study by Ferguson, which you seem to ignore, Steve, was the predicate for panic driving the Fauci/Birx advice for a rigorous shutdown to be enacted. This model’s dire predictions of disease and death quickly were dialed back. However, once fear has been implanted it’s difficult to then dissuade people away from being fearful. The Murphy model, from the U. Of WA, was then followed to predict the deaths that would be experienced by this virus. This model was also subject to many downward revisions. Recently, the CDC walked back their opinions on how long COVID remained in a contagious state on hard surfaces. The efficacy of masks has been tossed back and forth, with an increase of doctors questioning whether the merits of mask-wearing, by healthy people, was more symbolic than actually useful for most layman circumstances. Currently a study is being done dealing with the overuse of ventilators (perhaps needlessly killing thousands), something a young critical care Physician brought to people’s attention early on, but whose warnings were brushed off, and he was eventually transferred out of that unit.
Finally, I strongly disagree with those who put down the use of HQC because of not meeting some presumed testing standards. It has been a long ago FDA approved antiviral used in a variety of circumstances by a fair number of physicians with good margins of success. It’s also an oral med, with treatments requiring low doses to be effective, and is dirt cheap. If I have the time will post some efficacy percentages I ran across today, denoting the countries in which HCQ was met with approval.
Lessons learned-
Will we react in the same way in September if China seeds a second wave, experience having taught when and where to start, knowing that we are incapable of testing contact tracing or quarantine?
“The original study by Ferguson, which you seem to ignore, Steve, was the predicate for panic driving the Fauci/Birx advice for a rigorous shutdown to be enacted. This model’s dire predictions of disease and death quickly were dialed back.”
No, it didnt get dialed back. Someone actually read it, unlike you. It predicted a range of deaths based upon infectivity and population response. Next, remember that there has been a global response. Russia, India, Japan, S Korea didnt care what was said in Ferguson’s report and it was not the real driver in the US. It was Italy, the wealthy part of Italy, being overwhelmed.
“Currently a study is being done dealing with the overuse of ventilators (perhaps needlessly killing thousands), something a young critical care Physician brought to people’s attention early on, but whose warnings were brushed off”
This is where an ignorance of medicine makes it possible to believe stuff like this, preying upon people’s ignorance. Early on people did not know if Hi-Flo would work or if it would be safe. Same with Bi-Pap. There was also concern that pts might be difficult to intubate as there were reports of significant laryngeal edema. (For the people I have intubated there has been swelling but with video laryngoscopes it has not been a big issue.) So, first, once we figured it out it was safe to use the methods above, and we could safely wait longer to intubate, we didnt need to go on ventilators as much. Next, since the CTs looked like ARDS the pts were treated like ARDS. Then we found it that for most pts it was not really ARDS and that the ARDS protocols were not needed and maybe even harmful. This was all figured out during the first few weeks and is what people having been doing for the last 6-8 weeks.
So, I am assuming that you can follow the really watered down physiology here. If you want to see it as some great failure of expertise and damn the experts because it took a few weeks to optimize care for a brand new disease then I am afraid that we will almost always disappoint you. That said, we feel worse than you do. We sit with these people as they die. We talk with the families.
“Recently, the CDC walked back their opinions on how long COVID remained in a contagious state on hard surfaces.”
When they get better studies what should they do?
“The efficacy of masks has been tossed back and forth, with an increase of doctors questioning whether the merits of mask-wearing, by healthy people, was more symbolic than actually useful for most layman circumstances.”
Citation please.
“Finally, I strongly disagree with those who put down the use of HQC because of not meeting some presumed testing standards.”
Non medical people seem to think that all medicines are equally safe for everyone. People who work in medicine understand that all medications have downsides. NSAIDs are great medicines for arthritis pain. If you have significant CKD and running a Cr of 2 they can kill your kidneys. So HCQ has a god safety record when treating malaria, but that kind of self selects for a healthier population, travelers. With Covid you have an older, sicker population with an ongoing acute viral infection which we know affects the blood vessels and hearts of some people.
Selective use based upon the pts actual medical condition is what we would usually do. Instead, because it was an emergency we used it widely and indiscriminately waiting for the early studies. So far, and we know the studies are flawed, they suggest that using them on everyone is a bad idea. As the celebrity said, “what do you have to lose?” Maybe your life. We are now still using it, but within clinical trials to see if it helps and if it does, who it helps.
Of course this all depends upon the concept that medications that are perfectly safe for some people can be harmful for others. I dont know if you are too far into the conservative bubble to be able to understand that.
Steve
Steve,
Inaccurate Virus Models Are Panicking Officials Into Ill Advised Lock downs
The models are being shared across social media, news reports, and finding their way into officials’ daily decisions, which is concerning because COVID Act Now’s predictions have already been proven to be wildly wrong.
Here is a piece published by the American Journal of Epidemiology discussing the efficacy of HCQ..
Hydroxychloroquine+azithromycin has been widely misrepresented in both clinical reports and public media, and outpatient trials results are not expected until September. Early outpatient illness is very different than later hospitalized florid disease and the treatments differ. Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease. Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is <20%, 9/100,000 users, compared to the 10,000 Americans now dying each week. These medications need to be widely available and promoted immediately for physicians to prescribe.
This opinion, regarding the effectiveness of masking outdoors, has been published by The New England Journal of Medicine.
We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.
The article goes on to state in which setting masking is important:
The calculus may be different, however, in health care settings. First and foremost, a mask is a core component of the personal protective equipment (PPE) clinicians need when caring for symptomatic patients with respiratory viral infections, in conjunction with gown, gloves, and eye protection.
I posted a response to Steve, with appropriate links. But it was promptly sidelined because of Dave’s “moderation.”