What Tomorrow May Bring

When I rise tomorrow morning I expect the number of diagnosed cases of COVID-19 worldwide will have exceeded 1 million. That’s a large number but still a tiny fraction of the total human population—about .013%. I expect the number in the United States to start closing in on 250,000—about .076%. The case fatality rate is around 2%. In some states like New York it’s a bit more. Here it’s almost exactly 2%.

I don’t think that anybody, except possibly the head of the World Health Organization, actually believes the numbers the Chinese have reported. I’ve seen estimates everything from twice as large to forty times as large, both for cases and deaths.

Italy continues to be the best example of a bad example. It’s number of deaths per million population is the highest in the world—218, more than an order of magnitude higher than ours or just about anybody else’s except Spain. I presume that the Italian response will be studied for years to come.

South Korea remains the brightest hope. On the positive side it’s barely possible they’ve reached an inflection point—the number of deaths seems to be declining. On the negative side new cases continue to be reported and the number of new cases is inching up to exceed the number of new recoveries.

There has been a report of another prospective treatment: HC + Z-Pak + Zinc. I suspect that some brave physicians will continue to experiment with new treatments until a provably effective treatment is found.

From what I’ve observed in my walks today unless eliminating the spread within crowds is enough to “bend the curve” any hope of doing so is a fantasy. Cops idle their prowl cars a foot from one another and talk through the windows to each other. Lawn crews and other workmen continue as though nothing out of the ordinary were going on, not observing “social distancing”. People stand within a few feet of their neighbors, shooting the breeze. I sometimes actually need to challenge people for them to give me enough space.

13 comments… add one
  • steve Link

    HC + Z-Pak + Zinc. – Things have been busy, but I finally remembered to ask one of my ICU guys about that combination. They have mostly been using HC + Z-Pak but a couple of them always add zinc. Consensus seems to be that it has no effect on the ventilated patients. For the other ICU patients and the inpatients who dont need the ICU, if there is an effect it is not obvious. However, that is only looking at the sickest part of the population. It is possible that for those receiving it as outpatients it may be stopping the progression towards the need for inpatient care. Their caveat is that our ventilator pt population is just a bit older than expected.


  • Guarneri Link

    “From what I’ve observed in my walks today unless eliminating the spread within crowds is enough to “bend the curve” any hope of doing so is a fantasy.”

    And so at the risk of stating the obvious, unless a vaccine is quickly developed or seasonality retards the virus (which is looking dubious at this point) herd immunity is the end point. All the efforts at treatment and production of useful medical equipment should of course be pursued, but ease of transmission and noncompliance (just look at NYC or New Orleans) have dwarfed isolation efforts.

    Herd immunity was always the end point. And then will slowly come the residual infected.

  • CuriousOnlooker Link

    It is interesting even between the states there are huge differences.

    New York / New Jersey vs Connecticut, Ohio vs Michigan, Washington vs Oregon.

  • Icepick Link

    I saw something today indicating that HCQ might have a prophylactic value. Something about it being used as a treatment for some variety of lupus, and that none of the patients receiving it for that purpose had developed the SARS-CoV-2 infection. If so, giving it to patients early seems to be the way to go, as from what I gather it doesn’t seem to do much for those already in great distress.

    But from everything I’ve read, it seems like once someone gets to ICU it’s completely a crap shot on whether or not they live or die. This is one nasty, nasty disease.

  • Icepick Link

    CuriousOnlooker, I find the difference between FL and Louisiana to be the most interesting. Both have had large gatherings that should have been stopped (Spring Breakers and Mardi Gras), but LA’s caseload isn’t much smaller than FL’s despite the population difference, and LA’s death rate is over three times as high. I find the last bit especially curious, as FL had the first deaths east of the Mississippi river, and perhaps the first one outside of WA.

  • Icepick Link

    And then there’s Ecuador…. I’ll skip posting the rather harrowing video I saw.

  • GreyShambler Link

    And another: if this turns out to be true, poor Mexican peasants may actually be immune.

  • steve Link

    Addendum- I forgot to note that our N in our ICUs is in the 80 range, larger than the French study, but still what I would consider a small group to make any conclusions about. As much as you all poo poo actually studying this we need someone following this to see if it works. Drugs do have some downsides.

    On the immunity front I assume everyone saw the follow up studies questioning those who supposedly got reinfected? I think this is in the we dont know camp.


  • Guarneri Link
  • Something about it being used as a treatment for some variety of lupus

    It is presently being prescribed for some forms of lupus and rheumatoid arthritis. They’re not entirely sure of why it works but the evidence suggests that it works. It is believed that it works by deactivating certain cells involved with the immune system.

  • It is interesting even between the states there are huge differences.

    The differences may be due to the health systems being in different conditions in different states. For example, the New York is notably lacking in ICU beds for a state its size.

  • steve Link

    The German guy sounds like the typical “expert” pulled out by the tobacco companies to support smoking. Some emeritus guy like many of there tobacco hired guns. Overall death rates are easily available from Italy. If a city goes from 30 deaths a month to 160 a month, that’s a real change. Might some of those be due to a stroke or MI pt who couldn’t receive care because the hospital had no room and no ICU beds? Yes. Covid death? I think it pretty clear that pt gets different care if we didnt have Covid. So yes, Covid is leading to a lot of deaths, directly and indirectly.

    Air pollution? Air pollution? LOL. OK, let’s push for tougher environmental regs. I will remember that one.

    “It is interesting even between the states there are huge differences.”

    Depends a lot upon where they are in the outbreak. Rates are low at first as pts are typically on a vent for a couple of weeks before they die.


  • I would add that my observation has been that physicians are conflicted about Koch’s Postulates. They haul them out when it suits their purposes but fail to honor them when they don’t.

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