Interesting…

I present three articles for you edification without further comment…

First-

This could be extremely important: a renowned French doctor has reported the most extensive evidence so far that a combination of hydroxychloroquine and azithromycin can be an effective treatment for COVID-19:

Full article, HERE.

Second-

Localities that declared themselves “Sanctuary Cities” to reject federal law and coordination in order to harbor illegal immigrants are now begging for federal help in the face of the Wuhan virus pandemic.

Full article, HERE.

Third-

They were ready to roll whenever disaster struck California: three 200-bed mobile hospitals that could be deployed to the scene of a crisis on flatbed trucks and provide advanced medical care to the injured and sick within 72 hours.

Full article, HERE.

Make of these what you will. And if you don’t follow Aesop, you should be. He is on the front lines of the battle in the ER…

And I will leave you with this from Scott W. Atlas, MD is the David and Joan Traitel Senior Fellow at Stanford University’s Hoover Institution, the former chief of neuroradiology at Stanford University Medical Center.

Evidence-based, rational public policy is urgently needed, now more than ever, as the contagion of fear spreads far faster than the coronavirus COVID-19. The harms from continuing widespread isolation and this economic lockdown, including actual loss of life, could be enormous, far greater and longer lasting than from coronavirus infection itself.

Two important points need to be understood: 1) targeted isolation is correct policy in terms of medical science, not just economically; and 2) testing is important but it should be prioritized, instead of thought of as urgent for everyone.

Dr. John Ioannidis, an epidemiologist and co-director of Stanford University’s Meta-Research Innovation Center, stated that reported case fatality rates, like the official 3.4% rate from the World Health Organization, induce panic but are “virtually meaningless”. Patients who have been tested for coronavirus and seek medical attention are disproportionately those with severe symptoms and bad outcomes.

Dr. Ioannidis estimates the fatality rate in the general U.S. population to be from 0.05% to 1% based on the Diamond Princess cruise ship, the one closed and completely tested population. Importantly, the fatality rate in that group was 1.0% in a largely elderly population (approximately 60% over age 60), in which the death rate as well as infection from Covid-19 is much higher (note that approximately 75% of confirmed infections on that ship were over age 60).

This is similar to the more widely tested South Korea population (approximately 1% fatality). Among developed countries so far, the death rate is just over 1%. In developed countries (OECD), there are approximately 17 endemic viruses. Worldwide, about 2.6 million deaths occur from these per year. In the United States, deaths from the flu range from 30,000 to 45,000 in the United States.

There is massive uncertainty, but using Ioannidis’ mid-range fatality rate, this virus could cause about 10,000 deaths in the United States overall, overall, a number that would not be extraordinary news in the total of flu-like deaths every season. 

Dr. David Katz, the director of Yale’s Disease Prevention Center, wrote in The New York Times that the clustering of deaths and serious diseases in the elderly and those with significant chronic illnesses indicates we could and should preferentially protect those vulnerable populations. This would accomplish the goals of saving lives, avoiding the overwhelming of the medical system, allowing the essential immunity to develop among the population with virtually no risk of serious illnesses, and avoiding the massive economic calamity and all that would entail.

There is a different strategy, one focused on protecting the vulnerable, self-isolating the mildly sick, and limiting group interactions, similar to recommendations in the Netherlands. And the data so far show no worse spread than nearby countries like Germany, Belgium and France with far stricter lock-downs in place.

First, medical care must be sought by some, but it is not necessary for the majority of people who are infected. If a person, particularly the elderly, has underlying chronic lung disease, heart failure, kidney failure, or diabetes, and has a fever and respiratory symptoms like cough or shortness of breath, they should seek medical attention. These are the people who have a significant risk of progressing to severe illness, as reported all over the world and in the United States.

We know that up to 99% of positive cases have nothing beyond mild symptoms. A University of Oxford study estimated that fewer than 0.1% of infected cases have significant symptoms requiring medical care. Younger, otherwise healthy people with mild symptoms should not go to the hospital or seek medical attention, because treatment is not necessary and it will overwhelm the system while potentially infecting health care providers and patients.

These patients should stay home and isolate and get tested when it’s available – unless they develop shortness of breath or a fever above 38’C, (100.4F) for which they should seek care.

Second, isolation is key, but it must be targeted for specific groups of people. If someone outside the high-risk groups (elderly with chronic illnesses, HIV patients, immune-compromised people) has fever and cough but mild symptoms, they should remain isolated in their homes for 14 days. People without any symptoms who have not been directly exposed to someone sick do not need isolation.

More importantly, whole-population isolation is not medically ideal and will lead to less effective elimination of the infection threat. Population immunity for every disease like this can only be achieved by letting people who are not at risk for anything serious, who are not immune-compromised and elderly (the vast majority of people), get exposed to it.

This allows their bodies to put forth the immune response, so the virus is controlled and transmission to others is eliminated. That’s biology — not politics, not economics, and not non-medical risk assessment. We are preventing the development of immunity that is essential to stop the illness, and prevent a second wave when people are free to mingle. 

Third, testing is important, but right now, it is a priority only for certain groups of people. As recommended this week by the Infectious Diseases Society of America, testing for COVID-19 should be prioritized as follows:

Tier 1 — the highest priority — critically ill patients receiving ICU level care with unexplained viral pneumonia or respiratory failure; patients with fever and respiratory symptoms within 14 days exposure to proven coronavirus patients; immunocompromised patients (elderly with chronic illnesses, HIV patients, etc.) with fever and respiratory symptoms; and people with fever and respiratory symptoms who are critical pandemic response workers.

Tier 2 testing — another high priority — should be for hospitalized (non-ICU) patients and long-term care residents with fever and a respiratory tract illness. Fear of exposure, or people without symptoms who are outside priority groups, do not need urgent testing and should not seek it.

Strategic prioritization of testing, isolation, and medical care, with factual communication rather than worst-case scenarios extrapolating from misleading data are urgently needed to save the national interests and livelihoods of Americans.

To continue the current policy without targeting will unnecessarily overwhelm our medical system and literally endanger patients needing care and our health care providers. And to isolate the entire population and prevent all human interaction is actually harmful to eradicating the disease. We the people, including our leaders and policymakers, need to listen to the facts.

And at the last minute, h/t Tom Walls, via Ammoland.com DHS has said gun stores are essential businesses! Cue the left meltdown in three… two… 🙂

Comments

Interesting… — 19 Comments

  1. I was not aware of Aesop’s blog. Thank you for the heads up.

    Sleep? Who needs that?

  2. OK. I read Aesop a few days ago.
    And I see videos from a few health pros in the ERs.
    Panic! Everyone!
    Which does not conform to the other stuff I’m reading that says the predictions are overblown.
    Data driven health pro stuff.
    I am genuinely conflicted, but I tend towards not panicking, particularly after reading stuff like the body of your post.

  3. TXRed- Yep, they ‘get’ it…

    Art/Ed- Agreed, there are ‘many’ different approaches to what is going on.

  4. Dr. Ioannidis may be a very eminent physician but his 10,000 US fatalities is so far off (current figure is 31,537) that it calls into question the rest of his figures and conclusions. My uninformed personal opinion is that he is closer to correct than the “Chicken Little” wowsers I keep seeing in the news and on FB.

    • OOps. The spreadsheet I watch just adjusted the figures in the deaths column. The 33K is world wide not US. US is 2.4K. So the 10K seems much more reasonable.

      Rule 1. Murphy is alive and active.
      Rule 2. Double check your sources before opening mouth or engaging fingers.

  5. Niece heard from. She and hubby are doctors at Columbia in NYC. Per her direct observations.
    1. They are running so short of disposables that they are sterilizing and recycling things like masks and gloves. She didn’t mention sharps.
    2. Floor by floor the wards are being converted from other uses to CoV quarantine.
    3. Running so short on ventilators they are trying to figure out how to run 2 patients off 1 machine.
    4. Smaller regional hospitals in the NYC area are reaching capacity and having to both triage and ship elsewhere.
    5. Work weeks are running 60-70 hours for most medical and support personnel. There have been no grievous errors so far but Murphy is always waiting for one minute of inattention.

  6. My daughter is a nurse at the VA in Palo Alto,CA, Covid unit.
    Very long hours, NO masks.
    She is on the edge of quiting nursing. Five have already left.

  7. Aesop is vested in spreading panic and the worst case scenario.

    He was actively disappointed when Ebola didn’t get a toe-hold here.

    Read him carefully, he cherry picks his arguments and has since I first found him writing novel length comments at Hognose’s place.

    Someone should also differentiate between the infection fatality rate and case fatality rate.

    The IFR is the actual ratio between the total number of infections and people who died from them. We won’t know this number for a long, long time if ever. What we have from Diamond Princess, thanks to everyone on board being infected is the only IFR to date.

    CFR is the ratio of deaths from confirmed cases, and if you’ve tested everyone it matches the IFR. This will be much higher than the IFR when there’s only data from the people who felt sick enough to head to the doctor who then decided it was worth expending one of the limited test kits to check.

  8. So far for all the panicking that some bloggers have been exhibiting, the more moderate entries seem to be the norm.

    Except for places that actively went against any sort of common sense. Like a Lunar New Year’s festival where people were encouraged to gather together, with people from China. Thus New York City.

    Or the Mardi Gras parades and street partying amongst drug and booze addled idiots with no concept of safe distance or common sense. Thus… New Orleans.

    For the most part, this is a good practice for a real epidemic.

    And California screwing up everything, again? Right up there with New York City saying they didn’t need so many ventilators in hospitals (because equipment costs and personnel costs) so it’s okay for hospitals in NYC to get rid of many ventilator systems.

    As the Intrepid Reporter says… Top men. Top… Men…

  9. Angus is correct about Aesop.

    I quit reading his blog because after awhile you get real tired of the triple helping of California Smug. He thinks he is the only one on the internet who has any clue about any of this, so his entire blog has been one big harangue. (One of his posts was even titled “You Really Have No Idea”.) Oh, he makes some good points every now and then, but it seems impossible for him to make those points without scattering insults and acrimony in all directions.

    • I stopped reading him when he wouldn’t respond when questioned as to what good upstanding gun-owning citizens of California have done to take their rights back, since he wants all of the rest of the nation’s good upstanding gun-owning citizens to act just like the Californians and not fight for their rights.

      Yes, there are some people who seem to be overacting in defense of their rights. But at least they are defending them. Usually while making a point (like, oh, say, police rousting people who are legally carrying, and prosecutors going after the people who are legally carrying, thus some people rightly legally carry to the extreme in order to get the point across that they are legally carrying. So far none of the evil gun-larping open carriers have done much of anything more wrong than pissing off cops, prosecutors and some bloggers.)

      • As to Angus screaming about the health care system’s response to Novel Wuhan Communist China Corona Covid-19 2019 flu, well, live and work in a poophole, like Aesop does, and you see poop-hole everywhere.

        Live in the free world and things look much differently.

        Even here, in socialist Alachua County, things don’t look nearly as bleak as New Orleans, New York City and other cruddy places. Because, for all of it’s negative points, socialist Alachua County is still far right in comparison to New Orleans, New York City and other cruddy places.

        • That was supposed to be “As to Aesop screaming…”

          Angus doesn’t scream.

  10. The population as a whole is being shortchanged by this panic. People are not being treated for the day in/day out medical needs. That is surely going to bite in the months ahead.

  11. I seem to recall Aesop suggesting eventually a million and a half deaths in the U.S. possible. I ran into the problem of “non esential” medical procedures canceled even though Alaska’s system is not yet overloaded. Apparently pain control is nonessential so my appointment for a steroid shot in my lower back, which we have been using to avoid surgery was canceled last week!