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COMPARE Sars-cov2 TO THE SPANISH FLU, NOT SEASONAL FLU
Some (including healthcare providers) still compare SARS-CoV2 to the seasonal flu based on true death rates. Let’s assume that more of us have been infected with CoV2 than tested, making the “true” death rates lower.
BUT I don’t remember the last time the seasonal FLU virus (and every mutations thereof in recent years) shut down most of the developed world because there weren’t enough ventilators to go around and medical providers were having to choose whom to save and whom to let die, do you? AND how many nurses, doctors, and first line responders have died of the seasonal flu because they were treating seasonal flu patients?
Comparisons to the flu have been made more for economical and political debates versus a true desire to seek scientific answers. If we want to compare with the flu, at least use a more appropriate strain and compare CoV2 to H1N1 or the “Spanish flu” and see the world response during 1918-1920 to that outbreak as a more appropriate comparator.
Economical impact is genuine and mandates attention. Let’s address the economic impact directly, without leveraging still unclear science to mislead the public.
How is the US Covid19 Mortality Tracking?
Based on current trends, the US:Italy death rate is averaging 2.7 (as of 5/8/2020) based on death ratio of most recent week (7-day) average.
I plotted Covid19 deaths in the US and matched it against the death curve in Italy, off-set by 14 days (Italy’s death curve is 2 weeks ahead of US death curve). Updated daily.
My calculations/predictions are NOT based on general Covid19 mortality (example: 42,000 deaths/855,000 worldwide confirmed cases = 4.9% worldwide mortality of tested Covid19 or 3800 deaths/186,000 US confirmed cases = 2% US mortality of tested Covid19), but death curve established in Italy that is replicating in developed countries.
My death rate prediction is based solely on data and does not consider Ratio 2018 Population (US:Italy) = 5.4. Ratio 2018 Elderly (US:Italy) = 0.70 (source: Statista.com). If I consider the population size as well as % differences in elderly, I would put US death rate to be about 3.8x the death rate of Italy.
This may happen if there are multiple state-wide healthcare system overwhelms/collapses due to # of critically ill patients who succumb to Covid19 from treatment shortages. Data from https://www.worldometers.info/coronavirus/
Why I only track death rates and proportions:
- Infection rate isn’t accurate because infection rates depends on reliable testing. We do not have widespread, ubiquitous testing. The true infection rate is higher than what is being tested and reported as positive. There will be false positives and false negatives, which makes infection rates unreliable. Infection rate can be used as a ‘sampling’ of how well the quarantine/shelter-in-place measures are working.
- Death rate is both an indicator of Covid19 mortality and the healthcare system’s capacity at that moment. I don’t see the death rate as a true indicator of mortality, but actually Covid19’s mortality constrained within a country’s/state’s healthcare system. You can have a cohort of patients who theoretically CAN recover from Covid19, but do not, because healthcare providers are forced to assign life-saving ventilators based on the hospital’s algorithm.
- Death rate is imperfect: there may have been patients who have died from Covid19 complications but were not tested and therefore excluded from official death statistic, This skews the death rate down, making the death rate lower than it actually is.
- Death rate in Italy is suggested to be so high because of the high % of elderly population.
- This is why physical distancing and taking shelter-in-place/non-essential shut-down measures must be taken seriously: people often fixate on “infection”, when the true issue is “death by lack of healthcare resources”. We are not shutting in only to prevent infecting ourselves and others. We are shutting in to prevent a usage tsunami of our healthcare system such that a doctor has to remove life-saving vent from one patient to save another patient. Many of us will be infected. Some of us will become hospitalized. A few of us hospitalized will die. We are aiming to PREVENT deaths that can otherwise be AVOIDED if healthcare systems aren’t overwhelmed.
How are we doing in CA? (proportion of u.s. deaths)
% of CA covid19 death rate over US death rate. I also included NY % death over US death rate. Updated as data become available.
Stay at home order (CA) = March 19, 2020. Stay at home order (NY) = March 22, 2020.
Non-essential services closed (CA) = March 19, 2020. Non-essential services closed (NY) = March 20, 2020.
Educational Facilities closed (CA) = March 19, 2020. Educational Facilities closed (NY) = March 18, 2020.
Suggestions that CA is “2 weeks behind NY” appears SO FAR to not hold, as NY death rates continue to trend upward and CA death rates maintains below 10% national death rate. For those of us in CA, this is be a good reminder that what feels / appears to be an extremely stringent measure by state and local politicians do/can result in lower mortality rates, which gives CA’s healthcare systems the time required to “surge prepare”.
Thank You, My Fellow Californians.
Update April 6, 2020: What we are doing in California is TRULY working. We are FLATTENING the curve for Californians.
Our peak resource use date is predicted on April 13, 2020 BUT — we DO have enough beds, we DO have enough ICU beds, so that if/when one of us needs that level of care, it is available. This assumes our social distancing mandate lasts through May 2020. Source: https://covid19.healthdata.org/projections [That said, we still require 678 vents and I’m not sure about the status of that # of vents, but I am optimistic especially because California is now returning 500 vents to the federal stockpile.]
RESOURCE UTILIZATION IN THE UNITED STATES
https://covid19.healthdata.org/projections Gives a state by state prediction of days until peak resource use, including # of beds needed versus available. This gives a gut-kicking visual of what flattening the curve can look like, versus not flattening the curve on healthcare system impact (which directly affects patient outcomes/mortality/morbidity rates).
Assume Social Distancing thru May 2020, Predicted Peak/Surge Resource Use: [USA] = April 14-23, 2020. [CA] = April 13-23. [NY] = April 7-21.
FROM NextStrain.org website
Sit-Rep as of March 27, 2020 for North America:
- “Within the U.S., transmission patterns are complex: samples collected from opposite sides of the country still show close relationships.” In general, transmission across the US is “complex and not well-understood”.
- Genetic ancestry of the virus recently in CT show relationship with samples from WA suggesting recent transmission between distant states.
- California data is still early and limited but available evidence suggests 2 local transmission chains that started in Northern California in Solano County.
Additional Phylogenetic Analysis of Covid19 strains from PNAS.
What Information Sources am I Tracking/USING?
Dr. Rohin Francis (UK) has a Coronavirus Playlist that includes “How We’ll Beat Coronavirus”, “6 Reasons to be Optimistic about Coronavirus”, “Doctor with Suspected COVID19”, and “Are We Doing the Right Thing?” (This one addresses questions relating to the typical death rate and whether “the measures could be as bad as the disease” if typically that many people are going to die anyway, but those objecting conveniently ignores the time-compression of this phenomenon).
Dr. John Campbell (UK) does a daily update of Coronavirus status around the world and addresses specific and relevant topics such as reproduction number (R0), Viral aerosol and surface survival, whether reducing fever using over the counter medicines is “good or bad” (if you can tolerate it, don’t take anything; if you cannot then take acetaminophen*), and whether you can “boost” immune function (you can’t but you can reduce effectiveness of your existing immune function).
Dr. Roger Seheult (US) is a pulmonologist who has been looking at available scientific data relating to Covid19 mechanisms of action/kills as well as experimental avenues of treatment. He talked about zinc ionophores and chloroquine/hydroxychloroquine class of drugs before this became widely discussed. The channel is meant for medical students, but are useful for a public audience who may have a background in healthcare/scientific or are simply curious about actual science.
*Fact Check on concerns about ibuprofen and Covid19
BUT… I NEED TO CLIMB/HIKE/DO-WHATEVER-OUTSIDE!
I’ll be the first to admit that climbing has a real positive impact on my mental health (you’ve read my climbing as therapy article, right?). To those objecting to shut downs of state/national parks and hiking trails because “I doubt your 90 year old grandma is up there skinning up the trail” — Because first responders will have to RESCUE YOU if you get into an accident instead of helping other first responders with REAL patients needing REAL help in REAL remote areas. That is why accidents are called accidents. NONE OF US plan to have climbing/hiking accidents.
List of “I know how to climb safely”/”I am an experienced climber”/”I am nowhere close to anyone else”/”I know my own limits” cases of sucking up scarce first responder resources:
- A downed rock climber (rescue video) in Morrison, CO had to be removed utilizing a rope rescue system. Had to be transported to the hospital.
- First responders spent eight hours Sunday night rescuing two stranded climbers
- “A microspiked hiker found himself unable to go up or down amid a sea of glare ice in Tuckermans, facing a slide for life below him that we were called out to rescue.“
- “A guy in ski boots was hiking up the pike and we assumed slipped and slid 700′ from the top! A snowmobile and sled were dispatched, along with a ambulance ride!”
- I’m sure the hiker didn’t plan on breaking a bone and getting possibly bitten by a snake, yet here we are.
- “It was these rocks that ultimately saved her from plunging into the ravine, a fall that would have likely proved fatal”
- Hiker (who took along 2 young children) with a broken ankle was rescued by Maine game wardens and several other agencies on Tumbledown Mountain
- Hiker trapped under a boulder on Camelback Mountain rescued by firefighters.
- Climber survives 650ft fall and four others rescued by three mountain rescue teams, in heavy rain and 70mph winds
- Crowds climbing Snowdon warned they could put mountain rescuers at risk amid coronavirus crisis
- Exhausted climber rescued from cliff-face. “The climber had become cold and tired and was unable to climb back up the cliff.” SHOULD HAVE STAYED HOME.
- I’m sure these climbers didn’t plan on being “unprepared” and stranded and requiring rescue team to spend 8 hours on them.
“Despite mass outreach and the desperate warnings from physicians and health care workers worldwide, climbers from around the country have descended upon Bishop…”
Primary Source (First Person) Accounts & symptoms
Note: Just because you recover does not mean your lungs could ever fully recover. Could subsequent infections further reduce your lung function? Time will tell.
PJ McClelland, 37 (Brandon FL) Passed away from Covid19 but shared detailed updates of their experience with symptoms and the healthcare system.
Michael Bane, 42M (Chicago IL) “TL;DR version of this is: It’s brutal, and I have no doubt it can kill you. Anyone who is saying it’s just a bad cold is either had a far different personal experience than I have or is parroting stuff they found on the internet.” Excellent personal day-by-day logged experience. Update 2. Update 3. Update 4. Update 5.
ER Physician Account of Covid19 Patient Symptom Manifestation. An excerpt: “I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.
Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.
Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.
Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.”
David Anzarouth, 25M (Toronto Canada) “The fit 25-year-old living in Toronto didn’t worry about taking his vacation to South Beach in Miami, Fla., in early March. … “It was the most incredible pain I’ve ever experienced … My body felt like I had been flattened.”” — Not to mention he also exposed many people on the flight he was on.