Energy Prospectus

World
335,366 (not 316,659) - Total confirmed cases -
97,594 (not 94,176) - People recovered (and they "recovered" not just "because their immune systems could beat it," but, for some, they were able to get needed supportive treatment; importantly, some of their "recoveries" will never be total; many will have residual lung scarring and diminished lung capacity)
14,611 (not 13,599) - Total deaths

223,161 - Total active cases (not 208,884); Total serious/critical - 10,619

Observations:

- USA has moved up to #3 (not #4) in total confirmed cases, with 32,356, of which 8,138 (25%) were reported in the last ~24 hours.
- USA total cases per 1 million population now 98, having been 73 yesterday and 29 on 3/18.
- USA total deaths - 414 (not 347), 112 (27%) of which were reported in the last ~24 hours.
- USA is still in the rapid escalation phase, clearly shown by total case and total death curves. It is too early to draw reliable conclusions about USA eventual case and death rate (death rate currently 1.28%).
- USA has excellent health care systems, but at current escalation rate, many are still under-supplied, lacking adequate numbers of ventilators and (even currently) PPE to protect staff who are treating patients; and at least one, notably NYC, is already approaching bed capacity, early in the course of the pandemic.
- All containment and mitigation protocols that every American has been asked/told to take by federal, state and local officials to slow transmission ("flatten the curve") are unarguably necessary if we wish to avoid large-scale rationing of lifesaving care to acutely ill patients and potentially crippling exposure of our healthcare workers to COVID-19 while production and delivery of PPE and medical equipment ramp.
- USA still is several weeks, at best, from being able to demonstrate a safe and effective therapy for COVID-19; if hydroxychloroquine proves to be safe and effective in this clinical setting, it is already widely available.
- USA is likely a year from completing testing of a vaccine that is demonstrated to be safe and effective.
- Tens of millions of Americans have advanced age (52 million over 65) and/or underlying illnesses (e.g., asthma - 25 million, obesity - 70 million, diabetes -34 million, heart disease -30 million, cancer - 17 million, smokers - 34 million) that weaken their immune systems or otherwise make them vulnerable to COVID-19.
- Comparisons to influenza are flatly rejected by nearly all knowledgeable scientists and public officials. COVID-19 is much more highly contagious, and it spreads insidiously and more rapidly, than flu. Our healthcare infrastructure has had years to adjust to flu incidence; vaccines offer substantial protection to help reduce spread and lessen severity; therapeutic strategies (Tamiflu) have been developed and are widely available to mitigate severity and reduce strain on heath care resources. Death rates from COVID-19 so far are estimated to exceed that of flu (which vary widely) by about 10:1. Our healthcare workers are only infrequently infected by flu patients.

Recommendations
- Do more than just "wash your hands" to "stay safe."
- Stay home unless necessary to go out for work, food, medicine, fuel, especially if you live in areas that have "community spread" and are at elevated risk for a bad outcome from COVID-19. When going out, practice social-distancing, avoiding continuous, close contact.
- Do not assume, after going out and having close contact with others who appeared healthy, that you have not been exposed; it's possible that they may have been exposed, become infected, but still are without symptoms/unaware. Be vigilant for appearance of symptoms (fever, non-productive cough, weakness, shortness of breath), and upon onset of such symptoms distance yourself from others in your household until a doctor tells you otherwise.
- Do everything reasonable to avoid becoming a vector (becoming infected) and, before you discover it 5-6 days later, infecting someone else (who might suffer a fatal outcome).
- Do everything reasonably possible to keep your immune system strong, eating healthy foods, exercise, get adequate sleep, stay well-hydrated, ensure sufficient vitamin levels (especially vitamin D if one is exposed to less sunshine), and discard poor health habits.
- Adhere to all protocols and mandates from federal, state and local officials. There is no evidence that such measures are "overreactive," the result of "hysteria," or caused by "unbridled panic" or that they are motivated by a desire to gain control over our lives. They are instead the result of informed decisions to try to save many lives and to reduce unnecessary injury and death to our healthcare workers.
- Call your doctor if you have symptoms. Do not go to a doctor's office or, unless in an emergency, to a hospital without first calling. If you have an emergency, call 911 or go to an ER, but have someone call ahead/enroute if possible, and always follow all screening protocols when you arrive.
- That " this will pass" is likely, and we will be wiser and stronger as a result. But how and when "it will pass" is currently unclear. It is possible for new strains to evolve, for community spread in the southern hemisphere to escalate as their fall/winter approach (facilitating further mutations), such that we could see new strains by our next fall. Whenever COVID-19 is slowed or hopefully conquered, it will have been at great cost, which we must recognize and for which we must prepare.
- If you happen to talk with a health care provider who is involved in treating patients for COVID-19, show you are not taking them for granted, by thanking them for their unselfish dedication and sacrifices. They will appreciate it.

COVID-19 source: https://www.worldometers.info/coronavirus/

Questions:

Why is COVID-19 so much worse than Swine Flu? An estimated 60 million Americans got Swine Flu, 274,000 were hospitalized and over 12,000 died.

Are people who die from COVID-19 more important than people who die from the flu? So far only 5 Texans have died from the flu. Each year 3,000 to 3,500 Texans and ~400,000 in the world die from the flu. Just asking if a death is a death or is death from COVID-19 worse?

Your posts imply that I don't care about people who get sick from COVID-19. That is not true. BTW Susan & I are 66, so we are more at risk from the disease ourselves than average Americans. Susan's Father died from the flu, so I know what death from lack of oxygen looks like. It sucks!

All I'm saying is that the drastic measure the government is taking are going to cripple our economy and put countless people out of work. At some point soon we much get back to work. Shutting down our school, churches, businesses, etc. will cause incredible harm to our society. Living in FEAR causes people to do bad things. There is a reason gun sales are up.

I will respond to each of your questions.

Why is COVID-19 so much worse than Swine Flu? An estimated 60 million Americans got Swine Flu, 274,000 were hospitalized and over 12,000 died.

You are referring to the 2009 H1N1 flu. It started in Mexico in about March 2009 and ended in August 2010. Genetic analysis showed the strain contained genes from five known flu viruses. It was initially believed not likely to cause severe symptoms in most people. Although I did not take the below data from it, here is an excellent article comparing the two. https://www.livescience.com/covid-19-pa ... e-flu.html

Transmission speed and extent. H1N1's incubation period averaged 2 days (vs. COVID-19's estimated average 4-6 days), with H1N1's contagious period starting an average of 1 day before symptoms appeared (vs. COVID-19's contagious period starting at least several days before symptom onset). H1N1's speed of transmission was thus much slower than COVID-19. Also, H1N1's contagious period lasted a shorter period (5-7 days after symptom onset) vs. COVID-19 (unknown, but estimated at least 7-14 days), further contributing to slower, less extensive relative transmission for H1N1. Further, H1N1 spread was via water droplets, whereas COVID-19 is known to spread not only via water droplets but also as aerosolized, viral-contaminated fluids, heightening COVID-19's transmissibility. R0 for H1N1 was 1.46 (mean), while estimates for COVID-19 have ranged from 1.4 - 4.0, with most estimates now in the 2.0-2.5 range. That is an enormous difference.

Mortality rate. Quite significantly, H1N1's mortality rate was found to be 0.01-0.03%, compared to COVID-19's estimated mortality rate of 1-3% (highly variable depending on population and health care availability).

COVID-19 compared to H1N1, therefore, spreads more silently (longer period before symptoms appear), far more easily, and much faster. Far more Americans would be infected by COVID-19 than were infected by H1N1, and in a shorter period of time, without (maybe even with) aggressive containment and mitigation measures. Given the absence of a vaccine, containment and mitigation measures such as those recommended/imposed is the only way to try to reduce spread in a population of 330 million.

COVID-19 will likely kill many more (as much as 10-30 times) of those who it infects also because of our population. Tens of millions of Americans have advanced age (52 million over 65) and/or underlying illnesses (e.g., asthma - 25 million, COPD - 24 million, obesity - 70 million, diabetes -34 million, heart disease -30 million, cancer - 17 million) that weaken their immune systems or otherwise make them vulnerable to COVID-19 and predisposed to a poor outcome. Only time will tell the U.S. mortality rate.

Without aggressive containment and mitigation to decrease spread (measures virtually all countries have eventually taken at various times and to various degrees), infectious disease epidemiologists have modeled that 15% of our population (50 million) (I have heard some experts cite higher numbers) Americans could rapidly become infected and that 2% (1 million) of them could die. That would be a far cry from H1N1's 12,500.

The speed of the contagion would also pose a critical threat to our health care system, which simply has never been structured (in this age of just-in-time supply chain management) to handle, in such a short period, this many cases of a severe viral illness, some needing hospitalization. If 50 million Americans were to become infected over a 4 month period (some think that a conservative assumption without aggressive containment and mitigation), with only 5% (2.5 million spread out over 4 months) requiring hospitalization and intubation/mechanical ventilation, our healthcare system would quickly become overwhelmed, impacting health care delivery generally for everyone (all other illnesses must concurrently be treated, of course).

It is this threat -- collapse of our healthcare system -- that containment and mitigation measures are designed also to attempt to avoid and why "flattening the curve" (reducing incidence and stretching cases out over time) has become an ethical and practical imperative.

To be fair, none of these numbers is documented. Each viral pandemic throughout history has been different. Differences from one era to another, from general population health, to health care systems, access, differences in transmissibility mechanism, differences in contagion period and when symptoms appear (determining speed of transmission), among others, are unique in each pandemic. So are containment and mitigation measures. So R0 and death rates, and curve amplitudes are unique for each pandemic and aren't known until it is over and data are collected. In trying to predict/model an outbreak, we have to rely on experts based on their knowledge of the relevant facts. I have heard no experts saying anything other than that COVID-19 presents an unprecedented (in a bad way) challenge, that we are unprepared, and that very aggressive containment and mitigation is our only hope to lower the R0 and case and death incidence so that we can avert the above scenario.

Are people who die from COVID-19 more important than people who die from the flu? So far only 5 Texans have died from the flu. Each year 3,000 to 3,500 Texans and ~400,000 in the world die from the flu. Just asking if a death is a death or is death from COVID-19 worse?

Your question completely misses the issues. Of course no death is more or less important than another. But 1 million U.S. deaths (+/- 500,000) in 4-6 months and the overwhelming of our healthcare system would drastically affect the US, would do perhaps irreparable harm to the economy, and would threaten national security. Our healthcare system is structured to handle seasonal flu (at least so far), and we accept that 60,000 +/- U.S. flu deaths may occur annually because we generally are able to provide supportive care to flu patients. Our society has not yet progressed to rationing life-saving care on a large scale for critically ill patients, as could be required if we fail to meaningfully flatten the curve. Failure would present ethical issues, on a large scale, that all policy makers (and most of society) want to avoid.

COVID-19 is far more highly contagious, and it spreads insidiously and more rapidly, than flu. Our healthcare infrastructure has had years to adjust to flu incidence. Flu vaccines offer substantial protection to help reduce spread and lessen severity. There is none, and won't be for a year or more, for COVID-19. Therapeutic strategies (Tamiflu) have been developed and are widely available to mitigate severity and reduce strain on heath care resources. None has yet been satisfactorily proven for COVID-19, though hopefully we are close. Death rates from COVID-19 so far are estimated to exceed that of flu (which vary widely) by at least 10:1, depending on how effective mitigation and containment strategies will be. Our healthcare workers are only infrequently infected by flu patients. COVID-19 has the capacity, if unchecked aggressively, to overwhelm the U.S. health care system. Seasonal flu, so far, has not.

Your posts imply that I don't care about people who get sick from COVID-19. That is not true. BTW Susan & I are 66, so we are more at risk from the disease ourselves than average Americans. Susan's Father died from the flu, so I know what death from lack of oxygen looks like. It sucks!

I'm sorry for Susan's loss. I have not accused you of not caring about people who get sick from COVID-19. Your posts have, however, repeatedly contained erroneous premises and misunderstood analysis, incomplete data, and a misplaced (and uninformed) focus.

You have clearly not understood the potential scope and scale of the problem. To focus on the number of deaths from H1N1 or seasonal flu and to compare them to the potential problem posed by COVID-19 reflects a basic lack of understanding of the science (and uncertainties) of COVID-19 as well as the scale and impact of the potential realities they pose. You are misinforming, rather than informing.

On 3/18 you asked, "Are we going to shut down the world's economy for less than 0.0002 of the population, especially when over 95% of those who get it recover within two weeks?"

"Shut down the world's economy" substantially exaggerates what is happening. Some segments of the U.S. and global economies are hard hit, no doubt. But many (in the U.S., e.g., farming, food production, food retailing, trucking, health care, and the many industries that are partnering with the government, some personal services) are not. Those that are effectively curtailed (e.g., airlines, leisure travel, restaurants, some manufacturing, small businesses, some personal services) are temporarily being severely impacted, but government loans, grants and contracts are going to help most recover. China is already getting back to work. South Korea and Japan are close if not already underway. To characterize the U.S. protocols as "shutting down the world's economy" when posing any issue is just recklessly inaccurate.

As for your statistics (and your question), your postulated 66,000 deaths underestimates by orders of magnitude the potential number of deaths from COVID-19 were we not to pursue aggressive containment and mitigation protocols.

Moreover, it completely ignores the consequences of overwhelming of our health care system (for patients of all types and for health care professionals) that would likely result from not imposing such protocols.

Finally, it ignores the unprecedented ethical question that would be more likely to very quickly confront us. That is the widespread denial (through rationing) of life-saving care to large numbers (tens or even hundreds of thousands) of people. Your question implies you would find such to be an acceptable price for avoiding the cost of not using otherwise necessary containment and mitigation strategies. Actually, I think instead you would, if informed, favor such strategies.

On 3/21 you implicitly endorsed (by quoting in bold at the beginning of your 3/21 post) the characterization of the containment and mitigation measures taken thus far as having resulted from "unbridled panic." That characterization is simply untrue. That quote also falsely claimed that such "unbridled panic" was responsible for causing the "destruction being wrought on the global and U.S. economy."

Yes, the economic cost is significant. But our economy is not being destroyed. And certainly the admittedly drastic measures being employed to try to avert a catastrophe unlike any we have ever experienced are painful. But they have resulted from considered, deliberate analysis of rapidly developing facts on the ground of a challenge unlike any we have had in our lifetimes. Few, if any, of our 50 governors disagree. I know of no credible epidemiologist who would support the view that these measures result from "unbridled panic" or hysteria, or are an overreaction, given the gravity of the threat.

As I noted yesterday, "unbridled panic" would occur when thousands of patients whose lungs are filling with fluid and who are going into ARDS (and their families) are told there is no bed/ventilator or doctor available to treat them, just go home.

You also wrote, on 3/17: "My primary concern is that our government will use this to gain more control over our lives, like taking over the healthcare system. That will kill many more people. Remember: FEAR is a powerful human emotion. Throughout history it has been used by dictators to take control of many countries."

Yes, fear is a powerful emotion. Your expressed fear, that the U.S. "government will use this to gain more control over our lives" is irrational, without any evidentiary support, and has no chance of being realized. The public policy measures being urged and in some instances imposed will be limited to what the scientific facts justify and, in any event, will be temporary. Implying that those measures will result in a government takeover of our healthcare system is a use of unwarranted fear that distracts from the discussion of what public policy measures are immediately needed and how they can best be implemented.

Your "primary concern" might instead be whether you and others like you will have the necessary medical treatment available when it is needed (in the event you become infected or need some other type of care urgently) if Americans don't adopt the measures they are being asked to take. You might also be concerned about the many selfless healthcare professionals who are working very hard (and risking their health) 24/7 to treat those of us who need care.

All I'm saying is that the drastic measure the government is taking are going to cripple our economy and put countless people out of work. At some point soon we much get back to work. Shutting down our school, churches, businesses, etc. will cause incredible harm to our society. Living in FEAR causes people to do bad things. There is a reason gun sales are up.

Gun/ammunition sales are up because more people fear what would happen if law and order were to break down. Surely you are aware of what happened in New Orleans when exactly that happened. Governments' ability to manage this crisis effectively, including getting right the analysis of a never before occurring problem, and how to avoid major catastrophes such as those outlined above, will determine whether law and order is maintained. Yes, everyone will be stressed financially, some more impacted than others. But the economic rescue packages being enacted should help small businesses, workers, and some impacted industries eventually get back on their feet. We are all going to suffer economic loss from COVID-19. We can't afford to lose law and order by getting wrong our analysis of the scope of the COVID-19 problem and how to manage it.

cmm3rd,
Many thanks for taking the time to post your very detailed, thoughtful comments.