I look forward to, and greatly appreciate the effort that goes into, your weekly podcasts. Thanks for continuing to produce them.
In your 3/28 podcast, you claim that in Harris County "only 2 or 3" COVID-19 patients are hospitalized. That number vastly understates the facts (regardless of what you claim to have seen on TV). My source is a physician who is treating COVID-19 patients daily in just one Houston hospital. Unfortunately, that's all he is allowed to say.
In an undated chart, the Harris County Public Health Department reports 240 total confirmed cases, of which 2 are deceased, 34 recovered, and 204 are active (whether hospitalized not shown). http://publichealth.harriscountytx.gov/ ... rmed-Cases As of 3/29 afternoon, another source reported 922 confirmed cases, 8 deaths, and 57 recovered in the greater Houston area. https://www.click2houston.com/health/20 ... is-county/ (whether hospitalized not stated). These numbers of course do not include unreported cases.
Not only is Houston not representative of the rest of the country, however, there are hotspots other than NYC.
As a community hospital ER MD from New Orleans reported, as of 3/29 (1) they have to send home COVID-19 patients whose symptoms would ordinarily warrant admission (multifocal pneumonia, one MD, 12-15 such discharges per shift), (2) their 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19 (all intubated except one), (3) 75% of their floor beds have been cohorted into covid 19 wards and are full (4) they're averaging 4 rescue intubations a day on the floor and have 9 vented patients in their ER, (5) part of a hospital group, their main teaching hospital repurposed space to open 50 new Covid 19 ICU beds all of which are full, with 30 more by Friday; but even with the “lockdown”, their AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.
In describing "recovered patients," your slide erroneously states that they have "fully recovered." That is untrue. They have "recovered" according to specified criteria that vary by country (which I posted elsewhere). It is widely reported (and confirmed by my source) that some (percentage not yet known, this is a new disease) have "ground glass nodules" in their lungs, which can cause scarring (compromising lung function), and has, in other settings, been associated with increased risk of lung cancer, and that will require follow up pulmonary care. Regarding US recovered patients, you can say "recovered per CDC criteria" accurately, but you definitely cannot accurately claim "fully recovered."
Also, your claim that in the US, COVID-19 patients who are sent home from the hospital are not followed, and thus their recovery not documented, is not generally true. Public health authorities are to be consulted/notified, and a protocol for completion of quarantine/self-isolation is given. https://www.cdc.gov/coronavirus/2019-nc ... ients.html The rapidity with which public health authorities thereafter follow-up in individual cases and document recovery is unknown, and it can be speculated to vary. As the above-linked Harris County Public Health Dep't chart shows, 34 cases in Harris County are shown as "Recovered," with 204 shown to be "Active."
Regarding deaths, you repeat the misdirection that "this is not the millions that they said it was going to be." Credible epidemiologists said millions (globally, 500,000 in the UK), including as many as 2.2 million in the US could die if aggressive mitigation efforts were not undertaken. Well, those mitigation efforts have since been undertaken, and "they" now say the numbers will be much lower in great part because of those mitigation efforts. Moreover, your prediction that the total number of COVID-19 deaths won't make the top ten in this country in 2020 completely disregards both what is driving US policy (it's not just number of deaths, see below) and the fact that those mitigation policies are the very reason why there is still a chance your prediction regarding the ultimate number of deaths may prove to be correct.
Surprisingly, you overlook the most important datapoint: flattening the curve (did you even mention it once?). You don't discuss what it is, what it means, why it is the most important datapoint driving policy making at the federal, state and local levels, and where we are in our efforts. Flattening the curve is what will determine, probably on a state and local level, where mitigation efforts will ease, when that will happen and thus when economic activity will begin increasing (all of which will influence when crude demand destruction will begin reversing).
Slowing the spread of COVID-19 is the goal and the current focus not just because the nation is trying to reduce the number of deaths (a laudable and important goal), but more importantly because it buys time while the country ramps production of PPE, develops therapies, develops the ability to do mass testing, develops a vaccine, and creates additional beds. Spreading infections out over time also means our health care system has a better chance of not being overwhelmed, so that fewer health care workers become infected, more patients can be treated effectively, and people who need life-saving care won't be denied that care. Regarding our current shortage of PPE, see https://www.medscape.com/viewarticle/92 ... 8340&faf=1. It's like sending soldiers into battle without adequate protective gear. We need time to make up these shortages.
If you want to follow what the policy makers are considering, therefore, follow the curves on the charts/graphs underneath the numbers here: https://www.worldometers.info/coronavirus/country/us/ or elsewhere.
Flattening the curve, thus, is what is driving US policy, not "estimates of HUGE death rates" (your stated focus). Whether or not you agree with it, that is the reality. Note, curves will vary by region and when spread began and with what penetrance. And they will have to be interpreted alongside mass testing data (still to be done) for each region. So, while the national charts/graphs linked above give us some idea, they won't fully inform policy decisions. Keep an eye also on how quickly mass testing gets done, reported, and analyzed over the next few weeks using the just announced point of care technology. That data will be critical in decision-making.
I agree that "fear" of dying from COVID-19 would not be constructive. But, unlike what you have been claiming, "fear" is not what is driving our public policy response. Understanding how COVID-19 spreads, and what it would do if unchecked, is. Moreover, I believe most people are not "fearful" once they understand how and why mitigation works and what their part is in such efforts, and the results it will bring in accomplishing the above goals (which are, in fact, reducing everyone's risk).
You cite Japan and South Korea as examples of what the US can achieve. As I posted elsewhere, Japan's government has finally admitted they have a problem. They were vastly under-testing (pneumonia treated, but not tested for COVID; many deaths not tested), and according to recent reports they are now very concerned that their numbers will rise because they delayed instituting aggressive mitigation. South Korea is also not a good comparator because they began mass testing very early in their outbreak's course (facilitating more informed quarantining) and rigidly enforced containment and mitigation early in the course (they also don't have any problem forcing their population to comply with measures many Americans find unacceptable). Still, our goal has been to achieve S. Korea's case and death rates, not those of Italy. With continued mitigation measures, and mass testing, we have a chance to accomplish something close to that.
Finally, in the substantial time you devoted to discussing COVID-19, you didn't once mention the courage and sacrifice so many health care workers, first responders, and their families are exhibiting so that everyone who gets sick with COVID-19 can be cared for. Their unselfish dedication to serving the public in the face of this insidious disease is historic and noteworthy. They can't get vaccinated for it like they can for protection from influenza. So far, there is no proven therapy. Hundreds of their Italian colleagues have been infected, with over 40 deaths as of 3/26 (and Italy's population is about 1/6 that of the US). https://www.theguardian.com/world/2020/ ... isis-began. Worse, they don't have optimal PPE. Still, many thousands of them are fighting this war for us in the trenches 24/7, putting their lives on the line trying to save our fellow citizens' lives. Already, many have gotten sick and a few have died. They and their families are legitimately fearful. We all owe them a debt more than we can pay, and their selflessness should never be overlooked or taken for granted.