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covid 19 update
What follows is an email I received from a friend who recently retired from the CDC. Thought some of you might be interested in a pretty unbiased assessment from someone who has been working in infectious disease for 30 years as a researcher at the CDC.
As for me I have seen some Covid patients and have intubated three for the vent personally, one being a healthy 55 yo with no real medical issues. That hits close to home for this almost 62 yo. So far in Southeast TN the shelter in place seems to be keeping things under control. While the healthcare providers face the risk of infection we also are feeling the economic pain. My practice has furloughed half of our CRNAs and the physicians have take a 50% hit on pay. This is due to the cancellation of all elective procedures to conserve PPE. How I see that ending is patients scheduled for elective procedures will be tested for Covid 24-48 hours prior to surgery and will need to be negative and without a fever at the time of surgery.
i have thought about getting in the bus and running away from home many times! Here is my friends take on things:
Dear friends,
Several people have asked me for any personal insights I might have on the COVID-19 outbreak. I had some down time this afternoon as Mary and I shelter in place, so I thought it would be a good time to summarize how I see the current situation.
Flattening the curve: Here is where there is some good news. Country-wide data as well as data from New York, California, and Washington all show that the rate of new cases is slowing. A technical point on this: four different curves are sometimes shown of the daily case counts: by illness onset date, by diagnosis date, by report date, and mortality data by date of death. What you really want is by infection date, but since so many cases are asymptomatic, we won’t have good data by infection date any time soon. Data by illness onset date is the earliest indicator of flattening of the curve, and CDC has been publishing that data every day. It shows the nation’s curve began to flatten about a week ago. One thing I find interesting is that none of the big states have shown an impressive decline in the daily case counts. Italy and Spain have, but not here. South Korea, Taiwan, and Japan have experienced impressive declines in their daily case counts but have recently seen increases. There may be a limit to how much of a drop we will see. A modeling study published today concluded that the R naught in China was greater than 5 in January, meaning that on average, each infected person transmitted the infection to 5 others. China now is reporting almost no new cases except imported cases among travelers, but I don’t know how to interpret the reports by the CIA that China has not been reporting all their data.
When can we get back to normal? I have read opinion pieces by non-epidemiologists that once we get widespread antibody testing (FDA just approved an antibody test), we can get back to normal by having those with antibodies go back to work. I don’t see it. That would require a lot of otherwise normal people getting a test that is still rare. I have also read that we could let everyone under 60 go back to work, since their mortality rate is very low. I also do not see that, especially since Mary and I would be discriminated against, forced to wear a mask of shame forever. And the social distancing that is being practiced today is not because the government mandated it as much as it is because people are afraid to get infected. And, if California and Washington and New York have not seen dramatic declines in their daily case counts, I don’t see how they are going to lift restrictions until they do.
Did CDC really botch testing? Yup. I am not in the know at CDC anymore, but rumor has it that the initial CDC test had a viral RNA segment that was not a good match for all of the viruses being circulated, resulting in several false-negative results. Probably a combination of bad luck and being under pressure to move quickly. A bigger problem was that neither CDC nor FDA nor any other government agency apparently had plans for rapidly scaling testing in commercial labs. CDC normally works with state public health labs and normally does not tell commercial labs what to do.
Will the Midwest escape? There are very few cases in the Midwest, but a more important indicator than the daily case count is the rate of growth of that count. In Tennessee, cases are increasing at a doubling time of around 8 days, which is much lower than Italy or New York, but it still increasing exponentially. There does not appear to be a big difference between urban and rural Tennessee. It might be that the Midwest does not see the explosive growth that the coastal big cities did, but maybe we will all end up in the same place with a sustained number of new cases for a long time.
Treatment and vaccinations and immunity: I have been involved in a lot of clinical trials where promising initial results were shown to be false when properly designed studies were done. I would guess that the same thing will be the case with hydroxychloroquine. Recent anecdotal reports in this country have shown unimpressive results, but these reports have focused on the most ill patients. A drug might show substantial benefit at the early stages of an infection but much less later on. Since most patients improve without treatment, it will take a very large clinical trial before you can be certain a drug does or does not work. Tony Fauci has reported promising results from at least one vaccine in lab animals. I was also impressed to hear Bill Gates say that his foundation was testing 7 vaccines and already ramping up production for each one so that when the best vaccine was identified, they could scale production quickly. Not so good news was reported today that many Chinese who had recovered from covid-19 did not have neutralizing antibodies. This means that there is no guaranteed that infection confers protective immunity in all or that a vaccine will be highly effective. Yikes.
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36 Replies
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Great information – thanks for the post
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Thank you so much for your post. Lots of useful information.
On a lighter side how is your Marathon running ?
AL
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Thanks so much for all the good truthful info.
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So far the Marathon is running well mostly thanks to Jeff. I’m lucky that ETLC is about an hour drive from home so I can address all those little things that drive us crazy pretty easily as they occur.
Really wish all this Covid crap would end so I could get back in the bus and go! I see bus owners as having an advantage once things open up. We take our house with us so no need to be in hotels etc that may have big crowds and questionable sanitation.
Stay safe and this will get better. A lot of people smarter than me are working hard to deal with this mess.
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Thanks Chris, Stay well, my friend.
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OK. I’ll be “that guy”. Disagree if you want, but personal attacks due to a differing opinion – I can play that game too.
First of all, not many areas of the country are very similiar to Queens, NY – or even NYC for that matter. And yes, I’ve been in NYC and Queens multiple times. NY Times did an article by an ER Physician at Elmhurst Hosp. in Queens (called the epicenter of the epicenter) a few weeks ago. Wasn’t intended to be on one side of “this” or the other but gave a perspective of the primarily three communities served by that public hospital (that stays at or near capacity) and the living/commuting/working conditions of those people. Makes one realize how good most of us have it – to say the least. Like a third world country compared to many other places in the U.S. That article gives (probably unintended) a perspective of the contrast to most other places here. A little Trump bashing towards the end but I ignored that.
I am not a physician. I do have some friends/family that are, and regardless of how much they buy into the panic going on, none are going to speak out (publicly) and possibly land on the “wrong” side of this.
I’m no economic scholar either. But what is going on here is NOT sustainable – and borders on insanity for some of the inconsistent rules/regulations on what businesses can/can’t be open, or in some places what items can/can’t be sold at the same store. “Shooting from the hip making rules up as we go” for many municipalities. I could expand on that but will hold off for now.
For those that are extremely worried – stay home – for weeks, months or years if that’s what you feel comfortable with, wear a mask at home, in your vehicle or whatever suits you. I realize there is a risk. True with so many things in a free society.
There is likely an argument to be made by some that those in their 80′-90’s (or pick a number) are creating a safety hazard by driving – even if only or mostly to themselves. Do the powers that be take that away? I hope not.
We have a large Integris Hospital here that has actually closed temporarily. Due to the cancellation of elective type surgeries, they had excess staff that had nothing to do. My neighbor is a nurse that has been furloughed along with many others. That hospital is has been “available” for the potenital influx of possible Covid patients. Which has not happened – thankfully. Far cry from what you will see on Main-Stream-Media.
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Dr. Chris, I also appreciate the info that YOU provide and from others very close to “what is happening” on the medical side of it.
Thanks,
Mark
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If there was a real Santa Claus he would fill my Christmas wish.
No matter what I have read or seen on TV, there is equally and compelling opposing opinions and viewpoints.
I have a great deal of respect for Chris, and I wish I had the ability to evaluate all he says and determine if information to the contrary posted or reported by those with different information is valid. We have to trust professionals, but when those professionals are providing different opinions I tend to decide not to believe anyone, and just avoid all contact with everybody, not only until this pandemic is resolved, but even afterward.
Right now I view everyone as a threat to our health because I cannot interpret what information I should accept other than to take an extreme posture.
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Have been married for 51yrs. Wife is high risk. Two kids in med field. We have been isolating since 2nd week of march. Live in rural area. We will be taking extra time past when most activity has started back up. Chris.. Both of our medical trained children have had to lay off or reasign staff. They had to delayed elective procedures only to have them turn in to life threating situations. (not us) We really miss dance competitions and sports (grandkids). Everyone is missing some part of life experiences! Looking forward to new ones in future. Bob
Jeff and Lindsay
91 Marathon XL -
Fred,
Thank you for sending this to me …
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Just something to think about. The number of deaths claimed from Cv have been skewed by hospitals ,etc so they will receive 15% more stimulus $$. NY governor reported their death accounting method has been revised which resulted in increased totals. Are all these deaths really associated with CV ? Symptoms vary with persons. Are the test results accurate ? How do the number of cases compare to other yearly viruses ? Is this a fabricated pandemic for political reasons? Time will tell all.
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We will never know because all the talking heads seem to have an agenda. People are choosing sides with some wanting to get back to normal, some insisting if we go that route things will get worse, and every day the information changes so even if we stick to listening to one source we are still going back and forth.
And politicians are saying things and doing things now based on their poll numbers.
I wish the medical profession was able to get everyone else to shut up, and step back and the medical profession should provide advice and guidance based on what they think is necessary to make this go away. But even within the medical profession there are some mixed signals so we are stuck with doing what we think is best for us and ignoring all the background noise.
What a damn mess.
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Is the cure worse than the disease?
https://www.publicopiniononline.com/story/opinion/2020/04/16/cure-worse-than-disease/5149248002/
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I too wish that we could get accurate, objective information that isn’t skewed in one direction or the other. Just the straight honest truth, and all of it.
What is really going on?
Unfortunately I haven’t seen the news media take two or three hours to give us a straightforward, unbiased, factual review of how we got here, where we really are, and where we might be headed.
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