Saturday, April 4, 2020

COVID-19 Take Two

Boy, was I wrong a month ago in my first Coronavirus post. I estimated a doubling every six months. Reality showed a doubling every one to ten days, depending on country, location, available care and a hundred other figures.

Everyone has been wrong on this. On January 1, Taiwan began taking foreceful, expensive nationwide efforts to slow the spread. It is the unaqcknowledged champion, with a total of 30 cases and five deaths out of a population of 24 million.I won't speculate here about why this is being ignored. I will point out that this was during the time China was still sanctioning doctors for spreading rumors and the New York Times reassured us that it was not a big deal. It was more than two months before the World Health Organization issued a global pandemic warning.

Today, numbers are being bandied about and fingers are being pointed assigning blame. Little if any of that has any value, in my opinion. The numbers are derived from expert models, all of which turn out to be wrong on most forecasts for dates where we can check against reality. Two of the most trusted models predicted that yesterday we would have 50,000 people hospitalized in New York; Reality was 13,000.One of those models forecast 1,000 hospitalizations in Oklahoma yesterday; reality was 38. Be careful about believing numbers. This is serious, but it's not a reason to panic.

The danger is from overwhelming our hospitals. In the first world, the threshold for a physician to hospitalize a patient is lower than in places such as Niger and Paraguay. It is also impossible to put six COVID-19 patients in one bed at the same time. Thus, hospitalization gross numbers and rates should not be compared between countries.Not until we have a far larger sample size of people who have been tested will we get any reliable answers.

People are hurting badly. Being very sick is painful; so is losing your life's savings, your house and your job. The urge is to find someone responsible and hold her or him accountable through shaming. The unfortunate truth is that there are few villains. Nobody saw this coming, nobody predicted it. Nobody is hoping others suffer, and everybody cares. The most powerful force preventing getting things done is bureaucracy, which is our fault. We demand more and more regulation on more and more things, but the result is a hospital ship with a thousand beds sitting in New York Harbor with only about 25 patients on board. If we are sincere in assigning blame, we must first look in a mirror.

The truth remains that almost everyone will survive, and deaths will be most prominent in people over seventy with a history of heart, lung or kidney disease. People whose immune systems are damaged by chemotherapy or by diseases such as lupus or rheumatoid arthritis, are also vulnerable. Hydroxychloroquine is being prescribed around the world to thousands with COVID-19, The drug has been used daily for many decades by lupus patients; it is safe. Plasma therapy, injecting plasma from the blood of people who have recovered, is available although rare. A vaccine  is as little as 12 months away. We will survive this. It remains to be seen if we learn the right lessons from this.

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