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Then there are the actions/reactions we take. Those break down into political, economic and health categories. People link politics into everything and so that gets in the way of making fact-baed policies that impact economics and health. It’s unfortunate that politics gets in the way, but it does (and everyone knows their own opinion is based on their set of facts, so there ya go). Trying to keep politics out of it, but let’s see how I do.

 

We can compare this to post 9/11 and whether or not we did extra TSA screening at random or based on profiling. Some people said that profiling is a great way to prevent terrorist attacks. Other said it was racist or that because it was targeted it was unfair in some way.

 

Not giving an opinion, but here I do think that for health purposes vs. economic sustainability, we must have a health-based, profiling-based system to protect those whose profile would show them to be vulnerable. Based on the likely risk of having problems if you get COVID-19, which can range from no symptoms (50% of infections) to death, it’s too broad to permanently shut down the world economy until there is a vaccine. But it is severe enough for enough people that society cannot move forward without a rationale, targeted approach to protecting the vulnerable. Targeting means isolating those who are the most likely to suffer if they are infected (immunodeficiency, existing conditions).

 

Ok, so I buried the lead with my Rx on some logic on how we move forward. Here is the logic, based on what we know now, which is considerable.

 

First, we know that most people who have the virus have not been tested. How do we know this? Most of us by now know someone who is “presumed” positive b/c they have all the symptoms and have had them for many days. When they call their doctor, they are usually advised to self-quarantine and only go to the hospital if they cannot breathe. I’ve interviewed patients and doctors and heard from plenty of friends and family and the story is always the same. In most of these cases, the people are not even going in to get tested. If they have the symptoms, they are just advised to stay home and monitor, etc.

 

Ok, so now, of the 2.8 million Americans who have gotten test results, the reported statistics show (and each state does this a bit differently) that we have 553,000 infections and more importantly, about 92,500 hospitalizations. Some states report cumulative while others report current hospitalizations. I took whichever number was highest for each state and got to my 92,500+/- number. Ok, so that is 3.28% of the total number of people tested.

 

Alright, so one presumes that nearly everyone who was tested was tested because they had symptoms or was a healthcare worker who get tested as a matter of course due to their position. But we also know that for every person in the hospital, there are people who aren’t even getting tested and are self-isolating. I estimated this number by taking 100%/3.28% and got an estimate of about 30.5 symptomatic people who are not even getting tested for each person who tests positive. That brings us to nearly 17 million Americans with the virus AND symptoms.

 

Ok, so here is where it gets more interesting. You have seen me writing about Iceland a lot here. It’s due to the fact that they have been doing randomized testing from the beginning and for a very large portion of their population compared to other countries. In their randomized tests, they found that 50% of the infections had no symptoms. Other countries are only testing people with symptoms, so their figures are all out of whack. So what we know from Iceland is that they have a very high rate of infection (known b/c of their randomized testing), yet very few severe cases and only 8 deaths, or a fatality rate of 0.45%. this is about 4.5x the fatality rate of the annual flu, although the annual flu has a wide range of morbidity.

 

Anyway, back to the point. The point of the randomized testing is that 50% of the infected people had zero symptoms. (Annual flu is asymptomatic about 16% of the time on average, depending on the year). So this means that for every person who is positive with symptoms, we have a person who is positive without symptoms. So if we believe that 17 million Americans are symptomatic and positive, then we then estimated that we really have 34 million Americans infected, or about 10% of the population.

 

What does this also mean? It means we have a really good idea of the denominator, the big question that no one seemed to know and no one is really focused on (not good for ratings). So if this is true and we have 34 million cases and 22,000 fatalities, that puts our fatality rate at 0.065%, or less than the annual flu. Now, we also have a lag in the disease taking its toll on people. So let’s assume that there are many people currently who have it or are hospitalized who will die. So taking the estimates of fatalities for the next 14 days essentially doubles our fatalities to 44,000. This puts the fatality rate at 0.13%, or just about 30% higher than the annual flu.

 

If everyone in the 50 states (population about 327 million) were infected, it would then mean about 428,000 deaths (for comparison, heart disease is the leading cause of death in men and kills nearly 650,000 Americans per year). And because this virus is much more contagious than the annual flu, and because the spectrum of symptoms and outcomes is so extreme and often severe, it has swept the country and world very quickly.

 

But now let me note something else. Dr. Birx stated recently that everyone with COVID who dies is being classified as a COVID death, even if they actually died from something else (related or unrelated). 

 

From the April 7th press conference:

DR. DEBORAH BIRX: “So, I think in this country we’ve taken a very liberal approach to mortality. And I think the reporting here has been pretty straightforward over the last five to six weeks. Prior to that when there wasn’t testing in January and February that’s a very different situation and unknown.

 

There are other countries that if you had a preexisting condition and let’s say the virus caused you to go to the ICU and then have a heart or kidney problem some countries are recording as a heart issue or a kidney issue and not a COVID-19 death. Right now we are still recording it and we will I mean the great thing about having forms that come in and a form that has the ability to market as COVID-19 infection the intent is right now that those if someone dies with COVID-19 we are counting that as a COVID-19 death.”

 

So now this means that we as a country are likely overstating deaths related to COVID-19. Better safe than sorry? I’m not sure. If you are being less accurate in your reporting about the fatalities and hence, the rate thereof, then your policies are being misinformed. Over-reported fatalities are just as harmful to policy-making as underreported fatalities.

 

We do not know the % of deaths that may have been over reported. Let’s say it’s only 10%. Alright, that brings the fatality rate to 0.12% and then would bring the total fatalities to 384,000 if EVERYONE gets infected. For whatever reason (social distancing, antibodies, etc.), we know that not everyone will become infected. In fact, the most relied-upon model (IHME) suggests that the U.S. will see 60,000 deaths through August 4th due to the disease.

 

So, what does this mean for how we move forward? First, it means that the odds of having a severe reaction (enough to go to the hospital) to the infection is very very low (0.27%) and the odds of dying for the average American is 0.12% or less). The numbers are simply not as catastrophic as many would have us believe (remember the ratings on the cable news channels have never been higher and they love to scare us into watching). The reason this seems so catastrophic is how quickly it speads and overwhelms our healthcare infrastructure. But guess what? In most of the country, hospitals are sitting either partially empty or totally empty since they’ve cancelled elective procedures and optional appointments out of fear of a mass need for beds. They are closing down quickly-built COVID field hospitals in places like Seattle. The severity of the NY/NJ/CT problem, up to Boston and down to DC, is bad and it’s infecting the news media who are based there. These are also places with high rates of mass transit where people were getting and spreading infection quickly. But most of the rest of the country is not overwhelmed and likely won’t be, as infections and community immunity spreads.

 

That does not mean the disease is not deadly. But we also know that while there are some instances where otherwise healthy people appear to suffer unexpectedly, most of the severe cases are with people who have known or underlying conditions. Age is not even so much a factor….most of the infected people over 80 recover, unless they have underlying conditions. That means we can isolate those at-risk people without having to isolate the entire country, one by one, destroying theaters, restaurants, sports events and public transportation systems. All places where masses of people gather.

 

For the near-term, we need to protect ourselves from others and others from ourselves. Wearing masks in places with crowds or even small groups, good hygiene, gloves and perhaps a way to not touch your phone.

 

My prediction is the governments (federal, state) will be too scared to fully open the economy back up for fear of being labeled murderers. They have already had that label thrown at them (and frankly, I’ve even been called a murderer for bringing my own independent take on this that doesn’t match the media hysteria). But companies have every reason to figure out a way to make the public not fearful. Airlines, hotels, restaurants, sports, theme parks, retailers…they all should voluntarily put into place protocols that let the public know that they are putting health and safety first. Instant testing for anyone going to the airport to board a plane….you can’t go through TSA until you have a negative test result (would also help keep normal fever/flu off of flights). Sounds like a pain, but so was TSA when it got going after 9/11.

 

How about getting an instant test while you wait in line to get into Disney (socially distanced, of course). If you are positive, you can’t go in. This isn’t a government test, it’s company by company policy to test their workers and customers (although airports could be administered by TSA). Just a thought.

 

I cannot imagine we want the government figuring out how to test us and track us and all that goes along with it. But people give up all kinds of freedoms and information to participate in a commercial transaction online or in person. That is voluntary and would benefit public health and commerce. Apple/Google and others are already prepping an app to do this. Not sure I trust Google at all…. but Apple has shown they care about personal privacy and so I could get comfy with an app that knew my status without sharing my personal details. I think.

 

Ok, so if you got through this, you are probably really tired, as am I.

 

Remember, the headline here is that the virus, while very contagious, is not as deadly as the media and others portray. It is not likely worth shutting down the world economy down indefinitely or until there is a vaccine. We decided to for awhile, which was likely smart, to get data and slow the spread. But, we have enough data now to know that it’s not as bad as feared (it IS bad, just not shut the world down bad).

 

Many countries we love to idolize, like Sweden, have not shut down. They are enduring a quick uptick in fatalities, but also causing a very quick spread of “community immunity” that will make them stronger sooner, without having damaged their economy. For us, it is smarter to shield at-risk people and set new and stringent protocols for everyone to reduce transmission, work hard to increase overall immune health, improve vitamin levels, improve health levels generally, improve hygiene and reduce habits that cause premature death from all kinds of things: smoking, vaping, sitting around, obesity, eating a carb-based diet, etc.

 

I would love it if these statistics were shared and used by those in power and then used to inform public policy and private sector action. I do not expect our elected officials to really ever get it right. But I do know that people will always use a crisis to grab more power or further their own political or related goals. The media is just as culpable as the public figures, but instead they are doing it for their own power, in the form of eyeballs and advertisers.

 

Let’s continue to press for the best data and make personal and societal decisions based on the data alone, not peer pressure, public pressure, political pressure or financial pressure. As we get more data, we can shift our decisions accordingly. For now, it appears we should be looking at ways to shield the vulnerable and get the rest of us back to work in as safe a way as possible. The longer we draw this out, the longer our “community immunity” will take to forge and the deeper our recession will be. Other countries that get past it quicker can then take advantage of our weakened economic position, buy up our assets at pennies on the dollar, with other dominos falling from there.

 

I guess what is most frustrating is that no one else really seems to be connecting the dots, discussing what it all means and how we move forward. Not the media, not elected officials. I’m guessing the private sector will, but we could really use a group leadership effort of all of the above.