Thursday, April 9, 2020

COVID-19: Evidence that you probably already had it


With new science reports coming out these past two weeks that the prediction models were over-stated, I thought it might be useful to update you guys on a few other things that you might want to keep in mind:

1.     The total number of COVID-19 cases is grossly underestimated. This is because 80% or more of the cases have mild to moderate disease or no symptoms at all and so they aren’t able to count them in the total number of cases. Even Fauci supported this concept as published in the New England Journal of Medicine from March 26th: “If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza.”
2.     The data presented in the report from the WHO–China Joint Mission on COVID-19, also states that 80% of the 55,924 patients with laboratory-confirmed COVID-19 in China to Feb 20, 2020, had mild-to-moderate disease, including both non-pneumonia and pneumonia cases, while 13.8% developed severe disease and 6.1% developed to a critical stage requiring intensive care. When this fact is taken into consideration, the estimated overall infection fatality ratio for China was 0.66%, with an increasing profile with age…LANCET Infectious Disease, Verity et al, Published March 30th.
3.     All scientific reports I have read state that the virus is highly contagious, has an incubation period of up to 3 weeks before symptoms show up, and over 80% of the population have mild disease. The first case in the U.S. was documented in early January. That was 4 months ago. So then, it stands to reason that we are likely all exposed already and have fought it off successfully with our own immune systems. This scientific data should drive a proposal allowing release of all under the age of 65 who are at low risk of death and continue to quarantine those over 65 who are at higher risk of death.
4.     Every week I have calculated the fatality rate in Texas. It has been between 1.2 and 1.5 percent, even now when testing is not limited which means “deaths by COVID-19” are fairly accurate. Today the fatality rate to COVID-19 in Texas is 1.9% (199 deaths out of 10,230 confirmed cases). This is off the Texas COVID-19 dashboard. This number is likely to rise as these tracked cases succumb to the infection. But keep in mind that the total number of cases is grossly underestimated because 80% of us had mild or symptom-free infection and never got tested. Which means that the fatality rate has nowhere to go but DOWN, once they figure out how many of us are already infected but were not hospitalized.
5.     Fatality rates of flu in the U.S. are 0.1% (number of deaths to flu divided by number of cases of flu) in the last decade because the development of vaccines to the flu have reduced the number of severe cases. In 2009 when this strain of flu emerged and before there were any vaccines, there were at least 12,469 deaths in the U.S. to this virus. I say “at least” because we didn’t do as good of a job reporting cause of death then as we do now. Even with vaccination, flu continues to cause 7.1% of all deaths in the U.S. This is from FluView at the CDC website.
6.     The CDC is now reporting two different graphs. One is the cumulative report, which simply means that once you are counted as a case on a particular day, you get counted as a case for every day after that, even once you recover. This is the frightening graph, because that number continues to rise. The second is the episode report, which means you are only counted on the day that you are diagnosed. THIS IS THE ONE TO WATCH. We are waiting to see NEW cases decrease which will tell us that the peak has been reached. Here's the graph from yesterday.


7.     The CDC has also expanded the “gray box” I talked about on this graph to 10 days now, rather than 4. This was done because the original testing platform took up to 7 days to get the report back. The newer testing kits are substantially faster, but there is still a considerable lag, for reasons I don’t have time to figure out unless there is a lot of interest from you guys for me to read up on that.
8.     Models are just models. The guys who came up with the models for how many people will be infected, how many will die and when the peaks will be are arguing about which models are most reliable. We need to remember that these models rely on some data that is their “best guess”. What happened with the Imperial study was that the team had estimated a range of 2.2 million to 20,000 deaths in the U.S. That’s a big range, but decisions were based on the higher number which is why we are all sitting at home through the month of April right now. As more case data is gathered, the models will be modified and the number will come down because these early models were not accurate. Not by a long shot. There are two other models that have emerged now, with different predictions, and I can’t keep up. The fact is, there are so many variables to take into consideration for these models, there is no way that one model fits all situations. That’s why decisions shouldn’t be made on models. Particularly models trying to fit data that doesn’t exist. Like data on a new virus.
9.     In my post on March 22nd, I stated that the peak looked like it was on March 9th. That was an error for a few reasons. One, the number of tests were limited at that time, so there were only a certain number of tests that could be done per day. This would result in an artificial peak. Two, the time to get the results was at least 10 days in early March. This too would contribute to an artificial peak. Testing is now unlimited for the most part, but the reported results are still showing delay, probably related to the fact that too many people are getting tested who actually don’t have it. In fact, 90% of those getting tested in the US are negative. And we are only testing about 0.3% of the U.S. population. Meanwhile, unemployment is at 13% of the US population and the peak of new cases has been reached. Even in New York.
10.  A note on closing schools. CDC recommendations during Swine Flu in 2009: “School closure is not advised for a suspected or confirmed case of novel influenza A (H1N1) and, in general, is not advised unless there is a magnitude of faculty or student absenteeism that interferes with the school’s ability to function.”  CDC recommendations for COVID-19: “Available modeling data indicate that early, short to medium closures do not impact the epi curve of COVID-19 or available health care measures (e.g., hospitalizations). There may be some impact of much longer closures (8 weeks, 20 weeks) further into community spread, but that modelling also shows that other mitigation efforts (e.g., handwashing, home isolation) have more impact on both spread of disease and health care measures. In other countries, those places who closed school (e.g., Hong Kong) have not had more success in reducing spread than those that did not (e.g., Singapore).” Keep in mind that 60% of those infected with the H1N1 swine flu virus were under the age of 18, but that less than 5% of those infected with COVID-19 are under the age of 19, less than 1% of those were hospitalized, none of those have been in the ICU and none have died. Thus, it is unlikely that closing schools will impact the spread of COVID-19, according to The Lancet and The New York Times. Also keep in mind that the incidence of hospitalization among those under 18 is so small, even the clinical trials to treat COVID-19 won’t take patients under 18. Keep in mind these numbers may change as the case numbers increase, but are unlikely to change our basic understanding that those over 65 are at much higher risk of death than those under 65.
11.  I still can’t find the total number of ICU beds in the U.S. and how many of them are currently occupied by COVID-19 cases. This is an important piece of data to find, because we are being told that ICU beds are going to run short and the media has a tendency to feed on panic and hysteria. Example. CBS in the Morning reported that New York hospitals were overrun by COVID-19 cases. To substantiate that, the backdrop to the journalist giving this report was a heavily crowded hospital ward. Very grim. Turns out this backdrop was NOT a New York hospital! It was an overrun hospital from Italy. Birx stated they still have plenty of beds in New York (and ventillators), but I was hoping to get a more objective data source on that.
12.  Hydrochloroquine (HCQ). FOUR clinical trials have started to test this drug worldwide, ONE of which is in the US and sponsored by the National Institutes of Health. Also, the FDA approved use of that to treat COVID-19, and they are sticklers about that sort of thing. So now you have two massive federal institutions in the US (NIH and FDA) backing its use. The World Health Organization also has a trial of HCQ underway, so it’s not just us. That’s pretty amazing, considering so many “experts” are telling us that it won’t work, and yet they are still sanctioning these very expensive trials. 



     Thirty countries are currently using HCQ to treat advanced cases of COVID-19. The “experts” say the data is based on uncontrolled trials with small numbers of subjects. True. But I’ll bet the 20 treated patients in the Gautret trial who walked out of the hospital virus free because they got HCQ weren’t complaining.  Oh, and the trials are excluding subjects under 18 years old because there aren’t enough of them that are sick and hospitalized to include in the study. Yes, it’s an old drug. Yes, it’s used to treat malaria. Yes, there are fewer cases of COVID-19 in Africa probably because this population is highly treated with HCQ to prevent malaria.


And before you ask, yes, the death rate is higher in Africa for those who are positive because their health care system sucks and their population will go to hospitals only as a last resort. How long will it take to get the results? Probably July. The other NIH sponsored trial is with Remdesivir, an antiviral drug.
13.  Caution: Continue to follow the CDC guidelines for how to operate. Wash your hands because soap and water for 20 seconds kills the virus. Yes, there are other ways to spread it including talking because the virus hides in your spit (gross). But the main cause of spread is still by contact. So stay home when you are sick so you don’t infect anyone else. Do not visit those at high risk because you could be carrying the virus (but have fought it successfully with your good immune system and you probably didn’t even know you had it!). Hug those living with you often and watch for signs of depression. Americans do not cope well with being told what they can do and where they can go and over 16 million of us are now without jobs.
14.  One aside. The Corporation of Public Broadcasting is a federal program that provides support for radio and TV stations such as NPR and PBS. Given that information, you would think they would air the daily coronavirus update from the White House on NPR, their main radio station that is federally funded. They do not. When you follow the NPR link to the daily coronavirus update from the White House, what you get is a news article interpreting what was said during the report rather than the report itself. Not even a separate link to the video briefing. YouTube is hosting the daily reports in full so Americans can decide for themselves what to take away from these briefings. Why is the federal government funding an agency that refuses to air the president’s briefings?

Lancet Infectious Disease Article

New York Post article talking about how COVID-19 death rates are lower than model predictions

Fauci’s article in NEJM:

Nice explanation of the grossly over-estimated death rates:

Dashboard to Texas cases:

School recommendations by CDC in response to COVID-19

NY Times article on school closings

Lancet article on lack of evidence that school closings are useful to stop COVID spread

Clinical Trial summary on HCQ

Report on misleading news by CBS in the Morning

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