Apr
3

Don’t obsess.

Obsessing over stuff we don’t know and can’t control will make us nuts.

Instead, focus on what you can do to protect yourself and your loved ones, and help others any and every way you can.

Why you should ignore a lot of the “experts” and their models.

Just two days ago I said: Ignore anyone who says we’ll be back to normal by this date or that.

I’ll add – Ignore anyone who says there will be this many infections and this many deaths – their “models” are based on data that is likely wildly inaccurate and make assumptions that differ wildly.

(the model used in White House press briefings assumes all states impose lockdowns similar to China’s and keep them in place for months. Meanwhile, the President is talking about a lockdown that ends in a few weeks and many states were late imposing lockdowns – or haven’t yet.)

A basic rule of statistical analysis is “when different studies of the same thing don’t agree it’s probably because they aren’t counting the same stuff the same way.” (OK, I sort of made that up – but it’s entirely true.)

A percentage is based on a numerator (the top number), which in this case is the number of people who died “of COVID”, divided by the denominator – the number of people “infected”.

First, the numerator – deaths due to COVID.

The “death rate” in Germany is 1%, Italy’s is 10%, China’s 4 percent, and Israel a tenth of that at 0.4%.

What?? How can this be? Is it because Italians are older? no…Germany’s population is older than Italy’s. Are Israelis healthier? Well…

From the BBC – “it might seem simple enough: if a patient dies while infected with Covid-19, they died of Covid-19.” Perhaps – but they may have died from a car accident, or might have an underlying health condition such as COPD or asthma or heart disease. The UK counts ANYONE who dies and has tested positive for COVID as a COVID death. Even if they died in a car accident.

Here in the US, physicians have discretion; they report whether the patient died “as a result of this illness.” So, it’s not surprising that the UK would have a higher death rate than the US.

A related issue – reports from Italy indicate there are a lot more people dying of all causes than usual, and many of those “extra” deaths aren’t attributed to COVID. “Only 12 per cent of death certificates have shown a direct causality from coronavirus,” said the scientific adviser to Italy’s minister of health last week. [source here]

So, we do not know the actual number of people who have died “as a result of COVID.”

Now, the denominator – the number of people  “who have COVID.”

Different countries also report different “infection rates”;

  • China may not report people who test positive but don’t show symptoms (are “asymptomatic”). As a substantial percentage of people who get infected don’t show symptoms, that makes China’s “infection rate” seem a lot lower than it really is.
  • The number of tests isn’t as useful as the percentage of people tested. Reality is, if we aren’t testing everyone, we don’t know the real percentage of people with COVID.
  • Here in the US we are STILL way behind testing; we’re only testing about a hundred thousand people a day – about the same number we tested 9 days ago.

Oh, and there are two different “fatality rates.”

Again the BBC:

There are, in fact, two kinds of fatality rate. The first is the proportion of people who die who have tested positive for the disease. This is called the “case fatality rate”. The second kind is the proportion of people who die after having the infection overall; as many of these will never be picked up, this figure has to be an estimate. This is the “infection fatality rate”.

Head swimming yet?  Yeah, mine too.  Net is no one knows how many of us are infected and we don’t know the number of people who die of COVID-related conditions.

We DO KNOW:

  • social isolation will help keep you safe;
  • sanitizing everything will help keep you safe;
  • helping others will help keep you sane.

What does this mean for you?

Obsessing over stuff we a) don’t know and b) can’t control will just make you nuts. Focus on what you can control.

And be nice.

 


Mar
31

COVID19 – the latest data and the cost of ignoring reality

Ignore anyone who says we’ll be back to normal by this date or that.

The problem is straightforward –

  • we don’t have enough data,
  • far too many people are still doing stupid stuff, and
  • there’s still way too much happy talk from people who should know better.

Testing is only now ramping up – six weeks+ into the COVID era there have been less than a million tests in the US; we lag well behind other developed countries in the percentage of residents tested.

The painful reality is the government’s repeated missteps and screwups have left us in the dark about the real dimensions of the spread of COVID19.

Where are we today

We don’t have current, accurate data from an official governmental source on the actual number of COVID19 tests that have been conducted. The CDC’s own database reports a drop in the average daily number of tests since March 17 – but that doesn’t include all tests.

Fortunately, there’s a volunteer project documenting the test count and other key statistics; you can keep updated here. Pretty impressive effort, with data quality ratings as well so you can determine for yourself your level of comfort with the accuracy of the count.

As of 6:42 am eastern yesterday, there were 851,578 tests reported in the US, with 141,232 positive.

As of 6:42 am eastern today, Tuesday March 31, the Covid Tracking project reported 956,481 tests, with 162,399 positive.

Again according to the Covid tracking project, as of 7 am eastern yesterday March 30, 19,839 patients were hospitalized and 2,447 died.

The hospitalization count increased to 22,490 (13%), and the death count increased 21% to 2,981.

Another leading source is Johns Hopkins University; it’s numbers are slightly different than the Covid Project (143,055 positives and 2,513 deaths as of 6:11 am eastern yesterday March 30).

I’ll let you ponder why a group of volunteers and a university are able to do a better job tracking these data than the nation’s disease tracking institution. (fortunately the Trump Administration, which just three weeks ago had sought a $1.2 billion cut to CDC ‘s budget – and an additional $452 million cut to National Institute of Allergy and Infectious Diseases (NIAID)’s budget – changed it’s mind.

Then there’s the report from Wuhan China (the apparent originating location for coronavirus that 5% – 10% of people who a) tested positive, and b) recovered, have now tested positive again.

Communities and institutions that aren’t taking tough measures to control exposure are getting hammered.

Elected officials and many citizens of Fort Myers, FL listened to politicians, not scientists, keeping beaches, restaurants, and a casino open despite warnings. In a county where 30% of residents are over 60, only about 4 out of 10 residents complied with isolation guidelines last week. This may well have devastating consequences – so far there are 171 confirmed cases and 6 deaths in Lee County. with 40 hospitalized.

Those totals will certainly increase.

Many residents of The Villages, a retirement community in central Florida, ignored pleas to avoid socializing; 29 have tested positive as of last Friday.

Liberty University was one of the very few colleges that invited students back to campus after spring break; not surprisingly some showed COVID19-type symptoms, and at least one has tested positive. Yesterday Liberty President Jerry Falwell disputed some of the Times’ reporting; note earlier Falwell dismissed COVID19, comparing it to swine flu and inferring it was a North Korean plot or an effort to harm President Trump.

What does this mean for you?

I bring these to your attention to note that coronavirus doesn’t care about ideology; social distancing reduces infections and saves lives; not enforcing social distancing increases infections and kills people. Places like Ft Myers and Lynchburg VA (Liberty University’s location) – and the people who live there – will suffer from COVID deniers’ decisions.


Mar
27

COVID19 and Chloroquine – what does the science say?

The President and the Governor of my home state (New York) are all in on chloroquine and variations thereof.

Spoiler alert – there is no credible evidence that chloroquine is effective in treating COVID19.

And lots of evidence that the drug can be quite harmful.

Let’s unpack the “science”.

First, it’s important to note that this drug has been tried on numerous viral diseases; “Researchers have tried this drug on virus after virus, and it never works out in humans. The dose needed is just too high,” says Susanne Herold, an expert on pulmonary infections at the University of Giessen. source here

There appear to be two sources of “information” that chloroquine advocates cite as justification for using the drug.

Neither meets basic standards of credibility.

One is s tiny “survey” from France; you can read it here. The study’s authors concluded:

our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin.

Well…no.  The “survey” has many flaws, which combine to make it impossible to draw any meaningful conclusions.

(The primary author, one Didier Raoult has been widely criticized for various misdeeds…this is a detailed and quite damning profile)

  • the study was tiny – 42 patients in total at the outset, of which 26 received the drug and 16 did not (these were the controls)
  • out of the 26 who got the drug, 6 were excluded from the reported results, and 4 of those 6 did not do well:
    • 1 died
    • 3 were transferred to the ICU
    • 1 stopped taking the drug due to nausea
    • and 1 left the hospital
    • “As several people wrote sarcastically on Twitter: My results always look amazing if I leave out the patients who died, or the experiments that did not work.” source here
  • the survey’s authors claimed it was a 14 day study but that doesn’t fit between the 12 days from when the study was approved till the day it was concluded
  • the study was not randomized; that is, the separation of study patients wasn’t statistically random which could lead to selection biases (for example, the control group was much younger than the study group, which reflects non-random sampling
  • the “outcome” wasn’t consistently identified or measured;
    • many control patient outcomes are presented as Positive vs Negative, rather than a count (of the actual virus load) vs Negative, as they are for patients in the active treatment group
    • instead of a typical result e.g. 28 day post-treatment mortality (death) rate, for some patients it was the presence or absence of the virus in a nose-swab test.
    • most problematic, some patients tested “negative” one day then “positive” the next; others showed the opposite results...since the final test was a single snapshot and no follow-up was done, we don’t know if the patients that were “negative” at the end of the survey didn’t subsequently become “positive”…or vice versa
    • the outcome also wasn’t specific as it didn’t indicate how much of a “viral load” existed, only if it was present or absent (defined as viral load under a certain threshold)
    • so, “negative” patients could have had the virus, just not enough to trigger a “positive” test result
    • “It would have been better if the authors would use clinical improvement (e.g. fever, lung function) as the outcome, not a throat PCR. The virus could still be rampantly present in the lungs, and the patient could still be very sick, while the virus is already cleared out of the throat. If PCR is an outcome, it would be better measured as e.g. at least 2 or three consecutive days of PCR negativity.” source here
  • There’s a lot more to this – you can read a critique here.

Next – reports from China, which were cited by the French study’s authors as a reason to consider using versions of chloroquine.

The reports included

a) opinions from Chinese physicians that were based on their personal observations, not on actual studies.  A key source for this was a letter published that did not provide any details, data, or credible evidence as to the efficacy or safety profile of chloroquine and related drugs.

Remember…a letter – often cited by opioid promoters as evidence of the drug’s safety and efficacy – helped spark the opioid epidemic, I’d be careful relying on the Chinese letter as a rationale for using chloroquine.

b) many of the clinical trials that were started some time ago were canceled or suspended, leaving no data or substantive conclusions

Fortunately the WHO has begun several major scientific studies to evaluate various drugs’ efficacy and safety…we can be hopeful that they will yield actual credible information that will help us defeat COVID19.

Here’s a handy cheatsheet you can use to evaluate news reports and Facebook posts about COVID19 “cures”,

DANGER!

Finally, this stuff can be dangerous if not deadly. Doses of chloroquine and related drugs just slightly above recommended levels can kill. The drug can damage vision, appears to be dangerous for anyone with cardiac arrhythmia, and has a host of other nasty side effects, many of which occur even when patients are taking doses far lower than “recommended” by French and Chinese doctors.

What does this mean for you?

To quote Karen Masterson, author of THE MALARIA PROJECT;

We should learn from past mistakes. Federal officials after World War II failed to listen to public health experts about the limitations of chloroquine. Our top political leaders today should avoid the same error.


Mar
25

COVID-19 quick hits

First – reminder that every April 1 I do my annual April Fool’s post. It usually catches a few folks…you’ve been warned!

Now, a few things of note that crossed my virtual desk.

Chloroquine as a treatment for COVID-19

You may have seen President Trump talking about a malaria medication…

Two news items hit this morning, one noting that a patient just died after taking a version of the chemical.

A very small study found outcomes for patients that took chloroquine were not different than outcomes for patients that received a placebo. Out of  30 patients, 15 patients got the malaria drug and 13 tested negative for the coronavirus after a week of treatment. 15 patients didn’t get hydroxychloroquine; 14 tested negative for the virus.

Last week the drug was touted extensively on Fox and the Glenn Beck Show, with that “science” based on an unpublished paper describing what happened to a handful of patients treated with the medication.

Read the link if you want to understand why the “science” was crap and the “conclusions” total bullshit.

Takeaway – this drug can be very dangerous, is far from proven effective, and current studies are too small and have other limitations that make it impossible to draw any firm conclusions regarding its efficacy and dangers.

US Infection trend

As of 9:35 am eastern March 25, there are 55,238 confirmed cases in the US and 802 COVID-19 related deaths. Caveat – the number of cases is almost certainly significantly higher (not enough tests available) as is the actual number of deaths.

Takeaway – we are nowhere near the peak of this pandemic…here in New York we have over 25,000 confirmed cases…3 in our town of 4,800 people.

Conferences

are pretty much not going to happen.  NCCI’s annual confab will go virtual; more details on the free web-based event here. The date is May 12, 2020, and it kicks off at 1 pm ET.

Work-at-Home

Briotix Health has developed a free app to help we work-at-home folks prevent injuries and other nasty stuff. Info is here.

A link to the Virtual Office is here.


Mar
21

We are out of time.

The time to shut the country down is now. The infection rate just increased 5-fold in 4 days; if that continues, by Wednesday – 4 days from now – there will be 125,000 confirmed cases.

A week from tomorrow there will be 625,000.

Four days later 3 million of us will be infected.

By mid-April, 20 million will have tested positive for coronavirus, and hundreds of thousands will be dead.

Think that’s nuts?

If anything, the actual infection rate is higher than reported – because we still don’t have enough testing capacity.

We do not have the medical facilities, staff, or supplies to handle several million COVID-19 cases simultaneously.  Our government has failed catastrophically, leaving every medical provider from the VA to major hospitals to nursing homes desperately short of everything.

No cure, medication, or vaccine exists – and none will be here until this time next year at the earliest, there’s been lots of media from irresponsible blowhards.

The latest – chloroquine – has been touted as a “cure” despite a) extremely thin evidence that it is effective in humans; b) it can be fatal; and c: according to National Institute for Allergy and Infectious Diseases Director Anthony Fauci MD, None of the evidence has been collected through a controlled clinical trial, “so you really can’t make any definitive statement about it.”

This guy is NOT a medical doctor, he is NOT an “adviser” to Stanford University, the “research” was self-published and does not meet ANY standards for credibility.

All this is why we have to flatten the curve. If not, tens of millions more will be infected, the death rate will rapidly increase, and over a million will die.

If you detect more than a bit of anger here, you’re right. Two family members are nurses, both desperately struggling to prepare for the coming tsunami of cases. One is quarantined because there isn’t enough protective equipment, the other exhausted from days of overtime. And both know it will get a whole lot worse before it gets better – and that is terrifying.

The government won’t take responsibility, so we have to. Stop socializing. Go out only when you absolutely have to – and then act like everyone else has Ebola.

Wash your hands. Check on your neighbors, shop for those who are high-risk, call your family members and friends, and don’t panic.

It’s not all bad.  The response from regular people looking to do whatever they can to help out has been nothing short of wonderful. A local business here is using 3-D printing to manufacture face shields because there aren’t enough in emergency stocks (the owners are good friends).

And keep working at your regular job. It’s hard to focus…it’s also essential.

 


Mar
19

Hey workers’ comp – stop the legal BS and do your part.

Yesterday’s WorkCompCentral featured an interview with an attorney discussing whether or not COVID-19 is a covered condition under North Carolina’s work comp regs.

Couldn’t figure out why the piece bothered me so much until I woke up this morning, where it had crystallized in my sleep-befogged brain.

The article was so BC (Before COVID-19). The world has fundamentally, dramatically, and permanently changed, and now is not the time to engage in academic and frankly dangerous discussion over what constitutes “occupational exposure to Novel Coronavirus.”

Because while this assuredly endless debate goes on, the US infection rate is doubling every 2.5 days, (it doubled overnight here in New York state) and workers will:

  • not get tested because they can’t afford it;
  • won’t stay home because they can’t afford to;
  • will therefore expose others to the virus, infecting more of us;
  • and won’t get treated, infecting even more people.

This is not the time to debate arcane points of law and precedent. This is the time for insurers, regulators, and employers to Do The Right Thing – which means treating COVID-19 infections as covered by workers’ comp for healthcare workers, first responders, hospitality staff, airline employees, and others who may have contracted the disease thru contact on the job.

Some insurers are saying they will investigate each case to determine whether a particular workers’ coronavirus/COVID-19 will be covered. Yeah, that was the right policy – before COVID-19 came along and may kill millions of Americans.

Today, it’s just nuts. Not only is it impossible, it’s irresponsible. The confirmed infection rate is growing logarithmically; unless these insurers hire a gazillion investigators they won’t finish these “investigations” for decades.  Meanwhile, those undiagnosed, untreated workers will infect others, and more people will die.

from Statista

Some states – California, Michigan, Pennsylvania among them – have moved quickly to address the issue albeit not always comprehensively. Other states must clearly and immediately ensure COVID-19 is a covered condition for broad categories of workers and jobs

Yes, following the law is important. Precedent is important. Principled debates are important. Advocating for your client is important.

Or rather, was important. 

Now, what is overwhelmingly more important is stopping the pandemic – and workers’ comp must do its part.

What does this mean for you?

Do NOT quibble, cite arcane legal theories or case law, hide behind legal opinions, or waste time discussing the legal niceties and complexities.

Just accept the claim and get the patient treated. You can afford it; insurers are flush with cash, have billions in surplus/excess reserves, and the vast majority of infected workers will recover at home at minimal cost.

And when this is over, you will know you did the right thing.


Mar
18

COVID-19 update – what’s the real death rate?

Quick take – we don’t know.

Before you read this – don’t freak.  Yes this is worse – much worse – than I thought, but panicking and reacting without thinking is NOT helpful.

First, the facts.

That’s because the number of cases is expanding rapidly but people don’t die immediately.  This from the Lancet, based on data from China (as with any early assessment the numbers are rough)

patients who die on any given day were infected much earlier, and thus the denominator of the mortality rate should be the total number of patients infected at the same time as those who died. [emphasis added]

The blue line is the more accurate figure and indicates a death rate of 5.7%.

But…

  • Because of the lack of testing (especially early on in China and for far too long in the US), there are a lot of people with mild symptoms or no symptoms that are undiagnosed. Therefore, the denominator (the number on the bottom) is too low. This means the estimated death rate quoted above is likely too high.
  • Anecdotally, I’ve heard from healthcare workers that some patients dying of respiratory failure were not tested for coronavirus – thus these deaths aren’t counted as related to COVID-19.  Anecdote is NOT data…that said due to the lack of tests, I’m betting the actual number of deaths is higher than reported.

Okay, pretty scary stuff.

What’s scarier is doing stupid stuff – and there is nothing stupider than hoarding toilet paper.

Coronavirus will NOT destroy the supply chain – it will lead to disruptions and delays, but anytime people hoard stuff, that means they won’t need to buy it for a long time. So, while shelves may be empty today, when the supply chain catches up – which it will – there will be lots of pasta, rice, canned food, and yes, TP on those shelves.

What does this mean for you?

Let’s take a lesson from our friends in Italy; be kind and thoughtful, smile at everyone, say hello, and remember we are all in this together.

Oh, and do a lot of takeout and tip generously!


Mar
16

Covid-19 update and fact check

This is way worse than we thought even a week ago. The death rate remains much higher than the flu, while we continue to get confusing and contradictory messages from the White House.

Facts.

  • In the US, the number of diagnoses has tripled over three days.
  • The death rate is just shy of 2 percent – about 20 times greater than the regular flu.
  • Italy remains the worst-affected country, with almost 25,000 confirmed cases and 1800 deaths – a death rate of 7.2 percent.
  • Contrary to what you may have heard, Italy’s population is NOT the oldest in Europe – Germany’s people are slightly older – and many other countries are almost as old as Italy.

What will protect us?

Not this…

  • face masks.  those regular face masks are useless. Unless the facemask is specifically designed to eliminate most airborne moisture – and you have been trained specifically in how to fit the mask – it won’t protect you.
  • Unless you are already ill – in which case those regular masks help limit others’ exposure.
  • A vaccine. There will NOT BE A VACCINE for at least a year.
  • Drugs – THERE ARE NO MEDICATIONS TO TREAT COVID-19.

This.

Wash your hands. Use alcohol-infused wipes.

Stay home.

Avoid any close contact with anyone you do not KNOW.

Sorry, grandma…I didn’t mean to kill you.  For anyone younger than 30  or older than 60 reading this – forgive me for generalizing, but please stop doing stupid stuff. Going to St Patrick’s Day events, senior dance parties, concerts, beach parties, and bars won’t hurt you much (unless you are diabetic, asthmatic, have pulmonary issues, are obese, or have an immune deficiency (which you may find out the hard way) – but it will kill others who get Covid-19 from you.

Finally, what’s with this obsession with toilet paper? 

If this is the beginning of the zombie apocalypse – which it most definitely is not – I’m thinking we should be ensuring there’s enough nutrition to go into our bodies – if there isn’t, we will not have to worry about taking care of what exits our bodies.

Okay, after ten days of nothing but Covid-19 blog posts, we’re going back to our regularly-scheduled focus on healthcare, healthcare policy, and workers’ comp stuff.

 


Mar
13

Covid-19 update

Here’s where things sit today.

What we know:

  • Italy is getting hammered, especially the northern regions. The death rate is over 7%, healthcare facilities are overwhelmed, and there aren’t enough ventilators and oxygen to go around.
  • The number of reported cases in the US hasn’t increased much overnight – but that is likely due to complete failure by the government to get testing started quickly, and to develop an accurate test to begin with. And, yes, even now there aren’t enough test kitsthank goodness the Chinese are going to send us a half-million.
  • It looks like test kit availability will ramp up in the coming days – but we are weeks behind when actually needed them. Without testing, officials have no idea what’s actually happening, can’t allocate resources, make intelligent decisions about closures and travel bans.
  • Our healthcare “system” is uniquely problematic; there are north of 18 million who don’t have insurance, and among those who do, folks with high deductible plans will have to pay for treatment and many don’t have adequate funds to do so. The result – the disease will spread in part because victims can’t afford testing or treatment.
  • Social isolation and basic handwashing are the cure for the pandemic. 
  • My beloved Syracuse rowing teams won’t be racing this year; my heart goes out to the men and women who have trained like the champions they are for 8 months only to be sent home.  Same goes for every other athlete in every other sport at every other institution.

Please – be thoughtful, don’t travel or mix in with large groups, and don’t panic.

And, you now have time for an “at home date” with your significant other, hang with the kids, catch up on those home chores, read those books stacking up on your night stand, clean the windows, finish your taxes, and be forever grateful for important stuff.

Finally, I encourage you to read this – and thanks to reader Paul Meyer for the tip.


Mar
12

An Abundance of Caution

That – along with social distancing – is the phrase that will mark 2020.

So here’s where we are – typed as I wait to board a plane home.

This is from Johns Hopkins University; best site I’ve seen for current infection rates and locations.

What we know about Covid-19:

  • It is most dangerous for the elderly and those with underlying health conditions such as COPD, asthma, and other chronic conditions.
  • It is MUCH less dangerous for the rest of us.
  • The overall fatality rate appears to be between 1% and 2% – but may well be lower as we do NOT know how many of us are walking around with the disease and no symptoms
  • Most of the deaths in the US occurred in a nursing home in Washington state.
  • The epidemic appears to have peaked in parts of China, with fewer and fewer new cases appearing
  • Italy is hardest hit; the death rate appears to be about 8% – again that may be distorted due to inadequate testing.

What works

Social distancing – defined as staying a few feet away from others wherever and whenever possible.

Washing hands, covering coughs and sneezes, using sanitizers containing alcohol.

What we have to do

Be realistic. There’s a ton of happy talk out there about how this isn’t that bad, it’s a made-up crisis, and somehow all will be fine and it will disappear in April and a vaccine will be here shortly and .

That’s crap. A vaccine won’t be here for at least a year, hot and humid Singapore has a persistent outbreak, and Covid-19 is much deadlier than the flu.

But, Chill. This isn’t Ebola, SARs, or MERs. Yes it may be 10+ times worse than the flu, but it isn’t the black plague.

Tip service workers. Baristas, Lyft drivers, Uber Eats and Instacart workers, bartenders, maids are getting crushed financially. Help them out.

Be kind and thoughtful and nice.  We will get thru this, and we’ll be wiser for it.