Real Data

By

Leonard Zwelling

https://www.usnews.com/news/health-news/articles/2020-03-20/coronavirus-pandemic-overshadows-a-deadly-flu-season

         Courtesy of an avid blog reader:

         The CDC has posted the following regarding the numbers surrounding influenza in the U.S. from October 1, 2019 through March 7, 2020 (160 days):

         36-51 million cases: Mean=about 44 million cases or about 270,000 per day

         370-000-670,000 hospitalizations: Mean=about 520,000 or about 3250 per day

         22,000-55,000 deaths: Mean about 38,000 or about 241 per day

         As of March 22, 2020 there have been 297 total deaths from coronavirus so far.

         These numbers for both diseases need to be plotted together on one set of axes and made widely known to the public after which Americans can press their leaders as to why those leaders are making the decisions that they are. It may be wise to attempt social distancing given what the lack of it did to Italy,

https://www.nytimes.com/2020/03/21/world/europe/italy-coronavirus-center-lessons.html

 but it will probably drop the rate of influenza as well. It worked in other countries. Italy is constantly being used as a negative example. How about Taiwan as a positive one? As many articles are reporting, it is the hard suppression strategy used in the Asian countries that stopped the virus, yet we in the West have not really employed it yet.

         I understand the dire warnings by Governors Cuomo and Newsom, but what is going on under their noses with regard to influenza and why is the panic unique for coronavirus?

         The argument is that corona is a new virus with no vaccine, no drugs, no herd immunity and as yet undefined lethality. OK, say that for goodness sakes!! The mitigation strategies being demanded of Americans make sense, but how will we know if they are enough? When will we know? What did it cost? To answer those questions, the president would need a plan. He doesn’t have one beyond his 15-day list. And he has no articulated vision for the post-corona world. In the end, it may not be until the end that we will know whether our strategies were at all effective, but we should define what effective looks like now. Draw the worst scenario case curve and plot it against the actual case curve. If actual is less than worst case, we may be making progress. Many of the articles I am being sent do that and suggest this is far more serious than Mr. Trump is letting on.

         And on the subject of the need for ICU beds because the number of deaths could be in the millions according to some predictions, let’s think about that.

         The latest current estimate of the federal bailout for this pandemic is at least $2,000,000,000,000. The cost to the country of lost business must be greater, let’s just say it is equal to that so $4 trillion (although the loss in the stock exchange alone is many trillions, I suspect). If a million people die from the virus (that’s 6250 people per day over 160 days, the time span used in the influenza calculations, above) we will have paid about $4 million per life. If this is mostly the elderly, let us say over 70, most of them will have about ten years of life. So the actual cost of a quality life year may be in excess of that usually used to justify costly therapy, $400,000 rather than the customary limit of $100,000. That’s fine with me. I just think someone on Trump’s stage ought to say that. The scientists and the economists need to speak with one voice and then America ought to speak with a voice about what it wants. What a concept!

         And on another subject—research—it is my understanding that basic and other laboratory research is being halted all over the country at academic centers and that clinical patient-based research is being curtailed as well. Even some conventional therapy for cancer is being delayed like radiotherapy. This is quite simply outrageous. If I understand this, hospitals are making choices about who gets potential life-saving therapy. Coronavirus patients-yes; cancer patients-no. We actually saw a piece on NBC News that described a young woman with stage IV colon cancer who was told she cannot get the experimental therapy on which she was counting to save her life. The therapy was not described. It could have been phase 1 and therefore not really therapeutic, but every useful drug in medical oncology’s pharmacy was a phase one drug once.

         Academic centers should find a way to allow all research to go on in some form or massive investments in reagents, animals and personnel will be lost. Might creative solutions be needed (only one person per lab at any given moment)? Perhaps. But stopping all research for potentially months at a time is lost progress that can never be recouped. And as far as clinical research, where are all those investigators who insist that clinical trials are more than research, but a form of therapy? The patients who are the human subjects certainly feel that way.

         This blog is essentially a plea for two things, leadership at the national level being honest about why decisions are taking place, what the vision for the future is, and what the plan to get there is—not just one for the next 15 days. The second thing is data. Tell us when to expect the next decision. What will it take to declare this a disaster and when might we be out of it? The president has just got to do that. He hasn’t yet. He’s too busy yelling at Peter Alexander for asking a perfectly legitimate question of the man in charge. What do you want to say to the scared American people? So Trump yells.

https://www.nytimes.com/2020/03/21/us/politics/trump-coronavirus-leadership.html

         Mr. Trump is facing the first real crisis of his life that is not of his own making. He cannot declare bankruptcy. He cannot stiff the vendors. He cannot get money from his father and he cannot slam his ex-wife in divorce court or the New York Post. He was very slow on the uptake on this with the exception of the in-coming Chinese travel ban which was probably too late any way.

         Although Trump is joined by his team who get in line (not six-feet behind him) to pat him on the back, the jury is still out on how well Mr. Trump has done in his first real test.

         By my criteria, he came up short in the beginning, but may be warming to the job. That being said, he can now stop beating up on reporters and get out of the way and let Pence and Fauci run the show.

         It is very unclear at this time, how the U.S. will fare. Will it be more like Taiwan and be minimally affected or be more like Italy and really be inundated with sick people? It’s too soon to say, but not too soon to imagine what a successful vision will look like and a plan to get there. We are just waiting, Mr. President.

Leonard Zwelling