Month: October 2020

The US government’s response to the novel coronavirus has been poor from day one.  And now Mark Meadows, the White House Chief of Staff says the federal government has given up trying to control the Pandemic.  This admission of defeat is highly irresponsible and borders on the criminal.  Governments are elected to serve and protect the people and when they fail to do their number one job, they should be voted out.  

The President and his national security advisors knew in early January, and the President understood the seriousness of the novel coronavirus by late January – way before the public or other government officials knew. 

(1)  Even if he did not want to panic the public, he should have convened a meeting of federal officials, governors, and top local officials secretly and warned them about the coming crisis.  A Manhattan Project for the Pandemic should have been set up in January to help the USA deal with this crisis.  He downplayed the virus. 

(2)  The President should have invoked DPA (Defense Procurement Act – which he eventually did 6-8 weeks later) and made sure that the USA was prepared in terms of testing, contact tracing, quarantine facilities, hospital beds, masks, and other PPE (Personal Protective Equipment).  The governors did not have this power and had to bid against one another for PPE.  Kushner should not have dropped his committee work to develop more sources for PPE.  Masking should have never developed into a political issue if there were no shortages.

(3)  When the President found out that the CDC was poorly prepared to do testing he should have accepted Germany’s offer of a PCR test in January or bought ones from South Korea to supplement our short supply.  Governors were not allowed to bypass the Federal government restrictions until mid-March. To this day Trump has an irrational ambivalence to testing.  Testing and measuring is a bedrock concept in science, medicine, and even in business.  You cannot fix a problem if you don’t measure and understand the full scope of the problem.  Ignoring it does not make it magically go away. 

(4)  The President should not have politicized CDC recommendations regarding closing and reopening businesses.  Governors and local officials should decide when to shutdown/reopen businesses and facilities.  But national health guidelines should be available and consulted to avoided patchwork and ineffective responses and confusion.  Metro-NYC pandemic cannot be managed by a single governor.  When states run out of hospital beds, equipment and doctors and nurses, governors often have just the difficult choice to shut down the state or put patients out on the street.  Uniform, unbiased health guidance would help in making this difficult decision.

(5)  Uniform and equitable policy regarding testing, manufacturing, and distribution of vaccines and therapeutics are still lacking.  Governors have to beg for Remdesivir (or Regeneron antibodies) with Trump inserting himself to play favorites – ridiculous and dangerous repeat of PPE shortage fiasco.     

The USA has done orders of magnitude worse in this Pandemic than Taiwan, Japan, or South Korea so we know the Pandemic can be controlled.  On many COVID-19 measures, the USA ranks in the top-10 worst country in the world when it should be ranked the best.  225,000 (or 300,000 if you count excess deaths) Americans need not have died.  The sad thing is the USA is not much better prepared for this third attempt at controlling the Pandemic – 10 months after the first case appeared in the USA – 10 months after President Trump knew that this was a deadly disease and a serious national problem. 

Last month we were concerned that the leveling off of new daily cases in Florida and the USA was only temporary.  Over the last four weeks of steadily increasing daily case counts (see red squares in the figure below), we are increasingly concerned that we are seeing the beginnings of the third wave as temperatures cool and indoor activities resume in northern USA (Wisconsin is especially bad now).  We are also concerned that the pressures to reopen schools for in-person learning, reopen the economy before Election Day, and the increasing numbers of maskless, crowded rallies are exacerbating the normal seasonal rise in cases. 

Some of the increasing cases could be due to improved testing.  After stalling for 2 months testing has improved as schools and businesses reopen and want to keep ahead of increased infections by increasing testing.  This has again picked up an increasing number of asymptomatic and mildly symptomatic cases.  If this were the only reason for the recent increase in cases hospitalizations and death counts would not increase. 

In fact, after bottoming in mid-September, the number of currently hospitalized with COVID-19 in the USA has been rising for the last two weeks (see blue diamonds in the figure below).  As we had pointed out before this is a leading indicator of a future rise in death counts. 

Death counts are currently stuck near 750 per day (blue diamonds in the first figure above) but will rise again right near Election Day – lagging rising cases by 2 to 4 weeks.  This is not a good harbinger for President Trump’s re-election chances.  We had suggested that he ease off on maskless, crowded rallies in September to improve his chances of reducing the death count by November but he had chosen to forge ahead with large risky superspeader events such as the Rose Garden announcement for Amy Barrett in defiance of scientific advice.  Impatience bought him a second wave in June; impatience will have now bought him a third wave. 

President Trump announced that he tested positive for COVDI-19 on October 1^st.  Since then at least seven other attendees of a Rose Garden ceremony for Amy Barrett on September 26^th have tested positive for the virus.  We wish them all speedy and full recoveries.  However, the prognosis for each of them varies widely depending on their age, gender, and general health. 

The exponential age and gender behavior of COVID-19 patients has remained roughly the same since we first published our version of the graphic below 6 months ago.  Improved testing and identification of asymptomatic and mildly symptomatic cases mostly among younger adults have improved the overall case fatality rate (CFR = deaths/cases), but have not changed the strong exponential age dependence.  Better healthcare treatments in terms of logistics (avoiding bed, equipment, and supply shortages that plagued Italy early on) and the introduction of newer therapeutics such as Remdesivir, steroids, and clonal antibodies have prolonged patient lives and improved survival rates modestly. 

For example, a 50-yrs old female with average health, like the First Lady, would have a CFR of 0.7%.  On the other hand a 74-yrs old male with average health would have a CFR of 13%.  The President, being somewhat overweight with moderately high cholesterol and blood pressure issues would have a worse CFR – perhaps 30 times worse than for his wife.  For a 31-yrs old female of average health like Hope Hicks, her CFR is less than 0.1% similar to that for seasonal flu.  So the range of possible outcomes is extremely wide. 

Hospitalization is a leading indicator of the severity of the disease.  In Florida about a third of all hospitalized COVID-19 patients eventually die.  The risk of hospitalization for the very obese nearly triples that for a person with normal weight.  Currently the President and Chris Christy (with asthma and obesity) are both hospitalized.