Covid-19 Diary : Friday 3 April 2020

 

A quick announcement.  If you missed it, please go to Friday’s regular newsletter and answer the reader survey near the top of the newsletter about when you expect things will return to normal.  I’ll be publishing the results in a few days time.  The more answers, the more helpful the exercise becomes for us all.

I want to open today’s diary entry with another look at one of the aspects of the virus that has captured everyone’s imagination.  The desperate shortage of ventilators in the country, and the urgent need to get many tens of thousands of extra ventilators before patients start dying due to a lack of them.

As I’ve pointed out before, this is all totally (hate to use the term but it is apt) “fake news”.  We currently have between 100,000 and 150,000 ventilators in the country.  We’ll run out of staff before we run out of ventilators (insufficient staff for even 100,000 ventilators) (and we’re also shorter of hospital beds than ventilators too) and it now looks like we might be risking a shortage of the meds needed for ventilator patients, too.

There’s one other data point that has been ignored.  The model/projection being cited most approvingly by the government and most other “opinion leaders” is the IHME model from Seattle.  We have some doubts about its validity, because it started off basing its projections on the Chinese data, and the Chinese data has to be viewed as not fit for any purpose at all.  But the Seattle modelers are now revising their model and projections almost every day as we continue to get more local US data, so the reliance on bad Chinese data is diminishing.

This model projects a maximum need for ventilators on 15 April.  On that date, the projection sees as most likely that we might be short of 88,000 hospital beds, including being short of 20,000 beds in ICU facilities.  But, as for ventilators, the model yawns sleepily and says “no worries, mate” – the maximum need for ventilators will peak, that day, with only 31,782 ventilators required.  (Note – if you’re reading this some days after Friday 3 April, keep in mind that the model is reworked every day or two, with the next reworking on Saturday 4 April, so if you click the link above and the numbers are now different, that’s not because I’m making mistakes, it is because the model has changed.)

Even if the model is wrong by a factor of two or three or four, we still have more ventilators – right now, today – than will be required on the peak day.

Why is everyone obsessing about ventilators?

Current Numbers

There were no shifts in rankings for the seven states of any size with the highest infection rates, which are :

  • Vatican City/7 cases/8,739 cases per million (unchanged since yesterday)
  • San Marino/251 cases/the equivalent of 7,397 cases per million people
  • Andorra/439/5,682
  • Luxembourg/2,612/4,173
  • Iceland/1,364/3,997
  • Faero Islands/179/3,663
  • Gibraltar/95/2,820

Here are the top six major countries, showing death rates per million of population in the country.  France moved up another place today, swapping with Belgium. :

  • Italy/14,681 deaths/243 deaths per million
  • Spain/11,198/240
  • France/6,507/100
  • Belgium/1,143/99
  • Netherlands/1,487/87
  • Switzerland/591/68

To put those numbers into context, the death rates per million in US/UK/Canada are 22/53/6.  Of note is that the UK is now next in line after Switzerland.

For major countries and/or outbreaks, and in general :

Same Day
Last Week
YesterdayToday
Total Cases594,7911,014,2961,098,386
Total Deaths/Percent of all Resolved Cases27,255/17.0%52,982/20.0%59,159/20.5%
Active Cases (ie not yet died or cured)434,530749,296810,334
US Cases/Deaths/Case rate per million102,568/1,607/310244,230/5,886/738277,161/7,392/837
UK Cases/Deaths/Case rate per million14,543/759/21433,718/2,921/49738,168/3,605/562
Canada Cases/Deaths/Case rate per million4,757/55/12611,283/173/29912,375/208/328
Worst affected major country/case rateSwitzerland/1,494Spain/2,397Spain/2,549
Second worst country affectedItaly/1,431Switzerland/2,175Switzerland/2,265
Third worstSpain/1,406Italy/1,906Italy/1,982
FourthAustria/855Belgium/1,324Belgium/1,447
FifthNorway/696Austria/1,236Austria/1,280

The deaths as a percentage of all closed cases continues to rise.  My current explanation for at least part of this anomalous result is that countries aren’t formally closing cases when people are cured.  This is most evidenced by Britain.  While they’ve been suffering ever larger numbers of reported deaths each day, their count of people who have recovered has stayed steady at a mere 135 for many days (compared to 3,605 deaths).  So this is yet another utterly meaningless statistic, and we’re delighted to understand that.  We don’t have to now consider that if we’re found to have the virus, we’re 20% likely to die.

What is the actual fatality rate?  Pick a number, any number.  No-one knows.  Low estimates range down to 0.1% or less, high numbers are ten or twenty times higher.  No-one really knows, but everyone hopes for a number at the lower end of this enormous range.

Who Should Pay?

Here’s an interesting article about the liability – or, more to the point – the lack of liability – which cruise lines incur when passengers on their ships get infected with Covid-19 (or, in general, when just about anything bad happens).

We understand the law is the law, but it strikes us there’s something wrong when an American citizen buys a cruise from an ostensibly American company, doing business in America, then boards a cruise ship in an American port, goes for a cruise wherever, and gets off the cruise ship, also in an American port, only to be told that if they now have a problem, either international treaties or the laws of some foreign country that they have never visited and never knew was part of the equation would apply.

It is time for this to be addressed – not just for Covid-19, but in general.

We also loathe all “standard form contracts” which you have no possibility of negotiating or changing, and especially ones that require you to give up legal rights that you’d otherwise have.  “Must use arbitration”.   “Can’t join a class action suit”.

Timings And Numbers

The last few days have seen me exposing problems with how deaths are counted.  Here’s another type of problem.

I was speaking with a person I know in the Philippines last night, who told me that her aunt had a heart attack last weekend.  Because the hospital was full of Covid-19 cases, she was essentially left to die.

To be clear, the lady did not die of Covid-19 and probably had no Covid-19 infection.  For purposes of measuring the disease spread, she is not an obviou statistic.  But, equally clearly, she is “collateral damage”.  If there was no Covid-19 pandemic filling the hospitals, everywhere, she’d have received normal quality treatment and most likely still be alive today.

For purposes of measuring the “social cost” (and justifying the financial cost of our Covid-19 responses) how do we measure cases like this?

Closings

Not quite a closing, but almost.  We were considering buying an electronic item on Amazon today.  It is in stock, and participates in the Prime shipping program.  But a note on Amazon’s site said they are prioritizing “items that our customers need the most”.

So instead of being offered same day, next day, or two days after our order shipping, the Prime shipping time is three weeks.  Oh – and nowhere did we have a chance to tell Amazon if it was an item that we “needed the most” or not!

Our point is that if it is now taking three weeks to ship a regular commonplace and (somewhere) in stock piece of electronics to us instead of probably one day normally, we wonder how perilously close to total failure Amazon’s distribution system it getting.  This is not an attempt to complain or blame anything on Amazon, but rather an expression of concern.

Another part of the fragile series of interwoven dependencies that, between them all, see us living a happy and comfortable life, is food.  Here’s another article on a topic I’ve worried about in earlier diary entries – farm workers.

Perhaps we should be grateful that Amazon and farm workers are more stoic and steadfast than NYPD officers.  8% of officers have now called in sick.  Of these 6,400 “sick” officers, a mere 1,500 have tested positive for the virus.

Shortages

Our constitutional rights continue to be chipped away at, all under the auspices of good intentions and urgent public need.  But when I now read that the NJ governor has ordered the state police to commandeer any needed medical supplies, one really struggles to accept that without demur.

It is easy to understand an extreme case of an unsympathetic person who has been somehow unfairly getting supplies of face masks and filling his home with them – years and years of supply for a single family, and either refusing to sell/share them, or demanding rates ten times higher than the current market price.

But what about a cautious family that years ago stocked up on masks and other personal medical supplies and protective equipment.  They’ve enough stock on hand for themselves, for the foreseeable future, but no surplus beyond that.  They’ve kept quiet about their stock, but a neighbor who once saw inside their store room has reported them to the police.  Next thing you know, a SWAT team comes around and empties the family’s store room at gun point.

What part of that is fair?  Why should the prudent family be penalized, so imprudent families can now benefit?  Doesn’t this just encourage all of us not to be self-reliant, because if we do, we risk having everything we procured now taken from us at gun-point, and if we don’t, the government will look after us?  This destroys personal initiative and personal responsibility; and most of all, as the government is abundantly displaying at present, we can not rely on the government to help us in our hour of gravest need.

Remember the picture a few days back of New Yorkers, so excited and relieved at the sight of the enormous converted tanker/now hospital ship, USNS Comfort, steaming up the Hudson that they ignored social distancing to crowd together and welcome the ship to New York City?

The Comfort has 1,000 beds, and a staff of over 1200 medical professionals on board.  But now, several days after docking, it has 20 patients on board.  Its sister ship, the USNS Mercy in Los Angeles harbor has 15 patients on board.

The concept was that both ships would handle “normal” patients, freeing the regular hospitals for Covid-19 patients.  We suspect part of the reason for this is because the ships are not designed for highly infectious diseases, but rather for battlefield injuries.  But, whatever the reason, their deployments on both coasts are hardly what could be termed outstanding successes or of material help.

We gather that a key part of the problem is the ships won’t directly accept patients.  To get to the ship, a person has to first be admitted to a regular hospital, then checked if they have Covid-19 or not.  Only if they are clear of the Covid-19 infection can they then be transferred to the hospital ships.

The problem with this is the shoreside hospitals are too busy to process these patients.

Such a failure of concept would be sidesplittingly funny if it weren’t so potentially tragic.

Here’s an article that provides another perspective on the challenge of buying in-demand medical supplies at present.  But while the article vaguely blames someone/anyone/everyone but hospital purchasing officers, I see it differently.  How is it that people with no background in hospital supply sourcing are springing up everywhere, finding scarce supplies in various places, buying them at low prices and selling them on at higher prices?

While these new middle men are appearing at such a rate that it is now common for supplies to go through several middle men before reaching an end user, what are professional skilled experienced hospital purchasing officers doing?  As best it seems, totally nothing at all, other than passively waiting for the person with the highest price on a product call them and “make them an offer they can’t refuse”.  They are probably too busy complaining about the problems they are encountering to actually pick up the phone and start solving the problem, the way they are expected and paid to do.

Logic?  What Logic?

It is great to see that some of the main stream media is now starting to realize that many of the models and projections being cited as certain fact are actually nothing of the sort and now are tuning in on what Dr Fauci has said repeatedly, quoted in the linked article in the form

I’ve looked at all the models. I’ve spent a lot of time on the models. They don’t tell you anything. You can’t really rely upon models.

It is dismaying to see how irrationally some people act when stressed.  This article reports how in the UK, some people have decided that 5G cell sites are causing the coronavirus and have been burning cell towers.  We have plenty of concerns about 5G, but would never have decided that radio waves of any kind are interacting with a virus.

Medical

The virus just keeps getting worse and worse.  In the “terrifying if true” category is this report of recovered sufferers now having brain damage.  But this seems to be rare at present – maybe something else interacted with the virus.  Or maybe it is another new strain?  Not enough is yet known.

However, with that as something in the background, perhaps it adds some context to what news commentator and brother of the NY Governor, Chris Cuomo, experienced in his description of things here.

Money

The Dow eased back again today, closing 1.7% down at 21,053, and down overall for the week.

Other

Here’s a final item to possibly put a smile on your face.  It turns out that people truly do need more toilet paper at present.

Please stay happy and healthy; all going well, I’ll be back again tomorrow.

 

Please click here for a listing of all our Covid-19 articles.

 

2 thoughts on “Covid-19 Diary : Friday 3 April 2020”

  1. Just want to point out sadly that even if there is a ventilator for every patient that needs one, at least half of those patients on ventilators are still dying. A ventilator does not equal a life saved in every case.

    Also the IHME model is off recently when it comes to COVID19 hospital admissions. The actual number is running many times less than the IHME models in a lot of places.

    Also, unexpectedly, the hospital admissions for non COVID19 admissions is down which is increasing the number of available hospital beds and personnel to handle COVID19 patients.

    1. Hi, Don

      Thanks for your comments. You are correct, the slightly science-fiction capabilities of a ventilator, as commonly perceived, do bestow upon them magical powers that are not necessarily present.

      Interesting about a depressed number of regular admissions. Is that simply because hospitals and patients are both doing all they can to shift/delay regular admissions for scheduled/non-essential surgeries? The latest IHME model update is expected some time today, will be interesting to see how they’ve updated it.

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