Three opening points, all forward looking and with the slightest of hints of positivism. First, another thoughtful commentary about what happens after we’ve passed the peak numbers point.
Slightly good news – New York has seen a small dip in its new cases, and has also seen the total number of people in hospitals drop. And its earlier puzzling claim that it would run out of ventilators by today has now been extended until Tuesday or Wednesday.
Italy is also starting to experience lower daily increases and a drop in hospital ICU patients for two days running.
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)
- San Marino/266 cases/the equivalent of 7,839 cases per million people
- Andorra/501/6,484
- Luxembourg/2,804/4,479
- Iceland/1,486/4,355
- Faero Islands/181/3,704 (unchanged)
- Gibraltar/103/3,057
Here are the top six major countries, showing death rates per million of population in the country. Belgium and France swapped places, the other for countries stayed as before :
- Spain/12,641 deaths/270 deaths per million
- Italy/15,887 deaths/263 deaths per million
- Belgium/1,447/125
- France/8,078/124
- Netherlands/1,766/103
- Switzerland/715/83
To put those numbers into context, the death rates per million in US/UK/Canada are 29/73/7. 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 | Yesterday | Today | |
| Total Cases | 721,903 | 1,201,443 | 1,272,514 |
| Total Deaths/Percent of all Resolved Cases | 33,976/18.3% | 64,675/20.8% | 69,413/21.0% |
| Active Cases (ie not yet died or cured) | 536,626 | 890,594 | 941,616 |
| US Cases/Deaths/Case rate per million | 142,004/2,484/429 | 311,357/8,452/941 | 336,327/9,605/1,016 |
| UK Cases/Deaths/Case rate per million | 19,522/1,228/288 | 41,903/4,313/612 | 47,808/4,934/704 |
| Canada Cases/Deaths/Case rate per million | 6,302/65/167 | 13,912/231/6 | 15,512/280/411 |
| Worst affected major country/case rate | Spain/1,713 | Spain/2,699 | Spain/2,816 |
| Second worst country affected | Switzerland/1,713 | Switzerland/2,369 | Switzerland/2,438 |
| Third worst | Italy/1,616 | Italy/2,061 | Italy/2,133 |
| Fourth | Austria/976 | Belgium/1,590 | Belgium/1,699 |
| Fifth | Belgium/935 | France/1,378 | France/1,422 |
The US numbers are slightly below the IHME projections that are being most widely cited at present. The IHME statistics were going to be updated daily, but on Wednesday we were told the next update would be Saturday, and now we’re approaching Sunday evening and still no update.
Because their updating, we believe, enables them to reduce their reliance on probably totally wrong Chinese numbers and build on a better data series of actual events in the US, we’re very keen to see each of their recast projections, and wonder why they’ve gone so silent for so long.
Who Should Pay?
Here’s an article that talks about the complete collapse of economies in Africa due to the virus. It singles out Uganda for specific mention, but omits the point that currently Uganda has in total a mere 52 virus cases, having increased an easy 4 from yesterday, and with no change yesterday from the day before. The country has yet to have its first death. With 43 million people, that’s a case rate of around one per million people, and about 1/1000th of the case rate in the US.
I’ll avoid snide and unfair comments about African countries without an economy to worry about collapsing, and I do understand that any lockdown, anywhere in the world, is harmful. Nonetheless, it strikes me there are plenty more things to be massively more concerned about here in the US than a country in Africa that has been extraordinarily fortunate in avoiding the virus almost entirely so far.
The main point of the article seems to be to support Africa’s request for $150 billion from the G20 nations. Sorry, Africa. But charity begins at home. We’re on financial life-support ourselves, we have nothing spare for you. Our own people are risking losing their homes, their jobs, and becoming starving and destitute on the street. We must look after ourselves first.
Timings And Numbers
Here’s an interesting list of states ranked by how severely affected they’ll be by the coronavirus. How does your state do? We suspect the list is a tad on the optimistic side for all states – because our economies are interdependent and interlinked, what is bad for one state tends to be bad for all states (and vice versa).
The US case rate is now 1 person per 1,000 people in the country. That’s a fairly meaningless figure, but if we say for every known case, there are another two unknown cases, that means if you were to go to the supermarket and get close to ten people, you’d have a 2% chance of going past a person with an infection who didn’t know it. Do that every day, and within a month you’ll have interacted with an infected person.
That’s probably an acceptable risk at present, with distancing, maybe masks, and being careful with hygiene and hand washing. But now say you go to a sports stadium with 20,000 or 40,000 fans present for a game. That means there are between 40 and 80 unknown infected people in that stadium – that doesn’t feel quite so appealing, does it.
Which gives context to this question – when will you feel safe around 20,000 strangers again?
Shortages
Why are we still seeing articles, even in the Wall St Journal, about ventilator shortages? In the article, all it can do is talk about NY hospital memos about possible ventilator shortages.
Am I the only person to spot that, notwithstanding all the clamor for tens of thousands of ventilators, and with the country allegedly within about a week of peak medical stress, we still have plenty of ventilators with no real factual shortage cited specifically, anywhere, yet?
Sure, with exponential growth, a lot could happen in a week, but I’d love to see not just the hype about vaguely running out of ventilators, but actual solid figures of current ventilator utilisation and projected needs for the next ten days. All I see is panic about needing tens of thousands more ventilators. But how many tens of thousands are needed, how is that number calculated, and where are they needed? Are the staff, beds, meds, and other requirements all in place?
Even in New York, the most accepted projection, from IHME, says the hospital peak load will be on this Thursday (9 April) and on that day, the entire state will need only 9,427 ventilators. The projection suggests that won’t be a problem.
So, if NY is thought to only need 9,427 ventilators on its busiest day, why is the Governor asking for tens of thousands more?
Medical
First, in the “great news if true”, medical researchers in Melbourne, Australia, are investigating another commonplace drug that seems like it might be suitable to be repurposed not just for treating the coronavirus, but for other viral infections too. I guess I need to add Ivermectin (aka Stromectol) to my wish-list of medications to keep on hand – best of all, it just requires a single dose.
They don’t say in the article what dose strength is being experimented with, but the tablets are typically 3 mg each and doses for current treatments are in the range of 150 – 200 mcgs/kg of body weight. So if you weigh 200lbs, that would be between 13.6 mg and 18.2 mg, and proportionally more/less for other weights.
Sort of good news – Dr Fauci thinks the coronavirus might be seasonal. A reader points out that one reason why other infections are thought to be seasonal is there’s much less “social distancing” in the winter than in the summer, but we’ll take good news in any form it is offered to us.
Back to ventilators again. President Trump makes excellent points when he says he’d rather focus on treating patients while they’re in the early stages of fighting a virus infection, rather than focusing on the last ditch resort of ventilators.
Ventilators are amazing things, and it is easy to understand why there’s so much focus on their ability to seemingly/literally breathe life back into (almost) dead people. In some cases, they are brilliant. But in the case of ARDS – acute respiratory disease syndrome – it seems that by the time a person needs a ventilator, their survival chances, even on a ventilator, are lucky to be better than 50:50. We don’t know the survival chances for people where the ARDS is ongoing due to the viral infection, but we have to believe they’re probably at the lower end of the range, and I’ve seen some statements that point out the longer a person is on a ventilator, the less likely the patient is ever to recover.
The point he makes is two-fold. First, if you cure a person early in their illness, you possibly keep them out of hospital entirely, and if they are admitted, it is only for a short time and requiring few specialized services, support, and equipment. Second, people on ventilators will probably die anyway, after having used up weeks of scarce hospital resource.
So, yes, please, give us abundant hydroxychloroquine, azithromycin, zinc sulphate, and now ivermectin too.
Other
The UK and Commonwealth are so richly blessed by the presence of Queen Elizabeth II as head of state. No other country has a head of state of such stature and probity, and for sure, who else can say in a broadcast to the nation and world, “this reminds me of when I made my first radio broadcast, in 1940”!
For what is only the fifth time in her gloriously long reign, the Queen made a special broadcast today. I don’t know if it has the same effect to you as it does to me as one of her loyal subjects, but it certainly is an inspiration to me. You can see/hear it here.
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.
I’m struggling a bit with the last few days of newsletters:
– I agree with yesterday’s we need to understand what was wrong and how to do better. Even if this was the best we could have done (I hope not), we have to learn and do better next time.
Two days ago it was claimed a ventilator shortage was, your words, fake news. Unfortunately the report used national numbers. While you are reporting that, I’m watching every news channel including Fox talk about the shortages in NYC. Numerous discussions about maybe needing to put two “nearly compatible” people on one ventilator. And the NY Governor asked for ventilators and STAFF!
I assume the 9,427 ventilator max is coming from https://covid19.healthdata.org/projections. That study has a max, the upper margin of error, of 12,942. That isn’t mentioned. We are seeing some good news (less terrible news) out of New York State. But had the doubling rate been every 2 days instead of every 3 days for the past week, what would the need for ventilators been? This newsletter highlights the incredible challenges of good forecasts; but holds a governor to having an accurate forecast.
I’ll end with making this a bit personal. I’m nominally at high risk in New Jersey (barely over 60). I have 82/83 year old parents in SE Pennsylvania. The study referenced above said PA has adequate resources. I just hope and pray they are in the right part of the state!
Hello again, Biz
The fake news I referred to was a claim that doctors are having to decide which patients get ventilators and which do not. That was fake news last week, and it remains fake news today.
Let me make two simple points in reply to your comments.
First : If there truly are shortages of ventilators, anywhere, can you please tell me exactly where the shortage is, how great the shortage is currently, and how great it is projected to rise to, and what the basis of the projection is.
I’ve not seen a single actual number anywhere. Just wild and vague statements “we need tens of thousands more ventilators urgently”. That is my concern, in a nut-shell (augmented by the fact that the projection everyone seems to be relying on shows no need for even one more ventilator, in any of the 50 states.
I totally take your point that there’ll be some guesses and estimates, but – just like the models do – tell us the basis of the guesses. Tell us how many ventilators are already deployed, how many are already in use, and how many more they have facilities to support, and how many more they believe they will need, when they will be needed, day by day, and how they projected those numbers.
I am sure no Governor of any state can do this, personally. But every state has hundreds of people working in their public health departments, every hospital has I don’t know how many people who do nothing other than plan and project; and overlaid over all of that is the CDC, FEMA, and assorted other federal agencies. Somewhere in all of that is someone or some dozens of people who presumably are doing these sums. Let them stand up and be heard and be accountable for them.
Which leads to my second point.
Second : A ventilator might cost about $25,000. So 10,000 ventilators represents a $250 million spend, and of course, 20,000 is $500 million, and so on.
Isn’t it only fair and right and proper to see something more than a totally unexplained unsupported claim that they are needed before writing out a check of that magnitude for something that, if not needed, has no ongoing value or benefit?
At present, nothing has been offered to support these claims, just fearmongering and rhetoric, and when you scratch the surface of the fearmongering and rhetoric, what you find underlying are contradictions of the claims being made, not affirmations. You see the claim of “doctors turning away patients needing ventilators” is an utter lie, you realize that if we were to give NY or any other state thousands more ventilators, they lack the staff and hospital rooms and quite possibly drugs to support the ventilators, and you see that no credible source is supporting the projected need in the first place.
Lastly, am I the only one to notice the irony – the same people who lambast President Trump for making what they erroneously describe as unsupported claims in support of hydroxychloroquine as a potential drug to ameliorate the virus then turn around and make totally unsupported claims for ventilators costing hundreds of millions of dollars more than the 3c or less per tablet cost of hydroxychloroquine.