One doctor’s view – What are we doing here?

By on Mar 27, 2020

A Local Doctor’s View of Covid-19

AAPS (Association of American Physicians and Surgeons) response to proposed epidemiological model used by Dallas County Judge for Texas

Page_ Sheila.jpg By DR. SHEILA PAGE, President of Texas AAPS

The model presented has a number of limitations and is likely to be an exaggerated estimate of deaths for the state of Texas. It does not take into account the limitations of the available data, which include selection bias due to limited number of tests, high false positives and false negatives of the test widely used, differences in social structure, population density, population health and risk factors such as smoking among the nations reporting data. 

“Reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%. … A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational.”1

It is easy to see that by projecting a high number of COVID-19 related deaths while disregarding the increase in deaths that will result from the rapid economic decline,2the necessary delay of treatment for people with other medical needs such as cancer, and the inevitable worsening of mental illness related to severe isolation measures and media-driven fear,  a hollow victory may be claimed for implementing restrictions that edge closer to those used by communist dictatorships.  

Stanford University Professor and Nobel Laureate, Michael Levitt, MD, issued “remarkably accurate” predictions about the decline of cases in China. He now states that the data simply doesn’t support the dire predictions being made about deaths in the United States. “Levitt, who received the 2013 Nobel Prize in chemistry for developing complex models of chemical systems, is seeing similar turning points in other nations, even those that did not instill the draconian isolation measures that China did. He analyzed data from 78 countries that reported more than 50 new cases of COVID-19 every day and sees “signs of recovery” in many of them.” From  LA Times, March 23, 2020.  

In an article published yesterday, written by Dr. Eran Bendavid and Dr. Jay Bhattacharya, the high projected mortality rates are not supported by sufficient evidence. 

“If our surmise of six million cases [in the U.S] is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death.  This is one-tenth

of the flu mortality rate of 0.1%.  Such a low death rate would be cause for optimism.”5

According to John Dale Dunn, MD, JD, “Actual experience with the evidence  from the more than 3000 people on the Diamond Princess that showed only 17 percent of the population on the Diamond Princess were infected and half of the infected were not sick, a small number of the infected elderly died. Shelter in place has consequences and causes harm, lots of harm.  Quarantine is helpful for keeping defined groups from spreading a virus, but the virus is widely disseminated now, and quarantine is not an effective method.”

The United States has several advantages that will help limit the morbidity and mortality of the the COVID 19 pandemic. For example, smokers are at higher risk of severe COVID-19 and the United States has half the rate of smoking than China.  In China in 2015, smoking prevalence was 27.7% (52.1% among men and 2.7% among women). In the U.S. in 2018, 13.7% of all adults (15.6% of men, 12.0% of women) currently smoked cigarettes. Italy’s smoking rate for 2016 was 23.70%.

We have the advantage of lower overall population density.  “China’s population density is 397 people per square mile. Italy’s is 532 people per square mile, and South Korea’s is 1,366. The United States, by contrast, has only 94 people per square mile. That’s got to be a fact in our favor.”

Other unique features of American life may also protect us from the corona virus. The disease is most fatal to the elderly, and Americans are significantly younger than other nations. Italy’s median age is over 47 and South Korea’s is over 43. Ours, however, is only 38. Americans are also much less likely to live with older people than are Italians, Chinese or South Koreans. A German economics professor, Moritz Kuhn, has been looking into social interactions as a way of explaining the virus’s spread. He found that nearly 30 percent of Chinese between the ages of 30 and 49 live with their parents. More than 20 percent of Italians and South Koreans between those ages also live with their parents, but less than 10 percent of Americans do. In those other countries, it’s easier for a healthy middle-aged person to get the disease from social contact during the day and unwittingly transmit it to an elderly person during the evening. In the United States, that’s a very rare possibility.3
Putting the differences between the U.S. and other countries aside, Texas itself is a diverse state. Across the states’ 254 counties, population density varies between 2,718 residents per square mile and 0.1 per square mile.4Wuhan’s population density is 3,200 residents per square mile. “New York is one of the most densely populated places anywhere, with nearly 28,000 people per square mile.”  Imposing one-size-fits-all solutions across the state would be illogical and unwise.

In summary, we must be vigilant to protect our vulnerable citizens while allowing the productive elements of society to continue. If hospitals anticipate the need for ventilator support for an overwhelming number of patients, we should do our best to supply that need without jeopardizing patient care for other patients who have serious medical conditions, and most certainly without shutting down the engine of productivity in society that is critically necessary for the success of our efforts.  Keeping a healthy focus on successful early treatment and prophylaxis would curtail the need for ventilators.  The information coming from other countries regarding the successful use of hydroxychloroquine for treatment and prophylaxis should not be disregarded, and hindrances to the availability of this and other medications to the public via local primary care physicians must be removed.  


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