What COVID-19 metrics should we be following?

By Mark | March 31, 2020

I get that it’s important, from a public health perspective, to track the total number of active COVID-19 cases over time. Having a sense as to how many people have been diagnosed at a given point in time, should, in theory, give you a sense as to what you might expect a week or two down the line, as individuals recently infected by those diagnosed today begin to show signs of illness and seek treatment. [It’s currently thought that the basic R0 of COVID-19 is around 2.5, meaning that, on average, everyone with the disease passes it along to about 2.5 others. The R0 of the common flu, by comparison, is roughly 1.3, or about half.] So, if we had robust testing, and a decent understanding of social dynamics during this period of quasi-lockdown, one would imagine that we could model the progression of the virus fairly well, allowing us to plan accordingly, etc. But, when we aren’t really testing all that much, I don’t understand the purpose of tracking the number of confirmed cases. And I know that I probably don’t have a lot of epidemiologists in the audience right now, but, as I’m curious, I thought that I’d throw it out there for discussion anyway.

Maybe it’s because I keep hearing first-hand accounts of people seeking tests, who are being told to just go home and self-quarantine until such time that they either get well or begin to have trouble breathing, as there’s really nothing more that can be done for them until such time that they need respiratory intervention. And, if that’s the case — if people who likely have COVID-19 are being sent home without tests, as there’s really nothing that can be done for them anyway — I’m wondering what the value is in publishing the daily number of confirmed cases. [Might it give some a false sense of security?] I know it’s interesting, and that we feel obliged to look each day, but what does it really tell us? I’ll probably still continue to quote the daily number of confirmed cases — it’s now 7,615 in Michigan, by the way — but I have no idea what good that number actually does anyone.

It seems to me that the number of the dead, given that it’s more certain, is probably the metric that’s more predictive of what’s to come, right?

As for the number of people who have died from COVID-19 in Michigan, we’re now at 259, which, as of today, is the third highest in the country. I’m not, of course, an epidemiologist, but if we assume an average fatality rate of 1.4%, that means we’ve got roughly 18,500 with the disease presently, which is more than double the number of presently confirmed cases. I know that age of the population, weight, environmental factors, etc, all influence these numbers, and that no model is perfect. If it’s true, however, that we’re seeing something like a 1.4% fatality rate here in Michigan, then our 259 deaths would seem to indicated that we’ve got a lot more sick people out there than we’ve identified through testing.

Again, I admittedly know very little about this stuff. I’m just genuinely interested to know what useable information we get from the metric like “the number of diagnosed cases” when our testing still appears to be seriously flawed. I don’t know if the number of dead, the number of hospitalizations, or the number of people on ventilators is a better metric to pay attention to, but I have to think that all of them would be better than diagnosed cases.

Oh, and because I apparently still have a few minutes before falling to sleep, I might as well respond to recent comments by Mitch McConnell about how Donald Trump couldn’t respond as aggressively as he would have liked to the coronavirus threat because of his impeachment trial. As others have noted, Donald Trump still found time to golf and hold his rallies during the impeachment trial. If he had the time for those things, he could have found the time to respond responsibly to the threat… which we know that he was warned of as early as January in his intelligence briefings. Instead, however, he not only refused to act on the warnings for months, but played the threat down in public. So, no, Senator McConnell, this was not the fault of those bad Democrats and their reckless campaign to save the Republic. And even if they hadn’t tried to remove Donald Trump from office for having tried to coerce another world leading into launching a politically motivated investigation into a domestic opponent, chances are the same exact thing would have happened. When you allow family of Florida grifters to hot-wire party and take it for a joy ride, these are just the kind of things that should be expected.

OK, because I still can’t sleep, here’s Donald Trump admitting to the fact that, if we made voting easier in this country, the Republican Party would never win another election. Seems like an important admission, doesn’t it?

This, of course, was in response to an attempt on the part of Democrats to pass vote-by-mail legislation that would allow Americans to vote from home, instead of having to go to polling places next November, during what could be another deadly cold and flu season. The Republicans pushed back because the last thing they want is more people voting, for the very reasons articulated above by Donald Trump.

Posted in Health, Michigan, Politics, Uncategorized | Tagged , , , , , , , , , , , , , , | 35 Comments

On the bright side, COVID-19 is helping Donald Trump become a “ratings hit”

By Mark | March 29, 2020

I thought, upon first pass, that this was something posted by a parody account. Sadly, though, it’s apparently real. This is an actual tweet from the President of the United States in the middle of a global pandemic.

And, yes, he used the phrase, “the numbers are continuing to rise.” And they are. Only I’m not talking about ratings.

Over the past two days, the number of coronavirus deaths in America has doubled, and Donald Trump is posting quotes about how his daily press conferences are getting better ratings than The Bachelor.

This, I hope most of you would agree, is absolutely, fucking insane.

Yesterday, Dr. Anthony Fauci said that we’re likely going to have “millions of cases” in the United States, and that there could be “between 100,000 and 200,000” deaths from coronavirus. And today, with the death toll already at 2,391, and footage going around the internet of bodies being loaded into a truck by forklift in Brooklyn, the President is essentially posting about how much it must be kills the libs that this is turning out to be good for his brand. It’s absolutely unconscionable.

Here’s the context in which this came to me, as I was reading through my Twitter feed this afternoon. First there was a photo of bodies lined up along the corridor of a New York hospital, and then there was Donald Trump gleefully sharing quotes about how he was getting “Monday Night Football type numbers”.

The juxtaposition of these two posts was just too much for me… I’d wanted to write today about Donald Trump’s call for GM to start making ventilators in an Ohio factory that the company no longer even owned, and his ridiculous move to quarantine New York without having the authority to do so, but, when I saw this, just felt as though I had to vent instead.

There’s nothing I can say that I haven’t already said. The man is unstable. He’s not up to the job, and he knows it. Every elected Republican official knows it. The only people who don’t know it, are the sad, stupid fuckers in their red hats, who have so much invested by this point that they can’t hope to extricate themselves. So they just slip deeper and deeper in. And the Republican Party continues to go along for the ride, knowing that Trump’s personality, at this point, is all that they have, other than blatant racism and tax cuts for the wealthy, to hold a coalition together. And that’s the truly sad thing. They know the party is dead. They know it’s over. If that weren’t the case, they would have pushed Donald Trump out during the impeachment trial, putting everything they had on Pence, who would have given them the exact same results, without all the death, cynicism, narcissism and uncertainty. But they knew that the Republican Party was Trump’s party now, and they decided to go along with it for the corporate welfare, the tax cuts, and the tremendous high that comes with power. And so we all just sit here and watch this ridiculous drama play itself out — the saddest reality show over. The ratings, of course, are great, because everyone wants to know how close they are to death, as the least capable man that America had to offer attempts to navigate us through these dangerous waters, but we all know how it ends. It’s not how it ends, but when. We know it ends in carnage, humiliation, and lots of finger pointing. And the ratings, you can be sure, will be tremendous.

Posted in Health, Politics, Uncategorized | Tagged , , , , , , , , , , , , , , | 61 Comments

Is Donald Trump really demanding to be praised before sending Michigan COVID-19 aid? It sure looks that way.

By Mark | March 28, 2020

I like our “woman governor” here in Michigan. I think that, given the hand she’s been dealt, she’s been doing a good job for the citizens of the state. I do wonder, however, how much better things might be for us right now if she’d spent a little more of her time over the course of this crisis stroking Donald Trump’s fragile ego, instead of focusing on frivolous things like the health and wellbeing of her constituents. As Trump said yesterday, he encouraged Vice President Mike Pence, the head of the White House coronavirus task force, not to engage with Governor Whitmer, who he referred to as “the woman in Michigan,” as she didn’t appropriately praise his effective and masterful leadership over the course of the pandemic. “If they don’t treat you right, I don’t call,” Donald Trump told reporters. Here, for the unbelieving, is the video.

According to Whitmer, this outrageous behavior on the part of the President is having a very real impact on our ability as a state to respond to the exponentially growing needs of those suffering from COVID-19. Following is an excerpt from news radio WJR.

…”What I’ve gotten back is that vendors with whom we’ve procured contracts — They’re being told not to send stuff to Michigan,” Whitmer said live on air. “It’s really concerning, I reached out to the White House last night and asked for a phone call with the president, ironically at the time this stuff was going on.”

The other stuff was Trump speaking with Sean Hannity on FOX News about Whitmer, a Democrat who has said very pointed things about the federal government’s lack of coordinated response to the coronavirus crisis. Trump said of Whitmer, “She is a new governor, and it’s not been pleasant… “We’ve had a big problem with the young — a woman governor. You know who I’m talking about — from Michigan. We don’t like to see the complaints.”

Michigan’s request for disaster assistance has not yet been approved by the White House, and Trump told Hannity he’s still weighing it.

“She doesn’t get it done, and we send her a lot. Now, she wants a declaration of emergency, and, you know, we’ll have to make a decision on that. But Michigan is a very important state. I love the people of Michigan”…

“I’ve been uniquely singled out,” Whitmer went on to say. “I don’t go into personal attacks, I don’t have time for that, I don’t have energy for that, frankly. All of our focus has to be on COVID-19.”

She, of course, is right. No one, during a time of unimaginable crisis like this, should be forced to publicly lavish praise upon an elected official. It’s not surprising that this is happening, though. As you may recall, this was predicted. Stanford Law Professor Pamela Karlan warned us during Trump’s impeachment trial that, if we didn’t remove him from office for attempting to coerce the Ukrainian government into opening a bogus investigation into Joe and Hunter Biden, we could well see something like this happen. Remember how she said that an emboldened Donald Trump might attempt to use a domestic disaster to elicit statements of support from our governors? Well, here we are.

As for why Donald Trump has it in for Whitmer, I suspect it’s largely due to the fact that, last weekend, she said on national television that “lives will be lost because we weren’t prepared.” She was merely speaking the truth. We were unprepared for this. And people are dying. But Donald Trump clearly took it as a personal attack. Whitmer, for what it’s worth, was respectful in her comments at the time. She even said that she’d be grateful if he helped us acquire the ventilators we so desperately needed. Whitmer said, “I feel like we are making some progress, but if the federal government is able to procure some ventilators, and ship them to Michigan, we will be incredibly grateful.” But, of course, those ventilators from the federal stockpile never came. And, according to Whitmer, as you just read above, private companies have been instructed not to ship ventilators to Michigan. [If it turns out that the Trump administration did indeed intercede to stop shipments to Michigan, one hopes that it comes up in his criminal trial after the all of this is over.]

But, yeah, Whitmer wasn’t happy with the federal government, and she said so. That, by the way, is her job. She’s supposed to advocate for us, and that means calling out the federal government when they refuse to offer any significant help in the face of a pandemic… It’s kind of what we pay taxes for.

And this is federal problem. I know I’ve said it before, but Whitmer, and her fellow governors, were not privy to the the classified intelligence briefings that Donald Trump was receiving on the coronavirus outbreak back in January and February. They didn’t know the extent to which our medical infrastructure would be effected. They weren’t the ones receiving tactical advice concerning the necessity to stockpile things like medical masks and ventilators. They just knew, from our President, that everything was “very much under control.” [That, by they way, is an exact a quote from Donald Trump. On February 24, he said, “The Coronavirus is very much under control in the USA… Stock Market starting to look very good to me!”]

Donald Trump may not like to hear it, but it’s true — had he acted quickly when he first got word in January, we would not be in the fix we’re now in, where we’re talking about the possibility that doctors in Michigan might have to deny care to the elderly because of we don’t have enough ventilators to go around. With two months lead time, Michigan hospitals could have met this massive public health crisis properly outfitted, but Donald Trump chose to downplay the severity of coronavirus for months, instead of treating it like the legitimate public health crisis that it is. And now our hospitals in Michigan are trying to do the best they can with the 1,000 ventilators they have.

So, how does Donald Trump respond to this massive failure on the part of his administration? He looks for scapegoats, and apparently he’s decided to attack everyone from the Obama administration, which left office over three years ago, to the entire country of China, while also talking glowingly of his own accomplishments. And the governors of America figure prominently is this ‘it’s everyone’s fault but mine‘ narrative. When they offer statements of fact, saying, for instance, that they’re not receiving federal assistance, they’re met with comments like those above, and quotes like this one from Trump — “(They) shouldn’t be blaming the Federal Government for their own shortcomings.”

Here’s another example of Trump coming after Whitmer yesterday.

So, yeah, Trump is taking the opportunity during this crisis, with 112,468 Americans now infected, and 1,895 already dead, to shit on the Governor of Michigan, and blame us for not being better prepared, in spite of the fact that we’d received no warnings from the federal government to do so. One just hopes the people of Michigan keep this in mind come November, when it comes time to vote for the next president of the United States. As former Obama staffer Ben Rhodes just said on Twitter, “It will be GREAT when Michigan ends the Trump presidency.” We put him in the White House, and it’s on us to take him back out.

One last thing. Maybe Whitmer played this right after all. She’s reporting this morning that we just today received our first “112,800 N95 masks… from the strategic national stockpile.” And Donald Trump just approved our disaster declaration. Maybe more people should try standing up to our trifling, orange despot.

update: The Biden campaign just released an absolutely devastating ad about Donald Trump’s reluctance to work with states that don’t “treat (him) well.”

update: When asked about Trump’s comments, Dr. Fauci assures the American people that the “people who need things will get what they need” regardless of the President’s rhetoric.

update: Whitmer on Meet the Press Sunday morning, demonstrating leadership, and reiterating that now isn’t the time for us to be fighting one another.

update: Rudy Giuliani spells it out on Fox. “When you play with your boss, sometimes it’s better when you don’t win the golf game,” he says. “He’s the boss, he’s got all the resources.”

Posted in Health, Michigan, Politics, Uncategorized | Tagged , , , , , , , , , , , , , , , , , , | 66 Comments

Birx is lying when she says that hospitals aren’t debating changes in DNR policies

By Mark | March 27, 2020

Rare is the person who can both exist in Donald Trump’s orbit and retain his or her dignity. For every Anthony Fauci, there are probably several hundred Deborah Birxes — people who, for whatever reason, have chosen to take the path of least resistance, and sublimate themselves before Donald Trump. In the case of Birxx, a legitimate doctor who once served as our nation’s Global AIDS Coordinator, one imagines that she’s made a deal with the devil, having come to accept that, in order to get a seat at the table in Donald Trump’s White House, one has to constantly debase oneself in front of our incredibly fragile, insecure, and narcissistic president. I’m sure, at some level, the calculus makes sense to her. She likely thinks that if, like yesterday, she goes out on the White House lawn and talks at length about how “attentive to the scientific literature, the details, and the data” Trump is, and his incredible “ability to analyze and integrate data,” that maybe, when it comes time to talk him out of reopening the economy on Easter over the objections of the entire scientific community, that he might actually listen to her. That’s never how it works out, though. Everyone who plays this game, regardless of how good their intentions, always comes out the other end, their legacy in tatters, with absolutely nothing to show for it. [Ask Rex Tillerson.]

Today, Birx did more lying for Donald Trump, saying in response to questions about the American citizens who will invariably die when we max out our ventilator capacity, “there is no situation in the U.S. that warrants that kind of discussion.” That, however, simply isn’t true. And we know it… Here, before we get to that, are the two clips of Birx noted above.

First, we now know that there are over 100,000 confirmed cases of COVID-19 in the United States. [This, by the way, assuming we can trust the numbers being reported in other nations, makes us the world leader when to comes to the disease’s proliferation.] Second, we know that the number of confirmed cases has been doubling every two days, as testing is just now starting to be done in earnest, despite the claims from the administration weeks ago that everyone who needed a test was getting one. Third, we know that some 20% of those diagnosed with COVID-19 are requiring hospitalization, and that most of those need some kind of breathing assistance. According to reporting by NBC News, “13.8 percent (of those diagnosed) had severe disease, including respiratory problems, and 6.1 percent had critical illness, including respiratory failure.” And, fourth, we know that, when all of this started we only had about 62,000 ventilators in use in the United States, with somewhere between 4,000 and 10,000 additional units being held in reserve by the federal government.

So, let’s say, for the sake of argument, that one million people come down with COVID-19 by the time that this is done. [That’s a pretty low estimate based on where we are already, and what current models are projecting.] That would mean that some 13.8% would have severe respiratory disease. That’s 138,000 — which is more than double the total number of ventilators in the United States.

Here in Michigan, we can see it playing out already. We’ve been told from public health professionals that we have roughly 1,000 ventilators in the entire state. And, as of today, we have over 3,600 confirmed cases of COVID-19 in the state. Furthermore, we’re already maxing out our ventilator capacity at Belmont and Henry Ford hospitals. [They’re currently sending cases to U-M, but, with the cases growing in Washtenaw County, one imagines it’s just a matter of time before options become more limited.]

Earlier today, as you may have seen, a memo was leaked from Henry Ford Health System in which administrators attempted to explain how they may have to make decisions as to who will receive care, ventilator access, etc, and who will not. “Patients who have the best chance of getting better are our first priority,” the memo said. “Patients will be evaluated for the best plan of care and dying patients will be provided comfort care.” This, of course, shouldn’t be a surprise to anyone. Of course our hospitals are considering this. They, just as well as you and I, can see the trajectory of the infection curve, and they know we have limited resources with which to meet that need. So, yes, Dr. Birx, people in the medical field are talking about this. This administration has left them no choice. [Donald Trump could have called for more ventilators to have been made two months ago, but he waiting until today.] They’re wondering what to do when the last ventilators are taken, and how they transition into a scenario where they no longer try to save the lives of those who “code,” but instead just move that patient’s ventilator to the next person waiting, and just provide palliative care to the elderly, as the young have a better chance of surviving.

This was going to be a longer post. Look for Part-II tomorrow.

Posted in Health, Uncategorized | Tagged , , , , , , , , , , , | 55 Comments

How to handle groceries and wash produce in the age of COVID-19

By Mark | March 27, 2020

Our friend Lynne just left a comment here, alerting us to the existence of a video, made by Grand Rapids-based family practitioner, Dr. Jeffrey VanWingen, about how one should handle groceries in the era of COVID-19. I thought that I’d move it up here, to the front page, as it seems like a message that everyone should hear. Given that recent studies have shown that coronavirus can live on some surfaces, like plastic and stainless steel, for up to three days, it is incredibility important that we pay attention to what VanWingen is saying here. So please watch and share, OK?

As VanWingen says, “This all seems a bit time consuming, but, in truth, these days people do have a bit more time on their hands… (so) let’s be methodical and be safe, and not take any chances.”

[See also the Washington Post’s “Don’t panic about shopping, getting delivery or accepting packages.”]

Posted in Food, Health, Uncategorized | Tagged , , , , , , , | 14 Comments

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