A million+ #COVID19 cases and rapidly increasing

A grim milestone.

5.1% aggregate death rate.

On my iPhone at 3:41 EDT. The U.S. now accounts for nearly one-fourth of global cases. That proportion will only increase, likely for several more weeks. Data source, Johns Hopkins.

UPDATE: 24 HOURS LATER

Fatality rate now 5.4%

Below, April 4th, same time.

___

A Boston physician writes in The New Yorker,

This disease is different from what we typically see, and its severity has unsettled even our most experienced doctors. One man arrived and had to be intubated immediately; his blood-oxygen level, thirty-eight per cent, was the lowest any of us had ever seen. (Greater than ninety-five per cent is normal; eighty per cent is alarming.) We have seen other patients with levels in the sixties or seventies. Another patient’s levels plummeted to below twenty per cent in the few seconds it took us to connect him to a ventilator. Not long ago, one of our physicians started wearing a new fitness tracker that purports to measure stress levels; when it recognizes high stress, it vibrates and displays messages, like “Relax” and “Take a break.” During a recent shift, it buzzed almost continuously…

APRIL 3RD UPDATE: A HOSPITALIST REFLECTS

For many patients, a diagnosis of covid-19 carries with it a deep unease associated with the worst of maladies. It is not pneumonia, or diabetes, or even a heart attack; it is H.I.V. and cancer. They’ve heard the gruesome statistics on the news—the high death rates, the rapid rise in cases, the dwindling supply of needed resources. And there are few symptoms as troubling for patients as shortness of breath. With the coronavirus, the anxiety of labored breathing is exacerbated by the fact that it must be suffered alone, without friends and family and with limited contact with doctors. Among the cruellest aspects of covid-19 is the intense isolation that it inflicts…

I am sympathetic to those concerned about the widespread economic and social disruption created by aggressive social distancing, and to the political and business leaders asking whether it’s all worth it. But I think that if they saw what I see—the fear, the tears, the gasping for air, the destruction of bodies and psyches wrought by the virus, the daily contortions that doctors, nurses, and hospitals must make to provide even basic care—they, too, would understand that social distancing is the only option. They would feel what I feel: that we cannot return to normal during a time when thousands of Americans, of all ages and backgrounds, cannot breathe, and there aren’t enough people or supplies to help them...

MEANWHILE, BACK IN THE WHITE HOUSE

Donald Trump takes repeated emphatic (increasingly strident) pains to disclaim any responsibility for his initially indifferent, dismissively negligent reaction to the COVID19 pandemic: "It came from out of nowhere. No one could have foreseen it."

Right. Facts are inconvenient things.

Box 6: What Would the 1918 Influenza Pandemic Look Like Today?
In the worst pandemic in recorded history, the 1918 influenza pandemic, the novel virus infected approximately one-third of the global population over a period of 2 years, ultimately leading to 50 to 100 million deaths world-wide. One might imagine that the death rate would be lower today due to the advent of modern medical equipment and procedures that did not exist in 1918, but the global population is now approximately 4 times greater than in 1918. This growth, however, is disproportionately higher in low- and middle-income countries, often the ones with developing health systems. Many—predominantly in Africa, Southeast Asia, Latin America, and the Middle East—have experienced population growths of 1,000% or more since 1918. Crowded urban areas provide prime conditions for the spread of respiratory diseases, and urbanization is increasing globally, including the emergence of 47 “mega-cities” (populations over 10 million). By comparison, London was the world’s largest city in 1918, at approximately 5 million people. Additionally, global travel has increased by orders of magnitude compared to 1918. Even then, shipping and population movement (including World War I) played an important role in global spread of the disease, but today, humans can fly anywhere in the world in less than 1 incubation period, meaning that global transmission can be expected to be even faster.

In 1918, the global case fatality ratio is estimated to have been 2.5%, but it was considerably greater in low- and middle-income countries, with some estimates exceeding 10%. Today, some high-income countries would be expected to fare much better because of modern health care, but the case fatality in countries with limited access to healthcare could be as bad as or worse than 1918. Simple arithmetic would suggest the possibility of 100 to 400 million deaths if a 1918-like pandemic were to occur today, but unprepared or under-resourced health systems could further exacerbate disease transmission through nosocomial spread and an inability to promptly diagnose and render care, a particular concern for developing health systems. During the 2003 SARS epidemic, 72% and 55% of presumed and confirmed cases in Toronto and Taiwan, respectively, occurred as a result of healthcare transmission. A similar nosocomial outbreak in which healthcare facilities became amplifiers of the epidemic, this time of MERS, happened in South Korea in 2015. [Page 47 of 83]

Hat tip to Dr. Naomi Oreskes.

UPDATE

ERRATUM

Citizens who lost health coverage in past 2 weeks due to economic collapse:

USA 3,500,000

Australia 0
Belgium 0
Canada 0
Chile 0
Denmark 0
Finland 0
France 0
Germany 0
Greece 0
Hungary 0
Italy 0
Japan 0
New Zealand 0
Norway 0
Portugal 0
S Korea 0
Spain 0
Sweden 0
Turkey 0
UK 0

Hat tip to a good Facebook friend.
_____________

More to come...