The last time I posted on March 23, 2020, there was 1 documented case of COVID-19 in Douglas County. I indicated that there would be many more cases because we were just beginning to test for the disease. I also suggested that COVID-19 mortality rates were likely overstated by the CDC and World Health Organization because there was very little testing of those with limited or no symptoms and the majority of testing was performed on the most ill and those who required hospitalization. We did not know the prevalence of the disease in general population and there was clear adverse selection bias in the testing process. These problems remain. I also mentioned at the time that antibody testing would be a better measure of immunity in a community. These tests are coming but not as fast as I had hoped.
So, where are we now in regard to known COVID-19 statistics as of 4/6/2020?
Globally: 1,345,048 confirmed positives and 74,565 deaths.
United States: 366,614 confirmed positive and 10,783 deaths
Douglas County: 12 confirmed positive and zero deaths
Notice that I did not attach a mortality rate to the numbers above. Why? It is not a difficult calculation. The number of deaths is divided by the number who had the disease. The problem is that we do not know how many people really have or have had the disease. We only know how many have tested positive. With the numbers above, the global mortality rate is 5.5% and U.S. mortality is 2.9%. These mortality rates are not accurate values in my view.
I have found the South Korean data the most helpful since they tested people early and often. You can review the data yourself at https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030.
As of today, South Korea have tested over 466,000 people. The calculated mortality rate for those under the age of 60 is 0.2% (16 deaths divided by 7,839 confirmed positives). Unfortunately, those over the age of 80 had a mortality rate of approximately 19%, this is tragic number but not unexpected. In the United States, mortality rates for those over age 80 from viral pneumonia has been documented to be between approximately 15-20% and for this elderly population with pneumococcal pneumonia and bacteria in the blood, the mortality rate has been measured to be 37% in a 20-year study published in 2019. It is important to remember that the average life expectancy of a U.S. citizen is 78.6 years.
From 2018 U.S. CDC data, I found the following:
7,708 people, on average, died daily in the United States
2,813,503 U.S. deaths in a year.
55,672 died of pneumonia and another 160,201 died of exacerbations of chronic lung disease.
47,173 died from suicide
169,936 died in accidents
The New York situation is unfortunate. According to a Wall Street Journal Article, New York City closed nearly 20 hospitals over the course of the last decade. They have had significant capacity issues prior to the pandemic. It really isn’t a surprise that they are struggling now. I am confident that they will meet the challenge. Oregon has loaned over 140 ventilators to New York and Washington State has given 400 ventilators back to Federal government to distribute as needed. Perhaps, these states do not need them? The people in New York seem to be very motivated to do the right thing to slow the spread of the disease and medical professionals will navigate the crisis. I realize that the worse is predicted to come over the next several weeks. We shall see.
In early March, Evergreen had 34 patients on our inpatient hospital census. Today, I have 10 patients in the hospital. We have one elderly inpatient with COVID-19 who is improving due to great efforts from the patient and those that I have the privilege to work with as colleagues. In my opinion, there are many people who have or have had COVID-19 that are not counted in the daily statistics. This is not cause for alarm, it means the mortality rate is lower and we are hopefully developing some herd immunity. Evergreen is actively seeking out testing opportunities that evaluate our community’s immune response to this virus. We will let you know when that occurs. In the meantime, we are still targeting our limited available PCR testing for whom the results will impact care plans.
Why am I telling you all this? I hope to restore some perspective and hope. The pandemic has challenged us and changed routines in so many ways, but we will cope. Do not allow the alarm bells, statistical distortions and sensationalism to wear you down. Enjoy this time with your family and take the opportunity to reacquaint your teenager to the lawn mower and the weeds. They need the exercise and their eyes need to get adjusted to the sunlight as opposed to the light of the LED screen for a change.
Continue to use reasonable precautions as recommended by our public health partners. It is especially relevant if you are older or have significant chronic medical issues such as asthma, chronic obstructive lung disease or an immunosuppressed condition. I know there is a lot of stress in our community as it relates to the economic consequences to this pandemic. Don’t suffer alone, reach out for help if you need it.
I am so proud of the kindness and generosity of our community. Evergreen has benefited from the generosity of individuals who made or donated masks and local companies who donated N95 masks for our providers (Lone Rock Resources, Western Equipment & supply and many others). I have witnessed people show gratitude to grocery store clerks, health care personnel and other employees of businesses who are fortunate to remain open. Thank you, Douglas County for setting the bar so high.
We hope the next steps will be to get a better idea of the prevalence of this disease locally, deescalate the quarantine in a rational fashion, and get people back to their normal routines soon.
John Powell M.D.