Seth Corey: The pandemic is peaking

Dr. Seth Corey is Professor, Pediatrics and Molecular Medicine, and on staff in the Departments of Pediatrics, Cancer Biology, and Translational Hematology and Oncology Research at the Cleveland Clinic. He sends along this Facebook post under the heading Day 27+. Slow the spread. I have lightly edited Dr. Corey’s post. He writes:

This Wuhan pandemic is Peaking.

Surreal, these times have been, as suggested by the parody of one of Magritte’s paintings (at figure at right). If only one could say “this is not a pandemic.” Magritte’s pictures show a distorted reality. Or groups of objects which seemingly have no narrative unity. Magritte forces the viewer to construct his own explanation. There may be multiple “truths.” Scientific research is not so dissimilar. Lessons are to be learned.

Sometimes the models are right, as we have been informed for the past week at the daily White House press briefings: there is evidence that the new US cases and deaths are peaking at Easter time. Yesterday, there were 33,752 new cases; today 30,003. Yesterday, there were 2035 deaths; today 1830.

A study not yet published from Germany suggests that infection is indeed more widespread and fatality rates lower than expected [see our post “Maybe some good news”]. Using antibody testing, 15 percent of individuals had been infected with 2 percent having a current SARS-CoV2 infection. The case fatality rate was 0.37 percent whereas that of Germany was 1.98 percent. This is preliminary and should be taken as such.

Ohio’s numbers are reassuring, and may serve as an example of flattening the peak – the purpose was to prepare hospitals for the surge. The model keeps getting flatter and flatter. Hospitalized patients were 1755 yesterday, 1788 today. The hospitals are more than sufficiently prepared. Even New York City’s hospitalization, ICU, and ventilator usage are way under the estimates.

According to the flatter, revised model there should be about 1200 new cases today in Ohio; instead there are 372 cases. Time to revise the model and make it even flatter. This of course means that infections will last longer. Please note 247 deaths include 5 deaths under “CDC expanded death definition.” Please note that 63 of 6250 cases are defined as “CDC expanded case definition.” The median age of death in Ohio is 79 yrs (which agrees with Israel and Italy). The deaths in New York follow closely what is observed in Ohio.

Lesson to be learned, especially by New York leaders: the metropolitan NYC (NJ/CT) area needs to be better prepared for the next epidemic. It has the population density, center of international travel, and cultural/economic/ethnic diversity (but so does Houston, which is a minority majority city-but nowhere near the health crisis of New York City with COVID-19).

It is possible that the next pandemic could come from outside New York City, but that would require an extremely more contagious infection (high R0). In addition to comparing COVID-19 to past influenza epidemics, we should restudy the measles outbreaks (measles far more contagious than coronavirus or influenza but there is greater herd immunity due to childhood vaccination).

Lesson to be learned by all: healthcare workers need to be considered high risk. For Ohio, 21 percent of confirmed cases were in healthcare workers.

One needs to ask why the models were so off. One way is for models to be explained more explicitly. What assumptions were used? Where did the data come from? What are the confidence intervals? If models are going to affect 325,000,000 Americans then it is incumbent upon the modelers to provide explicit details so that other scientists can verify or repudiate or revise the models.

Lesson to be learned by all: All models are wrong, but some are useful.

Either one is dead or alive (none of the Schrodinger’s cat business). Either one is employed or not….Lesson to be learned not soon enough: economic and mental health concerns need to be factored into public health policy. This is not just an infectious disease pandemic.

Keep calm. Wash your hands. Avoid sick people. Avoid physical contact with high risk people. Get rest. Eat well. Keep hydrated. Take zinc. Wear a mask. Support your local businesses. Thank a healthcare worker. Be kind.

I wish a Happy and Healthy Easter to my friends at this surreal time.

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