Category Archives: Healthcare

dribs and drabs

If you’ve been a running fan for a long time, or subscribed to Runner’s World a decade or two ago, you’re probably familiar with Team Hoyt.  Dick Hoyt pushed his profoundly physically disabled son in hundreds of races.  If you click the link, you can read their inspirational and moving story.  Sadly, Dick Hoyt passed has just passed away.

The WSJ had an article about how the Covid vaccine may be protecting the old.  I thought a couple of the plots were encouraging.  This plot showing the decline in nursing home deaths as a share of overall deaths since the beginning of the year, even while overall deaths have declined precipitously, is extremely encouraging.

The progress isn’t as obvious on this age chart, but I think it’s still encouraging.

Deaths 85+ have dropped dramatically, while deaths 75+ have remained steady by percentage, but because 85+ deaths have dropped, I believe that really shows an improvement (since you are seeing a constant percentage of a smaller pie).  The share of deaths 55-64 is increasing, which is what you’d expect to see, since that group is more vulnerable to Covid due to age and not protected by the vaccine.  Seattle only opened it’s mass vaccination sites to 65 year olds on March 1st; previously they were open to 70+, and not longer before that, only to 75+.  I’m sure there are other cities doing similarly poorly, and in some other states, vaccine distribution seems rather haphazard, to put it nicely.  In any case, a huge percentage of 65-74 year olds only got the shot in the last month.  I hope that the curve will look even better in another month.

On the negative side, the CFR is roughly the same now as it was last September, so we haven’t made any measurable progress in either detecting minor cases or healing more serious cases in the last six months.

Covid predictions

I thought it might be “fun” to make some Covid predictions.  Many of my past Covid predictions from last year have come to pass – off the top of my head, vaccine availability date is so far right in line with my predictions.  I also predicted that masks were, in fact, useful and important to protect yourself and others.  I was right about thinking that many restrictions were silly and should be lifted, particularly those targeting outdoor activities.  Who can forget the police in Europe chasing some guy who dared jog on the beach?   I didn’t understand why people were talking about opening up too soon and suggesting that if we waited long enough the virus wouldn’t rebound.  Europe and other locations have amply proved that this was a fairy tale, wishful thinking.

I was wrong about the number of deaths.  I was wrong about cloth masks – it turns out that a triple layer, well-fitted cloth mask is nearly as effective as a surgical mask.  Though, since my pediatrician is sticking with surgical masks, I’ll do the same, or a KN95 if I find myself on a plane or similar.

Current predictions:

1.) There were 528,000 deaths in the US in the first year of the pandemic.  I predict 260,000 deaths in the US in the second year of the pandemic.  I predict we will continue to be in family with the largest countries in Europe for deaths per capita.

2.) I predict Washington state will still mandate mask wearing in some situations in March 2022.

3.) I predict Seattle area schools will not open full time in the Fall.  I would not be at all surprised if they close completely again next winter.

4.) I predict that vaccination will be annual.  This means Round 2 must start no later than December 2021.  In reality, since Covid is seasonal, we’ll need a booster for Winter 21-22, which they better have ready to roll out by early fall, like the flu shot.  I predict they’ll be behind the curve, and those of us who aren’t medical workers, old, or government workers or willing to cheat will not have the booster in time for next winter’s surge.

5.) I predict data will show that school closures in Democratic states, particularly Washington, Oregon and California, were devastating for the neediest kids, and caused a greater setback for “equity” than anything else that’s happened in the last decade, by a wide margin.

6.)  This is the third Coronavirus outbreak in 20 years.

  • SARS: 2002-2004
  • MERS: 2012
  • Covid-19: 2019

I predict another novel Coronavirus will emerge in the next ten years.  I predict another pandemic caused by a Coronavirus will occur within the next twenty years.

7.) I predict I will still be very grumpy about all things Covid at this time next year.

What do I think should happen?

1.) I think wealthy governments should focus #1 on infrastructure to vaccinate people with existing supplies.  But #2 and nearly as important, massive funding should go to building vaccine manufacturing capability domestically so that we can roll out the second vaccine round MUCH more quickly.  All wealthy countries should do this, even small ones.  Building up vaccine manufacturing capability takes years.  Start. NOW.  Please.

2.) The vaccine acceptance process needs to be speeded up for  select vaccine developers that have done a good job.  Pfizer, J&J, Moderna.  NOT AZ, obvs.  We can’t afford to wait so many months.  The cost benefit just doesn’t make sense for someone 80+.  Vaccine should be made available on an emergency basis with minimal testing to the most vulnerable.  The emergency is just not the same for old folks as it is for younger folks, even front line workers.  Also, for vaccine boosters, priority should be by age and age only.

3.) Remove all restrictions nationwide on outdoor gatherings and activities immediately, except masking.  This isn’t going away.  We have to figure out how to live our lives with Covid, and outdoors plus masks seems pretty darn safe.  In Washington, you still cannot gather more than two households together outdoors.

4.) The US needs a dedicated agency dedicated to pandemic spying – that is, identifying pandemics in countries that are not transparent about pandemics (eg China), or incapable of identifying pandemics (eg very poor nations).

5.) The mask mandate should be lifted outdoors nationwide by executive order once 50% of American adults are fully vaccinated.

6.) Schools should be opened full time nationwide in the fall by whatever means necessary.  Unions in the West will not permit this unless they are compelled to.

6.) Study how South Korea and Japan managed Covid.  Other than being island nations, were there other things they did that enabled them to be successful in managing Covid?  (Note that NZ and Australia did not *manage* Covid – they eliminated it, at great cost in the case of Australia, and NZ is so low population that I don’t think it’s relevant.  Japan and Korea are much more interesting to me.)  Because of the language barrier, it’s much more difficult to read about what they’ve done and how it’s being managed.

What are your predictions for the next year?  What do you think should be prioritized now?

incompetence

What an absolute fucking diasaster.  Masks have gotten so much attention, but how much more critical was the late test rollout?  46 days it took us longer than Thailand to produce useable tests thanks to CDC hubris an idiocy.  “Lindstrom warned superiors that dropping N3 might lead to missed cases of infection, false negatives. Villanueva told colleagues that the design was of “Nobel quality,” according to those familiar with the matter.”  The lead scientists were worried about getting an f-ing Nobel prize instead of being pragmatic.

We’ll never know what difference it might have made to get tests out in a timely manner.  By the time the US was able to test, Covid was so widespread, particularly in California, Washington, New York, and probably a couple other northeast states, that containment, a la Korea, was out of the question.  “Flattening the curve” was the only remaining option.  We’ll never know how many lives were lost, how much of our country’s reputation, how much negative economic impact was caused by this debacle.

I still believe this is epidemic-light.  There is another, worse epidemic coming.  I sincerely hope we can learn from these errors.  Will the CDC do better next time?  Let’s hope so.  Please don’t forget that the first positive COVID test in the US was *illegally* obtained in Washington against CDC guidelines.  (This is the same CDC, don’t forget, that was, while failing to produce tests, actively advising AGAINST mask-wearing.)

This is a book waiting to be written.  Honestly, there will be a cover-up, but if someone could get to the bottom of this, you could easily write a book JUST covering the testing debacle.

vaccines

Honestly, I think if you work in a long-term care facility and refuse to get vaccinated, you should find another job.  The government should provide financial support and assistance to allow long-term care facilities to increase salaries to replace those to refuse to get vaccinated and support those who do and want to stay.

Nearly 72% of certified nursing assistants say they don’t want to be vaccinated, a recent survey found.

The federal long-term-care vaccination program, led by CVS Health Corp. and Walgreens Boots Alliance Inc., will begin its broad rollout in a dozen states this week, with hundreds of facilities slated for visits during the next few days. But surveys have signaled that many staffers are reluctant to get the shots, and some already have been declining them in the limited number of facilities where vaccinations have been administered.

At the nursing home at John Knox Village, in Pompano Beach, Fla., which became one of the first U.S. facilities to get the vaccine last Wednesday, about one-third of staffers participated, according to Mark Raynor, director of health-care services.

Unbelievable.  The thing is, you have to vaccinate the people working at nursing homes.  The in-and-out is just too rapid for the residents.  I read life expectancy when you enter a nursing home is only five months.  It’s just not practical to assume you can vaccinate all those people with a vaccine that requires to shots a month apart.  I mean, that should happen, too, but it’s imperative that all staffers and all visitors have the vaccine.

I have to admit I was a little squirrely about the vaccine when it first was being developed six to eight months ago, simply because I was concerned about the speed of development, but you can call me a convert.  Got an extra Pfizer or Moderna vaccine?  I’m ready!  Let me know when and where!  Not only that, I feel like that could have / should have been even more aggressive about rolling the vaccine out to the most vulnerable.  The risk / benefit equation is very different for a ninety-year-old nursing home resident than it is for a thirty-year-old nurse, so the former should have gotten approval for the vaccine sooner.

Lawyers have said that employers are generally legally allowed to mandate Covid-19 vaccines for workers, a stance reinforced last week in guidelines released by the Equal Employment Opportunity Commission. But nursing-home owners have said they don’t plan to require the vaccine. Many facilities are already facing staffing squeezes after months of pandemic challenges.

death math

Can someone explain to me what the hell is taking the FDA so long to approve the vaccine?  There are about 2000 people dying every day.  40% of them live in nursing homes or the equivalent.  Every day that the vaccine is delayed, 800 people die.  Not only that, and equally important or perhaps more important, people in nursing homes have not been able to have normal visitation, in some cases any visitors, in months.  Life expectancy when you enter a nursing home is around six months.  This means many people have lived the last months of their lives in solitude.

If the FDA is truly scrutinizing the data more carefully, great.  If they truly took a four day weekend over Thanksgiving, I’d like to string them up by their thumbs.  Look at the data.  But every employee connected remotely to this better be working seven days a week, fourteen hours a day.  Seriously.

From Fauci:

“Dr. Fauci said the politicization of the pandemic in his own country had led regulators to move a little more cautiously than the British, to avoid losing public support. “In the United States, there is such a considerable amount of tension, of pushing back on the credibility of the safety and of the efficacy,” he said.”

Bullshit.  Follow the process.  Vaccine doubters are not going to be swayed by an extra week of data review, particularly since multiple other countries are beginning mass vaccination.

school and covid

Most Seattle area schools have announced closures for the first six weeks.  How are things in Seattle?  Well, here are our confirmed case counts:

Doesn’t look great, right?  Well, it’s worth looking at test counts.  We are currently at about 3.5% positives, compared to something like 20% positives early in the year.

As you can see, test numbers have risen dramatically.   Here are hospitalizations:

For me, hospitalizations are the most informative measure for understanding short-term Covid status.  Median time to symptoms is 4 to 5 days.  My understanding is that hospitalization normally occurs rapidly (within a few days at most) after symptoms arise, if it’s going to be necessary.  Looking at this plot, there is a definite uptick, but it is small.  King County provides paltry statistics on hospitalizations and Covid in general compared to, say, Texas, but we do know the following:

  • 2.4% of hospital beds are occupied by Covid patients
  • 64% of hospital beds are occupied / 36% are free

Deaths are obviously the best indicator of the impact of Covid, but there can be a huge lag.  Nevertheless, here are deaths in King County:

I don’t see any uptick in deaths whatsoever.  The “surge” started in mid-June, so if there were a legitimate increase in cases, I would think we’d see that reflected in deaths by now to at least some degree, but time will tell.

Again, I share all this to answer the question, should schools in the Seattle area open?  Should I send my children to school or elect the online option if they do open?

It’s also worth considering at some level the risk to various populations from Covid as compared to the flu.  Note that the CDC has updated their estimate of Covid fatality in the US from 0.4% to 0.6%, a significant increase, but still quite low (or quite high, depending on how you look at it, I suppose.)

Fatality rate is only part of the question.  How many people catch the illness is the other, and Covid appears very contagious.  I decided to look at deaths through the end of June for Covid and use the knowledge that the CDC says roughly 5% of Americans have been infected.  Let’s assume very conservatively that 100% of Americans would be come infected if we went about business as usual.  Therefore, to compare the relative impact, I multiplied fatalities through late June by 20 and compared against the worst fatalities for that age group from the flu in the last ten years.

Age Group Flu Max Deaths Covid Deaths Predicted Covid Deaths – 100% Exposure % Risk Delta
0-4 396 17 340 0.86
5-17 870 14 280 0.32
18-49 5240 2970 59400 11
50-64 6751 20665 413300 61
65+ 50903 92280 1845600 36

Now, 100% exposure would never be reached.  While a densely populated urban area might be able to reach close to 100% exposure, most places will not, so there is inherent conservatism in the approach.  However, given the overwhelming uncertainty, I think some conservatism is warranted.  Also, I should note that I calculated this a few weeks ago and haven’t updated it.  The risk should obviously remain constant as Covid spreads, but more data will make it more accurate.

In summary, the risk from Covid for a child between 0 and 4 is slightly less than a bad flu year.  Between 5 and 17, the risk is substantially less – less than a third the risk of a bad flu year.  The 18-49 age group is obviously of interest to all of us.  We have roughly 10 times the risk of a bad flu year from Covid.  Now, I consider my risk of death or permanent injury from flu negligible.  What’s 10 times negligible?  I think still extremely low and not worth worrying about.

50+ your risk is SIXTY times a bad flu year.  Given that at 50, your risk from the flu has also increased, this is starting to get alarming, and the Covid death numbers reflect this.  Obviously, the 65+ folks are hit the hardest.  While they have “only” a 36x factor on the flu, you can see that 50,000 people in this age group die of flu in a bad year, so their risk from flu is high to begin with, and 36 times high is very dangerous indeed.  Tell your parents and grandparents to stay home.  (I do, and they half listen to me.)

My conclusion from all this is that yes, Seattle schools should stay open.  Teachers aged 50 or older and with any co-morbidities should stay home.  Students who share a household with someone over 50 or with co-morbidities should stay home.  That’ll probably result in about half the kids in classrooms and half at home.  In a separate post, I’ll share the steps my school is taking for safety, as recommended by the state DOH.  If Seattle schools cannot support everyone going back, they should at a minimum open their doors to all students on free or reduced price lunches, typically less than half the student population in Seattle.

What do you think?

Since I started writing this, almost all Seattle-area public schools have announced they will be 100% virtual.  I expect them to remain virtual through next summer, given current numbers and what I know about vaccine development efforts.   Our small private school is currently planning to open its doors with an extensive array of safety precautions.  We are planning to send the kids to school.   (It wouldn’t surprise me if the county DOH forces the school to close, but we’ll see.)

Again, what do you think?  Am I being stupid and risking the lives of my family?  What would you do?

I should add that my job disappeared with Covid, and so I’m not working right now.  I’m enjoying being home with the kids, and I love that S gets to see her sisters all the time.  However, language immersion doesn’t really work through remote learning.

vacation. and covid resurgence.

We are on vacation today.  It’s our first vacation of any kind in about a year, and of course the first since S arrived.  We’re only about 90 minutes from home except that an hour ferry wait made it 2.5 hours.  Frankly, the trip was pretty rough.  When you’re in line for the ferry, you’re inching along at a snail’s pace.  Because you’re moving, the baby has to stay in the car seat.  You can’t pull off and take a break anywhere or you’ll lose your place in line.  And S was fussing and crying and the kids were being annoying.  Yeah.  Finally, after being here a few hours and getting S to bed, I’m starting to feel a bit relaxed.  I don’t think vacationing with a baby is ever really all that relaxing.  We’re probably a couple years at least from a vacation that is in any way truly relaxing.  But still.  It’s good to get out of the house.

Today, my county moves to “Phase 2.”  One 5 person gathering per week is now permitted.  Retail stores can now reopen at limited capacity, and restaurants can open at 50% capacity.  Frankly, I have no interest in going to a retail store or a restaurant or a hair dresser, but I’m glad to see us reopening.  However, I’m mostly depressed because Covid cases and deaths are continuing to surge.  We had another record high number of cases today since early May, and deaths are up the last couple days as well.  The cause is unclear – if the contact tracers know, they aren’t saying.  Cases are apparently up in young people and Seattlites, but are not directly linked to the protests (not that I necessarily trust them to tell us if they were.)  There have been transmissions in households driving it apparently.  But why would there be any change in how Covid is getting transmitted *within* households?  That makes no sense.

I should really stay away from the news and DOH website for a few days.  Tracking this is not helping anyone.  Do I have the willpower to not go to a news website or the DOH website for the rest of our vacation?  I have literally not missed a day monitoring the DOH website since a couple weeks after this started.