Category Archives: Healthcare

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.

covid surge

And . . . here comes the surge.  It turns out that having tens of thousands of people congregate in close proximity all day long, up to 60,000, is not an awesome idea in the middle of a pandemic.  I said in my last entry that numbers were high that day but had otherwise been good.  Well, numbers have been high every day since then, and just jumped again today.  We’ve had (in my county) an average of 57 new cases per day over the last week as compared to 36 the week before, a 60% increase, and today we had 94 new cases, the first time we’ve had that many since the first week of May.

In my opinion, the government has lost the moral authority to impose restrictions.  They’ve permitted gatherings of tens of thousands while simultaneously forbidding people to leave their homes and have gatherings of even five people.  Now, gatherings of five – FIVE – people are permitted but most everything is still shut down.  And leaders are issuing supportive statements about the protests.  I’ve seen photos of socially distant protests elsewhere, but there has been nothing socially distant about them here.  Ug.  I’m just sick of all of this.

Also, apparently the Washington state DOH has been overcounting negative tests, meaning that they’ve been understating the percent positive tests.  Really?  Why are these people so incompetent?

healthcare thoughts

It’s interesting to me how supporting government-run healthcare has become more or less standard for Democratic candidates.  I can’t argue that people – all people – should have access to healthcare, but I feel a lot of people don’t understand that what people get with government-run healthcare is not the same as what we get here.  I can mainly speak to Ireland and the UK, so that’s what I’ll talk to.

  • If you are in the hospital in Ireland, you’ll likely find yourself on a ward.  If not, you’ll be sharing a room.  As far as I can tell, wards don’t even exist on US hospitals anymore, except maybe in the ICU or whatever.  Private rooms are not a standard thing like they are here.
  • If you need some kind of treatment for something that’s not life-threatening, you’ll likely have to wait.  A long time.  Here’s a random example of an article on patients waiting 9 months or more to get shots for macular degeneration.  I didn’t KNOW that people had to wait a long time for that treatment, but I guessed they did.  My dad has macular degeneration, and it’s terribly time-critical to get treated.
  • When my American grandma got cataracts, she made an appointment and got them removed.  When my Irish great-aunt got cataracts, she got put on a waiting list, and a year later, she got them removed.
  • In Ireland, people unsatisfied with public health care pay for private health insurance.  15% of health care expenditures came from private insurance, and 40% of Irish people have some type of private insurance.  My aunt found a lump in her breast.  She was unsatisfied with the care she was getting from the public healthcare system, so she sought private treatment and surgery to have it removed.
  • Healthcare is like an HMO.  I’ve enjoyed being on a PPO for over a decade.  As a kid, my parents had an HMO which was super annoying because you couldn’t just go see a doctor if you had a problem.  You needed a referral.  Not a huge deal, but public healthcare tends to follow the HMO model – your GP is a gatekeeper.
  • Education requirements are WAY less to qualify as a doctor in other countries outside the US.  It takes five years to qualify as a doctor in Ireland.  In five to six years, you can qualify as a surgeon or specialist.  That’s out of high school, folks.  I actually think this is a good thing, but unless the model is changed, doctors here are going to expect to be paid more.
  • GPs in Ireland make $77,000 a year.  GPs in the US average between $140,000 and $190,000 a year, depending on the source.  And we have trouble finding enough GPs even at that salary level.
  • As far as I can tell, Medicare is great in the US.  But the rest of us are subsidizing it heavily.  Not only that, I’d assert that the US subsidizes healthcare around the world through paying through the nose for pharmaceuticals and advanced operations and equipment not available elsewhere.  New treatments are debuted in the US, and after they’ve been shown to work well, they move to the rest of the world.  A random example of British kids trying to get to the US for cutting edge cancer treatment.  Cancer treatment is very effective in Europe, but many of those effective treatments were developed and paid for here.
  • Despite the fact that a full 12% of Americans are uninsured, cancer survival rates are comparable between the US and Europe.  12% of Americans don’t even have healthcare, but survival rates are the same.  Why?  Shouldn’t they be much higher in Europe?  (It varies with type of cancer; for some types, survival rates are higher in the US, others higher in Europe, but comes out roughly even overall.)

I honestly believe healthcare will not be any cheaper whatsoever if we go to governement-run healthcare in the US.  I suspect that globally, the rate of advancements in healthcare will declines.  I would LOVE to see the US stop subsidizing drugs for the rest of the world, and perhaps government run healthcare would enable that.  I do believe it’s a moral obligation of this country to provide healthcare to all its citizens.  I’m not sure Medicare for all is the way to do that.  Maybe it is.  If Medicare for all IS the right answer, I definitely would be in favor of a gradual expansion – gradually reduce the eligibility age and add in children at the same time.  So, year one, move eligibility to age 55 and also make all children under 1 eligible.  People could still retain private insurance if they wished, but I imagine many or most wouldn’t.  Private insurance would experience a slow decline over the next 30 years while it adapted to a role more similar to that which it plays in Europe.

 

politics

Obama has come out with some positive proposals lately.  When I read that he was pushing for free community college I was super excited.  For about five seconds.  Then I realized it has zero zilch nada chance of passing congress and that it was political grandstanding on his part.  I think it’s a fantastic proposal and well worth spending money on – and I’d be willing to pay higher taxes to support it.  I could go on about why it’s a great idea, even if it’s pricey, but it’s pointless.  It’s not going to happen, at least not during Obama’s presidency.  Seriously the best thing about Georgia is the Hope scholarship.  I’m not sure what it’s status is today, but fifteen years ago, it was an amazing thing.

Then, today I read he’s pushing for six weeks paid maternity leave for federal workers.  On the one hand, this would be a great thing.  Are there federal workers out there not currently getting paid maternity leave?  My NASA counterparts get six weeks, don’t you, even without sick leave?  So, I’m a little confused.  Second, what about the rest of the country, all the non-federal workers who actually need the leave?  If this was really important to Obama he would have brought it up sooner.

On the bright side, I read that the percent of families suffering major financial insecurity due to medical costs dropped five percentage points in 2014 (from 2013, I think.)   I think it’s safe to say that Obamacare gets the credit.  That is a plus.  I just hope the Republicans don’t dismantle Obamacare.  While it’s obviously not a great system, I have yet to hear any counterproposals.  My first would be, how about the US stops funding the pharma companies all on its own and the rather smug Europeans and Canadians get to start pulling their weight?

I read in the NYT the other day that people with health insurance use the emergency room more than those who are uninsured.  Remember when we were going to save money by insuring more people because they’d stop using the ER?  In retrospect, that POV was rather insulting to the uninsured.

Harvard health costs

Cry me a river.  Don’t get me a wrong.  Employees should always advocate for themselves, and I don’t blame Harvard employees for doing so.  However, anyone who works in the private sector will have little or no sympathy for Harvard professors being forced to pay $20 co-pays and have a $250 deductible.

My benefits cost has gone up, and my actual benefits have gone down year after year.  This is at least in part due to Obamacare provisions that, in some cases thankfully, don’t benefit me – 1 million lifetime max being made illegal, healthcare for kids 21 to 26, and no longer being allowed to deny people with pre-existing conditions.  I don’t oppose any of these provisions, but you don’t get anything for nothin’.  If you factor in healthcare, while I got raises, some years, the healthcare cost negated that raise completely.  However, it’s hard to call it a paycut, because Blue had to shell out a lot of extra money as well to cover the 80%/50% (individual/family) share of the premiums.

Five years ago, I had excellent health coverage.  Now I’d describe my health care coverage as OK.  Thankfully, no one has had a serious illness to really test it.  It’s certainly not cheap on Cobra.

legalizing pot

These days I have no stomach for reading about sick kids.  It’s not like I ever enjoyed it, but lately, I can’t help but replace the child with L in my mind.  I’m no big proponent of marijuana legalization.  It annoys me when my neighbors smoke pot or when people smoke pot at parties, or pretty much any time when I’m around.  However, I have never understood why medical marijuana should be illegal.  I think a doctor should be able to prescribe whatever a patient needs to make them better, and marijuana should certainly be an option.  I’ve read two stories recently about young children whose lives appeared to be massively improved by marijuana.  In the first case, the child was taking these unbelievably powerful drugs which were basically killing her – and were still not doing a great job stopping the seizures.  But her doctors were hesitant to recommend marijuana, something so benign by comparison.  The second is the headline on CNN today.   This child said  “mama” for the first time after marijuana finally mitigated her seizures after everything else had failed.  Among other things, it’s so inexpensive compared to some of the drugs around.  It just breaks my heart reading about these poor kids.  Thank God they’ve finally found something to help.

We moved yesterday.  I had more contractions yesterday  than I’ve had the entire rest of my pregnancy combined, but we got through it.  Now our house is complete chaos.  I had breakfast in a mixing bowl with a baby spoon and B’s cereal.  Hopefully we’ll be able to get a little bit organized tonight.