COVID-19 A Second Wave? [Part 2 of 2]

Aaron Hartman, MD reviews COVID-19 case and death trends across the US in early July 2020. Deaths stayed flat while cases rose in some states, and he explains why: better clinical care, lower fatality rates among intubated patients, and dexamethasone use.
Chapters
So this is part two of our series on the new numbers with COVID 19 and what we're seeing in the United States. This data is from the Worldometer. Again a great place to go. The link will be provided. One of the parts reasons for doing things the way I do them is to educate people so that people can make their own decisions about this data and help interpret on their own. So let's walk through it together. You help me interpret this data and I'll help you kind of understand it. And I think that's a good way of looking at things because what I'm seeing right now in the main social media and other news forums is that a certain degree of misrepresentation of the data points. This is a little different than the CDC website. CDC website gives more trends. They run about a week to two behind because again, you're collecting data from an entire country, you can't really get it to that quickly. It's unrealistic. This actually gets things in a little quicker reports from day to day. One thing to remember is when you. The analogy I like to think about is investing in the stock market. I'm not going to change my investing patterns, my investing strategy based on one or two bad days, even a bad week. I'm looking at the trends. What do the trends tell me? The trends tell me things are bad. Then maybe I should change my strategy. So we have to look at trends, not just data points. So let's look at the new cases in the United States. And so we do see is across the country it's been pretty, pretty, you know, pretty flat. Less than 40,000 new cases given time. If you look at April 24, for example, they had 39,000 cases that day. But as we get to the week of June 27, we are seeing an uptick from about 38,000 to as high as 57,000 cases on July 2. So we are seeing an uptick in cases. Okay, so interesting. So and this is active cases in the United States. It was pretty flat. Is going up. We're not, not. That's not a huge spike though. Looking at this right here. This is not a massive spike. This is a gentle incline. Total deaths. That number is always going to go up because it's just additive of the entire thing. I think this is the next graph I think that's helpful which is daily deaths. This is the most important thing, you know, not how many people get this, but how many people get it and die. And what we see is that number actually has been going down the Entire time again, we've talked about, you know, if you got intubated with this, initially the chance of dying from it was about 80%. Now it's 30%. We've learned to manage it differently. We've learned to manage ventilators differently. We use different medications. We have remedic now, now we have dexamethasone. We learned a lot in the last six months. And that was one of the reasons why we did everything we did to flatten the curve and learn new treatment techniques. And we, and what we see is we see, you know, total daily deaths is not really changing a whole lot. One thing that you have to realize as well, you have these little dips and troughs here that you can see ups and downs. A lot of this is just a reporting phenomena. Over the weekend. Cases aren't as reported quite as much. The following Monday and Tuesday are. So you tend to see after every week you tend to see like a spike. But again, the overall trend is pretty flat. And that's for the United States. And I think that was probably the, the big graphic. I want to talk to you about that. So let's kind of get a little more granular because we live in the United States. But what state do you live in? Well, I live in Virginia. Virginia has been relatively unexciting. I know there's been areas that have had a lot of disease. There's a place in town in Richmond that was actually the most hard hit long term care facility in the country. But overall we've been relatively stable and places that have been stable. We had a fair number of cases. You know, we didn't quite hit the thousand daily cases, but a decent number. No big peak, but it's been pretty steady in Virginia for cases. And if you look at the actual daily deaths, you know, it's been some peaks and troughs, but no major change. The thing about Virginia is it wasn't super slow here. It wasn't super fast. It's been just kind of a steady, a steady trick, I shouldn't say trickle, but a steady, steady pace. Now let's go to the place everybody likes to talk about, which is New York City. They got hit hard. Now look at, you have to look at the novel coronaviruses daily. And we're not looking at thousands, we're looking at tens of thousands. New York is a big state, one of the top three states in the country. And they got hit hard on the front end. And this is a trend that I've noticed in the data. The states that Were hit hard in the front end, on the back end aren't being hit that hard now. They had a lot of cases and it's trickled off, which is what you'd expect of 25% of population in New York City. Plus has already gotten this. That's 25 plus percent. The people that aren't going to get it again, or if they do, it's going to be much milder because they've already been. It's no longer novel to them. And so you're not going to see a big tick. And so New York is not seeing a big tick in cases. And that's what we're hearing. If you look at daily deaths, which I think is another big number again, a lot in New York, and we all already know this story, I'm not going to reiterate it. And we can see how basically it's trailed off, it's not spiking again. So New York has kept things under wraps and done a good job with that. Let's look at California now. The one thing you have to remember about California is that California never got crazy. In California, it was pretty steady as well. Then the front end of things. People expecting a lot of people to get sick. It didn't happen. What's happening now? We're seeing the cases peak later. Why? Because it didn't peak on the front end. They shut down quickly. It didn't spread around. People didn't get it. So once we started opening up, we expect cases to start going up, which is what's happening in New York. Not a beeline, not a super big spike, A gentle, gentle curve. And we'd expect that to happen in any state that didn't have a big peak on the front end like New York. Bigger question again with California's deaths. It's really interesting. Even though they didn't have a big peak, the deaths have been pretty stable. That is actually quite interesting. New York, the cases were lower, but the relative amounts of deaths were a little higher. Now the cases are going up. The deaths have been unchanged. A lot of that relates to the populations getting disease. Older versus younger, Hispanic, non Hispanic, black, Asian. States have different mixtures of people groups. Every state in the United States is unique and so is California. And so this probably represents partly that and partly it's more outdoors, partly. California is a long state that goes up a lot, while New York is more compact. A lot of things. We haven't even quite figured it out yet. But the point is California's not going crazy. So let's go to Texas. Okay? Texas is another state on the front end of things. They were not crazy, they weren't as intrusive with their shutdown laws. You saw slow trickled cases. Well now you're seeing a peak in cases. Okay, fair enough. How about deaths? How are those numbers going and what we're seeing? Texas, same phenomena. Look at this. The deaths on the front end, it's relatively steady. When there are less cases, the cases are peaking. The death rates not really going up as well. For 100% disclosure, you have about a 19 day lag in death. It takes about that long for someone from infection to death. So you really can't really expect it to know where the trend is going for another two to three weeks. But now we can't really report on the future. We can only report on what we see. And what we see now is that the deaths are not going up. That's one of the things I've seen a lot with a lot of these speculations with what's going to happen. You know, case fatality rate, oh my gosh, 2.5 million people will die. No, it's gonna be 3 million. It's gonna be a million. You know, all these estimates have been gross over estimates so I'm a little hesitant to repeat the errors of the past all over again. I'm just looking at the data and the data says daily new deaths in Texas is not, not impressive. Florida, okay, Florida, another very populated state. If you all remember again, the front end of things, Florida did much better than New York. Closing down nursing homes, preventing the older people from getting this, which is one of the keys to how they kept this from spreading and kept the deaths low in the front end. Even though they're very populous now, the oldest population in the state, you didn't really see that big tick in the front end, but we're seeing it now in the back end. And that's again, we're all going to get 60 to 70% of the population has to get this. We're all going to get it. It doesn't all doing, all we're doing does is slow that process. If a goal is to wait for a vaccine which is a year to a year and a half from now, then that's a different perspective. But if the goal is just to slow the spread so it maintains controllability so that we can create new therapeutics, then that's a very reasonable way to do things. Okay? And then looking at daily new deaths in Florida, again, this has been pretty flat, you know, similar type store. In the front end you saw people getting it not dying. In the back end we see people getting it more but the same the death rates not changing a whole lot. So last but not least, I want to hit Arizona real quick. There's a place where similar trends, the front end flow again getting a little higher. But I do want to point it out with Arizona. We do see that the deaths are starting to pick up on the back end. I think this is where some of the data is coming from is the state of Arizona. Now, you know, I've looked at some of these charts trying to figure out where the data is coming from that's being pushed out there right now. I'm not 100% sure where it's coming from, but the point is that you gotta look at where you live the data from where you're at and then, and then give an appropriate estimation of that and not guesstimate what's going on. So anyway, hopefully that was helpful. I'll continue to put this information out there as I'm available. Please look the data yourself, find reliable sources you can use to figure things out and trust those. Don't exaggerate things, just find good data and stick with it. If this has been helpful, please share with your family and friends. We'll continue to put information out there on different social media platforms as well as videos and everybody take care and be safe.
More from Aaron

Too Many Gut Fixes Can Undo Your Healing. What Helps It Last | Dr. Sabine Hazan

Women’s Heart Attack Symptoms Differ From Men’s 95% of the Time — Only 30% Have Chest Pain #shorts

Heart Disease Kills More Women Than All Cancers Combined — 80% of Cardiac Research Is on Men #shorts

Women’s Physiology Was Systematically Ignored in Drug Research — The Consequences Are Still #shorts

It Took the FDA 20 Years to Realize Women Need Half the Dose of Ambien #shorts

Until 1993, Women Were Banned From Clinical Drug Trials — Then Those Drugs Were Prescribed t #shorts




