COVID-19 Update 03.23.2020

It's good to see everybody again. I was not planning on doing any updates today. Was going to wait till Tuesday or Wednesday just because not a lot has changed. The major things going on right now in regards to governments and politics. A lot of the stuff we see cycling is the old news being recycled, whether it's the hydroxychloroquine, all that kind of story numbers as well. But due to the, the uptick in cases in the United States, which we predicted several weeks ago, that we're seeing right now, and some of the concerns I'm getting from patients as well as from social media, a lot of it's actually from some of my wife's friends. I just want to go over the fatality, the symptom rates and the fatality rates just to remind us what's going on. This data actually comes from a journal in JAMA that was published a day or two ago, and it's mainly based on the Italian data. So. So just to put things in perspective, according to this study, the case fatality rate was about 7.2%. So that is a fairly bad number. So as I reverse things and reverse engineer things, I want you to take that into account that we're expecting our numbers here to be better. So what do they see in Italy on the most recent publication? Well, first of all, we see that about 59% of the patients are males versus 40% of females. So it's a male predominant disease so far, males more common than females. Of all the cases between 0 and 18 years of age, only 1.2% of the cases were in that age range. So I'm seeing a lot of patients, a lot of moms worried about their young children. Only about 1.2% of all cases were in that age range. 19 to 50 represented about 24% of cases. 50 to 51 was about 37% of cases. And over 70%, 70 years old was 37% of cases. So basically 67% or 2/3 of all cases were over 50. So this is predominantly hitting older individuals. But that's also to keep that in perspective. The importance of closing schools, closing social gatherings is to minimize kids, teenagers, young adults exposure because they ultimately expose older adults and grandparents. Of these, about 6.7% had no case, no symptoms whatsoever. So 6.7% of people won't have symptoms. They won't have cough, fever, chills. They'll just spread it for a while and they'll get better. That also includes your asymptomatic spreaders and your super spreaders. If you're all familiar with some of that information, about 10.6% of patients will have unspecific symptoms. It might be stomach ache, a little nausea, little diarrhea, but it won't be specific. For the COVID 19 infection, 6.6% will have just a fever, 46% will have mild symptoms. Means they won't come see me in my office. They definitely won't go to the emergency department. 25% will be severe. What that means is about a quarter of people that get infected will need some kind of medical intervention, and about 5% will be critical. Typically means being admitted to the ICU. So these numbers correlate with what we've been talking about the last two, three weeks, where 80% to 85% of people get infected, pretty much will be managed as an outpatient basis. Maybe 10 to 15% of people will need some kind of medical care admission to the hospital. And about 5% will be critical. And within that 5%, that's where your death rate comes from. So this is consistent with what we've been expecting. And this is again from Italy. And to keep things in perspective, Italy so far has been the most severely hit country. So we're using that as far as our. This is kind of as bad as it gets kind of scenario. So only about 5% of people that get infected will need intensive care admission. So as far as case fatalities, and this is what people are getting excited about, this is what people want to know about. This is Italian data. Again. Okay, as far as those that were less than 29 years of age, there were no. The case fatality rate was 0%. I know there's been a couple of cases of younger people getting this kids, but in the Italian literature, there are no. The case fatality of less than 29 was zero between 30 and 30. Between 30 and 39, it was 0.3%. And between 40 and 49 was 0.4%. I actually found that range between 46 turning 47. So 0.4%. Between 50 and 59 was 1%. Okay, 60 to 69, 3.5%. And this is where the numbers start escalating. Between 70 and 79 was 12.5%, 80 to 89 was right at 20% and 90 to 99 was 27%. So if you look at the fatality those, it starts to escalate over 60. Again, these are the numbers we come expected. The key though is in the young people. It's if you're less than 20, if you're less than 30, basically 0% case fatality, 30 to 50 ish, 0.3 to 0.4. And some of the literature, some of the stuff in the American, we've seen on the American side so far, it's been looking at a 0.2% for my age range. Again, a little better than this. But the point is that in the young, healthy individuals, we're not seeing high fatality, we're not seeing high hospitalization numbers. The reason we're stressing this so much is that we don't want this to be the older population to get exposed. Typically those are over 60. If you're over 65, it goes up over 80, 85. Initially we were thinking 15% mortality. This shows 80 to 89 being 19.8%. And that gives you a total case fatality of 7.2%. That's a brief summary of an article published in the last day or two from Lancet. The reason I want to go over these numbers is just because, you know, my wife was actually in Orlando at Universal Studios and Disney, I don't know, about three or four weeks ago. And for those of you who are familiar with the case where a individual was in his 30s, was there about the same time my wife, actually young male, got COVID 19 and ended up dying. Well, he was young, but he also had a history of testicular cancer. And this is in the news media as well as some other comorbidities. So wasn't your quote unquote, healthy young individual? This COVID 19 is doing the typical thing we expect a virus like this to do. It's getting susceptible. They're really old. The people with multiple health issues, hypertension, diabetes, appear to be specifically susceptible. Things to think about, alcohol consumption. If you drink a lot, I would include vaping in there. We just learned probably in the last six months, a year how bad vaping is smoking. But the point is that this is not the young healthy. This is not killing those patients. The relatively young. I say relatively young. I would consider myself relatively young. Less than 50, it's more. The over 60 population is being hit hard. And so why this is important is in light of maybe spring break last week we had a lot of young people spreading coronavirus around in Miami beach and other spring break destinations to go back and hopefully not. But they may end up affecting their parents and grandparents. This is really important for younger people to take seriously that they will get sick and better, but who will they spread it to? They probably have friends with illnesses. I see a lot of young patients with cancers Particularly young females with thyroid cancer, breast cancer, any childhood illnesses, type 1 diabetes, even pre diabetics. About up to a quarter of kids now thought to be pre diabetic or diabetic. So that's where just being careful. If you're, if you're healthy and young, the reason you want to stay, stay away from large groups is you're protecting everybody else. And that's where we need to kind of, you know, think globally, think about our fellow fellow members in our culture, our country. But the young people are going to get better kids. Moms and young kids will get better. Moms and dads with kids will get better. It's the people that are susceptible. And you have no idea who those people are. You have no idea who the young leukemia, a lymphoma patient who survived, who's in their 20s and 30s, you have no idea who the 40 or 45 year old mom who had breast cancer treated successfully. You just have no idea who these people are. So the reason right now we're quarantined, the reason right now we're doing social distancing. And this is based on the most recent literature from Italy. Again, looking at our numbers from America, it looks like our numbers are going to be significantly better than the Italian numbers. We just don't have the data. So, so also the reason for quoting these numbers again is just even though the Italian data has a case fatality of 7.2%, it's almost exclusively in the older, over 60 groups. So again, a lot of younger patients, yes, stay at home, yes, stay social, isolated. But you don't need to be fearful. You're doing this mainly for your parents and grandparents. You're doing it for your friends that have health conditions that you don't know have health conditions or, or the ones who have health conditions. You know, who has a friend who's had cancer, an uncle and aunt who's had cancer, or someone with diabetes in the family, someone with heart disease, or who has anybody who's older in their family. That's the reason we're doing this right now. And we need to be more altruistic and just think about those people. I know a lot of younger, younger individuals or even, you know, my wife has a lot of friends on social media, people getting stir crazy and it's been a week. The reason we're doing that is for everybody else. The reason 80% to 85% of people are doing this is for everybody else. And that's what being American is about. That's what being a human is about. That's what being in a community is. You do things for others, you do things altruistically. And so my hope is that knowing the data, people won't be quite as nervous about it. But at the same time, we realize we're doing this for other people. So just pull away. Don't go to the pubs and bars. Those are interesting to see over in England, some of the pubs and bars are still filled. It looks like England's going to probably just put mandate, close everything down. And it'd be kind of sad to get to the place where our governments have to act because we can't act for ourselves, because we can't do the responsible stuff. A lot of people are saying the governments are overreacting. And partly my take on things is people aren't taking things seriously enough. We do have a 1.4% mortality rate currently in the United States. That's still worse than the Spanish influenza. That's still a big deal. We need to take it more seriously. Hopefully in the next week or two we'll have better data. We should see more data coming back next week in the United States. Expect our incidents to skyrocket. We should not expect the case fatality to skyrocket. That's what we're looking for is just to see how many people who get it and die and how much that increases. I'll be updating everybody as that comes out, but just stay safe and be alert. But wear your mask when you go out in public. Wear your gloves when you go out in public. I was out this past weekend against my wife's better judgment, but I had to get some things and I was the only person with gloves and a mask and no one else had it. I felt kind of weird, but it was just we need to be more aware about our surroundings, environment and take it more seriously. Again, the numbers, just for recap, 60% male, 40% female. Of the cases, the vast majority are over 50, 37%, 37% over 70. If you're less than 50, that's about 25%. Those between 0 and 18 or 1.2%. You know, there's spring breakers that went around this past weekend are going to be spreading a lot of coronavirus. Unfortunately, 6.7% have no symptoms, 10% have unspecified symptoms. If you look at fever and mild, about 60, 70% of people will have mild symptoms and won't even really know about it. About a quarter will be severe and 5% will go into ICU. And among those will be also be the Fatalities. And then again, the numbers, if you're less than 50, about a 0.3 to 0.4% case fatality. If you're less than 30, zero. This is again from Italian literature. It's when you get to be up 60 and it skyrockets over 90. So again, we need to be aware of the information data. We need to make wise decisions being formed, be empowered, not be fearful, but be wise. The purpose of getting information, the purpose of learning stuff, the purpose of doing your Google searches and your media searches is to be wise to gain information, to make good judgment, not to drive fear, because fear creates torment. Fear also makes you make bad decisions. And so we just need to be aware of these things so we can make good decisions for ourselves, our family and for all the other people we're going to run into. Other people's grandparents, other people's loved ones who've survived cancer, who've survived serious illness. We need to do it for all those people. So have a great night. We'll do some more updates in the next few days as things change. Again, most of the updates are political in nature and these numbers are just a reiteration of numbers from a week or two ago. They're just now published from Italian literature and they're not really out of sync with anything we've talked about so far. So I just want to remind us of the numbers so we can be comfortable, rest, relax as best we can. But realize we're doing this mainly for everybody else. Unless you're like my parents who are in their 80s. I told them about two weeks ago to not go out and hope you've done the same with your parents. So take care, be safe, and have a great night's rest.