COVID-19 Update: Forecasting and Our Response

So it's real good to be with everybody again today. I'd like to do another update and there's some good news out there. So I'd like to go over some good statistics, some good news, as well as discuss briefly epidemiology, which is literally the study of epidemics. There's a lot of numbers being thrown around, so I want to walk through what some of that means because there's been a lot of deviation variations and changes. And so I want everybody to kind of appreciate a little better with all this, this means and then the point of a lot of these things we're talking about. So some of you all are familiar with Dr. Fauci, who's probably the country's top epidemiologist. Again, epidemiology is the study of epidemics. One of the things they're doing lots of is disease modeling. Now, some of you all remember back to the HIV days, people look at hiv, we actually have to predict out what was going to happen in the next one to three to five years. One of the results of that was the mobilization of our country to actually find treatment for hiv. That's one of the things we do that these models are supposed to do. They're supposed to inform us for decisions. And so one of the questions is, when we get this information, we get this modeling, what does it actually do? Does it help us make good decisions? You got to keep things in perspective, and perspective is absolutely huge. So one perspective is that the WHO, the World Health Organization back in January 14 said that some preliminary investigations showed no clear evidence that there was any human to human transmission from the COVID 19 virus identified in Wuhan. So why do I mention that? Well, because there's been a big change since then. By mid March, we literally had a worldwide state of alarm and there's a lot of changes. And so you have to understand what is kind of going on to appreciate that, you know, one month something that isn't transmitted between humans three months later is a worldwide epidemic. And that's where just interpreting the data kind of meal and wrap your brain around it and having people help you understand it is important data. Without understanding what it means, all it is is static many times. So good news, there's an article published from England the other day, and this will be actually put below in the video where this is posted, talking about there's between 7 and 43 million individuals in Italy that have been infected. So that puts the infection rate between 1.88% and 11.43% of the population in Italy. Now, if those of you who've been following us know that we talked about a little study that was published two weeks ago and Vaux in a city in Italy, northern Italy, is showing about 2.4% infection rate. You also probably recall another study three weeks ago looking at a plane coming from Wuhan to the United States showing a similar infection rate. So the actual, the higher the infection rate, the better, the more people that are actually infected now without people dying means actually we're better off. If the infection rate is 11.3%, then the mortality rate is actually 0.6 to 0.3%. It's much, much less. Now one of the good news is, one of the good things about this information is that the mortality rate in Italy has actually dropped. Some of you all remember it was close in the teens. At one point in time that was 8%. With this data, it shows the mortality in Italy being about 1.8% of the entire population now. So that's still a significant number. Looking at flu being 0.1%, looking at the Spanish influenza of 1918 being 18, I'm sorry, being 1.0.1%. But the point is this is, this is literally almost a six to seven fold lowering of some of the original projections. What does that mean? That's a good thing. But again, this is still all preliminary. I think the point is, and if you look at the, the higher number of 11.43%, use that number, that shows the, the death rate of this being 0.2% Italy. So either this is a little worse than the common flu or it's still pretty, pretty serious, but not as bad as we originally thought. So that's all good information. This is a moving target. One thing I want to let people know is the people that are true experts in this will commonly say, I don't know, I don't know. We don't know yet. We still need more information. And Those you follow, Dr. Fauci and following his update, his daily updates, you hear that a lot. And anybody who's really and the no Is going to say that more often than you'd like them to say that. Because we've only known about this entity for this was entity was unnamed literally four months ago. So now everybody's a COVID 19 expert, including myself, of course. Right. So some of the projections from this article as well, they're expecting the peak in the UK to be April 12, which is not that far off. The peak disease in New York City is now. And this is from Stuff Coming from, actually Bloomberg up in New York, that their peak, they're expecting about April 14th, around Easter time. So. And the peak in the United States being the end of April. So what that means is we have two to four more weeks in the United States before we see our peak here. And the hope is that we'll see it flattening out. We're already seeing it flattening out in certain parts of the country. We're already starting to see it flatten out in Italy. So we're already seeing signs that what we're doing is actually slowing the progression. But one thing to keep in mind, even if we use that 1.8% number in the United States, that is still 500,000 plus people that can die from this when they get it, realizing 80% of population is ultimately going to get this at some point in time, if not now, in the fall, we do a second. We have a second wave, if not in the fall, next year, as the coronavirus becomes instituted in our usual seasonal things, which is what typically happens. So. But my question is, what is our plan? I mean, data without a plane is just data. It just creates hysteria. If we come out of social distancing in the next month, which we can't do this indefinitely, will we have enough PPE to prevent a second peak early? That's gonna be one of the big things. Even in Los Angeles, they're now talking about doing everybody wearing masks. You know, that's what they typically do in Japan and South Korea during usual flu seasons since the SARS outbreak in 2000, three times 2004. South Korea has always been kind of on the cutting edge of these kind of things. If this doesn't die out this summer, what's our plan? These are all things we need to think about. No one really knows for sure, but we need to start talking about them, asking our local leaders, because ultimately the national leaders are only making recommendations. Most of this is happening at the state and local governance levels. Like in Virginia, where I live, Governor Northam is making most of the calls for the state of Virginia. That's how we can be involved, by being educated and then talking with our leaders and saying, what's your plan? Because we can't just shut everybody up for three months. That's not feasible. Are we going to get personal protection equipment? Are the most susceptible individuals, the elderly, going to stay in while the those who are healthy go back out? We don't know. We don't know. We don't. We just don't know. So face masks. There's been a controversy. And this is I'm going to do after this. I'm going to do a question section. Another video today. But face masks have been a big controversy. Initially, the CDC said, hey, don't wear them, they don't work. Then it's like, well, you know, only healthcare professionals like myself can get them. Regular people can't get them. Now in la, they're recommending wearing face masks. Governor Bloomberg is like, hey, maybe people should wear handkerchiefs. The big gist is this. Aerosolized particles can stay in the air for about three hours. And so a surgical mask is the best way to get those out. Water droplets which fall there really quickly can be mostly caught with a handkerchief or some material in front of your face. And then there's everything in between. Something is better than nothing. In the emergency rooms, when patients come in, if there's not PPE available, the patient and the physician is wearing a surgical mask, which is the lesser N95 being the better. If the point of the N95 for the patient is to prevent them from spreading, the point of the practitioner having the N95 mask is to keep them from getting and spreading. I don't know the controversy at this stage. I think the big controversy is just, we don't have them. If you get one, keep it. These things last for weeks. I've been using the same one for the last two weeks because we don't have a whole lot of them. You don't need a new one every day and hopefully these will be available soon. So other things to think about. Currently, the thinking is we'll have a vaccine in 12 to 18 months. This is a very optimistic thinking. We probably won't have one by early winter, but it is possible. There's a recent study I'll be talking about a little later from Pittsburgh showing a novel manner of vaccination that actually might be available come fall. But point is, we have institutions, organizations working on a vaccine. If we get one by the fall, that'll be actually very, very quick. I'm not expecting it, but again, who knows? I'm hoping that it will happen. And then the next question is, will this actually effectively save lives? Is what we're doing with social distancing? If our numbers are 250 to 500,000 people are going to die from this. Are we actually saving people or are we just putting off the deaths till the fall? These are all questions that I have not seen any predictive models by the epidemiologists. Look out past August and that's another thing to keep in mind. No one's saying, hey, we expect this in the fall. That's my question as a physician. Usually these things come back around the fall peak again starting from November through March to May timeframe. What are we really expecting? Great questions. So what I'm doing right now is encouraging my patients to take charge of their own health for now. What does that mean? It means initially social distancing, which we're all doing self quarantine for those who have the disease and then self care. You know, one of the ways I'm going to I'm helping patients with self care is educating them when they're in the office doing these videos. I'm actually in the process of putting out what I'm calling the COVID 19 Survival Manual, which is going to be hopefully full of a lot of good information that won't change. One of the things that's happening is information is changing quickly. I'm going to be putting in that hopefully information like face mask, hand washing, nutritional things, things to boost your immune system, things have been time tested and things that have a fair amount of data that won't be changing so that this resource will be good come fall time as well. At the bottom of this there'll be some other additional links and information. Please feel to continue to follow us if this information has been useful to you. Give us five stars. Like us, follow us. That just helps this information to become more available to other people. So if you really feel this is useful, the best thing you can do is like us and share it. That way other people can have access to information as well. Continue to leave comments. That's one of the ways we're communicating now with people is the comments that lets us know what your questions are so we can answer them. Which is what I'll be doing in the next video is answering some questions that we've been getting the comments on the social media. Hope you all have a great day. Stay safe. I'm going off to the office here in a few minutes to see patients. I'm working this weekend and my goal is to keep people out of the hospital and the ones I see who are sick to give them the appropriate treatment, including some of the newer things like azithromycin which I'll be, and hydroxychloroquine which I'll be talking about answering some questions in the next video. Take care.