COVID-19 Update: Reintroducing to Society and the New Normality (Pt. 2)

Alright, so now we thought about knowledge and wisdom and how we use that. Okay, what's the next step? What was the whole point of this lockdown? Okay, the first thing was to flatten the curve. But what we've seen is the curve has not just been flattened, it's been broadened. So if you think about the area under a curve, that is how many people are going to get this disease? That number has not changed. We still need 70 to 80% of our population to get this illness, to get herd immunity. That number has not changed. But instead of those people getting disease in six to eight weeks, we're spreading it out. All the current data is going to August 4th. What after August 4th? What about September 4th? What about November 4th? Do we have enough data to go forward? We have successfully flattened the curve that was gold one. But did we get the curve we expected to get? These are always the questions we ask. Question two was, did we get hospitals ready? And the answer is yes. A lot of systems were stressed. Here in Richmond, our system is being currently stressed. We're at the peak this upcoming week. But the reality is, to date, as far as what I've been reading, there's not been anybody die for a lack of a ventilator. That was a big thing. And with the hospital capacity, one thing as a physician, I see all, every year, every flu season, the ERs get overwhelmed, there are people in stretchers, people waiting for hours and there's not enough beds. That happens every flu season. But the point is, we did not overwhelm our hospital systems to what happened in Italy, where we're having to pick and choose who lives and who dies. So that point two was successful, point three was we needed more data. We needed to get accurate data we could work off of. We need to learn more data. So the question is, do we have enough data to move forward? How much data is enough and are we ready to move forward? We don't want to act too soon on this, but we don't want to wait too late. Do we have to wait a year to get enough data? Two years? The reality is if we're waiting for a vaccine, it's going to be too late. The vaccine will, will be ready in 12 months to 18 months and it'll take another six months to get the vaccine to 300 million arms. So let's quickly talk about the testing itself, because we're relying on tests that I don't think are as accurate as we think they are. So the PCR test, which is what most people are familiar with, that's the nasal swab or the throat swab. If you get someone on day one to three of illness, it's over 90% accurate, which is a really, really good test. However, if it's day six of illness, it's less than 80% sensitive. And after day 14, it's less than 50%. So this explains all the inconsistencies we heard about people getting it, not getting it, recurrent, because the testing itself, the accuracy depends on when you do the test. It also depends on how you do the test. If you do what's called a bronchiovolar lavage, you put fluid down someone's nose and, and suck fluid out of their lungs, that test is about 95% sensitive. If you get sputum from someone coughing, it's about 72. But, you know, mouth swabs are about 32% sensitive. So this explains a lot of these inconsistencies. And also, you have to look at the how we're getting the data. You know, the CDC criteria was basically, you have to be sick enough to be in the hospital, then you have to be sick enough and travel to places. And so we're missing all these people who weren't that sick. And some of the newer literature is like, hey, maybe half of people have no symptoms whatsoever. So the testing was useful. But is it good enough to base how we live our lives on? Maybe that's a question ask, is it good enough to determine that? And maybe, maybe not. The problem is that if you have no symptoms, the testing is not going to be deployed. And that's major issue. So here comes antibody testing. Antibody testing will be the savior. Antibody testing will answer our questions. Maybe, maybe not. Antibody testing is about 87% sensitive, which means if the test is positive, you have an 87% chance of having disease. It's 93% specific, which means if it's negative, you have a 93% chance of not having disease. So but with these tests, you have to say, how does this apply to 330 million people? And if the test is 87% sensitive, it means you miss 30 million people who actually have disease. And it's 93% specific. It means you miss 14 million people who don't have disease. So can we decide national policy based on the current testing we have right now? Are we even talking about this? You know, we're going to miss cases. And that's the problem, is no matter what testing you use, you're going to miss cases. So the next two questions I have to ask are which cases can we afford not afford to miss? Like my parents, they're in their 80s right now. Can we afford to miss them? No. My wife's parents, can we afford to miss them? No. Which ones it's okay to miss? You know, it's probably okay to miss me, my family, my kids, because we're fairly healthy. Those are the people who aren't getting ravaged by this disease. How do we now take this knowledge we've gotten and with wisdom apply it? At what point in time can we pull the switch? Can we pull the lever and lever and make decisions? At what point in time can we start using our common sense? Okay, I've been thinking about this for a long time and I've been holding off on these thoughts because me, like everybody else, have been waiting for more data this past week. I believe it got the data I was looking for. So first, JAMA had an interesting article, and all these articles will actually be attached below wherever this attachment is possible. And they looked at 215 pregnant women in New York admitted to delivery. So these were women with no symptoms going to hospital, ready to have babies. 1.9% had a fever on presentation and they tested positive. Great. But 211 had no symptoms whatsoever. So that means that 13.7% of all the women delivering babies in New York at this point, local hospital had infection and 87% had no symptoms. The implications of this are massive. So that means for New York City, for a city of 8.4 million people, that maybe a case with about 10% of the population having this. You know, I'm rounding down based on this data that say 13.7% of the population or pregnant women in New York already have it. That puts the case fatality down about 1.4%. Again, this is much, much, much lower. This is down the realm of Spanish influenza. Okay, which still bad. But not the 8%, not the 5%, et cetera, et cetera. And if we use this number, then we're in a much better place. The question is, is New York City? Richmond, Virginia is New York City, Louisiana Is New York City, Detroit? Well, let's look at the Dutch. The Dutch is not. This is another study that was published recently looking at blood donation. So these were people with no symptoms, just donating blood. And 3% of people in Holland actually had infection. So with this data, their mortality rate is 0.66%. Okay, we're not Holland, but wow, that's even less. But that's outside the country. How about the United States? Another Pre print article, pre peer reviewed article. Now this is research from Stanford and they do some pretty good research at Stanford. And they looked at 3,300 people tested randomly. Now they used Facebook to capture these people, put a screening out there. Then people came in and got tested and the prevalence was anywhere from 2.5 to 4%. So that's more like the Dutch data, not as high as the New York data. And you have to realize every city, every state, every locality is going to be different. Who decides when, which state to do what? I think the data is saying that needs to be made locally. That's maybe the first point is these decisions. Holland can't make decisions for Italy, Italy can't make decisions for England, and maybe New York shouldn't make decisions for California. That's the basic gist. But anyway, in this area, in Santa Clara, California, the case fatality rate based on the prevalence from these randomly selected people was 0.1% to 0.06%. Now all of a sudden we are in the typical mortality for the typical flu. That's a game changer. Now again, with this data, if everybody in the country gets exposed and 78% of people get this disease, you're still looking at 250,000 deaths, which is still the data that Dr. Fauci was referring to about four weeks ago. But now we know better that actually it's not going to be 2 million, it might be 250,000. Again, we flatten the curve. So those deaths, we're looking at 60,000 by August 4th. So we'll be spreading these deaths over two, maybe three seasons. So actually what we're doing is working. Okay, so another interesting article came out, was looking Iceland showed half of individuals who have disease had no symptoms whatsoever. So ultimately what that means is this whole thing of case tracing. We've been talking about isolation. How can you isolate a disease that most half of people have no symptoms for? How can you case trace a disease that maybe 13, 14% of the population already has? And the reality is you can't do that for something that's that prevalent. So we've taken that off the table. So our potential plan, what's our plan? You know, well, what's our plan based on, on a vaccine? Well, it's not going to be ready for 12 to 18 months. You know, one of the things we have been doing is creating lots of new drugs for the really sick people. We've been improving hospitalization criteria, We've got this PCR test and we have an antibody test. But who do we test if someone's negative? You know, does it matter if they're healthy or not healthy? If someone's negative and they're healthy, maybe they should go out and spread to their friends. Almost like chickenpox back in the day, right? Your kids have got chickenpox. You had them go out and play with their other kids, right? Because you wanted the other kids to get sick. Maybe we do that. You know, grandma stays at home, my parents stay at home. If they go out, they wear a mask. And us, the kids, we spread this around so that we protect them through herd immunity. And that's what's going to get us through this, is herd immunity. Probably not a vaccine unless we stay in place for two years or 12 months or 18 months. I don't think that's really practical. If someone has a negative antibiotic test and they're high risk, maybe those people again, like my parents would stay at home and shelter at home. We also have to realize this summer this disease will spread even during the summertime. But when we're outside and we're in the air, it's not going to spread as robustly. So the flu, just like the flu that's always around, people always spreading it, there's always someone getting a fever. It's just a person here, a person there. It's not 25% of the local community. During peak flu season, that will happen this summer as well, and more people will get it preparing for the fall. There's other technologies that are out there. Like UVC light is a very interesting technology that sterilizes the air. HEPA filters. I've got that in my home, in my office. They will actually remove viral particles attached to particulates in the air. NY5 masks, gloves. We have barriers that can allow us to go out in public. Now the question is, how do we implement these? Do we have the elderly sequestered and the healthy go out? This seems like the more logical thing with the data we have. One thing we have to remember, though, is we're holding off this vaccine. Wait for the vaccine. And until we get a vaccine, we're only slowing progression of disease in the population. That's all we're doing. That curve that's getting flat is being made long, and that is absolutely all that is happening right now. So what else can we do? And that's one thing I've been focusing on for the last two months, is how do we boost your immune system? How do we make it so that if you get sick, you get better quicker? If you are more likely to be hospitalized, you make it less likely. And those are some of the resources we've been talking about for the last two months on these video chats. I've been doing as well as all my COVID 19 survival guide, which is available free for download on our website. So we need to start thinking about a way forward. Do we start treating this like chickenpox? And I'm not trying to minimize this, but we get the idea, most of us get the idea that, you know, if you see a bunch of young, healthy people with this, you spread it around a little bit. And the older, sicker people, if you are in your 30s and you have not had chickenpox yet and you get it, it can be devastating. They can actually kill you. And that's one of the reasons why we developed the vaccine. Before the vaccine, basically, young people had to get it to keep the older people that who hadn't had it safe. We need to discuss among ourselves, among our friends, our family, our local community groups, our religious organizations, how are we going to move forward? We need to discuss it with our civic leaders. We need to talk about our local politicians, our local representatives at the local level, state level, what are their plans, how do we move forward? And this has to be a local response. New York City is not Richmond, is not la. LA actually gone through this pretty well. It's not Baton Rouge, Louisiana. We need to let them know what our thoughts are. Something this big and this major has to be a public debate. It can't be technocrats, those with knowledge, but maybe not as much wisdom, making decisions for all of us. It has to be a public debate. We all have to own this together. We, we have to be in this together. That's been one of the catchphrases. We're all in this together. Well, if we're all in this together, it means we have to make the decision together. This has to be something open to public debate. This is how our Constitution is put together. It took a couple years for that to actually go through and get ratified. It almost didn't make it. This needs to be the next big thing that we as a nation. East Coast, West Coast, Central United States, Florida. We all need to talk about this in the data because I think at this stage we have enough data to make some decisions on how we move forward. I've attached the links with the articles below. Hopefully this was helpful. If it was, please share it. That's how we get good information out there. If you didn't like this, but you want to use this to spur debate. I mean, that's what this is supposed to be about. You know, probably half the people out there agree with me and half the people don't. But we need to talk about it so we can get a plan, move forward. Inaction is just going to make us stay docile and isolated for another one to two, three months. And is that the right decision at this stage? I will continue to put out shorter videos to talk about that. Please share this with family and friends. That's how this good information gets out there. If you enjoyed this, you liked this, you felt it was helpful. Like us. Follow Us Join our Newsletter that's one of the ways as well. We get information out there on our website and all these links will be in the bio section. Hope you have a great weekend, a great week. Stay safe, be well, get educated, get knowledge. But ultimately the application of knowledge is wisdom. And hopefully throughout this time we're getting more of that as well. Take care.