COVID-19 Update: Week in Review 03.28.2020

Welcome back, everybody. What I'd like to do today is do a week in review. It's Saturday. Things are slowing down a little bit in some of the news cycle. At the same time, things are getting a little frothy. Many of you are getting interesting questions, are really concerned about what's going on. And I'm looking at the news. I feel the same way. So what I'd like to do in this week in review is just review what we've seen the last week. Well, as review some of our expectations and answer some questions. I've been getting lots of questions and so I'd like to answer some of those questions here. We are doing a live Q and A tomorrow and so we'll probably answer more of those tomorrow as well. So I just want to set the tone, tell people what's been going on, what our expectations have been, and just ease people's minds. Because it's just been a whole lot of misinformation and it's almost as if the media is trying to stir things up to keep people in the frenzy when for the last several weeks we've been talking about we're expecting this rise, we're expecting this acceleration. This is not unexpected. So what's been going on the last week is a number of cases have been rising in a parabolic fashion. So if you can imagine a wave and a parabolic curve kind of curves up like this, we're on the up part of that. And typically once we get to the fast acting part of the parabolic curve, we expect the number of cases to double every five days, plus or minus. And so it appears we're there. On Friday morning we had about 80,000 cases. And today on Saturday, we're at over 100,000 cases. So it's looking as if we'll double that number in five days. And then we expect to see a doubling of the doubling. So 80 becomes 160,000. By mid to late next week, that becomes 320,000. The question is, when does the doubling slow off, when does it peak and when does it go back? And we're expecting that to be a four to six week cycle. We're expecting things to peak out in New York in two to four weeks. But we're at the beginning of the wave. We've been talking about this for several weeks, so this is not unexpected. If you're here on the media, oh my gosh, we didn't expect this to happen. Then you need to find another source of information because we've actually been talking about here for several weeks. So, and we've been expecting this. Now when you look at pandemic numbers again, you expect them to double every three to five days once you're in the midst of it, which appears that's where we're at. The important thing to think about is that we have not seen a spike in deaths. When you look at the worldometer, and that's one of the questions people have asked me that I'll just kind of maybe go to right now. When you look at the worldometer, you start looking at countries and the cases in the countries. What you see is the United States is that, you know, 104,000 as of now, Italy's at 84, China's at 81. Literally yesterday morning we were all about 80,000, which you've not seen is a peak in deaths. United states is about 1700 compared to China's 3295. The thing about, thing about this is that the other thing to look at is recovered cases. And so right now in the United States, not that many people recovered. Most of the cases in China have recovered. Italy, many, many people, the majority of cases have actually recovered at this point in time. One note, we all probably need to just stop talking about the Chinese numbers for many, many reasons. You know, back in November when this first actually popped up, I actually personally remember during the Christmas time frame that hearing about some weird cases of people locally with weird pneumonias, people coming in, been coughing for two to four weeks, just, you know, things that, eh, it's been weird season. It probably was already here. We just didn't know about it and it took a long, long time for us to figure it out. When we talk about the United States, we compare the United States to other countries. We have to realize that the United States is like the eu. It's like New York is our Italy, you know, California is our England. You know, we have this widespread and you can't look at the country as a whole. If you look at within the United States right now, half of our cases are from New York and the majority of those cases are in New York City. So it's very similar to the European case where Italy represents most cases. And southern Italy, it's not that bad. Lombardia in the north is where most of the cases are. The other thing to look at is the actual recovered and the fatalities. And we're not seeing that big up spike right now. If you look at Germany, for example, with 53,000 cases, they only have about 400 fatalities. So again, we probably going to see the exact same thing in the United States that we're seeing in Europe, where different countries have different fatalities. And there's some questions that I'll go to that here a little bit. Now, what we're not seeing is we're not seeing the hospitals being overrun. About a week and a half ago, England was talking about running out of ventilators, and it was all the hysteria. And all of a sudden they found enough ventilators, and now it appears that the English system is not going to be overrun. Same thing in the United States. There was a concern about a week ago in New York City not having enough ventilators, and now we actually appear to have enough. What's happening is a lot of really cool things, like we're figuring out how to take one machine and use two patients, three patients on it. We're figuring out how to turn hospitals, day centers into hospitals. We're just transferring our whole system to take care of the capacity. So we've literally doubled our capacity to take care of the sick and ICUs in the last two weeks. So expect that to continue. So what's happening is the numbers of fatalities are not increasing at the same rate. We're increasing our capacity. Our capacity is increasing much greater. We're still waiting to get more ventilators online. But these are all reassuring things. And that's one of the reasons why we're not seeing our hospitals overrun. And that's the difference between our system and, say, the British system or the Italian system is we have a lot more flexibility in our system because all of our hospital systems are individually run and private. There's not central controls. It allows states, for example, Virginia, to operate differently than California. New York is our epicenter. So if we. It's probably not going to get worse than New York City. And I'm going to come back around to that in a little bit. Why is New York City so much worse than the rest of the country? Now, the mean incubation, right now the mean incubation time is about five days. Now, we all keep on hearing the three days. They keep on hearing the 14 days. But the mean right in the middle is five days, which means you get exposed and you get sick in five days. There's this interesting Kinza fever map. Kinza is actually a normal thermometer, and they have this fever map of Florida. And if you look at Florida, you'll see about a week and a half ago, all the temperatures in Florida rose significantly. That correlated, strangely enough, with spring break and Florida. And then after all the spring breakers broke up. We saw the fever map go down. So that just kind of reiterates to us that crowding crowded areas are a great way to spread this. And then we'll take that back around to my whole Italian New York City comparison. Why is this so. And I have a question. Why is this. My first question. Why is this so bad in New York City versus in la? That's a really good question. Why is, why is it so bad in northern Italy versus Rome or southern Italy? I mean, Rome's a pretty big city. Why is Lombardi, the place being devastated? Why was New York City? One of the things I was looking at was suggesting public transportation and looking at the LA versus New York City. LA is a very spread out city. Yes, it's populated, but there are a lot of cars. And if you're in a car, it's almost like you're in your own personal PPE where you're in your little bubble versus being jam crammed in the subway. And one thing I didn't know till this past week is that the subway system, the public transit system has still been running in New York. So we've still been spreading it. Now, one of the reasons I think we're having a current uptick right now is also because of the national quarantine in Virginia. Our national, our local quarantine, everybody has to go home, right? Stay in place. Well, what happened was everybody went to the grocery store. So what we know about this virus is if you cough in the air, the particles stay suspended for about three days. So just imagine coughing in an aisle and someone walking through that coughed air maybe 30, 45 minutes later. So we probably had a mass inoculation when everybody went to the grocery store. Same thing as we had the mass inoculation in Florida during spring break. And we've seen the fever map going up and we're having that mass inoculation ongoing in New York City because just the transit, you know, even though people are shelter in place, the young people are going out there, they're still running the public transit. Now most people are staying in place. But that was not the case two weeks ago. And so we're seeing now, two weeks later, the results of that. One number I want to repeat is the time from exposure to death is about 19 days. So if you see the peak, if you see incubation five days, you see people making their way to the hospitals in 12 to 14 days, in 19 days you expect to see a peak in actual death. So what that means is I'M curious to see what happens this week as we've seen our rapid uptake. By the end of next week, do we see the number of deaths double just like we have with we're gonna see next week the number of cases or do we see it not double? That's the question. That's the million dollar question. And that's what we're trying to do with again, social distancing is a flat things out to give us time to see what these numbers are and then hopefully we can test. I'm excited about antibody testing that's available. I'm going to test myself early on because the reality, looking at the way the spread from Hubei got to the United States, it's probably been here for three months. And so my question is, as a lot of patients I was seeing this past winter with bad coughs that coughed for four to six weeks was already exposed. Were they already exposed? Once we get these numbers, we can know who's safe and who's not safe. And we can keep the people who've not been exposed out of the public eye. And people like who've been exposed, get them back, get them back to work. So one thing also in the news is the United States is number one. You know, it was. I don't want to get into politics at all. But again, we were the number one country in the world. Now instance, again, that's. I don't. It's kind of hard. You have to break these numbers down. The United states is like 50 countries when you look at Europe, you know, and in Europe they have your populated, powerful countries. You have your Germany, which would be like our California. You have your mass population here as far as the epicenter of this, Italy, which would be our New York. So when you look at the United States as a whole, half the cases are in New York proper. And within New York proper, most of them are in New York City. So you have to compare apples and apples. Right now in Virginia, we're not having tons of cases, but the ERs are getting really busy. Most of the cases, there's a lot of the local Richmond area, a lot of coronavirus. One of the local nursing homes is an epicenter actually for this on the east Coast. So you have to look at. Yes, we're the number one country wise, but we are distributed just like every other place. You have to remember in China, in the Hubei province, all their, basically all of China's cases were in that one area and with that throughout the country, it was not that widespread. So we're seeing population pockets of this, Italy, New York. You have to wonder why. Is it population centers, Is it the way the public transport is? Is it air quality? That's another great question. Air quality, you know, I guess that kind of shoots the la, because supposedly air quality is not the best in la, but there's something that's causing us to pocket in certain areas and we don't know right now. And that'll be. That's one of my curiosities as well. When will this peak in the United States? Another great question. I think this is going to peak in the United States. That's a great question. I'm going to say two to four weeks. Up to six weeks. It's going to peak in New York City proper. Two to three, two to four weeks. The question is, how's it spread? You know, and if we can flatten the spread out, then we'll see a slow drain as we get testing out. New York has already been there. They're the epicenter. We should focus on them. But I'm just curious, what other epicenters do we have throughout the United States? Because again, half of our cases are in New York, not elsewhere. When do our numbers go down? Like China again, the Chinese numbers. One interesting thing a lot of people haven't been talking about is that the WHO was actually kicked out and the reporters were actually kicked out of China about a week or so ago. And an interesting thing happened was that all of a sudden the cases in China like went down precipitously. So we just need to stop looking at Chinese numbers. We have no idea what's going on there. One article came out, someone asked me about another question is there was a report in China about someone getting sick again? Again, not sure if I can rely on that data from the origin where it's coming from. The other thing about testing is you have to realize is the testing, the antibody testing is not super sensitive. About 30% of people that are actually have disease true positives will test for falsely. Also, if you don't have a fever with antibody testing, it tends not to be nasal swab antibody testing, it tends to not be as sensitive or accurate. So when I see someone with the flu, for example, if they don't have a fever and I swab them, the testing is much less likely to be positive than if they have a fever. So that's one of the questions. Were these actually truly people who got sick and got better, then got sick again? Or is it just poor testing? Or was it actually that the Test just is not accurate and it was just a false negative. We just need more. I can't make any clinical judgment on that data because it's just not good, solid information. So one person was asking another question, was asking, with the mortality being less than 1%, why are we making such a big deal about this? Is this overblown? You know, looking at the numbers and that's been something floating around. Is this overblown? The analogy I want to talk about is with the flu. Any particular flu season, about 25% of the population will get it because we've already been exposed, you know, which means which results in the country between 70 and 80 million people getting it. You know, multiply it by four, it's 320 million people. The thing about this is we're expecting 80% of the country to get it, not 25% of the country. And so we're looking at four times greater acquisition and death. If it's just like the regular flu, instead of 50 to 80,000 people dying from the flu, we're expecting 200 to, you know, whatever. Eight times four, 240, maybe up to a million people dying from this. And that's the thing. If this death rate is 1%, then we could be overrun. So the issue is, yes, it does appear that our fatality numbers are not as bad as other countries, which we've talked about previously. But we're sheltering in place, we're being safe because we don't know. And if you hear someone talking as an expert and you don't hear them say, I don't know enough times, they're talking like, hey, I'm the expert, I know everything. Then I would just say they haven't read enough stuff and they have been following this long enough. The last question really quickly, before we run out of time, is spontaneous cases popping up. Did the quarantine work? I think the country was seated by travel beforehand. I think we were seated already, and when everyone went home, they took it back with them. And that's what we're seeing pop up in Richmond area. Most of cases here have no travel, no Chinese experience. They're spontaneous cases. I think it was already spread and that's what we're seeing. So hopefully this information was helpful. We'll tomorrow we're doing a live Q and A session, trying to keep you updated with things. Feel free to follow us here on social media. Let us know if this is helpful. I want everybody to have a good, reliable, dependable source of information they can use and follow that can help them make really wise decisions. Everybody stay safe and be well, and we'll talk to you soon.