CV Update: Getting Our Data Straight—Comparing Apples to Apples

All right, everybody, great to be with you again. So I just finished recording, talking about sensitivity, specificity of some lab testing, talking about surveillance testing versus diagnostic versus confirmatory testing. Now, as I was thinking about these things, I just started thinking more about the countries and how the data is just being maybe misrepresented is maybe a better way of saying it. So I just wanted to walk through at the end of this week, beginning of next week, today, Sunday morning, kids are all still sleeping. It's kind of drizzly here in the Richmond, Virginia area. And just maybe walk through some data and numbers and charts. And how I look at these now, I think, and how you have to interpret stuff. And I think that might be something that might be helpful for people in this time. So looking at this chart right here, this is just the world. If you look at total cases and total deaths, it looks pretty profound. It makes you think, yeah, what's going on in the world there? Like, numbers are skyrocketing, deaths are going crazy. You know, these are the countries. You see all these plus marks here. It's really hard to compare yourself to the world. It's like saying, you know, I'm a human being. Like, well, there's different kinds, shapes, colors, genders. Like, how do we compare these? And that's. I think part of the problem is we're not comparing apples and apples. If you buy an apple and expect an orange, you can be disappointed, even if it's the most amazing orange in the world. And so I think you have to have the appropriate expectation when you look at data. So anyway, the United States. What's our expectations in the United States? If you look at our curve, this whole flattening the curve thing, we see that the numbers coming up, it's kind of curving here a little bit. So if you can imagine this curve completing itself, it looks like we're one third of the way through the United States, which sounds relatively good. So why are things so bad? Well, we're only one third of the way through is the first way to look at it. Second way to look at it is all These projections stop August 4th, assuming we shelter in place the whole summer. That is a massive assumption that's going to change all. Everything I'm talking about now changes once we start reintroducing ourselves into society. If you look at the daily new cases, we'll look at that. It's pretty flat, isn't it? Look, it kind of came up March 31. We saw cases going up, up, up, and then all of sudden we flattened it. In the whole entire country. You know, bravo to us, good job we've done. We flattened the curve, know we've mission accomplished, so to speak. Active cases is starting to. Now active cases is tricky because that's people that are infected in the hospital still going up, starting to flatten off a little bit again. Looks like we're maybe a third of the way through this until deaths, total deaths is also tricky because that's a line that will continue to go up. It will never go down because it's just additive. If one person dies today, one person dies tomorrow, one person dies the next day. The line just continues to go to go up. Daily new. Now this is more important than daily new deaths. Basically we're not having more people dying today versus yesterday. Maybe it's even starting to level off a little bit in the United States. But the United States, the thing I keep on talking about the United States is more like Europe where we have 50 states, multiple countries. Italy being the New York of the United States, Lombardy area, northern Italy area being the New York City of the United States per se. You know, our Sweden never closed down. Might be trying to think we've had about 20 states not closed down in the United States. Maybe the ones that closed down reopen. Maybe Switzerland is our Georgia. Okay, that closed down, but it's reopening. Or even England, the uk, they closed down initially, but then, well, they stayed open and then closed down. Let's look at Sweden, a country that never really closed down. You see their graph kind of sort of looks like ours. It's kind of to going. Going up a little bit. But you know, daily new cases, pretty flat. You have to realize Sweden's a different country. It's pretty cold up there. It's a pretty homogeneous group, one ethnic group. It's not a Malawi where you have like 15 different, 20 different ethnic groups in one country. It's a pretty homogeneous. More like maybe a North Dakota kind of, so to speak. That might be a better analogy. Even though we could look at the map a little later on, we'll see that Sweden is way north on latitude compared to any of our continental United States. But you don't see the daily new cases skyrocketing in a country that never closed down. Active cases. Looks like it's peaking out here. Again, the total death is going to be going up regardless. But we look at the total death, the rate at which the total deaths are going up. It does look like it's slowing down here a little bit. In a country that never really closed down in the daily new deaths. Again, doesn't look to be super, super crazy. So what have we learned from Sweden? What we're learning from Sweden is their curve doesn't look terrible. What's it look like compared to a lot of other people like say Switzerland? Switzerland's a country that didn't close down. They closed down. They've had a little, you know, kind of touch and go. But another homogeneous country, interesting enough, a lot of people lost skiing going on in Switzerland in the wintertime. And so the group of people in Switzerland and Germany that initially got this disease were young, healthy people. Then they eventually got to their, their parents and grandparents. So you look at the total cases there again means leveling off. New daily cases that looks like it's flattening out. So in Switzerland, which is, they never really got draconian, they never got crazy. They are seeing a leveling off of this active cases. Wow. They got their peak back, you know, March 30, it's almost a month ago. And the new deaths, you've seen that, that kind of come down as well. So we're seeing these countries level off. How about New Zealand? Now New Zealand are unique cases. Now one thing I want to note, I'll probably, I've got a map here, I'm going to look at a little bit. I'll come back to this in one second. But you have to visualize New Zealand, it's in the southern hemisphere. They're entering their fall. So look at New Zealand, look at Australia. That's what we should be looking to see what's going to happen in America next because they're exiting their summertime, entering their fall. We're exiting our wintertime, entering our spring, spring and summer. So they're, they're leading us as far as the second wave on this. So right now they're pretty flat. Total cases is flattened. Daily new cases. They crushed the curve. They crushed it, absolutely. They cut, they shut down things pretty, pretty robustly there as well. A lot easier to do in a smaller country with a small population. Again, that's one country. The United states is literally 50 countries. We even have a non continental United States, which is Alaska and Hawaii that are part of us. So how do we even take those things into account? You know, Florida's a peninsula. California, you know, represents a huge, huge portion of the United States population. Again, we have to compare apples and apples. But New Zealand basically has shut it down basically. So we should be watching them going forward to see what happens. Australia, another case where they kind of shut it down. Total new cases. Bamboo, you know, daily new cases. Look at that. That's pretty much shut down active cases again. Brought down new daily cases in Australia. Now again, you have to think they're in a different country, different location. Different, different, different. It's like a continent. That's one country. But the point is, is that they're also in the southern hemisphere and they're a season ahead of us. What we need to do is they, they cut it down. What's going to happen with them later on. So what I want to do now is just change the screen out a little bit and broaden it and share. This is from the University of Washington. Now one thing I want to note is again, we talked about this a week or so ago. Look at the projection August 4th. That has not changed. I did a recording on this a week and a half ago, maybe same day. You have to realize a lot of these projections are assuming we shelter in place till August 4th. Okay. And after that everything just goes away. And these are, how do we use these projections to determine the course of our country? That's a great question. Anyway, this is today. You look at the number range, it's flattening again. This, this flattening out by the University of Washington correlates with the flattening out. We looked at at the Worldometer, not a whole lot different. If we look at hospital resource use beds, the shortage, the usage icu, if you look. Actually, I think the better graph is this to see what their expectation range of ICU beds and needs. And we're basically past the big date. May 1st is coming close. Today's the 26th. That line is actually right where we're at right now. We look at beds needed again, we flattened the curve. What was the point to flatten the curve so that we didn't overwhelm our hospital system. It looks like in the United States we were actually successful with that desperate day. Appears it's the red line. Look at that, it's coming down. This red shaded area was representing what their expected range of variance was. So they could, you could have anywhere maybe, you know, 5,800 people died this day, maybe 473 people died this day. That's what that range of variance for April 22nd. And then the actual deaths were 2020. So this shows you the inaccuracy of some of these estimating things again today, which is the 26, you know, deaths per day. 1500 projection up to two to three times outside this range. So it's kind of hard to make public policy based on this kind of degree of inaccuracy. I live in Virginia. This is my state. You look at my state's numbers, we've flattened things out. Deaths per day, 26, 27. Today projected 5 to 94. You know, we're not a New York, we're not a California, we're not Texas or not Florida. So nothing. Hate big R. If you look at our hospital system actually was not overwhelmed. Total beds needed 984 beds available, 6581. Our hospitals are empty. You know, ICU needed, 261 available, 329. Okay, so, you know, maybe 2/3 of the ICU is filled. A lot of this capacity. We've canceled electric elective surgeries, we've canceled same day stuff. So our hospitals for the mass are empty, except for ICUs are 2/3 full. That's how you kind of interpret that. And then you look at this. This is basically ICU beds, resources, et cetera. Pretty flat. Nothing like you're going to see with New York, which will be our next one. Now, New York has done a pretty good job. The thing about New York, we know that anywhere from 17 to 19 to 22% of New Yorkers have been infected. And so what we can see with New York is their August 4th projections. The way they're going, they probably, they may reach herd immunity. Can we say that for Virginia or North Carolina or California? That's what we need surveillance testing for, which is the purpose of the ultimate use for antibody testing. Unless we have better quality antibody testing. New York, again, you can look at the usage. Beds needed. They did, you know, beds need, they did kind of exceed their capacity. ICU beds needed versus available. But the key here is that no one died in New York from lack of a ventilator. One thing I like to remind people of any flu season here in central Virginia and small city of Midlothian, which is where I live, um, during any flu season, the peak, the ERs are overwhelmed. There are gurneys in the hallways because there's not enough beds. Even when I was at mcv, sometimes the hospital, which is a big medical college, would be on diversion because there's no rooms at the end, the hospital's full. So there's always going to be that. You always going to any season you'll meet the maximal capabilities of your hospital system. You know, that happens routinely every flu season. It happens here in central Virginia every flu season. This is New York, one of the cultural centers of the world, population centers. So Kind of to be expected. But no one didn't make it because of lack of access. If you look at California, California is another massive state. Massive state. I mean bigger than New York. I think something like a third. The population's close to 30 million. Almost 10% of our country's population is in one state. Beds needed 2,500 beds available 26,000 so point California is not New York. ICU beds needed available 690 needed available 1994 so what's the difference between California where the population spread out? You know, everybody talks about LA area, their public transportation is not the best. People drive in their own isolated cars. So by definition they're not going to spread this around versus, you know, if there's a lot if you're out in the air. And this is one of the things I don't understand about, you know, banning people from going to parks. If you're in open air with the best ventilation, it's almost like you're in a nightingale ward outside, which is how they do things in England. You're going to get a lot of fresh air coming through UV light, uva B C which doesn't make it to Earth but UV A and B kill radio viruses. You know, you want to be outside in the air. California is a lot more natural stuff, huge state. Their cities aren't cramped like the major cities are like aren't cramped like New York City. People don't get in these sealed off tubes we call subway system. And that's one thing about New York City as well. The subways never shut down during this whole thing. So you'd expect people to spread it like crazy. And that's kind of what happened. California, not so much. That's the point. Point is California's a different. California's gonna be different than Europe. I think these are primary, the two extremes of two major coastal cities that have major Asian populations, multicultural states that have two vastly different outcomes to date. And so that's where it's. For me it's hard to say what they should do versus what Virginia should do because we're not comparing apples and apples. Again. They look at the number of total deaths, 1500. They're pretty close to the projection maximal 1900 to 1300 because they kind of clamped it. They have the same peak that New York. And the more radical the swings, the more variation in your estimates. So what I want to do is look at this world map real quick. If you look at Australia, the Tropic of Capricorn is down south. New Zealand is Off to the right, they're entering their fall. You look at the United States, we're up north to the up to the left. You look at how we're situated. We're actually situated more south and most of Europe, what we don't know right now is going to happen in South America, Brazil, what's going to happen in sub Saharan Africa. That's what we need to be watching. It's what's going on those countries right now that's going to kind of give us a little preview of what's going to happen to us in the fall. So again, keep on looking at numbers, keep on looking at the data. I think that's all I really had to share today. This is just Hopkins site for South Africa. South Africa is another country we're watching closely, see what happens there. Because they are a relatively western third world country. They had British influence for centuries, plus or minus or European, I should say European influence relatively advanced for an African country. Big population, the same thing, lots of poverty, lots of civil unrest. So I think watching their country will be helpful to see where hopefully they lead the way with what's going on in Africa. But we will, we will see. So again, if you like these updates, if they're helpful, continue to follow us like us on all the social media, share with friends. I will continue to do these if this was helpful. If you like this one while I was just talking, give us some feedback. If you like it to be more programmatic, more me think I did not plan for this at all. Usually I plan an hour or two. I have notes that I kind of talk through. If this was if you like this a little better, it's obviously easier for me to do. Give us some feedback. Also there's topics you'd like us to discuss or talk about is in the comments section below. Give us feedback as well. That's just really helpful for us to know what y' all what do you what's not what's important to you now what's important to me not what do I want to know, what do I want to educate you or show you, but what do you really want to know? Not just that type of feedback can be helpful to us as well. Take care and be safe.