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What Is Our COVID Endgame?

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One of the problems with the current pandemic has been that there is no clear and unified U.S. public health goal. Meaning, are we trying to protect the healthcare system, eliminate all deaths, or protect the economy? So let’s dive in today and cut through the media hysteria to try to figure out what makes the most sense.

Media Hysteria

Most in the media continue to fan the flames of mass panic in their never-ending quest to sell eyeballs to advertisers. The lack of an overarching public health goal is what has allowed them to keep us all whipped into a froth. So how can we deescalate the madness? Come up with a single unified game plan that everyone can buy into.

We can break down our options into a few categories:

  1. Maximize Public Protection-Allow no deaths or as few deaths as possible, regardless of what happens to the economy.
  2. Balanced Protection-Allow some deaths and protect the economy as much as feasible. Hence, our only goal should be to avoid any overload of our health-care system.
  3. Maximize Economic Protection-Allow whatever deaths will happen and maximally protect the economy.

The media seems to be headed toward number 1, which is why it freaks out at the notion that the number of cases may be rising in parts of the country. So let’s review these options and try to make sense of them. Before we do, we need to cover two topics: lethality and Non-COVOD deaths.

Lethality

As I have shown previously, the real COVID-19  infection fatality rate (the number of people who will die if they catch COVID-19) is somewhere less than 1 in 200 and more likely as low as 1 in 2,000. That’s FAR LOWER than the media had reported early on. Hence, this is a bad bug with a fatality rate of 2-4X flu, but it’s NOT the stone-cold killer that most Americans believe it to be.

Non-COVID Deaths

The problem we have in figuring out the perfect pandemic calculus is that the reaction of the general public to our response will kill lots of people. For example, people are foregoing routine healthcare that keeps them alive. In mid-May, a JAMA article estimated that nearly 23 million Americans aged 50-75 were past due for their colonoscopy screenings (1). Adult primary care visits were down by 49%!  The American Academy of Family physicians reported that we could lose 150,000 people due to the shut down because of deaths like suicide, alcoholism, or drug abuse (2).

Our Public Health Options

Maximize Public Protection

This is of course an admirable goal. However, there are some serious practical issues with this approach. Let’s dig in.

First, in this category, applying massive resources early in the pandemic is key. However, no U.S. administration has EVER allocated this level of resources to controlling a pandemic. Let’s review.

This early pandemic approach only works with HUGE dedicated resources and a willing population who is heavily policed. For example, Taiwan, which now has a huge pandemic response team (Central Epidemic Command Center (CECC)) down to the regional levels within cities, was burnt twice by SARS viruses coming out of China before it got it’s act together in time for COVID-19 (3).  For example, Taiwan has an entire pandemic war room, armies of workers dedicated to contact tracing, pandemic ward captains in large cities, a military that was used early in the pandemic to manufacture PPE, and imposed jail time for those citizens who didn’t play by the rules (4).

Without a massive early response like Taiwan, we’re left with only a late “catch-up” response which is like forever chasing our pandemic tail. Hence, the only response we could muster was to shut down our society and shelter in place. The problem is that this has caused devastating economic consequences.

What the four graphs above demonstrate is clear economic suicide. Basically, large sectors of the economy have been pulverized by the shutdowns and have yet to fully recover. You may be in a sector that didn’t initially get hit hard, but when 1 in 5 Americans are not able to work over the next year, whatever sector you’re in eventually be hit by the drop in economic activity. Hence, continuing to maximize public protection by continuing the shutdowns until we see very little virus activity or find an effective vaccine is not realistic.

Balanced Protection

This is balancing protecting the public with protecting the economy. The focus here is really on protecting the healthcare system from overload. Hence, no more shutdowns unless there is a credible threat to healthcare resources and hospitals being swamped. More people will die in this scenario, but the economy will limp along and recover more quickly, only suffering locally from small regional shutdowns.

The advantage here is obvious. We don’t destroy the economy. This disadvantage is also obvious. It’s likely that a few hundred thousand Americans will perish with this plan, perhaps more.

However, it’s critical to keep those deaths in perspective. First, shutdowns only push the peak of the disease down the road, they don’t change total deaths. The only way that total deaths are reduced is if we shut down for 1-2 years while we get a vaccine developed. A shut down of that length is just not economically possible.

In addition, it needs to be noted that hundreds of thousands of deaths due to a respiratory virus is in keeping with other pandemics that the US has suffered without shutdowns. For example, the 1957-1958 H2N2 influenza pandemic scaled to today’s population caused more than 250K US deaths. 

Maximize Economic Protection

In this plan, we maximize protecting the economy and let the pandemic rip along. Who has done it this way? Look no further than Sweden.

Sweden has been the pandemic bad boy country, deciding to forego the shutdown approach. It’s been heavily criticized in the media, but despite that criticism, it actually hasn’t fared badly. Let’s dive deep into this idea.

What is the Sweden approach? Tell everyone to social distance, but keep bars, restaurants, businesses, and schools open. How could that work out? Well, as shown above, comparing deaths per day in Sweden vs. the US is interesting. Both have similar drops in death rates over the past few months, but we shut down everything and they did not.

How about deaths per million inhabitants?  Just looking at today’s data, Sweden had 4.8 deaths per million and we had 2.45. However, that may not be a fair comparison, as for several days last week, Sweden reported 0 deaths per million. On Jun 18th their rate was a little more than 1 per million. Hence, the difficulty of direct comparison is that since they only have 10 million people to our 330 million, there are days that they have very few or zero deaths, whereas our lowest death toll per day (reported last week) was 267.

So why would Sweden’s data be similar to ours? Surely our shutdowns have saved lives? As I have noted before, this argues that some other external factor is reducing the COVID-19 death rate as we go into summer, other than the US shelter in place orders.

How did Sweden fare economically with its approach? Looking at the graphs above, Sweden’s GDP growth was down and stagnant, but the US fell off an economic cliff (7,8). That’s just the 1st quarter as most economists believe that the 2nd quarter, which will be reported soon, will be a MUCH bigger disaster. For example, the GDPNow tracker at the Atlanta Federal Reserve is currently stating that the average 2nd quarter U.S. GDP forecast is currently clocking in at -35%! (5) When was the last time we saw anything close to this level of decline in GDP? The great depression saw worldwide GDP fall by only 15% (6). In the great recession of 2008, the GDP declined only a paltry 1%.

What Makes the Most Sense?

As I have shown above, you could make a real argument that Sweden’s approach was no worse than our approach. However, I’ve always been a fan of the middle of the road approach rather than the extreme. Hence, to protect our economy and also as many people as possible, I’ll argue that avoiding healthcare system overload should be our ONLY concern. Meaning, we don’t focus on if cases are up or down, only if the models show that our healthcare system may get swamped. If that looks to be the case, then we act to impose regional shutdowns.

The same would also hold true with the total number of deaths. Given that past influenza pandemics in the US have seen deaths in the range of several hundred thousand US dead when scaled to today’s population, any number of total deaths in that range is what we will expect. We will obviously continue to test various treatments and improvements in therapy for severe COVID-19, so total deaths will likely be less as therapies improve. In addition, we would continue to maximally protect our elderly and those who are at high risk for severe disease. We would also continue social distancing and aggressively sourcing a vaccine.

The Media

If the public health game plan that makes the most sense is a balance between protecting people and the economy, then the media needs to get behind this plan. That means no more hysterical news stories about cases rising here or there!  No more “Panic Porn” as Bill Mayer has coined the term:

The upshot? Let’s stop the COVID hysteria. This is a disease that is not nearly as lethal as many media pundits guessed. We can’t continue to keep society shutdown and people away from hospitals because we have made them too paranoid to venture outside. We also need to start pressuring the media to end the Panic Porn. That means unsubscribing from your favorite media outlet that is participating in or fomenting mass hysteria.

______________________________

References:

(1) Issaka R, Somsouk M. Colorectal Cancer Screening and Prevention in the COVID-19 Era. Jama Health Forum. https://jamanetwork.com/channels/health-forum/fullarticle/2766137 Accessed 6/23/20.

(2) The Well Being Trust and the Robert Grahm Center (American Academy of Family Physicians). PROJECTED
DEATHS OF DESPAIR from COVID-19. https://wellbeingtrust.org/wp-content/uploads/2020/05/WBT_Deaths-of-Despair_COVID-19-FINAL-FINAL.pdf Accessed 5/8/20.

(3) Schwartz J, Yen MY. Toward a collaborative model of pandemic preparedness and response: Taiwan’s changing approach to pandemics. J Microbiol Immunol Infect. 2017;50(2):125-132. doi:10.1016/j.jmii.2016.08.010.

(4) The Wall Street Journal. Coronavirus Quarantine Breakers and Evaders Face Fines, Jail Terms. https://www.wsj.com/articles/asian-countries-wield-fines-jail-terms-to-stop-coronavirus-quarantine-violations-11582824849 Accessed 6/23/20.

(5) Federal Reserve Bank of Atlanta. GDPNow. Estimate for 2020: Q2. https://www.frbatlanta.org/-/media/documents/cqer/researchcq/gdpnow/RealGDPTrackingSlides.pdf Accessed 6/23/20.

(6) Wikipedia. Great Depression. https://en.wikipedia.org/wiki/Great_Depression Accessed 6/22/20.

(7) Trading Economics. Sweden GDP Growth Rate. https://tradingeconomics.com/sweden/gdp-growth Accessed 6/23/20.

(8) Trading Economics. United States GDP Growth Rate. https://tradingeconomics.com/united-states/gdp-growth Accessed 6/23/20.

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18 thoughts on “What Is Our COVID Endgame?

  1. Andrew Frederick Wilks

    Thank you for the article! Love it!!! I am getting fed up with all the hysteria and the medical tyranny also being imposed by lawmakers WORLD wide as well.

  2. CES

    Feel free to avoid the asymptomatic threat to vulnerable family and friends as long as you wish. This is only rational if you see the threatened population as “collateral damage” to protecting the economy over their lives.

    1. Chris Centeno, MD Post author

      CES, as scientists have told us time and time again, shutdowns do nothing to reduce the total number that die, they only push the peak out over a longer period of time. hence the same number of people die in either A, B, or C as discussed above.

  3. Anna Harmon

    This is a really well written article! Thank you for taking the time to look and share the 3 end game perspectives and the inherent Pro’s/cons in each

    I agree the media is making things worse., enough

    Thank you again!

  4. Ed Flynn

    I have been wondering this same question and I no longer watch anything that has to do with the covid 19, if i want to watch the news i tape it an fast forward thru anything that has to do with covid 19, i look for articles like this, that break things down so we are not put into panic mode and make an intelligent, educated decision.

  5. Ron Davis

    Some not so random thoughts re your essay: 1.) Question: Do you have a pony in this race which may be tilting you towards your present ‘ideological’ position? Answer:Of course you do! 2.) 120,000 + dead Americans [+ another 80,000 Americans . . . by November ] might disagree with what you are advocating.

    1. Chris Centeno, MD Post author

      I don’t treat COVID patients and am personally booked out months, so no personal pony in this race. You may want to check the CDC website as about 250K Americans (when scaled to today’s population) died in the 1968 influenza pandemic. We’re not close to that number. Especially when you remove all those who “died with COVID” versus “died of” COVID. When our state did that at our democratic Governor’s request, our COVID deaths dropped 25%. Hence that 120K number is likely under 100K at this point.

  6. Dan Green

    It’s true the shut downs only push deaths out further, but if they push them out past the point where we have a vaccine then many many lives are saved. In addition, most people will obey shelter in place orders which will flatten the curve. However, a large portion of our population has decided that social distancing and PPE are too inconvenient. What they don’t realize is that their personal decision puts the public at risk by increasing infection rates and deaths in the community unnecessarily. They don’t stop to think that their selfish momentary indulgences may kill my grandmother through community spread. Yes, the media has overdone it with their COVID reporting, but if it scares reckless idiots into making more responsible choices, then that’s a good thing.

    1. Chris Centeno, MD Post author

      So let’s unpack what you said. It takes 12-24 months at warp speed to produce a vaccine. We have never in history created a vaccine against coronaviruses. However, let’s say that we can create one in 12 months from March, which will be next to impossible. Let’s also say that we have already begun production on that candidate so that we have hundreds of millions of doses ready by March 2021. It will then take until the summer/fall of 2021 to get the population vaccinated. So you’re talking about a year or more of shutdowns? The small existing shutdown we did is expected to tank GDP by 35% in the second quarter. If we continued this through the third and fourth quarter this year and the first quarter next year, there would be no economy to return to. There would also be massive government debts. So how economically is your plan supposed to work? Print money? They have tried that throughout history, it doesn’t end well…
      Please review the data on mask use BEFORE you use that tripe here, as there is NO credible data that wearing a cloth mask is doing anything for anybody.

  7. Gerard A Malanga

    Totally agree Chris. Our country lacks thoughtful leadership from those in government and unfortunately the ” medical experts.” So many unsupported statements and fear mongering WITHOUT science to support it ! From masks, to the models, ventilators AND the crazy notion that a vaccine is the answer.
    Looking for property in Sweden soon !!!

  8. Tom H

    Dr. Centeno: I am interested in knowing if the chart comparison of deaths per day would look the same if shown alongside two charts comparing deaths per day per 1000 people. Would that lead to the same conclusion that Sweden’s approach gets a country to about the same place as that taken in the United States. Thank you, Tom.
    PS., my shoulder pain fully subsided about the time the shutdowns started (stem cell and PRP injections last August). I “tweaked” the shoulder about two months into the shutdown and now feel the injuries you diagnosed, but far less pain. Tom

    1. Chris Centeno, MD Post author

      Tom, great to hear about your shoulder. I’ll be happy to pull apart death per capita at a later date. Just looking at today’s data, Sweden had 4.8 deaths per million and we had 2.45. However, that may not be a fair comparison, as for several days Sweden reported 0 deaths per million. On Jun 18th their rate was a little more than 1 per million. The issue is that since they only have 10 million people to our 330 million, there are days that they have very few or zero deaths, whereas our lowest death toll per day (reported last week) was 267.

  9. Nancy B.

    The lethality of Covid isn’t the only standard one should use for judging the impact of this virus. What I am seeing lately is news that approximately 20% of infected individuals become ‘long haulers.’ Their Covid symptoms seem to wax and wane for weeks to months after the infection supposedly has cleared. It is too soon in this epidemic to know how long this phenomena will persist. And even this symptom doesn’t account for all the other damage Covid can do to other body systems even if people survive.

    I am somebody who is afflicted with ME/CFS, where there is no effective treatment. Having this has sapped the life out of me for decades, with no end in sight. I can’t help but wonder if there will be a new, huge sub-set of people with post Covid Chronic Fatigue Symptom. Mortality or survival shouldn’t be the main Covid considerations–one can ‘die’ little by little over time via the aftereffects–and I think it important to factor this in.

    1. Chris Centeno, MD Post author

      Nancy, I saw the Huff Post article. There is no scientific data suggesting that 20% of those diagnosed with COVID have long-term symptoms. That’s what what one woman thought based on Facebook groups that concentrate patients. That patient’s claim of a pulse ox of 88% told me everything I needed to know as a physician. That’s likely why the ER doctors keep sending her home as a pulse ox of 88% is pretty darn normal for COVID where patients walk into ERs with O2 sats of 60% (called happy hypoxics).

  10. Russ

    Thank you Chris. It bothers me that many of us from the least educated to supposedly the most educated use the term “vaccine” with the presumption that the mere mention of the word triggers in our minds a reflexive and immediate assumption that vaccines are “safe” and “effective”. The only problem becomes how fast can we create one, or logistically how will we deploy their use over the population, possibly using the military, or other considerations. In regards to previous vaccines that are encouraged for use, my understanding is there has never been a study done where the control group has not taken any vaccines at all and then compare the outcome of that group to another group that takes the vaccine being studied. We are not using a true placebo, say a saline solution or some other inert substance. The placebo group is subjected to many of the same adjuvants and preservatives that the real vaccine subjects are exposed to minus the active portion of the vaccine, so it’s not a true placebo. Is that a quality study? Aren’t these so-called studies or clinical trials performed by the manufacturers? Isn’t that a conflict of interest? You spend a lot of time judging the validity of the various Stem Cell industry participants. You have a good mind and the proper credentials to analyze good scientific practices where we might be able to draw the proper conclusions. Chris, have you ever examined the methods that been used in previous vaccine trials or studies so that you could comment on the integrity or scientific value of the results that they report.

  11. Nancy B.

    Chris, in response to your reply to my comment, no I didn’t get my information from the Huffington Post or Facebook. I got it here and on the national news; https://www.medpagetoday.com/infectiousdisease/covid19/86482

    The point I wanted to make is that Covid survivors can have lingering effects (of all kinds) which don’t make it as benign as some may think. As to the legitimacy of 20% affected, that isn’t a well established percentage and will probably change with time and experience. As for the oxygen saturation comments, I don’t know why you are bringing that up except that it is a common indicator of Covid infection.

    1. Chris Centeno, MD Post author

      Nancy, a news article with quotes is not a scientific citation. It’s just somebody’s opinion crafted and organized into a story. This opinion says that the symptoms of COVID can last for weeks. Yep. None of that has anything to do with what you originally posted, that 20% of COVID patients had long-term sequelae.

  12. bob swenk

    Good common sense summary- when you start with “there is no clear and unified U.S. public health goal ” … unified maybe no, but clear yes- the clear purpose of recommended policy was to “flatten the curve” and not overload the hospital systems. The reason that this policy does not seem clear is the continuous media barrage “oh no, not another case of covid…” as you so well have illustrated.

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