Reg's Blog

Senior and Post-Acute Healthcare News and Topics

Coronavirus: Perspective Required

Yesterday I began advising healthcare organizations to pull-out their disaster preparedness plans (required by federal code) and their pandemic policies, reviewing the same, etc. for an almost certain, foretold Coronavirus outbreak.  I was not alone in my advice as my email filled with updates across various trade publications issuing similar advisories.  As a colleague of mine was apt to say: “prior proper preparation prevents poor performance”. Wise words.

When I got home last night and turned-on the television, the programming had barely moved from the early morning cycle.  It was Coronavirus all the time.  The news media was cyclical, channel to channel covering the same subject matter with the same experts and pundits in the same locations.  And, to make the whole news mantra even more sickly, the stories included snarky political spin (from both sides).  It is after all, an election year and nothing feeds politics like a good ole’ crisis.  Think Bush’s hurricane Katrina or Carter’s OPEC embargo and gas prices/waiting lines (wow, am I dating myself).

As I was watching the news and flipping from outlet to outlet, I was struck by the apocalyptic tone.  I have been on the planet for six decades and for all six, facing imminent demise (along with the rest of humanity).  There has never been a period in my lifetime where doom wasn’t omnipresent.  Consider the following from my history (some of you may share parts or all of this journey).

  • As a kid, I was taught to “duck and cover” in school.  We were warned and trained to be vigilant about pending nuclear war.  I doubt that ducking under our desks would have saved me and my classmates.
  • In the early 80s, AIDS arrived and boy was it scary.  We were afraid of blood, gay people, and suspect drug abusers.  Catch it and death was certain.  Isn’t Magic Johnson still alive?
  • Finally, in the early 80s, we no longer had to worry about nuclear apocalypse or all-out war at our front-door.  While the threat does remain, the doomsday clock is also impacted today by climate change – not so in the early 90s.
  • Plagues and disease of one form or another has always threatened my and my fellow men and women’s existence. Aside from the various influenzas seasonal throughout my life, we encountered swine flu and bird flu, both lethal.  There’s been SARS, AIDS, Zika, Ebola, and the list goes on (world-wide pandemics according to WHO – Worldwide Health Organization).
  • Today, some oldies are returning, once eliminated or nearly eliminated.  The measles and small pox have returned.  Both primarily due to a cultural shift in public health focus and vaccination priority.

To the point: I’m still here and so are most of my family and friends.  Now, I’m in no way trying to minimize the importance of containing and understanding the health risks of Coronavirus.  I am saying that the 24 hour, in my (and your) face news cycles, and the need to trump (not that one) each story with a bigger “get” has us perhaps, unnecessarily on-edge. There is a great song by Don Henley that spells it best: “Dirty Laundry”.

As readers and fans of this site know, I am a health care guy and an economist.  For the past thirty-five years, I have been in and around health care and health policy as an executive and a consultant.  The economist in me favors numbers and analysis.  Thus, I have sought to put Coronavirus and where it is today, into a global perspective.  Yes, it is serious but so are lots of things, many presenting more direct risk of death.  Consider the following.

  • Coronavirus has infected 83,000 people world-wide and killed 2,800 as of today.  That is a mortality rate of 3.37%.  The majority of deaths are in China and other countries lacking in first-rate healthcare access.
    • Worldwide influenza deaths approach 500,000 annually (source: WHO)
    •  1.25 million people die in automobile deaths across the world, annually.  That’s 3,287 deaths per day! (source: US Dept. of Transportation)
    •  36,000 die in automobile crashes in the U.S.  If we include folks hit and killed by cars as pedestrians, the number exceeds 40,000.  Daily, auto related deaths in the U.S. amount to an average of 115.  This equates to a fatality rate per 100,000 US citizens of 11.18 and per 100,000,000 of 1.13. Yikes! (source: US Dept. of Transportation)
    • US hospital acquired infections account for 99,000 deaths per year from 1.7 million infections!.  This a mortality rate of 5.8%.  I’d almost rather take my chances with Coronavirus than being admitted to a US hospital! (source: Centers for Disease Control)

I could go on with the list but I think readers will get the point.  As we continue to listen to the news, boil our panic “stew”, seek surgical masks that are ineffective, and begin to self-diagnose our seasonal respiratory colds as something far worse (unlikely), consider the risks associated with getting a hospital acquired infection (sorry to all of my hospital colleagues).  Worse yet, consider the risks of driving to the hospital and then being hospitalized.

My point in this post is simple.  Take a deep breath or five.  Humanity  has been on the brink of the apocalypse before and will always remain there.  We ignore real risks like driving as “ordinary and safe” when not really but fret and panic about a respiratory virus that isn’t as potentially lethal as driving a car. Too many of us believe still that the annual flu vaccine if we take it, will make us sick yet the annual influenza variant is far more lethal than Coronavirus (based on mortality rates).  At least most influenzas have a vaccine.  Also with a vaccine sits the measles, increasing again worldwide.  Its lethality is known but due to an uptick in junk science, people are shying away from vaccines and thus, causing a re-birth of a possible pandemic.  Again, we teeter back to the apocalypse.

An old and treasured Irish proverb states: “Tomorrow is promised to no one”.  For an incredibly long list of reasons, I believe this to be true.  Top among the reasons list isn’t Coronavirus.

February 28, 2020 - Posted by | Policy and Politics - Federal, Policy and Politics - Wisconsin | , , , , , , , , ,

4 Comments »

  1. Well, Reg, I have the greatest respect for you but in this case, you are mistaken to conclude this is minor. First of all, the spread throughout the world is just beginning. Second of all, the spread is very easy because many who have COVID 19 are asymptomatic, thereby spreading to others unwittingly.

    You say “only 3.37%” but if 50 or 60% of the entire world population gets this, then the case fatality rate (which is really what you cited, not the “mortality rate” applied to global population is a really large number of people who die out of the total infected.

    Also, containment is not possible, they can only slow or delay the spread which is invevitable since it’s already “out there” in the “wild” and spreading globally. this is not like SARS or MERS because in this case, people who are infected do not always show symptoms. In SARS the case fatality rate was over 50% for the elderly who got it. The case fatality rate for the elderly (who are in the SNFs who many who read your advice care for) with COVID 19 is likely to be much, much higher than for the general case fatality rate for any of these outbreaks.

    Yes, everybody wishes to prevent panic, but this is very serious. It allows for patients who are supposedly “cured” to get re-infected and then Chinese physicians report some of these re-infected patients have damage to internal organs, heart, etc. and then many die.

    This is not something that is just going to go away, or that has been hyped. I thought it was hyped when first data came out, but it is increasingly clear that this is very spreadable, and even a low percentage can kill massive numbers of people. Even the 1918 flu pandemic has a (in your terminology) a”low percentage” of 2.5% or so, which actually is a very high case fatality rate (flu is much, much lower than that!) and killed over 50 million people globally, and possibly many millions more.

    This is not something we need to minimize. It is very serious. Not “apocalyptic” but very serious!

    Comment by Ron Panzer | February 28, 2020 | Reply

    • Mr. Panzer;

      Thanks for the comment and while we mostly agree in many respects, my intent was not too minimize the virus but to downplay the hysteria. Many, many health experts are attempting today, to do the same. The news has over-cooked this. Consider the following;
      * The US mortality rate for influenza is 6.9%
      * The preliminary mortality rate for Coronavirus is 3.37% (and yes, my phraseology is correct).
      * The WHO projects the case mortality rate for Coronavirus to be below 3% worldwide, with a strong possibility that the realized rate will be below 2%.
      * The CDC has stated that the infectious rate is lower than influenza. It is not apparently as virulent and/or as disabling as RSV and in the end, may have about the same lethality (though RSV deaths are under-reported).
      * The vast majority of Coronavirus cases are or have, fully recovered.

      My point in the post was not to minimize the virus and its associated health risks. I said so numerous times. My point was that the context was lost. Driving a car on a US highway carries a high degree of mortality risk, increasing the more one drives and the further one drives. We think nothing about getting behind the wheel. Today, in the US, the probability of death due to a hospital acquired infection is greater than the probability of dying from the Coronavirus. HAI risk isn’t being covered by the news 24/7. Shouldn’t it be? Of course not – the coverage would create mass panic and distrust in our healthcare system. Fear escalates from the unknown and the spread of misinformation or incomplete information. I believe that is what is going on with Coronavirus today – fear resultant from misinformation and incomplete information spread across common news sources.

      Comment by Reg Hislop III | February 29, 2020 | Reply

      • Hi Reg,

        Yes, we should not panic.
        Howver, as a nurse who cares for patients I would not that the statistics that apply to the general population are not the same as those that would be found in a SNF, for example. Everyone agrees that those with chronic conditions, or multiple chronic conditions, will likely be hit harder with this new virus than others. That is the SNF population of elderly, for the most part.

        How easy will it be to “quarantine” patients in a facility that is full with patients, some with 2 to a room or some with more.

        What steps should SNF administrators take in this case?

        How will staff protect themselves in a SNF, practically speaking?

        If staff become infected, this will create shortages of staff to care for the patients. How to manage that problem?

        If cases of COVID 19 actually occur in the SNF, what PPE will staff be mandated to wear?

        this would be helpful in a discussion of COVID 19.

        Those of us who are on the frontline caring for patients need to take practical steps to manage this new infection that could and likely will, infect some of our patients.

        Comment by Ron Panzer | February 29, 2020

      • P.S. And yes, you encourage managers to pull out their disaster-prep plans.

        Administrators need to re-evaluate their plans:

        Do these plans address the specific concerns of COVID-19 where staff as well as patients are likely at some time to acquire the infection? these may need modifications, and what those modifications should be need to be discussed and solutions found for very challenging circumstances.

        Time will tell. Thanks for all your updates!

        Comment by Ron Panzer | February 29, 2020


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