If you read enough articles and listen to enough podcasts on our evolving situation, one incontrovertible fact quickly takes shape: Barring an unlikely miracle, there are no (zero) good solutions to our current crisis. There are only a series of bad solutions, and what our states, the country, and the world will ultimately have to do is try and weigh out which is the lesser of all bad solutions.
Ultimately, as we all know, it’s going to come down to decisions that will pit the economy versus public health. Over time, as the sinking economy takes a toll on public health itself, the economy will eventually start to win out. Things will slowly start to reopen, and at that point, countries, states, cities, families, and individuals will have to make their own calculated risks.
Those calculated risks are terrifying right now, and weigh heavily on the public health side because — from the limited data we have — COVID-19 is 10x as lethal as the flu. However, serological tests will probably bring that rate down — limited antibody testing in Germany shows something closer to a .3 percent rate, or 3x the fatality rate as the flu. Will that be an acceptable rate for Americans?
I don’t know. We still have an enormous amount of data to collect to process before we can settle on any decisions because we cannot take calculated risks until we know what the calculation is. All we know right now is that around 80 percent of tested people have mild to moderate cases and that the disease hits those who are older or have underlying conditions the hardest.
What’s happening in New York City right now, however, is fascinating in terms of how COVID-19 patients are being treated. This chart right here is blowing my mind.
There’s video here of the Times speaking with a number of doctors in NYC, but the takeaway is that doctors are now rethinking how they treat COVID-19 patients. In the beginning of the outbreak, when patients came in with low-oxygenation levels, they were quickly intubated and put on a ventilator. Outcomes of patients on ventilators, however, are not great. Doctors are now trying new strategies, specifically something called “proning,” which is giving patients oxygen and turning them over on their bellies. It’s working.
At Lincoln Hospital in the Bronx, Dr. Nicholas Caputo followed 50 patients who arrived with low oxygen levels between 69 and 85 percent (95 is normal). After five minutes of proning, they had improved to a mean of 94 percent. Over the next 24 hours, nearly three-quarters were able to avoid intubation; 13 needed ventilators. Proning does not seem to work as well in older patients, a number of doctors said.
That’s why intubations are only increasing by 21 a day now. That’s why it doesn’t appear that a ventilator shortage will arrive in NYC. It’s also presumably helping to lead to a decrease in deaths. On Friday, there were 639 deaths in NYC; on Saturday, 398, and on Sunday, 326.
That drop in deaths, according to Governor Cuomo, correlates with the drop in intubations.
The drop in the number of new deaths across the Empire State correlates with other declining measures, particularly the falling number of intubations.
“When we talk about the number of deaths, those tend to be people who have been intubated for the longest period of time,” Cuomo said on Saturday. “This is a very good sign that intubations are down.”
Obviously, none of this means we’re out of the woods by any stretch, and we won’t be until there is a vaccine. However, it does show how much doctors have learned about the disease in only a month. When governors start easing restrictions in another month, doctors will know even more, and so while we’re probably never going to be able to really control the spread of infection until there is a vaccine, information like this is exactly what infectious disease experts had hoped for when the country went on lockdown: Not that we’d be able to snuff out the virus, but that we’d be in a much better position to manage it. Every single day, we get a little better, and while that might not prevent the spread, it may mean that thousands more people who contract the virus will not die.
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