Archives April 9, 2020

COVID-19 Pandemic: Optimistic Heart and Worrying Head

by Barry P Chaiken, MD


Every day around noon Governor Cuomo gives his daily briefing on the state of the pandemic in New York. His recent remarks express a cautious optimism that the outbreak is slowing as indicated by a smaller increase in the projected growth of positive COVID-19 tests and admissions to area hospitals. The death rate continues to climb but that is expected as deaths trail hospitalizations by two to four weeks.

Based on the data coming out of New York, I should be optimistic. The pandemic is peaking. The worst-case scenario predicted by models are proving wrong. The 2.2 million deaths modeled in a U.K. study just a few weeks ago shrank to 100,000 to 240,000 deaths last week, as announced by Dr. Deborah Birx during the administration’s daily briefing, to “just” 60,000 to 80,000 deaths announced in this week’s briefing.

Yet with all that good news I just cannot shake my feeling of worry. In addition to the briefings, I review the various corona virus maps put out by the New York Times. They tell a different story. The pandemic is nowhere near the peak in New Orleans, Detroit, Houston, Chicago, Philadelphia and other population centers. While Los Angeles and San Francisco successfully slowed disease spread, how long will it last? A Chicago jail is now a recognized hot spot and many researchers fear prisons will be a petri dish for COVID-19 spread. Correction officers are increasingly calling out sick.

Two other maps worry me. One shows the distance people traveled at various time periods in March. Large numbers of counties, mostly in the South, show did not start to limit their travel – practice social distancing – until the last week of March. This clearly indicates that the virus was spreading widely during this time. The second map of concern is the increase in cases in rural areas, many of which have a very small number of ICU beds, ventilators, and medical staff. As the number of cases increases in these areas, many of these patients will not receive the proper care they require to survive.

We know that comorbidities play a major role in hospitalized patients surviving a COVID-19 infection. Scanning obesity disease maps produced by the CDC show disproportionately high rates in southern states and rural counties. Obesity is usually associated with diabetes and heart disease. Therefore, it is expected that mortality rates will be higher in these areas than we have seen in New York or Washington State where chronic disease is less prevalent.

With our focus on what is happening in New York, many are missing what is happening elsewhere. Less than 15% of the country lives in and around New York City. That leaves over 300,000,000 citizens following a different pandemic curve, and we do not know what that curve looks like in most locals. While the curve appears to be flattening in New York, case rates may be accelerating in Minneapolis, Denver, and rural Pennsylvania. Without widespread COVID-19 surveillance testing, we have no idea where and how quickly and widely the virus is spreading.

Now you know why my heart hopes that the recent optimistic mortality projections are correct, but my head worries that they may be way off.

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