Why the pandemic is getting worse, and how to think about the future



Okay Richard, so there are about forty seven different things we could talk about to unpack the story of how we got here in where we're going, but we chose a few of the big ones to focus on in this episode, so testing was a mess at the beginning. It seemed to get better for a little bit, and now it seems like it's a mess again, so what happened? Well it is complicated. Let's take you back to the beginning of the epidemic when the decided to develop its own test for the corona virus, which is standard practice for them, but honestly they bungled it, and instead of reaching for tests developed in Germany and distributed widely by the World Health Organization the CDC fix this quickly, and they kept trying, but really that turned out to be a big mistake, and it cost us a lot of time. I think the CDC didn't really realize the scope of this epidemic early on federal health officials should have done what South Korea did for instance what they did overseas immediately spur commercial companies to produce large quantities of tests. The US eventually got to that point, but you know it was really late, and now, of course we are in better shape. The US is averaging something like six hundred thousand tests a day or sometimes even more than that, but. It's still far short of the amount of tests that experts say we should be doing. Yeah, and let me ask you about that. Because I've seen estimates that we need to be doing like double or triple, the amount of tests to really control the virus right and you know the number of tests you need to do is really relative to the number of infected people, so we have so many infected people, and that number is growing. We really need to be doing a lot more testing. For example scientists at the World Health Organization uses a rule of thumb that you should have enough tests that your when you get the results back only about five percent or coming back positive. That, means that most of the people are negative, which is what you'd hope what you'd expect right now. Unfortunately, we have states like Texas and Florida in Arizona where the number of percent positive is like seventeen, eighteen or even twenty five percent, and you know the percent positive rates keep going up, which means it's definitely not true as the president has frequently claimed at the cases are only writing, because we're testing more. No seeing more positive cases as we see more tests so okay. Let's talk about the case numbers of it back in April we were at about you know thirty thousand cases per day and now we're. Sixty thousand new cases a day, which is objectively worse and to put that in perspective, sixty thousand people wouldn't even fit in dodger stadium, which is the biggest baseball stadium in this country, so we're talking about you know. Give you a visual image of what we're talking about it right right and you know. Some of that is driven by big outbreaks in places like California, Texas and Florida. Let's talk a little. Little bit more about why cases are up in those places. Yeah, it's complicated series of reasons, but some of it is that we're what we were talking about a little bit earlier. Some of these were in states like Texas and Arizona that were determined to open really early, and we're a lot of people including politicians thought you know starting. Their economies was more important than being really cautious about the virus. Could also be other stuff at play here because you know it is summer, and those are places that very hot, so more people are spending more time in air conditioning that is to say indoors and one thing we know about this virus is spread more likely indoors among people who are stuck together for at least fifteen minutes or longer in an indoor space. Yeah, honestly like this idea of being indoors is something I've been thinking about. Because I'm looking ahead right and we're looking at the fall in the winter when you're going to have the exact same thing happening all over the country like more people forced indoors. That correlates with of course, the beginning of seasonal flu, circulating some people in the hospital. That kind of stuff right it's going to. We're going GONNA have both epidemics happening at once. It's going to be a real mess. Okay, let's talk a little bit about mortality or people dying from the disease, so the president and others have pointed out in the last few weeks that the numbers of people dying per day are down from early on in the pandemic, and that is true back in mid April. There were days where we had well over two thousand people dying each day, and in the last week or so the US is seeing more like hundred people dying every day on average, although that number seems to be rising again. Let's talk about a few reasons why that could be why we're seeing fewer deaths now than earlier right well, certainly, one of the biggest reasons is not the biggest reason that the death rates are so low now compared to the spring when New York City got clobbered as you recall is nowadays the viruses infecting mainly younger people, and they just frankly less likely to die in Arizona for instance of these days, half the cases are in people aged twenty to forty four years old and only. Only eleven percent of cases and people over sixty five, and of course people over sixty five, or really at the highest risk of death, and you know that that shift younger age groups is both good and bad. The good part diseases hitting a population that can more easily survive, though we should say some people do die should bad part is that the spread is accelerating and putting vulnerable people at higher risk, because now the virus is traveling far and wide and putting more older people and. And people with underlying health conditions in harm's way right and you know one thing to note though is that especially in the younger demographic? This is where we see a lot of the huge racial disparities up, basically which young people are surviving and dying a paper out of Harvard June showed that in this twenty five to thirty four age group, the mortality rate for black people was seven times more than for white people really matters. Who are the those young people are right? It absolutely does. Does the overall risk of death is very very low in this age group, but it does absolutely hit some people harder than others, particularly because more people of color are at risk for contracting the disease because of their jobs, they have to be out and about and also underlying health conditions may also be playing a role here. Yeah, so it appears more young people are getting sick. Fewer of them ultimately die, but to be clear. Young people do get very sick and die from the virus. So that's one reason we're seeing fewer deaths right now. Compared to the beginning of the pandemic as far as why the numbers of deaths don't seem to be matching up with the increase, in cases, yet is partially due to the fact that deaths are what we call a lagging indicator Derek Thompson at the Atlantic wrote a really nice piece on. This will make sure to put in. The episode notes for Richard Let's talk about that a little bit right. Yeah, it's a very plainly put. There's a gap in time between the day someone test positive until the day the either recover or unfortunately die, and then of course. Course there's another lag in which that death is reported health officials. So what you're seeing now. It really in-depth really reflects people who got sick. You know two or three weeks ago or even longer than that, so that's one reason why deaths have not followed in lockstep with a big spike in cases. Yeah, and then there's also this thing called lead time bias right right, and that's basically a phenomenon where data can make it seem like something new is happening, but actually just about how you're collecting. The data with the increases in testing. We've seen in these past few months. We may simply be detecting more this. This virus earlier in people than we did before, people may have been really sick and not get tested to the hospital now people are driving up in their cars right and doing okay, and so there earlier on in the course of disease, but that doesn't really change the percentage of cases that wind up being fatal. It will just take longer than it did early on in the epidemic for those fatalities to show up and of course Richard there a ton of complications that we didn't have time to get into more hospital capacity ventilators, so what sheep the hospitals in actually plays a role in who survives and who? Who doesn't and then you know even though there isn't a cure, of course, doctors have had more time to learn how to treat this disease, so we don't have a lot of data on this yet. In the United States, but it seems like perhaps more people are surviving this disease than right in the beginning right, I think that is clearly the case and you know as long as hospitals aren't totally overwhelmed with patients. They can make use of what they've learned so far to improve treatments. I'll give you just one example steroids which are used to reduce inflammation. Turn out to be quite useful in many instances. So Richard I'm curious like overall how you're feeling looking at where we are compared to. Let's say April, there are ways in which I feel like are a lot more prepared like we understand the virus. A little better were obviously farther along on a vaccine and some potential treatments, but we still don't have adequate testing. Cases are at an all time high. We're heading into the fall, which means we're GONNA, have this consolidation of cold and flu and corona season, plus the schools potentially opening up your really cheering me up here. But maybe the most concerning fig just to keep you just to keep you down. Richard is that I? Just don't feel like we are a country with like one central goal to fight this thing together. Yeah well I think. I would agree with that first off a corona virus vaccine is not going to help much at least not in this coming flu season. Even if one is amazingly enough approved by the end of the year, we'll take really a long time to vaccinate enough people to make a big difference. What really could help would be a good flu vaccine. I think only about half of Americans typically get the flu shot every year and public health officials say if they can dramatically increase that it would really help a lot against this sort of one two punch that we're going to have to be confronting. But you're right about the country, not working well together on this starting with leadership both at the federal level, and also tim states, but also including people who are ignoring all the guidance that's going all the good advice from scientists and people are hesitant to get vaccines because of misinformation. As for testing you know by the fall. There will be some help. I expect doctors offices should have a supply of Rapid Kobe tests. They're like rapid strep test, or whatever the aren't super accurate, but they can help relieve some of the testing bottleneck and sort of looking down the line a little bit farther. Scientists are also working on next generation of tests that you might even be able to do. Do at home and you know those might be ready sometime. Next year next year seems pretty discouraging, doesn't it? It's pretty far off, but you know I'm pretty well resigned to the fact that we're going to be in this for the long haul. covid nineteen is going to be with us for years so even technology that seems far off right now. We'll still be needed

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