Fudging the Coronavirus Numbers?

Deborah Birx, White House coronavirus response coordinator, shows charts 

on death estimates related to the coronavirus pandemic.

The Washington Post reports that experts do not know how the White House estimated that there would be 100,000 to 240,000 coronavirus deaths in the US. The WaPo writes:

“Leading disease forecasters, whose research the White House used to conclude 100,000 to 240,000 people will die nationwide from the coronavirus, were mystified when they saw the administration’s projection this week. The experts said they don’t challenge the numbers’ validity but that they don’t know how the White House arrived at them. White House officials have refused to explain how they generated the figure — a death toll bigger than the United States suffered in the Vietnam War or the 9/11 terrorist attacks. They have not provided the underlying data so others can assess its reliability or provided long-term strategies to lower that death count.”

In view of the refusal to provide the basis for the estimate, the most likely explanation is that the president grossly exaggerated the death estimate so that when the total comes out to be significantly less, he can claim he performed a miracle and then get re-elected.

The next most likely explanation is that the president took out his sharpie and drew a curve that looked good to him, like he did with hurricane Dorian last year.

The president analyzing and projecting the course of a hurricane

There may be other explanations, but they are not immediately clear.

What is Involved in Being on a Ventilator

There hasn't been much detail about what ventilators are, how they work and are used. After some rummaging around the interwebs, the answers that come back are quite unpleasant. If you need to go on a ventilator, you are extremely sick and in deep trouble. I wish the situation was not so  unpleasant. Here's some info from various sources.

“A ventilator, also known as a respirator or breathing machine, is a medical device that provides a patient with oxygen when they are unable to breathe on their own. The ventilator gently pushes air into the lungs and allows it to come back out like the lungs would typically do when they are able.

In order to be placed on a ventilator, the patient must be intubated. This means having an endotracheal tube placed in the mouth or nose and threaded down into the airway. This tube has a small inflatable gasket which is inflated to hold the tube in place. The ventilator is attached to the tube and the ventilator provides “breaths” to the patient.

If a patient is on the ventilator after surgery, medication is often given to sedate the patient. This is done because it can be upsetting and irritating to the patient to have an endotracheal tube in place and feel the ventilator pushing air into the lungs. The goal is to keep the patient calm and comfortable without sedating them so much that they cannot breathe on their own and be removed from the ventilator.

Patients who are not able to be removed from the ventilator immediately after surgery may require weaning, which is a process where the ventilator settings are adjusted to allow the patient to attempt to breathe on their own, or for the ventilator to do less work and the patient to do more. This may be done for days or even weeks, gradually allowing the patient to improve their breathing.”

Patients have to be sedated because they instinctively want to pull the tubes out of their lungs. One can imagine how irritating is it to have a tube run through your mouth or nose and into your lungs. Sometimes the tube is inserted through the trachea after a hole is cut through the neck:

“Ventilators normally don't cause pain. The breathing tube in your airway may cause some discomfort. It also affects your ability to talk and eat. 

If your breathing tube is a trach tube, you may be able to talk. (A trach tube is put directly into your windpipe through a hole in the front of your neck.) 

Instead of food, your health care team may give you nutrients through a tube inserted into a vein. If you're on a ventilator for a long time, you'll likely get food through a nasogastric, or feeding, tube. The tube goes through your nose or mouth or directly into your stomach or small intestine through a surgically made hole. 

A ventilator greatly restricts your activity and also limits your movement. You may be able to sit up in bed or in a chair, but you usually can't move around much. 

One of the most serious and common risks of being on a ventilator is pneumonia. The breathing tube that's put in your airway can allow bacteria to enter your lungs. As a result, you may develop ventilator-associated pneumonia (VAP). 

The breathing tube also makes it hard for you to cough. Coughing helps clear your airways of lung irritants that can cause infections. 

VAP is a major concern for people using ventilators because they're often already very sick. Pneumonia may make it harder to treat their other disease or condition. 

VAP is treated with antibiotics. You may need special antibiotics if the VAP is caused by bacteria that are resistant to standard treatment.”

A 2016 research article focused on the sedatives given to keep people from pulling the tubes out of their lungs. This article directly contradicts the statement above that ventilators normally do not cause pain. It sounds like they cause a lot of pain.

“On June, 2016, Klompas and colleagues published an article in the Chest entitled Associations between different sedatives and ventilator-associated events, length of stay, and mortality in patients who were mechanically ventilated, which investigated the effects of different sedatives on ventilator-associated events (VAEs), length of stay, and mortality in patients who were mechanically ventilated. ..... This study raises important questions about the sedation of critically ill patients.

Critically ill patients are submitted to several interventions that can lead to distress and pain, like endotracheal intubation, mechanical ventilation, and central venous and arterial catheterization. Indeed, pain is one of the most common memories from patients admitted to intensive care unit (ICU) and can lead to agitation and its consequences, as accidental extubation, and removal of intravascular devices (1). Accordingly, one of the most used drugs for patients in the ICU are sedatives and analgesics (1).” 

An Irrational Mind Meets Coronavirus

A favela in Brazil

The New York Times reports that Jair Bolsonaro, Brazil's president, has called the virus a “measly cold.” He is the last major world leader who questions lockdown measures. The NYT writes: 

“RIO DE JANEIRO — As coronavirus cases and deaths mount in Brazil, President Jair Bolsonaro has remained defiant, the last notable holdout among major world leaders in denying the severity of the coronavirus. 

Brazilians, he declared last week, are uniquely suited to weather the pandemic because they can be dunked in raw sewage and “don’t catch a thing.” 

Defying guidelines issued by his own health ministry, the president on Sunday visited a busy commercial district in Brasília, the capital, where he called on all but elderly Brazilians to get back to work. 

Then he insisted that an anti-malaria pill of unproved efficacy would cure those who fall ill with the virus that has killed more than 43,000 people worldwide.”

It will be interesting and sad to see how the virus will ravage a country that doesn't even try to deal with it. The US is projecting up to 240,000 deaths if containment measures are strictly adhered to. With no containment measures Brazil is probably going to experience the collapse of its health care system and several million deaths. The next 3-4 weeks will be instructive.

Coronavirus Compared to the Flu Virus

Vox produced an excellent 7-minute video on the difference between the flu and the current coronavirus. This really puts the two viruses in an easy to understand context. Vox writes:

“Covid-19, the disease caused by the coronavirus, can look very similar to the flu. They have similar symptoms — a fever, cough, and the possibility of leading to pneumonia — and even spread the same way. So wanting to compare the two is natural and, frankly, understandable. 

But Covid-19 is very different from the flu. It’s more dangerous in almost every way. 

Not only is it twice as contagious, but the time it takes you to realize you are contagious is much longer. With the flu, the average time it takes you to feel sick from the moment you become sick (called the incubation period) is two days.”