A Tale of Two Diseases

Today I would like to make some comparisons between COVID-19 and Influenza. For simplicity, we will look at data from the Southern Nevada Health District, which serves Las Vegas and surrounding communities.

This page will give you SNHD’s flu reports. Flu season is generally considered to run from October to March or April here. Let’s call it 6 months. Please note that when they refer to the week number, they mean for the year. So the first week of January is week 1. It is true that we never know exactly how many cases of the flu there are (the CDC estimates tens of millions of cases and tens of thousands of deaths nationwide). That’s because a lot of people recover at home without tests or hospital visits. However, if you look at the latest report, you’ll see that 47 people died of the flu this flu season. This number is pretty close to accurate; someone is either dead or they are not.

Now let’s move over to SNHD’s COVID-19 reporting. Just a reminder, COVID-19 is short for Coronavirus Disease 2019, it’s not the 19th anything. More about the basics here, but back to SNHD. We reported our first case March 5th, then our first death on the 16th. As of April 29th, we have 3979 confirmed cases. This needs to be treated as a minimum, because there simply hasn’t been enough testing. A lot of people are walking around with mild symptoms or none at all, blissfully unaware that they are spreading disease. Again, despite the lack of testing, there’s another number that is less prone to distortion.

The fact I want to point out is that as of April 29, Southern Nevada has had 202 deaths from COVID-19. In 6 weeks, 202 COVID-19 deaths, compared to 47 influenza deaths due to influenza in 6 months. Same population. Same location. Same risk factors. That’s four times as many deaths in about a quarter of the time.

In a nutshell, that is why we need to take this thing seriously.

I have become aware of voices on the Internet saying we shouldn’t waste time on a vaccine, but go for a cure. I would like to remind those folks that we never did get a cure for measles, polio, or rabies, just a vaccine. Even tuberculosis had a vaccine decades before we had a cure.

Stay safe out there. Wash your hands. Don’t stand too close to other people. Wear your mask in public. And remember that the economy is meaningless if you’re dead.

Ripple Effect

As I write, over 16 million people have filed for first time unemployment benefits in the last 3 weeks. There will be many ripples from the COVID-19 pandemic, and this is a good place to start.

First, I’d like to point out that at best this is a minimum number, and may in fact be a wild underestimate of the people who have lost their job in the last 3 weeks. Many state systems were slammed by not just 2 or 3 times normal volume, but 20 or 30 times normal volume. Turns out that many of these systems work using an ancient operating system called COBOL. For perspective, my late father used COBOL in the 60s and 70s. As if that’s not bad enough: “Still more people likely won’t qualify for unemployment benefits: parents who have to stay home with school-age kids, people quarantined because they’re at high risk for COVID-19 and new graduates who can’t even look for work.” That number probably doesn’t include most “gig economy” workers either.

Another direct ripple: those 16M+ people now don’t have health insurance. In a pandemic. I talked about this briefly very recently. COBRA is still a joke. If this isn’t a wake up call that we need true universal health insurance — not a patchwork of employer based benefits, not the “mandatory insurance” that Romneycare and Obamacare got us, but true “your citizenship is your insurance” universal health insurance — I don’t know what is. A lot of people are going to get a bill for tens of thousands of dollars just to keep from dying. And unlike diseases that can be traced to lifestyle, you can’t easily blame the victim. Keep that bill in mind, we’ll get back to it later.

A public health ripple: those unemployed people without insurance aren’t going to the doctor. They aren’t getting help for their small medical problem, so it’s becoming a bigger, more expensive medical problem. And if the problem turns out to be a communicable disease, they’re making other people sick. So yeah, the uninsured are a problem to your health.

Another ripple: people without jobs are having a hard time paying their rent or mortgage. Some of the renters who can’t pay in turn mean landlords can’t afford the mortgage. Sure, many areas have placed a moratorium on eviction and foreclosure, but that’s not a permanent solution. The forbearance plans in place still mean someday everything owed must be paid. Not meaning to sound insensitive, but how far do we kick the can down the road?

This ripple exposes another truth: over half of Americans had under a thousand dollars in savings just a few months ago. That hasn’t gotten better. With surging unemployment, it’s about to get worse.

Another ripple strikes the economy. About 70% of our economy is based on consumer spending. Consumers without jobs and without savings don’t spend a lot of money. Expect a drop in GDP.

And here’s where our ripples crash into the rocks. Eventually — not today, maybe not this quarter. Eventually, those rents and mortgages must be paid, or foreclosures and evictions will happen. Eventually the past due bills will grow including the medical debt, and bankruptcies will happen. Eventually we will have to confront the ways our health care system is not working. Eventually we will have to look at whether we can sustain an economy on services. Eventually we will have to come out of our shelters and see what is actually left of our economy.

Good luck, and keep your hands clean.

Lessons from a Pandemic

Some of these are things we are now learning. Some are things we should have long since learned but are now becoming obvious.

We should be taking medical advice from medical experts, not politicians. Insert the Fauci Facepalm here. Some of our Governors are remarkably well informed, because they choose to be informed by medical experts. Gov. Cuomo’s presentation Sunday was particularly level, and riddled with facts. Gov. Sisolak is doing the best with what he’s got. I wish him and NV Attorney General Aaron Ford much luck making banks follow rules.

Employer based insurance was [still] never going to cover everybody. Long time readers know I’ve been beating this drum for over a decade. First, it’s never going to cover all children. Second, it inhibits the growth of small business. And finally, there’s the unemployed. Which brings me to….

COBRA is [still] a bad joke on the newly unemployed. I said it years ago. People are now saying it on the radio!

The uninsured aren’t somebody else’s problem, they’re everybody’s problem. Cancer isn’t communicable, nor diabetes, nor hypertension. But TB sure is. And now, COVID-19 sure is. There’s a couple of problems with the uninsured in an epidemic or pandemic. First, people who don’t think they can afford a doctor are not going, not getting help, probably still going to work (because they can’t afford not to work, duh), and most importantly infecting other people. So yeah, now it’s your problem. Oh, I said a couple problems, didn’t I? All those unpaid costs are going to drive your medical costs up. The hospital isn’t getting paid for a bunch of critically ill patients? Your bed cost goes up.

It turns out a lot of jobs can indeed be done from home. I’m hearing radio shows from home studios, seeing TV shows done via videoconference. There’s a lot of “important meetings” that can now be done remotely, or not at all. That is a trend I hope sticks. Of course, this may mean that business travel is in for a longer term slump, since it’s easier, safer, faster, and cheaper to teleconference to San Jose than fly there.

It turns out a lot of jobs are essential. We all knew medical personnel, firefighters, and the like were essential. Some of us in reality-land also knew that “environmental services” (cleaning staff) were essential — I can’t keep people from getting diseases in a hospital if the hospital isn’t clean. Maintenance staff? Essential. Supermarket staff? Essential. Oh yeah, and that “kid” who makes minimum wage making your burger at lunchtime when an actual “kid” should be at school? Essential.

$1200 a month isn’t a lot of money. I don’t know if Congress actually considered this, but with a minimum wage of $7.25/hr, 40 hours of minimum wage a week for 4 weeks is $1160. Round that up to the nearest $100, and that’s $1200. So if you’re kvetching that you can’t pay your bills on that, think about the “essential” employee who does just that. More on what Congress did here.