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We’re only at the beginning of Covid-19 outbreak and it will get worse, researcher warns

By Peter Bergen

Infectious disease expert Michael Osterholm, who has been warning for a decade and a half about the possibility of a global pandemic, said the coronavirus we’re fighting is at least as infectious as the one that killed an estimated 50 million people in the 1918 flu worldwide outbreak.

Michael Osterholm

He said we’re only in the second inning of a nine-inning contest, with the possibility of as many as 800,000 deaths or more in the U.S. over the next 18 months.

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Osterholm also pointed to a shortage of chemical reagents that are necessary for widespread testing for the virus and said that the CDC’s low public profile in this pandemic in the U.S. has been a “tragedy.” He decried the lack of a national long-term strategy for the pandemic and noted that there are real questions about the efficacy of the antibody tests that are being developed to detect if people have been exposed to the virus.

Osterholm, who founded the University of Minnesota’s Center for Infectious Disease Research and Policy, warned in 2005 that “time is running out to prepare for the next pandemic,” a point that he expanded on in his 2017 book, Deadliest Enemy: Our War Against Killer Germs.

He discussed the coronavirus at a recent online event organized by the New America think tank with me. The discussion was edited for length and clarity and updated with new information.

MICHAEL OSTERHOLM: As we learn more about the transmission of this virus, it’s very clear that it is at least, if not more, infectious than even what the world experienced in the historic pandemic influenza of 1918. And I’m convinced that this pandemic is following what we experienced in 1918.

While I don’t expect the Covid-19 pandemic to be exactly like that of 1918, the epidemiology tells me that this first wave of illness is, in fact, just the beginning of what could very easily be 16 to 18 months of substantial activity of this virus around the world, coming and going, wave after wave. Robert Redfield, the director of the Centers for the Disease Control (CDC) commented Tuesday that he believes a 2020-21 winter wave could be worse than what we have experienced this spring.

Victims of the 1918 Spanish flu were cared for in large, make-shift hospital wards.

Will the next waves get bigger like they did in 1918 when there was a spring peak and a fall peak?

We don’t know that, but it surely is a virus that likely will have to infect at least 60 to 70% of the population before we see a major reduction in its transmission.

I think it’s very hard to realize that we’re first in the first innings of this crisis. A quote keeps coming back to me from Sir Winston Churchill: “This is not the end. It is not even the beginning of the end, but it’s perhaps the end of the beginning.” I think that’s where we’re at right now. You might say we’re in the second inning of a nine-inning game.

We’ve got to consider how we’re going to prepare ourselves for the possibility that some of the cities that have already been hit hard will have peaks some months down the road that may be much larger in case numbers than we’re seeing right now.

For several months, people kept pointing to Asia and saying, “If we just adopt the same response as China or Singapore or Japan, then we could bring this under control.” Finally, people are realizing that these comprehensive — some would consider them even extreme — control measures adopted in Asian nations are starting to show the breaks in their effectiveness.

Singapore has witnessed rapidly increasing transmission occurring in the community. The same thing has happened in Japan, which is now in a state of emergency. What’s even more confusing is what’s happening in China. We are seeing large public crowds in China again.

China is now reporting that most individuals who test positive for the coronavirus are asymptomatic.

Many health experts are very concerned that the Chinese government is not reporting all cases. After more than four months of some of the most extreme population movement limitations in modern history, we’re still seeing transmission occurring inside of China.

And as the Chinese government permits so many people in the Hubei province to go back to work, I’m very concerned that we’ll see increased transmission in other provinces of China. I don’t believe it will ever be as bad as it was in Wuhan in January, but we can’t use Asia as the perfect model for what control measures will work here. We are going to be dealing with Covid-19 on a global scale for months to come, trying our best to suppress it as much as possible.

What is our strategy in the U.S. going forward? At this point, my biggest concern is that we still don’t have a national plan. We have to develop a comprehensive and effective national response to Covid-19.

BERGEN: What should that long-term strategy look like?

OSTERHOLM: The first step is to acknowledge the need for a long-term strategy. We’re so focused on “the here and now” of this issue — the idea of just getting over this wave and flattening this curve. And I agree with that. It’s an immediate issue, particularly if you are in one of the places that’s on fire right now like New York, Detroit, Chicago or New Orleans. But people have handled these local hot spots almost like they were faced with a hurricane that has now made landfall. Now we can get into remediation and recovery from this first round of crisis.

So, the first thing we need is a plan. That’s critical.

The second thing we need to address is: What is our long-term strategy? I believe we have really two choices at the edges and some additional options in between. One choice is to try to lock down our society and economy like Wuhan did. Most of us understand that adopting that approach means we’re not only destroying the economy but also destroying society as we know it.

Despite the outcry for more testing, the process has serious limitations.

The other alternative is to let viral transmission go willy-nilly until it burns through the population. I am strongly against that approach for two reasons. First, that would mean we could potentially experience millions of deaths just in the United States. It would bring down our health care system as we know it; it would mean severely compromised care for Covid-19 patients and fewer care options for anyone else with other serious health issue such as a heart attack, acute asthma attack, cancer or an injury from an accident. So, that is not a viable alternative.

There’s got to be an approach in the middle. I call it “threading the rope through the needle,” where we open our economy and everyday life in a way that is capable of rapidly detecting the emergence of new waves of infection. Then we do whatever we can again with physical distancing to limit the new infection’s spread.

By the way, I find the term “social distancing” unfortunate. It is physical distancing that we need in order to stop the virus transmission. Let’s never social distance. Let’s try in our modern age of the Internet, to do a better job with staying social.

So how do we get the younger, otherwise healthy demographic back to work, a group we know will be at much lower risk of serious disease and death if they get infected? How do we bring a substantial number of these individuals back into society and at the same time try to protect those who have the highest risk of a severe outcome? Remember we have to get them through the next 16 to 20 months, or until we get a safe and effective vaccine.

For those who are vulnerable, it is imperative that we minimize the risk of infection and the likelihood of ending up in a hospital and dying. And please know this approach will never be perfect; some younger people will get sick and even die. But the rate of serious illness and deaths will be many times lower for the young than for older individuals or those with underlying health risk factors.

Our strategy can’t be the outcomes of day-to-day press conferences. It can’t be 30-day plans to “social” or “physically” distance. It’s got to address how we’re going to incorporate day-to-day prevention actions, and what we ask the public to do must be realistic.

For example, everybody wants to do widescale coronavirus testing today. Talking heads without any experience in testing declare, “We’ll test millions of people each week, and then we’ll know who is infected and can follow up.” Very few people realize that the testing community in this country can’t do that. We don’t have adequate international manufacturing capacity and supply chains for reagents, the chemicals needed to run these tests.

The reagent capability — meaning securing those chemicals that are key for running many of these tests, whether you’re testing for virus or antibody — before the pandemic was more or less, adequately supported by a “garden hose of production.” Then Covid-19 came along and the Asian countries, specifically China, demanded a major increase in reagent supplies.

Finally, the whole world caught the pandemic, and now there are billions of people who need to be tested. We need a firehose to meet that demand but we can’t build reagent manufacturing facilities overnight. I urge that whatever we do going forward has to be based on reality. We’re not going to test your way out of this thing when we don’t have tests.

I paraphrase a quote from former U.S. Secretary of Defense (Donald) Rumsfeld who said, “When you go to war, you don’t get to go with what you want. You have to go with what you have.”

So, we’re going to have this reagent issue for some time to come, and we must understand that and come up with a plan based on reality.

BERGEN: What is the role of the reagents in these tests?

OSTERHOLM: Reagents in the test are like the gasoline in a car. For example, if you take a nasal swab from a possible Covid-19 case, you have to extract specific material out of that swab. So, if you don’t have the chemical reagent to do that, you can’t run the test. You just can’t have a swab and walk into a lab and say, “Test this.” For each test, there are chemicals required to run it, and it varies by which kind of test you’re talking about.

BERGEN: You mentioned the 1918 pandemic in which some 50 million people died. I presume that public health generally has improved since then?

OSTERHOLM: I surely don’t want to suggest that the number of people who died in 1918 is the number we might expect with this novel coronavirus pandemic. Today, of course, we have a much larger population globally than we had back then. But I think that the epidemiology is following the trend of the 1918 pandemic, with the exception, of course, that in 1918 those who died were more often in the younger adult age population than we’re seeing today.

We should remember that the current pandemic is caused by a coronavirus and not an influenza virus like was the case in 1918. History will tell if the two act very much the same way in terms of the epidemiology of the diseases.

One issue is that, except for social distancing, we don’t have any other major public health tools to fight the virus. Even if we get effective drugs, which would surely be a godsend, that is not going to stop virus transmission. These drugs, if available on an international level, would lessen the impact of the pandemic in terms of numbers of severe cases and deaths. Transmission will still continue, as most of it is occurring early on in the illness before you would even start taking drugs.

BERGEN: You mentioned the University of Washington model, which seems to have been influential in the White House. But Muriel Bowser, the Mayor of Washington, DC, for instance, is using different models — one from the University of Pennsylvania, to evaluate the pandemic, and she has said that Covid-19 could peak in DC at the end of May. This is a very different conclusion than the mid-April peak suggested by the University of Washington model.

Shouldn’t it be the CDC’s job to come up with a nationally agreed upon model to evaluate the situation? No matter how good these individual universities are, local leaders are essentially shopping around for models that can vary from state to state or federal government to local government.

OSTERHOLM: The CDC’s absence in this pandemic in the United States has been, I think, a tragedy. Yes, we’re all well aware of the fact that there were problems with the rollout of testing early on. But there are some of the best minds in the business in the areas of preparedness and pandemic response at the CDC, and their inaction in coordinating all of these modeling activities in a way that we can synthesize them is really unfortunate. If I could urge any one thing happen today in the federal response, it would be to give the CDC a much more important role at the table than it currently has.

Right now, on the coronavirus task force, there is no primary public health expert member. I think Dr. Anthony Fauci has done an incredible job of representing the infectious disease perspective. I have the highest regard for him and thank God he’s been there. But with regard to the issue of modeling and the issue of surveillance, that expertise is at the CDC.

I’ve come to the point of concluding, let’s throw out all the models. They’re not helpful because they’re causing some to believe the administration is overinflating the numbers of potential cases and deaths. Meanwhile, others conclude the model used by the White House is intentionally underreporting the numbers and they think the administration is trying to downplay this pandemic. It seems that nobody trusts anybody.

I’m from rural Iowa where a lot of very commonsense, smart people live. I think to myself: if I were at the local café, how could I explain what’s going on to a group of people sitting at that table? I’d say to them, let’s just take the following simple numbers.

There are 320 million people in the United States. If half of them get infected in the next 6 to 18 months, that’s 160 million people. The 50% rate of infection over the course of the pandemic is at the low end of my colleagues’ consensus on what we can expect to see given the infectiousness of this virus.

Based on what we know from Asia, from the European Union and from the United States, about 80% of these cases will have asymptomatic, mild or moderate illness but won’t need professional medical care. About 20% of infected people will seek medical care. That’s 32 million people.

Of those, about half will be hospitalized. That’s 16 million people. Of those who are hospitalized, about half will actually require some form of critical care. That’s 8 million people. About 0.5 to 1% of the total number of 160 million infected people will die. So you have the possibility of at least 800,000 deaths in the U.S. over the next 18 months. This is the number of deaths I’m expecting.

If you don’t like the numbers I just used, go ahead and change them however you want. Just provide your justification. We have a long way to go with this pandemic. We just need to make people understand that this is going to be bad until we get a safe, effective and widely available vaccine. It’s a sad commentary about our state of affairs that the number of people who die from Covid-19 in the U.S. ranks as one of the top daily causes of death — on some days it’s been ranked higher than heart disease, cancer and accidents. Six weeks ago, it wasn’t even in the top 60 causes of deaths.

What I’m trying to get people to understand is that a model is just a model, and we’re putting way too much weight on its ability to estimate with precision where this pandemic is going. What we need is a general sense: Is this a Category 2, a Category 5, or a brand new category called a Category 8?

No matter how you slice it, on the most basic back-of-the-envelope estimate, this is a really bad situation. So, we have to be prepared for that.

BERGEN: Is there a world in which we would all be issued nationally recognized status as immune that would allow us to go back to work? Relatedly, would that really work if there are faulty tests?

OSTERHOLM: I’ve seen this idea expressed by a number of people in the past few days. They believe that we just need to have a kind of system where we see if you have been infected using antibody tests. Right now, Covid-19 virus and antibody testing in this country and in some other parts of the world is nothing more than the Wild, Wild West.

Before we can launch on any kind of an immune status national program, we have to understand two things. One is what the test results really mean. Does a positive antibody test mean someone has immunity or not? I think that’s a big challenge. In a low prevalence area for previous Covid-19 infection, which is most of the country, a positive antibody result could be a true positive or a false negative.

These both are important moonshot issues and we need to do the work right now to clarify. We need to invest in developing critical manufacturing infrastructure for reagents and support testing in general. And then, second of all, we have to know what that testing means.

I think there have been a number of health care workers who have been infected or who suspect they’ve been infected, but were never tested at the time. There wasn’t adequate testing available. Today if they could know that they were antibody-positive and there was sufficient data to support that they likely were protected against becoming infected again, then, wow! Think how that would change the picture of health care if 20% or 30% of our current medical staff were already protected. That would give them an incredible peace of mind.

The problem is that we don’t have a national prioritization around this issue.

BERGEN: Why did the US fail to have an adequate supply of personal protection equipment (PPE)? Is it a policy failure, or is it something else?

OSTERHOLM: Well, I think it’s a combination of several things. First of all, we did not anticipate this situation, and when you look at a strategic national stockpile that may have a tiny portion of the N-95 masks needed for the country, that’s hardly a stockpile. That’s not even a good late night stopover.

Right now, we’ve put 50 different governors in charge of the country, and I think many of them have performed admirably. They’re trying to thread that rope through the needle, and they are pretty much on their own.

Logistically, why are governors suddenly entering the private procurement market? As you’ve likely heard many times, we’ve basically directed the 50 states into an eBay-like environment where every state or major city has to outbid every other state or city to get critically needed supplies. That is crazy.

So what we need to do is come up with a standard. Which state should be the highest priority for ventilators and why? Which has the highest priority for PPE and why? And then we should match up inventory with that priority list. If we don’t have enough for each state’s need, then at least there’s transparency. Maybe resources didn’t show up in a particular state, but it wasn’t because that state couldn’t pay the most or wasn’t savvy enough to have a relationship with a private sector company.

Right now I liken the situation to this: we’ve got 50 pilots all landing their planes at the same time all by themselves, and only if they’re prepared to have a head-on collision with other planes do they get the chance to call the air traffic control tower. That’s unacceptable, and that’s what’s happening.

BERGEN: Now that we know that the virus is, to some extent, transmitted through droplets in the air, what is the relative risk of going to grocery stores, pharmacies and other necessary public places? Should we be ordering delivery or requesting curbside pickup? If most people in the store are wearing masks, is it safe to go?

OSTERHOLM: This is a huge challenge and a tough question to answer.

We have to acknowledge that we have put far too much emphasis on hand washing and environmental control. I come from a world of infectious diseases where I’ve spent my whole life preaching the importance of hand washing. It is important. But we have to be intellectually and scientifically honest with the public and admit that, while we shouldn’t we stop washing our hands, we also shouldn’t assume that decontaminating the environment or washing our hands is going to be enough to prevent us from becoming infected.

This virus could be in the air around infected people. It could be the same air we share and breathe. The more times you go into public spaces, the greater the likelihood you’re going to swap some air with somebody who has the virus and doesn’t even know it. Again, we have to be honest about that.

Does that mean you shouldn’t go to the grocery store? Well, I would say if you’re a person of high risk for a serious disease outcome, you should do everything you can to find a way to get those groceries delivered to you, even left outside your front door where you can go pick them up and not have to have contact with someone.

Now, for others who say, “Well, you know what? I’m at a relatively low risk of having a serious outcome if I do get infected,” you still have to think about whether you might be transmitting that infection to others. I think we have to be more honest and just say that, yes, breathing someone else’s air is going to put you at risk. On any one given day, how big of a risk is that? I don’t know.

We can’t stop living life. We have to move forward. But we must do so while thinking about how to get people back into society in a way that is thoughtful and takes into account every possible option to make sure people don’t get seriously ill and don’t subsequently die.
_________________

Credit: CNN

62 thoughts on “We’re only at the beginning of Covid-19 outbreak and it will get worse, researcher warns

  1. OK, I’ve read it now do I use the bathroom or go blind. What in the world is this doing to help? Bottom line someone has been warning of something for x number of years. My pet concern was automation crashing. So I can give you 10 things that could destroy humanity that are hanging over our head. Here is the real story, something is going to kill you unless something else kills you first.

    1. we will overcome this virus and the world hasn’t ended. Eventually we will find a vaccine and a treatment regiment… patience is the message of the day.

      1. You do know that virologists never had any success coming up with a vaccine for SARS. SARS is a coronavirus that had everyone on edge some years ago originating from the bat caves of China….So yeah, patience is good…

        1. A vaccine was not needed. By the time there was one getting close the SARS virus dropped off the scale.

    2. I think it might happen riding the bus to Machala, through the desert region where giant boulders hang in sand over the road. On the other side of the road, 100 meters below is the Jubones river. Being at the wrong place at the wrong time might result with the end blinking out, looking into the wide eyes of my beloved as we experience a most intense rollercoaster ride at the end of our lives.
      That would be a better end than lying in bed for a week with 5 sacks of concrete on my chest.

      1. I remember riding many a Bus to Tumbes going thru Machala.and On to Lima or Quito, Ahhh the Good Ole Days. Cuidate

  2. Very good article, all the data I’ve looked at confirms this portrayal of current and future events. Again unless something tangible changes the health environment, I think we all want to get to that goal, something that changes the game, a vaccine or a method of treatment that reduces the death rate… he does mention an asymptomatic reference number of 80% that I haven’t found in any data,,, if anybody know of any reference or data chart that shows asymptomatic % numbers I’d appreciate the site info.
    there are a lot of people that are tired of this lock down, but the alternatives, if not done with extreme care could make things far worse…

    1. His quote was “about 80% of these cases will have asymptomatic, mild or moderate illness but won’t need professional medical care.” This range falls into line with many reports.

      1. Ok, what do we do to not put, mother’s, brothers and sons in harms way? I’m on your team and want to find a solution to this dilemma… you seem to be be semi intelligent, as I am, you seem to be driven to want to find a solution, as I am, you seem to be well read on the herd immunity and I on the shelter in place, theories… can we together find a solution that works better and lays waste to this useless and confrontational attitude? I don’t see anything that helps in a constant confrontational state, do you?let’s make a difference and find the solution by using our differences to defeat a common enemy, agreed?

  3. ”…at least 800,000 deaths in the U.S. over the next 18 months”? I think this is a very conservative number. The figure, I believe, will exceed 1.25 million people dead from Covid-19 in the U.S.

    This assumes there isn’t a ”second” or ”third” phase, triggering further spikes of fatalities, and the Coronavirus doesn’t mutate out of control, whereby a single vaccine wouldn’t be sufficient.

    *IF there is widespread (accurate) testing implemented (and physical distancing not comprehensively observed), I wouldn’t be surprised if the number of deaths ultimately confirm more than 2 million Americans will die.

    1. You’re way too conservative, Karl. You need to consult with Mike– our resident statistician– who argues that 41 million Americans are going to be taken by Covid-19.

      Rumors are flying that he’s been invited to appear as a distinguished guest expert on John Oliver’s Late Night News.

      1. Well, only if we rush head long to open everything up following the advice of the quack from the UK you keep pushing as the truth the way and the light. Anyone with half a brain can do the math for themselves and see how many deaths there will be if the entire US gets this virus. It’s only your congregation that refuses to look at data or show data that backs up the UK quack.
        BTW it was you that asked about what the scenario would be and what the circumstances would be to have 41 million deaths, I was more concerned about the current numbers and the death rate than that. In the hopes the confirmed cases would flatten.
        Worldometers has all the raw data, no quacks, bias or conspiracies just data.

        1. Here’s some data for you, Mike:http://www.theblogmire.com/is-lockdown-essential-comparing-the-swedish-experience-with-the-imperial-college-model-suggests-otherwise/

          Don’t miss the graph near the end of the article that shows what the Imperial College model (from the idiots who triggered all this insanity) predicted for Sweden and what has actually transpired.

          And no, Mike; it was you who advanced the scare-stat of 41 MM Americans dying of this virus.

          1. Like I posted 4 weeks ago, If by the numbers, 40-60% of the population of the US gets this virus and nothing changes to alter the death rate. The math shows 41 million deaths. I didn’t get the huge number that he did in this article but again it was a month ago and he also has a 80% asymptomatic rate that I wasn’t privileged to have as well.
            Thanks for the heads up on the WHO data for that but I stopped using their data when it became obvious they weren’t properly recording the Chinese numbers.

      2. It’s funny just how close to what I’ve been saying is clearly written in this article… I don’t like what this article says either, nor do I like the numbers and death rate. That doesn’t make me a fear monger or alarmist.
        You can say it’s not real and not as bad as all that, all you want, the truth is, backed by the numbers, that it is what they are saying.
        I keep hearing about how the flu kills 65,000 and car accidents kill 140,000 and all these numbers are false.
        The whole world is shut down, let’s stop and look for a moment, every politician, every doctor, every epidemiologist and all the numbers match up with this as being as bad as the Spanish flu. Do you not feel the need to stop and take the necessary precautions and learn from a real historical event that killed millions. There are countries that are still open, Sweden is a good example, why not watch and see what happens there in the next few weeks. Follow the data and learn from that. Why rush to open the floodgates. If we have a resurgence then they’ll just lock it down again… and that helps no one.

  4. Goal of article: create fear. Successful.

    Remember that 99% of Italian deaths had up to 3 comorbidities as reported by the Italian NIH plus they have awful air pollution/elderly population/etc.. Remember that the US CDC has told their doctors that basically all deaths are coded as CV related even if vaguely suspected without proof. Same orders from Office of Vital Statistics. Doctors are reporting that their correct diagnoses on death certificates are being falsified to CV. So deaths attributed to CV are completely overstated in the US to prove that something is happening. One source reviewed the NY March death rates and reported they were 15% lower than the past 4 years. Etc .

    https://www.foxnews.com/health/nearly-all-ny-coronavirus-patients-suffered-underlying-health-issue-study-finds Same thing going on in NYC regarding comorbidities——new article from Foxnews indicates Hypertension was a concerning comorbidity and other doctors have reported that ACE inhibitors increase the chances of issues with the cv thing.

    1. Thanks kit, you’re exactly correct. Too bad so many people can’t see through it. It is all fear driven speculation. End of story. The Spanish flu was a different time with a different environment. World War 1 had just ended and there was chaos, destruction, homelessness and starvation. Perhaps that contributed to the loss of life for so many.

      1. Let the grand experiment begin, show us all how confident you are that this pandemic is nothing, rush back to your hometowns and throw all the doors open. Get everyone together and have a grand party… Darwin awards for all….

          1. I’m watching just like you, I hope it’s successful and we have a path out of this, just like you! I am a statistician I will wait for the numbers and do my own thinking, no graphs or outside potentially bias opinions for me. I’ll do the math and then read to see who matches up with the numbers…

            1. Mike, good to read comments that are designed with common sense and logic in mind. Feddy is just someone that thinks he has all the answers, and for that reason alone-beware!

                1. Keep ’em coming, Feddy. Rather than read your blah-blah-blah attacks, I’d opt for your sending websites. And although I don’t open them, I seem to appreciate you more.

                  1. Thanks, but I think I’ll opt for trying to provide useful information to people who have an open mind, are interested in hearing all sides of an important issue, and who respect other people’s time, their carefully considered opinions, and their efforts.

                    But I really appreciate your thoughtful comments. 😉

              1. Common sense and logic is good for us. It’s harder for those that don’t have that vision, they are frustrated and feeling cornered and confined… me too, this is hell for all of us. Just my opinion but, there is no wrong here, we need to be compassionate and empathetic we all need to sacrifice and work hard to beat this. The alternative is like the political front, chaos and confrontation.. no one wins… I too want to get home to my family… I have family that have tested positive.. i am afraid for their lives… it’s all encompassing… we shouldn’t point fingers and think we are superior we should group together and find common solutions to overwhelming and apocalyptic problems. Together we are an unbeatable force of wisdom, integrity and intelligence…

                1. You have edited this comment substantially since it was first posted. I hope that your family members who have tested positive are like the 80% of those who have tested positive and never knew they even had sars-cov2.

                  I completely agree with you that we need to employ wisdom, integrity and intelligence to address this dilemma; the problem is that we have forces supporting diametrically opposite solutions between which there is no compromise–the light switch is either on of off–there is no in between “happy middle ground.”

                  In such situations, the greater good must, should and always eventually will win out. And that greater good should be determined by facts, not emotion, fear, selfishness, greed or inaccurate statistics.

                  1. Statistically we are at least a week behind in the recovered cases column, this makes it very difficult to get an accurate death rate. On the bright side if you look at Italy’s data there death rate has been significantly reduced since there confirmed case numbers have levelled off. It went from high 30% range to 20%. Which I know is probably still high if the asymptomatic cases are around my suspected 40% range and are not being added to the totals as cases then that rate would drop again I haven’t done the calculation for that, yes I know I’m slacking off…
                    BTW it’s still early in the game but Sweden’s numbers aren’t looking good so far, I’m definitely keeping one eye on them and hoping to see a flattening curve..I’ll start watching Iceland as well…

                    1. Not sure what numbers you’re looking at but from what I see Sweden’s rate of growth in confirmed cases is on par with South Korea and Ecuador—far below USA, Italy, Spain, France, Germany, Belgium, Netherlands, etc.

                2. Like minded, Mike. However, regarding your “…we shouldn’t point fingers and think we are superior…”, that would be a real long-shot and “wishful thinking” on this website. Regardless, good to know you are here.

            2. Still waiting for you to show me where my math is wrong on the eggs example. You’re not bias (sic) against eggs are you?

              1. LoL. Sorry not going there yet, maybe after we solve all the worlds problems I’ll get back to it..
                No unfortunately my nephew, a nuclear scientist, is symptomatic and his wife appears to be as well, his job was deemed as essential, I guess it’s important to keep the lights on, So far he’s good but it’s still early. It’s my wife’s sisters son. While I stayed here to wait for my cedula my wife flew back home to look after my father in Detroit. And now she’s been enlisted to also help with her nephew in Toronto. I am very worried for her safety when she brings them food… she’s a smart girl and knows what to do… she wears her mask and carries a full can of Lysol just like Hiram…

            3. that is the thing about hindsight and statistics after the event. it is a shame that Tramp didn’t know in advance that 50,000 people (currently) would be dead of the virus or maybe he wouldn’t have sat on his hands and called ‘fake news’ for so long … maybe he would have acted more quickly and saved lives. he fires anyone that disagrees with him … maybe the highest turnover of staff in US presidential history. maybe he will fire his medical advisors now that they have said his plan to inject disinfectant won’t work ?

          2. Hey Feddy, I’m a little short of reading material. Can you send me some websites that you always seem to think will enlighten the world? Lol.

        1. and visit the hospital emergency rooms where they are treating the covid-19 patients (no mask please)

      1. We’re trying…but sure getting a lot of resistance from some quarters that offer no basis for such resistance other than their own self-centered unfounded, irrational fear.

  5. Osterholm, after all this blows over, I want to see you boldly and publicly stand up and apologize to everyone you freaked out with this outrageous rant. Then we’ll decide what to do with you afterwards.

    Seems to be tens of thousands of bloviating scare-mongers having their 15 minutes of fame right about now. They’d have us all imprison ourselves for the next 3 years if they could.

  6. I’m not sure anybody needs a national plan for local needs. The measures which are needed in Idaho or Wyoming are much different than NYC, just like the measures needed in Guayas are different from those needed in Azuay.

  7. It never ceases to amaze me that these experts never divulge a plan or give advice on how to prepare even though suggesting that planning, etc. needs to be done.

    1. Too true, if your going to have a shutdown this buys time. For what, well I would test the population to develop baseline, concentrating on finding the asymptomatic cases, keep the nonessential workforce and those most vulnerable isolated for the incubation period of the virus, develop protocol and procedure for when this incubation period is over to begin reopening the isolated population, prepare testing stations and deploy testing staff, have mobile and fixed laboratories ready to quickly get results, have a plan ready to shut down any hot spots as they appear and be prepared to reinitiate the area lockdowns if needed in affected areas as to not overwhelm the local hospitals.
      Does anybody think this is what was done with the time provided by the shutdown? Me neither, so I’m afraid if this reignites I think we can expect to see the area shutdowns occur when hospitals get overwhelmed. That is unless they have testing being arranged for just prior to the May 4 opening date.

  8. What no one likes to discuss about this pseudo pandemic is the health status of the people that die. Not only are some of the deceased old but most have medical conditions which leave them more vulnerable to die. Did you know that almost 50% of the US populace takes medications and 30% or more are obese.? We have shied away from the terrain concept to go amok with the germ theory of Pasteur who it is said to finally agree with Dr. Antoine Bechamp that the terrain was the most important factor in determining if one would get sick. A healthy lifestyle and healthy diet will go a long way to keep you from getting sick. Promoters of vaccines are proponents of the debunked germ theory. Why are so many taking medications? Is it a deficit of the medication? People need to wake up!!

  9. If I could extrapolate, paraphrase this well researched ,excellent article to Ecuador. It looks like this country is implementing a middle road strategy ..open the economy/everyday life gradually.But what must accompany this strategy is a way of “rapidly” detect an emergence of new waves of infection. Muchos problema…Ecuador does not have the money, mfg. capacity , supply chain to run these tests.Thus , Ecuador can not test its way through this pandemic .going forward it’s strategy has to be based on reality..I have tremendous ambivalence to this conundrum. Ecuador has to allow businesses to reopen or the economy will collapse and yet strict physical distancing must be continued. The ONLY tool we have to fight this virus is “physical” not social distancing..Do not let your guard down…Cuenca will be spiking after May4….Consider everyone you meet as POSITiVE..maintain safe physical distance.and one can still maintain a social interaction…Be safe…🙏🏼🙏🏼

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