While we plan to reopen the economy, Al Brooks warns that the worst is not behind us.

On Feb, 29, 2020, when there were only 70 confirmed cases of coronavirus infection in the United States, I wrote that possibly 3 billion people could get infected and 50 million people could die. In my chat room that week, I said that it was reasonable to consider the possibility of a million Americans dying and 50% of the country getting infected.

If you have been following the news, you might have heard Dr. Anthony Fauci a couple weeks ago say that maybe only 60,000 Americans would die. He and Dr. Birx said that the worst case is 100,000 to 200,000 deaths.

Who’s right, Dr. Brooks or Dr. Fauci (yes, I really am a physician)? They are political appointees and that constrains them when they speak. They will not lie, but they will also not freely say everything they believe if they want to keep their jobs.

I agree that he and Dr. Birx are the experts, but I do not see how we avoid 30% to 50% of the country getting infected. That is 100 to 160 million people.

Maybe only 20% will have symptoms, but 0.5% to 1% of the infected people will die. If 0.5% of 160 million infected Americans die, that is about 800,000 people.

If only 30% of the country gets infected, a 0.5% death rate results in 500,000 deaths. That is more than the total American deaths in World War II, the Korean War, the Vietnam War, the Iraq War and the Afghan War combined. I do not see how we avoid that. I think 200,000 American deaths is the best case, not the worst case.

Vaccine will not suddenly stop the pandemic

My prediction is far worse than the worst case of Dr. Fauci and Dr. Birx. I hope that Dr. Brooks is wrong and that Drs. Fauci and Birx are right, but I do not see how only 100,000 Americans will die.

Even if there is a vaccine in six months, the anti-social distancing crowd will guarantee that 30% to 50% of the country gets infected. I think we will be lucky if Dr. Fauci and Dr. Birx’s worst case of 200,000 deaths is the final total.

It is important to note that I am holding this view even with a vaccine coming early next year. The vaccine is not a light switch that instantly turns the pandemic off. It will roll on for many months after the start of vaccinations. Millions more Americans will still get infected after the vaccinations begin.

The importance of studies

Last week I wrote that I needed to see other studies confirming the benefit of Remdesivir in the treatment of severe Covid-19 infections. A study came out this week that found no benefit.

I mentioned that I was a medical scientist many decades ago and I never believe anything until it has been confirmed by at least three or four major medical centers. Also, I really need to see a double-blind study where neither the patient nor the doctor knows if the patient is receiving the medicine or the placebo.

What’s a double-blind study?

A double-blind study is one where both the patient and the doctor are “blind.” The patient is treated with either a placebo or the medicine, but neither the doctor nor the patient knows which is in the medicine bottle.

Here is a simplistic way to look at it. There is a box of pill bottles and each bottle has a different number on it. The doctor randomly grabs a bottle of pills and gives it to the patient. He then plugs the bottle’s number and the patient’s name into a computer.

When the date arrives for the end of the study, the doctors decide if each patient is better or not. They enter that into the computer. After the doctors vote on every patient, the computer program allows everyone to see if the patients who got the medicine did better than those who got the placebo. They compare the 2 treatments using every at every imaginable factor. That includes every symptom, sign, side effect, and measure of success.

It’s all about the math

A medical statistician applies some formulas to the data to determine how significant the result is. If the math shows that there is a 95% chance or better that the medicine is better than the placebo, the scientists conclude that the medicine is effective and that the result is statistically “significant.”

Again, they look at every way to measure what “effective” is. The headline ways are what you hear about. Those are things like the percent who died in each group or how long it took to get better.

The treated patients can do much better than the untreated patients, or just a tiny bit better. For example, assume that 1000 patients took the medicine, and all were 100% cured the next day. Also assume that only 1% of placebo patients were better on the 2nd day and the average placebo patient got better in 10 days. The drug is clearly effective.

But, for a different drug, assume that the average patient got better in 9 days and the average placebo patient took 10 days. There still might be 95% certainty that the medicine was effective, but it was not much better than the placebo. Most doctors would not prescribe the drug because every drug has side effects. Those could erase the 1-day benefit.

A well-constructed, big, double blind, multi-medical center test is considered the gold standard of medical testing. It is the best way to eliminate even minor biases, and of course, fraud. There are still ways to mess it up. But if it is done on a lot of patients with many doctors at many medical centers participating in the study, it is very reliable.

Also, remember the early studies that showed that anti-malarial drugs were helpful? I always cringe when I see non-scientists hype stuff like that. It is ignorant. It does a disservice because people die from following the stupid recommendations. Well, new studies have shown that they not only did not help, they increase the risk of death.

“It’s the vaccine, stupid”

All of this stuff about treatment is just entertainment to distract us from what everyone knows is true. There is no return to anything close to normal until there is a safe and effective vaccine.

And unless it is perfect, life for us might be different forever, at least to some extent. The more our behavior remains different, the more weight there will be on the economy.

Since the vaccines (there will be many options) will not be perfect, many people will curtail some activities forever. If enough reduce their spending, there will be a permanent reduction in the world’s GDP.
American hubris

I think the press is missing something. All I hear about is American scientists working on vaccines. There are already many vaccines currently being tested in the United States. But the FDA will not allow them to be used on the public until 3 phases of testing are complete. That will be in early 2021.

I have met many very smart doctors and medical scientists from around the world and they are just as good as our best. They are also working on vaccines. Many are in countries that do not have exactly the same lengthy 3 phase testing that we have. I bet one or more effective vaccines will be approved overseas within four to six months.

If the pandemic continues to be horrific, the FDA might be forced to allow these vaccines to be used in the United States before the regular 3 phase testing is complete. If not, lots of Americans will start flying again… to the countries that will give them the vaccine!

The vaccine has to be safe and effective. If the vaccine has a high incidence of serious side effects, most people will not get it. Life will remain as it is now.

Also, the vaccine has to be effective. The public has the erroneous opinion that effective vaccines prevent close to 100% of infections. That is nonsense.

In a good year, 30% of people receiving a flu shot can still get the flu. When 30% can get infected, that is considered a great flu vaccine. In a bad year, 70% can still get infected after vaccination. If the coronavirus vaccine is only 50% effective and if wears off in three months, then we still have a major coronavirus problem.

All viruses mutate. There is a reasonable chance that mutations of the current coronavirus (the official name is SARS-CoV-2) could be with us forever. If so, we might end up getting a combined flu and coronavirus vaccine every year.

Christopher Marlowe and the economy

If I am right, then the pandemic is going to last much longer and affect far more people than what the news is reporting. Yes, the stock market is rallying and there are many hopeful stories about several states getting back to work. But is this sustainable? Not if my thoughts about the pandemic are correct.

Why are states talking about lifting social distancing restrictions? Is Georgia’s governor saying that the pandemic is just about over so let’s get back to normal? No! He is arguing that it is better to have 1% of all Georgians die than to continue the anxiety and economic damage that the shutdown in causing.

In the short run, it is good for the economy to have everyone back at work. But over the course of the next year, it will result in 100 million Americans getting infected and 500,000 to 1 million dying. That is a Faustian bargain, and it is why the stock market will have a difficult time making a new high this year.

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