PHILADELPHIA — Arguing that Pennsylvania should move quickly to reopen its economy even as coronavirus cases surge in some areas, the state House’s Republican leader said this weekend that reopening schools in the fall should be a top priority.Not only do students deserve a chance to perform experiments in science labs and play instruments in recitals, House Speaker Mike Turzai said — children are largely protected from the ravages of the virus because of their youth, and would be safe if they go back to school.“Guess what, they’re not at risk unless they have an underlying medical issue,” sai...
Following weeks of criticism over his administration’s COVID-19 response, President Donald Trump pulled out new statistics to claim the nation is actually among the best in the world in fighting the lethal coronavirus.
“Germany and the United States are the two best in deaths per 100,000 people, which, frankly, to me, that’s perhaps the most important number there is,” Trump said at a May 11 Rose Garden press briefing.
We’ve followed the numbers closely on this. Germany has won praise for its early and aggressive testing-and-tracing responseto the pandemic. The United States has not.
With that in mind, we wondered: Are these countries so similar? And are they really the “two best”?
We contacted the White House to find out the basis for the president’s statement and never heard back. But of all the datasets tracking COVID-19 deaths, none supports anything near Trump’s assertion.
And when you look at the numbers on which experts rely, Trump’s claim is at best misleading. The United States’ rate of COVID deaths per capita is better than many countries — but in no universe is it one of “the two best.”
The Numbers
Deaths per 100,000 people — the per capita metric Trump used — is generally considered a valuable public health measure that helps quantify the intensity of an epidemic. In this situation, it tracks how many people have died from COVID-19 in relation to countries’ populations.
It’s an imperfect measure, to be sure. Globally, COVID-19 deaths are typically undercounted, since countries aren’t testing all the people who have been infected, let alone counting all deaths attributed to the virus. And comparing the numbers gets trickier when you place countries like Germany, which has tested large swaths of the population, against the United States, which has not.
But even when comparing apples to oranges, Trump’s claim inflated just how well the United States has performed.
“It is not supported by the facts,” said Jennifer Kates, a senior vice president at the Kaiser Family Foundation.
We looked at four credible estimates, all of which were recommended by health researchers: Johns Hopkins University’s coronavirus death count, along with global estimates published by the Kaiser Family Foundation, Our World in Data and Worldometer. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)
The Hopkins death count estimates that, in the United States, 24.66 people per 100,000 have died of COVID-19, as of Tuesday. In Germany, meanwhile, the rate is 9.24 — meaning the American death rate is 2.5 times that of Germany.
And that’s only part of the issue.
When compared with many other countries — including Canada, South Korea, Iran, Russia, Poland and Switzerland — the U.S. numbers don’t do very well. “We have higher levels of deaths per capita than countries and many others,” said Jeffrey Shaman, a professor of environmental health sciences at Columbia University.
That’s true no matter the dataset. The United States performs better than countries like Spain and Italy, but still far worse than Germany and worse than numerous other countries.
In fact, per Our World in Data’s estimates, the United States’ rate of COVID deaths per capita isn’t just worse than what we see in countries like Canada and South Korea. It’s also worse than the global average. As of May 12, 36.66 per million people had died of COVID for the entire world — in the United States, it was 243.76 deaths per million people.
There is another way to look at the numbers, Kates said. Instead of the cumulative number of people who have died per capita since the pandemic began, one can consider whether the United States is performing better when it comes to recent deaths. If American numbers were similar to that of Germany within a specific window of time, it would suggest that the United States is approaching a similar point in efforts to alleviate the crisis.
Even then, the United States falls short. As of May 12, numerous countries, including Canada, France, Germany, Russia and Italy, had fewer daily deaths per capita based on a seven-day average than did the U.S. — suggesting that the risks here are still greater than they are in those nations.
So, big picture? It is misleading to suggest the United States and Germany are in the same league, especially when it comes to COVID deaths per capita. It’s flat-out untrue to suggest that the United States is one of the “two best,” when countless other nations are seeing far lower death rates per 100,000 people.
“The claim is false,” Shaman said.
Our Ruling
Trump claimed that, when it comes to COVID-19 fatalities, “Germany and the United States are the two best in deaths per 100,000 people.”
This is untrue. While the metric Trump highlighted is important, there are countless countries performing far better than the United States on COVID deaths per capita. And it is misleading at best to categorize the American fatality count in the same group as Germany’s; Germany’s numbers are better.
As President Trump continues to complain on Twitter about the alleged "Obamagate" scandal, he put Senator Lindsey Graham on the spot this morning, telling him to call former President Barack Obama in to the Senate to testify.
"If I were a Senator or Congressman, the first person I would call to testify about the biggest political crime and scandal in the history of the USA, by FAR, is former President Obama," Trump tweeted. "He knew EVERYTHING. Do it @LindseyGrahamSC, just do it. No more Mr. Nice Guy. No more talk!"
According to Trump's narrative, Obama, along with his then-vice president Joe Biden, former FBI Director James Comey, and other intelligence agencies both in the U.S. and abroad, conspired to accuse Trump of colluding with Russia during the 2016 election by using fraudulent evidence that was then used to spy on Trump's campaign.
While much of America is holding out hope for a vaccination that will stop the spread of COVID-19, anti-vaccination activists are already preparing a massive informational warfare campaign aimed at convincing millions of Americans to forgo the eventual vaccine.
New York Times reporter Kevin Roose, who for years has been following the anti-vaxxer movement, writes that the campaign against the COVID-19 vaccine is already well under way -- and it stands a good chance of succeeding.
"They are much more organized and strategic than many of their critics believe," he writes. "They are savvy media manipulators, effective communicators and experienced at exploiting the weaknesses of social media platforms."
Roose predicts that anti-vaxxers will raise alarms about the quick development time of the COVID-19 vaccine by claiming that it was not put through a rigorous process to ensure its safety, and will also exploit fears of "mandatory vaccination" to convince people that the vaccine will put Americans' personal freedoms at risk.
"Organizations like the Centers for Disease Control and Prevention and the W.H.O. need to understand the dynamics of online anti-vaccination communities and start waging a hearts-and-minds campaign to restore faith in the medical establishment while a vaccine is being developed," he writes. "Social media companies need to take the threat of vaccine-related misinformation seriously and devote tremendous resources to stopping its spread."
During an interview with Fox Business this week, President Trump was asked about what he's going to do to bring the supply chain back to America. In response, he went into a rant about the F-35 fighter jet.
"I could tell you hundreds of stories of the stupidity that I've seen," Trump said. "As an example, we make a fighter jet. It's a certain fighter jet. I won't tell you which, but it happens to be the F-35, okay? ... And we make parts for this jet all over the world -- we make them in Turkey, we make them here, we make them there -- because President Obama and others -- I'm not just blaming him -- thought it was a wonderful thing."
But according to air war reporter Valerie Insinna, Trump's claim that the F-35 is made "all over the world" is bending the truth at best.
"By the time President Obama had stepped into office in 2008, the supply chain for the F-35 would have pretty much been struck in stone," she tweeted this Thursday. "Its first flight was in 2006, but many suppliers would have been lined up before the contract was awarded in 2001."
"The F-35's supply chain is always in flux, and that's part of the overall vision for the aircraft," she added. "The joint strike fighter was created not just for the US military, but for US allies and partners, who helped pay for the development of the aircraft in return for industrial work."
Medical experts at the Centers for Disease Control and Prevention and the TrumpWhite House have expressed different views on how the U.S. can safely reopen during the coronavirus pandemic — and the recommendations offered by the CDC last month were stricter than the Trump Administration’s recommendations. The Associated Press is reporting that Nancy Beck, who Trump has nominated to permanently head the U.S. Consumer Product Safety Commission, played a key role in the “decision to shelve” the CDC’s guidelines on April 30. And Democratic Sen. Maria Cantwell of Washington State is demanding answers.
“I am deeply concerned by the nominee’s involvement in advocating for the deregulation of toxic chemicals known as PFAS, and I also have questions about her potential involvement with the CDC coronavirus guidance,” Cantwell asserted in an official statement.
Beck is a former chemical industry executive, and she has a doctorate in environmental health. However, Beck isn’t a medical doctor and has no experience in virology — unlike Dr. Anthony Fauci or Dr. Deborah Birx, both of whom are part of President Donald Trump’s coronavirus task force.
E-mails obtained by AP, the news agency reports, “show that Beck was the U.S. Centers for Disease Control and Prevention’s main point of contact in the White House about the proposed recommendations. At issue was a 63-page guide created by the CDC that would give community leaders step-by-step instructions for reopening schools, day care centers, restaurants and other facilities."
According to AP, “Beck’s role in the coronavirus guidance document was revealed in a series of e-mails from late April obtained by AP. On April 10, CDC Director Robert Redfield e-mailed the guidance to a group that included some of the president’s closest White House advisers, including Trump son-in-law Jared Kushner, and counselor Kellyanne Conway, and Dr. Anthony Fauci, the government’s top infectious disease expert. Redfield wrote that he wanted White House review and clearance to post the documents on the CDC website.”
In order for Beck to be appointed to head the U.S. Consumer Product Safety Commission permanently, she will have to be confirmed by the U.S. Senate — and Beck is scheduled to appear before the Senate later this month.
A church in Catoosa County, Georgia, is canceling in-house services after three coronavirus cases connected to the church have surfaced.
According to WDEF, this isn't the first time the virus has popped up at a church in the state, and the Georgia Baptist Mission Board is doing what they can to help churches during this time, such as webinars offered online.
“Just practical suggestions, I mean, how do you get people from the parking lot to the church. How do you set up the seating. What should you do and not do and how quick should the service be,” Georgia Baptist Mission Board Public Affairs Representative Mike Griffin said.
When it comes to reopening, Griffin says churches should resort to prayer and determine it's something the congregation wants.
The president appeared Thursday on Maria Bartiromo's program on Fox Business, where he complained that his political enemies hadn't already been prosecuted and jailed, in an exchange flagged by Mediaite's Aidan McLaughlin.
"If I were a Democrat instead of a Republican, I think everybody would have been in jail a long time ago -- and I'm talking with 50-year sentences," Trump told Bartiromo. "It is a disgrace what's happened. This is the greatest political scam, hoax, in the history of our country."
Bartiromo agreed that it was the biggest political scandal in U.S. history, and Trump interrupted to complain that his enemies continued to walk free.
"People should be going to jail for this stuff and hopefully a lot of people are going to have to pay," he said. "No other president should have to go through. I'll tell you, Gen. [Michael] Flynn and others are heroes, heroes, because what's happened to them -- they weren't after Gen. Flynn, they wanted him to lie about me, make up a story, and with few exceptions, nobody did that."
"There were many people -- I watched K.T. McFarland the other day," Trump added, referring to Flynn's former deputy national security adviser. "I watched where she was knock, knock, FBI, you know, the FBI. Okay? This was all [Barack] Obama, this was all [Joe] Biden. These people were corrupt, the whole thing was corrupt, and we caught them. We caught them, and what you saw just now, I watched Biden yesterday, could barely speak. He was on 'Good Morning America,' right, and he said he didn't know anything about it, and now it just gets released right after he said that, it gets released that he was one of the unmaskers, meaning he knew everything about it. So he lied to your friend George Stephanopoulos."
Bartiromo agreed his allegations sounded serious, and she asked the president to explain the scandal to viewers -- and he repeated vague insinuations about two former FBI agents and Hillary Clinton that he rolled out throughout the Russiainvestigation and impeachment saga.
"It's very simple," Trump said. "Even before I got elected, you remember the famous -- the two lovers, right? [Peter] Strzok and [Lisa] Page -- the insurance policy. That means if I won, they're going to try and take me out. That's all it means, very simple. It's an insurance policy. 'So she's going to win, isn't she darling, isn't she going to win.'"
“Where have all the patients gone?” That’s what doctors in our West Virginia University hospitals began asking as the coronavirus pandemic spread.
We were prepared for a rise in COVID-19 patients, but we didn’t expect the sharp decline we saw in everyday cases. Our emergency department visits fell by half in early April, a time when we would normally see growth as flu season overlaps with an increase in trauma as the weather improves. Inpatient stays fell by nearly two-thirds during the same time period.
Did the population of a state that ranks in the bottom of most health indicators suddenly get better? Did their lung disease, heart disease and vascular disease improve?
In the emergency room, we heard the real reason: “I thought I could wait this out,” patients told us.
In hospitals across the U.S. and Europe, people fearing contracting COVID-19 have been choosing not to seek the emergency treatment they need. One survey conducted in April found that nearly a third of U.S. adults had delayed medical care or avoided seeking care because they were concerned about getting COVID-19.
A study in Spain found a 40% drop in the number of patients undergoing emergency cardiac catherization for a dangerous type of heart attack known as STEMI between the late February and mid-March. A similar study in the U.S. found a 38% drop in heart catherization for STEMI cases from January to March. Children’s vaccinations also dropped off significantly, according to the Centers for Disease Control and Prevention, raising new concerns after last year’s measles outbreak.
This has certainly been our experience as physicians and faculty at the West Virginia University School of Medicine. The patients we saw in the emergency room in April were a lot sicker, and the proportion of emergency room patients who needed hospitalization increased.
The costs of delaying emergency care
Delaying treatment for acute and chronic conditions comes at a cost, both human and financial.
A patient with appendicitis who gets treatment early will usually undergo laparoscopic surgery, using small incisions and a camera, and can go home two days later. If the same patient waits too long, however, and a pocket of infection known as an abscess forms, that means more complex surgery. We will have to insert a tube for several days to drain the abscess, and the patient will be hospitalized longer, in addition to going on antibiotics. In the worst case, the appendix could burst and lead to diffuse peritonitis and sepsis, a medical emergency with severe abdominal pain and low blood pressure.
Similarly, if a diabetic with a foot infection that is early in the stages of cellulitis, a painful localized skin infection, waits a week to two longer than usual, there’s a greater chance the infection has reached the bone, becoming an osteomyelitis that could require amputation.
The ultimate cost for delaying treatment can be loss of life. Data from the CDC shows the U.S. had 66,000 more deaths than expected from January through the end of April, with only about half of those linked to COVID-19.
In some cases, clinics are trying to balance the risks. For example, many clinics are delaying preventative care such as cancer screenings because of the risk of COVID-19. One U.S. study found an abrupt drop in preventative cancer screenings of between 86% and 94% through April. Treatments for cancer patients are continuing, with hospitals taking extra precautions to protect patients while their immune systems are compromised.
The hospital experience is changing
COVID-19 is not going away anytime soon, nor will heart attacks, strokes or appendicitis.
If you feel you need to see your doctor, go. If you feel you need to go to the emergency department, call 911. It’s better than the pain and costs that can come with delay.
Your experiences during hospital visits going forward will definitely be different for a while. People arriving for hospital care that doesn’t require staying overnight should expect some kind of screening process to make sure that they are not ill with COVID-19. The health care system will encourage social distancing at check-ins, as well as in the waiting rooms, and everyone will be wearing face masks.
As a patient, you might not be allowed to have visitors, but you will receive the health care that you need.
While these certainly unprecedented times have upended our care processes, they also offer patients and health care systems new opportunities.
When we talk to our patients, many of them appreciate the opportunity for virtual visits, especially those at highest risk for complications from COVID-19 infection. The ability to establish virtual urgent care as well as offer many clinical services through virtual visits is here to stay.
The past few weeks have seen very significant changes at all points of patient entry into a hospital or clinic. However, clinical medicine’s fundamental principle of primum non nocere, “first do no harm,” prevails, and we remain committed to making sure that patients that need care get it on time and do not have to delay their visits or ignore their symptoms.
President Donald Trump this week has claimed that disgraced former national security adviser Mike Flynn was the victim of a set up by Obama administration officials who supposedly tricked him into lying to the FBI.
However, as the New York Times reports, Trump's latest account of the Flynn saga is a blatant rewrite of the historical record, as the president himself said that he had to fire Flynn because he lied about the nature of his phone call with then-Russian ambassador Sergey Kislyak.
"Their revisionist narrative is in stark contrast to the view held three years ago not only by top FBI management but also by senior White House officials," the Times writes. "Mr. Flynn, the officials said then, had lied to Vice President Mike Pence and other aides about the nature of his calls to the ambassador, had lied repeatedly to FBI agents about the calls, and might have made himself vulnerable to Russian blackmail."
In fact, testimony from former Trump chief of staff Reince Priebus and former White House counsel Don McGahn to special counsel Robert Mueller's investigation revealed that both men viewed Flynn's lies to the FBI as troubling enough to justify the national security adviser's ouster.
"McGahn and Priebus concluded that Flynn could not have forgotten the details of the discussions of sanctions and had instead been lying about what he discussed with Kislyak," Mueller's report on Russian interference during the 2016 presidential campaign stated.
Here, COVID-19 cases have mushroomed due to dormitory-style living conditions and the inability of people, often with underlying health issues, to practice social distancing. As the virus rages on, comprehensive COVID-19 testing for these populations remains elusive.
Health officials agree that incarcerated individuals and correctional staff are at high risk of contagion due to crowded settings. But while both prisons and jails have curtailed visitations, they have fared differently amid the pandemic.
In prisons, where diversion and early release are often elusive, inmates with COVID-19 are quarantined in solitary confinement. However, this measure, more commonly used as punishment, may spur individuals with symptoms to skirt testing and avoid these conditions.
Though prisons have also become hot spots for COVID-19, they should be better placed than jails to limit exposure to outside diseases. That’s because they are efficient at confining their populace, and the flow of individuals in and out of prisons is tightly monitored. Prisons have larger medical units, more comprehensive assessment and release planning protocols including parole supports for individuals returning to their communities.
Jails are not designed for long-term stays. And they have flexibility with releasing individuals due to special circumstances like overcrowding. Thus, they have been a focus of calls for decreased admissions and the release of nonviolent inmates to keep incarcerated numbers low amid COVID-19.
Signs pleading for help hang in windows at the Cook County jail complex on April 9, 2020 in Chicago, Illinois.
Michigan’s 81 jails, for example, with 20,000 beds, have decreased incarceration levels by more than half due to reductions in bookings, posting of bonds and limiting bookings to violent offenders. Other measures such as eliminating bench warrant arrests – typically issued when an individual fails to make a fine payment or appear in court – and the early release of individuals at risk of COVID-19 have also helped bring down the populace.
Still, it’s important to recall that individuals who are jailed differ from those in state prisons in that they are often coming straight from the street. Many are experiencing financial, health and behavioral health issues. Others may be navigating substance misuse issues like withdrawal symptoms and intoxication. Scores suffer from psychosis or depression.
Jail diversion and public health
This poses a problem for states: Where will individuals with these behavioral health needs, with few financial and social resources, and possibly COVID-19, go?
In Michigan, inmates are being released with a signed, written promise to not engage in illegal activities and to appear in court when mandated. But these promises are hard to keep when you are struggling with addiction or mental health problems.
It is dangerous to release people into the community without first testing them for COVID-19 and providing them with access to public health and treatment services. Our research, informed by the Gains Center, which expands access to services for those with mental health and substance abuse disorders, shows that extensive transition planning, led by multidisciplinary teams, results in better outcomes for those reentering society. That includes giving them access to detox beds, housing and connections to day treatment.
The pandemic, however, has upended all norms. It has resulted in skeleton social service crews, restricted access to medical facilities and remote care requiring access to technology that homeless and recently incarcerated people often lack. People in jails have limited access to mental health services. This might make it harder for inmates to continue receiving the same medications when they leave jail, especially when it comes to treating psychiatric and opioid use disorders.
In worst-case scenarios, individuals attempting to stave off withdrawal may obtain drugs without maintaining social distancing. We have anecdotal evidence of suicide rates increasing among opiate addicts awaiting treatment. Other substance abusers are refusing treatment all together.
To beat COVID-19, we believe it is essential to secure housing for the homeless. “Staying at home,” for instance, is impossible when you don’t have one. And how do you social distance when you live in a shelter with no access to private quarters?
Cities like San Francisco and New York are attempting to reduce the homeless population by using hotel rooms. Other communities are erecting tent cities or getting people into permanent housing.
Despite these efforts, individuals in unstable housing are vulnerable to the coronavirus as well as food insecurity, violence and victimization. Some homeless people visit emergency rooms for health care and social needs – warmth, food, shelter and human touch. This renders them susceptible to contracting COVID-19 in the ER if they are negative or transmitting it if they are positive.
A coordinated national strategy
A coordinated and structured strategy, through a health equity approach, would likely interrupt the significant impact on marginalized communities.
For instance, while telehealth holds promise, it’s not ideal for people without access to technology. And social service providers do not have adequate staff, technology or finances. Consequently, they lack the capacity to plan for care during this unprecedented crises – because they are always operating in crisis mode.
The inability to plan, coupled with disinvestment in a robust public health and social safety net infrastructure, magnify health disparities. These shortfalls remind us that the structural and social health determinants for vulnerable populations need to be addressed. To not do so suggests that the value of life is not equally distributed.
Clinicians are working with limited resources against a disease that is very hard to predict. Knowing which patients are most likely to develop severe cases could help guide clinicians during this pandemic.
We are two researchers at New York University that study predictive analytics and infectious diseases. In early January, we realized that it was very possible the new coronavirus in China was going to make its way to New York and we wanted to develop a tool to help clinicians deal with the incoming surge of cases. We thought predictive analytics – a form of artificial intelligence – would be a good technology for this job.
In a general sense, this type of AI looks at existing data to find patterns and then uses those patterns to make predictions about the future. Using data from 53 COVID-19 cases in January and February, we developed a group of algorithms to determine which mildly ill patients were likely become severely ill.
Our experimental tool helped predict which people were going to get the most sick. In doing so, it also found some unexpected early clinical signs that predict severe cases of COVID-19.
The algorithms we designed were trained on a small dataset and at this point are only a proof-of-concept tool, but with more data we believe later versions could be extremely helpful to medical professionals.
All AI relies on data – in this case, the medical history of 53 COVID-19 patients in China.
To build this tool, we first needed data. We teamed up with an infectious disease specialist, Xiangao Jiang, in Wenzhou, Zhejiang, China. When we started working on this in early January, Wenzhou had the largest outbreak outside of Hubei, of which Wuhan is the capital. Between January and February, Dr. Jiang’s team collected and shared with us information from 53 COVID-19 patients at two hospitals. We got data on symptoms like fever, cough and diarrhea, lab values like blood cell counts, kidney function, inflammatory markers and vital signs and also X-rays.
Before we could start building the algorithms, we needed to wait until all the patients recovered or died so that we would know the final outcome of their cases. Thankfully, the Wenzhou outbreak wasn’t bad and by mid-February all the patients, even those with severe cases, had recovered.
From this data, we developed a set of algorithms that use predictive analytics to identify early symptoms in the body of a person with COVID-19. The algorithms then look for patterns and figure out which of those symptoms correlate with severe cases of COVID-19.
When medical problems are complicated and subtle, AI is the perfect tool.
For the 53 people in our study, the algorithms predicted with an accuracy of 70-80% the people who became extremely sick. That is pretty close to other uses of AI in medicine. We are now conducting further validations with large datasets.
This ability to predict which patients are going to decline could be very useful for clinicians, but the symptoms the AI identified to make these predictions could also provide valuable information to researchers.
Our predictive models found that slightly high levels of liver enzymes called ALT, elevated levels of hemoglobin – that is, red blood cells – and body aches were the strongest predictors of oncoming severe COVID-19. In a normal setting, doctors wouldn’t be concerned by slight elevations in ALT and hemoglobin, but it appears these are important signs during a coronavirus infection.
Since our study came out, other medical researchers have corroborated what our algorithms suggested. In one study, researchers found that slightly high liver enzyme levels may correlate with worsened COVID-19 outcomes.
COVID-19 is a new disease, one that doctors haven’t seen before and signs of an impending severe case are hard to spot. AI, which can recognize many elusive patterns simultaneously, is the perfect tool to help doctors identify high–risk patients early. This gives them time to better prepare for these cases and could save lives.
Additionally, the symptoms that the AI algorithms found to be important suggested that SARS-CoV-2 was affecting many more parts of the body than just the lungs. This ability to spot what symptoms are important could help doctors as they search for the many ways the virus attacks the body.
What’s next
It’s important to recognize the limitations of AI. Before a tool like this is put into use we need to give our system much more data to learn from. Since the AI was only trained on a small number of patients in one setting, its accuracy is limited to that setting. We are in the process of getting more data from other sources and will use this data to make the algorithms are more accurate and broadly applicable.
While the AI we designed is only a first test, the results are extremely encouraging. We believe AI has a role to play in fighting this pandemic and hope to soon put our system to work helping doctors on the front lines.
