Sunday, March 15, 2020

Becoming generalists in times of crisis

I have a sister-in-law who was a nurse in pediatrics for a brazillian years.

It shaped her world view.

When I suggested that we find away to minimize the number of caregivers who Mom is exposed to (17 per week) to minimize Mom's risk of exposure to Covid-19, she determined that I had panicked.

As a nurse in Peds, S-I-L spent much time calming down and reassuring children. "Everything is going to be OK".

Because even if everything wasn't going to be "OK", it would be worse if the kid panicked.

Adults are different. We can take responsibility for our actions. We can make meaningful changing the scheduling of reduce risks.

One of the articles S-I-L so thoughtfully passed along as "proof" that Covid-19 was not a big deal is this one: Coronavirus Myths Debunked...

Just a few treats from the article:

I have to say, that after being a doctor for 31 years, I’m not sure that I’ve seen anything quite like this level of abject panic regarding a respiratory virus in my career.  -Note, the author starts most paragraphs reminding the reader that he is a DOCTOR, but he never specifies that he is an Epidemiologist

As I’ll show below, when you have trusted names like Sanjay Gupta fanning the flames of fear rather than correctly interpreting data, you can see why people are so freaked.   -The author is assuming his first take on the data is the correct one and only reads Gupta's articles to cherry-pick points to refute.

COVID-19 DOES NOT have a 2-3% mortality rate. That number comes from the Chinese Wuhan data. The issue is that that number represents mostly sick people tested for the disease versus total deaths. Regrettably, that’s NOT how a mortality rate is calculated, which uses all that have contracted the disease as the denominator.  -In my humble opinion, he got this half right. It is virtually impossible to calculate a solid mortality rate in the early stages of an epidemic because you have so many cases suspended through various stages of the disease's progression. For instance, why would you include a patient who has the first stages (sniffles) in the mortality number. He has clearly contracted the disease but we do not know the outcome. He should not be in the denominator. And, in the early stages of an epidemic, people in the early stages of the disease dominate the denominator.
(Blogger Liz Specht) reported that by May we would have some 5.4 million cases in the U.S. using her pandemic math. The problem is that Liz isn’t a physician, so she seems to have missed this graph put out by the CDC.  -There we go. You cannot do research or basic math unless you are a physician.

And after all that blather about the mortality rate being between 0.2% and 1%, he has a paragraph where he wrote:

Forget about China, the real disaster is Italy!  We do know that Italy as of this writing has 9,172 coronavirus cases and has had 463 deaths.  -I don't have a medical degree, but I can run a calculator. 1% of 9000 is 90 dead patients. 463/9,172 is pretty close to 5%, more than five times greater than what he assured us was the "real" mortality rate of less than 1.0%.

The larger lesson, though, is to become more generalist in our world-view. That is especially hard for those of us who are older and more at-risk. We have to stop being Peds nurses and engineers and media-doctors. We have to take the scope we dialed to 9X and dial it back down to 3X. We need the larger field-of-vision because the target is moving through the brush and it is moving fast.


  1. I've seen the same level of dismissal in some other medical professions, who are not used to the totality of the situation. when the crisis spikes at the rate it is progressing, the capacity to care for those most at risk is overwhelmed. This is the point that is missed by most. Its not an increase in people who have a fever and cough, it is the total number who need care that cannot be given as the resources (vents, ICU beds, O2, infusion pumps etc) are outstripped by the demand.


    "Fully 62% of Republicans see news reports about the seriousness of the novel coronavirus as “generally exaggerated,” DOUBLE the percentage of Democrats saying so (31%). "

    Opposite to what I would expect. That is not going to help.

  3. Systems thinking. It's a thing, people. Learn it, live it.


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