Statewide Stay at Home Order is the Wrong Treatment for Michigan
Note: Data from April 26 and 27
In my home state of Michigan, and around the country political battles and protests have proliferated regarding shelter in place and distancing orders. When it comes to medicine,” following the science” means following the data. Following is relevant data in Michigan and elsewhere.
Patients requiring hospitalization, ICU bed and ventilator availability have trended significantly in the right direction as have the number of positive tests. With increased testing in mildly or asymptomatic cases the newly diagnosed patients will be less sick and require fewer hospital resources and should not significantly inform the shelter in place order if numbers rise with increased testing.
Statewide, hospitals are quite empty, with only 60% occupancy (typically >90%). ICU occupancy is 66%, (1050 beds available). Approximately 1300 patients are on ventilators with approximately 2200 additional ventilators available for use. Numbers vary dramatically throughout the state. In the Upper Peninsula hospital occupancy is 34%, ICU occupancy 50%, with only 1 out of 79 available ventilators used!
PPE is adequate with 21-day supply availability for N 95 masks and gloves at major centers, with a couple major Covid centers having under 14-day supply for surgical masks and gloves.
Data available throughout the United States and World suggests the presence of COVID in the general population is far higher than previously suspected. A detailed study on changes in influenza-like illnesses presenting to the emergency room this year projected nearly 9 million people were infected at the end of March, a time when the CDC had confirmed only 122,000 infections
Of the 4800 sailors on the USS Theodore Roosevelt 17% of the ship screw tested positive, 50% were asymptomatic, with four hospitalizations and 1 death. In Helsinki and Iceland random testing of the asymptomatic population found approximately 4% had been infected. Multiple studies where the disease is present have shown from 3 to 21% positivity in asymptomatic patients. Worldwide 97% of the cases are called mild. The early CDC estimate that 25% of COVID infections were asymptomatic has been proven low.
In New York state 94% of the deaths are in those over age 50 and 90% of the fatalities have at least one comorbidity. In New York City, 88% of those on a ventilator with COVID have died but this is comparable to the rate of 80% in other New York patients placed on a ventilator for non Covid respiratory illness.
Based on a large amount of data from around the world if you are under 50 years old with no comorbidities your risk of dying is less than 1/10 of 1%.
All available data suggests the mortality rate of COVID-19 in the general population will approximate that of the seasonal flu in the long run. It is the same patients in danger from either infection with similar hospitalization and mortality rates. Seasonal influenza is dramatically more dangerous for those ages 2 and under, than Covid.
Initial social distancing guidelines and eventually the shelter in place orders came into effect based on theoretical models and witnessing the hospital systems of Italy and China being overwhelmed. While the models have since been found to be wildly inaccurate, early actions taken in United States were defensible based upon the information available. The goal of shelter in place orders was to “flatten the curve” and protect the healthcare system. With public private partnerships and large amounts of federal government funding and logistical support there are now plenty of PPE, ICU beds, and ventilators available with many temporary overflow facilities being decommissioned without ever being used.
The US healthcare system has not and will not be overwhelmed. Mission accomplished.
The ultimate effect of the shelter in place orders is yet to be at determined. Outcomes in Sweden with no shelter in place orders has continued to rank mid pack in the EU using only social distancing with schools, restaurants and other businesses remaining open. Multiple US states have followed a similar strategy with good results.
Hospitals are underfilled with medical and hospital staff being furloughed. This is an urgent problem in the rural areas where hospitals fight to survive in normal times. In the geography roughly approximating Michigan’s 1st Congressional District the hospital occupancy is 39%, ICU 47% with 170 out of 203 available ventilators unused. In this same geography on April 27th Covid 19 patients consist of only 15 inpatients (ZERO in the UP), 15 of 79 patients in ICUs and only 3 of 36 on ventilators!
These numbers are similar in most of the rural geography in Michigan that have social distancing pre-existing in their daily community and work life.
Past studies document significant increases in suicide rate during mass job loss. Increased drug abuse and relapse with unemployment is also well documented. We hear daily from patients who are currently afraid to seek treatment for severe underlying problems like coronary artery disease, heart failure and diabetes that are more dangerous overall than the risk of contracting and becoming ill from COVID-19.
Additional testing will be important to screen healthcare workers and learn more about the disease and help guide social distancing in the high risk. Testing is not required to lift stay at home orders and begin returning society to normal function in most of Michigan’s geographic areas.
It is the high risk and positive patients who should shelter in place, not the healthy. The low risk and healthy should be free to resume their contributions to civil society and the economy.
For 35 years my responsibility as a practicing physician is to evaluate the risks and benefits of each potential treatment applied to an individual’s condition. All patients with the same disease do not get the same treatment, it is individualized. The “treatment” of shelter in place now offers significantly more risk than benefit to the overall “condition” of a large part of Michigan’s population. “Treatment” should be individualized by regions and industries starting now.
We are now past operating on theory, and can use “real science”, the data. All Michigan data quoted is taken from Michigan.gov. Michigan decision makers should use it.
Dr. Rob Steele, MD FACC
Board Certified Internal Medicine, Cardiovascular Diseases, Interventional Cardiology and Echocardiography
RNC Committeeman – Michigan