May 4 2020
Friend: The John Hopkins site used to have the graph of cases vs. recovered which showed that the recovery rate graph is about 4-5 weeks behind the new cases graph. It no longer shows that chart. But I downloaded the raw data and will try today to work on it if I have time.
Here in the Orange County, CA. We can see the new infections are going up slightly but hospitalization is consistently increasing as patients are staying while new patients are coming in. This is in contrast with ICU which are pretty much constant because people that die are no longer sick.
Dr. Why: It is not clear why there is such difference between total and recovered. I think, there is a lag in reporting. This is the only reasonable explanation. See Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. The max hospital stay in this study was 8 days. I doubt we have good data for discharged, or those who never went to the hospital. It will all be “I felt terrible for 2-4-6-8 weeks” testimony…
Friend: This was a 5 weeks study. Out of 5700 patients admitted 2100 were released and 500 died. Which means that 3100 are still in the hospital. Also the patients that are released may still be sick at home, just not in critical condition. For those that require ventilation only 3% were discharge.
So, if you are admitted to the hospital you have 58% chance of remaining in the hospital for more than 2.5 weeks (median days). If you were ventilated and you did not die (23%) you have 97% chance to remain in the hospital for more than 2.5 weeks. I don’t know where the 8 days is coming from.
Dr. Why: The article I shared with you Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area, clearly states that the longest stay was 8.4 days. The maximum for those who died was 7.4 days. These 5700 people were not admitted simultaneously but over 5 weeks. Therefore, only 2634 were discharged or died by April 4th. Hence, the rest were still in the hospital. Why do you think remaining 3066 will be any different from those who reached end points (discharge or death). The authors were in a rush to publish, so they essentially published interim results. Normally, they would wait until all 5700 patients achieved end point and then analyze and publish. The good news is that 2634 patients are more than enough to extrapolate not only to 5700 but the entire population of NYC and beyond. This is a very respectable sample which allows to do good quality statistics.
More importantly, at triage, 30.7%of patients were febrile, 17.3%had a respiratory rate greater than 24 breaths/minute, and 27.8%received supplemental oxygen. This means that 69.3% did meet criteria for admission. They should not have been admitted but they were! This inflates numbers overall, creates impression of overcrowding by seriously ill patients (70% were not, not even close!), and sets up these unnecessarily admitted for superinfection in the hospital not only with viruses but also bacteria, fungi, etc.
I had two patients in the last month who were admitted. One got discharged after 5 days, a second one, who did get intubated, left hospital after 8 days. Please remember that as opposed to the Israel, China, Russia, etc. the US healthcare system focused on cutting down hospital stay since 1970s and moving care of significant number of patients into out-patient settings: offices and surgical centers. I must say that more often than not, I feel that my patients get discharged too early regardless of reason they ended up in the hospital. I even feel patients are let go too early from outpatient centers after having pretty big surgeries. I always want patient to be observed overnight, but most get kicked out. I hope this helps
The 8 days is for people who discharged alive, not for people coming in. Probably there were some people that come in, get hospitalized for a day and get liquids, vitamins and cough control and then they are released to be sick at home. The 56% of people that are sill hospitalized are not in those statistics.
Friend: Over 5 weeks of admission and 56% of the people are still hospitalized. If what you say is right than after 5 weeks there should only be 22% still hospitalized.
Dr. Why: The patients who remained hospitalized were admitted closer to the cut of date on the 4th of April. Is it possible that some end up staying longer, yes! But this will not be earth shuttering number. The US system is not geared to longer stays.
Friend: Some of them were. But the majority of them were not. It’s a simple statistics.
Dr. Why: Where did you get this information? Do you know the number of people admitted each week of the study? If I am forced to guess, the majority was admitted to the end, because that’s when hysteria started. On March 1st, there were very few people who were worried about this. The state of emergency was declared by Trump and March 13th and New York locked down on March 19th.
Friend: Yes. It is true that there were 76 diagnosed on March 1st for the entire US. By April 1st, there were 58,000 diagnosed in New York City and Westchester county alone. So, the data is indeed backloaded. I asked my friend who run the COVID section in mission hospital to give me field data. He did not respond yet. He usually responds at night.
Dr. Why: Let me know what he thinks!