COVID 19 Update and Thoughts on Starting the MLB Season

It's been a little over 2 weeks since I last posted about COVID 19.  Wow!  It seems like over 2 years! Our world, countries and communities have changed dramatically since then.  We have been forced in a matter of a few days to completely rethink how we interact not just with society in general but with co-workers, customers, close friends and even family.  After 2 brutal and traumatizing weeks, it looks like the U.S. might, I say MIGHT, be close to the apex of the COVID 19 pandemic.  On that shred of hope, stock markets are up and we hear talk of "opening up the country" and yes, having professional sports seasons in one form or another.  With that background I again offer my thoughts on where we are in the pandemic and where we might be going.  Again, I will try to stick to facts as I understand them.  Any opinions I express are mine and do not necessarily reflect those of the leadership of my medical group or profession.

To date, the U.S. has recorded almost 470, 000 known cases and almost 17, 000 deaths.  The Case Fatality ratio for known cases is right around 3.5% which is remarkably similar to the experiences of other countries at similar stages.  That percentage may grow since deaths often occur 2-3 weeks after diagnosis.  It will also likely grow if the healthcare system is overwhelmed.  Worldwide, the known case-fatality ratio is approximately 5%.  The true case-fatality ratio is likely much lower because we do not know the true denominator for cases due to lack of available testing.  On the other hand, if you get sick enough to seek medical attention and get tested, you have at least a 3.5% chance of dying which is....well....terrifying.  If you get sick enough to need ventilator support, you have less than a 50% chance of surviving, also terrifying.  To date, there are still no proven effective therapies other than supportive care such as oxygen and ventilator support.

Some may look at the overall mortality from COVID 19 and be tempted to think this is not much different than seasonal influenza which kills between 20,000 and 50, 000 people every year.  These are probably not comparable numbers due to differences in counting methods.  With seasonal influenza, yearly death rates are not known until the entire flu season is over and are calculated based on the increase of overall death rates during flu season compared to baseline.  So far with COVID 19, death rates are based on deaths directly attributed to diagnosed cases.  In other words, we do not see large numbers of people get admitted to the hospital, suffer respiratory failure and die due to a specific diagnosis of influenza which is what we are seeing with COVID 19.  The total deaths attributable to COVID 19 will likely be much higher after this retrospective analysis is done.

In California, it appears that early mitigation efforts have successfully "flattened the curve" although we have a very worrisome surge going in multiple skilled nursing and assisted living facilities filled with extremely high risk residents.  I would liken this situation a large forest at the end of a long drought with a strong Santa Ana or El Diablo wind blowing.  Very scary situation!  Just to illustrate the ripple effects of a nursing home outbreak, I know a person whose significant other worked as a skilled healthcare provider in a skilled nursing facility which suffered an outbreak.  The significant other is now on a ventilator in an ICU and the person I know is now experiencing symptoms.

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Much analysis will need to be deferred until after the pandemic has run its course and we have all the data collected but I will offer some early thoughts on lessens we have learned so far:

1.  Early containment is possible as evidenced by countries such as South Korea and Germany who were able to aggressively test and quarantine infected individuals.  We did not do this in the U.S. and it is way too late to start now.  It may become a viable strategy again if/when we get the numbers of new cases to low numbers.  Right now, testing is mainly useful for triage purposes in hospitals.

2.  Mitigation efforts are effective.  The earlier and more aggressively they are instituted, the more effective.

3.  The economic vs public health choice is probably a false choice.  Every single country and state that has tried to preserve economic activity has eventually been forced by disastrous death rates to institute aggressive public health mitigation efforts.

4.  Barring the development of an effective vaccine or antiviral drug, it remains to be seen whether mitigation reduces total cases and deaths or simply flattens the curve while maintaining the same total volume under the curve.

5.  Even if the curve is only flattened, mitigation still likely saves lives by maintaining a functioning healthcare system.  A functioning healthcare system can likely save at least 50% of lives who would otherwise be lost.

6.  Early evidence suggests that if mitigation efforts are lifted too soon and too completely, cases and deaths start to rise again almost immediately.

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So, where are we headed and what does all this mean for the future of the entertainment industry in general and professional sports in particular?

1.  Large gatherings of people in one place will likely remain prohibitively risky until/unless we have an effective and widely available vaccine and/or anti-viral agent(s).

2.  In the meantime, entertainment venues will have to either remain shut down or will have to find ways to adapt.

3.  More than just entertainment venues, things like educational activities and business meetings and conferences will need to adapt, in some cases radically, to the need for continued mitigation.

4.  MLB(and other pro sports) is likely facing a choice between a fully cancelled season and finding an adaptive way to proceed.  The idea of having a regional season concentrated in Arizona is interesting but has enormous logistical barriers and risks which will be both costly and difficult to implement.  On the other hand, we may well be as much as 2-3 years away from being able to hold a normal baseball season with games played in front large, packed stadiums, so overcoming the logistical barriers and managing the risks may be worth the cost and trouble.

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Hot Tip:  If you enjoyed the books and/or movies Moneyball, The Blind Side and The Big Short, by economist and author Michael Lewis, you may also be interested in reading his latest book, The Fifth Risk which is directly related to the government's response, or lack thereof, to the current COVID 19 pandemic.  It was written in 2017, is downright prophetic and will likely change the way you think about government.

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One more thought:  There is a lot of interest in antibody testing and possibly allowing antibody positive people full access to the economy while keeping everybody else in social and economic isolation.  I want you to stop for just a minute and think about the enormous socioeconomic implications of this idea.