Evidence continues to mount that the new infections throughout much of the country are extremely mild, with the exception of some serious cases coming over the border from Mexico. Those two facts continue to be obscured from our policy debate over containing the virus in the southern states. The governors of California, Arizona, and Texas refuse to recognize that the mild nature of these cases is good news going forward, and they continue to ignore the threat of serious cases from the border.
Distinguishing between the two phenomena has become difficult, because the cause of both of them appears to have begun in late May and continued into June, especially in border states, which weren’t hard hit to begin with and therefore had little herd immunity to combat a new round of spread. But the timing of these serious cases at the border combined with milder cases in the interior seems to make it clear that we are seeing two distinct waves: the second and mild American wave and the importation of Mexico’s first, more serious wave.
In my previous article, I focused on the serious cases coming from the border. That issue appears to be confined to certain hospitals in the border states. What about all other cases throughout the country? They are turning out to be less potent than even the flu.
Increasing evidence that the new wave is mild for most of the country
As I pointed out regarding Florida, cases have been spiking for weeks, yet the deaths and numbers of serious cases are not rising. That dichotomy is perfectly illustrated in this graphic:
Also, much of the increase is superficial and illusory because of mass testing, multiple tests to return to work, and people coming back to the hospitals for normal care that was previously suspended. Such patients are automatically tested for the virus, regardless of their reason for admission. It appears that the virus has now spread to younger people but is also milder than it was when it first hit in earnest in March and April.
This reality is borne out by a fascinating data point about positive cases and Hispanic people. As of the week of April 25, according to the CDC, just 12.2% of the cases were among those identified as Hispanic. As of yesterday, 34.4% of all cases were among Hispanics. That is simply astounding. If you peel into some state data, you will find that cases among Hispanics compose 46% in Florida (twice their share of the population), 46% of cases in North Carolina (nearly five times their share of the population), 35% in Tennessee (nearly seven times their share of the population), and 24% of cases in Arkansas (nearly three times their share of the population).
Those numbers are astounding. But what is even more shocking is that while Hispanics compose 34.4% of confirmed positive cases, they account for just 17.7% of the fatalities, more line with their share of the national population. For example, in North Carolina, where they compose 46% of all cases, they account for just 9% of the deaths. What gives?
The only logical answer is that this is merely an illusion of mass testing of meatpacking plants and farm labor camps, where they began testing every worker, most of whom are Hispanic, especially in the southern states. Thus, as we saw with the Arkansas Tyson Foods plants, almost all of them are asymptomatic. Lots of cases; few deaths.
Why does there appear to be resurgence even beyond the accounting gimmicks? That could either be the next evolution of the virus itself or due to the mass protests and rioting. There is increasing evidence of the latter. Either way, it makes sense that it would hit in states like California, Texas, and Florida, large states that were previously barely touched by the first round and not in the northeast, which has likely achieved some degree of de facto herd immunity.
While there is still very little data quantifying who has a severe case or a mild case and who was hospitalized for coronavirus vs. hospitalized with coronavirus discovered through testing, here are two powerful anecdotes that drive home both points.
Car crashes are now COVID-19 cases
The New York Times reported on Sunday: “One-third of all patients admitted to [Miami’s] main public hospital over the past two weeks after going to the emergency room for car-crash injuries and other urgent problems have tested positive for the coronavirus.”
That is huge news that most people are not properly dissecting. Car crashes plummeted by as much as 75% in some states during the shutdown because the roads were empty. Now we are back up to normal levels of car crashes. For that matter, hospitals are now back up to normal levels of cancer, heart, stroke, and any number of procedures and treatments that were either suspended or declined because people were too scared to come in. Now that we have universal testing in the hospitals, we are merely discovering what already existed, but we never detected because hospitals were empty and we did not have universal testing capability.
These are people who would never have known they had COVID-19, much less rushed to the emergency room if not for the coincidence of their car accident or other ailment driving them into the hospital. Once they test positive, they are regarded as coronavirus patients, even if they are asymptomatic, which is the case with the majority of younger people who contract the virus.
What percentage of people counted as COVID-19 patients came because of COVID-19, vs. what percentage happened to have it asymptomatically? We don’t know, but the number has to be pretty substantial.
Cold-like symptoms as the new panic and threshold to trigger shutdown
What about those people coming to the hospital because of COVID-19? Most Americans probably conjure up images of people coming in with their lungs filled with fluid and suffering from acute respiratory distress syndrome, as we saw in New York in late March. That was never the case in most parts of the country, but it most certainly is not what’s happening now.
I long suspected, given the massive gap between deaths/ICU admissions vs. hospitalizations and cases, that these cases were much milder. Which leads me to the second anecdote. An emergency care executive from Texas explained to former New York Times reporter Alex Berenson that most cases he sees now in Texas are milder than a typical full-blown cold.
The managing partner and general counsel of the company that owns Complete Care, which operates 13 emergency care clinics in Texas, emailed Berenson with a statement illuminating the situation on the ground.
He noted that out of 2,231 tests the clinics have administered in June, although the positivity rate is at 20%, the “vast majority of the cases are mild to very mild symptoms.” He observed that most patients were in their 30s, most would not even have met the criteria for testing during the peak when kits were scarce, and that very few of them really need hospitalization. “Vast majority of the patients are better within 2-3 days of the visit and most would be described as having a cold (a mild one at that) or the symptoms related to allergies,” he said.
He further noted that half of them come in because they sneeze or cough and their employer makes them get tested.
Thus, ironically, the spike in hospitalizations now is because of the pervious lockdown, which they are now pushing again. As Dr. Robert Hancock of Texas College of Emergency Physicians said, “We saw just a rash of people that came in for relatively treatable conditions that had just waited to the point that it deteriorated. That’s kind of added to the ICU stress on top of just having the COVID-19 patients.”
Thus, what we are seeing in Texas and elsewhere is actually a fulfillment of what we all hoped for – a flattened curve of mild cases and hospitals that are able to handle severe cases, but ultimately few deaths. “Overall, based upon what we are seeing at our facilities, the above information is really more of a positive story,” wrote the emergency clinic executive to Berenson. “You have more people who are testing positive with minimal symptoms. This means that the fatality rate is less than commonly reported.”
This is perhaps why hospital officials in Texas, whose profession has typically led the charge in panic peddling since March, are actually warning the public that they are being misled with illusory data.
Houston Methodist CEO Marc Boom complained that the data is “being misinterpreted” “and, quite frankly, we’re concerned that there is a level of alarm in the community that is unwarranted right now.”
“We do have the capacity to care for many more patients and have lots of fluidity and ability to manage,” Boom said in a press conference with the CEOs of Houston’s largest hospitals as he pointed out the missing context the media and politicians are failing to provide. He pointed out that this time last year, ICU capacity was at 95%. If anything, what was occurring in April was abnormal because everyone was scared away from hospitals. And that was not a good thing.
As the media continues to be addicted to spinning bad news news, it’s incumbent upon everyone else to provide the missing context.