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The Healing American Healthcare Podcast
The Healing American Healthcare Podcast

Episode 20 · 1 year ago

COVID Update: Where We Are & What's To Come

ABOUT THIS EPISODE

Ed Eichhorn and John Dalton of The Three Minute Read™ share what we know about the new Delta variant of COVID-19 and its projected effects across the nation. They also look back on how far we've come since the start of the pandemic and the lingering symptoms Americans are currently experiencing.

Music: 

"The Discovery" 

by The Lemming Shepards 

Exzel Music Publishing (freemusicpublicdomain.com) 

Licensed under Creative Commons: By Attribution 3.0 

http://creativecommons.org/licenses/by/3.0/ 

Welcome to the three minute read podcast. I'm John Dalton, editor of the twice monthly newsletter of the healing American healthcare coalition. Joining me once again is at Ikorn, the coalition's cofounder and Co author of healing American healthcare, a plan to provide quality care to all while saving one trilli in the year. Hi John, together we have nearly a century of healthcare experience and we're still trying to figure it out. You can find our background and contact information at the end of the podcast. And I launched a three minute read in March two thousand and twenty to summarize some of the critical issues affecting busy clinicians and physicians as they've struggled to the pandemic. Today, eighteen months into the worst global pandemic in more than a century, we're here to discuss our thirty five issue of the three menut read as a real treat for our readers and listeners. We also have compiled a special import to share with you a look back at the past eighteen months and some of the highlights and blow lights. So let's dig in. The July first issue summarize six recent articles on three topics the first topic was the potential threat being posed by the Delta variant that first surfaced in India, and we discussed that on our prior pod kissed at the end of April. The latest information on Long Hall Covid the unfortunately, once you're over the infection, you may not be over the disease. And the third is the alarming decrease in American life expectancity as a result in part of the pandemic. The special report, on the other hand, focuses on the thirty seven member nations of the Organization of Economic Cooperation and Development and how they performed throughout the pandemic thus far, including a deeper dive into American performance. So let's begin by looking at the threat posed by the Delta variant. First, articles from Fox News titled Delta Covid Nineteen. Variant doubles risk of hospitalization compared to Alpha strain, a Scottish study finds. It was written by Alexandria him and the Public Health Scotland compiled the report. So conducted from April one to June six two thousand and twenty one. The study report that at the Delta variant, which first learned was be one point six, one seven, point two had become the dominant train in Scotland and was about twice as likely to result in hospitalization. And the Alpha variant the one we first identified as being one point, one point seven. That's the one that we began raging in Britain several last year, in January this year. But the World Health Organization that has started to use Greek letters to denote the variance. The delta variant was more prevalent in younger and more affluent groups than others, and both the ASTRAZENEC and Fiser Biontech Vaccines Dick up the risk of infection and hospitalization due to the Delta variant. But the study did not have any information on the modern a vaccine. That's not widely used in the United Kingdom. But both the ASTERSENIC AD fires of violent tech appear to be effective against the Delta Varian. The article of the study was published June fourteen in the lansing, that prestigious British Medical Journal, and then that article the authors commented quote. Given the observational nature of these data, estimates of vaccine effectiveness need to be interpreted with caution. The next article on the Delta Varian comes from the World Health Organization or from C NBC. And, as the World Health Organization says, Delta is the fastest and fittest covid variant and will, quote, pick off the most valuable and is written by Berkeley Level as junior and in the photy...

...you see Dr Michael Ryan from the World Health Organization. It was first identified or India, but the Delta variant has now spread to ninety two countries, replacing the highly contagious Alpha variant that has, we know it, earlier swept the course Europe and then later the US earlier this year. According to Dr Michael Ryan, who's the exactly can conrector of World Health Organization Health Emergencies Program and a very prominent figure, you out this pandemic. Quote, this particular Delta variant is faster, it is fitter, it will pick off the more vulnerable more efficiently than previous variants. That's a five alarm fire. Ryan said. World leaders and public health officials can help defend the most vulnerable through the donation and distribution of cold vaccines. He described the fact that we have, as quote, a catastrophic moral failure at a global level. Well, concurred with the release of this article. The Biden Administration and assets donation of fifty five million vaccine doses. I think there was an ass prior to the the article. Most of them will be distributed to Kovacs, the WHO backed immunization program, and you have an update. Yes, I think it's important to share that at the g seven summit that occurred after this interview, President Biden agreed to dosages to five hundred million, with two hundred million going out before the end of two thousand and twenty one and another three hundred million going out next year. And the United States will also donate four billion dollars to Kovacs to help cover the cost of distribution and administration of the vaccines. So it's a great increase and in addition to that, the g seven nations agreed to match the United States nation and these two large donations will go a long way to beginning to help the eighty nations that are lower middle income nations to vaccinate their populations. I said, the final article on the Delta variant theme comes from the Associated Press. They've concluded that nearly all covid deaths in the US are now among the unvaccinated was written by Carla K Johnson and Mike Stubby, and the images that of Dr Rochelle Wilenski, the current head of the Centers for Disease Control and Prevention. These analysis of available government data from May shows that breakthrough infections and fully vaccinated people accounted for fewer than one hundred of the more than eight hundred and fifty thousand covid nineteen hospitalizations. That's a very small, decimal fraction and, as you know, break through infections are when a vaccinated person contracts the particular disease they've been vaccinated against. In all of the vaccines there are some level of break from infections. The good news is that they typically are relatively mild and sometimes a symptomatic unlike being infected when you're unvaccinated. Deaths in the US have permitted from a peak of more than thirty four hundred a day on average in mid January to less than three hundred per day now, and that's good news. That's really pushing the curve dam only about of one hundred and fifty of maze more than eighteen thousand covid nineteen deaths were in fully vaccinity people. Some more than ninety nine percent of covid nineteen deaths in the US now are among the unvaccinated. CDC said, directed Dr Rochelle Wilenski, said during the White House coronavirus briefing that the vaccine is so affected that quote, nearly every death, especially among adults, due to covid nineteen, is at this point entirely preventable. She called such deaths particularly tragic. Expert predicted preventable deaths will continue, with unvaccinated pockets of the nation having outbreaks...

...next fall and winter. The university Washington is modeling suggests that the US will hit a thousand deaths per day next winter, and you may recall that was last spring, Spring of two thousand and twenty that the University of Washington is institute her health metrics gave its modeling forecast of somewhere between a hundred thousand and two hundred forty thousand deaths, and American with mitigation strategies, and that's pretty much for shock the trump administration into some awareness that this really was a serious event that we were fighting our take heed your doctor's life saving advice, if you haven't already done so. Get vaccinated. The life, you say, maybe your own, and you've got an update. Yes, a see in in recently interviewed Dr Fouchi and he warned that there may soon be two Americas as the divide widens between vaccinated and unvaccinated areas. With the Delta variant accounting for more than a quarter of covid nineteen cases, Dr Fouchi warns that there's soon could be two Americas, one where most people are vaccinated and another where low vaccination rates could lead to spikes and cases. The stark disparity between low and high vaccination areas is something Dr Fouchi is very concerned about, as he told CNN's Don Lemon on his recent interview, and you know, this underlines the importance of trying to reach herd immunity. Theoretically, this occurs when seventy to eighty percent of a nation's population are vaccinated, and it occurs in areas and would spread across the country. In the United States, the northeast looks like it's getting close to herd immunity, and so are some areas on the west coast. But the south central states of the United States have very low vaccination rates, and this is the concern that Dr Fouchi has about two Americas and in fact, given the spread of the Delta virus that John has been reporting on today, if you look at the two week rolling averages reported in the New York Times, today is the first day in a very long time that the average actually has gone up by fifty team percent and this should be an area of concern for public health officials throughout the nation, but especially in those states with very low vaccination rates. Thank you, guys. So, as Dr Mike Ryant said, it's the fastest and the fittest and it's it's flying fast. So our next topic looks at once you've beaten the infection, is the game over. Not The news. This is from CNBC on June seventeen new covid study hence at a long term loss of brain tissue. Dr Scott Got Leave Warns Covid in the brain. So, citing a new study from the United Kingdom for FDA directed Dr Scott gottlieb warned about the potential for long term brain loss post code. He stated, quote, the study suggests that there could be some long term loss of brainish tissue from covid and that would have some long term consequences. UK study examined brain imaging before and after a coronavirus infection and looks specifically at the potential effect on the nervous system. Godly said that the destruction of brain tissue could explain why covid patients lost their sense of smell, as we reported earlier, and Nasmia, or the loss of the sense of smell, was one of the key in this Sha that patient persons infected with covid. Next up, the CDC recognizes covid long holes. They finally have issued new guidance for treating covid nineteen long holes and they warn against relying on labs and imaging results alone, as got the commented,...

...most of the evidence they looked at were imaging results. This is written by day Yu Eo of fear self care, and appeared on June seventeen. CDC has released in room guidance for those healthcare providers treating patients for post covid conditions. The long haul conditions are a wide range of physical and mental health issues that sometimes persists four or more weeks after a covid nineteen infection. According to the CDC, many of the patient's post covid conditions can be managed by primary care providers. That's a good indication, because most of us do have a primary care physician who coordinates our care and Directsss when we need specialized assistance. Wrong covid conditions include heart palpitations, cognitive impairment or brain fog, insomnia, diarrhea and Post exertional malaise, a worship of symptoms following physical or mental exertion. The CDC warned against relying on diagnostic results as the only means of assessing the patient's condition. Quote. Lack of laboratory or imaging abnormalities does not invalidate the existence, severity or importance of a patient's symptoms or conditions. The agency said they quote, will continue to work in collaboration with federal, state, local, academic and community partners to better understand the long term effects of stars Covy to infection. Concurrently, the article cited a studied by fair health. Fair Health has an enormous database of health insurance claims that they mind continually to determine and analyze for various conditions. Their study found them more than twenty three percent of patients who had a covid. Nineteen affection experience one or more post covid conditions thirty days after their initial diagnosis. So will they beat the infection? They still had some residual effects of pain, breathing difficulties, hyperlipidemia or high coolesterol, malaise and fatigue and hypertension, with a five most common post covid conditions and, alarmingly, when more common among females than males. The infections, as we've learned over the course of the pandemic, tend to hit males harder, but the post covid conditions seem to be much more prevalent among females than males. The study also found a higher risk of mortality after acute treatment. Our take for nearly one out of four covid survivors being the infection is not the end of the battle. The war continues, for some symptoms continue to persist and May last for years. Preventing the next pandemic should be the number one priority on America'sublic health agenda, and I think you have an update to add. Yes, when we think about one out of four being a long haulers, I don't think that brings the reality to the forefront. So basically one in four or twenty three percent of the patients who develop long haul symptoms. Means that between seven and nine million Americans are suffering with long haul symptoms, and this is a very difficult large number because that needs a great deal of care and hopefully the researchers and physicians treating them will help them to eliminate their symptoms earlier rather than later. But that's still a very large number of people are suffering after having the covid infection. Yeah, the three men read first note of this issue back in August of two thousand and twenty, in an article that described a thirty year old British neuroscientist who was unable to return to work even at the time of the publication the article. She is brilliant woman suffering from brain fog as a postcode syndrome. Don't have any updates as to whether she finally shed the the symptoms, but this is not new news. That issue also had an article from Asini in New York talking...

...about setting up clinics and wanted to deal with long code symptoms. So this is one of the lingering effects of the covid pandemic. The final topic in this issue, a three minute read, deals with the alarming drop us life expectancy. This is from NPR. An article entitled the pandemic led to the biggest drop in US life expectancy since World War II, study finds, written by Alison Aubury, from NPR on June twenty three, two thousand and twenty one. And the truck below is kind of small but you can see the trend. The Blue Line is composite of high income nations and the Green Line, unfortunately, is America. And as you can see, we peeked about here and the then flat line that we've been in a decline, and alarming decline. The study is publish in the British Medical Journal and it indicates that life expectancy in the US has declined from seventy eight point nine years in two thousand and fourteen to seventy six point nine years at year end two thousand and twenty. African Americans and Hispanic Americans were especially hard hit, with declines of three point three and three point nine years respectively. Study offer both or Stephen Wolf is from the Virginia Commonwealth University of Medicine. He stayed quote, we have not seen a decrease like this since World War II. It's a horrific decrease in life experiency. Will further note that disruptions and behavioral health and chronic disease management during the course of the pandemic have contributed to the decline. Wesley Curtis, chair of the Department of Population Health Sciences at Duke University School of Medicine, commented, quote. It is impossible to look at these findings and not see a reflection of the systemic racism in the United States. Dr Richard Besser, president of the Rodal Wood Johnson Foundation here in Priston, New Jersey, said, quote. This study further destroys the myth that the United States is the healthiest place in the world to live. For example, life expectancy in Princeton, New Jersey, a predominantly white community, is fourteen years higher than Trenton, New Jersey, and predominantly black and Latino city, only fourteen miles away. Fourteen years of difference in life expectancy. The US has been losing ground and they with other wealthy huntries. Said mcgualley, the Barbari of the University of California Berkeley, in editorial that was published alongside the new study, will concluded. Quote. The US has some of the best hospitals and some of the greatest scientists, but other countries do far better in getting quality metal medical care to their population. We have big gaps and getting care to people who need it most when they needed most. And our take for vaccinated Americans? The covid nineteen pandemic appears to be under control, but what it's all of this taken especially among communities of color. At the semmer thirty one two thousand and twenty three hundred forty three thousand eight hundred eighteen Americans had perished. More than two hundred and sixty thousand have died since then. So US life expectancy. It will continue to plant. As your editor, I've often stated that America has the most thoroughly trained physicians and the best equipped hospitals in the world, but does not produce health first population. That has to change that. I think this is really important information and the decline is, as you said, is going to continue. It's a startling difference when you consider a place like Princeton, is only fourteen miles from Trenton, and the life expectancy is fourteen years longer. Moving healthcare to people that need it needs to be part of the work of the current Congress and there are bills being considered now to expand and develop a public option and to get healthcare to more people...

...around our nation to help stem the tide of a shorter life expectancy. Well, that's it for the June issue, but we have a special treat for our readers and listeners, a look back at the global pandemic and how various OECD member countries, as well as some others, have managed or in some cases mangled their response to the pandemic. Will start by looking at the timeline. As the pandemic hit the world, then key data from four of the following days. Able thirty two thousand and twenty, which is when Med and I began tracking some of the data. June thirty two thousand and twenty, half way through the year year in December thirty one, and then fast forward to where we were as a June thirty we celebrate the New Year of two thousand and twenty. Within an ascement from December thirty one. Two Thousand and nineteen, the government and Mouhan China confirmed the health authorities were treating dozens of cases of a pneumonia of unknown origin. So three weeks later the US, so it is first confirmed case in Washington state. Was a man in the studies and developed symptoms after returning from Uhan. And shortly thereafter I think all of us can remember seeing the ambulance is pulling up in front of a nursing home and Kirkland, Washington road. The first major outbreak had occurred. January, thirty two and twenty, the World Health Organization declares a global health emergency named the disease covid nineteen, and the way they've naming convention is is coronavirus disease discovered in two thousand and nineteen. In February two thousand and twenty, more than two point two million travelers arrived in New York from Europe, some already infected with the novel coronavirus. On March fifth here in New Jersey confirmed our first case. Immediately thereafter, Metro New York joined the Milan and Madrid as the global epicenters of the pandemic. I don't think any of us will ever forget the ambulances, sem cold storage refrigerators mind up outside the Queen's Hospital Center in Elmhurst and the shortage of PPE and the frontline healthcare worker is doing their best to treat patients with this disease that looked and acted far different from any that we have seen before. On Mark Thirty One, two thousand and twenty, president trump projects up to two hundred forty thousand coronavirus deaths, even with mitigation efforts. Univers of Washington student of health metrics had done their modeling and their worst case scenario with mitigation efforts was two hundred and forty thousand deaths. And a March thirty we began monthly tracking, is confirmed cases and deaths for the thirty seven member nations of the organization's Economic Corporation and Development, that is, the Organization of world the developed countries in the world who have met a certain economic criteria and applied for a membership. So let's look at where we were as of April thirty two thousand and twenty. Three major points to remember. The four Pacific Rim countries, Japan, Australia, South Korea and New Zealand where at the top of the chart, along with Slovakia. The Slovaki Republic and Colombia and staff America. The US rank twenty nine out of thirty seven, while ahead of Sweden. Sweden mangle their attempt at helping with the pandemic. They first decided to try to establish her immunity in her uniqu because everybody gets the disease and then you're immune. But I think what's realizing just how legal the disease was. The Sweden change course, but they were last among the four nordy countries, behind Finland, Denmark and Noy and it remained last, although, as you'll see later on, the four in order countries as a whole have done quite well in coping with the pandemic. The...

...worst mangler was Belgium and if you look at the chart that left hand side is the fatality rate for a hundred thousand for twenty OECD countries, arranged from zero to up to eighty hundred thousand. This is members just fall on Sinto the vandemic. So his Belgium and nearly seventy fatality rate for thousand, followed by Spain and Italy, which should you mentioned Milando Madrid with the initial global off centers of the vandemic. So the US two thousand undred thirty seven, or the top of the bottom courtile of the OECD. Two months later, June, thirty two thousand and twenty here on the updated fatality rates. Now the Chart Rangers from zero to ninety. Once again, the for Pacific Rim countries and Slovakia continued to top the chart. Columbie had dropped a bit in the total survitory and Ciral New Zealand at that point had a completely eradicated the coronavirus. They went through seventeen days stretch with no infections. Now, obviously it's isolated. It's an island nation, but they took some very strong steps early on and they were monitoring what was going on in Italy and they've quickly realized that New Zealand had a lot of fewer, I see you, beds per capita than did Italy the rest of the OECD. So they did. They takes some pretty drastic measures pretty early and guess what? They worked. The US slipped two places to number thirty one out of thirty seven, the head of France, Sweden, Italy, Spain and the UK. The UK is another country that kind of stumbled out of the gate but as you see later they did recover some time. Further down line, Belgium remains at the bottom of the barrel by a wide margin, and we published a couple of articles about the Belgian experience that were despite the lethality of the infection in Belgium, the hospitals were denied admission to patients from nursing homes, now a fact. Animals were instructed not to accept critically ill patients from their care homes, which are their equivalent nursing homes, and that is what contributed to their higher depth home at that point in time, and I were betting that nobody who was ever going to be Belgium. But as you see later on, some other countries also managed to mangle the response. Now, by June thirty much have been learned about covid nineteen. Under desperate circumstances that recall mid Mars through the end of April, when Metro New York was just buried with the covid cases. In New Jersey are CMO sheep. Medical officers were having daily conferences each morning first thing to compare notes and share of what they had learned. So we become much more effective in treating the virus. Once contracted. The fatality rates were declining, but we still had a great deal to to deal with. So we use June thirty two thousand and twenty as a baseline for looking at subsequent performance by country and by states. So at June thirty, this is the first time we did a deeper dive, appeeling back the US results and looking at individual states. So hereviously some selected states and New York City as a June thirty on this chart. The blue bars are the population of the particular states. So you see you've got some of the more populous states on here, Texas, California, Florida, Georgia, Pennsylvania, plus the northeastern states that were hardest hit. I don't have Louisiana on this chart, but they'd be right here around Rhode Island Massachusetts. Louisiana was one of the non northeast states that was hit hard early with Martin raw in February two thousand and twenty. That turned out to be a super spreader event. So the fatality rates but now as and we have Texas in California and Florida, Washington all in single digits, while at the other extreme we have New York, New Jersey and the Big Apple New York, New Jersey both that about...

...a hundred fifty, I'm sorry, five for a hundred thousand fatality rate or already at that point in the pandemic. So you clearly see how hard hit the northeast states were in the initial wave of the pandemic. In subsman slides will see how well or poorly various other states dealt with the challenges. Now let's face forward to the year end. Here we have the OECD again with the four Pacific Rim countries here reading New Zealand, South Threeedgeapan in Australia continue to top the char. So there's population, the blue bar and fatality rate. The gold war they were joining the top ten by four of the five Scandinavian countries. No Way, Iceland, Finland and Denmark. Sweden. That actually moved up into the third courtsile. But sweeden still had a much higher fatality eighty five, point three, four hundred thousand. Israel, Germany and Canada are at thirteen, fifteen and sixteen respectively. Canada, for whatever reasons, has managed the pandemic well consistently throughout. Germany managed it quite well through the initials and nine months of the pandemic, but then, like the rest of the central Europe got hit hard with the fall surge. That really hurts some of the central European countries, especially Hungary, the Czech Republic and Slovenia. Here in the US, as of December thirty one, again we've got the blue bars population. The gold bar is fatality ratings. The far end or New York and New Jersey with the highest fatality rates in the country, follow by Massachusetts. But some new information. Louisiana and northeast continue to be up at the top of the graph, but they were joined by what Dakota, South Dakota, Mississippi and some others. There was a sturgis motorcycle rally in South Dakota back in August for ten days and ended up being a super s better event on steroids. Puiser Family Foundation epidemia was just Joshma show commented, quote, holding a half million person rally in the midst of a pandemic is emblematic of a nation as a whole that maybe isn't taking in the novel coronavirus as seriously as we should. And, quote, on a positive note, in December the fires of biontech vaccine received an emergency use to authorization from the Food Drug Administration on December eleventh, and one week later mcdurnay received its EU A. President Biden was in ordinated on January twenty two thousand and twenty one and declared war on the pandemic, but during the audiation day the death fillso passed for Americans comcouraged from the seas. Six months later, totally different picture. With some consistency, can continue to see the for Pacific Room countries containing the pandemic, although with during June we heard concerns about some outbreaks in Australia and concerns about some outbreaks in Japan with the pending Olympics. Both of those relate to the fact that both countries have a very low vaccination rate and, as we know it earlier, the depth of variant is now spreading like wildfire. So, although those are concerning events, those countries still lead the world in terms of protecting their residence from the virulent disease. The for Scandinavian countries continue that top ten, and they followed by Turkey, Canada and Israel. The US, for the first time, moved out of the boardom court tile where now two thousand eight hundred and thirty seven. That's the highest ranking we've been able to attain. Our second April issue summarized articles about the pandemic that was raging in Brazil, India and Hungary. At to put those in perspective, hungry is least in the OECD. You see what happened between June...

...and December. Countries like Slovakia, the Czech Republican hungry, hit very hard by the full surge, managed to surpass the Belgians as worst in the OECD. Hungry is a particularly poor example of how not to deal with a pandemic, and covered that in detail and an article of the summarized in the April Isu. But let's think about where the they are in the total picture, because Brazilian indie are not part of the OECD. If India were part of the only seed the it's current fatality rate as bad as that disease has been in the country, with well over three Hunderzero one thousand deaths. At this point I probably understated. It would have ranked eight, between Finland and Denmark. It would have been right around here on the OECD rankings. Brazil on the other hand, would have ranked the franked higher. Brazil has had a much higher fatality, two hundred and forty one point nine hundred thousand. So we would have ranked just above hungry and after the check, big bubble in those rankings. The final slide will talk about really looks at the pandemic over time and in five major countries and with the OECD average. As most of you know, I've spoken a written widely on universal health systems, with particular emphasis on France, Germany and the UK, each of which has a different approach, but economies and demograph is quite similar to ours here in the United States. So I attract those three countries and he added cantered to the equation for a couple of reasons. One, there are nearby neighbors to the atom. We share a lot in common in terms of our approaches to democracy. But KATTA was also we kept hearing about in the presidential campaign from Centator Sanders and Senator Warren and others about the need to go to Medicare for all and any late the Canadian system. So let's look at how these countries fair. The first time I did this show I had also included data for the four Nord nations. If you think about Canada, Canada's population is about the same as California. If you had up the for Nordic nations, Sweden, Finland, Norway and Denmark, their populations about the same as Texas. So it's reasonably consider putting on a chart. When I put the no ord nations on this chart you couldn't tell the difference between them and cant so the track was exactly the same. They will as a group the for no order nations. And then Canada contained the pandemic quite well. Then we have a full searge that really hit everybody. This is the fall of two thousand and twenty, but Canada continues to do quite well. Germany, early on, probably because transfer ago Markle is a scientist that with a lot of credibility. She's just finished the sixteen year term as Chancellor of Germany, did very well early on. But again they were hit with the fall searge. That hits Central York very hard, and so they've struggled since, still doing better than the OLYCD average for French, UK and the US. UK's an interesting chart to look at because, remember said, they stumbled badly out of the gate. You see here they were, they were climbing steadily. They managed to control it well during the summer of two thousand and twenty, and this is one of the Alpha variant first appeared in UK. The Alpha Varian I first appeared in the UK. So the Alpha Varian infections and fatality race where climbing at an astronomical rate. Right about here, Prime Minister Bars Johnson implemented a radically a very aggressive vaccination program of getting the first vaccine administered and in that case is the fire as a violin tech and holding wolf on the second and as you can see, the strategy of the employee worked because since beginning of March the UK pretty much has flat line. But now they're coping with the delta very night as the west of the world. But there's it's like the TV show...

...the NYGAT cities. Say they're aiming and stories and in the naked city, while they're probably thirty seven different stories in the OECD put some others that we've discussed in three minute read. So that's that's the picture. Here we are in the US. Where are we? A June thirty back keep washing the state on his chart and they were the first where we saw a case and they were the first have a major outbreak. Yet throughout the pandemic, the state of Washington has managed to stay at the bottom of the chart in the US. I'm sure some academics are going to study Washington response providers with some information as to what they did to manage through the and so effectively. But other states, Georgia, Nevada, north and South Dakota, Arisona and Mississippi, now a fatality rates above the US average of a hundred and nine point one, four hundred thousand. So this is where we are in absolute numbers, with again in New Jersey at the high end of the chart. Just for hungry, is in the OECD. But what we took a look at was what happened between June two thousand and twenty, when we knew what we were dealing with, and June two thousand and twenty one, and that slide shows a slightly different picture. Here we go. This is the change of fatality rate between June thirty two thousand and twenty and June thirty two thousand and twenty one for twelve states that we track. So you can see that in Washington state the fatality rate increased by sixty one hundred thousand in Georgia. The other scheme was almost one hundred eighty a hundred thousand. So mentro, New York, the Connecticut, Europe New Jersey kept the disease somewhat under control, especially when you compared with states like Florida, Pennsylvania, Texas and Georgia at the far end of the chart. So we haven't tracktill fifty states. It's clear that within the US, Washington state probably has done the best job of all the states and protecting US residence. The northeastern states hit hard early on also perform well during the year that just ended, June thirty. The good news is that the latest data indicate that more than nine nine percent of current covid nineteen affections are among unvaccinated Americans. So listen to your doctors of rice, if you haven't already done so, get vaccinated, but, like you say, maybe your own and well. I want to thank you, John, for bringing up all the statistics that compare the United States with itself and other nations, and it all goes back to the importance of mitigation. To begin with, that we saw a done so well on the nations of the Pacific Rim and then all of the efforts to vaccinate people in order to bring down the infection and death rate. And you know, it's the same, same song that the public health officials, that led by Dr Fouchi, have been sharing with us since the very beginning of this. Mitigation without vaccination, and then vaccination after mitigation can bring the pandemic to an end. But that can happen unless we have great deal of cooperation among the public health officials around the United States and around the world, thanks aid. In our previous podcasts we talked about a survey and ask a lotting to participate. Well, the healing American healthcare coalitions healthcare cover survey report is available at our website. If, yes, that's one of you, just point out, John, that in one of our future podcast will go through the data that we learned through that survey. Will Continue to cover the topics that we've covered today and if they're particular interest that you'd like to see us probe, please feel free to contact us and we'll see you next time.

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