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The Healing American Healthcare Podcast
The Healing American Healthcare Podcast

Episode 20 · 6 months 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 Americanhealthcare coalition. Joining me once again is at Ikorn, the coalition's cofounder andCo author of healing American healthcare, a plan to provide quality care to allwhile saving one trilli in the year. Hi John, together we have nearlya century of healthcare experience and we're still trying to figure it out. Youcan find our background and contact information at the end of the podcast. AndI launched a three minute read in March two thousand and twenty to summarize someof 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 asa real treat for our readers and listeners. We also have compiled a special importto share with you a look back at the past eighteen months and someof the highlights and blow lights. So let's dig in. The July firstissue summarize six recent articles on three topics the first topic was the potential threatbeing posed by the Delta variant that first surfaced in India, and we discussedthat on our prior pod kissed at the end of April. The latest informationon Long Hall Covid the unfortunately, once you're over the infection, you maynot be over the disease. And the third is the alarming decrease in Americanlife 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 Organizationof 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 thethreat posed by the Delta variant. First, articles from Fox News titled Delta CovidNineteen. Variant doubles risk of hospitalization compared to Alpha strain, a Scottishstudy finds. It was written by Alexandria him and the Public Health Scotland compiledthe report. So conducted from April one to June six two thousand and twentyone. The study report that at the Delta variant, which first learned wasbe one point six, one seven, point two had become the dominant trainin Scotland and was about twice as likely to result in hospitalization. And theAlpha 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, inJanuary this year. But the World Health Organization that has started to use Greekletters to denote the variance. The delta variant was more prevalent in younger andmore affluent groups than others, and both the ASTRAZENEC and Fiser Biontech Vaccines Dickup the risk of infection and hospitalization due to the Delta variant. But thestudy did not have any information on the modern a vaccine. That's not widelyused in the United Kingdom. But both the ASTERSENIC AD fires of violent techappear to be effective against the Delta Varian. The article of the study was publishedJune fourteen in the lansing, that prestigious British Medical Journal, and thenthat 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 onthe 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 covidvariant and will, quote, pick off the most valuable and is written byBerkeley Level as junior and in the photy...

...you see Dr Michael Ryan from theWorld Health Organization. It was first identified or India, but the Delta varianthas now spread to ninety two countries, replacing the highly contagious Alpha variant thathas, we know it, earlier swept the course Europe and then later theUS earlier this year. According to Dr Michael Ryan, who's the exactly canconrector of World Health Organization Health Emergencies Program and a very prominent figure, youout this pandemic. Quote, this particular Delta variant is faster, it isfitter, 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 canhelp defend the most vulnerable through the donation and distribution of cold vaccines.He described the fact that we have, as quote, a catastrophic moral failureat a global level. Well, concurred with the release of this article.The Biden Administration and assets donation of fifty five million vaccine doses. I thinkthere was an ass prior to the the article. Most of them will bedistributed 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 summitthat 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 twentyone and another three hundred million going out next year. And the United Stateswill also donate four billion dollars to Kovacs to help cover the cost of distributionand administration of the vaccines. So it's a great increase and in addition tothat, the g seven nations agreed to match the United States nation and thesetwo large donations will go a long way to beginning to help the eighty nationsthat are lower middle income nations to vaccinate their populations. I said, thefinal article on the Delta variant theme comes from the Associated Press. They've concludedthat nearly all covid deaths in the US are now among the unvaccinated was writtenby Carla K Johnson and Mike Stubby, and the images that of Dr RochelleWilenski, the current head of the Centers for Disease Control and Prevention. Theseanalysis of available government data from May shows that breakthrough infections and fully vaccinated peopleaccounted for fewer than one hundred of the more than eight hundred and fifty thousandcovid 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'vebeen vaccinated against. In all of the vaccines there are some level of breakfrom infections. The good news is that they typically are relatively mild and sometimesa symptomatic unlike being infected when you're unvaccinated. Deaths in the US have permitted froma peak of more than thirty four hundred a day on average in midJanuary 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 mazemore than eighteen thousand covid nineteen deaths were in fully vaccinity people. Some morethan ninety nine percent of covid nineteen deaths in the US now are among theunvaccinated. CDC said, directed Dr Rochelle Wilenski, said during the White Housecoronavirus 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 universityWashington is modeling suggests that the US will hit a thousand deaths per day nextwinter, and you may recall that was last spring, Spring of two thousandand twenty that the University of Washington is institute her health metrics gave its modelingforecast of somewhere between a hundred thousand and two hundred forty thousand deaths, andAmerican with mitigation strategies, and that's pretty much for shock the trump administration intosome awareness that this really was a serious event that we were fighting our takeheed your doctor's life saving advice, if you haven't already done so. Getvaccinated. The life, you say, maybe your own, and you've gotan update. Yes, a see in in recently interviewed Dr Fouchi and hewarned that there may soon be two Americas as the divide widens between vaccinated andunvaccinated areas. With the Delta variant accounting for more than a quarter of covidnineteen cases, Dr Fouchi warns that there's soon could be two Americas, onewhere most people are vaccinated and another where low vaccination rates could lead to spikesand cases. The stark disparity between low and high vaccination areas is something DrFouchi is very concerned about, as he told CNN's Don Lemon on his recentinterview, and you know, this underlines the importance of trying to reach herdimmunity. Theoretically, this occurs when seventy to eighty percent of a nation's populationare 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 centralstates of the United States have very low vaccination rates, and this is theconcern that Dr Fouchi has about two Americas and in fact, given the spreadof the Delta virus that John has been reporting on today, if you lookat the two week rolling averages reported in the New York Times, today isthe first day in a very long time that the average actually has gone upby fifty team percent and this should be an area of concern for public healthofficials throughout the nation, but especially in those states with very low vaccination rates. Thank you, guys. So, as Dr Mike Ryant said, it'sthe fastest and the fittest and it's it's flying fast. So our next topiclooks at once you've beaten the infection, is the game over. Not Thenews. This is from CNBC on June seventeen new covid study hence at along term loss of brain tissue. Dr Scott Got Leave Warns Covid in thebrain. So, citing a new study from the United Kingdom for FDA directedDr 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 termloss 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 atthe potential effect on the nervous system. Godly said that the destruction of braintissue could explain why covid patients lost their sense of smell, as we reportedearlier, and Nasmia, or the loss of the sense of smell, wasone of the key in this Sha that patient persons infected with covid. Nextup, the CDC recognizes covid long holes. They finally have issued new guidance fortreating covid nineteen long holes and they warn against relying on labs and imagingresults alone, as got the commented,...

...most of the evidence they looked atwere 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 thosehealthcare providers treating patients for post covid conditions. The long haul conditions are a widerange of physical and mental health issues that sometimes persists four or more weeksafter a covid nineteen infection. According to the CDC, many of the patient'spost 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 careand Directsss when we need specialized assistance. Wrong covid conditions include heart palpitations,cognitive impairment or brain fog, insomnia, diarrhea and Post exertional malaise, aworship of symptoms following physical or mental exertion. The CDC warned against relying on diagnosticresults as the only means of assessing the patient's condition. Quote. Lackof laboratory or imaging abnormalities does not invalidate the existence, severity or importance ofa patient's symptoms or conditions. The agency said they quote, will continue towork in collaboration with federal, state, local, academic and community partners tobetter understand the long term effects of stars Covy to infection. Concurrently, thearticle cited a studied by fair health. Fair Health has an enormous database ofhealth 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 initialdiagnosis. So will they beat the infection? They still had some residual effects ofpain, breathing difficulties, hyperlipidemia or high coolesterol, malaise and fatigue andhypertension, with a five most common post covid conditions and, alarmingly, whenmore common among females than males. The infections, as we've learned over thecourse of the pandemic, tend to hit males harder, but the post covidconditions seem to be much more prevalent among females than males. The study alsofound a higher risk of mortality after acute treatment. Our take for nearly oneout 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 foryears. Preventing the next pandemic should be the number one priority on America'sublic healthagenda, and I think you have an update to add. Yes, whenwe think about one out of four being a long haulers, I don't thinkthat brings the reality to the forefront. So basically one in four or twentythree percent of the patients who develop long haul symptoms. Means that between sevenand nine million Americans are suffering with long haul symptoms, and this is avery difficult large number because that needs a great deal of care and hopefully theresearchers and physicians treating them will help them to eliminate their symptoms earlier rather thanlater. But that's still a very large number of people are suffering after havingthe covid infection. Yeah, the three men read first note of this issueback in August of two thousand and twenty, in an article that described a thirtyyear old British neuroscientist who was unable to return to work even at thetime of the publication the article. She is brilliant woman suffering from brain fogas a postcode syndrome. Don't have any updates as to whether she finally shedthe the symptoms, but this is not new news. That issue also hadan article from Asini in New York talking...

...about setting up clinics and wanted todeal with long code symptoms. So this is one of the lingering effects ofthe 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 sinceWorld War II, study finds, written by Alison Aubury, from NPR onJune twenty three, two thousand and twenty one. And the truck below iskind of small but you can see the trend. The Blue Line is compositeof high income nations and the Green Line, unfortunately, is America. And asyou can see, we peeked about here and the then flat line thatwe've been in a decline, and alarming decline. The study is publish inthe British Medical Journal and it indicates that life expectancy in the US has declinedfrom seventy eight point nine years in two thousand and fourteen to seventy six pointnine years at year end two thousand and twenty. African Americans and Hispanic Americanswere especially hard hit, with declines of three point three and three point nineyears respectively. Study offer both or Stephen Wolf is from the Virginia Commonwealth Universityof Medicine. He stayed quote, we have not seen a decrease like thissince World War II. It's a horrific decrease in life experiency. Will furthernote that disruptions and behavioral health and chronic disease management during the course of thepandemic have contributed to the decline. Wesley Curtis, chair of the Department ofPopulation Health Sciences at Duke University School of Medicine, commented, quote. Itis impossible to look at these findings and not see a reflection of the systemicracism in the United States. Dr Richard Besser, president of the Rodal WoodJohnson Foundation here in Priston, New Jersey, said, quote. This study furtherdestroys the myth that the United States is the healthiest place in the worldto live. For example, life expectancy in Princeton, New Jersey, apredominantly white community, is fourteen years higher than Trenton, New Jersey, andpredominantly black and Latino city, only fourteen miles away. Fourteen years of differencein life expectancy. The US has been losing ground and they with other wealthyhuntries. Said mcgualley, the Barbari of the University of California Berkeley, ineditorial that was published alongside the new study, will concluded. Quote. The UShas some of the best hospitals and some of the greatest scientists, butother 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 theyneeded most. And our take for vaccinated Americans? The covid nineteen pandemic appearsto be under control, but what it's all of this taken especially among communitiesof color. At the semmer thirty one two thousand and twenty three hundred fortythree thousand eight hundred eighteen Americans had perished. More than two hundred and sixty thousandhave died since then. So US life expectancy. It will continue toplant. As your editor, I've often stated that America has the most thoroughlytrained physicians and the best equipped hospitals in the world, but does not producehealth first population. That has to change that. I think this is reallyimportant 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 onlyfourteen miles from Trenton, and the life expectancy is fourteen years longer. Movinghealthcare to people that need it needs to be part of the work of thecurrent Congress and there are bills being considered now to expand and develop a publicoption and to get healthcare to more people...

...around our nation to help stem thetide 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 lookback at the global pandemic and how various OECD member countries, as well assome 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 thousandand 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 inDecember thirty one, and then fast forward to where we were as a Junethirty we celebrate the New Year of two thousand and twenty. Within an ascementfrom December thirty one. Two Thousand and nineteen, the government and Mouhan Chinaconfirmed 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 inWashington state. Was a man in the studies and developed symptoms after returning fromUhan. And shortly thereafter I think all of us can remember seeing the ambulanceis pulling up in front of a nursing home and Kirkland, Washington road.The first major outbreak had occurred. January, thirty two and twenty, the WorldHealth Organization declares a global health emergency named the disease covid nineteen, andthe 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 travelersarrived 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 coldstorage refrigerators mind up outside the Queen's Hospital Center in Elmhurst and the shortage ofPPE and the frontline healthcare worker is doing their best to treat patients with thisdisease 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 totwo hundred forty thousand coronavirus deaths, even with mitigation efforts. Univers of Washingtonstudent of health metrics had done their modeling and their worst case scenario with mitigationefforts was two hundred and forty thousand deaths. And a March thirty we began monthlytracking, is confirmed cases and deaths for the thirty seven member nations ofthe organization's Economic Corporation and Development, that is, the Organization of world thedeveloped countries in the world who have met a certain economic criteria and applied fora membership. So let's look at where we were as of April thirty twothousand and twenty. Three major points to remember. The four Pacific Rim countries, Japan, Australia, South Korea and New Zealand where at the top ofthe 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 totry to establish her immunity in her uniqu because everybody gets the disease and thenyou'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'llsee later on, the four in order countries as a whole have done quitewell in coping with the pandemic. The...

...worst mangler was Belgium and if youlook at the chart that left hand side is the fatality rate for a hundredthousand 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 andnearly seventy fatality rate for thousand, followed by Spain and Italy, which shouldyou mentioned Milando Madrid with the initial global off centers of the vandemic. Sothe US two thousand undred thirty seven, or the top of the bottom courtileof the OECD. Two months later, June, thirty two thousand and twentyhere 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 thechart. Columbie had dropped a bit in the total survitory and Ciral New Zealandat that point had a completely eradicated the coronavirus. They went through seventeen daysstretch 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 whatwas going on in Italy and they've quickly realized that New Zealand had a lotof fewer, I see you, beds per capita than did Italy the restof the OECD. So they did. They takes some pretty drastic measures prettyearly and guess what? They worked. The US slipped two places to numberthirty one out of thirty seven, the head of France, Sweden, Italy, Spain and the UK. The UK is another country that kind of stumbledout 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 widemargin, and we published a couple of articles about the Belgian experience that weredespite the lethality of the infection in Belgium, the hospitals were denied admission to patientsfrom nursing homes, now a fact. Animals were instructed not to accept criticallyill 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 theresponse. Now, by June thirty much have been learned about covid nineteen.Under desperate circumstances that recall mid Mars through the end of April, when MetroNew York was just buried with the covid cases. In New Jersey are CMOsheep. Medical officers were having daily conferences each morning first thing to compare notesand share of what they had learned. So we become much more effective intreating the virus. Once contracted. The fatality rates were declining, but westill had a great deal to to deal with. So we use June thirtytwo thousand and twenty as a baseline for looking at subsequent performance by country andby states. So at June thirty, this is the first time we dida 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 thischart. The blue bars are the population of the particular states. So yousee 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 RhodeIsland Massachusetts. Louisiana was one of the non northeast states that was hithard early with Martin raw in February two thousand and twenty. That turned outto be a super spreader event. So the fatality rates but now as andwe have Texas in California and Florida, Washington all in single digits, whileat the other extreme we have New York, New Jersey and the Big Apple NewYork, 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 initialwave of the pandemic. In subsman slides will see how well or poorly variousother 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 readingNew Zealand, South Threeedgeapan in Australia continue to top the char. So there'spopulation, the blue bar and fatality rate. The gold war they were joining thetop 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 andsixteen respectively. Canada, for whatever reasons, has managed the pandemic well consistently throughout. Germany managed it quite well through the initials and nine months of thepandemic, but then, like the rest of the central Europe got hit hardwith the fall surge. That really hurts some of the central European countries,especially Hungary, the Czech Republic and Slovenia. Here in the US, as ofDecember thirty one, again we've got the blue bars population. The goldbar is fatality ratings. The far end or New York and New Jersey withthe highest fatality rates in the country, follow by Massachusetts. But some newinformation. 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 forten days and ended up being a super s better event on steroids. PuiserFamily Foundation epidemia was just Joshma show commented, quote, holding a half million personrally in the midst of a pandemic is emblematic of a nation as awhole 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 vaccinereceived 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 inordinated 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 theseas. Six months later, totally different picture. With some consistency, cancontinue to see the for Pacific Room countries containing the pandemic, although with duringJune we heard concerns about some outbreaks in Australia and concerns about some outbreaks inJapan with the pending Olympics. Both of those relate to the fact that bothcountries have a very low vaccination rate and, as we know it earlier, thedepth of variant is now spreading like wildfire. So, although those areconcerning events, those countries still lead the world in terms of protecting their residencefrom the virulent disease. The for Scandinavian countries continue that top ten, andthey followed by Turkey, Canada and Israel. The US, for the first time, moved out of the boardom court tile where now two thousand eight hundredand thirty seven. That's the highest ranking we've been able to attain. Oursecond April issue summarized articles about the pandemic that was raging in Brazil, Indiaand Hungary. At to put those in perspective, hungry is least in theOECD. You see what happened between June...

...and December. Countries like Slovakia,the Czech Republican hungry, hit very hard by the full surge, managed tosurpass the Belgians as worst in the OECD. Hungry is a particularly poor example ofhow not to deal with a pandemic, and covered that in detail and anarticle of the summarized in the April Isu. But let's think about wherethe they are in the total picture, because Brazilian indie are not part ofthe OECD. If India were part of the only seed the it's current fatalityrate as bad as that disease has been in the country, with well overthree Hunderzero one thousand deaths. At this point I probably understated. It wouldhave ranked eight, between Finland and Denmark. It would have been right around hereon the OECD rankings. Brazil on the other hand, would have rankedthe franked higher. Brazil has had a much higher fatality, two hundred andforty one point nine hundred thousand. So we would have ranked just above hungryand after the check, big bubble in those rankings. The final slide willtalk about really looks at the pandemic over time and in five major countries andwith the OECD average. As most of you know, I've spoken a writtenwidely on universal health systems, with particular emphasis on France, Germany and theUK, each of which has a different approach, but economies and demograph isquite similar to ours here in the United States. So I attract those threecountries 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 interms of our approaches to democracy. But KATTA was also we kept hearingabout in the presidential campaign from Centator Sanders and Senator Warren and others about theneed to go to Medicare for all and any late the Canadian system. Solet's look at how these countries fair. The first time I did this showI had also included data for the four Nord nations. If you think aboutCanada, Canada's population is about the same as California. If you had upthe for Nordic nations, Sweden, Finland, Norway and Denmark, their populations aboutthe 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 differencebetween them and cant so the track was exactly the same. They will asa group the for no order nations. And then Canada contained the pandemic quitewell. Then we have a full searge that really hit everybody. This isthe fall of two thousand and twenty, but Canada continues to do quite well. Germany, early on, probably because transfer ago Markle is a scientist thatwith a lot of credibility. She's just finished the sixteen year term as Chancellorof Germany, did very well early on. But again they were hit with thefall searge. That hits Central York very hard, and so they've struggledsince, still doing better than the OLYCD average for French, UK and theUS. UK's an interesting chart to look at because, remember said, theystumbled badly out of the gate. You see here they were, they wereclimbing steadily. They managed to control it well during the summer of two thousandand 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 Varianinfections 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 thefirst vaccine administered and in that case is the fire as a violin tech andholding wolf on the second and as you can see, the strategy of theemployee 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 aimingand stories and in the naked city, while they're probably thirty seven different storiesin the OECD put some others that we've discussed in three minute read. Sothat'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 werethe first where we saw a case and they were the first have a majoroutbreak. Yet throughout the pandemic, the state of Washington has managed to stayat the bottom of the chart in the US. I'm sure some academics aregoing to study Washington response providers with some information as to what they did tomanage through the and so effectively. But other states, Georgia, Nevada,north and South Dakota, Arisona and Mississippi, now a fatality rates above the USaverage of a hundred and nine point one, four hundred thousand. Sothis is where we are in absolute numbers, with again in New Jersey at thehigh end of the chart. Just for hungry, is in the OECD. But what we took a look at was what happened between June two thousandand twenty, when we knew what we were dealing with, and June twothousand and twenty one, and that slide shows a slightly different picture. Herewe go. This is the change of fatality rate between June thirty two thousandand twenty and June thirty two thousand and twenty one for twelve states that wetrack. So you can see that in Washington state the fatality rate increased bysixty one hundred thousand in Georgia. The other scheme was almost one hundred eightya hundred thousand. So mentro, New York, the Connecticut, Europe NewJersey kept the disease somewhat under control, especially when you compared with states likeFlorida, 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, Washingtonstate 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 thatjust ended, June thirty. The good news is that the latest data indicatethat 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 thatcompare the United States with itself and other nations, and it all goesback to the importance of mitigation. To begin with, that we saw adone so well on the nations of the Pacific Rim and then all of theefforts 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 verybeginning of this. Mitigation without vaccination, and then vaccination after mitigation can bringthe pandemic to an end. But that can happen unless we have great dealof 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 aska lotting to participate. Well, the healing American healthcare coalitions healthcare cover surveyreport is available at our website. If, yes, that's one of you,just point out, John, that in one of our future podcast willgo through the data that we learned through that survey. Will Continue to coverthe topics that we've covered today and if they're particular interest that you'd like tosee us probe, please feel free to contact us and we'll see you nexttime.

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