What if and What to Do In The Future

In the United States, we have seen 105,000 deaths from Covid virus but 91% of deaths are patients 55 years and old, and vast majority of these patients have co-morbidity.  30 to 42 percent of those who have died, resided in nursing homes.  This represent 31,000 to 43,000 deaths from less than one percent of the population and more than 95,000 people who have died overall are over the age of 54 mostly with co-morbidity.

We can play Monday morning quarterback but in reviewing the past performance, we can do a better job of planning for a second wave this winter if it happens.   In the United States, the number of those who have died under the age of 55 is less than 10,000 and those 24 and under is 1,000, if not less. 

Florida and New York followed different strategy in dealing with their outbreaks.  Florida concentrated on reducing mortality in nursing homes whereas New York chose to do the complete opposite and even forced nursing homes to take Covid patients back in nursing home.   On a per capita basis, Florida has seen fatality rate one fourth of New York in nursing home.   If much of the United States adopted Florida strategy in reducing the virus among the elderly, we may have seen a 75% reduction in mortality among nursing home patients.  That would have saved 23,000 to 32,000 lives alone and if we concentrated our efforts on those over 55, we would have not only have saved lives but reduce the overall numbers of Covid-19 deaths as well as reducing usages in our hospitals.  If we reduced the overall mortality of those over 55 by half including nursing homes, we would have saved 48,000 lives.  There is a distinct possibility that a partial opening sooner may have seen an increase in numbers of Covid infections among younger patients, the number of deaths would not have increased substantially.  An increase of 20% overall confirmed infections would only add at most 500 overall deaths under the age of 55.  So maybe we could have seen significant reduction of overall mortality.  Just doing the Florida strategy on nursing home would have saved a net 22,500 to 32,500 lives. 

The second point would be the economic data.  In April, we had 14.7% unemployment rate and the big questions would a quicker partial reopening led to less economic dislocation and less unemployment?

In reviewing the most recent unemployment claims, we find that the average of the top 25 for lower unemployment claims was 8.4% whereas the bottom 25 plus DC was 15.6%. 

Both Utah and South Dakota never imposed a shelter in place and partially reopen their economy quicker.  For the past four weeks, Utah and South Dakota averaged 5.8% and 6% unemployment and they had ranges from 5.3% to 6.3% over the past four weeks.   New York and Michigan which had stricter shelter in place and have been behind in opening their economy.  New York has averaged 21.25% unemployment claims and Michigan has averaged 21% over the past four weeks.   These states had ranges from 20.3% to 22.5% in unemployment claims.

I then compared unemployment claims between two Red States, Texas, and Florida with two Blue States, New York, and California. California had unemployment claims ranged over the past four weeks 12% to 26.4% compared to Florida ranges of 5.7% to 22.4%. Both states have not yet seen a defined pattern but overall California has averaged 18.5% unemployment claims for the past four weeks versus Florida 11.1%.  Florida has begun their reopening sooner and California is still struggling with designing a reopening plan.  Florida overall unemployment claims are lower and both states are similar to death per capita with California slightly lower.

Texas and New York have had more consistent ranges and Texas unemployment claims have averaged 9.8% vs. New York 21.21%.  More importantly, Texas has the lowest death per capita than the other three states and both Florida and Texas overall death per capita is significantly lower than California and New York combined.   The trend within Florida and California is hard to digest but Florida economic numbers appear to be better than California and Texas have one half of the unemployment claims than New York. 


19 of the top 25 states are states with Republicans governor even though one of those states, Maryland can easily be categorized as a Blue State and both Kansas and Montana, two states with Democratic governors can easily categorized as Red States. The top seven in lowest unemployment claims are Red states run by Republicans.   We have seen that among four of the most populous states, the Red States have nearly one-half of the unemployment claims than two blue states just as we have seen top 25 states are one-half of the bottom one-half states.  

States with Republican Governors average 10% unemployment claims compared to 16% in Blue states. While unemployment claims may not equal unemployment rates, there is no doubt that by reopening states earlier and not having a shelter in place did less damage to various state economies.  One conclusion we can make is that those states that open up sooner plus those few states that never activated a shelter-in-place had less unemployment claims. 

The number one lesson is that shutting down the economy has a far more negative impact on the economy than keeping the economy partially open.  This lesson needs to be heeded if we hit a second wave later in the year.

The second lesson is that the number one priority of state and local officials is to concentrate efforts to reduce the death rates among the seniors and those with co-morbidity, encourage the most vulnerable to protect themselves by staying in shelter, wearing mask and encouraging social distancing.   I will estimate that we would have reduce the overall morality rate by at least 25% and maybe closer to 50% had states followed those strategies across the board from the beginning. Those who are the least vulnerable should be allowed to work. 

When we do have a vaccine available, those over 55 with co-morbidity get vaccinated first.

While I can’t judge exactly what the unemployment rates would be but I will guess that it would be between 7 to 9 percent and if we followed the Florida strategy of dealing with the virus, we could have saved at least 23,000 to 48,000 lives.  

This analysis is just a beginning and there is more data to collect including hospital utilization rates and its impact on other aspect of health care.  What has yet to be measured is the impact on the overall health care system as many “non-essential” services have been first been prohibited and then delayed.  This has led to lay offs for many hospitals and medical centers while delaying medical care for serious treatment of other ailments.  How many patients have died of heart attacks due to lack of treatment, how many illnesses left untreated from cancer to heart disease will shorten life?  There have been report of increase suicides as result of the economy’s decline.  These impacts also need to be reviewed and if we reduced the number of seniors dying, we not only reduced hospital utilization for Coronavirus but also allowed other disease to promptly treated.   Others can follow up on my own theory that a different strategy would have saved many businesses from being shut down, reduce unemployment, and reduced overall deaths to Coronavirus.  And if my theory is correct, then we must use a totally different strategy if we have a second wave later this year or early next year.

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