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The case for optimism: USA and Coronavirus

"fear about worst-case scenarios has at times obscured certain facts that should lend some optimism to what’s ahead"

by Scott W. Atlas, David and Joan Traitel Senior Fellow at Stanford’s Hoover Institution and the author of “Restoring Quality Health Care: A Six Point Plan for Comprehensive Reform at Lower Cost.”

No one should underestimate the urgent issues facing the United States and the world from the COVID-19 pandemic. Thousands of people have already died, and thousands more are in critical condition. The death totals will certainly increase for weeks, even in the best-case projections.

Serious likely shortages, as projected by Murray and the Health Metrics Sciences group, represent a crisis, and all efforts are required to minimize them. But fear about worst-case scenarios has at times obscured certain facts that should lend some optimism to what’s ahead.

First, the rate of increase in deaths from COVID-19 is decreasing, in the United States and in most countries. That means there is a slowing of deaths, not just the calculated mortality rate, a different statistic that will keep decreasing as we unveil a larger number of people carrying the virus with mild or no symptoms. In the United States as well as in Italy, Spain and other countries most heavily impacted, there is a significant slowing in added deaths. This is evidence that isolation policies are working.

Second, we have at least anecdotal evidence from several countries that some drugs work in sick patients. It is true that current reports are not proof. But there is fundamental underlying science and solid evidence from previous testing in other similar viruses that both oral and intravenous drugs have a reasonable chance of working and saving lives. They are approved by the FDA for emergency use and are now being tested in valid, controlled studies. Their likelihood of working should not be minimized.

Third, outcomes in other severely ill patients cared for in ICUs are typically superior in the United States. Numerous studies have demonstrated that mortality rates in the United States are lower than in Western Europe and Japan from sepsis and in Acute Respiratory Distress Syndrome (ARDS), life-threatening conditions that depend on mechanical ventilators as a mainstay of patient management. Odds of survival have been higher in the USA-dominated group than in high-income groups of European countries studied.

Researchers asked: Is the higher mortality rate in Europe than in USA due to lower number of ICU beds available in Europe? Which brings us to the fourth point. Although we are undeniably grappling with a serious shortfall, the availability of ICU beds in the United States exceeds the availability in every other country. According to a Columbia University study, the United States has 20-31 beds per 100,000 people, two to five times as many as any countries in that study, including Canada, Denmark, Australia, Sweden, Japan, the UK and New Zealand. Data from the National Center for Biotechnology Information and the journals Intensive Care Medicine and Critical Care Medicine show that the United States critical care beds per 100,000 far exceeds those in Germany, Italy, France, South Korea, Spain, Japan, the UK, China and India. Adjusting for each nation’s elderly population, the United States dwarfs every other country in available critical care beds per 100,000 65-plus population, those most at risk for needing an ICU due to COVID-19. Given that analyses have shown a strong correlation between ICU beds and fatality in ICU patients, this is certain to avoid even more deaths.

Americans should also take some solace that in other life-threatening diseases requiring urgent care, the United States has the world’s best outcomes, including cancer, heart disease and stroke, all of which require rapid diagnosis and treatment with trained specialists, innovative drugs, advanced technology and critical care. That’s because Americans have faster access to life-saving drugs proven to correlate to better survival; more access to state-of-the-art imaging like CT and MRI scanners essential to management and highly correlated to better outcomes in diseases with the most mortality; and far faster access to specialists and treatments than single-payer systems throughout the world.  

What’s more, by virtually every metric, the Unites States leads the world in health care innovation, the ultimate key to stopping the tragedy of death and disease. While this extraordinary emergency will undoubtedly stress our system, and we will sadly lose many loved ones as we await drugs to treat the sick and immunize others, Americans should not panic. The United States has the most advanced medical care in the world for situations like this.

(originally published "On the Hill" as The Case for Optimism.)

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