The last time I posted here on March 2nd feels like a lifetime ago.
We had just returned from a nine week trip filming for the Cholesterol Code Documentary and we were gearing up to do more filming at Low Carb Denver. I had many great interviews lined up with very top level talent. But a few days later, in what I thought was an abundance of caution, I decided to cancel the trip in the very off chance I was an asymptomatic carrier for Covid-19 (coronavirus) given we just traveled the world, including many of “hot spots”.
Yet since getting back I had also had a series of discussions with many great doctors and researchers I’ve come to know through my research who were all very concerned about the seriousness of the outbreak coming from Covid-19. These are people I’ve never known to show such a level of distress, with some being somewhat apocalyptic in their predictions given the data on the ground.
After canceling the trip I did the same as I did for lipid research and went to see the numbers for myself. Just how fast are these cases increasing? What is the true mortality rate? How do all these metrics compare to influenza (flu)?
Within 24 hours I was convinced this was indeed very serious.
The Pandemic is Real
The virus, “SARS-CoV-2” that causes COVID-19 (“Coronavirus”) is indeed very contagious and compared to the flu, current data suggests it’s much more deadly. Just how contagious and how deadly is still being figured out, but we can safely say each metric is substantially high. Moreover, it appears to have a high rate of need for hospitalization with some requiring admission to the ICU (Intensive Care Unit) where many unfortunately have to be put on ventilators.
This tweet thread posted on March 6th went viral where it discussed the rate of spread being exponential:
Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate. 2/n— Liz Specht (@LizSpecht) March 7, 2020
She goes on to explain if we are seeing an exponential increase where total cases are doubling every six days – then we would likely be looking at cases numbering in the millions by May:
We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go. 4/n— Liz Specht (@LizSpecht) March 7, 2020
I’m writing this on the morning of March 23, which is 17 days since her initial thread was posted. If confirmed US cases (lab-diagnosed) had been doubling every six days, they would be at 1,587 right now. Instead, they are at 35,070 (note this page continually updates).
This increase is likely due in part to expanded testing capability, not just the spread of the virus itself. That said, there’s little question as to the speed of viral spread within the US to have so many confirmed cases already.
My New Focus on Covid-19
While it has only been a couple weeks, I’ve certainly been pouring my time into trying to understand this pandemic. I’ve put up four different videos here, here, here, and here. I’ve also discussed this at length on both the 2 Keto Dudes and The Fat Emperor podcasts.
Personally, I’d much rather be focusing on lipids again. The days of comparing marginal P values seen in cardiovascular outcomes over decades seems so much more attractive than the exponential rates of change in mortality throughout the world over just a matter of weeks.
This crisis is extremely immediate, appears unusually deadly, and understandably commands all our attention. Much of social media interaction over this time has been to raise awareness, particularly regarding the need to “Flatten the Curve”.
1/ Please RT –> #FlattenTheCurve Hidden Costs Explained with Animation— Dave Feldman (@DaveKeto) March 14, 2020
When you consider all the factors, the choice is clear. But some of them aren't that easy to see…#coronavirus / #covid19 pic.twitter.com/M1BDQe9fTn
Is the Cure Worse Than the Disease?
At the time of my writing this we are seeing greater and greater quarantine efforts both around the world and within the US. This has led to many business shutting down, jobs lost, and lots of panic buying on necessities. Without question, there are extremely serious economic disruptions that will likewise have major consequences on many things we take for granted in the supply chain (many shortages of varying degree are likely ahead).
Naturally, this begs the question: Are we are doing too much?
On social media and in private I’ve been engaging many skeptics across the spectrum. Some are quite certain we won’t be posting the kinds of concerning rates we see right now in Italy. Sure, many ERs and ICUs will be maxed out, but they will be a fraction of the whole and we should just work better at resource allocation.
Others concede this is a particularly bad pandemic, but that it’s worth taking a more serious route toward herd immunity sooner given its inevitability anyway. Can we really all remain quarantined for months or even a year without wrecking our economy in lost productivity and setting us back years or even decades? Why not put extra focus on quarantining those at the highest risk and let others go about their business?
These are all very valid questions that should be explored and continually kept in mind.
As I write this I’m reading The Fed is sounding the word it will now have open-ended QE (Quantitative Easing), which in effect means it will create as much money (“money printing”) as it feels necessary to keep the economy going. This is very much a “trading tomorrow for today” effect as there will almost certainly be major economic consequences for this down the road.
Why Testing Matters
For me, just about everything comes down to the testing.
The sooner we expand our testing, the sooner we can plan more effectively for this disease and also get people back to work. Of course, “soon” is very relative here.
Without going into the different types of tests, let’s just put them into two general categories: those that detect the virus itself (typically via antigen) and those that detect immunity to the virus (typically via antibodies).
We are currently ramping up testing for the virus itself, but the demand still exceeds the supply considerably. Regardless, this doesn’t actually give us the kind of data we need to truly understand the rate of spread and existing communities given so many people are asymptomatic or choosing to self-quarantine in spite of mild symptoms (yet don’t know if they actually have it or not).
The game changer will be widespread “serologic tests” being rolled out soon (hopefully):
The serologic tests, which are different from the ones used to diagnose active infection, would allow researchers to test the blood of people who were not confirmed cases of Covid-19 in communities where the virus spread. They would be designed to look for signs that people have mounted an immune response after being exposed to the virus.
CDC Director Robert Redfield told Congress that the agency is working on two of these types of tests. “CDC has developed two serological tests that we’re evaluating right now so we can get an idea through surveillance what’s the extent of this outbreak, how many people really are infected,” he told a House panel. “That is being moved out now to do these extensive surveillance programs.”
It’s hard to put into words how important this milestone will be. It will allow us to gauge many important things simultaneously depending on the populations sampled:
- What is a much more accurate proportion of infection?
- What is a much more accurate reflection of hospitalization and Case Fatality Rate?
- What is the likely rate of immunity turnover?
- How close are we to herd immunity?
Again, these can only be applied one population at a time given the US isn’t one homogeneous territory. Moreover, there may be a higher priority to doing this surveillance testing in harder hit areas first.
Regardless — this has to be done soon. The sooner we have this capability, the better our decision making for next steps. South Korea is a rare success story through this pandemic in large part due to their extraordinary level of testing.
Coming Posts at Cholesterol Code on Covid-19
This site was never intended to cover a virus pandemic, of course. While it’s true we veer off topic at times, I don’t anticipate I’ll be putting a lot of material on here both for the content difference and, frankly, because the information is changing so rapidly anyway.
Hence, while I may do an occasional post such as this one in the coming weeks, most of my active updates on this topic will likely be on Twitter and my YouTube channel.
It’s worth repeating here what I have said elsewhere many times over – we’ll get through this.
Yes, this may indeed be a test of our generation like nothing we’ve ever experienced before. I truly believe we’re in for wave after wave of bad news. There will be many things we couldn’t have imagined before now that will become our reality in the coming months. We’re entering a dark time and we should own it.
With that said, we’ve never had so many incredible minds around the planet focusing on a single problem. They are all highly empowered with a level of communication and collaboration that never existed before now through information technology. And thus, we may see solutions ahead that will amaze us as they unfold.
I have a new saying that I’ll state again here. For all the numbers I obsess over, there’s none I’d want you to know more than the number 100. It’s the percent of times we as a species have made it through pandemics and whatever other great challenges we’ve faced. In time we regain our footing, respect our losses, and ultimately improve to a new quality of life than what we had before.
Thanks Dave, the key will be the testing. Also, curious about the high incidence of diabetes and pre-diabetes in severe cases and the metabolic connection. Immune function of ldl a factor?
p.s. My wife and I were in Vegas March 5-9th. I think it was the last “normal “ week-end there !!
As it happens, there’s some very strong evidence already with regard to T2D and risk. I’m not yet sure on prediabetes yet.
And of course I’m very interested in what we’ll see with LDL levels and their association. There is a much circulated study on it right now that shows lower LDL associating with worse outcomes, but that study is looking only at those effects *while* the patient was already infected. What we’re really interested in is what those levels are *before* the infection (such as in an annual exam).
Glad you got one last go at Vegas. I’m sure we’ll never quite be the same after this.
this is a second test
Thanks, Dave. Will be reading when the sun comes up. 🙂
I’ve read that the soonest that serum tests
will be available is June. That’ll be the key.
Only if you know you have some semblance
of immunity can you safely go out.
Take basketball for instance: Only after every
single player has developed a reaction to
the infection could the leagues possibly
start up again.
I recently found your website. I live in New Zealand and I am 64 ys old. I recently had 2 heart attacks and 1 month ago-Triple bypass op. I watched your interview with Dr Joel Kahn, been in touch with him and he has offered a Consult with me. However, before I spend a lot of money I want to get as much info. as possible of where I should focus my energy and funds to help myself. I was diagnosed with CAD in 2003, took no drugs and did a lifestyle change. My LDL went from around 6.8mmol/L ( we have different units) to 3.8mmol/L in 3 months-no drugs. However, I am also learning about the possibility of the role of infection and I had some dental issues like Root canals.
My Mother is 86 ys Chol. level around 8mmom/L but hypothyroid and my father was much lower-meas.? and he died 74 heart attack.
I am an osteopath from England who lives and works in new Zealand. I am highly motivated for improved health. I am on several drugs now incl. Atorvastatin. I am aware of the comments of Dr Malcolm Kendrick-UK based GP and Uffe Ravnskoff in Sweden.
Am I able to get some guidance through your work?
Hi – you are of course welcome to post any particular questions to the site if you have them. We can’t offer medical advice, as we’re not doctors, but we can offer our thoughts or resources that we would find helpful if in a similar situation ourselves.