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DR. LEWIS: “Knee-Jerk Reactions Will Harm Tennessee’s Children”

“Knee-Jerk Reactions Will Harm Tennessee’s Children”

An Op-Ed from Dr. Terri Lewis of Tennessee

In recent days, the contingent of state legislative anti-vaxxers successfully browbeat the Tennessee Department of Health into cancelling childhood vaccine outreach programs – not just for COVID19, but for all routine childhood immunization programs.

On face, it appears that the TN Dept of Health, responsible for public health in 89 of Tennessee’s 95 counties excluding major metropolitan areas where local agencies wield more authority, will no longer conduct public outreach for any preventable childhood communicable disease.

‘Don’t ask, don’t tell’ seems to be the new public health strategy.

Tennessee lags behind the nation in all measures of disease prevention through vaccination. As of July 13, the number of fully vaccinated Tennesseans for COVID settled at 2,599,234 or 38.06% of the population. Overall, Tennessee ranks 33rd among the 50 states with a childhood vaccination rate of 79.9% against a population of 6,944,260. Tennessee currently meets HP2030 targets for 2 out of 3 vaccination-related measures for 24-month old children.

But there are significant gaps.

Many of Tennessee’s children have not completed the entire series of vaccines for preventable illnesses in the last decade. Minority children are less likely to be fully immunized. Some parents refused any and all routine immunizations.

Progress toward meeting vaccination rates for children up to the age of 24 months is located on theTNDOH website [1].

As concerning is the announcement by Dr. Tim Jones, Chief Medical Officer, that henceforth, no vaccination efforts will be conducted for routine childhood vaccines, with the HPV vaccine particularly singled out.

No outreach includes “pre-planning” for flu shots events at schools and back to school vaccines, and by inference, routine immunizations for infants, toddlers, teens and college students. Responsibility for back to school vaccines will become the responsibility of the Tennessee Dept of Education, not the TNDOH.

The elements of a successful outreach effort are well documented.

First, parental and community education and messaging around the safety, efficacy, and importance of childhood immunization is essential to ensure that children receive the full complement of preventive vaccines. With the gap in health insurance coverage for children this is an important function of the TNDOH at the county level across the state.

Second, there must be ready access to immunizations at every opportunity. The percent of children without health insurance increased from 5.2% in 2018 to 5.7% in 2019, with Hispanic children most represented in the childhood insurance coverage gap [2]. By fall of 2020, 9% of Tennessee children were uninsured, more than twice the level at the same time in 2019, according to the Vanderbilt Center for Child Health Policy[3]. Brief periods of being uninsured can have long-term effects on the health of children and their achievement in school… children who lose their insurance miss important immunizations and go months with major unaddressed problems…” [J. Zickafoose, MD, MS, Monroe Carrell Children’s Hospital at Vanderbilt]. Children who fall into the coverage gap are least likely to receive preventive care.

Third, reliable and readily accessible immunization records that provide a non-duplicated reflection of on-time immunizations are important for ensuring an accurate personal history for personal health management. This responsibility lies with health providers, not the Tennessee Department of Education. Lack of health coverage will magnify the negative impact of the childhood coverage gap where the health system fails to conduct routine outreach.

Finally, preventable childhood diseases are on the rise with the reduction in vaccination rates. Uninsured children are particularly vulnerable. When compared with privately insured children, uninsured children have more health disadvantages including need for medical or dental care; greater severity of illness, more hospitalizations and higher mortality rates; more vaccine-preventable disease; and higher rates of chronic illness such as asthma and diabetes [4].

The announced actions that resulted decisions to termination vaccine program leadership and cease immunization program outreach will have harmful effects resulting in tangible, measurable harms to Tennessee’s children and youth.

I strongly encourage the re-examination of these knee-jerk reactions to pressures exercised from certain sectors of the population.

[1] https://www.tn.gov/content/dam/tn/health/documents/cedep-weeklyreports/2020-24-Month-Old-Survey.pdf

[2] https://www.aappublications.org/news/2020/12/01/researchupdate120120

[3] https://www.vumc.org/health-policy/tennessee-poll-uninsured-kids-covid19-2020

[4] https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/Uninsured_children/state/TN

Dr. Terri Lewis

Silver Point, TN

Global Immunization Action Network Team

https://www.giant-int.org/

 

 

 

@TheTNHoller

DR. FISCUS RESPONDS, WITH RECEIPTS

Yesterday, the Tennessee Department of Health released a letter they claim was written by Chief Medical Officer Dr. Tim Jones on July 9th outlining their reasons for firing Dr. Fiscus, Tennessee’s top vaccine expert. For some reason this letter was not mentioned when the story of the Fiscus firing initially broke, and quickly became national news – and, according to Dr. Fiscus, was not shared with her at the time of her firing.

The Jones letter attacks the leadership and management abilities of Dr. Fiscus, and even goes so far as to accuse her of attempting to self-deal by steering Department resources to an organization she stood to gain from, without evidence. We posted a link in which Dr. Fiscus addresses those baseless accusations. We have also reached out to Dr. Jones and Commissioner Piercey for interviews about it, but have not heard back.

Dr. Fiscus has also gone ahead and addressed the letter point by point in a scathing takedown of the Jones letter. We have posted it below in its entirety.

-She says she’s “disappointed in people I considered friends and mentors,” describing how CMO Tim Jones and John Dunn (who wrote glowing reports) supported her… until they didn’t.

-She addresses CMO Tim Jones’ attacking her leadership and character by pointing to and including excerpts from her glowing performance reviews, with receipts.

Jones attempted to use a meeting with another physician against Dr. Fiscus — who counters with a text from that physician calling her “the greatest treasure the department had” and referring to her firing as “complete and utter bullshit”.

-In the dirtiest part of the Jones letter, he implies Dr. Fiscus is self-dealing. Her performance reviews show they not only knew about Immunize TN (the org she convened), they call it “very successful” in her performance reviews.

Jones accuses Dr. Fiscus of sharing “her own interpretation” of the mature minor doctrine without running it by counsel. Sooo… she includes an email from TDH counsel saying the summary has been blessed by Governor Lee’s office and is ok to forward” — oops.

-Lastly, Dr. Fiscus takes on Governor Lee’s office “dodging the question” and “twisting the narrative away from the subject” of how they’ve changed the vaccine program for children in Tennessee. (which their own anti-vaccine supporters have bragged that they have).

Bottom Line: This Dr. Fiscus rebuttal makes it clear The Tennessee Department of Health and Governor Lee not only were willing to scapegoat TN’s top vaccine expert for political reasons… they’re also very comfortable making things up to assassinate her character as well.

Good luck with recruitment.

 

For Immediate Release

July 15, 2021

Michelle Fiscus, MD FAAP Response to Tennessee Department of Health’s Justification of Termination

I apologize in advance for the length of this response, but there is much to say in response to TDH’s recently released letter attempting to justify my termination. I became aware of the existence of the document today when it was shared with my husband by a member of the media.

First, let me say how disappointed I am in people whom I considered friends and mentors in the Department of Health. Dr. Tim Jones, who signed this letter to Commissioner Piercey, recruited me to the position of medical director of the Tennessee Immunization Program in 2018 and has been a trusted friend and colleague. He has confided in me throughout this pandemic response, and first let me know that my employment at TDH was threatened in late June 2021. I asked him at that time, in a meeting with my direct supervisor, Dr. John Dunn, on what grounds I was to be terminated and he replied, “None, as far as I’m concerned” and told me he would continue to “fight” for me to remain at TDH. In the moment, I told Drs. Jones and Dunn that I would resign before I would allow them to terminate me.

Over the next few weeks, both Dr. Dunn and Dr. Jones voiced their continued support for me, with Dr. Dunn telling me repeatedly that I “belonged at TDH” and that he did not want me to leave. I repeatedly shared with Dr. Dunn that I would not remain at TDH, but that I hoped my departure would be on my timeline rather than that of the administration’s. Dr. Dunn went to far as to text state Chief Operating Officer, Brandon Gibson, regarding the injustice he felt over the talks of my termination at the level of Governor’s office. I asked Dr. Dunn if Chief Gibson responded to the text, to which he replied, “She ‘hearted it’”.

On Saturday, July 3rd I received an unexpected call from Dr. Jones on my personal cell phone. Dr. Jones asked if I was at home because he wanted to “drop something by the house.” I assumed it was a letter ending my employment, but Dr. Jones said, rather sheepishly, that he was bring by scones that his wife, Jill, had baked for me. “…and an orchid.” I asked Dr. Jones if he was also bringing a letter with him and he sounded surprised that I asked. He responded, “No. I just want you to know you’re not the only one lying awake at night staring at the ceiling over this.” I told him I was out of town, he said, “good” and we ended the call. On Wednesday, July 7th, when I returned to the office, the plate of scones and the orchid were on my desk (I have since given the orchid to one of my former employees rather than bring it home) as well as the Amazon envelope containing the dog muzzle. I sent Dr. Jones a text thanking him for the scones and the orchid and asked if he also sent the muzzle. He said he did not. This does not seem to be behavior consistent with that of an individual who would write this letter of justification that was dated just two days later.

On July 12th at 0617 Dr. Dunn sent me the following text: “Good morning Shelley. I think all their timelines and decision points are said he [sic] sure you have everything you need and one [sic] today.” I called Dr. Dunn because his text was unclear and he stated that I should connect with Tim (Jones) sometime that day and that I should make sure “you have everything you need”. Shortly after this, Tim Jones called me on my personal cell phone and said, “You will be getting an invite for a meeting today at 3:30pm. I probably won’t be alone. Let me know if you would like to talk before then.” “What would we talk about?”, I asked. Tim replied, “Well, if you want to give me anything.” I replied, “Oh, no. Thanks.”

Just prior to 3:30 I went up to see the Deputy Commissioner, who has been a dear friend in the Department. I found Dr. Jones pacing in the hallway, clearly distressed. His back was to me and I said, “are you pacing???” but did not wait for a reply. As I have previously stated, Dr. Jones met with me and a member of the human resources department at 3:30pm, stated he was sorry to have to have the meeting, and provided me the choice of resignation or the “expiration of my executive service”. Dr. Jones appeared somewhat surprised with my choice to be terminated.

I will address the content of the letter point by point:

On multiple occasions during the 2020-2021 COVID response, Dr. Fiscus has failed to maintain satisfactory and harmonious relationships among her team. In February 2021, CEDEP leadership and TDH Human Resources received multiple complaints from program staff regarding her management style, treatment of employees, and poor program morale. Dr. Dunn met with five senior team members who expressed consistent complaints related to management of the program by Dr. Fiscus during the COVID response. He had several coaching sessions with Dr. Fiscus, with minimal improvement in the situation noted. Two of her most senior leaders have subsequently resigned.

My annual reviews from my four years at TDH refute these allegations. From my annual review for the period of 10/1/2019-9/30/2020, written by Dr. John Dunn and approved by Dr. Tim Jones:

“Dr. Fiscus has consistently exceeded expectations during this evaluation period. Her leadership in running the program activities has been exceptional. Many of the program staff have been on AWS yet they are meeting program objectives and deliverables.” End of cycle outcome rating: Outstanding

“Dr. Fiscus has selflessly focused on the needs of her team and not [sic] her own professional development plan. Her attention to team dynamics and staffing have been outstanding during this rating period. She is providing opportunities to her staff to step into leadership roles. Dr. Fiscus has considtently [sic] exceeded expectations in regards to management of HR issues and balancing the additional workload related to C19.” End of cycle outcome rating: Outstanding

From my interim evaluations from 12/01/2020 – 6/30/2021, written by Dr. John Dunn (changes in HR policy no longer required Dr. Tim Jones’ approval):

“The vaccine team and Dr. Fiscus have been under tremendous stress with attrition being noted. Dr. Fiscus is working closely with her team to provide growth and development opportunities while balancing the workload of COVID vaccine.”

The two employees referenced who have resigned have completed exit interviews with senior leaders outside of my program. Their comments were shared with Dr. Dunn and did not indicate that their resignations were due to my leadership. One of the two employees accepted an opportunity with a global health organization, which was their aspiration. Both I consider to be good friends and are still in frequent contact with me.

On March 7, 2021, Dr. Dunn and I met with Dr. Fiscus and another departmental physician to mediate complaints against Dr. Fiscus of disrespectful treatment and ineffective management. The meeting terminated with a refusal of both parties to communicate constructively, and with a refusal by the other physician to work further on the VPDIP team. Dr. Fiscus was coached on professionalism and teamwork.

This has been a pandemic of historic proportions and a COVID-19 vaccine roll-out that required that I, as well as members of my team, work extraordinary hours for months on end. It was stressful and, at times, there were disagreements. The physician referenced above reached out to Dr. Jones because she was concerned about my ability to continue to work at the pace I was working and hoped Dr. Jones might be able to assist me with delegating responsibilities. I was never “coached on professionalism” although I was coached on teamwork and the need to work on my ability to delegate responsibility to others. The physician referenced above sent a text to me on Monday, July 12, after learning of my termination. It read (shared with permission):

“What you may not know from our interactions is that I truly believe you are the greatest treasure TDH had. This is complete and utter [expletive] and I am incredibly proud of you, the work you’ve done, and your response to this situation. Stay strong and keep up the good fight!”

Dating back to December 2020, the vaccine planning team required intervention by CEDEP leadership to address inefficient use of team resources, including poor inter-program communication regarding vaccine distribution. Repeated failures by Dr. Fiscus to appropriately delegate to others resulted in repetitive, long, and inefficient meetings. These meetings took already busy colleagues away from other tasks.

Again, annual reviews refute these allegations. The statewide roll-out of multiple new vaccines using new means and methods developed by the federal government that must be adapted to a local environment is complex and extremely challenging. It did take time to determine the most efficient and effective means for accomplishing this goal, which I accomplished with excellence.

From my annual review for the period of 10/1/2019-9/30/2020, written by Dr. John Dunn and approved by Dr. Tim Jones:

“Dr. Fiscus has been a strong leader for the VPD team and has been an integral piece of the COVID pandemic response. Her leadership and efforts in multiple areas have been critical.”

“Dr. Fiscus has exceeded expectations for this work outcome [Ensure that reports of vaccine preventable diseases are responded to rapidly and thoroughly]. Her efforts to maintain programmatic [sic] activities have been notable. She has been a key contributor and leader for the C19 response. Her work in balancing the upcoming flu and C19 vaccine planning has been excellent. End of cycle outcome rating: Advanced

“Dr. Fiscus has done an outstanding job representing TDH and CEDEP. Her work has far exceeded expectations in regards to outbreach [sic] to stakeholder groups and collaborators in the C19 response…. I greatly appreciate her leadership and teamwork. End of cycle outcome rating: Outstanding

Over the past three months Dr. Fiscus requested to give a new non-profit organization TDH funding to support VPDIP activities. This organization was founded and led by Dr. Fiscus, had no Executive Director or other employees, and had no other substantive source of funding. Providing funds to such an entity would be poor judgement and a substantial conflict of interest.

When I joined the Immunization Program I looked to see what the state’s immunization coalition had been doing and found Tennessee was one of only two states in the southeast that did not have a statewide coalition.

As evidenced by my 2019 job plan:

“VERY SUCCESSFUL”

As you can see, leadership at TDH was well aware of my work to convene ImmunizeTN and celebrated those efforts. I convened stakeholders who went on to incorporate as a 501(c)3 non-profit organization. I am not on the board of directors, I am not on the payroll, and I serve in only an ex-officio advisory capacity to the board. The coalition has funding from the American Academy of Pediatrics and it is true that I was going to use CDC funding to support the work of the coalition to promote immunizations and provide education to healthcare providers and to the public. ImmunizeTN also has a social media presence which is used to spread pro-vaccine messaging and refute anti-vaccine mis- and disinformation. The CDC provides funding to state immunization programs to support this work and encourages states to provide financial support to their immunization coalitions. There is no conflict of interest as I do not benefit materially from the coalition. I would argue that the refusal of TDH to allow the use of CDC funds to support the work of this coalition further obstructs our ability to combat vaccine misinformation and overcome vaccine hesitancy.

I have released my annual evaluation, in their entirety, to the media, except for the 2018-2019 document, which is not in my possession. I have requested a copy of that document from TDH Human Resources without response. I request that this document be released immediately as it, too, supports my record as an exemplary employee of TDH.

In June, 2021, Dr. Fiscus communicated directly with a state university regarding the department producing COVID-vaccine reports for the institution. She did not notify or consult with supervisors, and the situation only became evident when departmental legal counsel received formal documents directly from the university memorializing the arrangement. The requested reports were not produced by the department.

As I do not have access to my state email account, I cannot be certain of the details of this situation. As the state-appointed liaison to all levels of education in Tennessee as it pertained to the COVID-19 response, I was the point contact for all colleges and universities in the state. To my recollection, the University of Tennessee asked if TDH would be able to provide data regarding the COVID-19 immunization coverage rate of UTK students and staff using data from the immunization registry. UTK provided a draft data use agreement which I forwarded to the TDH Office of General Counsel for their review and thoughts, but I do not recall receiving a response. There was no consultation with supervisors because I did not completely understand what was being requested by UTK and my first inquiry was to OGC for the review of the document.

In May, 2021, Dr. Fiscus broadly shared a letter regarding her own interpretation of state and federal law with external partners with respect to vaccinations and other medical treatment of minors. The letter should have been reviewed by both leadership and departmental legal counsel. However, Dr. Fiscus did not share the letter nor otherwise include any of these parties in the drafting process prior to sending it out. This action resulted in confusion of both law and policy for private providers, parents, and legislators.

The details of the Mature Minor Doctrine memo of May 10th have been shared broadly, as have the emails that led up to the release of that document. The memo is in the public record. There is no personal interpretation of the doctrine included in that memo—the language, with the exception of the introductory paragraph and the final line, “There is no federal, legal requirement for parent or caregiver consent for COVID-19, or any other, vaccine”, was taken verbatim from the document provided to me by Grant Mullins, TDH chief legal counsel. It was not customary for my communications with medical providers regarding the logistics and administration of COVID-19 vaccines to be reviewed, and several memos preceded this one without any discussion of the need for internal review. To state that I did not include legal counsel in the drafting process is clearly untrue, given Mr. Mullin’s email to me below which states, “this is forward facing so feel free to distribute to anyone.”

Additionally, I would like to respond to statements released by the Governor’s office.

Governor Lee’s press secretary, Casey Black, stated the following in an email to the media on July 14, 2021:

Despite misleading reporting, the Department of Health has not halted the Vaccines for Children Program that provides information and vaccine access to Tennessee parents. This program covers immunizations including DTap, MMR, Polio, Chicken Pox and Hepatitis B and will continue to be successfully administered:

• Tennessee ranked among the top 10 states for MMR vaccination coverage among kindergartners during the 2019-2020 school year • 95.3 percent of 2020-2021 kindergarten students in TN were fully immunized

• For more than a decade Tennessee has above 90 percent coverage of kindergarten students receiving childhood immunizations including DTap, MMR, Polio, Chicken Pox, Hepatitis B.

The department is mindful of ensuring parents, not kids, are the intended audience for any outreach efforts regarding medical decisions for children and has simply re-evaluated some tactics like reminder postcards and follow-up communications. While childhood immunization rates temporarily dropped during the COVID-19 pandemic, we are already seeing vaccination rates rebound to pre-pandemic levels and will continue supporting parents who are working to get their families back on track.

I know a lot of misleading info is being shared, so don’t hesitate to give me a call if you have any questions.

I’ve also copied Sarah Tanksley from the Dept. of Health here in case any follow up is needed on her end.

Thanks again,

Casey Black Press Secretary | Office of the Governor

What is stated above is, indeed, factual; however, it is not relevant to the concern regarding TDH’s moratorium on childhood vaccination events in schools, outreach to adolescents or their parents regarding COVID-19 vaccinations, or the directive to not publicize National Immunization Awareness Month in August. I have never stated that the Vaccines for Children Program had been halted. The VFC Program is an entitlement program that provides vaccines to children who are insured through TennCare or who are uninsured, and I would certainly hope that the work of that program has been unhindered. What has been halted is the partnerships between local health departments and outside agencies, such as schools, to provide vaccines outside of a local health department. What has been halted is any attempts to communicate to parents that their children are in need of critical routine immunizations during this back-to-school season. That is a significant change from the standard operations of the Department of Health and this decision creates barriers to immunization and will result in decreased vaccination coverage rates, especially among poor and minority populations. It is interesting that the talking points provided discuss the past accomplishments of the program, all of which were under the direction of myself and my immediate predecessor and have absolutely nothing to do with the current concerns regarding the actions taken by Dr. Piercey to appease a handful of outraged and uninformed legislators. The information I have shared is not “misleading”, it is the response from the Governor’s office that both dodges the questions posed and twists the narrative away from the subject at hand.

 

 

TN HEALTH DEPT. HIGHER-UPS ATTACK DR. FISCUS’ CHARACTER

Earlier today the Tennessee Department of health released a letter from Chief Medical Officer Dr. Tim Jones to Department Commissioner Dr. Lisa Piercey (supposedly from July 9th) outlining the justification for firing Dr. Michelle Fiscus, the state’s top vaccine expert. This comes after a tremendous amount of blowback on a national scale, and reeks of a cleanup effort on the part of Governor Lee’s administration.

The letter disparages Dr. Fiscus in many ways, questioning her character, leadership abilities, and relationships, which doesn’t seem to jive with her glowing performance reviews – but it also goes the extra mile and alludes to outright corruption, implying Dr. Fiscus was steering resources to a foundation for her own benefit, calling it a “conflict of interest”.

Dr. Tim Jones says:

“Over the past three months Dr. Fiscus requested to give a new non-profit organization TDH funding to support VPDIP activities. This organization was founded and led by Dr. Fiscus, had no Executive Director or other employees, and had no other substantive source of funding. Providing funds to such an entity would be poor judgement and a substantial conflict of interest.

We spoke with Dr. Fiscus about this. She says she helped convene Immunize TN, a 501(c)(3) organization, to raise awareness about immunizations and refute anti-vaccine propaganda and get more Tennesseans vaccinated. “We’re asked by the CDC to put together pro-vaccination coalitions, and they give a grant to the state to support your state’s immunization coalition,” Dr. Fiscus told us. “Tennessee didn’t have one, so we got one together to make one. Immunize TN was going to do some of the work we were asked to do, which is standard operating procedure.”

Dr. Fiscus says she doesn’t receive pay from Immunize TN and is not on the board, saying she helped bring it together and was trying to steer resources to it to help it grow and become effective, part of her job as the state’s top vaccine expert. “They’re making it seem like I was trying to feather my best, which is completely false. The letter from Tim Jones alleges there was no board of directors, which is untrue. It has been in the works for 2 years and is part of my work plan.”

She says requests for funding for Immunize TN were made by Doctor Dorothy Sinard, who is on the board and is one of the other doctors involved. Dr. Sinard could not yet be reached for comment.

“Why wouldn’t that letter have been shared with me at the time of my termination?” Dr. Fiscus wonders.

A fair question.

REP. CLEMMONS ON THE FISCUS FIRING: “I’M INFURIATED”

Rep. John Ray Clemmons shared his feelings on Governor Lee firing Dr. Fiscus for doing her job and trying to keep Tennesseans safe, saying all Tennesseans should be “infuriated” at Lee for caving to the extreme science-denying right. Clemmons also expresses disappointment with TN Dept. of Health commish Dr. Lisa Piercey for not standing up for Dr. Fiscus.

DR. FISCUS CALLS GOV. LEE “TOXIC TO WORK UNDER”

Today Tennessee’s top immunizations expert Dr. Michelle Fiscus is making the rounds on national shows talking about her firing at the hands of Governor Lee for doing her job and trying to keep Tennessee safe. She isn’t holding back. Below are some clips.

HEALTH DEPT’S FISCUS FIRED FOR DOING HER JOB

Today, Dr. Michelle D Fiscus, who serves as the Medical Director of Tennessee’s Vaccine Preventable Diseases and Immunization program, has been fired from her role by Governor Lee’s administration.

This comes in the wake of public pressure from elected Republicans, who have threatened to dissolve the department because of what they perceive to be a push to encourage young Tennesseans to get vaccinated, which might be reasonably considered to be part of her job.

Last month in a government ops committee meeting things got heated when Republicans learned the Tennessee Department of Health had been allowing young Tennesseans over 14 to get the COVID-19 vaccine if they so chose even without their parents signing off on it.

The Health Department did this because the law allows them to, and because the data shows the vaccine is protecting people – almost every single Tennessean to die of the disease in recent months has been unvaccinated – but that didn’t stop Rep. Scott Cepicky and others from attacking the department and threatening dissolution.

The number of younger Tennesseans to get the vaccine without parental approval was exactly eight, three of which were TN Dept of Health commissioner Dr. Lisa Piercey’s own children.

The Fiscus firing is pretty clearly Governor Lee’s way of sacrificing her to the extreme right in an effort to alleviate some of the pressure.

In essence, Dr. Fiscus is being fired for doing her job as she tries to get Tennesseans vaccinated.

We are currently towards the very bottom in terms of vaccine intake, in no small part because of a lack of leadership at the top, not only from Rep. Cepicky, but also from TN House GOP caucus chair Jeremy Faison, who has actively been trying to dissuade Tennesseans from getting the vaccine.

Tennessee Republicans have also gotten plenty of help from Fox News and other conservative sites, who have been repeatedly and constantly disparaging the vaccine even though they themselves have been vaccinated, including Fox chief Rupert Murdoch.

The cynicism is breathtaking.

STATEMENT FROM DR. FISCUS:

July 12, 2021

Today I became the 25th of 64 state and territorial immunization program directors to leave their position during this pandemic. That’s nearly 40% of us. And along with our resignations or retirements or, as in my case, push from office, goes the institutional knowledge and leadership of our respective COVID-19 vaccine responses.  I will not sit quietly by while our public health infrastructure is eroded in the midst of a pandemic.

We are a group of dedicated public health professionals who have worked endless hours to make COVID-19 vaccines, the ONE tool we have to effectively end the scourge of the COVID-19 pandemic, available to every person in our jurisdictions.  Along the way we have been disparaged, demeaned, accused, and sometimes vilified by a public who chooses not to believe in science, and elected and appointed officials who have put their own self-interest above the people they were chosen to represent and protect.

On May 6, 2021, in advance of the approval of the Pfizer COVID-19 vaccine for 12-15 year olds and in response to multiple questions I had received regarding the rules around vaccinating minors, I reached out to Tennessee Department of Health’s general counsel to request a statement regarding Tennessee’s Mature Minor Doctrine that resulted from a Tennessee Supreme Court Ruling in Cardwell v Bechtol in 1987. In response, I received a document attached to an email stating, “Sure—Attached is the new summary of the doctrine that has just recently been posted to the website and is blessed by the Governor’s office on the subject. This is forward facing so feel free to distribute to anyone.” On May 10, 2021, I copied and pasted the language provided to me into a memo that was distributed only to providers who were administering COVID-19 vaccines. A recipient of that memo was upset that, according to Tennessee Supreme Court case law, minors ages 14-17 years are able to receive medical care in Tennessee without parental consent and posted the memo to social media. Within days, legislators were contacting TDH asking questions about the memo with some interpreting it as an attempt to undermine parental authority. Let me be clear: this was an informational memo containing language approved by the TDH Office of General Counsel which was sent to medical providers by the medical director of the state’s immunization program regarding the guardrails set 34 years ago by the Tennessee Supreme Court around providing care to minors.

What has occurred in the time between the release of this memo and today, when I was terminated from my position as medical director of the vaccine-preventable diseases and immunization program at the Tennessee Department of Health, can only be described as bizarre. On May 19th TDH was asked to appear before the Government Operations Committee due to the concern that the memo was “a bit of a prodding or encouraging to vaccinate children without parental consent”.  This was followed by a series of requests from members of the Committee for data around the impact of COVID-19 on children and a request to appear before the Committee again on June 16. It was at that June 16th meeting that the Department was accused of “targeting” youth through Facebook messaging and its actions were described as “reprehensible” by one Committee member. That member went on to call for the “dissolving and reconstitution” of the Department of Health in the midst of a pandemic where one out of every 542 Tennesseans has died from COVID-19 on their watch and less than 38% of Tennesseans have been vaccinated. It is the mission of the Tennessee Department of Health to “protect, promote and improve the health and prosperity of the people of Tennessee” and protecting them against the deadliest infectious disease event in more than 100 years IS our job. It’s the most important job we’ve had in recent history. Specifically, it was MY job to provide evidence-basededucation and vaccine access so that Tennesseans could protect themselves against COVID-19. I have now been terminated for doing exactly that. Each of us should be waking up every morning with one question on our minds: “What can I do to protect the people of Tennessee against COVID-19?”. Instead, our leaders are putting barriers in place to ensure the people of Tennessee remain at-risk, even with the delta variant bearing down upon us.

What’s more is that the leadership of the Tennessee Department of Health has reacted to the sabre rattling from the Government Operations Committee by halting ALL vaccination outreach for children.  Not just COVID-19 vaccine outreach for teens, but ALL communications around vaccines of any kind. No back-to-school messaging to the more than 30,000 parents who did not get their children measles vaccines last year due to the pandemic.  No messaging around human papilloma virus vaccine to the residents of the state with one of the highest HPV cancer rates in the country. No observation of National Immunization Awareness Month in August. No reminders to the parents of teens who are late in receiving their second COVID-19 vaccine. THIS is a failure of public health to protect the people of Tennessee and THAT is what is “reprehensible”. When the people elected and appointed to lead this state put their political gains ahead of the public good, they have betrayed the people who have trusted them with their lives.

I was told that I should have been more “politically aware” and that I “poked the bear” when I sent a memo to medical providers clarifying a 34 year old Tennessee Supreme Court ruling. I am not a political operative, I am a physician who was, until today, charged with protecting the people of Tennessee, including its children, against preventable diseases like COVID-19. I have been terminated for doing my job because some of our politicians have bought into the anti-vaccine misinformation campaign rather than taking the time to speak with the medical experts. They believe what they choose to believe rather than what is factual and evidence-based. And it is the people of Tennessee who will suffer the consequences of the actions of the very people they put into power. The public health professionals at the Tennessee Department of Health have worked themselves to exhaustion to protect Tennesseans from this virus. They are heroes. They have prevented suffering and saved countless lives. They are to be honored and commended, not cursed and vilified. And the “leaders” of this state who have put their heads in the sand and denied the existence of COVID-19 or who thought they knew better than the scientists who have spent their lives working to prevent disease… who have ignored the dead and dying surrounding them—even when their own colleagues have fought for their lives—they are what is “reprehensible”. I am ashamed of them. I am afraid for my state. I am angry for the amazing people of the Tennessee Department of Health who have been mistreated by an uneducated public and leaders who have only their own interests in mind. And I am deeply saddened for the people of Tennessee, who will continue to become sick and die from this vaccine-preventable disease because they choose to listen to the nonsense spread by ignorant people. At this point, you are going to get vaccinated or you are going to get sick. Yes, not getting the vaccine is a personal choice.  It’s true that you are likely to survive COVID-19.  It’s the 1 out of every 542 people surrounding you that will suffer the consequences of an unfortunate decision to remain vulnerable to this horrible disease.

May God bless the people of Tennessee.

Michelle D. Fiscus, MD FAAP

NYT’s “THE DAILY” Podcast On GREENEVILLE, TN’s Vaccine Hesitancy

Today’s episode of the New York Times “The Daily” podcast is called “Rural Tennessee’s Vaccine Hesitators”, and it’s all about vaccine hesitancy in GREENEVILLE, Tennessee – a community hard-hit by COVID where vaccine intake is exceptionally low compared to nationwide standards.

In general, Tennessee is at the bottom when it comes to vaccine intake, in large part thanks to a lack of leadership by Governor Lee, who made little fanfare of getting the vaccine himself, and has promised a marketing campaign to encourage folks to get the vaccine that has never materialized.

The Daily episode talks to doctor Daniel Lewis, a much-respected Greeneville doctor who nearly died of COVID, and has been doing his best to encourage folks in the area to get the shots.

VIDEO: GOVERNOR LEE GRILLED 🔥🔥ON REFUSAL TO EXPAND MEDICAID

At his first Virus update presser of the week yesterday, Governor Lee was grilled repeatedly, first by Alex Apple of Fox Nashville, then by Phil Williams of News Channel 5, about his refusal to expand Medicaid in Tennessee.

Expanding Medicaid would bring $1 BILLION of our own tax dollars back to our state each year. Instead Lee is touting a new $10 MILLION grant to rural hospitals. Meanwhile we’re #1 in rural hospital closures per capita and medical bankruptcies.

Not expanding literally is policy murder.

Lee says he’s only concerned about virus victims right now, but the truth is there’s no moral reason to be less concerned about those suffering from other diseases who have just recently become unemployed through no fault of their own, and who now find themselves without insurance. There are only political reasons.

Read this new STUDY that lays out what a huge mistake Lee and the Tennessee GOP supermajority are making, and watch the video below:

“IT’S A CLUSTER. GET YOUR CRAP TOGETHER.” – A Ballad Health Hospitalist Speaks Out

Governor Lee has spent the past few weeks telling us “the storm is passing”, but the virus doesn’t appear to be listening. It continues to spread at a rapid pace, including here in Tennessee. Even our rural communities are far from immune, with massive outbreaks in Sumner County and then just two days ago at a nursing home in Cookeville.

After 10+ days of urging from thousands of Tennessee doctors and nurses Lee finally issued a stay-at-home mandate Thursday, citing traffic data from Unacast showing movements in Tennessee starting to tick up again as his reason, particularly in rural Tennessee. (Unacast gives TN a “D-” for social distancing and an “F” to over half our counties)

Lee believes the Unacast data means rural TN is still not taking the threat of the virus seriously enough. The data does show an uptick recently, but it’s not the first uptick in recent days, so it seems a convenient reason to justify doing something he really didn’t want to do.

He was the 40th governor to issue a stay-at-home mandate.

Waiting nearly 2 weeks to do what he should’ve done a long time ago likely means many more will be infected, particularly because this disease is largely spread by folks who don’t show any symptoms, and who don’t even know they have it. This is why it’s still of utmost importance to have people of all ages and health conditions to look at pages such as https://www.sciquip.co.uk/products/ppe.html and others so they’re able to purchase suitable personal protective equipment to protect themselves and others against the spread of the virus.

The people most at risk are our frontline health care workers. They’ve been getting standing ovations from their neighbors all around the world for good reason, and they deserve to be the “TIME MAGAZINE PERSON OF THE YEAR” this year with no close second.

The problem is, despite Governor Lee’s assurances, we’re not properly protecting them. While health care workers in China appear to have Hazmat suits to go to battle with, our health care workers here in America are being given sports ponchos and garbage bags, and even being told to strap diapers on their faces in Tennessee – despite Governor Lee telling us otherwise.

As recently as yesterday Lee said “we’re staying ahead of the need” here, but those whose lives are on the line tell a different story. We spoke to a hospitalist in the Northeast Tennessee Ballad Health Care system about the lack of preparedness and communication there.

She spoke to us on a condition of anonymity to express her concern about the way things are being handled at Ballad hospitals – and it seems fair to wonder if this isn’t how it is in many hospitals around our state. (The anonymity comes because she’s certain Ballad would fire her if her identity got out. Not only are our health care workers not being protected throughout the country, they’re also being pressured to stay silent)

For context, Ballad is a state-sanctioned health care monopoly in Northeast Tennessee with over a dozen hospitals. They have come under fire recently for suing thousands of poor folks for not being able to pay their hospitals bills. Those who are struggling to cover the cost of their healthcare and are looking for help with this may want to consider using a crowdfunding platform online – check this site – in order to generate the necessary funds.

They were also the target of over 200 days of protest in Kingsport, and CEO Alan Levine was the mouthpiece for a company that was found guilty of Medicare fraud and forced to pay $260 MILLION in fines. (He was also recently tapped by Governor Lee for his statewide charter school approval board, which is in place to override local rulings on charter schools, and he has been known to insult people on twitter from time to time.)

But Levine’s transgressions aside, the Ballad Hospitalist tells us the reaction by Ballad has been “A CLUSTER”, citing a lack of protective equipment and testing and poor communication and education of frontline health care workers.

To be fair, these don’t seem to be entirely uncommon issues throughout the country, but the picture she paints is much different from the rosier one Governor Lee is painting for us at his press conferences, which still seem to lack the needed wartime urgency.

The Ballad Hospitalist started out by talking about masks, saying frontline health care workers at Ballad Health weren’t even wearing PPE like surgical masks throughout the day until recently:

“We didn’t even get surgical masks until 3 days ago (March 31st). Even when we knew it could be present. I had started wearing a surgical mask because it’s all I could get. It was frowned upon, but I didn’t care. I couldn’t find an N-95, but I do wear a surgical mask. We get ONE for the entire day, that’s it.”

She said nurses whose masks break or get misplaced are afraid to go ask for another one, and tells a story of having to go to bat for a nurse who couldn’t find theirs. It’s understandable that supplies will run low with many people needing new masks frequently, however, there should be no reason as to why they can’t try and stock up on as much PPE as possible. Protective masks are being produced and provided in many different places now, for example, you can find some here or other places online. There should be no reason for such low supplies.
About the fact that supplies are so short, she has no patience for it:

“We don’t have enough supplies? GET THEM. This is your people. This is going to kill people. Maybe they didn’t think it was going to come to podunk Tennessee. But it’s here. At least 20 cases at Ballad that I know of. We’ve had 3 deaths, and at least 3 health care workers are now sick.

Governor Lee and the Tennessee Department of Health continue to brag about how many people Tennessee is testing as a way to deflect criticism being leveled at them in comparison to neighboring states like Kentucky, which took stronger, quicker action against the spread, has seen its numbers climb far more slowly, and recently told their citizens not to travel to Tennessee.

But despite the claim that there are no-to-few barriers to testing in Tennessee, tests are taking up to 10 days to turn around, and many are still being denied tests throughout the state and country. Some sites in TN are even charging up to $200 per test, which destroys the idea that “whoever wants a test can get one”.

The Ballad Hospitalist still has serious concerns:

“We really weren’t even testing for it. Nobody really knows who’s supposed to be testing or what the hell they’re doing. The Director of the ER has been complaining how the testing works, do we or don’t we? They don’t want to test in the ER. We just now got the rapid testing which can be turned around in 6 hours. Here in the USA we should be testing everybody.”

One of her biggest concerns at Ballad was communication, which she said is all over the place, and has led to a lot of confusion among health care workers that interact with sick patients on a daily basis:

“They’re just not communicating well. Nobody really knows what to do. Education is lacking. I watch these nurses, they have no idea how to put on or take off protective equipment. The nurse has a Covid patient, then has a full patient load and has to go deal with other patients. They’ve been putting nurses at the door to take our temperature as we come in, but I’ve been having to tell nurses to take my temperature. They just ask “you don’t have a temperature do you”?

I do think there’s going to be a huge surge of problems.”

As for what happens when a health care worker is concerned they might have been exposed or feel symptoms, she says nurses are being forced to use their paid time off, and they’ve started laying off staff – something many hospitals have been doing now that elective procedures, which are reimbursed by insurance companies at a higher rate, have stopped – the perils of an entirely for-profit health care system.

As for her message to Ballad, it’s simple really: “Get your crap together.”

“Ballad needs to GET THEIR CRAP TOGETHER. I think Ballad historically does a good job with things. A lot of people have complained since Ballad combined two systems into one, and some jobs were cut and pay was reduced – but when it comes to health care I think they’ve done a pretty good job. BUT THIS HAS BEEN A CLUSTER.

It’s sad to me because I see such a mix of people that still don’t think it’s a big deal. Even doctors I’ve heard say this is being blown out of proportion. Sadly I think that’s because they live here. READ THE NEWS. Look what’s going on in other places. They say it’s because the numbers are skewed. No. This is real.”

As for what made her start to take it seriously, she points to a Washington hospitalist who spoke her language about what patients are going through.

“A hospitalist in Washington speaking about a patient’s progression is what really spoke to me. I was like – okay, this is a big deal. This thing is ugly. She was talking about her co-workers dropping like flies, speaking about it in a medical language that I could understand, from medical people that have seen it. Not news speak. “
Unfortunately, The Ballad Hospitalist has to stay anonymous because she says it’s clear that if you speak out Ballad will fire you – their emails say “CONFIDENTIAL NOT TO BE SHARED WITH MEDIA” – and they’re really the only employer in the area for what she does.
We appreciate her, and that she was willing to talk to us. Frontline health care workers are heroes, and they deserve to be protected.

The bottom line is in the richest country in the world we’ve lacked a uniform, comprehensive reaction to this problem, and we have been caught unprepared in large part because of a reluctance by Trump (and Fox News) to take the problem seriously until it was too late. (also, cutting the CDC budget and firing the Pandemic response team didn’t help)

Our numbers have skyrocketed. Our outbreak is the worst in the world. Our for-profit health care system system has been exposed on many levels, and we can only hope now our state doesn’t suffer even more because of a slow response and lack of seriousness by our local officials, state government, and hospital management here at home.

If you want to tell Governor Lee to hurry up and get the needed testing and gear for workers like her, holler at him HERE.

GOVERNOR LEE WANTS “DATA AND EVIDENCE”? HERE’S SOME, GUV.

Governor Bill Lee has said he’s waiting for “DATA AND EVIDENCE” before issuing a stay-at-home order for Tennessee, which many states have done, and which doctors and mayors and the Tennessee Medical Association are asking him to do.

Instead he’s writing op-eds saying “The Storm Is Passing” despite all evidence to the contrary.

MARC LORE is an entrepreneur who works at one of the biggest companies on the planet. He has crunched the numbers, and his findings are somewhat reassuring… but require swift, immediate action.

Read what he wrote below — HIS CONCLUSION, for the Too Long Didn’t Read Folks:

“If we stay locked down and don’t spread the virus there won’t be many people who are still infected by May 1st. That’s why I believe we will be in a position to open up. But we need to remain vigilant. I feel great about NYC, but am concerned about what I am seeing elsewhere in the country. In order to keep deaths in the US below 20,000 we need to lock down the country like we did NYC immediately.”

This is “DATA AND EVIDENCE” Marc sent to family and friends in full. Hopefully someone can show this to Governor Lee before it’s too late.

—-

March 26

Dear friends,

I’m here in NYC on March 26th, day 10 of sheltering in place at the epicenter of COVID-19 with many of the symptoms and no way to get tested. NY represents almost half of the cases in the country and 1/3 of the deaths. Many of my friends and colleagues have symptoms as well, ranging from mild to hospitalization and they are all under 50. Coronavirus is no joke. It seems to be spreading extremely quickly, with the death rate constantly increasing. We keep seeing on the news that other countries are taking more extreme measures than us, particularly in workplaces. We’ve seen some businesses using sneeze guards from Versare on their desks to ensure that germs are contained and aren’t spread. As the virus is airborne, it can spread quickly so it’s important that workplaces try and keep their employees safe with safety measures like sneeze guards. Businesses in other countries are also sending employees home to work remotely, again limiting the contact between people and therefore limiting the spread of the virus. It isn’t easy – especially when working out of the office – but staying organized during uncertain times is key to continued success. Hopefully, the US will start taking the virus seriously soon!

I’ve been reading everything I can, but it is difficult to make sense of all of the contradicting facts and figures. I find myself contemplating: How bad is this going to get? When will it be over? How does Coronavirus compare to the flu? What is the true death rate? What is the real risk for young people?

I’ve read the articles and analyzed the stats and found there to be so much bad info out there, so I decided to try and make some sense of the facts and thought I would share what I’ve learned.

In summary, this is not just a little more dangerous than the flu, but it is also not 20-40x as deadly as others claim.The Coronavirus, by my estimate, has a death rate of around .42%, on average. In a normal year the flu has a death rate of approximately .10% and in the bad flu season of 2016/2017 it was .14%. This implies Coronavirus is about 3x as deadly as the flu in a bad season. However, I’ll share some stats later that will show that the virus might actually infect older people at a higher rate than younger people. If this is true, this fact, combined with higher death rates among those 70+, explains how COVID-19 can overall be 3x as deadly as the flu, but only 1.2 – 2.5x as deadly for any specific age group. The heavier concentration of older people in the sample raises the overall death rate.

INFECTIOUS RATE

In addition to the higher death rate, Coronavirus is also more contagious. This is why quarantining is so important and why things like dating should be put on hold, although there are some rules you can follow for hopefully a virus-free interaction with someone you love. In the tough flu season of 2016/2017, 14.5 percent of the entire population was infected and there were 61,000 deaths. It is hard to know what percentage of the population would be infected if we didn’t lock things down and were business as usual. We do know that COVID-19 is more infectious and spreads more quickly than the flu. Someone with the flu infects, on average, 1.4 people, while COVID-19 infects 2.3. On the Princess Diamond cruise ship almost 20 percent of the entire population was infected within days. Granted it is a confined space, but it multiplied fast.

Even if we use 14.5% (% of population infected by the flu) at the low end and 80% of the population at the high-end we get a range of between 200k – 1 million deaths in the US. Based on what I’ve learned I would take the midpoint and estimate 600k deaths. That implies, COVID-19, if left unchecked, would kill 1 in every 545 people (.18%) in America.

This is not a worse case. This is very likely what would happen if we did nothing. We absolutely needed to move quickly and lock things down. But now we need to be much more aggressive with testing. We are behind.

Based on my analysis, however, if the rest of the country can learn from NYC and lock everything down now (NYC waited too long and is paying the price), we can keep US deaths under 20,000 with rigorous testing and quarantine. And I believe we will be in a position to open small businesses in NYC by May 1st.

COVID-19 DEATH RATE

I said Coronavirus has a death rate of .42%. That is a lot lower than what you read. Basic math would suggest a death rate of more like 4.3% since there are currently 491,253 Coronavirus cases worldwide as of March 25 and 22,165 deaths (22,165 / 491,253 = 4.5%). This implies that Coronavirus is over 30x as deadly as the flu. That is just wrong.

The primary reason why the death rate isn’t 4.3% is simply because people with mild or no symptoms aren’t getting tested, so we have a denominator problem. I believe the true number of infected cases is about 10-11x higher than what’s being reported, which translates to a death rate of .42% vs 4.5%. That might sound like a big difference but keep in mind about half of the people with COVID-19 don’t even exhibit any symptoms at all. Let me share how I arrive at .42%.

COVID-19 DEATH RATE RATIONALE

In order to know the true number of cases you need to test everyone. Fortunately, we do have a couple of places where we’ve done that. Although it is a small data set, it tells us a lot.

Let’s start with South Korea. They have the most advanced Coronavirus testing program in the world. They have tested around 350,000 people and have 9,241 cases. That means they tested 38x the number of people who had it. This is the best proxy we have for calculating a death rate when everyone with symptoms is tested. In South Korea there are currently 131 deaths for a death rate of 1.4 percent (131/9,241). Since they are seeing less than 100 new cases a day I don’t expect the death rate to change very much although it will creep up.

Although they have a rigorous testing program they likely didn’t test those without symptoms and they definitely missed people earlier on before they started testing. They have a population of 51 million people and tested just 320,000 people. So the question is: What percentage of people have the virus and show no symptoms? We actually have two data points. On the Diamond Princess cruise they tested everyone and found 47 percent of those that tested positive didn’t show any symptoms. Also, in the city of Vo, Italy they tested all of the residents and found that 70 percent showed no symptoms.

If we take the South Korea death rate of 1.4% and adjust for 50 percent of people with Corona who have no symptoms that calculates to a .7% death rate (1.4% * 50%). Since it took a while before Korea started testing I tried to figure out how many cases there likely were before they started testing based on the number of deaths and reverse engineering how many cases there should have been. I estimate there were another 13,000 or so cases that weren’t accounted for, making the true number of cases more like 31,000. Divide by 131 deaths and you get a death rate of .42%, which is 3x as deadly as the flu in the 2016/2017 season where we saw a death rate of .14%. Now let’s look at a few other examples to pressure test this estimate.

On the Diamond Princess cruise there were 3711 passengers and crew aboard. Everyone was tested and 697 had COVID-19 (18.7% of the population – a good example of how fast this could spread in a closed area), and 47 percent showed no symptoms at all. Nine people died for a death rate of just over 1.3% (9/697) which is higher than the .42% I estimated earlier. However, the 1.3 percent is misleading because of the heavy skew toward older people. All 9 of the people who died were over 70 years old. Since there were 288 confirmed cases for 70+ the death rate for 70+ is 3.1% (9/288). Since the flu death rate for those over 70 is about 1.2%, the Coronavirus death rate appears to be 2.5x as deadly as the flu for that age group. Let’s take a look at another example where everyone in a population was tested.

In Vo, Italy, where the entire town of 3,300 people was tested, 89 individuals had the virus and 70 percent didn’t show any symptoms. One person died for a death rate of 1.1% (1/89). But again, the population is skewed much older and the individual who died was over 70. For the 70+ age group the death rate is similar to the flu, which is approximately 1.2%. However, I admit the data sample is too small. That’s why we can’t look at any one data point. But when you start to make sense of all of the points you can begin to triangulate on a number that has statistical significance.

Another way to examine death rates is to simply focus on those of the elderly. There seems to be an interesting difference between the flu and COVID-19 regarding the likelihood of older people contracting the virus relative to younger people. For the flu, people over the age of 65 are no more likely to get it than younger people. I would have thought that the older you are the more susceptible you would be to getting the flu, but the 65+ age group represents 13.3 percent of all flu cases and 13.1 percent of the population in 2016/2017 flu season.

It appears to be different for COVID-19. On the Diamond Princess I looked at the percentage of the population that were infected by age and found an interesting trend. Here are the infection rates by age: under-50 = 6.5%, 50-60 = 7%, 60-70 = 8.2%, 70-80 = 9.4%; 80+ = 13.4%. There could be other factors at play here, but the results would suggest that an 80 year old is twice as likely to contract the virus as someone under 50, assuming equal exposure. So, not only is the death rate 3x the flu for over 80, they may also be twice as likely to contract the virus. If this were true (and I admit there may be some particular contributory circumstances that explain this) that older people are more likely to contract the virus, then it would explain why the overall Coronavirus could be 3x as deadly as the flu, but much less deadly for any specific age group.

Let’s dig in deeper on age specific death rates. If we examine the 80+ population in South Korea we see a death rate of 9.26%. Remember, we adjusted the overall death rate of 1.4% down to .42% in South Korea after adjusting for missed cases and asymptomatic people. If we apply the same multiple to the 80+ age group we get a death rate of 2.78% (9.26% / 3.3). Since the flu death rate in this population is about 1.75% this would suggest that Coronavirus is about 1.6x as deadly for this population.

Another way to analyze this is to look at the death rate for those below age 50. The reported death rate for under 50 in Korea is approximately .05%, and that is before making the correction. In fact, no one under age 30 died. If we divide .05% by 3.3 we get a death rate of .015% for under 50. Since the death rate for under 50 for the flu is .013% it implies that Coronavirus is about 1.2x as deadly as the flu for those under 50. However, it is not just the death rate for this population that needs to be considered. People under 50 are getting very sick and are being hospitalized and put on ventilators at a much higher rate than we see with the flu.

In conclusion, I believe that the true death rate on average is .42% or about 3x as deadly as a bad flu season, however for any specific age group it is between 1.2x – 2.5x as deadly.

US – PREDICTED CASES/DEATHS

With the exception of NY, I believe many states may have caught this in time, so the actual death rate will be a fraction of what it could have been. If you look currently at US data, there have been 68,211 cases as of March 25 and 1,027 deaths for a rate of 1.50 percent. However, the number of deaths will grow even if there were no new cases because there is a lag time between diagnosis and dying. Two days ago the percentage was 1.25% and now it is 1.5%. It will keep climbing. I took each of the daily cohorts of new cases and assigned a probability of dying by day based on what has been observed. Then I estimated how many deaths there would be if cases ceased today. With this calculation, I get a death rate in the US of 4% (on observed cases) which is much closer to the current global average of 4.5%. This gives me some comfort that the model is working. We know we haven’t done the testing, but this proves how little we have actually done because we’ve established that the actual death rate based on infection is really more like .42%. This means that the number of true infections in the US is more like 10x what is being reported. I estimate around 680,000 actual (not the reported number) cases in the US vs 68,000.

Based on the modeling I did, assuming some period of incubation, I estimate that the true number of cases (true, not reported) in the US could grow from 600k to between 2-5 million, infecting about 1 percent of the population. To put that in context, in Vo, Italy almost 3 percent of the population was infected.

With 2-5 million predicted infections in the US and a death rate of .42%, I would expect about 15k deaths in the US (range 8k – 21k). Remember that in the 2016/20117 flu season we had 61,000 deaths. I will continue to update the model as the days pass based on the new information.

NY – PROJECTED CASES/DEATHS

In NY we are now at 33,000 Coronavirus confirmed reported cases as of March 25th, but the true number of infections is more like 250,000, (the multiplier is not 10x because NY has done more testing than the rest of the country) based on the way deaths are materializing. I built a model to predict cases and deaths by modeling the daily number of new infections and applying a distribution of the incubation period before symptoms show. The data I have from NIH shows that less than 2.5% of people will see symptoms in the first 2.2 days, and 97.5% will see symptoms within 11.5 days with the average number of days being 5.1 days. We don’t know the actual number of infections, but we can reverse engineer the number if we know the number of cases and deaths.

Given the incubation period and time to get tested, we are now at a point, 10 days removed from the lockdown, where we’ll know any day if we’ve slowed the virus. Each day will give us critical info. I’ll be watching the numbers closely and will send an update. If we see the number of new reported cases in NY remain under 8,000 today after 6,618 cases yesterday I think we’ll be tracking toward about 5,000 deaths in NY, which is a lot lower than what people in NY fear. Today is a critical data point.

5,000 deaths equates to around 1.2m true infections (5,000 / .42%) and implies, based on the 19.5m population in NY, that 6.1% of NY State will become infected. Since almost half the state’s population is in NYC and most of the infections are concentrated there it implies over 10% of people in NYC would become infected. If this should be the case, it should be about time that those that govern NYC should look to learn more about coronavirus applications in order to track and trace COVID infections uniquely and be able to trace the movements of those infected. While also looking to educate NYC residents more on the dangers of being mobile in the midst of the pandemic and what they should be doing to decrease the risk of exposure.

With 10% of the population infected in NYC we would need a maximum of 15,000 hospital beds. Today we are using 5,327 hospital beds up from 3,805 the day before. There is absolutely no way we will need the 140,000 hospital beds that Governor Cuomo said we will need. 140,000 beds would be required if every single person in NYC were infected at the same time. I know this because of the actual number of hospitalizations and deaths, which implies a certain number of infections. It is mathematically impossible to get to 140,000 hospital beds being needed at one time. And 5k ventilators will be more than enough to handle all of the cases in NY.

Let this be a lesson to the rest of the country. If we extrapolate the NYC death rate nationally we would see nearly 200,000 deaths in the US vs my current prediction of less than 20,000. All states need to take this seriously.

WHAT SHOULD WE DO NOW?

It makes sense to shut everything down so we stop the spread, but we also need to ramp up testing dramatically.We have 6.5 times the population of South Korea and they tested 350,000 people before they were able to stop it, so that means we may need over 2 million tests. The quicker we start testing and isolating people the quicker we can get back to life. I expect restaurants and small businesses in NYC to start opening before May 1st given the more aggressive stance NYC has taken on testing and the current trends. I’ll let you know if this estimate changes.

Hope this is helpful. If you have any new data points that I should include please let me know. I will update the model daily and send an update.

NY Update – March 27

I said it would be a good sign if the number of new cases were less than 8,000 yesterday and we had less than 7,000 so that is a good sign, but I’m seeing a lot of bad data relating to the number of cases. The cases are too dependent on the number of tests and the timing of the results. Therefore, I am going to focus on the number of hospitalizations and deaths because those numbers are more concrete.

For today, March 27th, I am projecting 7,568 hospitalizations and 142 deaths. My projections track toward reaching a maximum of 15,000 hospitalizations in 11 days. And we are tracking to 5,700 deaths, with a daily peak of about 250 per day. Don’t be alarmed if daily hospitalizations and deaths double over the next week and a half. That would be a good sign as most predictions show a multiple of my projections. It means that the lock down is working.

The next few days are so critical because we are 11 days from lockdown, so we’ll know in the next few days if we dramatically slowed the number of new people being infected because the average number of days from first symptoms to hospitalization is 12-13 days.

Please let me know if you find any info that would be helpful to include in the model. This needs to be a group effort.

Be safe and shelter in place. We can beat this.

NY Update – March 28th

I was looking for 7,568 hospitalizations and it came in at 7,328 up from 6,481. This is huge news! As I said each day is super critical. The 240 shortfall is a big number and means the lockdown is working for sure. It is not just the single datapoint that is encouraging. The 3 day trend is very positive and the number of new hospitalizations has peaked.

As a result I am taking my peak hospitalizations down to 12,000 from 15,000. And the number of ventilators down to 3,000. And I cut my projections for hospital beds needed tomorrow down to 8,142. If the lockdown didn’t work we would have been at 10,655 beds today going to 13,454 tomorrow. It is working!

The 209 new deaths was surprising this early, and a big jump from 134 the day before. The total deaths stand at 728, but I have total deaths of 809 to date, based on the model. I don’t think NY captured all of the earlier deaths and so I believe this is partially a catch up. We will know a lot more in the next day or two. The other possibility is deaths are happening faster than the avg 5.1 days I modeled or the distribution is off, but I don’t think the death rate can be off because my cumulative total is still a little higher. I am projecting 164 deaths tomorrow.

If we stay locked down and don’t spread the virus there won’t be many people who are still infected by May 1st. That’s why I believe we will be in a position to open up. But we need to remain vigilant.

I feel great about NYC, but am concerned about what I am seeing elsewhere in the country. In order to keep deaths in the US below 20,000 we need to lock down the country like we did NYC immediately.