https://inside.upmc.com/shapiro-economy-roundtable/

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As we prepared for the pandemic, we radically transformed our hospital operations to create a safe environment for patients and staff, we delayed non-urgent surgery, reducing it by 70%, and we scaled up telemedicine 38-fold, performing 250,000 visits in April.

We indeed saw a steady stream of patients but never "surged." At peak in mid-April, COVID-19 patients occupied 2% of our 5,500 hospital beds and 48 of our 750 ventilators. Subsequently, admissions have been decreasing with very few patients now coming from the community, almost all now being from nursing homes. Of note, in the 36 UPMC-owned senior facilities we have had zero positive cases.

Our outcomes are similar to the state of Pennsylvania, where the median age of death from COVID-19 is 84 years old. The few younger patients who died all had significant preexisting conditions. Very few children were infected and none died. Minorities in our communities fared equally as well as others, but we know that this is not the case nationally. In sum, this is a disease of the elderly, sick and poor.

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The question before us is what will happen as we re-open society and how should we manage it? For New York and a handful of other cities with high case rates as a result of density, travel and socioeconomic issues, they must open up in a measured step-wise manner with extensive testing, tracing and treatment.

But for the rest of the country, as people come out of their homes cautiously and safely, if we protect our vulnerable seniors, particularly those in nursing homes, we should be able keep case rates low, buying time for a potential resurgence as we bolster our supply chain and find effective intervention.

COVID-19 is a disease that ravages those with preexisting conditions whether it be immunosenescence of aging or the social determinants of health. We can manage society in the presence of this pathogen if we focus on these preexisting conditions.

What we cannot do, is extended social isolation. Humans are social beings, and we are already seeing the adverse mental health consequences of loneliness, and that is before the much greater effects of economic devastation take hold on the human condition.

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In this particular case, the problem we're not going to be able to fix in the short term is the complete eradication of the virus. The problem we can fix is to serve and protect our seniors, especially those in nursing homes. If we do that, we can reopen society, and though infectious cases may rise as in the Theodore Roosevelt, the death rate will not, providing time for the development of treatments and vaccines.

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TL;DR: Open up society, but protect the elderly and vulnerable.

Travel should be limited to and from hot spots. Turns out the NYC is the originator for much of the US.

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median age of death from COVID-19 is 84 years old.

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Isn't the expected median life expectancy for Americans about 80 years old?

Yep. Life expectancy in the US at birth is a hair under 80.

But life expectancy at 80 is about 8 years - a little less for men, and a little more for women. In other words, about half of those that celebrate their 80th birthday will live to see 88.

Great post, thank you

I agree with this. Unusual. When it hit initially I saw a handful of 50 somethings. With a few deaths. Some otherwise healthy. Mostly travel related. Now - elderly. Institutionalized. Just as OP. Makes one think.............

Think what exactly? Really interested in your thoughts.

tysker said:

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Maybe not the forum to post this but I have a sneaking suspicion that after almost three months of fighting this, the on-the-ground medical personnel are starting to see a patient load that may run counter to some prevailing narratives and policies. I also wonder if there is a patient trend that shouldn't/can't be openly discussed in our highly politicized world.

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Some data that is significant and should be easy-to-find is really challenging to dig up. Or not exactly broadcast with enthusiasm.

For example, as mentioned by the physician above, age distributions. Or percentage of deaths from nursing homes and long-term care facilities. Hugely important factors that should be guiding public policy.


But a very, very small number of kids showing signs of disease with no tangible evidence that it's linked to COVID? That's national headlines! Spots on the nightly news!

(https://www.nbcnews.com/health/health-news/15-children-n-y-c-identified-rare-covid-linked-condition-n1200256)

i do think this is a disease you don't actively want to seek out

but there's a significant group of elite opinion that does not want to break the paranoia, even in the face of better news/data

the NYC serology study being my complete obsession - it wasn't dismantled like the CA serology studies, so the immediate pivot was to we can't actually protect the vulnerable

it's defeatist and we are grossly misallocating resources right now

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I also wonder if there is a patient trend that shouldn't/can't be openly discussed in our highly politicized world.

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My concern, which I probably posted 2 months ago, was what would happen when this got loose in the rural South. People talk about how wonderful the US health care system is, but in proportion to our wealth, our health care is terrible. Sure, it's great once you're sick, but the combination of individual choice and awful preventative medicine leaves many people vulnerable.

Long story short, America has this decades long reality where the poor people are the most overweight. THIS is the issue that is politically incorrect to talk about.

The OP mentions "socioeconomic issues." It alludes to "poverty." Sorry, being poor doesn't make you sick any more than it makes you a criminal. I'd like to know the average BMI of the people under 65 who are hospitalized. It's not mean-spirited. It's a legitimate question, and if we're going to write a detailed piece that confuses matters by saying "socioeconomic issues," we should stop *****-footing around what those issues are.

It's turned into fear porn, and it's getting old.

Keegan99 said:

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NY mandated that nursing homes admit or readmit patients without proof of being COVID negative.

In other words, NY forced potentially COVID positive patients into nursing homes.

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Yeah, I know, and they also had COVID positive HCW's working in nursing homes. NY really couldn't have handled things much worse than they did, but somehow Cuomo is being treated as a heroic leader in this. It's crazy.

I do not find this particularly surprising or interesting. A few areas in our country have been hit hard, the rest haven't. It's widely known now that we avoided overloading our hospitals and that estimates for hospitalization were initially overestimated. If you did the same interview to a number of cities, you would get similar responses.

That should not invalidate the experience of doctors who do work in harder hit areas of New York City, Newark, New Orleans, or Detroit either. We have some Aggie doctors on this very board who have shared exactly why this virus is fearsome.

My point is not that one person's experience is more valid than the other, my point is that they're both valid and they tell the story of the virus.

I also find it so counter productive to complain about the news. We all know that the news is driven off of views and clicks and the general public viewing behavior drives the style and substance of the news they consume. Fox News isn't pushing these narratives you are saying the media is pushing, and it's largely because they're feeding the red meat that their constituency wants to see. The same reason CNN/NBC/CBS are pushing their narratives. It's well-known that people react much stronger to negative information than positive information, the Freakonomics podcast details the situation very well in their latest podcast about the challenges news organizations face in this regard.

Despite what has been said here, the age distribution of the virus has been widely known and widely distributed for literally months now. Two full months ago I posted on Facebook about the age-dependency and comorbidity dependency of CV. It wasn't some state secret being withheld from the public.


I know that it's not the intent of the messenger, but sometimes a lot of the responses to the age distribution dying has the tone of "so what, they are old and were going to die soon anyways." My grandma is in her early 80s and she has some preconditions that would make her at risk if she caught CV. I don't think that she has one foot in the grave quite yet, she still works, throws parties almost every weekend, does DIY home projects, gardening etc. If she died it would absolutely cut her life short and devastate me and my other family members robbing us of valuable time with a special person.

The fact that we went from 1 known death of CV in the US on March 1 to ~2,000 people dying every day for a fully sustained month now is a jarring and severe situation and shows the lethality and transmissability of the virus. We should start to open up and get our economy rev'd up, but we shouldn't do so in a way that disregards the very real threat of the virus and act like it's no risk to anybody under 70. This isn't a disease where you can bear all the risk of your decisions. This is a disease where your decisions risk yourself and every person you come into contact with. It should be treated that way.

the coronavirus isn't the only way to die as it turns out.
Should we make a list of ways a person can die?

How many could we come up with? thousands?