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3 dean ganoIn the Wake of this corona virus pandemic it has occurred to me that while our governments are created for the protection and safety of the citizens, they may not be doing a very good job of this. Here is my analysis of the current situation as of April 15, 2020.

About Dean Gano

Creator of Apollo Root Cause Analysis, I have been working to help people be better problem solvers for over 20 years. My current mission is to bring the process to the masses by creating new tools and teaching techniques to anyone interested in effective problem solving.

Specialties: Effective Problem Solving for any kind of human situation.
  

The Governor of the State of Washington, Jay Inslee, recently issued a second Stay Home Order; here is a condensed version of the Governor’s reasons for this action:

Stay Home/Shutdown Order Caused By:

COVID-19 shows significant progression and broad spread in Washington State

AND High Risk of death to most vulnerable populations evidenced by 247 deaths in the state so far

AND models predict that many hospitals will reach capacity or become overwhelmed by COVID-19 patients in the next few weeks

AND COVID-19 continues to threaten the life and health of our people as well as the economy of Washington State.

SOLUTION: Extend the Order to STAY HOME and the shutdown of non-essential businesses from April 27th to May 4th.

See Attachment 1 for a copy of the Governor’s Proclamation.

Analysis:

Effective problem analysis requires the following:

  1. Clear Problem Definition to include What, When, Where, and Significance.
  2. All causes must be clearly defined.
  3. All causes must be supported by sensed evidence.
  4. The Causal Analysis must follow the principles of causation.
  5. Causes must be sufficient and necessary - no guessing and voting on them.
  6. Effective Solutions must:
    1. Prevent Recurrence
    2. Be within your control
    3. Meet your goals and objectives
    4. Not cause other unacceptable problems

If we compare the Governor’s order to the requirements for effective problem-solving we see the following deficiencies:

Step 1: Clear Problem Definition to include What, When, Where, and Significance.

There is no clear problem definition, just a bunch of conditions that sound pretty scary. However, from what is being said, it can be assumed that the “What” is death, the “When” is now, the “Where” is the State of Washington, but there is no stated “Significance.” So, what is the significance? Is it an unacceptable number of deaths? How many is this? Who gets to determine this? How do these projected numbers compare to other acceptable conditions?

A second stated problem is “overwhelming our healthcare system” which should be treated as a separate problem with separate solutions, but it is not. So, by the way the problem is presented, “overwhelming our hospitals” requires everyone to stay home and most businesses to be shutdown which is causing significant loss of revenue and possible bankruptcy, not only for businesses, but the hospitals themselves. Caused by not doing the normal business of helping people with serious health problems. We’ll get back to this problem later.

For now, let’s just look at the problem of death. To help us better understand the significance of “Death from COVID-19,” let’s see what is really going on, since the governor didn’t provide any details:

One of the numbers the experts throw around is the percent of people who contract the virus and then die. On the fifth of March, the World Health Organization (WHO) projected a 3.4% death rate of those infected. Based on what we know of the infection rate in the general population, that would mean about 2.2 million people in the United States would die.

On the Diamond Princess Cruise ship that was stuck in Japan in February and March, the death rate was only 1.3% of those infected. The problem with these various case numbers is that with the exception of the cruise ship statistics, the actual known cases in the given population is unknown so any stated death rate is totally false other than the cruise ship case. And while the population was known for the cruise ship event, the subjects were older than the average US population and they were, in effect, all living in the same house.

Given these conditions, there is no dataset to help us understand the effects of the virus on the general population. However, because this is the only “controlled case,” let’s look at the Diamond Princess Cruise ship event to get a better understanding of this disease and how it actually affects people in a controlled and isolated environment.

Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 (Figure 1). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died. 

 

1 who cruise ship graph

 

The above statement and Figure are provided by the WHO. Notice the death rate they give is for the number of people who contracted the virus, not the entire population of the ship. If we divide 9 deaths by 3,711 passenger/crew, we get a death rate for the entire population of 0.24%, or one in 412 people died.

However, on Princess cruise ships the crew usually represents about 28% of the total capacity, so 72% of 3,711 = about 2,672 passengers. If we assume 90% of them are over 55 years old (which is common for this type of cruise), we have a population of 2,405 old people who are responsible for somewhere between 78% and 97% of the deaths from COVID-19 (More on these percentages later). Since 9 of them died, the death rate for old people in this case is 9/2405 = 0.37%.

With 29% of the population in the United States over 55, that equates to about 95.7 million old people and if 0.37% of them could die, that would be about 354,000 deaths. If that number represents 78% of the deaths, then 354,000 is to 78% as the Number of young people is to 22%. Which would mean about 100,000 young people could die, for a total of about 454,000 deaths in the US. If we use the 97% number for old people, then only about 11,000 young people would die, for a total of 365,000 deaths.

But how do these numbers compare to something “normal” like the annual Flu season? According to an estimate by the Centers for Disease Control and Prevention (CDC), there were approximately 45 million cases of the flu in the United States during the 2017-2018 influenza season, resulting in an estimated 810,000 flu-associated hospitalizations and an estimated 61,000 flu-associated deaths. This results in a death rate of those infected of 0.14%. So, the cruise ship numbers represent 6 to 8 times more deaths than a bad flu season, so relatively speaking, the COVID-19 virus appears to be very dangerous.

But let’s look a little closer at the cruise ship event. A cruise ship is like a home, where everyone in it is eating, socializing, and most importantly touching the same surfaces and breathing the same air. Unlike most of our communities where people live in their own houses and do not touch the same surfaces as their neighbors, except when they leave occasionally to go out for food, medicine, entertainment, etc. This is especially true in rural communities, but not so much for large cities like NYC and Seattle, where the number of infected are highest. Given these facts, the cruise ship case is not a good reference point.

Also, since the numbers from the cruise ship are significantly higher than the models are predicting or from what we are seeing so far in the US, these are not data we should use to determine the significance of the problem.

A better way to evaluate the significance of this pandemic is to ask how many people die in our country each year, because then we can compare the COVID-19 death rate with “normal” deaths from all other causes and give us some perspective.

According to the US Center for Disease Control (CDC), about 0.86% of the US population died from ALL causes in 2019, which is about 2,800,000 deaths. If the virus kills 200,000 people in the US in 2020 as suggested by Dr. Anthony Fauci that would be a 7% increase in the total number of deaths from all causes. This provides some perspective of the significance, but let’s see how it compares to other causes of death in the United States:

2 us causes of death

The total number of deaths per year means one person in every 116 people die each year from “acceptable causes,” meaning causes that do not require us to cease living our lives and destroy our economy.

For more details go to the CDC website: https://www.cdc.gov/nchs/nvss/vsrr/mortality-dashboard.htm#

Furthermore, the 200,000 possible deaths number does not take into account the huge differences we are seeing in different parts of the country. For example, Los Angeles County has 10 million people. They currently have about 6,377 cases of COVID-19 and 147 deaths which is 0.00147%, or about one person in 68 thousand have died.

In King County, Washington, (the Greater Seattle area) which has 2.25 million people, they currently have 3,331 cases with 222 deaths which is 0.01%, or about one person in ten thousand has died.

In the New York City metropolitan area, which has 18.8 million people, they have 72,181 cases and 3,485 deaths which is about 0.02% of the population, or about one person in five thousand have died.

The United States as a whole has about 330,000,000 people with 383,256 confirmed cases and 12,021 deaths as of April 7, 2020, which is 0.004%, or about one person in 27,500 people have died so far in the US. This is about 230 times less that the total number of all deaths per year.

In summary, when we compare the COVID-19 deaths to “acceptable normal deaths” one in 68,000, or one in 27,500, or one in 10,000, or one in 5,000 is significantly less than the one in 116. A number we seem to accept as socially acceptable. At least something we should not shutdown the entire economy for and restrict our God given rights to life, liberty, and the pursuit of happiness.

While this is only a snapshot of the current conditions, it’s not the end of the world. Even if these numbers increase by a factor of 10, that would be about 95,000 deaths, or one in 2,750 versus 1 in 116. That’s 1/24th of acceptable deaths.

The latest University of Washington model, which has never been right, predicts somewhere between 25,000 and 155,000 United States deaths will have occurred when this epidemic supposedly ends in early June. If it is 25,000 (which is what I predict), that would be less than the annual Flu season deaths or one in every 13,200 people. If it is 155,000 it would be about 6% of the total annual deaths/year from all causes.

I hope this provides some perspective of the actual significance of COVID-19, but that is not the focus of this problem. The focus should be on the causes so we can find one or more that we can apply effective solutions to. So, let’s look at the possible causes.

Step 2: All Causes must be clearly defined.

and

Step 3: All causes must be supported by sensed evidence.

The Report’s stated causes for the shutdown are:

  1. COVID-19 Virus,
  2. a progressive spread, and
  3. some models that predict this illness will overwhelm our healthcare systems.
  4. threatens the life and health of our people as well as the economy of Washington State.

Let’s take a closer look at each one of these stated causes:

COVID-19 Virus:

We know it exists and it is one of the causes of death, but the principles of causation (Step 4) require that every effect must have at least two causes in the form of at least one action cause and one or more conditional causes. Governor Inslee’s analysis ignores this fundamental principle. The CDC reports that 78% of people who have died from the virus had pre-existing conditions. In New Orleans, LA, health authorities reported that 97% who died so far had pre-existing conditions. By failing to present this important conditional cause, the Governor’s analysis is fundamentally deficient because it precludes a cause that could be addressed with some kind of solution. If you do not include all the causes in your analysis, you cannot ensure the most effective solutions to the defined problem.

Some perspective:

According to the Washington Stated Dept. of Heath COVID-19 website, 1.2% of Washington State’s Population has been tested as of April 3, 2020, and 8.6% had COVID-19. Of those infected 4.1% had died and 93% of those that died had pre-existing conditions and were over 60 years old. This older age bracket represents 36% of the confirmed cases, while about 61% of the confirmed cases are aged 20 – 59 years old and only 8% of that age group have died. So, if you are older than 60 you are very vulnerable and if you are younger, you are mostly just a carrier who can transmit the disease to others.

Significant and Broad Spread of Virus:

The evidence for significant and broad spread of the virus is in the number of cases and number of deaths. Currently there are 530 COVID-19 deaths (per Johns Hopkins COVID-19 tracking map) in Washington State, but is that unusual? There were 91 deaths from the Flu in Washington State in the 2018 -19 Flu season, (85 of which were old people), and three times that many deaths (296) from flu the year before. So, yes, 530 and rising is an alarming number, but most of them, just like those who died from the Flu had other health issues, which are not accounted for in their analysis. In addition, the death certificates often do not list Flu as a comorbidity cause, so the reported number of Flu deaths is not accurate, but it is still a significant difference, so this cause is valid. But what is the cause of the broad spread?

One reason for significant spreading is that half of those infected don’t know it. In Iceland, where they have randomly tested 5% of their population, they found that 50% of the people were asymptomatic. This correlates to the 46% of passengers on the Princess Cruise ship who were asymptomatic.

Once they discovered this, why didn’t someone start asking why are half the people infected asymptomatic? Do they have some natural immunity? What is it? Can we learn something more about the causes of transmission? Fortunately, some people did ask this question, but no one in government did – why? More on this game changing cause a little later.

While there is little information in the Governor’s report about how the virus spreads, the CDC reports that the COVID-19 virus was found on surfaces in the cabins of the Princess Cruise ship 17 days after the passengers had left. This is totally contrary to the common belief and reports that say it only last 3 – 4 days on plastic and stainless-steel surfaces.

So, the big and unstated question here is: how is the virus transmitted? The bottom line is, no one knows because no studies have been performed to answer this critical question. And specifically, no studies have directly evaluated the biophysics of droplets and gas cloud formation for patients infected with the SARS-CoV-2 virus. See this interesting report for more details: https://jamanetwork.com/journals/jama/fullarticle/2763852

However, we do know that if someone in a family unit gets infected the whole family usually gets it too. So, surface transmission and particles in the air would be possible causal paths, but our scientist have never done any tests on any virus or other contaminants to find out how humans transmit diseases – mind boggling! They have done simulations as the referenced reports show, but it doesn’t appear that they have ever taken the exhaled air of an asymptomatic patient and tested it for COVID-19. For more details on this subject here is a very interesting article: https://www.livescience.com/how-covid-19-spreads-transmission-routes.html

Furthermore, the CDC’s guide for the Principles of Epidemiology in Public Heath Practice, does not provide any guidance on how to determine transmissibility of a disease. They seem to be more focused on collecting data than understanding the detailed causes of epidemics. They do look for causes, just not very deep - probably because they do not know the principles of causation, because our schools do not teach them.

However, notice from Figure 1 that the infection on the cruise ship lasted for about 27 days and they sheltered in place, but the air being circulated thru the ship while not highly filtered, must travel long circuitous paths where any particulate droplets would be splattered on the surfaces of the ductwork; which tests of the ships actually showed. This seems to support the cause path of transmission was primarily by touching, not the air.

The solution of isolating infected and non-infected people would stop the spread because they do not touch the same surfaces.

Model Predictions:

The models are not provided so we have no way of knowing if they are valid or not. Statistical models by their very nature are based on many assumptions, so we need to know what those are if we are to buy into the drastic solution the Governor has mandated. Of note here: The most important aspect of any solution is if it works for you. Where the definition of “works” is defined by you not someone else. And I can tell you there are lots of hikers, hunters, golfers, and fishermen for whom this solution is not working. If the transmission is primarily by touch and not the air, then the best place to be is outdoors, not stuck in a dwelling somewhere.

The Governor references a model created by C. J. L. Murray, Professor, IHME Director, Chair, Department of Health Metrics Sciences at the University of Washington., which has repeatedly been shown to be wrong by several orders of magnitude. Note: This is a very robust analysis and interesting to observe. Also, they are very diligent to update it based on daily changes found in reality. To see it in action go to: https://covid19.healthdata.org/projections Please note, I am not faulting Dr. Murry or his team. Modelling is very difficult and they are doing a good job given what they have.

As a way of comparing scientific models, please note that all of the man-caused climate change models other scientists have created have never been correct in their predictions.

Modeling something as complex as the weather, just like modeling anything where humans are involved is extremely difficult because each human can change the direction of the vector or cause and only they can determine that at the time of the event.

Another major problem with the models is the fact that no one knows when the first case was introduced because China has lied about it from the beginning. California, which has a large Chinese population and tens of thousands of visitors from China each year, had a very large number of influenza cases last fall which may have been COVID-19. Today they only have 1,783 deaths amongst 40 million people. That’s half as many as NYC alone, so perhaps the new corona virus got to California last fall and we didn’t know it because the Chinese Communist Party didn’t inform the world they had it until late December.

Threatens the life and health of our people as well as the economy of Washington State:

As discussed above, COVID-19 certainly threatens the life and health of our people, but not the economy. What threatens our economy is the ill-informed solution the Governor has proposed by shutting down our economy.

Unstated Causes:

And, what about other conditional causes for these deaths, like the lack of medicine or ventilators (which turns out not to be a problem). These are not stated, nor do we know if they are included in the models.

Based on small formal studies and many anecdotal ones, we know that Hydroxychloroquine sulfate works very well to prevent those infected with the virus from dying if given early. There are also some studies that show it protects against developing symptoms of the virus if taken before an infection.

Other existing drugs are showing good efficacy for treating COVID-19 virus. One such drug is Remdesivir. See this article for more details: https://www.upi.com/Health_News/2020/04/06/Trials-begin-for-potential-COVID-19-drug-remdesivir/6211586198872/?mpst=4

Another drug called EIDD-2801 is also showing great promise. See this article for more details: https://www.upi.com/Health_News/2020/04/06/New-drug-shows-promise-for-pneumonia-caused-by-COVID-19-study-finds/1141586201659/

It has been reported there are 140 different drugs that could prevent death from COVID-19.

While the evidence for the effectiveness of these drugs is not “scientifically” proven yet, they have very few if any side effects, so why are these possible solutions to preventing the problem of death not being pursued as a primary solution. The Governor’s report does not mention these solutions for preventing death at all.

As for the problem with not enough ventilators, it has proven to not be a problem because the pandemic is significantly slowing down and there are more than enough to handle needs, but if the government and our scientists had jumped on the use of these medications, which they knew worked to kill other corona viruses, there would be no need for ventilators.

Also, if the total time for the Princess Cruise ship epidemic to play out and finish propagating was 27 days (about 4 weeks), why is the governor extending the shelter in place order by another week?

When we look at the U of W models, they originally showed the duration of the event in Washington State to be from about 5 weeks to 8 weeks. Since the 5-week duration is closer to the Princess Cruise ship event of 4 weeks, I suspect it would be more realistic. Using the latest predictions by the U of W model, it shows the epidemic being over about 4 May and we know it is always overestimated, so why not stop this insanity earlier.

So, the question becomes, does the solution of staying at home and shutting down the economy meet our solution criteria?

Effective Solutions must:

  1. Prevent Recurrence
  2. Be within your control
  3. Meet your goals and objectives
  4. Not cause other unacceptable problems

The Governor’s solution to the problem of death is to Stay Home and shut down all “non-essential” businesses.

The solution of isolating infected and non-infected people can stop the spread of the virus because they do not touch the same surfaces, but as we discussed in the Significance section, is stopping the spread, the primary effect we want to prevent or is it death? For me, this is where the governor and his advisors got it all wrong. As seen in the CDC’s guide for the Practice of Epidemiology, the very nature of Epidemiology requires the scientist to focus on the study and prevention of the disease. They are not the arbiters of our social norms. That role is left to us, the citizens! They advise, we act.

By shutting down the economy, the Governor has created other unacceptable conditions that may cause many more deaths from poverty, suicide, homicide, etc. – we don’t yet know what effect this solution will have on the whole of society, but it violates a fundamental tenant of effective solutions. If he had focused on a Primary Effect of “Death,” maybe he would have come up with a better solution.

If we look a little closer into the causes of this problem of “Death” we see the following abbreviated causal analysis of this epidemic:

Note: There are many other causes, to include lack of testing, the Chinese lying about the initial cases, etc., but by focusing on “Death” as the primary effect of this problem, all the other causes become secondary and should be managed separately to prevent this debacle from happening again.

Death is caused by a COVID-19 infection

AND

Pre-existing Conditions

The Virus Infection is caused by Touching Infected Surfaces

AND

Breathing Infected Air

AND

Immune System Fails

Immune System Fails is caused by Not Enough Zinc in the Blood

Not Enough Zinc in the Blood is caused by Old Age

We know the last cause, because someone asked why do 50% of those people infected not have any symptoms, and they found those people have high levels of Zinc in their blood.

All inflammatory diseases result from or are caused by Zinc deficiencies. Zinc is critical to over 300 enzymatic regulatory functions in the body.

Given this cause path, wouldn’t a good solution be to help the immune system work better by giving it some Zinc? Well, that is what some clinicians have done, and it is a much better solution than what the Governor has enacted. Had someone on the governor’s team simply asked why do 50% of those people infected not have any symptoms, they would have come up with a much better solution.

Dr. Vladimir Zelenko has now treated 699 coronavirus patients with 100% success using Hydroxychloroquine Sulfate, Zinc and Z-Pak (aka Zithromax). For details read this report:

https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-treated-699-coronavirus-patients-100-success-using-hydroxychloroquine-sulfate-zinc-z-pak-update/

“Hydroxychloroquine is a game changer and the beginning of the end of the coronavirus pandemic,” Infectious Disease Specialist Dr. Stephen Smith says. See article below:

https://techstartups.com/2020/04/01/hydroxychloroquine-game-changer-beginning-end-coronavirus-pandemic-infectious-disease-specialist-dr-stephen-smith-says/

By removing “Death” as the Primary Effect of this problem, there is no need for the drastic measure of shutting down the entire economy. Yes, people may still get sick, but that’s life - get over it. At least they won’t die from the COVID-19 virus or poverty or insanity, or medical conditions that are not being treated because our hospitals are also shutdown, or all the other problems the shutdown has created.

And, this solution, unlike the Governor’s solution, meets all the criteria for effective solutions.

Of note, I went to our local hospital this morning to get a monthly injection - it was deserted. The parking lot, which is usually full, was ¼ full. As I walked thru the halls and looked into the rooms, they were all empty; when they are normally full. So, not only is normal commerce shutdown, our hospitals are shutdown. This means the other cause the Governor used to justify his drastic solution has done exactly the opposite. The Hospitals are not overwhelmed, they are vacant and will go bankrupt if this insanity isn’t stopped soon.

CONCLUSION:

If it were up to me, I would rescind the order to self-isolate immediately and make sure anyone who shows the first signs of this disease get Hydroxychloroquine, Zinc, and Z-Pak. Also, all healthcare workers and anyone with a compromised existing condition should be given a proper dose now to prevent the virus from infecting them. These actions will stop the epidemic in its tracks, and we can get back to work and become humans again.

Also, since antibody response effectiveness is dependent upon the body’s extracellular Zinc availability, Zinc supplementation coupled with natural carrier molecules like polyphenol flavonoids, the most common of which is Quercetin, should be a front line of defense by anyone over 50. If someone is really worried about this virus, this is something they could do right now and does not require the help of any healthcare provider or the Governor.

Everyone should be mindful of their health regardless of this epidemic, so wash your hands, watch what you touch, and try not to touch your face, but get on with living.

Dean L. Gano

April 15, 2020

Attachment 1

The Governor’s order is written by lawyers and states a bunch of conditional causes using the legal notation of Whereas blah blah blah, I, Governor Inslee, am therefore telling you to stay home or else.

So, lets’ take a look at these conditions: (I am going to paraphrase some of them to cut out the nonessential mumbo jumbo legalese.

WHEREAS, as a result of the continued worldwide spread of COVID-19, its significant progression in Washington State, and the high risk it poses to our most vulnerable populations, I have subsequently issued amendatory Proclamations Blah, Blah, Blah, exercising my emergency powers under RCW 43.06.220 by prohibiting certain activities and waiving and suspending specified laws and regulations, including issuance of Proclamation 20-25, Stay Home – Stay Healthy, prohibiting all people in Washington State from leaving their homes or participating in social, spiritual and recreational gatherings of any kind regardless of the number of participants, and all non-essential businesses in Washington State from conducting business, within the limitations therein, and

WHEREAS, the COVID-19 disease, caused by a virus that spreads easily from person to person which may result in serious illness or death and has been classified by the World Health Organization as a worldwide pandemic, has broadly spread throughout Washington State and is a significant health risk to all of our people, especially members of our most vulnerable populations; and

WHEREAS, since Proclamation 20-25 was issued on March 23, the number of confirmed cases and deaths in Washington State has more than doubled, and there are currently at least 5,984 cases of COVID-19 in Washington State with 247 associated deaths; and, furthermore, models predict that many hospitals in Washington State will reach capacity or become overwhelmed with COVID-19 patients within the next few weeks unless we significantly slow its spread throughout the state; and

WHEREAS, hospitalizations for COVID-like illnesses have been sharply increasing for the past month, and a large surge in the number of serious COVID-19 infections will compromise the ability of our health care system to deliver necessary health care services; and

WHEREAS, these conditions necessitate that to protect the health and safety of all Washingtonians, the stringent restrictions imposed on the people of Washington State in Proclamation 20-25 must be continued until May 4, 2020; and

WHEREAS, the worldwide COVID-19 pandemic and its progression in Washington State continues to threaten the life and health of our people as well as the economy of Washington State, and remains a public disaster affecting life, health, property or the public peace; and

A couple more nonessential WHEREAS’s

NOW, THEREFORE, I, Jay Inslee, Governor of the state of Washington, as a result of the above-noted situation, and under Chapters 38.08, 38.52 and 43.06 RCW, do hereby proclaim and order that a State of Emergency continues to exist in all counties of Washington State, that Proclamation 20-05 and all amendments thereto remain in effect as otherwise amended, and that, to help preserve and maintain life, health, property or the pubic peace pursuant to RCW 43.06.220(1)(h), Proclamation 20-25 (Stay Home – Stay Healthy) is amended to extend all of its provisions and each expiration date therein to 11:59 PM on May 4, 2020. All other provisions of Proclamation 20-25 shall remain in full force and effect.

Violators of this of this order may be subject to criminal penalties pursuant to RCW 43.06.220(5).

For full text go here:

Link to: Washington State Governor Inslee, Stay Home Order


About Dean Gano

Creator of Apollo Root Cause Analysis, I have been working to help people be better problem solvers for over 20 years. My current mission is to bring the process to the masses by creating new tools and teaching techniques to anyone interested in effective problem solving.

Specialties: Effective Problem Solving for any kind of human situation.
 

Experience