 Yeah, we're back, we're live. This is Think Tech. I'm Jay Fiedel. The handsome fellow with me is Lou Plouderisi. And, you know, we were gonna talk about energy. Well, we always talk about energy in one way or another. Sometimes it's less connected, but you know, energy, the economy, that's all totally connected. So although we're gonna touch on birds and wind turbines, we're gonna skip that for now, okay Lou? Instead we're gonna talk about COVID. We can get to that one when the wind turbines go back to work. There's so many other things to talk about and worry about, I might add. You know, it's like these guys were having a conversation and somebody said, oh, you know, it's amazing how the Chinese have developed this virus and it only hits older people. So what's the point of weaponizing it, Jay? What's the point of developing a virus that just hits older people? Is there a point in that? Who would do that? And the answer is nobody would do that. And yet here we have, and you have data to show that older people are really getting the shaft here in large numbers. Maybe we weren't so fully aware up till now exactly how many of them were dying and how unsuccessful our efforts have been, you know, to protect them. Right, I mean, I think one of the interesting things that's happening now is, and let me just say, if you're going to see energy in America come back, people are gonna have to have the confidence to go to work. They're gonna have to have the money to buy airplane tickets. So, and they're gonna have to, you know, buy automobiles, do all the things you need in a normal functioning economy. I saw some day to day that if you go sector by sector, huge numbers of companies run out of money from 20 to 40 days. If they don't have any revenue, they just run out. Now, there are assistance coming in the, you know, the paycheck protection program and stuff, but those programs are always hit or miss. They work for some people and not others. And the answer to this problem is to figure out how to balance public health but also recognize that the cost of the lockdown are massive. Yeah, who's actually working on that, Lou? You're working on that? Yeah, yeah, I am working on that. In fact, yesterday, I helped a colleague who's getting ready to publish something in the Journal of Transplantation. I'll show you a slide of a forthcoming today. So maybe we should just go through the data and talk about what we know now. And I have a really short conversation, isn't it? Yeah, no, we know quite a bit actually. We're learning a lot. And we have a lot of data about how different procedures are working or not working. So I'd like to show you a table from a forthcoming article that's going to appear by Dr. Hell. Let's go to the first slide. This shows the mortality for the US population for everyone greater than the age of 64. You might be getting close to that age, Jay, as far as I know. How many years to go before I reach that age? And you can see here from the data that for this population, you're walking around crude death rate, annual death rate is about 4.5%. That when you get out of bed, as anyone who's above in this, it's a very huge cohort. People of course above 80 have a higher number than people at 64, but the average for this group is about 4.5%. And from what we know, under a worse case... What does that mean out of every 100 people that contract the disease? No, no, no, no, no. This has nothing to do with, we're not gotten to COVID-19. The 4.5%, 4.48% is all the things that happen to you. Gunshot wounds, auto accident, heart disease, cancer. That's what's called in the vile statistics world, the crude death rate. And the crude death rate, just you're walking around death rate is about four to five per 100, right? So when you get out of bed, walk around, sometime during this year, you have about a 4.5% chance of not getting to the end of the year, okay? Just has to do with everything that happens to people in this age group. Thank you for that nice thought. Well, you know, we can't live forever, okay? So now, and so the question is, what does if you took 200,000 deaths, 200,000, which is a pretty worst case scenario and allocated it just to this group, how much does it increase the mortality rate? And actually it increases it from about 4.5% to about 5.25%. And the reason these guys are working on this now is because the folks that do transplants are looking at what their failure to get kidneys, hearts, all the kinds of transplants that take place, their failure to make those operations now because they can't get access to the hospitals or people are worried about infections, whatever reasons the doctors are in lockdown and we're not working on COVID-19, that the mortality rate of these folks is going to go up by a lot. So one of the things that's very hard for people to understand is that everything in life requires trade-offs, right? So when some politician gets up and says, we don't put value on life, every life is priceless. Well, in a way, every life is priceless. On the other hand, we as a society make decisions all the time and those decisions are that we are willing to accept a certain level of risk to do a certain number of things. I just think that's a reality that is lost on the public generally. They tend to view these things as random or things like that. Society as a whole makes decisions all the time. Now, I think what's very interesting- There has to be a moral thread in all of that. Of course people die and of course decisions result in deaths or at least they shorten lives. But the question is whether what you're doing is necessary and the question is also, have you applied a moral stamp on it? Because sometimes it isn't worth it that a life is more important than the initiative involved. And so there's a whole philosophical approach to this. And I don't think government really incorporates that kind of thinking these days. They do, but it's very poorly done. It's very poorly done. For example, they have a statistical calculation. They know if they build a road a certain way, they can spend more money and make it safer. But how much more money should they spend to reduce one statistical life? It's not a real life, it's a statistical calculation. Something some accountant does. And the other problem is in a lot of environmental studies and things is that they look at the benefits per life saved. How much should they put on that? Because they are going to spend money. And I think one of the interesting things is a lot of the work on the economists did on COVID-19, we're trying to suggest that the lockdown was worthwhile because they were using very high numbers, 2.2, 2.5 million deaths, and they were applying $10 million for every life saved. But the models were not very good for the lockdown. And we have argued, or I have argued in an article I did in Real Clear Markets, was that we could do a lot better than do a lockdown. We could focus on where the high returns are. And I think we have some... But nobody will say that the United States government did a good job here. And I say that really means Trump because he was calling the shots in every direction. So I don't think you won't find anybody on the street that'll say, oh, he did a good job. If you and I were put in charge of this loop, even without knowing anything about it, we would have done a better job. Yeah, so I'm not that interested in this political stuff because these things are... The responses to this are at very different levels, at the federal level, bureaucracy. And I'm willing to blame Trump for whatever you wanna blame him. But we have a much more diffuse system than that. You can, in one way, blame the president. In other ways, you can argue that different states did different things. And let's take... Well, I'm only saying that a rational approach from the outset, forget about politics, okay? The rational approach using science, in respecting science would have resulted in a lot fewer deaths and a lot less stress for the economy, too. And I agree with you that just doing a lockdown, just a total lockdown, I think it's been the best idea in the first place. Right, I agree. But I'm not sure whether we understood enough about this. I do think the Chinese kept us in the dark a bit. But we did learn. I'm not excusing any of these guys, okay? I don't wanna do that. But I do wanna look at the numbers show. So one of the interesting things is that, if you look at the US, we now have a death rate of about 309 per million. That's a good way to think about it. So the annual crude death rate for everything is about 8,400 per million, right? Per year. The annual crude death rate now is about 300 million. It's probably gonna rise by another 100 by the end of the year, right? Well, it's already, hasn't it already? Are you talking about the death rate in the ordinary course now? No, I'm talking about the death rate from COVID-19 today. All right. 209 per million. Yeah, it's easy to do that math. We have a population of 330 or so, and we have 100,000 deaths. It's very straightforward. In Spain, it's 580. In Italy, it's 547. In France, it's 438. In Germany, it's only 102. The death rate for Hawaii per million is 12. So if you're, by that metric, we should let the Hawaiian government run the entire world COVID-19 response, right? Because obviously they have the, one of the best-performing metrics. Now, well, do you understand why it's only 12? No, that's why this stuff is very interesting to me. We don't really have good data, but we're learning more. So there was some very interesting research that's come out in the last few days. And really, it has to do with the way we allocate resources in the US and what kind of information. So let's take a look at the next picture, the next slide here, which is COVID-19 deaths occurring in nursing home and assisting facilities. According, about 0.62, like a little more than a 1.5% of the US population lives in nursing homes or assisted living facilities, right? They are now, through a gross estimate, they're accounting for 43% of all the COVID-19 deaths. 43% among this small group of the population. And analysis by Avik Roy and Greg Given, some of them write for Forbes, is that that number is probably too low. It's probably much higher, right? And if you look at Ohio, it's as much as 70%. And if you look at New York, New Jersey, Michigan, right, they essentially ordered everybody who was, in from an assisted living facility who went to a hospital, got well enough to leave to go back to the nursing home. Oddly enough, this governor of Florida, DeSantis, this guy who's been completely vilified by the press, he had a woman who ran his healthcare division. Her thing, I think, is Barbara Mayhew. And she told the hospitals because under, and you have to think of how Medicare reimbursement works, Medicare reimbursement is an incentive to get people in and out of the hospital as soon as possible. If you're running a hospital and you have a Medicare patient, you wanna take care of them and get them out of your hospital because your compensation is limited, right? She's told the hospitals, I don't care what the rules say or your reimbursement, we'll work about that later. If you have an active patient, you have a patient with an active COVID-19 indicator, we are forbidding them to go back to the nursing home. We are also very early on, DeSantis made sure that those facilities, he banned visitors and guests and he flooded the nursing homes with personal protection equipment. So DeSantis is this kind of problematic character, you could argue in some ways, he's not very charismatic like Cuomo. And Cuomo got all this wonderful attention and people just love him and his brother interviewed him on CNN. DeSantis on the other hand, was actually highly criticized because he didn't do a lockdown, but he in fact at the margin did the most effective things. And he as a result has a very low, a relatively low death rate per million. And he spotted this nursing home issue and they managed it very quickly, very well they had. So part of that is not just DeSantis, he had- Are you saying he has a low rate in general or just with nursing homes? Well, if you can stop the spread of the disease in nursing homes, you can cut the death rate because we now know it's a killing feel for this thing. Right? Yeah, well, that's true. But you know what he was saying before, we really don't know that much about it. We don't know for example, unless you know why nursing homes are so dangerous. Oh, we do know. What is the reason? One is the people are indoors, they are in facilities where they're close together. The help is moving around from room to room. If they are not well, if they're not engaged in very, a lot of outside visitors are coming in and many of them may be asymptomatic but are spreading the coronavirus. So the social distancing is very close and it's not being exposed. It's the quarters in these places are such that it moves all around the facility. Why this has not happened in Hawaii would be a very interesting question. You should try to get somebody on your program. Well, you have to have patient one. You know, you have to start somewhere. And that's why you can say that Hawaii has great numbers and it does have any cases in several days. But you know, the problem is it only takes one. And then you really have to test and track and track and test and limit the infection. The other thing I was going to ask you that, you know, okay, you described what happens in nursing homes but what about these extraordinary rates in other similar circumstances like meatpacking plants? Well, I think meatpacking plants. What's going on in meatpacking plants? So let's go, let's talk about that. I mean, meatpacking is another thing. The air is probably pretty stale. You're packed together. It's hot or it's, you know, it's enclosed. It's, I just think it's a naturally Petri dish, a natural for spreading the virus. It's just not, now maybe there are things you can do. We're getting smarter. I suspect there'll be much better at trying to find procedures to distance people. You know, this is going to be a big problem with the airline. The airlines are now, the manufacturers are now experimenting with different filter systems. You know, it's only recently we've gotten a better sense of that this thing is mostly person to person or in or aerosol contact spreading of the infection, not contact office spaces and not so-called fomite transmission. So let's go to the next one, which I think is a very interesting chart. Okay. What did the previous chart tell us though? So it just showed the percentage of deaths that were occurring in nursing homes, right? But the next one is better because this one shows you the share of nursing home and assisting facility debt caused by COVID-19 per 10,000 residents, right? So this adjusts for population size. And you can see, for example, Montana is like seven. New York is, I think, looks like New York is eight 27. As you can see, the New England states, Pennsylvania, Massachusetts have very high numbers. You can see them here in the Northeast. Texas, lower numbers, even Seattle were broke out as relatively low numbers. They got on top of it. But it's really important to understand that you as a person worried about, am I going to get this and die from this, right? You have to realize that your probability of getting this is probably half the published numbers if you are not living in a nursing home. That's what the data show. But why do you say half of the published numbers? Why is that? If you're not, because we know that well over half, about half, maybe well over half the deaths in part of the country are people who live in a nursing home. So if you take the total deaths, which 100,000 and 50,000 of those are in nursing homes, it's gonna be more over time. At a minimum, CDC should be publishing this stuff. They say, look, if you don't live in a nursing home, your risk is lower by this much. It's important for people to know that. It's important for policy makers to know that and how they formulate strategies to do. Absolutely, we don't know it doesn't. When you open up Hawaii, you don't wanna be operating on data as a risk factor that is based on a lot of information off of circumstances that are not taking place in Hawaii. Totally true, totally important. We need to know the risk factors that we have to deal with. For example, my personal belief is when you go outside, the whole thing about the droplets and the contagion through breathing near someone is minimized because the wind is blowing. You have a breeze, and so it dilutes it. And before you know it the way you might have been the direct flow of somebody's breathing, you're no longer there. So probably healthy for that. And it's an outdoor community. And I think that that probably helps. It's just one influence, one factor that we should know about. Sunshine and temperature of a big effect. That too, yeah, yeah, yeah. So what I wanted to do is that you can see. But you know what this tells me though? If you and I were caused to make a decision or our respective families were caused to make a decision, whether we should go into a senior facility at any price, take the most expensive place in the community at any price, wouldn't go, wouldn't go because those factors are present and because the stats are terrible. It's like a death warrant to go. Also, these facilities also have high rates of communication of traditional influenza. Okay, that's important to remember. First, you tend to die when you get really old. You need to keep that in mind. You're going to die of something. You need to keep that in mind also. But you don't want to have it accelerated by, I mean, if we had understood this and if we had focused on sort of turning these nursing homes into class five labs or something, you know, we've really put a lot of effort. We probably could have cut the death rate nearly. I mean, the Florida example. But you reply there that turning them into labs would be expensive and it may not worth the effort or the money, but in fact, some of the things you would do are not costly. They're just smart. I'm just telling you, if you're going to take down, we think the national economy is probably contracted by as much as 20 to 30%. That is trillions of dollars. Take my word, this would have been a cheap date. Of course, we would have had a contraction. Even if we had no lockdown, people would have been nervous. We would have some level of contraction, but it wouldn't be as big as it is now without that. So if we could do this all again, and you and me, we went in a room and tried to work it out, be as smart as we could. We would say, look, in order to save the economy, the first thing you got to do is make people confident of the environment. And if that costs money, fine, because that, as you said, it's cheap date compared to losing your whole economy. Absolutely. I mean, in the end, we're learning a lot here. So you can, I'm not, I mean, I kept plenty of problems with Trump, but I don't really hang this entirely on him. There's a lot of players in this thing. CDC was really slow off the mark. They didn't understand it. They screwed up those tests, but that's the nature of your office. That's the nature of your office. I don't, you know, we agreed not to put politics in here, but you know, the thing is snapshot right now, what we need is smart, focused leaders and health leaders who give us clear signals about what we have to do and not do. And if you start right now at this moment in time, three o'clock on a given Wednesday, we should have better instructions from whoever is handing us those instructions. And I'm afraid to say that the mistakes that we made before, let's put them behind us, but there'll be more mistakes going forward. That's what it looks like. So, you know, let's take a look at the last picture because I think this really focuses where the problem is. And this shows you, if you run their model, and this is having to do with Greg Gerber and Eric Roy, and you assume we hit 150 deaths. I don't think that's an unreasonable worst case scenario. We're at 100,000, by the end of the year, we could get to 100,000. Why do you say 150 though? I mean, that sounds like pie in the sky. In a sense that we never, everybody went to the, they went to the parades, they went to the concerts, they went to the beaches. We haven't paid the price for that yet. Well, it depends how we do with the social distancing for the different age groups. Now take a look at this data. This is why the data is important. If we take a look here, we can see that, now this is the deaths per million people, right? Remember, the state of Hawaii is about, what did I say, 15 or 17, but 12. The state of Hawaii is 12 per million, right? So per million is a way to think about it. The crude death rate for society is about 8,400 a year, per, 8,400 per million. And we see that for the U.S. as a whole, COVID-19 adds about 310 per million, right? But you can see that this death rate is highly distributed, in the unevenly distributed against older folks, right? So if you're greater than 85, your crude death rate, the crude death rate doubles. So if you have about a 0.8%, 8,400 per million is about a 0.8% probability of dying. It's now moved to 1.6%, right, for the whole society. But for that particular age group, it's probably gone from, I don't know, 85, I think is about a 14% probability. It's probably gone from 14 to 28%. I suspect it's probably nearly doubled. It has, you can see 73.02, no, it's gone up by about 25%, even for the oldest people. So it's a lot, but it's against a relatively small number. But this data suggests to me, right, that if you could just find a way to directly address the risks on the older segment of the population, you could really get control of this in a way that would allow the rest of the economy to go. Now, I'm in the geezer cohort, right, like a lot of people. So, but I feel I don't have any co-morbidity. So this information is useful. It suggests I should be careful. But on the other hand, if I could get on an airplane and go to Honolulu or visit friends of Japan, or I would probably do that. So, well, are you saying that it's time? It's time for us to get out there? Because I don't have a high level of confidence with that. I think we're about to have a resurgence myself. Because I think the cost to the economy is too high. And we have to let individuals, including businesses, figure out how they're gonna deal with this. And whether it's different seating at restaurants, I don't think the government can fix this all themselves. We need to give the public what they need to do, give them the procedures and the information they need to protect themselves. And- Can I add something to that? I don't think the government has helped us in the slightest here. We have 100,000 people who has died. You could fill up the whole New York Times, not just the front page. And maybe the New York Times for weeks with all the names of these people who died. And they died in agony. And they died without their families. It's hard to capture that on an emotional level. But what's happened is we really haven't done anything clear. And we have got to do that to make me feel confident that I can go out there. This thing you mentioned about the various factors, influences, variables, what this data tells us on this conduct and that conduct and this environment and that environment, that's very valuable. If I had that, I'd feel a lot better. And businesses would be a lot more responsive if we had that kind of instruction. CDC, as you mentioned, has not provided it. The White House has not provided it. They're telling us to take drugs that have been debunked. There's really no guidance coming down. And I suggest to you that you're not gonna feel confident and neither am I and a lot of other people I know until there is clear guidance. And it has to come from one place, not 50 states or thousands of towns, that most of this has to come from one place. And that means the federal government. I just think these communities are different. I don't think, I don't think- In some ways they are. In some ways they are. But the larger issue is the federal government. The larger issue is the country in general because it's an epidemic. I think the government can do a lot of positive things and they're spending a lot of money on vaccines and ventilators and all this stuff. But the policies that work in New York City are not the same as the policies that will work in Honolulu. There's just completely different communities. For the federal government to say, you guys do it, take care of it. It's your problem. And then blame them when it doesn't work is not helpful. And I think the federal government, I agree with you that it differs from town to town and village to village. But we have to have national policies, national advice and counsel. I think we need the resources of the government to undertake the research. And the resources, right. And the resources to deal with the medical and the public health issues. But we need the information so individuals can make informed decisions on risk. They make them now in lots of areas. They make informed decisions on risk when they drive a car, when they go surfing. Well, maybe that's not important, when they go surfing. Maybe not so informed, yeah. Yeah. Yeah. Well, you know, but what you've done, I mean, looking at the data, you're a data guy, Lou. And looking at the data is so important. So it's getting the data. It's getting good data. And it's analyzing the data. It's having conversations like this and ultimately finding policy and finding advice and counsel to 330 million people. That's what we need to do. And I'm afraid we have yet to do it. So the question to me, and we'll have to leave it soon here. The question to me is, you know, are we going to have a resurgence? And if we do, I suspect we'll have at least some resurgence, at least. If we do have a resurgence, how is that going to affect public confidence? So apparently... How is that going to affect the economy? So Fauci is saying we may not get a resurgence. And that's a whole nother topic. We've spent a lot of time looking at that. Who, you know, innate immune systems versus our T cell immune systems. And we've talked to a lot of people because this is very important in terms of how people feel. When they... In other words, they have to have confidence to go to a restaurant or a bar, get in their car, go on the holiday. So this is a topic for a further meeting, I suspect. You know when your heart it is anyway. Yeah, we got to continue this conversation because I think you're right. There's an intrinsic connection between energy and the economy, and of course between the economy and public health these days. So let's continue the conversation. Let's continue the, you know, the gathering and evaluation of the data, such as you have been able to do that. And in the meantime, stay out of the senior facilities and stay healthy, will you? We need you. We need you, Lou. Thank you so much. Talk to you next time. Take care. Wash your hands.