 Welcome back to Think Tech for the one o'clock show. This is Coronaville. What's next? And Mike, the chief scientist here at Think Tech joins us for a discussion of where we're going, you know, on the numbers. And can we really reopen? Can we really reopen? Let me ask you the third time. Mike, can we really reopen? Eventually. Thank you. That's the problem. You've got to decide how many casualties you're willing to take and how fast you want to take them. I mean, that's kind of dismal math and dismal to think about. But unless we get a vaccine, that's what's going to take. We're going to have a lot of dead people and a lot of crippled people before we get to the other side of this. Well, let's dwell on that for a minute. I mean, it's not as simple as we thought. The disease, I don't want to use the word mutation because I don't know enough about mutation. But the disease is striking now young children, which we thought we knew better that it would not strike young children and doing bizarre things to them, things that it does to the children. I've got to be, I'm in a meeting, Mary. But it doesn't do to other people. And the other thing that's happening is we are learning that it does damage to various organs of the body. And this damage is permanent. Yeah, it makes us disabled, disables you for the rest of your life and makes you a candidate for some serious comorbidities. So we didn't notice it first. I mean, at least the public didn't anyway. We thought, well, you get through it. It's OK. You'll be OK. You'll go back to your regular life. But it's not necessarily so. You can go into a kind of special zone where you are being injured in very bizarre ways. And I mean, A, this was not the case before and has become the case because the virus has changed. Or B, it was always the case. But we were not watching carefully enough to know that it was having this effect. And why could be both? Yeah. Yeah, it could be both. And yeah, I had this conversation with a relative in Kansas City. He was saying, look, I'm 58. I'm OK if I die as long as my kids survive and prosper. And I'm like, dude, you can't bargain with nature like that. There's no guarantee your kids will survive. And there's no guarantee you will die. There's no guarantee they will prosper, even if you both survive. Or you both die. So I mean, there's this bargaining I'm seeing with people. They think we're not in a high risk group. Or if I'm in a high risk group, I'm willing to sacrifice myself. Well, everybody is in a risk group. Nobody is guaranteed to survive this. Nobody is immune to this. And it's not a small thing. It's not something that you can afford to that will just pass you by somehow. It will have a profound effect on you, even if you do survive. And of course, there are those who have it and pass it along to everybody in view, because they're shedding virus and they don't know it, they're asymptomatic. And there are those who have had a coronavirus and they show antibodies from the coronavirus and then they get it a second time. This is the strangest virus. But then viruses are strange. Yeah, yeah. And then I know a lot of people who have this, what I call a delusion of insulating privilege, because they're rich and white and they'll be all right. And oh, it's not even your friend, Mr. Trump. Yeah, Trump's not being male is a risk factor. Yeah, right. And he's right in there. I mean, he's probably got co-operatives himself. And he's got people around him who have it. We know that. And he's got habits that are not particularly healthy. Doesn't want to wear a mask or all that. So I really wonder when it's safe. It's that line out of the marathon, man. Is it safe? No, let's go with some numbers. Let's just start looking at some numbers and we can have something to talk to. OK. We go to the first slide that has numbers on it. A lot of people are saying antibody tests will save us. Well, the antibody tests right now have a 5% or so false positive rate, which means that if 1,000 people are tested, 50 who have never been exposed to the virus will test positive. In Hawaii right now, we have less than 1 in 1,000 people actually have had the disease. So for every 50, false positives of one true case. So if you test positive, your odds of having been really exposed or being immune at best are 2%. And every, yeah, right. So this comes under the heading of Bayesian statistics, a Reverend Bayes invented this back in 1800s. And it's not intuitive, but it's the dismal math we're facing. If you have a test that has a false positive rate, the true incidence of the disease in the population has to be much, much higher than a false positive rate for the test to be useful to you at all. That's why they only want to test subset of people's. People show symptoms because that raises the prior probability that you have the disease, say for maybe 1 in 1,000 to 1 in a few hundred or even higher. So in Hawaii, until about 70,000 people have had the disease, a 5% false positive rate test doesn't tell you the population statistics at all. It doesn't tell you whether it's safe yet to open Hawaii, which is really unfortunate. So the antibody test would have to be 99.9% accurate. Have a false positive rate less than 1 in 1,000 to be useful to us. And every time you test positive for the antibodies, they have to stick a swab up your nose and do the invasive test to do the polymerase chain reaction, the PCR test, which is way more accurate, more specific to follow it up. So every true case you find, you'll have 50 people have to go through this testing. So that's not going to save us. And even if you screen tourists, say, we're going to screen every tourist, well, if you come from a place on the US mainland where it's a 1.5%, on average, on the mainland, there's 1.5% of people who've had the disease. That means out of 1,000 visitors, 15 will test positive who have never been exposed. But you've got to test all 15. And then maybe you'll find out of that 15, one or two, actually have truly either had the disease and are immune or still have it in our contagious, which is what you're trying to find. You just don't know for sure. I mean, I can see that's a problem for somebody who wants to come to Hawaii, is struck with a romance and all that, comes here, gets tested, and is sent back, but not with any good cause. Right, right, right, right. Not with any good cause or with a fault or with a false sense of confidence because they didn't have the disease on the invasive of your nose swab test, but they still tested positive for the antibody. It's like, hey, I'm immune. No, you only have a 2% chance of being immune. So that's, yeah. So is it safe? No. So let's go to the next slide where we talk about what it will take to make it safe. So if the lockdowns have bought us a lot of time, when I started looking this in February, I said that by now, with the way the disease was doubling back, then by now we'd have about 800 million cases in the world, about 100 million in the United States, and about 100,000 in Hawaii. Well, we're no or near that. The lockdowns have really bought us time. They bought us a lot of time. They cut their fatality rate by at least 90% so far. I said, cut, I really mean delayed. Because if this disease is anywhere in the world, nowhere is safe until we have a vaccine. Well, there's always going to be somebody out there, patient zero, right, who can start the whole bubble machine up again. Yeah, right, right. So if we go to the next slide, oops, let's see, next slide. I'm not trying to get my computer to work here. So I can say, if it's anywhere in the world, you can say you can start the whole bubble machine again, nowhere is safe. Can we open Hawaii or to be able to brand Hawaii as the safest place in the world, like the protesters or the tourism authority want to do? Well, the thing that would be best for the whole planet would be if all the governments of the world got together and said, we're going to shut down the whole world for 60 days and kill this virus. If they did that and then make sure they follow up with contact tracing and stamp out all the final little flare-ups, we'd be done with this in a couple of months. Tell me how that would work, Mike. You shut the whole world down for 60 days. What does that mean? And how do you know that you stamped it out? Yeah, so it would be like New Zealand. They claim they have wiped out the disease in New Zealand or Hawaii, which is almost wiped it out. So we have to do relentless contact tracing to make sure we catch any little traces of transmission. But we did that by social isolation, banning gatherings, keeping them getting together in groups. New Zealand did that. Taiwan seems to have pretty well done that. And America, of course, never had the disease. But all these places have in common the islands. It's easy to control movement of people from place to place. That's what you would have to do globally. I don't think that'll work. I mean, it would work, but it won't happen. The governments of the world will not work out as tragedy. But hypothetically, if I shut a place down for 60 days, then I do tests to make sure that there's nobody there. And I find somebody. I find somebody there. What am I going to do with that person to make sure that I've shut it down? Tracer contacts. Yeah. Tracer contacts, tester contacts. If any of the contacts have symptoms or have any kind of test that turns positive, quarantine them, you just have to be relentless with your contact tracing. Everybody gets quarantined. That's the idea. Yeah, that's the idea. Everybody who's been in contact with a patient when it's down the low level gets quarantined. And then if I find that he has the disease, I treat him. Oh, yeah. And I make sure that the people around him are protected. And then he goes through the disease. And theoretically, he's not going to have it. Well, he's not going to have it again, hopefully. Then I've stamped out every single case that I could possibly find in that 60-day period. Yeah, and it would take a lot of work. But here, we've almost done it in Hawaii. We still have one or two cases a day. They claim to have done it in New Zealand. So it's possible, theoretically, to do this, whether the governments of the world would get together and actually make it happen. I don't think there's enough goodwill. I don't think there's enough trust. There's too much desire to avoid blame or to cast blame. It's unfortunate. So the best option isn't going to be the one that happens. So then the next option is to get it. But at your 60-day thing, you would have to quarantine them all that couldn't go work. Oh, it'd be like here, where we have restaurants closed, movie theaters closed, no gatherings on the beach. Everybody stays home. Everybody stays home. Everybody stays home. No economy. Right. But only for two months. We've already been through that. The whole world had gotten together and decided to do this. Yeah, got it. Right. The whole world had gotten together and decided, we're going to stamp this out. China screwed up. OK, they let it get out. We're going to stamp it out now. We're not going to wait for any more who did it, who is responsible discussion. They're going to stamp it out. The whole world could have done this. We'd be done now. The whole world could still do this. And we'd be done in July. Well, that's hard as a policy. It's been politicized, so you can't stop it. But let me ask, suppose I insert into this process testing. And let's say that the tests are absolutely accurate. I come up with a test that is absolutely accurate. Forget about antibodies for a minute, just the test. And the problem is, so I test you on Monday. I don't know who you saw before we got to Tuesday. So I have to test you at a certain frequency. Now, if I want to make it safe, I've got to test you at a certain frequency, or else I'm shooting my foot again. So how frequent is that, Mike? That's a good point. In the latent period of the disease, it's like four or five days. So that's probably what you have to do, maybe weekly. I don't know for sure, because I'm not a doctor. I'm not a physician. But yeah, so it seems like you have to test weekly. So there's a company of a brother in Kansas City who's going back to work today. And they tested every one of the antibody tests today. That was a condition for being able to allow to work. You take the fingerprint antibody test. And if in a few minutes that shows positive, you get the nose swab, and you stay home until that swab result comes back. That's kind of the thing you would have to do. Now, the antibody test is, like I said, has a false positive rate. It's way more accurate than a lot fewer people are unnecessarily given the invasive test. And you have to do this maybe every Monday. Everybody gets tested. Why do I have to have both, Mike? Why do I have to have the antibody test? Well, that's true. Well, the other thing, the swab thing is really invasive. If they came out with a simple spit test or something like that that would give you an answer in a few minutes instead of a couple of days, then we could greatly speed up this process. That would be ideal. But, well, the idea would be wiping out the virus. The next thing is do these tests, come with something fast, noninvasive, effective, and then just test everybody. That's what it's gonna take for companies to really reopen. But then to go to my point, you have to take everybody every day or every four or five days within a fairly short time. You have to keep repeating the test. That's why I do not understand when the White House and so many others say, well, we've tested 5,000 people, 20,000 people, 100,000 people. Well, that's cumulative. And maybe a lot of those were tested a month ago or more. Then it's all this time has passed where they could have been infected again. So to say that you have a static number of tests, even a cumulative static number of tests is non-probative. You have to have them frequently. So we need that to be in the formula. You have to test everybody so often, I mean, ever so often. Oh, you have no level of confidence that a lot of those people got the disease after they were tested. Right. And I know you saw in the news yesterday that now that the White House is requiring everybody to be masked and to be periodically tested. So even the White House themselves are requiring periodic retesting ever, but it goes to the White House. So, you know, the recognizing reality, you know, the late, but the thing is, it's right. It's gotta be done for everybody in the United States. It's gotta be, we're gonna be doing millions of tests a day, not millions of tests cumulatively. Well, it's very troubling if the White House can do all these tests, but the average person cannot. Not right. And even now, I mean, if I decided one given Tuesday morning that I wanted to get a test, what would I do? What would you do? It's not so easy. In fact, it may not be doable at all. It might not be doable right now. Right now it might not be doable, but we need to get there. But well, the next best thing to, you know, world shutting down and wiping out the disease by, you know, stopping the transmission from person to person would be a universally safe and effective vaccine. Now, we would have to have six billion doses of that. And we had to distribute it widely and cheaply. No, just because somebody's poor, they gotta be vaccinated because otherwise everybody else is at risk still. Because sometimes vaccines don't take. Sometimes people can't be vaccinated because of a suppressed immune system. So we need a safe effective vaccine that's universally available. The earliest that could probably happen is still a year, year and a half off. So we're gonna have to have the economy shut down until then, or we can try to open up the economy and allow a steady rate of cases to happen. You could achieve herd immunity by getting to 60% of the population, maybe 80%, but let's say 60% to be easy. In Hawaii, we'd have to have had a million people infected with the disease to achieve herd immunity. And that's the only way to be safe to have unfettered tourism here. And that is presuming that your immune or almost everybody who gets it is immune for a good long time after that. Well, let me ask you some questions about herd immunity, which troubles me on a logical basis. That is, okay, so 60% of the people in the community, whatever community it is, have had it. And then you achieve herd immunity. But of the 60%, a certain percent, and that is especially the case for elders are going to die. Yes, absolutely. So pay a price for herd immunity, people die. So you're almost asking for more cases, more deaths, and then you have immunity. But query, 40% of the people in the community have never had it. Are they not exposed? Well, they're less likely to be exposed because if they get sick, 60% of the people around them are immune. Or if you wanna be more conservative, say 80% of the people around them are immune. So that reduces the transmission. So right now this thing, on average, they think three or four people get it for every person who has it. So every person who has it gives it to three or four other people unless you take these masking, quarantine, isolation measures. So, but if 80% of the people around you are immune and you were gonna infect four people, now there's only one left, well, now you've got that infection rate down to one. Or maybe lower, just naturally, because of the herd immunity. If it's below one, the epidemic peters out. If it's at one, people get infected at a steady rate, which is what they're trying in Sweden, to keep them infected at a steady rate to maybe manage it in the healthcare system. So let's look at the numbers. But it doesn't mean you can't get it if you're in the 40%, you certainly can. You have no immunity whatsoever. It just may be a slow and steady thing where a certain number of people can get it and infect others. And maybe somebody, well, maybe people will still die. It's just that it won't be considered a multiplier epidemic, that's all. Yeah, yeah. The immunity is the wrong word for that, isn't it? Yeah, I would say that what's gonna happen. So that's what you're hearing from a lot of people say, re-open the economy. They're saying it's inevitable that we're gonna have all these people die. So let's just rip the bandage off and let them die sooner, so we can re-open the economy. That's not gonna work. Let's go to the numbers on the next slide. So I show, so 60% of Hawaii, and maybe it should be 80%. Let's go with 60% because there's even million people. Fatality rate in Hawaii right now is 2.7%. New Zealand is 1.3%. So let's just say that the true fatality rate we can get down to the New Zealand rate, well, it's still 13,000 people dead in Hawaii to achieve herd immunity. And our normal fatality rates like 7,000 a year from all causes. So we're like twice as many people will die of this as dying a normal year of everything. Here in Hawaii, serious cases, about 12% of the population because we're older population or have other risk factors. So that means 120,000 people have to be hospitalized. And if they're in a hospital for an average of 11 days, that's 1.3 million hospital bed days. Well, if you wanted to be done on this in a year, you take 1.3 million people divided by 365 days, that's 3,600 beds just for COVID-19 cases. That far exceeds the capacity of our healthcare system now. We should be maybe be ramping up to that, but there's no way we can achieve herd immunity in a year with what we have now. We would collapse the healthcare system and there'd be a lot of other people dying of other things. There would be no transplants happening, heart disease wouldn't get treated, cancer might not get treated. We've got people dying of other things. So according to the Star Advertiser March 18th, we have maybe 800 beds in Hawaii total that we could devote to COVID-19 patients. So if you take that 1.3 million and 800 beds, you get to four and a half years. So if there are existing capacity, we might achieve herd immunity in four and a half years if we allow a steady state rate. And that rate's about 600 people a day. We have 600 people a day get sick of this disease in order to not overwhelm the hospitals. And we'd still lose 13,000 people, but we wouldn't have the knock on effective, not treating cancer, not treating heart disease, not treating these other things. So... Well, I just come back to the basic question, Mike. Is it safe? No, it's not safe. So all this talk about, we're gonna open the shopping center. We're gonna have people come in. We're gonna do this very magical thing about how we're gonna put all the tourists on quarantine. I don't know how you do that. And all that social distancing is gonna be modified because you can go to a restaurant. I don't know what else they're opening up, but these things are gonna get us in trouble. And have you done any thinking about what kind of a resurgence we would have with Rio? Right, so here's the point I wanna make, that there is a risk to the lockdown. The risk is that the suicide rate will go up, marital violence will go up, spousal abuse will go up, hunger will increase, homelessness will increase, all the things that will kill you that comes with homelessness will increase. So we have a public health risk on that side. What I would like for the people who say, reopen Hawaii to do is to tell us how many deaths the lockdown is causing. And then we can say, okay, that sets the bar for how fast we want the COVID-19 to hit us. We want the collateral effect of the lockdown to be less than the disease itself. But I've heard nobody actually go calculate these death effects, these morbidities from the lockdown itself. They're all talking about money. Well, don't talk about money. Talk about the impact on public health and people's lives. You know, talk about how people are gonna be sick, you know, crippled, die because of the lockdown. Because we can estimate how many will be sick, crippled and die from the disease and the numbers are staggering. So, I guess we're asking 13,000 of our fellow citizens to die of this in order to reopen the economy. So what's on the other side of the ledger? Right, I haven't heard anything like that before and it's totally correct. You have to identify and track and attract may not be the right word, but you have to identify all the deaths that take place as a consequence. And let me say, for this discussion, a direct consequence or perceptible consequence of the lockdown. And that means, correct me if you feel otherwise, that means you have to identify the kinds of things that happen with being cooped up. The kinds of illness and deaths that result from a lack of hospital beds, right? For the ordinary things, are we including that? Well, we can include that, but it's also, so the doctors right now are scared. Like I have a colleague, a friend who has cancer and he has more than one tumor and they need to do a biopsy of the other tumors. See if they're metastases or de novo and new cancers. They're afraid to have him come in for the biopsies because they're afraid of the hospital of exposing him to COVID or getting COVID themselves. So we have that. Now that's not a consequence of the lockdown as a consequence of the COVID-19. But well, it's sort of a consequence of the lockdown. There's a hospital's lockdown. So we have these, but when we talk about the lockdown itself, the consequences of the lockdown itself, independent of the COVID-19, talking about like, right now, I can't go get my cataracts in my right eye fixed. Okay, that's not a morbidity. It's just an inconvenience for me because I have one good eye. All right, but there are other people who have more serious things that can't get fixed because of the lockdown. But there's also people who will turn to drugs or alcohol because they've lost their jobs. They are having problems in their home because everybody's cooped up together and everybody's cranky. You'll have people who have heart attacks because of the financial stress because they don't know how they're gonna pay their bills. How do we estimate those things? How do we estimate how many people are gonna die from the economy being shut down versus how many people are gonna die from the virus? Well, first of all, it's hard to define exactly what this category is, what should be in the category, what should not be in the category. And then so often, it's gonna be a question of degree where the lockdown could be a factor. Maybe the guy was gonna have a heart attack anyway, but the lockdown accelerated it. How do you make a direct connection? You really can't? Well, you can do it statistically. You can say like, well, on average, like last year in Hawaii, we had about 7,000 cases of all-cause mortality. So now we look at month to month and compare what last year's mortality rate was or the average for many years was. So we can say, we're having this many extra deaths now that compared to historical average. And you can say, well, some of this is attributable to the lockdown because you can say you can probably tease out the ones that are attributable to the disease itself. But right now in Hawaii is negligible. We got down to one case a day, a new case a day. So we've squashed that. So now we can look at the mortality we're getting and attribute the rest of them to the lockdown. So... But isn't there, there's a factor working. The longer I lock down, the more I'm gonna have of these co-morbidity of these other factors killing people. And you can't just make a blind comparison from before till now. You have to somehow crank in the dynamic of the lockdown taking longer time and thus having greater damage. Right. So you have to come up with a model they say on the Great Recession maybe or even the Great Depression. How many people died excess from the Great Depression? Because that's the kind of economy we're in right now. A Great Depression level economy. So if we can estimate how many excess deaths that were from the bad economic times in the 30s and try to correct for things that were better now or worse now than back then, we can estimate how many people are gonna die from the current depression. And then say, okay, if that number is greater than the number of people are gonna die COVID-19, then maybe we ease the lockdown up. But I see nobody try to do that. I mean, all I hear is arguments about money and business. I don't hear arguments about deaths from other causes that are caused by the lockdown. And that's what I would like to hear, I think. Yeah, absolutely. And it's doable, as you say. It's doable. You can use statistics, you can use AI, you can use comparative analysis. There's a lot of ways that a trained scientist that trained statistician can do this. And then we can have an index, you know. And is this index, the index of people dying from the lockdown versus the index of people dying from the COVID, and you can see them right there. You can balance them and make public policy choices. But we're not doing that now. And frankly, I totally agree that if you don't do that, you really don't know where you are on the moral curve. Right, right. You don't know where you're on the moral curve. Right now, they're putting money against lives. I want to see lives against lives. Then you have a chance to do the moral calculus in a way that actually sort of makes sense. It sort of is your main. Right now, I don't see anybody really doing that. Yeah, well, maybe somebody watch this video and get the idea of how much we're missing when we make these sort of blind analyses. Right now, it's a blind analysis. We can't tolerate a depression. Therefore, we have to let X people die. It's not scientific at all. Right, right. It needs to be 1930s. We had this many excess deaths per year on average. This is what we can expect out of this depression. Okay, now that means we can allow up to X number of COVID-19 cases a day to develop because we'll have a mortality rate then from COVID we can predict. And as long as that rates, in balance with the number of people that would have died if we had kept the economy locked down, we can make the moral case to open up the economy. Yeah. Well, unfortunately, I mean, I think the science community would understand this. Maybe some people in the public policy community would understand this. The medical community would certainly understand this. But the political community, I'm not so sure, and the White House, and the White House, I don't think they will understand this. Yeah, I think in Hawaii, at least Lieutenant Governor, I think, would understand it. Yeah, yeah. Because he's a doctor, he's in the emergency in things. I can't say anything about the other politics. I haven't really observed them so much. I'm sure the White House doesn't sell though the beginning to get a clue now because two people in the White House aids to Trump and Pence, got it. And it's like, oh, oh, oh, my delusion of insulating privilege is no longer valid. On the other hand, the political pressure from the powers that be, the lobbyists, you know, the multinational corporations, those pressures are all the stronger every day because you're losing so much money. Well, you and I have to continue to talk about this, Mike. And we have to take snapshots going forward. And we have to see how it really works and how it is working because it's a moving target on all sides. Oh, for sure, for sure. Yeah, yeah. Thank you, Mike, to our Chief Scientist here at Think Tech Hawaii. We so enjoyed talking with you. We'll talk to you again soon. Thank you, Jay. Appreciate it. Bye-bye.