Reemerge . What is that metric, dr. Faust . Guest the metric that i think that is been discussed the least, but matters the most is what is called excess mortality or excess deaths. That is is simply the number of people who are dying in comparison to the usual rates we know about. Have been00 years, we good about keeping track of how Many Americans die every day, every week, every year from all causes, heart attacks, cancer, old age, and the numbers are remarkably stable. We know that. It is a credit to the epidemiologists of the past and present that we know that, but what has occurred in the last month is unprecedented in recent decades, and were seeing a gigantic spy concern areas of the country in debts total. We know the reason is covid19 right now, but the more important thing is the sheer numbers. This is having an outlandish effect as compared to a bad flu season or something else. Deaths, we number of know how real this is, and when that goes away, now we have a handle on it. Host in the case of the washington post, here is how you framed the argument. Excess mortality does not depend on kind the number of covid19 death with ultimately relies on physicians and medical examiners. Offering their best guesses. Entire generations blend into the next. There is an unusual line in deaths, say young men in the 1990s. There is a sudden spike in new york and new jersey in september of 2001. Most of those, the death count goes on with the march of time, without much deviation and without fail. Guest yeah. I was sitting at my laptop writing that, and it occurred to me that this is an important moment in the history of our species in the need to acknowledge that, so i think excess mortality, excess death is a terrifying opportunity for us to see that, and to respond accordingly. On one hand, a very scary moment, and on the other hand, a light bulb to say we can really track this and know where we are at in no if we are safe and and know if safe we are safe. Host that seems to be the question in this phase of the pandemic. How do you strike that balance between public safety, personal safe the, and also beginning to reestablish an economy that has basically been shut down for the last seven weeks with more than 39 americans now out of work . Guest it is a very difficult problem that our leaders face. I dont and be the people who have to decide what to do next, but what i would say is that i think historians will look back , and they will wonder what we knew when we decided to proceed with reopening the economy in this particular moment. And i imagine they would like to know if we knew the extent of the excess mortality . Yes, we know that, we knew that, but it was determined that other things mattered more. What i am not really hearing, and it could be the case, is the argument saying, well, if we stay closed for too long, it could cause starvation and all kinds of deaths. We have heard the argument that staying closed is causing a little bit of a decrease in the normal care, fewer heart attacks being diagnosed right now wake means that are happening at home, but the number of deaths occurring because of that is a tiny fraction compared to covid. Is, we are message reopening the economy without really having done a very analysis and saying, what do we really water be really risking here . How many lives will be caused by this strategy, and how many jobs will that save . That is a hard balance to find what i dont have a sense that is a question anyone is seriously asking. Host what are you seeing as an er doctor . What is coming into the hospital today . Guest again, every day is a different day. It is so random. That is the life of an emergency doctor. That is what i love my job. You never have the same date wise. There have been times in the past month where i did not love tryinguch because it was to keep people alive. We do a lot of assurance. We are proud of the fact that we save lives here and there, and there were times we were seeing a nation ordinary number of sick anple we were seeing extraordinary number of sick people wouldve there have been times people have been afraid to come in. Number of icu patients was off the charts for us. We were able to expand in time because we saw it coming, so we were over our sins of capacity in the intensive care unit, but we had developed good policy to expanded time. Now, we are seeing a drop off, but it is so random because you could actually have a spike tomorrow, not necessarily in the number of cases, but if you want through one or two nursing homes, you could have a hundred more cases. 50 of them could require the icu endive, whether a bunch of Young Students got together and got it, you may have a couple of bad cases that are very bad, but entrance of the capacity issue, we would not feel it in the same way. It is feeling like little bit about lull, and i look at the numbers and we are nowhere out of this. I cannot say that with any confidence. It in yourstion this position, but how are the hospitals dealing with all of this because they dont have the elective surgery. They have these patients, who are quite ill, in no icu units, many who cannot afford to pay the bills when they leave the hospital. ,uest hospital administrators we get daily updates, and my sense is that they have the eye on the prize. They know the one thing that matters is getting through the crisis. Ofm sure they are thinking how to stay in business and all that, and i have heard lots of people nationally talking about what it will look like to help the hospitals get through this because of all the revenue stream issues you bring up. Havense again is that they been laser focused on the problem at hand. That being said, you know, we do have to use this moment to take stock of how we do things. I think the system is in many broken, notnot adequate. We see this crisis effect the poor, minority communities. Why . Because they have undiagnosed and unmanaged, chronic, medical conditions like diabetes and high blood pressure. So this virus hits them harder. I think we are looking at this problem and saying, how can we get through it . And what can we learn about it . I dont want to be like mr. Pessimistic this entire hour, but the one Silver Lining i think we will have to look for is what have we learned . What has this experience taught us about how we do Public Health . If we really actually look inward at that, and learn about ourselves, that could save lives, and it could be in the final analysis years from now what we learned today will be could save more lives than we ever lost. So, it is really an open question. Host in a recent oped, you say there is no way to compare covid19 to the seasonal flu to different viruses with coronavirus for more serious . Guest correct. The thought there was, if people for whatever reason, and i think it makes some sense, seasonal influenza is the benchmark, sorta the baseline upon which we make comparisons for all kinds of infectious diseases. It is something that people have heard of. The problem is that the statistics that are excepted by even fellow physicians would also the public, about how many deaths there are per year from influenza, actually estimates that are determined by very complicated algorithms, by the centers for Disease Control and prevention in atlanta. And these methodologies have been used for years, and they are accepted as dogma. The problem with it is that it would seem to suggest that 60,000 or so deaths per year can be a trip it to influenza. The reason i became interested in this was about the same number of deaths per year as opioids, and as gunshot gun violence, and Motor Vehicle safety related collisions and all that. That i had toed tell many families that their loved one had died because of those other things, but i cannot remember any time where i had to do that with the flu. And it was not because i was an er doctor. Plus, i see all kinds of infections. Estimates seems to overstate the cases. We are counting covid deaths one by one, and were estimating flu deaths, and we are seeing those estimates may not have been as accurate as we were led to believe. Apples re apples to just comparing apples to apples, the coronaviruses killing per week around 20 times more americans than seasonal flu does during its worst week of the year. So week to week the worst week of flu to last week of covid, looks on average 20 times worse. If we get better data, it will be higher than that but i cannot substantiate that. Agree times worse does with what we are seeing on the ground here. I dont remember seeing anything like this. Queensyork, i worked in as a resident physician, which was the epicenter of this crisis in new york, and no one had ever seen that, and that hospital treats tuberculosis from patients from africa. It is an amazing place. People say it is like the flu, but i found that rationale not correct. Host jeremy faust is joining us thackeray is joining us. Caller good evening. Weeks that it takes a few for test to be counted, and it could be off by a couple of thousands. How accurate are these tests . I was wondering that. Host how accurate are these tests . Guest the death tolls lag a little bit. It depends on statebystate. The cdc is the slowest because they have a responsibility to aggregate everything. Example, thefor cdc will publish the provisional, daily counsel coronavirus, and they will say as of yesterday. That is very incomplete data, kind of like when you watch on Election Night and you say 23 of presence are reporting. Like yesterday, the total number 7 deaths as of may fifth, 6, is lower than it was last year. That is because after one day, we only have a certain number of precincts reporting. What is remarkable is we have a dozen states reporting excess mortality, even this early. It is like, oh my goodness, and a week or two when the lag catches up, this is how many bodies we were told about, we will see how many states report excess mortality. There is a little bit of a lack, but it is not so long we cannot figure out where we are, especially when he broken the threshold. On day one, you are always over. Next call is from open, california. Good evening. Caller my question is this, since only talk about it, we tend to say, as black and brown that are dying. I think there would be a different take on things if you would say it the other way, that six out of 10 virus people ift are dying are white, and it was considered something attacking them, they would take it more seriously than dealing with other issues as to how people feel about minorities. That is not the issue. People are dying. Americans are dying. But i think they were treated more seriously if it were racialized the other way. Six out of 10 white people are dying. Host we will get a response. Dr. Faust . Guest well, i understand the colors point of view. It is unfortunate that we live in a society where people will care about which race dies more than the next. I am sure that is true in certain segments of the country. We have a major we have an historical legacy to deal with. General,hat people in in my experience, they identify, as a caller , with people who look like them and are from the community as with the caller says, people who look like them and are from the community. Even though there are an extraordinarily high amount of deaths, it is not enough that one person knows one person was died from it. To get to that place, you have to have half Million Deaths or so. So, to her point, how do you make it real, and is it to say people like you are dying as part of it . I think she is right, but unfortunately, it is what the eye sees. Zones, everyone understands it, and there is a lot of solidarity there. That the issue is social determinants is a major driver of these differences. It is not a genetic thing. Catchphrase for social determinants of health for many years is it is not your genetic code, it is your zip code that determines health care. It is a cold it is a call to action. We need to have undiagnosed hypertension diagnosed. So once Something Like this happens, the same people who continuously get hit hardest our and again unfairly disproportionately impacted. Host dr. Faust, you are an er physician and contribute to opeds and you are a podcast host . Guest yeah. But the past six or seven years, i had a podcast, which i do with my colleagues and another er doctor. Nurseseally for doctors, and other health care professionals, and we bridge the old gaps. At the past couple of months, we went to all koby all the time, and i started a log, which is andtline emergency doctors experts. Our Research Director is a physician and a lawyer, and our Research Editor is a john hopkins resident physician. We tried a packet the latest news we tried to package the latest news and make it readable for our colleagues, but also the general public because i think good information is needed. He thought we would step up and fill in some gaps. Host christina is from st. Louis, missouri. You are on with dr. Jeremy faust. Caller my question is, in i still protecting myself by staying in because i heard in new york, some of the people who died covid19 stayed in . Host that was the number that Governor Cuomo said, about 60 on the latest cases for people who had stayed home and yet still contracted covid19 . Guest it is a very difficult question. Dont want toi give advice as to whether the caller should do. Just listen to Public Health officials on the local level. Point nk the greater there is a greater point to be drawn from the question, so i am really glad it was brought up, which this virus is very different from almost any virus we have ever encountered, which it spreads even in patients who dont yet have symptoms. Asymptomatic or symptomfree patients. That is an unusual circumstance. When you think about it, you get sick and we know about it, and because of the fever, because of the cough, we feel crummy and we selfisolate all the time. We stay home from work. That is what we do. If you think about the evolutionary that if you think about the evolution of that i was talking to a colleague of mine at yale not only of immune responses we put out the cough and fever are crude fight to kill the virus, but it also has a population benefit. It tells the world, stay away from me. Im sick right now and i will hunker down and ride this out until i feel better. This virus exploits that assumption because it doesnt make everybody feel sick. So people go out and spread it. That is what makes this virus different. There are not many viruses that do that, and also seem to kill 1 of the people it comes into contact with. Viruss what makes this and once in a century pathogen. Host and why and so many cases, severe chest pains, respiratory conditions, with coronavirus . Guest that is a great question. We are trying to unpack the bigger question which is, the virus that causes covid19, is this particular virus, is it really different . Is there something truly isferent than the usual, or it viral subsidies, which a bad virus that makes your body fight and fight. That means it is your own immune system starts to turn on itself. You are trying to fight the virus, but causing organ damage because your body is flailing. It is early to know because we havent experienced a viral entity of pathogen a viral entity or a pathogen like this to know what it looks like when a virus like this goes across a population who has never seen it before. It is likely humanity has seen it before. In 1918, that is probably what happened. Virus came across and it wreak havoc. It is unclear if there is Something Special about this virus, or whether it has been a long time since we have seen thatdled attack on a body doesnt have any kind of immunity. The way we will in a few years. Host our guess is dr. Jeremy faust. Physician at brigham and womens hospital, and an instructor at harvard medical center. Richard, in mourning good evening . Caller a few minutes ago, dr. Faust was asked about reopening the economy, and made the assumption that the economy should be reopened only if the caused byths would be covid19 as a result of reopening the economy, would be exceeded by the death that would be avoided by reopening the economy. And that assumes we have absolute value to avoid death. But our Society Makes choices for death all the time. Like driving dangerous automobiles like motorcycles because of the pleasure, so we traded all for death. Smoking. Why should cigarettes even exist . We make those tradeoffs all the time. It seems to me, some people might say, i want to watch professional sports, even if there are excess deaths as a result of covid19. It isnt just the question of the deaths caused by turning down the economy, but it is also the pleasure of how much people value that pleasure in comparison to how manage compares how much people value death. Host how would you proceed . Faust i just think, dr. Was making the wrong assumption. It wasnt the tradeoff that people make individually in our society in terms of policy. That is not for me to choose. That is the choice that has to be made. Host thanks for the call. Guest somebody has to say in number. It is really difficult. The caller makes a great point. It is not it is not consistent with what i wrote in the washington post. We did not say, excess deaths isnt the only thing. It says it has to be a big part of the conversation. ,t reminds me of an old quote which if you do everything doctors tell you to do, you will live a long life, and it will feel like a long life. Callerller , as the says, there is room for enjoying life. What i am getting with this concept and with an adjacent concept he is referring to, is this notion we do make these kinds of determinations all the time, but we actually, whether we know it or not, are very deliberate about that. We decide to raise a speed limit 10 miles an hour in some states for convenience, or for the economy, and we know when we do that, there is a death corlett to it. The same thing is true when we decide to say 18yearolds can smoke. All kinds of decisions we may, as he says, are constantly taking this into account. It is the way society works. I am writing about this concept. I take the callers point because im thinking about it. And i hope to bring you that soon board bring you that soon parted my point is that we need to be very explicit about what our parameters are because right now, some people would say, open up right now because i dont care how many people die. I got to get back to work. Other people would say, how dare you. You are essentially a friending data you are essentially infringing on my right to live. That you are essentially infringing on my right to live. My assessment is very few people are thinking about it in those terms and saying, it has been a couple of weeks now, i think it is time to open again. Host coming up, we will talk to a George WashingtonUniv