In this capstone webinar presentation, closing out Dr. Cady's series on dealing with COVID 19, he turns his attention to a nunmber of interesting thems: - what's the REAL case fatality rate of COVID 19 - How is it likely that society will reopen? - What's going to happen in education and medicine? - What's going to happen when the robots and AI arrive? - What's the future going to be out 500 years?

1. Webinar 5
Designing Your
Future: What’s
Coming Next?
May 27, 2020 – 6 pm CST
A gift to my patients, the
Tristate, and the internet-
at-large community.
Louis B. Cady, MD, FAPA
CEO, Founder Cady Wellness Institute
Architectural Detail. Calgary, Alberta Canada.
© 2019 Louis B. Cady, MD

2. “The one thing
about the future
that we can be
certain of is that
it will be utterly
fantastic.”
- Arthur C. Clarke,
Profiles of the Future.
Architectural Detail. Calgary, Alberta
Canada. © 2019 Louis B. Cady, MD

3. Quick review
• Webinar 1: How to boost your immunity
• Webinar 2: How to get your head right.
• Webinar 3: How to take care of yourself
BIOLOGICALLY
• Webinar 4: How to save money on your
health care (which involves content from
webinar 1, 2, 3, and 4)
• Webinar 5 – tonight: What’s Next?

4. www.slideshare.net/lcadymd

5. Future Facts
• The COVID 19 pandemic will end.
– Herd immunity, vaccination, and creatively networked
drugs will be used.
– Multiple waves of infections and shutdowns will occur
until vaccine and herd immunity arrive.
• There will continue to be paroxysms in health
care. The present system will collapse.
• Technology will continue to disrupt
– Burrus’ Three Drivers:
• Processing power
• Increased storage
• Increased bandwidth

6. Future Facts, continued
• Some people and companies will go bankrupt.
– Boomers will continue to age and get demented & other
degenerative diseases based on lifestyle choices.
– Depression will increase in the short term (more stress)
• Chronic disease will continue until:
– It becomes personally untenable to have to pay for the
care/drugs/surgeries that you have caused.
– Darwinian selection will occur
• Technology will improve capacity to deliver
healthcare and mental health care.
• Cognitive testing remotely
• Pharmacogenomic testing

7. Future Facts, continued
• Future politics (if society and current civilization
survive) will have to become more inclusive and
more democratic.
– The “poisoned discourse” will stop.
– Fact checking will be universal. (see
technology, upcoming)
• “You can’t fight the [communication power of the]
internet.” – Cady
– Therefore…
– Political lies will become impossible.
• A new Baby Boom!!! (and downstream effects)

8. • Epidemic: “an outbreak of disease that
spreads quickly.”
• PANDEMIC – an epidemic that has
spread over a large area, that is –
throughout a country, continent, or the
entire world.
Infectious disease & pandemics
https://www.dictionary.com/e/epidemic-vs-pandemic/
accessed 5/23/2020

9. Lehner UC. We’ve come a long way since the Black Death.
Asia Times April 11, 2020 – accessed 05/23/2020

10. The Black Death
• Affected Europe and Asia in mid-1300’s.
• In early 1340’s “The Great Pestilence” was
reported in China, India, Persia, Syria, and
Egypt. Appears to have originated in China.
• Oct 1347 12 “death ships” arrived in
Messina.
• In 5 years it killed 20 million people in
Europe – 1/3rd of the continent’s population.
https://www.history.com/topics/middle-ages/black-death

11. Black Death- positive changes (?!)
• “Hastened the breakdown of Europe’s rigid
class system.”
– (with labor short, peasants who had previously
been vassals of noblemen “roamed the
countryside demanding higher wages.”
– Nobility began to welcome marriages with
merchants (who had money)
Lehner UC. We’ve come a long way since the Black Death.
Asia Times April 11, 2020 – accessed 05/23/2020

12. The Black Death is still around….
• Black Death epidemic burned out by early 1350’s,
but then appeared every few generations for
centuries.
• Modern health practice and sanitation mitigated it.
• Antibiotics are now available to treat it.
• WHO: still 1,000 to 3,000 cases per year.
• CDC – 1 – 17 cases of plague per year in US
https://www.history.com/topics/middle-ages/black-death
https://abcnews.go.com/Health/plague-exists-now-
us/story?id=55860883 (both accessed 5/23/2020)

13. • “Spanish Flu” – 1918 –1919
–H1N1 virus, avian origin
– 500 million (1/3rd of the world’s population) became
infected.
– 50 million deaths worldwide (10% death rate) with
675,000 in the US
– Killed 1 – 3 % of the world’s population
– Tx’ed with isolation, quarantine, good hygiene, use of
disinfectants and limitations of public gatherings.

14. How did LA cope?
• Oct 1, 1918 – first case; Oct 11 - 680 cases - city closed
down
• Run on listerine, peroxide, and other antiseptics. Also mouth
washes.
• Public schools all closed by mid-October. Parents stuck at
home with ”bored, antsy children.”
• Churches closed.
• Club/civic meetings banned.
• “Slacker” – one who went out in public while ill and “Generally
disregarded the prudent recommendations of city authorities.”
• Regulations remained until Jan 1919. In Feb, schools opened.
https://laist.com/2020/03/25/how_did_la_cope_with_the_influenza_epidemic_of_1918.php
Accessed May 27 2020.

15. The CDC on what a 1918 repeat would
look like…
https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-
virus.html (accessed 5/23/2020)
“If a severe pandemic, such as occurred in 1918 happened
today, it would still likely overwhelm health care infrastructure,
both in the United States and across the world. Hospitals and
doctors’ offices would struggle to meet demand from the
number of patients requiring care. Such an event would
require significant increases in the manufacture, distribution
and supply of medications, products and life-saving medical
equipment, such as mechanical ventilators. Businesses and
schools would struggle to function, and even basic services
like trash pickup and waste removal could be impacted.

16. More pandemics
• H2N2 “Asian flu” 1957
– Included 3 different genes, originating in avian
influenza A virus
• 1.1 million deaths worldwide; 116,000 in the US
• 1968 pandemic H3N2 – included two genes
from an avian influenza A cirus
– 1 million daths worldwide; 100,000 in the US.
• This continues to circulate worldwide as seasonal
influenza A virus.
• Associated with seve illness in elderly
• Continues regular antigenic drift

17. • (H1N1)pdm09 virus “Swine Flu” - 2009
– 1/3rd of people over 60 had antibodies, likely
from previous exposure to another H1N1
– Vaccine was produced, but not until after the
peak of the pandemic ended in August 2010.
– (H1N1)pdm09 continues to circulate as as
seasonal flu virus.
https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-
pandemic.html

18. Ebola Virus -
• Discovered in 1976 near the Ebola river.
• 2014-2016 Ebola outbreak in West Africa spread to urban
areas and across borders. “Global epidemic.”
• Affects people and nonhuman primates (monkeys gorillas
and chimpanzees.”
• Six different strains. Four cause disease
• Intermittent outbreaks since then.
• Animal born – bats and nonhuman primates.
• Spread through contact with blood, body fluids, and tissues
of animals.
• Ervebo® - 2019 - first FDA approved immunization.
Merck& Co.
https://www.cdc.gov/vhf/ebola/history/summaries.html – accessed 05/23/2020

19. COVID 19
• Number of infected people who die
– {1 – 10%}??? – open to question
– Depends on age, obesity, pre-morbid lung
function
• In comparison – death rate from:
– Black Plague 50 – 70% death rate
– Spanish flu – 10%

20. What can we learn from Europe?

22. 1,606353 (infected
/recovered)
99,804 deaths
= 6%
https://www.euronews.com/2020/05/25/covid-19-coronavirus-breakdown-
of-deaths-and-infections-worldwide
23,473 deaths
212,975
infected/recovered}
= 11%
CURRENT, unadjusted stats.
Denominator not adequately
determined. And probably not the
nuymerator, either!

23. (2,610,105 + 2,364873)
347,852 deaths
= 7%
https://www.euronews.com/2020/05/25/covid-19-coronavirus-breakdown-
of-deaths-and-infections-worldwide

24. https://www.euronews.com/2020/05/25/covid-19-coronavirus-breakdown-
of-deaths-and-infections-worldwide

25. SARS-CoV-2 structure and peculiar
biology of infection
• high risk of inter-human transmission
• long incubation time combined with early and sustained
viral load
• existence of asymptomatic or mildly-symptomatic carriers
• viral shedding for days after symptom relief
• unfavorable progression towards respiratory distress and
death in up to 5-10% [sic]of patients thus causing dramatic
healthcare challenges, as well as environmental
contamination.
Lippi G et al Coronavirus disease 2019 (COVID-19): the portrait of a perfect
storm. Ann. Transl Med. 2020 Apr;8(7):497.

26. 98,223 / 2,041,925 = 4.8% CFR (case
fatality rate)

27. “There are three types of lies…
•Lies.
•Damn lies
•and Statistics.”
Benjamin Disraeli (1804-1881) – two-time
Prime Minister of the United Kingdom.

28. Stanford and the Santa Clara County Study
• 2.8% of residents were infected by early April but
didn’t know it.
• Implies 48,000 – 81,000 people infected – which
is 50 – 85 FOLD more than the number of
confirmed cases in the county.” [Let’s take
“50X” – Cady]
• “This suggests that the large majority of the
population does not have antibodies and may be
susceptible to the virus.”
– [It also establishes that there are a much larger number
of people who have had clinically silent infections –
Cady]
Bendavid E et al. COVID-19 Antibody Seroprevalence in Santa Clara County, California.
MedRxiv. Pre-print and not peer-reviewed. Posted April 30, 2020 accessed 5/25/2020
https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v2

29. 2 more studies…
• 13.7% of 211 asymptomatic pregnant women who
delivered at NY Presbyterian Allen Hospital were
seropositive for SARS-Cov-2.
– Sutton, D et al.. Universal screening for SARS-CoV2 in women
admitted for delivery. NEJM –Letter published on April 13, 2020.
• SARS-CoV2 studied in ICELAND. 13.3%of
those recruited for testing tested positive for
COVI 19.
– 6.7% for children under age 10
– 13.7% for age group > 10.
• Gudbjartsson DF et al. Spread of SARS-CoV-2 in
the Icelandic population. NEJM Apr 14, 2020

30. Come, let us reason together…
• Fatality % = number dead /TOTAL infected.
• Univ. of Miami Miller School of Medicine/Miami-Dade
Country - second round of community testing
– 1,800 people complete blood tests for antibodies and
shared health information.
– 6% actually tested positive to SARS-CoV2 (COVID 19)
virus. = 165,000 people
• SIGNIFICANTLY MORE than the “10,000 cases” previously
reported in testing site data.
News releaseMiami-Dade Country April 24, 2020
https://www.miamidade.gov/releases/2020-04-24-sample-testing-results.asp accessed
May 26, 20200
[Calculation, Cady: 10.65X adjustment for number
infected]

31. • “…we are 95% certain that the true amount of
infection lies between 4.4% and 7.9% of the
population, or between 123,000 and 221,000
residents “
• “These results are similar but not identical to other
recent, non-randomized testing programs that
have been conducted throughout the United
States.”
• “African American and Caribbean communities
may be twice as likely to be infected with COVID
19 than other racial groups.”
News releaseMiami-Dade Country April 24, 2020
https://www.miamidade.gov/releases/2020-04-24-sample-testing-
results.asp accessed May 26, 20200

32. And the NUMERATOR could also be off
• Under-reporting of deaths posited to be 318,000 instead of
the 201,000 reported, via Financial Times analysis of
overall fatalities during the pandemic in 14 countries.
– [ = 1.58X more deaths than reported- Cady]
– Burn-Murdoch J et al. Financial Times – April 16, 2020. Accessed
May 26, 2020
• NYC – 24,800 estimated excess deaths vs. 20,720
reported = 17% UNDERcount.
– [ = 1.2X more deaths than reported- Cady]
– Wu J et al. 74,000 Missing Deaths: tracking the true toll of the
Coronavirus Outbreak. NY Times May 19, 2020 update. L
Accessed May 26, 2020
Calculation, Cady: 1.58 + 1.2/2 = 1.35X
adjustment factor – for deaths.

33. https://github.com/TheEconomist/covid-19-excess-deaths-
tracker/tree/master/output-data/excess-deaths

34. (98,223 * 1.35X adj.))/ 2,041925 *30.3X adj. =
132,601 actual deaths / 62,278713 actual infected =
0.2% ACTUAL case fatality rate
So what’s the REAL death rate???

35. From “10 commandments of
mathematics"
1. Thou shalt read thy problem
2. Thou shalt look back even unto thy youth and
remember thy arithmetic
3. Thou shalt master each step before putting they
heavy foot down on the next.
4. Thou must use thy “common sense” else
thou wilt have flagpoles 9000 feet in height,
yea…. Even fathers younger than sons.”
http://fac.hsu.edu/worth/libarts/pr_slvng/sld005.htm - accessed
5/27/2020

36. “Seat of the pants” test
• CFR
– Diamond Princess cruise ship – quarantined at
Yokohama for one month
• 14 people died / 700 people (known to be infected = CFR of
2%
– Ovation of the Seas = 1 dead/79 infected = CFR of
1.3%
• True prevalence:
– Celebrity Apex – 224 perons tested positive out of
1,444 tested = 15% prevalence in population,.
https://en.wikipedia.org/wiki/COVID-19_pandemic_on_cruise_ships
Accessed May 27, 2020

37. (98,223 * 1.35X adj.))/ 2,041925 *30.3X adj. =
132,601 actual deaths / 62,278713 actual infected =
0.2% ACTUAL case fatality rate
So what’s the REAL death rate???

40. Are the Best and Brightest
Staying in Medicine?
http://www.mayorswellnesscampaign.org/wp-
content/uploads/2009/05/merritt-hawkins-survey.pdf.
Accessed April 3, 2010.
Slide courtesy of John Adams, MBA – CEO, Cenegenics
“60% of physicians
would not recommend
medicine as a career to
their children.”
– The Physicians’

41. Shanafelt, TD et al. Changes in burnout and Satisfaction with Work-Life Balance in
Physicians… (2011 vs. 2014) Mayo Clin Proc. December 2015;90(12):1600-1613
• “Burnout and satisfaction with WLB
[work-life balance] among US
physicians are getting worse.
American medicine appears to be at a
tipping point with more than half of US
physicians experiencing professional
burnout.”

43. Treatment – nothing really great

44. Once COVID-19 antibodies are confirmed, the donor blood can
be used for convalescent plasma therapy. This type of therapy
introduces antibodies that can bind and kill the virus from one
person into the blood stream of an infected patient that does not
yet have immunity to the virus. The blood is processed through a
machine that collects the plasma, a different part of blood than
serum, and returns the blood cells to the patient.

45. Cady’s Caveats
• The system will run out of money for healthcare.
• Patients will run out of money for healthcare due
to:
– Increased cost of drugs
– Higher deductibles
– Higher premiums
– Constantly changing insurance plans.
• Both medical and mental health care will end up
as a “split model” – some in person, some via
telemedicine.

46. The Economy
Jobs will vanish….

47. An old-time country doctor on the
previous treatment of ADHD…
“Well, in my day, we’d
just call’em slow and
send ‘em to work on the
farm.”
John Jenkins, MD

48. Ordinary people are
losing their jobs too….

51. The Two Dan’s:
Dan Sullivan & Daniel Burrus
• The Great Crossover (Sullivan © 1997)
– First –LANGUAGE
– Second – WRITING
Third – the PRINTING PRESS
– Fourth – THE MICROCHIP
• The “Three Drivers of Change (Burrus, Techno-
trends (1993)
• Processing power
• Increased storage
• Increased bandwidth

52. New anesthesiologist on the
team…

53. 2018!

54. Forbes ~ Feb 9, 2019

56. https://knowledge.wharton.upenn.edu/article/rise-robo-advisor-
fintech-disrupting-retirement/ accessed 05 27 2020

57. https://dzone.com/articles/will-ai-replace-teachers-in-universities

58. Unemployment, underemployment are
contemporary problems & will likely worsen…

60. “The war on normal people.”
From: “The World on Normal People” Andrew Yang. Chapter 2.
“How We Got Here”

61. From: “The World on Normal People” Andrew
Yang. Chapter 2. “How We Got Here”

62. “The war on normal people.”
From: “The World on Normal People” Andrew
Yang. Chapter 2. “How We Got Here”

63. And…
• Loss of jobs for anything that can be done
by a machine. (Checkers, anesthes-
iologists, family medicine docs (replaced by
computer and NP’s/PA’s.) Lawyers,
paralegals, ditch diggers, asphalt layers,
“garbage men,” teachers.

64. • The Impact of Artificial Intelligence -
Widespread Job Losses. ... A two-year
study from McKinsey Global Institute
suggests that by 2030, intelligent agents
and robots could replace as much as 30
percent of the world's current human labor.
• “We need to prepare for a future in which
job loss reaches 99 percent.”
– Calum McClelland, iotforall January 15, 2020
– https://www.iotforall.com/impact-of-artificial-
intelligence-job-losses/ accessed 05 27 2020

68. Top 10 EducationalTrends
Tom Vander Ark – Forbes Mar 24, 2020
1. Big class of 2040  .
2. More remote work
3. More personalized competency-based learning. “Show
what you know.”
4. Community connect project-based learning.
5. THE END of 30 year standards based reform
6. More home-based/hyrid learning leading to…
7. FEWER expensive schools and colleges.
8. Continuity of learning with a blended curriculum.
9. Better safety nets.
10. New “mutuality.”

69. Things to consider:
• Retail, healthcare and education when we go back – what
will it look like? What about public gatherings?
– CLEAN. Social isolation until pandemic over. Masks. Extra cleaning.
Cleaning certifications. Temperature checks.
– Increased clarity about true risk of COVID 19.
• use of smart phones to pay for things (“touchless”)
• Improved testing is likely in the near future.
– Possible “immune badges” on smart phones.
• Hybrid system of education and work:
– Some at the office or school
– Some at home.
– Some MOBILE. (cf Tim Ferris – The Four Hour Workweek.)

70. What about your health and resilience??

71. HOW DO YOU
WANT TO
AGE??

72. QUICK REVIEW:
• Webinar 1 – boost your immune system.
• Webinar 2 – get out of your head and get
RATIONAL.
• Webinar 3 – don’t be depressed. Get your
micronutrients right.
• Webinar 4 – stop sabotaging yourself with
bad habits and activities.
• And tonight: CHANGE IS COMING. Now
is the time to deal with it.

73. MY ADVICE:
• Google.com
• Scholar.google.com
• PubMed.gov

74. And more upsides…
• From Daniel Burrus:
– “The pandemic is an accelerator to innovation.”
– “In every single industry, it wasn’t perfect in the first
place.”
• From me:
– The revelation of videoconferencing, tele-medicine.
– We are going to have to have some hard conversations
about medicine, who is going to pay for it, and how you
qualify for it.
– Commerce or self-sufficiency will be required.

75. https://steemit.com/homesteading/@walkerland/if-you-want-to-
see-a-change-for-the-better

76. The medium
and far future…
• Climate change (two different
interpretations)
• Rise of intelligent robots
• Minerals/chemicals farmed from
the sea.
• Moonbase(s) from CAVES.
• Terrafarming of Mars (2015 -
2080). Genetically engineer lants
(2080-2115). Ice melts at ice
caps (2115-30
– Fianl stage: Towns multiply with
farming and high-tech industry.
(2130-70)
• Need to avoid asteroids.
• Mining asteroids for precious
metals.
• Interstellar travel using anti-
matter drives. (!!)

77. “Mind has waited for three billion years on this planet
before composing its first string quartet. It may have to
wait another three billion years before it spreads all over
the galaxy.
I do not expect that it will have to wait so long. But if
necessary, it will wait.
The universe is like a fertile soil spread out all around
us, ready for the seeds of mind to sprout and grow.”
Freeman Dyson, Infinite in All Directions
Mesa Arch - Canyonlands

78. Thank you for attending!
lcady@cadywellness.com
Office: 812-429-0772
www.slideshare.net/lcadymd