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Message
re: Coronavirus Disease 2019 (COVID-19) ***W.H.O. DECLARES A GLOBAL PANDEMIC***
Posted on 5/19/20 at 1:54 am to Korkstand
Posted on 5/19/20 at 1:54 am to Korkstand
quote:
Are you suggesting that a significant portion of the excess mortality is due to isolation or an aversion to seeking healthcare?
And also failures of diagnosis and treatment due to restrictions placed on healthcare delivery.
quote:
Almost every state with few covid deaths shows no noticeable excess deaths. Deaths actually seem to be lower than usual in these states.
States with a high concentration of Covid deaths, especially New York/NJ, obviously have more all cause excess deaths. That's not in question. I'm saying that the policy response is contributing heavily to the unconfirmed component of excess deaths, both in states with spikes and in states that appear closer to normal (trauma deaths are down).
And I'm saying that the the mandatory healthcare restrictions will persist over time due to delayed diagnosis, treatment and screening, and the long term economic death toll could be worse than all of that combined.
1
Posted on 5/19/20 at 2:08 am to wdhalgren
I can't disagree with the long-term economic death toll prediction, and I think the response has been far in excess of what was called for.
But I do have to disagree on your assumption that healthcare "restrictions" have or will have a noticeable effect on death rates. Elective procedures were denied, but which states really stopped regular medical visits? Louisiana didn't afaik, my doc continued doing routine appointments and bloodwork stuff throughout all of this. I can't imagine that a significant percentage of people around the country have not gotten the medical care that they needed to prevent death.
Your guesswork here seems much less likely to be correct than the guesswork of counting probable covid deaths.
But I do have to disagree on your assumption that healthcare "restrictions" have or will have a noticeable effect on death rates. Elective procedures were denied, but which states really stopped regular medical visits? Louisiana didn't afaik, my doc continued doing routine appointments and bloodwork stuff throughout all of this. I can't imagine that a significant percentage of people around the country have not gotten the medical care that they needed to prevent death.
Your guesswork here seems much less likely to be correct than the guesswork of counting probable covid deaths.
Posted on 5/19/20 at 2:16 am to Korkstand
quote:
If you want to estimate the impact of a pandemic in near real time,
This isn't just a pandemic, it's a pandemic morphed into a social/medical/economic boondoggle. I want to estimate the impact of all of that.
quote:
then we have to take a probabilistic approach given that 100% CoD determination is not possible on a case by case basis.
Probabilities based on what, previous pandemics? Remind me which ones we mandated a severe restriction of normal healthcare delivery? Which ones did we force hundreds of thousands of businesses to close and put a quarter of the work force on unemployment? Which ones did we enforce social isolation of the entire population, with policing and fear? Which ones did we run 3-5 trillion dollar deficits and monetize the debt? We don't have probabilities for this. There's no simpleminded model for this based on something like the swine flu.
quote:
but given that it's relatively rare for a person to come down with a cough and then die within weeks, it's a pretty safe bet that covid is the cause right now.
If we're talking about an elderly person with chronic medical problems found dead, that's not a safe bet. If we're talking about someone who had new onset chest tightness three months ago and is still waiting on a stress test, that's not a safe bet. I can think of hundreds of cases where that's not a safe bet.
Posted on 5/19/20 at 2:32 am to Korkstand
quote:
But I do have to disagree on your assumption that healthcare "restrictions" have or will have a noticeable effect on death rates. Elective procedures were denied, but which states really stopped regular medical visits? Louisiana didn't afaik, my doc continued doing routine appointments and bloodwork stuff throughout all of this. I can't imagine that a significant percentage of people around the country have not gotten the medical care that they needed to prevent death.
I've responded to similar claims multiple times from people who didn't know what they were talking about. It's starting to open up now, but we have had severe restrictions to normal care. Here are the sort of things that have been postponed all over the country: Heart valve procedures, CABG procedures, angioplasty/stent, diagnostic caths, stress tests, bronchoscopies with biopsy, cancer resection/biopsy, gall bladder removal, organ transplants, colonoscopies, upper endoscopies, and many other diagnostic procedures and treatments. As a result, physicians have been furloughed, practices have cut back hours, operating rooms turned into ghost towns and hospitals ran at a fraction of normal census. Individually, these things were "elective", meaning the patient wasn't expected to suffer immediate harm from a delay. Collectively over 330M people, this has and will cost lots of lives. Many people die every day under optimal conditions, many more die under suboptimal conditions.
quote:
Your guesswork here seems much less likely to be correct than the guesswork of counting probable covid deaths.
My guesswork is based on an MD degree, practicing medicine, and talking to other people who practice medicine, and reading extensively about what has taken place. As for the guesswork of counting deaths, that's fine if it's to make charts on the CDC website and if there are no other variable contributing factors. If it's for deciding how long to lockdown the country, more diligence is in order.
This post was edited on 5/19/20 at 2:46 am
Posted on 5/19/20 at 2:44 am to wdhalgren
quote:Yeah I think we all would like to know the impact of all of that, but that's quite a bit more difficult than estimating deaths.
This isn't just a pandemic, it's a pandemic morphed into a social/medical/economic boondoggle. I want to estimate the impact of all of that.
quote:Probabilities based on medical opinions and typical death rates due to other causes.
Probabilities based on what, previous pandemics?
quote:Can you tell me where this has happened aside from elective procedures?
Remind me which ones we mandated a severe restriction of normal healthcare delivery?
quote:None of that is relevant to the death counts.
Which ones did we force hundreds of thousands of businesses to close and put a quarter of the work force on unemployment? Which ones did we enforce social isolation of the entire population, with policing and fear? Which ones did we run 3-5 trillion dollar deficits and monetize the debt? We don't have probabilities for this. There's no simpleminded model for this based on something like the swine flu.
quote:If they had other conditions and no covid symptoms, then it's very likely that they would not be counted as covid. But if they had been coughing or had other symptoms, covid is a very safe bet.
If we're talking about an elderly person with chronic medical problems found dead, that's not a safe bet.
quote:Again, most likely would not be counted as a probable covid.
If we're talking about someone who had new onset chest tightness three months ago and is still waiting on a stress test, that's not a safe bet.
quote:I'm sure you can, and in the vast majority of those cases the death would not be counted as covid.
I can think of hundreds of cases where that's not a safe bet.
Why are people under the impression that covid deaths are being recorded willy-nilly on a wide scale? Seems that people see the word "probable" and think it means "wild arse guess", when it really means a medically educated opinion. You know, like every other death where the cause is not known with certainty.
Posted on 5/19/20 at 2:58 am to Korkstand
quote:
that's quite a bit more difficult than estimating deaths.
If you aren't willing to make the attempt, then you can't estimate the deaths.
quote:
Probabilities based on medical opinions and typical death rates due to other causes.
Medical opinions, absolutely what I was suggesting. But, typical death rates from other causes are not necessarily applicable right now.
quote:
Can you tell me where this has happened aside from elective procedures?
All over the country.
quote:
None of that is relevant to the death counts.
Every bit of it is relevant to the death counts.
quote:
If they had other conditions and no covid symptoms, then it's very likely that they would not be counted as covid. But if they had been coughing or had other symptoms, covid is a very safe bet.
Coughing is a symptom of multiple severe diseases that can kill a person in a short period of time.
quote:
I'm sure you can, and in the vast majority of those cases the death would not be counted as covid.
You said if the person was coughing Covid was a safe bet. I'm just pointing out that the differential diagnosis of coughing is very long and lots of those diseases can kill in a matter of days or weeks.
This post was edited on 5/19/20 at 3:00 am
Posted on 5/19/20 at 3:03 am to wdhalgren
quote:In your opinion, if none of the procedures you listed were done for an entire year, how many more people would die than usual?
I've responded to similar claims multiple times. It's starting to open up now, but we have had severe restrictions to normal care. Here are the sort of things that have been postponed all over the country: Heart valve procedures, CABG procedures, angioplasty/stent, diagnostic caths, stress tests, bronchoscopies with biopsy, cancer resection/biopsy, gall bladder removal, organ transplants, colonoscopies, upper endoscopies, and many other diagnostic procedures and treatments. As a result, physicians have been furloughed, practices have cut back hours, operating rooms turned into ghost towns and hospitals ran at a fraction of normal census. Individually, these things were "elective", meaning the patient wasn't expected to suffer immediate harm from a delay. Collectively over 330M people, this has and will cost lots of lives. Many people die every day under optimal conditions, many more die under suboptimal conditions.
quote:Oh sweet. What percentage of deaths would you say typically have no immediately known cause? Honest question, I'd really like to know.
My guesswork is based on an MD degree, practicing medicine, and talking to other people who practice medicine, and reading extensively about what has taken place.
quote:Absolutely. And to be clear, I believe that the covid risk absolutely does NOT justify the course we've taken. You could tell me we've saved 500k lives and it still wouldn't be worth the cost so far. Plus it's doubtful that we are saving any lives in the long run anyway, assuming we reach herd immunity before we get a vaccine (if that ever happens). At best we might be saving a year of life per person on average by delaying the inevitable.
As for the guesswork of counting deaths, that's fine if it's to make charts on the CDC website and if there are no other variable contributing factors. If it's for deciding how long to lockdown the country, more diligence is in order.
That said, in order to do any meaningful calculations in this respect, it must start with a somewhat accurate measure of the IFR. And in order to do that, we must count at least the large majority of the probables, because we know with certainty that the true number of deaths MUST be larger than the confirmed ones.
Posted on 5/19/20 at 3:41 am to wdhalgren
quote:I am willing to make the attempt, but that attempt starts with estimating the deaths.
If you aren't willing to make the attempt, then you can't estimate the deaths.
quote:
Coughing is a symptom of multiple severe diseases that can kill a person in a short period of time.
quote:Sure there are, but that brings us back to probabilities. I'm going to do some rough calculations, and I will be as conservative as possible.
You said if the person was coughing Covid was a safe bet. I'm just pointing out that the differential diagnosis of coughing is very long and lots of those diseases can kill in a matter of days or weeks.
About 55k people die every week. How many of those are accompanied by a cough? Well surely all of the ones with chronic respiratory issues (3k), and all of the flu/pneumonia (4k), a third of the cancers? (4k), some of the diabetes? (1k), and let's throw in half of the "other" (5k). That's 17k deaths every week that are accompanied by a cough. Does that sound reasonable? More than 30% of all deaths?
Now we know that, at minimum, the US as a whole has reached at least 72k deaths in 1 week's time in April, 17k more than expected. What is the likelihood that a death accompanied by a cough during that week was due to covid? Well, a very naive calc says 50%. So right off the bat, if a cough is the only symptom, we would be right about half the time just guessing covid.
But doctors aren't that careless, are they? Surely they would know whether their patient has a history of chronic respiratory problems, or lung cancer, or what have you, and they wouldn't just chalk it up to covid, would they? Especially not if they don't have a positive test. If we knock off just lung cancer and chronic resp, we're at 63% likely to get it right by making a wild-arse covid guess. I'm sure a doctor such as yourself would be much more accurate than that, though.
The only way to be worse would be via rampant fraud, right?
Posted on 5/19/20 at 6:18 am to Korkstand
quote:Sure. Pretty much the entire United States
Can you tell me where this has happened aside from elective procedures?
Annuals were postponed. This includes labs for adults that screen for various different ailments, and vaccinations for children were put off
Posted on 5/19/20 at 6:56 am to Korkstand
quote:
because we know with certainty that the true number of deaths MUST be larger than the confirmed ones.
You need to slow your roll with the excess death numbers. You are acting like it’s slam dunk evidence of something and it’s not.
We don’t know if CV just sped up some deaths by a few months and we are going to see a lower than average death toll over the next 3-4 months. It’s quite possible since a lot of the numbers of heart attacks, strokes, etc. Basically disappeared. When a yearly flu wave comes through it precipitates a lot of these vulnerable deaths, this could have been another “flu wave” after the typical flu wave and precipitated more deaths of people who were very close to death. I think it’s a strong possibility given that the average age of death from CV is equal to the average life expectancy.
So it’s really not wise to be clamoring about the excess deaths until all the numbers are in at the end of the year or even longer.
This post was edited on 5/19/20 at 6:57 am
Posted on 5/19/20 at 7:58 am to WaWaWeeWa
LINK
Article sounds very promising
quote:
Although doctors and scientists are testing a vast arsenal of existing drugs and drug candidates in the fight against the novel coronavirus, SARS-CoV-2, EIDD-2801 stands out. It attacks the same viral enzyme, the RNA-dependent RNA polymerase, as Gilead Sciences’ remdesivir, which the US Food and Drug Administration recently granted emergency use authorization, allowing it to be used by doctors in the pandemic. But unlike remdesivir, which has to be given intravenously, EIDD-2801 can be taken orally as a pill.
Article sounds very promising
Posted on 5/19/20 at 8:19 am to WaWaWeeWa
quote:
Gilead Sciences
Incoming funding for a study to prove that this treatment doesn't work...
Posted on 5/19/20 at 9:00 am to WaWaWeeWa
I agree that most of the excess deaths right now are in people who are nearing end of life. Not only are those people highly vulnerable to Covid-19, they're also highly vulnerable to other changes in their environment, even something as simple as fewer visits from people in their personal support network.
Excess mortality seems like a catch all category being used to create a case for longer lockdown. What the people making that case don't understand, apparently, is that it only takes a small percentage increase in standard causes of mortality to rival the rate of viral deaths. And they can't seem to envision how this radical response could cause that small increase in the most dependent demographic groups. Obviously nobody knows the exact numbers right now, but we'd better be trying to find out because non-Covid deaths will rise and spread to other cohorts if the lockdowns persist.
Excess mortality seems like a catch all category being used to create a case for longer lockdown. What the people making that case don't understand, apparently, is that it only takes a small percentage increase in standard causes of mortality to rival the rate of viral deaths. And they can't seem to envision how this radical response could cause that small increase in the most dependent demographic groups. Obviously nobody knows the exact numbers right now, but we'd better be trying to find out because non-Covid deaths will rise and spread to other cohorts if the lockdowns persist.
This post was edited on 5/19/20 at 9:15 am
Posted on 5/19/20 at 9:01 am to Korkstand
quote:
Korkstand
*clears throat*
You were saying?
Only a third of nursing home deaths in England and Wales have been proven to be caused by CoviD, thus far.
Looks like they are attributing this increase to patients being moved out of hospitals to make room for CoviD surge. (Also, is this movement because of their socialized healthcare system?) So, they were likely very old and ill to begin with.
Underdiagnosis is probably likely, though.
This post was edited on 5/19/20 at 10:38 am
Posted on 5/19/20 at 10:28 am to GOP_Tiger
quote:
Finally, some direct evidence linking Vitamin D deficiency to COVID-19 infection
I hope they eventually do the same analysis for COVID severity not just chance of infection.
Where I think it really matters is the start of cytokine storm and Reduction of IL-6
Posted on 5/19/20 at 10:41 am to Sasquatch Smash
There have been hundreds of articles, ranging from individual stories to insurance claims analyses, demonstrating a large decline in hospitalizations for severe illness. Some of it is due to mandated restrictions on care, including encouraging hospitals to reduce census, some due to patients noting the lockdowns and self-isolating in fear. In the case of nursing home patients it's obviously not a matter of choice. But for some reason there are still people who minimize the impacts of social isolation and healthcare disruption on mortality. And a sizeable part of that disruption has been a matter of policy, but the media response has been so focused on Covid fearmongering and the need for lockdowns that people thought the rest of the healthcare system would function on autopilot. Here are some numbers from a Cigna study from late April.
This article didn't address another issue, which is that patients have had trouble getting appointments with their doctor, or getting diagnostic procedures which would have identified the need for hospitalization. The interruptions in care have been stem to stern.
quote:
Researchers at the insurer studied care utilization among their commercial group and individual plan members between January and March across seven conditions and found decreases in hospitalizations across the board.
Large numbers of patients pushing off care for acute needs could have major repercussions as the industry emerges from the pandemic, said Saif Rathore, M.D., head of data and analytic innovation at Cigna and one of the report’s authors. “This is part of us trying to sound the alarm. There will be consequences for this kind of care deferral.”
quote:
For example, the hospitalization rate related to atrial fibrillation decreased by 35% between February and March.
quote:
Other conditions included in the study are transient ischemic attacks, or “mini-strokes,” which saw hospitalization rates decrease by 31% in that same window. Rates associated with epilepsy and seizures decreased by 28%, and hospitalization rates for gastrointestinal bleeding were down by 24%.
Between February and March, hospitalization rates for aortic aneurysm and dissection decreased by 22%, for acute appendicitis by 13% and for acute coronary syndromes by 11%.
quote:
the team decided to examine these rates after hearing anecdotally from hospitals and other industry colleagues that they were seeing such declines.
quote:
“We need to be able to walk and chew gum,” Rathore said. “Yes, focus on COVID and make sure they’re handling COVID, but not at the cost of letting patients leave other things on the table.”
This article didn't address another issue, which is that patients have had trouble getting appointments with their doctor, or getting diagnostic procedures which would have identified the need for hospitalization. The interruptions in care have been stem to stern.
This post was edited on 5/19/20 at 11:26 am
Posted on 5/19/20 at 11:23 am to wdhalgren
quote:
“We need to be able to walk and chew gum,” Rathore said. “Yes, focus on COVID and make sure they’re handling COVID, but not at the cost of letting patients leave other things on the table.”
That's a good quote.
Posted on 5/19/20 at 11:49 am to WaWaWeeWa
quote:This sentence that you quoted from me is just stating the fact that the confirmed covid death figures will always be an undercount of the true number of covid deaths. That's just a basic fact of logic and reality.quote:You need to slow your roll with the excess death numbers. You are acting like it’s slam dunk evidence of something and it’s not.
because we know with certainty that the true number of deaths MUST be larger than the confirmed ones.
Posted on 5/19/20 at 12:25 pm to Sasquatch Smash
quote:From the article:
*clears throat*
You were saying?
Only a third of nursing home deaths in England and Wales have been proven to be caused by CoviD, thus far.
Looks like they are attributing this increase to patients being moved out of hospitals to make room for CoviD surge. (Also, is this movement because of their socialized healthcare system?) So, they were likely very old and ill to begin with.
Underdiagnosis is probably likely, though.
quote:I wouldn't say that's proven either way.
Of those 30?000, only 10?000 have had covid-19 specified on the death certificate
Look, no doubt some people have died as a result of policy rather than covid. And again, I wholeheartedly disagree with the severely outsized response to this. And I know it will be years, if not decades, before we have even a reasonable understanding of the real impact of both the virus and the policy response.
But just look at what people are arguing here. The claim is that care workers in hospitals and nursing homes are taking actions, driven by policy, that are killing people by the thousands. That seems like quite a stretch, doesn't it? Multiple posters have now said that the same policies apply across the entire US. If it's the policy, why don't we see thousands of excess deaths in every state? In states where there are few covid cases, the total all-cause deaths are right on "schedule".
If, instead, the claim is that excess non-covid deaths only occur where the healthcare system is overloaded by covid, that doesn't seem to align with the data, either. In all but a handful of states, the excess deaths are on par with the peak of a typical flu season. Nothing the system can't handle.
Maybe one day we will have data that proves that other cause deaths increased significantly due to policy. But as of now, that's a really tough sell for me. The policy is somewhat consistent nationwide, and as long as there are few covid patients, there is no problem. But then the claim is that for every X% bump in excess deaths, half of them are due to something other than covid?
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