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The Institute for Health Metrics and Education at the University of Washington has published a prediction for the progress of the COVID-19 pandemic in the US. They are estimating that the peak demand on the health care system will be on April 14. On that date, they are predicting that the death count will be 31,615 and that eventually 81,114 deaths from the disease will be recorded around August. The website also lets you see predictions by the individual states.
Peak demand for healthcare for New York is projected as being on April 6; for California on April 24; for Florida on May 14.
Whatever the accuracy of these predictions at least they are focusing on the right questions: when does our health system need to be ready for the worst strain? what is that need likely to be? how many people will the disease kill? Death is the “sunk cost” of this epidemic. It is terrible, it is tragic, it needs to be minimized, but it is inevitable. Our national strategy has to involve how to get beyond the deaths that will be recorded. Our personal strategy is to reckon with our own risk. And that leads to the subject of comorbidity — thought of the day. (Because there are so many days and so little thought.)
@brianwatt, had an excellent comment on my post about Day 66:
Where is the data of CV-19 deaths by location – people in their homes…people in nursing homes…people in hospitals…people in ICUs – by age and whether they had other underlying or active medical conditions – like cancer, respiratory conditions, diabetes, heart disease, kidney issues (on dialysis) or other health- or immune-compromising issues?
Unless that specific data starts to become published, then universal numbers that treat all segments equally only serves to propagate a panic narrative.
There is a reason that Italy has been adversely affected and why the virus ran rampant in a nursing home in Seattle – because nearly all of the victims were elderly with other underlying conditions and in a facility where the virus could easily and quickly propagate amongst the staff and introduced by visitors who were relatively resistant to the effects of the virus.
We have heard a lot about “underlying issues” and “underlying conditions” that make getting COVID-19 more severe/deadly. One of the tweeted criticisms that Professor Bergstrom focused on Aaron Ginn’s Evidence Over Hysteria, was:
Disaggregating data is essential to provide context, especially for transmission processes. That the virus can cross national boundaries does nothing to negate the importance of spatial structure and within-country analysis. Aggregating data obscures critical patterns.
And that is what Brian Watt was talking about. And it needs to be done if we are to get the nation back up and running. Slicing and dicing the data so we know who is most at risk and what we can and should do about it.
And it starts with comorbidity. That is, in medical terms, the presence of an existing disease to which the new disease, COVID-19, is added making the person’s condition worse: accelerating the death-dealing nature of the prior morbidity or creating a new condition, e.g., viral pneumonia, that did not exist in the absence of the new disease. And this is why professional diagnosis, care and/or intervention is required.
A lot of people have some form of existing chronic disease, or morbidity. That fact may or may not place them at greater risk of severe illness or death if they contract COVID-19. But the public needs a better picture of what does. For example, take diabetes. 86 million people have what is called “pre-diabetes” for which they may have been prescribed medication to control it. People with pre-diabetes are at risk to progress to Type 2 Diabetes which, in turn, may progress to a need for insulin injections, kidney dialysis, and/or kidney transplant. Type 1 diabetes starts in children as something they were born with and requires insulin and stringent dietary controls to preserve life.
There are about 1.2 million Type 1 diabetics in the US. I could not find a statistic with regard to the number of people who have been diagnosed with Type 2 diabetes, but given the number of pre-diabetics, that number has to be substantially higher than Type 1 diabetics. And then there is “gestational diabetes”. Between 2 percent and 10 percent of pregnant women develop diabetes during their pregnancies. If they do it predisposes them to develop Type 2 diabetes within 10 years of their pregnancy. All told one can estimate that about 100 million people in the country have some stage of “diabetes.” We hear the experts say that people with diabetes are at greater risk. What does that mean? Disaggregate the data for us.
The same goes for “heart disease” and for “kidney disease” and whatever other comorbidities that alarm the health community with respect to COVID-19. We live our lives by “rules of thumb.” Are we dealing with Category A, Category B, Category C, etc.? In my professional life, I was sometimes nervous about definitive answers. Lawyers are always issuing so many caveats that sometimes a client doesn’t know what actually is the advice. Doctors are doing it, too. Medicines (and TV commercials about medicines) have a long fine print of “don’t use this drug if” list.
I recognize that there is uncertainty, a confidence level that is reflexively modifying the statements of researchers and physicians. But now is the time that everyone just does their best, gives clear guidance and accepts that there will be bad outcomes when someone falls in the margins between Category A and B. As a public we need to accept it so our politicians and health care professionals can accept it.
The perfect is the enemy of the good. Or in this case — what we need to do to get through this.
[Note: Links to all my COVID-19 posts can be found here.]Published in