Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Day 68: COVID-19 Comorbidity
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:
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 General
Exactly.
It’s interesting the differences between the various states. The margins of error on the data for NC are much tighter than for many of the other states I looked at; I wonder why they’re more confident about those projections.
I understand why they keep the number of ICU beds available constant across the graphs, since there’s no easy way to predict how those will increase, but it seems unreasonable to assume that they won’t increase any over the next month or two. Especially in places where they expect a shortage. It’s not like people are just going to be sitting around waiting for that shoe to drop and not making any efforts to mitigate the damage.
I’m also curious whether they’re doing their modeling based only on state level actions. Here in NC it shows that there is no statewide order to stay at home (although I think there is now), but in our largest counties those orders went into place earlier this week. If they’re only looking at what happens at the state level they could be missing a lot.
I think the purpose regarding the ICU beds is to show current situation versus future need with the idea that it will help planning to get those beds. I’ll note that in my state (Arizona) the state Department of Health Services is estimating bed and ICU shortfalls much larger than in the IHME report.
I agree, the rate of growth is below 20% now over most of the country.
COVID-19 could start spreading again. There’s a danger that we could be heading for a roller coaster with repeated peaks in numbers of new cases. This has happened in other pandemics, like the Spanish Flu.
COVID-19 will be a threat until an effective vaccine comes out.
As I understand it, in Japan they wear masks if they are sick in order to protect others.
That is the usual. But in broader based flu epidemics they can have up to 80% of people wearing. Once you reach critical mass it becomes protective in both directions.
The masks would stop infected people from coughing and leaving virus-laden droplets on surfaces. That’s why it would help. I think people would understand that and be grateful to have them if it meant they could walk around outside their home confidently.
I believe it is simple to explain and that everyone would do it. Everyone has to do it because no one is sure who is and is not infectious right now.
FDA
CDC
OSHA
and another acronym I can’t recall
Obama doesn’t believe in the rule of law or the constitution
The NYT has explained it all:
I nominate @rodin and @arizonapatriot as Ricochet members of the month!
yes, big difference between nyc and albany and syracuse and buffalo and etc
the new york times keeps getting stupider by the minute.
NY times stupidity is growing exponentially
this is not the spanish flu
of course because they want more money from the feds and anyone else
has any government health department ever said, “we’re good, we have enough supplies and money and staff”?
We hope.
It’s something more disgusting than just stupidity.
Did you notice the headline has been changed? It’s still stupidly offensive and offensively stupid, but it now reads: The Religious Right’s Hostility to Science Is Crippling Our Coronavirus Response.
I wonder if anyone is keeping track of all the shifting headlines.
the spanish flu virus was not a corona virus unlike H1N1.
The spanish flu killed people quickly, 72 hours or less.
The spanish flu killed many between ages 20 and 60.
The spanish flu started at the end of world war 1.
Trench warfare is not social distancing.
We in Seattle are quite accustomed to seeing people in masks and think nothing of it. I’m beginning to think it’s irresponsible to go out to the grocery or drug store without disposable latex gloves and a mask. I don’t have a mask, but maybe the next time I go shopping I’ll wear a kerchief on my face like a robber in the old west. Perhaps I’ll look silly, but at this point who cares.
That top graph is telling, especially for one number. It turns out that all the focus on ventilators and supposed shortages is completely misleading and distracting from real issues. However many die here, it will not be for lack of ventilator support. We already have far more than the maximum projected demand.
Need a graph, and a model.
I haven’t read that Clifford but so hope you’re right. Do you have a source?
I hope they don’t come pre-infected, like USB storage media, digital picture frames, and other technology from China sometimes do.
I might just let them sit for a week before I distibute them.