Recommended by Ricochet Members Created with Sketch. Day 78: COVID-19 Post Hoc Ergo Propter Hoc

 

Our current snapshot above. But New York appears to have cleared the apex:

The deaths attributed to COVID-19 in NY will continue to rise for the next few days even as new cases fall.

The post today is prompted by a comment by @ontheleftcoast that linked to a video of Montana physician Dr. Annie Bukacek discussing how COVID-19 death certificates are being manipulated. Briefly, Dr. Bukacek describes how there is a distinction between: (1) people dying from some other cause while having detectable levels of the COVID-19 virus in their system, (2) people dying where COVID-19 exacerbated a condition from which the person would die fairly soon but maybe not as soon as they did, and (3) where COVID-19 is the cause of death to a normally healthy person without comorbidities (what I will call “true COVID-19 fatalities”). Think of number (3) as being the equivalent of the young people who died in 1918-1920 from the Spanish flu pandemic. How prevalent is that?

At some point we are going to know how many people were exposed to the virus and how many people were infected by the virus. That will form the denominator for post-event assessments on the lethality and severity of this disease. But Dr. Bukacek is highlighting that CDC guidance on how and when to list COVID-19 on death certificates makes cause of death presumptively COVID-19 if the person presents with any of the symptoms or has a positive test and subsequently dies. This means that the numerator for the infection fatality rate is most certainly going to be overstated. In other words, not only do the models project a level of death, but the procedure for assigning the official cause of death will tend to support the predictions whether or not it is factually so. Post hoc ergo propter hoc — “after this, therefore because of this” — we predicted people will die of COVID-19, therefore they must have died of COVID 19.

Why should we care if the cause of death and/or diagnosis is wrong? Three reasons: (1) a lot of important public policy decisions are being made on the assumption that this virus has a certain prevalence combined with lethality, (2) we can’t improve our epidemic modeling if the data is significantly wrong, and (3) mischaracterizing cause of death injects error into all other data regarding mortality. The third reason is real, but as Dr. Bukacek points out a substantial number of death certificates already convert mere educated guesses into solid statistical facts.

Let’s consider what we know and don’t know about the contagion and lethality of the COVID-19 virus. Here is a chart that was included in a New York Times piece last updated on February 28:

Left to right is contagion from lower to higher. Down to Up is lethality from lower to higher. Recent reports about aerosolization — that the virus can be transmitted through exhalation without riding on a droplet from a sneeze or cough — moves the salmon-colored box further to the right than where it was placed on February 28. But note that on the chart (a logarithmic presentation) the infection fatality rate estimated on February 28 was from 0.1% to more than 5%. But as of this date we still have no idea how many people have been infected, we only know the number of people who either were diagnosed based on presenting symptoms or who tested positive for the COVID-19 virus even though asymptomatic. The latter group is pretty small because, as a general rule, tests are not currently being administered to anyone who is asymptomatic.

The case fatality rate (CFR) (as opposed to the infection fatality rate shown on the graph above) in the US is currently greater than 3% because dividing the current death toll by the current case total (3.2%) does not reflect how many of the new cases will end in death. But the CFR calculation only reflects people diagnosed or testing positive, not those infected but not presenting symptoms or experiencing symptoms so mild that they do not seek medical care for the condition. And CFR is also being overstated because COVID-19 is being listed as the cause of death routinely now for cases that would have listed a different morbidity in the past.

So the truth is we still don’t know with any precision what the likelihood of infection is or the likelihood of severe illness or death in the event of infection. We do know some of the risk factors that lead to more severe cases and death. Foremost amongst these is being very old.

But what is “old”? We all have both a chronological age and a biological age. We all know our chronological age but few of us know our biological age. If we knew the biological age of true COVID-19 fatalities, what would that tell us about the disease?

[Note: Links to all my CoVID-19 posts can be found here.]

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  1. Susan Quinn Contributor

    I’m amazed at you, Rodin, and all the people who are determined to persist in dealing with all this information. It is mind-boggling. Just when we think we might have a handle on the data, some new factor comes in. And much of it is critical data to making sense of all the other data. I wonder if part of the problem is that everyone–everyone–wants answers right now! But when we jump to certain kinds of conclusions that are central to reaching other conclusions, rushing is clearly a problem.

     

    • #1
    • April 7, 2020, at 12:36 PM PDT
    • 6 likes
  2. DonG (skeptic) Coolidge

    I agree that attribution is a problem. I think the only honest way is to lump together seasonal flu, pneumonia, and C19 for the whole season. That should improve a lot of the mistakes and is sufficient for analysis. The models are joke, so it doesn’t matter that much. Hey Google, you have actual 24×7 location information and demographic information and some health information on most Americans, what does your model look??

    • #2
    • April 7, 2020, at 12:54 PM PDT
    • 4 likes
  3. EODmom Coolidge

    And people are asking what possible motive the DOCTORS could possibly have for manipulating data. Aside from CYA for having been really wrong about the trajectory of this virus, there’s money on the table. A lot of it. And when was the last time DOCTORS were the public faces of history? Those public medical faces have as much proclivity to political agenda as the next guy and susceptibility to fawning or flattery makes them good targets for progressive policy makers. I think policy makers are making decisions with far ranging implications without thinking through much or any of it. Same as when this whole business started. I’m pretty sure none of them thought about the “have not” businesses that won’t reopen because they were subsistence businesses just supporting themselves and their 3 employees without 3 months of cushion and no realistic way to pay back and small business loan. Feeling cranky today, even after Susan’s mindful comments this morning. 

    • #3
    • April 7, 2020, at 1:07 PM PDT
    • 5 likes
  4. Susan Quinn Contributor

    EODmom (View Comment):

    And people are asking what possible motive the DOCTORS could possibly have for manipulating data. Aside from CYA for having been really wrong about the trajectory of this virus, there’s money on the table. A lot of it. And when was the last time DOCTORS were the public faces of history? Those public medical faces have as much proclivity to political agenda as the next guy and susceptibility to fawning or flattery makes them good targets for progressive policy makers. I think policy makers are making decisions with far ranging implications without thinking through much or any of it. Same as when this whole business started. I’m pretty sure none of them thought about the “have not” businesses that won’t reopen because they were subsistence businesses just supporting themselves and their 3 employees without 3 months of cushion and no realistic way to pay back and small business loan. Feeling cranky today, even after Susan’s mindful comments this morning.

    I think that for this post, you’re entitled to cranky, @eodmom. Besides, cranky is a long way from anger!

    • #4
    • April 7, 2020, at 1:09 PM PDT
    • 1 like
  5. Valiuth Member
    Valiuth Joined in the first year of Ricochet Ricochet Charter Member

    Well if one is to argue about what counts as a COVID-19 death exactly, then one also has to consider the over all increased rate of death observed in places like Italy which isn’t officially attributed to COVID-19. Probably the most honest way to assess the impact of the virus on mortality, is to look at the overall rate of seasonal death of a country or region experiencing COVID-19 outbreak and compare it to previous years. Technically COVID-19 isn’t the cause of death if you die of a heart attack or injury, but if that death occurs because the medical system is being swamped with COVID-19 patients, and you can’t get treatment that normally would have saved your life is that not an affect of the COVID-19? The impacts of the pandemic are numerous and subtle, and honestly we won’t have a true sense of what it has done until we can look at it with some hindsight and distance. 

    • #5
    • April 7, 2020, at 1:10 PM PDT
    • 9 likes
  6. Bartholomew Xerxes Ogilvie, Jr. Coolidge

    Susan Quinn (View Comment):

    I wonder if part of the problem is that everyone–everyone–wants answers right now! But when we jump to certain kinds of conclusions that are central to reaching other conclusions, rushing is clearly a problem.

    This is what I keep reminding myself. We all want to know the answers to questions like “When will this be over?” and “How much risk is there?”, and there is no shortage of experts who are willing to give it a guess. But the bottom line is, right now we don’t know. There is far, far too much basic data that we just don’t have, starting with some very fundamental things like how many people are infected.

    This is not an indictment of the experts; they have no choice but to do the best they can with what little they have. But this is the fog of war; we’ll have to wait until the histories are written before we really know what happened in 2020.

    • #6
    • April 7, 2020, at 1:15 PM PDT
    • 4 likes
  7. Susan Quinn Contributor

    Valiuth (View Comment):

    Well if one is to argue about what counts as a COVID-19 death exactly, then one also has to consider the over all increased rate of death observed in places like Italy which isn’t officially attributed to COVID-19. Probably the most honest way to assess the impact of the virus on mortality, is to look at the overall rate of seasonal death of a country or region experiencing COVID-19 outbreak and compare it to previous years. Technically COVID-19 isn’t the cause of death if you die of a heart attack or injury, but if that death occurs because the medical system is being swamped with COVID-19 patients, and you can’t get treatment that normally would have saved your life is that not an affect of the COVID-19? The impacts of the pandemic are numerous and subtle, and honestly we won’t have a true sense of what it has done until we can look at it with some hindsight and distance.

    A dilemma at looking at overall rate of seasonal death, @valiuth, is they can vary tremendously from year to year. We only have to look at the numbers for flu to see the huge swing from one year to another. It’s tough, isn’t it?

    • #7
    • April 7, 2020, at 1:16 PM PDT
    • 1 like
  8. EODmom Coolidge

    Susan Quinn (View Comment):

    EODmom (View Comment):

    And people are asking what possible motive the DOCTORS could possibly have for manipulating data. Aside from CYA for having been really wrong about the trajectory of this virus, there’s money on the table. A lot of it. And when was the last time DOCTORS were the public faces of history? Those public medical faces have as much proclivity to political agenda as the next guy and susceptibility to fawning or flattery makes them good targets for progressive policy makers. I think policy makers are making decisions with far ranging implications without thinking through much or any of it. Same as when this whole business started. I’m pretty sure none of them thought about the “have not” businesses that won’t reopen because they were subsistence businesses just supporting themselves and their 3 employees without 3 months of cushion and no realistic way to pay back and small business loan. Feeling cranky today, even after Susan’s mindful comments this morning.

    I think that for this post, you’re entitled to cranky, @eodmom. Besides, cranky is a long way from anger!

    You’re very kind – we’ve been talking a lot about the “have/have-not” nature of these policies and I’m closer to anger. The haves: all the “essential” employees (which includes EODDad who’s really busy because his company’s orders for Q2- from Asia – are ahead of forecast because they are not pausing) and government of all stripes employees, most of whom are on paid vacation since offices are closed, education professionals and support….. you get the picture. Then there are the have-nots: the hair dressers, “local” retail and non-take out franchise, restaurants, bars and diners who really can’t do take-out, 95% of hospitality…… you get the picture. There are a lot of businesses on our Seacoast that will not re-open. Tax relief doesn’t help when you have no revenue. Said policy makers were far too cavalier about the shut down. Elephant gun for a mosquito. Maybe if I plant the forsythia I just got I’ll be more optimistic. I’ll measure the peony stalks to see how far they’ve grown. They won’t bloom until June but. You’re kind. 

    • #8
    • April 7, 2020, at 1:22 PM PDT
    • 5 likes
  9. Rodin Member
    Rodin

    Susan Quinn (View Comment):
    I wonder if part of the problem is that everyone–everyone–wants answers right now! But when we jump to certain kinds of conclusions that are central to reaching other conclusions, rushing is clearly a problem.

    Yes. I don’t know when I first heard the term “creative procrastination”. It is based on the belief that things generally sort themselves out if you just wait rather than react. And the solutions, when they occur are just as good or better than what the presumptive “actor” would have imposed.

    It’s something that power holders and power seekers do not generally employ. The last president to have practiced creative procrastination on an important national issue was Calvin Coolidge. Herbert Hoover did not and put the nation on a path for a prolonged Depression. (FDR just blamed Hoover and copied the playbook, with some additional progressive embellishments that made things worse.)

     

    • #9
    • April 7, 2020, at 1:48 PM PDT
    • 4 likes
  10. Rodin Member
    Rodin

    Valiuth (View Comment):
    Technically COVID-19 isn’t the cause of death if you die of a heart attack or injury, but if that death occurs because the medical system is being swamped with COVID-19 patients, and you can’t get treatment that normally would have saved your life is that not an affect of the COVID-19?

    This is why protecting the health care system was always job #1. 

    • #10
    • April 7, 2020, at 1:57 PM PDT
    • 2 likes
  11. Larry3435 Member

    On almost every line of this chart the number of actives cases plus the number of deaths is more than 90% of the total cases. Whiskey Tango Foxtrot! Does no one ever recover from this disease?

    • #11
    • April 7, 2020, at 2:13 PM PDT
    • 3 likes
  12. Rodin Member
    Rodin

    Larry3435 (View Comment):

    On almost every line of this chart the number of actives cases plus the number of deaths is more than 90% of the total cases. Whiskey Tango Foxtrot! Does no one ever recover from this disease?

    @larry3435, have you met @henryracette?

     

    • #12
    • April 7, 2020, at 2:22 PM PDT
    • 2 likes
  13. Ontheleftcoast Member

    Nutritionist (as in PhD) Chris Masterjohn (a really smart guy who knows how to read papers) 

    The first is a research letter published in the Nature journal Signal Transduction and Targeted Therapy. They found that low lymphocyte percentage strongly predicts whether someone with a severe case recovers or dies. They focus on the lymphocyte count at two time points:

    • 10-12 days after symptoms arose, someone with a lymphocyte count below 20% would become a severe case and someone with a lymphocyte count above 20% would not.
    • On days 17-19 after symptoms arose, someone with a lymphocyte count below 5% would wind up in ICU and have a strong chance of dying within 12 days; someone with a count between 5-20%, by contrast, would recover.

    However, if you look at Figure 1A, another point emerges: on the first day of symptoms, the mean lymphocyte count of people who never developed into a severe case was just over 25%, with very little variation. Those who wound up in ICU had a mean of 15%, with little variation. Those who wound up with severe cases that were cured also had a mean close to 15%, but (as represented by the error bar in the graph) there was a lot of variation in that group.

     

    The second study used 36 patients and was published on Saturday as a preprint, which means it hasn’t yet been peer-reviewed. The vast majority of influential information circulating on COVID-19 comes from preprints simply because the situation is evolving so rapidly and it takes so long to get something peer-reviewed.

    This study found that interleukin-6 (IL-6) is an extremely effective predictor of whether someone will require ventilation.

    Typical levels of IL-6 in a healthy person are 5-7 pg/mL or lower.

    Figure 1 from this paper shows how IL-6 can be used both at first admission to the hospital, and, when measured over time, at peak level, to predict who will need mechanical ventilation. Upon first admission, a threshold of 15 pg/mL or higher would capture everyone who would eventually need ventilation, while also including many patients who would not. A threshold of 50 pg/mL would eliminate 95% of those who would not need ventilation, while only losing 23% of those that would.

    IL-6 is even more useful if measured regularly. 93% of those who would go on to need ventilation had a peak IL-6 above 80 pg/mL, while only 4% of those who did not need ventilation had a peak IL-6 that high.

    Everyone who went on to need ventilation had a peak IL-6 above 50 pg/mL, while only 17% of those who did not need ventilation had a peak IL-6 that high.

    Both are small studies; neither is adequate as a basis for an evidence-based standard of care. But where we are now? Enough to be actionable by a physician.

     

     

     

     

    • #13
    • April 7, 2020, at 2:26 PM PDT
    • 3 likes
  14. Locke On Member

    Larry3435 (View Comment):

    On almost every line of this chart the number of actives cases plus the number of deaths is more than 90% of the total cases. Whiskey Tango Foxtrot! Does no one ever recover from this disease?

    Recovery stats are very spotty, inconsistent among states and countries, and probably not very accurate to begin with. It’s unlikely that there’s much follow-up on those who test positive, aren’t ill enough for the hospital, and are just sent home to self-quarantine and recuperate. No one has the time.

    • #14
    • April 7, 2020, at 2:28 PM PDT
    • 6 likes
  15. Jerry Giordano (Arizona Patrio… Member

    Rodin: Briefly, Dr Bukacek describes how there is a distinction between: (1) people dying from some other cause while having detectable levels of the COVID-19 virus in their system, (2) people dying where COVID-19 exacerbated a condition from which the person would die fairly soon but maybe not as soon as they did, and (3) where COVID-19 is the cause of death to a normally healthy person without comorbodities (what I will call “true COVID-19 fatalities”). Think of number (3) as being the equivalent of the young people who died in 1918-1920 from the Spanish flu pandemic. How prevalent is that?

    I think that there is another category, somewhere between (2) and (3). Call it (2.5), people dying after contracting COVID-19 who are susceptible to opportunistic infection because of a comorbidity or advanced age. 

    Such a person would not necessarily “die fairly soon” in the absence of a COVID-19 infection, but they are more susceptible to death than the typical person.

    Our bodies have a limited ability to repair damage, whether the damage is from gross physical trauma (say a cut on the arm) or smaller cellular trauma (from a disease or poison). As we age, our bodies seem to gradually lose their ability to self-repair, and other health problems (comorbidities) can also make it more difficult to repair damage.

    When such a person dies of COVID-19, it is true that the COVID-19 caused the death, even though the person might well have survived had they been younger or healthier.

    I definitely agree that there is a danger that COVID-19 fatalities are being overcounted.

    • #15
    • April 7, 2020, at 2:36 PM PDT
    • 7 likes
  16. Rodin Member
    Rodin

    Ontheleftcoast (View Comment):
    lymphocyte count

    Ontheleftcoast (View Comment):
    interleukin-6 (IL-6)

    @ontheleftcoast, do you know whether the observation is dependent on or independent of viral infection? That is, do these (one or both) predict a higher risk of severity of illness or death if infected, or do these (one or both) react to the presence of the virus?

    • #16
    • April 7, 2020, at 3:11 PM PDT
    • Like
  17. Unsk Member

    LA County has fallen below it’s apex as well.

    4-6 550 cases, (6960 total, 8.6% growth ) 22 deaths ( 169 total 14.97% growth)

    4-5 420 cases,

    4-4 663 cases

    4-3 711 cases ( apex) 

     

    Washington also looks like it is way past it’s apex and is falling down through pack in terms of total cases. California is also falling down through the pack, but not as radically. 

    • #17
    • April 7, 2020, at 4:49 PM PDT
    • 4 likes
  18. Ontheleftcoast Member

    Rodin (View Comment):

    Ontheleftcoast (View Comment):
    lymphocyte count

    Ontheleftcoast (View Comment):
    interleukin-6 (IL-6)

    @ontheleftcoast, do you know whether the observation is dependent on or independent of viral infection? That is, do these (one or both) predict a higher risk of severity of illness or death if infected, or do these (one or both) react to the presence of the virus?

    I suspect that it may be both, depending. In many acute viral diseases, lymphocytes in general go up to deal with the infection, so having enough of the right ones to begin with is a good thing.

    T cells and B cells are lymphocytes. They became better understood — and better known to the public — as AIDS was initially elucidated. Both are triggered by (and memory T cells help produce) our immune “memory.” There’s also a subset of T cells call “Natural Killer” cells which don’t need to be primed by antibodies to destroy damaged or virally infected cells. All will be reflected in the lymphocyte count. Regulatory T-cells (T-regs) are known to modulate immune tolerance, including tolerance to self which gets out of whack in autoimmune diseases.

    NK cells are primed by cytokines, which are sort of like pheromones for cells. Inflammatory cytokines tend to be released by cell damage or distress. IL-6 is heavily proinflammatory except in muscle cells, where itcan also modulate inflammation. (Heart is also a muscle.) NK cells themselves are also regulatory in action.

    At least in part, an antibody response is initiated by infection or foreign matter that’s not contained by cell-mediated immunity (the initial NK cell and phagocytic cell (including white blood cell) response; this sets off “danger” signals which result in antibody formation. If there is already immune dysregulation, or if the damage is so massive that the danger signaling expands or persists, the combination of debris from our own cells plus a hyper-aware antibody response can result in antibodies forming to our own cells in places and a manner which are abnormal. (Autoantibodies are probably regulatory in a healthy organism. It’s a good basic rule of thumb that all long standing inflammation produces autoimmune damage.)

    So initially elevated IL-6 would suggest that your patient started out behind the 8-ball before the virus hit: it’s a component of a lot of those pre-existing pathologies; already the result of being steered towards “less bad” choices because good ones aren’t so available. You could say that “good health” is a result of less accumulation of “less bad” responses.

    My guess is that low lymphocytes, particularly NK cells, impairs the response to SARS-CoV-2, but it may also be that the virus damages lymphocytes as well. And it also looks as though the antibody forming process may be impaired as well; see the paper linked in the continuation.

    • #18
    • April 7, 2020, at 4:52 PM PDT
    • 3 likes
    • This comment has been edited.
  19. Ontheleftcoast Member

    A Chinese paper:

    Of the 452 patients with COVID-19 recruited, 286 were diagnosed as severe infection. The median age was 58 years and 235 were male. The most common symptoms were fever, shortness of breath, expectoration, fatigue, dry cough and myalgia. Severe cases tend to have lower lymphocytes counts, higher leukocytes counts and neutrophil-lymphocyte-ratio (NLR), as well as lower percentages of monocytes, eosinophils, and basophils. Most of severe cases demonstrated elevated levels of infection-related biomarkers and inflammatory cytokines. The number of T cells significantly decreased, and more hampered in severe cases. Both helper T cells and suppressor T cells in patients with COVID-19 were below normal levels, and lower level of helper T cells in severe group. The percentage of naïve helper T cells increased and memory helper T cells decreased in severe cases. Patients with COVID-19 also have lower level of regulatory T cells, and more obviously damaged in severe cases.

    So my best guess is that both low lymphocytes and high IL-6 are part of the predisposition to a bad outcome at the time of infection, but that they also may predispose to, and be part of, vicious cycles once the infection gets going.

    ————–

    Which, as a postscript, are part of the bad outcome. Positive feedback can be a good thing, until it doesn’t stop when it should and gets redefined as vicious cycles.

    • #19
    • April 7, 2020, at 5:08 PM PDT
    • 3 likes
    • This comment has been edited.
  20. Bartholomew Xerxes Ogilvie, Jr. Coolidge

    Locke On (View Comment):

    Recovery stats are very spotty, inconsistent among states and countries, and probably not very accurate to begin with.

    This is one of the reasons why I continue to be so frustrated with the media focus on the the two scariest-sounding statistics: total number of cases, and total number of deaths. Those two numbers will never do anything but go up, and neither one tells us anything at all about the demands on the health-care system, which is supposed to be what we’re worried about.

    Much more interesting to me is the question “How many people are sick with COVID-19 right now?” Unfortunately, because mild cases are not tracked to recovery, I don’t think anyone knows. The closest we have is statistics on hospitalizations, which at least are possible to find if you look for them. Our local TV news has at least started to include that number in their charts for North Carolina, but of course it’s not the number they write headlines about.

    • #20
    • April 7, 2020, at 5:55 PM PDT
    • 3 likes
  21. Caroline Thatcher
    Caroline Joined in the first year of Ricochet Ricochet Charter Member

    Is NYC undercounting deaths? I thought this was an interesting article. Maybe some data experts will look at trends like this in all the hot spots. 

    https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths 

    • #21
    • April 7, 2020, at 6:03 PM PDT
    • 4 likes
  22. Hammer, The Member

    Caroline (View Comment):

    Is NYC undercounting deaths? I thought this was an interesting article. Maybe some data experts will look at trends like this in all the hot spots.

    https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths

    There was an article like that on NR as well. I think the evidence cited also supports a totally different conclusion. People stay home because of lockdown orders and because they are now scared to go to the hospital. Some people may well die for lack of treatment when they would otherwise go to the Dr. or ER. The headline could just as well read: “Cure Worse than Disease: are People staying home instead of getting care?”

    I’m not saying one of those is definitely correct, just that the conclusion is rarely as obvious as those writing the articles would like to suppose.

    • #22
    • April 7, 2020, at 6:13 PM PDT
    • 5 likes
  23. MarciN Member

    It’s important to keep in mind that the CDC has been attributing to the “flu” many deaths that were actually caused by secondary infections that ended up as pneumonia. What was the cause of death? To me, it was pneumonia. To the CDC, it was the flu. It’s just exactly what you are describing is happening right now with the CDC and covid-19. If someone tests positive for flu or is admitted to a hospital with flu symptoms during flu season and the person dies, the death certificate says the person died of the flu or complications from the flu. That’s not really helpful or entirely accurate.

    It is definitely political and financial. Flu shots would stop the whole upper-respiratory disease chain of events that leads to the deaths. The flu weakens the patient, and other viruses and bacteria go in for the kill. In the mind of the good people at the CDC, “Just get the flu shot, and you can avoid all this.”

    While I understand what they are saying, they are not being entirely truthful–it’s more a lie of omission than commission. :-)

    It serves the CDC’s purposes to attribute as many deaths to the flu as possible as a way to convince people to get a flu shot. However, you’ll see on every web page in which they discuss flu mortality, the dodgy wording always includes something about secondary infections. The secondary infection is most often viral or bacterial pneumonia.

    So they are–for some altruistic purpose, I’m sure–already fudging numbers for political purposes. It’s no stretch for them at all to similarly fudge the death certificates for covid-19.

    The only way we will ever sort all this out is to take and store for research purposes vials of blood from deceased people so we can construct a profile of antibodies and active viruses and bacteria.

    It’s hard for me to take seriously the CDC’s or state’s numbers on the flu deaths because I know most of those are caused by a secondary infection, usually pneumonia. All they are doing now is further obfuscating the flu-virus picture by adding on the covid-19 deaths. The created a problem for themselves–Hello, Pinocchio. :-)

    They need a good conference with Jordan Peterson on the subject of the importance of truth. :-)

    • #23
    • April 7, 2020, at 6:50 PM PDT
    • 2 likes
    • This comment has been edited.
  24. Valiuth Member
    Valiuth Joined in the first year of Ricochet Ricochet Charter Member

    Susan Quinn (View Comment):

    Valiuth (View Comment):

    Well if one is to argue about what counts as a COVID-19 death exactly, then one also has to consider the over all increased rate of death observed in places like Italy which isn’t officially attributed to COVID-19. Probably the most honest way to assess the impact of the virus on mortality, is to look at the overall rate of seasonal death of a country or region experiencing COVID-19 outbreak and compare it to previous years. Technically COVID-19 isn’t the cause of death if you die of a heart attack or injury, but if that death occurs because the medical system is being swamped with COVID-19 patients, and you can’t get treatment that normally would have saved your life is that not an affect of the COVID-19? The impacts of the pandemic are numerous and subtle, and honestly we won’t have a true sense of what it has done until we can look at it with some hindsight and distance.

    A dilemma at looking at overall rate of seasonal death, @valiuth, is they can vary tremendously from year to year. We only have to look at the numbers for flu to see the huge swing from one year to another. It’s tough, isn’t it?

    Well, no system is perfect. I think the in the looks at Italy they used an average seasonal mortality rate averaged over several years. Generally, even highly stochastic events over time smooth out, and you can get an idea of the background level. Then you can use that to see if something is now out of the ordinary. So with COVID-19 in Italy they were seeing something like 2000 extra deaths in a city were the average mortality rate for March was something like a few hundred people normally and only half that number was directly attributed to COVID-19 by Italian authorities. I think in New York I read that the number of at home deaths has started to shoot up. Most of those will not be counted as COVID-19, and most probably aren’t directly COVID-19. But it is hard to imagine that the aggravating factor for the increase isn’t COVID-19 in one way or another.

    • #24
    • April 7, 2020, at 7:08 PM PDT
    • 3 likes
  25. Locke On Member

    Bartholomew Xerxes Ogilvie, Jr. (View Comment):
    Much more interesting to me is the question “How many people are sick with COVID-19 right now?” Unfortunately, because mild cases are not tracked to recovery, I don’t think anyone knows. The closest we have is statistics on hospitalizations, which at least are possible to find if you look for them. Our local TV news has at least started to include that number in their charts for North Carolina, but of course it’s not the number they write headlines about.

    Our state health department is tracking and releasing data on hospitalizations and ICU cases, which seems to be better than most. They aren’t tracking (or at least not releasing) counts on out-of-hospital recoveries.

    I think we’re going to end up needing to do massive antibody screening anyway, to figure out how many asymptomatic cases were missed, and what the population immunity level is, as part of a restart plan.

    • #25
    • April 7, 2020, at 7:55 PM PDT
    • 4 likes
  26. Ray Kujawa Coolidge

    I went looking for the answer to my own question. HCQ has been in trials for a week in NYC and the first numbers should have been available Tuesday, yesterday.

    • #26
    • April 8, 2020, at 12:32 AM PDT
    • 2 likes
  27. iWe Reagan
    iWe Joined in the first year of Ricochet Ricochet Charter Member

    Valiuth (View Comment):
    Technically COVID-19 isn’t the cause of death if you die of a heart attack or injury, but if that death occurs because the medical system is being swamped with COVID-19 patients, and you can’t get treatment that normally would have saved your life is that not an affect of the COVID-19? The impacts of the pandemic are numerous and subtle, and honestly we won’t have a true sense of what it has done until we can look at it with some hindsight and distance. 

    Which means that we cannot be sure whether COVID or our own auto-immune reaction to it is the cause of death. Our society needs to chill the reaction down…

    • #27
    • April 8, 2020, at 5:29 AM PDT
    • 2 likes
  28. Mendel Member
    Mendel Joined in the first year of Ricochet Ricochet Charter Member

    The question of “what really caused this patient’s death” is very important, but can also quickly turn into counting angels on the head of a pin.

    The two extreme examples are obvious: either a young, healthy person being killed by the 1918 flu or a lifetime smoker who dies of lung cancer but is positive for herpes simplex virus 1 (as is the majority of the population). In the former case we would attribute 100% of the cause of death to the virus, in the latter case 0%.

    The difficulty is that most Covid-19 patients will lie somewhere in between, and at some point trying to figure out if they belong to category 2.25 or 2.26 is mere hair-splitting. Luckily, there are already other metrics that can be used that are more meaningful:

    The first is the concept of quality-adjusted years of life (QALY). The concept is based on the notion of: how much longer would we have expected this person to have lived without the infection? It’s obviously a hypothetical question that can only be answered using analysis of lots of demographic and health data, but there are well-established tools to perform these calculations that are used worldwide on a daily basis and which seem to be much more reliable than, see, epidemiological modeling algorithms.

    The other metric is what Valiuth mentioned above: how many total deaths are registered in the time/region of an outbreak? If the total number of deaths doubles or triples during an outbreak – which has been observed in Spain, Italy, and even NYC – then we can reasonably say the virus is placing a highly unusual burden on our healthcare system that can’t simply be waved away.

    • #28
    • April 8, 2020, at 5:49 AM PDT
    • 3 likes
  29. Mendel Member
    Mendel Joined in the first year of Ricochet Ricochet Charter Member

    The other incredibly important companion question to “what are people really dying of?” is “how many people would Covid-19 kill without ICU care?”.

    Most of the deaths so far have been very elderly people who by all accounts were already in poor health. Conversely, the demographic makeup of coronavirus patients in ICU units is much more diverse: many more (relatively) younger and healthier people who would presumably have many more years of life ahead of them. If these people would start dying in the event of overfilled ICUs, that would change the calculus regarding the value of providing care and/or slowing the spread of the epidemic.

    But as far as I can tell there’s no reliable, consistent data on this topic anywhere.

    • #29
    • April 8, 2020, at 5:52 AM PDT
    • 3 likes
  30. Kozak Member
    Kozak Joined in the first year of Ricochet Ricochet Charter Member

    Hammer, The (View Comment):

    Caroline (View Comment):

    Is NYC undercounting deaths? I thought this was an interesting article. Maybe some data experts will look at trends like this in all the hot spots.

    https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths

    There was an article like that on NR as well. I think the evidence cited also supports a totally different conclusion. People stay home because of lockdown orders and because they are now scared to go to the hospital. Some people may well die for lack of treatment when they would otherwise go to the Dr. or ER. The headline could just as well read: “Cure Worse than Disease: are People staying home instead of getting care?”

    I’m not saying one of those is definitely correct, just that the conclusion is rarely as obvious as those writing the articles would like to suppose.

    Some of these deaths are likely in fact due to people staying home and not seeking treatment for other disease like heart attack, stroke, diabetes.  But there is no way it would account for an 8 fold increase in the number of people dying at home. Most of those deaths are almost certainly due to Covid related illness.

    • #30
    • April 8, 2020, at 8:18 AM PDT
    • 5 likes