Coronavirus

[Julian]

So, when we knew nothing, I was more fearful of this virus. As I know more now, I'm a lot less fearful. The virus has been weaponized for political gain. My predictions are that if one party sweeps, the virus becomes a non issue by April. If the underdog sweeps, or even retains one branch of government, the virus will continue to "kill us all" until 2024.

Personally, I rely on statistics to determine my fear level. I think the news and political focus on "cases" is complete bullshit. If you're a hammer, everything looks like a nail. If we put the same focus on other viruses each year, we would have a lot more reported cases. Deaths are what makes this virus lethal (literally). In the same way, if we reported all car accidents, no matter how big or small, in WI in a day, it sure would look a lot more scary than vehicle related deaths.

Where I live, in Wisconsin (a so-called hot zone), I look at our death rate. Currently, our death rate is 2x as much as the 2019 flu season. If I use reason and say "not all flu deaths in 2019 were probably reported correctly AND it's possible that there were deaths associated to covid in 2020 that probably weren't covid..." then one could reasonably say that the death rate for covid is higher than the seasonal flu, but not by much.

I believe that in 10 years we will look back on the politicians and the media that made tons of money on this pandemic and scream "shame on you." However in the current culture of cancellation for a view outside of "common sense" (also known as collective echo chambers), a dissenting opinion could ruin your life.

Btw, just to show my work:

From: Influenza (Flu).
"During the 2019-2020 flu season, there were 36,175 cases of the flu in Wisconsin. Of these, there were 4,425 flu-related hospitalizations and 183 deaths, including three children "

So in 2019, .5% of all reported flu cases in WI ended in death.

From (and as of this post):

wisconsin covid deaths - Google Search

www.google.com

183,000 cases and 1,624 deaths

So in 2020, where we're hypervigilant about testing and attributing covid, the death rate is .9%

I don't think comparing the death "rate" is the correct approach here. I'd suggest that comparing the number of deaths 1624 (in half a year) VS 183 in a full year is what you should be comparing. In that case the increase in the death rate is very concerning (and only covers 1/2 a year, and not the part of the year when we typically see the biggest spike in airborne communicable disease (using Flu as the closest disease). Is it something anyone should panic about....no. But it is a massive amount more than the flu kills.

The annual numbers for flu deaths is estimated to be 30-60,000 (and this is an extrapolated number, not confirmed tests, but based on actual death counts (7700 in the last flue season) excess death data, tests etc). This same approach is being used to estimate the complete Covid death rate - fortunately because we are testing a ton, the miscount is only 10-20% low (so the 220,000 dead so far is more like 242,000-264,000 - to make the flu comparison apples to apples). So at least 4 times the death rate so far - and we don't have a full year yet on the covid data to a maximum of 8 times (depending on if you use the low or high range numbers.

60,000 flu deaths vs 242,000 covid deaths = 4 times
30.000 flu deaths vs 264,000 covid deaths = 8.8 times

Sobering numbers no matter how you look at it. One way to wrap your head around it: Flu - 1 intercity jet crashing a day (164 people). Covid - 6 inter city jets crashing a day (1000). Neither is good.

 

[Evil Sports]

Personally, I rely on statistics to determine my fear level. I think the news and political focus on "cases" is complete bullshit. If you're a hammer, everything looks like a nail. If we put the same focus on other viruses each year, we would have a lot more reported cases. Deaths are what makes this virus lethal (literally). In the same way, if we reported all car accidents, no matter how big or small, in WI in a day, it sure would look a lot more scary than vehicle related deaths.

Thanks, I dont feel so alone any more.

 

[tabbibus]

You might get censored in Twitter for saying anything helps. It was somewhat tongue in cheek comment. The plasma exchange makes sense, but is it a widespread and available treatment? It seems it is not scaleable. The steroids make sense. My wife’s business has been decimated by covid as their major product is nebulizers. It seems there is a fear of spreading covid with a nebulizer vs successful treatment alternative.

Plasma exchange is only been done in the ICU in my institution. I suspect it is the case for many other places as well. It is as scaleable as hemodyalisis, which is to say it can be but it is not easy.

Nebs, yeah, we still shy away from doing aerosol generating procedures with known covid patients. That being said, all other restrictions at least in my neck of the woods have been relaxed to what they were before. So inpatient asthmatics and COPD folks can get their nebs again. I also use steroid nebs for pts recovering from covid at home.

 

[tabbibus]

So yeah, has it been used for political gain, absolutely. And I will not delve into the merits of that in this discussion. But that does not make it any less real or dangerous. See Julian's post above. And statistics aside, all I can say is that I've seen it first hand. I've treated flu for many years and now I've treated COVID. No doubt covid is worse. I have zero doubt in my mind about it.

Lastly, I wish we would stop focusing on deaths so much. I think I've also said this before. But recovery from COVID does not look like recovery from flu, or any other viral PNA. It is long, hard, debilitating. And complications post COVID are not only for those who had serious disease. I've seen my fair of young healthy people who only had some sniffles and shortness of breath end up with lung scarring (no way to fix this) or heart issues.

 

[Evil Sports]

Can you say from a medical standpoint why Plasma exchange works

 

[tabbibus]

Can you say from a medical standpoint why Plasma exchange works

The general theory is this:
- One of the main contributing factors for how sick people get is the inflammatory response from the body. This is made up of cytokines, think about them as signals. These signals tell our immune system to go beserk. And this leads to organ damage.
- These cytokines are soluble. Once produced and secreted they travel in the liquid part of the blood, the plasma.
- During plasma exchange we remove the patient's plasma that is all nasty and full of pro inflammatory cytokines and we give them new, "clean" plasma that does not have these cytokines.
- We do this for 5 sessions, one a day.
- The inflammatory markers that we measure go waaaaaay down and most patients respond very well, needing less oxygen and if awake, feeling better.

Caveats
- not the same as convalescent plasma. In fact, if you give convalescent plasma and then do exchange soon after, you basically defeat the purpose of the first one.
- It requires a big ol catheter placed in a large vein (jugular, subclavian, femoral). This has it's own set of risks
- It requires close monitoring of many blood parameters.

So it is not like we can offer this to everyone. Just those that get sick enough to come to the ICU.

 

[anmut]

I don't think comparing the death "rate" is the correct approach here. I'd suggest that comparing the number of deaths 1624 (in half a year) VS 183 in a full year is what you should be comparing. In that case the increase in the death rate is very concerning (and only covers 1/2 a year, and not the part of the year when we typically see the biggest spike in airborne communicable disease (using Flu as the closest disease). Is it something anyone should panic about....no. But it is a massive amount more than the flu kills.

The annual numbers for flu deaths is estimated to be 30-60,000 (and this is an extrapolated number, not confirmed tests, but based on actual death counts (7700 in the last flue season) excess death data, tests etc). This same approach is being used to estimate the complete Covid death rate - fortunately because we are testing a ton, the miscount is only 10-20% low (so the 220,000 dead so far is more like 242,000-264,000 - to make the flu comparison apples to apples). So at least 4 times the death rate so far - and we don't have a full year yet on the covid data to a maximum of 8 times (depending on if you use the low or high range numbers.

60,000 flu deaths vs 242,000 covid deaths = 4 times
30.000 flu deaths vs 264,000 covid deaths = 8.8 times

Sobering numbers no matter how you look at it. One way to wrap your head around it: Flu - 1 intercity jet crashing a day (164 people). Covid - 6 inter city jets crashing a day (1000). Neither is good.

Yes, you're correct on comparing the 2019 not-novel flu virus to a completely novel virus. But I wonder what the flu's mortality rate looked like when it was novel?

And you have to admit that, if all you're ever looking for is the covid-19 virus, then that's all you'll ever see in the deaths associated from it. There's zero information on underlying issues for these deaths. All we hear is "cases are up, panic!" "deaths are up, panic!" 1 in every 4 deaths is related to heart disease in the US each year - but nobody's suggesting masks should be worn while eating fast food, right?

What I want to know is pretty simple (but of course completely hidden because it's not the agenda): How many covid deaths are people that smoke. How many deaths were from people that spent one or more days in a hospital in the twelve months before they had covid? What is the average BMI of someone that died from covid?

This is rational, non-HIPPA related information, that isn't shared, isn't talked about by pundits, politicians (on either side), or media networks, but is ABSOLUTELY necessary for those of us with a brain that can, and want to, make their own decisions on how dangerous this is.

 

[tabbibus]

You are right. HIPAA. But to generally answer you question based on the many COVID patients I have taken care of in the ICU

COVID does not care. Older, obese, hypertensive patients do worse. But I have had 40 somethings die on me. With no previous medical history. I don't know what else to tell you my man. Does it matter if they had other comorbidities? Fact is, they are still getting sick.

And if you listen to scientists and doctors (yes I know, apparently this is a bad thing to do per some people in power who shall not be named), we are not advocating panic. We are asking for common sense, we are asking for us to care about others, we are asking simple things like mask wearing and to not congregate in closed quarters. Man, it really is not that hard. We will raise the tone of our asks when our ICUs and floor beds are overwhelmed, because believe me, that shit is panic inducing. When we have sick people and no where to put them, we panic. But we are not asking the general population to do so.

 

[Ronnie]

The 18 year old I know who tested positive for Covid, and which caused my family to be tested, tested positive again after a two week quarantine. He is a good friend of my Son and a good kid generally (varsity athlete, 4.5 gpa, accepted to uc Berkeley, polite/considerate). I am happy he was never admitted to the hospital and that his recovery is going well so far but am concerned that he may now be stricken with life long after effects, like scarred lungs and / or Covid cloudiness (media term). I reiterate that he didn’t die which is excellent news but he may not be able to reach his full potential physically or mentally again. To think he is just one of millions of other Americans who were infected is just heart breaking, especially in light of the fact that he is a “common citizen” who is not likely to get any special, expedited or experimental treatments or therapies. The mortality rate is important but what about the rate of survivors whose lives will be forever changed? Shouldn’t we as a society care about this, the living, at least as much as we care or appear to care about the dead?

 

[Julian]

Yes, you're correct on comparing the 2019 not-novel flu virus to a completely novel virus. But I wonder what the flu's mortality rate looked like when it was novel?

And you have to admit that, if all you're ever looking for is the covid-19 virus, then that's all you'll ever see in the deaths associated from it. There's zero information on underlying issues for these deaths. All we hear is "cases are up, panic!" "deaths are up, panic!" 1 in every 4 deaths is related to heart disease in the US each year - but nobody's suggesting masks should be worn while eating fast food, right?

What I want to know is pretty simple (but of course completely hidden because it's not the agenda): How many covid deaths are people that smoke. How many deaths were from people that spent one or more days in a hospital in the twelve months before they had covid? What is the average BMI of someone that died from covid?

This is rational, non-HIPPA related information, that isn't shared, isn't talked about by pundits, politicians (on either side), or media networks, but is ABSOLUTELY necessary for those of us with a brain that can, and want to, make their own decisions on how dangerous this is.

Are you suggesting that there is something else besides Covid that has caused the excess deaths we know are happening (at a rate higher than covid deaths), that our healthcare system is unaware of?

 

[GTBRMC]

Are you suggesting that there is something else besides Covid that has caused the excess deaths we know are happening (at a rate higher than covid deaths), that our healthcare system is unaware of?

It is quite clear that the hard shutdowns across much of the country in March - June timeframe caused many healthcare organizations to postpone all sorts of medical, dental, and other care from routine checkups to surgeries of various types to chemo and other time-sensitive therapies. It is also likely (but less clear) that patient and/or provider fear or reluctance to pursue such care has continued to be a problem.

These effects have contributed to 2020 excess deaths, no doubt. I have never seen any data, nor even estimates, about the magnitude and significance of these effects, however. Has anyone else seen such data?

 

[AZMark]

If anyone’s chemo or emergency surgery was delayed it was due to an overwhelmed system, not a government shutdown.
If there were no shutdown then you would absolutely have more COVID cases, which would tax the system further, which means maybe more people get diagnosed but less get treated.

 

[Julian]

It is quite clear that the hard shutdowns across much of the country in March - June timeframe caused many healthcare organizations to postpone all sorts of medical, dental, and other care from routine checkups to surgeries of various types to chemo and other time-sensitive therapies. It is also likely (but less clear) that patient and/or provider fear or reluctance to pursue such care has continued to be a problem.

These effects have contributed to 2020 excess deaths, no doubt. I have never seen any data, nor even estimates, about the magnitude and significance of these effects, however. Has anyone else seen such data?

I've not seen any data to this effect, but I've heard this theory and it seems plausible as a possible explanation for some excess deaths. I've not heard of anyone delaying chemo or time sensitive therapies, only elective surgeries. Some have theorized that people who SHOULD have gone to the ER didn't, and thus died at home vs possibly being saved in the ER. Seems plausible, but also would seem like we'd be able to look at the "died at home" data and see if that has spiked - in particular with no covid diagnosis.

Here is a good article on the subject: A Spike in People Dying at Home Suggests Coronavirus Deaths in Houston May Be Higher Than Reported

 

[Evil Sports]

anmut, I would love to see more statistical data like you were saying. I have been asking to see this type of analysis without HIPPA violations. Blood type, BMI, recent hospitalizations, age, ect. With the amount of numbers being tossed out there we should be able to get a much clearer picture of the people most at risk and work back from there to protect those.

 

[Bluewater272]

anmut, I would love to see more statistical data like you were saying. I have been asking to see this type of analysis without HIPPA violations. Blood type, BMI, recent hospitalizations, age, ect. With the amount of numbers being tossed out there we should be able to get a much clearer picture of the people most at risk and work back from there to protect those.

Yeah, can't wait to see some more misinterpretation of statistics. Are younger, healthier people at a lower risk of complications? Sure, but this isn't a young, healthy population inside these borders. Nearly 1/3 of Americans are hypertensive, 2/3 of Americans are overweight or obese, median age is 38, etc. Blood type gets bandied about based on a few small studies. Even if its accurate, that leaves 93% of Americans without the possibly advantageous but not protective Type O blood.

It's a public health policy, not an individual one.

I've not heard of anyone delaying chemo or time sensitive therapies, only elective surgeries.

It happened more often than you might think, especially in the March-May timeframe. My day job is overseeing clinical trials of cancer patients, we haven't done a final analysis of the COVID impact on clinical trials yet (since COVID isn't over), but we had a number of patients skipping or delaying treatments, missing scans, etc., due to concerns about visiting a clinic during all of this. Clinical trial patients are only a fraction of the overall population receiving chemo/RT/immunotherapy, but I would be surprised if that anecdotal experience wasn't representative of the larger population.

 

[I_squared_r]

Everyone I know that died from this was a smoker, obese, or combination of the 2. During the height of the pandemic, I saw similar people in the grocery store with masks, face shields, and gloves while stocking up their shopping cart with oreos. I couldn't help but notice the irony of it.

I'm going to brazil for NYE and i'm not sure what to expect. My friend says "you will love it here! it's like coronavirus never happened". People don't care there and lockdowns ended a long time ago. And looking at their statistics, Brazil is 2nd to the United States in cases and deaths. I have a few theories. Brazil has less obesity (35% vs 42%). And Brazilians aren't quick to go to the doctor like Americans (personal anecdote). Americans tend to go to the doctor for everything. My first 4 days will be in Rio de Jainero and there I will do my best to practice social distancing. The rest of the trip will be outdoors and easier to social distance.

 

[scokill]

If anyone’s chemo or emergency surgery was delayed it was due to an overwhelmed system, not a government shutdown.
If there were no shutdown then you would absolutely have more COVID cases, which would tax the system further, which means maybe more people get diagnosed but less get treated.

The system was never overwhelmed here....on the contrary, people were furloughed or laid off at our bustling hospital down the street. This was directly due to the shutdown and moratorium on almost all procedures.

 

[AZMark]

The system was never overwhelmed here....on the contrary, people were furloughed or laid off at our bustling hospital down the street. This was directly due to the shutdown and moratorium on almost all procedures.

That's extreme mismanagement by your local health agency or hospital if emergency or life saving chronic care procedures were cancelled due to a government shutdown. That would open them up for a mountain of lawsuits.

 

[Julian]

That's extreme mismanagement by your local health agency or hospital if emergency or life saving chronic care procedures were cancelled due to a government shutdown. That would open them up for a mountain of lawsuits.

I dont think he was saying all prodedures were cut. Hosptal's #1 money maker is ELECTIVE surgery (highest margin). That is what was stopped a lot....and that is what has caused so much disruption in healthcare staffing.

 

[Rockfords Fosgate]

I'm going to brazil for NYE and i'm not sure what to expect. My friend says "you will love it here! it's like coronavirus never happened". People don't care there and lockdowns ended a long time ago. And looking at their statistics, Brazil is 2nd to the United States in cases and deaths. I have a few theories. Brazil has less obesity (35% vs 42%). And Brazilians aren't quick to go to the doctor like Americans (personal anecdote). Americans tend to go to the doctor for everything. My first 4 days will be in Rio de Jainero and there I will do my best to practice social distancing. The rest of the trip will be outdoors and easier to social distance.

I believe the Astra Zeneca late stage trial is still going on down in Sao Paulo, maybe you can latch on.