The Vaccine

[adrianp89]

I'm hoping the asymptomatic (or not tested) / non vaccinated category is significant and gets us there quicker. It seems that as a policy, we need to shift from worrying about case numbers to hospitalizations as our primary measure of success.

I would think it is, but this is may be a state-by-state thing. I would think almost all of FL has been exposed by now, while NY is much much lower.

 

[Evil Sports]

It seems that as a policy, we need to shift from worrying about case numbers to hospitalizations as our primary measure of success.

I have been saying that since the beginning, tell me about people in peril not ones home sick for 2 days.

 

[tabbibus]

All numbers are important. Case numbers and positive rate matter to understand how high risk a particular location is.

 

[mwalker4]

All numbers are important. Case numbers and positive rate matter to understand how high risk a particular location is.

Yes important to track and understand, just as we do with other diseases. As vaccinated/previous infection rate continues higher, the percent of cases becoming hospitalizations should drop dramatically. Thus, hospitalizations will become a better indicator of the impact of the disease to society.

 

[Yambers]

A question for all of those way smarter than I am.. Lets say I am in a car accident and admitted to the hospital. I then test positive for Covid. I end up being on a vent due to my injuries. I pass. Am I in the Covid statistics or am I in the car accident statistics?

 

[tabbibus]

A question for all of those way smarter than I am.. Lets say I am in a car accident and admitted to the hospital. I then test positive for Covid. I end up being on a vent due to my injuries. I pass. Am I in the Covid statistics or am I in the car accident statistics?

If you die on my watch and die from the injuries, when I fill out the death certificate it will say from trauma, not covid. Covid diagnosis will be in your history, and you will count as a case, but not as a death from covid. Now go knock on some wood.

Now, if you crashed because you passed out due to your oxygen being low... I think that would be a covid related death (grey zone but just my opinion).

 

[2kwik4u]

A question for all of those way smarter than I am.. Lets say I am in a car accident and admitted to the hospital. I then test positive for Covid. I end up being on a vent due to my injuries. I pass. Am I in the Covid statistics or am I in the car accident statistics?

Assuming the Vent is due to a collapsed lung or something related to the car incident, then you're a car accident statistic. If you end up on the vent because your body can't handle a lung infection AND severe trauma at the same time I would think it would be a COVID statistic.

Barring human error (purposeful or accidental).

I'm not an expert, just the way I would expect it to be done. I have no firsthand knowledge.

 

[Yambers]

@tabbibus @2kwik4u kind of what my thought process was, but still uncertain how it would be documented based on circumstances, individual filling out certificate, etc.

 

[Julian]

Tracking case rates and hospitalization rates are both important.

• Case rates can be/are used to track spread and rate of spread.
• Hospitalization rates are used in conjunction with case rates to understand what percentages of people have bad infections/outcomes.

Both will change gradually over time, and when used together, can help us prepare/predict hospital load levels, and the need to increase/decrease other protection measures (the swiss cheese model I showed a ways back). If infection rates are climbing quickly, and we know the infection to hospitalization ratio, we can then give a good idea if we have a hospital capacity issue approaching.

On the cause of death discussion - these are carefully regulated and reviewed processes because of insurance fraud (both private and public insurance fraud).

 

[Lurch]

Without wanting to go back and verify death reporting data which may be somewhat subjective - from 2019 to 2020, we had a ~15% increase in total deaths vs a ~1% increase in population, even accounting for an <65/>65 age cohort. I can't speak to the breakdown on cause, although COVID and lack of/inability to access treatment for other medical issues are the obvious long poles in the tent. Regardless, fuck the CCP.

 

[Beachbummer]

@Lurch, Chinese authorities knew what was going on and did not lock down until after Chinese new year. Not sure if it was malice or incompetence, but that was very uncool. I share your sentiment.

 

[TXsweetcheeks]

Question for the medical professionals on this discussion...my bro-in-law passed away a month ago.
I assumed it was due to Covid but I haven't seen the medical documentation, yet.
He was 43, unvaccinated and his comorbidities were obesity, CHF, and asthma. (I added this info so everyone could get a fuller picture of his health)
His only symptom that was abnormal for him was extreme fatigue (he already had a chronic cough) so he got tested and it was positive.
He was scheduled for BAM infusion 2 days later and as soon as they started treatment, his oxygen levels plummeted.
They admitted him and put him on a ventilator. They did an induced coma and he quickly went down-hill. He went into cardiac arrest a couple times and they finally convinced my sister to sign a DNR so next time he went into cardiac arrest they wouldn't have to defib him again.
A couple hours later (due to no medical intervention and the DNR) he expired 10 days after admission.
Based off the info I provided can you tell me why his death certificate says failure to thrive as cause of death?
Additional dx on the death certificate is respiratory failure, sepsis and last listed Covid.
Any helpful insight/education would be greatly appreciated.

 

[Bruce]

@TXsweetcheeks, sorry about your brother in law.

I am not medical but this explanation of failure to thrive in adults may be helpful. Geriatric Failure to Thrive

My guess is that he may have had impaired immune response allowing CoVID to progress to a severe level before detection with minimal symptoms.

 

[tabbibus]

Question for the medical professionals on this discussion...my bro-in-law passed away a month ago.
I assumed it was due to Covid but I haven't seen the medical documentation, yet.
He was 43, unvaccinated and his comorbidities were obesity, CHF, and asthma. (I added this info so everyone could get a fuller picture of his health)
His only symptom that was abnormal for him was extreme fatigue (he already had a chronic cough) so he got tested and it was positive.
He was scheduled for BAM infusion 2 days later and as soon as they started treatment, his oxygen levels plummeted.
They admitted him and put him on a ventilator. They did an induced coma and he quickly went down-hill. He went into cardiac arrest a couple times and they finally convinced my sister to sign a DNR so next time he went into cardiac arrest they wouldn't have to defib him again.
A couple hours later (due to no medical intervention and the DNR) he expired 10 days after admission.
Based off the info I provided can you tell me why his death certificate says failure to thrive as cause of death?
Additional dx on the death certificate is respiratory failure, sepsis and last listed Covid.
Any helpful insight/education would be greatly appreciated.

I'm so sorry for you loss.

Hard to make an educated guess without more knowledge of some details. What did his CXR look like? CT chest? Any pulmonary embolisms?

With a disclaimer that this is speculation/deduction these are my observations:
* It is possible he was on his way to develop respiratory failure from COVID. Timeline fits. Obviously can not rule out BAM adverse reaction but this is not something we've seen.

* The course seems very fast though. With delta we have had more people crash and burn this fast but it is still the less common presentation. Again, it could be that he was sicker than initially thought.

* I agree with a DNR for someone like him in his situation. It is futile at that point to keep doing compressions and CPR if the cause of arrest is respiratory failure that we can't readily fix.

* DNR never means no medical intervention. We continue to actively support the patient unless the arrest again. Comfort measures, sometimes called decelerating care, / withdrawal of care / hospice is different. This is when we stop aggressive interventions and focus on sedation and pain control to let the patient pass away peacefully.

* Failure to thrive is a very weak sauce cause of death. I would not have put that first. In fact, I would not use that diagnosis based on the info provided by you on your post.

* Based on info provided, death certificate / summary would say:
1. Acute hypoxemic respiratory failure
2. Shock
3. COVID19

* COVID19 is usually the last diagnosis in the list because we list last the thing that caused it all, and first the thing that actually made the patient pass away.

Again, please take my thoughts as just speculation because in reality there is a lot of variables that can be in play.

 

[TXsweetcheeks]

@Bruce @tabbibus thank you for your sympathies.
I understand that the small amount of info I gave you does not paint the complete picture but my questions really lie with why his cause of death was failure to thrive. He did have blood clots forming and they were starting treatment on those before he passed.
His CXR looked like shit from what I understood. My sister saw it and said both lungs were completely white.
I asked my sister to request a copy of his medical record so I can take a peek out of curiosity.
@tabbibus thank you so much for trying to make sense of those dx for me despite not having the full picture. Deeply appreciative

 

[Troch1]

@tabbibus @2kwik4u kind of what my thought process was, but still uncertain how it would be documented based on circumstances, individual filling out certificate, etc.

The death certificate is filled out/certified by an MD (at least in my state of practice). I concur with the statements above from @tabbibus and @2kwik4u regarding your question and I also would fill it out as trauma and an accident (cause of death needs to be noted as natural causes vs. accident, again, at least in my state). Is there room for an unscrupulous doc to falsify a record or make a bad judgement call...sure, but in my experience, I've never seen egregious errors like that.

 

[Julian]

I'm so sorry for you loss.

Hard to make an educated guess without more knowledge of some details. What did his CXR look like? CT chest? Any pulmonary embolisms?

With a disclaimer that this is speculation/deduction these are my observations:
* It is possible he was on his way to develop respiratory failure from COVID. Timeline fits. Obviously can not rule out BAM adverse reaction but this is not something we've seen.

* The course seems very fast though. With delta we have had more people crash and burn this fast but it is still the less common presentation. Again, it could be that he was sicker than initially thought.

* I agree with a DNR for someone like him in his situation. It is futile at that point to keep doing compressions and CPR if the cause of arrest is respiratory failure that we can't readily fix.

* DNR never means no medical intervention. We continue to actively support the patient unless the arrest again. Comfort measures, sometimes called decelerating care, / withdrawal of care / hospice is different. This is when we stop aggressive interventions and focus on sedation and pain control to let the patient pass away peacefully.

* Failure to thrive is a very weak sauce cause of death. I would not have put that first. In fact, I would not use that diagnosis based on the info provided by you on your post.

* Based on info provided, death certificate / summary would say:
1. Acute hypoxemic respiratory failure
2. Shock
3. COVID19

* COVID19 is usually the last diagnosis in the list because we list last the thing that caused it all, and first the thing that actually made the patient pass away.

Again, please take my thoughts as just speculation because in reality there is a lot of variables that can be in play.

@TXsweetcheeks Very sorry for your loss.

@tabbibus what are your thoughts on Sepsis being listed as #2 in his cause of death? I've read a couple of articles in the last year talking about how Sepsis is the number one cause of death worldwide. I had a close friend die from sepsis after she got the flu. Just curious if your "Shock" is related to "septic shock" or sepsis, and would you not put sepsis down? Is there an agreed upon way to diagnose "Sepsis" - seemed like when I researched it with my friend it was a combination of things....

 

[Bruce]

@TXsweetcheeks, you could call the doctor or coroner to ask about the cause of death.

Non medically I see it this way, he failed to recover or show signs of recovery from illness. The sepsis suggests multi organ failure. His body was shutting down leading to cardiac arrest. It is likely that his body was so damaged that he would not have recovered regardless of treatment. CoVID causes harm far beyond the lungs and respiratory system.

In that way he did "fail to thrive".

Listing that cause of death may have been a lazy way to fill in the blank.

I lost an aunt to a similar situation last year. Her previously healthy body was destroyed by the infection.

 

[tabbibus]

@TXsweetcheeks Very sorry for your loss.

@tabbibus what are your thoughts on Sepsis being listed as #2 in his cause of death? I've read a couple of articles in the last year talking about how Sepsis is the number one cause of death worldwide. I had a close friend die from sepsis after she got the flu. Just curious if your "Shock" is related to "septic shock" or sepsis, and would you not put sepsis down? Is there an agreed upon way to diagnose "Sepsis" - seemed like when I researched it with my friend it was a combination of things....

Great question.

Sepsis most definitely has a distinct definition. septic shock can be considered in the spectrum of sepsis. It is not the scope of this post to define it but if you are interested look up the “survive and sepsis guidelines“.

Generally, when you think about sepsis it is usually a bacterial or a fungal cause. Patients with viral respiratory illnesses such as Covid or influenza pneumonia generally do not die with a florid septic picture. But as everything in medicine it can happen. The word sepsis sometimes gets thrown around as a catchall for somebody who is severely sick. So sometimes used incorrectly.

I deliberately use the word shock vaguely. Now knowing that he had pulmonary embolism, it is possible that his shock was a type called obstructive shock. It could even be cardiogenic. So I really didn’t specify on purpose. On a real death certificate I would want to be as accurate as possible and I would have all the clinical information in front of me to try and determine what type of shock was it. That being said it can be more than one type of shock at the same time.

I am sorry if I got too much into the weeds. Also pardon any typos and lack of proper punctuation because I am using Voice dictation

 

[tabbibus]

@TXsweetcheeks, you could call the doctor or coroner to ask about the cause of death.

Non medically I see it this way, he failed to recover or show signs of recovery from illness. The sepsis suggests multi organ failure. His body was shutting down leading to cardiac arrest. It is likely that his body was so damaged that he would not have recovered regardless of treatment. CoVID causes harm far beyond the lungs and respiratory system.

In that way he did "fail to thrive".

Listing that cause of death may have been a lazy way to fill in the blank.

I lost an aunt to a similar situation last year. Her previously healthy body was destroyed by the infection.

In general failure to thrive is applied to somebody who is chronically ill and it’s just not getting better. Frail old person or a patient with cancer. Usually not used in the acute setting