COVID-19

[IrishLion]

So uh.

https://twitter.com/johncardillo/status/1247859223184244736?s=19

That seems.... reasonable?

If I have a heart issue that hasn't killed me, then get COVID-19, then die from my heart issue because of complications due to COVID-19, and wouldn't have had those complications if I DIDN'T have COVID-19... doesn't it make sense to chalk that up to the virus?

 

[Polish Leppy 22]

This is what I don't understand from people, especially a media dude like Clay Travis who originally said "I'll be surprised if the US has more than 3500 deaths from this."

If we come in under projection, doesn't it mean the social distancing likely worked in flattening the curve? We're dealing with it longer via quarantine and restrictions, but the projected death tolls don't reach the potential peaks that were theorized.

Some states aren't in lockdown, but that doesn't mean the overall effort hasn't been effective, especially in places where it's been taken seriously. My friends in public service in Cincy are worried that isolation will be relied on for TOO long, but won't deny that the lockdown prevented a crisis in Cincinnati hospitals just based on people that would have had to be brought in with respiratory issues, had it spread unchecked with no social effort to curb the virus.

I guess I don't get people that want to celebrate the projections being "wrong" when the whole point of everything is to make sure they ARE wrong.

There are people out there who originally said "this is all dumb and unecessary"... 10 million people could die, and certain people would crow about being right or vindicated because the total wasn't 11 million.

1) Anyone in the US who was quoted about the danger of this virus in January/ early February should not be held liable because we didn't have the accurate information. Because China lied. We don't blame FDR for Peal Harbor, do we?

2) Some politicians and the majority of US media have been downright disgusting throughout this ordeal. They've been selling panic and fear and it worked. So when these "expert" estimates are now being downgraded and adjusted to lower numbers, don't be surprised when people celebrate.

3) As many people have enjoyed selling fear, a sad number have shown themselves to enjoy living in fear too. A girl I work with had herself convinced yesterday she had the rona. Symptoms...chills, fever, vomiting. She wanted to get tested. Went to her primary doc. It was dehydration and food poisoning.

 

[notredomer23]

So uh.

https://twitter.com/johncardillo/status/1247859223184244736?s=19

As they should be.

 

[ulukinatme]

That seems.... reasonable?

If I have a heart issue that hasn't killed me, then get COVID-19, then die from my heart issue because of complications due to COVID-19, and wouldn't have had those complications if I DIDN'T have COVID-19... doesn't it make sense to chalk that up to the virus?

That was my take. You can die from any number of things, but if COVID is the one that finally pushes you over the edge, I'd put that down as the cause.

 

[ACamp1900]

Woke up to learn a member of Halo Nation (Like the FB version of IE for Angel Fans) I really enjoyed interacting with over the years died of COVID yesterday. Sucks, he seemed like a really good dude. Guy was married with three young daughters too. Just awful. He passed in the same hospital my daughter was born it sounds like.

 

[Irish#1]

This is what I don't understand from people, especially a media dude like Clay Travis who originally said "I'll be surprised if the US has more than 3500 deaths from this."

If we come in under projection, doesn't it mean the social distancing likely worked in flattening the curve? We're dealing with it longer via quarantine and restrictions, but the projected death tolls don't reach the potential peaks that were theorized.

Some states aren't in lockdown, but that doesn't mean the overall effort hasn't been effective, especially in places where it's been taken seriously. My friends in public service in Cincy are worried that isolation will be relied on for TOO long, but won't deny that the lockdown prevented a crisis in Cincinnati hospitals just based on people that would have had to be brought in with respiratory issues, had it spread unchecked with no social effort to curb the virus.

I guess I don't get people that want to celebrate the projections being "wrong" when the whole point of everything is to make sure they ARE wrong.

There are people out there who originally said "this is all dumb and unecessary"... 10 million people could die, and certain people would crow about being right or vindicated because the total wasn't 11 million.

Well stated

So uh.

https://twitter.com/johncardillo/status/1247859223184244736?s=19

I have no problem with that.

 

[AKRowdy]

So uh.

https://twitter.com/johncardillo/status/1247859223184244736?s=19

This is what happens with other diseases as well. They aren’t artificially inflating the numbers. Example: if you have underlying heart disease and end up getting the flu and dying, you’d be classified as dying from the flu.

 

[ab2cmiller]

Article talking about a growing concern among some doctors that typical ventilator use, may be doing more harm than good. This is causing some doctors to try to avoid ventilators, or if they are put on a ventilator, that the programming be changed to avoid the high pressure settings that are typically being used.



https://www.yahoo.com/news/rethinking-coronavirus-some-doctors-question-how-we-use-ventilators-123733204.html

 

[wizards8507]

That seems.... reasonable?

If I have a heart issue that hasn't killed me, then get COVID-19, then die from my heart issue because of complications due to COVID-19, and wouldn't have had those complications if I DIDN'T have COVID-19... doesn't it make sense to chalk that up to the virus?

As they should be.

That was my take. You can die from any number of things, but if COVID is the one that finally pushes you over the edge, I'd put that down as the cause.

This is what happens with other diseases as well. They aren’t artificially inflating the numbers. Example: if you have underlying heart disease and end up getting the flu and dying, you’d be classified as dying from the flu.

I'm not talking about "underlying conditions and then COVID-19 pushes you over the edge." That's totally legit. I'm talking about "something entirely unrelated to COVID-19 kills you and you just so happen to test positive."

I know with 100% certainty that the infant in Connecticut that they're reporting as having died from COVID-19 was killed in a completely unrelated incident. Every national and local news outlet ran with the story as an example of "SEE! IT CAN KILL YOUR BABIES TOO!" It was the very definition of fake news.

What's worse is that you don't even have to test positive. You just have to have symptoms consistent with the virus such that they reasonably believe you MIGHT have it. So if the regular flu kills you, they don't have to test to confirm before they report it as COVID-19.

 

[IrishLion]

I'm not talking about "underlying conditions and then COVID-19 pushes you over the edge." That's totally legit. I'm talking about "something entirely unrelated to COVID-19 kills you and you just so happen to test positive."

I know with 100% certainty that the infant in Connecticut that they're reporting as having died from COVID-19 was killed in a completely unrelated incident. Every national and local news outlet ran with the story as an example of "SEE! IT CAN KILL YOUR BABIES TOO!" It was the very definition of fake news.

What's worse is that you don't even have to test positive. You just have to have symptoms consistent with the virus such that they reasonably believe you MIGHT have it. So if the regular flu kills you, they don't have to test to confirm before they report it as COVID-19.

The article you linked from Fox News doesn't seem to be saying that, though. It seemed her comments said "if underlying conditions result in death via a connection to COVID-19, we count it. Other countries are not counting that."

If anything, I'd argue that it sounds like other countries are under-reporting based on that premise.

In your example, which I wasn't picking up on from the article, that is OVER reporting for sure, and I'm sure is happening, but probably not to the extent that would make a good Fox News conspiracy.

 

[wizards8507]

The article you linked from Fox News doesn't seem to be saying that, though. It seemed her comments said "if underlying conditions result in death via a connection to COVID-19, we count it. Other countries are not counting that."

If anything, I'd argue that it sounds like other countries are under-reporting based on that premise.

In your example, which I wasn't picking up on from the article, that is OVER reporting for sure, and I'm sure is happening, but probably not to the extent that would make a good Fox News conspiracy.

https://www.weforum.org/agenda/2020...mating-the-death-rate-for-covid-19-heres-why/

"Take for example an elderly New Yorker who is mildly sick. She calls her family doctor who makes a clinical diagnosis of suspected COVID-19 based on her symptoms, not a test. Because she is not very sick, she is advised to stay home. There is no mechanism for her doctor to report her diagnosis to the health authorities, so if she gets better, she is never counted. Only if she becomes ill enough to be admitted to the hospital, is she counted as a COVID-19 case. If she dies she will be counted as a COVID-19 death."

Trying to find the United States equivalent of this, but from the UK standards:

If before death the patient had symptoms typical of COVID-19 infection, but the test result has not been received, it would be satisfactory to give COVID-19 as the cause of death.

 

[wizards8507]

Here it is:

"COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death."

"Assumed to have contributed" is a pretty low bar.

https://www.cdc.gov/nchs/data/nvss/...w-ICD-code-introduced-for-COVID-19-deaths.pdf

 

[ab2cmiller]

The article you linked from Fox News doesn't seem to be saying that, though. It seemed her comments said "if underlying conditions result in death via a connection to COVID-19, we count it. Other countries are not counting that."

If anything, I'd argue that it sounds like other countries are under-reporting based on that premise.

In your example, which I wasn't picking up on from the article, that is OVER reporting for sure, and I'm sure is happening, but probably not to the extent that would make a good Fox News conspiracy.

Agreed. You could argue that it's over reporting. But you could also argue that we are under reporting since some of the people that are dying at home with COVID-19 may not be counted since they may not have been tested.

There is no consistency in reporting from country to country which makes for difficulty in analyzing the data.

Counting deaths from Influenza in a typical year is even less consistent. Because the flu is so common, many times it's not listed on the death certificate and the death is attributed to the underlying condition. The CDC knows that and they use some statistical models to get a better estimate.

 

[wizards8507]

Agreed. You could argue that it's over reporting. But you could also argue that we are under reporting since some of the people that are dying at home with COVID-19 may not be counted since they may not have been tested.

There is ZERO standard that requires testing. The people who are dying at home are assumed to have died of COVID-19 unless proven otherwise, not the other way around.

 

[InKellyWeTrust]

Yeah, this is bunk. I read this somewhere else too. I believe it's based off an opinion piece by a NY ICU physician. There is nothing in the literature to support it. This would fly in the face of all the evidence and standard of care for ARDs in general and prior coronavirus outbreaks MERs and SARs.

Let me retred on this a bit. The pathophysiology he explains makes sense. There seems to be a growing number of patients presenting to EDs hypoxic but breathing comfortably without terrible imaging. But this still would fly in the face of everything we know about this type of viral disease to date. This is an hypothesis that needs further investigation.

 

[AKRowdy]

Here it is:

"COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death."

"Assumed to have contributed" is a pretty low bar.

https://www.cdc.gov/nchs/data/nvss/...w-ICD-code-introduced-for-COVID-19-deaths.pdf

But it’s not. These people have likely gotten work-up for other viral illnesses and given the findings that are specific to COVID (ie chest CT, negative Flu, leukopenia, negative viral PCR, viral like illness, + sick COVID contacts). Yes, some may be reported in error, but I’d imagine that this would be low. Low enough to not impact our numbers significantly. Physicians are not just writing COVID on death certificates because it’s the “cool” new trend.

 

[ab2cmiller]

There is ZERO standard that requires testing. The people who are dying at home are assumed to have died of COVID-19 unless proven otherwise, not the other way around.

Again, there will be no consistency in how this is applied from city to city and state to state. What "assumed to have caused" will be different for each person. Some areas may undercount and some may overcount based upon what "assumed to have caused" means to them.

 

[AKRowdy]

How many deaths occur at home that are just “assumed” to be due to cardiac causes? When it could’ve been a PE, sepsis, liver failure, overdose, etc? It happens all the time in medicine, you never truly know unless there’s an autopsy performed for the at home deaths.

 

[Irishnuke]

Not a lot to be laughing about these days, but this is funny. Louisiana police used The Purge siren to announce curfew.

https://www.indiewire.com/2020/04/louisiana-police-purge-siren-coronavirus-curfew-1202223466/

 

[Irish#1]

Per the John Hopkins website we will be passing the 400,000 case mark in a few minutes. Currently at 399,979.

https://coronavirus.jhu.edu/map.html

 

[Irishize]

That was my take. You can die from any number of things, but if COVID is the one that finally pushes you over the edge, I'd put that down as the cause.

I read that’s how the US is going to count deaths going forward. But you can look at it from both sides. If a patient has terminal lung cancer and is on hospice they are more susceptible to pneumonia, flu, COVID-19, etc. If they didn’t’ have terminal lung cancer their chances of contracting any of the aforementioned ailments would be minimal. Maybe it’s a state medical ruling but where I live the hospice groups have always been instructed to put the event that put them in hospice (terminal cancer, Alzheimer’s, AIDS, etc) as the primary cause of death. If pneumonia, flu, etc is what wast he final straw, they list that as secondary/tertiary cause of death as they were less likely to contract that condition had their immune system and overall health been good (i.e., they weren’t already dying).

 

[Irish#1]

How many deaths occur at home that are just “assumed” to be due to cardiac causes? When it could’ve been a PE, sepsis, liver failure, overdose, etc? It happens all the time in medicine, you never truly know unless there’s an autopsy performed for the at home deaths.

In Indiana if you die at home, an autopsy is required. I think most states have this same law.

 

[wizards8507]

Physicians are not just writing COVID on death certificates because it’s the “cool” new trend.

I'm not saying there's any kind of grand deliberate conspiracy. I'm saying there's a compounding effect when "err on the side of COVID" is applied over and over again in the chain.

Again, there will be no consistency in how this is applied from city to city and state to state. What "assumed to have caused" will be different for each person. Some areas may undercount and some may overcount based upon what "assumed to have caused" means to them.

1. These are national CDC guidelines. Doctors aren't CHOOSING to assume COVID, they're being TOLD to assume COVID. Nationally.

2. Variation between cities and states is irrelevant anyways, because the only city that moves the needle of the aggregated statistics is New York.

How many deaths occur at home that are just “assumed” to be due to cardiac causes? When it could’ve been a PE, sepsis, liver failure, overdose, etc? It happens all the time in medicine, you never truly know unless there’s an autopsy performed for the at home deaths.

The relevant comparison is influenza, because it's the most similar COD that is widely understood. If the reporting (and mitigation plan) is going to be based on "X times more contagious and Y times more deadly than the flu," then cases and deaths should be measured in the same way as the flu.

 

[Irish#1]

1. These are national CDC guidelines. Doctors aren't CHOOSING to assume COVID, they're being TOLD to assume COVID. Nationally.

They aren't guidelines if they are being told to assume COVID-19. However, I have to believe doctors will be somewhat selective in listing the cause of death instead of just attributing it to COVID-19. As mentioned earlier, if someone already had a major condition that was terminal or close to terminal and COVID-19 pushed them over the edge the doctor will list the major condition.

 

[Pops Freshenmeyer]

That is closer to how flu deaths are counted. You can even test negative for the flu and still be a flu death.

https://www.cdc.gov/flu/about/burden/how-cdc-estimates.htm

Seasonal influenza may lead to death from other causes, such as pneumonia, congestive heart failure, or chronic obstructive pulmonary disease. It has been recognized for many years that influenza is underreported on death certificates. There may be several reasons for underreporting, including that patients aren’t always tested for seasonal influenza virus infection, particularly older adults who are at greatest risk of seasonal influenza complications and death. Even if a patient is tested for influenza, influenza virus infection may not be identified because the influenza virus is only detectable for a limited number of days after infection and many people don’t seek medical care in this interval. Additionally, some deaths – particularly among those 65 years and older – are associated with secondary complications of influenza (including bacterial pneumonias). For these and other reasons, modeling strategies are commonly used to estimate flu-associated deaths. Only counting deaths where influenza was recorded on a death certificate would be a gross underestimation of influenza’s true impact.

This is why flu data within the past two years is considered provisional; it initially gets modeled based upon data from prior years.

New York usually sees 150 deaths per day this time of year. If you can find the total number of deaths per day right now I would be interested in seeing it; all I can find are the COVID reports.

 

[notredomer23]

I'm not saying there's any kind of grand deliberate conspiracy. I'm saying there's a compounding effect when "err on the side of COVID" is applied over and over again in the chain.


1. These are national CDC guidelines. Doctors aren't CHOOSING to assume COVID, they're being TOLD to assume COVID. Nationally.

2. Variation between cities and states is irrelevant anyways, because the only city that moves the needle of the aggregated statistics is New York.


The relevant comparison is influenza, because it's the most similar COD that is widely understood. If the reporting (and mitigation plan) is going to be based on "X times more contagious and Y times more deadly than the flu," then cases and deaths should be measured in the same way as the flu.

Why does it matter what the death is attributed to? They had COVID, they died. The death rate being .1% or 1% or 10% has little factor on reopening the country as long as people are being hospitalized for it.

 

[AKRowdy]

I'm not saying there's any kind of grand deliberate conspiracy. I'm saying there's a compounding effect when "err on the side of COVID" is applied over and over again in the chain.

The relevant comparison is influenza, because it's the most similar COD that is widely understood. If the reporting (and mitigation plan) is going to be based on "X times more contagious and Y times more deadly than the flu," then cases and deaths should be measured in the same way as the flu.

Understand what you’re saying. Also these death reports go similar to this as an example: Cause of death influenza compounded by acute respiratory failure, compounded by shock, compounded by COPD.

So it takes into account the patients past medical history.

 

[Irishize]

That is closer to how flu deaths are counted. You can even test negative for the flu and still be a flu death.

https://www.cdc.gov/flu/about/burden/how-cdc-estimates.htm



This is why flu data within the past two years is considered provisional; it initially gets modeled based upon data from prior years.

New York usually sees 150 deaths per day this time of year. If you can find the total number of deaths per day right now I would be interested in seeing it; all I can find are the COVID reports.

Correct. CDC has to extrapolate out to nationwide based on reported deaths

 

[IrishLion]

Why does it matter what the death is attributed to? They had COVID, they died. The death rate being .1% or 1% or 10% has little factor on reopening the country as long as people are being hospitalized for it.

This is what I keep coming back to.

I understand why people are concerned with an accurate death rate. The media wants to report a scary number, and the government will keep people restricted longer if the number looks scary, and people want to fight back against that stigma.

But ultimately, it's not really about the death rate right now. It's about managing case loads and avoiding larger healthcare issues via overcrowded hospitals.

Arguing the death rate is missing the forest for the trees right now.

 

[wizards8507]

This is what I keep coming back to.



I understand why people are concerned with an accurate death rate. The media wants to report a scary number, and the government will keep people restricted longer if the number looks scary, and people want to fight back against that stigma.



But ultimately, it's not really about the death rate right now. It's about managing case loads and avoiding larger healthcare issues via overcrowded hospitals.



Arguing the death rate is missing the forest for the trees right now.

You don't see how one begets the other? Most people get the flu and they don't even call their doctor, let alone go to the emergency room. They buy a case of Gatorade and try to sleep as much as possible. Now, you get the flu and you're all "OH MY GOD I'M GOING TO FUCKING DIE!" and you admit to the hospital for two weeks. The fear-mongering is causing (in part) the run on the hospitals.