Corona Virus Mortality Risk for Diabetes and High Blood Pressure

(Doug) #61

Sure, but we are talking about often substantial deaths in addition to expected ones, not in place of them. Anywhere that the medical system gets overwhelmed or even close to it - what rational suggestion that they should have done less can there be? At the worst, New York City had people dying at 6 times the normal rate.

“Prepare for the worst and hope for the best.” – In most places (at least by geographical area) medical systems have not been truly overwhelmed. But we did not know in the beginning just how bad things would be. That “the worst” didn 't happen in a given area is a good thing - and it’s no argument against taking precautions.

No, because we indeed did not know what all would happen in the future. If the lethality was higher, more like an ebola, etc., then there would be much less pushback against restrictions. Mostly, we’d have people complaining about the lack of political action and that too little was done too late. (And indeed that would be true - at that point it’s too late to fix it.)

Now that we know more, the talk is turning toward lifting restrictions or not, etc., all the whats and whens. We also don’t know where the numbers will end up. The virus hasn’t really gotten into most of the world’s population, across Asia and Africa.

The U.K. is rather in the “middle ground” - it’s far from the worst in the world, as far as virus deaths, but it also has roughly 100 times the per-capita deaths of the few countries that really acted surely and quickly. Some people think that much more should have been done, and some think too much was done - I think that’s always going to be the case, the way things are now.

Nick, (at this time) I think the rate for the U.S. as a whole will be well under 1% for sure. But even the initial Imperial College report in the U.K., the “worst case if nothing is done” deal that many people refer to, only had a rate of ~0.67% for the U.S. and 0.75% for the U.K. (the difference being the slightly-older U.K. population).

Well said, and (gulp…) you’re right…

(bulkbiker) #62

Except that it isn’t “substantial” it seems this year to be 1-2% over the expected number of deaths…

(Doug) #63

The numbers themselves are neverthess often substantial, and the effects on the medical system as well. After the fact, with hindsight, perhaps we’ll be able to say that some measures weren’t really needed in some areas, etc. But to decry gov’t action taken early on doesn’t really make sense.

It will be interesting to see what people think a year or two from now, i.e. “Did the Government do the correct thing, or should it have done less, or more?”

(bulkbiker) #64

Indeed it will… but I’m pretty sure it will be seen as an overreaction and hysteria in the general populace engendered by the media reporting… we shall see…

(bulkbiker) #65

(Doug) #66

Much of the feeling of “overreaction” comes from a presumption that the economic decline is due to gov’t restrictions. My prediction is that the lifting of restrictions will prove very disappointing in ths regard, that the economic decline is overwhelmingly due to people’s change in behavior and the actions of the markets themselves. I can see some years of cascading effects working their way through the global economy - even to the extent of economies continuing to decline after restrictions are lifted.

(bulkbiker) #67

The damage of the restrictions has already been done.

Many businesses who were marginal will never be able to re-open… many jobs will not come back even when the restrictions are lifted…

Millions will be unemployed for years to come.

(Doug) #68

Which is comparatively very little, against what was already happening and what was going to occur, regardless.

The Ivor Cummins tweet affirms that it’s a good thing not to overload medical systems (not a surprise to any sensible person, there, and moreover - an argument for restrictions, whether gov’t mandated or adopted willingly by the citizenry) and that Sweden’s social-distancing efforts have had success. We’ve been observing the same thing - that things were moving relatively slowly in Sweden. The low population density and the considerable changes that people have made, both due to gov’t decree and by personal choice to follow gov’t suggestions, have made for this.

Mark, I have a feeling that if the actions in Sweden were all due to Gov’t restrictions, rather than some from willing adoption by the people, that you’d be saying they were acting hysterically, even though the actions and the effects would be exactly the same.

(Elmo) #69

Are we placing faith in the World Health Organization now? :smile::lying_face::roll_eyes:

Sweden has a long way to go. So far, the virus has mainly hit Stockholm (the black area on the map) and made a swath over toward Göteborg, so a little bit south and then west to the coast (the path of the dark red counties on the map). Most of the country is just getting started, and the country already has one of the worst per-capita death rates in the world. I have relatives toward the outside of Stockholm - they are in for the long haul.

(bulkbiker) #70

And if UK deaths had already peaked before lockdown measures could have had a significant effect then it’s all been for nothing?

(Windmill Tilter) #71

One thing that hasn’t been well examined yet are the deaths and long-term health consequences due to exclusively to people deferring annual checkups, blood tests, cancer screening, and outpatient care. My expectation is that more people will die this year from deferred healthcare and suicide than will die from CV19 itself.

Throughout the state of NY the hospitals are eerily empty. This is true in the 99% of the state (geographically) where CV19 is lower than the national average. All the CV19 cases and deaths are in a 25 mile radius of NYC. People in NY state 200 miles away are dying in their homes rather than calling an ambulance or going to the emergency room for heart attack symptoms because they are so terrified of hospitals right now. This phenomenon is happening nationwide. Empty hospitals, empty emergency rooms, empty surgical theaters.

Consider that all cause mortality in the US is 2,800,000. If the deferred healthcare by people who are terrified of going to the doctor/hospital increases results in a 10% increase in ordinarily preventable death, it will mean 280,000 people will die without ever catching the CV19 bug.

All those folks dying at home are being counted in CV19 death toll without being tested. A large proportion of them died trying to avoid CV19, not because of CV19 infection. Even in the epicenter of the crisis, NYC, the emergency rooms are eerily quiet.

All Cause Mortality Statistics:

(Doug) #72

Where did you see this, Nick? Until 2 weeks ago, the U.S. was only counting Americans who lab-tested positive, thus obviously drastically under-counting things.

We know that all-cause mortality tends to decline during economic contractions, to begin with. Over time, what you describe - deaths from other causes than the Coronavirus and due to deferred care - will increase, certainly, It’s a question as to how much it will actually be.

Here too - where did you see this? Average hospital bed utilization in the U.S. is 60 - 70%. Do you really think it’s less than that, now?

(Doug) #73

I’ve wondered about that, Mark - as with Sweden - “What if the gov’t finally gives in and issues mandatory stay-at-home orders, just as deaths start heading downhill on their own…?” Rather “the worst of all worlds…”

After locking down, new virus cases and deaths start declining - the exact timing varies, country by country. The U.K. - locked down on the 23rd of March - had a relatively long period of still-increasing deaths and cases, longer, for example, than Italy and Spain. In no way had U.K. deaths peaked before, not even close. Comparing all countries with lockdowns, the U.K. really acted pretty fast.

(bulkbiker) #74

And deaths peaked on 08th April 2 weeks later …

(Doug) #75

From what I’m seeing, the peak in the U.K. came on the 21st of April - you can see it’s the tallest bar on the chart. For a while, before all the numbers were in, the 8th of April did look like some kind of a peak, at least in the short term. I don’t think it matters too much - we’re still close to the range of what other countries have experienced.

Italy, locked-down, peak in deaths came 18 days later. In Spain, 19 days. The U.K. - 17 days to the 10th of April, which is the 2nd highest day if we throw out the 21st of April as an outlier, or 28 days if we take the 21st of April.

(Windmill Tilter) #76

Now that I think about it, I’m not even sure of how they’re counting deaths in NY right now, it’s changed a few times. There were some articles about it in the NY times. It’s reflected in the “Gothamist” website where it show the difference between “presumed” and “confirmed”. I may be wrong about how things are being counted, and every state is different. I guess a more accurate point would be that it’s not correct to assume that over-all increase in all cause mortality is directly due to CV19 infections, many will be due to uninfected people not going to the emergency room, or deferring healthcare.

Just newspaper articles that I’ve been reading. It’s anecdotal, I don’t have any stats. Many governors have ordered postponement of elective surgeries and procedures though, it’s not just here in NY.

(Doug) #77

Yeah - there’s a huge gap between expected deaths (historical norms) + reported Covid-19 deaths and total observed deaths. The question is what portion of the “gap” deaths are due to what causes. You say “many” will be due to non-Coronavirus causes. Maybe - it depends on how we define “many” and what, hopefully, increased testing will reveal.

Relatively early on in the virus outbreak, country-by-country, there were a lot of increased deaths in nursing homes and aged care centers, here too “many” of them with symptoms consistent with Covid-19. These weren’t people choosing to defer healthcare or postpone going to the hospital, and they were a large part of the “gap” deaths.

In the beginning, only deaths where a patient had a positive virus test and then later died in the hospital were counted. The U.S. has been changing - new CDC guidelines as of April 14 call for a difference between “probable cases” and “confirmed cases,” and that states should be proceeding that way. A few are - NYC is, but I’m not sure about NY state as a whole. Ohio is doing it, but the U.S. as a whole is a mess - some states aren’t even reporting deaths outside of hospitals yet.

It wasn’t until a day or two ago that the U.K.'s official figures included deaths outside hospitals. Italy, Spain, etc., have made changes but there still isn’t enough testing to be even halfway sure.

(bulkbiker) #78

Except… the days of actual death and the days those deaths were reported show a slightly different picture…

(Susan) #79

They are not doing autopsies right now either; (at least not where I live in Ontario, Canada) so people might be dying of Covid 19 or some other thing -reports might be skewed atm from that too.

(Doug) #80

Mark, NHS England’s data does not include deaths reported outside hospitals (although - something changed in the last couple days, right?). We may not agree on the portions of the “extra” deaths - those beyond normal levels and confirmed Covid-19 deaths, but obviously many deaths were occurring outside hospitals - the Office of National Statistics has been pointing this out all along.

Yet even regardless of all that - the U.K.'s experience is still similar to Italy, Spain, etc. - a little while after locking down, i.e. a few weeks later we see daily new cases and daily deaths stop increasing as fast and level off or even start declining.