[Sivad]

"Many people who die of Covid would have died anyway within a short period" - Professor Sir David John Spiegelhalter OBE FRS, Medical Research Council Biostatistics Unit, Cambridge Statistical Laboratory

[BeesKnee5]

"Many people who die of Covid would have died anyway within a short period" - Professor Sir David John Spiegelhalter OBE FRS, Medical Research Council Biostatistics Unit, Cambridge Statistical Laboratory

Good call

"shows that there is no systematic relationship with age."

"Covid could be considered as packing what amounts to your current annual risk into a few weeks. This is an additional risk, of course, and certainly does not mean that these deaths would have occurred anyway in the following year (although some would have)."

So about that 2/3rds within 12 months. Your evidence is just a tad light. You've taken a comment that said might out of context and claimed it as general consensus by epidemiologists.

[Sivad]

So about that 2/3rds within 12 months. Your evidence is just a tad light.

My evidence is that 90% have comorbidities, over 60% have multiple comorbidities, and 75% are over the age of fifty(if I remember right over half the deaths are in people over 65). So that's a pretty solid case for a major harvesting displacement.

You've taken a comment that said might out of context

I haven't taken anything out of context, we know it's going to be at least half and given the data, 2/3 is most likely an underestimate.

and claimed it as general consensus by epidemiologists.

No I did not. And even if I did I'd be right because all epidemiologists are aware of mortality displacement and all they have to do is look at the data to see that a major displacement is definitely occurring here. They might not all agree that it's 2/3 over the next year but there's no doubt they would all agree that it's a large percentage because unlike you they grasp the basic reality here and they know trying to deny it just isn't tenable.

[BeesKnee5]

I haven't taken anything out of context, we know it's going to be at least half and given the data, 2/3 is most likely an underestimate.

Again, you have no evidence to support this.


"and claimed it as general consensus by epidemiologists."

No I did not.

Yes you did.

the epidemiologists are saying 2/3 would have died within the year regardless,

[late]

The desperate hunt for an excuse continues..

[XogGyux]

It is funny to see these self-made home statisticians and epidemiologists.

Let me get this straight, you want to prove this virus is nonsense, not particularly lethal and the dumb idiot in the white house with all the resources (including world-class epidemiologists and statisticians) got fooled into closing the biggest economy of the world and that the whole world actually followed suit all because of some sort of hoax?
The propensity of certain people for conspiracy theories is spectacular.

Sadly, the data that we have is not the highest quality. First, its been just a couple of months of this disaster. Second, the area where this originated not only has not been very transparent with the rest of the world but have actually suppressed information. The western, slightly more trustworthy governments, many of them have been overwhelmed and the data collected in short-staffed hospitals that are being overwhelmed might suffer in quality and accuracy all of this compounded by the fact of early testing issues and finally mitigated by nearly universal social distancing. That is to say, that as much as it bothers you, we might never find out how bad it could have been if left unchecked. It turns out, that the things that we have done to mitigate this virus seem to be working rather well which in turns translate into statistics that appear more benign that they would otherwise be if we just let it be.
Reminds me of the patient with hypertension that shows in the clinic with a BP of 150/90, you are worried because this is unusual, the last 4 visits over 2 years the BP was well controlled. You ask what happened for such sudden change and when you interrogate enough you find out that patient has not been taking the BP medication because he saw his BP was well controlled and figured that he didn't need it anymore... Yes it was well controlled because we were controlling it.

[Kaiserschmarrn]

I have been trying to make sense of Australian statistics. There is a very low death rate and a very high recovery rate compared to world averages.

https://www.abc.net.au/news/health/2020-04-04/what-is-recovering-from-coronavirus-like/12119282

This article claims 600 recovered, but the ABC stats claim almost 3000 recovered. Almost half of all cases. Overseas have much lower recovery rates. Do other countries only count those released from hospital as recovered rather than anyone who tested positive and now tests negative?

https://www.abc.net.au/news/2020-03-17/coronavirus-cases-data-reveals-how-covid-19-spreads-in-australia/12060704

In Germany, Switzerland and Austria the recovery rate is between 40% and 50% as well. The German RKI, which publishes daily reports, says that in Germany this is an estimate. On the other hand, in Sweden, Norway and the Netherlands it's less than 5%. I don't know how the recovery criteria or the reporting differs in different countries, but it could account for some of the differences.

I really don’t know why the death rate in Australia is so low. Maybe the pandemic is at an earlier stage and more critical cases will not recover?

Yes, I think Australia and NZ caught this early. Here they say that much of the growth is still driven by returning travellers and you can see this partly in the age distribution of the cases which skews towards a younger demographic.

NZ:



For Australia:



Iceland, which has tested 10% of its population so far, including lots of asymptomatic people, is probably fairly close to the real number of cases and it's CFR currently stands at 0.5%. Age distribution in Iceland looks like this:



Here is an interview with the CEO of the company which does the screening of the general population in Iceland.

My guess is that currently under ideal circumstances the IFR will be around 1%, possibly a bit lower. Since we are still in the early stages, as long as countries have the spread under control, the CFR will go up over time, as more people in critical condition die. Of course, there is now a race to find treatments and doctors will hopefully also learn how to improve the management of people who require hospitalisation, so with a bit of luck survival rates should increase over time as well.

[Sivad]

we might never find out how bad it could have been if left unchecked.

No, we're absolutely gonna find out and the very serious experts aren't gonna be able to hide what they did here.

[Sivad]

My guess is that currently under ideal circumstances the IFR will be around 1%, possibly a bit lower.

[QatzelOk]

Saddam's WMDs are able to hit major European cities in days!! Hours!!! Minutes!!

Within a few months, his newer systems will be able to hit North American cities!!

Which is why we have to act now (without thinking!!) and get that vaccine into everyone's bloodstream! Now! Why do we still have any choices about anything??!

[Kaiserschmarrn]

Thank you for this,
It's very interesting and some of the information is unexpected.

The BMI chart in particular showing cases matching general population and those with viral pneumonia having a lower BMI in particular .

I noticed that too, although in France they think a high BMI is a major risk factor, so there are definitely differences in the statistics between different countries.

Also answering a question I couldn't answer previously with the period mechanically ventilated being 4-9 days.

With the caveat that these are the people who had an outcome, i.e. discharge or death, while the majority of patients were still being treated at the time.

A recent paper about Lombardy has this:

[...]

Findings In this retrospective case series that involved 1591 critically ill patients admitted from February 20 to March 18, 2020, 99% (1287 of 1300 patients) required respiratory support, including endotracheal intubation in 88% and noninvasive ventilation in 11%; ICU mortality was 26%.

[...]

As of March 25, 2020, the median (IQR) length of stay in the ICU was 9 (6-13 [95% CI, 9-9]) days (n = 1591). Among patients still in the ICU (n = 920), the median (IQR) length of stay was 10 days (8-14 [95% CI, 10-11]); among patients discharged from the ICU (n = 256), the median length of stay was 8 days (5-12 [95% CI, 8-9]); and among patients who died in the ICU (n = 405), the median length of stay was 7 (5-11 [95% CI, 7-8]) days.

[...]

The population in this study consisted mostly of men (82%, which is higher than previously reported) and older individuals.4,9,10 The median age of the patients admitted to the ICU was 63 (IQR, 56-70) years old, which is the same as the median age of all the positive Italian cases with COVID-1912 suggesting that, to date, older age alone is not a risk factor for admission to the ICU.

In this cohort of patients, 68% had at least 1 comorbidity, in line with that reported by Wang et al (72.2%),9 but much higher than in other reports.4,5 Similar to other previous reports,4,9 hypertension was the most common comorbidity, followed by cardiovascular disorders, hypercholesterolemia, and diabetes. Among older patients, comorbidities were common but a relatively small percentage of patients had pulmonary disease.

Previous reports described different mortality rates among patients requiring ICU admission, from 16%9 to 38%,5 62%,10 67%,8 and 78%.11 In this study, at 5 weeks after the first admission in ICU, the majority of the patients (58%) were still in the ICU, 16% of the patients had been discharged from the ICU, and 26% had died in the ICU. The death rate was higher among those who were older. However, these outcome data should be interpreted with caution because most patients were still hospitalized in the ICU and the minimum follow-up was 7 days; in particular, the mortality rate could eventually be higher.

[...]

Patient characteristics:

[Sivad]

Montana Physician Dr. Annie Bukacek Discusses How COVID-19 Death Certificates Are Being Manipulated

April 6, 2020

Figures Don't Lie, But Liars Figure

Dr. Bukacek is a longtime Montana physician with over 30 years' experience practicing medicine. Signing death certificates is a routine part of her job.

In this brief video, Dr. Bukacek blows the whistle on the way the CDC is instructing physicians to exaggerate COVID-19 deaths on death certificates.

[late]

Montana Physician Dr. Annie Bukacek...

...is a nut.

https://themontanapost.com/blog/2020/04/10/annie-bukacek-the-bundy-of-the-flathead-endangers-public-health/

[late]

It is funny to see these self-made home statisticians and epidemiologists.

Let me get this straight, you want to prove this virus is nonsense, not particularly lethal and the dumb idiot in the white house with all the resources (including world-class epidemiologists and statisticians) got fooled into closing the biggest economy of the world and that the whole world actually followed suit all because of some sort of hoax?
The propensity of certain people for conspiracy theories is spectacular.

Sadly, the data that we have is not the highest quality. First, its been just a couple of months of this disaster. Second, the area where this originated not only has not been very transparent with the rest of the world but have actually suppressed information. The western, slightly more trustworthy governments, many of them have been overwhelmed and the data collected in short-staffed hospitals that are being overwhelmed might suffer in quality and accuracy all of this compounded by the fact of early testing issues and finally mitigated by nearly universal social distancing. That is to say, that as much as it bothers you, we might never find out how bad it could have been if left unchecked. It turns out, that the things that we have done to mitigate this virus seem to be working rather well which in turns translate into statistics that appear more benign that they would otherwise be if we just let it be.

Great post.

It's amazing how many on the Right are The World's Greatest Geniuses, rewriting science after science after grueling seconds of study.

[Sivad]

...is a nut.

https://themontanapost.com/blog/2020/04/10/annie-bukacek-the-bundy-of-the-flathead-endangers-public-health/

a retarded assertion with zero evidence of any kind of nuttery.

[late]

a retarded assertion

It's an observation.

You should be used to being wrong.

[XogGyux]

Montana Physician Dr. Annie Bukacek Discusses How COVID-19 Death Certificates Are Being Manipulated

April 6, 2020

Figures Don't Lie, But Liars Figure

Dr. Bukacek is a longtime Montana physician with over 30 years' experience practicing medicine. Signing death certificates is a routine part of her job.

In this brief video, Dr. Bukacek blows the whistle on the way the CDC is instructing physicians to exaggerate COVID-19 deaths on death certificates.

I wonder, she just happens to be wearing the lab coat and a stethoscope when she wandered into the conference/theater room for the lecture .
That's funny. Anyhow she is making a strawman of the situation. First, the cases of people that came to the hospital for unrelated reasons, died for unrelated reasons and for some reason was tested and positive for COVID19 are few and very sporadic. The truth of the matter that since this COVID-19 issue started here in the US, tests have been very short in supply and the vast majority of doctors wouldn't even think of ordering such test unless they truly think the patient might have it (and contributing to the presentation). In fact, just 3 weeks ago I had some ED colleagues of mine complaining of how hard it is to order such tests and to actually get them. This has improved and last week my hospital for the first time started testing some people without symptoms/risks factors because they were being discharged to facilities and these facilities would not accept patients without a negative test. But this is a very recent development, nothing that could significantly alter the statistics that we have been collecting for weeks. So this idea that somehow someone came into the hospital with a gunshot wound and was tested for COVID 19 and tested positive even though the person had no symptoms and later went to die from GSW complications and was reported as COVID 19 death is mostly a strawman. Could it happen for a minority of cases? probably but the cases are so few and sporadic that it will balance out by those that die at home/facilities and are never tested (or reported for that matter).

Finally, all of this non-sense of co-morbidities and death certificates. The vast majority of Americans have at least 1 comorbidity. Obesity, smoking, Hypertension, Asthma, Diabetes, with only those few you can readily see why it is actually hard to find a "healthy" 30 years old.
Of course, a mildly hypertensive person on therapy, well-controlled is probably at a similar risk as someone that doesn't have hypertension at all (this is admittedly speculative from my part but based on an understanding of pathophysiology) but it makes a difference in reporting and carries into the statistics. Also, not all institutions collect the data with the same reliability especially in times like this. How do we know if you have co-morbidity if you have never been in my hospital? We ask you. What happens if you can hardly breathe and get intubated immediately? We don't get much information. We might go by the pills that you take if you presented to the hospital with a bag full of pills (often it is not the case) and sometimes if you ever got prescriptions electronically some EMRs might show SOME of the prescriptions that have been filled for you in the past, but if you weren't taking anything because you were not seeing a doctor for your chronic conditions... well we won't know and it won't get reported.

Finally "cause of death" is easier said than done. It is true what she says that we get a lot of flexibility to what to list in a death certificate and that we often don't know the cause. But it is far more subtle than she lets on. The problem is that there is a "proximal cause of death" and usually, an underlying disease/problem that lead to that proximal cause of death. For instance for COVID - 19 the patient might die from Cardiopulmonary arrest, or they could have a Brain death due to a prolonged period of hypoxia, or it could be a refractory shock (Blood pressure tanks), or severe progressive multi-organ dysfunction. COVID19 itself doesn't cause the death but rather causes stress of the different organ systems until one or more of them fail and that causes the death. It is analogous to saying that a bullet does not cause a death, the whole in the heart caused the death... Sure, this might be technically accurate but misses the point.

[QatzelOk]

Montana Physician Dr. Annie Bukacek Discusses How COVID-19 Death Certificates Are Being Manipulated
...blows the whistle on the way the CDC is instructing physicians to exaggerate COVID-19 deaths on death certificates.

But why would so many media sources be playing along, Sivad? Any ideas late, or XogGyux ?

But this time there are plenty of dead bodies, and plenty of money to be made, since people are justifiably scared to death. That’s why Big Pharma stocks are rising, even as most of Wall Street is collapsing. Commander-in Chief-Trump even reportedly offered a billion dollars to a German Pharma company in exchange for exclusive patent rights to the U.S. for the company’s forthcoming vaccine. Google and Facebook, heavily invested in pharmaceuticals, will no doubt—as a public service of course—continue to track us all through our mobile phones and work with the authorities to make sure we all get all our future COVID-19 vaccine shots.
...

It seems like mass death (and then, vaccine sales!) is the last fast-money scheme of our corrupt, usury-addicted mafia leaders - the same leaders who wrecked the environment.

Why do humans think they're any less disposable than the rest of the environment, to our current crop of leaders?

[Sivad]

The IFR is also going to be inflated because doctors are killing people with high pressure ventilation because they just mindlessly run ARDS protocols instead of critically assessing and treating individual pathophysiology.

[Godstud]

Dumb. Get fucking both sides of it, not just a rant meant to incite panic amongst conspiracy theory babbits. Typical Sivad.

Doctors fighting coronavirus face a ventilator Catch-22

Physicians treating the wave of patients infected with the novel coronavirus face a difficult choice.

As critically ill patients struggle to breathe, healthcare workers have deployed invasive ventilators that take on the job for them—and help protect those around them from infection. But as more information becomes available about the success of mechanical ventilation in Covid-19 patients, some doctors are questioning whether intubation is the best way to keep these patients alive.

Critically ill Covid-19 patients usually display symptoms of acute respiratory distress syndrome (ARDS)—they can’t efficiently transfer oxygen from damaged lung tissue to their blood. Typically, the first line of treatment for ARDS is a non-invasive form of assisted breathing: Doctors try to raise oxygen levels by delivering it through a nasal tube, a face mask, or helmet.

Doctors treating Covid-19 patients with ARDS at hospitals, though, may skip less invasive methods and insert a breathing tube into lungs, a process called intubation, to avoid patients’ oxygen levels from falling dangerously. Invasive ventilation is the most aggressive way to provide oxygen to patients; it literally operates their lungs for them when they cannot. But there’s another reason healthcare workers might favor ventilators over noninvasive breathing assistance: It could help prevent the spread of the disease in hospitals.

“With [Covid] patients we are really starting to bypass non-invasive ventilation, unless you have helmet masks like those Italy has been using, where the patient’s head from the shoulder up is cordoned off,” Robert Aranson, a critical care physician in Pennsylvania, told Quartz.

To be sure, intubating a patient is risky for physicians, nurses and respiratory technicians, who can be exposed to the virus during the insertion of the breathing tube. But after insertion, intubation is better at preventing the spread of coronavirus in the air than a tube or mask that doesn’t isolate the patient’s respiratory system. “We don’t want to give them high-flow oxygen because when you cough against that jet, the chances you are going to spill [the virus] further is a big problem,” says Dr. Govind Rajan, the director of clinical services in the anesthesiology department at the University of California, Irvine, Medical Center.

That problem is exacerbated by the lack of sufficient protective gear for healthcare workers and resources to separate Covid-19 patients from other sick people. In this environment, ventilators can start looking like a more attractive option. “The moment the tube goes in, the system becomes closed, the spread of the virus becomes zero,” says Rajan. To make intubation as safe as possible, hospitals are setting up special rooms for the procedure and limiting the number of healthcare workers who are present. They can also give patients paralytic drugs to stop their respiration before the procedure, rather than after.

The choice to use a ventilator is becoming more fraught as information emerges about outcomes in intubated Covid-19 patients. Critical care doctors are beginning to worry that stress caused by invasive ventilation may contribute to the grim measures of fatality among Covid-19 patients on ventilators: One recent study of 338 Covid-19 patients (pdf) in the UK who relied upon invasive ventilators to breathe found that two-thirds died. The researchers compare that to a 36% fatality rate among sufferers of viral pneumonia who relied upon invasive ventilation from 2017 to 2019.

The high rate of ventilator deaths may simply reflect the virulence of the disease, which can progress with astonishing speed, doctors say. “For Covid, by the time they come into the hospital in any kind of respiratory distress, they go downhill quickly,” Aranson says. “If patients are trending [downward] quickly, they’re going to be better off bypassing non-invasive ventilation.” In Italy, one recent study of 1,591 Covid-19 patients reported 88% received invasive ventilation.

But some clinicians believe that patients with plunging oxygen levels who would normally would be placed on a mechanical ventilator may do better receiving oxygen with less aggressive means. Measures of oxygen saturation that might suggest the need for immediate intubation may be deceiving, Dr. Martin Gillick of Harvard Medical School told STAT, because the problem is not getting oxygen into the lungs, but from the lungs into the bloodstream. In that case, using ventilators to increase the pressure of oxygen pumped into the body may do more harm than good.

Rajan echoed these concerns, saying that unlike more common causes of respiratory distress that stiffen the lungs and make ventilation a more sensible choice to get oxygen into the bloodstream, this “virus goes from the air side, hits the alveoli”—the sacs in the lungs where oxygen and carbon dioxide are exchanged—”makes them extremely inflamed and very susceptible to pressure-induced injury.”

He also worries that patients already weakened by fighting the virus and now stressed by invasive ventilation may spur an immune system overreaction known as a cytokine storm. That occurs when the immune system begins attacking the body’s own organs, and may be an explanation for the deaths of younger, otherwise healthy Covid-19 victims.

Even before Covid-19, medical researchers investigated the connection between ventilator-induced lung injuries and cytokine storms in an attempt to explain why so many sufferers of advanced respiratory distress syndrome ultimately die from multiple organ failure. But the complexity of the interaction between the lungs, the immune system, and the diseases that lead to advanced respiratory distress make it difficult to derive a clear-cut answer. Some investigators say there is no connection between ventilators and immune system overreaction.

Another worry among doctors are the new ventilators being rushed into manufacturing to make up for shortages. Typical ventilators can be carefully adjusted to change how often the patient breathes a certain volume of oxygen and at what pressure. If simpler ventilators lack the controls to configure them to a patient’s needs, they could exacerbate ventilator injuries. Nurses and respiratory technicians can take action to ensure the new ventilators are used responsibly, but they are already stretched thin by the crisis. “They are often the ones setting up the various oxygen therapies,” says Aranson. “Were it not for them, there would be no one to run these vents.”

Rajan is part of a group of doctors who have developed a design for one of those simple ventilators. The Bridge Ventilator Consortium’s goal is to make the simpler devices available for patients who need breathing assistance but have healthier lungs, in order to free up sophisticated machines for patients with damaged respiratory systems.

Now, he and his colleagues are looking at cheaper ways to build non-invasive ventilators that also prevent the spread of the virus in the air. In Italy, engineers have adapted full-face scuba masks into non-invasive ventilators.

“We do not have the technology to do non-invasive ventilation while at the same time there is no spillage happening,” Rajan says. “It’s Catch-22—if you do not intubate these patients, you risk all the healthcare providers.”
https://qz.com/1833147/doctors-fighting ... -catch-22/