Coronavirus

[dfwatt]

True. When I posted that asymptomatic transmission was happening back in March, it got zorched by some pretty knowledgeable folks here as "just not possible."
Well.
Robin

Who?

 

[AlanSubie4Life]

Probably quite a bit less if you adjust for co-morbidities. These people were not all at death's door, as the just-a-flu crowd likes to pretend, but quite a few of them had conditions which reduced their life expectancy vs. the averages.

This is corrected for co-morbidities (see the original plot posted way above). Of course, it is just an estimate. It might well be a bit lower - it’s just an estimate, but probably in the ballpark.

The main thing I took away from it is that it is very common to live 5-30 years with co-morbidities. (Which I guess is not really a surprise.)

 

[AlanSubie4Life]

True. When I posted that asymptomatic transmission was happening back in March, it got zorched by some pretty knowledgeable folks here as "just not possible."
Well.
Robin

Yeah, would be a bit surprised if that were in this thread. Asymptomatic transmission has been known to be a big problem for a long time.

 

[golfcart]

Average years of life lost has been about 11 years - see earlier chart (with a very wide distribution, but have not seen that distribution shape, which would be relevant here - but I don’t believe it is strongly bimodal or anything like that, though the mode is likely less than 11 years), so I’d expect this effect to be fairly small (it’s going to be difficult to see 130k fewer deaths spread over an average of 11 years - spanning ~1 year to 30+ years, so likely less than 2k per month nationwide peak - but depends on the distribution characteristics).

I'm not sure why you rated that post funny, I didn't intend to write any jokes in there. I just asked a reasonable question.

But to clarify my point more I will say this.

42% of the COVID-19 deaths were nursing homes and assisted living facilities according to this study.

42% of COVID-19 Deaths in Nursing Homes & Assisted Living Facilities

and the median and mean length of stay for older adults in nursing homes at the end of life is 5 and 14 months respectively (according to this study)

Length of stay

If 42% of the deaths came from places where people typically last around a year, and the median age of people that died is around 80 then I have a hard time believing the average years of life lost is really 11 years. Not saying the study you cite is right or wrong, I can't go through all of the assumptions they make and comment intelligently. It certainly could be, my great-grandpa lived to be 101 and spent his last 5 years in a nursing home having workers wipe his ass for him after a stroke, so maybe all of those nursing home residents had long lives ahead of them still...but I am skeptical.

That said, I am not here to minimize the death of old people, my comment was just to provide a possible reason why we might see deaths drop in the short term if and when this pandemic has passed. And that was only in response to what a poster had said about what they were seeing in Wisconsin.

 

[blckdmp]

Maybe we can stop with the Sweden success story theme now?
Sweden's Tegnell admits too many died
Too many died, says man behind Swedish virus plan

 

[Daniel in SD]

& Assisted Living Facilities

Assisted living facilities are different from nursing homes. Anecdotally my grandparents lived in an assisted living facility for about 10 years and the nursing home on the ground floor of the same building for about a year.

 

[KenC]

Maybe we can stop with the Sweden success story theme now?
Sweden's Tegnell admits too many died
Too many died, says man behind Swedish virus plan

Was that just a platitude for public consumption, cause wasn't their strategy to stay open just enough, as to not overwhelm the healthcare system, and didn't they succeed in doing that? Wouldn't that mean, a maximum number of infections that they could sustainably treat, and thus also a maximal number of deaths? I don't know if his expression of remorse is real.

From the same article: "However, he was unclear what Sweden should have done differently and at a press conference later on Wednesday later he underlined that "we basically still think that is the right strategy for Sweden"."

Maybe, it's because I watched that movie, Midsommer, (that takes place in Sweden), not long ago that is making me feel a bit queasy about the Swedish approach.

 

[N5329K]

I didn't find any responses to it at all.

I certainly wouldn't go back to "uncover" who was so certain that asymptomatic transmission couldn't happen. It really doesn't matter that much and we all have learned a lot since then. But the pertinent phrase I recall was "It goes against everything I know about epidemics" and that could easily be a garbled recall on my part. The essential thing is this: it's all unproven until it isn't, and when real proof shows up we should pay attention. I encounter people every day who still mouth "it's no worse than flu."
I don't take down names and report them to the moron police. Though I admit, I am pretty tempted.
Robin

 

[Right_Said_Fred]

A retrospective cohort study (preprint and therefore not yet peer reviewed) found Vit D insufficiency/deficiency high in COVID 19 ICU patients. This doesn't establish causality, but it adds to the existing body of evidence that Vit D is a moderating variable in severe viral illnesses. My money is one the idea that Vit D at 40+ is moderating of severe illness. Won't prevent illness, but may buffer severity significantly.

From personal experience I can agree with your assesment, although my ‘evidence’ is just anecdotal. For a period of ten years I got flu like symptoms about 10 to 15 (!) times each winter, and occasionally in summer too. Five years ago I started taking 3000 iu of Vitamin D3 per day. I have not been ill since!

 

[dfwatt]

From personal experience I can agree with your assesment, although my ‘evidence’ is just anecdotal. For a period of ten years I got flu like symptoms about 10 to 15 (!) times each winter, and occasionally in summer too. Five years ago I started taking 3000 iu of Vitamin D3 per day. I have not been ill since!

A good move for sure. Who turned you on to vitamin D supplementation?

 

[golfcart]

Assisted living facilities are different from nursing homes. Anecdotally my grandparents lived in an assisted living facility for about 10 years and the nursing home on the ground floor of the same building for about a year.

fair point, the study does discuss the difference between the two I should have taken that into account.

Unfortunately, the study doesn’t do a great job of differentiating how many come from each type of facility.

 

[Right_Said_Fred]

A good move for sure. Who turned you on to vitamin D supplementation?

My brother. He and I actually develop and sell food supplements for a living (together with a third brother) but the possible positive effects of Vitamin D on the immune system had been overlooked by me for too long. My brother has a medical/scientific background and suggested I try a high dose of vitamin D3.

 

[Yuri_G]

Nate Silver linked to this data aggregator for the States. I like how the testing/cases/hospitalization data is graphed side by side.

Tableau Public

 

[dfwatt]

My brother. He and I actually develop and sell food supplements for a living (together with a third brother) but the possible positive effects of Vitamin D on the immune system had been overlooked by me for too long. My brother has a medical/scientific background and suggested I try a high dose of vitamin D3.

From the perspective of what we know about vitamin D in our deep ancestry (our best benchmark) it's not a high dose. In other words hunter-gatherers (which provide us with the best image of what long-term adaptation happened in the homo sapiens line since we arrived on the planet 200,000 years ago) probably had vitamin D levels over 50 regularly. They were outdoors all the time. 100 international units probably raises the average person's vitamin D blood level by one point. So 3,000 international units probably picks it up about 30 points. If you were indoors much of the time and particularly if you're indoors and living in a Northern latitude, decent chance that without supplementation your level is in the teens. It's worth reminding people that vitamin D isn't really a vitamin it's a hormone, and as such acts as a transcription Factor modulating an unknown percentage of the human genome. But probably at a bare minimum 2000 genes are modulated by vitamin D. In relationship to inflammation, it's both an essential cofactor for an immune response (white cells of various types express vitamin D receptors that need the ligand vitamin D in order to allow cell activation and immune responses), and it's essential also to restraint of the immune system although this part is less well understood. Vitamin D deficiency is enormously widespread in Western societies. While I agree with dkp Duke that vitamin D deficiency has been falsely hyped as explaining in some single-factor way the Diseases of Aging, there is no question it is a factor in relationship to all the major diseases of Aging. In concert with a whole bunch of other factors including a huge role for diet, sedentary lifestyle, sleep issues, and social isolation/chronic stress. Once you get past looking for a Magic Bullets, you realize that health and the most common diseases are about a complex recursive causality (including a bunch of polymorphisms) not single factors.

 

[AlanSubie4Life]

I'm not sure why you rated that post funny, I didn't intend to write any jokes in there.

my comment was just to provide a possible reason why we might see deaths drop in the short term if and when this pandemic has passed. And that was only in response to what a poster had said about what they were seeing in Wisconsin.

There are about 50k deaths a week in the US in normal times, or so. A lot of people die!

Even if we assume that most people who died would have lived less than 5 years more (I believe this to be an incorrect assumption based on the data available), that would be an average of 130k/260weeks = 500 deaths per week.

1% effect on the weekly deaths is going to be hard to see, was my first reaction. I appreciate you saying that you're not trying to minimize the deaths of the elderly. Regarding the "funny" - I just have heard that same comment about "these people were going to die really soon anyway" so often that I find it difficult to not chuckle (sadly and morbidly) when I see something that resembles that argument (since it's definitely not true).

There are just a lot more very good reasons for reduced mortality that WOULD be noticeable. There are 170k accidental deaths per year, for example - I would expect most of those would be reduced significantly right now (I expect annual numbers to be substantially reduced). There's probably less stress overall with people receiving large unemployment benefits, which will result in fewer cardiovascular disease deaths (650k per year!!!). If you don't have to work and get outside the house, I imagine the risk of a cardiac event goes down a fair amount. Also less McDonald's/fast food/unhealthy meals, probably (I believe, though I am not sure, that recent meals have an impact on likelihood of a cardiac event - not a doctor, so someone would have to confirm that).

When you combine these factors it looks quite clear to me that the effect of those reductions would be much more significant than reduction in deaths due to recent COVID mortality. Of course, there WILL be a reduction in mortality for the next 5-30 years due to this pandemic. I'm not saying there won't be. It's just likely to be a very small change to the baseline.

Now, if we just let the pandemic rip, THEN I think the effect even in the short term might well be noticeable.

Another (much simpler!) way to look at this: Only 4% of the population has been affected by this disease so far, and it's not THAT deadly - even in the elderly "only" 25-50% of the infected die. So it's unlikely that the mortality associated with the disease will have a very noticeable effect on mortality going forward.

 

[TheTalkingMule]

There's probably less stress overall with people receiving large unemployment benefits, which will result in fewer cardiovascular disease deaths (650k per year!!!). If you don't have to work and get outside the house, I imagine the risk of a cardiac event goes down a fair amount. Also less McDonald's/fast food/unhealthy meals, probably (I believe, though I am not sure, that recent meals have an impact on likelihood of a cardiac event - not a doctor, so someone would have to confirm that).

What universe are you living in? 1/4 of the working population lost their jobs, another 1/4 living constant fear of same, and everyone's been locked in their house pumped full of fear that millions of Americans are going to die.

As for cardiovascular disease. Sitting on your ass and stress eating for 3 months is not the way to decrease that death rate. Booze consumption is through the roof.

You should stop posting here 24/7 and go get yourself a CATScan.

 

[AlanSubie4Life]

Nate Silver linked to this data aggregator for the States. I like how the testing/cases/hospitalization data is graphed side by side.

Tableau Public

Nice visualization. Seen this guy's visualizations for a while, thanks for the link. Bookmarked!

As I expected, seems like there is some evidence for just a few states going off the rails so far, while most are doing ok. Looks like North Carolina, Wisconsin, South Dakota, and Texas are cause for some concern. I wonder if this is driven by carelessness and lack of regulation around nursing and long term care facilities, or just a general increase in disease burden?

 

[AlanSubie4Life]

What universe are you living in?

The one where all-cause mortality, when removing COVID deaths, appears to have been reduced. I imagine that sitting very still and not exerting yourself probably reduces cardiac events in the short term if you have pre-existing cardiovascular disease (isn't the recommendation for people with cardiac issues to not over-exert oneself, and improve diet?), but I am not a doctor.

I think that having a guaranteed unemployment income that is higher than your normal income provides some short term stress reduction, as well. It's going to be an interesting set of data to analyze after the fact, that's for sure! May provide a good real world simulation of what the effect of UBI might be. Interesting stuff to study.

You should stop posting here

That is good advice. I said I was going to do that a couple weeks back. Should get back to it.

 

[golfcart]

Even if we assume that most people who died would have lived less than 5 years more (I believe this to be an incorrect assumption based on the data available), that would be an average of 130k/260weeks = 500 deaths per week.

I think you may have forgotten that I was very specific to say "most of the places hit hard by the virus". The math you are doing assumes the general population of the United States, which generally speaking has not been hit that hard at all outside of the Northeast and a few other large cities.

I'm talking specifically about places like NYC and other places where large portions of the population have contracted it and the excess deaths (compared to normal) are very large. I never mentioned the U.S. as a whole. Go back and look at the original post.

Over the long term the area under the curve tends to remain relatively consistent for total deaths. If we have huge spikes now (particularly for the 65+ demographic which is seeing almost double normal) it stands to reason there will be deficits later. Certainly not of the same intensity but they should be noticeable.

Tracking covid-19 excess deaths across countries

 

[AlanSubie4Life]

hat is not what I said.
IF you have read the article you would know that the throat swabs were taken from people who presented to the hospital who were ill.
It is nonsensical to turn that into a warning that asymptomatic people may be infectious.

I'm sorry, I just cannot tolerate play doctors in this thread spreading FUD. You are placed on ignore. My list is growing daily.

The most basic problem with the 'asymptomatic and infectious' notion is that it goes against a century of understanding viral respiratory disease epidemiology and pathophysiology. Symptoms are indicative of significant cytopathic effect, itself indicative of viral load. Spread is via cough and sneezing; and to a lesser degree rhinitis, all symptoms of infection.

Also, the search feature is great. If found a post from you in mid March (Coronavirus) mentioning asymptomatic transmission but I didn't find any responses to it at all.

I certainly wouldn't go back to "uncover" who was so certain that asymptomatic transmission couldn't happen.

I went back and uncovered it. And the search feature is great. I guess I should have caveated my "would be a bit surprised" statement earlier. I'm not surprised this came from @SageBrush - I got the same treatment as you for "playing doctor." It's actually impossible for @SageBrush to follow along in this thread now, since he has most people on ignore. It's kind of comical.

Asymptomatic transmission has not been a surprise to me. I think it's been well documented since February some time, as I recall. Maybe even January - would have to go look at all the publications but won't bother. You can tell it was a known problem, based on South Korea's strategy.