I’d like to highlight a huge revision from the CDC (https://www.cdc.gov/coronavir…/…/hcp/planning-scenarios.html) to the USA case fatality ratio for COVID 19 to current estimate of 0.4% overall for symptomatic cases. Not 3.4% which was the WHO’s value from China and what we started the pandemic with. But that number hides just how significantly it changes with age. The value for people under 50 is 0.05 percent, and when you take into account that CDC estimates that 35 percent of cases are asymptomatic, you get a infection fatality rate of 0.0325% for people under 50, and if you factor in the effects of pre-existing conditions and the likelihood that younger people have a higher asymptomatic rate than older people, it’s probably less. If you are under 50 without any COVID preexisting conditions, you’re chance of dying isn’t one in a million but it is getting surprisingly close – heck, if you’re under 25 it may actually be better. 

But let’s compare that to the flu, and we will leave it at the 0.03%. Looking up values for last seasons flu numbers which CDC estimates led to 60,000 deaths in the US (and let me say it’s a very loose estimate- all values from: https://www.cdc.gov/flu/about/burden/2017-2018.htm) for the 18-49 year age bracket we have estimates of 2,803 deaths from 14,428,065 illnesses or 0.02% death rate for that age group, which is 50% higher but sure looks pretty similar especially as they are both estimates. So for the under 50 crowd COVID19 looks like a bad flu. And does anyone remember any lament in the spring of 2018 that the flu season that year had killed more Americans than the Vietnam war?

For the over 65 crowd, you have a 0.86% for the flu in 2017-2018, the number is 1.3% for symptomatic which I’m not going to adjust because at that age I’m not sure how many cases are asymptomatic which again leads to about a 50% higher death rate but at those values doesn’t look too similar. And since the over 65 crowd is estimated to have suffered 51,000 deaths out of the estimated 61,000 that season, you can see how the seniors not only drive the flu numbers but drive the COVID numbers even more. 

Did you know that if you are under 50 your chance of dying from an accident as you go about your daily life is higher than of dying from COVID if you catch it?

If you’re really feeling cheery, dive into the Deaths and Mortality (2017 is the latest) statistics with me (https://www.cdc.gov/nchs/fastats/deaths.htm) where you can see that at 100,000 deaths COVID has passed up flu/pneumonia (55,700 deaths) and diabetes (83,500) – although since diabetes is considered one of those death enhancing preconditions for COVID, which one gets credit if someone dies with both diabetes and COVID – and is closing in on Alzheimers (121,400). Then comes stroke (146,300), chronic lower respiratory disease (160,200 – and same question as diabetes), accidents (169,900) and then the two biggies – cancer (599,100) and heart disease (647,500). I’m hoping COVID doesn’t make it past Alzheimers. When you add it all up, the average death rate for all causes for all Americans in 2018 was 0.87%.

So while on the one hand it’s kind of amazing that COVID can come out of nowhere and become the seventh leading cause of death in roughly 3 months, on the other hand all those others kill people year in and year out without much fanfare from the media or concern on our part.

Tags: Deaths

All the politicians and bureaucrats who are making the rules we live by these days always invoke science and data as the ultimate arbiter for all the rules.   You would be hard pressed to find a bigger fan of science and data than me, and less of a fan of politicians and bureaucrats.  So now that CDC says transmission is primarily through respiratory droplets and not surfaces, how important is it to wash our hands?  (Full disclosure, I still wash my hands for 20 seconds after returning home).  What’s the science and data on the effect of masks?  I think it’s accurate to say not clear and copious.  (Full disclosure, I wear a mask when indoors and around others.)  And how about the magic 6 foot rule?  Yeah, not a lot there either, and if you’re indoors and down fan from a sick person 6 foot isn’t enough.  In most of Europe, it’s 2 meters except Nordic countries where their yardstick is 1 meter.  (Full disclosure, I still try to keep my distance from others, especially indoors).  I think they are all good guidelines, I’m not sure how scientific (as opposed to commonsense) they are.

First data analysis showed no correlation between lockdown timing and cases by state.  Now data analysis shows by and large declining transmission after state reopenings. And not just in the US, but in Europe as well.  And then comes along video from Memorial Day weekend that showed people violating all the rules.  So once again I’m asking we stop focusing exclusively on something and pull back and take a systems look.  Quit focusing on the edicts and look at people’s behavior, in its full spectrum.  Governors etc. have pretty good control over government actions, but much less over citizens behavior.  The better they understood that, the more they would try to persuade and provide data and keep current, as opposed to the current approach of rules, rules, rules that can’t help but be arbitrary whereupon you lose compliance.  What do you see in those videos at the Lake of the Ozarks?  Big signs saying stay 6 feet apart.  So how are those rules and edicts working out for you?

And the news media is not helpful, as ever since they pivoted to coronavirus is not going to happen here to a non-stop unchanging if one solitary virus so much as touches you, you’re dead.  So one half of the country is too terrified to take in new data and the other half has decided since they are still alive the virus must be gone.  

And as the data has rolled in, the picture is changing.  For instance, this virus is a lot less deadly than first thought (see https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html) with an overall infection fatality rate of 0.26%, not the original 3.4% WHO reported.  And the death rate is strongly correlated with age – CDC says 0.003% if under 50 (bad flu territory),  and 0.845% (or higher) if over 65.  When you look at the death statistics, basically the older you are the more likely you are to die.  Keep in mind, these are all estimates in part because there is fuzz on both number of infections and number of deaths.  I did find it interesting that when looking at the length of time in hospital, non-ICU and ICU, time on ventilator, percent that are admitted to ICU and that go on ventilation there is not a lot of variation between age groups.  So other than raw numbers, the disease looks pretty much the same  to healthcare workers regardless of patient age. 

The data on children is very encouraging, as it appears those under 25 don’t contract the disease as much, don’t transmit the disease as much, and have milder cases that result in death only with an underlying condition.  As much as it pains me, for once not only do they feel invincible, they kind of are.

So why are we not adjusting?  Shouldn’t we be less fanatic about sanitizing everything? Shouldn’t we be reopening schools, playgrounds, daycares, summer camps, etc. because the only thing you have to do to keep it safe is keep the over 25 crowd away.   Pools are safe, how many of them are open?

Hospitals have been just crushed by the lockdowns.  We issued suspension edicts because of our fear that there wouldn’t be room for all the COVID patients who never materialized, so why are we not going full open on all healthcare immediately?  Why can’t we trust hospitals, clinics, practices, etc. to manage their own affairs to take care of all the normal issues while keeping enough space, PPE, etc to cover coronavirus cases safely?  It’s one more ball in a hundred ball juggle and why we think governors are able to make a positive contribution is beyond me.

Why is the media not shouting these new numbers from the rooftops?

Why are we not letting everybody manage their own safety based on their own risk factors? Government’s default setting is one size fits all – if the government managed clothing we’d all be wearing muumuu’s.  The only way to make someone responsible is give them responsibility. 

And given how less deadly the disease is for people of working age (i.e. not significantly different than flu), and how much deadlier the disease is for older and those with certain underlying conditions, and extremely so for those in group care settings (AKA nursing homes) where at least 40% of Americans (out of 1.8% of the population) have died from COVID, we should really think about how to protect those who are at elevated risk without causing significant disruption, and increased death rates for those who aren’t.  

PS I  would add a couple of health guidelines, not just for COVID but life in general, take vitamin D and get regular exercise

Tags: Deaths