COVID-19 | science, damage limitation, NO POLITICS

[TechTalk]

A reasonable comparison of COVID-19 to other causes of death would be to compare the virus to other communicable diseases. Your stroke or heart attack isn't going to infect and kill someone else.

[Alan Klein]

A reasonable comparison of COVID-19 to other causes of death would be to compare the virus to other communicable diseases. Your stroke or heart attack isn't going to infect and kill someone else.

Certainly that is one comparison that could be made.  But the chart and article we were discussing was comparing it to diseases that people die from.

[Bart_van_der_Wolf]

Certainly that is one comparison that could be made.  But the chart and article we were discussing was comparing it to diseases that people die from.

Most people die of old age (not a disease by most definitions).
Most people die in bed. How relevant would that be in finding ways to avoid that????

Let's stay on the topic of science ...

[TechTalk]

Certainly that is one comparison that could be made.  But the chart and article we were discussing was comparing it to diseases that people die from.

You can compare COVID-19 deaths to anything that you like. You could compare the death rate to the number of people that die from falling off a cliff. However, I don't think that it would be very useful.

It's a virus that can be spread and therefore increase or decrease the number of deaths depending on actions that are taken to control it. If there is a useful purpose in comparing it with diseases that are not communicable, other than for purely statistical reporting, I'm open to being enlightened.

[LesPalenik]

So much for the theory that the virus will subside with the warmer temperatures. A record number of over 38,000 new cases was reached today in US. Thew good thing is that number of deaths is down. I suspect that many snow birds won't be flying this fall and winter southbound.

Confirmed coronavirus cases in the United States surpassed 2.5 million on Sunday as a crushing new wave of infections continued to bear down throughout the country’s South and West. Across the nation, more than 38,000 new daily cases were reported by 5:15 p.m. on Sunday.

Florida, Texas and Arizona are fast emerging as the country’s latest epicenters after reporting record numbers of new infections for weeks in a row. Positivity rates and hospitalizations have also spiked. On Sunday, Arizona (3,857) and Georgia (2,225) hit new one-day case highs.

Global cases of covid-19 exceeded 10 million, according to a count maintained by Johns Hopkins University, a measure of the power and spread of a pandemic that has caused vast human suffering, devastated the world’s economy and still threatens vulnerable populations in rich and poor nations alike.

https://www.washingtonpost.com/nation/2020/06/28/coronavirus-live-updates-us/

[BobShaw]

It's a virus that can be spread and therefore increase or decrease the number of deaths depending on actions that are taken to control it.

That is the thing. It can grow exponentially if not controlled.
I was watching a news broadcast this morning about a spike in Texas. They said that they have "gone back to washing their hands". Is that serious? Did they ever stop? The US has passed another milestone, their death toll from WW1.

https://metro.co.uk/2020/05/30/graph-shows-how-quickly-coronavirus-became-worlds-biggest-killer-12780314/

[Ray]

Most people die of old age (not a disease by most definitions).
Most people die in bed. How relevant would that be in finding ways to avoid that?

Let's stay on the topic of science ...

That's an interesting point, Bart. I was surprised when I first came across a comment some time ago, that old age was never mentioned on a death certificate as the cause of death.

Here's an article which addresses the issue.
https://www.abc.net.au/news/health/2017-06-14/can-you-die-from-old-age/8605896

"It is never old age alone that causes someone to die. Rather, it is the increasing likelihood of complications arising from the conditions that accumulate with age.

Doctors won't always know the precise cause of death in an elderly person because they may have overlapping conditions that interact in different and subtle ways, making it difficult to determine one official cause.
Doctors are less likely to carry out invasive testing that might uncover a specific cause in older people, compared with young, healthy patients.

In many cases, the death certificate will only say what is the most likely cause of death without necessarily having a specific or post-mortem proven cause of death," Dr Rosenfeld says.

Every death certificate, even when they don't know what it was, they would usually say heart attack, cardiac arrest. If it's an old person in a nursing home they probably usually say pneumonia."

This situation is very relevant for Covid-19 infections. The elderly are most at risk because of the comorbidity associations. There are probably thousands of elderly people who have been included in the Covid-19 death statistics, who would probably have died of other causes within a few days, or a few weeks, or a few months, as one or more of their other deteriorating conditions became fatal, even if they had not tested positive to Covid-19.

[Robert Roaldi]

So much for the theory that the virus will subside with the warmer temperatures.

That was always more a wish or a hope than a theory, but I know what you mean.

[TechTalk]

There are probably thousands of elderly people who have been included in the Covid-19 death statistics, who would probably have died of other causes within a few days, or a few weeks, or a few months, as one or more of their other deteriorating conditions became fatal, even if they had not tested positive to Covid-19.

I appreciate the fact that you are making a conditional assertion by prefacing your statement with the word "probably". If you have underlying medical conditions such as hypertension, obesity, and high cholesterol and then die from a sudden heart attack, wouldn't you expect the cause of death to be listed as a heart attack? The underlying conditions are contributing factors not the cause.

The same holds true when death occurs from an infectious disease that attacks someone with serious existing health conditions. The fact that many elderly people have medical conditions that make them weaker or reduces their immune system's ability to resist a serious contagious disease doesn't alter the fact that the actual cause of death is the infectious disease. The underlying health conditions are contributing factors to the infection reaching a level where it becomes fatal. They don't become the cause of death as it is always unknown what their longevity would be were it not for the infection. Infections are capable of causing death in young, old, healthy, and frail individuals. When they do, they are listed as the cause of death.

On the other hand, I don't have any education in these things. I'm reasonably confident that trained pathologists and epidemiologists are better able to make those determinations than either you or I.

[Ray]

If you have underlying medical conditions such as hypertension, obesity, and high cholesterol and then die from a sudden heart attack, wouldn't you expect the cause of death to be listed as a heart attack? The underlying conditions are contributing factors not the cause.

Doesn't everyone die after their heart stops beating, unless they are brought back to life with 'cardiopulmonary resuscitation', or very occasionally revive naturally in the morgue, or even in the coffin if their burial takes place quickly after they've mistakenly been pronounced dead? 

Everything is subject to 'cause and effect'. If a person is suffering from a heart condition, the causes of that condition have to be identified by the doctor in order for the doctor to treat the patient. If there are a number of contributing causes, which is often the case, it might not be possible (or practical due to lack of resources) to correctly identify which was the major cause of the person's heart attack which resulted in death.

[kers]

in Brazil they have lost their patience with the virus...

https://www.beeld.nu/LL/VID-20200624-WA0004.mp4

[faberryman]

Everything is subject to 'cause and effect'. If a person is suffering from a heart condition, the causes of that condition have to be identified by the doctor in order for the doctor to treat the patient. If there are a number of contributing causes, which is often the case, it might not be possible (or practical due to lack of resources) to correctly identify which was the major cause of the person's heart attack which resulted in death.

Let's say I have terminal cancer. And I am hit by a car and killed on the way to the hospital for treatment. The cause of death is the injuries caused by being hit by a car, not cancer, even though I would have died sometime down the road from cancer.

[TechTalk]

Let's say I have terminal cancer. And I am hit by a car and killed on the way to the hospital for treatment. The cause of death is the injuries caused by being hit by a car, not cancer, even though I would have died sometime down the road from cancer.

It wasn't clear to me what point Ray was trying to make regarding Covid deaths; so I gave up. How the virus kills is clear. It attacks the lungs, reducing oxygen supply to the body. Doctors, pathologists, and medical examiners generally are not going to have much difficulty determining cause of death as they chart the fall of oxygen levels.

Death is often the result of acute respiratory distress. In the worst case scenarios, death occurs slowly as the virus reduces oxygen supply from the lungs to the organs resulting in the gradual failure of multiple organs prior to death. It's a very very ugly disease and depending on the severity of the infection is quite capable of killing young healthy individuals.

[Jeremy Roussak]

It wasn't clear to me what point Ray was trying to make regarding Covid deaths; so I gave up. How the virus kills is clear. It attacks the lungs, reducing oxygen supply to the body. Doctors, pathologists, and medical examiners generally are not going to have much difficulty determining cause of death as they chart the fall of oxygen levels.

If the patient is in hospital. Those who die in nursing homes or in their own homes are less reliably classified - and there are an awful lot of them.

Jeremy

[Alan Klein]

I don't believe on death certificates that people die from Covid.  It is a contributory factor.  Primary cause of death would be something like respiratory failure or cardiac arrest.  You don't get enough oxygen or your heart stops beating, so you die.  Secondary or contributory factor on the certificate is Covid. 

[hogloff]

I don't believe on death certificates that people die from Covid.  It is a contributory factor.  Primary cause of death would be something like respiratory failure or cardiac arrest.  You don't get enough oxygen or your heart stops beating, so you die.  Secondary or contributory factor on the certificate is Covid.

Personally I've never seen a death certificate, have you? Have no idea, but both my parents died from cancer as that is what their doctors told me.

[TechTalk]

If the patient is in hospital. Those who die in nursing homes or in their own homes are less reliably classified - and there are an awful lot of them.

Jeremy

You're absolutely right. Getting precise data is difficult and messy and requires best estimations by experts as a result. There is an article from Scientific American that addresses the issue fairly well. Non-experts that have a desire to claim either over or under reporting will find plenty to glom onto in the article. I do not and would not make any claims regarding the estimates from epidemiologists as they're educated and trained in the field and I am not.   https://www.scientificamerican.com/article/how-covid-19-deaths-are-counted1/

Regarding Deaths in the Hospital...

How hard it is to accurately determine whether COVID-19 was truly that last straw depends on the situation. Most COVID-19 deaths seen at Mount Sinai Health System in New York are in people who have comorbid (or co-occurring) conditions such as coronary artery disease or kidney disease, said Dr. Mary Fowkes, the chief of autopsy services at Mount Sinai. But it’s not typically difficult to tell what killed them.

“Most of the cases are pretty straightforward,” Fowkes told Live Science. “The lungs are usually so severely involved with pathology, so they are two to three times or more the normal weight of a normal lung.” (The excess weight is due to fluid and cell detritus from damaged lung tissues.)

Regarding deaths at home...

In some cases, particularly those where someone dies at home or quickly perishes after entering an emergency room, the determination can be a little more fuzzy, said Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Massachusetts. “The challenge is knowing who died of COVID-19 versus who died with the virus that causes COVID-19,” Faust told Live Science.

All of the inconsistencies of cause-of-death reporting precede the COVID-19 pandemic, says Jay Wolfson, a professor of public health at the University of South Florida (USF). But getting good data about deaths is now extremely pressing, he told Live Science. Death certificates are often used by epidemiologists and public health officials to detect strange clusters of deaths or to link certain risk factors to certain causes of death. But because different states and localities have different rules about recording and reporting causes of death, the cumulative data is always messy.

“I think some states are reluctant to open their databases up, knowing they have validity problems or knowing the data might be misused,” Wolfson said. But public health officials need access, he said, and they need to figure out ways to dig into the data and standardize them. Wolfson and other researchers at USF are already working with state officials to see what kind of data the state can legally release, he said.

Both undercounts and overcounts of COVID-19 deaths are possible, Wolfson said, but it’s not yet clear which is more likely, or whether they might simply balance each other out. Fowkes said that based on her experience, it’s more likely that COVID-19 deaths are being missed than overcounted. That’s because New York is among several cities that show spikes in deaths at home, and these anomalous spikes could be due to untested, untreated COVID-19.

[TechTalk]

I don't believe on death certificates that people die from Covid.  It is a contributory factor.  Primary cause of death would be something like respiratory failure or cardiac arrest.  You don't get enough oxygen or your heart stops beating, so you die.  Secondary or contributory factor on the certificate is Covid.

From the same Scientific American article linked above...

For COVID-19, the immediate cause of death might be listed as respiratory distress, with the second line reading “due to COVID-19.” Contributing factors such as heart disease, diabetes or high blood pressure would then be listed further down. This has led to some confusion by people arguing that the “real” cause of death was heart disease or diabetes, Aiken said, but that’s not the case.

“Without the COVID19 being the last straw or the thing that led to the chain of events that led to death, they probably wouldn’t have died,” she said.

[Alan Klein]

Personally I've never seen a death certificate, have you? Have no idea, but both my parents died from cancer as that is what their doctors told me.

Yes I've seen them.  We say people die from cancer.  But that's the contributory cause.  The primary or immediate cause of death would be let's say renal failure.  The cancer attacks the organs so they stop working properly and you die.  But we don't say the person died from renal failure, we say they died from cancer which caused the renal failure.  I believe these often get confused or there may be unknown reasons especially if there's no autopsy. If someone is really old, and dies, they're not going to perform an autopsy unless it looks like there was foul play. 

[TechTalk]

If someone is really old, and dies, they're not going to perform an autopsy unless it looks like there was foul play.

The patient or family can also request or give permission for an autopsy. In the case of my elderly father, he gave permission for an autopsy shortly before he died from heart disease for the purpose of educating students in the university hospital where he died.