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Author Topic: COVID-19 | science, damage limitation, NO POLITICS  (Read 33463 times)

Alan Klein

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1600 on: June 29, 2020, 03:31:59 pm »

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

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1601 on: June 29, 2020, 03:47:15 pm »

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.
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faberryman

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1602 on: June 29, 2020, 04:29:47 pm »

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.
Who is "we"? Who gets confused? Also, where did you go to medical school?
« Last Edit: June 29, 2020, 05:46:33 pm by faberryman »
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Ray

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1603 on: June 29, 2020, 08:09:21 pm »

Who is "we"? Who gets confused? Also, where did you go to medical school?

As I've already mentioned, everything is subject to 'cause and effect'. In many situations the causes and effects over a period of time are so numerous that they are difficult to both quantify and qualify.

Consider Alan's example of a person dying of renal failure which was caused by cancer. That's just two causes and two effects. If one goes back further and questions what caused the cancer, it can get very complicated and very uncertain.

For example, to what extent was the cancer caused by a bad diet, or by a lack of exercise, or by exposure to harmful chemicals, or by a genetic weakness, or by a combination of all those conditions plus many more that are not identified, and perhaps cannot be identified?

Edit: And another possibility; the side effects of drugs administered to treat other ailments.
« Last Edit: June 29, 2020, 08:15:58 pm by Ray »
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Jeremy Roussak

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1604 on: June 30, 2020, 03:36:52 am »

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.

Seen many, completed many.

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. 

In the UK, there is considerable flexibility in certifying the cause of death. A death certificate contains

I(a) Disease or condition directly leading to death:
I(b) Other disease or condition, if any, leading to I(a):
I(c) Other disease or condition, if any, leading to I(b):
II Other significant conditions CONTRIBUTING TO THE DEATH but not related to the disease or condition causing it:

I've never certified a death in the US; the form may well be different.

The last sentence is untrue, at least in the UK: a death must be referred to the coroner if the deceased has not been seen by a doctor within two weeks of death. That rule has been relaxed for the last three months, which has done little to improve the reliability of data on cause of death.

Jeremy
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Alan Klein

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1605 on: June 30, 2020, 08:55:01 am »

Seen many, completed many.

In the UK, there is considerable flexibility in certifying the cause of death. A death certificate contains

I(a) Disease or condition directly leading to death:
I(b) Other disease or condition, if any, leading to I(a):
I(c) Other disease or condition, if any, leading to I(b):
II Other significant conditions CONTRIBUTING TO THE DEATH but not related to the disease or condition causing it:

I've never certified a death in the US; the form may well be different.

The last sentence is untrue, at least in the UK: a death must be referred to the coroner if the deceased has not been seen by a doctor within two weeks of death. That rule has been relaxed for the last three months, which has done little to improve the reliability of data on cause of death.

Jeremy

It's pretty similar in the US but probably varies a little among the 50 States which each make their rules.  I found this on the web.

"For example, in all U.S. states, an autopsy can be ordered if there is suspicion of foul play. This type of autopsy is referred to as a forensic autopsy and is performed to gather information of interest to authorities and to determine the manner of death (homicide, suicide, accident, natural death, or undetermined manner).

In most states, autopsies may also be ordered if there is a belief that the death represents a significant public health concern (such as from a threatening infectious disease), if a person inexplicably dies who was not under medical care, who was receiving medical care from a physician for less than 24 hours, or if a person dies from an injury, such as an automobile accident. Autopsies that are ordered by authorities are performed and evaluated in the medical examiner's office or coroner's office.

If an autopsy is not required by law or ordered by authorities, the deceased person's next of kin must give permission for an autopsy to be performed."

https://www.medicinenet.com/when_is_an_autopsy_mandatory/ask.htm

Jeremy Roussak

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1606 on: June 30, 2020, 01:36:35 pm »

Interesting news article from the Karolinska Institute: active T cells found in some people with no antibodies. Might explain the high negative rate of the antibody test in those who have been symptomatic (not false negatives after all) and casts further doubt on the usefulness of the test; on the other hand, it may be that immunity is more common than has been thought. There's a link to the as yet unpublished paper. The usual caveats about lack of peer review apply, of course.

Jeremy
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Alan Klein

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1607 on: June 30, 2020, 02:27:37 pm »

Interesting news article from the Karolinska Institute: active T cells found in some people with no antibodies. Might explain the high negative rate of the antibody test in those who have been symptomatic (not false negatives after all) and casts further doubt on the usefulness of the test; on the other hand, it may be that immunity is more common than has been thought. There's a link to the as yet unpublished paper. The usual caveats about lack of peer review apply, of course.

Jeremy
Correct me if I misunderstand.  So if people have T cells that are protecting them from Covid, that means that they have natural immunity because of their DNA?

This could be helpful in reaching herd immunity. It may also mean that the disease will "die out" soon or have minimum secondary effects afterwards.

Will they be able to test people to see if they have the T cells.  If so, those that have them could more easily get on with their lives without the worry the rest of us are facing.

kers

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1608 on: June 30, 2020, 07:56:41 pm »

America First;   
130.000 deaths and ticking...
Going for 100.000 new cases a day, if they don't watch out ( according to Fauci)
https://apnews.com/8e2b3b7ca3bb2475b9ae901dad4e09ee

Maybe it is time for some action? Direction? Apparantly NY now knows how to deal with it, maybe they should go and visit to get some lecture.

meanwhile " The US has bought up virtually all the stocks for the next three months of one of the two drugs proven to work against Covid-19, leaving none for the UK, Europe or most of the rest of the world."
https://www.theguardian.com/us-news/2020/jun/30/us-buys-up-world-stock-of-key-covid-19-drug

Europe is keeping the US travelers out, for 1 of every 200 US citizen (or more) is infected.

« Last Edit: June 30, 2020, 08:10:29 pm by kers »
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jeremyrh

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1609 on: July 01, 2020, 06:47:01 am »


meanwhile " The US has bought up virtually all the stocks for the next three months of one of the two drugs proven to work against Covid-19, leaving none for the UK, Europe or most of the rest of the world."
https://www.theguardian.com/us-news/2020/jun/30/us-buys-up-world-stock-of-key-covid-19-drug

AIUI the ones who this would benefit wouldn't be sick enough to be admitted to a UK hospital anyway, so no big deal - except for what it says about US attitude to a global problem.
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Alan Goldhammer

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1610 on: July 01, 2020, 03:42:39 pm »

Interesting news article from the Karolinska Institute: active T cells found in some people with no antibodies. Might explain the high negative rate of the antibody test in those who have been symptomatic (not false negatives after all) and casts further doubt on the usefulness of the test; on the other hand, it may be that immunity is more common than has been thought. There's a link to the as yet unpublished paper. The usual caveats about lack of peer review apply, of course.

Jeremy
Several other investigators have found the same thing and it may be this is the main immune mechanism in young people as it appears to be age related.  We don't know what the level of prevalence is here and I would not be quick to dismiss the utility of the antibody test.  Testing in general is still a black box as some people can harbor viral DNA fragments for several weeks after clinical symptoms have disappeared.  They still have positive PCR test but no viable virus can be cultured from nasal or throat swabs.  There is just a lot of weird things about this virus that continually amaze me.  As a former pathologist you might be interested in this Washington Post story.  Just some more grist for the COVID-19 mill.
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Alan Goldhammer

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1611 on: July 01, 2020, 03:52:20 pm »

Correct me if I misunderstand.  So if people have T cells that are protecting them from Covid, that means that they have natural immunity because of their DNA?

This could be helpful in reaching herd immunity. It may also mean that the disease will "die out" soon or have minimum secondary effects afterwards.

Will they be able to test people to see if they have the T cells.  If so, those that have them could more easily get on with their lives without the worry the rest of us are facing.
Everyone has T cells.  What is not known is why there is a differing immune response in some people and not others.  Killer T cells can help the body clear out viral infections.  The whole immune system is quite complicated with lots of different signalling going on in response to an infection.
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LesPalenik

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1612 on: July 01, 2020, 09:32:39 pm »

Over 51,000 infections in USA one day! That's a number even the most staunched deniers couldn't imagine just a few months ago - for the entire disease duration.

Today, I spoke on the phone with a Canadian lady from Ottawa who got stuck in March in Orlando, and she still can't get home. There were over 6,500 recorded cases in Florida today. She was quite scared and worried.

LesPalenik

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1613 on: July 01, 2020, 11:56:32 pm »

The border restrictions between US and Canada put in place in March have been extended three times and are now set to expire on July 21 - unless they will be extended again.

Quote
"My guess is it's going to have to stay closed for more than 12 months," Colin Furness, an epidemiologist at the University of Toronto, told CBC News this week. "It's hard to imagine what's going to happen in the United States until we have a vaccine or until the population has been sufficiently infected that you have herd immunity."

https://www.cbc.ca/news/politics/canada-u-s-border-pandemic-covid-coronavirus-1.5633650

BobShaw

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1614 on: July 02, 2020, 01:50:09 am »

Over 51,000 infections in USA one day! That's a number even the most staunched deniers couldn't imagine just a few months ago - for the entire disease duration.

Today, I spoke on the phone with a Canadian lady from Ottawa who got stuck in March in Orlando, and she still can't get home. There were over 6,500 recorded cases in Florida today. She was quite scared and worried.
Surely Canadians are allowed into Canada with quarantine?
Or is it a case that she can't get there? I would get in a car and drive rather than stay. (Big drive I know)
Nearly all of the cases in Australia are returning Australians and their only issue was getting a flight. (Can't drive home.)
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Jeremy Roussak

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1615 on: July 02, 2020, 03:59:17 am »

I would not be quick to dismiss the utility of the antibody test ... As a former pathologist you might be interested in this Washington Post story.

I wasn't dismissing its utility, merely observing that a test with such a very high false-negative rate must be treated with circumspection. And I was a surgeon, not a pathologist.

The whole immune system is quite complicated...

That comment reminds me of a trip I took some years ago to the Getty museum in LA, in the course of which the guide described John Paul Getty as "a successful businessman": it's the understatement of the decade. Not only is the immune system staggeringly complex, it's fractal: the closer you look, the more complex it gets.

Jeremy
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LesPalenik

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1616 on: July 02, 2020, 04:10:54 am »

Surely Canadians are allowed into Canada with quarantine?
Or is it a case that she can't get there? I would get in a car and drive rather than stay. (Big drive I know)
Nearly all of the cases in Australia are returning Australians and their only issue was getting a flight. (Can't drive home.)

That's what I thought. I wonder if the rules changed recently with the new explosion of cases in USA.

As to driving to and from Florida, I have done it many times from Ontario, but many people especially older folks can't drive or are afraid to drive such long distances (over 2,200km from Orlando to Ottawa). And they would need to stop for 2-3 nights in motels what adds also a risk factor. Most probably she flew there and even if she has a driving license, renting a car for one way trip from US to Canada could be now quite expensive.

faberryman

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1617 on: July 02, 2020, 09:31:55 am »

In the US about 30% of COVID deaths may not be classified as such, largely due to a lack of testing:

https://www.cidrap.umn.edu/news-perspective/2020/07/about-30-covid-deaths-may-not-be-classified-such

Alan Klein

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1618 on: July 02, 2020, 10:41:30 am »

That's what I thought. I wonder if the rules changed recently with the new explosion of cases in USA.

As to driving to and from Florida, I have done it many times from Ontario, but many people especially older folks can't drive or are afraid to drive such long distances (over 2,200km from Orlando to Ottawa). And they would need to stop for 2-3 nights in motels what adds also a risk factor. Most probably she flew there and even if she has a driving license, renting a car for one way trip from US to Canada could be now quite expensive.
My "snow bird" friends here ion New Jersey travel to Florida for four months during the cold winter.  They use the car-train for part of the way picking it up in Virginia.  The train loads up you car and you get a sleeper for yourself.  It terminates in northern FLorida where they can drive to their final destination in a couple of hours. They spend one night on the train.

Alan Klein

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Re: COVID-19 | science, damage limitation, NO POLITICS
« Reply #1619 on: July 02, 2020, 10:44:52 am »

In the US about 30% of COVID deaths may not be classified as such, largely due to a lack of testing:

https://www.cidrap.umn.edu/news-perspective/2020/07/about-30-covid-deaths-may-not-be-classified-such


There's also the belief that more people are dying of these other diseases even though they are not infected with Covid.

Numbers of Non-COVID-19 Deaths Up During Pandemic
"But a third possibility, the one we're quite concerned about, is indirect mortality -- deaths caused by the response to the pandemic," he said. "People who never had the virus may have died from other causes because of the spillover effects of the pandemic, such as delayed medical care, economic hardship or emotional distress."
https://www.usnews.com/news/health-news/articles/2020-07-01/numbers-of-non-covid-19-deaths-up-during-pandemic
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