You might find this report from a Swiss physician about the situation in Italy interesting. I cannot confirm its veracity. Here’s a snippet:
According to the latest data of the Italian National Health Institute ISS, the average age of the positively-tested deceased in Italy is currently about 81 years. 10% of the deceased are over 90 years old. 90% of the deceased are over 70 years old.
80% of the deceased had suffered from two or more chronic diseases. 50% of the deceased had suffered from three or more chronic diseases. The chronic diseases include in particular cardiovascular problems, diabetes, respiratory problems and cancer.
Less than 1% of the deceased were healthy persons, i.e. persons without pre-existing chronic diseases. Only about 30% of the deceased are women.
The Italian Institute of Health moreover distinguishes between those who died from the coronavirus and those who died with the coronavirus. In many cases it is not yet clear whether the persons died from the virus or from their pre-existing chronic diseases or from a combination of both.
The two Italians deceased under 40 years of age (both 39 years old) were a cancer patient and a diabetes patient with additional complications. In these cases, too, the exact cause of death was not yet clear (i.e. if from the virus or from their pre-existing diseases).
You might also find these snippets from the most recent update interesting:
German immunologist and toxicologist, Professor Stefan Hockertz, explains in a radio interview that Covid19 is no more dangerous than influenza (the flu), but that it is simply observed much more closely. More dangerous than the virus is the fear and panic created by the media and the „authoritarian reaction“ of many governments. Professor Hockertz also notes that most so-called „corona deaths“ have in fact died of other causes while also testing positive for coronaviruses. Hockertz believes that up to ten times more people than reported already had Covid19 but noticed nothing or very little.
and
Using data from the cruise ship Diamond Princess, Stanford Professor John Ioannidis showed that the age-corrected lethality of Covid19 is between 0.025% and 0.625%, i.e. in the range of a strong cold or the flu. Moreover, a Japanese study showed that of all the test-positive passengers, and despite the high average age, 48% remained completely symptom-free; even among the 80-89 year olds 48% remained symptom-free, while among the 70 to 79 year olds it was an astounding 60% that developed no symptoms at all. This again raises the question whether the pre-existing diseases are not perhaps a more important factor than the virus itself. The Italian example has shown that 99% of test-positive deaths had one or more pre-existing conditions, and even among these, only 12% of the death certificates mentioned Covid19 as a causal factor.
Keep calm and carry on.
I’ve already read several pieces corresponding to the information gleaned from the Italian National Health Institute. Digging into the stats more deeply produces a much different lethal picture of the virus, than only looking at the raw numbers coming out of Italy. Also, worthwhile to note is the much smaller number of ICU beds per 100,000 people than there are in the US. – something like 12 versus 34 (approximate numbers). Basically, our medical apparatus and free market govt is better prepared here, than in a Italy and most other countries, to handle this medical crisis.
The 2nd excerpt posted, comparing the flu to COVID-19, merits at least some consideration, as more and more people in the field of medicine are citing similar relationships, including the negative impact of fear coupled with too restrictive governmental responses.
Finally, John Ioannidis, mentioned in the Diamond Princess study, has recently been added to the government’s Coronavirus Task Force, offering opinions focused on data and demographic subsets rendering predictions different from those centered in the worst-case-scenarios models. His perspectives may be why the president is extending more “hopeful,†positive verbiage than what the media feeds us everyday.
Hockertz is clearly an ideologue who never enters a hospital. Flu acts nothing like this. With flu you don’t end up with 2-3% of pts needing an ICU, 5% -10% needing hospital. It just doesnt happen. We have been through many, many rounds of the flu. We have NEVER had to turn entire new sections of the hospital into an ICU. Never had to have general floor nurses and regular internists cover the ICUs. Has never happened. If we end up having death rates similar to the flu it will only be because we massively transformed thousands of our hospitals into giant ICUs.
OK, who took a course in statistics, or even more than one? What would we want to know? Maybe what percentage of our elderly in general have pre-existing morbidities? How about, do hospitals get reimbursed more if they list more co-morbidities? Do electronic records lead to more of those following a pt?
So maybe Covid is just like the flu and in Italy they routinely tell people if you are over 70 and need a ventilator they domino have one so you just die. The rich area of Italy with income close to ours.
Steve
3 observations that go against the article.
1. The percentage of 70+ year olds who have no comorbidity — no diabetes, no cancer, no CVD, no lung disease is a minority of 70+ olds.
2. There are officials in Italy who state the death toll is actually significantly understated. The death tolls for some towns in Italy are quadruple from the same month last year, yet only half of the excess deaths were patients who were tested for coronavirus.
https://www.euronews.com/2020/03/21/italian-mayor-claims-the-true-death-toll-from-covid-19-likely-to-be-much-higher
3. I have never heard of a flu that attacks health care workers like coronavirus. Maybe it really is under-reported during flu season — but do doctors / nurses regularly hospitalized while trying to treat patients?
Isn’t there some space between “just like the flu” and “the Black Death”? I think there is. Saying that “the best analogy we have is the flu” seems to me to be a fair statement. Maybe the best analogy would be measles. Or cholera. I’m open to suggestions.
I don’t think that measles is a good analogy because there’s already a pretty good vaccine for that. A vaccine may never be developed for COVID-19. Cholera responds to antibiotics so that’s not a particularly good analogy. A cold isn’t a good analogy because so few people die of rhinovirus.
CuriousOnlooker:
Maybe that’s because 80% of health care workers get the flu vaccine every year.
” but do doctors / nurses regularly hospitalized while trying to treat patients?”
No. Ebola was an issue and was actually easier to catch and more deadly if you caught it, but it was an illness easier to control.
“Isn’t there some space between “just like the flu†and “the Black Deathâ€? I think there is.”
Certainly. Have you heard me call it the Black Death? Of course not. The problem with using the flu as analogy is that it is so poor it is meaningless and is just used to minimize Covid.
Here is your challenge. Go find a bunch of people actually caring for Covid pts to tell you it is just like the flu.
No. But you have repeatedly treated it as though it were a death sentence. What’s the mortality rate? We don’t know. What’s the mortality rate for those over 60? We don’t know. What’s the mortality rate for those over 60 without comorbities? We don’t know. But it’s probably closer to the flu than it is to a death sentence.
https://www.preprints.org/manuscript/202003.0191/v1/download
Thought this was a pretty interesting paper about difference in susceptibility based on ACE2 receptor expression. Would be interested to hear Steve’s impression if time permits.
” But you have repeatedly treated it as though it were a death sentence. ”
BS. I have repeatedly said that I think the mortality i probably between 1%-2%. I have also treated it as though it will probably more than fill up our ICUs and beyond with pts need ICU care and many needing vents. Care to dispute that?
“What’s the mortality rate? We don’t know”
Have agreed with this every time you have said that. As a matter fact again just today in a prior post.
“We don’t know. What’s the mortality rate for those over 60 without comorbities?”
What percentage of old people have comorbidities? What percentage if they have an EMR? (I believe you are familiar with the literature showing that EMRs often increase medical costs. One reason being that they track co-existing disease so well.) This is so disappointing for someone who has some facility with numbers. Let me help you out. With an EMR I have never seen a pt without comorbidities.
Steve
Well, I’m well over 70 and have no comorbidities. At least none diagnosed or being treated. I take no medications. I have no idea what the rate is across the population.
“Would be interested to hear Steve’s impression if time permits.”
Not really my area of expertise, but I have been reading this a bit and would note that people smarter than I who study this stuff for a loving are divided on whether ARBs or ACE-I would be good or bad with Covid. Strikes me as interesting but we really need a clinical study because the lab people are studying one tiny area and in real life things are usually more complex than that. (How is that for a definite maybe!)
Steve
If you have been saying that the mortality rate for those who contract COVID-19 is 1%-2% I have misunderstood you and I sincerely apologize.
Thought you said you had chronic pain?
Steve
It’s not being treated. It doesn’t seem to express as anything but pain. They tried to treat it for several years without much effect. Then we gave up. That was 20 years ago. I’ve also been told that I have a remarkable ability to manage pain. 30 years of martial arts.
My blood pressure is fine as is my cholesterol. My resting heart rate is excellent for my age, verging on that of an athlete.
Strikes me as interesting but we really need a clinical study because the lab people are studying one tiny area and in real life things are usually more complex than that. (How is that for a definite maybe!)
Understood…thanks
Steve:
‘We have been through many, many rounds of the flu. We have NEVER had to turn entire new sections of the hospital into an ICU. Never had to have general floor nurses and regular internists cover the ICUs.’
What is the current occupancy rate of the beds in the original ICU with Kung Flu patients? What is the current occupancy rate of the beds in the new ICU sections of your hospital with KF patients? What is the expected occupancy rate at the peak of the crisis? It would be interesting to know after the worst is over how bad it was for you. I would be very happy if they ended up being severely underutilized.
Dave- On my EMR you would be listed as having a co-morbidity, chronic pain. The fact that no one can treat it would not eliminate the diagnosis. There are a number of diagnoses we cant treat or at least no treat very well, but it would show up as a diagnosis. Think of essential tremors and how many people don’t find a med that controls it, or if it is mild just put up with it.
Steve
Steve – the issue isn’t whether this version of the flu is particularly serious, or particularly hard on those with other health issues. The issue is what is the most effective strategy to deal with it given the realities of the resources available, and what are the costs of that strategy.
We deal with such realities and life choices everyday, and always have in the past.
How we deal with an event such as this tomorrow is, well, for tomorrow.
Tyler Cowen is posting unidentified source in Japan (from an international team, but not medical researchers) claiming that the extent of Japan’s spread of the virus has been understated. The reasons given are:
1. Japan is undercounting asymptomatic individuals, who can spread the virus. (Policy very restrictive on testing anybody without symptoms)
2. Japan’s reported deaths are likely caused by a larger infection count than it is reporting. (I think this is a conclusion reached by a model comparing previous death rates at a local level to current figures, to conclude that some recent deaths are being misattributed)
3. Countries that test people who have been in Japan find more infections than Japan does. (This seems to be based entirely on Singapore aggressively checking at airports)
I’m agnostic on this, but Japan’s numbers have seen surprisingly low given age, and would not be surprising that the reality is worse, but how worse? The authors seem to think that the situation has given the Japanese false sense of security.
I have little doubt that the Japanese attribute their EXTREMELY low death rate per million population due to COVID-19 (currently .4) to the superiority of Japanese people. I wonder how they’ll explain the excess deaths?
“What is the current occupancy rate of the beds in the original ICU with Kung Flu patients? What is the current occupancy rate of the beds in the new ICU sections of your hospital with KF patients? What is the expected occupancy rate at the peak of the crisis?”
Here are the number increases of pts on a vent. These numbers are 2 days apart except for the last two numbers, 3 days apart.
1,2,5,9,25
Our numbers tested turning positive is running about the same proportion. We are opening the extra ICU space ahead of time. Not started filling them yet. Our current prediction from the stats guys is that if we have 20% of pts positive with Covid we will bye OK. Over that and it will be tough. Cross training lots of people.
Steve: Thanks for the update on ICU occupancy and predicted occupancy. Hope that the predictions for ICU occupancy are far too high and that the staff don’t run themselves down to sickness. I know what it’s like to be understaffed.
Thank you. Appreciate that.