Monday, November 30, 2020

COVID-19: My Little Library Of Statistics And Analysis

For months now, I have been slowly building a document of COVID-19 resources when I run across things that catch my eye: a post on social media that I wanted to check;  an intriguing news story floating through my Flipboard feed; friends who work in the medical field post heart-breaking updates on their work in hospitals, only to be dismissed as if they must be lying. Sometimes I read articles (rightly) criticizing the inconsistency of public health organizations over time, or the words vs. the actions of politicians who said one thing and did another. Sometimes I simply wanted to know more about how to first re-open and then keep open our church in a way that offers a reasonably safe and accommodating space.

Whatever the reason, I built this document over time. It represents a pursuit of knowledge; I am well aware it's not the end of it! And as serious as I believe the coronavirus to be (as you will see), I’m not curled up in a ball quivering in fear, as anyone who knows me can attest. I assume I will get it at some point (as most of us will); I assume I will be like most people in my demographic, and when I do get it, it will be somewhere on a spectrum short of fatal, and likely relatively mild, though it's definitely unpredictable. [1] So that’s not why I compile stuff like this. I just want to know what’s true about the world. 


Oh, and one other note. 


I am interested in the stats and the science for the purposes of this post, so I don' have anything about politics or freedoms or the constitution here. Those are important topics for a different time. They just aren't my focus here. You can write that one :)


At to the science, it has obviously and publicly evolved over time around the entire world. It’s frustrating, and it can understandably make us leery of trusting authoritative voices, but it’s how science works. It's not a sign of a nefarious plot. I am far more confident in the science now than I was six months ago, for sure. I’m also sure three months from now doctors and epidemiologists will know even more, and will have pivoted yet again in some way.  


With that in mind, if you want to add to the discussion by agreeing or disagreeing - and I would like you to add to this, because I want to pursue truth as I build this database -  post links and offer thoughtful insights from your research and experience. I don’t mind being thoughtfully challenged. I’m not a big fan of being called stupid or deceived or ‘sheeple.’ That line of discussion will not be pursued. 

 

* * * * *

STATS (PARTIALLY UPDATED 4/6/21)


·    US Coronavirus sicknesses. Nobody really knows how many people have it. There have been over 27 million cases officially, but I think everyone agrees a lot more people have had it than are accounted for in the official numbers. This uncertainty makes definitive statements about both infection rates and mortality rates almost impossible. We are left with the actual count, which is enough to let us see how COVID-19 is impacting the world. For what it’s worth, the CDC has pretty clear guidelines on how to report the underlying cause of all deaths, and certainly to distinguish between those who have died of COVID-19 vs. those who have died with COVID-19.[2] Check out the links in the footnotes. There’s a process; it’s publicly accessible for anyone to see.


·     US Coronavirus Deaths[3]: Worldometer currently reports approximately 570,259 deaths in the US from COVID-19. In contrast, US flu deaths for the 2019-2020 flu season were 22,000,[4] and the flu is barely registering so far in 2021, probably due to the implementation of COVID protocols. The CDC presumes an average of 61,000 flu deaths per year over time.[5] Since December 2019, COVID-19 has killed more people in the U.S. than influenza has in the last nine years.[6]  And if we were to try to estimate COVID deaths like we do flu deaths, the numbers would probably be higher. [7] I know that seems like a bold claim because of the concern they are overcounted, but check out the links in footnote #5.  According to the Journal of the American Medical Association, 

“Between November 1, 2020, and December 8, 2020, the 7-day average for daily COVID-19 deaths nearly tripled—826 to 2,226 deaths per day. Daily deaths in the first 13 days of December averaged 2,381 per day,1 already well exceeding the 1900 average daily deaths during the initial peak from April 15 to May 15.1 On December 9, 2020, deaths reached a record high of 3,411, more than 2 per minute and roughly 400 more than the September 11, 2001, attack. Such numbers elevate COVID-19 as a cause of death higher than heart disease and cancer, which, for decades, accounted for 1700 and 1600 deaths per day, respectively.” 

·    We have  over 2,000 deaths a day since early December until late February, making COVID-19  the #1 case of death in the U.S. for three months in the past year.


     World Coronavirus Deaths. Every year an estimated 290,000 (official/actual,I assume) to 650,000 (estimated) people die in the world due to complications from seasonal influenza (flu) viruses. So far, 2,885,278 have died due to COVID-19.  There are 795 to 1,781 deaths globally per day due to the seasonal flu. We passed those numbers for the coronavirus in the USA alone for at least three months.[8] According to Worldometer's seven day moving average, the world has recorded a 7 day average of 8,500 COVID-19 deaths or more since November of 2020.


·    Deaths per million of population: Currently, 1,715 in the United States, and sure to climb.[9]  Flu deaths per million:180-200.[10]  This is per the entire population, not just those who are known or assumed to be sick. We are currently 5th in the world in deaths per million of the population.


     Average daily number of deaths. In 2019, an average of 7,967 death occurred in the U.S. per day from all causes The average deaths per day for COVID-19 since the first case in the U.S.  is 1,133  (even though COVID deaths didn't get out of single digits per day until mid-March), compared with 331 for influenza. The 7-day moving average has been over 1,000 since November 10, and over 2,000 since December 5 (which was also true between April 15-26). It was as low as 484 in July. The COVID Tracking Project, with its plethora of graphs making these realities visual, is not for the faint of heart. 


·     The CFR (case fatality rate) for seasonal flu is 0.1 to 0.2. The CFR for COVID-19 is .25 to 10%, with the United States at 2.1 as of November 23. [11]  Important note: as I understand it, the CFR studies known cases and known fatalities, not estimated cases or assumed fatalities. “Case-fatality rates depend on testing: a country that tests only people with severe symptoms, for example, will have an outsized case-fatality rate compared with one in which asymptomatic testing is widespread. And fatality rates in intensive-care units can mislead if the demographics of the people admitted change over time. For example, many hospitals reported high numbers of younger patients as the pandemic wore on.” [12] So while one can (and probably should) question the actual CFR if all cases were known, the point is that the CDC compares apples to apples when determining the CFR.  

      A study conducted by the Imperial College London found the COVID-19 infection fatality ratio (IFR - the fatalities from all assumed infections, not just official cases) to be  about 1.15% of infected people in high-income nations and 0.23% in low-income nations, "with the risk of death doubling for every eight years of aging and ranging from 0.1% for people under 40 and 5% among people over 80 years old. The disparity between high and low-income nations is due largely to facts that high-income nations tend to have larger number of elderly in their populations whereas low-income nations’ population tend to skew youngers."


·     COVID patients in hospitals: Currently 91,440, which is a blessing after we were over 100,000 from December 2 to January 29,  in a row and topping out on January 7 at 132,370 which is the highest by far in the United States since COVID started. [13]  The high in the first surge was just under 60,000. Fortunately, the death rate for those hospitalized has dropped from 25% to about 7%. [14]  Here is a great website from the University of Minnesota that tracks not only hospitalizations for COVID-19, but how many patients are in the ICU and on ventilators. It also has helpful graphs to see how it has been changing over time. 


·     Hospitalizations in MI: after dropping really low over the summer, our state numbers are  spiked to the highest point at the beginning of December (4,326), but have been slowly declining since then (now at 1,907).  [15] This December, the Michigan Health and Hospital Association, which represents all 133 community hospitals in the state, asked the governor to extend restrictions because of the dire situations in hospitals. It appears to have worked in lowering both the cases and deaths, though there are serious concerns about long-term economic impacts.


·    Deaths in Michigan. Flu deaths in 2020 were officially 2,179. [16] Coronavirus deaths are over 17,343. [17] It will be the third leading cause of death in Michigan in 2020, behind heart disease and cancer (based on the last year of official stats). [18]


·    The average stay in the hospital for flu is 4-6 days; for COVID, 4-6 days is the short side. It is not unusual for hospitalization to last 2 to 3 weeks. [19] 


·     The long term effects are significantly more serious than influenza. [21]

       

      Interesting side note: flu cases have plummeted around the world, in some places as high as 98%, starting last spring. It is likely a combination of more people getting the flu vaccine and a benefit from all the COVID-19 cautions like masks, hand washing, and sanitizing. As of last week, there were less than 1,500 positive test for influenza in U.S. labs since the end of September. That's less than 400 positive tests in the U.S. in four months. This is remarkably low.     According to the CDC: 

 


      As for Michigan, influenza activity this year is incredibly low. See the weekly updates from Michigan for yourself. For example, there were only 20 doctor visits and 4 positive tests for influenza-like illness last week. 

ARTICLES

·“No, COVID-19 Is Not The Flu” – John Hopkins University

· “COVID-19 and the Flu are not the Same.” OSF Health Care. 

·“Coronavirus vs. flu: Similarities and Differences.” Mayo Clinic 

·“Comparing COVID-19 and the Flu.” University Of Nebraska Medical Center 

· “No, COVID-19 Is Not Like The Flu—And We Have To Stop Comparing Them.” Northwell Health 

"No One Is Listening To Us"  theatlantic.com

_____________________________________________

 

POINTS OF INTEREST (AT LEAST TO ME) 

1. From what I can tell, there is a professional consensus (not unanimity) that the majority of people in the United States will get COVID-19 by the time this is over. “Flattening the curve” has never been about stopping the infection as much as it has been about spreading it out so a) hospitals are not overwhelmed, and b) better treatments emerge. [22] As noted above, better treatments have indeed emerged, with the chance of death for hospitalized patients dropping from 25% to 7%. Unfortunately, the scenes in hospitals right now are still grim.[23]  Here’s a message I posted in early December (with permission) from a friend, Jennifer, who is a nurse in Muskegon:

"Anthony - we have over 150 COVID patients in my hospital. No COVID ICU beds available as of yesterday while I was working in the COVID ICU, but then 3 people died over about 5 minutes. So those beds would be available after the patients are cleaned and placed in a COVID body bag. We then we wash the bag itself with an antiseptic before security will come to pick it up. Last week we had 1 day where 8 people died, IN ONE DAY. There are over 100 employees home sick with COVID. We also had 30 COVID sick people in the ER waiting for beds yesterday. These are only the ones too sick to go home. There are hundreds sent home. It's a nightmare. And it's probably gonna get worse before it gets better. Yesterday I took care of a man in the COVID ICU who got put on the ventilator, and lines put in. I had him sedated, paralyzed and on 3 different medications to support his blood pressure. He tried to die once on me... His wife is in GR sick with COVID too. She is also on the ventilator. So their kids are gonna lose both of their parents. This has happened over and over and over. Husbands and wives....fathers and sons. That is what it looks like in Muskegon... Just thought I would share."


Another friend, a nurse in Oklahoma, posted last week, “I was working alongside [another nurse] trying to find a COVID ICU bed last night in Oklahoma and the surrounding states. There are NONE. Take care of yourself and your loved ones." She added later, “We called for hours looking for beds. One did become available about 12 hours later- in HOUSTON.” But you don’t have to take her word for it. Newspapers have been reporting the same thing.[24]I ran across a friend last week here in Traverse City who works in Munson (our local hospital). He noted that Munson is converting non-COVID wings to COVID care because they don’t have room for the COVID patients. 


2. The virus becomes increasingly dangerous depending on factors like blood type, [26] age (80% of deaths are in those 65+), and comorbidities such as diabetes (which 10% of people in the US have), heart disease (48%), lung disease (it’s the #4 cause of death[27]), cancer (1.8 million new cases a year), chronic liver and kidney disease (around 17% of the population, combined), hypertension (50% of adults) and obesity (over 40%). [28] As you can see, when we talk responding to COVID by having people who are at risk simply withdrawing to keep themselves safe, that’s… a lot of us. A LOT of us. And we forget that a lot of them are not just consumers who can stay home and order stuff online and have people bring them things. They are the producers who make it happen. Low-income people have a much greater risk at having serious symptoms from COVID than do middle or upper class folk. Part of the reason has to do with health care and nutrition. The other is even more obvious: they are working in jobs that are considered high-risk right now: “grocery story workers, delivery drivers or home health aides,” for example. [29] 

 

3. Masks/social distancing/hand sanitizing/lockdowns are an attempt to “flatten the curve’ and slow both the rate of the spread and the severity of the illness so that hospitals are not overwhelmed and better treatments can develop. While the efficacy of masks were overhyped early on (as were concerns about deoxygenization or mold or breathing in too much CO2), and we now know that the virus does not spread on surfaces as much as once thought, there is still merit to be considered in the recommended protocol that had become clearer over time. 


  • Masks (not worn professionally in hospitals). The right kind of masks [31] worn properly slow down the rate of transmission from 10% to 50% depending on the mask and the use [32] from a sick person to those around them, which can make a tremendous difference in entire communities practicing this consistently. [33] Masks are recommended primarily for the benefit of those around the mask wearer, [34] though they do appear to have some small benefit for the wearer also. [35] They do not keep the wearer safe from ever getting sick, but they do offer some protection in that it is likely that it cuts down the exposure to the virus, thus reducing the ‘viral load’ and reducing the severity of the disease if and when one does get sick. [36] This mitigated exposure may even be bringing about a natural form of vaccination which builds up the resistance in the “herd,” an outcome that should make the signers of the Great Barrington Declaration happy. However, as an epidemiologist friend who works for the CDC pointed out to me today, though we may well get to the 60% to 70% "herd immunity" infection rate next year, twice as meany people will die on the way there.
  • Social distancing and hand sanitizing benefits all parties, with social distancing being the key protocol. [37]
  • Lockdowns are rightly controversial. Google the “Great Barrington Declaration” vs. "Jon Snow Memorandum” if you have any questions about this. [38]  Even the WHO doesn’t particularly care for the early style of lockdowns, preferring “targeted interventions” in local situations. [39] There are different ways to do lockdowns, of course, and they have significantly different outcomes on various levels. Some of have been done well; some have not. [40] Here is an interesting article from the Lancet on lessons learned from various nations’ coronavirus restrictions. (It’s from a couple months ago, but I’m having a hard time finding up-to-date one.) A lot of Europe went back into some form of lockdown again in first week of November, but they are experimenting with different kinds of lockdowns. [41] It seems lockdowns can be avoided – and probably should - if people wear masks and businesses/establishments take reasonable steps to limit the congestion of people, keep the place clean, and have an abundance of fresh air. [42]  Interestingly, parts of the anti-lockdown Great Barrington Declaration are not actually that different from how nations are trending, with the exception that the GBD makes no mention of masks or reduced capacity in high risk indoor areas.



4. The percentage of serious cases in the US is going down  across all demographics even while positive tests are going up. Hospitalizations were on the rise in terms of raw numbers [43] which is worrisome because of the overload it puts on hospitals, but hospitalizations are not rising as a percentage of those who test positive and they have been going down as of late. Speculation about why the percentage of serious cases is falling includes the following:

  • many of the most vulnerable tragically succumbed in the first wave(s)
  • more infections are occurring in younger people
  • we have been slowly building up an immunity because of repeated low dose exposures;
  • all the protocol is lowering the “viral load” that determines the severity (which is one reason cruise ships and nursing homes were so deadly early on);
  • we have better treatment plans;
  • all of the above.[44]


5. Schools. Because I am on a school board, I am privy to the discussion happening behind the scenes with schools and local health authorities. It appears that, at least in my state, local health boards are not excited about in-person classes being suspended in elementary, middle and high schools. They are more worried that kids without the structure of a school day are more likely to engage in the kind of risky behavior that spreads the virus. Meanwhile, when schools do have problems, it’s rarely because of spread between students in normal school settings where reasonable protocol is being followed. Schools tend to have trouble keeping enough staff in the building because not only do they get sick, but they must also quarantine after exposures. 


So there you have it. My current database. Like I said, feel free to help me expand it by correcting me where I am wrong or confirming me where I am right. 


Just... do it with grace and truth. 



[1] It’s unpredictable, to be sure. I know entire families who got it, and in some cases each person has wildly different symptoms and severity, and some who were young and healthy got laid out hard for a week, and came back slow. Others barely felt it. Weird.  

[2] “Understanding Death Data Quality: Cause of Death from Death Certificates.” 

https://www.cdc.gov/nchs/data/nvss/coronavirus/cause-of-death-data-quality.pdf

“Instructions for Classifying Underlying And Multiple Causes Of Death.” https://www.cdc.gov/nchs/nvss/instruction-manuals.htm

“Reporting and Coding Deaths Due to COVID-19.” https://www.cdc.gov/nchs/covid19/coding-and-reporting.htm

“Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID–19).”

https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf

[3] You can see how the CDC records deaths here “Provisional Death Counts for Coronavirus Disease 2019 (COVID-19)”

https://www.cdc.gov/nchs/nvss/vsrr/COVID19/ and here https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf“Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID–19)”. It’s all right there in the open. Nothing secretive about it.

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