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“Underlying conditions” and COVID-19 — 79 Comments

  1. Thank you for your thoughtfulness in your posts. I check all three of your of some of your the items mentioned on this post.

    Oh mucinex will cause a side effect mentioned on the box. I start taking two, twice a day at 12 hours apart. Third day Wham!

  2. neo,

    I too am dismayed by the lack of useful information. I heard a podcast with a respiratory therapist and he went into a detailed explanation of why certain pre-existing conditions are especially exacerbating when on a respirator.

    He explained why obesity is a major problem with lung infections and their treatment. He also added many Americans are obese, including elderly Americans. He did not know whether that was being considered when “underlying conditions” are listed in the statistics.

    He also detailed what is involved with caring for a patient on a respirator. He said having two on a shift is exhausting for the attending physician, and the physician has to be a specialist in the operation of the machine. It’s not a set it and forget it situation. He felt we’ll face a shortage of qualified physicians before we run out of machines.

  3. Yes, but is age the vector of influence, or just a confounding variable, being correlated with these conditions? Or would a regression analysis provide evidence both are influences? (Wasn’t statistical analysis of public health data one of Michael K’s many practice lines?).

    (NB, if the Diamond Princess data are representative, 95% of the people over 60 with a symptomatic illness will not die of it; this is a subset of the old, so what is salient about that subset?).

  4. There is a Italian study out there and it contains exactly what you are looking for. It gives a age breakdown of deaths but I thought this table was particularly relevant. Some of the pathologies are of course related, e.g. if you have diabetes you will have 1 or 2 other pathologies as well. The age vs deaths from WA state were quoted by Briggs on his website the other day.

    Table 1. Most common diseases observed in patients who died as a result of COVID-2019 infection diseases

    N %

    Ischemic heart disease 117 33.0
    Atrial fibrillation 87 24.5
    Stroke 34 9.6
    Hypertension 270 76.1
    Diabetes mellitus 126 35.5
    Dementia 24 6.8
    COPD 47 13.2
    Active cancer in the past 5 years 72 20.3
    Chronic liver disease 11 3.1
    Chronic renal failure 64 18.0

    Number of pathologies
    N %
    0 pathologies 3 0.8
    1 pathologies 89 25.1
    2 pathologies 91 25.6
    3 or more pathologies 172 48.5

  5. He said having two on a shift is exhausting for the attending physician, and the physician has to be a specialist in the operation of the machine. It’s not a set it and forget it situation.

    This sounds like a job for AI and machine learning. I assume the medical guild would object.

  6. Andy:

    I don’t see the data I’m looking for. That’s a list of the incidence of these co-existing conditions, but I see nothing there that gives the incidence of those same conditions in the general population over 65.

  7. Art Deco: I thought the Diamond Princess was the perfect lab.
    But I think the problem is the relative affluence of the passengers.
    That may skew the results, vis-a-vis a metropolitan center.

  8. But I think the problem is the relative affluence of the passengers. That may skew the results, vis-a-vis a metropolitan center.

    I would think it more that they were willing and able to travel, not that they had the funds to travel.

  9. Neo: The clinical definition of ‘Diabetes’ is akin to the drunk looking for his keys under the lamp post.

    Why is this so? A whole bunch of reasons, including just plain institutional stupidity.

    But one simple reason is that the fasting blood glucose test is Easy.

    Sure elevated blood glucose is damaging. But persistent *hyperinsulinaemia* is also very deleterious. I’m no endocrinologist, more like an engineer… but the thing with the hormonal system is that it’s full of feedback loops and cascading chains of reaction.. and it’s *not* a good thing at all when one hormone (insulin) gets majorly out of whack — does all kinds of bad stuff to the others.

    A far better test would be an actual blood insulin assay. This is not easy. Even better is a 5 hour insulin response curve to a glucose challenge – Kraft did research on this back in the 70s and showed that response curve shape told him a great deal about patient morbidities. It helped that Kraft was also a pathologist and got to autopsy many of the patients he’d earlier done insulin assays on.

    Long story short… the 35% diabetes prevalence is meaningless (drunk under lamp post). The percentage of population walking around with diet-related comorbidities is much higher than this. T2D diagnoses catch people when they have already experienced a lot of systemic degradation.

    FWIW there are papers one can google up which look at immune system response to viruses and how they are modulated by hyperinsulinaemia / Insulin Resistance. Basically the less of these your have the better your immune response.

    Not saying that being IR is a death sentence. Obviously bunch of other factors in play here too. But this kind of 35% of people have diabetes statement is one of the problems we face. Our current medical system and many of our other decision processes are based on semi-axiomatic ‘facts’ which in fact are not facts at all. As someone who loves facts (and I happily admit that you’re far more methodical and calm in your thought and writing processes than I am :D) I’m sure you’ll appreciate why this is a problem for us all when something new and societally disruptive pops up.

  10. Short version: Our civilization has accumulated so much cruft and bullshit now baked into institutions and ‘Scientific Fact’ that decision making under uncertainty is becoming more and more error-prone.

    This before Political Correctness and usual human failings of cowardice, ass-covering, backstabbing, etc.

  11. Edward R Bonderenka,

    First, I should have been using the word, “ventilator” rather than “respirator.” Thanks for the correction!

    They way he described the situation with COVID-19, patients who reached a point who need to be put on a ventilator have fluctuating levels. It wasn’t so much that he needed to be at the controls for 8 continuous hours, but he said these patients require enough attention that he didn’t think more than 2 a shift was feasible. Just some MD I heard on a podcast. I’m not sure he has had a COVID-19 patient yet and I’m sure your experience with your wife gives you a lot of insight into the machinery and care required.

    I hope your wife recovered fully. I’m sure that was a difficult time for her and you.

  12. Trying to come up with some of these answers in the midst of a pandemic is futile. There’s just too many people doing too many things in too many places. Anyone remember the expression “the fog of war?” Well, this battlefield is as big as the whole world and eight billion soldiers are involved.

    I think you have to focus on the simplest and most reliable numbers you can get, which is why right wing Twitter is back to aggravating me. I just can’t take another tweet about how “They said we’d need 100,000 hospital beds today and we only needed 35,000!” As though the projection being a week early is some sort of bizarre impossibility.

    Mike

  13. By the way, when I did the “if the rest of the country winds up like New York” calculation a day or two ago, that worked out to 35,000 dead. Now it’s at 41,000.

    Mike

  14. Again, if the rest of the country just gets to where New York is on April 2, 2020, that’s going to be 41,000 dead. That’s if New York doesn’t have one single more death and if no state has more per capita deaths than New York has right now until the pandemic ends, which could be next year.

    I don’t mind questioning the model. I mind when finding fault with the model because it suits your ideology blinds you to what’s actually happening.

    Mike

  15. The rest of the country can’t get to where NY City is; population density is just one significant unique characteristic. That would be a fact that you would have to consider in your model, or in your wild ass guess.

    It isn’t ideology it’s called the real world. Many fields of science and engineering use models: when the results from a model don’t fit reality the model isn’t held in high regard; for example you don’t piss away money treating theoretical (predicted by a model) groundwater contamination when the tests from the actual water tells you the model is wrong. The real world is complicated, simple models or models using incorrect assumptions are costly or futile.

  16. MBunge:

    Re your comment at 8:27 PM.

    I’m not sure why you’re so upset with people complaining that a prediction was for 100K on a certain day and reality is only 35K on that same day. That’s about 1/3 of what was predicted. Now, you seem to think that the error only involves the date. But the dates are important, because they have to do with the rate at which the problem is growing. If they are that far off, it’s reasonable to suspect they are far off on a lot, including not just the timing of the peak but perhaps what the peak will actually be and what the needs will actually be.

    We are relying on their models to advise us, and based on their advice we are doing enormous damage to our economy.

  17. MBunge:

    I don’t get your point at 8:47. If the rest of the country gets to where NY is on April 2 – when? If the country gets there according to what time frame? In 2018, flu killed 61,000 people. Hardly anyone paid a particle of attention. This is predicted to be worse by a lot – and I agree – but how much? Certainly, I think most people expect the toll to go higher than the 41K you mention. I certainly do.

    And, as om points out, New York is different than rural areas, which are almost never hit as hard during epidemics of pandemics.

  18. THANK YOU! This has been one of the biggest missing pieces of information in my opinion. I am making decisions about going in public and I have an autoimmune issue as well as dealing with recent increases in blood pressure. Am I at risk or not? How do I gauge my risk level? I don’t want to put my job at risk but I also don’t want to leave my sons without a father earlier than absolutely necessary.

  19. I wonder when viruses began in the earth’s history? Are they like mitochondria—essentially commensual chemical boxes that came from prokaryotes==>invaded archaea and then decided not to settle down as eukaryotes and continued to invade other cells ad infinitum?

    There are thousands of viral DNA and RNA fragments in sea water of unknown types.

    They are a lot like prions, those CNS proteins that fold the wrong way and then keep folding.

    It is odd that chemicals want to reproduce themselves. It must have to do with free energy, Josiah Willard Gibbs, the sun, entropy…all that stuff. Why would the universe have this emergence of information driving chemicals to reproduce themselves?

  20. Rufus, she’s fine and fully recovered.
    She has epilepsy and they over sedated her, thus the ventilator.
    I successfully argued the doctors to change their strategy and they lowered the profofol and took her off the ventilator.
    She has been seizure free for 18 months now! Thank God!
    She is a walking miracle. She has literally half a brain, the right temporal lobe having been mostly removed.
    And she’s still a conservative! 🙂
    You would never suspect she had that done to/for her.

  21. Zapod is absolutely right about hyperinsulinemia as the root cause of most metabolic diseases – pre-diabetes, diabetes, hypertension, hyper-cholesterolimia, Alzheimer’s, obesity etc

    A thumb rule .. if your waist (at your belly button)/height ratio is >0.5, you most likely have metabolic syndrome and therefore, have an underlying condition.

  22. Such were the expectations for the Navy hospital ship U.S.N.S. Comfort that when it chugged into New York Harbor this week, throngs of people, momentarily forgetting the strictures of social distancing, crammed together along Manhattan’s west side to catch a glimpse. On Thursday, though, the huge white vessel, which officials had promised would bring succor to a city on the brink, sat mostly empty, infuriating local hospital executives. The ship’s 1,000 beds are largely unused, its 1,200-member crew mostly idle.

    only three patients…

  23. Neo
    Your readings of data very good reflects the causes that represent the core for this crises.

    However if we take the numbers of people you mentioned in your report and compare it to recent unemployment numbers that doubled in few days!

    The main side factors to all crises like this is the panic and may be some people looking for personal benefits.

    This crises is vey much was over stated and states countries over reacted.

    We should stope at one major factor some irresponsible folks who don’t follow the steps and rules for self protections measures like social distancing and washing hands no social to gathering etc.
    That what in NY
    The People Ignoring Social Distancing
    https://www.theatlantic.com/family/archive/2020/03/coronavirus-social-distancing-socializing-bars-restaurants/608164/

  24. JimNorCal:

    Fairly simple hypothesis might explain this. Nicotine has potent anti-inflammatory effect.

    Guess what you don’t want if you don’t want to drown from your lungs filling up with fluid? Yup: excessive inflammation.

    In the long run, Smoking has plenty of ways to kill a person. In the short-term it could well be highly protective against serious WuFlu complications. Now can you imagine *that* getting the Surgeon General’s stamp of approval? 😀

  25. Being over the age of 60 is a pre-existing condition- lots of stuff can kill you that wouldn’t kill a 50 and under person. That is just life.

  26. Zaphod – so, after learning in the last week that (a) vodka is a hand sanitizer; (2) green tea cures COVID-19 patients*; and (3) smoking can be good for you — this is very unsettling to a good teetotaling Mormon!

    *(2) isn’t actually true – but it’s being passed around like so many other internet hoaxes.
    https://www.techarp.com/science/chinese-tea-covid-19-hoax/

  27. Artfldgr —

    NYC is blaming the military for accepting so few patients on board the Comfort.

    https://www.nytimes.com/2020/04/02/world/coronavirus-live-news-updates.html#link-41547386

    A tangle of military protocols and bureaucratic hurdles has prevented the Comfort from accepting many patients at all. On top of its strict rules preventing people infected with the virus from coming on board, the Navy is also refusing to treat a host of other conditions. Guidelines disseminated to hospitals included a list of 49 medical conditions that would exclude a patient from admittance to the ship.

  28. Edward R. Bonderenka,

    That is wonderful news! It is great to hear she is well and thanks for sharing your story of how your advocacy convinced the doctors to modify her treatment, which was successful. I know of quite a few times a persistent loved one fought with a doctor over a diagnosis or care, only to be vindicated. Nothing against doctors, but they tend to play the odds; 85% of the time when a patient presents with symptoms x, y and z it’s condition Suchandsuch, so treat for Suchandsuch. Loved ones who research the condition, especially medications and their effects and side effects, and know the patient’s history and lifestyle may have insight the Doctor does not. I tend to err on the side of trusting Doctors and their diagnoses, but they often have limited time with patients and have to make educated guesses based on limited information.

    “She has literally half a brain… And she’s still a conservative!”

    I know quite a few people who think that is a pre-requisite for being a conservative! 🙂

  29. It seems odd to see the NYT complaining about bureaucratic hurdles, they like them so well when they stop conservatives from doing something useful.

    The Comfort needs to maintain strict quarantine against COVID patients or the ship is going to become useless for treating anyone else; and it makes sense to exclude people that they aren’t equipped to treat.

    https://nypost.com/2020/04/01/how-an-italian-hospital-protects-its-medical-workers-from-coronavirus/

    The coronavirus pandemic has exacted a heavy toll on medical workers in northern Italy, but the situation is far different in a hospital in the southern city of Naples — where armed guards and high-tech equipment keep them safe, according to a report.

    The Cotugno Hospital, which specializes in infectious diseases and has only been treating coronavirus patients lately, has had time to prepare for the onslaught and taken extraordinary steps to protect its doctors and other staff, according to Sky News, which got an inside look.

    While 66 doctors have died as a result of the pandemic in Italy, according to numbers compiled by the National Federation of Orders of Surgeons and Dentists, not a single health care worker has been affected at Cotugno, the news outlet reported.

    The sickest patients at the facility are treated by staff wearing ultra-high-tech masks and hermetically sealed, waterproof suits — and who follow proper protocols to the max, including separating infected areas from sterile ones.

    Lest anyone forget, armed security guards patrol the corridors.

  30. Rufus T. Firefly on April 3, 2020 at 1:40 am said:

    No good deed goes unpunished.
    * * *
    Sometime during today’s briefing, President Trump mentioned that the governors would ask for something, he would give them that and more, they would thank him in private, then complain on some news program that he didn’t give them enough.
    CTH probably has the transcript up — I may check it later to make sure I remembered correctly.
    But the illustration, if fake in the specifics, is accurate in general.

  31. Some of the underlying conditions may be speculative, because countries are not providing accurate data.

    https://nypost.com/2020/04/01/china-acknowledges-underreporting-coronavirus-cases/

    https://nypost.com/2020/04/02/rotting-corpses-litter-ecuador-streets-as-coronavirus-spreads/
    (more dead bodies literally in the street than government is reporting)

    https://nypost.com/2020/04/02/italys-coronavirus-death-toll-likely-much-higher-than-reported/

    One country seems to be doing things right.
    https://nypost.com/2020/04/01/half-of-coronavirus-patients-in-iceland-are-symptom-free-study/

    But, how big is Iceland, anyway?
    This is the country that gene-mapped one-third of its population of about 320,000 – which is roughly twice the size of Guam, or half the size of DC.

    https://www.genome.gov/27561444/iceland-study-provides-insights-into-disease-paves-way-for-largescale-genomic-studies

  32. And don’t look for any useful data from Iran.
    They don’t need anybody’s help, anyway.
    https://nypost.com/2020/03/31/theres-just-no-helping-irans-evil-regime/

    Secretary of State Mike Pompeo notes that America is already “doing everything” it can to “facilitate humanitarian assistance” and ensure “financial transactions connected to that” take place.

    There’s no sanction on medicines or humanitarian aid, he adds. “They’ve got a terrible problem there” in Iran, and America truly would like to help.

    Tehran’s response? It’s rejecting aid. Last week, French-based Doctors Without Borders said it was sending a 50-bed inflatable hospital, and France was offering more aid. Yet Iran huffed that it didn’t need the help and besides, the French group — wait for it — is part of a spy network.

    “We have empty beds and spare capacity,” Iranian health official Alireza Vahabzadeh told Bloomberg. “We don’t need this help.”

    The reason is rooted in their theological world view, as explained here (via Instapundit):
    https://pjmedia.com/news-and-politics/death-to-dirty-christians-love-for-pure-muslims-during-covid-19/

    Dr. Abdullah Badr—an Egyptian Muslim scholar, Al Azhar graduate, and onetime professor of Islamic exegesis—once explained during a videotaped conference how he is so “disgusted” by Christians, to the point that, if a Christian were to touch his cup, he would not drink from it: “I get grossed out, man, I cannot stand their smell … I don’t like them, it’s my choice. And they gross me out; their smell, their look, everything. I feel disgusted, disgusted!”


    Badr added that he once entered a store in Egypt to buy food, but when he saw the crosses and Christian icons on the wall and understood that the owner was Christian, he immediately gave the food away on the street.

    Contrast such behavior with Muslim behavior towards their coreligionists; then, nothing is too “disgusting,” since apparently a Muslim can never pollute anything. Indeed, Muslims are currently encouraging other Muslims to come into contact with each other despite global fears of contracting COVID-19. “Sharing food eaten by another Muslim leads to Shifa [healing] and not corona,” one Muslim man recently declared on social media. “Islam teaches us that shaking hands spread love not coronavirus,” said another. (Keep in mind that handshaking should be limited to fellow Muslims; according to a well-known hadith, Muhammad decreed that Muslims should not offer the salaam greeting to Jews and Christians, but rather push them into the narrow sideways.)

    Elsewhere around the Islamic world, Muslims are protesting the idea of temporarily closing mosques, since clearly nothing associated with Islam and especially Islamic worship can get them sick.

    All of this—both the irrational aversion for “infidels” and the irrational acceptance of fellow Muslims even at a time of endemic disease—is reflective of that one doctrine whence all divisiveness emerges, al-wala’ w’al bara’, which is variously translated as “loyalty and enmity,” or “love and hate”: Anything and everything Islamic is to be loved, hoped for, aided, and certainly never feared; anything and everything non-Islamic is to be hated, despised, rejected and worked against. As should be evident by now, though the most physical and obvious manifestation of this doctrine is jihad, virtually everything in the Muslim worldview is colored by this doctrine—is good or bad exclusively based on its affinity or lack thereof to Islam.

    Classic experimental conditions being set up .

  33. I am 69 and have no pre-existing conditions except for a touch of arthritis. I don’t have heart or lung problems, I have never smoked, I don’t have high blood pressure, I don’t have diabetes. I haven’t been sick at all for the past 4 years. I am not at all afraid of this virus, but I don’t take chances and have been keeping myself pretty well isolated for several weeks. My county has had 17 cases of Covid and no deaths.

  34. (more dead bodies literally in the street than government is reporting)

    I’ll wager you the New York Post is trading in urban legends. Annual deaths in Ecuador are currently 87,000 a year, or 3,300 every fortnight. The 120 people who have recently died of this ailment are not going to induce city morgues or local undertakers to dump bodies in the street.

  35. Now every person under the age of 50 who succumbs to this virus is given a national obituary. The latest in my neck of the woods is an unfortunate 31 year old gentleman, described in all the headlines as “previously healthy”. Of course, all the pictures provided of him crop his body off just below the shoulders, but despite those machinations, you can tell the man was obese, if not morbidly obese. Furthermore, if you dig through the articles on him, buried in a few, they left in a quote from a family member who mentioned he suffered from a “bit of asthma” which is why they made sure he got to a hospital after developing symptoms.

    Until a pro athlete dies from infection, I’m likely to presume anyone young the media reports that has died from this had a significant comorbidity that contributed to their decline or else died of something completely unrelated (and happened to have some nonspecific symptoms at the time, e.g. sore throat). Mass panic and misleading information from “experts” is the only way to keep the country shut down until November 11th, when all the mail-in votes across the country have been swiftly and correctly tallied and confirm that Trump has been roundly voted out of office. Restaurants will be back open for the first time that weekend!

  36. But, how big is Iceland, anyway?
    This is the country that gene-mapped one-third of its population of about 320,000 – which is roughly twice the size of Guam, or half the size of DC.

    AesopFan: Iceland is a curious case I’ve been puzzling over. They have a high infections per million: 3,865 — 62% of NYC’s rate, but deaths per million: 12 vs ~180 for NYC.

    Some of the best data is coming out of Iceland. Iceland has tested 5% of their population. I suspect the high rate of testing partly explains the high infection rate.

    https://www.ibtimes.com/coronavirus-update-icelands-lab-suggests-half-covid-19-positive-cases-showed-no-2951434

    Of course it helps to have a small population to do that much testing. The US population is roughly 1,000x that of Iceland.

    I’d like to see Iceland someday. Apparently I’m not the only one. Iceland is a surprisingly popular tourist destination.

  37. Morning update: I missed yesterday due to a medical procedure, NOT virus related at all.

    US cases still going right along on my sigmoid curve. Reminder: I’m not modeling, just fitting past data and using a function that usually describes virus epidemics. If the US cases were still on an exponential growth we should have seen close to 450,000 cases yesterday instead of the 220,000. That gap is just going to get larger. As of now I would say the flattening will be obvious in about 5-6 days. Serious cases still following a 3rd order polynomial. NY following a linear trend, and in the last 2 days, CT has also started to bend away from an exponential. I may have to start playing with a Gaussian function to see if we will start seeing an actual decrease, though I don’t think any country has shown that yet except for S Korea.

  38. Neo –> Mbunge: I’m not sure why you’re so upset with people complaining that a prediction was for 100K on a certain day and reality is only 35K on that same day.

    This is a shrink avoiding their teachings… when people have a world view that depends on certain confirmations to their bias… (my sister does), then anything that shakes that world view is something that shakes their world… if they are all in on trusting models, trusting the “good” advice of politicans who want them not to have kids (while they have 5 or more and import replacements), and so on and so forth… a prediction number not met is a proof they have to somehow fix to keep their worldview… ok… the prediction was right, but the timing was off… (as if that makes wrong right)… ok they removed the signs from all the state parks that said no glaciers and the models too… they will put them back up once they make new ones… etc.

    this is how you get zero success in all these models and yet they have not shaken the trust of the people in them… they look to the better models in archetecture and building, or physics to make the bomb, or the models used to make their phones work or GPS, and want all models to be good… what a wonderful orderly world it is if that was true? not really…

    our reality is full of dystopian malthusian models that make us act and make politicans make wrong headed choices… silient spring anyone? 40 million people in nyc for soylent green? how about “Rat Heaven” or the secret of nim… you know the policy followed by the work of John Bumpass Calhoun on rats? then embeded in culture, then followed later… was the secret of nim really the secret of nimh? are humans like rats? where when you over crowd them, homosexuals appear in larger numbers as they did in Calhouns rat worlds?

    feminism a way to control population and give the rats that did not mate a purpose? if you read the studies and the others on it, you will find social things politicans have been fomenting that match the models of Calhoun… forgetting that unlike the rats or mice, we can move, we can do other things…

    scary stuff if you combine it with others work that is also as popular… skinner… boas.. etc.

  39. Isnt it funny that there is a video online making politicans look ignorant on computers and phones (they are), but how their belief that google can track you, which was denied by google…

    leads to this

    Coronavirus: Google Releases Location Data To Help Authorities Check Lock-downs
    [are we “locked down”? a term used in prisons?]

    Alphabet’s Google division has on Thursday published data for 131 countries that shows whether people are obeying self-isolating and quarantine rules.

    The ‘Community Mobility Reports’ from the search engine giant showed whether visits to shops, parks and workplaces dropped in March, Reuters reported.

  40. Ellen,

    Smart plan! Stay safe and healthy!

    I have had to be out and about a fair amount because of my job, but I’m avoiding being too close to others and doing lots of hand washing and hand sterilizing. My wife has been able to stay home and practice tele-medicine with her patients (more for their sake than hers). One of my sons is laid off due to this and another, a daughter, was sent home from College, so they are both back at home. My son is doing some socializing with friends, but they appear to be using good sense. Both kids are going stir crazy. Our daughter is going on a lot of walks and runs.

    My most optimistic hope is that we have all already been exposed, had mild cases and have the anti-bodies, but we are certainly taking care to stay healthy.

  41. coffeetube,

    I have noticed the same thing, and it’s disgusting. Why can’t they simply give us accurate information. Isn’t that what journalism is supposed to be. I have noticed many of the photos seem outdated, due to clothes, or picture quality. When I dig a little deeper I find underlying externalities not mentioned in the story.

    Now I also believe some healthy, young people have died from this. I have two cousins who both died of pneumonia from complications of flu in their mid-30s. Pneumonia can come on quickly and so severely that modern medicine cannot halt its attack.

    Just give us the actual information. Every death is tragic. The images and information don’t need to be massaged for ratings. Treat human life with dignity.

  42. huxley,

    Iceland does get a lot of tourists, but for years they have been cleverly offering incentives to airlines that stop there on layovers. My children are EU citizens through my wife and one of our sons lived in Germany for about a year. We flew him back and forth on Wow Airlines, a former Icelandic carrier with crazy low fares. Every flight had a connection through Iceland and made sure passengers had time for duty free shopping.

    My understanding from folks who have vacationed there is that it is beautiful, the folks are fairly fun but it is very expensive.

  43. Thanks, physicsguy! I thought I had missed yesterday’s update on a thread I hadn’t read (although I searched fairly diligently as evidenced by the dozens of comments I’ve scattered across neo’s posts). Good to hear your medical procedure went well.

    And thanks for the forecast. Amazing the virus evolved to somehow communicate among all it’s gazillion copies scattered across the globe to stay along that sigmoid curve. Also amazing it independently discovered the derivative along with Leibniz and Newton! 🙂

  44. coffeetube, I have also noticed that photos of those who have died often show people who are way overweight. People who are clinically obese often have pre-diabetes or diabetes or hypertension, and these conditions may not be diagnosed. That doesn’t mean, of course, that all of these unfortunate deaths are of the obese, or that any one of the deaths isn’t tragic. We may be on the way to re-defining what being “in good health” means.

    physicsguy, thanks for the update.

  45. “I’m not sure why you’re so upset with people complaining that a prediction was for 100K on a certain day and reality is only 35K on that same day.”

    1. The obsession with one incorrect projection to the exclusion of all other numbers. I just did the “New York now to rest of the country” calculation and just overnight when virtually no new data came in and it went from 41,000 dead to nearly 43,000 dead. That will likely be 44,000 or 45,000 dead by the end of today and all of a sudden that 100,000 dead projection isn’t looking so crazy,

    2. I don’t object to people questioning the projections being made or pointing out where they fail. Though I am starting to wonder why medical school takes so long since it only takes a few weeks on Twitter to become an expert on epidemiology. I am concerned about the clear ideological motivation behind the questioning and how that’s feeding into paranoid hysteria and conspiracy theories.

    Here’s my position: Stop obsessing over projections and pay a little attention to the actual numbers in state after state after state that are showing a 1% to 3% death rate. Then do the math on what it would take for a 2% death rate to become a .5% death rate and realize that even if the numbers are off that much, we’re still talking about hundreds of thousands of dead.

    Mike

  46. Yet another Northeastern Illinois shopping report.

    This time We went back to one of our regular chain store just about at the start of senior – and restocking – hours.

    Restocking is important because we usually go through the fruits and vegetable area first. It looked quite picked over. Then we noticed the employees pushing carts piled high with stuff into the area. So we decided to do the rest of our shopping first and go back to the area later.

    Which gave us time to stroll through the aisles. Which we could do at a leisurely pace since very few other shoppers were there.

    About the only thing in short supply was toilet paper which was absolutely missing.

    Hand sanitizers seemed back to fully stocked as did hand soaps. Frozen foods were plentiful. We were even able to get our favorite Chicken Pot Pie which had been missing.

    All of the self-serve bulk bins for grains and spices were ‘temporarily closed’ and as is usual now there were no freebie snacks.

    Dairy seemed back to normal except that quart sized milk was gone entirely replaced by half-gallons.

    And when we finally made it back to the produce Department it was in the process of being fully restocked.

    Shoppers were maintaining Social Distancing but now perhaps a third – not us among them – were wearing masks.

    All in all things looked pretty much back to what might be considered The New Normal.

    ——

    Any advice on face masks?

    We are both retired and in our mid 60’s. We are very conscientious in doing the self-isolation thing. We only go out for food runs and just to drive around during the day to relieve the boredom.

    When we go for walks we give and are given wide berths by others. We do see the kids and grandkids often, but ONLY by FaceTime.

    SWMBO is a hobby seamstress so sewing a face mask or two might be boring for her but not particularly Difficult. I happen to have an unopened pack of 100% Cotton tee-shirts that can be cut up for fabric.

    So do you guys think we … uh … she should make a few and wear them when we go grocery shopping? Asking for a friend … nyuk nyuk nyuk

  47. Iceland does get a lot of tourists, but for years they have been cleverly offering incentives to airlines that stop there on layovers.

    Rufus T. Firefly: Thanks for clearing that little mystery up!

    Iceland took a heavy hit in the 2008 financial crisis. All three of its major private banks defaulted.

    Relative to the size of its economy, Iceland’s systemic banking collapse was the largest experienced by any country in economic history.

    –https://en.wikipedia.org/wiki/2008–2011_Icelandic_financial_crisis

    Iceland made a strong recovery. Increased tourism was part of the solution.

  48. Tuvea: Shopping report from senior time in ABQ, New Mexico.

    I’m running short on rice and beans, so I went early to see if that would work. No joy. Just a few packs of lima beans (ugh!) and lots of Minute Rice variations. The meat dept. looked good except no fish.

    I’ve been a just-in-time shopper, but now I’m trying to get ahead of the curve and stock my pantry and freezer.

  49. Neo, It would be really great to be able to post images, etc in our comments. Every other board I’m on has that capability. Is there something I’m missing?

  50. WARNING for those looking for work…
    Scammer just called me, as i get headhunter calls..
    this one was unique, wanted a copy of my drivers license, last 4 SS, and birthdate
    no freaking way!!!

    blocked the number…
    if anyone is looking, be on the look out for these..
    they are the SAME people who do the refund scams from india
    [of which online there was more than one that used the cash to apply to come to the west and go to school or be h1b visa programmers… nice.. eh?]

  51. MBunge: “Here’s my position: Stop obsessing over projections and pay a little attention to the actual numbers in state after state after state that are showing a 1% to 3% death rate. Then do the math on what it would take for a 2% death rate to become a .5% death rate and realize that even if the numbers are off that much, we’re still talking about hundreds of thousands of dead.”

    You apparently missed my post a day or so ago where I showed how to get to that 100k death number in about 60 days. The problem with my projection is that I literally pulled out of my butt a guess that 20% of the listed serious cases die. I have no idea what the real number is, but it has a huge effect on the final results and timeline. Also, if the active cases starts to flatten, so will the serious cases, and thus the deaths. My projection just assumes the serious cases keep rising as they are now; which I don’t think will happen. I did this work to try and understand where the government was getting these numbers. Will we reach 100k deaths? Maybe. Probably. When, which is the big question?? Too many variables that are not known now.

    You’re right about the current simple death rate. From today, if you average all the states/territories listed on worldometer, you get a simple death rate average (total deaths/total cases) of 2.4%. However, the standard deviation is a whopping 1.75%, which means 93% of all the states fall somewhere between 0 and 4.1% rates. i.e. all the data says is that there are LARGE variations due to factors I don’t think anyone knows.

  52. In researching what little is known about the autoimmune disease called ulcerative colitis, I noticed that a LOT of people exhibited a strong belief that nicotine damped down a flare-up. It would be kind of amazing to find that nicotine’s anti-inflammatory effects were enough to cancel out its irritation of the lungs, but I guess we’ll see. There were an awful lot of early reports claiming that China’s high death rate, especially among men, correlated with smoking habits. Of course, it’s possible to get nicotine into the system without frying the lungs with hot smoke.

  53. Kate,

    About a decade ago an MD friend was talking to me about elderly care and some of the medical and economic issues looming in our near future due to the Baby boom, increased life spans and the cost of medical care in the last year of life.

    I asked him, “if you could wave a wand and no one was overweight what would it mean for health care?*”

    He replied it would probably cut costs in half, and eliminate the need for much additional medicine and care required to deal with the affects of obesity on patient health. He said it was the one, single thing that could have the greatest impact on our nation’s healthcare system.

    No easy answer there. Our modern lifestyles and food supplies make it very difficult for folks to not pack on weight, especially as we age, and even a lot of our young are very overweight. It makes medical treatment more difficult.

    *Regarding glass houses and stones, I could certainly stand to lose 10 pounds myself.

  54. Here’s a video (35 minutes) in which a doctor gives a detailed laymen’s description of how COVID-19 infects us and what happens once we are infected. I don’t necessarily agree with his estimate of how the epidemic will play out, but this is an informative video and the doctor, who is a American born Vietnamese, is somewhat entertaining.
    https://www.youtube.com/watch?v=4J0d59dd-qM&feature=youtu.be

    It doesn’t explain in detail why pre-existing conditions make you more vulnerable, but it’s pretty clear that if your lungs, heart, kidneys, and liver aren’t in tip top shape, the disease can quickly become out of control. Caution; Some adult language.

  55. Laura Ingraham had a doctor on Wed, then with a good feed on Thursday. He reported that all his patients that had to be intubated were diabetic or pre-diabetic and had a BMI of 30+. The high BMI was a common factor in his younger serious patients.

    Speculating, it seems to me that this virus provokes an immune response, that then will go into overdrive if there are additional inflammations from co-morbidities. The response to the virus’ inflammation in the lungs causes the pneumonia, …

    Me, I’m being very careful with the sugar in my diet right now. Unfortunately, the lock-down might cause many to increase their load of sweets and sugars.

  56. “COVID-19: What’s New for April 3, 2020
    As the pandemic progresses, we are working to incorporate new data about the virus in the US. Please check back on Saturday, April 4 for our next update.”

    Strange that their predictions haven’t come down more, and they think deaths are in line.

    The co-morbidity, especially with overweight folk, will become a huge issue. Slovakia’s first death was an 84 yo woman with a major heart attack, who was positive for the virus. But primary death was heart attack. Some comment has a list of Italian deaths in one place where 0 co-morbidity was 1 of 179; 1 & 2 co-morbidities were both about 25%, and 3+ co-morbidities was almost 49%.

    We’ll find out later that the best estimate is that very elusive “excess deaths”. Take an avg day / week / month from last 3 years, total health deaths, compared with this year’s. That difference is the closest data we’re likely to see on Wuhan virus real-world death effect.

    40 instead of 6; 72 instead of 14. Most of those dying being sick with other things, too. Wuhan is worse in reality than it looks in sterile labs.

    I haven’t yet seen age categorized; it looks like there should be BMI / weight categories, too.

    America should be tracking and publicizing weight stats (BMIs) on deaths, as well as ages.

  57. The “If the rest of the country winds up like New York now” number stands on Friday afternoon at nearly 49 thousand dead.

    Mike

  58. Death rates in Europe are down on normal. Even deaths by respiratory disease aren’t up much.

    Sector Drummond has put some of these figures on Twitter.

    Meanwhile in NZ they are talking about extending the lock down. Deaths? One woman in her 70s. It’s beyond over-reacting.

  59. He also added many Americans are obese, including elderly Americans.

    I no longer trust the term “obese”, because they moded the term about 15y ago to make anyone not a starving beanpole into a hyperfat cow.

    I’ve seen what the numbers tell me I “should be”, and they are preposterous. I barely matched those numbers when I was 30 and could have run marathons, while also benchpressing 2x my weight.

    Not sure who the deception benefits, but I stopped believing it. Look up a chart that is 30y old, and see how THAT classes you.

  60. Rufus T. Firefly, I hear you on the extra ten pounds. But I think that’s not a problem; it’s an extra thirty, forty, or more, putting people in the “very overweight” category. Extra strain on all the internal organs.

  61. Summary from someone else, I concur with:

    At this point, all the evidence is that this is not anywhere NEAR as big a deal as the media has been pushing down our throats, and certainly does not justify the absurd over-reaction to this that is being taken by every hysterical nitwit with power to make those decisions.

    The 1957-58 “Asian” flu killed over a MILLION people worldwide and over 100k in the USA… with a US and world population about 50% of our current population (so double those numbers for comparison purposes).

    https://www.cdc.gov/flu/pandemic-resources/1957-1958-pandemic.html

    No one shut the fucking economy down, no one closed businesses, no one “sheltered in place”.

    This is total bullshit, and has been almost from the start.

    Yes, it’s a reason for caution and care — not claiming otherwise.

    But the reaction on almost ALL levels has been nothing short of absolute hysteria.

  62. physicsguy:

    It is possible to embed YouTube (or other) videos in the comments. But I don’t know of a way to do images. I haven’t seen that in other WordPress comment pages. Have you? Where?

  63. Neo — bad link on the obesity paradox. You’ve got “<a hrefi=…" (note the "i" after "href").

  64. MBunge:

    You write “in state after state after state that are showing a 1% to 3% death rate.” But you’re not talking about death rate. No state has anywhere NEAR that death rate, nor does any country as far as I can tell. I explained what death rates are here and how they differ from case fatality rates.

    You are talking about case fatality rates. That’s a whole different thing, and completely dependent on the number of positive tests, which in turn is very dependent on the number of tests that have been done and the criteria for testing. Case fatality rate is almost certainly way too high at present, compared to the true case fatality rate, which only emerges much later as more and more testing is done.

    One of the many many uncertainties that make predictions very difficult.

  65. om: I’d say you buried the lede when you threw out this great link from American Thinker without mentioning its main point.

    https://www.americanthinker.com/blog/2020/04/new_york_city_is_lying_about_chinese_virus_death_rates.html

    I’m aware some nations are lowballing their Covid numbers for propaganda purposes (China, Iran, North Korea).

    But it hadn’t occurred to me that New York City might be inflating its Covid death numbers:

    Now that New York has become the epicenter of the pandemic in the United States, we are now regularly inundated on cable TV news with the latest pandemic statistics from the city. The statistics grow gloomier by the hour.

    These figures have frightened people into submission as state and local governments across America enact repressive measures they say are necessary to contain the virus or slow its proliferation.

    After doing everything in their power to oust President Donald Trump, journalists and others are now calling him a weakling for supposedly not doing enough, while they demand an unprecedented nationwide crackdown.

    The problem starts with the fact that the highly influential statistics from the Big Apple paint a false picture of what is actually happening.

    In New York City, the death of anyone who dies who tests positive for COVID-19 is counted as a coronavirus death. This is the case even if the coronavirus failed to play a significant role in the person’s passing or illness.

    This also suggests a strong answer for why Iceland, with a comparable infection rate to NYC, has 15x fewer deaths per infection than NYC.

    Thanks for the link, om.

  66. huxley:

    Your welcome. OT – How is New Mexico coping with the oil price catastrophe?

  67. om: Can’t speak for others, but I sure squinted, then smiled, when I pulled into a station and saw gas for $1.59 per gallon.

    I’ve learned you can do even better.

  68. Rufus T., thanks for the video link. Sure wish I’d seen it before the 35 minute video. Simple, yet complete. Now I have to send it to all my correspondents and apologize for longer one. 🙂

  69. neo,

    I used to run a word press blog* and our commenters could imbed images with no special rights to our site. I think it was the “img” tag?

    I had not heard about the obesity paradox (although my erudite Dr. friend most certainly has). Thanks for the link. Interesting reading!

    *Interestingly, after 15 years the site was recently destroyed by Japanese hackers. No idea why we were a target. Odd.

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