This sort of observation is not uncommon with COVID-19:

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”.

I agree that excess deaths is an informative metric. But one of the many problems is that since we’ve all become a nation of obsessive handwashers and distancers, flu deaths will almost certainly go down as well and skew those numbers.

And that’s just one small part of it.

I’ve written about co-morbidities (aka “underlying conditions”) before here, mentioning that one problem with the concept is that most people over 65 have an underlying condition of some sort, broadly defined. And yet COVID-19 can kill them when they would not otherwise be dying and might otherwise have had many many long years of life ahead of them.

And then there’s the following true story.

I have a friend who nearly died from H1N1 a few years ago. And by “nearly died,” I mean that quite literally. She had a flu-ish bug for about a week, nothing so out of the ordinary (she thought), and rather suddenly she had trouble breathing. This was a woman in her early 50s with no pre-existing conditions, healthy as a horse. She went to the ER, they gave her antibiotics and sent her home, and just a few hours later she worsened. A friend took her back to the ER where she was immediately placed in a coma and intubated. It was touch and go for many days, and although she ultimately recovered it took her a year to feel at all well again.

The reason I’m telling the story is this: I was told that she was placed in the coma and intubated because the struggle to breathe and the lack of oxygen would have been so arduous for her body that she was at grave risk of dying not just of respiratory failure but from a heart attack. That’s how much stress there was on the system of a previously healthy and not-all-that-old woman with no heart disease at all.

So the people with previous heart disease who are dying from COVID-19 present a dilemma for doctors, one that’s not limited to COVID. How bad was the person’s heart disease prior to contracting the disease? If it’s mild enough that they were walking around doing normal things, with a decent life expectancy and relatively good health (which describes a huge number of people with heart disease), then it was probably COVID that killed them. Heart disease contributed in some difficult-to-quantify way, perhaps. But it would almost certainly not be the primary cause of death.

A person with heart disease does not ordinarily and out-of-the-blue come down with ARDS, an acronym which stands for a terrible thing: acute respiratory distress syndrome. And yet as far as I can tell, ARDS is the mechanism that starts the dying process for most people with COVID who die. Whether a person was previously healthy (such as my already-described friend who had H1N1) or had some condition such as mild heart disease, once ARDS rears its ugly ugly head there is a very good chance of death.

[NOTE: People with more medical knowledge than I, please feel free to add and/or correct.]