Just like a phoenix who rose from the ashes

[Cardboard]

Trump says he will leave hospital Monday, urges people not to fear the deadly virus

https://www.cnbc.com/2020/10/05/trump-says-he-will-leave-walter-reed-hospital-at-630-pm-monday.html

 

And the market rallies big!

 

Go Regeneron and screw the FDA and all so-called experts/scientists such as WHO or only good to predict what happened and do nothing to solve issues.

 

Cardboard

[Gregmal]

If he does fully recover, it will be quite interesting to then see what happens with the rest of the prominent folks who had it as well. For the past 6 months you've had plenty of people living in their basements and only emerging in hazmat suites and going around crying about other people not taking this seriously. Trump being one of them who had the audacity not to piss in his pants about this thing. So Trump basically just goes about living his life, despite being across the board, in the highest risk category....and what? Has a one week disruption? LOL. Thats it? Which of course then leads people to claiming he's getting "the good stuff"...you know. Like vitamin D and remdesivir, which you know, was what normal folks with serious cases or who were of high risk, were given all the way back in February and March....Or the Regeneron drug! Which is basically in the experimental phase and if Trump had previously recommended it, people would be saying "dont take it!"...

 

Always good for a story and laugh these folks are.

[orthopa]

If he does fully recover, it will be quite interesting to then see what happens with the rest of the prominent folks who had it as well. For the past 6 months you've had plenty of people living in their basements and only emerging in hazmat suites and going around crying about other people not taking this seriously. Trump being one of them who had the audacity not to piss in his pants about this thing. So Trump basically just goes about living his life, despite being across the board, in the highest risk category....and what? Has a one week disruption? LOL. Thats it? Which of course then leads people to claiming he's getting "the good stuff"...you know. Like vitamin D and remdesivir, which you know, was what normal folks with serious cases or who were of high risk, were given all the way back in February and March....Or the Regeneron drug! Which is basically in the experimental phase and if Trump had previously recommended it, people would be saying "dont take it!"...

 

Always good for a story and laugh these folks are.

 

If the general public had the ability to see the general/medical condition of the great majority that have died and not the exceptions that have died, Trumps' recovery would not be that surprising.

[cubsfan]

If he does fully recover, it will be quite interesting to then see what happens with the rest of the prominent folks who had it as well. For the past 6 months you've had plenty of people living in their basements and only emerging in hazmat suites and going around crying about other people not taking this seriously. Trump being one of them who had the audacity not to piss in his pants about this thing. So Trump basically just goes about living his life, despite being across the board, in the highest risk category....and what? Has a one week disruption? LOL. Thats it? Which of course then leads people to claiming he's getting "the good stuff"...you know. Like vitamin D and remdesivir, which you know, was what normal folks with serious cases or who were of high risk, were given all the way back in February and March....Or the Regeneron drug! Which is basically in the experimental phase and if Trump had previously recommended it, people would be saying "dont take it!"...

 

Always good for a story and laugh these folks are.

 

If the general public had the ability to see the general/medical condition of the great majority that have died and not the exceptions that have died, Trumps' recovery would not be that surprising.

 

If this is indeed true - then this really becomes the scam of the century - and it would not surprise me in the least given the lack of morals of both

politicians and the media.

[LC]

If the general public had the ability to see the general/medical condition of the great majority that have died and not the exceptions that have died, Trumps' recovery would not be that surprising.

 

The ole spidey-sense is making me think this will be a walk down bullsh1t alley, but I'll bite. What are these 'general/medical conditions' that would be so unsurprising? 

[orthopa]

If the general public had the ability to see the general/medical condition of the great majority that have died and not the exceptions that have died, Trumps' recovery would not be that surprising.

 

The ole spidey-sense is making me think this will be a walk down bullsh1t alley, but I'll bite. What are these 'general/medical conditions' that would be so unsurprising?

 

No BS and I'm happy to discuss with you in greater detail in this thread, but how much of a frame of reference do you have for treating pts with multiple comorbidities such as those that have made up the majority of deaths? Keep in mind the population and age group most affected and dx.  If you feel able then it would be helpful for us to then go in realistic expectations for life expectancies in said population as well as true cause of death and mechanism of such.

 

For example what was the cause of death in someone on palliative opioid therapy with a terminal cancer diagnosis who tested positive for covid? Or a stage 4 renal dz patient on a transplant list with liver cirrhosis and bilateral leg amputations with chronic ulcerations and an infected PICC line? These are 2 patients that come to mind that I have treated that died WITH covid. Did covid kill them or were they dying already?

 

Enter Trump, his condition, and his outcome.

[LC]

I too am happy to discuss. To answer your question, my medical training starts and ends with aspirin.

 

Also, I am a statistician, so I am a bit hesitant to answer your questions about your patients.

 

I would need to know what the joint PDF of your two patients conditions. What is the probability of a terminal cancer patient dying? A COVID patient dying? A COVID+cancer patient dying?

 

I would also ask what the full circumstances were. Did they walk in with a knife in their back?

 

But I have a basic question:

 

If COVID was NOT the cause of death in the majority of "COVID" deaths, why is there such a large excess of all-cause mortalities seen this year?

 

And I have a second hopefully basic(er) question:

 

When a COVID+ patient with a history of a non-terminal condition (e.g. asthma) dies, is the "true" cause of death COVID, or asthma?

[Cigarbutt]

...

If COVID was NOT the cause of death in the majority of "COVID" deaths, why is there such a large excess of all-cause mortalities seen this year?

...

The best answer i can come up with is that, in the end, we'll all be dead.

i assume your question will continue to look for an answer but there's a related point about people "dying already".

Hoping to get a better answer, this has been looked at directly and indirectly and it's mostly about educated guesses now. There are regional variations but it's reasonable to suggest that something like 50% of people who died had very limited life expectancy and and even less quality life expectancy. Anecdotal cases don't help that much as the virus may have removed minutes or hours of life in certain specific cases but can also lead a younger entrepreneurial-type with limited risk factors to spend a few weeks in intensive care and to 'enjoy' a tracheostomy for a few weeks.

width=200https://m.media-amazon.com/images/S/aplus-media/vc/f5ed1550-611e-402c-92de-7a4278dd19ea._CR0,0,350,175_PT0_SX350__.jpg[/img]

So, without going into detailed data, a convincing piece of evidence that goes against the very short time period of life removed by Covid for the typical patient is the NYC data. The picture below shows some leading indicators that need to be watched but the death line has stayed close to zero for a while.

The excess mortality data coming from NYC should show, if orthopa's anecdotal inputs are correct that people who died of Covid (the huge peak) were due to die shortly anyway, an inverse and proportional peak in negative and opposite territory. The graph does not show that. The lower than expected go-forward death rates due to the excess peak will appear over time, in correlation to the number of years lost by all who died (prematurely) due to Covid. The results may be difficult to see on a chart if the pattern reverses over a few years. See attached.

 

[flesh]

Regarding the co morbidities, my three doctor friends have the same anecdotes as orthopa, two of them surgeons.

They have absolutely no doubt that some would have died anyway or very soon. They are clear that many reported covid deaths did not or were never tested positive for covid.

 

Regarding the excess deaths argument, I submit we need to calculate all the excess death resulting from 30 millions job

losses/shutting down the economy. Namely, suicide, murder, drug overdose, and subtract those from our excess deaths number. Also we need to control for a greater percentage of the population being older in 2020 vs 19, there were more people closer to death. I believe we will see excesses here for years, if it's caused by shutting down, it's all causal. All the excesses for at least a few years in these areas should be subtracted.

 

Also, assuming there are excess suicides, murders, drug overdose, it's safe to say there are more people that were close to doing all of those things.  People suffering from serious mental health issues. What value do we put on causing people of all ages serious mental problems? Maybe .1 deaths?

 

No doubt there were excess deaths from covid, but if the number is half, that's an important lesson for everyone.

 

[LC]

They have absolutely no doubt that some would have died anyway or very soon. They are clear that many reported covid deaths did not or were never tested positive for covid.

 

This goes to Cigarbutt's point. If that is truly the case and that mortalities were "pulled forward" so-to-speak, where is the subsequent "dip" in mortality rates that would be expected?

 

Also we need to control for a greater percentage of the population being older in 2020 vs 19, there were more people closer to death.

 

This is already controlled for in average mortality baselines.

 

Regarding the excess deaths argument, I submit we need to calculate all the excess death resulting from 30 millions job losses/shutting down the economy. Namely, suicide, murder, drug overdose

 

Completely reasonable.

 

Do you have estimates of how much murder, suicide, and overdose mortality rates have increased due to COVID?

[Williams406]

The Ethical Skeptic has done some stat work on excess non-covid mortality that may be useful in this discussion.

 

https://theethicalskeptic.com/

[Castanza]

They have absolutely no doubt that some would have died anyway or very soon. They are clear that many reported covid deaths did not or were never tested positive for covid.

 

This goes to Cigarbutt's point. If that is truly the case and that mortalities were "pulled forward" so-to-speak, where is the subsequent "dip" in mortality rates that would be expected?

 

Also we need to control for a greater percentage of the population being older in 2020 vs 19, there were more people closer to death.

 

This is already controlled for in average mortality baselines.

 

Regarding the excess deaths argument, I submit we need to calculate all the excess death resulting from 30 millions job losses/shutting down the economy. Namely, suicide, murder, drug overdose

 

Completely reasonable.

 

Do you have estimates of how much murder, suicide, and overdose mortality rates have increased due to COVID?

 

There is a relatively old statistic out there that says for every 1% unemployment goes up roughly 25-35k people die.

[Spekulatius]

They have absolutely no doubt that some would have died anyway or very soon. They are clear that many reported covid deaths did not or were never tested positive for covid.

 

This goes to Cigarbutt's point. If that is truly the case and that mortalities were "pulled forward" so-to-speak, where is the subsequent "dip" in mortality rates that would be expected?

 

Also we need to control for a greater percentage of the population being older in 2020 vs 19, there were more people closer to death.

 

This is already controlled for in average mortality baselines.

 

Regarding the excess deaths argument, I submit we need to calculate all the excess death resulting from 30 millions job losses/shutting down the economy. Namely, suicide, murder, drug overdose

 

Completely reasonable.

 

Do you have estimates of how much murder, suicide, and overdose mortality rates have increased due to COVID?

 

There is a relatively old statistic out there that says for every 1% unemployment goes up roughly 25-35k people die.

 

Is this also correct if you earn more income sitting at home than going to work? I doubt there are stats on that. In addition, I think the entire psychological dynamic of an epidemic affecting the population is entirely different than garden variety recession.

 

If suicide rates would have risen according to this Rule of thumb, shouldn’t we have seen a huge rise in suicides ? The US had roughly 50k suicides in 2018, so with the unemployment rate spiking to above 10% from very low levels, we should have seen a doubling at least?

[LC]

The Ethical Skeptic has done some stat work on excess non-covid mortality that may be useful in this discussion.

 

https://theethicalskeptic.com/

 

So I applaud this guy's attempt but I do have some issues here. The biggest of which is that he wrote his COVID work ALPHABETICALLY.

 

Where the hell do you find that kind of sadist?

 

But what bothers me is that it seems many of the excess "ancillary" deaths he is misattributing.

 

Let's take circulatory diseases, for which he claims contributed 10k of the 22k total deaths he attributes to lack of access to timely medical care. I selected this because it the most material sub-factor. The second being Alzheimer's (6.6k deaths)

 

Now, these excess deaths may have been attributed to lack of healthcare access in March, April, May.

But in June, July and August, hospitals were re-opened. So let's review the weekly deaths for these categories.

 

Take a look at the CDC dashboard (https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm) for "weekly number of deaths by cause group".

 

We see a distinct rise in March/Apr, peaks and falls in May, June, then rises again for the second wave in July and Aug.

 

Now circulatory disease deaths are relatively consistent through both peaks. If hospitals shut down caused these deaths during the two COVID waves, we would first not expect to see a spike but a level shift. This is not the case.

 

So why do we see the same spike and reliefs in circulatory-disease deaths that co-incides with COVID deaths?

 

The same holds for Alzheimer's (another large claimed contributor at 6.6k deaths)

 

Interestingly, respiratory diseases did not see a similar phenomenon during the second wave - this indicates to me that those diseases were subsequently (correctly) classified as COVID deaths during the 2nd wave.

 

So on the 25k claimed excess deaths due to lack of healthcare, I find issues.

 

Of the remaining, he attributes 28k excess deaths to "despair" - alcohol/drug overdoses being the largest contributor at 19.5k

 

How does he calculate this? He takes 147k annual overdoses (not overdose DEATHS) for the 16 week period he examines, and applies a 42% increase, which he sources here: https://www.washingtonpost.com/health/2020/07/01/coronavirus-drug-overdose/

 

Let's visit that source:

Suspected overdoses nationally — not all of them fatal — jumped 18 percent in March compared with last year, 29 percent in April and 42 percent in May, according to the Overdose Detection Mapping Application Program, a federal initiative that collects data from ambulance teams, hospitals and police. In some jurisdictions, such as Milwaukee County, dispatch calls for overdoses have increased more than 50 percent.

 

So it looks like he cherry picked a month, unjustifiably extrapolated it to the entire year, and then misapplied it to the wrong population  :o

 

It's good he clearly labels himself as EthicalSkeptic because otherwise I would characterize his misrepresentations as "unethical"  ;D

[orthopa]

I too am happy to discuss. To answer your question, my medical training starts and ends with aspirin.

 

Also, I am a statistician, so I am a bit hesitant to answer your questions about your patients.

 

I would need to know what the joint PDF of your two patients conditions. What is the probability of a terminal cancer patient dying? A COVID patient dying? A COVID+cancer patient dying?

 

I would also ask what the full circumstances were. Did they walk in with a knife in their back?

 

But I have a basic question:

 

If COVID was NOT the cause of death in the majority of "COVID" deaths, why is there such a large excess of all-cause mortalities seen this year?

 

And I have a second hopefully basic(er) question:

 

When a COVID+ patient with a history of a non-terminal condition (e.g. asthma) dies, is the "true" cause of death COVID, or asthma?

 

All good questions and my medicine mine thinks differently and is a very imprecise practice. I don't think anyone can realistically give you accurate percentages of who would die in your given scenarios that isn't fraught with personal experience or just something read in a medical journal. Your questions are valid and precise answers would be helpful but I don't think I can get my point across with precise statistics relative to what we have seen as a society in response to this virus.

 

My point and comment was in response to Gregmal and peoples perception of the disease who these 210k dead are. As the CDC says  something like 6% had no comorbidities. These are the exceptions your young adult/child/ "healthy" 35 year old that died. The other 94% are sick, sick people. Any lay person would visually understand immediately who I am referring to.  They have on average 2.6 comorbitites. All you need is 1 "bad" comorbidity and everyday that person wakes up is a blessing. Do their deaths not count, of course not but lets keep things in perspective here when we go to the lengths we have as a society.

 

Lets think about those that haven't died that are well known, Trump, Melania, Tom Hanks, Pink, Steven Miller, all of those in the white house who will get it, on and on. For some reason I think America and the general public thinks its these types of people dying from the virus because that's what they see. How many people on a regular basis hang out at dialysis centers, end of life care facilities, nursing homes, halfway houses etc. No one. So when they see covid deaths they think everyday people just walking around 30 years old, boom your dead. I see, treat and call these people back with positive results everyday in the clinic, and guess what not one of these people are dead.

 

There is no question in my mind that there is excess death and covid played a role. It helped lift the other foot when there was already one in the grave.  In reality their life expectancy was pulled forward. Would it be out of line to expect less deaths next year? I would say no.  My point is as a medical practioner Im not the least bit surprised the people that are dying (the face and condition of which America knows nothing about) are the ones dying. Also who is filling out the death certificate? and what is there perception? Through all of this there has been an undeniable trust in that judgement both ways.

 

I think the Trump covid experience for America is a great one. The problem is it will projected as an exception due to unbelievable care when in reality its honest to god what the vast vast majority of who gets this virus will experience. The 40-50% who get no symptoms will have it even better.

 

In regards to the asthma covid question I would say Asthma killed the pt. Why? Because of modern day medicine we are under the assumption that asthma and other prevailing medical conditions are no big deal because no one we know dies of them anymore. The seriousness is lessened and perfect treatment and outcome is expected.  Nevermind the fact that outside of our observable lifetimes these diagnoses took millions and millions of lives. Its all perception. The fact that many covid patients die of pneumonia is abhorrent in todays society....because who does of pneumonia anymore, didn't we fix that?

 

 

[LC]

There is no question in my mind that there is excess death and covid played a role. It helped lift the other foot when there was already one in the grave.  In reality their life expectancy was pulled forward. Would it be out of line to expect less deaths next year? I would say no.

 

To me this reads in one of two ways:

 

(1) illogical and un-mathematical, or

(2) an allegation of widespread fraud

 

So before beginning to tackle door number (1), I'll just pause here and ask you to clarify...are you suggesting there is widespread fraud to the order of 200,000+ excess deaths being recorded this year over the average, corroborated by similar trends in Europe, Asia, and South America?

 

In regards to the asthma covid question I would say Asthma killed the pt. Why? Because of modern day medicine we are under the assumption that asthma and other prevailing medical conditions are no big deal because no one we know dies of them anymore. The seriousness is lessened and perfect treatment and outcome is expected.  Nevermind the fact that outside of our observable lifetimes these diagnoses took millions and millions of lives.

 

Yes, we live in 2020. I mean, your argument is difficult to take seriously.

 

It would be like saying that HIV never killed anyone. It's a bit of a dishonest position to take, which is why the CDC recognizes that HIV was the cause of death for 750,000+ people since the AIDS Epidemic (not the Pneumonia Epidemic) began.

[orthopa]

There is no question in my mind that there is excess death and covid played a role. It helped lift the other foot when there was already one in the grave.  In reality their life expectancy was pulled forward. Would it be out of line to expect less deaths next year? I would say no.

 

To me this reads in one of two ways:

 

(1) illogical and un-mathematical, or

(2) an allegation of widespread fraud

 

So before beginning to tackle door number (1), I'll just pause here and ask you to clarify...are you suggesting there is widespread fraud to the order of 200,000+ excess deaths being recorded this year over the average, corroborated by similar trends in Europe, Asia, and South America?

 

In regards to the asthma covid question I would say Asthma killed the pt. Why? Because of modern day medicine we are under the assumption that asthma and other prevailing medical conditions are no big deal because no one we know dies of them anymore. The seriousness is lessened and perfect treatment and outcome is expected.  Nevermind the fact that outside of our observable lifetimes these diagnoses took millions and millions of lives.

 

Yes, we live in 2020. I mean, your argument is difficult to take seriously.

 

It would be like saying that HIV never killed anyone. It's a bit of a dishonest position to take, which is why the CDC recognizes that HIV was the cause of death for 750,000+ people since the AIDS Epidemic (not the Pneumonia Epidemic) began.

 

I think your HIV example is ignorant and hard to take seriously. Did 94% those that die of HIV have 2.6 comorbidities or was it without regard? (Do you even know what a comorbidity is?) Were children not affected by AIDS? Were 45-50% of of the 750,000 people who have had HIV asymptomatic? Bad example.

 

Your assumption that is 2020 and medical care is expected as such is the reason malpractice in the US is what it is. Do you sue doctors? If not when do you plan to do so? If you are going to do so please do all of us a favor and tell him/her ahead of time so they can steer clear of you. Sheesh.

 

In regards to the death reporting are you aware of the criteria for death reporting in the US, Europe, Russia etc? I'm not, please share it if you will.

 

This discussion will be useless.  You have no first had knowledge of the point I was trying to make and I should have realized this at the start. I'm happy to continue arguing with you but your medical knowledge beginning and ending with Aspirin will make this a complete waste of time. But if your happy to keep wasting yours Ill oblige.

[LC]

How quickly you've become acquainted to the politics section of this website!  ;D

 

I agree it's important to defer to the medical knowledge of experts, particularly as it relates to each individual discipline. I would therefore submit a few points from epidemiologists and infectious disease experts, which we would both agree "trump" the knowledge of a GP (for example).

 

After the CDC released the comorbidity data which you refer, there's a pretty balanced response written by a Johns Hopkins epidemiologist (https://hub.jhu.edu/2020/09/01/comorbidities-and-coronavirus-deaths-cdc/) which warns the following:

 

To some extent I think some people are willfully misinterpreting to treat this as a "gotcha" moment to undermine the seriousness of COVID-19. They're not taking time to actually understand the data.

 

He goes on to explain some of the "misinterpretations", for example how some comorbidities are caused by the COVID virus itself (respiratory illness being the primary one).

 

As experts quoted by another article point out (https://www.livescience.com/covid-19-comorbidities.html)

 

"When you look at the number of excess deaths this year in comparison with previous years, it's staggering," Dr. William Hanage, a professor of epidemiology at Harvard University’s School of Public Health told Live Science. That's an estimated 228,200 additional deaths in the United States, according to the Weinberger Lab at the University of California, San Francisco. Hanage noted that many of the people who have died so far had nonfatal diseases and would not have perished but for contracting the new coronavirus as well. For instance, someone with diabetes or high-blood pressure might have lived decades longer if they had not contracted COVID-19. Dr. William Schaffner, a professor of preventative medicine and infectious diseases at Vanderbilt University Medical Center in Tennessee, echoed the same reality. "The point is that those people would not have died except that they were carried away by COVID," Schaffner told Live Science.

 

In addition, deadly medical complications can be the immediate cause of death when in fact a virus is the ultimate culprit, as is evident with HIV/AIDS. More than 32 million people worldwide  have died so far of HIV/AIDS, for instance, but the disease itself isn't usually the immediate cause of death. Dr. Shahnaz Azad, an infectious disease expert in Olympia Fields, Illinois, told Franciscan Health, "It's not HIV that kills you. HIV kills your immunity, and then you become susceptible to all kinds of infections and cancers."

 

These coincidentally are the points I have made in this thread and the Coronavirus thread in the general forum.

 

As an aside, I do find it interesting that the sentiments of a medically untrained statistician (myself) regarding the validity of COVID comorbidities more closely echo sentiments shared by epidemiologists and infectious disease experts, rather than an orthopedic doctor on an anonymous message board. Surely, food for both thought and malpractice claims!

 

In regards to the death reporting are you aware of the criteria for death reporting in the US, Europe, Russia etc? I'm not, please share it if you will.

Yes, I am - but I recall the old saying about teaching a man to fish. I wouldn't dare deny you those fruits of learning! To get you started, here are the morbidity data reporting units for the majority of EU countries: https://www.euromomo.eu/about-us/partners/

[Cigarbutt]

...

To me this reads in one of two ways:

(1) illogical and un-mathematical, or

(2) an allegation of widespread fraud

...

I think your HIV example is ignorant...

Your assumption that is 2020 and medical care is expected as such is the reason malpractice in the US is what it is. Do you sue doctors? If not when do you plan to do so? If you are going to do so please do all of us a favor and tell him/her ahead of time so they can steer clear of you. Sheesh.

...

This discussion will be useless.  You have no first had knowledge of the point I was trying to make and I should have realized this at the start. I'm happy to continue arguing with you but your medical knowledge beginning and ending with Aspirin will make this a complete waste of time. But if your happy to keep wasting yours Ill oblige.

Why such hostility and unwarranted condescension?

It's really about a basic question (basic math and logic).

Taking the NYC excess mortality data for example, even forgetting the cause (direct, indirect, marginal or even lockdown related) of deaths for analytic purposes (life expectancy lost because of whatever happened during the excess mortality period), if the life expectancy of all those who died was a few days, weeks or months, how is it mathematically or logically possible that excess mortality has not reversed in the negative direction now that reported Covid deaths have gone down to very low levels (close to zero) for months?

Do you actually think that the excess mortality data is fake?!