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COVID-19 Check-in
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Comments
@razorachilles This group did a good job but there are some concerns I have and they pointed out some of them in the paper.
I agree with their overall assessment that most people probably don't have to worry about TdP from this type of treatment. If CQ/HCQ turns out to have some effect on COVID-19, we need to know who the high risk individuals are that would require monitoring during the treatment. For example, one of the people that had to stop treatment was having to take QT prolonging drugs for preexisting conditions.
Agree on all points - particularly #1. Regarding 2 & 3, I spent much of my career in the orphan/rare disease space so I'm personally more familiar/comfortable with the concept of extrapolating study data with small enrollment - often without a placebo arm due to difficulty identifying/enrolling patients who are commonly undiagnosed due to the low prevalance for rare diseases)- but that's a different topic for a different board (!)
My point was more around people running with headlines (on all sides of the argument) but new information which might change one's position is not always applied consistently once made available (particularly if it's not reported as broadly).
Two other interesting things today:
PA has the 5th highest # of C19 fatalities in the nation to date - of those fatalities:
Kasey, it's heart warming knowing that we live in a society that is so generous to others, especially from people that don't even know your friend. The GoFundMe has raised almost $60k with an initial goal of 15K. Almost 650 have donated at this time.
I know it's a drop in the bucket for what the family will need over time, but it's a good start for his wife a kids. Hope it keeps going!
I agree with you on people being hesitant to change their position when presented new information. Nuance is dead, and everything is seen in black and white terms.
Covid-19 like most respiratory diseases is going to affect old people the most. Most numbers I've seen have the fatality rate for people below 40 around .1 to .3%. 40 to 49 is around .5%, 50-59 1.5%, 60-69 4%, and above that is 15%+. All of the fatality rates being reported are still crude (confirmed deaths/confirmed cases). We need to find out how many people have actually been infected with reliable serological tests and get an accurate death count. From everything I've read deaths are being under reported. We likely won't have an accurate fatality rate for a while.
He was well loved for sure. Just one of those guys that made you feel like you were his best friend. And it's very heartwarming in these dark times
It seems like we should be able to get accurate death numbers. I know a lot of rumors have gone out about over reporting by hospitals trying to get higher reimbursement rates from medicare/medicaid. Having seen a little bit of that world, I don't know how many would risk filing fraudulent claims. That theory doesn't pass the sniff test for me.
Why don't we test every death for Covid-19 for the next 12-18 months? If you have a positive test you report it, if you have a negative test you don't, but there shouldn't be a category for uncertain. Maybe have a separate column for people who test positive but clearly died from something else like a gunshot wound or drinking too much fishbowl cleaner. It frustrates me that we have such shoddy data with so much on the line.
The letter shows that 61% of those that died had hypertension. This is hardly surprising given that 70% of adults 60 and older have hypertension.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768730/
To go along with the fraud risk, there is a bigger financial incentive to under report covid cases. There is a net loss of a few thousand dollars per Covid patient. Hospitals can charge insurers up to around 30k for covid related treatments, but the most severe patients run into the 70k range. The indirect incentive is lower numbers makes it seem like the virus is under control or dying off. This would allow hospitals to resume elective procedures and actually make money.
We don't have enough tests to go around to waste on people that have already died. We need to start producing enough to use on people who want to rejoin the workforce as well as people who get sick.
Fair points. There are many financial incentives to get the economy up and running again. However, just because the incentives are financial doesn't mean they are invalid. I don't condone fudging numbers to make it happen, but I wasn't for a shutdown even with astronomical death projections. The issue is a weighty one to be sure.
I agree with you - this would seem pretty simple to confirm with a test - even postmortem.
I think the CDC guidance - although likely well-intended - provides enough flexibility that allows hospitals to classify deaths as COVID without a positive test result. It reads:
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In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as “probable” or “presumed.” In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely. However, please note that testing for COVID–19 should be conducted whenever possible.
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I understand the need to have such language, but the total % of probable C19 deaths in the NYC count is eye-opening: as of 6 PM on Tuesday, there were 13,938 confirmed and 5,359 probable deaths from COVID-19 in the five boroughs (nearly 30%).
Full guidance from the CDC site can be viewed here:
I'm all for discussions on when to open the economy and how we should do it. What we don't need is people lying about numbers to justify their positions. I agree with you completely on that.
I agree that numbers are under reported. Prime example is up until now only hospitals and nursing homes are reporting the deaths. There are significant numbers that have died at home or before getting to the hospital which are not counted. NY is looking at death certificates where Covid is listed as the COD but are not included in the totals. If you recall there was a huge increase in NY cardiac arrest deaths in March/April which likely was due to the virus but not shown as such. The lack of testing also means that early on a number of deaths were deemed influenza before the virus was even recognized as being in the country and no tests were available. Illinois is reviewing their January/February deaths to see if these were in fact covid related. This seems plausible given the high level of Flu deaths were attributed to vaccinating for the wrong strain this year. France also now thinks it may have been in Europe during late 2019.
Yeah we're likely going to end up with a range of probable COVID-19 deaths based off of an analysis of how many people died with COVID-19 like symptoms that is statistically significantly higher than what we would expect at certain times of the year. It will probably leave no one happy, but you can't give exact numbers with those types of analyses.
DHEC in SC every day - in our newspaper - confirmed cases in SC and then in the next sentence gives probable cases in SC as 10 times that amount. Is this being reported elsewhere? Just curious...
Graydawg, we've had some great conversation on this thread and i have really appreciated it. I've always understood the frustration about shutdown and don't need convincing. I'm also frustrated by those who early on and again now who mock those who take it seriously. I want us all to practice good hygiene (Baxleydawg was right about its inportance) and take precautions so we can reopen without unnecessary death and healthcare expense. I fault more than anything the fracture in our nation that divides us into either/or answers when most Americans, I believe, want to take Covid19 and our economy seriously.