Old codgers with pre-existing conditions
We keep reading that COVID-19 kills mostly the old and infirm. Except, from where I sit, a person doesn’t have to be so very old or infirm to be in those categories.
Yes, the disease kills a lot of very debilitated extremely elderly people in nursing homes, the same group that has a high death rate every year from “ordinary” seasonal flu. But COVID also seems to kill younger old people in fairly high numbers, and those with rather common pre-existing conditions such as obesity, asthma, cancer, diabetes, heart disease, and hypertension.
At least, that’s what we’ve been led to believe so far. But it’s not easy to get good statistics. For example (and I’ve mentioned this before) a lot of people over 60 have one or even several of those conditions. Are we just talking about age being the real factor? Are people over 60 with those conditions dying in higher percentages than the frequency of the conditions in the general over-60 population?
Just taking one of these conditions, we hear about obesity. But it turns out that preliminary research indicates that obesity is a factor only in the group younger than 60 years of age. That’s – interesting.
There’s also asthma, which originally was listed as a risk factor and the most recent data from NY is now indicating that it is not an extra risk factor, although this may seem counter-intuitive.
This article at Vox is one of few I’ve found that looks at age more carefully, and discusses age decade by decade – up to a point. That point is reached at 70, when it lumps everyone over 70 into a single category. I find that quite unhelpful.
However, for ages 50-60, the article contains this useful information:
Almost half of Americans ages 55 to 64 have at least one preexisting condition, according to the Kaiser Family Foundation.
Those numbers are only going to increase as people get older.
Most of the data on age and COVID deaths is expressed in terms of what percentage of cases in each age group die (case fatality rate). Although it may exist somewhere, I have yet to see what I’m really looking for: what percentage of all COVID deaths occur in each age group.
I did find this:
Among the 105 patients who had died in Italy as of March 4, two-thirds had three or more preexisting conditions. The most common was hypertension, followed by ischemic heart disease and diabetes mellitus.
That’s a small group, but it bears out what I’ve suspected: it’s often a combination of pre-existing conditions rather than a certain condition on its own that increases the risk so dramatically. The study cited and linked to is in Italian, so I’m not going to tackle that right now.
And here’s an invitation to you to attempt to answer some of these questions if you can find relevant studies that I haven’t been able to find. Or even to ask more questions.
“Although it may exist somewhere, I have yet to see what I’m really looking for: what percentage of all COVID deaths occur in each age group.”
Neo, if I correctly understand what you’re looking for here, there’s a pie chart on this page: https://www.syracuse.com/coronavirus-ny/ that shows the percentages by age group of the 12,192 deaths counted as COVID that have taken place in New York as of today, broken down into age groups of 39 and younger, 40-49, 50-59, 60-69, 70-79 and 80 and over. Of course, it has no information about who had co-morbidities and who didn’t. But adding up the percentages shown as of today is rather startling: 85% of COVID deaths in New York so far have taken place in those over 60, and 95% in those over 50.
I’ve said it before. BMI or similar measurements are close to useless. I used to run four to eight miles a day most days. I would have qualified for obesity. But when I went to give blood, the nurses would look at my BP, pulse rate, respiration, and wonder how they could get such a low-stress job. Nice of them to be kidding around. Even my temp was about 97. Lots of folks I’d see trotting along didn’t fit the scrawny marathon runner’s build. I ran a ten miler and didn’t see morbid obesity passing me, but short of jiggling lard, it was pretty average folks and many would have flunked the BMI.
There were guys in the Army who looked like a beer barrel walking on two fireplugs, without an ounce of fat on them.
So the arbitrary and unrealistic measures of “obesity” are nuts. Half or more of the folks in the younger cohorts would flunk without being “obese” in any sense. Which means it’s a non-starter for underlying conditions. I suppose you could count “still has most of his hair” and get about the same correlation.
I’m 69 and my wife is 75. We both have health problems (wife diabetes, me heart disease etc). Mid January we both came down with something that could have been covid19. All the same symptoms. It lasted for about 2 weeks and then we were fine.
I would love to be tested to see if we have antibodies but to date have not been able to get a test.
Here’s a really interesting related development that I discovered just now while updating my data. Funny, you just wrote a post on the topic of pre-existing conditions. Since yesterday, NYC has totally altered its stats for deaths without underlying conditions (among deaths from confirmed cases):
https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-daily-data-summary-deaths-04172020-1.pdf
Today, it shows that across all ages, there are 42 deaths for people with no underlying conditions out of 7,890 total (confirmed) deaths.
Yesterday, there were 152.
Their presentation splits a death count into deaths with pre-existing conditions, deaths without pre-existing condictions, and deaths with unknown pre-existing conditions. The latter grows or drops from day to day – I’ve been following it daily for a while now.
KyndyllG:
But what I would love to know is what percentage of the US population has at least one of those pre-conditions. I would also like to know what percentage of the US population over 60 has at least one of those pre-conditions. And then the statistics on COVID and pre-existing conditions might mean something. Otherwise, they have no meaning to me.
jack:
Agreed that an antibody test for everyone who wants one would be great. But it’ll be quite a while, I think, before that might be possible.
“As many as 82 million Americans with employer-based coverage have a pre-existing condition, ranging from life-threatening illnesses like cancer to chronic conditions like diabetes, asthma, or heart disease.”
https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/preexisting
Mike
Neo, I agree that would be great info to have. Knowing the percent of the population would really fill in the merit of the numbers I just linked to. For instance, 4,035 people 65 and over whose pre-existing conditions are known are shown as having died. Of them, 4 did not have pre-existing conditions. I suspect that there is a higher percent of people 65 and over who have none of the pre-existing conditions NYC is tracking, but it makes a huge difference if this data reflects their rarity, or proves the significance of underlying health conditions.
As a side note on antibody tests, I will go out on a limb and predict that in upcoming days in MSM/social media you’ll hear a lot of about sensitivity of such tests and how unreliable they are. Not that they are, or aren’t – because what’s true isn’t important here; what’s important is shaping public perception. I predict this because early returns are consistently indicating much higher incidence of cases than what is reported in the given area or jurisdiction, and to question the reliability of the tests has become the stock response of the contingent that isn’t giving up on doom yet.
It’s similar to what happened a few weeks ago when it became obvious that many and possibly even most cases are asymptomatic. Instead of allowing the public to think, “Ah, so then it must be much more widespread and must be less serious than originally thought,” it suddenly became imperative to terrify the general public into wearing masks because of asymptomatic COVID zombies.
A little more info. Wife and I both had yearly flu and 5 year pneumonia booster shot a couple months earlier. Wife also went to Dr at peak of all this and she was given Zpack and anti biotics. I’m wondering if all this kept us out of the hospital. She wasn’t tested for covid19. It really wasn’t in the news 24/7 mid january.
I’m 73. My high BP is under control with meds. I had prostate cancer 5 yrs ago and had radiation treatment for it. My kidney functions is low normal. Does knee replacement count? Yes I am overweight but not obese except by BMI standards.
I guess I am a walking dead man.
In Minnesota, the average age of Covid-19 deaths was 87. Of course all deaths are a loss, but shutting down the state’s economy because of deaths at age 87? It’s no wonder there was a demonstration outside the Governor’s Mansion today.
Tune in almost any TV channel or radio station, if you are masochistic, and you are likely to find some MD, Epidemiologist, or statistician with the latest theory or projection. Many are conflicting. My wife gets too much of her information from late night radio. It puts her to sleep but at a cost; she is a bundle of anxieties. I am trying to ignore most of the noise. Ignorance may not be bliss; but, it is a lot more peaceful.
Since we are octogenarians with pre-existing conditions, asthma and a history of caner for her, and heart issues for me; we are careful. That is all that we can control. (I hardly go out of the house except to go fishing, and putter in the yard; she doesn’t do that.) Fortunately, we have a caring and supportive daughter near by.
Just had a chat with our Siamese cat. I find it soothing to talk to her because so long as I provide Delectable cat treats on schedule, she usually tolerates my opinions without argument. I cautioned her that things in this country will never be the same. I think her reaction was along the lines of she had seen worse (she was adopted at an advanced age), and really didn’t give a damn. So, focus on basics; tickle my ears, and I may reward you with a purr. She is a codger cat with a fairly philosophical perspective. I am trying to pattern myself more after her.
PS I agree with you, Cap’n Rusty. At this point, the thing I dread most is being a burden. I suspect that most of us in the age group would agree.
Stat I saw the other day (unattributed) “Covid-19 has killed more people over the age of 100 than under the age of 30.”
All this info, especially the qty of say under 50 who have dies, is relatively meaningless without knowing how many are infected.
Mrs Whatsit:
That helps, thanks. But to be very very specific: what I’d like is a more complete breakdown for those older age groups. “80 and above” doesn’t tell me much, although it’s better than “60 and above” or “70 and above” because it’s less broad. But a person of 80 is often quite different than a person of 95 who’s in a nursing home, and yet they’re lumped into the same group. What percentage were in nursing homes? And I’d also like to know what the percentage of each age group is in the general population, for comparison.
Lung capacity is reduced by age for all of us. So just plain getting old does reduce our odds of beating the virus.
Israel:
Not totally meaningless. It depends what you’re looking for. If you want to know case fatality rate, it’s meaningless. If you want to know death rate per thousand or per million in the general population, it’s meaningful.
I wonder if someone like Oldflyer would be helped by an exercise program. I know that my father who had a naturally robust constitution and build but never formally exercised, started up in his 70s on the exercise bike, treadmill, and rowing machine.
It did him a lot of good in those seasons when he could not go up to the farm and play Green Acres.
Speaking generally, I think that more people would do better for themselves by adding resistance exercises to their workouts. Many claim the excuse that it’s too boring. But there is no reason you cannot do curls or presses while the TV or radio are on.
Just keep it off politics or the news, or you will wind up throwing the barbell though a window.
One other question that’s been floating around in my brain is this. We’ve heard quite a few stories of people with no preexisting conditions who are perfectly healthy getting extremely ill and dying from COVID-19. Are there stories of people with preexisting conditions, who have mild cases? I have to believe that there are, but they just haven’t been talked about often. Rand Paul would be one example. He had lung/breathing issues after his altercation with his neighbor, but said he barely had any symptoms.
KyndyllG:
Three-quarters of people over 70 have hypertension. And then we have this:
So, what does it all mean in terms of that being a COVID risk factor, if age is also a COVID risk factor? I rarely if ever see these points even being mentioned, much less adequately and intelligently addressed.
For the most part, I pay attention to daily reports from the Iowa Department of Public Health. Deaths for those age 18 to 40 plus those for age 41 to 60 are more than double those age 61 and above.
DNW, thanks and I agree. I am on a personal exercise program on a more or less daily basis, and when I fish, once or twice a week, it is 4 or 5 hours in a kayak. (I would fish most every day if I didn’t have to drive so far in SoCal traffic).
There is no question that at any age an appropriate exercise program is beneficial in a variety of ways.
Here are some charts from Snohomish County, WA.
First, the umber of cases by age:
https://www.snohd.org/ImageRepository/Document?documentID=3691
I’m surprised at how many cases there have been in people under age 20.
Next, deaths by age:
https://www.snohd.org/ImageRepository/Document?documentID=3612
This indicates that, if you are over 80, you still have a 50/50 chance of surviving. Hang in there, octogenarians. 🙂
Next is the number of deaths by date:
https://www.snohd.org/ImageRepository/Document?documentID=3643
Testing results by date;
https://www.snohd.org/ImageRepository/Document?documentID=3715
Now for the current status of active cases:
Last Updated: 2 p.m. 4/17/2020
Isolation (home or in long-term care) 201
At isolation and quarantine facility 2
Hospitalized 64
Recovered 1,499
Deceased 88
Under investigation/Unknown 365
Finally, deaths by gender and with/without underlying conditions:(Last updated: 2 p.m. 4/17/2020)
Gender:
Female 36
Male 52
Underlying conditions:
Yes 81
No 6
Unknown 1
It’s a small population (about 822,083), but we had the first Covid-19 patient in the USA here at Providence hospital in January, followed by a cluster of cases in several nursing homes in the county. It’s on the wane, as seen in the charts, but we need to ramp up the testing to keep it under control.
In a previous comment to an earlier post by Neo (https://tinyurl.com/ybdtjk9o), I noted that the CDC has compiled statistics from a wide variety of government publications, and re-published them as an online handbook called “FastStats” (https://tinyurl.com/y8ct8ee8).
FastStats can be browsed for data on specific diseases. Typically, the data is broken down by race, gender, and age group. Unfortunately, the statistical categories often don’t match the categories found in other data sources — e.g. The New York City COVID-19 daily reports. Consequently, it’s often impossible to make valid quantitative comparisons. Even so, if anyone is interested in finding data on underlying conditions for the general population, FastStats is an easy place to start.
For example, physician-diagnosed diabetes, as a percentage of the general population, from the interval 2013-2016, is as follows (https://www.cdc.gov/nchs/data/hus/2018/014.pdf):
age: 20-44 3.0%
age: 45-64 14.2%
age: 65 & over 20.9%
Much, much more at the link.
In several other comments, I’ve complained about the poor data quality and lack of data collection standardization for COVID-19, but I have to admit that this isn’t an easy task. My hope is that, within the next year or so, we’ll get research that provides valid statistical answers to questions of co-morbidities.
As an example of what I’d like to see, here’s a paper entitled “Determinants of Fatal Outcome in Patients Admitted to Intensive Care Units With Influenza, European Union 2009–2017” (https://tinyurl.com/yblcfnbw).
If you take a look at Table 2, you can see that they’ve done both univariable and multivariable analyses to determine risk factors for both age and underlying conditions. That’s what we need for COVID-19. How will it differ from influenza?
Cornflour…yes. I was just thinking about multivariable analyses. It’s not good enough to look at “how many smokers have bad COVID outcomes” and “how many people in different age categories?” and “how many men vs women?”, etc; it’s necessary to see how these variables interact. That’s why techniques like regression analysis, and later improvements on it, were developed and are widely use. Haven’t seen anything of that sort for coronavirus; hopefully someone is working on it.
Metabolic Syndrome, Metabolic Syndrome, Metabolic Syndrome….
Lots of people have it. You don’t need to be old, you don’t even need to be Fat on the Outside to have it. All you need to do is eat a modern diet of refined carbohydrates and industrial seed oils.
Don’t listen to me. I have no standing. This man however:
https://www.youtube.com/watch?v=nWz_nlAVeIw
Tom:
They don’t tend to feature those stories, but most people even with pre-existing conditions and who are old usually survive.
For example, Tom Hanks is 63 and a diabetic, and he came through well. He’s only featured because he’s a celebrity.
There’s also this 106-year-old woman. Great story.
Neo:
I read that Hanks’ wife had a much more severe case than his, and she was “healthy”. I think that who does and does not have a severe case has much more to do with genetic makeup than underlying health conditions. I think some people have an immune system that deals with the disease much better than others. Maybe it’s that they’ve been exposed to a similar pathogen in the past, or maybe something else about their genetic makeup gives them an advantage over other people. A similar mechanism to the effects of sickle cell anemia. (I’m only using sickle cell anemia as an example of a genetic factor giving some people in a population an advantage over others in that same population.) I remember a lesson from high school biology that discussed the way a rabbit population cycles. It get’s too large, and then a pathogen takes a large percentage of the population out, but some always remain because they have some genetic advantage. Future generations of that rabbit population carry that immunity.
OldFlyer:
I’ve always wanted to ask, What did you fly? I’m hoping it had one or more propellers.
All of this risk aversion drives me kind of nuts. I am in bonus time, prostrate cancer 19 years ago, check ups for that found kidney cancer in my only good kidney and we got it out and then it came back and we got it out once more. Slight blood pressure stuff that controls with cheap meds and my numbers have been getting better every year even thought I probably drink, according to those who know, too much scotch every evening. My docs tell me keep on doing what I am doing because it works.
Every one who is born is going to die, over all these 70 plus years I have lost a lot of friends, one within the last few months and looking back it might have been this Corona-19 stuff, I was in the room when they took him off of the ventilator and he passed away later that evening, he was done and not coming back so I know about those hard, pull the plug things.
My suggestion is for every adult to take a hard look at their own health and act accordingly, for those who have small children take care of them and for those who are strong in good health use every precaution you are aware of and for use old people, be extra, extra careful and if it is your time, the bell might toll for thee. It is not that complicated and it will take a ton of time for real meaningful actuarial numbers to be recorded.
Live each day as if your days are numbered because they really are and be thankful for the ride you have had so far. A couple of scotch drinks make me a little bit, — fatalistic — thankful — optimistic — for the younger generations, so there’s that.
All you need to do is eat a modern diet of refined carbohydrates and industrial seed oils.
Fasting is the solution as well as the evidence that much of the FDA stuff are merely poisons.
“Live each day as if your days are numbered because they really are and be thankful for the ride you have had so far.” – OldTexan
Nobody gets out of life alive.
It is sad when the younger ones go, as they have more unexplored potential than us old codgers (although we probably still have undeveloped potential), but everybody is missed by somebody.
Lost the first of our friends to COVID Tuesday (true case, not a medico’s guess). Age 84, don’t know his comorbidities, because we were occasional attendees of an annual “hobby” convention at the same time, and there was more to talk about than age and infirmities.
His wife declined into dementia several years ago, although otherwise in good health. That is sad too, I think; she was intelligent, creative, social, lots of fun to be with, spoke several languages, and was an expert folk dancer on the side.
There are kids to care for her, but they can’t get into the nursing home to see her.
After they tell her, she may not even really register that he is gone.
Another good one on Viral Resilience:
https://www.youtube.com/watch?v=PJ7A1Nqca64
Ymarsakar,
About 10 years ago I started doing intermittent fasting, which, for me basically meant skipping breakfast. It didn’t take long (a few days?, a week?) to notice I felt better. I fast for at least 14 hours/day at least 80% of the time now, and have been doing that for years. I also fast longer sometimes, including more than 24 hours, usually not more than 48. It seems to be a good fit for my metabolism.
When possible (which is most days) I want to eat dinner with my family, but if I had my druthers I’d probably eat breakfast and skip dinner, getting my 14 hours on the back end, rather than the front. I’ve never been particularly excited about meals (an hour + meal with friends in a fancy restaurant is not my thing, although I have to do it a lot because it’s most people’s thing); however, breakfast is the one meal I have always enjoyed.
“Vital Surveillances: The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020” is the title of a recent paper published in “China CDC Weekly.”
(Yes, it’s China, we all know.)
The paper has data broken down by age, gender, and comorbidities. For those in a hurry, take a look at Table 1.
Here’s a link
http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51
Two common-sense notes:
1) Compared to the USA, smoking is much more common in China, especially among men.
2) Compared to the USA, obesity is much less common in China.
Data from S. Korea now show infected and “recovered” people are still positive for COVID some two weeks after symptomatic/clinical recovery. Small group studied, but nevertheless….
Medically, I’ve only “pulled the plug” once in my life, long ago, and that still haunts me. Yes, she was brain-dead, but there is still something fundamentally troubling and wrong with a healer terminating a life. I was young and arrogant then. Or with the next-of-kin requesting plug-pulling. It frays our moral fabric and starts us down an irreversible slippery slope.
The Hippocratic oath has now been revised at 90% of medical schools toward political correctness and social justice: New York Medical College, Tulane, and the University of California, San Francisco, all have students vow not to discriminate against patients based on gender, race, religion, or sexual orientation. Or financial status, the ability to pay for care. Thus MDs are care-“givers”, which implies donation, not mere “providers”. The revisions are mute on abortion and euthanasia.
The original oath, recited for millennia, reads in part, opposition to abortion, and vows abstinence from euthanasia.
To abstain from euthanasia. That is the bottom line, in these times.
Cicero,
That is disturbing. One assumes “do no harm” is rather straightforward and apolitical, but alas, we humans make everything difficult.
The governor of Michigan says abortions must be allowed in the coronavirus situation because they are “life-sustaining.”
Rufus:
Actually, we humans are imperfect and thus commit sins even as we justify them for the greater good or an excuse in a similar tone.
Donald Rumsfeld comes to mind: “there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know.”
Great wisdom from an imperfect man.
I spend more time than I should reading various theories on COVID-19 (I have a background in microbiology and clinical lab work b4 changing careers to IT)… anyway I found this podcast interesting. https://youtu.be/PJ7A1Nqca64
I seems that a large % of the population has some metabolic issues as they get older. (I am in my 60’s) So I’ve spent a lot of time keeping my metabolic markers inline due to an APOE4 issue. I feel that if our food supply was more whole foods we’d all be able to fight this virus better. Just my two cents FWIW 🙂