COVID or the flu?

The New Neo Posted on by

A person gets a cough, a fever, fatigue. Ordinarily, that doesn’t engender much alarm. But this year of COVID is different. Almost anyone with those symptoms believes he or she might have it. Depending on the state or city, and depending on the severity of symptoms, many of them manage to secure a test. And the majority of them test negative for COVID.

There are also a lot of people who had similar symptoms earlier this winter and are convinced they had COVID back then. Maybe they did. But maybe they didn’t.

Actually, even now, chances are better that it was actually old-fashioned influenza. Flu can kill, too, but it infects tons of people and kills a very small percentage of them. For the vast majority, flu is a bother and a pain and nothing more.

So far this season (2019-2020), flu has infected many people, almost certainly way more than COVID (which so far appears to have a higher case fatality rate, although exactly how much higher has yet to be determined). Take a look at the CDC page for this year’s flu in the US, and see the kind of numbers I’m talking about. It says 39,000,000 – 55,000,000 cases of flu, 18,000,000 – 26,000,000 doctor visits, 400,000 – 730,000 hospitalizations, and 24,000 – 63,000 deaths.

It adds this:

Because influenza surveillance does not capture all cases of flu that occur in the U.S., CDC provides these estimated ranges to better reflect the larger burden of influenza. These estimates are calculated based on CDC’s weekly influenza surveillance data and are preliminary.

Influenza testing across the United States may be higher than normal at this time of year because of the COVID-19 pandemic. These estimates may partly reflect increases in testing in recent weeks and may be adjusted downward once the season is complete and final data for the 2019/20 season are available.

I wonder whether levels of flu have been going down since all this social distancing began, though. It seems logical to conclude that would be so.

This and that

The New Neo Posted on by

The “this” is that I’ve had a lot of internet trouble today. That always makes me break out into a cold sweat. It seems to have been fixed, but you never know. And right now I – like so many others – am even more dependent on the internet than ever.

The “that” happened last night when I was getting ready for bed. I turned around to do something, and as I did so my arm or hand brushed against a toilet paper roll, only about one-quarter used, that was sitting unsecured on a shelf. Bullseye, right into the toilet.

I almost wept. I definitely cursed.

“We have destroyed the economy”

The New Neo Posted on by

I see that statement quite regularly these days: “We have destroyed the economy!” And I agree that we’ve dealt it a terrible blow. But a fatal one? Isn’t that as prematurely doom-laden as the “COVID will kill us all!” folks?

I’m as concerned as most people. In fact, one of the particularly terrible things about the current crisis is that it’s a wallop in the gut on so many levels and topics that evoke deep fear and/or anger: health of self and/or loved ones and others, economics and finance, government overreach, politics, social cohesion, press bias, and personal isolation.

But on the economic front – the stock market had already undergone a huge drop right at the beginning, before the government had done much of anything. In many places in the country, businesses were already floundering; people were already not going to restaurants, sports had been canceled as well as concerts and many other gatherings. Even now, portions of the economy are still functioning: groceries stores, pharmacies, and trucking, to take a few examples. But a large part of the economy is shut down and gravely threatened, with many small businesses set to fail.

It’s awful, actually. But how much actually is self-inflicted as a result of what the government has done? How many of these businesses would have continued to function and kept their head above water if state and local governments hadn’t forced shutdowns or shelters-in-place or whatever you want to call all the present edicts forcing us to stay home? More would almost certainly survived than is likely now, but how many? And for how long? What if, without any shutdown, things had gotten much worse in terms of people dying? Would restaurants, for example, have just gone on as before?

I doubt it. But I don’t know; that’s why I couch these things in the form of questions.

And at what point is an economy “destroyed”? Can we not recover? Maybe yes, maybe no, maybe not back to the level we achieved before this happened. How long will it take, and how hard will it be along the way, and how much will change as a result?

Predictions on that seem as iffy as predictions on all the rest. In this post, I’m not even including links to economic prognostications (although feel free to discuss it all in the comments) because I don’t think anyone knows. Previous recessions and depressions and downturns had more to do with fundamental problems or forces within the economy, but this one is self-imposed and/or imposed by a health crisis that is not primarily economic. And it appears to be worldwide, particularly in the developed countries that so far seem to be the ones hardest hit.

I actually think that, in this situation, that much-overused word “unprecedented” is warranted.

I was doing some tidying up today…

The New Neo Posted on by

…and came across one of those neighborhood freebie papers from about a month ago. You know, the ones that list concerts and meetings, and have ads for restaurants.

Ordinary stuff. Unremarkable.

Except today it seemed like an ancient relic from a lost civilization. Concerts? Meetings? Restaurants where you sit down with people around you, and have a leisurely meal?

I believe all of this will come back. I just don’t know when. And even though it’s only been a few weeks that we’ve been in this isolated state, time’s a funny and elastic thing. It seems longer.

I feel that way even though I know that this is nothing compared to what people have gone through in the past. Hey, tell it to those who endured the Siege of Leningrad, for starters. To them, our current situation would feel like paradise. Internet, cell phones, supermarkets nearly full – what’s the problem?

And yet there is a problem. Part of it is the unknown nature of the wait. Part of it is dealing with cooped up children (I don’t have that problem, but many do). A big part of it is isolation and loneliness, as well as economic stress. Still another part is the fact that it’s self-imposed, and perhaps unnecessary but perhaps necessary and effective – we just don’t know.

And still another part of it is political. I’ve noticed that many of the people I talk to on the phone have increased (or in some cases begun) their casual sniping at Trump; the assumption is that of course he’s stupid and incompetent and perhaps even malevolent. Those of us on the right continue to worry that this will set the stage for more government control in the future, and/or for a loss in 2020. Reading the paper or listening to cable news only fans the flames, so that’s pretty much out (at least for me).

And yet the virtual world is at our fingertips. We can watch concerts and performances online. Movies and TV shows, lectures, documentaries. Take a course. Read the classics. Reread the classics. Watch funny videos about dogs and cats.

It’s not the same as being outside among crowds of people, or traveling. But it’s still a blessing to have.

I’ve read a lot of articles much like this one

The New Neo Posted on by

That is, first-person accounts from someone described as having COVID. This one is from a young woman in Brooklyn who writes that her entire family came down with it.

But as I read it, one thing in particular leaped out at me (ignoring the obligatory Trump-dissing). Here’s the passage in question:

I called a pediatrician whose main advice was that one of us, my husband or me, should get tested, “so you know what you’re dealing with.” But what were we dealing with? And how, on March 22, to get tested? Call 311, she said, maybe there was a drive-through still taking walk-ins. I called 311, got routed to someone someplace whose connection was too fuzzy to make out who he was and what he could do. He took my info and then I never heard from him again. I emailed my primary care doctor and was prompted to install an app to take a test. I installed the app, took the test, and then an admin person replied that I probably had the virus, but new guidelines prohibited outpatient testing. Even if we had directions from a pediatrician? My wording grew stronger. A different admin person replied with an electronic shrug.

I read that several times trying to decipher what the author was saying. There is no app that can diagnose COVID – and if there is, please tell us, pronto. All an app can do is ask a list of questions about symptoms, and give a guess as to whether they conform to possible COVID. And that appears to be the foundation on which this entire essay rests: a family has either COVID or the flu, and is miserable and scared.

Even now, in New York, most people who are tested are not found to be positive for COVID. They must be having symptoms of it or they would not be tested. But they don’t have it. Does this woman? I have no idea, but she’s making a lot of assumptions here, as are her editors. And I looked through quite a few of the comments (certainly not all) but didn’t find anyone remarking on the fact that her case was never diagnosed.

Later in the essay she writes (emphasis mine): “There is no doctor to see, no tests to confirm what we already know.”

This is not the first article I’ve read that’s supposed to be by someone with COVID and yet the person never got a diagnosis. Now, I have no doubt it’s both frightening and frustrating to have symptoms that seem to conform to those of the disease and yet to have no access to a test. I have sympathy with that. But with the rate of negative results, and the fact that the symptoms also are consistent with flu, I find it disturbing that people accept a self-diagnosis at face value.

Disturbing, but probably not surprising.

Another thing about COVID-19 and co-morbidities

The New Neo Posted on by

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.]

“Underlying conditions” and COVID-19

The New Neo Posted on by

This problem has bothered me from the start:

WHAT PERCENTAGE OF AMERICANS IN GENERAL HAVE AN UNDERLYING CONDITION? 73% of Americans Hospitalised With COVID-19 Had an Underlying Condition, Says CDC. No numbers, but there’s this: “The CDC noted that many of the conditions reported by patients are fairly common among Americans in general.”

So maybe this says that the disease mostly just kills people who are already sick. But if “already sick” encompasses things like “former smoker” and “high blood pressure” — under the new guidelines, it’s like 1/3 of the public having high blood pressure — then that’s not much of a comfort.

I keep reading statistics about this that make no sense without a comparison to age-corrected statistics for the general population.

And it doesn’t help to give statistics that are NOT age corrected, such as this:

For the 7,162 cases in which patients’ underlying health data were available, the CDC said 71 percent of patients hospitalized with COVID-19 and 78 percent of those admitted to intensive care units had preexisting conditions or risk factors.

By contrast, just 27 percent of people who tested positive but weren’t hospitalized had underlying health issues.

Meaningless, for the simple reason that we also know that COVID-19 impacts far more heavily on people over 65 than on younger people. And it’s people over 65 who have a lot of pre-existing conditions. In fact, although I know a lot of people in that age group, I’m hard-pressed to think of anyone without a pre-existing condition.

And yet I see this “pre-existing” stuff over and over without any mention of its connection to age. Until researchers tease out which conditions are actually and independently related to higher mortality and which ones merely go along with advanced age, we have no idea what it means.

For example (and unfortunately I can’t recall where I read it or heard it, and don’t have time to find it right now), I heard that around 30% of COVID patients needing ICU care have diabetes. But then I looked up the incidence of diabetes in people over 65 and – you guessed it – close to that. The same thing happened with high blood pressure – the incidence in the older population was the same as the incidence reported in COVID patients doing badly.

I don’t expect researchers to know all that much at that point; it’s so early. But I do expect people speaking to the press, and the press reporting what they say, to explain these things properly.

I know, I know – that’s a highly unrealistic expectation on my part. Maybe it’s just a hope.

Red tape and COVID-19

The New Neo Posted on by

Some of the red tape surrounding the development of new treatments and tests for disease is designed to protect us from rushed and/or botched jobs. But some of it is the result of the natural tendencies of government agencies to become ever more complex and far-reaching (and sometimes counter-productive) in their rule-making.

Anyone who’s been following the COVID-19 story has almost certainly noticed the initial (and in some cases continuing) foot-dragging by such agencies as the CDC and FDA. Part of the reason is that such agencies tend to be cumbersome and hard to turn around, somewhat like the Titanic.

Here’s an important post that describes how the widespread “Certificate of Need” regulations limiting the growth of hospital beds over the years has hampered our response to the crisis.

Here’s another article I recommend reading, on the subject of red tape and the response to COVID-19.

And here’s something that has little to do with the above, but it’s the image that comes to mind when I get angry at red tape. It’s a solo for the vengeful Medea, from the Martha Graham piece called “Cave of the Heart.” Very intense:

Well, this is encouraging

The New Neo Posted on by

Not a controlled study, but still it’s good news:

Dr. Stephen Smith, founder of The Smith Center for Infectious Diseases and Urban Health, said on “The Ingraham Angle” on Wednesday night that he is optimistic about the use of antimalarial medications and antibiotics to treat COVID-19 patients, calling it “a game-changer.”

“I think this is the beginning of the end of the pandemic. I’m very serious,” Smith, an infectious disease specialist, told host Laura Ingraham…

Smith, who is treating 72 COVID-19 patients, said that he has been treating “everybody with hydroxychloroquine and azithromycin [an antibiotic]. We’ve been doing so for a while.”

He pointed out that not a single COVID-19 patient of his that has been on the hydroxychloroquine and azithromycin regimen for five days or more has had to be intubated.

“The chance of that occurring by chance, according to my sons Leon and Hunter who did some stats for me, are .000-something,” he said, adding that “it’s ridiculously low.”

The article also describes a Chinese study.

One of the many effects of this pandemic is a feeling of intense impatience at the seemingly slow pace of research on this and other drugs such as antivirals, as well as the vaccine. And that’s even though I know that such processes are actually being speeded up because of the crisis, and medical researchers are working their butts off. There’s just such a strong feeling that time is of the essence.

It’s of the essence for so many reasons. Some are personal: I’m in the particularly-at-risk population, and of course I also worry about my loved ones, whether they are or aren’t in that group as well. Some my reasons are broader: I want this disease to become very treatable and/or preventable ASAP, so it can cease to be all that much of a concern, the death toll will fall precipitously, and we can all go back to mild OCD rather than full-blown OCD.

I very much want the economy to start to recover, and the sooner that happens the better.

And I want the Democrats and the MSM to be revealed as smaller and smaller and meaner and meaner and wronger and wronger in their continual attacks on Trump’s handling of the crisis.