Old codgers with pre-existing conditions

The New Neo Posted on by

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.

They’re all here for me

The New Neo Posted on by

I get several emails every day that chorus, “We’re here for you!”

The pharmacy, the grocery store, Walmart, my doctors, the hairdresser I went to briefly ten years ago, ditto a trainer and physical therapist. The universities I attended in the distant past, which weren’t really even there for me back then, I’m afraid.

But all of them are here for me now. And even though some of it seems ridiculous – my alma matres, really? – much of it is very real. My supermarket is there for me, with stockers and clerks increasing their own risk in order to serve the public. Doctors and nurses and the local hospital – they are brave souls. Even the pizza delivery driver I sometimes see in the neighborhood, wearing a mask and gloves these days, is performing a yeoman’s task in being there for me and for you.

I haven’t ordered a pizza, though. I would probably just scarf it down. Best to keep the eating as light as possible to avoid the weight gain that a lot of my friends are complaining has happened to them.

What did the FBI know and when did they know it? Plenty, and early.

The New Neo Posted on by

No surprise here:

Additional information released on Wednesday shows exactly when in 2017 the FBI received evidence that Russian intelligence operatives fed Steele with disinformation.

The FBI obtained information on Jan. 12, 2017, two days after BuzzFeed News published the dossier, Steele’s allegation that former Trump lawyer Michael Cohen visited Prague in August 2016 was likely the product of Russian disinformation.

The FBI received evidence on Feb. 27, 2017 that Russians may have fed disinformation to Steele regarding his most explosive claim: that Donald Trump used hookers during a 2013 trip to Moscow. (RELATED: The FBI Knew The Steele Dossier Contained Russian Disinformation Three Years Ago — And Somehow That Never Leaked)

The footnotes declassified on Wednesday say that the FBI’s Transnational Organized Crime Intelligence Unit sought a validation review of Steele as an FBI source in 2015 because of his links to five Russian oligarchs.

The footnote says that the FBI unit found that five Russian oligarchs who sought meetings with the FBI that year had intermediaries who contacted Steele.

I doubt many people are paying attention to this, with COVID-19 dominating everything. And even if there was no pandemic, I very much doubt the news would make a particle of difference to most (perhaps all) of the Trump opposition.

Using “history” to push the continuation of social distancing

The New Neo Posted on by

Some people clearly want draconian forms of social distancing to go on and on and on. Some of them probably say this from fear. Some of them probably say it because of a desire to control people. Some of them are merely following those epidemiologists who advocate it.

And some are quoting misinformation such as this, which I’ve seen floating around lately here and there. It’s rather typical of the sort of thing one often sees on social media:

People grew sick of the social distancing measures as they dragged on into the summer of 1918. When the Great War finally ended in late November, people took to the streets to celebrate their good fortune. In the coming weeks, the second wave of the pandemic killed more people than the war. It’s not a game…

Let’s take this point by point.

The Great War didn’t end in late November; it ended on November 11, 1918. But when did the parades occur? Well, in a quick search, I found this large one in NYC in September of 1919, a date much too late for the above quote. The troops hadn’t come back the moment the war ended:

Demobilization began in late 1918; by September 1919 the last combat divisions had left France, though an occupation force of 16,000 U.S. soldiers remained until 1923…

It’s hard to get a sense of when most of the parades were held. This article mentions some in St. Louis that occurred almost immediately after the armistice, but the larger ones (you have to scroll down to see the articles) seem to have occurred in 1919.

The case of Philadelphia has come up before in various articles, but its parade that is linked to a huge increase in flu occurred before the war’s end:

Two days after the parade, the city’s public health director Wilmer Krusen, issued a grim pronouncement: “The epidemic is now present in the civilian population and is assuming the type found in naval stations and cantonments [army camps].”

Within 72 hours of the parade, every bed in Philadelphia’s 31 hospitals was filled.

And yet the situation was nowhere near as simple as that:

If St. Louis had waited another week or two, they might have fared the same as Philadelphia, says the lead author on the first study, Richard Hatchett, M.D., an associate director for emergency preparedness at NIAID. Despite the fact that these cities had dramatically different outcomes early on, all the cities in the survey ultimately experienced significant epidemics because, in the absence of an effective vaccine, the virus continued to spread or recurred as cities relaxed their restrictions.

The second study also shows that the timing of when control measures were lifted played a major part. Cities that relaxed their restrictions after the peak of the pandemic passed often saw the re-emergence of infection and had to reintroduce restrictions, says Neil Ferguson, D.Phil., of Imperial College, London, the senior author on the second study. In their paper, Dr. Ferguson and his coauthor used mathematical models to reproduce the pattern of the 1918 pandemic in different cities. This allowed them to predict what would have happened if cities had changed the timing of interventions. In San Francisco, which they found to have the most effective measures, they estimate that deaths would have been 25 percent higher had city officials not implemented their interventions when they did. But had San Francisco left its controls in place continuously from September 1918 through May 1919, the analysis suggests, the city might have reduced deaths by more than 90 percent.

Perfect timing is impossible; we simply don’t know enough. And diseases often come roaring back no matter what we do. In addition, if extreme social isolation measures continue, a city dies in other ways.

With COVID-19, there are scientists who are saying that extreme social distancing doesn’t matter all that much because the disease follows a certain course with or without it. Make of the following what you will:

A prominent Israeli mathematician, analyst and former general claims simple statistical analysis demonstrates that the spread of COVID-19 peaks after about 40 days and declines to almost zero after 70 days — no matter where it strikes, and no matter what measures governments impose to try to thwart it.

Prof Isaac Ben-Israel, head of the Security Studies program in Tel Aviv University and the chairman of the National Council for Research and Development, told Israel’s Channel 12 (Hebrew) Monday night that research he conducted with a fellow professor, analyzing the growth and decline of new cases in countries around the world, showed repeatedly that “there’s a set pattern” and “the numbers speak for themselves.”

While he said he supports social distancing, the widespread shuttering of economies worldwide constitutes a demonstrable error in light of those statistics.

To get back to the original quote that began my post – “In the coming weeks [following WWI victory celebrations], the second wave of the pandemic killed more people than the war…”. But that’s a misleading connection, too.

The second wave was very deadly around the world, including countries that were not really major participants in WWI, and it peaked before the war’s end for the most part [emphasis mine]:

The second wave of the 1918 pandemic was much more deadly than the first. The first wave had resembled typical flu epidemics; those most at risk were the sick and elderly, while younger, healthier people recovered easily. By August, when the second wave began in France, Sierra Leone, and the United States, the virus had mutated to a much more deadly form. October 1918 was the month with the highest fatality rate of the whole pandemic.

Lest you think (as I did) that Sierra Leone had nothing to do with WWI, there actually was some action involving military there, but it occurred solely in West Africa and was not part of the European theater of war. At any rate, as you can see from the above quote, the second wave was well underway in the US and elsewhere prior to the end of WWI and was especially deadly in the month before the war’s end.

I am heartily sick of the sharing of information that is based on nothing but someone’s statement, and designed to lead to a certain result. In this case, that result is the continued clamping down on the US public, and the damping down of objections to it.

Personally, I’m all for the continuation of a certain amount – a milder amount – of social distancing. And in particular, since I’m in a high risk group because of age and a pre-existing condition, I plan to be fairly strict with myself. But that has nothing to do with what should happen in the larger society. I wouldn’t advocate a bunch of parades, of course. But I believe businesses need to reopen and people need to get back to something approximating regular commerce and regular life, and it needs to happen pretty soon in most places.

It is possible that there are huge costs in terms of illness, but it is virtually certain there are huge costs as well in keeping things closed. Those latter costs are not just economic, either. They can and probably will impact on physical and mental health as well, with people shut in and worried about their livelihoods, taking it out on each other in many instances, drinking, not exercising, overeating, becoming depressed, and not tending to other medical needs.

The disease of “late-stage capitalism”

The New Neo Posted on by

AOC isn’t cute, despite her youth and looks. And although she’s widely considered by the right to be stupid, I beg to differ. She’s an dedicated ideologue with an attractive demeanor, and to many people on the left (and not just the far left, either), she’s a heroine and an oracle.

Here’s one of her most recent tweets:

Look how much AOC packs in there. The implication is that the job losses are somehow capitalism’s fault, not the coronvirus’s fault. Would she have preferred no closings? I am positive she would have criticized that approach, too. And notice how she combines it with her casual and au courant “takes a selfie” to leaven the message and make it especially appealing to the young people who admire and follow her.

But I think the most interesting part of that tweet is the phrase “late stage capitalism,” which for me conjures up the idea that capitalism is a disease in its final moribund days.

AOC didn’t make the term “late capitalism” up; it’s been in vogue for about three years, but it certainly predated that. You guessed right if you guessed “Marxism”:

it was Marxist thinkers that came up with it to describe the industrialized economies they saw around them. A German economist named Werner Sombart seems to have been the first to use it around the turn of the 20th century, with a Marxist theorist and activist named Ernest Mandel popularizing it a half-century later. For Mandel, “late capitalism” denoted the economic period that started with the end of World War II and ended in the early 1970s, a time that saw the rise of multinational corporations, mass communication, and international finance. Roberts said that the term’s current usage departs somewhat from its original meaning. “It’s not this sense that things are getting so bad that the revolution is going to come,” he told me, “but rather that we see the ligaments of the international system that socialists will be able to seize and use.”…

“Late capitalism” took on a darker connotation in the works of the 20th-century critical theorists, who borrowed from and critiqued and built on Marx and the Marxists. Members of the Frankfurt School, reeling from the horrors of World War II, saw in it excessive social control on the part of big government and big business. Theodor Adorno argued that “late capitalism” might lead not to socialism, but away from it, by blunting the proletariat’s potential for revolution. “The economic process continues to perpetuate domination over human beings,” he said in a speech on late capitalism in 1968.

Much more at the link.

One thing I can say about AOC: she’s not really trying to hide who she is, unlike many other American leftists.

Suddenly, the Chinese lab origin theory of COVID-19 becomes more than a baseless right-wing conspiracy myth

The New Neo Posted on by

You may have noticed that I haven’t written much if at all about COVID-19’s origins, despite having written a ton about the disease. Was it from a wet market? Was it from a lab? My opinion was that it was 50/50 and that we just didn’t know, so I didn’t want to waste much verbiage on it.

But now I’m leaning towards the lab theory.

Here’s Jonathan Turley on the subject:

When the coronavirus first appeared in Wuhan, China, many people immediately raised the concern that it might have been the result of a lab release from a controversial Chinese the Wuhan Institute of Virology. The lab was working on coronavirus and had raised concerns over its containment protocols. Then there was the fact that China hid the outbreak, arrested top doctors, and buried research on its origins. However, a narrative quickly emerged in countering President Donald Trump’s references to the “China virus.” People, including members of Congress, who referred to the lab were ridiculed on CNN and other outlets as conspiracy theorists like Politifact declared the theory to be utterly baseless. For some of us, the overwhelming media narrative seemed odd and artificial. It would seem obvious that a lab working on viruses in this area would be an obvious possible source. Now, after weeks of chastising those who mentioned the lab theory, another cache of documents and information shows that there are ample reasons to be suspicious and that concerns were raised two years ago within the State Department.

The Washington Post reported that embassy officials in January 2018 alerted U.S. officials of serious problems in the lab which was conducting risky research on bats, the very source of COVIT-19. The United Kingdom has issued a statement that they are seriously considering the lab as a possible source.

Apparently the lab was already flagged as being lax about safety, raising obvious concerns. And if you think about it, China has been lax about safety regarding its manufacture of drugs, as the recurrent recalls of blood pressure medications for contaminants indicate. Please note that in that article, datelined September 2019, it quotes Trump as “calling on US industries to manufacture here at home, instead of outsourcing to China.”

Prescient, that.

More from Turley:

The point is not that this proves that the virus originated in the lab. Rather, my interest is the overwhelming media narrative that emerged to deny that this was a credible potential source. That narrative emerged around the time that the media was hammering Trump for his use of “China virus” and “Wuhan virus.” That criticism was enhanced by the argument that the virus developed naturally. That could still be the case but it never seemed rational to me to discount the lab theory.

What is most amazing is that, if the Chinese allowed this virus to escape and then arrested doctors raising the alarm over the spread, it would be one of the greatest stories of our lifetime: a world pandemic caused by human error. Millions have been infected and thousands have died. If the cause was negligence by a totalitarian nation (that ignored warnings and punished doctors), this would be a story of the century. Suddenly magazines care saying that they are now thinking about the “unthinkable.” Yet, it was never truly unthinkable was it?

It was only “unthinkable” when it served their purposes to brand it that, as part of their “Trump and the right are racist xenophobes and crazy people” narrative. The evidence must be getting very strong for them to begin to abandon that stance now.

I agree with Turley that “it would be one of the greatest stories of our lifetime” if the escaped-from-lab theory turns out to be true. And I don’t mean “great” as in “wonderful” – I mean “great” as in “enormous, compelling, transformative.” I use the latter word because I believe this entire COVID-19 episode is going to change the standing of China in the world, and already has begun to do so. No wonder China was so keen to cover it up from the start.

“Presumed” COVID-19 deaths in NYC

The New Neo Posted on by

There’s been a sudden hike in the NYC death toll from COVID-19:

The Big Apple’s new death toll is 10,367. That figures combines the 6,589 victims who tested positive for the virus plus another 3,778 who were never tested, but whose death certificates list the cause of death as “COVID-19 or an equivalent,” according to city Health Department data from March 11 through April 13.

A description:

Probable coronavirus deaths were more common than confirmed coronavirus deaths among victims ages 75 and older, according to the city’s Health Department…

More than 90 percent of confirmed COVID-19 deaths happened at city hospitals while about 60 percent of probable coronavirus fatalities occurred in hospitals. The other 40 percent of probable coronavirus victims died at their own homes or in nursing homes.

This is another illustration of the slippery nature of the COVID-19 statistics. Even if people are trying their best to make them accurate (and you may or may not agree that they are trying to do that), it’s challenging. In several recent posts and comment threads (see this as well as this) I’ve pointed out the similarities between COVID-19 and flu in terms of symptoms, mode of death, and ages and types of people who are more likely to die from each disease, as well as the difficulties of testing for flu. So some of these 3,778 home and nursing home deaths may indeed be COVID-19 or they may be flu, or they may be pneumonia from some other cause.

One way to try to ascertain what’s actually going on is to compare this year to last year:

Aside from confirmed and probable COVID-19 deaths, 8,184 people died in the city from March 11 through April 13. During the same period last year there were just 5,167 so the difference could be coronavirus fatalities that neither tested positive nor were designated as COVID-19 victims in their death certificates.

Possibly. Or maybe they are stress-related – we’ve certainly all been under extra stress, haven’t we? Or maybe some of the deaths come from people with other ailments who are shying away from doctors and hospitals out of fear.

Or maybe – maybe it’s the flu:

The current flu season is on track to be one of the worst in years, Director of the National Institute of Allergies and Infectious Diseases Dr. Anthony Fauci told CNN.

CNN reports that Fauci says the 2019-2020 flu season is on track to be as severe as the 2017-2018 season, which was the deadliest in at least a decade.

New data from the CDC released on Friday estimates that so far this season, at least 6.4 million people have caught the flu, 55,000 people have been hospitalized and 2,900 people have died — 800 more people then were estimated the week before.

That was written on January 4th. So any comparisons of deaths between last year – a fairly light flu season – and this year, which was on track to be an extremely heavy one, are not going to tell you much about COVID-19 deaths, because the years are not equivalent.

Then again, maybe that severe and deadly flu year that Fauci noted in early January was actually a result of cases of COVID-19 making early inroads. We wouldn’t have known, since COVID-19 would have not been suspected or able to be detected even if it had been suspected.

I wonder whether we’ll ever know the truth. And you don’t even have to posit some nefarious intent on the part of authorities in order to say that.

I wonder who Nancy Pelosi thought this would appeal to

The New Neo Posted on by

I guess ice cream lovers everywhere. But the “let them eat cake” comparisons are irresistible and inevitable (although you probably won’t see them emanating from the left):

As Nick Arama notes at Red State:

As we reported earlier, House Speaker Nancy Pelosi is bragging about blocking additional funding for the Paycheck Protection Program that’s been saving jobs.

But, no skin off her nose, right? She’s not about to lose her job (well, we can hope, come November, but it is San Francisco so chances are small). What does she care if millions are thrown out of theirs, apparently.

The House beat it out of Washington and wouldn’t be meeting on anything until May 4, “absent an emergency,” says Democrat House Majority Leader Steny Hoyer. Not like we’re in the middle of an emergency and people might need that money to help stay afloat.

Many commenters have pointed out that those two fridges cost a ton of money. But Pelosi has plenty.

She seems to like fridge metaphors. The video reminded me of this quote of hers from ten years ago, speaking of Obamacare:

It’s like the back of the refrigerator. You see all these wires and the rest. All you need to know is, you open the door. The light goes on.

And yes, I’m aware that Marie Antoinette didn’t really say “let them eat cake.” Just shows you how a bad press and fake news can follow you for centuries:

Lady Antonia Fraser, author of a biography of the French queen, believes the quote would have been highly uncharacteristic of Marie-Antoinette, an intelligent woman who donated generously to charitable causes and, despite her own undeniably lavish lifestyle, displayed sensitivity towards the poor population of France.

That aside, what’s even more convincing is the fact that the “Let them eat cake” story had been floating around for years before 1789. It was first told in a slightly different form about Marie-Thérèse, the Spanish princess who married King Louis XIV in 1660. She allegedly suggested that the French people eat “la croûte de pâté” (or the crust of the pâté). Over the next century, several other 18th-century royals were also blamed for the remark, including two aunts of Louis XVI. Most famously, the philosopher Jean-Jacques Rousseau included the pâté story in his “Confessions” in 1766, attributing the words to “a great princess” (probably Marie-Thérèse).

Dean Baquet of the NY Times turns himself into a pretzel trying to explain the paper’s “coverage” of the sexual allegations against Biden

The New Neo Posted on by

See Ace on this.

It’s hard to say whether this is a new low on the part of the Times in recent years (there were even lower lows in the more distant past, such as Duranty), because there’s so much competition. But suffice to say it would be funny if it weren’t so despicable, sad, and serious.

I’m not saying the allegations against Biden are true. I have no idea if they’re true or false, and that’s usually the case with such stories at an early stage and without a trial. But I am very consistent; my attitude is the same no matter what side the accused politician is on. In the case of Biden’s accuser Tara Reade, her allegations are actually more “credible” than those of most such accusers, and certainly far more credible than those of Christine Blasey Ford. Among other things, Reade has a person who says Reade told her the story way back when.

Again, that doesn’t mean Reade is telling the truth. But the utter inconsistency of the Times and its differential treatment of the two sets of allegations (against Biden and Kavanaugh) is glaringly apparent to any thinking person. Unfortunately, Baquet’s utterly weaselly excuses will probably be just fine with a lot of Times readers.

Please read the whole thing.

Obama endorses Biden

The New Neo Posted on by

Big yawn. Of course he does.

The part that made me chuckle in a rather bitter way was this: “I believe Joe has all the qualities we need in a president right now.”

“All the qualities we need.” Those qualities? Willing to do whatever the left wants in carrying on Obama’s “legacy” and taking it to the next leftist level.

Also, somewhat demented.

And presently alive. That counts for something, too.

The rest – the covering-up for China, the sexual allegations that are at least as “credible” as all the others the left got so energized against – well, Obama and company are counting on their buddies in the press to sweep it all under the COVID/badTrump rug.

ADDENDUM:

Now, here’s an endorsement that seems more surprising:

State Rep. Vernon Jones bucked his party Tuesday and endorsed President Donald Trump, making him the first state elected Democratic official in Georgia to back the Republican’s bid for a second term.

The lawmaker drew a backlash from Democrats who accused him of betrayal at a time when state and national figures were rallying around former Vice President Joe Biden. Top House Democrats responded by endorsing Jones’ primary challenger, while others cast him as a narcissist.

Long a polarizing figure in Georgia politics, Jones told The Atlanta Journal-Constitution that he views Trump as a transformative president whose policies have helped African American voters, military veterans and farmers.

“It’s very simple to me. President Trump’s handling of the economy, his support for historically black colleges and his criminal justice initiatives drew me to endorse his campaign,” said Jones, who added that he had no immediate plans to switch parties.

According to the article, Jones has been straddling the line for quite some time and issuing pro-Trump messages. But his district is very left-leaning and only 17% of voters went for Trump in 2016. Predictably, other Georgia Democrats would dearly like to get rid of Jones and are pushing his challenger and saying things like this:

…[Jones] chose to stand with the racist president who has made an all-out assault on black Americans, who has tried to rip away American health care and who has failed our country in its greatest time of need…

“All-out assault on black Americans.” And there’s no need to explain what that even means, because so many people will nod their heads and agree.

Part II: Is this “just a bad flu”? (deaths, ventilators, and estimates)

The New Neo Posted on by

[NOTE: Part I can be found here.]

Flu (otherwise known as influenza) has been around far longer than COVID. Flu comes every year and it kills a lot of people.

So one might think that we know a great deal about flu; for example, that the number of flu deaths per season would be known if not precisely, then at least fairly well, because everyone who has a very serious case would be tested for it. But actually, flu deaths are always estimated, and there are good reasons for that:

First, states are not required to report individual flu illnesses or deaths among people older than 18 years of age to CDC. Second, influenza is infrequently listed on death certificates of people who die from flu-related complications. Third, many flu-related deaths occur one or two weeks after a person’s initial infection, either because the person may develop a secondary bacterial co-infection (such as bacterial pneumonia) or because influenza can aggravate an existing chronic illness (such as congestive heart failure or chronic obstructive pulmonary disease). Also, most people who die from flu-related complications are not tested for flu, or they seek medical care later in their illness when influenza can no longer be detected from respiratory samples. Sensitive influenza tests are only likely to detect influenza if performed within a week after onset of illness. In addition, some commonly used tests to diagnose influenza in clinical settings are not highly sensitive and can provide false negative results (i.e. they misdiagnose flu illness as not being flu.) For these reasons, many flu-related deaths may not be recorded on death certificates. These are some of the reasons that CDC and other public health agencies in the United States and other countries use statistical and mathematical models to estimate the annual number of flu-related deaths.

Flu deaths in children are slightly different though because these are nationally notifiable, which means that individual flu deaths must be reported to the Centers for Disease Control and Prevention. States report flu-related child deaths in the United States through the Influenza Associated Pediatric Mortality Surveillance System. However, even deaths in children may be underreported, for many of the same reasons listed above.

You may have noticed that there are some similar problems with COVID reporting, in particular the aggravation of existing chronic illnesses muddying the waters of cause of death.

All flus are far from equal in their lethality or their symptoms, as I wrote in Part I. But flus tend to have certain basics, and COVID-19 has some resemblances to these basics in terms of symptoms, especially in mild cases – and similarities in the manner in which people die and also the co-morbidities that often help lead to their deaths.

There is very real complexity and difficulty in trying to design a system that can tell us how many flu deaths we have. This isn’t an issue I’d ever thought about prior to the COVID-19 pandemic, and I would guess most of you hadn’t, either. However, I’ve thought about it a lot ever since COVID became a big big deal, because it’s clear that ascribing a death to COVID isn’t a simple matter either. The criteria can vary a great deal, and it’s also tempting to compare the COVID death rate to the flu death rate and try to draw conclusions. And yet both of those rates are hard to pin down.

I also have thought about this topic for personal reasons. Several people with whom I was very close have died (or in the case of one, nearly died) in ways similar to those reported with COVID-19, although their deaths were several years ago.

I’ll tell you the story of one of these friends who died. She was in her mid-60s and had a pre-existing condition but had been doing pretty well for years. Then she got what seemed like a mild flu.

I don’t think she was ever tested for flu; at least, not that I know about. She had some typical flu symptoms but nothing at all major, and was functioning quite well. The suddenly one afternoon, she became confused and was having trouble breathing. He husband immediately took her to the ER that was about three minutes from their home.

She had walked to the car, but by the time they got there three minutes later, she was unable to walk out of the car. That was the detail that seemed particularly vicious and terrifying to me. She was taken (by wheelchair) into the ER, and immediately put into an induced coma and placed on a ventilator. Doctors had determined that she was suffering from ARDS, something I’d never heard of prior to that:

Causes may include sepsis, pancreatitis, trauma, pneumonia, and aspiration. The underlying mechanism involves diffuse injury to cells which form the barrier of the microscopic air sacs of the lungs, surfactant dysfunction, activation of the immune system, and dysfunction of the body’s regulation of blood clotting. In effect, ARDS impairs the lungs’ ability to exchange oxygen and carbon dioxide…

The primary treatment involves mechanical ventilation together with treatments directed at the underlying cause. Ventilation strategies include using low volumes and low pressures. If oxygenation remains insufficient, lung recruitment maneuvers and neuromuscular blockers may be used. If this is insufficient, extracorporeal membrane oxygenation (ECMO) may be an option. The syndrome is associated with a death rate between 35 and 50%.

Globally, ARDS affects more than 3 million people a year.

See that death rate? It’s brutal, absolutely brutal. You also might recognize the similarly of her story to that of the unfortunate COVID-19 victims who wind up on ventilators. The situation is even more puzzling with COVID-19, though, because it’s emerging that although COVID deaths may resemble those like hers, leading from flu to ARDS, COVID-19 might be different in important ways:

In a letter last week in the American Journal of Respiratory and Critical Care Medicine, researchers in Germany and Italy said their Covid-19 patients were unlike any others with acute respiratory distress. Their lungs are relatively elastic (“compliant”), a sign of health “in sharp contrast to expectations for severe ARDS.” Their low blood oxygen might result from things that ventilators don’t fix. Such patients need “the lowest possible [air pressure] and gentle ventilation,” they said, arguing against increasing the pressure even if blood oxygen levels remain low. “We need to be patient.”

I’m not a doctor and don’t have a deep understanding of this issue, but I’m aware that lower pressure is indicated in non-COVID ARDS as well:

Recent studies have shown that high tidal volumes can overstretch alveoli resulting in volutrauma (secondary lung injury). The ARDS Clinical Network, or ARDSNet, completed a clinical trial that showed improved mortality when people with ARDS were ventilated with a tidal volume of 6 ml/kg compared to the traditional 12 ml/kg. Low tidal volumes (Vt) may cause a permitted rise in blood carbon dioxide levels and collapse of alveoli because of their inherent tendency to increase shunting within the lung…

Low tidal volume ventilation was the primary independent variable associated with reduced mortality in the NIH-sponsored ARDSnet trial of tidal volume in ARDS.

More on ventilators and COVID:

To be “more nuanced about who we intubate,” as she suggests, starts with questioning the significance of oxygen saturation levels. Those levels often “look beyond awful,” said Scott Weingart, a critical care physician in New York and host of the “EMCrit” podcast. But many can speak in full sentences, don’t report shortness of breath, and have no signs of the heart or other organ abnormalities that hypoxia can cause.

“The patients in front of me are unlike any I’ve ever seen,” Kyle-Sidell told Medscape about those he cared for in a hard-hit Brooklyn hospital. “They looked a lot more like they had altitude sickness than pneumonia.”

We obviously have a lot to learn, and quickly. And not just about COVID, but about flu as well.

[NOTE: And now we also have people wondering whether some of the spike in flu deaths during late December and January may have been COVID-19 mislabeled as flu.]