COVID 19 Is not as bad as we think and here’s why
I saw this as a comment in a different post and thought I’d share some updated insights. My father is a physician and between his anecdotes of work at the hospital and the perceived mortality rate and case distribution, I’ve developed my own opinions and would love to hear some other thoughts.
To start, I believe the “total COVID deaths” is severely inflated and the amount of COVID cases is largely underreported. For example, the COVID case volume in NYC is reported by the NYT to be more than 1.3 mm. But the number of confirmed cases is only .25mm. Now is the death toll based off of assumed positive or confirmed cases? You guessed it, assumed positive cases. And this is because hospitals are incentivized to report any patient with COVID symptoms (which are generic symptoms of the common cold and the flu) as COVID-19. The hospital receives a greater DRG payment for COVID-19 than they would for someone with the same symptoms but that is negative. And while testing is not readily available everywhere, they just mark that they assume they are positive so they can collect that check. So that makes me believe that the actual amount of “severe COVID” cases and deaths are far less than we are seeing.
The actual case volume is probably much higher given that 60% to 80% of us who have it are asymptomatic / don’t show enough symptoms to warrant a hospital visit. So if we assume that of the confirmed cases, that only accounts for 20% - 40% then the actual case volume in the US expands to 3.42mm - 6.85mm confirmed (that’s calculated at confirmed volume of 1.37mm divided by 40% and 20%, respectively.) And with 82000 assumed deaths, we can calculate that only 20% of those (extrapolated from NY confirmed case divided by NY assumed case) are actually COVID confirmed. This drops the death rate to .239% -.479% (16,400 / 3.42 mm or 16,400 / 6.85mm). For comparison the infection-mortality rate of the seasonal flu is 0.1%.
Now you may say, “Twizz, bro this is a bunch of hocus pocus.” You numbers don’t make sense. But wait there’s more. What if I told you that the number of deaths attributable to COVID could be EVEN lower? Here is where the anecdotal portion comes in. Since the outbreak, his hospitals (he works in 4) have seen a DRAMATIC decline in case volume for other diseases. Not to mention, no one in the US is dying of anything different. It appears as though COVID-19 has cured cancer, heart disease, chronic respiratory illness, strokes, diabetes, and nephritis! They just aren’t killing people anymore, it’s COVID-19. But really we can thank that hefty DRG that incentivizes COVID to be the left lead killer.
So, I ask... if I had stage 4 lung cancer or coronary artery disease and I contract a case of COVID-19.. what killed me? The underlying death sentence I already had, or a Chinese disease that may be slightly more severe than the seasonal flu?
I am by no means making claims that we should open anything or put people at risk as that’s not the point of this post (though I have my opinions).
TLDR; I am merely speaking to the point I think the deaths are over reported, the cases under reported, and therefore the infection mortality rate is far less than televised.
COVID-19 hot take threads are now spreading as fast as the actual virus.
People are tired of being cooped up!
That shouldn't impact their ability to post responses in relevant threads that already exist instead of creating yet another new COVID-19 thread.
did anyone do a covid test? does it hurt?
I would say the opposite might be true due to the lack of testing available and how people who die in their homes due to the virus may not get included in the count.
Interesting point. Im not privy to any information about at home deaths. I was under the impression that anyone who was severe enough to die would more than likely be at the hospital. Especially in places that are not NYC. But thank you for the comment!
also I don’t see why those deaths wouldn’t be reported. If someone dies at home they will probably get medical attention and at least code them as assumed COVID
Well, I am just parroting the comment of a physician who seemed to be knowledgeable.
Because the US healthcare system is complete shit. It literally doesn't have the capacity to take care of everyone.
Huge shortage and other supply side issues have been the case for decades before COVID. This is the main reason why healthcare is so expensive in the US.
Not enough personnel, not enough equipment, not enough drugs, not enough everything.
EDIT: Why is this getting so much MS? It literally comes down to basic economics if you look at the facts. I'm not pulling this out of my ass... If you don't believe me, I can provide a litany of facts and resources.
Clearly explains (although some extraneous details) how the US healthcare got so expensive as a result of decades worth of mismanaged regulations that restricted the supply side increase while letting the demand increase (aka skyrocketing healthcare cost).
https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of…
Facts 10 & 11 clearly discusses high cost incurred by healthcare providers + restricted supply of doctor, which, if we all remember our basic microecon, should mean the price goes up.
https://data.oecd.org/healthres/medical-graduates.htm
You can clearly see that the US has one of the lowest rate of medical graduates per capita out of the OECD.
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-1…
In the light of COVID, FDA is temporarily curbing down on its restrictions when it comes to medical devices to increase the supply. The FDA has been restricting medical supply for decades, a lot more stricter than most countries.
It's incredibly likely that the COVID mortality rate is inflated.
What's dangerous about COVID is that there's no immunity, and it's much more contagious than the flu. In a world of open travel and no social distancing, this means way WAY more people are going to contract it and a lot faster. If we go with a flu mortality rate of about 0.1% (high), and we assume 49 million people get the flu (close to max according to CDC), you have 49,000 deaths in a year. Now that's terrible and a lot, so you should definitely get your flu shot and wash your hands.
But let's say we have the same mortality rate of 0.1% for COVID, but 328 million people contract it over the course of 6 months. Now you've got almost 7 times as many deaths at 328,000 and even drastically more hospitalizations, all in a shorter span of time.
Now consider that the mortality rate is probably actually 0.4% like you said, and all of a sudden COVID is the leading cause of death in the United States at 1.3 million deaths, not to mention the severely overwhelmed hospital system. It's easy to see a 0.2% or 0.4% mortality rate and say that it's not "as bad" as we thought, but I bet if you asked any nurse or doctor in NYC, Wuhan, or Rome they'd disagree.
what are you talking about? the majority of information out there indicates that there is immunity to COVID-19 (once whoever had it recovers and creates anti bodies)
Where? I have only seen the opposite. A vaccine will not work against this COVID virus. That’s why we have never had a vaccine for SARS or MERS
Sorry, I wasn't super clear. I meant nobody has any immunity before they are infected (unlike the flu which has a vaccine).
On second thought, my estimates are still kind of off because I didn't really account for herd immunity, so the number of people who get infected probably won't actually be the entire US, but it would still be way more than the flu. My main point is still that COVID stands to kill way more people than the flu regardless of the mortality rate.
It sort of would make sense that hospitals in the south only have a handful of cases–that was the goal of the shut down. However, depending on testing and tracking capabilities, I'm also open to less dense areas starting to open up. I just worry that a lot of people say "the mortality rate isn't that different from the flu" and think that means they don't need to worry and this was all for nothing. It doesn't seem like that's what you're trying to do, but a lot of people can easily misinterpret statements like that.
People who are immune can still contract the virus. And they aren't gonna be included in the mortality rate so the numbers above still hold.
Some people will always have immunity. That's just how diseases work. It's an evolutionary game. Disease wipes out certain portion of population, the ones who are immune survive. Disease evolves and the whole thing starts again.
If you think about it, a third of Europe didn't have immunity to the Black Plague. And that's the number of people who died. Much higher mortality rate there but still, 0.1~0.4% is a lot.
If you look at the numbers for the top CODs in the US (excluding accidents and self inflicted harm) the deaths from COVID would be near that of the sum of the COVID comorbidities. Like I said earlier, from what I’ve heard hospitals aren’t seeing people dying from cardiac disease, cancer, strokes, chronic respiratory illness, etc. They are just saying COVID. So if we use your numbers then the people who die from COVID will likely be made up almost entirely of people who were likely to die from comorbid diseases.
Im be no means saying open everything up, because I believe you are right in that it would overwhelm the hospitals. But I think COVID is getting too much credit for actually killing people. It’s just not good news for people with already limited life expectancy.
And the reason places like NYC, Rome, Wuhan, etc is bad is because they have such a high population density. The hospitals in the south (where I live at least) are pretty empty. They have a handful of COVID patients and the rest of the hospital is just waiting for an influx of cases that has yet to come. No one is doing elective surgery, no one is coming in for anything. So realistically, dense areas should reopen very very slowly and aspire to reach herd immunity over time and minimize the deaths by keeping hospitals at capacity but no overwhelmed. But for pets if the country that aren’t cramming millions of people into a small space they could probably reopen with precautions imo
Do you have a source that says none of those deaths are really being reported? And if those people are actually testing positive for COVID along with co-morbid conditions, isn't it likely that COVID is aggravating the preexisting conditions people have? And if those are really the underlying conditions that are killing people, then why has there been such an enormous uptick in deaths and hospitalizations?
It seems like you're saying that COVID is generally just expediting death for people with underlying conditions. If they wouldn't have died without being infected with COVID, isn't it still worth it to try to prevent them from getting infected? I honestly don't understand the point you're trying to make with that. Regardless of who is vulnerable, the fact that COVID is so infectious means it will reach way more vulnerable people than other diseases, so there's little point in comparing the mortality rates.
All that being said, I think we're generally on the same page about re-opening, but maybe my idea of precautions is different than yours haha
I have heard reports that hospitals get paid per patient if the cause of death is COVID, and that physicians are pressured/encouraged to list that on death certificates.
I don't think we will have a good answer to these questions for a few years after it's all audited by various constituencies...
Yes! The DRG payment for COVID is quite the incentive
You are right with the underreporting of cases. The actual case numbers may be much higher (and in consequence the death rate far lower). You are wrong in everything else.
You take a very US-centric opinion. Frankly, results from many different countries with many different health systems largely agree on a few things. One is that roughly 10% of detected (!) cases die. Even if there are financial incentives in the US, there are plenty of other samples that falsify your statement.
Further, it is unlikely that other deaths are going down. There have been several studies (including ones featured in the Economist) that deaths attributable to related diseases (such as the flu) are far higher this year than the years before. This suggests we are falsely attributing covid deaths to other diseases.
I agree with you. It is likely that the death rate is still lower than officially stated. But that is because of underreported cases, not overreported deaths.
I don’t know man. I’m just speaking from what I’ve seen first hand and through second hand anecdotes. I mean the whole nomenclature has changed with COVID. Right now it’s “This guy died of COVID.” With the flu it’s, “Dude died of complications from flu with stage 4 cancer.” And that gets reported as cancer not flu.
I mean. Thats because of how the diseases work. Most people who die from covid die because of suffocation which can be interpreted as a direct consequence of the disease. Most people who die from the flu die because of something known as a cytokine storm, which is more the reaction of a weakened immune system to a disease then the disease itself. That's why flu deaths are often referred to as deaths from complications. Also. I can guarantee you that other countries refer to flu deaths as just flu deaths. Where I'm from you'd never hear "death from flu complications".
Look, I'm not saying news outlets are always to be trusted. They have their own incentives. But can we at least trust the experts who are literally dedicating their life to fighting and preventing outbreaks like these?
https://www.nytimes.com/interactive/2020/04/28/us/coronavirus-death-tol…
I'd disagree that there's an overcounting problem. Check out these graphs of total deaths in major coronavirus hotstops – New York has ~5 times more deaths than usual over the past month.
NYC also has a much greater population density.
Not really sure how that's relevant, just trying to say that looking at overall mortality, a lot more people have been dying recently than we would expect, so its not the case that COVID is just being called the cause of death for a bunch of folks who were going to die anyway.
First of all, your analysis has the statistical rigor of a college freshman who just learned about linear regression trying to estimate the number of girls he'll hook up with given the number of girls you he hooked up with in high school.
Second, sick people without COVID aren't being disguised as COVID patients. This is just a shit argument for several reasons.
1) People sick with illness other than COVID aren't in the hospitals anymore. The US healthcare system has had a huge supply-side issue (shortage) in almost every aspect even before COVID - not enough hospitals, not enough doctors, not enough drugs, not enough medical equipment, etc... (Why do you think healthcare is so expensive in the US?)
Lots of people just aren't going to hospitals - they fear they might contract COVID; they know hospitals are overwhelmed and are afraid that might lead to malpractice in Non-COVID patients. Some are just told to go elsewhere because the hospitals are at full capacity.
People are still sick and still dying. We just don't have enough room for sick people without COVID.
2) Cancer vs. COVID - what killed me? This is just farcical. Seriously, how many cases like this do you think we have? Negligible amount. The probability of contracting two fatal diseases is low. Comparing patients with serious diseases and regular people, the probability of contracting COVID isn't particularly high. In fact, the probability should be much lower for people who are already receiving medical care. If it wasn't, then the US healthcare is far worse than we think - that's some 3rd world country type of shit.
By the law of large numbers, this low probability means that number of fatally ill people contracting COVID and then dying should be absolutely minimal. If it ever happened more than once at any hospital, that's just medical malpractice and any hospital that let it happen is begging for a lawsuit.
3) There is no fucking way that patients gets classified as a COVID patient without being tested. Again, this is just medical malpractice and a lawsuit waiting to happen. Doctors have an oath you know (and this thing called a medical license). No one's risking their license over this shit.
Everything you said is literally “no way” but you don’t back it up. Look up NYC case volume and youll see like 1.3 mm. Look up NYC confirmed cases and it drops to .25mm. Sure some of those are probably true cases. Others are not. They just assume you are positive for the safety aspect and if you die they won’t waste a test on you. They will just say he was probably COVID so let’s get the DRG payment for COVID. I can find sources to back up almost everything I’ve said.
So while my argument has some factual basis, yours is solely your thoughts and opinions.
Also I’ve sat in on a few hospital “COVID task force meetings” and can say with certainty that the practice is “to code assumed-positive patients as COVID positive.” They are taking precautions for the doctor’s safety because the physicians life is far more valuable and useful than any one patient.
So lmao stop talking out your ass
That response was so quick and incomprehensive that I doubt you read anything past my 3rd sentence.
1) Bulk of your argument was about "why aren't there lower number of cases for other illnesses". And I explained to you the primary reason is not because those people are being misdiagnosed as COVID but because they aren't showing up to the hospital in the first place. https://www.boston.com/news/health/2020/03/30/massachusetts-coronavirus… https://www.cnbc.com/2020/04/14/doctors-worry-the-coronavirus-is-keepin… https://texasscorecard.com/state/emergency-rooms-hospitals-report-decli… https://abc13.com/covid-19-coronavirus-hospitals-in-texas/6125309/
All these 3 articles describe the exact same phenomenon at very different places in the US. Number of non-COVID related ER visits and general visits are are decreasing (30~50% according to these sources) significantly. And this enough to suspect that a similar thing might be happening throughout the country.
2) You seem to be suggesting that the reason why COVID deaths are inflated is because "people who are dying are all gonna be classified as COVID deaths". I mean you're literally talking about "how cancer, strokes, heart disease, diabetes,etc... seem to be killing less people and how convenient it is that DRG incentivizes COVID to be the lead killer".
I'm simply attacking your assumption. Like I said, I don't think doctors aren't incentivized to classify "any" death as COVID death like you seem to be suggesting. And neither does it seem likely that many deaths were related to patients who had both COVID and other fatal diseases, because the number of such patients would've been negligible. I provided (what I think is a fairly reasonable) a probabilistic framework to support my rebuttal.
Your argument would've been stronger if you just said that deaths from similar lower respiratory diseases that's not COVID might be getting classified as COVID deaths. Now that'd be a good assumption to make.
But, it seriously looks like you're saying "All or lots of fatal diseases are being classified COVID". Hey, you brought up the whole coronary artery disease and diabetes talk not me... Even if a patient has symptoms that look like COVID, wouldn't they test for other diseases first? I think that's a fair enough assumption.
The whole "Statistical rigor" thing was about the assumptions you're making to deduce your conclusions. And I think your assumptions aren't very well thought out.
If you want to disagree, make sure to actually attack my points. Don't go around making claims that are tangential to what I was talking about.
Last but not the least, leave the inferential modeling work to us data scientists and statisticians.
https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6919e5-H.pdf
So if this is the case, why did 24,000 more people die than expected in NYC these last 2 months?
Also your story is retarded because like all conspiracies, it relies on literally thousands, if not tens of thousands of doctors, nurses, and hospital staff to keep their mouths shut about false coding. You don’t think there are plenty of right wing doctors or nurses who would be on Fox News daily talking about how things are being falsified by the libtards if what you’re saying is true?
Measuring the severity of the disease by reported CVD-19 deaths is probably a fool's errand. It's too complicated. There are probably people dying from it without being recorded, and others who never got it but were presumed positive at their deaths. And the question of "dying of" versus "dying with" gets extremely complex when you start to think about it.
The best way to measure the effect of the virus will be to look back in several years and measure the increase in total mortality over an extended period. The period should capture the epidemic and some time (say a year) afterwards. Multiple things could happen:
There is no increase in mortality- i.e. the number of people who died of (not with) CVD-19 is not that high, and many whose deaths were attributed to the virus didn't even have it.
There's an increase in mortality during the height of the epidemic, and then a dip afterwards. That would imply that the virus mostly accelerated the deaths of people who didn't have long to live.
There's an increase in mortality during the height of the epidemic, and then not much of a decline afterwards. That would imply that the virus killed a bunch of people who would have lived substantially longer otherwise.
Complicating factors: the shutdowns are probably saving some lives (Expect a dip in annual traffic fatalities, for instance) and ending others (people avoiding the healthcare system and missing cancer screenings, etc.) Need to control for those to the extent possible.
That was interesting to read, thank you. And I’m sure that that type of analysis will occur once we’ve moved past this
Lmao it’s not a conspiracy theory. Im just saying what I’ve seen and if I extrapolate from my experiences then I tell how it applies to the whole situation.
Also it’s not that political. The doctors and nurses don’t get paid for it the hospital does. The doctors and nurses take precautions for their own safety by coding them as assumed positive. And if they assume they are positive then the hospital gets paid for it and they are being conservative with the amount of cases they have. So from a medical standpoint they can’t just not do it. It’s not safe for them and it’s not protocol.
And to your other point, I’m not a doctor. I am parroting anecdotes from many physicians that I’m acquainted with. So there are people speaking out. Fox news would not say anything about this for the same reason you all hate it. There isn’t enough hard data to back it up. It’s anecdotal. They would catch shit trying sell this story. The dems are incentivized to have this whole situation last until November and to blow it out of proportion. If they can convince people the Trump economy never existed and this was a market correction, they can get Creepy Uncle Joe in office, Where he will inevitably resign as he admits he’s unfit (probably has dementia or alzheimer’s) and will give up his office to a VP that the DNC really wants in the office but could never make it across the finish line running by themselves.
Guys stop arguing with this guy. There's no point. He is a Trump supporter.
Trump learned about this virus in Jan and did jack shit about it except stopping flight to and from China. That was SO effective. Instead of building hospital capacity, expanding contact tracing capabilities, and storing PPE, Trump did literately nothing. Nothing at all. States have been dealing with this themselves. This country deserved better when dealing with this unprecedented public health crisis.
I wish you and your family well. I am sure nobody in your family has underlying health conditions and will be asymptomatic when exposed. Good luck.
Hahaha what did you want him to do? How could we have expanded hospital capacity when the vast majority of hospitals are privately owned? How can we store PPE when China was buying all of the PPE back in November and December when they first learned about? How would we expand contact tracing capabilities when we didnt have exposure to the virus?
What’s the best way to deal with something unprecedented like this? To react. If you are familiar with the idea of Black Swan events that’s all you can do. React.
Also he gave power to the governors to let them be flexible in how they deal with it because you’re a fool if you think one standard policy across the board would solve this or even make it better. Some states are barely infected, some are getting rocked. That’s the idea of decentralization, let the states choose what’s best for them.
I don’t love Trump but I agree with how he’s handled it. I also think he’s done a better job than Obama or Hillary would have. But of course since you’ve declared me a “Trump supporter” everything I say must be wrong.
Do I even want to know what you agree with...?
So this guy handled it well? You agree with the handling?
The states and federal government built quite a bit of overflow hospital capacity, and it went almost entirely unused, even in NYC.
Yes, the hospitals down here are pretty damn empty
The states and federal government built quite a bit of overflow hospital capacity, and it went almost entirely unused, even in NYC.
Herd immunity would be reached by the 50-60% mark. In a broad spread scenario, people's actions would be altered (those at risk would stay home) so the 50-60% would be concentrated in the young.
More realistic would be (and you can google and corroborate this with latest research) ~0.4% * 120m = 500k deaths in line with smoking. And median age of death is 80 (global and us average, pls google to confirm) so we're losing what? 5 years of life span per person?
I don't think the level of cost the US is incurring makes sense. We're incurring at least 4 trillion in cost (5% output loss median estimate for 2020 + increased gov debt to prevent further output loss of 3tr+) = 4-5tr.
So we are spending 10m per life to save 80 year olds. I don't mean to sound harsh but that doesn't make any sense. If that made sense it would be economically sensible to pay every american 1 grand cash to take the flu vaccine. (40k flu deaths * 10m/life = 400bn). That's a cost of 330bn and you "save" 300-400bn in lives not lost (in reality u only need to vaccinate maybe 70-80% of country b4 herd immunity prevents vast majority of flu deaths).
Is anyone seriously advocating paying 1k to everyone to take a flu shot? What about cigs? We could pay every american 5k PER YEAR to stop smoking at a cost of 1.5 tr per annum. If it's worth spending 10m/life you'd still "make" money putting a dent in the 500k/per year that die from smoking. You could give every american 5k/yr to not smoke and breakeven if only 150k fewer people died per annum. Is anyone seriously supporting this?
Where is the logical consistency? Nowhere.
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