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Thread: Disease and pandemics thread (because it's science)

  1. #2341
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    There are claims on “social media” that COVID-19 is listed as the only cause in just only 6% of COVID-19-related deaths.
    The reason for pointing this out (if true) probably belongs in a different thread or board.


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  2. #2342
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    Quote Originally Posted by Extravoice View Post
    There are claims on “social media” that COVID-19 is listed as the only cause in just only 6% of COVID-19-related deaths.
    The reason for pointing this out (if true) probably belongs in a different thread or board.
    Seems about right. Death certification documentation varies from country to country, as does reporting, but the corresponding figure in England & Wales for Covid-related deaths in March and April was about 10%. (UK Office of National Statistics).
    To give an idea of how complicated this is to actually interpret, take a look at the doctor's guidance on completing the UK death certificate. In someone who is severely ill, who dies shortly after coming into hospital, even the causal chain of disease processes can be difficult to define, and the contribution (or otherwise) of contributing conditions is largely based on guesswork and gut feeling.

    Grant Hutchison

  3. #2343
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    It's a political effort to downplay the seriousness of the virus; more we cannot discuss here.
    Cum catapultae proscriptae erunt tum soli proscript catapultas habebunt.

  4. #2344
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    Quote Originally Posted by Trebuchet View Post
    It's a political effort to downplay the seriousness of the virus...
    Of course it is. Everyone who tells you any number has an agenda.

    There's a spectrum of ways in which people use "number theatre" in order to pursue their own agendas:
    Giving numbers with no basis in reality
    Giving real-world numbers out of context
    Giving real-world numbers without quoting the spread of possible values
    Giving real-world numbers without appropriate comparisons to other relevant real-world numbers
    Giving real-world numbers in a way that correctly reflects their importance

    So I'd say that recognizing that there's a political agenda behind the numbers is the start of the process, not the end. We should always ask ourselves, "Why am I being told this number, and not some other number?"
    In this case, the number itself seems to me to be about the right order of magnitude, given UK experience and the uncertainty surrounding death certification. Beyond that, it's a pretty meaningless figure without good demographic context and appropriate comparison with other infectious diseases.

    Grant Hutchison

  5. #2345
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    Unsure footing here, folks. Nothing over the line quite yet (or maybe a little) but have a care. I'll also mention that making comments of a political nature, then saying we shouldn't talk about that is...silly...to put it mildly.
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  6. #2346
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    Quote Originally Posted by grant hutchison View Post
    Of course it is. Everyone who tells you any number has an agenda.
    I don't, I'm old-fashioned, so I have an agendum.
    A: "Things that are equal to the same are equal to each other"
    B: "The two sides of this triangle are things that are equal to the same"
    C: "If A and B are true, Z must be true"
    D: "If A and B and C are true, Z must be true"
    E: "If A and B and C and D are true, Z must be true"

    Therefore, Z: "The two sides of this triangle are equal to each other"

  7. #2347
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    In a nice bit of synchronicity, pretty much exactly as I was posting my previous remark, David Spiegelhalter (a statistician who is Chair of the Winton Centre for Risk and Evidence Communication at Cambridge University) posted the following in a newspaper article:
    Numbers may not measure what you think they may be measuring, but they are rarely completely wrong.
    If I'd seen it earlier, I could have saved myself a lot of typing and just quoted Spiegelhalter instead. The point is that we really need to try to ignore the agenda of the person quoting the number, and set ourselves the task of working out what the number really means.

    (I won't link to the article, since while it is not particularly political, it does contain comments about politicians.)

    Grant Hutchison

  8. #2348
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    Quote Originally Posted by Extravoice View Post
    There are claims on “social media” that COVID-19 is listed as the only cause in just only 6% of COVID-19-related deaths.
    The reason for pointing this out (if true) probably belongs in a different thread or board.
    This is actually something I was wondering about, and perhaps Grant has some comment about this. There is a lot of talk about "comorbidities" (I was kind of wondering if Publiuser was asking about complications or co-morbidities in post 2339, but anyway. The question I have is, it is said that some conditions are associated with more serious disease, for example obesity, high blood pressure, diabetes. Now what I wonder is, is, does anyone know whether this is a cause-and-effect, or just an association, in the sense that those conditions are indicative of poor health status in general. For example, older people tend to have higher rates of diabetes, and also have weaker immune systems. Or is it really complicated to unravel them (for example, diabetes can weaken the immune system, I am sure).
    As above, so below

  9. #2349
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    Teasing out the direct effect of comorbidities requires a statistical analysis that controls for potential confounding factors, like age. So the list of comorbid risks for Covid-19 severity reflects independent risk from these conditions. So diabetes independently increases your risk, in addition to its association with cardiovascular disease, which also increases your risk.
    The list actually isn't surprising--it's just a list of disease states that we know pretty much always reduce your chance of surviving serious illness. The surprise would have been if obesity and heart disease didn't affect mortality. Smoking (and its apparent protective effect) remains the one outlier, though the messages are now becoming more mixed, and we have a clear mechanism (ACE2 interactions) by which smoking might have a paradoxically protective component to its effects.

    (One thing we do know is that the whole "would have died soon anyway" argument about co-morbidity and Covid-19 deaths is a) epidemiologically unsound and b) ethically repellent.)

    Grant Hutchison

  10. #2350
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    The 6% figure that people seem to be getting so exercised about comes from the CDC weekly update, by that way. So essentially the same data gathering process as the UK Office of National Statistics figure I quoted earlier.

    Grant Hutchison

  11. #2351
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    Quote Originally Posted by grant hutchison View Post
    The 6% figure that people seem to be getting so exercised about comes from the CDC weekly update, by that way. So essentially the same data gathering process as the UK Office of National Statistics figure I quoted earlier.

    Grant Hutchison
    As far as I am concerned, this just means that the corona virus accelerated the death of these people with preexisting conditions by a lot. Still a tragedy and this was known from the beginning. No conspiracy here.
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  12. #2352
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    Quote Originally Posted by Copernicus View Post
    As far as I am concerned, this just means that the corona virus accelerated the death of these people with preexisting conditions by a lot. Still a tragedy and this was known from the beginning. No conspiracy here.
    That’s technically true of anyone that succumbs to the disease. Everyone has preexisting conditions, even if it is just “subject to aging” but a good percentage who have died from the virus could have likely lived for decades longer.

    "The problem with quotes on the Internet is that it is hard to verify their authenticity." — Abraham Lincoln

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  13. #2353
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    I think all the questions about news and online non-science claims might be better asked on the OTB Covid thread.
    "I'm planning to live forever. So far, that's working perfectly." Steven Wright

  14. #2354
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    But now that we know where the figure comes from and what it means, a whole other issue is evident. It's always unusual for people to die with only one cause listed on their death certificate, even if they had no pre-existing health conditions, and especially if they spend time in hospital with people trying to keep them alive. Multiple things start to go wrong, and multiple things eventually lead to death. And looking at the CDC's list, it's evident that several of the "other conditions" in their table are "stuff that happens after you develop Covid-19", not necessarily (or at all) "stuff that makes you susceptible to Covid-19".
    So we have:
    Influenza and pneumonia (the CDC lumps these together for reporting purposes, but secondary bacterial pneumonia is a common adjunct of viral pneumonias like Covid)
    Adult respiratory distress syndrome (an inflammatory condition of the lungs associated with sepsis)
    Respiratory failure and respiratory arrest (well, yeah)
    Cardiac arrest, cardiac arrythmia, cardiac failure (commonly associated with hypoxia, sepsis and inflammation)
    Sepsis (again, a common complication of viral pneumonia especially if you spend time on a ventilator)
    Renal failure (it's what happens to hypoxic people with sepsis and cardiac failure)

    I haven't gone through the list and added up the numbers, but a very significant chunk of what people are blindly assuming to be "pre-existing health conditions" are nothing of the sort--they're the ways sick people die.

    I'm sorry to keep going on about this, but it's yet another example of why we need to read the original sources, and not just assume that a number means what someone wants to tell us it means.

    Grant Hutchison

  15. #2355
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    Quote Originally Posted by grant hutchison View Post
    Teasing out the direct effect of comorbidities requires a statistical analysis that controls for potential confounding factors, like age.
    Yes, hopefully that is done. I'm not sure it always is, however. I saw an article in a Japanese tabloid yesterday (didn't read the article, just the headline), that said, "bald people at high risk of dying from COVID-19." Without reading, my suspicion is, risk is higher for men, risk is higher for older people, therefore... I kind of doubt that anybody did a study comparing elderly bald men with elderly non-bald men.
    As above, so below

  16. #2356
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    Quote Originally Posted by Jens View Post
    Yes, hopefully that is done. I'm not sure it always is, however. I saw an article in a Japanese tabloid yesterday (didn't read the article, just the headline), that said, "bald people at high risk of dying from COVID-19." Without reading, my suspicion is, risk is higher for men, risk is higher for older people, therefore... I kind of doubt that anybody did a study comparing elderly bald men with elderly non-bald men.
    Well, that's another demonstration that it's important to read the relevant reports, rather than tabloid headlines, I'm afraid.
    That headline was presumably based on reports that started with two "Letters to the Editor" in dermatology journals, which are essentially short case series submitted as "hypothesis forming" reports--male-pattern baldness is linked to androgen levels, it's been suggested that higher androgen levels might have something to do with Covid-19 susceptibility, and here's an observation that male-pattern baldness seems to be surprisingly common in a small group of people admitted to hospital with Covid-19. End of story.
    The first report is here; the follow-up letter by the same authors is here. The second makes a very slight effort to age-match controls. Neither pretends to be anything but an interesting observation. But these are exactly the sort of just-beyond-anecdote accounts that have led to important discoveries in the past - the link between cancer and smoking, the link between oestrogen contraceptives and blood clotting; we got our first inklings of these from very similar little "here's an interesting thing" letters to medical journals. No epidemiological hypothesis has ever been initially tested by a large multicentre well-controlled clinical cohort, for obvious reasons. There have been a couple of subsequent, similar observational reports from other centres, which are probably the trigger for the newspaper report you saw.
    So this is just a tiny little flicker of information that may or may not be important, but is the sort of thing that makes many doctors turn to the letters page of their journals before they start wading through the research papers. Until we got into our present idiotic situation, they went unremarked by tabloid journalists, and the world was a happier and less misinformed place as a result.

    Grant Hutchison
    Last edited by grant hutchison; 2020-Sep-02 at 01:41 AM.

  17. #2357
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    Quote Originally Posted by Van Rijn View Post
    That’s technically true of anyone that succumbs to the disease. Everyone has preexisting conditions, even if it is just “subject to aging” but a good percentage who have died from the virus could have likely lived for decades longer.
    Definitely some could have lived 4 decades longer.
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  18. #2358
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    The measure of interest here is Years of Life Lost (YLL), which is estimated from death certificate information and actuarial tables. So you take the age, sex and burden of long-term conditions (LTCs), and produce an estimate of how long each person dying of Covid-19 might have lived.
    There's a first draft of that here:
    Using the standard WHO life tables, YLL per COVID-19 death was 14 for men and 12 for women. After adjustment for number and type of LTCs, the mean YLL was slightly lower, but remained high (13 and 11 years for men and women, respectively). The number and type of LTCs led to wide variability in the estimated YLL at a given age (e.g. at ≥80 years, YLL was >10 years for people with 0 LTCs, and <3 years for people with ≥6).
    The main problem with this is that we don't have a measure of the duration or severity of the long-term conditions with which each person died. Emphysema, for instance, could be mild and non-progressive, or severe and life-threatening. So I'd guess these are likely to be upper bounds rather than central estimates.
    Our analysis is novel in that it adjusts YLL for the number and type of underlying LTCs. This is important as people with underlying multimorbidity are recognised to be more vulnerable to COVID-19. However, although we had data for eleven common and important LTCs, we did not have markers of underlying disease severity among those who died. Severity of the underlying LTC has considerable impact on life expectancy. Moreover, we had no data for rarer severe LTCs, which may nonetheless be common among those who die from COVID-19 at younger ages. As such, the attenuation of YLL following adjustment for LTCs may be an underestimate. However, we think that this effect is unlikely to be substantial enough to reduce YLL to the orders of magnitude suggested by some commentators. Indeed, on stratifying by age and multimorbidity counts, we rarely found average YLLs of below three. Also, we were not able to adjust our estimates for other factors and exposures (such as socioeconomic status, occupation, smoking, health behaviours) which would have given a more accurate representation of life-expectancy in the absence of COVID-19.
    Grant Hutchison

  19. #2359
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    This looks interesting :

    A Supercomputer Analyzed Covid-19 — and an Interesting New Theory Has Emerged
    A closer look at the Bradykinin hypothesis


    The renin–angiotensin system (RAS) controls many aspects of the circulatory system, including the body’s levels of a chemical called bradykinin, which normally helps to regulate blood pressure. According to the team’s analysis, when the virus tweaks the RAS, it causes the body’s mechanisms for regulating bradykinin to go haywire. Bradykinin receptors are resensitized, and the body also stops effectively breaking down bradykinin. (ACE normally degrades bradykinin, but when the virus downregulates it, it can’t do this as effectively.)
    The end result, the researchers say, is to release a bradykinin storm — a massive, runaway buildup of bradykinin in the body. According to the bradykinin hypothesis, it’s this storm that is ultimately responsible for many of Covid-19’s deadly effects.
    I've not seen this mentioned here before, so apologies if I've missed it.

    It appears that the peer reviewed paper is available here.

  20. #2360
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    Not wishing to put a damper on things, but ...
    People have actually been discussing the role of bradykinin in severe Covid-19 more or less from the start of the pandemic. Here's a Rapid Response in the British Medical Journal back in January, for instance.
    Hence, we suggest that bradykinin antagonism may be an area for future therapeutics for COVID-19 infection.
    More recently, a tiny case-control series of a bradykinin antagonist produced encouraging results, and I'm sure larger clinical trials will start reporting soon.

    So I guess it's not clear to me why we needed a supercomputer to churn through a massive genetic database, when a bit of clinical acumen and some physiological knowledge had already pointed clinicians in the right direction. Sledgehammer, meet pre-cracked nut.

    Grant Hutchison
    Last edited by grant hutchison; 2020-Sep-05 at 06:35 PM.

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    Quote Originally Posted by Jens View Post
    I have no idea where that came from...9,700 people out of what? Out of total COVID deaths worldwide, which is like 850,000? That would be like one out of a thousand people.
    Probably from folks playing the risk down (radio).
    My thinking is that those cases should be studied to see what they have in common...a supercomputer might not have seen anything novel this time...but it could later.

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    Quote Originally Posted by publiusr View Post
    Probably from folks playing the risk down (radio).
    My thinking is that those cases should be studied to see what they have in common...a supercomputer might not have seen anything novel this time...but it could later.
    I think that you should probably go back and carefully read Grant's good post, #2354, which explains it better than I can. I think that you simply can't read much into that figure. Apparently it is just what doctors write on the death certificate. So for example, if a person is diagnosed with COVID-19, but doesn't have symptoms, and they are sent home, and then the next morning they are found dead by a family member, then the doctor might simply write COVID-19 as the cause of death. But if the person is in the hospital, the doctor might write "cardiac arrest" along with "COVID-19," and so that gets into the figures. And if the doctor has asked the person about other conditions and the person mentioned high blood pressure, then the doctor might write that in the death certificate as a contributing factor. So it is really a question of how doctors write the reports. And it appears that is of total deaths in the US, as it is from the CDC.
    As above, so below

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    Yes, I think the only remarkable thing about this number is the way in which it is being portrayed as remarkable.

    But we've been on that treadmill for months. Remember back in March, when a whole bunch of pretty standard aspects of respiratory virus transmission and infection were being reported as if they were demonic properties unique to Covid-19?

    Grant Hutchison

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    What are the chances that people who are shedding damaged and dead virus are actually vaccinating the rest of us? It just doesn't make sense how few people have been infected.
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    Quote Originally Posted by Copernicus View Post
    What are the chances that people who are shedding damaged and dead virus are actually vaccinating the rest of us? It just doesn't make sense how few people have been infected.
    The problem is, the second sentence doesn't necessarily follow from the first.

    I think the answer to the first question is that, yes, they are. Because we know there are asymptomatic cases. And essentially, the people without symptoms are being vaccinated. But they can still spread the virus to other people while they are infected.

    But regarding the second sentence, the "vaccination" is clearly why there are few cases, because the number of cases per population varies widely between places. In some places it has been very low, and in others not so low. So I think that clearly the number of cases being low related to measures taken to prevent the transmission, like tracking and isolation of cases, and things like social distancing.
    As above, so below

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    Quote Originally Posted by Jens View Post
    The problem is, the second sentence doesn't necessarily follow from the first.

    I think the answer to the first question is that, yes, they are. Because we know there are asymptomatic cases. And essentially, the people without symptoms are being vaccinated. But they can still spread the virus to other people while they are infected.

    But regarding the second sentence, the "vaccination" is clearly why there are few cases, because the number of cases per population varies widely between places. In some places it has been very low, and in others not so low. So I think that clearly the number of cases being low related to measures taken to prevent the transmission, like tracking and isolation of cases, and things like social distancing.
    What I meant was, are the recovered people, who are shedding dead or damaged virus, actually vaccinating, without infecting people. With the R naught value of coronavirus, there should be many more people infected, than are infected. There should be hundreds of millions to billions infected already. This is a very contagious disease.
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    Quote Originally Posted by Copernicus View Post
    What I meant was, are the recovered people, who are shedding dead or damaged virus, actually vaccinating, without infecting people. With the R naught value of coronavirus, there should be many more people infected, than are infected. There should be hundreds of millions to billions infected already. This is a very contagious disease.
    If that were the case, I would think that we would see an initial explosion and then it would peter out. In fact, what we are seeing is a gradual spread that seems (to me) to be either accelerated or decelerated by policies implemented to try to contain it. It seems to me that it spreads very effectively, but in certain specific conditions, i.e. enclosed spaces where people are talking or singing without maintaining much distance. That is why it generally seems to spread through clusters. Even early on in the pandemic, when clearly people had not been vaccinated, it did not spread that quickly.
    As above, so below

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    Quote Originally Posted by Jens View Post
    If that were the case, I would think that we would see an initial explosion and then it would peter out. In fact, what we are seeing is a gradual spread that seems (to me) to be either accelerated or decelerated by policies implemented to try to contain it. It seems to me that it spreads very effectively, but in certain specific conditions, i.e. enclosed spaces where people are talking or singing without maintaining much distance. That is why it generally seems to spread through clusters. Even early on in the pandemic, when clearly people had not been vaccinated, it did not spread that quickly.
    In Sweden, where the spread was not artificially attenuated, there was an explosion, and then it petered out. No second wave.
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    Quote Originally Posted by Copernicus View Post
    In Sweden, where the spread was not artificially attenuated, there was an explosion, and then it petered out. No second wave.
    I'm sorry, but that is just plain wrong. There may be an impression that Sweden did nothing to attenuate the spread, but that is absolutely false. The situation in Sweden is a bit akin to that in Japan. They certainly did implement measures, such as contact tracing. In my understanding, early on in Sweden a lot of the spread was in nursing homes, and they implemented measures to try to stop such clusters.

    https://www.government.se/government...-for-covid-19/

    I'm not sure where you got the idea that Sweden is doing nothing to attenuate it. Maybe that's the impression the media creates.
    As above, so below

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    Quote Originally Posted by Jens View Post
    I'm sorry, but that is just plain wrong. There may be an impression that Sweden did nothing to attenuate the spread, but that is absolutely false. The situation in Sweden is a bit akin to that in Japan. They certainly did implement measures, such as contact tracing. In my understanding, early on in Sweden a lot of the spread was in nursing homes, and they implemented measures to try to stop such clusters.

    https://www.government.se/government...-for-covid-19/

    I'm not sure where you got the idea that Sweden is doing nothing to attenuate it. Maybe that's the impression the media creates.
    I feel like people are making stuff up. First Sweden is criticized for not doing what everybody else did because it was foolish not to do what everybody else did. Now that we see there is no second wave there now the narrative was that they did do a bunch of stuff.
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