It turns out it is more controversial than I thought. A year ago I might have taken the CDC's numbers at face value, but their reputation has taken a hit, to say the least. The link includes how it is that they arrive at those numbers. It all seems reasonable, except...well, it's pretty soft. I can accept that there is a lot of range (29-59K for last year, for example), but this goes beyond even that. A lot of those deaths attributed to influenza are not solid, nailed-down diagnoses. I'm not telling you I've got better ones. There are sites out that that put the number much, much lower, claiming that pneumonias and rhinoviruses are the actual culprits some of the time, and pointing out (technically accurately, but perhaps misleadingly) that few of the deaths meet all criteria of positive influenza test and clear evidence that it was the overwhelming reason for death. As some of those sites seem to have a bias toward selling you some health ideas and programs, I do not link to them, but at least a couple looked legit.
This interests me because a lot of people who are claiming C19 is oversold and not that big a deal are making the same argument about that virus - that people who are dying of something else but also test positive for, or just look like, C19, are being counted as CoVid deaths. I think we have to bring the same amount of suspicion to both numbers. One can't say "it's exaggerated and not worse than the seasonal flu" when the seasonal flu numbers may be exaggerated in much the same way. Upon examination the validity of either set of numbers may change. I'm not trusting much of anyone to get it right at present. But at the outset, I think you if you provisionally accept or reject one you have to do the same for the other.
What was the old line? "All deaths, in the end, are heart failure."
ReplyDeleteAble and Baker each decide to kill Charlie during his trip in the desert. Able poisons his canteen, and Baker pokes a hole in it. Charlie dies of thirst. Whodunnit?
I wound up in the ER last month because of a combo deal. Either problem by itself wouldn't have knocked me down so hard, but together...
IIRC, pneumonia is one of those killers that can either strike by itself, or opportunistically. Whodunnit?
As soft as the number for flu-attributed-deaths is, my impression is that it is calculated pretty much the same way year on year. So as soft as it is, the magnitude of the Δ is still very useful from a prediction, preparation, and policy perspective.
ReplyDeleteThere just isn't that much upside for flu in spending the money for "complete" testing, it wouldn't give different information than the sampling done by the practitioners who are participants in the influenza surveillance network.
In contrast, in ~3 weeks, the board and management of one of my employers are going to be making decisions about what parts of the business they think we'll be operating in the summer. This will very directly affect whether I have employment come July.
I'm pretty confident that the possible range of “R naught,” for transmission of SARS-CoV-2 is highly likely to be in the "no job for Unknown/Douglas2" range whether or not the numbers are fiddled – either in the numerator or the denominator of the equation.
But I certainly understand the perspective of those who would see dumping superficially-probable cases in with actually-tested ones as a malevolent action by the health authorities.
I've seen some blog comments that look like they are informed ones that public-health researchers have managed to keep the numbers for "we're pretty certain it was COVID-19 because of documentation from their hospitalization" segregated from "they died at home or in a care home so we can't really know it was COVID-19" in the reporting from local health departments. So I'm confident that we'll have "right" numbers in the long-run, but that may be after a lot of business failures in the western world and a lot of starvation in the third world that will both inevitably result from the lack of retail-purchasing in the US.
I agree it is the comparison numbers, not the absolutes.
ReplyDeleteI don't know how to encourage you on your own situation. Some purchases will bounce back quickly, some will slowly, and some never will.
Americans have usually rejected a fully utilitarian approach of "greatest good for the greatest number" because of the active imposition of negative outcomes for some, however much they are disguised as passive. But there's no getting around it. When we adopt that refusal to impose negative outcomes on the few, we progressively move away from greatest good for the greatest number, and it's not just a classroom exercise. There is real cost.
This time we eschewed utilitarianism. If this happens again soon, we might not, or not so thoroughly. Real people are real people, after all.
I'm suspicious of numbers that can be maximized or minimized depending on the expected impact on disaster funding. It does make it hard to compare them usefully to other numbers. Setting that concern aside, though, I think it's fairly reasonable to include in COVID-19 deaths quite a few deaths that were severely complicated by pre-existing conditions, unless the patients were pretty near-term terminal already. I have pre-existing conditions, but if I keel over dead from COVID in the next couple of months, it's going to seem to me like the virus is killing me, because I was not otherwise dangerously ill.
ReplyDeleteHad zoom cocktails with a group that included a local ER doc. He talked about one of the issues with ramping up covid testing is that not many viral panels are done routinely because if you present with flu symptoms during flu season it really doesn't add anything unless the dr suspects something else might be going on. 20/20 hindsight says it might have been nice to know if people were coming in with flu-like symptoms from an unknown virus in December or January. It sounds like this might be what the South Koreans did, and built a kind of early warning system for unknown viruses.
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