Tuesday, January 11, 2022

Just Approximate Numbers

Omicron is said to be less deadly, but deaths are still high. They've been worse, but we are still over 1000/day. I wondered if this is the last gasps of Delta, augmented by some few Omicron?  Apparently not.  It's pretty much all Omicron at this point.  So what gives? After all, we supposedly know what we are doing in treatment than we did at the beginning. I think I falsely expected that because Omicron was less deadly that it was going to shortly mean no deaths at all.  I was looking only at the positive herd immunity possibility. Overoptimistic again. Looking at the death numbers doesn't seem to treat that in me for long.

The short answer is that there are so many cases. In the first months not everyone was counting carefully, and it is still true that not every state - not even every hospital in a state - is counting in exactly the same way.  But whatever the relationship of counting is to cases, it has very likely been stable for well over a year, and comparisons between peaks and troughs has some meaning. Comparisons of cases between states is still approximate, BTW. Hospitalisations and deaths are not identical in definition between localities, but are much closer to a true comparison.

New cases are at three or even four times the rate of our previous highest peak. Active cases are twice as high as they have ever been. That does suggest that active cases are about to get worse.  For how long? Opinions differ, and I will not choose among them. Deaths are not also at record pace, but they are at about the rate of two of the previous three peaks. It was a good deal worse a year ago. 

So the picture is that Omicron does not kill you as often, but it still kills you - and the public service announcement is "particularly if you aren't vaccinated." How much of that is people going back to their old ways of interacting - I will guess that being in closed spaces and average less distancing are a bigger factor than masking on that - how much of that is underestimating the deadliness of this variant, I don't know.  Even though hospital staffing problems have strained capacity, I don't know that it has caused many of the deaths. 

It did occur to me that it is not only medical services, but anyone who is responsible for staffing anything that is feeling the pinch at this point. Even if your employee is telling you they feel fine, most places have required time before return, usually based on local regulations, but sometimes on policies from company headquarters elsewhere. Some places might be shading the truth and looking the other way in order to keep going, but hospitals won't be among them. If you tested positive, you can't come in. It is also hard to measure the impact of the virus on staffing as some people move to better-paying jobs in their field pretty rapidly at this point. If they resign it might be opposition to mandatory vaccination - we certainly see people jump to that conclusion on the internet often enough.  But heading for better pay at another nearby restaurant, hospital, or manufacturer, when they can raise their wages and yours can't or won't is a long-established pattern, as is deciding that this is the time to finally pack up and go live near your sister and find a job there. 

Yet even if it is only for a relative few days each, a constant percentage of the workforce being at home strains all systems.


Eric said...

I'd still like to see deaths "with COVID" separated out from deaths "from COVID". With Omicron being quite transmissible, it's entirely possible that deaths "with COVID" are high, but deaths "from COVID" quite low.

Roy Lofquist said...


The CDC disclosed yesterday that more than 75% of reported fatalities attributed to COVID involved at least four other morbidities.


Assistant Village Idiot said...

It's an artificial distinction that isn't as helpful as people think. It is only brought out with the intent of minimising how bad covid is. Outside of that agenda, it doesn't exist.

If you get blind drunk and run into a tree, your death certificate will record the head injuries that killed you. But any common conversation about the situation will recognise that the drinking was a contributing cause of death - actually the main cause of death - even if you didn't die of too much alcohol. None of your passengers who died will have anything about alcohol in their certificate either, but everyone familiar with the situation will know. If you die of smallpox in a place where there is a vaccine, your death certificate will call it smallpox. You don't technically die from "lack of vaccine." But everyone will ask "How the hell did he die of smallpox in this day and age?" They will know that avoidance of that preventative was the real cause. If you faint while working on the roof, what will be the cause? Even more, if you have a heart attack on the roof of uncertain severity, so that it is unclear whether you would have died of it anyway, what do we say the single cause of death was?

We have a million Americans dead because of covid. Exactly how that is recorded is not very important.

Donna B. said...

@Roy Lofquist

This is what was disclosed:

"Among 1,228,664 persons who completed primary vaccination during December 2020–October 2021, severe COVID-19–associated outcomes (0.015%) or death (0.0033%) were rare. Risk factors for severe outcomes included age ≥65 years, immunosuppressed, and six other underlying conditions. All persons with severe outcomes had at least one risk factor; 78% of persons who died had at least four."

It's really important to note that only 36 of the 1.2 million people in this study died - 78% of those 36 had at least 4 of the risk factors for severe covid.

@Eric - would you classify those 36 deaths as "with COVID" or "from COVID"?

GraniteDad said...

Donna B- great detail, thank you for sharing

On staffing, I'm definitely seeing the pinch anecdotally here locally. Drove by the local Applebee's strip mall at 5pm. Applebee's was open, but the pizza place was closed, the Thai place was closed, the nail salon was closed. Went to Wendy's, the drive-through said it was closed, dining room was locked, so I ordered on the app for carside delivery because allegedly the store was open. Waited 15 minutes, no one came out. I could see some young girl working inside apparently by herself, but I wasn't about to go bang on the door and scare her half to death. Order just got cancelled overnight- head office and local staffing not aligned I suppose.

Grim said...

It's an artificial distinction that isn't as helpful as people think.

I've heard you argue this several times now, both here and at my place, and I feel like I can see both sides of this one. On the one hand, as you say, people are dead who would not have been; and probably COVID played some kind of role, so that if it had not come up they would (probably) have been still alive. Thus, there is a causal role of some sort; explaining exactly what it was in every case may not matter much.

The other side of the argument seems to me to be clearer in disanalogy to your alcohol illustration. If the guy hadn't gotten drunk, presumably none of the deaths in any way threatened. For these 'four comorbidity' cases, though, you've got a guy who already is (say) obese, with high blood pressure, high cholesterol, and some fourth thing that probably is as mutually reinforcing with those three conditions as they are with each other. This guy is going to die, sooner or later; only perhaps the miracles of medical science have kept him from dying so far. Somehow he is toddling along in spite of mutually-reinforcing conditions that expose him to heightened risk of both of the leading causes of death, cancer and heart disease. COVID here isn't like the alcohol abuse, which was the real cause; it's more like a little nudge that destabilized an already-barely-stable condition.

In that case, I think I see the counterargument, which is that we should probably not bend our society in pretzels to address the COVID when we've not done so to address the obesity/blood pressure/diabetes/cholesterol situation. Those are the real killers; COVID is just undoing some of the improbable success of medical science in making those conditions livable. If we're going to engage in large-scale maneuvers as a society to improve health outcomes, they should be aimed more at encouraging exercise than isolating people in their homes; more about getting them out in the sun and wind than keeping them away from each other; more about reshaping diets towards healthy outcomes than mandating what we continue to call 'vaccines' even though they are proving to be functionally therapeutics.

Insofar as it's causal, in other words, it's the cause-of-the-cause rather than the actual cause. The alcohol was the actual cause of them hitting the tree; the COVID is the cause of their system of care failing, which leads to their death like a rat whose chewing was fraying the cord holding one of the other Swords of Damocles that have been long hanging over their heads. Without the rat, the sword might not have fallen for quite a while; but it was the sword, not the rat, that finally killed them.

Assistant Village Idiot said...

@ Grim - your argument would be quite strong if that "four comorbidities" info was what it purports to be. But it isn't, and I have a two- (at least two) part answer coming up. But for now, I think it is an important point to note that the conservative press and citizen journalists were supposed to be a corrective to the liberal mainstream press and give us what was missing. They are now as bad as the mainstream media or worse, we just like their biases better. Too many conservatives/populists/libertarians are believing what they read from those sites without applying any corrective. I have been singing that song for two years or more now and don't think I'm seeing a lot of people putting on the brakes.

David Foster said...

Note that the CDC data on 75% of the reported fatalities involving 4 or more comorbidities ***is based on vaxxed people only***. If they have reported a similar analysis for unvaxxed people, I haven't seen it.

One way to interpret the 4+ result is that the vax is so effective at preventing bad symptoms that you have to have a LOT of other problems to die if you're vaxed.

But this can't be determined definitively without comparable data for the unvaxxed population.

Fo4Ho1 said...

Yes, and in the meantime zillions of us just become more frustrated, not knowing where the line of truth is, as it seems to move every day. Plus the amount seems to shrink

Donna B. said...


One problem with your rat and Sword of Damocles analogy is that the 'bending of our society into pretzels' was not about protecting those with the co-morbidities of age and its progressive health problems. The most drastic efforts have been aimed toward the working age population and children. I've not heard of a mandate for those over 65 to be vaccinated.

Another problem is that you skate closely to blaming those with co-morbidities for not having taken proper care of themselves for... however many years. While you are correct that medical science has certainly helped them along, I submit (as one example) that anyone with Type I diabetes who is 65 or older has taken quite good care of themselves.

Grim said...

@AVI and Donna: I'm not making a counterargument, so much as explaining that I can see how both the argument you're advancing and the reply make a kind of sense. Both of them seem valid to me, from a certain perspective.

@Donna: What I'm talking about is efficient causality, not morality. A rat that gnaws a thread holding up a sword is efficiently causing the breaking of the thread; he is not necessarily wrong to do so. The sword that falls efficiently causes death by striking the man underneath it; the sword has no moral responsibility for this.

High blood pressure is often genetic: it is efficiently causal of bad things without being morally blameworthy. So too diabetes in your example. It is necessary for many purposes to distinguish the moral from the physical.

@David Foster: See my comment on Tom's post where you made the same point. The older data, pre-vaccine but also pre-Delta/Omicron, was 2.9 comorbidities in a patient who died. It's hard to make sense of that given how much has changed, but one potential reading of it is that the vaccines plus the new variants have raised the number of necessary comorbidities by approximately one.

Donna B. said...
This comment has been removed by the author.
Donna B. said...


My statement was that you skate closely to those making such a moral argument, in that the reasoning is somewhat similar... ie, by society not addressing the "real sin" with such governmental 'pretzal' requirements -- which were not done.

FYI, high blood pressure and cholesterol levels are not mentioned in the co-morbidities included in the cited study's six risk factors.


Grim said...

@Donna: The comorbidities you say are not present in the current study are certainly present in the older one I mentioned in my remarks to Mr. Foster; I'm surprised they would be omitted here, although perhaps they are not. "Chronic cardiac" is so regularly associated with high blood pressure and cholesterol, it would be odd indeed if they were not present (even if not broken out specifically).

Here are the older numbers:


With kind respect, I accept no responsibility for making an argument that sounds to you like a different argument. When I want to talk about sin, which isn't all that often, I don't mind to use the word explicitly. All I'm saying is that I can see how both perspectives in this discussion have a kind of sense to them, and neither strikes me as wholly wrong.

Assistant Village Idiot said...

@ Grim - I note somewhat humorously that you are defending some ideas better than their originators have been doing. Whether that is because you have secret sympathy for the ideas and are fighting the rearguard action, or because you a naturally protective underdog rooter, or some other reasons i know not. But you are engaging honestly and I don't have an issue with you personally on this. I do think the conservative sites that people are going to for information have gotten sloppy because the ready-made audience willing to disbelieve CNN on everything keeps a raft of sources afloat. This is... but no, I have two longer posts forming in my head because I am seeing two separate problems that I need to address, and I don't think they can be shortened. Neither is entirely new, but i hope to refine my argument each time.

@ Roy Lofquist - I was already thinking of those two posts because it was your statement that set them off. My mind divides too easily.
1. You have been a useful addition to many discussions over the years - and I don't just mean by saying "You go AVI! You tell 'em!" but adding content that no one else was. So I am tempted to shrug and say "Eh, I think he's missed a trick here, but no biggie." However...
2. Don't invoke Nazism here without preparing a really solid defense of it in advance, because you will likely be challenged. I know that people sometimes are just trying to add a dramatic touch or suggest that this is the type of thing that can get away from them and lead to Nazism, but to my mind that is part of the new sloppiness in conservative thinking over the last few years that I mentioned to Grim, above.
3. Others have hit some of my main points, but here is where I think it's wrong. The study is about the unvaccinated. I have seen it referenced in half-a-dozen places over the last few days without that being put forward as a disclaimer. Someplace along the way, and maybe early in the conservative news sharing, it just got quietly dropped. Even when it is present, it looks obscured. Next, what are called comorbidities include some things that I don't think come immediately to mind to readers, and I don't like not having that out there. Being 65 is an excellent example. But let me add to that. These comorbidities are not only remarkably common - obesity has been defined down, for example - but many people don't think of themselves as having them. At my hospital we would frequently be providing a first diagnosis for medical conditions even though that isn't what they were admitted for. We would do routine bloodwork and vital signs and tell people pretty quickly "You have hypertension. You have diabetes." They didn't know. It can matter. I don't know how many of those comorbidities were discovered on that final hospitalisation when they died of covid, but i guarantee it was some, just because I have seen this even on psychiatric admissions, which should be largely unrelated. It's part of the circular pattern I will address in those two upcoming posts, of trying to insist that covid isn't dangerous in order to prove that "they" just like telling people what to do, which proves in turn that covid isn't that dangerous, etc.

So I will use a sports analogy, even though one of the posts will be about how sports analogies are not that useful. I don't pretend we are the major leagues here - more like a AA team or a D1 college team or something - but I would like to at least maintain that. I don't know if I'm the coach, or your catcher, or the umpire, or an opposing player in this analogy, but whichever, you can't bring your high school fast ball here. It works in other places but I'm not overlooking it. I've seen you throw better.

Donna B. said...


The link of numbers you provided cannot be compared with the study I'm referring to regarding the greater than 75% of deaths with more than 4 co-morbidities. Apples to mangoes. As to your comments to Mr. Foster... I missed them. I was very ill for much of the last month (not Covid related) so I missed some things.

I suspect we'd agree on many things were we able to sit together sharing a nice single malt whisky. At the very least, any disagreement would be ever so amiable.

Donna B. said...


uh oh.
"3. Others have hit some of my main points, but here is where I think it's wrong. The study is about the unvaccinated. I have seen it referenced in half-a-dozen places over the last few days without that being put forward as a disclaimer."

The study noted by Roy Lofquist is very explicitly about the FULLY VACCINATED. Typo?

Assistant Village Idiot said...

Yes, typo. I had internalised it as "study that notes an important difference between vax and unvax, should be mentioned" then just wrote it wrong when I entered it. Thanks.

Roy Lofquist said...


I did NOT invoke Naziism. I cited the man who was the genesis of the big lie meme. The fact that he was a Catholic or had a club foot does not invoke religion or handicaps.

If I had cited Clinton (with that woman) I would not be invoking Democrats or Southerners or people with poor taste in women.

If I had cited Obama (you can keep your doctor) I would not be invoking race.

The most insidious form of disinformation is to assert that correlation implies causation. This is the stock-in-trade of the statistician. A statistical analysis, of necessity, involves reductionism. You can't consider, or even be aware of, all relevant factors. What you consider and what you ignore shape the results. If you don't like the results change the inputs. But we know in our hearts that "they" would never do that because they were all Eagle Scouts and are pure as the driven snow.

With respect to the Wuhan Flu we have been inundated with a cacaphony of conflicting information. With so much money ($trillions) involved I am automatically leery of any of it. I am reminded of a Bob Dylan song: "in that jingle jangle morning I'll come following you".

Tom Bridgeland said...

With or from covid. I take care of both kinds of patients. Recently lots of people come in with covid but that isn't why they are there. All I can say is that covid makes everything else worse. You are not going to efficiently heal up after your heart attack when you can barely breathe to begin with.

Seeing lots of diabetic DKA patients recently, with covid. They feel like crap, stop eating, stop taking their meds or checking their sugars, and end up in critical care with blood sugars in the 500s. What killed them? Covid, or the underlying diabetes?

It's a distinction without a difference. I find the whole argument trying.

I'll note again that it's the overweight people who really suffer with covid, particularly the big, husky, muscular men. I have seen too many of these guys sent to ICU for intubation. Not always older guys either, many in their 30s-50s.