Tuesday, May 5, 2020

The Winning Ticket

Everyday the crazy daily lottery announcements by Cuomo in New York and Murphy in New Jersey has become at one point de rigueur watching then loathing by many who have become immune to the daily Colbert show graphics, the scolding and of course the sibling Cuomo rivalry.  From the absurd threats and faux tears over deaths of citizens that on a daily basis these men would give two shits about is now passed the point of absurd. This is now in month two, entering month three and the jig is up. You are fucked and you know it. What they believed that it would somehow move or compel the federal government to finally step up and take leadership has failed, then it went into a way of insuring compliance by scaring the public shitless, has now become a type of cheerleading performance art.  This is another way of manipulating the public into believing they are the reason and are heroes due to their social distancing aka home imprisonment as they have nothing else.   Basically it is men doing what they do best - coercing compliance and consent in order to fuck you.

I was led to an article about the Jersey City Mayor who is opening the city up for no other reason that he needs to get business and in turn money into the city coffers.  If they stay closed much longer there is less likelihood they will ever reopen and in turn those closures will kill more lives than Covid in the long run.

The true measure of what this pandemic is is about the death rates and how they are in relation to normal death rates at any given time and what extrinsic factors contribute to rises and falls in a population due to any number of variables.    Chicago could use shooting deaths or say Ohio Opioid related ones that affect a cohort in higher numbers over another.  AIDS was perhaps the largest one I recall in my generation but we have had others such as 9/11 that led to an uptick in death  long after the attack due to deaths by illnesses suffered by first responders, including suicides.  And Covid appears to share that but in this case may cities are counting all dead as Covid related and that artificial count is somehow to include those who died but were not confirmed as that as cause of death and those who for whatever reason died and is believed may not have, but due to Covid and the push at hospitals, led them to die sooner than expected.  Sure that is a good idea, not at all.

And lets talk briefly about testing. Again in the article with Jersey City Mayor there is a requirement that front line Municipal workers must be tested every two weeks, there is no given number of how many that is but each week that must be a significant number which in turn is counted again and again against overall tests and the negative and in turn positive numbers that never seem to die off (pun intended) which means that it is front line "essential" workers contributing to the large number of positives as few are tested without meeting criteria otherwise. Then add to that any retests and follow up tests for those who did test positive and have to return to verify that they are now past the contagion stage which also means 14 days following recovery.  How many of those are tested and what are their results? Are they finding them all negative now or are they still positive?  And in turn what percent/proportion of those allocated tests given to them.   So again how many people in need or desire of wanting to be tested regardless of symptoms are being tested again that are not municipal employees or follow ups?

As we move on with this disease that is clearly problematic we are going into the unknown but again the data lovers can rely on one number that cannot be denied - total deaths.  Regardless of the way the  individual died we have a total death number for a period so that may be the clue in what it means to move forward.  If I hear one more comparison to fucking 1918 I will throw on my suffragette gown to rally for women to vote.  We are in the 21st Century with much more effective means to communicate, a robust global medical field of scientists, universities and companies that have this virus/drug thing as a full time occupation and in turn we are also supposedly better educated and in turn aware of our surroundings and long term needs so I don't get why we are still talking about 1918. Even I wasn't alive then.  So lets work with what we have - FACTS. Oh those are the real problems here we don't have those but we do have the dead, so they do tell tales.

The metric that could tell us when it’s safe to reemerge

May 4, 2020
The Washington Post

By:  Jeremy Samuel Faus, an emergency physician in the Division of Health Policy and Public Health at Brigham and Women’s Hospital in Boston and an instructor at Harvard Medical School. Carlos del Rio, a professor of medicine and global health at Emory University. The views expressed are solely their own.

There’s a metric that can indicate when it is safe to reopen society that does not depend on politics or guesswork. It’s called excess mortality.

Excess mortality is the number of deaths from any cause that both occur in a given time period and surpass the expected number. Deaths in the United States have been carefully counted for more than a century. These “all-cause mortality” numbers are extraordinarily stable. We know to a remarkable extent how many Americans are expected to die every day.

As The Post reported Saturday, there were an estimated 37,100 excess deaths across the United States in March and the first two weeks of April — nearly 13,500 more than are currently attributed to covid-19. The number of such deaths can be useful in indicating when the coronavirus threat may be less potent.

Remember, excess mortality is a metric that does not depend on the number or percentage of positive SARS-CoV-2 tests. Those statistics depend on policies: How many tests are being done, and on whom? Similarly, the “case fatality rate” of confirmed or suspected cases of covid-19 is subject to forces resulting from testing decisions.

Excess mortality does not depend on counting the number of covid-19 deaths, which ultimately relies on the subjective opinion of physicians and medical examiners proffering their best guesses on death certificates (and whose minds might be understandably steered by the day’s news — “Did this patient with advanced cancer die of the coronavirus, or with the coronavirus?”).

In graphs that track the number of deaths per week, month and year, entire generations blend into the next. For years, nothing much seems to happen. Then there’s an unusual rise in deaths, say, among young men in the 1990s. It tapers off by the end of the century. There’s a sudden spike in New York and New Jersey in September 2001. Mostly, though, the death counts drone on with the march of time, without much deviation and without fail.

These graphs make visible the mundane reality that death is a part of life, quantified. They also show when something unusual is happening. In Massachusetts, for example, the week-to-week data show that this year began like usual. Then, on the week ending March 29, there was a blip: 10 percent more deaths than the usual number. Nothing unprecedented, but it looked like a fluke. Rates returned to normal the next week.

Then history began to unfold in the graphs. The following week, 11 percent more deaths occurred than expected. The next week, 35 percent more. The week after that, there were 73 percent more deaths than normal. Then the number climbed again, to 119 percent more deaths than expected. By April 19, there had been 2,946 more deaths than expected since the beginning of March. By then, the state had reported 1,800 deaths from the coronavirus.

Now, are these undercounted deaths directly caused by covid-19? Did they occur indirectly due to covid-19, because patients who needed medical attention were scared to seek it?

The reliability of excess mortality lies in eschewing this question. Put another way, using excess mortality as a barometer of this pandemic involves being deliberately agnostic to such questions. Excess mortality cares not why anyone died. It simply observes the fact.

This is also why excess mortality presents an unusual opportunity. By closely monitoring excess mortality, which is occurring all over the United States, it is possible to determine when it is safe to reopen the economy and when is too soon.

As long as excess mortality rates are observed, the effect of SARS-CoV-2 remains too substantial to return to normal. Conversely, as excess mortality abates, it’s possible that physicians will continue to observe that some people who die have also tested positive. Even so, if death rates remain at expected levels, the virus is not posing an unusual threat to our normal way of life.

This will be especially potent if new cases spike in several months. Many cases may occur in people who — knowingly or not — already had the virus. If this coronavirus behaves like other respiratory illnesses, second exposures should be milder. If most people who test positive in the coming months have already had the virus, the death rate will be very low — assuming that our immune systems behave as expected. Excess mortality rates would therefore be indispensable in helping health officials to contextualize future spikes in covid-19 cases.

Excess mortality should form the core of evaluation around reopening the economy. Excess mortality can, however, lag behind caseloads because covid-19 deaths start cropping up a couple of weeks after infection, so comprehensive testing is still necessary. Without tracking excess mortality closely, there is a risk that officials might see the results of universal testing and interpret a handful of new cases as bigger threats than they truly are. This could paralyze society for too long.

While excess mortality information in the absence of adequate testing could inform policymakers that another shutdown is necessary, such information might come too late to prevent another major outbreak. Employing these tools together, however, would allow us to determine whether this pandemic has subsided — and likely detect any resurgences.

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