Persistent misconceptions about COVID-19

JasperL said:

Deaths from pneumonia aren't "automatically" attributed to CV19. Glad we could clear that up!

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They are in the worldometer tally.

Aberro said:

But it’s propaganda

(funeral directors across New York City, O’Keefe uncovered a shocking narrative where, without fail, every director he spoke to expressed his or her concern that coronavirus deaths are being inflated and every death in NYC is being recorded as a COVID death with or without testing to confirm.)

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O'Keefe! :lamo :2rofll:

And what in the hell do funeral directors know about cause of death. They get a dead body, and they are not doctors. How in the hell can a funeral director intelligently opine on the recorded cause of death without an autopsy, that they'd be incompetent to perform?

sjmay said:

Good, then you explain what U07.1 and U07.2 mean when it comes to Covid-19, should be easy for you

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Of course. They are ICD-10 codes (the 10th edition of the International Classification of Diseases) for deaths caused by COVID-19, the U07.1 being for tested cases, and the U07.2 for clinical diagnosis unconfirmed by testing.

We do clinical diagnosis without a full-blown autopsy for a huge number of death causes. There is nothing extraordinary with this. It's not a plot to damage Donald Trump. 214 countries in the world last I check had COVID-19 outbreaks. There is only one with a Donald J. Trump. As you might want to realize, the I in ICD-10 stands for International. It's sponsored by the WHO. It's been like this forever for other diseases, no conspiracy theory necessary.

Satisfied?

Now, what is interesting is that some colleagues think that the FLU numbers are the ones overestimated:

Comparing COVID-19 Deaths to Flu Deaths Is like Comparing Apples to Oranges - Scientific American Blog Network

It's an interesting read.

GreatNews2night said:

Of course. They are ICD-10 codes (the 10th edition of the International Classification of Diseases) for deaths caused by COVID-19, the U07.1 being for tested cases, and the U07.2 for clinical diagnosis unconfirmed by testing.

We do clinical diagnosis without a full-blown autopsy for a huge number of death causes. There is nothing extraordinary with this. It's not a plot to damage Donald Trump. 214 countries in the world last I check had COVID-19 outbreaks. There is only one with a Donald J. Trump. As you might want to realize, the I in ICD-10 stands for International. It's sponsored by the WHO. It's been like this forever for other diseases, no conspiracy theory necessary.

Satisfied?

Now, what is interesting is that some colleagues think that the FLU numbers are the ones overestimated:

Comparing COVID-19 Deaths to Flu Deaths Is like Comparing Apples to Oranges - Scientific American Blog Network

It's an interesting read.

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So then, when I said that the death tallies, counted unconfirmed cases, it's true....right, kinda the opposite of what you said initially.

Lursa said:

And I can ask JasperL too, who is also a Dr. After a time, I believe both of them.

I realize you dont care if I believe you, but it does affect my responses to your posts. I wont be taking your 'credentials' as sources.

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You ask a question. I reply nicely. You come back with ten stones. I wonder what non-MD posting you're talking about that I am supposedly guilty of posting, but, again, whatever.

JasperL said:

They said their numbers ARE undercounted because of delays and WILL lag county and state health departments by 1-2 weeks, and tell us lots of reasons for those predictable and known delays and differences in reported numbers.

Provisional Death Counts for Coronavirus Disease (COVID-19):

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That is correct. That's what I said. Health Departments get reports first and only later pass them on to the CDC.

This is why we always see a dip in Worldometer during weekends when Health Departments are closed.

sjmay said:

It does, so when the CDC is saying that people who died but are not confirmed to have Covid-19, but you can count them as having it, you don't see that to be an issue?

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It's not an issue. Clinical diagnosis is perfectly valid. The syndrome by COVID-19 is quite typical. By now we know very well how it evolves.

sjmay said:

It does, so when the CDC is saying that people who died but are not confirmed to have Covid-19, but you can count them as having it, you don't see that to be an issue?

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No, not if we want to be consistent with deaths from "the flu" for example. In NYC for example, where the issue is perhaps biggest, the health professionals there have better things to do than test dead people to get the coding correct. They'd be inserting tests into an already overburdened testing system that don't help the living. And if we want to know how many died, then attributing deaths to CV19 that have all the clinical signs of CV19 but that haven't been tested is in fact the correct way to observe the ACTUAL impact of the virus. We trust doctors every day to make those decisions and nothing changes here.

JasperL said:

No they don't, actually. They do include pneumonia deaths because CV19==> pneumonia is a common sequence, and CV19 is correctly attributed as the cause of death. Same thing with heart attacks that follow CV19.

You've seen references to deaths from 'the flu' about 10,000 times on these threads lately. The VAST majority of those deaths attributed to "the flu" aren't from "the flu" but from pneumonia mostly and other complications following the flu. Nothing changes with CV19. Same methods. Same thing happens if I get shot in the gut and I ultimately die from complications from infections caused by the gunshot. I didn't die from the gunshot but from infection, but the gunshot is what started that train in motion and is the underlying cause of death.

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Hey, JaspertL, you'll like this link I just posted. Not a scientific paper, just a blog, and just someone's opinion, but it's actually interesting:

Comparing COVID-19 Deaths to Flu Deaths Is like Comparing Apples to Oranges - Scientific American Blog Network

sjmay said:

The first column, literally has U07.1, which per the CDC is "Coronavirus disease deaths are identified using the ICD–10 code U07.1. Deaths are coded to U07.1 when coronavirus disease 2019 or COVID-19 are reported as a cause that contributed to death on the death certificate. These can include laboratory confirmed cases, as well as cases without laboratory confirmation."

The fourth column, is coded as Pneumonia deaths are identified using multiple cause-of-death codes from the 10th Revision of ICD (ICD–10): J12–J18, excluding deaths that involve influenza (J09–J11).

So what you are sayingis that the CDC doesn't know it's own coding.....and that everyone is coded as having died from Covid-19.

The fifth column, is pneuominia AND Covid-19......

Literally, the only argument against using these CDC numbers, is that they lag.....

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Yes, that's correct. It's what we've all realized from the beginning and you're just now catching up to. The CDC numbers are wrong, because they will lag the direct reporting from counties and states by up to two weeks. If you want to know deaths about two weeks ago, look at CDC. If you want more accurate counts, look elsewhere at the several sites that take feeds from county and state health departments every day.

JasperL said:

LOL, the poor irony meters are getting hammered here!

No, CDC isn't just counting confirmed cases. The guidance to also count cases that are clinically consistent with CV19 but not tested came from....THE CDC!!

Here's CDC telling you this: Provisional Death Counts for Coronavirus Disease (COVID-19):

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Exactly, like I said in a post up there, the CDC changed the criteria to avoid missing all the cases in New York City that were quite typical but were untested from 200 people dying daily at home. Then the New York State Health Department updated the totals. Like you said, this guidance came exactly from the CDC.

The only issue with this guy's numbers is the delay in reporting. Eventually the numbers from the CDC will catch up with the Health Departments. Worldometer does get the numbers from the Health Departments already counted and so does Johns Hopkins. The totals are very comparable between Johns Hopikins and Worldometer.

sjmay said:

They are in the worldometer tally.

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No, they aren't. Only when the pneumonia is either a viral pneumonia, or a superimposed bacterial pneumonia on a patient with viral pneumonia from SARS-CoV-2.

They go by Health Department reports, and nobody is trying to inflate anything. Gee. Put down the tinfoil hat, will you? You don't seem to have the slightest clue about how death certificates are written.

JasperL said:

No, not if we want to be consistent with deaths from "the flu" for example. In NYC for example, where the issue is perhaps biggest, the health professionals there have better things to do than test dead people to get the coding correct. They'd be inserting tests into an already overburdened testing system that don't help the living. And if we want to know how many died, then attributing deaths to CV19 that have all the clinical signs of CV19 but that haven't been tested is in fact the correct way to observe the ACTUAL impact of the virus. We trust doctors every day to make those decisions and nothing changes here.

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I suppose, to me, it seems a bit much, and to the dead guy, I guess it really doesn't matter if he died from the flu or Covid-19.

It has the feeling though, of drastic measures, let's inflate the death rate, scare the **** out of everyone, tell them we have the answer (we being government) and see how far we can push them.....

People don't know whether to **** or go blind right now and it's showing up in every state.

Greatnews thinks in the end, the death rate will be .008%, (from one of his/her posts about herd immunity, 270,600,000 = 2,164,800 people dying) I think it's a lot less because I think there a ton of false cases in the numbers he/she is using.....

But your post here makes sense as to the why they do it that way...

sjmay said:

The first column, literally has U07.1, which per the CDC is "Coronavirus disease deaths are identified using the ICD–10 code U07.1. Deaths are coded to U07.1 when coronavirus disease 2019 or COVID-19 are reported as a cause that contributed to death on the death certificate. These can include laboratory confirmed cases, as well as cases without laboratory confirmation."

The fourth column, is coded as Pneumonia deaths are identified using multiple cause-of-death codes from the 10th Revision of ICD (ICD–10): J12–J18, excluding deaths that involve influenza (J09–J11).

So what you are sayingis that the CDC doesn't know it's own coding.....and that everyone is coded as having died from Covid-19.

The fifth column, is pneuominia AND Covid-19......

Literally, the only argument against using these CDC numbers, is that they lag.....

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It's not its own coding. Just to clarify, although it's nitpicking. The CDC doesn't publish the ICD. The WHO does. The CDC adopts the WHO codes, the owners of the copyright for the ICD.

sjmay said:

They are in the worldometer tally.

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No, they aren't. Worldometer.com counts deaths coded by doctors as CV19 as reported by states and counties, and that will not include ALL pneumonia deaths. I know from friends that are tested for influenza and CV19 and that have been negative for CV19. If that patient develops pneumonia and dies, you cannot point to any guidance or evidence that patient testing positive for the flu but negative for CV19 is coded anywhere or counted anywhere as a CV19 death. It's a BS lie spread by people to attempt to delegitimize the recorded deaths, undercount them, claim fraud, a hoax, a conspiracy, etc.

If you think I'm wrong, cite your evidence. I won't wait up.

sjmay said:

I suppose, to me, it seems a bit much, and to the dead guy, I guess it really doesn't matter if he died from the flu or Covid-19.

It has the feeling though, of drastic measures, let's inflate the death rate, scare the **** out of everyone, tell them we have the answer (we being government) and see how far we can push them.....

People don't know whether to **** or go blind right now and it's showing up in every state.

Greatnews thinks in the end, the death rate will be .008%, (from one of his/her posts about herd immunity, 270,600,000 = 2,164,800 people dying) I think it's a lot less because I think there a ton of false cases in the numbers he/she is using.....

But your post here makes sense as to the why they do it that way...

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Not 0.008% but .008 or .8%. Neil Ferguson in his original model used 0.9%. So in the range of 1% is what we've been looking at since March. We won't know for sure until the serology studies are done on a large scale.

And there are "false" cases in the flu numbers, and lots of missed cases. What seems clear to me is there is no conspiracy to inflate deaths by CV19. With the flu, very few are recorded as deaths from the flu, so CDC and others do studies to see changes in cases of pneumonia and other deaths typically caused by the flu, so it's a statistically derived number every time you read - the flu caused e.g. 60,000 deaths in 2018 or whatever. From what I've read maybe 5,000 or something had "influenza" or whatever on the death certificate and all the rest is statistically determined based on trends, historical data and all the rest. From what I've seen the 'excess' deaths especially in NYC FAR exceed those attributed to CV19, which indicates a big undercount, not an overcount.

GreatNews2night said:

Hey, JaspertL, you'll like this link I just posted. Not a scientific paper, just a blog, and just someone's opinion, but it's actually interesting:

Comparing COVID-19 Deaths to Flu Deaths Is like Comparing Apples to Oranges - Scientific American Blog Network

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He's just pointing out that the talking point we hear so often on DP is uninformed. If we want to compare "the flu" to CV19, then the only way to do that is with VERY broad definitions of what counts as a CV19 death. Or we can take deaths from "the flu" and divide by 5 or 10 or something and compare those to tested CV19 deaths. But the right wing talking points wants it both ways - broad, statistically derived deaths for 'the flu' and very narrow definitions for CV19. :roll:

sjmay said:

I suppose, to me, it seems a bit much, and to the dead guy, I guess it really doesn't matter if he died from the flu or Covid-19.

It has the feeling though, of drastic measures, let's inflate the death rate, scare the **** out of everyone, tell them we have the answer (we being government) and see how far we can push them.....

People don't know whether to **** or go blind right now and it's showing up in every state.

Greatnews thinks in the end, the death rate will be .008%, (from one of his/her posts about herd immunity, 270,600,000 = 2,164,800 people dying) I think it's a lot less because I think there a ton of false cases in the numbers he/she is using.....

But your post here makes sense as to the why they do it that way...

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No, I've explained why I work with the 0.8% number. And no, the numbers are NOT over-inflated, if anything they are under-inflated, like Threegoofs explained to you.

Sure, the ultimate CFR will be lower than what we provisionally see now. I just doubt it will be much smaller than 0.8%.

First, why in the hell do you think the CDC would be trying to inflate numbers supposedly for some sort of political plot? If you don't know it, the director of the CDC was appointed by Trump.

Second, 0.8% is a guess, sure, but an informed one. The most significant point of data for this is that there is ONE cohort that was one segmented population, in which EVERYBODY got tested, therefore there were no mild or asymptomatic cases missed: the Diamond Princess. The 4,000 people there, crew + passengers, were all tested, not a single one missed. And in that cohort, the CFR (a true one) was 1.4%.

Now, we can partially adjust this down because part of the population in the Diamond Princess was older than the general population, as retirees often go on cruises. But only part of it because there were quite a number of young people too, and the crew had a much younger average age than the passengers.

South Korea epidemiologists got to 0.9% with very good targeted testing and estimated they were missing half of the cases so we'd get to 0.45%, but then, South Koreans, unlike the Diamond Princess cohort, got the opposite effect, since they very tightly isolated their elderly, so that the pyramid of demographics was quite different there, the very elderly being in the minority of COVID-19 deaths unlike in Italy, because they simply didn't catch the virus. So their 0.45% was underestimated.

Why do I like 0.8%? It's a compromise. The true, real, ultimate CFR once this is all said and done and once we hopefully get a real idea of the infected cohort by antibody tests (hopefully without the issue of false positives that has plagued these tests), is likely to be higher than the 0.45% estimated by South Korea (because they sequestered their elderly) and lower than 1.4% for the Diamond Princess (because they had a somewhat higher percentage of senior citizens in that cohort). Let's compromise: 0.45% + 1.4% = 1.85%, divided by two, 0.925%, midway between these two. I knocked down another 0.125% for good measure, and came up with 0.8%.

This is just my personal estimate. I've seen similar numbers quoted elsewhere by epidemiologists (although I've studied epidemiology in school, I am not an epidemiologist). But I think it's a pretty decent estimate, supported by what we're seeing on the field.

Think of it the other way around. The CDC has calculated the average of seasonal flu deaths per day counting the last 31 flu seasons. They came up with 64.

We got 65,598 deaths in America so far. The first one (if we don't count the two that supposedly now are being seen as having happened earlier) was on February 29, 63 days ago. So, we have a daily average so far of 1,041 deaths per day. That's 16 times more than the average flu season.

The CFR for the flu most years is 0.1% (usually from bacterial pneumonia complications of the flu).

16 times more would be 1.6%, a lot closer to the 1.4% of the Diamond Princess, and DOUBLE of my 0.8% estimate.

So, why in the hell do you think that my 0.8% is overestimated, pray tell???

JasperL said:

He's just pointing out that the talking point we hear so often on DP is uninformed. If we want to compare "the flu" to CV19, then the only way to do that is with VERY broad definitions of what counts as a CV19 death. Or we can take deaths from "the flu" and divide by 5 or 10 or something and compare those to tested CV19 deaths. But the right wing talking points wants it both ways - broad, statistically derived deaths for 'the flu' and very narrow definitions for CV19. :roll:

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Yes, agreed.

JasperL said:

Not 0.008% but .008 or .8%. Neil Ferguson in his original model used 0.9%. So in the range of 1% is what we've been looking at since March. We won't know for sure until the serology studies are done on a large scale.

And there are "false" cases in the flu numbers, and lots of missed cases. What seems clear to me is there is no conspiracy to inflate deaths by CV19. With the flu, very few are recorded as deaths from the flu, so CDC and others do studies to see changes in cases of pneumonia and other deaths typically caused by the flu, so it's a statistically derived number every time you read - the flu caused e.g. 60,000 deaths in 2018 or whatever. From what I've read maybe 5,000 or something had "influenza" or whatever on the death certificate and all the rest is statistically determined based on trends, historical data and all the rest. From what I've seen the 'excess' deaths especially in NYC FAR exceed those attributed to CV19, which indicates a big undercount, not an overcount.

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LOL, the poster we're talking with doesn't seem to know where to put his decimal point. Yes, my estimate is 0.8% which is 0.008, not 0.008% like he wrongly quoted me. In no post of mine EVER on this issue I said 0.008%.

sjmay said:

So then, when I said that the death tallies, counted unconfirmed cases, it's true....right, kinda the opposite of what you said initially.

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The "unconfirmed" cases may be unconfirmed by testing, but are confirmed by clinical characteristics. Like I said, in the everyday medical care, the overwhelming majority of death certificates we write are ultimately "unconfirmed" if you think that it's just a tiny fraction of deaths that go to autopsy (when there is suspicion of foul play, or some public health reason, or a request by a family member who might be looking into a malpractice lawsuit, etc.).

If you think that all death certificates are "confirmed by testing" you are sorely mistaken.

By now, we know VERY well how a COVID-19 case evolves... down to what typically happens in the first few days (cough, muscle aches, fatigue, loss of sense of smell, etc), what typically happens in days 5 through 10 (the progressive worsening of the symptoms with start of shortness of breath), what typically happens in the end of the second week... We get in the middle of a freaking pandemic, and we see a case with the typical progression to shortness of breath and pulse-ox dessaturation, followed by, well, the freaking namesake of the virus, a Severe Acute Respiratory Syndrome, culminating with intubation, coma, CT scan of the lungs showing huge fluid retention, multiple organ failure especially kidneys, myocarditis, disseminated intravascular coagulation, then death... yeah, dear, that's a COVID-19 death, even if for some shortage reason the case doesn't get tested (and often, since the flu test is diffused everywhere, these cases have been already ruled out as not being the flu).

Pray tell, what exactly do you think would have caused the death of such a patient if not COVID-19, in the freaking middle of a freaking pandemic of... COVID-19, with all the freaking typical symptoms???

Oh, maybe you'd say, "what if the patient died of a car crash?" "What if he died of metastatic cancer?" "What if he died of his wife poisoning him with arsenic?"

Uh, no. Those have different symptoms.

Of course, the guy died of COVID-19. That's a case confirmed by clinical criteria regardless of it not having been tested DUE TO A SHORTAGE OF TESTING.

It's 100% guaranteed that the case I've just described would have tested positive, if a test were available.

That's why the CDC revised the guidelines to ALSO include these cases: because it makes sense!!!

The right wing is making it sound like whatever cause of death, we're for some weird political reason trying to pile them all up as COVID-19 deaths. That's not the case.

Again, the CDC is part of the TRUMP administration, for God's sake!!! The director is a direct Trump appointee!!! Why in the hell would he be trying to inflate up the numbers???

Got it?

JasperL said:

No, they aren't. Worldometer.com counts deaths coded by doctors as CV19 as reported by states and counties, and that will not include ALL pneumonia deaths. I know from friends that are tested for influenza and CV19 and that have been negative for CV19. If that patient develops pneumonia and dies, you cannot point to any guidance or evidence that patient testing positive for the flu but negative for CV19 is coded anywhere or counted anywhere as a CV19 death. It's a BS lie spread by people to attempt to delegitimize the recorded deaths, undercount them, claim fraud, a hoax, a conspiracy, etc.

If you think I'm wrong, cite your evidence. I won't wait up.

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If that patience dies and has tested negative for CV 19, agreed, he wouldn't be counted,

What if that patience dies, but was never tested?

GreatNews2night said:

Well, we can always print money in an emergency. Sure, it will drive up inflation. I have no illusion that this won't have a huge economic impact; which is a world-wide problem, not only ours. But some injection of money for the most distressed people and most in need, may indeed mitigate things for a while until the economic engine can re-engage. But yes, ultimately we'll all suffer, with inflation, Wall Street losses impacting on retirement plans, state budgets suffering, high unemployment, inflation... but checks to currently highly distressed families who are at risk, is something that I actually support. Not that I think that Trump should make of it an electoral propaganda piece by adding his letter to it... but otherwise I do support the CARES act and other measures voted after it, and more might need to come, neither will fail to have its own negative economic impact too, but it's an emergency.

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I agree that we need to help those hurt the hardest.

I only partially supported the CARES act. I felt it tried to just throw an insane amount of money at the problem without any targeting who would be most affected and of course there was plan at all to ever pay it back. But it's all spent now so whatever. We're not going to do it again. And again. And etc. All by itself it grew the national debt about 10%.

Going forward I think we should extend unemployment benefits, and maybe expand EBT for a few years, and that's pretty much it. Even that is going to grow the debt by leaps and bounds. But that will help the ones hurt the most. As for the rest of us, we need to get back to work and gradually reopen the safer parts of the economy over the next month. With proper precautions of course.

sjmay said:

If that patience dies and has tested negative for CV 19, agreed, he wouldn't be counted,

What if that patience dies, but was never tested?

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Then if the doctor sees clinical indications he or she had CV19 and that is what in his/her professional judgment got the train moving, he will likely per CDC guidelines record it as a death attributable to CV19. That's how it's supposed to work. Doctors record deaths every day where they're required to use professional judgment about what is/are the causes of death. To know for sure many cases would require an autopsy, but they're not generally necessary and would be a waste of resources, so they do what they can to get it right.

The point is nothing is unusual about how CV19 deaths are being recorded. If NYC only recorded those tested positive, we know 100% that the city would miss thousands of 'true' cases over time. I'm sure they will record some that might be 'the flu' etc. as CV19 but those errors happen every single day, and other heart attacks or other deaths that were set in motion by CV19 will be missed. And when the final data come in maybe 2-3 months later, the stats people can get to work and look at the trends and get a pretty good idea of what the 'excess' is, what's been attributed to CV19, or the flu, etc. and that's how we'll get final numbers - the unattributed excess deaths basically - same way we think we know how many died of the flu last year or in previous pandemics like the 1918 pandemic.

With a country as big as ours, we can predict very closely how many deaths will happen each month and each year from various causes because we have a lot of historical data to look back on, and those will change with aging of the population, and treatments and all that but they are identifiable variables, and can be controlled for. But with such large numbers, the statistical trends are VERY stable. So when the stats people see a big jump over those trends, they KNOW something is pushing the numbers. So if 5k/month heart attack death trend goes to 15k in April, and CV19 is active, and the flu is mostly over, it's going to be CV19 driving that huge jump (there are many more controls than that, but that's how these things work).

Lursa said:

And I can ask JasperL too, who is also a Dr. After a time, I believe both of them.

I realize you dont care if I believe you, but it does affect my responses to your posts. I wont be taking your 'credentials' as sources.

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Yeah, theres no question in my mind that GN2N is a medical professional. And a pretty sharp one, at that given his posting history.

There’s certain terms and phrasing that are obvious tells after a while- I’m usually pretty skeptical of most claims from posters, although I tend to accept what most people say at face value here for the purposes of DP.