New Covid Study

[westwoodmom04]

New York Times is reporting on large scale study of covid fatality that is to be published in the peer-reviewed and very prestigious journal Nature. https://www.nytimes.com/2020/07/08/health/coronavirus-risk-factors.html Update: fixed link, but the video on why confederate statues bad is worth watching, but obviously I put it here by mistake.

No surprises really, age is the biggest predictor of death, followed by ethnicity (which needs more attention).

[squimp]

Here is a link to the article itself.
https://www.nature.com/articles/s41586-020-2521-4

There was a really good The Daily podcast episode yesterday about the NYT's data journalism about COVID in the US. Their work also showed the racial disparities, especially when you adjust for age and include the entire country.

[ezcc]

I'm really curious to read more about vitamin d deficiency as a factor- I have seen it mentioned in a couple of less mainstream places but not widely. It seems like that could explain some of the racial difference and also why the northeast had such terrible outcomes while the southern outbreaks don't seem to be seeing quite as many deaths.

[PZMommy]

I'm really curious to read more about vitamin d deficiency as a factor- I have seen it mentioned in a couple of less mainstream places but not widely. It seems like that could explain some of the racial difference and also why the northeast had such terrible outcomes while the southern outbreaks don't seem to be seeing quite as many deaths.

Also the current outbreaks are younger people and the earlier outbreaks were older people, so that could play a factor in the death rate as well.

[legaleagle]

Also the current outbreaks are younger people and the earlier outbreaks were older people, so that could play a factor in the death rate as well.

Right, plus improved treatments and deaths are very much a lagging indicator of infections.

[PZMommy]

Right, plus improved treatments and deaths are very much a lagging indicator of infections.

Our public health officer said she expects the deaths to spike in a few weeks. We have sky rocketing numbers, but our deaths are only around 40 a day.

[nfceagles]

Our public health officer said she expects the deaths to spike in a few weeks. We have sky rocketing numbers, but our deaths are only around 40 a day.

The uptick in deaths from the southern surges started a couple days ago IMO. Hopefully it will never reach the same levels of the N.Y./NJ/CT epicenter in April due to improving treatments and younger cases but it’s coming and unfortunately didn’t have to happen IMO.


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[legaleagle]

Very good article in the Atlantic https://www.theatlantic.com/ideas/archive/2020/07/why-covid-death-rate-down/613945/

[maydaymommy]

Right, plus improved treatments and deaths are very much a lagging indicator of infections.

I think improved treatments are key. Friends who are doctors in two separate ER’s, in the northeast, both said that when they first got Covid patients, they didn’t know what to do with them. The data from elsewhere wasn’t reliable and they basically had no manual of best practices to follow. Early on, as numbers increased locally, they were still learning about the virus. Now, more patients have better outcomes because there are more proven treatments. I’ve heard that even the advice that doctors give to patients who are able to treat themselves at home has evolved.

[bisous]

I’m really interested in these improved treatments! Can someone steer me that direction?

[dogmom]

I'm really curious to read more about vitamin d deficiency as a factor- I have seen it mentioned in a couple of less mainstream places but not widely. It seems like that could explain some of the racial difference and also why the northeast had such terrible outcomes while the southern outbreaks don't seem to be seeing quite as many deaths.

Before we go running off into the Vit D rabbit hole there are a lot of things to look at. (I say this as someone who knew an ICU researcher doing a lot of work of Vit D and ICU outcomes and although it was promising at first it just didn’t hold up in larger, well designed studies. This is a common outcome.)

First, you need to make sure your are comparing the right numbers, case fatality rates vs death rates. The first is based on the number of people positive to Covid vs death rate from Covid vs population. So I don’t think by case fatality rate you can say it was so deadly in the Northeast vs South. The numbers all over the place. The truth is we just don’t have good data yet, that will come later. There are so many variables: is every death classified right, when in the epidemic did an area reach its peak, were the hospitals overwhelmed, what was the age & race breakdown in an area, were there big outbreaks in nursing homes, were there even enough tests. I suspect given what we know of diabetes and high BMI as risk factors the South will have more than enough deaths eventually.

You can see the paltry data we have on case fatality here:

https://coronavirus.jhu.edu/us-map

Also, I KNOW you don’t mean it this way, but talk about Vit D sufficiency or some other “race” related thing is problematic. Race is a societal, not a biological construct. The genetic diversity of people in African is much wider and deeper than other areas, such as people do European descent. There are some traits that can be attracted to people of African background, such as sickle cell. However the population considered “African American” has a lot of European DNA. Some do the highest rates of death are in Latinex communities and some of the Native American Communities are being decimated. I can tell you right now if a researcher goes to a black community ands says “I’d like to test you for Vit D because we think you are dying disproportionately because your skin is dark” the community members are going to roll their eyes and go “Of course it’s the color of our skin to any number of societal issues around race. Would you like to conduct a study on syphilis on our community while you are at it?”

[dogmom]

I’m really interested in these improved treatments! Can someone steer me that direction?

Bisous it is really in flux right now. The two big things I’ve seen is proning patients before intubation and holding off intubation. (Breathing tube + vent) It’s very counterintuitive for us to hold off intubation when you see the oxygen level dropping, because all we think of is “get the airway in before they code” and putting someone on their belly when they having breathing problems. Most other patients with breathing issues (COPD/heart failure) can’t breath if the lie flat and need their head up, but it’s a different problem. The other area is the use of dexamethasone, but that works in sick, hospitalized patients. No data to support early home use.

[gamma]

I’m having trouble interpreting NJ statistics. According to our Governor’s numbers, which he posts each day, NJ is 45 in the nation for Covid cases per 100,000/ population, but 2 in deaths? How can we have so many deaths? I’m not sure if I’m understanding this correctly, but it appears to me that if I contracted Covid, I would double or triple my chance of survival just by crossing the Hudson River into NY. What does that say about our health care in NJ? Even though I have a MS in this field, I’m stumped. Would any of you be able to decipher this for me?

[Globetrotter]

I’m having trouble interpreting NJ statistics. According to our Governor’s numbers, which he posts each day, NJ is 45 in the nation for Covid cases per 100,000/ population, but 2 in deaths? How can we have so many deaths? I’m not sure if I’m understanding this correctly, but it appears to me that if I contracted Covid, I would double or triple my chance of survival just by crossing the Hudson River into NY. What does that say about our health care in NJ? Even though I have a MS in this field, I’m stumped. Would any of you be able to decipher this for me?

Since NJ was a big part of the initial wave, were most of the deaths from the early days, before we had any information on treatment? (And PPE and equipment shortages) plus isn’t NJ more densely populated on the whole, whereas NY has huge variability.

[doberbrat]

Iirc, NJ had a very high population in nursing homes that contracted it - statistically, the elderly and already ill are at highest risk. I'm sure that's not the only issue but that may account for part of it.

Also, posthumously declaring deaths due to covid can change percentages. There was a point when they werent testing many people. So there were not many people who "had" covid. If they then go back and test samples in suspected cases, it changes things because they arent going back and adding recovered people to the numbers.

I wouldnt worry too much; I'd assume that hospitals in NJ are on par with NY. :hug:

[gamma]

Since NJ was a big part of the initial wave, were most of the deaths from the early days, before we had any information on treatment? (And PPE and equipment shortages) plus isn’t NJ more densely populated on the whole, whereas NY has huge variability.
They are posting the ranking based on the daily numbers, but he did say some of the numbers are from cases which were diagnosed post autopsy with Covid 19. Yes, NY and NJ released COVID patients back to the nursing home where they were admitted from to free up hospital beds which were critically needed until the military ship arrived and army corps of engineers converted convention centers into hospitals and tents were set up in Central Park. It was quite a nightmare! But the older cases added definitely explains why our daily death ranking is in the top 2-8 highest of the states. I heard about the older cases added for the first time the other day.As far as density, north eastern nj is very dense, along with Camden, Trenton, Atlantic City but the rest of the state is suburban, farm land, seasonal beach towns.

[KrisM]

They are posting the ranking based on the daily numbers, but he did say some of the numbers are from cases which were diagnosed post autopsy with Covid 19. Yes, NY and NJ released COVID patients back to the nursing home where they were admitted from to free up hospital beds which were critically needed until the military ship arrived and army corps of engineers converted convention centers into hospitals and tents were set up in Central Park. It was quite a nightmare! But the older cases added definitely explains why our daily death ranking is in the top 2-8 highest of the states. I heard about the older cases added for the first time the other day.As far as density, north eastern nj is very dense, along with Camden, Trenton, Atlantic City but the rest of the state is suburban, farm land, seasonal beach towns.

Michigan reports the deaths of people who had not been diagnosed with COVID yet tested positive after death. They mark that number when reporting. The other day, they reported 15 deaths and all 15 had not been considered a COVID patient until after death. They go through death certificates a few days a week and look for ones that aren't in the COVID system already. Maybe something like that as well for NJ.

[Melbel]

I’m really interested in these improved treatments! Can someone steer me that direction?

The EVMS website has a good protocol, explanations, and summary plan: https://www.evms.edu/covid-19/covid_care_for_clinicians/?fbclid=IwAR1MO-5GJzpoSADAo5X27HfCH7q2NNOqGxwn9qTHilCnydznZyPcPabN OBA#covidcare

Not mentioned in the EVMS protocol, hydroxychloroquine is showing promise in prophylactic and early studies: https://c19study.com/?fbclid=IwAR2TQWayQCy1_qnXjSNKvZsq_QNYLlrkRyGbIMIt 6386y4a6z4l4p0oTVdE

[chlobo]

Not mentioned in the EVMS protocol, hydroxychloroquine is showing promise in prophylactic and early studies: https://c19study.com/?fbclid=IwAR2TQWayQCy1_qnXjSNKvZsq_QNYLlrkRyGbIMIt 6386y4a6z4l4p0oTVdE

I'm confused by this. I thought they discontinued studies because it "wasn't" working?

[wallawala]

The EVMS website has a good protocol, explanations, and summary plan: https://www.evms.edu/covid-19/covid_care_for_clinicians/?fbclid=IwAR1MO-5GJzpoSADAo5X27HfCH7q2NNOqGxwn9qTHilCnydznZyPcPabN OBA#covidcare

Not mentioned in the EVMS protocol, hydroxychloroquine is showing promise in prophylactic and early studies: https://c19study.com/?fbclid=IwAR2TQWayQCy1_qnXjSNKvZsq_QNYLlrkRyGbIMIt 6386y4a6z4l4p0oTVdE

The early studies have not panned out. Hydroxychloroquine has not shown benefit with follow up over time and is not a treatment.

[Melbel]

I'm confused by this. I thought they discontinued studies because it "wasn't" working?

Unfortunately, HCQ was politicized and not prioritized as a legacy off patent, cheap drug. Studies showing no benefit were either (1) given way too late and only given to sicker patients compared to controls (i.e. the VA study); (2) given at too high of doses (i.e. the Brazil study and one arm of the WHO study with near lethal doses); and/or (3) were retracted due to unverifiable data (i.e. Lancet and NEJM studies). It is crucial to look beyond the media headlines and read the actual studies. Countries that are using HCQ at proper dosages early or prophylactically are doing much better than those who are using it late or not at all.

Here are two recent studies:

Michigan: Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with #COVID-19 (https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext?fbclid=IwAR3PANxrywZXB6JbR2C4HPMUHzAiIRCZ m4o_p3Nsg56OMY6fOJhaxGiqSmg#)
-82% received HCQ w/in 24hrs of admission
-HCQ reduced mortality by 66% (p=0.001)
-HCQ+AZM reduced mortality by 71% (p=0.001)
Takeaway: EARLY treatment at proper dosages is critical.
https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext?fbclid=IwAR3PANxrywZXB6JbR2C4HPMUHzAiIRCZ m4o_p3Nsg56OMY6fOJhaxGiqSmg#

India: https://indianexpress.com/article/india/vadodara-administration-drive-hcq-helping-in-containing-covid-19-cases-say-docs-as-analysis-begins-6486049/

[elbenn]

The early studies have not panned out. Hydroxychloroquine has not shown benefit with follow up over time and is not a treatment.

My understanding is the exact opposite. I thought that the recent studies have shown that it can be helpful. All of the contradictory studies are very confusing.

[carolinamama]

My understanding is the exact opposite. I thought that the recent studies have shown that it can be helpful. All of the contradictory studies are very confusing.

Super confusing! But it's a novel virus and we learn new information about the disease and treatments everyday. It's bound to continue changing as more and larger studies are done. That's a good thing, but hard to keep up with it.

[Melbel]

The early studies have not panned out. Hydroxychloroquine has not shown benefit with follow up over time and is not a treatment.

Not true. Read the actual studies. This is a great summary of all the studies to date: https://c19study.com/?fbclid=IwAR2TQWayQCy1_qnXjSNKvZsq_QNYLlrkRyGbIMIt 6386y4a6z4l4p0oTVdE

HCQ is far more promising with fewer side effects than Remdesvir, but you would not know that from the media stories. HCQ has been used to treat RA and Lupus for years with an overall strong safety rating. From 1955-2019 it was widely regarded as a safe, essential drug. It is also used to treat malaria and Babesia (a parasitic tick-borne infection).

[bisous]

My understanding is the exact opposite. I thought that the recent studies have shown that it can be helpful. All of the contradictory studies are very confusing.

I heard a study on NPR that because of the politicization of HCQ they were having difficulty getting volunteers to test the drug. I am confused by the whole issue, I confess but definitely heard that it was not as effective as hoped.