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Let me preference this by saying that this pandemic is serious. Lots of people are getting ill and it’s indeed exhausting medical resources in many places right now. The guidance from the CDC has bipartisan support andpeople are running out of reasons to not take this thing seriously. But since this is a thread that is largely fueled by statistics, I thought that I’d add my insight on considerations (though they don’t really matter in the grand scheme...I don’t want to come off like this is not to be taken seriously).
What’s the #1 reason for ICU admission? Respiratory failure (many ICUs sitting at about 50% for conditions like COPD exacerbation). Even amongst cardiac failure, respiratory failure still is the primary reason why they make their way into an ICU. One of the common reasons for ICU admission...sepsis...most commonly is a complication of pulmonary disease. How does someone die of cancer? Usually by infection and very often by sepsis/pneumonia/respiratory failure. Another leading cause of death? Alzheimer’s. How does someone withAlzheimer’s die? Often by sepsis/respiratory failure.
So you can see the challenge of categorizing deaths. Most people die of respiratory failure but that’s not what is being written down on their death certificate? When Grandma with end-stage cancer dies from sepsis or renal failure...what gets written on her death certificate? The answer is overwhelmingly cancer. Because of the prevalence of this virus there are going to be many people who are already very sick who will die with this virus. But it doesn’t mean it was the cause...again, people die from respiratory failure every day in very large numbers, even without a trigger. There are patients in nursing homes that are only alive by the grace of God and world class medical care...and many of them will be in the ICU within the year any given year. This virus has a high prevalence and testing is showing that there is a relatively high carrier phenotype that is essentially asymptomatic. Is it possible that that phenotype is only present in healthy individuals? Possibly, but the same errored logic was used when asymptotic HIV patients in the beginning of that epidemic. The truth is that as testing expands, the incidence of asymptomatic patients will expand and some of that patient will die from diseases other than Coronavirus, and since Coronavirus is in the mindful eye of literally everyone right now, including over worked physicians writing death certificates, I don’t think that there is any question that it will be overcalled. But at the same time our overall mortality rate may be lower by improved detection in less ill individuals...and our overall incidence rate for that same reason may be high. So when I hear that the US has the highest incidence of the virus in the world with a lower mortality rate...that’s probably a good thing. All I really care about is what I hear from other physicians. When I hear that a hospital is out of ventilators or that young physicians are dying while being exposed to insanely high viral loads from poor PPE...that’s what catches my attention. The EDs and ICUs are going to be busy...they were busy BEFORE this, so that shouldn’t be a surprise. It’s not like the average ICU has a bunch of extra ventilators collecting dust.
I'm sorry man. I am still not getting it how this premise fits with the current topic.
If someone with COVID-19 dies from respiratory failure, there is likely a <1% chance that they would have died at that moment if they did not have COVID-19 (Yes, I totally made that percentage up, but the point remains that the odds are so extremely low that even if this did occur in some people, it would not have much of an impact on the bottom line figures we are getting).
If a person that has lung/respiratory issues gets shot in the chest and dies because they now have a hole in their lungs, we aren't classifying that death as respiratory failure. No, we are classifying that person as a gunshot victim. The same principle applies here to COVID-19 in my opinion.
We can just agree to disagree here.