Guest Post by Willis Eschenbach [Note updates at the end]
Since the earliest days of the current pandemic, Italy has been the scary member of the family that you absolutely don’t want to emulate, the one cousin that gets into really bad trouble. The Italians have the highest rate of deaths from the COVID-19 coronavirus, and their numbers continue to climb. Here’s the situation today.
Figure 1. Deaths from the COVID-19 coronavirus expressed as deaths per ten million of the country population. Percentages of the total population are shown at the right in blue. All countries are aligned at the date of their first reported death. Most recent daily chart and charts of previous days are available by going here and scrolling down.
Italy, with over six thousand dead, is up well into the blue range. This is the range of annual deaths from the flu in the US. If the US coronavirus patients were dying at the same rate as in Italy, we’d have 38,000 coronavirus deaths by now in addition to the same number of flu deaths …
As a result, there has been much debate about why the Italian death rate is so high. People have suggested that it’s because they have one of the older populations in Europe. Others have noted that they often live in extended families. Some say it’s high numbers of smokers and polluted air. And some have pointed to their social habits that involve touching, kissing cheeks, personal contact during church rituals, and the like.
But we haven’t had good data to take a hard look at the question, or at least I hadn’t seen any.
In the comments to my post entitled END THE AMERICAN LOCKDOWN, wherein I passionately advocate just exactly that, I was given a link by a web friend, Mary Ballon, hat tip to her. It’s a report by a Swiss medical doctor about the COVID-19 deaths in Italy, well worth reading.
And in that document, there’s a further link to an Italian Government report. It’s in Italian of course, I have it on good authority that’s what they actually speak over there, who knew? They reported on the statistics of a large sample of the Italian deaths (355 out of 2003 total deaths at the time of the report). I got it, and the numbers are very revealing.
Let me start with the age distribution of the 2,003 Italians who had died at the time of the report. Figure 2 shows that it’s almost entirely old people.
Figure 2. Age of 2,003 Italians who had COVID-19 at the time of death.
Out of the 2,003 deaths, seventeen were people under fifty, and only 5 people under thirty died, while almost two hundred deaths were of people over 90. I’d read that the people dying in Italy were old, but I didn’t realize quite how old they actually are …
One thing I learned on this voyage was that the Italians distinguished between dying FROM the virus on the one hand, and dying WITH the virus on the other. Once I looked at the state of health of the Italian victims, however, I could see why they had to do that. Figure 3 shows the generous apportionment of serious diseases and conditions among the unfortunates.
Figure 3. Numbers of diseases in the sample of 355 Italians who had COVID-19 at the time of their death.
WOW! Yeah, they all had COVID-19. But three-quarters of them also had hypertension, a third had diabetes, a third had ischemic heart disease, a quarter of them had atrial fibrillation tossing clots into the bloodstream, and so on down the list.
As you can see from Figure 3, some people must have had more than one other disease besides COVID-19. Figure 4 shows the breakdown of the number of other diseases per patient.
Figure 4. Other diseases (comorbidities) of a sample of 355 of the 2,003 Italians who had COVID-19 at the time of their death.
For me, this was the most surprising finding of the entire study. Of all 355 people who died, only three did not have any of the diseases listed above. Three!
Looking at all of this as a whole picture, I had a curious thought about who they were representing. I thought … consider the characteristics of the people who died:
- More of the patients were over 90 than were under 60.
- The average age was 79 years.
- All but three of them had at least one other disease, so basically all of them were already sick.
- Three-quarters of them had two other diseases, and half of them had three or more other diseases. Half!
My thought was … that’s not a sample of the people in the street. That’s not a sample of an Italian family.
That’s a sample of a totally different population.
I was forced to a curious conclusion, both discouraging and encouraging. It is that most of these diseases were probably not community-acquired. Instead, I would hazard a guess that most of them go by the curious name of “nosocomial” infections, viz:
nos·o·co·mi·al
/ˌnōzōˈkōmēəl/
adjective MEDICINE
(of a disease) originating in a hospital.
Here’s what I suspect. I think that the COVID-19 disease got established in a couple of areas in Italy well before anyone even knew the disease was there, perhaps even before the Chinese recognized it as a novel disease.
And in some fashion, it got into the medical system. Doesn’t matter how. But once there, it was spread invisibly to other patients, in particular the oldest and weakest of the patients. It went from patient to patient, from patient to visitor and back again, and it was also spread by everyone in the hospital from administrators to doctors and nurses to janitors. In many, perhaps most cases, they didn’t even know they were sick, but they were indeed infectious.
And that’s why the pattern of the Italian deaths is so curious, and their number is so much larger than the rest of the world. It’s not a cross-section of the general population. It’s a cross-section of people who were already quite sick, sick enough that they were already visiting doctors and having procedures or being bedridden in hospitals. It was 85-year-olds with three diseases.
And it’s also why the death rate in Italy is so high—these people were already very ill. I can see why the Italians are distinguishing between dying FROM the virus and dying WITH the virus.
DISCUSSION AND CONCLUSIONS
As I said, this is both discouraging and encouraging. It’s discouraging because getting the virus out of a modern medical facility and a dispersed medical system isn’t easy. Italy has a big job ahead. And it’s discouraging because it means that the medical personnel who are so needed for the fight are getting the disease as well. Very likely they won’t die from it, but they will be hors de combat for three weeks or so. No bueno.
On the other hand, it is encouraging in a couple of aspects.
First, it lets us know what we need to do to prevent the Italian outcome. We have to, must, keep the virus out the medical system.
- We need to seriously quarantine the sufferers away from other sick people.
- We need to set up testing facilities at all medical centers and test the medical personnel daily.
- In areas with a number of COVID-19 infections, we need to set up separate field hospitals. There are a number of commercial versions of these that are expandable by adding modules, and are pathogen-tight, with airlocks at the doors, HEPA exhaust filters and negative air pressure maintained throughout. We know how to do this stuff, we’ve just got to do it.
- We need to test in-hospital patients at the time of their arrival and continue to test them at intervals during their stay.
- We’ll have to be very careful with visitors to patients in the hospitals
It’s a big job, and we absolutely have to do it.
Second, it cautions us to not claim that everyone who tests positively for COVID-19 after death actually died FROM the disease. They may very well have died WITH the disease.
Finally, the other reason it’s encouraging that Italy’s infection is likely nosocomial is that it removes Italy as the mysterious bogeyman of the COVID-19 pandemic. In addition, it points to just what we have to do.
IF (and it’s a big if) we take the proper precautions to protect our vulnerable medical system and personnel, I don’t think that the US will get as high a death rate as Italy has today.
Note that this makes me seriously question the idea of “flattening the curve” … if you let the virus into your hospitals and medical system you’re toast, no matter how flat the curve is.
So let’s end this crazy American lockdown, there’s a whole raft of work to be done shoring up our medical sector to withstand the coming wave, and it can’t be done at home with our heads in the sand, hundreds of thousands of people not working, jobs disappearing daily, and our economy in a shambles …
My very best regards to all, stay well in these parlous times,
w.
As Usual: I ask that when you comment, QUOTE THE EXACT WORDS YOU’RE DISCUSSING. Knowing who and what you’re referring to avoids endless misunderstandings and arguments.
[UPDATE]: Just after publishing this, I was reading about loss of the senses of smell and taste being symptoms of coronavirus infection. In the article, I found this:
Hopkins says an Italian doctor shared that “he and many of his colleagues had lost their sense of smell while working in northern Italy dealing with COVID-19 patients.”
… “many of his colleagues”. Kinda support my theory of nosocomial infection in Italy.
[UPDATE 2]: In the news today, the headline Coronavirus: 4,824 Italian Health Workers Are Infected … one in ten of their coronavirus cases are health workers …
[UPDATE 3]: Here’s a graph showing just how different Italy is from the other countries with numbers of cases …
PS—Let me take this opportunity to provide a wider readership to a comment that my obstropulous (yes, it’s a real word) good friend Steve Mosher posted on my blog yesterday. He’s living in Korea and has been a close observer of just how they are succeeding in controlling the virus. He spells out the level and the details of what we have to do. His comment is below, my thanks to him.The key is changing the criteria for testing. Here [in Korea] we test and track.
An employee of a call center in Seoul, was infected.
Office had 207 people.
March 8th. he tested positive.
EVERY person in that office was tested. today 152 have tested positive, they tested floors above and below his floor. Today 3 more from the 11th floor were found and 1 contact.
They are now tracing the contact, and the contact’s contacts. All will be tested. The business was in a residential building. 553 of the people in that building were tested. floors 13-18
This little beastie lives on surfaces for up to 3 days. See that elevator button? the hand rail on the stairs? the bathroom door handle? the coffee cup that pretty girl behind the counter handed you? it’s there. Now in my building we have hand sanitizer by the elevator buttons. you get in the habit of not touching public pretty quickly. Trust me I am not a germ phobe, but the changes have been simple when they are reinforced.
Let me give you a little taste of the highly detailed info we get.
Info that is shared daily in one spot, I will include some of the earlier call center case snippits
“In Daegu, every person at high-risk facilities is being tested. 87 percent completed testing and 192 (0.8 percent) out of 25,493 were confirmed positive. From Daesil Covalescent Hospital in Dalseong-gun, 54 additional cases were confirmed, which brings the current total to 64. In-patients on 6th and 7th floors are under cohort-quarantine.”
“From Guro-gu call center in Seoul, 7 additional cases (11th floor = 2; contacts = 5) were confirmed. The current total is 146 confirmed cases since 8 March. (11th floor = 89; 10th floor = 1; 9th floor = 1; contacts = 54)”
“From Bundang Jesaeng Hospital in Gyeonggi Province, 4 additional cases were confirmed. The current total of 35 confirmed cases since 5 March (20 staff, 5 patients in inpatient care, 2 discharged patients, 4 guardians of patients, 4 contacts outside the hospital). The 144 staff members who were found to have visited the hospital’s Wing no. 81 (where many confirmed cases emerged) were tested, 3 of whom tested positive.”
“Five additional confirmed cases have been reported from the call center located in Guro-gu, Seoul, amounting to a current total of 129 confirmed cases from the call center since 8 March. As of now, 14 confirmed cases in Gyeonggi Province has been traced to have come in contact with a confirmed patient who is a worker at the 11th floor call center at a religious gathering. Further investigation and tracing are underway.”
Test, Trace, Test more.
A random test in Iceland found 1% infected. 50% asymptomatic.
If the US persists in only testing the symptomatic you won’t squash this bug.
Our cases are going up in Seoul. So we will have 15 days of voluntary social distancing.
go to work
stay away from crowds
wash your hands
wear a mask
don’t touch your face
I gotta say this (I have not perused all the comments, if I’m repeating someone else’s observations, I apologize for taking up pixels), in your very first chart, your Figure 1, that red line, supposedly for the course of the Wuhan virus in China, caused my B.S. alarm to ring, loudly. That red line is much too smooth, that does not look like a graph of empirical data, that looks like a graph of a model-produced trend-line. In which case, I suspect the “model” was programmed to produce exactly and only what the Chinese Communist Party wanted it to show. In other words, it’s a total fabrication. Can there be any other explanations for such a smooth line?
Steven Mosher March 24, 2020 at 10:19 pm
You keep bringing this up. First, here was my actual prediction, in this post of mine:
Not a hard number. The curve could bend up or down.
And for number of deaths, I said:
Early days. More uncertain.
First, I didn’t specify a number in either case. I said “on the order of”. I said “give or take”. I said it was not a hard number, and that there were lots of things that could happen to change the numbers.
Given those caveats and the fact that AFAIK I was the first person to make such a public estimate, I’d say I did well. There were 60 deaths in Korea at the time, and it certainly looked like it could go through the roof.
Next, you say “the curve for Korea was wrong as I pointed out at the time”. I just reread every comment you made on that post of mine and I can’t find you saying that … although it’s a long thread and I could have missed it.
Nor, as far as I can find, did you make a corresponding estimate at the time of the Korean deaths. You didn’t say how many you thought there would be … I did. So for you to now pretend that I predicted hard numbers and you were all prescient is historical revisionism. You didn’t make an estimate, I did, and now you want to nitpick and misquote my estimate?
Next, as I said about the Korean data back when I made the estimate, “It’s still early, deaths are still happening, so this will be more uncertain.” However, now we have a bit more data. The Gompertz curve is now saying that Korean deaths will end up on the order of 210 … and yes, the usual caveats apply—there are lots of things that could push that estimate either up or down.
Next, you say that “The problem with Gompertz and Farr’s law is they are non mechanistic.
For a mechanistic model you want SIR compartmental models.”
In general, a more complex model is likely to give a better answer. Presumably based on such models, you say above that the Korean deaths :
“Next, you say “the curve for Korea was wrong as I pointed out at the time”. I just reread every comment you made on that post of mine and I can’t find you saying that … although it’s a long thread and I could have missed it.”
You want to double down after we hit 94 I questioned you again and you re interated your prediction
of 100.
But I guess now your predictions are not really predictions?
basically it is time to say that Gompertz is not a good model.
I explained to you that we had two other zones popping .
maybe if Mann had fit a gompertz you’d have less tolerance for the mistake
Steve, first off, please quote where I “doubled down” on my 100 number. AFAIK, I just pointed out that we hadn’t hit 100 deaths in Korea at that point.
Next, you say “But I guess now your predictions are not really predictions?”
I hedged them about from day one, saying that THEY WERE NOT HARD NUMBERS and that THE UNCERTAINTY WAS LARGE and that THINGS COULD CHANGE TO PUSH THEM UP OR DOWN. I put that in CAPITALS because you continue to ignore it. I did it in part because I knew how uncertain that they were, and in part because I knew some prick would come along and hassle me if they weren’t exactly right …
Given those caveats, are they “predictions”? Yes, just fairly general ones.
Is fitting a Gompertz curve to the data a “good model”? Well, since the curve fits the death results of every country to date, I’d say yes. Is it predictive? Well, it’s done a pretty good job, I’d say. So I’d disagree that fitting it was a “mistake”.
Finally, all you do is sit on the sidelines and snipe. AFAIK, your vastly superior models haven’t given us one number as a prediction. But when I do, you want to tear it apart … look, I’m not trying to predict it to within ± 1% or something. I’m trying to get a handle on it. When the Korea death data first came out, it looked like it could be going to be going up, up, up into the multiple thousands. That was scary to me.
But when I fitted the curve, it said in the hundreds, not the thousands. I thought that was valuable information, and it has been borne out. Yes, it looks more like 200 than the 100 I estimated while SAYING IT WAS EARLY DAYS AND I HAD LITTLE INFORMATION …
So what? Seriously, so what? Why this incessant unsuccessful reaching up on your part to try to bite my ankles? What’s the point? Yes, the Gompertz curve is a rough tool … but it has a huge advantage, in that you don’t have to know the R0 and the time of infectivity and the other dozen things that go into your model … and we still don’t have that data.
Heck, over at Judith Curry’s always excellent blog there’s a new post by Nic Lewis entitled COVID-19: Updated data implies that UK modelling hugely overestimates the expected death rates from infection … the experts can’t get your vaunted models right, and you want to rag on me for back-of-the-envelope calculations in the right order of magnitude?
Get a life, bro’ … this is a very ungood look on you.
Please stay well, as much as we disagree, you’re a very valuable contributor to all of the ongoing discussions.
w.
PS—Mosh, here’s another expert modeler of the kind you seem to prefer … The Scientist Whose Doomsday Pandemic Model Predicted Armageddon Just Walked Back The Apocalyptic Predictions
He predicted 500,000 deaths in the UK, now says 20,000 … and you think my prediction is worth dumping on? Sadly, his model was accepted by both the UK and the US and led to the current lockdown mania …
w.
And another … Inaccurate Virus Models Are Panicking Officials Into Ill-Advised Lockdowns.
Yeah, those models are so much better than considering Gompertz curves as a rough-and-ready estimator, all right … they’ve already cost us TRILLIONS via this crazy lockdown. Well done!
w.
show me where I prefer him?
quote my words.
haha
what I objected to was simple Willis. YOU DID NOT LOOK AT THE DATA!
if you looked at the local data it was obvious gompertz would not work
same for deaths.
BUT you had a story to sell,
I’m betting you still haven’t looked at the local data.
as for biting ankles, you’re a big boy
First you were aggravating.
Then you were amusing.
Now, you’re just boring.
Go whine at someone else. Not interested.
w.
Over 130 now willis
headed to 10000
You didn’t listen
you still are not
You could just say , thanks steve! next time I’ll look at the data rather than fitting a curve
Go bother the guy who used one of your models and wildly overestimated Britain’s deaths, leading to all kinds of misjudgments.
And if you think the Korean deaths are headed for 10,000, I’m not going to comment on that prediction at all.
Finally, you foolishly say I should have said: “next time I’ll look at the data rather than fitting a curve” … um … er … just what do you think I was fitting the curve to? The air?
You truly don’t seem to understand the concept of using a “back-of-the-envelope” calculation to constrain the possibilities.
And seriously … don’t you have something better to do with your time than to publically fail at harassing me for making an early estimate based on early data? I’m out here doing things, and you’re standing on the sidelines and whining and bitching about a meaningless point? That’s your contribution?
Your choice. Me, I’m a doer.
w.
Just when I start liking Mosher for the good stuff he can do, I see why everyone picks on him, and downright slams him. He seems to like it. He will even go as far as to make some detailed and fake stuff up, which is all twisted, and try to pin it on someone to see if they will play his game and defend it.
Willis, I feel for you here. I am sorry you have to deal with this crap and hope this does not deter you from the free stuff you do that’s worth gold to the rest of us.
I have noticed that older people are always handing their phones to other people because they can understand what is being said.
With phones we are always handling them with, usually unwashed hands, and then putting them right to our faces.
For all those who think it is just old farts with underlying health problems that die.
A UK 21 year old healthy girl died today and a 37 year old UK ambassador to Hungary also died.
Was Coronavirus is the autopsy as cause of death?
No other conditions present?
is healthy verified or only said ?
“For all those who think it is just old farts with underlying health problems that die.”
No one has ever said that only old people with underlying health problems die.
What the stats clearly show is that out of all the people who die, that demographic represents almost everyone.
Some people are clearly saying that only old and sick people are dying.
Even the yearly flu kills healthy young people.
It’s all about the percentages.
I know of 3 healthy younger people who ended up with pneumonia with this year’s influence.
influenza
Italians over 65, and those with health problems, get an annual flu vaccination. Free.
As do a lot of other European citizens.
In the UK the old, sick and children get annual flu vaccination.
The only people being admitted to hospital in the UK, for sars-cov-2, are those with serious respiratory problems. Elective surgery for non-life-threatening problems has all been cancelled. My local hospital is not even admitting people to emergency care for minor injuries/illness.
There is always the possibility that there is common denominator in the gene pool of some localities which make people more susceptible to succumbing.
Also are there customs in some localities such as a greeting involving close personal contact?
from the swiss doctor Regarding the situation in Italy: Most major media falsely report that Italy has up to 800 deaths per day from the coronavirus. In reality, the president of the Italian Civil Protection Service stresses that these are deaths „with the coronavirus and not from the coronavirus“ (minute 03:30 of the press conference). In other words, these persons died while also testing positive.
As Professors Ioannidis and Bhakdi have shown, countries like South Korea and Japan that introduced no lockdown measures have experienced near-zero excess mortality in connection with Covid-19, while the Diamond Princess cruise ship experienced an extrapolated mortality figure in the per mille range, i.e. at or below the level of the seasonal flu.
Current test-positive death figures in Italy are still less than 50% of normal daily overall mortality in Italy, which is around 1800 deaths per day. Thus it is possible, perhaps even likely, that a large part of normal daily mortality now simply counts as „Covid19“ deaths (as they test positive). This is the point stressed by the President of the Italian Civil Protection Service.
However, by now it is clear that certain regions in Northern Italy, i.e. those facing the toughest lockdown measures, are experiencing markedly increased daily mortality figures. It is also known that in the Lombardy region, 90% of test-positive deaths occur not in intensive care units, but instead mostly at home. And more than 99% have serious pre-existing health conditions.
“More than 99%” is an wild exaggeration.
I have seen zero data suggesting anything like that number.
That would suggest a healthy person has virtually no risk of dying.
We know this is not true.
The risk of any serious medical condition is greatly elevated for the elderly and those who have serious health problems.
But exactly what counts as “serious” is open to interpretation.
Hypertension can be either quite mild or it can be life threatening.
It can be well controlled, or uncontrolled, it can be being treated it it can be undiagnosed and untreated.
Given that…is it accurate to call it blanketly a “serious pre-existing health condition”?
No one dies from mild pre-hypertension, although it is a risk factor for hypertension later in life and greatly increases risk of many other medical conditions.
It can increase risk of stroke or heart attack…but people can have these without ever having elevated blood pressure too.
In the Dutch study, it describes about 1/4th of those hospitalized had any other medical conditions.
It does not say what this proportion is for those who dies, but many other sources have described numerous examples of deaths among people with no health conditions who were not elderly.
About the [possible] use of antibody-rich blood plasma for cure and prevention:
Article: How blood from coronavirus survivors might save lives
New York City researchers hope antibody-rich plasma can keep people out of intensive care.
Source: https://www.nature.com/articles/d41586-020-00895-8
Some excerpts:
“US researchers are hoping to increase the value of the treatment by selecting donor blood that is packed with antibodies and giving it to the patients who are most likely to benefit.”
“A key advantage to convalescent plasma is that it’s available immediately, whereas drugs and vaccines take months or years to develop. Infusing blood in this way seems to be relatively safe, provided that it is screened for viruses and other infectious agents. Scientists who have led the charge to use plasma want to deploy it now as a stopgap measure, to keep serious infections at bay and hospitals afloat as a tsunami of cases comes crashing their way.”
Antibody plasma kills the virus: “But Liang Yu, an infectious-disease specialist at Zhejiang University School of Medicine in China, told Nature that in one preliminary study, doctors treated 13 people who were critically ill with COVID-19 with convalescent plasma. Within several days, he says the virus no longer seemed to be circulating in the patients, indicating that antibodies had fought it off. But he says that their conditions continued to deteriorate, suggesting that the disease might have been too far along for this therapy to be effective. Most had been sick for more than two weeks.”
“In one of three proposed US trials, Liise-anne Pirofski, an infectious-disease specialist at Albert Einstein College of Medicine, says researchers plan to infuse patients at an early stage of the disease and see how often they advance to critical care. Another trial would enrol severe cases. The third would explore plasma’s use as a preventative measure for people in close contact with those confirmed to have COVID-19, and would evaluate how often such people fall ill after an infusion compared with others who were similarly exposed but not treated. These outcomes are measurable within a month, she says. “Efficacy data could be obtained very, very quickly.”
“Even if it works well enough, convalescent serum might be replaced by modern therapies later this year. Research groups and biotechnology companies are currently identifying antibodies against the coronavirus, with plans to develop these into precise pharmaceutical formulas. “The biotech cavalry will come on board with isolating antibodies, testing them, and developing into drugs and vaccines, but that takes time,” says Joyner.”
Even the best treatments for viral infections are highly sensitive to the stage of the illness of the patient.
In Ebola testing for the Regeneron monoclonal antibody, it cured over 94% of people who were recently infected , had low viral loading in serum assays, or had recently presented with symptoms.
But in patients with high plasma viral counts, the success rate of even this very effective treatment was well below 50%. At that stage, most patients died, no matter what was done.
You can’t use a map unless you know where you are and know if you are going in the right direction. Before we do RANDOM testing of 100 individuals with antibody testing (to determine who has had Corona and are immune) and 100 swabs to determine number of active cases in the population, and repeat this every day, we have no idea where we are and where we are going. If we decrease social distancing and the random test still shows more immune people and less active cases, we can continue, if not, it is back to lockdown ASAP. But we have to know. DO THE RANDOM TEST. Aren’t there any scientists out there?
How do we do random tests?
Knock on doors?
Stop traffic?
Pick people out of a phone directory?
What rights have people to participate or refuse?
Who is gonna do it?
Who has funding, or authorization, or the manpower…or the test kits?
Scientists are being told to stay home and social distance too.
What sort of scientists are qualified to go around testing people?
Medical information is protected and privileged…has HIPAA been suspended?
It has not.
And what sort of test?
Nasal swabs are invasive and uncomfortable and expensive and must be done with careful adherence to PPE, both to protect the tester and the testee.
Is the guy testing me infecting me? Does he change his gloves with every patient?
How and when was he trained?
What is a nasal swab test actually saying?
Not really related to Italy, but I have made a simulator showing what different levels of distancing can do, and is attempting to answer the question of what level of suppression will work to avoid overwhelming the medical system… https://naturalclimate.wordpress.com/2020/03/24/coronavirus-model-what-level-of-suppression-is-enough/
very Nice Micheal
This link gives the distribution by age of patients in The Netherlands: https://www.parool.nl/nederland/cijfers-rivm-meeste-patienten-tussen-55-59-jaar-oud~b06453055/?referer=https%3A%2F%2Fwww.google.be%2F
It actually shows
– distribution by age of people tested positively
– distribution by age of people hospitalized
– distribution by age of deaths
Unsurprisingly the peak shifts right.
Conclusion from this
– all age groups get it equally, the first graph is almost a cross section of the population (apart from kids)
– mostly the old die
I find this undermines your reasoning to come to the hypothesis of “I was forced to a curious conclusion, … that most of these diseases were probably not community-acquired. Instead, I would hazard a guess that most of them go by the curious name of “nosocomial” infections”
Note that you first call this a guess, then a suspicion and then you put it forward as “likely”.
You are every inch right that this can be a hypothesis, but you should only start to call it likely based on good evidence.
That famous swiss doctor report is again a list of incomplete quotations. 2 examples
While the Italian report indeed does reveal things it should be read well, eg on the deaths -40. It says they are nearly all “with serious pre-existing pathologies (cardiovascular, renal, psychiatric pathologies, diabetes, obesity).”. Note that they call diabetes and obesity a serious pre-existing pathologie. According to CDC data 10% of Americans have diabetes and a whoppy 40% is obese. Ignoring that there is probably overlap one could say that half of the US population has at least 1 serious pre-existing pathologie and thus is at risk!
The Swiss doctor says that 90% does not die in an IC unit. The report goes on to mention that patients do not make it to the IC unit in time, because of an overload on the medial system.
If you are not an expert in a domain it is best to stay out of it
The newest version of the Edge browser has a built in function that will translate entire web pages.
The link you posted would be worthless to me without it, but I can read it in English with one mouse click.
Thank you for the link!
Eddie
Excellent comment, thanks.
Rgds
J.-P. Dehottay
Medical experts tell us that when it comes to people above the age of 50 and especially 60, nearly everyone has a “comorbidity”.
How many people who are 60 take zero medications?
How about 70?
75?
80?
Other questions abound: Someone with mildly elevated blood pressure in the US is strongly advised to treat it. Below a certain limit, this condition is not strictly speaking hypertension, but is prehypertension.
With medications both prehypertension and hypertension can be either well controlled or poorly controlled, or uncontrolled.
But in postmortems, are these distinctions being accounted for?
Is anyone taking a medication being lumped together?
It is likely many people are undiagnosed (but hypertensive) when they arrive in a hospital with a COVID infection. It may well be that pneumonia raises a person blood pressure above the limit of hypertension.
Are they talking about what a person was measured as having while they were well, or after arriving at a hospital or ICU? Zero data on this from the sources reporting on these things.
Later stages of illness often cause a drop in blood pressure as the body goes into shock.
A quick review of an internet search reveals that pneumonia is given as both raising and lowering BP.
There is an awful lot of parsing required to know what conclusions can validly be made of this data.
“If you are not an expert in a domain it is best to stay out of it”
don’t expect any one here to listen.
well, I’ll listen
A look at stanford data science
https://youtu.be/GgaY099XqlI?t=781
Hi Willis, another aspect of nosocomial deaths is from ther respirators. This US study https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1741-6787.2006.00066.x says ” Preventable adverse patient events, including hospital‐acquired infections, are responsible for 45,000 to 100,000 deaths annually, …in the United States (Kohn et al. 2000). Ventilator‐associated pneumonia (VAP) is the leading cause of nosocomial infection in critically ill adult patients around the world, surpassing central line‐associated bloodstream infections and catheter‐associated urinary tract infections (Patel et al. 1998; Centers for Disease Control and Prevention [CDC], 2003). The incidence of VAP ranges from 4% to 42% of all mechanically ventilated intensive care unit (ICU) patients…”.
Some people have said people over 60 are not getting ventilators in Italy, but I haven’t been able to verify that, and if so how consistent is the practice and when did it start.
Willis
There are a lot of underlying reasons for what is happening in Italy. It isn’t just the numbers.
1. there are 330,000+ Chinese working in 4000+ Chinese owned factories in Italy.
2. The outbreak happened shortly after the Chinese new year (January 25th – February 8th) ended. , (One guess as to where a lot of the Chinese workers in Italy went for the most important holiday.)
3. The Italians did not close their borders or stop air traffic from China because they feared being called racists. Political correctness is a hallmark of left leaning governments.
4. Italians are very touchy-feely. They kiss on both cheeks, young and old, every time they meet; it is to them what a hand shake is to us.
5. They have large families which get together often and most certainly on holidays or for sporting events.
6. Evenings are spent out and socializing; they walk everywhere and eat out often. They are rarely alone.
7. A large percentage of the population smoke, male and female, which has a negative affect on the the lungs.
7. At mass they use a common challis and many go to mass several times a week.
I am sure I missed some, but in short it was the perfect storm. Their customs are based on close contact, they are heavy smokers; add to that a massive influx of COVID-19 carriers and a government that did little to shut the gates. Sometimes it is more than just statistics.
https://www.rebellionresearch.com/blog/northern-italy-wuhan-partners-for-better-or-worse
https://uk.reuters.com/article/uk-health-coronavirus-italy-timing/italian-scientists-investigate-possible-earlier-emergence-of-coronavirus-idUKKBN21D2IT
The article points out that this claim is far from proven. It does not speculate that the Wuhan virus might be a joint Milan/Wuhan venture, that a bat virus from Wuhan infected some in Milan before it mutated into its novel evil form. Wild speculation, with lots of ‘coulds’. Maybe they will exhume some early Milan victims.
the swiss doctor is deceptive he published data of march 7th initaly the 24th sayong no signal on mortalityt and at that time it was true..
but this is deceptive
A question for a statistician…
I’m curious if someone can interpret this and tell me if this represents a statistical artifact of our testing procedures in the U.S? The “Infection Trajectory” chart would suggest we now have the most cases AND the fastest rate of increase of cases.
To see the U.S. hover over the curves. Ours is furthest to the left.
https://www.visualcapitalist.com/infection-trajectory-flattening-the-covid19-curve/
We are now doing the most testing of any country, which is why cases have exploded up far faster than the number of deaths, and the number of patients in critical condition.
All of these numbers are rising, but for a long time we were hardly doing any testing, and now we are doing a lot of testing…but as far as I know, we are not testing large numbers of people not known to have been exposed, and are not testing anyone at random.
So even with greatly expanded testing, we are surely only seeing the tip of the iceberg regarding the number of people actually carrying or have carried the virus.
And it may be many people are dying without going to hospitals.
Typically, people who die of flu at end of life stage include a large number of people who die in their bed at home after a long period of being bedridden or close to it.
Correction to above post on the infection trajectory: is the graph telling us (in the States) that we have the fastest rate of increase – and may soon have the largest number of confirmed cases?
I have open the link and will have a close look, but I wanted to offer some thoughts first.
One is that, due to many possible and actual disparities between countries and even regions and states and cities within a country in how information is tallied, data is collected, and how terminology is defined (such as what counts as “critical” condition, when is a death due to COVID, etc), and other such vagaries, all of these graphic comparisons ought likely be taken with a larger than usual grain of salt.
Superimposed on the above…in the midst of any crisis, particularly one in which people are not able to be in the sorts of places that typically compile statistics, all information is spotty and hence dubious, at best.
In a way this situation is akin to an earthquake or hurricane, in which info from ground zero is more likely than not incomplete at best, at least from the aspect of detailed information.
” is the graph telling us (in the States) that we have the fastest rate of increase – and may soon have the largest number of confirmed cases?”
Yes cases are dominated by NY, they have a doubling time of ~4-5 days, But it is slowing
lockdown will start to bend the curve there, already has.
Other states are behind on testing. Marti Gras ( they allowed it to go on) will start to show up
in hospitals. Spring break seeds will return home .. more cases.
where will the USA end up? past China but only on cases not on deaths,,,,
unless hospitals get swamped.
state data
https://docs.google.com/spreadsheets/d/18oVRrHj3c183mHmq3m89_163yuYltLNlOmPerQ18E8w/htmlview#
Pretty soon there will be county data for the USA, THAT will tell you a lot. its the Granularity that
planners use.
So Ignore all national data, unless you want to muck about and make mistakes. County data, or city data if you can get it.
The Department of Public Health for states track by county.
https://coronavirus.maryland.gov/
Yes, Florida has detailed info on every single case.
I was thinking that other states have similar data.
The CDC had long ago stopped trying to collect and collate all the data from the whole country.
They probably do not have the manpower or resources to do it, and it is redundant and tedious in any case.}
Detailed info for Florida by county here:
https://experience.arcgis.com/experience/96dd742462124fa0b38ddedb9b25e429
Complete info page for Florida here:
https://floridahealthcovid19.gov/
Phil. March 17, 2020 at 7:37 pm
michel March 17, 2020 at 1:04 am
“Finally, a plea for proportion. US coronavirus deaths are currently at 67, we’ll likely see ten times that number, 670 or so, might be a thousand or three”
Looking at the US data the number increases by a factor of ten in ~12 days so I would anticipate being over 1000 deaths by the end of the month.
I posted this in another of Willis’s posts just over a week ago. Looking at the death stats it seemed clear to me that the US would clear 1,000 by the end of the month (at that time there were 67 deaths), unfortunately if anything that was an underestimate. Deaths are doubling still in 2-3 days so I expect us to be over 2,000 by the end of the month. I believe that the rate in NY is starting to flatten so if they can maintain control of the hospitals that should be good but other states which have hitherto been relatively unaffected are sating to pick up so I think the overall rate will stay exponential for a week or so.
what works
https://www.theguardian.com/commentisfree/2020/mar/20/south-korea-rapid-intrusive-measures-covid-19
I have the app, but my distance set is 5 minutes by taxi.
went off twice this morning. Now I know 2 places to avoid today when I go out
Stephen, a query on the SK testing if I may…
…when a case is identified do you know “how far removed” contacts are traced and tested?
In the example you’ve highlit of a high-rise.
In the high rise you said a floor plus one above & below, and more floors IIRC when +ves (positives) were found.
Was each +ve then queried as to, say, friends, businesses visited, workplace, public places such as a restaurant?
Would direct contacts only be checked (or not), attempts to find visitors to the public places?
“In the example you’ve highlit of a high-rise.
In the high rise you said a floor plus one above & below, and more floors IIRC when +ves (positives) were found.
According to previous reports, at first they tested all employees on floor 10, 11, 12.
Guy sat on the 11th floor of a call center. Its on the news every night. Poor company.
Then they announce that 553 residents of the building would be tested. I think it was
floors 13-18 ( I could go reread it )
Was each +ve then queried as to, say, friends, businesses visited, workplace, public places such as a restaurant?
From the Reports, family members are all tested ( 80% of transmission in china was family)
Then Contacts tested.
The Travel history is collected and we have apps where you can see where various
“cases” travelled. Then you can decide if you want to report for testing.
They don’t track down Everyone who went through a station.
If you went through station X, then you can go present and ask for a test.
In that case if you have no symptoms they might charge you 132 bucks
Would direct contacts only be checked (or not), attempts to find visitors to the public places?
Contact tracing App
http://www.koreaherald.com/view.php?ud=20200326000987
Many thanks, and the link, I also found an earlier sciencemag article link.
This building had both residential and business premises, I had misunderstood that the business and the residential were different examples in different places.
I might say there’s an element of both active & passive intervention.
Active – we’re going to test people.
Between the two – you get a warning of nearby cases if you have the app/kit/user skills.
Passive – location information is available, up to the individual to discover/choose.
Datasharing on people’s lives seems key. And there is (recent) legislation to provide for this.
I’m in the UK and of course concerned that the level of testing and tracing is woefully short.
I struggle to see, despite the seriousness of the situation, that the UK would be willing to row back on data protection, privacy and personal freedom to allow this to work. Even temporarily.
Despite it being demonstrably successful and an example of best practice.
Much technical literacy is also needed in the population. Need smartphone as a minimum.
On the plus side might engage the young more who are the heaviest users of such tools.
Yes, in the UK we have suffered badly from the first cases because the Government didn’t name the people or at least give an exact location of where they lived or exact locations of where they had been.
Nobody had any idea if they had been in contact with them or their surroundings, the Government relied on the patient remembering who had had contact with.
Madness.
From Willis’ article: I think that the COVID-19 disease got established in a couple of areas in Italy well before anyone even knew the disease was there, perhaps even before the Chinese recognized it as a novel disease.
Yesterday (Weds) on UK Column they saI’d there was a doctor who said that there was a new disease causing pneumonia in Italy BEFORE this thing started in China.
(I’d need to go back and find exactly whar was said, buts too hard for me in this phone.)
https://www.ukcolumn.org/ukcolumn-news/uk-column-news-25th-march-2020
Anedoctal: My parents’ GP, who is also a rescue volunteer, said he noticed an unusually high rate of pneuomonia back in November 2019.
Flu surveillance system in the US says 2020 was an “up” year
“Here’s what I suspect. I think that the COVID-19 disease got established in a couple of areas in Italy well before anyone even knew the disease was there, perhaps even before the Chinese recognized it as a novel disease.”
Yes, one more piece of the puzzle. More and more it is clear that this originated in the USA.
It is not possible for the Australian sources of infection 2 or 3 weeks ago to show huge numbers from the USA (three times those from China and we have significant Chinese population and significant travel from) unless it was there *before* the Chinese found it.
My understanding is they traced back to November 2019, the fish market was not ground zero, it was just where a clear cluster occurred leading them to the diagnosis.
– Ft Dettrick floods in August 2019.
– Mysterious ‘vaping ling disease’ in October, probably misdiagnosed COVID-19.
– CDC shuts Ft Dettrick (too late!) due to failed effluent treatment systems and staff ‘accidental’ leakages.
– Why is the CDC silenced at the moment?
Right now the source does not matter, this evil genii must be put back in a bottle and the bottle destroyed.
More and more it is clear that this originated in the USA.
(See my post for more)
1. there are 330,000+ Chinese working in 4000+ Chinese owned factories in Italy.
2. The outbreak happened shortly after the Chinese new year (January 25th – February 8th) ended. , (One guess as to where a lot of the Chinese workers in Italy went for the most important holiday.)
re: “More and more it is clear that this originated in the USA.”
From: https://wattsupwiththat.com/2020/03/24/the-italian-connection/#comment-2946341
“How a bat virus goes to pangolins and picks up a wicked spike/cleaver feature.”
https://www.foxnews.com/science/the-coronavirus-did-not-escape-from-a-lab-heres-how-we-know
See the article for links to scientific papers. For those who do not follow links, here is the gist:
————————-
“A group of researchers compared the genome of this novel coronavirus with the seven other coronaviruses known to infect humans: SARS, MERS and SARS-CoV-2, which can cause severe disease; along with HKU1, NL63, OC43 and 229E, which typically cause just mild symptoms”
“[they] looked at the genetic template for the spike proteins that protrude from the surface of the virus. The coronavirus uses these spikes to grab the outer walls of its host’s cells and then enter those cells. They specifically looked at the gene sequences responsible for two key features of these spike proteins: the grabber, called the receptor-binding domain, that hooks onto host cells; and the so-called cleavage site that allows the virus to open and enter those cells.”
“That analysis showed that the “hook” part of the spike had evolved to target a receptor on the outside of human cells called ACE2, which is involved in blood pressure regulation. ”
“SARS-CoV-2 is very closely related to the virus that causes severe acute respiratory syndrome (SARS), which fanned across the globe nearly 20 years ago. Scientists have studied how SARS-CoV differs from SARS-CoV-2 — with several key letter changes in the genetic code.”
“The overall molecular structure of this virus is distinct from the known coronaviruses and instead most closely resembles viruses found in bats and pangolins that had been little studied and never known to cause humans any harm.”
“One scenario follows the origin stories for a few other recent coronaviruses that have wreaked havoc in human populations. In that scenario, we contracted the virus directly from an animal — civets in the case of SARS and camels in the case of Middle East respiratory syndrome (MERS). In the case of SARS-CoV-2, the researchers suggest that animal was a bat, which transmitted the virus to another intermediate animal (possibly a pangolin, some scientists have said) that brought the virus to humans. In that possible scenario, the genetic features that make the new coronavirus so effective at infecting human cells (its pathogenic powers) would have been in place
before hopping to humans.”
“In the other scenario, those pathogenic features would have evolved only after the virus jumped from its animal host to humans. Some coronaviruses that originated in pangolins have a “hook structure” (that receptor binding domain) similar to that of SARS-CoV-2. In that way, a pangolin either directly or indirectly passed its virus onto a human host. Then, once inside a human host, the virus could have evolved to have its other stealth feature — the cleavage site that lets it easily break into human cells. Once it developed that capacity, the researchers said, the coronavirus would be even more capable of spreading between people.”
Scenario two has less probability of future outbreaks among humans, it says.
re: “More and more it is clear that this originated in the USA.”
“NYT visualization: How the Chinese government enabled the spread of coronavirus
Allahpundit”
Posted at 5:01 pm on March 22, 2020
https://hotair.com/archives/allahpundit/2020/03/22/nyt-visualization-chinese-government-enabled-spread-coronavirus/
The Times gave its feature the anodyne headline “How the Virus Got Out,” but scroll through it and the culpability of the ChiCom regime becomes bracingly clear. Seven million people, many infected, left Wuhan and started seeding outbreaks around the world during the first three weeks of January while the Chinese government was busy assuring everyone that there was no cause for alarm.
Two months later, we’re staring at a global depression and potentially millions of people dead before this thing burns itself out.
https://www.againstcovid19.com/singapore/
https://www.wired.co.uk/article/germany-coronavirus-death-rate
would be better to give at least the mortality per age.. and per condition of health..
and mortality per age in two cases..you could get intensive care or not..
if not you just don’t know what to think about the numbers.especially italian ones .
people want to know” i have diabitis i am 73 “how likely am i to die if i get the virus..
and if you want to project mortality to speculate about the maximum number of death s.. you have to be more precise and make group because mortality vary a lot ..
i read somewhere that they have to make hard choice because o the lack of respiratory devices for instance, meaning they didn”t take care of the old sick people that well.. so can that explain partly the fact that old and sick people die?
I posted above but part was unfortunately missing.
If one looks at graphs of the number of new daily cases in China and Italy (which has peaked 21 March), one will find a potentially remarkable similarity.
I say potential, because, although the number of new cases continues to decline in Italy, it is possible a second peak may be introduced due to reporting lag.
Cases peaked after approximately 21 and 28 days in China and Italy respectively. Post peak cases in China declined to almost nothing within 3 weeks. If the trend holds for Italy, new cases should decline to a handful by April 11th give or take.
https://www.worldometers.info/coronavirus/country/italy/
https://www.worldometers.info/coronavirus/country/china/
Yes of course they are peaking in Italy, they are on LOCKDOWN, what about lockdown don’t you get?
If they weren’t on lockdown the numbers would still be accelerating at exponential rates.
Why do you think they introduced lockdown, because they wanted to lose lots of money?
You also seem to forget that when hospitals are totally overwhelmed everybody who needs intensive care operations or treatment dies, stroke, heart attack, renal failure, accident victims, cancer patients, because they either don’t get what they need or COVID19.
You can double the numbers of dead from just COVID19.
If the world was actually prepared with all the necessary equipment and actual, real Isolation/Quarantine Hospitals with thousands of beds in every country what you suggest would be OK.
But unfortunately they don’t exist.
You keep asking for how contagious COVID19 is compared to flu.
Educate yourself.
https://www.sciencealert.com/the-new-coronavirus-isn-t-like-the-flu-but-they-have-one-big-thing-in-common