Coronavirus (COVID-19)

[pwny]

37 minutes ago, dtait93 said:

"In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as “probable” or “presumed.” In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely."

In other words, it's okay to guess, even though the, "opinion should be based on sound medical judgement." The amount of subjectivity coming in to play is astounding.

"Ideally, testing for COVID–19 should be conducted, but it is acceptable to report COVID–19 on a death certificate without this confirmation if the circumstances are compelling within a reasonable degree of certainty."

The CDC literally isn't even requiring a test to be conducted in order to report a COVID-19 death. This is a problem. It is so easy for the corrupt to twist these numbers.

A perfect example is the infant that passed in Connecticut. The governor explicitly said, "probably the youngest person ever to die of COVID has died here in Connecticut." The state epidemiologist as well stated that because the baby tested positive it was reported properly as a death connected to a positive COVID-19 result. Yet, officials said it is possible the baby actually died from position asphyxiation or sudden death syndrome. This is why we need medical examiners reporting who is actually dying from COVID-19 because as the article correctly states, "Public health officials report daily the total number of people who have died and have tested positive for the virus, either before or after their deaths. But only the medical examiner determines whether the virus or complications it caused actually led to each of those peoples deaths." https://www.courant.com/breaking-news/hc-br-infant-death-coronavirus-positive-20200404-54z75ceqzfei7ajtwskc4ncrua-story.html

Probable deaths are not reported as part of the confirmed death total. That’s literally why they note them as probable and not confirmed.

See:

Quote

"The KDHE (Kansas Department of Health and Environment) classified it as a probable – not presumptive-positive – case of COVID-19 on Monday. A probable case meets clinical criteria with a presumptive-positive lab test for blood work, but was negative in nasal swab testing for an active COVID-19 virus, according to the KDHE," the health department explains. "Because of this, the case has not been counted toward Harvey County’s case count at this time, but is attributed as a probable COVID-19 death. The Health Department will seek further guidance from the KDHE on its classification."

or

Quote

Dozens — if not hundreds — of coronavirus deaths in New York City will not be included in the Big Apple’s grim tally, because victims died at home without being tested, The Post has learned.

This is the standard for literally everything when it comes to reporting. Only confirmed cases are counted as confirmed cases, even if we assume that they are probable. New York will soon be adding cases that it’s highly suspected to their official list, but that’s not the case normally, nor has it been the case through all of this.

And no, what you’re reading there doesn’t mean that it’s just okay “to just guess”. It means that if it looks like it was COVID-19 related but you’re unable to verify, please make sure that’s noted and it will be counted once they’re able to confirm. 

Edited April 14, 2020 by pwny

[Ragnar Danneskjold]

34 minutes ago, dtait93 said:

The CDC literally isn't even requiring a test to be conducted in order to report a COVID-19 death. This is a problem. It is so easy for the corrupt to twist these numbers.

The death certificate in most, if not all states, is filled out by the physician caring for the patient.  What motivation would the physicians have for "twisting" these numbers?  

[pwny]

And every expert on the subject believes that the death rates are being underreported.

https://www.factcheck.org/2020/04/social-media-posts-make-baseless-claim-on-covid-19-death-toll/

Quote

Michael Baden, a former chief medical examiner of New York City and a high-profile pathologist, told Fox News that it’s reasonable to include people with the virus, who also had other health issues, in the count.

“In the normal course, autopsies would then determine whether the person died of the effects of the COVID virus, whether the person had a brain tumor or brain hemorrhage for example that might be unrelated to it and what the relative significance of both the infection and the pre-existing disease is,” he said. Even if the number of autopsies being conducted are low because of concerns of infection, he said, “then you will include in those numbers some people who did have a pre-existing condition that would have caused death anyway, but that’s probably a small number.”

Likewise, Marc Lipsitch, a professor of epidemiology at Harvard University, told us in an email: “There are going to be some people who die of something else, happen to have COVID and get tested, and get counted as COVID deaths but would die anyway. It would be wrong to say that number is zero. However given current testing shortages and protocols, the number of such cases will be small.”

“A greater issue is errors in the other direction — deaths caused by COVID that are not counted as such,” he said.

Lipsitch cited at least two reasons for that underreporting: Someone having and dying from clear COVID-19 respiratory symptoms but never being tested (especially early in the epidemic, when tests were scarce). Or, he said, someone dying from causes, such as a heart attack or stroke, triggered by the infection — with no one ever suspecting or testing for the disease.

 

[mission27]

1 minute ago, pwny said:

And every expert on the subject believes that the death rates are being underreported.

https://www.factcheck.org/2020/04/social-media-posts-make-baseless-claim-on-covid-19-death-toll/

 

Agreed but we have to be a little careful with terminology 

# of deaths = under-reported

% of deaths = way way way over-reported

[mission27]

46 minutes ago, dtait93 said:

The CDC literally isn't even requiring a test to be conducted in order to report a COVID-19 death. This is a problem. It is so easy for the corrupt to twist these numbers.

Do you honestly think front line doctors whose patients are dropping like flies are spending time and emotional energy faking COVID deaths?  And for what reason?

I can buy there are issues with the reporting because its hard to determine cause of death but corruption is pretty far fetched tbh

[squire12]

22 minutes ago, Ragnar Danneskjold said:

The death certificate in most, if not all states, is filled out by the physician caring for the patient.  What motivation would the physicians have for "twisting" these numbers?  

Its must more paperwork for them to do, what else is going on now that would be more pressing?  like a ER, ICU filled with patients and ever changing policies and procedures on how to treat a pandemic without sufficient equipment, supplies and treatment understanding?  those dam MD's not taking the proper steps to take the time to fill out an iron clad cause of death so some football forum posters can argue about what the exact numbers and % are.  pompous pricks

[Ragnar Danneskjold]

8 minutes ago, squire12 said:

Its must more paperwork for them to do, what else is going on now that would be more pressing?  like a ER, ICU filled with patients and ever changing policies and procedures on how to treat a pandemic without sufficient equipment, supplies and treatment understanding?  those dam MD's not taking the proper steps to take the time to fill out an iron clad cause of death so some football forum posters can argue about what the exact numbers and % are.  pompous pricks

I am not sure how to take your post.  

As an ICU doc, you kind of know what your patient has wrong with them before they die.  It isn't a hard form to fill out.  Kind of doubt there is a larger error rate on them.  JMO

[squire12]

3 minutes ago, Ragnar Danneskjold said:

I am not sure how to take your post.  

As an ICU doc, you kind of know what your patient has wrong with them before they die.  It isn't a hard form to fill out.  Kind of doubt there is a larger error rate on them.  JMO

Full sarcasm.   I work in healthcare and I fully understand that there are things that matter and things that do not.   in a pandemic, I would guess, filling out this item may not be the highest priority.   All depends on the volume and workload/work conditions.

[Ragnar Danneskjold]

1 minute ago, squire12 said:

Full sarcasm.   I work in healthcare and I fully understand that there are things that matter and things that do not.   in a pandemic, I would guess, filling out this item may not be the highest priority.   All depends on the volume and workload/work conditions.

Been there, done that.  Unless you assume that the normal documentation of an assessment and diagnosis is missing in things like the H&P and progress notes, the cause of death shouldn't be an issue in the stats.

I can see some potential for ambiguity in the early days when testing wasn't available as necessary, but as test availability has come up, the number of untested patients should be few in number.  

I just am struggling to understand the belief that the numbers are overstated.

[mission27]

3 minutes ago, Ragnar Danneskjold said:

Been there, done that.  Unless you assume that the normal documentation of an assessment and diagnosis is missing in things like the H&P and progress notes, the cause of death shouldn't be an issue in the stats.

I can see some potential for ambiguity in the early days when testing wasn't available as necessary, but as test availability has come up, the number of untested patients should be few in number.  

I just am struggling to understand the belief that the numbers are overstated.

I think the concern is that, if you have a large portion of the population get infected at the same time and given most of the deaths are in the elderly, you may be counting deaths that are not truly caused by COVID and just happen to be contemporaneous with the patient being COVID positive

An extreme example but if 5-10% of the population were infected right now, surely some of the 5-10% of the elderly population is going to die from other causes over a 3 week period and if you have a patient who dies from complications from congestive heart failure for example and happened to have COVID, maybe that gets listed as a COVID death even if COVID wasn't the difference between life and death 

I think its an overblown issue though and obviously to suggest doctors are doing this on purpose for some reason is nuts

[Shanedorf]

2 minutes ago, Ragnar Danneskjold said:

I just am struggling to understand the belief that the numbers are overstated.

Its not a data-based belief.
Its a belief- based belief, which is why its not consistent with the data or the reports

[mission27]

One question I do have

If you have a patient who is COVID positive who dies, but the cause of death is determined to probably not be COVID, how is that reflected in the reporting?  Like another extreme example but if I have COVID and get hit by a bus

Theoretically you have to close that case, its not a recovery, but listing it as a death is also misleading.  What do they do?

[squire12]

5 minutes ago, Ragnar Danneskjold said:

Been there, done that.  Unless you assume that the normal documentation of an assessment and diagnosis is missing in things like the H&P and progress notes, the cause of death shouldn't be an issue in the stats.

I can see some potential for ambiguity in the early days when testing wasn't available as necessary, but as test availability has come up, the number of untested patients should be few in number.  

I just am struggling to understand the belief that the numbers are overstated.

I think it is fair to say that the numbers in some locations might be over stated (due to variance in testing and other components) and under stated ( for similar type reasons)

Contemplate that the early tests for the virus took labs a few hours to run.  running like 30-50 at a time.    I read a local article that it was like 4 hours.  that is around 200 to 300 tests a day.  For a city of 100K, that would be a full year to test everyone.  that is 1 time.  1 positive test then adds to that number of tests needing to be done.  

Not to mention the necessary reagents and supplies to perform the tests are not readily on hand in those quantities.  

[mission27]

Boris has now tested negative for coronavirus 

Really great to see him back on his feet, that was scary

[Shanedorf]

1 minute ago, mission27 said:

if you have a patient who dies from complications from congestive heart failure for example and happened to have COVID, maybe that gets listed as a COVID death even if COVID wasn't the difference between life and death 

Unfortunately you can never know this.
Nobody can ever make ever that determination and its so rarely black and white.
The cancer didn't kill the patient, it was the neutropenia that pushed them over the edge. Is that a cancer death ?
So it comes down to which side of the ledger you wanna put it on as the data collector when you build the models

And that's the beauty of these models, with the push of a button you can toggle between variables and learn even more about what's going on