Last Friday The CDC’s National Center for Health Statistics published its daily update on the current Covid-19 pandemic statistics. Much has been written and discussed in the media of the finding that 96% of Covid associated deaths were caused by underlying medical conditions. This fact in and of itself should be placed in proper context. We must remember that 80% of Covid-19 deaths occur in patients over the age of 65 and that an estimated 80% of those under the age of 65 that have died during the current pandemic have had comorbid conditions like obesity, hypertension, diabetes or immune compromised states.
This has been the case an all 5 pandemics over the past 140 years. In the Spanish Flue pandemic of 1917-1918 after World War I, 80% of people died from secondary bacteria pneumonia—diplococcus or streptococcus being the most common organisms. Penicillin and streptomycin had not yet been developed in 1919. The average age of death was 28 and 50-100million people died during the pandemic at a time when the world population was 1.8 billion people.
By 1969 with the Hong Kong Flue there were an estimated 4million deaths worldwide with a case fatality rate estimated to be <0.2%, though this is an estimate because advanced serologic testing was not available and only through archived tissue and blood studies using PCR serology testing has the incidence of the disease been able to be estimated.
In 2009-2010 the Swine Flu (H1N1) strain same phenotype as the earlier Spanish Flue an estimated 700,000 to 1.4 million people died with a world population of 6.8 billion people. In all cases, the CFR(Case Fatality Rate) and Infection Fatality Rate) decreased. I have discussed these numbers in an earlier article.
People die from the flue of secondary causes. Over the years with new antibiotics, therapeutics, and strategies deployed in the ICUs, these secondary causes of death are better addressed. From 1918-2020 the average age of death has gone from 28yrs to over 65 years.
Nationwide we now have over 6 million confirmed patients with 180,000 deaths. In State we have 32,256 confirmed cases with 364 deaths. Worldwide as of today, we have had 848,000 Covid-19 associated deaths with a total worldwide population of 7.5 billion people. According to the WHO annually we have between 300,000 to 650,000 deaths from seasonal flu, which will probably end up being half of the number who will die from Covid-19 associated diseases.
And just 8 hours ago the American Academy of Pediatrics came out with their estimate that children less than 12 years ago having a case fatality rate of 0.1-0.3% very much in line with seasonal flue. Have we been wrong in not closing down our schools and colleges for seasonal flue?
But here is what I am most concerned about. The quality of data and reporting. When the scientific community and the media have a preset narrative, many studies—especially those scientists whose income is dependent on future Federal Grants, become suspect because of that preset narrative. Remember The Lancet and The New England Journal of Medicine having to retract stories about the efficacy of Hydroxyclolorquinoline? What about the readjustment of sensitivity and specificity statistical analysis of PCR testing? What about the differences in the quality of the tests that are dependent on the manufacturer, or what about the large number of positive tests in blank placebo viles in Northern California—confirmed by the very nurses who were performing the tests?
And maybe most importantly is the economic incentive facilitated by a specific section of the CARES ACT that reimburses providers at a higher rate for Covid-19 CPT-10 coded patients? A patient admitted to the ICU with a respiratory condition that is coded for a Covid-19 diagnosis no matter if they tested positive or not and irrespective of their disease and admission having anything to do with their Covid (or not) diagnosis can be reimbursed at a higher rate—sometimes to the tune of over $40,000 higher, than if the patient carried a diagnosis of influence or pneumonia. This is classically described as “upcoding” and is ubiquitous throughout the whole country and was 1st identified in the Tri-State surge earlier this spring. We’re nursing homes and extended care facilities incentivized to apply Covid-19 CPT diagnosis to patients and did this contribute to patients being herded back into compromised clinical settings?
The media, government agencies, many politicians have contributed to what economists call “created utility” Most of the time their motives if not pure have at least not been Machiavellian, though at times one has to wonder. When fear is used to promote such a narrative bad decisions are the result. Public Health Officials are boxed into managing such false narratives and politicians defer instead of confer with their recommendations. As Milton Friedman famously said, “The world to hell is paved with good intentions”. But those good intentions based on bad data that is not put in proper context can lead to bad and costly outcomes.
Everything in the data when compared to previous pandemics says we should open up our country and state and businesses and schools.
The single biggest mistake government has made across most of the world including our country and State has been to deploy a Type 2 mitigation strategy that did not protect the most vulnerable the elderly and nursing home patients, and not deploy a type 3 strategy of isolating those at-risk patients. Were economic incentives operating in these situations or was the desire for control and power by government the problem? Or both? When stakeholders are placed on advisory committees whose constituents and clients are positioned to benefit from misplaced economic incentives and inappropriate mitigation strategies I believe the answer is both.