7 ms·

Severe Outcomes Among U.S. Patients with Covid-19, Feb 12–Mar 16, 2020

74 points by js2 7y ago

notacoward 7y ago
I freaking love that summary format. What is already known? What does this add? What are the policy implications? Boom!
- yellowapple 7y ago
  Yep. Very reminiscent of "Bottom Line Up Front" (BLUF).
- divbzero 7y ago
  Yes, clear communication like this is exactly what we need in a fast-moving crisis.
ekidd 7y ago
> fatality was highest in persons aged ≥85, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons aged 55-64 years, <1% among persons aged 20–54 years, and no fatalities among persons aged ≤19 years. The problem with all of these numbers is that they assume sufficient medical care and access to an ICU. This report here breaks down how many people need an ICU by age: https://www.statnews.com/2020/03/18/coronavirus-new-age-analysis-of-risk-confirms-young-adults-not-invincible/ https://www.statnews.com/2020/03/18/coronavirus-new-age-anal... > In contrast, among people 20 to 44, 14% to 21% of 705 cases were admitted to hospitals and 2% to 4% to ICUs; 0.1% to 0.2% died. If we assume that ICUs are overloaded, how many of the that 2-4% would die? Not that this doesn't count the people who won't catch the virus because of herd immunity. There may also be some people who are immune, or who defeat the virus quickly enough to not show positive on an RNA test.
- deleted 7y ago
  [deleted]
- glibby 7y ago
  That report just sources the same CDC report, but I think it gets some of its conclusions wrong. It says: >In contrast, among people 20 to 44, 14% to 21% of 705 cases were admitted to hospitals and 2% to 4% to ICUs; 0.1% to 0.2% died. But the CDC report indicates that 12% total (of all cases) are known to have been hospitalized, and of that number, 20% were age 20-44. So that would mean that (0.12*.2=) 2.4% of people total were 20-44 and in the hospital. Now 29% of all cases were in that age group, so that would mean for the 20-44 age group there was a (2.4/29=)8.3% chance of hospitalization. Maybe I misunderstood something there, but I think I'm right.
  - mcbits 7y ago
    I think you're reading it right, assuming they do know the ages of all people hospitalized, and the total cases with known+unknown age have close to the same distribution as the cases with known age. 102 hospitalizations / 1226 total cases = 8.3%. A huge remaining unknown is how many people were infected but not tested, which would tend to reduce that 8.3% but perhaps not to a negligible level.
  - dougmwne 7y ago
    Actually that's not correct. The CDC study has a lot of null data and there's some very inconsistent excluding of data while calculating these numbers. I had to work with it in Excel for awhile to reconstruct the approximate raw numbers. Out of 4226 cases 2449 have known ages 705 were 20 to 44 ~488 of that age have a known age and hospitalization status ~101 of that age were hospitalized ~14 of that age went to ICU (14.3% of the known # of cases for that age and 20.8% of the known # of cases for that age with a known hospitalization status were hospitalized) Check this against Figure 2 in the CDC study and you will see where the StatNews article is pulling its data from. This is very sobering information. Please stay safe!
    - deleted 7y ago
      [deleted]
    - mcbits 7y ago
      It says "Among 508 (12%) patients". 508 is 12% of the whole 4226, not just the 2449 with known ages. 20% (102) of those 508 were aged 20-44. It's not known how many of the 4226 were aged 22-44, but if it's roughly the same as the 29% of known ages, that would be 1226. 102/1226 is 8.3%. I hate to say it, but it seems the table at the bottom is overestimating the proportion of hospitalizations by ignoring 1777 patients who have an age even if it's unknown, instead of making an estimate for them.
makomk 7y ago
Note the caveat here: "the initial approach to testing was to identify patients among those with travel histories or persons with more severe disease, and these data might overestimate the prevalence of severe disease". One of the things that makes it frustratingly hard to tell the real likelihoods is that almost all data has this problem to some extent, except maybe the Diamond Princess cases, and there weren't enough young people on there to get good numbers.
- lonelappde 7y ago
  Another thing to remember is that the scientific medical terms are "grade deflated" Scientific -> what a layperson would say Mild -> sick Moderate -> hospitalized Severe -> deathly ill
chimichangga 7y ago
From Gregory Rigano: UPDATE: Full peer reviewed study has been released by Didier Raoult MD, PhD drive.google.com/file/d/186Bel9…. After 6 days 100% of patients treated with HCQ + Azithromycin were virologically cured p-value <.0001 covidtrial.io https://twitter.com/riganoesq/status/1240273631604809728?s=21 https://twitter.com/riganoesq/status/1240273631604809728?s=2...
- softwaredoug 7y ago
  Is this something that be manufactured at scale to treat 1-4% of the world's population in the next few months?
  - voidmain 7y ago
    I'm no industrial chemist, but from a glance at the chemical formula [1], I'm going to guess that it could be produced by the trainload (provided that you shoot the FDA first, which we should have done on the first day of the epidemic judging by their track record so far) [1] https://en.wikipedia.org/wiki/Hydroxychloroquine https://en.wikipedia.org/wiki/Hydroxychloroquine
    - kortex 7y ago
      Former process chemist here. Yep, you could produce trainloads of this stuff within the month if you bypass the FDA, and even if you do play by the book, current capacity could easily crank out kilos of GMP HQ a day.
      - Engineering-MD 7y ago
        Could you expand a bit on the required base materials and possible bottlenecks? Would third world countries be able to produce this, and would export restrictions on reagents/chemicals limit production for some countries?
  - gpm 7y ago
    There were 5.7 million american prescriptions for Hydroxychloroquine in 2017, and the wholesale price quoted on wikipedia is 5 dollars for a months worth of pills. I don't know how difficult scaling up production is, but the above numbers make me hopeful.
H8crilA 7y ago
Please just stay at home. At all times. I've locked myself in weeks ago, before the government of my country ordered lockdowns. Even if the true fatality rate in your age range is low - you'll kill some old person out there. Perhaps dozens. It's the most you can do. Bill Ackman does a good job of explaining why you should do that (and why should all countries be shut down): https://www.cnbc.com/2020/03/18/bill-ackman-pleads-to-trump-to-increase-closures-to-save-the-economy-shut-it-down-now.html https://www.cnbc.com/2020/03/18/bill-ackman-pleads-to-trump-...
- 6nf 7y ago
  Shutting down the country destroys everything. I'm not sure it's worth it.
  - madeofpalk 7y ago
    Everyone dying destroys everything. I'm not sure saving a cafe is worth thousands or millions of deaths.
    - nostromo 7y ago
      People work at that cafe and use their income to feed and house their families, and to provide them with healthcare. Don’t be dismissive of these concerns, they are very real.
      - applecrazy 7y ago
        Which is exactly why social safety net programs exist and continue to function during these times. Not to mention the checks that will be mailed out to every taxpayer soon. We can and should essentially shut down the country
        6nf 7y ago
        We don't have a safety net that can feed the whole country. Some people still have to work to actually grow the food, do the distribution, and feed everyone. How is that going to happen if everyone sits at home for 2 months?
rosybox 7y ago
Could this be skewed at the moment due to the number of nursing homes in Washington State that were hit early on?
- dboreham 7y ago
  Yes
- blaser-waffle 7y ago
  I believe it was just one big one that had a lot of very old and very frail. Staff didn't pick up on what was going on and by the time they connected the dots people were dying. Regardless of the number of nursing homes, the point stands that the figures are skewed by a few clear outliers.
1996 7y ago
My very naive take: could the difference in mortality between South Korea and Italy be explained by how SK tried antiviral drugs even when there was no strong evidence yet, while Europe stuck to anti inflammatory which we know now to be linked to severe outcomes? Also, the probability of receiving a prescription drug is almost linear with respect to age. So, could the highest death of >60 y.o. with comobidities be explained similarly by them taking drugs that have a negative impact on the disease?
- dboreham 7y ago
  Hypertension being a highly prevalent comorbidity seems suggestive of something.
  - lowbloodsugar 7y ago
    On that note: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang https://www.escardio.org/Councils/Council-on-Hypertension-(C... Some threads on the internet say to stop taking ACE inhibitors because they boost ACE2, the gate that the virus uses to get into our cells. However, other threads on the internet says that while ACE inhibitors boost ACE2, they also cause them to be blocked (bound) by ATR-1, so you're good. Unless you stop, in which case now you have twice as many ACE2 and they're all unblocked. So I'm listening to what the doctors say and not the internet.

74 points by js2 7y ago

notacoward 7y ago

I freaking love that summary format. What is already known? What does this add? What are the policy implications? Boom!

yellowapple 7y ago
Yep. Very reminiscent of "Bottom Line Up Front" (BLUF).
divbzero 7y ago
Yes, clear communication like this is exactly what we need in a fast-moving crisis.

ekidd 7y ago

> fatality was highest in persons aged ≥85, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons aged 55-64 years, <1% among persons aged 20–54 years, and no fatalities among persons aged ≤19 years. The problem with all of these numbers is that they assume sufficient medical care and access to an ICU. This report here breaks down how many people need an ICU by age: https://www.statnews.com/2020/03/18/coronavirus-new-age-analysis-of-risk-confirms-young-adults-not-invincible/ https://www.statnews.com/2020/03/18/coronavirus-new-age-anal... > In contrast, among people 20 to 44, 14% to 21% of 705 cases were admitted to hospitals and 2% to 4% to ICUs; 0.1% to 0.2% died. If we assume that ICUs are overloaded, how many of the that 2-4% would die? Not that this doesn't count the people who won't catch the virus because of herd immunity. There may also be some people who are immune, or who defeat the virus quickly enough to not show positive on an RNA test.

deleted 7y ago
[deleted]
glibby 7y ago
That report just sources the same CDC report, but I think it gets some of its conclusions wrong. It says: >In contrast, among people 20 to 44, 14% to 21% of 705 cases were admitted to hospitals and 2% to 4% to ICUs; 0.1% to 0.2% died. But the CDC report indicates that 12% total (of all cases) are known to have been hospitalized, and of that number, 20% were age 20-44. So that would mean that (0.12*.2=) 2.4% of people total were 20-44 and in the hospital. Now 29% of all cases were in that age group, so that would mean for the 20-44 age group there was a (2.4/29=)8.3% chance of hospitalization. Maybe I misunderstood something there, but I think I'm right.
- mcbits 7y ago
  I think you're reading it right, assuming they do know the ages of all people hospitalized, and the total cases with known+unknown age have close to the same distribution as the cases with known age. 102 hospitalizations / 1226 total cases = 8.3%. A huge remaining unknown is how many people were infected but not tested, which would tend to reduce that 8.3% but perhaps not to a negligible level.
- dougmwne 7y ago
  Actually that's not correct. The CDC study has a lot of null data and there's some very inconsistent excluding of data while calculating these numbers. I had to work with it in Excel for awhile to reconstruct the approximate raw numbers. Out of 4226 cases 2449 have known ages 705 were 20 to 44 ~488 of that age have a known age and hospitalization status ~101 of that age were hospitalized ~14 of that age went to ICU (14.3% of the known # of cases for that age and 20.8% of the known # of cases for that age with a known hospitalization status were hospitalized) Check this against Figure 2 in the CDC study and you will see where the StatNews article is pulling its data from. This is very sobering information. Please stay safe!
  - deleted 7y ago
    [deleted]
  - mcbits 7y ago
    It says "Among 508 (12%) patients". 508 is 12% of the whole 4226, not just the 2449 with known ages. 20% (102) of those 508 were aged 20-44. It's not known how many of the 4226 were aged 22-44, but if it's roughly the same as the 29% of known ages, that would be 1226. 102/1226 is 8.3%. I hate to say it, but it seems the table at the bottom is overestimating the proportion of hospitalizations by ignoring 1777 patients who have an age even if it's unknown, instead of making an estimate for them.

makomk 7y ago

Note the caveat here: "the initial approach to testing was to identify patients among those with travel histories or persons with more severe disease, and these data might overestimate the prevalence of severe disease". One of the things that makes it frustratingly hard to tell the real likelihoods is that almost all data has this problem to some extent, except maybe the Diamond Princess cases, and there weren't enough young people on there to get good numbers.

lonelappde 7y ago
Another thing to remember is that the scientific medical terms are "grade deflated" Scientific -> what a layperson would say Mild -> sick Moderate -> hospitalized Severe -> deathly ill

chimichangga 7y ago

From Gregory Rigano: UPDATE: Full peer reviewed study has been released by Didier Raoult MD, PhD drive.google.com/file/d/186Bel9…. After 6 days 100% of patients treated with HCQ + Azithromycin were virologically cured p-value <.0001 covidtrial.io https://twitter.com/riganoesq/status/1240273631604809728?s=21 https://twitter.com/riganoesq/status/1240273631604809728?s=2...

softwaredoug 7y ago
Is this something that be manufactured at scale to treat 1-4% of the world's population in the next few months?
- voidmain 7y ago
  I'm no industrial chemist, but from a glance at the chemical formula [1], I'm going to guess that it could be produced by the trainload (provided that you shoot the FDA first, which we should have done on the first day of the epidemic judging by their track record so far) [1] https://en.wikipedia.org/wiki/Hydroxychloroquine https://en.wikipedia.org/wiki/Hydroxychloroquine
  - kortex 7y ago
    Former process chemist here. Yep, you could produce trainloads of this stuff within the month if you bypass the FDA, and even if you do play by the book, current capacity could easily crank out kilos of GMP HQ a day.
    - Engineering-MD 7y ago
      Could you expand a bit on the required base materials and possible bottlenecks? Would third world countries be able to produce this, and would export restrictions on reagents/chemicals limit production for some countries?
- gpm 7y ago
  There were 5.7 million american prescriptions for Hydroxychloroquine in 2017, and the wholesale price quoted on wikipedia is 5 dollars for a months worth of pills. I don't know how difficult scaling up production is, but the above numbers make me hopeful.

H8crilA 7y ago

Please just stay at home. At all times. I've locked myself in weeks ago, before the government of my country ordered lockdowns. Even if the true fatality rate in your age range is low - you'll kill some old person out there. Perhaps dozens. It's the most you can do. Bill Ackman does a good job of explaining why you should do that (and why should all countries be shut down): https://www.cnbc.com/2020/03/18/bill-ackman-pleads-to-trump-to-increase-closures-to-save-the-economy-shut-it-down-now.html https://www.cnbc.com/2020/03/18/bill-ackman-pleads-to-trump-...

6nf 7y ago
Shutting down the country destroys everything. I'm not sure it's worth it.
- madeofpalk 7y ago
  Everyone dying destroys everything. I'm not sure saving a cafe is worth thousands or millions of deaths.
  - nostromo 7y ago
    People work at that cafe and use their income to feed and house their families, and to provide them with healthcare. Don’t be dismissive of these concerns, they are very real.
    - applecrazy 7y ago
      Which is exactly why social safety net programs exist and continue to function during these times. Not to mention the checks that will be mailed out to every taxpayer soon. We can and should essentially shut down the country
      - 6nf 7y ago
        We don't have a safety net that can feed the whole country. Some people still have to work to actually grow the food, do the distribution, and feed everyone. How is that going to happen if everyone sits at home for 2 months?

rosybox 7y ago

Could this be skewed at the moment due to the number of nursing homes in Washington State that were hit early on?

dboreham 7y ago
Yes
blaser-waffle 7y ago
I believe it was just one big one that had a lot of very old and very frail. Staff didn't pick up on what was going on and by the time they connected the dots people were dying. Regardless of the number of nursing homes, the point stands that the figures are skewed by a few clear outliers.

1996 7y ago

My very naive take: could the difference in mortality between South Korea and Italy be explained by how SK tried antiviral drugs even when there was no strong evidence yet, while Europe stuck to anti inflammatory which we know now to be linked to severe outcomes? Also, the probability of receiving a prescription drug is almost linear with respect to age. So, could the highest death of >60 y.o. with comobidities be explained similarly by them taking drugs that have a negative impact on the disease?

dboreham 7y ago
Hypertension being a highly prevalent comorbidity seems suggestive of something.
- lowbloodsugar 7y ago
  On that note: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang https://www.escardio.org/Councils/Council-on-Hypertension-(C... Some threads on the internet say to stop taking ACE inhibitors because they boost ACE2, the gate that the virus uses to get into our cells. However, other threads on the internet says that while ACE inhibitors boost ACE2, they also cause them to be blocked (bound) by ATR-1, so you're good. Unless you stop, in which case now you have twice as many ACE2 and they're all unblocked. So I'm listening to what the doctors say and not the internet.