4 ms·

The biggest difference is in the waistlines. As reported just the other day[0]: > Of the 2.5 million COVID-19 deaths reported by the end of February 2021, 2.2

The biggest difference is in the waistlines. As reported just the other day[0]: > Of the 2.5 million COVID-19 deaths reported by the end of February 2021, 2.2 million were in countries where more than half the population is classified as overweight Japan is not one of those countries. As someone who lives in Japan I can tell you that the general population isn't wearing high quality, fitted masks in controlled conditions and using their clinical training to avoid disease transmission, which might provide the conditions that any study done on masks could have the possibility to back. No, there's plenty of cheap, reused, badly fitted, incorrectly worn, regularly touched and inconsistent mask wearing by people who've not had any training in how to limit transmission, which would explain the frequent flu epidemics[1][2][3]. [0] https://www.worldobesityday.org/assets/downloads/COVID-19-and-Obesity-The-2021-Atlas.pdf https://www.worldobesityday.org/assets/downloads/COVID-19-an... [1] https://www.nippon.com/en/japan-data/h00386/japan-gripped-by-major-flu-outbreak.html https://www.nippon.com/en/japan-data/h00386/japan-gripped-by... [2] https://english.kyodonews.net/news/2018/01/e609ee653721-flu-epidemic-rages-in-japan-with-record-high-cases-in-one-week-reported.html https://english.kyodonews.net/news/2018/01/e609ee653721-flu-... [3] https://pubmed.ncbi.nlm.nih.gov/28668446/ https://pubmed.ncbi.nlm.nih.gov/28668446/

cdavid 6y ago
Obesity does not really explain order of magnitude fewer cases, and obesity is much less of a factor than age for mortality. I can't find the numbers now, but it is better to be younger and quite fat than much older and fit. Japan does not lack people above 85 years where the fatality rate is double digit if you catch the disease. The only reasonable answer I have seen so far about Japan is that we don't really know. It is certainly true that many people don't wear masks properly in Japan (e.g. every time I get out, even just to combini, I see people not wearing masks on the nose). But is it worth than not wearing one ? I am not sure we really know. I've seen conflicting info there.
- brigandish 6y ago
  Well, problems with obesity might also correlate with older, wealthier populations but they also looked at that: > The figures are affected by the age structure of national populations and a country’s relative wealth and reporting capacity, but our findings appear to be independent of these contributory factors It's got links to a lot of other studies (admittedly, I'm yet to read those) but the summaries they give seem to really place the importance on the size of the waistline.
  - cdavid 6y ago
    Just looking at your second link, the odds to hospitalized w/ a severe obesity (> 35 BMI) is 2.5 higher than people w/ BMI in healthy 20-25 range Now, according to https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investi..., the risks of hospitalization in 85+ years is more than 10x the risk in 30-39 year old range. If we're talking about mortality, it is more than 100x difference between those two age ranges. It is really not comparable: being old is much much worse than being obese as far as hospitalization/mortality goes w/ covid.
    - brigandish 6y ago
      No one is disputing that age is a factor. From the very first line of the foreward: > As we show in this report, increased bodyweight is the second greatest predictor of hospitalisation and a high risk of death for people suffering from COVID-19. Only old age rates as a higher risk factor. But if you're really going to compare against age then you'd need to correct for obesity or you're simply including it and possibly compounding any risk. > the risks of hospitalization in 85+ years is more than 10x the risk in 30-39 year old range. Is the difference 10x in Japan, too? The point is (or was) to discern a difference between why Japan has lower cases and/or mortality vs Europe and America. All three have plenty of old people, Japan has the greatest percentage. There is also a marked difference between their average waistlines too. Japan should have the highest cases and/or mortality of the three and yet it has the lowest. I'm not a betting man and "masks are the reason", without a shred of evidence to back it, isn't going to change that habit, especially given the competition: > Is this link between COVID-19 and overweight found across the globe? > Yes. > A large number of studies and systematic reviews have found increased risk of severe symptoms from COVID-19 associated with excess bodyweight. The table here gives some examples (pg 14) And the table really does give plenty of examples. From the US: > People with obesity more than twice as likely to need hospitalisation and more than six times as likely to need mechanically assisted breathing and more than six times as likely to die following development of COVID-19. (pg 14) From the UK: > People with overweight 67% more likely to need intensive care, and people with obesity three times as likely to need intensive care, following development of COVID-19. (pg 14) …among many others. It continues: > Taking data from over 160 countries, we find linear correlations between a country’s COVID-19 mortality rates and their estimated degree of overweight or obesity prevalence (pg 15) and here's the kicker: > The diagram shows high mortality rates *only* in countries where overweight prevalence exceeds around 50% of the adult population. (pg 15) Emphasis mine. As to directly comparing Japan and the US and UK, they've added a helpful index: - COVID-19 deaths per 100,000 population (01/01/2021) - Adult overweight BMI >25kg/m2 (2016) - Adult obesity BMI >30kg/m2 (2016) - Population age over 65 years (%) (2020) - Per capita Gross Domestic Product $US (2019) - Healthy life expectancy years (2019) Insufficient physical activity % adults (2016) - Japan 2.60, 27.2, 4.3, 28.4, 74.1, 35.5 - UK 110.73, 63.7, 27.8, 18.7, 70.1, 35.9 - US 105.68, 67.9, 36.2, 16.6, 66.1, 40.0 As to mask wearing, well, if survey results of real world usage are to be believed, then it really is no contest, as the charts here show: https://twitter.com/ianmSC/status/1366148529983426560 https://twitter.com/ianmSC/status/1366148529983426560 Edit: formatting. I do like the stripped down approach of HN but would it really be too much to supply a markdown processor, or <gasp> a format guide?
- mealkh 6y ago
  I have heard air humidity cited as one relevant factor, which was also recently brought up as one of the reasons masks may have a protective effect (humidity from breathing collects in there). Something about keeping membranes being healthier in warm, humid air than in cold, dry air?
offtop5 6y ago
Agreed, I feel one result of political correctness has been a refusal to acknowledge how much obesity affects every aspect of your health. I used to be morbidly obese and I was constantly sick up until I lost 70 or so pounds and got to a reasonable weight. This also made dating so much easier. I'm going off on a tangent, but if I had to give one piece of advice to any young person it would be to get to a healthy weight. Tons of damage is done to your body for every day you're obese, and it's not always reversible even if you start eating right later. It's unsurprising countries with obesity epidemics such as the United States have higher rates of covid mortality. There have been several stories where someone in their twenties dies of covid, but until you see the photo you had no idea they were morbidly obese. If I had to guess I'd say in healthier populations many people may have covid and just shrug it off without necessarily getting tested and adding to case numbers.
- brigandish 6y ago
  > I'm going off on a tangent, but if I had to give one piece of advice to any young person it would be to get to a healthy weight. Following that tangent, I had a couple of family members turn 16 recently and I wondered what advice I could give them now that they are adults (or, at least, they will certainly believe that to be so! Ah, the folly of youth:) My thoughts settled on what would basically be me telling my younger self about my regrets or (perceived) failings in life and to avoid them. I then wondered if they'd listen, which I doubt (again, the folly of youth) and whether I'd even be able to put it in a form that they would understand. Rather like me trying to teach them programming before they've opened a terminal or even an HTML file, I can't tell them the deepest insights until they've done quite a bit and failed quite a bit too. I haven't decided on my advice yet or if I should, but yours sounds good. Still, it's hard to realise what unhealthy means when you're young and fit, even if it's only relative to your older self.
  - offtop5 6y ago
    A big part of being 16 is thinking that you know everything. But to be perfectly blunt, to a young man I would just tell him girls aren't going to really like you unless you get down to a healthy weight. That's the only thing that will probably get though.
lhl 6y ago
Co-morbidities certainly have an impact on outcomes and explains why the IFR is much worse in certain parts of the world but IMHO it doesn't fully explain the magnitude lower attack rate/spread (50-100X worse in the US). That's still a mystery for which there are many plausible contributors, but I don't think it's so easy to just say it's obesity. In the US, this n=5700 NYC study showed 41.7% were obese [1] (not so different from the current US adult obesity rate is currently of about 42% [2]). Note that age is actually the most reliable predictor for hospitalization and death with COVID-19 [3][4] although you can make more accurate estimates with some other factors as well [5]. Note, based on the age-stratified pyramids, Japan's expected IFR sits right at the top [6], so even if you discount the undercounting of hospitalizations and deaths, there's still a huge disparity to make up. BTW, your argument on flu outbreaks actually lends credence that the mask mitigations have been extremely effective. Here's a recent NHK report on the flu numbers this year [7]: - "The number of patients with seasonal flu in Japan was below 100 during the first seven days of February. That's far below the levels seen before. ... Usually, seasonal flu peaks at this time of year, with the number of flu patients per week ranging between 100,000 and 200,000 people." Flu cases are 1000-2000X less than normal. I'm in Tokyo myself and paying close attention to how people are behaving (and comparing it to the footage and media I'm seeing from the US and other countries) and there's a huge difference in behavior from what I've seen over this past year. If you're disappointed by how the general population behaves here, I suspect you'd be horrified/stupefied by what's going on in the rest of the world. My conclusion is that on a population/public health level, it actually doesn't take all that much effort to contain the spread of the virus (elimination is much harder, although several countries have shown that it can be done, and have reaped the economic & social benefits of doing so). [1] Richardson, Safiya, Jamie S. Hirsch, Mangala Narasimhan, James M. Crawford, Thomas McGinn, Karina W. Davidson, and the Northwell COVID-19 Research Consortium, et al. “Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area.” JAMA 323, no. 20 (May 26, 2020): 2052. https://doi.org/10.1001/jama.2020.6775 https://doi.org/10.1001/jama.2020.6775. [2] https://www.cdc.gov/obesity/data/adult.html https://www.cdc.gov/obesity/data/adult.html [3] O’Driscoll, Megan, Gabriel Ribeiro Dos Santos, Lin Wang, Derek A. T. Cummings, Andrew S. Azman, Juliette Paireau, Arnaud Fontanet, Simon Cauchemez, and Henrik Salje. “Age-Specific Mortality and Immunity Patterns of SARS-CoV-2.” Nature 590, no. 7844 (February 2021): 140–45. https://doi.org/10.1038/s41586-020-2918-0 https://doi.org/10.1038/s41586-020-2918-0. [4] Levin, Andrew T., William P. Hanage, Nana Owusu-Boaitey, Kensington B. Cochran, Seamus P. Walsh, and Gideon Meyerowitz-Katz. “Assessing the Age Specificity of Infection Fatality Rates for COVID-19: Systematic Review, Meta-Analysis, and Public Policy Implications.” European Journal of Epidemiology 35, no. 12 (December 1, 2020): 1123–38. https://doi.org/10.1007/s10654-020-00698-1 https://doi.org/10.1007/s10654-020-00698-1. [5] Ghisolfi, Selene, Ingvild Almås, Justin C Sandefur, Tillman von Carnap, Jesse Heitner, and Tessa Bold. “Predicted COVID-19 Fatality Rates Based on Age, Sex, Comorbidities and Health System Capacity.” BMJ Global Health 5, no. 9 (September 9, 2020). https://doi.org/10.1136/bmjgh-2020-003094 https://doi.org/10.1136/bmjgh-2020-003094. [6] https://github.com/mbevand/covid19-age-stratified-ifr#age-stratified-ifr-applied-to-countries-population-pyramids https://github.com/mbevand/covid19-age-stratified-ifr#age-st... [7] https://www3.nhk.or.jp/nhkworld/en/news/20210215_26/ https://www3.nhk.or.jp/nhkworld/en/news/20210215_26/

cdavid 6y ago

Obesity does not really explain order of magnitude fewer cases, and obesity is much less of a factor than age for mortality. I can't find the numbers now, but it is better to be younger and quite fat than much older and fit. Japan does not lack people above 85 years where the fatality rate is double digit if you catch the disease. The only reasonable answer I have seen so far about Japan is that we don't really know. It is certainly true that many people don't wear masks properly in Japan (e.g. every time I get out, even just to combini, I see people not wearing masks on the nose). But is it worth than not wearing one ? I am not sure we really know. I've seen conflicting info there.

brigandish 6y ago
Well, problems with obesity might also correlate with older, wealthier populations but they also looked at that: > The figures are affected by the age structure of national populations and a country’s relative wealth and reporting capacity, but our findings appear to be independent of these contributory factors It's got links to a lot of other studies (admittedly, I'm yet to read those) but the summaries they give seem to really place the importance on the size of the waistline.
- cdavid 6y ago
  Just looking at your second link, the odds to hospitalized w/ a severe obesity (> 35 BMI) is 2.5 higher than people w/ BMI in healthy 20-25 range Now, according to https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investi..., the risks of hospitalization in 85+ years is more than 10x the risk in 30-39 year old range. If we're talking about mortality, it is more than 100x difference between those two age ranges. It is really not comparable: being old is much much worse than being obese as far as hospitalization/mortality goes w/ covid.
  - brigandish 6y ago
    No one is disputing that age is a factor. From the very first line of the foreward: > As we show in this report, increased bodyweight is the second greatest predictor of hospitalisation and a high risk of death for people suffering from COVID-19. Only old age rates as a higher risk factor. But if you're really going to compare against age then you'd need to correct for obesity or you're simply including it and possibly compounding any risk. > the risks of hospitalization in 85+ years is more than 10x the risk in 30-39 year old range. Is the difference 10x in Japan, too? The point is (or was) to discern a difference between why Japan has lower cases and/or mortality vs Europe and America. All three have plenty of old people, Japan has the greatest percentage. There is also a marked difference between their average waistlines too. Japan should have the highest cases and/or mortality of the three and yet it has the lowest. I'm not a betting man and "masks are the reason", without a shred of evidence to back it, isn't going to change that habit, especially given the competition: > Is this link between COVID-19 and overweight found across the globe? > Yes. > A large number of studies and systematic reviews have found increased risk of severe symptoms from COVID-19 associated with excess bodyweight. The table here gives some examples (pg 14) And the table really does give plenty of examples. From the US: > People with obesity more than twice as likely to need hospitalisation and more than six times as likely to need mechanically assisted breathing and more than six times as likely to die following development of COVID-19. (pg 14) From the UK: > People with overweight 67% more likely to need intensive care, and people with obesity three times as likely to need intensive care, following development of COVID-19. (pg 14) …among many others. It continues: > Taking data from over 160 countries, we find linear correlations between a country’s COVID-19 mortality rates and their estimated degree of overweight or obesity prevalence (pg 15) and here's the kicker: > The diagram shows high mortality rates *only* in countries where overweight prevalence exceeds around 50% of the adult population. (pg 15) Emphasis mine. As to directly comparing Japan and the US and UK, they've added a helpful index: - COVID-19 deaths per 100,000 population (01/01/2021) - Adult overweight BMI >25kg/m2 (2016) - Adult obesity BMI >30kg/m2 (2016) - Population age over 65 years (%) (2020) - Per capita Gross Domestic Product $US (2019) - Healthy life expectancy years (2019) Insufficient physical activity % adults (2016) - Japan 2.60, 27.2, 4.3, 28.4, 74.1, 35.5 - UK 110.73, 63.7, 27.8, 18.7, 70.1, 35.9 - US 105.68, 67.9, 36.2, 16.6, 66.1, 40.0 As to mask wearing, well, if survey results of real world usage are to be believed, then it really is no contest, as the charts here show: https://twitter.com/ianmSC/status/1366148529983426560 https://twitter.com/ianmSC/status/1366148529983426560 Edit: formatting. I do like the stripped down approach of HN but would it really be too much to supply a markdown processor, or <gasp> a format guide?
mealkh 6y ago
I have heard air humidity cited as one relevant factor, which was also recently brought up as one of the reasons masks may have a protective effect (humidity from breathing collects in there). Something about keeping membranes being healthier in warm, humid air than in cold, dry air?

offtop5 6y ago

Agreed, I feel one result of political correctness has been a refusal to acknowledge how much obesity affects every aspect of your health. I used to be morbidly obese and I was constantly sick up until I lost 70 or so pounds and got to a reasonable weight. This also made dating so much easier. I'm going off on a tangent, but if I had to give one piece of advice to any young person it would be to get to a healthy weight. Tons of damage is done to your body for every day you're obese, and it's not always reversible even if you start eating right later. It's unsurprising countries with obesity epidemics such as the United States have higher rates of covid mortality. There have been several stories where someone in their twenties dies of covid, but until you see the photo you had no idea they were morbidly obese. If I had to guess I'd say in healthier populations many people may have covid and just shrug it off without necessarily getting tested and adding to case numbers.

brigandish 6y ago
> I'm going off on a tangent, but if I had to give one piece of advice to any young person it would be to get to a healthy weight. Following that tangent, I had a couple of family members turn 16 recently and I wondered what advice I could give them now that they are adults (or, at least, they will certainly believe that to be so! Ah, the folly of youth:) My thoughts settled on what would basically be me telling my younger self about my regrets or (perceived) failings in life and to avoid them. I then wondered if they'd listen, which I doubt (again, the folly of youth) and whether I'd even be able to put it in a form that they would understand. Rather like me trying to teach them programming before they've opened a terminal or even an HTML file, I can't tell them the deepest insights until they've done quite a bit and failed quite a bit too. I haven't decided on my advice yet or if I should, but yours sounds good. Still, it's hard to realise what unhealthy means when you're young and fit, even if it's only relative to your older self.
- offtop5 6y ago
  A big part of being 16 is thinking that you know everything. But to be perfectly blunt, to a young man I would just tell him girls aren't going to really like you unless you get down to a healthy weight. That's the only thing that will probably get though.

lhl 6y ago

Co-morbidities certainly have an impact on outcomes and explains why the IFR is much worse in certain parts of the world but IMHO it doesn't fully explain the magnitude lower attack rate/spread (50-100X worse in the US). That's still a mystery for which there are many plausible contributors, but I don't think it's so easy to just say it's obesity. In the US, this n=5700 NYC study showed 41.7% were obese [1] (not so different from the current US adult obesity rate is currently of about 42% [2]). Note that age is actually the most reliable predictor for hospitalization and death with COVID-19 [3][4] although you can make more accurate estimates with some other factors as well [5]. Note, based on the age-stratified pyramids, Japan's expected IFR sits right at the top [6], so even if you discount the undercounting of hospitalizations and deaths, there's still a huge disparity to make up. BTW, your argument on flu outbreaks actually lends credence that the mask mitigations have been extremely effective. Here's a recent NHK report on the flu numbers this year [7]: - "The number of patients with seasonal flu in Japan was below 100 during the first seven days of February. That's far below the levels seen before. ... Usually, seasonal flu peaks at this time of year, with the number of flu patients per week ranging between 100,000 and 200,000 people." Flu cases are 1000-2000X less than normal. I'm in Tokyo myself and paying close attention to how people are behaving (and comparing it to the footage and media I'm seeing from the US and other countries) and there's a huge difference in behavior from what I've seen over this past year. If you're disappointed by how the general population behaves here, I suspect you'd be horrified/stupefied by what's going on in the rest of the world. My conclusion is that on a population/public health level, it actually doesn't take all that much effort to contain the spread of the virus (elimination is much harder, although several countries have shown that it can be done, and have reaped the economic & social benefits of doing so). [1] Richardson, Safiya, Jamie S. Hirsch, Mangala Narasimhan, James M. Crawford, Thomas McGinn, Karina W. Davidson, and the Northwell COVID-19 Research Consortium, et al. “Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area.” JAMA 323, no. 20 (May 26, 2020): 2052. https://doi.org/10.1001/jama.2020.6775 https://doi.org/10.1001/jama.2020.6775. [2] https://www.cdc.gov/obesity/data/adult.html https://www.cdc.gov/obesity/data/adult.html [3] O’Driscoll, Megan, Gabriel Ribeiro Dos Santos, Lin Wang, Derek A. T. Cummings, Andrew S. Azman, Juliette Paireau, Arnaud Fontanet, Simon Cauchemez, and Henrik Salje. “Age-Specific Mortality and Immunity Patterns of SARS-CoV-2.” Nature 590, no. 7844 (February 2021): 140–45. https://doi.org/10.1038/s41586-020-2918-0 https://doi.org/10.1038/s41586-020-2918-0. [4] Levin, Andrew T., William P. Hanage, Nana Owusu-Boaitey, Kensington B. Cochran, Seamus P. Walsh, and Gideon Meyerowitz-Katz. “Assessing the Age Specificity of Infection Fatality Rates for COVID-19: Systematic Review, Meta-Analysis, and Public Policy Implications.” European Journal of Epidemiology 35, no. 12 (December 1, 2020): 1123–38. https://doi.org/10.1007/s10654-020-00698-1 https://doi.org/10.1007/s10654-020-00698-1. [5] Ghisolfi, Selene, Ingvild Almås, Justin C Sandefur, Tillman von Carnap, Jesse Heitner, and Tessa Bold. “Predicted COVID-19 Fatality Rates Based on Age, Sex, Comorbidities and Health System Capacity.” BMJ Global Health 5, no. 9 (September 9, 2020). https://doi.org/10.1136/bmjgh-2020-003094 https://doi.org/10.1136/bmjgh-2020-003094. [6] https://github.com/mbevand/covid19-age-stratified-ifr#age-stratified-ifr-applied-to-countries-population-pyramids https://github.com/mbevand/covid19-age-stratified-ifr#age-st... [7] https://www3.nhk.or.jp/nhkworld/en/news/20210215_26/ https://www3.nhk.or.jp/nhkworld/en/news/20210215_26/