Medical Discussion of Coronavirus

[East coast]

https://web.archive.org/web/20201126...ue-to-covid-19

JHU econometric researcher pulled CDC data and discovered no net deaths in US due to COVID. Instead there appears to be massive substitution in the form of reduced deaths reported in all other major categories. Of equal importance, the absolute number of deaths is relatively constant year to year as well.

The link is to an article about the results rather than the analysis. Sorry, this is all I could get.but it seems like good data. For those of you who have an epidemiological bent, is there any obvious reason to doubt this report? Has anyone looked at the same data in a peer reviewed paper?

First clue of reliability should be that the article is only accessible in a waybackmachine format. Turns out that's because the student paper pulled and deleted it.

[Tim]

I'd question the data from the webinar. It's not published. It's not even in the article. Here's the CDC's report on the same issue. They estimate 300k deaths through October. To put that in perspective, cancer deaths in 2019 were 600k (would theoretically be smaller when calculating excess deaths).

https://www.cdc.gov/mmwr/volumes/69/...tino%20persons.

If both are sourced from CDC data, it would be convenient to understand the differences. Total deaths should balance.

Are the expected deaths being calculated from a different data set?
Expected numbers of deaths were estimated using overdispersed Poisson regression models with spline terms to account for seasonal patterns, using provisional mortality data from CDC’s National Vital Statistics System (NVSS) (7)

[Larry Ragman]

First clue of reliability should be that the article is only accessible in a waybackmachine format. Turns out that's because the student paper pulled and deleted it.

Sure, and it was also contrary to virtually every other reference I had seen on the topic. That’s why I asked if anyone knew of related peer reviewed work.

[Larry Ragman]

If both are sourced from CDC data, it would be convenient to understand the differences. Total deaths should balance.

Are the expected deaths being calculated from a different data set?
Expected numbers of deaths were estimated using overdispersed Poisson regression models with spline terms to account for seasonal patterns, using provisional mortality data from CDC’s National Vital Statistics System (NVSS) (7)

The delta will probably not resolve until we have full year data. Then in addition to excess deaths, which is statistically inferred, we will be able to evaluate total deaths in comparison to past years. The CDC paper Jhwkr542 linked has that data by week year to date, but it is not clear yet how much substitution (in cause of death) is a factor.

[jhwkr542]

If both are sourced from CDC data, it would be convenient to understand the differences. Total deaths should balance.

Are the expected deaths being calculated from a different data set?
Expected numbers of deaths were estimated using overdispersed Poisson regression models with spline terms to account for seasonal patterns, using provisional mortality data from CDC’s National Vital Statistics System (NVSS) (7)

Since I was curious, I actually am listening to the webinar. It's some level of stupid. She's highlighting seasonal peaks and analyzing the peaks in the first 30 mins. For most years, peak deaths occur in the winter from all causes. She then highlights the yearly peaks and zooms in on them to look at everything. She then compares the peak from 2018 which occurred around Jan. 1 to the peak from this year, which has occurred in April. She points out that deaths this year from non-covid causes are decreasing at the peak, whereas the peak in 2018 had peaks in all causes of mortality. Well, duh...of course all those other causes of mortality won't be peaking in April 2020 because they don't usually peak there. The total deaths peaked in April of this year because that's when covid deaths peaked. She's comparing apples to oranges on time period and basically just ignoring this massive spike in deaths between March and September.

Edit: Omg, I can't believe she just inferred something this ridiculous. Over a 3 week period in April this year, when deaths from all causes are generally trending down every year, the deaths from all causes went down when compared to the previous week 530, 2540, and 1605. These numbers just happened to be similar to the difference between covid-related deaths and heart disease (covid deaths were leading cause of death in this short 3 week timeframe). She's implying that there's a correlation between the difference of covid deaths and heart disease and the decrease in the deaths in the time frame, but offers no explanation outside of implying they're related. She just ignores that over these 3 weeks in April, the total deaths decrease every single other year in this time frame. It's so obvious from her own data that there's this massive spike of deaths of around 10-15k per week in April that can't be explained by anything else other than covid. I forgot to mention that earlier in the talk she looked at the ratio of age groups to total deaths and found them to be similar. But covid disproportionately kills older people, probably not too unlike normal deaths. This relative rate is not useful when looking for excess deaths if covid kills at a rate similar to all cause mortality in age groups.

Overall, there's just this huge spike in deaths this year at a time when deaths normally nadir. Trying to come up with any explanation that isn't covid-related is probably rooted more in political beliefs and confirmation bias than valid scientific reasoning.

[snowcanyon]

We are surging in my state.
Our standard PPE is surgical mask and face shield.
We use PAPRs for "aerosolizing" procedures.
I use an N-95 for every routine patient encounter because there is ample evidence that Covid is airborne, and I'm always up in people's faces sewing lacerations, looking in ears, suctioning, packing noses etc. No one has said anything, and I source my own.
Admin has now decided that this is not fair on nurses and support staff, who are concerned that their surgical masks are not enough, and that we should all use surgical masks only because it's unfair otherwise.

Thoughts?

[G]

We are surging in my state.
Our standard PPE is surgical mask and face shield.
We use PAPRs for "aerosolizing" procedures.
I use an N-95 for every routine patient encounter because there is ample evidence that Covid is airborne, and I'm always up in people's faces sewing lacerations, looking in ears, suctioning, packing noses etc. No one has said anything, and I source my own.
Admin has now decided that this is not fair on nurses and support staff, who are concerned that their surgical masks are not enough, and that we should all use surgical masks only because it's unfair otherwise.

Thoughts?

Yeah, same as before: tell them to pound sand

[G]

We are surging in my state.
Our standard PPE is surgical mask and face shield.
We use PAPRs for "aerosolizing" procedures.
I use an N-95 for every routine patient encounter because there is ample evidence that Covid is airborne, and I'm always up in people's faces sewing lacerations, looking in ears, suctioning, packing noses etc. No one has said anything, and I source my own.
Admin has now decided that this is not fair on nurses and support staff, who are concerned that their surgical masks are not enough, and that we should all use surgical masks only because it's unfair otherwise.

Thoughts?

Actually, you re EM, correct? And also hate your job? I would send them the ACEP policy statement on personal PPE and the number of a local labor attorney and tell them you look forward to discussing your payment.

[snowcanyon]

Thank you, and keep it coming. Sometimes you need to hear it from someone else, as many someone elses as possible.

I was taken off guard that my administrators were so late to this party; I thought (thanks for the ACEP rec, @G) we had gone through the denial, anger, bargaining etc on this last spring.

[Kamban]

We are surging in my state.
Our standard PPE is surgical mask and face shield.
We use PAPRs for "aerosolizing" procedures.
I use an N-95 for every routine patient encounter because there is ample evidence that Covid is airborne, and I'm always up in people's faces sewing lacerations, looking in ears, suctioning, packing noses etc. No one has said anything, and I source my own.
Admin has now decided that this is not fair on nurses and support staff, who are concerned that their surgical masks are not enough, and that we should all use surgical masks only because it's unfair otherwise.

Thoughts?

The nurses and support staff are free to buy N95 on their own or the admin can order and supply to them. Ask the admin to follow you day in and day out with only a surgical mask instead of sitting on the rear in heated suites.

[Jaqen Haghar MD]

We are surging in my state.
Our standard PPE is surgical mask and face shield.
We use PAPRs for "aerosolizing" procedures.
I use an N-95 for every routine patient encounter because there is ample evidence that Covid is airborne, and I'm always up in people's faces sewing lacerations, looking in ears, suctioning, packing noses etc. No one has said anything, and I source my own.
Admin has now decided that this is not fair on nurses and support staff, who are concerned that their surgical masks are not enough, and that we should all use surgical masks only because it's unfair otherwise.
Thoughts?

If I were told this directly in this situation, I would say “absolutely” and just go on wearing my N95 and going about my business as usual as if nothing ever happened. I would continue this course of action if repeatedly warned. I would not even give it a second thought.

If they demanded I take the mask off immediately, I would pause and calmly say “no”, and stare at them in silence.

Sometimes administrators just like to administrate every once in a while. It’s cute, but then they have to run along when serious work is being done.

[Lithium]

If I were told this directly in this situation, I would say “absolutely” and just go on wearing my N95 and going about my business as usual as if nothing ever happened. I would continue this course of action if repeatedly warned. I would not even give it a second thought.

If they demanded I take the mask off immediately, I would pause and calmly say “no”, and stare at them in silence.

Sometimes administrators just like to administrate every once in a while. It’s cute, but then they have to run along when serious work is being done.

It’s comical to imagine what they’ll do if you refuse to comply. Can you imagine them firing you?

”Local hospital system terminates physician for refusing to remove N95 mask.” The media would be frothing at the mouth.

I’d actually see if they’re dumb enough to submit this demand to you in writing.

[GasFIRE]

It’s comical to imagine what they’ll do if you refuse to comply. Can you imagine them firing you?

”Local hospital system terminates physician for refusing to remove N95 mask.” The media would be frothing at the mouth.

I’d actually see if they’re dumb enough to submit this demand to you in writing.

A system early on did actually fire an ER doc: https://time.com/5812006/washington-...e-staff-fired/
Never underestimate the ability of a corporate suit to be stupid, petty and vindictive. That said, I agree with JHagharMD, just keep wearing the mask and see if there’s an administrator stupid enough to call you out on it.

[MaxPower]

A system early on did actually fire an ER doc: https://time.com/5812006/washington-...e-staff-fired/
Never underestimate the ability of a corporate suit to be stupid, petty and vindictive. That said, I agree with JHagharMD, just keep wearing the mask and see if there’s an administrator stupid enough to call you out on it.

That story was different than just refusing to wear an N95 though. He publicly criticized his hospital for not doing enough to protect workers. Clearly that wasn’t, or shouldn’t have been, a fireable offense either, but somewhat different circumstances.

[snowcanyon]

I don't think they'd fire me for it. I think they would start a long process of finding other ways to fire me.
But this is the hill I will die on. I just needed to hear the hivemind's thoughts. Thank you.